April 2013

Canberra Doctor is proudly brought to you by the AMA (ACT) Limited Circulation: 1,900 in ACT & region Don’t lose sight of your patients – Ama says Optometry Board puts glaucoma patients’ care at risk The AMA is advocating health professions to work together assessed for signs and symptoms of (under the previous guidelines) for participa- The table below shows the to manage patients with glaucoma, glaucoma, with an ophthalmologist tion in a documented shared-care or man- anti-glaucoma medicines that the that Australian Health and also recommends the sharing of confirming that diagnosis and then agement plan with an ophthalmologist”. Optometry Board of Australia has Ministers reverse a information with the patient’s GP to discussing and initiating treatment. The AMA asserts that no evidence listed for optometrists to prescribe decision by the complete the clinical team. In a Fact Sheet, the Optometry of the “practical limitations” was pro­ independently, compared to other “Glaucoma Australia wants Board states that it considered “the vided to the Board in the submis­ regulatory arrangements and the Optometry Board of the current arrangements for the detection and management of practical limitations of the requirement sions made to its consultation paper. NHMRC Guidelines: Australia to allow glaucoma to be maintained. NHMRC Australian Register Medicine PBS Listing optometrists to “Yet the Optometry Board has Guidelines of Therapeutic Goods given the green light for optome­ independently manage trists to go it alone in caring for Apraclonidine medical practitioners only 2nd line treatment Listed patients with glaucoma. glaucoma patients. Betaxolol Shared care with, and diagnosis confirmed by, 1st line treatment Listed “This is an irresponsible deci­ ophthalmologist AMA President, Dr Steve sion by the Board and it must be Bimatoprost Diagnosis confirmed by, and shared care with, an 1st line treatment Listed Hambleton, said that the decision reversed immediately,” Dr Ham­ ophthalmologist puts comprehensive quality care of ble­ton said. glaucoma patients at risk. Brimonidine Shared care with, and diagnosis confirmed by, 2nd line treatment Listed On 21 March 2013, the Opto­ ophthalmologist “The Optometry Board deci­ m­etry Board of Australia released sion goes against the advice of the revised guidelines for optometrist Brinzolamide Shared care with, and diagnosis confirmed by, 2nd line treatment Listed Pharmaceutical Benefits Advisory use of schedule medicines. ophthalmologist Committee (PBAC) and against the The Optometry Board asserts Carbachol Not listed 3rd line treatment Listed wishes of the peak glaucoma sup­ that optometrist “competency stand- port group, Glaucoma Australia,” ards address differential diagnosis and Diprivefrin Not listed Not listed Not listed Dr Hambleton said. treatment options …” Dorzolamide Shared care with, and diagnosis confirmed by, 2nd Line treatment Listed “Glaucoma is known as the In its submission to the Opt­ ophthalmologist ‘sneak thief of sight’, and one in om­­etry Board, Glaucoma Australia Latanoprost Shared care with, and diagnosis confirmed by, 1st line treatment Listed 10 Australians over 80 will develop stated: ophthalmologist the disease. Independent and ongoing man­ “It is a complex disease that ­agement of a glaucoma patient by an Levobunolol Not listed 1st line treatment Listed comes in many forms, and requires optometrist alone has the potential Pilocarpine Shared care with, and diagnosis confirmed by, 3rd line treatment Listed highly specialised care over time. to increase the likelihood of missing ophthalmologist “The Optometry Board has disease progression on the one hand Timolol Shared care with, and diagnosis confirmed by, 1st line treatment Listed shown that is out of step with best or to over-treat glaucoma suspects ophthalmologist practice care for patients with glau­ on the other. Glaucoma Australia coma. believes the best option from a Travoprost Shared care with, and diagnosis confirmed by, 1st line treatment Listed “PBAC recognises the impor­ patient perspective is the current sys­ ophthalmologist tance of optometrists confirming tem where optometry is the logical Potential systemic side effects from beta-blocker eye drops (eg Timolol) include bronchospasm, hypotension, diagnoses of glaucoma with ophthal­ first port of call for the Australian bradycardia, heart block, masked hypoglycaemia, adversely affected lipid profile, impotence, fatigue, depression, mologists, and the need for these two community to be comprehensively reduced exercise tolerance, fainting, confusion, and alopecia.

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April 2013 Volume 25, No. 3 TERRITORY TOPICALS – from President, Dr Andrew Miller I have just returned from a brief to add, not ANU) as “teach yourself A senior bureaucrat said to me these “frequent flyers” are character­ holiday in the apple isle, walking on medicine”. I find myself asking just today “just another stupid decision”. ised by a lack of insight. the Freycinet Peninsula. Just experi­ what, other than meaningless jargon, I couldn’t agree more. None of this has convinced me encing a few days without mobile is an “efficiency dividend” in educa­ The news about these taxation that a profession-wide revalidation phone contact was refreshing. While tion, and how does one reap it? changes has served to overshadow process will achieve the espoused there I met an interesting young I have also just paid my registra­ another “conversation” that we are outcome. If we are not careful the man. He was the guide for our tion for my college annual scientific told we will need to have. Appropriate burden of meeting statutory require­ group; and extraordinarily enthusias­ meeting. To meet my CPD require­ really considering the company it ments will become a significant tic and knowledgeable. He had com­ ments for continued registration I keeps. This concerns “revalidation” impediment to productivity. The pleted a certificate IV course in tour­ need to attend this conference of medical professionals. Whilst the UK experience is suggesting that a ism in Tasmania 18 months previ­ because it will provide a large slab of Medical Board of Australia has indi­ disturbing number of work hours; ously after spending his years after cated its intention to work consulta­ up to 15% or more, may be expend­ school doing casual labouring jobs CPD points (not all that I need, but ed undergoing revalidation activities. a significant contribution). The reg­ tively with the profession in its con­ with, by his own admission, no real versations with us, the public rheto­ The debate will happen, that Dr Andrew Miller future and no plans. Since obtaining istration cost was over $1200 for 5 much is out of our control; so it is days. The exotic resort is Darling ric revolves around protection of his qualification he had been work­ the community from bad doctors. most important that we engage contracted services is core business ing on a number of the “Great Harbour. The cheapest accommoda­ actively. This will happen at a politi­ for the AMA and I’d encourage sala­ tion will still push me over $2000 The most often quoted source is Australian Walks” as a