August 2015

Canberra Doctor is proudly brought to you by the AMA (ACT) Limited Circulation: 1,900 in ACT & region In the fifth in a series on Canberra’s hospitals, we go just across the border to Queanbeyan District Hospital, which works in partnership with the ACT A major $51 million dollar upgrade in 2009 The eight-chair Renal Unit is operational Monday to Saturday, transformed Queanbeyan District Hospital, just in partnership with ACT Health over the border, into a modern acute care public Renal Services through TCH. hospital which shares in a cross-border Queanbeyan District Hos­p­ ital is a mixture of VMO GPs relationship with the ACT. and Specialist Medical Officers. It is classified as a regional hos­ The Queanbeyan District and inpatient surgery. There is pital with an on call anaesthetic Hos­­­­pital and Health Service a theatre with laminar flow, and obstetric service. There are works closely in partnership and an endoscopy room. Spec­ Junior Medical Officers on the with ACT Health and the Canb­ ialties­ provided are general ward seven days a week. The erra community. It is only a 15 surgery, gyn­­aecology, endos­ introduction of Diploma Obstet­­­ minute drive from The Canberra copy and den­­­t­­­­al. Minor ortho­ ­ric trainees commenced in Feb­ Hospital (TCH) and 25 minutes paedic procedures have com­ ruary this year. from Civic. menced recently. The Medical Imaging Dep­ Run by the Southern NSW The ED has recently been artment­ has been boosted thr­ Local Health District, it is assist­ upgraded to provide even bet­ ough the addition of a CT scan­ ing with ACT’s waiting lists by ter specialist care. A new FACEM ner that will go into service later treating its patients from NSW in Director has been appointed this year. The department per­ vice in the nursery. Queanbeyan the hospital’s patient directed a new reverse-flow agreement and the unit has also gained a forms ultrasounds, mammogra­ has three labour rooms, seven visitation policy, meaning open signed this year. More than 100 full-time GP ED Registrar, with phy, plain X-rays utilising the post-natal rooms, and a midcall visiting hours, has improved NSW patients have been accept­ two more to join next year. As RIS/PACS. The service operates service (post discharge visit). The patient and family satisfaction— ed from ACT lists already, and well as a major step up in care from 8.00am to 9.00pm, with an Maternity Unit has been awarded and that of course benefits staff. they will now have their general for the 17,500 patients using ED on-call service available out of its fourth consecutive Baby The hospital and health ser­ surgery, minor orthopaedics, each year, Queanbeyan’s ED hours. A NSW Breast­screen ser­ Friendly Health Initiative accredi­ vice listens to patients, giving the and maternity and gynaecology has become a training and men­ vice also operates from the Im­ tation certificate, an aw­­ard devel­ local community a voice through procedures at Queanbeyan. toring facility. aging Department. oped by the World Health Org­ its Community Consultative Com­ Queanbeyan District Hos­­ p­­ The 24-hour ED has seven The Pathology Department an­isation and UNICEF. ­mittee. Through the committee, ital’s Medical/Surgical ward has acute and two resus beds and caters for inpatient and outpa­ Community and Allied the Health Service hears the 38 beds. There are 18 medical/ two paediatric beds (four hours tient appointments from 8.00am Health Services include oral patients’ thoughts and concerns surgical beds, a four-bed Close only). The ED has an isolation to 6.00pm, with an on-call ser­ health and an extensive range to improve the service and more Observation Unit, two mental room, three procedure rooms – vice available out of hours. of support services including thoroughly meet expectations. health rooms and two isolation eye, plaster and treatment – two Queanbeyan’s maternity ser­ physio and occupational thera­ While not a Canberra hospi­ rooms consultation rooms and a men­ vice links with TCH through the py, and a pharmacy service. tal, it’s a modern hospital on Two operating rooms and tal health bed with mental health specialist obstetricians and a For staff, patients and visi­ Canberra’s doorstep, and a pro­ facilities cater for day surgery service. recently installed telehealth ser­ tors there is ample parking, and active partner with ACT Health.

August 2015 Volume 27, No. 7 Capital Conversations with President, Dr Elizabeth Gallagher It is with great sadness that I done and kept her nose clean”. boundaries. ACT is no longer maternal death, readmission as a write my first column without One thing I can say even though ass­ociated with rural areas where result of a HPAE, readmission for our long standing CEO Christine I have only been on the AMA we have built strong ties and any related condition within 28 Brill by my side. True to form scene for a mere fragment of her relationships, and with no regard days, or a HPAE while in hospital. though, she did prepare this edi­ career, is that Christine has stood to patient flow. Quean­beyan, As an obstetrician, the thought tion to be published after she behind our presidents and Bun­g­­endore, Braidwood and that this sort of control will make retired at the end of July. Many boards, often working very hard, coastal towns to the Vic­torian me even more likely to work of the past presidents that have and then standing back while border will now get their rural with my team to prevent a mater­ served alongside Christine, as we took the credit for things that GP trainees from Southern Syd­ nal death is laughable! What they well of some of our longest serv­ she did. I have great respect for ney. This may well impact on our are assuming is that anything ing members said our farewells her, and will miss her support local GP training scheme, as more than a 0% complication rate last week at her retirement din­ and encouragement. trainees who want to work in is a reflection of poor practice. ner at the Boathouse. I enjoyed On the other hand- there are those areas, and who may have There is evidence that only hearing the tributes, and stories also exciting times ahead as we already spent time in those reg­ 44% of the events being pro­ from our older members who welcome Peter Somerville as our ional centres as medical students posed are preventable. The protest about the Border Force have seen her progress through new CEO. Peter has a law back­ and junior doctors, may not be implications for patient care in Act. It is proposed we walk from her career. ground, and is moving from able to remain Canberra based. private hospitals is obvious. Private hospitals will have to AMA House to Parliament House. Christine started with the Sydney to take on this new role. At the time of writing, nego­ We are very interested to gauge ACT branch of the AMA in 1983, He will need to get to know the tiations between Medibank and monitor the procedures it pro­ her first job as she returned to Canberra medical community as Calvary Health Care have broken vides. Patients at high risk of interest and support for this, as work having started to raise a it is the local knowledge that he down and even despite media­ falls, those patients that require we do not want to arrange it family. Her first role was as the is new to. Saying that, he has tion through the Private Health more difficult or complicated unless we can get enough sup­ executive officer, which was a spent many years working close­ Insurance Ombudsman an agree­ procedures that are associated port to show solidarity, strength part time position, and the offices ly with the Federal AMA as part ment was unable to be reached. with a higher complication rates and determination. This is a very were a small space on the ground of the ASMOF team, so has an While Medibank’s argument is could be shifted to the public important issue as it is effectively floor of the residences of the then excellent knowledge of what the that Calvary could not agree to hospitals. Patients who suffer the trying to stifle the rights of health Woden Valley Hospital. As the AMA is about, and industrial measures to “reduce unfortunate worst and most expensive com­ care workers to speak out about AMA grew, so did Christine.­ She relations. I am hoping at some mistakes that can occur in hospi­ plications, may also need to the treatment and health of asy­ completed graduate qual­­ifications stage in the future, Peter will tals” they are using The Classi­­ move to the public hospitals. lum seekers and turn them into in management and employment write a paragraph or two in the fication of Hospital-acquired Calvary is not arguing that criminals. I urge you to read the relations, and a Masters of Human Canberra Doctor about his Diagnoses­ (CHADx) which was quality and safety is not impor­ article on page 12 of this edition Resource Management.­­ She has visions for AMA-ACT over the intended for use within hospitals tant, just that the tool Medibank and register your support with seen us get independence from next few years. Welcome Peter. to track unintentional patient is using is flawed. The AMA is the AMA-ACT if you would like the Federal AMA, grow our mem­ On another note, there are a harm. It was not intended as a also busy lobbying to get a satis­ to be involved. bership and influence, grow out few local issues I would like to means for external monitoring of factory resolution to this. And just a final note for all of our premises, and grow the bring to your attention. hospital performance and to hold Unfortunately in Canberra, two our VMO members. The next work required to keep our organ­ The consultation period for them to account. What Medibank of our largest private hospitals round of contract negotiations isation growing, and running. GP training boundaries recently is proposing is that it will not are affected. It was suggested by with ACT Health have started Those who have known her for closed, and tenders were issued cover the extra care required to the staff at Medibank to one of this month, will continue through all those years tell me that at first mid- July. Unfortunately, despite treat patients who suffer a “Highly my pregnant patients that she to November, with arbitration of she presented as a quiet, mild intense and commendable lob­ Preventable Adverse Event” ask if she could go to another unresolved issues is due to start mannered lady, whose confi­ bying by the ANU Medical (HPAE) of which it has listed 165 hospital, showing how little in February. Please feel free to dence grew over the years. She School and ACT Health, some of conditions, some of which are insight into the impact on pri­ call me if there are any issues never shied from confrontation our local politicians, and with the the most common surgical com­ vate healthcare in Canberra. you would like raised. and yet when things got tough, support of AMA-ACT, the De­­p­ plications. They are not going to AMA-ACT has been app­ Our next edition will be the or murky, somehow “got the job art­ment of Health has fixed the cover sentinel events, such as roached about staging a rally to first for our new CEO. Till then…

