Medical titan calls it a day after stellar three-decade career

The clinical architect of Townsville University Hospital’s (TUH) modern-day emergency department (ED), who also spearheaded the region’s first aeromedical retrieval service, is calling it a day after more than three decades of delivering emergency care and medical leadership to the region.

Chief medical officer Dr Niall Small, who led the charge to create Queensland’s largest ED after a relentless and passionate public campaign in the 2000s, said he was proud to leave the place ‘a little better’ than he found it.

“The growth has been extraordinary since I arrived in 1997 from the Gold Coast with four mates, who continue to be great friends to this day, giving us the critical mass to create a medical specialist group in emergency,” he said.

“Up to that point there hadn’t been a consistent group of emergency medicine specialists until the four of us went up, so that was really the start of it all.

“Since that time, emergency medicine has gone from strength to strength.”

Dr Small’s medical career began in his native Scotland in 1985 where, as a newly minted graduate of the University of Edinburgh, he started his surgery internship at Wishaw, southeast of Glasgow.

After 12 months, he moved to the Eastern General Hospital in Edinburgh, renowned for its physician training.

“There was a famous physician, Dr Munro, who would come and check our admissions and then mark them the next day with a red pen so that kept us on our toes,” Dr Small said.

After that it was stints in the Royal Infirmary Edinburgh, in the heart of the city, and global travels with Operation Raleigh as the expedition doctor where he ironically ended up in the Torres Strait Islands.

“As it turned out I didn’t have much doctoring to do so I did everything else and after four months flew home for Christmas,” he said.

Dr Small said a couple of epiphanies followed including realising that he wasn’t a good fit for general practice.

“In those days in Scotland, the GP would drive around the town with a pager telling you which house to go to next,” he said.

“I’d been going all day, door to door, when I had a call to see a sick baby.

“I knocked on the door and examined the baby who was smiling happily at me while the growling family Alsatian scratched on the door waiting to be unleased.

“I probably should have kept my mouth shut but I unwisely told the father that he hadn’t really needed to call me as the baby was really very well.

“He hung out the window as I left, unleashed a tirade of expletives, and questioned my medical qualifications in a very colourful way.

“I realised at that moment that general practice probably wasn’t for me.”

At some point during 1989, Dr Small remembered the sun and sand of the Torres Strait and wondered if it might not be a good time to return to Australia.

“I got out the atlas and looked at Queensland and found Cairns,” he said.

“They didn’t have any jobs, so I moved my finger a bit further down the map to Townsville.”

After 18 months in Townsville Dr Small moved back to Edinburgh where he married his Queensland partner, Helen Kanowski.

“We met at the Criterion Hotel, which was a very Townsville thing to do, and after about 12 months in Scotland we went back to the Gold Coast and finally back to Townsville,” Dr Small said.

“We said we’d give it at least a couple of years but we’re still here and loving it.”

And it was in Townsville that his passion for emergency, rural, and retrieval medicine became his legacy - the modern, emergency service of today.

“We pushed hard for clinical coordination to stay local across North Queensland, and I’m proud that our model for consultant-led rapid access retrieval has been picked up around the country,” he said.

“I get great satisfaction from the success of the short-stay model of care in ED as well as the hospital and maintenance in the home programs that some people were dead against, believing that the only safe place to deliver care was in a hospital.

“I am also very proud of the training for emergency medicine specialist trainees and for other clinicians, including a really positive relationship with QAS over many years.”

Current emergency department director Dr Deanne Crosbie described Dr Small as the founder of emergency medicine in Townsville.

“He was appointed ED director in his first year, an almost impossible thing to do, but he flourished and we flourished with him,” she said.

“Niall has not only been a mentor and inspiration; he’s also been a wonderful friend and colleague to many of us in ED.

“His greatest legacy is the culture of cohesiveness and teamwork he fostered that continues today.”

Dr Small said the demands on TUH ED continued to increase.

“Our staff look after everyone regardless of the situation,” he said.

“I get really annoyed when people play down the public health system as somehow second string because it’s a very good system.

“If you’re really sick or have something unusual, you want to be looked after in the public system.”

Chief executive Kieran Keyes said Dr Small's contribution to emergency medicine and medical leadership in the region was unparalleled.

"His contributions have been transformative,” Mr Keyes said.

“The scope and breadth of emergency and medical care provided by this health service would rival any hospital and health service in Australasia.

“Much of that is due to Niall’s vision and leadership.

"He has left a powerful legacy and starts his next chapter with our best wishes and immense thanks.”

Dr Small said he was grateful to the many colleagues and friends at TUH and around the world who helped shaped his career.

But his greatest thanks are reserved for Helen and their children Ewan, a lawyer based in Canberra, Angus, and Annie who followed their parents into health as a doctor and occupational therapist respectively.

“They have always been my greatest supporters and the reason for everything I do,” he said.

Dr Small said he wasn’t sure what the next chapter looked like but didn’t consider himself ‘retired’.

“I’d like to keep my hand in with some advisory and college work but also some travel, including home to Scotland, and more time with Helen, our children, and our lovely dog Daisy.”