guide. This Bismark MM, Studdert D (Realising cal level with the AMA, but we also ried and privately practising doctors qualification had been transforma­ expenditure; and that without eating need to ensure that our colleges who are not yet members to join up anything or travelling. the research power of complaints tional. I looked up the course today. data. NZ Med J 2010;123:12–1). Here come on board as well. and reap the benefits that belonging It costs $1900, not allowing for text­ I have read the Treasurer’s press I also think it important for each to the largest independent medical release, euphemistically titled “Ref­ a study of complaints databases books and equipment. found that 3% of doctors were one of us to “act local” by engaging association in the country can offer. I am old enough to remember orms to self-education expense at a personal level with our col­ For some time out, I thoroughly responsible for 49% of complaints. leagues, to support and mentor. another facet of the Hawke years, deductions”. I wonder about our Now, there is little doubt in my mind recommend Tasmania as a holiday one not mentioned by Simon Crean junior doctors and the fees that they In terms of acting locally, I destination. Our lodge accommoda­ and Martin Ferguson. I am recalling that we as a profession have great dif­ would like to report that the VMO must pay as they undergo advanced ficulty dealing with problematic col­ tion on the Freycinet Peninsula had the “Clever Country” campaign; and training, for exams and courses; contract negotiations are progress­ a policy of showcasing local prod­ find myself contrasting this with the leagues. The community perceives ing as expected. This means that we about the cost of journals and texts. these as a failing in systems designed ucts. The food and wine had trav­ recently announced higher educa­ The AMA is taking the only have made substantial progress elled very few kilometres to our tion and self-education savings to ensure that quality standards are towards defining the essentially irrec­ stand that is reasonable in these cir­ preserved. What Bismark has high­ tables. The quality was excellent. The measures announced by the Gillard cumstances; one of firm opposition. oncilable differences between our­ government to help fund the Gonski lighted is that it is possible to identify selves and the offer from ACT walking was suitably strenuous, but It will be interesting to see if the doctors at risk of persistent poor while looking at where I was putting report-inspired secondary education government is willing to listen. Health Directorate. This means that expenditure increases. practice. They did not advocate a pro­ arbitration is pretty much inevitable. my feet I found an amazing variety I have had 3 children attend uni­ And I think about our young fession-wide process. Gallagher TH, The negotiations have been con­ of fungi! My new photographic fad; versity, in a variety of courses; and a guide in Tasmania; and how he and Levinson W (Physicians with multiple ducted professionally and in good Tasmania aifunghi. 4th just start this year. I have been so many others like him who are not patient complaints: ending our faith. I hope that all the parties A final sad note though. Daryl struck by the reduction in face to sheltered by HECS may hope to silence. BMJ Safety and Quality Online involved in the upcoming salaried Lawrence, wife of well-known face teaching that prevails these days make opportunities for themselves so 2013; 10.1136/bmjqs-2013-001880) in doctors EB negotiations will con­ Canberra anaesthetist, Dr Hugh compared with our own BC (before that they don’t have to be the ones a reasoned editorial have argued that duct themselves in a similar manner. Lawrence, died recently following a computer) years in tertiary educa­ sweeping the floors while 457 visa the keys are found in collegiality, local The AMA-ACT has been requested long journey with cancer. We, at tion. Part of the drive to on-line edu­ holders work the plum jobs (to para­ activism and performance monitor­ to act as representative by a number AMA ACT and Canberra Doctor, cation is, I am sure, a cost-saving phrase our Prime Minister’s appalling ing. They also cite Egener B.( of salaried doctors and so plans to send Hugh, his daughters and son measure. I recently had a colleague misrepresentation of our health sec­ Addressing physicians’ impaired be at the table as the process unfolds. and extended family members our describe the training in a medical tor work force). The clever country communication skills. J Gen Intern Med The AMAs involvement in the heartfelt condolences at this very course (at another university I hasten would seem to be dumbing down. 2008;23:1890–5) who states that fundamentals of employment and sad time.

2 April 2013 The history of the Port Phillip Medical Association Minute Book – 1846-1851 166 years ago the concerns of our medical pioneers, “The book is of great interest was to devise a standard set of fees process will make junior doctors and many of the issues they because it reflects Victorian society based on the UK scale. This better doctors and should be com­ tradition of medical addressed – quality of care, medical at the time, including how much ensured that an equitable schedule pulsory for students. “It gives us all associations was founded ethics, education, billing and so on doctors earned per patient – a guin­ of fees was established from the the knowledge of where we’ve – still echo today. ea in 1848, which translates to outset, and reinforced the status of come from as doctors.” in the form of the Port These early practitioners, about $4–5,000 in today’s terms,” the profession. The group also The complete package is avail­ Phillip Medical despite their isolation, kept abreast says Dr Segal, former AMA defined the boundaries of the pro­ able for sale for $24.50 (incl. GST, Association (PPMA). of developments in medical prac­ Victoria President and honorary fessional association, agreeing that p&p). tice, and there is an account of an archivist. the AMA would not act as a regula­ How to order: The original Minute Book of early demonstration of the use of “In those days, medical treat­ tor (like the Medical Board, for the PPMA is the most treasured ether as an anaesthetic. ment was for rich people only. example) or set ethical standards. By phone or email: Ring AMA document in the archives of AMA Recognising that the copper­ Seeing one patient per day was suf­ As with all fledgling organisations, Victoria on (03) 9280 8722 or Victoria and a replica is available plate script and the idiosyncrasies ficient for a doctor to keep himself there were disputes and transgres­ email [email protected] and for purchase. of 19th century English at times (and they were, for the most part, sions. The first big fight broke out provide name, address and credit Three years ago it was pains­ present challenges for the reader, male) in great comfort – but doctors over ‘hazing’, which was the pinch­ card details. takingly restored and its pages pho­ the contents have been fully ‘trans­ would see up to five. This workload ing of another doctor’s patient – a By mail: Send your order and tographed. Since then, a