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WESTERN AUSTRALIA
Journal of the Australian Medical Association WA | March 2015 Volume 55 / Issue 2 | amawa.com.au
THIS IS
THE NEW
LEXUS
THIS IS HEART RACING
What’s the measure of a luxury performance car?
The Revs Per Minute or Beats Per Minute?
Newton Metres of torque or the tingle of adrenalin?
The design of the air intake or the short, sharp breaths you take?
The all-new Lexus RC coupe. This is heart racing.
This is now available at Lexus of Perth.
359 Scarborough Beach Road, Osborne Park WA 6017
enquiries @ lexusofperth.com.au www.lexusofperth.com.au
After Hours: Morgan Haase 0419 959 658
DL18807
Phone 9340 9000
Council
President
Dr Michael Gannon
Immediate Past President
Dr Richard Choong
Vice Presidents
Dr Andrew Miller
Dr Omar Khorshid
Honorary Secretary
Dr Janice Bell
Assistant Honorary Secretary
Dr Marcus Tan
Honorary Treasurer
Professor Bernard Pearn-Rowe
Councillors
Division of General Practice (WA)
Dr Steve Wilson
A/Prof Rosanna Capolingua
Division of Specialty Practice
Dr Tony Ryan
Dr Alexandra Welborn
Division of Salaried and State
Government Service
Dr Mark Duncan-Smith
Prof Geoff Dobb
Ordinary Members
Dr Daniel Heredia
Dr Stuart Salfinger
Dr Marcus Tan
Co-opted Members
Dr Steve Wilson
Dr Frank Jones
A/Prof Peter Maguire
Dr John Zorbas
Dr Chris Wilson
Dr Ian Jenkins
Prof John Newnham
Prof Shirley Bowen
Dr Sandra Hirowatari
Mr Kiran Narula
Ms Kate Nuthall
AMA (WA) Office
Executive Director
Mr Paul Boyatzis
Director: Industrial & Legal
Ms Marcia Kuhne
Executive Officers
Mr Michael Prendergast
Ms Christine Kane
Ms Josphine Auerbach
Mr Simon Bibby
14 Stirling Highway
Nedlands WA 6009
(08) 9273 3000
[email protected]
www.amawa.com.au
March 2015
22
44
Cover Story:
When Chronic Pain Strikes!
Flying with the Eagles
Dr John Suthers
16
20
AMA (WA) Intern Cocktail Function
FEATURES
16
Staying the course
Surgical and medical skills lab CTEC
celebrates 15 years of operation
18
Young Australians let down
by ageing system
Senator for WA, Linda Reynolds
speaks her mind
Medicus
031015-70
Editor and Director of
Communications
Mr Robert Reid
Deputy Editor
Ms Janine Martin
Advertising Inquiries
Phone Mr Des Michael (08) 9273 3056
Copy Submissions
Phone Ms Janine Martin (08) 9273 3009
or [email protected]
REGULARS
22 C
over Story: When
Chronic Pain Strikes!
52 Opinion
03 Politics
58 AMA in the Media
02 President’s Desk
56 Dr YES
05 From the Editor
34 Opinion
Services
06 Industrial
61 Drive
Business Services Manager
Ms Noelle Jones
Financial Services Manager
Mr John Gerrard
Medical Products Manager
Mr Anthony Boyatzis
Health Training
Australia Manager
Mr Geoff Jones
08 Immunisation
37 Feature: Last Orders,
Please!
38 For the Record:
Dr Joe Pracilio
65 Food
The publication of an advertisement,
article or inclusion of an insert does not
imply endorsement by the AMA (WA) of
the views, service or product in question,
and neither the AMA (WA) nor its agents
will have any liability for any information
contained therein.
09 News
16 F
eature: CTEC
celebrates 15 years
of operation
40 Research
44 Profile: Dr John Suthers
62 Travel
67 Wine
68 M
ember Benefits &
On the Town
18 F
eature: Young
Australians let down
by ageing system.
46 Opinion
48 A
MA (WA) Award
Nominations
71 Classifieds
Professional Appointments
& Positions Vacant
20 A
fter Hours: AMA
(WA) Intern Function
49 Opinion
75 Greensheet
51 Protecting Wealth
March
ME D I C US 1
PR E SIDE N T ’S DE SK
PATS – support our regional
GP colleagues and their patients
I
Dr Michael Gannon
AMA (WA) President
recently gave evidence to a
Legislative Council Standing
Committee reviewing the functions
of the Patient Assisted Travel Scheme
(PATS). The AMA (WA) has a
significant interest in the function of
this system, representing as we do not
only General Practitioners in rural and
regional areas, but specialists in larger
towns and the metropolitan area. PATS
is an important part of a system which
tries to give Australians living in rural
and regional areas the access to health
services that are perhaps taken for
granted by their city cousins.
AMA members were given the
opportunity to inform the submission
to the Parliamentary Committee and
amongst other things complained about
the paperwork burden. The Committee
is looking at ways of streamlining the
red tape which is another part of the
everyday burden taking GPs away from
direct patient care.
My evidence represented an
opportunity to discuss consequences of
the massive reconfiguration of Perth’s
hospital system. The two largest hospitals
in our health network, Sir Charles
Gairdner Hospital and Fiona Stanley
Hospital lie in areas where there is a dearth
of affordable accommodation options.
The PATS accommodation payments are
increasingly out of step with the cost of
motel stays in these areas.
One of the failings of the Reid Report
which recommended the closure of
Royal Perth Hospital was the failure
to recognise the benefits of retaining a
major teaching hospital in the city. Perth
is also a public transport hub that serves
all five railway lines. The same cannot be
said of leafy Nedlands.
While the vision of building our newest
teaching hospital on a greenfield site south
of the river might be applauded, and the
proximity to institutions like Murdoch
University and St John of God Murdoch
Hospital prove to be advantageous in
the future, the fact is that there is little
2 M ED I CU S March
infrastructure in the area for staff and for
patients visiting the hospital.
Jewell House used to be a source of
accommodation for patients travelling
from country areas to Royal Perth
Hospital for care. It has been deemed
unsafe and closed. In the absence of
other accommodation options, it has
become a not uncommon sight for
Aboriginal patients and their families
to sleep rough in Wellington Square
and Weld Square. This is an entirely
unacceptable solution for healthy people
in our community, let alone those who
might be travelling for review of chronic
renal conditions.
There was significant publicity about
the evidence I gave in regard to dental
care. The Committee needed to be
brought to a greater understanding of the
difference between specialist and subspecialist care.
Other issues were raised, including the
dislocation suffered by women moving
to Perth to deliver their babies. While
there are safety issues in keeping small
maternity units that have no or limited
Caesarean Section capability open, the
two weeks accommodation allowance
paid to expectant mothers means that
there is increased pressure to perform
induction of labour when it might better
be deferred. It means that too many
babies are born before arrival, sometimes
increasing perinatal morbidity.
I gave evidence about the importance
of multidisciplinary teams in healthcare.
It is not enough that a General Surgeon
might visit a country town. The
involvement of dietitians, nurses or
counsellors are a key part of Bariatric
Surgery success. The PATS system must
maintain the flexibility to listen to patients
and their doctors. It must retain humanity
in its flexibility, not forcing Narrogin
patients with relatives in Perth to go to
Bunbury because it is 5 km closer.
Opportunities for incentivising
specialists to visit rural areas to provide
telehealth consultations and to improve
The two largest
hospitals in our health
network, Sir Charles
Gairdner Hospital and Fiona
Stanley Hospital, lie in areas
where there is a dearth of
affordable accommodation
options
the working conditions for specialists
who work in medium-sized regional
towns were also discussed at some length.
A better-funded PATS will add to the
value seen in alternative initiatives to get
doctor to patient, not vice versa.
The Health Minister, Dr Kim Hames,
points to the substantive increase in
funding that the PATS Scheme in
Western Australia has received since
the election of the Barnett Government.
He states that it compares favourably
with schemes in other parts of Australia.
This does not obviate the need for the
AMA to give robust representations
to Parliamentarians about the way the
health system can be improved.
The geography of WA is vast. I have
previously told friends or colleagues from
overseas about an imaginary land mass
much bigger than Germany, France,
Italy, the Benelux countries and the
Iberian Peninsula put together, with 80
per cent of its population living in a city
about where Lisbon is.
The people who live in the metropolitan
area benefit from the vast wealth of
our State with our natural resources of
gold, diamonds, gas and haematite iron.
Previous generations benefited from the
wealth generated from the sheep’s back.
There is consistent evidence showing
poorer health outcomes for our country
cousins in areas such as five-year survival
from cancer and heart failure. We must do
everything we can to support our regional
GP colleagues and their patients. ■
P OL I T IC S
IN DEFENCE OF HEALTHWAY
Throw out the bathwater if you want Premier, but don’t risk the baby
T
Dr Rosanna Capolingua
Chair - WA Health Promotion Foundation (Healthway) 2009 -2015
he recent events concerning the
so-called “ticket scandal” has
featured a regrettable deluge of
bad press reflecting adversely not only
on individuals associated with Healthway
(particularly myself, as its Chair) but also
upon the Foundation itself.
As an individual adversely affected
by this press, I have my own remedies
(which I intend to vigorously pursue)
under the Defamation Act 2005 against
media reports that have inaccurately and
unfairly defamed my reputation.
But what of Healthway? This is a vital
question and I urge you to express your
support for the Foundation whose role
in Western Australian society is vital.
Healthway was established under
the Tobacco Control Act 1991 (now the
Tobacco Products Control Act 2006)
as a Foundation independent of
Government. The Act enshrines its
functions in section 64:
(a) t o fund activities related to the
promotion of good health in
general with particular emphasis
on young people;
(b) to support sporting and arts
activities which encourage healthy
lifestyles and advance health
promotion programs;
(c) to provide grants to organisations
engaged in health promotion
programs;
(d) to fund research relevant to health
promotion.
Healthway sponsorship messages
“Smarter than Smoking”, “Make
Smoking History” and “SunSmart” are
well known in our community.
Healthway is now critically poised,
implementing its five-year strategic plan
with a focus on the contemporary public
health challenges of alcohol and obesity.
“Alcohol. Think Again” and “Live
Lighter” are now well-known messages.
This strategic direction implemented
by the Board sought greater accountability
in health value return for taxpayer
dollars. The obvious impacts within
our community of the obesity epidemic
and excessive alcohol consumption
(particularly in young people) have led
to our focus on alcohol and junk food
promotion in sport and the arts.
This direction is founded on clear
evidence that marketing and promotion
of these products (just as it had been
with smoking) using sport and the arts
have a significant positive effect on
market, sales, consumption, culture
and behaviour. Research in the WA
community clearly showed that Western
Australians (particularly families) are
worried about the influence of these
industries on sports. Too often young
people are influenced by the conduct
(and misconduct) of role models in all of
the sporting codes.
No campaign succeeds instantly.
The culture of obsession with alcohol
is one that has to some degree become
entrenched with sport and celebration.
The focus of Healthway is to encourage
sporting bodies to move away from
the lucrative relationship they would
otherwise enjoy with alcohol and junk
food sponsors.
Let’s take Healthway’s successful
partnership with the WACA. In 2012
there were direct approaches from the
Premier to the Health Minister to ask
what Healthway was doing when it
fell out of a sponsorship relationship
with the WACA for 12 months. This
occurred when the WACA was not
able to meet the Healthway criteria
concerning alcohol advertising and
promotion through cricket.
In 2013, Healthway entered into
its now brilliant partnership with the
WACA, promoting “Alcohol. Think
Again”. You may recall the days
when the WACA had to erect “nets”
to contain drunken behaviour on the
ground. Those days are over and the
WACA has welcomed the return of
families. Congratulations to the WACA
and all other sports that have stepped
up and shouldered the responsibility of
changing community attitudes. This
includes the Perth Wildcats, Perth
Glory, Perth Heat, Netball WA, Hockey
WA, Surfing WA and more. Healthway’s
new partnership with Rugby WA sees
the Western Force and Rugby Union
move away from previous sponsors
towards a health-oriented sponsorship.
Healthway has also achieved the
fantastic result of being listed for its health
promotion research project grants on the
Australian Competitive Grants Register
(ACGR). This is run by the Federal
Department of Education and as a result
of the Healthway listing, universities in
WA that are awarded Healthway health
promotion research grants are eligible to
receive infrastructure income for these
grants from the Australian Government
Research Block Grant Scheme and the
WA Medical Research Infrastructure
Fund.
Healthway is an essential Foundation
that contributes enormously to the
health of our State. The challenges to
health – and in particular the health
of our children – remain ever present.
This Foundation must be preserved –
its independence cherished, its values
acknowledged and its achievements
recognised.
The issues that confronted Healthway
over the “ticket scandal” are matters
which have been already resolved. I was
confident at the time of my resignation
as Chair that the circumstances
responsible for this, the way in which
Board oversight was deliberately evaded
and governance policies insisted on
by the Board not implemented – have
been addressed by Healthway and it
continues to fulfil its statutory function
and purpose.
I urge you to stand up for Healthway
– it must remain independent, funded
and continue to function for the good
of the State. ■
March
ME D I C US 3
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Lumbar Epidural Injection
Injection under CT guidance
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Facet Joint Injection
Nerve Root Sleeve Injection
Perth Radiological Clinic provides a comprehensive image-guided spinal
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10 reasons to send your patients to us.
1. Training – interventional fellowship trained radiologists
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2. Experience – very experienced doctors with an
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3. Assurance – electronic online storage of results that allows
for the review of ALL relevant previous imaging to ensure
that we do the correct procedure at the correct level and
relevant to the patients’ symptoms.
4. Convenience – we offer spinal injections at the majority of
our hospital and community locations across Perth resulting
in shorter wait times for appointments.
8. Feedback – all patients are given a pain self-assessment
tool after their procedure so feedback can be provided to
their referring practitioner.
9. Supervision – all patients are closely supervised during and
after their procedure. Strict protocols are adhered to in the
unlikely event of a reaction.
10. Guidance – doctors will offer guidance about the
appropriateness of referral for injection, following
imaging findings.
Easy access at multiple sites means
shorter wait times for your patients...
5. Patient comfort – injection under CT guidance minimises
the length of the procedure and potential discomfort to
the patient.
6. Safety – low dose CT is used for all injections ensuring the
lowest possible dose of radiation to the patient.
7. Team approach – communication between the doctors
and experienced technical staff to ensure the accuracy of
injection site.
www.perthradclinic.com.au
Leaders in Medical Imaging
FFROM
ROM TTHE
HE EEDIDITTOR
OR
Fighting for positive change
T
he Australian Medical
Association (WA) represents the
health community of our state.
Every month we fight for positive
change in the health arena. Sometimes
we have to fight to stop reversers – those
people and those organisations who
want to turn back the clock. Reversers
believe that it would be okay for
tobacco companies to begin advertising
their product again. That it would be
acceptable to have tobacco companies
once again standing in shopping centres
handing out single cigarettes on the basis
that they are a legal product.
Every month the AMA argues its view
on a huge range of subjects.
This month alone for example, the
Association has commented on issues
ranging from the continuing worrying
growth in teenage substance abuse and
the nationwide hepatitis outbreak caused
by contaminated frozen berries.
The AMA has also been closely
involved in other key subjects over the
past month across a wide range of media
outlets – such as moves by a national
pharmacy group beginning a discount
war for flu injections.
According to the Association, these
moves would drag vaccinations from
being medical procedures into the same
aisles as toilet paper and cheap and
generally useless vitamins.
Even the debate about smacking or
not smacking your children involved the
views of the AMA.
In other public advocacy, AMA (WA)
President Dr Michael Gannon presented
to the Legislative Council Committee
investigating WA’s Patient Assisted Travel
Scheme, and argued that major changes
are needed to fully meet the expectations
and health needs of patients.
Dr Gannon told the Committee that
the travel subsidies were inadequate,
the scheme lacked flexibility and that
medical advice and decisions were being
taken by bureaucrats.
As Dr Gannon said before the
Parliamentary Committee: “It (PATS)
needs to be reformed and it needs
to be tidied up. We need to increase
the amount of money that is paid to
individual patients so it is a more realistic
payment towards the ever-increasing
price of accommodation and transport.”
In a press release later in the day, the
AMA congratulated the Committee
for its review of the scheme, said it was
looking forward to the Committee’s report
and putting the State Government and
Minister on notice that the AMA would
continue to push for positive changes.
But the biggest health issue over
the past month has been about an
organisation that is almost a quarter of a
century old and has in our view, served
the Western Australian population well
for that time.
Healthway has been a lighthouse for
health advocates since its formation
– offering a sweeping light on the hill
for other states and nations to replicate
– using funds to take over sponsorship
which would otherwise go to fast food
or alcohol companies and to remove
advertising from impacting on families
on young people.
So successful has Healthway been that
it has maintained and even increased its
role over that quarter century through
a variety of governments of both major
political parties.
While it is generally accepted that
the Healthway Board has not always
been a happy collection of like-minded
individuals, it has still successfully
delivered a number of positive public
health messages.
It has also managed to maintain its
strong independent role. In other words
it has always remained steadfast against
political pressures. When money is
provided to groups through an extensive
process, politicians have not been
presenting the cheques themselves.
Despite some pressure on Healthway
in the past, its funding has never been
used as party political tool.
Perhaps therefore it is not unusual that
Healthway’s very independence has been
one of the issues that has caused some to
try and influence the public regard for
the organisation.
The AMA has been clear in its
stance on this matter. While there
have been governance issues that
While it is generally
accepted that the
Healthway Board
has not always been a
happy collection of likeminded individuals, it has
still successfully delivered
a number of positive public
health messages
need to be examined and the Board
selection process needs to be altered,
there remains a need for a strong and
INDEPENDENT body to do what
Healthway has always done.
With the introduction of the bill
into the WA Parliament that included
the establishment of the WA Health
Promotion Foundation (now Healthway)
the then Health Minister, Keith Wilson
said: “The foundation will not be a
Government lapdog.”
He went on: “I believe this Bill will
do more to benefit the community than
any other single measure to have been
implemented in recent years,” and: “It
is of overwhelming importance to the
community.”
As an inaugural member, the
AMA has taken a strong interest in
the activities of the Foundation, and
consequently Healthway. It has not
always been smooth sailing and there
have been, throughout its quarter
century, some questionable decisions.
But the health of West Australians
has always been its principal aim and
its independence from government
interference has always been part of
its success. To change or remove this
independence, enshrined in legislation,
would not just shackle Healthway but
would enslave it. Whatever is decided
about Healthway’s future, it should be
on the back of Parliamentary change.
Emasculating a body established by
Parliament should only be made by
Parliament itself after full and extensive
debate – and not by government fiat. ■
March
ME D I C US 5
INDUS T R I A L
SNAPSHOTS
Closure of Swan District Hospital - opening of Midland Public Hospital
NEGOTIATIONS ARE CONTINUING with St John of
God Health Care (SJG) and the Department of Health
(DOH) concerning transition issues.
Key issues being discussed are firstly, entitlements of
doctors moving to Midland Public Hospital (MPH) prior
to the closure of Swan District Hospital (SDH). To avoid
the possibility that individual practitioners miss out on
a separation payment, negotiated last year pursuant to
the Special Transition Entitlements Agreement, the AMA
(WA) has proposed to both DOH and SJG that doctors
transferring early should be seconded to MPH by SDH until
the date of closure of SDH. Secondment would overcome
the need for early resignation. The notion of secondment has
been agreed in principle, but confirmation in writing has not
yet been received.
Secondly, the AMA argues doctors are entitled under
recent amendments to the Fair Work Act 2009 to have their
service transferred for purposes of professional development
leave (PDL), including overseas PDL. This would enable
doctors transferring to MPH to have access to PDL accrued
at SDH or within WA Health. SJG acknowledges this to be
the case and is holding discussions with WA Health.
Other issues concern protection of SPA account moneys
for professional development leave, securing full-time
equivalent (FTE) numbers at MPH and discussing Visiting
Medical Practitioners (VMP) arrangements.
The AMA will continue to monitor these issues and
discuss with DOH and SJG.
In addition, the AMA is preparing a draft new enterprise
agreement to apply at MPH after the expiry of the
Department of Health Medical Practitioners (Metropolitan
Health Services) AMA Industrial Agreement 2013 (the MHS
Agreement) upon which the Copied State Agreement is
based. The Copied State Agreement applies to all medical
practitioners who were employed by SDH at the date of
hospital closure who transfer to MPH. One meeting has
been held with a sub-committee of members at SDH and
further meetings will be scheduled as necessary. ■
Reconfiguration of SMHS
THE AMA CONTINUES to raise issues with Fiona
Stanley Hospital (FSH) and Royal Perth Hospital (RPH)
related to reconfiguration and the proposed job planning
policy. On this issue, both hospitals have agreed to make
amendments sought by the AMA to ensure there are no
breaches of the MHS Agreement.
The reconfiguration of South Metropolitan Health Service
(SMHS) is a standing item for the AMA, and will continue
to be a focus of attention as issues continue to surface. We
encourage members to raise issues with the AMA (WA)
industrial relations team. ■
Fiona Stanley Hospital: Agreeing to amendments.
Pic: Douglas Black
Carer’s Leave
THE AMA IS confident it will reach agreement with DOH
to ensure that carer’s leave includes both care and support of
an immediate family member of an employee.
This matter was sparked by the denial of carer’s leave to
a medical practitioner when she applied to extend a period
of annual leave overseas (as carer’s leave) due to her father’s
sudden hospitalisation, subsequent transfer to hospice for
palliative care and finally his death.
The AMA put its position to the DOH based on the
Minimum Conditions of Employment Act 1993 whereby carer’s
6 M ED I CU S March
leave is not confined to situations where the employee assists
in providing direct care to the member of their immediate
family or household, but also to situations where the employee
provides support.
It has now been acknowledged by the DOH that carer’s
leave, which forms part of personal leave, can be accessed
in situations where a family member of the employee is in
hospital, the employee is not providing “direct” or nursing
care, but providing support to the family member. The AMA
is awaiting confirmation in writing by DOH. ■
Q:Who
sets
the standard
in winning
cases for its
members?
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IMMUNIS AT ION
LONGER POST VAX SURVEILLANCE REQUIRED;
NO JAB NO REBATE…...
ALL THE LATEST UPDATES ON IMMUNISATION
6
Minutes newsletter recently reported the need for an
increased awareness amongst parents and doctors that
the onset of anaphylaxis can occur more than half an
hour after immunisation. A Victorian study conducted by
Immunologists and Paediatricians has countered current
medical practice guidelines that recommend the observation
of patients for at least 15 minutes post immunisation. The
study has found that this could lead to missed episodes of
anaphylaxis.
The six-year study, entitled Paediatric anaphylactic adverse
events following immunisation in Victoria, Australia from 2007
to 2013 (Daryl R Cheng, Kirsten P Perrett, Sharon Choo,
Margie Danchin, Jim P Buttery, Nigel W. Crawford), of all
suspected and reported paediatric anaphylaxis as an adverse
event following immunisation in Victoria, shows that one
quarter of cases are likely to develop more than 30 minutes
after immunisation. The researchers suggest that doctors
provide a specialised assessment for their patients who have
had a previous anaphylactic reaction and this assessment
should include a discussion around the risks and benefits of
immunisation.
NO JAB NO REBATE
The Australian Productivity Commission has publicly
advocated for legislative change that would see parents who
refuse to have their children vaccinated stripped of childcare
payments unless their childcare is restricted to within the
family home. The Commission’s report on childcare has
stated that Australian parents’ access to childcare rebates
“must be conditional on the child being fully immunised,
unless care occurs in the child’s home”.
As with his predecessors and previous Prime Ministers,
current Social Services Minister, Scott Morrison,
has expressed a willingness to consider
toughening up protections that
are already in place. Leader of the
Opposition, Bill Shorten, has gone
further in backing the Productivity
Commission’s call for legislative action.
The situation that exists today,
whereby ‘vaccine refuser’ parents can
claim the so-called ‘vaccination bonus’
without immunising their children is
out of step with research showing the
importance of achieving herd immunity
(achieved only when 95 per cent of
the population is vaccinated). The
NSW Sunday Telegraph which played
a major role in the NSW ‘No Jab No
8 M ED I CU S March
Play’ campaign has urged the Federal Government to accept
the Productivity Commission’s recommendations. The ‘No
Jab No Play’ campaign resulted in State legislation being
amended to require parents enrolling children in childcare to
have their child vaccinated or to hold an authorised exemption
certificate. The Sunday Telegraph has reported that this small
but significant change has resulted in a marked increase in
child vaccination rates in NSW. The AMA (WA) has strongly
lobbied the State Government to implement similar legislative
change in WA.
PREGNANCY & VACCINATION
AMA (WA) President, Dr Michael Gannon, has recently
fronted a video on antenatal immunisation for WA Health’s
Communicable Disease Control Directorate. The aim of the
video is to educate pregnant women about the importance of
antenatal immunisation. In the video, Dr Gannon stresses
that pregnant women are very vulnerable to influenza during
this period due to their lowered immunity during pregnancy.
They are at greater risk from influenza than other healthy
adults.
The benefits of receiving the influenza vaccine during
pregnancy are not only for the mother, but also to her baby
for the first six months of life when the baby is too young to
receive the vaccine themselves. The influenza vaccination is
safe to be given at any stage of pregnancy. Newborn babies
are also at greater risk from influenza.
IMPORTANT INFORMATION ABOUT THE 2015
SEASONAL INFLUENZA VACCINE
The Department of Health has advised that the National
Seasonal Influenza Immunisation Program for 2015 will not
commence on the usual start date of 15 March.
