CANBERRA

Informing the Canberra Doctor medical community since 1988 JUNE/JULY 2016 | Canberra Doctor is proudly brought to you by the AMA (ACT) Limited. Circulation: 1,900 in ACT & region Prof Steve Robson looks to the future as AMA (ACT) President

Earlier in May, I had the privilege of taking over the Presidency of With the Australian Government as a whole. If we, as a profession, AMA (ACT) from my colleague, Dr Liz Gallagher. Liz has been an spending about $40 billion more expect funding for the work we do extremely popular and effective president and it was with some than it actually receives each year then we need to be able to dem- trepidation that I stepped into her shoes. We all owe Dr Gallagher a and no mining boom around the onstrate that we provide clinically corner to save us, it is clear that effective and cost-effective care. heartfelt vote of thanks for the wonderful job that she’s done. health expenditure must be justi- With the Federal Coalition having fied. There is absolutely no point in been returned, we face an election For those who don’t know me recognisable. The AC/DC album doctors calling for more and more for the ACT Legislative Assembly well, and those who are won- was released when I was at high spending without conceding that by mid-October. Health is the larg- dering what direction a clinical school and I don’t think a week funding will have to be taken away est single expenditure item for all academic might wish to take has gone by since then when I from something else to pay for it. state and territory governments, a your AMA, I thought a good start haven’t listened to at least one I hope we can capture some of Spending on the health of Aus- situation that provides us with both would be to introduce myself and track from the album. It has en- these enduring qualities at AMA tralians is undoubtedly a good an opportunity and a threat. Our let you know where I think our dured over almost four decades (ACT) over the next couple of years. investment, but like all invest- opportunity is to engage with gov- organisation should be focussed and become the biggest-selling ments a careful due diligence ernment and those seeking elec- A sustainable health system for the next two years. popular record of all time. It must be undertaken. I am part tion to help shape the approach to seems to me that there are three In 1984 when I first joined the of the Australian Government’s health spending and provide maxi- Back in Black reasons for this: the music is AMA as a medical student, health Review of the Medicare Benefits mum benefit for Canberrans. The threat? That we deal ourselves out For anybody of my vintage – shall completely unpretentious; all of spending was just over 6.5% of Schedule and have a keen sense of negotiations and end up having we say I’m in my mid-50s and the songs have memorable riffs; GDP. Thirty years later, the pro- of how important it is that spend- to accept what we are given. leave it at that – the three words and, it is done with a tremendous portion has grown to 8.8% of GDP ing is appropriate and benefits “Back in Black” will be instantly sense of fun. or around $150 billion annually. our patients and the community Continued page 4...

Volume 28, No. 4 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AMA National Conference – a new President and much more

While the key outcome of must be trained in performance Shadow Minister for Health, Cath- the conference was the management of their trainees erine King announced several election of Dr Michael and that any complaints must ALP initiatives including estab- Gannon as the new AMA be investigated quickly and thor- lishing an independent medical President, Dr Suzanne oughly by an independent inves- panel to advise the Department of Davey writes that was tigation team. The Royal Aus- Immigration on matters concern- tralian College of Surgeons have ing asylum seeker health; un- one highlight of many in freezing the Medicare rebate and a conference that offered announced a zero-tolerance ap- proach to bullying and harass- rejecting the rise in script costs so much. ment and they have appointed for all PBS scripts; setting up a an independent advisory group to permanent commission to advise the Australian, State and Territory Assisted dying investigate the issue and advise governments on healthcare re- the RACS how to address and The ABC’s Tony Jones moderated form – to be done in consultation prevent discrimination, bullying a Q & A style panel of experts to with clinicians. discuss assisted dying. The panel and sexual harassment in the consisted of Em Prof Bob Doug- practice of surgery. Other colleg- The leader of the Australian Green’s, las in a role as a potential aging es may learn from their approach Dr Richard Di Natale, stated that consumer, Ms Georgie Haysom, to deliver a safer, healthier and the Greens would aim to close off- head of advocacy at Avant, Dr Ka- more respectful work environ- shore refugee processing centres. ren Hitchcock, author and doc- ment. He supported the continuation of tor working in acute and general Medicare and rejected the concept Politicians, medicine at the Alfred hospital, of a Medicare rebate freeze. policy and pundits Professor Malcolm Parker, Pro- He stated that the Greens would fessor of Medical Ethics at Uni- Of course, an AMA Conference support primary care in order to versity of Queensland and Assoc cation which is to be self-adminis- of course, is exactly where this line in an election year is bound to reduce hospital admission rates Prof Mark Yates, geriatrician and tered by the terminally ill patient. should be drawn. attract politicians and discus- by providing a need method of authority on dementia. This medication can only be pre- Closing the gap sion on the election. While I’m funding the care of chronic care scribed after a 15 day cooling off The AMA position is that the doc- pleased to say we now have a patients. period between two requests by The AMA remains committed government, a quick recap on tor’s role is to alleviate pain, even Health Minister, Sussan Ley, was the patient. to trying to reduce disparities in the politicians and their party’s when that treatment may shorten guest speaker at the Gala Dinner. indigenous life expectancy and positions put to the conference is life. Not initiating or continuing The situation in Oregon was com- chronic disease outcomes and worthwhile – even if it’s only for The panel of pundits, facilitated life-prolonging measures does not pared with the very different mod- reducing rates of indigenous in- the record: by senior journalist Paul Bon- constitute euthanasia or physician el in some European countries carceration and supporting indig- assisted suicide. where the physician actually as- enous medical education. Facilita- The US state of Oregon’s Death sists in the suicide of a patient, at tor and Political reporter Brooke with Dignity Act, passed some 19 the patient’s request. Boney gave a moving account of the experiences of her own indige- years ago, was also similarly a fo- As might be expected, both the cus of the discussion. The Act sets nous family and their lack of health panel and questioners from the care and opportunities. up a framework for assisted dying floor, presented a variety of views, – the patient must be 18 or older, with all agreeing the role of the law Bullying and harassment mentally competent and diag- was to very clearly draw the line Dr Ruth Mitchell, neurosurgical nosed with a terminal illness that between palliative care that may trainee, and barrister specialis- will lead to death within 6 months hasten a patient’s death and the ing in discrimination law, em- In these circumstances, a doctor physician actually killing the pa- ployment law and administrative may prescribe a life-ending medi- tient at their request. The debate, law, made the points that doctors

