Author: Dr Stephen Brough, FRACS

I started work as a urological surgeon at the Launceston General Hospital (LGH) on 7 February 2000. As a general urologist working in regional England, I had watched the centralisation of surgical services following the 1995 Calman–Hine report with some disquiet. It is hard to deny better results are usually achieved by those who carry out procedures frequently. But where does that leave those of us with general training—and more pertinently, where does it leave patients who live in rural and regional areas? Ultimately, they are left having to travel away from family and friends, or they are left unable to access adequate treatment.

I spent time on exchange in Brisbane as a registrar and lived there with my family in 1994. We came to appreciate the Australian way of life (work hard, play hard, beer o’clock), so once an opportunity for work in regional Tasmania came up, we migrated. The first few years were difficult as staff specialist salaries were poor; we needed to settle our 10-and seven-year-old girls into a new school, and I had to sit the FRACS (Urol). However, the girls did well; the exam was passed, and I became busy in public and private practice. We had a house built on 10 acres overlooking the mountains just 15 minutes from work and school, and we enjoyed bushwalking, fly-fishing, horse-riding and the local classical music scene since.

In the last 25 years, the LGH urology unit has grown from two consultants and one non-accredited registrar to five consultants, one accredited registrar rotating from Melbourne, two non-accredited registrars (both expected to get on to urological training), and a clinical nurse consultant. We remained generalists but have developed sub-specialist interests in complex laparoscopy, renal calculi, functional urology and Holmium laser prostate surgery. We are expecting the da Vinci robot to arrive in July this year at the public hospital so that our patients no longer travel to Melbourne for robotic radical prostatectomy or partial nephrectomy.

How do we ensure our regional patients achieve surgical outcomes in our hands comparable to those achieved in major metropolitan centres? Firstly, we must take an honest interest in our results. The Confidential Enquiry into Perioperative Deaths was established in the UK in 1987, and I saw its power and influence as a Trainee. I was happy to join the Tasmanian Audit of Surgical Mortality management committee at its inception in 2004. I promoted its activities and fed back its findings to my colleagues. I am on the Prostate Cancer Outcomes Registry—Tasmania steering committee as a Northern Tasmania representative and a past chairman of our Department of Surgery Morbidity and Mortality Meeting. Our urology unit audit meeting is held four-weekly and routinely attended by the whole team. Constructing and managing surgical outcome databases is expensive and time-consuming. Still, we need to be able to interpret the data for others who do not have our knowledge and expertise. Surgical representation is essential at all levels.

Secondly, good working relationships with colleagues in major centres are essential. I am indebted to Nathan Lawrentschuk, Daniel Moon and Declan Murphy from the Peter MacCallum Cancer Centre in Melbourne; Lih-Ming Wong from St Vincent’s in Melbourne; Justin Chee from Alfred Hospital in Melbourne; and Conrad Bishop from Melbourne Urology Consultants for their support, advice and visits to Launceston to operate on our patients. Also, James Wong, Howard Lau, Vincent Tse from Sydney, and David Nicol, erstwhile of Brisbane, have provided invaluable advice, support and proctorship. In the future, I think it is essential for regional units, like ours, to strengthen ties with the metropolitan units through joint multidisciplinary team meetings, shared protocols review of results, and a regular program of operating with colleagues in each other’s hospitals. We can all benefit from this—surgeons and patients alike.

I am retiring on 27 June 2025 after nearly 31 years as a consultant in England and Launceston, and I don’t anticipate missing work. I am an umpire for the Northern Tasmanian Cricket Association. I am developing an interest in rehabilitating injured raptors, and I will join the local food bank as a volunteer. I may also learn to play the banjo that has been sitting in a cupboard at home for many years in mute rebuke. I am greatly looking forward to spending time with our new granddaughter.

Finally, I want to acknowledge my Launceston colleagues, whose collegiate support and friendship have been more than I could have hoped for. I’d also like to thank my teacher, mentor and friend, Peter Heathcote, who has guided and encouraged me for the last 30 years.

Lastly, I could not have done this without the love and care of my wife, Liz, who has carried more of the load than she should.