Doctor Q Spring 2018

SPRING 2018 | VOL. 108

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Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by Medical Defence Association of South Australia Ltd. Before you make any decisions about any of our policies, please read our Product Disclosure Statement and Policy Wording and consider if it is appropriate for you. Call MIGA for a copy or visit our website at www.miga.com.au A business must be a Qantas Business Rewards Member and an individual must be a Qantas Frequent Flyer Member to earn Qantas Points with MIGA. Qantas Points are offered under the MIGA Terms and Conditions www.miga.com.au/qantas-tc. Qantas Business Rewards Members and Qantas Frequent Flyer Members will earn 1 Qantas Point for every eligible $1 spent (GST exclusive) on payments to MIGA for Eligible Products. Eligible Products are Insurance for Doctors: Medical Indemnity Insurance Policy, Eligible Midwives in Private Practice: Professional Indemnity Insurance Policy, Healthcare Companies: Professional Indemnity Insurance Policy. Eligible spend with MIGA is calculated on the total of the base premium and membership fee (where applicable) and after any government rebate, subsidies and risk management discount, excluding charges such as GST, Stamp Duty and ROCS. Qantas Points will be credited to the relevant Qantas account after receipt of payment for an Eligible Product and in any event within 30 days of payment by You. Any claims in relation to Qantas Points under this offer must be made directly to MIGA by calling National Free Call 1800 777 156 or emailing clientservices@miga.com.au. Š MIGA November 2017

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CONTENTS

REPORTS

12

32

4

Editor’s desk

6

President’s report

8

F E AT U R E S 14

Medical Officers’ Certified Agreement

CEO’s report

18

Overtime awareness campaign

44

Member benefits

22

My Health Record

66

Foundation news

2018 JUNIOR DOCTOR CONFERENCE PHOTOS

BUSINESS TOOLS

DR SANJEEV BANDI IS ONE OF OUR NEWEST COUNCIL

38

How to talk to patients about diet

40

Clinical Skills Development Service

52

All types of fraud

54

Is property your next investment?

56

Keep your cool and ensure a fair dismissal

58

What you need to know about My Health Record

60

Patient referral spotlight: Carers Queensland

67

Utilise the equity in your home

MEMBERS

CURRENT ISSUES 16

AMA Queensland opposes greater scope for pharmacists

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Mater Resident Medical Officers’ Enterprise Agreement

24

Increase to the minimum rates of pay

26

Termination of pregnancy laws and conscientous objection

28

New family and domestic violence leave entitlements

30

Digital transformation

32

AMA Queensland Council and Board final positions

33

Seeking compassionate care

34

Workplace bullying

36

Best use of health funding

42

Going green

PEOPLE & EVENTS

45

O B I T U A R Y: D R J O H N L E E

LIFESTYLE

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Junior Doctor Conference photos

61

Ski USA and Canada

45

Obituary: Dr John Lee

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46

A Day in the Life of an Ophthalmic Surgeon

Restaurant review: Three Blue Ducks

64

All About You

48

Local Medical Association round up

65

Dendy Cinemas

50

Events calendar

68

Let’s make Australia slim again

69

In defence of Merlot

70

InPrint: Williams Obstetrics 25th Edition

Doctor Q Spring

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Editor’s Desk Q U E E N ’ S B I RT H DAY H O N O U R S Congratulations to our members who were recently recognised in the Queen’s birthday honours.

Professor Anthony Frank BROWN AM was named a Member in the General Division of the Order of Australia for significant service to emergency medicine as a clinician, author and educator, and to professional organisations.

Professor Lawrence William HIRST AM was named a Member in the General Division of the Order of Australia for significant service to medicine in the field of ophthalmology through the development of clinical care techniques and eye disease management.

Dr Jacqueline Kim MEIN OAM was awarded a Medal of the Order of Australia in the General Division for service to medicine and to community health.

Dr Michael MIROS OAM was awarded a Medal of the Order of Australia in the General Division for service to medicine, particularly to gastroenterology.

Professor Bernard Mark SMITHERS AM was named a Member in the General Division of the Order of Australia for significant service to medicine in the fields of gastrointestinal and melanoma surgery, to medical education, and to professional organisations.

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 Dr Paul Bryan General Practitioner Craft Group Dr Michael Clements North Area Representive

OBITUARIES

Dr Sarah Coll Specialist Craft Group

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

Haydn Dodds Medical Student Craft Group

Dr Kerry Vincent CASEY Radiologist Late of Pullenvale Life Member of 57 years

Dr John GALLAGHER Orthopaedic Surgeon Late of Toowong Life member of 69 years

Dr Gary Edward O’ROURKE Radiologist Late of Clayfield Member of 33 years

Dr John Francis LEE Past President 1972-73 Emeritus Vice President Late of Kenmore Life member of 69 years

Dr Terence Michael CASEY Dermatologist Late of Fig Tree Pocket Member of 32 years

This year, we are featuring covers that inspire you to relax and have a few moments of peace and tranquility.

This edition’s cover photo is taken at Lake Baikal, Olkhon Island in Eastern Siberia.

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Clare Mahon Medical Student Observer

Dr John Hall Downs and West Area Representive

Dr Bav Manoharan Greater Brisbane Area Representive

Associate Professor Geoffrey Hawson Retired Doctors Craft Group

Dr John F. Murray Specialist 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

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

COVER IMAGE

Ben Hancock Skilled Director

Advertising: Louise Glynn

(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.

President’s report

DR DILIP DHUPELIA

It is indeed remarkable how quickly the honeymoon period disappeared in my role as President, as the association immediately faced important issues of advocacy, representation and media involvement that required an energetic drive from the outset.

to be ‘substantial risk’ for a treating practitioner. AMA Queensland CEO Jane Schmitt and I recently met with the Department of Health’s Legislative Policy representatives and pushed for changes in accordance to agreed principles at federal AMA level.

PHARMACY COUNCIL

INCLUSIVENESS IN POLICY

AMA Queensland provided feedback to the Queensland Parliament’s Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee on the proposal to establish a pharmacy council in Queensland. By the time this column goes to print, I would have fronted the public hearing of the pharmacy inquiry.

Council has taken a strong position on the proposed scope of practice of pharmacists. See page 16 for further information on the AMA Queensland Pharmacy Submission.

I need to mention two other big highlights that were very pleasing to me. The first is the endorsement by Federal Council of the Uluru Statement from the Heart, which calls for a First Nations’ voice in the Australian Constitution. Secondly, the AMA Federal Council has formally adopted a new Anti-Racism Statement. AMA policy actions such as these make a huge impact on heath policy makers within governments and demonstrate the AMA leadership. You can find both statements on the AMA website.

M A N D AT O R Y REPORTING

RURAL BIRTHING

On 2 August 2018, the COAG Health Council (CHC) approved a targeted consultation process, with a very short turn around period, for amendments to mandatory reporting requirements by treating practitioners. At the recent AMA Council meeting, federal and state AMA Presidents and CEOs considered the proposed reforms. AMA Queensland has continually lobbied to overturn the unintended consequences of the current law that leads to doctors not seeking treatment out of fear of the consequences. The ministers are steadfast in not weakening consumer protection; however, they are proposing to raise the existing ‘risk’ threshold 6 Doctor Q Spring

The issue of safe rural birthing services has been in the news lately.

AMA Queensland’s position has always been of a doctor-led obstetric service in collaboration with midwives to provide the safest care. AMA Queensland has appointed Past President and Queensland Obstetrician, Associate Professor Gino Pecoraro, onto the Ministerial Rural Maternity Taskforce.

We will report on progress in future editions of Doctor Q.

BOARD AND COUNCIL Dr Sarah Coll has recently been appointed Director of the Board following a call for nominations to

fill the casual vacancy created by my elevation to the presidency. Sarah is an active member of the AMA Queensland Council and I welcome her to the Board. We also welcome four new Councillors and this will ensure further enhancement of the wide expertise that we have on Council to assist in the important policy work that we do.

Council is eager for more involvement.

I have heard their message and have already taken steps to utilise Council’s expertise in between Council meetings in a more meaningful way. The Board would like to thank the numerous other members who nominated for these positions. It is a healthy sign for the association that so many of you wish to be involved.

ON TOUR I have commenced my tour of Local Medical Associations (LMAs) in the state and I thank both the Toowoomba and the Central Queensland LMAs for hosting great functions that allowed me to update a large number of members and non-members on the advocacy work we are currently undertaking, as well as an opportunity to meet face to face. In the coming months I will be visiting Brisbane North, Redcliffe, Sunshine Coast and Cairns. I am a firm believer that LMAs play a vital role and I am keen to see a reinvigoration of this network.

I was delighted to be guest of honour of the Indian Medical Association at their flag-raising ceremony and the launch of the first edition of their Queensland Branch newsletter on Indian Independence Day on 15 August. Our two associations will be meeting shortly to determine further ways of collaboration.

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VICTORIA PARK

GOLF CLUB

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12 October Friday

Group bookings and individual tickets are available.

FOR MORE INFORMATION VISIT WWW.AMAQ.COM.AU Doctor Q Spring

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CEO’s report

JANE SCHMITT

W AT E R F LU O R I D AT I O N Over the last few months, I met with several Hospital and Health Services across Queensland to discuss a range of issues, including water fluoridation.

AMA Queensland has long been advocating with the Australian Dental Association Queensland for fluoridated water to be restored across Queensland.

As many of you would be aware, fluoridation of local water supplies was mandatory in Queensland until 2012, when councils were given the choice of whether to fluoridate or not.

Since then, two thirds of Queensland’s councils have opted out, including Cairns, Rockhampton and Bundaberg, Mount Isa, and Mackay.

Water fluoridation is cheap, it’s proven to be beneficial, and data repeatedly proves that it is effective in reducing cavities in children and benefits the overall health of Queenslanders.

AMA Queensland will continue to endorse water fluoridation as a safe and effective public health measure and lend its voice for positive change, as a counter to some of the misinformation that often accompanies this issue.

D E AT H E D U C AT I O N IN SCHOOLS AMA Queensland has called for death education to be integrated into the current school curriculum to raise awareness of care at the end of life and planning.

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As a result of women having babies later in life, this generation of now school-age children will be looking after their ageing parents in their late 30s and 40s, at a time when they are mid-career and busy with children of their own. They will need to be resilient and have a solid understanding of the aged care system and the legal implications in relation to caring for ageing parents and endof-life planning.

At-school-learning about the legal and medical issues that surround ageing and dying ageing will make it easier for young people to navigate these issues when they arise and will prevent them from adopting their parents’ anxieties and concerns.

It is a sensitive topic, but is time to address the elephant in the room.

NEW EXCLUSIVE OFFERS FOR YOU I’m excited to announce a new partnership between AMA Queensland and Officeworks that will enable our members to access exclusive business pricing across a wide range of office supplies.

You will find further details on the AMA Queensland website at www.amaq.com.au.

Recently we have secured further special offers for our members with Accor Hotels and Red Balloon. Contact the Membership Team on email membership@amaq.com.au to obtain the unique access code.

I encourage you to look on our website and take advantage of all our exclusive member offers. Other popular lifestyle benefits include BMW, Lexus and VW discounts, Emirates

flight discounts and savings off QANTAS and Virgin Lounge annual memberships. You can view the full range of 2018 member benefits available to you at www.amaq.com.au.

DINNER FOR THE PROFESSION The forthcoming Dinner for the Profession (see page 7 for further details) is the highlight social event of the year for AMA Queensland. It will be a great opportunity to mingle with colleagues, mentors and friends, while enjoying a three-course dinner, live entertainment and a silent auction.

You can register at www.amaq.com.au and I look forward to seeing you on 12 October.

MEMBERSHIP RENEWAL Finally, you will receive your membership renewals notice late next month and we are counting on your support - your membership helps us to help you and your patients. We are the only body that advocates for your rights – during your junior doctor years, in salaried practice, general practice, specialist practice and upon your retirement. Membership is an investment in your future. For convenience, annual payers can now elect to switch to monthly payments, to do so contact the Membership Team on (07) 3872 2222 or email membership@amaq.com.au

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 register your interest visit gssuites.com.au or contact Uma Ranchigoda on 0412 470 882

www.gssuites.com.au

LEXUS CORPORATE PROGRAMME EXPERIENCE EXCEPTIONAL Lexus represents an incomparable driving experience and the Lexus Corporate Programme builds upon this by providing a service uniquely tailored to our corporate clients. It is with pleasure the Lexus of Brisbane Group offers the Lexus Corporate Program to AMA Queensland members across the entire Lexus range including luxury sedans and SUVs.

CORPORATE PROGRAMME BENEFITS INCLUDE: — Preferential Pricing 2

ADDITIONAL BENEFITS FOR AMA QUEENSLAND MEMBERS:

— 3 year/60,000km complimentary scheduled servicing 3

— Dedicated Lexus of Brisbane Group representative for all enquiries

— Reduced dealer pre-delivery fee of $995 (ex GST) — Competitive total cost of ownership

— Access to the Lexus of Brisbane Group’s Airport Valet Parking, collection and return service from Brisbane Airport 4

— Access to Lexus Corporate Evaluation Vehicles

— Spicers Retreat Experience1

— Priority invitations to Lexus of Brisbane Group corporate events

— Priority ordering and allocation ENCORE PROGRAMME BENEFITS: — Service loan cars or complimentary pick-up/drop off during servicing — Lexus DriveCare providing 24-hour roadside assistance — Lexus Exclusive Events

THE ULTIMATE LUXURY PAIRING PURCHASING A NEW LEXUS HAS NEVER BEEN SO RELAXING

Offer applicable to Private and ABN buyers, who are current members of AMA Queensland, on all new vehicles purchased between 1st February 2018 to 31st December 2018 and delivered by 31st December 2018. The Lexus of Brisbane Group reserves the right to extend any offer. Excludes demonstrator and pre-owned vehicles. Spicers Retreats Certificate is valid for period of 12 months and cannot be exchanged or redeemed for cash. Spicers Retreats two night luxury stay is available at the following properties only: Spicers Hidden Vale, Spicers Balfour, Spicers Clovelly, Spicers Tamarind, Spicers Potts Point and Spicers Vineyard Estate.

