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ALIA WESTERN AUSTRALIA Journal of the Australian Medical Association WA | December 2014 Volume 54 / Issue 11 | amawa.com.au A new car could help you see the world without even leaving the garage Some credit cards cap the number of points you can earn. At BOQ Specialist, we don’t impose such restrictions. The more you spend, the further you can fly.# It’s really that simple. And we do more than that. You can buy a car or equipment on your card, earn points# and then roll the purchase into a fixed term finance contract.^ What’s more, you can make your monthly repayments on selected BOQ Specialist finance contracts using your credit card and earn even more points. As they say, the sky’s the limit. Visit us at boqspecialist.com.au/card or call 08 9214 4500. 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BOQS0001128 11/14 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 Melita Cirillo Dr Ian Jenkins Prof Ian Puddey 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 Ms Nicola Roman 14 Stirling Highway Nedlands WA 6009 (08) 9273 3000 [email protected] www.amawa.com.au December 2014 20 Cover story The Good, the Bad and the Ugly Services 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 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. A good man in a crisis Dr Andy Robertson UWA Dedication Ceremony FEATURES 7 Medicus Editor and Director of Communications Mr Robert Reid Deputy Editor Ms Janine Martin Advertising Inquiries Phone Mr Des Michael (08) 9273 3000 Copy Submissions Phone Ms Janine Martin (08) 9273 3009 or [email protected] 42 16 FIFO Report echoes AMA concerns WA’s Education and Health Standing Committee releases discussion paper on mental health impacts of FIFO work 9 38 Dekker appeal supports doctor’s right to choose Success after 12 years For the Record: Professor Peter Klinken The State’s Chief Scientist on why we need a “Team WA Approach” REGULARS 62 Travel 03 From the Editor 38 For the Record: Professor Peter Klinken 05 Industrial 40 Clinical Edge 67 Wine 06 Immunisation 42 P rofile: Dr Andy Robertson 68 M ember Benefits & On the Town 44 Research 71 Classifieds Professional Appointments & Positions Vacant 02 President’s Desk 7 Comment 10 News 16 F eature: UWA Dedication Ceremony 47 Opinion 55 Beyond Borders 20 C over Story: The Good, 57 AMA Training 59 AMA in the Media the Bad & the Ugly 35 Opinion 65 Food 76 Greensheet 61 Drive December ME D I C US 1 PR E SIDE N T ’S DE SK Flexibility fundamental to gaining best and brightest doctors by Dr Michael Gannon AMA (WA) President T he Health Department of Western Australia recently announced a decision to cease seeking Area of Need (AON) determinations to employ overseas trained doctors at the junior doctor level. This is a welcome announcement. It reflects a maturity of our medical training arrangements in Western Australia. The AMA (WA) position should in no way be interpreted as being a slant against that significant proportion of doctors in the West Australian community who were trained overseas. Indeed it includes a significant proportion of past presidents of this august Association! That there is a clear benefit to the community of having indigenous medical schools should not be questioned. I remember my first meeting of the Australian Medical Students Association (AMSA) that I attended in 1992 as the representative of the WA Medical Students’ Society. That week a retired Chief Justice of the Supreme Court in New South Wales had spoken of the burden and expense of local medical schools. He asserted quite ridiculously that Australia should import all of its doctors. Such a proposal was resisted by AMSA and the AMA at the time. His Honour clearly had no comprehension of the tremendous benefit that medical schools bring to their local community. It was that recognition that led the people of WA to raise money to fund the development of their own medical school at the University of Western Australia via a lottery process in the 1950s. Having local medical schools promotes medical research. It allows for recruitment and retention of high quality academic staff. It also means that the doctors of the future are trained to relevant local social and cultural mores. While Australian society might be roughly comparable to that of Britain, Ireland, Canada or New Zealand, there are very specific and unique things in our health system, including our effective public and private mix, our geography and the uniqueness of 2 M ED I CU S December Aboriginal Australians. Of course any system must have a flexibility to allow for a transfer of ideas. I personally benefited from spending three years in Ireland and England during my specialist training. I have made contacts and friendships that I hope will last a lifetime. This interchange of ideas should be encouraged and health systems must retain the flexibility to allow doctors to move around the world, perhaps ideally at the Senior Registrar level. There are numerous examples, but in my own experience, I know that the Fellow positions in Interventional Radiology and Gynaecological Oncology available in Perth are world renowned and every year attract high-quality doctors from interstate and overseas. We must also maintain flexibility to deal with acute workforce shortages. Part of the crisis afflicting the mental health system in WA is a significant shortage of Consultant Psychiatrists. Our system must retain the flexibility to vet, import, credential and then support Psychiatrists who have trained overseas. Then there is the issue of chronic doctor shortages. It is a fact that it has been difficult to attract doctors to ‘onehorse’ towns in our vast State. Historically we have been reliant on doctors trained overseas to work in these towns. The promise of a life in Australia has been enough for many of our colleagues to take on these positions in often very difficult and trying circumstances. The reality of displacement from opportunities for collegial support, continuing medical education and desirable social and cultural activities has meant that a lot of our colleagues in these positions move back to the city once their period of bondage has ended. While not perfect, this system is not completely without its merit. The AMA (WA) tries very hard to support those doctors who come from other countries and go to work in the bush. Providing locum support, supporting spouses and families, and The AMA (WA) tries very hard to support those doctors who come from other countries and go to work in the bush. Providing locum support, supporting spouses and families, and providing educational and professional opportunities is important providing educational and professional opportunities is important. We are hopeful that changes to the way doctors are trained, including the introduction of the Rural Clinical School and increasingly the amount of time that all medical students are exposed to the bush will increase the number of doctors who wish to make rural and regional Australia their home in the long term. It has been desperately sad that the WA Health Department has felt the need to employ doctors trained overseas under AON provisions rather than considering why doctors leave the public system at consultant level or break contracts at RMO level out of desperation at not being granted access to accrued leave. There has been a culture that this is an easier fix than looking honestly at the problems that cause workforce shortages in the public system. Health Workforce Australia has been disbanded by the Commonwealth Government. Neither HWA nor any of its predecessors have been brilliant in predicting the future. We are still paying for the ill-considered Provider Number changes of the 1990s and a failure to invest in medical training 25 years ago. The projections in HWA’s final report assume that something like 20 per cent of doctors will continue to come from overseas. We must retain flexibility in the system. Continued on page 3 F ROM T HE E DI T OR SANTA COMES EARLY FOR SOME T his month’s cover story looks at health over the year past and into the future. And with health spending now taking around a third of Western Australia’s total state budget, it’s no wonder that this one issue dominates public debate in so many ways. Even recent events such as the death of a little boy who wandered into an unfenced lake and drowned, or children killed by reversing vehicles, or swimmers taken by sharks, highlight the continuing debate about how safe is too safe. How far should we go to protect the health and safety of citizens? Even the seemingly simple issue of peanuts being made freely available at a popular WA theme restaurant stimulated strong debate after Australian Medical Association (WA) President Dr Michael Gannon said commercial operators had a community responsibility to ensure people with peanut allergies were protected. As Dr Gannon said airlines no longer make peanuts freely available and it was important for other outlets to consider those with life-threatening allergies. Dr Gannon’s comments were even more poignant as he had grown up with a serious peanut allergy. But how far should we go to protect our fellow citizens? Should we take every effort to protect the vulnerable and should we fence all water features, make reversing cameras compulsory or force swimmers only to enjoy the water behind shark enclosures? This of course is not a new debate – in one way or another, we have been having it for hundreds, even thousands of years. Did some people really fight against the imposition of sewer lines as not being necessary and a tad too expensive for a community, perhaps arguing that the risk of spreading disease was a risk worth taking? Does anyone believe that imposition of safety rules in the workplace or on roads is not a positive for society? The AMA (WA) will certainly continue to advocate for the health and safety of the community both within government and in the public arena. We live in a much healthier environment and enjoy our lives more thanks to health advocates arguing for sensible changes in the way we manage our society. On this front, we would like to thank WA Health Minister, Dr Kim Hames for the slightly early Christmas present he gave us a few weeks ago. Dr Hames finally agreed that WA will join other states and ban the commercial use of solariums from the beginning of 2016. We are not surprised that this has occurred. However we are surprised that it took so much effort by the AMA (WA), along with other public health organisations, a media campaign, and even taking out an expensive advertisement in The West Australian before the Government came on board. The fact that Dr Hames had to fight in the Liberal Party room for WA to join other states in taking a national approach to these “death machines” is especially worrying. More concerning, however, is that some tried to question the science behind banning these machines. But the fact is WA has now joined the rest of Australia – finally. While this very timely Christmas The fact that Dr Hames had to fight in the Liberal Party room for WA to join other states in taking a national approach to these “death machines” is especially worrying. More concerning, however, is that some tried to question the science behind banning these machines present is welcome, there remains doubt about the finer points. We look forward to Dr Hames releasing further details about the regulations before too long, including compensation plans and plans to stop these machines falling into the black market. And that’s when we can actually unwrap the present. But for those groups in the public health field, it is another victory for good health and safety. Finally, it is appropriate that Medicus and the AMA (WA) wishes all members and readers a very happy Christmas and an even better 2015. Medicus has had a stellar year with more writers and more issues discussed and debated than ever before. And we have plans to make your magazine even better in the coming 12-months. There are more health issues to fight for and more good, common sense initiatives to propose. In the meantime, keep safe. ■ Continued from page 2 Flexibility fundamental to gaining best and brightest doctors by Dr Michael Gannon We want the best doctors in WA. But lazy use of AON provisions to grant doctors provider numbers for areas of workforce shortage like Attadale and Mount Lawley do not serve a community that stretches 2.5 million sq km beyond the Swan River and its immediate environs. Medical Schools benefit the community. There is now doubt that they carry a prestige for the University. How medical schools are run, the number of doctors they train and the content of the course must never lose sight of the demands and needs of the community in which they work. The people of WA recognised this in the 1950s. It should never change. Outside the doctors produced locally, there will always be a need to augment that with colleagues from across the world, many of whom I am proud to call my colleagues and friends. ■ December ME D I C US 3 Insurance for your Medical Practice Insurance that is tailored to meet the unique needs of your medical practice AMA FINANCIAL SERVICES 08 9273 3077 understands ...we go the extra mile to understand, protect and care for the Financial Wellbeing of the Health Professional protects cares Accordingly it is important that you read the Product Disclosure Statement (PDS) of the actual provider carefully, and ensure that the PDS and the exclusions are appropriate for your business and personal needs. INDUS T R I A L SNAPSHOTS Closure of Swan District Hospital T he AMA (WA) has been active advocating for practitioners working at Swan District Hospital to ensure: • WA Health meets both contractual and moral obligations towards practitioners whose contracts of employment will be terminated in November 2015 due to the government’s decision to close the hospital. Government obligations include options for employment elsewhere in the public sector and transfer/paying out of leave and other entitlements required under the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2013; and • St John of God Health Care (SJG), as the private operator, makes offers of employment to existing practitioners at SDH prior to considering external appointments, and agrees to preserve current terms and conditions for practitioners accepting employment at SJG. Further issues related to transfer of leave, payment to practitioners involved in commissioning work and other matters are also being discussed. At the time of writing, the AMA has successfully negotiated arrangements with WA Health to ensure practitioners who prefer to remain in the public sector can do so and practitioners who wish to accept positions at SJG are able to do so without losing leave entitlements or termination payments accrued during their employment with WA Health. The position presented by WA Health in response to AMA demands was discussed with members at a meeting held at Swan District Hospital on Tuesday 25 November 2014. Negotiations with SJG are continuing. ■ Restructure of South Metropolitan Health Service T he AMA continues to receive feedback from members about issues concerning the management of contracts, processes and rosters, among other things, within South Metropolitan Health Service (SMHS). The issues result from: • t he impact of significant resources being drawn away from health services within SMHS, particularly RPH, following the opening of Fiona Stanley Hospital. This has resulted in disputes at RPH in departments such as Gastroenterology and Geriatric Medicine. •R PH introducing “job plans” that propose significant changes without any consultation with consultants or the AMA in breach of the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2013. • a budget-centred focus on management of issues at FSH. For example, there are reports of rostering planned for SCGH RMO Term Allocation Dispute F urther to the update provided in the November edition of Medicus, the AMA has written formally to Dr Victor Cheng, regarding the correspondence received by junior doctors which appeared to lay blame on the delay in providing term allocations on the Association. Following this, the AMA has received assurances from Sir Charles Gairdner Hospital (SCGH) that no further correspondence would be sent or any action taken which would have the effect of further straining the relationship between SCGH, their junior doctors and the Association. The AMA is monitoring the situation as it is still unclear as to how many RMOs will be expected to undertake two leave relief terms in 2015. This issue will be raised formally with the Acting Director-General. ■ FSH whereby sessions rostered during the week would be reduced commensurate with dollars paid for weekend sessions. • lack of clinical academic and supporting research nurse positions at FSH, publicised as the flagship hospital for clinical innovation and research in WA; and • WA Health not complying with its own policies during the reconfiguration. For example, DOH Operational Directives set out a process of quarantining positions that were or became vacant during the reconfiguration process and making sure that a practitioner who had been identified as surplus could be redeployed into the quarantined position. The AMA, through the Inter Hospital Liaison Committee, has raised the issues with the Acting DG, FSH, RPH and the Minister and will continue to advocate on behalf of members and in the interests of patient care. ■ Royal Flying Doctor Service F urther to the article published in the October edition of Medicus, the AMA wrote to the RFDS expressing concern about the introduction of major operational changes at RFDS without any consultation with practitioners affected or the AMA in breach of the Royal Flying Doctor Service of Australia (Western Operations) Medical Practitioners Industrial Agreement 2013. The RFDS indicated it would meet with the AMA for discussions. Given leave commitments of RFDS personnel, there have been no discussions. However, the RFDS has indicated it will meet with the AMA within the next fortnight and it is understood that changes previously touted have not been introduced. The AMA will keep members informed of any progress and would welcome feedback from practitioners affected. ■ Continued on page 6 IMMUNIS AT ION NE W S IMPROVING IMMUNISATION SERVICES USING THE PROVIDER INFLUENZA VACCINATION ASSESSMENT TOOL Professor Paul Effler Medical Coordinator, Prevention and Control Program Communicable Disease Control Directorate, Department of Health, WA D o you know how many of your at-risk patients you immunised against influenza this past influenza season? If not, the Western Australia Department of Health has recently created a GP practice data extraction software program to help General Practitioners answer this question, and improve influenza vaccination coverage among their patients. Developed in partnership with Bentley-Armadale Medicare Local and Datavation, the Prevention and Control Team of WA Health has created the Provider Influenza Vaccination Assessment Tool (PIVAT) for use by general practices to estimate seasonal influenza vaccination coverage of their patients. By using data already contained in medical practice software, PIVAT calculates the number of patients who received a seasonal influenza vaccine, by age group and medical risk factors. It is compatible with a range of practice management software packages including Medical Director, Best Practice, Practix, and MedTech. The objective of the PIVAT program is to allow GPs to assess how well they are doing in getting their patients in vulnerable target groups immunised against influenza each year, as an important first step in improving immunisation services. In 2013, 110 practices in Western Australia installed and used PIVAT, finding that on average, 17 per cent of all patients at participating GP practices were immunised against influenza. As expected, influenza vaccine coverage was highest in patients 65 years and older, patients with chronic obstructive pulmonary disease and coronary heart disease – with over 50 per cent of these patients recorded as immunised. Immunisation coverage varied widely by practice, however, with <2 per cent of patients in some practices immunised and 52 per cent immunised in others. Reports PIVAT generates use de-identified information that permits practices to benchmark their immunisation rates against their peers. Practices which use PIVAT are sent an annual report of results across WA from the Prevention and Control Team, indicating how their immunisation rates compared with other practices. Feedback from participating GP indicates this information is useful to practices in assessing how well they are doing in immunising patients against influenza. It is available at no cost to GP practices in WA. To prepare the 2015 influenza vaccination season, and if your practice is interested in learning more about how PIVAT can help you improve vaccination coverage, please contact Prevention and Control at (08) 9388 4863 or by email at [email protected]. ■ Continued from page 5 INDUSTRIAL SNAPHOTS Fiona Stanley Hospital BPT Recruitment Process T he AMA fielded a number of calls from concerned junior doctors earlier in the year regarding the recruitment process for Basic Physician Trainees (BPT) at Fiona Stanley Hospital (FSH). The concerns related to the nature of the questions asked at interviews as well 6 M ED I CU S December as comments made by the Director of Physician Education at FSH at Registrar Information sessions held in the lead-up to the recruitment process. The AMA became aware that a large number of applicants were poised to make complaints to the Public Sector Commission regarding the recruitment process. Following this, the Association made immediate contact with FSH asking for a meeting to discuss the implications of the flawed recruitment process. Discussions between FSH, AMA and representatives from the AMA Doctors in Training Committee resulted in an overhaul of the recruitment process, with COMME N T FIFO REPORT ECHOES AMA CONCERNS T he State Government’s Education and Health Standing Committee, chaired by Dr Graham Jacobs, has released a discussion paper detailing the preliminary information that has come out of its inquiry into the mental health impacts of fly-in, fly-out (FIFO) work arrangements. The report, titled Shining a Light on FIFO Mental Health will be the precursor to the Committee’s further investigations and discussions with stakeholders. The discussion paper is based on submissions received from health, industry, employee and regulatory groups including the AMA (WA), Lifeline WA, the Chamber of Minerals and Energy (CME), the AMWU, the CFMEU and the Department of Mines and Petroleum. The Committee established the need for quality research on the impact of FIFO on the mental health of its workforce and concluded that this research should focus on “the extent to which FIFO work practices are safe, as well as the extent to which risks to psychological wellbeing are managed”. The Committee further noted the absence of reliable data confirming the nine suicides within the FIFO workforce in a 12-month period as was reported by the media. As the inquiry progresses, the Committee will pursue the establishment of evidence to support these figures. The AMA submission to the inquiry focused strongly on the characteristics of FIFO work practices and the risks posed to a workforce that is particularly vulnerable to mental health problems and illness – particularly given the predominant demographic characteristics of the FIFO workforce (males aged between 25 and 44). The Committee concluded that “this group of at-risk people is then employed under a structure that removes them from their normal life and its usual support systems for extended periods of time. The normal support systems that usually exist for every member of society – such as family, friends, access to a GP in conditions of assured privacy – become inaccessible (or accessible only with difficulty) for extended, and regular periods”. Factors negatively impacting on mental wellbeing that are associated with the structure of FIFO workplaces that were identified in a number of submissions included remoteness and social isolation, the “macho” work culture, rosters, travel time, accommodation, disconnection from family and friends, lack of adequate communication facilities and fear of termination of employment should an employee come forward with their mental health concerns. Of great concern is the issue reported to the Committee concerning site drug testing. Evidence was received that “some FIFO workers, fearing detection by urine tests screening for drugs, either do not disclose or cease taking their prescribed mental health medication”. The AMWU further reported that some employees feared negative consequences in the event that they sought professional mental health treatment or were prescribed medication outside of work. In its submission, the AMA highlighted the use of alcohol and drugs as a noneffective coping strategy employed by FIFO workers to cope with the unique pressures of working in a FIFO environment. Lifeline WA further reported evidence showing higher levels of alcohol and substance use found amongst FIFO workers when compared to the national average. The WA Mental Health Commission warned that “people self medicating emerging and existing mental health problems, such as depression, with alcohol will be further supported in the risky behaviour”. Several submissions, including that of the AMA, identified the link between employee stress and the regimented nature of FIFO life. The Association’s submission cited onerous rules and a lack of control over work and ‘off-duty’ time as being significant stressors in the FIFO lifestyle. The Committee will table its final report in June 2015. In the interim, further evidence will be gathered from stakeholders. Within a very short timeframe, the discussion paper has highlighted important issues relating to FIFO mental health that will require further investigation and the AMA supports the assertion of Dr Jacobs that it is vital to continue the discussion. The Association is also pleased to note that new legislation which deals with mine safety, to be introduced in 2016, will specifically include the mental health of workers given the silence of the current Act on this aspect of their health. ■ the initial interviews being put aside, a new recruitment panel drafted in and all applications reviewed for a second time. Offers for employment contracts have now been issued with BPT positions to be offered shortly. The AMA understands that those applicants who have made satisfactory progress in their training will automatically be offered a BPT position in 2015. Those who have not will be interviewed along with all BPT 1 applicants. The AMA has worked closely with FSH to ensure that the recruitment process conforms by Public Sector Standards. Going forward, the AMA and Committee representatives will seek to work with all BPT sites to develop a standard set of recruitment principles and selection criteria which can be applied state-wide to avoid further issues arising in the future. Any questions about FSH BPT can be directed to the Industrial team at the AMA (WA). Phone: 9273 3000. ■ December ME D I C US 7 Hollywood Private Hospital welcomes da Vinci Xi to WA The da Vinci Xi Surgical System is the most advanced surgical robot in Western Australia and is only at Hollywood Private Hospital • Optimisedfora range of specialties including urology, ENT, gynaecology and general surgery • Designedfor efficiencyand ease of use • Willbethe platform for future technologies The next frontier in minimally invasive surgery The da Vinci Xi Surgical System is a tool that utilises advanced, robotic, computer technologies to assist surgeons with operations. With revolutionary anatomical access, the da Vinci Xi has broader capabilities than prior generations of the da Vinci system. It can be used across a wide spectrum of minimally invasive surgical procedures and has been optimised for complex, multi-quadrant surgeries. For more information please contact: Dr Daniel Heredia, Director of Medical Services, Hollywood Private Hospital (08) 9346 6249 hollywoodprivatehospital.com.au WE’RE BIG IN HEALTH COMME N T Dekker appeal supports doctor's right to choose D r Leila Dekker, Radiologist, was involved in a motor vehicle accident in the Pilbara in April 2002. Dr Dekker was stationary at a T intersection in her car on a dark road near Roebourne. Another car travelling at high speed drove towards Dr Dekker, who took evasive action by driving across the intersection and onto an embankment. The other car passed behind her and crashed. Dr Dekker didn’t see the other car crash, but heard the impact. Shocked and shaken, and without a torch, mobile phone or first aid kit, Dr Dekker drove directly into the nearest police station, a short distance away, and reported the incident and the possibility of an accident. Dr Dekker