Dr Daniel Rankmore

08/09/2026

Before my monthly skin cancer operating list at Gunnedah Hospital, we set aside some time for team teaching. Today’s topic was local anaesthetic systemic toxicity, known as LAST.

Local anaesthetic is used safely every day, but rare complications can occur. Knowing the early warning signs and where to find emergency equipment helps the whole theatre team respond quickly and confidently.

For reassurance, the amounts used in routine skin cancer surgery are usually well below recommended limits. We generally use lignocaine 1% with adrenaline, buffered with sodium bicarbonate to make the injection more comfortable.

A typical skin excision may require only 2–10 mL. For a healthy 70 kg adult, the commonly cited maximum recommended dose is approximately 49 mL, although individual health factors must always be considered and the figure considered a ceiling, not a target.

Good patient care is not only about performing the procedure well. It is also about preparation, teamwork and being ready for the rare occasions when something unexpected happens.

04/09/2026

A very relatable article.

A good GP cares. We care about our patients, their families, their stories, and what happens after they leave the consulting room. But caring takes a toll.

When the system feels not just unsupportive, but increasingly hostile, with chronic underfunding, growing red tape, administrative burden and pressure to see more patients in less time, that kind of medicine becomes difficult to sustain.

Burnout is often framed as a problem of individual resilience. Sometimes the problem is the system people are being asked to remain resilient within.

Worth a read.

‘Patients are not pieces of metal on a conveyor belt’: Dr Elly Goodsall shares why disillusion and a system that undervalues complex care has left her walking away from general practice.

03/09/2026

02/09/2026

At the moment, I’m listening to Stephen King’s The Stand.

We've shared book reviews here before, both medical and professional, as well as the occasional work of fiction. Running and travelling create plenty of opportunities for audiobooks, while reading a physical book still has a way of slowing the mind down and sharpening attention.

Horror is a genre I usually avoid, particularly when it has a dark supernatural element. The Stand certainly leans into that territory, and it rightly deserves its R18+ rating. But dystopian science fiction is a genre I return to often, and The Stand regularly appears in top-10 lists.

The premise is simple and grim: a human-modified influenza virus escapes and wipes out 99.7% of the population. The first part of the novel follows both the initial wave of deaths and the second-order consequences as social structures, services and support systems begin to collapse.

What struck me most was the emotional progression: hopeful naivety, fear, desperation, confusion, grief, and eventually the beginnings of adaptation. The virus spreads through ordinary human behaviour. People flee. People travel for work. People have incidental contact. People care for those they love.

Five years ago, I’m not sure I could have read it.

Working through COVID left its mark on healthcare workers, myself included. Time may not cure everything, but it does create distance. Reading The Stand now, there is something strange and useful about reflecting on those experiences through fiction.

02/09/2026

Rural Generalist Medicine has now been formally recognised as a field of specialty practice within General Practice. Eligible Rural Generalists can apply through Ahpra for recognition as a🕺🏼Specialist Rural Generalist🕺🏼.

A significant milestone recognising the breadth of skills required to deliver comprehensive rural healthcare.

Breaking news! 🎉

Rural Generalist Medicine has been officially recognised as a new field of specialty practice within general practice.

Existing FRACGP-RG award holders can now apply to Ahpra through the portal, following years of advocacy by the RACGP to formally recognise the skills and expertise of Rural Generalists.

This is an important milestone for our members and for rural and remote communities – giving greater recognition to the doctors delivering comprehensive care where it’s needed most.

Think you may be eligible? Find out more about the requirements, application process and RACGP support available: https://bit.ly/4ycT5qL

31/08/2026

Intismeran autogene: a personalised mRNA vaccine for melanoma

You may have heard in the news about a new “melanoma vaccine”.

Intismeran autogene is not a vaccine designed to stop you getting melanoma. It is a personalised cancer treatment designed for people who have already had a high-risk melanoma removed.

A sample of the patient’s melanoma is genetically analysed. A personalised mRNA treatment is then created to teach the immune system to recognise features unique to that person’s cancer. Cool new tech.

