medic MAGAZINE OF THE AUSTRALIAN MEDICAL ASSOCIATIONSA (SOUTH AUSTRALIA) INC.

Election 2018: 4HEHEALTHPLEDGES

(ISTORICAGREEMENTFORRURALPRACTICEs4RANSFORMING(EALTHnTHEROUND UP .EW-EDICAL"OARD0ROFESSIONAL0ERFORMANCE&RAMEWORKs-ENTALHEALTH !-!3! ANDSOCIALMEDIAs.EWFEDERAL2URAL(EALTH-INISTERs-OTORING Volume 31 Number 1 March 2018 FOOT & ANKLE IMAGING

BRAIN PATHOLOGIES

LIVER ELASTOGRAPHY CARDIAC IMAGING OPTIONS THYROID & BREAST LUMPS

LOWER BACK PAIN RESPIRATORY Commited to Referrer Educaton Previous Educaton Events Dr Jones & Partners contnues to ofer RACGP accredited educaton for GPs, ofering opportunites for practtoners to develop their knowledge ▪ SAHMRI Oncology and skills in accordance with the QI&CPD program. The learning ▪ Liver Elastography outcomes are planned and organised with the use of an evidence-based Respiratory Imaging needs assessment and relate specifcally to the domains of general ▪ & Assessment practce, with the key aim of improving patent care and management. ▪ Imaging of the Foot & Ankle Our recent events have been delivered by a sub-specialised Radiologist ▪ Lower Back Pain and Specialists in Gastroenterology, Respiratory & Thoracic Medicine, Imaging the Injured Knee Orthopaedics and Neurosurgery. The event structure encourages ▪ interactvity by way of Q&A and case studies. This format has been ▪ Cardiac Imaging Optons well received by atending GPs. ▪ Head & Stroke Imaging ▪ Thyroid & Breast Lumps www To register your interest for upcoming events, visit www.drjones.com.au/referrer-educaton

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Dr Jones & Partners is pleased to introduce Associate Professor Christen Barras

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Doctor Led • Patent Focused • Quality Driven drjones.com.au Contents 8 3 President’s column Mental health 4 News & views Dr Bawa-Garba; Preventing suicide in new hospital’s dark the medical profession few minutes; Royal The Final Report of the National Commission: a big call Forum on Reducing Risk of Suicide in the Medical Profession – jointly 5 Editor’s letter convened by the AMA and Doctors’ 7 SA Election 2018 Health Services Pty Ltd – was AMA calls for urgent released recently. health remedy

11 Transforming Health The wash-up 15 14 AMA(SA) dispatches Cover story 19 Rural health Election 2018: More support needed The health pledges 20 Council News Election 2018: who has promised 22 Australia Day Honours what? In this article are some of the undertakings and activity from parties 23 Charity on areas highlighted by the AMA(SA) Backpacks 4 SA Kids and of interest to those in health – 25 Student medals some good, some not so good. 26 Graduation 2017 28 Student news 17 31 Motoring Rural health 33 Social media Historic agreement 35 Council update landed for rural health New student reps A landmark agreement, delivered 37 Leisure by former AMA(SA) Council member and National Rural Health 39 In practice Commissioner Prof Paul Worley, has 43 The Schedule been reached to develop a national framework for Rural Generalist 44 Practice notes medical specialty.

Australian Medical Association medicSA Disclaimer Neither the Australian Medical Association (South Editorial (South Australia) Inc. Australia) Inc nor any of its servants and agents will Editor: Dr Philip Harding AMA House, Level 2, !61 Ward Street, have any liability in any way arising from information Managing Editor: Heather Millar or advice that is contained in medicSA. The North Adelaide SA 5006 Director of Policy and Communications: Eva O’Driscoll statements or opinions that are expressed in the PO Box 134 North Adelaide SA 5006 magazine reflect the views of the authors and do Cover image not represent the official policy of the Australian Telephone: (08) 8361 0100 © istock/skynetphoto; Nu Young, Leap Studio Medical Association (South Australia) unless this Facsimile: (08) 8267 5349 Advertising is so stated. Although all accepted advertising Email: [email protected] Heather Millar 0409 196 401 material is expected to conform to ethical standards, Website: www.amasa.org.au such acceptance does not imply endorsement by Production the magazine. Typeset and printed for the AMA(SA) by Executive Contacts All matter in the magazine is covered by copyright, Douglas Press Pty Ltd. ISSN 1447-9255 (Print) President and must not be reproduced, stored in a retrieval ISSN 2209-0096 (Digital) Dr William Tam: [email protected] system, or transmitted in any form by electronic or mechanical means, photocopying, or recording, After hours: (08) 8361 0100 Unsolicited material: Unsolicited editorial material should be sent to the without written permission. Chief Executive Officer AMA(SA) c/- the Managing Editor no later than six Images are reproduced with permission under Joe Hooper: (08) 8361 0109 weeks prior to the target month of distribution. limited license.

medicSA MARCH 2018 1 heading

2 medicSA MARCH 2018 William Tam President’s Report

Election time: standing for health

S I write this report, it is just also a must. With that in mind, we are areas. Increased rural training places a few short weeks until the also calling for a new Clinical Senate to for specialists would bring needed skills Aelection. The major and minor provide advice directly to the minister and support. And funding for ongoing parties are still rolling out their policies: for health, as well as increased local professional development for country the contest of ideas is afoot. Soon, authority for clinical leaders to make doctors should be stepped up. South Australians will cast their votes decisions in their health networks. The AMA(SA) is promoting an and we will know more about what the The right information is one part of investment in a hybrid model of care, next four years will hold. However the the equation – another is appropriate including hospital specialists, rural GPs cards fall, the AMA(SA)’s task will be the planning. Both come together in another and medical trainees, and an increased same – to advocate for health and the of our key calls for this state election scope of services in larger hospitals. patients and communities we serve. – a clinician-led review of services for Country Health should also be The past years have been a challenging children, and development of a child responsible not just for clinical care but time, with major changes. We have health plan. Health starts in the cradle also clinical research and training. These a shiny new biomedical precinct, and the right start means a better future. are all part of the picture. Other priorities and the doors are open at the new Of course, the future of the Women’s include local medical representation Royal Adelaide Hospital. Various and Children’s Hospital is a major in hospital governance, improved other hospitals are also sporting new element – and the AMA(SA) is calling access to mental health care, fixing additions, with more planned to come. for the co-location of the ‘full package’ procurement, and increased support for The Transforming Health reform project with the new RAH, not a piecemeal rural patients and families who need to has come and gone but left major approach that divides women’s and travel for health care. reconfigurations in its wake. The EPAS babies and children’s services. These are just a few snapshots of some electronic medical record system Planning is also integral to rural and of the areas we have been highlighting. continues, at least for now, but remains regional services, which is another There are many more. Over 50, in fact, a hot-button issue. key priority area for the AMA(SA). are detailed in our People-First Health Ambition is writ large in much that has For too long, rural and regional SA Strategy for South Australia, released been attempted, but with high risks has been under-served by our city- in the election lead-up. We have had a attached. Battles of ideas have become centric health system. Not only is it number of commitments from the major battles over data, and its interpretation. under-funded, there is also a failure and minor parties as to what measures Numbers are argued over and to plan for and invest in the skills and they would adopt, some already straightforward questions descend into support that will be needed to keep our reflected in policy announcements to linguistic tangles and semantics. What is rural services flourishing. I was glad to date. Our work is not done though. We a bed, and how do you count it? Who is visit the south-east late last year and will continue to fly the flag for health over a clinician? What does ‘better’ look like? hear about many of the issues first- the days, weeks and years to come, hand from rural members, and their with your help. We are up for those arguments, but comments underlined many of the wouldn’t it be nice to avoid some of You can find updates on policy issues we have been raising in them? One way is by having a source announcements on our website, and our advocacy. of data and informed analysis that sits we will be glad to hear from you on outside the politics. We already have In our election priorities we have any emerging issues as they arise. We the Health Performance Council – as called for a range of people-focussed have faced some challenging times but one of our key election priorities the measures to support regional doctors I would urge you to stay active, stay AMA(SA) is calling for the addition of an and patients. Better access to locum engaged, and help us keep the focus independent Clinical Data Analytics Unit services for exhausted local doctors is on the health system we need, to be to further inform health policy. Better one. Another is incentives and support able to deliver the care our communities clinical input into decision-making is for local graduates to work in rural expect and deserve.

medicSA MARCH 2018 3 AMA(SA)heading Council Dr Bawa-Garba – Office Bearers implications for Australia? President: A/Prof William Tam Vice President: Dr Chris Moy The recent decision of the UK High Court to overturn a decision of the Medical Practitioners Tribunal that imposed a 12-month Immediate Past President suspension from practice on Dr Hadiza Bawa-Garba, replacing Dr Janice Fletcher this with a permanent ban, has caused significant concern among Chair members of the medical profession – both here and overseas. Dr David Walsh

Ordinary Members R Bawa-Garba was convicted of manslaughter over the death of a six-year-old Dr Michelle Atchison, Dr Philip Gribble, boy who died under her care at a UK hospital in 2011. Dr Matthew McConnell, Dr Clair Pridmore, DShe received a two-year-suspended sentence and was then suspended from Dr Raj Ramadoss, Dr John Woodall medical practice for 12 months by the Medical Practitioners Tribunal Service.

Specialty Groups But the General Medical Council, Britain’s supreme regulator of doctors, pursued Anaesthetists: Dr Perry Fabian the case further — successfully appealing the 12-month suspension at the Dermatologists: Dr Jeffrey Wayte High Court. General Practitioners: Dr Bridget Sawyer That led to Dr Bawa-Garba being struck off the medical register. Obstetricians and Gynaecologists: Dr Jane Zhang Doctors say the case reflects systemic failures at the hospital and in the broader Orthopaedic Surgeons: Dr Jeganath Krishnan healthcare system, and that it could have happened to any one of them. Pathologists: Dr Shriram Nath The High Court concluded the Tribunal fell into legal error by not giving the weight Paediatricians: Dr Patrick Quinn required to an earlier jury verdict of manslaughter, instead reaching its own views as to Physicians: Dr Nimit Singhal the level of culpability. Psychiatrists: Dr Tarun Bastiampillai Radiologists: Dr Nicholas Rice The AMA is looking closely at the implications of this decision for Australian doctors, Surgeons: Dr David Walsh recognising that many of the same pressures on the health system exist here. That analysis will be published once the AMA has had the opportunity to fully consider the Regional Representatives facts of the case. Northern: Dr Nigel Stewart, Dr John Williams

Public Hospital Doctors Representative Royal Commission: a big call Dr Andrew Russell

Student Representatives A-BEST leader Nick Xenophon made news in February with a pre-election University of Adelaide: Mr Simon Cousins call for a Royal Commission into the health system. The proposal came Flinders University: Ms Mekha John Sas a surprise to the AMA(SA), which said that it looked “expensive and expansive”. AMA(SA) Executive Board Mr Andrew Brown, Mr John McLaren, If undertaken, “there would need to be a guarantee that this would not be an expensive Dr Chris Moy, Dr Peter Sharley, and time-consuming exercise that would take money away from the provision of Dr William Tam frontline health services, and delay needed changes,” AMA(SA) state president A/Prof William Tam stressed. AMA(SA) Office: Key Contact “A Royal Commission which goes back to look at problems is not a substitute Chief Executive: Mr Joe Hooper for health policies and initiatives which we need now to improve the health of South Australians.” Federal Councillors A/Prof William Tam (State Nominee) The AMA(SA) has, however, called for an independent clinical data analytics unit to Dr Chris Moy (Area Nominee SA/NT) provide transparent information to both judge the health system and make Dr Susan Neuhaus (Craft Group constructive recommendations. Nominee: Surgeons) The Commission proposal appears extremely ambitious in scope, described on the The AMA(SA) office is located at party website as “a root and branch review of South Australia’s health system … to look at every scandal, those that are already known, and those still hidden.” 161 Ward Street, North Adelaide. You can contact us by telephone on The proposal is opposed by Labor and Liberal leaders at the time of writing, although (08) 8361 0100, by fax to (08) 8267 5349 Mr Xenophon has said that if SA-BEST holds the balance of power he would make the or email to [email protected]. Royal Commission a condition of support.

4 medicSA MARCH 2018 heading Dr Philip Harding Editor’s LETTER

N life, trust is everything. In particular, we rely on those we trust to provide our needs Iand make decisions in our best interest. Of the four men on the cover of this issue, the third from the left – our president William Tam – certainly enjoys the trust of our profession in these respects. But what about the other three, both from our viewpoint and that of the State as a whole, with the

Courtesy: The Advertiser/Jos Valdman election looming in but a few days? For the people of South Australia, this will depend on their track record, what policies they have announced, and to what extent they are perceived as having the will and the means New hospital’s dark to implement them. This latter is where the trust factor comes in. few minutes In the Health portfolios, Labor is off to a bad start with the millstone of Transforming Working in the dark is not a common event, but it is one that faced Health still hanging round its neck, along AMA(SA) president A/Prof William Tam when a power failure hit with its management of the new RAH project the northeast E block of the RAH in early February … having received so much adverse criticism. Failure to be able to keep the lights on there (see opposite) is hardly good news for them. power failure has put the new Royal Adelaide Hospital in the news for all the Another job for Elon Musk, perhaps? The wrong reasons in the sensitive election lead-up. Caused by two software problem for the Liberals is the length of time A glitches, the outage affected a seventh of the hospital and lasted 17-20 they have been out of office and hence the minutes. Struck by the outage were: two operating theatres with surgery underway; uncertainty of the population regarding the radiotherapy; nuclear medicine; several outpatients clinics; cancer day treatment; trust factor. Both major parties have some cardiology; general surgery; palliative care; respiratory; and general medicine. attractive policies, summarised in this issue There was also some confusion after the outage as to whether or not to with the latest information available as we go proceed with operations. to press, but people will have to judge what is best for the State as opposed to wooing The hospital is designed to be able to function self-sustainably in the event of a voters in sensitive electorates. catastrophe. To ensure it can, six backup generators undergo monthly testing on Wednesday mornings to ensure they are blackout proof. It was during this process that SA Best’s suggestion of a Royal Commission the outage occurred, apparently as a result of a pump issue which saw a generator seems widely unpopular as a waste of time run out of fuel before testing was complete, and then being unable to return to mains and money. power due to a further error. Whoever wins simply must reintroduce an Of the two theatres affected, AMA(SA) state president A/Prof William Tam was in one, adequate level of clinical governance into undertaking a delicate endoscopic procedure for an elderly patient, which could not the management of the health system. In be paused; however, he was able to finish it thanks to one remaining screen that was the pages of medicSA, we have previously unaffected by the outage. Describing the incident as a “wake-up call” for SA Health, drawn attention to the evidence-based he stressed that in medicine “often every minute counts” and there is “no room for beneficial effect of involving appropriately complacency” with safety systems. qualified clinicians both in policy development and day-to-day administration. This is a key “Hospitals are a high pressure environment where we are all striving to keep things on point in the AMA(SA)’s People-First Health track for our patients. The systems and safety nets need to work for us. When they Strategy for South Australia, referred to don’t we soldier on – but we need to know it won’t happen again,” he stressed. He elsewhere in this issue and also e-published also said doctors should be informed when testing is occurring. in The Voice on 22 February. The parties’ The AMA(SA) will follow up on investigation findings, and what measures are responses to this and other measures being taken to ensure such an outage does not occur again, as well as improved called for by the AMA(SA) can be seen communication protocols. on our website (see also pages 15-16).

medicSA MARCH 2018 5 heading

Renew your AMA membership for 2018

As an AMA member, you are not alone

The AMA – a voice for the profession, across the profession members.amasa.org.au/renew

Advocacy Advice Resources Representation Services Benefits

6 medicSA MARCH 2018 news & views SA Election 2018: AMA calls for urgent health remedy The start of February saw the AMA(SA) amping up its pre-election advocacy, criticizing all sides of politics for inaction on health and highlighting the solutions put forward in its pre-election wishlist.

