medicFEBRUARY 2020 SAVOLUME 33 NUMBER 1

Feeling the burn GPs offer support and solace to fire-ravaged communities

Health sector prepares for AMA(SA) Culture and Bullying Summit Virus prompts calls for national response

STATE BUDGET PRIORITY LIST • REMEMBERING OUR FIRST FEMALE PRESIDENT INFECTIOUS SYPHILIS A RELIC NO MORE • JUNIOR DOCTOR’S BOTSWANAN ELECTIVE dr jones book online

Calvary Adelaide Hospital clinic Dr Jones & Partners is pleased to introduce our brand new clinic in the Calvary Adelaide Hospital (CAH). Located over two levels, this clinic is the largest private radiology clinic in SA. Purpose built to provide the best patient experience with separate patient journeys for inpatients, outpatients and ED patients, multiple comfortable wait areas and artwork that embraces the Adelaide CBD. The service offering reflects Calvary Adelaide Hospital that of the hospital with specialty foci on MSK, interventional, Cardiac and Neuro Level 2, 120 Angas Street, imaging as well as having capacity for 24/7 ED imaging and the broader imaging needs of General Practitioners. Adelaide

Adding CAH to our existing clinic network creates a concentration of six clinics and 1800 669 115 17 subspecialist Radiologists and Nuclear Medicine Physicians daily in and around Dr Nick Bajic the CBD. Imaging services have been carefully tailored to the needs of both CAH Clinic Director referrer and patient across all medical and surgical specialties. Gawler Health Service clinic Dr Jones & Partners is commited to delivering high-quality medical imaging services in regional South Australia. Gawler clinic 21 Hutchinson Road, Patients and refererrs from the northern Adelaide and Barossa region now benefit from new imaging services at the Gawler Health Service. Our contempory clinic Gawler East features all new state-of-the-art imaging equipment. This includes the latest 8505 1599 Siemens CT machine for dual energy, ultra-low dose scanning, faster imaging times, and spinal intervention (facet, foraminal and epidural injections). Dr Mitchell Raeside Gawler Clinic Director Latest Siemens CT machine • Ultrasound • Mammography • Low Dose Digital X-ray • Dental Imaging • Screening and Fluoroscopy • Bone Densitometry • MRI coming soon

Enquiries & Bookings: CRIC, 1800 875 290 For all enquiries & bookings GAWLER CLINIC X-RAY SUITE, CALVARYcall ADELAIDE 1800 HOSPITAL 875 CLINIC290 2 | medicSA Doctor Led • Patient Focused • Quality Driven drjones.com.au dr jones book online Contents

7 President’s report

8 Editor’s letter

9 Indigenous health card Calvary Adelaide Hospital clinic targets oral health 12 Bushfires: Country Dr Jones & Partners is pleased to introduce our brand new practices the missing link clinic in the Calvary Adelaide Hospital (CAH). in fire recovery efforts

Located over two levels, this clinic is the largest private radiology clinic in SA. 17 Celebrating our Australian Purpose built to provide the best patient experience with separate patient of the Year journeys for inpatients, outpatients and ED patients, multiple comfortable wait areas and artwork that embraces the Adelaide CBD. The service offering reflects Calvary Adelaide Hospital 18 Council news that of the hospital with specialty foci on MSK, interventional, Cardiac and Neuro Level 2, 120 Angas Street, imaging as well as having capacity for 24/7 ED imaging and the broader imaging 19 New year, new student needs of General Practitioners. Adelaide representatives on Council

Adding CAH to our existing clinic network creates a concentration of six clinics and 1800 669 115 20 Rural support heads 17 subspecialist Radiologists and Nuclear Medicine Physicians daily in and around AMA(SA) State Budget Dr Nick Bajic priorities the CBD. Imaging services have been carefully tailored to the needs of both CAH Clinic Director referrer and patient across all medical and surgical specialties. 23 Loud calls for more GP training Gawler Health Service clinic 24 Student news Dr Jones & Partners is commited to delivering high-quality 26 National concern over 12 syphilis outbreaks Gawler clinic medical imaging services in regional South Australia. ‘An unmitigated disaster’ 21 Hutchinson Road, 34 Reflection Patients and refererrs from the northern Adelaide and Barossa region now benefit Woodside GP Dr Hugh Allen watched as fire burned to his from new imaging services at the Gawler Health Service. Our contempory clinic Gawler East surgery’s back door and destroyed the homes and properties 36 Remembering a role model features all new state-of-the-art imaging equipment. This includes the latest 8505 1599 of long‑time patients. Siemens CT machine for dual energy, ultra-low dose scanning, faster imaging 38 Dispatches times, and spinal intervention (facet, foraminal and epidural injections). Dr Mitchell Raeside Gawler Clinic Director Latest Siemens CT machine • Ultrasound • Mammography • Low Dose Digital X-ray • Dental Imaging • Screening and Fluoroscopy • Bone Densitometry • MRI coming soon

Enquiries & Bookings: CRIC, 1800 875 290 For all enquiries & bookings GAWLER CLINIC X-RAY SUITE, CALVARYcall ADELAIDE 1800 HOSPITAL 875 CLINIC290 medicSA | 3 Doctor Led • Patient Focused • Quality Driven drjones.com.au Experts for your financial health.

Lisa Hickey+ Adrian Zoppa* Mark Mullins* Business Advisory Financial Planning Risk Insurance

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Hood Sweeney is a long term partner of the Australian Medical Association of South Australia providing accounting and financial planning services to their members. Our Health team understands the complexities of everything from setting up a medical practice – including IT and service fees – to selling it, along with personal financial planning, wealth protection, tax strategies and performance coaching. For a second opinion on the fiscal fitness of your practice or your personal finances, email our Health team on [email protected] or call 1300 764 200.

ACCOUNTING & BUSINESS ADVISORY CONSULTING & PERFORMANCE COACHING FINANCIAL PLANNING TECHNOLOGY SERVICES FINANCE +Lisa Hickey, Heang Lay and Trien Ly are Representatives of Hood Sweeney T 130 0 76 4 20 0 F 08 8232 1968 Accounting & Business Advisory AFSL 485569 [email protected] * Adrian Zoppa and Mark Mullins are Representatives of Hood Sweeney www.hoodsweeney.com.au Securities Pty Ltd AFSL No. 220897 4 | medicSA Australian Medical Association Experts for your (South Australia) Inc. AMA House, Level 2, 161 Ward Street, North Adelaide SA 5006 financial health. PO Box 134 North Adelaide SA 5006 Telephone: (08) 8361 0100 Facsimile: (08) 8267 5349 Email: [email protected] Website: www.amasa.org.au Executive contacts President Dr Chris Moy: [email protected] After hours: (08) 8361 0100 medicSA 11 14 Editorial Editor: Dr Philip Harding CLOSE CONTACT STRONG Managing Editor: Karen Phillips The AMA(SA) has been FOUNDATIONS Cover and bushfire images a major contributor to AMA(SA) Culture and Bullying Brett Sheridan, SA’s response to the Summit speaker Professor Blue Razoo COVID-19 virus. Michelle Tuckey targets Advertising organisational pressures. [email protected] Production Typeset and printed for the AMA(SA) by Lisa Hickey+ Adrian Zoppa* Mark Mullins* Douglas Press Pty Ltd. ISSN 1447-9255 (Print) Business Advisory Financial Planning Risk Insurance ISSN 2209-0096 (Digital) Unsolicited material Unsolicited editorial material should be sent to the AMA(SA) c/- the Managing Editor no later than six weeks before to the target month of distribution.

Disclaimer Neither the Australian Medical Association (South Australia) Inc nor any of its servants and Heang Lay+ Trien Ly+ Matt Book agents will have any liability in any way arising Accounting Accounting Technology Services 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 Hood Sweeney is a long term partner of the policy of the Australian Medical Association Australian Medical Association of South Australia (South Australia) unless this is so stated. providing accounting and financial planning Although all accepted advertising material is services to their members. expected to conform to ethical standards, such acceptance does not imply endorsement by the magazine. 28 32 Our Health team understands the complexities of everything from setting up a medical practice All matter in the magazine is covered by copyright, and must not be reproduced, SLEEPING BEAUTIES OUT OF AFRICA – including IT and service fees – to selling it, along stored in a retrieval system, or transmitted The fall in SIDS deaths is Former AMA(SA) Councillor with personal financial planning, wealth protection, in any form by electronic or mechanical a modern health success Dr Diana Hancock broadens tax strategies and performance coaching. means, photocopying, or recording, without story – or is it? her life view in Botswana. written permission. For a second opinion on the fiscal fitness of your Images are reproduced with permission practice or your personal finances, email our under limited license. Health team on [email protected] or call 1300 764 200.

ACCOUNTING & BUSINESS ADVISORY CONSULTING & PERFORMANCE COACHING FINANCIAL PLANNING TECHNOLOGY SERVICES FINANCE +Lisa Hickey, Heang Lay and Trien Ly are Representatives of Hood Sweeney T 130 0 76 4 20 0 F 08 8232 1968 Accounting & Business Advisory AFSL 485569 [email protected] * Adrian Zoppa and Mark Mullins are Representatives of Hood Sweeney www.hoodsweeney.com.au Securities Pty Ltd AFSL No. 220897 medicSA | 5 DRAFT

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Australian doctors at the frontline

s you read this, we will all holding onto these dreams and ideals, be two months into 2020 which I implored them to do. – a new year and a new These young doctors give me hope. decade. I have at times We must not let their spirits be broken Abeen accused of a tendency to being by a culture of bullying in health or, somewhat ‘passionate’ in entering the worse, to become indoctrinated into fray regarding matters which I think becoming bullies themselves. So, for me, are of importance – certainly this is the Culture and Bullying Summit we are President’s the criticism levelled by my children staging stands as an important moment report when I talk to them as a parent! But I to say ’this has to stop’, and also a time must say, events early this year have to begin initiatives to create a more been almost overwhelming. The first positive – perhaps even happy – culture Dr Chris Moy few weeks of 2020 have thrown at in the workplaces where we provide us unprecedented bushfires and the care to our patients. prospect of years of challenging efforts Working with SA Health, GPs and other towards recovery. A virus that, as I write health practitioners to respond to the this, is threatening to become a global coronavirus threat has also reaffirmed pandemic. And for more and more of us, my belief that when the going gets these events seem to be the very much tough, we really do try and put aside predicted health impacts of climate our differences for the common good. change. I wonder what can come next. It must be said, however, that the But amid chaos there is hope. As federated nature of the Australian government and the health system Christopher Reeve said, ‘Once you makes it more difficult to respond choose hope, anything’s possible’. effectively and efficiently as they could In January, as communities across to an outbreak such as the COVID-19 Australia were battling raging fires, virus. Despite the jurisdictions coming other Australians banded together as together to bring a level of coordination never before to raise funds, provide at a national level, individual states have goods and services, and to just turn up wasted energy on duplicated efforts. to give support. Doctors have been very much at the front line of this effort. Many of Putting aside our those of us with experience in mental differences health, general practice, burns recovery and other medical fields have found It now seems clear that a national ways to collaborate and support our Centre for Disease Control (CDC), which communities and our members who the AMA has been advocating for, would themselves have been directly affected have put the country in a better position by the fires. AMA(SA) member Dr Hugh to address the current outbreak early Allen tells his story in this issue; it shows – and this might make the difference not only that doctors so often become should we face a more virulent threat ‘the port in a storm’ in emergencies, in the future. but that this status could be the basis of But, in the end, I choose hope over longer-term recovery efforts. criticism and cynicism. It was good Also, in January, I met interns at enough for Christopher Reeve, and he Flinders Medical Centre embarking on was Superman; later, as a quadriplegic, ... As Christopher the first year of their medical careers. he raised millions for stem cell research They told me of their nervousness, and increased people’s awareness of Reeve said, ‘Once anxiety and fear – and their joy and spinal cord injuries around the world. you choose hope, excitement. Many are now beginning for As we move further into 2020 and the real the lives they have dreamed of since decade to come, his kind of hope is a anything’s possible’ ... childhood. The trick for them will be wonderful and precious thing.