was charged in the Karratha District Court with dangerous driving causing death. After being convicted by a jury, Dr Dekker was sentenced to pay a fine of $10,000 and a driving licence suspension of two years. Dr Dekker subsequently appealed and in a 2:1 decision in 2009, her appeal was successful and her conviction quashed by the Supreme Court of Appeal. In July 2006, the Medical Board of WA filed a complaint against Dr Dekker with the WA State Administrative Tribunal under Section 13 (2) of the Medical Act 1984 (WA) based on her being a “medical practitioner convicted of a [criminal] offence”. After the Court of Appeals quashed her conviction, the Medical Board amended its complaint with the Tribunal to allege Dr Dekker committed ‘infamous or improper conduct in a professional respect’ in violation of the Medical Act Section 13(1)(a), as a result of her failure to stop and render assistance after the traffic incident in 2002. Dr Dekker and the Medical Board participated in a compulsory conference with a Tribunal administrative member in August 2009. The Administrative Tribunal then issued its findings that Dr Dekker should be reprimanded and pay the Medical Board $35,000 to cover its costs of pursuing the complaint. Dr Dekker appealed, but in November 2013 (more than 11 years after the accident), a four-judge panel of the Administrative Tribunal issued its decision that: The practitioner’s conduct in failing to stop and render assistance immediately after the ‘near miss’ incident involving her vehicle and a second vehicle on 27 April 2002, but instead leaving the scene of the accident and reporting the incident and the possibility that the second vehicle had driven off the road to the Police, would reasonably be regarded as improper by professional colleagues of good repute and competency. Although the practitioner’s conduct did not occur in medical practice, there is a sufficiently close link or nexus between her conduct and the profession of medicine for the conduct to be ‘in a professional respect’. The practitioner is therefore guilty of ‘improper conduct in a professional respect’ within the meaning of 13(1)(a) of the Medical Act. The Tribunal did not accept Dr Dekker’s argument that she was in a state of severe shock after having been involved in a life-threatening accident, that her passenger actively encouraged her to go to the police rather than stop, that she did not have a mobile phone, torch or first aid kit with her and it was dark and that she knew Roebourne to be a town plagued by social problems including drugs, alcohol and violence towards women. The Administrative Tribunal rejected that Dr Dekker’s conduct was “infamous” because she immediately reported the incident to the police. The Tribunal did not consider there was evidence Dr Dekker could have done anything to have saved the injured woman from dying at the crash scene from her extensive internal injuries. SUCCESSFUL APPEAL – NOVEMBER 2014 On 21 November 2014, the Court of Appeal found that the Tribunal had erred when it considered that there was a specific professional duty on a medical practitioner to attend and provide medical assistance to a person who is not a patient in circumstances where the medical practitioner: a) is aware that a motor vehicle accident has occurred in their vicinity, or may have occurred in their vicinity b) is aware that anyone involved in the accident has suffered, or may have suffered, any injury c) is physically able to render assistance. The Court of Appeal found there was no evidence of such a specific professional duty. The Court of Appeal found that the rules of natural justice precluded the Tribunal from drawing on its own knowledge and experience to find such a specific professional duty. The Court of Appeal also found that insofar as the Tribunal merely relied on some more general duty or norm to care for the sick, as applied to the particular circumstances of this case, its finding was made in the absence of evidence. This decision does not give doctors a guarantee that disciplinary action will not be taken if a ‘Good Samaritan’ fails to assist in an emergency, but it will help to provide some assurance to doctors who may feel they are legally bound to assist – irrespective of the dangers they may face in providing assistance. ■ December ME D I C US 9 NE W S RESEARCH PROJECT ON POSTPARTUM HEALTH LOOKING FOR PARTICIPANTS F amilies often experience a number of challenges during the first six months after having a baby. This period is now well-recognised as one which has critical developmental aspects for all members of the family, especially in terms of psychological and emotional growth. For many, things go very well, and parents, infants, siblings and grandparents all find their lives made more meaningful through the experience of nurturing a new human being and supporting one another. Unexpected life events, ill-health and parental mental illness can tip the balance away from a healthy adjustment for each parent, and for babies and young children, and may have longreaching effects as children grow older. Some of these may be in the form of repeated episodes of depression and anxiety in mothers or fathers. Parental mental illness can interfere significantly with the attachment relationship with the growing child, with ramifications for his or her cognitive, social and psychological development. Unfortunately, parents of young children are frequently late in asking for help when they are struggling emotionally during the first six months postpartum. A pilot study of 35 mothers by A/Associate Professor Caroline Zanetti and Dr Michael Gannon at SJG Subiaco Hospital found that 77 per cent of mothers experienced some sort of significant struggle during the first six months after their baby’s birth – the most frequent being a significant medical problem in themselves or their infant, or infant sleep and feeding difficulties. Around 46 per cent of mothers reported panicky feelings, or finding it hard to maintain a cheerful mood, 34 per cent were worried about their relationship with their partner, and The researchers are 23 per cent were hoping that doctors concerned about will encourage their partner’s mothers with babies aged mental well-being. between six and 15 months to Mothers were participate by completing an quick to seek help anonymous electronic survey for health problems, but very shy about discussing problems related to their own or their partner’s mental health. Very few had actually sought help. The Take Up of Postnatal Services (TUPS) study is now underway to see whether these figures are true for all families. The researchers are hoping that doctors will encourage mothers with babies aged between six and 15 months to participate by completing an anonymous electronic survey. The survey will cover how things go for mothers in the first six months after having a baby, what problems do mothers face, and whether services out there in the community are easily accessible and meet the needs of new mothers. A number of Woolworths’ vouchers are offered as an incentive to mothers, who can access the study by following this link: https://www.surveymonkey.com/s/TUPS. ■ If you would like to promote this worthy research project to your patients, please contact Nisha Sikotra who will provide you with more information: [email protected] or call (08) 9382 6828. 2015 AMA (WA) Membership Renewal (due by 1 January 2015) Renew your AMA (WA) membership and ensure you continue to have access to individualised support and representation should you need it, and to the many benefits and services that are exclusive to members. Renewing your membership is easy Renew by 1 January, 2015 and go into the draw to WIN 1 of 3 iPads or a $500 Coles-Myer voucher • Online at www.amawa.com.au • By phone on (08) 9273 3055 • Fax completed renewal form to (08) 9273 3073 • Post completed renewal form to PO Box 133, Nedlands 6909. NE W S Hollywood welcomes latest da Vinci ‘robodoc’ H ollywood Private Hospital is the first hospital in Western Australia to invest in the newest addition to the da Vinci line of robotic surgical systems. The hospital recently purchased the da Vinci Xi Surgical System, the most advanced surgical robot in Australia. With broader capabilities than prior generations of the da Vinci system, it represents the next frontier in robotic surgery. The da Vinci Xi can be used across a wide spectrum of minimally invasive surgical procedures and has been optimised for complex, multi-quadrant surgeries. Director of Medical Services at Hollywood, Dr Daniel Heredia confirmed it will initially be used for urology and head and neck procedures. “Specific operations will include prostatectomies, partial nephrectomies and oral cancer surgery. Over time, the robotic surgery program will expand to include gynaecology and general surgery,” Dr Heredia said. Hollywood CEO, Peter Mott said the multi-million dollar investment in the robotic surgical system represents a continuation of the hospital’s focus on securing state-of-the-art medical technology and equipment. “This will be the most advanced da Vinci Surgical System of its kind available in Western Australia. Our decision to make a significant investment in the latest robotic technology is consistent with our commitment to providing the highest level of patient care” he said. Prior to using the da Vinci robot at Hollywood, surgeons will have to complete a comprehensive training program that includes up to 20 hours of simulated learning and a hands-on laboratory workshop at an accredited site overseas. “Surgeons are then required to complete the first five cases at Hollywood under the direct supervision of an experienced robotic surgeon,” Dr Heredia said. “Finally, surgeons are required to perform a minimum number of cases on the robot each year to maintain their WESTERN AUSTRALIA Expanding services: Director of Medical Services at Hollywood, Dr Daniel Heredia, Deputy Director of Clinical Services, Dr Patricia Whalley and CEO Peter Mott with the da Vinci Xi Surgical System. accreditation as a robotic surgeon at Hollywood.” The da Vinci system brings a range of benefits to both patient and surgeon. As with other forms of minimally invasive surgery, potential benefits of undergoing a procedure using the da Vinci surgical system include shorter recovery times, fewer complications and reduced trauma to the patient. Some of the major benefits experienced by surgeons have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualisation and improved access. ■ WESTERN AUSTRALIA UPDATE YOUR MEMBERSHIP DETAILS If your details have changed recently, please contact AMA (WA) Membership on (08) 9273 3055 or email [email protected] December ME D I C US 11 It’s our mda national Wherever you practise in Australia, you can be assured that MDA National will be there to support you. Members’ views count and together we will continue to build a strong, successful organisation that offers true value. Across the country we’re listening – it’s our MDA National. Dr Rod Moore Acting Mutual Chairman Freecall: 1800 011 255 [email protected] mdanational.com.au The MDA National Group is made up of MDA National Limited (MDA National) ABN 67 055 801 771 and MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417 AFS Licence No. 238073. NE W S ‘Books on Prescription’ program useful in mental illness management L ocal GPs in Subiaco have welcomed an innovative program that offers self-help books for patients with mild to moderate mental health issues. Launched by the City of Subiaco, Books on Prescription is the first of its kind to be rolled out in the Perth metropolitan region. The program involves a GP or other qualified health professional, prescribing a book that may assist patients to understand and manage their mental health issue. A prescription is issued that details self-help books (hard copy and audio) available to borrow from the City of Subiaco Library. Dr Shane Morley from Rokeby GP said the instant reaction of many doctors from the practice was “what a great idea”. “Education is such a vital component of the management of any medical condition, but in particular, emotional issues and mental illness,” Dr Morley said. “Education makes people more able to accept they have a mental illness and therefore accept treatment. “Medication is only one facet of treating mental illness. Self-help and psychotherapy are equally and often more vital than medication,” he said. Across the primary care sector, there is an increased demand for mental health services. The Books on Prescription program aims to act as a support or an alternative to medication, this being strictly under the guidance of a GP or qualified health professional. The program is useful as an interim intervention while the individual is waiting for a consult within the mental health system. “The books we will be prescribing contain information on the benefits of exercise, healthy lifestyle, communication, time for self, relaxation techniques, solving problems and many other techniques people can use themselves,” Dr Morley said. “Also there is much information on the methods a therapist or psychologist will use including Cognitive Behaviour Therapy, mindfulness and acceptance/ commitment therapy. “Rokeby GP doctors are currently compiling lists of publications, which Great idea: Dr Shane Morley and Dr Luise Thorpe from Rokeby GP. they have found to be useful. The fact that the library will have the exact books that we have recommended is incredibly valuable.” Dr Morley explained the use of a prescription for the book formalises the service making it more likely the patient will actually get the book. “The use of the library for books is convenient and free. Too often we doctors recommend patients buy a book and this does not happen. “We encourage the public to approach their personal GP and suggest they too adopt the program.” The City of Subiaco won an award for the Books on Prescription program in the ‘Innovation’ category at the Local Government Managers Australia (LGMA) Awards in October this year. ■ Applications open for 2015 Churchill Fellowships A pplications are now open for the 2015 Churchill Fellowships, which provide an opportunity for Australians with a passion to travel the world in search of new ideas, excellence and innovation. The high international regard for Churchill Fellowships provide a pathway for Fellows to access expertise from around the world to expand their knowledge and experience. More than 100 Fellowships are awarded each year valued at more than $20,000 each. “A Churchill Fellowship is a remarkable opportunity to research a topic or an issue that you are passionate about. They are recommended for anyone who feels they have exhausted opportunities within Australia and would like to see what overseas has to offer,” said Paul Tys, CEO, The Winston Churchill Memorial Trust. Applications are open until Monday 16 February 2015, for travel between 1 September 2015 and 31 August 2016. ■ December ME D I C US 13 NE W S Bethesda casts its net further B ethesda Hospital – well known to anyone living in Perth’s western suburbs – has been given a brand revival that will be a core part of the health facility’s future growth strategy. Perched high on one of Perth’s most beautiful stretches of land with incredible views of the Swan River and Freshwater Bay, Bethesda Hospital in Claremont is an 88-bed facility that offers a range of medical and surgical services. With 68 overnight beds and 20 day procedure beds, seven (soon to be nine) operating theatres and state-of-the-art facilities, Bethesda Hospital currently offers a range of clinical specialties and onsite services that ensures a continuation of excellence in healthcare and is looking to extend its services. At a recent function held at Bethesda Hospital, board members, senior staff, doctors and other stakeholders, including the Chair of the Patron’s Group, businesswoman Rhonda Wyllie, were briefed on plans for 2015 and beyond. Hosted by Hospital Chairman, Dr Neale Fong, attendees were given the first glimpse of the results of a six-month brand revitalisation process involving an impressive new logo and a new name – Bethesda Health Care. “Beth” is a word found in both the Old and the New Testaments of the Bible, and means “house” while “Bethsaida” means “house of fish”. The name “Bethesda” was chosen in 1943 by Matron Beryl Hill, who had returned to Perth after missionary service in India. The new name was selected to reflect plans currently underway to extend Bethesda’s expansion plans. The new logo is based on a combination of two stylised ‘b’s that merge together to create an embrace, reflecting personalised care. Dr Fong thanked all Bethesda Health Care staff, volunteers and accredited doctors for their dedicated work. Dr David Sofield, Chair of the Bethesda Hospital Medical Advisory Committee also spoke to the group, supporters and friends and thanked them for supporting the Committee through the year. ■ (From top) Looking forward: Bethesda Hospital Chairman, Dr Neale Fong, thanks staff, volunteers and accredited doctors for their dedicated work. Dr David Sofield, Chair of the Bethesda Hospital Medical Advisory Committee, addresses the gathering. (From left) Dr Sven Goebel, Dr Grant Booth and Dr Ben Hewitt. AMA welcomes GP toolkit on domestic violence A new toolkit designed to help General Practitioners identify the signs of domestic violence has been welcomed by Australian Medical Association (WA) President Dr Michael Gannon. The toolkit was launched by the Women’s Law Centre of WA on Tuesday, 25 November, which was the International Day for the Elimination of Violence Against Women. “We know that women who suffer from domestic violence tend to visit GPs and hospitals more often, and it is vital that a resource is available so more cases are identified and the necessary support is provided,” Dr Gannon said. “Full time GPs can see up to five women per week who have suffered from some form of domestic abuse. 14 M E D I CU S December “The fact that one woman in Australia dies at the hands of a current or former partner every week is absolutely reprehensible, and more needs to be done to address this problem. “At odds with the perceptions of many, the incidence of domestic violence does not vary with social class. It does not discriminate according to income, race or religion. “Of great concern is that many women experience physical violence for the first time when they are pregnant. Pregnancy is a time of greatly increased risk to women, with the potential of injury to their unborn baby. “It’s an important and complex part of General Practice, so we applaud the Women’s Law Centre of WA for providing what will be a vital tool in picking up the tell-tale signs of abuse,” Dr Gannon said. The Toolkit, originally developed by the Women’s Legal Services NSW and adapted by the Women’s Law Centre of WA, provides practical advice for GPs on issues including: • note-taking for legal purposes • mandatory reporting • immigration and family violence provisions • summons and subpoenas • ethical issues such as continuing care for the patient, when the patient is the perpetrator, and when both partners are patients. ■ To view the toolkit, use the link: http:// www.wlcwa.org.au/resources/GP-Toolkit2014-Final.pdf over 40 in‑house Q: With specialist medico‑legal experts, who’s ready to take your call 24/7? Dr. Angie Di Re Avant member Avant. Experience you can always count on. We’re Avant. We’re Australia’s largest MDO and we’ve got 120 years of experience defending doctors’ good names. With over 40 specialist medico-legal experts in-house ready to protect and defend you, we’re on-call 24/7. So whatever situation you find yourself in, we’re always available to give you personalised support and advice. To find out more, call 1800 128 268 or visit avant.org.au Not all doctors are the same. The same goes for MDOs. That’s why you need to choose one with more expertise and more experience. Avant is owned and run purely for the benefit of its doctor members. So if you’re looking for experience you can always count on, Avant is the answer. mutual group Your Advantage *IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. U WA DE DIC AT ION Hard work pays off: AMA (WA) President, Dr Michael Gannon and Dr Alison Buckland, winner of the prestigious AMA Gold Medal. AMA GOLD MEDAL WINNER ALMOST GAVE MEDICINE A MISS Cheers rang out as the newest doctors in town were inducted at UWA’s Dedication Ceremony I t was a hat trick of awards followed by one very special prize for Dr Alison Buckland on the morning of 22nd November. At the Dedication Ceremony 16 M E D I CU S December for medical students of the University of Western Australia, Dr Buckland not only picked up the Peter Anderton Memorial Prize in General Practice, the Western Australian Faculty of The Australasian College for Emergency Medicine Prize and the Fred Johnston Memorial Prize, she also received the U WA DE DIC AT ION prestigious AMA Gold Medal for scoring the highest aggregate mark over the entire six-year MBBS course. It was a crowning achievement for someone who almost did not choose medicine. Although always interested in the field, Alison had the rather inconvenient problem of feeling lightheaded at the sight of blood. Instead, she studied to be a Speech Pathologist and spent some years working at PMH. However, the call of medicine proved too strong to ignore and in 2010 finally, Alison joined UWA’s School of Medicine. AMA (WA) President, Dr Michael Gannon congratulated Alison, presenting the visibly thrilled new doctor with the AMA Medal and a bust of Hippocrates. Just a few minutes earlier and much to the delight of the audience, Dr Gannon also gave a special shoutout to the student who came 88th in the rankings. “That’s about where I finished. So whoever you are, congratulations!” This year’s medical cohort from UWA was the 57th class to have successfully completed the MBBS degree. What was also significant was the fact that 44 rural students from 23 towns in WA and five Indigenous students graduated as well. Hosted by Professor Ian Puddey, Dean of the Medical School at the University’s historic Winthrop Hall, the event was bittersweet for some. “It is with mixed feelings that I emcee this ceremony today as it marks my tenth and final dedication ceremony as Dean,” Prof Puddey said. “I will miss partaking in what is undoubtedly the happiest day of the school year,” he added. If Prof Puddey addressed the gathering at what was his final Dedication Ceremony, Dr Michael Gannon attended his first as AMA President. Twenty years ago, Dr Gannon too graduated from UWA – although back then, the ceremony was held at the Octagon Theatre, not at Winthrop Hall. Dr Gannon’s brief yet emphatic address acknowledged the role of the students’ families in helping them reach this happy day and he exhorted the graduands to “always put patients and the community you serve at the centre of your practice” Delivering the Occasional Address at the Dedication Ceremony was Winthrop Professor Geoff Riley from UWA’s School Of Paediatrics and Child Health. Professor Riley discussed Plato’s list of virtues and offered the graduands words of wisdom, depth and great encouragement. “Hold the patient as they heal as surely as a splint holds a fracture,” he said. He also pointed out that the goal of medicine was the relief of pain and that it was a doctor’s duty to judiciously practise medicine with humility and virtue. “But give yourself time and don’t be too hard on yourself if you’re not perfect by January,” Professor Riley said tongue-in cheek. ■ 2014 Graduating Class Prize Winners •Australian Medical Association (WA) Gold Medal: Alison Buckland •Alan Charters Elective Prize: Hsern Ern Tan •Alfred Nailor Jacobs Memorial Prize: Amy Murdoch •Australian and New Zealand College Of Anaesthetists /Australian Society Of Anaesthetists Gilbert Troup Prize: Natalie Smith •Arch Ellis Memorial Prize in Psychiatry: Georgia Farrah & Primero Ng •C B Kidd Memorial Prize in Psychiatry: Georgia Farrah •Fred Johnston Memorial Prize: Alison Buckland •Hamish Macmillan Prize in Dermatology: Georgia Farrah •Helen Jane Lamard Prize in Medicine: Jolene Lim •Helen Jane Lamard Prize in Surgery: Zi Qin Ng •Hing-Hang Leung Prize in Palliative Care: Kirsten Biddle •Peter Anderton Memorial Prize in General Practice: Alison Buckland •Western Australian Faculty of The Australasian College for Emergency Medicine Prize: Alison Buckland December ME D I C US 17 U WA DE DIC AT ION 1 4 2 Pic: Phillips and Father; www.phillip sandfather.com 4 3 6 5 8 9 7 10 13 11 14 15 17 16 18 M E D I CU S December 12 18 U WA DE DIC AT ION (From left) Good advice: Dr Michael Gannon exhorts the graduands to always put patients first; Winthrop Professor Geoff Riley delivers the Occasional Address; and Professor Ian Puddey emcees his final Dedication Ceremony. GRADUATING WITH MBBS HONOURS Ashton Catherine Biddle Kirsten Boothroyd Alarna Buckland Alison Carter Sean Cheng Chien Chi Chevis Erin Chua Chee Wei Combrinck Jana Davidson Nicholas De La Hunty Daisy Dorkham Mariana Dubrawski Kaitlin Duguid Robert Edwards Julius Elphick Bryn Farrah Georgia Finkelstein Luke Flynn Anita Franke Malcolm Gandhi Aesha Hall Alexandra Hanson Matthew Hew Anthony Hiew Valerie Hillwood Jessica Ho Joshua Holmes Pippin Hutchinson Vinayak Jagadish Pragnya Jasper Emily Jervis Lee Jones Emma Jones Sasha Joseph Simon Jude Emily Jurgenson Janelle Kelly Robert Kenner Peter Kovacic Thomas Lan Nick Leathersich Sebastian Lewis Dr Katie Lim Si Ying Lim Xian Hui Lim Jolene Manickavasagar Usha Maurel Amelie McDonald Samantha Menon Lalitha Moffat Andrew Mun Ha Murdoch Amy Ng Chien Young Ng Primero Ng Zi Qin Ng Jacinta Ng Joanna Ong Jessica Patterson Heather Power Phoebe Prendiville James Prosser Alana Prosser Jessica Punch Ashleigh Puri Nidhima Rengel Anthony Roche Caitlin Sage Anne Shah Joanna Sim Eng Swen Smith Natalie Snelson Zakary Sommer Jessica Sprigg Dustin Stanes Erin Stone Michal Tan Daren Tan Hsern Ern Thorpe Brodie Tu Danny Walters Cameron Ward Joanna White David GRADUATING WITH MBBS Ayyar Priya Bavich Paige Bui Justin Caldow James Carroll Bronwyn Carroll Jackson Chan Hayley Chee Yan Shan Chen Oliver Chen Yixiao Chia Christopher Chia Elisa Chong Vincent Chong Sylvia Christiner Thomas Chung Kimberley Clarke Sarah Colvin Katherine Combs Nathan Coyne Jared Cullingford David Curtin Shona Dama Madhuri Davis Amelia Derwort Joseph Devereaux Rose Edmiston Phillipa Ellis Rowan Ellis Jennifer Fairclough Kyle Fernando Shrimal Fleyfel Ibrahim Fong Zhan Yao Foulkes-Taylor Verity Frew Georgia Greenall Marcus Hanly Gabrielle Hayes Cameron Hee Edric Ho Sheng En Ho Jia Min Hudson David Idris Hala Intrada Kavin Ireland Mark Jayaratne Thilina Jayasena Warunika Jha Nihar Johnston Gemma Joseph Zacharia Kamaruddin Mohd Kannegiesser-Bailey Madeleine Khouri Jessica Killalea Michelle Kingston Sarah Kirk Daniel Kirwin Brendan Koek Sharnice Koh Hoon Kok Wei Fuong Lam Jonathan Lam Danielle Lambert Katherine Lee Amy Lee Rebecca Lee Samantha Leed Catherine Li Marie Liew Sarah Lim Ming Hwee Loy Timothy Luk Lincoln Lumby Joshua Marcano Marie McGeough Jessica McHugh Margaret Menon Shirin Mercier Sarah-Jane Mohamad Ahmad Hakeem Moss David Mouritz Sari Mukhopadhyay Sandeepan Mummert Katharine Ng Verna Nicholls Sylvia Nicholson Zoe O'Hare Kate Parker Erica Pathmarajah Tishanthan Rogers Katrina Rogers-Angeles Anni Rooney Kathleen Silva Amali Sim Kwang Kiat Skoda Liam Smith Emma Smith Katherine Stokes Rachael Stone Andrew Swao Aliceba Tam Averil Tan Bryan Tan Herr Tan Eva Tan Jason Tan Kuok Tan Nadia Tan Nicholas Thornton Patrick Toh Christopher Tolman Frances Toster Sophie van der Linden Vanessa Vasantharao Praveen Vu Anthony Waters Georgina Watt Verity Wenzel Dorian White Christopher Williams Luke Wong Zhi Wan Wong George Xu Ling Yap Cameron Yap Francis Yap Zheng Liang 1. Dr Priya Ayyar (third from right) with mum, Dr Satya Ayyar, dad Dr Venkat Ayyar, sister-in-law Dr Rachana Desphande, brother Dr Nikhil Ayyar and partner Christian Moraru. 2. Graduands Dr James Caldow and Dr Jana Combrinck with their fathers, Dr John Caldow (extreme left) and Dr Johann Combrinck. 3. Dr David Cullingford with dad, Dr Robert Cullingford and mum, Sally. 4. Dr Daisy de la Hunty with parents, Dr Moira de la Hunty and Dr David de la Hunty. 5. Sixth Year WAMSS Representative, Dr Anthony Hew (centre) with brother Daniel and mum, Lyn. 6. Dr Julius Edwards with dad, Dr Glenn Edwards. 7. Dr Mariana Dorkham (third from left) with parents, Dr Zak Dorkham and Professor Samar Aoun with brother, Nicholas and partner, Benjamin Hawthorn (extreme right). 8. Dr David Hudson (second from left) with dad Dr Martin Hudson, wife Katherine, mum Mary and parents-in-law, Joyce and Gary Hamersley. 9. Dr Mark Ireland with parents Dr Ross Ireland and Anne Ireland. Mark’s sister, Dr Amanda Ireland was unable to attend. 10. Dr Pragnya Jagadish (second from right) with parents Dr Sarojini Jagadish, Dr Jagadish Jamboti and sister Annapurna. 