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Journal of the Australian Medical Association WA | December 2014 Volume 54 / Issue 11 | amawa.com.au
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BOQS0001128 11/14
Council
President
Dr Michael Gannon
Immediate Past President
Dr Richard Choong
Vice Presidents
Dr Andrew Miller
Dr Omar Khorshid
Honorary Secretary
Dr Janice Bell
Assistant Honorary Secretary
Dr Marcus Tan
Honorary Treasurer
Professor Bernard Pearn-Rowe
Councillors
Division of General Practice (WA)
Dr Steve Wilson
A/Prof Rosanna Capolingua
Division of Specialty Practice
Dr Tony Ryan
Dr Alexandra Welborn
Division of Salaried and State
Government Service
Dr Mark Duncan-Smith
Prof Geoff Dobb
Ordinary Members
Dr Daniel Heredia
Dr Stuart Salfinger
Dr Marcus Tan
Co-opted Members
Dr Steve Wilson
Dr Frank Jones
A/Prof Peter Maguire
Dr John Zorbas
Dr Melita Cirillo
Dr Ian Jenkins
Prof Ian Puddey
Prof Shirley Bowen
Dr Sandra Hirowatari
Mr Kiran Narula
Ms Kate Nuthall
AMA (WA) Office
Executive Director
Mr Paul Boyatzis
Director: Industrial & Legal
Ms Marcia Kuhne
Executive Officers
Mr Michael Prendergast
Ms Christine Kane
Ms Josphine Auerbach
Mr Simon Bibby
Ms Nicola Roman
14 Stirling Highway
Nedlands WA 6009
(08) 9273 3000
mail@amawa.com.au
www.amawa.com.au
December 2014
20
Cover story
The Good, the Bad and the Ugly
Services
Business Services Manager
Ms Noelle Jones
Financial Services Manager
Mr John Gerrard
Medical Products Manager
Mr Anthony Boyatzis
Health Training
Australia Manager
Mr Geoff Jones
The publication of an advertisement,
article or inclusion of an insert does not
imply endorsement by the AMA (WA) of
the views, service or product in question,
and neither the AMA (WA) nor its agents
will have any liability for any information
contained therein.
A good man in a crisis
Dr Andy Robertson
UWA Dedication Ceremony
FEATURES
7
Medicus
Editor and Director of
Communications
Mr Robert Reid
Deputy Editor
Ms Janine Martin
Advertising Inquiries
Phone Mr Des Michael (08) 9273 3000
Copy Submissions
Phone Ms Janine Martin (08) 9273 3009
or janine.martin@amawa.com.au
42
16
FIFO Report echoes
AMA concerns
WA’s Education and
Health Standing
Committee releases
discussion paper on
mental health impacts
of FIFO work
9
38
Dekker appeal supports doctor’s
right to choose
Success after 12 years
For the Record:
Professor Peter Klinken
The State’s Chief Scientist on why
we need a “Team WA Approach”
REGULARS
62 Travel
03 From the Editor
38 For the Record:
Professor Peter Klinken
05 Industrial
40 Clinical Edge
67 Wine
06 Immunisation
42 P rofile:
Dr Andy Robertson
68 M
ember Benefits
& On the Town
44 Research
71 Classifieds
Professional Appointments
& Positions Vacant
02 President’s Desk
7 Comment
10 News
16 F
eature: UWA
Dedication Ceremony
47 Opinion
55 Beyond Borders
20 C
over Story: The Good, 57 AMA Training
59 AMA in the Media
the Bad & the Ugly
35 Opinion
65 Food
76 Greensheet
61 Drive
December
ME D I C US 1
PR E SIDE N T ’S DE SK
Flexibility fundamental to gaining
best and brightest doctors
by Dr Michael Gannon
AMA (WA) President
T
he Health Department of Western
Australia recently announced a
decision to cease seeking Area of Need
(AON) determinations to employ overseas
trained doctors at the junior doctor level.
This is a welcome announcement. It
reflects a maturity of our medical training
arrangements in Western Australia.
The AMA (WA) position should in no
way be interpreted as being a slant against
that significant proportion of doctors
in the West Australian community who
were trained overseas. Indeed it includes
a significant proportion of past presidents
of this august Association!
That there is a clear benefit to the
community of having indigenous medical
schools should not be questioned. I
remember my first meeting of the
Australian Medical Students Association
(AMSA) that I attended in 1992 as
the representative of the WA Medical
Students’ Society. That week a retired
Chief Justice of the Supreme Court in
New South Wales had spoken of the
burden and expense of local medical
schools. He asserted quite ridiculously
that Australia should import all of its
doctors. Such a proposal was resisted by
AMSA and the AMA at the time.
His Honour clearly had no comprehension
of the tremendous benefit that medical
schools bring to their local community.
It was that recognition that led the
people of WA to raise money to fund the
development of their own medical school at
the University of Western Australia via
a lottery process in the 1950s.
Having local medical schools promotes
medical research. It allows for recruitment
and retention of high quality academic staff.
It also means that the doctors of the
future are trained to relevant local social
and cultural mores. While Australian
society might be roughly comparable
to that of Britain, Ireland, Canada or
New Zealand, there are very specific
and unique things in our health system,
including our effective public and private
mix, our geography and the uniqueness of
2 M ED I CU S December
Aboriginal Australians.
Of course any system must have a
flexibility to allow for a transfer of ideas. I
personally benefited from spending three
years in Ireland and England during my
specialist training. I have made contacts
and friendships that I hope will last a
lifetime. This interchange of ideas should
be encouraged and health systems must
retain the flexibility to allow doctors to
move around the world, perhaps ideally
at the Senior Registrar level. There are
numerous examples, but in my own
experience, I know that the Fellow
positions in Interventional Radiology
and Gynaecological Oncology available
in Perth are world renowned and every
year attract high-quality doctors from
interstate and overseas.
We must also maintain flexibility to
deal with acute workforce shortages. Part
of the crisis afflicting the mental health
system in WA is a significant shortage
of Consultant Psychiatrists. Our system
must retain the flexibility to vet, import,
credential and then support Psychiatrists
who have trained overseas.
Then there is the issue of chronic
doctor shortages. It is a fact that it has
been difficult to attract doctors to ‘onehorse’ towns in our vast State. Historically
we have been reliant on doctors trained
overseas to work in these towns. The
promise of a life in Australia has been
enough for many of our colleagues to take
on these positions in often very difficult
and trying circumstances. The reality
of displacement from opportunities for
collegial support, continuing medical
education and desirable social and cultural
activities has meant that a lot of our
colleagues in these positions move back to
the city once their period of bondage has
ended. While not perfect, this system is not
completely without its merit.
The AMA (WA) tries very hard
to support those doctors who come
from other countries and go to work
in the bush. Providing locum support,
supporting spouses and families, and
The AMA (WA)
tries very hard
to support those
doctors who come from
other countries and go to
work in the bush. Providing
locum support, supporting
spouses and families, and
providing educational and
professional opportunities
is important
providing educational and professional
opportunities is important.
We are hopeful that changes to the
way doctors are trained, including the
introduction of the Rural Clinical School
and increasingly the amount of time that
all medical students are exposed to the
bush will increase the number of doctors
who wish to make rural and regional
Australia their home in the long term.
It has been desperately sad that the WA
Health Department has felt the need to
employ doctors trained overseas under
AON provisions rather than considering
why doctors leave the public system at
consultant level or break contracts at RMO
level out of desperation at not being granted
access to accrued leave. There has been
a culture that this is an easier fix than
looking honestly at the problems that cause
workforce shortages in the public system.
Health Workforce Australia has
been disbanded by the Commonwealth
Government. Neither HWA nor any of
its predecessors have been brilliant in
predicting the future. We are still paying
for the ill-considered Provider Number
changes of the 1990s and a failure to
invest in medical training 25 years ago.
The projections in HWA’s final report
assume that something like 20 per cent
of doctors will continue to come from
overseas.
We must retain flexibility in the system.
Continued on page 3
F ROM T HE E DI T OR
SANTA COMES EARLY FOR SOME
T
his month’s cover story looks at
health over the year past and into
the future.
And with health spending now taking
around a third of Western Australia’s total
state budget, it’s no wonder that this one issue
dominates public debate in so many ways.
Even recent events such as the death
of a little boy who wandered into an
unfenced lake and drowned, or children
killed by reversing vehicles, or swimmers
taken by sharks, highlight the continuing
debate about how safe is too safe. How
far should we go to protect the health and
safety of citizens?
Even the seemingly simple issue of
peanuts being made freely available at a
popular WA theme restaurant stimulated
strong debate after Australian Medical
Association (WA) President Dr Michael
Gannon said commercial operators had a
community responsibility to ensure people
with peanut allergies were protected.
As Dr Gannon said airlines no longer
make peanuts freely available and it was
important for other outlets to consider
those with life-threatening allergies.
Dr Gannon’s comments were even
more poignant as he had grown up with a
serious peanut allergy.
But how far should we go to protect
our fellow citizens? Should we take every
effort to protect the vulnerable and
should we fence all water features, make
reversing cameras compulsory or force
swimmers only to enjoy the water behind
shark enclosures?
This of course is not a new debate – in
one way or another, we have been having
it for hundreds, even thousands of years.
Did some people really fight against the
imposition of sewer lines as not being
necessary and a tad too expensive for
a community, perhaps arguing that
the risk of spreading disease was a risk
worth taking? Does anyone believe
that imposition of safety rules in the
workplace or on roads is not a positive
for society?
The AMA (WA) will certainly
continue to advocate for the health and
safety of the community both within
government and in the public arena. We
live in a much healthier environment and
enjoy our lives more thanks to health
advocates arguing for sensible changes
in the way we manage our society.
On this front, we would like to thank
WA Health Minister, Dr Kim Hames
for the slightly early Christmas present
he gave us a few weeks ago. Dr Hames
finally agreed that WA will join other
states and ban the commercial use of
solariums from the beginning of 2016.
We are not surprised that this has
occurred. However we are surprised
that it took so much effort by the AMA
(WA), along with other public health
organisations, a media campaign,
and even taking out an expensive
advertisement in The West Australian
before the Government came on board.
The fact that Dr Hames had to fight
in the Liberal Party room for WA to join
other states in taking a national approach
to these “death machines” is especially
worrying. More concerning, however, is
that some tried to question the science
behind banning these machines.
But the fact is WA has now joined the
rest of Australia – finally.
While this very timely Christmas
The fact that
Dr Hames had to
fight in the Liberal
Party room for WA to join
other states in taking a national
approach to these “death
machines” is especially
worrying. More concerning,
however, is that some tried to
question the science behind
banning these machines
present is welcome, there remains doubt
about the finer points.
We look forward to Dr Hames releasing
further details about the regulations
before too long, including compensation
plans and plans to stop these machines
falling into the black market.
And that’s when we can actually
unwrap the present.
But for those groups in the public
health field, it is another victory for good
health and safety.
Finally, it is appropriate that Medicus
and the AMA (WA) wishes all members
and readers a very happy Christmas and
an even better 2015.
Medicus has had a stellar year with
more writers and more issues discussed
and debated than ever before. And we
have plans to make your magazine even
better in the coming 12-months.
There are more health issues to fight
for and more good, common sense
initiatives to propose.
In the meantime, keep safe. ■
Continued from page 2
Flexibility fundamental to gaining best and brightest doctors
by Dr Michael Gannon
We want the best doctors in WA. But lazy
use of AON provisions to grant doctors
provider numbers for areas of workforce
shortage like Attadale and Mount Lawley
do not serve a community that stretches
2.5 million sq km beyond the Swan River
and its immediate environs.
Medical Schools benefit the
community. There is now doubt that
they carry a prestige for the University.
How medical schools are run, the number
of doctors they train and the content of
the course must never lose sight of the
demands and needs of the community
in which they work. The people of WA
recognised this in the 1950s. It should
never change. Outside the doctors
produced locally, there will always be a need
to augment that with colleagues from across
the world, many of whom I am proud to call
my colleagues and friends. ■
December
ME D I C US 3
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INDUS T R I A L
SNAPSHOTS
Closure of Swan District Hospital
T
he AMA (WA) has been active advocating for
practitioners working at Swan District Hospital to
ensure:
• WA Health meets both contractual and moral obligations
towards practitioners whose contracts of employment will
be terminated in November 2015 due to the government’s
decision to close the hospital. Government obligations
include options for employment elsewhere in the public
sector and transfer/paying out of leave and other
entitlements required under the Department of Health
Medical Practitioners (Metropolitan Health Services) AMA
Industrial Agreement 2013; and
• St John of God Health Care (SJG), as the private
operator, makes offers of employment to existing
practitioners at SDH prior to considering external
appointments, and agrees to preserve current terms and
conditions for practitioners accepting employment at SJG.
Further issues related to transfer of leave, payment to
practitioners involved in commissioning work and other
matters are also being discussed.
At the time of writing, the AMA has successfully
negotiated arrangements with WA Health to ensure
practitioners who prefer to remain in the public sector can do
so and practitioners who wish to accept positions at SJG are
able to do so without losing leave entitlements or termination
payments accrued during their employment with WA Health.
The position presented by WA Health in response to AMA
demands was discussed with members at a meeting held at
Swan District Hospital on Tuesday 25 November 2014.
Negotiations with SJG are continuing. ■
Restructure of South Metropolitan Health Service
T
he AMA continues to receive feedback from members
about issues concerning the management of contracts,
processes and rosters, among other things, within South
Metropolitan Health Service (SMHS). The issues result from:
• t he impact of significant resources being drawn away from
health services within SMHS, particularly RPH, following
the opening of Fiona Stanley Hospital. This has resulted in
disputes at RPH in departments such as Gastroenterology
and Geriatric Medicine.
•R
PH introducing “job plans” that propose significant
changes without any consultation with consultants or
the AMA in breach of the Department of Health Medical
Practitioners (Metropolitan Health Services) AMA Industrial
Agreement 2013.
• a budget-centred focus on management of issues at FSH.
For example, there are reports of rostering planned for
SCGH RMO Term
Allocation Dispute
F
urther to the update provided in the November edition
of Medicus, the AMA has written formally to
Dr Victor Cheng, regarding the correspondence received
by junior doctors which appeared to lay blame on the delay
in providing term allocations on the Association.
Following this, the AMA has received assurances from
Sir Charles Gairdner Hospital (SCGH) that no further
correspondence would be sent or any action taken which
would have the effect of further straining the relationship
between SCGH, their junior doctors and the Association.
The AMA is monitoring the situation as it is still unclear
as to how many RMOs will be expected to undertake two
leave relief terms in 2015. This issue will be raised formally
with the Acting Director-General. ■
FSH whereby sessions rostered during the week would
be reduced commensurate with dollars paid for weekend
sessions.
• lack of clinical academic and supporting research nurse
positions at FSH, publicised as the flagship hospital for
clinical innovation and research in WA; and
• WA Health not complying with its own policies during
the reconfiguration. For example, DOH Operational
Directives set out a process of quarantining positions that
were or became vacant during the reconfiguration process
and making sure that a practitioner who had been identified as
surplus could be redeployed into the quarantined position.
The AMA, through the Inter Hospital Liaison Committee,
has raised the issues with the Acting DG, FSH, RPH and the
Minister and will continue to advocate on behalf of members
and in the interests of patient care. ■
Royal Flying Doctor Service
F
urther to the article published in the October edition
of Medicus, the AMA wrote to the RFDS expressing
concern about the introduction of major operational changes
at RFDS without any consultation with practitioners
affected or the AMA in breach of the Royal Flying Doctor
Service of Australia (Western Operations) Medical Practitioners
Industrial Agreement 2013.
The RFDS indicated it would meet with the AMA for
discussions. Given leave commitments of RFDS personnel,
there have been no discussions. However, the RFDS
has indicated it will meet with the AMA within the next
fortnight and it is understood that changes previously touted
have not been introduced. The AMA will keep members
informed of any progress and would welcome feedback from
practitioners affected. ■
Continued on page 6
IMMUNIS AT ION
NE W S
IMPROVING IMMUNISATION SERVICES USING THE
PROVIDER INFLUENZA VACCINATION ASSESSMENT TOOL
Professor Paul Effler
Medical Coordinator, Prevention and Control Program
Communicable Disease Control Directorate, Department of Health, WA
D
o you know how many of
your at-risk patients you
immunised against influenza this
past influenza season? If not, the
Western Australia Department
of Health has recently created
a GP practice data extraction
software program to help
General Practitioners answer
this question, and improve
influenza vaccination coverage
among their patients.
Developed in partnership with
Bentley-Armadale Medicare
Local and Datavation, the Prevention and
Control Team of WA Health has created
the Provider Influenza Vaccination
Assessment Tool (PIVAT) for use by
general practices to estimate seasonal
influenza vaccination coverage of their
patients. By using data already contained
in medical practice software, PIVAT
calculates the number of patients who
received a seasonal influenza vaccine,
by age group and medical risk factors.
It is compatible with a range of practice
management software packages including
Medical Director, Best Practice, Practix,
and MedTech.
The objective of the PIVAT program
is to allow GPs to assess how well they
are doing in getting their patients in
vulnerable target groups immunised
against influenza each year, as an
important first step in improving
immunisation services.
In 2013, 110 practices in Western
Australia installed and used PIVAT,
finding that on average, 17 per cent of
all patients at participating GP practices
were immunised against influenza. As
expected, influenza vaccine coverage
was highest in patients 65 years and
older, patients with chronic obstructive
pulmonary disease and coronary heart
disease – with over 50 per cent of these
patients recorded as immunised.
Immunisation coverage varied widely
by practice, however, with <2 per cent
of patients in some practices immunised
and 52 per cent immunised in others.
Reports PIVAT generates use
de-identified information that
permits practices to benchmark their
immunisation rates against their peers.
Practices which use PIVAT are sent
an annual report of results across WA
from the Prevention and Control Team,
indicating how their immunisation rates
compared with other practices.
Feedback from participating GP
indicates this information is useful to
practices in assessing how well they are
doing in immunising patients against
influenza. It is available at no cost to GP
practices in WA.
To prepare the 2015 influenza
vaccination season, and if your practice
is interested in learning more about how
PIVAT can help you improve vaccination
coverage, please contact Prevention and
Control at (08) 9388 4863 or by email at
Prevention.Control@health.wa.gov.au. ■
Continued from page 5
INDUSTRIAL SNAPHOTS
Fiona Stanley Hospital BPT Recruitment Process
T
he AMA fielded a number of
calls from concerned junior
doctors earlier in the year regarding the
recruitment process for Basic Physician
Trainees (BPT) at Fiona Stanley
Hospital (FSH).
The concerns related to the nature of
the questions asked at interviews as well
6 M ED I CU S December
as comments made by the Director of
Physician Education at FSH at Registrar
Information sessions held in the lead-up
to the recruitment process.
The AMA became aware that a large
number of applicants were poised to
make complaints to the Public Sector
Commission regarding the recruitment
process. Following this, the Association
made immediate contact with FSH asking
for a meeting to discuss the implications of
the flawed recruitment process.
Discussions between FSH, AMA and
representatives from the AMA Doctors
in Training Committee resulted in an
overhaul of the recruitment process, with
COMME N T
FIFO REPORT ECHOES AMA CONCERNS
T
he State Government’s Education
and Health Standing Committee,
chaired by Dr Graham Jacobs, has
released a discussion paper detailing the
preliminary information that has come
out of its inquiry into the mental health
impacts of fly-in, fly-out (FIFO) work
arrangements. The report, titled Shining
a Light on FIFO Mental Health will be
the precursor to the Committee’s further
investigations and discussions with
stakeholders.
The discussion paper is based on
submissions received from health,
industry, employee and regulatory groups
including the AMA (WA), Lifeline WA,
the Chamber of Minerals and Energy
(CME), the AMWU, the CFMEU and the
Department of Mines and Petroleum.
The Committee established the need
for quality research on the impact of
FIFO on the mental health of its workforce
and concluded that this research should
focus on “the extent to which FIFO work
practices are safe, as well as the extent to
which risks to psychological wellbeing are
managed”.
The Committee further noted the
absence of reliable data confirming the
nine suicides within the FIFO workforce
in a 12-month period as was reported by
the media. As the inquiry progresses, the
Committee will pursue the establishment
of evidence to support these figures.
The AMA submission to the inquiry
focused strongly on the characteristics of
FIFO work practices and the risks posed to
a workforce that is particularly vulnerable
to mental health problems and illness
– particularly given the predominant
demographic characteristics of the
FIFO workforce (males aged between
25 and 44). The Committee concluded
that “this group of at-risk people is then
employed under a structure that removes
them from their normal life and its usual
support systems for extended periods
of time. The normal support systems
that usually exist for every member of
society – such as family, friends, access
to a GP in conditions of assured privacy
– become inaccessible (or accessible only
with difficulty) for extended, and regular
periods”.
Factors negatively impacting on mental
wellbeing that are associated with the
structure of FIFO workplaces that were
identified in a number of submissions
included remoteness and social isolation,
the “macho” work culture, rosters, travel
time, accommodation, disconnection
from family and friends, lack of adequate
communication facilities and fear of
termination of employment should an
employee come forward with their mental
health concerns.
Of great concern is the issue reported
to the Committee concerning site drug
testing. Evidence was received that “some
FIFO workers, fearing detection by urine
tests screening for drugs, either do not
disclose or cease taking their prescribed
mental health medication”. The AMWU
further reported that some employees
feared negative consequences in the event
that they sought professional mental health
treatment or were prescribed medication
outside of work.
In its submission, the AMA highlighted
the use of alcohol and drugs as a noneffective coping strategy employed
by FIFO workers to cope with the
unique pressures of working in a FIFO
environment.
Lifeline WA further reported evidence
showing higher levels of alcohol and
substance use found amongst FIFO
workers when compared to the national
average. The WA Mental Health
Commission warned that “people self
medicating emerging and existing mental
health problems, such as depression, with
alcohol will be further supported in the
risky behaviour”.
Several submissions, including that
of the AMA, identified the link between
employee stress and the regimented nature
of FIFO life. The Association’s submission
cited onerous rules and a lack of control
over work and ‘off-duty’ time as being
significant stressors in the FIFO lifestyle.
The Committee will table its final
report in June 2015. In the interim,
further evidence will be gathered
from stakeholders. Within a very short
timeframe, the discussion paper has
highlighted important issues relating
to FIFO mental health that will require
further investigation and the AMA
supports the assertion of Dr Jacobs that it
is vital to continue the discussion.
The Association is also pleased to note
that new legislation which deals with
mine safety, to be introduced in 2016, will
specifically include the mental health of
workers given the silence of the current Act
on this aspect of their health. ■
the initial interviews being put aside, a
new recruitment panel drafted in and all
applications reviewed for a second time.
Offers for employment contracts
have now been issued with BPT
positions to be offered shortly.
The AMA understands that those
applicants who have made satisfactory
progress in their training will
automatically be offered a BPT
position in 2015. Those who have not
will be interviewed along with all BPT
1 applicants.
The AMA has worked closely with
FSH to ensure that the recruitment
process conforms by Public Sector
Standards.
Going forward, the AMA and
Committee representatives will seek
to work with all BPT sites to develop a
standard set of recruitment principles
and selection criteria which can be
applied state-wide to avoid further
issues arising in the future.
Any questions about FSH BPT can
be directed to the Industrial team at the
AMA (WA). Phone: 9273 3000. ■
December
ME D I C US 7
Hollywood
Private
Hospital
welcomes
da Vinci Xi
to WA
The da Vinci Xi Surgical System is
the most advanced surgical robot
in Western Australia and is only
at Hollywood Private Hospital
• Optimisedfora
range of specialties
including urology,
ENT, gynaecology
and general surgery
• Designedfor
efficiencyand
ease of use
• Willbethe
platform for future
technologies
The next frontier in minimally
invasive surgery
The da Vinci Xi Surgical System is a
tool that utilises advanced, robotic,
computer technologies to assist
surgeons with operations. With
revolutionary anatomical access,
the da Vinci Xi has broader
capabilities than prior generations of
the da Vinci system. It can be used
across a wide spectrum of minimally
invasive surgical procedures and
has been optimised for complex,
multi-quadrant surgeries.
For more information please contact:
Dr Daniel Heredia, Director of Medical Services,
Hollywood Private Hospital
(08) 9346 6249
hollywoodprivatehospital.com.au
WE’RE BIG IN HEALTH
COMME N T
Dekker appeal supports
doctor's right to choose
D
r Leila Dekker, Radiologist, was
involved in a motor vehicle accident
in the Pilbara in April 2002. Dr Dekker
was stationary at a T intersection in
her car on a dark road near Roebourne.
Another car travelling at high speed drove
towards Dr Dekker, who took evasive
action by driving across the intersection
and onto an embankment. The other
car passed behind her and crashed.
Dr Dekker didn’t see the other car crash,
but heard the impact.
Shocked and shaken, and without a
torch, mobile phone or first aid kit,
Dr Dekker drove directly into the nearest
police station, a short distance away, and
reported the incident and the possibility
of an accident.
Dr Dekker was charged in the
Karratha District Court with dangerous
driving causing death. After being
convicted by a jury, Dr Dekker was
sentenced to pay a fine of $10,000 and a
driving licence suspension of two years.
Dr Dekker subsequently appealed and
in a 2:1 decision in 2009, her appeal was
successful and her conviction quashed by
the Supreme Court of Appeal.
In July 2006, the Medical Board of WA
filed a complaint against Dr Dekker with
the WA State Administrative Tribunal
under Section 13 (2) of the Medical Act
1984 (WA) based on her being a “medical
practitioner convicted of a [criminal]
offence”. After the Court of Appeals
quashed her conviction, the Medical
Board amended its complaint with the
Tribunal to allege Dr Dekker committed
‘infamous or improper conduct in a
professional respect’ in violation of the
Medical Act Section 13(1)(a), as a result
of her failure to stop and render assistance
after the traffic incident in 2002.
Dr Dekker and the Medical Board
participated in a compulsory conference
with a Tribunal administrative member
in August 2009. The Administrative
Tribunal then issued its findings that
Dr Dekker should be reprimanded and
pay the Medical Board $35,000 to cover
its costs of pursuing the complaint.
