medicAUGUST 2020 SAVOLUME 33 NUMBER 4

Care factor Leading the AMA through the pandemic

AMA'S NEW LEADERSHIP TEAM • MANAGING COVID-19 IN RURAL SA FEEDING THE PLANET • HEALING HANDS • VALE SENIOR MEMBERS Specialist radiology services in the Adelaide CBD Calvary Adelaide Hospital is the largest private medical imaging clinic in South Australia and offers a comprehensive range drjones.com.au/ of specialist radiology services without comparison. calvary-adelaide- The clinic boasts a Siemens Vida 3.0T MRI and a Siemens Sola 1.5T MRI which hospital compliments the low dose CT, X-ray, Ultrasound, Interventional Radiology, Nuclear Medicine and Dental Imaging capability. All are designed to deliver the highest quality diagnostic / interventional radiology services whilst providing the best patient experience in the heart of the Adelaide CBD.

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Dr Nicholas Bajic Clinic Director, drjones.com.au/online-referring Calvary Adelaide

2 | medicSA Doctor Led • Patient Focused • Quality Driven drjones.com.au Contents

Australian Medical Association 5 President’s report (South Australia) Inc. Level 1, 175 Fullarton Road, 6 Being mortal – former AMA(SA) president Dr Phil Harding Dulwich SA 5065 records his own health challenge PO Box 134 North Adelaide SA 5006 9 Zooming in on the AGM Telephone: (08) 8361 0100 Facsimile: (08) 8361 0199 10 Winning ticket – new Federal AMA President and Email: [email protected] Vice President outline their vision Website: www.amasa.org.au Executive contacts 16 Healing hands – the pandemic’s lasting influence on President health workplaces Dr Chris Moy: [email protected] 19 Country practices – managing COVID-19 in rural medicSA South Australia Editorial Editor: Dr Philip Harding 20 On trial – South Australia’s advantages as a biomed Managing Editor: Karen Phillips trial site Cover image 24 Food for thought – diet guidelines for a healthy planet Brett Sheridan, Blue Razoo Advertising 28 A smashing serve – the benefits of AMA(SA) membership [email protected] Production 31 New treatments, new hope for paediatric Typeset and printed for the AMA(SA) by neurology patients Douglas Press Pty Ltd. 38 We can be heroes – leading well in a crisis ISSN 1447-9255 (Print) ISSN 2209-0096 (Digital) 40 Vale – remembering Dr Dean Southwood Disclaimer and Dr Malcolm Wheaton Neither the Australian Medical Association (South Australia) Inc nor any of its servants 46 Dispatches and agents will have any liability in any way arising from information or advice that is contained in medicSA. The statements or opinions that are expressed in the magazine reflect the views of the authors and do not represent the official policy of the Australian Medical Association (South Australia) unless this is so stated. Although all accepted advertising material is expected to conform to ethical standards, such acceptance does not imply endorsement by the magazine. All matter in the magazine is covered by copyright, and must not be reproduced, stored in a retrieval system, or transmitted 10 in any form by electronic or mechanical means, photocopying, or recording, without written permission. What's next? Images are reproduced with permission under limited license. While AMA(SA) colleagues, family and friends gathered elsewhere – at COVID-acceptable distances – AMA(SA) President Dr Chris Moy took a few moments to prepare for his vice-presidential candidate’s speech during the National Conference on 1 August. Soon, Dr Moy would be elected Federal Vice President alongside new President Dr Omar Khorshid, becoming the first South Australian to hold the national VP office since Dr Trevor Mudge from 2000 to 2003.

medicSA | 3 DRAFT

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Strange days are these

s I write this, we in South and beyond, that was a major reason Australia can but feel like we I nominated for the position of AMA are living in a safe parallel Vice President alongside my friend President’s universe when compared to and former AMA Western Australia Aour Victorian brothers and sisters. report President, Dr Omar Khorshid. It was a Leaving to one side the causes of the strange campaign; Omar and I didn’t second wave of COVID-19 infections Dr Chris Moy meet in person once during our months which have struck Victoria, what is not of preparation. And it was an equally in dispute is the frightening rapidity in strange AMA National Conference, with which it developed and how quickly it delegates sprinkled across our nation took health services to the brink, as well connected via technology and computer as overwhelming testing and contact screens. But we were fortunate that tracing capabilities. There was almost our shared vision for a better, stronger, universal alarm at the handling of the more approachable and inclusive AMA escalating situation by the Victorian Government, which was putting not seemed to strike a chord with delegates only the Victorian community at across the country, so that Omar and risk, but the rest of Australia as well. I were successful in our respective However, this was not voiced publicly elections at the National Conference by many authorities due to a need to on 1 August. I am pleased that we can maintain the appearance of cohesion now begin the work we promised would which has served Australia well so far in be the focus of our efforts. We want to the pandemic. advocate for all AMA members, and This is where the independence can only do that if we hear from you. of the AMA became important in I’ll be doing my best to support Omar in recent weeks, as it became essential to leading your AMA. I hope you’ll let me articulate to the public the seriousness know how to do it better as we go along. of the situation and the need for I would like to thank the AMA(SA) Victorian authorities to move quickly Council and Executive Board, South to a much higher level of lockdown. Australian delegates, the AMA(SA) AMA(SA) provided support to our AMA secretariat and our wonderful CEO Victoria colleagues including in using Dr Samantha Mead for their support our media influence, culminating in an these past months. interview on national television where Meanwhile, I will continue in my I explained that it was ‘now or never’ for role as President of the AMA in this Victoria to move to Level 4 restrictions state. This role is as important to me because ‘finicking around’ had not as the national one and I have been so worked and was risking the rest of the fortunate to have presided at a time … our shared vision country. Within days of a concerted media effort by the entire AMA, Victoria when I have been able to see how you, for a better, stronger, moved to Level 4 restrictions. our members, have contributed so much more approachable Our independence, and our to the recent efforts in South Australia. willingness to stand up when it is Although a great deal of uncertainty and inclusive AMA required for patients and colleagues, remains regarding the course of the seemed to strike a seems to me to be at the core of why the COVID pandemic, what I am certain AMA has the trust of the community. about is that the community can chord with delegates It was the need to reinforce this continue to rely on their doctors and our across the country … independence, during the pandemic profession to be there for them.

medicSA | 5 EDITORIAL

Brain tumour masquerading as an IT problem Former AMA(SA) President Dr Philip Harding discovered the hard way that a brain tumour is one of the problems that can’t be fixed by turning the computer off and on again.

hen I wrote my editorial fixes in the program settings. column for our first These made some difference but online edition in June, not to a satisfactory extent. I could specifically on the subject not come up with a solution and Wof the new Calvary Adelaide Hospital became quite frustrated with the Dr Philip Harding pictured at the AMA Federal and the way in which it had acquired poor performance of Dragon, Election gathering at AMA(SA) offices at and then lost its original name of which has for a long time been Fullarton on 1 August Wakefield Hospital, I had no idea that such an essential tool with all my within a few weeks I would be lying computer work, particularly as I am a was agreed with the neurosurgeon that within this new institution as a patient hopeless typist. what was being observed was a relatively with a serious medical emergency. The Then, on May 14, a day of which I severe dysarthria. unusual way in which this presented is have no recollection, my wife noticed After a few days in the neurosurgical worthy of documentation. that on rising I was unsteady and that ward I was transferred to the I have been a very long-term user of my speech was particularly slurred. rehabilitation ward on site at Calvary voice recognition technology in the She thought I was developing a stroke Adelaide and commenced an active form of Dragon Dictate, also known and despite my protestations called the program including quite intensive as NaturallySpeaking, and use it for emergency ambulance. The crew agreed physiotherapy, speech pathology and everything I write, including what with her assessment and conveyed occupational therapy. On day 23 I was you’re reading at the moment. In early me to the new RAH, where a CT scan discharged home to continue these 2019 I re-equipped my office with a showed a mass in the right temporal activities under the supervision of the new desktop system and upgraded region with significant associated Rehabilitation in the Home program the Dragon to professional version 15. cerebral oedema and midline shift. I This was a huge overnight download was transferred to Calvary Adelaide (RITH), a public-sector program from Dragon’s US base, accompanied under neurosurgical care. Partial operating from the Queen Elizabeth by a long online tutorial from one of resection of the lesion, which turned Hospital that supplies home visits from its expert technicians, as I recall from out to be a high-grade glioblastoma, was the above-mentioned allied health somewhere in the depths of Minnesota. undertaken that evening. professionals. The speech pathology There were some differences from The surgical decompression and was particularly effective; both the the version 11 I had previously but the associated high-dose steroid therapy professionals and my family and friends system generally worked well. rapidly relieved the cerebral oedema noticed that I was speaking much more Sometime in about March this year and reversed the midline shift, and clearly. Associated with this, the Dragon I began to experience inaccuracy with clinical improvement began to occur. NaturallySpeaking program now works the voice recognition. Those familiar On initial presentation at the new perfectly. There had been no problem with these systems will be aware RAH I was observed to have a left with the software: the dysarthria that the program has to be trained hemiparesis, which did not persist, and presumed to be an effect of the to the voice of the specific user. The was also found to have been aphasic. developing tumour and consistent with accuracy problems persisted despite As I’m right-handed, this latter finding its location in the right (non-dominant) my contacting the Dragon agent in would have been inconsistent with the temporal area prevented the program Sydney who suggested some simple non-dominant site of the lesion, and it from recognising my speech correctly.

6 | medicSA EDITORIAL

By this stage a definitive treatment 1950s. This was a very controversial program had been agreed, following event, the British government discussion of the relevant clinical trial knowingly allowing significant data, involving an intensive three- Australian servicemen and the local AMA(SA) week protocol of daily Monday-Friday indigenous people to be exposed to COUNCIL radiotherapy sessions and simultaneous radiation. I enjoyed watching the oral chemotherapy using temozolomide, series - mostly while in hospital - as to be followed by an adjunctive I felt connected with it in two ways. Office Bearers phase of six cycles five day/28 days First, as a teenager growing up in President: Dr Chris Moy temozolomide. The three-week program Salisbury North at the time these tests Vice President: Dr Michelle Atchison that started when I returned home was were conducted, I had several friends Immediate Past President well tolerated with minimal side effects; whose families were British expatriates A/Prof William Tam the worst was fatigue attributable to the involved with the test program. Second, radiotherapy. At the time of writing - in 1967 as part of my military service, Ordinary Members day 46 from initial presentation - I am I was senior medical officer at RAAF Dr Daniel Byrne, Dr Penny Need, having a rest from all treatment pending Edinburgh and the remaining skeleton Dr Rajaram Ramadoss, a major review with imaging at the facilities at Maralinga were part of my Dr Andrew Russell, end of July, which will act as a baseline administrative responsibility. Dr Nimit Singhal, Dr John Williams for further follow-up and possible On one occasion I gave the civilian active treatment. Specialty Groups doctor in charge at Maralinga a weekend A thought that has been wandering Anaesthetists: Dr Simon Macklin off and went up there to relieve him. around in what remains of my mind Dermatologists: Dr Patrick Walker It was an interesting weekend in a has been why I should develop such a Emergency Medicine: Vacant number of ways but one of the things I problem with its uncertain prognosis, General Practitioners: having been fortunate to avoid most did was to go out to Emu Field, which had been the site of one of the major Dr Bridget Sawyer of the shafts and arrows of life during Obstetricians and Gynaecologists: almost 80 years of healthy life. My only tests, and stand on the spot where Dr Jane Zhang other significant ‘other side of the sheet’ it went off, identified by the marker episode was an aortic valve replacement depicted here and showing warnings Ophthalmologists: Dr Edward Greenrod conducted successfully (and about persisting radiation levels. I do Orthopaedic Surgeons: coincidently in Calvary’s predecessor remember wondering whether all the Prof Edward (Ted) Mah Wakefield Hospital) in 2014. excitement was really such a good idea. Paediatricians: Dr Patrick Quinn Just about the time the emergency And sometime in the past few weeks I Pathologists: Dr Shriram Nath situation occurred in mid-May, ABC related this story to my brother, who also Psychiatrists: Prof Tarun Bastiampillai has a history as a RAAF medical officer. television started screening Operation Public Hospital Doctors: Buffalo, a semi-documentary series He commented, ‘I wonder how many Dr Clair Pridmore depicting the series of British atomic people who did that stupid thing now Surgeons: Dr Peter Subramaniam bomb tests at Maralinga and nearby have brain tumours?’. areas in far-west South Australia in the Food for thought, perhaps. Radiologists: Dr Jill Robinson Regional Representatives Northern: Dr Simon Lockwood Doctors in Training Representative Dr Hannah Szewczyk Student Representatives University of Adelaide: Mr Jack Rumbelow Flinders University: Ms Matilda Smale AMA(SA) Executive Board Dr Michelle Atchison, Mr Andrew Brown, Dr Guy Christie- Taylor, Dr Chris Moy, Dr John Nelson, A/Prof William Tam, Ms Megan Webster Federal Councillors Dr Michelle Atchison (Area Nominee SA/NT) Dr Matthew McConnell (Specialty Group Nominee: Physicians) Dr Hannah Szewczyk (State Nominee – Proxy)

A marker at the Emu Field test site at Maralinga

medicSA | 7 8 | medicSA ANNUAL GENERAL MEETING

A foundation for growth The 2020 annual general meeting of AMA(SA) provided a different perspective on new and emerging issues.

he annual general meeting of the Australian Medical Association in South Australia mirrored so many Tmeetings of 2020, with members of the AMA(SA) Executive Board, Councillors, members and Secretariat staff members ‘gathering’ in the Zoom meeting on 6 August. The meeting included the re-elections to the positions of President and Vice-President of incumbents Dr Chris Moy and Dr Michelle Atchison. While the 2019 Annual Report reflects AMA(SA) activities in 2019, discussion at the AGM included recent challenges that have affected and will continue to dramatically influence the organisation in 2020: the fire at AMA House on 6 May and the resultant move of the Secretariat to temporary premises, and the immeasurable impacts of the pandemic. Board Chair Dr John Nelson said that despite the ‘internal and external challenges’ facing AMA(SA) in the past two years, ‘somewhat perversely and in a purely financial sense, the outcome is currently positive.’ Dr Moy, who chaired the meeting, said reasons for optimism included the ‘exciting’ re-organisation of the AMA(SA) Doctors in Training Committee, the restructure of the AMA(SA)CGP, and the medical students’ involvement and commitment in The AMA House fire will be an issue for the AMA(SA) responding to the pandemic. Executive Board in 2020 and beyond.

