Down Under



If you want to know how big the world really is, I suggest you take a trip from McPherson, Kansas, to Sydney, Australia, in one day. You won’t be able to do it, by the way. The construct of days prohibits you from doing this from East to West. Your vessel will pass the International Date Line and you will lose the day (sort of the opposite of seizing the day). Don’t worry. You’ll get it back on the return trip. In this way, the universe seems to enjoy a certain symmetry. But even by first class in a “Sky Couch,” your body will understand how far 8,666 miles is. Trust me: The world is a big place.

There is something unsettling about stepping out of a metal tube that was going Mach 0.7 for 13 hours into a world with “mates” and where the bathtub water drains out the “wrong” way. It’s a little like a “Twilight Zone” episode in which the guest star notes everything in this world is familiar except just different enough to make all the difference.

Dr. Tyler G. Hughes

Dr. Tyler G. Hughes

I entered this zone because I have the great good fortune to know John Kyngdon, MD, FRACS. Dr. Kyngdon was the convener for this year’s Rural Surgery Section of the Royal Australasian College of Surgeons, aka, RACS. I was delighted to attend the 2016 RACS annual meeting, which had the theme of technology and communication.

We Americans can be pretty smug when it comes to our health care system, our training, and our outcomes. Traveling to the other side of the world and spending time with surgeons working in Australia and New Zealand can take the smug right off one’s face. Australia is a land of immense distances and minuscule population for such a large land mass. The challenge of providing care across this gigantic continent, the center of which contains an immense desert filled with some of this most deadly insects, snakes and other creatures on the planet, is epic for sure. Yet, where an American baby boomer like me might decry the hopelessness of such a task, the Australians smile and carry on. These people just don’t understand that their task is nigh on impossible, so they succeed to a large degree against the odds.

RACS, of course, does not just include Australia and New Zealand but the South Pacific and Southeast Asia as well. It was formed in part from the efforts of Dr. Will Mayo, who supported the effort of an ACS-like organization for this part of the world. RACS members seem to have a special affection for Americans, consequently, and one feels entirely at home with them. While ACS has many more members, the quality of the presentations given at the RACS annual meeting is certainly on par with much of what one would see in October at the ACS Clinical Congress. American surgeons commonly attend, and I was delighted to see ACS Vice President Ron Maier, MD, there, as well as Gary Timmerman, MD, of South Dakota and Nathaniel Soper, MD, of Northwestern.

The striking point for me is the commonality we surgeons share worldwide. Whether trained under a UK, Australian, or American-type system, the problems we face are similar. For RACS members, the challenge of managing the EHR is about the same, and as would be expected, interoperability is a huge problem for them! Because of the distances involved in Australia, they are much more involved in telemedicine than are US surgeons, but they are just beginning to deal with privacy issues that come with the technology. They are haunted by quality metrics just as we are. Malpractice is quite different from the US in that, at least in New Zealand, surgeons are not sued for compensation, but they can lose their professional credentials over a bad outcome attributed to them. Burnout among surgeons is a problem Down Under, just as it is here. Governmental intrusions and misadventures, ditto.


I had the opportunity to observe teaching of anatomy at a medical school and learned about dissecting electronically as well as in the flesh. One of the keynote speakers at the RACS meeting was an Australian dotcom entrepreneur. From him and his cohorts on the panel I learned that, in the very near future, over 90% of health care data will likely be gathered not in medical offices but from patient-worn devices. I saw apps based on patient-generated data claiming over 97% accuracy.

Of course, I got to spend a few days touring. Who wouldn’t? I got to see animals such as kangaroos that had been just pictures to me before. By the way, have you ever noticed those sharp claws on the “cuddly” koala? Eventually, I had to return and endure the jet lag that is always worse going West to East. Naturally, my first night on call kept me up most of 30 hours. Jet lag and call lag have the same effect. You just want to get some sleep but don’t know how.

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