Continued on page 9
NE W S
WA’S LEADING MEDICAL
RESEARCH ON SHOW AT
SCIENCE ON THE SWAN
HOT TOPICS SUCH as the influence of maternal nutrition
before and during pregnancy on a child’s development of
conditions including obesity, type II diabetes, autism and
attention deficit disorder will be canvassed at a high-profile
gathering of some of the world’s finest medical science and
health research minds in Perth this April.
Local and international experts will come together at Science
on the Swan, the first in a series of conferences organised by all
five of Western Australia’s major universities – The University
of Western Australia, Curtin University, Murdoch University,
Edith Cowan University and The University of Notre Dame – in
partnership with the Telethon Kids Institute, the Harry Perkins
Institute of Medical Research and the WA Government through
the Department of Health and the Office of Science.
The conference will focus on ‘Hot Topics in Life Course
and Development’ and will discuss the influences of prepregnancy, pregnancy and immediate post-natal periods
on later life health and disease. Subjects will include the
developing brain, especially in relation to attention deficit
disorders, autism and early school performance, and the
connection between diet, development of the blood system in
babies and young children and the likelihood of developing
high blood pressure, heart disease and stroke later in life.
Other subjects will include how and why metabolic disease,
diabetes and obesity develop and how the factors which
influence them may be controlled and how to make and
keep healthy blood vessels. Presentations will tackle how the
bacteria which inhabit our bodies (the microbiome) can alter
development and influence diseases like asthma and diabetes;
and how a mother’s microbiome may influence whether a
baby develops certain diseases or is born too early. Experts
will explore ways to alter good and bad bacteria to potentially
prevent preterm birth and improve a baby’s post-natal health.
Conference Co-Chair Professor John Challis, Pro ViceChancellor (Health and Medical Research) at UWA, said
Science on the Swan was a unique opportunity to bring
together WA’s top medical and health researchers and their
national and international research partners.
“These links benefit not just the researchers, government and
industry, but the wider community as we work towards solving
major 21st century health issues,” Professor Challis said.
“Our development as human beings, our ability to learn as
children, and our pre-disposition to disease in later life, are
all influenced by the environment to which we were exposed
as babies inside the uterus and during life immediately
after birth. This conference will explore some of these
relationships.”
The conference will run annually, focusing on different
areas of research in subsequent years. The inaugural
conference, which is open to academics, students and the
public, will run at the Perth Convention and Exhibition
Centre from 21-23 April this year.
To learn more about the speakers, view the conference
program and book, visit www.scienceontheswan.com.au ■
Continued from page 8
LONGER POST VAX SURVEILLANCE REQUIRED;
NO JAB NO REBATE…
ALL THE LATEST UPDATES ON IMMUNISATION
A federal department of health spokesperson has advised the
program has now been further delayed to 20 April. The
main reason for the delay is that the 2015 southern
hemisphere seasonal influenza vaccine will contain three
seasonal influenza strains, with two strain changes from
the 2014 vaccine.
This double-strain change, which is an unusual
occurrence, has caused manufacturing delays. A decision
has been made to delay the program until sufficient supplies
of influenza vaccine are available from at least two suppliers
in order to mitigate the risk of administration of bioCSL’s
Fluvax to children under five years of age. The delay will not
affect vaccine supply volumes, and no vaccine shortages are
anticipated.
The trivalent influenza vaccine components for the
Australian 2015 influenza season will contain the following:
• A (H1N1): an A/California/7/2009 (H1N1) – like virus,
15 µg HA per dose.
•A
(H3N2): an A/Switzerland/9715293/2013 (H3N2)
– like virus 15 µg HA per dose.
•B
: a B/Phuket/3073/2013 – like virus, 15 µg HA per dose.
When available, further information will be placed
on the Immunise Australia website,
www.immunise.health.gov.au. ■
March
ME D I C US 9
NE W S
Genomic Sequencing reveals new
treatment options for pancreatic cancer
AN INTERNATIONAL PROJECT assisted by researchers
from The University of Western Australia has offered new
hope to patients with pancreatic cancer.
While many advances have been made in other types of
cancer, pancreatic cancer remains largely incurable, with
survival rates less than five per cent five years after diagnosis.
The Australian Pancreatic Genome Initiative (APGI),
funded by the NHMRC and led by a team at the Garvan
Institute and Kinghorn Cancer Centre in Sydney, has led an
international program aimed at changing this.
Dr Nicola Waddell, of the Queensland Centre for Medical
Genomics at The University of Queensland, led the latest step
in the initiative, a study which examined the variations in the
genome present in 100 pancreatic adenocarcinomas – the type
most frequently diagnosed.
The research allowed those cancers to be further divided
into four categories, one of which demonstrated high amounts
of genomic instability – a trait which ironically may also
render them susceptible to treatments which work through
DNA repair mechanisms.
Several of the cancers were also found to have mutations
amenable to treatment with drugs used for other cancers, and
not at present for pancreatic cancer. In addition, two novel
gene mutations were observed which may offer leads for new
approaches to treatment.
Adjunct Associate Professor Nikolajs Zeps, of UWA’s
School of Surgery and St John of God Subiaco Hospital,
oversaw the collection of pancreatic cancer samples from
patients diagnosed in WA. He said the paper was a great
example of the benefits of strong collaborations within WA
and with colleagues nationally.
“This project depends upon getting access to high quality
specimens that are ethically obtained,” Dr Zeps said.
“Working closely with our colleagues in surgery, pathology
and medical
oncology, we have
not only supported
this project but
have established
pathways that will
benefit people
who suffer from
other cancers. This
kind of teamwork
exemplifies the way
cancer research is
now done.
“The work of
Nicola Waddell and her colleagues is particularly important
because it has for the first time revealed clear markers that
will be useful in selecting
more appropriate therapies for
patients with pancreatic cancer.
The next steps will be to
use these genetic signatures
as the basis for new clinical
trials aimed at alleviating the
suffering from this cancer.”
He said the study was a
good illustration of the power
of biobanks linked to genomic
sequencing.
Adjunct Associate Professor
“Further investment in these
Nikolajs Zeps
activities in WA will enable us to
continue making similar exciting advances in the future.”
The paper, Whole Genome Sequencing Redefines the
Mutational Landscape of Pancreatic Cancer, was published in
the international weekly journal of science, Nature. ■
The AMA (WA) welcomes the new members who joined during February 2014.
Joel Adams
Emmanuel Awogun
Julie Bourne
Adrian Brooks
Matthew Brown
Arjun Chandran
Jan Ho
Wayne Hoskins
Nadine Hughes
Vicki-Lee Jefferson
Surabhi Khosla
10 M E D I CU S March
Michal Levitt
Alicia Lim
Angela Lumsden
Kim Maher
Balqis Mansor
Chhaya Mehrotra
Dennis Millard
Claire Mitchell
Vijaya Mohan
Tatenda Mukwena
Chien Young Ng
Ho Ng
Sindhura Nirmalarajan
Aine O'Brien
Peter Oyewopo
Glenn Parham
Jasmine Pradhan
Brooke Rule
Paul Sander
Abhey Singh
Philip Singh
Karrthik Srigandan
Tanya Suthers
Aliceba Swao
Courtney Taylor
Christopher Toh
Jolandi Van Heerden
Shanek Wickramasinghe
Sze Ling Wong
Patricia Wong
Deepti Yagnik
Melanie Yeoh
Florian Zepf
NE W S
Neuroscientist shares promising new
research for spinal cord regeneration
IN AUSTRALIA, MANY victims of spinal cord injury
are young men whose lives are changed in an instant, and
Western Australia – with its love of cars, sport and the great
outdoors – has twice as many cases as other Australian states.
Neuroscientist Professor Giles Plant, whose research
on spinal cord regeneration at The University of Western
Australia led to him setting up a Stanford University research
centre, is back in town to share with fellow researchers
exciting developments being pursued at his US centre. The
novel techniques being tested have the potential to improve
outcomes for wheelchair-bound victims of spinal cord injury.
Dr Giles Plant, who completed a PhD at UWA, is Director
of the Stanford Partnership for Spinal Cord Injury and
Repair. He said being offered the challenge of establishing the
centre in 2010 was both an accolade for the work he had been
doing at UWA and an opportunity to join what is arguably the
best neuroscience faculty in the US.
While spinal cord regeneration remains elusive, Dr Plant said
there had been huge advances since he began his PhD research
at UWA. One of the most exciting lines of research his centre
was pursuing involved new techniques using adult stem cells.
“At our centre we are using neural stem cells to improve
functional movement, and because there is the potential to
use the patient’s own stem cells we avoid the ethical issues
around embryonic stem cells,” Dr Plant said.
“In our model we are able to get neurons transplanted into
the spinal cord to synapse and form electrical connections
with other neurons to achieve functional movement. We are
able to see the stem cells integrating and providing regrowth,
and we’re able to see functional benefits in movement in
animals used in testing. We’ve never seen this before, so it is
really promising – but we are at an early stage and it is slow,
methodical work.
“What is promising is there are techniques now being
studied that will allow us to get better outcomes for those with
spinal injuries. At present this particular line of research is
only being done in Stanford – that’s why I’ve come to Perth to
tell my colleagues about it.
“I’m here to open a door and to ask, why not try this?”
Dr Plant returned to Perth briefly to deliver lectures in the
Raine Visiting Professor Lecture Series, supported by the
Raine Medical Research Foundation. ■
AMA (WA) 2015
Elections - get involved!
Healthcare is yet again under the budgetary
WESTERN AUSTRALIA
microscope. Primary healthcare is under
pressure with General Practice patient rebates frozen until
2018. The new Federal Minister for Health, Sussan Ley, has
stated that she wants to consult with the profession and
your AMA representatives have been lobbying hard with the
government to reconsider its plans. The government has now
dumped its flawed Co-payment model, but health funding
and General Practice in particular are still facing serious
cuts. The Australian Medical Association (WA) members
are therefore urged to take a strong interest in the coming
elections of the Association, not only by voting, but by getting
involved and nominating for Council Office Bearers.
Included in this edition of Medicus is a nomination form for
the following positions:
Council:
­
- President
­
- Vice Presidents
­
- Honorary Secretary
­
- Assistant Honorary Secretary
­
- Honorary Treasurer
­
- Six Division Delegates
­
- Three ordinary members elected by members of
the Association.
Nominations must reach the AMA (WA) Returning Officer
no later than 5pm on Friday 17 April, 2015. This is an
opportunity to increase your involvement in the AMA (WA)
and to assist in serving your fellow members.
WESTERN AUSTRALIA
March
ME D I C US 11
Pictured:
da Vinci Xi
NE W S
RCPA LAUNCHES GENETIC TESTING GUIDELINES
IN A GLOBAL-FIRST, the Royal College of Pathologists
of Australasia (RCPA), together with the Human Genetics
Society of Australasia (HGSA) and the Human Variome
Project, has launched a set of new standards to be applied
across clinical databases used in genetic testing. These
standards aim to ensure a consistent approach when
analysing the results of genetic tests, ultimately delivering
greater efficiencies, speed of diagnosis and accuracy of
results.
Created with financial assistance from the Australian
Department of Health, the aim is to establish a global
framework for assuring the quality of these databases.
The new guidelines will initially be implemented in Australia
and New Zealand this year.
Chair of the Genetics Advisory Committee and
spokesperson for the RCPA, Dr Melody Caramins said
introducing a recognised framework would provide
laboratory scientists, pathologists and clinicians with a
benchmark for genetic analysis.
“It will also enable us to begin discussions internationally,
with the intention to use this platform on a wider scale,” she
said.
“It’s our goal to improve the quality and integrity of
genetic databases and the results they help to provide, thus
ensuring patients are in a position to make better informed
health decisions which may affect them, their children or
their potential offspring.”
Currently, there are no recognised international guidelines
in place to ensure the accuracy of databases and the subsequent
clinical interpretations of this data.
“Genetic testing has evolved rapidly over the last 10 years.
In the past, testing for rare diseases could have taken years to
determine a diagnosis, however with the use of next generation
sequencing, we can now look at a greater number of genes at one
time.
In many cases, we’re reducing the diagnostic odyssey from
three to five years, to a matter of months, which is an incredible
achievement. To keep apace of these technological advances
and harness this valuable and comprehensive data, we need a
recognised set of standards,” Dr Caramins concluded. ■
New DNA screening test to detect colorectal cancer
THE FAECAL IMMUNOCHEMICAL Test (FIT), is
now being widely promoted as the frontline screening test
for colorectal (bowel) cancer in Australia and New Zealand.
According to researchers, the new test is the most simple and
non-invasive screening test on the market.
According to Professor Graeme Young, gastroenterologist
and spokesperson for The Royal College of Pathologists of
Australasia (RCPA), the FIT test is expected to reduce the
perception that people who have reached 50 years of age should
have a screening colonoscopy.
“This view creates a major burden on colonoscopy resources
and some are unnecessary. FIT is the most accurate noninvasive simple screening test,” Prof Young said.
“When positive, it identifies the subgroup of people who are
most in need of undergoing a colonoscopy.
“Colonoscopies are best reserved for those with symptoms
or who are in a high risk group, due for example due to a family
history.”
Prof Young went on to explain that the purpose of a
screening test is to detect abnormalities that might require
further investigation.
“In an ideal world, these tests should be simple, non-invasive
and easy enough for people to undergo without anxiety or
discomfort, however by their very nature, they are not perfect.”
He explained new molecular tests that require a blood
sample rather than a faecal sample might prove to be useful as
a ‘rescue strategy’ for people who won’t undergo faecal tests or
colonoscopy.
“As one in 23
Australians will
be diagnosed with
colorectal cancer
in their lifetime, we
are encouraging all
eligible Australians
to take part in the
National Bowel
Frontline screening: The Faecal
Cancer Screening
Immunochemical Test.
Program.”
A report in 2014 revealed that only 40 per cent of
Australians over 50 years of age participated in the ongoing
National Bowel Cancer Screening Program (NBCSP). Prof
Young said that there is still a high number of Australians
who have not taken part in this program, despite its proven
success.
“The number of eligible Australians who are currently
participating in the NBCSP is alarmingly low. We
acknowledge the social barriers that are associated with
faecal testing, however we know that this test is an effective
screening method in identifying colorectal cancer.”
Professor Graeme Young was one of the many presenters
at the 14th Annual Pathology Update Conference hosted by
the Royal College of Pathologists of Australasia (RCPA) in
Melbourne last month. ■
March
ME D I C US 13
F E AT UR E
Staying the course
Celebrating 15 years of operation, surgical and medical skills lab
CTEC continues to do its bit to produce well-trained doctors in WA
W
hen the Clinical Training and Evaluation Centre
(CTEC) at The University of Western Australia
opened its door to doctors and medical students in
2000, it was the first of its kind in the country.
“It was an audacious move; an extraordinary gesture on
behalf of both UWA and the West Australian community,”
says CTEC Medical Director Professor Jeffrey Hamdorf, “but
one that has exceeded the ambitions and expectations of all
involved”.
Acknowledged as a hub of medical simulation knowledge
and knowhow in WA because of its highly practical approach
to medical and surgical skills training, CTEC has helped train
more than 30,000 healthcare professionals.
In 2014, the centre ran 240 courses from its premises at
UWA, a staggering number for a state the size of WA – and up
to 4,000 doctors trained at the centre.
The majority of courses vary from half a day up to three
days. However, there are courses such as the Master of Surgery
program, which could run over three years.
CTEC has looked beyond borders too, and counts helping
Indonesia to establish its own skills facility – ICTEC – as one
of its proudest achievements.
“It was an honour to
be asked to help guide the
establishment of a facility for a
nation of 220 million people,”
Prof Hamdorf says.
As it marks 15 years of
operation, CTEC continues to
move from strength to strength.
New courses are being
introduced such as a five-month
evening program which helps
junior doctors prepare for life
as a surgeon. CTEC will also
unveil an Honours Board to
CTEC Medical Director
commemorate its most faithful
Professor Jeffrey Hamdorf
supporters.
“There are senior doctors who continue to give their valuable
time for free in order to impart their knowledge and skills to
tomorrow’s generation. Their generosity of spirit is remarkable.”
Medicus spoke to Professor Hamdorf about CTEC, the
opportunities, challenges and the changes it has experienced
over the past years, and the road ahead.
Q . How has simulation technology revolutionised
the medical landscape?
JH. Simulation has become an integral part of
the medical education landscape. Most medical
practitioners, students and consumers have
an expectation that doctors will participate in
simulation as they learn new techniques and
refresh their skills. When our medical students start
on their surgical attachments, they visit CTEC and
learn how to suture using synthetic tissue – definitely
much safer than learning on the job. We provide a
safe, reproducible environment for people to learn
and practise new skills without the risk of patient
injury.
Focus group: The Cutting Edge course targets country GPs.
Q . How has CTEC evolved over the past 15 years?
JH. Western Australia has always had an appetite
for procedural education courses through CTEC and
over the years this has meant that our models have
improved and we have developed fresh frozen
cadaveric technology.
Support for CTEC from industry has also grown
extraordinarily as has the generosity of the West
16 M E D I CU S March
Australian public through the University’s bequest
program.
In addition, our two strongest sources of support remain
the Health Department of WA and our senior doctors.
Q . Paint us a picture of CTEC in the year 2000?
JH. Interestingly in 1999, whilst CTEC was being built,
we ran 45 courses out of the demonstration lab at the
F E AT UR E
School of Anatomy next door. So when CTEC officially
opened in 2000, we hit the ground running as we had
already earned quite the reputation as a skills lab.
In 2000, we mostly imported courses from the College
of Surgeons in England. However, within a year or so,
we quickly came to realise that to meet the needs
of WA doctors, we would need to develop our own
courses.
Q . What are some of the most popular training
programs at CTEC?
JH. The Cutting Edge, a suite of courses for country
GPs, and another called the Anatomy of
Complications have been our biggest drawcards.
We developed the latter following an approach from
the Medical Defence Association of WA to CTEC and
more importantly to specialists, Drs Ian Hammond
and John Taylor through KEMH. The course was
specifically developed to help reduce the risk of
complications to patients through gynaecological
surgery and it has been a massive success.
Our Core Skills Courses for surgical trainees are fully
subscribed as well. We also run a series of master
classes that attracts senior doctors learning new
techniques, be it computer-aided navigation for joint
replacement or bionic ear implantation.
Q . How important is CTEC training to a doctor’s
clinical practice?
JH. Our approved, accredited courses are important
to a doctor’s ability to maintain their skills. Simulation
courses only provide a small supplement of a doctor’s
professional education; they can never totally replicate
the experience of surgery on a human. CTEC would
never pretend to replace professional behaviours or
even certify competence. We can ascribe a technical
skill level to people and teach them how to do things,
but professional competence is a much broader theatre
than that.
Q . What is the impact of simulation training in risk
management strategies?
JH. We are confident this is an important strategy in
patient safety. This has been endorsed by feedback
from medical defence organisations. For example,
the Anatomy of Complications workshop has
helped contribute to the fall in complication rates in
gynaecological surgery.
Q . Globally, what are the latest advances in
simulation technology you are excited about?
JH. The virtual world presents great opportunity at
the moment. When we go to the cinemas nowadays,
we expect the highest level of realism. I’m most
disappointed that this technology has not yet been
adapted to the medical scenario.
We need high fidelity digitised images of anatomy,
which could then be rendered into three dimensions,
allowing us to be interactive. We should be able to
Benefit: The Anatomy of Complications workshop has helped
lower complication rates in gynaecological surgery.
strip away a 3D rendering of an anatomical structure,
which would help a surgeon prepare for surgery.
High fidelity 3D rendering is an absolute must for
technological development, and the next step is
interacting with it – will I be able to touch and feel it in
the virtual world. We need Haptic Technology – if I cut
a blood vessel in a computer environment, I want it to
bleed, so I feel scared!
The virtual world does allow us to develop teaching
in navigation skills. For example, as people train in
endoscopy or colonoscopy, we have a virtual reality
trainer for them to practise in which allows realistic
navigation through the virtual gastrointestinal tract.
But that’s the limit of virtual reality at the moment.
Q . How does Australia stack up globally when it
comes to simulation technology?
JH. We are doing as well as anywhere in the world.
The development of simulation technology lies in the
hands of computer engineers and a limitation, as
always, is funding.
Q . Where does CTEC derive its funding from?
JH. We have a good mix of help from the WA Health
Department, industry (mainly in the form of provision
of surgical instrumentation and consumables); and
participant registrations. ■
The Royal Australasian College of
Surgeons will host its 84th Annual
Scientific Congress in Perth from 4-8
May. CTEC will run seven satellite
courses to coincide with the Congress.
Visit www.ctec.uwa.edu.au for more
information and to register.
March
ME D I C US 17
F E AT UR E
Young Australians let down by ageing system
Linda Reynolds
Senator for WA
E
very now and then in politics you stumble upon an
issue so compelling it serves as a profound reminder as
to why you entered the job in the first place.
For me it was the plight of some of the most vulnerable
people in our society– disabled younger Australians living
in aged care. At present, nearly 6,500 Australians under the
age of 65 live in aged care facilities, including 510 Western
Australians, and many thousands more live in inappropriate
accommodation.
An aged care facility is no home for young people.
When I entered the Federal Parliament as a WA Senator
I heard of just some of the challenges facing younger
Australians with disabilities who are forced to live the life of
an old person. At the moment there is nowhere else for them
to go so they are placed in aged care facilities in conditions
totally unsuitable for their interests and needs.
It is for that reason that I initiated a Senate Inquiry into the
adequacy of existing residential care arrangements for young
people with severe physical, mental or intellectual disabilities.
But reading and hearing the testimony of parents,
wider family members and friends and young people
themselves last month chronicled overwhelming
feelings of disempowerment, despair, loss of dignity,
and perhaps most significantly, a loss of control.
At times, I have been brought to tears hearing and
reading about their struggle.
After scratching the surface of this largely hidden
social issue, the extent of the problem has become
apparent thanks to the Inquiry currently underway,
as has the need for urgent and decisive action.
Many of the accounts from young residents
throughout the inquiry, some as young as 17,
provided insight into their experiences of being
surrounded by dementia, dying and death. Most
have few, if any, visitors because the environment
is too intimidating. All are required to eat denturefriendly food and conform to the sleep, ablution and
social routines of the elderly.
I recently met with Kirrily Hayward, a vibrant and
vivacious 27-year-old woman from Geelong with Spina Bifida
who lost both legs, and is now living in aged care. Kirrily was
forced to leave her independent living situation and university
18 M E D I CU S March
studies over two years ago after pressure sores failed to heal,
and now lives in a nursing home where the average age of
fellow residents is 84.
“As a young person living in this environment, I am
constantly confronted with aged-care-related end-of-life
circumstances, seeing things a young person in the prime of
their life should not see,” Kirrily said.
“Whilst living here, there have been many times I have felt
isolated, alone and misunderstood.
“It is very difficult to maintain friendships and
relationships, and it is impossible to nurture new ones,”
she said.
Sadly Kirrily’s story is just one of thousands around Australia.
James Nutt entered a nursing home at the age of 21 and
spent six years in the facility after acquiring a debilitating
brain injury. James has battled suicidal thoughts, not because
of his disability, but because of his living arrangements and
quality of life.
“Life in the nursing home was designed for those people
12 months and counting: Senator Linda Reynolds (left) met
with Kirby Littley during a visit to her Geelong nursing home in
association with the Summer Foundation last month. Kirby is a
29-year-old woman who has been living in a nursing home for the
past 12 months. Kirby has an acquired brain injury, the result of
several strokes which were triggered by surgery to remove a brain
tumour. Kirby is in the very early stages of recovery and is hopeful
of eventually returning to live independently with support.
F E AT UR E
of old age, food choices were non-existent and
repetitive, of a processed and puréed nature, and
seemed to be appropriate for people at the later
stages of their life, not someone like me,” James
said.
“Outside activities were also limited and didn’t
drive me to be more motivated or interested in life.”
It is hard to imagine living such a slow-paced
existence as a young person. Unfortunately, many
younger people in aged care are forced to endure
this existence for years or even decades. What they
crave most of all is independence and freedom of
choice to live a full and liberated life. Instead most
feel stuck and see no way out.
Alarmingly, the numbers show no signs of
slowing, as more than 300 people under the age of
50 are admitted to nursing homes each year with
many more housed in inappropriate accommodation. This
is an issue nearing crisis point as younger Australians with
disabilities face considerable waiting lists for accessible and
affordable housing.
The impact of this problem is not limited to the younger
aged care residents. There is also a growing number of ageing
carers and parents in despair about the fate of their dependants
as they reach a point where they can no longer meet their care
requirements. Carers face significant logistical, mental, social
and physical challenges looking after their loved ones in their
own homes. Carers and parents are eventually but reluctantly
forced to seek care and residential alternatives.
Mother-of-two Leona Jones detailed the heartbreaking
decision to admit her children into aged care because of their
rare genetic disorder.
“I felt I’d betrayed their trust by leaving them there,”
Leona said.
“I overcame this fear by going less frequently, then even
less frequently. It was as if as parents, we’d abandoned our
children by placing them in a nursing home.”
Unfortunately the provision of services and long-term care
for people with complex needs under the age of 65 years is
limited. This has to change and I am determined to ensure
this Inquiry gives these young Australians, who have been so
often left to languish behind closed doors, an opportunity to
be heard and to take back control of their own lives.
The story that hit me hardest was Perth mum Kirstine
Bruce who was forced to place her daughter Ariana into a
nursing home at the age of 17 after she acquired the rare
illness, Anti-NMDA.
Kirstine gave up work to provide appropriate daily care for
Ariana who lives over 40 minutes away. She said this had a
huge impact on her family of six.