Dr Dekker appealed, but in November
2013 (more than 11 years after the
accident), a four-judge panel of the
Administrative Tribunal issued its
decision that:
The practitioner’s conduct in failing to
stop and render assistance immediately
after the ‘near miss’ incident involving her
vehicle and a second vehicle on 27 April
2002, but instead leaving the scene of the
accident and reporting the incident and the
possibility that the second vehicle had driven
off the road to the Police, would reasonably
be regarded as improper by professional
colleagues of good repute and competency.
Although the practitioner’s conduct did not
occur in medical practice, there is a sufficiently
close link or nexus between her conduct and
the profession of medicine for the conduct to
be ‘in a professional respect’. The practitioner
is therefore guilty of ‘improper conduct in a
professional respect’ within the meaning of
13(1)(a) of the Medical Act.
The Tribunal did not accept
Dr Dekker’s argument that she was in
a state of severe shock after having been
involved in a life-threatening accident, that
her passenger actively encouraged her to
go to the police rather than stop, that she
did not have a mobile phone, torch or first
aid kit with her and it was dark and that she
knew Roebourne to be a town plagued by
social problems including drugs, alcohol
and violence towards women.
The Administrative Tribunal rejected
that Dr Dekker’s conduct was “infamous”
because she immediately reported the
incident to the police. The Tribunal did
not consider there was evidence
Dr Dekker could have done anything to
have saved the injured woman from dying
at the crash scene from her extensive
internal injuries.
SUCCESSFUL APPEAL –
NOVEMBER 2014
On 21 November 2014, the Court of
Appeal found that the Tribunal had
erred when it considered that there was
a specific professional duty on a medical
practitioner to attend and provide medical
assistance to a person who is not a patient
in circumstances where the medical
practitioner:
a) is aware that a motor vehicle
accident has occurred in their
vicinity, or may have occurred in
their vicinity
b) is aware that anyone involved in the
accident has suffered, or may have
suffered, any injury
c) is physically able to render
assistance.
The Court of Appeal found there
was no evidence of such a specific
professional duty. The Court
of Appeal found that the rules
of natural justice precluded the
Tribunal from drawing on its own
knowledge and experience to find
such a specific professional duty.
The Court of Appeal also found
that insofar as the Tribunal merely
relied on some more general duty or
norm to care for the sick, as applied
to the particular circumstances of
this case, its finding was made in the
absence of evidence.
This decision does not give doctors a
guarantee that disciplinary action will
not be taken if a ‘Good Samaritan’ fails
to assist in an emergency, but it will help
to provide some assurance to doctors who
may feel they are legally bound to assist –
irrespective of the dangers they may face
in providing assistance. ■
December
ME D I C US 9
NE W S
RESEARCH PROJECT ON POSTPARTUM
HEALTH LOOKING FOR PARTICIPANTS
F
amilies often experience a number of challenges during
the first six months after having a baby. This period is
now well-recognised as one which has critical developmental
aspects for all members of the family, especially in terms of
psychological and emotional growth.
For many, things go very well, and parents, infants, siblings
and grandparents all find their lives made more meaningful
through the experience of nurturing a new human being and
supporting one another.
Unexpected life events, ill-health and parental mental illness
can tip the balance away from a healthy adjustment for each
parent, and for babies and young children, and may have longreaching effects as children grow older.
Some of these may be in the form of repeated episodes
of depression and anxiety in mothers or fathers. Parental
mental illness can interfere significantly with the attachment
relationship with the growing child, with ramifications for his
or her cognitive, social and psychological development.
Unfortunately, parents of young children are frequently late
in asking for help when they are struggling emotionally during
the first six months postpartum.
A pilot study of 35 mothers by A/Associate Professor
Caroline Zanetti and Dr Michael Gannon at SJG Subiaco
Hospital found that 77 per cent of mothers experienced some
sort of significant struggle during the first six months after
their baby’s birth – the most frequent being a significant
medical problem in themselves or their infant, or infant sleep
and feeding difficulties. Around 46 per cent of mothers
reported panicky feelings, or finding it hard to maintain
a cheerful mood, 34 per cent were worried about their
relationship with
their partner, and
The researchers are
23 per cent were
hoping that doctors
concerned about
will encourage
their partner’s
mothers
with
babies aged
mental well-being.
between
six
and
15 months to
Mothers were
participate by completing an
quick to seek help
anonymous electronic survey
for health problems,
but very shy about
discussing problems
related to their own or
their partner’s mental health. Very few had actually sought help.
The Take Up of Postnatal Services (TUPS) study is
now underway to see whether these figures are true for
all families. The researchers are hoping that doctors
will encourage mothers with babies aged between
six and 15 months to participate by completing an
anonymous electronic survey. The survey will cover
how things go for mothers in the first six months after
having a baby, what problems do mothers face, and
whether services out there in the community are easily
accessible and meet the needs of new mothers.
A number of Woolworths’ vouchers are offered as an
incentive to mothers, who can access the study by following
this link: https://www.surveymonkey.com/s/TUPS. ■
If you would like to promote this worthy research project to
your patients, please contact Nisha Sikotra who will provide
you with more information: nisha.sikotra@sjog.org.au
or call (08) 9382 6828.
2015 AMA (WA) Membership Renewal
(due by 1 January 2015)
Renew your AMA (WA) membership and ensure you continue to have access to
individualised support and representation should you need it, and to the many benefits
and services that are exclusive to members.
Renewing your membership is easy
Renew by 1 January, 2015
and go into the draw to
WIN
1 of 3 iPads or a
$500 Coles-Myer
voucher
• Online at www.amawa.com.au
• By phone on (08) 9273 3055
• Fax completed renewal form to (08) 9273 3073
• Post completed renewal form to PO Box 133,
Nedlands 6909.
NE W S
Hollywood welcomes latest da Vinci ‘robodoc’
H
ollywood Private Hospital is the first hospital in Western
Australia to invest in the newest addition to the da Vinci
line of robotic surgical systems.
The hospital recently purchased the da Vinci Xi Surgical
System, the most advanced surgical robot in Australia. With
broader capabilities than prior generations of the da Vinci
system, it represents the next frontier in robotic surgery.
The da Vinci Xi can be used across a wide spectrum of
minimally invasive surgical procedures and has been optimised for
complex, multi-quadrant surgeries.
Director of Medical Services at Hollywood, Dr Daniel
Heredia confirmed it will initially be used for urology and head
and neck procedures.
“Specific operations will include prostatectomies, partial
nephrectomies and oral cancer surgery. Over time, the robotic
surgery program will expand to include gynaecology and general
surgery,” Dr Heredia said.
Hollywood CEO, Peter Mott said the multi-million
dollar investment in the robotic surgical system represents a
continuation of the hospital’s focus on securing state-of-the-art
medical technology and equipment.
“This will be the most advanced da Vinci Surgical System
of its kind available in Western Australia. Our decision to make
a significant investment in the latest robotic technology is
consistent with our commitment to providing the highest level
of patient care” he said.
Prior to using the da Vinci robot at Hollywood, surgeons
will have to complete a comprehensive training program that
includes up to 20 hours of simulated learning and a hands-on
laboratory workshop at an accredited site overseas.
“Surgeons are then required to complete the first five cases at
Hollywood under the direct supervision of an experienced robotic
surgeon,” Dr Heredia said.
“Finally, surgeons are required to perform a minimum
number of cases on the robot each year to maintain their
WESTERN AUSTRALIA
Expanding services: Director of Medical Services at Hollywood,
Dr Daniel Heredia, Deputy Director of Clinical Services,
Dr Patricia Whalley and CEO Peter Mott with the da Vinci
Xi Surgical System.
accreditation as a robotic surgeon at Hollywood.”
The da Vinci system brings a range of benefits to both
patient and surgeon. As with other forms of minimally invasive
surgery, potential benefits of undergoing a procedure using the
da Vinci surgical system include shorter recovery times, fewer
complications and reduced trauma to the patient.
Some of the major benefits experienced by surgeons have been
greater surgical precision, increased range of motion, improved
dexterity, enhanced visualisation and improved access. ■
WESTERN AUSTRALIA
UPDATE YOUR
MEMBERSHIP
DETAILS
If your details have changed
recently, please contact
AMA (WA) Membership on
(08) 9273 3055 or email
membership@amawa.com.au
December
ME D I C US 11
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support you. Members’ views count and together
we will continue to build a strong, successful
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Across the country we’re listening
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peaceofmind@mdanational.com.au
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NE W S
‘Books on Prescription’
program useful in mental
illness management
L
ocal GPs in Subiaco have welcomed
an innovative program that offers
self-help books for patients with mild to
moderate mental health issues.
Launched by the City of Subiaco,
Books on Prescription is the first of
its kind to be rolled out in the Perth
metropolitan region. The program
involves a GP or other qualified health
professional, prescribing a book that may
assist patients to understand and manage
their mental health issue. A prescription
is issued that details self-help books (hard
copy and audio) available to borrow from
the City of Subiaco Library.
Dr Shane Morley from Rokeby GP said
the instant reaction of many doctors from
the practice was “what a great idea”.
“Education is such a vital component of
the management of any medical condition,
but in particular, emotional issues and
mental illness,” Dr Morley said.
“Education makes people more able
to accept they have a mental illness and
therefore accept treatment.
“Medication is only one facet of treating
mental illness. Self-help and psychotherapy
are equally and often more vital
than medication,” he said.
Across the primary care sector,
there is an increased demand for
mental health services. The Books
on Prescription program aims
to act as a support or an alternative to
medication, this being strictly under
the guidance of a GP or qualified health
professional. The program is useful as an
interim intervention while the individual
is waiting for a consult within the mental
health system.
“The books we will be prescribing
contain information on the benefits of
exercise, healthy lifestyle, communication,
time for self, relaxation techniques,
solving problems and many other
techniques people can use themselves,”
Dr Morley said.
“Also there is much information on
the methods a therapist or psychologist
will use including Cognitive Behaviour
Therapy, mindfulness and acceptance/
commitment therapy.
“Rokeby GP doctors are currently
compiling lists of publications, which
Great idea: Dr Shane Morley and
Dr Luise Thorpe from Rokeby GP.
they have found to be useful. The fact
that the library will have the exact books
that we have recommended is incredibly
valuable.”
Dr Morley explained the use of a
prescription for the book formalises the
service making it more likely the patient
will actually get the book.
“The use of the library for books is
convenient and free. Too often we doctors
recommend patients buy a book and this
does not happen.
“We encourage the public to approach
their personal GP and suggest they too
adopt the program.”
The City of Subiaco won an award
for the Books on Prescription program
in the ‘Innovation’ category at the
Local Government Managers Australia
(LGMA) Awards in October this year. ■
Applications open for 2015
Churchill Fellowships
A
pplications are now open for the 2015 Churchill
Fellowships, which provide an opportunity for
Australians with a passion to travel the world in search
of new ideas, excellence and innovation.
The high international regard for Churchill
Fellowships provide a pathway for Fellows to access
expertise from around the world to expand their
knowledge and experience.
More than 100 Fellowships are awarded each year
valued at more than $20,000 each.
“A Churchill Fellowship is a remarkable opportunity
to research a topic or an issue that you are passionate
about. They are recommended for anyone who feels
they have exhausted opportunities within Australia and
would like to see what overseas has to offer,” said Paul
Tys, CEO, The Winston Churchill Memorial Trust.
Applications are open until Monday 16 February
2015, for travel between 1 September 2015 and
31 August 2016. ■
December
ME D I C US 13
NE W S
Bethesda casts
its net further
B
ethesda Hospital – well known
to anyone living in Perth’s
western suburbs – has been given a
brand revival that will be a core part
of the health facility’s future growth
strategy.
Perched high on one of Perth’s
most beautiful stretches of land
with incredible views of the Swan
River and Freshwater Bay, Bethesda
Hospital in Claremont is an 88-bed
facility that offers a range of
medical and surgical services.
With 68 overnight beds and 20
day procedure beds, seven (soon
to be nine) operating theatres and
state-of-the-art facilities, Bethesda
Hospital currently offers a range
of clinical specialties and onsite
services that ensures a continuation
of excellence in healthcare and is
looking to extend its services.
At a recent function held at
Bethesda Hospital, board members,
senior staff, doctors and other
stakeholders, including the Chair of
the Patron’s Group, businesswoman
Rhonda Wyllie, were briefed on
plans for 2015 and beyond.
Hosted by Hospital Chairman,
Dr Neale Fong, attendees were
given the first glimpse of the results
of a six-month brand revitalisation
process involving an impressive new
logo and a new name – Bethesda
Health Care.
“Beth” is a word found in both
the Old and the New Testaments of
the Bible, and means “house” while
“Bethsaida” means “house of fish”.
The name “Bethesda” was chosen
in 1943 by Matron Beryl Hill,
who had returned to Perth after
missionary service in India.
The new name was selected to
reflect plans currently underway
to extend Bethesda’s expansion
plans. The new logo is based on a
combination of two stylised ‘b’s that
merge together to create an embrace,
reflecting personalised care.
Dr Fong thanked all Bethesda
Health Care staff, volunteers
and accredited doctors for their
dedicated work.
Dr David Sofield, Chair of
the Bethesda Hospital Medical
Advisory Committee also spoke
to the group, supporters and
friends and thanked them for
supporting the Committee through
the year. ■
(From top) Looking forward: Bethesda Hospital
Chairman, Dr Neale Fong, thanks staff, volunteers
and accredited doctors for their dedicated work.
Dr David Sofield, Chair of the Bethesda Hospital
Medical Advisory Committee, addresses the gathering.
(From left) Dr Sven Goebel, Dr Grant Booth and
Dr Ben Hewitt.
AMA welcomes GP toolkit on domestic violence
A
new toolkit designed to help General
Practitioners identify the signs of
domestic violence has been welcomed by
Australian Medical Association (WA)
President Dr Michael Gannon.
The toolkit was launched by the
Women’s Law Centre of WA on Tuesday,
25 November, which was the International
Day for the Elimination of Violence
Against Women.
“We know that women who suffer from
domestic violence tend to visit GPs and
hospitals more often, and it is vital that
a resource is available so more cases are
identified and the necessary support is
provided,” Dr Gannon said.
“Full time GPs can see up to five
women per week who have suffered from
some form of domestic abuse.
14 M E D I CU S December
“The fact that one woman in Australia
dies at the hands of a current or former
partner every week is absolutely
reprehensible, and more needs to be done
to address this problem.
“At odds with the perceptions of many,
the incidence of domestic violence does
not vary with social class. It does not
discriminate according to income, race or
religion.
“Of great concern is that many women
experience physical violence for the first
time when they are pregnant. Pregnancy
is a time of greatly increased risk to
women, with the potential of injury to
their unborn baby.
“It’s an important and complex part
of General Practice, so we applaud the
Women’s Law Centre of WA for providing
what will be a vital tool in picking up the
tell-tale signs of abuse,” Dr Gannon said.
The Toolkit, originally developed by
the Women’s Legal Services NSW and
adapted by the Women’s Law Centre of
WA, provides practical advice for GPs on
issues including:
• note-taking for legal purposes
• mandatory reporting
• immigration and family violence
provisions
• summons and subpoenas
• ethical issues such as continuing care
for the patient, when the patient is the
perpetrator, and when both partners
are patients. ■
To view the toolkit, use the link: http://
www.wlcwa.org.au/resources/GP-Toolkit2014-Final.pdf
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U WA DE DIC AT ION
Hard work pays off: AMA (WA) President, Dr Michael Gannon and
Dr Alison Buckland, winner of the prestigious AMA Gold Medal.
AMA GOLD MEDAL
WINNER ALMOST GAVE
MEDICINE A MISS
Cheers rang out as the newest doctors in town were
inducted at UWA’s Dedication Ceremony
I
t was a hat trick of awards followed by
one very special prize for Dr Alison
Buckland on the morning of 22nd
November. At the Dedication Ceremony
16 M E D I CU S December
for medical students of the University
of Western Australia, Dr Buckland
not only picked up the Peter Anderton
Memorial Prize in General Practice,
the Western Australian Faculty of The
Australasian College for Emergency
Medicine Prize and the Fred Johnston
Memorial Prize, she also received the
U WA DE DIC AT ION
prestigious AMA Gold Medal for
scoring the highest aggregate mark over
the entire six-year MBBS course.
It was a crowning achievement for
someone who almost did not choose
medicine. Although always interested
in the field, Alison had the rather
inconvenient problem of feeling lightheaded at the sight of blood. Instead,
she studied to be a Speech Pathologist
and spent some years working at
PMH. However, the call of medicine
proved too strong to ignore and in 2010
finally, Alison joined UWA’s School of
Medicine.
AMA (WA) President, Dr Michael
Gannon congratulated Alison,
presenting the visibly thrilled new
doctor with the AMA Medal and a bust
of Hippocrates.
Just a few minutes earlier and
much to the delight of the audience,
Dr Gannon also gave a special shoutout to the student who came 88th in
the rankings. “That’s about where
I finished. So whoever you are,
congratulations!”
This year’s medical cohort from
UWA was the 57th class to have
successfully completed the MBBS
degree. What was also significant was
the fact that 44 rural students from
23 towns in WA and five Indigenous
students graduated as well.
Hosted by Professor Ian Puddey,
Dean of the Medical School at the
University’s historic Winthrop Hall,
the event was bittersweet for some.
“It is with mixed feelings that I
emcee this ceremony today as it marks
my tenth and final dedication ceremony
as Dean,” Prof Puddey said.
“I will miss partaking in what is
undoubtedly the happiest day of the
school year,” he added.
If Prof Puddey addressed the
gathering at what was his final
Dedication Ceremony, Dr Michael
Gannon attended his first as AMA
President. Twenty years ago, Dr Gannon
too graduated from UWA – although
back then, the ceremony was held at the
Octagon Theatre, not at Winthrop Hall.
Dr Gannon’s brief yet emphatic
address acknowledged the role of the
students’ families in helping them reach
this happy day and he exhorted the
graduands to “always put patients and
the community you serve at the centre
of your practice”
Delivering the Occasional Address
at the Dedication Ceremony was
Winthrop Professor Geoff Riley from
UWA’s School Of Paediatrics and
Child Health.
Professor Riley discussed Plato’s list
of virtues and offered the graduands
words of wisdom, depth and great
encouragement.
“Hold the patient as they heal as
surely as a splint holds a fracture,”
he said.
He also pointed out that the goal of
medicine was the relief of pain and that
it was a doctor’s duty to judiciously
practise medicine with humility and
virtue.
“But give yourself time and don’t
be too hard on yourself if you’re not
perfect by January,” Professor Riley
said tongue-in cheek. ■
2014 Graduating Class Prize Winners
•Australian Medical Association (WA) Gold Medal: Alison Buckland
•Alan Charters Elective Prize: Hsern Ern Tan
•Alfred Nailor Jacobs Memorial Prize: Amy Murdoch
•Australian and New Zealand College Of Anaesthetists /Australian Society Of
Anaesthetists Gilbert Troup Prize: Natalie Smith
•Arch Ellis Memorial Prize in Psychiatry: Georgia Farrah & Primero Ng
•C B Kidd Memorial Prize in Psychiatry: Georgia Farrah
•Fred Johnston Memorial Prize: Alison Buckland
•Hamish Macmillan Prize in Dermatology: Georgia Farrah
•Helen Jane Lamard Prize in Medicine: Jolene Lim
•Helen Jane Lamard Prize in Surgery: Zi Qin Ng
•Hing-Hang Leung Prize in Palliative Care: Kirsten Biddle
•Peter Anderton Memorial Prize in General Practice: Alison Buckland
•Western Australian Faculty of The Australasian College for Emergency
Medicine Prize: Alison Buckland
December
ME D I C US 17
U WA DE DIC AT ION
1
4
2
Pic: Phillips and Father; www.phillip
sandfather.com
4
3
6
5
8
9
7
10
13
11
14
15
17
16
18 M E D I CU S December
12
18
U WA DE DIC AT ION
(From left) Good advice:
Dr Michael Gannon exhorts
the graduands to always
put patients first; Winthrop
Professor Geoff Riley
delivers the Occasional
Address; and Professor
Ian Puddey emcees his final
Dedication Ceremony.
GRADUATING WITH MBBS HONOURS
Ashton Catherine
Biddle Kirsten
Boothroyd Alarna
Buckland Alison
Carter Sean
Cheng Chien Chi
Chevis Erin
Chua Chee Wei
Combrinck Jana
Davidson Nicholas
De La Hunty Daisy
Dorkham Mariana
Dubrawski Kaitlin
Duguid Robert
Edwards Julius
Elphick Bryn
Farrah Georgia
Finkelstein Luke
Flynn Anita
Franke Malcolm
Gandhi Aesha
Hall Alexandra
Hanson Matthew
Hew Anthony
Hiew Valerie
Hillwood Jessica
Ho Joshua
Holmes Pippin
Hutchinson Vinayak
Jagadish Pragnya
Jasper Emily
Jervis Lee
Jones Emma
Jones Sasha
Joseph Simon
Jude Emily
Jurgenson Janelle
Kelly Robert
Kenner Peter
Kovacic Thomas
Lan Nick
Leathersich Sebastian
Lewis Dr Katie
Lim Si Ying
Lim Xian Hui
Lim Jolene
Manickavasagar Usha
Maurel Amelie
McDonald Samantha
Menon Lalitha
Moffat Andrew
Mun Ha
Murdoch Amy
Ng Chien Young
Ng Primero
Ng Zi Qin
Ng Jacinta
Ng Joanna
Ong Jessica
Patterson Heather
Power Phoebe
Prendiville James
Prosser Alana
Prosser Jessica
Punch Ashleigh
Puri Nidhima
Rengel Anthony
Roche Caitlin
Sage Anne
Shah Joanna
Sim Eng Swen
Smith Natalie
Snelson Zakary
Sommer Jessica
Sprigg Dustin
Stanes Erin
Stone Michal
Tan Daren
Tan Hsern Ern
Thorpe Brodie
Tu Danny
Walters Cameron
Ward Joanna
White David
GRADUATING WITH MBBS
Ayyar Priya
Bavich Paige
Bui Justin
Caldow James
Carroll Bronwyn
Carroll Jackson
Chan Hayley
Chee Yan Shan
Chen Oliver
Chen Yixiao
Chia Christopher
Chia Elisa
Chong Vincent
Chong Sylvia
Christiner Thomas
Chung Kimberley
Clarke Sarah
Colvin Katherine
Combs Nathan
Coyne Jared
Cullingford David
Curtin Shona
Dama Madhuri
Davis Amelia
Derwort Joseph
Devereaux Rose
Edmiston Phillipa
Ellis Rowan
Ellis Jennifer
Fairclough Kyle
Fernando Shrimal
Fleyfel Ibrahim
Fong Zhan Yao
Foulkes-Taylor Verity
Frew Georgia
Greenall Marcus
Hanly Gabrielle
Hayes Cameron
Hee Edric
Ho Sheng En
Ho Jia Min
Hudson David
Idris Hala
Intrada Kavin
Ireland Mark
Jayaratne Thilina
Jayasena Warunika
Jha Nihar
Johnston Gemma
Joseph Zacharia
Kamaruddin Mohd
Kannegiesser-Bailey
Madeleine
Khouri Jessica
Killalea Michelle
Kingston Sarah
Kirk Daniel
Kirwin Brendan
Koek Sharnice
Koh Hoon
Kok Wei Fuong
Lam Jonathan
Lam Danielle
Lambert Katherine
Lee Amy
Lee Rebecca
Lee Samantha
Leed Catherine
Li Marie
Liew Sarah
Lim Ming Hwee
Loy Timothy
Luk Lincoln
Lumby Joshua
Marcano Marie
McGeough Jessica
McHugh Margaret
Menon Shirin
Mercier Sarah-Jane
Mohamad Ahmad
Hakeem
Moss David
Mouritz Sari
Mukhopadhyay
Sandeepan
Mummert Katharine
Ng Verna
Nicholls Sylvia
Nicholson Zoe
O'Hare Kate
Parker Erica
Pathmarajah
Tishanthan
Rogers Katrina
Rogers-Angeles Anni
Rooney Kathleen
Silva Amali
Sim Kwang Kiat
Skoda Liam
Smith Emma
Smith Katherine
Stokes Rachael
Stone Andrew
Swao Aliceba
Tam Averil
Tan Bryan
Tan Herr
Tan Eva
Tan Jason
Tan Kuok
Tan Nadia
Tan Nicholas
Thornton Patrick
Toh Christopher
Tolman Frances
Toster Sophie
van der Linden
Vanessa
Vasantharao Praveen
Vu Anthony
Waters Georgina
Watt Verity
Wenzel Dorian
White Christopher
Williams Luke
Wong Zhi Wan
Wong George
Xu Ling
Yap Cameron
Yap Francis
Yap Zheng Liang
1. Dr Priya Ayyar (third from right) with mum, Dr Satya Ayyar, dad Dr Venkat Ayyar, sister-in-law Dr Rachana Desphande, brother Dr Nikhil Ayyar
and partner Christian Moraru. 2. Graduands Dr James Caldow and Dr Jana Combrinck with their fathers, Dr John Caldow (extreme left) and
Dr Johann Combrinck. 3. Dr David Cullingford with dad, Dr Robert Cullingford and mum, Sally. 4. Dr Daisy de la Hunty with parents,
Dr Moira de la Hunty and Dr David de la Hunty. 5. Sixth Year WAMSS Representative, Dr Anthony Hew (centre) with brother Daniel and mum,
Lyn. 6. Dr Julius Edwards with dad, Dr Glenn Edwards. 7. Dr Mariana Dorkham (third from left) with parents, Dr Zak Dorkham and Professor
Samar Aoun with brother, Nicholas and partner, Benjamin Hawthorn (extreme right). 8. Dr David Hudson (second from left) with dad Dr Martin
Hudson, wife Katherine, mum Mary and parents-in-law, Joyce and Gary Hamersley. 9. Dr Mark Ireland with parents Dr Ross Ireland and Anne
Ireland. Mark’s sister, Dr Amanda Ireland was unable to attend. 10. Dr Pragnya Jagadish (second from right) with parents Dr Sarojini Jagadish,
Dr Jagadish Jamboti and sister Annapurna. 11. Dr Katherine Anne Lambert (centre) with mum Dr Suzanne Elliott and stepdad George (extreme
right), and dad Stephen Lambert and stepmum Vikki (extreme left). Katherine’s brother, Dr James Lambert was unable to attend.