2 August 2015 Opinion: Pre-conception genetic screening – let the mutants beware! By Steve Robson ciation studies have mapped CVS tests tumble to the point SNPs and the presence of many where it is going to be difficult All of us are mutants, common conditions: many hun­ to train future specialists in these whether we like it or dreds of disease-SNP associa­ invasive techniques. not. The human tions have now been identified The next area where micro­ and more are being discovered array technology is going to genome differs in every all the time. have a massive potential impact individual, so there is This new and expanding is ‘screening’ for polymorphisms bank of genetic knowledge has and mutations in couples before no ‘normal human developed in concert with re­ they try for a pregnancy. But genome.’ markable changes in molecular whereas NIPS is commonly diagnostic technology. Pre­vious used either to triage women Areas of our genome where mutation testing based on poly­ who have a higher-risk com­ treatment, parents planning a atrophy, which are relatively differences between people are merase chain reaction (PCR) for bined screen, are older, or have pregnancy can have potential common, it is completely un­ commonly found are referred to single-gene mutations has been some other risk factor, ‘pre- health problems in their off­ clear as to whether there is any as ‘variations,’ and in locations overtaken by highly multiplex­ed pregnancy genetic screening’ – spring identified early and allow value (other than commercial) where the frequency of alleles is tests that can detect thousands PGS – of the potential mother them to make ‘better reproduc­ for wider screening tests. greater than 1% these variations of variants at the same time. and father before a pregnancy tive choices.’ Is this really the The information provided are called ‘polymorphisms.’ The These are based on a comb­­­in­­ is conceived has extraordinary likely outcome? As new tests by genome-scale screening tests term ‘mutation’ is generally res­ ation of microfluoresence detec­ potential ramifications that are offer more and more compre­ has the potential to be very erved for a DNA change that is tion methods and computer chip only just being recognized. hensive identification of disease confusing and to present diffi­ known (or thought) to be asso­ manufacture processes, allowing Because providing PGS is susceptibilities, decision-mak­ culty in interpretation. The con­ ciated with a disease. The com­ ‘gene chips’ to be mass-pro­ so potentially profitable (since ing in light of the results be­ ditions detected may be untreat­ monest mutations known to duced to exacting standards – a there is a strong economy of comes more and more chal­ able, or indeed very mild in lead to disease are those in the lenging. Genetic screening pro­ single chip can detect hundreds scale), commercialisation and effect. Treatments may become cystic fibrosis transmembrane of thousands of base-pair varia­ direct marketing to prospective grams are already beset by conductance regulator (CFTR), tions in just hours, and cheaply. parents will put doctors under unanticipated incidental find­ available over the lifespan of with about one person in 26 car­ The chips are a matrix of small, great pressure. But as Feero and ings, ambiguous results, false- the child conceived. rying a mutation in this region of sequence-specific oligonucleo­ colleagues pithily remind us in positives, and over-diagnosis. Doctors who wish to engage the genome. Mutations for spinal tides fixed on a microarray. the New England Journal of All of us perform genetic with commercially-available pre- muscular atrophy are also rela­ A person’s DNA is cut into Medi­cine,­ “don’t order a test screening for our patients, a pro­ pregnancy genome-scale testing tively common. small fragments, labelled with unless you know what to do cess we know as taking a family – the type heavily marketed by When these polymorphisms fluorescent marker, and merely with the result.” history. The ability to assess for biotechnology companies – will or mutations are present in the incubated with the microarray Polymorphisms are so com­ multiple heritable risks simulta­ need to be very conversant with germ cells – sperm and eggs – a chip. Computerized analysis is mon that it is highly likely neously, and at a level of detail the technology, the results, and disease tendency can be trans­ performed on the fluorescence ‘screening’ will detect disease almost beyond comprehension the diseases and predispositions mitted to an offspring and will pattern and the sequences pre­ predispositions in couples that to all except experienced genet­ tested for. If you find this confus­ generally be present in every sent in the DNA sample are are completely healthy. More ic counsellors, can present tre­ ing and daunting, imagine how somatic cell of the body. When interpreted with high sensitivity importantly, with the rapid pace mendous difficulties for couples. difficult it is for your patients. Let new mutations arise in somatic and specificity. The pace that of medical advance, improve­ This screening approach is not all of us mutants beware. cells, tumours may develop but this technology is moving is ments in management of dis­ designed to allow any treatment these will obviously not be truly breathtaking. ease are likely to change the – the usual goal of screening – A/Prof Stephen Robson is a transmitted to an offspring. The fruits of this change has course of many heritable illness­ but to give prospective parents Canberra O&G specialist and As we are all aware, the been evident for about two es before any child conceived the opportunity to avoid the President Elect of AMA (ACT). pace of genetic research is ex­ years now, with easy commer­ comes of age. This effect has birth of an ‘affected’ child. Recommended Reading: traordinary. Large-scale re­ cial availability of cell-free DNA dogged screening for adult dis­ Unfortunately, doctors’ des­ Feero WG, Guttmacher AE, search projects have identified testing for Down syndrome ease in other areas: over-diag­ ire to avoid litigation and the Collins FS. Genomic medicine – single-nu­­­cleotide polymorphis­ from maternal blood in the first nosis and false-positive tests can commercial interests of compa­ ms (SNPs) throughout the ge­ trimester, commonly referred to be extremely stressful for peo­ nies marketing these tests (often an updated primer. N Engl J nome (the ‘Genome-wide Ass­ as ‘non-invasive prenatal screen­ ple who have screening tests. directly to patients) is likely to Med 2010; 362: 2001-11. ociation­­ Study’) that now allow ing’ or NIPS. The introduction of The assumption made by drive uptake. While a clear case Burke W, Tarini B, Press NA, identification of the genetic asso­ NIPS, based on massively-paral­ those offering PGS is that, since can be made for pre-pregnancy Evans JP. Genetic screening. ciations for many complex con­ lel sequencing, has seen the newborn genetic screens iden­ screening of mutations for cyst­ Epidemiol Rev 2011; 33: ditions. The genome-wide asso­ number of amniocentesis and tify children who benefit from ic fibrosis and spinal muscular 148-64.

August 2015 3 AMA warns against Opinion: Caught in the middle – radical changes to the controversies of intersex medical intern intervention training By Ben Loel In 1965, during what The AMA has lodged a processes, and exp­­ anding­ pre­ was to be a routine submission in vocational experience in non- traditional settings, such as the circumcision, the penis response to an options community and private set­ of a Canadian boy was paper released by the tings, where there is evidence accidentally destroyed Council of Australian that these chan­­ges produce re­ sults.”­­ beyond repair. The Governments (COAG) A/Prof Owler said the boy’s name was David Health Council COAG Review is considering Reimer. David was born National Review of a range of options to reform into an era now Medical Intern intern training, from incre­ mental change to more radical commonly remembered Training. proposals such as a two-year as the ‘sexual AMA President, A/Prof prevocational training pro­ revolution’, a time Brian Owler, said that there is gram or transferring the intern no need to radically change year into the last year of med­ characterized by rapidly the Australian model of medi­ ical school. changing ideologies cal intern training. “The Review shows there regarding gender and “The AMA urges caution is a lack of data surrounding though not in the way he had tal disregard to the essential on any proposed major chang­ the quality and effectiveness of sexuality. envisioned. human right of self-determina­ the intern year in preparing Acting on the concept that tion? Unfor­­ tunately­­ and to the es to internship training for At the center of the sexual junior doctors for independent the appearance of one’s genitals surprise of many, the answer is medical graduates,” A/Prof revolution was sexologist and practice,” A/Prof Owler said. largely influences their gender, also, but not so simply, yes. Owler said. psychologist John Money, who “The AMA believes the Money deemed David’s penis David was not intersex, but “There is no evidence to was receiving media attention Review must propose new no longer compatible with be­ he represents a lesson learnt show that the current model of for his controversial theories internship in Australia is ‘bro­ systems to provide better ing male. He proposed that sur­ on the potentially devastating around gender. Money postu­ ken’, or that radical changes to information on the quality of gically crafting David female consequences of taking anoth­ lated that humans are born its structure are required. medical intern training, the genitals would therefore ensure er’s gender in your own hands. gender-neutral and that gender “Our submission highlights transition from medical school him a better life as a female. One in 2000 babies are born is an embodiment of physical that the current model of intern to intern training, and in the David was raised as a girl, intersex, many of whom pos­ appearance and environmental training in Australia has served remaining prevocational and but by 13 years old had assumed sess ambiguous genitalia. exposure, meaning that it could the community well. vocational training years. a male identity. He committed There are two reasons these be altered accordingly. “It gives new medical grad­ “To support this approach, suicide at the age of 16. Despite infants undergo surgery: to Soon after this tragic surgi­ uates a well-rounded, general­ the AMA has recommended a his own appraisal of the suc­ treat a physical malfunction or cal complication, driven by ist, supervised, and protected national survey of medical cess of this intervention, it is disease, or to make them what was undoubtedly honest introduction to medicine, training, similar to the survey now a unanimous consensus appear more male or female. and well-intended parental which enables junior doctors that the General Medical Coun­ that Money was sadly mistaken. The latter still occurs due the concern, David’s family sought to develop their medical skills cil undertakes in the United Fast forward to now – has failure of many to properly dis­ Money’s pro­­fessional advice. and professionalism. Kingdom.” the situation changed? The tinguish it from the former. “Instead of sweeping Mon­­­ey seiz­­ed this opportunity answer is simply and obviously The dichotomisation of changes, we need to build on The AMA submission is at to implement an experimental yes. But do surgeons still under­ gender and pathologisation of what works. https://ama.com.au/ form of ‘therapy’, which would go non-therapeutic surgery on non-conforming gender identi­ “We support improvements submission/medical-intern- subsequently alter the course the genitals of children – argu­ ties means that medical inter­ to supervision and assess­ ment­­­­ review of David and his family’s life, ably representing a fundamen­ vention on intersex babies is