11. Dr Katherine Anne Lambert (centre) with mum Dr Suzanne Elliott and stepdad George (extreme right), and dad Stephen Lambert and stepmum Vikki (extreme left). Katherine’s brother, Dr James Lambert was unable to attend. 12. Outgoing WAMSS President Dr Sebastian Leathersich (third from left) with sister Amy, mum Clair, dad Mark and brother Michael. 13. Dr Usha Manickavasagar (centre) with dad Manicka, sisters Dr Revathy Manickvasagar (second from left) and Dr Vaanitha Manickvasagar, and mum Kala. 14. Dr Lalitha Menon with mum Sharadha, brother Dr Shankar Menon and dad, Muralee. 15. Dr Natalie Smith with dad, Dr Craig Smith. 16. Dr David White with mum Dr Christina White, dad Dr Garry White and sister, Dr Caitlyn White. 17. Sixth Year WAMSS Representative Dr Averil Tam (in red) with (from left) Aunt Tam Po Lin, mum Margaret, sister Cynthia, dad Ming and grandmother, C N Tam. 18. Dr Cameron Yap with dad, Dr Ming Yap. December ME D I C US 19 CO V E R S T OR Y The good, the bad and the ugly There are great lessons to be learnt from the past 12 months in health, says Robert Reid 20 M E D I CU S December CO V E R S T OR Y I t was the best of years – and the worst of years. The good, the bad, the significant steps forward and occasionally backward – Medicus has reported the year. This final issue of Medicus for 2014 is an opportunity to take a look back at what has been and to try and look over the horizon at what might be coming in 2015, with a range of political and medical views. This was the year when we saw – and took part in – the opening of Australia’s newest and most impressive health facility, Fiona Stanley Hospital. Once the cleansing opening smoke cleared, all those at the ceremony could see a magnificent hospital that will meet the health needs of our fast-growing southern metropolitan corridor for decades. It was the combined work of two governments, thousands of builders, and is now the workplace of many hundreds of doctors and other medical and support staff. In many ways, the opening of FSH was a demonstration of what our State does best – prepare for our future health needs in a manner that we can all be truly proud of. But 2014 was also the year when we watched on, feeling helpless, when the WA State Government refused to take what would have been an easy decision for the future and add two extra floors on Perth’s new children’s hospital. As the AMA (WA) has said on a number of occasions, the failure to take up the opportunity to “future proof” the hospital will be felt not by this generation, but by the next. In recent weeks, the release of new population growth data has shown quite definitively that this statement was wrong. The abject failure to add the two additional floors will be felt within a year or two of the Perth Children’s Hospital officially opening its doors – not by decades. It appears that this government will be one to harvest its own failure. Twenty-fourteen was also the year that we saw further alarming figures about immunisation and a growth in the number of parents refusing to protect their children and the rest of their community. Despite the best efforts of many, especially the AMA and the Health Department, there appears to be a reticence by a worryingly high number of parents to leave the importance of immunisation to others. So much for community responsibility! It was the year that discussion about a possible over-supply of doctors got underway at the same time that some were advocating for a third medical school; and when the spotlight finally swung to the growing issue of mental health in our society and the Government promised a new plan to handle the implications – of course without any undertakings for additional funding. However there was better health news by the end of the year when the State Government decided to join the rest of the nation and ban the commercial use of solariums, albeit 12 months later than all other Australian states. And we now look forward to 2015 when health will once again be the main topic of debate on most days. The first major announcement by the State Government is likely to be the naming of a new permanent DirectorGeneral for WA Health – to replace the remarkable Professor Bryant Stokes. On the financial side, 2015 is likely to be a tough year. The government is looking to cut spending and like all other departments, Health will suffer. We know that any cuts in staffing levels will have a negative impact on frontline health delivery – wherever in the infrastructure the job may be. The progress of the coming year will be punctuated by the opening of a number of new hospitals as the State Government’s incredible $7 billion health building program comes to fruition. The first quarter of the year will see the roll-out of final services at Fiona Stanley Hospital, most notably Emergency. This will be followed by the opening of the new Perth Children’s Hospital with 298 beds and the new Midland Hospital with a combined public/ private total of Despite the best 367 beds. efforts of many... Of course, there appears to be a the opening of new hospitals reticence by a worryingly high always brings number of parents to leave the with it a sense importance of immunisation to of trepidation others. So much for community by some in the responsibility! medical world, but hopefully the sense of concern will soon be answered once offers of secure appointments are made. There will hopefully be action very soon on the redevelopment of Royal Perth Hospital. There are many decisions yet to be made on what services will be available from RPH, what buildings should be detonated or renovated, and what part of the magnificent site will be ready for sell-off to developers. This time next year we will almost certainly be discussing the possibility of a new Health Minister after current Minister, Kim Hames, indicated his decision to retire at the next election and the desire of Premier Colin Barnett to have new ministers in place well before the early 2017 poll. The government will also need to respond to the recent State Parliamentary Report on FIFO workers and their health needs. Certainly 2014 was a great year for health. But we failed in too many areas to take great comfort from our achievements. We hope that 2015 will see more health-related victories and fewer failures. We hope that we repeat our achievements and leave any failures behind. The fight to improve the health of all West Australians must continue. ■ December ME D I C US 21 CO V E R S T OR Y Significant reform to healthcare planning, delivery and facilities Hon Dr Kim Hames MLA WA Minister for Health A s the year draws to a close, it provides an opportunity for all of us to reflect on achievements and challenges over the past 12 months, and as Health Minister I believe 2014 has seen some particularly exciting and satisfying developments in the WA health system. Western Australian hospitals are treating more patients than ever before, while still meeting important national performance targets. The WA median wait time for elective surgery, for example, is the lowest for all urgency categories, compared with other states and territories. The WA Health Clinical Services Framework 2014-2024, released last month, acknowledges that the WA health system will need to progress reforms to meet crucial challenges, particularly associated with changing health needs, a growing population, rising costs, and outdated legislation and governance arrangements. In an unprecedented reshaping of the WA public health system, this State Government has invested more than $7 billion in 80 health facility upgrades and new construction works across the State to alleviate pressure points on the public system. Notable among these is the first newbuild tertiary hospital project in the State for more than 50 years, with the $2 billion Fiona Stanley Hospital, fully operational in March next year. It is the most complex of its kind to be commissioned in WA and is the biggest and most technologically-advanced health facility in the State. But it’s more than that – it represents a new era in WA public health. It signals a time of new infrastructure, new models of service delivery, new technology and better ways of doing things. Additionally, the $1.16 billion Perth Children’s Hospital on the Queen Elizabeth II Medical Centre site is on track for completion at the end of 2015, along with the $360.2 million, 300-bed Midland 22 M E D I CU S December Public Hospital which will replace the ageing Swan District Hospital and increase healthcare capacity for the north-eastern suburbs by approximately 50 per cent. Likewise, the $218.2 million expansion of services and facilities at Joondalup Health Campus, and the announcement of a new $15 million 37-bed paediatric ward, herald a major upgrade to services in response to growth in demand. It’s an exciting time for new construction and redevelopment right across WA, including the $120.2 million Busselton Hospital, and the $58.4 million Kalgoorlie Health Campus redevelopment – both due to complete their final phases of works in 2015. Upgrades to facilities at Carnarvon Health Campus ($26.8 million), Esperance Integrated District Health Service ($32.7 million) and the Exmouth Hospital ($7.6 million) have been joined by initiatives such as the Southern Inland Health Initiative ($329 million) and the North West Health Initiative ($147.3 million) – all with funding from Royalties for Regions. New infrastructure complements new innovation. This year, the $54 million Comprehensive Cancer Centre at Sir Charles Gairdner Hospital became home to Australia’s first CyberKnife, a $9 million piece of advanced technology used in the treatment of cancers affecting organs such as the lung, brain, liver and prostate. Research received strong support in 2013-14, with $8.71 million awarded from three State Government health research funds. Researchers will share $5.96 million of Medical and Health Research Infrastructure Fund grants; six projects will share $1.55 million in Targeted Research Fund grants; and six WA Health clinicians will share $1.2 million of Clinician Research Fellowship funding. And there are seeds of other initiatives that will bear fruit next year. In a first for WA, a special exemption from the WA Chief Pharmacist means health workers other than dental practitioners will soon be able to apply fluoride varnish to help prevent tooth decay among children in remote communities. That’s a significant step in the treatment and prevention of tooth decay among Aboriginal children. Funding of $38 million over four years has been allocated for additional school health staff across the State, most of whom will be based in regional teams servicing a number of schools in each area. More than 100 dedicated Aboriginal health services will be delivered under the new Footprints to Better Health strategy for regional healthcare, supported by the allocation of more than $32.2 million and building on the work already undertaken to improve life expectancy for Aboriginal people. I am delighted to now have Party Room support for a ban on commercial solaria in WA, and I’ll be looking to progress the final steps of that over the next few months. There are a few health issues that I think would benefit from a coordinated national approach, such as the ban on commercial solaria, and more rigorous testing and research into cannabis for medicinal purposes. In addition, the Review of the Surrogacy Act 2008 this year made a number of recommendations to address state, national and international surrogacy arrangements coordinated through Commonwealth agencies. These are topics I intend to pursue with my federal counterparts at Council of Australian Governments meetings in 2015. In releasing the Public Health Bill at the end of November, I reflected how much healthcare planning, delivery and facilities across the State have undergone significant change and reform. I’m proud to have been part of that and am looking forward to advancing other WA health initiatives over the next year and beyond. The challenge will be to improve both clinical care and financial sustainability, and to support a more responsive, accountable and engaged health system. ■ CO V E R S T OR Y Services fall behind and policy stalls as the axe begins to fall Roger Cook MLA WA Opposition Spokesperson for Health A s the WA Labor Shadow Minister for Health, I greeted the recent opening of Fiona Stanley Hospital (FSH) and the progress on the new children’s hospital with pride, knowing that these important aspects of WA Labor’s vision for health were now being realised. However, this last year is also one of frustration at glossy government advertising produced to distract West Australians from the cost blow-outs, deteriorating performance, policy paralysis and a crisis of leadership that was 2014 for health. FSH will make a big contribution to healthcare in this State, despite the government’s mis-management of such important health infrastructure. In particular, the regret from the decision to privatise management of the hospital was demonstrated when the Acting Director General clawed back patient facing services in May 2014 as they were better provided by the State to maximise patient care. Further, as documented in the Education and Health Parliamentary Standing Committee report, More than Bricks and Mortar, the FSH delays were evident at least five months before it was scheduled to open in April 2014. The failure to act early and the resultant further six-month delay on the SERCO 4.5 billion contract cost the state $118 million. But ribbon cutting and diversion of public focus through an avalanche of glossy brochures and multi-million dollar advertising campaigns cannot hide the real story of the crisis in health in 2014. Currently we have: • A mbulance ramping at an all-time high of over 1500 hours in August and October • Four-Hour Rule improvements that have peaked and are unlikely to meet NEAT benchmarks • Elective surgery median waiting times increasing and the waitlists growing; and • T he increase in patients waiting longer than ever to see their specialist – ‘waiting to wait’. The Minister for Health has acknowledged in Parliament: “It is true that ramping has been higher than it has ever been. It is true that in opposition, I was extremely critical of the former government for its ambulance ramping”. Nevertheless he refuses to answer to the same standards that he previously demanded. Promoting infrastructure achievements should not be allowed to camouflage the struggle of WA Health to contain costs as a result of the government’s incapacity to deliver innovation to hospital culture. Disappointingly, commitments to reduce the gap between WA costs and the national average price for a hospital episode are not being met. Indeed this government has presided over an increase from $5319 in the 2013-14 Budget to $5540 in 2014-15 Budget to treat an average patient in hospital while the national prices reduced. To compound the cost stressors being placed on WA hospitals, the share of the national medical research pie, which attracts a medical workforce with research opportunities and associated career paths, is diminishing. Subsequently the only option for this government is to open the purse strings and build a workforce around attractive pay packets. This is an effective but blunt policy tool, which is also unsustainable and will ‘rob Peter to pay Paul’. WA’s healthcare system has a massive challenge in our growing and ageing population. Our hospitals are hamstrung by a government unable to respond to the tsunami of increase in demand and age-related illnesses. Hospitals need to be innovative and embrace new ideas and technology. Yet our hospitals are driven by clumsy efficiency dividends and government directions without insight and strategy. Following years of government mismanagement, health is now in for a budget haircut. The question must be posed, as given many of the costs are fixed, exactly where is the fat in the system? Compounding this, the government’s previous efforts at the efficiency dividend approach have failed and recent evidence from the Department is that they will not meet the new government-imposed leave liability targets. A razor gang has been appointed to examine where cuts will be made. What will be missing in this inquiry is the role government has played in creating this situation. It is the Minister who should take responsibility for his mismanagement of the State Budget, and now inevitable budget deficit. Sadly it will be the doctors and nurses working on the frontline who will have to deal with the consequences. While raising their glasses to the patients finally being admitted at FSH, there is little sign that the Minister has acknowledged that there is a funding crisis and there is even less demonstration that he has a plan on how to tackle it. Chief among this policy hiatus is the failure by the Barnett Government to attract a permanent Director-General to the Department. I am an unwavering fan of Professor Bryant Stokes – his energy and wisdom is perhaps unmatched in the Western Australian health community. However, is WA so bereft of talent or so low in reputation that we are unable to engage a senior health public servant to lead our health system in the long term? The problem is the longer the government takes to resolve these challenges, the more the situation of cost blow-outs, deteriorating performance and policy paralysis will continue. The challenges for Health in 2015 with a Minister in retirement mode, will be in delivering a sustainable and effective health system and long-term leadership rather than acts of self-congratulation at hospital openings. ■ December ME D I C US 23 CO V E R S T OR Y Resourcing the Mental Health Sector Hon Helen Morton MLC WA Minister for Mental Health T he mental health system in Western Australia has been suffering from a historical legacy of inadequate investment and it will take some time to build the system we need. Reform of our mental health system has been significantly advanced through this government, but more needs to be done. Central to this work will be the progression of the Mental Health Act 2014, which I anticipate will be enacted in late 2015. Improved resourcing of the mental health system has also been a key priority. The State Budget delivered record funding of $791.6 million in 2014 and in overall terms, a 68 per cent budget increase since 2008. This increase in funding has ensured real growth in specialised public mental health services as well as services provided by non-government organisations. According to the 2014 Report on Government Services (RoGS), WA has consistently had the highest per capita expenditure on specialised mental health services. In 2011-12, WA spent an average of $244 per person on specialised mental health services, compared with the national average of $198. The RoGS also demonstrated that WA has consistently employed more direct care mental health staff in all staffing categories in publicly-funded specialised mental health services than the national average since 2005-06. In 2011-12, WA employed 126.3 direct care staff per 100,000 population, compared with the national average of 111.6 per 100,000. This includes a rate of 14.6 medical staff (comprising Psychiatrists and other medical officers) per 100,000 population compared with a national average of 13.1 staff per 100,000. I acknowledge that the most recent workforce data shows that while the number of employed Psychiatrists across all service settings has been increasing in WA since 2008, it still remains below the national average and has not increased over 24 M E D I CU S December the past two years. This is compounded by a high rate of substantively vacant positions and a difficulty in recruiting to these, rather than the absence of funds to do so. Data from the recent national AIHW Mental Health Services—in brief 2014, indicates that in contrast to other states, WA has a considerably lower rate of service contacts delivered by community mental health services (324.6 per 1,000 compared to 371.1 nationally) and the lowest rate of care days in residential mental health services (18 per 10,000 population compared 124.9 nationally). I am in no doubt that the shortage of communitybased services and support within WA is placing significant pressure on our acute sector. The AIHW report also indicates that WA continues to be below the national average in the rate of Medicare-subsidised mental health services delivered by GPs. This is at least partly due to the lower number of GPs in WA, particularly impacted by the State’s vast geographical area. Medicare per capita expenditure on mental health services in WA was $27.67 in 2012-13 – significantly lower than the national average of $39.57. This gap in expenditure has been widening over the past five years, with per capita expenditure on mental health services decreasing by an annual average of 0.3 per cent in WA, compared with an annual average increase of 3.8 per cent nationally. This has undoubtedly added to the pressure on the services funded by the State. In recognition of the need to systematically improve the mental health system, the Mental Health, Alcohol and Other Drug Services Plan 2015-2025 (the Plan) as recommended by the Stokes Report, has been released for public consultation. The Plan is a blueprint of what services our system needs and covers the entire service spectrum, from prevention and promotion to acute inpatient services. Clinical input has been vital to develop the Plan and will be essential throughout the consultation process. Feedback will be used to refine and prioritise strategies and actions in the consultation draft and prepare a final Plan, which will be released in 2015. Of the remaining recommendations of the Stokes Report, a total of 31 recommendations are complete, with the balance progressing well. Progress has continued on a range of other service improvements. Commencing in February and progressively throughout 2015, 136 new and replacement acute specialist mental health hospital beds will open. With an average length of stay of 14 days, the opening of 40 additional beds in 2015 (with the additional staff required) will result in the availability of 1,042 additional inpatient admissions per year. Also underway is the development of community-based sub-acute services across the State. The Individualised Community Living Strategy is being expanded to include 148 individuals, the pilot Mental Health Court Diversion program for adults and young people continues to make good progress – and further funding has been provided to continue the Statewide Specialist Aboriginal Mental Health Service. The Ministerial Council for Suicide Prevention is close to finalising the next multi-year strategy to build on the foundations of the first Strategy. During 2014-15, an additional $3 million was allocated to strengthen the sustainability of Community Action Plans and maintain the Response to Self-Harm and Suicide in Schools. I am very much looking forward to the changes and opportunities that lie ahead in improving our mental health system. This will take time and will need the combined efforts of government, service providers and the community if we are to deliver the best results. ■ CO V E R S T OR Y Reflections from a Consumer Perspective Michele Kosky AM Health Consultant & Former Executive Director, Health Consumers Council, WA T he year 2014 has been characterised by change and continuity for WA health consumers, families and carers – continuity in recognising that Australia and Western Australia maintain a highquality, accessible healthcare system that is the envy of people in other countries. One only has to read dispatches from the frontline of Medecins Sans Frontieres to appreciate how privileged we are to have a safe, effective health system. Of course from a consumer perspective, there are always improvements that need to be made. We are, after all, the experts by experience. Consumer participation brings a different energy to the matters under consideration. What an amazing change that the Australian Commission on Quality and Safety in Health (www. safetyandquality.gov.au) has established standards for the accreditation of healthcare organisations. Standard 2 is ‘Partnering with Consumers’, which means consumer participation at all stages and every level of the health system – though ironically not with WA Health Department; unlike hospitals, health departments do not have to be accredited. However given the Department’s past record of consumer involvement, there is optimism in the consumer sector that the spirit of ‘Standard 2’ will be adopted and implemented across the State. For the community in 2014, the big ticket items would appear to be the opening of Fiona Stanley Hospital, the development of the Perth Children’s Hospital and the Midland Health Campus, the opening of the GP Super Clinic, ECU Health Centre at Wanneroo, and in country WA, investment and expansion in hospitals from Broome to Esperance, Kalgoorlie to Karratha, Carnarvon to Busselton. So we note the results of major capital investment across the WA health system in 2014, but indeed it is what happens within and without these health settings that is of greatest consequence to consumers. How these shiny new buildings are connected to your local GP or community allied health worker or aged care facility is what exercises the minds of consumers. What is the information flow between primary care and tertiary care, or my local country hospital or my local Aboriginal controlled health service? Where are my needs, wishes and values reflected? How is my care integrated and co-ordinated? Might technology and the long-awaited eHealth Record contribute to the better coordination of my care? Why do we continue to emphasise the investment in hospitals and diminish the role of primary healthcare? Maybe that could go on a wish list for 2015 – a multimedia campaign that informs the community about the critical importance of General Practice and other components of primary healthcare. Better primary healthcare is related to better population health at lower healthcare costs – one of the ‘continuities’ in 2014 but one that has yet to be adequately addressed. Another ‘continuity’ is the importance of effective communication between patient and medical practitioner – which remains cause for a large number of complaints. Listening to what the patient has to say without interruption, encouraging questions and explaining why a particular approach is best takes time and patience and of course, requires the patient to be prepared for the consultation. Health literacy is a bit of a buzz word, but its definition demonstrates how it can influence patient outcomes. Health literacy is the ability to obtain, read, understand and use health information. Low health literacy reduces the success of treatment and increases the risk of medical error. Encouraging patients’ questions has improved health behaviours in people with low health literacy. Is this an area where the AMA (WA) might work in partnership with consumers to remedy low health literacy in vulnerable populations? During a recent conversation with a former colleague, the question was put – what were the main concerns of mental health consumers in WA this past year? The reply was salutary. Mental health consumers are radically over represented in health complaints as the right to participation in decision-making about care and treatment (taken for granted by most of us), is often neglected for people with mental illness. Issues of consent, information about medication benefits and risks, and working in partnership with your medical practitioner or mental health worker were cited as examples where people with mental illness felt they were not getting a fair go. Other concerns for consumers in 2014 related to long waits for GP appointments particularly in the southern suburbs, complete lack of discharge planning by private hospitals and a lack of co-ordination overall. In addition, senior consumers reported the failure of good advice by medical practitioners in instructions to pharmacists making up medicines for consumers. In 2014, it is not acceptable to write “take as directed by your doctor” with no advice about how much to take, at what time, with or without food etc. or no instructions at all provided, just the “no instructions specified, check with your doctor if unsure of dose”. Surely, we can improve this! Working with rural consumers in mid2014 reminded me of the information gaps in the health system but also, of the great appreciation people have for new initiatives. The introduction of the Emergency Telehealth Service was a win for regional consumers and WA Country Health. These consumers suggested more information and access to End of Life choices including Advance Care Directives, and an electronic register to make it easy for hospital or health service staff to access patient wishes, more information about ‘Not for Resuscitation’ policies, and an improvement in culturallysafe health services for Aboriginal people. My wish list for 2015 would include a Community Conversation about