COUNCIL NEWS

in Kaurna language. I personally find it the current Victorian situation with quite moving. Well done to Michelle for a special emphasis on health-care making the effort to learn this and put it workers’ access to appropriate PPE. As into practice. Federal Vice President, Chris is now in This was the first AMA(SA) Council the thick of representing our front-line meeting since the 2020 AMA National health care workers all over Australia. Conference at which our SA President I know he is bringing his enthusiasm, Chris Moy was elected Vice President energy and passion to do just that. Dr Danny Byrne with Dr Omar Khorshid from WA One of the most important items gaining the Presidency. As he cannot on the agenda was to endorse the Councillor hold two spots or have two votes, draft Terms of Reference (ToR) for the Chris nominated Doctor in Training Doctors in Training Committee. Hannah AMA(SA) Council Meeting representative, Dr Hannah Szewczyk, as and her team have worked hard to August 2020 his ‘proxy’ to represent the AMA(SA) on modernise the ToR, with a special effort Federal Council, a motion unanimously to update the representative structure. supported by Council. The Committee will be more reflective Two casual vacancies on Council of the 20:20 make-up of our Doctors in ouncil continues to meet via needed to be filled, with Professor Ted Training across the geographic spectrum Zoom and I have to say we are all Mah filling the vacant spot representing and the mix of specialities represented. becoming better and better at C orthopaedics and Dr Clair Pridmore to A final agenda item was to using the technology and remembering represent public hospital doctors. Please recommend to the AGM that followed to ‘unmute’ before we speak. make use of your representatives on this Council meeting to reappoint AMA(SA) Council Chair and Vice AMA(SA) Council; we are only too happy Pitcher Partners as the auditors for President Michelle Atchison has to listen to any feedback, concerns 2020. With COVID-19 and the AMA introduced a new practice for our or ideas. House fire it was thought important to Council, opening each meeting with an COVID-19 is never far from our minds. have continuity and stability in this area Acknowledgement to Country spoken Dr Moy was able to give an update on of governance.

medicSA | 9 FEDERAL ELECTION

Running mates

West Australian surgeon Dr Omar Khorshid and AMA(SA) President Dr Chris Moy were elected as Federal AMA President and Vice President on 1 August. In the weeks leading to the election, Dr Khorshid and Dr Moy released two podcasts in which they explained their perspectives on issues such as why they campaigned on a ‘joint ticket’ and the role of the AMA during and after the pandemic. Some of the key questions and their answers (changed for brevity and readability) are provided here.

What's your vision for the AMA of inertia and resistance that have often What about the bullying aspect? under your leadership? held sway in the past. CM: I've been a victim of bullying and I've seen what it looks like, and it's OK: My vision is to be the peak There are a lot of doctors facing something I feel really needs to go. And medical body. The body that financial challenges because of the everyone else looks to for direction I think something like bullying about pandemic. How do you think the and for leadership. We have a lot of the mask issue is representative of the representative bodies, colleges and AMA can help their members with fact that the doctors and nurses are associations within our membership this side of things? not the priority in healthcare. And so, – within our profession – and we've also OK: We need to have our hospitals safe for example, in South Australia, we're got lots of other really important players places to work so we can keep treating trying to embed into legislation that boards have equal responsibility, that in the health system, starting from patients there, even while we've got is explicit that they have to care for the patients, of course, but also hospitals, viral outbreaks in nursing homes or health and welfare of their staff right private health insurers, governments. in certain geographic areas. The other And our health system is so complex. We up there with caring for patients and thing that's going to be a really big item need to bring all those people together to managing budgets. on our agenda is the financial impact on have the big conversations about where our whole economy. And we as an AMA With the current COVID-19 we need to take health to deal with the pandemic, why do you think the challenges we know are coming. We do need to be ready to lead the profession AMA's visibility is vital? need also to engage with other medical – whether it's reform ideas, even just organisations, not compete with them. bringing people together to discuss OK: During COVID, we have had an We want to be the peak medical body, the future. enormous impact as an AMA. Different at a national level to each state, but a lot and that means bringing those other Part of the role of president of the organisations together rather than of collaboration with the government fighting with them. And that's certainly AMA is advocating for doctors in and the big decision makers in something that I'm committed to do. We the media. Recently we learned government, but also some really strong really want an AMA that doctors care doctors working in Sydney hospital statements from the AMA in the public about, that doctors aspire to be members were being bullied by hospital from some of our state AMA presidents of, and when they are a member, that it administrators, simply for asking for from our federal president that actually has a meaning to them. pushed the government to make hard protective masks. How would you decisions and got the public to realise What has COVID-19 meant for the respond to this? that actually these decisions are okay if AMA and its members? OK: We saw this a lot early on during they're needed. And that's what saved us OK: Right at the start, we saw a lot the COVID-19 pandemic, but things have from a huge early outbreak of COVID. of fear; we saw uncertainty about how changed. We've now got clear guidelines Can you talk about why you are do we even treat patients with this and we've got a great supply of PPE. condition? Our members were also involved in the AMA? No health worker should contract this affected in more practical ways; not CM: What I've found behind the disease in the course of their work. It's being allowed to operate for surgeons, scenes and what people don't realise, for instance, meant a complete loss of a strong message, really to the hospital is that the organisation has an almost income for a couple of months. But there administrators, to say: ‘You are going to frightening level of influence. Therefore, have been positive lessons as well; we've be responsible. You have to provide a safe I understand that there is a need for this learned we can make change really fast. workplace and you will be responsible if organisation to change both practically CM: There's been this can-do attitude, your health workers are not safe in their so that people can get what they need which has really broken through a lot workplaces’. from the organisation, and also in spirit

10 | medicSA FEDERAL ELECTION

so that they can feel more welcomed and so that we can encourage younger members and members who are maybe more diverse in their views to join the fight and become the leaders of the future. The AMA is only as strong as its membership, so what will you be doing to encourage retention and entice new members? OK: The AMA does an awful amount of hard work for all members, and in fact non-members, all doctors and health in the community. Dr Omar Khorshid Dr Chris Moy What we're not so good at is explaining that to people, showing them have the commitment to deliver. We've able to open our hearts to those ideas what is being done on their behalf, and got to have the passion, the energy, we're also not that good at listening. and really incorporate the ideas from our the availability to make sure that we're So, I think those are two key issues: members so that they can be generally a out in the community being seen by working out how to communicate better part of where we go from here. politicians, by patients, and, of course, outwards, and how to accept feedback by doctors. Your elevator pitch: you each have issues from members. [We need] to 30 seconds to convince members to What about AMA policy? change our culture, to be more inclusive vote for you. and allow people access to our leaders OK: Policy is probably the strength Our profession needs a strong, within the AMA, but also use technology of the AMA. Our whole structure is OK: to better engage with the broader designed to be a policy factory. We vibrant, and nimble AMA, especially membership and the broader profession. bring together a broad group of people in these times. Our challenge is to demonstrate our leadership of the To avoid the AMA being too city- and we develop great policy. Where we profession through active listening, centric, how will you attract doctors sometimes fall down is in implementing that policy. That's really the challenge. engagement, clear and targeted from rural and regional areas? communication, and by working with Why do you want to do this CM: We need to use technology, government and other stakeholders job, Omar? number one, and we need to genuinely while also maintaining our independent listen. I think one of the other things is OK: The reason I want to do it is it's and trusted advice. I've always been a to go visit, not just sit in our ivory towers, actually really important. It's one of proud AMA member, and I hope to have but to get out there. [For example] as those opportunities for the AMA to reach the opportunity to transform our AMA AMA South Australia president, I had out into the community, to build that into an organisation that all doctors my eyes opened to the needs of those in trust and recognition of our brand and of aspire to join. the country when I visited the west coast our profession and the great things that COVID's showing me that the of South Australia and saw the real need we do. So, it's just got to be done, it's part CM: out there. of the job, and I'm up for it. AMA is fantastic at standing up and getting things done. Now is the time Strategy does sometimes feel a bit Why is communication so to build on this and to mould the remote from members' everyday important when it comes down organisation into something that works work, but why is strategy so to implementing new strategies for members and potential members, important for AMA members? and policies? and really inspires them to become OK: The strategy of the AMA isn't CM: This is a membership involved and then to serve and really feel something the average member should organisation and we should be like it is the way that they can change the need to think about, but it's a tool we representing members, and we need world for the better. need to use to help us focus on what to understand what they have in their we are and what we stand for, and minds and hearts. So, we need to be able Describe yourself in three words. to target our efforts to improve the to listen. And to be able to listen, we OK: Logical, persistent, collaborative. health of Australians. Strategy isn't firstly have to have the mechanisms to CM: Direct, positive, everything, though. We also need to do so. And number two, we need to be and compassionate.

medicSA | 11 PRESIDENT'S AWARD

Support for asylum seekers earns President’s Award

AMA ACT President Dr Antonio Di Dio has been presented with the AMA President’s Award for his work representing the AMA on the independent panel established to assess the medical evacuation cases of asylum seekers in offshore detention.

r Di Dio, a Canberra GP, the medical profession and the AMA, Dr Antono Di Dio devoted countless hours of applying his expertise without fear or his own time as the chair favour while discharging his duties with circumstances that were highly politically charged. of the Independent Health care and compassion,’ AMA President DAssessment Panel (IHAP), which was ‘It is a tribute to Antonio’s skill and Dr Tony Bartone said. compassion that he was able to so set up under the Turnbull Government ‘Antonio’s IHAP duties required effectively discharge his duties; a matter under the Medivac legislation to review serious statutory obligations, involving that reflects great credit on both him the cases of detainees on Manus Island his skills as a medical practitioner, and and the AMA.’ and Nauru. as an officer of the AMA. Dr Di Dio was presented with the ‘At all times, Dr Di Dio undertook his ‘All of this involved an extraordinary President’s Award at the AMA National work with IHAP in the best traditions of call on his personal time, during Conference on 1 August. Tasmanians lead Fellows list Two current State AMA Presidents, two past State Presidents, the Medical Journal of Australia editor, and a married couple have been inducted into the AMA Roll of Fellows, in recognition of their outstanding contributions to medicine, the medical profession, and the AMA.

our of the seven are from Conference, held via videoconference on ‘Dr Stuart Day has shown tremendous Tasmania. The new Saturday, 1 August. dedication to the AMA for the past Finductees are: ‘These seven outstanding doctors quarter-century, representing hospital • AMA Tasmania Past President and demonstrate the extraordinary range doctors and serving in a variety of roles, anaesthetist Dr Stuart Day and professionalism of the AMA including as AMA Tasmania President. • AMA ACT President and GP membership,’ Dr Bartone said. ‘Dr Antonio Di Dio has been the Dr Antonio Di Dio ‘Dr Anne Wilson and Dr Don Rose driving force behind the doctors’ health • AMA NSW Immediate Past President have devoted close to 70 years of service in Canberra, and provided and GP Dr Kean-Seng Lim service to their community in northern countless hours of his own time to • AMA Tasmania President Tasmania and to the AMA, while raising review medical transfer requests for and occupational physician a family of four. asylum seekers in offshore detention. ‘Professor Nick Talley has ‘Dr Kean-Seng Lim is committed Dr Helen McArdle combined his work as a world-leading to providing integrated care, where • Medical Journal of Australia editor and neurogastroenterologist with his role doctors, nurses, and other health neurogastroenterologist Laureate as editor of one of the world’s most professionals work together for their Professor Nicholas Talley influential medical journals, the Medical patients, and helped develop a schools- • Tasmanian representative on the Journal of Australia. based obesity prevention program now AMA Federal Council of General ‘Dr Helen McArdle, who last month in use in 24 schools. Practice and GP Dr Anne Wilson became the first female President of ‘All of these doctors have excelled • AMA Tasmania State Council AMA Tasmania, is a senior medical not just in their medical specialties, representative and GP Dr Don Rose. administrator and an occupational but in their roles as advocates for Outgoing AMA President, Dr Tony physician, who is committed to diversity the profession. Bartone, announced their addition and equity within the profession, and to ‘They have made real contributions to the Roll at the AMA National doctors’ wellbeing. at the State and Federal level to

12 | medicSA AMA FELLOWS

improve working conditions for Dr Kean-Seng Lim one of the most influential clinician- doctors, to improve safety for Dr Kean-Seng researchers in the world, with more patients, to train the next generations Lim, the immediate than 1,000 papers published in peer- of medical practitioners, and to Past President of reviewed literature. make the Australian health system AMA NSW and Prof Talley has been Editor-in-Chief work more effectively for patients Deputy Chair of the of the Medical Journal of Australia since and communities. AMA Council of 2015, and was previously co-editor-in- ‘I commend them for their service.’ General Practice, chief of Alimentary Pharmacology and is a specialist GP with particular Therapeutics and editor of American Each new AMA Fellow has an interests in sports medicine, nutrition Journal of Gastroenterology. He is impressive record of achievement, and lifestyle, and integrated care. His also the author of the authoritative as these edited excerpts from their practice in Sydney’s western suburbs is textbooks Clinical Examination and citations show: built on a multidisciplinary approach, Examination Medicine. Dr Stuart Day integrating doctors, nurses, allied health In 2018, he was honoured with the Dr Stuart Day has practitioners, and a non-dispensing Companion of the Order of Australia. shown tremendous pharmacist, using the Patient Centred Professor Talley has contributed to dedication in his Medical Home principles. AMA NSW and to Federal AMA by his commitment to Dr Lim used his AMA NSW presidency contribution to excellence in medical the AMA and to focus on measures to reduce education and the standards he has the profession overweight and obesity, and helped established for students, doctors in throughout his develop the schools-based obesity training, and doctors. As MJA editor, 24-year membership, holding roles prevention and lifestyle education he has contributed to a highly valued including AMA Tasmania President program – SALSA. member resource. (2016-2018) and Federal Councillor, as Dr Lim has passionately campaigned well as more than 10 years as head of for increased primary care funding, arguing that early intervention and Australian Salaried Medical Officers better management of long-term Federation (ASMOF) Tasmania. health problems is a more sustainable He continues to be an active member healthcare strategy. of the AMA, and is generous in the Dr Helen McArdle giving of his time and advice to all who Dr Helen McArdle, seek it. the first female Dr Antonio Di Dio President of AMA Dr Anne Wilson and Dr Don Rose Dr Antonio Di Tasmania, is a Dr Anne Wilson and Dr Don Rose Dio, the AMA ACT long-standing AMA have given outstanding service to the President, is an AMA member, a highly AMA for more than three decades, Federal Councillor respected AMA supporting each other in both their and a member of the Federal Councillor, a senior medical AMA endeavours and their marriage, Ethics and Medico- administrator, and Occupational raising four children while working as Legal Committee, Physician and medical leader. GPs in northern Tasmania. and has served his colleagues through Dr McArdle has contributed to the They are active members of the AMA leadership of, and involvement with, work of the AMA at all levels of the Tasmania Northern Division, State the AMA, AMA ACT and the NSW organisation since 1990. A Federal Councillor, and Tasmanian delegates and ACT Doctors’ Health Advisory Councillor since 2012, she has made to the AMA National Conference for Service (DHAS), providing much- landmark contributions as a member many years. needed support to troubled doctors and of the AMA Ethics and Medico Legal Dr Wilson has been the Tasmanian Committee, including the development their families. representative on the AMA Council of of the AMA Position Statement on In 2019, Dr Di Dio was appointed General Practice for the past six years. Euthanasia and Physician Assisted as the AMA representative to the Dr Rose has represented the AMA on Suicide 2016, and as inaugural Chair Independent Health Assessment Panel various bodies, including as the current of the AMA Equity, Inclusion and AMA representative member of Primary (IHAP) and subsequently served as its Diversity Committee. Health Tasmania. Chair. His IHAP duties have required Dr Dr McArdle contributes at the Both Dr Wilson and Dr Rose have Di Dio to undertake serious statutory highest level to her profession as been tireless in their efforts to ensure obligations involving the exercise of a clinician, educator, leader, and GPs remain at the centre of patient his skills as a medical practitioner that policy maker. care in policy development and health have made an extraordinary call on his Professor Nicholas service delivery in the public and personal time, in circumstances that Talley AC private domains. were highly politically charged. Professor Talley is a While each nomination was It is a tribute to Dr Di Dio’s skill world-leading neuro– considered independently and on and compassion that he was able to gastroenterologist, its merits, Dr Rose and Dr Wilson are so effectively discharge his duties; a educator and a true partnership and one cannot matter that reflects great credit on both researcher, and is be mentioned without speaking of him and the AMA. widely recognised as the other.