Subject to Spicers Retreats availability. Upgrades or additional nights available to purchase. See your Lexus of Brisbane Group dealer for full terms and conditions. 2 Complimentary scheduled servicing expires at 3 years or 60,000km from the date of first registration, whichever occurs first. Conditions apply. 3 Eligible employees must provide such documentary evidence as Lexus or the Lexus Dealer may require to confirm entitlement to receive preferential pricing. Terms and conditions apply. 4 Visit http://www.lexusofbrisbane.com.au/about/about-us/benefits for full terms and conditions. See your Lexus dealer for further details.

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As an AMA Queensland member, you will receive a two night luxury stay at a Spicers Retreat property of your choice upon purchase of your new Lexus ^. With stunning destinations in South-East Queensland and NSW, each Spicers destination offers an exclusive, private escape from the world. Now is the time to experience another benefit of owning a Lexus. The hardest part will be choosing where to go.

To discuss the Lexus Corporate Programme and all the benefits offered to you as an AMA Queensland member, please contact our dedicated Lexus of Brisbane Group representative Derek Klette today.

Derek Klette | Group Sales Manager | derek.klette@lexusofbrisbane.com.au | 0419 723 937

FORTITUDE VALLEY | INDOOROOPILLY | MAROOCHYDORE | SPRINGWOOD | SOUTHPORT

JDC Wrap up “Great conference!

Speakers are amazing and inspiring!

Topics are useful and relevant!”

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4 1. Dr Tim Chalk 2. Dr Michael Wagels Clinical translation of 3D printing technology: where are we at and where to from here 3. Dr Sandro Demaio Solving obesity: the crucial role of millennial doctors 4. The Clinical Skills Development Service winning team from the Gold Coast Hospital: Drs Stefanie Tran, Kris Salaveria, Emma Keen, Jarrad Blackburn with Dr Hashim Abdeen 5. Dr Mikaela Seymour 6. Brigadier Michael Bond CSC Above and beyond: leadership excellence

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“Amazing conference!

Should be compulsory for all interns!”

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“An inspiring and well-rounded weekend which sported opportunities to be an audience to world-renowned medical visionaries and fellow junior doctors alike, develop clinical skills, and enjoy cocktails with friends and colleagues!”

A huge thank you to our sponsors PLATINUM SPONSOR

PREMIUM SPONSOR

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MAJOR SPONSORS

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AWARDS LILIAN COOPER PRIZE Drs Harrison Theile and Bethany Holt JOHN BOSTOCK PRIZE IN PSYCHIATRY Dr Alexandra Miller

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“JDC 2018 was a fantastic conference for junior doctors across Queensland. The social events, academic lectures, panel discussions and entertaining competitions were very topical and informative and everyone who attended learnt a great deal from the experience. I have no doubt next year’s event will be even larger and better judging from the experiences of those who went this year.”

WILLIAM NATHANIEL ROBERTSON PRIZE Dr Bethany Holt HAROLD PLANT MEMORIAL PRIZE Dr Harrison Theile AMA MEMORIAL PRIZE Drs Harrison Theile and Bethany Holt AMA QUEENSLAND MEDAL OF ACHIEVEMENT – JAMES COOK UNIVERSITY Betrice Ellen Walker AMA QUEENSLAND CHILD HEALTH PRIZE – BOND UNIVERSITY Dr Navtej Chhibber AMA QUEENSLAND CHILDREN’S HEALTH PRIZE – GRIFFITH UNIVERSITY Dr Aisha Bouhafs

R E S E A R C H P R E S E N TAT I O N

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7. Haydn Dodds and Carl Haupt 8. Dr Ira van der Steenstraten and Dr Geoffrey Toogood speak on the panel Junior doctor mental health/mandatory reporting: challenges and solutions 9.

Delegates peruse the poster presentations 10. AMA Queensland CDT Deputy Chair Dr Hashim Abdeen presents Navtej Chhibber with the AMA Queensland Child Health Prize for Bond University 11. Queensland Health Minister Steven Miles gets a run through with the Clinical Skills Development Services (CSDS) with Dr Katherine Gridley and CSDS trainer Davin Arthur 12. Dr Jessica Dean on the panel discussion on The habits of medicine’s best leaders

We’ve listened to your feedback and moved the conference dates away from the end of term.

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SAVE THE DATE JDC 2019

Hilton Hotel, Brisbane

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15 - 16 June plus NEW Careers Expo

WINNER Dr Tom English, PGY3, Robina Hospital Targeted interventions to reduce iron deficiency, anaemia and blood transfusion in elective arthroplasty RUNNER UP Dr Benjamin van Haeringen, PGY1, Princess Alexandra Hospital Metastatic colorectal carcinoma: Prognostic clinical, pathological and molecular biomarkers and elucidating associations of high neutrophil:lymphocyte ration

P O S T E R P R E S E N TAT I O N WINNER Dr Sean Morrow, Senior House Officer, Mater Hospital Brisbane A case of delayed emergence after general anaesthesia to functional disorder RUNNERS UP Dr Tom English, PGY3, Robina Hospital Case report: Recuronium anaphylaxis Dr Samuel Thambar, PGY6, Gold Coast Hospital Case report: Recuronium anaphylaxis

Doctor Q Spring 13

MOCA timeline Following a great number of meetings of doctors in public hospitals, member feedback and hard work by our committees, the log of claims was finalised. Our aims when negotiating on behalf of Resident Medical Officers (RMOs) and Senior Medical Officers (SMOs) for a MOCA 5 agreement included: a five per cent salary increase per year for the three years of the agreement; increased professional development leave and allowances;

indexing allowances which haven’t previously been indexed; and travel provisions to support doctors working in regional public hospitals.

I N F O R M AT I O N A N D F E E D B A C K SESSIONS In November and December last year, the Workplace Relations Team held two free member webinars and visited the following hospitals to survey and review feedback on MOCA:

Toowoomba Hospital Ipswich Hospital Sunshine Coast University Hospital Caboolture Hospital Redcliffe Hospital The Prince Charles Hospital

Lady Cilento Children’s Hospital Royal Brisbane and Women’s Hospital Princess Alexandra Hospital QEII Hospital Gold Coast University Hospital Logan Hospital

Between March and July 2018, the Workplace Relations Team were on the road visiting hospitals across Queensland to provide updates on the current MOCA 5 negotiations and seek feedback from public hospital doctors.

The team ran multiple information sessions on MOCA 5 negotiations and workplace relations support at:

THE MOCA 5 TEAM HAVE VISITED H OSPI TA LS A L L OVER QUEENSLAND 14 Doctor Q Spring

Toowoomba Hospital Gympie Hospital Sunshine Coast University Hospital Gold Coast University Hospital Bundaberg Hospital Maryborough Hospital Gladstone Hospital Lady Cilento Childrens’ Hospital Cairns Hospital QEII Hospital Royal Brisbane and Women’s Hospital Rockhampton Hospital Hervey Bay Hospital Princess Alexandra Hospital Ipswich Hospital

N E G O T I AT I O N M E E T I N G S AMA Queensland, in partnership with ASMOFQ, has been meeting with Queensland Health fortnightly since February 2018 to advocate for your future pay, terms and conditions (MOCA 5 agreement claims). AMA Queensland requested that existing terms and conditions from MOCA 4 be preserved and rolled over into MOCA 5. Queensland Health agreed to this claim. Dr Chris Maguire, Chair of AMA Queensland Council of Doctors in Training covered the Resident Medical Officer (RMO) claims, in particular: increase in the Vocational Training Subsidy to $6,000; increase in the Professional Development Allowance to $4,000; increase in the Professional Development Leave to four weeks; and meal breaks and rest pauses.

WHY ARE WE IN THIS POSITION? As you would recall, we have been involved in protracted negotiations for over six months as a result of Queensland Health’s failure to have their bargaining framework approved by Cabinet Budget Review Committee (CBRC) before MOCA 4 expired. This meant that Queensland Health was only able to make a formal offer after MOCA 4 expired.

Given that the delay in CBRC approval occurred through no fault of ASMOFQ, we will continue to strongly advocate to secure back pay.

QUEENSLAND H E A LT H ’ S O F F E R Queensland Health made their first offer on 2 August. We believe the offer is deficient and has not satisfactorily taken into consideration your claims.

In summary, all medical officers will receive a 2.5 per cent remuneration increase along with: Resident Medical Officers (RMOs): Examination Leave increased from two days to four days per permissible occasion.

Professional Development Leave (PDL) increased from one week to one week and three days (excluding interns).

Three days PDL travel entitlement for those in rural and remote locations.

Professional Development Allowance increased by $500.

Vocational Training Subsidy increased by $873.50.

Senior Medical Officers (SMOs): Professional Development Allowance increased from $20,000 to $20,500 per annum (2.5 per cent increase, not indexed).

Medical Officer with Private Practice (MOPP) and Medical Superintendent with Private Practice (MSPP): Rates to match the Senior Medical Officers wage rates level 13 - level 18.

L AT E S T O F F E R Queensland Health provided a revised offer on 31 August, which proposed the following additional increases above the previous offer: SMO Professional Development Allowance: Year 1 - $20,500 Year 2 - $21,000 Year 3 - $21,500 This represents an additional $500 increase in year three.

Vocational Training Subsidy for RMOs Year 1 - $3,670 Year 2 - $3,761.75 (2.5% increase) Year 3 (2.5% increase) - $3,855.80

This represents an additional increase of $170 in year one (indexed).

RMO Professional Development Allowance Year 1 - $2,200 Year 2 (2.5% increase) - $2,255 Year 3 (2.5% increase) - $2,311.37 This represents an additional increase of $124.07 in year one (indexed).

In the event that a new Government Wages Policy delivers a higher quantum than the current wages policy, Queensland Health has committed that any additional increase will be passed on and back dated to the commencement date.

NEXT STEPS ASMOFQ continues to make all reasonable attempts to advocate on your behalf to improve/enhance the offer. We will keep you up-to-date as we finalise the negotiation.

Doctor Q Spring 15

AMA Queensland opposes greater scope for pharmacists The Queensland Parliament is currently undertaking an inquiry into the possible establishment of a pharmacy council in this state.

The proposed pharmacy council would be responsible for enforcing rules around pharmacy ownership and locations, but the inquiry is also looking at how the council could be used to enhance the scope of practice of pharmacists and pharmacy assistants.

The issues paper developed by the parliament makes reference to a Victorian Parliamentary enquiry which found that “of more than 122 million GP visits annually, around 19 per cent can be categorised as ‘less complex’ – that is, they involve management of only one problem, with only one or two medications prescribed, and do not involve referrals, tests or other treatment.” It is these visits which the committee believes could potentially be undertaken by pharmacists as part of a larger scope of practice.

Some of the functions being sought by pharmacists include supplying contraceptive pills without a prescription and providing

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certain medicines to people with cardiovascular disease and respiratory illnesses without the need for a repeat prescription.

AMA Queensland strongly opposes the establishment of a pharmacy council and any increased scope for pharmacists and pharmacy assistants.

With the assistance of our Council of General Practice and with input from all members of our Council we developed a strong submission, which outlined:

the clear conflict of interest between being a dispenser and a prescriber;

the value of general practice and how consultations for repeat prescriptions can result in better patient outcomes;

the difference in training between a doctor and a pharmacist; and

the potential danger of allowing pharmacists to prescribe prescription-only medicine at a time when the dangers of doctor shopping are already well known.

Our submission is available at our website if you wish to access a copy.

AMA Queensland also worked closely with other medical stakeholders including the Royal Australian College of General Practitioners and the Rural Doctors Association of Queensland to impress upon committee members the united opposition our organisations share towards this ill-considered proposal.

“This is the thin edge of the wedge,” AMA Queensland President Dr Dilip Dhupelia said. “The pharmacy lobby is riding roughshod over the best interests of our patients.

Prioritising convenience over health outcomes and letting pharmacists do what they want puts Queenslanders’ health at risk.”

The Parliamentary Committee is due to report back to the Parliament with its findings by 30 September 2018. AMA Queensland will do all in its power to push back against any increased scope for pharmacists. We will also keep members regularly informed via updates in Doctor Q and our online newsletter Pulse.

Escorted Study Tours in 2019 with specialist Queensland Tour Leaders

The spectacular Lofoten Islands, Norway

Place des Heros, Arras, France

Military and Medical History in Western Europe

Kingdoms of the North 12 – 26 May 2019

1 – 13 July 2019

Tour leader: Professor John Pearn Bergen • 7 nights Norway cruise • Kirkenes • Edinburgh • Orkney • Edinburgh

Tour leader: Dr Paul Luckin Arras • Ypres • Nuremburg • Dresden • Berlin

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Journey to the Arctic Circle and back through some of the most breathtaking scenery in the world and explore the great Kingdoms of the North.

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Travel through WWI, WWII and Cold War sites in France, Belgium and Germany alongside a cultural itinerary.

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Experience Viking heritage, ancient Neolithic sites, beautiful music and medical and military history in the lands of the midnight sun.

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This specialist tour also focuses on the psychology of war and the often-accelerated advances in medicine during the war years.

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Led by experienced tour leader Professor John Pearn, a Brisbane clinician and medical historian.

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There is an optional extension to the spectacular glacier lands of Iceland after the tour.