Assisted Dying Panel. ALP Health Spokesperson, Catherine King. [2] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 JUNE/JULY 2016 Dr Paul Bauert, AMA medal winner for significant contribution (third from right), with AMA past presidents, Drs Pesche, Hambleton, Capolingu and Prof Owler. giorno, comprised Sue Dunlevy, Malcolm Farr, Andrew Probyn and Laura Tingle in the mode of an ‘Insiders’-type programme where the experts fielded ques- tions from the floor. The feeling amongst the group was that the election result would be very close, but would probably go the way of the Coalition based on their assessment of the way votes would fall in marginal elec- torates. They felt that, although Prime Minister Turnbull had failed to live up to his early promise, Aus- tralian electors simply did not have the appetite for a fifth prime Minister in as many years. Health and Education would remain the most important issues for most electors. Prof Brian Owler with Health Minister, Sussan Ley.

New AMA Fellows (left), Drs Bartone, Mara, Sharley, Rudd and Gannon and Prof Brian Owler. JUNE/JULY 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [3] Women in Medicine Breakfast

On the Friday morning of the AMA National Conference held in late May, the AMA (ACT) held its inaugural Women in Medicine Breakfast. The WIM Breakfast was sponsored by Tress Cox Lawyers and featured an address by Dr Sue Packer AM. A edited version of Sue’s speech features in this edition of The Canberra Doctor.

The breakfast was a great opp­ Special thanks to the Federal AMA ortunity to meet new people and for assisting us in holding the renew acquaintances with a var- breakfast, to Tress Cox Lawyers ied group present – from medical for sponsoring the event, Rolfe students and Doctors in Training BMW for providing the prize of a through to local GPs and special- weekend use of a BMW car and ists. Of course the highlight of the Dr Sue Packer for being the guest day was Dr Sue Packer’s address speaker. with Sue holding the room spell- bound as she described the living conditions of asylum seeker chil- dren in the Inverbrackie detention BELOW: Dr Sue Packer and centre in the Adelaide Hills. A truly Dr Suzanne Davey. unforgettable moment. RIGHT: Guests at Breakfast.

Prof Steve Robson...continued ...from page 1 We need to look after ourselves In particular, women tend to have if we are to make the most of the the greatest influence on the Looking after ourselves training and experience we have. health of their families – they in- Doctors are very good at looking Don’t forget we have the Doctors fluence the health of children, of after their patients, but in my ex- Health Advisory Service that you their spouse or partner, and often perience not so good at looking can call at anytime for help or just of their parents too. The AMA is a confidential talk to a colleague. after themselves and especially not fulfilling its role unless it is their colleagues. These are areas The contact number is 0407 265 standing up and providing strong where the AMA is ideally placed to 414. advocacy for those at greatest make a big difference. Helping the disadvantaged need. I have seen colleagues give their Despite our prosperity and rela- I am really looking forward to own health and wellbeing a low tive comfort, there are many meeting and working with as priority. This is a very bad situation members of our community who many of Canberra’s doctors, for three reasons: patients look to are at great disadvantage. As their doctors for an example of a caring profession this should and indeed all those interested how to look after themselves; to shock us and move us to action. in health, over the coming two provide good care the doctor must Just as it is the role of your AMA to years. If you have any issues at all, be functioning at an optimal level; advocate for the profession, so it please make sure you contact the and, reduced productivity from is that we should provide a strong AMA office here in Canberra – we doctors is bad for the community. voice for those at disadvantage. would love to hear from you. AMA (ACT) is now on Facebook! AMA (ACT) has jumped into the wide world of Facebook so please get online and like us. It’s a great way to find out what’s going on quickly and keep up to date with events. Recent posts have featured the decision by Fair Work Australia to retain one agreement for ACT hospital doctors and the meeting with ACT Health Minister, Simon Corbell. It’s easy – just search for AMA ACT.

[4] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 JUNE/JULY 2016 Some things i’ve learnt along the way

Dr Sue Packer AM FRACP was the guest speaker at the AMA (ACT)’s inaugural Women in Medicine Breakfast held in conjunction with the AMA’s National Conference. Sue has been a paediatrician since 1972 and has worked as a Community Paediatrician, with a special interest in both child abuse and neglect and their prevention, since 1990. The following is an edited version of her speech to the Breakfast.

