February 2012

Canberra Doctor is proudly brought to you by the AMA (ACT) Limited Circulation: 1,900 in ACT & region AMA ACT welcomes the ANU Medical School students The annual AMA ACT welcoming reception for new medical students at the ANU Medical School was held at “Barocca” on Thursday 9 February.

AMA President, Dr Steve Hambleton, with AMSA President, Mr James Churchill and Mr Mark Russell ANU Medical School representative to the AMA ACT Advisory Council

Host AMA ACT President, Dr Iain Dunlop and Chair of the Advisory Council, Dr Andrew Miller with new students. The event was generously sponsored by Investec.

Dr Iain Stewart | Dr Malcolm Thomson | Dr Nicholas Kenning | Dr Damien Hoon | Dr Karen Falk | Dr Mike McKewen Dr Robert Greenough | Dr Fred Lomas | Dr Paul Sullivan

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February 2012 Volume 24, No. 1 The State of the Territory Beginnings only 20 hours of CPD annually, and attended negotiations. You In the same vein, consultation Last week 91 new medical stu- ‘qualification’ in Chinese Medicine should note that the AMA ACT is has commenced on the ACT dents began training at ANU as merely evidence of 5 years of the truly independent party at the Palliative Care Strategy and Services Medical School. I met many of practice since 2002 and no require- table. Like most projects, the final Plan and details are available from them at our AMA Medical Student ment to speak English to a stand- 10% takes a disproportionately [email protected] Welcome Reception on Thursday 9 ard expected of other health pro- long time to complete. John Buckingham am February. It is always a good event, fessionals, or to have an interpreter Vmo contracts for present at consultations. The AMA It was wonderful to see that an evening that re-invigorates us, negotiation this year Dr John Buckingham AM was the established clinicians, who may submits that all health profession- als should have a minimum stand- And just as these negotiations posthumously recognised in the lose sight of the wonder and privi- are closing, the next round of the 2012 Australia Day Honours List. lege of our profession in the face ard of English and formal curricu- lum, training and CPD require- VMO contract negotiations is set Our congratulations go to his fam- of the workload and administrative to begin. Once again, the AMA ily and our thoughts to him. A pro- challenges. Here were many who ments. It is extraordinary that more will be there. posal for an Australian Honour actively chose ANU as a first choice cannot be lodged posthumously, for studying medicine and Canberra than half of AHPRA’s income Health planning comes from medical practitioners although it may be so granted. The as a place to live and work for the The Health Directorate is AM recognises John’s living contri- Dr Iain Dunlop next five or more years. The reputa- yet the standards accepted for planning a new ‘ACT Chronic other health professionals are so butions to the profession and the tion of the ANU Medical School is Disease Strategy’ based on the community. first class. Many were attracted by lenient by comparison. 2008-2011 strategy of the same A medical life the research reputation of the ANU National efficient price of name. There is an opportunity for Sad note I began this discussion with in general. All felt that the teaching services in public hospitals community and stakeholder input On another note, it was sad to our newest medical students. I hope ratios and clinical exposure were at an individual level and at a hear of the passing of Dr Bill that all have the opportunity to Another current AMA con- complete as rich and full and excellent. There was a palpable cern is the development of the forum planned for early March. A Coupland, one of the great con- excitement, mixed with some trepi- draft strategy will be available for tributers to our AMA ACT and to rewarding a medical life as did Bill Independent Hospital Pricing Coupland. That means commit- dation, to be beginning studies. Authority (IHPA) which is charged public consultation in April-May the Canberra community. Amongst These students had achieved a goal 2012. A policy consultant has be his unsung achievements was per- ment to one’s patients, one’s col- with setting the ‘national efficient leagues and one’s profession. That with hard work and application. price’ of services delivered in pub- appointed, Cathie O’Neill. (cathie. forming one of the first Australian Barring exceptional circumstances, [email protected]). The web- bone-marrow transplants at the is the ‘space’ that the AMA occu- lic hospitals. It is the flow-on pies. they will all become doctors, and effects of underfunded hospitals site to register your interest is at then Royal Canberra Hospital in our colleagues. and stifled introduction of new quorus.com.au/projects/act- 1968. Our thoughts are with his Iain Dunlop Cpd concessions granted by technologies that should concern chronic-disease-strategy family and friends at this time. President ACT AMA ahpra to new health you as clinicians. How a ‘national professions efficient price’ will be set and adjusted is unknown as yet. The I was reflecting on these stu- Commonwealth will pay 40% of dents, and the path they have this price and the States and ahead, during an AMA meeting Territories will make up the rest, discussing National Registration which may well be more than the matters. You may know that apparent 60% remaining. Activity Chinese Medicine has been added based funding is complex and is to the list of health professions frequently a distraction to service covered by the National delivery. The AMA will argue for Registration scheme. Each health weightings of the ‘national effi- profession has an autonomous cient price’ based on local factors. Board which must act within the The only current recognised overarching supervision of weighting is ‘Aboriginality’. AHPRA (Australian Health Practitioner Agency). Given Salaried doctors workplace AHPRA’s strict training and CPD agreement being finalised requirements for continuing regis- Negotiations for the new tration as a medical practitioner, Salaried Doctors award are draw- the AMA is objecting to the pro- ing to a close. The AMA ACT is a posals for just what is required for full party to these negotiations. We registration as a Chinese Medicine thank those junior doctors who practitioner. Their Board proposes have informed our submissions