health Continued on page 28 December ME D I C US 25 CO V E R S T OR Y WA’s public hospitals in 2014: a bumpy ride on a precipitous road with a sick system Associate Professor Dave Mountain AMA (WA) Emergency Medicine Spokesperson Y ou may have picked up from the title that all is not well in our public hospitals. Western Australia has been lucky to have a great public hospital system that performs well above average on most measures in the last few years, delivers high quality care and does so to an isolated population dispersed over a huge area. The reason WA has been able to manage many challenges and be a leader on issues like NEAT/NEST targets whilst improving quality and outcomes of care is due to a highly motivated, skilled and trained workforce. Our major hospitals produce excellent results and punch well above their weight in terms of quality and access to care. Major outer metro and regional hospitals have also delivered excellent results, are high acuity by most standards and contribute significantly to teaching and training of new waves of doctors, nurses and other professionals. These major achievements are based on highly successful research (often started in WA), great training and skilled workforces. All of these achievements and the building blocks for future success are being put at risk by draconian responses to current fiscal problems, major cuts to clinical staffing and services – all driven by a mantra around Activity-Based Funding (ABF). This is the biggest threat to delivering quality patient care we have seen for a generation – at least as applied in WA. ABF pretends that if you look for the system/ hospitals around the country that deliver the highest number of widgets per dollar, that is the efficient system. It has no significant measure of quality of care, doesn’t monitor outcomes and represents a soulless dive for the bottom. It drives a destructive disregard for the real costs of teaching, training and research required to deliver functional high quality teaching hospitals. This dismissal of research and training is highly regressive as we know real efficiencies and good outcomes occur in hospitals that value, support and enhance research, teaching and training. These are always the easiest things to remove first when you aim for a low cost without regard to quality. ABF modelling has no way of measuring the real costs of delivering these services after over a decade of implementation in the East. Our administrators are busy destroying academic posts, research infrastructure, reducing handover times and wrecking rosters to save money, which in the end will deeply impact on training, quality of care, true efficiencies and translational research outcomes. All they are interested in at the moment is dollars, removing FTEs and meeting targets. They have no vision for quality, safety or a dynamic highperforming health system. They use the (very expensive – millions in one hospital alone) fig leaf of external consultancies from the normal suspects (KPMG, PWC etc.) to produce reports justifying what they were going to do anyway. The reports of course are never to be seen by clinicians or even Heads of Department (HoDs), so no one knows how they are done, what assumptions are made and what they were told to come up with in the first place. These same blindsided HoDs are also told to manage on ABF models and meet stringent budgets even though the budgets given to them by hospitals have nothing to do with ABF funding – and if they increase activity, they are told funding is capped. The reason WA spends more dollars per head of population for its health system than most other states is because until recently, we valued our population’s health, spent more to achieve more, and gained the benefits of a better resourced health system – barring mental health and other pockets of neglect. Where are we now seeing the pressures in the system? Frontline clinical services are now being decimated as the toe cutters move through. The worst of these have occurred so far at Sir Charles Gairdner Hospital, but to a degree they chose the most stable part of the system to take their pound of flesh first – obviously nothing was to get in the way of the good ship, Fiona. But other services and other hospitals are also being targeted for similar 10-15 per cent budget decreases and FTE decreases of up to 10 per cent of workforce over the next two years. At most sites, these are being deliberately targeted at clinical services whilst administration and back room services delivering no appreciable benefit to service delivery are protected. They have suffered too much previously, we are told. Beds are being closed with nebulous and unlikely plans for reopening if they get it wrong – a near certainty given previous experience of health system forecasting. In the recent winter (unplanned for in any meaningful way), hospitals routinely hit 95 per cent occupancy rates and yet we are planning for 5-7 per cent bed closures in our major hospitals. This at the same time that we face a major system reconfiguration where anyone with any sense would know we need some flexibility and capacity in the system to deal with inevitable problems during these system dislocations. This brings us on to the ongoing issues with the Fiona Stanley Hospital (FSH) and its opening. Firstly, to say it looks good and was built on time are the positives. However the ongoing problems with the staffing models, poor management of key personnel, service models, outrageous SERCO contracts, IT problems (the not so paperless hospital) and the severe dysfunction managing the FSH opening has wrought havoc on the rest of the system. A relatively thin talent pool in medical administration has been regularly redistributed to cover and manage the FSH cracks whilst IT for the rest of the state is a disaster area with no funds, support or meaningful updates for three years. The way staff have been dealt with by HR and administrators has been offhand, sometimes underhand and has seriously dented morale and goodwill for the new Continued on page 27 26 M E D I CU S December CO V E R S T OR Y Continued from page 26 WA’s public hospitals in 2014: a bumpy ride on a precipitous road with a sick system Associate Professor Dave Mountain AMA (WA) Emergency Medicine Spokesperson S ST PI A PSYCHIA IN TR C IS T CHALLENGES ARE OUR SPECIALTY MENTAL HEALTH MOOD & ANXIETY MANAGEMENT F- a N BI-POLA DEPRESSION R DISORDER N ART THERAPY EA MN DO TSIPOINRAI TLU, APLH HY ES AI CLTA HL TIO PROGRAM THERAPISTS BREAK THE CYCLE OF RELAPSE R E F L EC L I T Y D I SO R D E R S S AN D OCCUPATIONAL TRAUMA RECOVERY SE L S T E g sy R E G Illeviatin GROUP THERAPY HIGHLY SKILLED HEALTH PROFESSIONALS COGNITIVE BEHAVIOUR THERAPY 70 I N - PAT I E N T B E D S E X PRE SIO SO N A A MI ND and p D A p tom s E R m IN-PATIENT AND DAY-PATIENT CARE AND TREATMENT PER the best for our patients or our staff anymore. We can see the levels of stress in the amount of sick leave, stressed colleagues and overt unhappiness around us in our hospitals. It is time for our supposed leaders to manage change and fiscal problems in a more imaginative way, prune out true waste and excess, remove back room nonsense that doesn’t deliver patient care and bring your staff along in ways of stabilising FTEs, increasing activity or throughput using best models and translational research. But the current slash and burn mentality is deeply unhealthy for our patients, staff and the system in general. Amputations should always be taken after serious consideration, should preserve as much as possible and have a good rehab plan. The current plans for our public hospital look truly medieval – slash high, slash quick, dip in pitch and fingers crossed the patient doesn’t die. ■ SOCIAL WORKERS LIFE’S THE SENIORS’ PROGRAM TH ER ER RD gaps. Of course unfortunately, really sick psychiatric patients don’t wait for these times and NGOs are unwilling and unable to manage really unwell psychiatric patients. If this report delivers more of the same from a new Mental Health Commissioner and wastes more money on non-24 hour services (we need 24 hour a day community and hospital-based services), I think all hope will be lost in the devolved model of mental health ministry and management. Finally it is not just Psychiatry where despondency, poor morale, anxiety and fear for the future are rife. Our hospitals are currently truly unhealthy and unhappy places to work. Our staff feel under constant threat for their jobs due to working conditions and from micromanagement and administrative bullying. They feel unvalued and undermined by their administrative colleagues on a routine basis. There is no trust or belief that we are doing I UL AN D B EXIA OR NT AN ME NG AT DI TRE LU S MATIC STR TRAU ESS STRS E S DI PO OLLED NnUg recurrence P SO HYS ENR reventi IO hospital. The modelling with regard to patient flow when FSH opens is hardly believable with RPH supposedly losing 30-40 per cent of its work and reductions in staff based on this on the basis of some DoH’s best guess. Anyone who has watched DoH modelling unravel as many times as I have over the last 20 years understands what a ridiculous way round this is. Watch what happens first and reduce the workforce after, if you get it right. Finally to public mental health – both the mental health system and that of our staff and our colleagues. The mental health system performs badly even by national comparators. It has been subject to endless reviews, the latest of which is 15 months late and only just released for discussion. Morale in acute public mental health/ Psychiatry is woeful – and for good reason. The current review shows that yet again 5/7, 9 to 5 NGO services are going to be looked at to fill mental health 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 CO V E R S T OR Y General Practice continues to do the heavy lifting amidst growing pressures T his year, like the previous half dozen (and perhaps even longer), has not been a positive one for General Practice, and most of its problems can be put down to poor government policy and a failure to listen to the critical part of medicine that is doing the heavy lifting. Governments continue to demand that GPs do more in the primary healthcare space to keep patients out of hospitals and Emergency Departments which saves them a fortune; but they also expect them to bulk bill the patients to avoid voter backlash. GPs are doing more, but it is coming out of their pockets, not the government’s – and this is having a big impact on infrastructure and capacity. It wasn’t enough that the previous government capped rebates, the new Federal Government did absolutely nothing to rectify the problem. What they did do to contribute to patients’ and practices’ woes, was introduce a budgetary measure to send a so-called price signal to the community – a co-payment. This initiative is not only a blunt instrument, it is indicative of a health policy vacuum. The Federal President is correct when he says that there is a need to be talking about policies that provide better access to health services, not policies that will deter people from seeing their doctor. The government’s co-payment model does nothing to address that objective. All this does is: • disadvantages vulnerable patients – the poor, the elderly, the chronically ill, and Indigenous Australians; • discourages prevention and chronic disease management; and • is realistically not able to be implemented by July 2015 because of the complexity, technology, billing systems, and red tape that would be imposed on medical practices, adding yet another cost burden on GPs. What is particularly galling is that General Practice had to stand by and witness the previous Federal Government fritter hundreds of millions on the flawed super clinic and Medicare Local initiatives, but then sigh with relief when the current government scrapped them. But now they’re being replaced with Primary Healthcare Networks (PHNs), which is being funded out of General Practice and Primary Healthcare money. What will GPs and their patients get out of this new layer of expensive bureaucracy? Probably very little, other than demands to fill in numerous forms, questionnaires and voluminous contracts to justify their expensive existence. General practices do not want, or need another expensive layer of bureaucracy to deal with; they want to treat their patients and they require the practice infrastructure to do the job. Redirecting scarce resources and money to flawed policy initiatives is no way to achieve that objective. GPs know this from their experience of previous iterations. If health funding is out of control, then throwing money at PHNs is no way to save scarce primary care dollars. GPs are also seeing more patients with mental health problems than ever before and again face the impediment of the Federal Government’s constraints on the number of allied mental health services a patient can receive rebates for. This remains at 10 per calendar year, other than for exceptional circumstances. At state level, there is currently little primary care focus from a mental health resourcing standpoint and GPs currently find getting access for their patients a frustrating exercise. It is hoped that a strong GP-focused community model of care will be implemented in 2015 in WA. That will require consulting directly with GPs. We must keep GPs at the centre of this model. A positive piece of news is that GP training is experiencing a renaissance and we need to ensure it is sustained for the long term. WAGPET overall is doing a terrific job and the profession in WA must do everything in its power to ensure it is resourced and supported in continuing to carry out this important role in 2015 and beyond – free from bureaucratic and government interference. If we needed any proof of the value and cost effectiveness of GPs, we should look no further than the long-running Bettering the Evaluation and Care of Health (BEACH) study, which has found that 85 per cent of all Australians see their GP at least once a year, and in 2013-14 there were 35 million more GP services than a decade earlier – a 36 per cent increase. It also showed that not only are GPs seeing people more often, but they are spending more time with them – the average GP consultation now takes almost one minute longer than a decade ago because their patients are ageing and presenting with a wider array of chronic and complex health problems. In all, GPs spend an extra 10 million clinical hours with their patients – a 43 per cent increase. Underlining the cost effectiveness of General Practice, the authors found that the same service provided by a GP for around $50 would cost between $396 and $599 if performed in a hospital ED. As the Federal AMA President says, “General Practice keeps people healthy and out of hospital. It makes sense for the Government to invest heavily in primary care, and the most cost-effective quality primary care is provided by GPs.”1 ■ Reference: 1. Australian Medicine. Continued from page 25 Reflections from a Consumer Perspective Michele Kosky AM funding over the next 20 years; consumer participation at all stages and every level of the health system; better integration and co-ordination for patients; a Centre for Patient Experience at a major Perth 28 M E D I CU S December hospital; improved interpreting services for people without English as a first language; an emphasis on quality of life rather than length of life; and finally, the adoption and implementation of the recommended National Aboriginal and Torres Strait Islander Health Authority to actively purchase and commission the very best health services for Aboriginal and Torres Strait Islander people. ■ CO V E R S T OR Y It is time to move on...with optimism, generosity and respect Dr Alexandra Welborn Psychiatrist, Royal Perth Hospital and AMA (WA) Psychiatry Spokesperson C hristmas is a time of hope, generosity and fellowship. The mental health sector is certainly in in need of something to look forward to, after a year of turmoil and uncertainty at senior levels about the right way forward. Now, the Office of Premier and Cabinet has authorised the release of the much anticipated 10 Year Mental Health Plan by the Minister of Mental Health and the Mental Health Commissioner. The Plan was launched on Wednesday, 3 December 2014 and a four-month consultation phase has begun, which will include six visits by the Commissioner to rural areas. The AMA will be providing a detailed submission to help shape the final product, which will be completed in April 2015. The Plan is based on robust epidemiological data which maps the anticipated population growth to 2025 and calculates the expected proportion of that population to have severe mental illness (3 per cent). This modelling process, using an evidence-based estimator, confirmed that the major deficit continues to be in community services. It is overwhelmingly clear from that the inappropriate use of Emergency Departments for mental health crisis management, and the problems of bed-block, can only be solved by further extensive development of communitybased prevention, early intervention and rehabilitation services. A focus on acute services is the wrong investment, and a population health model of care based on primary, secondary and tertiary prevention is well overdue. The Plan starts with whole of population prevention measures and steps through dramatically expanded community treatment to specialised services addressing big gaps in our current public service provision, including public eating disorder beds and public services for adults with ADHD and autism. The Forensic expansion is comprehensive and particularly necessary for mentally disordered offenders. Much has been made of Professor Stokes’ off-the-cuff remark that he would like to put a bomb under Graylands Hospital. He qualified that he did not anticipate that the patients would still be within the buildings. “A series of staged explosions”, the statesman said at the launch. But where will the patients be when the now familiar rumble and dust rises? The big work of individually relocating each of the 170 people in the 170 beds to long-stay community beds or acute beds needs to begin now. Graylands Hospital occupies a unique place in our state’s history and it is not helpful to demonise the place. “Claremont” as it used to be called, was built with the State’s windfall from the Kalgoorlie gold rush, and at the time was seen as a tremendous advance from the appallingly over-crowded Fremantle Asylum (now the Fremantle Arts Centre). The broader public perception must now be that Bedlam has indeed been lurking in Claremont for the past century. How bizarre that the Claremont Royal Show announced this year that it had created a true replica of Bedlam Hospital, for the paying public to be frightened by actors simulating asylum lunatics! It was the outraged voices of the carer and consumer sector that led to the appropriate closure of that ‘ride’. It is time to move on, and we must all be ready to meet the challenge of further developing services informed, with the true spirit of Christmas, by optimism, generosity, and respect for persons suffering from mental illness as true fellows on our journey. “There but for the grace of God go I.” In fact doctors and health professionals are no more immune from mental illness than anybody else. What kind of services would you like for yourself or members of your family? There has been unprecedented coverage of all things mental health this year, and the voices of carers, consumers and families are being increasingly heard. It is critical that the specialist psychiatric voice is part of the balance, to ensure that evidence-based assessments and treatments are available to those suffering from mental illnesses. One good example here is the incontrovertible ongoing role for electroconvulsive treatment (ECT) for people with psychiatric illnesses and physical illnesses such as anti-NMDA encephalitis for example. Ill-informed unbalanced opinion would have that treatment banned. The Commissioner has indicated his commitment to a clinical reference group to provide advice to him. Much has been made of finding, that “one in five” of the Australian population will suffer from some form of mental illness, and that the Australian Bureau of Statistics epidemiological surveys show that 25-30 per cent of the population have a DSMdiagnosable disorder in any six-month period. The medical profession, and the community, must acknowledge that specialist psychiatric services – public and private – can never provide services to a quarter of the population. Psychiatric services are specialist services, and must necessarily focus on the 3 per cent with the most severe illnesses. The overwhelming majority of medical mental health treatment is provided by General Practitioners. Psychiatrists could have a more active role in helping GPs, and service development should try to give Psychiatrists and GPs the opportunities for helpful liaison and shared care. The Medicare item number for management plans provided by Psychiatrists to GPs is under-utilised, and GPs and private Psychiatrists might like to consider innovative models such as Psychiatrist sessions in GP surgeries for these types of assessments. There are only 270 Psychiatrists in WA and we feel the stress too. But we are all in the boat together and perhaps we are now finding ways to row in the same direction. There is a crack in everything, that’s how the light gets in – Leonard Cohen. ■ References • The Mental Health, Alcohol and Other Drug Service Plan 2015 – 2025. Consultation Draft available from 3 December 2014 on the Mental Health Commission’s website. • Burns, Tom. Our Necessary Shadow. The Nature and Meaning of Psychiatry. Allen Lane. 2013. December ME D I C US 29 CO V E R S T OR Y The IR story – achievements and setbacks T he year in Industrial Relations got off to a flying start with the registration of comprehensive new agreements negotiated by the AMA (WA), securing improved pay and conditions for salaried public sector medical practitioners working in public facilities throughout the State. Similarly improved agreements for private salaried practitioners at St John of God Hospital Murdoch and the Royal Flying Doctor Service were also registered. While agreement was reached to replace the 2011 agreements, the Department of Health was not prepared until recently to replace subsidiary agreements made under the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2011. Agreement has still not been reached to replace subsidiary agreements that put in place special on-call and call-back arrangements for plastic and orthopaedic surgeons called back on weekends. Agreement has been held up due to a dispute over the interpretation of the call-back provisions set to be heard by the Industrial Magistrate in March 2015. The reconfiguration of the South Metropolitan Health Service (SMHS) due to the opening of Fiona Stanley Hospital and the realignment of health services at Royal Perth Hospital and Fremantle Hospital has produced a mixed result. Some Consultants and Doctors in Training have been encouraged about working at FSH by the attraction of a new state-of-the-art facility, better hours for their personal circumstances and a range of other reasons. The AMA has met with FSH Senior Executives throughout the year to resolve contractual, rostering and training issues. The AMA has also been active in representing members adversely affected by the faulty preferential employment registration process by being locked out of preferences or, having been assured that there would be no change to their particular department and not completing a Preference Registration Form, then being locked out of the process when the information later changed. The PRF process combined with the Department of Health’s fixation over costcutting had a significant impact at RPH and Fremantle Hospital. Sudden decisions to downsize Departments and introduce new structures and job plans with no concern for employer responsibilities under the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2013 resulted in the AMA notifying SMHS of disputes within a number of departments at RPH and with Continued on page 33 AMA steers changes for Junior Doctors in the system This past year has seen a number of substantial wins for junior doctors in Western Australia thanks to the advocacy undertaken by the AMA (WA). The AMA (WA) Doctors in Training Committee (the Committee), along with the industrial team, have worked tirelessly to implement new initiatives, advocate for changes in WA Health policy and lobby for improvements to recruitment processes. The year started on a high. Following discussions between the AMA and the Postgraduate Medical Council of WA (PMCWA), a raft of changes were introduced to address the deficiencies associated with the Centralised RMO Recruitment Process. These changes have resulted in a smoother and more transparent recruitment process in 2014. A significant area of concern for the Committee and the AMA in 2014 was the lack of access to leave entitlements in WA for junior doctors. Following a survey of junior doctor members, which received over 250 responses, the AMA published an ‘Access to Leave Scorecard’ in an attempt to bring the issue to the attention of the tertiary hospitals. Following the release of the scorecard, the Association was able to secure a leave policy overhaul at Royal Perth Hospital. Discussions with Sir Charles Gairdner Hospital, the lowest ranked hospital on the scorecard, are ongoing and the AMA hopes to see an improvement in 2015. The launch of the AMA (WA) Part Time Doctor Portal marked another substantial achievement in 2014. The lack of access to flexible working arrangements is one of the key issues affecting junior doctors in the State. Junior doctors who require access to flexible working arrangements are 30 M E D I CU S December usually asked to pair themselves up with another junior doctor in order to secure part-time employment in the form of a shared job arrangement. The Part Time Doctor Portal will facilitate this process by providing a space for junior doctors to share information with one another to find their perfect jobshare partners. The Portal has received excellent feedback from both members and hospital executives. Other significant wins for the AMA in 2014 include the RMO Term Dispute at SCGH, as well as the AMA’s involvement in ensuring the BPT recruitment process at Fiona Stanley Hospital was overhauled following significant concerns raised by junior doctors. More information on both of these issues can be found on page 6. One of the highlights of 2014 has been the collaboration between the Committee and the Membership team at the AMA. The membership engagement strategies implemented have resulted in a substantial increase in the number of junior doctors joining the Association. In fact, junior doctors accounted for over 65 per cent of new members in 2014. This collaboration will continue in 2015 with several exciting initiatives lined up, including the launch of an online Research Portal. Now that 2014 is drawing to a close, the AMA is looking forward to celebrating a successful year for junior doctors in style. The Junior Doctor Sundowner will be held on 14 December 2014 at Mosman Park Bowls Club. AMA members are invited to come and relax with colleagues over a few drinks, whilst enjoying bowls, a BBQ and the delights of the Mr Whippy Van! CO V E R S T OR Y Healthway successes easily outweigh road bumps hit during the year Associate Professor Rosanna Capolingua Healthway Chair A s Chair of Healthway, at the end of every year it is easy to look back at achievements and successes – and 2014 has truthfully been more eventful than most. Unquestionably, Healthway has, since its creation in 1991, had a major and positive impact on physical activity, smoking, unhealthy eating, and the influence of alcohol. Occasionally we need to remind fellow West Australians that Healthway was created and is governed by provisions of the Tobacco Products Control Act. According to the Act, the aim of Healthway is to: “… fund activities related to the promotion of good health in general, with particular emphasis on young people; and To support sporting and arts activities which encourage healthy lifestyles and advance health promotion programmes; and To provide grants to organisations engaged in health promotion programmes…” This is our responsibility to the WA people through State Parliament. Healthway has always taken these directions seriously and, I am confident, will always do so. Our objective to promote and protect the health of West Australians has continued to drive us. Even though the challenges during 2014 have been many, I can say confidently that once again we have delivered strongly for the WA population. But we do, as a matter of course, work closely with government and with healthrelated bodies and individuals, universities and researchers, the Cancer Council, the Heart Foundation, DAO and importantly through sponsorship