From Climate to COVID, a Year Like No Other

medicDECEMBER 2020 SAVOLUME 33 NUMBER 6

2020 vision From climate to COVID, a year like no other

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2 | medicSA Doctor Led • PatientFocused • Quality Driven drjones.com.au Australian Medical Association (South Australia) Inc. Level 1, 175 Fullarton Road, Dulwich SA 5065 PO Box 134 North Adelaide SA 5006 Telephone: (08) 8361 0100 Contents Facsimile: (08) 8361 0199 5 President’s message – an unforgettable year Email: [email protected] Website: www.amasa.org.au 9 Standing firm – the AMA argues for climate action Executive contacts 12 Blinding errors – Australian of the Year Dr James President Muecke talks sugar Dr Chris Moy: [email protected] 14 AMA(SA) advocacy: medicSA • Time for change – AMA(SA) and the support for Editorial decriminalisation of abortion Editor: Dr Philip Harding • From the top – Board roles in preventing bullying Managing Editor: Karen Phillips 18 Where there’s smoke – the health effects of Australia’s Advertising worst bushfires [email protected] 21 The costs of COVID – a year in review Production Typeset and printed for the AMA(SA) by • From the President Douglas Press Pty Ltd. • Helping the healers ISSN 1447-9255 (Print) • Climatic collisions ISSN 2209-0096 (Digital) • The mental toll Cover artwork by Catherine Waite. • Turning to technology Computer image fizkes (iStock). • Exit strategies ‘Zoom’ images: Top row, from left - AMA(SA) Vice-President • Grief and the grieving and Council Chair Dr Michelle Atchison 45 Council news during a Zoom Council meeting, bushfires on Kangaroo Island (image Blue Razoo), 49 In committee, 2020 AMA(SA) President Dr Chris Moy. 55 Book review – Andrew Wakefield’s awful legacy Middle row, from left – Professor Nicola Spurrier and Health and Wellbeing Minister Stephen 60 Vale – remembering Dr Ian Steven Wade in one of their first coronavirus media and Dr Brenton Mollison conferences, the virus (image Rost-9D, iStock), AMA House after the May fire. Bottom row, from left – Australian of the Year Dr James Muecke, AMA(SA) Culture and Bullying Summit keynote speaker Professor Michelle Tuckey, AMA Federal President Dr Omar Khorshid. Disclaimer Neither the Australian Medical Association (South Australia) Inc nor any of its servants and agents will have any liability in any way arising from information or advice that is contained in medicSA. The statements or opinions that are expressed in the magazine reflect the views of the authors and do not represent the official policy of the Australian Medical Association (South Australia) unless this is so stated. Although 24 all accepted advertising material is expected to conform to ethical standards, We’ve all been in it together … and we’ve all found ways to try and cope such acceptance does not imply with the pandemic and its ramifications. One trend that has brought smiles endorsement by the magazine. to faces of many people, adults and children alike, in South Australia has been the placement of teddy bears and their stuffed peers in windows All matter in the magazine is covered by and gardens, to provide some sunshine in the lives of passers-by in the copyright, and must not be reproduced, dreary days of lockdown. It’s been a bit of fun for the doctors and staff of stored in a retrieval system, or transmitted Chandler’s Hill Surgery – but other impacts haven’t been so entertaining, as in any form by electronic or mechanical Dr Kerry Hancock explains. means, photocopying, or recording, without written permission. Images are reproduced with permission under limited license. medicSA | 3 Dr Divya Sabharwal General practitioner South Australia

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4 | medicSA

210x297mm_medicSA_OCT20.indd 1 19/10/20 4:29 pm REPORT

Life in a year

President’s

Dr Divya Sabharwal report General practitioner South Australia Dr Chris Moy

long with most people, I feel action to reduce the risk of more fear at key moments during this year as if time in 2020 has warped climate-related disasters. As I write this, like no other. and weaved – some days seem it is nearly 40 degrees Celsius, and it is With so much evidence of the trust to have passed in a matter of still November. Action cannot come placed in us, perhaps it is little wonder Ahours, while others have felt like weeks. soon enough. that in mid-November the Governance It is staggering that we are nearly at The immediate threat of the bushfires Institute of Australia’s Ethics Index 2020 the end of what has been for everyone, was still with us as a new and very – a survey of 1,000 Australians – found Leading support in your everywhere, a most tumultuous year. different threat reached our shores. that GPs are, after fire services workers, This time a year ago, AMA(SA) Since the term ‘novel coronavirus’ perceived as the most ethical workers CEO Dr Samantha Mead and I visited entered our consciousness, our lives in Australia and more ethical than doctors and hospitals on Eyre Peninsula and, for many of us, our livelihoods the same survey found a year ago. The times of need – it’s why and witnessed firsthand what we have been turned upside down through AMA is ranked among the top five most knew was the dire situation of health illness, death, and economic impacts ethical organisations in Australia, and practitioners looking to care for patients and uncertainty. There is much said the most ethical member organisation. and communities in that region. We about COVID-19 and its impacts later in We have ‘done good’ this year, and our more doctors choose Avant returned filled with resolve to fight for this issue; here, I’ll just say that while it patients have noticed. genuine improvements after listening has been devastating to so many people, In a year when the challenges have to the personal stories of the region’s we must be thankful that through been immense, our profession has doctors and hearing of the challenges wise, science-based management, stood up and inspired. I hope that Avant is more than an insurer, we provide holistic support for doctors that helps them practise at their best which they had to overcome to care for and a measure of luck, Australia has among the hardship there has been a their communities. had fewer than 30,000 cases while, as through challenging times. reaffirmation in each of us about what it Then came summer and the bushfires I write this, the state of Texas, which is that is important in being doctor. And, that raged across the country and has a population about the same as together as a profession, I would like Award-winning defence Advocating for your interests Financial stability to protect you rightly occupied the nation. The world that of Australia, has had more than A 270-strong* team including As Australia’s leading medical defence Avant’s financial stability means we watched and did what it could to help 1.2 million cases. to believe that we can sustain this, and Australia’s largest health law firm organisation, we use our loud and can offer a range of assistance to as South Australians, along with our As doctors, we have been at the for this to be reflected in our patients recognised for their expertise, credible voice to affect positive members and ensure we are here to neighbours in the eastern states, battled frontline of the pandemic. We have maintaining their deep trust in our skills providing members with on-the- change to health policy, such as on protect doctors for years to come. the worst fires in the nation’s history. supported and cared for our patients and sense of ethical behaviour, and ground support in six states telehealth and PPE provision during The ‘Black Summer’ killed 34 people and through some of the most sickening the knowledge that we will always put and territories. the COVID-19 pandemic. charred more than 18 million hectares and frightening days of their lives. We them first. of land. The ongoing health impacts are have advised them about what to do, That is worth more than any other still being measured and assessed. sometimes amid rapidly changing and present under our Christmas tree. In late 2019, in a terrible premonition, even conflicting information. Time and On behalf of the AMA in South Join or renew today the AMA issued a strong statement time again, we have donned masks and Australia, thank you all for your hard about the need to act against the ‘global gowns and other PPE and put ourselves work and sacrifices this year. It has been 1800 128 268 health emergency’ that is climate – and so too our families – at risk. an outstanding effort, collectively and avant.org.au change. This statement – on October 26, And this is while dealing with our individually, from our members and our no less – coincided with the beginning own anxieties. For, despite and perhaps profession. Best wishes for a healthy IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of of the summer’s fires. It called on the because of the information which I have and safe holiday season from all of us at the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and Product Disclosure Statement, which is available at avant.org.au or by contacting us on 1800 128 268. *Accurate as at 30/6/2020. MJN219.4 10/20 (DT-1678) federal government to take urgent had, I admit to experiencing genuine the AMA.

medicSA | 5

210x297mm_medicSA_OCT20.indd 1 19/10/20 4:29 pm EDITORIAL

t the present time, it is difficult to better than to do a simple Google search on reflect on almost any issue without the term ‘Andrew Wakefield’. Otherwise, Aconsidering the impact of the please read the review and, if sufficiently COVID-19 pandemic. One particular matter interested, the book itself. which confronted me as I wrote this was I also draw attention to the motoring the news that almost 200 doctors had now segment in this issue, a report by Robert died of coronavirus infection in Italy, many Menz on an electrically driven Volvo; undoubtedly in the course of their medical medicSA has in the past two years work. It is hard to imagine having to cope published reports on a number of electric with the impact that would have on our cars as we feel them to be of particular workforce, our colleagues and our patients interest to our readership in terms of if it happened here in Australia. We can their low environmental impact. As we only hope that a vaccine will soon be head into another summer, the health of Editor’s available to help the efforts of health care our environment, along with that of our workers here and around the world. friends, family members, patients, and letter Mention of the word ‘vaccine’ leads colleagues, will be very much on our minds. me to draw attention to the review I have Best wishes to you all for the festive Dr Philip Harding written (page 55) of the book The doctor who season. After the year we’ve had, some fooled the world by British journalist Brian relaxation will be very much appreciated Deer. It catalogues the somewhat fractured by everyone. career of Andrew Wakefield (no relation to the Edward Gibbon Wakefield who was prominent in the colonial development South Australia), a British consultant physician and clinical researcher whose dubious practices ultimately led to his deregistration by the UK General Medical Council in 2010. Vaccines are a major theme of the book. Anyone who quickly wants to learn more about this could do no

Survey to assess performance

he pandemic has brought a lot of equipment, and negotiated for workable SAVE attention to the AMA, nationally public-private arrangements in the early Tand in South Australia. days of the pandemic. THE Across the country, time and again, Now, as 2020 comes to a close, the AMA leaders including incoming AMA in South Australia wants to know Federal President Dr Omar Khorshid how the state’s doctors – members DATE! and new Vice President and AMA(SA) and non-members – perceive it has President Dr Chris Moy have been asked performed during possibly the most to explain, comment on and discuss the THE AMA(SA) GALA health-focused year in memory. We’re ramifications of the COVID-19 virus and asking that you complete a brief survey DINNER WILL BE associated policies. to tell us what’s been most important to BACK NEXT YEAR, Nationally and in each state, the you, and how the AMA could support AMA has advocated for policies, ON 22 MAY 2021. you in 2021 and beyond. guidelines and legislation that have helped doctors and health practitioners If you’re a doctor who is an AMA Please watch out for do their jobs, and assisted individuals member, please complete the details in The Voice in the and communities manage physical survey here. If you’re a non-member new year, and the February and mental health issues directly doctor, a slightly different survey is issue of medicSA. and indirectly related to the virus available here. and lockdowns. The survey is open until 15 January Our advocacy helped accelerate the 2021. The results will help guide rollout of telehealth and electronic our advocacy and improve our prescriptions, urged government to communication with you. We hope provide appropriate personal protective you’ll participate – to help us help you.

6 | medicSA AMA(SA) COUNCIL

Swings and roundabouts AMA(SA) It’s been a year like no other for COUNCIL doctors, patients and AMA(SA). CEO Dr Samantha Mead dons not-so-rosy Office Bearers glasses to look back on 2020. President: Dr Chris Moy Vice President: Dr Michelle Atchison Immediate Past President he Queen in her Christmas front – personal, professional, social A/Prof William Tam message in 1992 described that and economic. Ordinary Members Tyear as an annus horribilis. One Our organisation faced its own can only imagine the phrase she will use challenges with a random arson attack Dr Daniel Byrne, Dr Penny Need, to sum up 2020. ‘Unprecedented’ seems badly damaging AMA House. By then, Dr Rajaram Ramadoss, to be the word of the year so perhaps staff were working from home and Dr Andrew Russell, she’ll stick with that. ‘meeting’ via ZOOM; later, as restrictions Dr Nimit Singhal, Dr John Williams There is no question that 2020 has eased, we moved into temporary been heart-breaking and challenging for accommodation in Dulwich. Specialty Groups so many. If there is an upside, it is that Despite these challenges, we were Anaesthetists: Dr Simon Macklin 2020 has taught us how quickly we can reminded of how much we can achieve General Practitioners: adapt to change. when we pull together – as our fearless Dr Bridget Sawyer If I think back to the beginning leader, Dr Chris Moy, would say. Ophthalmologists: Dr Edward Greenrod of the year, I remember most the AMA(SA) swung its support behind the devastating fires. I felt for those who campaign to elect Dr Omar Khorshid as Orthopaedic Surgeons: had endured loss and fear: experiences Federal AMA President and Dr Moy as Prof Edward (Ted) Mah I understood having lost members of my Vice President. While this has led to a Paediatricians: Dr Patrick Quinn community and my own home in the crazy amount of work for the latter in Pathologists: Dr Shriram Nath Ash Wednesday fires. his dual state and federal roles, it has As a membership organisation and become very clear how valuable it is to Psychiatrists: Prof Tarun Bastiampillai advocate for public health, AMA(SA) have Dr Moy in a national leadership Public Hospital Doctors: mobilised to help those supporting their role. His passionate advocacy and voice Dr Clair Pridmore communities ravaged by the bushfires. of reason throughout the pandemic have Surgeons: Dr Peter Subramaniam We noted that many doctors involved been a source of assurance to colleagues Radiologists: Dr Jill Robinson as first responders were likely to be and the community around the country. traumatised by the experience. As a And, of course, despite the various Regional Representatives profession, doctors needed to be on crises we have managed throughout Northern: Dr Simon Lockwood the look-out for signs of mental-health 2020, we have also stayed the course Doctors in Training Representative impacts of the bushfires. with our agenda to push for culture Dr Hannah Szewczyk The AMA campaigned for resources change in the public health system and Student Representatives to help with the ongoing mental and to support doctors’ wellbeing. physical impacts of emergencies and Other important work has also University of Adelaide: through organisations such as DRS4DRS. continued, including advocating for Mr Jack Rumbelow At the same time, we advocated for resources to improve conditions for rural Flinders University: Ms Matilda Smale better protocols to enable doctors doctors, to decriminalise abortion, and AMA(SA) Executive Board to work effectively with emergency to support clinicians at the Women’s and services and to recognise the important Children’s hospital in a time of flux. Dr Michelle Atchison, role GPs play in supporting fire- This year has allowed us to ‘bring our Mr Andrew Brown, Dr Guy Christie- ravaged communities. whole selves to work’ and we became Taylor, Dr Chris Moy, Dr John Nelson, The beginning of the year was also aware that you never know what people A/Prof William Tam, when we started to hear more about are going through beyond collective Ms Megan Webster the spread of a novel coronavirus: the challenges such as COVID and bushfires. dreaded COVID-19. Immediately, the We also could not fail to recognise Federal Councillors AMA(SA) had to jump into action – the value of the AMA in speaking for Dr Michelle Atchison like all businesses around the country, doctors, colleagues and patients in (Area Nominee SA/NT) evaluating and mitigating risks and the face of unexpected and unceasing Dr Matthew McConnell adapting to new work practices. threats. But as we approach 2021, we in We had perhaps never been busier, AMA(SA) can only hope that – perhaps (Specialty Group Nominee: Physicians) helping inform the community with the aid of tried and tested vaccines Dr Hannah Szewczyk about the public health response – the next few months are healthier, (State Nominee – Proxy) and supporting our members as they happier and slightly less challenging tackled challenges on almost every for us all.

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ACHA_MedicSA_FullPg_174x248mm_Christmas 2020_301020 FINAL.indd 1 30/10/2020 12:22:34 PM In the thick of it

Climate change, bushfire prevention and vaping joined aged care as key advocacy issues for the AMA in 2020.

he AMA has joined the Business contribute to more frequent and intense Council of Australia in backing natural disasters,’ AMA President the Climate Change Private Dr Omar Khorshid said. Member’s Bill introduced by ‘The AMA recognises that climate TIndependent MP Zali Steggall. change is a health emergency, with clear The aim, says Ms Steggall, is to use scientific evidence indicating severe framework legislation as has been impacts for Australians now and in the done in the UK, France and Ireland to future. Last summer’s unprecedented introduce mandated targets and remove bushfires were a devastating the politics from Climate Change policy. demonstration of this.’ AMA President Dr Omar Khorshid Ms Steggall said the legislation was The AMA and Doctors for the Environment Australia (DEA) have needed following recent bushfires and home residents, arguing this will cut called on the federal government to the drought which showed climate out the person’s regular GP and further adopt a suite of key measures to help change to be an immediate challenge. fragment care. reduce the risk of further climate- ‘The provisions within the Climate The key feature of the proposed model related disasters. Change Act ensure there are equitable, is that a GP practice would have to be This includes: transparent and science-based plans to accredited to work in aged care. An older • a national climate change and health address the impacts of climate change, person entering a nursing home might strategy to facilitate planning for prevent worsening consequences have to abandon a trusted GP and find a future climate health impacts and take advantage of economic GP who has aged-care accreditation. • an ambitious reduction in Australia’s opportunities,’ she said. Dr Khorshid said the proposal to greenhouse gas emissions aligned to The proposed Climate Act allow aged care residents to enrol with science-based targets will mandate: niche, accredited general practices may • a National Climate Risk Assessment • an Australian Sustainable discourage many GPs from providing • a National Adaptation Program Development Unit to support care to aged care residents. • a Net-zero target by 2050 environmentally sustainable practice ‘With our population living longer and • establishment of an independent in healthcare and reduce the sector’s entering residential aged care at older Climate Change Commission. own significant emissions ages and in more frail states of health, AMA Vice President Dr Chris Moy • policies that acknowledge the we should be aiming to bring aged care said sensible, non-political legislation is health benefits of a transition to and health care closer together, not needed to embed Australia’s obligations renewable energy. further fragment them,’ he said. to reach Paris Agreement targets. The AMA has also called for a national ‘Although the AMA is pleased ‘Just as the government has responded Centre for Disease Control to educate the with many of the Aged Care Royal so well to the COVID health emergency public about large scale-disease threats, Commission recommendations, they’ve by listening to the science and evidence, including air and water quality. missed the mark when it comes to better we ask that they do the same for the ‘As Australia recovers from the acute access to health care and improving the health impacts of climate change,’ phase of the COVID-19 pandemic and model of GP care. Dr Moy said. adjusts to ongoing restrictions and ‘The AMA is very concerned that the The AMA has also urged the economic changes, it’s important that proposed new model will be a two- government to implement the we also prioritise the health impacts of tiered system where continuity of care recommendations of the Royal climate change,’ Dr Khorshid said. would be discarded to the detriment of Commission into National Natural ‘The 2019-20 bushfire season our elderly for the convenience of aged Disaster Arrangements to reduce in Australia had severe health care providers. the health and human cost of consequences. Along with more than ‘Devising new models of care should future bushfire seasons, and other 30 tragic deaths directly attributable to not be a substitute for improving natural disasters. the fires, exposure to bushfire smoke inadequate MBS rebates that do not Its recommendations echo the AMA’s caused an estimated 417 excess deaths, recognise the complexity of care being long-standing call for GPs to be more 1,124 hospitalisations for cardiovascular provided to aged care residents.’ involved in disaster planning, and to problems, and 2,027 hospitalisations for The AMA supports mandating prioritise mental health services during respiratory problems.’ minimum staffing ratios in aged care and after natural disasters. AGED CARE MODEL and has called for registered nurse ‘The Royal Commission also FALLS SHORT availability in aged care 24/7, with the acknowledges that further global The AMA has criticised a proposal for aim of bringing staffing ratios closer to a warming is inevitable and will a new primary care model for nursing five-star model.

medicSA | 9 NATIONAL ADVOCACY

Recommendations include a new to stop people accessing nicotine for aid are significantly more likely to still Aged Care Act based on human rights any use without a prescription and will be vaping after a year than people using principles for older people, mandated ensure patients see their doctor for nicotine patches or other therapies. staffing ratios in nursing homes, advice on the most reliable and safe ‘While doctors can already prescribe demand driven access to aged care, methods to stop smoking. nicotine for vaping, it is very rare – and a new and independent process for The AMA is keen to ensure that the TGA estimates that only about 10 setting aged care quality standards. nicotine use – both in smoking and doctors in Australia currently do so.’ vaping – is increasingly limited given Dr Khorshid said there is no TGA- VAPING DECISION approved nicotine vaping product, due CLOSES LOOPHOLE the overwhelming evidence that it is universally harmful. It is also wary to a lack of evidence of their efficacy A proposal to prevent people of claims that vaping is a useful quit- or safety. from accessing nicotine without a ‘Their use should be only as a method smoking aid. prescription is an important step in of last resort,’ Dr Khorshid said. ‘Nicotine is a poison, and the AMA the process of preventing smoking and ‘Doctors will need clear and well- opposes all use of nicotine-containing vaping although it may initially spike communicated guidance on appropriate vaping products,’ Dr Khorshid said. demand, says Dr Khorshid. dosages and recommended timeframes ‘Exposure to nicotine can harm The Therapeutic Goods for use. The AMA recommends adolescent brain development, and Administration (TGA) has proposed including a time limit for prescribing nicotine vaping products contain these products to ensure that patients carcinogens including formaldehyde who do not intend quitting cannot have ... the evidence that and solvents. access to an ongoing supply. vaping is effective as ‘The evidence that vaping is effective ‘The prescribing criteria must also as a quit smoking aid is inconclusive, specify that nicotine-containing a quit smoking aid is but there is plenty of evidence that it products may only be prescribed to inconclusive, but there causes harm. Multiple studies show current smokers, and we strongly that vaping can lead to previous non- recommend that the changes should be is plenty of evidence smokers taking up tobacco smoking, evaluated after 12 months to assess the that it causes harm ... and that people using vaping as a quit impact on smoking rates.’ Patients adopting digital health services

he pandemic demonstrated the ‘This will represent the biggest reform all Australians with access to telehealth, vital need for widespread digital to Medicare since its introduction,’ with more than 30 million Medicare- health services in Australia – Dr Khorshid said. eligible telehealth services delivered and now they’re here to stay. ‘Telehealth will not replace face-to- since March. TSince Medicare Benefits Schedule face care, but it does support better A $5 million investment has (MBS) item numbers were created to access to care for patients, including been made to fast track electronic enable safe access to medical services by supplementing face-to-face care or prescribing, and $25 million has been including GP and specialist services by supporting patients with barriers to provided to support home delivery during the COVID restrictions, patients care, such as those in rural areas.’ of medicines. and doctors have embraced telephone The AMA expects its proposal that From May to late November, more and video consults – but only when patients enrol with a general practice to than 1 million electronic prescriptions build a relationship with their usual GP supported by face-to-face treatment. were issued, including over 800,000 will be part of the permanent model of The AMA is now working with the original electronic prescriptions and MBS-funded telehealth. Australian Government to embed over 400,000 repeat tokens to patients. ‘It gives patients much more telehealth into the Australian The use of My Health Record flexibility in how they can access healthcare system and permanently by healthcare providers has also care from their usual GP or treating enable telehealth consultations to be specialist, particularly when they do grown significantly, providing subsidised under the MBS. not require a physical examination,’ Australians with secure access to their ‘The temporary COVID-19 Dr Khorshid said. ‘This saves a patient’s health information. arrangements have allowed us to test time and money and often means Since March, the volume of the model, and have shown where they do not need to take time away documents uploaded by healthcare refinements can be made,’ AMA from work. providers such as hospitals, pathologists President Dr Khorshid said. ‘Telehealth enables doctors to better and radiologists increased by 40 Announcements in November support their patients to access care per cent. There are now more than indicated MBS-funded telehealth when they need it.’ 275 million clinical and medicines arrangements will be finalised by the Meanwhile, the federal government documents in the system that were next federal budget. has committed $2.4 billion to provide uploaded by healthcare providers.