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4 August 2015 driven largely by social ideol­ procedure is assumed by the community and supported by ogy despite unequivocal scien­ parent or legal guardian. In a unbiased outcome measures, a tific evidence to dispute its medical emergency, consent is transcendence of binary sex therapeutic outcomes. A recent not required to perform surgery and its inextricable link to gen­ study that followed up intersex that is life saving or to prevent der is required. Today, only the babies who underwent gender serious harm. The question aris­ stubborn remnants of archaic allocation contradicted the es however, should parents be gender stereotyping prevent dominant view by concluding able to consent to intersex sur­ doctors from considering a per­ that early gender allocation or gery when it is not a medical son’s individual experience of ‘sex assignment’ was not the emergency? The courts have gender in their medical man­ best predictor of gender iden­ never directly addressed this tity development. Subsequently, issue. However, in 1992 the agement. they called for a reassessment High Court of Australia deliber­ It is for no one to argue of medical app­roaches to inter­ ated on whether a parent was that there is a simple solution sex people, and a conceptual able to consent to a hysterec­ to what is undoubtedly a com­ divorce between gender iden­ tomy and oophorectomy to be plex ethical issue. However, tity and gender role. performed on a 14 year-old girl when such a dispute between Numerous other studies with an intellectual disability. opposing moral imperatives have raised uncertainty about The case is now well continues to impact newborns the outcomes of surgical sex known as Marion’s case. The across the world, it is a conver­ allocation of intersex babies, court ruled that court authori­ sation that needs more airtime. yet the practice remains largely sation is required for a medical To some extent, we are all unquestioned. intervention that is invasive, victims of the discriminatory Aside from the uncertainty irreversible and not for the and marginalising ideologies regarding the actual benefit of purpose of curing malfunction held by the society in which surgical intervention in many or disease. The courts decision we are raised. But the more cases, why else might it be mor­ was to ensure the child’s best access we have to information ­ally wrong? If you wish to take interest, given the serious con­ and technology, the greater an unbiased approach to this sequences po­­­tentially resulting ability we have to ask ques­ issue, with a goal to ensure the from a poorly informed deci­ best outcomes for the people at sion. How then, is non-thera­ tions ourselves, and at a lesser the center of the debate, listen­ peutic surgery on an intersex expense. Ignorance is no long­ ing to them is a start. Int­ersex infant any different? Yet cos­ er a forgivable excuse. If a bla­ organisations across the world metic alteration of the clitoris is tant defiance of social and take a pretty unambiguous just one of several non-thera­ human rights will not insight stance towards intersex surgery peutic genital altering surgeries you to ask these questions, – they don’t like it. that occurs on intersex babies than perhaps the idea of medi­ Alternatively you could today, despite being shown to cal mutilation in the absence of explore the human rights of result in higher rates of non- sufficient supporting scientific intersex babies that have argu­ sensuality and inability to ach­ evidence will. ably been disregarded. Consent, ieve orgasm. for example. In Australia when There is no current standard Ben Loel is a Year 3 student at a person is too young to dem­ of care for intersex infants in the ANU Medical School onstrate competence, responsi­ the ACT. For one to exist, one References are available on bility to consent to a medical that is embraced by the intersex request from the author

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August 2015 5 AMA responds to racs issues paper on bullying and sexual harassment Following a Four Corners report on bullying and breakdown the male norm well and where there is ongoing database to harassment amongst the medical professions of the culture. AMA room for improvement. accurately target problem supports the principle of „„The AMA believes that areas on an ongoing basis. earlier this year, the Royal Australasian College of such strategies. health departments and Surgeons established an Expert Advisory Group to „„Cultural change needs to be hospitals should maintain A copy of the AMA submission examine the issue within the surgical workforce led by the senior male reporting statistics (de– in full can be obtained from members of the profession. identified) to develop an AMA (ACT). (http://www.surgeons.org/about/expert-advisory- Explicit statements to the group/). An issues paper was developed by the effect that sexual harassment is unacceptable are one EAG aimed at “triggering debate and finding means of doing this. 51% more likely to die: solutions to address discrimination, bullying and „„Bystanders are often silent sexual harassment in the practice of surgery”. because they do not older patients in the firing line recognise discrimination, should be to receive the care The issues paper covered „„Education of all bullying and sexual Older patients are harassment or they do not they need.” four areas – organisational cul­ practitioners, both in the suffering most of all Ideally, a person admitted to ture, the culture of surgery, workplace and as part of have faith in the systems the training curriculum, is meant to deal with these from overcrowded an ED is given the acute care ‘bystanders are silent’ and com­ they need and then either sent plaints. Comment on each area required. Trainees, fellows issues. hospitals, according to and managers should be home or moved into the main was sought from stakeholders „„Colleges must have systems new research body of the hospital to receive including the AMA. trained and aware of the in place that provide for a different components and undertaken at the further care. But with Australia’s The AMA’s submission to fair and safe appeals and growing, ageing population the issues paper covered sever­ requirements of relevant remediation process and Canberra Hospital, ACT. policies in accordance with there are fewer hospital beds al areas: must ensure that trainees available, leading to overcrowd­ roles, obligations and rights. are aware of how to access The three-year study looked „„Although discrimination, at the experiences of over 13,000 ed EDs and ambulance ramping. bullying and sexual „„There is a need to ensure grievance and remediation “This important research that female trainees have processes if required. patients aged over 50. harassment are not limited It found that patients who adds to the already significant strong, supportive female „„The AMA supports a body of evidence demonstrating to the medical profession, role models. waited more than four hours to the AMA believes doctors centralised, accessible the very real negative health „„Work stressors, leadership database about be transferred to a bed in the impacts caused by access block,” should take a leading role main body of the hospital after in addressing them. styles, systems of work, discrimination and related said Dr Anthony Cross, ACEM work relationships and complaints for effective, receiving their emergency care President. „„While policies are generally workforce characteristics all on-going management. were 51% more likely to die “The likelihood of these in place to deter or deal than people who waited less add to the likelihood of „„The AMA believes that the findings being replicated in hos­ with these matters, the discrimination, bullying and than four hours. ­­pitals across Australia is high, implementation of a The finding calls into ques­ awareness of those policies sexual harassment national training survey is which paints a concerning pic­ is low. occurring. tion the rationale used by hos­ ture about the level of care over- essential to provide data on pitals to decide which patients „„More co-ordination between „„Research shows that which training programs 50s can expect from our health are moved into a bed first. system.” colleges and employers is ‘intentional inclusion’ and locations are managing “In emergency departments needed strategies are needed to bullying and harassment “Older patients shouldn’t (EDs), we take in the most vul­ be put at risk simply because nerable patients first,” said Ass­ their more complex conditions ociate­­ Professor Drew Richard­ require more resources.” son, who conducted the study, “But this hospital is using differ­ Associate Professor Richard­ ent criteria to decide who should son is Chair of Road Trauma be moved from the ED to the and Emergency Medicine at main body of the hospital.” the Australian National “The sicker patients with University Medical School. He the more complex problems – presented his findings at the who are almost always over 50 ACEM Winter Symposium in – are not being admitted into Alice Springs at 11.00 am the hospital as soon as they Monday 27 July 2015.