12. Outgoing WAMSS President Dr Sebastian Leathersich (third from left) with sister Amy, mum Clair, dad Mark and brother Michael.
13. Dr Usha Manickavasagar (centre) with dad Manicka, sisters Dr Revathy Manickvasagar (second from left) and Dr Vaanitha Manickvasagar,
and mum Kala. 14. Dr Lalitha Menon with mum Sharadha, brother Dr Shankar Menon and dad, Muralee. 15. Dr Natalie Smith with dad,
Dr Craig Smith. 16. Dr David White with mum Dr Christina White, dad Dr Garry White and sister, Dr Caitlyn White. 17. Sixth Year WAMSS
Representative Dr Averil Tam (in red) with (from left) Aunt Tam Po Lin, mum Margaret, sister Cynthia, dad Ming and grandmother,
C N Tam. 18. Dr Cameron Yap with dad, Dr Ming Yap.
December
ME D I C US 19
CO V E R S T OR Y
The good,
the bad and
the ugly
There are great lessons to be learnt from the
past 12 months in health, says Robert Reid
20 M E D I CU S December
CO V E R S T OR Y
I
t was the best of years – and the worst of years. The good,
the bad, the significant steps forward and occasionally
backward – Medicus has reported the year.
This final issue of Medicus for 2014 is an opportunity to
take a look back at what has been and to try and look over the
horizon at what might be coming in 2015, with a range of
political and medical views.
This was the year when we saw – and took part in – the
opening of Australia’s newest and most impressive health
facility, Fiona Stanley Hospital. Once the cleansing opening
smoke cleared, all those at the ceremony could see a
magnificent hospital that will meet the health needs of our
fast-growing southern metropolitan corridor for decades.
It was the combined work of two governments, thousands
of builders, and is now the workplace of many hundreds of
doctors and other medical and support staff.
In many ways, the opening of FSH was a demonstration of
what our State does best – prepare for our future health needs
in a manner that we can all be truly proud of.
But 2014 was also the year when we watched on, feeling
helpless, when the WA State Government refused to take what
would have been an easy decision for the future and add two
extra floors on Perth’s new children’s hospital.
As the AMA (WA) has said on a number of occasions, the
failure to take up the opportunity to “future proof” the hospital
will be felt not by this generation, but by the next. In recent
weeks, the release of new population growth data has shown
quite definitively that this statement was wrong.
The abject failure to add the two additional floors will be felt
within a year or two of the Perth Children’s Hospital officially
opening its doors – not by decades. It appears that this
government will be one to harvest its own failure.
Twenty-fourteen was also the year that we saw further alarming
figures about immunisation and a growth in the number of
parents refusing to protect their children and the rest of their
community. Despite the best efforts of many, especially the AMA
and the Health Department, there appears to be a reticence by
a worryingly high number of parents to leave the importance of
immunisation to others. So much for community responsibility!
It was the year that discussion about a possible over-supply
of doctors got underway at the same time that some were
advocating for a third medical school; and when the spotlight
finally swung to the growing issue of mental health in our
society and the Government promised a new plan to handle
the implications – of course without any undertakings for
additional funding.
However there was better health news by the end of the
year when the State Government decided to join the rest of
the nation and ban the commercial use of solariums, albeit 12
months later than all other Australian states.
And we now look forward to 2015 when health will once
again be the main topic of debate on most days.
The first major announcement by the State Government
is likely to be the naming of a new permanent DirectorGeneral for WA Health – to replace the remarkable
Professor Bryant Stokes.
On the financial side, 2015 is likely to be a tough year.
The government is looking to cut spending and like all other
departments, Health will suffer. We know that any cuts in
staffing levels will have a negative impact on frontline health
delivery – wherever in the infrastructure the job may be.
The progress of the coming year will be punctuated
by the opening of a number of new hospitals as the State
Government’s incredible $7 billion health building program
comes to fruition.
The first quarter of the year will see the roll-out of final
services at Fiona Stanley Hospital, most notably Emergency.
This will be followed by the opening of the new Perth
Children’s Hospital with 298 beds and the new Midland
Hospital with a
combined public/
private total of
Despite the best
367 beds.
efforts of many...
Of course,
there appears to be a
the opening of
new hospitals
reticence by a worryingly high
always brings
number of parents to leave the
with it a sense
importance of immunisation to
of trepidation
others. So much for community
by some in the
responsibility!
medical world,
but hopefully the
sense of concern
will soon be
answered once offers of secure appointments are made.
There will hopefully be action very soon on the redevelopment
of Royal Perth Hospital. There are many decisions yet to
be made on what services will be available from RPH, what
buildings should be detonated or renovated, and what part of the
magnificent site will be ready for sell-off to developers.
This time next year we will almost certainly be discussing
the possibility of a new Health Minister after current Minister,
Kim Hames, indicated his decision to retire at the next election
and the desire of Premier Colin Barnett to have new ministers
in place well before the early 2017 poll.
The government will also need to respond to the recent State
Parliamentary Report on FIFO workers and their health needs.
Certainly 2014 was a great year for health. But we failed in
too many areas to take great comfort from our achievements.
We hope that 2015 will see more health-related victories and
fewer failures. We hope that we repeat our achievements and
leave any failures behind.
The fight to improve the health of all West Australians
must continue. ■
December
ME D I C US 21
CO V E R S T OR Y
Significant reform to healthcare
planning, delivery and facilities
Hon Dr Kim Hames MLA
WA Minister for Health
A
s the year draws to a close, it
provides an opportunity for all
of us to reflect on achievements and
challenges over the past 12 months, and
as Health Minister I believe 2014 has seen
some particularly exciting and satisfying
developments in the WA health system.
Western Australian hospitals are treating
more patients than ever before, while still
meeting important national performance
targets. The WA median wait time for
elective surgery, for example, is the lowest
for all urgency categories, compared with
other states and territories.
The WA Health Clinical Services
Framework 2014-2024, released last
month, acknowledges that the WA health
system will need to progress reforms
to meet crucial challenges, particularly
associated with changing health needs,
a growing population, rising costs, and
outdated legislation and governance
arrangements.
In an unprecedented reshaping of
the WA public health system, this State
Government has invested more than
$7 billion in 80 health facility upgrades
and new construction works across the
State to alleviate pressure points on the
public system.
Notable among these is the first newbuild tertiary hospital project in the State
for more than 50 years, with the $2 billion
Fiona Stanley Hospital, fully operational in
March next year.
It is the most complex of its kind to be
commissioned in WA and is the biggest
and most technologically-advanced
health facility in the State. But it’s more
than that – it represents a new era in WA
public health. It signals a time of new
infrastructure, new models of service
delivery, new technology and better ways of
doing things.
Additionally, the $1.16 billion Perth
Children’s Hospital on the Queen
Elizabeth II Medical Centre site is on track
for completion at the end of 2015, along
with the $360.2 million, 300-bed Midland
22 M E D I CU S December
Public Hospital which will replace the
ageing Swan District Hospital and increase
healthcare capacity for the north-eastern
suburbs by approximately 50 per cent.
Likewise, the $218.2 million expansion
of services and facilities at Joondalup
Health Campus, and the announcement
of a new $15 million 37-bed paediatric
ward, herald a major upgrade to services in
response to growth in demand.
It’s an exciting time for new
construction and redevelopment right
across WA, including the $120.2 million
Busselton Hospital, and the $58.4 million
Kalgoorlie Health Campus redevelopment
– both due to complete their final phases of
works in 2015.
Upgrades to facilities at Carnarvon
Health Campus ($26.8 million), Esperance
Integrated District Health Service ($32.7
million) and the Exmouth Hospital ($7.6
million) have been joined by initiatives
such as the Southern Inland Health
Initiative ($329 million) and the North
West Health Initiative ($147.3 million) – all
with funding from Royalties for Regions.
New infrastructure complements new
innovation. This year, the $54 million
Comprehensive Cancer Centre at Sir
Charles Gairdner Hospital became home
to Australia’s first CyberKnife, a $9 million
piece of advanced technology used in the
treatment of cancers affecting organs such
as the lung, brain, liver and prostate.
Research received strong support in
2013-14, with $8.71 million awarded from
three State Government health research
funds. Researchers will share $5.96
million of Medical and Health Research
Infrastructure Fund grants; six projects
will share $1.55 million in Targeted
Research Fund grants; and six WA
Health clinicians will share $1.2 million of
Clinician Research Fellowship funding.
And there are seeds of other initiatives
that will bear fruit next year. In a first for
WA, a special exemption from the WA
Chief Pharmacist means health workers
other than dental practitioners will soon
be able to apply fluoride varnish to help
prevent tooth decay among children in
remote communities. That’s a significant
step in the treatment and prevention of
tooth decay among Aboriginal children.
Funding of $38 million over four years
has been allocated for additional school
health staff across the State, most of whom
will be based in regional teams servicing a
number of schools in each area.
More than 100 dedicated Aboriginal
health services will be delivered under the
new Footprints to Better Health strategy
for regional healthcare, supported by the
allocation of more than $32.2 million and
building on the work already undertaken
to improve life expectancy for Aboriginal
people.
I am delighted to now have Party Room
support for a ban on commercial solaria
in WA, and I’ll be looking to progress the
final steps of that over the next few months.
There are a few health issues that I think
would benefit from a coordinated national
approach, such as the ban on commercial
solaria, and more rigorous testing and
research into cannabis for medicinal
purposes. In addition, the Review
of the Surrogacy Act 2008 this year
made a number of recommendations to
address state, national and international
surrogacy arrangements coordinated
through Commonwealth agencies.
These are topics I intend to pursue with
my federal counterparts at Council of
Australian Governments meetings in 2015.
In releasing the Public Health Bill at
the end of November, I reflected how
much healthcare planning, delivery and
facilities across the State have undergone
significant change and reform. I’m
proud to have been part of that and am
looking forward to advancing other WA
health initiatives over the next year
and beyond. The challenge will be to
improve both clinical care and financial
sustainability, and to support a more
responsive, accountable and engaged
health system. ■
CO V E R S T OR Y
Services fall behind and policy
stalls as the axe begins to fall
Roger Cook MLA
WA Opposition Spokesperson for Health
A
s the WA Labor Shadow Minister for
Health, I greeted the recent opening
of Fiona Stanley Hospital (FSH) and the
progress on the new children’s hospital
with pride, knowing that these important
aspects of WA Labor’s vision for health
were now being realised.
However, this last year is also one
of frustration at glossy government
advertising produced to distract West
Australians from the cost blow-outs,
deteriorating performance, policy
paralysis and a crisis of leadership that
was 2014 for health.
FSH will make a big contribution
to healthcare in this State, despite the
government’s mis-management of such
important health infrastructure. In
particular, the regret from the decision to
privatise management of the hospital was
demonstrated when the Acting Director
General clawed back patient facing services
in May 2014 as they were better provided by
the State to maximise patient care.
Further, as documented in the
Education and Health Parliamentary
Standing Committee report, More than
Bricks and Mortar, the FSH delays were
evident at least five months before it
was scheduled to open in April 2014. The
failure to act early and the resultant further
six-month delay on the SERCO 4.5 billion
contract cost the state $118 million.
But ribbon cutting and diversion of
public focus through an avalanche of
glossy brochures and multi-million dollar
advertising campaigns cannot hide the
real story of the crisis in health in 2014.
Currently we have:
• A mbulance ramping at an all-time
high of over 1500 hours in August
and October
• Four-Hour Rule improvements that
have peaked and are unlikely to meet
NEAT benchmarks
• Elective surgery median waiting times
increasing and the waitlists growing;
and
• T he increase in patients waiting
longer than ever to see their specialist
– ‘waiting to wait’.
The Minister for Health has
acknowledged in Parliament: “It is true
that ramping has been higher than it has
ever been. It is true that in opposition,
I was extremely critical of the former
government for its ambulance ramping”.
Nevertheless he refuses to answer to
the same standards that he previously
demanded.
Promoting infrastructure achievements
should not be allowed to camouflage the
struggle of WA Health to contain costs as
a result of the government’s incapacity to
deliver innovation to hospital culture.
Disappointingly, commitments to
reduce the gap between WA costs and
the national average price for a hospital
episode are not being met. Indeed this
government has presided over an increase
from $5319 in the 2013-14 Budget to
$5540 in 2014-15 Budget to treat an
average patient in hospital while the
national prices reduced.
To compound the cost stressors being
placed on WA hospitals, the share of
the national medical research pie, which
attracts a medical workforce with research
opportunities and associated career paths,
is diminishing.
Subsequently the only option for this
government is to open the purse strings
and build a workforce around attractive
pay packets. This is an effective but blunt
policy tool, which is also unsustainable
and will ‘rob Peter to pay Paul’.
WA’s healthcare system has a massive
challenge in our growing and ageing
population. Our hospitals are hamstrung
by a government unable to respond to
the tsunami of increase in demand and
age-related illnesses. Hospitals need to
be innovative and embrace new ideas
and technology. Yet our hospitals are
driven by clumsy efficiency dividends and
government directions without insight and
strategy.
Following years of government
mismanagement, health is now in for
a budget haircut. The question must
be posed, as given many of the costs
are fixed, exactly where is the fat in the
system?
Compounding this, the government’s
previous efforts at the efficiency dividend
approach have failed and recent evidence
from the Department is that they will not
meet the new government-imposed leave
liability targets.
A razor gang has been appointed to
examine where cuts will be made. What
will be missing in this inquiry is the role
government has played in creating this
situation. It is the Minister who should
take responsibility for his mismanagement
of the State Budget, and now inevitable
budget deficit. Sadly it will be the doctors
and nurses working on the frontline who
will have to deal with the consequences.
While raising their glasses to the
patients finally being admitted at FSH,
there is little sign that the Minister has
acknowledged that there is a funding crisis
and there is even less demonstration that
he has a plan on how to tackle it.
Chief among this policy hiatus is the
failure by the Barnett Government to
attract a permanent Director-General to
the Department. I am an unwavering fan
of Professor Bryant Stokes – his energy
and wisdom is perhaps unmatched in the
Western Australian health community.
However, is WA so bereft of talent or so
low in reputation that we are unable to
engage a senior health public servant to
lead our health system in the long term?
The problem is the longer the
government takes to resolve these
challenges, the more the situation of cost
blow-outs, deteriorating performance and
policy paralysis will continue.
The challenges for Health in 2015 with
a Minister in retirement mode, will be
in delivering a sustainable and effective
health system and long-term leadership
rather than acts of self-congratulation at
hospital openings. ■
December
ME D I C US 23
CO V E R S T OR Y
Resourcing the Mental
Health Sector
Hon Helen Morton MLC
WA Minister for Mental Health
T
he mental health system in Western
Australia has been suffering from a
historical legacy of inadequate investment
and it will take some time to build the
system we need.
Reform of our mental health system has
been significantly advanced through this
government, but more needs to be done.
Central to this work will be the progression
of the Mental Health Act 2014, which I
anticipate will be enacted in late 2015.
Improved resourcing of the mental
health system has also been a key priority.
The State Budget delivered record funding
of $791.6 million in 2014 and in overall
terms, a 68 per cent budget increase
since 2008. This increase in funding
has ensured real growth in specialised
public mental health services as well as
services provided by non-government
organisations.
According to the 2014 Report on
Government Services (RoGS), WA has
consistently had the highest per capita
expenditure on specialised mental health
services. In 2011-12, WA spent an average
of $244 per person on specialised mental
health services, compared with the national
average of $198.
The RoGS also demonstrated that WA
has consistently employed more direct care
mental health staff in all staffing categories
in publicly-funded specialised mental
health services than the national average
since 2005-06.
In 2011-12, WA employed 126.3
direct care staff per 100,000 population,
compared with the national average of
111.6 per 100,000. This includes a rate of
14.6 medical staff (comprising Psychiatrists
and other medical officers) per 100,000
population compared with a national
average of 13.1 staff per 100,000.
I acknowledge that the most recent
workforce data shows that while the
number of employed Psychiatrists across
all service settings has been increasing in
WA since 2008, it still remains below the
national average and has not increased over
24 M E D I CU S December
the past two years. This is compounded by
a high rate of substantively vacant positions
and a difficulty in recruiting to these,
rather than the absence of funds to do so.
Data from the recent national AIHW
Mental Health Services—in brief 2014,
indicates that in contrast to other states,
WA has a considerably lower rate of service
contacts delivered by community mental
health services (324.6 per 1,000 compared
to 371.1 nationally) and the lowest rate
of care days in residential mental health
services (18 per 10,000 population
compared 124.9 nationally). I am in no
doubt that the shortage of communitybased services and support within WA is
placing significant pressure on our acute
sector.
The AIHW report also indicates that
WA continues to be below the national
average in the rate of Medicare-subsidised
mental health services delivered by GPs.
This is at least partly due to the lower
number of GPs in WA, particularly
impacted by the State’s vast geographical
area.
Medicare per capita expenditure on
mental health services in WA was $27.67
in 2012-13 – significantly lower than
the national average of $39.57. This
gap in expenditure has been widening
over the past five years, with per capita
expenditure on mental health services
decreasing by an annual average of
0.3 per cent in WA, compared with an
annual average increase of 3.8 per cent
nationally. This has undoubtedly added
to the pressure on the services funded by
the State.
In recognition of the need to
systematically improve the mental health
system, the Mental Health, Alcohol and
Other Drug Services Plan 2015-2025 (the
Plan) as recommended by the Stokes
Report, has been released for public
consultation.
The Plan is a blueprint of what services
our system needs and covers the entire
service spectrum, from prevention and
promotion to acute inpatient services.
Clinical input has been vital to develop
the Plan and will be essential throughout
the consultation process. Feedback will
be used to refine and prioritise strategies
and actions in the consultation draft
and prepare a final Plan, which will be
released in 2015.
Of the remaining recommendations
of the Stokes Report, a total of 31
recommendations are complete, with the
balance progressing well.
Progress has continued on a range of
other service improvements. Commencing
in February and progressively throughout
2015, 136 new and replacement acute
specialist mental health hospital beds will
open. With an average length of stay of 14
days, the opening of 40 additional beds in
2015 (with the additional staff required)
will result in the availability of 1,042
additional inpatient admissions per year.
Also underway is the development of
community-based sub-acute services
across the State. The Individualised
Community Living Strategy is being
expanded to include 148 individuals,
the pilot Mental Health Court Diversion
program for adults and young people
continues to make good progress – and
further funding has been provided
to continue the Statewide Specialist
Aboriginal Mental Health Service.
The Ministerial Council for Suicide
Prevention is close to finalising the
next multi-year strategy to build on the
foundations of the first Strategy. During
2014-15, an additional $3 million was
allocated to strengthen the sustainability
of Community Action Plans and maintain
the Response to Self-Harm and Suicide in
Schools.
I am very much looking forward to the
changes and opportunities that lie ahead
in improving our mental health system.
This will take time and will need the
combined efforts of government, service
providers and the community if we are to
deliver the best results. ■
CO V E R S T OR Y
Reflections from a
Consumer Perspective
Michele Kosky AM
Health Consultant
& Former Executive Director, Health Consumers Council, WA
T
he year 2014 has been characterised
by change and continuity for WA
health consumers, families and carers –
continuity in recognising that Australia
and Western Australia maintain a highquality, accessible healthcare system that
is the envy of people in other countries.
One only has to read dispatches from the
frontline of Medecins Sans Frontieres to
appreciate how privileged we are to have a
safe, effective health system.
Of course from a consumer perspective,
there are always improvements that need
to be made. We are, after all, the experts by
experience.
Consumer participation brings a
different energy to the matters under
consideration. What an amazing change
that the Australian Commission on
Quality and Safety in Health (www.
safetyandquality.gov.au) has established
standards for the accreditation of healthcare
organisations. Standard 2 is ‘Partnering
with Consumers’, which means consumer
participation at all stages and every level
of the health system – though ironically
not with WA Health Department; unlike
hospitals, health departments do not
have to be accredited. However given the
Department’s past record of consumer
involvement, there is optimism in the
consumer sector that the spirit of ‘Standard
2’ will be adopted and implemented across
the State.
For the community in 2014, the big
ticket items would appear to be the opening
of Fiona Stanley Hospital, the development
of the Perth Children’s Hospital and the
Midland Health Campus, the opening
of the GP Super Clinic, ECU Health
Centre at Wanneroo, and in country WA,
investment and expansion in hospitals
from Broome to Esperance, Kalgoorlie to
Karratha, Carnarvon to Busselton.
So we note the results of major capital
investment across the WA health system in
2014, but indeed it is what happens within
and without these health settings that is of
greatest consequence to consumers. How
these shiny new buildings are connected to
your local GP or community allied health
worker or aged care facility is what exercises
the minds of consumers. What is the
information flow between primary care and
tertiary care, or my local country hospital
or my local Aboriginal controlled health
service? Where are my needs, wishes and
values reflected? How is my care integrated
and co-ordinated? Might technology and
the long-awaited eHealth Record contribute
to the better coordination of my care?
Why do we continue to emphasise
the investment in hospitals and diminish
the role of primary healthcare? Maybe
that could go on a wish list for 2015 – a
multimedia campaign that informs the
community about the critical importance
of General Practice and other components
of primary healthcare. Better primary
healthcare is related to better population
health at lower healthcare costs – one of the
‘continuities’ in 2014 but one that has yet to
be adequately addressed.
Another ‘continuity’ is the importance of
effective communication between patient
and medical practitioner – which remains
cause for a large number of complaints.
Listening to what the patient has to
say without interruption, encouraging
questions and explaining why a particular
approach is best takes time and patience
and of course, requires the patient to be
prepared for the consultation.
Health literacy is a bit of a buzz word,
but its definition demonstrates how it can
influence patient outcomes. Health literacy
is the ability to obtain, read, understand
and use health information. Low health
literacy reduces the success of treatment
and increases the risk of medical error.
Encouraging patients’ questions has
improved health behaviours in people with
low health literacy. Is this an area where
the AMA (WA) might work in partnership
with consumers to remedy low health
literacy in vulnerable populations?
During a recent conversation with a
former colleague, the question was put
– what were the main concerns of mental
health consumers in WA this past year?
The reply was salutary. Mental health
consumers are radically over represented
in health complaints as the right to
participation in decision-making about
care and treatment (taken for granted by
most of us), is often neglected for people
with mental illness. Issues of consent,
information about medication benefits
and risks, and working in partnership with
your medical practitioner or mental health
worker were cited as examples where people
with mental illness felt they were not getting
a fair go.
Other concerns for consumers in 2014
related to long waits for GP appointments
particularly in the southern suburbs,
complete lack of discharge planning by
private hospitals and a lack of co-ordination
overall.
In addition, senior consumers reported
the failure of good advice by medical
practitioners in instructions to pharmacists
making up medicines for consumers. In
2014, it is not acceptable to write “take as
directed by your doctor” with no advice
about how much to take, at what time,
with or without food etc. or no instructions
at all provided, just the “no instructions
specified, check with your doctor if unsure
of dose”. Surely, we can improve this!
Working with rural consumers in mid2014 reminded me of the information gaps
in the health system but also, of the great
appreciation people have for new initiatives.
The introduction of the Emergency
Telehealth Service was a win for regional
consumers and WA Country Health. These
consumers suggested more information
and access to End of Life choices including
Advance Care Directives, and an electronic
register to make it easy for hospital or health
service staff to access patient wishes, more
information about ‘Not for Resuscitation’
policies, and an improvement in culturallysafe health services for Aboriginal people.
My wish list for 2015 would include a
Community Conversation about health
Continued on page 28
December
ME D I C US 25
CO V E R S T OR Y
WA’s public hospitals in 2014: a bumpy ride
on a precipitous road with a sick system
Associate Professor Dave Mountain
AMA (WA) Emergency Medicine Spokesperson
Y
ou may have picked up from the
title that all is not well in our public
hospitals. Western Australia has been
lucky to have a great public hospital system
that performs well above average on most
measures in the last few years, delivers
high quality care and does so to an isolated
population dispersed over a huge area.
The reason WA has been able to
manage many challenges and be a leader
on issues like NEAT/NEST targets whilst
improving quality and outcomes of care
is due to a highly motivated, skilled and
trained workforce. Our major hospitals
produce excellent results and punch well
above their weight in terms of quality and
access to care.
Major outer metro and regional hospitals
have also delivered excellent results,
are high acuity by most standards and
contribute significantly to teaching and
training of new waves of doctors, nurses
and other professionals.
These major achievements are based on
highly successful research (often started in
WA), great training and skilled workforces.
All of these achievements and the building
blocks for future success are being put at
risk by draconian responses to current fiscal
problems, major cuts to clinical staffing and
services – all driven by a mantra around
Activity-Based Funding (ABF).
This is the biggest threat to delivering
quality patient care we have seen for a
generation – at least as applied in WA. ABF
pretends that if you look for the system/
hospitals around the country that deliver the
highest number of widgets per dollar, that
is the efficient system. It has no significant
measure of quality of care, doesn’t monitor
outcomes and represents a soulless dive for
the bottom. It drives a destructive disregard
for the real costs of teaching, training and
research required to deliver functional high
quality teaching hospitals.
This dismissal of research and training
is highly regressive as we know real
efficiencies and good outcomes occur in
hospitals that value, support and enhance
research, teaching and training. These
are always the easiest things to remove
first when you aim for a low cost without
regard to quality. ABF modelling has
no way of measuring the real costs of
delivering these services after over a
decade of implementation in the East.
Our administrators are busy destroying
academic posts, research infrastructure,
reducing handover times and wrecking
rosters to save money, which in the end
will deeply impact on training, quality of
care, true efficiencies and translational
research outcomes. All they are interested
in at the moment is dollars, removing
FTEs and meeting targets. They have no
vision for quality, safety or a dynamic highperforming health system. They use the
(very expensive – millions in one hospital
alone) fig leaf of external consultancies
from the normal suspects (KPMG, PWC
etc.) to produce reports justifying what
they were going to do anyway. The reports
of course are never to be seen by clinicians
or even Heads of Department (HoDs),
so no one knows how they are done, what
assumptions are made and what they were
told to come up with in the first place.
These same blindsided HoDs are also
told to manage on ABF models and meet
stringent budgets even though the budgets
given to them by hospitals have nothing to
do with ABF funding – and if they increase
activity, they are told funding is capped.
