Ross River Virus

ALIA
WESTERN AUSTRALIA
MEDICUS
Journal of the Australian Medical Association WA | March 2012 Volume 52 / Issue 2 | amawa.com.au
Ross River Virus
on the rise in Western Australia
March ME D I C US 1
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2 M ED I CU S March
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Council
MEDICUS
March 2012
President
A/Prof David Mountain
Immediate Past President
Prof Gary Geelhoed
Vice Presidents
Dr Richard Choong
Dr Michael Gannon
Honorary Secretary
Dr Omar Khorshid
Assistant Honorary Secretary
Dr Janice Bell
Contents
Honorary Treasurer
Dr Simon Towler
Councillors
Division of General Practice (WA)
Prof Bernard Pearn-Rowe
A/Prof Rosanna Capolingua
Division of Speciality Practice
Dr Tony Ryan
Prof Mark Khangure
Division of Salaried and State
Government Services
Dr Nigel Armstrong
Prof Geoff Dobb
Ordinary Members
Dr Andrew Miller
Dr Daniel Heredia
Dr Stuart Salfinger
Co-opted Members
Prof Ian Puddey
Prof Gavin Frost
Dr Stephen Wilson
A/Prof Frank Jones
Dr Peter Maguire
Dr Dror Maor
Dr Cassandra Host
Mr Ghassan Zammar
Mr Benjamin Host
President's Page
Opinion
Some light at the end of the
tunnel?
Ross River Virus: it is time to act
p.2
p.39
Industrial
Research
AIMS Form: Urgent
Information
Giving birth after a caesarean:
lowering the risk to babies
p.9
p.41
AMA (WA) Office
Travel
Executive Director
Mr Paul Boyatzis
Deputy Executive Director
Mr Peter Jennings
Executive Officers
Mr Michael Prendergast
Ms Christine Kane
Ms Clare Francis
Mr Gary Bucknall
Medicus
Intern Cocktail Party
p.10 - 11
ditor and Director of
E
Communications
Mr Robert Reid
Advertising Inquiries
Phone Mr Des Michael (08) 9273 3000
Copy Submissions
Phone Ms Robyn Waltl (08) 9273 3009
or [email protected]
Services
Business Services Manager
Ms Noelle Jones
Opinion
The Longest Eight
Seconds in the world
p.58–59
GPs and Emergency Planning
why are we ignored?
p.18
Financial Services Manager
Mr John Gerrard
Medical Products Manager
Mr Anthony Boyatzis
Health Training
Australia Manager
Mr Geoff Jones
14 Stirling Highway
Nedlands WA 6009
Web: www.amawa.com.au
Email: [email protected]
he publication of an advertisement
T
or inclusion of an insert does not
imply endorsement by the AMA (WA)
of the service or product in question
and neither the AMA (WA) nor its
agents will have any liability for any
information contained therein.
Cover Story
Members Only
Benefits and On the Town
p.64–65
Classifieds
Professional Appointments
& Positions Vacant
Ross River Virus
p.66–71
p.32–37
March ME D I C US 3
President’s Page
A/Prof David Mountain
Some light at the end of
the tunnel?
The last few months have been an interesting time for
medicine and how it is perceived. On a number of fronts
I think we can feel that there has been some progress in
improved understanding of the value of the doctor (a real one
that is – of medicine, not chiropractic, chiropody, pharmacy
or chinese herbal medicine) to the patient and community
they live in. What has renewed my faith in our standing in the
community?
Well, over the last few months there have been many
individual stories on varied topics in the media where
evidence-based practice has been the issue. And the
profession’s thoughtful, forceful and principled replies in
many arenas have stood us in good stead. What is more,
the willingness to stand up for important principles and
fight against charlatanism, quackery, opportunism and the
increasing fragmentation of health care have allowed many lay
commentators to speak up and defend modern medicine for
the fantastic boon it is.
So what are the principles and the issues that have been
driving these important debates?
First and foremost is the importance of evidence as the
basis from which good care derives its authority. Second is the
need for a professional who understands how this vast array
of evidence applies to the individual, their issues and total
wellbeing. Finally the realisation that for effective health care,
there has to be a leader and coordinator of the team. In the
vast majority of circumstances that will be the doctor.
The systematic application of the best research and a
constant willingness to review your care and adapt to better
information are the hallmarks of good professional medical
practice and the scientific tradition. In many areas recently,
fights have been fought (and mainly won) in the public arena.
In particular the teaching of non-scientific, implausible pseudo
‑health in universities has been challenged. In the UK most of
the quackery courses are now closed or closing as universities
have been shamed into removing them. Homeopathy looks
likely to be named soon by the NHMRC as being both
ineffectual and implausible. In the area of supplements,
vitamins and other non-therapies spruiked by an unholy
alliance of pharma, pharmacists, some celebrity doctors and
naturopaths, the TGA looks like it is finally finding some
teeth. The Pharmacy Guild of Australia’s dalliance with
Blackmores was exposed and lead to a humiliating public
retreat. Lawsuits against companies making ridiculous claims
about supplements have again improved public awareness
of the claims and products being pushed at them. In other
areas such as home birth there has been much more comment
recently defending the safety, sense and spectacular success of
4 M ED I CU S March
modern obstetrics.
Elsewhere the anti-vaccination lobbyists and their fellow
travellers, although not having been legally stopped from
spouting their dangerous and deluded ideas, have had major
media condemnation and scrutiny. Overall there has been a
renaissance in rational thought and debate on these issues,
and the primacy of scientific method and scrutiny has been
reinforced.
Secondly, although there have been some very poor bits of
policy recently, such as increasing independent prescribing
rights to any “profession” registered with AHPRA and
allowing pharmacists to prolong prescriptions, there are
signs that this may be the high-water mark for these silly
policies. The arguments martialled against these retrograde
and fragmenting policies were effective in the public arena.
Commentators understood that having eight different
professions potentially prescribing and/or investigating for
one patient without a coordinator is dangerous as well as likely
to be very expensive. As the costs and complications of this
lunacy become apparent, a government desperate for real
savings will pragmatically rein in these stupid programmes.
Finally although no profession or doctor is perfect and
all systems have flaws, you can feel a grudging respect and
acceptance coming through in many commentaries that only
one professional group can look at the whole picture and
guide patients through the many pathways and pitfalls of
modern health care. That professional is almost always the
doctor, and most often the family GP. Because, in the end,
patients and the commentariat do understand they don’t have
the knowledge or skills to pick which professional to go to for
which issue, medication or treatment. They do realise that the
ability, knowledge and evidence base to know your patient well
and holistically, and to diagnose, manage and coordinate care,
only rests with one group. And that is the reason people rightly
trust their doctors. This trust is also why it is so important
for the profession to accept when there are problems (such as
hospital infection rates and the need for routine handwashing),
and to advocate and lead sensible change of our own practices.
It is also one of the reasons we need to be involved in pushing
public health policies that improve overall health.
So amidst all the retrograde spin that passes for policy, and
the fragmentation of care under the guise of “coordinated”
care, sold under the banner of “convenience”, I think the
messages about scientific practice, caring, evidence-based
professionals and the increasing need for the doctor as patient
advocate and coordinator are cutting through. There will still
be dark moments ahead, but in the end patients want the best
health care, and most of them still know where to go to get it!
Business and medicine
go hand in hand
In thousands of cases medical professionals are also small
business people. In many other cases they are big
businesses and even very big enterprises. And
yet Government at all levels often forget medical
professionals when they think of businesses – they
seem to believe the provision of health is controlled
and guided by the Health Department, be it State
or Federal.
It also sometimes seems the Health Department
believes its own publicity and that it alone runs the
whole of health in WA. The reality is the Health
Department has almost no involvement in general
practice, which is the arm of health that most residents
of our great State have contact with.
Yet, think of almost any sector of government, virtually any
department, and you find some interaction with medicine,
especially general practice.
One general practitioner commented this week that
apart from having to provide regular notification of various
diseases, her contact with the Health Department was
virtually zero.
Over the last year, the most regular contact this practitioner
had with government was with the Office of Energy –
mainly relating to the apparently difficult task of providing
a regular power supply. This is electricity that is essential to
ensuring vaccines are kept under the most optimum (that is
refrigerated) conditions!
The second most regular contact with government
authorities, over the past year this particular GP had was with
WA Police and local government to make repeated complaints
related to graffiti on and around her practice.
The AMA (WA) sees and assists members with these sorts
of issues almost every day – and has to deal with a huge range
of departments outside that of health, such as planning, main
roads, industrial relations, training and even little known
bodies such as the Country Housing Authority.
Your Asscociation devotes significant resources to ensuring
government bodies and bureaucrats understand the range of
pressures and challenges faced by our members and that they
consult the Association when contemplating policy changes.
The wide stretch of general medicine means there is a range
of likeminded stakeholders that the AMA works with on a
regular basis. These not only include organisations formed to
tackle particular administration and policy issues, illnesses
or to raise money for further research. Over the years, the
AMA (WA) has also developed close ties with groups such as
the RAC in key areas of common interest like road safety. As
AMA (WA) President, Associate Professor David Mountain
recently said, doctors are at the forefront of public issues such
as road trauma, and should therefore play a major part in
these areas of public debate.
General practice is the key to excellence in Australia’s
world-class health system and must be encouraged and
supported wherever possible.
GPs are not just skilled medical professionals providing
health care – they are also skilled business people, having to
be mindful of business law, insurance, training and education,
consumer rules, and a host of other regulations and legislation.
These days, many GPs regular ask themselves if they are a
doctor or a business owner, a human resources director or a
trainer and teacher.
Your AMA represents general practice across the board
and is increasingly taking a strong stance with government at
all levels. While the AMA meets with the Health Minister on
a regular basis, it also meets with a range of other Ministers
to make sure all departments remember how their decisions
affect the health sector.
With the rapidly changing health environment it has never
been more important to medical professionals for the AMA,
to be involved in administration in Western Australia. It
is important to make sure the medical communities’ voice
continues to be heard.
It is more important than ever for legislators to protect the
health system, especially the role played by general practice.
And as we approach the 2012-13 State and Federal budgets,
the role of the AMA (WA) will be even more important as
the Government makes decisions on the provision of health
across the State. There will also be major decisions made
about workforce issues, as the Government attempts to tackle
the fast growing (and aging) population and the shortage of
medical practitioners to meet demand that already exists.
While the future remains bright for health in Western
Australia, the demands on medical professionals are ever
increasing, especially for GPs. The experts within the AMA
however are always here to provide advocacy and advice.
March ME D I C US 5
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Online images now available for your
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Features:
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• Full patient history
• Priority Reports
• Transfer of images
to other healthcare
practitioners
6 M ED I CU S March
www.perthradclinic.com.au
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If you would like more information or to be connected, please contact:
[email protected]
Leaders in Medical Imaging
(WA)
Clinical
Conference
(WA)
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Conference
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The AMA (WA) Clinical Conference 2012 will take delegates to magnificent
23 October
– 5 November 2012
South America – visiting Argentina, Peru and Chile. Highlights of our 14 night
include:
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March ME D I C US 7
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Relationship Building
for a Better Future
Each year hundreds of Australian doctors work all over the
world; sharing their knowledge and skills while at the same
time learning from their international colleagues. Equally,
members of the international medical community come to our
shores to further develop and share their medical skills.
This sharing is important to Australia being at the forefront
of health care delivery. The establishment of partnering
agreements to help facilitate this process of exchange has
become more commonplace, with medical practitioners from
overseas providing enormous benefits to Australia’s health
care system. This international collegial approach has also
helped establish and maintain Australia’s world-class health
care services.
One such partnering relationship has recently been
established between Peel Health Campus (PHC) and
Frenchay Hospital (FH) at Bristol in the United Kingdom.
PHC, in Mandurah, is working towards establishing
its Emergency Department (ED) as a training centre of
excellence. This, coupled with the ED’s need to meet
growing demographic demands whilst complying with the
requirements of the 4-hour rule, is what underpins the
development of this relationship.
PHC has a 22-bed ED and sees approximately 45,000
patients a year, with a 4-hour rule target of 98% by April 2012.
Demographic growth in the region has brought about a rapid
increase in demand, with the ED experiencing a 10% annual
presentation increase. Establishing PHC as a centre of training
excellence and meeting this growing demographic demand
will require the experience and direction of highly skilled
practitioners; hence the rotation of FH medical professionals
through the ED is an important component of PHC meeting
its desired and required outcomes.
Frenchay Hospital is a regional neurosciences centre that
contains one of the United Kingdom’s leading emergency
medicine facilities, seeing approximately 85,000 patients a
year, with over 97% of patients being treated and discharged,
or admitted to hospital, within four hours of presentation.
PHC will draw on FH’s wealth of experience and knowledge,
with several physicians from Bristol rotating through the ED
over the next few years. The first of these doctors, senior
emergency physician Dr Paul Younge, began at Peel early this
year.
“One of the reasons we set up this rotation is we have a
well-established training and teaching programme in the UK,
which I am heavily involved in. The Peel Campus is growing
rapidly, so along with FACEMS we have expanded the
teaching programme for nurses and doctors,” Dr Younge said.
8 M ED I CU S March
Dr Younge graduated from the University of Southampton
in 1987 and has over 16 years’ experience in emergency
medicine. He has been instrumental in the development of
emergency medicine teaching programs, and has seven years’
experience as a paediatric emergency lead. He is also a college
examiner and lead for regional and local registrar training and
emergency department clinical governance and guidelines.
His vast knowledge and experience means he is well equipped
to assist PCH to become an emergency training center of
excellence, and his involvement in the implementation and
management of the 4-hour target* in the UK will provide
invaluable guidance and insight.
“The 4-hour target can be very stressful,” Dr Younge said.
“But if you asked the simple question, to most emergency
physicians in the UK, as to whether they would want to
get rid of that target, they would say no. They just want it
de-emphasised slightly, in terms of the level at which it has
to be achieved, and also they want lots of other services to
be involved so the spotlight is taken off just the emergency
department, and instead put on the whole hospital.”
“Some of the interventions that made the biggest difference
in the UK were simply lengths of stay. Given the people
who stay longest in hospital are generally older people with
more complex medical requirements, you have to look at a
whole package of social care for them in terms of respite care,
placement, family involvement and welfare-rights advice. One
of the best things that has occurred as a consequence of the
4-hour target is very comprehensive early intervention in the
aged care area,” he said.
Dr Younge’s placement at the PHC is not his first in
Australia; he worked in Queensland about 12 years ago as an
emergency department consultant. At the time Dr Younge
was still relatively new to emergency medicine and wanted
to develop his skills further. “I have a very high regard for
Australasian emergency medicine, so I applied for the position
in Queensland as I knew I would learn a lot in Australia, and I
did,” Dr Younge said.
Dr Younge confesses WA seems very different from
Queensland, although he is not sure whether this is because
he has far more experience now or it is representative of a
changing Australia. “The WA population I am seeing at the
Peel Campus is a lot more multicultural than I experienced
in Queensland, so that is really good. And I am meeting a lot
more indigenous people here than I did there, which is a really
interesting experience for me,” he said.
“Western Australia is a fantastic environment; it is a
wonderful place to be, the climate is great, the people are
friendly, and you have different and specific landscapes. There
is the ocean and so many different areas to visit – I am really
enjoying it! Perth is a lovely city; it has a very open, relaxed
feel,” he said. He and his wife have already enjoyed several of
the Perth Festival events and some of the local beaches. Dr
Younge also hopes to get an opportunity to head south to try
out his long-board on some of WA’s world-class waves.
Unlike his Queensland visit, this time around
Dr Younge is a highly experienced emergency
practitioner and educator. His wealth of
knowledge and experience, along with
that of his FH colleagues who
will visit the campus over the
coming years, will help shape
the future of the PHC in a
positive and productive way.
* 4-hour target is the UK
equivalent of Australia’s
4-hour rule. The term
‘target’ was adopted over
‘rule’ as the four hours was
seen as a benchmark to be
aimed for, not a rule that
was mandatory to achieve.
March ME D I C US 9
Awards Night
AMA (WA) 2012
& CHARITY
GALA DINNER
Saturday 7 July 2012 AT 6.30pm
State Reception Centre
Kings Park
The AMA (WA) will host the 2012 Charity
Gala Dinner and Awards Night in
recognition and support of the Dr YES
Youth Education Sessions. This unforgettable
evening will honour the achievements of outstanding
Western Australians who have made significant
contributions to medicine in WA.
Please join us for a magical
night of celebr ation,
entertainment and prizes.
Tickets are strictly limited.
Book now for this exclusive event by contacting Liz Gray
on 9273 3027 or email [email protected].
AMA Members $195 per head
Corporate Tables (10) $2,050
Dress Black Tie (Optional)
Supporting the
health of Western
Australia’s Youth
through Dr YES
10 M E D I CU S March
AIMS Forms
URGENT INFORMATION
In June 2011 the Health Department provided only 24
hours’ notice before Clinical Incident Investigations using
the Advance Incident Management System (AIMS) in WA
pubic hospitals and health services ceased to be protected by
“qualified privilege” under Commonwealth legislation.
This removal of privilege increases the risks of legal
exposure for practitioners. Under this new regime if a
practitioner provides details on the AIMS form, given they
have lost privilege, this information can now be used by
lawyers against them or other clinicians who were named on
the form.
This created a situation which was contrary to the original
intent of reporting clinical incidents for the purpose of
facilitating quality improvement without fear of recrimination.
The Australian Medical Association (WA) issued advice
that doctors should continue to notify the Health department,
but only via information contained within normal patients
notes. Anything outside of this information should only be
submitted to a process which provides qualified privilege.
The AMA (WA) made urgent representations to the
Director General and Minister for Health about the lack of
consultation. The Association put forward solutions to either
restore privilege or simplify the AIMS form so that it is
purely a notification form, with an alternative process being
developed whereby further details could be considered by
way of a privileged process.
As a result of these representations the Department
agreed to draft a simplified form for consideration by
the AMA (WA). Despite several attempts to have the
Department honour its commitment to draft a simplified
form, it is still dragging its feet. The Department’s
lack of response led to the AMA (WA) undertaking
further discussions with the Director General, but
the Association is still waiting for a response from the
Department.
What has the Department done since the AMA
(WA) first raised concerns about the removal of
qualified privilege?
It seems, nothing.
The AMA (WA) reiterates that there has been no
consultation. All the Department has done is rebadge
the AIMS form, deleted the reference to privilege
and changed its colour. The Department has failed
to restore any form of qualified privilege, including
the transferring of this provision of detail to a
privileged process.
Whilst the Department seeks to impose
timeframes on clinicians in areas such as the
4-hour rule, its tardiness and failure to follow
through on commitments is becoming a matter
of increasing concern.
I
ndustrial
As a result of the Department having not satisfactorily
advanced this issue, the AMA (WA) now finds it necessary to
reiterate the previous advice provided by both the Association
and MDA National.
The AMA (WA) and MDA National encourages you to
COMPLETE PAGE ONE of the Clinical Incident (AIMS)
form; i.e. provide details notifying that an incident has
occurred, the name of the patient and clinical details of the
incident.
However the AMA (WA) and MDA National STRONGLY
CAUTION YOU AGAINST COMPLETING PAGE
2 ONWARDS in the absence of advice from either the
AMA (WA) or your Medical Defence Organisation, as the
information you provide could potentially be utilised against
you in legal proceedings. If practitioners have any questions
regarding the above advice or the AIMS form please contact
the AMA (WA) or your Medical Defence Organisation.
The AMA (WA) can be reached on 9273 3000 or via
[email protected].
Do not be deceived by a “wolf in sheep’s clothing” –
changing the colour of the form and removing the reference
to qualified privilege does not provide practitioners with any
comfort or protection.
The full Industrial Update in relation to this issue can be downloaded
from www.amawa.com.au/WorkplaceRelations/IndustrialUpdate.aspx
or you can contact AMA (WA) on 08 9273 3000.
March ME D I C US 11
Intern
Cocktail Party
The AMA (WA) Intern Cocktail Party has not only become
one of the most popular social events organised by the
Association, it is almost a rite of passage.
With more than 200 interns – the largest ever – along with
dozens of senior members of the medical profession, the
Chief Medical Officer and Health Minister Kim Hames, the
2012 AMA (WA) Intern Cocktail Party held in February
provided the interns with the chance to share their new work
experiences over good food and wine.
As the sun set over the popular Matilda Bay Restaurant,
AMA (WA) President A/Prof David Mountain welcomed the
interns to the profession and reminded them of the benefits
not just of joining their AMA but also of becoming active
within it.
They would find their new careers stimulating, exciting and
rewarding, as well as, at times, extremely challenging, A/Prof
Mountain said.
There would be numerous occasions when the services
and special skills of the AMA (WA) would be needed for
any number of issues, including dealing with the interesting
salary calculations sometimes made by the Health Corporate
Network.
The Co-Chair, Doctors in Training Committee, Dr
Cassandra Host, provided the audience with a guide to being
an intern in an address which combined humour with reality
to provide a real-world view of how to handle the demands of
being an intern in a busy hospital - including such key aspects
as looking after yourself and getting enough sleep.
The crowd also heard an address from Rhodes Scholar and
researcher Dr Aron Chakera, who used the well-known book
House of God as an example of the sort of working experience
they might – or might not – actually see.
Special guest speaker Health Minister Kim Hames took the
opportunity to dispense with his usual departmental speech to
provide a Sherlock Holmes moment.
First putting up on screen a grizzly looking piece of
uncooked flesh, Dr Hames offered a bottle of wine to the first
intern who could accurately identify what it was (a benign
tumour). That mystery solved, Dr Hames then asked where it
had come from (his own back).