medicSA | 13 FEDERAL ADVOCACY

Priorities for progress

The AMA has demanded a commitment to adequate funding for the successful implementation of the new Closing the Gap agreement.

he National Agreement and Torres Strait Islander on Closing the Gap has the people, their communities, potential to deliver dramatic organisations and businesses, improvements in Aboriginal recognising that success depends on 7. By 2031, increase the proportion Tand Torres Strait Islander health and joint ownership of the initiatives and of Aboriginal and Torres Strait wellbeing but must be supported outcomes. The approach builds on Islander youth (15–24 years) who by funding to achieve targets, says the strong foundations Aboriginal are in employment, education or the AMA. and Torres Strait Islander people have training to 67 per cent Outgoing AMA president Dr Tony through their deep connection to family, 8. By 2031, increase the proportion Bartone said that without needs-based community and culture. of Aboriginal and Torres Strait funding, the targets would remain ‘With the targets principally Islander people aged 25–64 who are unattainable, continuing the trend in developed by a network of Aboriginal employed to 62 per cent disappointing progress in meeting the and Torres Strait Islander organisations, 9. By 2031, increase the proportion of Closing the Gap objectives. they are set up for best possible Aboriginal and Torres Strait Islander For the first time, the National success,’ Dr Bartone said. ‘We know that people living in appropriately Agreement on Closing the Gap Aboriginal and Torres Strait Islander sized (not overcrowded) housing (the National Agreement) has been people have better health and life to 88 per cent developed in genuine partnership outcomes when they have a say over 10. By 2031, reduce the rate of between Australian Governments and their lives and the policies and programs Aboriginal and Torres Strait Islander Aboriginal and Torres Strait Islander that affect them.' adults held in incarceration by at peak organisations through a co- The new Agreement has the least 15 per cent design process. following 16 targets: 11. By 2031, reduce the rate of Aboriginal The National Agreement sets 1. Close the Gap in life expectancy and Torres Strait Islander young ambitious targets and new priority within a generation, by 2031 people (10-17 years) in detention reforms that aim to change the way 2. By 2031, increase the proportion of by at least 15 per cent governments work to improve life Aboriginal and Torres Strait Islander 12. By 2031, reduce the rate of over- outcomes experienced by Indigenous babies with a healthy birthweight representation of Aboriginal and Australians. Under the agreement, all to 91 per cent Torres Strait Islander children in levels of government will be required 3. By 2025, increase the proportion of out-of-home care by 45 per cent to report on their progress towards Aboriginal and Torres Strait Islander 13. A significant and sustained these objectives. children enrolled in Year Before reduction in violence and abuse In addition, the Productivity Fulltime Schooling (YBFS) early against Aboriginal and Torres Commission will undertake a three- childhood education to 95 per cent Strait Islander women and yearly independent report on progress 4. By 2031, increase the proportion children towards zero against the National Agreement. This of Aboriginal and Torres Strait 14. Significant and sustainedreduction will be followed by an Indigenous-led Islander children assessed as in suicide of Aboriginal and Torres review of progress every three years, developmentally on track in all Strait Islander people towards zero and the Joint Council on Closing five domains of the Australian Early 15. a) By 2030, a 15 per cent increase in the Gap will have an ongoing role in Development Census (AEDC) to Australia's landmass subject to monitoring progress. 55 per cent Aboriginal and Torres Strait ‘The AMA is cautiously optimistic 5. By 2031, increase the proportion of Islander people's legal rights or that governments will hold up their end Aboriginal and Torres Strait Islander interests of the bargain and fully implement the people (age 20-24) attaining year 15. b) By 2030, a 15 per cent increase in actions under this new Agreement,’ Dr 12 or equivalent qualification to areas covered by Aboriginal Bartone said. 96 per cent and Torres Strait Islander ‘Yet best intentions will not work 6. By 2031, increase the proportion of people's legal rights or without sustainable, guaranteed Aboriginal and Torres Strait Islander interests in the sea funding for programs and services. people aged 25-34 years who have 16. By 2031, there is a sustained The AMA supports the partnership completed a tertiary qualification increase in number and strength of approach to driving change where (Certificate III and above) to Aboriginal and Torres Strait Islander governments work with Aboriginal 70 per cent languages being spoken.

14 | medicSA FEDERAL ADVOCACY

Primary sources The AMA’s new vision for primary health places GPs at the front and centre of care.

ederal Government spending In addition, the on general practice and growing prevalence of primary health care should be chronic health conditions mandated at a minimum 16 per has greatly increased Fcent of total health spending to meet demand for and cost of the increasingly complex medical treatments, with patients needs of an ageing community, the with chronic diseases AMA advises. accounting for 47 per cent of In releasing the AMA vision for preventable hospitalisations. the future of primary health care ‘The Australian population and general practice, AMA outgoing is growing, ageing, and president Dr Tony Bartone said developing more complex COVID-19 had highlighted the chronic health needs as chronic underfunding of general practice and disease and mental ill-health the need for sustainable funding for continue to increase,’ the primary health care. report notes. ‘General practice funding coordinated with multidisciplinary ‘Successive governments have models must change to meet the needs healthcare teams led by GPs, to overseen a rate of investment in of the community.’ manage and reduce the risk of patient general practice that has not matched While telehealth has been successfully comorbidities and decrease the number the increase in the cost of providing implemented and embraced during the of adverse medication events. high-quality patient care,’ Dr COVID-19 pandemic to support general It outlines immediate funding goals Bartone said. practice and reduce the risk of infection, recommended as part of the Federal ‘Government spending on GP it represented only a fraction of the Government’s 10-year Primary Health services is about $391 per person innovation and transformation required Care Plan and provides a framework that annually, down from $395 in 2017‑18.’ in the rest of the general practice can be implemented over three tranches The vision, Delivering Better Care for framework, Dr Bartone said. to support the transformation of general Patients: The AMA 10-Year Framework The report notes that inadequate practice into high-performing, patient- for Primary Care Reform, notes that support for general practice leads to centred medical homes. while general practice is the key to care that breaks down between general Four key recommendations sit at the ensuring a high-quality, equitable practice and other arms of the health centre of the vision: and sustainable health system, many system, and causes significant cost • primary care reforms to build on the practices have required large financial increases to the health system. existing GP-led model of primary incentives to keep them viable during In 2016-17, 6 per cent of all health care, which delivers high- the pandemic. hospitalisations were due to 22 quality, cost-effective outcomes for The report notes that government preventable conditions that could be patients indexation of Medicare rebates has managed by general practice. This not kept pace with the rising cost of accounted for over 2.8 million hospital • a suitable funding model to transform medical practice. While the Consumer bed days. general practice into a medical home Price Index and medical costs increase As well as reducing pressure on • adequate funding for general practice by about 3 per cent each year, Medicare hospitals, increased support for to reach its full potential and meet the rebates increased by 1.2-2.5 per cent general practice and preventative community’s increasingly complex between 1995 and 2012, before the primary health care is expected to healthcare needs, with a mandated 16 recent Medicare freeze prevented have far‑reaching economic and per cent of total health spending indexation completely. social effects, reducing absenteeism, • continued investment in long-term Medicare-funded services are also presenteeism and poor productivity. strategies to ensure a sustainable often inflexible or inadequate without More investment in general practice medical workforce. catering to the changing needs of would assist in the early diagnosis and Delivering Better Care for Patients: patient care and red tape associated treatment of acute and chronic diseases, The AMA 10-Year Framework for Primary with chronic disease management and and improve workforce participation Care Reform is available at https://ama. residential aged care facilities hinders and economic productivity. com.au/article/delivering-better-care- primary care, the report says. The AMA vision notes patient patients-ama-10-year-framework- iStock/davidf care should be integrated and well- primary-care-reform

medicSA | 15 COMBATTING CORONA

Acts of kindness

The Pandemic Kindness Movement is one COVID-19 outcome that we want to continue and celebrate, writes the Commissioner on Excellence and Innovation in Health, Professor Paddy Phillips.

he Commission on Excellence demonstrate that poor clinician and and Innovation in Health other health-worker wellbeing leads (CEIH) works with clinicians, to sub-optimal clinical care, patient consumers, and other dissatisfaction, staff absenteeism and Tcollaborators to build a health system turnover, and reduced team efficiency. where people are truly at the centre, There are several factors that align where everyone has access to the to bring the health and wellbeing of latest evidence and data to make the clinicians and other health-workers to best decisions, where innovation is the fore, now more than ever: Professor Paddy Phillips encouraged and it is safe to think big and • the SA Government response to the try new things, where no task is done in Independent Commissioner Against seek help due to stigma and perceived isolation but instead achieved through Corruption’s report, Troubling impacts on patients, colleagues, and partnership and collaboration. Ambiguity: Governance in SA Health, their careers. Given the additional pressure of requires each Local Health Network Many health systems have begun the global COVID-19 pandemic, it is to develop a mentally healthy promoting strategies such as heartening to see partnership and workplace plan mindfulness meditation to improve collaboration come to the fore. CEIH • the annual cost to SA Health of wellbeing for individuals working hopes to capitalise on this spirit of psychological injuries caused by the within them, and there is evidence to openness to address a significant workplace is $7 million and rising support the efficacy of these approaches. challenge to creating a health system • the AMA(SA) Culture and Bullying However, while there are individual where people are at the centre: the Summit in February 2020 highlighted factors that may predispose some wellbeing of our workforce. the impact of bullying behaviours on doctors and other health-workers to The focus on wellbeing staff wellbeing and patient outcomes health and wellbeing issues, many of Recent surveys show that one in five • the Federal Health Minister’s the factors that affect their wellbeing doctors in training reported suicidal commitment to the target of zero are systemic and environmental rather ideation in the past year, while half health-worker deaths from COVID-19. than inherent within individuals. These of the total number of junior doctors Physician, heal thyself include: experience moderate or high levels Traditionally, wellbeing is seen as an • long hours without adequate of distress. individual problem, with the individual recovery time This is not unique to those in the responsible for addressing their issues. • unpredictable schedules and lack of medical professions, with nurses This ignores the fact that doctors control over work-life balance regularly experiencing burn-out struggle to identify and address their • increasing clinical workload symptoms such as depersonalisation own health and wellbeing issues, with • professional or geographic isolation and emotional exhaustion. less than 40 per cent of doctors having • cultures of traditionally being required Nor is this unique to South Australia. general practitioners (GPs). Many to tolerate stress and so continuing to Studies from the UK, US and globally doctors are understandably reluctant to work despite such stress • the complexity of navigating the health system. Learning from others CEIH’s approach to improving the health system is to look for new perspectives and solutions to challenges. In relation to the health and wellbeing of South Australia’s health workforce, we believe it is worthwhile to find examples of other sectors with experience of improving workforce wellbeing and learning how they succeeded. One such example is the Australian mining sector. The mining sector employs almost 150,000 people and shares many characteristics with healthcare: a challenging work environment,