The reason WA spends more dollars per
head of population for its health system
than most other states is because until
recently, we valued our population’s health,
spent more to achieve more, and gained the
benefits of a better resourced health system
– barring mental health and other pockets
of neglect.
Where are we now seeing the pressures
in the system? Frontline clinical services
are now being decimated as the toe cutters
move through. The worst of these have
occurred so far at Sir Charles Gairdner
Hospital, but to a degree they chose the
most stable part of the system to take their
pound of flesh first – obviously nothing was
to get in the way of the good ship, Fiona.
But other services and other hospitals
are also being targeted for similar 10-15
per cent budget decreases and FTE
decreases of up to 10 per cent of workforce
over the next two years. At most sites, these
are being deliberately targeted at clinical
services whilst administration and back
room services delivering no appreciable
benefit to service delivery are protected.
They have suffered too much previously,
we are told.
Beds are being closed with nebulous and
unlikely plans for reopening if they get it
wrong – a near certainty given previous
experience of health system forecasting.
In the recent winter (unplanned for in
any meaningful way), hospitals routinely
hit 95 per cent occupancy rates and yet
we are planning for 5-7 per cent bed
closures in our major hospitals. This at
the same time that we face a major system
reconfiguration where anyone with any
sense would know we need some flexibility
and capacity in the system to deal with
inevitable problems during these system
dislocations.
This brings us on to the ongoing issues
with the Fiona Stanley Hospital (FSH) and
its opening. Firstly, to say it looks good and
was built on time are the positives. However
the ongoing problems with the staffing
models, poor management of key personnel,
service models, outrageous SERCO
contracts, IT problems (the not so paperless
hospital) and the severe dysfunction
managing the FSH opening has wrought
havoc on the rest of the system.
A relatively thin talent pool in medical
administration has been regularly
redistributed to cover and manage the FSH
cracks whilst IT for the rest of the state is
a disaster area with no funds, support or
meaningful updates for three years.
The way staff have been dealt with by
HR and administrators has been offhand,
sometimes underhand and has seriously
dented morale and goodwill for the new
Continued on page 27
26 M E D I CU S December
CO V E R S T OR Y
Continued from page 26
WA’s public hospitals in 2014: a bumpy ride on a precipitous road with a sick system
Associate Professor Dave Mountain
AMA (WA) Emergency Medicine Spokesperson
S
ST
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PSYCHIA IN
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CHALLENGES
ARE OUR SPECIALTY
MENTAL HEALTH
MOOD & ANXIETY MANAGEMENT
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THERAPISTS BREAK
THE CYCLE OF RELAPSE
R E F L EC
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S
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OCCUPATIONAL TRAUMA RECOVERY
SE L
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R E G Illeviatin
GROUP THERAPY HIGHLY SKILLED HEALTH PROFESSIONALS
COGNITIVE
BEHAVIOUR
THERAPY
70 I N - PAT I E N T B E D S
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IN-PATIENT AND DAY-PATIENT CARE AND TREATMENT
PER
the best for our patients or our staff
anymore. We can see the levels of stress
in the amount of sick leave, stressed
colleagues and overt unhappiness
around us in our hospitals.
It is time for our supposed leaders to
manage change and fiscal problems in
a more imaginative way, prune out true
waste and excess, remove back room
nonsense that doesn’t deliver patient
care and bring your staff along in ways
of stabilising FTEs, increasing activity
or throughput using best models and
translational research.
But the current slash and burn
mentality is deeply unhealthy for our
patients, staff and the system in general.
Amputations should always be taken
after serious consideration, should
preserve as much as possible and have
a good rehab plan. The current plans
for our public hospital look truly
medieval – slash high, slash quick, dip
in pitch and fingers crossed the patient
doesn’t die. ■
SOCIAL WORKERS
LIFE’S
THE
SENIORS’
PROGRAM
TH
ER
ER
RD
gaps. Of course unfortunately, really
sick psychiatric patients don’t wait for
these times and NGOs are unwilling
and unable to manage really unwell
psychiatric patients.
If this report delivers more of the same
from a new Mental Health Commissioner
and wastes more money on non-24
hour services (we need 24 hour a day
community and hospital-based services),
I think all hope will be lost in the devolved
model of mental health ministry and
management.
Finally it is not just Psychiatry where
despondency, poor morale, anxiety
and fear for the future are rife. Our
hospitals are currently truly unhealthy
and unhappy places to work. Our staff
feel under constant threat for their jobs
due to working conditions and from
micromanagement and administrative
bullying. They feel unvalued and
undermined by their administrative
colleagues on a routine basis. There
is no trust or belief that we are doing
I
UL
AN D B
EXIA
OR
NT
AN
ME
NG AT
DI TRE
LU S
MATIC STR
TRAU
ESS
STRS E S
DI
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ENR reventi
IO
hospital. The modelling with regard to
patient flow when FSH opens is hardly
believable with RPH supposedly losing
30-40 per cent of its work and reductions
in staff based on this on the basis of
some DoH’s best guess. Anyone who
has watched DoH modelling unravel
as many times as I have over the last 20
years understands what a ridiculous way
round this is. Watch what happens first
and reduce the workforce after, if you get
it right.
Finally to public mental health – both
the mental health system and that of our
staff and our colleagues. The mental
health system performs badly even by
national comparators. It has been subject
to endless reviews, the latest of which is
15 months late and only just released for
discussion.
Morale in acute public mental health/
Psychiatry is woeful – and for good
reason. The current review shows that
yet again 5/7, 9 to 5 NGO services are
going to be looked at to fill mental health
WE’RE BIG IN
MENTAL HEALTH
Visit our website for a list of Hollywood
Private Hospital’s Psychiatrists and for more
information on our services and programs.
For any enquiries, please contact our
Admissions Coordinator at
The Hollywood Clinic on (08) 9346 6850.
hollywoodclinic.com.au
CO V E R S T OR Y
General Practice continues to do the heavy
lifting amidst growing pressures
T
his year, like the previous half dozen
(and perhaps even longer), has not
been a positive one for General Practice,
and most of its problems can be put down
to poor government policy and a failure to
listen to the critical part of medicine that is
doing the heavy lifting.
Governments continue to demand that GPs
do more in the primary healthcare space to
keep patients out of hospitals and Emergency
Departments which saves them a fortune; but
they also expect them to bulk bill the patients
to avoid voter backlash. GPs are doing more,
but it is coming out of their pockets, not the
government’s – and this is having a big
impact on infrastructure and capacity.
It wasn’t enough that the previous
government capped rebates, the new
Federal Government did absolutely nothing
to rectify the problem. What they did do to
contribute to patients’ and practices’ woes,
was introduce a budgetary measure to send
a so-called price signal to the community –
a co-payment. This initiative is not only a
blunt instrument, it is indicative of a health
policy vacuum. The Federal President is
correct when he says that there is a need to
be talking about policies that provide better
access to health services, not policies that
will deter people from seeing their doctor.
The government’s co-payment model does
nothing to address that objective. All this
does is:
• disadvantages vulnerable patients – the
poor, the elderly, the chronically ill, and
Indigenous Australians;
• discourages prevention and chronic
disease management; and
• is realistically not able to be
implemented by July 2015 because
of the complexity, technology, billing
systems, and red tape that would be
imposed on medical practices, adding
yet another cost burden on GPs.
What is particularly galling is that
General Practice had to stand by and
witness the previous Federal Government
fritter hundreds of millions on the flawed
super clinic and Medicare Local initiatives,
but then sigh with relief when the current
government scrapped them.
But now they’re being replaced with
Primary Healthcare Networks (PHNs),
which is being funded out of General
Practice and Primary Healthcare money.
What will GPs and their patients get out of
this new layer of expensive bureaucracy?
Probably very little, other than demands
to fill in numerous forms, questionnaires
and voluminous contracts to justify their
expensive existence.
General practices do not want, or need
another expensive layer of bureaucracy to
deal with; they want to treat their patients
and they require the practice infrastructure
to do the job. Redirecting scarce resources
and money to flawed policy initiatives is no
way to achieve that objective. GPs know this
from their experience of previous iterations.
If health funding is out of control, then
throwing money at PHNs is no way to save
scarce primary care dollars.
GPs are also seeing more patients with
mental health problems than ever before
and again face the impediment of the
Federal Government’s constraints on the
number of allied mental health services a
patient can receive rebates for. This remains
at 10 per calendar year, other than for
exceptional circumstances.
At state level, there is currently little
primary care focus from a mental health
resourcing standpoint and GPs currently
find getting access for their patients a
frustrating exercise. It is hoped that a strong
GP-focused community model of care will
be implemented in 2015 in WA. That will
require consulting directly with GPs. We
must keep GPs at the centre of this model.
A positive piece of news is that GP training
is experiencing a renaissance and we need
to ensure it is sustained for the long term.
WAGPET overall is doing a terrific job and
the profession in WA must do everything in its
power to ensure it is resourced and supported
in continuing to carry out this important
role in 2015 and beyond – free from
bureaucratic and government interference.
If we needed any proof of the value and
cost effectiveness of GPs, we should look no
further than the long-running Bettering the
Evaluation and Care of Health (BEACH)
study, which has found that 85 per cent of
all Australians see their GP at least once a
year, and in 2013-14 there were 35 million
more GP services than a decade earlier – a
36 per cent increase.
It also showed that not only are GPs seeing
people more often, but they are spending
more time with them – the average GP
consultation now takes almost one minute
longer than a decade ago because their
patients are ageing and presenting with a
wider array of chronic and complex health
problems. In all, GPs spend an extra 10
million clinical hours with their patients
– a 43 per cent increase.
Underlining the cost effectiveness of
General Practice, the authors found that the
same service provided by a GP for around
$50 would cost between $396 and $599 if
performed in a hospital ED.
As the Federal AMA President says,
“General Practice keeps people healthy
and out of hospital. It makes sense for the
Government to invest heavily in primary
care, and the most cost-effective quality
primary care is provided by GPs.”1 ■
Reference: 1. Australian Medicine.
Continued from page 25
Reflections from a Consumer Perspective
Michele Kosky AM
funding over the next 20 years; consumer
participation at all stages and every level
of the health system; better integration
and co-ordination for patients; a Centre
for Patient Experience at a major Perth
28 M E D I CU S December
hospital; improved interpreting services for
people without English as a first language;
an emphasis on quality of life rather than
length of life; and finally, the adoption
and implementation of the recommended
National Aboriginal and Torres Strait
Islander Health Authority to actively
purchase and commission the very best
health services for Aboriginal and Torres
Strait Islander people. ■
CO V E R S T OR Y
It is time to move on...with optimism,
generosity and respect
Dr Alexandra Welborn
Psychiatrist, Royal Perth Hospital and AMA (WA) Psychiatry Spokesperson
C
hristmas is a time of hope, generosity
and fellowship. The mental health
sector is certainly in in need of something to
look forward to, after a year of turmoil and
uncertainty at senior levels about the right
way forward.
Now, the Office of Premier and Cabinet
has authorised the release of the much
anticipated 10 Year Mental Health Plan
by the Minister of Mental Health and the
Mental Health Commissioner. The Plan
was launched on Wednesday, 3 December
2014 and a four-month consultation phase
has begun, which will include six visits by
the Commissioner to rural areas. The AMA
will be providing a detailed submission to
help shape the final product, which will be
completed in April 2015.
The Plan is based on robust
epidemiological data which maps the
anticipated population growth to 2025 and
calculates the expected proportion of that
population to have severe mental illness (3
per cent). This modelling process, using
an evidence-based estimator, confirmed
that the major deficit continues to be in
community services. It is overwhelmingly
clear from that the inappropriate use of
Emergency Departments for mental health
crisis management, and the problems of
bed-block, can only be solved by further
extensive development of communitybased prevention, early intervention and
rehabilitation services. A focus on acute
services is the wrong investment, and a
population health model of care based on
primary, secondary and tertiary prevention
is well overdue.
The Plan starts with whole of population
prevention measures and steps through
dramatically expanded community
treatment to specialised services addressing
big gaps in our current public service
provision, including public eating disorder
beds and public services for adults
with ADHD and autism. The Forensic
expansion is comprehensive and particularly
necessary for mentally disordered offenders.
Much has been made of Professor Stokes’
off-the-cuff remark that he would like to
put a bomb under Graylands Hospital.
He qualified that he did not anticipate
that the patients would still be within the
buildings. “A series of staged explosions”,
the statesman said at the launch.
But where will the patients be when the now
familiar rumble and dust rises? The big work of
individually relocating each of the 170 people
in the 170 beds to long-stay community beds
or acute beds needs to begin now.
Graylands Hospital occupies a unique
place in our state’s history and it is not
helpful to demonise the place. “Claremont”
as it used to be called, was built with
the State’s windfall from the Kalgoorlie
gold rush, and at the time was seen as a
tremendous advance from the appallingly
over-crowded Fremantle Asylum (now the
Fremantle Arts Centre).
The broader public perception must now
be that Bedlam has indeed been lurking in
Claremont for the past century. How bizarre
that the Claremont Royal Show announced
this year that it had created a true replica of
Bedlam Hospital, for the paying public to
be frightened by actors simulating asylum
lunatics! It was the outraged voices of the
carer and consumer sector that led to the
appropriate closure of that ‘ride’.
It is time to move on, and we must all
be ready to meet the challenge of further
developing services informed, with the true
spirit of Christmas, by optimism, generosity,
and respect for persons suffering from
mental illness as true fellows on our journey.
“There but for the grace of God go I.”
In fact doctors and health professionals are
no more immune from mental illness than
anybody else. What kind of services would you
like for yourself or members of your family?
There has been unprecedented coverage
of all things mental health this year, and the
voices of carers, consumers and families
are being increasingly heard. It is critical
that the specialist psychiatric voice is part of
the balance, to ensure that evidence-based
assessments and treatments are available to
those suffering from mental illnesses.
One good example here is the
incontrovertible ongoing role for
electroconvulsive treatment (ECT) for
people with psychiatric illnesses and
physical illnesses such as anti-NMDA
encephalitis for example. Ill-informed
unbalanced opinion would have that
treatment banned. The Commissioner
has indicated his commitment to a clinical
reference group to provide advice to him.
Much has been made of finding, that
“one in five” of the Australian population
will suffer from some form of mental illness,
and that the Australian Bureau of Statistics
epidemiological surveys show that 25-30
per cent of the population have a DSMdiagnosable disorder in any six-month period.
The medical profession, and the
community, must acknowledge that
specialist psychiatric services – public
and private – can never provide services
to a quarter of the population. Psychiatric
services are specialist services, and must
necessarily focus on the 3 per cent with the
most severe illnesses.
The overwhelming majority of medical
mental health treatment is provided by
General Practitioners. Psychiatrists could
have a more active role in helping GPs,
and service development should try to give
Psychiatrists and GPs the opportunities for
helpful liaison and shared care.
The Medicare item number for
management plans provided by Psychiatrists
to GPs is under-utilised, and GPs and
private Psychiatrists might like to consider
innovative models such as Psychiatrist
sessions in GP surgeries for these types of
assessments.
There are only 270 Psychiatrists in WA
and we feel the stress too. But we are all in
the boat together and perhaps we are now
finding ways to row in the same direction.
There is a crack in everything, that’s how
the light gets in – Leonard Cohen. ■
References
• The Mental Health, Alcohol and
Other Drug Service Plan 2015 – 2025.
Consultation Draft available from 3
December 2014 on the Mental Health
Commission’s website.
• Burns, Tom. Our Necessary Shadow. The
Nature and Meaning of Psychiatry. Allen
Lane. 2013.
December
ME D I C US 29
CO V E R S T OR Y
The IR story – achievements and setbacks
T
he year in Industrial Relations got off
to a flying start with the registration of
comprehensive new agreements negotiated
by the AMA (WA), securing improved pay
and conditions for salaried public sector
medical practitioners working in public
facilities throughout the State. Similarly
improved agreements for private salaried
practitioners at St John of God Hospital
Murdoch and the Royal Flying Doctor
Service were also registered.
While agreement was reached to replace
the 2011 agreements, the Department of
Health was not prepared until recently
to replace subsidiary agreements made
under the Department of Health Medical
Practitioners (Metropolitan Health
Services) AMA Industrial Agreement
2011. Agreement has still not been reached
to replace subsidiary agreements that
put in place special on-call and call-back
arrangements for plastic and orthopaedic
surgeons called back on weekends.
Agreement has been held up due to a dispute
over the interpretation of the call-back
provisions set to be heard by the Industrial
Magistrate in March 2015.
The reconfiguration of the South
Metropolitan Health Service (SMHS) due
to the opening of Fiona Stanley Hospital
and the realignment of health services
at Royal Perth Hospital and Fremantle
Hospital has produced a mixed result. Some
Consultants and Doctors in Training have
been encouraged about working at FSH
by the attraction of a new state-of-the-art
facility, better hours for their personal
circumstances and a range of other reasons.
The AMA has met with FSH Senior
Executives throughout the year to resolve
contractual, rostering and training issues.
The AMA has also been active in
representing members adversely affected
by the faulty preferential employment
registration process by being locked out
of preferences or, having been assured
that there would be no change to their
particular department and not completing
a Preference Registration Form, then
being locked out of the process when the
information later changed.
The PRF process combined with the
Department of Health’s fixation over costcutting had a significant impact at RPH and
Fremantle Hospital. Sudden decisions to
downsize Departments and introduce new
structures and job plans with no concern
for employer responsibilities under the
Department of Health Medical Practitioners
(Metropolitan Health Services) AMA
Industrial Agreement 2013 resulted in the
AMA notifying SMHS of disputes within
a number of departments at RPH and with
Continued on page 33
AMA steers changes for Junior Doctors in the system
This past year has seen a number of substantial wins for
junior doctors in Western Australia thanks to the advocacy
undertaken by the AMA (WA). The AMA (WA) Doctors
in Training Committee (the Committee), along with the
industrial team, have worked tirelessly to implement new
initiatives, advocate for changes in WA Health policy and
lobby for improvements to recruitment processes.
The year started on a high. Following discussions between
the AMA and the Postgraduate Medical Council of WA
(PMCWA), a raft of changes were introduced to address the
deficiencies associated with the Centralised RMO Recruitment
Process. These changes have resulted in a smoother and more
transparent recruitment process in 2014.
A significant area of concern for the Committee and the
AMA in 2014 was the lack of access to leave entitlements in
WA for junior doctors. Following a survey of junior doctor
members, which received over 250 responses, the AMA
published an ‘Access to Leave Scorecard’ in an attempt to
bring the issue to the attention of the tertiary hospitals.
Following the release of the scorecard, the Association
was able to secure a leave policy overhaul at Royal Perth
Hospital. Discussions with Sir Charles Gairdner Hospital,
the lowest ranked hospital on the scorecard, are ongoing
and the AMA hopes to see an improvement in 2015.
The launch of the AMA (WA) Part Time Doctor Portal
marked another substantial achievement in 2014. The lack
of access to flexible working arrangements is one of the key
issues affecting junior doctors in the State. Junior doctors
who require access to flexible working arrangements are
30 M E D I CU S December
usually asked to pair themselves up with another junior
doctor in order to secure part-time employment in the form of
a shared job arrangement. The Part Time Doctor Portal will
facilitate this process by providing a space for junior doctors
to share information with one another to find their perfect jobshare partners. The Portal has received excellent feedback
from both members and hospital executives.
Other significant wins for the AMA in 2014 include
the RMO Term Dispute at SCGH, as well as the AMA’s
involvement in ensuring the BPT recruitment process at
Fiona Stanley Hospital was overhauled following significant
concerns raised by junior doctors. More information on both
of these issues can be found on page 6.
One of the highlights of 2014 has been the collaboration
between the Committee and the Membership team at the
AMA. The membership engagement strategies implemented
have resulted in a substantial increase in the number
of junior doctors joining the Association. In fact, junior
doctors accounted for over 65 per cent of new members in
2014. This collaboration will continue in 2015 with several
exciting initiatives lined up, including the launch of an online
Research Portal.
Now that 2014 is drawing to a close, the AMA is looking
forward to celebrating a successful year for junior doctors
in style. The Junior Doctor Sundowner will be held on
14 December 2014 at Mosman Park Bowls Club. AMA
members are invited to come and relax with colleagues over
a few drinks, whilst enjoying bowls, a BBQ and the delights
of the Mr Whippy Van!
CO V E R S T OR Y
Healthway successes easily outweigh
road bumps hit during the year
Associate Professor Rosanna Capolingua
Healthway Chair
A
s Chair of Healthway, at the end
of every year it is easy to look back at
achievements and successes – and 2014 has
truthfully been more eventful than most.
Unquestionably, Healthway has, since its
creation in 1991, had a major and positive
impact on physical activity, smoking,
unhealthy eating, and the influence of alcohol.
Occasionally we need to remind fellow
West Australians that Healthway was
created and is governed by provisions of the
Tobacco Products Control Act.
According to the Act, the aim of
Healthway is to:
“… fund activities related to the promotion
of good health in general, with particular
emphasis on young people; and
To support sporting and arts activities which
encourage healthy lifestyles and advance health
promotion programmes; and
To provide grants to organisations engaged
in health promotion programmes…”
This is our responsibility to the WA
people through State Parliament. Healthway
has always taken these directions seriously
and, I am confident, will always do so.
Our objective to promote and protect the
health of West Australians has continued to
drive us.
Even though the challenges during 2014
have been many, I can say confidently that
once again we have delivered strongly for
the WA population.
But we do, as a matter of course, work
closely with government and with healthrelated bodies and individuals, universities
and researchers, the Cancer Council, the
Heart Foundation, DAO and importantly
through sponsorship of sport and the arts,
we reach into the community.
We achieve so much because of our
partners and supporters.
This year has led me to reflect that
sometimes Healthway might be seen as just
a pot of cash to be accessed in sponsorship,
and that the health objectives are slipping
into a secondary position.
I challenge all of us to reassess what we
are doing, and how we are doing it.
It is vital that all those involved in health
and all those who partner with Healthway
look at our relationships, look at our Board
composition and direct ourselves to remain
true to our objectives.
We are accountable to our basic mission;
and that is a mission about health promotion.
We are after all, HEALTHWAY.
Alcohol harm, mental health tragedy,
obesity and chronic disease are all propelled
by the social determinants that Healthway
and its partners can in some way affect.
Our sponsorship of sport and arts
continues to grow.
With the Western Australian Cricket
Association, the message over the year has
been “Alcohol. Think Again”. We have
come a long way from the well-known, even
celebrated drunken behaviour at the WACA,
to respect for safe consumption and healthy
food and drink choices. The result has been
a better environment for everyone and a
great role model for other sporting codes and
young people. To our friends at the WACA,
thank you for your brave and excellent work.
The WACA is one success story. We
share success with many sporting codes and
their targeted campaigns:
• Wildcats – Alcohol. Think Again
• Rugby WA (Union) – Alcohol.
Think Again
• WA Rugby League – Smarter Than
Smoking
• Perth Glory – LiveLighter
• Football West (Soccer) – Smarter
Than Smoking
• West Coast Fever/Netball WA –
Alcohol. Think Again, and Smarter
Than Smoking
• Basketball WA – Smarter Than
Smoking
• Drug Aware Margaret River Pro
Surfing – Drug Aware
• Perth Heat/Baseball WA – Alcohol.
Think Again, and Smarter Than
Smoking
Over the last year we have also seen
the Arts partnerships join our mission
with strong health messages promoted:
•W
A Symphony Orchestra – Alcohol.
Think Again
•W
A Opera – Alcohol. Think Again, and
Smarter Than Smoking (for schools
program)
•W
A Ballet – Alcohol. Think Again
•M
ellen Events Concert Series – Make
Smoking History
It is fair to say, the year has also brought
some challenges for Healthway. In October
we launched a new partnership with the
West Australian Opera. This generated
intense public debate around the fact that
WA Opera decided not to schedule Carmen,
a work that depicts smoking on stage, at
their annual Opera in the Park event.
For the record, Opera in the Park is
marketed to families with children and
not only to the traditional fans of opera
who regularly attend performances at His
Majesty’s Theatre. There is overwhelming
evidence from international research that
children and young people who are exposed
to artistic performances that portray
smoking are more than twice as likely to
take up smoking than those who are not
exposed. That is the basis of Healthway’s
policy on not supporting artistic
performances that depict smoking.
Nevertheless, public comment was
quite forceful. Healthway was accused of
censoring the arts and our partners at WA
Opera were criticised for their decision not
to perform Carmen at Opera in the Park.
To be clear, Healthway does not shy
away from public debate about public
health issues. And here, I will quote
from Healthway’s Strategic Plan, a plan
developed by Healthway’s Board to chart
our course for five years from 2012 to 2017.
The Plan defines Healthway as
“an agent for change in moving community
thinking and action into a healthier direction
for West Australians, challenging community
norms and encouraging individuals and
organisations to change behaviour and practices
…Healthway acknowledges this work may
create challenges for some of our partners…”
We are aware that the public debate
Continued on page 33
December
ME D I C US 31
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CO V E R S T OR Y
Continued from page 30
Continued from page 31
The IR story – achievements and setbacks
Healthway successes easily outweigh
road bumps hit during the year
no resolution apparent, the AMA filed
disputes in the WA Industrial Relations
Commission involving Gastroenterology
and Renal Departments.
The AMA’s representation on
behalf of members ensured Consultant
involvement in change processes,
reduced the loss of FTE, protected
employment contracts of long-serving
and experienced practitioners, and
secured appropriate separation
packages for Consultants who preferred
to exit WA Health. Visiting Medical
Practitioner contracts and service
delivery matters also required the
AMA’s attention and representation
out of the reconfiguration process.
A substantial area of work for the
AMA has centred on protecting
practitioner conditions of employment
in the run-up to the closure of Swan
District Hospital in November 2015
and the opening of the Midland Public
Hospital to be operated by St John
of God Health Care. The AMA has
successfully negotiated arrangements
to ensure practitioners who prefer to
remain in the public sector can do so,
and practitioners who wish to accept
positions at SJG are able to do so
too, without losing leave entitlements
gained during their employment with
WA Health and also gaining separation
payments.
