Doctor Q Autumn 2019

Doctor Q is free to AMA Queensland Members

AUTUMN 2019

Townsville Floods PHARMACY GUILD PUTS PATIENTS AT RISK

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CONTENTS

REPORTS

24

4

Editor’s desk

6

President’s report

8

CURRENT ISSUES 12

Pharmacy Guild puts patients at risk

CEO’s report

20

MOCA 5 final update

22

CDT update: Making a difference

24

Engaging with clinicians: imperative for health systems

32

Research round up

26

34

Member news

Do you remember your first day?

62

Do you know a person or project that needs financial support?

28

Managing bullying allegations

30

Health, climate change and our role

46

Annual General Meeting information, election notice and nomination form

QUEENSLAND CLINICAL S E N AT E ’ S N E W C H A I R : DR ALEX MARKWELL

F E AT U R E S Townsville floods

16

MBS Review - not before time

35

Obituary: Dr John Herron AO

Pre-budget submission

36

Local Medical Association meetings

38

Events calendar

40

Meet the speaker: Dr Eric Levi

42

Meet the speaker: Associate Professor Michael Greco

44

AMA Queensland Annual Conference: Global trends in health care delivery

18

35

40

PEOPLE & EVENTS

14

O B I T U A R Y: DR JOHN HERRON AO

MEET JUNIOR DOCTOR CONFERENCE SPEAKER: DR ERIC LEVI

BUSINESS TOOLS 37

New content from Therapeutic Guidelines

48

Scout’s motto: be prepared

50

Recruitment: your greatest missed opportunity

52

Reviewing Labor’s proposed super changes

LIFESTYLE 63

All Aboard!

54

Practices to pay for misleading Medicare

64

Restaurant review: A food hall for a feast of fancy

56

How to achieve private practice start up success

66

All About You

67

Dendy Cinemas

68

The Bear, The Block and The Batchy

69

More reasons to abandon the big brands

70

InPrint: Harrison’s Endocrinology, 4th edition

58

Take care with Medicare

60

Patient referral spotlight: Autism Queensland

61

There is more to an equipment purchase than just finance

Doctor Q Autumn

3

Editor’s Desk I did some research for this edition on Associate Professor Michael Greco, who is the CEO at Patient Opinion Australia.

It’s an organisation that encourages patients to share their experiences with health services. I was intrigued. This is fine for a business, but surely patients would likely be negative about a doctor telling them bad news or giving advice they didn’t want to hear? I thought about my own experiences though, both positive and negative and wondered how this would play out. There would have been so much to learn from both cases - how to do it and how not to do it. Associate Professor Greco is speaking at our Private Practice and Medico-Legal Conference in August - definitely worth the registration alone! Michelle

BOARD OF DIRECTORS Dr Dilip Dhupelia President

Dr Sarah Coll Member Appointed Director

Dr Mellissa Naidoo Member Appointed Director

Dr Bav Manoharan Member Appointed Director

Dr Peter Isdale AM Skilled Director

Dr Hashim Abdeen Gold Coast Area Representative

Dr Jim Finn Greater Brisbane Area Representive

Dr John de Laat Greater Brisbane Area Representive

Dr Fatima Ashrafi Specialist Craft Group

Dr (Deborah) Erica Gannon Part-time Medical Practitioner

Dr Chris Maguire Doctors in Training Craft Group

Dr Michael Cleary Vice President Dr Shaun Rudd Chair of Board and Council

COUNCIL

Dr Sanjeev Bandi Capricornia Area Representative Dr Kimberley Bondeson Greater Brisbane Area Representive Dr Bill Boyd Immediate Past President

OBITUARIES The following AMA Queensland members have recently passed away. Our sincere condolences to their families.

Dr Brian Frederick Charles SMITH Obstetrician and Gynaecologist Late of Manly West Life member of 65 years Dr John Barrie MORLEY Neurologist Late of Toowoomba Life member of 59 years Dr Colin Bruce PAGE Emergency physician Late of Bardon Member for 25 years Dr Alexander John MACLEAN General Practitioner Late of Ninderry Life member of 65 years Dr Allan Francis SMITH Surgeon Late of Noosaville Member for 37 years

FOLLOW US: 4 Doctor Q Autumn

Dr Ronald Ian WAUGH Public hospital doctor Late of Bli Bli Member for 64 years Dr Michael Harry MORENY General surgeon Late of Branyan Member for 45 years Dr Kevin James MURPHY Internal medicine Late of Wilston Life member of 66 years Dr John Joseph HERRON AO General surgeon Late of Ascot Life member of 62 years AMA Queensland President 1988-89 Dr John Joseph SULLIVAN Pathologist Late of Indooroopilly Life member of 70 years

Ben Hancock Skilled Director

Dr Paul Bryan General Practitioner Craft Group Dr Michael Clements North Area Representive Dr Sarah Coll Specialist Craft Group Haydn Dodds Medical Student Craft Group

Dr John Hall Downs and West Area Representive Associate Professor Geoffrey Hawson Retired Doctors Craft Group Dr Wayne Herdy North Coast Area Representive Dr Scott Horsburgh General Practitioner Craft Group Dr Viney Joshi International Medical Graduate Craft Group Professor Steve Kisely Greater Brisbane Area Representive

Clare Mahon Medical Student Observer Dr Bav Manoharan Greater Brisbane Area Representive Dr John F. Murray Specialist Craft Group Dr Rachael O’Rourke Greater Brisbane Area Representive Dr Siva Senthuran Full-time Salaried Medical Practitioner Craft Group Dr David Shepherd Far North Area Representive Dr Nicholas Yim General Practitioner Craft Group

AMA QUEENSLAND S E C R E TA R I AT Jane Schmitt Chief Executive Officer

Filomena Ferlan General Manager Corporate Services

Holly Bretherton General Manager - Member Relations and Communications

Editor: Michelle Ford Russ

Doctor Q is published by AMA Queensland

Graphic Designer: Aleisha Coffey

Phone:

Journalist: Chiara Lèsevre

(07) 3872 2222

Address: PO Box 123,

Red Hill QLD 4059 Email:

amaq@amaq.com.au

Print Post Approved PP100007532 Disclaimer – All material in Doctor Q remains the copyright of AMA Queensland and may not be reproduced or transmitted in any form without permission. While every care is taken to provide accurate information in this publication, the material within Doctor Q is for general information and guidance only and is not intended as advice.

Readers are advised to make their own enquiries and/or seek professional advice as to the accuracy of the content of such articles and/or their applicability to any particular circumstances. AMA Queensland, its servants and agents exclude, to the maximum extent permitted by law, any liability which may arise as a result of the use of the material in Doctor Q.

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Doctor Q Autumn

5

President’s report DR DILIP DHUPELIA

Two important pieces of legislation have been introduced into State Parliament already (mandatory reporting and Health and Wellbeing Queensland), together with dealing with the contentious issues of rural maternity services and clinicians concerns with the ieMR project in public hospitals. Federally, we are currently dealing with the changes to Private Health Insurance and obtaining MBS changes for aged care services.

PHARMACY COUNCIL C A M PA I G N Our campaign against the Pharmacy Council establishment has seen many of our members writing to and meeting with their local MPs to voice their concerns with an expanded scope of practice for pharmacists. If you haven’t yet done so, please find out how you can get involved at www.amaq.com.au.

I have met with Queensland’s Health Minister on a number of occasions to press the case regarding the dangers of the proposal. The government has delayed the response until April to give it further consideration. Our Pharmacy Working Group has made a further written submission to Queensland Health, and your support will be vital in reinforcing our message. Colleagues, it is extremely important that we make our voice heard to counter these efforts.

See page 12 for further information on our Pharmacy Council Campaign.

AGED CARE, PA L L I AT I V E C A R E A N D V O LU NTA RY ASSISTED DYING The Queensland Parliament is holding an inquiry into aged care, end-of-life, palliative care and voluntary assisted dying, with a report due by November 2019.

An issues paper has been released.

AMA Queensland has been invited to prepare a submission to the inquiry and, after seeking views of members last year, AMA Queensland Council has sought advice from the Ethics and 6 Doctor Q Autumn

Medico-legal committee on to how to proceed, particularly as Euthanasia and Voluntary Assisted Dying becomes legal in Victoria on 1 July 2019, with other states commencing similar enquiries.

At the February meeting of the Ethics and Medico-Legal committee, members discussed whether we should adopt the AMA position statement on Euthanasia and Physician Assisted Dying. We will engage with as many members as we can to ensure the submission to the inquiry captures and respects the consensus view of as many members as possible, especially when we are dealing with such life and death matters. Provide your feedback to policy@amaq.com.au.

AMA Queensland is also collaborating with Palliative Care Queensland to develop a public health approach to palliative care.

M A N D AT O R Y R E P O RT I N G I have fought hard to make it easier and more acceptable for health professionals to seek treatment and get help for their own health condition.

In February, AMA Queensland and AMA strongly advocated for the Queensland Parliament to adopt the ‘WA model’, which has been shown to work. It relies on health practitioners’ ethical and professional obligations to report a practitioner-patient who may put public safety at risk. There is no evidence to suggest diminished patient safety in WA since introduction.

This advocacy included meetings with the Health Minister Steven

Miles; a meeting with Shadow Health Minister Ros Bates; appearance at the parliamentary enquiry public hearing, numerous media interviews and a recent joint letter to all MPs in Queensland seeking bi-partisan support for the bill to be passed with the amendment.

On 26 February, the Queensland Parliament passed the Mandatory Reporting Laws as part of the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018 without amendment.

This decision flew in the face of our strong advocacy on the issue.

We will not give up. We will continue to advocate for changes to mandatory reporting laws in Queensland, particularly in the lead-up to the State election next year.

AMA QUEENSLAND ELECTIONS It’s surprising how quickly this comes around, with Board and Council elections once again due in the coming months. There is significant unfinished business, therefore, after consultation with family and senior members of AMA Queensland, I intend to contest for a second term this year.

DR JOHN HERRON AO On behalf of the Board and Council, I extend our sincerest condolences on the passing of AMA Queensland Past President Dr John Herron AO. We have included his obituary on p35. We honor his legacy and mourn his loss alongside his family, friends, and colleagues.

May he rest in peace.

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CEO’s report JANE SCHMITT

2019 QUEENSLAND BUDGET SUBMISSION

E H E A LT H W O R K I N G GROUP

Ahead of the 2019 State Budget, we presented our pre-budget submission to the Queensland Health Minister Steven Miles, with seven recommendations, which you can read about on p18.

As you may be aware, in March last year AMA Queensland established an e-health working group to enable clinicians to identify benefits and disbenefits with the integrated electronic medical record (ieMR) program, which is being rolled out across Queensland hospitals.

Our budget submission, which draws on the collective experience of our members at the coalface of delivering health services in Queensland, acknowledges the important contribution of State Government, local councils, community organisations and the general public to improving the health of Queenslanders.

In response to our budget submission launch, Premier Annastacia Palaszczuk welcomed our campaign and agreed that water fluoridation had proven health benefits. She said local councils remained the ultimate decision-makers.

We look forward to working with the Queensland Government on the initiatives herein.

2019 AMA QUEENSLAND ELECTIONS Nominations will open on 25 March at 5pm for the positions of President, Vice President, Chair and Council positions.

The election results will be announced at our AGM on 17 May 2019. Please find our election notice, annual general meeting notice and nomination form on p46.

The state government’s proposal to create an independent statutory body to deliver grassroots programs and resources to fight obesity answered AMA Queensland’s calls for urgent action.

Late last year, we met with the Health Minister and highlighted the need for hospitals to engage more effectively with doctors at the coal face to ensure the digital system was enhancing the delivery of patient services.

AMA Queensland has been working closely with the State Government on meaningful ways to curb the growing health crisis caused by obesity and associated chronic diseases.

We have met with Queensland Health in late February to reiterate the concerns of our members. Queensland Health has advised that the ieMR will be part of their IT Review which they are currently undertaking. AMA Queensland will be interviewed and contribute to this.

AMA Queensland will continue to work closely with Queensland Health to ensure clinicians are provided with efficient workplace programs so they can focus on their top priority of delivering healthcare to Queenslanders.

I encourage you to send your views and feedback to the ieMR to our AMA Queensland e-health working group at iemr@amaq.com.au.

AMA QUEENS LAND

4

9

Grants for Healthy Infrastructure

4

proved so successful Resilience on the Run wellbeing and in helping to improve in 2017 the reducing burnout that funded Queensland Government the program deliver AMA Queensland to from 2017-2019. to all medical interns to be an enormous This has also proven from those success. Feedback received training has in the who have taken part positive. been overwhelmingly

the Department of Local Queensland Health and grant package to local AMA Queensland encourages to develop an infrastructure councils to Government to work together used specifically to allow (LGAs), which would be tracks and gym equipment government authorities such as bike paths, running improve existing infrastructure by members of the public. more appealing to use to make them safer and a Local Local Government offers that the Department of assistance AMA Queensland is aware which provides funding be Subsidies Program (LGGSP) Government Grants and projects. The LGGSP would to deliver infrastructure the total amount of funding to support local government this infrastructure however 2019/20 and 2020/21 an ideal program to deliver set at $57.906m over the currently is projects councils available for all a subsidy towards eligible allows councils to gain financial years. This funding total eligible cost. of the Water Fluoridation of up to 60 percent of the the amount Following the amendment increase to councils the choice which gave local the Queensland Government Actto2008 in 2013, supplies, almost AMA Queensland, encourages $10 million to allow councils from their drinking in 2020/21 by an additional to offered through LGGSP such as extensions to bikeways, to remove fluoride Queensland opted local infrastructure projects of this delivery The deliver health focused local councils around equipment. twenty include outdoor gym and their water. These better lighting, and contemporary community to become more physically active including remove fluoride from the largest regional centres infrastructure will encourage on the health system. ultimately reducing costs some of Queensland’s and Hervey Bay. improve connectedness, request a Rockhampton, Bundaberg local governments can Cairns, unwilling to accept guidelines state that whilst for Local councils seemingly We note that the LGGSP discretion of the Minister With these local the safety and efficacy 60 percent, this is at the known to local higher subsidy rate than of evidence proving that it should be made weight Minister the the believes this to be would AMA Queensland a healthy lifestyle Government. We recommend projects which promote of fluoridated water, by the governments that infrastructure to attracting a higher subsidy rate. through direct action regards must be rectified looked on favourably in

1

MAND ATE WATER FLUOR

IN 2017; the public hospitals attended 633 interns from 21 sessions in Queensland Resilience on the Run and of techniques, exercises Mindfulness in terms to be the most useful examples was considered attendees, followed by by element of the program self-care, self-awareness and meditation exercises, how to avoid burnout where to get help and

IN 2018; public hospitals who 790 interns from 21 on the Run sessions attended the Resilience in Queensland to the post session 84% of the 728 respondents Run between 4 and on the survey rated Resilience 5 out of 5

self-care tips and hearing Mindfulness techniques, were rated as the most the stories of their peers the sessions useful elements of

REINTRODUCT COSTS FOR THE TABLE 1 - INDICATIVE

8 Doctor Q Autumn and Doctors’ Wellbeing

(Far North Qld) Tablelands Council Qld) Charters Towers (Central South Burnett (South

West Qld)

We further understand the introduction of RTPM will come with legislation that will make it an offence for a doctor prescribing medicines such as S8 drugs

35,575

1

ABS 3218.0, Regional

editions and Australia, various estimates Population Growth, Queensland Treasury

program with very of career.” to succeed emotionally helpful and practical information.

Will be of great in their junior doctor value to anyone years.” wanting

“ROR helped normalise

FINANCIA L ASSISTAN CE FOR GPS:

An evaluation from a more recent Resilience November 2018 on the Run program with a group of held in registrars found equally positive results.

32 registrars from We recommend the GCUH Queensland Government attended the course. develop a financial practices who may require package to support computer or other infrastructure those equipment that will upgrades to purchase allow them to become the real time ready. This tested and capped at assistance should be $10,000 per individual means GP to help purchase IT training and the development of internet necessary computer infrastructure where rural and remote areas 89% of the upgrades, necessary (for respondents to with intermittent or example, no internet access). the post sessionin

survey rated the Resilience on the Run course as excellent.

PER ANNUM INDICATIVE COST and $25,338 Between $15,202 $11,968 Between $7,180 and and $32,575 Between $19,545

20181.)

11,968

Wellbeing at Work

were heaving similar a lot of my thoughts and feelings.

AMA Queensland will It was reassuring experiences.” develop and deliver to hear my whole a campaign over 12 educate and advise cohort months, which will“This was an excellent GPs on the need to alert, become real time ready responsibilities under hope to share some program which was straight to and what their obligations the new laws will be.

AMA and of these strategies and resources the point. I can take a lot away well as information from this and distributed via our member Queensland will deliver this via workshops with my colleagues.” in addition to our website as magazine Doctor Q, our online newsletter and social media feeds.

Pulse

COUNCILS IN QUEENSLAND IN THREE REGIONAL ION OF FLUORIDE $A

25, 338

8

TIME READY

not to look at the RTPM database before issuing prescription. Although the AMA this measure in principle Queensland supports (subject to viewing the final legislation and the associated penalties) as a means to ensure the RTPM system is effectively used by GPs around the state, we are concerned there will be many GPs who do not currentlyTestimonial possess the responses skills from effectively use, or whose to participants doctors practices further place may notinbe and derive access the new RTPM able to from the Resilience reinforces the value junior system in a reliable on the Run program. manner. This could result in the RTPM not being used as effectively as possible, may lead “Any knowledge to medico-legal consequences or skill we can learn GPs and could result that is able to contribute Resilience on thefor in delays for patients, run is delivered to junior doctor particularly in a practical and in rural, regional and well-being is and resilience.” relevant way and remote areas. AMAawareness can't help but improve brilliant.

Queensland therefore calls on the Government to assist “Enjoyable, empowering GPs across Queensland to become session. Actually realistic and applicable “real time ready.”

“Great to stage

EDUCATIO N:

Government calls on the Queensland AMA Queensland to mandate the 2019-20 year water to legislate within supplies in any council occurring. fluoridation of water is not already naturally through supply where fluoride Health, call on Queensland to As part of this, we provide briefings Health Services, to the Hospital and of fluoridated the safety and efficacy local councils on health benefits. water and its associated between estimated to cost With water fluoridation year (Townsville City Council, per 60 cents per person (Australian Dental per person per year 2016) and $1.00 council are not the costs for local we Association, 2016) 1 below), however Table (see overly prohibitive require greater local councils may For recognise that some fluoride to their communities.