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2 February 2012 Perceived practice change in Australian doctors as a result of medico-legal concerns – By Shrikar Tummala and Yusuf Sediqi Arguably one of the and 11% stating that they prescribed with each particular patient will the guidelines for administering guidance and support for junior medications more than usual. save time with subsequent visits each of the medications thus doctors, who may then be prone most trustworthy Respondents also reported improved and also improve the patient’s increasing the risk of missing a to malpractice. A lack of positions in any given communication of risk (66%), care by reducing mistakes and dose or over dosage. experienced and specialist increased disclosure of uncertainty having a holistic picture with Additionally, excessive doctors may also mean that the society, a healer of men, (44%), developed better systems for every encounter. prescription of medications doctor shortage in rural areas women and children, and tracking results (48%) and better However, there are also many poses significant costs for the will be exacerbated and more a wealth of knowledge methods for auditing clinical practice disadvantages regarding the impact health care system. generally, the quality of (35%). Concerns about medico-legal of medico-legal concerns on how „„The fear of litigation causes the healthcare will fall and there will about what we are. issues led to 40% considering retir- Australian doctors practise medicine. doctor’s practice to shift from be added pressure on existing ing early, 33% considering giving up being patient-centered to This is the predetermined image Disadvantages: doctors. medicine and 32% considering doctor-centered. Doctors aim to „„The fear of litigation is an we have when we see a name with reducing their working hours. These „„Doctors who have had personal create a safeguard against the salutation “Dr” suffixed. But are experiences with medico-legal added stressor to an already proportions were all significantly malpractice liability by ordering stressful life of a doctor. these facets true in the real world? greater for doctors who had previ- issues appear to excessively more tests, making more Are all medical practitioners near ously experienced a medico-legal order more tests. This may seem In conclusion, doctors aren’t all referrals, prescribing more they’re cracked up to be which gods when it comes to practising matter compared with those who beneficial in that doctors are medication and avoiding high- what they’ve spent half a lifetime in had not. But what does all this mean more likely to correctly diagnose means that they are very likely to trying to train up to and refine? It risk procedures or situations. make mistakes as they practise medi- with regard to practise in medicine? the patient, however by ordering This essentially puts the patient’s may be quite a surprise to many but There are clear advantages and more tests than what is required, cine. The presence of legislation the reality of the situation is other- health in the backseat and serves as a means of justice for disadvantages with medico-legal poses a significant cost burden creates a sense of lack of wise. A doctor is not always trust- concern in practice, attributable to on the healthcare system. patients who have suffered as a worthy, a doctor sometimes may empathy for the patient, which result of a doctor’s malpractice. The the whole picture of medical prac- Furthermore, the fear of is in direct violation of the hurt rather than heal, and a doctor’s tise, which includes the patient, the experiencing a medico-legal thought of facing medico-legal knowledge is surely not absolute. Declaration of Geneva which issues strikes fear into a doctor’s doctor, and the healthcare system. issue appears to have a negative states that “the health of my Thus it is essential to have laws in effect on doctors in that rather heart and appears to have an impact place for the purpose of protecting Advantages: patient will be my first on how they practise medicine, and „„There was a significantly higher than improving the way doctors consideration.” This practice the welfare of patients. But are these take a medical history from a while there some advantages of this laws for better or for worse? Nash et rate reporting an improved also devalues human life as fear impact, the disadvantages are great- communication of risk(s) and patient (which also increases the of litigation is placed above al. (2010) conducted an Australia chance that the doctor correctly er. As medical students and future wide cross-sectional survey of medi- disclosure of uncertainty. This is improving the health and doctors, the idea of medico-legal cal professionals in a wide range of clearly of benefit to the patient. diagnoses the patient), doctors welfare of a patient which goes seem to opt for the easier issues and the impact they have on fields to determine whether medico- It gives the patient the against both the beneficence the way we practise medicine is cer- legal concerns were affecting their autonomy that he/she has a option of ordering more tests. and non-maleficence principles „„Doctors appear to unnecessarily tainly something we need to be practice at all, and if so, how? right towards. Autonomy is the stated by Beauchamp and aware of and also something we prescribe more medication. Childress and the Declaration The objective of the study was first of four bioethical principles need to avoid. We need to accept Again, this may seem beneficial of Geneva which states that “I to explore the perceived impact of by Beauchamp and Childress that as future doctors, we will that every medical practitioner is in that the doctor is trying to will maintain the utmost respect medico-legal concerns on how encounter a great deal of challenges required to uphold in Australia, treat a condition(s) with a range for human life”. Australian doctors practise medicine and that sometimes we will make and to compare doctors who have and is defined as the right or of medications that are „„As a result of experiences with condition of self-government. indicated for it, however, it medico-legal issues, doctors feel mistakes, however, this shouldn’t experienced a medico-legal matter deter us from providing a duty and with those who had not. There were „„Medical practitioners were should be noted that excessive inclined to retire early; give up employing better systems for prescription of medications medicine; reduce working hours; standard of care that we swore an 2999 participants from all major spe- oath to give to patients. We need to cialty groups, trainees and a sample tracking results and improved dramatically increases the risk or change specialty. Training of general practitioners who were patient data storage. Good of drug interactions, toxicity, each medical practitioner costs focus on learning from our mistakes insured with a medical insurance document keeping is important adverse effects, allergic reactions the government a significant and improving our knowledge and company. on many levels. As well as being and non-compliance, all of amount of money and so to do skills so that we can be worthy of Respondents reported changes important in medico-legal which may give rise to further any of the above will add to the the title ‘doctor’. in practice behaviour due to medico- concerns from the doctor’s medical problems for the cost burden of the health care References available on request legal concerns, with 43% of doctors perspective, it’s also important patient. Furthermore, the system. Furthermore, it also from the authors. stating that they referred patients in providing optimal patient prescription of a cocktail of means that there will be fewer Shrikar Tummala and Yusuf more than usual, 55% stating that care. To keep track of the medications may make it more experienced doctors in various Sediqi are at the ANU Medical they ordered tests more than usual, precise events in your practice difficult for the patient to follow specialties resulting in less School

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February 2012 3 ACCC institutes ACT (nearly) 100 years and growing The Australian Capital now comprising 400 beds. It is the Zuccherelli as Deputy Director of proceedings against regional tertiary hospital for trauma, Anaesthesia at TCH and Dr Simon Territory is to celebrate its being the only designated trauma Robertson as the regional education commercial breast centenary in 2013. The site hospital west of the divide. This leads officer. to pressures, particularly as the south The climate (change) of the nation’s capital was coast of NSW is a popular retirement destination. As with all hospitals in Australia, imaging providers chosen after months of there is an inherent conflict in the „„were an effective substitute The Canberra Hospital provides The Australian deliberation, a waste of a all services except for paediatric car- pursuit of key performance indica- Competition and for mammography services. good sheep paddock diac surgery, major burns, solid organ tors relating to meeting times for cat- The ACCC alleges that these perhaps, but it is now transplants and interventional neuro- egories of elective and non-elective Consumer Commission representations were false. radiology. It is the regional referral surgery. At TCH, over 60 per cent of has instituted The ACCC also alleges that home to 400,000 people hospital for obstetrics with over 2000 the operating theatre caseload is non- between May 2009 and August with many new suburbs deliveries annually. Planning for car- elective, less than 50 hours of a proceedings in the 2011 Safe Breast Imaging falsely diac surgery began in the late 1990s potential 120 to 130 hours per week Federal Court against represented that its breast imaging being developed to with the first case done on cardiopul- is designated emergency or non-elec- tive operating time. Safe Breast Imaging Pty service included the provision of a accommodate the predicted monary bypass in early 2000. On the northside, at Calvary This inconsistency in resource customer report prepared by a population growth. allocation is a constant source of Ltd and its sole director medical doctor. The ACCC alleges Hospital, 200 public beds are co- located with a 160-bed private hospi- frustration and perplexity and no Joanne Firth, alleging that in many instances the reports The Royal Canberra Hospital doubt familiar to all. The difference was built on what is now the site of tal. General surgery, ear, nose and false and misleading provided to customers by Safe throat (ENT), ophthalmic, obstetrics in the ACT is that excess workload Breast Imaging were not prepared the National Museum of Australia. cannot be dealt with by bypass to conduct in relation to Reflecting its origins in the Cold War, and gynaecology (O&G), maxillo- by a medical doctor. facial, and orthopaedics comprise the another institution: there is nowhere the provision of breast The ACCC is seeking declara- the operating theatres were built else for timely assessment and man- underground whilst the wards looked in-hours workload. Out-of-hours tions that Safe Breast Imaging and agement of trauma. “Ramping” of imaging services. out over the Molonglo River and work comprises general surgery and O&G with approximately 1200 deliv- ambulances is not an option as there Breast Check market gardens that were later flood- The ACCC has also instituted contravened the Trade Pract­ eries annually. Trainees benefit from are seven vehicles on the road as a ed to become Lake Burley Griffin. In minimum with two demand crews separate proceedings against ices Act 1974 and the Australian exposure to different work practices the 1960s, the Woden Valley Hospital for busier times. Breast Check Pty Ltd and Dr Consumer Law and that Ms Firth in this setting. Alexandra Boyd alleging false and was constructed to service the south- Certainly there has been recent and Dr Boyd were knowingly con- There are about 160 other pri- misleading conduct in relation to ern suburbs and in 1979 the Calvary vate beds spread among three more huge investment in health with acqui- the provision of breast imaging cerned in the conduct. The ACCC Hospital, run by the nuns of the private hospitals. Across the territo- sition of a positron emission tomog- services. is also seeking: Little Company of Mary, opened to ry’s hospitals and day surgery facilities raphy (PET) scanner and on-table Safe Breast Imaging and for a „„injunctions provide public and private hospital there are 42 operating theatres. Ten magnetic resonance imaging (MRI). care to the northside. From the early Major building works at the TCH site certain period of time, Breast „„pecuniary penalties of these have been commissioned in Check, used a device known as the 1970s, there were unaccredited jobs the last three to five years and about are due for completion soon: a larger Multifrequency Electrical „„an order that corrective for aspiring primary candidates who, 18 are in public hospitals. mental health facility including secure Impedance Mammograph to cap- letters be sent to affected once successful, moved on to training There are over 60 anaesthetists in unit, and a women’s and children’s ture images of a customer’s consumers places elsewhere. the ACT and there are still shortfalls. hospital (which will utilise the main Currently the good burghers of breasts. Breast Check also used a „„an order for findings of fact The area-of-need process has been operating theatres). For the present, the ACT and region are served by a Calvary Public Hospital continues to digital infrared thermographic pursuant to section 83 of the ultimately beneficial to the Canberra number of hospitals within the ACT. serve the rapidly expanding northside camera to capture images. Competition and Consumer anaesthetic community, despite the The “region” is south eastern New inevitable politics of such a process, suburbs. In the future, there may be a The ACCC alleges that Safe Act 2010 Breast Imaging and Breast Check South Wales and overlaps the catch- with several highly regarded anaes- third public hospital solely for elec- represented that the breast imag- „„costs; and ment areas for Wagga Wagga to the thetists settling in the ACT. Their tive surgery. However, the duplica- ing services they provided: „„an order that Ms Firth be west, Albury to the south, Orange to passage through the international tion of radiology and other services the north and Bega on the far south disqualified from managing a medical graduate specialist (IMGS) would appear to make this a more „„were an effective means of coast, the ACT being an “island” sur- expensive exercise than first mooted. corporation for a period of process has been interesting for all assessing whether a customer rounded by NSW. The major public parties but the hard work of many As to the development of local was at risk from breast cancer five years. hospital is The Canberra Hospital generous Fellows as well as the indi- hospital networks, ACT Health has and the level of that risk; A directions hearing was (TCH), the result of amalgamation viduals concerned has been reward- expressed interest in developing these „„could assure a customer that scheduled for both matters before of The Royal Canberra and Woden ed. Their hard work continues in key with Queanbeyan and Yass Hospitals. they do not have breast Justice Barker in the Federal Court Valley hospitals in the early 1990s at roles such as Dr Imran Ali in the However, the necessary negotiation cancer; and in Perth in January. the Woden Valley Hospital site and Chronic Pain Unit, Dr Lisa between NSW Health and other