medicSA | 7 REPORT

s I write this column on our national to 100 seconds to midnight, the closest day, there is good news and bad; and point to prediction of annihilation or AI’m not referring to the invasion near-annihilation of the human race since rallies as either. it was established in 1947. They relate this We must all be delighted at the prediction to the increasing incidence of appointment as 2020 Australian of the Year severe climate events – of which we are of our member Dr James Muecke, rather painfully aware in Australia at present – remarkably the second South Australian and to the proliferation of nuclear weapons. doctor in successive years to be accorded The existence of organisations such our nation’s highest honour. medicSA as International Physicians for the congratulates James, whose achievements Prevention of Nuclear War and Doctors and aspirations were featured in our for the Environment shows how we, as a Editor’s December issue, soon after he was named profession, have serious concerns about South Australian of the Year. We hope these matters. Doubtless there will still be letter this additional recognition and national some sceptics who talk about just another spotlight will help his campaign to raise hot summer or hailstorm. But no one can fail to be concerned about the increasing Dr Philip Harding awareness of, and prevent, diabetes-related and other forms of visual loss. number of countries, some with dubious Likewise, we pay tribute to the five moral compass or quality of leadership, colleagues whose contributions to our that already possess or are trying to develop profession and the community have been weapons of mass destruction. What we do recognised in the Australia Day awards, as as individuals I do not know, but it is at least detailed on page 17. cause for reflection. Well, that’s the yang; what about the yin? A coalition of respected scientists and global leaders recently announced the advancement of the Doomsday Clock

Among friends MA(SA) Councillors have capitalised on professional meetings and Asocial occasions including the President’s Breakfast and the Australian Chinese Medical Association Dinner to share the views of members with local and international officials. The contribution to the AMA(SA) of former Council Chair David Walsh was recognised at the February Council meeting. Dr Walsh’s artwork will be hung in AMA House.

The AMA(SA) will hang Dr David Walsh’s painting of an owl in recognition of his service as Chair of the AMA(SA) Council.

AMA(SA) President Dr Chris Moy (left) and Immediate Past President A/Prof William Tam (right) with Health and Wellbeing Minister Stephen Wade Ms Daniela Ciccarello of RACS Immediate Past President A/Prof William and Ms He Lanjing, Consul-General of the People’s and Mr Leigh McMahon Tam, former President Dr Janice Fletcher, Republic of China, at the Australian Chinese Medical of Hood Sweeney at the Dr Nick Vlachoulis and Minister Stephen Association Dinner on 8 February. President’s Breakfast. Wade at the President’s Breakfast.

8 | medicSA NEWS

AMA(SA) COUNCIL

Office Bearers President: Dr Chris Moy Vice President: Dr Michelle Atchison Immediate Past President Focus on oral health to A/Prof William Tam Ordinary Members avoid broader Indigenous Dr Daniel Byrne, Dr Matthew McConnell, Dr Penny Need, Dr Clair health concerns Pridmore, Dr Rajaram Ramadoss, Dr John Williams, Dr David Walsh Specialty Groups Simple policy changes promoted by the AMA will help Anaesthetists: Dr Simon Macklin Indigenous Australians improve their oral health. Dermatologists: Dr Patrick Walker Emergency Medicine: asily implemented, cost-effective ‘As a consequence, a significant Dr Thiruvenkatam Govindan policy changes could make proportion of the Indigenous population General Practitioners: a dramatic difference to the lives without regular dental care, which Dr Bridget Sawyer poor oral health of Indigenous has adverse outcomes for their health Obstetricians and Gynaecologists: EAustralians, according to the AMA’s and wellbeing. Dr Jane Zhang latest ‘Indigenous Health Report Card’. ‘Governments must ensure that Ophthalmologists: Dr Edward Greenrod Aboriginal people are twice as likely Aboriginal and Torres Strait Islander as non-Indigenous Australians to suffer people have access to affordable, Paediatricians: Dr Patrick Quinn from dental pain and are five times more culturally appropriate oral health Pathologists: Dr Shriram Nath likely to have missing teeth due to poor care programs.’ Physicians: Dr Andrew Russell The AMA suggests an increased focus access to dental care, fluoride and oral Psychiatrists: Dr Tarun Bastiampillai on value-based health care, particularly health promotion. preventative measures and culturally Public Health Doctors: The report card notes they are more appropriate oral health promotion. Dr Nimit Singhal likely to live in areas without fluoride The association is calling for a in the water, particularly in Queensland Surgeons: Dr Peter Subramaniam commitment to a national minimum where nearly half of the Aboriginal and Radiologists: Dr Jill Robinson standard of 90 per cent population Torres Strait Islander population does access to fluoridated water as a safe, Regional Representatives not have water fluoridation. effective and equitable way to reduce Northern: Dr Philip Gribble, AMA President Dr Tony Bartone says dental decay. Dr Simon Lockwood that as well as being fundamental to As well as a focus on oral health Doctors in Training Representative eating well and speaking without pain or promotion, the AMA is proposing a tax Dr Hannah Szewczyk embarrassment, oral health is important on sugar-sweetened beverages, to reduce to prevent illnesses such as rheumatic consumption in Australia which is Student Representatives heart disease and diabetes. among the highest in the world. University of Adelaide: He says Indigenous Australians, like The AMA’s Report Card cites five Mr Jack Rumbelow other low socio-economic groups, often action areas to improve the oral health of Flinders University: Ms Matilda Smale struggle to access dental care due to the Indigenous Australians: AMA(SA) Executive Board cost and fear of dental treatment. • fluoridated water supplies – especially ‘Poor oral health complicates and in Queensland Dr Michelle Atchison, contributes to other illnesses – illnesses • oral health promotion, particularly Mr Andrew Brown, Dr Guy Christie- that afflict Aboriginal and Torres Strait fluoride varnish programs and a tax Taylor, Dr Chris Moy, Dr John Nelson, Islander Australians at a far greater on sugar-sweetened beverages A/Prof William Tam rate than their non-Indigenous peers,’ • an effective dental workforce with Federal Councillors Dr Bartone says. greater participation of Aboriginal A/Prof William Tam (State Nominee) ‘Many Aboriginal and Torres Strait and Torres Strait Islander people Islander people often rely on public • better coordination and reduced Dr Chris Moy (Area Nominee SA/NT) oral health services – where they institutional racism in oral Dr Matthew McConnell (Specialty exist … however, these services can health care Group Nominee: Physicians) be unsustainable to due to piecemeal, • data to know that programs make arbitrary and short-term funding. a difference.

medicSA | 9 Supported by:

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AMA calls for central AMA INSURANCE BROKERS disease body

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However, AMA(SA) President Dr Chris Moy says been able to get away with this only he says, a national centre could manage the Federal and state communicable because the disease has primarily future threats in a more coordinated health authorities has worked closely affected our already marginalised and effective way. with the AMA and other groups after Indigenous communities. 3 ways we can help you during a claim ‘A National Centre for Disease Control news of the outbreak reached beyond ‘Australia needs a National CDC for (CDC) would help ensure that everyone's China, to issue up-to-date information conditions such as syphilis and to be on the same page, and everyone has and develop responses and advice. better prepared for the next serious a real understanding of the networks ‘I saw first-hand the practical barriers virulent viral outbreak, so responses can Expert Advice required to deal with any threats,’ to getting everyone on the same page be fast, decisive, better coordinated and Dr Bartone says. to work together – such as to develop reduce duplication of efforts.’ Our advice doesn’t stop once we’ve arranged your insurance policy. messaging to all front-line health ‘We are the only country in the While he says Australia is behind other OECD that doesn't have such an entity.’ staff expected to face a large number We can give you advice throughout the claims process and can advocate on nations in not having a national centre Expert He says the management of of potentially infectious patients,’ your behalf with insurance companies for no extra charge. for disease control, Dr Moy says Australia recent ‘scares’ had improved the way Dr Moy says. advice is a world leader in the race to develop information is gathered and shared ‘At this stage, the effort seems have better testing and a vaccine for COVID-19 across Australia. 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Dr Moy says the outcomes syphilis outbreak in be carried out by a national CDC in central and northern coordinating advice to doctors about Australia (discussed on appropriate reporting and management page 27) is an example of suspected cases, and to outline Free call 1800 262 287 or visit amainsurance.com.au of the ‘appalling’ appropriate steps for patients who may failures caused by have been exposed to the virus. In preparing this information, Amacis Pty Ltd T/As AMA Insurance Brokers is not providing advice. It has been prepared without taking into account your personal objectives, financial situation or needs. Accordingly it is important that you read the Product Disclosure Statement (PDS) of the actual provider carefully, and ensure that the PDS and the exclusions are appropriate for your business and personal needs. AMA Insurance Brokers ABN 40 064 488 106 AFSL No 235312. medicSA | 11 ADVOCACY

Country practices the missing link in fire recovery efforts

As a Woodside GP, Dr Hugh Allen watched as fire reached his practice’s back door in January. Now he suggests practices such as his should become the hub of health and community recovery services.

Burned landscape near Woodside, and (top right GP Dr Hugh Allen

ust as the Woodside Country been a string of patients coming in for Dr Allen has watched as services Practice was almost on the front five minutes and staying for 30 as they have been slow in coming to the people line of the Cudlee Creek Fire, it has tell their stories. The appointment book of Woodside. Crisis support – though been at the frontline of the is peppered with notes: Patient A, lost welcome – seems poorly coordinated Jcommunity recovery, providing house; Patient B, lost farm. They arrive and many struggle to access funding a salve for everything from burns to to share stories with practice staff who and services spread across the public broken hearts and dreams. have their own tales of shock, tragedy and private sector and non-government Situated in the heart of Woodside in and loss. organisations. People who have paid the Adelaide Hills, the practice closed on ‘We saw many burns patients insurance premiums for decades are 20 December 2019 and diverted patients who would normally have gone to confronting barriers in accessing to Mount Barker, as the town braced the hospital, and we even ran out of payouts. He’s aware of the increasing for catastrophic fire conditions. Flames dressings. They were tough Hills people anger in the community, along with burned almost to the clinic’s back and they refused to go to hospital. They a realisation of the long and painful door. Yet only a day later, the Woodside wanted to be out doing what needed reality of having been left with nothing Country Practice opened its doors to to be done – euthanasing their injured but the clothes they left home with on a community desperately in need of animals and fixing fences and things that haunting, hot and windy Friday physical and mental help. like that. We patched them up and sent in December. For Dr Hugh Allen, originally from them back out there.’ ‘They [fire victims] have no idea where Ireland but an Adelaide Hills local now Two months after the fire, many to start,’ he says. ‘They are literally after 22 years in the area, the scale of patients are walking in with various starting from the ground up. Their bank the Cudlee Creek fire has reinforced the levels of post-traumatic stress disorder details and scripts are gone, and many importance of community connections, (PTSD), and will continue to do so for a do not know how to access services.’ and of the role of GPs in managing long time to come. Dr Allen says GPs have the knowledge those connections. Dr Allen says he ‘We are seeing some very anxious and networks to become ‘recovery hubs’; quickly recognised that the practice people. Many of them are experiencing that his practice is ‘a natural place for would become a natural meeting place something like the stages of grief,’ people to come at a time like this’. for people to gather and tell their tales Dr Allen says. ‘People I’ve known ‘We’ve been helping people find their of tragedy and relief; to be ‘patched up’ for 22 years have lost everything – way and to make decisions about the with burns dressings before heading the fire would have burnt mine too next steps,’ he says. ‘We are in the heart out again to fight fires and clear if the wind had been blowing in a of the town. People would just come their properties and those of friends different direction. in and talk. It was good just to listen. and neighbours. ‘The vast majority of people hit are And we could put them in touch with It would make sense, he suggests, in their 70s – the second and third services – we are next door to a real for surgeries such as his to become the generations, who have lived in those estate agent, for example, organising links between crisis services for people houses all their lives,’ Dr Allen says. ‘It’s counselling, re‑writing scripts. affected by the recent bushfires. an unmitigated disaster for them. Many ‘There needs to be some kind He says he is treating many people will seek assisted accommodation, and of centralised aspect to the relief who have ‘literally lost everything’ in the many will leave their area, which is very operations, and it makes sense that

fires. Since the Cudlee Creek fire, there’s difficult at their stage of life.’ general practitioners help in that.’ © Blue Razoo