“ HE major and minor parties’ As reported in the last edition of health announcements so far medicSA, the Association is calling for Thave failed to address the real a range of measures in our Election concerns of the public,” said AMA Priorities, with themes including clinician- South Australia state president A/Prof led decision-making; integrated hospital William Tam. and GP services; resources for rural and remote health care; training and “Access to quality healthcare is the most important priority to most South research; mental health; palliative care; Australians… We must have confidence and support for doctors’ wellbeing. Key that our health system and services will asks include: care for the sick, whoever and wherever s An independent Clinical Data Analytics they are,” he stated. Unit to provide true robust data on the “If you were to ask me, what is the mood state of our health system’s outcomes on the ground now, at the hospitals, and better inform action. in EDs, among our members, I’d say s A co-located, unified Women’s and You can find the full Election Priorities people are hurting. Doctors are not able Children’s Hospital with a full suite document and ongoing pre-election to deliver the care they should. Waiting of clinical services for women and updates on the AMA(SA) website lists are too long. Morale is low. Stress infants, located on one site with the at amasa.org.au. You can also is high. Working conditions are verging find an overview of some of the new RAH, and a clinician-led Child on dangerous.” parties’ pre-election promises on Health Plan. The AMA’s national 2017 Public Hospital page 15. We are glad to report that s Significantly increased clinical services Report Card, which covers data from since our criticisms at the start of in our larger rural hospitals, with 2001-2016, highlighted declining February, the parties have had expanded training and proper workforce numbers of urgent ED patients seen in more to say on health, with a range the recommended time, and increasing planning for country hospitals. of announcements. elective surgery waiting times. Data reported from a recent Productivity Commission report also points to issues with overdue elective surgery, ambulance response times and ED waits. Have you arrived? “Over the past months, we have heard Congratulations to all those who have about significant and unacceptable recently graduated to become interns this year! system failures. Our political leaders must not simply paper over the worst problem areas with quick fixes or You can now join the AMA – another building announcement,” the peak group for doctors – said A/Prof Tam. as a full member and receive the full range “We need a real commitment to a healthy system. Not just bricks and of member benefits. mortar, but people and services. Not just winding back some of the more Visit www.amasa.org.au unpopular elements of the ‘Transforming to find out more or call Health’ cuts. Not just a few nice ideas Charlie on 8361 0108. or cash boosts. We need to see some vision for the future.

“We urge all South Australians to put that Don’t forget, membership fees are eligible for professional question to anyone seeking your vote development allowance reimbursement or are tax deductible. in this election. What would their party deliver for your care?”

medicSA MARCH 2018 7 mental health Doctors call for action to prevent suicide in the medical profession The Final Report of the National Forum on Reducing Risk of Suicide in the Medical Profession – jointly convened by the AMA and Doctors’ Health Services Pty Ltd (DrHS) – was released recently.

HE report records the “The strong overarching message from considerations and the Forum was that cultural change has Trecommendations of 82 doctors to come from within the profession and – nominated by key medical stakeholder doctors must care about and value the organisations – from a forum that health of their colleagues.” examined the individual, organisational Federal AMA vice-president, Dr Tony and environmental issues that impact Bartone, said there are many factors negatively on the emotional health and that can affect how doctors and medical wellbeing of doctors. students cope with the stressors of their DrHS Chair, Dr Janette Randall, work roles. said that the Forum was a day of “Not enough doctors and medical impassioned conversations about students have a GP who they see issues that deeply affect the medical regularly, and not enough doctors profession and individual doctors, engage in preventive health care such as from medical school through healthy lifestyle, proper work-life balance, “Across the profession, we have to get to retirement. and regular check-ups – simple, yet better at seeing the signs when matters “The themes that emerged from the vital, actions that can keep stress and like ageing, burnout, compassion fatigue, day were culture and compassion. We depression at bay,” Dr Bartone said. traumatic events, bullying, and harassment are eating away at our colleagues and heard stories of psychological harm, “The stress can build up over time and, ourselves,” Prof Willcock said. mental illness, and suicide, which in worst-case scenarios, can lead to self- are the sad and tragic reality of the harm and suicide.” “These things affect our health and pressures of being a doctor in Australia wellbeing and our effectiveness as The facilitator of the Forum, Professor today,” Dr Randall said. doctors, and ultimately can affect Simon Willcock, clinical director of the quality of care we are providing “Importantly, we also heard stories of primary care at the Macquarie University our patients.” how doctors at the coalface are working Health Sciences Centre, said that on solutions to protect their own health, doctors do not currently recognise and The report is available here: ama.com. the health of their colleagues, and respond to illness in themselves or au/article/national-forum-reducing-risk- their patients. their colleagues. suicide-medical-profession-final-report.

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8 medicSA MARCH 2018 mental health AMA Position Statement 2018: overarching mental health plan needed The AMA is calling for a national, overarching mental health ‘architecture’, and proper investment in both prevention and treatment of mental illnesses.

LMOST one in two Australian adults “The AMA is calling for the balance “Community-managed mental health will experience a mental health between funding acute care in public services have not been appropriately Acondition in their lifetime, yet mental hospitals, primary care, and community- structured or funded since the movement health and psychiatric care are grossly managed mental health to be towards deinstitutionalisation in the 1970s underfunded when compared to physical correctly weighted. and 1980s, which shifted much of the health, federal AMA president, Dr Michael care and treatment of people with a “Funding should be on the basis of need, Gannon, said. mental illness out of institutions and into demand, and disease burden – not a the community. Releasing the AMA Position Statement competition between sectors and specific on Mental Health 2018 on 14 January, conditions. Policies that try to strip “The AMA Position Statement supports Dr Gannon said that strategic leadership resources from one area of mental health coordinated and properly funded is needed to integrate all components of to pay for another are disastrous. community-managed mental health mental health prevention and care. services for people with psychosocial “Poor access to acute beds for major disability, as this will reduce the need for “Many Australians will experience a mental illness leads to extended delays in costly hospital admissions.” illness at some time in their lives, and emergency departments, poor access almost every Australian will experience the to community care leads to delayed or The Position Statement calls for effects of mental illness in a family member, failed discharges from hospitals, and governments to address underfunding friend, or work colleague,” Dr Gannon said. poor funding of community services in mental health services and programs makes it harder to access and coordinate for adolescents, refugees and migrants, “For mental health consumers and their prevention, support services, and Aboriginal and Torres Strait Islander families, navigating the system and finding early intervention. people, and people in regional and the right care at the right time can be remote areas. difficult and frustrating. “Significant investment is urgently needed to reduce the deficits in care, It also calls for government recognition “Australia lacks an overarching mental fragmentation, poor coordination, and and support for carers of people with health ‘architecture’. There is no vision of access to effective care. mental illness. what the mental health system will look like in the future, nor is there any agreed “As with physical health, prevention is The AMA Position Statement on national design or structure that will just as important in mental health, and Mental Health 2018 is available at facilitate prevention and proper care for evidence-based prevention can be socially https://ama.com.au/position-statement/ people with mental illness. and economically superior to treatment. mental-health-2018.

Mental Health Strategic Plan for South Australia released

HE Mental Health Strategic Plan SA Mental Health Commissioner Chris 2017-2022, which was released Burns said the Plan’s three core Tlate last year, sets out a 20-year strategies and seven strategic vision for mental health and wellbeing directions present a unique and exciting in South Australia, focusing on state- opportunity to set the direction for wide strategic directions over the next greater productivity and prosperity five years to build a more resilient, by growing the mental health of compassionate and connected South South Australia. Australian community. “South Australians told the Commission The SA Mental Health Commission led that good mental health and wellbeing The Commission will now co-ordinate, the development of the Plan, which is built lie beyond the hospital sector,” facilitate and oversee the implementation on the stories and views of over 2200 Commissioner Burns said. of the Plan and the development of future actions to address key areas identified by South Australians across metropolitan “They said we need to act early on South Australians. and country areas, as well as work done the signs and symptoms of poor at local, national and international levels in mental health before people reach a The Mental Health Strategic Plan is available mental health and reform. crisis point.” at samentalhealthcommission.com.au.

medicSA MARCH 2018 9 heading

Your Membership Benefts. Looking afer Looking afer you locally. your lifestyle.

Membership of the AMA(SA) is open to medical practtoners who are We secure reduced rates, registered to practse medicine in South Australia. By being a member, corporate deals and special you help support the AMA’s advocacy on behalf of your medical discounts through businesses and profession and help set priorites on local, state and natonal levels. organisatons such as American Express There are additonal benefts associated with membership outside the BMW advocacy work we do and the services and resources we provide, such as Hertz Car Rentals our tax deductble membership fees, which may also be wholly or Mercedes Benz partly claimable against your Professional Development Allowance. Qantas Club Naval & Military Club. Additonally, corporate services are available through our ‘platnum’ partner for accountng and fnancial planning services, Hood Sweeney. You can also access a range of eatng Hood Sweeney ofer members exclusive rates for establishing new out and travel discounts through the self-managed superannuaton funds and discounts for accountng services. Ambassador Card program, accessible through your AMA(SA) Member Card. Norman Waterhouse Lawyers, a South Australian commercial law frm, are our preferred partner in the provision of legal advice for personal and professional maters for our members.

Membership ofers you more than you realise when you consider a full tme GP, living in South Australia, would cover the cost of membership if already purchasing the AMA Fees List, DoctorPortal Resources, Qantas Club, AMEX Card and available Tax Deductons. Paying for membership provides this and more and we always encourage members to take advantage of the full range of benefts on ofer. Please note: terms and conditons apply Your member benefts are there to look afer you. to most member benefts.

AMA(SA) More informaton is Your Profession. available via Your Voice. www.amasa.org.au Your AMA. or email www.amasa.org.au [email protected]

10 medicSA MARCH 2018

Member Benefits - medicsa Page Design.indd 1 20/02/2018 10:44:59 AM transforming health Transforming Health: The wash-up Whether Transforming Health was a well-intentioned tilt at improving health services or a cynical cost- saving exercise will depend who you ask. Soon it may be a moot point as the current Government is drawing a line under it, and the election looms. But what have we learnt, and are we better off?

HE history is now well known. productivity savings while improving s delays in bed reconfiguration and Transforming Health began as quality across the system. FTE reductions due to consultation a response to federal budget requirements and IR matters T The SA Health Performance Council cuts. Then health minister Jack Snelling indicates that Transforming Health s financial benefits modelling was started the process in 2014 with service changes were designed to based on 2014-15 activity data advisory groups, consultants, and a improve the delivery of consistent with no allowance for growth – will for change. The objectives were quality of care in response to ten but SA Health experienced 2.7% a better health system, and savings, identified issues: (1) Too many deaths growth in activity which were hoped to go hand in hand. occur in SA hospitals; (2) Senior A discussion paper was arrived s some of the models of care clinicians unavailable overnight; (3) at soon after, including a catchy required LHNs to reinvest from Insufficient opportunities for staff to motto, six quality principles, and within existing resources. maintain their skills, (4) Too many 282 clinical standards. cancelled elective surgeries; (5) Low The auditor’s report indicates the The motherhood principles were day surgery rates; (6) Too many Department: “has identified the need inarguable, the clinical standards procedures being performed; (7) to consult with unions sooner for future were problematic. Some raised Long waiting times for discharge or projects and allow sufficient time in questions, some were debatable. placement; (8) Too many transfers future project plans for consultation, While some were self-evidently a between hospitals; (9) The SA health review, feedback and approval good idea, there were no footnotes. system is unable to meet some national processes required to implement bed The evidence and reasoning standards; and (10) Risk to the financial closures and workforce reductions. behind them was not there to be sustainability of SA’s healthcare. This learning has been captured interrogated. A large collection of on the Transforming Health lessons A number of cited improvements material was released in conjunction learned register.” with a Transforming Health summit, have been credited to Transforming but presented data rather than Health, but it is hard to say where a LHN CEOs were told to implement answers. The AMA(SA) queried final analysis will leave it. It is being other business-related strategies to or raised issues with many of the evaluated by the SA Academic Health make up for Transforming Health standards, but very little changed Science and Translation Centre for savings shortfalls and meet savings by the next iteration and no the Department of Health, and the targets, and came up with a combined clarifications came. outcome of that review will no doubt $121.2 million, but ended the financial make interesting reading, if released. year with a shortfall of $64.6 million. Time was of the essence, however. In the meantime, three recent reports The Department’s Corporate Finance Minister Snelling said the process can give some insight into the flagged concerns about the viability had unearthed 500 ‘extra’ deaths Transforming Health journey – from and high-risk nature of some strategies. a year in SA – no time was to the auditor-general, Health Issues were also raised in the be lost in implementing improvements Performance Council, and the auditor’s report around risk and issue to avoid them. The standards Transforming Health Parliamentary management, and management of flagged as unachievable under the Select Committee, chaired by Health contracting arrangements with Deloitte current system were to be met by Shadow Stephen Wade. system changes. Capital works and Ernst and Young, including were placed on hold pending new On the financial front, the auditor- performance reviews for the latter. plans. The process began with general’s report for 2016-17, At the time of the audit, work was external consultants McKinsey and tabled in October 2017, found that underway to embed the Clinical Co, then Deloitte as implementation Transforming Health savings targets Standards of Care within business as partner, then Ernst & Young as were not achieved and there was a usual processes. Resolving the 40-odd the independent program lack of mitigating strategies to standards flagged as ‘not achievable’ management office. address savings shortfalls. It also may still be problematic. found a lack of planning for The business case approved by The Department of Health advised Transforming Health strategies to cabinet in March 2015 bundled up that it has progressed various initiatives realise future financial benefits. Transforming Health as a measure to deliver consistent, quality care for sustainability, quality and The Program Delivery Support across all services and sites. Some standards – it was to deliver a more Office advised that the savings significant achievements it listed for sustainable health system through shortfall was due to: 2016-17 included:

medicSA MARCH 2018 11 transforming health

s completion of the reconfiguration s In the same time period, the places, impacts on clinical research, of clinical services within NALHN, percentage of in-hospital deaths in and other losses. Changes in clinical with LMH being the major metropolitan Adelaide public acute services have created public confusion tertiary hospital undertaking hospitals fell from 1.6% to 1.4%. and anger. And the morale of staff has complex multi-day and The latest national figure is lower also suffered. emergency surgery and Modbury at 1.0%. “We can do a lot better, and better established as the subacute and s The percentage of inpatients governance and data to inform elective surgery centre for the transferred between hospitals policy is a big part of that. The North/North East has risen from 4.7% to 6.2%, AMA(SA) is calling for a governance s completion of service moves from higher than the national figure framework and investment that the RAH and TQEH to the LMH of 5.6%. supports clinician-led evidence-based decision-making and a culture s planning and consultation for some s Looking at the people admitted of openness, accountability and general rehabilitation to move from to metropolitan Adelaide public mutual respect, instead of blame- the Hampstead Rehabilitation acute hospitals this quarter, shifting and fear. Centre to Modbury in-hospital deaths for aged persons is down over the “We also need to separate the s completion of a number of service past ten years, from 3.4% to information from the propaganda moves and continued consultation 2.7% of all hospitalisations and spin. That’s why the AMA(SA) and planning to support clinical (inpatient separations). is calling for an independent source reconfiguration across SALHN of truth – a new, fully funded Clinical Transforming Health ceased with Analytics Unit to inform decision s development and progressive the decommissioning of the Repat making in healthcare. It would sit implementation of various clinical and the opening of the new RAH, in an academic environment free of improvement projects and the clinical service reforms are political influence. s completed capital works, including to return to being part of usual a new Noarlunga ambulance business. However, the final report “History will judge Transforming Health station; new facilities at Noarlunga; of the parliamentary Select but the practical work of improving new and upgraded rehabilitation Committee into Transforming Health the health system is something we as facilities at Modbury; and a new cites 42 ‘unachieved’ Clinical doctors will continue, whatever the cardiac catheter lab at LMH Standards and the open question of slogans of the day.” the contested 500 ‘avoidable deaths’ s progress of capital works, as unfinished business. A better transformation: including construction of new facilities at FMC, and construction The Committee characterised AMA(SA) priorities of a new Veterans’ Mental Health Transforming Health as a health As part of its Election Priorities for Precinct at Glenside portfolio response to an increase the 2018 state election, the AMA(SA) in budget savings targets in the has dedicated a section to improved s continued workforce modelling, 2014-15 financial year that has in policy and reform through clinician-led change management, culture and fact “made health reform harder to decision-making including: leadership development initiatives. implement in South Australia”. s a new clinician-led senate to The Department also advised that “it This may well be true, according provide independent health is continuing to achieve better quality to AMA(SA) state president A/Prof strategy and clinical advice directly care, further reductions in waiting William Tam. “Whatever you think to the minister for health times and inpatient lengths of stay about Transforming Health, reform s an independent clinical analytics and improvements in access and does present an opportunity for some unit within the university and patient flow.” positive changes and some hard research sector that interfaces conversations. A lot of very genuine The most recent monitoring report of seamlessly with the clinical senate people went into various aspects of the the Health Performance Council on Transforming Health juggernaut trying s appropriate funding to enable Transforming Health (November 2017) to do the right thing and improve the rigorous, open and independent indicates that: system. They came with their goodwill evaluation and reporting s Between July-September 2007-08 and their experience and their data s increased local authority for and July-September 2017-18, and they tried to be heard and make a clinical leaders such as unit heads the average length of an overnight difference. Unfortunately a really poor to make decisions within their stay at metropolitan Adelaide process let them down. health network public acute hospitals declined “Transforming Health promised to from 6.6 days to 5.6 days. In s a culture of continuous deliver a more efficient and effective comparison, the average length improvement and leadership – health system. of overnight stay at public acute with people encouraged hospitals across Australia in 2015- But it led to many unintended to speak their mind even if it 16 was lower at 5.4 days. consequences, including lost training is unpalatable.

12 medicSA MARCH 2018 spotlight Time travel for our hopes and wishes: Advance Care Planning National Advance Care Planning Week is being held from 16 to 22 April 2018. Dr Chris Moy explains why it is time to look into the future with those we love and trust.

WO things that almost all of difficult. And there is a high chance that So advance care planning is like us would like at the end of our we will lose decision-making capacity, time travel – it allows you to transmit Tlives are self-determination, and therefore transferring the burden of very your goals into the future by giving to leave our loved ones with happy difficult decisions about our care onto you the chance to document your memories of our time on earth with unprepared family members. wishes, or allowing you to appoint a them. Unfortunately, reality may instead substitute decision-maker to represent This is why advance care planning is so end with intrusive and distressing you when you can no longer do important. It’s the process of talking medical interventions being provided so yourself. with your family and friends – and to us at odds with what we want, health team – about your wishes, goals National Advance Care Planning Week and loved ones left remembering with and what you do and do not want to is an ideal time to encourage your distress and guilt – rather than any happen to you when you lose decision- patients and those around you to start sense of peace – the events surrounding making capacity. This will bring the process. For more information, go to our last days. everyone onto the same page regarding advancecareplanning.org.au. Why does this happen? One reason what you want to happen, and it also Dr Chris Moy is an ambassador for is that our friends and families, along allows for subsequent documentation National Advance Care Planning Week. with our doctors, cannot read minds. of your wishes and goals. In SA, this He is AMA(SA) vice president and chair The period near the end of life is often can be done on a legal Advance Care of the Federal AMA Ethics and Medico- intensely emotional, making decisions Directive Form. legal Committee.

medicSA MARCH 2018 13 dispatches AMA(SA) dispatches

AMA National Conference AMA(SA) Council meetings Your CV and interview skills Attend one of the most significant events Meetings of the AMA(SA) Council are open The ‘Your CV and interview skills’ in the AMA’s calendar and make a to all members. The next meeting will be presentation is on again this year for difference to the future of your profession held on Thursday 3 May. Any member young doctors, on Wednesday 11 April at and health care. The AMA National wishing to attend a Council meeting the Osmond Function Centre, Norwood. Conference, taking place on the should contact Claudia Baccanello on Dr Janice Fletcher and Dr David Walsh 25 – 27 May in Canberra, will bring [email protected] or 8361 0109. will provide the useful tips to polish your together doctors from across the own CV and interview skills, to assist country. For more information, go to 2018 AMA(SA) Charity you to get into your preferred training natcon.ama.com.au. program. It was a hugely successful Gala Dinner ‘Eclectica’ presentation last year, so book early. For The AMA(SA)’s 2018 Charity Gala Dinner Call for nominations on more information, go to ama.com.au/sa/ will be held on Saturday, 19 May 2018 sa-events-seminars. AMA(SA) Council at the Hilton Adelaide. This year we will The AMA(SA) is calling for nominations be supporting Backpacks 4 SA Kids, a on AMA(SA) Council for the positions of: Are you working part-time? charity which provides children who are Did you know you can adjust your AMA s President living in foster care with a backpack full membership to reflect your current s Vice President of personal items to call their own. For situation? GPs and other specialist s Ordinary Members more information visit ama.com.au/sa/ members reducing hours (up to five s Regional Representatives sa-events-seminars. half days per week) can still access all benefits of membership for just $945 For details or to access the nomination 2018 Women in per year. This pricing may benefit you form, contact Claudia Baccanello if you are moving into retirement or are on 8361 0109 or email claudia@ Medicine High Tea mixing work with your paternity leave, amasa.org.au. Join us on Sunday, 18 March 2018 at the Mayfair Hotel, 45 King William St, 1.30- for example. Your membership price For conditions and enquiries relating to reduces to $406.20 if you are working for 4pm. Tickets can be purchased online the nominations, please contact the Chief not more than two half days per week. for $50 members/$65 non-members. Executive, Mr Joe Hooper on 8361 0109 AMA(SA) is pleased to announce that If you would like to discuss your or [email protected]. Marie Shaw QC will be our guest speaker membership options with our Nominations close at 5pm on Thursday, at this popular event. To register, visit membership officer Charlie, please call 22 March 2017. ama.com.au/sa/sa-events-seminars. 8361 0108 or email membership@ amasa.org.au. If you have renewed, Notice of Annual General Meeting your membership card is TO BE HELD THURSDAY, 3 MAY 2018 AT 8.00PM in the post! At the Naval, Military and Air Force Club of South Australia Did you know your AMA(SA) membership 111 Hutt Street, Adelaide. Immediately following the card doubles as an Ambassador Card – State Council meeting which commences at 7.00pm. accepted in partnered restaurants, The AGM will be followed by light refreshments hotels, retail outlets across Australia. You may access and check the list from your BUSINESS mobile phone while out and about, via The business of the meeting will be: 5. Appointment of Auditors ama.ambassadorcard.com.au. 1. Welcome and apologies 6. Report from the AMA(SA) Chief Executive 2. Approval of the minutes of the previous meeting (Annual General 7. Farewell to Retiring Members Meeting held 4 May 2017) of Council Thanks to Avant 3. President’s Report and Adoption 8. Election of Office Bearers The Board of The Medical Benevolent of the Annual Report for the year 9. Election of Council Positions due Association of South Australia (MBASA) ended 31 December 2017. by rotation wishes to publicly acknowledge and thank the Avant Medical Insurance 4. Financial Report and adoption of 10. Any other business Group for yet another generous the Auditor’s Report for the year 11. Closure of meeting donation to assist the work of our ended 31 December 2017 organisation. Their ongoing support is Members wishing to attend the AGM should email: [email protected] greatly appreciated.

14 medicSA MARCH 2018 election 2018 The Pledges: Who gives what Election 2018: who has promised what? Below are some of the undertakings and activity from major and minor parties on areas highlighted by the AMA(SA) and of interest to those in health – some good, some not so good. Read on to find out more …

Labor Party (eg EPAS) and integrated with public Service >> Enhance the SAHMRI pathology, imaging and pharmacy mental health registry. Clinician-led decision making, by June 2019 >> Primary/tertiary Palliative care >> Purpose-built data and IT >> Support for clinician collaboration and review of Palliative Care Unit at Modbury ($15.5 involvement and advocacy, and the outpatient systems >> SA Health million); expanding the GP Palliative Health Performance Council >> and SA PHNs have purchased Shared Care to country; developing Combining data science and health HealthPathways; model of care for care pathways. >> Continue palliative services; SA Health Quality Information older people; and an end of life care specialist visits to rural areas and Performance Hub >> Outpatient care strategy. clinic waiting times published online, post withdrawal of federal funds to Rural health >> $140 million to 30 June, and to look at a future revised in time >> Independent review of EPAS upgrade country infrastructure, model of care. to resolve issues raised by clinicians including renal at Whyalla and Mount and consider improvements suggested Other areas of interest >> Almost Gambier >> Moving away from models by AMA(SA); AMA(SA) to engage with $80 million over four years to replace relying on GPs to cover hospitals EPAS Clinical Advisory Group. equipment in metro and country 24/7; improving training opportunities hospitals >> Supportive of AMA(SA) NALHN, Modbury and Lyell McEwin in country SA; investigating additional call to adopt WA model on mandatory >> Expansion of the Modbury Acute incentives to attract rural health reporting of doctors – will discuss at Surgical Ward ($35 million), with 1-3 workforce >> Exploring expanded COAG and look at WA and replication night stays >> Increasing LMH self scope of clinical services in larger in SA if COAG agreement not reached. sufficiency to around 80% eg in ED hospitals; steering groups to rheumatology, dermatology, plastics, collaborate with GPs and co-design vascular, ENT; LMH can expand future services. intensive care beds on need >> Free Liberal Party Training and research >> $3.6 volunteer shuttle bus in NALHN; billion health and biomedical precinct Engagement with clinicians and improving the public transport network; including SAHMRI; proton therapy communities; data and IT >> working party to review and improve unit >> Established Health Industries Commission on Excellence and patient transfers. SA; purpose-built Clinical Trials Innovation in Health, governed Children and the WCH >> $528 Research Centre (with HRF) opened by a board including doctors >> million for a new Adelaide Women’s Dec 2017; new partnerships such as Decentralise the public health system: Hospital (WH) co-located with the the Beat Cancer Project >> Ensuring boards of management for each LHN, new RAH in 2024; new Children’s training needs considered in any with clinicians on boards, and clinical Hospital site as close to the precinct service configurations >> Supporting engagement >> Open to engaging as possible, announced by the end statewide/networked training and university research units to help of 2019; Helen Mayo House to move accreditation; expansion of training manage and utilise data; government/ to the WH. WCH to be upgraded >> positions in rural areas; recognise the SA Health will need to maintain A clinical services plan for children; need to increase specialist rural its own capacity for data analysis continue ‘No Jab No Play’; preventive training places; a rural intern training >> Outpatient clinic waiting times measures against childhood obesity pathway from 2019 >> Advocate with published online from 1 July 2018, on a quarterly basis by speciality and and diabetes. granting agencies for rural medical research grants. hospital >> Suspend EPAS roll-out; RAH >> Committed to previously an independent review of its Mental health >> Centre of announced evaluation processes functionality, performance and future, Excellence for sub-acute care for including performance, benefits and to determine if it should progress, people with severe-extreme dementia; equipment. Some reviewing already costs to fix, or a pathway to a better support the concept of multiple commenced including security; system; involving the AMA(SA) and Specialist Residential Units for non- signage; blue space; outpatients. Pain other organisations to address EPAS acute accommodation for this Management has moved to TQEH. issues >> Real-time prescription group >> New mental health and drug >> Feasibility study underway on the monitoring against drug misuse. addiction community outreach; new Chest Clinic; interim strategies in place. suicide prevention programs; new TQEH, Modbury, Noarlunga and Integrated hospital and GP services specialised service for people with the Repat >> TQEH to be a key >> My Health Record expansion, BPD; reverse federal cuts to cardiac centre as part of a $270 including viewing in other systems the Intensive Home Based Support million upgrade >> $110 million