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4 February 2012 ACT (nearly) 100 years and growing involved parties makes this a very ‘far of the ACT tirelessly whilst being an Personalities such as Dr Ray The national scientific congress scientific convenor and preparations in the future’ project. exemplar of the art of anaesthesia. Cook, Dr Hugh Lawrence and Dr (NSC) of the ASA was held in are well under way. Training His efforts and those of all involved Gerry Flynn took on much more Canberra in 1962, organised at a fed- Retrieval services in registrar teaching and exam prepa- Until the late1990s anaesthetic than their fair share to advance the eral level. The next national meeting The Capital Region Retrieval ration were rewarded when a local interests of anaesthetists and trainees hosted in the ACT was in 1992; this services in the ACT were almost trainee, Dr Louise Ellard, was award- Service (previously known as Snowy exclusively delivered by visiting med- alike. Dr Linda Weber, Dr Vida was one of the first ASMs of the Hydro Southcare Retrieval service) is ed the Cecil Gray Medal at the Viliunas, Dr David Kinchington and new Australian and New Zealand ical officers (VMOs). As a result, the Christchurch annual scientific meet- the local ACT aeromedical retrieval necessary conditions for provision others have carried the baton into College of Anaesthetists, held with service that serves the ACT and ing (ASM) last year. this century. the Royal Australasian College of of a training scheme were difficult to With respect to other support of region. achieve. Nevertheless, as a result of The annual scientific meeting, Surgeons (RACS) meeting. The service started in 1998 with trainees, a mentor program began a the “Art of anaesthesia”, was the The first locally organised the initiative and dedication of few years ago co-ordinated by Dr two ACT Ambulance Service enthusiasts such as Dr Paul Christie, brainchild of Dr Cook and started national anaesthetic meeting to be Intensive Care Paramedics rostered Natalie Marshall. More recently, the nearly 20 years ago as a local event to held in Canberra was the ASA NSC Dr Hugh Lawrence and Dr George Group of Australian Society of to cover helicopter jobs each shift Jerogin, these difficulties were gradu- coincide with Floriade, Canberra’s in 2001. Despite several challenges but doing the usual road work unless Anaesthetists Clinical Trainees spring flower festival. Proving popu- including the events of 9/11, the ally surmounted. (GASACT) has organised sporadic called out. It was soon appreciated Accredited registrars from St social functions that aim to foster lar and successful, it has evolved over meeting was a great success under that doctors brought additional and George and Liverpool hospitals trainee collegiality. the years under a succession of dedi- the direction of such stalwarts as Dr necessary skills and an initially ad hoc rotated for six months to TCH for The two departments of anaes- cated convenors such as Dr John Cook, Dr Lawrence, Dr Weber, Dr roster comprising surgeon, anaesthe- their “rural” placement from the thesia also provide anaesthetic expe- Ellingham. Viliunas, Dr Kinchington, Dr Nicola tists, intensivists and emergency spe- eighties on. Locally accredited train- rience for trainees from intensive More recently, with Professor Meares and Dr Nick Gemmell- cialists provided on-call services. In ees started with three positions in care and emergency medicine, and Thomas Bruessel as convenor, it has Smith. 2008, a review over six months, con- 1997. Negotiation with hospital training and refresher experience for metamorphosed further to include Canberra will host the ASA ducted into aeromedical services in administration for allowance for pro- general practitioner anaesthetists. international speakers and a change national congress again in 2013, a the ACT, recommended adoption of tected teaching time was an achieve- Medical students from the medi- of season to autumn. This meeting significant centenary celebration! Dr the doctor-paramedic model for its ment which enabled a more struc- cal school at the Australian National often captures the anaesthetic zeit- Mark Skacel is the convenor and has standard level of care (as is the tured approach that yielded success University, and previously from the geist and continues to attract broad already demonstrated great industry model of care elsewhere). in both parts of the exam and led to University of Sydney, are also benefi- interest. in the role. Dr Paul Burt is to be the Continued page 5. the expansion in numbers to the cur- ciaries of the time and knowledge of rent cohort of 26. Many who were Canberra anaesthetists whether in local trainees have returned to work lectures, tutorials, in the operating as consultants, a gratifying situation. theatres or as examiners. Additionally, Rotations of four registrars through the auspices of the John annually to Albury on six-month James Medical Foundation, medical placements commenced about 10 students from James Cook University years ago. Despite the consolidation gain anaesthetic experience as part of obstetric services to Wodonga, of a fully funded placement at the necessitating travel across the Murray, Calvary John James Hospital for it is a mark of the success of the their elective term. rotation that several trainees have of recent years returned to Albury as Continuing medical education consultants. Rotations to Calvary Canberra has gradually expand- commenced in 2001, initially with ed in activity and in the number of just one registrar, now expanded to anaesthetists. As a city-state, Canb­ six anaesthetic trainees. erra labours under the disadvantage All modules can now be complet- of operating state sectional commit- ed in the ACT scheme. In the recent tees and activities (including training, past, it has taken some ingenuity to continuing medical education ensure adequate and equivalent expo- (CME), other College activities, sure for members of occasionally those of the Australian Society of larger than expected part 2 candidate Anaesthetists, and broader medical groups. It is a credit to the efforts of representation in bodies such as the the supervisor of training at the time, Australian Medical Association) with Dr Frank Lah, that no one was disad- the human resources of a small vantaged. He has served the trainees town.