10 | medicSA NATIONAL ADVOCACY

about their care needs. Instead, patients would be assessed using an online tool GPs front and centre in which would enable patients to bypass their GP altogether rather than having mental health treatment the GP coordinate a multidisciplinary team to support the patient. The AMA has highlighted the central place of ‘The report should have placed much GPs in access to mental health services. more emphasis on the patient-centred medical home as the ideal model for people seeking care for their mental proposal to scrap GP mental system, focusing on prevention and health,’ Dr Khorshid said. ‘GPs form life- health treatment plans and early help – both early in life and early in long relationships with their patients, replace them with an online illness’. and building mental health into general assessment tool would be ‘But we cannot accept practice will further enhance the role of Acounterproductive in the quest for recommendations that take away GPs in early intervention.’ person-centred care, says the AMA. support for GPs at a time when the The AMA supports recommendations While the Productivity Commission’s burden of mental illness is growing,’ to address workforce shortages that Mental Health Inquiry Report aims he said. make it difficult for patients to access to establish a person-centred mental One in five Australians have a mental specialist psychiatric care – particularly health system, undermining the role health consultation with their GP every of GPs would result in less support and year, with a satisfaction rate of more in rural areas. more fragmented care, AMA President than 80 per cent. ‘With the mental health sector Dr Omar Khorshid said. Yet the report offers little in the way receiving less than half the funding The Mental Health Inquiry Report calls of extra support for GP care in mental of the comparable burden of disease for a $2.6 billion overhaul of the mental health, other than the introduction of funding, one thing is clear – any health system, estimating the total cost a Medicare item for GPs to seek advice government response to this report of poor mental health and suicide to be from a psychiatrist about a patient in will need to be backed by much greater as much as $70 billion per year. their care. funding, otherwise patients will Speaking after the release of the report The report proposes abolishing continue to struggle to access the vital on 16 November, Dr Khorshid said the Medicare-funded GP mental health care that they need,’ Dr Khorshid said. AMA ‘welcomed the report’s aspirations treatment plans, which the AMA says are The AMA is reviewing the report’s for a person-centred mental health care fundamental to engaging with a patient extensive recommendations. AMA: industry attacks put profit before health New Australian guidelines for alcohol that not drinking alcohol is safest ‘The AMA respects the NHMRC’s consumption will help Australians for their baby. systematic and rigorous approach to understand the serious health effects ‘Drinking alcohol has a range of the evidence review and believes that of drinking alcohol, AMA President health effects, both in the short and long this approach has clearly held the Dr Omar Khorshid says. term,’ Dr Khorshid says. health of Australians as its highest While industry groups have described ‘Many Australians are unaware that priority,’ he says. the new guidelines as being overly alcohol consumption can contribute In its Position Statement, Alcohol cautious, Dr Khorshid says such to cancer and cerebrovascular, Consumption and Alcohol-related Harms, criticisms are not based on evidence. cardiovascular, liver and digestive the AMA says: The updated Australian Guidelines disease. It’s important that these ‘Australians drink a large volume to Reduce Health Risks from Drinking guidelines are not interpreted as of alcohol overall, and many drink at Alcohol, released by the National Health “safe” or “allowable” levels of alcohol harmful levels, including teenagers and Medical Research Council (NHMRC), consumption, but as a way to reduce and young adults. Young Australians recommend that healthy people drink your level of risk. are starting to drink at an earlier age, no more than 10 standard drinks per ‘As the NHMRC says, people drinking and most drink in a way that puts week. The previous guidelines allowed alcohol within the guidelines lower their own and others’ health at risk. for 14 standard drinks per week. their risk of dying from an alcohol- ‘The harms of excess alcohol use The Guidelines also recommend a related disease or injury to one in are significant and warrant serious limit of no more than four standard 100. Not drinking alcohol at all is measures, especially regarding drinks on any one day, and that children the best way to reduce your risk of adolescents and youth. The AMA is younger than 18 years, pregnant women, alcohol‑related harm.’ committed to Australia achieving and women who are planning to become Dr Khorshid says the response from the greatest possible reduction pregnant should not drink alcohol at alcohol industry groups has been to in the harmful effects of excess all. Breastfeeding parents are advised attack the NHMRC’s credibility. alcohol consumption.’

medicSA | 11 2020 IN REVIEW

Don’t sugar-coat it

AMA(SA) member Dr James Muecke has spent much of his year as Australian of the Year to educate his country about the devastating health impacts of excessive sugar consumption.

t’s a cliché to say 2020 has been a and ultra-processed foods that year like no other. But for Adelaide cause type 2 diabetes and its ophthalmologist Dr James Muecke, associated vision loss and other 2020 has brought even more major health problems, including Ichanges than for most of us: named liver disease. In his case, it meant Australian of the Year in January, he much less ice cream and chocolate. Dr James Muecke, 2020 Australian of the Year looked forward to countless speaking And the lockdown stopped the engagements in which he could educate temptations that come with ‘on the road’ in the 1960s,’ Dr Muecke says. ‘Now, we and influence Australians about the dinners and late-night hotel snacks. see roughly 250 new cases in Australia dangers of sugar. The diagnosis certainly gave a each day.’ It wasn’t long before COVID-19 personal touch to his speeches. In the And, he says, the sugar and refined restrictions meant that his diary many presentations he’s delivered, Dr carbohydrates – white flour, white rice, switched from being filled with in- Muecke explains that every year he sees white potatoes and the foods made from person presentations to one dominated increasing numbers of people losing these – that comprise so much of what by on-line conferences and webinars. vision and even going blind due to we eat and drink are largely to blame. Fortunately, Australians became familiar diabetes, especially type 2 diabetes. ‘Refined carbohydrates are pretty with the format; his message could still ‘More than 150,000 Australians now much pure starch and starch is simply be delivered. have sight-threatening eye disease due long chains of glucose which are broken Then, in March, Dr Muecke was to diabetes. Type 2 diabetes makes up down into single molecules of glucose himself diagnosed with a disease close to 90 per cent of all cases – yet is a when they reach the gut,’ he points out. directly related to his own excessive largely preventable dietary disease due ‘When we ingest refined carbohydrates, sugar consumption: fatty liver. As a tall, to the consumption of too much sugar we are giving ourselves a big sugar hit. fit and apparently healthy man with in our modern diet,’ Dr Muecke says. And there’s no biochemical process in no symptoms, the diagnosis came as a ‘Diabetes causes damage to the our bodies that demands it. shock; he was, he learned, one of the blood vessels throughout the body, ‘This is a phenomenally expensive increasingly common ‘TOFI’ – thin on including the retina. Diabetes can cause disease, costing our health system the outside, fat on the inside – people bleeding inside the eyes that can take close to $20 billion every single year for who develop diet-related fatty livers. away the eyesight in an instant, and treatment and lost productivity. And The doctor was forced to practise even sometimes permanently. we are now seeing type 2 in our kids. more strictly what he was preaching ‘But 98 per cent of the loss of This is a disease that used to be called – consume minimal amounts of the vision due to diabetes is preventable “maturity onset diabetes”; there are now sugary products, refined carbohydrates or treatable. However, to avoid the over 1,100 Aussie kids and teens with blinding consequences type 2 diabetes. of this disease, patients ‘Globally, in 2001, less than 3 per cent with diabetes need to of diabetes in children was due to type have their eyes checked 2; by 2011, it had risen to 45 per cent. regularly. In Australia, of And what’s really concerning is that we the 1.7 million Australians are now seeing type 2 diabetes in Aussie with this disease, well over kids as young as seven.’ half are not having their regular, all-important, SO WHAT IS TO BE DONE? sight-saving eye checks.’ ‘Being a dietary disease, it should be as That’s why, he says, simple as reducing our sugar intake,’ he diabetes is now the says. ‘But there are a number of factors leading cause of blindness that make this difficult for us to achieve.’ among working age With a national platform amplifying adults in Australia, and his voice and enabling him to reach the fastest-growing cause more politicians, doctors and parents, of vision loss among Dr Muecke has urged governments Aboriginal people. and industry to enact strategies to ‘This is a disease that counter what he has termed ‘the 5As of Retinal haemorrhage due to diabetes was virtually non-existent sugar toxicity’:

12 | medicSA • Addiction – sugar is as addictive they’re stressed. A walk in nature, as nicotine music, doing a good deed have all been • Alleviation – we often consume shown to be as effective as sugar in sugar to make us feel better when countering the cortisol reaction that’s we’re down flooding our body during anxious times.’ • Accessibility – sugar is everywhere, Action in the other three As including at supermarket checkouts demands accountability. and in vending machines ‘We need business, industry and • Addition – about 75 per cent of our government to do the right thing by foods and drinks have added sugar the people of Australia – remove sugary • Advertising – we are inundated products from vending machines in with ads and commercials for schools, hospitals and universities, and A human fatty liver sugary products. from checkouts; agree to graphic labels Dr Muecke says action to counter that indicate the added sugar content of to reduce purchase and consumption the first two requires making people beverages and other products; and ban in 17 countries. In the 10 years to 2017, aware that sugar is addictive, and that ads for sugary products in television, the consumption of sugary drinks in we do consume sugary products to social media, and on government Australia increased by 30 per cent and alleviate stress. buildings and services.’ it’s been modelled that a 20 per cent ‘For most, it will be a physical He has pleaded with the Australian levy just on sugary drinks would raise dependency,’ he says. ‘I went through a Government to change the Australian $600 million, which could then be used sugar detox after my fatty liver diagnosis Dietary Guidelines, which he says are to fund health initiatives and combat and it’s very unpleasant – far worse ‘packed’ with products made from health inequalities. than caffeine withdrawal. For some refined carbohydrates as well as other ‘We also need hard-hitting strategies people however, there may be a deeper, foods that can have relatively high – ads and awareness campaigns – as we psychological addiction, and we may amounts of sugar in them, including did with cigarette smoking,’ Dr Muecke need to introduce help lines, self-help tropical fruits, low-fat dairy, baked beans says. ‘Doctors shouldn’t have to keep groups and counselling, as we’ve done and ultra-processed foods. treating and Australians keep paying for for alcohol and nicotine addiction. Then there is the much-discussed the life-changing and life-threatening ‘For alleviation, people need to look sugar tax. Dr Muecke says a levy on complications of a preventable and to alternatives to sugary products when sugary drinks has already been shown reversible dietary disease.’

Dr James Muecke explains how the excessive consumption of sugar is the leading cause of death in Australia including type 2 diabetes, heart attack, dementia and stroke.

ucrose, or table sugar, which which is then exported away from fatty plaques, which block the blood is the most common additive, the liver and stored in healthy fat vessels and in turn produce the many Scomprises 50 per cent glucose cells around the body. But when the devastating consequences of type and 50 per cent fructose. The body production of fat by the liver outstrips 2 diabetes. handles these two substances in its ability to be exported, the liver Blockage of the fine blood vessels completely different ways. then starts taking on that fat, and we can lead to impotence, numbness and Firstly, glucose. When glucose develop a ‘fatty liver’. pain in the extremities. It can also is absorbed into the bloodstream Fructose is the 50 per cent of sugar cause damage to the retinal tissue from the gut it triggers the release that gives sugary products their with bleeding inside the eye and of the hormone insulin from the sweet flavour. Fructose suppresses macular oedema – damage to the fine pancreas. The insulin helps move the our appetite control system. When blood vessels in the central vision glucose into every cell of our bodies, fructose is absorbed into the area causing fluid leakage and then where it’s then stored or used as an bloodstream, 100 per cent of it is taken distortion and reduced vision. energy source. up by the liver and about one-third is Diabetes can also cause dementia – With excessive and prolonged converted immediately into fat. It’s about 70 per cent of patients with type sugar intake, the cell becomes full actually much more dangerous than 2 diabetes will ultimately succumb to of glucose. The insulin level rises to glucose in leading to a fatty liver. dementia – and kidney failure. Every push more glucose into the cell, but It takes on average about 13 years for year in Australia, an estimated 4.5 it reaches a stage where the cell can someone to develop type 2 diabetes million hours are spent by patients take no more in – which is when we after they become insulin resistant. with type 2 diabetes hooked up to become ‘insulin resistant’. This leads It’s a complex metabolic process, but dialysis machines. to an overflow of glucose back into ultimately the liver can take in no Type 2 diabetes is now the sixth- the bloodstream, which is then taken more fat and the excess fat is exported biggest killer in our society. But if you up by the liver and converted initially away from the liver as triglyceride, consider it also plays a critical role into glycogen. which is harmful to our health. It’s in stroke, dementia and heart attack, The body has limited glycogen the high level of triglyceride in the as well as hypertension and cancer, stores. Once these are full, the liver blood, combined with the high insulin it may well be the biggest killer in starts turning the glucose into fat, level, which leads to the formation of our midst.

medicSA | 13 STATE ADVOCACY

AMA(SA) has provided public support for the may be involved to undergo scans and other tests that are now available, and decriminalisation of abortion as proposed in a Bill have some time to consider what this now before parliament, writes AMA(SA) President information means before making what is a devastating decision. Health services Dr Chris Moy. provide counselling and support during he Termination of Pregnancy results of which were released in June this decision-making time. Bill presented to the South 2020 – found: Besides terminations performed by Australian Parliament in • two-thirds of the 1,012 adult medication, a medical practitioner is required to approve and perform the November aims to change the respondents support the availability procedure in the period up to 22 weeks Tlaw so that in this state, as elsewhere in of abortion care and 6 days. Australia, abortion is regarded by the • 80 per cent support decriminalisation. After 22 weeks and 6 days, there law as a women’s health issue. If passed This Bill comes at a time when as a must be two medical practitioners in its current form, women seeking society and as individuals, we recognise involved, to ensure the procedure is abortion will no longer have the threat that women should have control over medically appropriate. of criminal action adding to the already their bodies and be at the centre of their There is no evidence here or complex issues they contemplate when health decisions. elsewhere that this Bill will increase the considering whether they should or The law as it stands prevents many number of late-term abortions. It didn’t must terminate their pregnancy. Nor women from exercising that control, happen in Victoria or Queensland when will suitably trained doctors and other especially if they live in rural or remote the legislation was changed; in those health practitioners face such a threat. areas or are new to this state. The decriminalisation of abortion states, approximately 99 per cent of is long overdue. Women who seek WHAT WILL CHANGE? terminations continue to be performed abortions should not have the threat The Bill places control with the before 20 weeks. of criminal prosecution adding to the woman, rather than with the medical The small percentage of women who other complex and distressing factors practitioner as is the case with the seek abortions after 20 weeks, and the that they face when contemplating this current legislation drafted in the 1960s. even smaller that do so after 22 weeks, health procedure. Fortunately, it seems However, it does not change anything do so almost invariably because a many of the politicians who must vote in terms of the medical and health woman or couple who very much want on this Bill agree with this major change processes. But it does recognise that the pregnancy discover through a scan to the legislation. technology and health services have at 19 or 20 weeks that the foetus has a It seems that in supporting changed and improved, with knowledge serious health condition, or because of a decriminalisation, the parliament is and technology now enabling doctors risk to the woman herself. aligned with community sentiment. to identify foetal health issues such Examples of this include: While some South Australians have as spina bifida, major cardiac or • A minor with an intellectual disability religious or other objections to neurological malformations, at the 20- became pregnant as a result of sexual terminations that are genuine and week scan. abuse by a family member. Given must be respected, a survey1of South This proposed legislation supports a her intellectual disability, she was Australians conducted in May 2019 – timeline where a woman and others who unable to appreciate or understand ... continued over page AMA positions on abortion The AMA Position Statement on in certain medical treatments has a conscientious objection to Conscientious Objection 2019 states: or procedures based on a abortion, they must inform the 1.2 A conscientious objection conscientious objection. patient of their objection and ensure occurs when a doctor, as a result 1.5 A doctor’s refusal to provide, the impact of a delay in treatment of a conflict with his or her own or participate in, a treatment or does not constitute a significant personal beliefs or values, refuses procedure based on a conscientious impediment to the patient accessing to provide, or participate in, a legal, objection directly affects patients. services. The doctor must take legitimate treatment or procedure Doctors have an ethical obligation to whatever steps are appropriate to which would be deemed medically minimise disruption to patient care ensure the patient’s access to care appropriate in the circumstances and must never use a conscientious is not impeded. Due to the time under professional standards. objection to intentionally impede critical nature of abortion services, in 1.3 A conscientious objection is patients’ access to care. some circumstances providing the based on sincerely held beliefs and The AMA Position Statement on patient with sufficient information moral concerns, not self-interest Ethical Issues in Reproductive on accessing such services may or discrimination. Medicine 2019 states: be sufficient while other situations 1.4 It is acceptable for a doctor to 2.4.1 Doctors hold differing views may require an effective referral to refuse to provide or to participate regarding abortion. Where a doctor another practitioner.

14 | medicSA STATE ADVOCACY

... continued from previous page other health practitioners, as with other the onset as it aligns with both the her pregnancy until she was at a late members of the community, do not Federal AMA positions and the view gestational stage. When her situation wish to perform terminations because of AMA(SA) Council as set out in its became known, the girl was clear that of genuine and long-held beliefs. submission to SALRI, and subsequent to she did not wish to proceed with her The clauses about conscientious a request for the input of all members. pregnancy and a late-term abortion objection reflect the submission from Most importantly, however, was carried out. the AMA(SA) to the South Australian AMA(SA)’s support of the Bill is founded • In NSW, the Health Minister noted Law Reform Institute – which on the view that in 2020 it is totally that she sat for two hours with one investigated the existing legislation, inappropriate and anachronistic for young woman who very much wanted invited submissions from interested the burden of criminality to be placed a baby but at 20 weeks a scan showed parties, and drafted a Bill for Attorney- on a woman who is already facing a that the baby's organs were growing General Vickie Chapman – and Federal difficult decision about a matter related outside its body. It was first diagnosed AMA Positions. to her health. at 12 weeks, but she hoped for a I am aware that views regarding miracle. When she was checked at abortion are varied and deeply held 1Cations, M., Ripper, M., & Dwyer, J. just over 20 weeks it became obvious among our members, members of the (2020). Majority support for access to that she had to have a termination. health profession and individuals in the abortion care including later abortion THE RIGHT TO OBJECT community. I have and will continue in South Australia. Australian and New At the AMA’s insistence – even to to show the highest respect for these Zealand Journal of Public Health, 44(5), the point of specifying wording – this views. However, I have also chosen to 349-352. https://doi.org/10.1111/1753- Bill recognises that some doctors and be clear in supporting the Bill from 6405.12997

Campaigning for care MA(SA) representatives have In a letter to Minister Wade in we’ve seen the result: a hospital that been vocal in campaigning October 2020, Dr Moy emphasised has problems that patients and staff for world-class care at the the importance of clinical input. are forced to tolerate and find work- Women’s and Children’s ‘The knowledge and expertise of arounds for.’ AHospital (WCH) in North Adelaide our members and colleagues in the Dr Moy says the new WCH must be throughout 2020. medical profession is fundamental to ready and able to address the needs of From the State Budget submission consideration of how the new Women’s and opportunities provided by changing forwarded to Health and Wellbeing and Children’s Hospital (nWCH) is demographics, social expectations and Minister Stephen Wade in December designed and built to best cater for the technological innovations over the 20 2019 to high-profile advocacy in the needs of women, babies and children in years or more after it opens. media in recent months, AMA(SA) the years ahead,’ Dr Moy wrote. ‘This type of planning requires input members and Councillors have urged Dr Moy says the AMA consistently from the people who will work in and that plans for the new WCH ensure argues for health services and use the hospital, and so clinicians and patients, families and carers have access infrastructure to be planned for, other practitioners must be included in to the best care. designed and used to maximise the these discussions from day one,’ Dr Moy says. ‘There must be no loss of services, In addition, doctors have demanded benefits for people. no loss of beds.’ that services at the existing WCH must ‘For a new Women’s and Children’s For example, Dr Moy says, basing not diminish in quality or capacity while Hospital, that means the planning bed numbers on predicted averages is a South Australians wait for the new and design stages of the physical mistake. ‘Hospital bed numbers should hospital to be built. Long-time AMA infrastructure must address the needs of have built-in redundancy and capacity member Dr Michael Rice – for whom patients, carers and visitors, doctors and to cater for peak periods – a clear and the paediatric cancer ward at the WCH other healthcare professionals, and other horrendous failure in the build of the is named – has been particularly vocal people who must use it,’ he says. current RAH,’ he says. in demanding that children continue to ‘Clinicians must also be involved in ‘Where the views of consultancy receive the care they need. planning how the hospital will operate firms and finance override those of In December 2019, AMA(SA) President and be managed. This will require a coal-face clinicians in decision-making, Dr Chris Moy submitted the AMA(SA) clinician-led governance structure you end up with fixed problems that Council’s list of priorities for the 2020-21 that includes innovative, talented and create ongoing costs for the care of the State Budget. While COVID-19 has had medically qualified administrators who community and Treasury – the RAH a dramatic effect on priorities, budgets are enthusiastic about healthcare and again being the prime example.’ and other resource issues since that are remunerated appropriately. Dr Moy says it will be several years submission, Dr Moy says planning ‘Minister Wade understands that before the new WCH is built and ready for the WCH continues to proceed – we want clinicians to be involved in to support patient care. ‘The AMA is and progress must incorporate the discussions about planning the hospital monitoring the provision of quality knowledge and expertise of doctors and from day one. That didn’t happen with care in the existing hospital and other health practitioners. the new Royal Adelaide Hospital, and other services.’

medicSA | 15 2020 IN REVIEW

Towards zero tolerance The AMA(SA) Culture and Bullying Summit in February has inspired nation-leading legislation to provide safe workplaces for South Australia’s health care workers.