16 | medicSA long hours, a culture that stigmatises packages. This is clear evidence of health-workers from all professions, help-seeking and barriers to accessing leadership commitment! including doctors. The Compassion support services. These factors A kind response Labs teach about the physiological have created a workforce in which Doctors Health SA has for some time and psychological benefits of the prevalence of high or very high offered clinical services, advice and compassion and help participants psychological distress is almost three support, and co-ordinates a state-wide learn how to exercise compassion in times that of the general population,1 network of GPs with additional training their personal and professional lives. and the prevalence of substance misuse in treating doctors and medical students It starts by assisting participants to be disorders is second highest of any But the pandemic has brought new, compassionate towards themselves, industry2. additional and extraordinary changes so they can sustain compassion The Minerals Council of Australia to our lives. Feelings of concern and towards others. CEIH is co-ordinating a launched its Mental Health Blueprint anxiety are normal and expected compassion collaborative to continue in 20153. Key to this framework is the responses as we navigate this new and supporting participants to build on their demonstrated commitment of leaders uncertain situation. The Pandemic learning, starting in July 2020. in the Australian minerals industry to Kindness Movement was created by Improving health-worker wellbeing the safety and health of its workforce, clinicians across Australia to support To address the causes of poor health- such that everyone goes to work and and enhance the health and wellbeing worker wellbeing, several organisations, returns home safely, and that no task is of all health-workers during the including the Office of the Commissioner so important it cannot be done safely. pandemic. Supported by CEIH, the for Public Sector Employment, Heads Up, By working with staff, unions and Agency for Clinical Innovation in NSW, and Beyond Blue, identify four domains charities such as MATES in Construction, Safer Care Victoria, and the Queensland that require action to address workplace Energy, and Mining, mine sites have Government, it has produced respected, wellbeing issues: raising awareness, been able to raise workforce awareness evidence-based resources that are preventing harm, responding to mental of wellbeing issues and equip people curated by teams of clinicians and illness, and creating a work environment with the knowledge and skills to spot wellbeing experts. that supports mental health. These when someone may require support The Pandemic Kindness website has domains include individual risk factors and intervene. resources organised under the domains while acknowledging the effects of MATES delivers training to workers of Maslow’s hierarchy of needs to reflect the environment and system in which that ranges from general awareness potential challenges on the health individuals work. and crisis intervention to suicide workforce, plus leadership actions. intervention skills. Additionally, MATES In the initial stages of the COVID-19 Health-worker wellbeing program accredits sites that meet the standards pandemic, resources in ‘basic needs’ The CEIH health-worker wellbeing for mental health, safety, and wellbeing (such as those addressing fatigue, program brought together clinical, of the people that work there. The sleep, nutrition and hydration) were operational, and workforce leaders MATES program demonstrated an the most accessed consistently across across the health system in South 8 per cent reduction in suicide, or 15 lives Australia. However, since July there Australia on 17 August to improve saved over five years in Queensland, has been variation between states, health-worker wellbeing. The aim of during a period in which suicide in the with South Australians prioritising the initial workshop was to support general population increased. resources in the ‘safety’ and ‘love and providers to: It is interesting to note that some belonging’ domains. • create the impetus for change mining organisations have worker In June 2020, CEIH worked with • demonstrate leadership commitment wellbeing a key performance indicator, social change consultant Mary Freer to to improve health-worker wellbeing iStock/FatCamera so that it affects leaders’ remuneration deliver Compassion Labs to about 80 • connect leaders with validated tools

medicSA | 17 COMBATTING CORONA

Develop strategies, policies Ensure work health and safety and procedures that address management systems protect risks to mental health and and support mental health and • identify practical steps that health-care providers evaluate their effectiveness systematically manage risks can take to improve health-worker wellbeing • create a network to drive systematic and environmental change. Build the Prevent CEIH is well placed to connect and support Positives Harm and Develop organisational Work environments Manage Risk providers no matter where they are at on their culture that reduces support Mental health health-worker wellbeing journey. Working at stigma, supports mental mental health risks are health and enhances Raise reduced arm’s length to government, we can support both engagement at work Awareness Build understanding public and private healthcare providers. Acting as and capability to support Design roles and work mental health a connector and providing constructive critique, environments that better CEIH can help identify opportunities to collaborate protect mental health and learn from others in the sector, sharing best practice and helping organisations overcome specific Increase the capability of our people to recognise and Intervene Early and challenges as they make changes to the environment respond to mental illness, reduce stigma and support Support Recovery and systems of work. people to seek help early Mental illness is recognised and The health system in South Australia is dealing responded to with multiple challenges. CEIH believes that a focus Provide appropriate support services that enable employees on health-worker wellbeing will support providers with a mental illness to stay at or return to work I WORK FOR SA to improve healthcare for South Australians, reduce avoidable harm to consumers and workers, and make sure that everyone who comes to work in References healthcare goes home safely at the end of the day. To involve your practice, please contact mike. 1 https://www.mja.com.au/system/files/issues/208_09/ [email protected]. To access resources for support, 10.5694mja17.00950.pdf please visit the Pandemic Kindness Movement site. 2 https://www.headsup.org.au/docs/default-source/ If you are at immediate risk, call 000. resources/beyondblue_workplaceroi_finalreport_may-2014. Professor Paddy Phillips was appointed to lead South pdf?sfvrsn=90e47a4d_6 Australia’s new Commission on Excellence and 3 https://minerals.org.au/sites/default/files/ Innovation in Health in May 2019. MCA_Mental_Health_Blueprint.pdf

18 | medicSA COMBATTING CORONA

Common decency The pandemic has highlighted how good people respond to great challenges, writes Port Lincoln GP Dr John Williams.

am motivated to write by great outbreaks in Australia and this was to be optimism. I’m incredibly optimistic expected. These are being managed well at present because of two but not without difficulty – which again observations: the remarkable speed is to be expected. Iof change in health in response to the From a rural perspective. COVID-19 crisis and the corresponding We are struggling with all the changes ‘flattening of the curve’ that has given as everywhere else in the health Australia the luxury of preparation system. The sometimes daily changes and planning. to procedures and recommendations. Dr John Williams Our government has taken expert The confusion created by this. The advice and the general population has uncertainties we have and those of taken this to heart with remarkable our patients. results – the result being that the providing care to 25 per cent of the We greatly appreciate the steady hand vulnerable of our society have been state’s community. and clear thinking that is going on in protected so far. We are extremely grateful for our medical leadership. Doctor Rieux in the Albert Camus metro colleagues who provide support novel The Plague remarked, ‘... the only Rural doctors live on the fragile and understanding in the care of our means of righting a plague is – common edge of our state’s health system and patients. We have a firm hope that in decency’. He explained further that ‘... in have daily challenges in such logistics the future we can strengthen these my case I know that it consists in doing as patient transport, arranging basic strong collegial bonds and improve my job’. pathology and radiology, transporting the outcome for our patients. And In the midst of this pandemic, I thus the visiting specialists to and from our help maintain and build our rural come to the very heartening conclusion communities, local management of PPE, medical workforce. that we live in a very decent society. COVID testing, etc. Almost every aspect It is difficult to express how helpful And that I am a member of a very of our daily practice has been impacted it is to have a friendly voice on the decent profession. by the COVID containment measures. other end of the line when plan A is I wrote this in April and still feel Our workforce is fragile. Ten per cent failing and plan B is an ICU or HDU the same in August. We are having of our state’s medical workforce is 800 km away.

Remembering Dr Harry Nespolon

eneral practice members ‘General practitioners, healthcare and colleagues from across workers and patients across this South Australia have joined country have benefited from Harry’s AMA(SA) President Dr Chris dedication and his determination to GMoy in paying respects to former have doctors’ voices and concerns RACGP President Dr Harry Nespolon, heard and heeded,’ Dr Moy said. who has died from pancreatic cancer. ‘His commitment to doctors and Dr Nespolon was a graduate from patients continued even as his health Flinders and spent the early years of deteriorated as Australians confronted his career in South Australia. the many challenges posed by Dr Moy said Dr Nespolon had been the pandemic. an extremely vocal and active advocate ‘On behalf of the AMA in South for GPs and the medical profession for Australia, I offer condolences to Harry’s many years. family, colleagues, friends and patients.’ Dr Harry Nespolon

medicSA | 19 COMBATTING CORONA

A patient receiving treatment for a longstanding metabolic condition with trials coordinator Leanne Price

A testing time South Australia’s research capabilities and geographical location make it the perfect place to build a world- renowned trials industry, writes Professor Guy Ludbrook.

here has been a great deal of are available, we will know more about Phase 4 trials where high-volume use in media focus in recent weeks on if, and how, this product should be the marketplace allows examination for the trial of a potential COVID progressed. While we await these data, uncommon risks and benefits. It is often vaccine being developed in it is an excellent time to examine where under-appreciated that all new products TSouth Australia. We are pleased that the clinical trials industry is, and should in clinical practice are, in effect, still in state institutions including Flinders be, heading in South Australia. the trials phase, and closely monitored University, the Royal Adelaide Hospital, Scientifically based clinical trials are for safety and efficacy. Hence, we should the University of Adelaide and SA essential to determine whether potential not be surprised or overly concerned if Pathology have been able to quickly therapeutic goods are sufficiently safe products are occasionally recalled. This pull together substantial and valuable and effective to be registered with is not usually a failure of development expertise, facilities and services the relevant regulatory agency, the and regulation, but an example of the to support industry to make this Therapeutic Goods Administration effectiveness of our monitoring of trial possible. (TGA) in this country. These clinical quality and safety. This Phase 1, first-in-human trial trials are usually industry sponsored, Why should we want clinical trials in involves administration of the potential and run to very high and closely South Australia? They can be perceived vaccine and placebo to 40 healthy monitored standards. Products as not a core aspect of healthcare; as a volunteers to determine both if there must progress through a number of discretionary or even distracting activity. are adverse effects and if it can generate development phases: Phase 1 trials But nothing could be further from the an antibody response that may protect with small numbers, aimed primarily truth. Firstly, it is well described that against COVID infection. As I write this at safety and dose ranging; then Phase centres undertaking trials provide on 3 August 2020, there are promising 2 and 3 trials with larger numbers and better healthcare. We can debate data on safety. When the final results aimed at both safety and efficacy; and whether this relates to attracting leading

20 | medicSA COMBATTING CORONA

PARC Clinical Research’s senior trials coordinator Louise de Prinse in the unit clinicians, or exposure to the rigor and accurate, timely and efficient data consistency in care, or clinicians and collection. And (again as I write this), I’d like to acknowledge the administrators seeing the benefits of due to our state’s public health policy main“ investigators in the COVID-19 continuous innovation and change, or and actions, as well as our geography, vaccine trial, Professor David Gordon patient improvement from innovative we are largely COVID-free, providing and Dr Pravin Hissaria, Vaxine treatments. What we cannot debate is opportunities for volunteer- and patient- Pty Ltd; the support from CALHN that these are all positive elements. based trials to proceed without a major HREC and Research Services, RAH Secondly, clinical trials form a very risk of interruption. All this sits on a Pharmacy, SA Pathology, and the large industry in this country, with background of Australia’s substantial an annual value of tens of billions tax benefits for industry that undertakes Department of Anaesthesia at RAH; of dollars. Growth in this activity is clinical trials, and rapid processes for and the incredible work of Kathy a great opportunity for the state at a trials approval and commencement. Heyman and her team at PARC. time of economic challenge. Lastly, What do we need to do? Clinical and so importantly, the trials enable research needs to be a high priority at ” our patients to receive innovative a time when opportunities for South treatments that would otherwise not be Australia are substantial, with a surge available to them, without adding to the in interest in placing trials in this state. health budget. Critically, it needs to be a high priority Can we attract and expand clinical for SA Health and its hospitals, as well trials activity in South Australia? Absolutely – in fact, there are few as the private healthcare sector, to places better placed to do so. We enhance quality of care for the reasons provide high-quality healthcare with outlined previously. It needs rapid excellent and connected clinicians. and visible commitment to space and We have outstanding scientists and infrastructure, to clinical positions researchers, as well as highly regarded with dedicated time for research and contract research organisations innovation, and a business model to (CROs) and internationally recognised provide the agility needed for a fast- dedicated trials units. We have world- moving industry. Professor Guy Ludbrook is an anaesthetist, class infrastructure – one only needs This COVID trial has shown us what a co-investigator in the COVID-19 vaccine to look down North Terrace to see an can be achieved in a short space of time trial, director of an RAH-based early astonishing biomedical precinct. and shone a light on the tremendous phase clinical trials unit (PARC Clinical Importantly, too, we have a state-wide capacity and potential within this state. Research), and provides expert advice to electronic medical record to facilitate We must use this opportunity. TGA committees.

medicSA | 21 RURAL HEALTH

Commissioner paves the way for rural and remote doctors

South Australian doctor and educator Professor Paul Worley was Australia’s inaugural National Rural Health Commissioner. His sights are now on other challenges.

he shortage of doctors in rural Associate Professor Ruth Stewart from and remote areas is the stuff Thursday Island. Professor Paul Worley of legends but not for much ‘One of her major roles is to oversee longer says the immediate past the implementation of the pathway within general practice and it is also TNational Rural Health Commissioner, and continue the work on the quality, seen as a career meeting the needs of Professor Paul Worley. distribution and access to allied health disadvantaged communities. For those people who want intellectual challenge, With a new National Rural Health services in rural and regional Australia.’ skills challenges and the challenge of Generalist pathway on track for delivery While a needs-based assessment meeting the needs of disadvantaged – with the full support of students and will determine how many positions are communities, rural generalist practice is the general practice and specialist created, it’s likely that between 350-400 just for you. positions will be initially created, aiming colleges – as his three-year tenure ended ‘The key to the pathway is to use to reverse decades of medical exodus in June 2020, he’s certain the health what have historically been social from rural Australia. sector is about to be transformed. disadvantages of rural and remote ‘With an appropriate training ‘We have proposed a 12-year pathway practice and flip them to become program, we are confident it will be overall – which involves having end- advantages. Historically, medical seen as a very attractive specialised to-end medical school training in the schools have been based in our capital field within general practice and bush and then end-to-end postgraduate cities and have had an outreach to rural training in the bush – not that you both colleges are very excited about Australia and those students, when they the prospects for the National Rural are conscripted to stay there but just go out there, do enjoy it.' Generalist Pathway,’ Professor that the training is so good and so Then, he says, many make comments Worley says. appropriate that you won’t want to such as, ‘it would be wonderful to be a With two years of the rural generalist leave,’ Professor Worley says. rural or remote doctor but …’, with the training program allocated to acquiring ‘The first tranche of the $62.2 million but almost invariably related to family, additional skills, junior doctors will announced in the 2019 Federal budget social, recreation, other aspirations be trained in specialist areas such as has been released and there are signs of they have, their partner’s job, the needs obstetrics, anaesthetics, mental health, of their kids or their ability to see those funds flowing. As we speak, rural aged care or palliative care, based on themselves working in relative isolation. generalist coordinating units are being what their community needs. ‘However,’ Professor Worley asks, established in each of the jurisdictions Registrars will be employed by a ‘if you have a medical school and a around the country. single employer throughout their postgraduate program based in those ‘It is a transformative change in training, ensuring they retain access to rural and remote areas from the outset, medical training, and it is one where entitlements such as maternity and long wouldn’t it be great to get to a situation Australia really will lead the world. It’s service leave that they currently lose where you had to convince people to go also one of the reasons the government through the transition from hospitals to to the city, rather than convincing them introduced legislation in the parliament training in private practice. to go to the bush?’ to extend the role of the National ‘Increasingly, rural generalist practice Professor Worley is confident Rural Health Commissioner and they is seen as having significant status the approach will work, having have appointed a new commissioner – as a highly skilled specialised field implemented the Northern Territory

