urgicalVol: 12 No:8 September 2011 Sthe royaL Australasiannews College of Surgeons doorsOpen

The College showcases its fascinating wares to the public. page 26

The College of Surgeons of and New Zealand President’s Perspective

urgicalVol: 12 No:8 September 2011 STHE ROYAL AUSTRALASIANnews COLLEGE OF SURGEONS doorsOpen 131 degrees

The College showcases its fascinating wares to the public. PAGE 26 Important issues debated at the NT/SA/WA Annual Meeting The College of Surgeons of Australia and New Zealand

on the cover: Crowds gather to see inside for Set your home free Melbourne Open House

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Want more information? 12> Vision for East Timor Call your local Medfin Relationship Manager A new eye centre for Dili on 1300 361 122 or visit medfin.com.au Uluru at dusk, courtesy of Charlotte Jennifer Padbury. 16> Law Commentary and request a quote. Children and surgery

30> Food for thought Glenn McCulloch on our future Ian Civil President 32> Fellowship survey What you told us ike most Fellows of the College meeting. There was a vigorous debate I have flown over it many times. over the College involvement in surgical 34> Part-time training LHowever, in the past I had not been endeavours away from the ‘big smoke’ of A new landscape? truly aware of its significance. Longitude the major metropolitan areas. There is no 129 degrees or as it is frequently called the doubt that in the awesome breadth of the 38> Online library 129th east defines the border outback, with its particular health needs, Orthopaedic resources between and South more resources from various governments Australia/. Longitude and more endeavours from all health 131 degrees passes through , professionals are needed. , Island of Waigeo in , the In this meeting the balance of Dampier Strait, Melville Island and then generalism versus specialism was continues through Uluru (formerly Ayers particularly felt. I have spoken recently of Rock) in the Northern Territory. It was all the tensions in the health systems that regular pages a majestic backdrop to the Combined are accentuating the issue of increased 5> Relationships & Advocacy 2011 Annual Scientific meeting of our specialism. Although specialism is not Northern Territory, Western Australia and all bad because extended knowledge in 7> Poison’d Chalice Finance for your: Car • Equipment • Practice • Property • Cash flow needs regional committees. a particular area and expanded technical medfin.com.au 18>ASC 2012 It is not surprising that providing expertise provides benefits to society 23> PD Workshops surgical workforce and building robust in general and patients with relevant surgical departments as well as the problems in particular, we need to be 35>Members Benefits contemporary issues of indigenous particularly alert to some of the downsides. Important Information: Because we do not know your personal objectives please consider whether this product is appropriate for your circumstances. Before acting on any 45>Surgeons’ Bookclub health were major components of the Surgery has the particular problem u of the information in this brochure, please seek independent financial advice. Approved customers only. Subject to credit assessment. Terms and conditions apply. Fees and charges apply. Medfin Australia Pty Limited ABN (89 070 811 148). A wholly owned subsidiary of National Australia Bank Limited (ABN 12 004 044 937), and part of Surgical News Page 3 September 2011 the NAB Health specialist business. (SN 9/11)

Surgical News.indd 1 11/08/2011 10:51:25 AM Relationships & Advocacy

Outback flowers, courtesy of QASM Clinical Director John North FRACS. Society has given us the right to be regarded as a profession with key elements of; > An exclusive right to practise in a defined area of endeavour. Training and reform on the agenda > A right to professional autonomy. > A duty, individually and collectively to put the interest of patients ahead of our own interests, and of our profession.

It is on this last element of clearly needing to meet The Federal health patients’ needs across the breath of surgical presentations Keith Mutimer Vice President reforms have a long that we need to focus and ensure it is satisfied. Not doing way to go to see so is unprofessional. The consequences will eventually results be the privileges of professionalism are challenged and here have been interesting withdrawn. We are already seeing that with increased developments on both sides of the There was a vigorous debate over the government intervention in all aspects of our clinical TTasman recently. endeavours, the nationalisation and bureaucratisation The College’s National Board in New “College involvement in surgical endeavours of regulatory authorities and health service governance Zealand issued a media release on 4 August away from the ‘big smoke’ of the major without our input. As Geoff Davies stated: “While expressing its concern over reports that the metropolitan areas individually you may decide, for whatever reason, to proposed elective surgery unit at the North restrict your practice to only a narrow field, you cannot Shore Hospital in Takapuna will operate with ” do so collectively and still retain your collective rights. specialist medical staff only. The release noted Your collective field of practice is defined for you to some of increased technical specialism where advantage of a broad perspective would that if this is to be the case it will seriously extent by the public perception of the role of a surgeon1.” surgeons could become increasingly be lost. reduce the opportunities for Trainees to get the There is no doubt that we have a collective irrelevant to the care of patients as a However it does go deeper than that. vital surgical experience they need. responsibility to provide a broad scope of surgery in each whole, effectively marginalising our Many surgeons that I have spoken to have If the North Shore Hospital elective unit discipline, but also a professional requirement to ensure contribution in medicine. Our clinical read and re-read the words of the Hon arrangements mirror those at Waitakere high quality timely generalist surgery is readily available. decision making could be left in the Geoffrey Davies that have been printed in Hospital, the already considerable difficulties At Uluru there was much to challenge ourselves as hands of non surgeons and our range of the ANZ Journal of Surgery about the chal- in accessing sufficient elective surgery for in the public sector. At the time of writing, the new system will see federal funding of the individuals, employers – be they hospitals or health expertise only confined to an operating lenges of professionalism that confront our training in a number of specialties will only the College’s New Zealand National Board is public hospital system rise to 50 per cent of new department – and the College to continue to provide this theatre. Without doubt, the position of College.1 His clearly stated view and one be made worse. The growth in New Zealand’s seeking an urgent meeting with the Waitemata expenditure. This is hardly the revolutionary meaningfully into the future. surgeons as influential contributors to that I support is that when a societal need, population and the shortage of trained DHB to clarify the situation and its potential initiative to “end the blame game” which was surgeons requires an ongoing increase in impact on training. originally promised. The College maintains the healthcare universe would diminish. such as care of acute and emergency prob- Reference Trainee numbers. Limiting Trainees’ access to Meanwhile in Australia, after nearly four the position it held throughout the period of From those of us who still believe we are lems is not met then we are sacrificing our 1. Davies, G., Professionalism of surgeons: a collective responsibility. “physicians who operate” that distinct professional responsibilities as surgeons. ANZ J Surg. 81(4): p. 219-26. elective surgery will have exactly the opposite years of negotiations and political stand-offs, negotiations – that the single funder model effect. the nine Australian governments have now alone can achieve this goal. With the College and Health Workforce New signed on to new funding arrangements for the While we obviously welcome the new Zealand already looking at what opportunities Australian public health system. spending contained in the agreement, exist for training in the private sector, it makes A far cry from the scheme first proposed we remain sceptical about the capacity of Younger Fellows Forum no sense to remove opportunities for training by then Prime Minister Kevin Rudd in 2007, Australia’s already overstretched public 3 – 5 MAY 2012, KUALA LUMPUR All Younger Fellows are invited to nominate for 2012 Younger Fellows Forum. Correspondence to Surgical News should be sent to: Surgical News Editor: David Hillis [email protected] © 2010 Royal Australasian College of Surgeons The Forum provides a unique opportunity to debate ‘hot surgical topics’ and a chance to relax Letters to the Editor should be sent to: All copyright is reserved. [email protected] The editor reserves the rights to change material submitted and network with your colleagues and Council representatives. Next year’s theme is ‘The Public The College privacy policy and disclaimer apply – www.surgeons.org -Private Balance in a Surgeon’s Working Life’. The Forum is a unique chance to share ideas and Or The Editor, Surgical News Royal Australasian College of Surgeons The College and the publisher are not responsible for errors or consequences from reliance on information in this publication. Statements represent the experiences that affect your professional and personal life. College of Surgeons Gardens views of the author and not necessarily the College. Information is not 250-290 Spring Street intended to be advice or relied on in any particular circumstance. Attendance at the Forum and airport transfers to the venue is covered by the College. East Melbourne, Victoria 3002 T: +61 3 9249 1200 F: +61 9249 1219 Advertisements and products advertised are not endorsed by the College. Applications are open from 1 September to 1 December 2011. W: www.surgeons.org The advertiser takes all responsibility for representations and claims. Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. Contact Professional Development Department. Ph: +61 3 9249 1106 Fax: +61 3 9276 7432 Email: [email protected] ISSN1443-9603 (Print) ISSN 1443-9565 (Online) ACN 081 735 891, ABN 44081 735 891of 129 Bouverie St, Carlton. Vic 3053.

Surgical News Page 4 Vol: 12 No:8, 2011 Surgical News Page 5 September 2011 Relationships & Advocacy Surgical Services

With the College and Health Workforce New Zealand Poison’d Chalice “already looking at what opportunities exist for training in the My contract is up for renewal private sector, it makes no sense to remove opportunities for training in the public sector ”

hospital system to meet the ambitious targets In place in Western Australia since April Money alone can’t solve systemic problems. Professor U.R. Kidding “lucky Alf” because he was the only set by government. Even with new investment, 2009, the four hour rule was significantly There needs to be root and branch reform of the person who could be totally secure in the the target of performing 100 per cent of elective watered down in October last year. Despite this whole system, ensuring patients are receiving his means a number of things – knowledge that he wouldn’t end up on the surgery within clinically recommended modification of the rule, Fellows report that appropriate care in appropriate facilities. including a performance appraisal wrong end of Alf wielding a scalpel. VMO’s timeframes is probably unachievable. it continues to lead to premature diagnoses, The elderly and frail who currently occupy interview with the CEO and the were the real surgeons – their skills honed in the Significantly, what was once an “elective inappropriate admissions, exacerbated beds in the wards of our public hospitals T Medical Director – an opportunity to assess cut and thrust of the turmoil of private practice. surgery guarantee” has become an “elective overcrowding in the wards and unsustainable should be moved to dedicated facilities for my relationship with the organisation and So what has changed? I suppose I have surgery target”, so one suspects that the pressure on surgeons – many of whom are the aged. This would free up beds in public to hear what the organisation thinks of my to a large extent. I have become an advocate politicians quietly consider 100 per cent called repeatedly through the night as the hospitals and go some of the way to addressing contribution. The latter is an interesting issue – for some full-time surgeon appointments. unachievable as well. deadline for a decision on a patient approaches. elective surgery waiting lists and relieving neither the CEO nor the Medical Director has I pushed hard for the hospital executive to Of particular concern is the agreement’s These surgeons are then returning to work the pressures on emergency departments. been in their respective roles for very long. fund these positions. In our institution, full- commitment to the four hour rule. Ninety next day significantly sleep deprived. There are The College believes that pressures on the In fact, I am now into my fourth CEO time equates to six patient contact sessions per cent of patients presenting at public also reports that the rule is being circumvented public hospitals of Australia and New Zealand and, counting acting Medical Directors, my and three non-contact sessions. Without these hospital emergency departments will need by way of imaginative record keeping and can also be alleviated by the separation of sixth Medical Director. I have the advantage surgeons, we would never have got emergency to be admitted, discharged or transferred number juggling. the elective and emergency surgical streams. of “corporate knowledge” – whatever value admission wards off the ground and I would within four hours of triage. Experience in the The College has been very vocal in its Where such separation has been implemented, that confers. Alas, good ideas are beginning not have been able to backfill unexpectedly UK, New Zealand and Western Australia has opposition to this chaotic state of affairs and particularly by way of the establishment of to recycle. Administrators come and go, vacant operating sessions. demonstrated that time-based targets, applied the retiring Regional Chair in WA, Jessica Yin, consultant-led acute care units, there has been governments come and go, but senior clinicians More importantly audit, teaching artificially and inadequately resourced, run is to be congratulated for the effectiveness of a marked improvement in the efficiency of both persist – the backbone of the organisation, and research have flourished. I still need counter to the principle that emergency care her advocacy. An opinion piece written by emergency and elective work. Significantly, no the culture of the organisation. The words of VMO’s – they provide the numbers to fill should aim at the timely assessment and Jessica appeared in the West Australian in late hospital which has implemented the reform Helena in “All’s well that ends well” (1, i, 231- rosters, especially the emergency rosters, but appropriate management of the patient. Time- June, prompting a letter of support from the has ever reversed it. 232) come to mind – “our remedies oft in interestingly, the feedback from the VMO’s our remedies oft in based targets make the fundamental error of AMA and a less than supportive letter from the A position paper documenting the reasons ourselves do lie”. has been that the full-timers have made their placing promptness of care before quality of WA health minister. for, and proven success of, the initiative was ourselves do lie So has the organisation moved on over the involvement with the hospital much more “ care. Interestingly, however, the four hour rule is recently sent to health ministers and senior past couple of years? Sure our debt is a little satisfying and worthwhile. ” The precipitate implementation of such now being reviewed by the WA government. departmental figures in both nations. It is bigger, but we have treated more patients than When I began surgical practice, no-one rules, particularly without a corresponding That begs the question why, when the rule is one example of how to achieve efficiencies ever before. Have we treated the patients well? Our would have thought of applying for a full- without the back-up of a major organisation is commitment to more beds in wards, more under such a dark cloud in Western Australia, in our public hospitals by drawing on the quality indicators have shown improvement, time position as a surgeon in a public hospital. unappealing? Or maybe it is just the certainty nursing staff and better diagnostic services, have all other Australian jurisdictions just experience and ideas of clinicians rather than but there are constantly adverse events, analyses Now, whenever we advertise, there are lots of of a good income, defined hours, paid holidays simply forces more patients – many of whom signed up to it? the prescriptive and unrealistic targets of of which have led to demonstrable changes. Peer applicants – both newly graduated surgeons, and study leave? have not been properly diagnosed – into In short the agreement sets targets without bureaucrats. Fellows can read the paper on the review has improved. but more experienced surgeons as well. Whatever, I am just grateful for the already overcrowded wards. really identifying the means of achieving them. advocacy page of the College website. There was a time when if I uttered ‘oops’ Why is this so? For the newly graduated applicants. But I am also grateful for the VMO’s during the operation, it would cause the surgeons it is perhaps more understandable. who choose to work in the public system anaesthetist to ‘peer’ over the drapes and In the past they might have gone overseas for – who choose to impart their knowledge, Operating a Private by lunchtime, the whole hospital would be a year or two before entering surgical practice experience and example to the future ‘reviewing’ the case! We have improved the pre- proper – that is more difficult now. The generation of doctors and trainee surgeons – Practice is not easy... admission process with registrars attending the jobs are scarce and their spouses seem to be all for a sessional payment that barely covers clinics, we have begun separating emergency professionals with careers of their own. their costs. It is tough to do everything, be everywhere, surgery from elective throughput and possibly But why are the more experienced, Now how do I fit all of that into my manage staff and be a great surgeon. most importantly, we have begun employing seemingly established surgeons attracted contract renewal? None of these issues had Rooms with Style can help. full-time surgeons. to full-time employment? Has generation Y boxes for ticks next to them in the 360 degree We renovate, refurbish, deal with council, recruit This is a new development for us. I was thinking affected surgeons? Or is the sheer assessments! Hopefully they will just look at and manage motivated staff, provide marketing services, brought up in an era of VMO’s. Of course there cost of private practice taking its toll – constant me and mutter those great lines from Kylie build you a website, provide streamlined accountancy were a few full-timers attached to academic staff challenges, indemnity uncertainty etc. Minogue (with all apologies to the Bard) services and much, much more..... We work departments, but by and large they didn’t operate Or is it that patients themselves have become – “Better the devil you know”. Great song – Call or email us today 1300 073 239 We have been helping surgeons achieve and exclusively a great deal – dabbled really. I remember Alf – part of the problem? Have they become so came out 21 years ago. The year I started at [email protected] maintain successful practices for years. for a professorial appointment – great academic demanding, so suspicious, and so ungrateful the hospital. I wonder where the CEO and the Specialists. www.roomswithstyle.com.au brain, hopeless surgeon. He went by the name that dealing with them on an individual basis, Medical Director were then …

Surgical News Page 6 Vol: 12 No:8, 2011 Surgical News Page 7 September 2011 Fellows in the News

