Taking general practice beyond the letters 'GP'

I'm told on good authority that a visit to the Schwarz Family Practice in Elderslie near Camden, Sydney to meet with Dr Jane Gray, described simply to me as a "young female GP", will be a rewarding experience. I like being unprepared. With a total of 31 staff the Schwarz Family Practice on Sydney's outskirts has 10 doctors who see an average of 822 patients weekly. While that is a substantial number of patients the practice has expanded since 1985 from a family home built by Jane’s father, Dr John Schwarz with little funds and a single consulting room, into a spacious, modern, ever-evolving complex complete with backyard paddock and rural outlook.

The practice actively takes medical students, trains registrars and offers under one-roof general practice services, pathology, a dentist, a pharmacist, a dietician, an ENT specialist, a community nurse for home visits, an audiologist, psychologist, counsellor and occupational therapist. Their practice nurse recently won Best Practice Nurse of the Year for Immunisation. I arrive to a hearty welcome from 39-year-old Jane, a third-generation doctor who works at the practice together with her husband Dr Matthew Gray. They do this while juggling family commitments to four boys aged 5, 6, 9 and 11. Conversation initially focuses on this fact – "What we feel passionate about is family time," Jane says. From this there is no doubt in my mind, as the story unfolds, that family has greatly influenced Jane's work in general practice and beyond.

 

Some history… Jane's grandfather, Dr Fred Schwarz, who died at the age of 96, was a well-respected GP from Brisbane who operated a successful practice in Strathfield which he closed in 1955 to devote time to the Christian Anti-Communism Crusade he founded. In 1960 he wrote a best-selling book You Can Trust the Communists (To be Communists). He is said to have had a big influence on a generation of Americans including Ronald Regan, William F Buckley and James Kennedy to name a few.

Jane, who has a passion for aged care, and her family nursed him until his death in January last year. "I wanted to go into the area of aged care as the systems just aren’t there for GPs so there is a scarcity of them in this area. Only about one in six GPs visit the elderly. There seems to be no recognition that they are a valuable resource. I would love to be able to make a difference so old people can access basic healthcare".

Initially trained as a nurse like her mother, Rosalie Schwarz who is also very involved in the Schwarz practice, Jane met her husband in medical school. Dr Matthew Gray is now Chair of their local Division and Vice-Chair of RACGP (NSW and ACT). When questioned about keeping ‘doctors in the family’, Jane says with a smile "We are all very keen as a family to try and keep Australians healthy". Matthew agrees, citing his interest in keeping GPs at the centre of primary care, contributing to longevity of life, ensuring patient satisfaction and reducing the number of preventable deaths.

 

"Few people seem to know we have the second-highest life expectancy in the world after Japan," Jane says as she begins her story of growing-up in South Africa where her father, Dr John Schwarz was a mission doctor from1975-1984 working as Medical Superintendent of Emmaus Hospital to the Zulus in KwaZulu Natal, South Africa. At the practice I meet John who is on his way to giving a speech at a local school and he admits he was thrown out of university on his first attempt at medicine for "enjoying" rather than "studying". Clearly he passed the second time around! John talks of his work at the mission hospital for Zulus where the clinical work was incredibly challenging. He moved to Sydney to establish his family here. More than a decade ago John, Rosalie and their sons returned to South Africa and visited hospitals, villages and graveyards to make a video about HIV orphaning millions of South Africans.

 

Jane says she has an extremely close link to Africa from her childhood spent there. "I understand poverty and the unfairness of the world. When my parents took my younger brothers back they discovered that all their friends had lost at least one family member to AIDs. "My generation was dead," she says. "Grandmothers were left to care for grandchildren. Mum and Dad took footage of the situation and on their return decided to set-up the African AIDs Foundation.

This is where the story extends outside the realm of general practice, or 'GP' – to what I have now coined as an abbreviation for 'great people'. Jane's parents return to South Africa twice-a-year and the Foundation they set-up raises $150,000 per annum, mostly via donations and the sale of calendars and numerous items handmade by Rosalie which are available for sale at their Elderslie practice. The practice also absorbs all the administration costs of running the Foundation.

"We are such a privileged, spoilt generation," Jane says. "As a GP I see people with depression. This a terrible problem contributed-to by our obsession with materialism, whereas in Africa a calico bag Mum makes and sells here for $2.00 buys a kid a school uniform. I try and balance my general practice work in Australia with supporting those far less fortunate."

 

The Foundation assists orphanages and teaches children how to plant crops for food, educates them, looks after the 'grandmothers' who are the 'carers' due to AIDs and basically supports many of the older local women who can be looking-after large groups of children. In Africa there are unknown numbers of child-headed households due to the generation wipe-out from AIDs and the AAF supports around 5,000 in the valleys where they have close connections to relief providers. "We are trying to actually get these kids to the point where they have a skill, so they have some hope," says Jane.

 

The family bond that runs through this family generation of doctors in general practice is what makes them unique – they help not only their patients on a daily basis but also give to those far less fortunate. Jane is genuinely inspired by her father and grandfather and I can see that while she agrees medicine is in a state of flux, her role-models have taught her and her husband Matthew, the ‘now generation of doctors’, to enjoy their work and find the positives in it. "We believe it is a calling – it’s what we’ve been dealt with – and being able to help is a privilege."