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February 2012 5 From page 5. to a number of organisations in anaesthetist who trained in Hobart This has taken several years to places outside the ACT. and has worked in Canberra for accomplish with most doctors now Dr George Jerogin travelled over 20 years. Dr Yorke was a sig- trained for winch and search-and- with Interplast teams for many nificant driver behind the Specialist rescue work. years. A team consisting of neuro- Volunteer Programme and indeed A new purpose-built base has surgeon Dr Nadana Chandran, made the first foray to Katherine anaesthetist Dr Cliff Peady and two with a team of orthopaedic sur- just been completed which includes theatre nurses has visited Fiji to facilities for education, video-con- geons. In recognition of his work provide neurosurgical services for for the Foundation, as an adminis- ferencing, training and accommo- the past 11 years under the Pacific dation for on-call onsite shifts. The trator rather than as an anaesthetist, Island Project program. the clinical services building at the variety, nature and amount of work Patients with requirements for has resulted in the service recently John James Hospital was recently tertiary or more protracted care named in his honour, a signal being awarded accreditation for six have been treated at TCH with months of advanced training for achievement. costs met by fund-raising and ACT The objective of this program trainees in both the College of government support. Orthopaedic Emergency Medicine and our is to provide medical services in surgery has been the focus of trips areas where there is a shortfall and College. These positions have been to Timor by Dr Don Lu for the last keenly sought and are already filled its genesis coincided with the inter- two years under the ATLASS vention in the Northern Territory. for next year. Program of RACS. Twenty proce- As part of the trainee’s place- The target is 12 trips annually and dures were completed on the most the specialties involved thus far ment, completion of a Pre-Hospital recent Timor trip on new patients Trauma Course, Helicopter Under­ and those whose treatment began have been ophthalmology, paediat- water Escape Training (HUET), a on the previous visit. ric dental surgery, ENT, gynaecol- directed fitness test relating to work Local paediatric surgeon Dr ogy, orthopaedics and general sur- activities and ground school (where David Croaker and paediatric gery. they will be taught to become a anaesthetist Dr Nick Gemmell- Support from the foundation member of the helicopter crew and Smith have been to places as far has been generous with the pur- become accredited in winching away as Mongolia and Ethiopia chase of an ultrasound machine for activities and search-and-rescue where big cases were performed the gynaecologists and a portable missions) is expected. under a mix of halothane, ketamine slit lamp and tonometer for the Overall it provides a very and local anaesthesia. These trips ophthalmologists enabling the rewarding time that encompasses have been under the auspices of medical staff to perform point-of- both the excitement of pre-hospital Kind Cuts for Kids, a Melbourne- care assessment in remote places. Anaesthetic registrars from Dr Carmel McInerney, medical care in the aeromedical based charity. Specialist anaesthetists from the Darwin have also formed part of Chair, ACT Regional Committee ACT including Dr Prue Martin, Dr field with the specific training of The Specialist Volunteer the paediatric dental team and Dr McInerney would like to thank all the particular doctor’s specialty and Programme is a local initiative Don Lu, Dr Vida Viliunas, Dr Phil found the experience valuable. established and funded by the John Morrissey, Dr Stephen Brazenor, So, in summary, life as an anaes- who collaborated in compiling this article. exposure to consultants from other Reprinted with the kind permission of specialties. James Medical Foundation. This Dr James French and Dr Yorke thetist in the ACT provides many medical charity emerged from the have enjoyed providing anaesthetic diverse opportunities to fulfill the the author and Australian and New Volunteer work sale of the operation of the John services in places such as Katherine roles of the profession as well as Zealand College of Anaesthetists. This Fellows have long provided James Memorial Hospital under the and Gove, and have been made to achieving a work-life balance that article was published in the December anaesthesia services as volunteers guidance of Dr Peter Yorke, a local feel very welcome. many in larger cities might envy. 2011 edition of “ANZCA Bulletin”.

6 February 2012 Government must strengthen the ‘pillars’ of the health system LETTER The AMA is calling on reforms that have been reached, practices that are already commit- TO THE EDITOR and that we can adjust those ted to their communities. We con- the Federal Government reforms and policies that have not tinue to battle for a reversal of cuts Sir to use the May Budget to quite hit the mark. to the Better Access program for I noted, in the November/December “The AMA wanted more from GP mental health services. strengthen the ‘pillars’ of the COAG Agreement but we “For the AMA, general prac- issue of the Canberra Doctor, yet the Australian health acknowledge the significant extra tice, public hospitals, and medical another article on sleep deprivation in system at a time when the funding from the Comm­onwealth training and workforce are at the and the move to activity based top of the list. doctors; ie, “safe working hours”, this world is entering a phase funding that has been promised. “The AMA is also urging the time by Unsworth and Liu. They of economic uncertainty. “The single funding pool is a Government for action in the key repeat most of what has been said step in the right direction and there areas of Indigenous Health, AMA President, Dr Steve is now greater transparency in the Climate Change and Health, Health before and, like their predecessors, Hambleton, said that in hard times system. The States are now unable and Medical Research, and changes avoid any consideration of the it is important for governments to to pass the blame for the perfor- to the proposed model for an elec- strengthen those parts of the mance or non-performance of tronic health record. consequences of their health system that will provide the their hospitals. “The AMA Budget Sub­miss­ recommendations. greatest benefit to patients and the “It is in the primary care area, ion proposes practical and afford- community. however, where we seek more con- I acknowledge completely the effect of fatigue on able policies that would deliver tan- mood and personality (more so as one gets older) “There is every indication that sultation and cooperation from the gible benefits to patients and local this will be a frugal Budget across Government. together with the consequences and that it leads to communities around Aust­ralia. “cognitive slowing” (in English this means that you the board, but health funding must “We note that the Medicare “We urge the Government to not go backwards,” Dr Hambleton Locals are part of the landscape understand and learn more slowly) but it does not give this Submission serious con- abolish it. In my career I saw very few mistakes made said. but we do not accept that the gov- sideration and we look forward to “The ‘pillars’ of the health sys- ernance model has to stay the from doctor fatigue but many from inexperience up to meaningful engagement and con- and including, recently, consultant rank. While I tem – the parts that work well and same. There must be strong GP sultation with the Government on leadership and management of acknowledge the many improvements that have been which patients and communities health funding and health policy rely on – must be recognised and Medicare Locals. made in training programs you can’t teach experience “The Government must revisit development and implementa- and you can’t get it from a self-learning module. You funded accordingly in the Budget,” tion”, Dr Hambleton said Dr Hambleton said. the GP Super Clinics program. We acquire it (and retain it) only by putting in many hours have no problem with the concept “People need to be encour- “at the coalface”. “Economic circumstances aged to do more about their own around the globe are not strong where they meet genuine commu- In my own specialty the years of training have nity need, but we have serious con- health and wellbeing, particularly in been reduced from around nine to six and the hours and the regard to obesity, smoking and Government will be keen to cerns in many locations. We cannot worked per week by some fifty percent. The effect on support them where they compete alcohol. Preventive health pro- the acquisition of experience does not require descrip- shore up the Australian economy grams must be supported,” Dr for what many predict could be with existing GPs delivering exactly tion. Suffice to say that, both here and abroad, col- hard times ahead. the same service. Hambleton said. leagues tell me that they are called in to assist (or take “On top of this, the days of “The AMA believes the money The AMA Federal Budget over from) young consultants in situations which they would be better spent through the Submission 2012-13 is available themselves would have been expected (and were com- ‘big bang’ health reform are behind petent) to deal with as relatively junior registrars. Soon us for now. oversubscribed infrastructure on the AMA website: www.ama. grants program on existing general com.au the last of those relics of the past will be gone and “Minority Government at the what then? There may be obstetricians coming into Federal level and the expected fur- consultant practice today who have been deprived of ther changing of the guard to the experience of managing longer labours from Coalition governments at the State beginning to end and who are now expected to do so level mean that big changes in the and teach their juniors how to do so. At present, many way that health services are obstetric procedures are being progressively aban- financed and delivered are now doned in favour of caesarean section, which sounds almost impossible to achieve. The fine until you realise that there are occasions on which, ‘once in a generation’ opportunity in order to save life, either the ability for immediate has passed. and skilful manipulation or instant access to theatre “It is important, though, that (with a team to get the patient there) are required. The there is no slippage in the positive former is becoming rare and the chance of the latter negligible. One might perhaps (uncomfortably) accept that today’s specialists will gain the experience of their pre- decessors while in consultant practice were it not for Medical Women’s Society the fact that many state that they have no intention of working the hours of their predecessors and more and of the ACT and SNSW more work part-time, thereby compounding the prob- lem. invites all medical women to our annual The questions for Unsworth and Liu and all oth- ers of their persuasion are simply: Are we to accept a general “dumbing down” of the profession and reduce our expectations of care and survival for our- COCKTAIL PARTY selves and our loved ones when we are in need of the meet and greet and network! system, are we to substantially increase the years of specialist training or are we to introduce the intelligent – new female doctors to Canberra most welcome! compromise of a sensible increase in both working hours and years of training? There is, unfortunately, an When: Wednesday 15 March 2012 alternative which, history shows, mankind tends to adopt – do nothing until there is a disaster, then wring Time: 6.00pm till 8.00pm our hands and wish we had done something sooner. Where: 80 Empire Circuit, Deakin ACT Yours provocatively Cost: $10.00 paid at the venue (med students FREE) Martyn Stafford-Bell (retired gynaecologist) RSVP: Ann Hosking at [email protected]