It has seemed to me for a long time that the Knowing when not to operate technology,“ expertise and money now available in first world medicine have outstripped the social Professor Mohamed Khadra felt that to promote end of life discussion, it needed to be played out on stage, with help from David Williamson discussion about how best to use them ”

fter having published three books two of his works and ran back to present them exploring perspectives of the health with security staff chasing him believing him Asystem – both as a surgeon and as a to have taken the books without paying. patient – Professor Mohamed Khadra recently “It was funny at the time and I think he entered new artistic territory when he co-wrote thought I was a nut but I certainly got his Professor Khadra caught a play with Australia’s most famous playwright attention,” Professor Khadra said. the attention of playwright David Williamson. “I wrote my phone number in one of the David Williamson at the Brisbane Writers Festival Titled At Any Cost? the work investigates books and then about six weeks later he called end of life issues that are becoming increasingly back while I was operating and I talked to him complex and controversial in first-world high- while my registrar held the phone up to my ear.” technology medicine and is based on his most Professor Khadra explained his interest in recent book Terminal Decline which comprises the issues and Williamson saw the dramatic a series of interviews with the politicians, potential of a family dealing with death and bureaucrats and administrators who have the two began the collaboration with Professor shaped Australia’s health system. Khadra focusing on the medical voice while Professor Khadra said he wanted to Williamson developed the characters of the understand and then shift thinking about the family coping with the terminal illness of an social belief that doctors and surgeons must aged parent. do anything and everything to maintain life no “I felt like a finger painter matter the quality of that life or the cost to the working alongside a master,” system. Professor Khadra laughed. “This is not about euthanasia, but about “At one stage we spent a A scene from the play at the Ensemble theatre; Inset: Martin Vaughan in At Any Cost. the everyday decisions health professionals are day together at the Nepean asked to make to prolong life just because we Hospital talking to social can and the difficulties facing family members workers about aspects of the “One night we had once that a good surgeon knows when to if they don’t know the wishes of their loved human drama that play out about 60 doctors in the operate, but a great surgeon knows when not one,” he said. at such times – anger, fear, audience and I was as to operate.” “It has seemed to me for a long time that the abuse – along with staff in nervous as a kitten, but Professor Khadra said that while surgeons technology, expertise and money now available the intensive care unit to get a the reaction was positive, and doctors should always concentrate on in first world medicine have outstripped the feeling for how the staff dealt which was a great relief,” alleviating suffering, patients can be made social discussion about how best to use them with such times. he said. comfortable to allow nature to take its for the good of both the majority and the “He was wonderful “However, it is the course. individual patient. to work with, considerate, general public I am most Doing otherwise, he said, could not only “More than 40 per cent of the health budget respectful and it was a wishing to reach with this. cause unnecessary suffering, but also affect in countries like Australia is spent on the last wonderful experience.” We doctors are well aware the doctors, surgeons and nurses caring for the month of life and although it may seem hard- Finally, after 15 drafts and of these issues, but still patient. hearted to ask the question, still it does have countless phone calls between we need guidance from “It has been estimated that more than 30 to be asked if this is the best use of resources.” the two, the play opened in July at Sydney’s the person in the bed and the people around per cent of health professionals experience at Professor Khadra, Head of Urology at the Ensemble theatre following its world premier at the bedside if the patient cannot communicate. least one disabling anxiety episode throughout Nepean Hospital in Penrith and Professor the Noosa Longweekend Festival in June. “I would hope that the one message that their working lives and I think that at least of Surgery at the University of Sydney, said With considerable black humour and the audience members would take from the play some of that is due to feeling compelled to do he thought a play would be the best artistic involvement of such well-known actors as is to have the discussion with each other about things based on medico-legal grounds, rather vehicle to promote that discussion and when Martin Vaughan, Tracy Mann and Kate Raison, what they want, the quality of life they want than acting solely in the best interests of the he saw David Williamson at the Brisbane the play has received glowing reviews and or don’t want, the use of organs for transplant. patient. Writers Festival, he pounced. could soon be set to tour the nation. “With medical technology as it now is we “That is not the way to practice medicine First he went up to the playwright and But it was, perhaps, the views of his medical can do almost anything to extend life for a very and not what most of us signed up for, and introduced himself, suggested they collaborate colleagues that had Professor Khadra most long time, but should we? until this changes we all pay a price.” on a play, ducked off to a bookstand to grab anxious. “I can remember a mentor of mine saying With Karen Murphy

Surgical News Page 8 Vol: 12 No:8, 2011 Surgical News Page 9 September 2011 Fellows in the News National Trauma Research Institute presents From Roadside to Recovery - Successful Systems of Trauma Care ANZ Society for Vascular Surgery 18 - 19 November 2011 Part of the big picture Novotel Melbourne St Kilda 16 The Esplanade, St Kilda,VIC 2 011 Scholarships from the College have helped David Chang pursue better outcomes for patients and become a part of a project hoped to revolutionise cancer treatment

SAVE THE

previous recipient of College DATE Brisbane, 12 - 15 November 2011 research Fellowships was recently IN YOUR A awarded the Cancer Institute Premier’s Outstanding Cancer CALENDAR “Vision and Reality” Research Scholar award for 2011. Mr David Chang, a Pancreatic and Upper www.vascularconference.com GI Surgeon, received the award in July for PhD studies that could help surgeons and clinicians For more information please contact: make more informed decisions to optimise an Abbey Williams individual’s management. MEETING CONTACT: Conferences and Events Department Emma Thompson Royal Australasian College of Surgeons That work was part-funded through the RACS Conferences & Events Management College’s Sir Roy McCaughey Fellowship in Royal Australasian College of Surgeons T: +61 3 9249 1260 250-290 Spring Street Incorporating 2009 and 2010 and was undertaken under East Melbourne VIC 3002 F: +61 3 9276 7431 The ANZSVN the supervision of Professor Andrew Biankin, T: +61 3 9249 1139 E: [email protected] Scientific Seminar National Trauma Research Institute - A department of Alfred Health E: [email protected] Head of the Pancreatic Cancer Research Group at the Garvan Institute of Medical Research in Sydney and Professor Rob Sutherland, Director of the Cancer Research Program David Chang with his supervisor Prof Andrew Biankin after the award ceremony. Mr Chang said his research investigated ONLINE REGISTRATIONS EARLY REGISTRATION DEADLINE: Monday 24 October 2011 how tumour biology can be used to predict NOW OPEN: outcomes and treatment responses of patients Oncology in 2011 through a Merit Award and “It’s really the next step after the Human http://tinyurl.com/AlfredGSM with pancreatic cancer. featuring the findings in ASCO Post. Genome Project and a very exciting endeavour “At the moment we do a Whipple’s Now with his PhD thesis almost complete, to be part of. procedure which is a major operation of the Mr Chang is operating one day a week at “This project will revolutionise the way 2011 SYDNEY COLORECTAL pancreas, which means that patients take a the Bankstown Hospital in Sydney while we study and treat cancer, shifting paradigms long time to recover,” he said. continuing his research work as part of a and inducing dramatic changes in the clinical SURGICAL MEETING “We know it helps about half of patients major international effort to deeply define practice of oncology,” he said. 19 November 2011 and cures about a quarter, but we just don’t the genomic aberrations that characterise “There have been major breakthroughs in Hilton Sydney Hotel know who they are ahead of time. pancreatic cancers. cancer therapy, particularly in breast cancer, “We wanted to know that if we were to This effort, the International Cancer that has improved outcomes. We are hoping to 488 George Street, Sydney, NSW do such a large-scale operation, there would Genome Consortium (ICGC) has been achieve similar results through the sequencing be a definite benefit to the individual patient. organised to elucidate the genomic changes project.” With a better understanding of the molecular present in the majority of cancers that Mr Chang said he was honoured to have pathology of pancreatic cancer, we can contribute to the burden of disease worldwide. been chosen as the Outstanding Cancer The Alfred potentially define an optimal personalised Australia is a member of the ICGC and will Research Scholar as well as having received treatment plan.” contribute by sequencing pancreatic cancer in such strong support from the College. General Surgery Meeting Mr Chang said that while pancreatic cancer a project primarily incorporating the Garvan “Having the opportunity to undertake a The Langham Melbourne was not one of the most common cancer types, Institute of Medical Research in Sydney and PhD was invaluable because I think research 28-29 October 2011 it was the fourth most common cancer-related the Institute of Molecular Biosciences (UQ) helps me understand disease biology and make death with many patients suffering a recurrence in Brisbane. The project, estimated to cost better clinical decisions while conversely, my Practical Updates for over $80 million, was initiated by the award of clinical work helps guide research questions and General surgeons of the disease within six months of surgery. CONFERENCE ORGANISER He said such patients are perhaps better the largest single peer-reviewed grant of $27.5 how to translate my bench findings,” he said. Katie Fagan treated in other ways given how little benefit they million by the NHMRC. “The work we’re now doing as part of RACS Conferences & Events Management received from such a major procedure. However, “Our project is called the Australian the Australian Pancreatic Cancer Genome Royal Australasian College of Surgeons more aggressive surgery may be justified in Pancreatic Cancer Genome Initiative and is Initiative is cutting edge and having the C P: +61 3 9249 1248 F: +61 3 9276 7431 patients with a good prognostic tumour. led by pancreatic surgeon Professor Andrew support to contribute is a once in a lifetime further information: E: [email protected] The clinical importance of this work was Biankin and Professor Sean Grimmond in opportunity for me.” P: +61 3 9249 1260 recognised by the American Society of Clinical Brisbane,” Mr Chang said. With Karen Murphy E: [email protected] R Surgical News Page 10 Vol: 12 No:8, 2011 Surgical News Page 11 September 2011 International Development

Participants at the workshop; Dr Marcelino Correia and President Jose Ramos Horta at the eye centre opening;

Swiss-Australian Ophthalmologist Dr Andreas Kreis, who trained in Switzerland and worked in Australia, took up his new position working with the East Timor Eye Program (ETEP) in June this year. Here he speaks to Surgical News

Why did you wish to work in East Timor? I always had the desire to work in developing countries. This was one of the main reasons I chose to do medicine. Once I had finished my training in ophthalmology I was ready to tackle that big task. Also, I was born in Jakarta, Indonesia, so Timor was sort of like going back home. When Dr Verma told me about eye conditions to allow for improved the project, I came to visit the place last year education, training and up-skilling of local to see if it was workable in terms of my family. New vision for East Timor specialists, doctors and eye care nurses. The decision was then made with my wife • Increased health promotion in Julia to come here. It was an easy decision and Andreas Kreis at work. The opening of a new eye centre in Dili will mean treatment for more people communities to improve awareness and for me the logical next step in our lives. understanding of eye conditions and to What does the establishment of the centre he provision of eye care to the people be treated at the centre which comprises The opening of the National Eye Centre in encourage patients to visit their nearest Where have you worked previously? mean in terms of the provision of eye care ? of East Timor reached a landmark in consulting suites and a theatre with the facility Dili in July was also used as an opportunity to eye clinic as opposed to seeking treatment I studied in several places including Basel, I think it is fair to say that eye care in Timor TJuly with the official opening of the being jointly run by the ETEP and the Ministry bring all stakeholders together for a workshop using traditional medicine. Geneva, Paris and Montreal, but did my is the most advanced, best organised and National Eye Centre in Dili and the arrival a of Health in East Timor. run by the RACS to discuss the current eye • Expanded outreach and screening activities ophthalmological training in Lausanne, most sustainable medical specialty in this month earlier of a new ophthalmologist, Dr “This does represent a significant milestone health situation in East Timor, identify key to improve detection and identification of Switzerland, for four years and in Melbourne country. We have a well-functioning general Andreas Kreis. in our efforts to provide eye care to the people challenges and plan for the future. patients. for four years. I started off in Australia as a clinic in Dili and we will soon be starting a Funded through AusAid and the Fred of East Timor,” he said. The meeting was held under the banner • Establishment of a comprehensive eye research Fellow at the Centre for Eye Research specialty clinic once a week for medical retina Hollows Foundation in Australia and New “Not only will it be equipped to undertake of V2020, an advocacy group that helps direct care service which includes treatment and Australia (CERA) under Professor Tien Wong. and glaucoma. We have a well functioning Zealand, the Centre was opened by the more complex surgeries such as corneal resources and attention to blindness and seeks management of sub-specialty cases, with I was offered thereafter a Senior Registrar job outreach program that not only covers the President of East Timor, Mr Jose Ramos transplants, perhaps more importantly it to eradicate avoidable blindness by delivering sub-specialty clinics to be run by visiting at the Royal Victorian Eye and Ear Hospital five referral hospitals in the main districts, Horta who used the occasion to urge for the creates a focus for co-ordinated national eye eye health and vision care to areas of need. teams to address more complex cases such (RVEEH), but kept my research activities going but we have also started moving deeper into elimination of the backlog of cataracts. care efforts. Held at the Hospital Nacional Guido as paediatric ophthalmology/glaucoma, for a couple more years. the country to screen patients and operate More than 13,000 people in East Timor “Having our own operating theatre also Valadares in Dili and facilitated by Dr ocular oncology and vitreoretinal disease or refer in more remote places. This sounds are needlessly blind, with the vast majority means that we won’t have to fight for theatre Marcelino Correia, national ophthalmologist, as well as diabetic retinopathy. When will the new National Eye Centre in all very nice and easy, but there are relentless of them suffering from cataract blindness, a time, which means of course that we will be the workshop drew together members • Ensuring that the appropriate Dili be operational? and ongoing efforts from all sorts of people disease which places considerable social and able to treat more patients.” of a variety of organisations including infrastructure, supplies and consumable I hope in September. Although the clinic has and organisations over the past decade to this economic strain on the developing nation. Mr Verma said that the Eye Centre, representatives from the Ministry of Health, are available to provide a comprehensive been officially already opened, there is still a lot day and hopefully in the future. The more “We can free thousands of people from which is yet to be commissioned, would the RACS and ETEP, the East Timor Blind eye care system able to treat disabling eye of work ahead, mainly in terms of managerial intensified involvement of RANZCO over having to look after people who have a very predominantly service the people of Dili with Union, AusAid, the Optometrist Association of conditions in-country. issues for me. Managing is about 40 per cent of the last couple of years is certainly more than simple eye disease, cataract, so that they are team visits by Australian and New Zealand Australia and Foresight. my work here in Dili, which I deal with before appreciated here. cured and they are treated and the people who Ophthalmologists still necessary to treat the The challenges listed by workshop Members of the workshop also set as a or after my clinical and surgical duties. have to look after them are released into active people in regional areas. participants included the cataract backlog, goal the aim of having ten ophthalmologists How have you and your family found life? productive life,” Mr Ramos Horta said at the “All our surgical teams are now seeing the lack of education and training in the early working in East Timor by 2030, with 25 What types of procedures do you expect to After a very difficult first three months we opening ceremony. more patients because the word has gone diagnosis of such conditions as conjunctivitis and ophthalmic nurses and 50 primary eye care undertake there, apart from cataract surgery? have finally found a place that we call home “I hope that working together in the next out; because more people are starting to keratitis, the inadequacy of workforce numbers practitioners. We are covering a broad field of ophthalmic now. My wife Julia and daughter Anais have few years to come, that the backlog of cataracts understand what we can do and because the with only four full-time ophthalmologists in To date, the ETEP has performed more than operations. Starting with cataracts we will found lots of new friends among locals and is eliminated.” screening and outreach programs are working East Timor to service a population of more than 4,811 eye operations and treatments and provided also be doing oculoplastic procedures, with other expat families and therefore have The head of the RACS-managed East so well,” he said. one million people and the lack of eye services eye consultations to over 46,000 Timorese. The anterior segment surgery including Corneal found a good balance, which, of course, is very Timor Eye Program (ETEP), Dr Nitin Verma “Now we are going deeper and deeper in the regional areas. program dispensed almost 30,000 spectacles, transplants, filtrating glaucoma surgery and important for all of us. People tend to have a said that while the building was funded into the sub-districts so that people don’t have In response, the workshop established supported training of East Timor’s first paediatric ophthalmology surgery for squints lot of romantic ideas about working and living through the Fred Hollows Foundation, it had to travel to Dili and we are in the process of specific goals to work towards including: ophthalmologist and established sub-specialty are just the most important ones. I should in the tropics and developing countries, but been equipped through funding provided to putting eye care services into health centres • The development of guidelines or ophthalmology programs including corneal also mention the huge amount of ophthalmic you quickly learn that life is difficult and often the College through AusAid. that would represent the next level down from manuals on identification, management transplantation and laser surgery. trauma surgery undertaken that uses up lots very frustrating under these circumstances, He said more than 50 people a day could regional hospitals.” and treatment of acute and chronic With Karen Murphy of time and resources in our daily clinical life. although often very rewarding too.