6 August 2015 Educational partnership launched: nps Medicinewise and Primary Health Care In a new initiative ­icineWise clinical services spe­ focus for the network and Prim­ titioners and available via the “This partnership with Pri­ cialists – independent, evidence- ary has a strong commitment to Primary Health Care Institute.” mary Health Care Institute will Primary Health Care, based learning that focuses on education and continuing pro­ NPS MedicineWise CEO Dr enhance and build on Primary’s NPS MedicineWise and quality use of medicines and fessional development. Lynn Weekes said she is delight­ commitment to fostering con­ the Primary Health Care medical­­ tests. ‘Primary continues to focus ed that NPS MedicineWise pro­ tinuous learning across its net­ Primary Health Care oper­ on training opportunities for grams will be available to Pri­ work.” Institute are pleased to ates a total of 71 medical cen­ our doctors and practitioners mary Health Care staff through announce a partnership tres across Australia, with app­ and we are delighted to be part­ this new partnership with the in which NPS roximately 1300 general practi­ nering with NPS MedicineWise Primary Health Care Institute. tioners, specialists and allied to ensure our professionals “Keeping up-to-date is a MedicineWise will health professionals within its network. Primary Health Care have access to the best and constant challenge for busy support the continuing facilitates 7.5 million consulta­ most recent thinking on medi­ health professionals. The edu­ professional tions with GPs every year which cines and medical tests,” says cational partnership enables us development of Primary is around 7% of national GP Mr Gregg. to deliver our educational pro­ care, and also operates imaging “This educational partner­ grams face-to-face throughout Health Care health clinics and pathology labs. ship will bolster existing learn­ the Primary network and will professionals. Primary Health Care Ins­t­ ing initiatives at Primary, includ­ support practitioners to make itute CEO and Managing Direct­ ing regular clinical training acc­ better decisions in line with the The partnership enables or, Peter Gregg, says providing redited­ through the Royal Aust­ latest evidence and best prac­ educational­­ visits with NPS Med­ learning opportunities is a key ralian College of General Prac­ tice,” says Dr Weekes. New "Women Want to Know" campaign targets Canberra doctors Did you know that 97% nancy is associated with a range to drink alcohol after becoming accredited training and resourc­ can play in influencing their of adverse consequences inc­­­ aware of their pregnancy. es which are relevant to health heal­­­th decisions. of Australian women luding miscarriage, still birth, Research also shows that professionals and women. More information about wanted to be asked low birth weights and Fetal health professionals encounter These resources was pres­ Women Want to Know and about alcohol use in Alcohol Spectrum Disorders a range of barriers in initiating ent­ed at the ACT event, where resources, including free print (FASD). There is no known safe conversations with women Women Want to Know was off­ materials and online training for pregnancy? level of alcohol consumption about alcohol consumption. icially launched by Deputy medical professionals, is availa­ where damage to the fetus will Some say they are reluctant to ble at www.alcohol.gov.au. A new campaign launching Chief Minister, Simon Corbell not occur. discuss alcohol consumption – MLA at the ACT Legislative Ass­ Women Want to Know was this August in the Australian For these reasons, Austral­­ as they are concerned that developed by the Foundation Capital Territory (ACT) encour­ ­­­embly 12:30pm on Wednesday ian health guidelines recom­ women may feel uncomfortable 12 Aug­­ust. for Alcohol Research and ages Canberra’s health profes­ mend that for women who are with the conversation, or are Education (FARE) in collabora­ sionals to speak to women pregnant or planning pregnan­ unsure of what advice to pro­ The ACT launch of Women tion with leading health profes­ who are pregnant, or planning cy, not drinking alcohol is the vide and where to refer women Want to Know also presented sional bodies including the a pregnancy, about alcohol. safest option. if necessary. new research from the University Australian Medical Association Each year 5,316 babies are Unfortunately, research This new campaign, Women of Canberra on women’s under­ and the Royal Australian Coll­ born in the ACT region, and shows that awareness of this Want to Know, aims to over­ standing and perceptions of ege of General Practitioners. It beginning these important con­ advice remains low. The Nat­ come these barriers and sup­ health messages around alcohol is funded by the Australian versations will reduce the risk ional Drug Strategy Household port Canberra’s health profes­ consumption in the ACT. This Government Department of of children being exposed to Survey (2010) undertaken by sionals to broach the subject. re­­­search highlights how women Health and supported by the alcohol before birth. the Australian Institute of Health Women Want to Know pro­ interpret­­ health messages and ACT Government under the Alcohol is a teratogen and and Welfare, found that one in vides online Continuing Pro­ the important role which health ACT Health Promotion Grants its consumption during preg­ five Australian women continue fessional­ Development (CPD) professionals,­­­ as a trusted source, Program.

August 2015 7 AMA President, A/Prof Brian Owler expressed his views on private health insurers and more at the National Press Club The following is an healthcare system. However, For the first time, we have a Personally, however, I find our support is predicated on the major insurer in the market – it offensive that a private insur­ edited version of the review not being aimed at cut­ with 29.1 per cent market share er would refuse to cover the AMA Federal President, ting the funding to health. While and coverage of 3.8 million peo­ costs of that patient and hospi­ Associate Professor it’s early days, we already have ple – where the primary respon­ tal in such a tragic event. If concerns about the direction of sibility of directors is to share­ someone thinks that a financial Brian Owler’s address the review and the need to holders. We know shareholders incentive will motivate doctors, to the National Press engage with experts, especially care about growing market share nurses or anyone else in a hos­ Club on 22 July 2015. our Colleges and Specialist So­ and increasing returns. pital to prevent maternal death cieties. Periodically, each private any more than they desire to “Twelve months ago, at my We agree with not paying hospital­­ group negotiates an do so now, then they have no first National Press Club address, for procedures that don’t work agreement with each private understanding of medicine or I outlined the strengths of our for certain indications, but we health insurer. The details are the people in it. health care system – the founda­ also need to ensure that we normally not disclosed, but the don’t deprive people of impor­ The Future for Our tions that make the Australian negotiations between insurers Healthcare System healthcare system one of the tant services. and funds appear to have be­ I want to now talk more gen­ best in the world. Indexation freeze come more aggressive. There I talked about universality, erally about where we should be The freeze on indexation of have been recent reports of a going with our healthcare sys­ equity of access, the sanctity of patients' Medicare rebates is dispute between Medibank the doctor–patient relationship, tem, and I want to make five key still Government policy. Private and the Calvary Health points. a balance between private and It is important that people group. As things stand, Medi­ public medicine, and the high understand that the Medicare ploy the practice nurse or invest bank Private patients will no First and foremost, it is time to level of training of those within rebate is the rebate to the patient in the equipment for their prac­ longer be fully covered for treat­ value health. the system, especially our doc­ and it is only in the case of bulk tice that helps them provide the ment in a Calvary Hospital. We need to recognise what tors. billing that the rebate goes patient with better health care. This is very concerning for our healthcare system means to I reminded our politicians, directly to the doctor. The freeze to indexation is patients in the ACT, Tasmania, us and our families, value those our doctors and healthcare The freeze is, once again, a a direct attack on general prac­ and South Australia, in particu­ working within it and recog­ workers, and our community proposal based purely on reduc­ tice. This is not AMA rhetoric. It lar, where Calvary Hospitals are nise the contributions that all that these foundations must be ing health expenditure, rather is what GPs all over the coun­ most prominent. healthcare workers make to the preserved and they cannot be than investing in the health of try are saying to the AMA and The dispute is wrapped in health care of all Australians. taken for granted. patients. The Government failed to their patients. the cloak of concerns for quality. Health is an essential ingre­ Since the 2014 budget, the to consider the consequences. Private health insurers Medibank Private has proposed dient to any economy; it’s essen­ AMA has fought to preserve For a long time, the Medi­ I am proud of many of the that they will not pay for treat­ tial to learning and to going to those foundations and seen off care rebate has been indexed in school. Health is essential for the worst elements of the 2014 features of private health insur­ ment in the instances of a num­ such a way that it has failed to ber of ‘preventable complica­ training and employment, and budget – the $7 GP co-pay­ keep pace with the value of the ance in this country. Patients with pre-existing conditions tions’. While the AMA does not to supporting a family. ment, changes to the Level A services provided, let alone the We need to see healthcare and Level B consults and the $5 cost of providing those services. have been able to join a health have any problem for refusing to fund and receive treatment, cover rare mistakes such as sur­ expenditure not as a waste, but cut to Medicare rebates. As wage costs increase and as an investment. However, the freeze on other practice costs increase – even for their pre-existing con­ gery on the wrong site, there are indexation of patients’ Medicare and we expect more from gen­ dition, after a waiting period of many other areas where compli­ Second, we need an rebates is still in place. eral practice – the costs of pro­ usually one year. Patients can­ cations will occur despite full overarching plan for health This year I want to talk viding services will be passed not be denied coverage. Comm­ preventative measures. care. about what we should be doing directly on to patients.­ unity rating ensures that patients The Medibank Private list What is the national strate­ to strengthen our healthcare While the Government por­ with significant medical condi­ includes 165 different ‘prevent­ gy for our healthcare system? A system and the first of these trays doctors as being only con­ tions continue to be covered. able’ clinical conditions or long-term, bipartisan National relates to the Government’s cerned about indexation in Without these measures, events. One of those is mater­ Health Strategy may be difficult review of the Medicare Ben­ terms of their incomes, this both our private and public nal death associated with child­ to achieve, but allowing our efits­ Schedule (MBS). argument is false. This is about systems would be in jeopardy. birth. Unfortunately, maternal healthcare system to meander The AMA welcomes the the viability of practices in The private health insurance death can and still does occur risks its future, and allows its opportunity­­ to ensure the MBS socially disadvantaged areas. It landscape changed last year with in a very small number of cases foundations to be undermined meets the needs of a modern is about whether they can em­ the float of Medibank Private. – as tragic as that is. piece by piece.

