Better, all round

Dr Kean-Seng Lim was always going to study medicine, but deciding what kind of doctor he wanted to be came down to how he felt about himself as a person

Dr Kean-Seng Lim had several reasons for becoming a general practitioner. Perhaps the most compelling was the simplest.

“It was about me becoming a better person”, Dr Lim tells the MJA.

“After graduation I didn’t have a fixed idea about what I wanted to do next. After various rotations I found that I had a more generalist approach.

“And I discovered that a hospital is an unhealthy environment for me. It was depersonalised care — treating a series of diseases rather than a whole person.

“It was making me into a worse person.”

A solution was readily at hand.

Dr Lim’s father, who trained at the University of Sydney and then returned to his native Malaysia to practice, had brought the family back to Australia when his son was 7 years old, and set up a general practice at Mt Druitt, in Sydney’s west.

Dr Lim did his 6-year medical degree in the United States, then his internship and 2-year residency in Gosford, before completing his GP training in the lower Hunter Valley.

“My father’s practice had been established for 25 years by the time I joined up”, Dr Lim says.

“It was convenient, and a natural fit for me, because I really enjoyed Mt Druitt.”

Dr Lim credits his father with providing him with insight into the life of a GP.

“Medicine was always on the cards for me due to my father, but from then on it was about deciding what to do in medicine.

“To be honest, a medical course doesn’t give you any good idea what it’s like outside university.

“Because of my family’s influence I had a better idea of a GP’s life. Even so, doing it was something else again.”

It has been 20 years since Dr Lim signed on for duty in Mt Druitt, a battling suburb wedged between Parramatta and Penrith in Sydney’s outer west.

“It’s one of the more disadvantaged areas in metropolitan Australia”, Dr Lim says. “It has the highest bulk-billing rate in Australia; it’s high on the low socio-economic index; lower educational levels and health literacy; poorer health outcomes.

“It has the highest prevalence of diabetes, lung disease and smoking in New South Wales. Approximately a third of the kids are obese, and 80% of adults over 45 are obese.

“In many ways it’s a very interesting place to work”, he says.

“You grow into a community over the years and I really like the patients. It’s the challenges that make it interesting.”

Mt Druitt has a large and transient migrant population, with first generation migrants settling there, before their children move further out of the city, and another wave of immigrants arrives.

Dr Lim’s work was rewarded at the end of last year when he was named as the Royal Australian College of General Practitioners’ GP of the Year at GP15.1

RACGP president, Dr Frank Jones, said Dr Lim was “highly regarded”.

“Dr Lim has shown a true passion for and commitment to integrated care and the needs of his community,” Dr Jones said.

“He is highly regarded amongst his peers for his knowledge, leadership and devotion to his patients, staff, colleagues, registrars and students.

“Dr Lim has also been integral to the development of a schools-based obesity prevention and lifestyle education program in western Sydney, which is empowering high school students to make healthy choices for the future. I congratulate him for achieving this great honour.”

That schools-based obesity program is called SALSA (Students As Lifestyle Activists) and involves Year 10 students being trained by university students to be peer leaders, teaching their classmates about nutrition and physical activity through videos, games and activities.2

Starting at Rooty Hill High School in 2004, the SALSA program is now in 24 schools in Sydney and is in the process of being assessed by the NSW Health Department for use through the state.

“The effects have been quite interesting”, Dr Lim says.

“The benefits to the students and the peer leaders through role modelling have been significant and we find that the peer leaders go on to be school leaders.

“We think SALSA is causing a sustained cultural change.”

As for being GP of the Year, Dr Lim is delighted.

“It’s not something you apply for, and it was never a lifetime ambition”, he says.

“I just keep doing the same things every day. But it is very nice to have, and it’s gratifying to know that my work is appreciated by my colleagues.”

For now, Dr Lim is intent on improving outcomes for his patients and lifting his practice to greater heights, despite the frustrations of changes in government policy and funding cuts.

“Are GPs underutilised? I think so”, he says.

“Is general practice performing to the best of its capacity? No, we can do better, but we need the right system and the right supports.

“We have to develop improved models of service delivery.

“Sometimes it is very frustrating — the pure shortsightedness of [the Government’s approach]. All these cuts and changes in policy — they are not aimed at reform. There’s no approach, or strategy or vision.

“There’s no question that we can do things better, but before we make wholesale cuts, it would be sensible to ask, ‘What does the system we want to have look like?’ and ‘How do we fund it to make it run the way you want it to?’”

Dr Lim does what he can, and his aim is to run his practice the way he’d like to see the health care system run.

“I’m trying to develop the practice into what I want it to be”, he says. “We’re nowhere near where I want it to be, but we are going in the right direction.”

Quality data collection and implementation, as well as a multidisciplinary team approach, are crucial to Dr Lim’s practice.

“That multidisciplinary team is a very big part of the practice reaching its full potential”, he says.

“We have a dietician, physiotherapist, psychologist and a practice pharmacist, and we share the record system. We try to work very closely together, with regular meetings.”

Dr Lim and his colleagues have a “red list” of their patients who are at the greatest risk for hospitalisation. They work intensively with those patients, and, he says, they have a high level of success at avoiding hospitalisation.

“Hospitals provide serial care”, he says. “We provide continuing care.

“Funding, of course, is the limiting factor, but we can show good, measurable improvements in our patient outcomes.”

A better person, all round.