Waikato doctor Dr John Bonning, the first Kiwi head of the Australasian College of Emergency Medicine, will be the first New Zealander to head the peak body for emergency medicine in Australasia.

He will take on the position of president-elect of the Australasian College for Emergency Medicine (ACEM) next month.

Bonning, a specialist emergency medicine physician of 15 years and former director of Waikato Hospital’s department of emergency medicine, will serve in that role for one year before becoming president in late 2019.

It will be the first time in the College’s 35-year history that a Kiwi has held the role.

Babies to centenarians

Bonning say it is the variety that attracted and has kept him in emergency medicine.

“One minute I can be with a 102-year-old patient and then I’m seeing a two-week-old baby.

He said the Waikato emergency department could see about 250 patients a day.

“I work with a huge variety of people, all of whom present with something different. It’s about making a real difference in the patient’s lives.

“But I also really enjoy working shoulder to shoulder with my colleagues, from the nurses right through to specialists. It is a hectic day-to-day environment, but every day is different.”

Bonning began studying medicine straight out of high school.

“I had strong role models in the health system already, including my sister. I wanted a challenge, I enjoyed science, medicine seemed like the right career.”

About 20 years ago, he made the decision to specialise in emergency medicine.

“I sort of meandered around the health system for a while, did some travel, and wasn’t really sure what to specialise in.

“Back then, emergency medicine was something of an emerging field in terms of speciality. I had a desire to work across the breadth of medicine, and this is what drew me to it.”

Intoxicated patients take up valuable ED time

Being at the coalface of the health system as an ED specialist, Bonning was soon a strong advocate for having the legal blood alcohol limit for drivers over 20 changed, as well as changing the way blood alcohol samples were tested. “It frustrated me that the [previous] level was too high, I felt. People weren’t necessarily intoxicated at that level, but they did lose their judgement.”

New Zealand changed its laws in 2014 – lowering the blood alcohol limit from 80mg of alcohol per 100mls of blood to 50mg.

He said medical professionals were overwhelmed with the paperwork that resulted from dealing with intoxicated patients.

“The paperwork the doctors had to sign were all legal documents, on carbon paper, with about 20 different clauses. It was an antiquated system that needed to change.”

Drunk patients also took up valuable time and resources within the health system, he said.

“I absolutely believe in people’s right to have a drink, but it’s about fairness for everyone. If you’re in hospital because of your drinking, even if it’s only you that has been physically injured, you have a problem. You’re also taking time and resources from people who are actually sick.”

Goal of sound public health system and supported ED staff

Rationalising the health system is a goal Bonning hopes to work on during his time as president.

“My goal is about sustainability of a sound public health system. I’m a strong advocate for the Choosing Wisely campaign (choosingwisely.org.nz), and it’s an important conversation we should all be having.”

The campaign aims to promote a culture where “low value and inappropriate clinical interventions” are avoided.

“We need to make sure we aren’t over-diagnosing and over-treating. It’s about making sure people are received the best and most appropriate care, based on evidence, and are not put at risk by having unnecessary tests, treatments and procedures.”

Having just returned from a four-month tour of hospitals’ emergency systems across America, Canada and Europe, Bonning is keen to continue the College’s work around gender and cultural equality and diversity.

“I want good gender equity. Not only in the workforce, but in governance too. Making sure we have women as leaders and in positions of influence is something I will be working towards.”

Attracting and retaining more Māori into the workforce, as well as ensuring culturally safe and appropriate care for Māori patients is another goal.

“I am also very keen to support the broadest range of emergency departments, from the large located in metropolitan and major regional centres to the smaller emergency departments situated in rural areas.”

Mental health is also a passion of his, both for patients and staff.

“Emergency doctors and nurses are on the frontline to the health system, playing a unique role in the provision of safe, high quality acute medical care to everyone in the community.

“Doctors and nurses are also there as shortcomings in the mental health system play out, that’s why we have participated in the independent inquiry into mental health and addiction.”

Staff fatigue and burnout was also on his radar.

“Supporting all who work in emergency departments, especially our Fellows and trainees, advocating for them with District Health Boards, politicians and the public, is a priority for me.”

An honour and a privilege

Bonning said he was proud of New Zealand’s health system and that his tour around America emphasised “how not to do it”.

“You have half the population who are over-insured, and who are getting over-diagnosed and over-treated.

“Then the other half has virtually no medical care. It’s incredibly unequitable.”

Bonning has worked in various roles at the College for the past decade. Currently chair of the New Zealand faculty, he has been a board member since July 2014.

He is also the current chair of the New Zealand Council of Medical Colleges.

Bonning said it was both an honour and a privilege to be elected as president of ACEM.

“I’m really humbled. I’m excited to learn from both sides of the Tasman. As much as we joke about Australia, there is synergy between the countries. ”

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