12 | medicSA Warning signs for AMA campaigns survivors and first for GP support MA efforts during the responders summer’s bushfire Aemergencies have ensured Australian doctors will be better Doctors should be on the lookout for signs of equipped to deal with future mental‑health impacts of the bushfires, says bushfire emergencies. Better protocols to deal with AMA(SA) Vice‑President Dr Michelle Atchison. emergency services and more resources to help with the ongoing mental and physical impacts of natural MA(SA) Vice-President • P ersistent thoughts or nightmares and other emergencies are being Dr Michelle Atchison says about what they have experienced. developed, thanks to the AMA’s efforts doctors should be aware This is normal in the first weeks since mid-December. of the warning signs that after a terrible event, but if it is still AMA President Dr Tony Bartone Aa mental health problem may have happening two months later should has raised concerns with Health developed through exposure to the be considered a ‘red flag’. Minister Greg Hunt about ongoing recent bushfires. • P ersistently depressed mood or a air quality hazards following the fires, ‘Whether it is in our patients who loss of interest in things that used the ongoing mental health impacts have been affected by loss in the to be enjoyed. This usually presents for patients and doctors in fire- bushfire, or in patients who were as a lack of motivation, finding affected areas, and the need for new first responders, we should be aware it harder to engage in life and emergency management protocols and look for the warning signs,’ says relationships and a general sense of to allow doctors to be involved in Dr Atchison, a psychiatrist with a fatigue. Physical complaints such crisis responses. special interest in helping survivors of as breathlessness, chest pain or ‘The AMA has been extensively major trauma. generalised pain are common. engaged in responding to both ‘Right now, most people who have • Ex cessive reliance on drugs, our patients and the wider public’s been directly affected by the bushfires including alcohol, to self-medicate concerns about the impact of will be feeling distressed,’ she says. ‘But anxiety or depression. Another hazardous air on individual and not everyone who is distressed during particular form of self-medication population health over the last couple and immediately after an event such of months,” Dr Bartone says. that is easier to ‘hide’ is gambling. as this goes on to have a mental health He says general practitioners Dr Atchison says there will be mental problem that requires specific attention. treating people in fire-ravaged areas health services made available over ‘In fact, many people use this as have seen first-hand how people have coming months – but those most in a period of growth and show their been affected physically and mentally need of them may not be ready or able resilience to stress.’ by ongoing exposure to hazardous air. She says doctors should watch for to access them. While some areas of South Australia signals of mental health problems ‘Many of those affected by the had suffered air pollution, the eastern among their patients, including: bushfires are people who view states have suffered prolonged smoke • A change in sleep patterns, themselves as strong and independent, hazard, with Canberra experiencing particularly trouble getting off to sleep and the thought of going to counselling air quality 22 times worse than the and wakefulness during the night. or having medication is likely to be hazardous rating. This is usually a sign of heightened difficult for them,’ she says. ‘The risks Help is available to doctors anxiety, so that it is harder to relax at of not treating are high, so please affected by the crisis who need night and people come awake more encourage those you identify at risk to support for their own health and

© Blue Razoo fully between sleep cycles. have the help they deserve.’ wellbeing through DRS4DRS.

medicSA | 13 ADVOCACY

‘Change systems to eliminate bullying’ The AMA(SA) Culture and Bullying Summit’s keynote speaker has found systems, not people, are the basis of most workplace bullying.

risk audit tool designed and are not unique in having bullying and tested at the University of South harassment issues. AAustralia is now being used When she joined UniSA in 2005, Dr around the world to identify and rectify Tuckey’s focus was work and well-being. the causes of workplace bullying. She became interested in workplace Professor Michelle Tuckey Professor Michelle Tuckey of the bullying and the stress that bullying University of South Australia’s Centre for generates, which led to more targeted Six further studies have finetuned the Workplace Excellence has developed the questions about the risk management original results. Professor Tuckey and tool after years of increasingly targeted of bullying: how can organisations her team have also demonstrated the research into the factors that cause improve their culture and results if extent to which bullying does corrode bullying in workplaces as diverse as they identify and remove bullying from culture and performance in a wide range large and small businesses, community their workplaces through systematic of industries and workplaces. It led to service organisations, health workplaces risk controls? the development of a ‘risk audit tool’ and correctional services facilities. It was a question few were asking; now being used around the world. She says every workplace has a unique even now, few academics around the The online risk audit tool identifies mix of the factors that can lead to world are exploring it. ‘Bullying is the social and organisational factors that stress and other issues that directly or clearly erosive to health and well-being – employees identify as being present in indirectly cause bullying. But, she says, I wanted to uncover something new that their workplace. It highlights hot spots it is almost always workplace systems, could change what we can do about it,’ for bullying, stress, and other threats to structures and processes that are she says. the mental health of workers, providing the root causes. An examination of 342 complaints guidance for solutions customised to ‘Other approaches – such as bullying lodged with SafeWorkSA from a that workplace, unit and team. awareness training and complaints variety of workplaces and sectors ‘The tool pinpoints where risk investigation – focus on the bullying generated about 5,500 pages of data. control interventions can be behaviour because that’s what’s visible. The analysis provided new evidence of introduced to support their workers’ But that’s just the tip of the iceberg. the structures and processes that lead mental health and wellbeing and My approach is to rectify what’s at the people to feel they have been bullied in build a mentally healthy workplace,’ bottom of the iceberg,’ she says. their workplaces. Professor Tuckey says. ‘For example, Professor Tuckey is the keynote ‘We identified how bullying manifests in our validation work we showed speaker at the AMA(SA) Culture and through the way work is designed,’ that the risk assessment tool can Bullying Summit on 29 February. Her Professor Tuckey says. ‘By discovering discriminate between high-, medium- presentation will demonstrate that what the risk factors are, we can focus and low-risk hospital wards, based on hospitals and other health workplaces on them and introduce solutions.’ independent outcome data.

The Risk Audit Tool assesses 10 groups of factors • Working hours, rostering and • Training and professional • Tasks and workload – how scheduling – how work shifts are development – identification work resources are managed, and rostered and how hours of work of staff training needs, and the tasks and workloads are allocated are assigned provision of learning, coaching and and coordinated • Leave and entitlements – how mentoring opportunities • Maintaining a safe working employee leave and breaks are • Appraising and rewarding job environment – what activities are allocated and managed performance – how performance is present or available to assess and • Job roles – the assignment of evaluated and how employees receive manage physical safety hazards employee job roles and the clarity of feedback, recognition and rewards • Interpersonal and team information about job descriptions, • Promoting mental health and relationships – how employees are responsibilities and expectations wellbeing – what activities are present treated individually and coordinated in • Under-performance – how issues or available to promote and protect the work unit, through communication, of employee under-performance workers’ mental health and wellbeing, participatory decision-making, and are addressed and to reduce risks to mental health personal concern and support

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‘What we see is that the risk breeding ground for stress,’ Professor they’re structured, with not enough assessment tool provides a good Tuckey says. resources, with hierarchy and the overview of the risks. And it ‘But we work with people to find tension between aiming for optimal resonates with staff – they get it. The the right solutions. Some can start patient safety and the health and intervention process involves staff and the very next week – for example, it wellbeing of people in the workforce – management at all levels, with everyone may be changing the way information that make them among the workplaces working together on solutions. That is managed and shared. Other with the highest risk of it occurring.’ actions may take a year or more – Professor Tuckey says the introduction collaboration is very powerful. Everyone such as changing the management of a new governance structure – such as has a voice, and it gives everyone hope.’ structure or establishing leadership the new Local Health Network boards Eventually, she says, ‘we can get to a development programs.’ introduced in South Australia last set of actions that changes the way the Now, Professor Tuckey is being year – provides an ideal opportunity workplace functions, reduces stress, and approached by businesses and for change. She says the evidence limits the possibility of bullying’. governments around the world shows that monitoring and evaluating ‘There are identifiable types of interested in her audit tool. risk factors, and having performance workplaces where it is likely to happen ‘We find bullying everywhere,’ on such indicators included in board – places where their systems, design Professor Tuckey says. ‘But there are evaluations, helps drive meaningful and pressures have been shown to be a things about health systems – the way change in bullying prevention.

her research findings that the root Solutions needed to stop causes of workplace bullying are often organisational structure and systemic bullying process issues. He says doctors forced to work in The AMA(SA) Culture and Bullying Summit aims to address environments where bullying is not the many impacts of bullying on doctors and patients. ‘called out’ are likely to suffer stress and other mental health effects that influence their capacity to provide he impacts of bullying in health and harassment are issues that must best-quality care. workplaces on doctors and be addressed. ‘This Summit has attracted health practitioners, and the Minister Wade and representatives T representatives from across the health measurable effect on their capacity to of Doctors Health SA, the AMA(SA) sector,’ he says. ‘We all know things care for their patients, will be a major Doctors in Training Committee, have to change, and we all want to focus of the AMA(SA) Culture and the Royal Australasian College of Bullying Summit on 29 February. Surgeons, and the Health Consumers identify and be part of solutions that AMA(SA) President Dr Chris Moy Alliance of SA are among speakers and recognise the variety of triggers and says Health and Wellbeing Minister panellists at the Summit, to be staged experiences in different workplaces.’ Stephen Wade’s agreement to speak at the University of Adelaide. A report with recommendations for at the Summit demonstrates the Dr Moy says keynote speaker action will be submitted to Minister sector-wide recognition that bullying Professor Michelle Tuckey will discuss Wade after the summit.

