Campbell Murdoch |  Founding Head of The Rural Clinical School of Western Australia

Campbell is the name I’ve always been called by, right from the beginning. I was named after my grandfather John Campbell who was a foreman pastry cook in Springburn in Glasgow and married to an Irish lady called Agnes Kyle.

DMacA: Tell me about your academic career.

CM: I qualified in Glasgow in 1966 and originally I wanted to do academic surgery. My second job after house jobs was a surgical Academic Fellowship in Glasgow but we got married in 1967 and it was clear that supporting a family was not going to happen on an Academic Fellowship. So, I decided to do general practice and started in general practice in Kirkintilloch, which is near Glasgow, in 1968. Like most of us in general practice I was blown away by the specialty, a part of medicine I’d never actually been taught at Medical School. As a student, I remember being told that if I wanted to do general practice I could do it during my holidays and if I knew a nice GP I could maybe get some time there. I went to my own GP for two weeks and that blew me away. The great thing about it, I found, was that you actually lived your life in this job. I got four weeks vocational training from a wonderful man called Eric McKay who was the senior partner. And then I was ‘it’. I was ‘The Doctor’.

By mistake, I got an opportunity for academic work. A former senior partner in the practice looked after a hospital in Kirkintilloch for what we then called ‘mental deficiency’ so I got two mornings off from the practice to go to Waverley Park Hospital. It turned out that he hadn’t gone regularly and there was no room available for me. And, I thought – why don’t I do some research. The hospital was part of a large group that included Lennox Castle Hospital which had 1500 beds for ‘mental deficiency’. I’d always been interested in Down’s syndrome there was a group of about 80 adults with Down’s Syndrome. I went through the research process that we now teach – you’ve got to have a question, you do your literature search, etc. I looked at the deaths in the hospital of people with Down’s Syndrome and heart disease seemed to be the problem. With the help of friends back at medical school I devised a research plan to look at cholesterol levels, blood pressures, and thyroid function and compared them to other patients with ‘mental deficiency’, age and sex matched. That turned out to be very successful and after five years or so, I wrote my MD thesis. I hadn’t any supervision, apart from friends who knew about things I didn’t know anything about, and it was amazing.

Then I began to think that I’m not really an academic, I’m just a GP, and I must try to get an academic position to take this further… I’m still not sure whether that was the right decision to make but, that was the way it started.

DMacA: You moved into the academic world and then began to travel. You moved to a number of different countries.

CM: I went to Croatia to the „Andrija Štampar“ School of Public Health in Zagreb for a two-week visit with a British Council scholarship. I went to SIMG (Societas Internationals Medicine Generalis), and I used to go there every year. I was working Dundee with Professor Jimmy Knox, who was one of the early professors in Scotland, and I got to know the academic community very well. In Dundee I continued my interest in Down’s syndrome but I then got really interested in the care of the elderly.

My main task in Dundee was to set up the medical school teaching practice. In those days we believed that Academic Departments of General Practice should be real GP’s as well, an issue that has been dropped in a lot of places, to my great regret. So, I inherited a practice from an older GP who had been in the same practice for 40 years with a large proportion of elderly patients- but, they were about 20 years younger than I am now!

I did my PhD Thesis from Dundee in the 80s. I then decided to follow all the people over 65 years old in the practice until they died. That’s why I see the amazing research opportunity we have in general practice.

DMacA: But you’re also a pioneer in rural practice, one of the leaders in developing the whole concept.

CM: I went to New Zealand. I was the first Professor of General Practice in New Zealand and my interest was in chronic fatigue syndrome. And the reason for that was a press interview when I arrived. There was this illness that people called Tapanui Flu that had been described by a GP in Otago and it was in the news. The press asked me -do you believe this is a real illness? Fortunately, I had known about some of the research in UK and I said, “Yes, this is a real illness”. From New Zealand I went to United Arab Emirates as Chair of Family Medicine for five years. And I went from there to Malaysia with the University of Sheffield to the Asian Sheffield Medical College and I was there for about a year.