Government assistance to deliver call on the Queensland in this year’s this reason, we also is made available require to ensure that funding councils who may in their Budget to assist those g water fluoridation assistance in re-establishin local water supplies.

POPULATION (ABS,

COUNCIL

Healthy Workplaces

Real Time Ready

HELPIN G GPS BECOM E REAL

IDATIO N

Queensland Government.

Fluoridation Queensland’s Water of In the first instance, to mandate the supply Act should be amended supplies. In 2013, when water former fluoride into local they criticised the Labor was in Opposition, removing the water fluoride for they have Newman Government winning Government mandate, but since this. not acted to remedy

Helping Gps Become

AMA Queensland understands the Queensland Government plans to implement real time prescription monitoring (RTPM) in Queensland in 2020.

We have previously advocated for a real time prescription monitoring system to be urgently introduced into Queensland so we strongly support plan2. It is clear that this the current “Monitoring of Drugs of Dependence System” (MODDS) system maintained Queensland Health by is not updated frequently enough to ensure that doctor shopping and prescription medicine abuse is effectively monitored.

GRANTS FOR HEALTHY INFRASTR UCTURE

WELLBEIN G AT WORK

Queensland In August 2015, AMA the AMA Queensland launched the pilot of educational program Resilience on the Run aimed at providing at Rockhampton Hospital, and coping interns with the resilience thrive in and skills needed to survive The program was the field of medicine.

Council developed by AMA Queensland of Doctors in Training.

7

5

2

5

Wellbeing at Work

7

In February, Health Minister Steven Miles introduced a bill into parliament to establish a new health promotion agency – Health and Wellbeing Queensland (HWQ).

The e-health working group has been monitoring carefully the roll out of the system and continues to gather feedback from clinicians on the ground.

201 9 bu dg et su bm iss ion

Mandate Water Fluoridation

H E A LT H A N D WELLBEING QUEENSLAND

2

4

AMA Queensland Real Time Prescription Monitoring Position Statement (2017), https:// ama.com.au/sites/defau lt/files/QLD/PDFs/ Real%20time%20prescr iption%20monitoring%2 0 position%20statement.p df

94% of the respondents to the post session survey rated Resilience on the meeting their needs. Run as 84% of the respondents to the post session survey for the Resilience on the Run course indicated the course would help them do a better job.

With the value of the program self-evident, AMA Queensland now advocates for extending the program beyond the intern years to PGY 5 from July 2019.

The extended program,2 through Wellbeing at Work, to be named can be delivered state-wide, by AMA Queensland.

100% of the respondents to the post session survey rated the length of the Resilience on the Run course as adequate.

79% of the respondents to the post session survey for the Resilience on the Run course indicated they had gained 1 or more specific skills they could implement in their area of practice.

This should be seen as clinicians - to increase an investment in individual their wellbeing prepare them for and to better their system. Queensland roles within the health patients would beneficiaries through be the ultimate healthier treating physicians.

Health and Wellbeing Queensland is one of the solutions AMA Queensland has recommended and strongly supported.

Doctors at the front line of health care in Queensland are experiencing first-hand the impact of growing numbers of people needing treatment for chronic diseases caused by obesity and lifestyle factors.

AMA Queensland applauds the fact that Health and Wellbeing Queensland will take a whole-of-government approach and will work to close the health gaps that exist in rural, indigenous and low socioeconomic communities.

More than one tool is needed to effectively address this issue and Health and Wellbeing Queensland is a bold step towards real, sustainable improvements for all Queenslanders regardless of where they live.

AMA Queensland looks forward to continuing to work with the State Government to bring Health and Wellbeing Queensland to life.

The new bill is expected to be debated in Parliament in May.

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Pharmacy Guild puts patients at risk On 3 May 2018, the Queensland Parliament established an inquiry into the establishment of a pharmacy council, transfer of pharmacy ownership and increasing the scope of practice for pharmacists in Queensland to include prescribing.

AMA Queensland does not support the establishment of a pharmacy council in Queensland as most of the proposed functions and powers will provide very few benefits. The current arrangements have been serving patients and the broader health system extremely well and the move to an ‘independent’ body presents a serious threat to that stability.

The Pharmacy Guild has also been lobbying for the scope of practice for pharmacists to include prescribing.

In the interests of patient safety and quality in health care, AMA Queensland does not support extending the scope of pharmacists.

AMA Queensland agrees with the Pharmacy Guild who say that the “separation of prescribing and dispensing of medicines provides a safety mechanism as it ensures independent

fraThis g p an ment ropo ou d pr pa sal tc tie wil o d om pu u c t e p nt c l tin es, in oor are a d g p as w ha if e er of ficul rma ll as int t c cis t o er es nfli s t. ct

12 Doctor Q Autumn

review of a prescription occurs prior to the commencement of treatment.”

If the scope of practice for pharmacists was to be extended to allow them to become both a prescriber and a dispenser, this safety mechanism would be put at risk. It exposes the pharmacist to an inherent conflict of interest, including upselling ‘front of shop’ complementary medicine products that have few, if any, proven health benefits, as opposed to evidence-based PBS subsidised medications. Doctors avoid this conflict of providing advice and prescribing with the associated financial gain of selling medications, by avoiding the latter entirely and concentrating solely on providing high-quality healthcare and advice to the patient.

If pharmacists were given approval to prescribe, AMA Queensland is concerned that this would lead to fragmentation of care and place in doubt the trust and understanding which exists when a patient and doctor have a long term relationship based on comprehensive care.

Whereas public opinion suggests visiting a pharmacist may be more convenient than visiting a GP, empirical evidence from the Australian Bureau of Statisticsi, the Bettering the Evaluation and Care of Health2 (BEACH) data, the Organisation for Economic Co-operation and Development (OECD)3 data, the British Medical Journal4 and numerous other sources clearly demonstrate you are likely to live longer and achieve better health outcomes overall by seeing your GP regularly.

There is evidence that AMA Queensland’s efforts are having an impact as the government response to the establishment of the Pharmacy Council, which was due in February 2019 has been delayed until April 2019.

If you have not already done so, please visit the AMA Queensland website and use the resources we have developed for you to write and meet your local MP to voice your concerns. If you require any assistance in doing this, feel free to contact the AMA Queensland Policy Team via policy@amaq.com.au

1. Australian Bureau of Statistics, Patient Experiences in Australia: Summary of Findings 2016-17, Canberra 2. Lyndal J Trevena, Christopher Harrison and Helena C Britt, Med J Aust 2018; 208 (3): 114118. || doi: 10.5694/mja17.00225 Published online: 19 February 2018 3. OECD (2017), Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris 4. Pereira Gray DJ, Sidaway-Lee K, White E, et al, Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality, BMJ Open 2018;8:e021161. doi: 10.1136/bmjopen-2017-021161

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Townsville “The flood warnings came thick and fast for many areas across Townsville, but generally for those under the Q100 line. These lower-lying areas prepared their houses and some evacuated early and fared pretty well, considering.

Unfortunately, there was little warning for many areas above the Q100 line. Many of the suburbs that were previously safe were inundated with water and even the updated warning maps sent by the council underestimated the breadth of the devastation. It was now being referred to as a Q500 disaster, a one in five hundred year event.

My family and I were in an area supposed to be safe. There were no evacuation orders and the warning texts we received were generic and referred to a whole suburb so we decided to not evacuate with a plan to move upstairs if things worsened.

Everyone around us were caught by surprise, roads were cut off and we had to shelter in place, we ended up with ‘refugees’ from nearby houses in our place ending up with 17 all up as we watched the waters rise.

Social media and text messages were showing hundreds of trapped and stranded people throughout the night, 000 calls for help were prioritised, those on roofs getting priority over those knee deep in water in their houses. It took some hours before a flotilla of army boats started going down our streets making door-to-door rescues into the early hours of the morning.

The next day saw army helicopters and amphibious battle vehicles driving through the submerged streets around us picking up isolated families.

Townsville boaties came out in force, hundreds of individual rescue missions unfolding throughout the day.

Now we are out of the flood but in the thick of the recovery phase, all of Townsville’s hotels, rentals, everything, are all full right now because there are so many unliveable houses. Our neighbourhood is eerily quiet because most of our neighbours can’t live in their flood damaged homes.

A bright spark of community spirit came out in the disaster amongst Townsville GPs who were checking on each other and on community needs in a buzzing Facebook page. People were able to say “I need this help in this specific place” and the community, particularly local GPs, were able to help.

The hospital, which was high and dry, also really needed GPs to keep people out of the emergency department.

Evacuation centres were overrun with people who had only the clothes they were wearing who needed treatment for injuries or medication for existing conditions. Local GPs were able to triage patients to see who needed medication more or less urgently.

As the floodwaters receded, a new threat became apparent – melioidosis.

Eight people ended up in intensive care with it and there are so many

DR MICHAEL CLEMENTS General Practitioner and Owner, Fairfield Central Medical Practice; Director, Rural Generalist Training, Queensland Rural Generalist Pathway; and Far North Area Representative, AMA Queensland Council

other health issues because of the wet, dirty conditions.

We haven’t even really heard about the worst of it yet. We’ve heard some harrowing stories so far about evacuation trucks tipping over, parents being separated from children, evacuation boats getting tipped over by waves – the community has a long clean up ahead, physically and emotionally.”

More than 1,700 homes and businesses have been damaged in the unprecedented Townsville floods: 1,063 properties have been identified with minor damage;

595 with moderate damage; and

93 with severe damage.

The numbers of damaged properties is still expected to rise.

14 Doctor Q Autumn

floods

“It all just happened so quickly. The rain just fell with such intensity for such a long time, it was unprecedented. Townsville people are used to cyclones, but not floods. The community came together in a way that we’d never seen.

“The Primary Health Network, Hospital Health Service, Townsville City Council, local doctors and pharmacists all worked together to find solutions on the fly.

We’re now looking at implementing some of those methods for the long term.

“Now, the clean up continues and everyone finds out if they are covered by insurance or not. It will really separate the community into the haves and have nots. Many people are finding they are covered for storm damage, but not flood damage.

“If people are covered, the estimates are already underway and the builders have begun. For those who are not covered, there’s no emergency accommodation organised for them, they will struggle to engage tradespeople and will likely pay an unreasonable amount of money if they can engage them.

“The streets are unrecognisable. Huge areas are set aside for people to drop off their ruined belongings. Anything that the flood water has touched has to be thrown out. It’s just heartbreaking to see everyone’s possessions destroyed and out on the road.”

DR TONI WELLER Townsville GP and General Practice Liaison Officer (GPLO)

HELPFUL NUMBERS: AMA Queensland: (07) 3872 2222 Doctors’ Health Advisory Service: (07) 3833 4352 Beyondblue: 1300 224 636 NQ Connect: See your GP if you would like to discuss your mental health, or contact NQ Connect on 1300 059 625 or nqconnect.com.au/floodsupport/

“The best thing we can do is get people back to their regular family doctor”

So many general practices and their equipment have been affected by the flooding in Townsville and surrounding areas. GPs Down Under have set up a Go Fund Me page to raise funds for these business owners to rebuild their practices, set up interim practices or replace their equipment. The fund is to help doctors get back to work as quickly as possible so they can look after their community’s health.

DONATE NOW: http://bit.ly/2X8VJx3

Doctor Q Autumn 15

MBS Review not before time I was invited to join the Medicare Benefits Schedule (MBS) Review Taskforce three years ago and have been privileged to work with other Queensland AMA colleagues including Associate Professor Beverley Rowbotham AO and Dr Eleanor Chew OAM. We thought we understood the enormity of the task and I guess were hoping to finish this project in two years. We have now completed three and are moving into year four.

We are considering how the more than 5,700 items on the MBS can be aligned with contemporary clinical evidence and practice and improve health outcomes for patients. We are also seeking to identify any services that may be unnecessary, outdated or potentially unsafe.

The taskforce’s outputs are recommendations to the Australian Minister for Health that we hope will allow the MBS to deliver on these four key goals: 1 Affordable and universal access 2. Best practice health services 3. Value for the individual patient 4. Value for the health system.

The taskforce has used a methodology whereby clinical committees and working groups undertake the necessary clinical review of MBS items. To date, there have been over 70 clinical committees and working groups. Over 95 per cent of Medicare items are either under review or have been reviewed already. We could not have got this far without the over 700 doctors, health professionals, consumers and academics, that put in time, energy and experience, to ensuring the schedule is fit for purpose in modern Australia.

16 Doctor Q Autumn

The taskforce has made numerous recommendations to the Commonwealth Government over the past three years. We have seen some of the responses in the last budget and there were more announcements at the recent Mid-Year Economic and Fiscal Outlook. Recommendations from the work of the review are now reflected in every update of the schedule as the work continues.

There has been an extensive list of changes since 2016 to the MBS in the areas of: gastroenterology; diagnostic imaging; ear nose and throat surgery; obstetrics; dermatology, allergy and immunology; knee imaging; endocrinology; renal medicine; spinal surgery; thoracic medicine; and capsule endoscopy.

Apart from the massive time commitment the review is not without its challenges. Our stakeholders, including health professionals and experts, health consumers, medical colleges and indeed the AMA who have worked closely with and are crucial to the success of the review, have been challenged by the volume of consultation required on the reports from the taskforce’s clinical committees. Quite rightly, our stakeholders value the opportunity to properly consider each report and wish to provide their highest quality advice to the taskforce.

Many clinicians and experts have been challenged by the scope of the review and the potential for changes to the MBS to, for example, drive reforms in clinical care or ensure that patients can access the services they need, where they need it and at a price they can afford.

It is worth restating in response to some of the criticism from various quarters that at no time has the taskforce considered that it was involved in a cost cutting exercise.

Indeed, it would have been extremely unlikely that we would have had so many individuals and groups willing to support the process up to this point. One notable area where there were savings made available for reinvestment was in the after hours where the strong feedback from the profession indicated that the previous levels and structure of the MBS rebates were driving distortions in the efficient delivery of health services that needed correction.

More recently, in accordance with the findings of the Australian Atlas of Health Care Variation Series, a small number of committees have found discrepancies in billing or service numbers that cannot be explained by normal clinical variation in practice.

These findings have required the committees to working very closely with the colleges and societies to develop and refine recommendations to improve the MBS for all Australians.

Very soon there will be another 17 clinical committee reports released for consultation over the coming months in addition to the reports currently out for consultation. The taskforce itself will consider at least 24 reports from clinical committees and working groups this year, 2019, and make final recommendations to government.

Each taskforce member has been involved in many of the committee meeting and Dr Chew and I also contributed to the recently published Phase Two report from the General Practice and Primary Care Consultative Committee.

The committee’s vision for the future of primary health care in Australia is for a primary health care system that provides continuing care for the person rather than episodic treatment for illness. It is a system that is supported to emphasise

prevention and health promotion in addition to disease management and one that focuses on outcomes rather than process and one that provides collaborative team based care integrated into the larger health system.

All the general practice recommendations are intended to support a significant investment in general practice, noting the potential for financial and non-financial benefits downstream in the health system by investing in primary care. There is strong evidence that high quality, patient-centred primary health care is key to improving effectiveness of care, preventing illness, and reducing inequities, variation and costs.

The general practice recommendations are also intended to support the components of practices that are drivenby the goal of quality improvement. These include engagement in research and teaching, continuous quality improvement and self-reflective practice. The Committee

recognises the need for more proactive engagement in prevention, especially in the context of chronic disease. They also support shared patient-doctor decision-making and informed patient consent.

This work and the work of all the committees has proven to be a monumental, but highly important task. We could not pass up this unique opportunity to update the schedule based on the most contemporary evidence and research currently available. It is also focussing minds on redoubling efforts to ensure Australia’s Medicare system puts the needs of patients first, while ensuring the financial sustainability of our universal public health system into the future.

ADJUNCT PROFESSOR STEVEN HAMBLETON Deputy Chair MBS Taskforce, Past President, AMA Queensland and AMA

1. https://www.safetyandquality.gov.au/atlas/ 2. http://www.health.gov.au/internet/main/ publishing.nsf/Content/MBSR-consult-2018taskforce-reports

Doctor Q Autumn 17

Pre-budget submission Every year, AMA Queensland provides the Queensland Government with a budget submission which outlines where we think funding is best placed to strengthen the health system and improve patient outcomes.

K E Y R E C O M M E N D AT I O N S

1

M A N D AT E W AT E R F L U O R I D AT I O N

Legislate to mandate fluoride back into water supplies across Queensland and provide assistance to councils to help them meet costs.

2

HELP GPS GET REAL TIME READY

Queensland is likely to introduce real time prescription monitoring (RTPM) in 2020. To ensure a smooth and seamless transition to the RTPM system, Queensland Health should develop a targeted information campaign to assist prescribers with knowledge of the new system and their medico-legal responsibilities.

3

P U B L I C H E A LT H A W A R E N E S S C A M PA I G N O N O B E S I T Y

AMA Queensland calls on the Government for assistance in funding and developing an innovative education and awareness campaign to help combat the obesity epidemic facing Queensland. The campaign would be developed and rolled out in partnership with Queensland Health.

4

W E L L B E I N G AT W O R K

AMA Queensland is seeking Government support to expand this successful program, which provides interns with the resilience and coping skills needed to survive and thrive in the field of medicine to PGY2 to 5.

5

GRANTS TO LOCAL COUNCILS FOR V I T A L P U B L I C H E A LT H I N I T I AT I V E S

AMA Queensland sees an opportunity for the Queensland Government to encourage local councils to invest in consistent public health infrastructure, such as drinking fountains and better-lit exercise routes and gym equipment.

6

A D D S P I N A L M U S C U L A R AT R O P H Y TO NEWBORN HEEL TEST

New South Wales and the Australian Capital Territory have added Spinal Muscular Atrophy (SMA) to the newborn heel prick test, in a bid to give children diagnosed with this condition the best chance in life. AMA Queensland recommends Queensland follow their lead and ensure that the same opportunity is afforded to Queensland newborns.

7

S U S T A I N A B I L I T Y I N H E A LT H C A R E

Establish an Office for Sustainable Healthcare (OSH) and Regional Sustainability Units (RSU) to reduce costs to Queensland Health in energy use and climate change emissions.