PAEDIATRIC UROLOGIST PAEDIATRIC GENERAL SURGEON

North Adelaide | Stirling | Mount Barker North Adelaide | Stirling | Mount Barker

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medicSA | 15 sportsmed’s Dr Justin Alexander Shoulder, Elbow, Wrist and Hand Surgeon and GP Dr Marco Gleeson Pro Health Care Kidman Park continuity of care is quality care

We understand how important it is to build relationships with GPs to understand a patient’s At sportsmed, our world- individual needs and medical history. It is critical class team of orthopaedic for us to be part of an effective transition for surgeons specialise in the assessment, treatment and patients from GP referral through to aftercare recovery of orthopaedic, communication. sporting, musculoskeletal and arthritic injuries and conditions, That’s why we are committed As the primary practitioner we’re including bone and joint care. to a collaborative approach that here to support and educate you Our sub-specialists are highly creates a superior experience for to provide the best patient care trained in a range of techniques the patient. and experience. Please call our from minimally invasive, exclusive GP hotline for advice arthroscopic procedures Our surgeons understand the and urgent referrals. to joint replacements and need for setting patient treatment reconstructions for surgery goals and the importance of Upper Limb GP hotline of the hip, knee, foot, ankle, effective communication back 8130 1122 shoulder, elbow, wrist and hand. to the local GP for their overall Lower Limb GP hotline healthcare management. 8130 1111

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www.sportsmed.com.au16 | medicSA | T 08 8362 7788 South Australians earn national accolades

Australian of the Year Dr James Muecke heads the list of South Australian doctors recognised in the 2020 Australia Day Honours List. sportsmed’s Dr Justin Alexander he Australian Medical and again when announced as Shoulder, Elbow, Wrist and Hand Surgeon and GP Dr Marco Gleeson Association was pleased Australian of the Year, James promised Pro Health Care Kidman Park to congratulate long-time to use his time in the spotlight to shed member Dr James Muecke AM light on the growing threat of diabetes Tof Norwood when he was named and its impacts. Australian of the Year last month. ‘The AMA(SA) Council and our Ophthalmologist Dr Muecke members will help James however we has spent his medical career can to spread the word about how the fighting blindness in Australia scourge of diabetes, which now affects and internationally, and is a strong more than one million Australians, continuity of care campaigner to raise awareness of can lead to a terrible loss of sight.’ type 2 diabetes, a leading cause of Dr Newnham is a world-renowned Dr James Muecke blindness in adults. obstetrics specialist who has made is quality care Dr Muecke was one of a number Western Australia a global centre for of medical practitioners honoured research and clinical excellence in in the Australia Day Honours list, pregnancy and life before birth. His including Senior Australian of the Year research has unravelled many of the Dr John Newnham of Perth. We understand how important it is to build mysteries of life before birth, how Dr Muecke was recognised for his health and disease throughout our relationships with GPs to understand a patient’s At sportsmed, our world- work in founding the Vision Myanmar lifespan may result from pre-birth Program, a $1 million initiative of individual needs and medical history. It is critical class team of orthopaedic events, and how common illnesses the South Australian Institute of surgeons specialise in the and disabilities can be prevented for us to be part of an effective transition for Ophthalmology, which developed assessment, treatment and during pregnancy. and operated health and blindness In South Australia, Dr Edward patients from GP referral through to aftercare recovery of orthopaedic, projects in Myanmar. received sporting, musculoskeletal and He also co-founded Sight for All, (Ted) Tuckseng Mah communication. the Public Service Medal (PSM) for arthritic injuries and conditions, which raises funds to treat and prevent outstanding public service to public blindness in low-income nations. That’s why we are committed As the primary practitioner we’re including bone and joint care. health in South Australia for more Dr Muecke donates more than 40 to a collaborative approach that here to support and educate you Our sub-specialists are highly hours of his time and expertise each than 25 years. Dr Mah was a faculty creates a superior experience for to provide the best patient care trained in a range of techniques week to Sight for All. member in Flinders University’s the patient. and experience. Please call our from minimally invasive, Dr Moy congratulated Dr Muecke, College of Medicine and Public Health exclusive GP hotline for advice arthroscopic procedures along with all AMA members and and in 2019 he received the AMA(SA) Award for Outstanding Service in Our surgeons understand the and urgent referrals. to joint replacements and other medical practitioners, for awards he said recognised the care Medicine for his tireless work in need for setting patient treatment reconstructions for surgery Professor Ted Mah and services many doctors provided teaching research in and the practice goals and the importance of Upper Limb GP hotline of the hip, knee, foot, ankle, ‘above and beyond’ for patients and of orthopaedic surgery. effective communication back 8130 1122 shoulder, elbow, wrist and hand. communities at home and around Dr Walter John Russell OAM labelling and colour‑coding is now to the local GP for their overall Lower Limb GP hotline the world. is a life member of the AMA(SA). included in international requirements. healthcare management. 8130 1111 ‘James is a dedicated doctor who has He was a long-serving member of Other South Australian medical shared his knowledge and expertise to the anaesthetics department at the practitioners honoured in this year’s list help patients, doctors and students,’ Royal Adelaide Hospital, recognised include endocrinologist and medical Dr Moy said. for his research into the causes educator Dr Sanghamitra Guha AM, ‘He is a role model in demonstrating and prevention of hypersensitivity Quorn GP Dr Anthony Lian-Lloyd Stepney Healthcare Hub • Blackwood • Morphett Vale • Victor Harbor that many of us have opportunities to reactions to anaesthetics. OAM, gynaecologist Dr Ken Rollond Goolwa • Mt Barker • Salisbury Plain • St Agnes • Darwin do more and give more. During his career, Dr Russell OAM, Wakefield Orthopaedic Clinic Broken Hill • Mt Gambier • Mildura ‘Immediately upon being named became known as a bioengineer orthopaedic consultant Dr David South Australia’s nominee as as well as an anaesthetist. His Marshall OAM, and cardiologist Australian of the Year in November, development of anaesthetic syringe Dr Sadanand Limaye OAM. www.sportsmed.com.au | T 08 8362 7788 medicSA | 17 COUNCIL NEWS

AMA(SA) and it is to be hung as a mark of appreciation for Dr Walsh’s years of service as Chair. Dr Moy urged Councillors to attend the AMA(SA) Culture and Bullying Summit to be staged on 29 February. AMA(SA) Vice-President and new Doctors in Training (DiT) Council Chair Dr Michelle Atchison and representative Dr Hannah Szewczyk said President Dr Chris Moy thanked Dr David she will discuss the results of the DiTs’ Walsh for his service as Chair, at the Dr Shriram Nath February meeting. Councillor South Australian Hospital Health Check at the Summit, and pointed out that floods that affected 75 per cent of the recently released AMA data will provide Port Lincoln Hospital. AMA(SA) Council Meeting a national perspective on the issue. The looming threat of COVID-19 was February 2020 Councillors highlighted the impact a timely issue, as was the important of the bushfires that have devastated role of the AMA in South Australia so much of Australia over the summer and elsewhere in developing and on doctors, patients and communities. disseminating factual, practical he AMA(SA) Council starts the It was suggested that practical and advice to doctors and patients. Dr year with a new Chair. sustainable measures to embed the Moy said Health and Wellbeing T Vice-President Dr Michelle climate effects of health into public Minister Stephen Wade and senior Atchison was elected unopposed policy are the most effective approach– SA Health officials had relied on the into the position made vacant when and that the AMA is a solution-based AMA(SA) for support and guidance. Dr David Walsh resigned as Chair. group that can (and should) lead the Councillors expressed significant Dr Walsh’s period will be remembered discussion, because of the links between concern that the rural GP training for many reasons – not least his painting climate change and health. positions, along with the generalist of an owl, Are You Looking At Me?, How the AMA(SA) can best program, did not attract enough which AMA(SA) President Dr Chris Moy support medical practitioners in candidates. Dr Moy reinforced the work bought as a mark of respect and thanks bushfire-affected areas was discussed. the AMA is doing locally and nationally at the recent Royal Australian College The rollercoaster nature of the season’s to advocate for increased resourcing for of Surgeons (RACS) Charity Dinner. weather was highlighted when health in rural areas, and to improve the Dr Moy has donated the painting to the discussion of the fires turned to the image and appeal of rural practice.

ASHFORD MedicSA_Half Page Ad [174x120mm] Jan2020_210120-2.indd 1 30/01/2020 10:01:41 AM 18 | medicSA ADVOCACY

Changing of the guard

MA(SA) President Dr Chris Moy took an opportunity in the holiday season to thank the AMA(SA) Council’s 2019 student representatives for their contributions Aduring a busy year. Dr Diana Hancock and Patrick Kennewell represented Flinders and Adelaide universities respectively. New Councillors Jack Rumbelow (far left) and Matilda Smale ‘During their 12 months on Council, Diana and Patrick (far right) with CEO Dr Samantha Mead, Dr Chris Moy, participated in important discussions and decisions about Dr Diana Hancock and Patrick Kennewell issues ranging from abortion law reform to end-of-life care legislation, from how we should advise the South Australian Government about planning the new Women’s and Children’s Hospital to ensuring our rural colleagues receive the funding and support they need,’ Dr Moy said. ‘It is critical that our Council represents the diverse Join friends, colleagues and the groups within our membership and within the medical profession. I hope Patrick and Diana have also benefited wider medical fraternity at the from the experience, and that we can look forward to 2020 AMA(SA) Gala Dinner at them continuing to bring their knowledge and experience the Adelaide Convention Centre to the AMA(SA).’ on 23 May. The Council welcomed its new student members, For bookings or queries, Matilda Smale from Flinders University and the University please contact Rebecca Hayward of Adelaide’s Jack Rumbelow, at its first 2020 meeting on 8361 0108 or at on 6 February. [email protected]

medicSA | 19 ADVOCACY

AMA(SA) submits big ‑ticket items for State Budget

Rural health is among the items the AMA(SA) has identified as needing a large injection of funds in the 2020-21 Budget.

he AMA(SA) has reinforced who form the to the State Government that core of the rural increased funding for rural medical workforce. and regional health staff The 10 issues Tand services, and for mental health of most concern services, is urgently needed if South to rural GPs, as Australians across the state are to identified in their receive quality care. feedback to the 2019 AMA Rural Health 100,000 residents, compared to the AMA(SA) President Dr Chris Moy and Issues Survey, included: Australian average of 42 beds per Council identified the major issues that • the need for extra funding and 100,000 population. the AMA considers require dedicated resources to boost staffing levels at The AMA(SA) also calls for state- State Government funding and rural hospitals based support for measures outlined in attention in the 2020-21 Budget. • encouraging medical colleges to the National Suicide Prevention Plan. ‘I have sought the input of our include rural rotations for trainees to 4. Implementation of the outcomes Council, which has among its members rural areas of the AMA(SA) Culture and representatives of general practice – • ensuring rural hospitals have modern Bullying Summit including rural general practice – other facilities and equipment The AMA(SA) Culture and Bullying medical specialties, doctors in training • access to high-speed broadband for Summit on 29 February 2020 will and South Australia’s two medical medical practices generate recommendations for action to school student bodies,’ Dr Moy wrote. • more support for training of junior be presented to the Minister for Health He said the priorities ‘are provided in doctors in rural areas. and Wellbeing. The AMA(SA) asked that the hope they will guide the allocation 2. Public hospitals, including the funds be allocated to implement the of funding to health and wellbeing RAH and the new Women’s and recommendations, which will aim to infrastructure, programs and services, Children’s Hospital improve working conditions for doctors so that our state’s health system is best ‘This state needs an evidence-based, and other health practitioners, the placed to provide quality care to all clinician-led health system that puts health and wellbeing of those doctors South Australians’. people first,’ Dr Moy wrote. ‘Buildings and health practitioners, and the Dr Moy said the suggestions were such as the new Women’s and Children’s safety of patients. essential ‘investments in the immediate Hospital (WCH) must be designed 5. Funding for palliative care and and long-term health of the community and developed in consultation with Advance Care Directives promotion we all serve’. A summary of the the AMA(SA) and other clinicians’ and education priorities and the Council’s reason for bodies, to ensure they are best placed ‘Professor Wendy Lacey’s review of their inclusion is provided below. to offer those services and address the the Advance Care Directives Act 2013 1. Rural and regional health, needs of patients, doctors and health laid bare the lack of understanding including support of rural general practitioners, and other users.’ in the community and among health practitioners, resident specialists, He said funding was needed for practitioners of Advance Care Directives and pathways to encourage ‘neglected work’ in the health system, (ACDs) and the key role they play in junior doctors to enter rural including a Comprehensive Childhood protecting the self-determination of general practice Health Plan for South Australia. patients who have lost decision-making The AMA(SA) believes the draft 3. Mental health services capacity, especially at end of life,’ ‘Rural Medical Workforce Plan’ must The AMA(SA) called for significant Dr Moy wrote. ‘This has been due to be backed by adequate funding and investment in mental health services, totally inadequate levels of funding for implemented in a new, improved including in psychiatric beds. Dr Moy the promotion of ACDs and education spirit of cooperation with general said South Australia has 32 psychiatric about their use among individuals and practitioners (GPs) and other specialists beds – 27 public and five private – per health practitioners.