Surgical News Page 12 Vol: 12 No:8, 2011 Surgical News Page 13 September 2011 Personal Piece The SURGICAL RESEARCH SOCIETY

Reflections from South Australia 48th ANNUAL There are many important issues Fellows must consider over the coming months MEETING will be held in Adelaide on Friday 11th November 2011 at the Basil Hetzel Institute, Woodville I have recently become interested in the to dismissal for recidivists. I urge the for each Federal Council meeting problems of alcohol in the medical workplace. College to grasp this nettle and give to realise that this has become an This meeting is open to those It seems that this may not be an insignificant our patients the level of confidence onerous, thankless and seemingly involved in or interested in research, problem. If worldwide figures are to be believed, they deserve. impossible task. including surgeons, surgical or there may be as many as two per cent of the The imminent apparent departure It would indeed be a great shame medical trainees, researchers, Greg Otto, workforce affected by alcohol or drugs at any of the Orthopods from the College if the Orthopods departed. I believe scientists and medical students. SA Fellow one time. I would expect the medical workplace has also been a frequent topic of that united we stand, particularly in Australia to be no different. It may even be discussion among my colleagues and in the areas of relationships and JEPSON LECTURER: hings have been fairly quiet in South an underestimate, given that in this country we me over recent weeks. I learnt a lot advocacy. In order to address the Professor Wayne Morrison Australia (SA) over the last few months. enjoy the dubious distinction of the largest per about the motives behind this move issues, I think that the College Director of the Bernard O’Brien TThere are four areas I would like to capita consumption of alcohol in the world. in discussions. It seems that our needs to reinvent itself in a leaner Institute of Microsurgery and highlight. Recent workplace experience has orthopaedic colleagues wish to have form. Many of the current functions Professor of Surgery and Head The first is the State health budget brought demonstrated how powerless institutions complete autonomy in many of the should be devolved to the specialties of Department of Plastic and down by Health Minister Hill in July. Ever are to act, when allegations of intoxication areas currently run by the College. by Memorandum of Understanding Reconstructive Surgery, St Vincent’s the consummate politician, Minister Hill are made against an individual. It seems the To a certain extent, these views or similar instrument. Hospital, Melbourne. somehow managed to increase the health jurisdictions, the Medical Board and indeed are shared by many other specialties Core functions currently “Tissue engineering – Regenerative budget by $133 million despite these fiscally the College are unable to act effectively. The and seem to be at the centre of done well, such as library journal, surgery” restrained times. Of surgical interest is the difficulties relate to lack of concrete evidence. It dissatisfaction with the College, relationships and historical archive, new investment of $42 million for digitisation seems that in the current legalistic environment expressed to a greater or lesser would be retained centrally as a extent by many. The current College glue to bind us together. In this way ASSOCIATION FOR of BreastScreen SA, a welcome initiative. The of disciplinary hearings, hearsay evidence just ACADEMIC SURGERY government is determined to push on with the won’t cut it. I think that it is time to revisit the structure has stood us in good stead the College will survive the next 80 GUEST SPEAKER: reform of OPD services and the four hour rule, idea of random drug and alcohol testing in the for 80 odd years and in that time the years as a strong united voice for Dr Justin Dimick both of which the College has serious concerns medical workplace. College has tried to be all things to surgeons and surgical standards. Director of Policy Research at the about. We have expressed these concerns to Some safety critical industries such as all Fellows. I think the time when Rather than be all gloom and doom, Center for Healthcare Outcomes & the relevant individuals. The final outcome aviation already have such regimes in place this might have been even remotely the orthopods stand may have just Policy and Assistant Professor of remains to be seen. for protection of the public and the workers. possible could be coming to an shown us the way ahead as a united, Surgery, University of Michigan I have also raised the issue of nonpayment This has resulted in considerable reduction of end. One only has to look at the but evolving group. We just have to be “Measuring surgical outcomes: of the College accreditation fee for the various Conflicts of interest abound in the medical workplace intoxication rates, and consequently 1,000 pages of documents to be read bold enough to accept the challenge. Rethinking the calculus of quality” sites. I brought this up with the Chief Medical profession. Some of you may have seen the improved safety. Surely our patients deserve Officer, Professor Paddy Philips. He indicated Four Corners program on an alleged conflict and expect an alcohol and drug free medical that the government was not intending to pay. of interest related to hip replacements. workplace. Surgery is inherently a much more Apparently this position had been adopted Discussions around these issues convinced dangerous activity than air travel. CALL FOR ABSTRACTS: 2011 Victorian Annual General Scientific We are now calling for abstracts; by all Health Ministers and was unlikely to me that the College should take a leadership If random testing proves to be too these must be submitted no later change. It might be time for stronger action role in minimising these conflicts of interests. expensive to introduce, then empowering & Fellowship Meeting than Friday 30th September 2011. from the College. A good start would be to automatically reject the workplaces to demand an immediate Friday 21 – Sunday 23 October 2011 Abstract forms will be available SAIMET, the SA medical training all scientific articles with declared or suspected blood alcohol estimation for any employee Quality Inn Gateway, Wangaratta, Victoria. from the email address below. organisation has voiced an interest in conflicts. This is a matter requiring vigilance. accused or suspected of drunkenness, would Several awards are on offer for accrediting posts for surgical training. They I am also of the view that all industry be an alternative strategy. This would be a outstanding presentations. have indicated that they want to accredit funding of conferences and workshops useful, cheaper, but probably just as effective Under the theme “Outreach Surgery, The Third World: At Home” an exciting some basic generic attributes of facilities, thus should be phased out, in favour of a user pays alternative to random testing, as it would program has been developed that will cover the broad depth of surgical specialties whilst bringing Fellows and Trainees together on a variety of CONVENOR: Professor Guy Maddern saving the College some time and effort in the scheme. These conflicts are an anathema to provide evidence on one hand and protect the issues that involve the surgical community today. accreditation process. SAIMET have had some our credibility as scientists, and as a group in wrongly accused on the other hand. PRESIDENT:Professor John McCall problems with intern post allocation this year, general. The College could easily address these The power to compel an individual to have Co-Convening the AGSFM are Francis Miller and Peter Thomas. causing some issues for sixth year medical obvious conflicts starting with the College a blood test could be conferred by legislation, Additional perspective to the presentations and panel discussions will be FOR FURTHER INFORMATION students whose career paths often depend journal. A research fund could be established bylaw or contractually, but it would need to provided by a number of invited speakers including Leslie Bolitho, Andrew CONTACT: Mrs Sue Pleass on Intern postings. Hopefully SAIMET‘s in order to supply alternative funding to be formalised in some manner. Offending Cochrane, Michael Dobson, Glenn Guest, Ollapallil Jacob and Edmund Poliness. T: +61 8 219 0900 processes will improve before they get involved worthwhile projects. I would like to see the individuals could then be dealt with in an E: [email protected] in accreditation of College training posts. College taking the initiative in this area. appropriate fashion by counselling initially, up to register please phone 03 9276 7406 or email [email protected]

Surgical News Page 14 Vol: 12 No:8, 2011 Surgical News Page 15 September 2011 Law Commentary

This is an area of practice which and cosmetic surgery “ can create tension between the Children interests of the child, parents, – the legal position of the doctor the state and the law. ” There are important issues to consider when treating children

What are the risks and much cosmetic surgery is performed in Consent and Autonomy understanding of what is involved to give parents can decide on the treatment, but they potential liability of the Queensland and Australia, or how old the It is a general principle of law that a person consent valid in law. Until the child achieves must act in the child’s best interests. In the area doctor in such cases? people are that are having the surgery.” must consent to health care before it can be the capacity to consent, the parental right of elective cosmetic surgery, the circumstances This is an area of practice which can create This is an area of interest, whether it is an lawfully provided. A practitioner who treats to make the decision continues save only in may be rare where the procedure is clearly Michael Gorton AM tension between the interests of the child, area for substantial concern in Australian and someone without first gaining a valid consent exceptional circumstances”. within the child’s best interests. The Court in Principal – Russell Kennedy Solicitors parents, the state and the law. It involves issues New Zealand we don’t really know. for the treatment exposes himself or herself to So from birth it is the parents’ responsibility Marion’s case did specifically refer to cosmetic and Kate Hannah of consent, the autonomy of the child and States other than Queensland do not legal liability. In order for a person to be able and right. surgery as being within the ordinary scope of a questions of the best interests of the child (a have a statutory limitation, but other to give a valid consent to health care (that is, The child will gain capacity to give consent parent to consent to (p49). Whether the Court here are many situations where child being a person under 18 years of age). considerations are still required at law. one that can be legally acted upon), that person to procedures at various stages depending was using the same definition, excluding any cosmetic surgery for children is The Queensland Government examined However, the doctor’s principal professional must have the legal capacity to consent, and upon their own development and the issues medical requirement, is not clear. It was also beneficial and clinically indicated (for T this issue some years ago, and altered the law obligation continues – to require the doctor give the consent voluntarily. involved in the procedure. noted that determining the child’s best interest physical and psychological health reasons). within that state to “ban cosmetic surgery on to consider the best interests of the patient For young people, however, capacity to The second case is known as Marion’s is a difficult and subjective task. If there is no However, news reports indicate a growing children”, requiring doctors to have regard to (child), even despite consent or insistence of consent is a real issue because the law has case: (Secretary, Department of Health & medical requirement for cosmetic surgery, it trend for elective cosmetic surgery being the best interests of the child, after balancing the parents. traditionally assumed that young people Community Services v JWB & SMB, (1992)175 is difficult to see why it is not something best sought for children – under pressure from the risks with potential benefits. Cosmetic surgery can be defined as lack capacity to make health care decisions CLR 218). left until the child reaches competency – also a both the child and their parents. In some cases, Queensland Health noted in the paper “reshaping normal structures of the body by reason of their immaturity. Parents have There, the parents of an intellectually factor to be considered under the Queensland the surgery was not “medically necessary” and “Have Your say: Children and Young People using surgical and non-surgical techniques… generally been given the responsibility of and physically disabled girl wanted her to be legislation limiting elective cosmetic surgery accordingly exposed the child to the risks of Using Cosmetic Surgery and Solariums in Initiated by the consumer to improve their making those decisions on their child’s sterilised. There was no doubt the girl did not for children. unnecessary surgery. Queensland” (2007): “There is some evidence appearance and self esteem” as defined by the behalf. The law has developed to a point have the capacity to understand the issues or to that there may be an increasing number of “Cosmetic Surgery Report: Report to NSW where it is willing to recognise that young consent, but could the parents do so? (I am grateful for the assistance of Kate Hannah children and young people in Queensland Minister for Health Oct 1999”; quoted by people may have sufficient maturity to be The Court found that other than where in the preparation of this article.) and Australia who are using cosmetic Tina Cockburn, QUT, Children, Competency given decision-making responsibilities in the sterilisation would be an incidental result surgery... The media have explained the and Consent to Cosmetic Surgery. relation to their own health care. But, unlike of surgery, which was otherwise necessary to trend for cosmetic surgery as being caused Or as the NSW Medical Council, adults, the law requires something more than cure a disease or correct a malfunction, the Consider: (NSW Medical Council, Cosmetic Surgery a broad understanding. In order to recognise parents did not have the power to authorise the by young people’s obsession with celebrities, Before undertaking unnecessary or including cooling off period for persons a young person’s competence, the young procedure. Because of the seriousness of the aggressive marketing by cosmetic clinics and elective cosmetic surgery on children, under 18 years of age, June 2008 – www. person must have sufficient understanding procedure only the Court could give approval. some doctors, and the promotion of having consider: mcnsw.org.au/page/317/resources/policies) and intelligence to enable him or her to The Court went on to say that the power the perfect body... At the moment there are 1. The best interests of the child – warn has defined it; “Procedures undertaken by understand fully what is proposed, including of parents (in the ordinary course) to offer no statistics collected on what and how of the risks. a qualified medical practitioner to revise the risks and benefits (“NSW Law Reform consent on the child’s behalf diminishes as the 2. Consent issues. Is the child mature or change the appearance, colour, texture Commission Report 119 (2008): Young child grows in capacity and maturity. enough to consent or is parental structure or position of normal body features people and consent to health care”). Informed consent can be given by a child consent required? Is the consent with the sole intention of improving the This position is set out in two main cases. when he or she has sufficient understanding rational? patient’s appearance of self esteem”. The first is Gillick. (Gillick v West Norfolk and intelligence to understand fully what is 3. The Queensland legislation gives some Procedures such as rhinoplasty & Wisbech Area Health Authority [1986] 1 proposed, the consequences and risks of the guidance on matters for review: (‘nose job”), otoplasty (ear pinning), and AC 112). proposed treatment, and the consequences of a. the views of the child, if sufficiently removal of prominent birth marks could The mother of five girls sought a declaration non-treatment. mature; be considered within the definitions, but that provision by the Department of Health of The physician, parents and the patient b. the views of the parent; appear to be outside the area of controversy contraceptive advice to her daughters, under must consider the type of treatment, the effect, c. the health of the child, and whether or rising concern. It is accepted that these 16, without the parents’ consent was unlawful. other options, the child’s ability to understand the procedure has clinical merit; are performed to prevent embarrassment The question was whether the girls themselves the problem, the expected outcome, the risks, d. the risks of the procedure; and social issues. For this reason the could give that consent. Lord Scarman (p189) general maturity, age and schooling before e. the psychological health of the child, Queensland study excluded any procedures said a young girl was able (competent) to commencing any such surgeries. and whether the procedure will be done for medical reasons to correct physical consent to the advice and treatment when Consent to the treatment is one way of beneficial; conditions which cause problems for she: “achieves a sufficient understanding and looking at it. Increasingly we find people f. the timing of the procedure, and medical, psychological or social welfare. intelligence to enable her to understand fully talking about their rights, their right to whether waiting for adulthood This does not mean any procedure with a what is proposed. It will be a question of fact treatment, children’s rights or parent’s rights. would be better. similar aim is automatically acceptable. whether a child seeking advice has sufficient If a child is not able to give consent, then the

Surgical News Page 16 Vol: 12 No:8, 2011 Surgical News Page 17 September 2011 Notice to Retired Fellows RACS ASC 2012 Thank you to Mr Ian Valentine Lishman Royal Australasian College of Surgeons and Mr Graham Sinclair. st The College maintains a small 81 Annual Scientific Congress reserve of academic gowns for use by Convocating Fellows Kuala Lumpur Convention Centre, Malaysia and at graduation ceremonies at the College. 6 – 10 May 2012 Convocation/Workshops: Sunday 6 May Annual Scientific Congress If you have an academic gown taking up space in your Scientific Sessions: Monday 7 - Thursday 10 May wardrobe and it is superfluous Coordinator to your requirements, the College would be pleased to receive it to add to our reserve. The current Annual Scientific Congress Coordinator will We will acknowledge your W: asc.surgeons.org retire from the position following donations and place your name the 2012 ASC in Kuala Lumpur (May 2012). on the gown if you approve. The College wishes to appoint a Fellow to the role before the current Coordinator retires to ensure an adequate hand-over period.