A further area of extensive
representation from the AMA concerns
advocacy over WA Health’s policy to
clear ‘excess’ annual and long service
leave. The AMA has successfully
secured reversals where members had
received a cash-out of leave without
payment of allowances. This is an
area of ongoing advocacy seeking a
change of policy.
The AMA’s work has incorporated
ongoing advocacy to influence WA
Health industrial and employmentrelated policy development and
amendment. Examples include
sponsored travel and gift policy, open
disclosure and qualified privilege, use
and distribution of clinical images,
e-credentialing and audio-recording of
patient diagnosis. ■
Associate Professor Rosanna Capolingua
around this issue certainly did put pressure on our
partners at WA Opera. To them, I say thank you
for standing with us and thank you for doing the
right thing for health promotion and the health and
wellbeing of children and young people in our State.
Healthway will continue to be ahead of public
opinion and generate debate about health issues.
Another example is the inclusion of e-smoking in
Healthway’s minimum health policy requirements.
In response to queries by some of our sponsored
partners, electronic-smoking is now included along
with tobacco smoking in Healthway’s minimum
health policy requirements for all organisations
we sponsor. Evidence is mounting as to the health
risks of e-cigarettes. Why would Healthway
support a potentially harmful product?
The business, media, social and political
challenges have been many but our successes
have easily outweighed whatever road bumps we
may have hit.
I am proud to be Chair of Healthway. But
more importantly, as West Australians we should
all be proud of our incredible achievements over
the years in the health arena – so many of them
coming from Healthway. ■
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DRIVEAWAY
OPINION
To be or not to be (your own boss)
– that is the question
Dr Steve Wilson
Chair, AMA (WA) Council of General Practice
A
long time ago I said, “you must
care for your profession as much as
you do your patients”. Hence, my twodecade long involvement in fighting for
General Practice through the Divisions,
AMA and the College.
However if we’re honest and General
Practice were a patient, many senior and
influential colleagues believe General
Practice, as we know it, would be fatally
wounded – perhaps never to return to its
former glory. Why so? There are many
reasons but I see them like this:
Loss of the time-honoured
past:
Gone are the home visits, caring for the
elderly in their residences; the disabled
in shared accommodation; aged care
facilities and lodges. Medicare off-site
visit rebates, the loss of time travelling
and endless paperwork have made
such care unattractive and financially
unsustainable. Safety issues also abound
especially for female GPs.
Further, there was something
irresistibly simple about renting or
buying an old house or commercial
space, and fitting it out to be your
practice. Set-up costs were less – all
you needed were phones, a fax, files, a
receptionist, couches and desks, lights,
an autoclave etc. GPs charged a fair
fee for a good service; government
regulation and interference was
minimal; and “we all felt we could
practise great medicine in the middle
of a cow field”. Our weapons’ chest was
the doctor’s bag in hand, our clinical
skills and the power of our patient-GP
relationship.
A fractured present:
The government likes to talk about
“the finest health system in the world”
but through the poor Item Tiering
and long-term lack of indexation of
the GP rebates in the MBS, both the
attractiveness of General Practice as a
vocation and its low income base mean
graduate numbers entering General
Practice have been in free-fall.
Further, the “commoditisation of
General Practice” – reduced to being
about ‘units-of-service’ rather than
‘relationships built over many years’ –
has affected loyalty, long-term care etc.
If you like, the politically-driven Super
Clinics are an embodiment of that – “if
you build it, they will come”.
But never has there
been a greater
need in our craft
group’s history for us to
foster our own future and
turn around the seemingly
irreversible slide in general
practice ownership
An uncertain future:
Training and Workforce are in a
current no-man’s land as government
once again tries to seize control over
the profession. We see all too often
how government manipulates health
financing, structure, training and
excessive regulation. The profession
itself has changed its own future by
continually relinquishing practice
ownership, and refusing to work as
their GP forefathers did – preferring
life over work and choosing part-time
over more full-time work. Furthermore,
the growth of corporatisation and the
risk of potentially losing our business
autonomy and (frequently) some clinical
autonomy, has changed us and our work
perspective.
I am the first to admit that being
a practice principal is a seriously
tough gig – to quote Dr Janice Bell,
CEO of WAGPET. Yes there is
regulation, accreditation, PIP, SIP, HR
management and myriad issues to deal
with. However, as a practice owner, I
find getting doctors the hardest of all i.e.
workforce.
I often think that until the GP
workforce reaches saturation in Perth,
GPs will always want to work closest
to home, work around school hours,
holiday periods etc. It is indeed, the
attractive parts of General Practice that
make it unique, yet difficult in terms of
maintaining service. Getting doctors
to come and stay is really hard, even
in Bassendean, which is only 12km
from the CBD, but classified neither as
Outer Metro for trainees nor District of
Workforce Shortage (DWS). The result?
We cannot utilise doctors on AB19
Provider numbers.
I need help urgently where I am, but
the Commonwealth ensures there are
barriers. Therefore succession planning
for practices such as mine is hard and
may only force a further slide in private
practice ownership. I’ve invested close
to $2 million and 20 years of my life
into the area. And as the recent Monash
study in South Australia showed, older
GPs like me – stupidly or otherwise – do
worry about who will take care of their
patients once they retire.
But never has there been a greater
need in our craft group’s history for
us to foster our own future and turn
around the seemingly irreversible slide
in general practice ownership. Being
your own boss has real merit and
General Practice must own its own
future.
Finally, we must still urgently address
the persistent lack of business and
Human Resources training for GPs if
we are to skill the GPs of the future to
join, own, and run their own enterprises
– an ideal, that I might add, is essential
to provide a sound population of
QUALITY practice to train the
registrar GPs of the future. ■
December
ME D I C US 35
OPINION
Swift, adequate and compassionate action
needed for Ebola response
Dr Tim Koh
Chair, RACGP WA Faculty & AMA (WA) Councillor
I
t has been a busy month since stepping
into the sizeable shoes of Frank Jones as
RACGP WA Faculty Chair. In addition to the
busy task of trying to meet with as many GPs
and organisations as possible, a number of
important issues have arisen requiring my
immediate attention.
The most prominent of these has been the
education of GPs about the Ebola virus, which
involved addressing the multitude of questions
and concerns that accompany this West
African (and now international) epidemic.
The aim is to provide local GPs with the best
preparation possible for managing the disease.
The advent of international transmission of
Ebola infection, and the subsequent media
hype necessitates that Australian GPs must
update their knowledge and skills to be in
a position to deal with the concerns of the
public. This is a prime example of the difficult
nature of General Practice – we work in an
environment that is constantly changing and
throwing up new challenges.
The RACGP has released numerous
resources and held Ebola education events
for GPs. I had the pleasure of chairing one
of these meetings with Dr Paul Armstrong
from the Communicable Disease Network
WA. The facts that have been conveyed to
GPs and the public are, firstly, the outbreak
in West Africa has been more significant than
36 M E D I CU S December
expected. Secondly, the risk of exposure is
low unless people are exposed to the body
fluids of infected patients. Finally, GPs
need to be aware of the clinical picture and
exposure history. From these meetings, many
GPs raised concerns about what resources
would be available in anticipation of infection
occurring in Australia. To this end, it is
apparent that there are a considerable amount
of government resources (both state and
federal) that have been allocated to ensure
that we, as a community, are well prepared
for such an outbreak. The events in the US in
which local health workers became infected
whilst caring for an Ebola patient clearly
demonstrate that adequate preparation and
sound clinical protocols are critical measures.
With so much time and resources being
channelled into preparing for an Ebola
outbreak in Australia, there is one concern
that remains largely ignored by the public,
media and government – why has Australia’s
international aid response to the Ebola crisis in
West Africa been so slow and muted? While
most of the attention remains fixed on the
possibility of the infection reaching Australian
shores, there seems to be a complete ignorance
of the fact that it is much more sensible to
deal with this issue at its source in West
Africa rather than concentrating efforts in
Australia where it is yet to occur.
There is an excellent precedent for this
that has occurred in the brief history of this
epidemic in which an outbreak of Ebola in
Nigeria was contained predominantly with
good public health measures. Unfortunately
Liberia, Sierra Leone and Guinea have been
less successful in these measures partly due to
the severe lack of resources. Our tardiness in
responding to the evolving crisis reflects a
lack of understanding that addressing this
problem at its root is not only in the interests
of the many thousands of West Africans
affected by this crisis, but also ourselves.
Beyond this, the trend of Ebola to infect
doctors and healthcare workers (in countries
that are already extremely deficient) will
undoubtedly result in severe long-term health
consequences for these populations that will
long outlast the epidemic. It is estimated that
Liberia had approximately 50 doctors servicing
a population of 3.8 million prior to the most
recent outbreak. One can only imagine the state
of affairs that will be left behind for those who
survive the epidemic in these regions.
As clinicians who work in preventative
medicine, we are well positioned to advise
government about the importance of acting
swiftly and adequately in response to this
crisis. As Australians, it is in our own interest.
As a compassionate community, it is the
right thing to do. ■
December
ME D I C US 37
“The sight of the star
filled them with delight”
Matthew 2:10
St John of God Health Care wishes our doctors and everyone
working in Western Australia’s health care community a blessed and
joyful festive season.
Our hospitals, pathology, home nursing and social outreach services
will continue to grow in the New Year and we look forward to
working with you in 2015.
Bunbury Hospital | Geraldton Hospital | Midland Public & Private Hospitals (Opening November 2015)
Mt Lawley Hospital | Murdoch Hospital | Subiaco Hospital | Pathology | Health Choices | Social Outreach
www.sjog.org.au
FOR THE RECORD
‘Team WA’ approach needed
PROFESSOR PETER KLINKEN
CHIEF SCIENTIST OF WESTERN AUSTRALIA
Q. You have been Chief Scientist of WA for almost
six months now. Have your initial impressions of
the position lived up to expectation?
imagine previously. In addition, powerful new technologies in
the Life Sciences such as genomics, proteomics and imaging are
transforming these fields.
PK: I would have to say that the position has more than lived
up to my expectations. I am loving the role, and hope that I can
play some small part in promoting science in WA. There are few
occasions in your life when you get the opportunity to provide advice,
which might contribute to the scientific direction of the State.
Q. How can WA build its reputation in science
and research?
Q. Any pleasant, or unpleasant, surprises so far?
PK: The most pleasant surprise has been exposure to many areas
of scientific strength in WA, especially in sectors that I didn’t
know much about. The biggest disappointment has been the silo
mentality of some groups. If this State is going to make an impact
in science internationally we have to work together, and take a
‘Team WA’ approach. I am delighted that the medical sector
has taken the lead with a state-wide ‘Team WA’ approach for
Advanced Health Research and Translational Centres.
PK: A comprehensive plan for the future direction of science
is essential – the entire research sector is looking for clear
direction. We must demonstrate a commitment to science,
and value our researchers. Research must be viewed as
an investment that improves the health and wealth of our
community, as well as the environment. The SKA is a
marvellous example of where the State saw an opportunity,
invested in it and recruited international luminaries – as a
consequence, we now have the world’s biggest scientific project
in our backyard!
Q. Did your predecessor, Professor Lyn Beazley
offer any words of advice?
Q. What attracted you to the job?
PK: I have has several chats with Lyn, and she has been extremely
PK: The Chief Scientist’s position is not one you apply for – it is by generous with her support. I have also been fortunate to get great
advice from several wise heads including Ian and Liz Constable,
appointment. I was truly honoured when the Premier approached
me to take up the role. The opportunity to provide strategic advice Alan Robson, Graeme Morgan and John Poynton.
on the future of science in WA is a rare privilege indeed.
Q. Your heroes in science?
Q. On a scale of 1 to 10 (with 10 being the highest), PK: I only have one hero in science and that is the inimitable
how would you rate WA’s science industries?
Don Metcalf, who discovered the growth factors which regulate
Where are we falling short?
white blood cell production. To me, he is a superstar who
PK: I think we are doing OK and would give WA an overall score
of 7. We could do better by developing a more strategic, long-term
vision for science – this could overcome a lack of cohesion and
scale in certain areas. New facilities and infrastructure that have
been developed recently will definitely act as beacons for talented
researchers. In addition to the physical environment we have
generated, the supportive emotional environment we provide will
attract stellar scientists to WA.
Q. Where do you believe WA’s strength lies when it
comes to science and research?
PK: The five key areas of strength that have been identified for
WA are – radioastronomy (particularly with the Square Kilometre
Array or SKA), Energy and Mining, Biodiversity and Marine
Science, Agriculture and Medical Research. These sectors will
be underpinned by massive supercomputing power that the SKA
is bringing, enabling big datasets to analysed in ways we couldn’t
should have been awarded a Nobel prize, especially as these
hormones are used in the clinic and have transformed the way
many cancers are treated. His determination, focus, rigour,
work ethic and passion have been really inspirational to me.
Q. The book you are reading at present?
PK: That’s easy – my brother-in-law Richard Rossiter’s novella
Thicker than Water. I’ve just been given Wisdom by Andrew
Zuckerman, which I’m looking forward to reading soon. Other
books I would like to read over the summer include The Emperor
of all Maladies by Siddartha Mukajee on the history of cancer,
and The Biggest Estate on Earth by Bill Gammage about how
Aboriginal people managed this land in pre-European days.
Q. The last time you felt like a teenager…
PK: Yesterday – I’ve always been young at heart. Some might
say that I’ve never really grown up… ■
December
ME D I C US 39
CL INIC A L E DGE
Totally Endoscopic Video-Assisted Thoracic
Surgery (VATS) – a paradigm shift in chest
surgery in Australia
Mr Pragnesh Joshi MCh, FRACS
Consultant Cardiothoracic Surgeon, St John of God Subiaco Hospital
& Sir Charles Gairdner Hospital
F
irst introduced almost two decades
ago, totally thoracoscopic major
pulmonary resection has revolutionised
the surgical approach to the treatment of
lung cancer and other thoracic diseases.
Totally thoracoscopic pulmonary
resection is different to Video Assisted
Thoracic (VAT) surgery. However, the
term ‘VAT’ has been used for both.
A thoracotomy, which requires rib
spreading and muscle division, has been
the traditional approach to carry out
pulmonary resection. The large incision
required for a thoracotomy, the division of
extrathoracic muscles and rib spreading,
have been responsible for quite a few
post-operative issues. A VAT pulmonary
resection procedure eliminates these
problems to a large extent.
The recently published consensus
statement defines VAT surgery as a
procedure where rib spreading is strictly
avoided and individual dissection of the
vascular structure is performed.1 The key
difference lies in not spreading the ribs
and operating through a telescopic view in
totally endoscopic surgery.
Since there is some overlap between
totally VAT surgery and VAT with
rib-spreading thoracotomy, I believe the
appropriate term for non-rib spreading
totally endoscopic surgery should be
Totally Endoscopic Thoracic Surgery
(TETS). However, VATS is still the most
commonly utilised terminology.
INTRODUCTION
Thoracotomy has been the traditional
approach for the surgical treatment of
thoracic diseases, including lung cancer.
However over the last decade or so,
VAT surgery without rib-spreading
thoracotomy has emerged as an effective
alternative. Despite having been shown
to be equally effective, cardio-thoracic
surgeons have been slow to adopt VATS
(or TETS) as a new technique, unlike
General Surgeons who have rapidly
embraced the laparoscopic approach for
40 M E D I CU S December
abdominal surgeries.
The slow adoption was justified
in some ways as the VATS/TETS
approach had to prove its efficacy in
cancer surgery.2,3 There is no doubt
about the cosmetic superiority of
VATS over thoracotomy. Some studies
have also shown significantly reduced
perioperative morbidities.3,4 Studies
have confirmed equivalent or better
outcomes in terms of post-operative
stay, respiratory function, access to
adjuvant therapy and pain control.5,6
Figure 1. Specialised tools: Different types
of endo-staplers for the division of lung and
vascular structures. Pic: Covidien
WHAT IS VAT/TET SURGERY?
All VAT/TET surgeries are carried
out under general anaesthesia. For
lung surgeries, patients are placed in
a lateral position while for mediastinal
tumours, a semi supine position is
preferred. The lung on the side of the
operation is selectively isolated from
ventilation by a double lumen tube
(DLT). A pre-operative bronchoscopy Figure 2. Action: Clamping of pulmonary
artery with vascular endo-stapler followed by
is then carried out, confirming the
division during left side VAT pneumonectomy.
position of the
DLT and allowing inspection of the
• No rib spreading – less post-operative
bronchial tree.
pain and neuralgia
The number of ports varies from
• Shorter hospital stay – usually 2-3 days
four to one – there are usually two in
• Faster recovery
our practice. The size of ports is usually
• Better operative visualisation due to
1-1.5cm. In addition to two ports, a
magnification.
small thoracotomy (also known as utility
PATIENT SELECTION
port) measuring about 3-4cm is also
Any operable lung cancer can be
required. However, there is strictly no rib
removed by VATS/TETS. However,
spreading. The utility port is also used to
suggested selection criteria are tumours
deliver lung specimens.
less than 7cm, predicted post-operative
The entire operation is carried
FEV1 >40 per cent and DLCO>40
out purely with thoracoscopic vision.
per cent and absence of involvement of
Specialised staplers (figure 1) are utilised
mediastinal lymph node.1 Lymph node
to divide vascular and lung structure
dissection for lung cancer can be carried
(figure 2). Upon separation of the
out without any difficulties. Previous
cancerous lobe from the rest of lung, it is
thoracic surgery makes the procedure
delivered in a sac via the utility port. Ports
complex due to adhesions but this is not a
are closed with single chest drain in situ.
contraindication for VATS/TETS. One of
the most important factors is the surgeon’s
ADVANTAGES OF VAT/TET
experience and comfort with VAT/TETS
SURGERY
techniques.
• Smaller incisions – cosmetically much
Other common VATS procedures are:
superior (figure 3)
CL INIC A L E DGE
Figure 3. Smaller incisions: Post-operative
scars following totally endoscopic VAT right
upper lobectomy.
•P
leurodesis for recurrent pneumothorax
• Pleurectomy
• Wedge resection of lung for biopsy/
treatment
• Mediastinal tumour resection e.g.
Thymoma, neurofibroma
• Pericardial window for pericardial
effusion
• Thymectomy.
Experienced VAT/TETS surgeons
also carry out thymectomy and
mediastinal tumour resection. However,
a lager-sized tumour can be a limiting
factor in some patients.
POST-OPERATIVE RECOVERY
Most patients get discharged from the
hospital in 2-3 days’ time. This can be
attributed to minimal bleeding, reduced
incidence of post-operative air leak and
less pain.
CURRENT STATUS OF TETS
The thoracoscope provides an enhanced
view during surgery due to magnification
and light. It has been used in lung surgery
in a limited role for many years. Minor
procedures such as pleurodesis and
lung biopsy have been carried out using
totally endoscopic techniques for quite
some time. Major pulmonary resection
using the totally endoscopic technique
has been a challenge for surgeons. VAT/
TET surgery requires an exceptional
level of hand-eye coordination – which
means operating in the patient’s chest
while looking at the screen. Twenty per
cent of pulmonary resections in the
US and 10-15 per cent in Europe are
carried out thoracoscopically.7 Although
becoming increasingly popular in
Australia, training and skillset acquisition
for VAT/TET has been a great challenge
for new as well as established surgeons.
A minimum of 50 cases are required to
overcome the learning curve of VATS/
TETS pulmonary resection.1
The most critical aspect of major
pulmonary resection is to safely ligate
and divide branches of pulmonary artery.
The surgeon also has to ensure complete
resection in the case of lung cancer.
The other significant aspect is loss of
tactile sensation, as a surgeon cannot use
their hands or fingers during endoscopic
lung resection. The surgeon also has
to make themselves familiar with
thoracoscopic anatomy. In an attempt
to carry out thoracoscopic resections,
some surgeons have been able to reduce
the size of the thoracotomy while using a
thoracoscope during surgery. However,
they still have to use the rib spreader
as the majority of the operation is
carried out by direct vision through the
thoracotomy wound. The use of the rib
spreader frequently leads to rib trauma,
injury to intercostal nerves and increased
post-operative drainage. The trauma to
the intercostal nerves can cause postoperative pain and neuralgia. Going by
the definition of VATS, the rib spreader
must be avoided in order to realise the
full benefits of the surgery.
Unlike laparoscopic surgeons,
cardiothoracic surgeons are not very
familiar with endoscopic skills. However,
interest and dedication have led many
to learn and master the skills required
for VATS/TETS by attending training
workshops and having a proctor to begin
their initial cases.
Currently, very few surgeons in
Australia carry out totally endoscopic
pulmonary resection, but this number
is on the rise. Reduction in hospital stay
and post-operative morbidity also leads
to significant cost savings for hospitals
and health funds. ■
References:
1. Yan TD, Cao C, D’Amico TA, et al.
Video-assisted thoracoscopic surgery (VATS)
lobectomy at 20 years: a consensus statement.
Eur J Cardiothorac Surg 2014;45:633-9.)
2. Wright GM Video-assisted thoracoscopic
pulmonary resections- The Melbourne
experience Ann Cardiothorac Surg
2012;1(1):11-15
3. F
lores RM1, Park BJ, Dycoco J, Aronova
A, Hirth Y, Rizk NP, Bains M, Downey
RJ, Rusch VW.Lobectomy by video-assisted
thoracic surgery (VATS) versus thoracotomy
for lung cancer. J Thorac Cardiovasc Surg.
2009 Jul;138(1):11-8.
4. C
ao C, Manganas C, Ang SC, et al. A metaanalysis of unmatched and matched patients
comparing video-assisted thoracoscopic
lobectomy and conventional open lobectomy.
Ann Cardiothorac Surg 2012;1:16-23.
5. Petersen RP, PHAM D, Burfeind WR, et
al . Thoracoscopic lobectomy facilitates the
delivery of chemotherapy after resection for
lung cancer. Ann Thorac Surg 2007;83:12459; discussion 1250
6. N
agahiro I, Andou A, Aoe M, et al.
Pulmonary function, postoperative pain,
and serum cytokine level after lobectomy :
a comparison of VATS and conventional
procedure. Ann Thorac Surg 2001;72:362-5
7. W
alker WS. Editorial. Ann Cardiothorac
Surg 2012;1(1):2
December
ME D I C US 41
PROF IL E
A good
man in
a crisis
Dr Andy Robertson is
WA Health’s go-to person
when disaster strikes,
says Janine Martin
D
r Andy Robertson knows only
too well that if death is the great
leveller, then disaster comes a close
second. As Director of WA Health’s
Disaster Preparedness and Management
Team, Andy has led Australian Medical
Assistance Teams (AUSMATs) into
the Maldives following the December
2004 Tsunami, earthquake-ravaged
Yogyakarta in Indonesia a couple of
years later and more recently, advised
the Australian Embassy in Tokyo
on radiation health matters after the
Fukushima meltdown.
Dr Robertson illustrates the point with
a story of the first relief team that landed
in Banda Aceh, Indonesia following the
2004 Tsunami.
“The team had 14 tonnes of
equipment which they had to unpack by
themselves and load onto trucks. They
then drove to the local hospital and
helped to clean it, shovelling out dirt and
42 M E D I CU S December
debris,” recalls Andy.
“Their number one goal was to have
the hospital running and get the mission
over the line. If that meant shovelling out
tonnes of dirt, so be it. Medical hierarchy
has no place at times such as these.”
This from a man who has spent a
large part of his medical career in an
institution defined by hierarchical codes
– the Royal Australian Navy. Yet Andy,
who remains a Captain in the Navy
Reserves, maintains that having the right
mindset is a critical skill when faced
with emergency situations and natural
disasters.
Today’s AUSMATs undergo rigorous
training in safety and security to prepare
them for different environments.
“We encourage them to undergo
general disaster medicine training –
which involves mental health components
such as psychological management of
victims as well as self-care.”
Any ongoing concerns, Andy says, are
addressed during AUSMAT’s annual
local training exercise.
“The teams sleep in tents and get to
work all the equipment. We put them
through field exercises where we simulate
being stopped at a check point, being
ambushed etc. We place volunteers
in challenging situations – albeit
simulations – to check their physical and
psychological preparedness.”
Andy says it is during these sessions
that some volunteers decide to bow out,
while others move forward.
“It’s not easy to gauge but from these
training sessions, we do get a good idea
of people who will work well in teams.”
Andy confirms that Australia’s foreign
aid teams stack up well compared to their
global counterparts.
“The teams, which comprise of
doctors, nurses, logisticians and other
support staff are pretty robust and over
PROF IL E
the past 10 years, we have built up both
our medical equipment and general
sustainability caches,” he says.
The challenges arise when it comes to
entering certain countries.
“Some of these places are difficult to
enter and the Australian Government
plays a key role in getting our teams in
and out.
“Obviously some countries are quite
advanced in their preparedness for
disaster response and the reception of
foreign aid teams. Others, with fewer
resources, are only partly along that
route.
“Every country, every place offers its
own lessons. Depending on housing,
population and geography, disasters
impact people differently.”
While Andy captains WA’s disaster
response teams overseas, he also
maintains a strict vigil when it comes to
domestic preparedness.
“I hate to say it but we are leading up
to our ‘busy season’ – bush fires, cyclones
and heat waves. These events may come
in varying degrees but we need to be
prepared.
“We also work with other agencies
such as the police on big events such as
music festivals and leavers’ celebrations.”
This year Andy has been involved
in a slightly more unusual project – the
various moves to Fiona Stanley Hospital.
“We have been involved in the
coordination of the operation centre and
the logistics of moving patients using our
Track Me system.
“It’s like a controlled evacuation of a
hospital – and evacuating places is what
we do. This was a good opportunity to
exercise our systems.”
For a boy from Gundagai, the famous
small town in New South Wales, Andy
has certainly come a long way. Life on a
farm and the accompanying hardships
that he saw his father weather convinced
him to look elsewhere for a career choice.
Having long nurtured an interest in
science, Andy decided on medicine and
subsequently a medical career in the
Navy.
“I felt I could have the opportunity
to do a range of things in the Navy that
were different from the more routine path
of medicine,” he says.
Some of the “different” things that
Andy had the opportunity to do, included
training in hyperbaric medicine and
studying the health aspects of biological,
chemical and radiological weapons. It
was the latter that led him to become the
Principal Health Advisor in that area
to Australia’s Defence Department. It
was a position that he held for a decade
and Andy remembers his missions in
Iraq during Saddam Hussain’s rule, as a
particular highlight.