Y O U C A N R E A D T H E F U L L 2 0 1 9 B U D G E T S U B M I S S I O N AT W W W. A M A Q . C O M . A U 18 Doctor Q Autumn

“

I’m honoured to be joining Gold Coast Spine.

It’s an internationally-renowned practice with a proud record of evidence-based medicine and patient-centred care.

”

Asst Prof. Mario Zotti Orthopaedic surgeon (spine)

Gold Coast Spine welcomes Assistant Professor Mario Zotti MBBS, MS (Orth), FRACS, FAOrthA to its Southport practice.

Asst Prof. Zotti is an orthopaedic surgeon with first class honours in medicine from Monash University prior to completing his specialist orthopaedic training in South Australia.

Having completed a PFET accredited spinal fellowship with Associate Professor Matthew Scott-Young at Gold Coast Spine in 2018, Asst Prof. Zotti is now welcoming new appointments including Department of Veterans’ Affairs and workers’ compensation referrals.

Asst Prof. Zotti has clinical interests in: • neck and back conditions (degenerate & deformity) • radiculopathy/sciatica (arm & leg pain) • sacroiliac joint dysfunction • urgent spinal conditions (trauma, tumour, infection).

Also an honorary adjunct professor at Bond University, Asst Prof. Zotti visits Pindara Private Hospital, Gold Coast Private Hospital and John Flynn Private Hospital.

phone: 1300 281 979 email: info@goldcoastspine.com.au web: goldcoastspine.com.au facebook: @GoldCoastSpine Southport Central, Level 5, Building G 27 Gaden Street, Southport QLD 4215

MOCA 5 final update The Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ), in partnership with AMA Queensland are pleased to announce the MOCA 5 is nearing completion.

DIGITAL RECALL After months of negotiations, ASMOFQ and AMA Queensland can confirm that Queensland Health has agreed to the wording for Digital Recall, which is a significant win for both RMOs and SMOs. WIN for RMOs and SMOs Queensland Health had proposed alternative wording, which removed RMOs from accessing the entitlement and made it difficult for SMOs to claim this new entitlement. However, after a united push from both Unions, Queensland Health has accepted the Digital Recall clause listed below.

11.19.4.1 A medical officer on call and who is recalled to perform duty and is able to perform that duty using appropriate (meaning suitable or right for

a particular situation or occasion) digital resources without the need to leave their residence and/or without the need to return to the facility will be remunerated for the digital recall accordingly: *RMO - a minimum of 30 minutes at applicable overtime rate of the relevant base rate for each time the employee performs such duties. *SMO - a minimum of 30 minutes at 270 per cent of the relevant base rate for each time the employee performs such duties.

An exception to this is any digital recall within the minimum period of thirty minutes shall not be regarded as a separate digital recall.

G R A N T E D P R I VAT E PRACTICE AGREEMENT (GPP AGREEMENT) ASMOFQ has raised significant concerns with the GPP Agreement, specifically clause 10.2(e), which provides: The Employer may terminate the Medical Officer’s Granted Private Practice agreement by giving the Medical Officer notice in writing, effective from the date specified in the notice, if (e) the Certified Agreement is terminated or replaced.

Queensland Health has confirmed that the GPP Agreements will continue. In consultation with ASMOFQ, Queensland Health is proposing to implement a Health Employment Directive (HED) to apply to SMOs who have not been issued with a new GPP Agreement when the MOCA 5 is certified.

ASMOFQ will not support the termination of MOCA 4 until we are satisfied with the HED and new GPP Agreements to ensure our members are not disadvantaged.

20 Doctor Q Autumn

11.19.4.2 For the purpose of clarity, digital recall includes, but is not limited to, work that requires access, review and/or creation of a record containing a patient’s medical information, care or treatments received, test results, diagnoses, and/or medications taken and includes clinical decision documentation. Examples of digital recall include, but are not limited to, participating in an after-hours state wide service such as the alcohol and drug clinical advisory service and/ or reviewing and providing advice on medical images.

Once MOCA 5 has been certified by the Queensland Industrial Relations Commission (QIRC), if members experience any issues with the payment of this new entitlement email us at asmofq@amaq.com.au

NEXT STEPS - APPROVAL PROCESS FOR MOCA 5 1. ASMOFQ will review the final draft MOCA 5 document and make any necessary changes in line with the intent during the negotiation process.

2. Upon finalisation of the MOCA 5 draft document, ASMOFQ in consultation with Queensland Health will engage in a consultation process with members, whereby the significant changes within the document will be explained in detail. The consultation period will last two weeks.

3. Following the consultation period, eligible employees will vote on the MOCA 5 Agreement.

4. Provided the MOCA 5 Agreement receives a majority vote in support, the Agreement will be provided to the Queensland Industrial Relations Commission (QIRC) for certification.

5. Once the MOCA 5 Agreement is certified, the terms and conditions will be applicable to Queensland Health RMOs, SMOs, MSPP and MOPP. We invite members to contact us directly on (07) 3872 2222 or email moca5@amaq.com.au if you are uncertain what the MOCA 5 means for you or require clarification regarding any of the clauses.

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Doctor Q Autumn 21

AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING

Making a difference AMA Queensland’s Council of Doctors in Training (CDT) had a busy 2018 with the MOCA 5 negotiations, another successful Junior Doctor Conference, our Surviving Rural Relieving and Thrive in your Junior Doctor Years seminars, the third annual Resident Hospital Health Check and our overtime awareness campaign.

We have another full year planned ahead for our members including the following events and services: Teaching and Mentoring - Practical Skills for Junior Doctors Seminar – 4 April; Junior Doctor Conference and inaugural Queensland Medical Careers Expo where we will have the colleges present to give tips and tricks about applying to their programs – Saturday 15- Sunday 16 June 2019 at Hilton Brisbane;

DR HASHIM ABDEEN Chair, AMA Queensland Council of Doctors in Training

Resilience on the Run – our AMA Queensland wellbeing program available to all interns via their hospital and health service; and Many more advocacy campaigns alongside our 2019 Resident Hospital Health Check.

AMA Queensland members get special discounts and access – so don’t forget to renew or sign up as soon as possible!

2019-20 CDT COUNCIL We are currently processing nominations for representatives on the 2019-20 Council of Doctors in Training (CDT), as well as representatives for: each hospital; events and training; communications;

industrial relations; and rural and remote doctors.

We are here to work on the big workforce issues that impact you as a doctor in training and to improve your working conditions and career prospects.

For further information, contact us at cdt@amaq.com.au or on (07) 3872 2222.

I also wanted to thank our outgoing CDT Chair Dr Chris Maguire for his contribution over the past year as Chair. We wish him the best of luck in his career and welcome his input as the immediate past chair.

As you can see, 2019 is going to be a busy year for the AMA Queensland Council of Doctors in Training. Please keep an eye out for expressions of interest for our hospital representative positions and also executive elections. If you have any feedback or would like to get in contact with the CDT – please contact us via email (cdt@amaq.com.au) or through your hospital reps.

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22 Doctor Q Autumn

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Engaging with clinicians: imperative for health systems Dr Alex Markwell was appointed Chair of the Queensland Clinical Senate in January 2019. She replaces Dr David Rosengren who held the position for six years. Dr Markwell is an emergency physician at the RBWH and former president of the AMA Queensland. Dr Markwell can be contacted via the Senate at qldclinicalsenate@health.qld.gov.au

the most respected and productive clinician bodies in Australia—has had a huge impact on the health system in Queensland.

As Queensland Health’s strategic clinician advisory body, the senate has helped to identify real improvements in the way clinicians deliver care. In partnership with consumers, clinicians and managers, this has been translated into improved outcomes for patients, and has included: Throughout my career in medicine, I have had constant reminders about why clinician engagement is so vital to our health system and our patients.

With the absolute best of intentions, health administrators and project managers have ideas that are great on paper but in reality, don’t always translate into effective clinical practice.

Reason being; only the users clinicians and consumers - can truly road test the concept. So much of health care and medicine is not coded or explicit. Anyone starting a new medical job will relate to the enormous amount of information that is implicit and not written down in any manual or handover notes.

Clinicians will often have a unique take on a situation and, given a voice and access to the decision makers, can have a tremendous, positive impact.

Since its inception 10 years ago, the Queensland Clinical Senate—one of

24 Doctor Q Autumn

GP access to The Viewer; publicly funded bariatric surgery for a defined group of people; a community education program about end of life care, including a charter for end of life care for adults and children; funding to support the implementation of innovative models of integrated care; an evidence-based review of the quality of patient health outcomes related to National Emergency Access Targets (NEAT), resulting in a revised NEAT target of 80 per cent; and a charter of clinical requirements for digital health.

The Accelerated Chest Pain Risk Evaluation (ACRE) is another great example of how clinician engagement can positively impact on patient care.

Led by a team of clinicians, the ACRE

DR ALEX MARKWELL Chair of the Queensland Clinical State

project has changed the way patients presenting to emergency departments in Queensland hospitals with possible cardiac chest pain are assessed.

Emergency department staff now use the most current, evidence-based advanced diagnostic protocol to assess patients. The result has been reduced length of stay and hospital admissions.

Engagement that is meaningful and part of the planning process can be the difference between a project that fails and one that translates into positive patient outcomes.

Clinician and consumer engagement, particularly with Aboriginal and Torres Strait Islander peoples and health workers, must continue to be a routine aspect of health-care planning that is genuinely valued by health system architects.

As I take the reins of the Queensland Clinical Senate, I am acutely aware of the ever-increasing pressures facing healthcare funding that drive the need for more efficient and effective health care. But we must ensure this doesn’t compromise patient outcomes. And I believe this is a vital and ongoing focus of the senate.

For more information about the Senate visit: https://clinicalexcellence. qld.gov.au/priority-areas/clinicianengagement/queensland-clinicalsenate.

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Below industry average premium increases For the last seven years we’ve delivered below industry average premium increases for our members, whilst continuing to provide quality products and expert service.

Your provider, your choice We believe you know best who should treat you. We advocate for clinical independence and freedom of choice with no restrictive preferred provider networks for your extras cover.

94% Member Satisfaction Rating In addition to our quality cover we also provide exceptional service to our members, which is why we have been able to 2 maintain a member satisfaction rating of above 94%* for more than 8 years.

Unique medical gap benefit Our premium Top Cover hospital provides the highest level of hospital cover and pays a medical gap benefit based on the AMA list of medical services and fees.

receive a Westfield XS Eftpos Gift Card* BRONZE PLUS GOLD

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Join the health fund created exclusively for the medical community by calling

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or visiting doctorshealthfund.com.au

1 www.health.gov.au - Average premium increases by insurer by year 2 Doctors’ Health Fund Member Satisfaction Survey 2011-2018 *To be eligible for the offer, the cover start date and join entry date must be between 12.59 AM (AEST) 4 March 2019 and 11.59 PM (AEST) 30 April 2019. This offer is only available to those eligible to join Doctors’ Health Fund and who do not currently hold, or have in the last 12 months held, insurance with Doctors’ Health Fund. The new member must take out combined Hospital and Extras cover to be eligible for the Gift Card, and must be active and financial for 12 continuous weeks before the gift card will be issued. Only one Westfield XS Eftpos Gift Card will be provided per policy as follows: a) $200 when purchasing a single Smart Starter hospital cover and any extras cover policy; b) $400 when purchasing a couples Smart Starter hospital cover and any extras cover policy; c) $300 when purchasing a single Prime Choice hospital cover and any extras cover policy; d) $600 when purchasing a couples/family/single-parent Prime Choice hospital cover and any extras cover policy; e) $400 when purchasing a single Top Cover hospital cover policy and any extras cover policy; or f ) $800 when purchasing a couples/family/single-parent Top Cover hospital cover and any extras cover policy. If the level of cover changes within the first 12 weeks, the value of the gift card will be determined by the lowest level of cover held in that period. This offer is not available with other offers. You should look to the product issuer for all warranties, terms and conditions. The Westfield XS Eftpos Gift Card is valid for redemption 3 years from issue. Westfield Gift Card terms and conditions apply, for more terms and conditions, visit www.westfieldgiftcards.com.au. Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group.

Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy. For full terms & conditions visit www.doctorshealthfund.com.au/xs-giftcard DHF 265_2/19

Do you remember your first day?

Over 700 interns in Queensland have now started the first job of their medical careers. Those I have spoken to at intern orientation events, have expressed a range of emotions – excitement, trepidation, relief and in some cases sheer terror. I’m sure even those readers for whom the intern year is a very distant memory can still recall the emotions of those first days!

In online medical literature, blogs and social media there is a vast outpouring of advice, tips and words of encouragement for these new interns from those who have trodden this path before. Comments range from the philosophical “medicine is a team sport, not a tribe of individual soldiers” to the practical “work out a system to organise and carry your paperwork” and not forgetting perhaps the most crucial advice of all “never take the last chocolate”.

Initially, it is often not the acquisition of new clinical skills and knowledge that occupies the most mental load, but rather the seemingly menial environmental and cultural factors that have to be consciously considered, time and again, before they become familiar and automatic. This can be as mundane as “where on earth are the green cannulas kept on this ward?” to the more significant “who do I feel comfortable turning to when I need advice and support?”

Of course, this won’t be the last time the interns of 2019 find themselves in uncharted waters. Transitions occur repeatedly throughout the arc of a medical career and each time we do so we have to familiarise ourselves with a new microculture, that is to say, ‘the way things are done around here’.

26 Doctor Q Autumn

Whenever we are in the position to do so, those of us more settled in our roles can and should help our colleagues to navigate these tricky transition periods, whatever career stages they are moving between. By taking the time to reflect on our own experiences of being ‘the newbie’ we can be better placed to offer support, advice, and maybe even compassion and understanding when pointing out for the fourth time where the cannulas are kept…

Each time we model collegiality and compassion with our new colleagues we are helping to positively influence some key drivers of physician engagement.* Dr Tait Shanafelt, the first ever Chief Wellness Officer at Stanford Medicine, outlines the key drivers of physician engagement as follows: workload and job demands; efficiency and resources; meaning in work; culture and values; control and flexibility; social support and community at work; and work-life integration.

When these drivers become less optimal over time, we start to see the symptoms of burnout – exhaustion, cynicism and inefficiency, which in turn can have repercussions not only for the individual doctor, (effects on mental health, professional efficacy and relationships) but for the system (decreased patient satisfaction, decreased productivity and increased physician turnover5). Whilst many of these drivers are at the organisational and systems levels, we each have

VICKY DAWES Education Officer, Queensland Doctors’ Health Programme

QDHP

Queensland Doctors’ Health Programme

24/7 HELPLINE (07) 3833 4352

a significant role in influencing the practice environment through collegiality, culture, social support and sense of community in our workplaces.

Only then can our new colleagues feel safe and supported enough to focus on the important business of becoming engaged physicians who practice with vigour, dedication and absorption.

Perhaps we should be shifting the focus away from the ever-expanding list of tips and tricks for our new colleagues to try to remember, and instead developing our own pearls starting with ‘remember this can be a trying time, act with compassion and understanding’?

The Queensland Doctors’ Health Programme provides a confidential 24/7 helpline for Queensland doctors and medical students. For more information, visit www.dhasq.org.au or email: admin@qdhp.org.au * Physician engagement as defined by Shanafelt comprises vigour, dedication and absorption.

References 1. https://www1.racgp.org.au/newsgp/professional/ why-mastery-of-medicine-is-a-dangerous-myth 2. http://www.ashleighwitt.com/2015/01/about-tobecome-real-doctor.html 3. https://twitter.com/onthewardsorg/ status/1087185825316560896 4. Shanafelt, T. D., & Ceo, J. H. N. (2017). Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings, 92(1), 129–146. http://doi.org/10.1016/j. mayocp.2016.10.004 5. https://www.psychology.org.au/inpsych/2014/ december/phwp

GREATER SPRINGFIELD MEDICAL & OFFICE SUITES Mater applauds Springfield City Group for the establishment of the specialist suites adjacent to Mater Private Hospital Springfield.

The hospital is looking forward to productive conversation and partnerships with doctors who move into this facility.

Justin Greenwell Director, Mater Private Hospital Springfield

Sale I Lease I Invest

Be part of Australia’s largest integrated health and wellness precinct.

Purchase or lease your own medical suite in the heart of Health City in Springfield Central at the new Greater Springfield Specialist and Office Suites.

Now open, this brand new facility is directly adjacent to the Mater Private Hospital Springfield, AVEO Springfield, Quest Apartments and childcare.

With areas from 34m2 to whole floors of 474m2 over five levels (above ground floor retail and car parking), don’t miss this unique opportunity to grow your patient base in the heart of South East Queensland’s growth corridor.

To book an inspection or to request a brochure contact Uma Ranchigoda on 0412 470 882 or visit gssuites.com.au

www.gssuites.com.au

Managing bullying allegations R E A S O N A B L E M A N AG E M E NT ACT I O N TA K E N I N A R E A S O N A B L E WAY It’s expected that an employer may need to take reasonable management action from time to time.

It is reasonable for managers and supervisors to allocate work and give feedback on a worker’s performance.

These actions are not workplace bullying if they are carried out in a lawful and reasonable way.

A manager exercising their legitimate authority at work may cause some discomfort. The question of whether management action is reasonable is determined by considering the actual management action rather than a worker’s perception of it, and where management action involves a significant departure from established policies or procedures, whether such a departure is reasonable in the circumstances.

28 Doctor Q Autumn

Examples of reasonable management action include but are not limited to: setting realistic and achievable performance goals, standards and deadlines; fair and appropriate rostering and allocation of working hours; transferring a worker to another area or role for operational reasons; deciding not to select a worker for promotion where a fair and transparent process is followed; informing a worker about unsatisfactory work performance in an honest, fair and constructive way; informing a worker about unreasonable behaviour in an objective and confidential way; implementing organisational changes or restructuring, and

taking disciplinary action, including suspending or terminating employment where appropriate or justified in the circumstances.1 It is not uncommon to find that although an action is regarded as reasonable, the way in which it was delivered is found to be unreasonable.

The term ‘in a reasonable way’ is best characterised as: use of a fair process (procedural justice); applying the process consistently (distributive justice); treat parties fairly during interactions (interactional justice); and providing parties relevant information (informational justice).