“50 years ago, on Australia Day, I derful things in their subsequent With a longer lens, our year also graduated from Sydney University; lives, but given different chances, numbered outstanding doctors one of about 50 women graduates I know they would also have done with verified convict ancestry, in a cohort of 320 students being so in medicine and their regret is which they now celebrate. the survivors of a record-breaking palpable in their accounts of their Most of us come from intake of 650 students, six years lives, despite their successes. earlier. somewhere else Our lack of curiosity and compas- So, Australia is a country whose For our 50 year reunion this year, sion for our fellow students is so entire non-indigenous population we produced a progress yearbook glaringly apparent considering our is made up of migrants, refugees in which we were invited to con- student years in retrospect. and convicts and their descend- tribute what we would like others ants. We are a wealthy, successful to know about our lives. We made Post-war cohort country. This all makes it harder great efforts to include accounts of There was a very sizeable cohort for me to understand how we can the lives of those who have died, who were completely invisible and remain intransigent and paltry in with contributions from friends unconsidered in our undergradu- the face of so much human suffer- and families. ate years that were those students ing in our region. Even worse, how Compared to today there were so who had come to Australia as mi- can we continue to knowingly inflict few women. As a student, I was not grants and refugees in the after- harm on a relatively small number aware of overt signs of the sexism math of WW2. We were a year of of people, most already confirmed which had curtailed earlier women war (and even pre-war) babies. to be refugees, who have happened Dr Sue Packer addresses the audience. in medicine, but I was bewildered Reading the accounts of their early to end up being in the wrong place and bemused anyway, having at the wrong time, because of our Inverbrackie or four troubled families at a time lives now, 50 years later is mov- was bewildering and exhausting. come to university from coun- ing and sometimes harrowing change in policies, and who are Detention Facility try NSW. We seemed to have the and heartbreaking. Many of these, now condemned to languish with- In the event, I participated in one All the families were desperate to same opportunities as the men. my co-students in medicine, only out hope in indefinite detention, such visit. On Monday, May 12, put across their cases and all were Some tutors were “difficult” with reached Australia because of the with such uncertain rights and pro- 2014, I visited Inverbrackie in so similar, with so much trauma women. Some were just plain “dif- involvement of people smugglers, visions, at our leisure. South Australia as one of the HRC and distress – and real fear – re- ficult” with everyone. flected in all the anticipated clini- bribery and false identity docu- My work in paediatrics for the last investigative party. We only had cal signs and symptoms which we Of great concern, reading the 50 ments. Some are still making their 30 or so years has all been related one short day there and I have nev- tried to document. year updates, is the realisation own journeys of discovery about to abuse, neglect, emotional trau- er worked under such sustained that a number of women gradu- their own true circumstances ma and all of its life altering rami- pressure- conducting interviews Inverbrackie, in terms of location ates from my year never practiced and identities, and those of their fications and how to avoid these via interpreters. In all, I saw eight and facilities, at first glance was medicine. This seems to have been parents, 50 years later, as they ills. Because of this, I offered to families, all with two parents and unremarkable- even favourable. It because of the rigid hospital em- shared with us at our reunion. be part of the health assessment with a total of 18 children from was the “showcase facility” for the ployment requirements and the Their contribution to the richness teams organised to visit the deten- 24 years to 2 months. They were Department of Immigration. But I non-existent childcare options. of Australia, in every sense but es- tion centres within Australia and from three language groups and learned so much about the “devil But the end result was that they pecially resulting from their gen- offshore, as part of the Australian all were accompanied by excellent in the detail”, which transformed gave up and abandoned their med- erous medical careers, has been Human Rights Commission Na- interpreters but conducting semi- this reasonable place into a cen- ical careers before they had even truly remarkable and deserving of tional Inquiry into Children in Im- structured interviews simultane- tre of emotional disintegration. begun. They have done many won- recognition. migration Detention. ously in two languages to three Continued page 6...