Travel through key sites with expert tour leader, Dr Paul Luckin, who will provide talks that give context to the visits.

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There is also an optional pre-tour extension to Normandy.

www.jonbainestours.com/kingdoms

www.jonbainestours.com/militaryeurope

To book or enquire about these and other tours, please contact: Jon Baines Tours (Melbourne) Email: info@jonbainestours.com.au Tel: 03 9343 6367

www.jonbainestours.com

Overtime awareness campaign AMA Queensland ran a #Claimovertime social media campaign through July to highlight the difficulty of claiming and being compensated for overtime.

According to the MOCA 4 Agreement, overtime rates apply to: 4.4.1 Resident Medical Officers A RMO performing additional hours of duty in excess of the ordinary hours specified in Clause 4.1, of this agreement shall be, subject to approval by the authorised manager, paid for such excess duty hours as follows: (a) Monday to Saturday – time and one-half of the ordinary rate for the first 3 hours and double time thereafter; (b) Sunday – double time of the ordinary rate; (c) Public holidays – double time and one-half of the ordinary rate.

Despite what the agreement says, we regularly hear from junior doctors not being paid overtime. So what are some of the reasons why they aren’t being paid and are these reasons valid?

T H E S U RV E Y S AYS In the 2017 AMA Queensland Resident Hospital Health Check Survey, 50 per cent of junior doctors reported being advised not to claim overtime and 31 per cent of those who claimed did not get paid for it.

QUEENSLAND H E A LT H ’ S P O S I T I O N ON CLAIMING OVERTIME In May 2018, AMA Queensland wrote to Queensland Health asking the following questions and wanting written confirmation confirming RMOs have a right to claim overtime when worked, and no request will be unreasonably refused or be discouraged in any way from claiming overtime when worked. The examples where we assert overtime should be paid: RMOs are directed, requested or expected to commence ward rounds prior to the commencement of their shift.

90 per cent of respondents said they worked over 14 hours of unrostered overtime per week, with five per cent working an extra 24 hours of unrostered overtime per week. 16 per cent of those respondents actually claimed their overtime.

Accurately recording the working hours of medical practitioners will likely make it easier to identify those who are working unsafe hours and ensure we have an accurate understanding of the workload. This in turn should lead to rostering practices that ensure there is an equitable balance between patient needs, training requirements and rest.

The RMO is in surgery and continues to work beyond the finishing time of their shift.

The RMO has an excessive workload and works beyond the finishing time of their shift.

The written response from Queensland Health was: It is Queensland Health’s position that overtime is applicable and payable to RMOs when they are directed to work outside their rostered ordinary hours.

This includes when RMOs are: directed to start their shift before the specified start time;

OUR ADVICE Record and submit any overtime you’ve worked by filling out the AVAC form.

If your application for overtime is refused, make sure you ask why and record the reason provided. Having this recorded in an email is probably the best approach. The collecting evidence is important as this is what is often sought by management, human resources and Shared Services when we talk to them about unpaid overtime.

directed to work beyond their specified finish time; and requested to work an additional overtime shift beyond their rostered ordinary hours.

Support in claiming overtime is a KEY benefit of membership. If you find your claim has been refused and you are an AMA Queensland member, contact claimit@amaq.com.au.

1. Chinchilla Hospital junior doctor Marco Giuseppin 2. Gold Coast junior doctors Timothy Turk and Hash Abdeen

1 18 Doctor Q Spring

3. Senior doctor John Hall supporting junior doctors to claim overtime.

MANY O O N B O F YO U J U M PE A #C L A I R D A N D S E D NT MIT P I CT TO S U PPOR URES CA M P T O U R A I G N.

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Doctor Q Spring 19

on ly c

Mater Resident Medical Officers’ Enterprise Agreement Mater Group notified Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) on 14 June of its intention to commence negotiations for the Mater Resident Medical Officers’ (RMOs) Enterprise Agreement 2018 in July 2018.

The first meeting took place on 17 July 2018 with the parties exchanging their Logs of Claims on 30 and 31 July 2018.

Broadly, ASMOFQ is seeking:

that existing terms will not be eroded;

three-year agreement;

remuneration increase;

improved consultation provisions;

improved professional development support and leave;

increase to afternoon and night shift penalties; and

rest pauses during shifts.

increased vocational training subsidy;

ASMOFQ has engaged with a group of interested RMOs and is keen to hear from any other member RMOs who are interested in the enterprise agreement negotiations. We encourage you to review the log of claims on our website and email your responses to mater2018@amaq.com.au.

Negotiation of the enterprise agreement is an important time for current and future RMOs. Participating in the process and sitting at the bargaining table is the best opportunity junior doctors will have to positively influence the industrial framework that will dictate their employment for several years.

ASMOFQ is keenly aware of the proximity of Mater Hospital to the adjacent Lady Cilento Children’s Hospital. Never before has consideration of the relationship between Mater and Queensland Health been more pertinent. We are also aware that Mater will argue that the relationship is not relevant to the enterprise agreement discussions. With members working across the two sites, it would be unrealistic if we did not consider the terms available to Queensland Health doctors, particularly when many will complete rotations at the Mater Hospital.

A link to the meeting minutes and our log of claims is on the AMA Queensland and ASMOFQ websites.

Please take the time to read the log and provide your feedback to the ASMOFQ Team.

www.amaq.com.au | www.asmofq.org.au 20 Doctor Q Spring

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Therapeutic Guidelines Limited Therapeutic Guidelines Limited (TGL) is an independent not-for-profit organisation. Its aim is to promote the quality use of medicines, and it does this through the writing, publication and sale of Therapeutic Guidelines.

The Therapeutic Guidelines range of digital and print products is widely considered to be an unsurpassed source of best practice therapeutic information.

Therapeutic Guidelines are written principally for prescribers (general practitioners and trainee physicians in particular) to provide clear, practical, succinct and up-to-date therapeutic information for the management of patients with specific conditions.

eTG complete is Therapeutic Guidelines’ core product and is designed for use on desktop computers and mobile devices. eTG complete has the latest version of all topics published by TGL in a range of convenient formats, including online, offline and download. Licence options are available to meet the needs of single users, clinics or larger organisations. eTG complete app The eTG complete app is also available. The app provides all of the eTG complete content for use on mobile devices and tablets. Ideal for those who practise in a variety of locations, or those in the rural and remote health sector.

For more information, go to www.tg.org.au Doctor Q Spring 21

THE BENEFITS OF

My Health Record My Health Record is at an important stage of its ongoing evolution.

AMA President Dr Tony Bartone was spot on when he wrote in a column published in the Sydney Morning Herald on 24 July: “We have come a long way over the past decade. There has been considerable consultation and trialling to get things right and safe. We must push ahead with this My Health Record.”

By the end of 2018, all Australians will have a My Health Record created for them, unless they choose not to have one.

This decision is theirs to make after considering the benefits of having immediate online access to their health and care data, and being able to share it with their clinicians.

The My Health Record is about supporting better, safer care, not replacing current clinical record keeping systems or professional communication. Importantly, it will not replace the all-important patient – doctor relationship and clinical judgement. It is a secure online repository of health data and information that would not be accessible otherwise.

With over two million episodes of medication misadventure and upwards of 230,000 hospital admissions every year because of medication misadventure, costing the Australian taxpayer $1.2 billion annually, we simply need to do better. The death toll from

above is well above the road toll. Many of these could be avoided if people and their clinicians had better access to vital medicines and allergy information.

People who choose to have a My Health Record will have access to information such as their medicines and allergies, hospital and GP summaries, investigation reports — this could save their life in an emergency and help their clinicians find vital information more quickly so that they can make safer health care decisions.

For your patients, it means their medical conditions, medicines, allergies and test results are kept together in one place and for the first time automatically shared with them. Access to this sort of information will contribute to increased involvement in their own health care.

Individuals can also choose who sees their My Health Record and what’s in it. They can choose to share their information with the healthcare providers involved in their care.

Importantly, patients can share their Advanced Care Directives to ensure their wishes are carried out even if they are not able to speak for themselves.

The data in a My Health Record flows from securely connected clinical information systems in hospitals, general practices, pharmacies, specialists’ rooms, and pathology and radiology providers. It also provides access to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data, the Australian Immunisation register and the Australian Organ Donor registry.

Now that I have the ability to easily and securely share information on the My Health Record, my understanding of the purpose of my notes and in particular

22 Doctor Q Spring

my health summary has changed from an aide memoire for myself to a collection of information that can benefit my patient as they touch other parts of the health system. An upto-date shared health summary that can be rapidly accessed by the other healthcare practitioners my patients encounter can help them make much more informed decisions to maximise benefits and minimise misadventure.

A key section of My Health Record is the Medicines View. All of the patient’s providers can see what has been dispensed and what has been prescribed by other doctors with links to the original documents. Allergies from all sources are there, patient recorded information is there as well as information from the discharge summary if the patient has recently spent time in hospital.

For a number of patients this has already decreased my search time for information that has not yet arrived.

The My Health Record is particularly beneficial when I get information that the patient would like me to have, but for some reason or another, hasn’t arranged for it to be sent directly to me. While it is true that much information does come to me as the patient’s GP directly, we all know that a lot doesn’t.

I had a patient recently who was prescribed something new by her cardiologist and asked me about it.

The letter had not yet arrived but thankfully the pharmacy where the medication was dispensed uploaded the dispense record and from the Medicines View I was able to find it – update their record and have an informed discussion with the patient.

People are understandably concerned about privacy and security and accordingly the Australian Digital Health Agency has made the privacy and security of health information its first priority. The system’s security has

not been breached in its six years of operation. There is no complacency however – My Health Record system security operates to the highest standards, working with the Australian Cyber Security Centre and others. It is under constant surveillance and is regularly threat tested.

The steps required for a health care practitioner to view a My Health Record require a number of security authentications to take place. For a provider to access the My Health Record via their clinical information system, they must be a registered health care provider, they must also have a valid provider identifier and work in an organisation with a valid organisational identifier.

The software must be conformant and, for the best experience, the most recent version, with a secure and encrypted connection to the My Health Record system supported by digital security keys. In addition, the patient must already have a record on the

provider’s clinical information system as a patient of the practice.

We know from the Personally Controlled Electronic Health Record (PCEHR) review, the review of the Northern Territory MyEHR and the analysis from the Opt-Out trials that My Health Record will become more and more valuable to healthcare providers and, more importantly to our patients, as more data sources connect and contribute to our patients’ My Health Record.

DR STEVE HAMBLETON

AMA Past President and My Health Record Expansion Programme Deputy Chair

Just as medical practitioners today could not work effectively without computers, doctors in the Northern Territory told me that the MyEHR, had become so useful that if the government stopped funding it they would “pay for it themselves rather than lose access to it”.

I have no doubt that the My Health Record will be viewed similarly as it matures.

Doctor Q Spring 23

Increase to the minimum rates of pay There has been a 3.5 per cent increase to the minimum rates of pay under the Health Professionals and Support Services (HPSS) Award and the Nurses Award. The new 2018-2019 rates of pay are now available. Contact the Workplace Relations Team for a copy on (07) 3872 2211 or workplacerelations@amaq.com.au.

The increase applies from the first pay period on or after 1 July 2018. If you have not implemented the 3.5 per cent increase to staff being paid the award minimum rate for their classification, you will need to back pay the difference in your next pay cycle.

W H AT I F I PAY M Y STAFF ABOVE THE AWARD?

DO I NEED TO ISSUE A NEW EMPLOYMENT CONTRACT?

In some circumstance an above award payment may absorb an increase to the minimum rates of pay. This is in line with Clause 2.2 of both the HPSS Award and the Nurses Award. It is important to check that the previous above award payment is not below the new minimum rates of pay.

It is a great time to check that you are using up-to-date employment contracts and that all staff are correctly classified under their applicable award. If all other contractual terms are remaining the same, you can issue a letter of amendment, rather than having to issue a whole new contract.

The letter of amendment can be quite simple and it is important that you keep a copy on the employee’s employment record.

It is also important that you review all your employee’s contracts to ensure there is no conflicting clauses which would guarantee an increase to their hourly rate. If you are unsure, contact the Workplace Relations Team and we can review the contract for you.

H AVE THERE BEEN ANY CHANGES TO THE AWARDS? There has been an increase to some allowances under the awards and these are outlined below: Both awards: Meal allowance - $12.88 after one hour of overtime and a further $11.61 after four hours of overtime HPSS Award only: Deduction for board and lodging $25.33 for employees receiving full adult rate of pay $11.44 for trainees A further $15.79 where the employer buys their meals at ruling cafeteria rates

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Visit: ama.com.au/qld/employment-advice/ private-practice/wr-resources

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Termination of pregnancy laws and conscientious objection In late 2017, the Queensland Law Reform Commission (QLRC) called on AMA Queensland as well as other stakeholders, to provide feedback on a number of questions it had regarding reform of Queensland’s termination of pregnancy laws. This request came about following two failed attempts to pass legislation decriminalising abortion through the Queensland Parliament in 2016.

The current laws, which have been part of the Queensland Criminal Code since 1899, state that the termination of pregnancy in this state is a crime, and a woman who procures one and a medical practitioner who performs one are both criminally liable for having done so. Although in practice, case law allows for pregnancy terminations to occur if it is to save the woman’s life, medical practitioners who perform these procedures have long called for legal certainty.