he Summit staged by AMA(SA) ability to claim unrostered overtime, with at the University of Adelaide as many as 39 per cent reporting they had heralded a year in which been told not to claim it. working conditions for doctors – Other speakers – MIGA senior solicitor Tand particularly junior doctors – were the Tim Bowen, A/Prof Christine Lai of the subject of discussion around Australia. Royal Australasian College of Surgeons The concerns regarding poor culture (RACS), and A/Prof Jill Benson, Clinic and bullying highlighted by state-based Doctor at Doctors’ Health SA – supported AMA(SA) Culture and Bullying Summit Hospital Health Checks (HHC) in recent her evidence. keynote speaker Professor Michelle Tuckey years had reached a point that no one Keynote speaker Professor Michelle could ignore them. Tuckey of the University of South to care for their greatest asset: their In South Australia, the issue had Australia’s Centre for Workplace workforce,’ he says. generated front-page headlines in Excellence explained that while every As a result, the Bill now reads that September 2019, after AMA(SA) workplace has factors that can lead to each Board, which reports to the SA President Dr Chris Moy told the stress and other issues that may cause Health Chief Executive, is responsible Parliamentary Inquiry into Workplace bullying, those factors and the bullying for ensuring that a hospital in Fatigue and Bullying in South Australian itself are usually symptoms of bigger its jurisdiction: Hospitals and Health Services of the problems: the workplace systems, (i) promotes a healthy workforce culture ‘toxic’ culture in the state’s hospitals. structure and processes. for and among staff employed to work Dr Moy’s statement described work BOARD RESPONSIBILITIES within the incorporated hospital; and environments in which doctors and (ii) implements measures to provide for It was a comment from Women’s other health practitioners were subjected and promote the health, safety and and Children’s Hospital LHN Chair and to bullying and harassment that led to wellbeing of those staff within the former SA Health Chief Executive Jim stress, anxiety and fatigue. workplace (including the psychosocial Birch that led discussion at the summit It was not only doctors and other health, safety and wellbeing of staff); back to the key question of where health care workers who suffered and through such treatment, Dr Moy responsibility lies for the matter of (iii) implements policies issued by the Chief said: tired, stressed doctors make culture within the SA Health system. Executive on workforce health, safety mistakes that have serious effects on Dr Moy says this 'aha moment' has led and welfare (including policies on their patients. to a ground-breaking recognition of the workforce harassment and bullying), Dr Moy announced that in early 2020, role of Local Health Network boards in so far as those policies apply to the the AMA in South Australia would demanding staff wellbeing as a non- incorporated hospital. bring together doctors, academics, negotiable ‘performance indicator’ in the Dr Moy believes this ‘tangible result of administrators and politicians at a South Australian health system. the Summit’ may be a first in Australia; ‘Culture and Bullying Summit’, to An unequivocal statement that LHN he says AMA President Dr Omar identify bullying issues and causes and Boards are ultimately responsible for Khorshid is now looking at the South demand that ‘bullying must stop’. the welfare for their staff is included Australian legislation as a template On 29 February, more than 100 of the in an amendment (that has now been to recommend as a model for other state’s leading health and medical minds passed) for the Health Care Governance Australian jurisdictions. and leaders in South Australia attended Amendment Bill 2020 that Dr Moy and He is pleased it has been achieved in the Summit. They heard Dr Hannah AMA(SA) Council drafted and strongly a constructive rather than adversarial Szewczyk, chair of the AMA(SA) Doctors advocated for. In a letter to Health and way, with AMA(SA) working closely with in Training Committee, report that South Wellbeing Minister Stephen Wade, Dr Minister Wade on an idea which may Australia’s HHC results mirrored those Moy said it was important to ‘be explicit now seem obvious but was not so before of other states in relation to workforce in setting out of the responsibility of the Summit. factors such as access to leave and LHN Boards to promote and ensure ‘To have support for this key change, professional development opportunities, psychosocial health and wellbeing in particularly from our leaders, is rostering and overtime, and bullying the workplaces for which the Boards important and appreciated – particularly and harassment. are responsible’. this year when doctors and staff have Dr Szewczyk said most junior doctors ‘The amendments bring LHN gone through so much for their patients.” reported concerns about making Boards into line with their corporate Meanwhile, Dr Szewczyk and the a clinical error due to fatigue, and counterparts by bringing clarity and DiT Committee disseminated their fatigue had caused some to crash their balance to their imperatives – not only 2020 South Australian HHC survey cars. However, she said, the issue that the need to provide good quality health in November and will have results in concerned most junior doctors was their care and to maintain budgets, but also early 2021.

16 | medicSA Crises management So much work is yet to be done to combat what the AMA has repeatedly called a ‘global health emergency’ while climate change joins COVID-19 as a danger for all Australians, writes Dr Ingo Weber.

hances are you are sick of ever before. Further, for better or for hearing what a ‘crazy and worse COVID-19 has disrupted our unprecedented’ year 2020 has ‘business as usual’ approach. This been. So, instead, let us ask, what represents a great opportunity for a Dr Ingo Weber Cis it that defined this year for you as a healthy recovery by dealing with both health professional? the climate change and COVID-19 even before the tragic bushfire season Just one year ago we were beginning crises at the same time. How? Well, commenced. Both organisations are to experience the greatest fires in who best to ask than our economists now again calling on the Australian Australia’s recorded history, as well and our health experts? According to Government to demonstrate leadership as unprecedented (that word again!) them, investing in new renewable and through vision and act in a bipartisan floods and storms affecting so many adaptive technologies means we will way on our climate health crisis. The Australians, with rural Australia being generate many more net jobs than in the AMA has also declared support for the hardest hit. Billions of Australia’s fossil fuel industries, produce cheaper Zali Steggall’s climate Bill, which asks precious wildlife were killed. Some electricity, and avoid air pollution and for a clear plan towards zero emissions species have become extinct. lower greenhouse emissions in keeping by 2050 as well as an independent Analysis by the Bureau of Meteorology with the Paris Agreement. expert climate change commission to in 2020 showed that 2019 was the hottest Yet Australia has neither a plan nor a recommend policies based on science, year on record for Australia (1.52 degrees commitment on how to get there. This independent of political ideology. Celsius above the 1961-90 average of is noted on the international stage, with In the health sector, which contributes 21.8C and well above the previous hottest the UK and the US asking Australia to between seven and 10 per cent of year in 2013 at 1.33C above the average). commit to zero emissions by 2050. Australia’s greenhouse gas emissions, Nine of the 10 hottest years recorded Bizarrely, in regard to COVID-19 we much needs to be done to reduce our in Australia have occurred since 2005. have seen politicians act with vision and own greenhouse emissions to zero. The The most recent report issued by BOM leadership based on sound science and AMA and DEA are therefore calling and CSIRO State of the Climate 2020 health advice. So why not when it comes on the Australian Government to further suggests that within 20 years, to our climate crisis? The cost to act on establish an Australian Sustainability these extreme temperatures, fires and the threat posed by the virus was great. Development Unit to support sustainable storms will become the ‘new normal’. In But the cost for not acting would have practices in healthcare and reduce the the 58 years from 1960 to 2018 there were been far greater. The same is true for our sector’s own significant emissions. 24 days where the average maximum climate crisis; but it extends the cost to Both organisations are also asking the temperature across the continent hit 39 countless of generations to come. government to support policies that degrees or higher. In 2019 alone it was 33 For this reason, the AMA, along with acknowledge the tremendous health days. Sadly 2019 gave us a taste of what Doctors for the Environment Australia benefits possible through a transition to is yet to come. What will be the health (DEA), last year declared the climate renewable energy. impacts on our communities and in crisis a ‘global health emergency’ – By encouraging our policy makers particular our rural communities as this and political leaders to work together situation is set to worsen? and to listen to the science, by outlining Just as we were recovering from and the significant health benefits, and reflecting on the dreadful environmental by working on reducing our own disasters, the COVID-19 pandemic greenhouse gas emissions in the hit. Our increasing interference and health sector, the AMA and DEA are intrusion into the natural environment demonstrating leadership in order is without doubt disturbing the balance to protect Australian lives now and and stability of our life support systems. into the future. We can deal with both However, by reflecting on COVID-19 the COVID-19 and our climate health there is also a good news story to be told. challenges at the same time. At the We showed the world how well Australia end of 2020, hindsight 20:20 gives us managed the pandemic by listening to a clear vision for the required future the science and public health experts, policies. The opportunities are right here and by acting early and decisively. right now. Clearly this saved many lives and AMA Vice-President and AMA(SA) minimised the damage to our economy President Dr Chris Moy with Zali Steggall Dr Ingo Weber is Chair of Doctors for Public health and its medical experts MP, an advocate for Australian Government the Environment Australia (DEA) in are now being appreciated more than action to combat climate change South Australia.

medicSA | 17 2020 IN REVIEW

The air we breathe

Research shows bushfire-related pollution has increased healthcare costs, but that South Australia has fared better than the eastern states.

he health costs associated with partly because the more populous states air pollution following the were exposed to extreme pollution for 2019-20 bushfire season jumped up to several months. nearly 70 per cent in South This pollution was a complex and TAustralia to $35.84 million, a recent dynamic mix composed of particulate study1 published in the journal Nature matter and a range of gases such as has found. nitrogen dioxide, carbon monoxide, Yet the state fared significantly better volatile organic compounds, and Nicolas Borchers-Arriagada than in NSW with bushfire-related polycyclic aromatic hydrocarbons. health costs of $1.07 billion and Victoria The study of health costs builds on was more than 14 times the historical with $493 million. work by the same authors published in population-weighted mean 24-hour The study by the Menzies Institute the Medical Journal of Australia2 earlier PM2.5 value of 6.8μg/m3. for Medical Research at the University this year which estimated population ‘Our findings indicate that the smoke- of Tasmania calculated a total of nearly exposure to particulate matter less related health impact was substantial,’ $1.95 billion in bushfire smoke-related than 2.5μm in diameter (PM ) based 2.5 the authors concluded. health costs in Australia during the 2019- on publicly available air quality ‘Smoke is just one of many problems 20 season, calculated from 1 October monitoring data during the last quarter that will intensify with the increasing 2019 to 31 July 2020. These costs are not of 2019 and the first quarter of 2020 frequency and severity of major usually included in economic analysis of (1 Oct 2019 to 10 Feb 2020). the costs of bushfires. This research found that in the period bushfires associated with climate This was found to be driven by an between the last quarter of 2019 and first change. Expanded and diversified estimated 429 smoke-related premature quarter of 2020, population exposure approaches to bushfire mitigation and adaptation to living in an increasingly deaths with 3,230 hospital admissions to PM2.5 exceeded the 95th percentile for cardiovascular and respiratory of historical daily mean values in the hot and fire-prone country are disorders and 1,523 emergency eastern states on 125 of 133 days, on at urgently needed.’ attendances for asthma. least one air quality monitoring station The authors found concentrations of Discussing the air quality research within the study area. fire-related air pollution this season were following the release of the latest cost The highest population-weighted well in excess of any of the previous 19

data, researcher Nicolas Borchers- PM2.5 exposure level, 98.5μg/m3 on 14 seasons and the 2019-20 smoke-related Arriagada says the 2019-20 fire season January 2020, exceeded the national air health costs were unprecedented in hit the eastern states particularly hard – quality 24-hour standard (25μg/m3) and magnitude: more than nine times higher

18 | medicSA 2020 IN REVIEW

than the median of the previous 19 with the wind and in the case of South transnational. Equally, air pollution seasons of $211 million. Australia, air pollution was pretty good from the Australian bushfires during The bushfire health costs research at about 8 micrograms on average, the 2019-20 fire season affected air found Canberra’s smoke-related health he says. quality in New Zealand and plumes costs were 48 times the previous year’s, However, if South Australia is were observed travelling through the while in NSW they were up by nine times exposed to prescribed burning or southern hemisphere. and in Victoria three times the previous more bushfires there is a potentially Managing wildfire smoke is thus a year’s costs. high risk in the future – the east coast global policy challenge that requires ‘We looked at the costs associated with shows the potential impacts of air multiple strategies ranging from global mortality related to bushfire smoke, pollution on health and its related costs, climate stabilisation through to local- hospitalisation for cardiovascular Mr Borchers‑Arriagada suggests. scale fuel management, the report says. or respiratory problems, emergency ‘Air pollution research shows that department presentations from October exposure has a chronic effect in the long Johnston, F.H., Borchers-Arriagada, N., 2000, and there are obviously many term including lower life expectancy, but Morgan, G.G. et al. Unprecedented health more smoke-related health impacts in this case we are talking about acute costs of smoke-related PM2.5 from the that we didn’t account for,’ Mr Borchers- exposure (that’s sub-daily to weeks). 2019–20 Australian megafires. Nat Sustain Arriagada says. In general, we haven’t been exposed (2020). ‘For example, during extended to many events with these levels of https://doi.org/10.1038/s41893-020- smoky periods, work productivity pollution exposure. 00610-5, 21 Sept 2020 was likely affected, and this could ‘If you think about what happens 1 Nicolas Borchers-Arriagada, Andrew have had a relevant impact in the with normal urban air pollution, and Australian economy.’ J Palmer, David MJS Bowman, Geoffrey the expected increase in magnitude and The study did not include the G Morgan, Bin B Jalaludin and frequency of natural disasters including premature mortality associated with the Fay H Johnston extreme fires, I would think there would bushfire contribution to annual average be some lasting health effects.’ 2 Unprecedented Smoke-related Health air pollution, which is much greater than Studies of the impact of air pollution Burden Associated with the 2019-20 that associated with short-term daily on large populations from tropical Bushfires in Eastern Australia, iMed fluctuations in air pollution. deforestation fires in southeast Asia J Aust 2020; 213 (6): 282-283. || doi: ‘For these reasons, the health and have shown significant health impacts 10.5694/mja2.50545 Published online: economic assessments we present are – and that this form of pollution is likely to be an underestimate of the true 23 March 2020 burden,’ the study notes. However, the report acknowledges that those at greatest risk of death from short-term smoke exposure are likely to have pre-existing diseases and potentially a shorter life expectancy than the average for others of the same age. While the 2019-20 bushfires took a terrible toll in South Australia with the loss of three lives, 196 homes, 660 vehicles and $200 million of agricultural production, the estimated health costs of pollution associated with bushfires in 2019-20 in South Australia were not as great as those in 2002 and 2009; then the health costs reached $35 million and $38.19 million respectively. ‘Maybe there were a few days that were really bad but when you look over a few months and in comparison to other

years since 2000, the exposure to PM2.5 was not as significant as with previous fire seasons in South Australia,’ Mr Borchers-Arriagada says. ‘You could also say that this fire season wasn’t so bad in South Australia in terms of health costs partly due to its lower population in comparison to the eastern states and possibly the environmental conditions that might have played a role in dispersing the smoke.’ Air pollution generally returns to

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first – we have largely accepted that to follow the evidence will be best for A year to stand up all of us. We haven’t been swayed by conflicting calls to ‘put the economy Australia's doctors will remember 2020 as a first’. And it is now unequivocal that by putting health first and eliminating unique time in our careers, writes AMA(SA) the virus, we are in fact in the best place President Dr Chris Moy. to survive and recover economically. Nationally, too, the AMA has been central to the creation and dissemination s the year began, in among the innocent descriptor ‘novel’ could in a of sensible, science-based decision- terrible stories of bushfires few months wreak so much havoc on making. Our advice has been sought across the nation, we first people’s lives, businesses, and economic by governments and communities, as heard the murmurings of an and social security. No one could have well as our members and other health Ainfectious condition caused by an agent known that my reference to ‘uncertainty practitioners and administrators. termed a ‘coronavirus’ that had started to and confusion’ in that first media Throughout the year, and even now, cause deaths in Wuhan, China. release would continue to influence we have fought for the most appropriate, Within days, I was one of the many our mental health and wellbeing as we safe personal protective equipment for doctors, administrators and policy- approach Christmas. health workers. And every day, often makers developing and disseminating How wrong I was, and here we are. many times a day, journalists asked AMA carefully worded statements about And, of course, it is not even close to members for explanations, comments how Australians who had recently been being over. But the end of the year and advice to help our country and to Hubei Province should monitor provides a milestone from which to its people navigate the ‘uncertainty symptoms and, depending on their remember that while there has been so and confusion’ that exists even now. contacts, isolate. In South Australia, much trauma and tragedy, we have all Six weeks after we prepared that the AMA drafted our first media release learned many lessons; reflect on our first media release, and two weeks about the ‘Novel Coronavirus’ over the experiences; and recognise what has before South Australia’s first lockdown Australia Day weekend. been achieved along the way. began, I penned an opinion piece for How long ago that seems. And how At a state level, I believe that the local media. In it, I implored that South much has changed. I think it’s fair to strong position we are in now is due Australians think about each other say no one would have believed in late to two factors. First and foremost, we and be kind; that we look beyond our January that what would quickly become have followed the science, and we individual needs and instead show the internationally known as COVID-19 have followed the people who have spirit of generosity, bravery and big- would change everything about how followed the science. From the Premier heartedness that was so evident during we live and work, in Australia and and Commissioner Grant Stevens to and after the summer’s bushfires. around the world. No one could have those of us going to work and school, I think we have done just that. imagined what would be required of us visiting supermarkets and walking our In the face of a once-in-a-lifetime as individuals; as students and educators; dogs, we have been willing to accept threat, we have pulled together and as health practitioners, staff members and adhere to policies based on the looked after each other. And I’m so and employers; as colleagues, family evidence evaluated and presented by very proud to have been a part of members and friends. No one could Professor Nicola Spurrier and her team. the AMA as an incredibly important have predicted that a virus with that Second – and this flows on from the contributor to where we are today.

medicSA | 21 2020 IN REVIEW

their career aspirations and extended their wait and training by another year. Medicine is a high calling COVID-19 has exposed the infrastructure of some clinics as not The pandemic has forced us all to look at life, ourselves and ‘fit-for-purpose’ and ill-suited to meet our chosen profession differently, writes Doctors’ Health SA the future expectations of patients in the and NT’s Dr Roger Sexton. new infectious environment. The stress of implementing COVID-19 protocols in consulting clinics has been ur training is long and COVID-19 has markedly increased our significant and required such changes as arduous. We sacrifice a lot to engagement with doctors at this time disposal of furniture and new protocols reach the point of Fellowship and at Doctors’ Health SA we have seen to safely streamline patients into and and to commit to life-long a range of personal and professional out of clinics. Olearning and the service of others. Only reactions to COVID-19. Doctors using telehealth report: we, as doctors truly understand this. Doctors are mostly gregarious and • 65 per cent of GPs have had medico- We acquire such skills as leadership, prefer human contact to working from legal concerns about having to work calmness in a crisis, strong emotional home. We have seen doctors forced into in an unfamiliar way with social intelligence, pattern recognition and isolation away from their usual social distancing in the consulting rooms, the judicious application of a ‘tincture musters and the social aspect of their using telehealth and consulting of time’. We learn pragmatism and workplaces with patients and staff. from cars in the carpark or drive- the satisfaction of achieving clear The cancellation of elective surgery through clinics. and measurable clinical outcomes triggered by COVID-19 restrictions • 80 per cent of doctors have expressed for patients. exposed the lack of preparedness their fear of bringing COVID-19 home We learn how to adapt, calmly lead and financial vulnerability of some to family members. and cope when there is a professional doctors who were operating as highly Rural doctors working remotely in emergency, and this influences our leveraged individuals and on the vulnerable Indigenous communities personal response to external shocks basis that cash flow would remain have been expected to lead and hold such as COVID-19. We have expectations continuously positive. a functional clinical team together, of ourselves that as trained doctors, we At the same time, COVID-19 has often as other clinical and support will handle it. offered some over-committed doctors staff have frequently come and gone. But COVID-19 ‘got personal’. permission to step back from the many They have been trapped in remote and We found ourselves as community roles that have been fulfilling, and to interstate places unable to be with members sharing the same concerns take a breather. family and where the requirement to as others about family, safety, mental Doctors’ Health SA sees many quarantine twice made escape tedious health, income and the future. burdened doctors with extraordinary and pointless. Our responses at home may have been capacity to work across many roles, As valued members of a key essential more subdued or more intensified by provided they are well. There is little services profession during COVID-19, our knowledge and training. opportunity however, to step back we have been trusted above all others Our work in complex health systems voluntarily from these even though to advise patients and guide politicians is exposing us to diverse workplaces many would like to do so! and law enforcement agencies in their and work practices. Some of these COVID-19 cleared our diaries of highly consequential financial and are quite unhealthy and require us to societal decision-making. individually adapt. It is unusual to hear dinners, events and meetings and other commitments. This has been welcomed We have all reacted to COVID-19 as of workplaces that adapt to our needs. social individuals and professionals by many doctors who were over- We also carry a large work burden working in the health system. We committed and unable to voluntarily and are expected by others to handle have all managed this differently and step back. this. We are seen as professionally experienced a variable impact. And then there is the professional toll well-resourced and supported. This can It has reminded us we have: that the pandemic has taken. COVID-19 deny doctors permission to express their • a need for a social life has added to the long list of work, health struggle and share how much burden, alongside medicine and safety hazards to which doctors are COVID-19 included, they are carrying • permission to pause periodically exposed. Examples are: each day. and take a step back to examine the • unsafe work hours Doctors are typically reluctant to burden we are carrying • physical violence ask for external assistance when the • a society who values medical • fatigue road becomes difficult and corrugated, leadership and our contribution as preferring to privately sort problems out • burnout medical practitioners by ourselves. When help is eventually • information and website overload • momentum in the health needed, it can be difficult to find. • easy access to medications system hierarchy. Since the profession established • infectious diseases (including These are things to enjoy Doctors Health SA in 2010, our team COVID-19). and celebrate. of doctors has seen over 1100 doctors Doctors in Training and service and students from all craft groups and registrars seeking entry into specialist Dr Roger Sexton is the medical director of heard their stories and offered acute training programs experienced Doctors’ Health SA and NT and deputy crisis intervention. COVID-19 interruptions that have stalled chair of MIGA.