“In some ways, it was safer then.
There were no random bombs exploding
in market places and we were under
UN protection. But it still wasn’t a
particularly welcoming country.”
The frosty reception Andy received
may well have had a lot to do with his role
as a Chief Biological Weapons Inspector
in the UN Special Commission.
He admits there was a lot of pressure
on the monitoring groups to find
evidence of Saddam Hussain’s chemical
and biological weapons programs.
“And we did. The Iraqis had already
admitted to having a chemical weapons
program and in 1993, they destroyed
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the more obvious weapons such as the
mustard and nerve agents.
“They hid their biological program for
the first five years but eventually admitted
it in late 1995.”
The following year Andy visited Al
Hakam, Iraq’s biological weapons facility
and says most of the evidence had been
deliberately destroyed.
“This meant we had to try and piece
together what the Iraqis had originally,
how much had been produced and
whether all of it had been destroyed, as
they claimed.
“And then the real question arose: were
the Iraqis continuing a weapons program
somewhere else within the country?”
While Iraq remains a career highlight,
Andy says, places including the Maldives
(after the 2004 tsunami), Jakarta
(following the 2006 Earthquake) and
Fukushima (after the nuclear incident in
2011) left indelible impressions on him
too.
His work, in turn, has impressed many
others. Andy has been the recipient
of multiple awards significantly the
Conspicuous Service Cross and the
Humanitarian Overseas Service Medal.
He also currently serves as WA
Health’s Deputy Chief Health Officer and
Editor-in-Chief of the Journal of Military
and Veterans’ Health, a peer-reviewed
journal published by the Australasian
Military Medicine Association.
For someone who has travelled the
world in his various capacities in the
Navy and WA Health, Andy is now
happy to call Perth home and is looking
forward to enjoying the sunny days
ahead – until that next phone call at
three in the morning. ■
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December
ME D I C US 43
R E SE A RCH
Vitamin D: a hot topic with
many uncertainties
Winthrop Professor Robyn Lucas
Telethon Kids Institute, UWA
T
here is substantial and legitimate
scientific debate on the health
benefits and harms of vitamin D – and
General Practitioners (GPs) in Western
Australia are in a position to help answer
some of the important vitamin D questions.
In the recent Australian Health Survey,
23 per cent of Australians over the age
of 12 years were reported to be vitamin
D deficient (serum 25-hydroxyvitamin
D of less than 50nmol/L).1 For Western
Australians, the figures were 13 per cent
in summer and 28 per cent in winter.
Vitamin D deficiency is much more
common in some population subgroups,
for example, nearly 60 per cent of those
born in South East Asia.
Australian doctors are very well aware
of concerns around vitamin D deficiency
and possible links to ill health. This has
resulted in a high level of testing for
vitamin D deficiency – an increase of
almost 4000 per cent in the last 10 years.
Indeed, in May 2014, there were over
700,000 vitamin D tests in a single month.
And GPs report that low vitamin D levels
are common among their patients.
However, from 1 November 2014
there has been a crackdown on Medicare
rebates for testing, so that only those with
a few specific indications can receive
a Medicare rebate for a vitamin D test
(http://www.msac.gov.au/internet/msac/
publishing.nsf/Content/0014r-public).
The problem with vitamin D is that
there is so much that we don’t know.
Measurement has been problematic, with
poor quality assays, so that it is not clear
that any single measurement of vitamin D
provides a true result.2 It is not clear what,
if any, health effects are associated with
vitamin D, and what level needs to be
maintained to avoid health risks. It is clear
that severe vitamin D deficiency – that is
a serum 25-hydroxyvitamin D (25(OH)
D) level of less than 25-30nmol/L – needs
to be treated, generally with vitamin D
supplementation.
What is less clear is whether slightly
higher levels, for example those
44 M E D I CU S December
around 50nmol/L or just under, need
treatment. A level of 50nmol/L or higher
is recommended as sufficient by the
US Institute of Medicine, although
other bodies recommend higher levels
of 75nmol/L or more.3 It may be that
vitamin D status can be improved
in people with mildly low levels, e.g.
40-50nmol/L, by advising them to get a
bit more sun (safely) rather than taking a
supplement.
The evidence around the health
benefits of higher vitamin D status is
contradictory.4 In many studies, people
with the disease of interest have lower
25(OH)D levels than those who do not
have the disease – but is this because
low 25(OH)D increases the risk of the
disease? Or does the disease increase
the risk of low 25(OH)D levels? When
it has been studied, giving vitamin D
supplements does not decrease the risk of
these same diseases.4
Although there are some concerns
about whether the clinical trials are
really valid, they do suggest that there
is no beneficial effect of vitamin D
supplementation on disease risks. One
explanation for the contradictory findings
may be that something else that is linked
to higher 25(OH)D levels, such as just
being in generally better health, being
more physically active, or having more
sun exposure, lowers disease risks, i.e.
that the low 25(OH)D reflects a low level
of some other desirable exposure.
There are now several studies around
the world that have shown that sun
exposure itself may have benefits on
health – particularly for immune function
and cardio-metabolic health (including
blood pressure). The pathways are not
completely clear, but may involve the
release of nitric oxide from the skin
following sun exposure.5,6 But it does
seem that these are not vitamin D
pathways. This is important. Firstly,
it could explain why low 25(OH)D is
associated with increased disease risk,
but vitamin D supplementation does
not decrease the risk, i.e. it is not the low
25(OH)D per se that is important, but
only that low 25(OH)D is a proxy for
low sun exposure. Secondly, if this is
not a vitamin D effect, then getting the
benefits requires some sun exposure. And
treatment of mildly low 25(OH)D levels
may be best managed by prescribing sun
exposure, not vitamin D supplements.
But, Australia has the highest skin
cancer incidence in the world. So, we
need to have a good understanding of just
how much sun exposure is required to
gain benefits and how the risks are best
avoided.
In 2013, Cancer Australia funded
the Sun Exposure and Vitamin D
Supplementation Study (SEDS Study)
to answer some of these questions.
Specifically, the study aims to answer the
questions:
• Can you manage mild vitamin
D deficiency (25(OH)D level of
40-60nmol/L) with advice to safely
increase sun exposure? and
• If so, how much sun exposure
equates to what level of vitamin D
supplementation?
A second set of questions focuses on
the possible effects of sun exposure on
immune function and cardiometabolic
health, and the extent to which these are
independent of vitamin D.
The SEDS Study is currently
recruiting participants who are aged
18-64 years and have had a recent
vitamin D test result of between 40
and 60 nmol/L. Eligible participants
are randomly allocated to receive one
of two different doses of vitamin D
supplementation or placebo, and one
of two different types of sun exposure
advice. Participants are followed
over one year, with data collection
by questionnaire and sun exposure
monitoring every three months, and
blood sampling on four occasions.
Since participants have to have
had a recent vitamin D test, with a
result between 40 and 60nmol/L, we
R E SE A RCH
are seeking interested GPs to work
with us on participant recruitment.
We have very streamlined processes that
ensure minimal disruption and time
consumed – GPs ask patients with a
recent test with an appropriate result if
they would be happy to have the study
team contact them (the patient). If yes,
the contact details are passed to the
study by fax or email, and the study
team will take it from there.
If you are interested in vitamin D and/
or sun exposure, and might be interested
in helping us to recruit participants for the
SEDS Study, we would be happy to hear
from you. We are also keen to visit and talk
with GPs in person to explain the study and
to answer any questions about vitamin D
and/or sun exposure.
If you would like to learn more
about the SEDS Study, please visit
the study website, www.sedsstudy.
org.au, email us at: info@sedsstudy.
org; or phone us at:
1800 73 2223. ■
References:
1. A
ustralian Bureau of Statistics. The
Australian Health Survey Biomedical
Results. Canberra; 2014. (www.abs.gov.
au). (Accessed 10 Nov 2014 2014).
2. L
ai JK, Lucas RM, Banks E, et al.
Variability in vitamin D assays impairs
clinical assessment of vitamin D status.
Intern Med J 2012;42(1):43-50.
3. Institute of Medicine. Dietary Reference
Intakes for Calcium and Vitamin D.
In: Ross A, Taylor C, Yaktine A, et al.,
eds: Institute of Medicine of the National
Academies, 2010.
4. Autier P, Boniol M, Pizot C, et al.
Vitamin D status and ill health: a
systematic review. Lancet Diabetes
Endocrinol 2014;2(1):76-89.
5. L iu D, Fernandez BO, Hamilton A,
et al. UVA Irradiation of Human Skin
Vasodilates Arterial Vasculature and
Lowers Blood Pressure Independently
of Nitric Oxide Synthase. J Invest
Dermatol 2014.
6. Geldenhuys S, Hart PH, Endersby R,
et al. Ultraviolet radiation suppresses
obesity and symptoms of metabolic
syndrome independently of vitamin d
in mice fed a high-fat diet. Diabetes
2014;63(11):3759-69.
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December
ME D I C US 45
OPINION
Reflections on a year gone by
Dr Melita Cirillo
Co-Chair, AMA (WA) Doctors in Training Committee
A
s 2014 draws to a close, so does
my period of office at the heart of
the DiT Executive. The past 24 months
have passed by extraordinarily fast and
this year in particular has been one of the
most productive I can recall as far as the
achievements of the AMA (WA) DiT
Committee go.
The first quarter saw the AMA DiT
Leave Scorecards dominate the agenda.
The issue prompted robust discussions
across all the main tertiary sites and some
positive changes, which hopefully will
continue in 2015.
The recent launch of the Junior Doctor
Part-Time Portal has been another feather
in the DiT Committee’s cap. Following
a significant amount of work by many
including Dr Courtney Majda and AMA
staff members Caela Del-Prete and Nicola
Roman, the portal is the first of its kind to
be launched in Australia and is a fantastic
benefit for AMA members.
The aim is to link junior doctors
interested in part-time work prior to job
applications – making it easier for them to
be employed. Appointments for 2015 are
mostly finalised, however we look forward
to providing this service to members when
applying for jobs in 2016 and beyond.
Membership has always been a great
strength of the AMA and pleasingly
for junior doctors, our numbers have
continued to increase this past year to just
under 50 per cent of all members. I believe
this reflects the currency of what we are
doing, and the appetite of junior doctors
to create change within a system straining
under the increasing numbers of medical
graduates and residents.
Increasingly, the concern over training
pathways and job prospects will feed into
this, and hopefully in WA we can continue
to be ‘ahead of the curve’ in identifying
solutions to cope with this demand.
Some exciting work has also begun
this year to facilitate junior doctors into
clinical and basic research. Whilst all
the details are not yet finalised, the DiT
Committee plans to create a web-based
46 M E D I CU S December
portal for junior doctors to access Senior
Practitioners with a research interest and
a link to projects. This will hopefully
become yet another benefit in the AMA’s
membership armoury.
Plenty of other industrial work has
taken place during the year. The opening
of Fiona Stanley Hospital highlighted
the increasingly competitive nature of
job applications in WA. This process will
become even more stringent in future, and
has made many DiTs increasingly aware of
their industrial rights and obligations.
Now all of these achievements – both
big and small – don’t just ‘happen’. I
would like to acknowledge the exceptional
contribution of Nicola Roman, our DiT
Secretariat and Industrial Officer as well
as my Co-Chair, Dr John Zorbas who have
both brought vigour and enthusiasm to the
team, sacrificed much in personal time and
supported me during the past 12 months.
I chose not to nominate for the position of
Co-Chair in 2015 and am pleased to formally
announce that Dr Chris Wilson (former
JMO Forum Chair) will be taking the reins
along with Dr John Zorbas next year. I have
been involved with the DiT Committee for
the past seven years, and am pleased to be
leaving its leadership in the capable hands
of two very competent gentlemen.
What do I see as the major issues ahead?
‘Training pipeline’ might be the current
catchphrase in medical education circles,
but it will become the single biggest
challenge for the current generation of
Interns and Residents. The competition
to gain employment at tertiary sites grows
tougher each year, with many RMOs in the
eastern states already missing out in 2015.
WA sits at the fulcrum, with the tipping
point of under-employment looming in the
next one to two years.
What we really need, to manage this
going forward, is a key organisation to take
control of prevocational training of junior
doctors in WA. Intern education is under
the watchful eye of the PMC. Registrars
have their Colleges for formalised
training pathways. Yet most Residents
'Training pipeline’
might be the current
catchphrase in
medical education circles,
but it will become the single
biggest challenge for the
current generation of
Interns and Residents
are swamped in service provision with
no clear group advocating for quality in
their training. There is also significant
variability in what the hospitals provide at
this level.
We are also starting to see the effects
of a tougher fiscal climate feed into
hospital rostering and overtime practice,
particularly at the RMO level. At some
hospitals, afterhours and weekend cover are
rostered completely out of relief pool staff
to avoid paying the team’s “ward” doctor
overtime for performing these duties.
Increasingly, departments looking to
save money choose to delay start times for
junior doctor hours to facilitate budgetary
constraints. Some surgical interns start
after 8am – when their team has already
completed the ward round and is in
theatre – resulting in them missing out
on the important decision-making and
learning process. Perhaps this is all just
part of life in the ‘ethical and accountable’
health system trying to provide a high-level
service for the ‘most efficient price’.
There are different approaches being
trialled to manage this problem (e.g. the
Hospital Out Of Hours [HOOT] service
for FSH), but I think we are yet to see the
best way forward and time will be critical
in assessing the training outcomes of DiTs
who progress under these models.
Indeed these are interesting and
challenging times for junior doctors in WA,
but I’m confident Drs Zorbas and Wilson
will be proactive in skilfully representing
DiTs on these issues. Meanwhile, I wish
you all a happy and safe holiday season. ■
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OPINION
Now that the training wheels are coming off
Dr Glen B. Legge MBBS, Ph.D.
L
ate November I had one of my
Induction Days at Fiona Stanley
Hospital (FSH) – a time to prepare
for my forthcoming stint as an RMO.
It was a day of resuscitation training,
annual competencies, click clacks
and pearls of wisdom from Professor
Greg Sweetman, FSH’s Director of
Physician Training.
It was also a chance to get sized up
for a uniform and again, to see this
beautiful space that is growing into a
hospital. I do like what I see.
In addition, Induction Day provided
an opportunity to catch up with some
of my medical school colleagues who
have been at SCGH or RPH, and will
join us next year. There are sure to
be many more – the centre of gravity
for healthcare in Western Australia is
shifting. I too am moving with the tide
to make this huge new experiment a
reality and success.
So does our big girl work yet? Not
quite. There are several teething
problems that will be ironed out over
the coming months. This was readily
acknowledged during the induction
program and was much of the reason
for a staggered opening of the wards
throughout the hospital.
One such problem which I
experienced first-hand was trying to
fax a referral out of office hours from
Armadale Hospital to an outpatient
clinic at FSH. Many of these services
have moved from F5 clinics at
Fremantle Hospital. It seemed to
me that FSH is more geared up for
electronic referrals internally, rather
than a hodgepodge of faxes arriving
externally at all times of the day.
However being the hub of specialty
outpatient clinics in the South
Metropolitan Area, it will still have
to deal with the mass of faxed paper
referrals from GPs and other hospitals.
What is clear from my own
experience is that if you run into a
problem, have patience and don’t
keep it to yourself, like I did initially.
Rather, communicate it to the hospital
administration so that the basics are
running as smoothly as possible for our
arrival en masse in 2015.
The induction also left me with a
strong feeling that I will have to work
on my typing speed to keep up with
ward rounds as I manipulate around the
Digital Medical Record for each patient.
This is why much of the induction was
spent showing the incoming medical
workforce the new applications and how
to use them. Fortunately many of these
electronic glitches are being ironed out
and road tested for our arrival through
the rehab, renal and now the maternity
wards.
A strong piece of advice that filtered
down was to submit and not to save.
It’s going to be a challenge to go
electronic, but I am sure that once
these tools are mastered, there will be
no going back.
For me, time beyond the Internship
year beckons. AHPRA has written
indicating it would like a cheque from
me to transition from Provisional to
General Registration. A pay rise is
on the horizon, as are the additional
responsibilities of the RMO (including
night shifts and on-calls).
Additionally, as my application for
Basic Physician Training has been
approved, it is back to the books and
study. This time, it will be on top of
my RMO and family duties.
Will my scientific background help
during the next stages of my training?
It certainly did during the GAMSAT,
but less so as I went along. I was more
comfortable dealing with the ins and
outs of cholera toxin as a scientist than
I was at mastering Calot’s triangle and
other anatomical gems as a medical
student. This is perhaps why I am
heading down the path of a physician,
rather than surgeon or Psychiatrist.
It is more molecular overall, and it is
where I aim to merge what I have done,
What is clear from
my own experience
is that if you run
into a problem, have patience
and don’t keep it to yourself,
like I did initially
with what I am going to do in an area
of translational research.
Next year will therefore be the first
point of specialisation in my medical
career. Many from my cohort have,
like myself, had a career before this
medical journey. That is all in the past.
What matters is what we do with where
we are now. This means getting the
basics right such as DRSABCD and
the doctor-patient relationship, as well
as how we go about learning the rigors
of our chosen specialisations.
Meanwhile as this Intern year comes
to a close, we can reflect on the huge
changes that we have gone through.
Even as I invest my efforts into
improving the health of each patient I
interact with, I too learn daily lessons
from them. I have had many wins and
of course, a few losses. Beyond the
workplace environment, our Intern
cohort has had it share of engagements,
marriages and births.
It has been a pleasure to work with
the Interns at Fremantle Hospital and
the postgraduate medical education
group there. I will fondly remember
our Wednesday AM breakfast lectures
(both at F5 and Armadale), coffee in
the Blue Room and that view across
the Indian Ocean when looking out
from B9N. Thanks also to the medical
teams whom I worked with and my
Consultants for their kind words in my
term assessments.
I wish you all the very best for 2015.
May you enjoy the next stage of your
career, wherever it may lead you. ■
December
ME D I C US 49
OPINION
Local graduates without
internship equals great loss
Kiran Narula
President, Western Australian Medical Students’ Society
A
s I reflect upon the year gone, I am in
awe of the generous work the students
of UWA undertake. Within WAMSS,
an extraordinary committee dutifully
represents its students, gladly organises
social occasions, and selflessly educates
their peers. Thank you to my wonderful
colleagues for their tireless contributions.
At the helm of this organisation this
year has been a diligent Executive, led by
my predecessor Sebastian Leathersich.
Sebastian has been inspiring, leading
the society with aplomb and distinction.
I personally revere his insightfulness,
coupled with his strong compulsion to
be well informed on all student matters.
It is therefore sad for WAMSS and I to
witness him leave, but we are certain that
he will be a singular man and will serve his
community with excellence!
I must also thank Professor Ian Puddey
– Dean of the Faculty of Medicine,
Dentistry and Health Sciences at UWA
– who will be retiring shortly. We have
been very fortunate to have a Dean who
recognises the value of student input,
and is so eager to seek it. Through his
leadership, UWA medical students have
representation at every critical decisionmaking committee, and enjoy a faculty
that is both attentive and responsive to
any student concern. Professor Puddey,
on behalf of WAMSS, as well as past and
current students, I congratulate you and
thank you for your wonderful service.
Maintaining the high note, it is with
delight that I can inform you that all UWA
students who sought an internship in
Australia this year have received one.
This is a remarkable achievement in our
current political climate, and is a testament
to the strength of WAMSS’ external
relationships and its advocacy platform.
This elation will not be buoyed for long
however. I am concerned for my peers
graduating in the Class of 2015 across
both medical schools – especially for our
international students. Next year will see
a significant increase in graduate numbers
to 350 students, but there are only some
310 internships currently funded in
Western Australia. This mismatch is the
consequence of the increasing student
numbers, and it remains to be seen how the
State Government will respond.
It would be our great loss if local
graduates were unable to secure an
internship. The WA Government
would be throwing away the significant
investment made, by our education
and medical systems, with your money.
Furthermore, we would waste doctors who
are trained and practiced in culturallysensitive Australian medicine. Without an
internship and the full registration status
that it confers, these employable medical
students could never become the doctors
our system is in desperate need for.
From a student perspective, it is
therefore encouraging to see that the
WA Health Department has recognised
that local medical graduates can fulfill
the urban demand for doctors. For most
junior medical officers, the news will
have positive effects on the availability
and stability of currently oversubscribed
RMO and Registrar positions. It is
however disappointing news for our IMG
colleagues who contribute significantly to
our health system. Additionally, it is as yet
unclear if this new recognition includes
locally trained international students. I
believe it must..
WAMSS has always been a passionate
advocate for its students. This year we
will continue to pursue internships for all
local graduates, and press for constructive
actions to resolve long-standing issues in
the postgraduate training pathways.
As the incoming committee and I
prepare for the new year, we are grateful
for the fantastic efforts of previous
members. Their work is the foundation of
WAMSS’ continued strength in student
advocacy and representation. This is not
a responsibility that I and the incoming
Executive (Vice-President Internal
Sophie Doherty; Vice-President External
Vibhushan Manchanda; Treasurer
Malcolm Teo; and Secretary Georgina
Carr) take lightly. But, we are very much
looking forward to the year ahead.
On behalf of WAMSS and the medical
students at UWA, thank you to our many
teachers; congratulations to the Class of
2014; and finally, I wish each of you a
Merry Christmas, a Happy New Year,
and all the best for the year to come. ■
Medicus article submission dates for 2015
In order to distribute Medicus in a timely fashion, and to
meet our commitment to readers, all article submissions
are required by the following date:
If you would like to submit an article or
clinical/research paper for inclusion in Medicus
please contact Janine Martin in the first instance,
at janine.martin@amawa.com.au
Issue
Submission Date
March
April May
June
July
1 February
1 March 1 April 1 May
1 June
NOTE: These submission deadlines are for articles, classifieds and professional listings. For Display Advertisement
timelines and submission requirements please contact Des Michael on (08) 9273 3056.
50 M E D I CU S December
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26/09/2014 11:55 am
Annual Conference and
Trade Exhibition 2015
HYATT REGENCY PERTH | 7 and 8 March 2015
Looking for the gold in the old
Health care for our ageing rural populations
l
l
l
Leading speakers
Clinical updates
Hands-on learning workshops
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Case study discussions
Networking opportunities
Family program
Register online at www.secureregistrations.com/rhwac2015
OPINION
Support and advocacy for
students top priority list
Kate Nuthall
President, Medical Students’ Association of Notre Dame
I
t is an honour and a privilege to
be elected to the position of President
of the Medical Students’ Association
of Notre Dame (MSAND) for 2015.
The new committee is looking forward
to living up to the exceptionally high
standard set by the previous committee,
and I would like to thank the 2014
committee for all of their hard work
and commitment. Molly Kehoe and
her team have made student life at the
Notre Dame School of Medicine much
easier – continuing the strong tradition
our MedSoc has of supporting MSAND
students, helping provide a range of
educational opportunities and putting
together a social calendar to help us
occasionally escape our studies.
MSAND is entering its tenth year.
For a Medical Society that is so young,
we’ve established a strong culture of
support and inclusiveness. As a graduate
course, Notre Dame medical students
are a strongly diverse cohort, with people
coming from a wide range of previous
life experiences to study medicine. Our
diversity gives us a great richness and I am
constantly inspired by the achievements
of my colleagues, both prior to and since
their admission to their medical degree.
MSAND has also traditionally had
a large number of interstate students.
This means that the Association plays a
vital role in helping to ensure students
are able to effectively transition to not
only a new degree, but also a new state.
This is done through education nights,
social events and the mentoring program.
Many students move across the country to
pursue their medical dreams, and having
MSAND help to provide an instant
support network is incredibly important in
making this move easier.
In line with the Australian Medical
Students’ Association’s (AMSA)
extremely successful mental health
campaign, MSAND will run a series
of programs to help maintain students’
mental health in 2015. In the past few
weeks, all of our students have had exams
and have found themselves under a fair
amount of stress. As the social events
wind down and the long nights spent
studying take over, it’s important that
we all remember to take a break. Our
pre-clinical years have the advantage of
being only two blocks from the beach and
Fremantle provides plenty of distraction
when it comes time to take a ‘study break’.
One of the past year’s most popular
wellbeing events was a visit from a group
of WA guide dog stress puppies. Students
and staff all enjoyed a lunchtime spent
with the future guide dogs, cuddling away
some of that exam-induced stress.
One of MSAND’s most important
roles is advocating for students. There is
a range of issues that we need to consider,
such as the proposed deregulation of
university fees and the availability of
quality internships for graduates. We
will continue to work with our friends at
WAMSS to oppose a third medical school
in WA until issues such as postgraduate
Stress buster: Notre Dame medical
student, Pip Moffatt gets some love from
a WA Guide Dogs puppy.
training positions and Intern and RMO
places are adequately addressed. We
need to ensure that we are allocating our
resources in a considered manner aimed
at meeting the long-term healthcare needs
of our community.
This year MSAND farewells a highly
successful and motivated cohort and
on behalf of MSAND, I would like to
wish them all the best in their future
careers. I have no doubt that they will
make MSAND exceptionally proud and I
know from personal experience that they
will make a fine group of doctors. Many
of these students will make up the first
group of Interns at Fiona Stanley Hospital
and we look forward to seeing them on
the wards.
As the Committee prepares for 2015,
we are aware of the responsibility of the
roles that have been entrusted to us. It is
essential that we continue to support and
advocate for our students. I have every
faith that the year ahead will be a fantastic
one for MSAND. ■
The AMA (WA) welcomes the new members who joined during November 2014.
Stuti Joshi
Lakshika Kathriarachchi
Mugunthan Krishneswaran
Anton Lambers
Hoh Peng Lee
Larry Liew
Jackie Mak
Claire McQuillan
James Miller
Jonika Mosedale
Shazia Mushtaq
Lakmal Nandadewa
Olusegun Odude
See Ki Ong
Olivia Pegram
Charles Qiu
Robert Reed
Hafees Saleem
Jacqui-Lyn Saw
Benjamin Schussler
Awf Shaban
Hla Shwe
Dilan Siriwardena
Eckhard Strydom
Mark Teh
William Tjhin
Simon Wamono
Georgia Werner
Yoke Mooi Wong
Alan Wright
Ian Yusoff
December
ME D I C US 53
Protect your family’s way
of life and financial future
AMA Financial Services offers you obligation free
consultations for life and income protection insurances
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08 9273 3077
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This is general advice only and does not take into account your financial circumstances, needs and objectives. Before making any decision based on this document, you should assess your own
circumstances or seek advice from a financial adviser and seek tax advice from a registered tax agent. Information is current at the date of issue and may change.