In August, a large Phase 3 trial reported that intismeran combined with pembrolizumab (Keytruda) significantly improved recurrence-free survival and reduced distant spread compared with pembrolizumab alone.

Full results are still to be presented, and the treatment remains investigational (read: experimental) while regulators consider approval.

So what does this mean today?

For most of us, melanoma prevention and early detection remain unchanged: protect your skin, know your own skin, perform self-checks, have appropriate professional skin checks, and investigate and manage suspicious lesions according to established guidelines.

31/08/2026

Finished Saturday’s trail run by heading down Tamworth’s brand-new Skywalk. There are definitely a few stairs involved, but also some great views across town and toward the Liverpool Ranges.

The 1.5 km Skywalk links Oxley Scenic Lookout with Victoria Park and Endeavour Drive. The project grew out of community consultation, with the aim of creating a safer walking connection, encouraging exercise and adding another attraction for visitors to Tamworth.

The $18 million project was funded with $14.3 million from the NSW Government’s Regional Tourism Activation Fund and $3.7 million from Tamworth Regional Council.

There was a great community turnout for the opening on Saturday. Good to see a major new piece of local infrastructure that people can actually get out and use.

I’ll also be interested to see the Strava segment records develop for those that enjoy stairs.

16/08/2026

Sunset at the lookout...

09/08/2026

After last week’s post on five people whose work changed human survival, a few names were conspicuously missing.

🧼 Ignaz Semmelweis
Suggested by page follower Angelic Kat. In the 1840s, Semmelweis showed that doctors washing their hands with chlorinated lime dramatically reduced deaths from puerperal fever. His ideas were resisted during his lifetime, but became foundational to modern infection control.

🚰 John Snow
The famous Broad Street pump was one of the stories we studied in population health at university, and it deserves a place here. During London’s 1854 cholera outbreak, Snow mapped cases, traced them to contaminated water and persuaded authorities to remove the pump handle, helping lay the foundations of modern epidemiology.

🔪 Joseph Lister
Building on emerging ideas about germs, Lister introduced antiseptic techniques into surgery. At a time when surviving an operation could still mean dying from infection afterwards, antiseptic surgery helped transform operating theatres from extraordinarily dangerous places into something approaching modern surgery.

💉 Edward Jenner
In 1796, Jenner demonstrated that exposure to cowpox could protect against smallpox, establishing the principle of vaccination. Smallpox would eventually become the first human disease eradicated worldwide.

🦠 Louis Pasteur
Pasteur helped establish the microbial basis of infectious disease and developed vaccines including those for anthrax and rabies. His work helped change medicine from simply treating illness to understanding, preventing and controlling its causes.

None of these discoveries happened in isolation, and putting an exact number on the lives saved is impossible. But modern medicine would look very different without them.

07/08/2026

Who has saved the most lives in human history?

BBC Science Focus recently highlighted five people whose discoveries may have saved hundreds of millions of lives.

💉 Maurice Hilleman
One of the most important scientists most people have never heard of. He developed more than 40 vaccines, including vaccines against measles, mumps, hepatitis A and B, chickenpox and meningitis.

🧫 Alexander Fleming
In 1928, Fleming noticed that mould contaminating a Petri dish was killing bacteria. That observation led to penicillin, although Howard Florey, Ernst Chain and their team were crucial in turning it into a practical medicine.

💙 Frederick Banting
Before insulin, type 1 diabetes was usually fatal. Banting and his colleagues helped develop insulin into an effective treatment, transforming the outlook for millions of people.

🌾 Norman Borlaug
Not a doctor, but arguably one of history’s greatest lifesavers. His high-yield, disease-resistant wheat helped drive the Green Revolution and dramatically increased food production across the world.

🩸 Karl Landsteiner
Landsteiner discovered the major human blood groups, helping explain why some transfusions worked while others caused deadly reactions. His work laid the foundations for modern blood transfusion and major surgery.

The exact number of lives saved by each person is impossible to calculate, and none worked completely alone. But their impact is staggering.

Not all heroes wear capes. Some wear white coats.