Further, AMA Queensland argued strongly that conscientious objection for medical practitioners should be recognised. Our submission stated:

AMA Queensland’s submission was debated and endorsed at a meeting of our full Council. The submission advised the QLRC that in AMA Queensland’s view:

Terminations of pregnancy should be decriminalised in Queensland if performed by a registered medical practitioner. Similarly, we believe a woman should not be criminally responsible for an abortion. This is a view shared by many other legal and health stakeholders, including the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

26 Doctor Q Spring

After 22 weeks gestation, the Council argued that terminations should only occur if endorsed by two medical practitioners, one of whom must be a specialist obstetrician. The second medical practitioner should be of a specialty relevant to the circumstances of the case – for example, if the termination is due to be performed on mental health grounds, the medical opinion of a psychiatrist should be sought to determine if the termination is appropriate on mental health grounds or if another form of treatment could be considered.

If the situation is not an emergency, a doctor’s conscientious objection should be respected. However, conscientious objectors should not use their objection to impede access to treatments that are legal or which would impede the patient’s access to care and AMA Queensland therefore supports an obligation to refer to a doctor who does not have a conscientious objection.

In an emergency, a doctor should always provide medically appropriate treatment in an emergency situation, even if that treatment conflicts with the doctor’s personal beliefs and values. However, we advised the

QLRC that any potential legislation should recognise that not every medical practitioner will have the skills and training to provide an abortion, even in an emergency.

Therefore, only a registered medical practitioner who has the necessary skills and training to safely perform a termination of pregnancy should be under a duty to do so.

In mid-July, Premier Annastacia Palaszczuk announced the findings of the QLRC report. AMA Queensland’s recommendations were accepted by the QLRC, with conscientious objection a key part of the law. They also accepted AMA Queensland’s recommendation of a gestational limit of 22 weeks.

AMA Queensland supports the QLRC’s recommended changes. Whilst we appreciate that this can be an emotive issue, the QLRC’s recommendations strike the right balance between ensuring women can legally access pregnancy terminations whilst ensuring the rights of conscientious objectors are protected.

The bill, which will enable these changes, was introduced to the Parliament in August and AMA Queensland is scrutinising the bill to ensure that the QLRC’s recommendations are accurately reflected within it. We are currently drafting a submission in response to the bill which will be on our website by mid-September.

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New family and domestic violence leave entitlements

The Health Professionals and Support Services Award and the Nurses Award have been varied to include an entitlement for employees (including casuals) to access up to five days of unpaid family and domestic violence leave each year. This new leave entitlement will form Clause 36 in both awards. The new clause will apply from the first full pay period on or after 1 August 2018.

Family and domestic violence means violent, threatening or abusive behaviour by an employee’s family member that seeks to coerce or control the employee and that causes them harm or to be fearful.

A family member includes an employee’s:

spouse, de facto partner, child, parent, grandparent, grandchild or sibling of the employee; a child, parent, grandparent, grandchild or sibling of a spouse or de facto partner of the employee; or a person related to the employee according to Aboriginal or Torres Strait Islander kinship rules.

NOTE: A reference to a spouse or de facto partner also includes a former spouse or de facto partner.

The leave will be available at the start of each 12 month period of the employee’s employment and will not accrue year to year.

CONFIDENTIALITY As an employer, you will be required to take steps to ensure the information concerning any notice or evidence an employee has given to take a period of unpaid family and domestic violence leave is treated confidentially.

Where there is a requirement by an Australian law or it is necessary to protect the life, health or safety of the employee or another person, the employer is not prevented from disclosing information.

As the information provided by an employee is sensitive, it must be handled appropriately as if it is mishandled, it could have adverse consequences on the employee or another person.

If you would like a copy of the new awards please contact the Workplace Relations Team on (07) 3872 2211 or workplacerelations@amaq.com.au.

28 Doctor Q Spring

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Digital transformation The digital transformation of our health system is proceeding at pace across Queensland, and across Australia, so let’s start with the national agenda and My Health Record (myHR).

Make no mistake, this is a very important initiative for both the Australian and Queensland health systems. It will enable the appropriate use of vital information across all our systems and will set the platform for much of what is to come as we strive to achieve the triple aim of modern healthcare – better patient outcomes delivered with a better experience within an affordable healthcare system.

The issues around privacy (information governance) and (cyber)security are of paramount importance to address, and we must get these absolutely right, and in so doing we must not let the naysayers and cynics derail the whole agenda. While no one has ever died from a breach of privacy of their healthcare data, we can work to improve the care and outcomes for people in instances where we are not sharing critical information effectively.

The AMA has lobbied the federal government very effectively to ensure additional measures are put in place to strengthen the myHR in terms of privacy and security, and with a positive and concerted effort as a system, we will create a legacy that

30 Doctor Q Spring

will have a very significant influence on the quality of the healthcare we deliver over the coming years.

In Queensland, we are aligning our systems to enable us to make best use of the myHR functionality across our population of now five million people.

This is part of a much bigger initiative involving the aggregation of health data in its widest sense (including eventually data on the wider social determinants of health), linking this all at the individual patient level, and providing that aggregated rich, longitudinal information set to inform better practice and decision making at the clinician-patient interface, to enable high level population health analytics (a population of five million is optimal in this regard), and to set a platform for the future whereby we can move towards the delivery of true precision medicine through the application of deep learning algorithms and realising the value from the so-called “-omic” revolution.

All of this will occur within an environment of public trust based on robust information governance standards and state-of-the-art cybersecurity capability.

This will prepare us for the future and enable us to deliver high reliability healthcare in the near term. All health

PROFESSOR KEITH MCNEIL Chief Clinical Information Officer, Queensland Health

jurisdictions around the world are working in one way or another towards this agenda, looking for ways to more effectively use the data generated by the millions of clinician-patient interactions that occur daily across systems. In Queensland, with the rollout of a single instance of the ieMR covering most of our hospital based healthcare episodes, the pending replacement of our current patient administration and laboratory information systems (PAS and LIS respectively), and with the functionality afforded by the Viewer, we are very well placed to lead this agenda both nationally and internationally.

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Doctor Q Spring 31

AMA Queensland Council FINAL POSITIONS

The final positions have now been filled on the AMA Queensland Council and Board

Dr Hashim Abdeen

Dr Sanjeev Bandi

Dr Erica Gannon

MBBS B BIOMEDICINE

MBBS FRCSI FRACS

B PHARMACY M B B S FA C E M

Gold Coast Area Representative Specialty: Medical Registrar

Capricornia Area Representative Specialty: Urology

Dr Abdeen is the Deputy Chair of AMA Queensland Council of Doctors in Training (CDT) and has served as Chair on numerous junior doctor committees.

Currently, he is a member of the Royal Australasian College of Physicians College Trainees’ Committee; the Medical Board National Training Survey (NTS) Advisory Committee; and the MDA National State Advisory Committee. Dr Abdeen is also a Confederation of Postgraduate Medical Councils Board Director.

Dr Bandi is a consultant urologist trained in India, Ireland and Australia.

Dr Bandi was the Chair of the Special Advisory Group (SAG) in Andrology of the Urological Society of Australia and New Zealand (USANZ) for two terms from 2007 to 2014.

“My medical leadership roles have allowed me to gauge the advocacy, training and wellbeing needs of doctors in training. I hope to empower my Gold Coast colleagues to become involved with AMA Queensland and take charge of their futures. I hope to inspire others to take part in medical leadership and to foster an inclusive AMA environment to maintain the legacy of the organisation and to produce strong medical leaders of the future.”

Dr Jim Finn DIPT BED MBBS FRACGP FA C R R M

Greater Brisbane Area Representative Specialty: Addition Medicine

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Dr Bandi is the International Scientific Advisor and Marketing Director for Urodev and Clinical Advisor to the multi-award winning CancerAid app.

“I am looking forward to representing the regional doctors from the Capricornia Area, and those of us who work hard in these trying times to balance work and family commitments. I would like to see doctors be more proactive in influencing their own quality of life and set an example for healthy living. I am keen to be a role model to influence a change in the nutrition and activity practices across the wider community.”

Dr Finn is a Senior Medical Officer credentialed in addiction medicine working at The Prince Charles Hospital. He was formerly the Medical Superintendent of Dirranbandi Hospital and has been a long term councillor of the Australian Salaried Medical Officers Queensland (ASMOFQ) since 2009.

Part-Time Medical Practitioner Craft Group Specialty: General Practice Dr Gannon is a senior medical officer and staff specialist emergency physician at Caboolture Hospital.

A former pharmacist, she began her medical studies in 2000 at the University of Sydney. Dr Gannon completed her early training at RBWH and most of her emergency training there as well. She received her fellowship in Emergency Medicine in late 2012. As a senior medical officer she is highly motivated and an enthusiastic with a dedication to teaching and ongoing learning.

“I am keen to advocate on behalf of other working mothers and help to lobby for better working conditions and flexible working environments. I believe that the AMA is a powerful, important body and a community of members.”

Jim is the current State and Federal Secretary of the Australian Salaried Medical Officers Federation (ASMOF).

He is the Chair of the Board of General Practice Training Queensland and was the ASMOF appointee to the Quality Assurance Committee for CliPPS, the Clinician Performance Support Service.

He is currently the AMA Queensland representative on the Queensland Coalition for Action on Alcohol (QCAA).

Seeking compassionate care CHALLENGING THE PHYSICIAN’S PHYSICIAN With the expanding body of knowledge around physician health, there are increasing opportunities to reflect on this together. The benefits of maintaining our health has clear value for the physician personally, for their health care team, for their patients and the health system in which they work.(1) For many years, studies of physician health have repeatedly measured stress and burnout, highlighting its persistence, underscoring concerns, noting that burnout is associated with medical error, reduced patient satisfaction and increased staff turnover.(2) These impact directly on patient care. Other studies remind us that suicide rates are higher than those of the general population.(3) Physician wellness runs as a thread woven through the discourse of quality in health care. Bodenheimer and Sinsky highlighted this, building on Berwick’s triple aims of improving the population’s health (enhancing the patient’s experience of care, and reducing the cost of health care), by adding improved work life of health care providers as a fourth aim.(1) While our profession wrestles with these broader questions, there is an inevitable ‘tag line’ in current publications and the words of experts in the field that all doctors should have their own general practitioner (GP). Despite this ubiquitous recommendation, research into the doctor-doctor clinical relationship has been limited. Certainly, more doctors are answering ‘yes’ when surveyed about whether they have a GP. (We seem to have worked out which box to tick when given that binary choice.) However, very few

studies drill down to ask whether that doctor-patient actually visited their doctor recently. Is that doctor’s doctor even aware of their (supposed) role in enabling that box to be checked?

Perhaps the paucity of research investigating this issue results, at least in part, from our cultural blindness. Current studies tend to focus on the impaired or seriously ill doctor. (Perhaps we are more comfortable with that?) A close read of the literature, suggests outdated advice with the Parsonian model of care promoted as the ideal when the doctor is the patient. The shared decision model of care would seem more appropriate.(4) Is this a challenge for the doctors who are providing the care?

When Francis Peabody entreated doctors to care, “the secret of the care of the patient is in caring for the patient”, he had terminal cancer.(5) Nearly a century on, we need to better understand the therapeutic relationship when the patient is a doctor.

Developing a deeper understanding of the care-experience of the doctor-patient and recognising that the treating-doctor can also find the doctor-doctor relationship perplexing will open new conversations towards improving the health access of doctors. Research such as this will help inform the training of doctors to ensure we can deliver more compassionate care to our colleagues.

DR MARGARET K AY Medical Director, Queensland Doctors’ Health Programme

1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014; 12:573-6.

2. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis.

Lancet. 2016; 388:2272-81.

3. Center C, Davis M, Detre T, Ford D, Hansbrough W, Hendin H, et al. Confronting depression and suicide in physicians: a consensus statement.

JAMA 2003; 289:3161-3166.

4. Kay M, Mitchell G, Clavarino A. What doctors want? A consultation method when the patient is a doctor. Aust J Prim Health. 2010; 16:52-59.

5. Peabody FW. The Care of the Patient. JAMA 1927; 88:877-882.

QDHP

Queensland Doctors’ Health Programme

24/7 HELPLINE

(07) 3833 4352

Let’s start by reflecting on the care we deliver to the doctors who seek our advice and care.

Doctor Q Spring 33

Workplace Bullying The Workplace Relations Team has prepared a four-part series on the burgeoning issue of workplace bullying: 1. trust and confidence in the employment relationship; 2. bullying in Australian workplaces; 3. managing workplace bullying for both employers and employees; and 4. what to do if an application is filed with the Fair Work Commission (FWC) or Queensland Industrial Relation Commission (QIRC).

B U L LY I N G A N D H A R A S S M E N T In a 2010 Productivity Commission (PC) report, it was estimated that workplace bullying costs the Australian economy up to $36 billion per annum in direct and indirect costs.1 Prior to the introduction of the anti-bullying jurisdiction, workplace bullying was primarily covered by workplace health and safety legislation as a safety matter.

However, under that regime, there was no recourse available to targets of bullying to stop the behaviour. An action relied on there being a risk to health and safety of workers because of the alleged bullying conduct.

In addition, psychological injury

34 Doctor Q Spring

under the workers’ compensation regime required an individual having recognised damage resulting from bullying conduct and that the employer, being made aware of the conduct, did not take reasonable action to stop it.

Arising from the 2010 PC report and a subsequent Senate inquiry in 2012, the bullying jurisdiction was introduced into the federal jurisdiction through Part 6-4B of the Fair Work Act 2009 (Cth) (FWA). An action under the stop bullying provisions does not require actual harm to have happened but that a real risk to health and safety exists. The standard in this action is substantially lower and is

focussed on stopping the behaviour before serious damage is caused.

Part 6-4B of the FWA defines what is bullying at work, who is covered by the provisions and how a worker can make an application to the FWC to stop bullying directed at them by an individual or group in their workplace. The federal jurisdiction covers workers employed by a constitutional corporation.

Queensland introduced parallel provisions in 2016 in chapter seven of the Industrial Relations Act 2016 (Qld) (IR Act), providing recourse to workers employed in Queensland who do not have access to the federal jurisdiction.