22 | medicSA RURAL HEALTH

Medical Program as Dean of the Having delivered on the commitment Having seen the potential of the rural Flinders University medical school, and to rural health training, Professor generalist pathway, Professor Worley is confounding the sceptics in doing so. Worley is turning his sights to an even excited about the prospects for applying ‘We were told at that time that the more intractable challenge than the it to health care in remote areas. workforce wasn’t stable enough, that the rural health service shortage: the remote ‘It was a great privilege to travel the supervisors weren’t there, that students area medical workforce. country to meet rural doctors and would struggle with their experiences. ‘Regional centres will benefit from other rural health professionals all The exact opposite has been the case. that tree change and sea change that across our wide brown land and to hear The students have had wonderful is occurring in Australia but remote their stories of challenge and success learning opportunities and the presence Australia needs targeted and significant and bring them together in a way that of the medical school has added stability to the workforce. It has added to the investment to have an equitable share of creates hope for a better future,’ he says. attractiveness of that location for the education and health infrastructure ‘Watch this space – there’s a lot more doctors and doctors are staying. that Australians otherwise take for work to do and I’ve got even more ‘I would anticipate that this would granted. Remote Australia currently enthusiasm to be part of it having seen be the case with this pathway as it is relies on a fragile workforce supply what we’ve been able to achieve in the implemented across the country. It will chain which leaves it vulnerable at the past couple of years. The time is right reinforce, stabilise and improve the best of times, and even more so with to really push ahead and change the status of the workforce,’ he says. threats like COVID-19.’ paradigm forever.’ Rural advocate takes the reins

ural health advocate, medical rural and remote communities,’ and develop strategies to best serve rural practitioner and researcher Minister Hunt said. and remote Australia. Associate Professor Ruth ‘Associate Professor Stewart’s wealth ‘I will work with Aboriginal and Torres Stewart has been appointed of experience and expertise will be Strait Islanders peoples across the Ras Australia’s second National Rural invaluable in driving the Australian nation to ensure that these policies are Health Commissioner. Government’s commitment to culturally safe and directed at closing The Government recently extended improving rural health outcomes and expanded the Office of the National around the nation.’ the gap,’ she said. ‘This is an exciting Rural Health Commissioner to have A/Prof Stewart has had a challenge for my office to develop and a broader focus. The Commissioner distinguished career in rural health, promote innovative and integrated will be supported by two Deputy both as a practitioner and an academic, approaches to health care delivery in Commissioners to look after allied most recently working as an Associate rural and remote areas. health, nursing and Indigenous health. Professor of Rural Medicine, Director ‘Working with the Deputy Minister for Health Greg Hunt said of Rural Clinical Training and Support Commissioners I will be able to focus on the Federal Government is delighted to at James Cook University. She lives and the whole of the multidisciplinary team. appoint Associate Professor Stewart to works on Thursday Island, where she ‘In this I am fortunate to be able to this important role. has been a Senior Medical Officer with pick up the National Rural Generalist ‘One of the early priorities for the obstetric credentialing. expanded Office will be to support the A/Prof Ruth Stewart said it will be a program of work for medicine and Government’s ongoing rural response to great privilege to work with rural and allied health conducted by my esteemed COVID-19 and to examine the impact on remote communities to improve their predecessor, Professor Paul Worley the health workforce planning in regional, health outcomes, helping set priorities inaugural Rural Health Commissioner.’ AMA promotes rural pathways

n May 2020, the AMA released a and rural areas and increased retention • moving to competency-based training new position statement to promote of non-GP specialists outside of rather than time-based training rural specialist training pathways. metropolitan centres. • developing clinical mentoring The AMA position is that to The AMA acknowledges that networks Iachieve this, the current barriers for some colleges have formulated their • introducing flexible assessment accreditation of prevocational and own strategies for developing and • utilising technology to guarantee vocational training posts in rural and implementing rural training pathways. adequate supervision regional areas must be identified However, there are still significant • funding positions appropriately and addressed. barriers for many more trainees. • using data effectively. The ideal outcome is increased Key principles of the position The Rural Training Pathways for training of doctors with skills specific statement are: Specialists Position Statement 2020 to the unique requirements of remote • ensuring quality and safety is available on the AMA website.

medicSA | 23 MEDICAL RESEARCH

Eating for the planet An Adelaide contributor to an international study of dietary guidelines says Australia should overhaul its guidelines to meet its health and environmental objectives.

University of Adelaide ‘Poor diet and associated researcher is part of an diet-related chronic diseases international team that are responsible for 14.7 per cent has found most national of all Australian deaths and Adietary guidelines do not meet global 75 per cent of the Indigenous environmental and health targets. health gap,’ Mr Spajic says. Adelaide Medical School Honours ‘Dietary guidelines are the basis student Luke Spajic has worked with for advice given by doctors lead author Dr Marco Springmann of and dieticians and the basis of Oxford University since the beginning nutrition policy. Our analysis of 2019. Mr Spajic was a visiting research found that the Australian diet University of Adelaide researcher student with the Centre on Population is the most emissions-intensive among Luke Spajic the G20, 50 per cent higher than that of Approaches for Non-Communicable Health Association of Australia, to Argentina, whose diet comes in second. Disease Prevention at Oxford, when include environmental sustainability ‘Australia’s current dietary guidelines COVID-19 led to his early return to in Australia’s most recent dietary would exceed the climate budget by a Adelaide in March. guidelines, but this was successfully factor of 4.3 if adopted.’ The team's paper, published last opposed by industry,’ he says. Mr Spajic says despite researchers’ month in The BMJ, examined the health For this study, Mr Spajic and his calls for environmental sustainability to and environmental impacts of 85 colleagues modelled the adoption of be included in dietary guidelines since guidelines at both the national and countries’ dietary guidelines. It was the the 1990s, most FBDGs do not explicitly first of its kind to analyse both the health global level, and compared the impacts mention environmental sustainability. to global diet-related environmental and and environmental outcomes of national Then, in late 2019, the World Health health targets that governments have food-based dietary guidelines (FBDG) Organization published guiding agreed to. These included the goal to around the world. principles on healthy and sustainable reduce premature mortality from non- Mr Spajic says there are environmental diets in recognition of the importance of communicable diseases by a third, and consequences to FBDG adoption, including environmental sustainability. the agreement to limit global warming to whether or not environmental ‘There was a joint campaign below 2 degrees Celsius. sustainability is explicitly mentioned in from researchers and civil society On average, adoption of national a country’s guidelines document. organisations, such as the Public dietary guidelines was associated with

G20 countries’ per capita dietary greenhouse gas emissions in relation to 'carbon budget' for food (left) and (right) EAT-Lancet Commission's recommended 'planetary health diet'

24 | medicSA MEDICAL RESEARCH

a 15 per cent reduction in premature meat (particularly processed red meat) – ‘The focus should start in medical mortality, and a 13 per cent reduction would make the guidelines healthier and school. A review published in the Lancet in greenhouse gas emissions from tremendously more environmentally Planetary Health in 2019 found that the food system. However, one-third sustainable.’ medical students are not supported to of the guidelines were incompatible Mr Spajic says the Australian provide high-quality, effective nutrition with the global health agenda on Government announced that it would care, something I witnessed first-hand non-communicable diseases, and review Australia’s dietary guidelines the in medical school. It recommended between 67 per cent and 87 per day after the paper was published. that medical education – and the cent were incompatible with the ‘This is the perfect opportunity for effectiveness of future doctors – could be Paris Climate Agreement and other health professionals and the AMA to improved by making nutrition education environmental targets. advocate to ensure our next guidelines compulsory in medical training.’ Together, 98 per cent of national reflect the best available evidence on He says health promotion campaigns guidelines were incompatible healthy and sustainable diets,’ he says. are also essential – including in with at least one global health and ‘Keeping industry out of this process, countering the lobbying, public environmental target, meaning that as was done in Canada, is essential to campaigns and funding of studies that even if the whole world followed them, ensure the public of the integrity of create doubt about the links between particular food groups and disease or the global population would still fail the guidelines. to meet the targets governments have environmental degradation, as has ‘The best dietary guidelines are signed up to. been seen with a sugar-sweetened meaningless if not backed by policy – The study also assessed the global beverage tax. But, he says, they must be and in this country, the largest global risk dietary recommendations from the backed with a range of other policies to factor for disease is not a government World Health Organization (WHO) and be effective. priority. At the moment, Australia’s the more comprehensive and ambitious ‘Some may refer to such policy as FBDGs are incompatible with climate recommendations of the EAT-Lancet the “nanny state”, but it is clear from targets the Australian government has Commission on Healthy Diets from the evidence that a hands-off approach Sustainable Food Systems. It found agreed to and the Australian public has failed,' he says. ' Two-thirds of that if populations followed the WHO expects us to meet.’ Australians are overweight or obese, recommendations it would likely result Mr Spajic says general practitioners with rates still rising, and only 5 per in health and environmental outcomes and medical education have important cent consume the recommended similar to those from following current roles in encouraging healthy vegetable intake. national guidelines. eating practices. ‘And as previously stated by VicHealth However, adoption of the EAT-Lancet ‘GPs collectively see most of Australia’s CEO medical doctor Sandro Demaio, recommendations was associated with a population each year,’ he says. ‘This if two-thirds of a teacher’s class were one-third greater reduction in premature presents a perfect opportunity to failing, we would surely question the mortality, more than three times greater highlight to Australian adults and teacher rather than solely the willpower reductions in greenhouse gas emissions, children the benefits of healthy diets. of the pupils.’ and general attainment of the global But it’s not just GPs who should be The research paper is available at: health and environmental targets. promoting good nutrition - the health https://www.bmj.com/content/370/ In Australia, the study found, adopting benefits are relevant to all specialties. bmj.m2322 the EAT-Lancet recommendations could lead to 86 per cent less food-related greenhouse gas emissions and 31,000 We are what we (don’t) eat fewer diet-related deaths, compared to 46 per cent and 28,000 if current The researchers recommended: guidelines were adhered to. • Changing national and WHO dietary guidelines in line with the current ‘As the AMA emphasised when scientific understanding on healthy and sustainable diets, and providing declaring a climate emergency, it is concrete examples in terms of different dietary traditions and patterns, not possible to separate human and including predominantly plant-based ones such as pescatarian, which, planetary health, regardless of whether when well composed, were found to be among the healthiest and the environment is explicitly referenced,’ most sustainable. Mr Spajic says. ‘Fortunately, there is great • Improving the environmental sustainability of dietary guidelines by providing overlap between the latest evidence on stringent guidelines on the recommended consumption of animal-source healthy eating and what constitutes an foods, in particular beef and dairy, in regions such as Australia where they environmentally sustainable diet. are consumed in large quantities. ‘The flexitarian EAT-Lancet diet was formulated with the exclusive • In most regions, providing clear advice on increasing the intake of whole goal of identifying the healthiest diet, grains, fruits, vegetables, nuts, and legumes; reducing the intake of red and only afterwards assessed for its and processed meat; and highlighting the importance of maintaining a environmental impacts. The EAT-Lancet healthy weight. diet and the changes we recommended • Addressing the currently poor adherence to dietary guidelines by investing to FBDGs, including Australia’s, are in measures that would help populations improve their diets, such as health consistent with the Mediterranean promotion programs, aligning menus in school and work-place canteens, diet – more whole grains, more nuts and ensuring that healthy food is the easiest, cheapest choice. and seeds, more legumes and less red

medicSA | 25 Supported by:

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employment, to the rural GP worried about their community and accessing PPE, to the numerous specialists trying to treat patients remotely and surgeons who suddenly couldn’t operate, I was reminded during every call why the AMA does what it does – and of the importance of our strong, trusted Rebecca Hayward advocacy and respected leadership amid the storm. We are the ‘go to’ for AMA(SA) Member Services evidence-based policy and advice, and in many cases for a calm and reasoned Manager voice of comfort. and the wider community, which However, the strength of our voice recently includes: and influence and our capacity • contributing to plans to stop the to make a difference rely on our here’s no doubt COVID-19 has spread of COVID-19 status as representing all South brought with it many challenges • introducing telehealth MBS and Tand changes to the way we live Australia’s doctors. electronic prescribing and work. But for our doctors who have The AMA is the only membership • providing financial and mental health been at the coalface, there are the extra organisation representing all doctors support for doctors responsibilities of caring for others and disciplines. There’s never been a • advocating for adequate PPE while also trying to keep themselves, more important time to work together, • supporting Doctors in Training and their families, co-workers, and the wider and with a broad suite of disciplines medical students. community safe. and Adelaide and Flinders University I have had the privilege of speaking Medical Schools represented on our The battle continues. with countless members from around Council, you can be assured that in Please join us to strengthen the state as they tried to grasp, and joining the AMA in South Australia your your voice, and ours. adjust to, the ever-changing landscape voice is welcome and heard. To find out more, please go to of COVID-19, and the speed in which To our existing members, thank you. https://sa.ama.com.au/membership, changes have occurred. From the Your support has made it possible for us or contact me on 08 8361 0108 or at Doctor in Training concerned about to achieve all that we have for doctors [email protected].

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medicSA | 27 As well as advocating for doctors, the AMA(SA) provides a range of member services and benefits that support doctors in your AMA(SA) Member Benefits practice, your medical careers and your day-to-day lives.