AMA Financial Services supports the Medical Profession, staff are not commission based and all profits are returned to the AMA to benefit the medical sector.
B E YOND B OR DE R S
Small, simple, significant
LINCS’ humble contribution to a community hospital in western Uganda
will go a long way, says Dr Anthony Hew
L
ast year I and three other students
- Doctors Hsern Ern Tan, Josh Ho
and Bryan Tan – from the University
of Western Australia had the incredible
opportunity to complete a medical elective
in Kisizii Hospital, a mission hospital
nestled in the vast hills of western Uganda.
It was an unforgettable and life-changing
experience, practising medicine in a busy
African hospital. The ability to provide
effective healthcare is a challenge in
rural Uganda. Medical facilities in this
geographically landlocked country find it
difficult to obtain much-needed supplies
and resources for a growing population
that is finally flourishing after decades of
internal war and conflict.
We saw an incredibly diverse spectrum
of pathology and disease, including
malaria, pericarditis secondary to
tuberculosis and HIV-associated psychosis
and encephalopathy. I vividly remember
watching helplessly as the medical team
could do nothing but watch as young men
and women died from kidney failure due
to the lack of dialysis.
What struck me most was
the incredible clinical skill and
ingenuity displayed by the
medical staff in the absence
of the medical equipment and
technology we take for granted
here in Australia. I witnessed
Unforgettable experience: Dr Anthony Hew and
old Coca-Cola bottles being used
Dr Jemma Sayer, a visiting Pediatrician from the
as spacers for puffers and tins of
UK, with local children in the town of Kisiizi in
Western Uganda.
old paint cans filled with stones
used to provide traction to a
by both staff and patients at Kisizii.
fracture. Portable X-ray was non-existent
Medical supplies are often difficult to
and the hospital made its own alcohol
obtain in Africa due to costs, tariffs and
hand wash.
transportation issues. The hospital was
Also making an invaluable contribution particularly grateful for the supply of
to Kisizii Hospital was the Local and
oxygen saturation probes. These provide
International Needs Contribution Scheme vital information about how well a patient
(LINCS), a not-for-profit organisation
is. Whilst every patient is able to have their
run by student volunteers of Interhealth,
own saturation monitoring in countries
the Global Health Group of the Western
such as Australia, many African hospitals
Australian Medical Student Society
are lucky just to have the one oxygen sats
(WAMSS). LINCS provided supplies and
probe across the entire ward. Even the most
a monetary grant to the hospital, a generous basic medical equipment goes a long way in
contribution which was greatly appreciated rural Uganda. ■
IDENTIFYING, AND MEETING HEALTHCARE NEEDS
The Local and International Needs Contribution
Scheme or the LINCS initiative aims to improve the
standard of healthcare around the globe in poorly
resourced hospitals and other healthcare facilities. This
is achieved by raising funds and procuring donations
of unused, reusable or surplus medical supplies and/
or equipment from donors in Australia that can benefit
resource-limited communities. These medical supplies
are then transported overseas to in-need areas of the
developing world with the help of students heading
there on their electives or exchanges.
LINCS aims to gain a basic understanding of what
recipient hospitals require in order to best meet their
needs. Recipient host hospitals or health facilities are
asked to make a wish list from an inventory of items
available at the LINCS warehouse.
While each year, LINCS sends a significant amount
of much-needed medical equipment with students
travelling to developing countries, approved monetary
grants are also available for recipient hospitals to
purchase items not readily available from the LINCS
warehouse.
Anyone travelling overseas to poorly resourced nations
for their electives or exchanges can apply to receive
and take LINCS equipment or monetary grants. We
strongly encourage all medical students from UWA and
the University of Notre Dame to contact LINCS before
undertaking their electives.
This year, LINCS has expanded its fundraising efforts
to spread greater awareness of the health needs of
developing nations to the wider community. It hopes to
promote insight into the important issues of global health,
the challenges affecting the world’s poorest people and
high need communities and the amazing opportunities
that can help facilitate change, a little bit at a time.
Please contact the LINCS coordinator (lincs@wamss.
org.au) if you are interested in making material and/or
monetary donations, are able to take medical supplies
to areas of high need, or if you would like to get
involved in fundraising efforts.
December
ME D I C US 55
F ROMA MTAHET RE ADIIINING
NT OR
ING
New AMA scholarship underlines
value of customer service
C
ustomer service is essential to the success of any business
– and medical practices are no exception. For many years,
the Australian Medical Association (WA) has been delivering its
medical reception course which emphasizes the importance of
excellent customer service.
The opportunity now exists for practice staff dealing with
complex customer interactions to further develop their skills
and obtain a nationally-recognised Certificate IV in Customer
Contact under a traineeship arrangement.
For a limited time and for a limited number of places, the
AMA is offering scholarships to help medical practice staff
obtain a Certificate IV in Customer Contact through AMA
Training Services.
For those successful in obtaining a scholarship, the
qualification can be completed at no cost to the individual or
the practice. The scholarship will cover the cost of the tuition
fee and is valued at around $1300. The bulk of the cost of
the training will be covered by funding received by AMA
Training under the WA Department of Training and Workforce
Development Future Skills program.
Scholarship places are limited and participants must be
New skills: Dr Sid Baxi (second from left) from Genesis Cancer Care
WA with staff members Una Cooper Rebecca Molles, Ian Quinn,
Mary Rohan, Steven Gillingham and Glenda O’Doherty, all of whom
have commenced traineeships in Customer Contact.
eligible to undertake a Traineeship. Subject to eligibility,
practices may receive up to $4000 in Australian Government
Incentives where new workers are enrolled as trainees in the
qualification. Payroll tax exemption on trainees may also apply
for eligible employers.
For further information, contact AMA Training on 9273 3033
or complete an Expression of Interest for the Certificate IV in
Customer Contact by visiting the Featured Courses page at
www.training.amawa.com.au. ■
Murdoch
Hospital
Now in the heart of the South
With internationally recognised expertise in clinical management and research, our cardiologists are
leaders in their fields. From January 2015, Perth Cardio will open doors at its new south of the river clinic
in Wexford Medical Centre – Murdoch Hospital. That means, for patients in the south, world-class
cardiology care just got a whole lot closer. Visit perthcardio.com.au to find out more.
LEADERS IN C ARDIOLOGY | ECHO | ECG | HOLTER MONITORING | ECHO | TOE | E XER CISE STRESS TESTING
December
ME D I C US 57
A M A IN T HE ME DI A
AMA IN THE MEDIA
NO-JAB FEARS
Almost one in 50 WA children aged under
seven is not immunised, as more parents
become vaccine-refusers.
AMA WA President Dr Michael Gannon
said it was hard to understand why
any parent could not see the value of
immunising their children.
“I suspect with some who are prone to
accepting conspiracy theories, we will
never be able to change their minds and we
will always have flat-earthers who are more
inclined to believe rubbish on the internet
that the evidence,” Dr Gannon said.
Dr Gannon said of particular concern
were low rates in five year-olds. This was a
vulnerable time as children started school.
The West Australian, 15 November 2014
AMA SLAMS FLUORIDE-FREE
PETE
AMA WA President Dr Michael Gannon
slammed chef Pete Evans, saying: “Does
he have nice teeth? If so, he has fluoride
to thank. It’s always disappointing when
people use their celebrity in a way that is
not useful to society.”
The AMA WA has dismissed the Perthbased group as a “vocal hodge podge of
conspiracy theorists.
“In cases like this, when people are simply
wrong, we ask that they butt out of the
debate. Water fluoridation is something
that has the full support of the Australian
Dental Association and the AMA, it’s
cheap, it’s proven to be beneficial, and
data repeatedly proves that it is effective in
reducing cavities in children,”
Dr Gannon said.
Sunday Times, 7 December 2014
BABY DELIVERY TURF WAR
LOOMS
A turf war is brewing in WA over moves
to allow private midwives to admit and
manage women in labour in public hospital
maternity units.
AMA WA President Dr Michael Gannon
said he feared doctors would be called in at
the last minute to rescue unsafe situations.
“Over the years we have developed a
system where obstetricians and midwives
work together but obstetricians are
ultimately responsible if the pregnancy or
delivery gets dangerous,” he said.
‘Moving away from that is a retrograde
step,” he said.
The West Australian, 22 November 2014
The AMA (WA) social media pages have
had an explosive month, with Facebook in
particular seeing massive growth since the
last edition of Medicus. An incredible 26,900
people saw AMA (WA) President Dr Michael
Gannon’s comments on the proposed
solarium ban in
WA, indicating
the public
interest in this
particular issue.
Another wellreceived post
detailed
Dr Gannon’s
comments
on fluoride,
generating a
heated debate
between those
for and against
water fluoridation.
The AMA (WA) Facebook page has had
significantly more engagement and ‘likes’ than
any other state AMA over the past month, and
continues to go from strength to strength.
Twitter followers continue to rise, with more
journalists and MPs (including Premier Colin
Barnett) now following the page.
OTDNET
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The OTDNET Sub-program B is designed
to help overseas trained doctors (OTDs) with General or
Limited Registration, who are working in a General Practice
environment, prepare to undertake the required assessments
of the Australian College
of Rural and Remote Medicine (ACRRM) or the Royal
Australian College of General Practitioners (RACGP).
Delivered over a twelve month time frame,
the program is specifically designed to:
• Enhance your clinical and communication skills
• Prepare you for sitting your Fellowship examination.
For more information and to apply visit
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or contact WAGPET at gpcareers@wagpet.com.au.
APPLICATIONS CLOSE 14 JANUARY 2015
OTDNET for AMA.indd 1
4/12/2014 2:43:55 PM
December
ME D I C US 59
RENT WITH HERTZ AND SAVE
Hertz offers great rates to AMA Members on all
our vehicles, including our Prestige Collection
of BMWs.
Just quote this CDP number: 283826 when
you make your booking*.
*Terms and Conditions: Customer Discount Program (CDP) number 283826 must be quoted
at time of reservati For full terms and conditions, please visit the Hertz section on your
intranet.
LE
DR I V E
SP XUS
OR NX
TL 3
UX 00
UR H
Y
Edgy style and
formidable function
PIC: TONY HEWITT
T
Dr Peter Randell
he newest Luxury EXport to the
US has become the first Lexus to
have its release in China, not the USA.
Beijing was given a big blast of fashion and
style when the Lexus 300h was released
earlier this year, and now it is our turn.
The NX 300h is an edgy, modern
fashion statement with the trendy
combination of a very efficient
(5.7litres/100kms) petrol four-cylinder
2.5-litre engine combined with an electric
motor and a battery system producing a
syrupy 147kW of undetectable origin. It
is possible to silently depart under pure
electric power before the petrol engine
kicks in without fanfare to supplement
progress. A petrol turbo 174kW version
arrives soon.
From the outside, one sees a modish
razor-edged body with arrow-head LED
sidelights below three individual LED
bulbs forming the headlight. The radiator
grill is the now signature Spindle Grill of
chrome, and further back along the sharp
sides of this cross-over vehicle are partially
chrome-plated side mirrors producing a
tromp l’oeil of thinness.
Large 18-inch mag alloys strut their
stuff in prominent wheel arches, oozing
testosterone. The rear taillights have a
similar sharp edge to their design and
again, are LEDs.
Within, the immediate impression
is of luxury with most surfaces being
covered with soft-touch leather or classy
chrome plating and faux-metal. The
driver’s seat is well back until the ignition
button is pressed – when the seat advances
to the last selected position and the steering
wheel simultaneously participates in the
pas-de-deux, coming forward and down.
The steering wheel is a smarty – having
buttons for phone, audio and cruise
control.
Just behind the rim lie the paddle shifters
for those who wish to force the smooth
Continuously Variable Transmission into a
six-speed gearbox. I tried it, but Lexus does
it better. Use the CVT. Just to the left and
proximal to the gear selector lies a touchpad with haptic (touch and proprioception)
sensitivity, which I found to be very
reactive. This pad guides one through the
menu allowing selection from the phone,
GPS and other lists. A wrist-rest eases
the process. Above this lies a rotary dial
to select Eco, Normal, Sport and Sport+.
The latter settings modify engine reaction,
suspension settings and responsiveness.
Directly ahead, the driver sees the
Head-Up-Display of speed, revs or
GPS instructions, reflecting in the inner
windscreen.
The central column is crowned by
the touch screen, which on selecting
‘reverse’ produces a bird’s eye view of the
ground surrounding the car, as well as
a conventional rear-view camera image.
It is startling and with experience, very
reassuring. The cameras in the
side-mirrors combine with those
at front and rear and clever
software blends the
four images. Surely
this will become
compulsory
in time?
Clever: The rear view and surround
cameras in action.
I was reversing out of my driveway which has
poor vision of the roadway, yet could see the
street clearly. The sensors in the rear bumper
suddenly beeped urgently and after I braked,
a car came into sight on the screen. The Rear
Cross Traffic Alert had done its job. Another
must-have on the next Randell Family
Transporter list of requirements!
Combine that with the Blind Spot
Monitor in the outer segment of the rear
view mirror, eight airbags, ABS, Electronic
Brake force Distribution, Brake Assist,
Hill Start Assist Control, Vehicle Stability
Control, Lane Departure Warning,
Traction Control, Active Cruise Control
(which is responsive to the speed of the
preceding vehicle) and that is as good as it
gets in safety in cars of any price in 2014.
But wait! There is more. The rear seats
on the Sports Luxury split 60:40, and have
electric fold-down via switches in the boot,
which itself is opened from the driver’s seat,
key or at the rear of the 300h. Below the
driver’s left elbow rest is an induction pad to
wirelessly recharge smart phones on the run.
The driving experience is all ease, with
sedan-like handling on the twisty bits,
though some CVT hum comes through
when pushed really hard. This is a vehicle
which must be driven at night for the
theatre of the lighting. It is excellent with
auto-high beam being cut off by oncoming
vehicles, and bendy lights from the fog
lights when turning corners. Fashion, style
and function. Meet the Lexus NX 300h
Sport Luxury.
RRP from $55,000; Sport Luxury
$75,000. Vehicle supplied by Lexus
of Perth. ■
Knight of Nights: This is a vehicle which must
be driven at night for the theatre of the lighting.
December
ME D I C US 61
T R AV E L
A holiday
from
my holiday
A desire to experience something more
than beach basking in Thailand leads
Nicola Roman to Khao Sok National Park
Home on the water: The Floating
Bungalows on Cheow Lan Lake.
I
spent the first three days of my weeklong holiday in Thailand at one of
the numerous European-style resorts
dotted along the Andaman Coast.
The quintessential Thailand beach
experience. The beach certainly was
stunning, with crystal clear waters and
white powder sand. However, I couldn’t
62 M E D I CU S December
help but feel that, other than the
resident elephant that stalked the resort
grounds, I could have been home in
Australia at a resort in Queensland, or
indeed any resort on any tropical coast
in the world.
After three days on the Andaman
Coast, my reading material was
exhausted, my desire to lounge on a
beach had diminished and after falling
off a paddle-board one too many times,
I needed a holiday from my beach
holiday.
My desire to experience a different
side of Thailand before returning to
Australia saw me venture inland to
T R AV E L
Khao Sok National Park. The park is
located about halfway between southern
Thailand’s two coasts. In recent years
the area has emerged as a popular spot
on the tourist trail but still retains its
authenticity. Even in peak season you
won’t battle with large crowds in Khao
Sok – quite refreshing after the hustle
and bustle of the coastal resorts.
As you travel the 90-minute journey
from the coast to Khao Sok, the coastal
resorts and tourist towns disappear
over the horizon as the vista becomes
dominated by lowland jungle and
limestone crags. The scenery is truly
breathtaking.
Khao Sok village is an ideal base for
experiencing all the National Park has
to offer. Not only is the village equipped
with amenities such as ATM machines
and a supermarket, the banana pancakes
found in Khao Sok are second to none.
The perfect sustenance for a day in the
jungle.
A trip to Khao Sok is not complete
without experiencing a trip on Cheow
Lan Lake. If you only have a day in
Khao Sok on your travels, this is the way
to spend it.
The scenery is spectacular and karst
formations abound. An oft-cited quote
in the tourism brochures describes the
backdrop perfectly – “Nowhere in the
Kingdom of Thailand can one find
a more spectacular setting for karst
topography than the flooded reservoir
of Cheow Lan”. The vistas, more
commonly associated with Ha Long Bay
in Vietnam or the lakes in South China
Karst, are indescribable with photos
rarely able to do the scenery justice.
Tourists are transported by a
long boat around Cheow Lan
before docking at one of the 17
‘Floating Bungalows.’ Here guests
are provided with a traditional
home-cooked lunch provided by
Thai families who have made
the lake their home. The floating
bungalows are available for rent
should you wish to spend the
night. Waking up to the sound
of hooting monkeys and the
deafening buzz of cicadas is an
experience
not quickly
forgotten.
Following
lunch (and
a refreshing
swim),
a trek
through
the jungle
is the last
part of the
itinerary
before
boarding the long boat back to the
mainland.
Khao Sok National Park is home to
gaurs, leopard cats and tigers, although
the only wildlife I came into close
contact with were the leeches that were
intent on making my trek just that little
bit more exciting. However, even without
spotting a leopard, the jungle trek was a
fantastic experience.
Should one be inclined, there is also
the option to venture into one of the
rainforest caves. Due to the risk of
flash flooding, tourists are no longer
allowed to explore too far inside, but
nevertheless this isn’t an experience for
the fainthearted or claustrophobics.
There is an abundance of activities to
be experienced in Khao Sok and whilst
Cheow Lan Lake was certainly my
highlight, there are many other options
for exploring all that Khao Sok has to
offer.
Why not hop on a rubber tube and
drift down the river for two hours?
It’s probably the most stress-free
way of travelling. Whilst
Beautiful calm: Khao Sok National Park is
a refreshing change from the hustle and bustle
of Thailand’s coastal resorts.
‘river-tubing’, you meander downstream
passing limestone cliffs, towering jungle
trees and, if you’re ‘lucky’ enough you
will spot sleeping snakes in the tree
branches above your head.
If ‘river-tubing’ isn’t your cup of
tea, how about exploring the jungle by
canoe, or on the back of an elephant?
Or go the old-fashioned way – on
foot. A local guide will lead you to
the most breathtaking waterfalls and
swimming spots and point out all the
lizards, snakes and birds that you miss
whilst you’re busy gazing in awe at the
surroundings.
So next time a holiday to South-East
Asia is on the agenda, why not seek to
experience something a little different?
Move away from the coast and make
the journey inland. You won’t find
scenery as beautiful, or locals more
accommodating. The banana pancakes
are just the icing on the cake. ■
Resident attractions: Khao Sok is home to gaurs, leopard cats, monkeys, birds and tigers.
December
ME D I C US 63
ALIA
and Happy New Year!
The AMA (WA) wishes all members a very
Merry Christmas and a safe, healthy and
prosperous New Year
Operating hours for the AMA (WA) during
the festive season are:
SECRETARIAT & MEMBERSHIP
Closed from noon, 24 December 2014;
will reopen Monday, 29 December.
Closed 1 & 2 January 2015;
will reopen on Monday, 5 January.
AMA INSURANCE & FINANCIAL SERVICES
Closed from noon, 24 December 2014;
will reopen Monday, 29 December.
Closed on 1 & 2 January 2015*;
will reopen on Monday, 5 January.
*(after-hours service operating on 2 January)
AMA MEDICAL PRODUCTS
Closed from 24 December 2014;
will reopen on Monday, 5 January 2015.
WESTERN AUSTRALIA
F OOD
Festive feasting
Brendan Pratt
Head Chef, Indiana
A
Christmas celebration minus a table laden with festive goodies is as exciting as Santa without his sack! So if
you’re planning on rolling out the heavy artillery for a Christmas meal, the recipes below will serve you very
well. These are traditional yet tweaked just that little bit for a different take on things. I promise, even your most
discerning guest will leave impressed! Happy holidays and happy eating!
ROLLED CONFIT TURKEY
Serves 4
Ingredients
• ½ turkey; boned
• 220g table salt
• 120g caster sugar
• 4L water
• ½ cup coriander seeds
• 1 cinnamon quill
• Duck fat
Method
For brine
•P
lace salt, sugar, water,
coriander seeds and cinnamon
in a medium-sized pot. Heat
and bring to the boil.
•O
nce boiled, take off the heat
and cool to room temperature.
For turkey:
•A
dd the turkey to the brine and
let sit in the refrigerator for 2
hours.
•A
fter 2 hours, remove from the
brine and place into a roasting
tray. Cover with duck fat.
• Cover tray with cling film and
tin foil before placing into the
oven at 78C for 12 hours.
• Once cooked, remove from the
oven. Pull apart meat and place
pieces on an open piece of cling
film. Roll the turkey in the cling
film to form a cylindrical shape.
• Place into an ice bath and chill.
• Once chilled and set cut into
slices.
Method
• Place sugar and cinnamon
quills in a saucepan with
1/2 cup (125ml) cold water.
Stir over low heat until sugar
dissolves. Simmer for 1
minute, then remove and cool.
•C
ombine 100ml of the syrup
in a blender with eggs, cream,
milk and alcohol. Pour into
cocktail glasses over ice and
serve dusted with nutmeg.
ICED EGGNOG
Serves 4
Ingredients
• ½ cup castor sugar
• 2 cinnamon quills; whole
• 2 eggs
• ¾ cup milk
•1
00ml each brandy,
spiced rum, sherry
•F
resh nutmeg; roughly
grated
ROASTED HEIRLOOM CARROTS WITH ALMONDS AND SMOKED PAPRIKA
Serves 4
Ingredients
• 1kg whole heirloom carrots
• 3tbs balsamic vinegar
• 2tbs honey
• 6 sprigs thyme
• 2tbs sweet smoked paprika
• 3tbs roasted almond flakes
To taste
• Sea salt and pepper
• Olive oil
Method
• Preheat oven to 200C.
• Trim the tops off of the carrots,
leaving some green and peel.
Leaving carrots whole, toss
with a couple of tablespoons
of olive oil and place in a
single layer on a baking sheet
lined with parchment paper.
Sprinkle very lightly with salt
and pepper to taste and then
top with four whole sprigs of
thyme.
• Roast the carrots for 30-35
minutes until they are tender
enough to pierce with a fork.
• Remove the carrots from the
oven, toss with the balsamic
vinegar, honey, the remaining
2 sprigs of thyme and smoked
paprika.
• Return the carrots to the oven
for 5-10 minutes or until they
begin to caramelise.
• Remove from the oven and
place onto your dish.
• Sprinkle with the roasted
almonds and serve.
December
ME D I C US 65
From classic to contemporary,
we create…
D E S I G N + B U I L D + M A I N TA I N | w w w.t d l . c o m . a u | (0 8 ) 94 4 1 0 2 0 0
W INE
Must-have wines
this Christmas
T
his is the last column for 2014 on
all things vinous. The following
are a selection of wines that you might
consider trying over the Christmas-New
Year break.
The Woods Crampton Eden
Valley Riesling 2013 is a good place
to start. This is sourced mainly from
a single, established vineyard situated
at almost the highest point in the Eden
Valley, well over 500m in altitude. Close
to Mount Adam and the old Leo Buring
High Eden Vineyard, the site is an
ideal expression of High Eden Riesling.
The wine is hand harvested and whole
bunch pressed, the fermentation is very
cool – around 12 degrees – and allowed
to ferment to bone dry. It is bright
straw green. The nose is very fresh and
floral with notes of citrus fruit and bath
powder. The palate is tightly wound with
a long fine acid line and a dry, crunchy
finish. Delicate lemon and citrus flavours
provide an indication of the future
profile of this wine with careful cellaring.
For those who enjoy a Sauvignon
Blanc, Shaw & Smith Sauvignon
Blanc 2014 is worth a try, particularly at
this time of the year. Shaw and Smith’s
description says it all – “It is lively and
aromatic with notes of passion fruit,
nashi pear, and nettles. On the palate
there is intense flavour, with fresh,
limey fruit, mouthwatering acidity, and
remarkable purity. It is bone dry and
unoaked to maintain freshness”. It also
has a long finish.
For something a bit posh, try
Leeuwin Estate Art Series
Chardonnay 2011. James Halliday says,
“There is always cause to genuflect in
the presence of Chardonnay royalty such
as that of Leeuwin Estate. It imposes
its will without a flicker of effort; the
line between citrus and stone fruit, and
between oak and mineral comes and
goes, leaving you grasping at straws;
it’s a wine of flawless balance, line and
length. Drink: to 2031”. Share it with
people you like and who will appreciate
the quality.
Christmas celebrations require some
bubbly and Delamotte Brut NV is a
must. Delamotte is called the second
wine of Salon, which is unfortunate.
While it is true that lots of Salon that
do not go into the Grand Vin make
their way into Delamotte, Salon is
Chardonnay, while Delamotte is also
half Pinot Noir and 20 per cent Pinot
Meunier. The wine is elegant and light
with long vanilla flavors in the mouth
and on the finish, and just a touch of
sweetness to this sweet-discerning
palate.
A red to savour is Henschke Mount
Edelstone 2012. First bottled as a
single-vineyard wine in 1952, it became
recognised as one of Australia’s greatest
shiraz wines. As you know, the Henschke
family has been making wine since
Johann Christian Henschke planted a
small vineyard on his diverse farming
property at Keyneton in 1862. The wine
is matured in 88 per cent French and
12 per cent American (54 per cent new,
46 per cent seasoned) hogsheads for 21
months prior to blending and bottling.
Halliday says the wine is “vivid, deep
purple-crimson; this is a blue-blood
aristocratic shiraz, certain in its supreme
power, length and balance, and not going
out to prove anything. If anyone doubts
its quality now, the scales will fall from
their eyes over the decades ahead, as it
will be recognised by all and sundry as
one of the greatest Mount Edelstones”.
Agreed. Enough said.