W H A T I S B U L LY I N G ?

Chapter seven of the Industrial Relations Act 2016 (Qld) covers employees bullied in workplaces not covered by the federal jurisdiction. The Queensland bullying provisions reflect the federal standards and define workplace bullying as:

The term workplace bullying covers a broad range of behaviours, whether intentional or unintentional, including but not limited to:

“An employee is bullied in the workplace if, while the employee is at work, an individual or group of individuals repeatedly behaves unreasonably towards the employee or a group of employees of which the employee is a member and that behaviour creates a risk to the health and safety of the employee.”

abusive, insulting or offensive language or comments;

unjustified criticism or complaints;

deliberately excluding someone from workplace activities;

withholding information that is vital for effective work performance;

setting unreasonable timelines or constantly changing deadlines;

setting tasks that are unreasonably below or beyond a person’s skill level;

denying access to information, supervision, consultation or resources to the detriment of the worker;

spreading misinformation or malicious rumours; and

changing work arrangements such as rosters and leave to deliberately inconvenience a particular worker or workers.5

The concept of ‘risk to the employee’s health and safety’ is not defined in the act, but applications made under the FWA 2009 have established that it is not necessary to provide proof of actual harm to health and safety, as long as it can be shown that a risk to health and safety created by bullying behaviour exists. The risk must be real, not just conceptual, but does not have to be imminent.2 The state legislation makes it clear that the definition does not apply to reasonable management action carried out in a reasonable manner.3 The FWA considers that a worker is bullied at work if, while the worker is at work in a constitutionally-covered business, an individual or a group of individuals repeatedly behaves unreasonably towards the worker, or a group of workers of which the worker is a member and that behaviour creates a risk to health and safety.4

The critical factor is that the bullying conduct has actually caused or creates a risk to health and safety in the workplace.

W H A T I S N O T B U L LY I N G ?

As the authority that oversees workplace bullying investigations on the basis of workplace safety, The Office of the Workplace Health and Safety, Electrical Safety Office and Workers’ Compensation Regulator has established that a single incident of unreasonable behaviour does not constitute bullying but as it may be repeated or escalate, it should not be ignored.

Unreasonable behaviour that involves violence, for example physical assault or threat of physical assault is not considered bullying per se, must be dealt with urgently and may be considered if it is shown to be part of a course of conduct by an alleged perpetrator. Physical assaults may also result in criminal charges against the perpetrator.

Reasonable management action, in connection with a worker’s employment, is not considered workplace bullying if it is carried out in a lawful and reasonable way, taking the particular circumstances into account.

Acts of unlawful discrimination or sexual harassment may be related to and provide evidence of workplace bullying but of their own, they do not constitute bullying. However, they may subject of discrimination complaints.

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.

1. Productivity Commission (2010) Performance Benchmarking of Australian Business Regulation: Occupational Health & Safety Research Report, Canberra, Australia.

2. Drew,R; Stop bullying orders, Queensland Teachers’ Journal, 122 (4), 2 June 2017, p27. <http://www.qtu.asn.au/collections/queenslandteachers-journal/legal-qtj/2017/legal-stop-bullying-orders/> 3. s272 (2) Industrial Relations Act 2016 (Qld).

4. s789FD Fair Work Act 2009 (Cth).

5. https://www.worksafe.qld.gov.au/injury-prevention-safety/ mental-health-at-work/tools-and-resources/workplace-bullying

Workplace conflict amounting to differences of opinion and disagreements are generally not considered to be workplace bullying.

Doctor Q Spring 35

C L I N I C A L S E N AT E

Dr David Rosengren Chair of the Queensland Clinical Senate

Best use of health funding The future sustainability of the healthcare system is one of the most significant challenges facing health administrators and us as clinicians and consumers. With an ageing population, increased chronic disease and everincreasing costs of technology, the demand on the system fiscally and physically is reaching crisis point – it cannot be sustained.

To read the value-based healthcare meeting report and full list of recommendations visit: https://clinicalexcellence. qld.gov.au/priority-areas/ engagement/queenslandclinical-senate/meetings/valuebased-healthcare-shifting

36 Doctor Q Spring

value care (care that absorbs resources without offering much qualitative value to our patients – in some instances even causing harm) and invest in highvalue innovative models of care?

Already there are remarkable stories of innovation and success from hospitals around the state.

At the Royal Brisbane and Women’s Hospital, more than 130 initiatives were introduced in a 12-month period as part of the Choosing Wisely movement (www.choosingwisely.com.au).

We work in a system that has historically been funded according to activity throughput. While in many cases, activity throughput can equate to high quality care, it is not always One such initiative in the emergency the case. In department is helping addition, many of to reduce waste of “A S H I F T I N the highest value O-negative blood. A health services simple timer is attached THINKING we can deliver to the blood boxes to reduce throughput F R O M V O L U M E remind busy staff that by keeping people they have 60 minutes to with chronic TO VALUE IS transfuse the blood or send disease well it back to the blood bank.

ESSENTIAL IF and away from On the Sunshine Coast, acute hospital a home visiting model T H E H E A LT H C A R E care and as such of care using telehealth are continuously S Y S T E M I S T O B E technology has increased vulnerable the number of palliative to budget care patients being seen S U S T A I N A B L E ” rationalisation. by a specialist in a timely As clinicians it manner. The patient is is easy to order tests out of habit able to speak with the consultant via because ‘we have always done it this videoconferencing, eliminating the way’ or because we think it’s expected. need for patients and the consultant Nevertheless, we need to adopt a to travel. new way of thinking and challenge The senate’s focus on value-based ourselves continuously around the healthcare has certainly helped to value of the service being provided to raise the profile of the issue and make the community for the investment of it a priority in Queensland. resources used.

Value-based healthcare has since been We need to have the confidence included as a key priority in the State to stop and rationally assess our Government’s My health, Queensland’s decisions in the best interests of the future: Advancing health 2026 strategy. individual patient.

In 2016, the Queensland Clinical Senate brought clinicians and systems leaders from around the state together for a think tank on value-based healthcare.

We challenged delegates to think differently about value-based healthcare and to find opportunities to move resources away from low-value to high-value models of care. In other words: how can we disinvest in low-

And, as a member of the Queensland Health Value-Based Healthcare Steering Committee, I can confidently say that a great deal of work is happening to progress the value-based healthcare agenda in Queensland.

A continued focus in this space will ultimately translate into a more sustainable healthcare system and a better healthcare experience and outcomes for patients.

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Doctor Q Spring 37

How to talk to patients about diet

THE DOCTOR’S DIET BY DR SANDRO DEMAIO D R K AT G R I D L E Y Advanced Emergency Trainee, Lady Cilento Children’s Hospital; and member, AMA Queensland Council of Doctors in Training

Diet is one of the leading risk factors for death and disability worldwide, with more than two billion of us overweight or obese. Alarmingly, Australia is leading the charge, with two thirds of our population overweight, and a dismal 93 per cent of Australian adults and 97 per cent of Australian children failing to eat enough fresh fruit and vegetables to stay healthy.

We know how critical diet is as a risk factor for overall health, but it can be incredibly hard to have the conversation about diet with our patients. In a world of body positivity, there’s a particular taboo associated with talking about diet and losing weight for fear of causing offence or anxiety. For those without a nutrition background, it can be even more difficult knowing where on earth to start or what advice to give.

Luckily, Dr Sandro Demaio has drawn on the latest health, nutrition and medical research and translated this into an easy to digest cookbook, proving to be a valuable resource for doctors and patients alike.

Norwegian-based but Australiangrown Dr Sandro Demaio is a public health doctor by trade but a crusader against non-communicable diseases by nature. Only recently stepping away 38 Doctor Q Spring

from clinical medicine, Sandro has had an illustrious career in research and global health on the international stage, which started as a junior doctor when he became fascinated in diet as a preventative strategy against the burden of non-communicable diseases like type 2 diabetes.

His cookbook is unlike any other you’ll find (unless the Lancet start publishing recipes), as he eloquently synthesises the latest research into layman’s terms, and then applies them to 110 quick, affordable, tasty and sustainable recipes.

Part one, two and three of the book are focused on simple and easy to follow steps for lifestyle modification. This includes tips for navigating processed foods at the supermarket and how to read a nutritional label, understanding the myriad different terms for sugar and fat and how to control portion sizes without going hungry. There are also helpful tips on how to shop smarter and more affordably, buying good seafood and meat and how to be savvy with food waste. Even erudite foodies like myself can learn a lot from this!

The food ideas that follow are best described as surprisingly simple, honest, healthy home cooking at its best. Recipes start with making your

own condiments like aioli, pickled black olives, sundried tomatoes, stock or pesto with recipes that would make every Nonna proud.

The focus then changes to breakfast and gives some excellent ideas for making your own flavoured yogurts, bircher and muesli, with some cheeky treats like French toast and pancakes thrown in for good measure. And it wouldn’t be an Australian cookbook without a variation of avocado toast!

The follow chapters focus on feeding a crowd, simple everyday food, vibrant salads and making your own bread and pizza. Think the best ever homemade dips, risottos, bruschetta and delicious takes on fish and chips or roasted chicken, followed by hearty soups, easy pasta recipes and bread dough with no kneading required!

This is an incredibly useful cookbook, not just for its practical recipes but also for its simple and easy to understand nutrition advice. It is quite a skill to synthesise the latest research and translate it into the everyday lives of our patients. However, Demaio has taken evidence-based practice to an entirely new and delicious level here, with The Doctor’s Diet sure to sit proud next to Talley and O’Connor on your bookshelf!

Why do 700 doctors choose to work with us?

Flexibility to fit work around your life Rewarding income • Variety of presentations practising urgent care medicine • Autonomy to practise independently while being supported by an on-call mentor • •

Join us as an afterhours doctor to experience seeing varied presentations, practising urgent care medicine and caring for our community’s most vulnerable in homes and aged care facilities. We have flexible opportunities to fit around your life. You can even travel and work across our 17 locations. If you are a VR GP, a GP Registrar or a PGY3+ hospital doctor who is considering a pathway to General Practice, please contact our specialist recruitment team.

Call: 1300 643 737 Email: recruitment@homedoctor.com.au www.homedoctor.com.au/doctor-jobs

Doctor Q Spring 39

Clinical Skills Development Service The Clinical Skills Development Service (CSDS) is a state-wide service based at the Royal Brisbane and Women’s Hospital committed to healthcare improvement through training, collaboration and innovation.

As one of the world’s largest providers of healthcare simulation education, CSDS is developing innovative learning solutions to address everyday problems and challenges for clinicians to improve the standard of healthcare in Queensland.

The service offers interactive, relevant learning solutions that allow individuals and teams to build knowledge, skills and confidence when providing patient care.

CSDS continues to evolve beyond delivering simulation using purely traditional educational modalities, to create learning adventures based on interactive models and cutting-edge technology. The results are accessible and affordable training solutions.

With a vast range of education options available, CSDS can offer face-toface, eLearning and blended learning solutions to suit any individual career pathway. The following are just a brief snapshot of what is on offer.

INTERCOSTAL C AT H E T E R INSERTION TRAINER The latest addition to their suite of learning solutions is the Intercostal Catheter (ICC) Insertion Augmented Reality Trainer. The course combines theory, clinical procedural skills and augmented reality to deliver an immersive learning experience in how to insert a large bore ICC into a patient.

The guided learning journey provides eLearning for required theory, a 360° 40 Doctor Q Spring

video and interactive app to detail the safe anatomical landmarks for insertion and a realistic demonstration of the procedure. The learner is then provided materials, to apply augmented reality and consolidate knowledge, practice and refine ICC insertion technique.

ADVANCED LIFE SUPPORT COURSE Refresh skills and tick off mandatory recertification requirements with the Advanced Life Support course.

Individuals can complete interactive eLearning modules at their own pace, before attending the face-to-face component of the course to undertake realistic assessment scenarios in small teams within an immersive, simulated environment.

ANAESTHETIC CRISIS RESOURCE MANAGEMENT COURSE Broadening the understanding of human factors and their impact on clinicians and patient safety is the aim of the Anaesthetic Crisis Resource Management course. The course studies the interrelationships between humans, the tools and equipment they use in the workplace and the situations in which they work within the anaesthetic environment. Participants will identify and challenge their concepts of cognitive bias, and learn why situational awareness can have a critical and significant impact on decision making in complex health care environments.

INTRAOSSEOUS ACCESS COURSE The Intraosseous Access course delivers the basic theory and required

practical understanding of how to gain intraosseous access using the EZ-IO® device in adult and paediatric patients.

Repetition of the learned skill allows participants to confidently refine the skill in a safe environment.

EMERGENCY D E PA RT M E N T T E A M TRAINING The Emergency Department Team Training course explores concepts around human factors and their impact on healthcare workers and patient safety within an emergency department environment. The course aims to create a greater understanding of the interrelationships between humans, the tools and equipment they use in the workplace and the situations in which they work. Participants identify and challenge their concepts of cognitive bias, and learn why situational awareness is critical.

RECOGNISING AND RESPONDING TO CLINICAL D E T E R I O R AT I O N I N T H E A D U LT P A T I E N T The Recognising and Responding to Clinical Deterioration in the Adult Patient course is designed to enhance the skills and knowledge required to conduct a systematic patient assessment and manage worsening clinical conditions. Study a range of topics including: using deterioration detection system tools; managing escalation of care using an early warning and response system tool; and communicating in a structured way to escalate care.

CSDS learning solutions are designed to support and enhance current education programs for a wide range of interests and career pathways.

Through collaboration, creativity and innovative thinking, ideas are turned into action. At CSDS, work is ongoing to design new systems, play with new technology and ultimately develop new solutions that inspire change and create experiences to improve patient care and patient outcomes.