I went back to New Zealand and needed a job. I thought about applying for other Chairs but I really didn’t want to travel anymore. If you want a job in rural practice it’s an absolute breeze compared to wanting to be a professor- because people want you there.  There’s no competition. I decided to accept a partnership in a rural practice in Winton in Southland. I got chucked in at the deep end. It was 24/7 general practice, intrapartum obstetrics, the whole deal, and it was a wonderful time. Age 57 is a great time to get re-educated if you’re a general practitioner. Then, about two years later, while I was attending a WONCA conference in Christchurch, I was asked by one of the Australian academics if I’d ever heard of the Rural Clinical School and I hadn’t heard of the Rural Clinical School at that point…

(In response to concerns about medical workforce shortages in rural Australia the Rural Clinical School of Western Australia was created in 2002 with a view to increasing recruitment and retention and to create a cohort of medical graduates interested in rural careers.)

The wonderful thing about the Rural Clinical School was that I had the best job in the world at the end of my career. I went to Kalgoorlie in 2002 and we’ve just celebrated the 20th anniversary. We started with seven students in three places and, when you’re talking about Western Australia, it’s as large as Western Europe with an enormous hinterland. They’ve now got 120 students in 15 locations.

It was all sparked by a student who came to see me in Winton from Dunedin. He said to me, “you know, I see more here than I ever do in the teaching hospital, what’s that all about?” and that stuck with me. And, in Western Australia we found all these wonderful GPs in rural locations, working in Aboriginal Medical Services, or as specialists in rural areas, and they had this amazing capacity to teach medical students.

DMacA: How is the Rural Clinical School progressing?

CM: The Rural Clinical School movement has made a huge difference to medical education. The wonderful thing about what happened in Western Australia is that when we started off it was very tentative. When the Commonwealth Government gives you an annual budget of millions and says 25% of your students have got to spend a whole year, at least a year in a rural location, the Head of School has got to live in a rural area, and most of your staff have got to do that, they police it very vigorously.

The big lesson that taught me was that, in academic medicine, money talks. You’ve got to have that kind of backing to get medical schools to change. The other wonderful thing was that academics in various specialties then proceeded to produce papers which demonstrated that the teaching of obstetrics and other subjects was just as good, if not better, when it was done by these so-called ‘primitive GPs’ out in the sticks.

There was this whole “Community of Scholars” in the bush, as we call it in Australia. But, in that “Community of Scholars” the level of academic discourse with this group, living and working in rural Australia, was just amazing. It was as good, if not better, than the level of discourse in the so-called ‘Ivory Towers’. And, the students responded to this. Students began to choose us, not because so much it was rural but because it was a good experience. They learned a lot and it was a much better clinical experience.  For a while I worried that they were choosing us because we were so good rather than because we were so rural.

In 2007 we got a Carrick Award, an award that’s given for educational innovation. It was very thrilling that a group like us, out there in Western Australia, won that prize for educational innovation. It’s just a testament to the kind of people we were working with. I may have been the ‘so called’ founder, the leader, and all that sort of stuff but, I was just a good circus ringmaster really.

DMacA: One of the big concerns in primary care is about the future of rural practice. Many countries in Europe, Canada and indeed in Australia, are having difficulty attracting people to rural practice. Is this a worry?

CM: That was the whole raison d’être for the Rural Clinical Schools and certainly, in many areas of Australia, we seem to have sorted that out because we’ve now got consultants who came through the Rural Clinical School. In the last 20 years close to 1500 students have gone through this experience so, we’ve got consultant obstetricians, specialists, and GPs coming back. In Australia they came up with money, they threw money at it, but it was only successful because the people who got the money were motivated to do all the other things as well.

DMacA: That’s a perfect note on which to end our conversation, – that  it’s about motivation as much as about money.

But, that’s wasn’t the end of the conversation, Campbell continued…

CM:  When you look back on this wonderful privilege. I am so privileged to have worked in general practice or 50 years. It’s a great honour and it’s because the people that I worked with were such honest and realistic people. I always remember when I left Kirkintilloch to become an academic, I went to see an old lady who I had visited every month for eight years, to tell her a story that I thought was going to break her heart. And she looked at me very seriously and said, “Doctor Murdoch, I’m sorry you’re going away. It’s an awful pity, just as we were beginning to like you”