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JUNE/JULY 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [5] ...from page 5 these already traumatised, appre- hensive women? The families had no control over any aspect of their lives, despite liv- These were the mothers who soon ing in houses with their own cook- afterwards went on hunger strike ing facilities, with health services, in Darwin and attempted suicide access to school and counselling in the hope that their infants could and lovely outdoor playgrounds and then stay in Australia rather than other facilities. But all the houses being moved to Manus or Nauru. had to be shared, even though there The fear of that possible fate, at were enough houses for each fam- the time I interviewed them, pre- ily to live alone, and families had no vented any of the families from be- choice who to share with. ing able to enjoy the relative calm The facilities could only be used of their time in Inverbrackie. strictly as directed, so many fine This facility was closed within things like the playgrounds were months of our visit and the in- scarcely used at all. mates moved on, in keeping with Many medical appointments were their worst fears. conducted without interpreters What can we do? and all access to appointments and even minutiae like children’s I admire the brave continuing ef- clothes and computer time was to- forts of so many medical organi- Guest speaker, Dr Sue Packer, second from right. tally controlled by the guards, who sations and individuals, including could give or withhold at will. Simi- the AMA, working to address this I attribute so much of her success June spoke of the tragedy of FASD Learning from children larly there were excursions but shameful situation. It takes a spe- to the caring, perceptive and so- in her community and the devastat- I will finish with my thoughts on en- always accompanied by uniformed cial kind of courage to persevere in cially competent neighbours help- ing impact it has had, particularly counters with children. There are guards and there was never any this way in an environment of de- ing her to see life differently. Her on the capacity of so many of the the things we “do” to children (and say as to where and when excur- termined inaction and suppression coming to the funeral makes me children to learn and develop. She doctors figure large in this) – things sions occurred. of all aspects of the situation so we think she sees it this way too. helped lead the brave plan to ban like immunisations and painful pro- are made to feel crazy for caring. Roll calls and late night Teachers and GPs so often can ex- takeaway alcohol from the com- cedures. Things beyond the child’s transfers In some ways it is not so different ert similar enduring influences be- munity, with inspirational results capacity to intervene. These deal- ings can easily become abusive and More intrusively, despite this be- from my work with abused and ne- cause they have the skills and op- which have been well publicised. ing a recognised low risk facility, all glected children and their families portunities to show that they care She then moved on to determine need our constant vigilance. and carers over so many years. detainees, including the babies, had and actually like the person for the true incidence of FASD in her Then there are the things we do How much do we really know and to be roll called four times each 24 him or herself, despite many chal- community, the first time this has “for” children – things like pro- care about these struggling indi- hours and two of these were photo lenges. This is the side of medicine been done, and discovered that one viding food, clothing, toys, driving checks. The last check was at night. viduals, both the children and their and child protection which can be Many children would be asleep. families and carers? so fulfilling and worthwhile. The guards would enter each home At a superficial level there is real Child Aware Approaches without knocking and shine a torch community distress at the thought on the sleeping infant’s face. No of our suffering children, but there is Earlier this week I attended the wonder the children were in such also an anxious willingness to see it Families Australia conference in parlous emotional states. as someone else’s problem; “they” Brisbane “Child Aware Approach- es”. At the conference I heard from Three of the women I saw were ought to do something about it. two of the most inspired Indige- pregnant. Subsequent to my visit, The enduring positive changes after the birth of their infants, I nous women I have been privileged achieved are so often the result of read that they had been moved out to meet and the inspiration was quiet sustained efforts, most often of Inverbrackie at 3am for transfer their collective vision for a future by one or a few individuals. A prime to Darwin. How would this addi- for their children and our children example of this is an old ex-neigh- tional trauma be experienced by and grandchildren, by working bour of mine who died a few years from the past traumas and their ago. At his funeral I met a young present legacies to a future ena- woman, who obviously knew me bling all children to delight in their well but I couldn’t place her. I then lives. Their visions were inclusive, realised that she had been a child community initiatives. in just the sort of family who is re- The women were Professor Kerry ported to child protection and she Beth Altson from sponsors, Tress Cox Lawyers. had lived next door to this old man Arabena, whom some of you might and his wife. know from her time in ACT earlier in five of their children is affected. them to sport and parties and to in her career and June Oscar AO, Her community is now developing say nothing of cleaning, shopping After school, when her siblings already well known for her work at trauma informed supports to en- and cooking. were getting into mayhem, she Fitzroy Crossing in Western Aus- able these children to develop and Then there are the things we do would visit the neighbours for a tralia addressing the overwhelm- learn as well as possible in a car- “with” children – the magical and quiet, civilised afternoon tea and a ing issues of Foetal Alcohol Spec- ing, committed community and at memorable occasions when you chat. She loved the calm, welcom- trum Disorder. ing environment and went there the same time prevent the birth of and a child share things together very frequently. Her family moved Kerry spoke of her vision for the further affected children by con- on an equal footing and with mutu- on a few years later, but she main- Australian model of the First 1000 trolling access to alcohol. al enjoyment. They are the memo- tained an intermittent connection Days: Making the World of Differ- ries we keep with us forever and It is the courage and inspiration with her old friends. As a young ence for Aboriginal and Torres we should make time for more of and determination of women such adult she has a good job and is Strait Islander Children. Her pro- them; they can’t be rushed. happily married with a young fam- posal did achieve some very mod- as these which encourages me ily. She has been able to support est funding in the latest federal to continue in my sometimes de- As I learned from a wise school her siblings in their various, fore- budget but it requires so much pressing work, that and my ongo- principal: “If you haven’t learned seen mishaps and it was a real de- more to make this inspirational, ing learning and enjoyment from anything from your children today, Dr Suzanne Davey, AMA (ACT) Secretary. light to meet her again. but achievable plan a reality. my encounters with children. then you haven’t been listening!” [6] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 JUNE/JULY 2016 The Medical Benevolent Association of NSW celebrates 120 years

The Smith family* were referred by a palliative team. Brian Smith was an intern at the time he was diagnosed How you can donate: with oesophageal cancer. Medicine was Brian’s second Testimonial career and the family’s financial resources had been The MBANSW’s Annual appeal has started, you can stretched during his years of study. At the time of donate: I would like to referral their emotional resources were also stretched l Online - www.mbansw.org.au thank the board for because family support was in the UK. There were l Telephone - 0405 244 544 “ the generous and three children, the oldest had just started high school. l Fax - 02 9987 2970 or continued support

l Mail - PO Box 1660, Dee Why NSW 2099 that you provided for Brian passed away three months We are proud to be celebrating the after referral. The Medical Benev- 120th anniversary of the MBANSW If you, or someone you know, are in need of me over the period olent Association of NSW (MBAN- this year. Over the past 120 years assistance, please contact our social worker, of my two operations SW) assisted with a contribution the MBANSW has helped thou- Meredith McVey on and time away from towards rent and utilities which sands of beneficiaries with finan- (02) 9987 0504 or through the MBANSW website continued for some months until cial assistance in the millions of www.mbansw.org.au work. Your support Brian’s wife was able to find child- dollars, as well as countless hours and the contact with care and return to work. of dedicated social work counsel- ling. There have only ever been the social worker was The above case study is a prime ex- four social workers employed in Caring wonderful at a time ample of why the Medical Benevo- the history of the MBANSW, all of lent Association of NSW exists. The whom have been tirelessly sup- for 120 years... of financial distress. organisation was originally set-up ported by councils made up of ...and with your help I am now back on my in 1896 as the Medical Benevolent volunteer medical professionals. we will keep caring feet – literally – and Fund of New South Wales with the The underlying mot­­i­­­vation from for 120 more vision “to afford assistance to any all involved in the MBANSW is working full time, and duly qualified medical man, widow to help their careers in times of I am very appreciative or orphan children of such whom need, which is reinforced by the of the role you played the committee deem worthy”. It MBANSW’s slogan: “by doctors port from donors. To ensure the then officially became known as for doctors”. MBANSW continues to grow over in my recovery. the Medical Benevolent Associa- MBANSW has consistently grown the next 120 years the association * Not their real names. tion of NSW in 1926, but the vision over the past 120 years. This has needs your continued support. All has remained the same. been possible due to the sup- donations are tax deductible.