22 | medicSA Self-care replaces holidays during COVID-19 COVID-19 threatened the viability of many private medical practices, but most seem to be bouncing back, says AMA(SA) Councillor Dr Edward Greenrod.

ike many other private practices, anaesthetists performed a fraction 2020 has been ensuring the emotional Dr Edward Greenrod says, of their usual surgical caseload for and physical wellbeing of staff. Early ophthalmology practices such a considerable time, as hospitals on, there was the constant challenge as his had to rapidly adjust to conserved their personal protective of sourcing adequate supplies of PPE, Lthe challenge of providing telehealth equipment (PPE) to prepare for and hand sanitiser and isopropyl alcohol where possible – even though most of manage COVID-19 requirements. surface wipes, which was ‘just stressful’ their work typically requires face-to-face ‘Early on, the greatest worry for all for everyone, Dr Greenrod says. Practice patient assessments. of us was that patients would simply staff also had understandable concerns Having access to Medicare avoid healthcare during the pandemic, about job security for themselves and numbers for telehealth and telephone which would result in a wave of their family members and for some consultations greatly helped provide missed diagnoses or late presentations there was a degree of fear about potential continuity of care and reassurance of sight-threatening eye disease,’ exposure to COVID from contact with to patients during the pandemic, Dr Greenrod says. members of the public. even where it was impossible or not ‘Some patients did seem very scared ‘It’s easy for us to forget now just how appropriate to schedule a face-to-face early on and cancelled their scheduled new all of the processes and procedures appointment, he says. appointments. For those patients who were for staff,’ he says. ‘This became a ‘For about two months most needed scheduled regular treatment to real focus for us at our own practice, practices in our field were using phone protect their sight, that was the worry.’ to ensure staff were feeling supported consultations when it was possible, Yet, he says, the initial worries about during the early period and keeping which was a totally new situation for missed eye care appear not to have regular communication open. many of us,’ Dr Greenrod says. ‘We eventuated. ‘During the slower weeks, the practice barely ever use telehealth consultations ‘I suspect that overall, across South also took the opportunity to catch up on in ophthalmology – examining and Australia, there may have been some procedural administration, including assessing eye patients is typically very delay for patients making their follow- reviewing our audits and policies.’ reliant on visual assessment with the slit up appointments or seeking care,’ While COVID cast a shadow over most lamp and other diagnostic technology Dr Greenrod says. areas of the community, he says the in the rooms. ‘However, at least from our own additional time and opportunity to focus ‘Although assessing patients over experience, we haven’t seen any patients the phone was quite limited for us, who’ve missed their appointment or on personal connections were the ‘silver patients really appreciated the simple treatment and suffered as a result. lining’ for private practice. verbal contact and reassurance. What ‘Since the initial COVID wave flattened ‘Good medical care is all about was also quite surprising was that, in out in South Australia, a considerable teamwork and relationships are critical some situations, patients could take number of our older patients have told in the running of any private practice, great photos of their eye with their us that looking after their health had so I think it was a great chance for staff smartphone camera, and the quality become their new focus. to reconnect on a personal level,’ Dr of image was so good that they were ‘We’ve seen patients who have finally Greenrod says. ‘It was impressive also to actually very useful to help triage a got around to scheduling themselves see how so many of our staff put in the number of conditions such as red eyes or for their specialist appointment or the extra time and effort to ensure patient eyelid problems.’ elective procedure that they had been care was prioritised throughout the As with other specialties, putting off. This has been reassuring entire period. ophthalmology practices limited their to see, both in the sense that patients ‘The other thing we noticed is that the face-to-face consulting to emergency are prioritising their health even staff in our practice became a lot closer. conditions and those conditions needing during uncertain times and that private We were already close, but it’s become time-critical treatment or surgery – practices still have an important role a really tight-knit bunch and they really overall, comprising a relatively small to play in providing services during the enjoy working with each other – of all proportion of ophthalmic presentations. COVID era.’ the positives during these challenging State-wide restrictions on elective Dr Greenrod says the other major times, for us that’s certainly been one of surgery also meant surgeons and challenge for private practices during the greatest.’

medicSA | 23 2020 IN REVIEW

A total rethink

South Australian GP Dr Kerry Hancock is one of the thousands of medical practitioners around Australia who has found COVID-19 to have enormous professional and personal costs.

ith personal experience of the week and then we would attend of being ventilated with webinars a few nights of the to keep up an Acute Respiratory to date with all the new information Distress Syndrome illness, coming through,’ Dr Hancock says. Wand having adult children in London ‘Trying to keep everyone on the same and Melbourne during the COVID-19 “song sheet” was often challenging. lockdowns, it would have been easy Having a very cohesive leadership group Dr Kerry Hancock for general practitioner (GP) Dr Kerry – including the practice partners, nurse Hancock to be preoccupied with anxiety manager and our business manager – as agile in establishing alternative channels throughout 2020. the conduit to the rest of the practice for training – but for some doctors, it just ‘I tried to put my own personal was crucial.’ meant more time online. anxieties aside during those first few Providing between 4,000 and 5,000 There was an understandable burst of weeks and months,’ Dr Hancock says. ’flu vaccinations safely during the excitement when face-to-face education ‘I had a son in London in the UK with a pandemic created a logistical puzzle, events were finally permitted. British wife … My other son, his wife and but the practice rose to the challenge, Dr Hancock says her practice needed my grandson were in Melbourne and our including spending days at the local to update its phone system for NBN and borders had closed. retirement village and visiting vulnerable add to its five phone lines in addition ‘The reality of COVID-19 hit home patients at home. The practice’s doctors to the fax and internet lines. The phone when my daughter-in-law’s grandfather, embarked on a vaccination blitz over four rang constantly and the fax machine whom I had sat next to at the wedding Sundays either side of Easter, with strict worked overtime, sending scripts to less than a year ago, succumbed to triaging and social distancing protocols pharmacies. Other paperwork (such as COVID-19 and my other son’s best friend’s in place. certificates) needed to be scanned and father in the UK also died of COVID. ‘We had great feedback from our emailed to patients securely, testing the My mother was also in a vulnerable patients – I think they felt safe and limits of admin staff. Many doctors tried age group. respected,’ Dr Hancock says. to consult from home and found that ‘I just could not even imagine what Introducing telehealth in the form challenging with the burden of scanning it would be like to be in an ICU on a of telephone consults was viewed as and emailing adding to the workload. ventilator or even unwell in hospital, extremely valuable in the short and Widespread concern in the when there were restrictions on hospital longer term, but doctors were concerned community, which prevented people visitation in this COVID time, without that they could ‘miss’ things as they from going to the doctor for routine the support from family, friends and could not see the person. This increased appointments, and costs associated with colleagues as I had when I was unwell. I GPs’ anxiety; the practice leaders made COVID-proofing the practice added to just tried to not think about it.’ themselves available to chat with doctors GPs’ pressures. Life in Dr Hancock's Happy Valley and staff at any time including after ‘I just felt I couldn’t take “my eye of practice was frantic as she and her hours, she says. the ball” for weeks and months!’ Dr colleagues tried to re-think workflows There were so many questions: which Hancock says. ‘In retrospect, I was more and procedures to limit potential platform to use, how to use it, how were hypervigilant than I had been since infections. They mobilised early, meeting privacy issues being resolved, did the starting in general practice more than to redesign the practice set-up to have patients know how to access and use the 36 years ago. For the first time since one entrance and a separate exit, various platforms. residency I felt I could be out of my establish patient and visitor screening ‘I look back to the first webinar that comfort zone. questions and sanitiser stations, I had to facilitate in early June and just ‘I felt as if I lived, breathed and slept and secure enough limited personal how much I have learnt about webcasting with COVID-19 for those first few months. protective equipment (PPE). and webinars and ethernet cables, speed But I was OK physically and mentally There were meetings at the surgery tests and earpods, Dr Hancock says. ‘And and I knew that I had good support with partners, other clinicians, my neck didn’t appreciate all the mobile around me.’ administration staff and managers; phone use, even after I purchased some She says that as a doctor, the toughest webinars to share information about the decent earphones.’ aspect was dealing with the uncertainty virus and restrictions; meetings with While doctors appreciated how quickly around the science – just as it had been in clinicians at the Local Health Network to the new technology and Medicare item the early days with other diseases such as discuss how and even if patients should numbers were instituted, she says many HIV/AIDS. attend practices, before other pathways found they became ‘webinar-ed out’ ‘I had a patient who developed and GP respiratory clinics were in place. with an overload of digital meetings and COVID-19 in the third week of March,’ she ‘We were holding Zoom or car park service delivery. Continuing Professional recalls. ‘At that stage, the specialised GP meetings with the clinicians most days Development (CPD) providers were also service had not quite been established,

24 | medicSA 2020 IN REVIEW

so I needed to review her via phone and especially staying home and away from cartoon our business manager would then face-to-face as she was recovering. work, public transport and school and the come up with each week – always one for ‘I was needing to check the guidelines shops when you have a viral infection. us in Adelaide and one for our Seattle- all the time so it was great that we There is also an accumulation of based GP colleague and friend who is had SoNGs to refer to, as well as the knowledge about what to do differently still part of our practice, despite being GP Liaison at SA Health.’ ‘next time’ – including having a steady isolated on the other side of the world,’ Keeping the team safe and happy supply of PPE, measures to accelerate Dr Hancock says. remained a constant challenge, with testing to reduce wait times, and systems ‘With the events in America you can often overwhelming information coming and practices to protect residents in imagine that there was a lot of fodder from all directions – from SA Health, the aged care facilities while keeping them for some very entertaining cartoons Communicable Disease Control Branch, connected to family and friends. and memes.’ the Royal Australian College of General She also praises the cooperation Practitioners, the AMA and South between the public and private Australia Police. sectors, with valuable systems And, while the testing regime was established such as the GP Liaison a feather in South Australia’s cap, in the Coordinating Centre. Dr Hancock says it came at a cost. If nothing else, Dr Hancock’s ‘There always seemed to be a doctor team has learnt quite a bit or nurse or an admin staff or two away about each other – such as who because they were either being tested has politically incorrect Zoom themselves and waiting on a result, or pseudonyms or background looking after someone waiting for a pictures – and who is up with result, putting pressure on the workload the latest lingo; certainly not the for the day.’ colleague who was repeatedly Some lasting lessons have emerged heard telling amused colleagues from the COVID-19 experience, to ‘check their junk’ [slang for particularly in relation to infection genitalia] instead of check their prevention and control, including junk email. Chandlers Hill Surgery nurse manager Casey social distancing, cough etiquette, hand ‘We were also kept amused (and Franchi and operations manager Meera Simon washing, staying away from children with informed) by our usual weekly staff consider systems to protect staff and patients upper respiratory tract infections, and newsletter wondering what funny during the pandemic.

Professor Carney and Professor Spark kindly thank their patients and referring GP’s for their continued support over this transition period and look forward to offering more medical services in the future. We are conveniently located in both the Adelaide CBD and at Flinders Private Hospital.

Prof. Simon Carney Prof. Ian Spark ENT Surgeon Vascular/ Visit us at adelaidesg.com.au Endovascular Surgeon or call us on 8277 0288

medicSA | 25 2020 IN REVIEW

Towns and country

It’s been a rollercoaster of a year, professionally and emotionally, writes 2019 RACGP National GP of the Year and new AMA member Dr David Lam.

just want all people living in are also required to undergo Australia to be safe and healthy, chemical sedation and air regardless of age, race, gender, transfer to Adelaide. As the beliefs or postcode.’ As a Hakka treating doctors, we must take ‘I(客家)Chinese Australian doctor, this into consideration risks never was my response when asked what contemplated as metropolitan winning the RACGP National General doctors, such as, ‘Is this Practitioner of the Year Award in 2019 patient more at risk right now and being named in the 2020 InDaily of their mental illness if I don’t 40 Under 40 list meant to me. Despite involuntarily admit them or the challenges of 2020, rural South more at risk from iatrogenic Dr Lam outside Cleve Hospital with University Australians have united and looked after harm and the inevitable of Adelaide medical students Ellie Schofield each other through bushfires and then anaesthetic risks if I do detain, and Bianca Melzner the COVID-19 pandemic. We are still sedate and transfer them?’. looking to innovate, improve and level Port Lincoln is therefore not an easy Recruitment and retention remain two the playing field between health care in job. We are required to treat patients huge challenges for the rural workforce rural and remote areas compared to our not just in our general practices but and patients alike. The problem is multi- metropolitan equivalents. also when they present to Port Lincoln factorial, but solutions must surely COVID-19 aside, healthcare in South Hospital emergency department begin with the simple notion of ‘grab Australia will always be plagued by the requiring life-saving care. No matter how them while they are young’. Cadetships tyranny of distance. I live and work good you are, you just cannot safely be in and youth development programs are in Port Lincoln, 650 km away from two places at once. This sadly translates a tried and true strategy of the vast Adelaide. This means I am 650 km into a perpetuating cycle of suboptimal majority of successful companies and away from the nearest intensive care primary care. If I am suddenly called sporting clubs. Doctors leaving their unit, cardiac suite and psychiatric ward. away from a clinic full of patients for the country towns after short periods Patients are frequently transferred to next four hours to deal with a patient of service is a problem commonly Adelaide by air with life-threatening in the emergency department having a attributed to sustained isolation from conditions; as a Port Lincoln doctor heart attack, any one of these patients their partners and families, who often you often must do what you can until in my waiting room could deteriorate remain in metropolitan Adelaide more help arrives. For example, patients into next month’s heart attack because presenting with severe mental illness their appointment was cancelled and for careers or schooling. We must requiring an inpatient treatment order opportunities for preventative care therefore strive to expose medical were lost. 2020 was even students and junior doctors to rural harder due to bushfires practice as early as possible in their and COVID-19. There was careers, while they are still flexible a spike in mental health without mortgages or masses of family issues relating to financial commitments in Adelaide. hardship, businesses I came to Port Lincoln as a medical closing and mandatory student of the Adelaide Rural Clinical isolation from friends and School. I was so fascinated by the vast family. Cancellation of scope of practice that I volunteered to elective procedures and return as a GP Registrar and then elected postponement of ‘routine to remain serving this community health check ups’ impacted after completing my fellowship. It is heavily on the quality of life an honour to now be working with the and the preventative care Adelaide Rural Clinical School as its of patients. Logistically, Rural Medicine Coordinator, teaching COVID-19 also hurt us by all 42 University of Adelaide medical creating barriers for urgent students placed in rural South Australia medical transfers to Adelaide on a weekly basis. It was also wonderful and disrupting the flow of as a GP registrar supervisor to see our help coming from interstate registrars, James Ashby and Keith Jarrett, locums, upon which the successfully pass their exams and also small country towns of South Dr Lam being presented the InDaily 2020 40 Under 40 choose to remain serving Port Lincoln Australia are so very reliant. award by Adelaide entrepreneur David Rohrsheim after Fellowship.

26 | medicSA 2020 IN REVIEW

COVID-19 has meant we have had to Lincoln to provide vital assistance to Dr than local doctors from neighbouring be creative with medical training. This Bradley, who would otherwise be the towns with invaluable familiarity of local year I had to convert my tutorials into sole GP in a remote town unsustainably services and resources. a free podcast called ‘GP Lyf Hacks’ to on call 24/7. Cleve, Cowell, Kimba and 2020 has certainly been a challenging make up for the cancellation of face- Elliston were also depicted in the article year, all the more so in the provision of to-face teaching with our registrars. as Eyre Peninsula towns separated by healthcare in rural South Australia. The To minimise risk of spread, medical hundreds of kilometres run tenuously workforce is depleted but hopefully the students were offered long placements as a single model/entity by the Eyre and strength of country people combined at a single rural practice. Two standout Far North Local Health Network (EFN with innovations in IT and teaching and final-year students, Ellie Schofield and LHN). These four towns are diligently training will create a sustainable health Bianca Melzner, were instrumental in managed by three local doctors taking system for all Australians, regardless of their service to the region, assisting it in turns to be on-call for all four towns their postcodes. me with outreach trips to surrounding simultaneously. But with so towns without a regular medical service few of them, taking leave and presenting clinical cases with me at is exceedingly difficult. the RACGP National Rural Forum. During the pandemic, these The pandemic and forced closure of towns used coverage by state borders has also unfortunately Dr Graham Fleming from highlighted how many South Australian neighbouring Tumby Bay, towns are reliant on interstate locums. and me, to support their Twelve months ago, a medicSA article doctors. In a unique effort outlined the hardships faced by the to promote awareness and Eyre Peninsula town of Streaky Bay, recruit for this struggling which had remained doctorless for region, I brought my medical a protracted period. This year, Dr students, Ellie and Bianca, Victoria Bradley thankfully assumed with me to gain experience the role of Streaky Bay’s regular GP. in these towns. However, Jonas Woolford, Chair of the Streaky now that borders have Bay Medical Clinic Board, has worked reopened, the EFN LHN has hard to implement a plan in which I elected to resume service visit regularly from neighbouring Port from interstate doctors rather Dr Lam at Streaky Bay

ASH_MedicSA_HlfPg_174x120mm_East West Urology_041120-2.indd 1 5/11/2020 12:24:00 PM medicSA | 27 2020 IN REVEIW

An anxious wait Early findings indicate serious impacts of the pandemic on mental health, but no increase in the suicide rate - yet.

necdotally, mental health – – and 20 per cent higher in Victoria than especially among younger in other jurisdictions. people – has been a casualty of A recent Australian study in Frontiers COVID-19. in Psychology found that depression and AThe Adelaide Suicide Prevention anxiety levels were significantly elevated severely restricted the size of public and Service run by AnglicareSA has reported in people with no previous mental private gatherings; and banned foreign being overrun by demand for services just health diagnosis, compared to previous nationals from entering Australia; and was after the COVID-19 lockdown and while population data. enforcing strict quarantine measures for numbers stabilised in August/September, The study was the first to survey Australians returning from overseas. the service expects Christmas pressures a representative sample from the The study measured the prevalence to precipitate more suicide attempts. Australian population at the early of clinically significant symptoms of Yet at this stage, rigorous data on the acute phase of the COVID-19 pandemic. anxiety and depression and measured impact of the pandemic on mental health Depression, anxiety, and psychological association with other recent adversities. is limited, pointing to the need for more wellbeing were measured with well- It also considered the degree to which research to form the basis of appropriate validated scales (PHQ-9, GAD-7, WHO‑5). symptom severity was associated with resource allocations in coming months. The study tested for associations exposure to COVID-19 and the impact of The Australian Institute of Health and between mental health and exposure the pandemic on the person’s financial and Welfare (AIHW) notes that while there to COVID-19, impacts of COVID-19 on social circumstances. has been a rise in the use of mental health work and social functioning, and socio- The study found the social, work, and services, there is no clear evidence that demographic factors. financial disruptions associated with the COVID-19 has been associated with a rise It found that the disruption to work and social conditions caused by the acute phase of the COVID-19 pandemic in the suspected suicide rate, self-harm, impaired community mental health in suicidal behaviour or suicidal thoughts. pandemic were strongly associated with elevated depression and anxiety Australian adults. Modelling by Australian National Exposure to COVID-19 was not found University suggests this may in part symptoms, as well as decreased psychological wellbeing. Financial to predict mental health in this cohort; be due to the JobKeeper and JobSeeker distress due to the pandemic, rather than neither was being required to work from payments that led to many people job loss per se, was also correlated with home associated with any mental health reporting they were in better financial poorer mental health. effects at the acute stage of the pandemic. positions while they received these Direct exposure to COVID-19 or the ‘Our results suggest that, at a population payments than they had been before recent bushfires was not correlated with level, changes to social and work the pandemic. elevated levels of anxiety and depression functioning due to COVID-19 were more The AIHW found notable rises in the although exposure to bushfire strongly associated with decrements in use of crisis lines and mental health smoke was correlated with reduced mental health than amount of disease services since the onset of the COVID-19 psychological wellbeing. contact. This finding is consistent with a pandemic, with calls to Lifeline between The report’s authors said innovative recent UK-based finding that their citizens 10 August and 6 September 2020 and creative policy measures were were more concerned about how societal increasing by 15.3 per cent compared with required to minimise disruption to work changes will impact their psychological the same time in 2019. and social functioning and increase and financial wellbeing, than becoming Contacts to Beyond Blue increased access to mental health services in unwell with the virus,’ the authors said. by 38.6 per cent and calls to the Kids the community. The finding also aligned with emergent Helpline by 24.5 per cent over the While previous studies of the effects work indicating that loneliness is playing a same period. of pandemics (such as SARS and Ebola) central role in the observed mental health ‘It is not clear to what extent this rise in on mental health focused on the mental impacts of the COVID-19 pandemic. contacts is driven by rises in psychological health of disease survivors, this study Escalating psychological distress distress rather than a higher proportion examined the mental health impacts associated with the pandemic pointed to of people seeking assistance for other of the COVID-19 pandemic on the a likely rise in demand for mental health reasons such as loneliness and concern broader population. services which would also be stretched about contracting COVID-19,’ the It surveyed a representative sample of by social distancing requirements and AIHW said. Australians from 28 to 31 March 2020, would need to be delivered flexibly, the Demand for Medicare-subsidised and during the acute phase of the pandemic authors noted. telehealth mental health services also in Australia. The findings also suggest the need increased. The total number of mental- Mental health issues in Australia had for policy responses to the pandemic to health-related MBS services in the four just started to escalate. In the previous minimise financial and social disruption. weeks to 6 September was 12.5 per cent fortnight, the Australian government had ‘Our results suggest policy approaches

higher than the equivalent period in 2019 closed restaurants, bars, and churches; that target financial support to those © iStock-chamelonseye

28 | medicSA 2020 IN REVIEW

experiencing financial strain may be FDV services in NSW, 44 per cent advice on how best to engage with useful, rather than on the basis of lost reported an increase in client numbers victim survivors. employment alone. We also found that and 56 per cent reported an increase in 1 well-established risk factors for poorer case complexity since the beginning of R Digirolamo, Demand spikes for suicide mental health—younger age, identifying the COVID-19 pandemic. help, The Advertiser, December 1, 2020, p 16. as female, and having a pre-existing Recommendations from the 2 Australian Institute of Health and mental health condition—continue to be AMA included: Welfare, The use of mental health services, associated with increased risk within the • funding for flexible support packages psychological distress, loneliness, suicide, pandemic context. to make it easier for victim survivors in ambulance attendance and COVID-19, ‘Governments should consider financial distress to access support and https://www.aihw.gov.au/suicide-self-harm- additional measures to monitor and monitoring/data/covid-19, 17 November support these at-risk groups,’ the improve their safety 2020. authors said. • funding for longer-term affordable and Family and domestic violence (FDV) safe housing for victim survivors and 3 Amy Dawel, Yiyun Shou, Michael is also a major concern related to their children Smithson, Nicolas Cherbuin, Michelle deteriorating mental health during the • funding for specialised support for Banfield, Alison L. Calear, Louise M. Farrer, pandemic. In its submission to the House women in vulnerable groups Darren Gray, Amelia Gulliver, Tambri of Representatives Standing Committee • appropriate resources to support Housen, Sonia M. McCallum, Alyssa R. Inquiry into Family, Domestic and Sexual adequate implementation planning Morse3, Kristen Murray1, Eryn Newman, Violence in July 2020, the AMA said: and performance measurement of any Rachael M. Rodney Harris 5 and Philip Natural disasters and pandemics are new funding J. Batterham3, The Effect of COVID-19 associated with a number of risk factors • targeted support for frontline workers, on the Mental Health and Wellbeing on for FDV. These include higher levels of including medical professionals, on the a Representative Sample of Australian financial uncertainty and insecurity; unique effects of the bushfire season Adults, Frontiers in Psychology,: 06 October psychological distress; and higher and COVID-19 on FDV, including 2020,doi: 10.3389/f psyt.2020.579985. consumption of alcohol and other drugs – all of which have increased in the first half of 2020. STOP PRESS The AMA noted: • Australian Institute of Criminology Scholarship winner to help research showing that among women who reported they had experienced remote communities physical or sexual violence from an intimate partner in the last three physiotherapist who switched to would let me provide the type of help that months, two-thirds reported that the medicine after seeing the needs of the local people needed,’ Mr Diggins says. violence had started or escalated since Aremote Aboriginal communities Mr Diggins has continued to work for the start of the COVID-19 pandemic has been awarded the 2020 AMA WA Country Health Service alongside his • St Vincent’s Hospital in Melbourne Indigenous Medical Scholarship. immediate and extended family while reported a doubling in domestic Lloyd Diggins, now in his third year as a completing his medical studies. violence-related presentations in the medical student at the University of Notre ‘I have seen how a lack of palliative care first quarter of 2020, compared to Dame Australia, is currently working in and dialysis in rural and remote areas is figures in the same period in 2019 Kununurra as part of the Rural Clinical devastating to Aboriginal people, who are • 1800 RESPECT reported a 38 per cent School of Western Australia. dying away from their country and their increase in the use of its online chat Mr Diggins, 29, is a Wongi Aboriginal families,’ he says. tool for sexual assault, domestic and man from Western Australia who became Mr Diggins eventually hopes to develop family violence counselling between determined to make a difference, having a formalised Aboriginal medicine training March and April witnessed the overrepresentation program for future students. • the NSW Bureau of Crime Statistics of Indigenous people in the health AMA President Dr Omar Khorshid has and Research reported an overall 4.1 system while working as a hospital described Mr Diggins as an exceptional physiotherapist in Perth. young man with a real gift for making per cent increase in domestic violence Discouraged from combining his those around him feel listened to incidents over the last two years, culture with his work, and frustrated by and valued. with anecdotal evidence suggesting a racist experiences, he moved to Darwin on ‘At the end of 2019, there were just over significant increase in demand for FDV the advice of his sister who was providing 600 Indigenous doctors in the medical services from March-May of this year healthcare with a cultural focus. workforce, which is about 0.5 per cent of • surveys conducted by Monash Research Working at the allied health service at the workforce,’ Dr Khorshid says. ‘This is a in Victoria and Queensland with FDV Gove District Hospital in East Arnhem slight improvement on previous years, but service providers, including those Land, Mr Diggins discovered the area to reach population parity of 3 per cent the in the healthcare sector, found that needed another GP. number should be closer to 3,600. providers were experiencing significant ‘I had fallen in love with the Yolngu The AMA Indigenous Medical increases in demand as well as more people and the Gove region, and I thought Scholarship was established in 1994 with complex cases since the outbreak of that if I was going to live in Arnhem Land a contribution from the Commonwealth COVID-19 for the rest of my career, I ought to “duck Government. Donations are tax- • of surveyed frontline workers in into town” and pick up a degree that deductible and can be made online here. Aboriginal and Torres Strait Islander

medicSA | 29 Clusters, cleaning and contamination History suggests we should start mapping an exit strategy from the pandemic, says Flinders University’s Emeritus Professor and infectious disease (ID) physician Peter McDonald AM.