team of lated’ and are provided on CD stands in stark contrast to that of the heinous crime in those days. cheque (made payable to AMA dedicated volunteers, Drs Walter alongside the digital replication of GPs of today, who have ever- Another dispute took place over a Victoria, $24.50 per copy) to AMA Heale and Peter Lowe and Associate the Minute Book. The third com­ increasing patient loads and limited president who died and left the Victoria, PO Box 21, Parkville, Professor John Hart, has tran­ ponent of this fascinating package spare time in their working days. entire medical library in private Victoria 3052. scribed the contents and compiled is the history of the PPMA The leisurely working hours hands. The association sued his a detailed and absorbing history of It details the historical context doctors kept in those days gave estate to reclaim these precious the Association. of the Association, a summary of them plenty of spare time, and this medical books, which were at that Established in 1846, the PPMA its activities over the five years it meant there was room for commu­ time (in the absence of the plethora predated both the British and existed and biographical notes on nity involvement. Many became of media now available for learning American Medical Associations its founding members. The final upstanding members of their local and teaching) fundamental to medi­ and was the forerunner of the product is a tribute to the many vol­ communities – mayors, for exam­ cal practice, and were shipped on a Victorian Medical Association, the unteers who have contributed to ple, or philanthropists. “In a sense yearly basis from the UK. Medico Chirurgical Society and the the project’s completion. they were visionaries, because they Dr Segal says that the book Medical Society of Victoria. The digital replication of the devised the rules for medical asso­ should be of great interest not only The Minute Book covers the original Minute Book, its transcrip­ ciations well before any other med­ to anyone with an interest in early period from the PPMA’s inception tion and the history of the PPMA ical group in the world,” says Dr Victorian history, but also to those to its disbanding in 1851 (some of are now being made available to all Segal. “They were pioneers who who wish to understand how medi­ its members reformed six months members of AMA Victoria and will influenced their peers in the UK cal societies function. “All doctors later as the Victorian Medical Ass­ certainly be a valuable addition to and US – their ideas and the rules should read this because it explains ociation). the bookshelves of everyone with they created were solid.” the ethics and boundaries by which The minutes provide a fasci­ an interest in the medical profes­ One of the achievements of we work as doctors, and how they nating insight into the thoughts and sion and its history. AMA Victoria’s ‘founding fathers’ evolved. An understanding of this

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April 2013 3 Medical training a You probably already knew this, casualty of education but research has confirmed expense reforms - chicken pox vaccine is saving AMA seeks meeting children’s lives The widespread chicken pox cases, with 1500 hos­ which in a few cases required with Treasurer pitalisations and between 1-16 intensive care treatment. Based on maintain their skills through con­ introduction of a chicken Doctors face the difficult deaths. the results of our studies, this is tinuing professional development. pox vaccine in Australia The study also shows that of choice of paying higher “A $2000 cap on tax deduc­ now mostly preventable”, said in 2006 has prevented children needing hospitalisation Associate Professor Marshall. out-of-pocket costs to tions self-education expenses for for severe chicken pox, 80% had doctors falls well below many [The PAEDS network was thousands of children not been immunised. pursue life-saving basic course costs. established to provide accurate medical training courses “For example, the Australian from being hospitalised The research was led by Ass­ ociate Professor Helen Marshall and timely data on paediatric con­ or cutting back on these and New Zealand Surgical Skills with severe chicken pox ditions of public health impor­ Education and Training (ASSET) from the University of Adelaide types of courses as a program costs $3280, the Care of and saved lives, and Women’s and Children’s Hos­p­ tance and requiring hospitalisa­ result of self-education the Critically Ill Surgical Patient according to new ital, and researchers of the Paed­ tion. PAEDS is coordinated by course costs $2735, and a GP iatric Active Enhanced Disease the Australian Paediatric Surv­ expense reforms attending a Clinical Emergency research from South Surveillance (PAEDS) product. eillance Unit and the National announced by the Management Program (CEMP) Australia. “These results are a very Centre for Immunisation Research workshops can face combined strong endorsement of the impact and Surveillance in Sydney and Government over the In a national study of chicken costs of over $3000. of chicken pox vaccine being funded by the Federal Department weekend. “Many doctors will undertake pox admissions at four participat­ available for children through the of Health and Ageing. PAEDS more than one course a year in ing Australian children’s hospitals, national childhood immunisation Under the reforms, the tax collects data from major paediat­ order to maintain and improve researchers found the number of program, and of the need to deduction for work-related self- their qualifications. children hospitalised with chicken ric hospitals in SA (Women’s and education expenses will be limited immunise all children against “Australian doctors also travel pox or shingles had dropped by chicken pox,” said Associate Children’s Hospital), WA (Princess to $2,000 per person from 1 July overseas to learn about the latest Margaret Hospital), NSW (The 2014. 68% since 2006. Professor Marshall. medical research and innovations, Children’s Hospital at Westmead)­ AMA President, Dr Steve innovative surgery techniques, and Prior to the chicken pox vac­ “A higher level of immunisa­ Hambleton, said the Government advances in overall patient care. cine being available, each year tion would have spared most chil­ and Victoria (Royal Child­ren’s has created a huge disincentive for “Self-education costs for doc­ Australia had an estimated 240,000 dren from severe chicken pox, Hospital).] doctors to pursue specialised edu­ tors are very high. cation that could help save lives “The Government’s proposed and improve the quality of life for reforms will hit junior doctors, many Australians. salaried doctors, GPs and other “Medical training courses are specialists, and patients. very detailed and do not come “We urge the Government to cheap,” Dr Hambleton said. reconsider these ill-informed “Australia has some of the changes,” Dr Hambleton said. most demanding medical training Feedback from local junior courses in the world, and the medical staff highlights real con­ Medical Board of Australia and the cerns about this new ill-conceived Medical Colleges require doctors to initiative of government.