“As a mother of a child who now has a brain injury living
in an aged care environment, it rips my heart out watching her
sit in a chair in front of the TV all day,” she said.
“I have sat with other residents of all ages – from 30-yearolds to 50-year-olds. I sit and listen to their complaints of
Unacceptable: Senator Linda Reynolds (left) and
Kirrily Hayward, a 27-year-old woman who has been
living in an aged care facility for the past three years.
living in an aged care environment. The frustration and anger
just rips my soul. No young teen or adult should have to live
the life of an elderly person.”
Kirstine said each and every person with an acquired brain
injury required individualised treatment because their needs
were different.
“To treat someone with dignity is to treat them as being of
worth, in a way that is respectful of them as an individual,”
she said.
People like Kirstine and the thousands like her are the
reason for the Inquiry. While this issue is complex one, there
are solutions.
Firstly, I believe Australia needs to develop an effective longterm strategy for more accessible and affordable housing for
younger Australians living with complex needs. It’s clear the
current ‘one-size-fits-all’ approach and a government tendency
to categorise and then allocate people on the basis of their illness
or disability is clearly not working for all.
Secondly, many Australians with high support needs exist in
a bureaucratic ‘no-mans-land’ between the aged care, disability,
health, housing and community services sectors. Often these
agencies work in silos resulting in a fragmented and ineffective
coordination and allocation of funding and resources.
The NDIS is a testament to how a rethink focused on the
needs of the individual can change lives in a meaningful way,
but this is only part of the picture.
Federal, state and local governments must also find a way to
work together at the grass roots level to ensure young people
with disabilities are seen as the people they are, and receive
tailored support.
Finally, it is my hope that younger Australians with
complex needs are defined by the quality of their character
and their abilities, not by the disabilities they live with.
This is something I will be fighting for in my role as
Senator for Western Australia. This is an issue about
which we are judged as a society as a whole. We can, and
must, do better. ■
March
ME D I C US 19
A F T E R HOUR S
The newest doctors in town were welcomed
at the AMA’s annual Intern Cocktail Party
Y
ou would have been in good hands if you were an
animal at Perth Zoo and feeling unwell on a Tuesday
night in late February. All you’d have to do was raise
your head ever so slightly and emit some sort of croak, wail or roar,
before you’d have just about every Intern in WA by your side – all
desperate to demonstrate their newly-found medical skills.
Luckily no sick animals turned up at the annual meet-andgreet for Western Australia’s newest Interns, which was held
at Perth Zoo for the very first time. The only inmates who did
drop by – a bobtail lizard; a stick insect and a turtle –were quite
friendly and accommodating.
Hosted by the Australian Medical Association (WA), the
Rothschild’s Room at the zoo saw more than 150 eager young
doctors catching up with their peers, several senior doctors
along with stalwarts of WA’s medical community, including WA
Minister for Health Dr Kim Hames, newly-appointed CEO
of MDA National Ian Anderson, Acting Chairman of MDA
National Dr Rod Moore, and CEO of Fiona Stanley Hospital
Commissioning, Dr David Russell-Weisz.
AMA (WA) President Dr Michael Gannon welcomed the
gathering, touching upon several initiatives of the Association’s
Doctors in Training Committee (DiTC), including access to
leave and part-time work, commitment to doctors in rural areas,
as well as plans to finalise and deliver an online research portal.
“The idea behind this is to connect doctors in training with
senior clinicians to facilitate research developments.
“We did not have these opportunities when I was an Intern
about 20 years ago. It would be fair to say that for most doctors
then, research was not necessarily a massive part of their career
pathway, whereas now it’s considered an important way of
sorting the wheat from the chaff,” Dr Gannon said.
In his address, Dr Kim Hames acknowledged medicine
had been a “fantastic” choice for him even though he hadn’t
practised for 15 years.
Recalling his time as an Intern in 1977, he admitted times
were different then and most young doctors were just thrown in
the deep end without specific training.
“Dermatology was a mess; I don’t think I’d ever seen a rash
on a patient. And then again, the same rash would look different
on half a dozen different patients.”
DiTC Co-Chair Dr Chris Wilson also spoke, advising about
the benefits of joining the committee, which is especially strong
in WA.
“My Co-Chair Dr John Zorbas and I recently attended the
DiT National Council in Sydney and following discussions with
peers in the east, realise that we have got it good over here.
“But there’s a reason we’ve got it good.
“The AMA has always backed its junior doctors and the
only way this can happen is if we continue to have strong
membership numbers,” Dr Wilson said.
The speeches for the evening complete, it was time for door
prizes with everything from fabulous Willie Creek pearls and
the use of a fancy Audi for a weekend to hair salon and movie
vouchers up for grabs.
THE AMA WOULD LIKE TO THANK THE SPONSORS
FOR THE EVENING: COMMONWEALTH BANK, MDA
NATIONAL, WAGPET, AVANT MUTUAL GROUP,
JOONDALUP HEALTH CAMPUS AND HBF. ■
4
1
3
5
2
1. Perth Zoo , s carousel was a hit with the junior doctors. 2. Interns meet up with
one of Perth Zoo’s smaller residents and its keeper. 3. AMA (WA) President,
Dr Michael Gannon addresses the room. 4. WA Minister for Health, Dr Kim
Hames makes a new friend. 5. AMA (WA) DiTC Co-Chair, Dr Chris Wilson.
20 M E D I CU S March
A F T E R HOUR S
2
3
1
4
7
5
6
8
9
11
12
10
1. Dr Bryan Tan and Dr Joshua Ho. 2. Dr Georgia Frew, Dr Bryn Elphick and Dr Natalie Smith. 3. Dr Ghassan Zammar, Dr David Porritt and
Dr Christopher Wylde. 4. Dr Jade Hollingworth, Dr Danielle Vlahov with Dr Abigail Hudson. 5. Dr Jason Laurens and Dr Jacky Yeung.
6. Dr Justine Mackie, Dr Siobhan Hurley and Dr Suanne MacConnell. 7. Dr Leon Zhang and Dr Jacqueline Lovatt Stern. 8. Dr Molly Kehoe
with Dr Chloe Attree. 9. Dr Sebastian Leathersich and Dr Alexius Julian. 10. Dr Trenton Lee, Dr Perdita Gregory and Dr Pasquale Italiano.
11. Dr Samantha McDonald (centre) with sisters, Drs Alana and Jessica Prosser. 12. Dr Janelle Jurgenson and Dr Mariana Dorkham.
Winners’ List
STERLING SILVER FRESHWATER PEARL & CUBIC
ZIRCONIA EARRINGS, DONATED BY
WILLIE CREEK PEARLS
DR GEORGIA FARRAH
MOTHER OF PEARL ROLLER BALL PEN, DONATED
BY WILLIE CREEK PEARLS
DR SHEHAB ABDALLA
THE USE OF A NEW AUDI A4 2.0 TFSI QUATTRO S LINE
FOR A FULL WEEKEND, DONATED BY AUDI PERTH
DR JADE HOLLINGWORTH
GOLD PACKAGE GIFT VOUCHER, DONATED BY
MAURICE MEADE HAIR SALON
DR RACHAEL STOKES
$100 AMA MEDICAL PRODUCTS VOUCHER,
DONATED BY AMA MEDICAL PRODUCTS
DR GHASSAN ZAMMAR
March
ME D I C US 21
CO V E R S T OR Y
22 M E D I CU S March
CO V E R S T OR Y
P
ain can be, and often is complex
to understand. There are several
key factors that make each
individual’s experience of pain both
puzzling and unique. These are as
follows:
1. Unravelling the puzzle of pain
starts with each person who has
persistent pain becoming aware of
the interlinking contribution of injury
pain (thought of as nociception),
neuropathic pain, inflammatory pain,
and increasingly, the likelihood of
immuno-reactive component(s).
2. The management of pain is a bit
like a jigsaw puzzle, with medications
or procedures only representing one
of the ‘pieces’ of a multi-piece ‘jigsaw’
of co-care options. Co-care implies
co-ordinated care between upskilled
consumers and a broad range of
healthcare providers, as a partnership
in knowledge and skills for that unique
individual.
3. Pain is invisible (so is stress).
Changes within the nerves, spinal
cord and brain are known to occur,
but hard to quantify whilst the
patients are alive, notwithstanding the
fascinating studies using functional
MRIs, which highlights differences
in blood flow to regions of the brain
across a range of changeable factors
including mindfulness, virtual reality,
and empathy. Specifically, there aren’t
(currently) any biochemical markers
for pain that show up on blood tests.
Animal studies at a microscopic
level do highlight the changes in the
nervous system, immune responsive
glia, neurotransmitters and receptors.
4. The well documented disconnect
between radiological pathology and
pain is obvious. That is, radiological
investigations show structure, not
pain. So, if you take an X-ray, CT
scans, MRI of a patient with shingles
i.e. if you don’t examine them by
taking their shirt off, or if they
don’t mention a rash, the diagnosis
will be missed, as the pain within
the nervous system is unable to be
imaged (to date).
5. However, the associated distress and
disability from adversarial situations
with work incidents and motor vehicle
accidents isn’t as obvious, whilst
perceived ‘injustice’, anger
and distress further increases pain and
disability.
6. If people in pain are only able to
access passive treatments, including
non-addictive and addictive
medications, as their principal or sole
treatment, their progress is limited.
In some cases, further issues arise
when they proceed to the regular use
of habit-forming analgesics such as
opioids, and then it is not uncommon
for them to have co-prescribed
habit-forming anxiolytics such as
benzodiazepine medication with
side-effects of memory loss, excess
sedation and death, and this of course
further contributes to the failure of
rehabilitation.
7. In WA, it is uncommon to see
assessments that include validated
questionnaires that measure the
injured worker’s biopsychosocial
risk of disability such as the Orebro
musculoskeletal questionnaire
(OMPQ for persistent pain) or
StartBack (low back pain). Further,
it is not routine practice outside
of pain medicine to use screening
questionnaires for neuropathic pain
(such as Pain Detect); nor pain and
Continued on page 24
March
ME D I C US 23
CO V E R S T OR Y
Continued from page 23
function (such as Brief Pain Inventory, Pain Disability, Roland
Morris or Oswestry); whilst the use of instruments that are
validated for people with persistent pain to measure anxiety and
depression such as HADS and the DASS are not seen outside
multidisciplinary pain services – yet anxiety is enmeshed in the
experience of pain.
This is a key point, because if pain didn’t make people
feel intrinsically anxious or worried to avoid a potentially
threatening event, then pain would not be an effective alarm
signal. That is, we are all wired as a biological imperative to
respond and avoid pain and injury. This makes the standard use
of the above tools to complement the history and examination of
people with persistent pain fundamental.
Anyway, the biopsychosocial model of assessment and
management of people with pain isn’t new. It has been part
of the teaching of Pain Medicine to doctors and healthcare
professionals since I was a Registrar in the mid 1990s.
The difference is that in the last decade, a range of healthcare
professionals and managers have worked extremely hard to
provide systems that easily provide both pain education and
skills to be taught as the ‘first-line’ treatment to people with
complex persistent pain.
In 2007, Fremantle Hospital & Health Service Pain Medicine
Unit introduced the Self-Training Educative Pain Sessions
(STEPS) which is an eight-hour, two-day pre-program which
70-80 per cent of people attend prior to individual consultations.
This was funded via a translational research grant in 2007-2008
from SHRAC (WA DOH).
The STEPS pre-clinic ‘entry’ program taught pain
knowledge including neuroplasticity, and skills such as pacing,
pain approach, mindfulness, making sense of pain, and medical
options. The key healthcare professionals are pain physicians,
musculoskeletal physiotherapists, behavioural psychologists
and occupational therapists. In this tertiary sector, from 2007
to 2014 approximately 3000 patients attended the Fremantle
Hospital STEPS program, halving the unit cost of a referred
new patient as well as dramatically reducing waiting time as
the capacity of the unit to see new patients increased (doubled)
because patients were able to more readily engage and
implement with non-medically focused options. Sir Charles
Gairdner Hospital and Royal Perth Hospital have similar entry
group programs.
The focus is shifted to what is it the patient can do, such as
pacing activities, paced daily walk, non-vigorous movements,
pain approach, mindfulness, relaxation, acceptance, and
reduction of life stressors. This last point is vital as many people
are juggling several or many life stressors.
Some of the skills we teach patients include:
• I ssues that can’t be worked on or solved any time soon need
to get less thinking time
• E ach minute spent running through the problems (in their
head) makes them feel bad and pushes their mood down
• Try using the ‘3 Ds approach’ – ‘Do it, Dump it, or Delegate
it’ (I have this as my mantra)
24 M E D I CU S March
•D
o use short-term goal setting with realistic expectations
that are achievable
•C
hanging their response to negative events by trying not to
get drawn into unhelpful emotions using the analogy of the
‘dead bat’.
Our tracking of the Fremantle Hospital participants who
returned validated questionnaires from October 2007-end 2009
showed that the hundreds of participants had improved abilities
to do daily chores with less disability, as well as implementing
increased number of active pain strategies.
The expansion of co-ordinated pain services, STEPSPNML, STEPS-BAML and STEPS-PSCML started in
2011 with collectively about 300 patients attending these
Medicare Locals to date. It was thought that to bridge the gap
in primary to secondary care for people with persistent pain
with less complex mix of co-morbidities, attendance at the
two day STEPS program, combined with a one-off pain team
assessment (physiotherapist, behavioural psychologist, pain
physician) would provide support to the patient (and significant
others) as well as community healthcare professionals.
The subsequent care is filtered to either primary care
(less complex) or tertiary care (more complex) depending on
ongoing options and requirements of the patient’s pain team’s
management plan. These programs help people with pain to
improve function and return to a more normal life. The positive
feedback from patients and their families recognising that they
feel empowered, with more control is significant, as well as
improving health outcomes for these participants and leading
to significantly reduced waiting times at the tertiary pain clinics
in WA.
Patients with a high number of complex issues continue to
require access to existing tertiary services to access ongoing
expertise and experience of specialised healthcare professionals,
investigations, interventional pain procedures, non-PBS
medications and to provide the ongoing care that is required for
people in pain with multiple medical co-morbidities, co-existing
mental health conditions, and complex medication regimes
(including S8 opioids), and access to more intense (longer)
cognitive-behavioural group programs.
Future analysis of the triage information will enable –
hopefully – a simple tool for assisting services in determining
the optimal referral pathway between primary-secondary and
tertiary services. ■
Dr Stephanie Davies is also Adjunct Associate
Professor, Curtin University, School of Physiotherapy;
Senior Lecturer, UWA, School of Medicine and
Pharmacology; Chair State Wide Pain Services (SWPS);
Co-Chair Pain Health Working Group (PHWG) and
WA Director, Australian Pain Society.
CO V E R S T OR Y
W
ithout functioning pain
receptors, the human body
gets into serious trouble.
We would not necessarily be aware of
developing an acute appendicitis or
cholecystitis. We would not feel a hot
stove or sprained ankle.
The type of pain from these conditions
can be called nociceptive, physiological
or ‘good/useful’ pain. Symptoms of
nociceptive pain can be described as
hot, sharp, stinging or dull, aching and
throbbing. This type of pain is usually
well localised and if treated appropriately,
of short duration and so it is helpful.
Children born without pain receptors
(nociceptors) do not survive long and
develop significant injuries. Congenital
insensitivity to pain is caused by a
mutation in the SCN9A gene.
Pain can also be described by its
duration of onset. Acute pain is pain of
sudden onset and is of such a nature that
ordinarily if the condition that is causing it
is treated, the pain will resolve. Arbitrarily
acute pain becomes chronic or persistent
if it is still present at three months, or if
still present when normally the condition
causing it would have been expected to
resolve. To complicate things, patients
often use the word ‘acute’ to mean severe.
Teleologically, pain may have played a
part in survival by forcing people to rest,
so aiding recovery from an acute injury.
Acute physiological, nociceptive pain
of course is not always ‘good’ because it
can cause, via its input to the brain stem,
variable physiological changes such as
hypertension and tachycardia. If these
adverse events occur in individuals with
ischaemic heart disease, complications
can ensue. After trauma or in the post
operative period, severe pain can prevent
or delay effective rehabilitation, with
increased risk of deep vein thrombosis or
pulmonary emboli developing. Pain is also
usually very unpleasant!
Healthcare professionals have long
been aware that different people respond
differently to similar amounts of
nociceptive input. This can be seen every
day in the emergency department, the
labour room and on post-operative wards.
Clearly the physiological pathway and
transmission of the pain signals from
the site of injury to the brain is the same
in all humans. The different responses
between different individuals are due to
modulation in the pain signalling as it
travels to the somatosensory cortex. Our
past experience, our current emotional
state, the causes (and their meaning),
expectations, environment, culture, mood
all affect our overall pain experience and
of course, our behavioural response.
Acute nociceptive pain fortunately
responds very well to treatment whether
it be a non-drug strategy such as
explanation, reassurance, RICE (rest,
ice, compression, elevation), fixing
the problem (surgery) or multimodal
analgesia such as paracetamol
NSAIDs and opioids.
Acute nociceptive pain that does not
resolve by three months is ‘bad’ and
a whole host of changes occurring in
the spinal cord (dorsal horn) and brain
(thalamus) sensitise the pain signalling
pathways.
Neuropathic pain, (pathological/bad/not
useful) is defined as pain occurring when
there is damage to or a lesion of the somatosensory nervous system. For example,
painful diabetic neuropathy, post herpetic
neuralgia, central post stroke pain, pain
following spinal cord injury or phantom
limb pain. This type of pain is described as
burning, painful numbness, electric shock
sensation, tingling or shooting. It is not
biologically useful and is unhelpful to the
body. It is usually not well localised and is
often difficult to treat.
As with acute nociceptive pain, there
is also significant pain signal processing
of the impulses generated along this
Continued on page 27
March
ME D I C US 25
Visit the AMA (WA)
Part-Time Doctor Portal
CO V E R S T OR Y
Continued from page 25
pathological pathway, which is also
modulated by the patient’s personality,
their environment, expectations, beliefs,
culture, and past experiences.
All pain must start off as acute.
Common types of acute neuropathic pain
are seen following trauma, for example
illioinguinal neuralgia after inguinal hernia
repair, intercosto brachial nerve damage
following axillary dissection at mastectomy,
or after an infection such as herpes zoster.
Treatment of neuropathic pain
while more complex and less effective,
can still be addressed using non-drug
strategies, for example, explanation,
education and behavioural treatment
(acceptance) and/or drug strategies.
While there is some evidence for the use
of paracetamol and NSAIDs, their effect
is limited. Opioids can be effective but
their value is limited to medium-term
use only because of the development
of tolerance, dose escalation and side
effects such as cognitive impairment,
immunosuppression, constipation,
addiction and the potential development
of opioid hyperalgesia (increased opioid
dose causing increased pain).
Specific anti-neuropathic pain
drugs such as the ‘broad spectrum’
antidepressants amitriptyline and
nortriptyline are first-line options. The
newer serotonin noradrenaline reuptake
inhibitor (SNRI) antidepressants such as
venlafaxine and duloxetine together with
the anti-epileptics, traditionally sodium
valproate and carbamazepine and more
recently, gabapentin and pregabalin, are
second-line options.
Cancer pain commonly presents with a
mixture of acute and chronic (or acute
on chronic) nociceptive and neuropathic
symptoms and signs. Clearly patients
with cancer pain are helped by many
non-drug treatment strategies. Drug
treatments using multimodal analgesia
for both nociceptive and neuropathic
components including opioids can also be
extremely valuable.
Tolerance, however, does develop in
cancer patients and sometimes, high
doses are required to control symptoms
with both the patient and relatives
accepting the cognitive and other side
effects related to high-dose opioids.
In the next decade as cancer treatment
becomes increasingly effective and the
cancer is ‘cured’, palliative care and pain
physicians along with General Practitioners
are going to see patients with post-cancer
pain syndromes. These will predominantly
be neuropathic in nature, for example postoperative nerve damage as described above
and chemotherapy or radiation-induced
neuropathy. These patients may well be
on moderate to high-dose opioids but still
experiencing ongoing pain. Management
of this group of complex patients will be
our challenge for the future.
Make a pain diagnosis. Is this pain
acute or chronic? Is it nociceptive or
neuropathic? Think about non-drug
strategies as well as drug strategies.
Use multimodal analgesia and beware
of using opioids beyond the short term
unless you are treating patients with
advanced cancer pain. ■
GENERAL
PRACTICE
Applications for the 2016 Australian GP Training (AGPT) program open from:
Monday 13 April - Friday 8 May 2015
To apply go to: agpt.com.au
For more information contact (08) 9473 8200 or [email protected]
[email protected] | wagpet.com.au | 08 9473 8200
AMA Medicus Ad 2015 V2.indd 1
5/03/2015 8:53:41 AM
March
ME D I C US 27
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CO V E R S T OR Y
S
ufferers of chronic non-cancer pain often present with episodes of acute pain which is by definition pain of recent onset.
This ‘acute pain’ may be due to new and potentially treatable pathology or a ‘flare-up’ of the chronic pain condition.
The following principles may help to sort out what are common, sometimes challenging and often time-consuming
diagnostic and treatment problems (Henderson et al. 2013).
Some of the key factors are to:
• Exclude serious pathology
•Differentiate nociceptive and neuropathic pain (these may
co-exist)
• Identify psychiatric disorders, especially anxiety and
depression, and assess the contribution of psychological,
social and environmental factors to the presentation
• Screen for addiction and consider drug-seeking behaviour
• A ssess beliefs, expectations, and typical coping responses
• Identify usual providers, especially the General Practitioner.
Red flags (Box 1) are pointers to serious pathology such as
malignancy, infection, cauda equina syndrome or fracture,
suggesting the need for further investigation. Yellow flags
(Box 2) are risk factors in the patient for the development
of long-term pain and disability. Both flag types have been
developed for acute low back pain (95 per cent of which is
non-specific), but are useful in other presentations.
Most acute pain is nociceptive but some presentations will
involve neuropathic pain. The latter is due to dysfunction
of the nervous system, and is typically described with
terms like ‘burning’ and ‘shooting’. It may occur with
other neurological features such as dysaesthesia, sensory
loss and allodynia (pain due to a stimulus that is normally
non-painful).
Source (Boxes 1 & 2): modified from Hunter Integrated Pain Service.
‘Acute pain management: scientific evidence’ (published online
at www.anzca.edu.au/resources/college-publications) addresses
analgesic options, different groups (e.g. paediatric, pregnant,
opioid-tolerant, addicted and Indigenous patients) and diagnoses
(e.g. musculoskeletal and medical conditions, cancer, HIV). A new
edition is to appear in 2015.
Management of new or suspected acute pathology is the same as
for other patients, using best practice guidelines for conditions such
as acute migraine and acute low back pain. Acute episodes of back
and neck pain, in the absence of sinister pathology, should be managed
with (re)assurance, activation and analgesia (Cohen et al. 2008).
Depression and anxiety may be consequent to chronic pain, and
can precipitate deterioration – their management improves the
patient’s ability to cope with acute exacerbations.
Pharmacological options include simple analgesics, diseasespecific or modifying agents (e.g. anti-migraine drugs),
adjuvant drugs (e.g. anticonvulsants, anti-depressants), nerve
blocks and opioids. Consider also non-pharmacological
therapies such as active physiotherapy (for a paced exercise
program), hot or cold packs, and transcutaneous electrical
Continued on page 30
March
ME D I C US 29
CO V E R S T OR Y
Behavioural Psychology and chronic pain
Carl Graham
Clinical Psychologist
P
ain is a response of the body to the threat of actual or
potential cell damage. All behaviour is behaviour in a
context and this is true also of the pain response. Our
context includes all the normal medical and physiological
issues as well as an additional multitude of psychological and
social factors. These factors have a direct effect of the overall
threat a pain experience presents to us. This is a part of why a
pain experience is not necessarily well explained by the level of
cell damage alone.
The psychosocial factors that will influence the context in
which pain occurs are necessarily complex. There are normal
distress responses to the pain and injury which will affect
coping and have a potential exacerbatory role in inflammation.
There may be mood changes implicated in inflammation and
extended exposure to an aversive stimulus such as pain. There
will be prior learning and experiences, the level of trauma
associated with an injury, current load factors and future
concerns and expectations. All of these issues in combination
produce a level of challenge (or threat) to the whole person that
account for the pain experience in ways that injury severity
alone doesn’t.
The role of the behavioural psychologist in the management
of pain is to address the behavioural, emotional, cognitive
and social factors implicated in a problematic pain response,
and is most
typically involved
once patients are
presenting with
a persisting pain
condition. Ideally
any psychological
and behavioural
treatment is
conducted in
a cooperative
process with
integrated medical
management and physical rehabilitation to provide a coherent
‘biopsychosocial’ approach. In this model, it is of paramount
importance that the patient is an active participant in their own
care. The nature of any behavioural intervention is predicated
on the patient being the key player in the process. Medical
treatments allow a patient to be a passive recipient of care from
their doctor, whereas behavioural psychological treatment
requires willingness from the patient to be actively involved in
the change process.
For some patients, there may have been a difficult prior
history of abuse or neglect that will place additional burdens
Continued from page 29
nerve stimulation (TENS).
Although opioids form the
mainstay of management in many
acutely painful conditions, there
is increasing evidence that they
are of limited benefit in chronic
pain and may lead to opioidinduced harm (Blanch et al. 2014).
If considered necessary, use a
short-term course and choose
those with lower attractiveness for
abuse (e.g. tramadol, tapentadol,
buprenorphine, rather than
oxycodone).