of sport and the arts, we reach into the community. We achieve so much because of our partners and supporters. This year has led me to reflect that sometimes Healthway might be seen as just a pot of cash to be accessed in sponsorship, and that the health objectives are slipping into a secondary position. I challenge all of us to reassess what we are doing, and how we are doing it. It is vital that all those involved in health and all those who partner with Healthway look at our relationships, look at our Board composition and direct ourselves to remain true to our objectives. We are accountable to our basic mission; and that is a mission about health promotion. We are after all, HEALTHWAY. Alcohol harm, mental health tragedy, obesity and chronic disease are all propelled by the social determinants that Healthway and its partners can in some way affect. Our sponsorship of sport and arts continues to grow. With the Western Australian Cricket Association, the message over the year has been “Alcohol. Think Again”. We have come a long way from the well-known, even celebrated drunken behaviour at the WACA, to respect for safe consumption and healthy food and drink choices. The result has been a better environment for everyone and a great role model for other sporting codes and young people. To our friends at the WACA, thank you for your brave and excellent work. The WACA is one success story. We share success with many sporting codes and their targeted campaigns: • Wildcats – Alcohol. Think Again • Rugby WA (Union) – Alcohol. Think Again • WA Rugby League – Smarter Than Smoking • Perth Glory – LiveLighter • Football West (Soccer) – Smarter Than Smoking • West Coast Fever/Netball WA – Alcohol. Think Again, and Smarter Than Smoking • Basketball WA – Smarter Than Smoking • Drug Aware Margaret River Pro Surfing – Drug Aware • Perth Heat/Baseball WA – Alcohol. Think Again, and Smarter Than Smoking Over the last year we have also seen the Arts partnerships join our mission with strong health messages promoted: •W A Symphony Orchestra – Alcohol. Think Again •W A Opera – Alcohol. Think Again, and Smarter Than Smoking (for schools program) •W A Ballet – Alcohol. Think Again •M ellen Events Concert Series – Make Smoking History It is fair to say, the year has also brought some challenges for Healthway. In October we launched a new partnership with the West Australian Opera. This generated intense public debate around the fact that WA Opera decided not to schedule Carmen, a work that depicts smoking on stage, at their annual Opera in the Park event. For the record, Opera in the Park is marketed to families with children and not only to the traditional fans of opera who regularly attend performances at His Majesty’s Theatre. There is overwhelming evidence from international research that children and young people who are exposed to artistic performances that portray smoking are more than twice as likely to take up smoking than those who are not exposed. That is the basis of Healthway’s policy on not supporting artistic performances that depict smoking. Nevertheless, public comment was quite forceful. Healthway was accused of censoring the arts and our partners at WA Opera were criticised for their decision not to perform Carmen at Opera in the Park. To be clear, Healthway does not shy away from public debate about public health issues. And here, I will quote from Healthway’s Strategic Plan, a plan developed by Healthway’s Board to chart our course for five years from 2012 to 2017. The Plan defines Healthway as “an agent for change in moving community thinking and action into a healthier direction for West Australians, challenging community norms and encouraging individuals and organisations to change behaviour and practices …Healthway acknowledges this work may create challenges for some of our partners…” We are aware that the public debate Continued on page 33 December ME D I C US 31 A Huge HBF saving for AMA Members. • Upto12%discountonallHospitalsandEssentialscover. • Receiveadiscountonanypaymentsmadeintheyearoftakingupthe discountoffer(appliesfromthedateofjoiningtheAMACorporatePlan). • ToaccessthisAMAmemberbenefit,callHBF’sAMACorporateMembership line:[email protected] AMA members are required to quote their AMA membership number which can be obtained from the AMA Membership Office: 9273 3055 or [email protected] CO V E R S T OR Y Continued from page 30 Continued from page 31 The IR story – achievements and setbacks Healthway successes easily outweigh road bumps hit during the year no resolution apparent, the AMA filed disputes in the WA Industrial Relations Commission involving Gastroenterology and Renal Departments. The AMA’s representation on behalf of members ensured Consultant involvement in change processes, reduced the loss of FTE, protected employment contracts of long-serving and experienced practitioners, and secured appropriate separation packages for Consultants who preferred to exit WA Health. Visiting Medical Practitioner contracts and service delivery matters also required the AMA’s attention and representation out of the reconfiguration process. A substantial area of work for the AMA has centred on protecting practitioner conditions of employment in the run-up to the closure of Swan District Hospital in November 2015 and the opening of the Midland Public Hospital to be operated by St John of God Health Care. The AMA has successfully negotiated arrangements to ensure practitioners who prefer to remain in the public sector can do so, and practitioners who wish to accept positions at SJG are able to do so too, without losing leave entitlements gained during their employment with WA Health and also gaining separation payments. A further area of extensive representation from the AMA concerns advocacy over WA Health’s policy to clear ‘excess’ annual and long service leave. The AMA has successfully secured reversals where members had received a cash-out of leave without payment of allowances. This is an area of ongoing advocacy seeking a change of policy. The AMA’s work has incorporated ongoing advocacy to influence WA Health industrial and employmentrelated policy development and amendment. Examples include sponsored travel and gift policy, open disclosure and qualified privilege, use and distribution of clinical images, e-credentialing and audio-recording of patient diagnosis. ■ Associate Professor Rosanna Capolingua around this issue certainly did put pressure on our partners at WA Opera. To them, I say thank you for standing with us and thank you for doing the right thing for health promotion and the health and wellbeing of children and young people in our State. Healthway will continue to be ahead of public opinion and generate debate about health issues. Another example is the inclusion of e-smoking in Healthway’s minimum health policy requirements. In response to queries by some of our sponsored partners, electronic-smoking is now included along with tobacco smoking in Healthway’s minimum health policy requirements for all organisations we sponsor. Evidence is mounting as to the health risks of e-cigarettes. Why would Healthway support a potentially harmful product? The business, media, social and political challenges have been many but our successes have easily outweighed whatever road bumps we may have hit. I am proud to be Chair of Healthway. But more importantly, as West Australians we should all be proud of our incredible achievements over the years in the health arena – so many of them coming from Healthway. ■ 30% OFF ALL PEARL PENDANTS ONLINE AVAILABLE FOR AMA (WA) MEMBERS ONLY - NO EXCLUSIONS. Enter code: AMAXMAS at checkout to receive your discount. Valid until 31/12/14, not available in conjunction with any other offer. My true love sent to me... WIN A $5000 PEARL SHOPPING SPREE THIS CHRISTMAS Plus the chance to win one of 12 gift vouchers valued at $500 each. Simply make any purchase to enter. 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BARBAGALLO JAGUAR DL2061 354 Scarborough Beach Road, Osborne Park, WA 6017. 1300 591 252 BARBAGALLO.COM.AU/JAGUAR JAGUAR XF STYLE EDITION FROM $85,990 DRIVEAWAY OPINION To be or not to be (your own boss) – that is the question Dr Steve Wilson Chair, AMA (WA) Council of General Practice A long time ago I said, “you must care for your profession as much as you do your patients”. Hence, my twodecade long involvement in fighting for General Practice through the Divisions, AMA and the College. However if we’re honest and General Practice were a patient, many senior and influential colleagues believe General Practice, as we know it, would be fatally wounded – perhaps never to return to its former glory. Why so? There are many reasons but I see them like this: Loss of the time-honoured past: Gone are the home visits, caring for the elderly in their residences; the disabled in shared accommodation; aged care facilities and lodges. Medicare off-site visit rebates, the loss of time travelling and endless paperwork have made such care unattractive and financially unsustainable. Safety issues also abound especially for female GPs. Further, there was something irresistibly simple about renting or buying an old house or commercial space, and fitting it out to be your practice. Set-up costs were less – all you needed were phones, a fax, files, a receptionist, couches and desks, lights, an autoclave etc. GPs charged a fair fee for a good service; government regulation and interference was minimal; and “we all felt we could practise great medicine in the middle of a cow field”. Our weapons’ chest was the doctor’s bag in hand, our clinical skills and the power of our patient-GP relationship. A fractured present: The government likes to talk about “the finest health system in the world” but through the poor Item Tiering and long-term lack of indexation of the GP rebates in the MBS, both the attractiveness of General Practice as a vocation and its low income base mean graduate numbers entering General Practice have been in free-fall. Further, the “commoditisation of General Practice” – reduced to being about ‘units-of-service’ rather than ‘relationships built over many years’ – has affected loyalty, long-term care etc. If you like, the politically-driven Super Clinics are an embodiment of that – “if you build it, they will come”. But never has there been a greater need in our craft group’s history for us to foster our own future and turn around the seemingly irreversible slide in general practice ownership An uncertain future: Training and Workforce are in a current no-man’s land as government once again tries to seize control over the profession. We see all too often how government manipulates health financing, structure, training and excessive regulation. The profession itself has changed its own future by continually relinquishing practice ownership, and refusing to work as their GP forefathers did – preferring life over work and choosing part-time over more full-time work. Furthermore, the growth of corporatisation and the risk of potentially losing our business autonomy and (frequently) some clinical autonomy, has changed us and our work perspective. I am the first to admit that being a practice principal is a seriously tough gig – to quote Dr Janice Bell, CEO of WAGPET. Yes there is regulation, accreditation, PIP, SIP, HR management and myriad issues to deal with. However, as a practice owner, I find getting doctors the hardest of all i.e. workforce. I often think that until the GP workforce reaches saturation in Perth, GPs will always want to work closest to home, work around school hours, holiday periods etc. It is indeed, the attractive parts of General Practice that make it unique, yet difficult in terms of maintaining service. Getting doctors to come and stay is really hard, even in Bassendean, which is only 12km from the CBD, but classified neither as Outer Metro for trainees nor District of Workforce Shortage (DWS). The result? We cannot utilise doctors on AB19 Provider numbers. I need help urgently where I am, but the Commonwealth ensures there are barriers. Therefore succession planning for practices such as mine is hard and may only force a further slide in private practice ownership. I’ve invested close to $2 million and 20 years of my life into the area. And as the recent Monash study in South Australia showed, older GPs like me – stupidly or otherwise – do worry about who will take care of their patients once they retire. But never has there been a greater need in our craft group’s history for us to foster our own future and turn around the seemingly irreversible slide in general practice ownership. Being your own boss has real merit and General Practice must own its own future. Finally, we must still urgently address the persistent lack of business and Human Resources training for GPs if we are to skill the GPs of the future to join, own, and run their own enterprises – an ideal, that I might add, is essential to provide a sound population of QUALITY practice to train the registrar GPs of the future. ■ December ME D I C US 35 OPINION Swift, adequate and compassionate action needed for Ebola response Dr Tim Koh Chair, RACGP WA Faculty & AMA (WA) Councillor I t has been a busy month since stepping into the sizeable shoes of Frank Jones as RACGP WA Faculty Chair. In addition to the busy task of trying to meet with as many GPs and organisations as possible, a number of important issues have arisen requiring my immediate attention. The most prominent of these has been the education of GPs about the Ebola virus, which involved addressing the multitude of questions and concerns that accompany this West African (and now international) epidemic. The aim is to provide local GPs with the best preparation possible for managing the disease. The advent of international transmission of Ebola infection, and the subsequent media hype necessitates that Australian GPs must update their knowledge and skills to be in a position to deal with the concerns of the public. This is a prime example of the difficult nature of General Practice – we work in an environment that is constantly changing and throwing up new challenges. The RACGP has released numerous resources and held Ebola education events for GPs. I had the pleasure of chairing one of these meetings with Dr Paul Armstrong from the Communicable Disease Network WA. The facts that have been conveyed to GPs and the public are, firstly, the outbreak in West Africa has been more significant than 36 M E D I CU S December expected. Secondly, the risk of exposure is low unless people are exposed to the body fluids of infected patients. Finally, GPs need to be aware of the clinical picture and exposure history. From these meetings, many GPs raised concerns about what resources would be available in anticipation of infection occurring in Australia. To this end, it is apparent that there are a considerable amount of government resources (both state and federal) that have been allocated to ensure that we, as a community, are well prepared for such an outbreak. The events in the US in which local health workers became infected whilst caring for an Ebola patient clearly demonstrate that adequate preparation and sound clinical protocols are critical measures. With so much time and resources being channelled into preparing for an Ebola outbreak in Australia, there is one concern that remains largely ignored by the public, media and government – why has Australia’s international aid response to the Ebola crisis in West Africa been so slow and muted? While most of the attention remains fixed on the possibility of the infection reaching Australian shores, there seems to be a complete ignorance of the fact that it is much more sensible to deal with this issue at its source in West Africa rather than concentrating efforts in Australia where it is yet to occur. There is an excellent precedent for this that has occurred in the brief history of this epidemic in which an outbreak of Ebola in Nigeria was contained predominantly with good public health measures. Unfortunately Liberia, Sierra Leone and Guinea have been less successful in these measures partly due to the severe lack of resources. Our tardiness in responding to the evolving crisis reflects a lack of understanding that addressing this problem at its root is not only in the interests of the many thousands of West Africans affected by this crisis, but also ourselves. Beyond this, the trend of Ebola to infect doctors and healthcare workers (in countries that are already extremely deficient) will undoubtedly result in severe long-term health consequences for these populations that will long outlast the epidemic. It is estimated that Liberia had approximately 50 doctors servicing a population of 3.8 million prior to the most recent outbreak. One can only imagine the state of affairs that will be left behind for those who survive the epidemic in these regions. As clinicians who work in preventative medicine, we are well positioned to advise government about the importance of acting swiftly and adequately in response to this crisis. As Australians, it is in our own interest. As a compassionate community, it is the right thing to do. ■ December ME D I C US 37 “The sight of the star filled them with delight” Matthew 2:10 St John of God Health Care wishes our doctors and everyone working in Western Australia’s health care community a blessed and joyful festive season. Our hospitals, pathology, home nursing and social outreach services will continue to grow in the New Year and we look forward to working with you in 2015. Bunbury Hospital | Geraldton Hospital | Midland Public & Private Hospitals (Opening November 2015) Mt Lawley Hospital | Murdoch Hospital | Subiaco Hospital | Pathology | Health Choices | Social Outreach www.sjog.org.au FOR THE RECORD ‘Team WA’ approach needed PROFESSOR PETER KLINKEN CHIEF SCIENTIST OF WESTERN AUSTRALIA Q. You have been Chief Scientist of WA for almost six months now. Have your initial impressions of the position lived up to expectation? imagine previously. In addition, powerful new technologies in the Life Sciences such as genomics, proteomics and imaging are transforming these fields. PK: I would have to say that the position has more than lived up to my expectations. I am loving the role, and hope that I can play some small part in promoting science in WA. There are few occasions in your life when you get the opportunity to provide advice, which might contribute to the scientific direction of the State. Q. How can WA build its reputation in science and research? Q. Any pleasant, or unpleasant, surprises so far? PK: The most pleasant surprise has been exposure to many areas of scientific strength in WA, especially in sectors that I didn’t know much about. The biggest disappointment has been the silo mentality of some groups. If this State is going to make an impact in science internationally we have to work together, and take a ‘Team WA’ approach. I am delighted that the medical sector has taken the lead with a state-wide ‘Team WA’ approach for Advanced Health Research and Translational Centres. PK: A comprehensive plan for the future direction of science is essential – the entire research sector is looking for clear direction. We must demonstrate a commitment to science, and value our researchers. Research must be viewed as an investment that improves the health and wealth of our community, as well as the environment. The SKA is a marvellous example of where the State saw an opportunity, invested in it and recruited international luminaries – as a consequence, we now have the world’s biggest scientific project in our backyard! Q. Did your predecessor, Professor Lyn Beazley offer any words of advice? Q. What attracted you to the job? PK: I have has several chats with Lyn, and she has been extremely PK: The Chief Scientist’s position is not one you apply for – it is by generous with her support. I have also been fortunate to get great advice from several wise heads including Ian and Liz Constable, appointment. I was truly honoured when the Premier approached me to take up the role. The opportunity to provide strategic advice Alan Robson, Graeme Morgan and John Poynton. on the future of science in WA is a rare privilege indeed. Q. Your heroes in science? Q. On a scale of 1 to 10 (with 10 being the highest), PK: I only have one hero in science and that is the inimitable how would you rate WA’s science industries? Don Metcalf, who discovered the growth factors which regulate Where are we falling short? white blood cell production. To me, he is a superstar who PK: I think we are doing OK and would give WA an overall score of 7. We could do better by developing a more strategic, long-term vision for science – this could overcome a lack of cohesion and scale in certain areas. New facilities and infrastructure that have been developed recently will definitely act as beacons for talented researchers. In addition to the physical environment we have generated, the supportive emotional environment we provide will attract stellar scientists to WA. Q. Where do you believe WA’s strength lies when it comes to science and research? PK: The five key areas of strength that have been identified for WA are – radioastronomy (particularly with the Square Kilometre Array or SKA), Energy and Mining, Biodiversity and Marine Science, Agriculture and Medical Research. These sectors will be underpinned by massive supercomputing power that the SKA is bringing, enabling big datasets to analysed in ways we couldn’t should have been awarded a Nobel prize, especially as these hormones are used in the clinic and have transformed the way many cancers are treated. His determination, focus, rigour, work ethic and passion have been really inspirational to me. Q. The book you are reading at present? PK: That’s easy – my brother-in-law Richard Rossiter’s novella Thicker than Water. I’ve just been given Wisdom by Andrew Zuckerman, which I’m looking forward to reading soon. Other books I would like to read over the summer include The Emperor of all Maladies by Siddartha Mukajee on the history of cancer, and The Biggest Estate on Earth by Bill Gammage about how Aboriginal people managed this land in pre-European days. Q. The last time you felt like a teenager… PK: Yesterday – I’ve always been young at heart. Some might say that I’ve never really grown up… ■ December ME D I C US 39 CL INIC A L E DGE Totally Endoscopic Video-Assisted Thoracic Surgery (VATS) – a paradigm shift in chest surgery in Australia Mr Pragnesh Joshi MCh, FRACS Consultant Cardiothoracic Surgeon, St John of God Subiaco Hospital & Sir Charles Gairdner Hospital F irst introduced almost two decades ago, totally thoracoscopic major pulmonary resection has revolutionised the surgical approach to the treatment of lung cancer and other thoracic diseases. Totally thoracoscopic pulmonary resection is different to Video Assisted Thoracic (VAT) surgery. However, the term ‘VAT’ has been used for both. A thoracotomy, which requires rib spreading and muscle division, has been the traditional approach to carry out pulmonary resection. The large incision required for a thoracotomy, the division of extrathoracic muscles and rib spreading, have been responsible for quite a few post-operative issues. A VAT pulmonary resection procedure eliminates these problems to a large extent. The recently published consensus statement defines VAT surgery as a procedure where rib spreading is strictly avoided and individual dissection of the vascular structure is performed.1 The key difference lies in not spreading the ribs and operating through a telescopic view in totally endoscopic surgery. Since there is some overlap between totally VAT surgery and VAT with rib-spreading thoracotomy, I believe the appropriate term for non-rib spreading totally endoscopic surgery should be Totally Endoscopic Thoracic Surgery (TETS). However, VATS is still the most commonly utilised terminology. INTRODUCTION Thoracotomy has been the traditional approach for the surgical treatment of thoracic diseases, including lung cancer. However over the last decade or so, VAT surgery without rib-spreading thoracotomy has emerged as an effective alternative. Despite having been shown to be equally effective, cardio-thoracic surgeons have been slow to adopt VATS (or TETS) as a new technique, unlike General Surgeons who have rapidly embraced the laparoscopic approach for 40 M E D I CU S December abdominal surgeries. The slow adoption was justified in some ways as the VATS/TETS approach had to prove its efficacy in cancer surgery.2,3 There is no doubt about the cosmetic superiority of VATS over thoracotomy. Some studies have also shown significantly reduced perioperative morbidities.3,4 Studies have confirmed equivalent or better outcomes in terms of post-operative stay, respiratory function, access to adjuvant therapy and pain control.5,6 Figure 1. Specialised tools: Different types of endo-staplers for the division of lung and vascular structures. Pic: Covidien WHAT IS VAT/TET SURGERY? All VAT/TET surgeries are carried out under general anaesthesia. For lung surgeries, patients are placed in a lateral position while for mediastinal tumours, a semi supine position is preferred. The lung on the side of the operation is selectively isolated from ventilation by a double lumen tube (DLT). A pre-operative bronchoscopy Figure 2. Action: Clamping of pulmonary artery with vascular endo-stapler followed by is then carried out, confirming the division during left side VAT pneumonectomy. position of the DLT and allowing inspection of the • No rib spreading – less post-operative bronchial tree. pain and neuralgia The number of ports varies from • Shorter hospital stay – usually 2-3 days four to one – there are usually two in • Faster recovery our practice. The size of ports is usually • Better operative visualisation due to 1-1.5cm. In addition to two ports, a magnification. small thoracotomy (also known as utility PATIENT SELECTION port) measuring about 3-4cm is also Any operable lung cancer can be required. However, there is strictly no rib removed by VATS/TETS. However, spreading. The utility port is also used to suggested selection criteria are tumours deliver lung specimens. less than 7cm, predicted post-operative The entire operation is carried FEV1 >40 per cent and DLCO>40 out purely with thoracoscopic vision. per cent and absence of involvement of Specialised staplers (figure 1) are utilised mediastinal lymph node.1 Lymph node to divide vascular and lung structure dissection for lung cancer can be carried (figure 2). Upon separation of the out without any difficulties. Previous cancerous lobe from the rest of lung, it is thoracic surgery makes the procedure delivered in a sac via the utility port. Ports complex due to adhesions but this is not a are closed with single chest drain in situ. contraindication for VATS/TETS. One of the most important factors is the surgeon’s ADVANTAGES OF VAT/TET experience and comfort with VAT/TETS SURGERY techniques. • Smaller incisions – cosmetically much Other common VATS procedures are: superior (figure 3) CL INIC A L E DGE Figure 3. Smaller incisions: Post-operative scars following totally endoscopic VAT right upper lobectomy. •P leurodesis for recurrent pneumothorax • Pleurectomy • Wedge resection of lung for biopsy/ treatment • Mediastinal tumour resection e.g. Thymoma, neurofibroma • Pericardial window for pericardial effusion • Thymectomy. Experienced VAT/TETS surgeons also carry out thymectomy and mediastinal tumour resection. However, a lager-sized tumour can be a limiting factor in some patients. POST-OPERATIVE RECOVERY Most patients get discharged from the hospital in 2-3 days’ time. This can be attributed to minimal bleeding, reduced incidence of post-operative air leak and less pain. CURRENT STATUS OF TETS The thoracoscope provides an enhanced view during surgery due to magnification and light. It has been used in lung surgery in a limited role for many years. Minor procedures such as pleurodesis and lung biopsy have been carried out using totally endoscopic techniques for quite some time. Major pulmonary resection using the totally endoscopic technique has been a challenge for surgeons. VAT/ TET surgery requires an exceptional level of hand-eye coordination – which means operating in the patient’s chest while looking at the screen. Twenty per cent of pulmonary resections in the US and 10-15 per cent in Europe are carried out thoracoscopically.7 Although becoming increasingly popular in Australia, training and skillset acquisition for VAT/TET has been a great challenge for new as well as established surgeons. A minimum of 50 cases are required to overcome the learning curve of VATS/ TETS pulmonary resection.1 The most critical aspect of major pulmonary resection is to safely ligate and divide branches of pulmonary artery. The surgeon also has to ensure complete resection in the case of lung cancer. The other significant aspect is loss of tactile sensation, as a surgeon cannot use their hands or fingers during endoscopic lung resection. The surgeon also has to make themselves familiar with thoracoscopic anatomy. In an attempt to carry out thoracoscopic resections, some surgeons have been able to reduce the size of the thoracotomy while using a thoracoscope during surgery. However, they still have to use the rib spreader as the majority of the operation is carried out by direct vision through the thoracotomy wound. The use of the rib spreader frequently leads to rib trauma, injury to intercostal nerves and increased post-operative drainage. The trauma to the intercostal nerves can cause postoperative pain and neuralgia. Going by the definition of VATS, the rib spreader must be avoided in order to realise the full benefits of the surgery. Unlike laparoscopic surgeons, cardiothoracic surgeons are not very familiar with endoscopic skills. However, interest and dedication have led many to learn and master the skills required for VATS/TETS by attending training workshops and having a proctor to begin their initial cases. Currently, very few surgeons in Australia carry out totally endoscopic pulmonary resection, but this number is on the rise. Reduction in hospital stay and post-operative morbidity also leads to significant cost savings for hospitals and health funds. ■ References: 1. Yan TD, Cao C, D’Amico TA, et al. Video-assisted thoracoscopic surgery (VATS) lobectomy at 20 years: a consensus statement. Eur J Cardiothorac Surg 2014;45:633-9.) 