Like previous intern cocktail functions, the door prizes
garnered much attention, with a number of lucky interns
leaving the function carrying significant prizes worthy of a
good night.
The Sterling Silver Cultured Australian South Sea Pearl
Bracelet valued at $350 was won by Dr Natalia Magana, while
the Sterling Silver Mother of Pearl Cufflinks valued at $175
was won by Dr Ramin Ourangui. Both major prizes were
donated by Willie Creek Pearls.
AMA (WA) INTERN COCKTAIL PARTY 2012 DOOR PRIZE
Major Prize Female – Sterling Silver Cultured
Australian South Sea Pearl Bracelet (valued at $350)
Donated by Willie Creek Pearls
Winner: NATALIA MAGANA
Overnight Accommodation in a
Deluxe King Room at Pan Pacific
Donated by Pan Pacific
Winner: ERASMIA CHRISTOU
Major Prize – Male – Sterling Silver White
Mother of Pearl Cufflinks (valued at $175)
Donated by Willie Creek Pearls
Winner: RAMIN OURANGUI
$200 Coles Myer Voucher
Donated by Smart Salary
Winner: KELLY HOUWEN
$250 Gift Voucher
Donated by Maurice Meade Hair Salon
Winner: ALEXANDRA MASLEN
Littman Classic II SE Stethoscope
Donated by AMA Medical Products
Winner: ANNIKA MASCARENHAS
12 M E D I CU S March
Two Bottles of Premium Wine
Donated by AMA (WA)
Winner: KEVIN CHUNG
Three Movie Vouchers, each of which contains
double passes to three separate movies
Winner: NISHANT HEMANTH DAVIDOSS
Winner: RAJ SUBRAMANIAM
Winner: AMBER LOUW
1. Dr Jessica Bradley and
Dr Justin Hii
2. Dr Bernard Pearn-Rowe and
Dr Michael Gannon
3. Dr Kongposh Koul and
Dr Shevya Tiwari
4. Dr David Russell-Weisz,
Dr Robyn Lawrence and
Dr Hadley Markus
5. Dr Katherine Vautin, Dr Claire
Savage and Dr Chad Green
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
6. Dr Stephanie Lam, Dr Megan
Nettleton and Dr Katherine
Crerie
7. Dr Yee Yeo, Dr Beatrice Chin,
Dr Joanne Chew and Dr Zi Ng
8. Prof Gavin Frost, Dr Nicholas
Young, Dr Chris Wilson and
Dr Adrian Tarca
9. Dr Kelly Houwen, Dr Robert
Henderson and Dr Shannon
King
10.Dr Simon Bradbeer and
Dr Falk Reinholz
11.Prof Michael Quinlan and
Dr Rod Moore
12.Dr Rohen Skiba and
Dr Kim Lake
13.Dr Tiki Ewing and
Dr James Murtagh
14.Dr Stephanie Bishop, Dr Adam
Boyt and daughter Elizabeth
15.Minister Dr Kim Hames
16.Dr Sarbroop Dhillon
17.Dr Simon Towler and Dr Ruth
Blackham
18.Dr Ramin Ourangui and
Dr Cassandra Host
19.Dr Aron Chakera
20.Dr Raj Subramaniam, Dr Amber
Louw, Dr Cassandra Host,
Dr Nishant Davidoss
March ME D I C US 13
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M E D I CU S March
Health
Department
Bureaucracy
Has it gone too far?
The AMA (WA) is becoming increasingly concerned about
the Department of Health, on the one hand for its inertia and
its failures to respond to issues in a timely manner, and on the
other hand with its increasing bureaucracy.
The approach to alleged complaints against doctors also
appears to be increasingly punitive rather than performance
management orientated. The propensity to allege misconduct,
commence investigations and report to AHPRA, rather
than manage issues predicated in the absence of prima facie
evidence on the presumption of innocence, almost reverses the
onus of proof. Have they gone too far?
Years ago, the health system was supported by
administrators whose role was to assist clinicians, doctors
and nurses to care for patients by ensuring the requisite
resources were in place and supporting their individual
institutions in striving for excellence.
Later “administrators” evolved into “managers” with
an increased focus on budget accountability. Slowly, but
seemingly inexorably, following experiments in the 1990s
with “managed competition” through purchase/provider
mechanisms seeking to utilise Diagnostic Related Groups – an
activity based funding mechanism – through the concerningly
named Council Of Purchasers (COPs). They strove to
increase competition between institutions for funding on
the premise that this would decrease costs. The “managed
competition” experiment known as Funder Owner Purchase
Provider (FOPP) flopped and historical funding returned.
However, centralised management then increased, with
claims of duplication contributing to the sacking of Boards,
the establishment of the Metropolitan Health Service single
Board, and what became known as the 2020 push – a shortsighted endeavour aimed at “breaking down silos” and
treating institutions as factories – a philosophy that appears to
continue today.
Most recently a number of members have remarked upon
the seemingly symbolic extension of this push with the change
of letterheads within the health sector. The institution logos
have been removed and replaced with generic administrative
Health Department letterheads.
In parallel with this push, bureaucratic rules have flourished
and to some extent stultified the system by increasing
compliance costs and reducing efficiency. These take the form
of policies by the dozen, often developed without consultation
and in some cases impractical, such as the requirement
for various police and working-with-children clearance
certificates, notwithstanding unconditional registration, the
mandatory completion of various courses and mandatory
reporting.
No one would argue that some of these developments are
appropriate, but again, have they gone too far? Certainly,
once-proud institutions which attracted the brightest
and driven to secure prestigious appointments at tertiary
institutions now have difficulty in attracting and retaining
key staff. Many doctors now see them as factories and choose
to practice in the private sector, free from bureaucratic
imposition and frustrations.
A turning point appears to have been the problems in
Bundaberg with “Doctor Death” fuelling a “managerialism”
overshoot of more and increasing bureaucracy without
evidence of a return on resources allocation that could
otherwise have been directed to patient care.
Does the Department value add, increase efficiency and
reduce cost, or has the system overreacted and been wrapped
up in costly red tape?
Rather than dealing with issues internally through
performance management, matters which years ago would
have been dealt with through other mechanisms and would
never have been sent to Medical Boards are being referred
as a matter of course, with investigation alleging misconduct
at the outset. Such actions raise a number of concerns: they
consume countless resources, often cause unnecessary
continued on page 14
March ME D I C US 15
continued from page 13
emotional distress and damage to reputations and increase
costs to the system, often with no discernible benefit, and
reduce attraction /retention. Management process issues
without first ascertaining whether the allegations are serious
or exercising judgement regarding the right method to address
the particular issue. Recent examples of such references
include alleged conduct issues, which have little to do with
clinical standards or professional conduct but are referred to
APHRA before prima facie judgements have been made. Even
trainees, who need guidance and performance management
– not presumptions of guilt – lack support and have simply
been reported rather than, after appropriate investigation,
counselled and provided with remedial support and guidance.
At the same time, bureaucrats who are not registered, or
indeed even certified, whilst extolling the virtues of the 4-hour
rule rarely respond within even four weeks and sometimes
months. They remain unaccountable.
Is it time to re-think?
Is it too late to try to recalibrate so-called management
to ensure that it is supportive of patient care and the
underpinning key issues? Rather than taking a punitive
approach, could issues be managed internally where
appropriate and only referred when a prima facie case has
established breaches of legislative obligation.
Some of the Health Department’s policies assert the
benefits of performance management and confirm it is
designed to be a positive process of reviewing unsatisfactory
conduct and remedying that without reference to higher
authorities who should rightly focus on cases of clinical
negligence or conduct that is adverse to patient care. But they
do not practice what they preach. For example, the reference
of a case to APHRA/the Medical Board should only be made
after due enquiry, without double jeopardy, where there is a
reasonable concern that the particular conduct constitutes
substantial departure from professional standards. Otherwise,
internal performance management processes should apply,
with a presumption that the intent of health care professionals
is to do good and that conduct which is not related to patient
care should not be subject to any greater discipline than
those which apply to others in society, including bureaucrats.
Perhaps they can also provide additional support and address
matters in a more timely manner – What do you think?
New members
The AMA (WA) welcomes new members who joined during January
Matthew Aldred
Tammy Bennetts
Julia Bistrow
William Blakeney
Phoebe Brownell
Simon Byrne
Joanne Chew
Beatrice Chin
Ariadna Cuiesdean
Kristelle Day
Iyad Dayoub
Paris Dove
Miles Earl
Jodi Eatt
Omar El-Domeiri
Jan-Marie Fonseca
Amanda Gee
Robert Graydon
Gordon Hay
Kai Hellberg
Robert Henderson
Alexandra Hofer
Nathan James
Shital Julania
Lincoln Kappikulam
Pauliah
Kongposh Koul
Peter Leck
Amber Louw
Natalia Magana
Paras Malik
Annika Mascarenhas
Michael Mbaogu
Andrea Meehan
Suzanne Nenke
Megan Nettleton
Debbie Olsson-White
Simon Papaelias
Jake Parker
Maya Rajagopalan
Habeeba Rockley
Tanya Ronaldson
Peter Sarkis
Syed K H Shah
Ajay Sharma
Aris Siafarikas
Benedict Tan
James Teow
Yoshei Tien
Kelly Valentin
Ross Vander Wal
Matthew Vandy
Anand Venkataraman
Simon Wall
Amanda Watts
Timothy Witting
Courtenay Wood
Wen-Chan Yeow
The winners of the 2012 early subscription payment prizes were:
Dr Dhanvee Kandadai – Apple iPad 2 (64GB WiFi)
Dr Steven Ward – Apple iPad 2 (64GB WiFi)
Dr Andrew Davies – $2,000 travel voucher
16 M E D I CU S March
Osborne Park Volkswagen
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March ME D I C US 17
*The discount price is only on selected models and does not include options and accessories. Cannot be used in conjunction with any other offers . Required to be an AMA
member for at least 3 months prior to delivery.
R
eview
Claremont General Practice
book review by Dr Janice Bell
Stories like this don’t come along very often. The absolute
joy of this recounting lies in its innocent and microcosmic
version of the history of general practice – and it is all there,
all of it. Oh, for the gift of hindsight; oh, for the wisdom of
foresight! It pains one to read and, knowing as we do the
realistic and macrocosmic version, the end is predictable. There isn’t a single major shift in government community
health policy whose profound and often disturbing impact
isn’t illustrated with archaeological precision in this delightful
narrative. Over its 115 years, Claremont General Practice flew
bravely in the face of this succession of government-driven
upheavals and concomitant business pressures, and yet held
to the singular priority of meeting the health needs of its
community. In the early years, the Claremont general practitioners
proceeded the policy makers. They were the first rural
generalists, though they didn’t call themselves that. They
were, simply, general practitioners. The Claremont general
practitioners were surgeons, anaesthetics, psychiatrists,
hypnotists, sports physicians, educators and gynaecologists. Claremont General Practice was a team effort long before
anyone made a point of it, without bureaucratic team plans
and complicated funding models. Everyone worked with the
same patient-centred intent, long before the rhetoric. There
was innovation, too; the practical kind that comes only from
resilience and passion and the willingness to learn. Claremont
General Practice fostered and mentored successive generations
of multi-skilled, urban general practitioners, imparting a
courageous openness to the new and confronting. Long after others baulked at the cost and inconvenience, the
practice continued to provide home visits and hospital visits
both private and public (though less commonly on horseback).
Local specialists came to the practice and saw patients
collaboratively – and we are still waiting for the government
policy on that. But the practice also watched over the disintegration of the
previously seamless community-to-hospital-to-community
patient journey and the loss of continuity of care as workforce
shortages (yes, even in leafy Claremont) bit hard, and there
just weren’t enough hours in the day to go around. No wonder
we cautiously welcomed locums, after hours clinics and even
our own version of a general practice super clinic! (It failed
miserably, and you can read all about it in this telling account.
It is eerily familiar territory).
Not all change was benign. Private general practice is a
business, however we feel about that. While the authors argue
for a town-gown divide as the coup de grace, perhaps it is better
portrayed as a head–heart schism. In the end, the numbers
just didn’t add up. Fundamentally, though, this is a story about the people
whose lives unfolded in and around this historic practice. As
18 M E D I CU S March
The Medical Practice at 328 Stirling Highway,
Claremont From 1896–2011
Authors Dr Peter Tunbridge and Dr Max Kamien
a registrar I was mentored by Max Kamien, who was strong
and generous enough to teach from his mistakes file, and
then worked from the Peter Tunbridge room, wherein I swear
the space told stories of byegone times that comforted on
particularly challenging days. More recently, June Foulds, one of the many earlier staff
who returned to say goodbye at this book’s launch, wrote to
me: “I worked at the Claremont Medical Centre 328 Stirling
Highway Claremont many many years ago – my daughter
is now 24 years of age and she was known as the ‘328
baby’. Being invited to the book launch was like a journey
back in time. Yes, the building had begun to look terribly
neglected and sad, but within those walls were so many
memories, good and bad. It simply won’t be the same, when
one is stuck in traffic just before Bay View Terrace lights, to
look at that site and see an ugly, too tall high rise – progress
yeah, yeah.” I am sure that the spirit of Claremont General Practice,
clearer still for being released from its rent and taxes and profit
margin shackles, will always remind us all about what really
matters, even if it breeds in us a naive hope for our future. We will protect
your professional
reputation and ours.
We know that you value financial responsibility from your insurer.
Our Members tell us that financial responsibility is one of the most important aspects
of their Membership.
At MDA National, we are committed to you for the long term and in the event of a claim
will support you the way that you would expect.
We Listen to Our Members.
Call us today on
1800 011 255
We responsibly manage our finances for the benefit of Members who seek security from
a stable insurer.
MDA National is a clear choice when you value expertise, trust and
a good reputation.
Insurance products are underwritten by MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417 AFS Licence No. 238073, a wholly owned subsidiary of The Medical
Defence Association of Western Australia (Incorporated) ARBN 055 801 771, trading as MDA National. The liability of Members is limited. With limited exceptions they are available only to
MDA National Members. Before making a decision to buy or hold any products issued by MDA National Insurance, please consider your own circumstances, readMarch
the Product Disclosure
Statement
19
and Policy wording available at www.mdanational.com.au. DIP039
ME D I C US
O
pinion
GPs and Emergency Planning
why are we ignored?
by Dr Steve Wilson Chair, AMA (WA) Council of General Practice
For a full two years or more we have had a standing item
on the AMA Federal Council of General Practice agenda:
to examine the role of general practitioners in large-scale
emergencies. I would like to acknowledge my good friend
and AMACGP convenor Professor Bernard Pearn-Rowe for
championing this cause so strongly and the AMA Secretariat
(from whom I have borrowed heavily in this article) for
profiling such an important issue.
AMACGP had previously produced a discussion paper
entitled “General Practice – A resource in disasters with mass
casualties,” and this paper and the issue were discussed at the
Australian Health Protection Committee (AHPC) meeting
on 10 August last year. A second CGP paper was worked up,
and AMACGP has received a formal response from AHPC
chair Professor Chris Baggoley, Australian Government Chief
Medical Officer. Sadly their response was fairly general and
lacked any new commitments to supporting the role of GPs in
emergency planning. Each State/Territory Government had
to agree on any response, hence there can be no surprise at its
general and non-committal nature, but it was at least good to
see the role of GPs in emergency planning being discussed at
such a high level.
Last year the World Medical Association released the
“Declaration of Montevideo on Disaster Preparedness and
Medical Response,” highlighting the international pressures
and issues affecting disaster responses around the world and
noting that much work needs to be done to ensure doctors are
right at the forefront of planning and responding to natural
and human-made disasters.
AMACGP’s papers have focused on the needs of GP
practices in disaster-affected areas in the immediate, twoweek aftermath of a disaster situation. The papers highlight
key issues including pre-disaster planning; a temporary GP
location in case of emergency; what needs to happen postdisaster/emergency; and the assistance which needs to be
provided by governments.
We GPs have demonstrated in recent natural disasters,
such as the Black Saturday fires and the cyclones and flooding
across the Eastern States, that we have a critical role in
assisting communities in disaster situations, and that we are
willing, with support, to fulfil that role. In addition, GPs could
be involved in interstate and even international deployments
to assist in providing medical care “on the ground” to disaster
victims, for example, through the SES, Army Reserve
involvement or as volunteers if utter demand required it.
Planning for disaster situations that involve mass casualties is
incomplete and substandard if it does not consider and provide
20 M E D I CU S March
for how GPs could effectively contribute in any response. Our
roles could include triage of victims, provision of primary
treatments and supervision, and administering first aid.
We know that poor triage, such as that provided in the Bali
bombings, adversely impacts on the survival rates of victims.
Those GPs who have undertaken specific training in this area,
such as the Major Incident Medical Management certificate,
could and should be included in medical response teams.
Off-site GPs can support emergency responses by providing
medical services for the walking wounded, either within their
practices or at designated venues (like evacuation centres or
minor injury treatment centres), backfilling hospital positions,
operating vaccination clinics, major surgical asissting,
supporting disaster-affected GPs to keep their practices open
and providing mental health support, acutely and ongoing.
In short we GPs are a fantastic medical resource that, with
proper resources and planning, can be mobilised quickly and
can make a significant contribution in disaster situations.
Also, as seen in the Queensland and Victoria floods, General
Practices can themselves be affected and GPs need support
to keep practising wherever possible. In addition we need
flexibility with provider numbers, the use of temporary
locations to practise, and access to services where patients have
lost Medicare/DVA cards, and access to essential medicines to
ensure the public receive the care they need from a GP during
and in the immediate aftermath of an emergency or disaster.
Currently each State and Territory has response plans
which are ad hoc and largely ignore the role of the GPs, some
being better than others.
The AMA understands that each State and Territory
in Australia (bar the ACT) operates Australian Medical
Assistance Teams (AUSMATs), which are deployable
in disaster/emergency situations. We believe that the
Commonwealth and State and Territory governments are
collaborating on the development of a nationally agreed set of
protocols and guidelines for the preparation, pre-deployment,
deployment and post-deployment of AUSMATs nationally
and internationally. Althoigh, understanding of the role of
AUSMATs is very variable by all doctors.
However AUSMATs alone is not enough and is not
applicable to all medical practitioners. Each State and
Territory plan should make provision for input from GPs at
every level of response as a minimum requirement of planning
for disasters. At our AMAMCGP meeting in Canberra on
17 and 18 February 2012 there was broad support for these
papers to be now fully scoped to completion into AMA
Position Statements. I look forward very much to those final
documents and will keep you informed.
I know MDA National
will support me.
We know that you expect strong support during a claim.
Our Members tell us that our support and assistance if they receive a claim is one
of the most important aspects of their Membership.
At MDA National, our Claims Managers are reputable experts in the medico-legal
field who understand that claims and investigations are more than just a legal process;
it’s also about the medicine.
We Listen to Our Members.
Call us today on
1800 011 255
MDA National is a clear choice when you value expertise,
trust and a good reputation.
Insurance products are underwritten by MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417 AFS Licence No. 238073, a wholly owned subsidiary of The Medical
Defence Association of Western Australia (Incorporated) ARBN 055 801 771, trading as MDA National. The liability of Members is limited. With limited exceptions they are available only to
MDA National Members. Before making a decision to buy or hold any products issued by MDA National Insurance, please consider your own circumstances, readMarch
the Product Disclosure
Statement
21
and Policy wording available at www.mdanational.com.au. DIP037
ME D I C US
WE SAVE DOCTORS
UP
TO 0.75%
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NEW HOME LOANS
WE
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UP TO 0.75% PA ON NEW HOME LOANS
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Commonwealth Bank of Australia ABN 48 123 123 124. Qualification Criteria To be eligible for the AMA offer within Wealth Package AMA(WA) you must: 1) be a
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Commonwealth Bank of Australia ABN 48 123 123 124. Qualification Criteria To be eligible for the AMA offer within Wealth Package AMA(WA) you must: 1) be a
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of your household income to a Viridian Line of Credit, Line of Credit or transaction account with the Bank; 4) pay an annual fee, currently $350 (debited to
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a Viridian
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to
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As this information
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prepared
without taking
of your
objectives,
situation
or needs,
youPackage
should,AMA(WA)
before acting
on this infornominal Commonwealth
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credit
card
or Commonwealth
bankaccount
transaction
account).
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of Wealth
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objectives,
financial
situation
or needs,
before
acting on this information, consider its appropriateness to your circumstances. Applications for finance are subject to normal credit approval. Fees and charges are payable.
22 M E D I CU S March
O
pinion
Junior Doctors...
Training to be a medical specialist
is a long apprenticeship
by Dr Cassandra Host Co-Chair, Doctors in Training Committee
or overseas to complete their training
requirements. It is important that
these hard-earned entitlements
are carried over, despite a brief
‘leave of absence’ to complete
The
our training. Fortunately, our
heterogeneity
industrial agreement allows
of our health
for a “break” in employment
service allows
to “undertake a period of
for an enhanced
study or employment interstate
training
or overseas to further their
experience
professional skills.” Unfortunately
this does not specifically stipulate
that time spent in WA at private
hospitals is or is not included. Many DiTs
are now facing losing all accrued entitlements
as they leave the Metropolitan Health Service to
spend brief time with another organisation, even though they
intend to return and provide consultant services to the public
sector in the future. This can be a disheartening experience.