JUNE/JULY 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [7] Pregnant Pause – FARE’s campaign for alcohol free pregnancies

The Foundation for Alcohol Research and Education (‘FARE’) is shortly to re-launch “Pregnant Pause”, its innovative health promotion campaign that asks participants to take a break from alcohol during their pregnancy or the pregnancy of a loved one.

FARE is asking Canberra resi- lend their support to the cause as dents to “give the gift that truly Pregnant Pause Ambassadors and lasts a lifetime”. to help raise awareness that there is no safe type, safe amount, or safe Supported by the ACT Government time to consume alcohol during under the ACT Health Promotion Grants Program, the campaign pregnancy. will be working closely with local Building a stronger partners over the next three years support system (2016-2019) to encourage as many Canberrans to make the pledge to Pregnant Pause wants to make it go alcohol free and contribute to easier on mums-to-be, and aims healthier ACT kids. to build a strong support system which will help women achieve The campaign features an extensive an alcohol free pregnancy and digital and social media component raise awareness of this important coupled with broadcast advertise- health message. ments on television and radio, com- But mums-to-be don’t have to do The campaign will also raise you need to pass on this important munity activities and events leading We recognise that this seemingly it alone; like getting fit, changing awareness of the consequences of health message to patients and up to International Fetal Alcohol easy task of giving up alcohol can be diet or moving house, life is easier alcohol consumption during preg- other contacts in your network. Spectrum Disorders (FASD) Aware- challenging – especially in an envi- when you have support. nancy; such as miscarriage, still or ness Day on 9 September. ronment where alcohol and social- premature birth, low birth weights Please contact FARE if you would ising so often goes hand-in-hand. In fact, a recent study found that and FASD (the umbrella term for a like to receive free posters, flyers Local Canberra media person- 31 per cent of Australian women range of lifelong learning and de- and postcards which you can dis- alities, Kristen and Rod from the And there’s also a lot of anecdotal would be less likely to drink alcohol velopmental disabilities). play and distribute to spark con- popular Mix106.3FM breakfast ra- misinformation adding to the con- during pregnancy if their partner or versations with your patients and At its heart, Pregnant Pause is a dio program have come on board to fusion. spouse also stopped drinking. show support. positive and empowering cam- That’s why FARE believes Preg- paign. It’s never too late to cut Email Kamara at kamara.bu- nant Pause is a campaign that down or stop drinking alcohol dur- [email protected] to place your everyone can take part in. ing pregnancy, and even a small order today. Aiming for zero alcohol change can make a big difference for both mum and baby. To keep up to date with all that is during pregnancy happening in the world of Preg- The Pregnant Pause campaign pro- How you can get involved nant Pause check in with their Fa- motes the idea that, for women who in your practice cebook page at PregnantPauseAU are pregnant or planning a pregnan- FARE’s range of Pregnant Pause or follow the campaign on Twitter cy, no alcohol is the safest option. printed materials have everything @PregnantPauseAU.

Directory of Medical Specialists, Allied Health Professionals & General Practitioners with Special Interests For inclusion in the… – 12th edition 2017 Specialist Directory 2017

…download the entry form from www.ama-act.com.au Submit to Karen Fraser Fax: 6273 0455 email: [email protected]

This Directory is publishedCopyright by AMA ( of the Australian Medical Associaion (ACT) Limited This work is the copyright of the AMA ACT) Limited as a service to ACT and regio Therefore, no part of the public (ACT) Limited. All rights reserved. The co n General Practitioners during AMA’s Famil or otherwise than by medical and aation may be reproduced, stored in a retrie ntents of this work are protected by Copy y Doctor Week. llied health professionals listed in the directoval system, or transmitted in any form or by right Law, including the Copyright Act 19 The use of information in rythis and directory their staff for for their professional use, any means - electronic, mechanical phot 68 (Cth). commercial purposes is prohibited.unless prior permission of AMA ACT has ocopying, recording been sought and given. $199

[8] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 JUNE/JULY 2016 Why not try a slice of lime seminar? Have you heard of LIME – Leaders in Indigenous Medical Education? The LIME Network is a program of the Medical Deans Australia and New Zealand that aims to ensure the quality and effectiveness of teaching and learning of Indigenous health in medical education.