W H A T T O D O I F T H E R E I S B U L LY I N G , O R R E P O R T S O F B U L LY I N G , A T W O R K

T A K E C A R E O F H E A LT H AND WELLBEING

Employers and principals have a duty of care to provide a safe workplace under Work Health and Safety laws and are encouraged to respond quickly and appropriately to issues of bullying.

Bullying at work is a serious issue that can affect the health and wellbeing of targets. Dealing with serious bullying can affect a target’s capacity to perform their duties and it is not unusual for bullying matters to become apparent to employers as a result of performance management processes. Having allegations of bullying conduct made against you is also a difficult matter to deal with.

When responding to bullying grievances or stop bullying applications to a commission, all parties should consider that the purpose of the anti-bullying jurisdiction is to preserve and promote mutually safe and productive working relationships.

Employers and principals should note that when dealing with an application for an anti-bullying order, the commission takes into account what, if any, action has already been taken to prevent further bullying behaviour. In cases where employers have already taken positive action to resolve issues of bullying, the commission may find that orders are not required.

Employers and principals should also note that a worker who has made a bullying application may have exercised a workplace right, and that any adverse actions taken against such a worker may be a breach of the general protections provisions of the industrial relations legislation applying to their employment.

As previously identified, bullying conduct is also covered by Queensland Health and Safety Legislation and Workers’ Compensation3. A finding against an employer arising from a stop bullying application may lead to fines and increased workers’ compensation premiums so it is important that employers are aware of the risks and take reasonable steps to manage the risk in their workplaces.

Workplace bullying has always existed but has only recently been recognised as having substantial cost to the community.

The resolution processes are still evolving and it is often left to a target to manage the process. This situation may lead to further damage to health and wellbeing.

The most recent theory on managing bullying comes from the United States4 and recommends that: the bullying behaviour needs to acknowledged and named; the target should seek assistance from counsellors and health professionals to manage stress related health issues; the target should raise their concerns with their employer in a documented grievance; and targets should not directly address the bullying conduct with the perpetrator.

1. https://www.worksafe.qld.gov.au/injury-prevention-safety/mentalhealth-at-work/tools-and-resources/workplace-bullying 2. ss17 - 19, Work Health and Safety Act 2011(Qld).

3. s32, Workers’ Compensation and Rehabilitation Act 2003 (Qld).

4. The WBI 3-Step Target Action Plan, Workplace Bullying Institute online <http://www.workplacebullying.org/individuals/solutions/ wbi-action-plan/>

If you have been subjected to bullying in your workplace and would like advice on how to handle it, please contact the Workplace Relations Team at AMA Queensland on (07) 3872 2211 or email workplacerelations@amaq.com.au.

If you require assistance to understand the impact of bullying, we recommend that you AccessEAP (employee assist program) through your workplace or the Queensland Doctors’ Health Programme (QDHP) to talk through your experiences.

Doctor DoctorQQAutumn Spring 29

Health, climate change and our role In the last year Queensland has had drought, floods, heat and bushfires in an unprecedented manner. Much of the Great Barrier reef has died due to increased sea temperature and acidity.

Across Australia, similar extreme weather has had severe effects with the drying up of the Murray Darling system and huge bushfires in Tasmania. Australia has always experienced droughts, fire and flood, but a warming climate has increased the frequency and intensity of events – it is ‘loading the dice’.

Climate change is happening faster than we thought, with climate impacts predicted to be much worse over the next few decades. This has widespread health, social and economic impacts. These are particularly felt in rural and remote communities but also by those who are vulnerable: the elderly, young, the indigenous and those with chronic illness.

Health effects can be direct, such as heat exhaustion, burns in fires and air pollution, or indirect, such as increased range of vector borne infections to persisting mental health burden following extreme weather events (eg suicide and depression in rural areas during prolonged drought.)

Doctors and health care professionals need to understand and respond to this major public health challenge, the biggest global health threat of the 21st century.

As parents and grandparents, we all need to urge mitigation measures that enable our children and grandchildren a similar health and liveability opportunity as we have had, that is intergenerational equity.

Doctors need to provide leadership through advocacy to the community and our decision makers on climate change, just as we did with cigarettes, seat belts, lead, asbestos and other public health problems dating back to John Snow and the Broad St pump. As with all our public health advocacy, we need to premise this on the best science. We have the evidence that climate change is occurring due to man-made emissions and that there is an

30 Doctor Q Autumn

urgency in reducing fossilfuel use. Collectively it is time for doctors to reduce health sector emissions and advocate for policies that reduce emissions across all sectors.

DR MICHAEL WILLIAMS Paediatrician, Doctors for the Environment Australia

The health sector alone contributes seven per cent to Australia’s carbon emissions, especially hospitals.

The UK NHS has for 10 years not only reduced their greenhouse gas emissions, but also saved £90 million annually, with improved clinical outcomes. We need to emulate this in Queensland, building in such Sustainable Healthcare processes into Queensland Health, our hospitals and health centres. This can occur with advocacy to government as well as from us all to our health services. The areas to focus on are energy (with use of renewable energy) and water use, waste, transportation, food, pharmaceuticals and purchasing. Queensland through its leadership in telehealth has demonstrated an example of sustainable health care. Our telehealth has enabled good clinical care to be delivered to patients in their community, saving money, while reducing carbon emissions.

Others have provided examples for us to follow, including the Mater Health Services in Brisbane.

In moving to sustainable health care, we will convey to the community the message that care for our environment, especially our climate, is a preventative health priority, just as was banning smoking in and near hospitals. We can further inform ourselves through the information on the Doctors for the Environment Australia website (www.dea.org.au). Currently DEA has a campaign called ‘No Time for Games’. We encourage all doctors and students to add their signature to this pledge which will be presented to our political leaders. As healthcare professionals we need to bring to the public climate change discussion the important message of its serious health impacts to all in our global community and demonstrate by our actions.

Research round up Research Review Australia is an independent publishing organisation that puts together clinical research updates for Australian health professionals across more than 50 clinical areas.

Every month the publications feature a local expert’s chosen ten research papers from global journals with their commentary on the impact to everyday practice.

We have handpicked some key research articles from recent editions that are a ‘must see’ for those working in various clinical areas:

T I M E D E L AY S I N LU N G C A N C E R R E F E R R A L I N A N O RT H Q U E E N S L A N D S T U DY Australian study in Lung Cancer Research Review Issue 29 Reviewer: Dr Malinda Itchins In Australia, the five-year survival for lung cancer is four per cent lower in remote Australia and worse again in Indigenous communities. This large, prospective study sought to further understand referral patterns and explanations for delays, including patient perceptions. GP delays were identified due to underreporting of symptoms by patients, which was comparable between urban and rural and occurred in at least half, however, rural patients were less likely to be ‘doctor people’ and misunderstanding of symptoms was more common with rural GPs. Distance was cited as a significant barrier to receiving medical care in rural areas, including also the financial barrier.

Educational campaigns aimed at improving symptom recognition among all populations (both rural and regional) may address the issues identified in this report, which is a valuable Australian study serving to raise awareness and may improve resource allocation to areas of need, harmonising patient care.”

H E A LT H Y L I F E S Y L E F A C T O R S A S S O C I AT E D W I T H L O W E R R I S K O F C O LO R ACTA L C A N C E R I R R E S P E CT I V E OF GENETIC RISK Gastroenterology Research Review Issue 63 Reviewer: Dr Ian KC Fok CRC is the third most common cancer in Australia where one in 23 Australians will develop bowel cancer in their lifetime.

Smoking and alcohol are modifiable behavioural factors that have been shown to increase the risk of multiple cancers; their associated link with bowel cancer here is not unusual or unexpected. Obesity is linked with not only an increased risk of bowel cancer but also an earlier age at diagnosis; both obesity and smoking are risk factors for sessile serrated adenomas.

Environmental risk modification is useful in augmenting the strategies we have in lowering the risk of bowel cancer in atrisk individuals with a significant family history.

M S U D E P O S I T S I N A S Y M P T O M AT I C S O N S O F G O U T PAT I E N T S Rheumatology Research Review Issue 100 Reviewer: Professor Peter Youssef There is just no escaping our genes. I was not surprised by the finding that about two-thirds of the sons of gout patients had a serum urate above 0.36 mmol/L. This study nicely demonstrates that crystals are first laid down in the first metatarsophalangeal joints and during the third decade of life. However, what was interesting was that some of the subjects were laying down crystals at urate levels between 0.30 and 0.36. It is possible that these subjects had higher urate levels previously, although no MSU crystal deposition was seen at serum urate levels of <0.30. This study suggests that ultrasound may provide a screening tool for asymptomatic subjects likely to develop gouty arthritis. What is unclear is whether these should trigger an intervention.

Current and back issues of Research Reviews can be found at www.researchreview.com.au Australian health professionals can sign in and download copies.

32 Doctor Q Autumn

Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 to inspect or discuss further.

An opportunity to practice in Upper Mount Gravatt, is available now. The Centre for Minimally Invasive Neurosurgery and Spine Surgery (CMINS) is located at Level 3, 12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis.

Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists. CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care. Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design.

Other features include:     

On-site Parking.

State of the art phone system.

Lift access providing accessibility for all patients.

Large kitchen and staff common area.

Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices.

Other nearby specialities include: Neurosurgery An opportunity to practice in Upper Mount Gravatt, is available Neurology  Ophthalmology now. The Centre for Minimally Invasive Neurosurgery and Spine Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 or discuss Surgery (CMINS) is located atto inspect Level 3, further.

12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis.

Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists.

CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care.

Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design.

Other features include: On-site Parking.

State of the art phone system.

Lift access providing accessibility for all patients.

Large kitchen and staff common area.

Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices.

Other nearby specialities include: Neurosurgery Neurology Ophthalmology

Doctor Q Autumn 33

Member news

Queensland Health employees can now pay their membership via fortnightly payroll deductions. These deductions are tax deductible and will appear on your group certificate at the end of the financial year. If you would like to pay your membership fees via payroll deductions, please contact the AMA Queensland Membership Team at membership@amaq.com.au or phone (07) 3872 2222 for a payroll deduction form.

There is no penalty fee for paying by this method.

refer a member AND RECEIVE A DISCOUNT ON YOUR MEMBERSHIP RATES

ong r t s ip h s r e b m e keep our m !

y a d o t h c t i w s make the AUSTRALIA DAY AWA R D S Congratulations to our members who received honours in the Australia Day awards.

34 Doctor Q Autumn

Associate Professor Beverley Rowbotham AO for distinguished service to medicine through roles with professional associations, to pathology, and to medical education.

Group Captain Gregory Vincent Hampson AM for exceptional performance of duty in the development and sustainment of clinical aviation medical services in the Australian Defence Force.

REFER 1 MEMBER

REFER 2 MEMBERS

25% discount on your membership

50% discount on your membership

REFER 3 MEMBERS

REFER 4 MEMBERS

75% discount on your membership

No membership fee for one year

Dr Roger Konrad Wilkinson AM for significant service to medicine as a cardiovascular surgeon, and to the community.

Dr Ian Lintern Airey OAM for service to the community through the Wesley Mission Queensland.

Dr Eleanor Chew OAM for service to medicine in the field of general practice.

Dr Steven Miles Coverdale OAM for service to medicine on the Sunshine Coast.

Dr Peter Charles Marendy OAM for service to medicine, and to the community.

Dr Dinesh Bandara Palipana OAM for service to medicine.

Dr Gregory John Thompson for service to sport through a range of organisations.

OBITUARY

Dr John Herron AO M B B S F R A C S F R C S F R C S E FA M A 4 September 1932 – 25 February 2019 AMA Queensland Past President 1988-89 Dr John Joseph Herron AO was born in Home Hill in 1932 and was educated at the University of Queensland where he graduated in medicine and surgery in 1956. He trained at Royal Brisbane Hospital and Princess Alexandra Hospital before travelling to England and working as a surgical registrar. On returning to Queensland in 1963, he was the first research fellow in the Queensland Melanoma Project.

He was appointed as a visiting surgeon to Princess Alexandra Hospital in 1968 and worked at several practices along Wickham Terrace, before going into partnership with fellow surgeon Jon Cohen, where they established what became the largest private practice at the time, at Athol Place. He was appointed Chief Surgeon at the Mater Public Hospital in 1974.

Dr Herron served as AMA Queensland President in 1988-89; and on AMA Federal Council. He was a Life Member for 62 years; and received the Bancroft Medal from AMA Queensland and a Fellowship of the AMA. He was Chairman of the Royal Australasian College of Surgeons and the Australian Association of Surgeons of Queensland. He was an officer in the Royal Australian Army Medical Corps and a squadron leader in the Royal Australian Air Force.

He was a Fellow of the Royal Australasian College of Surgeons, The Royal College of Surgeons England, and the Royal College of Surgeons of Edinburgh.

He was awarded the Justin Fleming Medal from the Australian Association of Surgeons in 1978; and a Citation by the Royal Australasian College of Surgeons; and was an honorary member of the Australasian Stomal Therapy Nurses Association.

Dr Herron was President of the Liberal Party in Queensland from 1980 to 1983 and was an Australian Senator from 1990 – 2002, representing Queensland. From 1996 to 2001, he was the Minister for Aboriginal and Torres Strait Islander Affairs. From 2002 to 2006, he was the Australian Ambassador to Ireland and the Holy See, before returning to Australia and taking up a post as Chairman of the the Australian National Council on Drugs, and The Royal Brisbane and Women’s Hospital Foundation.

In 1994, he worked as a volunteer doctor in Rwanda, where he saw the aftermath of some of the atrocities committed there, an experience that would lead him to push strongly for Australia’s support for the creation of the International Criminal Court. Later, he received the Humanitarian Overseas Medal for his service as a Care Australia medical officer during the Rwandan crisis and the Australian Service Medal.

Dr Herron was a Knight Commander of the Order of the Holy Sepulchre of Jerusalem, and during his tenure as Australian Ambassador to Ireland and the Holy See was made a Papal Knight of St Gregory.

In 2012, he was named an Officer of the Order of Australia for distinguished service to the Parliament of Australia, to international relations through diplomatic and humanitarian roles, to professional medical associations, and to the community. The Australian Catholic University granted him their highest honour, Doctor of the University.

Following a hospital stay four years ago at the age of 82, he established a Medical Almoners Group comprised of medical practitioners who were prepared to visit colleagues in hospitals and nursing homes.

According to his daughter Catriona, he always considered his greatest achievement his happy marriage (he and his wife recently celebrated 60 years of marriage), raising a successful loving family, and his 24 grandchildren.

“He will be remembered for his enduring sense of humour, his enormous generosity, his unfaltering faith and his unshakeable integrity.

“Known for his meticulous planning, his annual re-visiting of his five-year plan, his ‘Map for Life’, his extensive journaling in diaries that he has written every day for the past 55 years, and for being highly organised, he directed his own departure from this life, surrounded by family and holding Jan’s hand, exactly as he planned it,” said Catriona.

Doctor Q Autumn 35

Local Medical Association Tour In February, Dr Dhupelia attended the inaugural combined meeting of the Gold Coast Medical Association (GCMA) and General Practice Gold Coast (GPGC). It was a very positive and productive gathering.

In March and April, he will concentrate on assisting to reinvigorate the LMAs in Townsville, Mackay and Bundaberg, as well as visiting the Cairns Local Medical Association.

Drs Katrina McLean and Philip Morris, AMA Queensland President Dr Dilip Dhupelia and Dr Geoff Adsett.

These visits are a unique opportunity to gain firsthand feedback from members on important local issues.

Local Medical Association round up Redcliffe District Local Medical Association (RDLMA)

Ipswich & West Moreton Medical Association (IWMMA)

Contact:

Contacts: Dr David Morgan, President; Dr Aletia Johnson, Meetings Convenor; Dr Thomas McEniery, Treasurer Phone: (07) 3281 1177

Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3049 4444

Sunshine Coast Local Medical Association (SCLMA) Contact: Jo Bourke, Secretariat Web: www.sclma.com.au Email: jobo@squirrel.com.au Phone: (07) 5479 3979 Meetings: 28 March 2 May 30 May

Gold Coast Medical Association (GCMA) Contact: Professor Philip Morris Web: www.gcma.org.au Email: info@gcma.org.au Phone: 5531 48380

Mackay Local Medical Association (MLMA) Contact: Phone:

Dr Bill Boyd 0419 676 660

36 Doctor Q Autumn

Brisbane Local Medical Association (NLMA) Contact:

Dr Robert (Bob) Brown, President Phone: (07) 3121 4029 Meetings: 9 April 11 June

13 August

8 October

10 December

Fraser Coast Local Medical Association (FCLMA) Contact: Dr Nicholas Yim, Secretary Email: drnnyim@gmail.com Phone: 0421 659 892

Toowoomba and Darling Downs Local Medical Association (TDDLMA) Contacts: Dr Mark Wyche, President; Dr Peter Schindler, Treasurer Web: www.tddlma.org.au Email: info@tddlma.org.au Phone: (07) 4633 1939

Wilsonton Medical Centre (Dr Peter Hopson)

Cairns Local Medical Association (CLMA) Contact: Phone:

Dr David Shepherd (07) 4031 8400

Central Queensland Local Medical Association (CQLMA) Contact: Phone:

Dr Michael Donohue 0419 715 658

CANâ&#x20AC;&#x2122;T FIND YOUR LOCAL AREA? If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au.

NEW CONTENT FROM

Therapeutic Guidelines Therapeutic Guidelines recently published new content on eTG complete including the release of the new diabetes guidelines, as well as updated topics in the ulcer and wound management guidelines.

Diabetes, version 1 is packed with new information on hospital and community care, including the management of drug-induced hyperglycaemia. Check out the new comparative drug table, designed to help with treatment selection in patients with type 2 diabetes.

Ulcer and Wound Management, version 2 has been extensively revised.

Focusing on individualised patient-centred therapy, it includes advice on how to optimise the treatment and prevention of common ulcers and wounds including skin tears, surgical wounds, abrasions, haematomas and pressure injuries. Also included is a new topic on minor burns, and a guide to starting compression therapy. eTG complete covers over 2,500 clinical topics and makes 3,500 drug recommendations. Topics are written by Australian expert groups independent of government and the pharmaceutical industry. Follow Therapeutic Guidelines on Twitter @TGLGuidelines to be kept abreast of upcoming releases, hidden clinical gems and more.