February 2012 7 Getting the right PCEHR AMA President Dr Steve Treatment can happen more Doctors will have to consider ‘shared health summary’. This is a It is only reasonable that Hambleton presented to quickly. the impact of this additional key feature of the PCEHR. patients should receive a Medicare This is why the AMA sup- workload and the changes to clin- This is a very specific clinical rebate for this very important the Senate Community ports the long-term goal. The ical workflow on the fees they task. GPs will work with their clinical service so that the PCEHR proposed system could be charge their patients. system truly works to improve patients to ensure that a complete Affairs Committee improved to make it much more The biggest impact will be on patient care and reduce waste and Inquiry into the PCEHR useful for treating doctors. general practitioners. and accurate summary is available risk in health care. legislation via The reality of patients having GPs will take on the role of to be used by other health care The full AMA submission is to opt-in means that when doc- ‘nominated healthcare providers’ providers in their clinical deci- available at http://ama.com.au/ teleconference on tors look for a patient’s record, and create and maintain the sions, and this will take time. node/7302 they will often find there isn’t one. Monday 6 February to Our submission highlights that explain the AMA’s we don’t know what the opt-in rate will be. Submission to the If doctors were to find that Inquiry. most of their patients had a PCEHR, they would be more like- Here is an edited extract of ly to keep using the system. But his opening remarks to the they will quickly become reluctant users if they look for and can’t Committee … find a record for their patient. Most AMA members are For better patient care, the enthusiastic about using shared AMA advocates for an opt-out electronic health records. They system that provides treating doc- know that with the right system, tors with access to the key clinical they can improve the patient information to inform their clini- healthcare experience. cal decisions. The right sort of shared We are uncertain about how record system will help doctors much of the system will be avail- deliver better care. They will have able on 1 July 2012, and how well important information about the system will be connected to their patients to help them make health care providers. good clinical decisions. The Parliament may pass the legislation. Some of the technical Some of my elderly patients work might be finished. can tell me the strength and name But there will be no benefit of their tablets and some the col- for patients and medical practi- our and size of their tablets, but tioners until appropriate, interop- many others can’t. With new erable, tested, and affordable patients, I have to question them practice software is available for about that and it takes a little providers to connect up to the longer to work out what the med- system. ication is. In terms of the legislation, With a good system, I can at the AMA is concerned about the least confirm my assumptions by administrative impact on medical reading what the last doctor pre- practices. scribed. This would be an Medical practitioners who improvement over the current sit- decide to use the system will have uation. to adapt their clinical workflows A good system will save extra and train their staff to work with- costs for repeat tests. It will save in the requirements of the legisla- time chasing down results. tion.

In memoriam You will never have heard of wartime experiences, was Tours of the Western Front operate Wilton Gainsford Harcourt forgotten. from Amiens, a town easily reached by train from Paris Gare Evans, and indeed until a Like so many of his du Nord. The battlefields in which family genealogist Australians fought are surprisingly comrades, Evans GW (as he discovered his existence small, and easily covered in one was known by the Army) has quite recently, nor had I. He day; extended tours are available. no known grave. His We travelled with True Blue Digger was a first cousin of my memorial in France is the Tours, despite its name owned maternal grandmother. Born and operated by Barbara Legrand, wall at the cemetery of in 1895, he was one of the a Frenchwoman who previously Villers-Bretonneux, itself a worked at the Australian Museum very many Australians who village rebuilt with on top of classrooms at Victoria volunteered for service in School, Villers-Bretonneux. Australian assistance in the World War I. He was killed in Although it was not necessary to 1920s. After 93 years, he action on the Western Front do so, we stayed two nights in had his first family visit. Amiens, for half what it would in 1918, and as none of my have cost in Paris. We travelled at ancestors talked about John Donovan our own expense. Photos: Andra Donovan

8 February 2012 New AMSA Executive to tackle challenges in medical education and training The Australian Medical continue to represent all medical guided. We have already seen over According to the latest figures students as we advocate on impor- the last few years that simply from the Department of Health Students’ Association tant issues in medical education”, increasing numbers will not push and Ageing, the proportion of (AMSA) has recently he said. doctors into rural areas. medical students from rural back- welcomed its new AMSA has slammed claims “Instead, AMSA calls for grounds is lagging below the 25% from Curtin University that a new funding that may go to new medi- government target. National Executive for medical school, planned to open in cal schools to be directed to estab- The Rural Undergraduate 2012. The team 2014, will help address Australia’s lished programs such as rural clini- Support and Coordination funding comprises students from medical workforce shortages. cal schools, recruiting students (RUSC) scheme provides medical James Churchill has warned with rural backgrounds and sup- schools funding to promote the three Victorian medical recently that further increases in porting rural doctors in educating selection of rural applicants. RUSC schools, the University of medical student numbers will jeop- students and trainees in rural also funds support systems for ardise the quality of clinical train- areas,” Mr Churchill said. medical students interested in rural Melbourne, Monash ing and may result in doctors who AMSA calls for the govern- medicine and rural placements for University and Deakin are unable to find jobs. ment to place a cap on medical stu- Australian medical students. University, and is led by “We need to ensure that the dent numbers and new medical “Rural background is a key quality of medical education and schools to open until all medical determinant of the likelihood a training is maintained at the high student will go on to practice rural Mr James Churchill, a Higher Education Base Funding students currently in training can Review,” said Mr Churchill. levels that we expect in Australia. medicine,” Catherine Pendrey said. final year medical student Clinical training capacity is already be assured high quality clinical Of the 18 schools that received “Our key priorities in 2012 will placements and that the number at the University of be to advocate for quality clinical stretched, and opening a new med- RUSC funding in 2010, 10 did not ical school will place a greater of internships is commensurate meet the 25% target. Melbourne. placements and adequate numbers with the number of medical stu- of high quality internships for strain on an already struggling sys- “Medical schools engage in a dents graduating. Incoming AMSA President Mr graduates of Australian medical tem”, said Mr Churchill. variety of strategies to promote James Churchill said that the organ- schools. With increasing numbers “Medical student numbers In calling for more rural medi- rural practice amongst medical stu- isation had had a number of key of medical students, we now face a have doubled in the last decade cal students from rural back- dents. However, AMSA encourag- advocacy successes in 2011; how- situation where one in four stu- and, in 2013, 3045 students will grounds to be accepted into medi- es more schools to adopt a proac- ever, he emphasised that a number dents are not guaranteed an intern- graduate. This increase has not cal degrees, AMSA vice president, tive approach to increase enrol- of significant challenges still exist ship”, he said. been matched by a requisite Ms Catherine Pendrey said: “In ment of medical students from for the organisation in 2012. AMSA will also be maintain- increase in funding and support order to address the rural medical rural backgrounds”, said Ms “Clinical training capacity is ing its focus on medical student for universities, senior doctors and workforce shortage, AMSA Pendrey. being stretched, with twice as well-being and other issues affect- academics, or the creation of believes it is vital that recruiting The importance of rural back- many medical students now in the ing Australian medical students. internships. rural background students is part ground in determining future doc- system compared to 2005 and sig- “I am proud to lead this “Curtin’s argument that their of a holistic approach, which tors’ decisions to work in rural areas nificant underfunding of medical Victorian Executive in what will be medical school will help reduce the actively supports all students to has recently been reaffirmed by education as highlighted the recent an exciting year for AMSA. We will rural workforce shortage is mis- engage with rural medicine,” researchers from NSW and Victoria.