AMA Fees List Hood Sweeney Ambassador Card The AMA List of Medical Services and Fees is an Members receive Members save at over 2,400 outlets including restaurants, cinemas, attractions and important reference for medical practitioners to assist discounts including 10% on accounting services and accommodation, and a huge range of retail outlets including Coles Myer, David Jones, in determining fees. 20% on the establishment of a new self-managed Freedom, Witchery, Rebel Sport, Adrenaline, Barbecues Galore, Priceline Pharmacy Available free to members, and via subscription to non- superannuation fund from our long-term partner and and Sheridan. members for $499/year. preferred provider, Hood Sweeney. Doctors in Training Members can also make significant savings on a wide range of home, electrical and entertainment products at the new receive additional benefits, including your first tax return Online Shop. For more details and to access the list, go to free. https://feeslist.ama.com.au/. On all benefits, including those below for details please go toama.ambassadorcard.com.au , and log in using your SA Contact the Health team at Membership ID and email address. ********** [email protected] or call 1300 764 200 for doctorportal more information. Learning and CDP ********** Goodlife Health Clubs Tracker Save 15% on your Active Plus Membership and receive a wide range of additional benefits from all Goodlife Health Clubs. Austofix To redeem, present the offer available on ama.ambassadorcard.com.au, and show your Ambassador Card. Available free to members, doctorportal Learning offers AMA(SA)’s recent partnership high-quality medical education, and a streamlined way of with leading Adelaide-based Hoyts eGift Card tracking your learning and meeting your Medical Board medical device manufacturer Austofix gives members Save on a range of ticket and candy bar vouchers, plus 8% on e-Gift cards when purchasing online. of Australia reporting obligations. access to high-quality PPE (branded Austosafe) when Event Cinemas eGift Card CPD Learning (valued at $11/module) offers a you need it most, and from a company that guarantees Save on a range of tickets and food and beverage e-vouchers, including Gold Class, plus 7% on e-Gift cards when broad range of educational content such as practice our members will receive fast, customised service. purchasing online. management, ethics and professionalism, and leadership More information is available at and management. https://austosafe.com.au/. The Home eGift Card CDP Tracker (valued at $22/month) covers multiple ********** Save 10% when purchasing online. Redeemable at Adairs, House, Wheel & Barrow, Provincial Home Living, Matt Blatt, specialities and non-specialties and enables you to Matchbox, Robins Kitchen and VIP Home Services. Mercedes-Benz Adelaide upload and track your external learning, plus have isubscribe Medical Board of Australia/AHPRA audit-ready reports Save thousands and enjoy a range of benefits with Save 10% on already discounted prices on over 2,000 magazines. at your fingertips. Mercedes-Benz Corporate Program, including three More information is available at www.dplearning.com.au. years’ complimentary scheduled servicing, reduced Country Road eGift Card retailer delivery fee and complimentary loan car, or Save 7.5% when purchasing online. Valid at all Country Road outlets and online. ********** pick-up/drop-off when servicing Norman Waterhouse your vehicle. Members receive discounted For more details contact rates from our long-term partner and preferred [email protected] provider of legal services, Norman Waterhouse. Its or call 08 8152 5000. team offers a full suite of legal services across areas ********** including employment, industrial relations, commercial and business structuring, family law, wills, and probate. American Express Contact Lincoln Smith on Members receive a range of benefits with the AMA 08 8210 1203 American Express Platinum and Platinum Edge Cards, including a reduced annual fee and complimentary Accor ********** Plus membership. For information on all Federal benefits go to https://ama.com.au/membership/benefits. ********** 28 | medicSA

Member Benefits - TwoPageSpread.indd 2-3 5/08/2020 11:21:16 AM As well as advocating for doctors, the AMA(SA) provides a range of member services and benefits that support doctors in your AMA(SA) Member Benefits practice, your medical careers and your day-to-day lives.

AMA Fees List Hood Sweeney Ambassador Card The AMA List of Medical Services and Fees is an Members receive Members save at over 2,400 outlets including restaurants, cinemas, attractions and important reference for medical practitioners to assist discounts including 10% on accounting services and accommodation, and a huge range of retail outlets including Coles Myer, David Jones, in determining fees. 20% on the establishment of a new self-managed Freedom, Witchery, Rebel Sport, Adrenaline, Barbecues Galore, Priceline Pharmacy Available free to members, and via subscription to non- superannuation fund from our long-term partner and and Sheridan. members for $499/year. preferred provider, Hood Sweeney. Doctors in Training Members can also make significant savings on a wide range of home, electrical and entertainment products at the new receive additional benefits, including your first tax return Online Shop. For more details and to access the list, go to free. https://feeslist.ama.com.au/. On all benefits, including those below for details please go toama.ambassadorcard.com.au , and log in using your SA Contact the Health team at Membership ID and email address. ********** [email protected] or call 1300 764 200 for doctorportal more information. Learning and CDP ********** Goodlife Health Clubs Tracker Save 15% on your Active Plus Membership and receive a wide range of additional benefits from all Goodlife Health Clubs. Austofix To redeem, present the offer available on ama.ambassadorcard.com.au, and show your Ambassador Card. Available free to members, doctorportal Learning offers AMA(SA)’s recent partnership high-quality medical education, and a streamlined way of with leading Adelaide-based Hoyts eGift Card tracking your learning and meeting your Medical Board medical device manufacturer Austofix gives members Save on a range of ticket and candy bar vouchers, plus 8% on e-Gift cards when purchasing online. of Australia reporting obligations. access to high-quality PPE (branded Austosafe) when Event Cinemas eGift Card CPD Learning (valued at $11/module) offers a you need it most, and from a company that guarantees Save on a range of tickets and food and beverage e-vouchers, including Gold Class, plus 7% on e-Gift cards when broad range of educational content such as practice our members will receive fast, customised service. purchasing online. management, ethics and professionalism, and leadership More information is available at and management. https://austosafe.com.au/. The Home eGift Card CDP Tracker (valued at $22/month) covers multiple ********** Save 10% when purchasing online. Redeemable at Adairs, House, Wheel & Barrow, Provincial Home Living, Matt Blatt, specialities and non-specialties and enables you to Matchbox, Robins Kitchen and VIP Home Services. Mercedes-Benz Adelaide upload and track your external learning, plus have isubscribe Medical Board of Australia/AHPRA audit-ready reports Save thousands and enjoy a range of benefits with Save 10% on already discounted prices on over 2,000 magazines. at your fingertips. Mercedes-Benz Corporate Program, including three More information is available at www.dplearning.com.au. years’ complimentary scheduled servicing, reduced Country Road eGift Card retailer delivery fee and complimentary loan car, or Save 7.5% when purchasing online. Valid at all Country Road outlets and online. ********** pick-up/drop-off when servicing Norman Waterhouse your vehicle. Members receive discounted For more details contact rates from our long-term partner and preferred [email protected] provider of legal services, Norman Waterhouse. Its or call 08 8152 5000. team offers a full suite of legal services across areas ********** including employment, industrial relations, commercial and business structuring, family law, wills, and probate. American Express Contact Lincoln Smith on Members receive a range of benefits with the AMA 08 8210 1203 American Express Platinum and Platinum Edge Cards, including a reduced annual fee and complimentary Accor ********** Plus membership. For information on all Federal benefits go to https://ama.com.au/membership/benefits. ********** medicSA | 29

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New technologies, new hope A quiet revolution is afoot in paediatric neurology, with new technologies bringing new treatments and new hope for children with neurological illness, writes paediatric neurologist and Australian Medical Association (SA) Councillor Dr Clair Pridmore.

xciting advances in This is a great example of bench-to- Dr Clair Pridmore neurodiagnostics and bedside medicine. therapeutics have revolutionised Advanced neuroimaging technologies methods to facilitate personalised the practice of paediatric including functional magnetic drug screening and the development Eneurology in South Australia in recent resonance imaging (MRI) and nuclear of precision therapeutic strategies for years, and our paediatric neurologists medicine imaging have transformed these disorders. are enthusiastically capitalising on these the surgical management of epilepsy, Our Australian Collaborative Cerebral Palsy Research Group has found that technological developments. making seizure freedom a reality for cerebral palsy, previously assumed to We frequently used to hear statements some children. Rapid expansion in our be exclusively due to acquired factors like, ‘Neurologists are good at making understanding of the molecular basis such as a difficult birth, frequently has of the epilepsies has allowed precision diagnoses, but can you actually treat?’. a genetic contribution. Furthermore, in medical management for more and But with recent advances, this is no in a collaboration with Melbourne more patients. longer the case. Due to the explosion researchers, the Adelaide team is The list is long in terms of major in genetic techniques in particular, implementing clinical guidelines for developments in this subspecialty over it is now uncommon for patients to childhood stroke, to improve diagnostic the past 10 years or so. Autoimmune reach adulthood without a diagnosis. and treatment timeframes, provide encephalitis was not a recognised Genetic diagnoses arm families with greater access to reperfusion therapies, entity until recently; now we provide the knowledge they need about known and close the gap between children targeted immune therapies, which co-morbidities, risks and prognosis, and adults. significantly improve outcomes. At the and assists with family planning for Innovative technologies and therapies same time, paediatric multiple sclerosis the parents and wider family. Genetic have been eagerly embraced by South was previously under-recognised and diagnosis is likely to become even more Australia’s paediatric neurologists for undertreated. Advances in therapeutics important in the future, as it provides their patients but keeping up with the have improved the clinical course for exponential growth in service demand targets for precision medicine. these children. Picture an infant who has just been is proving challenging. The department All neurologists are involved in is hoping that additional resources can diagnosed with spinal muscular clinical research conducted outside their be secured to meet the accelerating atrophy, already very weak, but alert, SA Health commitments. Under unit demand and to position itself as a centre with normal intelligence. Only a few head Dr Nicholas Smith, in collaboration of excellence in the coming years. years ago, we had to counsel parents with the University of Adelaide, Flinders It will also be essential to grow that death from progressive weakness University and the South Australian our capacity to train the paediatric was expected within two years. Now, Health and Medical Research Institute, neurologists of the future. It is a very due to improvement in the molecular the team is leading the development and exciting time for our specialty and it understanding of this disease, we offer delivery of gene therapy technologies is certain that further advances will a gene therapy that has been proven to for childhood dementia and other follow in quick succession, promising allow children to achieve some motor neurodegenerative disorders. Excitingly, a brighter future for children with milestones and extend life expectancy. they are also developing cutting-edge neurological illness.

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Making dreams happen REAMIN is an acronym for the Dean Richards Endeavour to Assist the Medically Ill and Needy. It Dhonours the memory of the late Dean Richards, a stalwart of the Rotary Club of Prospect. It was founded in 2003 and provides a mechanism to support appropriate medical intervention services for those people in need in South Australia, Australia and developing countries. The Foundation is chaired by Professor Suren Krishnan and its board includes junior doctors, members of the Rotary Club of Prospect and the wider community. The Annual DREAMIN Foundation Adelaide Cup Day function was held on 9 March at the beautifully renovated Dulwich House. We were so thankful we could hold our function before South Australia’s COVID-19 lockdown and that due to the generosity of members and donors, the event raised about $30,000. The foundation's work with Maranatha Health in Uganda continues to gain the attention of our supporters. The Maranatha health Dr Jarrad Hopkins (left) and Professor Suren Krishnan (right), with DREAMIN volunteers team announced plans to build a new at the March 2020 fundraiser at Dulwich House (below) hospital and remain in Fort Portal. The existing facility has about 30 beds and the plan is to build a 200-bed facility with additional paediatric, maternal health and community health services. Land has been purchased and planning is underway. A very generous philanthropic Adelaide family has since provided $50,000 towards the foundation's vision to support the development of operating room facilities for the new hospital. The DREAMIN Foundation organises fundraising events during the year to support the vital work being carried out by generous South Australians. As a charity, the DREAMIN Foundation relies on the generosity of members of the Prospect Rotary Club, associated medical professionals, and members of the DREAMIN Foundation to raise much-needed funds to continue the valuable work of the Foundation. For more information, including how to donate, go to dreamin.org.au

Dr Jarrad Hopkins is a director of the DREAMIN Foundation.

medicSA | 33 MEDICAL EDUCATION

Seeking common ground and the capacity to create innovative their trust in us. Deviations from the LIAM RAMSEY and personalised management traditionally steadfast approach may STUDENT NEWS: plans. Qualitative research of GPs’ cause undue anxiety for patients already FLINDERS UNIVERSITY experience of vulnerability has feeling significant uncertainty. found that doctors who appreciated Vulnerability that is measured, commonalities between themselves purposeful, and meaningful can octors are expected to be and their patients enhanced their enhance doctor-patient, doctor-doctor, steadfast, omnipotent, iron- ability to be compassionate. Further, it and doctor-allied health professional Dclad in the face of uncertainty, fostered their own internal awareness relationships. As I finish medical school, but also warm, considerate, and of emotions and reflexivity, similar to I have been in awe of some doctors’ empathetic. These contrasting qualities countertransference and psychodynamic control of their emotional state and self- reflect the colliding biomedical and tools already used by some doctors such awareness of ego and self, and how they anthropological arms of medicine. It as psychiatrists and GPs. Despite our use this to optimise patient care. As I has long been held that doctors showing society being increasingly pluralistic it is leave medical school and join the next vulnerability is a sign of weakness and crucial we continue to find commonality generation of doctors, I am inviting and an inherently negative quality. But this with our patients. encouraging myself to be human. I am paradigm is shifting. Emerging discourse For doctors to safely capitalise on their re-defining my vulnerability and will now paints vulnerability as an important vulnerability they must be cognisant of endeavour to find strength in openness tool and a real strength. their shortfalls and mistakes. It means and weakness. Vulnerability is defined by the Oxford expressing uncertainty, something Dictionary as ‘the quality or state of that is often perceived as failure by the being exposed to the possibility of being medical profession. We should challenge attacked or harmed, either physically or this notion and invite doctors to be emotionally’. We cannot escape being human. We should rephrase intentional vulnerable as doctors. In the doctor- and meaningful vulnerability as patient relationship, it is fundamental a strength, rather than weakness. for the establishment of trust and Emotional intelligence underpins meaningful connection; it underpins much of our success in medicine and collaboration, help seeking, and it’s a skill we need. It can be unnerving reporting medical errors. Despite this, we for some of us as it often challenges It’s never been more continue to attempt to circumnavigate cognitions learned during our induction this intrinsically human experience. to medicine. It can be unsettling and important to stay in touch. This should be challenged. Vulnerability fraught with feelings of shame and For updates on AMA(SA) news and activities, should instead be recognised as a clinical not belonging. please follow us: tool to enhance our role as doctors and Yet there is a flipside to the benefits for Facebook: @AMASouthAustralia as humans to help us navigate life, death, our profession and patients. Unchecked Twitter: @ChrisMoyAMASA and difficult circumstances. doctor vulnerability can lead to empathy Instagram: @amasamembers Vulnerability can improve doctors’ burnout. Oversharing can be perceived LinkedIn: Australian Medical Association (SA) ability to empathise with patients as unprofessional by patients or impair To ensure you receive future ‘bumper’ (June and December) editions of medicSA, please provide your name, phone, postal address Adelaide Cancer Centre are pleased to introduce a new Consultant Haematologist,and preferred email address to: [email protected]. Dr Akash Kalro MBBS MD FRACP FRCPA If you are a member, check for our Informz newsletters in your inbox. Dr Akash Kalro will be consulting at the Tennyson Centre, Kurralta Park and 480 Specialist Centre, Windsor Gardens. His special Interests are; malignant and non-malignant haematology, in particularl lymphomas, myeloma and haemostasis.