The Coordinator is based in the Conferences and Events department at the College in Melbourne. The role is remunerated at three sessions per week (plus superannuation) and is supported by a full time member of staff. The Coordinator works closely with the members of the Conferences and Events department, the Executive and Scientific committees convening each Annual Scientific Congress and the Chair of the ASC Planning and Review committee; the Coordinator Programs: is an ex officio member of each of these bodies. Bariatric Surgery International Forum Surgical Education Breast Surgery Medical Student Program Surgical History Burn Surgery Medicolegal Surgical Oncology The Position Description, the Person Cardiac Surgery Military Surgery Thoracic Surgery Specification and an application form are Colorectal Surgery Neurosurgery Trainees Association available from the College’s HR department If you would like to donate Craniomaxillofacial Surgery Paediatric Surgery Transplant Surgery ([email protected]). your gown to the College, Endocrine Surgery Pain Medicine Trauma Surgery Potential applicants may contact the current Co- please contact Katie Fagan ordinator ([email protected]) for on +61 3 9249 1248. General Surgery Plastic & Reconstructive Surgery Vascular Surgery information regarding the role. Alternatively you could mail the gown to Head & Neck Surgery Rural Surgery Women in Surgery The closing date for applications is 30 October. The Katie Fagan c/o Conferences and Events HPB & Upper GI Surgery Senior Surgeons start date is negotiable but it is envisaged that the new Department. Royal Australasian College of Surgeons. 250-290 Spring St, EAST Co-ordinator would begin the role two months before MELBOURNE, VIC 3002 the 2012 Annual Scientific Congress. For more information contact: T: +61 3 9276 7406 Conferences & Events Department F: +61 3 9276 7431 Royal Australasian College of Surgeons E: [email protected] Royal Australasian Surgical News Page 18 Vol: 12 No:8, 2011 W: asc.surgeons.org College of Surgeons Professional Development

Writing Medical Reports in a Brave New World: Covidien Writing medical reports can be made easier if you understand the process Travelling Fellowship Educational Leigh Atkinson The impact of the impairment following Grant Chair, Medico Legal Section Executive Committee the incident on care and maintenance of the plaintiff will be required, together with ongoing rom time to time, all surgeons will be aspects of the need for care and additional required to provide medical reports treatment and possibly physical adjustments to various jurisdictions throughout 2012 F to the home and employment site. The surgical Australia. Twelve months ago, legislation expert should carefully address these issues as was passed introducing national medical they have additional impact on the assessment Younger Fellows face registration. As a result, the medical expert by the courts. many challenges witness is now free to provide medical reports Having completed the report, it needs to be when undertaking post to jurisdictions in any Australian state or dictated, typed, edited and personally signed. territory. Increasingly the courts are requiring expert Fellowship studies or This national medical mobility however witnesses to provide concurrent medical training. The Younger is compromised by the variations in the use reports. This has some advantages in that it Fellows Committee of the American Medical Association’s (AMA) allows clarification of the issues and resolves Guidelines to the Evaluation of Permanent areas of borderline conflict. Still, it can be time- in partnership with Impairment; the 5th Edition is accepted by the consuming. Covidien offers two courts in Australia, the 4th Edition is relevant The courts require the combined experts travelling scholarships in some cases, the 5th Edition in others and in an area of special expertise to outline their modifications of the 5th Edition are also used. areas of agreement, their areas of disagreement, annually which can As surgeons, at times we will receive a and the reasons for this position. In completing help to offset the cost of request from a solicitor to provide a medical reports, it is useful to develop a tight executive studying overseas. report with respect to a plaintiff. On occasions summary highlighting the specific issues in this solicitor requires only a preliminary the case, ideally on one page. This is provided discussion on the documents submitted. at the front of the report. A detailed CV of the You are eligible to apply More frequently, a written report is requested surgeon should be attached. if you are planning to following an examination. Usually extensive In some cases, additional medical train overseas within The surgeon should then review the information or investigations and, in documents from the solicitor are accompanied of conclusions with references if indicated. information may subsequently be provided the next 12 months but by an extensive list of specific questions Finally, the medical report must acknowledge detailed material that has been provided. providing the report, it may be necessary to and then a supplementary medical report is regarding the plaintiff. In addition, the solicitor that the surgical expert witness has read the This will include medical reports from other identify that a supplementary medical report required. These days most cases are resolved returning to Australasia will identify that he or she is responsible Code of Conduct and agreed to be bound by expert witnesses, primary care physician will be required. In some cases, the plaintiff by mediation and it is increasingly uncommon to practice. Applications for payment of the report. At this time, the these rules. records, investigations and reports from may not have reached maximum medical for the surgical expert witness to be required will be accepted until 30 physiotherapists, occupational therapists and improvement. solicitor will also forward material regarding At the time of the consultation, a careful to attend court. However, if one is required to September 2011. civil procedure rules introduced in specific history of the medical incident is required psychologists. With this extensive information, Usually the final report is only applicable attend court, it is to be remembered that the jurisdictions early in this decade. with additional background information the surgeon can now proceed to develop a once the plaintiff has reached maximum expert witness cannot be expected to know all Now the surgeon can proceed with on the current symptoms, the past medical report in his or her area of specialist expertise, medical improvement. In providing the the details of a case that come before the judge. a consultation and examination prior to history, the family history and recreational for example Urology or Orthopaedic surgery. report, the medical expert should identify Finally, it has to be accepted that very often For more providing the final document. In doing this, it and employment activities prior to and The opinion should be expressed the causation for the injury. In addition, in the the surgical expert does not hear the final is important to conform to the rules for expert following the incident. An examination is in language that is concise and that is event of previous injuries, an apportionment outcome of the case. information, evidence for the relevant State or Territory. required and, in the case of a female plaintiff, understandable to the common man. There with respect to the impairment is indicated. In please contact What follows are general guidelines for it is recommended that a nurse or secretary is a place to carefully recognise the issues in that case, the reasons for the opinion regarding Professional producing a good report. be present during the examination and that the case and to recognise the losing person’s the impairment need to be clearly identified. Development The surgeon will be required to identify his this is documented. It is useful to document position as the report is developed. In Increasingly, the occupational therapists Department or her name, qualifications, and the material the length of the consultation and it is usually particular, a final impairment rating under are providing reports on the impact of the For more information, contact P: +61 3 9249 1106 reviewed, together with the history provided necessary to identify the plaintiff with such the AMA Impairment Guidelines used in the impairment on activities of daily living and the Professional Development by the plaintiff, the relevant examination and documents as a driver’s licence. As a medical specific jurisdiction should be then developed. future employment expectations. The surgical Department at +61 3 9249 1106 and F: + 61 3 9276 7432 investigations, the facts and assumptions on expert witness, the surgeon is not entitled to On occasions, the medical expert expert witness will also be required to report [email protected] or visit E: [email protected] which the opinion is based and a summary take over the management of the case. witness may decide that there is inadequate in this area. www.surgeons.org.au

Surgical News Page 20 Vol: 12 No:8, 2011 Surgical News Page 21 September 2011 Professional Development Professional Development Occupational Medicine Course; workshops ” Professional development is important as it supports your life- getting patients back to work long learning. The activities offered by the College are tailored to needs of surgeons. They enable you to acquire new skills and A visit to GMH in Adelaide in May this year showed the integration of health services knowledge while providing an opportunity for reflection about how you can apply them in today’s dynamic world.

Edward (Ted) Schutz, paint shop, and the sequence of fitting all of the A future visit to the GMH Engine Plant in >Building Towards Retirement Convenor components which make up the car, including Fishermans Bend in Melbourne is proposed; 1 October, Brisbane Surgeons from all specialties who are considering retirement from operative or other types of the wiring harness, seats, dashboards, refitting most likely combined with a visit to an adjacent surgical practice will benefit from attending this day long workshop. The program covers key issues he latest workshop was at General of the doors toward the end of the production large industry. including maintaining health and well being, job opportunities after surgery, superannuation and Motors Holden (GMH) in South process, and installation of the engine and drive legal advice, community involvement and building relationships and networks. TAustralia, held in conjunction with train. We also saw part of the plastic injection the ASC in May. Organised by Erik Eriksen, moulding section. Due to time constraints the >Practice Made Perfect; successful principles in practice management together with great support from RACS metal stamping section was not included. 3 October, Brisbane 2011 DATES: and GMH staff, including the occupational We were able to see a wide variety of This whole day workshop focuses on the unique challenges of running a surgical practice. sep – NOVEMber medical team, the 13 participants were able to tasks performed, including many workers Forthcoming events Learn more about the six principles of running a surgical practice. Practice managers, practice view much of the production line of vehicles. with lighter duties suitable for return to work. for your diary: staff and Fellows are encouraged to join these workshops for a valuable learning experience. ACT The workshop opened with an interactive There were many stops during the tour to view Sydney, Friday, 4 November, 2011: A visit to >9 November, Canberra NEW session on occupational health and safety and particular activities and have lively question the Qantas heavy maintenance area combined >Writing Medico Legal Reports NEW redesigned evening program* Keeping Trainees on Track (KToT) medical challenges faced by GMH and their and answer discussions. A robust discussion with either another section of Qantas or a 19 October, Brisbane measures over recent years to reduce injury- of matters of interest arising from the tour visit to the container port to make a whole This half-day (evening) workshop uses lectures, activities and practical demonstrations to help NSW related time off work. GMH has developed completed the visit. day program. Registrations from interstate are improve your skills in preparing medical reports for use in legal matters and giving evidence as a medical expert witness effectively in court. It is an opportunity to gain understanding of >19 October, Sydney NEW a system whereby medical services are an During the site visit we had the enthusiastic most welcome. Keeping Trainees on Track (KToT) the legal rules covering admissibility of an expert report and how to prepare and set out an integral part of the design of work stations and support of management, supervisors and Sydney, Friday 25 November to Sunday 27 expert report to ensure compliance with court rules. >20-22 October, Sydney modified duties, especially for injured workers medical team comprised of an occupational November, 2011: AOA/RACS combined Surgical Teachers Course returning to work. physician, hand therapist, physiotherapist, and Medico Legal Section meeting at the Masonic > 4 November, Sydney >Polishing Presentation Skills Occupational Medicine: getting This session was followed by an extensive Health Services Manager. Centre, Sydney, following similar innovative 21 October, Perth patients back to work and highly successful meetings in Melbourne, tour of many sections of the factory, starting Health services are integrated with factory This whole day workshop helps to advance your presentation skills and provide you with a step- > 25-27 November, Sydney at the assembly line where pressed steel management and production and with great 2009 and Gold Coast, 2010. by-step presentation planning process and practical tips for delivering your message. It is equally AOA/RACS combined Medico Legal components are welded together by robotics to trust and everyone cooperating, the system has applicable to presentation sessions in hospitals, conferences and international meetings. Section meeting form the chassis and body. We then observed produced low injury rates and enviable return For more information email PDactivities@ the initial fitting and removal of doors, the to work results. surgeons.org or call +61 3 9249 1106 >Occupational Medicine: getting patients back to work QLD 4 November, Sydney >1 October, Brisbane This workshop focuses on the knowledge of task adaptation and communication strategies that Building Towards Retirement will enhance patients’ successful return to work. A tour of QANTAS heavy maintenance and >3 October, Brisbane another site visit are being planned. Interstate visitors are most welcome. Practice Made Perfect >19 October, Brisbane NEW YOUNGER FELLOWS LEADERSHIP EXCHANGE STEP (Surgical Teacher Education Program) Writing Medico Legal Reports FEBRUARY 14-16 2012, LAS VEGAS >Keeping Trainees on Track (KToT) NEW >18-20 November, Brisbane 23 Sept, Hobart, 19 Oct Sydney, 21 Oct Wangaratta Vic Sustaining Your Business Each year our College and the Association for Academic Surgery (AAS) in America exchange delegates as part This 3 hour workshop focuses on how to manage trainees by setting clear goals, giving effective of a leadership exchange. The purpose is to two fold; firstly to provide professional development for a Younger feedback and discussing expected levels of performance. You can also find out more about tas Fellow, particularly in relationship to leadership and secondly to promote an exchange of ideas and possible encouraging self-directed learning at the start of term meeting. >23 September, Hobart NEW solutions for common issues affecting Younger Fellows in both organisations. The exchange also aims to >Sustaining Your Business Keeping Trainees on Track (KToT) identify opportunities for our Younger Fellows to access International Clinical Fellow positions in the US. 18-20 November, Brisbane Effective business and financial planning is important for both private and public clinical VIC The Exchange covers airfares, accommodation, transfers and conference attendance expenses for practices. This 2½ day workshop provides the foundation for the development and >21 October, Wangaratta NEW the RACS representative. The 7th Academic Surgical Congress is from February 14-16, 2012 implementation of business plans to sustain business growth and performance. It explores Keeping Trainees on Track (KToT) financial management; from the preparation and analysis of responsible budgetary plans, at the Encore at Wynn, Las Vegas >12 November, Melbourne decision making, management and reporting to the development of estimates and capital Communication Skills for Cancer Interested Younger Fellows are encouraged to apply by 30 September 2011. investment proposals. Clinicians Please contact the Professional Development Department on +61 3 9249 1106, WA Contact Professional Development Department. Ph: +61 3 9249 1106 Fax: +61 3 9276 7432 Email: [email protected] by email [email protected] or visit the website at www.surgeons.org >21 October, Perth - select Fellows then click on Professional Development. Polishing Presentation Skills

Surgical News Page 22 Vol: 12 No:8, 2011 Surgical News Page 23 September 2011 Fellows at the ASC Alfred ICU and Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) present:

The Pyrford Course Nutrition in the critically ill and Alan Apley was appointed to the staff of The Rowley Bristow Hospital Nutrition across the spectrum Reminisces of the Rowley in1947. He enjoyed teaching and organised a series of lectures on Park Hyatt Melbourne, Nov 10-12 2011 orthopaedics and fractures, which developed into a special course Bristow Hospital at Pyrford for the final Fellowship examination. The lecture material was very International Guest Speakers: well organised and requests were made for printed notes. Professor Alastair Forbes When these were seen by Ian Aird, the Professor of Surgery at (an expert in intestinal failure and inflammatory bowel disease) Hammersmith, he suggested to the author that they be published as a book. The first soft bound edition appeared in 1959 and additions  Professor Mette Berger (strong expertise in ICU nutrition, especially nutrition for burns and revisions followed. For the sixth and seventh editions, Apley patients and micronutrient requirements) enlisted the aid of Louis Solomon as a co-author in their production. Sessions include:: In the preface to his book, published in 1959, Apley says that >Nutrition for critically ill patients with Burns, GI surgery many students were not lacking in factual knowledge so much as a >Glutamine supplementation in the critically ill patient >Nutrition Support in the Compromised Gut methodical approach, and the form of his presentation was designed >Nutrition in Practice – The surgical patient to overcome this handicap and to inculcate method. >Making Parenteral Nutrition Safe on the Ward This was to be done by describing physical signs in a constant sequence using a standard series of headings for both orthopaedic For further information and registration visit: conditions and fractures. The headings he used throughout his www.alfredicunutrition.org.au lecture series were; Look, Feel, Move, X-ray. For assistance please call Cathy Oswald on (03) 9076 5397. The lecture room at Pyrford was set up with a stage and examination couch, above which was a large mirror so that the audience could see the patient, and the physical findings being demonstrated. A large number of patients were available for the display of pathological conditions and for candidates to examine. Also, there was a large display of X-ray films illustrating pathological The Rowley Bristow Hospital in Pyrford, UK, conditions. was established in 1907 as a home for poor Nearly all the lectures were given by Apley himself, with some and crippled children by the Waifs and Strays assistance from other members of the staff. He was most meticulous in the preparation of the contents and this would have been done in Society. Over the years it developed into a hospital the same way as he believed papers should be produced – the drawer and special school and later became a centre method. Material would be put aside to be reviewed later, revised of excellence for the practice and teaching of and polished, probably many times. The result was that they were orthopaedic surgery until its closure in 1990 given with great clarity, an air of spontaneity and with the flair of a professional actor. Memorable phrases and jokes were orchestrated into the Reginald Magee Martins Hospital and Special School, with Rowley Bristow taking over substance of the lecture and held the attention of the audience. After Queensland Fellow its direction. delivery, a lecture would be reviewed, improved and rememorised for The hospital acquired its own operating theatre in 1928 and further the next occasion. n the 1950s and 60s, many young medical graduates desirous of a enlargement took place in 1936. In 1937, a decision was made to admit At the end of each day, those who had booked on the ‘full’ course career in surgery made their way to the UK to take advantage of the adult patients and two wards were adapted for this purpose. and had been allowed to examine patients were invited to discuss their Iteaching offered by the Colleges and hospitals. Also, there was the With the outbreak of war, the children were moved to other homes cases, demonstrate their findings and be questioned. On the final day, opportunity to gain operative experience. and the hospital further adapted to take war casualties. When the a trick case was offered to the last candidate. This was a patient with Established since 1977 One favoured hospital was The Rowley Bristow at Pyrford, Surrey orthopaedic department of St Thomas’ Hospital was destroyed in an air- Charcot’s joints and while the findings were being presented, Apley where a three weekend cram course in the management of orthopaedics raid, the whole department was moved to Pyrford. would surreptitiously alter the physical signs a couple of times. Although and fractures was run by Mr A Graham Apley. The FRCS was the basic Rowley Bristow died in 1946 and in memory of his services, the this caused some confusion to the candidate and mirth to the audience, qualification for all branches of surgery and aspiring surgeons, especially hospital was named after him. it was a good example of the mobility of the Charcot’s joints. those with little orthopaedic experience, found these lectures invaluable. In its functioning days, The Rowley Bristow had seven wards With the closure of the hospital, the Pyrford course shifted to This hospital had its beginning in 1907 as one of the homes including babies and children. The consultant surgical staff were Mr F.A the orthopaedic unit at St Peter’s, Chertsey. In a letter in 1992, Apley established by The Church of England for the care of poor and disabled (Sam) Simmonds, A.G. Apley and R.J Furlong. said that although he enjoyed being involved with the course there, it children many of whom suffered from such conditions as tuberculous The hospital retained a liaison with St Thomas’ from the days of lacked the magic of Pyrford. bone disease, the effects of poliomyelitis, rickets, other bone diseases Rowley Bristow and George Perkins and members of the Rowley Bristow Alan Apley died in 1996 but he will always be remembered as one and deformities; all of which necessitated long stays in hospital. Because staff would attend St Thomas’ each week to assist with the outpatient of the finest teachers of his subject of all time. Specialist Consultants in permanent and temporary medical staff placements. of this The Board of Education in1918 insisted that a school should be clinic So what began as a service for the welfare of waifs and strays added to the home and provided with teachers trained to teach disabled The hospital continued to work with the National Health Service became a centre of excellence for the practice and teaching of Contact Carol Sheehan children. until 1962 when it was joined to the Woking and Chertsey Group. It later orthopaedic surgery. Telephone 03 9429 6363 In 1922, Mr. Rowley Bristow, orthopaedic surgeon at St Thomas’ passed to the control of the North West Surrey Health Authority. The Rowley Bristow Hospital has gone. All that remains as Facsimile 03 9596 4336 Hospital, London, came to live in West Byfleet. He took an interest in The Rowley Bristow Orthopaedic Hospital finally closed its doors a reminder is a grey granite stone at the one-time entrance to the the welfare of the inmates of the St Nicholas and St Martin’s homes and on 21 December, 1990 and its services transferred to St Peter’s hospital hospital grounds which has the inscription, “nearby once stood Email [email protected] became the honorary surgeon. Any children who required surgery at Chertsey. The area became derelict for some years and the grounds were the world renowned Rowley Bristow Orthopaedic Hospital, which Website www.csmedical.com.au that time were transferred to St Thomas’. The establishment gradually used for paint-ball war games. Finally it was redeveloped into a residential began as a Waifs & Strays Home 1907 – 1990”. Address 22 Erin St Richmond 3121 developed into a hospital and became known as the St Nicholas and St estate named as the St Nicholas Crescent and St Martins Mews. The rest is memories.