The aims of the LIME Network „„Build the capacity of those between Indigenous are designed to: working in Indigenous health community controlled at medical schools „„Enable the continuing health organisations and development and „„Develop pathways for vertical medical schools to improve implementation of integration of Indigenous collaboration, student health curriculum and quality Indigenous health placement opportunities and student recruitment curriculum to improve research initiatives medical education for all strategies with specialist medical students colleges The LIME Network has also de- „„Build on and strengthen „„Strengthen Indigenous veloped a seminar series that can appropriate recruitment health initiatives across be accessed via youtube at www. and retention initiatives for health disciplines youtube.com/user/LIMENetwork- Indigenous students „„Facilitate key relationships Program:

Slice of LIME Seminar 1: Slice of LIME Seminar 4: Admissions criteria for diverse student cohorts. Finding common ground – avoiding the terminol- ogy trap. Slice of LIME Seminar 2: Having the hard conversations, using deconstruc- Slice of LIME Seminar 5: tion to work successfully with resistant, uncritical Health literacy. and reacist responses to indigenous health cur- riculum. Slice of LIME Seminar 6: Traditional Aboriginal healing and western medi- Slice of LIME Seminar 3: cine – the missing gap. Ngara…deep listening…seeing two ways; what can indigenous knowledge, mindfulness and observa- tional skills training bring to medical practice?

Personal and supportive service Doctors’ Health Advisory Service (ACT) Here for you and your needs The DHAS (ACT) provides peer support for you and your family The DHAS (ACT) provides a protective environment of anonymity, cultural sensitivity, confidentiality and discretion. There is no charge for using the DHAS (ACT). The DHAS (ACT) is a group of experienced Canberra-based general practitioners who are committed to providing support to colleagues and their families experiencing difficult times – which may include: l a stressful incident l burnout l violence or trauma in your workplace l your professional life l workplace issues such as bullying or harassment l your career plans l workload concerns l personal issues l feelings of stress or inability to cope l your well-being The DHAS (ACT) can link you with expert services and resources according to your needs. Privacy and confidentiality are assured. The DHAS (ACT) is fully supported by, but operates independently of, the AMA (ACT) Ltd as a community service. 0407 265 414 24 hours

JUNE/JULY 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [9] Doctors in Training update

The past couple of months have seen quite a lot happening with the AMA holding its National Conference here in Canberra and also seeing the election of a new AMA Federal President.

AMA National Conference Updates on EBA Tony Jones, from ABC TV’s Q&A With the negotiations for the next program facilitated a session on EBA coming up in early 2017, we assisted dying, hearing not only want to make sure Doctors in Train- panellists’ perspectives, but from ing are fully informed and mobilised AMA members too. Sessions were to ensure their views are well repre- also held looking at the Medical sented in the negotiations. Profession’s Role in Closing the Gap and Bullying and Harassment. We encourage you to take part in the dialogue during the lead-up Doctors in Training issues were to the negotiations and the nego- also at the forefront of discussions tiating process itself. Information throughout the weekend, with and feedback sessions are being Federal AMA presidential candi- Dr Nick Coatsworth, guest speaker at planned to cover certain segments dates addressing Council of Doc- Dr Nushin Ahmed (centre), Chair of AMA (ACT)’s Council of DITs at the Leadership the Leadership Development Dinner. of the EBA to allow DiTs to share Development Dinner. tors in Training members individu- their opinions on specific matters ally and as a group to hear what Dr Gannon has a long history with – keep an eye out for these ses- relations services we provide to nals. Tony is also an experienced matters were most important in the AMA including as past-chair of sions and be sure to come along to Doctors in Training. Consequently, workplace mediator. the DiT sphere. the Council of Doctors in Training. get better informed! I’m pleased to advise you that from In the very near future, we will also 4 July we have employed Tony The Leadership Development Din- be employing a “Hospital Organ- If you have any comments, ques- Chase to the new position of Man- ner, held at The Boathouse by the iser” whose job will be to support tions, or concerns, contact AMA ager of Workplace Relations and Lake, saw Dr Nick Coatsworth give DITs by being a regular presence ACT Manager of Workplace Re- General Practice. Tony is a vastly an engaging account of his time in in your hospital workplace and lations and General Practice, experienced Workplace Rela- Medicines Sans Frontiers and les- on the phone to deal with issues Tony Chase, at industrial@ama- tions Practitioner and has worked sons learnt as a doctor in training. around membership, communi- act. com.au. across Territory, State and Com- cations and workplace relations. New AMA President monwealth jurisdictions in the A message from the AMA The Hospital Organiser will be em- Dr Michael Gannon, Western Aus- private and public sectors. He has (ACT) CEO: new workplace ployed on a full-time basis. tralian obstetrician and gynae- for many years worked at a senior cologist, was elected as the new services for ACT DITs level for industrial membership- To accommodate these changes, President of the Federal AMA dur- From earlier this year, the Board based associations and has ap- Andy Ozolins has finished up with ing the AMA National Conference, of AMA (ACT) has been looking at peared as an Industrial Advocate AMA (ACT) and we wish him well replacing Professor Brian Owler. Dr Michael Gannon, AMA President. ways to improve the workplace in most Australian industrial tribu- for his future endeavours.

[10] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 JUNE/JULY 2016 CLINICAL CASE STUDY Parathyroid 4D CT BY Dr John Connors, MBBS FRANZCR

In the clinical setting of hypercalcaemia and elevated parathyroid hormone levels, imaging for the presence of pararthyroid adenoma(s) helps to localize the tumour to a quadrant and thus facilitate minimally invasive surgery.