Where opioids are indicated (e.g.
for a fracture prior to definitive
management), patients with chronic
pain may require larger than usual
30 M E D I CU S March
Box 3
MANAGEMENT APPROACH
CO V E R S T OR Y
on their capacity to cope with pain. A traumatic injury or
onset of pain is frequently associated with an exacerbation
of the pain experience. Management of trauma related to
the injury or past experiences, where they are found to be
impacting currently on pain and distress, would be a target for
intervention.
Extended exposure to the difficulties described above often
leads to impacts on a patient’s mood. Not all chronic pain
sufferers will be depressed but most will experience pressure
on their mood and benefit from assistance. Fortunately, many
of the active management principles involved in addressing a
persistent pain problem are helpful in behavioural treatment
for mood disorders and can be conducted concurrently.
A behavioural intervention will be aimed at reducing
problematic pain responses such as distress and avoidance of
activity. The focus is on short, medium and long-term goal
setting that leads the person towards functional improvement
and re-engagement with valued activity. This often requires
the psychologist to assist with the emotional issues that arise
with adjustment to changes in functional capacity and a
patient’s sense of self-worth. There may be cognitive issues
present that reduce adaptability and flexibility, and these need
to be explored to improve coping and resilience.
Patients who are coping with ongoing pain are encouraged
to gradually return to a balanced and fulfilling life, one step
at a time. In a chronic disorder, symptom management alone
is not sufficient to provide a balanced life. The trading in of
functional capacity to reduce pain is common but rarely viable
in the longer term and tends to lead to additional anxiety and
mood problems over time – both of which, in turn, exacerbate
a pain experience. A balanced life will contain the basics of
doses. Contributing factors include
opioid tolerance, central sensitisation,
expectations (often of under-treatment)
and other cognitive and psychological
factors, all of which may amplify the pain
experience.
Self-management approaches assist
patients not only with their chronic
symptoms, but can also improve their
capacity to deal with acute exacerbations
and even reduce their frequency.
Unfortunately, there are many funding
and other barriers to patients accessing
these interventions.
Chronic pain has its highs and lows,
and patients can be assisted to put in
place a plan to manage ‘flare-ups’. This
is best done during a time of relative
stability and control.
productivity, people, fun and movement. These are the things
that behavioural psychologists aim to re-incorporate into the
patient’s daily life alongside their symptom management.
Patients frequently report that reclaiming their lives was
fundamental to being able to achieve sustainable improvements
in their chronic pain over time.
There have been some developments in recent times in
the model of intervention many psychologists deploy to assist
their patients. Cognitive-behavioural approaches to treatment
(CBT) are being combined with what are termed ‘3rd wave’
behavioural treatments (like ACT). This incorporates
evidence-based psychological treatment with features also
present in motivational interviewing and the addition of
relatively advanced cognitive skills such as mindfulness
techniques. The utility of this approach in persistent pain
has seen ACT oriented CBT interventions quickly achieve
evidence-based therapy status in the treatment of chronic pain.
To summarise, pain is a complex response to the threat
implicated in tissue damage. The threat perceived by central
immune and nervous systems will take into account a raft
of factors present in the injury context, including physical,
psychological and social components. The level of pain
problem reported by individuals in persistent pain will
therefore generally be accounted for better by the combination
of those factors than by tissue injury alone. It follows that
management of a persistent pain condition would address these
broad biopsychosocial contributors. Behavioural psychologists
can provide specialist interventions to reduce pain-related
distress, impacts on mood, trauma, and avoidance of activity
to assist in the interdisciplinary management of complex and
chronic pain disorders. ■
Patients with chronic pain pose
substantial assessment and management
challenges when they present with acute
pain episodes. While most consultations
will involve non-specific exacerbations,
careful assessment should exclude sinister
and treatable pathology. Management
should focus on a multimodal approach,
avoiding potential harm. ■
Dr Lindy Roberts is immediate past
President of the Australian and New
Zealand College of Anaesthetists.
Her clinical interests include acute
pain management in patients with
complex pre-existing issues. She
is a previous director of the SCGH
Acute Pain Service and ANZCA
Faculty of Pain Medicine examiner.
References 1.Blanch B et al. An overview of the patterns
of prescription opioid use, costs and related harms in
Australia. Brit J Clin Pharmacol 2014;78:1159-66.
2. Cohen M. Acute low back pain and acute
musculoskeletal pain. Clinical pain management. 2nd
edition, 2008. Hodder Arnold, London.
3. Henderson JV et al. Prevalence, causes, severity,
impact and management of chronic pain in
Australian general practice patients. Pain Medicine
2013; 14: 1346-61.
4. Hunter Integrated Pain Service. Practice guidelines.
Available at http://www.hnehealth.nsw.gov.au/pain.
Accessed 17 Feb 2015.
5. Macintyre PE et al. Acute pain management:
scientific evidence, 3rd edition, 2010. Australian and
New Zealand College of Anaesthetists and Faculty of
Pain Medicine. Available at http://www.anzca.edu.
au/resources/college-publications.
March
ME D I C US 31
CO V E R S T OR Y
C
hronic pain is defined in terms of the longevity of
pain, rather than its complexity1. For consumers2, this
definition has limited merit because it doesn’t capture the
implications of the changed nature of pain from acute to chronic.
In chronic pain, the original tissue injury becomes a minor
part of the scenario for treatment purposes3. It is important
for this transformation to be understood by consumers before
a multi-faceted pain management approach, including selfmanagement, can be appreciated and taken up. Consumers
need opportunities within the primary healthcare sector to
learn to manage chronic pain4 and access community services
to maintain and extend self-management of chronic pain. The
incidence of chronic pain is high at one in five Australians
and back pain is the leading cause of employees leaving the
workforce early due to ill health – with a heavy burden of disease
personally and for the country5.
Chronic pain profoundly affects the individual physically,
emotionally, cognitively and socially6. The Pain Link helpline
1300340357 sees a wide range of ramifications including:
• disturbed sleep
• anxiety
• struggles to return to work or adjusting to changed jobs or roles
• suffering with altered family roles
• financial strife
• loss of house, and
• break-up of the family.
APMA provides (unfunded) services coaching consumers
towards:
• understanding chronic pain
• accepting long-term pain
• actively engaging with their treating health team, and
• maintaining their pain self-management to limit the distress
of chronic pain.
There are many diseases and injuries that lead to chronic
pain. It may be the case that the disease is no longer active or
the injury has healed, but pain remains. Early into the journey
of chronic pain, unrealistically high expectations of treatment
can lead to disappointment and despondency – many patients
want their pain to end or at least take a holiday. This can lead
to avoiding tasks, including those once enjoyed, waiting for the
magic potion.
However, positive expectations of a prescribed treatment are
important predictors of the treatment outcome and real pain
decrease. For this reason, patients being realistically informed of
the likely reduction in pain for a particular medication based on
evidence such as the number needed to treat will help to develop
understanding of treatments founded on scientific research.
Realistic but positive expectations of pain relief can improve
32 M E D I CU S March
treatment results7.
At times, consumers can be perplexed why persisting pain
can’t be fixed in this era of medical marvels such as transplants
and growing 3D body parts. This view of ‘pain is simple’ which
family members and society at large perpetuate, can lead
individuals to focus on passive therapies such as medication
and avoiding activities as they may do for acute pain scenarios.
Sadly, continually evoking these methods, even when they are
unsuccessful, can lead to more distress, disability and pain8.
Acceptance of long-term pain (at a tolerable level) is not
giving into the pain but rather allowing its presence while not
attaching stressful and unpleasant thoughts to it. Acceptance of
a reasonable level of pain is a powerful tool to usher in the steps
towards rehabilitation because it implies recognition that while
a cure for chronic pain is unlikely, having some pain does not
preclude enjoyment in life and taking an active part in living it.
Acceptance of chronic pain is associated with consumers
concentrating less on their pain and more on other parts of
their life. Acceptance of chronic pain is linked to consumers
who are the “active copers”; consumers who are engaged with
daily activities and want a positive life. However, people living
with chronic pain can still have their lifestyle impacted on by
intermittent high level pain which will interfere with daily life
at times, as other chronic conditions do. Accepting the reality
of living with pain allows consumers to begin to move toward
re-engaging with activities that matter to the person with pain
and makes their life worthwhile.9
Active self-management is the process of adopting tailored
information and active strategies to manage the impact of
chronic pain by the person in pain. This active coping style
includes cognitive and physical strategies recommended
by treating health professionals with the expertise. Selfmanagement is a well-tested tool, crucial for effectual medical
care of chronic pain. In terms of improved outcomes for
consumers, self-management needs to be viewed by the health
system as an economically viable and effective population health
strategy for chronic pain, much of which requires ongoing
patient effort.10
The experience of chronic pain can be affected by many
CO V E R S T OR Y
variables. Multidisciplinary pain
management in primary care can
provide the best chance for the person
with chronic pain being able to
rehabilitate and return to a worthwhile
and productive life. However, a dearth
of multidisciplinary pain management
services in primary healthcare means that
the misconception that acute and chronic
pain are the same, is often not challenged.
This results in too many living with
the disorder experiencing unnecessary
confusion, uncertainty and an overreliance on the doctor treating chronic
pain through surgery or pills. ■
References:
1. Pain Australia 2011, National Pain
Strategy, viewed 13 January 2015 http://www.
painaustralia.org.au/images/pain_australia/
National%20Pain%20Strategy%202011%20
Exec%20Summary.pdf
2. The term consumer is used in preference to
patient to emphasise the active participation of
the person in the management of their condition
3. Macintyre PE, Schug SA, Scott DA,
Visser EJ, Walker SM; APM: SE Working
Group of the Australian and New Zealand
College of Anaesthetists and Faculty of Pain
Medicine (2010) Acute Pain Management:
Scientific Evidence (3rd Edition), ANZCA
and FPM Melbourne. 4. Smith, Blair H. Elliott, Alison M. Active
self-management of chronic pain in the
community, Pain: February 2005 - Volume
113 - Issue 3 - p 249–250
5. The impact of back problems on retirement
wealth, Schofield, Deborah; Kelly, Simon; et
al. Pain: January 2012 - Volume 153 - Issue
1 - p 203–210
6. Viane, Ilsea; Crombez, Geerta; Eccleston,
Christopher Devulder, Jacques; De Corte,
Wilfried, Acceptance of the unpleasant reality
of chronic pain: effects upon attention to pain
and engagement with daily activities, Pain:
December 2004 - Volume 112 - Issue 3 - p 282–288
7. Turner, Judith A. et al., Blinding
effectiveness and association of pretreatment
expectations with pain improvement in a
double-blind randomized controlled trial Pain:
September 2002 - Volume 99 - Issue 1-2 - p
91–99.
8. Van Damme, Stefaan; Crombez, Geert;
Eccleston, Christopher., Coping with pain:
A motivational perspective Pain. 139(1):1-4,
September 30, 2008.
9. McCracken, Lance M; Eccleston, Chris.,
Coping or acceptance: what to do about chronic
pain? Pain. 105(1-2):197-204, September 2003.
10. Self-management of chronic pain: a
population based study, Blyth, Fiona;
March, Lyn M; Nicholas, Michael;
Cousins, Michael, Pain: February 2005 Volume 113 - Issue 3 - p 285–292.
Medicus article submission dates for 2015
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THE LINK BETWEEN
HEARING LOSS & MENTAL HEALTH
Find out more at the ESIA 2015 GP EXPO
All GPs are warmly invited to attend this highly
anticipated RACGP Accredited training event.
Utilising current research indicating the impact
of hearing loss on mental health outcomes,
ESIA experts will provide GPs with practical
workshops and hands-on demonstrations for
use in real life situations in GP clinics.
Entry is Free with food & beverages provided
Course is RACGP Accredited
Limited places available – book early
Where: UWA Club Banquet Hall, Hackett Drive Crawley
When: 23 April 2015
Register at: www.ESIAgpexpo.com
March
ME D I C US 33
OPINION
Reporting back from Canberra...as promised
Dr Steve Wilson
Chair, AMA (WA) Council of General Practice
I
have written a number of times in
the last few months of the need for
a full MBS reform and a true vision
for health funding – not more bandaid measures, scapegoating of General
Practice, while leaving hospitals off the
discussion table. Even the Productivity
Commission’s own report highlighted
just how efficient GPs are.
Last weekend was Federal AMA
GP Council in Canberra, with the
President, Vice President present and
full Council in attendance. The AMA
and its members can be incredibly proud
of the staggering amount of work done
at Branch and Federal AMA levels to
overturn the government’s appalling
GP policies, specifically the Level A/B
issue, and more recently the $5 rebate
cut and the Co-payment. But the battle
is far from over as yet more splintered
suggestions, even NHS style funding
models radiate out of Canberra.
The Level A/B issue was deliberately
released just before Christmas – it
created more anger and rancour among
the profession than I’ve seen in years. I
was contacted more in the last 10 weeks
by colleagues than at any time in my 10
years as WA CoGP Chair.
However, there still appears to be no
clear vision for GP Funding – even the
AMA is struggling with its complexities
and what is economically and politically
achievable.
I urge all of you to read, get informed,
get involved and work with the AMA
to shape future funding models, our
professional landscape and take charge
of our future direction. Be aware that
the dismantling of the GP space is
an international phenomenon, not
just in Australia. Worldwide General
Practice seems under assault; do google
https://www.opendemocracy.net/
ournhs and read UK GP Bob Gill’s
article, whats-happening-to-my-localgp-carrots-sticks-and-long-game-ofnhs-privatisation. The parallels are
staggering.
34 M E D I CU S March
Pharmacists in General Practices
Last year I wrote about Pharmacists in
General Practices and undertook to update
you once further developments occurred
between the AMA and the Pharmaceutical
Society of Australia (PSA). To build the
full multi-disciplinary team, we really need
to integrate non-dispensing pharmacists
into general practices as members of the
GP-led primary care team.
After careful consideration at its last
meeting in November 2014, AMACGP
agreed on a Practice Nurse Incentives
Program (PNIP) style model to support
practices to employ a pharmacist – it was
not only more likely to be accepted by the
profession, but has the highest likelihood
of government support.
The fundamentals of the model are:
• $25,000/year per 1000 SWPE where
a pharmacist works at least 12+2/3hrs
per week.
• Incentives capped at five per practice,
meaning that practices will be eligible
to receive up to $125,000 per year to
support their pharmacist workforce.
• A loading of up to 50 per cent for rural
practices would also apply.
Where to from here? The AMA recently
contracted the services of an economist to
undertake economic modelling and a costbenefit analysis of the proposed PNIP-like
model, and to prepare the business case
for GPs to participate in the incentive. It
should enhance patient care by improving
the use of medications, and reduce adverse
drug events and thus hospitalisations.
The AMA will use these analyses to
prosecute the case for the incentive with
the government as a part of the 2015-16
Budget Submission – this will give the
AMA over a year to advocate its benefits to
both sides of government in the lead up to
the 2016/17 Budget and the Election.
Pharmacists NOT in General
Practices
The GP Council’s concern however, is that
the PSA still seems to want it both ways.
Whilst not supporting initiatives such as
Pharmacy Skin Checks, the PSA strongly
supports an enhanced role for pharmacists
in patient care. The PSA is currently
moving to the implementation phase of its
Health Destination Project, which aims
to reposition the pharmacist as a primary
healthcare provider and the pharmacy
as a healthcare destination. The PSA
would argue there is an increasing body
of evidence to show that a pharmacist’s
role in assisting patients with a range of
minor ailments in a community pharmacy
leads to a high proportion of appropriate
referrals to a GP. Don’t be fooled! The
Health Destination Project’s real aims
are to enhance the financial viability of
pharmacies through increased sales of S2/
S3 medications to customers and raise
profit margins.
The AMA has advised the PSA that we
see the pharmacist’s greater role in patient
care being within General Practice as part
of the GP-led team and that we remain
opposed to any pharmacy-based activities
which undermine the GP’s role in quality
patient care, including vaccinations, sleep
disorders, minor ailments and wound care.
MBS Chronic Disease Item
Reform
Regarding MBS Chronic Disease Item
Reform, the AMA has continued to
provide strong advice to the Minister from
the Council of General Practice. The
Department of Health’s aims in the short
term are to:
• address long-standing criticisms
concerning the complex requirements
in the items and improve the efficiency/
effectiveness of CDM items by
reducing red tape for doctors whilst
maintaining necessary accountability.
• restructure the item fees to discourage
opportunistic claiming – and reward
those GPs who provide the longitudinal
high quality care for their patients.
Medicare has the capacity to easily
identify the ‘usual doctor’ and so stop
the appalling practice of opportunistic
billing of the well-paying CDM item
numbers by other doctors not usually
involved in the patient’s care.
Continued on page 35
OPINION
Managing multimorbidity patients
Dr Tim Koh
Chair, RACGP WA Faculty & AMA (WA) Councillor
T
he increasing prevalence of
multimorbidity (patients with
two or more chronic medical
conditions) in Australia presents a
difficult challenge for both GPs and our
health system.
For GPs, these patients often provide
us with the ‘heart sink’ moment which
comes from knowing that you do not
have enough time or resources to
solve the vast array of problems that
these patients present. Patients with
multimorbidity are also significantly
more likely to have fragmented care
(multiple specialists and healthcare
providers) and have a higher prevalence
of mental health issues. These issues
result in significant costs for our
healthcare system and at the end of it all,
patients often have lower quality of life
and feel let down with their care.
A recent article in January’s BMJ
provides some simple and practical
suggestions for managing multimorbidity
patients in General Practice. The first
suggestion is for practices to identify
patients with multimorbidity and assign them
a single doctor for their continuous care.
The second suggestion is to prioritise
these patients for longer consultations.
On face value, these suggestions appear
to be blindingly obvious, low-cost
interventions that have great potential
to help patients with complex health
needs. Beneath this, there are
complexities in our health system,
which make even these simple steps
hard to achieve.
The first suggestion – single doctor
continuous care – is difficult to
implement as our system (unlike the
UK) does not attach patients to a single
practice. This provides patients with
advantages such as options for access
and cost but risks fragmented care. For
multimorbidity patients, fragmented
care provides significant cost and
makes management of the already
complex problems more difficult.
The RACGP has advocated a ‘medical
home’ model for several years in which
patients were voluntarily registered to a
practice. A medical home would facilitate
better channelling of information back
to the GP, which is also invaluable for
patients with complex multimorbidity.
Equally important is that a medical home
would signal to patients and other health
providers the importance of single doctor
continuous care.
The second suggestion – allowing
more time to consult with multimorbidity
patients – is difficult to overcome as
our GP funding system rewards volume
Patients with
multimorbidity are
also significantly
more likely to have fragmented
care (multiple specialists
and healthcare providers)
and have a higher prevalence
of mental health issues
of patients seen, ahead of longer time
consultations or quality of care.
Ultimately our system requires
General Practice funding to reward both
volume and quality care. To some extent
this has happened in the past with the
addition of GP management plans to our
fee for service system. However these plans
renumerate doctors managing patients
with one medical condition equally to
those with complex multimorbidity.
Obviously it is hard to argue for
increased funding for patients in an era
of fiscal restraint. This argument is
easier to comprehend when it is put into
the context of the enormous costs that
multimorbidity patients have on our
health system. ■
Continued from page 34
Reporting back from Canberra...as promised
Dr Steve Wilson
• moderate growth in expenditure on
CDM items.
However the AMA specifically wants to:
• r educe red tape for doctors
• i dentify key actions/outcomes for
chronic disease patients (rather
than focusing on production of a
plan no one will read)
•m
aintain accountability
• and determine if the need for
multidisciplinary care under TCAs
remains relevant, without loss of
funding.
In addition, the AMA wants to:
• Evaluate the patient’s response
to the Management Plan and
treatment, support for GPs who
provide high quality, best practice
cycles of care, to distinguish less
complex patients’ needs from those of
highly complex patients, and identify
those who will gain the greatest
benefits from CDM interventions.
•Target referrals to Medicare
subsidise allied health services:
including how to better target the
allied health referrals so they are
directly related to the treatment of the
patient’s chronic condition, improve
allied health reporting/communication
back to the GP and prevent the
practice of ‘reverse’ referrals.
Until next month… ■
March
ME D I C US 35
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OPINION
Last Orders, Please!
Dr Richard M. Mendelson, MRCP FRCR FRANZCR
Professor Turab M. Chakera
W
ords are such small things,
like confetti in the brain, and
yet they color and clarify
everything, they can stain the mind or
warp the feelings. Diane Ackerman1.
Semantics is the study of meaning.
Words have denotations (i.e. literal
meanings or “dictionary definitions”)
and connotations (i.e. cultural or
emotional associations).
In linguistics, words also have
pragmatic or contextual meanings,
reliant in part on the subject matter,
the situational context, and the relative
positions of the speaker and listener.
With this in mind, let us examine the
word order.
The denoted meaning is “an
authoritative command or instruction”
(Oxford Dictionaries online) (http://
oxforddictionaries.com/definition/
english). The connotation of the word
is that the receiver is subordinate to
the giver and that the action resulting
from the order is not contingent on the
receiver’s agreement to undertake it.
Therefore, on the face of it, in the
case of radiologic “orders”, the word
would seem to be highly inappropriate,
because not only does it connote that
imaging specialists have no choice in the
matter of whether procedures are carried
out, it also markedly undermines the
roles of radiologists as consultants and
gatekeepers, on an equal footing with the
“orderers”. In addition, as the president
of the ACR stated in 2007, when we
allow others in medicine to treat imaging
studies as orders for tests rather than
requests for consultations, we further
enhance the danger of turning what we
do into a commodity.2
Some readers will undoubtedly argue
that the above is “just semantics,” but
we contend that it is for the very reason
of semantics (in the scientific sense of
the word) that it is so important that we,
as radiologists, strongly oppose the use
of the word order in our field.
Thoughts undoubtedly
determine our words, but
conversely, our words, through
habit of use, come to have lives
of their own and influence
our thoughts. And thoughts
determine our behaviour.
As the Chinese philosopher
Lao Tzu said, “Watch your
thoughts; they become words.
Watch your words; they become
actions. Watch your actions;
they become habit.”
All of the above is in support
of an appeal that at all costs, we should
avoid the use of order when it applies to
the referral of a patient for an imaging
examination, if we wish to change
the culture under which we practice
our specialty and (re)emphasise the
clinical consultant role we play in
patient investigation and management.
Our duty is not only to minimise the
number of inappropriate examinations
that are performed but also to ensure
that patients receive the most costeffective diagnostic management and
that the potential benefit of what we do
outweighs the risks.3
Were we kings for a day, we would
insist on the replacement of order with
request or referral or, better still, a
request for consultation. “Ordering” a
radiologic examination is not the same
as ordering a pizza.
In our hospital, junior clinical staff
members who utter the word order are
sent away with fleas in their ears. They
soon learn their error. Bearing in mind
that these are the consultant clinicians
of the future, we hope that the culture
of “ordering” will change and be
replaced with one of mutual respect and
cooperation in the management of our
patients. ■
This article was first published in
the Journal of the American
Some readers will
undoubtedly argue
that the above is
“just semantics,” but we
contend that it is for the very
reason of semantics (in the
scientific sense of the word)
that it is so important that
we, as radiologists, strongly
oppose the use of the word
order in our field
College of Radiology.
Richard M. Mendelson and
Turab M. Chakera are from the
Department of Diagnostic &
Interventional Radiology, Royal
Perth Hospital.
References
1. Ackerman D. One hundred names
for love: a stroke, a marriage, and the
language of healing. Farmington Hills, MI:
Gale Group; 2011.
2. Borgstede JP. 2007 ACR presidential
oration: four foundations for our future. J
Am Coll Radiol 2007; 4:875-8.
3. Chakera T, Khangure MS.
Radiologists’ lament. Med J Aust 2008;
189:628.
March
ME D I C US 37
FOR THE RECORD
Old school
Anaesthetist
proud of new directions
at SJG Subiaco Hospital
DR JOE PRACILIO
Director, Medical Services
St John of God Subiaco Hospital
Q. St John of God Subiaco Hospital is
extending its suite of services by launching
a three-theatre day surgery just across the
road from itself. What prompted the decision?
JP: St John of God Subiaco Hospital (SJGSH) over the
past few years has been attracting a more complex surgical
case mix. It had always been our plan to have open heart
surgery being performed at SJGSH, which I am proud to
say commenced on 17 October 2012. We were also aware
that combined with the ever increasing comorbidities of our
patients, we would be doing more bariatric and complex
surgeries. We have now created a facility where the focus is
exclusively day case surgery.
Q. What is unique about the St John of God
Wembley Day Surgery, due to open next
month?
JP: The St John of God Wembley Day Surgery (SJGWDS)
is a state-of-the-art facility. It is a 23-hour hospital, with
three large operating theatres, and has a capacity to have
up to eight patients stay overnight if required. We offer
a personal service to each patient with our caregivers
displaying the values of our organisation.
Q. What impact is it expected to have in
terms of elective surgery numbers in the
metropolitan area?
JP: We all know the demand for day surgery is ever
increasing and the opening of SJGWDS will help to meet
this increase in demand. By opening this facility, patients
have more surgical options and can choose to come to a
hospital that offers the values of Hospitality, Compassion,
Respect, Justice and Excellence.
Q. What have the primary challenges been in
the run-up to the launch next month?
JP: To be frank it has been a relatively smooth process.
Our lead executive, Mr Stephen Cooper (Director
Corporate/Finance) has done an outstanding job in
38 M E D I CU S March
engaging and partnering with everyone involved in the
project. In particular, I wish to highlight the exceptional
service given to us by Bateman Architects and the
builders, Georgiou Group who have both been incredibly
collaborative with us throughout the whole process. They
have delivered us an amazing suite of theatres which will
continue to meet our needs well into the future.