2. Wright GM Video-assisted thoracoscopic pulmonary resections- The Melbourne experience Ann Cardiothorac Surg 2012;1(1):11-15 3. F lores RM1, Park BJ, Dycoco J, Aronova A, Hirth Y, Rizk NP, Bains M, Downey RJ, Rusch VW.Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2009 Jul;138(1):11-8. 4. C ao C, Manganas C, Ang SC, et al. A metaanalysis of unmatched and matched patients comparing video-assisted thoracoscopic lobectomy and conventional open lobectomy. Ann Cardiothorac Surg 2012;1:16-23. 5. Petersen RP, PHAM D, Burfeind WR, et al . Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 2007;83:12459; discussion 1250 6. N agahiro I, Andou A, Aoe M, et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy : a comparison of VATS and conventional procedure. Ann Thorac Surg 2001;72:362-5 7. W alker WS. Editorial. Ann Cardiothorac Surg 2012;1(1):2 December ME D I C US 41 PROF IL E A good man in a crisis Dr Andy Robertson is WA Health’s go-to person when disaster strikes, says Janine Martin D r Andy Robertson knows only too well that if death is the great leveller, then disaster comes a close second. As Director of WA Health’s Disaster Preparedness and Management Team, Andy has led Australian Medical Assistance Teams (AUSMATs) into the Maldives following the December 2004 Tsunami, earthquake-ravaged Yogyakarta in Indonesia a couple of years later and more recently, advised the Australian Embassy in Tokyo on radiation health matters after the Fukushima meltdown. Dr Robertson illustrates the point with a story of the first relief team that landed in Banda Aceh, Indonesia following the 2004 Tsunami. “The team had 14 tonnes of equipment which they had to unpack by themselves and load onto trucks. They then drove to the local hospital and helped to clean it, shovelling out dirt and 42 M E D I CU S December debris,” recalls Andy. “Their number one goal was to have the hospital running and get the mission over the line. If that meant shovelling out tonnes of dirt, so be it. Medical hierarchy has no place at times such as these.” This from a man who has spent a large part of his medical career in an institution defined by hierarchical codes – the Royal Australian Navy. Yet Andy, who remains a Captain in the Navy Reserves, maintains that having the right mindset is a critical skill when faced with emergency situations and natural disasters. Today’s AUSMATs undergo rigorous training in safety and security to prepare them for different environments. “We encourage them to undergo general disaster medicine training – which involves mental health components such as psychological management of victims as well as self-care.” Any ongoing concerns, Andy says, are addressed during AUSMAT’s annual local training exercise. “The teams sleep in tents and get to work all the equipment. We put them through field exercises where we simulate being stopped at a check point, being ambushed etc. We place volunteers in challenging situations – albeit simulations – to check their physical and psychological preparedness.” Andy says it is during these sessions that some volunteers decide to bow out, while others move forward. “It’s not easy to gauge but from these training sessions, we do get a good idea of people who will work well in teams.” Andy confirms that Australia’s foreign aid teams stack up well compared to their global counterparts. “The teams, which comprise of doctors, nurses, logisticians and other support staff are pretty robust and over PROF IL E the past 10 years, we have built up both our medical equipment and general sustainability caches,” he says. The challenges arise when it comes to entering certain countries. “Some of these places are difficult to enter and the Australian Government plays a key role in getting our teams in and out. “Obviously some countries are quite advanced in their preparedness for disaster response and the reception of foreign aid teams. Others, with fewer resources, are only partly along that route. “Every country, every place offers its own lessons. Depending on housing, population and geography, disasters impact people differently.” While Andy captains WA’s disaster response teams overseas, he also maintains a strict vigil when it comes to domestic preparedness. “I hate to say it but we are leading up to our ‘busy season’ – bush fires, cyclones and heat waves. These events may come in varying degrees but we need to be prepared. “We also work with other agencies such as the police on big events such as music festivals and leavers’ celebrations.” This year Andy has been involved in a slightly more unusual project – the various moves to Fiona Stanley Hospital. “We have been involved in the coordination of the operation centre and the logistics of moving patients using our Track Me system. “It’s like a controlled evacuation of a hospital – and evacuating places is what we do. This was a good opportunity to exercise our systems.” For a boy from Gundagai, the famous small town in New South Wales, Andy has certainly come a long way. Life on a farm and the accompanying hardships that he saw his father weather convinced him to look elsewhere for a career choice. Having long nurtured an interest in science, Andy decided on medicine and subsequently a medical career in the Navy. “I felt I could have the opportunity to do a range of things in the Navy that were different from the more routine path of medicine,” he says. Some of the “different” things that Andy had the opportunity to do, included training in hyperbaric medicine and studying the health aspects of biological, chemical and radiological weapons. It was the latter that led him to become the Principal Health Advisor in that area to Australia’s Defence Department. It was a position that he held for a decade and Andy remembers his missions in Iraq during Saddam Hussain’s rule, as a particular highlight. “In some ways, it was safer then. There were no random bombs exploding in market places and we were under UN protection. But it still wasn’t a particularly welcoming country.” The frosty reception Andy received may well have had a lot to do with his role as a Chief Biological Weapons Inspector in the UN Special Commission. He admits there was a lot of pressure on the monitoring groups to find evidence of Saddam Hussain’s chemical and biological weapons programs. “And we did. The Iraqis had already admitted to having a chemical weapons program and in 1993, they destroyed medicloud TM No Server, No Worries FocusNet GROUP TM www.focusnet.com.au 1300 077 777 the more obvious weapons such as the mustard and nerve agents. “They hid their biological program for the first five years but eventually admitted it in late 1995.” The following year Andy visited Al Hakam, Iraq’s biological weapons facility and says most of the evidence had been deliberately destroyed. “This meant we had to try and piece together what the Iraqis had originally, how much had been produced and whether all of it had been destroyed, as they claimed. “And then the real question arose: were the Iraqis continuing a weapons program somewhere else within the country?” While Iraq remains a career highlight, Andy says, places including the Maldives (after the 2004 tsunami), Jakarta (following the 2006 Earthquake) and Fukushima (after the nuclear incident in 2011) left indelible impressions on him too. His work, in turn, has impressed many others. Andy has been the recipient of multiple awards significantly the Conspicuous Service Cross and the Humanitarian Overseas Service Medal. He also currently serves as WA Health’s Deputy Chief Health Officer and Editor-in-Chief of the Journal of Military and Veterans’ Health, a peer-reviewed journal published by the Australasian Military Medicine Association. For someone who has travelled the world in his various capacities in the Navy and WA Health, Andy is now happy to call Perth home and is looking forward to enjoying the sunny days ahead – until that next phone call at three in the morning. ■ INCLUDES: Seamless data backup IT support 99.9% uptime guarantee �������������������������� Comprehensive security and user protection Scalable as your business grows Simple monthly billing December ME D I C US 43 R E SE A RCH Vitamin D: a hot topic with many uncertainties Winthrop Professor Robyn Lucas Telethon Kids Institute, UWA T here is substantial and legitimate scientific debate on the health benefits and harms of vitamin D – and General Practitioners (GPs) in Western Australia are in a position to help answer some of the important vitamin D questions. In the recent Australian Health Survey, 23 per cent of Australians over the age of 12 years were reported to be vitamin D deficient (serum 25-hydroxyvitamin D of less than 50nmol/L).1 For Western Australians, the figures were 13 per cent in summer and 28 per cent in winter. Vitamin D deficiency is much more common in some population subgroups, for example, nearly 60 per cent of those born in South East Asia. Australian doctors are very well aware of concerns around vitamin D deficiency and possible links to ill health. This has resulted in a high level of testing for vitamin D deficiency – an increase of almost 4000 per cent in the last 10 years. Indeed, in May 2014, there were over 700,000 vitamin D tests in a single month. And GPs report that low vitamin D levels are common among their patients. However, from 1 November 2014 there has been a crackdown on Medicare rebates for testing, so that only those with a few specific indications can receive a Medicare rebate for a vitamin D test (http://www.msac.gov.au/internet/msac/ publishing.nsf/Content/0014r-public). The problem with vitamin D is that there is so much that we don’t know. Measurement has been problematic, with poor quality assays, so that it is not clear that any single measurement of vitamin D provides a true result.2 It is not clear what, if any, health effects are associated with vitamin D, and what level needs to be maintained to avoid health risks. It is clear that severe vitamin D deficiency – that is a serum 25-hydroxyvitamin D (25(OH) D) level of less than 25-30nmol/L – needs to be treated, generally with vitamin D supplementation. What is less clear is whether slightly higher levels, for example those 44 M E D I CU S December around 50nmol/L or just under, need treatment. A level of 50nmol/L or higher is recommended as sufficient by the US Institute of Medicine, although other bodies recommend higher levels of 75nmol/L or more.3 It may be that vitamin D status can be improved in people with mildly low levels, e.g. 40-50nmol/L, by advising them to get a bit more sun (safely) rather than taking a supplement. The evidence around the health benefits of higher vitamin D status is contradictory.4 In many studies, people with the disease of interest have lower 25(OH)D levels than those who do not have the disease – but is this because low 25(OH)D increases the risk of the disease? Or does the disease increase the risk of low 25(OH)D levels? When it has been studied, giving vitamin D supplements does not decrease the risk of these same diseases.4 Although there are some concerns about whether the clinical trials are really valid, they do suggest that there is no beneficial effect of vitamin D supplementation on disease risks. One explanation for the contradictory findings may be that something else that is linked to higher 25(OH)D levels, such as just being in generally better health, being more physically active, or having more sun exposure, lowers disease risks, i.e. that the low 25(OH)D reflects a low level of some other desirable exposure. There are now several studies around the world that have shown that sun exposure itself may have benefits on health – particularly for immune function and cardio-metabolic health (including blood pressure). The pathways are not completely clear, but may involve the release of nitric oxide from the skin following sun exposure.5,6 But it does seem that these are not vitamin D pathways. This is important. Firstly, it could explain why low 25(OH)D is associated with increased disease risk, but vitamin D supplementation does not decrease the risk, i.e. it is not the low 25(OH)D per se that is important, but only that low 25(OH)D is a proxy for low sun exposure. Secondly, if this is not a vitamin D effect, then getting the benefits requires some sun exposure. And treatment of mildly low 25(OH)D levels may be best managed by prescribing sun exposure, not vitamin D supplements. But, Australia has the highest skin cancer incidence in the world. So, we need to have a good understanding of just how much sun exposure is required to gain benefits and how the risks are best avoided. In 2013, Cancer Australia funded the Sun Exposure and Vitamin D Supplementation Study (SEDS Study) to answer some of these questions. Specifically, the study aims to answer the questions: • Can you manage mild vitamin D deficiency (25(OH)D level of 40-60nmol/L) with advice to safely increase sun exposure? and • If so, how much sun exposure equates to what level of vitamin D supplementation? A second set of questions focuses on the possible effects of sun exposure on immune function and cardiometabolic health, and the extent to which these are independent of vitamin D. The SEDS Study is currently recruiting participants who are aged 18-64 years and have had a recent vitamin D test result of between 40 and 60 nmol/L. Eligible participants are randomly allocated to receive one of two different doses of vitamin D supplementation or placebo, and one of two different types of sun exposure advice. Participants are followed over one year, with data collection by questionnaire and sun exposure monitoring every three months, and blood sampling on four occasions. Since participants have to have had a recent vitamin D test, with a result between 40 and 60nmol/L, we R E SE A RCH are seeking interested GPs to work with us on participant recruitment. We have very streamlined processes that ensure minimal disruption and time consumed – GPs ask patients with a recent test with an appropriate result if they would be happy to have the study team contact them (the patient). If yes, the contact details are passed to the study by fax or email, and the study team will take it from there. If you are interested in vitamin D and/ or sun exposure, and might be interested in helping us to recruit participants for the SEDS Study, we would be happy to hear from you. We are also keen to visit and talk with GPs in person to explain the study and to answer any questions about vitamin D and/or sun exposure. If you would like to learn more about the SEDS Study, please visit the study website, www.sedsstudy. org.au, email us at: info@sedsstudy. org; or phone us at: 1800 73 2223. ■ References: 1. A ustralian Bureau of Statistics. The Australian Health Survey Biomedical Results. Canberra; 2014. (www.abs.gov. au). (Accessed 10 Nov 2014 2014). 2. L ai JK, Lucas RM, Banks E, et al. Variability in vitamin D assays impairs clinical assessment of vitamin D status. Intern Med J 2012;42(1):43-50. 3. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. In: Ross A, Taylor C, Yaktine A, et al., eds: Institute of Medicine of the National Academies, 2010. 4. Autier P, Boniol M, Pizot C, et al. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol 2014;2(1):76-89. 5. L iu D, Fernandez BO, Hamilton A, et al. UVA Irradiation of Human Skin Vasodilates Arterial Vasculature and Lowers Blood Pressure Independently of Nitric Oxide Synthase. J Invest Dermatol 2014. 6. Geldenhuys S, Hart PH, Endersby R, et al. Ultraviolet radiation suppresses obesity and symptoms of metabolic syndrome independently of vitamin d in mice fed a high-fat diet. Diabetes 2014;63(11):3759-69. Radiologists for Western Australia Perth Radiological Clinic has been providing Medical Imaging Services to Perth & its surrounding suburbs since 1948. The Practice has a vacancy for a motivated radiologist within the subspecialities of Women’s Breast Imaging, Gynaecology and Obstetrics to join our dynamic Team. The successful candi-date will be rostered across our existing sites including Midland Health Campus (opening 2015). Salary for the position will be commensurate with skills and experience. We offer: • Excellent remuneration packages • Hospital based and private practices • State of the Art equipment • Modern, purpose built premises • Regular interaction with referrers Candidate Requirements: • Registration with RANZCR • Registration with AHPRA • Valid Visa Contact Alice Sutherland on 08 9337 0042 or email [email protected] www.perthradclinic.com.au Leaders in Medical Imaging December ME D I C US 45 OPINION Reflections on a year gone by Dr Melita Cirillo Co-Chair, AMA (WA) Doctors in Training Committee A s 2014 draws to a close, so does my period of office at the heart of the DiT Executive. The past 24 months have passed by extraordinarily fast and this year in particular has been one of the most productive I can recall as far as the achievements of the AMA (WA) DiT Committee go. The first quarter saw the AMA DiT Leave Scorecards dominate the agenda. The issue prompted robust discussions across all the main tertiary sites and some positive changes, which hopefully will continue in 2015. The recent launch of the Junior Doctor Part-Time Portal has been another feather in the DiT Committee’s cap. Following a significant amount of work by many including Dr Courtney Majda and AMA staff members Caela Del-Prete and Nicola Roman, the portal is the first of its kind to be launched in Australia and is a fantastic benefit for AMA members. The aim is to link junior doctors interested in part-time work prior to job applications – making it easier for them to be employed. Appointments for 2015 are mostly finalised, however we look forward to providing this service to members when applying for jobs in 2016 and beyond. Membership has always been a great strength of the AMA and pleasingly for junior doctors, our numbers have continued to increase this past year to just under 50 per cent of all members. I believe this reflects the currency of what we are doing, and the appetite of junior doctors to create change within a system straining under the increasing numbers of medical graduates and residents. Increasingly, the concern over training pathways and job prospects will feed into this, and hopefully in WA we can continue to be ‘ahead of the curve’ in identifying solutions to cope with this demand. Some exciting work has also begun this year to facilitate junior doctors into clinical and basic research. Whilst all the details are not yet finalised, the DiT Committee plans to create a web-based 46 M E D I CU S December portal for junior doctors to access Senior Practitioners with a research interest and a link to projects. This will hopefully become yet another benefit in the AMA’s membership armoury. Plenty of other industrial work has taken place during the year. The opening of Fiona Stanley Hospital highlighted the increasingly competitive nature of job applications in WA. This process will become even more stringent in future, and has made many DiTs increasingly aware of their industrial rights and obligations. Now all of these achievements – both big and small – don’t just ‘happen’. I would like to acknowledge the exceptional contribution of Nicola Roman, our DiT Secretariat and Industrial Officer as well as my Co-Chair, Dr John Zorbas who have both brought vigour and enthusiasm to the team, sacrificed much in personal time and supported me during the past 12 months. I chose not to nominate for the position of Co-Chair in 2015 and am pleased to formally announce that Dr Chris Wilson (former JMO Forum Chair) will be taking the reins along with Dr John Zorbas next year. I have been involved with the DiT Committee for the past seven years, and am pleased to be leaving its leadership in the capable hands of two very competent gentlemen. What do I see as the major issues ahead? ‘Training pipeline’ might be the current catchphrase in medical education circles, but it will become the single biggest challenge for the current generation of Interns and Residents. The competition to gain employment at tertiary sites grows tougher each year, with many RMOs in the eastern states already missing out in 2015. WA sits at the fulcrum, with the tipping point of under-employment looming in the next one to two years. What we really need, to manage this going forward, is a key organisation to take control of prevocational training of junior doctors in WA. Intern education is under the watchful eye of the PMC. Registrars have their Colleges for formalised training pathways. Yet most Residents 'Training pipeline’ might be the current catchphrase in medical education circles, but it will become the single biggest challenge for the current generation of Interns and Residents are swamped in service provision with no clear group advocating for quality in their training. There is also significant variability in what the hospitals provide at this level. We are also starting to see the effects of a tougher fiscal climate feed into hospital rostering and overtime practice, particularly at the RMO level. At some hospitals, afterhours and weekend cover are rostered completely out of relief pool staff to avoid paying the team’s “ward” doctor overtime for performing these duties. Increasingly, departments looking to save money choose to delay start times for junior doctor hours to facilitate budgetary constraints. Some surgical interns start after 8am – when their team has already completed the ward round and is in theatre – resulting in them missing out on the important decision-making and learning process. Perhaps this is all just part of life in the ‘ethical and accountable’ health system trying to provide a high-level service for the ‘most efficient price’. There are different approaches being trialled to manage this problem (e.g. the Hospital Out Of Hours [HOOT] service for FSH), but I think we are yet to see the best way forward and time will be critical in assessing the training outcomes of DiTs who progress under these models. Indeed these are interesting and challenging times for junior doctors in WA, but I’m confident Drs Zorbas and Wilson will be proactive in skilfully representing DiTs on these issues. Meanwhile, I wish you all a happy and safe holiday season. ■ An exclusive corporate program for an exclusive group of drivers. Introducing AudiCorporate® – where AMA WA Members receive exclusive benefits and a superior service on a selected range of luxury Audi models. AudiCorporate® members enjoy: • No cost, scheduled servicing for 3 years or 45,000km • Corporate evaluation vehicles • Free pick-up and drop off of your vehicle for servicing in the CBD (or within a 20km radius of the servicing dealer) • Priority vehicle order and allocation • Loan cars when your A5/S5, A6/S6, A7/S7, A8, R8, Audi Q5, Audi Q7 or RS model is being serviced. For further details on the AudiCorporate® program, visit www.audicentreperth.com.au Audi Centre Perth | 337 Harborne Street, Osborne Park Tel: (08) 9231 5888 | audicentreperth.com.au D/LMD22023. MRB1416. Overseas model shown. Need staff? AMA Recruit can help AMA Recruit provides a specialised permanent placement recruitment service to hospitals, private medical practices, allied health professionals and not-for-profit health and community organisations. AMA Recruit provides a one stop shop for all your recruitment needs Our recruitment and placement services include: • Advertising and marketing • Searching our established database of registered applicants • Interviewing and pre-screening • Short-listing of candidates for employer interviews • Skills testing • Reference checking • Contract negotiations Let us help you fill your vacancies. Contact AMA Recruit’s specialist consultants on (08) 9273 3033 or by email at [email protected] AMA Recruit is a division of the AMAWA Group of Companies AMA Recruit: 14 Stirling Highway Nedlands Western Australia 6009 Telephone: (08) 9273 3033 Email: [email protected] | www.amawa.com.au OPINION Now that the training wheels are coming off Dr Glen B. Legge MBBS, Ph.D. L ate November I had one of my Induction Days at Fiona Stanley Hospital (FSH) – a time to prepare for my forthcoming stint as an RMO. It was a day of resuscitation training, annual competencies, click clacks and pearls of wisdom from Professor Greg Sweetman, FSH’s Director of Physician Training. It was also a chance to get sized up for a uniform and again, to see this beautiful space that is growing into a hospital. I do like what I see. In addition, Induction Day provided an opportunity to catch up with some of my medical school colleagues who have been at SCGH or RPH, and will join us next year. There are sure to be many more – the centre of gravity for healthcare in Western Australia is shifting. I too am moving with the tide to make this huge new experiment a reality and success. So does our big girl work yet? Not quite. There are several teething problems that will be ironed out over the coming months. This was readily acknowledged during the induction program and was much of the reason for a staggered opening of the wards throughout the hospital. One such problem which I experienced first-hand was trying to fax a referral out of office hours from Armadale Hospital to an outpatient clinic at FSH. Many of these services have moved from F5 clinics at Fremantle Hospital. It seemed to me that FSH is more geared up for electronic referrals internally, rather than a hodgepodge of faxes arriving externally at all times of the day. However being the hub of specialty outpatient clinics in the South Metropolitan Area, it will still have to deal with the mass of faxed paper referrals from GPs and other hospitals. What is clear from my own experience is that if you run into a problem, have patience and don’t keep it to yourself, like I did initially. Rather, communicate it to the hospital administration so that the basics are running as smoothly as possible for our arrival en masse in 2015. The induction also left me with a strong feeling that I will have to work on my typing speed to keep up with ward rounds as I manipulate around the Digital Medical Record for each patient. This is why much of the induction was spent showing the incoming medical workforce the new applications and how to use them. Fortunately many of these electronic glitches are being ironed out and road tested for our arrival through the rehab, renal and now the maternity wards. A strong piece of advice that filtered down was to submit and not to save. It’s going to be a challenge to go electronic, but I am sure that once these tools are mastered, there will be no going back. For me, time beyond the Internship year beckons. AHPRA has written indicating it would like a cheque from me to transition from Provisional to General Registration. A pay rise is on the horizon, as are the additional responsibilities of the RMO (including night shifts and on-calls). Additionally, as my application for Basic Physician Training has been approved, it is back to the books and study. This time, it will be on top of my RMO and family duties. Will my scientific background help during the next stages of my training? It certainly did during the GAMSAT, but less so as I went along. I was more comfortable dealing with the ins and outs of cholera toxin as a scientist than I was at mastering Calot’s triangle and other anatomical gems as a medical student. This is perhaps why I am heading down the path of a physician, rather than surgeon or Psychiatrist. It is more molecular overall, and it is where I aim to merge what I have done, What is clear from my own experience is that if you run into a problem, have patience