A bit of French tipple never goes
astray, and Guigal Cotes du Rhone
2010 is, like its predecessors, a lovely
drop. The reason for its consistent
quality is that Guigal is known
throughout the Rhone Valley for paying
the highest price for generic Cotes du
Rhone, and that in large part explains
the quality of this wine year in and year
out. The man understands quality. It
is a well-structured wine with powdery
tannins and sweet juicy dark berry fruit,
balanced by earthy leathery flavours
and a lovely finish. Put a case under the
Christmas tree for yourself.
Moss Wood Amy’s Cabernet 2013
should also be considered. The Moss
Wood Amy’s offers undeniable Moss
Wood quality at an easily affordable
price. It is beautifully soft yet fullbodied, shows pristine varietal character,
impeccable balance and is simply a
pleasure to drink – whether it be upon
its release, when it shows optimum
primary fruit and robust texture or
after a few years in the cellar, when the
classic secondary characters begin to
wonderfully take control.
Now for some red bubbly – and not
of the Christmas cake sparkling Shiraz
variety. Dominique Portet Brut Rose
NV is surprisingly good. The current
Brut Rosé release is a blend of 50 per
cent Pinot Noir, 30 per cent Chardonnay
and 20 per cent Pinot Meunier, made in
the traditional method and sourced from
fruit grown in the Yarra Valley. The
grapes were handpicked, gently pressed
and fermented before going through
the secondary fermentation inside this
bottle. The wine was aged for two years,
then disgorged and lightly dosed prior
to release. It is a savoury, sparkling wine
with fresh strawberries and rose petals
on the nose that follows into a fresh, dry,
creamy finish. Halliday describes it as
“pale, bright pink; a lively and fresh wine
with strawberry fruit to the fore; the low
dosage provides a vibrantly fresh finish,
and does not imperil the balance”. ■
December
ME D I C US 67
Member BENEFITS
In addition to the valuable services the AMA (WA) provides members, the Association
also secures significant savings with a host of exclusive benefits.
For more information, visit www.amawa.com.au/membership/memberbenefits.aspx
50%
15%
Knee Deep Wines
McKinnon & Penny
Perth surgeon Dr Philip Childs and Sue Childs, owners
of Knee Deep Wines in Wilyabrup, have supported the
AMA (WA) over a number of years and are happy to
offer colleagues membership to their ‘Knee Deep in Wine
Club’ with a 15% discount (from full RRP price) and free
freight on wines purchased from our online store.
Contact AMA (WA) membership on (08) 9273 305
to obtain the member discount code then visit
www.kneedeepwines.com.au to make your purchase, or
contact the Knee Deep Winery office via email:
office@kneedeepwines.com.au
McKinnon & Penny offers AMA (WA) members who are
buying or selling their home or office property a personalised
and professional conveyancing service with a settlement fee
that is discounted to 50 per cent of the scale fee.
Visit and request a quote by email or call Joe Stolz on
(08) 9221 1222.
$$$$
Hi Tech Marine
10%
Margaret’s Beach Resort
Offering idyllic four-star self-contained Margaret River
accommodation by the sea, Margaret’s Beach Resort is one
of the best beach resorts in WA. It is the perfect location for
a romantic getaway or memorable family holiday. Just 10km
from Margaret River town, and only 500m from the pristine
Gnarabup Beach, Margaret’s Beach Resort is the only resort
accommodation by the sea.
The resort includes a wide range of facilities including an
outdoor resort pool, children’s playground, onsite surf shop
and onsite restaurant – the award-winning Gnarabar.
AMA (WA) members can save 10 per cent off Best
Available Rates (subject to availability).
Phone (08) 9757 1227 or email
stay@margaretsbeachresort.com.au to book.
FREE
CONSULT
Tim Davies Landscaping
Tim Davies Landscaping (TDL) has been an awardwinning leader in the WA landscaping industry for 30 years,
focused on listening and working with clients to create
unique gardens. Services include residential and commercial
landscape design and construction, commercial landscaping
maintenance and residential maintenance. No matter what
size the project is, TDL’s passion is turning a vision into
reality and creating “a garden for life”.
TDL offers AMA (WA) members a complimentary one hour
in-office consultation with a landscape architect/designer.
68 M E D I CU S December
Award-winning dealership Hi Tech Marine is one of the country’s
leading certified marine service and re-power centres. Hi Tech
Marine is pleased to offer AMA (WA) members the following:
• 10% off accessories (not including electronics, oil and already
discounted prices)
• 10% off all servicing
• 10% off all repair work
• Free membership to the Hi-Tech loyalty program
• Free trailer inspection
• 10% off all condition reports
• $1000 off all Atomix 5.6 and 6 meter boat motor trailer packages
• One year’s free trailer registration with every boat motor trailer package
• One-stop insurance and finance service; we sell loan protection
and gap insurance too.
For more details, visit www.hitechmarine.com.au
$$$$
Audi Corporate Program
Audi Corporate® is an exclusive corporate program for a select
group of drivers such as AMA (WA) members who receive
exclusive benefits and superior service on a selected range of
luxury Audi models.
AudiCorporate® members enjoy:
• no cost, scheduled servicing for three years or 45,000km
• free pick-up and drop off of your vehicle for servicing in the
CBD (or within a 20km radius of Audi Centre Perth)
• priority vehicle order and allocation
• loan cars when your A5/S5, A6/S6, A7/S7, A8, R8, Audi Q5,
Audi Q7 or RS model is being serviced, plus more.
For further details on the AudiCorporate® program,
call (08) 9231 5888.
On the TOWN
To win a double pass to one of the following events, simply go to
www.amawa.com.au/membership/onthetown.aspx
Entries must be received by 4pm, Monday 22 December
Mr. Turner
In cinemas 26 December
Acclaimed director and writer
Mike Leigh (Secrets & Lies)
brings a legend to life in
Mr. Turner, starring Timothy
Spall (who won Best Actor
at Cannes for this role).
The film explores the last
quarter century of the great
if eccentric British painter
J.M.W. Turner.
Profoundly affected by
the death of his father,
loved by a housekeeper he
takes for granted and who
he occasionally exploits sexually, Turner forms a close
relationship with a seaside landlady with whom he eventually
lives incognito in Chelsea, where he dies.
Throughout this, he travels, paints, stays with the country
aristocracy, visits brothels, is a popular if anarchic member
of the Royal Academy of Arts, has himself strapped to the
mast of a ship so that he can paint a snowstorm, and is both
celebrated and reviled by the public and by royalty.
Wild
In cinemas 22 January
In Wild, director JeanMarc Vallee (Dallas Buyers
Club), Academy Award
winner Reese Witherspoon
(Walk the Line) and
Academy Award nominated
screenwriter Nick Hornby
(An Education) bring
bestselling author Cheryl
Strayed’s extraordinary
adventure to the screen.
After years of reckless
behaviour, heroin addiction
and the destruction of her marriage, Cheryl Strayed makes a
rash decision.
Haunted by memories of her mother and with absolutely no
experience, she sets out to hike more than a thousand miles
on the Pacific Crest Trail all on her own. Wild powerfully
reveals Strayed's terrors and pleasures – as she forges ahead
on a journey that maddens, strengthens, and ultimately,
heals her.
St. Vincent
In cinemas 26 December
The singular Bill Murray
teams with first-time
director/screenwriter
Ted Melfi for St. Vincent,
the story of a young boy
who develops an unusual
friendship with the
cantankerous old guy next
door.
Birdman
In cinemas 15 January
Birdman is a black
comedy that tells the
story of an actor (Michael
Keaton) – famous for
portraying an iconic
superhero – as he
struggles to mount a
Broadway play.
In the days leading up to
opening night, he battles
his ego and attempts to
recover his family, his
career, and himself.
Taken 3
In cinemas 8 January
Liam Neeson returns as
ex-covert operative Bryan
Mills, whose reconciliation
with his ex-wife is tragically
cut short when she is brutally
murdered. Consumed with
rage, and framed for the
crime, he goes on the run to
evade the relentless pursuit of
the CIA, FBI and the police.
For one last time, Mills must
use his “particular set of
skills,” to track down the real
killers, exact his unique brand of justice, and protect the only
thing that matters to him now – his daughter.
December
ME D I C US 69
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Professional Notices
ENDOCRINOLOGY AND DIABETES
Professor Richard Prince
BSc, MB ChB Birm, MD Melb,
FRACP, MRCP (UK)
My area of expertise includes:
• A ll varieties of mineral and bone
disorders including osteoporosis
• All varieties of thyroid disease
• Diabetes and metabolism
• General endocrinology.
I have had an appointment at Sir Charles Gairdner
Hospital for public patients for over 30 years and
recently have moved to Hollywood Hospital for private
patients.
For appointments or advice
please contact
Suite 18, 85 Monash Ave.
Hollywood Medical Centre Nedlands, WA 6009
Office Hours: Fridays 8am to 12pm and 1pm to 5pm
Secretary phone: Landline (08) 9386 7488
Prof Prince: Mobile 0419937100
Fax number: (08) 9386 7478
Email: reception@ccwa.net.au
Website: www.princeendocrinology.com.au
HAND SURGERY
HAND & UPPER LIMB SURGERY
Mr Peter Hales
MBBS FRACS FRCS(E)
Hand and upper limb surgeon. Extensive
experience in hand, wrist, elbow and shoulder
surgery, both acute and elective.
Special interest in hand and wrist Arthritis and
arthroscopic procedures of shoulder, elbow and
wrist, including Endoscopic Carpal Tunnel Release.
Onsite Hand Therapist and Splint Making.
Peter can be contacted on (08) 9212 4200 or
peterhales@perthorthopaedics.com.au
Mr Paul Jarrett
FRACS
Experienced Specialist Hand, Wrist, Elbow and
Shoulder Upper Limb Orthopaedic Surgeon
providing a comprehensive elective and trauma
orthopaedic service at the St John of God
Hospital, Murdoch.
Mr Jarrett provides orthopaedic consultations for Private,
Veteran’s Affairs and work-injured patients at Murdoch.
For more information please visit www.pauljarrett.info
or call 9311 4636 for appointments.
Weekly clinics are offered at Fremantle Hospital for uninsured
patient referrals.
Lewis Blennerhassett
MBBS FRACS
Mr Angus Keogh
FRACS
- Hand and Upper Limb Surgeon
Dr Blennerhassett is a plastic surgeon with postgraduate fellowship in hand surgery certified by the
American College of Surgeons. Expertise in all aspects
of acute and chronic hand disorders, both paediatric
and adult, is provided.
For all appointments, phone 9381 6977.
Emergencies phone 0438 040 993 – all hours.
Mr Craig Smith
MBBS FRACS
Hand, wrist and plastic surgeon has his main practice
at 17 Colin Street, West Perth in association with
Specialised Hand Therapy Services. This means
that consultation, hand therapy and splinting are all
available at the one location.
His areas of interest include all acute or chronic hand
and wrist injuries or disorders as well as general plastic
surgical problems. He continues to consult in Bunbury
and Busselton.
For appointments or advice
please call 9321 4420.
My interests include traumatic and
degenerative conditions of the upper
limb including hand surgery, arthroscopy
including small joints, complex elbow and
wrist instability.
I consult in private rooms at St John of God Subiaco
and St John of God Murdoch. Please call 08 9489
8784 for appointments. I consult weekly at Sir
Charles Gairdner Hospital – please call 08 9346 1189.
Workcover accepted.
HAND & PLASTIC SURGERY
Dr Robert Love MBBS FRACS (Plas) Dip ANAT
All hand surgery, microsurgery and plastic surgery including:
Dupuytren’s Contracture; Arthritides, Carpal Tunnel.
24hr Emergency. Requests for advice welcome.
17 Richardson St West Perth and SJOG Murdoch
Tel: 9321 3344 Mobile: 0409 132 602
December
ME D I C US 71
Professional Notices
INFECTIOUS DISEASES
Dr Desmond Chih
MBBS FRACP FRCPA
Infectious Diseases Physician and Clinical Microbiologist
All aspect of adult general infectious diseases and
diagnostic microbiology including: fever of unknown
origin; bone and joint infections; surgical infections;
skin and soft tissue infections; travel related infections;
tuberculosis; and antibiotic resistance.
Consults at Joondalup, SJOG Murdoch (Inpatient)
and Myaree.
All correspondence to 74 McCoy Street,
Myaree 6154
Tel: 08 9317 0999
Appointments: 08 9317 0710
Fax: 08 9467 2826
Email: Desmond.Chih@wdp.com.au
NEUROLOGY
Dr Julian Rodrigues
MBBS (UWA), FRACP
has commenced private practice in
general adult neurology and
neurophysiology (Nerve Conduction
Studies / EMG) with particular
expertise in:
• Movement Disorders including
Parkinson’s Disease, Tremo
and Dystonia
• Assessment for Deep Brain Stimulation and
other advanced therapeutic options
Botulinum toxin treatment of:
• Chronic migraine and other primary headache
syndromes
• Axillary, cranial and palmoplantar hyperhidrosis
• Spasticity including post-stroke and cerebral palsy
• Hemifacial spasm, blepharospasm and spasmodic
dysphonia
• Bruxism, temporomandibular disorders and sialorrhea
• Focal dystonias including cervical dystonia/torticollis,
writers and musicians’ cramp
• Musculoskeletal indications including tennis elbow and
patellofemoral disorders
• Complex EMG-guided botulinum toxin administration.
Medico-legal and workers compensation patients accepted.
Inpatient consultation available.
Consulting and neurophysiology servwices provided at
Hollywood Medical Centre, Hollywood Private Hospital
and Joondalup Health Campus.
For all appointments and enquires: Hollywood
Medical Centre, Suite 45/85 Monash Ave,
Nedlands 6009 Ph: 9420 4900; Fax: 9386 9277
Email: admin@drjulianrodrigues.com.au
Web: drjulianrodrigues.com.au
72 M E D I CU S December
OPHTHALMOLOGY
Dr Michael Wertheim
MBChB FRCOphth FRANZCO
Comprehensive general ophthalmologist
consults at: Suite 26 Wexford Medical
Centre, 3 Barry Marshall Parade,
Murdoch 6150
Early and urgent appointments
available
Operates at: Eye Surgery Foundation, West Perth
(private patients) Bentley and Osborne Park
Hospitals (public patients)
Special Interests: cataract surgery, pterygium surgery,
general ophthalmology, Uveitis
For appointments:
Phone 9312 7222
or Fax 9312 7333 or Email
info@pertheyeclinic.com.au
www.pertheyeclinic.com.au
PSYCHIATRY
The Marian Centre
The Marian Centre is pleased to announce that
Dr Richard Magtengaard has commenced practice at
the Marian Centre consulting rooms.
Dr Richard Magtengaard: General Adult Psychiatry,
Depression, Anxiety, and Mood Disorders.
Address: 200 Cambridge Street, Wembley 6014
Referrals: Phone 9486 7399
or fax 9381 2612.
Professor Brian D Power
BMedSci (Hons) MBBS PhD FRANZCP
Cert. Psych. Old Age
has commenced practice at Hollywood Medical Centre
(85 Monash Avenue, Nedlands), with expertise in older
adult mental health (problems with mood, memory,
anxiety and psychosis in later life) and neuropsychiatry
(psychiatric conditions secondary to organic brain
disease including, but not limited to: stroke, multiple
sclerosis, parkinsonian disorders, Huntington’s disease,
epilepsy).
For appointments or enquiries:
mobile 0478 597 781, or email
briandiarmidpower@gmail.com
Professional Notices
RADIOLOGY/NUCLEAR MEDICINE
Envision Medical Imaging
178 Cambridge Street, Wembley (opp. SJOG Hospital
Subiaco)
Tel: 08 6382 3888
Fax: 08 6382 3800
Web: www.envisionmi.com.au Envision Medical Imaging
is an independent Radiology practice, located directly
opposite St John of God Hospital Subiaco on Cambridge
Street, with free parking behind the building. Services
include:
Ultrasound – including injections
• MRI – GP referrals accepted
• X-ray – low dose
• CT – general and cardiac imaging
• Nuclear Medicine scans
• Dental – Cone Beam and OPG
*Same day appointments available
Imaging Specialists include: Brendan Adler, Lawrence
Dembo, Tonya Halliday, Tom Huang, Eamon Koh,
Bernard Koong, Michael Krieser, Michael Mason, and
Patrick Ng.
SKG Radiology
Web: skg.com.au
Appointments: (08) 9320 1288
Providing diagnostic imaging services in WA since 1981,
SKG Radiology has grown to become one of the State’s
largest providers with a network of 20 metropolitan and
country branches as well as premier hospital locations.
Continually providing a premium quality service through
the expertise of sub-specialised Radiologists, highlytrained technicians and support staff, the professional
team is committed to providing your patients with the
highest standard of care, every time:
• MRI • PET-CT • Low Dose CT
• U ltrasound (including Nuchal Translucency and
Doppler scanning) • Nuclear Medicine
• Fluoroscopy • Mammography • Interventional
Radiology • General X-ray • Dental X-ray (OPG)
• FNA Biopsy • Bone Densitometry
SKG is a preferred supplier and proud sponsor of WA’s
sporting elite – West Coast Eagles, Perth Wildcats, Perth
Heat, West Coast Fever and West Coast Waves.
RENT WITH HERTZ AND SAVE
Hertz offers great rates to AMA Members on all
our vehicles, including our Prestige Collection
of BMWs.
Just quote this CDP number: 283826 when
you make your booking*.
*Terms and Conditions: Customer Discount Program (CDP) number 283826 must be quoted at time of reservation. For full
terms and conditions, please visit the Hertz section on your intranet.
Executive Style Meets
Comfort and Practicality
Vehicle shown is a
118 TSI Elegance Sedan
The Superb brings visual energy to its class. With an attractive design that impresses at
first glance, showing a character that is striking and elegant at the same time.
Superb In Facts:
ŠKODA Superb Elegance
• Leather interior
• Bi-Xenon headlights with Adaptive Frontlight
• Cruise Control
• Touch Screen Columbus Satellite Navigation
• Electric adjustable driver and front passenger seats
$43,240
From
Driveaway*
• Front and rear heated seats
• Dual-zone Climatronic air conditioning
• Automatic Parking Assist with front and rear parking sensors
European quality without the European price tag.
BARBAGALLO ŠKODA OSBORNE PARK
352 Scarborough Beach Rd, Osborne Park WA 6017 DL 2061
*Driveaway price shown in the Manufacturer’s Recommended Driveaway Price (MRDP)(with the added option of metallic paint). Available at Barbagallo ŠKODA.
The driveaway price shown is based on the owner being a ‘rating one’ driver aged 40 with a good driving record. Actual driveaway price may differ depending on
choice of dealer and individual circumstances. Contact Barbagallo ŠKODA to confirm your specific price. ŠKODA Australia reserves the right to vary the MRDP in
its discretion. Consult with Barbagallo ŠKODA regarding any relevant model year/running changes.
Phone : 1300 720 457
PROUD
PARTNER OF
PROUD
PARTNER OF
ROOMS FOR LEASE – EXMOUTH WA
NEDLANDS
Brand new premises available for entrepreneurial GP. Be
the first private GP in town, with opportunity to focus on
occupational and dive medicine as well as family practice.
Wonderful lifestyle with stunning scenery and wildlife to
explore. Contact draburkett@live.com
Medical Specialist Consulting Rooms and Treatment
Room
• F ully serviced consultation rooms at Hollywood
Specialist Centre
• Secretarial support – highly experienced long-term staff
• Genie solutions practice management software
• Online Medicare claims
• Telehealth consultation facilities
• Paperless practice supported
• Treatment room – available for ambulatory procedures
• Access to Hollywood Private Hospital for inpatient
care and theatre bookings supported
• Inpatient billing supported.
Any enquiries can be directed to Mrs Rhonda Mazzulla,
Practice Manager, Suite 31,
Hollywood Specialist Centre,
95 Monash Avenue, Nedlands, WA 6009,
Phone: 9389 1533
Email: suite31.hollywood@bigpond.com
NEDLANDS
Office space of 119sqm at Suite 3, Hampden Court,
186 Hampden Road, Nedlands is available for rent
now – with option to buy. Interested party please ring
Ian Forsyth at Abel McGrath on 9286 3655.
NEDLANDS
Nedlands Consulting Suite, Hollywood Specialist Centre
54 sq m consulting suite already fitted out, with furniture
Available for rent or purchase
Contact Tim Cooper 0411 876 480
Consultant Psychiatrist
People caring for people
Joondalup Health Campus Perth, Western Australia
An exciting opportunity exists for a suitably experienced and talented clinician
to join the Mental Health Team at Joondalup Health Campus (JHC).
Why this Role?
Joondalup Health Campus has a culture of innovation and
change. Our clinicians are valued and enjoy a close and
collaborative relationship with the hospital executive team,
unencumbered by unnecessary bureaucracy.
You will work with an established team of Consultant
Psychiatrists who are supported by junior medical staff
including Registrars and RMO’s, Allied Health Practitioners
and an experienced team of nursing staff committed to
provide 24 hour care for patients in our Mental Health Unit.
Why Joondalup?
JHC is a 664-bed public and private hospital campus,
owned and operated by Ramsay Health Care. Situated
on the coast 30 minutes north of Perth’s CBD, we provide
If you are this person please forward your expression
of interest and application to:
Lucinda Cavanagh, Executive Administrative Assistant
Email: cavanaghl@ramsayhealth.com.au
comprehensive acute medical care to the community of
Perth’s northern suburbs.
The Public Mental Health Unit at Joondalup Health Campus
treats both voluntary and involuntary public patients with
47 beds consisting of 37 open beds and 10 beds in our
Psychiatric Intensive Care Unit.
Who Are You?
You are an experienced Consultant Psychiatrist with
excellent communication skills. You are a FRANZCP and
hold full specialist registration with AHPRA. You believe
that working collaboratively with other specialties, health
professionals, and services within the hospital will achieve
your primary aim, which is to provide first-rate health
outcomes for the community.
For further information contact:
Professor Hans Stampfer, Director of Psychiatry
Email: StampferH@ramsayhealth.com.au
www.joondaluphealthcampus.com.au
December
ME D I C US 75
Please forward submissions for Greensheet by
6 January for the February 2015 edition.
Email: Sophie.Yeomans@amawa.com.au
WESTERN AUSTRALIA
WESTERN AUSTRALIA
Youth Friendly Doctor Training 2015 Program
The Youth Friendly Doctor (YFD) Program was developed by the AMA (WA)
Foundation in consultation with doctors and other health professionals.
The program builds the capacity of doctors to communicate effectively and
optimise their contact with young people. Practical sessions are delivered
by experts in the relevant medical and legal fields. In addition to providing practical youth-specific training, YFD provides
doctors with reference materials, referral links and ongoing support to encompass a holistic youth friendly practice.
To be accredited as a Youth Friendly Doctor, you will be required to complete both the core module workshops plus one of
the elective workshops.
This program is accredited with the ACRRM and the RACGP, attracting Category 1 and/or Category 2 QI&CPD Points.
Rural doctors have the opportunity to participate via the virtual online classroom.
All workshops are held on a Tuesday evening at the AMA (WA) House in Nedlands from 6:30 – 8:30 pm.
FREE for AMA (WA) members; $50 per workshop for non-members.
MODULE 1
MODULE 3
Establishing Connections and Conducting
Assessments with Young People
Risk Taking Behaviours and Harm Reductions among
Young People
Workshop 1 – (Core) Young People, Ethics and
the Law – 3 February, 2 June & 20 October 2015
Workshop 1 – Alcohol and Drug Use among Young People
– 3 March 2015
Workshop 2 – Social Media and the Internet: The
Impact on Young People’s Wellbeing - 7 July 2015
Workshop 2 – Young People’s Sexual Health – 5 May 2015
MODULE 2
MODULE 4
Mental Health Disorders
Eating Disorders in Young People and their
Management
Workshop 1 – Mental Health Disorders in
Young People – Diagnosis and Assessment
– 7 April & 3 November 2015
Workshop 2 – (Core) The Psychosocial Wellbeing of
Young People – 21 April & 17 November 2015
Workshop 1 – Eating Disorders in Young People
– 4 August 2015
Workshop 2 – Overweight and Obesity in Young People
– 1 September 2015
For enquires relating to the YFD program or to enrol in the workshops, please visit: http://www.amawa.com.au/
in-the-community/yfd-training-program/, phone (08) 9273 3000 or email yfd@amawa.com.au
POSTGRADUATE EDUCATION & TRAINING
Date
Course/Workshop
11-12
Feb-15
Basic Surgical Skills: Gynaecology. Compulsary for all first year registrars in Gynaecology
and experienced residents may apply to attend.
Please contact Anita
Ingleby, KEMH, 9340 1388
20 Mar-15
The Cutting Edge: Managing Skin and Soft Tissue Injuries. Suitable for GPs, GP
Proceduralists and Remote Nurse Practitioners. Accreditted with RACGP QI (40 Points Cat
1) and with ACRRM for 30 PRPD points, 30 EM MOPS points and 30 surgical MOPS points.
Approved for 1 Day EM/Surgical Procedural Grants. Venue: CTEC, UWA. Cost: $742 pp.
Email john.linehan@uwa.
ed.au or call: John Linehan
on 6488 8049
26 Mar-15
Core Skills: General Surgery Trainee Workshop. Suitable for SET 2 to SET 4 trainees.
Duodenotomy, pyloroplasty, exploration of common bile duct, gastrectomy, axillary dissection,
mastectomy, thyroid, submandibular gland and choledochojejunostomy will be covered.
Venue: CTEC, UWA. Cost: $980 pp.
Email john.linehan@uwa.
ed.au or call: John Linehan
on 6488 8049
76 M E D I CU S December
Perth Radiological Clinic supports
Low Dose CT screening for lung cancer
On December 31st 2013, the US Preventive Services Task Force (USPSTF)
endorsed Annual Low Dose CT screening of high risk smoking patients for the
early detection of lung cancer. Now that there is sufficient evidence PRC will
provide this service:
• Very low dose chest CT screening scans using the latest iterative reconstruction
techniques at all 15 comprehensive practices across Perth
• All screening chest CT scans for early detection of lung cancer will
be reported by our team of specialist chest radiologists
• Screening chest CT scans for pensioners and health care card
holders will be bulk billed across all sites
• Same day or next day appointments available at most sites
www.perthradclinic.com.au
Leaders in Medical Imaging