We are fortunate to have a training system that
encompasses a large cross-section of society with a variety of
training jobs. As our workforce and population demands grow,
it is likely that increasingly large portions of our training will
be divided across the public and private sectors. It is important
to foster a relationship that encourages consultants to return
to our public hospitals. Current management processes view
the junior doctor as a “human resource,” with minimal good
will without contingency. It is mutually beneficial for the
Health Department to foster an environment that encourages
the junior doctor to feel a valued and appreciated part of the
health team. Doctors in training need to be empowered to
protect their entitlements, and these should be honoured.
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Doctors in training give many years of service to the public
health sector. We have been sent from Port Hedland to Albany,
to Geraldton and Kalgoorlie, to Broome and Bunbury, from
Joondalup to Rockingham, Hollywood to Swan Districts (and
there are many more). We are rotated everywhere, sometimes
at our request, sometimes for the benefit of the employer. All
for the purpose of our training.
The heterogeneity of our health service allows for an
enhanced training experience, and until recent times our
training and experience has largely been under the one
umbrella – WA Department of Health.
With our increasing population and health demands, we
have seen an enormous growth in our private health sector and
private–public partnerships. An increased number of medical
graduates has created an environment for expanded training
in the private sector.
This has meant increased secondments, most notably
Joondalup Health Campus, which now is the primary
employer to many RMOs and provides a great training
experience. In the future it is likely a similar opportunity will
arise in the St John of God private–public partnership at the
new Midland Campus.
Training to be a medical specialist is a long apprenticeship
to ensure the production of highly skilled doctors that are
judged among the best in the world. The minimum time
for a doctor to be selected into a hospital-based specialist
program and to complete their training is around seven years,
with many doctors taking closer to ten. During this time,
many hours of sick leave and accrual of long-service leave
occurs. However, employee beware! Your loyalty may not be
recognised.
In that training period, it is likely that most DiTs will have
to gain experience elsewhere, at a private institution, interstate
PREVENTIVE
PRIMARY HEALTH CARE
By Dr Patrick Shanahan Oral Health Consultant
Background
Dentists are trained to treat those who have serious medical
conditions. Often prior to a medical procedure, the GP will
refer the patient to his own dentist, or a public dental clinic,
and request them to be rendered dentally fit.
This is “medically necessary” dental care to prevent
expected infections from dental bacteria. This is preventive
medicine, not restorative dentistry.
The US made this distinction when it adopted Medicare
dental legislation in 1995. A US Institute of Health Study
found treating dental infections prior to medical treatment
saved many times more than it cost. The US legislation
specified exactly what medical conditions would be covered.
There had to be clinical or radiographic evidence of dental
infection. It excluded ALL restorative dentistry. This position
has never changed.
The Australian Chronic Disease Dental Scheme (CDDS)
introduced by the Howard Government in 2004 did not
specify the medical conditions or require clinical evidence of
dental infection, and it included
comprehensive restorative
dentistry. The CDDS did
not target national health
priority groups – the
indigenous, the frail
aged, the young disabled, and mental health populations, and
was not means tested.
Medicare
Prior to Medicare legislation (1975), 70% of the population
had private health insurance, which included dental.
Premiums and health expenditures were partly offset through
the taxation system. The uninsured presented a long standing
problem. Medicare was intended to fix this, but to do this it
had to remove all the above taxation benefits. The uninsured
got medical care, but not dental care. This was a State
responsibility. The exclusion of dental from health policy has
carried with a huge economic impost. Consider this: recently
a patient presented at Oral Health Centre of Western Australia
(OHCWA) public dental clinic for an urgent dental extraction.
It would cost $18, which he didn’t have. It would have cost
OHCWA $136, of which he would have contributed $18.
He didn’t have the tooth extracted. Two weeks later he was
admitted to hospital with heart complications at a daily cost
of $1,428. The eventual cost was $25,000! How often has this
happened over the past 36 years? How much has it cost?
Medically Necessary Dental Care
The Chronic Disease Dental Scheme (CDDS) introduced by
the Howard Government in 2004 was intended to fix this. But
since gaining office in 2007, Labor governments have tried to
remove it and replace it with what has previously failed.
In operation, the CDDS has cost many times more than it
should. The GP refers the eligible patient directly to a dentist
for a dental treatment plan. The GP is responsible for medical
outcomes, so they should be in a position to prescribe what
dental treatment is required, and if Medicare is to pay for the
dental treatment, that treatment should be qualified by those
experienced in oral and health care, not exclusively dentistry.
This is not happening, and until it does, it will not achieve its
intended outcomes.
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STATEResearch
Better Brain Health
A pioneering therapy that uses magnetic
pulses to stimulate the brain to treat
conditions such as Parkinson’s disease,
depression, schizophrenia, epilepsy and
stroke is now better understood due to
researchers at the University of WA and
the Université Pierre et Marie Curie in
France.
Research Associate Professor Jennifer
Rodger from UWA’s School of Animal
Biology said she and her team tested the
therapy. “Our work demonstrated for
the first time that pulsed magnetic fields
promote changes in brain chemicals that
correct abnormal brain connections,
resulting in improved behaviour and
brain function.”
NEWDevice
World’s First Completely
Invisible, Extended-Wear
Hearing Aid
The world’s first completely invisible
hearing aid is now available in Perth.
As featured recently on
Channel 9’s Today show,
Lyric is worn around the
clock for up to four months
at a time, allowing users to
shower, sleep, swim, talk
on the phone and even
listen to headphones.
There are no batteries
to change, no daily
cleaning routine and
no daily insertion or
removal is required.
AMAFederal
AMA TAKES ACTION TO
PREVENT BULLYING
In recognition of the National Day of Action
Against Bullying and Violence, on Friday
16 March 2012 the AMA released two new
practical tools to help raise awareness of
child and adolescent bullying and its health
effects, and to provide sound advice about
who people can turn to for help.
A brochure for older children and
adolescents, Bullying: What you need to know,
explains what bullying is, provides specific
information on cyber bullying, and gives
advice about how to deal with being bullied and how to identify
bullying behaviours.
A second brochure, AMA Guidance for Doctors on Childhood Bullying, contains a
childhood bullying fact sheet for use by medical professionals who are interested to
know more about childhood bullying and its health impacts.
MedicalSERVICES
New Palliative Care Service for
Peel Health Campus
In recognition of the growing
population and increased need for
palliative care services in the Peel
region, Peel Health Campus (PHC)
in collaboration with Murray Medical
Centre (MMC) Mandurah has recently
appointed a dedicated resource to
oversee this vital community service.
Dr Aji-Bola Oki is the new palliative
care registrar at PHC, who will provide
a consultative service to patients
requiring palliative care and assist in
the education of medical and nursing
staff at the Mandurah-based hospital.
STATEGovernment
WA’s Chief Medical Officer
Resigns
Dr Simon Towler, who was appointed
to the position of CMO in 2005, will
step down in April 2012. At this time
Dr Towler will return full time to
his clinical role as an intensive care
specialist at Royal Perth Hospital.
“As CMO, Dr Towler has been a
strong and unrelenting advocate for
health reform. He
has been a visionary
whose legacy
will last for many
decades,” AMA
(WA) President
A/Prof David
Mountain said.
STATEInfrastructure
Major Expansion Unveiled at Joondalup Health Campus
WA Health Minister Dr Kim Hames officially opened the new theatre block at Joondalup
Health Campus on Thursday 8 March 2012.
A major milestone in the $393m expansion of the hospital, the block includes 12 operating
theatres, a 9-bed intensive care unit, a 6-bed high-dependency unit and a 10-bed coronary
care unit.
The new operating theatres are among the most advanced in Australia. They include four
state-of-the-art iSuites with video and touch-screen technology to enable surgeons to view
and capture images from inside the body while they operate.
The redevelopment of Joondalup Health Campus is a key part of the State Government’s
strategy to grow hospital facilities and reduce pressure on tertiary hospitals by expanding
local general hospitals.
“The last major milestone of the expansion of Joondalup Health Campus is on course for
completion in early 2013,” the Minister said. “At that point, additional inpatient beds will
become available for public patients.
“These additional beds will allow us to grow activity at the hospital so that most patients
from Joondalup and surrounds can receive care close to home rather than at a city hospital.”
March ME D I C US 27
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M E D I CU S March
Journey to GP training
Insights from junior doctor, Dr Yvette Bruce, on her GP
training application experience
“I like the concept of continuity of care and of being involved ‘from
birth until death.’ I wanted to be able to care for the entire family.
And I wanted to be able to do it in about 40 hours per week!!”
I’m not young. In fact, to many of you, I may be considered
“old”. I’ll be 48 years old by the time this goes to print. I have
three grown-up children 22, 19 and 17 years of age. In many
ways, my age was a major contributing factor in my decision to
enter into a career in general practice. I did not want to spend
the limited time (and energy) I have left in my career trying to
reach an elusive consultancy position. But this was by no means
my only consideration. I like the concept of continuity of care
and of being involved “from birth until death.” I wanted to be
able to care for the entire family. And I wanted to be able to do it
in about 40 hours per week!!
GP Careers Information Session
GP Careers Information Sessions will be held at the main
tertiary hospitals and regional hospitals from February
through to April.
Come and hear first-hand from WAGPET Medical Educators
and GP registrars about the GP training programs and their
experiences.
For session details visit www.wagpet.com.au or email
[email protected].
The length of the General Practice training program is very
appealing – it’s only three years; four if you’d like to train rurally.
This is relatively brief when compared with almost all other
training programs. The program is also flexible, allowing you
to take leave to have children (not something I will be doing,
obviously!), or to specialise in different areas like sports medicine,
palliative care or paediatrics, to name a few.
I applied for the Australian General Practice Training
(AGPT) program in my intern year as I had made up my mind
about general practice early in my medical studies. My father was
a general practitioner, so I had a fair idea about what it involved
Going Places Network
A junior doctor network exploring the world of general
practice during hospital training. Information on network
events, hospital GP Ambassadors, publications and online
resources available at www.gpaustralia.org.au.
and I loved my general practice placement as a student. I could
see no benefit in spending more time than necessary in the
hospital system.
When I applied for general practice training, I also applied for
a Prevocational General Practice Placement Program (PGPPP)
rotation for my PGY2 year. PGPPP gives you the opportunity to
spend time in general practice as one of your hospital rotations.
I will be working across Currambine Family Practice and the
Emergency Department at Joondalup Health Campus.
Following my application for AGPT, I came to WA General
Practice Education and Training (WAGPET), who delivers
the program in WA, for a Multiple Mini Interview (MMI)
and Situational Judgement Test (SJT) to be assessed for
Important dates
AGPT applications
Applications open 16 April and close 18 May.
To apply visit www.agpt.com.au.
PGPPP applications
Intern applications open 7 May and close 8 June.
RMO applications open 11 June and close 13 July.
To apply: nominate a WAGPET Prevocational General
Practice Placement on your hospital employment
application form.
the program. I felt fairly well prepared after attending an
information evening organised by the Going Places Network.
The event had speakers from WAGPET and current GP
registrars, at various levels of training. They explained what
to expect, and although they could not give any real exam
questions or interview scenarios, it was helpful to understand
the type of format used.
Despite much preparation, it was still a daunting and
challenging process. Many of the people who sat the exam with
me failed to complete all the questions in the allocated time.
My advice is: keep an eye on the clock – there is a lot of reading.
Luckily for those applying this year, the time allocated for the
SJT has increased from 1.5 hours to 2 hours.
The interviews were relatively straightforward – read the
general practice guidebook available at www.agpt.com.au
and you’ll have an idea of what the interviewers are looking
for. Always have some clinical scenarios from your real life
experience available about teamwork, problem solving, risk
Got questions?
WAGPET can help you with any questions you may have
about AGPT, PGPPP, GP Careers Information Session and
the Going Places Network. Visit www.wagpet.com.au or
email [email protected].
management; the usual situations that arise in a medical
environment.
It is important to think about the rotations that you will
need to cover in PGY2 if you are serious about completing
general practice training relatively quickly. Many people enjoy
their hospital time and are not in a hurry to move into private
practice. However, if you wish to limit your after-hours work
and begin a more “normal” lifestyle in a timely manner, like
me, it is necessary to complete paediatrics in PGY2. There are
a limited number of hospitals that provide this option. This
year I am employed by Joondalup Health Campus with both
paediatrics and obstetrics and gynaecology rotations. This
means I will be able to move straight into the general practice
setting at the beginning of PGY3.
March ME D I C US 29
O
pinion
Two’s company, but…
Curtin University Medical School
by Benjamin Host President, Western Australian Medical Students’ Society
Lately, there has been much talk about Curtin University’s
proposal to open Western Australia’s third medical school.
Recent weeks have seen promotional and advertising material
supporting the planned school alongside articles of criticism
and opposition to the idea. Social media and national media
coverage means that this debate has had a broad reach and is
not confined to WA. For some, this recent publicity may be
the first they have heard of the Curtin proposition, however,
this push to create a Curtin University
Faculty of Medicine is not a recent
occurrence.
Since 2009, Curtin
University has been
planning to introduce a
five-year undergraduate
Over the past
medical degree and
greatly increase the
decade, the number
number of medical
of medical student
student graduates in
Western Australia.
graduates in Western
With UWA’s recent
Australia has
course restructure to a
postgraduate MD degree,
increased by 250%
along with UNDA’s
current postgraduate
program, there is a niche in
the market for an undergraduate
medical degree in WA. A medical school
would be in keeping with Curtin’s provision of teaching in
many allied health fields and their aim to be “an international
leader … positioned among the top 20 universities in Asia by
2020.”
Curtin University’s rationale for this drive centres on the
long-running issue of the shortage of doctors in Australia.
Their motive behind increasing the number of medical
student graduates is “to service the needs of indigenous,
mental health, aged and rural and remote clients with a focus
on chronic disease and to meet increasing community demand
for doctors.” These goals are indeed admirable, and on the
surface it seems a simple equation – more students equals
more doctors and better medical care. The reality, however
unfortunate, is that things are much more complex.
Over the past decade, the number of medical student
graduates in Western Australia has increased by 250% (from
approximately 120 to over 300). This increase has been
echoed Australia-wide. We have already seen the increase
in numbers in this equation, and now we have to train them
30 M E D I CU S March
and ensure they are of equal or better quality than their
predecessors. This takes time, valid and credible clinical
rotations, and enough committed teachers and mentors.
The positive impact of any rise in medical training places
will not be felt for a significant number of years. The 2009
graduates from the first cohort of increased student positions
(affectionately known as “the hump”) are now in postgraduate
year three. As medical training extends past our graduation,
these doctors currently filling junior positions in our hospitals
will have the training to influence the shortage within the
next 5–10 years. According to estimates by E/Professor
Lou Landau the recent increase in graduates will more than
cover the attrition rate of approximately 200 doctors per
year and possibly lead to excess. Curtin’s proposed five-year
undergraduate degree, though shorter than the combined
seven at both UWA and UNDA, will still be too late to fill the
State’s short-term need and may contribute to a glut in future.
Despite this recent large jump in numbers, there has
not been an equivalent increase in the resources required
to accommodate the new trainees. This strain on medical
education, by medical students and junior doctors alike, is
being felt with increased student numbers within hospitals,
a lack of adequate intern positions in most States, and a
shortage of prevocational and vocational clinical teachers.
With current funding and numbers of senior doctors there is
a finite number of trainees that can be accommodated before
the quality of teaching, and thus the skill of the clinicians that
we produce, is severely diminished. Medical training does
not end at the medical school gate, therefore throwing more
graduates into an already strained medical education system is
not the answer. It is not the letters before and after one’s name
that makes a good doctor but the years of excellent training
and quality experience that each student receives whilst at
university and in their clinical careers. Dilute this and you
reduce the calibre of the profession.
It is often asked why doctors should have the privilege of
guaranteed jobs after graduation whilst other degrees do not.
What makes doctors different when, after all, doctors are
not inherently “special”? This is a question of community
benefit. It is a considerable investment by taxpayers to produce
a doctor, therefore it is logical that this investment is one
that produces returns for the community with productive
service provision by the medical practitioner. “Graduating
doctors to be taxi drivers” is not just a throw-away line but
an unfortunate reality in the UK. If the foundation of your
justification for increasing student numbers is based on the
need for more doctors to care for the community, then you
continued on next page
O
pinion
Students Teaching Others
by Ghassan Zammar President, Medical Students’ Association of Notre Dame
A few weeks ago I stumbled across an interesting article
published in the British Medical Journal titled “Learning
how to teach others” by Tasker et alia (2012). It grabbed my
attention because earlier that week I was revising the concept
of haemodynamics with a fellow student in my cohort. Of
course I’m far from being an expert on the topic, but like
many other medical students, a crucial form of my learning is
through the sharing of knowledge with my peers.
The ability to teach others has often been an intrinsic
quality that many doctors possess, or have at least gained
through their years in medical school. As the article suggests,
it’s crucial for medical students to obtain not only the
knowledge of medicine, but also the ability to pass on that
information to others. This includes educating other students,
our patients or even the doctors assigned to teach us.
The Good Medical Practice Code published by the Australian
Medical Council states that we should “seek to develop the
skills, attitudes and practices of an effective teacher, whenever
we are involved in teaching.” This highlights the importance
of learning HOW to teach effectively during our years in
medical school.
Notre Dame University revolves a majority of its teachings
around the Problem Based Learning (PBL) model. This
system allows students to augment their teaching abilities on a
weekly basis by sharing with others what they have learnt from
a list of learning objectives defined by their PBL group.
Another avenue that gives students the opportunity to
gain teaching experience is the mentoring program created
by MSAND. Developed in 2010, this program is designed
to align first-year medical students (the mentee) with thirdyear students (the mentor). The same system runs between
second-year and fourth-year medical students. Mentoring
relationships are well recognised as important and
effective tools in shaping the careers and attitudes of
medical professionals, as well as helping foster strong peer
support networks amongst students.
There are many clear benefits the program can offer the
mentees. For example, it’s a useful means
of learning clinical examination
techniques and reinforcing
technical skills, whilst
also giving students
the opportunity to
interact with others
from different year
The ability to
groups.
As for the
teach others has
mentors, the
often been an
program serves
as an important
intrinsic quality
way of enhancing
that many
their teaching
skills in a simulated
doctors possess
clinical setting. The
opportunity to practice
such skills will also broaden
and reinforce the mentors’
clinical knowledge and may improve
academic performance through the ongoing
revision and application of information.
There is an onus on medical students to educate each
other and take on the teaching role. Since its inception, the
mentor program has been embraced by students from all
year groups and well supported by the School of Medicine.
continued from previous page
must ensure that those that graduate are able to work in the
health system. Otherwise, it is a waste of valuable public
money with no benefit to the very people you seemingly set out
to aid.
Surely, further increases in medical student numbers can
be sustained with the provision of additional staff, resources
and infrastructure to support their education. However
there must also be an increased capacity for employment of
medical graduates and support for ongoing training of junior
doctors. In the current situation in which we find ourselves,
it is misguided to assume that recklessly increasing student
numbers will be beneficial. Rather we risk jeopardising the
quality of our doctors. Therefore, we must find ways to
improve the existing system – to be able to accommodate
those that we have already in training and, in time, create
an increased capacity for those doctors that we need in
future. Funding needs to be directed toward finding creative
new ways to entice graduates into fulfilling careers in rural
medicine, indigenous health, mental health and aged care. It is
the responsibility of all parties involved; the government, the
medical profession and universities to work together to create
the best model to provide patients with the quality of care that
all Australians deserve, rather than risk sacrificing our worldrenowned quality for the sake of quantity.
March ME D I C US 31
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A Year of Internment
O
pinion
Each year hundreds of young doctors start their internships at one of Perth’s three teaching institutes: Fremantle, Sir Charles Gairdner
and Royal Perth Hospitals. The intern year provides these young doctors with an insight into the practicalities of being a medical
practitioner as they begin the process of deciding their medical speciality and where they would like to practise.
Medicus will follow three of these interns, Dr Robert Marshall, Dr Maya Rajagopalan and Dr Scott Sargant, as they put university
behind them and embark on their careers as medical practitioners.
Taking it Interns
by Dr Robert Marshall 2012 Intern at Sir Charles Gairdner
It’s incredible what a title can do. I’m not referring to the
undoubtedly pun-filled sentence above this body of text, but
rather the one we use to designate our profession: Doctor.
Just a couple of months ago the 300-odd interns who
have started working in our State’s public hospital system
were happily going about their lives as Mr’s and Mrs’s, and
suddenly, with a simple ceremony and a reasonable amount
of fanfare, we all ‘became’ doctors. The distinction between
final-year medical student and medical practitioner may seem
somewhat arbitrary, but as I have learnt over the last month
working at Sir Charles Gairdner Hospital, it makes a whole
world of difference.
The key distinction between student and intern is not the
fact that you get paid (although that is a particularly pleasing
novelty to those of us who have been students for the better
part of a decade); it is the set of obligations that go along
with being a medical practitioner. Some of these obligations
are clearly set out in legislation; some are monitored by the
Medical Board and imposed by contracts, hospital executives
and administrators. But there is a whole raft of other
obligations that go with being a doctor that I have begun to
appreciate as an intern.
The first is the obligation to teach. Our medical education
system is built upon the apprenticeship model, whereby we
learn clinical medicine by being in the hospital or clinic,
watching and learning from other doctors around us. As
the first wave of new medical students joined our team last
week I realised that the obligation to teach falls not only on
consultants and registrars, but on every doctor in the hospital,
interns included. With the doubling in numbers of medical
students in this State over the past decade, there has never
been a greater need for more clinical teachers and for everyone
to take an active role in clinical education. The flipside of this
obligation is that I have also realised just how difficult it can be
to find time to teach students amidst the business and chaos of
a day on the ward.
