Joan graduated from the University of Melbourne in 1999 and undertook her residency years at St Vincent's Hospital Melbourne. She then moved to Northeast Victoria to obtain her General Practice Registration (Rural Pathway) and Diploma in Obstetrics and Gynaecology. During that time, she worked as a rural GP obstetrician and provided services to the nearby ski medical centre, local district hospital and general practice. She returned to Melbourne and joined the team at Bluff Road in 2007. Since then, she has completed an Expert Certificate in Dermoscopy (skin cancer diagnosis) and currently works regularly as a surgical assistant at Cabrini Hospital.
Joan enjoys the breadth and diversity of patients and challenges encountered in primary healthcare as well as educating and empowering oneself to respect their own health and well-being. She wishes she could travel and ski more but for now, enjoys spending time with her family and friends, the Arts and boxing.
Question: What's a typical day like for you, at Bluff Road Medical Centre?
Dr Joan San: A typical day begins at around 6.30 - 7am as I get my children ready for school to leave just after 8am to drop off to school and rush the chaotic bayside traffic to get to work with 15-20 minutes spare to action incoming results, send-off letters and make a quick phone call to a patient. Consulting starts at 9am and there is a solid flow of scheduled appointments with patients for the next 3 ½ to 4 hours. The day never ceases to be boring as the concerns and issues continually change with every face that walks through the door. From a worried mum about fever in her child, a recurring musculoskeletal pain, chest pain and palpitations to difficulties with mood and anxiety and physical check-up, the minutes morph into hours. Time management is a GPs constant battle and balancing that with the interruption of phone calls and "squeezed in" patients, note-taking and the flow of having to listen, assess, advise, direct and reassure are constant challenges faced. Quick mouthfuls of water may occasionally punctuate the session and the hunger is hopefully appeased in 15-20 minute break before racing to begin the afternoon session on time. Yet after the scheduled patients are gone, there would typically be another hour of attending to emails, more results before leaving the premises just after 6.30pm to relieve the babysitter and face the chaos of family life or fit in some exercise.
Question: What originally inspired your passion for healthcare?
Dr Joan San: Most would agree that it is difficult to know exactly what one should be when they leave high school and I was no different. I originally studied Medicine after attending a few University Open Days because it seemed the most intriguing field to study and of course, going to University was always the end point after high school for me. However, my passion for healthcare only began to grow when I was privileged to spend 2 months in East Africa near the end of my degrees, gaining experience in a mission hospital. For me, I learned then that all the knowledge that I had acquired could in fact help someone and the ability to do so, sparked the desire to continue on in the endeavour of providing healthcare to those who needed it.
Question: Can you talk us through how you conduct a typical skin check?
Dr Joan San: It usually begins with a brief chat about history of previous skin cancers, family history, skin type and query of any current concerns. The patient has usually been instructed not to apply any creams or make up, including sunscreen and moisturiser prior to the check. An extensive examination of the skin from top to toe is then performed with a dermatoscope (magnification tool), total body photography and "micro" images with the FotoFinder technology. The patient is given instructions about positioning for examination or image capturing whilst always being given consideration for modesty.
Question: How can we be more aware about our skin between skin check?
Dr Joan San: It would be prudent for all of us to develop a conscious effort to "notice" our skin, that is, to pay attention to our skin eg. When we moisturise or bath, change clothes, look in the mirror. Any new spot or mark that has appeared for a several weeks that is either tender, weeping, scaly or growing bigger in size or changing colour may be a reason to see your doctor. Most moles change slowly and if one is changing over a few weeks to months, this should also be a reason to get it checked.
Question: What advice do you have for those who will be spending a lot of time in the sun, this Summer?
Dr Joan San: The sun is important for a variety of reasons: vitamin D for bone strengthening and our mental health! The Ultraviolet factor is important and commonly the peak hours occur over the middle of the day to early afternoon. At these times, if the temperature is also hot, it would be prudent to avoid prolonged sun-exposure but if required, wearing loose long sleeves, a broad-brimmed hat and sunscreen are important. Don't forget to re-apply every 1-2 hours depending on how much you are sweating or swimming.
Question: Do you believe there is such thing as a healthy or safe tan?
Dr Joan San: "Safe tan"? This is especially a controversial term! Depending on your skin type, one can tan very easily outside peak UV hours of the day with minimal exposure and possibly for these people, one might argue that this may be as close to a safe tan with incidental sun-exposure. However, apart from slapping on tinted moisturisers / products, the most conservative of skin cancer doctor would probably have to disagree with such a thing! Apart from the cumulative risk of skin cancer, another reason to reduce sun-exposure would be to reduce the demise of the aging skin with spots and blemishes, redness and depigmentation.
Question: What's next, for you?
Dr Joan San: For me, continual improvement has been a resolve in my work ethic. Consolidate the skills acquired; continue learning to challenge the mind to improve my practice and provide the best to the person who walks in the door. That can be hard at times as I am also a wife, mum of 4, daughter, sister and friend to those that make up the community around me. Life is busy and full, hence I periodically have to check in with myself to make sure I am living in the moment! For now, there is no other "job" I would rather do than be a GP mum; no regrets here.
Interview by Brooke Hunter
Photo by Hush Naidoo on Unsplash