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4 April 2013 Time to address CPSC and ACCC warn of poison student mental health dangers with liquid laundry packets The Australian Medical Students’ Association (AMSA) has released its Student Mental Health and WASHINGTON, D.C. – The U.S. Consumer If swallowed or exposed Product Safety Commission (CPSC) and the to the eye: Wellbeing Policy, which calls on the Federal „„immediately call the Poisons Government to work with Australian universities to Australian Competition and Consumer Commission Information Centre on: address the significant mental health burden (ACCC) are urging parents to take immediate action 13 11 26. to ensure their family is not exposed to the hazards „„if swallowed, rinse as much afflicting Australian youth. Despite their high of the detergent as possible burden of disease only 23 percent of those with a posed by liquid laundry packets or capsules. from the mouth. mental health disorder access health services. Young children who are laundry capsules,” said ACCC „„if exposed to the eye, flush exposed to the highly concentrat­ Deputy Chair Delia Rickard. the eye with water for at least Australian Institute of Health health conditions or provide ed, toxic detergent are at risk of and Welfare data shows that more access to early intervention. “The experience in Australia is 15 minutes. serious injury. consistent with an international “The ACCC has been work­ than a quarter of 16 to 24 year “Students who suffer from Reports of incidents in the olds experience a mental health trend, where most cases have ing closely with industry associa­ poor mental health are less likely to United States and Australia have disorder over a 12 month period. involved a child aged five years or tion Accord Australasia to improve perform well at university, which prompted the product safety Acting AMSA President, will impact on their long-term pro­ younger.” the safety and packaging of these Richard Arnold, said when launch­ agencies to warn parents about ductivity and contribution to the what can happen if these prod­ The number of incidents, in products. With the assistance of ing the Policy, “that the Federal Australian economy. a relatively short period of time, Accord, industry has acknowl­ Government is aiming for 40 per­ ucts are not used safely. Children “Research and intervention suggests that children are highly edged our concerns and has sig­ cent of 25 to 30 year olds to hold who have ingested detergent now, will benefit the Australian from the packets have required attracted to the packets, which nalled that changes will be made. a Bachelor degree by 2025. This Expected changes include the means at least 40 percent of community and economy into the medical attention and hospitali­ can resemble play items. The soft future.” zation for loss of consciousness, redesign of the product and outer Australia’s youth should pass and colourful product can be eas­ packaging so it features prominent through a tertiary institution, cre­ The full policy can be found at excessive vomiting, drowsiness, ily mistaken by a child for candy, throat swelling, and difficulty warning labels and consistent safe­ ating an ideal opportunity for the www.amsa.org.au/adovcacy/ toys, or a teething product. ty information,” said Ms. Rickard. institutions to help prevent mental official-policy breathing. Eye contact has also Water, wet hands, and saliva resulted in reports of injury, For more information about including severe irritation and can cause the packets to dissolve product safety in Australia, temporary loss of vision. quickly and release their highly vist www.productsafety.gov.au, “Poison call centres across concentrated toxic contents. follow the ACCC on Twitter at Australia have received more Parents and caregivers are urged www.twitter.com/ACCCProd than 85 calls in the last 18 months always to handle the product Safety or call the ACCC relating to exposure to these carefully and with dry hands. Infocentre on 1300 302 502.

April 2013 5 What’s the AMA doing for General Practice? This report from vocationally registered GPs the consultation or for use at home Discussion of ehealth busi­ teach or are accredited to teach. if the service is bulk-billed; and ness solutions to facilitate non face Kambah GP, Dr Suzanne The percentage of PIP practic­ (b ) a registration fee cannot to face interactions between GP Davey, is a summary of es hosting medical students has be charged to attend a practice if and patient and be able to change the February 2013 declined since last year from 19.9% the consultations are to be bulk- for them: - AMA will update posi­ to 16.2%. The AMA has proposed billed tion statements on ehealth after meeting of the AMA’s that the PIP be doubled, the federal The AMA encourages doctors asking secretariat to investigate Council of General government called upon to expand to set their fees based on their pros and cons. the GP infrastructure grants pro­ practice cost experience including „„The 2013 Family Doctor Practice. The Council gram, and that new initiatives be consumables that are used as part Week promotion will focus members come from identified and developed to encour­ of the service. age and support more GPs to teach. around the slogan: Your across the nation to „„DHS Large practice Com­ Family Doctor Your Medical „„ The concept of discuss issues of Revalidation: pliance project: DHS believes Home. (Canberra Doctor will revalidation is seen as inevitable that some larger practices (4 or again celebrate regional GPs in importance to general by the Medical Board. The AMA more doctors) are not complying its annual Family Doctor Week Executive Council wishes to with MBS item number billing edition in July 2013). practice, general their availability for direct phone engage with the Medical Board and is to investigate billing practitioners and patients. communication. I brought up the on the issue. In particular, it practices in these practices. „„Chronic Diseases items issue that hospital discharge sum­ wishes to introduce the concept review: DOHA is seeking input Further information of any of maries now contain reams and of professional responsibility for The AMA has pointed out from AMA about developing a the issues highlighted below can reams of results with very little addressing risky behaviour that medical practitioners may not better funding model for man­ be obtained from Dr Davey or analysis of what the patient’s actual directly with colleagues on the have autonomy over billing prac­ aging­ chronic disease. App­ from the AMA ACT Secretariat. diagnosis was, with a future plan of basis of avoiding the need to tices, diagnostic requests and refer­ arent­­­ly there is exploitation of rals in larger practices. The AMA „„Support for RACGP initia­ action. It was thought that this was make a mandatory report. chronic disease management because the most junior member Several points were made. Older states that consideration needs to item numbers by other than tives. Federal AMA President, be given as to the set-ups/drivers/ Dr Steve Hambleton thought of the team wrote the discharge doctors should change their usual doctor charging for them. systems that put medical practi­ that the AMA should support summary, and that this person practice style so that they see AMA has developed a Chronic tioners at risk of non-compliance. the RACGP initiatives re often lacked understanding of what fewer patients and spend longer Disease Management Plan with funding for training and no actually went on during the patient’s on each consultation. Multiple The AMACGP thought DHS’s so called which it will brief DOHA. loss of chronic care funding, in admission. It would be preferable tools should be used to assess “education” letter to be There is no more money avail­ sent to GPs was overly threatening this election year. for the Registrar or Specialist to doctors, looking for panhy­poc­ able- just a fairer redistribution. write the discharge summary. ompetence. and punitive, and Steve Hamble­ton „„The GP/Hospital Integrat­ ion­ was to write to DHS accordingly. „„Medicare Locals: In view of the Position statement is to be „„PCeHR: There have been „„IMGs: a discussion paper on IMGs was presented which (An edited version of this letter is Opposition’s lack of clarity re upgraded from the 2006 vers­ion, 62,000 patient registrations out Medicare Locals, the AMACGP of a possible 20 million. stated that IMGs would included in this edition of Canberra taking into account the ageing Doctor). is to ask Federal Council to call on population with its chronic DOHA has advised that 4,200 continue