The second obligation is to our patients. It would seem very
obvious to most patients that all of the doctors in the hospital
are there to manage and treat them while they are sick, but
I think there is a range of attitudes towards what the role of
the intern actually is amongst the medical community. Of
course there is paperwork to be done, and it’s important that
someone is managing all of the seemingly minor tasks that go
into a patient’s care, but interns who convince themselves (and
I have heard this often over the past few years) that they are
“only paper pushers” are selling themselves short. Our clinical
experience may pale into insignificance when compared to a
senior consultant, but that doesn’t mean we don’t have a role
as a doctor to the patients under our care. Every doctor, intern
included, has an obligation to be an advocate for their patient,
to spend time talking to them, explaining and discussing the
various aspects of their care and applying critical thought to
every test, treatment and therapy arranged for those patients.
Woe betide the intern who asks a radiologist for a CT scan
simply because “my Boss said so”, and that is exactly how it
should be, since we are employed to practice medicine, not
paperwork. Being less experienced is not an excuse not to be
involved, and as with anything in medicine, it would seem to
me that you get out of it what you put in.
The third major obligation we have as doctors is to
remember to look after the people who are looking after the
patients: ourselves and each other. A lot of work has been done
to raise the profile of doctor wellbeing over the last decade and
I think we are now starting to behave like physicians towards
both our patients and our colleagues, which can only be a
change for the better.
It’s surprising that I had to start working in a hospital
before I realised these additional obligations that fall upon a
doctor, since they are right there in the title: to be a teacher
(doctor from docere, Latin: to teach); to be a doctor in the true
sense of the word to our patients; and to be a doctor to each
other and ourselves when the need arises. The only question
that remains about our newfound titles is why the dictionary
definition of the word “intern” is to confine someone as a
prisoner, in particular for political reasons. But I guess I may
have a better understanding of that as the year goes on.
March ME D I C US 33
34 M E D I CU S March
ROSS
RIVER
Virus
On the rise in
Western Australia
The mosquito-borne Ross River virus is on
the rise in Western Australia, with 568 cases
recorded during the November 2011 to January
2012 Statewide Notifiable Diseases reporting
period, which is up from 251 reported cases
for the same period in 2011 and only 82 in
2010. The increase is attributed to above
average summer rainfall, higher than usual
minimum temperatures and recurrent high
tides associated with the La Niña phenomenon.
Previous major outbreaks of Ross River virus in
WA, which occur every three to five years, have
been associated with similar weather patterns.
The unseasonal rains and high tides allow
extensive breeding of mosquitoes in natural
wetlands and in man-made breeding sites
across urban environments. The rainfall and
high tides during mosquito control spraying
periods has also led to flushing of treated
water-ways, reducing the effectiveness of the
pesticide applications.
continued on page 34
March ME D I C US 35
Ross River Virus:
On the rise in Western Australia
continued from page 33
Where it all began
When Dr J R Nimmo’s article “An Unusual Epidemic”
appeared in the Medical Journal of Australia in 1928, few knew
this would mark the first recorded incidences of what is now
referred to as Ross River virus.
Dr Nimmo, a NSW country medical practitioner in the
Narrandera region, noted that within a six-week period around
100 patients presented with fever, joint pain, swelling and skin
eruptions:
“During March and April of this year there has
occurred a number of cases of a disease which I cannot
nail down as any known epidemic, nor can I cast into
the practitioner’s ‘dust-bin’ of diagnosis and name
‘influenza’.”
At the time the humble mosquito was ruled out as the
carrier of the causative agent, with our arch-enemy the fly
being blamed. It was believed this epidemic was an allergic
reaction to stinging flies, which were in plague proportion at
the time.
“The absence of the usual constitutional disturbances
found in an acute bacterial infection causes me to class
this complaint among the allergic phenomena ...
There has been a plague of ‘stinging flies’ in the
district for the last two months. Residents of long
standing cannot remember such a previous occurrence.
Unfortunately the fly theory occurred to me too late to
question all patients closely on their experience.”
It was not until 1963 that mosquitoes were identified as the
“causative agent.”
At the beginning of 1959, over a ten-day period, 88 female
Aedes vigilax mosquitoes were collected, some being caught in
mangroves near the Ross River at Townsville, Queensland.
After being on dry ice for three years at the Commonwealth
Serum Laboratory, in 1962 the mosquitoes were sent to
the Queensland Institute of Medical Research (QIMR) in
Brisbane. At the Institute a single pool of inoculant was
developed from the mosquitoes and was injected into infant
mice.
In mid-1963 Dr Ralph Doherty of QIMR isolated a virus
from the infected mice, which was designated as T48. This
virus was identified as a Group A arbovirus and was found to
cause epidemic polyarthritis. Further testing also revealed that
antibodies to T48 virus were commonly found in people in
eastern Australia, particularly in the Townsville area.
The collection zone for the original mosquitoes used in
the study and the prevalence of a virus-resistant population
around the Townsville region lead to T48 being named Ross
River virus (RRV). However, although Dr Doherty recovered
RRV in mice in 1963, it wasn’t until early in the 1970s that the
virus was isolated from a human.
In 1971 RRV was recovered from a child at the Edward
River Mission. However, the patient did not present with
classic epidemic polyarthritis features, so the case could not
be used as final proof of RRV as the causative agent. However,
during the 1979–1980 RRV outbreak in the Pacific region
the virus was finally isolated in an epidemic polyarthritis
patient. This isolation lead to the development of a reliable
screening process that uses the Aedes albopictus (C6-36) cell
line to isolate the virus. The use of an indirect enzyme-linked
immunosorbent assay for RRV diagnoses meant a more
accurate presentation count could be obtained.
Ross River, Queensland
36 M E D I CU S March
The following summary of the epidemiology, clinical features, diagnosis, management and prognosis of Ross River virus disease are reproduced with
permission from the Western Australia Department of Health and are taken from Environmental Health Directorate’s guideline entitled: Ross River
Virus: A Management Guide for General Practitioners.
regular activity during and
soon after the wet season
Where it occurs
RRV occurs in environmentally driven cycles between
mosquitoes and animals. It is transmitted only by mosquitoes
and cannot be caught from direct contact with another person
or animal. The virus, which is taken up in blood during the
mosquitoes’ feeding cycle, multiplies in the mosquito and is
then transferred several days later at its next feeding.
RRV is endemic in several regions throughout Australia,
with it being most active in Western Australia during late
spring and summer in the south-west, during and just after
the wet season in the north, and in late summer and autumn
in the interior. Large epidemics of RRV disease occur every
few years in WA, including throughout the south-west, where
notification rates are highest in the vicinity of the Peel–Harvey
estuary (Mandurah region), Leschenault estuary (Bunbury
region), Capel and Busselton. Many suburbs of Perth,
particularly the outer metropolitan area, have also experienced
local transmission during large RRV disease outbreaks.
occasional outbreaks after
rainfall or coastal high tides
regular spring/summer
activity with major outbreaks
after extreme spring rainfall
or very high tides
occasional outbreaks
after later summer/
autumn rains
Clinical presentation
Incubation period
Joints: Peripheral joints are most commonly involved
Usually between 7–9 days (range 3–21 days)
in RRV disease, including knees, ankles, wrists and
fingers. Most patients have symmetrical involvement
of joints. The involvement of joints can range from
tenderness and minor restriction of movement to
severe swelling, effusion and redness.
Asymptomatic infection
Most people infected with RRV are either asymptomatic or
have only mild symptoms.
Typical presentation
There is no specific order of symptom onset in patients with
RRV disease.
Other symptoms (lymphadenopathy, sore throat, coryza,
headache, neck stiffness and photophobia) are unusual.
Jaw – 12%
Neck – 39%
Shoulder – 49%
Rash: The rash is commonly distributed on the limbs and
trunk. It is usually maculopapular and resolves within two
weeks.
Frequency of symptoms/signs of
RRV disease in patients
Elbow – 43%
Wrist - 69%
Hip – 14%
(Harley, Sleigh, Ritchie, 2002; Smith 2001)
Symptom/Sign
Frequency
Joint Pain
95%
Duration >1 month
90%
Fatigue
90%
Arthralgia
80%
Myalgia
60%
Rash
50%
Fever 50%
Hand (includes fingers
and thumbs) – 64%
Knee – 72%
Ankle – 75%
Feet – 42%
Toes – 47%
Frequency of involvement of joints in
Ross River Virus patients
continued on page 36
March ME D I C US 37
continued from page 35
Diagnosis
Management
Diagnosis is based on:
• clinical symptoms and signs suggestive of RRV disease;
• residence in, or recent travel to, an area with endemic
or epidemic RRV activity (see Epidemiology); and
• laboratory investigations.
There is no specific treatment for RRV disease. None of
the current treatment recommendations for RRV disease
are based on high levels of evidence, such as randomised
controlled trials.
Laboratory Investigations:
RRV IgG serology
•
•
•
A case of RRV disease is most reliably diagnosed
by showing a >4-fold rise in RRV lgG antibody,
or seroconversion, between acute and convalescent
samples.
The first serum specimen should be taken during the
acute stage (within seven days of onset of symptoms)
and the second specimen at least 10 days later.
Other diagnoses should be considered if there is not a
rising lgG titre.
Single IgM serology
•
•
•
lgM serology cannot be relied upon to conclusively
diagnose RRV disease.
A single serum specimen with a positive RRV lgM is
highly suggestive of RRV disease, but not conclusive.
RRV lgM can persist for months to years after primary
infection. Thus, a positive RRV lgM may represent
previous mild or asymptomatic infection and does not
represent the cause of the presenting illness.
False positive lgM results do occur and this should be
suspected if lgM is detected in the absence of lgG. A
convalescent serum sample should be taken to confirm
the diagnosis through lgG seroconversion.
Differential Diagnosis
The differential diagnosis of RRV is broad, and includes
a spectrum of infectious and non-infectious causes of
polyarthopathy.
Infectious differentials include Barmah
Forest virus and parvovirus B19 (erythema
infectiosium).
Non-infectious differentials include
acute onset of non-infectious arthritides
(including rheumatoid arthritis, SLE and
adult Still’s disease), Reiter’s Syndrome
and Henoch Schonlein purpura.
If the patient has:
• a high ESR/CRP,
• anaemia,
• persistent reduction in joint
movements, or
• radiological changes,
then the diagnosis of RRV disease should
be considered.
38 M E D I CU S March
1. General measures
•
•
•
Rest is useful in the acute phase of infection.
Some patients find that gentle physical therapies,
including hydrotherapy, physiotherapy, massage and
swimming, can improve symptoms.
Patients with a more prolonged course of illness
commonly experience depression and other
psychological sequelae from RRV disease.
Psychosocial management and referral to other
agencies, as appropriate, form an important part of the
management of some patients.
2. Medications
•
•
Many patients find that simple analgesics, such as
paracetamol or aspirin, are sufficient to control pain.
Non-steroidal anti-inflammatory drugs (NSAIDs) can
effectively reduce pain and swelling in some patients.
Corticosteroids are not a recommended treatment
due to their questionable efficacy in RRV disease and
adverse side effects.
3. Other therapies
•
Anecdotal evidence suggests that some patients find
relief from symptoms through self-help techniques
such as the use of heat on sore joints, relaxation
exercises, planning daily activities to avoid fatigue,
maintaining a good diet and moderate exercise.
Prognosis
•
•
•
Most patients will experience resolution of major
symptoms within 3–6 months.
Some patients have a chronic course of symptoms,
with persistence of non-rheumatic symptoms (such as
fatigue and poor concentration) a common feature.
In some of these cases, prolonged illness may be
due to a co-morbid condition, and it is important to
investigate for other conditions that may be causing or
contributing to symptoms.
A relapsing course of RRV disease is occasionally
experienced.
•
More Information
•
•
For more information about RRV disease consult a
clinical microbiologist, infectious diseases physician, or
rheumatologist.
•
For more information about the ecology of RRV, surveillance
programs and management of outbreaks contact the
Environmental Health Hazards Unit of the Environmental
Notification
•
aimed at identifying the most likely time and place of
exposure to infected mosquitoes.
Notification data are vital for informing mosquito
control programs and future land-use planning.
Health Directorate on (08) 9285 5500.
RRV disease is a notifiable disease under the Health
Act (1911). All cases of laboratory-confirmed RRV
disease should be reported to the Department of
Health.
Upon receipt of notification of a case of RRV disease,
the Department of Health will initiate an investigation
via local government environmental health officers
•
For more information on RRV and mosquito control, visit
www.public.health.wa.gov.au.
•
Patients can be referred for patient support information and
groups to the Arthritis Foundation of WA on (08) 9388 2199
or www.arthritiswa.org.au.
References
Harley D, Bossingham D, Purdie D, Pandeya N, Sleigh A. Ross River virus disease in tropical Queensland: evolution of rheumatic manifestations in an inception
cohort followed for six months. Medical Journal of Australia 2002; 177(7):353–5.
Harley D, Sleigh A, Ritchie S. Ross River virus transmission, infection and disease: a cross-disciplinary review. Clinical Microbiological Reviews 2001; 14(4):909–32.
Mylonas A, Brown A, Carthew T, McGrath B, Purdie D, Pandeya N et al. Natural history of Ross River virus-induced epidemic polyarthritis. Medical Journal of
Australia 2002; 177(7):356–-60.
Smith D. Ross River virus and Barmah Forest virus infections. Perth: PathCentre; September 2001.
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O
pinion
Ross River Virus: It is time to act
by Dr Richard Choong, AMA (WA) Vice President
When reading DR J R Nimmo’s An Unusual Epidemic, it struck
me that even in 1928 it was a general practitioner who was seeing
This is a battle and we have to be ready and willing to fight.
Firstly, there has to be careful monitoring of the level of
a problem first-hand and reported on the debilitating impact of an
coordination between all levels of government. State Government
unknown illness to other GPs.
officials assure me that local governments are working closely
Almost 100 years later we know what the illness is – but there
together on the issue. They tell me that funding is available (not
remains no cure. Rather, GPs are seeing Ross River Virus not only
that it is growing) and that coordination is increasing. However
as a serious problem, but as a growing one. In fact, the number of
patients tell me that they have contacted their local councils
Ross River Virus cases in WA has doubled over the last year and
and are told that there is no money to undertake the appropriate
numbers are showing little sign of slowing down.
mosquito control.
I calculate that there are, conservatively, around 1,500 RRV
I believe we must remain vigilant on this issue and should be
cases in WA each year – or around 15,000 over the last decade.
ready to have the State Health Department move in if necessary
Worryingly, the number of RRV cases is also on the rise. These
and take over responsibility for spraying if there is the slightest
numbers are only the tip of the iceberg, representing the number
indication that local government is shirking its responsibilities.
of cases diagnosed and reported. There would be several times
Any local government authority which conducts spraying or
more patients that have contracted the illness but remain
other steps to combat RRV sporadically or without full and open
undiagnosed and unreported, their symptoms passing in due
coordination is just asking for trouble. A proper effort to tackle
course.
this worrying and growing problem must be coordinated between
Back in 1928 it was GPs who saw the problem first, and GPs
today are seeing the debilitating impact this particular problem
health and local government departments.
We should also acknowledge that there is a major issue brewing
is having on the lives of thousands of Western Australians of all
in the spread of new housing developments into or very close to
ages, all incomes, and in a growing number of suburbs.
areas of the larger Perth region where mosquitoes are prevalent.
It is normally GPs who have to tell people who present in our
My understanding is that planning authorities have approved
surgeries that there is no known cure. We often have to break it to
a number of very large housing developments even against the
sufferers that it might affect them for years. Australian society has
strong recommendation of the Health Department.
to tackle this problem in the same way as we have tackled other
medical issues that have bedevilled society from the dawn of time.
We need to acknowledge the serious nature of the issues. We
need to agree that research is vital and that it needs money. We
Voltaire is famed for saying that “common sense is not so
common,” but placing the homes of thousands of people next to
wetlands is just asking for trouble.
While the opinion of the Health Department is often ignored
need to look over the horizon to see if other nations have tackled
at this point of the debate, the Health Department is the first
the issue of mosquito vector control and how they have done it.
government authority residents will come to when they, their
I was recently taken to task by one acknowledged expert for
my statement that it was “not rocket science” to fight Ross River
Virus. And yet the WA Government provides a tiny amount of
money each year for this battle. There needs to be more than
one helicopter available for spraying and there needs to be a
willingness by the State Government to take over responsibility
for this issue if local government authorities fail to effectively and
quickly deal with the issue.
I wish to make it clear that the members of the WA Health
family members, or friends and neighbours fall ill with the virus
first identified in 1928.
As a general practitioner I have too often seen the impact of our
half-hearted efforts to date.
I have seen the huge impact that Ross River Virus can have on
individuals, on families and on the wider economy.
This is a very worrying and debilitating disease and must be
tackled with a strong effort to control the spread of mosquitoes.
This should be done not just through effective and coordinated
Department with whom I have met and who have responsibility
spraying campaigns but also planning ahead and not placing
for the program are intelligent, resourceful and hard-working
residential areas too close to wetlands.
members of our public service. But without a strong public and
political advocate, finding more money and resources to fight this
scourge it will be like pushing a boiled pea up a hill by your nose.
In short, this is a battle and rather than waiting on the sidelines
throwing the occasional marshmallow at the issue, we need to
show a willingness to tackle it head on.
We should, as a society, be asking for more action from our
elected representatives.
We need better research, better compilation of numbers of
sufferers and a greater acknowledgement that this is an issue that
needs careful and coordinated action.
It is time to act. And it is time to act now.
March ME D I C US 41
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42 M E D I CU S March
Australia’s Leading MDO
Giving Birth After
a Caesarean:
Lowering the risk to babies
A major national study lead by the University of Adelaide has
found that women who have had one prior caesarean can lower
the risk of death and serious complications for their next baby
– and themselves – by electing to have another caesarean.
The study, known as the Birth After Caesarean (BAC)
study, is the first of its kind in the world. It involves more than
2,300 women and their babies and 14 Australian maternity
hospitals.
The study shows that infants born to women who had a
planned elective repeat caesarean had a significantly lower
risk of serious complications compared with infants born to
mothers who had a vaginal birth following a prior caesarean –
the risk of death or serious complication for the baby is 2.4%
for a planned vaginal birth, compared with 0.9% for a planned
elective repeat caesarean.
The mothers of these babies were also themselves less
likely to experience serious complications related to birth. For
example, the risk of a major haemorrhage in the mother is
2.3% for a planned vaginal birth, compared with 0.8% for a
planned elective repeat caesarean.
“Until now there has been a lack of high-quality evidence
comparing the benefits and harms of the two planned modes
of birth after previous caesarean,” says the study’s leader,
Professor Caroline Crowther from the Australian Research
Study leader, Professor Caroline Crowther from the
Australian Research Centre for the Health of Women and Babies
Centre for the Health of Women and Babies (ARCH), part of
the University of Adelaide’s Robinson Institute.
“The information from this study will help women, clinicians
and policy makers to develop health advice and make decisions
about care for women who have had a previous caesarean.
“Both modes of birth have benefits and harms. However,
it must be remembered that in Australia the risks for both
mother and infant are very small for either mode of birth,”
Professor Crowther says.
Caesarean section is one of the most common operations
performed on childbearing women, with rates continuing to rise
worldwide. Repeat caesarean births are now common in many
developed nations. In Australia in 2008, more than 90,700
women gave birth by caesarean, accounting for more than
31% of all births. Of Australian women who had a previous
caesarean section, 83.2% had a further caesarean for the birth
of their next child. In South Australia alone, repeat caesarean
births amount to 28% of the overall caesarean section rate.
“We hope that future research will follow up mothers and
children involved in this study, so that we can assess any
longer-term effects of planned mode of birth after caesarean
on later maternal health, and the children’s growth and
development,” Professor Crowther says.
The BAC study is funded by the National Health and
Medical Research Council (NHMRC) and the Women’s
and Children’s Hospital Research Foundation. The study is
coordinated by researchers from the University of Adelaide’s
Discipline of Obstetrics and Gynaecology and Discipline
of Public Health; Department of Neonatal Medicine at the
Women’s and Children’s Hospital, Adelaide; and the Faculty
of Health Sciences at the Australian Catholic University,
Melbourne, with collaboration from clinicians at the 14
participating maternity hospitals.
March ME D I C US 43
O
pinion
GPSI: A GP with specific interests
by Associate Professor Frank R Jones Chair, RACGP WA Faculty
What sort of phenomenon is this? Is this an oxymoron? Surely
we are by definition and nature “generalists” (thankfully in
this world of medical super-specialisation, someone has a
whole-patient view!). The antonym of specialist is general
practitioner!
We all remember the heady days of being a student/resident,
then registrar. Mostly everything we did was new, challenging
and exciting. Each speciality held specific demanding
intellectual rigour and the need to acquire new skills. The
problem was that each job I did, I enjoyed, and was inclined
to stay with this speciality… until I tried another! And so it
became increasingly obvious I was destined to be a generalist,
and I have never regretted this decision.
The Royal Australian College of General Practitioners
(RACGP) defines general practice as follows “General
practice provides person centred, continuing, comprehensive
and coordinated whole-person healthcare to individuals and
families in their communities.” The completion of Fellowship
of the RACGP recognises the ability to practice unsupervised
general practice anywhere in Australia.