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February 2012 9 AMA membership The ama at work in 2011 – great reasons to be a member in 2012 Public hospitals – the Happy New Year gift you give yourself The 2011 AMA Public Hospital Report Card highlighted that there was little improvement in public hospital capacity and performance across Australian Medical Association (ACT) Limited Australia in 2009-10, despite extra ABN 29 008 665 718 Commonwealth funding. The AMA is calling for robust, long-term data col- lection so that it can have proper year PO Box 560, Curtin ACT 2605 on year monitoring and analysis of Level 1, AMA House, 42 Macquarie Street, Barton ACT 2600 hospital capacity and performance, Phone: (02) 6270 5410 Facsimile (02) 6273 0455 including counting elective surgery patients from the time they are referred Email: [email protected] by a GP to be assessed for surgery. Professional MEMBERSHIP APPLICATION Services Review The AMA worked with the PSR to improve the transparency and pro- Personal Details cedural fairness of the PSR process. As result, the PSR has produced a Guide to the PSR process, into which Given Name(s): ______Surname: ______the AMA had significant input. The Guide assists people who are being Preferred Name if different: ______reviewed by the PSR to understand the process, and to know what will happen in each step of the review. The Date of Birth: ______Male: n Female: n Guide allows people to check that their review experience accords with the documented process. In 2012 the Preferred mailing address: n AMA will continue to work with the Home Address: ______PSR to develop additional guidelines about very specific parts of the review process. ______E-health ______Phone: ______The AMA was a constant medical voice in the debate on the design and construction of the Personally Preferred mailing address: n Controlled Electronic Health Record. Practice Address: ______Several AMA representatives partici- pated in many workshops on very spe- cific aspects of the PCEHR. The AMA ______scrutinised draft legislation and was successful in achieving amendments ______Phone: ______that will provide for greater public scru- tiny of the basic access controls to the PCEHR. The AMA also ensured the governance arrangements included the E-mail Address: ______participation of medical practitioners. The AMA is working closely with key Web Address: ______Mobile Number: ______Government agencies to accelerate the rollout of e-health initiatives, and ensure that clinicians working in public Qualifying Degrees (Date & Place): ______hospitals have access to high quality IT infrastructure. Health reform Postgraduate Degrees (Date & Place): ______The AMA argued at every oppor- tunity for greater transparency in pub- lic hospital funding and for medical practitioner input into service plan- Registration (Date & Place): ______AHPRA Number: ______ning and delivery of health care. As a result medical practitioners have a role in the governance arrangements for Practice Information: n Private Practice n General Practice Local Hospital Network Governing n n Councils, and advisory roles in the Salaried Practice Doctors In Training National Health Performance n Specialist Practice Authority and the Independent Hospital Pricing Authority. Aged care Previous Membership of the AMA (State & Year): ______The AMA convened an advisory medical group to provide first hand advice to the Productivity Commission inquiry into caring for older Other Relevant Information (including languages spoken): ______Australians. As a result, medical care to the elderly is featured in the ______Productivity Commission report, including a recommendation that The Medicare rebate for medical services provided by general practitioners visiting residential