AMA Queensland members get a 20 per cent discount for new subscribers. Terms and conditions apply. Contact AMA Queensland on (07) 3872 2222 on membership@amaq.com.au for your discount code.

Breathe new life into your patientsâ&#x20AC;&#x2122; bodies.

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When used for cancer treatment, radiation can sometimes impact how oxygen passes through the soft tissues that the body relies on to recover and repair itself. By using a pressurised environment to increase oxygen levels in your blood, Hyperbaric Oxygen Therapy could help overcome soft tissue radiation injury. Along with being non-invasive, safe and cost-effective, this treatment is medically proven â&#x20AC;&#x201C; acknowledged by Medicare and most heath funds. As a licensed day hospital located within the Wesley Hospital precinct, we are fully equipped and ready to help your patients recover faster.

To see how Hyperbaric Oxygen Therapy could help your patients recover faster, call us and discuss the treatment with one of our doctors today.

wesleyhyperbaric.com.au/radiation

07 3371 6033

Doctor Q Autumn 37

Events calendar

MORE 2019 EVENTS

30 - 31 August Private Practice and Medico-Legal Conference 22 - 28 September AMA Queensland Annual Conference, Edinburgh

AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING PRESENTS REGIONAL PRIVATE PRACTICE SEMINAR SERIES ONE 2019

recruiting well avoiding or minimising the legal and cultural pitfalls during recruitment

R E G I O N A L P R I VAT E P R A C T I C E SERIES ONE

R E C R U I T I N G W E L L - AV O I D I N G O R M I N I M I S I N G T H E L E G A L A N D C U LT U R A L P I T F A L L S D U R I N G RECRUITMENT Date: 20 March - 31 May Location: Toowoomba, Mackay, Townsville, Brisbane South, Cairns, Brisbane North, Brisbane West, Gold Coast, Sunshine Coast, Rockhampton and Bundaberg Register for your local training session and join Michelle Cowan, Senior Industrial Officer, AMA Queensland, who will present session one: Recruiting well - Avoiding or minimising the legal and cultural pitfalls during recruitment and Samantha Miklos, Director, Cornerstone Medical Recruitment, who will present session two: Recruiting well The ultimate PR opportunity.

PRACTICAL SKILLS FOR JUNIOR DOCTORS

FREE EVENT TEACHING AND MENTORING: PRACTICAL SKILLS FOR JUNIOR DOCTORS Date: Thursday 4 April Location: Education Centre, Royal Brisbane and Women’s Hospital, Herston and via live webinar From intern year right throughout your Doctor in Training years and beyond, you are required to teach, mentor and model best clinical and behavioural practice for those who follow in your path. This practical panel comprising junior and senior doctors will discuss their strategies and techniques, and how their own positive and negative experiences along the way have influenced their style as teachers, trainers and mentors.

AMA QUEENSLAND

AMA QUEENSLAND PRESENTS:

starting a private practice S TA RT I N G A P R I VAT E P R A C T I C E Date: Saturday 11 May and Saturday 1 June Location: Brisbane and Gold Coast Join AMA Queensland’s Workplace Relations Team and network of trusted corporate partners who will step you through the logical pathway and process to setting up your private practice. The panel will discuss: correct structuring, financial and funding considerations; considerations for managing and mitigating risk, along with staffing and compliance issues; and the fundamental considerations for marketing.

JUNIOR DOCTOR CONFERENCE + CAREER EXPO 2019

ANNUAL JUNIOR DOCTOR CONFERENCE + CAREER EXPO 2019 Date: Saturday 15 - Sunday Saturday 16 June Location: Hilton Brisbane The 2019 Junior Doctor Conference will include a Career Expo, where doctors in training will have the opportunity to network with prospective employers and colleges.

Connect with over 25 local, national and international keynote speakers speaking on leadership, teamwork and well-being

Visit www.amaq.com.au for more information or to register for our upcoming events.

38 Doctor Q Autumn

AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING PRESENTS

Thursday 4 April 2019

PRACTICAL SKILLS FOR JUNIOR DOCTORS REGISTRATION TIME: 6pm

NETWORKING:

CANAPES AND DRINKS: Upon arrival and from 8.30pm - 9.30pm

TIME: 6.30pm - 9.30pm SEMINAR/WEBINAR TIME: 7pm - 8.30pm

VENUE:

Royal Brisbane and Women’s Hospital Conference and Education Centre, Herston and via live webinar

COST:

FREE for AMA Queensland members and non-members

VIA LIVE WEBINAR FOR RURAL AND REGIONAL MEMBERS

What makes for a great junior doctor teacher, mentor and role model? What are the techniques that are not necessarily taught in medical school? This practical panel (comprising junior and senior doctors) will discuss their strategies and techniques, and how their own positive and negative experiences along the way have influenced their style as teachers, trainers and mentors.

PANE L:

Dr Dilip Dhupelia, President, AMA Queensland; Director of Clinical and Medical Services, Queensland Country Practice, Queensland Health; and GP, SmartClinics; Dr Sally Aubrey, Registrar, Townsville Hospital; Dr Melanie Rule, Emergency Physician, The Prince Charles Hospital; Dr Thomas Brennan, Anatomical Pathology Registrar, Royal Brisbane and Women’s Hospital

MC:

A/Prof Louise Cullen, Senior Staff Specialist, Department of Emergency Medicine, Royal Brisbane and Women’s Hospital

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REGISTER NOW ONLINE AT WWW.AMAQ.COM.AU

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Junior Doctor Conference Meet the speaker

DR ERIC LEVI

Dr Eric Levi is a specialist otolaryngologist, head and neck surgeon based in Melbourne, Australia. He has completed fellowships in head and neck surgery, facial plastic and reconstructive surgery and paediatric otolaryngology in Canada, Australia and New Zealand. He has subspecialty interests in adult head and neck cancer, thyroid, sinus, salivary glands, paediatric complex airway reconstruction, paediatric head and neck tumours, vascular malformation and rhinoplasty.

dr Eric Levi Consultant Ear, Nose and Throat Surgeon, St Vincent’s Hospital and The Royal Children’s Hospital

Dr Levi writes and speaks regularly on matters close to his heart including leadership, teaching and doctors’ well-being. To best introduce you to Dr Levi, we thought we’d share an abridged version of one of his powerful blog posts.

Although I’ve never had serious suicidal thoughts, I – like many other doctors – have been through many dark seasons. When I carefully dissect my dark seasons, some common themes often emerge:

1. LOSS OF CONTROL

2. LOSS OF SUPPORT

3. LOSS OF MEANING

I have lost control of my days. I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car.

Plans change every single day at work because of emergencies. I can’t even be sure what the next hour will bring when I am on call. You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital?

When can I actually find support?

I don’t have time to talk to my colleagues about life. I don’t have time with my family. I don’t have time to catch up with friends. Social ties are lost when one stepped into medical school. I’ve lost count of the number of significant life events I have missed.

I am realising more and more that what brings me greatest distress is the relentless administrative pressure which takes away the meaningful clinical engagement I have with my patients. Medicine used to be a meaningful pursuit. The joy, purpose and meaning of medicine has been codified, sterilised, protocolised, industrialised and regimented. Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators.

Not only that, we are losing control of health care in general. Everyday, there’s a new form, a new guideline, a new protocol, a new health software, a new policy all dictating, restricting and modifying clinician activities. Some of these policies are written by people who do not see patients.

I know where I can get support, but practically, when and how am I going to get that support? Doctors who scream for help may be formally reported, therefore having restrictions placed on their practice and then incurring higher medical indemnity fees in some situations. Trainees who ask for help may be labelled as underperforming and have to be commenced on probation or remediation. We may not have practical access to the support that are often advertised.

The forces that pushed me to losing control of my emotions are likely the same forces that might push some of us to suicide.

Discounted member early bird registrations are now open for the 2019 Junior Doctor Conference. Book now at www.amaq.com.au

40 Doctor Q Autumn

#Qjdc2019

AMA QUEENSLAND member JUNIOR early bird rates DOCTOR CONFERENCE + CAREER EXPO 2019 AMA Members register by Friday 26 April 2019 for the early-bird rate.

I f yo a f u u r ro s l l r e te r fun cha d is nge av a s , ilab le.

CAREER CROSSROADS Saturday 15 - Sunday 16 June 2019

Hilton Hotel, Brisbane The Hilton Brisbane is offering JDC delegates the special rate of $200 per night for a King Hilton Guest Room.

wh at 's on of fe r JDC Careers Expo network with prospective employers and colleges.

Advice on building your brand as a doctor on social media.

Inspirational presentations by the best leaders in medicine.

Call for Research Abstracts - present your own research and build your resume.

Clinical skills hands-on workshops hosted by CSDS.

Explore traditional college and alternative/creative career pathways in medicine including locuming and medical start-ups.

Networking events.

Live issues Doctor in Training panel with the Queensland Health Minister.

Junior Doctor CPD points.

View full program online at www.amaq.com.au

JDC 2019 keynote speakers - Many more to be announced Dr Eric Levi,

Ear Nose & Throat Specialist, St Vincentâ&#x20AC;&#x2122;s Hospital; Author & Blogger

Dr Amandeep Hansra,

General Practitioner and Founder, Evermed Consulting

Dr Nic Woods,

Chief Medical Officer, Microsoft Australia

Dr Fiona Lander,

Doctor; Human Rights Lawyer and Consultant, McKinsey & Co

Dr Nelson Lau,

General Practitioner, Medibank Solutions and Telstra Health; Filmmaker

Doctor Q Autumn 41

Private Practice and Medico-Legal Conference

A S S O C I AT E PROFESSOR MEET THE SPEAKER

Opinion Australia sends that story to the staff involved so they can learn from it and encourage that health service to respond. Ultimately, patient feedback creates real, patientcentred change in that health service and helps health professionals understand the choices that patients are making in their health care. The feedback gives doctors, nurses and managers a feel for what patients are saying about the service they manage and in some States, the independent Quality and Complaints Commissions may receive all published stories and use them to improve services.

“We believe that patients’ feedback - good or bad - is essential to improving Australian health services,” said Associate Professor Greco.

So, you’ve treated the patient but how did your interaction go? Did they leave feeling that they trusted you? Did they leave understanding what’s happened and what will happen from here? Did they leave feeling confident in you, your decisions and your practice/hospital? Did they leave your care inspired to live a healthier life or did your advice fall on deaf ears? Did they leave feeling the interaction was more of a partnership rather than a one-way street? How does the carer, family members or allied staff feel about your approach and your care?

Associate Professor Michael Greco, a key speaker at our 2019 Private Practice and Medico-Legal Conference, specialises in patient interaction and feedback. He is a Director at ClientFocused Evaluation Programs (CFEP Pty Ltd), which helps health professionals gather patient-based evidence on the quality of their service and relationships with patients.

He is the Chief Executive Officer at Patient Opinion Australia, an organisation that encourages meaningful conversations between patients and health services. A patient can share a story about their experience with a health service, Patient

42 Doctor Q Autumn

“Medicine is becoming increasingly competitive and there is an emerging requirement for value-based care, not just activity based. We are seeing this more and more with the care of those with chronic conditions.

“At the conference, we’ll explore perspectives on excellence in patient care, how you can demonstrate evidence for valuebased care, how you can ensure your patients keep coming back to you, and how your patients can be the best word-ofmouth ambassadors for your private practice,” he said.

Professor Greco is also a Board Director at Health Leaders Australia, an organisation that provides programs and services that support health promotion and improved healthcare outcomes for the community. These programs and services include education and training of health sector workers and support staff and accreditation services, to assure the community of the quality and safety of health promotion and the healthcare services they receive.

In addition to these roles, Michael Greco is Associate Professor at the School of Medicine at Griffith University and Honorary Senior Research Fellow at the School of Medicine, University of Exeter in the UK.

#PPMLC2019

F R I D AY 3 0 - S AT U R D AY 3 1 A U G U S T R O YA L I N T E R N AT I O N A L C O N V E N T I O N C E N T R E , BOWEN HILLS

WELCOME AND UPDATE ON THE PRIVATE PRACTICE LANDSCAPE AND AMA PUSH FOR KEY REFORM OPENING SESSION Delivering excellence in patient care how to exceed patient expectations and keep your patients coming back PRACTITIONER STREAM: PRACTICE PLANNING, BENCHMARKING AND FINANCIAL DECISIONMAKING FOCUS Private practice planning and benchmarking Risky business in private practice The new rural generalist national program PRACTICE MANAGER STREAM: POSITIVE WORKPLACE CULTURE FOCUS Dealing with challenging workplace situations Ensuring the best employee experience for doctors and support staff at your private practice

PRACTICE STREAM The interface between digital health in hospitals and private practice - updates and improvements Buying into or selling a practice - tips and traps Clinical governance for practices Taking advantage of commercial property ownership for private practice - the options and benefits for best outcomes with the right structures and advice MEDICO-LEGAL STREAM Workplace contract law masterclass Mandatory reporting - what does it really mean for treating practitioners?

QUT presents end of life law for clinicians workshop THE AMA MBS ROUND UP - MAKING SENSE OF THE RECENT REFORMS PROCESS, COMMON ISSUES AND BILLING ETHICALLY

SPECIALIST STREAM: Understanding your rights as a VMO and right of private practice Common specialist complaints and how to avoid them GENERAL PRACTICE STREAM: Quality in general practice - where is it headed?

Understanding the latest PIP changes, including the quality PIP PRACTICE MANAGER STREAM Medicare essentials for practice managers

Q W W W. A M A

.COM.AU

M E M B E R E A R LY - B I R D R A T E S C L O S E 5 J U LY

PRACTICE MANAGER STREAM: MEETING AND PRACTICE DESIGN FOCUS Mapping the patient experience and the interplay with marketing How design and function benefits you, your patients and staff

Safe and healthy medical workplaces - best practice and your duty of care

Doctor Q Autumn 43

AMA QUEENSLAND ANNUAL CONFERENCE 2019

Global trends in health care delivery

S U N 22 - S AT 28 S E P T E M B E R 2019

Hear from world leaders in medicine, network with colleagues, and develop presentation and research skills at the 2019 AMA Queensland Annual Conference.

Themed Global trends in health care delivery, this yearâ&#x20AC;&#x2122;s program features a number of keynote presenters, including high-profile British, Scottish and Australian speakers.

In an exciting and unique location, sessions will cover a range of medical leadership and clinical topics, including: generational trends and changing needs; genetics/genomics and immunology;

SPEAKERS George Brandis, Australian High Commissioner to the UK Dr Sunil Lakhani, Executive Director Research, Head, Breast Pathology Group, UQCCR Dr Chris Zappala, Specialist, Respiratory Medicine Dr Catherine Calderwood, UK

foetal and maternal medicine;

Dr Andrew Jeremijenko, Occupational Medicine Specialist

end of life care and assisted dying;

Dr Elizabeth Ireland, UK

healthy health practitioners - doctors health and wellbeing;

Dr Tony Brown, GP, Thursday Island

innovations in sustainability in health care;

Dr Ruth Stewart, GP, Thursday Island

new trends in respiratory medicine; and

Dr Sarah Coll, Orthopaedic Specialist, Cairns

the future of forensic medicine.

Dr Mellissa Naidoo, Director, Medical Services, Greenslopes Hospital.

Dr Anthea Woodcock, Forensic Medicine Specialist Colleen Sullivan, Senior Practice Manager Professor James Garden, Edinburgh.

Jill Vickerman, Director, British Medical Association Scotland 44 Doctor Q Autumn

Edinburgh, Gaelic Dun Eideann, is Scotland’s inspiring capital where centuries of history meet a world class city in an unforgettable setting. Located near the southern shore of the Firth of Forth, the city’s magnificent architecture shifts from the narrow closes of the medieval Old Town to the grace of the Georgian New Town. Above it all, with its towering splendour, stands Edinburgh Castle.

A Unesco World Heritage Site, Edinburgh is a compact and bustling city yet home to the largest arts festival in the world. Looming over the city is Edinburgh Castle, home

to Scotland’s crown jewels and the Stone of Destiny, used in the coronation of Scottish rulers. Arthur’s Seat is an imposing peak in Holyrood Park with sweeping views, and Calton Hill is topped with monuments and memorials.

Offering outstanding food and drink and unforgettable experiences, Edinburgh is truly an award-winning city.

Beyond Edinburgh are the Scottish Borders, which provide a beautiful setting from the rich gems of the capital, the home of golf – St Andrews, and Glasgow, one of the friendliest cities in the world.

F O R M O R E I N F O R M AT I O N V I S I T W W W. A M A Q . C O M . A U

WWW.AMAQ.COM.AU

Election Notice 2019 ANNUAL GENERAL MEETING The Annual General Meeting of the Members of The Queensland Branch of Australian Medical Association Limited will be held at: Time:

6.30pm

Date:

Friday 17 May 2019

Venue:

AMA Queensland 88 Lâ&#x20AC;&#x2122;Estrange Terrace Kelvin Grove, Queensland

Business The business of the Meeting will be: 1.

To receive and consider the accounts, balance sheets and reports of:

4.

COUNCILLOR POSITIONS 2019-2021

For election as President or Vice President of the The Queensland Branch of Australian Medical Association Limited, one representative for each position is required.

Nominations must be in writing and signed by the nominee, and two (2) nominators. All persons must be financial members of the The Queensland Branch of Australian Medical Association Limited. Any two (2) ordinary or honorary members may nominate another member provided all members belong to and are registered in the same Geographical Area, Craft Group or other position.

A nominee must be an ordinary or honorary member; Any two (2) ordinary or honorary members may nominate the nominee.

Candidates for President or Vice President may submit with their Nomination Form: A short statement of no more than 250 words.

Any words in excess will be discarded;

The Board;

A brief CV of no more than 250 words.

Any words in excess will be discarded;

(ii)

Any committees instructed to report to the meeting; and

A passport-sized head and shoulder photograph; and

The declaration of the results from the election of: (i)

3.

PRESIDENT AND VICE PRESIDENT 2019-2020

(i)

(iii) The Auditors.

2.

The Returning Officer invites nominations and will hold an election for the positions of President, Vice President, Chair, Member Appointed Directors and Council of The Queensland Branch of Australian Medical Association Limited.

The President, Vice President, Chair, Member Appointed Director and Council members.