Emeritus Professor Peter McDonald

s nations the world over ‘A virus is always more pathogenic in “contamination” and are difficult and are grappling with possible the new host after it has jumped from expensive to sterilise and clean. new strains or clusters of another species. But the virus evolves ‘I observed this in managing COVID-19, policy makers and adapts. It becomes less pathogenic staph infections in the 1970s. When Aare faced with tough choices about – if it kills its host it cannot persist in the the environment becomes heavily balancing risks and easing restrictions. host population. contaminated, that’s when you get It will be vital to look to science and ‘It appears that the transmission rate lots of people becoming infected with public health rather than political is increasing while the virus is becoming the same strain as they touch drapes expediency to avoid fear, says infectious less pathogenic.’ and benches as well as transmitting disease physician Professor Peter Professor McDonald says the South infection person‑to-person.’ McDonald, who chaired the National Australian Government, SA Health and Professor McDonald says it is difficult Health and Medical Research Council the community had responded rapidly to begin considering an ‘exit strategy’ (NHMRC) committee that wrote to the community transmission when it when authorities are forced to manage Australia’s first national infection was first detected in an elderly patient emerging cases. Selecting the ideal time control guidelines in the 1980s. in an emergency room. Cooperation to start talking about a de-escalation The Parafield cluster and evidence was widespread, with levels of testing, of restrictions remains a challenge surrounding transmission within close quarantine and contact tracing boosting for policy-makers – particularly in the contacts and the broader community the precautions taken by people in their absence of a unified national approach, highlighted important issues around the homes and public places. such as the one that underpinned the likely evolution of the virus and how to ‘One of the most interesting aspects response to HIV/AIDS. manage it, Professor McDonald says. of the sudden call for lockdown was the However, he says, now might be time ‘The history of pandemics shows claim that this was a new cluster, highly for the organisations such as the AMA to viruses tend to evolve … From what we transmissible and consistent with a UK discuss with policy makers a strategy to are seeing overseas, it seems that the strain being imported with a returning emerge from the pandemic – ‘one based virus is evolving,' he says. citizen,’ he says. ‘Even more interesting on science rather than politics’. ‘It’s becoming more easily was the fact that this particular strain transmissible, but many of the Despite rising optimism about the people who get it are younger and was transmitted to other quarantining likelihood of a successful vaccine asymptomatic, which makes it very guests in the medi-hotel, raising issues becoming available in 2021, Professor difficult for contact tracing. about how this transmission could have McDonald says policy makers must await ‘The recent brief lock-down in South occurred in a “controlled” environment.’ the outcome of vaccination before going Australia illustrates important factors He says 30 years of managing cross- too far in relaxing restrictions. about the virus and the challenges infection in hospitals had shown the ‘We do need to keep our powder dry that authorities and the medical need for strict, universally adopted until vaccines are tested in greater community face in managing the on- infection control practices, including numbers,’ he warns. ‘In the end, a going pandemic. The Parafield cluster staff behaviours such as handwashing, vaccine is going to be important raised the question about whether use of personal protective equipment for COVID-19 in the same way it is there is a new cluster of a more highly and cleaning the environment. for influenza. transmissible virus that could have ‘Sensibly, the authorities have ‘Doubtless they are going to vaccinate been imported. decided to move all positive cases to a large numbers of people, but it remains ‘We can see from historical hospital environment where control of conjectural to say that it is going to save observations of past pandemics and transmission is vastly better than in a the situation. We must start providing from the experience overseas that hotel,’ he says. people with information about how viruses become less pathogenic as the ‘We’ve known for a long time the infection evolves and incorporate virus adapts to surviving in human hosts that fabrics like carpets, upholstery this into planning the strategy for after crossing from another species. fabrics and drapes harbour human relaxing restrictions.’

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medicSA | 33 t

Insurance Insight: BetterBetteValue of Advicegetr get insured Insight: insure whiled whil you’ree you’r e still bulletproof stillNever bulletproof underestimate the value of avoiding the pitfalls Value of Advice Insight: Value of Advice Insight: Never underestimateAs we journey through life, there arethe all sorts ofvalue financial obstacles of and avoiding pitfalls to negotiate – some the are minor pitfallsspeed bumps, but someNever can cause usunderestimate major setbacks, and a whole lot ofthe grief. These value are the ‘pitfalls’of avoiding you need to avoid –the IF you see pitfalls them coming.

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Consultum Financial Advisers Pty Ltd I ABN 65 006 373 995 I AFSL 230323 I Part of the IOOF Group This is general advice only and does not take into account your financial circumstances, needs and objectives. Before making any decision based on this document, you should assess your own circumstances or seek advice from a financial adviser and seek tax advice from a registered tax agent. Information is current at the date of issue and may change. Dialing in for pandemic care but warned appropriate regulation is needed to prevent misuse. Counselling service Beyond Blue said Australians have quickly learned to appreciate the benefits of telehealth has been particularly vital digitised medicine, but careful monitoring is needed to keep for those with mental health issues, data secure. providing continuity of care during COVID-19 restrictions. OVID-19 has slowed many aspects businesses, are particularly vulnerable Beyond Blue says telehealth should of our society and economy but to cyberattacks as they often have be an addition to the treatment toolkit Cthere are some things it has under-resourced cyber-security. The which may provide a sense of security accelerated – particularly the uptake of federal government recently advised for some patients, encouraging them to technology. Yet experts warn that great that organised criminal networks are speak more openly. 3 opportunity comes with great challenges using the COVID-19 outbreak to intensify Electronic prescriptions have also around misuse and cybersecurity as hacking efforts with phishing emails been fast-tracked during the COVID-19 hackers are out in force. and SMS messages embedded with pandemic after a protracted regulatory In medicine, the pandemic has helped malicious links.1 process to assist in containing the reduce the barriers to digital take-up Health systems were already a virus and to reduce medication-related that have undermined telehealth for a target of cyber-criminals before the problems. Under the new system, decade, particularly Medicare rebates for pandemic. The Royal Australian College medications dispensed by pharmacists consultations by phone or video. of General Practitioners (RACGP) – are collated in an electronic patient After years of debate, a total of 274 Expert Committee Practice Technology record to coordinate medications. new MBS items had been created and and Management reported Australia’s Meanwhile, in medicine as elsewhere, implemented in six weeks of COVID health sector accounted for 22 per cent teleconferencing has replaced many restrictions in Australia, with the first of all data breaches between July and scheduled conferences and meetings items commencing on 13 March 2020. December 2019, making it the highest during the pandemic. By October 2020, a CommBank GP reporting sector in Australia. In a journal article on telehealth for Insights Report with HealthCert found Yet only a third of Australian global emergencies, the authors note that more than 95 per cent of Australian healthcare organisations embed cyber- while telehealth has been particularly general practices were offering telehealth security awareness and training into useful in providing continuity of care in response to the pandemic, up from just their policies and procedures.2 safely during COVID-19, its longer, 19 per cent the same time last year. In June 2020, the Australian Digital sustainable use depends on developing The Centre for Online Health (Figure Health Agency (ADHA) partnered with a strategy for its integration into 1) shows 166.6 million Medicare Benefit cyber-security firm Cyber CX to produce mainstream care. This will involve Schedule (MBS) telehealth consultations guidelines to help health organisations redesigning clinical models of care and from March to September 2020, with use telehealth and conferencing securely. adequate education and training for 16.7 million in September alone. More The agency advises medical practices to health professionals.4 than 90 per cent of these were telephone use the latest operating system version 1A. Galloway, Coronavirus cyberattackers consults with less than 10 per cent and install updates as soon as they going after hospitals, SMH, May 20, 2020, videoconferencing – even in specialties are available to close the security gaps https://www.smh.com.au/politics/federal/ such as ophthalmology. During this that enable cybercriminals to infiltrate coronavirus-cyber-attackers-going-after- period more than 30 per cent of their systems. hospitals-20200520-p54uq3.html general practitioner consultations were ADHA has prepared a toolkit to help via telehealth. healthcare practices meet their data 2A. Tsirtsakis, Health sector remains biggest The technology take-up was driven security, privacy and other legislative and reporter of data breaches, 20 August, by millennials (born between 1981 professional requirements. 2020, newsGP, https://www1.racgp.org. and 1994/5) and Gen Z (1995-2012/15), The 'Using Online Conferencing au/newsgp/professional/health-sector- who are comfortable with interacting Technologies Securely - A guide for remains-biggest-reporter-of-data-brea online. Across the country, 73 per cent of healthcare organisations ‘Connected, 3Beyond Blue, Managing my daily life, Australians said they had either accessed secure consultations’ provides advice on https://coronavirus.beyondblue.org.au/ telehealth or were open to virtual important issues including the need for managing-my-daily-life/coping-with- consultations. Before the pandemic, just secure configuration, well-implemented isolation-and-being-at-home/telehealth-a- 3 per cent of patients had participated in encryption, access control and multi- useful-way-to-access-support.html a telehealth consultation. factor authentication (MFA) when While advocating for telehealth, the conferencing online. 4A. Smith, E. Thomas, C. Snoswell, AMA and other organisations have The AMA has welcomed the Australian H Haydon, A Mehrotra, J. Clemenson, warned that the increasing trend towards Government’s decision to extend L Caffery, Telehealth for global emergencies: digitalisation must be accompanied by temporary Medicare Benefit Schedule Implications for coronavirus disease greater cyber security and protocols. (MBS) telehealth from March 2020 until 2019 (COVID-19), vol 26/5, 2020, p 309- Medical practices, private hospitals March 2021 to help reduce the risk of 313, https://journals.sagepub.com/doi/ and pharmacies, like other smaller community transmission of COVID-19 pdf/10.1177/1357633X20916567.

medicSA | 35 2020 IN REVIEW

Living, dying and grieving well

The pandemic and its restrictions have prompted many questions about lingering grief and bereavement, write Palliative Care SA’s Professor Gregory Crawford and Mark Waters. Palliative Care SA Chair Professor Gregory Crawford (left) and Executive Director Mark Waters

rief and bereavement’ is the Clinicians from South Australia were once again; hopefully, it won’t be as long fifth stage of palliative care. part of national conversations as to reinstate as previously occurred. As a result of COVID-19, they contributed to sub-groups and Decision-making has been brought many people have been working parties. to the fore during the pandemic. ‘Gdiscussing what happens with people’s Initial fears emerged of people dying Choices to stay in place, either at home grief in the long term. If people were in isolation without family members or in aged care settings have been to die in isolation without family as had been witnessed overseas. Or, if accentuated. Advance Care Planning connectedness and touch, might that there was a family member present, they has been more evident with anticipatory lead to unresolved grief? If families have still would not be able to touch their conversations about goals of care being been separated due to border closures, loved ones. To a great extent, this did raised more frequently. For several how will this affect people’s future sense not occur in South Australia. However, months, it was apparent that people of loss? If funerals have been held where anyone residing in or visiting aged care were electing not to go to hospital if at limited numbers of people have been facilities understands the isolation all possible, and GPs and Community able to attend, what does this do to and severe restrictions that continue Palliative Care teams were looking to residual bereavement? to apply. support people to die at home. During Palliative Care SA (PCSA) – whose The revolution of telehealth has been the months of COVID-19 constraints, mission is that all South Australians a major gain from the past eight months. PCSA has provided more education can live, die and grieve well – is part of The Australian Government funding about Advance Care Directives a small project funded to explore these of consultations over the phone or via and the need for the clinical 7-Step issues until June 2021. The advent of video link is transformative and should Resuscitation Pathway. PCSA has been the COVID-19 pandemic has forced continue. The ability for palliative care trying to ensure that people’s wishes many people to consider their own workers to consult into people’s homes are well documented. It is even more mortality, risks taken and potential where there are restrictions upon entry critical that people have appointed consequences. This applies to health due to lockdown has been highly valued their substitute decision-makers, so and aged care workers and the general by patients, their carers and extended they are ready to act for the person and community alike. family. This system has strengthened have wishes understood. There has also PCSA’s role in the project will be to the links from Specialist Palliative Care been a significant increase in interest develop community conversations Services into country South Australia, from residential aged care facilities to about grief literacy using a improving access to palliative care have documents and decision-making ‘compassionate communities’ model. assessment, advice and support during in place. The group will also engage with general this time. While telehealth is not always COVID-19 has also led to more practitioners (GPs) about the grief issues the best form of contact and assessment, recognition of the need for self-care. they see in their practices and what especially where complex needs apply, Health and aged care professionals options are available for their patients. it has helped on a number of fronts. and workers need to be aware of their We know 90 per cent of people who Advocacy is needed by organisations own needs for care, too. How are they experience grief will be able to cope such as the AMA and PCSA to ensure looking after themselves? How are with their loss over time. But we are positive developments relating to they looking after each other? How interested in the remaining 10 per cent telehealth become embedded as core can carers be supported to have some who experience chronic and debilitating policy, funding and practice. time for themselves and re-charge their grief and what services are available Restrictions have applied to batteries to continue their vital role in for them. Community Palliative Care teams the community? PCSA has been using At an organisational level, PCSA has visiting people in their homes. 2020 to focus upon these concerns and seen significant coordination at national Volunteers, as part of a patient’s social has held webinars around these topics. and state level since during 2020. support, have been cancelled. Much After all, now more than ever before, we Palliative Care Australia (PCA) quickly telephone contact has occurred to check need to be kind to ourselves as well as convened the Australian COVID-19 how patients are, but it is not the same each other. Palliative Care Working Group. All state as personal visits. Volunteers were and territory palliative care associations starting to conduct community visits Professor Gregory Crawford is Chair and have been meeting regularly to share until the lockdown on 19 November Mark Waters the Executive Director of information through our networks. 2020 forced a closure to that program Palliative Care SA.

36 | medicSA Opioid campaign raising awareness

The AMA(SA) continues to support the ReachForTheFacts campaign led by ReturnToWorkSA, which asks doctors and the community to think about the potential side effects when prescribing or using opioids for chronic pain. RTWSA Medical Advisor Dr Chris Bollen explains why the campaign, now in its second year, continues to be so important.

t ReturnToWorkSA we Support for the campaign from relationships, fatigue, and effects on continue to recognise the local and national stakeholders who older persons. issues and negative impacts collaborate, inform and promote The second phase will feature new prescription opioids can the campaign continues to grow. television and cinema advertisements Ahave on our injured workers’ recovery New supporters include the Royal in 2021, given the market research and return to work after injury, as Australasian College of Surgeons and suggested strong recall of the well as their safety in the workplace. the Therapeutics Good Administration. campaign through television. The The impacts of prescription opioids The television advertisement had television, cinema and radio are not unique to our work injury almost 4.5 million views and campaign advertisements; social media; billboards scheme, but remain part of a broader assets for ReachForTheFacts appeared and posters; and brochures will community challenge. online 3.6 million times. Medical continue to point consumers, family The ReachForTheFacts campaign, practices across Adelaide that displayed members and health professionals to launched in July 2019, is a South brochures reported a significant number www.reachforthefacts.com.au. Australian-based community campaign being taken from the practice and the There they can find tailored information that raises awareness of the potential ReachForTheFacts website was visited about opioids and their side effects, tools harms of long-term use or misuse almost 36,000 times. to identify dependency, information of prescription opioids; encourages Market research conducted in March about pain, and multi-modal methods questions about alternatives for safe, and April of this year provided some of pain management. The testimonials effective pain management; and aims useful insights and validation for the remain a powerful feature and offer an to trigger behavioural change. Phase campaign. One of its objectives was honest and compelling insight into local One of the campaign encouraged to raise awareness of the dangers of South Australian’s experiences with the community to ask, ‘What are you long-term use of prescription opioids. prescription opioids. It is important to reaching for?’ and ‘Reach for the facts The research found higher levels of stress that the information presented on prescription opioids’. This campaign community awareness of all opioid- is objective and non-judgmental, and asked the audience to reconsider their related side effects including physical strongly encourages consumers to relationship with opioids. dependence and addiction. In addition, discuss any potential changes to their awareness of medications such as pain medication with their doctors. opioids increased, and there was significantly less uncertainty about what With the campaign now in its second people understood opioids to be. year, the website resources have Another Phase One objective was to increased substantially and continue increase the number of individuals who to be refreshed as new material discuss with their health professionals comes to hand for both consumers options other than opioids for safe and and health professionals. The health effective pain management. Market professional pages also provide up-to- research showed a 25 per cent increase date information about prescribing and in how comfortable people are talking deprescribing, as well as useful patient to their health professionals about information about pain and the side pain management, and an eight per effects of prescription opioids. I highly cent increase in the comfort of doctors recommend medical practitioners in talking to their patients about use these excellent resources in pain management. their practice, to not only support Phase Two of the campaign explores the education of their patients but the wider risks associated with opioid importantly to update themselves on all usage and aims to raise audience the issues of opioids, as the evidence for awareness of both the side-effects and their usage has changed. the biopsychosocial-related issues Any feedback about the campaign can such as absenteeism, impacts on be provided to [email protected].

medicSA | 37 New technology, new hope

SAHMRI’s New Proton Therapy Centre is a ray of light for cancer treatment in Australia.

he new Australian Bragg says Royal Adelaide Hospital (RAH) While proton therapy units are being Centre for Proton Therapy radiation oncologist Associate Professor developed in Singapore, Taiwan and and Research will not only Michael Penniment. Indonesia, the Bragg Centre is expected be a game changer for cancer The treatment is expected to be to fill a large gap in Australia and the Ttreatment in Australia, it will also particularly valuable for paediatric Asia-Pacific region. establish Adelaide as one of Australia’s patients; they face significant ongoing ‘The Bragg Centre will sit in SAHMRI leading cancer treatment centres. side-effects from irradiating healthy and will have a focus on equitable That’s the word from the team tissue, including learning difficulties, treatment – that will be the key,’ that has been lobbying for 20 years hearing and sight loss, and endocrine Associate Professor Penniment says. for a national proton beam therapy dysfunction. It will also be used for ‘It will focus on ensuring patients centre to treat cancers with highly adult patients with complex head, neck are treated according to their disease, targeted radiation. and spine tumours difficult to treat with not their ability to pay, while there will Work is now well underway on the traditional radiotherapy. also be scope for fee-paying patients new centre at the South Australian The ProTom International proton from overseas. Health and Medical Research Institute beam machine acquired by the Bragg ‘There will be tremendous (SAHMRI) and efforts are intensifying to Centre is similar to those installed opportunities for every doctor in identify a pipeline of talent ahead of the in Boston’s Massachusetts General Adelaide who has an interest in cancer planned opening. Hospital and the McLaren Proton treatment. We would hope there would ‘This is a generational, once-in-a- Therapy Centre in Flint, Michigan. be public and private flow-ons.’ lifetime major event. Not only is it going Sharing technical expertise is expected The cost of proton beam therapy to be well resourced, it will treat patients to deepen the ties South Australia machines has declined from around from interstate and overseas. This will has with leading international proton $300 million over the past decade but be a centre of international excellence,’ therapy institutions. remains in the tens of millions and the large up-front capital costs limit the availability of this technology. Currently only around 10-20 Australians are able to access treatment per annum – mainly in the US – with the Federal Government funding treatment costs that can be more than $150,000 for each patient. It’s expected that the new centre will initially treat around 200 patients, ramping up to around 600-700 patients a year. ‘We expect to move from only treating a dozen or two paediatric cases with radiotherapy in Adelaide to a large majority of patients requiring radiotherapy across Australia being treated here in Adelaide,’ Associate Professor Penniment says. In the past five years, the RAH has developed a computer modelling Associate Professor Michael Penniment - radiation oncologist, Associate Professor service that analyses the utility of Hien Le - radiation oncologist, Associate Professor Peter Gorayski - radiation oncologist, proton beam therapy for individual and Dr Scott Penfold – medical physicist at the site of the new Australian Bragg Centre cases, helping to build a national on North Terrace. assessment network. This system will