Surgical News Page 24 Vol: 12 No:8, 2011 Surgical News Page 25 September 2011 College in the news THE

coverstory HERITAGE College opens doors to crowds GROUP Speaker: Mr Nick Doslov in Melbourne Open of Renaissance Bookbinding House Friday 23 September 12pm A chance to showcase the historic building in Melbourne at The Royal Australasian College of Surgeons, 250-290 Spring Street, East Melbourne Hughes Room

$30 inc. GST per person and lunch. For further information contact [email protected] or phone: 9276 7447

PLEASE RETURN THIS SECTION WITH PAYMENT TO: ROYAL AUSTRALASIAN COLLEGE OF SURGEONS Megan Sproule, Resources Division College of Surgeons Gardens, 250-290 Spring Street, East Melbourne, VIC 3002 Alternatively fax completed form to +61 3 9249 1219

DELEGATE INFORMAtiON (Please print in BLOCK LETTERS) Title / Given Name: Surname: Mailing Address: Left to right: Barry King and John Royle talk of the history of the building. Top to bottom: Crowds lined up in the driveway by mid-morning; Curator Geoff Downe guiding a tour, Fellow Cas McInnes in the Library. A long two days: Tour guides Cas McInnes, Geoff Downe, Barry King and John Royle. Postcode: Ph: E-mail n a cool weekend at the end of July, As members of the College’s Heritage had come to see the College. Many replied that Dietary Requirements: the College’s historic Melbourne Committee, the Fellows have always found it was such an interesting building in such a Oheadquarters opened its doors to the building fascinating, though even they prominent position, they had passed by and become part of the Melbourne Open House were surprised to see the queue of people that wondered what it was used for and what it was PAYMENT OPTIONS (MOH) program for the first time. formed outside and snaked up the driveway like on the inside. 1.Pls make all cheques/bank drafts payable to the Royal Australasian The program began in 2008 as an over both days of the program. Both days were a great success in College of Surgeons (payable $AUD) opportunity for the public to see some of the MOH volunteers allowed around 20 people showcasing the College, with about 750 people 2. The following Credit Cards are acceptable architectural and engineering masterpieces of in for each tour led by Geoff Down or one of coming through. Queues became so long on Amex Diners Club MasterCard Visa card the city that are not often showcased. Despite the Fellows. They were shown the original the Sunday that the wait to get in was up to only opening eight buildings in its first year, front façade, the Foyer and Gallery, the Library, 90 minutes and unfortunately some had to be Card No: the day was a huge success with more than the Courtyard with the remnants of the Old turned away. This despite the best efforts of 30,000 visitors. The program has grown to Model School, the Museum and also the Hailes the tour guides who worked past 5pm to let as Expiry Date ……....… /………... Month Year the all-weekend event that this year saw 75 Room and the Council Room. many people as possible into the building. buildings open across Melbourne, and over Visitors were enthralled by the stories of sur- Card Holder’s Name 106,000 visitors. gical procedures of times past as well as some of Card Holder’s Signature College Curator Geoff Down liaised with the the better known characters in the College’s histo- MOH organisers and opened the College both ry. There was also considerable interest in the role All involved are to be thanked for Amount (inc. GST) $ days from 10am until 4pm with the help of MOH the College plays in the education of surgeons their efforts. The weekend will be volunteers, some College staff, and Fellows Cas today and the maintaining of surgical excellence. assessed to consider whether we McInnes, Barry King and John Royle. Fellow Barry King asked some why they participate in next year’s program. Date……… /……… /…………

Surgical News Page 26 Vol: 12 No:8, 2011 Surgical News Page 27 September 2011 Education Biogel aims to always be the safest, highest quality surgical glove to give you superior Competent protection surgical candidates The facts are: How the Minimally Competent Candidate is • Biogel gloves have the best freedom from holes (AQL 0.65) identified at the Fellowship examination • Every single glove is air-inflated and visually inspected to test for holes • Competitors’ gloves are more likely to have a hole out of field and careful attention is given to their modified to suit the type of written questions 1 own attributes and expertise before they are given. Like the vivas, the essay type questions the pack appointed to the Court of Examiners, to ensure are marked using the close marking system. • Biogel is the only major surgical glove brand that is they are capable of conducting this high-stakes For multi item assessments such as pyrogenic-free assessment process to the level required. MCQ or multiple short answer questions, Spencer Beasley • Biogel is the only major surgical glove brand with an Chair, Court of Examiners It is the responsibility of the examiners in the College prefers the “Angoff” method. each surgical specialty to determine the pass- The Angoff method of standard setting is exclusively powder-free range he Fellowship Examination is an mark, cut off or benchmark for each segment criterion referenced: this allows all competent assessment tool used by the specialty of the examination. These are clearly defined to candidates to pass the examination, unlike the Ttraining boards as part of their Surgical reflect what would be expected of a “minimally absolute or norm-referenced methods where Education and Training (SET) programs competent candidate”. a proportion of the candidates will fail. The to assess whether candidates are ready to The minimally competent candidate is Angoff method estimates the probability that practice unsupervised in the community as defined as one who “just passes” the examination a minimally competent candidate (i.e. the safe and competent surgeons. In addition, the and has “just” reached the standard of being just passing candidate) would (not “should”) 9 out of 10 surgeons agree that Biogel Fellowship Examination may be used to assess able to practice as an unsupervised consultant answer that question correctly. gloves provide the required quality and the comparability of International Medical surgeon on their first day of practice. Of The examiners review the questions and Graduates (IMGs) who wish to practice in necessity, the Court and specialty boards ensure estimate the probability for each question. durability needed throughout surgical Australia or New Zealand. that the standard is set at the appropriately high The probabilities are averaged over a number procedures2 There is vigorous debate as to what should level for this, primarily for the protection of the of examiners and a number of questions be the attributes and competencies of a community at large. to give a cut-off score or pass mark for that competent surgeon on the first day of his or In the viva segments of the examination, segment. The more examiners that can her consultant practice. the specialty mini-courts look at the pre- estimate the probability and the larger the The result of a recent international study The challenge for the specialty training prepared questions and examination material number of questions the more statistically boards, the Education Board of the College and to determine, based on a consensus of expert accurate the cut-off score is. Once a cut-off showed that in comparison with other glove the Court of Examiners is to define an agreed opinion, what constitutes a candidate’s score is determined by the standard setting brands, Biogel gloves have significantly standard that the candidate must reach to pass minimum level of competency. There may be process then a norm reference method is used 3 the Fellowship Examination. The intention several sections within that viva that relate to to convert the candidate’s score into bands to fewer observed failures is to pass all candidates who are safe to work different competencies: each will be assessed match the close marking system. unsupervised in their vocational scope. and marked separately. The Angoff method is dependent on: One issue is that the Fellowship If the pre-determined level is achieved, a vigorous discussion of the definition of a Examination in its present form is not a pass mark is awarded. If the candidate’s minimally competent cohort of candidates, designed or able to test adequately all nine of answers fall just below the required standard the expertise of the examiners estimating the the College’s defined surgical competencies. a borderline fail mark is awarded. If the probabilities, the validity and reliability of the In reality, it is only able to test in any detail candidate’s answers are well below standard questions and the number of examiners and medical expertise, clinical judgment and, to or there are concerns about patient or safety, a questions. It takes into account the difficulty some extent, communication. It relies on the definite fail mark will be given for that segment of individual questions so that different other surgical competencies to be assessed or section of the viva. examinations can be appropriately comparable. during SET training (or, in the case of IMGs, On the other hand, where a candidate’s Once the results of the examination during a period of supervision). answer is exceptionally good or outstanding are available, poor questions with a low The assessment tools used in the this too is recognised. The close marking discriminatory value can be identified and 1. MKT004 Why Choose Biogel Fellowship Examination include written tests system (akin to the modified Likert) scale of excluded and the cut-off score recalculated, 2. Data on File (2008). Proprietary independent market research. and oral vivas. The actual types of written marks is awarded for each marking point. The thus improving the validity of the process. 3. MHC In Use Surgical Glove Failure Rate Comparison Study G009-005. and oral assessments vary between the four possible scores range, in 0.5 increments, The Court of Examiners is very much (4658 total gloving events, glove brand code missing for 17 cases) surgical specialties in both form and content. from 8 (equals a definite fail) to 9.5 (equals aware that the ultimate aim of the Fellowship Each specialty mini-court has seven separate outstanding). Descriptors are used for each Examination is to ascertain whether a segments, and in general two of these are marking point to facilitate the award of an candidate who presents for assessment will be written segments and five are vivas. Each is appropriate mark. a safe and competent colleague. marked independently by two examiners. The For the written segments of the With Mr Richard Lander, Deputy Chair examiners are deemed to be experts in their examination, the marking may be different or (NZ) Court of Examiners The Mölnlycke Health Care and Biogel ® names and logos are registered globally to one or more of the Mölnlycke Health Care Group of Companies. Distributed by Mölnlycke Health Care Pty. Ltd., 14 Aquatic Drive, Frenchs Forest NSW 2086, Australia. T 02 9453 1144. F 9453 1155. Surgical News Page 28 Vol: 12 No:8, 2011 www.molnlycke.com.au ©2011Surgical Mölnlycke NewsHealth Care Page AB. 29 All rightsSeptember reserved. 2011

Biogel_Quality_Advert.indd 1 1/08/2011 10:17:06 AM Food for thought : A Personal Piece

Death of a College Theresurrection Glenn McCulloch is a former RACS Councillor and NSA President. The contents of these two articles are not necessarily the views of the RACS or NSA (or indeed possibly the author himself). They were written to stimulate thought and discussion.

Glenn McCulloch College is to have a “Lazarus” moment it will be in a different body – probably as a body of general surgeons, which is how the RACS t is with great sadness that I report the started. death of the Royal Australasian College It has been a strange disease as it has also of Surgeons (RACS). The terminal event I infected other bodies that thought they were occurred on 30 June, 2016, when it went into immune to the disease. The orthopaedic voluntary administration due to financial surgeon numbers in the AOA dropped as there problems caused by a marked fall in Fellowship were about 30 per cent of their members who numbers. did not want to leave the RACS and voted with Since the specialty societies left the College their feet by remaining Fellows and resigning t is with great pleasure that I report that SET was disbanded as they had nothing to con- One can only speculate what effects the between 2012 and 2014, there has really only from the AOA. the resurrection of the Royal Australasian sider and the Education Board reduced in size. Federal election in June 2014 may have had; it been support from the general surgeons and They were also worried about the large ICollege of Surgeons (RACS) is nearly In the view of some, the first treatment that was a close call. The Gillard government looked the vascular surgeons. The actual fee paying increase in fees to the AOA that were needed complete. The final triggering event occurred began to reverse the debilitating illness was as as if it may have be re-elected but two strong Fellows fell from the heydays of 2011 of about for running the new body. Again this in late 2014 when all nine specialty societies early as 2011 when the composition of the IMG candidates who happened to be surgeons won 5,500 to only 1,500. Their subscriptions new variety of the disease seems agreed that starting in 2016 they would meet assessment panels was altered such that there their seats from the Independents with their did not maintain the organisation contagious as Neurosurgery at the Annual Scientific Congress at least every were two specialty representatives on each panel. clear and articulate policies on health. and many departments closed. and Urology are seeing similar second year. This altered the dynamics such that the As you would recall the Gillard government The offices in the ACT, SA, NT, symptoms of dwindling The specialties that had been drifting away sole specialty representative was not a “voice in campaigned on a policy of “fixing health”. How- Tasmania and WA closed in 2014 numbers in the face of returned with vigour when they realised that the wilderness” and the view of the specialty ever it was apparent that their commitment to as a part of the atrophic process. increased fees. surgeons of all flavours needed to stick together was noted and given greater weight. There were building a $500 million Academy of Specialty Oddly enough the NZ office has At the same time as the and that there were indeed matters of common no longer the controversial decisions that had Training in Canberra and the employment of a strengthened as the NZ specialty RACS corpus was struggling interest to discuss. dogged this body in the past. number of overseas academics to run the train- societies stayed with the College. with its illness, the Gillard government The number of Fellows attending the last The Projects office was barely able to ing programs in all surgical and medical special- It is hard to see exactly when the fatal illness was re-elected in June 2014 with an agenda of ASC in 2016 was the largest ever with more cope as there were a larger number of Fellows ties was “pie in the sky” ideology. began. Nobody really saw the seriousness of many pro bono activities of the College. As well “fixing health”. One of their first acts was to than 3,000 attending. One of the overseas volunteering for the various projects. New good It was also apparent in the press material the illness until it was too late. There were some as the specific symptoms there were general commit to building a $500 million Academy guests commented that there was no equivalent altruistic overseas aid projects were started and released by the College that the true cost of symptoms in the orthopaedic department symptoms of malaise and lack of interest in life. of Specialty Training in Canberra and employ meeting in the world as elsewhere the Surgical old ones expanded. the proposal would have been a capital cost of in about 2006. At first it was a niggling At first there was a vigorous immune response, a number of overseas academics to run the Colleges had splintered into smaller sub-groups. As for the Finance section, they were $800 million and on-going running cost of in pain related to IMG assessment and trainee but as the defence mechanisms of the body training programs in all surgical and medical It is hard to see exactly when the previously initially sceptical when the subscriptions were excess of $80 million per year for surgery alone. dismissals. In some views it started with a weakened, the reactions became sluggish. specialties. progressive illness started to improve. It may decreased, but as there were fewer meetings After the election the new Federal Minister malaise in the SET Board of Training when As for the Finance section, there have been Many of these academics had been involved have been when far-sighted persons within the and committees and less travel costs the cost of Health announced there would be no change reasonable changes to the SET Orthopaedic no persons doing a Great Depression style leap in the changes to medical careers in the UK (you College realised that each of the SET Specialty of running the College decreased. Maybe it to the excellent Government medical indemnity program were rejected by the Board of SET. off the building, but some have been seen to remember that program that resulted in some Boards knew their own area well – orthopaedic was my imagination, but no longer did they support packages. She stated that she realised At about the same time this malaise spread stumble on their way down the front steps. of the finest UK graduates moving to Australia surgeons were the best ones to run orthopaedic stumble down the steps at the front but took that without these measures the system of to Neurosurgery. The exact aetiology of the in the early 2000s). Last month the new Federal training, urologists knew about how to make them two at a time. health provision in Australia would collapse. illness is yet to be defined, but it does seem Final days Minister of Health announced the hard-fought urologists, and so on. I have noticed a rather odd thing – the less As for me, when the illness was at its peak to be moderately infectious in the early stage There was some hope of a financial saviour changes to tort reform would be reversed in the They did not need micro-management involved that the College was in the Specialty I was going to cease my pro bono activities for and highly contagious in the later stage. In late when IKEA put in a bid for the Spring Street interests of “pluralistic equanimity”. Already from the RACS in regard to how to select their Societies, the more involved the surgeons the College and retire from College affairs, but 2012 it also infected Plastics and Urology and building for its new central Melbourne the Medical Indemnity organisations have trainees, how to assess their progress, develop wanted to be in the College. Perhaps this was the College and the Specialty Societies seem to in 2013 ENT, Paediatric Surgery and Cardio- showroom but they withdrew it when they announced rises of 400 per cent. the curriculum and similar educational mat- because the Fellows involved in Specialty have a new vigour. As I mix with the younger thoracic. found that Heritage Victoria would not allow As for me, I am so gloomy about the future ters. It was realised that each SET Board had to Society and College matters felt that they were surgeons and Fellows I feel a youthfulness that It also proved to be a painful illness with the building of a 15 story car park on site. They of surgery that I think I will stop my pro bono be self-reliant and run their programs in a fair appreciated and their views taken notice of. I have not felt for several years. I am sure that great anguish in the Projects office as many were some unconfirmed rumours of a Funeral activities for the College and resign. I tried and proper fashion using the Brennan princi- No longer were there meetings at which Dr Alzheimer will pass me by and that I can good altruistic overseas aid projects had to be Director being interested. to do so on-line, but the website has closed. ples (which have been mandated by the AMC); the Specialty Representatives felt that their hand on my knowledge and experience to the terminated early or not commenced due to The Administrator’s doctors have given an A resignation letter sent to Spring Street was they were, after all, a group of professionals. presence was simply to say that there had been next generation. The only problem is that there lack of Fellows and staff. There were also staff infusion of a magic drug that might fix the returned “not known at this address”. I am With this change came the need for fewer consultation when in reality no notice was are so many persons interested and enthused redundancies and a lack of volunteers to do the problems. The prognosis is grave and if the resigned to not being able to resign. meetings and supervisory Boards. The Board of taken of their views. that I may not be elected at the next election.