medicSA MARCH 2018 15 election 2018 to upgrade Modbury facilities and health and drug education in schools; improving health literacy >> Bowel services, including a 16-bed purpose- tackling bullying in schools; and cancer prevention initiative, catching up built palliative care unit; extended magistrate drug treatment orders for overdue colonoscopies in 12 months. emergency care unit; acute medical under-18s for up to 12 months >> Rural and mental health >> Address unit and 4-bed HDU >> 12-bed Appointment of an Aboriginal capital works backlog in country acute medical ward at Noarlunga Children’s Commissioner. hospitals; upgrades at Murray Bridge, (capacity to expand to 15); admission McLaren Vale and Yorketown; and to three days; and a new Women’s RAH >> Operational and design a 24-hour GP emergency service and Children’s Health Hub >> Retain problems at the RAH to be urgently at Mt Barker >> $20 million rural the Repat site as a health precinct, addressed, including securing sites for health workforce strategy including and look at Ward 18 for people respiratory and eye services, with the doubled country interns; recruiting with BPSD. involvement of frontline clinicians and organisations. and retaining resident specialists; and Children and the WCH >> A new increased support for rural generalists WCH co-located with the RAH; in the Integrated care, prevention and >> Statewide mental health service first 100 days, a high-level task force more >> Multidisciplinary teams, plan within 12 months, including including clinicians and representative integrated care, and preventative health country SA >> Permanent renal dialysis groups to drive the project and develop – including targeted interventions on the APY Lands; upgrading and a fully-costed plan, with a view to for chronic conditions, end of life, expanding the Mount Gambier unit co-location by 2024 >> $4 million and complex conditions >> Healthy >> Double chemotherapy delivered in paediatric eating disorder service; Communities Program to focus on regional SA through a country cancer $10 million Borderline Personality physical activity, smoking, alcohol, initiative, including piloting GP training Disorder program >> Aquatic safety; access to affordable healthy food, in oncology.

SA-BEST services (including additional resources They also support expanded services SA-BEST has not provided a for the LMH); a co-located WCH; and at Modbury, Noarlunga and TQEH personalised response to the independent, evidence-based reviews and a co-located WCH “at such time AMA(SA)’s election priorities, as we of child health, the RAH and EPAS, that the project can be paid for and go to press, but has announced with a focus on clinical expertise implemented appropriately”. and knowledge. a number of measures that reflect Australian Conservatives support the recommendations or issues raised The Greens also support the AMA(SA)’s AMA(SA) calls on training and research by the Association and some that proposals for collaborative team-based and propose the establishment of a differ. SA-BEST health policy themes models of care, funding for GP-led committee to determine what is most include: securing medical and health stepdown; and rural measures including needed rurally, and strongly support services (focussing on reversals or an increased scope of services in the implementation of a mental health mitigation of losses); and country larger hospitals and improved access registry. They also support investment health (upgrades, scope of services, to mental health care. The party also of $24.5 million to improve access and drug, rehabilitation and support support purpose-built, high dependency to palliative care services, and have services). Also supporting hospital accommodation for people with severe actively campaigned for appropriate and medical staff (whistleblower behavioural problems associated with anti-bullying laws. protection, protection against violence, dementia, mental illness and impairment. less external consultants, and Training and research calls are also Dignity Party workforce planning); and improved supported, and $24.5 million per annum The Dignity Party (formerly Dignity governance, transparency and funding for palliative care, with outreach for Disability) will have a number accountability (a Royal Commission to country SA and a purpose-built of candidates in this election and into the health system, online data hospice at Modbury. Other notable continue to focus on a range of issues and performance statistics, reviewing policies include increased carer respite, and areas also highlighted by the EPAS, and strengthening local voluntary euthanasia, and a five-year AMA(SA), including NDIS transition decision-making). plan for mental health. issues, the rights of people with a disability, mental health, the need for Greens Australian Conservatives access to services in regional areas, The Greens have provided a The Australian Conservatives have and supporting the ageing population. detailed and positive response to provided an informative and broadly measures called for by the AMA(SA), supportive response to measures called Full responses to the AMA(SA)’s supporting many of the Association’s for by the AMA(SA) including trialling Election Priorities 2018, commentary, recommendations, including for and implementation of a clinical senate and other policy information from the a Clinical Data Analytics Unit and and a clinical analytics unit to provide various parties, can be found at the Clinical Senate; expansion of Modbury independent strategy and clinical advice. AMA(SA) website www.amasa.org.au.

16 medicSA MARCH 2018 rural health Historic agreement landed for rural practice

landmark agreement has been (AMSA RHC) has also welcomed reached to develop a national the announcement. framework for rural generalist A Nic Batten, AMSA RHC Co-Chair, medical specialty. said: “We are thrilled to hear that The agreement has been delivered by ACRRM and RACGP have together former AMA(SA) Council member and committed to the goal of a national rural National Rural Health Commissioner generalist pathway.” Professor Paul Worley (right), and announced at the rural and regional Ms Batten said the rural generalist health forum in Canberra on 10 February. role is critical to addressing the complex healthcare needs of our rural Professor Worley’s first priority is to deliver and remote communities. It will also a rural generalist pathway to increase offer a clear career path for students doctor numbers into the regions. and young doctors who want to work The AMA(SA) is supportive of initiatives in the bush. This allows doctors to obtain further to increase the opportunities for rural Many students who are committed to training in their areas of interest and best doctors and is anticipating further working in rural communities aspire to serve the needs of their community. examination of the rural generalist model work as an all-rounder doctor, caring and its intersection with the current for patients in a range of settings and “For young doctors, this framework procedural GP workforce who already with the skills to match. Rural represents an exciting opportunity – a work in the areas of anaesthetics, generalism offers a wonderful clear rural training pathway, options to obstetrics and emergency medicine. combination of general practice and pursue their interests, and the flexibility The Australian Medical Students advanced skills, such as anaesthetics, of having their qualifications recognised Association Rural Health Committee emergency medicine, or obstetrics. across states,” Ms Batten said.

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medicSA MARCH 2018 17 rural health Encouraging more doctors to go rural The AMA has released its Position Statement – Rural Workforce Initiatives, a comprehensive five-point plan to encourage more doctors to work in rural and remote locations, and improve patient access to care.

HE plan proposes initiatives in “Australia does not need more medical for positive and continuing exposure education and training, rural schools or more medical school places,” to regional/rural medical training generalist pathways, work he said. “Workforce projections suggest T 2. Provide a dedicated and quality environments, support for doctors and that Australia is heading for an oversupply training pathway with the right skill their families, and financial incentives. of doctors. mix to ensure doctors are adequately It says that at least one-third of all new “Targeted initiatives to increase the size of trained to work in rural areas medical students should be from the rural medical, nursing, and allied health 3. Provide a rewarding and sustainable rural backgrounds. workforce are what is required. There has work environment with adequate been a considerable increase in the number And more medical students should be facilities, professional support of medical graduates in recent years, but required to do at least one year of training and education, and flexible work more than three-quarters of locally trained in a rural area to encourage graduates to arrangements, including locum relief live and work in regional Australia. graduates live in capital cities. 4. Provide family support that includes “International medical graduates (IMGs) In releasing the Position Statement, federal spousal opportunities/employment, make up more than 40% of the rural AMA president Dr Michael Gannon noted educational opportunities for medical workforce and while they that about seven million Australians live in children’s education, subsidies for do excellent work, we must reduce regional, rural, and remote areas, and they housing/relocation and/or tax relief often have more difficulty accessing health this reliance and build a more services than their city cousins. sustainable system.” 5. Provide financial incentives to ensure competitive remuneration. They often have to travel long distances The AMA Rural Workforce Initiatives plan for care, and rural hospital closures and outlines five key areas where governments For more information: ama.com.au/ downgrades are seriously affecting the and other stakeholders must focus their position-statement/rural-workforce- future delivery of health care in rural areas. policy efforts: initiatives-2017. For example, Dr Gannon said, more than 1. Encourage students from rural areas This article by Chris Johnson was first 50% of small rural maternity units have to enrol in medical school, and provide published in Australian Medicine on 24 been closed in the past two decades. medical students with opportunities January 2018.

AMA plan gives junior doctors the chance to stay rural The Australian Medical Students’ Association (AMSA), the peak representative body for Australia’s 17,000 medical students, has backed the AMA’s Rural Workforce Initiatives plan.

ANDICE Day, vice-chair of the I will still have to return to the city to train AMSA Rural Health Committee further, just at the time of my life when I C(right), said: “As a medical student hope to be starting a family and settling with the ambition to work in the bush, down,” she said. I am excited to see such a AMSA supports the plan to increase comprehensive plan, addressing the rural the proportion of students from rural workforce shortage at all stages of the backgrounds and the proportion of training pipeline, not just the start.” In a recent AMSA survey of more than time spent in rural areas during 1500 students, 70% were interested in Ms Day said that the primary issue for medical school, but emphasises that working in regional, rural or remote areas. junior doctors in rural areas is a lack of focusing on students is not the postgraduate training positions. whole solution. “The key is keeping junior doctors in the country after internship by giving them the “Rural hospitals lack opportunities for “The best bang for your buck is to invest opportunity to train to be specialists, GPs, students to complete specialist training. in keeping junior doctors rural after or rural generalists in rural hospitals,” Ms Even after completing a rural internship, internship,” Ms Day said. Day said.

18 medicSA MARCH 2018 rural health More support for rural health will help recruit and retain rural GPs Rural patient care by rural GPs is not in crisis – support for rural doctors doing their job is in crisis, writes Dr John Williams.

HERE is no doubt in a position to provide that high level that the provision of primary care. services by Australian T Rural patients trust their GP and will most GPs is of a very high often present to the GP before attending standard. In fact, rural GPs the hospital. are often in a position to raise the standard of care even higher. We provide a level of care that is safe, effective and cost effective. We are Rural GPs have high levels of patient already providing a level of care that is satisfaction. Patients are cared for by aimed for through metropolitan initiatives a doctor they know and trust, and and such projects as My eHealth. communication between the doctor and the patient and their family is of a GPs have been using electronic health high level. Communication between records for more than 20 years, and rural communication and a spirit of support. the GP and specialist care is also of a GPs easily connect these records with We are willing to communicate and work high level. hospital records. together to improve the level of service to our communities. Coronary heart disease, suicide, Rural GPs are dedicated, skilled and chronic obstructive pulmonary disease innovative. We would like to see our work Rather than view Port Lincoln and other and cancer show a clear trend of supported. This will aid recruitment and services as areas of crisis, they need to greater rates of burden in rural and retention of rural GPs. be viewed as areas of success. They are suffering because SA Health has not seen remote areas. There is a healthcare deficit of at or acknowledged our successes and least $2.1 billion in rural and remote In terms of chronic disease management extended support to maintain standards. areas, reflecting chronic underspend and admission prevention, identification of Medicare and the Pharmaceutical We are not a problem to be resolved – of at-risk patients and early initiation Benefits Scheme (MBS) and publicly we are a success to be supported of services is rural GP bread and provided allied health services. and replicated. butter. We know that to reduce admissions, primary care needs to We would like to see SA Health step Dr John Williams is a GP in Port begin 10 years before the presentation forward to assist the workers on the Lincoln and the AMA(SA) Regional to acute services and rural GPs are coal-face. We would like to see better Representative (Northern).

AMA(SA) welcomes New Minister for Rural Health

ENATOR Bridget McKenzie has been appointed as the Federal Minister for Sport, Rural Health and Regional Communications in December’s SFederal Cabinet reshuffle. Senator McKenzie is also deputy leader of the National Party.

Senator McKenzie’s family has lived and worked in regional Victoria for generations. “Growing up with the traditional rural influences of small business, sport and agriculture, I believe that strong regional economies and secure regional communities are critical to the future prosperity of our great nation,” she says.

Outgoing Federal Assistant Minister for Health, Dr David Gillespie, has moved to the portfolio of Assistant Minister for Children and Families. The AMA(SA) is hopeful Senator McKenzie, along with new National Rural Health Commissioner Professor Paul Worley, will bring significant improvement to the quality of medical care being delivered in our rural and regional communities. © istock/ swissmediavision

medicSA MARCH 2018 19 council news

AMA(SA) Council NEWS

discussed a range of issues, including at the table for a change to an Dr Nick Rice the longstanding dissatisfaction with independent board oversight model for Councillor the Department’s treatment of the future Departments of Health. AMA(SA) Council Meeting Chest Clinic, still located a mile from There was broad consensus that February, 2018 the new campus, with no proper the Therapeutic Goods Agency plans to deploy to a sensible site (TGA) has got it right in identifying close enough such that patients are the public harm caused by over-the- UR first Council meeting for not significantly impaired in their counter codeine, and to up-schedule the year had a very full travels from the clinic to the actual the drug to a prescription-only agenda, which commenced hospital itself. O medication. The AMA does not support with a quick round the table the campaign by the Pharmacy discussion of the latest pressing The upcoming election Guild of Australia for pharmacists to issues in the various represented was noted, with a dispense non-prescription codeine specialities. Psychiatry services at the certain amount of in rural areas. The TGA has made a Royal Adelaide Hospital (RAH) are cynicism felt by good evidence-based decision, and hampered by duress alarms that is working hard to ensure clinicians don’t work; Paediatrics describes Council regarding the understand the reasons for, and details a site that is crumbling around of, this process. them, and significant neglect of government’s Transforming human resources at the Women’s Health ‘journey’… Our two new student representatives – and Children’s Hospital (WCH); Simon Cousins and Mekha John – General Practice notes that some The upcoming election was noted, were welcomed, and they sought discharge summaries from with a certain amount of cynicism expressions of interest from councillors present, and indeed any private hospitals are particularly felt by Council regarding the government’s Transforming Health AMA member, to be involved in a uninformative, to name but a few of ‘journey’, and the waning enthusiasm mentorship program for students. the topics discussed. of the many clinicians disrupted This could take many forms, and the A recent meeting with the Minister in one form or another by it. There idea has certainly been successful in for Health, Mr Peter Malinauskas, was, however, considerable interest the past. AMA(SA) Council dinner celebrates year’s end

HE December Council Meeting October 1917 – and the special world took place on 7 December at of mateship. the Naval and Military Club to T Brigadier Wayland has had dual careers, celebrate year’s end and to thank all in finance and banking, and in the councillors for their support during the Australian Army. He has also been an year. Guest speaker was Brigadier Ellis Adelaide City councillor and served on Wayland AM (pictured right, with A/Prof several government committees including William Tam, above left, and Joe the Australian Bicentenary Board and the Hooper, above right) who spoke South Australian Jubilee 150 Board. He about the centenary of the battle of was an Honorary Aide de Campe to the Beersheba in World War One, and Governor General from 1984 to 1987. more specifically the charge of the For his service he was made a Member Australian Light Horse on the 31st of the Order of Australia in 1987.