Intercostal Catheter Insertion

ICC Online Course Gain knowledge and skills in the insertion of a large bore intercostal catheter.

Immersive 360° video demo Augmented reality demo app Part task trainer included Price $45 excl. GST To register, visit central.csds.qld.edu.au and search “ICC”

In 2014/15 Australian health care produced approximately 35,772 kilotonnes, seven per cent of the nation’s carbon emissions (CO2e). 38 per cent of that was emitted through primary healthcare activities. Given the unequivocal evidence for anthropogenic climate change and its subsequent health impacts, I have come to see that my responsibility to ‘do no harm’ extends beyond my one-to-one general practice consultations.

DR NICOLE SLEEMAN

General Practitioner, Far North Queensland Health and Sustainability Network

In April of this year, a colleague and I attended a presentation by Dr Gerard Brownstein, GP in rural Victoria, and founder of the North East Sustainability and Health Group (NESHG). Impressed and inspired by his project, we became partners with the NESHG, creating the Cairns-based Far North Queensland Sustainability and Health Group (FNQSHG) - a collection of primary and preventative health care practitioners committed to supporting and encouraging sustainable health care practices.

Our major goal is building healthy, resilient communities who will take an active role in reducing the impacts, and facing the challenges, of climate change. We, and NESHG, are aligned with the Global Green and Healthy Hospitals (GGHH) – a global program run by Health Care Without Harm – recognised partner and sustainability expert of the World Health Organisation.

Greening health care is a challenge. Single-use disposable items, for example, have long supported our modern-day successes in infection control. However, there are many actions which can be taken without sacrificing the quality of Australian health care, while saving costs and our planet. The GGHH sets out a ten-point agenda to guide all health services in instituting positive changes. They are: 1. LEADERSHIP: Prioritise environmental health 2. CHEMICALS: Substitute harmful chemicals with safer alternatives 3. WASTE: Reduce, treat and safely dispose of healthcare waste 4. ENERGY: Implement energy efficiency and

Going green 42 Doctor Q Spring

clean, renewable energy generation 5. WATER: Reduce health service water consumption 6. TRANSPORTATION: Improve transportation strategies for patients and staff 7. FOOD: Purchase and serve sustainably grown, healthy food

8. PHARMACEUTICALS: Safely manage and dispose of pharmaceuticals 9. BUILDINGS: Support green and healthy hospital design and construction 10. PURCHASING: Buy safer and more sustainable products and materials

We encourage health facilities to start with the ‘low hanging fruit’. An energy audit is a great place to begin. Such an audit was carried out in 2016, by Benalla Church St Surgery in Victoria, base for the NESHG which, to their astonishment, resulted in immediate cost savings of $4,051. Installation of solar panels saved an additional 76kwh/day, with a three-year return on investment. Following suit, the Onslow Road Family Practice, Shenton Park, Perth WA, spent approximately $4,500 on improving energy efficiency. Annual savings have since been about $1,275, and 2407 kWh (2.21t CO2e). With a tax deduction, the return on investment will be 3.5 years, after which time that saving will be annual and go back into the practice.

In 2015, the Lancet Medical Journal stated: “Tackling climate change could be the greatest global health opportunity of the 21st century”. I believe that climate change mitigation and planetary health – the health of human civilisation and the state of the natural systems on which it depends are part and parcel of our Hippocratic Oath. FNQHSG is our effort to act locally, whilst thinking globally. Because inaction, is an action in itself.

AMA Queensland

cairns breakfast with the health minister and local live issues panel discussion Date: Thursday 22 November 2018 Venue: Rydges Esplanade Resort, 209-217 Abbott St, Cairns Cost: Free for AMA Queensland members; $65 for non-members

Register online at www.amaq.com.au Doctor Q Spring 43

Member benefits THE AMA CAREERS SERVICE PROVIDES EXPERT I N F O R M AT I O N A N D S U P P O RT T O D O C T O R S AT E V E R Y S TA G E OF THEIR CAREER MEMBERS HAVE FREE ACCESS TO:

reviews of CV and application documents; interview skills coaching; expert advice on career pathways; Specialty Training Pathways Guide - with over 64 specialty pathways; and doctorportal learning - a CPD system for Australian doctors.

Register, complete and manage your professional learning here: https://learning.doctorportal.com.au

FIVE KEY POINTS TO MAKING THE RIGHT CAREER DECISIONS: 1. Know yourself and understand what motivates you.

2. Get as much experience as possible - find out what your preferred training collage is looking for and focus on that.

3. Think about where you want work, how hard you want to work and what you want your work and life to look like in the future.

4. If you’re leaning towards one specialty, ask a senior colleague if you can spend time in their team to get a feel for the discipline.

5. Your CV and application documents are critically important: use the AMA Careers Service to get expert advice.

Take your next steps towards your career goals.

Visit: https://ama.com.au/careers Phone: 1300 133 655 Email: careers@ama.com.au

Anita Fletcher is the Careers Advisor for the Federal AMA. With a human relations background in the private and NFP sectors, Anita knows what does and doesn’t appeal to recruiters and selection panels. She works closely with doctors to help them achieve their career goals. Anita can assist members with planning and preparing for the next steps in their career and improve communication skills so that doctors can approach critical interviews with confidence.

AMA QUEENSLAND’S MEMBER D I S C O U N T AT A C C O R H O T E L S , TAKE ADVANTAGE OF THE NEW MEMBER BENEFIT NOW AMA Queensland is proud to confirm that we are now part of the AccorHotels Business Offer program. This offer entitles our members to access the best current rates in over 3,000 selected hotels around the world. Our members can enjoy this exclusive offer at all participating hotels in the AccorHotels group:

To take advantage of this offer your will need a unique access code. To obtain your access code, please contact the Membership Team on (07) 3872 2222 or email membership@amaq.com.au.

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OBITUARY

Dr John Francis Lee M B B S F R A C S FA M A

11 November 1926 - 6 August 2018 AMA Queensland Past President 1972-73 Emeritus Vice President Dr John Francis Lee was born at Coorparoo in 1926. He attended the Church of England Grammar School where he excelled and played on the cricket and football teams. In his senior year, he won the Under 16 Athletic Cup and collected an Open Scholarship to University.

In 1943, at the age of 16, he began studying medicine at the University of Queensland, as well as Pure Mathematics. He graduated in 1948 with second class honours. During this time, Dr Lee travelled to Sydney with the Queensland Basketball team for the first Australian Basketball Championships and competed in inter-varsity athletics over several years.

On graduating, Dr Lee worked as a Junior Resident Medical Officer, and later, as a as Casualty Officer, at the Royal Brisbane Hospital. For the following two years, he was the University Surgical Registrar, where he also looked after the gynaecology wards.

In 1953, he travelled to England as Assistant Surgeon on the Orion.

While living at the College of Surgeons Hostel in Lincoln’s Inn Fields, he attended a course and sat and passed the primary exam for the fellowship. He spent the winter working at the Queen Alexandra Hospital at Cosham near Portsmouth and passed the second part the following year. The Orontes took him home and he commenced surgical practice at the Brisbane Clinic, a specialist group practice. He served on the syndicate committee at the clinic and later served as Chair for a decade.

In 1955, Dr Reg Quinn died suddenly and, while helping to maintain his practice, Dr Lee met Dr Quinn’s daughter Meriel. They were married on 22 September 1956. During their engagement, Dr Lee carried the Olympic torch for the Melbourne Olympic Games and part of their honeymoon was spent attending the games in Melbourne.

They were married for fifty years and had four children: Douglas, Penelope, David and Elizabeth.

From 1956, Dr Lee was a relieving surgeon at both the Royal Brisbane and Children’s Hospitals and a tutor in surgical anatomy and clinical surgery. He sat and passed the Fellowship of the Royal Australasian College of Surgeons in 1959 and was later appointed Assistant Surgeon to the Queensland Radium Institute and to the Royal Brisbane Hospital. Passing through the ranks of junior surgeon to senior surgeon, Dr Lee retired from the hospital at the age of 60 in 1987.

Dr Lee joined the First Military Hospital at Yeronga in 1966 and spent 27 years there doing a weekly session and being on call, although not a member of the army. Dr Lee was one of the original surgeons of the Wesley Breast Clinic when it was established in 1982 and continued there until 2007. He started at the St Andrews Breast Clinic in 1992 and continued there until its closure in 1996.

In the late 50s and 60s, Dr Lee lectured the Royal Brisbane Hospital nurses and became an examiner; he was one of the original

appointments to the General Surgical Board for the Worker’s Compensation Board (now the Medical Assessment Tribunals); and he spent three months in the Civilian Surgical Team attached to the Bien Hoa hospital in South Vietnam.

His service to medical associations began in 1959 when he was served as Honorary Secretary of the Queensland Branch of the then British Medical Association (BMA) (now AMA Queensland). He was a Council member from 1963 and was elected President in 1972. He remained on Council until 1981. In that time, he was a member of the Fees Committee, Organisation Committee and the Ethics Committee. Dr Lee was appointed an honorary Vice President because of his many years of service.

He was the Queensland representative on the AMA Council for almost 20 years, as well as serving on the AMA Medical Benefits Schedule Revision committee. He was elected a Fellow of the Australian Medical Association in 1976. Dr Lee was a Medical Board of Queensland member for 20 years.

Dr Lee’s father, Dr Alan E. Lee, who served as Queensland President of the BMA in 1943 and 1955, founded the Queensland division of the Medical Benefits Fund of Australia in 1950. When Dr Lee senior passed away suddenly in 1963, the younger Dr Lee was appointed to the State Executive Committee. He was later appointed to the Council and served as Federal President of the fund from 1983. He served on the Medical Defence Society of Queensland Council for 35 years, as well as Treasurer from 1971 - 1997. Dr Lee was also on the Clinical Research Ethics Committee of the Royal Brisbane Hospital from 1978 - 1196, where he served as Chair in 1982.

Doctor Q Spring 45

A DAY I N T H E L I F E O F A N

Ophthalmic Surgeon We chat to Dr Graham Hay-Smith, Ophthalmic Surgeon, Owner and CEO of Moreton Day Hospital and Moreton Eye Group.

W H AT M A D E Y O U D E C I D E O N OPHTHALMOLOGY? Ophthalmology enables me to combine my interest in infectious diseases and surgery. And the rest, as they say, is history. I was originally most interested in glaucoma, in part due to its relevance in the developing world. I spent a year on a major research project in Ghana and lived there with my family. I subsequently developed more of an interest in inflammatory eye disease and went on to do my fellowship year in medical retina and uveitis at The Chelsea and Westminster Hospital where one of the largest HIV wards for the South East of England is located. It was a fascinating place to work â&#x20AC;&#x201C; a large part of my job was on the wards with heavily immuno-suppressed patients with bizarre infections affecting their eyes.

HOW H AVE YOU DONE THINGS D I F F E R E N T LY ? W H A T I S Y O U R APPROACH? In relation to the Moreton Eye Group, which we have run for the past five years, the main thing that sets us apart is a strong collegiate character. I think that is the cornerstone to a good practice with excellent patient outcomes. It is getting more important still as we all are becoming increasingly sub-specialised. The six ophthalmologists that currently comprise the group all get along well with each other and we are all very happy to refer patients between ourselves. I have vitreo-retinal, corneal, paediatric, and general colleagues to help us cover all the bases. That way our patients are seen and treated by whichever colleague is best for them.

Dr Graham Hay-Smith and Peggy Ekeledo-Smith at the Moreton Day Hospital

46 Doctor Q Spring

I S T H E R E A PA RT I C U L A R C O N D I T I O N / P R O C E D U R E T H AT YOU SPECIALISE IN? I have studied glaucoma since very early in my career and am most published in that area. With glaucoma being the second most common cause of irreversible blindness in the community, I have always been looking for better ways of treating the disease. I have been following the development of MIGS (minimally invasive glaucoma surgery) stents since I was a research fellow at the Institute of Ophthalmology (part of University College London). I have been using a hydrus stents to Schlemm’s Canal as a trial device for more than two years now. This appears to be more efficacious with fewer adverse side effects compared to the other stents already commercially available, though possibly with a slightly steeper learning curve. I expect these stents to come off trial and be commercialised imminently – possibly by the time this article is published.

In clinic, I manage a lot of diabetes and uveitis - both conditions that I find very interesting. In all areas of medical retina, including age related macular degeneration there is so much progress in therapeutics and imaging – and a corresponding massive improvement in outcomes.

Y O U ’ V E R E C E N T LY O P E N E D A D A Y H O S P I T A L A T N O R T H L A K E S F O R N O T O N LY T H E E Y E S U R G E R I E S B U T F O R A L L K I N D S O F D A Y S U R G E R Y. C A N Y O U T E L L U S A B I T A B O U T T H I S ?

The hospital has three operating theatres and it has been designed to cater for a variety of different day surgeries, from top to bottom: from dental and eye operations to varicose vein removal and everything in between. We have an excellent team of nurses and support staff available to assist visiting surgeons and provide the best of care to patients. Most importantly, it meets the growing need to health services in our local community.

We know that patients do not like the journey into the CBD to receive treatment or to do their jobs. The Moreton Day Hospital in North Lakes makes the day hospital more central

and with easier access across the Moreton Bay Region. From here we can service the people of Brisbane’s northern suburbs and the Sunshine Coast.

The point of difference for the Moreton Day Hospital is that it is owned and operated by a clinician. I think this is really important and results in high quality care. We believe that investing in the best equipment and technology and having experienced and happy staff makes for good surgery. That is the ethos on which we run.