Dr Kalro is also a general haematologist practicing at the Royal Adelaide and The Queen Elizabeth hospitals with a focus on myeloma, lymphoma and autologous stem cell transplantation.

Dr Kalro trained in India before moving to Sydney where he completed his fellowship training in haematology. He worked at the Royal Darwin hospital for 9 years before moving to Adelaide. As a general haematologist he has been actively involved in care of patients across both benign and malignant haematology. Dr Kalro set up the flowcytometry service in the Northern Territory in addition to actively partaking in consultative thrombosis clinics. He was the Haemophilia Treatment Centre Director for several years before his move. Dr Kalro is an active member of various professional bodies and participates in clinical trials where he has been a principal and sub investigator.

Suite 10, Level 1, Tennyson Centre Suite 3, Level 1, 480 Specialist Centre 520 South Road, Kurralta Park SA 5037 480 North East Road, Windsor Gardens SA 5087 Ph 08 8292 2220 | Fax 08 8292 2230 www.adelaidecancercentre.com.au Ph: 08 7132 0480 | Fax 08 8292 2230

Adelaide Cancer Centre - Third Pg V2.indd 1 27/07/2020 11:46:14 AM MEDICAL EDUCATION

Changing tradition without dampening our spirits and bringing back the gaudium

April. Preceding the clinical placement The easing of restrictions has meant JADE PISANIELLO and teaching pause, the year 6 students medical students can go back to what STUDENT NEWS: were told that overseas travel could they do best: learning from South ADELAIDE UNIVERSITY understandably not go ahead. Australian doctors, nurses and patients So, the usual mark of the beginning in hospitals or our new medical school of holidays for students in years 4 and and, of course, planning the delivery of or 135 years, the Adelaide Medical 5 was instead met with a long-awaited our rich social and educational events. Students' Society has upheld three and much anticipated return to clinical From MedRevue to Graduation Week, Fcore values: ‘traditio, spiritus, placements. For pre-clinical students in practice examinations to EdForum, the gaudium’ – tradition, spirit and years 1-3, the beginning of the second AMSS is slowly but surely emerging good times. Although 2020 has seen semester marked the return to face-to- from hibernation and bringing back traditional medical school life go out face teaching. Through the dedication the gaudium. In mid-August, the AMSS the window, the AMSS has been hard of faculty members, the AMA(SA) was permitted to host the first in-person at work delivering virtual good times and countless hospital clinicians, event since our annual MedCamp at Adelaide University medical students and upholding spirits for some 900 Normanville in March. The society were finally permitted to head back medical students across all six years of presented InterYear Comedy Debating, into hospitals and the medical school. the program. when we saw the final year students Having placement and in-person This time of year classically marks the debate the fresh-faced first years and, teaching so abruptly halted, the ramble beginning of much-awaited holidays for the first time, the Adelaide Medical into hospital or university day after day for students in the years 4-6, with many suddenly seemed not so tedious. The School went head to head with the of the final years heading abroad for final-year cohort, who recommenced Flinders Medical School debating team. their Dean’s Elective: an opportunity placement back in April, have certainly With final-year students having just to pursue a month of clinical practice enjoyed seeing the faces of our younger been notified at which hospital networks in any medical field, in any part of the colleagues in corridors and theatres. they will complete their internships, world. For pre-clinical students in years The delivery of medical education via we cannot help but look to the future 1-3, these colder months make the trek exclusively digital means was difficult for and wonder when this chapter of to the Medical School on North Terrace student and teachers alike. Teaching to a ‘unprecedented times’ will draw to a even harder, with their holidays just in screen of tiny rectangles could not have close. For now, we are grateful for the sight. In the context of COVID, medical been without its challenges – and yet, the few moments where we are able to safely students across all years at the University consultants we know and love brought interact with each other, whether this be of Adelaide were pulled from hospitals their best e-selves forward to deliver in hospital, on campus - or even across and in-person university teaching in informative and entertaining teaching. the debating stage.

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medicSA | 35 Tattoo free breast radiation therapy now available at all GenesisCare treatment centres in SA

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Offer applies to new BMW vehicles ordered between 01.07.2020 and 30.09.2020 and delivered by 31.10.2020 at participating authorised BMW dealers by Australian Medical Association SA members or their spouse. Limited edition models exclusions apply. Excludes fleet, government and rental buyers. *Complimentary service inclusive - Basic, including Vehicle Check, is valid from date of first registration or whichever comes first of 5 years/ 80,000km and is based on BMW Condition Based Servicing, as appropriate. Normal wear and tear items and other exclusions apply. Servicing must be conducted by an authorised BMW dealer in Australia. ^Samsung Galaxy S20 Ultra 5G 128GB or 75” QLED 4K Smart TV – Q60T. Not redeemable for cash and is not negotiable or transferable. Unless excluded, this offer may be used in conjunction with other applicable offers during the promotion period. Subject to eligibility. Terms, conditions, exclusions and other limitations apply, and can be viewed at bmw.com.au/corporate. medicSA | 37 REFLECTIONS

Heroes are people too

However, no matter how fast a cyclist is, answers aren’t clear. There is no black they cannot win the Tour without a top and white. And the people leading us team. The team protects their leader, through this are experiencing the same gets them into position in the group and feelings and lack of certainty as the rest rides in front of them, which decreases of us. Perhaps some grace is required, the effort needed to maintain their rather than blame. speed. Due to the necessary tactics, the BLAMING SYSTEMS, NOT complexity and the elements of the bike PEOPLE race, you cannot win as a single rider. But when mistakes happen, when And so it is the team that should be the wrong decision is made, who is to celebrated, but it is the winner who blame? Is the pilot the one to blame stands on the podium and receives when the plane crashes? Is the surgeon the glory. to blame when a swab is left in the HOLDING UP AND TEARING abdomen, or the incorrect surgery is DOWN done? Is the physician to blame when Leaders are held up all around us an obvious diagnosis is missed or the and are praised — in the good times. incorrect medication is given to the By Dr Troye Wallet But a cultural shift is happening. Praise patient? Is the nurse to blame when the is becoming less common; blame and wrong IV is put up? Is the politician to shame are becoming more prevalent. blame when a decision has negative There is something about the age in consequences? which we live that leaders are vilified ir Richard Branson is an unlikely They could be, but another way is to rather than glorified. When times look at the systems surrounding the introvert. When he started Virgin, become hard, and the correct decisions he realised that companies are errors and blame the systems. This is not are not clear, leaders are dragged to say that people are not accountable uninteresting to the media. So, through the dirt. It seems instead of She changed his public persona and for their actions, but rather that we loving their heroes, people now love to became the outgoing, adventurous understand human nature and establish hate them. systems that are less likely to allow and extroverted man he is today — It is especially prevalent in our current all for a story in the paper. Because human flaws to manifest themselves. time when decisions are not easy, there Looking at the systemic nature of everyone loves heroes: they are held up is no apparent right answer, and the behaviour and errors is empowering as leaders and celebrated and praised. road ahead is unclear. at every level. Leaders such as Steve Jobs and Elon American author Professor Brené Musk become known because of the Brown talks about ‘the FFT’. The first USING A SYSTEMS APPROACH companies they build. Steven Marshall F is an expletive, and for the sake of At a personal level, systems thinking and Brendan Murphy have climbed this article, we’ll call it ‘the Flipping recognises that self-control is overrated the political ladder to leadership. Every First Time’. The idea is that the first and doomed to fail. Instead of shaming doctor and healthcare professional gains time something is done, it will be hard, ourselves because we are not strong the ‘leader’ label due to their training it’s supposed to be hard, mistakes are enough to resist that chocolate, we and respected position. supposed to be made, and it is supposed understand human nature and create GREAT LEADERS NEED A to feel awkward and uncomfortable. an environment to maximise the GREAT TEAM Framing FFTs in this way releases the chance of success. It shifts the focus The thing is, a leader is nothing tension of doing something new, as it from the individual to the environment without their team. normalises the discomfort. She says the and systems that lead to the behaviours. The Tour De France is the biggest pandemic is forcing us to do and think Removing all treats from the house bike race in the world, and the winner is about a lot of things for the first time. and a shopping list makes keeping to considered the best cyclist of the time. It’s not surprising it’s rough, and that the the diet easy.

38 | medicSA In his book The Happiness Advantage, there are two options. The first is a Shawn Achor introduces the concept massive public awareness campaign of activation energy. The idea is that ... Instead of that demands changes to behaviour every action requires energy to initiate among people resistant to making them. it. He tells the story of wanting to set shaming ourselves Or, as a second option, Adelaide could up the habit of playing his guitar every because we are create more bike paths. Building tunnels night. No matter how hard he tried, he not strong enough under the roads that cross the parklands found himself watching TV instead. His makes cycling around the city easy, solution was to remove the batteries to resist that safe and encourages activity. People from the remote control — increasing chocolate, we will naturally walk more, and runners the activation energy required to watch will circumnavigate the city. Average TV — and to put his guitar next to the understand human exercise would increase because the couch, decreasing the activation energy nature and create city supports it. Even better would be to to playing. That way it was easier for an environment to make the roads into tunnels and have him to practise guitar than watch TV a beautiful natural strip of land around — a system created to encourage the maximise the chance the entire city. But that is just dreaming. desired outcome. of success ... Environmental and urban design Systems thinking works at a changes the behaviour of the people professional level, too. For example, living there. if the doctors in a practice all have from people involved, examine the lunch scheduled at the same time, the A CALL TO ACTION system and the human flaw that led to environment generates opportunities This is a call to action. A call to for them to all be in the lunchroom at the failure. Then a change can be made support our leaders, hold them the same, which fosters brainstorming, to prevent it from happening again. accountable when necessary, but realise collaboration and teamwork. Human In cities, alterations to design change that decisions are not clear, and the nature is very predictable and generally behaviour more than public information correct path is hard to walk. A call to will take the path of least resistance. campaigns. To encourage walking, make set up the conditions for good things to If excellence is desired, set up the the footpaths wide and accessible. As a thrive and to set up the conditions that workplace or a system to encourage thought experiment and using Adelaide turn leaders into heroes. Because we learning. When errors occur, rather than as an example, if the goal is to be the need heroes now. Because we need the demanding change or extra vigilance healthiest and fittest city in Australia, courage to be those heroes.

medicSA | 39 VALE

With old school manners

Dr Malcolm Alfred Wheaton

1924 – 2020

‘Travelling the extra mile’ Dr Malcolm Alfred Wheaton

s the only general practitioner rope, travelling on to reach a gravely Yet, as Mrs Wheaton says now, this at the busy Booleroo Centre ill patient north of Willowie, 25 km was ‘simply what you did in those days’. practice in the southern north of Booleroo Centre. Unphased ‘He did what all the doctors in Flinders Ranges, the late by the call to brave the floodwaters, Dr neighbouring towns did; it was ADr Malcolm Alfred Wheaton had a Wheaton left his car on the side of the something they were trained to do,’ reputation for having a heart of gold and road and crossed safely, going on to visit Mrs Wheaton says. ‘The patients came never saying ‘no’ to the many and varied the patient who was later transported first. You saw patients when they needed requests that characterised his 37 years to Booleroo Centre. Happily, the to be seen and it was very rare that in the role. ambulance travelled via nearby Melrose, you sent them to Adelaide. There were Just like the United States postal Wilmington and Pinda Bridge rather specialists who were very helpful in worker who vows, ‘Neither snow nor than via the creek. providing support when it was needed.’ rain nor heat nor gloom of night stays Dr Wheaton’s car might have been Dr Wheaton worked hard for the these couriers from the swift completion the only casualty of the event but for a community, supporting local clubs and of their appointed rounds’, Dr Wheaton passing friend moving it from the flood as the medical representative on the was renowned for going the extra mile water that had surrounded his car. Booleroo Centre Hospital Board. He for patients. Dr Wheaton’s service to the people of was awarded life membership at the Booleroo Centre is a small town in Booleroo Centre and nearby farms and Booleroo Centre & District Ambulance South Australia’s mid north, 266 km towns began when he arrived in a blue Service and is widely acknowledged as north of Adelaide and about 70 km Morris Oxford as a single man in 1956. a generous, dedicated, thoughtful, kind north-west of Peterborough, well- Originally from Redhill, Dr Wheaton and wonderful man. served by the Booleroo Centre and studied medicine after returning from Indeed, the plaque mounted on the District Hospital. Dr Wheaton famously World War II and set up practice in renovated outpatient and theatre/ traversed the flooded Booleroo Creek, Booleroo Centre. He became a local, recovery area in 2002 is dedicated shoulder deep in water, and guided marrying Heather, a nurse at the to Dr Malcolm Alfred Wheaton, through to Booleroo Whim on a Booleroo Centre and District Hospital, in acknowledging his work for Booleroo 1963 and they later had four sons. Centre and District Hospital between Like many country medical families, 1956 and 1993. they lived at the practice where Dr Wheaton consulted Monday to Friday. The role seeped through the pores between work and home life as he was on call 24 hours a day. Farming provided his outside interest. Dr Wheaton visited patients at any time of day or night for those who were too sick to see him at his consulting rooms. He also operated and delivered babies around the clock. In the traditional manner of country general practice, nothing was too much trouble.