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‘The South Australian Government institutes, to advance investigations Australian public hospitals must may be considering the introduction and treatments, including precision be a priority. of voluntary assisted dying (VAD), medicine, and maintain South While there is extensive, urgent but any debate about VAD must not Australia’s nation-leading status. national (National Medical Workforce ignore the importance of the palliative A clinical data analytics unit is Strategy) and local (Rural Medical care services sought by 98 per cent of Workforce Plan) work to be done to needed that is ‘transparent and run patients at the end of their lives, even if overcome the gaps in knowledge independently of SA Health so there can VAD comes into effect.’ and future planning for the medical be no accusations of bias’. 6. Clinician-led research and workforce, there is also a need to creation of an independent data 7. Funding of advance maintain and increase advance analytics unit trainee positions specialist training positions. Dr Moy Funding is required to continue The AMA(SA) believe that funding said a failure to do so will risk losing cutting-edge, clinician-led research at for the adequate numbers of advance specialists to interstate hospitals and our teaching hospitals and research specialist trainee positions in South increase service gaps in South Australia.

Evidence-based advocacy

The AMA(SA) has provided feedback • a request from Child Protection for comment on the 10-year Primary recently to governments and other Minister Rachel Sanderson about the Health Care Plan Framework. entities on topics ranging from child operation of the Children and Young The AMA(SA) recognises the safety to the use of restraint in mental People (Safety) Act 2017 value of working with key partners health services in recent months. • Chief Psychiatrist Dr John Brayley’s to inform advocacy positions and Submissions to SA Health, Health request for a response to the draft and Wellbeing Minister Stephen Wade, standard that would eliminate the use improve the health and well-being of Child Protection Minister Rachel of restraint and seclusion in mental South Australians. Sanderson and other organisations health services Dr Moy has been working closely have emphasised that the AMA(SA) • an invitation to provide input with Chief Public Health Officer is the peak body for South Australian to the inquiry being conducted Associate Professor Nicola Spurrier doctors and the entity best placed by the Australian Government’s and her colleagues to develop accurate, to offer evidence-based opinions to Parliamentary Joint Committee on Law up-to-date information and resources influence health-related policy and Enforcement in relation to the value decision-making. and efficacy of public communications about South Australia’s response to In addition to its State Budget campaigns targeting drugs and COVID-19. The information has been priorities, the AMA(SA) provided input substance abuse shared with members on the AMA(SA) and feedback relating to the following • support for the AMA(SA) Committee website and through SA Health in December and January: of General Practice in contacting GPs digital media.

Dr Bartone said the aged care sector was ‘in turmoil’ and mental health Australian health system services were desperately in need of more, strategically targeted, funding. at tipping point - AMA In addition, he said, Australia needs ‘a renewed and reinvigorated focus on preventive health’. he AMA is calling on the ‘We are at the tipping point,’ ‘We need people to be fitter and Australian Government to Dr Bartone said. ‘The cornerstone of our taking responsibility to make better significantly increase recurrent health system is general practice. T lifestyle choices to keep themselves spending on health to properly meet ‘The role of primary care, especially current and future demand for quality healthier and out of hospital. This general practice, must be built up and will need considerable new funding care and services in the Australian properly supported to underpin and health system. and a coordinated approach from all coordinate service provision across the Releasing the AMA’s pre-Budget governments at all levels of government whole health system. (But it has been) submission for the 2020-21 Federal – Federal, State, and local. under-resourced and underfunded Budget, AMA President Dr Tony Bartone ‘The inescapable facts are that said the AMA wants the Australian for more than a decade. Our public Australia’s population is growing, people Government to lift spending from its hospitals are underfunded and are living longer, and the incidence of current level of 9.3 per cent to a level in operating beyond capacity. And despite chronic and complex health conditions line with comparable countries. recent reforms, private health insurance is expanding significantly. Keeping He said the Australian health system still lacks value and affordability … and people healthy and active will require is ‘facing a funding crisis’. the confidence and trust of consumers.’ funding – significant new funding.’

medicSA | 21 -

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480specialistcentre.com.au

22 | medicSA TRAINING

Training needs more GP content

octor training programs need a knowledge to care for the patients radical re-think to give trainees referred to them or who they treat in a chance to try – and love – emergency situations. general practice, particularly in ‘Unless you experience general Dthe rural areas, says Deputy Chair of the practice, you really don’t know what AMA(SA) Council of General Practice it is all about,’ Dr Need says. and GPEx Senior Medical Educator, ‘General practice is amazing, and Dr Penny Need. rural general practice is particularly Dr Need says only half of South fantastic, but you need to experience Australia’s rural GP trainee positions it to know. Dr Penny Need have been filled this year due to lack of ‘My personal opinion is that every interest, compounding an already dire intern should do a rural general practice round in the hospital,’ she says. ‘There is situation in rural health. rotation or a general practice term, just a breadth of opportunity untapped out as they have to do an emergency term GPEx is the South Australian training there in the rural space.’ and a surgery term. organisation for doctors specialising in ‘This is a people-facing profession ‘That would produce better doctors general practice. and (in general practice) you build across the board. We’re all going to While there is a joint SA Health and relationships over time,’ Dr Need says. communicate better together if we know GPEx study – the Medical Specialty ‘You do become the trusted source of a bit about what each other does.’ Decision Making Research Project – to clinical information and a go-to person Dr Need said there was capacity and determine drivers of this lack of interest, for them and coordinator of care. It’s willingness among general practices Dr Need believes the main reason is that nice to be that for them. to take students, but this needed to be students and junior doctors no longer ‘It’s being part of their story … I adequately funded so junior doctors receive enough exposure to general can’t quite explain how meaningful it can access Medicare rebates for their practice during their training. is. Seeing the little people grow into services, rather than being solely Whereas there were 197 junior doctors adults and being part of their lives supported by small businesses. - in South Australia who undertook rural is really good. rotations under the former, federally ‘There’s less hierarchical pressure funded, Prevocational General Practice ... ‘We urgently than many other areas of medicine. It’s - Placements Program (PGPPP), the Rural need to bring back a very friendly culture – once you are in Doctors Workforce Agency now includes GP training, you are a colleague.’ just 20 rotations. more prevocational GPEx, the AMA and AMA(SA) are There are also 12 rural intern positions exposure in working to raise the profile of general that started in 2019 and some additional practice, to expose students to it, and to rural resident medical officer positions general practice for help trainees prepare for the rigorous are likely to start soon. junior doctors’ ... exams set by the Royal Australian ‘It is a downward trend nation-wide, College of General Practice – for which but this is the first year we didn’t Equally, she says, the training the pass rate for one of the written even fill our general spots,’ Dr Need coordination needs to be adequately segments is only 55 per cent – and the says. ‘It’s looking a bit dire for GP supported. Dr Need points out that the Australian College of Rural and Remote training, considering that registrars PGPPP was supported to ensure quality Medicine exams, with a 30-40 per cent make up 25 per cent of the rural training, practice accreditation and to pass rate for the clinical assessment. workforce historically. organise placements; the new federal GPEx and the AMA(SA) are in ‘There is also very limited exposure in program to attract rural doctors is not. discussions with the Deans of the both of the (medical) schools in South Dr Need says general practice Adelaide and Flinders Medical Australia now – it seems to be getting had recently had ‘a bad rap’, with Schools to highlight the importance less and less.’ the perception that it was poorly of general practice. She says this limited exposure denies remunerated and over-corporatised. GPEx is also undertaking a hospital junior doctors – most of whom hail from But, she says, many of the students engagement initiative in partnership city backgrounds – the opportunity to and junior doctors who try it become with the Local Health Networks, aiming experience life as rural GPs. In addition enthusiastic advocates, attracted to the to increase awareness of what a career to increasing the number of junior variety of work, the ability to set their in general practice can offer. It is also doctors who opt for general practice and hours, the diagnostic challenges and the promoting general practice training rural practice, she says having all junior opportunity to ‘see cases through’. through social media. doctors include rural practice in their ‘Junior doctors and students who go ‘Once people do it, they love it,’ training would give those who choose out rurally get to do a lot more than Dr Need says. ‘We have fabulous 480specialistcentre.com.au careers as surgeons and specialists more they would sitting at the back of a ward trainees – we just need more.’

medicSA | 23 STUDENT NEWS

grounds of the university for the JADE PISANIELLO first time since 1995, the Australian STUDENT NEWS: Medical Students’ Association’s ADELAIDE UNIVERSITY National Convention will convene in Melbourne, and the first-year students will be welcomed to the AMSS at Normanville as part of our lthough medical school annual MedCamp over the March examinations might be long long weekend. Aforgotten for many reading While some of our events are this, or perhaps the memories of the steeped in tradition, we continue The 2020 AMSS Executive committee silent depths of the Barr Smith Library to strive to improve inclusivity and have been repressed, the Class of 2020 celebrate minority groups within the structure from MBBS in 2020 to MD recently breathed a sigh of relief (as did AMSS. Since its inception in 1889, the in 2021, in addition to continuing to many parents) after we passed our exit AMSS as had 116 male and just 14 female deliver a robust educational and social examinations at the conclusion of fifth presidents. In late 2019, I was elected calendar. We want to maintain our year in 2019. Congratulations to all of as the 15th female president. I will status as one of the most active medical the new sixth years. I hope that we will fulfil this role alongside an incredible student societies in the country. demonstrate leadership and generosity executive committee which is itself I write to you eight floors up from the of spirit to our junior students three-quarters female. In November picturesque library overlooking North throughout the year. 2019, our members marched for the Terrace at the Royal Adelaide Hospital, This year marks 131 years since the first time in the annual Pride March but many of my classmates are fulfilling inception of our society. The AMSS has which celebrates Adelaide’s LGBTQIA+ international electives all over the world evolved a great deal over the years, but community. Although we have a long - from rural sites across South Australia, the more things change, the more they way to go, we have certainly made Nepal, Vanuatu and everywhere in stay the same. The AMSS continues great strides and are looking forward to between. Our society prides itself on to host a variety of educational and continuing to promote diversity within a unique culture of solidarity and social events, among which some are our student body. camaraderie. No matter where in the new and some well-established: 2020 We’ll be focusing on guiding and world you find yourself, whether it be will see the (in)famous Skullduggery supporting students during the as a student or an alumni, an AMSS orientation week party return to the changing of the medical program member is never far away.