to made up a large portion of the Australian „„The Medical Home: The the opposition to commit to an disease burden and the pivotal general practices have registered independent review of Medicare role general practice plays in long HPI-O by late January 2013, as a workforce, and that the AMA AMA supports the internat­ion­ should endeavour to find out ally held concept of the “Med­ Locals, if elected. The AMA term patient management. The precursor to being able to claim remains concerned that MLs in AMACGP is to ask the Federal what their needs were and how ical Home” where the patient eHealth PIP payments. This is their current form will consume Secretariat to develop a new best to support them. identifies with a personal GP more than 90% of practices previ­ health funding that could be position state­­ment on discharge ously claiming the eHeath PIP. Note was made of the AMA within a nominated general summaries. Secure messaging remains a diffi­ nationally run Career Advisory prac­­­tice as the provider of pri­­­ better utilised by GPs in delivering cult issue. The AMA has put in a Service based in the AMA ACT mary health care to that person. services to patients, and that the This fits in with outcome of MLs will have a focus which the ACT Clinical Senate meeting Federal Budget submission empha­ which supports IMGs seeking jobs The AMA supports voluntary sising that practising clinicians with information, resume and inter­ registration of a patient with a extends beyond primary care and that I attended on in December support of GP service delivery, last year on Clinical Handover. should oversee the implementa­ view advice and career counselling. particular practice, but not so that primary care resources Issues were raised by hospital tion, evaluation, and adjustment „„Bulk billing Fact Sheet: capitation or compulsory regi­ specialists that they could not con­ of the PCeHR, as clinicians are DOHA has reiterated that no stration. may, in fact, be directed away tact GPs by phone because of the currently being squeezed out of charge can be made where a „„Private Health Insurer’s: from general practice. trouble they had getting through on the decision-making. service is bulk-billed. AMA supports efforts to bring Dr Suzanne Davey GP phone switchboards and in par­ „„Barriers to clinical teaching In particular: role of GPs more centrally into Chair, AMA ACT GP Forum ticular because of the part time were discussed, noting that (a) a charge cannot be made PHI’s current primary care & ACT AMA representative to hours many GPs worked, limiting currently only 10% to 20% of for dressings to be used either in focussed programs. the AMACGP

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6 April 2013 Billing accurately Warning issued by infectious diseases under Medicare experts to stay away from bats Medicare Australia is or reviews under the Practitioner Review Program Infectious diseases There is no proven effective writing progressively to where we detect billing of treatment for lyssavirus infection experts at a major in humans. Only experimental all health practitioners in concern international infectious treatments have been applied, such Australia throughout „„If service has been billed as the antiviral amantadine and 2013 reminding of the incorrectly under your diseases conference have other measures such as maintaining responsibility to bill Medicare provider number or issued a stark warning sedation and glucose balance, in your name you will be for people to stay away which have not been shown to be accurately under responsible for the effective. Once the disease has pro­ Medicare. repayment of benefits in from bats, after releasing gressed, it is almost always fatal. excess of what should have The 8-year-old boy is just the The letter, which may have details of the treatment third reported case of ABLV and been paid. These excess the first in a child. At the ASID already been received by some benefits are a debt owed to of an 8-year-old boy in practitioners, reminds that “you meeting, Dr Francis described are responsible, as an eligible the Commonwealth, and we Queensland, Australia, what happened to the 8-year-old health practitioner, for your bill­ are legally obliged to recover who died from boy, who was bitten during a ing, and you may be asked to sub­ these debts; and Australian Bat family holiday to northern stantiate claims made to Medicare „„Administrative penalities may Queensland in December 2012. using your Medicare provider apply. Lyssavirus (ABLV) The boy did not tell his parents number or in your name. This is earlier this year. he had been bitten, and three the case regardless of who pro­ The letter recommends that you weeks later began to suffer con­ vides the administration for the „„Ensure items billed for Dr Joshua Francis and Dr vulsions, severe abdominal pain billing, or the nature of your services you provide are in Clare Nourse (Paediatric Infection and fever, followed by progres­ business relationship with the accordance with MBS Management Service, Mater sive brain problems, with inter­ practice.” requirements mittent periods of lucidity. The Children’s Hospital, Brisbane, boy was intubated and ventilated The letter reminds that when QLD) and colleagues issued the you bill under Medicare: „„Review your billing at your while doctors frantically tried to „„Australian law determines the practice to identify and warning at the Australasian Society establish what was wrong with for Infectious Diseases (ASID) rules for billing under correct processes that may him. Analysis of his brain and anyone who has had skin or mus­ Medicare put you at risk of billing meeting held recently in Canberra. spinal fluid were normal at first, ABLV was first identified in cosal contact with saliva or neural „„If you bill under Medicare, incorrectly under Medicare but on day 10 of his admission Australian bats and flying foxes increased levels of lyssavirus tissue from an infected person. you must fulfil the „„Ensure you are able to This involves immunoglobulin requirements of the MBS in 1996 and remains common in were detected. The boy’s neuro­ substantiate all claims made both animals, though human logical condition deteriorated, treatment and vaccination. Foll­ „„You are legally responsible under your Medicare infection is extremely rare. Two characterised by symptoms such owing the diagnosis, we identified for services claimed under provider number or in your adult cases were confirmed in as abnormal movements, and he 175 potential contacts of the boy, Medicare when they are name, and then went into a coma. Treatment and of these five household billed under your Medicare 1996 and 1998, and followed a „„Advise Medicare if you are similar disease course to rabies with amantadine was unsuccess­ mem­­­­bers and 15 healthcare-work­ provider number or in your ful, and he tragically died on ­ers were offered PEP.” name aware of incorrect Medicare before being fatal in both cases. One was a woman bitten by a fly­ February 22, 2013. He concludes: “ABLV has „„It is also your legal payment by completing the ing fox after trying to remove it Dr Francis says the warning proved fatal in all cases reported to responsibility to ensure that Voluntary acknowledgment has been issued not just for the of incorrect payments form from a child, the other a carer date. There is a need for in­­creas­­ed any patient referrals or danger from bats themselves, but public awareness of the risk associ­ requests for services that will available at humanservices. who looked after these animals. the risk, however remote, that the ated with bat contact. In short, be claimed under Medicare gov.au/health professionals> Other lyssavirus strains circulate disease can spread between are medically necessary for DoingbusinesswithMedicare in bats in the USA and Europe, humans. He says: “Human to people should stay away from bats. For anyone exposed, PEP is effec­ the treatment of the patient >Compliance>IMCA and multiple cases of human human transmission of lyssavi­ tive at preventing progression to „„Medicare has sophisticate resources infection, and subsequent deaths, ruses had not been well docu­ ways to detect possible have been reported. Thus this mented, but it is theoretically pos­ disease, and should be considered inappropriate practice or warning issued by experts applies sible. Local and international as soon as possible in all cases that incorrect claiming. We may to wherever bat or flying fox guidelines recommend post- constitute a potentially significant undertake compliance audits populations exist. exposure prophylaxis (PEP) for exposure..