40 | medicSA So, it was not because he was not well- the disease when he first asked her and would be holding onto it to ensure he loved by staff and the community that was equally blank the second day after did not fall out during the trip. nurses reported hiding from him in the spending all night in the local pub. Dr Wheaton remained closely pan room during his hospital rounds. What he taught you, you learned for life, connected to the Booleroo Centre The same determination and dedication students noted. community throughout his life. that drove him to work tirelessly While eminently professional, with He lived to the great age of 96 and in the role was also reflected in his ‘old school manners’, Dr Wheaton is survived by Heather and three of commitment to training nursing staff. adopted some of the pragmatic, laid his sons. Dr Wheaton kept student nurses back approaches to problem solving on their toes, quizzing them on the characteristic of rural people. For Pictures and information supplied by meaning of medical diagnoses. If they instance, he and his family sometimes Dr Wheaton's colleagues, family and friends. didn’t know the first time, he would loaded his father’s wheelchair into the ask them again the next day. One back of a ute to bring him home for nurse recalled that she can still recite visits from the nursing home. As was the definition of shingles verbatim, the practice of the time, his father would having revealed she had no idea about be in the wheelchair and one of the boys

medicSA | 41 VALE

A fine innings

Dr Dean Southwood AM MBBS, DLO, FRACS

1936 – 2020

ean Southwood AM made a the RAH and home, significant and distinguished but over time the contribution as an innovator department became and committed teacher in widely recognised as Dfacial plastic surgery. one of the country’s To the outside observer his career path best teaching units. in medicine seemed logical. Yet as a The Dean Southwood young man, Dean dreamed of becoming Temporal Bone a professional golfer and was persuaded Laboratory, which he to follow in the medical footsteps of his personally funded, father Harry, a GP turned psychiatrist — attracted students Dr Dean Southwood if only as a back-up plan. from all over Australia Dean was passionate about sports – he and New Zealand. This remained branch chairman of the Australian was a golfer and captain of the Prince the sole laboratory for all Adelaide Society of Otolaryngology Head and Alfred College tennis and chess teams registrars until 2019 and included a Neck Surgery (ASOHNS) Section – and was an avid reader. He joined the comprehensive ENT library with audio- chairman from 1987 to 1988. Norwood Chess Club and, at his peak, visual and fixed dissections. Dean’s colourful personality, was able to play the game blindfolded. For some years, Dean organised and diplomatic mindset and fine skills But this played second fiddle to his love taught at Modbury’s popular biennial made him a strong advocate for the of the Norwood Football Club where he national temporal bone dissection profession and he organised many high- was an avid supporter all his life. courses, which still remain popular. level conferences and cadaver and live Dean was born on 16 May 1936 and Dean’s dedication to registrar training dissection courses, with top speakers. lived on South Terrace in the city, where was legendary. He was a long-time He helped to build a bridge between ENT his father ran a general medical practice. member of the State Registrar Training and plastic surgery and was captivating He married Margaret, a tutor and Committee and its chairman for many in his enthusiasm for otolaryngology researcher at the University of Adelaide years. He served as the South Australian and rhinoplasty. He was a wonderful while completing his final year of teacher and mentor, hosting pie and medicine at the same university. pastry tutorials and tennis at his home. Not to be diverted from sporting Dean was particularly fond of treating pursuits by study, he continued to excel children and was known for his child- at billiards, snooker and table tennis, friendly manner, which included a well- winning a South Australian amateur honed coin-out-of-the-ear trick. billiards title and contributing to three Dean developed strong links with team championships, and writing a esteemed members of the American bidding system for bridge. Academy of Facial Plastic and Nonetheless, Dean discovered a Reconstructive Surgery (AAFPRS), which passion for ear, nose and throat (ENT) formed the seed for the development of surgery during a rotation at the Royal the Australasian equivalent. He became Adelaide Hospital and, for the first the Founding President of the Australian time, knew exactly what he wanted to Academy of Facial Plastic Surgery do. Study was no longer a chore and he in 1990 and was widely regarded by spent many hours learning and teaching esteemed founders of American facial in a field that he enjoyed. plastics. He helped establish similar In 1985, Dean agreed to establish the organisations across the world and was Otolaryngology Unit at the Modbury invited to become World Chairman Hospital, where he remained until but declined, believing Australia was his retirement in 2015. He initially just too far away from the rest of the faced challenges in attracting doctors world. He strived to ensure Australian who saw Modbury as a long way from students were part of this international

42 | medicSA community, however, using a gift from that was formally supported by 1,500 his mother’s estate to fund a scholarship doctors from around the country. The for ENT students to attend a professional foundation raised so much money it was course in Bordeaux that he had able to build a state-of-the-art clubhouse particularly enjoyed. with the proceeds. His actions, and Sporting and card contests remained the accompanying furore, played an a strong theme throughout Dean’s life important part in achieving national and the family home revolved around anti-tobacco legislative changes. them. The tennis court was resurfaced Dean was a very gifted artist and with ‘Gabba Grass’ that accommodated enjoyed reproducing works of the a broader range of sports and the great masters to the extent that when backyard was converted such that a the family visited the impressionist card room opened onto an 18-hole paintings at the Jeu de Paume in Paris, putting green. his six-year-old daughter noted that Dean followed all sporting clubs that the gallery had copied Dean’s work. He wore the red and blue colours. The developed a love of classical music and Dr Southwood followed the red and blue Norwood Football Club recognised all things French, as well as movies that his life-long contribution with life he studied with the same enthusiasm he Dean was an outstanding contributor membership and named the family area brought to his work. to the medical profession, his specialty at The Parade in his honour. In 1992 Dean was awarded a Member and the sporting community. As his In the summer months, his interest of the Order of Australia for his services son Ian noted: ‘He gave tirelessly and turned to the East Torrens District to ENT and the anti-smoking lobby. generously and was always a man of Cricket Club, where he was president Initially he didn’t want the recognition, principle, even under the most testing of and later a life member. He famously but he eventually agreed to accept circumstances. He understood the value insisted on a firm stance against the honour after considering the time of persistence and hard work and was sponsorship of that club by tobacco and effort that others had put into deserving of the rewards he received in companies, personally offering a his application. With typically careful life.’ He is remembered by the medical significant donation if the club would consideration, he eventually decided profession as a father figure responsible refuse tobacco company sponsorship. it was in the best interests of his for training hundreds of grateful He then established a foundation profession and the cause. young surgeons.

PRACTICE NOTES

NOTICES accepts emergency plastic and hand Contact: Eleanor Clausen CEO surgery referrals. to discuss further. eclausen@ RICHARD HAMILTON MBBS, For convenience, referrals may be theinternationalspincecentre.com FRACS, plastic surgeon, wishes to faxed to 8373 3853 or emailed to Plastic surgeon Dr Peter Menz notify colleagues that his private clinic [email protected]. For all wishes to inform colleagues of my Hamilton House Plastic Surgery was appointments phone his friendly staff forthcoming retirement. The Oxford Day fully re-accredited under the rigorous at Hamilton House 8272 6666. www. Australian National Standards (NSQHS) Surgery Centre practice at Unley will hamiltonhouse.com.au for health care facilities and also by close in mid-September 2020. I have The International Spine Centre® the American Association for the enjoyed managing our patients there for (TISC) is hiring! Accreditation of Ambulatory Surgical more than 30 years, and I am grateful Facilities International We are looking for dynamic for the referral support over this time practitioners to join our interdisciplinary (www.AAAASF.org). that has enabled this to happen. team. Do you meet the ‘if’ criteria? If you Richard Hamilton continues to ANTHONY PISANIELLO MBBS are passionate about embracing change practise plastic and reconstructive PhD FRACP, interventional and in health care practice, delivering surgery at Hamilton House, 470 structural cardiologist, advises that collaborative care & putting patients first Goodwood Road Cumberland Park he has returned from subspecialty then we are the organisation for you. If with special interests in skin cancer training at Manchester Royal Infirmary, excision and reconstruction, hand you are drawn to teamwork & academic UK and The Johns Hopkins Hospital, surgery and general plastic surgery. He achievement, then consider TISC. If USA, and commenced practice at also conducts a ‘see and treat’ clinic you have a desire to grow personally for elderly patients with skin cancer. and clinically through interdisciplinary Calvary Adelaide Hospital and Adelaide Convenient free car parking is available. discussions, mentorship, research & Heart Clinic, 32 North Terrace, Kent Richard also consults fortnightly at hands-on theatre experience, then Town. He welcomes referrals for all Morphett Vale and McLaren Vale as please apply. cardiac conditions and has particular well as monthly at Victor Harbor and Spinal Clinician (SClin) expanded expertise in complex coronary Mount Gambier/Penola. He is available practice GP roles & clinical psychology intervention and transcatheter aortic for telephone advice to GPs on 8272 roles are available. It is our desire to valve implantation. Ph: 8362 6731. Fax 6666 or 0408 818 222 and he readily further your career. referrals to 8362 2724.

medicSA | 43 MOTORING

In the cockpit

The innovative Mercedes-Benz GLB SUV provides a myriad of fun surprises, writes Dr Robert Menz.

ercedes-Benz is one of the world’s oldest car companies and has always been at the forefront Mof innovation, particularly around issues of safety. Innovation also brings new models to the market – in this In case 165kW is insufficient, there is a of dexterity and nimbleness but once case, the GLB. GL in ‘Mercedes speak’ GLB 35 AMG (AMG is ‘Mercedes speak’ seated there is sufficient room for a refers to the range of SUVs and, as for sporty) with the same basic engine full-sized adult – at least for a short trip. you would logically expect, the B fits retuned to deliver 225kW. With seven seats in use there is limited in size between the established A and Many contemporary cars, especially in storage space, but the boot size is quite C models. If you want a larger SUV, the luxury field where Mercedes plays, adequate when set up as a five-seater. Mercedes also has GLE and GLS models are bristling with safety and comfort The test car had a panoramic glass corresponding to other E and S models roof (optional in the 200) with a small in its range. features and an increasing array of driving aids as well. More of these later. section above the middle row seats and The test GLB was the mid-range all- a large electric opening section over the So, what is special about the GLB? wheel-drive 250 4Matic. It features a front seats. The second row of seats was The most striking external feature is the 2L, 165kW turbo petrol engine matched set a little higher than the front seats, somewhat upright stance, reflecting the to an eight-speed automatic. The entry giving passengers excellent visibility. level 200 has a 1.3L 120kW power plant inclusion of a third row of seats. Access Sliding into the driver’s seat reveals a and drives through the front wheels. to the rear seats does require a degree very comfortable and multi-adjustable driving position both for the seats and steering wheel. A memory function allows the driving position to be set for the usual driver and, for those chilly mornings, the front seats are heated. What used to be called a dashboard is now called a multimedia system with wide-screen cockpit. There are two adjacent 10.25-inch digital screens that can be customised. I left the test vehicle set up with digital instruments including speedo and odometer in front of the driver and used the second screen for ancillary functions. These can be accessed either directly using the touchscreen, by using the small touchpad in the centre console, or by using some steering wheel- mounted buttons It would take several days to learn all the functions accessible through the touch screen; they include multimedia, including AM, FM or digital radio; telephony; navigation;

44 | medicSA MOTORING

and air conditioning. There are also several USB ports. Connecting my iPhone through Bluetooth was simple and meant I could play my own music through the car system if I wished. There is a wireless phone- charging pad in the console. One of the fun adjustments allowed me to change the ambient interior lighting to one of a wide range of fixed colours or to change subtly through a ‘rainbow’ function. Mercedes also has a voice recognition system called ‘Mercedes me,’ which is activated by saying ‘hi, Mercedes’. This worked well for telephone, navigation and even changing the radio station. The navigation system includes live ‘helicopter’ view, which shows adjacent We also managed two trips to the traffic updates. obstacles, kerb position and the white Adelaide hills, including transporting The mechanism to engage drive lines delineating a carpark, allowing or reverse is no longer in the centre Dr Phil Harding and his wife Margie to precision parking. console but is on a stalk to the right afternoon tea at FRED Eatery in Aldgate. Country driving was similarly of the steering wheel, and there are And the following evening Patricia and straightforward. Adequate power and paddles either side of the steering wheel I had a fireside pre-dinner drink at the AWD made for comfortable cruising. if you want to change gears yourself. Bridgewater Hotel. The GLB was quiet The GLB was certainly competent Indicator lights and windscreen wiper at highway speed with little road or through the curves, but the high centre functions are in the left stalk. The wind noise and I imagine reasonably of gravity was noticeable. multifunction steering wheel includes economical given that 1600 rpm controls for cruise control and speed equated to 110km/p/h on the freeway. limiter as well as volume adjustment for … While there I asked Mercedes about the target the sound system are much sportier market for this car and certainly As would be expected, the B-sized Mercedes, the GLB doctors with young families would be a SUV is very easy to drive. While there are predictable market, especially if there much sportier Mercedes, the GLB has has more than is a need to occasionally carry extra more than adequate acceleration to keep adequate acceleration passengers. I was initially surprised up with or even pass traffic. Although when told that a number of older not measured on this road test, the to keep up with or couples are buying GLBs as touring cars, claimed 0-100km/p/h acceleration even pass traffic … although realised this makes sense as takes only 6.9 seconds (5.3 if you opt for it is possible to flatten the middle row the AMG model). The cruise control maintained the of seats. More importantly, the B feels quite nominated speed, even with relatively How much would you need to pay solid on the road and, when it comes to steep downhill driving. However, it is not for all this innovation, safety, comfort breaking, stops very quickly. If there is adaptive, which is a surprise; adaptive and prestige? The listed retail price is a dangerous situation ahead, there are cruise is available as an extra in one of built-in safety mechanisms that activate the several option packages, in this case just under $74,000, and the test car the brakes before the driver has a a nearly $2,000 option that also includes drive-away price a little over $87,000 chance to do so, thus avoiding potential a driver assistance package, lane-change including on-road costs and one or two collisions. Again, this function was assist and extended automatic restart options including colours other than not tested! in traffic. The lane-change assist also white or black. Testing involved a range of driving provides a helicopter view of the car The test car was made available experiences. City driving was a breeze, showing the relative location of vehicles by Mercedes-Benz Unley. If you are and parking was very easy courtesy of in other lanes. interested in having your own test the information on the central screen. A day trip to Victor Harbor was drive call the sales staff on 8408 4333 The rear camera shows you the view rewarded with an easy view of southern (or 8152 5000 if Mile End is more immediately behind, but when you turn right whales less than 400 metres from convenient). the steering wheel, a pair of orange lines the beach. Fortunately, we did not have a appears on the screen predicting exactly flat tyre, as there is no spare. The run flat Dr Robert Menz is a GP and your path while reversing. There is also a tyres are good for at least 80 km. enthusiastic driver.

medicSA | 45 END NOTES

Polling place

riends and colleagues joined AMA(SA) President Dr Chris Moy and his wife, fellow F A/Prof William Tam and Dr Philip Harding GP Monika Moy, at the AMA(SA) Dr Chris Moy and Dr Monika Moy offices at Fullarton on 1 August to share the news – good or bad – of his Federal Vice President election bid. Former AMA(SA) Presidents Dr Janice Fletcher, Dr Philip Harding and A/Prof William Tam were among those who ‘socially distanced’ as they watched and participated in the online National Conference proceedings, which included the elections of Dr (From left) Professor Ted Mah, AMA(SA) Vice Dr Hannah Szewczyk, Dr Jemma Wohling Moy and new Federal President President Dr Michelle Atchison, Dr Philip and AMA(SA) Executive Board Chair Dr Omar Khorshid. Harding, Dr Monika Moy and Dr Ekta Paw Dr John Nelson

DISPATCHES

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