38 | medicSA planning their sabbaticals to help the this limited resource. The new Medicare new facility get underway. items will initially focus on paediatric, Associate Professor Penniment and adolescent and young adult (AYA) says the expectation is the centre will cancer, and certain rare adult cancers. employ about 15 radiation therapists ‘We believe many adult cancers can and 10 medical physicists. In terms benefit from proton therapy, but the of doctors, he predicts there will be international clinical trials for many of some fractional appointments, with these are ongoing. The results will likely as many as four training positions and play a role in the future use of proton four consultants. therapy in Australia,’ Dr Penfold says. ‘We’ve got a few years to develop a ‘From our cost-utility studies the workforce that goes all the way from value is definitely there for many engaging with the universities to paediatric and AYA patients and train people for the existing courses certain adult cases, despite the large – and that’s largely radiation therapy capital costs.’ medicine and physics – but also I think also be used to identify appropriate The centre is looking to build there is going to be a significant flow-on cases for proton therapy at the partnerships for key research projects, to clinicians who work in all aspects new centre. including innovative imaging solutions that touch on cancer treatment. We ‘One of our radiation therapists for adaptive proton therapy and see that as tremendous opportunity,’ came in the top five of planners establishing a national clinical network. Associate Professor Penniment says. internationally – pretty amazing given ‘We envisage a national referral ‘We’re not going to put a stress on the we don’t even have a proton therapy network that will meet [virtually] to current health system. We’re going to unit in Australia yet. We’ve been discuss the patients referred to the provide an opportunity for it to become building a team with international one of the leading health sectors in centre in Adelaide – that’s an approach credibility,’ Associate Professor the world.’ employed in several European Penniment says. Medical physicist Dr Scott Penfold, healthcare systems where they just have While most of the state’s graduating who has been involved in the long access to only one or two proton therapy radiation oncologists find positions quest to establish a proton therapy centres across the country,’ Dr Penfold interstate or overseas, the Bragg Centre centre in Australia, has recently says. ‘The multidisciplinary team come will provide significant opportunities been appointed as the centre’s first together to decide which patients will for South Australians, including employee, undertaking radiation benefit from proton therapy.’ graduates from basic sciences, pre- safety assessments and designing In his role as Chair of the Particle clinical, research and treatment. South tests to verify the new machine’s Therapy Working Group of the Australia is already working to build technical specifications. Australian College of Physical Scientists workforce capability and a virtual queue He’s also part of the Bragg Centre and Engineers in Medicine (ACPSEM), is forming among clinicians to work in team applying for new Medicare item Dr Penfold is also involved in developing the new centre. Leading international numbers for proton therapy in an professional standards for medical paediatric radiation oncologists are also attempt to ensure equitable access to physics working in proton therapy.

medicSA | 39 RESEARCH NEWS

An end to restless nights Help is on the way for GPs looking to help patients with insomnia.

leep is an essential biological targeted diagnostic and treatment requirement for mental wellbeing attention,’ Dr Sweetman says. and physical health – but is not as Chronic insomnia is characterised by simple as it seems. self-reported difficulties falling asleep or Flinders University researcher SThat’s why a Flinders University maintaining sleep throughout the night, Dr Alexander Sweetman research team is working to provide and impaired feelings or functioning general practitioners with information during the day which persist for at least about evidence-based treatment for three months. Chronic insomnia occurs the sleep disorders that affect many of in 10 per cent of Australian adults, insomnia. We’ve found that CBTi also their patients. with GPs commonly managing their improves symptoms of depression, and have reported The two most common sleep insomnia symptoms. anxiety and stress in a large review of more than 10,000 disorders, insomnia and obstructive When insomnia occurs with other patients that CBTi is associated sleep apnoea, collectively occur in more medical and psychiatric conditions with improved sleep and reduced than four million Australians and are such as chronic pain or depression, the dependence on sedative-hypnotic commonly managed by Australian insomnia should be considered as a medicine use.’ general practitioners (GPs). Insomnia ‘co-morbid’ condition that is responsive to targeted insomnia treatment, Dr While CBTi has historically been and sleep apnoea reduce quality of life, administered by trained therapists, it Sweetman says. increase risk of medical and mental has recently been translated to online He says research has found that the health conditions, and contribute to self-guided programs, ideal for the time most effective treatment for insomnia high healthcare utilisation costs. limits of GP appointments. is cognitive behavioural therapy for Flinders University researcher Dr Dr Sweetman’s group has developed insomnia (CBTi) – recommended as Alexander Sweetman says that while and tested a four-session CBTi program, first-line treatment for insomnia by the evidence-based treatments for both effective in a range of co-morbid RACGP and many sleep, medical and conditions exist, GPs commonly report conditions, which can be administered primary care associations world-wide. limited access to information, treatment by GPs and nurses, and hopes to roll this CBTi includes educational, cognitive, and referral options to manage out to Australian general practices. and behavioural components that sleep disorders. One of these, Sleepio, includes directly target the underlying causes of Dr Sweetman is part of a multi- six-weekly online sessions with an insomnia. Dr Sweetman says CBTi leads disciplinary team aiming to provide animated character (‘The Prof’), who to better sleep, daytime functioning Australian GPs with tools and treatment guides patients to self-administer and quality of life, with improvements options to manage sleep disorders. effective cognitive and behavioural persisting when treatment stops. He works with sleep specialists, GPs, treatment strategies. It has previously Yet, he says, while clinical guidelines psychologists, researchers, health been shown to improve sleep, daytime strongly recommend CBTi as first-line economists and translation experts functioning and mental health, and treatment, most patients with insomnia to improve knowledge and access to reduce dependence on sedatives. are prescribed sedative-hypnotic evidence-based treatments for insomnia ‘We would love to hear from GPs in medicines such as benzodiazepines South Australia who would like to have and sleep apnoea. or ‘z-drugs’ as the first-line approach, Researchers at the Adelaide Institute improved support and management with many patients remaining on these options for insomnia and sleep apnoea,’ for Sleep Health at Flinders University, medicines for many months or years. Dr Sweetman says. and the Discipline of General Practice ‘We are committed to providing ‘We’ve developed a software-assisted at University of Adelaide, aim to general practitioners with more pathway to help GPs to identify patients provide Australian GPs with a suite of information, tools, and treatment with insomnia, and to use the CBTi information, assessment, treatment, options for insomnia according to program Sleepio to treat their insomnia, and referral options to manage sleep – guideline recommendations. This may reducing dependence on sedative- and to reduce reliance on sedatives. allow them to manage more patients hypnotic medicine. This pathway is The research has recently with CBTi and reduce reliance on based on RACGP clinical insomnia demonstrated that non-drug sedative-hypnotic prescriptions as the management guidelines and evidence- treatment of insomnia improves “default” approach to manage insomnia,’ based diagnostic and treatment sleep, and commonly also improves Dr Sweetman says. tools.’The pathway is available through other associated symptoms such as ‘We have recently published several the Doctors Control Panel software depression, anxiety, and psychological articles to provide a step-by-step guide (https://www.doctorscontrolpanel. distress (See article here). to administering CBTi during general com.au/). To find out more contact ‘It’s clear that insomnia is a common practice consultations and to provide Dr Alexander Sweetman at the Adelaide and debilitating disorder in Australian information about different evidence- Institute for Sleep Health (alexander. general practice patients, which requires based CBTi treatment options for [email protected]).

40 | medicSA RESEARCH NEWS

Mounting case for subtotal tonsil surgery

Professor of Otolaryngology at Flinders University, Simon Carney

ounting clinical data for return to normal activities in the thousands of children have all validated points to the need to full tonsillectomy group was three to 21 the Australian cohort data. invest in subtotal tonsil days post-operation, with 11.1 days the The research shows subtotal tonsil surgery (tonsillotomy) — mean. In the subtotal tonsil group, this surgery reduces the likelihood of a Mincluding learning the technique and ranged from one to 14 days, with 4.6 return to theatre to stem bleeding by allowing additional time to perform days the mean. eight times and there is three times less the procedure, says Professor of ‘There’s a growing body of evidence chance of any bleeding at all. Otolaryngology at Flinders University, that this procedure has better outcomes Patients tend to return to normal Simon Carney. than a full tonsillectomy for patients activities, including a normal diet, Professor Carney says clinical with sleep disorders caused by enlarged four to six days faster, which alleviates studies of large numbers of subtotal tonsils and adenoids although full concern for parents. tonsil surgery patients in Australia tonsillectomies are still the gold However, despite the growing body of and overseas have indicated that standard for those with recurrent evidence, and its popularity overseas, the procedure, which is appropriate tonsillitis,’ Professor Carney says. Australian clinicians have been slow for patients with enlarged tonsils, He says it is also ideal as treatment of to adopt the procedure, Professor consistently results in less pain, tonsil stones in adults, although this was Carney says. In the UK the procedure is bleeding and a quicker recovery. not included in the recent study. performed in more than 50 per cent of Children with obstructed ‘Recurrent tonsillitis is much less cases and in the US over 85 per cent of breathing during sleep often have common than in the past. By far the ENT surgeons perform the technique, their tonsils removed – usually via a most common reason for tonsil surgery he says. In Scandinavia, where the total tonsillectomy which involves is now obstruction, most commonly surgery was pioneered, its use is even the removal of the entire tonsillar causing snoring and sleep issues, as well more common. capsule. The main risks following total as speech and eating problems in some tonsillectomy include haemorrhage and cases,’ Professor Carney says. ‘Yet in Adelaide it is probably used in a prolonged return to regular activity The study notes that tonsillectomy only 10 to 20 per cent of cases,’ he says. due to pain. is one of the most common ear, nose ‘That’s probably because it takes about In recent years, subtotal tonsil and throat (ENT) procedures, with more 15 minutes longer to perform and that surgery has become more common, than 35,000 tonsillectomies performed has implications for scheduling and particularly overseas. But it remains each year in Australian patients aged 17 cost structures. controversial, with some maintaining and under. ‘At the moment in Australia the that a full tonsillectomy remains as the The total tonsillectomy involves demand, to the extent that there is any only tonsil procedure that should ever removing the entire tonsillar capsule, for this treatment, is being driven by be performed for either infective or exposing a small portion of pharyngeal parents who have read the research. But obstructive symptoms. muscle, small blood vessels and free most remain unaware of it as it is not Recent publication of a study of nerve endings. The main risks include generally offered by surgeons. Professor Carney’s subtotal tonsil haemorrhage and a prolonged return to ‘It takes longer than a full surgery bleeding and pain outcomes for regular activity due to pain. tonsillectomy, but our data have shown 608 paediatric patients over 10 years In contrast, the tonsillotomy the benefits are just so great, we believe found the procedure was associated with procedure commonly uses coblation, parents need to be aware of this option.’ a significant reduction in the prevalence microdebrider, diathermy, argon plasma and severity of bleeding. It also led to a or laser, and leaves a small crescent 1 S. Attard and AS Carney, ‘Paediatric more rapid return to normal activities moon of tissue intact rather than patient bleeding and pain outcomes when compared to total tonsillectomy.1 removing the whole tonsil. following subtotal (tonsillotomy) and The study found that the total For children with sleep disorders total tonsillectomy: a 10-year consecutive, rate of any form of haemorrhagic due to enlarged tonsils and adenoids, single surgeon series,’ Australian and New event was 8.3 per cent (n = 23) for full massive meta analyses, Cochrane Zealand Journal of Surgery, ANZJSurg.com, tonsillectomy and 1.8 per cent (n = 6) reviews and other systematic reviews Royal Australasian College of Surgeons, for subtotal tonsil reduction. The range with data from multiple countries and 26 August 2020

medicSA | 41 Testing conditions

Education and training providers including AMA(SA) were faced with new challenges in how to reach and engage their students in 2020, writes AMA Skills Training Manager Michelle Cockshell.

hallenges and difficulties have affected all Accredited qualifications of us in 2020. This includes the Registered • BSB31115 Certificate III CTraining Organisation arm of AMA(SA). As a in Business Administration result of the pandemic and subsequent fire at AMA (Medical) House, AMA Skills Training had to adapt our delivery • HLT47315 Certificate IV in modes and options for student engagement. Health Administration AMA Skills Training is fortunate that, as a team, we • HLT57715 Diploma of already provided flexible training with a range of Practice Management delivery methods – including self-paced learning, • BSB30415 Certificate III either online or written, classroom workshops and in Business Administration mentoring sessions – for accredited training. Due • BSB51918 Diploma of to COVID-19, like most training providers in South Leadership and Management Australia we were forced to cancel all face-to-face • CHC33015 Certificate III learning for some time. However, the systems we in Individual Support have in place allowed us to transition with minor (Ageing, Disability and adjustments. We scheduled more one-on-one time Home and Community with individual students for training and mentoring Specialisations) sessions, instead of in groups as is the more usual • CHC43415 Certificate IV format. This required additional time for each trainer in Leisure and Health and assessor, which limited the amount of support that could be provided to students in any one day. Accredited units • HLTAID001 Provide Students have been unable to commence/complete cardiopulmonary resuscitation their required work placement (ageing and disability areas) which has resulted in additional mentoring • HLTAID003 Provide first aid being required. We scheduled Zoom classroom • HLTINFCOV001 Comply with workshops for Diploma of Practice Management infection prevention and students once a month from May to August. control policies and procedures The knowledge, skills and teamwork of staff, trainers Non-accredited professional development and assessors created a seamless transition to ensure AMA Skills Training can tailor professional the training journey for all students continued development workshops for your practice and to be successful. Feedback from students shows staff. Popular topics include: that the support given during this time helped them cope with their learning and the changing • Providing Quality Customer Service guidelines, knowing that AMA Skills Training • Dealing with Difficult/Challenging Behaviour in a was available to support them at any time. Healthcare Practice • Key Aspects of Safe Instrument Reprocessing for AMA Skills Training provides non-accredited You and Patient Safety professional development workshops once a month • Managing Challenging and Difficult Situations relevant to industry requirements. We recommenced • Leading a Winning Team these sessions in September via webinar, which has proved successful. In 2021 we will alternate between • Dealing with Workplace Bullying. webinars and face-to-face workshops, to include a wider range of participants and increased learning flexibility. General information is available on our website www.amaskillstraining.org.au. The systems we have in place will support diverse learning opportunities for both current and Enquiries can be directed to phone 8361 0141 or email future students. [email protected].

42 | medicSA #COVID19Aus #FlattenTheCurve Thank you to the doctors, healthcare workers and everyone putting their lives at risk to keep Australians safe.

Why your membership matters

Throughout the pandemic and the challenges it has posed, the AMA has been front and centre in advocating for doctors and the community, and instrumental in delivering Rebecca Hayward results. Whether you received or conducted a telehealth appointment, AMA(SA) Member Services accessed PPE that kept you Manager safe, used new COVID-19 resources developed eople choose to join, and for doctors in training, stay with, a membership or shared information organisation for various reasons, about COVID-19 that supported to those who have already renewed be it belonging to their peak your patients’ physical and mental their membership for 2021. Pmembership body, the availability of health,www.amasa.org.au you have directly benefited If you are not a member, please support services and informed advice, consider joining us. By doing so or accessing resources or commercial from AMA advocacy and the you not only strengthen our voice, benefits. While all are important and access to decision-makersama_south_australia valid, perhaps this year has reminded us around the country. but also enhance our ability to that what matters most isn’t determined @AMASouthAustraliaAs we move into 2021, the strengthen yours and those of your by a dollar value, but what can be respected, independent voice of colleagues and patients. achieved when people unite to serve the the@ChrisMoyAMASA AMA remains more important The gift of caring for others is greater good. than ever. However, as a not-for- a generous one. How important This year we’ve seen new barriers profit membership organisation, it is that doctors are safe in the to delivering and receiving health and the only one representing all knowledge you have the backing, care, and a demand on the medical medical disciplines, the strength of support and representation that profession to find solutions our voice is reliant on the support enables you to do so. and adapt swiftly. Doctors and of our members. For further information about colleagues have had to overcome To our existing members, thank joining or renewing your membership, these barriers while continuing to you. We could not have achieved all please contact membership@amasa.

medicSA | 43 Does your patient have a work injury?

Support for you You can access free clinical support services, clinical tools and patient resources to support and facilitate your patient’s effective treatment, recovery and return to work.

Support for your patient ReturnToWorkSA has a range of services your patient may be able to access which can support them as they recover and return to work.

We’re here to help Visit our website to find out more rtwsa.com/service-providers.

Our goal is to make your life easier when it comes to navigating the Return to Work scheme.

For more information please call 8238 5757 or email [email protected].

44 | medicSA COUNCIL NEWS

accuracy of temperature testing and asked to put forward issues they would how the accuracy compares to swab like included in the regular meetings testing. The standards of PPE are still between the Minister and AMA(SA) being addressed, in regard to recognised President Dr Chris Moy and Vice federal and state standards. President Dr Atchison. The much-debated cardiac paediatric The issue of limited data access to services at the Women's and Children’s improve clinical outcomes generated Dr Jill Robinson Hospital have generated tension due robust discussion, with Council Councillor to privacy issues and the AMA has suggesting there should be a merging of provided support on behalf of the public and private sector data. doctors at the hospital. Doctors in Training representative Dr AMA(SA) Council Meeting The Termination of Pregnancy Hannah Szewczyk reported the launch November 2020 Bill 2020 has focused on the of the 2020 Hospital Health Check decriminalisation of abortion and the survey. She noted that more than 1,400 AMA recognises this is an issue that not candidates had been affected by the he November meeting was held all members support. RACGP Registrar exam cancellation due in our new temporary office The membership subscription for to technical difficulties – an extremely Tat Greenhill Rd, due to the the 2021 year is to remain unchanged unsatisfactory situtation. An internal unfortunate fire at AMA House. This in view of COVID. The AMA Executive and external review will be held and the was a socially distanced ‘tête-à-tête’ board chair, John Nelson, delivered exams have been rescheduled in the first meeting, which was welcomed by a background briefing on current week of December. those able to participate in person after financials. There is to be a Constitutional Dr Moy raised the issue of nuclear he restraints of Zoom, and as usual Governance review to modernise and medicine and its by-products. Council Dr Michelle Atchison demonstrated formalise the objectives of the AMA. noted that this is a controversial political excellent ‘chairpersonship’. The collegial relationship with the issue, and that AMA commentary will COVID-19 continued to be the focus Minister for Health and Wellbeing only relate to the impacts of medical of discussion. Council questioned the continues, and Council members were nuclear waste disposal.

through our President Dr Chris Moy To finish on a positive note, the (now Federal AMA Vice-President) has AMA has been recognised in the top been at the vanguard of the efforts to five ethical organisations in Australia have a sensible and logical approach and topped the table as the most to minimise the health impacts of the ethical member organisation. High pandemic in South Australia. praise indeed. We have achieved In the midst of this, a significant fire the recognition that LHN Boards caused substantial structural damage are responsible for bullying and at AMA House that necessitated our harassment in the workplace, in Dr Simon Macklin transfer to a new temporary home on addition to providing healthcare with Councillor the Fullarton Road, which we haven’t fiscal responsibility. been able to enjoy in quite the way we Our medical student representatives had hoped due to the requirement for AMA(SA) Council Meeting Matilda Smale and Jack Rumbelow have social isolation! moved onwards and upwards to start December 2020 In this last meeting for 2020, a wide new lives as junior doctors. We thank range of issues was again discussed, them for the enthusiasm they have ranging from the COVID-19 response brought to Council, wish them well he meeting of 3 December was the to the proposed amendments to the in their future endeavours, and look final Council gathering for 2020 Abortion Act, and the looming crisis in what has been a busy year for in rural GP training to the progress of forward to welcoming them back to T Council in the years to come. all of us. First, there were bushfires of electronic prescribing. Rural GP hospital the like never been seen before. Then contract negotiations will continue in It is time for recognition and was the rise of the SARS Cov 2 pandemic 2021; and the relocation of WCH will nominations are now being sought for and we have watched as the virus has continue to be a work in progress to the two annual awards presented by carved its way around the world. In ensure a facility fit for purpose is put in the AMA: the AMA(SA) Award and the South Australia, we have been lucky to place. AMA(SA) Council will continue Medical Educator Award. Nominations have had strong leadership and active to work in these spaces for the benefit are due by 25 February; forms can be engagement of senior medical experts of our patients and the staff who obtained from Mrs Claudia Baccanello at by our politicians. The AMA (SA), serve them. [email protected].

medicSA | 45 STUDENT NEWS

Class of 2020: six years in the making

medical school, and our cohort still has JADE PISANIELLO plentiful and obvious passion. STUDENT NEWS: WHY ADELAIDE ADELAIDE UNIVERSITY MEDICAL SCHOOL? Although our reasons for choosing Adelaide in 2015 were diverse, I think s my time in medical school now we would all have a common draws to a close, I am moved to feeling about the qualities that would reflect on the person I was before A make us choose it again, if we were to starting this journey. I still remember, go back. The camaraderie, the culture in 2014, receiving that fateful email and the support have been phenomenal inviting me to sit an interview at the since day one. Adelaide Medical School Adelaide Medical School. So, too, did has certainly been a balance of business the people who are now graduating and pleasure, but it has also been alongside me as the Class of 2020. I where we have made lifelong friends, remember the absolute thrill as well as learned amazing skills, and grown and Above and below, AMSS students at the anxiety of it all – medical school was developed as individuals. Adelaide’s three teaching hospitals in 2020. so close and yet so far in that moment. I am the first to admit that six Six years down the line, and I wonder years ago, I never thought I would cohort has fared. I want to wish the how the Class of 2020 would answer if be where I am today. At that stage it fifth years the very best of luck with interviewed again… seemed insurmountable. Before I got their final barrier assessments – I well TELL US A BIT in, I thought that getting in was the remember being in your position, and ABOUT YOURSELF challenge; it was later that I realised I don’t envy you. I am proud of the way The Class of 2020 is a diverse and you have all continued to thrive in spirited group. They have experienced a difficult year. Rest assured that the evolution of the Adelaide medical your lives are not defined by your program, and have grown in maturity performance in these exams. and resilience through a program To the younger years, I hope that more challenging than that seen by 2021 sees a return to more normality. most cohorts. Our hobbies include I am well aware of the effect that complaining about medical school online learning and suspension and wearing RM Williams boots. Our of placement has had. It is an weaknesses include participation in isolating experience, and I am once online discussion boards. again proud of everyone who has persevered through it. I hope to see WHY DO YOU WANT TO some of you on the wards next year! BE A DOCTOR? Soon, applicants will interview Six years down the line, and I for the Adelaide Medical School think we would still mostly say Class of 2026. I hope that those who the same thing: we want to help that was just the beginning. We are once commence medical school have people. Our appreciation of what that again at that stage now, where having the same experience as I did. Medical means as health care professionals reached a major hurdle we realise that it school has been the greatest adventure may have become more nuanced, but, is but one step along the way. Previously of my life (so far), shared with so many nonetheless, it is passion that gives we thought passing medical school was wonderful people. I have no doubt us the energy for the marathon that is our greatest hurdle. With internship that the AMSS will continue to thrive, looming, it is becoming apparent that offering support and, of course, plenty of this is not the case. We are about to face gaudium! a whole new set of challenges, but I can I want to thank everyone who has say with confidence that the Class of helped us get through six years of 2020 is more than up to the task. medical school. From the faculty to our In December I hand over my role friends and families, we could not have to the incoming President, Patrick done it without you. Finally, I want to Kennewell. It has been an honour and thank once more, everyone who has a privilege to serve as President of the helped serve the AMSS throughout my AMSS. I am confident Patrick, and other time, but most especially through this members of the incumbent executive tumultuous year. It has been a pleasure and committee, will do an excellent job to have worked with you all. of serving the AMSS community. While this year has been far more challenging Dr Jade Pisaniello will begin her internship than I anticipated, I can reflect with with the Central Adelaide Local Health pride on the way the entire Adelaide Network at the RAH on 13 January.