Q. You have been Director of Medical Services
at SJGSH for a year now. What is the biggest
lesson you’ve learnt during this time?
JP: I have been amazed by the quality of our caregivers
at SJGSH. Our organisation attracts people who live the
mission and values of St John of God. The significant
lesson I’ve learnt is the need for collaboration and clear
communication. This together with recognising that
every team member is vital for the ultimate success of any
project has allowed me to be an approachable and hands-on
Director of Medical Services.
Q. Clinical duties, administration, research
or teaching – which do you find the most
satisfying?
JP: I love it all! I’ve been a Specialist Anaesthetist for 27 years
and I am known as a workaholic, but I get such an amazing
feeling of satisfaction when I’m part of a team. I love being in
theatre – I call it my R & R. My administration role allows me
to not only look after my medical colleagues, but ‘pay back’
to a healthcare system that has given me the honour of being
able to practise medicine. Overseeing Research and Teaching
at SJGSH enables me to contribute to the improvement of
healthcare in WA. We acknowledge that for any organisation
to achieve true clinical excellence, you need to incorporate
both Research and Teaching into the fabric of your hospital.
F OR T HE R E COR D
Q. You have worked at a Consultant level in
both Anaesthesia and Emergency Medicine.
However going forward, you chose to work as
a Specialist Anaesthetist. Why?
JP: When you are young, you think you are invincible
and that you can do everything! Both specialties are
demanding and to maintain the highest level of skill, I had
to choose between the two. I chose Anaesthesia for several
reasons. Anaesthesia gives you the opportunity to work in
many areas such as Pain Medicine, General Anaesthesia,
Emergency Medicine and Intensive Care. Anaesthesia for
me is being a perioperative specialist, in that I consult with
patients in my private rooms pre-operatively, anaesthetise
them in an operating theatre and then review them
post-operatively to manage any pain or other issues. By
practising in this manner, it allows me to use all my skills
that I learned in my training. I’m proud to be an ‘old school’
Anaesthetist.
Q. What is it about Anaesthesia and Pain
Medicine that continues to fascinate you? Are
there any particular developments, innovations
or research about which you are excited?
JP: I started giving anaesthetics in 1984. Three decades
ago, there were no oximeters, end tidal CO2 monitors,
anaesthetic gas analyzers just to name a few advances since
I started. The improved monitoring of patients and the
specificity and selectivity of new drugs allows Anaesthetists
to give patients an extremely safe anaesthetic. I love the fact
that I can have a fully awake patient, anaesthetise them,
protect them from my surgical colleague, and then wake
them up. I’m still fascinated by the whole process. I always
look forward to going into an operating theatre and doing
my job.
I am excited about introducing Anaesthesia Research
at SJGSH. We launched Anaesthesia Research on 10 May
2012. We are currently involved in the Balance Study and
I’m proud to advise that despite the fact that we started
approximately eight months after most sites in Australia, we
are currently the third biggest recruiting hospital, and we
aim to be Number 1 by the end of June this year. ■
March
ME D I C US 39
R E SE A RCH
25/25 Vision needed to see through
Ovarian Cancer misunderstandings
Dr Kathy Nielsen
Director, Research and Advocacy
Ovarian Cancer Australia
O
varian Cancer Australia’s
(OCA) recent study of
the level of understanding
and awareness of ovarian cancer by
Australians conducted by Wallis Market
and Social Research in February in the
lead up to Ovarian Cancer Awareness
Month revealed that knowledge on the
disease’s symptoms and prevention is
still widely misunderstood.
A third of the 643 respondents in
the Wallis study believed that most
women diagnosed with ovarian cancer
can survive – however, the reality is far
different. Each year, more than 1,400
Australians are diagnosed with ovarian
cancer and 1,000 will die. It has the
lowest survival rate of any women’s
cancer – only 43 per cent of women
diagnosed will be alive five years after
diagnosis, that’s well below the average
over all cancers. By comparison, breast
cancer has a five-year survival rate of 89
per cent. (Figure 1)
The study also showed that
over a quarter of Australians know
someone who has been diagnosed with
ovarian cancer, yet nearly half of the
respondents did not know that the
Figure 1: Five-year relative survival.
40 M E D I CU S March
disease has any symptoms. This finding
is particularly concerning given the
importance of knowing and recognising
the symptoms of ovarian cancer to
detecting the disease as early as possible.
Currently, 75 per cent of women
are being diagnosed at an advanced
stage where the cancer has spread
and is difficult to treat successfully.
If diagnosed at an early stage, when
confined to the ovaries, women have
greatly improved chances of being alive
and well after five years.
Ovarian cancer is commonly
misdiagnosed due to its non-specific
symptoms such as bloating, which is
often attributed to ‘menopause’, and
many women delay medical advice on
this basis.
The four key symptoms of ovarian
cancer include:
• abdominal or pelvic pain
• increased abdominal size or
persistent abdominal bloating
• t he need to urinate often or urgently,
and
• feeling full after eating a small
amount.
Women should consult their GP
if these symptoms are new, if they
experience one or more of them
persistently over time and particularly
if they are experienced with fatigue,
unusual weight-loss or gain and/or a
change in bowel habits.
The Wallis study also revealed that
over half the respondents wrongly
believed that the Pap smear can be used
to detect ovarian cancer, and around
one-third of the respondents incorrectly
believed that the HPV vaccine protects
against ovarian cancer. Only one in
10 Australians knew that the oral
contraceptive pill reduces the risk of
ovarian cancer and this is the least well
known among women aged over 50,
who are most commonly affected by
ovarian cancer. There is a clear need for
raising awareness of symptoms and the
risk factors for ovarian cancer and for
understanding when a woman should be
referered for genetic testing.
OCA’S NATIONAL ACTION
PLAN FOR RESEARCH
In November 2014, OCA launched its
watershed National Action Plan, setting
out urgent priorities for research that
R E SE A RCH
have the potential to make a significant change to the number of
women dying each year, and to fill the need for a cohesive national
strategy for funding and conducting ovarian cancer research.
The Plan has been developed in consultation with a wide
range of stakeholders including key opinion leaders and
consumers (women living with ovarian cancer), researchers
and clinicians. It sets out a roadmap for research priorities
and a Charter providing principles for conducting, funding,
evaluating and reporting research. The Charter also calls
for alignment from all researchers and funders in the field
to encourage collaboration and a common agenda across the
ovarian cancer community.
The National Action Plan is the first of its kind in Australia
and for the first time provides a priority-driven focus for
investment, unifying efforts and providing a blueprint for
researchers and funders from around the country with the goal
of improving outcomes for women living with ovarian cancer.
Australia is at a remarkable time in cancer research and
management. Advancements in our understanding of the
biology of ovarian cancer have afforded researchers new
insight into the significant differences between the distinct
cancer subtypes. This cannot be understated – not only is
it changing the way we might treat the disease with existing
therapies, it is also enabling the development of new, targeted
immunotherapy treatments.
Australian research has played an important role in
advancing this new understanding of the biological basis of
ovarian cancer, and due to high levels of expertise, access to
collaborative resources such as the Australian Ovarian
Cancer Study and ANZGOG, and the close networks of
researchers, the Australian research community is well
positioned to build on this progress.
the signs and symptoms of ovarian cancer and is
diagnosed as early as possible.
• increasing focus on raising awareness of symptoms
and risks of ovarian cancer in the medical
community to support early diagnosis.
II. I mprove the identification of women at risk of developing
ovarian cancer by:
• promoting a better understanding of family history
and improving referral to familial cancer centres for
genetic testing
• increasing research efforts into new genetic and
environmental risk factors and prevention
III. Increase access to effective treatments and care by:
• Timely and affordable access to new, targeted
therapies that may already be available in other
countries. This could be achieved by improving
regulatory processes for new therapeutics and
companion diagnostics and for their reimbursement.
• Making clinical trials more accessible to women
with ovarian cancer
• Making personalised medicine a reality, through
increased funding for small, smart clinical trials
(and supporting research) to target the women that
would benefit the most
• Ensuring equity of access to treatment and care
nationally – treatments need to be available to
women regardless of their personal circumstances
(e.g. location, culture, financial resources etc.). ■
25/25 Vision
Last month, OCA announced its 25/25 Vision to the
government on Teal Ribbon Day (25 February) at
Parliament House in Canberra. This ambitious campaign
aims to improve the five-year survival rate of ovarian
cancer by 25 per cent by the year 2025.
The Vision aligns with the World Health
Organisation’s 2013 World Cancer Declaration, which
calls for cancer societies around the world to collectively
work on targets to reduce the burden of all cancers by 25
per cent by 2025.
OCA is calling for stakeholders and supporters to work
Figure 2: Funds invested in ovarian cancer research in Australia.
together to achieve this Vision through the following
three-pronged approach:
I. Improve awareness and early diagnosis by:
• increasing the reach of community awareness
campaigns so that every woman in Australia knows
For more information about OCA, visit www.ovariancancer.net.au
For more information about OCA’s 25/25 Vision or to pledge your
support, visit www.ovariancancer.net.au/2525vision
March
ME D I C US 41
R E SE A RCH
Julian Heng, PhD
Associate Professor, UWA School of Medicine and Pharmacology
Group Leader, Brain Growth and Disease Laboratory
The Harry Perkins Institute of Medical Research
M
y name is Julian Heng, and it
is a pleasure and a privilege
to contribute an article to
Medicus. As a former Science graduate
of The University of Western Australia,
I am thrilled to have an opportunity to
conduct my research in this beautiful and
warm city, and to call Perth my home
once again.
My career as a research scientist really
began in the backyard of my family
home where I would dedicate myself to
disassembling any household appliance
or essential item I could find – the
vacuum cleaner, my parent’s VHS tape
of The Blues Brothers, and my identical
twin brother’s cassette recording of our
band’s musical performance.
While such recollections speak of
my contributions to housework and
home entertainment (or lack thereof),
and harkens back to a time before the
internet, my appetite for deconstruction
stems from an innate curiosity to learn
how a device is put together, how it works
effectively to store information, and to
deliver content. My interest to apply
myself to define the physical substrates
of one of the most enigmatic machines I
know of, the human brain, once took me
away from Perth. This interest in brain
research has now brought me back home
again.
As a young life scientist in the early
days of tertiary education, I took on
42 M E D I CU S March
a reductionist view of the biological
world, where the information encoded
within our genome is key to providing
the instructions to build an organism,
to program its survival, and to maintain
fitness in a constantly changing
environment.
Armed with this early knowledge, I
then gravitated towards the study of the
mammalian nervous system, with all its
secrets, to ask a simple question – how
are genes involved in the birth of brain
cells and the formation of functional
brain circuits?
In the late 90s, and despite my lack
of formal neuroscience training, I
undertook PhD studies at the Howard
Florey Institute with Professor
Seong-Seng Tan, one of the leading
developmental neurobiologists in the
world. He quickly recognised my
practical approach to research, and was
somewhat impressed by my out-of-thebox take on brain development.
As I deconstructed the scientific
literature to learn about the formation
of the cerebral cortex, the region of
the brain which governs our cognitive
abilities as well as the ability to express
emotions, it was clear that while it
comprised several different kinds of cells,
the cerebral cortex arises from a simple
sheet of epithelial-like cells of initially
uniform appearance and distribution.
The diversity of brain cell types comes
from genetic instructions within stem
cells of the foetal brain to coordinate
the timely production of neurons, glial
cells and oligodendrocytes which come
together to form neural circuits.
Arguably, there are few amongst us
whom would glance at an illustration
of the brain by Santiago Ramon y
Cajal, one of the founders of modern
neuroscience, and not be struck by his
beautiful representations of brain tissue
when examined as a thin slice. However,
it is the activities of genes which shape the
initial complexity of different cell types,
guide their cellular organisation within
the growing brain, and coordinate unique
cell shapes and particular branching
characteristics of neurons. Genes are
critical to the organisation of brain circuits
which fire and wire correctly.
I had an unforgettable experience
as a postdoctoral research fellow in the
UK (funded by a C J Martin Fellowship
from the National Health and Medical
Research Council, Australia, as well
as a Fellowship from the Medical
Research Council, UK) to study the
fundamental genetic mechanisms that
drive the formation and organisation of
new nerve cells within the developing
mouse brain. Working amongst my
enthusiastic international postdoctoral
researchers and colleagues, I made an
important discovery about the gene
regulatory functions that guide the
R E SE A RCH
proper placement of new neurons in the
embryonic cerebral cortex.1
Notably, I discovered that there is a
precise regulation of gene expression
that enables new nerve cells to navigate
their way to their appropriate locations
within the growing brain, and to make
the right connections. Critically, a
failure in this process can lead to an
inappropriate localisation of neurons and
the formation of abnormal brain circuits.
When I would stop pipetting and delve
into the scientific literature, it was clear
from what I read that these concepts
gleaned from studies of mouse brains
rang true in the context of human foetal
brain development and disease.
Indeed, brain malformations have
been known to occur in approximately
2 per cent of live births, with these
children presenting a spectrum of
clinical diagnoses such as cerebral
palsy and epilepsy. Furthermore,
brain malformations are increasingly
recognised as a feature in children
diagnosed with autistic spectrum
disorder. With the use of magnetic
resonance imaging to evaluate children
with neurological symptoms, there
is a growing realisation that brain
malformations are a common cause of
intellectual disability.
In the case of cerebral palsy alone,
which accounts for abnormal brain
formations termed Malformations of
Cortical Development (MCD), the annual
cost in Australia was $1.47 billion in
2008.² Equally concerning is the notion
that MCDs can be caused by genetic
mutations that disrupt the process of
human fetal brain development.
As I turned away from my research
articles and sat back at my postdoc bench
in the UK, I realised that I had acquired a
new experimental method to manipulate
gene expression in the developing mouse
brain, known as in utero electroporation.1
This technique was the means to study
how genetic manipulations might impact
upon the development of cerebral cortex
neurons. I was determined to apply my
skills to benefit clinicians caring for their
patients with neurological conditions.
In 2010, I had an opportunity to start
my own laboratory at the Australian
Regenerative Medicine Institute. It was
during this time when I was approached
by a fellow Australian scientist, David
Keays (Group Leader at the Institute of
Molecular Pathology, Vienna, Austria)
with what looked to be an enigmatic
mystery. Over the telephone, David
had described work with his clinical
colleagues which led to the identification
of three unrelated individuals whom
were diagnosed with brain abnormalities
consistent with MCD. Strikingly, each
individual had a genetic mutation to a
protein-coding gene known as TUBB5.
The question was – do genetic mutations
to TUBB5 cause brain disorders?
Armed with this hypothesis, my lab
set out to develop a preclinical model to
understand how this gene would normally
be important for brain development,
and whether the introduction of these
mutated forms of TUBB5 might be
detrimental to the functions of brain
cells. Exploiting the fact that the initial
steps of nerve cell production and cell
positioning within the cerebral cortex
drew significant parallels between the
mouse and the human, my lab conducted
a series of experiments in which we
modelled the presence of these mutated
versions of the human TUBB5 gene
during mouse brain development.
Using our newly perfected approach
of in utero electroporation, we introduced
either a normal or mutated version
of human TUBB5 into cells of the
embryonic mouse cerebral cortex to
enable us to study how its presence might
affect nerve cell development. To our
great excitement, we discovered that the
mutated versions of TUBB5 caused the
defective distribution and connectivity
of cerebral cortex neurons.³,4 Together
with a range of biochemical, molecular
biological and neurogenetic tests and
clinical data, we proved that mutations to
TUBB5 caused brain disorders.³ We have
identified a new brain disease-causing
gene in humans.
Since our discovery, we are learning
more about how TUBB5 is important
for fetal development. More broadly,
we now know to offer genetic screening
for mutations to TUBB5, among other
disease-associated genes, within the
context of genetic counselling and
planned parenthood. There are likely
to be more individuals in the world
suffering an MCD which could harbour
an undetected genetic mutation to
TUBB5. The discovery of TUBB5 has
also enlightened my research to focus on
this new player in neuronal development.
In discussing this research with a
WA clinician at a recent seminar, he
commented that we see “clarity from the
extremity”.
Important discoveries are made by
interdisciplinary teams with researchers,
clinicians and the community working
together to learn, to synergise their
strengths and educate each other along
the way.
Here in Western Australia lie
significant resources and expertise
to enable us to be a leading force
in understanding the genetics and
neurobiology of brain disorders. It is
clear that research institutions (the
Harry Perkins Institute of Medical
Research, the Telethon Kids Institute,
the Western Australian Neuroscience
Research Institute), genetic diagnostic
laboratory services (PathWest) and
hospitals (Royal Perth Hospital, Princess
Margaret Hospital), together with five
universities could contribute to this team
effort. Together with our collaborators
nationwide and across the world, we
can be the world leader in the discovery
of many more genes for brain disorder.
For me, TUBB5 is only the start of this
journey into brain-gene discovery.
Finally, I would like to mention that the
title to my article has two meanings. As a
scientist, I appeal to clinicians interested
in my research to get in contact with
researchers such as myself. Together, we
can piece together the critical genetic
signalling networks necessary to build
neural circuits in the brain. I appeal to
the readership of this journal to join me in
my cause to decipher the neurogenetics of
brain developmental disorders in humans.
The second meaning to my title lies
closer to home. I am innately curious
about the inner workings of the brain,
and to understand the underlying basis
for the biology of Brain Growth and
Disease. While the brain is definitely more
sophisticated than a vacuum cleaner, VHS
tape or cassette, knowing how this organ is
put together will enable us to unlock the
secrets to a healthy mind. ■
References available on request.
March
ME D I C US 43
PROFILE
S
itting in his West Leederville home that looks out to
Lake Monger, Dr John Suthers’ eyes – unlike mine –
aren’t drawn to the incandescent waters ahead. Instead
he’s looking upwards, considering the sky, which is awash
with fleecy clouds.
“It’s not a particularly good day for cross country gliding,”
muses John.
“What you need is good thermal updraft. However that
will only ‘crack’ around midday today.”
Noticing the complete incomprehension that suffuses
my face, John quickly plucks out a sheet of paper and starts
sketching. For the next hour and a half, I am introduced to
the world of gliding – or soaring, as some call it – by a man
whose passion for the sport is undeniable.
“Life on the ground is limited to two dimensions. When
I’m up there all by myself, I’m living life in 3D. How exciting
is that!”
44 M E D I CU S March
John turned to gliding about 10 years ago in a bid to spend
some quality time with his then 15-year-old son, David. Soon
two of John’s three children and even wife Marina became
enthralled by the sport, taking to the skies themselves.
It was – and still is – a fantastic exercise in family bonding,
John points out, and a relatively inexpensive one at that.
“It costs me around $2000 a year,” he says.
“What’s more important, however, is to make sure your
wife is part of it as well.
“It particularly helps to some extent when you’re
stranded in a wheat field after a land-out, like I was a
few weeks ago, and running terribly late for a family
gathering,” he chuckles.
As if on cue, Marina enters the room and frowns, “Yes of
course, he calls the wife first.”
An Occupational Physician working part time at the Next
Health Group, John savours the days he can go soaring in
PROF IL E
the single seat glider he co-shares with his good friend,
Ross Richardson.
A member of the Beverley Soaring Society, John
considers himself a relative newcomer compared to his
peers at the club.
“It’s a great bunch of completely mixed
personalities. Some members are very young; you can
go solo at 15 – even before you can get your driver’s
licence.
“And then there are pilots who have been gliding
since the 1970s and even the Second World War II,”
says John in a reference to Dick Sasse, a glider pilot
based in Morawa who was, up until quite recently,
winning competitions at age 91.
John does participate in competitive gliding, his most
recent outing being at the Southern Cross Competition
in December 2014. Ask him how he went, and he laughs:
“Poorly! There are so many out there who are far better
than I am.”
The absolute thrill of gliding is what takes John back
though, no matter how he fares.
He clearly remembers his very first solo flight.
“It took 85 flights with an instructor before I could go solo
– and when I did, it was exhilarating.
“The next major hurdle was my first 300km flight, which
was also very exciting,” John recalls.
“I remember reaching 1,000 feet AGL and 60km from
home and thinking I was going to land out in a wheat field.
But then out of nowhere, I found a thermal (a naturally
occurring current of rising air in the atmosphere) and got
lifted up to 9,000 feet in about 10 minutes.
“It is so exciting and such a relief to suddenly find a
thermal? These are what we call God’s petrol stations – free
air, free lift, free energy.”
Gliding in the airspace above Beverley, pilots are allowed
to go up to 8,500 feet but once they leave the immediate
vicinity, heights of up to 12,000 feet are allowed.
It took John roughly 200 flights before he plucked up the
courage to go cross country.
“It’s like cutting your umbilical cord as you are going
beyond ‘easy gliding home’.”
Cross country gliding involves catching a thermal up to
about 7,000-10,000 feet and then flying in a fairly straight
line to the turn point, taking more thermals on the way.
Distances of 300km are common. However a couple of
good pilots in WA have recorded 1,000km in one flight in a
single day.
Gliding, John explains, has little to do with power and
strength; it’s a mind sport. There is enormous skill and
discipline involved in taking that glider up, identifying
thermal currents in order to maintain your height, and then
landing back at home.
“It is 100 per cent focus and concentration. If I were to
answer my mobile phone while gliding, I could easily lose
control of my glider.
“Lookout – that’s what the game is about.”
The Gliding
Federation of Australia also places a
strong emphasis on safety, which dovetails into John’s work as
an Occupational Physician.
All glider pilots, he says, chart their course beforehand and
set up a flight plan.
“And then you stick to it!”
While John has glided overseas in Kenya over herds of
hippos, in Chile over the Andes with vultures for company
as well as in the UK, glider pilots have got it good here in
Australia, he says.
“The English weather rarely generates enough energy
to thermal beyond 4,000 feet. But the Australian summers
are ideal for those warm thermals. I’ve reached a height of
14,000 feet.”
Both John and Marina believed gliding would be a “fiveyear wonder” for their family; an activity they hoped to
pursue every other weekend.
“Yet it becomes your life; everything revolves around it,”
John says.
“You certainly can’t have too many late nights, or too
many ‘big’ nights before a day’s flying.”
The Suthers also hold the view that all teenagers should
learn to glide before they learn to drive.
“Discipline, focus and concentration are key – and you
have to think outside your space and have your options clear,
otherwise you limit yourself,” says John.
Solo gliders battle issues such as fatigue and dehydration,
and have to be in tune with their physical and psychological
limits.
“If only all drivers on the road maintained the same
discipline!” he says.
Discipline aside, the joy of gliding is unparalleled for John.
“It is so relaxing to be up in the air. You don’t think of
Perth, and work. And you’re flying with the eagles, literally.
“Wedge-tailed eagles can feel the lifting air better than
anyone. So if you see one, head for it! He’s in the best
thermal you’ll find for the next five kilometres.” ■
FOR MORE INFORMATION ON THE BEVERLEY SOARING
SOCIETY, VISIT WWW.BEVERLEY-SOARING.ORG.AU
March
ME D I C US 45
OPINION
Vale Freo
F
Dr John Zorbas
Co-Chair, AMA (WA) Doctors in Training Committee
or most junior doctors, the 3rd
of February 2015 wasn’t about
the opening of Fiona Stanley
Hospital. It was about the closure of
Fremantle Hospital. Sure, Freo remains
open but in a relatively crippled form.
The ED was closed. Bed capacity was
reduced to 300. Tertiary services were
closed and/or shifted elsewhere. The
RMO society ceased to exist.
For those who have known Freo, it
was a sad end to what was a glorious
place for doctors in training and patients
alike. I’ve spoken to a number of
Fremantle doctors both past and present
and there were three recurring themes as
to why Freo was such a great hospital.
“We were big enough to
service the community
and small enough to care”
A lot of hospitals like to claim the very
sexy cliche of being both big enough
to provide every service that was
required of them but small enough to
still maintain a sense of community.
I especially love the ones that place
variations of those slogans on the 15
forms you need to fill out to change
anything or request anything.
Freo had the balance right and it
didn’t achieve it through letterheads.
It achieved it through the right use of
human capital. In Freo, if you had a
problem, you knew who to speak to
and you knew how to speak to them.
This is a relatively simple concept and
yet so many large organisations get it
fantastically wrong. Hospitals should
never undervalue clear and rapid lines
of communication. They save time, they
save money, they make for a happier
workplace and they make for safer
patient encounters.
it’s true. You see, the
day-to-day business of
Freo was such that it
was hard to hide for too
long. If you came from
another hospital or
straight out of medical
school with an attitude,
you’d last a maximum
of one term before
someone called you on
it. This is important if
you want to maintain
End of an era: Fremantle Hospital’s emergency department services
closed on 3 February 2015. Pic: Gnangarra…commons.wikimedia.org
a positive culture in
your hospital. Some
formalised. The value of an operational
people claim that it was just a case of
common room is significant and you
having fewer staff or a smaller campus
demolish them at your own peril.
but I don’t believe that’s the case at all.
The scaling down of Freo was
The difference was that Freo forced you
an emotional loss because Western
to interact with other schools of staff,
Australia lost a precious culture that
whether you were heading to South
has not been preserved. Sure, you can
Terrace for a coffee, or attending an
transplant your staff to FSH but this
educational seminar. It’s hard to be
isn’t the same thing. Culture isn’t just
negative when you know the people
about people, it’s about the way those
you’re dealing with personally. This of
people are empowered to interact, and
course brings me to the third and most
we’ve lost what Freo had built. I cannot
vocal point.
even begin to quantify the reduction
“The Blue Room”
in mortality and morbidity from Freo’s
positive culture but Id love to find
Oh, the Blue Room. You could be
someone who can.
forgiven for thinking the Blue Room
To WA’s Directors of Medical
was some semi-magical palace after
Services, please take note of why
speaking to Freo staff. Hospitals in WA
Freo was such a successful exercise in
continue to underestimate the value of
common rooms and it’s because we can’t workplace culture.