Surgical News Page 30 Vol: 12 No:8, 2011 Surgical News Page 31 September 2011 Fellowship services Professional Development

Fellowship Survey – Helping Elective or retirement? your College work for you Preparing for retirement can be daunting without the right knowledge The results of last year’s survey will help us with our strategic direction

government, communication with Fellows, The survey results suggest there is limited protecting the title ‘surgeon’ and promoting the use of the Member Benefits Program by Fellows, value of ‘FRACS’. with 17 per cent of respondents reporting that Fellows are satisfied with the range of they have accessed the program. The services communication and publications currently Fellows would most like to see offered through available. A high proportion of Fellows reported the program are car hire, travel and corporate Cathy Ferguson that they were satisfied with Surgical News (80 memberships. In addition to the options Chair, Fellowship Services Committee per cent). This was followed by the Australian provided, other suggestions made by Fellows and New Zealand Journal of Surgery (70 risk management and medico legal areas were include New Zealand focused benefits (also ellows have provided valuable feedback per cent), Council Highlights (65 per cent), the most popular in 2006. the most frequent suggestion made in 2006), on the services and activities offered Regional Newsletters (54 per cent) and Library Sixty per cent of Fellows (n=1716) reported discount loan rates and credit card offers. Fby the College as part of the 2010 Highlights (53 per cent). The College Pocket that they contribute to the College in a pro Fellows were asked to nominate one Fellowship Survey. The survey results identify Diary received a mixed response with 50 per bono role, an increase from 44 per cent in change they would like to see made by areas for improvement, strengths and the path cent of Fellows indicating satisfaction. 2006. When asked about the type of pro the College, with more than 1,200 Fellows Fellows wish to take the College in the coming Fellows are also satisfied with their recent bono roles undertaken, over two-thirds of providing feedback. The most frequent years. The survey and recommendations were contact with College staff with two-thirds of respondents reported that they contributed responses received were to reduce bureaucracy considered at the June 2011 meeting of Council. respondents reporting satisfaction. In addition, to the College as a surgical supervisor and and ensure greater transparency, focus on The Fellowship Survey was conducted almost two-thirds of respondents indicated over half as an educational instructor/ strengthening relationships with specialities, between October 2010 and February 2011 that they were able to make contact with presenter. Other pro bono roles reported encourage innovation and offer more with all active and retired Fellows encouraged the appropriate person to assist with their include examiner/interviewer, Council/board/ interactive education, more direct support for to participate. A response rate of 45 per cent enquiries ‘always’ or ‘very often’. committee member, international aid as well surgeons and be more representative of all (n=2,929) was achieved. The College last gauged Of those active Fellows with a RACS as a contributor to the ANZ Audit of Surgical specialties and regions. the views of the Fellowship in 2006. Almost 60 CPD Program requirement, 72 per cent of Mortality and the ANZ Journal of Surgery. Further analysis on specialty and regional per cent of the Fellowship participated in the respondents reported that they were satisfied Fellows are satisfied with the College variations in the results will be featured in a 2006 Fellowship Survey and the College will with the College’s efforts to assist Fellows to library services and website. Active Fellows future edition of Surgical News. A full report now reflect and build on the changes that have meet the requirements. In addition, 44 per reported a higher use of the College library on the 2010 Fellowship Survey is available at Fred Leditschke the partner’s perspective of this potential occurred during this time. cent (n=940) of Fellows indicated that they services (including journal article request www.surgeons.org. Convenor radical change in life-style. Importantly, Fellows who participated in used CPD Online. This is a significant increase service, literature searches, loans and the The results from the Fellowship Survey There will also be presentations by the survey were a representative sample of when compared to 2006, where only 20 per cent online library) than retired Fellows. This was are being reviewed by Councillors in key etirement is an event we must all experts on the psychosocial implications; the broader Fellowship in terms of specialty of Fellows reported that they had used CPD particularly notable for the online library and governance roles and College management, prepare for. It is far better to plan estate planning, wealth management practiced, regions, age and gender. Active Online. Fellows provided a range of suggestions contrasts with results from the 2006 Fellowship with a particular focus on improvements to Ran elective retirement in five, 10 or and superannuation; medical indemnity Fellows comprised 2,583 of the respondents, on how to continue to improve CPD Online. Survey. In terms of satisfaction, 60 per cent of the services and programs provided. Feedback 15 years than to ignore the inevitable and and the legal obligations of closing down while 346 were retired. Survey results show that Fellows active Fellows indicated that they were satisfied will be instrumental in strategic planning for have to face the situation acutely. your practice. Dr Gino Pecoraro, the past Overall, Fellows are satisfied with the role of continue to have an interest in a wide range with the library services provided, compared 2012 and beyond, to ensure that our services, A ‘Building Towards Retirement’ president of the AMA, will expand on a the College and the services provided with over of professional development activities. The with 44 per cent of retired Fellows. communication and programs meet the needs workshop is being held on Saturday, October topic with which he has been very involved two-thirds of active Fellows (68 per cent) and 84 strongest expression of interest (more than Sixty-five per cent of Fellows (n=1,845) and expectations of Fellows. 1, 2011, at the RACS Queensland Regional – the implications of National Registration. per cent of retired Fellows reporting satisfaction. two-thirds) was for surgical teaching topics reported using the College website with strong Office, 50 Water Street, Spring Hill. If you As medical professionals, we have been Seventy-six per cent of respondents consider the (e.g. assessment and feedback) and more than levels of satisfaction being reported. A range of are considering retirement totally, partially very involved in our varied leadership roles College to be of ‘real benefit’ as a Fellow. This half of Fellows reported interest in managing suggestions were made by Fellows on how to or are merely in a contemplative mood, – as clinicians, administrators, teachers or meets a key performance indicator for the 2010- adverse outcomes, leadership/managing improve the website further, many of which this all day gathering with presentations examiners and assessors. The workshop I would like to take this 15 Strategic Plan. people and business/practice management. are being addressed with the current website by your surgical colleagues John Quinn, will provide an opportunity to examine opportunity to thank the More than 1,800 Fellows provided feedback Workshops continue to be the most preferred redevelopment and review. significant number of Fellows who Bill Coman, Errol Maguire, Ian Gough and where these roles might take you in the on areas that the College could improve on, delivery method, followed by presentations/ Fellows consider the Annual Scientific took the time to participate in the Leigh Atkinson may appeal. future as you pare back surgical practice. with key responses including the Surgical lectures and online learning. Fellows wish to Congress (ASC) to be equal to other scientific survey. The survey has provided They have some understanding of Come and join in the Q&A session Education and Training Program, relationships see professional development offered alongside meetings in terms of relevance, registration and valuable feedback and gives winding down from surgical practice which with the speakers, sponsors and enjoy some with Specialty Societies and Associations, scientific meetings, on weekends and as half day value, however a third of Fellows felt the ASC Council confidence that decisions can be of help to you and hopefully provide social intercourse with your colleagues. promoting collegiality and unity, lobbying and options. These results are reflective of the 2006 was below other meetings for relevance and and plans for the future reflect the some assistance with your diagnostic Conveners Roger Wilson and Fred political negotiations with external groups and Fellowship Survey; however, in terms of topics, value for money. views of the majority of Fellows. dilemmas. Mary Cooney will focus on Leditschke look forward to welcoming you.

Surgical News Page 32 Vol: 12 No:8, 2011 Surgical News Page 33 September 2011 Part-time Training The Royal Australasian College of Surgeons Member Advantage Benefit Program

Tried and tested A part-time position at the Royal Adelaide Hospital has proven its worth, and Susan Neuhaus would like to see more in the training landscape

Some successful part-timers: Eu Ling Neo and Bev Fosh with their families. he only ‘stand-alone’ part-time training position in general surgery currently Tavailable in Australia has now been shown to work successfully and similar models should be replicated across Australia, according to Associate Professor Susan Neuhaus. Associate Professor Neuhaus, who works with the Breast Endocrine and Surgical Oncology (BESO) Unit at the Royal Adelaide Hospital (RAH), said the unit had provided the part-time Associate Professor Neuhaus said the “Other disciplines in medicine, such training to three surgical trainees since 2007, all of position offered in the BESO Unit had been as obstetrics and physician training have whom have now passed their Fellowship exams designed to meet the needs of the unit and embraced part-time training, but surgery and returned to full-time work. the trainee, and both RACS and hospital has been more challenged in terms of Take advantage of your benefits She said the part-time training model not requirements. The trainee has two days off implementation. only worked to benefit the trainee, but also the per week, but they have each achieved above “While in the UK there is the aim of unit with the position designed to cover peak ‘pro-rata’ exposure in terms of operative cases, making up to 20 per cent of positions available RACS Fellows and Trainees can enjoy these great offers and many more.. activity days and with trainees able to cover for outpatient exposure and after-hours on-call. on a part-time basis, in Australia there remain colleagues on leave. There is also exposure to the private sector, concerns about the adequacy of clinical She said the three-day per week stand-alone which provides increased clinical exposure exposure, the impact on patient outcomes and Accommodation HotelClub Insurance Services Wide range of cover options position was much easier to organise than job- outside of the public hospital, mentoring continuity of care issues. Explore the world and enjoy up to 15% off accommodation rates at over 69,000 Protect your family and your assets with a wide range of personal insurance services, share arrangements and more cost-effective for opportunity and compensatory income. “There are also mysteriously entrenched hotels worldwide. Compare rates from lists of hotels available at your destination available to RACS Fellows and Trainees*. Enjoy complete peace of mind with reliable hospitals. She said that the role of the Board of concepts that part-time training is only for through our easy-to-use reservation facility. Bookings accessible online. cover at great rates within the industry. “There are currently two basic models Surgical Training was pivotal to selecting the women, or that it demonstrates a lack of of part-time training,” Associate Professor most suitable candidates. commitment to surgical training. Neuhaus said. “This stand-alone position is of most “Yet we know now that far from Packaged Tours Intrepid Travel Car Rental AVIS “There is the job share model based on a benefit to more advanced trainees who are demonstrating a lack of commitment, the Enjoy a 10% discount on all land tours through Intrepid Travel. Choose from over Access specially negotiated rates and reduced excess liability for passenger vehicle shared full time position, yet one of the key approaching their Fellowship because they ability to manage dual careers, the demands 1,000 trips available in over 300 destinations worldwide. Browse your options rental in Australia, New Zealand and other locations worldwide. Quote RACS AWD have the increased clinical experience, patient of training and family or other commitments disadvantages of this model is the need to find today via the Member Advantage website. number P203701 when making a booking. Available online or over the phone. an equivalent-level trainee wanting a part-time experience, skills and maturity to be able requires a high level of motivation and position in the same location at the same time to walk in and know where everything and organisational skill. everyone is up to,” she said. “In our current environment, we are all and in the same sub-speciality. Airline Lounge Memberships Qantas Club Car Buying Service Private Fleet “The employer also carries liability for two “At the same time, given that they are so challenged to find creative ways to break the Take advantage of our corporate rates and save hundreds on Qantas Club airline Receive up to 20% off the dealer price on new cars and a range of related finance employees and contractual issues of overtime close to completing their training, it is very nexus between ‘hours worked’ and perceived lounge memberships. Save $405 (AUD) on new two year memberships, and $255 services through Private Fleet. RACS Fellows and Trainees also enjoy free access to and superannuation. important that they be given the opportunity competence, and this model achieves that. “By contrast in 2006 we successfully to maintain their skill levels and not lose “It is now clear that such stand-alone (AUD) on 1 year memberships. the service, at a saving of $178. lobbied the State Department of Health for confidence by interrupting their training.” positions can benefit the unit, the trainee and the funding to develop a ‘stand-alone’ position on Since the stand-alone part-time position RACS by creating flexible training options to help the basis that our unit had sufficient excess was first offered, the BESO unit has trained overcome workforce shortages while increasing Magazine subscriptions iSUBSCRiBE Online Wine Sellers Cellarmasters / NZ Wine Society capacity in teaching and training - not for one trainee who returned after the birth of her diversity with the surgical profession and helping Access discounted rates on over 2,000 popular magazine titles via the iSUBSCRiBE Save $30-50 off your first online wine order with Cellarmasters (Australia) or NZ a full-time resident, but sufficient for a half second child, a trainee who needed time away retain our trainees. In addition it has effectively online store. Login to the Member Advantage website to redeem your discount Wine Society (NZ). You can also enjoy an ongoing 5% discount on all subsequent time position. from surgery to give evidence in a lengthy trial added a training position to the hospital. entitlement. Available to Australian and New Zealand Fellows and Trainees. orders. Visit the website to receive your discount code and voucher for purchasing. “The part-time trainee is employed and another with a young family who had “While not a panacea, this model has been alongside a full-time trainee and/or Fellow developed thyroid cancer during training. proven to work, it meets all the regulatory for 12 months in an accredited position, which Associate Professor Neuhaus said that now requirements of the College and the hospital gives them the equivalent of six months that all trainees had successfully passed their and we would strongly encourage more training while allowing for greater continuity exams and returned to full-time work it was positions like this to be available across Call Member Advantage on 1300 853 352 and stability for both the resident and time for the Australasian surgical community Australia and New Zealand.” or visit www.memberadvantage.com.au/racs the unit.” to embrace similar models of flexible training. With Karen Murphy NZ Fellows & Trainees call +61 3 9695 8997 Surgical News Page 34 Vol: 12 No:8, 2011 *Service available to Australian residents only. Surgical News Page 35 September 2011 Fellows abroad