46 | medicSA STUDENT NEWS

President no more - an unlikely commonality with Trump know them. For me, that was the most LIAM RAMSEY meaningful experience: getting to STUDENT NEWS: understand, actively listen to and develop FLINDERS UNIVERSITY relationships with all the students. The relationship with the College of Medicine and Public Health (CMPH) at riting my final piece for Flinders University has functioned as medicSA has brought a mixed a catalyst for a wide range of advocacy Wset of emotions. For one, wins. These included the course some personal relief that I have eased continuing through COVID-19, pre- the editors’ workload, as I regrettably clinical students rapidly transitioning to did not study English in year 12. On an online curriculum, clinical students another side of the coin it has prompted remaining on placement for the year, and some reflective thoughts on my year as re-invigoration of assessments. We feel President of the Flinders Medical Student a deep sense of privilege to have been Society (FMSS), with Matilda Smale as invited into decision-making decisions the Senior Vice President (SVP), and around the future of the MD at Flinders. our interactions with the student body and the College of Medicine and Public And we were so lucky to have Associate Health (CMPH) at Flinders University. It Professor Rosalie Grivell as the Director has been undeniably a successful year for of Flinders’ MD this year. FMSS in our continued advocacy work, There has been meaningful change adaptations of social and educational in the course, culture and student events and working towards creating a wellbeing. Student bodies are immense healthy culture among students. It has sources of knowledge and should be been a professional metamorphosis included – along with medical education for me, transitioning from student to experts, clinicians and community Socially distanced FMSS Executive a leadership role and now going onto members – when designing medical committee members (top) Riya internship in 2021. I am very grateful for schools. Students can help shape Ramakrishnan and Kvitika Mishira and the opportunity to write on behalf of the the degree to make us competent, (front) Liam Ramsey and Yuƶe Ƶhai FMSS throughout the year. empathetic and well-rounded doctors. Being student President has Advocacy really is the bread and The relationships formed between accelerated many personal processes (vegan) butter of being a student body the school and FMSS is allowing this for me (hopefully not ageing). I had to President. It’s our job to understand and to happen. grow up quickly to personally process represent diverse student populations As President, I wanted to ‘change the and deal with both the large empathy in our medical schools. You cannot culture at Flinders Medical School’. I burden I had taken on and how my advocate for such a pluralistic group possibly underestimated the complex relationships with peers would change. of individuals without getting to intersectionality of factors that influence I had to communicate between many culture to think we could change it in parties and understand how to repackage a year. But I do believe we have made information into actionable content. inroads in improving collegiality, It meant becoming an advocate for challenging hyper-competitiveness, students and addressing my own biases. establishing additional support networks I had to maintain my sense of self and for students and re-emphasising the not be reduced to a mechanism of power of peer-peer mentoring. With communication for student discontent. the CMPH we have addressed many I have tried to maintain this sense of self. issues such as assessment ambiguity, My role has redefined my professional assessment standard-setting, and image and provided me with deep clinical placement conditions that gratitude and fulfilment. I developed were also contributing to the frankly new friendships and found new toxic culture that had developed in our advocacy passions. student body. The CMPH was receptive Thank you to Matilda and Rosalie for to these concerns and throughout the your support, mentorship and friendship. year, under Rosalie’s leadership, many of Thank you to medicSA for the support these issues have been addressed or are and the platform, and to readers for under review. There has been a palpable ‘listening’. improvement in the culture and I hope it Liam Ramsey with FMSS Senior Vice continues to be rebuilt and reinforced in Dr Liam Ramsey will intern at the RAH President Matilda Smale at the Med Ball coming years. in 2021.

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48 | medicSA 2020 IN REVIEW - COMMITTEES

AMA(SA) Doctors in Training Committee

t certainly has been a busy year the pandemic, and considering the parents in training approved by Federal for medical advocacy. Although attention the issue has attracted in Council. it seems like a lifetime ago now, South Australia and across the country CDT has also produced position our year kicked off on 29 February this year. statements relating to general practice Iwith the AMA(SA) Culture and Bullying But COVID-19 has been the headliner training and a recommended single Summit, which hosted more than 50 of 2020 and it has had far-reaching employer model, rural training key stakeholders. impacts on doctors. One of the major pathways, and the health and wellbeing As part of the Summit, the AMA(SA) effects on junior doctors has been the of doctors and medical students. Doctors in Training (DiT) Committee changes to training examinations; Members have been heavily involved in presented the findings from the ‘2019 these have been cancelled, rescheduled, the proposed national changes to the South Australian Hospital Health Check cancelled and rescheduled again, and internship and PGY2 framework that is Survey’ that showed unacceptably high changed to online formats. In more in development. rates of bullying and harassment within than one instance these electronic Special interest groups and advisory our three main teaching hospitals, as examinations have failed, exposing the committees within CDT focus on well as high rates of fatigue among lack of contingency planning by the prevocational, vocational, general junior doctors and poor culture. The colleges, which has caused great distress practice and industrial issues as well AMA-initiated changes state that Local for many trainees already anxious as wellbeing and policy development. Health Network Boards are responsible about the exams and the impacts of These subgroups have helped expand for promoting healthy workforce culture the pandemic this year. The AMA engagement with the AMA, capitalised and the health, safety and wellbeing of Council of Doctors in Training (CDT) on the skill sets of our members staff. We hope recent work to include created and publicised a communique and enabled the CDT to function staff wellbeing as an LHN Board recommending minimum requirements more effectively. responsibility will improve workplace for examination contingency plans It’s been a year full of challenges, but culture in medicine, something that will and communication with candidates. with these challenges we have seen continue to be central to our advocacy. AMACDT has been working with opportunity and more motivation for Although delayed due to COVID-19, the colleges and the Australian change. I am optimistic we can continue we ran our 2020 Hospital Health Check Medical Council to have these this momentum into 2021 and improve Survey in November and results will recommendations implemented. workplaces, culture and training for be available soon. We are interested to CDT has also been working on many doctors in training across Australia. discover and report any change in the other issues, including conditions for Dr Hannah Szewczyk rates of bullying, fatigue and unpaid medical parents, and has recently had Chair, AMA(SA) overtime, especially in the context of a new Position Statement on medical Doctors in Training Committee

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myPRODERM_FINAL.indd 1 26/10/2020 12:36:44 PM medicSA | 49 Introducing East West Urology

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50 | medicSA

ASH_MedicSA_FullPg_174x248mm_East West Urology_041120-2.indd 1 5/11/2020 12:28:48 PM 2020 IN REVIEW - COMMITTEES

AMA(SA) Committee of General Practice

t is 18 months since the AMA(SA) • participate in forums relevant to our complaints are assessed to allow Committee of General Practice was craft group. vexatious complaints to be resolved Ire-convened, with me as chair and As you can see, we have a wide- more rapidly. As a committee we are Penny Need as vice-chair. The initial ranging brief. aware of the support our GP colleagues group of 11 has recently increased with Recent areas of discussion and may need if they are ever the subjects of two new members, including one GP review include COVID protocols, complaints, as well as in a wide range of representing Doctors in Training. provision of telehealth, GP training, clinical or administrative areas. We are ably supported by Catherine issues concerning the rural and remote The AMA(SA) CGP will be contacting Waite of the AMA(SA) Secretariat, who workforce, RACGP advocacy, ‘Hospital all GPs in the state in 2021 to outline took on the role after the departure of in the Home’, driving medicals, and flu the particular areas of interest of each Heather Allanson. vaccine availability and distribution. current committee member, including Time has been spent establishing As an AMA Council of General our other committee memberships. terms of reference and protocols, and Practice (AMACGP) Federal We hope that by getting to know us a understanding committee members’ representative, I am also able to little better, you will have direct points political, academic and clinical advocate South Australian GPs’ views on of contact should you need to speak to interests. Along with everyone else, we policy and direction during the regular colleagues about any problem or query. have adapted to Zoom meetings. Our Federal meetings held throughout I welcome any GP who wishes to join rural and remote members appreciate the year. The current focuses of the AMA(SA) CGP to contact me via the the format as we are all, finally, our attention are the Australian Secretariat. You will need to be an AMA attending and participating with the Government’s 10-year primary plan, member; if you are not yet a member, same constraints. for which the AMA has provided please consider joining AMA(SA) to add The roles of the committee are to: significant recommendations and the your voice and contribute to the AMA’s • review AMA policies from a GP Aged Care Royal Commission report. valuable advocacy here and around perspective At our last AMA(SA) CGP meeting, the country. • advise the AMA as to our view of held online on 4 November 2020, Dr Bridget Sawyer those policies Dr Roger Sexton spoke to us about Chair, AMA(SA) • review potential legislative changes, APHRA’s changing approach in dealing Committee Of General Practice AMA standards and requests from the with complaints against medical broader health community practitioners, and in particular how

AMA(SA) Road Safety Committee

s a consequence of COVID-19 The AMA members of the committee children play (pointing out that when and the AMA(SA) fire there have are Dr Robert Atkinson, Dr Peter Ford, road works are done speed limits are Abeen few face-to-face meetings Dr Monika Moy, Dr Stephen Holmes, the lower than when completed even of the Road Safety Committee this year. President Dr. Chris Moy (ex officio), me, though the road workers have special Nevertheless, committee members and Observer members Ms Mary-Lou signs and high visibility clothing; have been active in pursuing the goal of Bishop and Mr Martin Small. when road works are completed ‘ZERO for Road Crashes’ in the future. The points the committee have been speed limits are increased despite the Activities have included: emphasising include: presence of pedestrians including • involvement of Committee members • government mandating of Collision children none of whom wear high in South Australian Government road Avoidance Technology in all new visibility clothing) safety strategy planning vehicles • the importance of medical • a submission to State Opposition on • government support of public assessment of fitness ot drive. road safety goals transport and cycling with separation I thank the members of the • input into revision of fitness to of different transport modalities committee, both AMA members and drive guidelines. (e.g. separation of cycling paths invited observers, and the AMASA for The committee members continued from roads, separation of railways continued support of the committee. to be very concerned about the high from roads) Dr Bill Heddle level of death and injury on our roads • implementation of reduced speed Chair, AMA(SA) and continue to brainstorm how these limits in suburban streets, through Road Safety Committee can be reduced. shopping precincts and where

medicSA | 51 2020 IN REVIEW - COMMITTEES

Australian Society of Anaesthetists (SA & NT)

t the time of writing, South anaesthetist even featured on the cover One of the major ‘wins’ for the ASA Australia is dealing with the of Time magazine as a frontline hero! this year was successfully advocating for Afirst COVID-19 cluster for many The ASA spoke up for the safety the inclusion of specialist anaesthetists months. I hope that by the time you of anaesthetists and indeed for the in the COVID-19 MBS telehealth items read this we have not followed Victoria healthcare workforce in general from for pre-hospital consultations. These with our own ‘second wave’. If we have, the start of the pandemic in Australia. temporary MBS items were originally I imagine we will be well prepared due We were one of the first voices to call due to expire at the end of September to the many lessons learned from our for a halt to elective surgery so we and have now been extended to the Victorian colleagues. could adequately prepare, and we have end of March next year. The ASA This has been a year full of lessons continuously sought improvements will be working to ensure the items for the healthcare workforce as we in the recommendations for personal become permanent. have all become more vocal around the protection equipment (PPE) at national, Much of the ASA’s advocacy work state and hospital level. additional health and safety concerns during 2020 has been around the call for The ASA established a COVID-19 faced in our workplaces. I am proud mask fit-testing, especially as it became Working Group in the first week of to represent an organisation that was increasingly apparent that COVID posed March and our first guidelines were particularly vocal in this field, with the a risk with aerosol transmission. Our published on our website on 13 March, Australian Society of Anaesthetists interstate colleagues are envious of the only two days after the World Health respiratory protection program that has (ASA) being one of the key medical Organization declared COVID-19 a been in place in South Australia since groups speaking up in the media and pandemic. We have recently published 2013. We hope to see greater progress to governments for the wellbeing of our ninth edition of the guidelines and in this area of need in other states and our members. our website is a wealth of information, The global pandemic put a new focus with resources on airway management, territories for increased protection for on anaesthetists at the frontline of staff protection and pandemic planning. our workforce. critical care. The public certainly has a Wellbeing resources were also a key Dr Brigid Brown newfound appreciation of our role as focus given the enormous impact that Chair, South Australia and Northern intubation and ventilation became part we know the pandemic has had on our Territory Committee of Management of the general COVID vocabulary. An frontline workers. Australian Society of Anaesthetists Adelaide Medical Students’ Foundation

he Adelaide Medical Students’ grades in the first two years of medical In 2021 the AMSF hopes to expand Foundation (AMSF) is committed school. The Devitt Prize for surgical its relationships between both medical Tto serving and supporting excellence was awarded to Thomas students and doctors, including Adelaide medical students at an Bristow, for his performance in the through a mentoring program that individual, group, and organisational fourth-year surgical MCQ examination. is now being established. We look level. The Foundation works closely The foundation also awarded the forward to welcoming first-year with organisations such as the Adelaide Recognition Award to Teham Ahmad, medical students into the profession, including by continuing the tradition Medical Students’ Society (AMSS) and for his exemplary efforts in educational the University of Adelaide to provide of teaching them how to measure blood advocacy that extended beyond direct, tangible support to students. pressure and awarding introductory the realm of his role as AMSS Vice- Despite the impact of COVID-19 stethoscopes. We would love more President (Education). The newly in 2020, the AMSF has continued to doctors to guide the direction of our designed Ral Antic Rural Health Grant support medical students as best as foundation in 2021. Finally, a large was also awarded to two students, to possible in the circumstances. The part of the AMSF is providing financial largest impact of COVID-19 was limiting help them pursue rural education support for the University of Adelaide’s our travel scholarships and research opportunities. Lastly, the annual Intern medical students. For more information, conference grants; however, all other Teacher Awards and Student Teacher and to donate, head to initiatives continued, including our Awards are currently being awarded https://www.amsf.org.au Benevolent Fund and usual awards. for 2020 to recognise the outstanding Victoria Langton The foundation awarded the Kildea teaching efforts of interns and sixth- Chair, Graduate Advisory Committee, Prize to Daniel Subramanian, a third- year medical students during this Adelaide Medical Students' Foundation year student with the highest clinical unprecedented time. (AMSF)

52 | medicSA DREAMIN Foundation

REAMIN is an acronym for continues to gain the attention the Dean Richards Endeavour of our supporters. The Maranatha Dto Assist the Medically Ill and health team announced plans Needy. It honours the memory of to build a new hospital and the late Dean Richards, a stalwart of remain in Fort Portal. The the Rotary Club of Prospect and was current facility has about 30 founded in 2003 by our Founding beds and the plan is to build a patron Dr Jim Katsaros as the Adelaide 200-bed facility with additional Craniofacial Unit Foundation to help paediatric and maternal health the international work of doctors at the and community health services. Royal Adelaide Hospital. Land has been purchased and Above and below, Professor Suren Krishnan and Now renamed the DREAMIN planning is underway. This vision colleagues, including Dr Shridhar Krishnan, during Foundation, it is a charitable foundation was presented to a very generous philanthropic Adelaide family, recent visits to Mavanatha Health in Uganda. members of which provided an additional support junior doctors, training and $50,000 to support the providing service in developing nations. development of operating The foundation has a strong interest room facilities for the in those within our community who are new hospital. socioeconomically deprived. We have International projects just partnered and provided funds to support hearing programs support the assessment and provision in Tonga. The Foundation of support services to children with was about to start a hearing Autism Spectrum Disorders in the program in Cambodia when northern districts. the COVID crisis delayed The DREAMIN Foundation organises the venture. However, we fundraising events during the year to have continued to engage support the vital work being carried with our international out by generous South Australians. As contacts and in conjunction a charity, the DREAMIN Foundation is with the JBI (The Joanna reliant on the generosity of members Briggs Institute) are of the Prospect Rotary Club, associated producing training and medical professionals and members education for health of the DREAMIN Foundation to raise care workers to deal with much-needed funds. If you would like the COVID crisis in Africa. grateful to receive tax-deductible to donate, please visit our website donations from the public. We have been very fortunate to receive a generous bequest from a member of www.dreamin.org.au or contact The foundation now provides a the Rotary Club of Prospect. This has director the Board via the mechanism to support appropriate allowed us, in conjunction with the AMA(SA) Secretariat. medical intervention services for those Adelaide Medical Students Foundation, Professor Suren Krishnan people in need in South Australia, to create a scholarship in perpetuity to Chair, DREAMIN Foundation Australia and developing countries. Currently chaired by me, our board comprises junior doctors and members of the Rotary Club of Prospect and the wider community. The Annual DREAMIN Foundation Adelaide Cup Day function was held on the 9 March at the beautifully renovated Dulwich House. We are so thankful that we were able to hold our function before South Australia’s COVID lockdown and the event was very well received. We were fortunate that due to the generosity of members and donors, the event raised about $30,000. The Foundation's work with Maranatha Health in Uganda

medicSA | 53 There’s treatment and then there’s care

We understand that every person is an individual, needing more than just treatment.

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genesiscare.com54 | medicSA There’s treatment BOOK REVIEW and then there’s care InjectingHigh fear expectations AMA(SA) Editorial Committee member and We understand that every person A newretired book obstetrician about the Dr man Melissa largely Sandercock responsible is an individual, needing more than for findsmisconceptions much to think about about the indangers a New Yorkof vaccinationscolleague’s has ruminations valuable lessons about her as career.the just treatment. world waits for a COVID-19 vaccine, writes Dr Phil Harding. High risk - a doctor’s notes on pregnancy, Thebirth, doctor and the who unexpected fooled the world We ensure you have rapid access to personalised Radiation oncology by BrianDr Chavi Deer Eve Karkowsky comprehensive cancer care, close to home. treatment centres Providing high quality radiation oncology services Scribe Publications, 2020 to South Australians for more than 35 years. Adelaide City St Andrew’s Hospital he doctor who fooled the world neurologist and mother a general a wave of anti-vaccination hysteria is well-respected English practitioner. He was brought up in the resulting in a major drop in vaccination 352 South Terrace Tinvestigative journalist Brian Bath area and attended a prestigious rates and consequential outbreaks of Adelaide 5000 Our radiation oncologists Deer’s account of the life and career of public school followed by undertaking measles, in particular, in a number Tel: 08 8228 6700 | Fax: 08 8232 1243 Andrew Wakefield. Wakefield, now aged medicine at St Mary’s Hospital medical of countries. [email protected] 63, is – or was – a consultant physician School in London, an institution well- This article was much criticised and A/Prof. John Leung Dr Kevin Palumbo and clinical researcher in the British known to many Adelaide graduates who epidemiological studies published MBBS, FRANZCR MBBS, FRANZCR National Health Service. Now, having have undertaken postgraduate training Bedford Park by others refuted the suggested link been deregistered in 2010 and widely there – including yours truly – or anyone Flinders Private Hospital between vaccination and autism. The shunned by the research community, he familiar with the NHS teaching hospital Consults at: Consults at: Level 2, Flinders Private Hospital Lancet completely retracted the paper St Andrew’s Hospital, Flinders St Andrew’s Hospital, Tennyson is described in online biographies as an and research scene. The descriptions in February 2010 and, following the Private Hospital, Tennyson Centre, Calvary Central Districts 1 Flinders Drive anti-vaccination activist and ‘the darling are so insightful of the medical politics finding by the General Medical Council Centre Hospital Bedford Park 5042 of the anti-vaccination movement’. and associated subtleties of these Tel: 08 8179 5500 | Fax: 08 8276 7822 Deer is a veteran British investigative institutions that I would suggest the that there had been ethical violation and [email protected] journalist, best known for his inquiries book as a ‘must read’ for anyone who has deliberate fraud – including failure to Dr Marcus Dreosti into the drug industry, medicine, and worked there. disclose financial interests – Wakefield’s Dr Joshua Sappiatzer social issues for the Sunday Times of Wakefield developed the hypothesis medical registration was cancelled. BSc, Hons LLB, MBBS Elizabeth Vale MBBS, FRANZCR London. Among his awards, Deer was that there was a clinical association Wakefield subsequently moved to (Hons) FRANZCR Calvary Central Districts Hospital twice named the UK's specialist reporter between Crohn’s disease, vaccination, the United States where he promoted Consults at: Consults at: 25 – 37 Jarvis Road of the year, and in 2016 he was made and what appeared to be a developing the autism-vaccination concept and St Andrew’s Hospital, Tennyson St Andrew’s Hospital, Flinders Elizabeth Vale 5112 Doctor of Letters (honoris causa) by wave of autism and associated ‘spectrum’ developed considerable notoriety in that York St. John University. His book behavioural disorders. The book Centre, Calvary Central Districts Private Hospital, Tennyson Tel: 08 7285 6400 | Fax: 08 7285 6401 country. In fact, in an eerie coincidence could well have been titled ‘The doctor provides fascinating detail about how Hospital Centre, Victor Harbor [email protected] with current events, the opening passage who tried to fool the world’ or even this idea evolved in Wakefield’s mind and in the book describes him publicly ‘thought he had’. What precipitated how he went about recruiting subjects Kurralta Park his extraordinary fall from grace was for research projects designed to prove promoting his ideas at no less a function Dr Andrew Potter Dr Caroline Connell Tennyson Centre Wakefield’s development early in his the association, including manipulation than Donald Trump’s inauguration MBBS, BMedSc(Hons), MBBS (hons) FRANZCR ball on 21 January 2017, a day I well FRANZCR Suite 1, Tennyson Centre career of an interest in inflammatory of the media and the development of 520 South Road bowel disease, particularly Crohn’s working relationships with lawyers remember having just arrived in Los disease, and the notion that it might interested in promoting class actions. Angeles from Australia for a conference Consults at: Consults at: Kurralta Park 5037 have a viral aetiology. Measles virus Young children were subjected to and being somewhat concerned about St Andrew’s Hospital, Flinders St Andrew’s Hospital, Flinders Tel: 08 8375 3200 | Fax: 08 8351 5670 became a particular focus, with particles invasive protocols to investigate their the possibility of unrest associated Private Hospital, Mt Barker Private Hospital, Tennyson [email protected] Centre being described in tissue samples GI tracts. The work, later described by with Trump’s inauguration. Perhaps examined by some of Wakefield’s one observer as ‘the scientific scam of typically, Trump latched onto Wakefield’s Regional consulting available at: research associates; this led to the idea the century’ was mostly conducted at ideas, associated them with a perceived Mt Barker, Whyalla, Wallaroo, that these might have originated from the Royal Free Hospital (which again increase of spectrum disorders in his Dr Laurence Kim Dr Phuong Tran Victor Harbor the measles vaccine, either the single will be very familiar to colleagues with own family and said it was his idea that MBBS, FRANZCR MBBS, FRANZCR virus variety or the measles mumps London connections), and resulted in ‘it’s the shots’. rubella (MMR) vaccine. The development the publication by Wakefield and 12 of No Private Health cover is required Overall, this book is a fascinating of these notional associations might his colleagues of an article in the Lancet Consults at: Consults at: sound like the drawing of a long bow in a suggesting that MMR vaccine might account of how medical practice and Flinders Private Hospital, St Andrew’s Hospital, research sense, and probably was, but its predispose to behavioural regression clinical research can very easily go badly Tennyson Centre, Calvary Tennyson Centre, Calvary basis in Wakefield’s mind is described in and pervasive developmental disorder wrong. It deserves to be widely read, Central Districts Hospital, Central Districts Hospital, great detail. in children. particularly as very important work Whyalla Wallaroo Wakefield was born into a medical The publicity following the 1998 is going on towards development of a family, his father a prominent publication was shortly followed by coronavirus vaccine. genesiscare.com medicSA | 55 ???REFLECTIONS

‘What are you looking at?’