8 August 2015 AMA community residency program – a plan to train the A National Health Strategy The AMA is working with should guide our health poli­ private health insurers on ways next generation of family doctors cy, our decisions, and any that private health insurers can essary to meet future commu­ Background: future reform of the healthcare support our family doctors in The AMA is promoting system. It requires a commit­ nity demand. „„At the time of its the management of chronic its Community “Our plan sets out the des­ ment to engage with those conclusion, the PGPPP disease. Policies in health must Residency Program, a ign and funding principles that who work in the system, and funded 900 prevocational be re-orientated – they must plan to train the next would support opportunities placements in general political resolve from Federal for JMOs to undertake rota­ and State leaders. pivot to general practice. generation of family practice annually for JMOs. The fifth and final point is the tions of up to 13 weeks into The third point is efficiency. doctors. general practice, which would „„The PGPPP was a valuable importance of our public program for many reasons. Healthcare expenditure is help them to experience life as The Program, which is cur­ It supported efforts to not out of control and doctors hospitals. a GP and enhance their clini­ rently being examined by the deliver more training and have been working to make the People will always need cal ex­­p­erience. Government, was developed care in the community, healthcare system more efficient hospitals. Our public hospitals “A recent major study (Com­ following the scrapping of the supplementing the for decades, and have had re­ are far from meeting demand. ­­paring general practice and hos­ Prevocational General Practice traditional hospital-based markable success in doing so. We must continue to invest in pital rotations, http://onlineli- Placements Program (PGPPP) brary.wiley.com/doi/10.1111/ approach to medical However, there are ways our public hospital system. scheme in the 2014 Federal to reduce healthcare expendi­ tct.12224/pdf) shows clearly the training. Through careful Treasury estimates that $57 Budget. targeting, it also boosted ture without punitive meas­ AMA President, Professor educational value of a general billion will be taken out of our practice placement­­­ in compari­ access to GP services in ures, and without restricting public hospitals between 2017 Brian Owler, said today that the access for those people who son with hospital placements. rural and remote and 2025. This is a real cut from AMA Community Residency need it. Program would provide Junior “The study recommends communities. We need to be smarter at the funding commitments Medical Officers (JMOs) with that the expansion of prevoca­ „„The PGPPP gave JMOs a achieving efficiencies. Inte­ agreed­ to by the previous Fed­ opportunities to undertake im­ tional general practice place­ valuable insight into life as gration of our healthcare sys­ eral Government with the States. portant general practice prevo­ ments should be considered to a GP, and informed their tem, underpinned by informa­ The scale of the cuts is sig­ cational training in an effort to provide all junior doctors with career choice. the benefits of exposure to gen­ tion technology, is an obvious nificant and for the smaller encourage more young doctors „„The PGPPP also helped jurisdictions, the cuts will be to choose a career in general er­­­ alist­­ skills in the community. solution. Linking general prac­ “The AMA’s Community build an understanding of tices with each other, as well even more profound as they practice. how general practice “With the loss of the PGPPP, Residency Program is afforda­ as with hospitals and other struggle to manage the long- ble, and would be a very wor­ works, informing future healthcare workers, not only general practice is now the term healthcare needs of their only major medical specialty thy investment in our future practice in other specialty improves quality and safety, it community without a sufficient medical workforce,” Professor areas. With a deeper reduces waste and provides that does not offer JMOs the taxation base. opportunity of a prevocational Owler said. appreciation of the role of efficiencies. The funding of our public training experience,” Professor Details of the AMA Comm­ GPs, other specialists can Fourth, everyone knows that hospital system is not an argu­ Owler said. unity Residency Program for make better decisions the biggest challenge for our ment for the abstract. It is “You have to remember JMOs are available at https:// about patient care, and healthcare system is the about those in our society who that GPs must train for 10 to 15 ama.com.au/submission/com- work more closely with munity-residency-program their GP colleagues. growing burden of chronic are suffering, about those who years to become providers of disease. quality comprehensive care. are getting left behind. Investment in general “The AMA had serious con­ While I welcome the Prime cerns that the loss of the PGPPP practice is essential if we are Minister and Premiers’ discus­ going to keep people well and would see a decline in the gen­ sions about future funding of eral practice workforce, espe­ in the community and our health, this is the message that cially in rural and remote areas, family doctors are the corner­ at a time when community stone of chronic disease man­ I want to send to our leaders: Sort this mess out. Fund our need for GPs was growing. agement. They need to be “So we developed an alter­ supported to do this work public hospital system proper­ native GP training plan to en­ with investment, funding, and ly, and don’t keep leaving the sure Australia could keep pro­ resources. sick and the suffering behind.” ducing the GP workforce nec­

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August 2015 9 Opinion: Perioperative Medicine – Everything old is new again By Dr Bill Burke ping lattes for 3 hours and 59 ding on light on where we minutes before rushing out to should be paying more atten­ When my father returned to Sydney in the early 1950’s as a freshly minted clear the waiting room so they tion. It demonstrated that in a neurologist from a heady few years at Queen’s Square in London he was don’t get spanked. POM is in cohort of 4000 patients across advised in no uncertain terms that he would not make a living practising the process of becoming for­ Australia and New Zealand malised and if anything that over 70 having non-cardiac solely in neurology and he must do as all others before him had done. He should be taken as an overdue surgery 5% died within 30 was left in no doubt that almost by definition a physician was a “generalist recognition of its importance. days, 10% were admitted to The essence of the change with an interest”. Apart from family and horse racing, neurology was his Critical Care, 30% experienced centres on the identification of complications, many more which surgeries and patients great passion so he disregarded the proffered advice and over time built than one, and patients who are associated with most risk experienced one or more com­ for himself a large practice and a reputation to go with it. so appropriate measure can be taken before surgery as plications stayed a week long­ The 1980’s, the decade in was work coming my way from This has happened at least er in hospital. No doubt some which I started and finished my my surgical colleagues who partly as a consequence of the opposed to picking up the pieces afterwards along with factors integral to post-op physician training, is remem­ didn’t necessarily want to or “re-discovering” of general recovery are not easily remedi­ bered for many things. Big hair, feel competent to deal with the medicine­­­­ as a discipline and of course, prompt recognition and management of problems able such as age, frailty and Alan Bond and mostly bad inevitable post-op fluctuations the bel­­ ated­­ recognition of the nutritional parameters such as music spring to mind but medi­ in renal function, blood pres­ if they do arise post-op. The value of the generalist. Credit albumin levels but there will cally it was a decade that saw sure, blood sugar and electro­ must go to a number of indi­ REASON study into postopera­ be many patients with often the shift from general to sub­ lytes, chest and urine infec­ viduals who, over the past tive complications published multiple co-existing chronic specialty medicine at both a tions, DVT’s and PE’s, arrhyth­ decade and a half, have recog­ in Perioperative­ Medicine in micro and macro level. With mias etc. There were lots of nised this and championed the 2013 is one of a number shed­ medical conditions which are only a few notable and far- calls for help from colleagues revival of general medicine as sighted exceptions hospitals all at odd hours and all were wel­ a discipline in its own right over the country wound down comed. which has seen the re-opening their general medical units and I wasn’t the only one doing of a number of general medi­ physician training was very this of course. There were gen­ cal units and the formation of much sub-specialty based. erations of excellent physicians a collegiate representative in Locally the closure of RCH in like Frank Long, Bill Coupland the form of IMSANZ (The In­ 1991 was the catalyst for the and Brian Goldrick doing this ternal Medicine Society of new principal hospital to move well before I came on the Australia and New Zealand). to a subspecialty roster although scene and I was very grateful The RACP is now also firmly Calvary remains to this day a that they didn’t just tolerate­­­ but on board with accredited train­ general medical hospital al­ actively encouraged a newcom­ ing programmes in general though its subspecialty input er like myself. As they retired medicine now running in many centres. has grown by necessity with the work expanded and others Till relatively recently the the rapid growth of North have come to replace them and Canberra. perioperative part of general with the passage of time as When I returned to Canb­ medicine has been unstruc­ erra and put up my shingle in patients get older, their opera­ tured and ad hoc. While creep­ 1994 it was with an empty bank tions more complex and their ing over-regulation and over- balance and a growing list of list of co-morbidities and phar­ zealous accreditation require­ expenses that needed feeding maceutical interventions length­ ment are not always a good and clothing. Despite the fears ening, we are eventually seeing thing and the top down impo­ most of us have when starting the rise of a new branch of gen­ sition of “targets” and “KPIs” out eventually the work does ­­­­eral medicine generally now re­ can be more of a hindrance come, at times too much so, ­ferred to as Perioperative Medi­ than a help – are our ED doc­ but one of my early lifelines cine (POM). tors really sitting around sip­

