Reflections on WONCA Istanbul 2015

In October I had the privilege of attending the WONCA Europe regional conference in Istanbul.  The program was rich with a wide variety of topics ranging from the immigrant crisis in Europe to Music therapy.   It was great to meet new and old friends and colleagues.

VdGM Pre-conference

For any future and young doctors this is the place to mingle with your international colleagues.  The atmosphere is great and the new ides flow.  This year the pre-conference consisted of groups discussing difficult patients and research.  At the end of which the groups present their ideas.  The next pre-conference will be in Copenhagen in June 2016.

Rural practice of the future

One of the workshops I attended was EURIPA’s ( about the future of rural practice.  There was mention of all the ways social media is and can be used in the field of rural practice – online consultations with patients and colleagues, issues with patient safety, using/developing secure networks etc.  The second half of the workshop was a discussion on what we should keep, what we should discard, and what we should introduce into rural practice.  Ideas ranged from not sending young doctors into single practice at their first rural appointment, encouraging the development of more educated staff and community members to assist the health team, establishing local rural doctor networks to meet in person and battle isolation as well as discuss difficult cases, have a regular video link to hospital specialists and better develop that relationship.

Burnout – Keeping the Flame

As one of the facilitators of this workshop I was surprised by the great turn out  (100 participants).  I think it showed just how important it is to talk about this topic with out colleagues.  As an introduction some general information about the prevalence of burnout among doctors was shared.  For most of the workshop participants had the opportunity to talk about what had motivated them to be FM/GP, share their feeling about the pressures they face, think about how they identify the strong and week points and tool they can harness to avoid burnout.

Socioeconomic factors and primary care

It was the first time that BRITE presentations where introduced at a WONCA conference.  BRITEs are short, 5 min presentations on and issue you face in your practice or experience you wish to share after which their is a group discussion.  I think this is a wonderful way to get more people to share their unique experiences and also meet international colleagues interested in the same topic.  My BRITE presentation was about how socioeconomic factors can influence the delivery of primary health care.  From the political ideology, number of patients per day, salaries and other incentives, brain drain, patient socioeconomic status, immigrants, policy and other issues I face that affect my practice of medicine.  It was interesting to hear about what other colleagues from other countries face.

Balint groups

The workshop on Balint groups presented a way for us to share our difficult cases with colleagues and through discussion with them try to find new ideas for solutions.

There where so many great lectures/panels/workshops/research presentations to choose from that it was impossible to attend everything that you were interested in.  But WONCA Europe is definitely and event not to be missed – thank you Istanbul!  And I’m looking forward to doing it all again in Copenhagen!


New Doctor in Town – First 10 days

About two weeks ago I got a call from my employer that I would be taken off my GP training  program and be sent to “Town B” until further notice as there were not enough doctors.  I would be required to move and start working there the following week.  This was a bit of a shock as I was planning to go on vacation in 2 weeks and was looking forward to taking a break.  You may be wondering, as I did, how they didn’t realize that they were missing doctors.  Well it is holiday season and everyone needed to cover for everyone else.

So I moved to Town B on the border with Hungary.  The town had made an effort and had ready accommodation waiting (above the kindergarten)  for their new doctor.  I was quite pleasantly surprised, the flat was fully furnished and quite spacious, and most importantly very close to the office.

Town B

The town has about 1700 inhabitants, and the closest regional center is about 15km away with a population of about 8000 people.   There are three regional hospitals in the neighboring counties each approximately 40km away.  There is a kindergarten and primary school.  There is no public transport, train or bus lines that pass through the town so most people have at least one car.  They have had difficulty finding a doctor and have been without a more permanent GP for over 3 years.

Working with the people here is quite similar as in an urban center and the office is adequately equipped.  There are many elderly patients with multiple chronic conditions which may have been better monitored if there had been a full time GP present.  It can be quite difficult to decide how to treat a complex patient that you see for the first time in a 10-15min consultation.  The nurse has been extremely helpful as she has worked here for over 20 years, is a local and provides invaluable information.

Some observations:

–  Not having a functioning computer system during your first week can be extremely frustrating

– your mobile phone will be confused and think you are in another country when you work this close to a border

–  patients will not listen to your advice to rest when there is no one else to work in the field

–  you don’t need to go shopping as much because when fruit & vegetables are in season they will be brought to you

–  when going to home visits prepare to face farm animals

– patients will not visit you until they perceive their condition as serious enough

– the most common question is – will you be staying as our permanent doctor?

– as you walk around town people will notice you and say – “there goes our new doctor”

Andrija Štampar – “Man of Action”

Andrija Štampar is a very influential figure in medicine here in the Balkans.  He was a famous Croatian doctor who played a major role in forming the healthcare systems here and in other parts of the world.  He founded the School of Public Health in Zagreb in 1927, and was the president at the founding of the World Health Organization in 1946 (First World Health Assembly).  Find out more:


Andrija Štampar’s 10 Principles of Public Health and Social Medicine

1.  Informing the public is more important than the law.

2.  It is crucial to prepare the terrain and help shape correct opinions on health issues in communities.

3.  Everyone, regardless of position, should participate in issues of public health and work to improve it.

4.  Social therapy is more important than individual therapy.

5.  A physician should not be financially dependent on a patient.

6.  No differences should be made between the economically strong and economically weak.  (egalitarianism)

7.  When organizing healthcare, the physician should seek out the patient, not vice verse, so as to reach all those in need of care.

8.  The physician should be a teacher (to the public).

9.  Questions of public health are of greater economic than humanitarian concern.

10.  The place of greatest influence of the physician is in the community, not the office.


The Balkans

For those of you who are not familiar with the Balkans, this is a peninsular located in the south east of Europe.  It has had a turbulent and colorful history which has left an interesting blend of people and cultures scattered over some very beautiful and sometimes perilous landscapes.


I am a doctor in this part of the world.  This is sometimes a challenging, but never dull task.  The colorful people of the lands keep you on your toes.  I will share with you stories of medicine from this peninsular along with comments and views on how we compare to the rest of Europe and the world.