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24 | medicSA STUDENT NEWS

style of the individual students is unfortunately now lacking. Curiouser and curiouser Excessive clinical workload impedes clinical teaching and mentorship. Senior doctors want to teach, but patients must medical students being able to model be the No.1 priority. Students also have LIAM RAMSEY professional behaviour and that it to want to learn. Academic curiosity STUDENT NEWS: significantly influences the career is regarded as a desirable trait. But the FLINDERS UNIVERSITY trajectory of students. We know medical more schools include in a curriculum, students want engagement with senior the more you bludgeon this curiosity as doctors, but is this reciprocated? students strain to survive. was recently asked by an ENT The literature reflects that doctors Medical schools select and train professor if I knew what the term want to teach. It suggests their doctors. Being clinical mentors is I‘doctor’ meant. ‘Doctor’ is now an principal motivator is altruistic, making simply a pragmatic after-thought of academic title, but in its Latin origin it the next generation of doctors safer the profession. Educational pedagogy is an agentive noun of the Latin verb patient advocates, and being able to isn’t a core part of course curriculums, docēre, meaning ‘to teach’. pass knowledge and experiences they but doctors are ‘to teach’. Recent doctor Doctors are multi-faceted wish they knew in their junior years. training at the University of Sydney professionals; our fingers are Simultaneously, it fosters interest and headed by Dr Foster and Dr Laurent figuratively covered in different types promotes their speciality. demonstrated that when doctors are of honey. But do we dive into the honey However, the clinical ecosystem supported and given evidence-based pot that is so fundamental to our title does not always permit this altruistic teaching in medical education they feel ‘doctor’? We care for vulnerable people, behaviour. Student numbers have more prepared to teach in a meaningful we advocate for the marginalised, we steadily grown, and consultants are way and require less support to teach. research for the masses, but do we expected to teach and supervise With this in mind, let’s encourage teach our own? more students than previously. The student curiosity in a range of Teaching is a special skill. It is crucial apprenticeship model is changing specialities. Let’s create a culture to the development of all stages from to one of a mini-series of lectures that digresses from hierarchy and student to junior doctor to consultant. on ward rounds, at bedsides and in emphasises connectedness. Let’s get The literature reflects that senior doctors’ offices. The smaller-group back to the roots of what it means to clinician mentorship is central to teaching that can adapt to the learning be a doctor: to teach.

medicSA | 25 PUBLIC HEALTH

Syphilis returns as a threat

The return of syphilis is worrying doctors and governments across Australia, write SA Health’s Holly Skene and Dr Brendan Kennedy.

yphilis, a notifiable sexually 2013), 420 in WA (from June 2014) and 95 men, including 11 identifying as men transmissible infection (STI) in SA (from November 2016). having sex with men and two reporting caused by Treponema pallidum, Source: https://www1.health.gov.au/ sex with men and women. was once rarely seen and was internet/main/publishing.nsf/Content/7 SYPHILIS IN PREGNANCY Sclose to being eliminated in remote 1E8A32E7518E532CA25801A0009A217/$ Transmission of syphilis during communities in Australia. It is thought File/21-Surveil-Report-Dec19.pdf pregnancy can lead to perinatal of by many as a relic of the past, bringing In SA, approximately half (48 per cent) death, premature delivery and of all cases have been among young to mind images of Henry VIII and congenital abnormalities. people aged 15-29 years, compared with wartime posters about venereal disease. The ‘SA Perinatal Practice Guideline: between 61 and 70 per cent in other However, far from being a relic, Syphilis in Pregnancy’ has been infectious syphilis has made a states, with 55 per cent men and 45 per cent women. Six cases have been updated to reflect the importance of comeback, primarily in urban men repeat testing during the antenatal and who have sex with men, and in younger diagnosed in pregnant women with one confirmed case of congenital syphilis postnatal period in the context of an rural and remote Aboriginal and Torres outbreak. Routine screening should Strait Islander peoples. Infectious ... This outbreak, be offered at every first antenatal syphilis (which can occur during the appointment (12-14 weeks). For two years following infection) carries which has been Aboriginal and Torres Strait Islander significant health risks, particularly described by many women (or partners of Aboriginal and during pregnancy, and increases the risk Torres Strait Islander men) residing of HIV transmission. Currently there is as a case study of in, or travelling to or from an outbreak an outbreak affecting predominantly public health failure, affected area, additional screening rural and remote Aboriginal and Torres is recommended at 28 weeks, 36 Strait Islander communities in northern has so far led to the weeks, at birth, and at the six-week Australia. First declared in 2011 in death of seven infants post‑natal check. northern Queensland, the outbreak and amid 16 cases of Treatment should occur as soon as has since expanded to the Northern possible and ideally 30 days before Territory (NT) and Western Australia congenital syphilis ... delivery. For women suspected of having (WA), and into South Australia (SA) in syphilis who live in outbreak areas, the Far North, Eyre and Western, and that was treated successfully. While most treatment may need to be given before Adelaide regions. SA cases have been reported in the rural confirming results. and remote regions of the Far North (58 This outbreak, which has been THE OUTBREAK RESPONSE described by many as a case study of per cent) and Eyre and Western (5 per The Communicable Disease Network public health failure, has so far led to the cent), the proportion of cases occurring of Australia and the Australian Health death of seven infants amid 16 cases of in Adelaide (37 per cent) is increasing, accounting for 70 per cent of cases since Protection Principal Committee are congenital syphilis. January 2019. Nationally, Adelaide is the coordinating and overseeing efforts OUTBREAK EPIDEMIOLOGY largest city included in the outbreak. in conjunction with jurisdictions to From 2011 to 30 November 2019 there Overall, the outbreak has affected curtail outbreaks. In SA, a Syphilis were 3,224 infectious syphilis cases young, heterosexual and remote Outbreak Working Group comprised related to this outbreak reported in Aboriginal and Torres Strait Islander of government, non-government, Australia; 1,494 in Queensland (from communities. However, in Adelaide, Aboriginal Community Controlled January 2011), 1,215 in the NT (from July 25 cases (71 per cent) have occurred in Health Services (ACCHS) and sexual

26 | medicSA PUBLIC HEALTH

health stakeholders has developed a Syphilis Outbreak Response Plan. The plan has been endorsed by the Minister for Health and Wellbeing and focusses on antenatal and postnatal care; prevention, education and community engagement; workforce development; testing, treatment and partner notification; and surveillance and reporting. Projects under way include the Young Deadly Free health promotion campaign, workforce development, and the roll out of dedicated sexual health positions in outbreak affected areas. SA SYPHILIS REGISTER Accurate staging and interpretation of syphilis testing requires a history of the patient’s illness, including any previous test results and treatment. In response to Infectious syphilis outbreak cases notified in Aboriginal and the outbreak, the Communicable Disease Torres Strait Islander people in affected regions, January 2011 to Control Branch (CDCB) is establishing 30 September 2019 a syphilis register to help healthcare workers interpret results in cases in • For pregnant women at risk, increased Aboriginal and Torres Strait Islander syphilis screening is recommended people, to assist healthcare workers in at first visit (12-14 weeks), 28 weeks, MORE INFORMATION 36 weeks, at birth, and six weeks interpreting test results, and provide National Pregnancy Care post‑natal. advice on treatment and assist with Guidelines • The SA Syphilis Register is being contact tracing. https://bit.ly/2FSiWME established for cases in Aboriginal and KEY MESSAGES SA Syphilis Register 1300 232 272 / Torres Strait Islander people, and to • Infectious syphilis is increasing across Health.SASyphilisRegister@ help healthcare workers interpret test Australia, particularly among urban sa.gov.au results, provide advice on treatment men who have sex with men and National STI Guidelines and assist with contact tracing. in rural and remote Aboriginal and https://bit.ly/2Tr8XWq SA Health Guideline Torres Strait Islander communities. Ms Holley Skene is Senior Project Officer https://bit.ly/2uRj4K3 • There is a multi-jurisdictional syphilis HIV and STI in SA Health’s Communicable Adelaide Sexual Health Centre outbreak active across northern Disease Control Branch. Dr Brendan www.sahealth.sa.gov.au/ Australia, including in the Far North, Kennedy is an infectious diseases physician adelaidesexualhealthcentre Eyre and Western, and Adelaide in the Communicable Disease Control regions of SA. Branch and Royal Adelaide Hospital.

medicSA | 27 PUBLIC HEALTH

Preventing avoidable infant deaths Clear factors are now associated with a higher risk of SIDS, writes Wellbeing SA’s Dr Emma Dawes. Wellbeing SA Public Health Registrar Dr Emma Dawes

he SIDS story over the past Despite being a phenomenon of 25 years is considered one of interest from the early 1900s, the SUDDEN INFANT DEATH the great successes in infant changing definition, absence of SYNDROME (SIDS) The sudden unexpected death health care. Since public tissue‑based pathological features, of an infant less than one year of Thealth campaigns around safe sleep for and the highly emotive environment age, with onset of the fatal episode infants in the mid-1990s, the incidence in which deaths were investigated apparently occurring during sleep, resulted in marked heterogeneity of sudden unexpected infant deaths that remains unexplained after a between studies and their findings. in sleep has fallen by 85 per cent, and thorough investigation, including in Australia alone it is estimated that As new theories for its cause emerged, performance of a complete autopsy almost 10,000 lives have been saved. numerous and often contradictory and review of the circumstances The development of safe sleep guidelines recommendations for ‘safe sleep’ were of death and the clinical history. is an excellent example of how advocated (with variable uptake), (San Diego definition, 2004) translation of evidence into public health clouding the already complex landscape. Thanks to epidemiological practices SUDDEN UNEXPLAINED policy can save lives, and a sobering DEATH IN INFANCY (SUDI) reminder of the consequences when (making particular note of work done by South Australian researcher Susan Beal The similar, and often confused, evidence is not effectively translated. from 1970 to 1990), clear factors are now term is SUDI is an umbrella term for Sudden death in an otherwise healthy associated with an increased risk of SIDS. ‘the sudden and unexpected deaths infant during sleep is not a phenomenon These factors have been incorporated on infants under one year of age of modern times. Early examples of into ‘safe sleep’ campaigns, such the whose deaths remain unexplained public health policy designed to curb ‘Back-to-Sleep Campaign’ since 1995, and at autopsy, including but not limited to SIDS deaths’. As well as deaths deaths are known to have existed in the the subsequent 85 per cent decrease in from SIDS, SUDI encompasses 7th century. The phenomenon, known SIDS deaths is attributable to reductions infants whose deaths occurred in the as SIDS since 1969, has been understood in these risk factors. course of an acute illness that was to be a complex combination of intrinsic The success of safe sleep campaigns not thought to be potentially life- and environmental factors, rather than is heralded as a public health triumph threatening, arose from a pre-existing a single pathological process, since and has led to them becoming a ‘poster condition that had not previously been the mid-20th century. It was not until child’ for the benefits of evidence-based recognised, or resulted from any form 2004, however, that an internationally medicine. In many ways it is a triumph. of accident, trauma or poisoning. accepted common definition for the A retrospective review of evidence, (Blair, Byard, Fleming, 2009) term SIDS was agreed upon. however, reveals that if a systematic

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review had been performed at the time, that nurtures and affirms parents and • Multiple births there was sufficient evidence to change carers, empowering them to make • Male and first born infants infant sleeping practice from as early as safe choices. • Infants who have problems after 1970. Instead, the failure to appreciate SA SAFE INFANT SLEEPING birth, including a history of minor the strength of evidence, and modify STANDARDS viral respiratory infections and/or practices accordingly, resulted in the The SA Safe Infant Sleeping Standards gastrointestinal illness continued promotion of front sleeping were developed by government and ENVIRONMENTAL FACTORS for another 30 years. The predicted non-government experts under the ASSOCIATED WITH INCREASED 60,000 deaths that could have been direction of the South Australian Safe BASELINE RISK prevented reminds us as clinicians of Sleeping Advisory Committee in 2011. • Y oung parental age the importance of efficiently translating The guidelines were revised in 2016, • Mental health problems or cognitive evidence into practice; failure to do and again in 2018, to reflect current best difficulties experienced by so has had, and will continue to have, practice and legislation. They can be parents/caregivers dire consequences. accessed on the SA Health website. • Domestic violence occurring Now, despite the success of public MODIFIABLE RISK FACTORS in households health campaigns and the dramatic • Infants in a prone (face down, tummy) • T ransient lifestyle, with lack of access decrease in prevalence, SIDS remains a sleeping position to a stable home. leading cause of preventable death for • Unsafe cots, mattresses and bedding Specific notes on safe cots, infants between one and four months of • P arental smoking (before and mattresses, and bedding: The age. Coroners’ reports into infant deaths after birth) Australian Standards for Household Cots in Australia attributed to SIDS and SUDI • Use of alcohol and other drugs, (AS/NZS 2172) have been developed to over the past 10 years suggest that in including prescription medication, guide parents and clinicians. Further, many of these deaths there remain that makes the parent/caregiver there is a voluntary AS/NZS safety preventable elements: infants are often drowsy and less responsive to standard for cot mattresses, including found to have one or more identifiable infant cues an assessment of their firmness to risk factors for sudden death, and/or • Infants and parents/caregivers sharing reduce the risk of SUDI and SIDS to be sleeping in environments that do the same sleep surface (such as bed, from soft mattresses. A flat sleeping not meet all of the current safe sleep couch, sofa, chair etc.). surface is recommended at all times: standards. While there is only a small There is no evidence or requirement number of unexplained sleep-related PROTECTIVE FACTORS to raise the head end of a cot to treat infant deaths in South Australia each • Sleeping an infant in the same room as gastroesophageal reflux; this can year, these deaths have a devastating the parents/caregiver instead result in babies slipping down impact on those involved. And • Ensuring that an infant is under covers fully immunised evidence suggests each one could have Specific notes on sharing a • Using a pacifier once( breastfeeding been prevented. sleep surface: Research suggests the As medical practitioners, it is our has been established) risk of sharing a sleep surface can be role to reduce the risk of SIDS and • Breastfeeding compounded by modifiable risk factors, SUDI through helping our patients INFANT-SPECIFIC FACTORS but removing these additional factors understand the importance of care ASSOCIATED WITH INCREASED does not return the risk to baseline, and and sleep environments and practices BASELINE RISK the practice remains higher risk than that evidence has shown to be safe. We • Infants born prematurely (<37 weeks) that of sleeping an infant on a separate, should offer culturally inclusive advice • Infants of low birth weight (<2,500g) safe, sleeping surface.