The appointment of the Auditors and approval of the remuneration (if any) to be paid to the Auditors; To deal with all business which any statute, the Constitution, or the By-laws requires.

Proxy Notice A member who is entitled to attend and register one vote at the Annual General Meeting is also entitled to appoint another member as a proxy to attend and vote in his or her place.

Proxy forms can be downloaded from the AMA Queensland website (www. amaq.com.au/page/Election) or by phoning AMA Queensland on (07) 3872 2222 and must be received by 6.30pm 15 May 2019.

Annual Report *The 2018 Annual Report will be available online from 3 April 2019 at www.amaq.com.au/page/About_Us/ Annual_Reports

NOMINATIONS CLOSE 5PM FRIDAY 12 APRIL 2019 46 Doctor Q Autumn

A video statement of no more than three minutes. The candidates may elect to have their video statement filmed at AMA Queensland. Film in excess of three minutes will be discarded.

CHAIR AND MEMBER APPOINTED DIRECTORS 2019-2021 For election as Chair and Member Appointed Directors of The Queensland Branch of Australian Medical Association Limited.

One (1) representative for Chair is required; Three (3) representatives for Member Appointed Director role are required

Candidates for Chair or Member Appointed Director may submit with their Nomination Form: A short statement of no more than 250 words (any excess words will be discarded) that sets out their governance/directorial experience, including but not limited to strategy, financial performance, risk and compliance oversight, corporate governance and executive management and stakeholder engagement; A passport-sized head and shoulder photograph;

Craft Group Representatives required: Two (2) General Practitioner Craft Group Representative 2019-2021; Two (2) Specialist Craft Group Representative 2019-2021.

Other Positions required: One (1) Full-Time Salaried Medical Practitioner Craft Group Representative 2019-2021; One (1) Part-Time Medical Practitioner Craft Group Representative 2019-2021; One (1) International Medical Graduate Representative 2019-2021; One (1) Medical Student Group Representative.

Geographical Area Representatives required: Three (3) Greater Brisbane Area Representatives Postcodes 4000 - 4199, 4300 - 4349, 4500 - 4513, 4514 - 4549 inclusive; One (1) Far North Area Representative Postcodes 4851-4899 inclusive; One (1) Capricornia Area Representative Postcodes 4676-4798 inclusive; One (1) Downs and West Area Representative Postcodes 4350-4499, 4602-4618 inclusive.

Candidates for Council may submit with their Nomination Form: A short statement of no more than 250 words.

Any words in excess will be discarded; A brief CV of no more than 250 words. Any words in excess will be discarded; and A passport-sized head and shoulder photograph.

What is required of a Councillor?

A nominee must be an ordinary or honorary member; and

Availability to attend Council meetings, and relevant AMA Queensland events/functions such as the Dinner for the Profession;

Any two (2) ordinary or honorary members may nominate the nominee.

Actively contribute to setting policy for the Association;

In addition, for the position of Chair only, please include experience and qualities you would bring to the role as Chair.

Actively support membership retention and growth strategies;

Candidates can only apply for one position of President, Vice President, Chair or Member Appointed Director on the Board.

Provide a written report (template provided) for council meetings; and Availability to attend and contribute to AMA Queensland Committees.

If you need to make changes to your craft group, geographical area or other position in the register of members for the purpose of the election this must be done by 5pm Thursday 11 April 2019. Return completed nomination forms by 5pm Friday 12 April 2019 to the Returning Officer. Further nomination forms can be obtained at www.ama.com.au/qld/election from 5pm Monday 25 March 2019.

Following receipt of nominations, if required a ballot will be held and will close at 5pm 15 May.

Nomination Form

NOMINATIONS CLOSE 5PM FRIDAY 12 APRIL 2019

Nomination forms are to be returned to the Returning Officer, Andrew Vivian, by fax, email or post by 5pm, Friday 12 April 2019.

Time Frames 25 March 2019, 5pm:

Nominations open

Phone:

(07) 3232 2900

11 April 2019, 5pm:

Final changes to register of members

Fax:

(07) 3891 9292

12 April 2019, 5pm:

Nominations close

Email:

nominations@priestleyspfn.com.au

29 April 2019, 5pm:

Ballot opens

Post:

The Returning Officer, PO BOX 1770, COORPAROO DC QLD 4151

15 May 2019, 5pm:

Ballot closes

17 May 2019, 6.30pm:

Annual General Meeting

We nominate

(full name)

as a candidate for the position of Craft Group/Geographical Area/Other Position

(for councillor nomination only)

If nominating for President, Vice President or Chair, you can only nominate for one of these positions.

NOMINEEâ&#x20AC;&#x2122;S DETAILS: I consent to this nomination.

Full name: Date of birth:

Craft/Area/Other Position: Member number:

Telephone number:

Primary practice address: Residential address: Signature:

NOMINATORâ&#x20AC;&#x2122;S DETAILS X 2: Full name 1:

Full name 2:

Craft/Area/Other Position:

Craft/Area/Other Position:

Telephone number:

Telephone number:

Residential address:

Residential address:

Signature:

Signature:

Please Note If nominating for President, Vice President or Chair, you can only nominate for one of these positions; If nominating for a Member Appointed Director position, you can also apply, if eligible, for a Council position, however, you cannot apply for the position of President, Vice President or Chair; If nominating as a representative for a Craft Group, Geographical Area or other position, your nominators must both be registered in the Craft Group, Geographical Area or other position for which you are nominating; and You cannot represent a category on Council at the same time as you are President, Vice President, Immediate Past President or Chair of Council.

Access this nomination form and the position description for the role of President,Vice President, Chair and Member Appointed Director at www.ama.com.au/qld/election from 5pm Monday 25 March 2019.

THE QUEENSLAND BRANCH OF AUSTRALIAN MEDICAL ASSOCIATION LIMITED | ACN: 009 660 280 | ABN: 17 009 660 280

Scout’s motto: be prepared

JAMES WARWICK Medical & General Risk Solutions

P: (07) 3117 2470 E: james@mgrs.com.au Authorised Representative No.434578

Disclaimer:

For most medical practices, the ability to provide continuity of patient care rests on a number of critical functions, including the availability of:

the practice’s rooms, IT systems and key medical equipment;

external providers, such as hospitals and key suppliers, and often most importantly; and

key people – doctors, nursing, management and administration staff.

Without all key functions, a practice’s ability to provide patient care often grinds to a halt – as does the practice’s revenue.

The right insurances often play a key role in the ability to survive a major event, as recently experienced in the Townsville floods. Set correctly, insurances can be structured to cover the costs to repair or replace damaged buildings, rooms and equipment, and the resultant lost revenue and additional costs that often flow from a major event.

In order to set the right insurances, a practice first needs to consider the key risks it faces - and develop strategies 48 Doctor Q Autumn

to manage those risks. For example, in a solo doctor practice, often the doctor is the key person – both in terms of revenue and patient care. Having the right income protection insurance and business expenses covers (and other personal policies) will play a vital role in providing cashflow and income should the doctor be unable to work due to accident or illness.

Equally, most practices are reliant on the rooms and key equipment. Often, moving to alternative premises or closing while repairs are undertaken can be weeks, months, or longer.

Business Interruption Insurance can be purchased to cover lost revenue and additional costs following an ‘insured event’. Floods are a particular risk that practices need to consider, as in many North Queensland locations, flood cover for businesses is often either not available, or prohibitively expensive. When flood is excluded from a business policy, then often the resultant lost revenue from a flood will also be excluded.

A key risk management tool before insurances are considered, is for a practice to develop a Business Continuity Plan and Disaster Recovery

For general insurances, Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No. 240549, ABN 15 003 886 687.

Authorised Representative No 436893.

Life and Personal Risk Insurance services are provided by Stonehouse Financial Services Pty Ltd, Australian Financial Services Licence No. 292469, ABN 81 112 548 419. The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.

Plan. These plans should encompass a range of scenarios from natural disasters, loss of key people or rooms, equipment or IT. The plan needs to be tested and understood by all management and staff and not simply sit on a shelf as a part of accreditation.

An excellent article to read, which contains a number of equally excellent links can be found on MDA National’s blog post It never rains but it pours.

The links provide a practice’s ‘flood management plan’ – and one item to note is the practice specifically notes flood insurance is not available at their location. There are also a range of other links that direct to other available resources.

Should you wish to review or discuss your practice/individual insurance circumstances, please contact our advisors.

One less thing on your to-do list Specialist risk and insurance solutions for medical practitioners and healthcare businesses.

Prevention is far better than cure. This applies equally to our health, as it does to managing the complex and varied risks faced in running a healthcare business.

The issue for healthcare businesses is often the unknown risks….

We can identify your key risks and protect you with the right insurance program, all managed by your own expert insurance adviser:

Free insurance health check

• • • • • •

Medical Indemnity Practice Indemnity Management Liability Business Rooms Insurance Cyber Risks Personal Insurance (Life/TPD, Income Protection, Trauma)

For an obligation free discussion and initial consultation, contact James, Nick and Jon from our Brisbane offices.

GENERAL INSURANCE

PERSONAL INSURANCE

JAMES WARWICK

NICK WEBB

JON PAPINCZAK

james@mgrs.com.au (07) 3117 2470

nick@mgrs.com.au (07) 3871 4944

jon@mgrs.com.au (07) 3871 4944

www.mgrs.com.au

Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687. Life and Personal Risk Insurance services are provided by Stonehouse Financial Services Pty Ltd, Australian Financial Services Licence No. 292469, ABN 81 112 548 419.

Doctor Q Autumn 49

Recruitment: your greatest missed opportunity The recruitment of staff is often done in haste, in response to an unexpected resignation. What could be an exceptional opportunity to showcase why you are an employer of choice becomes one of the greatest missed opportunities. Every employer is competing for talent â&#x20AC;&#x201C; even if you have multiple applicants â&#x20AC;&#x201C; and the way you differentiate yourself during the recruitment process can significantly impact your recruitment outcomes now and in the future.

GET TEAM BUY IN Before you start recruiting, check in with key team members. Do they have any input on the role or the profile of the successful applicant? Do they know anyone they could refer?

Have they any ideas on how to enhance the recruitment and onboarding process?

This is a great opportunity to ensure that key colleagues are supportive of the new recruit and a chance to refine the process before you start.

MAXIMISE THE OPPORTUNIT Y

SIGNED SEALED SILENT?

The recruitment process is the first insight future employees get of your organisation. Applicants are making assumptions from the minute they apply to your advertisement. How well your advert reads. How quickly you respond to their application. The tone of your voice. The length of your recruitment process.

The feedback you provide.

How transparent you are regarding the employment contract. How clear your expectations are of the role.

How well you communicate throughout the process, and most importantly, how you make them feel.

A common mistake many employers make is not keeping regular contact with new recruits in the lead up to their start date.

However, the time between offering a new employee a role and their actual start date is the most critical in the recruitment process.

Great employees will rarely be let go without a fight!

If you have found a gem expect a counter offer from their existing employer.

Even unsuccessful applicants are an excellent opportunity to showcase just how well you treat people. These applicants can become a great referral source, and while unsuitable on this occasion might be the perfect applicant down the track.

The period before they commence work is a great opportunity to start building rapport.

Could they meet the team? If you are offering accommodation or car hire, be sure you understand their expectations. If they are relocating, check in regularly to see how this is progressing. Their commencement will be much smoother if you can make their transition as seamless as possible.

SAMANTHA MIKLOS CEO, Cornerstone Medical Recruitment

REINFORCE THEIR CHOICE The first week is a great chance to show your new employee they made the right choice! Have a welcome morning tea.

Offer a comprehensive orientation and onboarding process. Reconfirm your expectations for the role, and check in regularly to see how they are. If you offered accommodation, car hire or any extra perks, ensure their expectations have been met. If they have relocated, consider how you could help them and their family to settle into the community a little quicker. Many new recruits leave a position they love within the first year because their family have been unable to settle into their new location.

DID YOU KNOW? Members receive a 5% discount off recruitment services (excluding existing service level clients). Members also receive up to $500 towards travel, relocation or accommodation for permanent placements.

The recruitment and onboarding process is a fabulous opportunity to showcase to future applicants and existing employees why you are an employer of choice. Every element of the process is a chance to build rapport, reinforce your team culture and values, and maximise the likelihood that this new recruit will go the distance.

50 Doctor Q Autumn

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N E W C O R P O R AT E PA RT N E R

Reviewing Labor’s proposed super changes Much has been written already about Labor’s proposals to abolish refundable franking credits, remove negative gearing for new properties and reduce the capital gains tax discount.

However, there are a number of other policy changes (A Fair Go For Australia - Labour’s National Platform Constitution 2018) proposed by Labor that have not been debated as widely. Very few may know about Labor’s plans to make further changes to superannuation.

TERRI BRADFORD National Manager, Wealth Management

A B O L I S H I N G C AT C H - U P CONCESSIONAL CONTRIBUTIONS One of the more reasonable measures included in the ‘Super Reforms’ included catch up concessional contribution provisions. Essentially, this new provision means from 1 July 2018, individuals will be able to ‘catch up’ unused concessional contributions within the $25,000 concessional contribution cap over the next rolling five (5) consecutive financial years, where an individual’s total super balance is $500,000 or less. Labor’s proposal is to abolish this new legislation. Given it only became effective from 1 July 2018 with catch-up contributions utilised from 1 July 2019, this particular strategy may be finished before it even has a chance to start.

LOWERING THE HIGH INCOME SUPER CONTRIBUTION THRESHOLD TO $200,000 The previous threshold of $300,000 for high income earners paying an additional 15 per cent contributions tax (known as Div 293 tax) was reduced to $250,000, also as part of the ‘Super Reforms’ from 1 July 2017. Labor proposes to further reduce this cap from $250,000 to $200,000. When you consider ‘Adjusted Taxable Income’ to determine whether a person is over or under this threshold includes taxable superannuation contributions (SGC, salary sacrifice, personal deductible contributions), more and more individuals who do not actually earn this level of income could be caught in this lower threshold. Carry forward, or catch up, concessional contributions made from the 2019-20 financial year will also be included in adjusted taxable income calculations so this could also be a trap for the unwary.

EXAMPLE - 1 JULY 2017 THRESHOLD Sabina’s taxable income is $180,000 for an income year and her low tax contributions are $25,000 for the corresponding financial year. Sabina’s combined ‘adjusted taxable income’ including the low tax contributions is therefore $205,000, being $180,000 plus $25,000. As Sabina’s adjusted taxable income is under the $250,000 High Income Super Contributions threshold she will not incur any Div 293 tax on super contributions.

EXAMPLE - PROPOSED LABOR THRESHOLD Sabina’s taxable income is $180,000 for an income year and her low tax contributions are $25,000 for the corresponding financial year. Sabina’s combined ‘adjusted taxable income’ including the low tax contributions is therefore $205,000, being $180,000 plus $25,000. As Sabina’s adjusted taxable income is greater than the $200,000 High Income Super Contributions threshold Sabina will incur Div 293 on the excessive amount over the threshold. The excess equals $5,000 so Sabina will pay an additional 15 per cent tax, or $750, on this amount.

While it is important to be mindful of any potential super changes there is no guarantee any or all of the policies discussed here will become law. It will depend on the outcome of the federal election in 2019 and the subsequent passage of any new legislation. Politicians from all sides are well aware Australians are fed up with constant superannuation changes so it will be interesting to see if some or all of the policies are included in any future Federal Budgets should Labor win Government.

52 Doctor Q Autumn

Important Information: The information in this article is of a general nature. It does not take into consideration any personal or individual goals, needs or circumstances. You should seek professional advice before acting on this information to make sure the strategies meet your individual circumstances.

Doctor Q Autumn 53

Practices to pay for doctors misleading Medicare The Professional Services Review scheme (which investigates inappropriate practice with the MBS) has been extended to enable review of persons who engage practitioners under contracts of service, not just employees.

JOSHUA LIDDLE Associate, HWL Ebsworth

Medicare can now offset up to 20 per cent of MBS benefits payable to a practitioner against debts owed or garnish the salaries of employed practitioners to recover debts.

From 1 July 2019, Medicare will be able to determine that debts for false or misleading MBS billings are to be shared between the rendering practitioner and a practice, hospital or employer which engaged the practitioner.

In an effort to improve the rate of recovery of debts owed for incorrect or false claiming under the MBS, the government has passed legislation granting Medicare enhanced debt-recovery powers.

The new legislation will extend the Professional Services Review (PSR) scheme to allow the Director to review persons who contract with persons who render professional services. Previously, only the providers of professional services themselves or their employers could be reviewed.

This will expand the PSR scheme to potentially include medical practices which engage independent contractors and referral schemes such as home doctor services.

To aid enforcement under the expanded scheme, Medicare will be given expanded powers to recover debts related to the payment of MBS benefits. Doctors who are indebted to the Commonwealth due to overpaid or falsely claimed MBS benefits will be encouraged to enter a payment plan within 90 days. If that does not occur, Medicare may: offset up to 20 per cent of amounts that become payable to the doctor for MBS benefits; or issue a garnishee notice to a person who owes money to the doctor - such as a hospital at which the doctor is employed - to pay the recoverable amount or a specified percentage to the Commonwealth.

Further provisions coming into effect from 1 July 2019 will empower the Chief Executive of Medicare to determine that debts owed are shared debts where the primary debtor was employed or otherwise engaged by another person or entity. Shared debt determinations will be able to be made against medical practices, hospitals or others who engage medical practitioners.

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In determining whether a shared debt arrangement should be made, the Chief Executive will consider: whether the secondary debtor could have controlled or influenced the circumstances that led to the making of the false or misleading statement (in most cases the claim for an MBS benefit) to which the debt relates; whether the secondary debtor directly or indirectly obtained a financial benefit from the making of the false or misleading statement; whether any other factors make it fair and reasonable for such a determination to be made.

If you have any concerns about potential exposure, either as someone who renders professional services or as someone who contracts with persons who provide professional services, under the new provisions you should seek independent advice about your specific circumstances.

UNIQUE OFFER TO AMA QUEENSLAND MEMBERS HWL Ebsworth is a full service commercial law firm providing expert legal services at competitive rates. Through our combination of legal specialists and industry experience, HWL Ebsworth is ideally placed to protect the interests of our clients while enabling them to achieve their commercial and operational objectives. HWL Ebsworth is currently ranked as the largest legal partnership in Australia according to the most recent partnership surveys published by The Australian and the Australian Financial Review.