April 2013 7 Study shows that measles can spread beyond those seated immediately around an infectious person on aeroplanes New research published at the recently held Annual primary cases and became ill in the children, and where there were notification, and accessing flight 10-14 days after the flight) occurred multiple infectious cases travelling. manifests. Dr Dowse says: “We Scientific Meeting of the Australian Society for in people on 7 of 49 flights on “Because of delays in diagnosis recommend that direct contact Infectious Diseases (ASID) in Canberra demonstrates which infectious cases travelled. and notification of cases, and the tracing to identify susceptible peo­ that direct contact tracing of aeroplane passengers Secondary cases occurred on 7 of additional time to access flight ple exposed to measles cases on 36 international flights and none information, only 31% of flight aeroplanes should not be under­ seated immediately around an infected person, as is of the 13 domestic flights that manifests were available to health taken routinely, and other strate­ currently recommended in Australian and other infectious cases had travelled on. authorities within 5 days of travel­ gies should be considered.” international public health guidelines, is not an Most of the primary cases ling,” says Dr Dowse. “This means He concludes other strategies were Australians who were infect­ that in most cases it was too late to could include using general media effective strategy to prevent further cases. The ed overseas, in a range of countries provide vaccine or immunoglobu­ alerts identifying flights on which research is by Dr Gary Dowse, Communicable – primarily developing countries in lin that might prevent illness in passengers may have been exposed, SE Asia and Asia where measles exposed passengers who were and which provide advice as to transmission remains endemic, but found to still be susceptible to Disease Control Directorate, Department of Health, what passengers should do (such Perth, WA, Australia, and colleagues. also in some European countries, infection.” The delays identified including the UK, which have had do also have implications for the as see their doctor promptly if they think they have not been vac­ Not much data exists regarding cases notified in Australia in the measles epidemic activity in recent timeliness of being able to contact years. Almost all the secondary trace people potentially exposed to cinated as there may be time to be measles transmission during aero­ period Jan 2007 to June 2011, and protected, or if they develop plane travel, or the effectiveness of who were likely to have been infec­ cases were also Australian. other infectious diseases, which Nine (45%) of the secondary may be more serious than measles.. symptoms consistent with mea­ contact tracing. In this study, Dowse tious or infected while travelling on sles). Another possible strategy and colleagues analysed the risk of aeroplanes. cases were seated within 2 rows of The authors say that the results the index case, while 11 cases show that, despite secondary mea­ would be to consider SMS messag­ transmission associated with infec­ The researchers identified 45 (55%) were seated outside 2 rows, sles transmission occurring in 1 in ing or email alerts to all passengers tious measles cases who travelled infectious cases who had travelled beyond the range of seats for 5 international flights with infec­ on an affected flight, if airlines can on flights to or within Australia. on aeroplanes, involving 49 sepa­ which contact tracing is currently tious cases, the risk was not clearly provide such details (or send mes­ The authors obtained information rate flights (some had connecting recommended. Secondary trans­ related to seating proximity and sages on behalf of health authori­ from all state and territory health flights). 20 secondary infections mission was more likely to occur contact tracing was ineffective, ties if they are unable to release authorities in Australia on measles (people who were infected by the when primary cases were in young especially given delays in diagnosis, such information).

The notice board! Dr Rob Creer Orthopaedic Surgeon AMA Practice Managers Network TOPIC: ACT Work Health and Safety Legislation. Practice Relocation WHEN: 6 pm Wednesday 8 May 2013 VENUE: AMA ACT 42 Macquarie St Barton. ~ Sports and Reconstructive Surgery of the Knee and Shoulder A representative from Worksafe ACT will give a ~ Joint Replacement of the Hip Knee and Shoulder presentation on recent changes to the ACT Work Health and Safety legislation. For Appointments This session is open to practice managers and senior 02 6162 0807 staff of AMA ACT members. Suite 5, Cnr King and Denison Streets, Deakin ACT 2600 If you would like to attend this meeting, please RSVP by Friday 3 May to membership@ama- act.com.au www.drcreer.com.au

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8 April 2013 2012 AMA Junior Doctor Training, Education and Supervision Survey Quality clinical training, doctors beyond PGY2+, with investment in these activities “Quality clinical training, edu­ “The system is working best increasing integration of is adequate with indexed, cation and supervision in public for junior doctors in the struc­ education and unaccredited registrar posts protected funding; and hospitals underpin medical educa­ tured environment of internship supervision in public into vocational training; „„A framework for measuring tion in Australia,” Dr Hambleton and vocational training. said. hospitals underpin „„Recognition and development the quality of medical “But junior doctors working of the role of junior doctors training. This should include “Medical training must be in unaccredited roles or in seen as an investment in the future medical education in as teachers and trainers with consideration of a national unstructured training programs training survey, development health care for Australian com­ Australia and should be the provision of education munities. are less satisfied with their train­ and resources to develop the of key performance ing experience. indicators, and inclusion in “The AMA TES survey pro­ seen as an investment in teaching skills of junior vides clear guidance from the “There is room for significant doctors; the National Health improvement in providing quar­ the future health care for Performance Authority’s training coalface about what needs „„Improved provision of antined time for research, support performance and to be done to maximise the bene­ Australian communities. flexible working hours by fits from that investment. for part-time or flexible hours, accountability framework. The 2012 AMA TES survey both employers and “We must invest strongly to and providing teaching skills for vocational training providers; The AMA Junior Doctor provide better support for our junior doctors. of junior doctors delivers mixed Train­ing, Education and Super­vis­ „„ public teaching hospitals to main­ “Immediate significant invest­ results for public teaching hospi­ The urgent development of ion (TES) survey – conducted dur­ tals in Australia. While there are an articulated clinical tain the key teaching and training ment is needed to ensure the qual­ ing June and July 2012 – received roles and to preserve quality, safe­ ity of medical education and indications that the medical educa­ academic pathway for medical 1,112 detailed responses from jun­ tion system is coping despite large ty and good patient outcomes. training for the burgeoning medi­ students, trainees, senior ior doctors about their medical increases in training capacity, there “The survey indicates that the cal training pipeline.” doctors and existing clinical training experiences in the public is significant room for improve­ public hospital system is doing its academics; hospital system. The AMA Junior Doctor ment in a number of areas. best to support medical education „„The exploration of robust AMA President, Dr Steve in the face of growing numbers Training, Education and The AMA is calling for: and transparent funding Ham­bleton, said that the survey of medical students and junior Supervision (TES) survey „„Increased educational models for teaching and del­­ivered mixed results for public doctors, but the system’s capacity isavailable from oversight for prevocational training, ensuring that teaching hospitals in Australia. is being stretched. www.ama.com.au