We treat an enormous “ number of patients … and it was a pleasure to share these cases with my colleagues at the meeting”

For the people

Left: Barry with new graduates from the University in Jimma; with a baby rescued after the death of her mother. Above: A typical case. Barry Hicks has worked in Ethiopia on and off for more than 40 years and has seen the worst, but is drawn back to the people Africa shortly after receiving his Fellowship in the country for better pay and conditions ago, Mr Hicks said his PSA count was again on 1967. He began his life as a general surgeon in elsewhere and also many sick people turned the rise and that depending on his health he ack home in Queensland after his latest Mr Hicks, who was recently awarded “That is a tremendous waste of time and Shashemane working with Christian Mission away from receiving medical care for lack of would return in November to determine if the stint working and teaching in Ethiopia, the Member of the Order of Australia for his extremely frustrating and when you add to groups in impoverished hospital theatres with resources, yet still he keeps returning. improvements he had insisted on had begun to Bgeneral and thoracic surgeon Barry services to international humanitarian aid, that the lack of fly screens in the theatre and his surgical text books opened on a violin In July this year, he gave a presentation be met. Hicks speaks of his time there with an amused now has to decide what to do in the future. At the sewerage pits outside – and the inability stand beside him when dealing with situations at the Queensland RACS’ Annual Scientific “I felt that the only way to force change was tone that mixes great affection with enormous the moment, in his absence, there are only two to scrub between every procedure because of he had not previously met. Meeting focussing on the advanced pathology to refuse to sign up to a new contract until I frustration. surgeons teaching and training 270 medical a lack of water – it can become an extremely commonly seen in Ethiopia, but rarely found saw a desire to change,” he said. On the upside are the enthusiasm and students (increased this year from 150 per draining experience. Difficult times abroad in Australia. “All surgery was cancelled recently at learning capabilities of the medical students annum) and 17 post-graduate surgical trainees “There is so much exciting pathology to Forced to leave at various times through “People in Ethiopia tend to present very, one stage because there was no gauze in the under his tutelage and mentorship at Jimma at the university hospital. be seen in Ethiopia, so much to learn in terms personal illness, political revolution and very late which means we see some fascinating country and when things like that happen it is University, an institution educating 20,000 “My heart belongs in Ethiopia in a way, of disease progression, yet there is no research government decisions, Mr Hicks held a pathology,” he said. easy to lose heart. students based in the largest city in south particularly with the poor people, but there conducted, a very limited range of laboratory number of posts back home in Australia “We treat an enormous number of burns “I’m very grateful to my wife Robin who western Ethiopia. are times when you have to ask if it is worth it tests in the hospital and some tests undertaken including as Director of Surgery at Townsville patients partly because of untreated epilepsy; has stood by me in this work all these years On the downside of the ledger he lists the to keep going when you keep facing problems can take a month or more to finalise such as Hospital. we see an enormous number of intestinal and listened to my woes and when I received uncovered sewerage pits that lie just outside the every day that would be easily solved if there histopathology and they are still by no means His autobiography published in 2009 and obstructions and very advanced thyroid the AM recently I knew that 50 per cent of it operating theatre, the lack of basic equipment was the will to solve them,” he said. always accurate. titled Have Scalpel Will Travel, describes his disease and it was a pleasure to share these belonged to her.” and hygiene supplies and a cultural dynamic “The tertiary hospital I work and teach at in “But at the same time, the students are experiences treating everything and everyone cases with my colleagues at the meeting. Mr Hicks said that while many Australian that encourages lateness. Jimma serves a population of 15 million people, very bright young people, usually keen to learn from sick children to women in obstructed “Many people in the audience later said surgeons may wish to offer their services Now with his latest teaching contract at but we are only doing about five elective cases which makes it difficult to walk away, so this labour to men with gun-shot and spear they found the combination of the conditions to improve the surgical services offered Jimma University complete and a new one per day because few people in Ethiopia turn up year I’ve stipulated certain changes I wish to wounds, sometimes working only by the light we treat and the conditions we treat them in in Ethiopia, bureaucratic and complex under negotiation, Mr Hicks has made it on time which means that we quite often have see, in the hope of pushing change.” of candles. totally unimaginable and I suppose it is from administrative requirements made that clear he will only return if basic standards are an 8am theatre list that cannot start until 10am Mr Hicks has worked in Ethiopia He has known colleagues murdered, seen an Australian perspective.” difficult. improved. when all the theatre staff are ready. periodically for over 43 years, arriving in scores of the brightest young doctors leave Having suffered prostatic cancer some years With Karen Murphy

Surgical News Page 36 Vol: 12 No:8, 2011 Surgical News Page 37 September 2011 Library Report Foundation for Surgery

New resources for the Online Library The Library is continually growing and improving, but can always use your help

thank-youfor donating to the Foundation for Surgery Total $18,400

New South Wales Victoria Western New Zealand Cathy Ferguson Dr Philip Colman Ms Patricia Agostino Australia Mr John De Waal Chair Fellowship Services Dr Phohjin Tew Assoc. Prof. Joseph Epstein, AM Dr Jessica Yin Dr Belinda Scott Southern Star Productions Mr Russell Tregonning ellows and trainees frequently tell us Specialist Management how much they value the College online Services FLibrary. However, there is always room Ms S Taylor for improvement and in last month’s Surgical Mr Graeme Thompson News I flagged that the resources would be expanded for all surgical specialties over the coming months. New journal titles recently added include Surgery, Injury, European Journal of Surgical Oncology and Seminars in Paediatric Surgery. Other new resources include Access Surgery, an added-value multimedia product Yes, I would like to donate that supports lifelong learning and will assist to our Foundation for Surgery trainees in their preparation for examinations All donations are tax deductible by providing more than 1,400 questions and answers across the broad range of curriculum along with the ability to track and report scores. Name: Acland’s Anatomy is a web streamed Address: Telephone: video atlas presents expertly dissected human Email: Speciality: specimens as three-dimensional objects, with intelligent search and navigation tools so you can Enclosed is my cheque or bank draft (payable to Foundation for Surgery) for $ . easily find the content you need to teach, learn, or review. • Essentials of Musculoskeletal Care – 4th nine specialty elected Councillors seeking Please debit my credit card account for $ . A new initiative for the Library is a Edition, 2010 ideas for how to further improve the online Mastercard Visa AMEX Diners Club NZ Bankcard 12-month trial of Orthopaedic Knowledge • Essentials of Musculoskeletal Imaging – library. Their recommendations, together with Online, a substantial product from the 2004 feedback from other library users, will inform Credit Card No: Expiry / American Academy of Orthopaedic Surgeons • Orthopaedic Basic Science: Foundations the development of the 2012 Library budget. (AAOS). Orthopaedic Knowledge Online of Clinical Practice – 3rd Edition, 2007 Your passion. includes full text access to instructional course • Orthopaedic Knowledge Update – 10th Card Holder’s Name - block letters Card Holder’s Signature Date lectures, clinical topics, lectures, presentations, Ed., 2011 Your skill. I would like my donation to help support: self-study quizzes and multimedia. Clinical • Pathophysiology of Orthopaedic Diseases, Your legacy. General Foundation Programs International Development Programs topics are organised and searchable by all 2 Volumes – 2006, 2009 If you have suggestions for how Scholarship and Fellowship Programs Orthopaedic sub-specialties. Indigenous Health Programs we can make an already great I have a potential contribution to the Cultural Gifts Program We are trialling Orthopaedic Knowledge library service even better, then I do not give permission for acknowledgement of my gift in any College publication Orthopaedic Knowledge Online is Online for 12 months and based on your send these to college.library@ Your complemented by a new range of AAOS feedback we will make a decision regarding surgeons.org or log in to the Please send your donation to: e-books available to the College for the first the permanent availability of that resource. We College web site to complete Foundation. AUSTRALIA & OTHER COUNTRIES NEW ZEALAND time. These include: very much appreciate your advice regarding Foundation for Surgery Foundation for Surgery the online feedback form within 250 - 290 Spring Street PO Box 7451 • AAOS Comprehensive Orthopaedic the new resources. the online library section of the East Melbourne , VIC 3002 Newtown, 6242 Wellington Review, 2 Volumes – 2009 The College has written to each of the College web site. Australia New Zealand

Surgical News Page 38 Vol: 12 No:8, 2011 Surgical News Page 39 September 2011 Successful Scholar College Awards

Seeing the value in research Dr Henry To is grateful for the support of the College in valuable research

In Memoriam Our condolences to he current recipient of the College’s the family, friends and Foundation for Surgery Research colleagues of the following TFellowship, Dr Henry To, is using the Fellows whose death has attached funding to investigate the genetics of Barrett’s Oesophagus (BO) and Oesophageal been notified over the past month: Adenocarcinoma (OAC) to give surgeons and President Ian Civil with the Gannon family at the 2011 Adelaide ASC. clinicians the knowledge to allow for early >Ross Bohm, NZ detection and improved treatment. Orthopaedic surgeon Barrett’s Oesophagus is a squamous metaplasia of the oesophagus and is the risk >Ronald Eisner, factor with the highest known association for Great VIC General surgeon Oesophageal Adenocarcinoma. achievements >Raymond Windsor, Working out of the Peter MacCallum Associate Professor Brendon Gannon PHD; NZ Cardiothoracic surgeon Cancer Centre in Melbourne, Dr To is Award of the Heslop Medal >Donald Urquhart-Hay, using Next Generation Sequencing (NGS) technology to identify the genetic mutations NZ Urologist that cause both Barrett’s Oesophagus and Citation kindly provided by Mark Stringer Bren’s main research interest was in >Murray Ashbridge, Oesophageal Adenocarcinoma. BO and/or OAC. He said sequencing had now “I feel that in today’s era, the public FRCS FRCSEd and Fiona Stewart MBBS the microcirculation and lymphatics. He NZ Ophthalmologist Dr To’s investigation combines two research been done on the affected individuals to perform demands surgeons and doctors that are at the BSc, RACS RACS Anatomy Discipline published numerous scientific papers on Committee these topics in leading scientific journals, aims; using NGS to discover causative genes genome-wide screening for inherited genes in the forefront of scientific understanding, surgical We would like to notify readers that it achieving international recognition in in Barrett’s Oesophagus in familial settings protein changing variations. practice and innovation,” he said. he posthumous award of the is not the practice of Surgical News to the field. As a testament to his academic “It is exciting that we are finding genetic “Being involved in research gives me the Heslop Medal to Associate publish obituaries. When provided they to identify key protein changing (non- ability, Bren was a valued member of are published along with the names of synonomous) genetic mutations, and using variations that may cause OAC in areas of the foundation to continue my interest in scientific TProfessor Brendan Gannon numerous national grant bodies including NGS to discover causative genes in a sporadic genome that we have not thought of before,” study and also gives me exposure to areas of recognises his outstanding service to the Australian Research Council, the deceased Fellows under In Memoriam on matched normal/tumour cohort. he said. treatment and technology that I would not the Anatomy Committee at the Royal National Health & Medical Research the College website www.surgeons.org go “Oesophageal Adenocarcinoma is a “We remain hopeful of finding this key have in the regular hospital setting. Australasian College of Surgeons over Council, the National Heart Foundation to the Fellows page and click on cancer with very poor prognosis and limited genetic driver for this disease which may “I am able to meet and collaborate with many years. of Australia and the Anti-Cancer In Memoriam. treatment options and its incidence has been have relevance for genetic screening and risk scientists, medical and radiation oncologists As an undergraduate at the Councils; most of these appointments rapidly rising in the past two decades, with the profiling while changing clinical practice.” which are essential skills, particularly in today’s University of Melbourne, Bren was an spanned two decades or more. He was percentage rise far greater than that of breast, Dr To, a general surgery trainee, is era of multi-disciplinary care. outstanding student and after completing also a founder member of the Australian his primary degree in Zoology, he & New Zealand Microcirculatory Society Informing the College melanoma and colorectal cancers,” Dr To said. undertaking his research as part of his PhD and “Without the support of such fellowships, went on to complete a PhD entitled and his contribution to microscopy was If you wish to notify the College of “Yet while we know that Barrett’s is working under the supervision of Associate doing medical research is extremely difficult. “Comparative and biomedical studies of widely recognised, both at Flinders and the death of a Fellow, please contact Oesophagus is a precursor to the development Professor Wayne Phillips, Scientist and Head “You need the support of others to step the autonomic nervous system (1972)”. beyond. the Manager in your Regional Office. of adenocarcinoma it is difficult to identify of Laboratory at the Peter MacCallum Cancer outside the comfort zone of regular hospital Bren then undertook a two-year post- Bren joined the Anatomy Committee They are which patients will progress to cancer so to Centre and Surgeon Mr Cuong Duong. work and to receive a Fellowship does not doctoral fellowship at the University of at the Royal Australasian College of help stem this rise we need to know more He received the Foundation for Surgery simply represent financial support, but also British Columbia in Vancouver before Surgeons in 1997 and for six of the ACT [email protected] about the genetics of the disease. Research Fellowships, which carry a stipend of the moral support from the College that your moving back to Australia where, in 1974, subsequent 12 years he was the Deputy NSW [email protected] “There are currently no treatments $55,000 per annum, for both 2010 and 2011. research has real potential. I look forward to he was appointed first to Lecturer and Chair. He witnessed many major changes NZ [email protected] that completely reverse BO or reduce its Already he has presented his findings at working closely with the College to complete later to Senior Lecturer in the Human in the College examinations and proved predisposition to develop OAC, which means national conferences including the RACS this research and to being involved more in the Morphology Unit at Flinders University. to be a steadfast member of the group, QLD [email protected] that understanding the cellular and genetic Annual Scientific Meeting and the Australian future. In 1985, he was promoted to Associate developing many high quality questions SA [email protected] Professor in the department that is now for the multiple choice question bank. mechanisms of this disease will aid better risk Health and Research Medical Congress “Going through the rigorous application TAS [email protected] entitled ‘Anatomy and Histology’. Except Despite his ill health, he continued his stratification for screening and prevention and with publications in process in the Journal process and being accepted to receive this for temporary appointments as Visiting commitment and service to the Anatomy VIC [email protected] may even develop treatment options.” of Clinical Gastroenterology and the ANZ prestigious Fellowship shows that the College Professor in Physiology to several US Committee, attending meetings and giving WA Angela.D’[email protected] Working through the Familial Cancer Service Journal of Surgery. has interests that are aligned with my own – that universities (Arizona, Kentucky, and fully until his untimely death in 2009. NT [email protected] at the Peter MacCallum Cancer Centre, Dr To has Dr To said he was honoured to have is, investing both our time and money to support Louisiana), Bren remained at Flinders, The award was accepted by Professor prospectively identified a number of Australian received such strong support from the College innovation to benefit patients in the future.” becoming Assistant Dean in the School of Gannon’s son on behalf of the Gannon families with multiple first-degree relatives with to concentrate on pure science. With Karen Murphy Medicine in 2007. family.

