By Richard Hamilton MBBS, FRACS
NAME : John Andrew Baird HOKIN
Born: 28 November 1936, Died: 29 December 2020
John Hokin was a prominent Adelaide plastic surgeon whose career spanned 50 years. He is remembered for his talent as a surgeon, his generosity as a teacher, and his innovative approach to making plastic surgery more easily available to his patients. In the mid-90s,he pioneered the concept of free-standing day surgeries for plastic surgery in South Australia, saving patients the inconvenience and the cost of an overnight stay in hospital.
John was a country boy born in the small South Australian town of Balaclava 90 km north of Adelaide. He was the eldest of four children. Both his parents were teachers which meant the family moved from country town to country town for several years. He attended Victor Harbour High and then moved on to Adelaide High School.
In 1955 after matriculation John was accepted into the Faculty of Medicine at the University of Adelaide. He had met his future wife Margaret at a school dance the year before. John graduated with the MBBS degree in 1960.
In 1961, John demonstrated early independence eschewing the option of an internship at an Adelaide’s hospital. Instead he headed for Tasmania and the Royal Hobart. Weekend rosters were demanding there – but the experience in surgery was invaluable.
John had a cadetship with the RAAF at university and in return he had to fulfil a four-year commitment after graduation. Seeking further surgical experience, he organised an attachment as Surgical Registrar to the 3 RAAF Hospital at Richmond, west of Sydney where he remained from 1962-65. As well as general surgical duties, he assisted visiting plastic surgeons from Sydney like Mr Rod Chandler and Mr Basil Riley, took part in aero-medical evacuations, and spent time attached to SEATO in Thailand. John felt that the challenge of plastic surgery would suit him and both Sydney surgeons encouraged John to further his surgical training in the United Kingdom with an offer of a consultant position in Sydney on his return.
Taking their advice, John spent 1966-1968 in Edinburgh. He attended the Royal Infirmary of Edinburgh for training in General Surgery and the Bangour General Hospital for specialist training in Plastic Surgery. This was under the guidance of Mr AB Wallace, noted for having developed the rule of nines diagnostic tool for burn injuries and who himself had trained under the eminent Sir Harold Gillies, the “Father of Plastic Surgery”. There he passed his Fellowship of the Royal College of Surgeons of Edinburgh (FRCSE) exam.
Returning to Sydney in 1969, John took up the promised consultancy at the Royal North Shore Hospital, combining it with a private practice on Macquarie Street and operating at the Ryde and Mona Vale Hospitals. He obtained his Fellowship of the Royal Australasian College of Surgeons (FRACS) in 1971.
PRACTICE IN ADELAIDE
After a decade away, John returned to Adelaide in 1971 with Margaret and their three children. Initially there was the offer of a Visiting Medical Officer post at the Repatriation General Hospital. Showing his independence again, he shunned the idea of hanging his shingle up on North Terrace, South Terrace or in North Adelaide where most specialists consulted, and set up a private practice where the patients lived – in the suburbs! He established his practice in Glenelg, becoming the fourth plastic surgeon in Adelaide.
Some years later, John was appointed as the first senior visiting plastic surgeon at the newly established Flinders Medical Centre. He and Gwyn Morgan were joint heads of the unit until this writer joined them in 1980.
Having set up practice in Glenelg, John came to realise that the demography of his patients was mainly elderly people and that there was a great demand for skin cancer surgery. He began to treat them under local anaesthetic as “day surgery” patients in his rooms rather than in hospital, and this became the backbone of his practice. In doing this he established a new trend.
In the mid 1990s John travelled to the United States on behalf of Ashford Hospital to see how Day Surgery was developing there and came back inspired to help Ashford set up the first day surgery unit within a hospital in South Australia. Interestingly at that time Flinders Medical Centre was not convinced that day surgery was an effective use of resources.
The original free-standing day surgery model that John had set up at Glenelg proved not to be financially workable, so John explored the possibility of becoming a fully-licenced Day Surgery. This was made difficult by the fact that SA Health had no power to license day surgeries! John found a solution – he approached the Commonwealth Government and persuaded them to grant him a licence instead. Under this arrangement insured patients would be fully rebated for theatre costs, making day surgery financially viable. At the same time, patients and health funds would be saved the considerable costs of an overnight hospital stay. Of course, it was much more convenient for the patients. Glenelg Day Surgery in the mid 1990s became the first licensed free-standing Day Surgery in South Australia.
By setting up a small operating theatre, staffing it with committed nurses and earning accreditation from the Australian Council on Healthcare Standards, John pioneered free-standing Day Surgeries for plastic surgery in South Australia. Several colleagues soon followed suit including Dr Peter Menz, Dr Randall Sach, Dr James Katsaros and the present writer.
Patients for major reconstructive and aesthetic surgery requiring an overnight stay were treated at Ashford Private Hospital, where from 1985 –1996 John was Board member and Chairman of the Medical Advisory Committee.A man of strong convictions, John was instrumental in the introduction at Ashford of the first hospital “No Smoking” policy in South Australia over energetic opposition from some colleagues.
At Flinders Medical Centre from the early 1980s he collaborated with Dr Elizabeth Cant in breast reconstruction for breast cancer patients, using the Latissimus Dorsi flap and avoiding where possible the use of an implant. Their work was published in the American Plastic and Reconstructive Surgery Journal in the mid-1980s.
Amongst all of this demanding clinical and developmental work, John found time for work with Interplast, the charitable organisation that sends health volunteers to assist in developing countries. He led Interplast teams to Fiji and Papua New Guinea on nine occasions between 1986 and 1994. Assisted by colleague surgeons, anaesthetists, and sometimes by his own theatre nurse, Carol Amos, he operated on patients suffering from the effects of severe injuries and congenital conditions which local doctors had been unable to treat. This surgery was often life-changing for the patients. John also served as honorary secretary of the Plastic Surgery Section of the Royal Australasian College of Surgeons in the 1990s.
John travelled widely on professional study tours to the United States, Europe and the United Kingdom. He also enjoyed travel for pleasure, exploring by campervan or on walking tours the unique landscapes and cultures of many countries, including New Zealand, Czechoslovakia, Poland and especially France, which he greatly loved. He was a lover of fine wines and had vineyard interests in the Clare Valley. He had a wide circle of friends in Australia and overseas.
John retired from private practice at 73 years of age, after a career spanning 50 years. He was always very supportive of colleagues; his plastic surgery had a personal style influenced by his determination to help patients and achieve efficiency. He nurtured junior colleagues and was very generous in providing consulting space to those young plastic surgeons who had just entered the brave world of private practice. Because he was so methodical, he was an excellent teacher to registrars in training and willingly passed on all of his knowledge, wisdom and experience. John Hokin always had a definite and decisive way of doing things and he did them well.
John is survived by his wife of 60 years, Margaret, his daughters Frances and Catherine, and his son Michael.