10 February 2012 The ama at work in 2011 – great reasons to be a member in 2012 aged care facilities and people in their AMA lobbying, the MBA will relax graduate and specialist trainees that Indigenous health in health care facilities, as well as in homes should be independently reviewed to its documentation requirements in will be required between 2012 and Closing the gap in life expec- their own practices. The AMA high- ensure that it covers the cost of providing 2012 for those proceeding from 2025 to achieve a goal of self-suffi- tancy between Indigenous and non- lighted climate change as a key issue the service. provisional to general registration. ciency in the supply of doctors, Indigenous Australians is an AMA before the last two Federal elections Pharmacy prescribing This means that the majority of nurses and midwives by 2025. policy priority. AMAs independence interns will not have to submit the and will continue to highlight the The AMA strongly opposed the A national intern allows it to fearlessly report on same paperwork twice (at the time issues of importance in Indigenous potential impacts of extreme weath- Pharmacy Guild of Australia’s ‘con- allocation system er and longer term changes such as tinued dispensing’ proposal. The of graduation, and at end of PGY1). health on an ad hoc basis, as well as The AMA is leading the discus- drought on health, food and water AMA wrote to all MPs and Senators Global health sion on how to streamline PGY1 in its annual Indigenous Health Report Card. The AMAs influence supplies, and population shifts. urging their support for changes to Junior doctors are increasingly job applications via a national intern and partnerships allow it to provide the National Health Amendment (Fifth interested in practising abroad and allocation system. A position state- sound advice on practical health Youth health Community Pharmacy Agreement engaging in global health advocacy. ment recently approved by AMA measures designed to deliver real The AMA’s youth health poli- Initiatives) Bill, which was introduced The AMA is working with govern- Federal Council recommends a sin- benefits on the ground. The health cies aim to help young people make to Parliament in November. The Bill ments and colleges to create opportu- gle entry and exit point for all intern of Indigenous Australians is of would permit a significant change in nities for vocational trainees to under- applications while continuing the good health choices. We advise gov- the professional role of pharmacists take rotations overseas. The AMA, deep and abiding concern to AMA ernments on practical policies to use of local systems to prioritise members. that the AMA believes is not in the along with the Australian Medical applications and perform job match- improve the health of young people best interests of patients or the pro- Students’ Association (AMSA), has ing. This will make it easier for pro- Climate change and health today and preserve their health in fessional relationship between doc- developed A Guide to Working Abroad spective interns to apply for, and The AMA believes climate the future. AMA doctors have tors and pharmacists. If the Bill is for Australian Medical Students and Junior receive offers from, multiple states. change will produce serious and passed, pharmacists will be able to Doctors. The guide is a practical tool- developed practical, nonjudgmental The statement will shortly be pub- possibly irreversible impacts on resources that young people can use dispense prescription medication kit for trainees interested in working lished on the AMA web-site. health. It believes doctors have a key without a valid prescription and and training in overseas settings and to help make the right health and Specialist trainee survey role in promoting community without consulting a patient’s doc- has been written to meet a strong awareness of the impacts of climate lifestyle choices. AMA resources tor beforehand. demand from medical students and The AMA released the Report change and encouraging the sustain- cover a broad range of subjects Safer conditions junior doctors for information on of Findings for the 2010 AMA able reduction of carbon emissions from body piercing to drug use. studying and training overseas, and Specialist Trainee Survey (STS) on 3 The AMA leads the way nation- October 2011 providing medical ally on safe working hours. The global health more generally. colleges with important trainee AMA has conducted Safe Hours Social Media and the Medical Audits in 2001, 2006 and 2011. Its feedback about key training issues. Profession The STS advocates for quality train- REDUCING RED TAPE IN efforts are helping change the cul- In November 2010, the AMA ture of DiTs working dangerous ing, supervision and feedback for launched an online professionalism registrars and is an important tool in GENERAL PRACTICE hours to cover system-wide short- guide to assist doctors and medical ages. By highlighting the impact on raising awareness of areas where students to maintain professional trainees believe there is room for patients and DiTs through powerful standards when using online social The AMA recently met with officials from Centrelink and advocacy, the AMA continues to improvement including access to an media. The guide – Social Media effective appeals process, recogni- Medicare to discuss the findings of the AMAs red tape pressure health bureaucracies to and the Medical Profession – was ensure safe work hours. tion of prior learning, value for survey conducted last year. developed by the AMACDT, the money and overall cost of training. Doctors’ health NZMA Doctors-in-Training Completing Centrelink forms was the number one area AMA advocacy, including Council, the NZMSA and AMSA. It Health reform of concern GPs identified in the survey and the AMA was national surveys, has raised the pro- provides real life examples of the The AMA has led the public able to provide feedback from the survey to the officials debate about health reform. Its file of doctors’ health – including the repercussions that doctors can about where the red tape should be cut. need to establish a positive culture encounter through the misuse of views have been listened to by and support structures. This includes social media and aims to help doc- Government and many of its posi- In particular, the AMA advised Centrelink that priority continuing to ensure that doctors tors and students enjoy the online tions are reflected in the Govern­ should be given to: world safely while maintaining pro- ment’s plans for the National Health who need professional medical help • Improving software compatibility to make sure forms are can seek it from their colleagues fessional standards. Hard copy can and Hospitals Network. The AMA without fearing the consequences of be obtained from AMA ACT (call has been particularly active in mak- easily accessible and downloadable in GP offices; mandatory reporting laws. 6270 5410) ing sure that clinicians are repre- • Software must also enable GPs to have Centrelink sented in local governance struc- Rural workforce initiatives Education and training tures. forms open and be able to have their patient’s medical The AMA has worked tirelessly The Government has signifi- records open at the same time; to ensure that the Government cantly lifted the numbers of places General practice implements strategies to bolster the at medical schools, with the number General practice is the key to a • As much as possible, forms need to pre-populate with rural health workforce. The AMA, almost doubling in the past ten strong health system. Working known data; with other organisations, negotiated years. The AMA is advocating closely with GPs and GP registrars, • Repetition in forms needs to be cut; and a relaxation of conditions associat- strongly for increases in prevoca- the AMA called on the Government ed with the Bonded Medical Places tional and vocational training posi- to preserve and strengthen the role • Links should be made to forms that often need to be (BMP) program and continues to tions to ensure that medical gradu- of general practice in primary care. completed at the same time; eg, Disability Support advocate for incentive-based pro- ates can access training positions The AMA successfully lobbied the Pension, Carers’ Assistance, Mobility Assistance. grams to recruit doctors to work in and go on to achieve college fellow- Government for more prevocation- rural, remote and disadvantaged ships. More recently we have helped al and vocational positions in gen- The AMA also stressed that any redesign of Centrelink communities. In 2012, the AMA secure funding for more prevoca- eral practice. It also negotiates forms needs to be undertaken with input and feedback will work with other GP stakehold- tional and vocational training places, national minimum terms and condi- from GPs. Centrelink are working towards some ers to ensure that any proposal for a particularly in general practice. In tions for GP registrars. improvements and clearly the AMAs red tape survey has national rural generalist pathway order to maximise the benefits of Preventive health increases the number of doctors the increase in student numbers, the been influential in this. with the right skills in rural areas. Our ageing population and the AMA is now working hard to ensure prevalence of chronic and complex The summary report of the AMAs red tape survey was National registration that the quality of clinical training is health conditions in the community published in the November/December edition of Canberra and fees maintained. has made preventive health a major Doctor. The AMA has won a reduction National Training Plan element of the health reform agen- in the registration fees interns pay Building on the success of the da. The AMA encourages more the Medical Board of Australia Medical Training Summit in 2010, Government investment in preven- (MBA). Doctors are now paying two the AMA secured an agreement tion as well as treatment. Another and three times the previous regis- from Health Workforce Australia to key AMA policy objective is to tration fees to support the new undertake the development of a ensure that the unique opportunities bureaucracy – despite being assured National Training Plan (NTP). The doctors have to promote good national registration would bring NTP will provide estimated num- health are properly recognised and new efficiencies. As a result of bers of professional entry, post- supported in the health system.

February 2012 11 IMPORTANT NOTICE FOR AMA (ACT) 2012 SPECIALIST DIRECTORY LIMITED MEMBERS The Annual General … a publication of the AMA ACT Meeting of the Australian Medical Association (act) Limited (acn 008 615 778) The AMA ACT Medical Specialist Directory will again be published as a service to ACT General Practitioners in 2012 and distributed with the ‘GP Week’ edition of ‘Canberra Doctor’. will be held on All existing entries will be automatically included, a con rmation letter will be sent to all doctors Wednesday 16 May 2012 to allow for updates where necessary. For new entries the following form must be completed and returned to: at Ama House, level 3, 42 Macquarie Street Mail: AMA ACT, PO Box 560, CURTIN ACT 2605 Barton, act Fax: 6273 0455 Commencing at Cut-off-date: no later than COB 30 April 2012 7.00pm Further information will be forwarded in due course.

A News Magazine for all Doctors in the Canberra Region ISSN 13118X25 Published by the Australian Medical Association (ACT) Limited 42 Macquarie St Barton (PO Box 560, Curtin ACT 2605) Editorial: Christine Brill Ph 6270 5410 Fax 6273 0455 [email protected] Typesetting: Design Graphix Ph 0410 080 619 Editorial Committee: Dr Ian Pryor – Chair/Editor Dr Jo-Anne Benson Mrs Christine Brill – Production Mngr Dr Ray Cook Dr John Donovan A/Prof Jeffrey Looi Dr Peter Wilkins Jonathan Sen Advertising: Ph 6270 5410, Fax 6273 0455 [email protected] Copy is preferred by Email to [email protected] or on disk in IBM “Microsoft Word” or RTF format, with graph- ics in TIFF, EPS or JPEG format. Next edition of Canberra Doctor – March 2012.

Disclaimer The Australian Medical Association (ACT) Limited shall not be responsible in any manner whatsoever to any person who relies, in whole or in part, on the contents of this publication unless authorised in writing by it. The comments or conclusion set out in this publication are not necessarily approved or endorsed by the Australian­ Medical Association (ACT) Limited.

