Richard Tjiong – the last 50 years Published for the Reunion Celebration of medical graduates from the University of Sydney

Richard Tjiong – the last 50 years

After junior residency at Repatriation General Hospital Concord in 1965, I took on a lecturer post in Anatomy at the NSW University Medical School instead of pursuing senior residency year. In September that year, I was pleasantly surprised when I was told that I had achieved the top mark (92.5%) at the Primary Examinations of the Royal Australasian College of Surgeons. As it was my first attempt, I was awarded the Gordon Gordon-Taylor Prize. Unique in the College history, that Prize was shared (with a Victorian candidate). The Gordon-Taylor Prize led me into Sydney Hospital as surgical registrar in the following year- in the meantime, I spent the remaining months of 1966 completing my senior residency at the Royal South Sydney Hospital. Being a surgical registrar at Sydney Hospital was a mixed blessing- many of the Residents under my charge after hours were older than I was and the human dynamics proved challenging.

After Sydney Hospital, I spent almost three years in London teaching hospitals which included the Royal National Throat Nose and Ear Hospital at Gray’s Inn Road. In between hospital posts, I gained my surgical fellowship in 1969. Persuaded by the dearth of rural services, I commenced an ENT practice in the mid-north coast of NSW in 1971. Based at Taree, I was soon joined by three fellow graduates- John Fisher as anaesthetist, George Thomas in mixed GP, general surgery and anaesthetic, and Bala Duraiappah general surgeon. For some years, I was the only ENT surgeon between Newcastle and the Gold Coast. In covering the vast territory, I soon took on flying my own aircraft, a twin-engine Beech B58, and held Class One Instrument Rating (same as airline pilots).

Besides my clinical practice, I shared a Macadamia plantation project with John Fisher and George Thomas in the NSW North Coast, with modest financial benefits. I also became involved with the local private hospital which was on the brink of closing down, and played a leading role (as board chairman) in progressing it to a new facility on a 20 acre site. Mayo Private Hospital plays a key role in health delivery in the area.

Disenchanted with the law after seeing a number of colleagues being badly treated, I took on a Sydney University external law course, conducted under the authority of the Joint Solicitors and Barristers Admission Board. Struggling with time, I managed to finish the course and gain the Diploma in Law, which has the same standing as LLB from Sydney University. I was admitted as a barrister to the NSW Supreme Court in 1991 but not before joining the Council of NSW Medical Defence Union in 1986. I spent the next 15 years, first as treasurer and later as president/chairman, deeply involved with the plights of some colleagues, with the organisation and the finances of the MDO, and with some overdue reforms in the medical indemnity industry and in negligence law.

It soon dawned on me that aside from their mutual status, NSW MDU and all other MDOs were in substance conducting insurance business but without insurance licence. I shared the alarming concern of many people that all of these MDOs were severely and chronically underfunded, and they got away because of an apparent loophole in the law. Fortunately, an otherwise conservative council responded to external advice in adopting insurance accounting practices. By early 1989, we established an insurance arm, Australasian Medical Insurance Limited, duly licensed (and the first of its kind in Australia). I was the founding chairman. I was also very fortunate in being elected president of the parent body in 1993 and privileged to deliver the “The Centenary Speech NSW Medical Defence Union”, where I outlined a plan for a number of challenges. The speech was published in its Annual Report, and reproduced on the web (it can be found by googling my name, but see also “Medical Indemnity Reform” at http//www.richardtjiong.com.au).

The president of the UK based The Medical Defence Union, Dr Ian Kelsey Fry was moved by the Centenary proposals. We started exploring the formation of a national MDO in 1994-5, but unification of the industry began in earnest in 1997 when the Medical Defence Society of Queensland joined forces with NSW to form United Medical Protection. By late 1998, The MDU agreed to unite its Australian operations with UMP.

With a united profession, we were able to lobby NSW Parliament more productively; this resulted in the Health Care Liability Act in early 2001, which effectively curtailed the excesses in medical negligence suits against doctors in this state. The federal government followed with uniform negligence law in other States and Territories.

The “insuranisation” of discretionary medical defence organisations finally kicked in by the federal government in 2003 (after I had retired)- the previously ad hoc discretionary arrangement was banned. MDOs now needed to acquire an overdue insurance licence, conform to insurance accounting and operate under the purview of the insurance regulator.

These changes came at a considerable personal costs. For a time I was undeservedly blamed for the pains of others that accompanied the reforms.  Unwittingly, I invoked hostilities when large sections of the legal profession apparently suffered financially in the aftermaths of negligence law reform.  Competing MDOs objected to the dominance of United Medical Protection and its quest to unify the MDOs. UMP got blamed for what later turned out to be fictions. I retired from UMP in late 2001 after a TIA. Industry rationalisation continued in 2007 when MDA Victoria joined UMP and formed Avant.

I relinquished my ENT practice in 1998 and relocated to Sydney. After retiring from UMP, I was involved with the care of two family members- my eldest brother and my mother, and became embroiled in a family feud concerning the two people I was caring for. I tried mediation but did not get far after the two children of my brother started to involve lawyers. They took me to what could be described as an aberrant court trial, where – not so surprisingly in hindsight – I did not get the proper support from lawyers in my defence. Some skewed media publicity followed and stay on in some websites. In a digital age, I felt compelled to publish my story in an article on a website- “A Family Feud and the Australian Legal System”.

I am married to Kathryn for almost 47 years. Kathryn, a childhood school mate back in the tropics, was the first woman to graduate with Honours in pharmacy from the University of Queensland. She provided considerable support while I was working in London, and even more so in my journey in medicine and in the law in Australia. We have two children in Sydney: a daughter who is an ANU law graduate, she practises as a solicitor; and a son – a graduate in medicine from the University of NSW – in a family practice. We have two delightful granddaughters.

Fairly recently, I have spent extended periods in the mountains of Thailand, learning about Buddhism and the Buddhists’ way of meditating. I find developments in neuroscience and psychology rather exciting; I am seeking the links between these developments, meditation and quantum physics. I feel fascinated by the explosion of knowledge and where this is taking us- I hope to live long enough to see some exciting changes in human dynamics.

Richard Tjiong, 27 January 2015.