20 medicSA MARCH 2018 event

New intern orientation sessions well attended

EW interns were invited “The AMA has been fighting for to attend AMA orientation doctors’ rights to decide how best to Nsessions recently, at the deliver health care for over 150 years,” Southern Adelaide Local Health he said. “We care passionately about Network (for Flinders Hospital how medicine will look and doctors interns), North Adelaide Local will practice in the next 50 years. Health Network (for Lyell McEwin Hospital) and Central Adelaide Over 200 new doctors Local Health Network (for Royal Adelaide Hospital interns). attended, and AMA(SA) Over 200 new doctors attended, president William Tam and AMA(SA) president William addressed them on the Tam addressed them on the challenges of becoming challenges of becoming a junior doctor, safeguarding their own a junior doctor… wellbeing, intern places, and other issues facing doctors today. “We welcome your participation, your He also stressed how the thoughts on what sort of a doctor AMA(SA) – as their professional you want to be, and what the health association – is on their side. system should look like in the future.”

Orthopaedics SA are pleased to welcome Dr Anthony Samson, Orthopaedic Surgeon.

Dr AnthonyDr AnthonySamson Samson BMBS BSC (HONS) BMBSFRACS BSC FAOrth (HONS)A FRACS FAORTHOA OrthopaedicOrthopaedic Surgeon Surgeon APPOINTMENTSAPPOINTMENTS AND ENQUIRIES AND ENQUIRIES P 08 8267 8239P 08E [email protected] 8267 8239 E [email protected]

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medicSA MARCH 2018 21 awards South Australian doctors honoured in 2017 Australia Day Awards The AMA(SA) congratulates the prominent South Australian medicos who were recognised in this year’s Australia Day awards – including AMA member, Professor Maria Crotty PSM. Congratulations also to former federal AMA president, Dr Mukesh Haikerwal AO and editor-in-chief of the MJA, Professor Nick Talley who received the highest honour – Companion of the Order (AC).

Professor John He was also executive director of Prof Crotty – an AMA member – is a Medical Services, Women’s and Children’s rehabilitation physician and director of TURNIDGE AO Health Network – SA Health from the Rehabilitation Studies Unit at Prof Turnidge has been 2010 to 2011. Flinders University SA. Whilst a made an Officer (AO) professor of rehabilitation and aged in the General Division He has been clinical senior lecturer, care at Flinders University, she has for distinguished service to medicine Department of Paediatrics, Faculty of also been director of the rehabilitation as an infectious disease physician Medicine, University of Adelaide, and service at the Repat for 14 years and and microbiologist, particularly to the visiting lecturer at the School of led the move and opening of the new advancement of health policy in the Medicine, Department of Paediatrics, Rehabilitation Service at Flinders area of antimicrobial resistance, and to Flinders University. Medical Centre in late 2017. professional medical organisations. Dr Andrew As Chair of the Statewide Rehabilitation Professor Turnidge trained at Flinders Clinical Network for SA Health Medical Centre, has been head of LUCK OAM she assisted in developing and Microbiology and Infectious Diseases at Dr Luck was awarded establishing dedicated rehabilitation Monash Medical Centre in Melbourne, the Medal (OAM) in the services in country areas of the and director of the Division of Laboratory General Division for state. More recently she has Medicine at the Women’s and Children’s service to medicine in the field of promoted the expansion of telehealth Hospital (WCH) in Adelaide. colorectal surgery. and telerehabilitation across SA He has a long-standing interest in Dr Luck is a colorectal surgeon hospital rehabilitation services to antimicrobial prescribing and antimicrobial at the Lyell McEwin Hospital (LMH) allow greater patients with disabilities resistance, and has contributed in these and runs a private practice in Adelaide’s greater access. areas to government, international north. He was head of the LMH organisations and learned societies, Colorectal Unit from 2006 to 2012 Dr Raluca including the NHMRC, the WHO, the and director of surgery from 2010 TUDOR PSM to 2011. US-based Clinical and Laboratory Dr Tudor was award the Standards Institute, the Therapeutic He has been heavily involved with Public Service Medal (PSM) Guidelines-Antibiotic writing group, and the Colorectal Surgical Society for outstanding public service the European Committee on Antimicrobial of Australia and New Zealand to the mental health of older persons in Susceptibility Testinh (CSSANZ), having been President South Australia. from 2010 to 2012 and Chairman of He co-founded the Australian Society Dr Tudor has established a unique its Research Foundation from 2012 to for Antimicrobials, which now has over model of clinical leadership, in a multi- 2017. He was involved in the set-up of 800 members. disciplinary community health team the National Bowel Cancer Screening which has resulted in the Older Persons Program, is a current member of Dr Richard Mental Health Services in SA growing the Australia and New Zealand COCKINGTON OAM Training Board in Colon and Rectal and developing into one of the country’s Dr Cockington was awarded Surgery and a Board member of leading services. the Medal (OAM) in the the bowel cancer charity, the Jodi In 2011 she was key in establishing General Division for service Lee Foundation. the Older Persons Rapid Access to medicine as a paediatrician. Service, the first of its kind in South The late Dr Cockington was a paediatrician Professor Maria Australia. She was a driving force who was the long-time director of the CROTTY PSM in identifying the issues and the Child Development Unit at the WCH. Prof Crotty was awarded needs to provide some form of hospital In this role he played a very important the Public Service Medal avoidance for older consumers with part in the development of services for (PSM) for outstanding public a mental health condition living in developmentally delayed children living service in the rehabilitation sector in residential care facilities in the southern outside the metropolitan area. South Australia. region of the state.

22 medicSA MARCH 2018 charity AMA(SA) supports Backpacks 4 SA Kids through Gala Dinner The AMA(SA) 2017 Charity Gala Dinner is being held this year on Saturday, 19 May 2018 at the Hilton Adelaide. This year we will be supporting Backpacks 4 SA Kids, a charity which provides children who are living in foster care with a backpack full of personal items to call their own.

ACHAEL Zaltron (pictured) is the on the vulnerable children within our state,” Backpacks 4 SA Kids also provides a founder and general manager of she says. specialty teen homeless duffle bag called Backpacks 4 SA Kids. Anchor Pack, which not only supports R Backpacks 4 SA Kids provides backpacks young people’s day-to-day needs, but also Rachael started Backpacks 4 SA Kids after for any child or young person who aids their sexual and mental health. losing a special friend who was diagnosed has been displaced from home and is with terminal cancer at age 29. accessing emergency services such as “The support of the AMA(SA) will help foster care, domestic violence services Backpacks 4 SA Kids support an “During her battle with cancer she created and youth homeless services, as well as increasing number of children entering into a bucket list,” says Rachael. “On that list through SAPOL and the Women’s and the emergency services, raising awareness she said she wanted to be a foster carer, Children’s Hospital. about our cause and how easy it is to get but we both knew that wasn't going to involved,” says Rachael. happen, so we looked for other options.” “The backpacks are aimed at reducing the stress and anxiety a child endures “But most importantly, it will have an Rachael’s friend had two young daughters when they are removed from their homes amazing impact on the number of children who were the same age as Rachael’s by supplying a couple of sets of clothing, within South Australia we can support in children, and the two women decided underwear, pyjamas, socks, toiletries and one of the most challenging times of their to help some kids using their own kids’ distraction items such as a board game to young lives. We can bring them hope, clothing. The idea was based on the charity help kids socialise with others around them backpacks packed with love and items Backpacks 4 Aussie Kids in Queensland. and a torch to help orientate themselves at most have never received before such as “My friend and I were lucky enough to head night,” says Rachael. new pyjamas and underwear.” into a Families SA office with our backpack Home Starter Packs is another Backpacks Rachael’s team received a picture in the of bits and pieces, and a young girl was 4 SA Kids program which supports families post from a five-year-old girl. The picture in the office to receive the backpack. To affected by domestic violence who are was of the little girl in her underwear. On the see a child move through the emotions of starting again. back of the page was a note from the girl’s sadness and loss to smiling and joy was foster mum: incredible to watch,” says Rachael. “The Government provides a bulk payment for rent and bond for the first month of their “Our little girl arrived with your backpack … When Rachael’s friend lost her battle with new accommodation, but there was little she was most excited about her new cancer, Rachael decided she needed to to no money left to supply the basics for underwear with Tinkerbell on the front, make her own minutes count. She started families. The Home Starter Pack supplies because she had never worn new Backpacks 4 SA Kids. the basic items someone would need when underwear before – let alone underwear “I never dreamed it would become as large moving out of home with their children,” with a fairy on the front! Thank you for and have as much of an impact as it has says Rachael. helping her smile on a really bad day.”

medicSA MARCH 2018 23 heading

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24 medicSA MARCH 2018 student medals AMA(SA) student medal winners for 2017 Each year the AMA(SA) awards medals to two graduating students whose academic performances and contributions to their schools make them stand out. This year’s winners are Laura Sharley from the University of Adelaide and Anna Elias from Flinders University.

Laura Sharley “The impact of these experiences became Anna was selected by the Dean of University of Adelaide evident when I studied Indigenous Health Medicine and peers as the best final year AMA(SA) president A/Prof William Tam as a second-year elective in medical school. student in terms of academic performance presented the first student medal at Learning more about Australian history, and contribution to the Faculty of Medicine. the socio-economic determinants of the University of Adelaide’s MB BS “Anna Elias is a very worthy recipient of health and the distressing health statistics Declaration ceremony in November last this year’s AMA(SA) student medal, having of Indigenous Australians put the stark year to Laura Sharley. a string of academic publications to her memories of my childhood in perspective,” name on issues as diverse as children with Laura was selected by the Dean of says Laura, who has since been to many chronic health conditions, pneumonia and Medicine and peers as the best final year communities around Australia – from Yalata rural health,” Dr Moy said. student in terms of academic performance on the Eyre Peninsula to Wurrumiyanga on and contribution to the Faculty of Medicine. the Tiwi Islands. “Anna has already won awards for her tireless work on behalf of other students, “This year’s winner AMA(SA) student Four years ago, she and two other students shaping the curriculum and professional medal winner Laura Sharley has made a helped to create the AMSS APY Exchange significant contribution to the development opportunities; and she has community in a range of volunteered in Australia and contexts – to the University overseas and worked on of Adelaide Medical school, human rights issues.” and to rural medicine,” Anna told medicSA: “I said Dr Tam. have tremendous respect for the work done by the “Laura has not only won AMA, so being awarded a string of university the AMA medal means a lot academic awards, but to me. It shows that I can her CV is peppered with make a difference and that contributions beyond my colleagues appreciate academia as well – to the the time I dedicated to Aboriginal community, advocacy, education and to people with disability community service. and people in rural and remote areas,” he said. “Medical school is challenging and the Laura told medicSA: “It workload is intense, so was such an unexpected students often don’t have honour to be recognised by the time to effectively the university and the AMA.” Program, which enables medical student advocate for themselves,” Anna continued. “I hadn’t realised the potential impact volunteers to run a health-based youth “I could see that changes were of being involved with Indigenous holiday program in remote Indigenous happening at the university and in the health advocacy during my time at communities of SA and NT. healthcare sector that had the potential to medical school. I hope it may inspire Laura hopes to continue working with disadvantage students and junior doctors like-minded peers from younger year remote Aboriginal communities – “whether and wanted to be part of the conversation.” levels to continue pursuing their passion that be as a GP or as a visiting specialist,” for helping Indigenous communities,” As a former teacher, Anna is passionate she says. she said. about education. Laura is interning in the SALHN network, Laura was first exposed to remote “I hope to be involved in medical education primarily at Flinders Medical Centre Indigenous communities as a child on and training in future,” she says. “During my in 2018. family camping trips and found some of time at Flinders, I was able to experience these experiences confronting. inspiring clinicians, researchers and Anna Elias advocates, so I also want a career in “Then, during my time in high school, Flinders University academic medicine.” we would occasionally host a boarding Dr Chris Moy presented the other student student from Ngukurr, a remote Aboriginal medal at Flinders University’s MD/BMBS Anna is currently completing a research community on the banks of the Roper River Qualifying Ceremony in December to fellowship in the United States and will in the Northern Territory. Anna Elias. commence internship there in 2019.

medicSA MARCH 2018 25 graduation Congratulations to the 2017 The AMA(SA) would like to congratulate the Bachelor of Medicine and Bachelor of Surgery