To Freo’s various and numerous
give you the dollar value that you’ll save
administrators, we will never be able to
by investing in one. Common rooms
thank you enough for the service you
are, contrary to popular administrative
belief, not places where doctors can skive provided to doctors in training and by
extension, to the community alike.
off. They are places where doctors can
To Freo: Rest in peace, old friend.
communicate in confidence. They are
We’ll miss you dearly. ■
places where consults can occur with
rapidity and with the opportunity for
the senior to teach the junior at the same
time. They are places where teams can
“You couldn’t be a
debrief following traumatic or difficult
d*ckhead and get away
situations. They are places to relax and
with it”
get to know your colleagues. These kinds
I personally love this one, mostly because of systems are organic – they can’t be
46 M E D I CU S March
The AMA Doctors in Training Committee
would like to formally thank Fremantle
Hospital’s clinical and non-clinical
administrators for their successful hard
work over the years. Dr John Zorbas would
like to thank those who provided feedback
for the article.
OPINION
After-hours ward cover:
A stat course in triage
Dr Natalie Smith
Intern, Fremantle Hospital
L
ike many of my fellow interns,
after six years of medical
school I felt ready to take
on the challenges of the medical
internship. No longer would I have to
borrow my junior medical officer’s HE
number, or seek a signature for every
blood test or script that I organised
for the team. Finally, I was a medical
Intern at Fremantle Hospital.
The day-to-day happenings on
the ward were familiar territory after
three years of hospital placements.
Registrar or Consultant-led ward
rounds, followed by a long list of jobs
to complete, and, time permitting, a
coffee in the Blue Room.
What I was less accustomed to
were the happenings on the wards
after hours. As dusk rolls in, medical
staff slowly start to vacate the wards,
and the hospital becomes somewhat
quiet and peaceful compared to the
hustle and bustle of the day. My
peaceful reverie lasts no more than
five minutes, as the stillness is broken
by the piercing beep of my pager
– and I enter the unfamiliar territory
of my first evening ward cover shift.
I am the initial point of call for any
medical upsets, and have the added
task of being part of the Medical
Emergency Team (MET), for which
I carry a second “makes my heart
rate increase to MET criteria
whenever it beeps” pager.
The intensity of a ward cover shift
is entirely variable and can range
from re-writing medication charts, to
assessing a patient with chest pain, to
attending multiple medical emergency
calls. Often it is a combination of
the three, requiring the development
of a new skill – triaging your pager
messages. This can be difficult,
when each message is less than 100
characters with no context, and
invariably arrives when you are in
the middle of putting in a cannula.
However, once you are able to reach a
phone, you must determine from the
nurse how sick their patient is, and
where they should fall on your list of
patients to see.
Triaging patients based on
information gathered from a telephone
call – without the luxury of an end-ofthe-bed-o-gram – can be difficult as a
junior doctor. It is on these occasions
that you learn the importance of asking
targeted questions to the caring nurse,
and gain a true appreciation of the
experienced senior nurse.
As junior doctors, we are used to
receiving verification for the plans
we put in place for patients. This
verification is harder to come by in an
after-hours environment, and you just
have to learn to trust your judgement.
One of the circumstances I struggled
with the most was leaving an unwell
patient in order to move on and assess
the next patient on the list. I found
in these circumstances, a quick call
to the Medical Registrar was of great
assistance. Receiving confirmation of
your plan – and being able to document
“as discussed with medical registrar” –
can allow you to move on and assess the
next patient with a clear conscience.
As part of the Intern program at
Fremantle Hospital, medical interns
are included in the Medical Emergency
Team. Our inclusion in the team
is largely educational – to give us
exposure to the management of medical
emergencies on the ward. Although my
first shift with the team was somewhat
anxiety provoking, this apprehension
rapidly diminished with my first MET
call. The team has extensive medical
expertise and knowledge to manage
unwell patients, and being involved in
this process is invaluable.
Although an often challenging
experience, after-hours ward cover
gives you the chance to escape from
the ever increasing pile of paperwork
that encompasses a typical day as
an Intern. Your clinical skills and
knowledge are put to the test in an
environment that demands a steep
learning curve. And at the end of a
shift, you can turn off your pager, and
go home feeling like a real doctor. ■
March
ME D I C US 47
A M A ( WA) AWA R DS
It’s Awards season!
Nominations for the 2015 AMA (WA)
Awards are now open
Below are details for two awards that will be presented for 2015.
All awards will be judged by independent expert panels and
winners announced at the AMA (WA) Gala Dinner and Awards
Night on Saturday 1 August 2015 at Crown Perth.
AMA (WA) AWARD:
Nominations for the AMA (WA) Award are invited from all sectors of
the medical profession, before Monday 20 April 2015. It is expected that
nominees will have demonstrated a tireless dedication to either the service of
others, their chosen field, or be pioneers who have worked without seeking
recognition for their efforts. Nominations should be accompanied by
adequate evidence and include the names of supporting referees.
The winner is presented with a fine bronze bust of Hippocrates.
For further detail contact Paul Boyatzis either by email
Achievement: Professor Ian Constable (left) was
[email protected] or phone 9273 3007.
recognised with the coveted AMA (WA) Hippocrates
Award and Fred Chaney AO was presented with the
AMA (WA) President’s Award last year.
Junior Doctor of the Year 2015
Nominations for this prestigious annual award open on 27 March 2015.
The AMA (WA) Junior Doctor of the Year (Dr Camille
Michener Legacy Award) recognises the significant and outstanding
contributions of our Doctors in Training to the medical profession and
the community in areas such as teaching and education; leadership and
advocacy; and doctor’s wellbeing and community service.
The Award establishes a fitting legacy to the memory of
Dr Camille Michener who is remembered as a staunch advocate and
benevolent friend, well-liked and respected by all who knew her.
Nominations will close at 4.30pm on Friday 1 May 2015.
So start thinking about who you will nominate for this
Award to ensure that we continue to recognise and celebrate
the outstanding contributions of our Doctors in Training to the
medical profession and the community.
For further information please contact Skye Connor
([email protected]) or Josephine Auerbach
([email protected])
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Cormann and AMA (WA)
President Dr Michael Gannon.
In memory: Dr Camille Michener.
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OPINION
Mandatory Reporting – What Are Your
Legal Obligations?
M
Puja Menon
Claims Manager (Solicitor), MDA National
any health practitioners
are uncertain about
the Health Practitioner
Regulation National Law (National
Law). Similarly, many doctors are
not clear on when they must make a
mandatory report to the Australian
Health Practitioner Regulation Agency
(AHPRA).
Those who support mandatory
reporting believe it enhances patient
safety, allows poor performance to be
addressed and enables identification of
unsafe health practitioners.
In contrast, those who criticise
mandatory reporting believe it creates
a culture of fear, prevents health
practitioners from seeking help, and
allows for vexatious and frivolous
reporting (particularly against the
backdrop of professional rivalries).
Whichever side of the debate you sit on,
mandatory reporting is an area of law that
needs to be better understood. The aim
of mandatory reporting is to prevent the
public from being at risk of harm. This
is consistent with health practitioners’
general ethical and professional
obligations. However, the threshold to
trigger a mandatory report is high.
All health practitioners registered
under the National Law, employers of
practitioners and education providers
have an obligation to report “notifiable
conduct”. The Medical Board of
Australia’s guidelines for mandatory
reporting state that the “practitioner
or employer must have first formed a
reasonable belief that the behaviour
constitutes notifiable conduct or a
notifiable impairment or, in the case
of an education provider, a notifiable
impairment”.
“Notifiable conduct” is where the
health practitioner has:
• practised the profession while
intoxicated by alcohol or drugs
• engaged in sexual misconduct in
connection with the practice of the
profession
• placed the public at risk of
substantial harm in the practice
of the profession because of an
impairment
• placed the public at risk of harm by
practising in a way that constitutes a
significant departure from accepted
professional standards.
For those reporting notifiable conduct, a
reasonable belief must be formed – this
is a state of mind and involves a stronger
level of knowledge than mere suspicion.
The Medical Board has made it clear
that mere speculation, rumour, gossip or
innuendo is not “reasonable belief”.
The National Law provides for
categories of exemption from the
requirement for mandatory notification.
Currently, the exemptions include those
practitioners who:
• reasonably believe that AHPRA has
already been notified of the conduct
by someone else
• a re treating practitioners practising
in Western Australia
• a re exercising functions as a
member of a quality assurance
committee, council or other similar
body approved or authorised under
legislation which prohibits the
disclosure of the information
• are employers or engaged by a
professional indemnity insurer and
form the belief because of a disclosure
in the course of a legal proceeding or
the provision of legal advice arising
from the insurance policy.
The National Law has protection
provisions for health practitioners,
employers and education providers
making notifications in good faith under
the National Law. The protection is
from civil, criminal and administrative
liability including defamation.
In addition to the mandatory
reporting requirements of the National
Law, any entity that believes a health
practitioner’s behaviour presents a risk
to the public (but that behaviour does
not meet the threshold for notifiable
Whichever side of
the debate you sit on,
mandatory reporting
is an area of law that needs
to be better understood. The
aim of mandatory reporting
is to prevent the public from
being at risk of harm. This
is consistent with health
practitioners’ general ethical
and professional obligations.
However, the threshold to
trigger a mandatory report
is high
conduct) is able to make a voluntary
notification to AHPRA. This is based
on the ethical obligation to notify
concerns about a practitioner placing
the public at risk of harm.
Health practitioners need to better
understand what does and does not
trigger mandatory reporting. Making
a mandatory notification is a serious
step in preventing the public from being
placed at risk of harm and should only
be taken on serious grounds. You should
seek advice from your medical defence
organisation to discuss your obligations
before making a mandatory notification.
Those doctors who are unwell should
be able to access their own healthcare and
seek support from their colleagues. One
such support service is the MDA National
Doctors for Doctors program aimed at
providing Members additional support
during a medico-legal matter and
enabling them to share their experience
confidentially with another medical
practitioner. ■
This article is provided by MDA National.
It recommends that you contact your
indemnity provider if you need specific
advice in relation to your insurance policy.
March
ME D I C US 49
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PRO T E C T ING W E A LT H
Is your business
underinsured?
Sue Jowett
Business Development Manager
AMA Insurance Brokers
A
s a business owner you work hard to ensure your
business runs smoothly and you’ve taken the steps
to ensure it is protected if the unforseen happens
such as a fire, storm, wind or explosion or accidental damage.
BUT are you covered for replacement?
What is underinsurance?
Underinsurance may occur when you fail to obtain an
adequate level of business insurance to match the true value
of replacing business assets.
Research has shown that only 63 per cent of Australian
small to medium-sized businesses have adequate insurance,
with a further 26 per cent having no form of general
insurance at all.
In most instances, businesses only realise the impact of
being underinsured following an event such as flood or fire,
causing serious damage to stock or business premises.
Tips to avoid underinsurance
1) Re-evaluate your needs
The cost of building has risen sharply over the last few years.
Steel alone, as an example, is 40 per cent dearer than this
time two years ago. Inflation and general building costs have
also risen over time.
Ask yourself the following questions:
• Have you recently changed premises?
• Have you brought new stock or equipment?
• Has your annual turnover increased?
If you answered ‘yes’ to any of these questions, it could
mean that you’re currently underinsured. Make sure that you
are re-evaluating your insurance needs at least once a year in
order to ensure that you have the right level of cover.
2) Don’t always settle for basic cover
As a business owner, it can be dangerous to assume ‘it
won’t happen to me’ and subsequently opt for a basic level
of insurance coverage for your business. In most instances,
your business is your livelihood so it is well worth taking
out policies that not only meet but will exceed your business
requirements.
Chasing a lower premium may save you a small amount
of money at the time but in the event you are required to
Contact us: AMA Insurance Brokers
Email: [email protected]
Phone: 1300 763 766
claim on your insurance policy, it is likely that the losses you
experience will far outweigh the small saving you made on
opting for a basic policy with a lower premium.
This is one aspect of your business you should not try
to cut corners with. Taking the time to properly assess the
actual value of your business assets and securing adequate
insurance will protect you from a significant damage bill
should an incident occur.
3) Consider Business Interruption Insurance
For most small businesses, an unforeseen business disruption
that prevents them from providing their services for a
substantial period of time could create some serious financial
implications.
Sit down and thoroughly assess your business’ potential
risks and strategies that can be implemented to successfully
deal with those risks if they come to fruition. In conjunction
with a Business Interruption Insurance policy/cover which
assists you in the event your business has been disrupted for
a considerable amount of time, your business can avoid any
loss of income.
4) Seek professional advice
When considering your business insurance requirements,
it is often beneficial to talk to a broker who can provide you
with professional advice in relation to your unique business
requirements.
There are a vast number of insurance policies available and
it’s not always easy to determine which level of cover is right
for you so speaking with a broker will assist in ensuring your
business is properly covered. ■
References:
Insurance Council of Australia - http://www.
insurancecouncil.com.au/. Insurance & Risk
Professional - http://insuranceandrisk.com.au/67547e7c/
Underinsurance_puts_pressure_on_ Australian_businesses
AIMS – The pitfalls of underinsurance for businesses brochure.
Understand insurance - http://understandinsurance.
com.au/do-you-have-enough-insurance?search_
keyword=underinsurance#tab-2
General Advice Disclaimer
The information provided in this article is General Advice only.
It has been prepared without taking into account your objectives,
financial situation or needs. Before acting on any advice you should
consider the appropriateness of the advice, having regard to your
objectives, financial situation and needs.
March
ME D I C US 51
OPINION
Divest for a healthier future
A
Kiran Narula
President, Western Australian Medical Students’ Society
s doctors, we are trained to
respond to emergencies – the
more serious, the quicker we
respond. Yet, despite a well-established
connection between climate change and
ailing human health, we are still failing to
act in a meaningful and substantive way.
Climate change, which is estimated to
be already responsible for 400,000 deaths
annually, poses significant risk to our
health and our survival unless we mitigate
the threat now.
Directly, it promises more extreme
weather events leading to deaths and
injuries by heat waves, fires and floods.
Indirectly, global warming will result
in increased morbidity and mortality
by vector-borne diseases such as
dengue fever as pathogens’ and vectors’
distribution and lifecycles change.
The largest effects, however, will likely
be on our social systems – climate change
and sea rises will worsen food insecurity,
exacerbate poverty and drive increased
migration and conflict. Solomon Islands,
for example, are already formulating
evacuation plans for the inevitable.
This is not news – world institutions
acknowledged this most recently at the
2014 UN Climate Change Summit in
New York. However, despite facing “the
biggest global health threat of the 21st
Century”, movement to avoid climate
change is occurring very slowly. Organised
individuals have therefore taken it upon
themselves to pursue change.
One such movement is GoFossilFree. It
is an international network of campaigns
calling upon educational, religious, public,
and private institutions to divest from
fossil fuels – to uninvest their money from
companies that are profiting from mining,
exporting or generating energy from
fossil fuels. It is premised on the moral
argument that “if it is wrong to wreck the
climate, then it is wrong to profit from
that wreckage”.
Divestment is not a novel idea. It
was widely used in the 1970s and 80s
to punish any foreign company that
52 M E D I CU S March
continued business with the
apartheid regime of South Africa.
More recently, health institutions
led divestment campaigns against
tobacco companies during the
1990s citing ethical concerns. In
the case of GoFossilFree, there
are economic as well as ethical
justifications for divestment.
The financial rationalisation is
dependent upon a concept of the
‘carbon bubble’.
To avoid the worst effects of climate
change, global warming must be limited
to just 2 degrees above pre-industrial
temperatures (a threshold already
considered dangerous). To remain below
this limit, scientists estimate that we can
produce no more than 565 gigatonnes
of carbon dioxide. Known fossil fuel
reserves however, if burned, equate to
2,795 gigatonnes – a significantly greater
amount. Therefore, to achieve this target,
the majority of fuel reserves must remain
underground.
Because of this reality, many
economists are predicting a ‘carbon
bubble’. At present, the share market
valuation of fossil fuel companies does
not include the possibility that trillions
of dollars in fossil fuel assets could be
untouchable, but when it does, that bubble
will burst. Whilst divestment usually
seeks for investors to remove their money
for ethical reasons, fossil fuel divesting
is attempting to force investors to realise
the financial risk and move their money.
Divesting early is therefore not only a
political statement but also a move to
secure financial returns.
As to whether the economics of
divestment actually works is still
debatable, but the negative PR created
when multiple institutions declare it
unethical to invest in your business does.
Around the world, many organisations
have pledged to divest. Stanford
University, where the movement
originated has pledged not to invest in
coal.
In Australia, the Uniting Church
has resolved to divest from all companies
involved in fossil fuels. Most recently,
Sydney University declared that they would
cut their carbon footprint by 20 per cent
over three years, although there are calls
for them to do better. The boldest decision
however has come from the Rockefeller
Brothers Fund, a charity whose principal
wealth came from old oil money.
These institutions, and specific fossil
fuel free stock indices, are repeatedly
demonstrating that it is possible to achieve
similar or better returns than conventional
counterparts.
At this junction, I can tell you that
WAMSS is divesting too by changing its
banking and investment practices, placing
us on track to be the first medical student
society to do so. Our finances may be
small change but we believe we have an
ethical and fiduciary responsibility to do
so. My thanks must go to the previous
Executive for beginning this process,
and to Devaki Wallooppillai for being the
primary instigator.
As health professionals, we have a
responsibility to protect and promote
health, but a lack of action on climate
change goes in the face of that. We must
use our uniquely privileged role in public
discussion to unambiguously state that
there must be a transition to a more
sustainable society, for the health of our
people and planet alike. Divestment
affords us that opportunity.
For comments or references,
please contact Kiran Narula at
[email protected]
OPINION
Enacting the right higher
education reform is crucial
I
Kate Nuthall
President, Medical Students’ Association of Notre Dame
n the coming weeks it seems that
Christopher Pine, Minister for
Education (pending possible ministerial
reshuffle) intends to reintroduce legislation
to deregulate the fees Australian Universities
are able to charge students. This legislation
has the support of a number of universities,
many of whom claim that the current
level of tertiary education funding is
inadequate for universities wishing to
remain internationally competitive. Both
the National Union of Students and the
Australian Medical Students’ Association
(AMSA) oppose this legislation.
Often the concerns of medical
students regarding fee deregulation fall
on unsympathetic ears. We’re told that as
future high-income earners, we shouldn’t
be concerned with our future debts, patted
on the head and sent back to the library.
The people telling us this have mostly
enjoyed the benefits of a completely free
education and were only too happy to pull
the ladder up after themselves.
It is true that many of my peers will
go on to live out their days in the top
tax bracket. No doubt some of their
taxes may even go towards supporting
higher education in the future. However,
current medical students will already
leave university with a debt to the tax
office the size of a deposit on a house. Fee
deregulation would increase this amount,
making medical education more difficult
for those already facing economic and
geographic barriers.
The concern regarding fee deregulation
is two-fold. This is a matter that doesn’t
only concern the equity of access to a
medical education but also affects the
whole community. While fee deregulation
would undoubtedly improve the funding of
tertiary institutions, it is unlikely to propel
fresh graduates with large debts into jobs
that are less well remunerated. Quite often,
it is these jobs that primarily deal with the
isolated and disenfranchised members of
our community.
We all know that doctors earn a range
of salaries. A Melbourne University
Working Paper Series identified that
specialists can earn up to 32 per cent more
than their General Practice counterparts.
To think that this will not influence the
decision making of a fresh graduate with
a $200,000 debt, as opposed to a fresh
graduate with a $60,000 debt, is naïve.
Since the release of the 2014 Federal
Budget, we have seen the role of the
General Practitioner constantly under
attack. GPs seem to be the first target
for any cuts to health spending, despite the
essential role they play in preventative and
primary healthcare. The prevailing view that
General Practice is not a worthwhile place
to be spending our health dollars not only
damages the morale of a hard working group
of people, it also makes the career pathway
rather less attractive for new graduates.
We need GPs, we need people working
in Aboriginal Health, and we need
people working in remote and isolated
communities. We need people who come
from rural backgrounds to return to their
communities, rather than being shut
off from medical education because of
financial barriers.
MSAND prides itself on the diversity
of the Notre Dame medical cohort – we
have people from a range of backgrounds
and age groups, such is the nature of postgraduate medicine. Many of these people
would be at the stage of life where signing
up for a further four years of study and
a huge debt would be impossible. This
legislation would exclude a great number of
talented people from medicine.
Medicine is a course where demand far
outstrips supply – the number of applicants
for medical places far exceeds the number
of successful candidates. We know that we
are in a privileged position.
WAMSS President Kiran Narula
and I have previously spoken about the
consequences of increasing medical
students numbers in Western Australia
and the negative impact this would have
on training pathways. We cannot apply
the rules of the free market to medical
education. The market assumes that people
will always make a rational decision. Those
who gave up high-paying professions to
study medicine will happily tell you that
their decision to study medicine was not
an economically rational one – for many
people this is a vocation as well as a career.
We need to recognise that education
does not solely benefit the person who
receives it. Today’s students will go on to
work in public hospitals and undertake
extensive training at a post graduate level,
forgoing many opportunities in order to
take up a vocation that many have spent
We cannot allow
medical education
to be beyond the
means of talented people
who lack the resources to
enter into significant debt
the majority of their lives working towards.
A society that fails to value medical
education lacks the foresight to see how
quality medical education benefits us all.
Having the best doctors, as opposed to the
ones who were able to overcome financial
barriers and felt able to take on a large
amount of debt, benefits society as a whole.
Higher education reform is inevitable
– but enacting the right reform is crucial.
The Federal Government must ensure
that a balance is struck between the longterm viability of our universities and the
equitable access to tertiary education.
We cannot allow medical education to be
beyond the means of talented people who
lack the resources to enter into significant
debt. We also cannot turn medicine into
a purely economic pursuit where the best
paid specialties are flooded with people
trying desperately to pay off student debts
so they can get on with having families and
saving for house deposits. This will leave
a number of areas of medicine neglected
and only further exacerbate the current
problems surrounding equitable access and
distribution in the health system. ■
March
ME D I C US 53
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F ROM T HE OOPINION
E PDII NT OR
ION
All roads to the regions
Madeleine Gordon
President, SPINRPHEX (Students and Practitioners
Interested in Rural Practice, Health, Education Xetcetera)
I
t is with great pleasure that I write here as the new
President of SPINRPHEX. Firstly I would like to
thank the outgoing committee and its President, Patrick
Thornton, for all of their hard work during these past
12 months.
Now to the big question you are probably asking – who are we?
SPINRPHEX (Students and Practitioners Interested iN
Rural Practice, Health, Education Xetcetera) is a studentrun rural health club, which is comprised of more than 800
medicine, dentistry and nursing students. It is funded by
both the NRHSN (National Rural Health Students Network)
and the University of Western Australia (UWA). Formed in
1990 by UWA students, our reach has since widened and we
now represent students from all of the five universities across
Western Australia.
As a Rural Health Club, our overriding goal is to improve
the standard of healthcare in rural and remote Australia. We
achieve this by hosting academic and social events for students
that allow them to develop the passion and skill sets they need
to work in a rural setting.
So why attend our events?
One of the wonderful things about our club is the opportunity
for students to network with the people they will eventually be
working with. No longer are doctors the lone rangers – we work
as part of multidisciplinary teams – so it is to our advantage to
make these connections early. Our club provides students the
opportunity to meet and mingle with nursing and dentistry
students and in fact via joint events with our allied health
counterpart, WAALHIIBE, we offer the whole buffet.
Our events also give students unique educational
opportunities. We organise a range of workshops
throughout the year including sessions on Obstetrics,
plastering and mental health. This gives pre-clinical
students a unique opportunity to develop skills usually only
accessible to those in clinical years. This, combined with
the host of talented, experienced speakers who headline our
events, provides students with unique and personal insights
into working out bush.
SPINRPHEX also works with rural high school
students, encouraging and – hopefully – inspiring them to
pursue careers in healthcare and adopt healthy lifestyles.
A recent study by the University of Queensland1 has
demonstrated that one of the key predictors of working in
a rural healthcare setting is having a rural background.
As part of our commitment to the NRHSN, we visit a
number of rural high schools each year to encourage students
to consider working in healthcare. Unfortunately, due to the
expansive nature of WA, we found we were unable to access
as many schools as we would have liked. As a result, we
developed the SPINRPHEX Mentoring Program.
Now in its second year, the program allows high schools
students to connect with current medical and other
healthcare students via teleconference. Here students have the
opportunity to ask their mentors any questions they may have
about university, moving to the city and courses in health,
among other issues. The feedback has been most encouraging
with students commending the personal nature of the
program and the direct contact it facilitated with mentors.
The SPINRPHEX Committee and I look forward to
another exciting year for our club – during which we hope to
reach out to even more students and actively encourage their
interest in rural healthcare.
For membership enquiries or if you are interested
in speaking at one of our events, please contact us at
[email protected].
For more information head to our website https://
spinrphex.nrhsn.org.au/. Don't forget to ‘like’ us on
Facebook at www.facebook.com/Spinrphex or follow us
on twitter @SPINRPHEX”. ■
References:
1. Kondalsamy-Chennakesavan S, Eley DS, Ranmuthugala
G, et al. Determinants of rural practice: positive interaction
between rural background and rural undergraduate training.