Surgical News Page 40 Vol: 12 No:8, 2011 Surgical News Page 41 September 2011 Surgical sketches and silhouettes

An idea

Quoting Hackett, the story concerned those days would have had one of the largest scene – a source of refuge in the wee hours a young female medical researcher from aesthetic practices in Australia, thanks to of the morning. I recall once hearing one of India who submitted a paper to a prestigious the John Gorton $5 scheme). John always Poulenc’s pastorales plagiarised in an early American medical journal. It described for the encouraged the publication of new ideas and Stravinsky sonata – before he entered his first time the simple electrophoretic analysis of Tom submitted his breast reduction paper to dissonance phase. Even Mozart at 14 is said a blood sample on paper from a finger prick an American journal. It was rejected, I am sure to have transcribed the Allegri Miserere of test to gauge a blood sugar level on a colour with the usual tirade (or triad) of criticism of 1620 after the second hearing encouraged by scale. Its clinical importance today is still technicalities, statistics and demographics. his father. Thankfully we can still hear it today, resounding, yet her paper was rejected. But truth will out – in the late 1970s, Tom just as few of us are ever likely to be invited to a Some years later something extraordinarily happened to be at a conference in North America pontifical mass in the Sistine Chapel; formerly similar appeared in a major medical publication when his very idea was publicly presented. I the sole venue for its papal performances. in the United States with no acknowledgement. would have loved to have heard Tom, with his Surgically speaking we all encourage the One of the listed co-authors was a senior Scottish brogue, walking down the aisle, in apprenticeship model of surgical training. We consultant with editorial links to the very stentorian style, then audience up to the dais, are deeply indebted to our surgical mentors journal that had rejected it. microphone in hand, letting all and sundry and all who have gone before; quoting Sir Isaac In riposte the Indian researcher cleverly know what he thought about their presentation Newton “we stand on the shoulders of giants”. forwarded her rejection letter to a major of “his very idea”. Details could be obtained from We must acknowledge this debt, as I do to many, American newspaper. Not surprisingly, a Tom himself. Incidentally, he told me he had no since my V.P.S.U. days, especially Benny Rank for legion of resignations followed. problems subsequently with any publications. establishment, and Don Marshall for refinement. On the local scene in 1984 I presented at Don Marshall once mused that a person MUNCHAUSEN Surgical Plagiarism Part 1 – the RACS scientific meeting the principle of The Scottish background with ingrained talent, spontaneous artistic SYNDROME the “Fenestrated Full Thickness Graft” – an Tom and I did our Fellowships together and manifestations far exceed acquired skills, even alternative to the tie-over technique for Wolfe he told me that on emigrating from Glasgow when honed by repetition. Someone also said Recollections and fragments grafts for facial mitotic lesions. This idea came to Australia, he initially worked as a builders’ (was it Voltaire?): “Those with talent survive, to me in the late 1970s when one of my patients labourer. To go from this to an international and those without strive”. dislodged the tie-over dressing on day 2 and the surgical figure is no mean achievement. It I will have more to say about this topic (the K graft was fully viable beneath. I subsequently reflects quality, like his surgical style, and that editorial red pen is approaching) concerning a Y from my own surgical experience added drain-holes, creating what I thought of underlying Scottish surgical gene. Since the late 19th century textbook on flaps including M as a “holey” graft. 19th century, Scotland has been the source of cross-leg flaps by the French surgeon C Factitious disorders My RACS presentation needed a more outstanding surgeons – my mentor in England, Ombredame I recently found on the Left Bank formal title (without any religious ring) and Ian Wilson, worked for five surgical knights in Paris. It was published years before the idea As Sophocles, the playwright in the 5th century BC, once said (and yes he was a friend of I asked the late John Hueston (a wealth of from Edinburgh University. In Australia, drifted across the Channel under the Gillies

Plate: Musings about Munchausen Syndrome, are there three types? Aristotle): “I would prefer to fail even with honour then win by cheating” information on international publication), for Gordon Clunie and John Masterton carry on umbrella. suggestions. Standing outside his rooms at the this surgical tradition of excellence. Tom – a arts and copying is almost routine (as we see psycho-analysis in the early 20th century, rear of 89 Royal Parade (now called Jageurs Glaswegian with the usual inter-city rivalry at the Louvre). However, literary plagiarism, we continue to explore such links to help Lane) and resting against his Citroen DS23 – facetiously quotes, however, that “the best particularly since the time of Samuel explain innocent plagiarism or just blatant (he was a Francophile) he looked at the trestle thing that comes out of Edinburgh is the train Johnson, is frowned upon. Scientifically it is orchestrated deceit. Never forget the media is window of his Victorian terrace and suggested to Glasgow”. unacceptable. The term “plagiarism” originates very quick to report such episodes. I use the French word for a window (la fenêtre) Let’s revert back to these “plagiarists” fromlater thethat Roman evening poet discharged Martial herself.and the This Latin clin- I recallAs we an know ABC musing radio presenter, is gazing Drmeditatively Earle and title my talk the “Fenestrated Full Thickness and give them the benefit of the doubt. wordical historyplagiarus stimulated literally meansme to recounta “kidnapper”. the story Hackett,and refl from ectively 1975 in with a literary a great context.example. This He led Graft” – my idea, but John’s eponym. Was it merely a subconscious process? Did XOPXIIIIX Benof someJohnson of mydescribed other Munchausen plagiarism as experiences“literary recountedme to ponderthen on the his MunchausenThursday afternoon syndrome. After this Melbourne RACS meeting, they review an article and then forget it – a theft”over theand last the threeOxford and English a half Dictionarydecades, and (3rd three medicalWhether program by proxy an episode or direct involving involvement an where international surgical figures were in case of facilitated amnesia? Was it a simple Felix Behan, Behan ed)cases defines in particular it as “taking spring someone to mind else’s – Iwork wonder or Indianin the researcher, public oran theAmerican private publication sectors, this attendance, a similar idea appeared two years independent co-discovery, as Bob Goldwin Victorian Fellow Victorian Fellow ideaif this and is passing the statistical it off as one’saverage own”. (one every ten andpsychiatric possibly misplaceddisorder authenticity.is classifi ed Inas spite a facti- later as an original paper on the European said of my Bezier island flap submission to the was enjoying Tchaikovsky’s Piano yearsNavigating and I would consciously welcome through other thecomments). realms of tiousarduous sequence attempts of toclinical establish epi sodesthe specific - fancied, scene. How do I know this? John Newton PRS years ago? We may never know. Concerton a No.recent 1 (atheatre favourite list Iof had mine) an inter-on of FreudThe (whose second grandson, case makes an eccentric an interesting multi- accuratefeigned details or self-infl of thisicted-. story, It isI interestinghave been how (from Newcastle), just happened to be present We should remember in all publications P.S. Since starting on this the Queen’s Birthday weekend when the this eponym arose: Richard Asher in 1951 was on both occasions. Perhaps one could seek the notion is more important than the name, to I esting clinical experience even at millionairenarrative, inpost-expressionist the 1980’s. In those painter, days the died medi- singularly unsuccessful (even with a Sherlock venture, more examples ABC announcer Marian Arnold mentioned the specific details from his experience and quote John Hueston yet again. Gordon Clunie my age. In the Anaesthetic room a onlycal administratorrecently), Jung allowedand the usalter to ego,transfer certain insur- Holmesthe fi rstcape to and describe magnifying such glass self-harm, – the image recall- have come to light. I would Date: 27-SEP-2009 O Rubinstein’s critique of the first performance of patient was awaiting surgery. My registrar was elementsance patients emerge to theabout private our domain.own individual Over a two of inga frustratedBaron Munchausen sleuth). My insearch an articlehas now in the recollections. also taught during his academic years that if encourage these “victims” this 1890’s work. This director of the Russian not there with me to present the details on his personalitiesmonth period based a general on surgeon our experiences. and I operated comeLancet. to an He dead mentioned end, as the how Hackett the Baronobituary had a Now the stories get better. Tom Robbins you have a new idea, launch it locally and then to relate their experience in Conservatoireline of management. said it Hewas had “tawdry, mentioned plagiaristic before- Someon this ideas young subconsciously man a number originate of times. from He had appearedlist of fantasticin the Age stories, in April, beyond 2010, when belief, I first refl ect- (an international figure in breast reconstructive go international, as I did with the Keystone flap. separate submissions (Letters andhand non that pianistic”.this lady hadTchaikovsky presented was for deeplyremoval ansustained unknown abdominal source beforeinjuries their in a motorexternal vehi- beganing daringto reflect exploits, on this quiteissue. unbelievable. In his surgery), was initially reluctant to have his I originally called it an “arc” flap; Alan to the Editor) and also allowing offended,of something but statedoff her “I leg. will change nothing”. manifestation.cle accident, aCould perfectly these credible experiences story untilbe I obituaryHackett wasin the an Britishinteresting Medical ABC personalityJournal, it was experience revealed, but was convinced when Breidahl called it a “keystone” when he saw it, me to conclude with Freud, The word “plagiarism” stuck in my mind When I addressed the patient in this thelater genesis questioned of innocent the multitudi or subconsciousnous mature andmentioned presenter how– a Asherman ofrespectfully the arts anddedicated a I told him that it is part of medical history and incorporating architectural and philosophical who said: “Flowers are restful because it gave me some insight into the context, my question was “now what am I plagiarismabdominal or wall just scars co-discoveries? – another wa Fromrning the sign. pathologistthis syndrome who helpedto the Baronestablish the Blood therefore should be in the public domain. precepts in this surgical variation. Alan, it is a to look at; they have neither personalities, talents and criticisms of these removing today?” She said “I have a scar on the ideas of Jung (on this, the 50th anniversary Bank in South Australia. He was eventually From the 1970s, Tom worked in partnership “win-word” – merci. emotions nor conflicts.” times. Plagiarism is accepted in music and the with John Hueston (who incidentally in In conclusion I hark back to the musical leg at a skin graft site and I was told you could of his death), the alter ego and the dawn of Chairman of the ABC in November, 1975. Surgicalpossibly Newsfi x it”. Page Previous 42 Vol: attempts 12 No:8, at2011 serial scar “As one of my mentors and later colleagues said Surgical News Page 43 September 2011 revision had been unsuccessful. People knew years ago “Plastic surgeons are sometimes described I have successfully closed similar defects in melanoma patients with the usual keystone as psychiatrists with knives” – but not always.” technique. Like any experienced surgeon, I exposed Three days before discharge he asked a The Baron served in the Russian mili- the whole lower limb to examine it and found, young nurse for $15 so that his clothes could tary forces against the Ottoman Empire and to my horror, she had a donor site dressing on be dry-cleaned. I asked the young lady some acquired a reputation for witty and exagger- her upper thigh. On further questioning, it months later whether she had ever received her ated tales and became the subject of numerous Page: 40 transpired, this had been there for six months. money. She was never paid. texts published in 1862 by Gustav Doré, from I then glanced at her notes on the anaesthetic Some years later, I was doing Monday balloon fl ights, to taming wolves to shooting bench. There were fi ve volumes, each about fi ve morning rounds when I encountered the fl ocks of ducks and being mauled by bears (en. inches thick – “a warning sign”. At this stage the same individual, recently admitted again wikipedia.org). alarm bells were ringing and I asked her “why with abdominal trauma. Needless to say he However the idea occurred to me that have you been in hospital so often?” suspect- signed himself out within the hour when I this recollection had a similar ring to another ing some major clinical catastrophe like neph- confronted him. particular person who also wrote about rotic syndrome. She gave a history of repeat A further story relates to a nursing aide fi ctional and fanciful adventures. He was far overdose needing ICU admission. It transpired who burnt her fi nger on a steriliser. The regis- more readable and he became the second most she was seen in our unit six months earlier and trar in the Emergency Department referred translated author of all time, (second only to it was found that she has been putting oven her to me for grafting (which failed), which Agatha Christie). Having written Journey to cleaner on the skin graft donor site. was repeated and failed a second time before the Centre of the Earth in 1864, then 20,000 I took her into theatre and manually debri- doing a cross fi nger fl ap. The resultant stiff Leagues Under the Sea in 1869, and Around the ded the wound under general anaesthesia and fi nger years later resulted in a ray amputation World in 80 days in 1873 – none other than the dressed it with the usual donor site techniques, of the middle fi nger, by another specialist, as great Jules Gabriel Verne (1828-1905) reinforced with soft topical non-removable I discovered when she came back to me for a He lived along the Loire Valley. At the Pub: CMC TOTS dressings, and signed it “not to be removed medico legal report seeking compensation for school of St Donation College, one of his without my permission”. I heard that she had this work related injury. tutors in drawing and mathematics was possi-

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Article of Interest

Treating practitioner reports Orthopaedic surgeon Dr Gary Speck explores the art of negotiating the provision of treating practitioner reports. This article originally appeared in the August 2011 issue of the Australian Medical Association’s magazine vicdoc

” Gary Speck, Tribunal has stated clearly that just because Victorian Fellow the fees charged do not meet the schedule it does not mean that they are unreasonable.4 e all receive requests from insurers and solicitors to provide reports Requests for a patient’s medical Won our patients. For many of records from a lawyer or insurer us these requests are seen as a necessary Should an insurer want a copy of my patient’s distraction from healing the sick and injured, history, I send a quote back based on the cost in the red tape war that schemes such as of reviewing the record, organising a package WorkSafe engage in. of information and forwarding the package in However, in mulling over this article, secure post quickly. I wanted to ensure I captured my passion for I make sure that I have contemporary getting patients back to health, yet also my consent from the patient. If not I will write to equal frustration that WorkSafe is perceived as my patient asking if they consent to the release. mistrusting doctors and is cost-cutting. The quote will include the labour and out-of- They’re trusting you pocket expenses required to fulfil their request So what options do I have? Should I: and the time to deliver. A quote is provided • capitulate to the demands of a growing as the fee is greater than the statutory charge with their life. bureaucracy1 and dominant purchaser under the Health Records Regulations, but the and accept whatever price they determine service offered is greater than simply “allowing reasonable for my work? At the same time I prepare a report. Otherwise access” or “providing a copy” to a patient who Who are you trusting • skill my practice manager in the art of my pile of requests backs up. I keep this report attends my clinic. “shedding” WorkSafe claimants? until the requestor pays the fee, if requested, However, if this quotation is not agreeable with yours? • suggest options to my colleagues to manage accepts the quote or we agree on a price. then I advise that the patient can come to my WorkSafe requests so that we can all The timely preparation of the report is practice at an agreed time and read or make continue to treat people who are badly in an important step as it is in my interest and a copy of their record. In this instance I will need of our help? the interests of my patient to ensure a report charge only the statutory fee. Medical professionals carry a burden of significant exposures to blood-borne viruses and this is is prepared and available. The only issue that The last is the basis for this article. This practice means that I can continue on the increase.1 As a reasonably busy practitioner, should be subject to debate is whether the to treat my patients in the way I think they I receive requests for “treating doctor reports” insurance company will pay my fee, not my should be treated. I also manage all the other NEW Biogel PI Indicator is the only non-latex, double-glove indicator system that too. These are not medicolegal reports, but tardiness or refusal to write a report. Ensuring “stakeholders” in the process without having provides an immediate and clear visual warning that gives the protection surgeons and theatre reports regarding the treatment provided to my reports are prepared in a timely fashion is to subsidise their insatiable desire for more staff need from the consequences of cross-infection. patients. Most requests come from those who considered good practice by the Medical Board information. 2 are subject to a workers compensation claim. of Australia. I hope that my practice helps your practice. Of course insurers being insurers and It is a reflection of our commitment to your safety. But it is nothing less than you would expect Requests for treating WorkSafe being WorkSafe will say that I References from the maker of the world's finest surgical gloves. doctor reports am “charging more than the scheduled fee”. 1. WorkSafe staffing increased by 20% in five When I receive such requests I always ensure Frankly, what position are they in to determine Reference: years from 919 FTE in 2005 to 1105 FTE 1. Eye of the Needle. UK Surveillance of Significant Occupational Exposures that the patient has authorised provision of the what my fees will be? A WorkSafe policy on in 2010. See VWA Annual Report 2005, 82; to Bloodborne Viruses in Healthcare Workers, Health Protection Agency, information and report. I write to the insurer fees is just that – a policy. Our patients have WorkSafe Annual Report 2010, 87. November 2006; p4 http://www.hpa.org.uk/infections or solicitor and provide a quote based on the rights under legislation. WorkSafe is required 2. See Chapter 8, Good Medical Practice: a time it will take to complete, the complexity to reimburse claimants the costs of reasonable Code of Conduct for Doctors in Australia, of the question, and an estimate of costs. I medical and like expenses.3 If the price in the Medical Board of Australia 2010 ask them to acknowledge acceptance of the WorkSafe policy is OK some of the time, then 3. Section 99 Accident Compensation Act quote or they may contact me if they have any that is all well and good. However, policies 1985 (Vic). concerns. I will always consider a request for provide an indication of how WorkSafe will 4. Moore v TAC (2002) VCAT 737 Aug Mölnlycke Health Care Pty. Ltd., 14 Aquatic Drive, Frenchs Forest NSW 2086, Australia. T 02 9453 1144. F 02 9453 1155. www.molnlycke.com.au review of the quote if either an insurer or law react. Thankfully WorkSafe is unable to make 2002; TAC v Moore (2004) Supreme The Mölnlycke Health Care name and logo, Biogel® and IndicatorTM are registered globally to one or more of the Mölnlycke Health Care Group of Companies. Copyright (2009) firm is experiencing “hard times”. laws. The Victorian Administrative Appeals Court of Victoria April [2004] VSCA 60. All rights reserved. No part of this publication may be reproduced in any form without the express written permission of Mölnlycke Health Care Limited.

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