Historically, most GPs had a procedural skill and, with
increased Australian urbanisation, most city-based GPs
have lost/been sidelined out of procedural practice. However,
in rural and some outer urban regions’ general practice
there is an ongoing need for procedural skills in obstetrics,
anaesthetics and emergency medicine,
and these doctors require very
specific types of support
systems. There are
other avenues for GPs
to explore within
medicine that are
very specific, but
Is there a
not necessarily
requiring a
quantifiable time
traditional
within the working
procedural
expertise.
week that one has
So what is this
to be a generalist?
phenomenon of a GP
with specific interests
(GPSI)? They are GPs
who have incorporated
a special area of family
medicine into their broad based
comprehensive care practice; for
example, women’s health. There are also GPs
44 M E D I CU S March
who have a specific focused scope of practice whereby all or
the majority of the care they deliver is in a specific area of
family medicine, such as travel medicine or skin cancer clinics.
Are those doctors with a specific focused scope of practice still
generalists? Is there a quantifiable time within the working
week that one has to be a generalist? This debate will continue
to challenge.
In addition, these specific interest skills and practices
may well vary during the career trajectory of a GP. I know
colleagues who were fantastic procedural GPs, who now
provide superb care for patients with drug and alcohol abuse
issues. Multi-skilling indeed!
This becomes another critical attraction for doctors into
general practice. Young doctors in general practice training
can acquire specific skills during their “extended skills” year,
but it doesn’t end there – it’s only the beginning! Throughout
the GP’s career there are boundless opportunities to develop
specific interests, to invigorate and challenge, with the
ultimate goal of improving patient care.
In recognition of all the above, in 2008 the RACGP
endorsed the creation of a National Faculty of Specific
Interests (NFSI), which includes:
Networks: to share and develop related knowledge and
materials through regular contact.
Working groups: to develop specific educational
programmes for interested parties.
Chapters: to further develop specific curriculum
parameters with a view to a post nominal award via the
RACGP.
The RACGP NFSI has very specific operating principles.
It is charged with the role of conduit, allowing GPs with an
interest in a specific area of general practice the ability to
pursue their interest within their College rather than look
outside the College for like-minded members and networking
or educational opportunities.
This also acts as a two-way process – it is a tremendous
resource for the College, when expert opinion is required.
There are now 14 separate groups, each at various stages
of their development. A full list is available on the website.
Examples are aged care, palliative care, hospital care, mental
health and pain medicine, to name a few.
The RACGP Council has strongly endorsed the view that
a GPSI will always be subsidiary to comprehensive general
practice (generalists). The College will not initiate nor will it
support, any GPSI chapter claim for differential remuneration.
So, have a look at the NFSI’s website at www.racgp.org.au/
nfsi. See if there are like-minded colleagues to stimulate and
challenge you in your area of specific interest!
Supporting you and your steps as
your career grows.
Let our national medico-legal team
advise you.
Your medical indemnity partner, Avant 1800 128 268
We’re with you all the way.
IMPORTANT: Professional indemnity insurance products available from Avant Mutual Group Limited ABN 58 123 154 898 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 objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. Please read and consider the policy wording and PDS,March
which is available at www.avant.org.au or by
contacting us on 1800 128 268.
ME D I C US 45
THE NEW RANGE ROVER EVOQUE.
IN STORE NOW.
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Telephone: 1300 852 891
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Telephone: 1300 853 894
southernlandrover.com.au DL12540
RANGE
ROVER EVOQUE
M E D I CU S March
O
pinion
AMSA Welcomes a Year of Advocacy
and Wellbeing
by James Churchill President, Australian Medical Students’ Association
platform where issues (and solutions) can be discussed.
It is with great enthusiasm that the Australian Medical
AMSA is committed to a range of initiatives which aim to
Students’ Association (AMSA) begins the new year. In 2012,
improve the health and wellbeing of medical students. The
the National Executive is based in Victoria and comprises
AMSA Get-A-GP Campaign encourages medical students to
students from the University of Melbourne, Monash
build a relationship with a general practitioner early in their
University and Deakin University.
medical career.
This year, we plan to build upon the strong advocacy
The program involves recruiting GPs who are happy to
efforts of the Western Australian Executive team of 2011
bulk-bill medical students and provides a centralised
and continue to ensure that we represent medical students
database for students to access. Building a
across the country. We will continue to focus
relationship with a GP can be a great
on current issues in medical education
source of support throughout medical
including increasing student numbers
school (and life in general!).
and ensuring availability of quality
In 2011, AMSA in partnership
internships for graduates of Australian
with Beyond Blue produced
medical schools, eHealth, rural
Keeping your Grass Greener:
and indigenous medical student
the wellbeing guide for medical
recruitment and retention, and the
students. This booklet is
appropriate funding of medical
AMSA believes it is
designed to help break down the
schools.
important to promote
stigma that surrounds wellbeing
In addition to these issues in
student health and
and provide some practical tips
medical education, AMSA believes
wellbeing
for surviving and thriving at
it is important to promote student
medical school. It also includes a
health and wellbeing. In 2011, the
directory that lists helpful places or
Executive were successful in promoting
services in each State.
dialogue about wellbeing; we plan to
The AMSA Wellbeing Network
continue and build upon this momentum.
(WellNet) was also established in 2011.
Student wellbeing has been identified as one of the
WellNet consists of a representative from each of the
major areas of focus for our team in 2012.
20 Australian medical schools and provides a forum through
AMSA has been actively engaged in the recognition of
which ideas can be shared and medical student wellbeing
medical student and doctor wellbeing as an issue worthy of
can be discussed. The establishment of this network is an
significant attention. Medical students study in an extremely
important step towards ensuring that the conversation is
competitive, demanding and high-pressure environment.
happening at all medical schools, and that positive steps are
Semesters are long, content is hard, and feeling as though you
being taken to address issues of medical student wellbeing
are keeping your head above water is challenging at the best of
around Australia.
times. It’s not surprising that many students find it difficult to
With the support of a huge number of enthusiastic medical
lead a balanced life whilst at medical school, but it is important
students who are passionate about improving the health and
that students do find a balance so that they enjoy what they are
wellbeing of their peers, AMSA is optimistic that the future is
doing, and set themselves up for a long and rewarding career.
bright and looks forward to making a positive impact this year,
Wellbeing is about managing mental, physical, emotional and
and in the future.
financial health to achieve exactly that.
Medical students are typically high achievers who are used
For further information on any of AMSA’s wellbeing
to working hard and excelling academically. Many would not
initiatives or to register as a bulk-billing GP for our Get-A-GP
have had issues managing the demands of their education in
campaign, please contact:
the past. In order to encourage students to look after their
[email protected].
wellbeing, they need to first be aware that it may become a
problem throughout medical school.
AMSA is in a unique position to inform students of the
issues through various channels, and connect students to a
March ME D I C US 47
Simplify YOUR Life
We can help with everything
in one place
its just a phone call away
AMA FinAnciAl ServiceS
9273 3077
48 understands
M E D I CU S March
...we go the extra mile to
understand, protect and
care for the Financial
Wellbeing of the Health
Professional
protects
cares
Disclaimer: In preparing this information, AMA Financial Services is not providing advice. It has been prepared without taking into account your personal objectives, financial situation or needs.
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.
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.
Research
Translation Projects
The RTP program supports short-term research projects
that address efficiencies and cost savings that research, and
its translation into practice, can deliver to WA Health. These
projects are required to have a measurable economic impact
on WA Health activities, while maintaining or improving the
quality of care.
Independent health economic analysis of the first three
rounds of the RTP program, conducted in the financial
years from 2007/8 to 2009/10, shows a positive return-oninvestment over the 12 months the projects were funded. The
whole-of-life return on the investment into the RTP program
is much higher as savings from successfully implemented
projects accrue every year.
The RTP program has been internationally recognised for
its innovative focus on economic returns and the translation
of results into health service policy and practice. It has also
demonstrated the previously unrecognised, and consequently
underutilised, research capacity of frontline healthcare staff
including medical practitioners and others from multiple
clinical backgrounds. Since its commencement in 2007
nearly $10 million has been allocated to 74 projects in five
funding rounds.
Better for Less: A Successful Research Translation Project
Ambulatory care coordination (ACC) for children with chronic diseases
This project evaluated the health and economic benefits of
an innovative program that was being developed at Princess
Margaret Hospital. The program was aimed at children
who have complex chronic conditions that affect multiple
organ systems and who frequently attend the Emergency
Department, often resulting in long stays in hospital. In
addition to the obvious impact on the children, this has very
high human and economic costs to the families, the health
system and the community.
The ACC program offers a dedicated point of contact
with the hospital via 24/7 telephone support provided by
experienced tertiary care and community nurses. This support
includes the coordination of care, the planning of treatment
strategies, ongoing assessment, proactive management and the
effective sharing of information between health providers.
The results demonstrated that over the first year of the ACC
program, provided to 80 children, there was a 36% drop in
the number of days of hospitalisation and a 24% drop in ED
attendances. This equates to a cost-avoidance of $650,000.
Equally importantly, families and health professionals had
a very high degree of satisfaction with the program and its
health outcomes.
Department of Health
State Health Research Advisory Council
Research Translation Projects 2012 (Round 6)
Call for Applications – Closing date 1.00pm Thursday 26 April 2012
The Department of Health is now accepting applications for the 2012 funding round. These projects
are aimed at demonstrating improved cost effectiveness and/or efficiencies to WA Health while
maintaining or improving patient outcomes. Projects should address relevant contemporary challenges
faced by WA Health and should be substantiated by solid economic analysis.
Applications from persons in the clinical service delivery environment are encouraged.
Projects must be completed within 24 months and may be funded up to a maximum of $270,000.
Projects will be awarded on competitive merit.
The Application Form and Guidelines for Applicants are available online at
www.shrac.health.wa.gov.au/funding/translation.cfm
For more information contact the Research Development Unit at [email protected]
March ME D I C US 49
Obesity Surgery WA
Real Solutions • Real Support
Obesity Surgery WA offers a multidisciplinary team
approach to people with obesity and obesity related
problems.
We undertake pre-operative and post-operative counselling,
consultation with our dietician, physicians review and
surgery as our core business to achieve the best results
for our patients.
We also offer the opportunity for personal exercise
training, social interactions and more informal support
helping individuals through what is a difficult time in their
lives.
Real Solutions
Two Practical Surgery Options
• Laparoscopic Gastric Banding
Most popular choice in Australia
Safest obesity operation
Reversible and adjustable
Proven track record
• Laparoscopic Sleeve Gastrectomy
No adjusting once procedure is done
Hard to cheat
Better quality of eating
Ideal for people in remote areas
Real Support
• Obesity Assessment Clinician Janet Barry
• Dietician –
Clare Jurczyk
Harsha Chandraratna
Surgeon
Including • Motivational Counsellor
• Clinical Psychologist
• Personal Physical Trainer
• Physiotherapist
• Nurse Liaison and patient co-ordinator
Two convenient practice locations
Subiaco
Murdoch
SJOG Subiaco Clinic
Suite 321, 25 McCourt St
Subiaco WA 6008
Murdoch Specialist Centre
Suite 16, 100 Murdoch Dr
Murdoch WA 6150
Tel: (08) 9332 0066 Fax: (08) 9463 6202
www.obesitysurgerywa.com.au
50 M E D I CU S March
AMA in the MEDIA
Deadly hot weather warning
AMA WA vice-president Richard Choong said heat exhaustion was a
dangerous medical condition and could impact on a person quickly.
“It is sometime said that heat exhaustion is a silent killer so it is
important to remain aware of the impact of high temperatures,
especially on the young and elderly,” he said.
Merredin Mercury, 3 February 2012
Incentives for rural medics
Doctors who choose to work in rural areas may be rewarded with
several new benefits if the Australian Medical Association has its way.
The AMA has made a submission to the Senate Community Affairs
Reference Committee, which recommends two main initiatives to
make rural practices more enticing for doctors.
“If you’re going to get people into the country and don’t give
them the opportunity to recharge their batteries and go on holidays
or educational activities, they’ll burnout and won’t stay,” Associate
Professor David Mountain said.
The West Australian, 4 February 2012
Boom port builds ocean-front homes to attract doctors
Australian Medical Association state president Dave Mountain said
rents were one of the major disincentives for doctors to work in regional
and remote towns.
“This does seem like a sensible approach,” he said. “The problem
is those rents are so huge that if you insist on people paying for those
rents, it makes their practice unviable, often.”
The Australian, 6 February 2012
Mosquito virus raises alarm
Australian Medical Association WA vice-president Richard Choong,
a Port Kennedy GP, said doctors had seen a rise in cases of Ross River
virus since December.
“This is a very debilitating condition with symptoms that can last
months, so it’s one you want to avoid if you can,” Dr Choong said.
The West Australian, 8 February 2012
RPH’s high alert every two days – Battle to find beds
Dr Mountain said hospitals should not be on red alert regularly.
“It’s an indictment on the way the hospital system is run that we have
hospitals in disaster mode a significant proportion of the time.”
Sunday Times, 12 February 2012
Patients still ‘waiting to wait’
AMA WA vice-president Richard Choong said the Government
needed to set targets for outpatient waiting times. He claimed hospitals
“covertly discouraged” GPs from referring patients to outpatient
clinics in the hope some would opt to see a specialist privately.
“It’s very frustrating for patients and referring doctors because they
often don’t know what is the status of their referral,” he said.
The West Australian, 27 February 2012
Vital pills on sale without GP script
It (AMA) has warned a legal grey area exists if a patient has a bad
reaction to a drug given to them by a pharmacist. “It is further
fragmentation of healthcare delivery with people who are not fully able
to diagnose patients,” AMA WA president Dave Mountain said.
The West Australian, 2 March 2012
SEMINAR
PRACTICE MANAGERS
Throughout the year the Australian Medical Association
(WA) runs a number of free seminars for practice managers.
On 15 February the Association ran one such session which was
sponsored by MDA National.
Guest speakers Pip Brown, MDA National, and Dr Brendan
Adler, CEO and co-founder Envision Medical Imaging, spoke
about their respective organisations and the services they offer to
medical practices.
The session then proceeded to the ongoing issue of Personally
Controlled Electronic Health Records (PCEHR). AMA (WA)
executive officers discussed the PCEHR legislation and its
intended implementation on 1 July 2012. The PCEHR is currently
the subject of a Senate Enquiry, with the findings of the enquiry
being released after the seminar on 13 March. This report will be
the subject of an article in the April issue of Medicus.
The AMA (WA) executive officers discussed the confusion
currently surrounding the implementation of PCEHR, and
highlighted possible issues practice managers may encounter.
Attendees were encouraged to visit the National eHealth
Transition Authority website (www.nehta.gov.au) to obtain
further information and clarification on the specifications and
standards for PCEHR.
Guest speakers Pip Brown, MDA National, and Dr Brendan
Adler, CEO and co-founder Envision Medical Imaging
Medicus
Article Submission Dates
In order to distribute Medicus in a timely fashion, and to meet
our commitment to readers, all article submissions are required
by the following dates:
Issue
Submission Date
for 2012
Aprilclosed
May
10th April 2012
June
7th May 2012 July
6th June 2012
August
6th July 2012
September
6th August 2012
October
6th September 2012
November
8th October 2012
December
6th November 2012
If you would like to submit an
article for inclusion in Medicus
please contact Robyn Waltl,
in the first instance, via email
on [email protected]
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.
March ME D I C US 51
52 M E D I CU S March
I
ndustrial
Updates
 AMA Guidance for GPs Regarding
Nurse Practitioners
GPs have been asking what they should
do if they receive documents about a
patient from a nurse practitioner.
Last year, the AMA held a forum with
other GP groups, nursing bodies and
Medical Defence Organisations. The
forum agreed that a GP would be under
a professional obligation to:
• review the information; and
• consider what, if any, action was
required.
The same meeting concluded that,
where a GP receives documents from
a nurse practitioner, the following
courses of action would be appropriate,
depending on the general practitioner’s
circumstances:
1. If the GP is in a collaborative
arrangement with that nurse
practitioner, he or she should comply
with the terms of that arrangement.
2. If the GP is not in a collaborative
arrangement with that nurse
practitioner:
• If the results are clinically
significant, the GP should
satisfy himself or herself that
appropriate action is, or has been,
taken by the practitioner who
initiated the investigation(s).
• If the results are not clinically
significant, the GP should add
the information to the patient’s
file according to his or her usual
practice.
• If the clinical significance of the
information is not clear, the GP
should satisfy himself or herself
that appropriate action is, or has
been, taken by the practitioner
who initiated the investigation(s).
If you do not consider yourself to
be the patient’s usual GP because you
do not know or you have not seen the
patient for an extended period, you
should write to the nurse practitioner
and the patient advising to this effect
and asking not to be sent any further
results in relation to that patient.
The same letter should also state
that the results should be given to the
patient’s usual GP and that the patient
should consult the GP as soon as
possible.
Alternatively, you can suggest that the
patient make an appointment to see you
to discuss the results. If the information
suggests that the patient needs urgent
medical attention, this should be
highlighted, with the patient being
advised as a matter of urgency.
(This extract is from the
Federal AMA GP Network News)
 Amended Version of Nurses Award
2010
During 2011 Fair Work Australia varied
the Nurses Award 2010; the variations
related to the following:
• 9th March 2011, the Award was
varied as follows:
1. By deleting clause 4.1(b) and
replacing it with:
“(b) employers who employ
a nurse/midwife, principally
engaged in nursing/midwifery
duties comprehended by the
classifications listed in Schedule
B - Classification Definitions.”
2. By deleting clause 4.7.
3. By renumbering clause 4.8 as
clause 4.7.
4. By adding the following at the
end of clause B.2:
“For the purposes of this award
nursing care also includes care
provided by midwives.”
• 20 June 2011, the variation amended
wage schedules as a result of the
Annual Wage Review decision.
• 21 June 2011, the variations related to
allowances again following on from
the Annual Wage Review decision.
An updated version of the Nurses
Award is available from the AMA
(WA) website at WorkplaceRelations/
PrivateMedicalPracticeBulletin.
 Amended Version of Health
Professionals and Support Services
Award 2010
During 2011 Fair Work Australia varied
the Health Professionals and Support
Services Award 2010. The variations
related to the following:
• 20 June 2011, the variation amended
wage schedules as a result of the
Annual Wage Review decision.
• 21 June 2011, the variations related to
“expense related allowances” again
following on from the Annual Wage
Review decision.
• 21 June 2011, the variation the
Supported Wage Schedule by
increasing the wage payable.
An updated version of the Health
Professionals and Support
Services Award 2010 is available
from the AMA (WA) website
under WorkplaceRelations/
PrivateMedicalPracticeBulletin.
The Full Text verison of AMA (WA) Industrial Updates can be downloaded from
www.amawa.com.au/workplacerelations/industrialupdate.aspx
March ME D I C US 53
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Established in 1973, Killerby has grown to be one of Western Australia’s leading small
wineries, with a reputation for producing an outstanding range of varietal wines, namely
Shiraz and Semillon.
Situated in the cool and beautiful Margaret River region of Western Australia, about
2.5 hours drive from Perth; Killerby was one of the founding wineries of the world famous
Margaret River and Geographe regions of Western Australia. Dedicated and passionate wine
lovers laid the foundation for what is today one of the greatest wine producing regions in
Australia and indeed the world.
ORDERS-Free call 1800 655 722
Purchase 12 bottles for $252.00 doz (normally $360.00 doz)
54 M E D I CU S March
D
rive
Alfa Romeo 1750 QV Giulietta
by Dr Peter Randell
DNA – it shows through so often, in both medicine and cars.
In 1969 as a junior RMO at Fremantle Hospital, I lusted after
an Alfa Romeo 1750 GTV, then called a Giulia. Cost killed
the lust, as the ask of $2,450 was close to my annual income
of $3,300. Advance 43 years, and I have the 2012 iteration of
that model in my driveway. What a contrast, yet the DNA still
pulled in my memories.
Gone is the two-door coupe with rear wheel drive front
engine rorty four cylinder five speed with a carby; present is
a Milano fashionista, five-door swoopy hatchback, transverse
front wheel drive with a turbo-charged 1.8 litre with a sixspeed gearbox. The evocative heart-shaped radiator grill is
still recognisable after four decades, as is the Quadrifoglio
Verde – hence the QV in the name – on the front wheel guard;
the 4 leaf clover, green on a white background. This has been
used by A-R as a symbol of their performance models since
1923 when it made its initial appearance on the winner of the
Targa Florio in Italy.
Though giving the appearance of a two-door coupe,
my grandchildren did find the rear door handles after a few
seconds of puzzlement. As on other A-R models, the handles
are skillfully fashioned – and I use that word carefully - into
the upper edge of the door frame. Fashion plays a significant
part of the appeal of this pretty car, from the flashy 18-inch
turbine pattern mag wheels (through which can be seen red
brake calipers) to the enameled Alfa snake-and-cross insignia
in the horn boss. Beware the low side-skirts and nose cone
on kerbs though. The interior is a slick mix of shapes and
textures, with soft-feel plastics and some MINI-like switch
gear for the lights. The seats have the familiar Alfa-Romeo
horizontal pleated cloth and leather. Looks good, but I would
like a bit more lateral bolstering to hold hips in place during
spirited cornering. My passengers did not like the shiny
floor surface for the same lack of grip, and to finish my little
whinge, I missed a left foot rest. The intelligent steering wheel
has Bluetooth phone controls and stereo control. There is
a very punchy Bose system, with a clever sub-woofer in the
spare wheel well. Cruise control, a trip computer and twin
controls for the aircon fill out the dash switch gear.
Of them all, I LOVED that little switch that says “DNA!”