AMA Staff Assist The Medical Benevolent – helping you get the right staff Association of NSW (MBANSW) for your practice Provides a free and confidential support service to Canberra This new fee-for-service initiative has been designed doctors in need and their family. Financial assistance and to assist AMA members recruit staff. counselling support are available to colleagues who have fallen For details on this service please contact on hard times through illness or untimely death. Support is Christine Brill on 6270 5419 also available to medical practitioners who may be experiencing or by email: [email protected] difficulties at work or in their personal relationships. The MBANSW is funded by your donations; please allow us to continue to provide support and assistance to your colleagues in need by making a donation to the Medical Benevolent Association Annual Appeal. Donations can be made visiting our website www.mbansw.org.au

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10 August 2015 Patients at risk of losing subsidy for dry eye syndrome open to optimisation to red­ Charles Gardiner Hospitals Nearly half a million glands­­­­­ and affects around 1 in ocular lubricants that are the uce post-op risk. and a Perioperative MSc degree Australians who suffer 200 Australians,­­­­ 90% of them mainstay treatment to relieve One thing we do not is available in the UK. wom­­ en.­­­­­­ dry eye syndrome for patients want to see is a turf war de­ dry eye syndrome Early diagnosis is impor­ with this condition is critical.” This area is as yet in its tant for preventing the more The exact cause of Sjogren’s veloping between those who infancy in Canberra. There is that makes eyes feel have the greatest stake in the serious complications of the syndrome is unknown but sci­ as far as I’m aware no dedi­ ‘gritty’ or ‘sandy’ are at area; i.e surgeons, physician, disease and RANZCO recom­ entists think it has to do with a anaesthetists and intensivists cated hospital based POM ser­ risk of losing a subsidy mends people with dry eyes combination of genetics and and by no means do we want vice in the ACT although I am for ocular lubricants, see an ophthalmologist regu­ infection with a virus or bacte­ in the process of convening a larly to check for damage. ria. The most frequent com­ to be another barrier between often referred to as Dr Elsie Chan from RANZCO plaint is a sensation of a foreign patients and their necessary working group of interested artificial tears. says diagnosis is determined by body in the eye, often described surgery, but elective surgery, parties at Calvary Hospital an eye examination and perfor­ as a gritty or sandy feeling. which is where most of this where it will be a good fit There are serious concerns mance of a Schirmer Test which Other symptoms include effort will be directed,­ is just with the hospital’s strong gen­ that the Commonwealth gov­ measures production of tears decreased tears, redness, a that. Almost always elective eral medical support base and ernment may remove ocular using a special paper strip burning sensation, light sensi­ operations­­­ can be delayed designated elective surgery lubricants from the Pharma­ placed under the lower eyelid. tivity, eye fatigue, itching and a while medical status is ass­ ceutical Benefits Scheme which “If Sjogren’s syndrome is sus­ “filmy” effect that interferes essed and optimised and this role. I have started a regular subsidises their cost. pected as a cause,” she explains, with vision. Sjogren’s syn­ must involve a co-op­erative pre-operative consulting ser­ The dry eye condition can “exploratory blood tests will drome is often undiagnosed or approach between the disci­ vice with a group of local seriously reduce quality of life also be performed.” misdiagnosed because symp­ plines involved. Even many Orthopaedic colleagues. I’m and the Royal Australian and Dr Chan noted that some toms may mimic those of men­ semi-urgent procedures such hoping this article will stimu­ New Zealand College of Op­­hth­ patients with Sjogren’s syn­ opause, drug side effects or as neck of femur fractures late some interest and discus­ ­almologists (RANZCO) believes drome are prescribed hourly inflammatory conditions such will allow a small window to treatments should remain­­ subsi­ lubricant drops. “Diagnosed as rheumatoid arthritis. While sion and give the process a bit dised. The condition, known as patients have lifelong symptoms most patients are diagnosed in att­­end to any acute medical of a kick along and I would issues.­ Sjogren’s syndrome, is an auto­ that require effective manage­ their late 40s, age is no barrier love to hear from anyone who immune disease with no current ment to prevent further eye and children can also suffer Knowledge and interest in wants to be part of the pro­ cure. The disorder attacks the complications and loss of vision. from it. The disease can affect this area is building. POM now body’s moisture-producing Universal access to affordable nearly all ethnic groups. has its own dedicated journal, cess. If we get it right our a summit on the subject is patients will be better off and planned for February next year we will have less of those late in the USA, and within Australia night “hey doc I need” some Monash Hospital has rebadged help calls. it’s Anaesthetic unit as the De­ p­artment of Anaesthesia and Dr Bill Burke, Respiratory Perioperative Medicine and and General Physician with fell­­owships in POM are offered an interest in Perioperative at Monash, The Alfred and Sir Medicine

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August 2015 11 New Border Force Act designed to intimidate doctors The AMA has repeatedly called on the Federal Government to amend the Border Force Act 2015 (the Act) to explicitly protect health workers and allow them to advocate on behalf of their patients. The AMA has also called for the establishment of an independent medical panel to oversee the health of asylum seekers in Australia’s care. The Act contains new laws the laws as being designed to under which doctors could face intimidate doctors against two years’ imprisonment for speaking out and they will speaking out about shortcom­ pose a serious ethical dilemma ings in the healthcare of asylum for doctors working in immi­ seekers. Since the announce­ gration. He has strongly made ment of the provisions of the the case that doctors should Act, doctors and medical stu­ never be stopped from speak­ dents across Australia have gone ing out about concerns they public to show they will remain have for their patients and this Pictures: Hamed Shahnam, Common Rounds outspoken advocates for all of law erodes the heart of this their patients – asylum seekers ethical responsibility. fulfilling our obligations of pro­ the medical professions’ ethical speaking out about the repre­ or otherwise. It appears that Section 48 of viding good healthcare to peo­ requirements in relation to the hensible conditions in Aust­ Assertions by Immigration the Act permits past or present ple in detention. The law will care of children and adults in ralia’s detention centres. Minister, Peter Dutton that the detention centre employees to restrict doctors in a way that is detention. Medical students recently Act would “not restrict anyone’s speak out about a serious threat entirely at odds with Australian Medical students have also marched from the Australian ability to raise genuine con­ to life. This requires doctors to codes of medical practice and rallied against the law, march­ National University to Parl­ia­ cerns about conditions in make judgments as to whether clinical standards. ing from the ANU to Parliament ment House, before heading to detention, should they wish to or not a threat to life or health The Federal Government House calling for an amend­ their university tutorials and do through appropriate chan­ is “serious” enough to warrant has responded to doctors’ con­ ment to the Act. The Australian hospital rotations. They called nels” have provided doctors no disclosure. They are then cerns by asserting that the Medical Students’ Association on the Federal Gov­ern­ment to comfort. required to defend their actions Australian Border Force would issued a release stating: amend this Act, which effec­ Anyone deemed an ‘entrust­ in court. Does the unwilling­ investigate leaks of “operation­ The Australian Medical tively gags doctors and other ed person’ under the Act can be ness to do so, through fear of Students’ Association (AMSA) is health professionals working­­ in jailed for two years for publicly ally sensitive” information, and the consequences, make a doc­ that “the public can be assured vehemently opposed to the detention centres." commenting on what they see Federal Government’s Border President of the Australian inside detention centres. There tor complicit through his or her that it will not prevent people silence? How does the Act from speaking out about condi­ Force Act 2015, which will see National­­­ University Medical Soc­­­ is a belief amongst health pro­ doctors face imprisonment for iety, Chris Wilder, said that med­ fessionals working within deten­ define “serious”? Many practi­ tions in immigration detention tion centres that the law would cal, ethical and clinical ques­ facilities”. serve to silence them from tions arise from the Act. More than 100 doctors in speaking out about the human The AMA, together with Victoria recently gathered to Canberra doctors rights abuses they see within other medical organisations, speak out against the Act and to to rally against the immigration detention. Psychi­ a­­ had called for an amendment challenge the ethical constraints Border Force Act! trist, Dr Louise Newman, an ard­ to the law which would explic­ it will impose on them. The eth­ WANTED ent advocate for improving the itly protect health workers and ical considerations which are so mental healthcare of asylum allow them to advocate on integrally a part of medical prac­ If you are interested in taking part in this Rally which will begin seekers, considers this to be behalf of their patients. There is tice may be alien to politicians, at AMA House in Barton and walk to Parliament House, could “unprecedented interference in little government transparency but they are mandatory for doc­ you please email Karen Fraser, Secretariat Manager on medical and clinical practice, in respect to the provision of tors – under the provisions of [email protected] with a political agenda”. healthcare in Australian-run the Australian specialty medical The date for the Rally will depend on the number of doctors AMA President, Associate detention centres. This affords colleges and AHPRA. The AMA willing to protest the legislation and their availability. Professor Brian Owler, views little reassurance that we are has a clear position in respect to