Doctor Q Spring 47

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

Ipswich & West Moreton Medical Association (IWMMA)

Gold Coast Medical Association (GCMA)

Contact:

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

Contact:

Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3049 4444 Meetings: 30 October 7 December - end of year networking function

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: 20 September 25 October 29 November

Bundaberg Local Medical Association (BLMA) Contact: Dr Daud Yunus Email: daud.yunus@gmail.com Phone: (07) 4152 2888

Mackay Local Medical Association (MLMA) Contact: Phone:

Dr Bill Boyd 0419 676 660

Brisbane Northside Local Medical Association (NLMA) Contact:

Dr Robert (Bob) Brown, President Web: www.northsidelma.com Phone: (07) 3121 4029 Meetings: 9 October 11 or 14 December

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)

CANâ&#x20AC;&#x2122;T FIND YOUR LOCAL AREA? 48 Doctor Q Spring

Chantell Badenhorst, Secretariat Manager Web: www.gcma.org.au Email: info@gcma.org.au Phone: 0419 780 505

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

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

If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au.

Out and about In the coming months, AMA Queensland will be meeting with members, both locally and regionally and attending local medical association (LMA) meetings across the state. In August, AMA Queensland President Dr Dilip Dhupelia met with the Toowoomba and Darling Downs LMA (photos below) and the Central Queensland LMA. President Dr Dilip Dhupelia said LMA meetings are invaluable for understanding local issues of concern, directly from the practitioners on the ground in those areas. It also presents members with a chance to talk to the AMA Queensland Team directly about how they can contribute to AMA Queenslandâ&#x20AC;&#x2122;s important policy and advocacy work. There are visits to the Sunshine Coast, Redcliffe, Brisbane North, Fraser Coast and Cairns all planned before yearâ&#x20AC;&#x2122;s end.

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1. The busy meeting about to kick off, 2. Toowoomba and Darling Downs Local Medical Association Dr Mark Wyche, 3. Drs John Coghlan and Jeff Prebble 4. AMA and AMA Queensland Past President Dr Steve Hambleton and AMA Queensland President Dr Dilip Dhupelia, 5. Drs Theresa Johnson, Rachael Gray, Ben Wakefield, 6. Drs Rachael Gray, David Chettle, Ashraf Saleh and AMA Queensland Councillor Dr John Hall 7. Drs Peter Hopson, Carol Cox and Tony Ferris.

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Events calendar

DINNER FOR THE PROFESSION Date: Friday 12 October Location: Victoria Park Golf Club, Herston Network with colleagues over a threecourse dinner and live entertainment.

A silent auction will be featured with all proceeds being donated to the AMA Queensland Foundation.

MINISTERâ&#x20AC;&#x2122;S BREAKFAST CAIRNS

SURVIVING RURAL RELIEVING

Date: Thursday 22 November Location: Cairns Doctors in Cairns and surrounding areas will be joining the Queensland Minister for Health and Ambulance Services Steven Miles for this regional bi-annual forum.

Date: Thursday 29 November Location: Hunstanton Verandah, AMA Queensland, Kelvin Grove Join our expert panel for tips to navigate typical clinical situations experienced in rural communities and how to make the most of the experience, professionally and personally.

MORE

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

50 Doctor Q Spring

2018

EVENTS

16 and 18 October Brisbane and Gold Coast Intern Readiness Workshop 25 October Wine and Cheese networking event November - December Workplace Relations Training Series Two

free member registration REGISTER ONLINE AT WWW.AMAQ.COM.AU

surviving r ur r al re lie vin g

STRATE GIES FOR SUCCE SS ON YOUR RURAL RELIEV ING ROTATI ON

cdt member seminar / live webinar T H U R S D AY 2 9 N O V E M B E R , 6 . 3 0 P M 8PM

WHERE The rural relieving term fills many Doctors in Training with trepidation. Dealing with challenging clinical situations (often without immediate access to the resources and support of a large city hospital environment) and being away from family and friends are legitimate concerns. However a rural placement provides amazing opportunities for hands-on learning, often greater attention from supervisors and a higher level of autonomy – along with the chance to immerse yourself in a country community.

Join our expert panel for tips to navigate typical clinical situations experienced in rural communities and how to make the most of the experience, professionally and personally.

AMA QUEENSLAND, 88 L’ESTRANGE TERRACE, KELVIN GROVE AND VIA LIVE WEBINAR

COST

FREE FOR MEMBERS; $150 FOR NON-MEMBERS

proudly sponsored by

All types of fraud CHRIS MARIANI

Director, Medical & General Risk Solutions P: 0419 017 011 E: chris@mgrs.com. au Authorised Representative No.434578

Disclaimer: 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. 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.

Fraud can take many forms in a medical practice. Practitioners, owners and managers need to be vigilant – and put in place risk management strategies to minimise the chances of fraud occurring - and if it does, then to have appropriate insurance in place.

Recently a client contacted us to advise their employed receptionist had for numerous months been defrauding them. The employee was: 1. receipting cash payment consults and issuing receipts out of the medical records software; then 2. immediately pocketing the cash and reversing the payment - so that the daily banking amount balanced with cash receipted.

T I P S TO P R E V E NT T H I S S C E N A R I O:

The practice manager

should be requesting each doctor in the practice to ‘sign-off’ their billings on a daily or weekly basis and give the doctor the ability to report missing transactions.

W H AT S H O U L D P R A C T I C E OWNERS AND MANAGERS DO TO PREVENT FRAUD? As you can see from the few examples in this article, the risks of fraud are many. Being aware and vigilant is the first step, followed by putting in place controls such as:

52 Doctor Q Spring

Left undetected and with the employee taking advantage of lax (or no) controls, the employee grew bolder and increased their fraud efforts to other areas they could see ‘management’ were not vigilant. These sorts of fraud risks can and do - amount to tens or hundreds of thousands of dollars. While this scenario can be insured (usually under the ‘crime’ section of a Management Liability policy and with some insurers, under a ‘Cyber/ Privacy’ policy for Social Engineering, Phishing and Cyber fraud), putting in place management processes to prevent these from occurring in the first place is equally as important.

Establish a formal

process to review the right reports. For example, the ‘reversal’ report from the medical records system would have identified the employee who was continuously reversing transactions (a sure sign of either further training required, or fraud).

Consider employment hiring processes, criminal history checks etc. (it was later discovered the employee had a criminal history and issues with previous employers which should have come to light before a job offer was even made)

separating duties so no staff member can do everything; create dual authorities: - on all payments over say $1,000, - cto set up new ‘vendors’ in your internet banking/

accounting software;

consider what things you will do or approve yourself versus what you delegate (and delegate does not mean abdicate);

develop management reports such as the ‘reversal report’;

THE EXAMPLES ON THE LEFT PAGE ARE JUST ONE OF MANY WAYS A MEDICAL PRACTICE CAN FIND ITSELF THE VICTIM OF FRAUD. SOME OF THE STRANGER CASES WE HAVE WITNESSED INCLUDE:

The employee who stole patients’ credit card details (while they were undergoing a procedure) to fund their lavish lifestyle (not only did this create the fraud issue, but exposed the practice to a privacy breach under the ‘Notifiable Data Breach Scheme’ which came into force 22 February 2018)

The practice manager paying some of their own personal expenses using company funds as they had unfettered access to the banking and there were no controls in place such as dual authorities/separation of duties - to create and approve payments.

The business whose accounting software passwords were hacked and criminals managed to change BSB and account numbers so that when the business paid legitimate payments, the funds were transferred overseas. (please check if your accounting software can allow ‘multi-factor authentication’ which would have prevented this).

The fake email from the CEO to the finance manager requesting an urgent payment to “x” for “$y”. The finance manager pays as requested (the email address looked the same on first glance but was slightly different).

Please ensure you verify all payments, even if this means you pick up the phone and call.

The employee who created a new provider number (unbeknown to the doctor), recorded their own bank account number and then swiped Medicare cards of patients, their own and family members.

The irony is even those that should know better – get caught out. DUAL Insurance is one of the largest insurers of Management Liability in Australia. They grew rapidly from a small to a large “Lloyds underwriting agency”, failing to put in place fraud controls and as a result had a claims manager defraud them of $17 million - by setting up a fake law firm and paying claims into this. This is eerily like many medical practices – where on establishment - the doctor signs off on every payment, knows what’s in the bank, and has a tight control of income and expenses. They then get busy, take their eye off the accounts and delegate this to staff without putting in place any fraud controls. You can read a statement from the CEO of DUAL here https://www.insuranceandrisk.com.au/lessons-learnt-from-a-17m-fraud/ According to KPMG’s January 2017 Fraud Barometer1 the most common perpetrators are business ‘insiders’, with 36 percent of frauds attributable to company management and 40 percent of frauds in Australia take place over a five-year period before being discovered. 22 percent of frauds used technology – including credit card fraud; hacking into financial systems; use of fake adverts; creation of regular electronic transfers; and the use of online betting accounts to launder money.

1. https://home.kpmg.com/au/en/home/media/press-releases/2017/01/surge-fraud-i-aus-fraud-barometer-25-jan-2017.html

make it obvious to staff you are looking – if they think you are top of the risks, they are less likely to be tempted;

ask your accountant for their advice on what other steps you can do to manage the risks of fraud and get them to review and benchmark your expenses and income to their other medical practice clients;

particularly where you have ‘associate’ doctors, give them their billings and other reports and ask they check and review for any errors, omissions, etc

run criminal history and background checks when hiring;

consider bringing in expert consultants to do an audit on your Medicare billings, private health; and

purchase the right insurances including Management Liability and Cyber/Privacy Insurances and make sure you understand insurers have an expectation on areas like separation of duties, dual controls, verifying invoices.

Doctor Q Spring 53

JULIE O ’ R E I L LY

Is property your next investment?

The purchase of an investment property is a common wealth creation choice of medical professionals. There is often hesitation to begin the process of property investment due to a lack of time, but also an uncertainty or unwillingness to spend hundreds of thousands of dollars without being fully informed.

Find below five top tips to help you get started with property investment.

1. ENSURE YOU H AVE A S T R AT E G Y B E H I N D YOUR PURCHASE A doctor’s first investment property is often their first home. When they upgrade their family home, the first home tends to become a rental property. This can be convenient and doesn’t require much time, but also is sometimes not the best investment decision.

To assess whether your first home is a good property investment consideration should be paid to how much you think the property is likely to increase in value over time. If the answer is “not much” then holding the property does not make financial sense. It may be better to sell the property and reinvest in another area.

2 . U N D E R S TA N D W H AT YOU CAN AFFORD Speak with your bank and accountant to discuss what you could afford with a property purchase. Ask them to calculate the after-tax cost (the cost of the property after allowing for tax deductions) of holding the property.

It can be surprising how little an investment property can cost you after allowing for deductions. Also, ask the bank for loan pre-approval to save you time when making a property purchase. Pre-approved loans have a time limit so be mindful that you are acting within the set time limit.

3. THE GOLDEN RULE OF P R O P E RT Y I N V E S T M E NT – “INVESTING IS ALL ABOUT CAPITAL GROWTH” If you are really looking to build your wealth from property investment, the focus should be on the expected capital growth of the property, not the rental return. Without capital growth, your investment is stagnant.

4. ENLIST THE HELP OF PROFESSIONALS A buyer’s agent acts for the purchaser and are professional, licensed real estate agents that save investors time

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Business Advisory Director, William Buck Accountants P: (07) 3229 5100 E: julie.oreilly@ williambuck.com

in locating and acquiring investment properties. Some buyer’s agents charge on a commission basis while others charge on a fixed fee basis. We prefer to use one which charge on a fixed fee basis; that way they are motivated to find you the best deal and are not the most expensive!

5. A SOLID FINANCIAL STRUCTURE It is important to consider the choice of structure for a property investment as this will impact the application of capital gains tax on the sale of the property, whether you can access negative gearing benefits, the application of land tax and may have different asset protection implications.

Speak with your accountant beforehand to ensure that any entities are in place for when you are ready to purchase. A change in entity can have impact on the finance, especially if it is pre-approved, so having this in place is crucial.

If you are looking to make a property investment, contact William Buck to assist with referrals to buyer’s agents, introductions to home loan lenders, a complimentary review of your structures to ensure you are investment ready and provide an estimate of the after-tax cost of holding a property for you.

William Buck is dedicated to helping medical professionals build their wealth while reducing stress around financial matters.

MAKE

PROPERTY YOUR NEXT INVESTMENT WITH A DEDICATED HEALTHCARE PRACTICE, WILLIAM BUCK IS HELPING PROFESSIONALS GET INTO THE INVESTMENT PROPERTY MARKET. While purchasing investment property is a common choice in wealth creation for medical professionals, it can be difficult to navigate the investment property quagmire.

Here are our top tips to get you started: — Ensure you have a purchase strategy — Understand what you can afford — Remember the golden rule of property investment: “Investing is all about capital growth” — Enlist the help of Professionals CONTACT JULIE O’REILLY FOR A CONFIDENTIAL & COMPLIMENTARY CONSULTATION Phone: + 61 (7) 3229 5100 Email: Julie.OReilly@williambuck.com

Keep your cool and ensure a fair dismissal with the handyperson because he had fundamentally refused to follow instructions. In its decision, the FWC reaffirmed that a conscious failure to comply with the reasonable direction of the employer will often provide for a valid reason for dismissal. However, in the circumstances the FWC found the direction given by the owner to repair the faulty irrigation system “was not of a nature where it would be reasonably apparent that failure to comply would jeopardise continued employment.”

To overcome this deficiency, it was necessary for the direction to be accompanied by a warning of the potential consequences of any failure to comply.

In a recent decision of the Fair Work Commission (FWC), a small business owner was ordered to pay a former employee $18,596 in compensation because his dismissal was harsh, unjust and unreasonable.