...that is the DyNAmic driving request to the engine, steering
and I suspect suspension. Punch that switch when driving,
and there is an instant eagerness – palpable in hand and
foot. The turbo hits hard from about 2,500rpm and readily
finds the rev limiter if you are a little slow shifting up. Alfas
don’t like slow gear-changers, so concentrate! You are in
an Alfa, a driver’s car, so DRIVE it! Under the bonnet the
rather quiet and very efficient engine produces 173kW or
235 old-fashioned horses. This is a record power output
for this engine class. Torque is a solid 340Nm, sufficient to
induce torque-steer grab on full throttle acceleration. Weight
has been kept down to 1,320kg, thanks to aluminium and
magnesium replacing heavier steels where possible. Don’t
think that compromises safety, as the Alfa-Romeo Giulietta
was declared Europe’s safest compact car in 2011, and indeed
won European Car of The Year from a list of 41 candidates.
There are six airbags as well as the usual accompaniment of
electronic safety circuits controlling brakes/throttle interplay.
Thus there is the usual ABS, EBD, but also Cornering Brake
Control, Hydraulic Brake Assistance, and self-aligning head
restraints to decrease whiplash. Lighting now has a safety
role also, with most new vehicles including this Alfa showing
running lights when ignition is turned on. They are bright
LEDs, and are repeated in the tail lights
It is not hard to see why the European motoring press
gave the gong to the Alfa Romeo 1750 QV Giulietta
for their COTY. With its combination of spirited
performance, sexy swoopy looks, 7.6L/100kms
economy – if you don’t drive it like yours
truly, enjoying the experience! – extensive
equipment and especially its safety, it is a
winner in the class.
Though so different to my 1969 experience,
that Alfa Romeo frisson is still there in the
Giulietta thanks to that lovely Italian DNA.
Viva Alfa-Romeo!
Vehicle supplied by Barbagallo Alfa Romeo. RRP $41,990 – a mere trifle to a 21st century intern! Why, when I was a junior RMO living on a bare balcony with
winter winds whistling through the leaky louvres, we took turns sharing the blanket and...
March ME D I C US 55
F
ood
An Irish Stew for St Patrick
by Sophie Budd of Taste Budds, www.tastebudds.co
St Patrick’s Day is upon us, and what better way to celebrate
than to cook one of Ireland’s most popular dishes.
I spent a few wonderful months working for my cousins
in Ireland at their well known restaurant “Cliffords,” where
Michael and Deidre entertained guests with true Irish charm.
The restaurant at the time was above an old pub called ‘The
Bell’ in Tipperary, and at the end of each shift I would make
my way downstairs to head home. The landlord Tom always
had other ideas, and had a pint of Guinness waiting for me
on the bar. I couldn’t tell him that I wasn’t fond of the stuff,
so drank it slowly and headed home. One particular night
he poured me a few as the pub was alive with locals playing
music, from guitar, to triangle, to maracas or even just a stomp
on the floor. I drank away then tried to leave, but as the Irish
do, they insisted I stay. Being afraid of drinking too much
and driving home, I protested. Tom called out to all of the
drunkard men leaning on the bar and pronounced, “you have
no need to worry about that my dear, the whole of Tipperary
police force are here in the pub, there isn’t a copper on the
road tonight!” Yes, this was true, the whole pub cheered! Only
in Ireland! I assure you I stopped drinking and drove home
safely and I now have a great love for Guinness!
This recipe is so simple and traditional it will please the
whole family. It is important to buy the lamb shoulder as it has
quite a high fat content which enables it to melt and tenderise.
Buy it from your local butcher and ask them to save the bone
for you; it will add heaps of flavour. If you want to serve with
some creamy mash it will go beautifully!
I share this recipe with you and dedicate it to the most
amazing and talented late Michael Clifford.
Cliffords Irish Stew (serves 4–6)
1kg shoulder of lamb, well trimmed and diced
(keep the bones)
2 carrots, chopped
1 onion, chopped
2 small white turnips, chopped
4 potatoes, chopped
2 sticks celery, chopped
1 leek, finely sliced
Salt and black pepper
50g approx. green cabbage, finely shredded
125ml cream
Dash of Worcestershire sauce
Chopped parsley
56 M E D I CU S March
•
•
Place the lamb in a large pot. Cover with cold water
and bring to the boil. Drain and rinse the lamb, then
place in a clean pot. Add the bones to the pot, cover
with approximately 1 litre water and add the prepared
vegetables, except the cabbage. Season to taste.
Cover the pot and cook gently for about one hour, or until
the meat is tender, then remove the bones from the pot.
To finish the sauce, remove about 250ml of the liquid and
vegetables from the pot. Process this with the cream and
return to the pot with the finely shredded cabbage. Add the
Worcestershire sauce. Simmer for 5–10 minutes, until the
cabbage is heated through. Check the seasoning. Add the
parsley and serve in deep plates.
Now Selling/Leasing
Now Leasing Joondalup CBD
126 Grand Boulevard,
Joondalup
–
–
–
–
–
Busy medical centre
162m² approx
Open plan
Available immediately
Other tenants include general
medical practice, dental surgery,
pathology, radiology and fitness
centre
$68,850 pa + GST & outgoings
Clive Norman 0403 804 119
[email protected]
–
–
–
–
–
Now Selling
Now Leasing
7 Ellen Street, Subiaco
46/85 Monash Avenue, Nedlands
Freestanding character premises
Suit consulting rooms
Land area 455m²
Improvements 150m² approx
Near SJOGH Subiaco and PMH
$1,950,000 plus GST
Rob Selid
0412 198 294
[email protected]
Brian Neo
0411 868 486
[email protected]
–
–
–
–
Hollywood Medical Centre
Improvements 75m²
Three consulting rooms
Fully fitted out
$33,750 pa + GST & outgoings
Ben Flanagan
0405 929 167
[email protected]
March ME D I C US 57
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58 M E D I CU S March
DL12195
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W
ine
A new vintage from a
gifted winemaker
Barossa continues to look to the future and is producing a new
generation of wine makers to carry on the Barossan tradition
and push the wine making boundaries.
Fraser McKinley is one of the new Barossan breed and
a gifted wine maker. McKinley did a stint overseas, and on
returning to the Barossa, he has done vintages at Torbreck
Vintners and works with the Standish Wine Company. In
2006, McKinley began a new project developing his own
small winery with a name Sami-Odi, and began production
of small quantities of Syrah of incredible quality. He has a
particular gift for carefully selecting plots in the Barossa
valley’s finest vineyards and vinifies them separately to
produce the wines under the Sami-Odi label. His 2010 vintage
has been eagerly awaited and consists of three different
Syrahs.
2010 Sami-Odi Hoffmann Dallwitz 0.534 Syrah
The name of this wine is somewhat bewildering but the
following explanation may help. The fruit for this wine comes
from a small section consisting of 0.534 of a hectare located
within the Hoffmann families’ “Dallwitz” property in EbenEzer, a stone’s throw from the northern boundary of the
Barossa valley. The block was planted from ungrafted cuttings
in 1995 with a “VSP” trellis to encourage vertical shoots
and greater shading with a crop. McKinley’s viticultural
philosophy with respect to this vineyard is based upon
the lunar cycles, pruning, and adherence to basic organic
principles. All cuts in the vineyards are made in descending
moons with the greatest of care, with an aim of producing
fine canes, healthy and balanced clusters, small berries and
resilient skin. McKinley points out that each year, he shoots
thin in the late spring and tunes the crop in December and
January to allow a well balanced and shaded crop yielding
between 19–34 hectolitres per hectare. His goal with these
methods is to work and grow as “natural” as possible,
resulting in harvest of healthy fruit that requires no additions
or adjustment and little intervention. Once harvested and
hand-sorted, the clusters undergo their primary fermentation
at whatever pace the season dictates, without the use of
destemming and pumps, enzymes or temperature control. To
encourage the retention of naturally occurring carbon dioxide
(a by-product of fermentation and a natural preservative and
anti-oxidant) the wines are not racked or transferred and are
left sur-lie during their elevage, which typically lasts between
77 and 82 weeks. The five Piéces and two glass vats from
2010 were assembled and bottled during the descending
moon of October 2010. Prior to bottling, a homeopathic
addition of sulphur was utilised and the wine was bottled
without filtration, fining, stabilisation or sparging (the
removal of natural occurring oxygen and CO2). All transfers
were completed via gravity (and without electricity) prior to
bottling. 1,488 bottles were filled.
2010 Sami-Odi Hoffmann Dallwitz MCMXI Syrah
This wine’s name is a variation on the Hoffman Dallwitz
wine just discussed. The fruit for this Syrah came from a
‘slither-like’ sector of the Hoffman’s oldest plants which were
established prior 1912 by Oscar Falland on the land that at
the time belonged to the Dallwitz family. This 2.12 hectare
patch is again farmed by the Hoffman family each season
and has been cared for by the family since they commenced
share farming here in the 1920s. The 372 wines lie adjacent
to the younger plants and the roots are entrenched to a very
similar fusion of red/ brown earths over deep red clays with a
dissecting layer of limestone. The harvest for this vintage was
26 days later than the younger plants, with an identical yield
of 25 hectolitres per hectare. A small batch of 912 bottles was
made from the fruit.
2010 Sami-Odi Helbig Syrah
McKinely states this wine is a homage to one of the greatest
mentors a wine making novice would ever hope to encounter.
He states that “at the tender age of 67, Don Helbig is both a
paramount Sensie and the ultimate student, relentlessly fine
tuning his art as a wine grower without ever assuming mantle
or resting on his laurels.” The fruit for this wine is leached
from south-facing vines that are adjacent to Don Helbig’s
home on Reonnfeldt Road in the now tres chic Marananga.
The wines planted in 2003 are by no means old but to Don
Helbig and McKinley, they are certainly very special. This
parcel of fruit produced a sum of 324 bottles of the Sami-Odi
Helbig’s Syrah.
Now some readers may find some of McKinley’s
viticultural methods such as descending moons and
homeopathic remedies to be a little quirky, but at the end of
the day, it’s what is in the bottle – the finished product is all
that matters. If any of the previous handful of small-batch
vintages are anything to go by, these wines will be testimony
to a talented winemaker.
March ME D I C US 59
The longest
eight seconds in the world
by Kaye Fallick
Wayne Knight didn’t win the chuck
wagon race at this year’s Calgary
Stampede. In fact, he didn’t even make
the cut for the final of the “half-mile
of hell.” But winning isn’t his main
reason for racing: Wayne’s real passion
is reserved for his horses. He has saved
many of them from the knacker’s yard
and patiently nursed them back to
health, restoring their minds and bodies,
which often results in a “second career”
as champions on the rodeo circuit.
We meet Wayne backstage at the
2009 Calgary Stampede. The Stampede
originated with the informal races which
ranchers used to hold to show off their
skills at bull riding, bareback riding and
Wayne Knight
roping steers.
The chuck wagon racing began when
the cooks who drove the provisions
wagons held a competition to see who
was fastest at packing camp, racing
a wagon drawn by four horses, then
setting up camp and getting a fire going
at the next destination. Nowadays safety
reigns supreme and the tent poles are
plastic, as is the barrel which represents
the stove. All items need to be thrown
(accurately) into the wagon at the
60 M E D I CU S March
beginning of the race before the wagon,
horses and four outriders charge off
around the arena.
The Calgary Stampede is now a
10-day multi-media extravaganza
offering thrills, spills, laughter, tears,
shock and awe aplenty to daily crowds
of more than 100,000 riders, dancers,
cowboys, bachelorettes, mums, dads,
grandparents, uncles, aunts, cousins,
waiters, stall holders, exhibitors, TV
anchors and other attendees.
I could wax lyrical about the chinablue July skies and late-night Alberta
sunshine, but why lie? When I visit the
Stampede, it is a wild, wet and windy
affair, with sheets of rain dumping
two-and-a-half inches of water on the
main arena in just 45 minutes. The
Stampede ‘royalty’ – various beauty
queens and fundraisers from around
the world – are invited to take the stage
in this drenching downpour. Hairstyles
disintegrate, mascara streams, but
smiles are bravely fixed as a huge crowd
cheers and whistles.
Nothing, but nothing, stops for the
rain. Not the bull clowns who perform
handstands in rusty-coloured puddles,
nor the bareback riders on horses
slithering sideways, nor the bull riders
clinging for dear life during the longest
eight seconds in the world. Nor, indeed,
the hundreds of volunteers checking,
selling, stamping, shepherding,
announcing, greeting, healing and
consoling.
The show, it seems, will always go on.
We had a high-style pass, which
allowed us access to both the chuck
wagon stables and drivers and the
bucking chutes. At the chutes, we share
an insider’s view of the cowboys being
placed on the bulls, before the gate is
pulled open and the bull takes off into
the main arena with one intention – to
get that man off his back. The contrary
aim of the cowboy is to stay on for
the eight seconds. Performances are
adjudicated by two judges who award
points for both riding style and how
“rank” the bull is – the ranker the bull,
the higher the potential points.
Our knowledge of the finer details
of this rough-and-ready skill has been
gained during a visit to Joe Messina’s
Fantasy Adventure Bull Riding (FABR)
ranch. Joe, originally from Burra, New
South Wales, started bull riding at 15
before leaving home to try his hand at
rodeos in America and Canada. After
Joe Messina
in the cowboy hat
16 years in the saddle, he decided that
whilst bull riding is a younger man’s
game, spectators deserve a chance to
feel the adrenalin associated with this
elite sport.
T
ravel
The fantasy experience includes
a turn on the mechanical bull, but
the true highlight is Joe’s careful
explanation of the key techniques for
staying on – before you are assisted into
the chute and onto the back of one of his
900 kilogram animals. Mine is a fairly
resigned beast, but a quick hop on and
off still gives me bragging rights with
my (yet-to-be-born) grandchildren that
I have, indeed, ridden a bull. Others in
our group are far braver, particularly
Amy, whom Joe places on a ‘juiced up’
beast that bucks violently, requiring
Amy’s immediate extrication!
There are six major events at the
Calgary Stampede: bareback bull
riding, barrel racing, saddle bronc, steer
wrestling and tie-down roping. There
are novice events for those who are less
experienced, including the very junior
competitors who show their courage
in the wild pony racing. We enjoyed
all these events as well as the fun of
the fairground, agricultural show and
Nashville North, a huge barn with a
bar, live performers and hundreds of
cowgirls and cowboys doffing hats and
falling in love during the two-step.
There are winners and losers
every day, but it really doesn’t seem
to be about the money. For the 2,000
volunteers, it’s a chance to leave their
day jobs and join the biggest party in
town, reconnecting with the rural skills
and activities which drive the nation.
For the competitors, it’s an opportunity
to compete with the best in the world,
meet old friends and make some new
ones.
And for seasoned chuck wagon
hands like Wayne, it’s a way of life, an
opportunity to hone his skills and, most
of all, a reason to spend even more time
around his beloved horses.
This year the Calgary Stampede
celebrates its 100th anniversary over
6–15 July. You can find out more details
at www.calgarystampede.com.
Kaye Fallick is publisher of YOURLifeChoices website - www.yourlifechoices.com.au.
She travelled to Calgary courtesy of the Canadian Tourism Corporation.
March ME D I C US 61
P
hotography
Is HDR for You?
by Denis Glennon
HDR (High Dynamic Range) photography is when you take
three or more photos of the same subject at different exposure
settings and then merge them into a single image using special
software. What you get, when done correctly, are really
beautiful photographs with amazing detail, controlled lighting
and accurate colour.
Dynamic range is simply the variation in light level from
the brightest to the darkest areas in a scene. A landscape scene
on a bright sunny day in Perth can have a dynamic range
of 100,000:1, meaning the brightest area is 100,000 times
brighter than the darkest shadow.
It is very difficult for any camera sensor, irrespective of
price or number of megapixels, to capture this enormous
range of luminance (light).
Unlike a camera’s sensor, our eyes automatically adjust for
harsh light and dark shadows and interpret and record colours
and details much more precisely. You can experience the
marvellous ability our eyes have to adjust, if you view a bright
ocean scene for a while and then walk into a room that has
the curtains drawn. Within a minute or so you can accurately
discern the details in the darkest corners of the room and be
delighted by the softest hues in furniture fabrics.
Frequently we ask our cameras to do the nigh impossible
when we try to photograph subjects that have very bright areas
and lots of mid-level tones as well as very dark shadows.
Why Spend the Extra Effort on HDR?
Using HDR photography you can forget (more or less) about
the difficulties of capturing scenes that are very contrasty
and/or have extremes of harsh light and deep shadows. You
can instead produce wonderfully crisp photos with superb
detail primarily because you take personal control of the wide
variability of light on your subject. You no longer leave it to the
computer in your camera to decide on the best compromise
image it can produce.
There are some terrible “grungy” examples of HDR
photography (when the technique is pusher too far), but it does
not have to be like this, unless of course if you intentionally set
out to create this kind of result.
HDR is best suited, but not confined to, landscapes (if parts
of it do not move when you are shooting, for example, trees
in wind, waves in water, clouds in sky, etc.), buildings, indoor
subjects, vehicles (particularly old ones with character and
colour) and even wildlife (if standing still).
Despite what you read on the internet you cannot mimic
an HDR image by manipulating a single Jpeg or even a RAW
62 M E D I CU S March
image in Photoshop. Have a go if you like, but it really is a
waste of time compared to doing it correctly.
So How Do We Start?
It is perfectly fine to capture three images with a “pointand-shoot” or compact camera. It just means you have to
take a little more care and go through a few more steps at the
“taking” stage. If you use a compact camera, place in on a
small tripod or at least hold it against or place it on something
fixed, such as a wall, building, car, rock, or similar.
All you need is:
1. a reasonably good compact camera
2. a small tripod to stop the camera moving as you take
the three images and
3. a remote control cable for firing the camera – not
essential, but it helps enormously as you do not need to
touch the camera when you take the three images.
The following settings work well for me on a compact camera:
• Use an ISO of 100 or as low as your camera will allow.
• To start, shoot Jpegs – shooting in RAW will give far
superior results but let’s walk before we try running. I
shoot in RAW all the time.
• Turn off all auto settings such as flash, white
balance, autofocus, ISO, etc.
• Use an Aperture of f/16 or higher for better
sharpness and more depth of field.
• Shoot in Av (aperture priority) mode – this keeps the
aperture fixed.
• Use Manual Focus – focus on a point about a third of
the way into the scene.
• Compose and take the first shot as you would
normally – this captures the detail in the mid-tone
areas very well, but probably not so well in the dark
shadows or in the bright sky and clouds. We need to
take two more shots to fix this.
• Change the exposure to +2EV and take the
second shot – this captures the detail in the dark
areas. Do not move the camera!
• Change the exposure to -2EV and take the third
image – this captures the detail in the bright areas. Do
not move the camera!
• That’s it.
• Transfer the three images to your laptop/desktop
as you would normally do.
• We now use very intuitive software to combine
these three images into one that combines the best
parts from all three.
Which Software – The Easy One First?
If you have Photoshop CS2 or later you can use
HDR Merge; this does a good job and is very
easy to use. All you have to do when you open
Photoshop is go to File>Automate>Photomerge
and a new window box opens up; see Fig 1. To
start with use the “Auto” function, and ensure the
box “Blend Images together” is ticked, as shown
in Fig 1. Hit the “Browse” button and locate
your three images. When the data for your three
images appears in the white box, hit the “OK”
button and watch the magic happen!
The detail and the colours in the blended image
will surprise you.
If you are not quite happy with Photoshop’s
Auto mode efforts, you can use your preferred
Photoshop tools to enhance the image further.
Have fun!
Fig 1. Photomerge window box in Photoshop Cs2 and later versions.
NEXT MONTH: If you own a DSLR, there are a number of settings such as AEB (auto exposure bracketing) and Continuous
Shooting Mode (AI Servo on Canon) you can use to make life easy for taking three or more images rapidly. Also there is one
particularly good, inexpensive piece of software that does a better job than Photoshop’s Photomerge. Next month I will write
about this software, how to use your DSLR for HDR and include some example images.
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Telephone: 08 9388 2833
email: [email protected]
web: www.smithcoffey.com.au
March ME D I C US 63
G
arden
Autumn Snowflakes
Tim Parker Dawson's Team Member
We are happy to answer your gardening questions and stock enquiries.
Email: [email protected] or visit www.dawsonsgardenworld.com.au.
See us on facebook: www.facebook.com/dawsonsgardenworld
The fleeting flowers of Sasanqua
Camellias are an Autumn delight
Sasanqua camellias are one of the standout performers in the
autumn garden, providing an abundance of showy flowers
through autumn and often well into winter. While Sasanqua
flowers aren’t as long lasting as the Camellia japonica varieties,
they do flower in great profusion and the carpet of fallen petals
is a delight to behold. In Japanese temple gardens Sasanquas
are symbolic of fleeting beauty, their gently falling petals like
autumn snowflakes.
Sasanquas grow from between 1.5m to 4m in height,
perfect for privacy screening and hedging use. These versatile
camellias make wonderful container specimens when planted
in large tubs and glazed pots. You can also try your hand at
espalier, training them on walls and fences.
Their delicate appearance belies the fact that Sasanquas
are probably the hardiest and easiest of camellias to grow.
Favoured positions include those receiving morning sun and
afternoon shade, and semi-shaded areas. They can also be
grown successfully in full sun positions, provided they are
watered daily during the warmer months and a thick layer of
moisture-conserving mulch is applied.
Camellias prefer slightly acidic soils, so to grow them
successfully in Perth’s limey sands, blend in Dawson’s Organic
Soil Improver at the rate of two parts soil improver to two
parts soil (a 50:50 mix). Mulch around plants with a coarsegrade acidic mulch like Waterwise Pine Bark Mulch, leaving
a 10–15cm bare circle around the stem. Water newly planted
camellias daily until well established.