Ashford_MedicSA_Third Page AD_174x77mm_SA Foot&Ankle_2020_240120.indd 1 28/01/2020medicSA 11:25:26 AM| 29

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Massive shakeup for income protection insurance

A proposed overhaul of income protection insurance aims to stem the billions of dollars being lost by insurers each year and could have enormous implications for anyone considering a policy. Ms Hannah Waller (left) and Mr Mark Mullins of Hood Sweeney

ome of the mooted changes could Prudential Regulation Authority (APRA), unable to work due to illness or injury,’ come into effect as soon as April set a deadline for life insurers to start Mr Summerhayes said. 2020 and would affect all new steps that include formulating a strategy ‘In a drive for market share, life income protection insurance to address the issues identified by the companies have been keeping Scontracts, and potentially any changes review and reviewing income protection premiums at unsustainably low levels, being made to existing contracts. insurance’s product design and pricing and designing policies with excessively This type of insurance, also known practices to enhance its sustainability. generous features and terms that, as disability income insurance, can Some of the potential changes are in some cases, provide a financial provide replacement income to policy outlined in the table (below). disincentive for policyholders to holders if illness or injury render The review comes amid APRA’s return to work. them unable to work. concerns about what it cites as ‘Insurers know what the problems are, ‘As it currently stands, it can protect ‘lenient’ income protection insurance but the fear of first-mover disadvantage a family financially in the event of sold to individuals. The industry has has proven to be an insurmountable debilitating injury or illness, providing a collectively lost more than $3 billion barrier to them making the necessary replacement income of up to 85 per cent through this product offering over changes. By these measures, APRA is and allowing time for recovery without the past five years, with no signs forcing the industry to better manage the added stress of mounting bills,’ of improvement. the risks associated with disability said Mark Mullins, associate director APRA wrote to the industry in income insurance and to address and representative of Hood Sweeney May 2019 requesting action to unsustainable product design features – Securities Pty Ltd. address the problems. Since then, or face additional financial penalties.’ Mr Mullins said one of the most insurers have reported further losses If you are considering an income radical proposals would restrict the of $1 billion, prompting APRA to protection policy, or if your current benefit payment period to a maximum escalate its response. policy needs a review, call Hood of five years – a major change from the With at least one major reinsurer Sweeney on 1300 764 200 to explore existing benefit period up to age 65. indicating it was no longer prepared to options to suit your needs. ‘After five years, where would an reinsure individual income protection income come from for people still insurance, APRA Executive Board Mark Mullins is an Associate Director and recovering from an injury or illness?’ Member Geoff Summerhayes said there Representative of Hood Sweeney Securities, Mr Mullins points out. ‘How would they is now a genuine risk that insurers may AFS Licence No. 220897, pay a mortgage, school their children, or start withdrawing from the market. Hannah Waller is a Life Risk Specialist and put food on the table?” ‘Disability income insurance plays Representative of Hood Sweeney Securities, The Australian Government’s a vital role in providing replacement AFS Licence No. 220897. statutory authority, the Australian income to policyholders when they are

The information in this article contains Current income protection contracts Proposed income protection changes general advice and is provided by Hood Sweeney Securities Pty Ltd, AFSL No 220897. Income based at time of application or Income based at time of claim only That advice has been prepared without time of claim taking your personal objectives, financial situation or needs into account. Before acting Benefit period to age 65 Benefit period restricted to five years on this general advice, you should consider the appropriateness of it having regard to Up to 85% of income insured Maximum 75% of income insured your personal objectives, financial situation and needs. You should obtain and read the Initial contract term not exceeding five Product Disclosure Statement (PDS) before Guaranteed renewable contract years (with option to extend based on making any decision to acquire any financial contract at the time of extension) product referred to in this article.

medicSA | 31 An international perspective

Dr Diana Hancock has new views on paediatrics after an elective in Africa.

n August 2019, I travelled to Botswana to complete a medical elective in paediatrics. Botswana has a population of 2.3 million Ipeople, and has high levels of education with a high GDP per capita compared RAH intern Dr Anthony Leahy (left) with writer Dr Diana Hancock to neighbouring countries in southern border city of Francistown. The neonatal sepsis or neonatal jaundice. Africa. However, there are many public paediatric ward had 15 to 30 patients Unfortunately, due to a lack of health issues and a lack of medical while the special care babies unit and ultrasound during pregnancy, some of services, particularly for patients who do neonatal intensive care had 40 babies. the patients in SCBU had congenital not live in the capital city. In Botswana, there are low rates conditions like trisomy 18 and severe I spent six weeks doing my elective of contraception use and pregnancy hydrocephalus that were not diagnosed working with the doctors in the planning, and therefore low uptake of until after delivery. paediatric medical ward and the special folate during the first trimester. Neural There were a few cases which care babies unit (SCBU) at Nyangabgwe, tube defects such as myelomeningoceles particularly made me realise the the second-largest national referral are common. Most of the patients importance of having good public hospital in Botswana, in the eastern- in the SCBU were premature or had services available. The CT was broken

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32 | medicSA The Nyangabwe Referral Hospital’s paediatric medical ward (above) and Special Babies Unit (right). when we were there, so for months resources. They valued teaching, and any public patients were unable to be grand rounds and intern presentations scanned despite presenting with acute were scheduled weekly. Because of the cerebrovascular accidents. One patient frequency of presentations of conditions (I’ll call Kylie), was eight years old and such as meningitis, they were very had rheumatic heart disease. She good procedurally. Another positive received medical care at the hospital, aspect was that the paediatric team but due to a lack of specialists had to was very kind and friendly, both to the be flown to South Africa for surgery. staff members and to patients. One of By the time this was organised, she the nurses often encouraged four of had developed severe pulmonary the long-term paediatric patients aged hypertension. Her heart failure meant between eight and nine years, including that her procedure had to be delayed Kylie, to sit at a desk on the ward and by months, and she had to return to complete maths lessons. Nyangabgwe and wait. Many children Climate change has already affected Being an AMA Councillor in 2019 with type one diabetes presented in semi-arid Botswana, where about gave me the opportunity to see and be diabetic ketoacidosis because they 70 per cent of the land is within the grateful for different elements of our didn’t have access to blood glucose Kalahari Desert. A decrease in rainfall healthcare system. I am so glad I’ve had the opportunity to travel overseas for my strips at home. has brought longer dry seasons to elective and hopefully can return when I The doctors demonstrated a great deal people living in rural areas. These have more training. of resilience working in an understaffed people will be vulnerable to the effects hospital, often with insufficient of climate change that may further Dr Diana Hancock is an intern at the limit agricultural activities. Most fresh Queen Elizabeth Hospital and in 2019 produce is imported from South Africa was a student representative on the and already too expensive for most AMA(SA) Council. families. This is leading to oedematous malnutrition in many young children. Electives for medical students are a fantastic opportunity for students to do placements that are in an area of interest, both medical and geographical, and experience a health care system outside of the hospital where they have trained. It is valuable to gain an understanding of working as a doctor overseas and seeing the scope of medicine and public health outside our own cities. For students travelling overseas, it is important to be confident and be able to work safely with adequate supervision, but also to be aware of their Dr Diana Hancock (left) and Mount clinical limitations as a student. Gambier intern Dr Ilze Alexander.

medicSA | 33 REFLECTION

Considering beliefs about stress, hardship and growth

It may be hard to believe, but stress can be good for us.

elief is a weak word. It implies high level of stress and reported it was a degree of uncertainty and affecting their health. The surprising a choice rather than a truth. finding was that the lowest mortality Climate change seems to be was among those who reported high Bsomething about which some of us hold levels of stress but believed that stress a belief, which can invite discussion and was beneficial to them. argument, whereas there is no choice It seems stress itself is not the when it comes to accepting the presence problem, but rather the belief that stress of gravity. When you trip there is no is bad for one’s health. By reframing and negotiation, there is just falling. considering stress to boost productivity However, there is power in belief. It and vitality, the delirious effects dictates and governs our reality. What diminish. The way one views the world we think influences directly who we directly changes their reality. are, what we are, and how we walk through the world. This concept may THE YERKES-DODSON STRESS require some individual thought and PERFORMANCE CURVE convincing, but accepting it as true can By Dr Troye Wallet save your life. EXPLORING BELIEFS ABOUT STRESS It is well known that stress is a risk factor for morbidity and mortality. Heart attack, abdominal symptoms and mental health deterioration are a few broad areas caused by a stressful life. Stress increasing mortality, however, it is not entirely true. It turns out that a person’s belief and the way they think about stress has considerable impact on THE STRESS PERFORMANCE the effect of stress. CURVE In 1998, 30,000 people were asked Thinking about stress as a about their stress and whether they positive influence does not mean thought their stress was affecting their it does not deserve consideration health. Twelve years later, the results as a negative influence. The stress/ were both predictable and surprising. performance curve shown above, first Predictably, the highest mortality described by psychologists Robert M. was among those who had reported a Yerkes and John Dillingham Dodson in

34 | medicSA 1908, demonstrates how stress can be worlds; terms such as post traumatic can see positive personal and spiritual useful in managing a challenging job stress start to be mentioned to describe growth or a greater appreciation of life or situation. As one’s stress increases, their responses. ‘PTSD’ – post-traumatic as a consequence of trauma. It is more performance increases. Up to a point. stress disorder – is now part of the public commonly seen in people with a growth After that, performance drops off. consciousness and, unfortunately, a mindset and who seek out connection Understanding that each person’s common outcome of living through a with others. Tedeschi and Calhoun stress/performance curve is unique life- or world-shattering event. The grief, suggest that Post Traumatic Growth is gives insights into how different people loss and feelings felt in these times are more likely if people understand that work. If you are managing a team raw and hard to deal with. it is a possibility. A belief can change or mentoring a junior or advising a However, in that pain is the possibility the outcome of how people deal with colleague, ask them how stress affects of Post Traumatic Growth. Perhaps tragedy. If they believe it is possible, it their performance. Does their curve it is not discussed as much, because becomes possible. drop off quickly? If so, managing high TWO BELIEFS THAT WILL levels of stress is vital for maximum ... Post Traumatic SAVE LIVES. performance. For others, stress is a When belief is explored, it is motivating force and working under Growth is more not unbelievable that it is more a high load or to tight deadlines is likely if people powerful than expected. The cliche beneficial. As long as they think of stress understand that it that knowledge is power cannot as a positive part of their lives, they be overstated. will thrive. is a possibility ... Knowing and believing that stress POST-TRAUMATIC GROWTH it is easy to come across as lacking improves your productivity and vitality It seems that belief is stronger than empathy. However, being cognisant of makes it so. Realising that there is initially stated. If just the knowledge Post Traumatic Growth may open the opportunity to grow and strengthen in that stress is not unhealthy removes possibility of using pain to be stronger the face of tragedy makes it a possibility. the risk it imposes, perhaps the same than before. Knowing and believing can save concept is true in other areas. Post Traumatic Growth was theorised your life. Tragedy, such as the loss of a loved one by Richard Tedeschi, PhD, and Lawrence or caused by the bush fires in Australia, Calhoun, PhD, in the mid-1990s. The Dr Troye Wallett is an aged care GP, leads to suffering, grief and heartache. theory suggests that people who business mentor, writer and speaker. Events like these devastate people’s experience a psychological struggle [email protected]