HWL Ebsworth is very pleased to have recently welcomed the team from TressCox Lawyers to the firm. This team offers clients more than 100 years’ experience representing medical practitioners in various areas of health and aged care law.

The Health and Aged Care Services Team can help guide you through the increasingly complex operational, legislative and policy framework. We can provide you informed legal advice on litigious, disciplinary and commercial issues at all levels. With considered legal advice our team can assist you to operate a commercially viable business that complies with the health services industry’s unique and ever changing regulatory environment.

As a member of AMA Queensland, this partnership provides you with legal assistance and support, both individually, for your business and your staff. HWL Ebsworth will provide AMA Queensland members with an initial consultation by phone or in person at no cost (up to 30 minutes).

Take advantage of this benefit with advice from highly qualified lawyers on: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪

Setting up your practice, including buying a business, business structuring, contracts and advice on restraint of trade clauses; Running your practice, including IR & Workplace Safety, employment, service, and locum contracts and corporate governance; Group practice issues and bringing in additional owners including partnership, shareholder and buy-sell agreements; Selling your practice including helping to get ready for sale, workout and earn-out arrangements; Resolution of disputes about restraints, contracts (including building contracts and shareholder agreements) and debt collection; Regulatory issues including investigations by the OHO, AHPRA and Medicare Australia; Your personal matters including buying, selling and leasing property; and Estate planning including creating and documenting strategies to transfer wealth from one generation to the next.

Katharine Philp Partner P (07) 3169 4974 E kphilp@hwle.com.au

Lynette Reynolds Partner P (07) 3169 4960 E lreynolds@hwle.com.au

Bill Hickey Partner P (07) 3169 4768 E bhickey@hwle.com.au

Adelaide | Brisbane | Canberra | Darwin | Hobart | Melbourne | Norwest | Perth | Sydney

Tony Mylne Partner P (07) 3169 4975 E tmylne@hwle.com.au hwlebsworth.com.au

How to achieve private practice startup success

ANGELA JEFFREY Buisness Advisory Director, William Buck Accountants P: (07) 3229 5100 E: angela.jeffrey@ williambuck.com

Starting a private practice offers freedom, independence and flexibility as a practitioner, and the ability to carve out the work/life balance you desire. Itâ&#x20AC;&#x2122;s not easy, but those who take the time to create a well-balanced business can dramatically boost their chances of success.

1 . G O O D F R I E N D S D O N O T A LW AY S E Q U A L G O O D B U S I N E S S PA RT N E R S When considering starting or joining a medical practice, an important part of success is choosing the right business partnership. It is tempting to believe that an existing relationship will easily translate into a successful commercial union, however this is rarely the case. Even people with similar values and philosophies may not share the same approach to completing various business tasks.

To avoid differences between partners, a business planning checklist should be completed before commencing a startup.

The checklist should look at partner comfort levels for debt, profit, and time contribution, and overall practice and business direction. This will aid in working out group dynamics.

2. GET YOUR BUSINESS RIGHT FROM THE START It is important to consider which business structure will be most appropriate for your startup. Your chosen business structure will have impact on taxation treatment for income and capital gains tax, legal liability, and the costs and ability to add new investors. Two such structure options include owning a business through a trust or through a separate company. Both have advantages, but also carry disadvantages.

A practice that operates through a private company structure will report the net profit of the business in their individual tax return in the form of salary and wages and will incur the 27.5 per cent corporate tax rate. However, the capital gains concession does not apply to companies. This concession allows a 50 per cent discount for assets held for more than 12 months or more when they are sold or when the relevant capital gains event occurs.

A trust has often been viewed as one of the most taxeffective structures. Profits can easily be distributed against 56 Doctor Q Autumn

family members in such a way that tax is paid at the lowest possible individual marginal tax rate. Operating through a trust also means you can take advantage of the 50 per cent capital gains concession. However, a discretionary or family trust is not suited for every person and financial circumstance and setting up a trust may be a complicated and expensive process.

3. CONSIDER YOUR FINANCIAL STRUCTURE The impact on your long-term wealth can be dramatically affected by the structure you choose for any investments that you have. The most common situation is the purchase of equipment and fit-out. If fit-out components are financed under a lease, you obtain lease payments as a tax deduction, rather than just 2.5 per cent depreciation and the interest deductions that you would receive under a chattel mortgage.

If equipment is purchased using a chattel mortgage, you will have access to the immediate deduction for items under $20,000. You will also be able to obtain up to a 30 per cent depreciation deduction and the interest on the loan.

4 . S P O U S E A N D F A M I LY M E M B E R S C A N B E A C T I V E PA RT I C I PA N T S A medical practitioner can employ a spouse or family member in their personal services business provided the employment is bona-fide and wages are at a reasonable level. However, you need to make sure your practice is a personal service business, there is a proper employment arrangement, and reasonable remuneration.

A spouse working for the medical practitioner can receive a superannuation contribution of up to the maximum age-based limits without attracting tax avoidance provisions. These payments can reduce the personal income tax position of the doctor directly, even where they have paid a service fee.

THINKING OF BUYING YOUR OWN MEDICAL PRACTICE? William Buck can support your new private practice through: — Comprehensive assistance with your personal and business taxation affairs — Advice on how to structure your cash flow and maintenance of financial records — Practice structure advice, budgets and cash flow management — Assistance with insurances and compilation of assets and liabilities.

FOR MORE INFORMATION OR TO BOOK A CONSULTATION, CALL OR EMAIL US: — P: (07) 3229 5100 — E: qld.info@williambuck.com

NERISSA FERRIE Medico-legal Adviser, MDA National

Take care with Medicare With a recent increase in the number of investigations and audits, it seems an ideal time to provide some guidance on what you should do if you receive correspondence from the Department of Health about your billing.

Doctors are often confused and concerned about why they have come to Medicare’s attention. Some doctors feel they have been unfairly targeted by the Department of Health (DOH). In our experience, Medicare investigations tend to be one of the most black and white jurisdictions doctors are subject to.

Put simply, most doctors receive a tap on the shoulder from Medicare because they are statistical outliers. Medicare runs a series of computer algorithms which measures each doctor against every other doctor in Australia. If you are above the 90th percentile for a specific item number, your profile may be reviewed under the Practitioner Review Program.1 Other statistical triggers could be daily billing which exceeds the number of hours in a day, or ratios which are vastly different from your peers, e.g. Level B: Level D. If the anomalies are not readily explained by your practice profile, you may be asked to participate in an interview with a DOH medical adviser. You are more likely to come to Medicare’s attention if you are a specialist with an unusual subspecialty, or a GP with a special interest which alters your patient demographics.

References 1. Department of Health.

Practitioner Review Program. Available at: health.gov.au/internet/ main/publishing.nsf/ content/practitionerreview-program 2. Professional Services Review. The Three Stages of Review. Available at: psr.gov.au/about-the-psrscheme/the-three-stagesof-review

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Certain item numbers may be on Medicare’s radar, and we see some items numbers more regularly than others, including Chronic Disease Management and GP Mental Health Treatment Plan. Each investigation is unique to the individual doctor on the basis of their practice profile.

If you receive a letter from the DOH asking you to participate in an interview, you should contact your medical defence organisation (MDO) immediately.

Medico-legal advisers at your MDO should be able to review your documentation and take you through your practice profile, discuss the concerns raised, go through each of the relevant item descriptors, and generally assist you to prepare for your interview. After the interview, the DOH medical adviser may recommend no further action, a sixmonth review period, or a referral to Professional Services Review (PSR).2 Some of the more common criticisms we see from the DOH include poor documentation, and billing for services which are not clinically relevant. One of the most significant failures is not understanding the item descriptor or believing that “near enough is good enough.” We hear a lot of reasons, which simply don’t cut it with Medicare – I work 90 hours a week; the practice does all my billing; no other item number fits the service; I didn’t know those items couldn’t be billed together; I have never read the MBS. And one to really avoid – but all my colleagues do it.

If the DOH contacts you, it doesn’t mean you are doing something wrong. It means you are a statistical outlier and you need to satisfy the DOH that your billing is appropriate.

MDA National provides a range of support to members, from assisting with a simple self-audit through to full PSR Hearings. We are assisted in this process by external lawyers who are experts in this area.

This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy.

PAT I E N T R E F E R R A L S P O T L I G H T

Autism Queensland Autism is a complex and lifelong developmental disorder that affects the brainâ&#x20AC;&#x2122;s growth and development. For those individuals living with autism life can be challenging and the way they are affected may change over time.

Although no two people with autism are the same, they will all have challenges with social communication and interaction, and narrow interests and/or repetitive behaviours.

Australian Bureau of Statistics figures show that in 2015, there were 164,000 Australians with a diagnosis of Autism Spectrum Disorder (ASD), and that males were four times more likely to be have the condition that females.

One of the most important changes in the diagnosis process for ASD was when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013.

Using DSM-IV, patients could be diagnosed with four separate disorders: Autistic Disorder, Aspergerâ&#x20AC;&#x2122;s disorder (Aspergerâ&#x20AC;&#x2122;s Syndrome), Childhood Disintegrative Disorder (CDD) and Pervasive Developmental Disorder Not Otherwise Specified (PD-NOS). Under the DSM-V these disorders came under one category, ASD. It must be noted that any patients who were diagnosed before 2013 and present with one of the four pervasive developmental disorders from DSM-IV should still meet the criteria for ASD in DSM-5 or another, more accurate DSM-5 diagnosis.

When a diagnosis is provided, the individual receives a level between one and three to represent the amount of support that person will require, ie Level 1 (requiring support) through to Level 3 (requiring substantial support).

However, like the disability itself, these levels are not always clear cut and some individuals do not fit clearly into any them. The levels are based on the severity of autistic symptoms, but do not consider the impact of commonly co-occurring conditions such as intellectual disability, attention deficit disorders, language disorder, anxiety disorders and depressive disorders. About 70 per cent of individuals on the autism spectrum have at least one co-occurring condition. The DSM-5 does not recommend that these levels be used to determine eligibility for or provision of services.

60 Doctor Q Autumn

HOW CAN AUTISM QUEENSLAND HELP? Autism Queensland has been delivering specialised, evidence-informed services to individuals of all ages with autism for over 50 years.

Established in 1967, the organisation has a proud tradition of familycentred practice for individuals of all ages and the families, professionals and others who support them.

Our team of allied health professionals and educators deliver these services across Queensland from centres in Sunnybank Hills and Brighton in Brisbane, Gladstone, Rockhampton, Mackay and Cairns.

Autism Queensland is a registered NDIS service provider, and rebates for services provided by our therapists registered with Medicare are available through Medicare and Private Health Insurance companies with an appropriate referral.

As autism is a spectrum condition its impact on each individual is greatly varied. The services and supports provided by Autism Queensland are aimed at helping each person cope with the challenges associated with their diagnosis while also focussing on their individual strengths and abilities. They include: Individual Therapy (Speech Pathology, Occupational Therapy, Psychology) (all ages) Specialist and diagnostic assessments to support the diagnosis process Early Childhood Intervention (Group and individual programs) Group Therapy Programs focussing on elements such as behaviour, development, social skills, communication, anxiety, eating Specialist education for children from Prep age through to 18 at the Autism Queensland school at campuses at Sunnybank Hills and Brighton in Brisbane.

The Cairns campus opened in January and currently supports students in Prep-Year 2 Advisory Visits by teachers and therapists to schools

throughout Queensland providing information, advice and individual strategies to staff, other key professionals and parents of students on the spectrum Post-school transition, vocational and independent living programs for adolescents and adults Professional Development and Parent Education Supported Independent Living and support for people to live in and access the community across the Brisbane region.

Customised service designed to meet a diverse range of needs and available for individuals and families, community organisations, school and early childhood services, work places.

CONTACT P: (07) 3272 000 E: admin@autismqld.com.au W: www.autismqld.com.au FB: www.facebook.com/autismqueensland/

HUGH LANDER CEO, BOQ Specialist

Disclaimer Products and services are provided

by BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence No. 244616. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges and eligibility criteria apply.

There is more to an equipment purchase than just finance With the ever-increasing demands on medical professionals to run practices more efficiently, the productivity of both staff and equipment is a serious issue.

Equipment often requires a large outlay, affecting both business cash flow and debt, so the last thing you want is unproductive assets. Even worse is equipment still in use well after its used by date, which has a negative impact on productivity and the team.

Many of our consultants have years of experience with the medical industry and have a deep understanding of your niche needs and career trajectory. For example, after a specialist hits the 10-year mark practicing, they are often looking for their next challenge and, for example, may consider moving into more complex procedures. We

anticipate and facilitate such moves, which in turn require investment in further equipment.

By taking this long-term view of your career development, BOQ Specialist remains one step ahead, helping you ensure that your equipment purchases and leases complement the growth in your business and experience.

BOQ Specialist is an expert tools of the trade lender committed to the ongoing process of assessing and modernising your equipment.

A large volume of our commercial clients’ finance is for specialty equipment, and it is through everyday conversations with you and your equipment suppliers that BOQ Specialist stays ahead of the ever-changing technology and innovations in your profession.

While it’s important that you choose the right assets and equipment, it’s equally important that you are guided towards the right kind of financing.

When it comes to deciding whether a loan, lease, chattel mortgage or commercial hire-purchase is best, we work closely with your financial advisers and accountants to tailor an arrangement which fits with your tax structure. As part of our distinctive service, BOQ Specialist also conducts a cash flow projection, considering factors such as how many patients need to be seen over the life of an asset to ensure it is profitable.

To understand financing options and to enable practitioners to make an informed decision, speak to a professional in the industry with experience in providing finance for healthcare professionals.

BOQ Specialist has over 25 years’ experience working with medical professionals and understands your specific needs.

For further information on lending products, contact one of our financial specialists today on 1300 131 141 or visit our website at www.boqspecialist.com.au

Doctor Q Autumn 61

Do you know a person or project that needs financial support?

The AMA Queensland Foundation is a Public Benevolent Institution established in 2000 by the medical profession, as a means of relieving sickness, suffering and disability among Queenslanders in need. Through the AMA Queensland Foundation, medical colleagues and the business community help deliver vital services outside those catered for by the public health system.

AMA Queensland Foundation is about doctors doing good.

The project needs to be Queensland-based and must align with the AMA Queensland Foundation objectives outlined below (at least one required field): To relieve sickness by providing support of various kinds to disadvantaged and needy individuals for medical services and treatment.

To provide financial assistance to individuals in remote and rural regions to enable provision of medical services in those regions.

To provide funding to disadvantaged students wishing to undertake medical training but unable to do so due to financial hardship.

To provide financial assistance to projects and activities approved or promoted by AMA Queensland designed to enhance provision of existing medical services.

The Foundationâ&#x20AC;&#x2122;s incidental services are: To assist in the development and promotion of the Medical Benevolent Association Queensland and Queensland Doctorsâ&#x20AC;&#x2122; Health Programme.

To provide funds for medical research projects approved by AMA Queensland.

To provide a coordinated medical advice service to other not-for-profit organisations or to any government or governmental body or authority.

To promote and assist the training of doctors in Queensland through the support of education programs, scholarships, fellowship and other initiatives with financial support and expertise.

To submit an expresseion of interest, please visit www.amaqfoundation.com.au. The expression of interest link is on the home page. Otherwise, contact us on (07) 3872 2222 or email amaqfoundation@amaq.com.au.

The AMA Queensland Foundation sincerely thanks our donors, supporters and corporate partners for their generosity. We would like to take this opportunity to acknowledge Lexus of Brisbane for choosing us as their charity of choice with their recommended compulsory third party insurer, Suncorp. Suncorp pays a small charitable donation to AMA Queensland Foundation for every new Lexus owner who opts to purchase compulsory third party insurance with them.

We thank Lexus and Suncorp for their ongoing support.

62 Doctor Q Autumn

All aboard!

G R E AT T R A I N J O U R N E Y S O F T H E W O R L D “I have seldom heard a train go by and not wished I was on it”

AMA Queensland Orbit World Travel vider: preferred travel pro P: 1300 262 885 m.au E: travel@amaq.co l.com.au ave dtr orl tw rbi www.o

Paul Theroux

Embark on a unique and incredible train journey and discover a world of luxury hotels on wheels. Sit back and relax as you travel between unforgettable destinations. Whether you are seeking spectacular scenery, luxurious carriages, heritage steam trains or an epic long-distance journey aboard a sleeper train – there is still something romantic about travelling by rail. Some of the world’s wildest and most beautiful scenery is best enjoyed from a train window.

There are many stunning rail journeys on almost every continent that offer magical and unique experiences. Here are just a few to whet your appetite.

BELMOND HIRAM BINGHAM – PERU

Travel between Cusco and Machu Picchu and explore the land of the Incas from the elegant surroundings of the luxury Belmond Hiram Bingham – named after the archaeologist who discovered the ancient Incan city of Machu Picchu.

ROVOS RAIL – AFRICA

The Pride of Africa links some of Africa’s greatest destinations from Cape Town to Dar es Salaam, game reserves of Mpumulanga to the Victoria Falls, desert landscapes in Namibia to the lush cane fields of KwaZuluNatal and the magnificent garden route along the Cape South Coast.

B E L M O N D R OYA L S C OTS M A N – SCOTLAND

Embark on a grand highland fling and travel in the luxury of mahogany-clad cars married with Edwardian elegance, straight to the heart of Scotland. Pass through glens, lochs and mountains steeped in the lore of characters such as Rob Roy and Bonnie Prince Charles.

There are a variety of itineraries available, from two to seven nights, and these will combine perfectly before or after our Annual Conference in Edinburgh this year.

MAHARAJAS’ EXPRESS – INDIA

Offering five fascinating journeys crisscrossing some of the most vibrant destinations, the Maharajas’ Express offers journeys to the very heart and soul of India in sheer opulence.

V E N I C E S I M P L O N - O R I E N TEXPRESS – EUROPE

The fabled Venice Simplon-Orient-Express is undoubtedly one of the most famous trains in the world, travelling between some of Europe’s most iconic cities; London – Paris – Venice. Join royalty, celebrities, spies and even murderers who have travelled on this renowned train.