This autumn our nursery has turned out a bumper crop
of semi-advanced-size Sasanqua camellias, including these
classic varieties; Chansonette (double, lavender-pink blooms)
and Jennifer Susan (vigorous, semi-double pink), Rose Ann
(deep rose-pink, semi double), Setsugekka (classic, single
white blooms) and Yuletide (glowing, single red flowers).
64 M E D I CU S March
H
istory
Dr John Ferguson:
The doctor who wanted to farm
The history of medicine in Western Australia has many strands
that over the decades have combined to form our current world
leading health care system.
One strand involves a certain Dr John Ferguson, his family,
a ship called the Trusty, a desire to live off the land and the
history of wine in WA.
Born in 1802 in Dundee, Scotland, Ferguson became
a Member of the Royal College of Surgeons in 1822 and
practised at Auchtermuchty, Fife. Although
Ferguson was a highly regarded physician
and surgeon, his dream was to be a farmer.
In the early 1840s The West Australian
Company, located in London, was
promoting land under the Wakefield
System. The Wakefield System worked on
the basis that land in the colonies be sold at
a reasonable price, with the proceeds being
used to bring labourers and migrants to the
colonies to develop them.
In 1842, when Ferguson decided
to try his hand at farming, The West
Australian Company was promoting land in
Australind. The Company hoped to settle
a large number of pioneers for the purpose
of breeding horses for the Indian army, which was a lucrative
trade at the time. The Company needed settlers who could
breed the horses and grow the food crops needed to sustain the
community, and Australind takes its name from a combination
of Australia and India.
So, with the dream of farming planted firmly in his heart,
Ferguson packed up his wife and two sons, headed to Australia
and on 6 December 1842 he took up 400 acres of land on the
Brunswick River.
However, his intentions to give up medicine altogether were
short-lived. As is often the case when dreams meet reality,
farming life was not as easy or prosperous as he had hoped.
Ferguson’s medical skills were often in demand due to him
being far more experienced than the local doctors, which
proved to be fortuitous because his knowledge of farming was
very limited.
So Ferguson decided to return to medicine full time, and
in 1847 he applied for the post of Colonial Surgeon of the
Western Australian Colony.
Ferguson competed with five other contenders for the
position of Colonial Surgeon, and his appointment was met
with much contention, early proof that politics is never far away
in most aspects of life:
“It is generally understood that Dr Ferguson of Australind
has obtained the appointment of Colonial Surgeon, vacant by
the death of J. Harris Esq. We can positively assert that all the
civil officers as well as the public were taken by surprise when
the announcement was made, seeing that W. Sholl was entitled
to the berth by length of service in the colony, a promise of the
first vacancy and a voice of the majority of civil officers backed
by testimonials of the inhabitants as to his skill and unwearied
attention to his profession.” Perth Gazette, June 1846
Ferguson weathered the storm and proved himself to be a
champion of health reform – fighting for
the building and continued improvement of
the Colonial Hospital (now the Royal Perth
Hospital), better conditions for mental
health patients, access to medical care for
all (in particular the poor), and the delivery
of better health services.
In 1849 Ferguson used chloroform to
successfully amputate a man’s leg – one
of the first recorded cases of the use of
chloroform in this type of procedure and
only six months after its first practical test
in England.
In August 1852, he warned the Colonial
Secretary that a patient with whooping
cough, a Mrs Robertson, could pose a
threat to the wellbeing of the Aboriginal community. His
concern predates discussions in the wider medical profession
on the development of the immune system.
In 1870 he was appointed the first president of the newly
established Medical Board of WA.
Although Ferguson’s medical achievements were many,
today most people know of him not by his name but the
legacies he left as a landowner.
In 1859 he purchased farming land in the Swan Valley
from Colonel Houghton. Although there was already a small
vineyard on the land, Ferguson wanted to grow food crops,
such as wheat. But as with all his previous farming endeavours
his crops failed to produce any significant returns – but the
small vineyard thrived. In 1863 he enlisted the assistance of
his son, Charles, and purchased a neighbouring property,
Strelley, and they planted more vines.
In its first year of production Houghton Wines produced
25 gallons of “quality” wine, eventually becoming a winery
of international standing, with a name that is still recognised.
Ferguson’s dream of being a successful landowner was finally
realised.
Ferguson died at the age of 81 on 11 September 1883, and is
buried in the old East Perth Cemetery. He was survived by his
wife Isabella Ferguson, who lived to 91 years of age, two sons
and three daughters.
March ME D I C US 65
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
Wine, dine and stay at the iconic Hotel Rottnest located overlooking the crystal
clear waters of Thomson Bay. AMA (WA) members: One night’s accommodation
in a courtyard room, complimentary bottle of Sandalford wine on arrival and a $50
voucher for dinner in our bar (food only). $250 per couple (2ppl maximum).
To book or for more information call (08) 9292 5011 or [email protected].
au and quote code: AMA wine, dine & stay.
Conditions apply:
Offer valid to AMA (WA) members only, accommodation subject to availability,
package available Sun–Fri only, package inclusion on first night only.
Not valid for the months of December & January. *$190 for additional night stay
The Lexus Corporate
program will provide
AMA (WA) members
to a new standard
of luxury.
The program includes:
• Scheduled servicing to 3 years or 60,000kms
• Discounted dealer delivery and corporate pricing
• Airport valet service
• Complimentary service loan cars or pick up and delivery
• Plus much more ...
To find out more about exclusive offers for AMA (WA)
members contact Corporate Development Manager at Lexus
of Perth, Craig Nylander, on 9340 9000 or
[email protected]
Spotless Painting
offers AMA (WA) members
the following:
Painting in and out of hours to
minimise disruptions
Painting during Christmas
closures (subject to availability)
Low VOC paint (low fume)
Free colour matching if required
Obligation-free quotes
Accredited Sustainable Painting Practises-logo attached
Spotless Painting is offering AMA (WA) members a
5% discount.
For more information,
contact Spotless Painting on (08) 9371 6555 or
www.spotless.com/au/painting.
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% of the scale fee.
Visit our website at www.mckinnonandpenny.com.
au and request a quote by email or call Joe Stolz on
(08) 9221 1222.
Fly free from Darwin to Bamurru Plains
on the scheduled air
service!
Bamurru Plains is located just to
the west of Kakadu National Park
on the Mary River floodplains. A
profusion of bird and wildlife are on
the doorstep of a unique bush camp that exudes ‘Wild
Bush Luxury’ and brings a touch of style to a remote and
beautiful wilderness.
For exclusive offers for members contact Bamurru Plains
on 1300 790 561.
Into Wildlife is a one-day seminar ideally suited to
secondary students 15 years or over. It provides insight
into relevant tertiary courses and the variety of careers
available working with animals.
You will:
• Hear from guest speakers
from tertiary institutions and
conservation organisations
• Get tips on making contacts and
‘getting your foot in the door’ to
competitive and exciting careers working with wildlife
• Get an in-depth look at the work of zoo keepers.
There is limited availability so book soon!
For more information visit www.perthzoo.wa.gov.au/learn.
66 M E D I CU S March
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 COB Monday 2 April 2012
Titanic in 3D
In cinemas April 15
Treasure hunter Brock Lovett and his
team explore the wreck of RMS Titanic,
searching for a diamond necklace
called the Heart of the Ocean. They
recover Caledon “Cal” Hockley’s safe,
believing the necklace to be inside, but
instead find a sketch of a nude woman
wearing it, dated April 14, 1912, the
night the Titanic hit the iceberg.
Spud
In cinemas 19 April
Set in South Africa, 1990, where two
major events are about to happen:
the release of Nelson Mandela and,
more importantly, it’s Spud Milton’s
first year at an elite boys-only private
boarding school. John Milton is a
boy from an ordinary background
who wins a scholarship to a private
school in Kwazulu-Natal, South Africa.
Surrounded by boys with nicknames
like Gecko, Rambo, Rain Man and Mad
Dog, Spud has his hands full trying
to adapt to his new home. Along the
way Spud takes his first tentative steps
along the path to manhood. The path,
it seems, could be a rather long road.
A Dangerous Method
In cinemas 29 March
Seduced by the challenge of an
impossible case, the driven Dr Carl
Jung takes the unbalanced yet
beautiful Sabina Spielrein as his
patient in A Dangerous Method.
Jung’s weapon is the method of his
master, the renowned Sigmund Freud.
Both men fall under Sabina’s spell.
A love story about a boy and girl from
differing social backgrounds meet
during the ill-fated maiden voyage of
RMS Titanic.
Street Dance 2 in 3D
In cinemas 19 April
When top street dancer Ash is
humiliated and laughed off stage by
American dance crew Invincible, he
sets off to gather the best dancers from
around Europe to take them on – with
a dance style they weren’t expecting.
Ash falls in love with a beautiful salsa
dancer as he discovers the magic,
power and passion of dancing for the
ultimate global dance-off.
Stravinsky & Sibelius
Double pass, Friday 20 April
Stravinsky’s peasant wedding feast
set the world ablaze at its premiere
with its driving rhythms and mammoth
orchestra and chorus. Featuring the
West Australian Symphony Orchestra
together with three talented soloists
and the WASO Chorus, this will
be an incredible experience in the
magnificent acoustics of the Perth
Concert Hall. It is framed by two of
Sibelius’s greatest orchestral works.
March ME D I C US 67
Professional Notices
CARDIOVASCULAR
Perth Cardiovascular Institute
• Dr Jay Baumwol
• Dr Matthew Best
• Dr Andrei Catanchin
• Dr Michael Davis
• Dr Matthew Erickson
• Dr Athula Karu
• Dr Susan Kuruvilla
• Dr Kaitlyn Lam
• Dr Michael Muhlmann • Dr Anne Powell
• Prof Gerry O’Driscoll
• Dr Sharad Shetty
• Dr Jamie Rankin
• Dr Gerald Yong
We are pleased to announce the addition
of Dr Jay Baumwol to our practice. Dr
Baumwol is a consultant cardiologist at
Royal Perth Hospital and a member of the
West Australian Advanced Heart Failure
and Cardiac Transplant service. His interests
include general cardiology, echocardiography
and the management of heart failure. Jay
will be practising from our Nedlands and
Rockingham clinics. To make an appointment
for Dr Baumwol phone 6314 6809.
The group provides a comprehensive
cardiac testing service at nine conveniently
located sites: Nedlands (Hollywood Private
Hospital), Joondalup Health Campus, Bentley,
Duncraig, Esperance, Midland, Mt Lawley and
Rockingham.
Services offered include:
• Cardiology consultations
• Echocardiography
• Exercise Stress Testing
• Monitor Fittings (Ambulatory BP, Event
and Holter)
• ECG.
Visit www.perthcardio.com.au for more
information on our services.
For Cardiology appointments: 1300 4
CARDIO.
For Testing appointments: 1300 HEART
TEST.
General Enquiries: 6314 6833. Fax: 6314
6888. Email: [email protected]
GENERAL SURGERY
Mr Harsha
Chandraratna MBBS
FRACS
General Surgeon with
sub-specialists interest in:
• Disease of the
liver, pancreas and
gallbladder
• Management of obesity
68 M E D I CU S March
within a multidisciplinary setting
including bariatric surgery
–oswa.com.au
• Pilonidal problems
• L aparoscopic surgery including
appendicectomy, cholecystectomy
and hernia
• Emergency surgery
Consulting and operating at St John of
God Hospital Murdoch and Subiaco.
For all appointments Tel 9332 0066 or
Fax: 9463 6202
HAND SURGERY
Lewis Blennerhassett MBBS FRACS
Dr Blennerhassett is a Plastic Surgeon
with post-graduate fellowship in hand
surgery certified by the American College
of Surgeons. Expertise in all aspects of
acute and chronic hand disorders, both
paediatric and adult, is provided.
For all appointments please Tel: 9381
6977.
Emergencies phone 0438 040 993
– all hours
Mr Peter Hales
Whose interests are:• arthroscopic surgery of shoulder,
elbow, wrist and hand
• wrist and hand, arthritis and instability
• acute hand trauma
Operating at Bethesda Hospital he
has now joined Perth Orthopaedic and
Sports Medicine at 31 Outram St, West
Perth.
All appointments and enquiries
Tel: 9212 4200 or Fax 9481 3792
Mr Paul Jarrett
FRACS
Hand and Upper
Limb Surgeon
provides a
comprehensive
service for elective
and traumatic
conditions for the hand,
shoulder and upper limb
at Murdoch Orthopaedic
Clinic for Workcover and
Privately Insured patients.
Please call 9311 4636 for appointments.
I am happy to be referred public patients at
Fremantle Hospital where I hold weekly clinics.
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
Mr Angus Keogh FRACS
Upper Limb Surgeon
My interests include
traumatic and
degenerative conditions
of the upper limb
including hand surgery,
arthroscopy including
small joints, complex elbow and wrist
instability. I consult in private rooms at St
John of God Subiaco and St John of God
Murdoch. I consult weekly at Sir Charles
Gairdener Hospital – please call 08 9346
1189
Please call 08 9489 8782 for
appointments. Workcover accepted.
HAND & PLASTIC SURGERY
Dr Robert Love MBBS FRACS (Plas) Dip
ANAT
All hand surgery, microsurgery and
plastic surgery
• Dupuytren’s Contracture
• Arthritides, Carpal Tunnel
• 24hr Emergency
• Requests for advice welcome
17 Richardson St West Perth and SJOG
Murdoch
Tel: 9321 3344
Mobile: 0409 132 602
INFECTIOUS DISEASES
Dr Desmond Chih MBBS FRACP FRCPA
Infectious Diseases Physician and Clinical
Microbiologist
All aspect of adult general infectious
diseases and diagnostic microbiology
including
• Fever of unknown origin
• Bone and joint infections
• Surgical infections
• Skin and soft tissue infections
• Travel related infections
• Tuberculosis
• 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]
OPHTHALMOLOGY
Dr Michael Wertheim
MBChB FRCOphth
FRANZCO
Comprehensive General
Ophthalmologist
Consults at: South Street
Eye Clinic, Suite 10/73
Calley Drive,
Leeming 6149
Early and Urgent appointments available
Operates at: Eye Surgery Foundation,
West Perth (Private patients)
Kaleeya Hospital, East Fremantle
(Public patients) Special Interests:
Cataract Surgery,
General Ophthalmology, Uveitis
For appointments Ph: 9312 6033
or Fax: 9312 6044
ORTHOPAEDIC SURGERY
Mr Grant Booth
MBCHB FRACS
Orthopaedic Surgeon
Providing the complete
range of shoulder
surgery including:
• Arthroscopic and open
surgery for instability
and rotator cuff pathology,
• Shoulder arthroplasty including
revision arthroplasty,
• Surgery for fractures about the
humerus, scapula and clavicle. Mr Booth
has an appointment at Royal Perth
Hospital for public patient referrals.
He is happy to be contacted for advice
regarding shoulder conditions.
For appointments or advice contact:
Perth Shoulder Clinic, Bethesda Hospital
25 Queenslea Dr, Claremont 6010
Mr Peter Honey, MBBS,
Tel: 9340 6355 Fax: 9340 6356
www.perthshoulderclinic.com.au
[email protected]
FRACS
Orthopaedic Surgeon
Hand, Wrist, Elbow,
Shoulder and Knee Surgery.
Special interests
• Joint replacement
surgery of the hand, wrist,
elbow, shoulder and knee
• Arthroscopic wrist, elbow, shoulder and
Perth Shoulder Clinic
Mr Grant Booth and Mr Sven Goebel
have recently established Perth Shoulder
Clinic situated at Bethesda Hospital
in Claremont and have commenced
accepting new referrals. Perth Shoulder
Clinic offers a comprehensive service for
treatment of disorders of the shoulder
including:
• Arthroscopic and open surgery for
instability and rotator cuff pathology,
• Shoulder arthroplasty including
revision arthroplasty,
• Surgery for fractures about the
humerus, scapula and clavicle
For appointments or advice contact:
Perth Shoulder Clinic Bethesda Hospital
25 Queenslea Dr, Claremont 6010
Tel: 9340 6355 Fax: 9340 6356
www.perthshoulderclinic.com.au
[email protected]
Mr Sven Goebel
MD FRACS
Orthopaedic
Surgeon
Providing the complete
range of shoulder
surgery including:
• Arthroscopic and
open surgery for instability and rotator
cuff pathology,
• Shoulder arthroplasty including
revision arthroplasty,
• Surgery for fractures about the
humerus, scapula and clavicle.
Mr Goebel is happy be contacted for
advice regarding shoulder conditions.
For appointments or advice contact:
Perth Shoulder Clinic Bethesda Hospital
25 Queenslea Dr, Claremont 6010
Tel: 9340 6355 Fax: 9340 6356
www.perthshoulderclinic.com.au
[email protected]
knee surgery
• Treatment of sporting injuries (including
knee ligament injuries)
• Treatment of simple and complex upper
limb fractures and dislocations.
• Tendon transfer surgery (L’Episcopo,
Eden Lange, transfers for scapular winging)
• Paediatric upper limb surgery, including
correction of congenital deformity
Appointments and enquiries:
4 Altona Street, West Perth, 6005.
Tel: (08) 9481 2856
Fax: (08) 9481 2857
Urgent advice or referrals:
0418 948 652
Karl Stoffel MD, PhD,
FMH (Tr & Orth),
FRACS
Professor of
Orthopaedics and
Trauma Surgery has
commenced consulting
and provision of
orthopaedic elective
& trauma services for all Workcover, DVA
and Privately insured patients at Murdoch
Orthopaedic Clinic.
Areas of Specialty:
• Hip Surgery
• Knee Surgery
• Foot & Ankle Surgery
• Orthopaedic Trauma
• Sports Injuries
I offer a no-gap service for all major health
funds and will be very happy to see Private,
Worker’s Compensation and Department
of Veteran Affairs patients at Murdoch.
Consulting Rooms: Murdoch Orthopaedic
Clinic, Suite 10, 100 Murdoch Drive, Murdoch.
For Appointments: Phone 9311 4639 or
9366 1818 Fax: 9311 4627
I am happy to see public patients who
should be referred directly to me at
Fremantle & Rockingham Hospitals.
March ME D I C US 69
at UWA
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Wes
Western Australian
Doctor’s Orchestra
calling all musical doctors
rehearsals start late July on
WADO requires talented Saturday afternoons
players for a concert on
9 September 2012
Please reply by Friday 27th April 2012
to Lynda Chadwick on [email protected]
70 M E D I CU S March
Professional Notices cont.
PSYCHIATRY
Dr Dr Raj Sekhon
Dr Raj Sekhon is pleased to announce that
he has commenced private psychiatric
practice in Rockingham. Raj is a local UWA
graduate (1996) and is a Fellow of The
Royal Australian and New Zealand
College of Psychiatrists (FRANZCP), with
an interest in all aspects of general adult
psychiatry.
For referrals or other advice please
Ph: 9528 0996 or Fax: 9528 0850.
Sentiens Day Hospital
Please refer all private mental health
patients to Sentiens Day Programs.
Our patients usually have depression,
anxiety, bipolar, borderline personality
disorder, drinking problems, relationship
problems, stress, PTSD, OCD and
sometimes eating disorders and
schizophrenia. We offer group programs
in CBT (also evening), DBT skills,
creative therapy, alcohol management,
mindfulness, carer’s support,
self-esteem, health and wellness,
recovery, stress management, drug
related metabolic problems, anxiety
management, life skills, assertive skills,
online assessment via PsychAssess and
PsychScreen and online monitoring using
HealthSteps.
Refer to Dr Dennis Tannenbaum (Clinical
Director/Consultant) or directly to
Sentiens via phone for referral advice:
9481 1950 or Fax: 9481 1952.
See Sentiens.com for PDF referral.
www.HealthSteps.net.au
We provide a personalised, comprehensive
and professional digital imaging service.
Patients benefit by a short or no wait time
for an appointment, low radiation dose
equipment, family-friendly, comfortable
clinic and affordable examination fees.
RADIOLOGY/NUCLEAR MEDICINE
Oceanic Medical Imaging Leeming
Tel: +61 8 9312
7800 Fax: +61 8
9312 7878
Oceanic Medical
Imaging Hollywood
PET-CT CentreGround Floor,
Suite 14, Hollywood Medical Centre
85 Monash Avenue, Nedlands 6009
Tel: +61 8 9386 7800 Fax: +61 8 9386 7888
www.oceanicimaging.com.au
Oceanic Medical Imaging offers a wide
range of general and specialist medical
imaging utilising the latest imaging
equipment. Services include:
• 64-slice cardiac capable CT
• Digital General X-Rays
• Ultrasound
• Digital OPG & Cephalometry
• Nuclear Medicine Studies and Therapy
• Bone Densitometry
• DEXA Whole Body Fat Assessment
• Stress ECG suite with Myocardial
Perfusion Imaging • PET-CT
• CT/Ultrasound-guided injections
Envision Medical
Imaging
178 Cambridge Street (opp.
SJOG Hospital Subiaco)
Tel: 08 6382 3888 Fax: 08 6382 3800
Web: www.envisionmi.com.au
Web: www.envisionreports.com.au
(WebPAX™ online images & reports)
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: Michael
Krieser
Brendan Adler, Lawrence Dembo,
Bernard Koong, Conor Murray, Eamon
Koh, Jeanne Louw, Tonya Halliday
AMA Membership Discounts
Available on the Melville
Renault Range.
1.9% Business Finance on
Renault Passenger vehicles.
Conditions Apply. See website for details.