The President, Dr Andrew MIller, Educating Board, Members and Staff of the A News Magazine for all AMA ACT extend their sincere Doctors in the Canberra Region medical practice staff ISSN 13118X25 condolences to the families, Published by the Australian – a priceless gift friends and colleagues of Medical Association Dr Frank Vett and Dr Guy Harris. (ACT) Limited 42 Macquarie St Barton (PO Box 560, Curtin ACT 2605) Editorial: The National Health Christine Brill Training Package Ph 6270 5410 Fax 6273 0455 Diploma of Practice [email protected] Management (HLT52012) Typesetting: Setting a new government Design Graphix Ph 0410 080 619 endorsed standard for the Editorial Committee: qualification and skill level Assisting of Practice Managers. Dr Ian Pryor – Chair/Editor Dr Jo-Anne Benson Canberra Mrs Christine Brill – Production Mngr Dr Ray Cook Course topics include: Benefits: Doctors Dr John Donovan • Legal and Ethical Requirements • Flexible training options – A/Prof Jeffrey Looi and their • Staff Management at the Practice on or off site Dr Peter Wilkins Mr Jonathan Sen • Managing Risk • The latest contemporary Health families Advertising: • Leadership Industry course materials, developed with peak associations Ph 6270 5410, Fax 6273 0455 • Time Management too! [email protected] • Budgets and Finances • On the job skills development Copy is preferred by Email to with options for workshop series • Practice/Service Management [email protected] • Recognition of Prior Learning or on disk in IBM “Microsoft Word” • Policy Writing options The Medical Benevolent Association is an aid organisation or RTF format, with graphics in TIFF, • Recruitment and Selection EPS or JPEG format. Next edition of of Staff which assists medical practitioners, their spouses and Canberra Doctor – May 2013. children during times of need. • OH&S Management The Association provides a counselling service and financial The Diploma is now available as an Australian Apprenticeships pathway for assistance and is available to every registered medical Disclaimer eligible employees, providing Australian Government incentives to employers for employees to undertake the course. Final employee eligibility is determined practitioner in NSW and the ACT. The Australian Medical Association (ACT) Limited shall not be responsible in any by an Australian Apprenticeships Centre. manner whatsoever to any person who The Association relies on donations to assist in caring for relies, in whole or in part, on the contents Express your interest in enrolling now... the loved ones of your colleagues. of this publication unless authorised in writing by it. T 1300 558 936 The comments or conclusion set out in this publication are not necessarily approved or E [email protected] For further information please phone Meredith endorsed by the Australian­ Medical W www.esset.com.au Association (ACT) Limited. McVey on 02 9987 0504

April 2013 9 Criminal Negligence for Medical Professionals after Patel v The Queen [2012] HCA 29 By Kate Mahoney harm and sentenced to 24 years ism including his bedside manner. tion. The only criterion necessary Kate Mahoney (LLB/IB) is a incarceration in total. On appeal Unfortunately because the evi­ is an intention to do the act which second year student at the ANU In 2003 Dr Jayant Patel in August 2012, the High Court dence was so broad, they were inadvertently causes death.’ Medical School. Kate has arrived at Bundaberg quashed the convictions on the unable to show which specific Implications worked as a legal officer with Base Hospital appointed basis that there had been a sub­ actions led to the patient harm and Retrials in respect to many of the Commonwealth and as a stantial miscarriage of justice in lines of causation were muddled. the outstanding charges have com­ solicitor in Canberra. as a Senior Medical the running of the trial. Dr Patel Furthermore, on day 42 of the menced. References available from the has been acquitted of one charge trial the DPP substantially changed Notably, in preparations the author on request. Officer. Within a week of manslaughter in a re-trial while its case to include an allegation he was appointed the DPP has experienced complica­ outstanding charges remain. that the recommendation of the tions in formalising their pleadings. Director of Surgery The charges of manslaughter surgical procedures was criminally While it is tempting to blame and grievous bodily harm broadly negligent, after it had been revealed despite having no them for the problems, it high­ related to: performing a colectomy that in general the surgeries per­ lights that that criminal negligence specialist registration in on a 75 year old man with diver­ formed had been conducted rea­ is a little tried area of the law and Queensland. ticulitis complicated by bleeding sonably competently. one which is largely unsettled, from the rectum who subsequently Criminal negligence meaning that there are no clear In May 2005 the Queensland died; a colectomy on a man with The crux of the case is what rules to formulate clear lines of Government launched an Inquiry pre-malignant abnormalities of the actions by a doctor might amount causation upon. into all Queensland Hospitals com­ bowel; two oesophagectomies, one to ‘criminal conduct’ as opposed This reflects the difficult m­­­­­ encing­­­ with Bundaberg Base on a 46 year old man with advanced to ‘civil negligence’. Section 288 nature of finding medical profes­ Hospital. The Commissioner found renal failure on haemodialysis and Criminal Code (Qld) specifically sionals guilty of criminal conduct that Dr Patel caused 13 deaths and another on a 77 year old man with refers to medical professional if acting within the scope of their many serious complications in the oesophageal cancer, both of whom conduct and is curiously couched practice. On the one hand it is operations he performed. died shortly afterwards. There are in terms of negligence. It is an important to have medical profes­ The Inquiry also uncovered also outstanding charges of fraud interesting example of the inter­ sionals practising without fear of systemic problems in the adminis­ relating to changes to medical section of traditionally separate prosecution, on the other, it is tration of Queensland Health, the records. principles of law in an area that important for the public to have Medical Board of Queensland The case remains illusive. confidence in the professionals and the Bundaberg Hospital relat­ The High Court heavily criti­ The High Court clarified some treating them without the profes­ ing to Dr Patel’s appointment. cised the Queensland Director of of the uncertainty in relation to the sion being undermined. The tan­ The Commissioner recommend­ Public Prosecutions (DPP) for its law of criminal negligence in the gible implications for the medical ed further investigations including carriage of the matter, including, medical setting by creating an objec­ profession will doubtless be a police investigation into Dr the relevance of evidence brought, tive test: revealed over the coming months­ Patel’s actions. how the evidence was led, and for ‘The test does not require that following the outcome of the fur­ In 2010 Dr Patel was convict­ not trying each charge separately. the accused have an appreciation ther prosecutions, particularly if ed of three counts of manslaugh­ The DPP’s evidential focus was Dr of, or an indifference to, the risk the test in the High Court is effec­ ter and one of grievous bodily Patel’s broad lack of professional­ created by the conduct in ques­ tively applied.