and don’t keep it to yourself, like I did initially with what I am going to do in an area of translational research. Next year will therefore be the first point of specialisation in my medical career. Many from my cohort have, like myself, had a career before this medical journey. That is all in the past. What matters is what we do with where we are now. This means getting the basics right such as DRSABCD and the doctor-patient relationship, as well as how we go about learning the rigors of our chosen specialisations. Meanwhile as this Intern year comes to a close, we can reflect on the huge changes that we have gone through. Even as I invest my efforts into improving the health of each patient I interact with, I too learn daily lessons from them. I have had many wins and of course, a few losses. Beyond the workplace environment, our Intern cohort has had it share of engagements, marriages and births. It has been a pleasure to work with the Interns at Fremantle Hospital and the postgraduate medical education group there. I will fondly remember our Wednesday AM breakfast lectures (both at F5 and Armadale), coffee in the Blue Room and that view across the Indian Ocean when looking out from B9N. Thanks also to the medical teams whom I worked with and my Consultants for their kind words in my term assessments. I wish you all the very best for 2015. May you enjoy the next stage of your career, wherever it may lead you. ■ December ME D I C US 49 OPINION Local graduates without internship equals great loss Kiran Narula President, Western Australian Medical Students’ Society A s I reflect upon the year gone, I am in awe of the generous work the students of UWA undertake. Within WAMSS, an extraordinary committee dutifully represents its students, gladly organises social occasions, and selflessly educates their peers. Thank you to my wonderful colleagues for their tireless contributions. At the helm of this organisation this year has been a diligent Executive, led by my predecessor Sebastian Leathersich. Sebastian has been inspiring, leading the society with aplomb and distinction. I personally revere his insightfulness, coupled with his strong compulsion to be well informed on all student matters. It is therefore sad for WAMSS and I to witness him leave, but we are certain that he will be a singular man and will serve his community with excellence! I must also thank Professor Ian Puddey – Dean of the Faculty of Medicine, Dentistry and Health Sciences at UWA – who will be retiring shortly. We have been very fortunate to have a Dean who recognises the value of student input, and is so eager to seek it. Through his leadership, UWA medical students have representation at every critical decisionmaking committee, and enjoy a faculty that is both attentive and responsive to any student concern. Professor Puddey, on behalf of WAMSS, as well as past and current students, I congratulate you and thank you for your wonderful service. Maintaining the high note, it is with delight that I can inform you that all UWA students who sought an internship in Australia this year have received one. This is a remarkable achievement in our current political climate, and is a testament to the strength of WAMSS’ external relationships and its advocacy platform. This elation will not be buoyed for long however. I am concerned for my peers graduating in the Class of 2015 across both medical schools – especially for our international students. Next year will see a significant increase in graduate numbers to 350 students, but there are only some 310 internships currently funded in Western Australia. This mismatch is the consequence of the increasing student numbers, and it remains to be seen how the State Government will respond. It would be our great loss if local graduates were unable to secure an internship. The WA Government would be throwing away the significant investment made, by our education and medical systems, with your money. Furthermore, we would waste doctors who are trained and practiced in culturallysensitive Australian medicine. Without an internship and the full registration status that it confers, these employable medical students could never become the doctors our system is in desperate need for. From a student perspective, it is therefore encouraging to see that the WA Health Department has recognised that local medical graduates can fulfill the urban demand for doctors. For most junior medical officers, the news will have positive effects on the availability and stability of currently oversubscribed RMO and Registrar positions. It is however disappointing news for our IMG colleagues who contribute significantly to our health system. Additionally, it is as yet unclear if this new recognition includes locally trained international students. I believe it must.. WAMSS has always been a passionate advocate for its students. This year we will continue to pursue internships for all local graduates, and press for constructive actions to resolve long-standing issues in the postgraduate training pathways. As the incoming committee and I prepare for the new year, we are grateful for the fantastic efforts of previous members. Their work is the foundation of WAMSS’ continued strength in student advocacy and representation. This is not a responsibility that I and the incoming Executive (Vice-President Internal Sophie Doherty; Vice-President External Vibhushan Manchanda; Treasurer Malcolm Teo; and Secretary Georgina Carr) take lightly. But, we are very much looking forward to the year ahead. On behalf of WAMSS and the medical students at UWA, thank you to our many teachers; congratulations to the Class of 2014; and finally, I wish each of you a Merry Christmas, a Happy New Year, and all the best for the year to come. ■ Medicus article submission dates for 2015 In order to distribute Medicus in a timely fashion, and to meet our commitment to readers, all article submissions are required by the following date: If you would like to submit an article or clinical/research paper for inclusion in Medicus please contact Janine Martin in the first instance, at [email protected] Issue Submission Date March April May June July 1 February 1 March 1 April 1 May 1 June NOTE: These submission deadlines are for articles, classifieds and professional listings. For Display Advertisement timelines and submission requirements please contact Des Michael on (08) 9273 3056. 50 M E D I CU S December Auto Classic YOUR EXCLUSIVE MEMBER BENEFITS FOR A MORE REWARDING JOURNEY. Sales Finance Service Parts As a member of the AMA (WA) you are eligible to enjoy the many rewards of BMW Advantage, a member benefit programme that gives you the opportunity to get behind the wheel of the Ultimate Driving Machine. The exclusive ownership benefits include complimentary BMW Service Inclusive for 5 years/80,000kms and corporate pricing,* to name but a few. To find out how you could start a rewarding journey with BMW Advantage, visit bmw.com.au/advantage or contact Keith McDaid at Auto Classic on (08) 9311 8332 today. Auto Classic 48 Burswood Road, Victoria Park. Ph 9311 7533. A/H 0409 803 586. autoclassic.com.au LMCT 2271 Keith McDaid Corporate Manager Auto Classic *Benefits apply to the purchase of a new BMW vehicle and only to the vehicle purchased. Subject to eligibility. Terms, conditions, exclusions and other limitations apply, and can be viewed at bmw.com.au/advantage. BMW5659_277x190_Auto Classic_AMA Medicus_FA.indd 1 26/09/2014 11:55 am Annual Conference and Trade Exhibition 2015 HYATT REGENCY PERTH | 7 and 8 March 2015 Looking for the gold in the old Health care for our ageing rural populations l l l Leading speakers Clinical updates Hands-on learning workshops l l l Case study discussions Networking opportunities Family program Register online at www.secureregistrations.com/rhwac2015 OPINION Support and advocacy for students top priority list Kate Nuthall President, Medical Students’ Association of Notre Dame I t is an honour and a privilege to be elected to the position of President of the Medical Students’ Association of Notre Dame (MSAND) for 2015. The new committee is looking forward to living up to the exceptionally high standard set by the previous committee, and I would like to thank the 2014 committee for all of their hard work and commitment. Molly Kehoe and her team have made student life at the Notre Dame School of Medicine much easier – continuing the strong tradition our MedSoc has of supporting MSAND students, helping provide a range of educational opportunities and putting together a social calendar to help us occasionally escape our studies. MSAND is entering its tenth year. For a Medical Society that is so young, we’ve established a strong culture of support and inclusiveness. As a graduate course, Notre Dame medical students are a strongly diverse cohort, with people coming from a wide range of previous life experiences to study medicine. Our diversity gives us a great richness and I am constantly inspired by the achievements of my colleagues, both prior to and since their admission to their medical degree. MSAND has also traditionally had a large number of interstate students. This means that the Association plays a vital role in helping to ensure students are able to effectively transition to not only a new degree, but also a new state. This is done through education nights, social events and the mentoring program. Many students move across the country to pursue their medical dreams, and having MSAND help to provide an instant support network is incredibly important in making this move easier. In line with the Australian Medical Students’ Association’s (AMSA) extremely successful mental health campaign, MSAND will run a series of programs to help maintain students’ mental health in 2015. In the past few weeks, all of our students have had exams and have found themselves under a fair amount of stress. As the social events wind down and the long nights spent studying take over, it’s important that we all remember to take a break. Our pre-clinical years have the advantage of being only two blocks from the beach and Fremantle provides plenty of distraction when it comes time to take a ‘study break’. One of the past year’s most popular wellbeing events was a visit from a group of WA guide dog stress puppies. Students and staff all enjoyed a lunchtime spent with the future guide dogs, cuddling away some of that exam-induced stress. One of MSAND’s most important roles is advocating for students. There is a range of issues that we need to consider, such as the proposed deregulation of university fees and the availability of quality internships for graduates. We will continue to work with our friends at WAMSS to oppose a third medical school in WA until issues such as postgraduate Stress buster: Notre Dame medical student, Pip Moffatt gets some love from a WA Guide Dogs puppy. training positions and Intern and RMO places are adequately addressed. We need to ensure that we are allocating our resources in a considered manner aimed at meeting the long-term healthcare needs of our community. This year MSAND farewells a highly successful and motivated cohort and on behalf of MSAND, I would like to wish them all the best in their future careers. I have no doubt that they will make MSAND exceptionally proud and I know from personal experience that they will make a fine group of doctors. Many of these students will make up the first group of Interns at Fiona Stanley Hospital and we look forward to seeing them on the wards. As the Committee prepares for 2015, we are aware of the responsibility of the roles that have been entrusted to us. It is essential that we continue to support and advocate for our students. I have every faith that the year ahead will be a fantastic one for MSAND. ■ The AMA (WA) welcomes the new members who joined during November 2014. Stuti Joshi Lakshika Kathriarachchi Mugunthan Krishneswaran Anton Lambers Hoh Peng Lee Larry Liew Jackie Mak Claire McQuillan James Miller Jonika Mosedale Shazia Mushtaq Lakmal Nandadewa Olusegun Odude See Ki Ong Olivia Pegram Charles Qiu Robert Reed Hafees Saleem Jacqui-Lyn Saw Benjamin Schussler Awf Shaban Hla Shwe Dilan Siriwardena Eckhard Strydom Mark Teh William Tjhin Simon Wamono Georgia Werner Yoke Mooi Wong Alan Wright Ian Yusoff December ME D I C US 53 Protect your family’s way of life and financial future AMA Financial Services offers you obligation free consultations for life and income protection insurances AMA FINANCIAL SERVICES 08 9273 3077 ...we go the extra mile to understand, protect and care for the Financial Wellbeing of the Health Professional Authorised Representative of Consultum Financial Advisers Pty Ltd AFSL 230323 understands protects cares This is general advice only and does not take into account your financial circumstances, needs and objectives. Before making any decision based on this document, you should assess your own circumstances or seek advice from a financial adviser and seek tax advice from a registered tax agent. Information is current at the date of issue and may change. AMA Financial Services supports the Medical Profession, staff are not commission based and all profits are returned to the AMA to benefit the medical sector. B E YOND B OR DE R S Small, simple, significant LINCS’ humble contribution to a community hospital in western Uganda will go a long way, says Dr Anthony Hew L ast year I and three other students - Doctors Hsern Ern Tan, Josh Ho and Bryan Tan – from the University of Western Australia had the incredible opportunity to complete a medical elective in Kisizii Hospital, a mission hospital nestled in the vast hills of western Uganda. It was an unforgettable and life-changing experience, practising medicine in a busy African hospital. The ability to provide effective healthcare is a challenge in rural Uganda. Medical facilities in this geographically landlocked country find it difficult to obtain much-needed supplies and resources for a growing population that is finally flourishing after decades of internal war and conflict. We saw an incredibly diverse spectrum of pathology and disease, including malaria, pericarditis secondary to tuberculosis and HIV-associated psychosis and encephalopathy. I vividly remember watching helplessly as the medical team could do nothing but watch as young men and women died from kidney failure due to the lack of dialysis. What struck me most was the incredible clinical skill and ingenuity displayed by the medical staff in the absence of the medical equipment and technology we take for granted here in Australia. I witnessed Unforgettable experience: Dr Anthony Hew and old Coca-Cola bottles being used Dr Jemma Sayer, a visiting Pediatrician from the as spacers for puffers and tins of UK, with local children in the town of Kisiizi in Western Uganda. old paint cans filled with stones used to provide traction to a by both staff and patients at Kisizii. fracture. Portable X-ray was non-existent Medical supplies are often difficult to and the hospital made its own alcohol obtain in Africa due to costs, tariffs and hand wash. transportation issues. The hospital was Also making an invaluable contribution particularly grateful for the supply of to Kisizii Hospital was the Local and oxygen saturation probes. These provide International Needs Contribution Scheme vital information about how well a patient (LINCS), a not-for-profit organisation is. Whilst every patient is able to have their run by student volunteers of Interhealth, own saturation monitoring in countries the Global Health Group of the Western such as Australia, many African hospitals Australian Medical Student Society are lucky just to have the one oxygen sats (WAMSS). LINCS provided supplies and probe across the entire ward. Even the most a monetary grant to the hospital, a generous basic medical equipment goes a long way in contribution which was greatly appreciated rural Uganda. ■ IDENTIFYING, AND MEETING HEALTHCARE NEEDS The Local and International Needs Contribution Scheme or the LINCS initiative aims to improve the standard of healthcare around the globe in poorly resourced hospitals and other healthcare facilities. This is achieved by raising funds and procuring donations of unused, reusable or surplus medical supplies and/ or equipment from donors in Australia that can benefit resource-limited communities. These medical supplies are then transported overseas to in-need areas of the developing world with the help of students heading there on their electives or exchanges. LINCS aims to gain a basic understanding of what recipient hospitals require in order to best meet their needs. Recipient host hospitals or health facilities are asked to make a wish list from an inventory of items available at the LINCS warehouse. While each year, LINCS sends a significant amount of much-needed medical equipment with students travelling to developing countries, approved monetary grants are also available for recipient hospitals to purchase items not readily available from the LINCS warehouse. Anyone travelling overseas to poorly resourced nations for their electives or exchanges can apply to receive and take LINCS equipment or monetary grants. We strongly encourage all medical students from UWA and the University of Notre Dame to contact LINCS before undertaking their electives. This year, LINCS has expanded its fundraising efforts to spread greater awareness of the health needs of developing nations to the wider community. It hopes to promote insight into the important issues of global health, the challenges affecting the world’s poorest people and high need communities and the amazing opportunities that can help facilitate change, a little bit at a time. Please contact the LINCS coordinator (lincs@wamss. org.au) if you are interested in making material and/or monetary donations, are able to take medical supplies to areas of high need, or if you would like to get involved in fundraising efforts. December ME D I C US 55 F ROMA MTAHET RE ADIIINING NT OR ING New AMA scholarship underlines value of customer service C ustomer service is essential to the success of any business – and medical practices are no exception. For many years, the Australian Medical Association (WA) has been delivering its medical reception course which emphasizes the importance of excellent customer service. The opportunity now exists for practice staff dealing with complex customer interactions to further develop their skills and obtain a nationally-recognised Certificate IV in Customer Contact under a traineeship arrangement. For a limited time and for a limited number of places, the AMA is offering scholarships to help medical practice staff obtain a Certificate IV in Customer Contact through AMA Training Services. For those successful in obtaining a scholarship, the qualification can be completed at no cost to the individual or the practice. The scholarship will cover the cost of the tuition fee and is valued at around $1300. The bulk of the cost of the training will be covered by funding received by AMA Training under the WA Department of Training and Workforce Development Future Skills program. Scholarship places are limited and participants must be New skills: Dr Sid Baxi (second from left) from Genesis Cancer Care WA with staff members Una Cooper Rebecca Molles, Ian Quinn, Mary Rohan, Steven Gillingham and Glenda O’Doherty, all of whom have commenced traineeships in Customer Contact. eligible to undertake a Traineeship. Subject to eligibility, practices may receive up to $4000 in Australian Government Incentives where new workers are enrolled as trainees in the qualification. Payroll tax exemption on trainees may also apply for eligible employers. For further information, contact AMA Training on 9273 3033 or complete an Expression of Interest for the Certificate IV in Customer Contact by visiting the Featured Courses page at www.training.amawa.com.au. ■ Murdoch Hospital Now in the heart of the South With internationally recognised expertise in clinical management and research, our cardiologists are leaders in their fields. From January 2015, Perth Cardio will open doors at its new south of the river clinic in Wexford Medical Centre – Murdoch Hospital. That means, for patients in the south, world-class cardiology care just got a whole lot closer. Visit perthcardio.com.au to find out more. LEADERS IN C ARDIOLOGY | ECHO | ECG | HOLTER MONITORING | ECHO | TOE | E XER CISE STRESS TESTING December ME D I C US 57 A M A IN T HE ME DI A AMA IN THE MEDIA NO-JAB FEARS Almost one in 50 WA children aged under seven is not immunised, as more parents become vaccine-refusers. AMA WA President Dr Michael Gannon said it was hard to understand why any parent could not see the value of immunising their children. “I suspect with some who are prone to accepting conspiracy theories, we will never be able to change their minds and we will always have flat-earthers who are more inclined to believe rubbish on the internet that the evidence,” Dr Gannon said. Dr Gannon said of particular concern were low rates in five year-olds. This was a vulnerable time as children started school. The West Australian, 15 November 2014 AMA SLAMS FLUORIDE-FREE PETE AMA WA President Dr Michael Gannon slammed chef Pete Evans, saying: “Does he have nice teeth? If so, he has fluoride to thank. It’s always disappointing when people use their celebrity in a way that is not useful to society.” The AMA WA has dismissed the Perthbased group as a “vocal hodge podge of conspiracy theorists. “In cases like this, when people are simply wrong, we ask that they butt out of the debate. Water fluoridation is something that has the full support of the Australian Dental Association and the AMA, it’s cheap, it’s proven to be beneficial, and data repeatedly proves that it is effective in reducing cavities in children,” Dr Gannon said. Sunday Times, 7 December 2014 BABY DELIVERY TURF WAR LOOMS A turf war is brewing in WA over moves to allow private midwives to admit and manage women in labour in public hospital maternity units. AMA WA President Dr Michael Gannon said he feared doctors would be called in at the last minute to rescue unsafe situations. “Over the years we have developed a system where obstetricians and midwives work together but obstetricians are ultimately responsible if the pregnancy or delivery gets dangerous,” he said. ‘Moving away from that is a retrograde step,” he said. The West Australian, 22 November 2014 The AMA (WA) social media pages have had an explosive month, with Facebook in particular seeing massive growth since the last edition of Medicus. An incredible 26,900 people saw AMA (WA) President Dr Michael Gannon’s comments on the proposed solarium ban in WA, indicating the public interest in this particular issue. Another wellreceived post detailed Dr Gannon’s comments on fluoride, generating a heated debate between those for and against water fluoridation. The AMA (WA) Facebook page has had significantly more engagement and ‘likes’ than any other state AMA over the past month, and continues to go from strength to strength. Twitter followers continue to rise, with more journalists and MPs (including Premier Colin Barnett) now following the page. OTDNET APPLICATIONS NOW OPEN OVERSEAS TRAINED DOCTOR NATIONAL EDUCATION AND TRAINING (OTDNET) Are you an overseas trained doctor looking to attain specialist registration as a General Practitioner in Australia? The OTDNET Sub-program B is designed to help overseas trained doctors (OTDs) with General or Limited Registration, who are working in a General Practice environment, prepare to undertake the required assessments of the Australian College of Rural and Remote Medicine (ACRRM) or the Royal Australian College of General Practitioners (RACGP). Delivered over a twelve month time frame, the program is specifically designed to: • Enhance your clinical and communication skills • Prepare you for sitting your Fellowship examination. For more information and to apply visit http://wagpet.com.au/applicants/interested-in-otdnet or contact WAGPET at [email protected]. APPLICATIONS CLOSE 14 JANUARY 2015 OTDNET for AMA.indd 1 4/12/2014 2:43:55 PM December ME D I C US 59 RENT WITH HERTZ AND SAVE Hertz offers great rates to AMA Members on all our vehicles, including our Prestige Collection of BMWs. Just quote this CDP number: 283826 when you make your booking*. *Terms and Conditions: Customer Discount Program (CDP) number 283826 must be quoted at time of reservati For full terms and conditions, please visit the Hertz section on your intranet. LE DR I V E SP XUS OR NX TL 3 UX 00 UR H Y Edgy style and formidable function PIC: TONY HEWITT T Dr Peter Randell he newest Luxury EXport to the US has become the first Lexus to have its release in China, not the USA. Beijing was given a big blast of fashion and style when the Lexus 300h was released earlier this year, and now it is our turn. The NX 300h is an edgy, modern fashion statement with the trendy combination of a very efficient (5.7litres/100kms) petrol four-cylinder 2.5-litre engine combined with an electric motor and a battery system producing a syrupy 147kW of undetectable origin. It is possible to silently depart under pure electric power before the petrol engine kicks in without fanfare to supplement progress. A petrol turbo 174kW version arrives soon. From the outside, one sees a modish razor-edged body with arrow-head LED sidelights below three individual LED bulbs forming the headlight. The radiator grill is the now signature Spindle Grill of chrome, and further back along the sharp sides of this cross-over vehicle are partially chrome-plated side mirrors producing a tromp l’oeil of thinness. Large 18-inch mag alloys strut their stuff in prominent wheel arches, oozing testosterone. The rear taillights have a similar sharp edge to their design and again, are LEDs. Within, the immediate impression is of luxury with most surfaces being covered with soft-touch leather or classy chrome plating and faux-metal. The driver’s seat is well back until the ignition button is pressed – when the seat advances to the last selected position and the steering wheel simultaneously participates in the pas-de-deux, coming forward and down. The steering wheel is a smarty – having buttons for phone, audio and cruise control. Just behind the rim lie the paddle shifters for those who wish to force the smooth Continuously Variable Transmission into a six-speed gearbox. I tried it, but Lexus does it better. Use the CVT. Just to the left and proximal to the gear selector lies a touchpad with haptic (touch and proprioception) sensitivity, which I found to be very reactive. This pad guides one through the menu allowing selection from the phone, GPS and other lists. A wrist-rest eases the process. Above this lies a rotary dial to select Eco, Normal, Sport and Sport+. The latter settings modify engine reaction, suspension settings and responsiveness. Directly ahead, the driver sees the Head-Up-Display of speed, revs or GPS instructions, reflecting in the inner windscreen. The central column is crowned by the touch screen, which on selecting ‘reverse’ produces a bird’s eye view of the ground surrounding the car, as well as a conventional rear-view camera image. It is startling and with experience, very reassuring. The cameras in the side-mirrors combine with those at front and rear and clever software blends the four images. Surely this will become compulsory in time? Clever: The rear view and surround cameras in action. I was reversing out of my driveway which has poor vision of the roadway, yet could see the street clearly. The sensors in the rear bumper suddenly beeped urgently and after I braked, a car came into sight on the screen. The Rear Cross Traffic Alert had done its job. Another must-have on the next Randell Family Transporter list of requirements! Combine that with the Blind Spot Monitor in the outer segment of the rear view mirror, eight airbags, ABS, Electronic Brake force Distribution, Brake Assist, Hill Start Assist Control, Vehicle Stability Control, Lane Departure Warning, Traction Control, Active Cruise Control (which is responsive to the speed of the preceding vehicle) and that is as good as it gets in safety in cars of any price in 2014. But wait! There is more. The rear seats on the Sports Luxury split 60:40, and have electric fold-down via switches in the boot, which itself is opened from the driver’s seat, key or at the rear of the 300h. Below the driver’s left elbow rest is an induction pad to wirelessly recharge smart phones on the run. The driving experience is all ease, with sedan-like handling on the twisty bits, though some CVT hum comes through when pushed really hard. This is a vehicle which must be driven at night for the theatre of the lighting. It is excellent with auto-high beam being cut off by oncoming vehicles, and bendy lights from the fog lights when turning corners. Fashion, style and function. Meet the Lexus NX 300h Sport Luxury. RRP from $55,000; Sport Luxury $75,000. Vehicle supplied by Lexus of Perth. ■ Knight of Nights: This is a vehicle which must be driven at night for the theatre of the lighting. December ME D I C US 61 T R AV E L A holiday from my holiday A desire to experience something more than beach basking in Thailand leads Nicola Roman to Khao Sok National Park Home on the water: The Floating Bungalows on Cheow Lan Lake. I spent the first three days of my weeklong holiday in Thailand at one of the numerous European-style resorts dotted along the Andaman Coast. The quintessential Thailand beach experience. The beach certainly was stunning, with crystal clear waters and white powder sand. However, I couldn’t 62 M E D I CU S December help but feel that, other than the resident elephant that stalked the resort grounds, I could have been home in Australia at a resort in Queensland, or indeed any resort on any tropical coast in the world. After three days on the Andaman Coast, my reading material was exhausted, my desire to lounge on a beach had diminished and after falling off a paddle-board one too many times, I needed a holiday from my beach holiday. My desire to experience a different side of Thailand before returning to Australia saw me venture inland to T R AV E L Khao Sok National Park. The park is located about halfway between southern Thailand’s two coasts. In recent years the area has emerged as a popular spot on the tourist trail but still retains its authenticity. Even in peak season you won’t battle with large crowds in Khao Sok – quite refreshing after the hustle and bustle of the coastal resorts. As you travel the 90-minute journey from the coast to Khao Sok, the coastal resorts and tourist towns disappear over the horizon as the vista becomes dominated by lowland jungle and limestone crags. The scenery is truly breathtaking. Khao Sok village is an ideal base for experiencing all the National Park has to offer. Not only is the village equipped with amenities such as ATM machines and a supermarket, the banana pancakes found in Khao Sok are second to none. The perfect sustenance for a day in the jungle. A trip to Khao Sok is not complete without experiencing a trip on Cheow Lan Lake. If you only have a day in Khao Sok on your travels, this is the way to spend it. The scenery is spectacular and karst formations abound. An oft-cited quote in the tourism brochures describes the backdrop perfectly – “Nowhere in the Kingdom of Thailand can one find a more spectacular setting for karst topography than the flooded reservoir of Cheow Lan”. The vistas, more commonly associated with Ha Long Bay in Vietnam or the lakes in South China Karst, are indescribable with photos rarely able to do the scenery justice. Tourists are transported by a long boat around Cheow Lan before docking at one of the 17 ‘Floating Bungalows.’ Here guests are provided with a traditional home-cooked lunch provided by Thai families who have made the lake their home. The floating bungalows are available for rent should you wish to spend the night. Waking up to the sound of hooting monkeys and the deafening buzz of cicadas is an experience not quickly forgotten. Following lunch (and a refreshing swim), a trek through the jungle is the last part of the itinerary before boarding the long boat back to the mainland. Khao Sok National Park is home to gaurs, leopard cats and tigers, although the only wildlife I came into close contact with were the leeches that were intent on making my trek just that little bit more exciting. However, even without spotting a leopard, the jungle trek was a fantastic experience. Should one be inclined, there is also the option to venture into one of the rainforest caves. Due to the risk of flash flooding, tourists are no longer allowed to explore too far inside, but nevertheless this isn’t an experience for the fainthearted or claustrophobics. There is an abundance of activities to be experienced in Khao Sok and whilst Cheow Lan Lake was certainly my highlight, there are many other options for exploring all that Khao Sok has to offer. Why not hop on a rubber tube and drift down the river for two hours? It’s probably the most stress-free way of travelling. Whilst Beautiful calm: Khao Sok National Park is a refreshing change from the hustle and bustle of Thailand’s coastal resorts. ‘river-tubing’, you meander downstream passing limestone cliffs, towering jungle trees and, if you’re ‘lucky’ enough you will spot sleeping snakes in the tree branches above your head. If ‘river-tubing’ isn’t your cup of tea, how about exploring the jungle by canoe, or on the back of an elephant? Or go the old-fashioned way – on foot. A local guide will lead you to the most breathtaking waterfalls and swimming spots and point out all the lizards, snakes and birds that you miss whilst you’re busy gazing in awe at the surroundings. So next time a holiday to South-East Asia is on the agenda, why not seek to experience something a little different? Move away from the coast and make the journey inland. You won’t find scenery as beautiful, or locals more accommodating. The banana pancakes are just the icing on the cake. ■ Resident attractions: Khao Sok is home to gaurs, leopard cats, monkeys, birds and tigers. December ME D I C US 63 ALIA and Happy New Year! The AMA (WA) wishes all members a very Merry Christmas and a safe, healthy and prosperous New Year Operating hours for the AMA (WA) during the festive season are: SECRETARIAT & MEMBERSHIP Closed from noon, 24 December 2014; will reopen Monday, 29 December. Closed 1 & 2 January 2015; will reopen on Monday, 5 January. AMA INSURANCE & FINANCIAL SERVICES Closed from noon, 24 December 2014; will reopen Monday, 29 December. Closed on 1 & 2 January 2015*; will reopen on Monday, 5 January. *(after-hours service operating on 2 January) AMA MEDICAL PRODUCTS Closed from 24 December 2014; will reopen on Monday, 5 January 2015. WESTERN AUSTRALIA F OOD Festive feasting Brendan Pratt Head Chef, Indiana A Christmas celebration minus a table laden with festive goodies is as exciting as Santa without his sack! So if you’re planning on rolling out the heavy artillery for a Christmas meal, the recipes below will serve you very well. These are traditional yet tweaked just that little bit for a different take on things. I promise, even your most discerning guest will leave impressed! Happy holidays and happy eating! ROLLED CONFIT TURKEY Serves 4 Ingredients • ½ turkey; boned • 220g table salt • 120g caster sugar • 4L water • ½ cup coriander seeds • 1 cinnamon quill • Duck fat Method For brine •P lace salt, sugar, water, coriander seeds and cinnamon in a medium-sized pot. Heat and bring to the boil. •O nce boiled, take off the heat and cool to room temperature. For turkey: •A dd the turkey to the brine and let sit in the refrigerator for 2 hours. •A fter 2 hours, remove from the brine and place into a roasting tray. Cover with duck fat. • Cover tray with cling film and tin foil before placing into the oven at 78C for 12 hours. • Once cooked, remove from the oven. Pull apart meat and place pieces on an open piece of cling film. Roll the turkey in the cling film to form a cylindrical shape. • Place into an ice bath and chill. • Once chilled and set cut into slices. Method • Place sugar and cinnamon quills in a saucepan with 1/2 cup (125ml) cold water. Stir over low heat until sugar dissolves. Simmer for 1 minute, then remove and cool. •C ombine 100ml of the syrup in a blender with eggs, cream, milk and alcohol. Pour into cocktail glasses over ice and serve dusted with nutmeg. ICED EGGNOG Serves 4 Ingredients • ½ cup castor sugar • 2 cinnamon quills; whole • 2 eggs • ¾ cup milk •1 00ml each brandy, spiced rum, sherry •F resh nutmeg; roughly grated ROASTED HEIRLOOM CARROTS WITH ALMONDS AND SMOKED PAPRIKA Serves 4 Ingredients • 1kg whole heirloom carrots • 3tbs balsamic vinegar • 2tbs honey • 6 sprigs thyme • 2tbs sweet smoked paprika • 3tbs roasted almond flakes To taste • Sea salt and pepper • Olive oil Method • Preheat oven to 200C. • Trim the tops off of the carrots, leaving some green and peel. Leaving carrots whole, toss with a couple of tablespoons of olive oil and place in a single layer on a baking sheet lined with parchment paper. Sprinkle very lightly with salt and pepper to taste and then top with four whole sprigs of thyme. • Roast the carrots for 30-35 minutes until they are tender enough to pierce with a fork. • Remove the carrots from the oven, toss with the balsamic vinegar, honey, the remaining 2 sprigs of thyme and smoked paprika. • Return the carrots to the oven for 5-10 minutes or until they begin to caramelise. • Remove from the oven and place onto your dish. • Sprinkle with the roasted almonds and serve. December ME D I C US 65 From classic to contemporary, we create… D E S I G N + B U I L D + M A I N TA I N | w w w.t d l . c o m . a u | (0 8 ) 94 4 1 0 2 0 0 W INE Must-have wines this Christmas T his is the last column for 2014 on all things vinous. The following are a selection of wines that you might consider trying over the Christmas-New Year break. The Woods Crampton Eden Valley Riesling 2013 is a good place to start. This is sourced mainly from a single, established vineyard situated at almost the highest point in the Eden Valley, well over 500m in altitude. Close to Mount Adam and the old Leo Buring High Eden Vineyard, the site is an ideal expression of High Eden Riesling. The wine is hand harvested and whole bunch pressed, the fermentation is very cool – around 12 degrees – and allowed to ferment to bone dry. It is bright straw green. The nose is very fresh and floral with notes of citrus fruit and bath powder. The palate is tightly wound with a long fine acid line and a dry, crunchy finish. Delicate lemon and citrus flavours provide an indication of the future profile of this wine with careful cellaring. For those who enjoy a Sauvignon Blanc, Shaw & Smith Sauvignon Blanc 2014 is worth a try, particularly at this time of the year. Shaw and Smith’s description says it all – “It is lively and aromatic with notes of passion fruit, nashi pear, and nettles. On the palate there is intense flavour, with fresh, limey fruit, mouthwatering acidity, and remarkable purity. It is bone dry and unoaked to maintain freshness”. It also has a long finish. For something a bit posh, try Leeuwin Estate Art Series Chardonnay 2011. James Halliday says, “There is always cause to genuflect in the presence of Chardonnay royalty such as that of Leeuwin Estate. It imposes its will without a flicker of effort; the line between citrus and stone fruit, and between oak and mineral comes and goes, leaving you grasping at straws; it’s a wine of flawless balance, line and length. Drink: to 2031”. Share it with people you like and who will appreciate the quality. Christmas celebrations require some bubbly and Delamotte Brut NV is a must. Delamotte is called the second wine of Salon, which is unfortunate. While it is true that lots of Salon that do not go into the Grand Vin make their way into Delamotte, Salon is Chardonnay, while Delamotte is also half Pinot Noir and 20 per cent Pinot Meunier. The wine is elegant and light with long vanilla flavors in the mouth and on the finish, and just a touch of sweetness to this sweet-discerning palate. A red to savour is Henschke Mount Edelstone 2012. First bottled as a single-vineyard wine in 1952, it became recognised as one of Australia’s greatest shiraz wines. As you know, the Henschke family has been making wine since Johann Christian Henschke planted a small vineyard on his diverse farming property at Keyneton in 1862. The wine is matured in 88 per cent French and 12 per cent American (54 per cent new, 46 per cent seasoned) hogsheads for 21 months prior to blending and bottling. Halliday says the wine is “vivid, deep purple-crimson; this is a blue-blood aristocratic shiraz, certain in its supreme power, length and balance, and not going out to prove anything. If anyone doubts its quality now, the scales will fall from their eyes over the decades ahead, as it will be recognised by all and sundry as one of the greatest Mount Edelstones”. Agreed. Enough said. A bit of French tipple never goes astray, and Guigal Cotes du Rhone 2010 is, like its predecessors, a lovely drop. The reason for its consistent quality is that Guigal is known throughout the Rhone Valley for paying the highest price for generic Cotes du Rhone, and that in large part explains the quality of this wine year in and year out. The man understands quality. It is a well-structured wine with powdery tannins and sweet juicy dark berry fruit, balanced by earthy leathery flavours and a lovely finish. Put a case under the Christmas tree for yourself. Moss Wood Amy’s Cabernet 2013 should also be considered. The Moss Wood Amy’s offers undeniable Moss Wood quality at an easily affordable price. It is beautifully soft yet fullbodied, shows pristine varietal character, impeccable balance and is simply a pleasure to drink – whether it be upon its release, when it shows optimum primary fruit and robust texture or after a few years in the cellar, when the classic secondary characters begin to wonderfully take control. Now for some red bubbly – and not of the Christmas cake sparkling Shiraz variety. Dominique Portet Brut Rose NV is surprisingly good. The current Brut Rosé release is a blend of 50 per cent Pinot Noir, 30 per cent Chardonnay and 20 per cent Pinot Meunier, made in the traditional method and sourced from fruit grown in the Yarra Valley. The grapes were handpicked, gently pressed and fermented before going through the secondary fermentation inside this bottle. The wine was aged for two years, then disgorged and lightly dosed prior to release. It is a savoury, sparkling wine with fresh strawberries and rose petals on the nose that follows into a fresh, dry, creamy finish. Halliday describes it as “pale, bright pink; a lively and fresh wine with strawberry fruit to the fore; the low dosage provides a vibrantly fresh finish, and does not imperil the balance”. ■ December ME D I C US 67 Member BENEFITS In addition to the valuable services the AMA (WA) provides members, the Association also secures significant savings with a host of exclusive benefits. For more information, visit www.amawa.com.au/membership/memberbenefits.aspx 50% 15% Knee Deep Wines McKinnon & Penny Perth surgeon Dr Philip Childs and Sue Childs, owners of Knee Deep Wines in Wilyabrup, have supported the AMA (WA) over a number of years and are happy to offer colleagues membership to their ‘Knee Deep in Wine Club’ with a 15% discount (from full RRP price) and free freight on wines purchased from our online store. Contact AMA (WA) membership on (08) 9273 305 to obtain the member discount code then visit www.kneedeepwines.com.au to make your purchase, or contact the Knee Deep Winery office via email: [email protected] McKinnon & Penny offers AMA (WA) members who are buying or selling their home or office property a personalised and professional conveyancing service with a settlement fee that is discounted to 50 per cent of the scale fee. Visit and request a quote by email or call Joe Stolz on (08) 9221 1222. $$$$ Hi Tech Marine 10% Margaret’s Beach Resort Offering idyllic four-star self-contained Margaret River accommodation by the sea, Margaret’s Beach Resort is one of the best beach resorts in WA. It is the perfect location for a romantic getaway or memorable family holiday. Just 10km from Margaret River town, and only 500m from the pristine Gnarabup Beach, Margaret’s Beach Resort is the only resort accommodation by the sea. The resort includes a wide range of facilities including an outdoor resort pool, children’s playground, onsite surf shop and onsite restaurant – the award-winning Gnarabar. AMA (WA) members can save 10 per cent off Best Available Rates (subject to availability). Phone (08) 9757 1227 or email [email protected] to book. FREE CONSULT Tim Davies Landscaping Tim Davies Landscaping (TDL) has been an awardwinning leader in the WA landscaping industry for 30 years, focused on listening and working with clients to create unique gardens. Services include residential and commercial landscape design and construction, commercial landscaping maintenance and residential maintenance. No matter what size the project is, TDL’s passion is turning a vision into reality and creating “a garden for life”. TDL offers AMA (WA) members a complimentary one hour in-office consultation with a landscape architect/designer. 68 M E D I CU S December Award-winning dealership Hi Tech Marine is one of the country’s leading certified marine service and re-power centres. Hi Tech Marine is pleased to offer AMA (WA) members the following: • 10% off accessories (not including electronics, oil and already discounted prices) • 10% off all servicing • 10% off all repair work • Free membership to the Hi-Tech loyalty program • Free trailer inspection • 10% off all condition reports • $1000 off all Atomix 5.6 and 6 meter boat motor trailer packages • One year’s free trailer registration with every boat motor trailer package • One-stop insurance and finance service; we sell loan protection and gap insurance too. For more details, visit www.hitechmarine.com.au $$$$ Audi Corporate Program Audi Corporate® is an exclusive corporate program for a select group of drivers such as AMA (WA) members who receive exclusive benefits and superior service on a selected range of luxury Audi models. AudiCorporate® members enjoy: • no cost, scheduled servicing for three years or 45,000km • free pick-up and drop off of your vehicle for servicing in the CBD (or within a 20km radius of Audi Centre Perth) • priority vehicle order and allocation • loan cars when your A5/S5, A6/S6, A7/S7, A8, R8, Audi Q5, Audi Q7 or RS model is being serviced, plus more. For further details on the AudiCorporate® program, call (08) 9231 5888. 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 22 December Mr. Turner In cinemas 26 December Acclaimed director and writer Mike Leigh (Secrets & Lies) brings a legend to life in Mr. Turner, starring Timothy Spall (who won Best Actor at Cannes for this role). The film explores the last quarter century of the great if eccentric British painter J.M.W. Turner. Profoundly affected by the death of his father, loved by a housekeeper he takes for granted and who he occasionally exploits sexually, Turner forms a close relationship with a seaside landlady with whom he eventually lives incognito in Chelsea, where he dies. Throughout this, he travels, paints, stays with the country aristocracy, visits brothels, is a popular if anarchic member of the Royal Academy of Arts, has himself strapped to the mast of a ship so that he can paint a snowstorm, and is both celebrated and reviled by the public and by royalty. Wild In cinemas 22 January In Wild, director JeanMarc Vallee (Dallas Buyers Club), Academy Award winner Reese Witherspoon (Walk the Line) and Academy Award nominated screenwriter Nick Hornby (An Education) bring bestselling author Cheryl Strayed’s extraordinary adventure to the screen. After years of reckless behaviour, heroin addiction and the destruction of her marriage, Cheryl Strayed makes a rash decision. Haunted by memories of her mother and with absolutely no experience, she sets out to hike more than a thousand miles on the Pacific Crest Trail all on her own. Wild powerfully reveals Strayed's terrors and pleasures – as she forges ahead on a journey that maddens, strengthens, and ultimately, heals her. St. Vincent In cinemas 26 December The singular Bill Murray teams with first-time director/screenwriter Ted Melfi for St. Vincent, the story of a young boy who develops an unusual friendship with the cantankerous old guy next door. Birdman In cinemas 15 January Birdman is a black comedy that tells the story of an actor (Michael Keaton) – famous for portraying an iconic superhero – as he struggles to mount a Broadway play. In the days leading up to opening night, he battles his ego and attempts to recover his family, his career, and himself. Taken 3 In cinemas 8 January Liam Neeson returns as ex-covert operative Bryan Mills, whose reconciliation with his ex-wife is tragically cut short when she is brutally murdered. Consumed with rage, and framed for the crime, he goes on the run to evade the relentless pursuit of the CIA, FBI and the police. For one last time, Mills must use his “particular set of skills,” to track down the real killers, exact his unique brand of justice, and protect the only thing that matters to him now – his daughter. December ME D I C US 69 Why wait? We can improve your practice today! Personalised service Strategic Tax & Accounting advice Business improvement and structuring OuR mediCal ClientS Say... “ It is a pleasure to recommend the services of ROCG Stirling. From a technical viewpoint, their knowledge and understanding of complex tax issues is first rate. From a personal perspective I have always found the team to be knowledgeable, professional and friendly maintaining a high level of ethics and integrity. “ I would consider ROCG Stirling to be one of my most valuable resources. ROCG Stirling has been my CPA firm of choice for the past 4 years. In my experience their professionalism is unsurpassed and the delivery of their financial, tax and business guidance throughout this time has been invaluable. Their approach is progressive, innovative and modern. ROCG Stirling has always exceeded my expectations and I would have no hesitation in recommending their services. dr. Jonathan dalitz GP Melville FAMily HeAlTH CenTRe dr minh nguyen GP BedFoRd FAMily PRACTiCe The quality of the advice I have received has been very strategic and has saved me much time in medical as well as other areas of business & investment. ” ” Rob Femia, Michael Huynh and Tony Kolker Book now: (08) 9344 7799 ROCG Stirling Level 1, 35 Cedric Street, Stirling Taxation Advice and Planning • Accounting • Business Strategy and Improvement • Practice Structuring Professional Notices 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 recently have moved to Hollywood Hospital for private patients. For appointments or advice please contact Suite 18, 85 Monash Ave. Hollywood Medical Centre Nedlands, WA 6009 Office Hours: Fridays 8am to 12pm and 1pm to 5pm 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 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. Lewis Blennerhassett MBBS FRACS Mr Angus Keogh FRACS - Hand and Upper Limb Surgeon Dr Blennerhassett is a plastic surgeon with postgraduate 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. 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. 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 December ME D I C US 71 Professional Notices 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 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 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 72 M E D I CU S December 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 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] Professional Notices 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, highlytrained 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. RENT WITH HERTZ AND SAVE Hertz offers great rates to AMA Members on all our vehicles, including our Prestige Collection of BMWs. Just quote this CDP number: 283826 when you make your booking*. *Terms and Conditions: Customer Discount Program (CDP) number 283826 must be quoted at time of reservation. For full terms and conditions, please visit the Hertz section on your intranet. Executive Style Meets Comfort and Practicality Vehicle shown is a 118 TSI Elegance Sedan The Superb brings visual energy to its class. With an attractive design that impresses at first glance, showing a character that is striking and elegant at the same time. Superb In Facts: ŠKODA Superb Elegance • Leather interior • Bi-Xenon headlights with Adaptive Frontlight • Cruise Control • Touch Screen Columbus Satellite Navigation • Electric adjustable driver and front passenger seats $43,240 From Driveaway* • Front and rear heated seats • Dual-zone Climatronic air conditioning • Automatic Parking Assist with front and rear parking sensors European quality without the European price tag. BARBAGALLO ŠKODA OSBORNE PARK 352 Scarborough Beach Rd, Osborne Park WA 6017 DL 2061 *Driveaway price shown in the Manufacturer’s Recommended Driveaway Price (MRDP)(with the added option of metallic paint). Available at Barbagallo ŠKODA. The driveaway price shown is based on the owner being a ‘rating one’ driver aged 40 with a good driving record. Actual driveaway price may differ depending on choice of dealer and individual circumstances. Contact Barbagallo ŠKODA to confirm your specific price. ŠKODA Australia reserves the right to vary the MRDP in its discretion. Consult with Barbagallo ŠKODA regarding any relevant model year/running changes. Phone : 1300 720 457 PROUD PARTNER OF PROUD PARTNER OF ROOMS FOR LEASE – EXMOUTH WA NEDLANDS Brand new premises available for entrepreneurial GP. Be the first private GP in town, with opportunity to focus on occupational and dive medicine as well as family practice. Wonderful lifestyle with stunning scenery and wildlife to explore. Contact [email protected] Medical Specialist Consulting Rooms and Treatment Room • F ully 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] NEDLANDS 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. NEDLANDS 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 Consultant Psychiatrist People caring for people Joondalup Health Campus Perth, Western Australia An exciting opportunity exists for a suitably experienced and talented clinician to join the Mental Health Team at Joondalup Health Campus (JHC). Why this Role? Joondalup Health Campus has a culture of innovation and change. Our clinicians are valued and enjoy a close and collaborative relationship with the hospital executive team, unencumbered by unnecessary bureaucracy. You will work with an established team of Consultant Psychiatrists who are supported by junior medical staff including Registrars and RMO’s, Allied Health Practitioners and an experienced team of nursing staff committed to provide 24 hour care for patients in our Mental Health Unit. Why Joondalup? JHC is a 664-bed public and private hospital campus, owned and operated by Ramsay Health Care. Situated on the coast 30 minutes north of Perth’s CBD, we provide If you are this person please forward your expression of interest and application to: Lucinda Cavanagh, Executive Administrative Assistant Email: [email protected] comprehensive acute medical care to the community of Perth’s northern suburbs. The Public Mental Health Unit at Joondalup Health Campus treats both voluntary and involuntary public patients with 47 beds consisting of 37 open beds and 10 beds in our Psychiatric Intensive Care Unit. Who Are You? You are an experienced Consultant Psychiatrist with excellent communication skills. You are a FRANZCP and hold full specialist registration with AHPRA. You believe that working collaboratively with other specialties, health professionals, and services within the hospital will achieve your primary aim, which is to provide first-rate health outcomes for the community. For further information contact: Professor Hans Stampfer, Director of Psychiatry Email: [email protected] www.joondaluphealthcampus.com.au December ME D I C US 75 Please forward submissions for Greensheet by 6 January for the February 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 – 3 February, 2 June & 20 October 2015 Workshop 1 – Alcohol and Drug Use among Young People – 3 March 2015 Workshop 2 – Social Media and the Internet: The Impact on Young People’s Wellbeing - 7 July 2015 Workshop 2 – Young People’s Sexual Health – 5 May 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 11-12 Feb-15 Basic Surgical Skills: Gynaecology. Compulsary for all first year registrars in Gynaecology and experienced residents may apply to attend. Please contact Anita Ingleby, KEMH, 9340 1388 20 Mar-15 The Cutting Edge: Managing Skin and Soft Tissue Injuries. Suitable for GPs, GP Proceduralists and Remote Nurse Practitioners. Accreditted 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. Email john.linehan@uwa. ed.au or call: John Linehan on 6488 8049 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. Email john.linehan@uwa. ed.au or call: John Linehan on 6488 8049 76 M E D I CU S December Perth Radiological Clinic supports Low Dose CT screening for lung cancer On December 31st 2013, the US Preventive Services Task Force (USPSTF) endorsed Annual Low Dose CT screening of high risk smoking patients for the early detection of lung cancer. Now that there is sufficient evidence PRC will provide this service: • Very low dose chest CT screening scans using the latest iterative reconstruction techniques at all 15 comprehensive practices across Perth • All screening chest CT scans for early detection of lung cancer will be reported by our team of specialist chest radiologists • Screening chest CT scans for pensioners and health care card holders will be bulk billed across all sites • Same day or next day appointments available at most sites www.perthradclinic.com.au Leaders in Medical Imaging