Megane RS
MELVILLE RENAULT
164 LEACH HWY, MELVILLE • PH.9330 6666
www.melvillerenault.com.au
DL13660
March ME D I C US 71
FOR LEASE:
MANDURAH
Medical Centre/Offices
under construction
Located next to Peel Health Campus.
Expected completion 21 June 2012.
For details including potential fit out
details email
[email protected] or
mobile 0419 048 119
Female GP FT or PT Required
Located at Helena Valley, the practice is fully computerised, well equipped,
Accredited with nursing and admin support. Purpose built spacious work
environment.
Supportive and friendly team. Onsite pathology and psychologists available.
Attractive remunerations.
Email expressions of interest to [email protected] or call Practice
Manager 9374 0083.
FOR SALE
Leederville
Specialist rooms at
10 McCourt Street Leederville
Enquires to Chris Lawson-Smith on
9381 9213 or
[email protected]
MEDICAL
ROOMS
in BUSSELTON
Medical services tenant
required for consulting rooms
Located on the Bussell Highway
near Busselton Hospital, this newly
renovated 4 bedroom/1 bathroom
house is situated on 1077sqm and has
great highway exposure with ample
parking. The owner will develop to the
tenants requirements.
For more information contact
Neil Honey at
[email protected] or
call 0419 837 960
Consulting Room
for Lease
Consulting/Treatment room (available
F/T or P/T) in association but separate
to large dental clinic in popular Carine
Glades Shopping centre precinct.
Separate waiting recovery area, steri
room and support staff available.
Ideally suited for minor surgical and
cosmetic procedures.
5 minutes from Glengarry
hospital and professional rooms.
For further info contact Rob Donaldson
Dental Care @ Carine 9447 6444 or
email: [email protected]
GP Required
NORANDA
A FEMALE GP is required for an accredited, fully computerised, privately
owned practice in Noranda, with onsite pathology, dentist, podiatrist and
physio. Please call our team on 9276 8526 or mobile 0412 260 491.
INGLEWOOD
GP required. Hours negotiable with guaranteed 6-8 weeks holidays per year.
We are a friendly six doctor (3 male, 3 female) private billing, non-corporate
practice on the Bedford/Inglewood boundary. Generously staffed, including
practice nurse and pathology on site.
Phone Steve, Carl or Jeremy on 9271 9311 or email [email protected]
Applecross
Applecross Medical Group is a major medical facility in the southern suburbs.
Current tenants include GP clinic, pharmacy, dentist, physiotherapy, fertility
clinic and pathology. Both the GP clinic and pharmacy provide a 7 day service.
The high profile location (corner of Canning Hwy and Riseley Street Applecross),
provides high visibility to tenants in this facility.
A long term lease is available in this facility - the space available is 85m2, with
the current layout including 4 consulting rooms, procedure room and reception
area. Would suit specialist group, radiology or allied health group.
Contact John Dawson – 9284 2333 or 0408 872 633
WEST PERTH
Medical Suites Available
244m²
Rent: $325/m² plus outgoings and GST
Fitted out – waiting room, consulting rooms, dressing room, x-ray room and
reception. Fully cabled, 5 secure car bays available.
Contact Matt Campbell, CPG Corporate Real Estate on 0423 477 333
72 M E D I CU S March
FOR SALE
or LEASE
JOONDALUP CBD
Consulting Rooms/
Office Suite
77sqm Ground floor premises
located near the Hospital.
$550,000 + GST or lease
$395/sqm + vo + GST.
For details contact owner on
9405 2019 (A/H) or
email [email protected]
Consulting
Room
JOONDALUP
Consulting room located nr
the corner of Boas Ave &
Grand Boulevard.
Available on a
sessional basis.
Phone Jenny Galin on
0407 383 471
for further details.
Director
Industrial/Legal
The Australian Medical Association (WA) is a high profile organisation. It is the professional Association
for doctors and is active on all matters that relate to the standard of health care for the community of
Western Australia. The Association provides a broad range of services and advocates for members.
We are currently looking for a talented professional to join the AMA (WA) as Director Industrial/Legal.
It is envisaged that the successful candidate will be a strategic thinker, possess exceptional leadership
and communications skills and ideally have an understanding of the health sector.
Key responsibilities include:
•
•
•
•
•
•
Advocate for and represent the medical profession to government and other stakeholders
Lead Industrial Negotiator for the Association
Develop and implement strategy
Communicate with Members, Ministers and Heads of Government
Represent the AMA (WA) in public forums
Deputise as required for the Executive Director
It is envisaged that the successful applicant will be able to demonstrate:
•
•
•
•
•
•
•
•
Knowledge of the State and Federal health systems, public and private sector
Have strategic vision and strong analytical skills
Passion and focus to achieve outcomes for the organisation
Complex problem solving, disputes management experience
Highly developed influencing and negotiating skills
Well developed high level executive networks
An understanding of and experience in corporate governance
Tertiary qualifications in industrial relations/legal area or similar
An attractive remuneration package and terms will be negotiated with the successful candidate.
Located in Nedlands, this full time position offers an excellent opportunity to be part of an exciting and progressive organisation.
Interested applicants are invited to forward a letter of application and curriculum vitae to the AMA (WA) via email to
[email protected].
Australian Medical Association (WA) 14 Stirling Highway Nedlands WA 6009
Telephone 08 9273 3000 Fax 08 9273 3043
For further information about AMA (WA) visit: www.amawa.com.au
www.statigroup.com.au
Is this your new medical premises?
1140 Albany Highway, Bentley
400sqm to 2,366sqm available
High profile location along Albany Highway, with ample parking
Adjacent to Bentley Plaza Shopping Centre
400 Carrington Street, Hamilton Hill
400sqm to 1,200sqm available
Located on the corner of Carrington Street and Forrest Road
Suit GP and associated medical tenants
For all leasing enquires, please contact Patrick Owen on 0401 272 709 or [email protected]
March ME D I C US 73
Footy tipping
Members
The AMA(WA) invites you to join our
footy tipping competition.
Joining is simple:
e-mail Joshua Hymmerston at [email protected]
to receive your official invite with a link to Footy Tipping Competition.
Great Prizes including FREE 2013 AMA (WA)Membership
Show your tipping skills and join today!
Any queries contact:
Josh Hummerston on 08 9273 3054 or [email protected]
or John Gerrard on 08 9273 3077 or [email protected]
o
go
Doctors ad 150211
k!
uc
l
d
20/4/11
3:13 PM
WESTERN AUSTRALIA
WESTERN AUSTRALIA
Page 1
Come and join the family!
We need doctors at:
Armadale, Busselton, Cannington, Dianella, Gosnells, South Perth, Willetton
and Wembley.
Be a part of a dynamic group that will look after
all your needs… not just providing you with
facilities but also upskilling, organising overseas
conferences, to name a few perks.
74 M E D I CU S March
If you like to know more, please contact:
Dr Albert Ho
Mobile 0409 608 620
Email [email protected]
Postgraduate News
Please submit Green Sheet material by 4 April 2012 for
April 2012 edition.
Contact Jennifer Hughes at: [email protected]
WESTERN AUSTRALIA
WESTERN AUSTRALIA
Youth Friendly Doctor Training
2012 Program
MODULE 3
The Youth Friendly Doctor Program (YFD) seeks to build
the capacity of general practitioners to communicate more
effectively with young people, address the barriers young
people face in accessing health care and promote adolescent
friendly policies, facilities and service delivery. This program
is accredited with the RACGP and attracts Category 1 and or
Category 2 QI&CPD Points.
Risk Taking Behaviours and Harm Reductions among Young
People
Workshop 1 – Alcohol and Drug Use among Young People
7 February 2012
Workshop 2 – Young People’s Sexual Health
20 March 2012
MODULE 1
MODULE 4
Establishing Connection and Conducting Assessments with
Young People
Workshop 1 – Ethics and the Law in Young People
3 April & 2 October 2012
Eating Disorders in Young People and Their Management
Workshop 1 – Overweight and Obesity in Young People
7 August 2012
MODULE 2
Mental Health Disorders
Workshop 1 – Mental Health Disorders in Young People Assessment and Treatment
12 June 2012
Workshop 2 – The Psycho Social Wellbeing of Young People
10 July 2012
Workshop 2 – Eating Disorders in Young People
11 September 2012
For enquires relating to the YFD program or to enrol in the
workshop visit:
www.amawa.com.au/IntheCommunity/YFDTrainingProgram.
aspx
Phone (08) 9273 3000 or email [email protected]
POSTGRADUATE EDUCATION & TRAINING
Date
Postgraduate Education & Training
Contact Information
28 April
Western Trauma Course – Busselton / Bunbury
Email: [email protected]
28 April
Chronic Lung Condition and Smoking Cessation Seminar Day:
Focus on smoking cessation, chronic lung conditions and cancers
attributable to tobacco and other irritants. Online access via Lectopia
is available – UWA Club, Hackett Drive, Crawley 8am – 3.30pm
www.medpharm.uwa.edu.au/cpd/
program
30 April –
4 May
Doctors Certificate in Sexual and Reproductive Health for Medical
Practitioners: FPWA Sexual Health Service – 70 Roe St., Northbridge
www.fpwa.org.au
1 – 4 May
Interventional Pulmonology: Thoracoscopy, Ultrasonography & other
techniques– Suitable for Respiratory Physicians and Trainees.
International guest speaker – S/Professor David Feller-Kopman.
Venue: CTEC Building UWA
www.ctec.uwa.edu.au
7 May
Introduction to Eating Disorder Training - Part 1: Suitable for rural and
remote professionals and GP’s. An introduction to understanding,
identifying and assessing eating disorders, includes information
on screening, engagement and a comprehensive multi-disciplinary
assessment approach. Venue- PMH: 9am – 4pm
Email: Blanca.PrietoHugot@health.
wa.gov.au
14 May
Introduction to Eating Disorder Training - Part 2: Suitable for rural
and remote professionals and GP’s. Includes treatment strategies
for the eating disorder including the roles of different professionals.
Emphasis is on the phases of eating disorders across time and on
stages of motivation for change. Venue - PMH: 9am – 4pm Email: Blanca.PrietoHugot@health.
wa.gov.au
March ME D I C US 75
POSTGRADUATE EDUCATION & TRAINING continued
Postgraduate Education & Training
Contact Information
15 May 31 July
Vocational Graduate Diploma of Women’s Health- Office
Gynaecology: Suitable for GP’s, registrars, junior medical staff from
KEMH and other doctors. Venue – Agnes Walsh Lounge, KEMH
Subiaco. 6. 20pm – 8.30pm
18 May Anatomy of Complications Workshop – Suitable for Obstetric and
Gynaecology Specialists.
19 May
Core Skills – Oncoplastic Surgery – Suitable for Consultants,
Fellows and Trainees in SET 4-5. Venue: UWA
www.ctec.uwa.edu.au
19 May
Western Trauma Course – Port Hedland
Email: [email protected]
7 Jun
Bariatric Surgery – Contemporary Issues - Suitable for Set 3-5
Surgical Trainees, Consultants, Bariatric Physicians, Dietitians,
Psychologists and Nurses. Keynote Speakers: Professor Jeffrey
M Hamdorf and Professor James Toouli. Discussion on the Role
of surgery; Multidisciplinary Assessment Novel Techniques; and
Gastric Band versus Sleeve Gastrectomy at 5 years plus
www.etec.uwa.edu.au
9 Jun
Western Trauma Course – Broome
Email: [email protected]
11 Jun
Eating Disorders -Advances Individual Therapy: Suitable for
rural and remote professionals and GP’s. Through the use of case
illustrations and participants’ own experiences, this workshop
includes specific therapeutic interventions for the practicing
clinician. Venue-PMH: 9am – 4pm.
Email: [email protected]
21 June
Core Skills – Laparoscopic General Surgery– Suitable for RACS
General Surgery Trainees Set 1-3. This workshop aims to improve
surgical safety, operative confidence and operative efficiency in a
way that cannot be provided by surgical supervision or by other
simulated environments. Venue: UWA
www.ctec.uwa.edu.au
22 June
Anatomy of Complications Workshop– Suitable for Obstetric &
Gynecology Specialists, Venue: UWA
www.ctec.uwa.edu.au
23 June
Cardiac Core Skills Workshop– Suitable for RACS Surgical Trainees
in Cardiothoracic Surgery, Venue: UWA
www.ctec.uwa.edu.au
27 June
The Cutting Edge: Gynaecological Procedures – Suitable for GP
Proceduralists & GP Obstetricians, Venue: UWA
www.ctec.uwa.edu.au
28 June
The Cutting Edge: Advanced Procedures – Suitable for GP’s who
hold a VMP appointment in GP Surgery, Venue: UWA
www.ctec.uwa.edu.au
29 June
Emergency Procedures Practical Course – Part 1 – Suitable for GP
Proceduralists, Venue: UWA
www.ctec.uwa.edu.au
30 June
Emergency Procedures Practical Course – Part 2 – Suitable for GP
Proceduralists, Venue: UWA
www.ctec.uwa.edu.au
26-27 July
Advanced Vascular Surgery – Anatomical Approaches: Suitable for
consultants, advanced and intermediate Vascular Trainees.
Approved for College’s CPD program. Venue: CTEC at UWA
www.ctec.uwa.edu.au
11 Aug
Western Trauma Course – Carnarvon
Email: [email protected]
14 Aug –
30 Oct
Vocational Graduate Diploma of Women’s Health - Non-procedural
Obstetrics - Suitable for GP’s, registrars, junior medical staff from
KEMH and other doctors. Venue – Agnes Walsh Lounge, KEMH
Subiaco. 6. 20pm – 8.30pm
Email: [email protected]
76 M E D I CU S March
Email: [email protected]
www.ctec.uwa.edu.au
WESTERN AUSTRALIA
WESTERN AUSTRALIA
POSTGRADUATE EDUCATION & TRAINING continued
Postgraduate Education & Training
21 Aug
Contact Information
Core Skills – Neurosurgical Approaches– Suitable for Consultants,
Registrars & Trainees in Neurosurgery, Venue: UWA
www.ctec.uwa.edu.au
Register Your Interest
IUD and Implanon NXT workshops –
FRWA Sexual Health Services – 70 Roe St., Northbridge
www.fpwa.org.au
Open to all General Practitioners
St John of God – Subiaco Hospital Ground Rounds
3 April
Mr. Stephen Archer – Upper GI Surgeon;
10 April
Dr Andrew Dean – Oncologist;
17 April
C/Prof Shyan Vijasekaran – ENT Surgeon;
24 April
Dr Derek Eng – Pallative Care Physician
[email protected]
Conferences and MeetingS
Conferences and Meetings
Contact Information
Location
12 – 16 May
AZNCA Annual Scientific Meeting
Perth Convention &
Exhibition Centre
www.anzca2012.com
30 June
CTEC: Psychiatric Problems in General
Practice
ECU, Bunbury
www.ctec.uwa.edu.au
26-28 July
Faculty of Radiation Oncology Annual
Scientific Meeting
Shangri-La Hotel,
Cairns, Queensland
www.FRO2012.com
30 Aug – 2 Sep
AOCR & RANZCR 2012 Annual Scientific
Meeting
Sydney Convention &
Exhibition Centre
www.aocr2012.com
10 – 12 Sep
Population Health Congress 2012
Adelaide Convention
Centre
www.phaa.net.au/pophealth.php
3 Nov
CTEC: Tropical Medicine and Zoonoses
Seminar
ECU, Bunbury
www.ctec.uwa.edu.au
18 – 21 Nov
17th National Prevocational Medical
Education Forum
Perth Convention &
Exhibition Centre
www.prevocationforum2012.com
24 – 28 Nov
RANZCO AGM & Scientific Congress
Melbourne, Victoria
www.ranzco2012.com.au
Medicare – Health Professional Online Services (HPOS) Seminar:
Wednesday 18 April 2012 – AMA, Nedlands 6pm for a 6.30pm start
Health Professional Online Services (HPOS) gives you and your delegated staff access to Medicare online services
through a single entry point. This seminar is designed to assist doctors and practice managers with a better
understanding of the benefits of HPOS. This will include:
• How to access other services
• Patient verification
• PKI individual certificates
• Australian Childhood Immunisation Register
• New services available through HPOS
• Who do I contact to set up HPOS
• Use of the email subscription facility
March ME D I C US 77
OUR
AWARD
Postgraduate News
WESTERN AUSTRALIA
WESTERN AUSTRALIA
2012 Events Calendar
The AMA (WA)’s events, seminars and workshops focus on topics of interest and relevance to
medical practitioners and practice managers.
YOUR REWARD
Time
Wed 14th
6:00pm
Psychiatry of Physical Symptoms
S
AMA (WA), Nedlands
Tues 20th
6:30pm
YFD - Young People's Sexual Health
Y
AMA (WA), Nedlands
Tues 27th
6:00pm
Medical Careers Expo 2012
E
Burswood on Swan
Wed 28th
5:00pm
Practice Managers Networking Evening
E
Davro Interiors,
Northbridge
Thu 29th
6:30pm
CV Writing and Interview Skills workshop
S
AMA (WA), Nedlands
Sat 31st
9:00am
CPR Training for members
T
AMA (WA), Nedlands
Tue 3rd
6:30pm
YFD - Ethics and the Law in Young People
Y
AMA (WA), Nedlands
Wed 11th
ralia s Best Small
6:00pm
CPR Training for Practice Staff
T
AMA (WA) Nedlands
Wed 18th
6:30pm
Medicare - Health Professional Online Services
S
AMA (WA), Nedlands
Sat 12th
9:00am
CPR Training for Practice Staff
T
AMA (WA) Nedlands
Tue 15th
6:30pm
Médecins Sans Frontières
S
AMA (WA), Nedlands
6:30pm
Expert Medical Evidence and Medical Records
S
AMA (WA), Nedlands
6:30pm
YFD - Mental Health in Young People
Y
AMA (WA), Nedlands
Wed 13th
6:30pm
Annual General Meeting
E
AMA (WA), Nedlands
Wed 20th
6:00pm
CPR Training for Practice Staff
T
AMA (WA) Nedlands
Sat 30th
9:00am
CPR Training for members
T
AMA (WA), Nedlands
Sat 7th
6:30pm
2012 Awards Night and Charity Gala Dinner
E
State Reception Centre,
Kings Park
Tue 10th
6:30pm
YFD - The Psycho-Social Wellbeing of Young People
Y
AMA (WA), Nedlands
Sat 28th
9:00am
CPR for Practice Staff
T
AMA (WA) Nedlands
model shown
Tue 7th
6:30pm
YFD - Overweight and Obesity in Young People
Y
AMA (WA), Nedlands
Tue 4th
6:30pm
CV Writing and Interview Skills workshop
S
AMA (WA), Nedlands
Tue 11th
6:30pm
YFD - Eating Disorders in Young People
Y
AMA (WA) Nedlands
Sat 22nd
9:00am
CPR Training for members
T
AMA (WA), Nedlands
Y
AMA (WA), Nedlands
E
Royal Perth Golf Club
Apr
Mar
Day
s.
May
limentary
d stamp
duty.Wed 23rd
Jun
reputation isTue 12th
Nov Oct
Sept
Aug
July
ary 29.
Title
Email
Code
Tue 2nd
6:30pm
YFD - Ethics and the Law in Young People
LEXUS
CT
200h
Fri 12th
All day
2012 Charity Golf Day
Venue
Prestige
SPECIFICATIONS
Sat 10th
9:00am CPR Training for members
T ModeAMA
(WA), Nedlands
• Drive
Select
Car
over $35,000
at Australia’s Best Car Awards.
†
• 4.1L/100km
For more So
information
oncelebrate,
2012 events
please
visit www.amawa.com.au/membership/events.aspx
in order to
we’re
offering
you complimentary
• 5 Star
Email Code:
S - [email protected]
E - [email protected]
O ANCAP
- [email protected]
registration,T compulsory
third
party
insurance
and
stamp
duty.
• 8 SRS Airbags
- [email protected]
Y - [email protected]
Don’t delay, because while the Lexus CT 200h’s reputation is
• Metallic Paint / Alloy Wheels
Expert Medical Evidence
& Medical
Records Seminar:
• Daytime
Running lamps
growing, this offer is fleeting and must end March 31.
Wednesday 23 May 2012 – AMA Nedlands 6pm for a 6.30pm start
Médecins Sans Frontières Seminar:
The Lexus CT 200h has recently been voted Australia’s Best Small
Will you be called to give evidence in Court? If you are called, how
do you prepare, what is your role, can you give evidence that is
Visit lexusofperth.com.au to arrange your test drive today as this offer must enddetrimental
March 31. to your patient, will you be paid, can you be sued for
being negligent in the evidence you give?
Two field officers, recently returned from field
Tuesday 15 May 2012 – AMA, Nedlands 6pm for a
6.30pm start
placements, will provide an insight into what medical
colleagues are doing in all sorts of different places
around the world.
Medical Record keeping is a professional responsibility. Who owns
the records, do you have to give your patient full access to the
records, what records are they entitled to, do you have to correct
errors in the records, what if you believe it’s not in the best interest
of the patient to see their records, and can you charge a fee to allow
the inspection of records?
359 Scarborough Beach Road, Osborne Park WA 6017
Phone 9340 9000
78 M E D I CU S March
enquiries @ lexusofperth.com.au www.lexusofperth.com.au
DL18807
†ADR 81/02 (combined) - 4.1 L/100km. Available on new 2011 Lexus CT 200h purchased and delivered by March 31, 2012.
After Hours: Craig Nylander 0424 182 855
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CT
•
MR I
•
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•
U LT RAS O UND
March ME D I C US 79
•
NUCMED
•
DENTAL
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80
M E D I CU S