Neck ultrasound and Technetium- sestamibi SPECT scintigraphy Image 1 alone, or in combination, are the traditional first-line investigations for this localization. Sensitivities for these are approximately 55% and 62% respectively when de- ployed individually, increasing to 73% when used in combination.1 More recently, 4D CT has been proven to be a useful secondary modality when clinical and bio- Image 3 chemical suspicion remains de- spite negative first-line imaging. In We have been performing this 1. Hunter et al, Radiology Vol 264 experienced hands 4D CT has an study for over 2 years and maintain Sept 2012 accuracy of 87-94% in localizing a close relationship with our multi- 2. Houang et al Radiology Vol 270 an adenoma to a quadrant.2 Image 2 disciplinary clinical colleagues. Jan 2014 4D CT combines detailed 3-di- mentional cross-sectional imag- ing together with changes in en- hancement over time providing the AMA Career Assist fourth dimension. Pre-contrast scans are followed by arterial and – supporting you on your professional journey delayed (washout phase) contrast For professional advice on career options, preparing imaging. your application, CV development and presentation, The characteristic findings are contact your local support service. intense arterial-phase enhance- ment (Image 1) with rapid washout Contact your AMA ACT for Careers on the delayed scan. An adenoma Assistance. Phone 6270 5410. is typically low attenuation with respect to thyroid on the pre-con- trast scans due to the iodine con- tent of the former (Image 2). The The advantages of 4D CT are high cal localization method. The dis- presence of a so-called ‘polar ves- sel’ (Image 3) entering at the up- accuracy and the ability to detect advantages are a higher radiation per or lower pole can be present adenomas in ectopic positions. dose to the thyroid and a definite in up to two thirds of parathyroid It has been suggested that it be learning curve for the imaging adenomas. satisfactory as the sole presurgi- specialist.

The Medical Benevolent Association of NSW (MBANSW) Provides a free and confidential support service to Canberra doctors in need and their family. Financial assistance and counselling support are available to colleagues who have fallen on hard times through illness or untimely death. Support is also available to medical practitioners who may be experiencing difficulties at work or in their personal relationships. The MBANSW is funded by your donations; please allow us to continue to provide support and assistance to your colleagues in need by making a donation to the Medical Benevolent Association Annual Appeal. Donations can be made visiting our website www. mbansw.org.au

If you are concerned about your own situation or that of a colleague, please contact the MBANSW Social Worker, Meredith McVey on (02) 9987 0504.

JUNE/JULY 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [11]

Small business unfair contract terms – medical practices need to be aware BY Karen Keogh, Partner at TressCox Lawyers

Medical Practices need to be aware that from 12 November 2016, the unfair contract terms under the Australian Consumer Law will also cover standard form small business contracts entered into, or renewed, on or after 12 November 2016.

What does this mean? If your practice has: „„entered into a contract for the supply of financial goods or services; and „„at least one of the parties is a ‘small business’; and „„the upfront price payable under the contract does not exceed $300,000, or $1 million if the contract is for more than 12 months then you may have a legal remedy if you believe the contract is unfair. following kinds of terms may be What happens if a term is contractors) to work out which considered unfair: found to be unfair? contracts are affected by the new What is a Small Business? provisions of the Australian Con- „„automatic roll over for In the event the Court finds a term A ‘small business’ employs fewer sumer Law. excessive periods; to be unfair it has the power to de- than 20 people, including casual „„restrictions on the right of clare the term void and not bind- It is important to note that your staff who may be employed on ate the terms. For instance, a mo- one party to terminate the ing on either party. The rest of the medical practice itself may also a regular and systematic basis. bile phone contract or a contract contract will continue to bind the Accordingly, it is possible that contract; be subject to the Australian for medical supplies. parties if it is capable of operating Consumer Law if you enter into both parties to a transaction will „„unilateral variation; and without the unfair term. standard form contracts with be able to rely on the unfair con- When is a term unfair? „„excessive cancellation fees. tract terms. The Court may also vary the con- other small businesses. The Australian Consumer Law The Court will also consider tract, direct a party to refund does not provide a specific defi- Should an issue arise then ad- What is a standard form whether the terms and the con- money to the affected party or nition of what is to be consid- vice should be sought at the contract? tract as a whole is transparent. direct a party to provide services A standard form contact is usually ered an unfair term. In general, This involves looking at whether at that party’s expense. earliest possible time to en- characterised as an agreement a term will be considered unfair the terms are expressed in plain sure your rights are protected. pre-prepared by one party with if it would cause a significant language, presented clearly and Conclusion If you have any questions about standardised terms which is pre- imbalance between the rights of readily available. Terms are un- We recommend that you review the impact of the Australian sented on the basis that the other the parties or if it is not reason- likely to be transparent when all agreements (whether these Consumer Law please contact party can “take it or leave it” with ably necessary to protect the le- they are phrased in legal, com- are agreements with custom- TressCox Lawyers’ Health & no effective opportunity to negoti- gitimate interests of a party. The plex or technical language. ers, suppliers or independent Aged Care Team.

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JUNE/JULY 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [13] A short reflection

The following is an adapted text of a brief speech given by A/Prof. Jeffrey Looi, outgoing Psychiatrist Federal Council representative, at the Soapbox session of the AMA National Conference held in Canberra at the end of May:

A paraphrase of Dante’s Inferno, First Canto: Midway on the journey of life, I found myself in a dark forest, “ The way forward uncertain. The Australian Medical Associa- Those who suffer from mental tion needs to carefully consider illness, their lay and professional and methodically map a way carers still eke out life under forward in a time of dwindling stigma, under-resourcing and membership of professional or- plain neglect as do the aged. The ganisations through the dark for- AMA must also advocate for their est of the future. just and compassionate care. In discerning a way, the AMA should avoid: being swept into Baltasar Gracian, from the churning whirlpool of the his Oracle of Worldly new media and political cycle; steer away from the dangerous Wisdom, had a useful rocks of technological utopian- observation about ism and digital solutionism; and medicine: be ever mindful of the history of The art of the medical profession in pur- pose and action. medicine I advocate for two particular pri- lies in orities for the AMA. “ knowing Aged Care for those who loved, what not grieved, fought for and nurtured to do. so that their futures and our pre- sent have become manifest. The youth of today will live long and ism of members; nor for the hu- are hard won, difficult to main- care for the common health of yet need the care of the young In planning forward, the AMA bristic over-reach to right all of humanity.” and not so young born after should be mindful that we exist: tain and challenging to improve. humanity’s wrongs and heal the them. Thus ever has been the not to protect unwarranted pro- Therefore, the AMA should care- (The quotations are paraphrases. world’s pain beyond our ken and way of human life and the AMA fessional privileges; not as a ve- fully consider our vocation as Otherwise, the text represents expertise. should advocate for careful pro- hicle for the vainglorious political doctors in mapping a through the the author’s academic opinion on vision of health care. self-promotion or NGO career- Our medical skills and expertise dark woods: to learn, teach and health advocacy)

Qantas Club membership rates for AMA members Need a JP? Joining Fee: $240 (save $140) Certification of documents, witnessing 1 Year Membership: $390.60 (save $119.30) of statutory declarations and affadavits, 2 Year Membership: $697.50 (save $227.50) witnessing of signatures. (all rates are inclusive of GST) Call Christine Brill To renew your Qantas Club Corporate Membership For further information or an 0407 123 670 contact the secretariat to obtain the AMA application form please contact the corporate scheme number. AMA ACT secretariat on 6270 5410 For new memberships download the application or download the application from the from the Members’ Only section of the AMA ACT Members’ Only section of the AMA website: www.ama-act.com.au ACT website: www.ama-act.com.au

[14] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 JUNE/JULY 2016 Dr Eddie Cassar Dr Bish Mukerjee wishes to advise the FRCS FRCOG FRANZCOG ClosurE of the Canberra Consultant Obstetrician ROOMS specialist Clinic. Sapphire Coast Medical Practice & Gynaecologist is seeking 2 fully quali ed GP’s Special interest in He and his staff pass on to replace retiring GP’s ~ Pre pregnancy counselling TO LET their best wishes to clients ~ Vulvo vaginal diseases Enquiries to Janine Dixon and medical support over Phone: 02 6492 2555 Suite B9, 161 Strickland Crescent Deakin Email: [email protected] 6285 1292 CANBERRA the last 45 years. Web: scmp.com.au SPECIALIST CENTRE AMA ACT membership AMA ACT membership 80 square metres entitles you to access this entitles you to access this Member Reward Partner Fully furnished Member Reward Partner Dr Julie Kidd Procedure room with THE GP Hypnotherapist ensuite toilet ESSENTIAL INGREDIENT Smoking, alcohol, binge-eating, stress, anxiety etc. Excellent location with Ph: (02) 6295 7148 HOTEL REALM all medical facilities nearby – Inspiring great cooking with Ph: (02) 6163 1888 Canberra Complementary Health Practice Contact 0411 591 642 ingredients, books and cookware – Accommodation only Suite 4, Playoust Bldg, Hawker Pl, Hawker Conditions may apply and you must produce your Conditions may apply and you must produce your membership card to access these bene ts. membership card to access these bene ts. 0425 300 233 | www.canberrahypnosis.com.au

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JUNE/JULY 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [15] Associate Professor ARGYLE MEDICAL CENTRE WOMEN’S HEALTH A. J. Collins MB BS FRACS - GOULBURN ON STRICKLAND The dynamic group of doctors at the Breast and Thyroid Surgeon Argyle Medical Centre in Goulburn is seeking graduates in general practice Dr Liz Gallagher and Dr Omar Adham have now Oncoplastic Breast Surgery – including: to join them. introduced the MonaLisa Touch to their practice. w Immediate breast reconstruction and Argyle Medical Centre is an MonaLisa Touch is an innovative 5 minute, breast reduction techniques accredited and teaching practice non-hormonal laser treatment that achieves lasting located one hour from Canberra. w improvements for patients suffering from: Breast Cancer surgery If you are interested, please contact ~ Dyspareunia w Sentinel node biopsy Dr Ivan Wilden-Constantin on 02 4821 1188 ~ Incontinence and Urinary Urgency Thyroid and Parathyroid surgery ~ Vaginal itchiness and burning ~ Dryness and loss of lubrication Address: Suite 4A, Level 2 ~ Prolapse and laxity National Capital Private Hospital ~ Vaginal and vulval pain Phone: 02 6282 1191 For further information please call the practice on 02 6282 2033 Fax: 02 6282 8539 or email [email protected] Dr Sabari Saha MBBS (Hons), FRACP Geriatric Medicine Physician l Comprehensive Geriatric assessments l Falls assessments l Cognitive assessments New Dr Andrew Foote l Medication reviews location in l Braddon Obstetrician, Gynaecologist & Urogynaecologist Home visits & Residential Over 20 years experience Aged Care Facility visits Special Interests in: Hospital admissions - NEW: Botox Intravesical Injections for OAB can be arranged - obstetrics Bulk Billing available - prolapse - incontinence suite 11/12, napier close, - Mona Lisa vaginal laser deakin act 2605 1/30 Bougainville Street, Manuka Phone: 02 6154 5031 Phone 1800 URO GYN www.totalwomenshealth.com.au Fax: 02 6169 4437

Medical consulting RooM Orthopaedic available FoR Rent Surgeon The consulting room is available with secretarial support. PRACTICE LOCATION The consulting room is a Physician’s chambers in Woden. Please contact Kerrie on 02 6285 4298

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[16] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 JUNE/JULY 2016