2017 Flinders University MD/BMBS Graduands Guy Abell Damian Drew Paul Kaesler-Smith Lisa Murphy Roy Stathis Sine Aberdour Nadine Drummond Thomas Kaye Khadijah Nadeem Teresa Sutherland Mohammad Alamein Ellen Dunaiski Fong Wei Kee Sailesh Narsinh Sandra Sy Shannon Andrews Brenton Earl Judith Keith James Navaratne Claire Taylor Simon Austin Anna Elias Joshua Kelly Kiat Rui Ng Lauren Thomas Annette Baker Timothy Esselbrugge Michelle Key Loan Nguyen Minh-Son To Jemima Bell Nicole Evans Ashlee Kimball Hillary Nguyen Brianna Todd Elizabeth Bennett Thomas Everingham Oscar Kinsman Dimitri Niarchos Kunal Trehan Megan Bentley Kimberley Flavell Ben Kirsopp Luke Nuske Jessica Turner Natasha Bertschi Hannah Ford Pawan Koirala Brendan Phelan Mae Turpeinen Ibrahim Bhatti Laura Frank Malgosia Kowalski Natalie Pink Laura Walter Emily Blackwell Sarah Friend Karl Lee Christian Ptaszynski-Holgar Belinda Washington Blaire Brewerton Michael Fyfe Paul Lee Emma Quinn Tara Wenzel Sarah Case Maeve Gillan Kar-Kate Liang Sacha Reason Adam Whitehead Maxine Castillo Debbie-Ann Gillon Zhiyang Lin Holly Richter Jessica Willis Emily Cattanach Mogeshni Govender Brianna Lindley Ashlee Rigby Jack Wilson Andrew Chan Benjamin Green Daniel Loughnan Briony Robson Phillip Wilson Allena Cheong Sarah Greenslade Ryan Mahony Cameron Rosengarten Jessica Wisely Supriya Chhabra John Griscti Georgina Manos Anna Russo Martin Witney Pei-Ying Chiang Lekha Gupta Elyse Marx Nancy Saunders-Clay Pearlyn Wong Jagnoor Chugha Daniel Hack Laura Mcdade Rachel Seah Andrew Wren Sarah Coffey Stephanie Hendrijanto Lucy Mckinnon Madeleine Seeary Alexander Wright Miriam Cohen Bede Hennessy Angus Miller Thomas Sefton Josie Wright Thomas Condon Geraldine Herweijer Jamie Miller Richard Sexton Lewis Xiao Lachlan Cook Raif Hijjawi Andrew Milne Shams Shamid Yijie Yin Madeleine Cox Minhao Hu Allison Moore Owen Siggs Annetta Zheng Elizabeth Cuthbertson David Huynh Ellie Moore Thu Dang Kym Huynh Geordie Morgan Rasmeet Dhaliwal Kelsey Ireland Brandon Mu Cristina Dickson Brianna Jackson Monica Mu Jarrad Dickson Jade Jackson Christopher Muirhead Elizabeth Doecke Katherine Jones Sean Mullany Sarah Dolan Sanjay Joseph Virginia Munro Pictured above: 2017 Flinders NT Graduands

26 medicSA MARCH 2018 graduation medical school graduates 2017 graduating students of Doctor of Medicine, at both Flinders University and the University of Adelaide.

2017 University of Adelaide MBBS Graduands Ryan Agnew Graham Chua Michael Hii Yao Ly Daniel Pellegrini Olivia Tonnu Momina Allahwala Betty Chung Thien-Phuong Hoang Ashani Mahawattega Jimmy Pham Shabnam Torabiardakani Phoebe Allison Nicholas Clarke Eleanor Hobbs Emma McBean Alyssa Pradhan Helena Topry Jordan Anderson Jock Clarnette Tzu-Chieh Huang Megan Meredith Sharmini Punitham Alain Tran Isobel Anderson Anne Collinson Chantelle Ip Jolie Miller Olivia-Paris Quinn Jason Tran Meera Asokan Jane Collinson Salil James Thomas Miller Timothy Ramsey Tzu Mi Tseng John Au Adam Cooper Katarina Japp Michael Mills Jennifer Rice Hiep Tu Tony Au Stefan Court-Kowalski Matthew Jennings Sarah Milton Felix Ritson James Turnbull Stephen Bacchi Jennifer Dang Athul Joh Jack Mintz Juliette Roex Linh Van Michelle Bagster Samantha Davis Arvind Jothin Siobhan Misan Peter Rose Luke Vater Hamza Baig Dhiren Dhanji Alice Keane Druva Mitra Elias Salagaras Monica Venuti Jacynta Batt Georgina Digance James Kellie Grace Morcom Shriranshini Satheakeerthy Bhavani Viswalingam James Besanko Jacqueline Downey Ga Kim Edwina Munns-Cook Kwok See Magdalena Walc Linda Bi Charles Du Victoria Kollias Rachael Murray Laura Sharley Ann-Marie Walker Jacob Brazier Susannah Dunmall Felix Kotasek Pritesh Narsinh Jaya Sharma Amy Wan Stuart Brown Kieran Dunne Gabriel Kuo Charlotte Newitt Nathan Shugg Yuan Wang Danielle Brydges Jade Dutschke Anna Lammerink Shi Ng Nupur Shukla Sally Wark Alexander Buckby Tahlia Engelke Emma Lane Xia Fen Ng Harsimran Singh Stephanie Webb Ellen Burch Claire Ewen Thanh Le Thu Nguyen Karthik Sivarama Krishnan Tyson Whitelaw Amy-Lee Burgess Chi Feng Yong Hyun Lee Ai Nguyen Julian Smith Jake Willet Samantha Burns Matthew Fischer Nara Lee Damian Nguyen Georgia Smith Han Woo Alicia Callisto Mark Fitzgerald Alvin Lee Le Nguyen Katey Snaith Albert Wu Josephine Campbell Hewafonsekage Fonseka Michael Lee Dennis Nguyen Yiran Tan Sunny Wu Jacob Cappelletto Lisa Forbes John Lee Thomas O’Neill Bhuwan Tandon Angela Yao Christopher Chan Sanjaya Gamage Maverick Lee Qi-Zheng Ong Joshua Taverner Jia Yi Yeoh Desmond Cheng Gordon Goh David Lee Daniel Ong Nicholas Taylor Alistair Young Yi Chia Katherine Grant Kevin Leow Alice Ormandy Alice Terret Yadanar Zaw Ivana Chim Huaiyuan Guo Xinhui Lim Alessandra Orsillo Vinh Thoi Frank Zhang Athena Chin Nicola Gurner Steven Lim Logesh Palanikumar Evelyn Timpani Judy Zhu Kathrina Chooi Hannah Hancox Yong Lim Marie Palumbo Melisa Ting Kar Ven Cavan Chow Tayla Hassam Charles Livingston Bhairavi Parimalanathan Maya Todd King Wah Matthew Chu Marina Hayashi Thomas Lokan Charlotte Pascoe-Purvis Pei Toh Su Chua Rhiannon Hein David Low Andrew Peel Yumiko Tomo

medicSA MARCH 2018 27 heading

Medical students look forward to a stellar

As I write this article from Tanzania, making the most of the new Monica Chen I’ve had a challenging, but very Royal Adelaide Hospital. Pre-clinical interesting, four weeks experiencing students will be starting back in late STUDENT NEWS: healthcare in a developing country February to our shiny one-year-old UNIVERSITY OF ADELAIDE and comparing the stark differences Adelaide Health and Medical to Australia. Sciences building. In terms of AMSS advocacy, 018 is set to be a stellar year In terms of AMSS along with the support of the for the Adelaide Medical AMA(SA), we were pleased that Students’ Society (AMSS). advocacy, along with the 2 domestic students from the Over the summer, the Executive has support of the AMA(SA), graduating class of 2017 all received been planning social and educational we were pleased that internship offers. This should events as well as wellbeing and continue to be the case for future advocacy initiatives to fit into our domestic students from graduating cohorts, and we will full calendar. the graduating class continue to work on internship We’ve started the year with a bang with of 2017 all received offers for international South Australian graduates. our annual Clinical Students’ Welcome internship offers. This and Sixth-Year Welcome – thanks to Our TeamEd representation group MIGA. Meanwhile, the Committee has should continue to have been hard at work focusing been hard at work planning for our be the case for future on issues such as EPAS and login upcoming events: O’ Week to welcome access for all clinical students, the incoming first years, Skullduggery, graduating cohorts, and exam feedback, assessment surveys, MedCamp and JazzNight. we will continue to work health and wellbeing support, course On the other side of the world, sixth- on internship offers changes and more. year students have been jetting off for international South We’re looking forward to a great for their Dean’s Elective to tropical year ahead for the AMSS. If you destinations such as the Bahamas, Australian graduates. would like to know more information Vanuatu, Sri Lanka and Europe, on the activities or advocacy of while experiencing a whole new side Meanwhile, clinical students have the AMSS, get in touch via of medicine. been settling back into hospital and [email protected].

Retiring? Don’t retire your AMA membership … Retired members can access all the benefits of membership for just $330 per year, including:

s Discounts on Qantas Club membership s Free subscription to MJA and medicSA s Special travel offers s A wide range of Ambassador Card discounts and special offers on accommodation, dining and leisure activities Enjoy your retirement more as an AMA member!

To renew your membership as a retired member, contact Charlie on 8361 0108 or email [email protected]

28 medicSA MARCH 2018 heading year in 2018 as the year begins …

be sorely missed and we would like working hard to implement a new Stephen McManis to acknowledge his vast contribution peer mentorship program, partnering again here. with professional bodies, including the STUDENT NEWS: AMA(SA), to generate a new culture of FLINDERS UNIVERSITY As always, 2017 ended integrated collaboration between junior with a triumphant and senior students. FMSS is also excited to be opening the LINDERS Medical Students’ graduating class from the Aboriginal Healing garden in the former Society (FMSS) has a proud course, celebrating their Flegacy of improving and medical courtyard, level 5 FMC, on supporting the experiences of its achievements as a cohort Close the Gap day this coming March members through medical school. together for the last time. – all welcome! – an important date; and the event serves as a sage reminder of As always, 2017 ended with a the realities of health in our remote, as Steaming headlong into 2018, FMSS’s triumphant graduating class from well as urban, Aboriginal communities, priorities will be centred around our the course, celebrating their and the obligations we share as both new focus to enrich the academic, achievements as a cohort together dispossessors of traditional lands and professional and personal growth for the last time. skilled health practitioners to support of our members. Mental health has and fortify better health right across the This year, the graduating student emerged as a major theme for medical population. We are very honoured to body also presented Professor Paul students right across the country, and have community elders open the event Worley with an award honouring we are committed to ensuring that our and welcome us onto Kaurna land, his years of dedication to Flinders peers and future students are not only and remain certain in our goal to Medicine. His vision was for a ably supported through the challenges continue to raise awareness for progressive medical school, which of a modern medical degree, but Aboriginal health and reconciliation, focussed on community need and leave Flinders medical school as more being guided by those in the Aboriginal encouraged its pupils to be brave capable, as better communicators community. No doubt Professor enough to embrace the challenges and carers, as happier, more rounded Worley’s dream lives on within the spirit of medicine that are unique to our people, and primed to embrace the of FMSS and our members. region and its many populations, and constellations of their own attributes to in doing so, become leaders with be wonderful leaders in medicine in the Look to us in the coming months to see skills sought the world over. He will future. Of note here, we are currently how our many projects are evolving!

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medicSA MARCH 2018 29 motoring

The Performance you’ve been waiting for. New Golf GTI.

The original hot hatch is back and it’s more powerful. It’s the performance you’ve been waiting for. It’s what you’d expect from an icon and more, including a 169kW TSI engine that delivers exhilarating performance, classic ‘Clark‘ upholstery and impressive 18” Milton Keynes alloy wheels. It’s faster and smarter, packed with the latest innovation, like new generation infotainment systems, driving profile selection which changes the cars performance settings and driving experience at the touch of a button. Visit www.solitairevolkswagen.com.au to discover more and book a test drive.

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Your Volkswagen Partner Your Volkswagen Partner Solitaire Volkswagen Hawthorn Solitaire Volkswagen Medindie 30 Belair Road, Hawthorn LMVD65541 37-41 Main North Road, Medindie LMVD65541 1300 857 671 1300 263 629 30www.solitairevolkswagen.com.aumedicSA MARCH 2018 www.solitairevolkswagen.com.au motoring The new hot hatch from Volkswagen This issue, the Volkswagen Golf GTI Mark 7.5 gets put through its paces by our intrepid motoring duo Dr Rob Menz and Dr Philip Harding.

OB: Hey Phil. I used to think that the expression ‘hot hatch’ was Rcoined with the Golf GTI in mind, but in researching this article I have come to understand that the term was not introduced until 1984.

Volkswagen released the Golf in 1974 to much acclaim and its water-cooled in-line engine FWD was a significant departure from the air-cooled boxer engine of the Beetle era.

The demand for increased performance from the original Golf led to fuel injection and stiffening the suspension in the 1976 Mark 1 Golf GTI. However, this was initially only produced in left-hand drive and not formally imported to Australia. We had to wait until the Mark 2 GTI in the late ’80s.