We can choose the way we see the world – and, in turn, how our view affects us – writes Dr Troye Wallett.

Two friends walk down a city street. that they are becoming popular. The The one turns to the other and says, illusion also occurs with new ideas, ‘That’s a beautiful bird call – I don’t thoughts or experiences. often hear it at this time of year.’ With The Baader-Meinhof Group was a far- astonishment, the second asks, ‘How left militant West German organisation can you hear a bird over all the traffic active in the 1970s and responsible and noise of the city?’. for bombings and assassinations that ‘It’s all about what you listen for,’ says lead to the death of 34 people. It has the first. ‘Watch...’ absolutely nothing to do with the She takes a coin out of her pocket and Frequency Illusion except that the name drops it on the ground. The tin-on- has, amusingly, become synonymous cement sound is clear but soft. Around with it. In the 1990s a commentator them, strangers turn and look for the dubbed the Frequency Illusion the obviously dropped coin. The woman ‘Baader-Meinhof Phenomenon’ because smiles, picks up the coin and returns it he was surprised and amazed when he to her pocket. randomly heard of the group twice in There is a kids’ game that is both 24 hours. endearing and annoying, depending on The term 'Baader-Meinhof the prevailing mood. It is called Spotto Phenomenon' is a far more amusing and entails looking for yellow cars term than Frequency Illusion and is used and calling out ‘SPOTTO’ when one is in this article from this point. It shows spotted. It is amazing how many yellow us that just because things are serious cars are on the road, but only noticed does not mean we can’t have fun. when you are looking. When was the last The Baader-Meinhoff Phenomenon is Dr Troye Wallett is a time you saw one? powerful and can be used to direct one's GP who likes to build The phenomenon described in life. It reminds us that what is noticed Dthings and to talk. He both these situations is the Frequency and what is ignored makes a significant notices mountain bike riders, Illusion. Every second our brain decides difference to how we experience the opportunities and fun. He is which stimuli to pay attention to and world. It is like an Escher illusion, in delighted about the idea that which to ignore. When something which you see either a young or an old someone will notice Baader- becomes important to us, we notice it. woman in the same picture. Meinhoff after reading his There is also an element of confirmation Choose to notice the generous and writing and would love to hear bias involved. If we are thinking kind and the world fills with kindness from you. Email him at about buying a Tesla because they are and generosity. Read the news and see [email protected]. becoming popular, we start to see them fear and dismay, and the world fills with and come for a ride everywhere, which confirms the idea fear and dismay.

56 | medicSA MOTORING

Whether you see opportunity and Choose to see abundance, kindness, abundance, or scarcity is the same: opportunity and compassion and you a choice. will find them – just as you are bound to The world flows around and with see yellow cars and Teslas after reading us like the morning traffic in our daily this article. commute. We can choose to see the And what are the chances that you … ‘News is to the yellow cars and yell with exuberance are going to come across Baader- mind what sugar is ‘SPOTTO!’, or we can focus on all the red Meinhoff in the next 24 hours; lights and the selfish, entitled people slim perhaps, but you will notice it to the body ...’ that we perceive as cutting us off. if you do… - Rolf Dobell

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medicSA | 57 MOTORING

Smart work, Volvo In keeping with the support of contemporary technology and a particular interest in electric vehicles, regular reviewer Dr Rob Menz has test-driven a new Volvo hybrid.

olvo has committed to electric about how vehicles across its fleet by much power 2025 and the XC 40 is the first is being used The Volvo XC 40 has a 'preconditioning' feature that makes it more example to hit the showrooms. or how much comfortable in early mornings in some climates. VThe petrol XC 40 was released in electricity is Australia two years ago and has picked being regenerated when slowing down There is also a mode called up a slew of Car of the Year awards, or breaking. There are also indicators ‘preconditioning’ that allows the car to including in Australia. It comes with explaining distance to refill for both the be kept warm on chilly mornings and can a couple of variations, designated T4 battery and the fuel tank. be activated by a pre-set timer or, in some and T5. They each use a similar two- Drivers can choose between ‘pure’ parts of the world, through a mobile litre engine but have different levels of driving mode, which is battery-only phone app. A photograph in the brochure power. The T4 is front-wheel-drive, and power; hybrid mode, where the car of some snow-covered cars in a car park the T5 is all-wheel-drive. The plug-in decides whether to use electric or alongside the Volvo demonstrates the electric vehicle (PHEV) also has T4 and petrol power; or petrol only. The most value of this in certain climates. T5 designated variants; both are front- efficient use of power is in pure mode. Another useful feature is that if you wheel-drive. These are powered by a When in hybrid mode battery power return to your Volvo laden with shopping 1.5-litre turbocharged three-cylinder is preferentially used other than when or suitcases, the electric tailgate can be engine, again with different levels there is high demand, such as in rapid operated by moving your foot under the of power. The test car was the more acceleration or low temperatures. left rear bumper. Similarly impressive is powerful T5 featuring 132 kW from the A full tank of 95 RON petrol is good the automatic parking, which works for petrol engine and 60 kW from the 10.7 for several hundred kilometres. Volvo both parallel parking and perpendicular kWh electric engine. claims overall fuel economy of 2.2 litres parking – although this was reverse in Long gone are the days of boxy per 100 kilometres and this may be only and is not universally legal. Volvos with emphasis mainly on safety. achievable when the car is used mainly Most of the functions mentioned above Contemporary Volvos have a very smart for daily commuting with overnight can also be activated by voice control. design, although some commented that charging every day. The dashboard Learning the satnav system proved the C pillar was quite thick. There are a suggested the overall fuel economy interesting with my initial attempt to few clues to differentiate the recharge on the test car was five litres per find a street in Thebarton. The satnav did from the non-electric XC40s, including hundred kilometres. not recognise Thebarton as a suburb but a subtle ‘recharge’ label at the top of There is a large touchscreen in the did direct me to the same street name in the C pillar, a recharge badge on the centre of the dashboard that controls Adelaide – which proved to be the correct tailgate, and a charging port in front the ancillary functions of the car destination in Thebarton. However, of the passenger’s door. The test car’s including navigation, entertainment, the satnav misunderstood a road for a numberplate (40 PHEV) was a further phone connection, temperature, and driveway and then tried to direct me right clue. The car is equipped with a three- seat heating (the rear passenger seats through the middle of Westend brewery, metre charge cable that plugs into a are also heated). Swiping the screen which of course has locked gates. household socket and recharges the reveals several driver-assist modules Subsequent use of the satnav proved battery in four to five hours. This charge that can be switched off; these include much more successful. is good for up to about 45 km, which blindspot activation, a cross-traffic Driving the XC 40 was a breeze. is sufficient for most daily commutes. alert, a lane-keeping aid, and collision The very comfortable seats are multi- Other charging options include a specific avoidance assistance. adjustable with some electric controls charging port that can be attached to Another safety feature is called ‘city and there are three pre-set positions. garage or carport wall, or using one safety’. This feature is activated when Driving position is high, which provides of the increasing number of public there is a high risk of a collision. Initially very good visibility (apart from the charging stations. Volvo estimates there is an acoustic and visual warning thick C pillar mentioned above, which approximately $2.80 per charge but this signal from the dashboard, and this is can restrict the driver’s rear quarter would be less if using solar power. followed by applying the brakes if the view). When in reverse there is a very The fully electronic dashboard has driver has not braked or swerved. The clear ‘helicopter’ view of the car on the replaced the odometer with another system has been designed to detect central infoscreen. dial that gives information about power other vehicles, cyclists, pedestrians When driving at night the lights turn usage. The dashboard gives information or large animals. with the steering wheel, enabling the

58 | medicSA driver to see around a corner. As with all lunch, and a Sunday afternoon drive wheel, windscreen washer water, and electric vehicles the silence is uncanny. to Victor Harbor for a sunset dinner the enhanced parking assist. The test Despite the small displacement of the in addition to the usual commuting car was provided by Solitaire Volvo engines, the XC 40 keeps up with the around the city. at Parkside; please contact them to traffic very easily (claimed 0 to 100 The XC40 proved to be quiet and arrange your test drive. km per hour of 7.3 seconds is certainly efficient, and very capable of handling The fully electric XC 40 should be brisk enough). Handling is aided by twisted Hills roads. Rear-seat passengers released in 2021. Of interest to those the low centre of gravity, with the particularly enjoyed the views of trees seeking higher-performance Volvos, batteries located in what used to be a through the panoramic sunroof. The there is also a Polestar sedan and wagon transmission tunnel. 245/45 tyres on XC 40 is claimed to be a five-seater, available. Polestar is to Volvo what AMG 20-inch rims also help. And despite but our impression was that it would is to Mercedes, and the latest Polestar the low-profile tires, the ride was be uncomfortable for more than four variants also have hybrid power. remarkably smooth. occupants during anything but a very Dr Robert Menz is a GP and enthusiastic Four short days of testing did allow a short trip. motorist who has never owned a Volvo, Saturday afternoon drive through some The XC40 is priced at about $71,000, although his mother has owned two. lovely Adelaide Hills back roads to reach although the test car was fully optioned the Bridgewater Mill for an excellent with extras including a heated steering

PRACTICE NOTES

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medicSA | 59 VALE

‘Courageous and principled’

Dr Ian Douglas Steven MB BS (Adelaide), MD, MPH, FRACGP, FAFPHM

1945 – 2020

Dr Ian Steven (courtesy RACGP)

an Steven was educated at St Peters of ASPREN, the Australian Sentinel pattern. The statistics were damning. College and the University of Practice Network, in 1990. The AMA met with the relevant Adelaide: he resided at St Mark's As an aside from practice Ian was authorities, and prosecutions and College, graduating MB BS in 1970, the winner of the quiz show Sale of the suspensions resulted. Ian and I were Ihaving won the St Mark's Collegians Century in 1985. both aware that the damage done to Prize as outstanding undergraduate Ian's professional life was rich many of the victims was not reflected in 1969. and varied. Apart from his RACGP in the leniency of the penalties, His devotion to life-long learning positions, he worked in a consulting and our attempts to discover why is reflected in his further studies, role for Workcover SA, the WHO, the were thwarted. resulting in his MD, FRACGP, MPH and NHMRC Drug and Alcohol Services, However, as a result of recognition FAFPHM. His studies, and his text book and the SA Health Commission. of the growing problem of opioid Patient Presentations in General Practice, He saw the need for scrupulous abuse, the Medical Board eventually a Comprehensive Guide to Diagnosis management of pain, particularly approved an AMA(SA) Committee into and Management, were reflective of relating to work injury and his Pain Management report. Pethidine, his interests and were directed to specialist practice in this commenced then commonly used for migraine informing himself to enable him to in 1990. headaches, was removed from the practice with ease across a variety of Ian's interests included gemology and drug supply, eliminating it as a threat roles and of disciplines. ornithology, which he shared with his of iatrogenic addiction. All this After graduation Ian travelled, first wife Marg. They travelled extensively. resulted from Ian's courageous and within Australia and then to England. Ian is survived by Marg, his aunt, principled stand, despite threats to his His adventures included driving a cousins and families. personal wellbeing. second-hand Land Rover to Ethiopia On a personal note I met Ian in Ian managed to balance his via the Sahara Desert. He worked as the John Martins department store academic, social, recreational and a doctor, volunteering in a famine in the early 1960s while buying our personal life in an exemplary fashion relief project. undergraduate academic gowns. He and was critical of my inability to emulate him. Had I done so I would His interest in Africa was long- was a year behind me. We formed a have spent more time with him. standing and he travelled widely, comfortable if not close friendship. We interested in its history and culture. had a shared interest in fishing, and Vale Ian. He later donated a significant also in the quality of medical care. Dr Peter Joseph collection of artefacts to the South While Ian was Visiting Medical Australian Museum. Consultant for WorkCover SA, I After returning to Adelaide Ian was President of the AMA in South practised in Evandale, then set up his Australia. Ian obtained permission own practice in Collinswood (1978- to discuss with me a disturbing 1996). It was in this period that he pattern of pethidine administration gained his MD and MPH. by a small number of doctors working In the late 1980s Ian, as director of the for a deputising service which was RACGP research secretariat, brought billed to WorkCover. Some of the together the independent networks of patients had been opioid naive and sentinel practices of the state-based were not drug seekers. I was able to research committees. He expanded obtain information from the Health the project, leading to the formation Issues Centre that showed a similar

60 | medicSA VALE

Expect the unexpected

Dr Brenton Graham Mollison RFD, ED, ADC, MBBS, FRACOG, FRCOG

1936 – 2020

t is a testimony to his talent, Dr Mollison obtained his membership drive and loyalty that Dr Brenton of the Royal College of Obstetricians and Mollison had two stellar careers Gynaecologists in the United Kingdom in parallel – one as an eminent and returned in 1965 to private practice Iobstetrician and gynaecologist and the and at the Queen Victoria Maternity other as a commanding officer in the Hospital and the Women’s and Australian army. Children’s Hospital. He also worked in He was a man of enduring Jamestown and Victor Harbor, earning Dr Brenton Mollison relationships – with his wife Pam; the respect of the rural communities. children Morag, Briony, Sandy and He served on the medical staff in the innovative ways in which he Tom; and grandchildren – and with committee of the Queen Victoria imparted military medical knowledge.’ great friendships that lasted a lifetime, Hospital from 1971 to 1994 and was Chair Dr Mollison was instrumental in the including with students and in during a difficult period as the Queen success of the expansion of the RAAMC the military. Victoria Hospital merged with the in South Australia in the 1980s and Brenton Mollison was born on 23 Adelaide Children’s Hospital. 1990s, and is remembered as a source December 1936 as the only child of He was known as a teacher with of advice and common sense. He was Tom and Dorrie Mollison, and lived in great drive, ingenuity and originality. highly regarded by those with whom he what is now Glenelg East for most of His maxim ‘expect the unexpected’ served, Dr Byrne says. his early years. was the north star guiding students in During his career, he contributed to His longest standing friend, medicine and in the military throughout the Australian Medical Association, Dr Graham West, recounted that their careers. the South Australian Post Graduate – having forged a friendship when Dr West recalled that his friend had Medical Association, the South enrolling in the Infant School at Glenelg three great loves – his family, the army Australian Salaried Medical Officers – they spent their youth spent playing and the Order of St John of Jerusalem. Association, the Royal Australian cricket, football, tennis, swimming ‘He aimed always to help those in need, Artillery Association, the Royal United and mucking about in a canoe that developing methods to improve survival Services Institute of South Australia Graham’s dad built. rates and patient care,’ Dr West says. Inc, the Naval and Military and Air They continued to be great mates ‘He was absolutely besotted with Force Club, and the United Farmers and throughout their secondary schooling at everything about the Army. He loved Stockowners Association. St Peter’s College, where Brenton was a the history, the pageantry, the guns, the As well as being a longstanding office prefect, and at the University of Adelaide carefully documented routines and the bearer of the Queen Victoria Medical Medical School where Brenton had won special camaraderie he experienced Staff Society, Dr Mollison served on the a Commonwealth scholarship. in the Army.’ Royal Australian College of Obstetricians They worked together in the It was while at St Peter’s College and Gynaecologists (SA Branch), the dissecting room to learn anatomy, that the schoolboy Brenton began as a South Australian Health Commission in the pathology museum to learn cadet officer. Colleague Dr Peter Byrne Mortality Committee, and on the board about diseases, and in the casualty remembers him as a talented cadet of the Adelaide Medical Centre for department of the Royal Adelaide underofficer and an excellent rifle shot. Women and Children. Hospital to gain practical experience in Initially commissioned as an artillery Remarkably, he found time to devote suturing wounds. officer, Dr Mollison transferred to the to cattle farming (cutting a dash Brenton successfully completed Royal Australian Army Medical Corps in moleskins and Akubra hat) and his medical degree in 1960. The (RAAMC) in 1961. The pair served in restoring old military vehicles. friends were parted for the first time the RAAMC and they both served in He retired from obstetrics and in 1961 (after having spent 18 years the Royal Army Military Corps (RAMC) gynaecology in 2001 due to mounting together as students) when the young in the UK, although 10 years apart, in health issues but continued to lead an Dr Mollison worked as an intern at the 219 General Hospital. active life until the last few months. Queen Elizabeth Hospital at Woodville On returning from the UK, Brenton Dr Mollison is remembered as a while Dr West interned at the Royal commanded the 3rd Field Ambulance person who touched the lives of many Adelaide Hospital. and the 3rd General Hospital with an people who ‘enjoyed his cheery face, He met his wife, Pam, then a nurse infectious enthusiasm, Dr Byrne says. clever wit and benefited from his at the Queen Elizabeth Hospital, and ‘He gained an outstanding reputation as knowledge and kindness’. married in August 1963 before training a commanding officer and an excellent in obstetrics and gynaecology at the trainer of medical officers and soldiers. With thanks to Drs Graham West, Queen Victoria Maternity Hospital. His infectious enthusiasm was obvious Peter Byrne and Rob Atkinson

61 | medicSA medicSA | 61 DISPATCHES

AMA(SA) OFFICE CLOSURE e-newsletter and on our website, or see UPDATED FEES LIST OUT NOW The AMA(SA) temporary office at the February issue of medicSA. The latest AMA Fees List, released on Dulwich will close at noon on Tuesday, 1 November, is now available. Existing 22 December 2020, and reopen on members can access the list at no Monday, 11 January 2021. FEBRUARY COUNCIL MEETING cost at https://feeslist.ama.com.au/. We thank members for providing ideas, The next meeting of the AMA(SA) Non-members can buy an annual views and feedback, and for alerting Council will be held on Thursday, subscription for $499. us to matters of concern, during the 4 February 2021. COVID-19 pandemic. Your involvement Members may attend Council meetings. has been essential to ensuring we have If you are a member and wish to attend FREE MEMBER-ONLY been able to respond appropriately as the February meeting, please contact SEMINAR issues emerge and continue to affect Claudia Baccanello on 8361 0109 or at Managing and Growing your doctors, health practitioners, the wider [email protected], for up-to-date Personal Wealth health sector and communities. information about online or face-to- 25 February 2021 Since COVID-19 restrictions began face formats necessary at that time. 6:15 pm for a 6:30 pm start in late March 2020, staff have been alternating between working from Hood Sweeney Boardroom, home and from the temporary DO WE HAVE YOUR CORRECT 11‑16 South Terrace, Adelaide. accommodation at MEMBERSHIP DETAILS? The event will also be live-streamed. Level 1, 175 Fullarton Road, Dulwich. 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 A business must be a Qantas Business Rewards Member and an individual must be a Qantas Frequent Flyer Member to earn Qantas Points with MIGA. Qantas Points are offered under the MIGA Terms and Conditions (www.miga.com.au/qantas-tc). Qantas Business Rewards Members and Qantas Frequent Flyer Members will earn 1 Qantas Point for every eligible $1 spent (GST exclusive) on payments to MIGA for Eligible Products. Eligible Products are Insurance for Doctors: Medical Indemnity Insurance Policy, Eligible Midwives in Private Practice: Professional Indemnity Insurance Policy, Healthcare Companies: Professional Indemnity Insurance Policy. Eligible spend with MIGA is calculated on the total of the base premium and membership fee (where applicable) and after any government rebate, subsidies and risk management discount, excluding charges such as GST, Stamp Duty and ROCS. Qantas Points will be credited to the relevant Qantas account after receipt of payment for an Eligible Product and in any event within 30 days of payment by You. Any claims in relation to Qantas Points under this offer must be made directly to MIGA by calling National Free Call 1800 777 156 or emailing [email protected]  Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by Medical Defence Association of South Australia Ltd. Before you make any decisions about any of our policies, please read our Product Disclosure Statement and Policy Wording and consider if it is appropriate for you. Call MIGA for a copy or visit our website at www.miga.com.au © MIGA March 2019

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MIGA020 AMASA MedicSA 210x297 DA V1.indd 1 8/5/19 12:05 pm Benson Radiology open at North Eastern Community Hospital

PLAYFORD CLINIC

As the state’s largest The opening of our clinic at the > CT North Eastern Community Hospital locally owned > X-ray in Campbelltown, allows us to bring > Ultrasound imaging Practice, our high quality imaging services > Mammography to the referrers and patients of the Benson Radiology is > Bone mineral densitometry inner north eastern suburbs. delighted to announce > Dental imaging Opening from January 2021, MRI will also be available the opening of its our new clinic will provide: from mid 2021. newest clinic

For more information visit

64 | medicSA bensonradiology.com.au