12 August 2015 Medical Women's ical­­­ students across the country­­ medical professional or not, to to treat asylum seekers inhum­­­­ feel strongly about the impact of contact their Member of Parl­ ane­­ly, and unfortunately the Opp­ Society members run the Act, with many walking to iament and tell them that this ­­­­­­­­­­­­osition is cowardly com­­­­­plying. Federal Parliament today to pro­ Bill is unacceptable, James said." “The Federal Government for charity ­test the draconian legislation. “Australia’s treatment of refu­ is attempting to blackmail doc­ The ACT medical “Medical students know gees and asylum seekers is an tors into silence by leveraging that today’s detainees will be utter disgrace, and stands in di­ their personal freedom against women and friends tomorrow’s patients. As Aust­ rect opposition to both the Uni­ their desire to ensure the well­ braved the elements to ralia’s future health practition­ versal Declaration of Hum­­ an­ being of their patients. run or walk for charity ers, we have a duty to speak Rights and basic human dec­­­­ency. “AMSA calls upon the Fed­ out on their behalf,” Chris said. “The Border Force Act 2015 eral Government to amend the at the recent Mother's Medical students Australia- goes a step further, pushing doc­ offensive regulations from the Day Fun Run. Border Force Act 2015 immedi­ wide will also be calling Mem­b­ tors to compromise their ethics It was probably the worst ers of Parliament to convey their and contravene the Declaration ately.” Doctors should be able to possible May weather with a Dr Catherine Drummond outrage regarding the Bord­­er of Geneva. how­­ling gale threatening to and Dr Sue Packer. Force Act 2015 and its implica­ “Our Government is institu­ speak out and subsequently in­­­ form the public – together put­ blow runners off the bridge. tions. tionalising cruelty against an The women have been joining ting pressure on politicians to act particular interest for women AMSA President, James Law­ already vulnerable population, the Fun Run for some years but and children. This year the ­­ler, said that to silence those and censoring those who would against the illness and suffering this year won a very handsome of the vulnerable people within plan is to circle the globe in committed­­ to the preservation criticise them for it. It is both trophy for largest comm­unity 80 minutes. Australia’s detention centres. and protection of human life is cruel and unfair to ask doctors team – with a team of 31 – all Games, prizes and food from abhorrent, and contradicts the to choose between imprison­ This is an edited version of an proudly displaying the new around the world. Come and very nature of the medical pro­ ment and the safety of their article which was published in MWS T-shirts. The team raised join us and compete next fession. patients. Medicus – the publication of for $3303 for Breast Cancer­­­­­­­­ re­ month on Friday 21st August “AMSA encourages all con­ “It is disgraceful how far the the AMA WA – in July 2015. search. at the Ainslie Football Club cerned Australians, whether a Gov­­ernment has gone in its quest Reprinted with permission The next MWS function is for fun and laughter. annual fund raiser for Members and non- members chosen smaller charities of all welcome.

AMA Career Assist – supporting you on your professional journey For professional advice on career options, preparing your application, CV development and presentation, contact your local support service.

Contact your AMA ACT for Careers Assistance. Phone 6270 5410.

2015 directory of medical specialists, allied health professionals and GPs with special interests

CANBERRA GPs GPs in SURROUNDING AREAS OF CANBERRA If you are a Canberra GP (or an AMA member who is GPs in the surrounding areas of NSW and who refer not a GP) and have not yet received your complimentary into Canberra, please call and sufficient copies for your copy of the 2015 directory, please contact the AMA (ACT) practice will be mailed. secretariat manager, Karen Fraser on 6270 5410. GP REGISTRARS If you are a GP registrar, please contact Karen and a copy will be mailed to you.

NOT INCLUDED IN THE ABOVE, BUT WOULD LIKE A COPY OF THE DIRECTORY? The directory is available for sale ($199) from the AMA (ACT) secretariat. Please call 6270 5410 to purchase your copy.

August 2015 13 Opinion: Announcement of a smoke-free ANU campus – it’s more than smoke and mirrors By Anna Habeck-Fardy sinuses, larynx, uterine cervix, The decision to go smoke- because cigarette filters When Australian ovary, urinary bladder, kidney, free may be deemed a utilitari­ (“butts”) are not readily ureter and bone marrow. an approach, in that the auton­ biodegradable, and are the National University As a future health practi­ omy of a minority group is single most common item (ANU) Vice-Chancellor tioner currently attending the essentially being challenged for collected each Clean Up Professor Ian Young ANU medical school to learn the beneficence and non-malef­ Australia Day. icence of the campus majority. announced on “World about the pathology, prognosis, As a non-smoker, it is admit­ management and prevention of (Although, ultimately for the tedly easy to write such com­ No Tobacco Day” (May these (and many other) condi­ beneficence of the smoking ments, and it would be incredi­ 31) that the campus tions, as well as the ethical, minority, too.) However, this bly naïve and remiss of me to legal and human rights princi­ arguably depends on the time­ expect all of the smokers of the would be smoke-free ples that will underpin every scale being considered. Longer- ANU to use the switch to a smoke-free workplace restric­ from July 20, 2015, it conversation that I will have term, the smokers on campus smoke-free environment to quit was not merely a with my future patients about who quit, or cut down their tions, legislation is more effec­ smoking. Yet, if even just one or tive in doing so. public relations these (and many other) condi­ smoking subsequent to their two staff or PhD students accept tions, I am able to appreciate workplace becoming smoke- the ANU-financed QUIT course Professor Young and the free, are perhaps exercising exercise. the implications of the ann­ offer, and succeed, in my opin­ university should be applaud­ their autonomy to do so … pos­ ouncement.­ Sir Richard Doll ion, the announcement has also ed for the announcement made Much of this pertains to the sibly with some prompting. fact that the announcement was and Bradford Hill writing in the been a success (this is of course on “World No Tobacco Day”. I British Medical Journal first Indeed, this announcement thank you for my own health; I coupled with an offer to finance provides a classic example of foregoing the obvious benefits reported the link between thank you on behalf of my staff and PhD students to attend public health promotion and for the non-smokers on cam­ QUIT courses that will be run smoking and lung cancer some pus). The literature suggests future colleagues for potential­ 65 years ago, yet smoking was prevention, in that switching to on campus by certified educa­ a smoke-free campus: more than one or two ANU ly reducing the number of dif­ tors from the ACT Cancer Coun­ still the major cause of cancer in workers would quit smoking, (i) will enable people to ficult conversations they have cil. Recognising that smoking is 2014. Despite the widespread however. A systematic review of with a patient about a tobacco- knowledge about the detrimen­ increase control over, and a part of our society, and that it 26 studies on the effects of related health condition; and I tal effects of tobacco smoking, improve, their health; smoke-free workplaces found is not easy for smokers to quit, thank you on behalf of the the addictive quality of nicotine (ii) serves as a primordial that they are associated with a the offer reflects that this em­ members of the community ployer is exercising a level of is mostly underestimated. Thus, prevention strategy by ~4% reduction in smoking prev­ duty of care to its workers. quitting tobacco smoking is a limiting exposure to alence, as well as a reduction in who now perhaps will never Tobacco smoke is the sin­ complex task: physically, physi­ tobacco, thereby potentially the cigarettes smoked per day have to present with a tobacco- gle largest modifiable risk fac­ ologically, mentally, emotionally discouraging non-smokers per continuing smoker. This related health problem. to start; and tor for a multitude of health and socially. indicates that smoke-free envi­ Anna Habeck-Fardy is a Given that tobacco smoke is ronments do encourage smokers conditions including, but not (iii) is also primary prevention Year 2 student at the ANU limited to, cancer of the lung, such a conspicuous and modifi­ by supporting smokers to to reduce consumption, or quit, oral cavity, pharynx, oesopha­ able risk factor, it is appropriate stop. There are also in addition to protecting non- Medical School gus, stomach, bowel, liver, pan­ to look at this through a lens of positive longer-term smokers from passive smoking.­­­­­­ References are available on creas, nasal cavity, paranas'al medical ethics. environmental ramifications, And compared to voluntary request from the author