The expression ‘hot hatch’ was One of the problems of powerful who switch from Japanese to Euro retrospectively applied to cars from the front-wheel-drive cars is torque steer, hatches. Among the many really nice ’70s including the Golf GTI which would whereby the rotational forces produced features is a message which appears probably epitomise the moniker. It was by the engine can move the car to one on the dashboard reminding you to take also not the first, which some would say side during rapid acceleration. Clever your phone with you. So, what did you The Performance you’ve was the Renault 16 TS, but this was German engineering ensures torque think Phil? never actually called a hot hatch. steer does not occur in the GTI. It is Phil: Well Rob, I really think you’ve We were lucky enough to spend a few equally impressive pulling out of tight said it all. I thought it hugely fun to been waiting for. days testing the latest Golf GTI Mark corners with again no front wheel spin. drive without being ridiculously 7.5. The midcycle update has improved As a cruiser, the golf is very quiet with powerful, and at the same time a really the already impressive Mark 7. the odometer registering barely over practical everyday vehicle, easy to New Golf GTI. Some motoring writers have suggested 2000 rpm at freeway speed. park in tight spots yet with significant that Volkswagen made a big mistake Autonomous driving is getting closer ‘big car’ feel. I did think incidentally that with the Mark 7 in that, it seemed so and the GTI has both adaptive cruise the original hot hatch was the Peugeot The original hot hatch is back and it’s more powerful. It’s the performance good at release it would be very hard control which will keep a certain 205 GTI, but couldn’t swear to it. you’ve been waiting for. to improve upon. However, there has distance between the Golf and the car Overall, the Golf GTI gets a big tick It’s what you’d expect from an icon and more, including a 169kW TSI engine that been a modest increase in power it is following, and also lane-centring from the medicSA team. Driveaway delivers exhilarating performance, classic ‘Clark‘ upholstery and impressive 18” along with introduction of a larger steering which keeps the Golf in price is around $45K but might be Milton Keynes alloy wheels. infotainment screen. its own line, although if you try and influenced by your AMA discount deal – see below. It’s faster and smarter, packed with the latest innovation, like new generation There are so many excellent innovative drive with the hands-free, after about infotainment systems, driving profile selection which changes the cars and exciting features to the car, it’s hard 10 seconds a message appears on The test car was provided by performance settings and driving experience at the touch of a button. to know where to begin, so perhaps the dash saying ‘take control of Solitaire Motors. AMA has a Visit www.solitairevolkswagen.com.au to discover more and book a test drive. a description of a drive would suffice. steering wheel’. preferred provider relationship Pushbutton starting is standard these There is a variety of driving modes with Volkswagen Australia which days, and when idling the Golf, without provides significant discounts for from economy to sport, and pulling even moving, it appears to have a sense AMA members when they buy their We make the future real. the gearstick back from drive to sport of purpose. new GTI or anything else in the significantly changes the suspension Volkswagen range. Throttle response is excellent and and gear change settings. The GTI can almost instantaneous. The GTI has also be driven as a manual with flappy Rob Menz is a GP and drives a VW Your Volkswagen Partner Your Volkswagen Partner a solid road feel whether you’re paddles behind the steering wheel. The (Passat) daily. Phil Harding is editor of Solitaire Volkswagen Hawthorn Solitaire Volkswagen Medindie tootling around town or hurtling through cabin is ergonomically excellent and medicSA and regularly rents Golfs 30 Belair Road, Hawthorn LMVD65541 37-41 Main North Road, Medindie LMVD65541 the hills. there is just enough bling to satisfy those when on holiday. 1300 857 671 1300 263 629 www.solitairevolkswagen.com.au www.solitairevolkswagen.com.au medicSA MARCH 2018 31 heading

32 medicSA MARCH 2018 membership AMA(SA) online – connecting with our members The AMA(SA) has been hard at work creating an online presence so that members can access services more readily, keep up to date on our activities and connect with us.

South Australian Member Portal practice for managing your own https://members.amasa.org.au social or digital media communication During renewals you were directed channels and how your staff maintain to the new online SA member portal. ethical conduct in their dealings online, This service allows you to update your including via the AMA website. personal records on file, as well as We’d like to share our channels and renew your registration. You can also hear about yours. download and print a confirmation of membership letter. By way of response, you are encouraged to share with the AMA(SA) As this group was previously for We have plans for this members’ area links to your Twitter account, Facebook ‘Doctors in Training’, if you are a to grow. page, Instagram or other. more experienced/advanced doctor, Firstly, one recent pain point has been We would be delighted to connect on you may wish to take on a mentoring access to the AMA Fees List, which these platforms – with the purpose to philosophy to your postings and still requires the Federal member login. share your news through our channels encourage best practice among As an interim step, we are making the when we can. your peers. downloadable file available through your SA member portal. AMA(SA) social media Community guidelines will apply to all LinkedIn postings. Be ethical, be smart and Secondly, we are now also able to offer Please ‘follow’ the Australian Medical be aware. your registration tax receipt to you via Association (SA) on LinkedIn. www.facebook.com/groups/ this service. Furthermore, we welcome your support amasamembers Finally, a longer-term vision is for you promoting the outcomes of our joint Keeping up to date with to be able to track the use of your efforts, as we share media items and the AMA(SA) membership benefits, however we news through this same company Our website hosts a showcase of would appreciate your thoughts as page. This may be through a like or information and resources, and to what you think would be comment of encouragement. we encourage you to review advantageous too. The page is here: www.linkedin.com/ regularly for media releases, news, Federal member website access company/10677495/ information and resources. For Your old login still provides access to: Twitter example, have you read our recent https://feeslist.ama.com.au The AMA(SA) has created a Twitter releases such as: https://ama.com.au/careers/pathways profile for event and media (news) https://ama.com.au/sa/restrictive- https://www.doctorportal.com.au/ tweeting. You may ‘follow’ us practices-legislation-highly- via @amasamembers or use the complex-doctors Membership on social media hashtag #amasamembers. We Social media users in Australia are encourage retweeting! https://ama.com.au/sa/amasa- some of the most prolific in the world, media-release-prescribing-safer- Facebook with a total of around 60% of the system-pharmaceuticals The recently revamped Facebook group country’s population active users on is now open to all doctors in South We have recently included a ‘social Facebook, and 50% of the country gallery’, showcasing relevant and Australia and is a place where you can logging in at least once a day. (Source: important events where we have share and comment about issues that Social Media News.) been out publicly. See your AMA(SA) matter to you as a doctor in our state, out and about via ama.com.au/sa/ We encourage best practice use no matter where you are on your career social-galleries of social media to meet our legal journey. You are encouraged to provide obligations as health professionals – as feedback and suggestions to the If you have any additional queries or the AMA(SA) itself aims to tackle our AMA(SA) more broadly. We encourage technical questions, please contact: channels with candour and integrity. members to join the group, join the membership & marketing officer Charlie There is a plethora of articles and discussion and to simply be involved in Robinson on 8361 0108 or email

© istock/ RossHelen guidelines to help you achieve best a more general sense. [email protected].

medicSA MARCH 2018 33 update AMA(SA) Historical Committee update The AMA(SA) Historical Committee is calling for new members, as the AMA(SA) Past Presidents’ presentation is prepared to launch. Dr Tom Turner reports.

T the life members and past is an ongoing work. (Go to ama.com.au/sa Because Dr Trevor Pickering has had to presidents lunch three years ago, > History in SA > Virtual Museum). resign through ill health, we are without a ADr Patricia Montanaro asked for a formal chairman. I have been doing the job volunteer to join the Historical Committee. Now that our major current but feel I am too old to do it long term. Dr The main aim would be to complete the tasks are completed, we Jenny Linn has also succumbed to time. data the AMA(SA) had on the illustrious Dr Tony Ryan was a help but has moved band who have led it since the branch are examining how we on to other pursuits. We have a vigorous began in 1879. I put my hand up and have will make history more committee including foundation member Dr never regretted it. Thea Limmer and more recent members, accessible and interesting doctors Tom Turner, Peter Kreminski, David We had a few other tasks. One was to fill Fenwick and David Evans. We hope to our idle moments organising the library. to our members. welcome more in the near future – there is Due to the space constraints imposed by New Members will be much work to be done! the move, the library is now a skeleton of welcomed with open arms! its former glory. That is the fate of all small Now that our major current tasks are and some bigger institutions worldwide, completed, we are examining how we Now we are almost ready to publish as digitising and publishing to the Web will make history more accessible and the PowerPoint presentation titled Past becomes the preferred path. interesting to our members. New members Presidents of South Australia Branch of will be welcomed with open arms! We also constructed a Virtual Museum of the BMA and AMA 1879. This outlines the various surgical and medical artefacts the wide range of service they have given Tom Turner is reluctant de facto chairman, donated to the branch over the years. This to the profession and to the public of SA. AMA(SA) Historical Society.

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34 medicSA MARCH 2018 council update

New student representatives on AMA(SA) Council The AMA(SA) is glad to welcome new student representatives on Council Simon Cousins and Mekha John.

UR new Adelaide University representative on the AMA(SA) OCouncil, Simon Cousins, was president of the Adelaide Medical Students’ Society in 2017. In 2016, he was SA Representative for the Australian Medical Students Association (AMSA) National Advocacy Team in 2016. In this role, he advocated on behalf of student bodies to relevant stakeholders including political parties, universities, health departments and special interest groups. He was also representative of AMSS to AMSA’s National Council. Outside of medicine, Simon enjoys reading and music, playing trumpet Mekha is currently senior vice-president has taken an active role in empowering with the Adelaide University Medical of the Flinders Medical Students’ Society. equality in medicine through events Orchestra (AUMO). During holidays She acts as the liaison between the such as Women in Surgery. he’s a regular volunteer with Edmund medical school and AMA, where a large After making the move from New Rice Camps (SA), mentoring young part of her role involves advocacy and Zealand to Adelaide she has grown people from difficult backgrounds. vocalising the issues arising within the very fond of coastal walks and student body. Mekha John is a fourth-year medical anything and everything that will allow student and the new Flinders University Within medical school, she is involved for a bit of creativity – including music representative for the AMA(SA). across a range of student societies and and design.

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36 medicSA MARCH 2018

ACHA_MedicSA Ad_ASH+TMH Development_210x297mm_160218.indd 1 16-Feb-18 1:26:33 PM leisure Meandering magic along the Murray River Professor Michael Sage returned to his Riverland roots when he joined tour operator Tony Sharley for the four-day Murray River Walk.

ICK SAGE: Growing up on the Murray at Berri, I was excited Mto learn that a guided walk – Murray River Walk – had recently been established by local Renmark identity, Tony Sharley. While many people have taken a holiday on a houseboat on the Murray, my love for this area extends beyond the Murray itself to the wonderful adjacent flood plains with their amazing but sensitive vegetation, unique bird life and the intricate network of creeks, billabongs and anabranches. I therefore could not wait to undertake the walk and encouraged a group of Mick Sage (third from left) and his group of friends on the four-day Murray River Walk. friends to join us. Being locals, Tony and his guides Murray River Walk is a relaxing four-day, with million-dollar views, a roof-top have a wealth of knowledge which they three-night guided walk along hot spa and comfortable lounge/ were happy to share with us – and, as the Murray River and its intricate dining facilities. a result, we did not find the walking too networks of creeks, billabongs and strenuous for a group of age 70-plus oxbows, revealing a mighty river’s Novice and keen walkers enjoy the easy individuals. Tony’s extensive knowledge fascinating past and its innovative paced 40 km walk and 70 km cruising on of the Murray Darling Basin enabled him future. Accommodation is unique to Australia’s greatest river, and your guides to explain the efforts being made to allow the Murray River – a modern houseboat prepare three-course meals paired the river red gums and other vegetation that travels each day to your new with superb local wines each night, to recover after the relatively recent walking destination, boasting rooms celebrating the Riverland food bowl. devastating drought. At the end of each day we retired to our excellent accommodation in a modern houseboat where we were served an amazing dinner of local produce, preceded by drinks around a fire on the adjacent bank. My wife Helen and I, and the friends who joined us for the Murray River Walk, would encourage all South Australians to take the opportunity to undertake the Walk and take the You’ll love walking each day along Australia’s opportunity to learn how fortunate we are to have the mighty Murray and its Greatest River and spending each night on adjacent environment so close. spacious houseboat accommodation. I will leave it to Tony to expand on our wonderful trip. sss Tony Sharley: My discussions with Mick along the way on this particular Murray murrayriverwalk.com.au River Walk led to many recollections of family connections in the Riverland – a most rewarding part of the four-day journey for me.

medicSA MARCH 2018 37 leisure

Walking distances range from 10 to 14 to Renmark, and so stayed on the Murray River Walk aims to help people km per day. houseboat on the first two days while discover the magic of the Murray, the other members walked. A fishing rod and as walkers discover this it Murray River walk is popular with those was organised to help enrich his ‘resting’ becomes reassuring to know that keen to learn more about the Murray, on the boat, and two other walkers were the river has a new group of its wildlife, history, the symbiosis able to shorten their daily walks because passionate ambassadors. between vegetation on the floodplain a small pontoon boat was able to collect and flood regimes, and the challenges Murray River Walk became a member them at various pick-up points. and solutions for keeping our mighty of the Great Walks of Australia Signature Murray River healthy. Inescapable Collection in 2016 and won the beauty, spectacular sunsets and 2017 South Australian Tourism Award sunrises, red ochre coloured cliffs for Ecotourism. and peaceful surroundings are the Maximum group size is 10. Walking backdrop for good friendship groups is in the cool months from May getting outdoors and exercising, to September. Walks depart from while enjoying the creature comforts Renmark, South Australia. that cosy winter houseboat accommodation provides. Riverbank Tony Sharley grew up in Renmark. campfires are the new TV. After graduating from Roseworthy Agricultural College, Canberra It’s the people who make this guided University and Monash University, experience so rewarding – walker he then began a career working interest and appetite for knowledge on Australia’s rivers which took him and the sharing of life’s experiences from the Riverland to Canberra to makes each walk an absolute Kakadu and back, including a pleasure for everyone. 10-year stint as manager of Mick, who hailed from Berri originally, Banrock Station. Tony started certainly seemed to enjoy the Murray River Walk in 2016 to wonderful meander down memory share his knowledge and passion lane, recollecting his many adventures for the Murray. growing up on the river. His thirst for Mick Sage is emeritus professor of knowledge kept the guides on their toes Mick’s entire group enjoyed walking Medical Imaging at Flinders University as they shared their family histories and together on the last day – a highlight and was campus director at Flinders discovering many connections between included standing together on the cliffs Medical Centre until 2006 after which he his family and their own. overlooking the site where the now continued at the RGH until 2015. He has Murray River Walk is flexible and caters defunct Chowilla Dam could have been had a long association with the AMA and for all walking abilities while encouraging built in the 1960s – a breathtaking was awarded the Inaugural Award for a moderate fitness level. One walker in view and a ‘thank goodness it didn’t Contribution to the Medical Profession by the Sage group hurt his back on route happen’ moment. the SA Branch in 2000.

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38 medicSA MARCH 2018 in practice New Medical Board Professional Performance Framework The AMA is looking forward to working with the Medical Board of Australia to ensure the implementation of the new Professional Performance Framework is well considered and provides the best outcomes for doctors and their patients. Professor Robyn Langham reports.