12 February 2012 The new ANU Medical School students continued…

February 2012 13 Book Review: Satori AMA guidance for Don Winslow Linnear novels or, more recently, Headline Book Publishing by Barry Eisler in the John Rain GPs regarding nurse ISBN 9780755385966 series. An exotic combination of Eastern mysticism and aesthetics Satori is an prequel to the viz. shibumi underpins Hel’s char- practitioners novel Shibumi, authorised acter, which is moulded through a GPs have been asking „„If the results are clinically peripatetic childhood as a White significant, the GP should by the family of Russian emigre in Shanghai, dur- what they should do if satisfy himself or herself Trevanian. Trevanian, the ing the Japanese occupation of that appropriate action is, or China. Through the mentorship they receive documents has been, taken by the pen-name of Dr Rodney of his sensei-father-figure, Gen­ about a patient from a William Whitaker, a eral Kishikawa, Hel becomes an practitioner who initiated the nurse practitioner. Last investigation(s). Fulbright Scholar and adept of hoda-korosu or “naked/ kill” an allegedly potent martial art year, the AMA held a „„If the results are not university professor, was and hones his “proximity sense”, forum with other GP clinically significant, the GP the author of the skills advantageous to an assassin. should add the information In seeking to protect Kishikawa groups, nursing bodies to the patient’s file according bestseller Shibumi, which from the war crimes tribunal after to his or her usual practice. introduced Nicholas Hel, World War 2, Hel is imprisoned in and Medical Defence an American prison in occupied Organisations. The „„If the clinical significance of the protagonist of both Japan. the information is not clear, novels, in 1979. Hel finds himself in the belly Trevanian wrote in his original forum agreed that a GP the GP should satisfy of a byzantine beast of intrigue as novel: “...Shibumi has to do with would be under a himself or herself that Satori sinuously intertwines he emerges from prison. He is appropriate action is, or has elements from the sequel in the great refinement underlying com- recruited by the CIA and trained by professional obligation been, taken by the internecine intrigues prefiguring an alluring Frenchwoman for a monplace appearances.” Whilst the practitioner who initiated the the Vietnam war, depicting Hel’s deep-cover operation; impersonat- original intention of the publica- to review the forging as an international assas- ing a Frenchman during the tion of this authorised prequel may information; and investigation(s). sin and curiously, a mystic. Don Vietnamese insurgency, under have been to whet the appetite for If you do not consider your- Winslow has retained his own French colonial role. Hel is tasked a long-awaited release of an unpub- consider what, if any, self to be the patient’s usual GP Hemingwayesque style, eschewing to infiltrate the insurgency, and is lished novel by Trevanian, Street of action was required. because you do not know or you a pastiche of Trevanian’s acerbic, seemingly held in check by labyrin- the Four Winds, and Shibumi; have not seen the patient for an sardonic, and deliberately man- thine layers of deception, intrigue through Winslow we have a unique The same meeting conclud- extended period, you should nered tone. and betrayal. As in Japanese arts, contribution to the oeuvre, in itself ed that, where a GP receives write to the nurse practitioner Arguably Eurasian in heritage, including the martial, his world is shibumi. documents from a nurse practi- and the patient advising to this Hel could be considered an arche- replete with omote a public face, or tioner, the following courses of Reviewed by Jeffrey Looi effect and not to be sent any fur- type of the semi-mystical martial outside, and ura, a hidden face, or action would be appropriate, Associate Professor ther results in relation to that arts trained assassin depicted by inside. However, in Hel’s travails, depending on the general practi- Eric van Lustbader in the Nicholas what is omote and ura is opaque. ANU Medical School patient. tioner’s circumstances: The same letter should also 1. If the GP is in a collaborative state that the results should be arrangement with that nurse given to the patient’s usual GP practitioner, he or she should and that the patient should con- comply with the terms of sult the GP as soon as possible. that arrangement. 2. If the GP is not in a collabo- Alternatively, you can sug- VALE! rative arrangement with that gest that the patient make an nurse practitioner: appointment to see you to dis- The President, Board, members and staff of cuss the results. If the informa- AMA ACT extend their sincere sympathies to If the results are clinically significant, the GP should satisfy tion suggests that the patient the family and friends of our late esteemed himself or herself that appropri- needs urgent medical attention, colleague, William Warwick Coupland. ate action is, or has been, taken this should be highlighted, with by the practitioner who initiated the patient being advised as a the investigation(s). matter of urgency.

Of ce Space TO LET

77 Denison Street Deakin (backing onto John James Hospital) 56 metres, ground oor, one car space. Dr Peter Jones $19,600 pa ex GST. M.B.B.S.(Hons), F.R.A.C.P. ($350/metre). Respiratory & Sleep Phone: Isobel 6282 1783 Physician • Specialist consultation • Overnight sleep studies EXPRESSION OF INTEREST • Independently owned and sought re sale of operated • Not a CPAP distributor so no SUBSTANTIAL pressure to test and sell GRAZING PROPERTY • Complex lung function testing n One hour drive to Canberra • Bronchial challenge testing n Ample scope for tax deductible initiatives • Bronchoscopy Dr K Lubbe 4/121 Hawker Place, Podiatrists: Paul Fleet | Krystle Mann | Joanna Milgate | Matthew Richardson John James Medical Centre Hawker ACT 2614 6281 0447 P: 6254 7615 F: 6255 2032

14 February 2012 needed for very busy ATHERFIELD modern family practice. MEDICAL SERVICE OFFICE SUITE Flexible hours, To Advertise GP wanted to join our busy, no A/Hrs and good non-corp, accredited, computerised FOR LEASE in Canberra Doctor conditions to right practice in Yass (40 minutes drive Lidia Perin Medical Centre from CBD). candidate. Napier Close, Deakin email VRGP Allied health and nurse support. Phone Jamison Medical Clinic, Hours/wages negotiable. 230 sq metres, first floor [email protected] Macquarie – 6251 2300 Phone Kaylene (Practice Manager) Phone: Isobel 6282 1783 www.jamisonmedicalclinic.com.au on 02 6226 1888

CANBERRA LASER AND We are pleased to announce Dr Michael Ow-Yang GYNAECOLOGY CENTRE has joined Dr Justin Pik at

colposcopy & laser ACT NeuroSpine Clinic endoscopic surgery specialist gynaecology Besides the full range of neurosurgical services, Dr Ow-Yang has a special interest in: treatment of prolapse n Complex Spinal surgery n Minimally Invasive Spine Surgery Dr. P.M.V. Mutton n Vertebral tumour resection and reconstruction MBBS, FRCOG, FRANZCOG n Percutaneous pain management techniques

Dr Pik and Dr Ow-Yang are working together to provide high 6273 3102 quality neurosurgical services and minimise waiting times for patients in the ACT and surrounding areas. 39 GREY STREET DEAKIN ACT 2600 FAX 6273 3002 To refer a patient, please contact our office: EMAIL [email protected] Ph (02) 6260 4680 Fax (02) 6260 4633

Dr Elizabeth Gallagher & Dr Huda Younis Obsetricians and Gynaecologists wish to announce the new name for their practice. WOMEN’S HEALTH Dr Nicole Sides Fertility Specialist and Gynaecologist on STRICKLAND Offering a holistic, Canberra based approach to becoming pregnant Women’s Health on Strickland Suites 3-7 John James Medical Centre I Ovulation tracking and induction – Intrauterine Insemination 175 Strickland Crescent I IVF – IVF/ICSI for male infertility including vasectomy DEAKIN ACT 2600 I Known donor program Phone - 6282 2033 Fax - 6282 2306 Dr Sides located in: Suite 7, Level 2, 3 Sydney Ave, BARTON ACT 2600 www.isisfertility.com.au P 02 6282 5577 F 02 6282 5622

Territory Obstetrics Capital Specialist Centre Bruce & Barton ATTENTION ALL SPECIALISTS & Gynaecology Associates All appointments 6253 3399 Part time sessions available at 3 Sydney Ave, Barton with full secretarial & typing support. Excellence in Women’s Health, with timely & ef cient service We currently cater for both medical & surgical specialists in the prestigious Barton medical precinct. Public & Private patients, concessions for pensioners, daily emergency appointments available A very cost effective solution without the of ce Co-located day surgery management concerns. Phone 6253 3399 Dr Andrew Foote: interest in prolapse, urinary incontinence, obstetrics & general gynaecology

Dr Sim Hom Tam: interest in laparoscopic surgery, obstetrics & general gynaecology, speaks Mandarin and Hakka

February 2012 15