Med J Aust 2015;202 (1): 41-45.
Interaction: Students practise their suturing skills
at the annual SPINRPHEX camp.
March
ME D I C US 55
DR Y E S
A GOOD YEAR TO COME
New sessions and new schools on the radar for Dr YES, says Alex Hansen
New team: (from left) Saish Neppalli, Ellen Robinson, Karen Bromley,
Oliver Righton, Catherine Jolghazi and Alex Hansen.
D
r YES (Youth Education
Sessions) is a program run
by the Australian Medical
Association where medical students
and assured pathway students visit
metropolitan and rural high schools to
have open and engaging discussions
about the big issues facing youth health
– particularly alcohol and drugs, mental
health and sexual health. Dr YES
interacts with around 10,000 students a
year in Perth and across country WA.
The end of 2014 saw the appointment
of seven new coordinators and two
med assured mentors. The Dr YES
Coordinators for 2015 are Oliver Righton
(MD2), Catherine Jolghazi (MD2), Karen
Bromley (MD1), Benjamin Palladino
(MD1), Ellen Daniels (MD1), Maureen
Krasnoff (MBBS6) and myself (Alex
Hansen, MD1).
Saish Neppalli and Marissa Loh
(both assured pathway students) will
take on the important responsibility of
coordinating undergraduate recruitment
and mentoring, which will play a
fundamental role in ensuring the future
of Dr YES for years to come. Finally,
Verity Moynihan (MBBS6 and 2014
Dr YES Coordinator) is providing
handover training and mentoring the
new 2015 leadership team for the first
quarter of 2015.
As the popularity of Dr YES
56 M E D I CU S March
amongst Perth’s metropolitan schools
is constantly growing, January saw a
constant stream of school bookings flood
our email account. Sessions have been
booked as far in advance as September
and we are excited to get back into
schools this week with our first visit to
Iona Presentation College. Extending
into March we will be visiting up to
three schools every week, taking 10-12
volunteers per session. So, keep an eye
out for the brightly coloured Dr YES bus
hitting the road soon!
The popularity of Dr YES doesn’t
stop at the schools, as our recruitment
drive has seen a number of new assured
pathway and MD students register their
interest for our upcoming training nights
in March. We are excited to announce
that we have secured some great guest
speakers in the form of Chris Harris,
Clinical Services Manager at Youth
Focus, who will speak at our Mental
Health training session; Dr Lewis
Marshall who will be returning to give
his popular talk on sexual health; and
Leigh Cleary from the Drug and Alcohol
Office who will give insight into the
current trends in alcohol and illicit drug
use amongst WA’s youth.
Registrations for training nights
are constantly coming our way and
we’re shaping up to train over 150
new volunteers. The training of new
volunteers is also particularly exciting
as we are introducing brand new session
content to reflect the current and
important issues surrounding youth
health. For example a new section
regarding consent has been added in the
delivery of our sexual health teaching,
along with newly updated information
regarding contraception.
Additionally as the use of psychoactive
drugs, steroids and other synthetics is on
the rise, new modules addressing these
issues are close to being finalised and
will be added to our teaching modules
very soon. Further training later in 2015
is also in planning to give our volunteers
valuable insight into more specific areas
of youth-centred health.
Our rural trips are also in their
initial stages of planning with a visit to
Mandurah scheduled to occur in early
May. Our week-long rural trip will take
place in June and will see 20 volunteers hit
the road to Albany, visiting schools both
in the town itself and the surrounding
areas. These visits to rural areas of WA
are extremely important as it gives us the
opportunity to engage with young people
who may not have the same access to youth
services as metropolitan students.
Overall, 2015 is shaping up to be a busy
and exciting year for Dr YES and we are
looking forward to meeting thousands of
students. ■
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A M A IN T HE ME DI A
AMA IN THE MEDIA
DEAD SPOT
Doctors say the lives of patients are
at risk because some staff cannot get
mobile phone reception at Fiona
Stanley Hospital.
One doctor said the mobile black
spots were a “disaster waiting to
happen” and cited calls to three
doctors seeking advice about a patient’s
treatment going straight to message
banks because they did not have mobile
coverage.
AMA (WA) President Dr Michael
Gannon said the phone issue need to
be fixed urgently.
“A doctor’s mobile phone is an
essential part of their life and they
might be on call for patients in
numerous hospitals,” he said.
“There is an expectation doctors
will be available to answer questions
about their patient’s care and in some
specialties, there is an expectation they
will be available to attend to patients in
30 minutes,” Dr Gannon said.
The West Australian, 25 February 2015
CHEMIST FLU JABS CHEAP,
NASTY: AMA (WA)
A discount war for flu injections in
pharmacies is cheapening a medical
procedure into a product like shampoo,
according to some doctors.
The AMA (WA) said flu shots
marketed by chemists for as little as
$9.99 were turning vaccination into
something “cheap and nasty”.
But AMA (WA) President Dr
Michael Gannon said “shopping centre
vaccination” was not good medicine.
“We have to be open-minded
to different methods of improving
vaccination rates and health authorities
are doing it for the right reasons
but they have not listened to our
arguments,” he said.
“This is a cash grab and all they are
doing is helping to deliver profits to
multinational retail pharmacies,”
Dr Gannon said.
The West Australian, 20 February 2015
SCHOOL BERRY ALERT
Health and education authorities are
warning GPs and schools to watch
for signs of hepatitis after the first
West Australian became infected
in a nationwide outbreak caused by
contaminated frozen berries.
AMA (WA) President Dr Michael
Gannon said the outbreak showed up
a weakness in food safety in a country
that prided itself on high standards.
“Hepatitis A is highly infectious and
it’s essential people who prepare food
are extremely careful with personal
hygiene, Dr Gannon said.
The West Australian, 19 February 2015
LEFT WAITING
Perth’s hospital reconfiguration has
been blamed for the highest number of
West Australians waiting for elective
surgery in at least three years.
Doctors said the surge was related to
the opening of Fiona Stanley Hospital
and moving surgical specialties from
Royal Perth and Fremantle hospitals.
AMA (WA) President Dr Michael
The AMA (WA) social media pages have continued to have
a strong start to the year as the AMA reaches the ‘1000 likes’
mark. A recent collaborative video between the AMA and
the WA Department of Health on the importance of influenza
immunisation during pregnancy was very well received by
follower of the Association’s Facebook page, sparking a
heated discussion between anti-vaccination conspiracy
theorists and doctors. The post was seen by well over 3,000
people, and continues to generate discussion.
58 M E D I CU S March
Gannon said even if hospitals did more
surgery, it was hard for them to keep
their heads above water.
“But there is no doubt the hospital
reconfiguration is causing a temporary
blip in efficiencies and that’s before
you even consider the problems they’re
having at Fiona Stanley Hospital
because of the sterilisation issue, which
we know has slowed down the theatre
input,” he said.
Dr Gannon said the surge in
waiting list numbers also reflected
the increasing demand year-on-year
because of the ageing of the population
and more chronic diseases such as
obesity.
The West Australian, 28 January 2015
NOWHERE FOR SICK TO STAY
Country patients are being forced to
go without medical care because they
can’t find a place to stay overnight while
being treated at WA’s new flagship
hospital.
The AMA (WA) is calling on the
Barnett Government to urgently
address the shortage of accommodation
options near the $2 billion Fiona
Stanley Hospital in Murdoch.
AMA (WA) President Dr Michael
Gannon said the government must
make affordable accommodation
available near these hospitals or
substantially increase subsidies available
under the Patient Assisted Travel
Scheme.
The Sunday Times, 22 February 2015
Other popular posts include the Association’s concerns
with issues surrounding Fiona Stanley Hospital, and the very
successful AMA 2015 Intern Cocktail Party.
The AMA (WA) Facebook page continues to lead the
other AMA Facebook pages in terms of ‘likes’ per week and
engagement, a positive trend that shows no signs of abating.
Twitter followers continue to rise at a rapid pace, with
most WA Members of Parliament and senior journalists now
following the Association.
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MA
ZD
A2
Small, but big impact
PIC: TONY HEWITT
DR I V E
MA
X
X
Dr Peter Randell
I
f ever there was an example of
small NOT meaning less, it must
be the new Mazda2. In this very
competitive segment of the new car
market – light cars – mazda2 has
some seriously good little opponents.
Toyota Yaris, Honda Jazz, Suzuki
Swift, Hyundai i20, Ford Fiesta, Kia
Rio, Mitsubishi Mirage, Nissan Micra,
Peugeot 208, Renault Clio, Skoda
Fabia and Volkswagen Polo all fight it
out. There, I told you there was lots of
opposition.
From the initial visual hit, Mazda
makes its mark with the 2. This is a
sensuous small hatchback with flowing
aerodynamic lines, four doors and a
hatch back lift-up making for a practical
beauty. Slipping in to the comfortable
driver’s chair, one finds a clear dash
with a prominent speedo centrally,
and a lesser tachometer to the left. The
Maxx variant has a centrally mounted
screen showing audio settings, this
being the touch screen GPS map in
the more sophisticated Genki form.
The smart steering wheel has buttons
for phone, audio and cruise control,
and is adjustable for reach. Air con is
personalised for driver and navigator.
I sat my 175cms in the rear seat
comfortably, but any baggage needs to
go in the boot with the space saver spare.
Storage space is good for cups, phones
and coins, with all surfaces impressing
with an air of quality not expected at
this entrance level.
The Colour Pack Option was
particularly impressive in the Genki I
saw but did not drive – it has burgundy
upholstery with gloss red sides to the
central console, front door armrest
sides, the dash highlight panel and
vent surrounds. At $250, I suspect
it will be a popular option. It certainly
makes the usual black interior of most
cars look positively funereal.
Driving the car for the weekend was
a joy. Steering was accurate and well
assisted without making it feel like a
blancmange. All the safety features
remained discretely hidden and, I am
pleased to say, untested. For those who
meet challenging circumstances, there
is an alphabet of support – ABS, VSC,
EBD, EBA, TC and Hill Hold start. Pay
a little extra – I would – and you may
add Smart City Brake Support which
will slow and even stop your car
at speeds between 4-30kph
should the vehicle
in front slam
on the skids
when you
are looking
up a side
road. I
know you
would never
be looking down
at your phone sitting discretely on
your lap whilst you were driving…
Talking of extras, I was disappointed to
find that one has to opt for front and rear
sensors and a rear view camera as extras.
Get them! You will be safer for your fellow
man – and more importantly perhaps –
child. That is $1300 well spent.
Performance is sprightly without being
any risk to the MX-5’s reputation, the
1.5 litre four-cylinder making 79kW and
139Nm while returning an astounding
4.9-litres/100 kms with the six-speed
manual, and a little more with the auto
six speed. Thank that very clever Sky
Activ technology which Mazda has
developed. Intelligent-off engine at rest,
instant restart with foot off the brakes
and high compression ratio all helps.
Add low 91 RON fuel and this light car
is extraordinarily economical to run. If
you cannot come to terms with the onoff technology, you may turn it off with a
button to the right of the steering wheel
(next to the Vehicle Stability Control;
leave that one operational!).
I wanted to drive the Genki model,
but they are selling like hot cakes and
that variant was not available. It has
Mazda’s special MZD connectivity
which links to Internet radio (which
I love) and social media (which I do
not). The Genki also has a clear seveninch touch screen for Sat-Nav with
spoken street names and advanced lane
guidance…AND Head Up Display. A
Command Dial similar to BMW’s allows
a flick through menus and functions too.
Texts and emails can be read out loud,
helping push the image of a thoroughly
21st century car.
As I said initially, small does not mean
less. I love it!
Vehicle supplied by Osborne Park
Mazda. RRP: Neo version from
$14,990 (plus ORC); Maxx from
$18,990 (plus ORC); Genki from
$22,390 (plus ORC). ■
March
ME D I C US 61
T R AV E L
Mother
Table Mountain might be the
headline act in Cape Town, but
there is much more to South Africa’s
oldest city that will win you over
K
nown affectionately by South Africans as the
‘Mother City’, Cape Town is South Africa’s oldest
city and the gateway to its many diverse highlights.
There is good reason why discerning international travellers
succumb to the many charms of Cape Town.
Its rich blend of tradition, history and the many modern
influences on its food, culture and attitude create a spirit
that is unique to the city. Then of course, Cape Town and
its surrounding regions offer a stunning catalogue of some
of Mother’s Nature’s best work.
Table Mountain defines the city with its soaring profile
much like a silent, proud sentinel. This world heritage site is
a must on any visitor’s itinerary, especially for the amazing
views of the Cape that are afforded from its heights. There
are many other equally gorgeous natural landscapes within
the extensive boundaries of Table Mountain’s National Park,
and beyond.
62 M E D I CU S March
Rugged, pristine coastlines and impressive mountain
ranges enhance Cape Town’s reputation as one of the most
beautiful cities in the world. It is an entry point to a rich
tapestry of scenic touring routes which showcase many a
small coastal town on the way.
The vibrant Cape Town life centres around the famous
Victoria & Alfred (V&A) Waterfront. The Waterfront
has the fantastic energy of a working harbour and offers
visitors everything from upmarket shopping, quality
art and craft markets, theatres and live music venues,
talented buskers showcasing local music and dance, the
Telkom Exploratorium and the awe-inspiring Two Oceans
Aquarium. Museums and art galleries abound and South
Africa’s oldest building, the Castle of Good Hope, is located
in the heart of the city.
At the heart of the winelands of Cape Town is the
Stellenbosch wine country – a place of great beauty and
T R AV E L
Experience: Rolling vineyards, award-winning wines and and iconic
Cape Dutch homesteads are the hallmark of the Stellenbosch region.
culture steeped in South African tradition. Wine lover or not,
a visit to the region is an absolute must with its breathtaking
vistas and majestic mountain backdrops. Rolling vineyards
and iconic Cape Dutch homesteads are the hallmark of
the Stellenbosch region, not to mention an abundance of
world-class, award-winning wines. Stellenbosch town is a
treasure of beautifully restored buildings – elegant Cape
Dutch, Victorian and Georgian architecture can be seen
particularly in historic Dorp Street, which is reminiscent
of the rich and colourful past. There is a bustling sidewalk
café scene in the French tradition located in the heart of
Stellenbosch and it is easy to laze away a few hours enjoying
the ambience.
The Cape Peninsula is considered by many to be one
of the world’s most beautiful places. Pristine beaches,
sheltered bays and secluded coves abound and any visit to
Cape Town is incomplete without taking in the spectacular
views of the Cape Peninsula and Cape Point.
The best way to revel in the Peninsula’s unrivalled
beauty is to travel to the Cape of Good Hope Nature
Reserve along the Atlantic Coast passing through the
rustic fishing village of Hout Bay and over the aweinspiring, cliff-hugging Chapman’s Peak Drive to the endless,
white expanse of Noordhoek’s Long Beach.
Although Cape Point is not the most southerly tip of Africa as many people
believe, it is undoubtedly one of the most beautiful parts of the African
continent. A funicular ride to observe the old lighthouse and enjoy the
panoramic views is an absolute must. ■
Landmarks: Chapman’s Peak Drive is just one of several scenic touring routes
and (above right) the famous Victoria & Alfred (V&A) Waterfront.
Cape Town is the destination of the
AMA (WA) Clinical Conference in August 2015.
Visit www.amawa.com.au for further information.
March
ME D I C US 63
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F OOD
Minimal cooking, maximum flavour
Josh Catalano
C
ontinuing with last month’s theme of seafood, I have decided to present two recipes that require minimal
cooking, yet offer maximum flavour. Mussels are just about the easiest thing to cook that you can find,
and with a generous splash of white wine, these can be the star at any dining table. The smoked trout
salad involves hardly any cooking too – just the potatoes need boiling. All your hands need to do is a bit of slicing and dicing followed by some assembling and there you have it – seriously good fuss-free food!
MUSSELS IN WHITE WINE
Serves about 4
Ingredients
• 2kg fresh mussels
• 80g butter
• 2 garlic cloves
• 1 French shallot, diced
• 1 red chilli, diced
• 1 cup dry white wine
• 2 stalks of coriander,
separate the leaves
and stalks
• 1 lime
Method
This recipe works best if you purchase the mussels
that are already cleaned and debearded, and
vacuumed packed with ocean water in them.
• Heat a heavy-based saucepan or pot (big enough to
hold the 2kg of mussels) on medium high, then add
the butter, garlic, shallots and the chilli.
• Chop up the coriander stalks, add them to the
pan and cook for 2 mins, ensuring not to burn the
ingredients.
• Open the packet of mussels and retain 1 cup of the
water from the packet. Discard the rest of the water.
• Add the water and the wine to the saucepan and
cook for another 2 mins. Then add the mussels
and cook with the lid on for 3-5 mins, or until the
mussels are just open.
• Separate the mussels evenly and garnish with
coriander leaves and fresh cut lime.
SMOKED TROUT SALAD
Serves about 6
Ingredients
• 2 whole smoked trout
(350g)
• 4 large potatoes, boiled
and sliced
• ½ cup sour cream
• 1 lemon
• 50g capers
• ¼ red onion, diced
• Pinch of fresh herbs,
chives and parsley
• Salt, pepper & extra
virgin olive oil lime
Method
• To clean the smoked trout, peel back the skin
to expose the flesh. The top fillet will come
away from the bone easily. Then just break
up the flesh and remove any small fine bones.
Turn over the fish and repeat on the other
side.
• Place the sliced, cooked potato on a large
serving platter, then sprinkle over the capers
and diced red onion.
• I n a small bowl, add the sour cream and the
juice from the lemon, then drizzle over the
potatoes.
• Break up and scatter the smoked trout fillets,
then garnish with the herb mix and season
with salt, pepper and olive oil.
March
ME D I C US 65
W INE
Italian Varietals
A
– Australian Made
previous article went to
great lengths to encourage
readers to step outside their
comfort zone, eschew their usual wine
preferences and try some of the less
well-known European varietals – those
mostly coming from Spain, France and
Italy.
You don’t need to go fossicking on
the shelves of your wine merchant for
European labels for these varietals as
they are being produced in a number
of vineyards across Australia.
One such vineyard, Oliver’s Taranga
Vineyards, has taken these varietals
on as a special project, known as their
Small Batch range.
Fiano was Oliver’s foray into
this project and has been produced
annually since 2008, with stocks
selling out in quick time. Fiano
is relatively new to Australia, and
originates from the Campagna region
of Italy. This is their seventh vintage
of the variety and the Olivers love
working with it. It is a very interesting
variety, which is able to maintain acidity
in the grapes, even in the hot South
Australian summers. This is a minimal
intervention Fiano made with indigenous
yeast, and has no added acid.
The 2014 Fiano has been made
without the use of oak. The wine is
made by Corrina Rayment, a sixth
generation Oliver family member
and responsible for the quality wines
produced by Oliver’s. The wine is
pale straw in colour and the bouquet
displays preserved lemon, lime, cashew
nut, basil and ginger spice. The palate
has loads of pine nut and cashew
texture, sweet fruit roundness, with
great tannins and mouth feel. The
flavours are subtle with a lingering
aftertaste. This wine will have you
wanting another and another.
Oliver’s has also been producing
Vermentino since 2011. Also a native
of Italy, Vermentino is generating a
lot of interest in the wine community
due to its heat tolerance, and ability to
produce crisp and fresh wines, perfect
for the Australian palate.
The 2014 Vermentino was also
made without the use of oak, and is
made to drink in the next 12 months,
preferably with a plate of fresh Western
Australian seafood. It also won a
Bronze Medal at the 2014 Boutique
Wine Awards. Like the Fiano, its
You don’t need to
go fossicking on
the shelves of your
wine merchant for European
labels for these varietals as
they are being produced
in a number of vineyards
across Australia. One such
vineyard, Oliver’s Taranga
Vineyards, has taken these
varietals on as a special
project, known as their
Small Batch range
cooler, wetter year, certainly hasn’t
had any impact on the quality of the
wine. It is dark crimson in colour with
a slate-like bouquet, including florals,
Christmas cake, spice and ironstone
characters. The palate displays
liquorice and lovely floral tannins, with
loads of savoury fruit and a fresh acid
line.
Tempranillo is becoming a popular
variety in McLaren Vale with its
more savoury notes and rustic charm.
Oliver’s has been producing vintages
since 2006, using old French oak
only on this wine, letting the varietal
characteristics stand out. Only a small
quantity is produced and 2013 was
a warm vintage and a drought year,
resulting in excellent intensity and
flavour in the fruit. This vintage has
good drinking appeal. Its colour is
dark red cherry, the bouquet showing
lifted blueberry fruits, spiced plums
and sweet fruit. The palate is medium
bodied, with fresh acidity, more blue
fruit characters, lovely varietal tannins
and great length –bursting with cherry
vibrancy and flavours. Pure drinking
pleasure and a good food wine. ■
colour is pale straw. The bouquet
smells of lemongrass, ginger beer, lime
and sea spray. The palate displays
lifted freshness with an attractive
powdery tannin and mouth-watering
natural acidity; there is also lemon
grass and kaffir lime, with plenty of
texture.
Rayment also produced a
Sagrantino in 2011. This grape is
found traditionally in the town of
Montefalco in Umbria, and as such,
is used to plenty of heat and suits the
McLaren Vale region. The berries
have extremely thick skin, loads of
rich tannins, a beautiful floral aroma
and a great natural acid line. It is the
inaugural release of Sagrantino under
the Oliver’s small batch range. The
March
ME D I C US 67
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Bellfort
5%
At Bellfort commercial interior design and
fit-out, we pride ourselves on delivering high
quality commercial interiors on time, on budget, every time.
We specialise in:
• Personal and responsive customer service
• Single point of contact
• Cost-effective and innovative solutions
• High quality work
• Aftercare service.
Bellfort would like to offer AMA (WA) members a 5 per cent
discount on any interior fit-out confirmed prior to 30 June 2015.
For more information contact Bellfort on 6141 1030, via email:
[email protected]; or visit the website www.bellfort.com.au
Hyatt Regency Perth
Located by the beautiful Swan River,
Hyatt Regency Perth offers close proximity to the East
Perth shopping and business area, WACA Oval and
walking and cycling tracks.
This award-winning hotel offers superior comfort and
convenience for guests with complimentary Internet, fine
cuisine with five restaurants and bars, leisure facilities and
ample event space.
Hyatt Regency Perth is pleased to offer a 15 per cent
discount on the best rate of the day exclusively for AMA
(WA) members. Please call Reservations on 13 1234 to
book and mention AMA (WA) to receive your discount.
68 M E D I CU S March
10%
Windows Estate
Estate Grown. Estate Made. Estate Bottled.
This is one of the few artisanal grape-to-bottle wine producers
remaining in the Margaret River region – utilising traditional
winemaking techniques to handcraft wines of elegance and
distinction. A modern cellar door incorporates cheese and
gourmet foods, art, jewellery and gifts.
To get an exclusive 10 per cent discount and FREE freight
within Australia on all case sales, please call membership on
(08) 9273 3030 or email [email protected]
On the TOWN
To win a double pass to one of the following events, simply go to
www.amawa.com.au/membership/onthetown.aspx
Entries must be received by 4pm, Monday 23 March 2015
MACA Limited
Classics Series
Ravishing
Rachmaninov
7:30pm Friday 17 & Saturday
18 April
Perth Concert Hall
Rachmaninov’s Second
Symphony is a richly romantic
symphony, moving from
Conducting:
brooding mystery to wild
Diego Matheuz.
energy and unforgettable
Pic: Marco Caselli Nirmal
moments of utmost beauty.
The driving rhythms and exotic melodies of Borodin’s
famous Polovtsian Dances feature in the first half of the
concert. Principal Guest Conductor of the Melbourne
Symphony Orchestra and graduate of the famed El Sistema
program, the dynamic young Venezuelan conductor, Diego
Matheuz brings his trademark energy and passion to these
orchestral showpieces.
Carter: Holiday Overture
Borodin: Prince Igor, Act II: Polovtsian Dances
Rachmaninov: Symphony No.2
Diego Matheuz: conductor
Bookings through WASO on 9326 0000; www.waso.com.au
X+Y
In cinemas 9 April
X+Y follows Nathan, an awkward,
idiosyncratic teenager, grappling with
the sudden death of the one person
who understood him – his father. As
he struggles to connect with those
around him, he is introduced to an
anarchic and unconventional maths
teacher who takes Nathan under his
wing.
Soon Nathan finds himself selected
for the UK Mathematics Squad and, against the odds,
representing his country in Taipei. Over there, the
academically gifted aren’t bullied but celebrated, envied and
even invited to parties. Nathan’s rational brain can cope
with the most complex of maths problems just fine, the real
test comes when he meets his female exchange partner,
Zhang Mei, and has to cope with falling in love – the most
irrational thing of all.
Written by James Graham and directed by BAFTA Award
winner Morgan Matthews. Starring Sally Hawkins (Blue
Jasmine, An Education), Asa Butterfield (The Boy in the
Striped Pyjamas, Hugo), Rafe Spall (Life of Pi, Prometheus), Jo
Yang and Eddie Marsan (War Horse, Sherlock Holmes).
A Little Chaos
In cinemas 26 March
Reunited for the first time
since Sense and Sensibility, Alan
Rickman directs Academy
Award winner Kate Winslet
in the romantic drama A Little
Chaos. The film follows
Madame Sabine De Barra
(Winslet), a strong-willed
landscape designer who
challenges sexual and class
barriers when she is chosen to build one of the main
gardens at King Louis XIV’s (Rickman) palace at
Versailles, causing her to become professionally and
romantically entangled with the court’s renowned
landscape architect André Le Notre (Matthias
Schoenaerts, Rust & Bone). The film also stars
Stanley Tucci.