HOULD doctors strengthened. This will require doctors such as CPD already largely in place, be tested for their to complete at least 50 hours of CPD and other components such as the Sfitness to practise per year relevant to their scope of regular review of doctors aged 70 on a regular basis? What practice, and nominating a CPD ‘home’ and over needing further consultation factors increase the risk of of one of the Specialty Colleges, which and development. poor clinical performance? will then have responsibility to report to The AMA recognises that doctors How should doctors with multiple the Medical Board if CPD requirements over the age of 70 make a strong substantiated complaints be managed in are not met. contribution to clinical care in our the long term? s Doctors at most risk of poor community, but like other potentially These are just some of the thorny performance will be identified and high-risk professions, it is an opportune questions the Medical Board of Australia strategies put in place to manage time to establish a process to review a and, as a consequence, the AMA have them. For example, increasing age is person’s continuing ability to provide been grappling with over the last two a known risk factor, so three yearly care at that age. years as part of an investigation into peer review and health checks are However, the AMA, with the advice of whether Australia should adopt a system proposed for doctors aged 70 and the Medical Practice Committee, will be of ‘revalidation’ similar to that currently over who are still providing clinical considering how health and screening operating in the United Kingdom. care. Importantly, the Medical Board checks of older doctors would be best will not be party to any of the data The AMA has argued strongly against implemented to ensure they are fair from peer review and health checks introduction of the UK model, a model and consistent. unless there is a serious risk identified which has proven to be onerous, costly to patients. and complex, and undertaken by every The AMA is also concerned about how the Medical Board will obtain data on single registered medical practitioner on The AMA has also a five-yearly basis. The AMA has also an individual doctor’s performance in advocated strongly against the Medical advocated strongly order to manage high risk individuals. For Board’s original revalidation proposal against the Medical example, we oppose open data sharing which we considered was too heavy between medical defence organisations handed and problematic. Board’s original and the Board. While recognising the value of introducing revalidation proposal We look forward to working with extra measures to improve patient safety, which we considered the Medical Board to ensure the the AMA has urged instead the adoption implementation of this Framework of an approach that builds on the many was too heavy handed is well considered and provides systems already in place that support and problematic. the best outcomes for doctors and doctors in delivering high quality care. their patients. s Doctors with multiple substantiated Australian doctors already practise in a Full details of the new Professional complaints will be proactively highly regulated environment. Performance Framework and its managed including via the Late last year, after a lengthy consultation consultation and implementation introduction of a formal peer review process, the Medical Board announced timeframe are on the Board’s website: of performance. it had designed a new Professional medicalboard.gov.au > Registration . Performance Framework aimed at s The Board will revise and update Professional Performance Framework. ensuring: “that all registered medical registration standards and the code AMA members are encouraged to practitioners practise competently and of conduct. provide their views on these issues to ethically throughout their working lives”. s The Board will work in partnership [email protected]. Your comments The Framework replaces the Board’s with the profession on strategies to will help inform AMA advice. original revalidation proposal. further promote a positive culture Professor Robyn Langham is on This Framework is made up of focusing on patient safety, respect the federal AMA Medical Practice five components: and ongoing improvement. Committee. This article was first s The current continuing professional The Framework will be implemented published in Australian Medicine on development (CPD) system will be progressively, with some components 13 February 2018.

medicSA MARCH 2018 39 leisure Supported by:

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Update from the Australian Digital Health Agency

HE Australian Digital Health > Building a rich data repository of Agency (ADHA) has accurate information. Tprovided the AMA with updates relevant to GPs and My Former AMA President, Health Record. Dr Steve Hambleton, has Former federal AMA president, outlined the importance gov.au > About the Agency > Digital Dr Steve Hambleton, has outlined Health Space Blogs > My Health the importance of My Health of My Health Record… Record – a critical tool in improving Record in allowing for the patient care. straightforward and secure sharing AMA(SA) vice-president Dr Chris Moy of information. Up-to-date shared has represented the AMA over a number My Health Record will be expanded health summaries can easily be of years in fixing the My Health Record to an opt-out model in 2018 – accessed by other healthcare and to make it usable in the day-to-day information on this can be found at digitalhealth.gov.au > News and practitioners, allowing for patients to work of doctors. His experience with Events > #Share > #Share: January receive continuity of care. following up on an unwell patient with 2018 > A My Health Record for Read more about Dr Hambleton’s information from My Health Record is every Australian in 2018. experience and thoughts here: an example of the potential critical role digitalhealth.gov.au > About the of the system in the future. Read more The Department will be providing the Agency > Digital Health Space Blogs about his experience here: digitalhealth. AMA with updates.

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medicSA MARCH 2018 41 in practice Pain management and prescribing strong opioids

ITH codeine up-scheduling and examines issues around opioid use depending on the patient, different paths having come into effect on 1 and misuse. are outlined including: discuss treatment February 2018, GPs have been options; management; and prescribing W The AMA will be preparing a submission in advised that they may see an increase in authority. Find out more here: nps.org. response to the TGA Consultation. patients seeking ways to manage pain. au/supporting-patients-with-codeine- Pain Australia has launched a website to Read more about the TGA Consultation dependence. assist with alternative pain management here: tga.gov.au > News room › strategies. Find out more here: Consultations & reviews › Open NPS MedicineWise has also produced realrelief.org.au. consultations & reviews information on taking the opportunity for better care now that codeine is prescription Scriptwise also has useful online resources only. GPs with patients wanting to explore – scriptwise.org.au/codeine – as does the Resources for GPs: alternative pain management options Therapeutic Goods Administration (TGA) – codeine up-scheduling may be interested in how to manage the tga.gov.au/codeine-info-hub. NPS MedicineWise has created fact sheets transition away from codeine. Find out The AMA has remained firm on the up- to assist with the transition to prescription- more here: nps.org.au > Medical Info > scheduling of codeine, urging state and only codeine, focusing on how to support Clinical Topics > After over-the-counter territory politicians to resist pressure from patients with codeine dependence and codeine: opportunities for better care. pharmacy owners and lobbyists. opportunities for better care in light of the The TGA has provided an extensive list of up-scheduling of codeine. The TGA opened a consultation on the current up-scheduled codeine containing use and misuse of prescription strong The information on supporting patients products that may also interest GPs. Find opioids, which closed on 2 March. The provides a series of steps to follow when out more here: tga.gov.au > Consumers › discussion paper released in conjunction treating patients including: in preparation Consumer information & education › with the consultation explores whether (before patients start presenting); during Community Q&A > Current list of up- specific regulatory responses are required visit (initial assessment); and then, scheduled codeine containing products.

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42 medicSA MARCH 2018 the schedule

The Schedule: Upcoming Events

MARCH APRIL cont… ‘I’ve got your back’ – the GPs role 2018 UGSA ASM and General Meeting BreastScreen Australia Conference in treating lower back injuries UroGynaecological Society of Australasia 19-21 April Tuesday, 27 March, 6.00-8.30pm 14-18 March Hilton, Adelaide The Port Club, Alberton Hilton Hotel, Adelaide www.bsaconference.com.au Presented by Dr Bridget Sawyer ugsa.org.au Spine Society of Australia ASM ‘Scratching the surface’ – an 2018 Women in Medicine High Tea 27-29 April Sunday, 18 March, 1.30-4pm update on common paediatric Adelaide Convention Centre dermatological conditions Mayfair Hotel, 45 King William St spinesociety.org.au Speaker: Marie Shaw QC Tuesday, 10 April, 6.00 – 8.30pm ama.com.au/sa/sa-events-seminars MAY Cove Civic Centre, Hallett Cove Presented by Dr Simon Khoury ‘Better safe than sorry’ AMA(SA) Council meeting Work Health and Safety for Practice Staff Thursday 3 May, 7pm ‘Scratching the surface’ – an Wednesday, March 21, 6-8.30pm Members welcome update on common paediatric AMA House, Ward St, North Adelaide [email protected], 8361 0109 dermatological conditions Presenter: Jim Sinclair, Principal Wednesday, 11 April, 6.00 – 8.30pm WHS Advisor The essentials of practice Rydges South Park Hotel, Adelaide amaskillstraining.org.au management Presented by Dr Karen Koh Friday, 11 May, 8.30am – 3.30pm APRIL Presented by: Tim Lavis - ‘Breaks, sprains and twists’ – Your CV and interview skills Hood Sweeney injuries of the hand and wrist Brett Miller - 2017 SA/NT Wednesday 11 April Thursday, 3 May, 6.00 – 8.30pm Practice Manager of the Year Osmond Function Centre, Norwood Cove Civic Centre, Hallett Cove Sylvia Morris - CALHN RTO (RAH) Presenters: Dr Janice Fletcher and Presented by Dr Liz Clisby Dr David Walsh. Prashiba Thavarajadeva - ama.com.au/sa/sa-events-seminars Practice Manager and Director Work related psychological amaskillstraining.org.au Employment conditions and contracts and stress injuries – what the Wednesday, 18 April, 6-7pm 2018 AMA(SA) Charity Gala Dinner GP needs to know Presenter: Lincoln Smith Saturday, 19 May Thursday, 10 May, 6.00 – 8.30pm Partner Norman Waterhouse Lawyers Hilton Adelaide. Sage Hotel, Adelaide amaskillstraining.org.au 8361 0101 or [email protected] Presented by Dr Jules Begg

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medicSA MARCH 2018 43

practice notes

Where: Connery House, Calvary North PARKSIDE NOTICES Adelaide Hospital, 89 Strangways For lease – 60A Glen Osmond Rd (near Tce North Adelaide. Registration: Parklands). New building, stunning DR ROBERT J HALL, neurologist, http://www.trybooking.com/348171 design, high exposure, 169sq/m, up to advises that he continues to Enquiries: David Bowes - dbowes@ five rooms + reception + waiting (fit out perform electromyography (EMG) continencematters.com to suit). U/cover parking, lift, solar panels, and nerve conduction studies at double glazing, natural light. Contact DOCTORS’ HEALTH SA provides Memorial Medical Centre, 1 Kermode David Ente, 0412 127653. an anonymous and confidential 24/7 St, North Adelaide. Ph 8239 1933, Advice Line for doctors and medical NORWOOD fax 8267 6672. students. Call 8366 0250 to discuss Professional consulting rooms available MEDICO MUSOS any concern you may have with on sessional basis in Norwood. Recently Acapella singers who can ring a chord an experienced medical colleague. renovated stand-alone medical building wanted for medico-male Barbershop For more information, go to prominently located Kent Town end of Quartette. Sample at David Evans ph 0419023775, signage available. Monday to Friday. email [email protected] ROOMS FOR SALE OR LEASE Secretarial support by negotiation. Contact 0417 891136 for more MAKE AUSTRALIA KAPUNDA information and inspection. DRY WORKSHOP Consulting rooms available on a FREE GP workshop presented sessional basis Monday – Friday. NOTICEBOARD by Continence Matters. Topics: Located in a Allied Health Centre assessing the incontinent woman, next door to a large thriving medical MEDICAL BENEVOLENT how to examine for prolapse and practice in an expanding rural The Medical Benevolent Association fit pessaries, teaching pelvic floor community. Full administration of SA can provide financial assistance exercises, treatment options and services and support available to medical practitioners in need algorithms, who needs a cystoscopy including EFTPOS & HICAPs. and their loved ones. To contact the or urodynamics. When: Tuesday Contact Sandra 0433 288 338 or MBASA contact the AMA(SA) office 15th May 2018, 5.30pm to 8.30pm. [email protected]. on 8361 0107.

The AMA is here for members in welcome adversity: membership is like an to our new members! insurance policy.

By being a member, you help support the AMA’s advocacy on behalf of your Welcome: medical profession and help set the A/Prof Andrew Lee, Walkerville Dr Kar Ng, North Adelaide AMA’s advocacy priorities on local, Dr Alexander Strachan, Stirling Dr Kate Gowling, Craigburn Farm state and national levels. There Dr Alexandra Goldsworthy, Hawthorn Dr Kelly Papanaoum, Royston Park are many benefits associated with Dr Anna Elias, Seacliff Dr Luke Traeger, Unley membership outside of the advocacy Dr Arina Dan, QEH Dr Monika Skubisz, Somerton park work we do and services and Dr Chloe Lim, Glenalta Dr Raj Kumar, Newton resources we provide, such as: Dr Deric De Wit, Evanston Dr Samantha Burns, Norwood Dr Elizabeth Cuthbertson, Gilberton Dr Shannon Le Blanc, Leabrook • Your membership is tax deductible. Dr Felicity Ng, Heathpool Dr Troye Wallett, Marryatville • Your membership dues may be wholly Dr John Chen, Hawthorn Dr Warwick Black, Fullarton or partly claimable against your Dr Justin Munt, Toorak Gardens Dr Laura Sharley, Netherby Professional Development Allowance.

You may also access concierge services We are excited to have you as part of our membership. and discounts from our AMA(SA) Membership is a lifelong journey and we look forward partners, such as the Hood Sweeney to helping you start yours. Please let us know if you accounting services. The full list of have any questions about your membership by member benefits are available on contacting Charlie, our Membership Officer on 8361 0108 or email [email protected]. our website.

44 medicSA MARCH 2018 Always the first choice for medical indemnity insurance and protection for doctors

Annual or monthly direct debit with no fee Comprehensive medical indemnity cover1

Risk education - free with a premium discount on completion

24/7 emergency medico-legal advice and support Personalised advice and claims support

Dr Martin Altmann Chairman

Get a competitive quote on your Earn Qantas Points on your insurance 1800 777 156 insurance payment to MIGA2 or www.miga.com.au

1 Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by Medical Defence Association of South Australia Ltd. Before you make any decisions about any of our policies, please read our Product Disclosure Statement and Policy Wording and consider if it is appropriate for you. Call MIGA for a copy or visit our website at www.miga.com.au 2 A business must be a Qantas Business Rewards Member and an individual must be a Qantas Frequent Flyer Member to earn Qantas Points with MIGA. Qantas Points are offered under the MIGA Terms and Conditions www.miga.com.au/qantas-tc. Qantas Business Rewards Members and Qantas Frequent Flyer Members will earn 1 Qantas Point for every eligible $1 spent (GST exclusive) on payments to MIGA for Eligible Products. Eligible Products are Insurance for Doctors: Medical Indemnity Insurance Policy, Eligible Midwives in Private Practice: Professional Indemnity Insurance Policy, Healthcare Companies: Professional Indemnity Insurance Policy. Eligible spend with MIGA is calculated on the total of the base premium and membership fee (where applicable) and after any government rebate, subsidies and risk management discount, excluding charges such as GST, Stamp Duty and ROCS. Qantas Points will be credited to the relevant Qantas account after receipt of payment for an Eligible Product and in any event within 30 days of payment by You. Any claims in relation to Qantas Points under this offer must be made directly to MIGA by calling National Free Call 1800 777 156 or emailing [email protected]. © MIGA November 2017

AMA (SA) 2018 Charity Gala Dinner

‘ECLECTICA’

Saturday, 19 May 2018 Hilton Adelaide 7pm - Midnight $175 per head

Dress: Black tie/ Evening wear Non-Members welcome

Proceeds Supporting Major Sponsors

Further information and to purchase your tickets phone event organisers, sapmea on 8274 6054 or [email protected]