14 August 2015 Beware of tax time scams Book Review – The ATO is reminding taxpayers to be wary Quarterly Essay 58, of scams this tax time as scammer’s ramp up 2015: Blood Year by their efforts to defraud David Kilcullen the public of their ISBN 9781863957328 personal information AUD$ 22.99 and money. Dr David Kilcullen’s During the 2014 calendar essay guides the year the ATO received in excess general reader through of 42 000 reports from the pub­ lic of email and phishing scams. the shifting sands of John Becker, Chief Infor­­ the last year and mation Security Officer at the Aust­ralian Taxation Office antecedents in the (ATO) highlights that scammers amorphous “War on can be very convincing and Terror”. trick people into handing over money, their Tax File Number A senior military advisor in (TFN) or personal information. counter-insurgency and coun­ “Their tricks include imper­ ter-terrorism, Kilcullen con­ needed to defeat such a con­ sonating ATO representatives tends that major strategic ventional force, such as an air on the phone or sending fraud­ errors were made in Iraq, dur­ campaign and ground troop ulent emails,” said Mr Becker. using their official contact registered by checking at ing the post-Gulf War stabilisa­ engagement. The concept that details to call them www.tpb.gov.au/ tion phase resulting in a the normative state role can be Key tips to protect yourself directly. Never use contact onlineregister (link is viciously sectarian failed state. assumed by the insurgent fol­ „„Never share personal details provided by the external). Whilst there was success in lows on from the arguments information, such as your about the new nature of con­ caller – find them through „„Never put your tax file “disaggregating” the original TFN, myGov or bank an independent source terrorist movements such as Al flict in his previous book “Out account details on social number (TFN) on your of the Mountains (2013).” In such as a phone book or resume. Only give it to Qaeda into regional splinters, media. online search. this led to expansion of these this context, Kilcullen observes your employer after you that we are living in an era of „„Change any passwords „„Always keep your have started your job. regional groupings into the you may have shared with Arabian peninsula and Africa. persistent conflict that requires computer security up to a comprehensive strategy not family or friends. date with anti-virus and John recommends that if In parallel, there was the phe­ you receive a call from the nomenon of self-radicalisation, delimited to global terrorism. „„If you receive an email or anti-spyware software and He concludes that solutions a good firewall. Only buy ATO and are concerned about via exposure of the disaffected phone call out of the blue providing your personal infor­ will require great coordinated from ‘the ATO’ claiming computer and anti-virus to new terrorist media. The mation over the phone, ask for rebellion in Syria during the political will at the level of that you are entitled to a software from a reputable nations: “Preserving and streng­ source. the caller’s name and phone Arab Spring served as a launch­ refund or asking you to them back through the ATO’s th­ening the political will of our confirm, update or disclose „„ ing point for the establishment Never send money or give switchboard on 13 28 69. societies, the will to continue the confidential details like your financial details to of terrorist forces which ex­ panded into Iraq, exploiting struggle, without giving in to a your tax file number, press someone you don’t trust – People can also forward horrific adversary, but also ‘delete’ or just hang up. it’s rare to recover money suspect scams to the sectarian divisions. The so-called Islamic State without surrendering our civil from a scammer. [email protected] „„Don’t open any of Iraq and Syria represents, liberties or betraying our ethics, attachments or click on „„If you think you have or call the ATO during according to Kilcullen, a state- is not an adjunct to the strategy any links or reply to these provided your account business hours on 1800 building structure which en­ – it is the strategy.” (p.87) 060 062 to discuss a emails. They may take you details to a scammer, gages as a conventional mili­ Reviewed by Associate to a bogus website or contact your bank or suspected scam. tary force rather than as a ter­ Professor Jeffrey Looi, contain a harmful virus. financial institution More information: Read more rorist grouping. Kilcullen arg­ Academic Unit of Psychiatry „„If you’re not sure whether immediately. tips on how to protect your ues that at least elements of and Addiction Medicine, ANU a call or email is a scam, „„If you use a tax agent, identity or how to protect your conventional warfare will be Medical School verify who they are by make sure they are information online.

Editorial: A/Prof Jeffrey Looi Christine Brill Dr Ian Pryor Ph 6270 5410 Fax 6273 0455 Ms Lara Whitbourne [email protected] A News Magazine Advertising: Typesetting: Ph 6270 5410, Fax 6273 0455 for all Doctors Design Graphix [email protected] Ph 0410 080 619 in the Canberra Region Articles: Editorial Committee: ISSN 13118X25 Copy is preferred by email to Dr Jo-Anne Benson Published by the Australian Medical Christine Brill [email protected] Association – Production Mngr in “Microsoft Word” or RTF format, (ACT) Limited Dr Ray Cook (not PDF) with graphics in TIFF, EPS or 42 Macquarie St Barton Dr James Cookman JPEG format. Next edition of Canberra (PO Box 560, Curtin ACT 2605) Dr John Donovan Doctor – September 2015.

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

August 2015 15 Dr Julie Kidd WOMEN’S HEALTH GP Hypnotherapist ON STRICKLAND Smoking, alcohol, binge-eating, stress, anxiety etc. Dr Peter Jones M.B.B.S.(Hons), F.R.A.C.P. Dr Liz Gallagher and Dr Omar Adham have now Canberra Complementary Health Practice Respiratory & Sleep introduced the MonaLisa Touch to their practice. Suite 4, Playoust Bldg, Hawker Pl, Hawker Physician MonaLisa Touch is an innovative 5 minute, 0425 300 233 | www.canberrahypnosis.com.au Specialist consultation service non-hormonal laser treatment that achieves lasting Home based sleep studies improvements for patients suffering from: AMA ACT membership (bulk billed) ~ Dyspareunia entitles you to access this In-lab sleep studies ~ Incontinence and Urinary Urgency Member Reward Partner (bulk billed) ~ Vaginal itchiness and burning Complex lung function testing ~ Dryness and loss of lubrication BELLUCI’S Bronchial provocation testing RESTAURANTS ~ Prolapse and laxity Bronchoscopy Ph: (02) 6282 1700 (Phillip) ~ Vaginal and vulval pain Ph: (02) 6239 7424 (Manuka) 3/18 Bentham Street, – Award winning, Yarralumla ACT 2600 For further information casual Italian dining. P: 6260 3663 F: 6260 3662 please call the practice on 02 6282 2033 Conditions may apply and you must produce your www.canberrasleep.com membership card to access these bene ts. or email [email protected]

AMA ACT membership AGEinG WELL entitles you to access this CLiniC Dr Sabari Saha Member Reward Partner MBBS (Hons), FRACP Dr Sue Richardson Geriatric Medicine Dr. A-J Collins MB BS FRACS Bond Hair Consultant Physician in religion Geriatric Medicine Physician Breast and Thyroid Surgeon Ph: (02) 6295 8073 Emphasis on Healthy Ageing l Comprehensive Geriatric Bond Hair Religion is committed to Other areas of interest: assessments Oncoplastic Breast Surgery – including: creativity and service. Let us listen and • Cognitive Impairment/Dementia l look after you. • Medication Management Falls assessments w Immediate breast reconstruction and Conditions may apply and you must produce your • Falls l membership card to access these benefits. Cognitive assessments breast reduction techniques Geriatric Medicine Comprehensive l Assessment & Management Reports Medication reviews w Breast Cancer surgery as well as Consultant Physician l Home visits & Residential w CANBERRA LASER AND Patient Treatment & Management Sentinel node biopsy Plans provided which can be incor- Aged Care Facility visits GYNAECOLOGY CENTRE porated into GP & Team Care Hospital admissions Thyroid and Parathyroid surgery Management Plans can be arranged Residential Aged Care Facility & Private colposcopy & laser Hospital Consultations provided. Bulk Billing available Veterans Welcome endoscopic surgery Address: Suite 3, Unit 10, suite 11/12, napier close, National Capital Private Hospital specialist gynaecology Brindabella Specialist Centre deakin act 2605 Dann Close, Garran ACT Phone: 02 6154 5031 Phone: 02 6222 6607 treatment of prolapse Fax: 02 6222 6663 and incontinence APPointMEntS 02 6285 1409 Fax: 02 6169 4437 Dr. P.M.V. Mutton MBBS, FRCOG, FRANZCOG Orthopaedic for prompt, personalised and Surgeon experienced care NEW PRACTICE LOCATION 6273 3102 39 GREY STREET DEAKIN ACT 2600 FAX 6273 3002

ARGYLE MEDICAL CENTRE - GOULBURN The dynamic group of doctors at the Argyle Medical Centre in Goulburn is Dr Wisam Ihsheish seeking graduates in general practice MBBS(Adel) FRACS (orth) to join them. Accepting new referrals in Argyle Medical Centre is an accredited and teaching practice Canberra and Goulburn located one hour from Canberra. If you are interested, please contact CANBERRA 5/5 Baratta St, Crace ACT 2911 Dr Ivan Wilden-Constantin on Ph 6109 0002 02 4821 1188 Fax 6109 0003 GOULBURN ELLESMERE SPECIALIST CENTRE 56-58 Cliff ord St, Goulburn NSW 2580 Ph 4823 0223 Fax 4822 5417

16 August 2015