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medicSA | 35 VALE

AMA(SA) remembers its first female president

Dr Jeanette Linn OAM MD, FRACGP, SSStJ, CLJ. AMA(SA) President 1980-81

7 September 1930 - 19 November 2019

‘She used all her gifts to try and make the world a better place.’

eanette ‘Jenny’ Linn was a woman whose gravitas was generations. Her parents Harold Gard and Vera Thrush unusual for women of her generation, which led to were both professional opera singers and teachers, factors discomfort among colleagues and patients who perhaps no doubt responsible for Dr Linn’s lifelong love of music weren’t ready to confront and accept female and education – passions she passed on to her children Jmedical practitioners. and grandchildren. She was born Jeanette Thrush Brentnall Gard, somewhat Despite the tough economic conditions, she was educated celebrated as the first girl to be born into her family for at St Peter’s Girls School, which she said was instrumental in her development as a strong, determined, confident, faithful and compassionate woman. She graduated from St Peter’s Girls at 16 and began medical school at the University of Adelaide in 1947, finding herself one of the Sell your practice with few young women among a cohort largely comprising Australia’s only national ex ‑World War II servicemen. Among the former servicemen was John Linn, six years business brokerage. older than Jenny. She graduated in 1953 and married John You know how to run your practice… Linn the same year. They set up a country practice in Mallala, beginning a professional partnership that lasted until John And Benchmark knows how to sell your practice. Linn died in 2000, and began raising four children: Bruce, The Benchmark Medical Division twins Peter and Sally, and Jack. Sally died aged six in 1962. has brokers dedicated to structuring It was many years later that her sons learned that there was win/win transactions for the long term success, and benefit of all significant community resistance to her being both doctor parties involved. and mother in the regional town. ‘Jenny’s life would have Contact Brian Sander today for a been significant now but was truly outstanding for a woman free appraisal on your practice. born in the 1930s,’ Bruce said. The family moved from Mallala to suburban Walkerville in 1969, and over subsequent years Jenny welcomed daughters- in-law and, in 1977 and at the age of 46, the first of seven Brian Sander grandchildren. Her initial response was an indignant ‘I’m Specialist Business Broker much too young to be a grandparent,’ Bruce said.

0418 823 248 | 1300 366 521 In the 1970s, while running a busy general practice and [email protected] becoming the first medical superintendent of the Walkerville benchmarkbusiness.com.au Nursing Home, she completed her MD, focusing on the role of the nurse in chronic illness care and treatment. ‘She recognised the importance of interdisciplinary care several decades ahead of much of her profession,’ said Jack. MEDICAL & DENTAL At the same time, Jenny became increasingly involved in PRACTICE SALES the politics of medicine, culminating in her being the first Brisbane • Sydney • Melbourne • Adelaide • Perth • Gold Coast female president of the AMA in South Australia, and later sitting on the AMA’s Federal Council.

36 | medicSA She was awarded her fellowship of the of the Royal Australian College of General Practitioners in 1971, the only female GP to participate in and then pass the first Australian exam seminar. She served on and chaired several committees, including those focusing on family planning, publications and accreditation. She sat on the RACGP board for many years and was the first female provost of the South Australian and Northern Territory faculty. Her work with young graduates extended to the University of Adelaide, where she was a member of Council, clinical senior lecturer in the Department of General Practice, convenor of the Academic Progress Appeals Tribunal, and held various roles with the Alumni Association. Dr Jeanette Linn, second from left, is pictured with She also found the time to contribute to the Medical Dr Thea Limmer, Dr Janice Fletcher, and Dr Trevor Pickering Board of SA, the Administrative Appeals Tribunal, the Legal at the unveiling of her portrait, which now hangs in AMA House. Practitioners Conduct Board, the St Andrews Hospital board, the sapmea board, and pursue a special interest through her ‘She was passionate about the health and education of membership of the Aviation Medical Society. young people, working at the Student Health Service at the ‘Jenny had a strong sense of community, and much of her University of Adelaide for many years,’ Jack said. ‘She was a life energy, including her professional role, was directed mentor to a generation of young people, enabling them to toward church and community,’ Jack said. ‘Even after her achieve their potential.’ retirement from general practice, she continued to be a Among them was a young Dr Clare Fairweather, who community leader, including as an elected member of the managed Jenny’s care in her final years. Walkerville Council and a member of both the Order of St Outside her professional roles, Jenny was involved with John and the Order of St Lazarus.’ St Peter’s Cathedral for many years, including as the first Peter said that after the death of their father, her second female Dean’s Warden and later at St Andrew’s Walkerville. husband John Hain gave her ‘new energy and life’. She loved flowers, arranging flowers at the Cathedral for ‘John supported her as she declined as a result of many years, and the Cathedral music. dementia,’ Peter said. ‘Our mother was a role model to a generation of young Jenny was recognised with a Medal of the Order of people, including at the professional, community and family Australia in the 2002 Queen’s Birthday Honours List, levels,’ Peter said. ‘She used all her gifts to try and make the ‘for her services to the medical profession as a general world a better place.’ practitioner, lecturer and health advisor, particularly in the field of geriatrics, and to the community through a range of From the eulogies read by sons Bruce, Peter and Jack Linn at education, church and women’s groups’. Dr Linn’s funeral

PRACTICE NOTES

NOTICES and monthly at Victor Harbor, Penola available most days. Premium location and Mount Gambier. He is available with excellent patient parking and Plastic surgeon Dr Richard for telephone advice to GPs on public transport access. Contact Hamilton MBBS, FRACS wishes to 8272 6666 or 0408 818 222, and Dr Richard Kwiatek on 0447 070 358. notify colleagues that his private clinic welcomes emergency plastic and hand Hamilton House Plastic Surgery has surgery referrals. recently been fully re-accredited under For convenience, referrals may be ROOMS FOR SALE the Australian National Standards faxed to 8373 3853 or emailed to OR LEASE (NSQHS) for health-care facilities and [email protected]. For by the American Association for the appointments, phone Richard’s friendly NORTH ADELAIDE Accreditation of Ambulatory Surgical staff at Hamilton House on 8272 6666, Available for lease, grand Facilities International (AAAASFI). or visit www.hamiltonhouse.com.au. accommodation in Brougham Place, Richard continues to practise North Adelaide. Ground-floor consulting plastic and reconstructive surgery rooms/offices in prestigious Newland at Hamilton House, 470 Goodwood ROOMS TO RENT House to suit the medical, institutional Road, Cumberland Park, with special and corporate sectors. interests in skin cancer excision and NORTH ADELAIDE The tenancy is serviced with ducted reconstruction, hand surgery and Furnished sessional rooms to rent r/c air-conditioning and carparks. general plastic surgery. Convenient in gracious Victorian villa at North Negotiable rental rate and terms free parking is available. Adelaide, to join current specialists. available. For details and inspection He also consults fortnightly at Suitable for non-procedural medical arrangements please contact Morphett Vale and McLaren Vale, specialists or allied health, and Trevor Dunsford on 0412 231 014.

medicSA | 37 DISPATCHES

2020 GALA DINNER AMA(SA) ANNUAL AWARDS AMA(SA) members make informed financial decisions. Join friends, colleagues and the Each year, the AMA(SA) presents Phone 1300 764 200 or email wider medical fraternity at the 2020 two awards at the Gala Dinner: the [email protected] with AMA(SA) Gala Dinner at the Adelaide AMA(SA) Award for outstanding your query or to contact one of their Convention Centre on 23 May. Organise service in medicine and the AMA(SA) medical-profession specialists. a table for what promises to be a Medical Educator Award. If you wish to fantastic evening of fun, colour and nominate a friend or colleague for the Hood Sweeney also holds regular spectacular entertainment. 2020 awards, which will be presented seminars at AMA House, which are at the Gala Dinner on 23 May, please free for members to attend. For details The ‘Disco Lights’ theme is a chance download the nomination forms on the about forthcoming events, including to dig out your John Travolta suits and AMA(SA) website or contact Claudia ‘Life Begins at Retirement’ on 11 March, Xanadu glitter or your black-tie attire. Baccanello at [email protected]. please visit www.amasa.org.au. For bookings or queries, please contact Nominations must be received by COB Rebecca Hayward on 8361 0108 or at on Friday, 27 March 2020. [email protected] SUPPORTING PROFESSIONAL DEVELOPMENT HELPFUL HINTS – LOGGING AMA(SA) ANNUAL GENERAL INTO THE MEMBER PORTAL Created by the Australian MEETING Medical Association, doctorportal Are you having trouble logging on to Learning works with the best The Annual General Meeting of the update your details, renew your tax- subject‑matter experts to help AMA(SA) will be held at AMA House at 8 deductible membership for 2020, or doctors access and complete their pm on Thursday, on 7 May 2020. print your tax invoice? Here’s a simple development obligations. tip to help: The educational content goes beyond Please contact Claudia Baccanello on Head to: members.amasa.org.au clinical topics to include aspects such 8361 0109 or at [email protected]. Username: your email address as difficult conversations, ethics and au if you are interested in attending, or Password: whatever you have set this as. would like a copy of the agenda. professionalism, and leadership. For more information go to IS YOUR DATA CORRECT? www dplearning.com.au NOMINATIONS FOR AMA(SA) The AMA also has a range of practice Early career doctors are encouraged COUNCIL support tools for members, such as to review their membership accounts the GP Practice Support Toolkit. For to ensure the AMA(SA) database has AMA(SA) members are invited more information about resources accurate details. to consider nominating for about a range of specialty and For example, some interns forget AMA(SA) Council. professional development topics, to provide new email addresses to The Council welcomes nominations for visit www ama com.au. replace their student contacts. If the positions of President and Vice- you’re currently registered as a student If you’re a doctor in training, you may President. member and you’re now an intern, want to ensure you’ve covered all the It also seeks eight ‘ordinary members’ please let us know and we’ll change bases when applying for positions. and four regional representatives your membership category. The career resources at ama.com.au/ for two-year terms beginning at the To check your details, log into your careers/career-coaching are designed to help you understand what you’re same time. account or contact membership@ applying for, and how to stand out If you are interested in nominating, amasa.org.au. from the crowd. request a nomination form from Claudia Baccanello by calling 8361 0109 or emailing [email protected]. For conditions and enquiries relating to the PLANNING FOR THE YEAR nominations, please contact the Chief AHEAD Executive Officer, Dr Samantha Mead, The AMA(SA) office has a limited on 8361 0109 or CEO@ amasa.org.au MEMBER BENEFITS FROM number of 2020 wall planners to give Nominations close at COB on PARTNER HOOD SWEENEY away. If you’d like one, please email Wednesday, 25 March 2020. Do you need a financial health [email protected] – first in, Members are reminded that you are check-up? Are you ready to plan your first served! welcome to attend AMA(SA) Council financial future? meetings. Meetings are held eight Hood Sweeney is the preferred times a year (there are no meetings in accounting and financial planning GET SOCIAL WITH US! January, April, July and October). The provider of the AMA(SA) and a leader @amasamembers next meeting is scheduled for Thursday, in business and financial advice 5 March at 7 pm. Any member wishing to the health sector, and offers AMA(SA) Doctors Group & AMA(SA) to attend should contact Claudia AMA(SA) members special discounts Doctors in Training Committee Baccanello on [email protected] for accounting services. Hood Please add #amasamember to your or 8361 0109. Sweeney is passionate about helping pictures so we can see them and share!

38 | medicSA You’ve read

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