P R I VAT E T R A N S - S I B E R I A N – THE TSAR’S GOLD – BEIJING TO MOSCOW A journey on the legendary Trans-Siberian railroad is one of the last great travel adventures. You can now experience Russia, Mongolia and China by a private train in the safest, most comfortable and fascinating manner. Sit back and enjoy the dramatic changes in scenery as you journey through Europe and Asia’s stunning landscapes.

ROCKY MOUNTAINEER – CAN ADA

Unlock a hidden world of unparalleled beauty as you explore the majestic Canadian Rockies from your glass-domed carriage whilst being wined and dined. Choose journeys between Vancouver, Jasper, Banff, Lake Louise and Whistler.

I N D I A N PA C I F I C – A U S T R A L I A

The Indian Pacific train journey shows you two oceans on one of the world’s longest and greatest rail journeys. From the spectacular Blue Mountains to the guileless plains of the Nullarbor Desert, the four-day/threenight Indian Pacific journey between Sydney and Perth (or vice versa) is a quintessential Australian experience.

Doctor Q Autumn 63

RESTAURANT REVIEW

A food hall for a feast of fancy Mercado is not your average supermarket! Taking inspiration from Harrod’s in London and Gallery Lafayette in Paris, the latest addition to Brisbane’s King Street development is one for the foodies, entertainers and sommeliers alike.

If you haven’t graced the majestic food hall of Harrod’s in London, then imagine this if you will: a seemingly never ending maze of food counters, each window lavishly filled with handmade chocolates, fresh seafood, deli tidbits, pastries, gourmet meats and cheese to your heart’s content.

Among the produce are a number of restaurants that vary wildly in their cuisine, from casual bar style snacking to sitdown fine dining.

While Mercado is significantly smaller in size, it emulates the style of its English counterpart, and is certainly a first of its kind for Brisbane. Literal towers of cheese adorn the fridges, surrounded by an enormous selection of gourmet condiments. Their vibrant fresh fruit and vegetable display leads you to the aroma of fresh bread in their own bakery, and an impressive French style patisserie. Their floor to ceiling wine cellar is matched with their very own beer cellar, which is not to be outshone by their luxe display of fresh shellfish and gourmet meats.

64 Doctor Q Autumn

Like the food halls of Europe, there’s a schedule of cooking displays, wine tastings and ample supply of fresh produce to sample throughout the week. Mercado also features two dining options – a more casual bar restaurant, with the opportunity to dine at the chef’s table, as well as the fine dining Duck Room.

The breakfast menu is as lush as you would imagine, while being similarly priced to their local café neighbours. Ditch your regular avocado toast and try something entirely different, like confit duck crumpet with forest mushrooms, chilled mangosteen and vanilla conjee with lavender granola, yuzu curved salmon cerviche on artisan sourdough, or their open style omelette with drug aged corizo and crab meat.

Lunch and dinner is best shared. From the bar, try the butcher’s antipasto platter, beef tataki, chargrilled whole quail or tea-smoked dry aged duck breast. The pescatarian’s will enjoy their selection of local sashimi and nigri, their signature snapper and sea urchin pie, or their spring bay mussel pot with shellfish from France, Spain and Malaysia to try. Steak lovers will rejoice in their selection of meats , from dry aged O’Connor t-bone from South Australia, to Wagyu scotch fillet from local Queensland, severed with the likes of

truffle ponzu or red wine jus (with a side of roasted garlic truffle potatoes perhaps!).

Their fine dining outfit The Duck Room heroes the humble fowl as a versatile and delicious treat, among their menu of local and international meats and seafood. Dry-aged duck comes smoked with torched foie gras as not-youraverage Nigri, while their Cheong Fun menu sees scampi, short ribs and king prawns wrapped in rice noodles and served with oyster emulsions, sea urchin and summer truffle.

However, as a seasoned foodie and aficionado of gustatory delights, I simply could not resist the opportunity to try the Duck Room’s signature degustation. Six courses and an elegant sufficiency of food later, I can definitely say that it’s a feast that will linger in the memory and on the taste buds for quite some time after.

While the beverage menu is vast and flavourful as you’d expect from a venue with its own wine cellar, the cocktails are not to be ignored. You haven’t tried a martini quite like the Blood Orange Sake-Tini, made with sake and Nosferatu Blood Orange gin to produce the fresh, citrusy and perfectly smooth but not overtly sweet accompaniment to duck. If you’re a fan of something sweeter, the Garden Bramble with violet liqueur, finger lime and lemon juice will transport you back to the streets of London’s Soho with notes of blackberry and Bombay sapphire gin.

To start your degustation of epic proportions, shitake mushrooms and roasted duck are served stacked in a bowl, before being drowned in a glorious teapot of miso soup by your waiter. It’s wonderfully umami, with the roasted duck tender and melt in your mouth worthy after its miso Jacuzzi.

Next comes house processed scampi caviar. The smoked Hiramasa kingfish

belly tartate, capers, and finger lime served with crunchy sunflower seed cracker make every mouthful of this dish a surprise of sweet, sour, savoury and salty flavours, with the surprise burst of caviar like a luxurious savoury popping candy. Definitely a stand out for me!

The halfway point is reached with tuna Cheong Fun, the aforementioned rice noodle dumpling, served with soy pearls, ponzu and summer truffle.

Decadent and fresh without being overbearingly fishy, this will be a novel but delightful way to enjoy Mooloolaba seafood for many.

Next comes beef short rib, served in cooking juices with kim chi, Korean chilli and basil leaves. While I am not a chili fan and chose to leave the spice on the side, the flavour of this dish was remarkable nonetheless, with beef so silky soft you could almost forgo chewing it.

Then arrives the impeccable Borrowdale free range Pork Char-Siu, with flavours of honey and five spice, served with a zesty cucumber salad to cleanse the palate. And last but not least, just when the belt buckle needs undoing a notch, the final course is served.

D R K AT G R I D L E Y Advanced Emergency Trainee, Queensland Children’s Hospital; and member, AMA Queensland Council of Doctors in Training

immediate plans afterwards, as you are sure slip gently into a delicious food coma while you rest and digest!

Whether it’s shopping for your next dining party, enjoying a feast between friends, or adding a pinot noir to your collection, Mercado is without a doubt a fabulously unique shopping and dining experience.

Located at 3/30 King Street, Bowen Hills and open from 7am to 11pm for all your foodie needs!

Half a roast duck. Yes, that’s correct.

Dry aged for seven days, served in cooking juices with rice and broccolini, you’ll be glad they offer a doggy-bag as you’ll want to savour every single mouthful. If you can summon the strength of your dessert stomach, there is one final course on offer – a chance to try one of their stunning pastries from the cabinet. Cheesecakes, choux pastry, tartes and gateau galore, these pretty patisserie are almost too beautiful to eat.

This is one feast for the foodie bucket list. I do highly recommend wearing stretchy pants, embarking with an empty tummy and organising no

Doctor Q Autumn 65

All about you GO GREEN: SOFT PLASTICS

P O D C A S T: EARSHOT ABC’s Radio National presents documentaries about people, places and ideas, in all their diversity. One such interview is with a woman who has signed up to live on Mars, but a little closer to home (boom, tish) is the effect of asbestos on the Indigenous town of Wittenoom, nostalgic music used in treatment, foster families – the list of subjects is many and varied.

Listen on Apple Podcasts or download the ABC Listen app to check it out.

Even without plastic bags when you go grocery shopping, there’s still an awful lot of plastic in your shop, despite your best efforts. You can avoid plastics by taking your own light weight bags for fruit and veges, but there’s still frozen vegetable bags, cereal box liners, newspaper wrap, confectionary wrappers, biscuit packets. The good news is, you can recycle any plastic that you can scrunch through REDcycle and take it into Coles or Woolworths when you do your next shop.

T V: THE LAST KINGDOM

D O N AT E : GO BLUE FOR AUTISM 2 April is the day the state goes blue to raise funds and awareness for people with autism spectrum disorder and their families. Buy some blue merchandise, hold or attend a blue-themed event.

Visit www.goblueforautism.com.au for more information.

WIN

ets k c i t e i mov ! for two Name:

My name is Uhtred, son of Uhtred.

As a child, Uhtred witnessed his father being killed and the Saxon army defeated by invading troops. Danish warlord Earl Ragnar captured Uhtred and raised him in a Danish camp. You might think it’s too much like Vikings, but it’s based on Bernard Cornwell’s The Saxon Stories series of novels, so it has it’s own merit.

Uhtred grows into a very good-looking warrior (ahem) and his Viking family, who’s he’s grown to love, is killed. He’s torn between his English roots and his Viking upbringing, his loyalty to King Alfred and the birth of a new nation and his Viking brothers and his commitment to the Norse gods. While this is all about Uhtred, his co-stars are the real joy: his childhood friend Brida, Anglo-saxon warrior Leofric and priest Father Beocca add a great deal to the winning team.

66 Doctor Q Autumn

Telephone:

Member no:

Fill out the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au.

Entries close 30 March Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au

UPCOMING FILMS Please note upcoming film are subject to change

ADRIANA LECOUVREUR 6 April, 2pm | 7 April, 2pm | 10 April, 10am The Met Opera For the first time at the Met, Anna Netrebko sings the title role of Adriana Lecouvreur, the great real-life 18thcentury actress who is adored by many, but who loves only the military hero Maurizio, sung by Piotr Beczala.

Gianandrea Noseda conducts Cilea’s tragedy, directed

by Sir David McVicar, with the action partially set in a working replica of a Baroque theatre.

21 March The Lego Movie: the second part Swimming with Men 28 March Dumbo 4 April Shazam!

11 April Hellboy Missing Link

The cast also features Anita Rachvelishvili as the Princess of Bouillon, Adriana’s rival for Maurizio’s affections who will stop at nothing to win his love; Ambrogio Maestri as Michonnet, Adriana’s faithful friend; and Carlo Bosi as the duplicitous Abbé.

ALLELUJAH! 30 March, 1pm | 31 March, 1pm | 3 April, 10.30am National Theatre Live The Beth, an old-fashioned cradle-to-grave hospital serving a town in Yorkshire, is threatened with closure as part of an efficiency drive. A documentary crew, eager to capture its fight for survival, follows the daily struggle to find beds on the Dusty Springfield Geriatric Ward, and the triumphs of the old people’s choir.

One of Britain’s most celebrated writers, Alan Bennett’s plays include The History Boys, The Lady in the Van and The Madness of George III, all of which were also seen on film. Allelujah! is his tenth collaboration with awardwinning director Nicholas Hytner.

TINTORETTO - A REBEL IN VENICE 27 April, 2.15pm | 28 April, 2.15pm | 2 May, 10.30am Tintoretto, A Rebel in Venice tells the story of the painter Jacopo Robusti, known as Tintoretto, from the early years of his artistic career until his death in 1594 in the city that inspired and challenged him.

This visually spectacular new art film explores Tintoretto as the true mirror of Venice. A one of a kind genius, open-minded, restless, brave and with a strong love for freedom, unstable and elusive, he reflected the true spirit of the lagoon city.

THE TRAGEDY OF KING RICHARD THE SECOND 20 April, 12.45pm | 21 April, 12.45pm | 24 April, 12.45pm National Theatre Live Simon Russell Beale plays William Shakespeare’s Richard II, filmed live from the stage of the Almeida Theatre in London to cinemas.

This visceral new production about the limits of power will be directed by Joe Hill-Gibbins, whose previous plays include Little Revolution at the Almeida and Absolute Hell at the National Theatre.

Richard II, King of England, is irresponsible, foolish and vain. His weak leadership sends his kingdom into disarray and his court into uproar. Seeing no other option but to seize power, the ambitious Bolingbroke challenges the throne and the king’s divine right to rule.

Doctor Q Autumn 67

The Bear, The Block and The Batchy Television is great. It delivers us the news of the world. It shows us the globe. It shapes cultures and politics.

Places to which we would never dream of travelling are brought into our living rooms, direct. History is recreated.

Geography is revealed. Every musical and artistic whim you can dare to indulge can be presented almost as if you are there with the original artists.

Thanks to David Attenborough, we can visualise every species on our beautiful green and blue planet. And of course, as a sports lover, I am eternally indebted to television for bringing cricket, footy, tennis and the Olympics into my lounge room with immediacy and accuracy.

But of course, television has a down side. Our profession is well cognisant of the results of television watching on our Australian waist lines. Sedentary working lives are exacerbated by people watching television for mindless hours every night. This is compounded by every booze, fast food and soft drink advert that penetrates and infiltrates the minds of every viewer. Television has made Australia fat.

But I now fear television might be having an even more sinister impact. I call it compartmentalisation. People are compartmentalising their lives. Living out their existence vicariously. In segments.

It struck me as I watched The Bachelor.

It’s a grubby little secret I seldom share openly, but I do love a bit of Batchy.

I realised I get a real romantic fix from

68 Doctor Q Autumn

the show. I am not the world’s most romantic bloke. Flowers for my wife, Freya, generally mean ‘sorry’ rather than anything romantic. Any chocolates that I give her usually end up being scoffed by me. Admittedly, I do write poetry, but more about my cricket team than my long-suffering spouse. But I must admit I am emotionally involved in the weekly romantic trials and tribulations on the television. I realised that the romantic fix that I need and I am sure the fix that my romantically starved wife needs, is fulfilled right there on the telly. She can address the paucity of romance in her life by simply watching the Batchy. No need for any more subtle hints. No need to keep nagging. Just set up in front of the telly for two weeknights per week.

Romance. Tick.

It made me think about the other roles that television has usurped in our lives.

Other compartments of our lives that we sub-contract to TV. I am sure our basic masculine drive to play sport has been diluted because men now think they are sporty if they set up in front of the telly on Saturday arvo kitted out in their favourite jersey, with a six pack, a pie and a mate or two. Blokes may never again need to strap on a boot, kick a footy or delight in the smell of a brand-new leather Kookaburra cherry.

You never even need to have team mates in a real club because you can sense the mateship and camaraderie in the words of the players in their pre- and post-match interviews. They become de facto friends. You can experience the thrill of triumph and the devastation of loss by proxy as you idly watch the televised matches.

D R M AT T Y O U N G General Practitioner, Inala Medical Centre

The sense of adventure that traditionally sent great men like Vasco de Gama, Edmund Hillary, Roald Amundsen to oceans unknown, peaks unconquered and poles untamed, can now be sated vicariously in the living room by watching the Nat Geo channel.

Any yearning to pit oneself against the forces of nature can be experienced by turning on I’m a Celebrity, get me out of here or Bear Grylls. Any interest in travelling the globe and immersing oneself into other cultures is now easily served by tuning into Getaway.

One doesn’t need to head to Bunnings to satisfy the renovation bug. Merely series link The Block. And maybe David Attenborough is actually hampering people getting in touch with nature by keeping them transfixed in their living rooms rather than liberating them into their back yards or the bush.

It has even impacted my professional life. I used to love working one night per week in a Brisbane hospital emergency room, but ended up finding I could watch ER and enjoy all of the excitement and suffer none of the stress. So, I gave my shift away.

I haven’t got any answers but I suppose balance is the key. Anyway, I better sign off because the Batchy is on soon and I’ve taped the footy.

PHIL MANSER Wine Direct

More reasons to abandon the big brands

P: 1800 649 463 E: philmanser@ winedirect.com.au

Mike Farmilo is a former maker of Penfolds Grange, St Henri and Bin 707 and twotimer winner of the Jimmy Watson Trophy. He has been making wine in McLaren Vale for over 30 years and is a legend of the industry.

Early in my career, I happened upon Mike as winemaker at Seaview years before this brand was consumed amongst acquisition by one of the big companies. On this particular day, Mike was kind enough to give me a tour of an old-fashioned winery littered with wax sealed open fermenters and basket presses. Many of the wines made in that era are still alive today as evidenced by the 1982 Cabernet my father and I enjoyed over Christmas. Mike was humble and accommodating that day and not much has changed which is refreshing given his impressive list of accomplishments A truncated bio for Mike reads as follows: Completed winemaking at Roseworthy in 1977 Seaview winemaker in the 80s Worked for Angoves in the late 70s - including winning a trophy with a Riverland Riesling in 81 In the late 80s, Mike became Group Red winemaker for Penfolds/Southcorp – responsible for all Penfolds red wines including Grange and St Henri,

Lindeman’s wines, Seppelt’s, Wynns and Leo Buring During his tenure with Penfolds/ Southcorp Mike won at least one trophy at every capital city wine show every year and twice won the coveted Jimmy Watson trophy In the midst of all this Mike has also completed vintages in Germany, California, France and Chile

Nowadays Mike is the chief winemaker for Monterra and makes the excellent wines for Willunga 100 as well. The Monterra Reserve Shiraz is a stunning example of his work and only supports my argument to abandon the big brands and start exploring the plethora of small labels our industry is bursting with…

For special AMA pricing of this wonderful shiraz contact Phil at phil.manser@winedirect.com.au

Doctor DoctorQQAutumn Spring 69

INPRINT

Harrison’s Endocrinology 4TH EDITION Larry Jameson, J. Featuring a superb compilation of chapters related to endocrinology derived from Harrison’s Principles of Internal Medicine, Nineteenth Edition (including content from the acclaimed Harrison’s DVD, now available here in print), this concise, full-colour clinical companion delivers the latest knowledge in the field backed by the scientific rigour and authority that have defined Harrison’s. Harrison’s Endocrinology contains six sections that reflect the physiologic roots of endocrinology: introduction to endocrinology; pituitary, thyroid, and adrenal disorders; reproductive endocrinology; Diabetes Mellitus, Obesity, Lipoprotein Metabolism; disorders affecting multiple endocrine systems; and disorders of bone and calcium metabolism.

Harrison’s Endocrinology also features: coverage of discoveries emanating from genetics and molecular biology, along with the latest drugs that are transforming the field; integration of pathophysiology with clinical management; high-yield board review questions make this text ideal for keeping current or preparing for the boards; and

Win this book Fill out this form and

email to competitions@amaq.com.au Name:

valuable appendix of laboratory values of clinical importance.

Telephone:

BOOK WINNER Dr Ashlie Meigh won a copy of Smart time management for doctors, thanks to our friends at McGraw-Hill Education.

DENDY WINNERS

Entries close 16 April 2019

Doctor Q Ben van Haeringen Kevin Lee See

70 Doctor Q Autumn

Member no:

Events and Training eNews Ray Kerr Katrina Samios David Wood

Mark Wallace

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