Associate Professor John Richmond believes he has worked through the "golden time" of medicine as extraordinary advances have propelled medicine "from being an art-form to very much a science".
Subscribe now for unlimited access.
or signup to continue reading
Dr Richmond retires next week after 51 years in medicine including 40 years in Ballarat as a general physician and nephrologist, specialising in kidney disease.
In that time he has treated thousands of Ballarat residents with kidney disease and other illness, and overseen the development of nephrology services including life-saving kidney dialysis in the city.
He has also seen the evolution of kidney transplants and celebrated success with many of his patients undergoing transplants over the years.
"There was no nephrology here when I came," Dr Richmond said.
"Renal disease was a young specialty and we started with one dialysis chair in 1984 before we moved into a couple of houses in Windermere Street North which don't exist now ... and in 1997 we moved back into the physical structure of the hospital and now have 12 dialysis chairs and capacity of 60 patients."
Renal physicians in Ballarat also oversee care for patients who have their dialysis in Ararat, Horsham, Daylesford and Maryborough.
In his final months Dr Richmond, who works across Grampians Health Ballarat and St John of God Ballarat, has been leading a push to further expand the city's dialysis services to meet demand for the growing number of patients requiring treatment.
"When we built our current facility my expectation was we would have capacity for 15 years of growth," Dr Richmond said.
"That is in fact the case and ... now we are looking to double the size of that unit from 12 to 24 (dialysis) stations to allow us to increase capacity dramatically for another 10 to 15 years of growth.
"We have for some time been in discussion with government regarding funding of a new dialysis facility and I remain optimistic that government will be able to fund the current proposal which is around the possibility of providing a public private partnership."
The growth in the number of patients requiring dialysis, a process which takes over the work of the kidneys to removes waste, toxins and excess fluid from the bloodstream, will continue as the population ages.
I would always argue the bedrock of medical care in our community is not a nice shiny hospital but GPs in our community, many who have come through public hospitals here and had their training around all the skills they need
- Associate Professor John Richmond
Dr Richmond said when he began work as a nephrologist, there were relatively few people on dialysis and almost all of them were on the waiting list for a kidney transplant.
"In the current situation now there are 12,500 people in Australia on dialysis and only about 2000 on the transplant program," he said.
"We now understand there's a huge number of people who develop renal failure later in life because they survive other illnesses which in the past would have caused them to die, like heart disease, stroke and complications of diabetes which is most common cause of renal failure.
"They survive now because of advances in medicine and still have a good quality of life. If they have a good quality of life then dialysis is appropriate to provide even though they are not suitable for a kidney transplant," he said.
The dialysis unit at Ballarat Base Hospital, which operates in partnership with the Royal Melbourne Hospital where Dr Richmond trained in renal medicine, completes about 8500 dialysis treatments a year, up from around 1900 treatments just 15 years ago and that number will continue to grow.
Some of those patients will be lucky enough to receive a call for a kidney transplant.
"The change that has occurred in organ donation and transplants has been quite dramatic," Dr Richmond said.
When transplantation began organs could only come from deceased donors. Then rules changed to allow living related donors, then 'heart-beating' donors were permitted, more changes allowed spouses to act as donors and finally living non-related donors were eligible.
That has allowed a "paired donor" program to evolve where someone willing to donate a kidney to a friend or family member might not be a match to them, but might be a match to someone else waiting for a kidney and through a series of operations and transport flights in a day a number of linked transplants can occur.
When Dr Richmond started work in Ballarat there were just five general physicians at the hospital and few specialists, unlike today when specialists are the norm.
There's also a much bigger focus on medical students and training outside of metropolitan city hospitals.
READ MORE:
"Forty years ago there were a small number of students who rotated here from Royal Melbourne Hospital," he said.
University of Melbourne then established their rural clinical school in Ballarat, and 13 years ago Deakin University began their rural clinical role. For the past 13 years Dr Richmond has played a significant part in the training of third-year Deakin students.
"The goal has been that if you educate people in rural and regional areas you are more likely to encourage people to stay," he said.
But he maintains the most vital medical care in the community is local GPs.
"I would always argue the bedrock of medical care in our community is not a nice shiny hospital but GPs in our community, many who have come through public hospitals here and had their training around all the skills they need," Dr Richmond said.
Sign up to receive The Courier's news alerts straight to your inbox.