10 April 2013 A boost in the fight against First Anniversary of the John Curtin the killer on our doorstep An initiative to stop the woman with extensively drug- Medical Research Foundation resistant TB has become a medical spread of TB in refugee in Cairns. Originally from The John Curtin Medical research, and today’s research will ed multiphoton microscope was Australia, and reduce its Daru Island, a few hundred kilo­ Research Foundation was produce the treatments of the introduced by MC Mr Hugh impact on our metres north of Cape York, the future. Riminton. Mr Riminton explained woman spent a year in quarantine launched in March 2012 Chief Minister Ms Katy that this cutting edge piece of neighbours. and died in March this year. Gallagher highlighted the need for to support and advance collaboration in the area of medi­ equipment will help ANU The threat is not only to researchers contribute towards a A $2.5 million, six-nation ini­ developing countries. “Australia’s human health through cal research, education and prac­ tiative to fight tuberculosis has aging population and high num­ scientifically researched tice and congratulated the solution for some of the world’s opened at the Centenary Institute, bers of people with chronic health Foundation with bringing togeth­ biggest health issues through their Sydney. It brings together over 14 conditions increase our vulnerabil­ discoveries, medical er the key players in public and studies in cancer biology, immu­ institutes. ity as a nation,” says the University education and practice at private medical research areas. nology, metabolic and cardiovas­ Tuberculosis (TB) once killed of Sydney’s Associate Professor The Australian National ANU Vice-Chancellor cular diseases and neuroscience. more Australians than cancer. In Jamie Triccas, a chief investigator Professor Ian Young emphasised Chair of the Foundation Dr 2011 we saw just four deaths. But that the vision of the Foundation for the centre. University. Cameron Webber expressed his the fight against TB is getting Despite these threats Australia closely aligns with the University’s harder, and our nearest neighbour, On 7 March 2013, The John aim to be a national and interna­ gratitude to the Board of talented is uniquely positioned to lead mul­ and energetic individuals who have PNG, has more than 70 times the ti-national research into the pre­ Curtin Medical Research Foun­d­ tional leader in research, address­ cases. vention, detection and manage­ ation celebrated its first anniver­ ing the major issues facing human­ volunteered their time and efforts The Centre of Research Ex­ ment of TB within the Asia pacif­ sary with a dinner at Old Parlia­ ity and the nation. Professor to raise awareness for the need of cellence in TB Control (TB-CRE) ic region and beyond. The new ment House with guest speaker Young made it clear that the suc­ non-traditional funding to support links researchers in six countries centre hopes to establish Australia Nobel Laureate Professor Peter cess of both the University and medical research at the ANU. to improve TB control, with the Doherty. the Foundation lies with its com­ as a powerhouse for TB-based For more information on The ultimate goal of eliminating TB research. Approximately 140 guests munity of scientists, staff, stu­ transmission in Australia, and con­ The new Centre is working to: shared the Foundation’s vision dents, alumni and friends. John Curtin Medical Research tributing to the world-wide cam­ „„Develop new vaccines. that today’s medical treatments are This year’s fundraising target Foundation please visit http:// paign to eliminate TB by 2050. It a product of yesterday’s medical for the Foundation, a much need­ jcmrf.anu.edu.au/ is funded by the NHMRC, the „„Improve TB prevention, National Health and Medical particularly for vulnerable Research Council. children. “In the late 19th Century „„Develop ways of finding new tuberculosis was the leading cause cases faster and start of death in Australia—20 times treatment sooner – reducing deadlier per capita than all cancer the risk of transmission. conditions today put together,” „„Track, map and understand Familiar Faces – New Group says centre director Professor the spread of the disease. Warwick Britton. „„Tackle the ethical and legal From 29 April 2013 Canberra will enjoy the services and support TB remains a threat in the barriers of TB control such of a newly formed orthopaedic group practice. 21st century as new varieties of as establishing the rights of Orthopaedics ACT, bringing together the skill and experience of the disease which are deadlier and people with drug-resistant harder to treat have taken hold TB who pose a risk to others. Dr Damian Smith 6221 9321 across the globe. The TB crisis in Dr Chris Roberts 6221 9322 PNG illustrates the problem. (The centre is a collaboration between: Centenary Institute, Dr Alexander Burns 6221 9323 Papua New Guinea has the Dr Phil Aubin 6221 9324 highest TB burden in the Pacific University of Sydney, Woolcock region with over 14,500 new cases Institute for Medical Research, Dr Nick Tsai 6221 9325 diagnosed a year. The incidence of University of Melbourne, Dr Gawel Kulisiewicz 6221 9326 TB in the nation, which occurs at Vietnam, Indonesia, WHO/Fiji, Prof Paul Smith 6221 9327 China and New Zealand) a rate of 434 cases per 100,000 Located at 19-23 Moore Street Turner ACT 2612 people, is more than 70 times More details and a full list higher than in Australia. of collaborators at: Some of the worst cases are www.tbcre.org.au and To nd out more about our services, the team and our new of ces treated here in Australia. A young www.centenarynews.org.au. visit our interim website www.orthoACT.com.au or call 6221 9320

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12 April 2013