The project she was offered, looking at advanced care plans for patients in a regional primary care setting, appealed to an interest awoken during a public health unit offered by Dr Helen Ackland. Far from being a disadvantage, the project’s supervisors, Dr Bernadette Ward and Pam Harvey, welcomed the legal perspective Katherine could bring to the project. She was in.
Through an audit of patients who had had an over-75 health check at the Bendigo Primary Care Clinic, the project team was looking for a correlation between chronic diseases and where advanced care plans were in place.
|Multi-disciplinary team L-R: Pam Harvey, Katherine Allman, Nidhushie Tilak Ramesh, Dr Bernadette Ward, Dr Dennis O'Connor|
Interdisciplinary skills led to a natural split in the research tasks as Katherine worked closely with a final year medical student. “It was great fun. Nidhushie [Tilak Ramesh] was fantastic.” During the audit, Nidhushie was able to group patients into one of the eight chronic disease categories identified by the Australian Institute of Health and Welfare. “Having her able to do that and me not having to Google everything was brilliant.”
Katherine brought a completely different perspective. “We were reading through the literature, not just looking at the patients medically, but also legally: Who were the patients? Were they more vulnerable people?”
On the clinic’s side she was asking: “What are the obligations of a GP under the new legislation that will be introduced in March next year? What are the implications for best practice? Really trying to understand the tension between the demands of working in a GP clinic, but also trying to do the best thing for your patient,” she said.
Her ability to interpret legislation was valuable as was her training in statistics. “I basically become the stats monkey because I’d done quite a bit of stats training through my biomed degree. I did a lot of work with SPSS doing the data analysis, so I got very familiar with that. That was good to refresh those skills.”
Her law skills came into play most in the final analysis looking at how it all fitted into the framework. How do they make this meaningful?
Katherine has firsthand knowledge of advanced care planning. “My mum has just been through making an advanced care plan. She’s had a few unexpected turns with her health in the last 12 months. So we’d gone through the medical power of attorney, all the ‘person responsible’ things as well as looking at getting an advanced care plan put into place for her. So it was something that was quite close to home, but because of that it had really inspired me to learn more about it because there’s not a lot of public awareness there.”
Advanced Care Planning close to home
The research project also tapped into what she’d learned during a student project on euthanasia and the law. In Australia, she points out, death is a big taboo, so there is not much research around death. “The heavy lifters are really the US and Netherlands. When you come to Australia, everything is in the ICU and a little bit in emergency, which is where you’d expect it to be because they’re more the end of life stages. Nothing’s been done in a GP setting.”
Staying focussedIt’s a new field in Australia and as someone whose interests are so broad, Katherine found it easy to stray into related areas that intrigued her. “It’s very important to have a clear idea of what you want to achieve,” she laughed. “The time you’ve got, the funding you’ve got; you’ve got to come back to that one original idea.”
That focus enabled the team to come to some conclusions based on the data they'd collected. “Despite a government push for ACPs, medical powers of attorney are still predominant,” she said. They were also able to make recommendations about the need to review advanced care plans all along a patient’s health journey. Katherine’s final task was to draft an article for possible publication. “We’ve written the method we used in a way that we hope can be replicated in other clinics,” Katherine said.
While she’s leaning towards a career in health policy, Katherine has always been interested in medicine. Now she’s considering extending her studies to tackle graduate entry medicine. Whether she does end up in medicine, Katherine has at least proved that the “closed shop” reputation of research scholarships in the Faculty of Medicine, Nursing and Health Sciences is undeserved. Other disciplines have a lot to contribute to health care research.