The Book of Life
In cinemas 2 April
From producer Guillermo
del Toro and director Jorge
Gutierrez comes an animated
comedy with a unique visual style.
The Book of Life is the journey of
Manolo, a young man who is torn
between fulfilling the expectations
of his family and following his
heart. Before choosing which
path to follow, he embarks on an
incredible adventure that spans three fantastical worlds
where he must face his greatest fears. Rich with a fresh take
on pop music favourites, The Book of Life encourages us to
celebrate the past while looking forward to the future.
Samba
In cinemas 2 April
A recent migrant to France
(Omar Sy, The Intouchables)
fights to stay in his adopted
country with the help of a rookie
immigration worker (Charlotte
Gainsbourg) in this drama from
the directors of the breakout hit,
The Intouchables.
March
ME D I C US 69
2015 RANGE ROVER EVOQUE
CUT A PATH
THROUGH CIVILISATION
The 2015 Range Rover Evoque. Cutting edge design
and a true Land Rover at heart. Its undeniable off-road
capabilities will thrill inside the city and out.
Barbagallo Land Rover
354 Scarborough Beach Rd, Osborne Park DL2061 Ph: 1300 239 865 barbagallo.com.au
Southern Land Rover
1286 Albany Highway, Cannington DL12540 Ph: 1300 884 595 southernlandrover.com.au
Professional Notices
CARDIOLOGY
Dr Allison Morton
HeartCare Western Australia welcomes
Interventional Cardiologist, Dr Allison
Morton to their practice.
Allison graduated from the University of
Sheffield (UK) in 1998 and since qualifying in 2009 as
a Cardiology specialist, she has worked as a Consultant
Cardiologist at Sheffield Teaching Hospitals NHS Foundation
Trust and as Honorary Senior Lecturer at the University
of Sheffield. Allison has sub-specialist expertise in the
management of coronary artery disease, inherited cardiac
conditions and heart disease in pregnancy. She has worked
in and developed the specialist inherited cardiac conditions
service in Sheffield, a UK Nationally recognised service.
Allison offers a full-time presence at the HeartCare
Bunbury rooms, consulting and performing interventional
procedures at SJOG Hospital Bunbury.
For all appointments for Dr Morton,
Phone: (08) 9722 1673
Fax: (08) 9722 1678
Email [email protected]
ENDOCRINOLOGY AND DIABETES
Professor Richard Prince
BSc, MB ChB Birm, MD Melb, FRACP, MRCP (UK)
My area of expertise includes:
• A ll varieties of mineral and bone disorders including
osteoporosis
• All varieties of thyroid disease
• Diabetes and metabolism
• General endocrinology.
I have had an appointment at Sir Charles Gairdner Hospital
for public patients for over 30 years and more recently,
Hollywood Hospital for private patients.
For appointments or advice, please contact
Suite 18, 85 Monash Ave. Hollywood Medical Centre
Nedlands, WA 6009.
Secretary phone: Landline (08) 9386 7488
Prof Prince: Mobile 0419937100
Fax number: (08) 9386 7478
Email: [email protected]
Website: www.princeendocrinology.com.au
HAND SURGERY
Lewis Blennerhassett
MBBS FRACS
Dr Blennerhassett is a plastic surgeon with post-graduate
fellowship in hand surgery certified by the American College
of Surgeons. Expertise in all aspects of acute and chronic
hand disorders, both paediatric and adult, is provided.
For all appointments, phone 9381 6977.
Emergencies phone 0438 040 993 – all hours.
Mr Craig Smith
MBBS FRACS
Hand, wrist and plastic surgeon has his main practice at
17 Colin Street, West Perth in association with Specialised
Hand Therapy Services. This means that consultation, hand
therapy and splinting are all available at the one location.
His areas of interest include all acute or chronic hand and
wrist injuries or disorders as well as general plastic surgical
problems. He continues to consult in Bunbury and Busselton.
For appointments or advice please call 9321 4420.
HAND & UPPER LIMB SURGERY
Mr Peter Hales
MBBS FRACS FRCS(E)
Hand and upper limb surgeon. Extensive
experience in hand, wrist, elbow and shoulder
surgery, both acute and elective.
Special interest in hand and wrist Arthritis and
arthroscopic procedures of shoulder, elbow and
wrist, including Endoscopic Carpal Tunnel Release.
Onsite Hand Therapist and Splint Making.
Peter can be contacted on (08) 9212 4200 or
[email protected]
Mr Paul Jarrett
FRACS
Experienced Specialist Hand, Wrist, Elbow
and Shoulder Upper Limb Orthopaedic
Surgeon providing a comprehensive elective
and trauma orthopaedic service at the St
John of God Hospital, Murdoch.
Mr Jarrett provides orthopaedic consultations for Private,
Veteran’s Affairs and work-injured patients at Murdoch.
For more information please visit www.pauljarrett.
info or call 9311 4636 for appointments.
Weekly clinics are offered at Fremantle Hospital for
uninsured patient referrals.
Mr Angus Keogh
FRACS
- Hand and Upper Limb Surgeon
My interests include traumatic and degenerative
conditions of the upper limb including hand
surgery, arthroscopy including small joints,
complex elbow and wrist instability.
I consult in private rooms at St John of God Subiaco
and St John of God Murdoch. Please call 08 9489
8784 for appointments. I consult weekly at Sir
Charles Gairdner Hospital – please call 08 9346 1189.
Workcover accepted.
March
ME D I C US 71
Professional Notices
HAND & PLASTIC SURGERY
Dr Robert Love MBBS FRACS (Plas) Dip ANAT
All hand surgery, microsurgery and plastic surgery including:
Dupuytren’s Contracture; Arthritides, Carpal Tunnel.
24hr Emergency. Requests for advice welcome.
17 Richardson St West Perth and SJOG Murdoch
Tel: 9321 3344 Mobile: 0409 132 602
INFECTIOUS DISEASES
Dr Desmond Chih
MBBS FRACP FRCPA
Infectious Diseases Physician and Clinical Microbiologist
All aspect of adult general infectious diseases and diagnostic
microbiology including: fever of unknown origin; bone
and joint infections; surgical infections; skin and soft
tissue infections; travel related infections; tuberculosis; and
antibiotic resistance.
Consults at Joondalup, SJOG Murdoch (Inpatient) and
Myaree.
All correspondence to 74 McCoy Street,
Myaree 6154 • Tel: 08 9317 0999
Appointments: 08 9317 0710 • Fax: 08 9467 2826
Email: [email protected]
NEUROLOGY
Dr Nai Lai
MBBS, FRACP, Neurologist
Offers general neurology including EMG services
Mount Medical Centre, Suite 26, 146 Mounts Bay Road,
Perth.
Phone: 9322 2714; fax: 9486 1198
Hollywood Specialist Centre, Suite 34, 95 Monash Ave,
Nedlands.
Phone: 9389 9444; fax: 9389 7518
For inpatient consults, phone: 9346 3333
Dr Julian Rodrigues
MBBS (UWA), FRACP
has commenced private practice in
general adult neurology and
neurophysiology (Nerve Conduction
Studies / EMG) with particular expertise
in:
• Movement Disorders including
Parkinson’s Disease, Tremo and Dystonia
• Assessment for Deep Brain Stimulation and
other advanced therapeutic options Botulinum toxin
treatment of:
• Chronic migraine and other primary headache syndromes
• Axillary, cranial and palmoplantar hyperhidrosis
• Spasticity including post-stroke and cerebral palsy
• Hemifacial spasm, blepharospasm and spasmodic
72 M E D I CU S March
dysphonia
• Bruxism, temporomandibular disorders and sialorrhea
• Focal dystonias including cervical dystonia/torticollis,
writers and musicians’ cramp
• Musculoskeletal indications including tennis elbow and
patellofemoral disorders
• Complex EMG-guided botulinum toxin administration.
Medico-legal and workers compensation patients accepted.
Inpatient consultation available.
Consulting and neurophysiology servwices provided at
Hollywood Medical Centre, Hollywood Private Hospital and
Joondalup Health Campus.
For all appointments and enquires: Hollywood Medical
Centre, Suite 45/85 Monash Ave,
Nedlands 6009 Ph: 9420 4900; Fax: 9386 9277
Email: [email protected]
Web: drjulianrodrigues.com.au
ONCOLOGY
Dr Tim Clay
MBBS (Hons) FRACP
Tim is pleased to announce commencement
of private practice at:
• Bendat Family Comprehensive Cancer
Centre, SJOG Subiaco
• Genesis Cancer Care, Joondalup.
Public patients are seen at Rockingham
General Hospital.
Special interests: Treats all solid tumours with particular
interests in breast and lung cancer.
For appointments and advice please contact:
SJOG Subiaco – Suite C202, 12 Salvado Road Subiaco.
Ph: 6465 9200; Fax: 6465 9250
Genesis Joondalup – 57 Shenton Ave Joondalup
Ph: 9400 6200; Fax: 9400 6217
Email: [email protected]
OPHTHALMOLOGY
Dr Michael Wertheim
MBChB FRCOphth FRANZCO
Comprehensive general ophthalmologist
consults at: Suite 26 Wexford Medical
Centre, 3 Barry Marshall Parade,
Murdoch 6150
Early and urgent appointments
available
Operates at: Eye Surgery Foundation, West Perth
(private patients) Bentley and Osborne Park
Hospitals (public patients)
Special Interests: cataract surgery, pterygium surgery, general
ophthalmology, Uveitis
For appointments:
Phone 9312 7222
or Fax 9312 7333 or Email
[email protected]
www.pertheyeclinic.com.au
Professional Notices
PSYCHIATRY
The Marian Centre
The Marian Centre is pleased to announce that
Dr Richard Magtengaard has commenced practice at
the Marian Centre consulting rooms.
Dr Richard Magtengaard: General Adult Psychiatry,
Depression, Anxiety, and Mood Disorders.
Address: 200 Cambridge Street, Wembley 6014
Referrals: Phone 9486 7399 or fax 9381 2612.
Professor Brian D Power
BMedSci (Hons) MBBS PhD FRANZCP
Cert. Psych. Old Age
has commenced practice at Hollywood Medical Centre
(85 Monash Avenue, Nedlands), with expertise in older
adult mental health (problems with mood, memory, anxiety
and psychosis in later life) and neuropsychiatry (psychiatric
conditions secondary to organic brain disease including,
but not limited to: stroke, multiple sclerosis, parkinsonian
disorders, Huntington’s disease, epilepsy).
For appointments or enquiries:
mobile 0478 597 781, or email
[email protected]
Dr Raj Sekhon
Dr Raj Sekhon is pleased to announce that he has
commenced private psychiatric practice in Rockingham.
Raj is a local UWA graduate (1996) and is a Fellow
of The Royal Australian and New Zealand College
of Psychiatrists (FRANZCP), with an interest in all
aspects of general adult Psychiatry.
For referrals or other advice please phone
9528 0996 or fax: 9528 0850, or email
[email protected]
RADIOLOGY/NUCLEAR MEDICINE
Envision Medical Imaging
178 Cambridge Street, Wembley (opp. SJOG Hospital
Subiaco)
Tel: 08 6382 3888
Fax: 08 6382 3800
Web: www.envisionmi.com.au Envision Medical
Imaging is an independent Radiology practice,
located directly opposite St John of God Hospital
Subiaco on Cambridge Street, with free parking
behind the building. Services include:
Ultrasound – including injections
• MRI – GP referrals accepted
• X-ray – low dose
• CT – general and cardiac imaging
• Nuclear Medicine scans
• Dental – Cone Beam and OPG
*Same day appointments available
Imaging Specialists include: Brendan Adler,
Lawrence Dembo, Tonya Halliday, Tom Huang,
Eamon Koh, Bernard Koong, Michael Krieser,
Michael Mason, and Patrick Ng.
SKG Radiology
Web: skg.com.au
Appointments: (08) 9320 1288
Providing diagnostic imaging services in WA since
1981, SKG Radiology has grown to become one of
the State’s largest providers with a network of 20
metropolitan and country branches as well as premier
hospital locations.
Continually providing a premium quality service
through the expertise of sub-specialised Radiologists,
highly-trained technicians and support staff, the
professional team is committed to providing your
patients with the highest standard of care, every time:
• MRI
• PET-CT
• Low Dose CT
• U ltrasound (including Nuchal Translucency and
Doppler scanning)
• Nuclear Medicine
• Fluoroscopy
• Mammography
• Interventional Radiology
• General X-ray
• Dental X-ray (OPG)
• FNA Biopsy
• Bone Densitometry
SKG is a preferred supplier and proud sponsor of
WA’s sporting elite –
West Coast Eagles, Perth Wildcats, Perth Heat,
West Coast Fever and West Coast Waves.
March
ME D I C US 73
NEDLANDS
NEDLANDS
Medical Specialist Consulting Rooms and Treatment
Room
• Fully serviced consultation rooms at Hollywood
Specialist Centre
• Secretarial support – highly experienced long-term staff
• Genie solutions practice management software
• Online Medicare claims
• Telehealth consultation facilities
• Paperless practice supported
• Treatment room – available for ambulatory procedures
• Access to Hollywood Private Hospital for inpatient care
and theatre bookings supported
• Inpatient billing supported.
Any enquiries can be directed to Mrs Rhonda Mazzulla,
Practice Manager, Suite 31,
Hollywood Specialist Centre,
95 Monash Avenue, Nedlands, WA 6009,
Phone: 9389 1533
Email: [email protected]
Office space of 119sqm at Suite 3, Hampden Court,
186 Hampden Road, Nedlands is available for rent
now – with option to buy. Interested party please ring
Ian Forsyth at Abel McGrath on 9286 3655.
PSYCHIA IN
TR C
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SOCIAL WORKERS
LIFE’S
THE
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PROGRAM
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Nedlands Consulting Suite, Hollywood
Specialist Centre
54 sq m consulting suite already fitted out,
with furniture
Available for rent or purchase
Contact Tim Cooper 0411 876 480.
IM
UL
AN D B
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OR
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AN
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NG AT
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LU S
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NEDLANDS
CHALLENGES
ARE OUR SPECIALTY
MENTAL HEALTH
MOOD & ANXIETY MANAGEMENT
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L I T Y D I SO R D E R S
N
M E D I CU S March
TIO
SO N A
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DEPRESSION
R DISORDER
R E F L EC
PER
ES
AN D
PROGRAM
THERAPISTS BREAK
THE CYCLE OF RELAPSE
ART THERAPY EA MN DO TSIPOINRAI TLU, APLH HY ES AI CLTA HL
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OCCUPATIONAL TRAUMA RECOVERY
SE L
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GROUP THERAPY HIGHLY SKILLED HEALTH PROFESSIONALS
COGNITIVE
BEHAVIOURAL
THERAPY
70 I N - PAT I E N T B E D S
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74 IA
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IN-PATIENT AND DAY-PATIENT CARE AND TREATMENT
WE’RE BIG IN
MENTAL HEALTH
Visit our website for a list of Hollywood Private
Hospital’s Psychiatrists and for more information
on our services and programs. For any enquiries,
please contact our Admissions Coordinator
at The Hollywood Clinic on (08) 9346 6850.
hollywoodclinic.com.au
Please forward submissions for Greensheet by
6 April for the May 2015 edition.
Email: [email protected]
WESTERN AUSTRALIA
WESTERN AUSTRALIA
Youth Friendly Doctor Training 2015 Program
The Youth Friendly Doctor (YFD) Program was developed by the AMA (WA) Foundation
in consultation with doctors and other health professionals. The program builds
the capacity of doctors to communicate effectively and optimise their contact with young people. Practical sessions are
delivered by experts in the relevant medical and legal fields. In addition to providing practical youth-specific training, YFD
provides doctors with reference materials, referral links and ongoing support to encompass a holistic youth friendly practice.
To be accredited as a Youth Friendly Doctor, you will be required to complete both the core module workshops plus one of
the elective workshops.
This program is accredited with the ACRRM and the RACGP, attracting Category 1 and/or Category 2 QI&CPD Points.
Rural doctors have the opportunity to participate via the virtual online classroom.
All workshops are held on a Tuesday evening at the AMA (WA) House in Nedlands from 6:30 – 8:30 pm.
FREE for AMA (WA) members; $50 per workshop for non-members.
MODULE 1
MODULE 3
Establishing Connections and Conducting
Assessments with Young People
Risk Taking Behaviours and Harm Reductions among
Young People
Workshop 1 – (Core) Young People, Ethics and
the Law – 2 June & 20 October 2015
Workshop 2 – Young People’s Sexual Health – 5 May 2015
Workshop 2 – Social Media and the Internet: The
Impact on Young People’s Wellbeing - 7 July 2015
MODULE 2
MODULE 4
Mental Health Disorders
Eating Disorders in Young People and their
Management
Workshop 1 – Mental Health Disorders in
Young People – Diagnosis and Assessment
– 7 April & 3 November 2015
Workshop 2 – (Core) The Psychosocial Wellbeing of
Young People – 21 April & 17 November 2015
Workshop 1 – Eating Disorders in Young People
– 4 August 2015
Workshop 2 – Overweight and Obesity in Young People
– 1 September 2015
For enquires relating to the YFD program or to enrol in the workshops, please visit: http://www.amawa.com.au/
in-the-community/yfd-training-program/, phone (08) 9273 3000 or email [email protected]
POSTGRADUATE EDUCATION & TRAINING
Date
Course/Workshop
12-Mar-15
Emergency Skills & Crisis Management. Suitable for multi-disciplinary groups from specialty
areas, nursing or allied health. Accreditation: RACGP, ACRRM, Anaesthetics MOPS points.
Venue: The Avant Center, Subiaco. Time: 4 hours (8:30am-12:30pm). $255 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
16-Mar-15
Community Prescribing of Opioid Pharamacotherapy Training (CPOP).This course enables medical
practitioners to assess opioid dependence, safely prescribe methadone and buprenorphine, and
comply with CPOP policies and procedures. Suitable for GPs. Eligible for RACGP and ACRRM points.
Venue: Next Step Drug & Alcohol Services. 32 Moore Street, East Perth. Time: 6.75 hours (9:15am4pm). Training is provided free of charge. A light lunch will be provided.
Contact Craig Carmichael
on 9219 1896 or at craig.
[email protected]
16-Mar-15
Recognition & Management of Common Ear Disorders. Suitable for remote area nurses,
ED nurses, practice nurses, site medics, GPs, junior doctors and audiologists. Accreditation:
RACGP: QI&CPD Cat 2, 7 points. ACRRM. NMBA 7 CPD points for nurses and midwives.
Venue: The Avant Center, Subiaco. Time: 3.5 hours (8:30am-12pm). $275 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
20-Mar-15
The Cutting Edge: Managing Skin and Soft Tissue Injuries. Suitable for GPs, GP
Proceduralists and Remote Nurse Practitioners. Accredited with RACGP QI (40 Points Cat
1) and with ACRRM for 30 PRPD points, 30 EM MOPS points and 30 surgical MOPS points.
Approved for 1 Day EM/Surgical Procedural Grants. Venue: CTEC, UWA. Cost: $742 pp.
Contact John Linehan
on 6488 8049 or at john.
[email protected]
26-Mar-15
Core Skills: General Surgery Trainee Workshop. Suitable for SET 2 to SET 4 trainees.
Duodenotomy, pyloroplasty, exploration of common bile duct, gastrectomy, axillary dissection,
mastectomy, thyroid, submandibular gland and choledochojejunostomy will be covered. Venue:
CTEC, UWA. Cost: $980 pp.
Contact John Linehan
on 6488 8049 or at john.
[email protected]
March
ME D I C US 75
POSTGRADUATE EDUCATION & TRAINING
Date
Course/Workshop
27-Mar-15
Core Skills: Vascular Surgery Trainee Workshop. Suitable for Vascular & General Surgery
trainees SET 1-4. This course will focus on developing an understanding of historical and
contemporary surgical techniques; and anatomy of the structures operated on and adjacent
structures. Venue: CTEC, UWA. Cost: $860 pp.
Contact John Linehan
on 6488 8049 or at john.
[email protected]
27-Mar-15
ALS Algorithm & Defibrillation Safety. Suitable for GPs, medical officers, nurses and paramedics.
Accreditation: RACGP: QI&CME Cat 1, 40 points. ACRRM. NMBA: 4 CPD points for nurses and
midwives. Venue: The Avant Center, Subiaco. 4 hours (8:30am - 12:30pm) $275 per person.
Contact enquiries@
thecenter.org.au or
6380 4988
28-Mar-15
ALS Level 1: Immediate Life Support. Suitable for doctors, nurses and allied health
professionals from non-critical areas. Must have current knowledge of BLS guidelines.
Accreditation: RACGP: QI&CME Cat 1, 40 points. ACRRM. Venue: The Avant Center, Subiaco.
Time: 7 hours (8:30-4:30). $450 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
31-Mar-15
Ear Wax Management. Suitable for GPs; junior doctors; audiologists; remote area nurses and
medics; and practice and gerontology nurses. Accreditation: RACGP: 7 points. ACRRM. Venue:
The Avant Center, Subiaco. Time: 3.5 hours (8:30am-12pm). $275 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
7-Apr-15
Recognition & Management of Common Ear Disorders. Suitable for remote area nurses,
ED nurses, practice nurses, site medics, GPs, junior doctors and audiologists. Accreditation:
RACGP: QI&CPD Cat 2, 7 points. ACRRM. NMBA 7 CPD points for nurses and midwives.
Venue: The Avant Center, Subiaco. Time: 3.5 hours (8:30am-12pm). $275 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
18-Apr-15
Airway Management. Suitable for Remote Area Nurses, Emergency Department Nurses,
Practice Nurses; GPs and Junior Doctors. Accredited with RACGP (Cat 2, 7 points) and ACRRM.
Venue: The ESIA Avant Center. Time: 3 hours. $255 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
23-Apr-15
Core Skills: Gynaecologic Surgical Skills Workshop. Session 1- The Anatomy of Hysterectomy.
Suitable for RACS Surgical Trainees in Obstetrics and Gynaecology 1st and 2nd Year Registrars.
Approved in the RANZCOG CPD program (7 points). Venue: CTEC, UWA. Cost: $400. Lunch
provided.
Contact Anita Ingleby,
KEMH on 9340 1388
23-Apr-15
Core Skills: Gynaecologic Surgical Skills Workshop. Session 2- The Anatomy of Pelvic Floor
Surgery. Suitable for RACS Surgical Trainees in Obstetrics and Gynaecology 3rd and 4th Year
Registrars. Please note that 3rd and 4th Year Registrars may attend both sessions. Approved
in the RANZCOG CPD program (7 points). Venue: CTEC, UWA. Cost: $400 (one session), $800
(both sessions). Lunch provided.
Contact Anita Ingleby,
KEMH on 9340 1388
25-Apr-15
ALS Level 1: Immediate Life Support. Suitable for doctors, nurses and allied health
professionals from non-critical areas. Must have current knowledge of BLS guidelines.
Accreditation: RACGP: QI&CME Cat 1, 40 points. ACRRM. Venue: The Avant Center, Subiaco.
Time: 7 hours (8:30-4:30). $450 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
8-May-15
to
9-May-15
Australian Minimally Invasive Mitral Surgery (AMIMS) Workshop. Suitable for Cardiothoracic
Surgeons with an interest in minimally invasive mitral valve surgery. Approved in RACS CPD
Program. One point per hour (maximum 13 points) in Cat 4. Venue: CTEC, UWA.
Contact Cheryl DaneStewart on 9380 9955 or
at cheryl.dane-stewart@
medtronic.com
12-May-15
A-Z of Epistaxis. Suitable for Remote Area Nurses, Emergency Department Nurses, Practice
Nurses; GPs and Junior Doctors. Accredited with RACGP (4 points) and ACRRM. Venue: The
ESIA Avant Center. Time: 2 hours (8:30-10:30). $165 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
28-May-15
to
30-May-15
The Cutting Edge: Emergency Procedures Practical Course. Suitable for GPs, GP Registrars
and Nurse Practitioners. Approved by RACGP QI and CPD Program (40 Cat 1 points).
Accredited by ACRRM for 30 PRPD points, 30 EM MOPS, 30 Anaesthetics MOPS points and
30 Surgical MOPS points. Venue: CTEC, UWA. Cost: $2269 (GPs and GP Registrars) or $1161
(Nurse Practitioners). Lunch provided
Contact John Linehan
on 6488 8049 or at john.
[email protected]
29-May-15
ALS Algorithm & Defibrillation Safety. Suitable for GPs, medical officers, nurses and
paramedics. Accreditation: RACGP: QI&CME Cat 1, 40 points. ACRRM. NMBA: 4 CPD points
for nurses and midwives. Venue: The Avant Center, Subiaco. 4 hours (8:30am - 12:30pm)
$275 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
29-30 May
2015
At Home with Eating Disorders: The 2nd Australian Eating Disorders Conference for Families
& Carers. This is a collaborative event presented by The Butterfly Foundation, the Australian
New Zealand Academy of Eating Disorders and F.E.A.S.T. This event is for parents and carers of
those experiencing an eating disorder, as well as doctors and health professionals who support
them. This is a not-for-profit event held in Bell City, Preston, Melbourne.
http://www.
athomewitheatingdisorders.
com/
30-May-15
ALS Level 1: Immediate Life Support. Suitable for doctors, nurses and allied health
professionals from non-critical areas. Must have current knowledge of BLS guidelines.
Accreditation: RACGP: QI&CME Cat 1, 40 points. ACRRM. Venue: The Avant Center, Subiaco.
Time: 7 hours (8:30-4:30). $450 pp.
Contact enquiries@
thecenter.org.au or
6380 4988
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