In this case, the owner of the Two Shores Holiday Village engaged in a heated exchange with Mr Morley, the facility’s handyman and gardener and dismissed Mr Morley due to his delay in repairing a faulty irrigation system and his failure to follow reasonable directions.

The FWC found the owner’s decision to dismiss Mr Morley was without valid reason and was procedurally deficient. Further, the owner failed to provide Mr Morley with the requisite written confirmation of termination of employment.

While the setting of this case is quite different from a medical practice, the lessons we can learn from it are applicable to any business.

At times it may seem ‘easier’ to dismiss underperforming staff rather than having that difficult performance management conversation with them. But as this case demonstrates, dismissing someone in an outburst of frustration and for reasons that are not sound, well founded or defensible leaves a business exposed to a successful claim being made against it.

The Fair Work Act 2009 (Cth) sets out a number of factors the FWC must take into account when it determines whether an employee’s dismissal was harsh, unjust or unreasonable. These are considered below, along with some lessons businesses should adopt in an attempt to safely dismiss.

The reason for the dismissal is valid - A valid reason for dismissal must relate to the person’s capacity or conduct and be sound, defensible or well founded and not capricious, fanciful, spiteful or prejudiced. In this case, the owner had experienced difficulties

56 Doctor Q Spring

The person was notified of the reason for the dismissal - The FWC found the owner’s verbal notification was unacceptable and unreasonable and commented that even though the owner’s business is small, written documentation setting out the reasons for dismissal should have been provided.

Opportunity to respond Mr Morley had a limited time to respond to the reason for his dismissal. Consequently, this procedural deficiency meant there was little opportunity for Mr Morley to explain the delay with the repair of the irrigation system and the alleged inadequate watering of the gardens.

Unreasonable refusal to allow a support person to assist - as the owner failed to follow any proper process, the FWC found that Mr Morley had been unreasonably refused the assistance of a support person.

Warning about unsatisfactory performance - The owner had not raised any aspects of unsatisfactory work performance with Mr Morley previously. Furthermore, it was

VANESSA JAMES-MCPHEE Senior Associate, HWL Ebsworth

EDWARD JUDE Law Clerk, HWL Ebsworth

found that the employee had an understandable belief that his employer tolerated the extensive delay in the repair of the irrigation system. What the owner should have done before dismissing the handyperson was have a conversation with him, setting out clear standards and expectations, including notification that if poor performance continued his employment would be in jeopardy.

Other relevant matters Mr Morley’s personal circumstances, including his age, geographical location and the serious illness of his wife were factors the FWC held exacerbated the impact of the loss of employment.

This decision reaffirms the FWC position that regardless of a business’ size or human resources capabilities, employers simply cannot engage in improper and unfair conduct, and common-sense courtesies and the principle of fairness ought to exist in all businesses.

This case demonstrates the importance of employers adhering to fair and proper processes when performance managing and dismissing employees in order to minimise the risk of a successful claim against the business, which could cost thousands.

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

What you need to know about My Health Record All Australians will get a My Health Record (MHR) by the end of 2018 unless they choose to opt out between 16 July and 15 November 2018.1

M U S T I O P E N A PAT I E N T â&#x20AC;&#x2122; S M H R I F I NOTICE THEY H AVE ONE? No, you are not compelled to do so as a matter of routine, and you can decide whether you clinically need to access it.

DO I NEED TO GET CONSENT TO ACCESS THE MHR? No, as long as you are accessing the record to provide health care to the individual. Patients consent to this when they register for MHR. However, if you access it in their presence, it would be courteous to inform the patient. Patients can place controls on who can access their whole record or documents within their record.

They can also view which organisations have accessed their record and can get SMS or email notifications when an organisation first accesses their MHR.

CAN MY STAFF ACCESS AN MHR F O R M E I F I A M AT T H E H O S P I TA L ?

Yes, if they have been authorised. Once a healthcare organisation is registered to participate in the MHR system, individual healthcare providers and other relevant employees can be authorised to access the system.

All doctors and frontline staff need to know: the basic concepts of My Health Record;2 the personal choice elements,3 including that an individual may choose

to not have a My Health Record created; and how My Health Record is used within the context of their organisation.

This article addresses some frequently asked questions to help you understand MHR.

DO I NEED CONSENT WHEN I UPLOAD DOCUMENTS? When a patient registers for MHR, the patient provides a standing consent for documents to be uploaded to their MHR. So it is not necessary to obtain consent each time you upload a document, except for Shared Health Summaries (see below). However, the AMA recommends4 informing patients when you upload all documents, particularly if the information is sensitive. If a patient

WHERE CAN I FIND MORE INFORMATION? Australian Digital Health Agency: Shared Health Summary (example clinical document): digitalhealth.gov.au/files/assets/cdaExamples/ CDASharedHealthSummary.html Using the My Health Record System: digitalhealth.gov.au/using-the-my-health-record-system

Royal Australian College of General Practitioners: Digital Business Kit 1.5 My Health Record: racgp.org.au/digital-business-kit/nationalehealth-records-system

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.

58 Doctor Q Spring

requests that a document or a certain piece of health information not be uploaded, you are obliged to comply.

Patients are able to remove documents you have uploaded, but not edit them.

W H A T I S A S H A R E D H E A LT H SUMMARY? A Shared Health Summary (SHS) provides a patient’s status at a point in time. These are especially beneficial for patients with chronic conditions or multiple co-morbidities.

To create an SHS a healthcare provider must obtain the patient’s agreement that they are to be a nominated healthcare provider (NHP) for the patient. If you are not the NHP (but you are authorised) you can still access the patient’s MHR, and you can upload clinically relevant information using an Event Summary which details significant healthcare events relevant to ongoing care, e.g. a new diagnosis or a clinical intervention. Any healthcare provider at an organisation participating in the MHR system can upload an Event Summary.

CAN I BILL MEDICARE FOR UPLOADING TO AN MHR? There are no MBS item numbers for uploading to an MHR. However, the time taken to prepare documents for uploading counts toward consultation time for billing the MBS, as long as the document preparation was part of providing a clinical service, and the patient was present.

W H AT H A P P E N S T O M H R O N T H E D E AT H O F A PAT I E N T ?

The record is retained in the system for 30 years (or if date of death is not known, for 130 years after their birth date). It will not be accessible to healthcare providers, but only where allowed by law for purposes such as audit or maintenance.

D O E S T H E M H R F O R M PA RT O F THE RECORD FOR THE PURPOSES OF A SUBPOENA? No, as a doctor does not have possession and control of the MHR. However, if a doctor downloads documents from the MHR (e.g. a discharge summary or test results) into their own record, those documents will be part of the doctor’s record for the patient and will need to be produced in response to a subpoena.

ONLINE EDUCATION

@ your fingertips MDA National Members enjoy complimentary access to a range of online education activities which can be completed in your own time, at your own pace.

Activities are practical, interactive and userfriendly with tailored topics for your career stage. The majority are CPD-recognised.

Take advantage of this Member benefit today! mdanational.com.au/Online-Education-Activities

Not a Member?

Apply online mdanational.com.au or call 1800 011 255

References 1. The Department of Health. My Health Record: National Opt-out. Available at: health.gov.au/internet/main/ publishing.nsf/Content/my-health-record-national-opt-out 2. Australian Digital Health Agency. What is My Health Record?

Available at: myhealthrecord.gov.au/internet/mhr/ publishing.nsf/content/find-out 3. Australian Digital Health Agency. Managing Access, Privacy and Security. Available at: myhealthrecord.gov.au/ internet/mhr/publishing.nsf/Content/privacy 4. Australian Medical Association. AMA Guide to Using the PCEHR. Available at: ama.com.au/ article/ama-guide-using-pcehr

The MDA National Group is made up of MDA National Limited ABN 67 055 801 771 and MDA National Insurance Pty Ltd ABN 56 058 271 417 AFS Licence No. 238073. Insurance products are underwritten by MDA National Insurance. Before making a decision to buy or hold any products issued by MDA National Insurance, please consider your personal circumstances and read the Product Disclosure Statement (PDS) and Policy Wording available at mdanational.com.au. AD261

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

Carers Queensland There are 2.7 million people providing unpaid care for a family member or friend, but it’s estimated that up to 79 per cent don’t identify as a carer. A carer is someone who provides unpaid care and support to family members or friends who have a disability, mental illness, chronic condition, terminal illness or who are frail aged. One in every eight Australians is a carer. Carers come from all walks of life and every caring situation is different.

Caring can be challenging at times. Its responsibilities can affect the carers’ ability to leave a normal life - socialising, financial security, education and other opportunities that were once part of their day-to-day lives. Additionally, a carer’s own health and wellbeing can deteriorate because of those responsibilities involved in their caring role.

If you have a patient who is a carer, they can access support from Carers Queensland, who provides specialised carer, aged, and disability support services to over 474,000 carers around the state. Carers Queensland support carers to live their best life while meeting their caring responsibilities.

N AT I O N A L D I S A B I L I T Y INSURANCE SCHEME In partnership with the National Disability Insurance Scheme (NDIS), Carers Queensland is delivering the Local Area Coordinator Partners in the Community program in eight service areas across Queensland, including Ipswich, Toowoomba, Rockhampton, Brisbane North and South, Beenleigh, Robina, Caboolture/Strathpine and Maroochydore, working to ensure more people live fulfilling and connected lives.

As a NDIS Local Area Coordination Partner, Carers Queensland will get to know your patient, what’s important to them and help connect them to services to support the life they want, whether they want to become more involved in the community through volunteering, sports clubs or local theatre, live more independently, get a job or change their employment or improve their wellbeing.

W H AT M A K E S C A R E R S QUEENSLAND DIFFERENT?

RESOURCES Carers Queensland has a wealth of resources to support carers, including assistance in accessing benefits and payments, employment seeking resources, forums, publications and subscriptions.

Their support services include:

mental health resources;

no interest loans;

registered training;

support groups; and

specific support for young carers.

Carers Queensland has local offices throughout Queensland to ensure more caring families have greater access to services and the opportunity to participate in their communities.

Carers Queensland regional offices are committed to strengthening these relationships in order to provide the right support.

an information and advisory service;

counselling;

cultural and linguistic support;

disability support, NDIS services;

a transitioning to aged care program, Empower Care;

CONTACT

guardianship and advocacy;

CARERS QUEENSLAND INFORMATION AND ADVISORY SERVICE

60 Doctor Q Spring

Call: 1800 242 636

www.carersqld.com.au

Email: info@carersqld.com.au

Facebook-@CarersQueensland

Ski USA and Canada Famed for their knee-deep powder, immaculate slopes and wide tree-lined runs, the ski resorts in Canada and the United States are among some of the best in the world. Add to the mix unique wildlife and an array of breathtaking scenery and you have yourself the perfect combination for an unforgettable skiing holiday. Whether you are a first timer keen to hit the nursery slopes or a seasoned skier ready to tackle your next big challenge, here is a guide to some of the best.

USA

CANADA

ASPEN, COLORADO

P A R K C I T Y, U T A H

B A N F F, A L B E R T A

With over 1,360 hectares of stunning skiable terrain, Aspen is one of the biggest ski resorts in the USA, offering four separate ski areas for you to explore. Aspen Mountain offers long cruising blue runs, the Aspen Highlands easy intermediate slopes, Highlands Bowl challenges experts with pitches of up to 48 degrees, and Snowmass grants extensive terrain suitable for all skill levels.

In terms of USA ski resorts, Park City is second in size only to Whistler in North America and offers plenty of gladed, ungroomed tree runs perfect for intermediates and experts alike.

The resort features a two-way gondola that links it to Canyons next door which features lots of fabulously steep challenges for the seriously brave. This vast ski area encompasses over 2,950 hectares of terrain rivalling other big guns like Vail in Colorado and Big Sky in Montana.

In terms of Canadian ski resorts, it doesn’t get much better than the staggeringly beautiful area of Banff with its turquoise lakes and snow-capped mountain peaks. Perched at the heart of the Canadian Rockies, there are three world-class resorts here, Norquay, Sunshine Village and Lake Louise. All levels are catered for with gentle beginner slopes, long open runs for intermediates, and challenging steeps for the hard-core experts.

BRECKENRIDGE, COLORADO When it comes to skiing in America, few nursery slopes in the world can rival the wide gentle run of Breckenridge’s Peak 9. Couple this with beginnerfriendly chairlifts and you have the ideal launching pad for future Olympians. If you’re after a bit more of a challenge, its 1,170 hectares of steeper slopes above the treeline offer more confident types plenty of wintery wonderland to explore.

VAIL, COLORADO If you’re after ski resorts in the USA that cater to mixed-ability skiers then Vail will amply satisfy with nursery slopes at village level, moderate challenges for intermediates on the front face, and plenty of exciting tree runs for the experts in Blue Sky Basin. The resort is massive – nearly 5km from end to end, with innovative quad chairlifts offering speedy service.

WHISTLER, BRITISH COLUMBIA Considered one of the best mountain resorts in the world, Whistler makes skiing in Canada a powder lover’s dream. From groomed cruising runs to challenging mogul fields, there are adventure options galore here for all levels.

With a gondola connecting Whistler with Blackcomb, the area also offers plenty of opportunity for families to enjoy other wintery pursuits including tubing, snowmobiling and ice-skating.

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

Spring 61

RESTAURANT REVIEW

Three blue ducks

Coupling Queensland favourites with country hospitality, the new Three Blue Ducks in Brisbane City is proving to be the latest on-trend dining destination for you and your flock.

The original Three Blue Ducks venues in Bronte and Byron are famous on social media for their picturesque plating and paddock-to-plate philosophy. The Brisbane venue, headed by chefs Darren Robertson, Andy Allen and Mark LaBrooy is proving to be no different, combining fine-dining flavour with the honesty of home-cooking and utilising only Australian produce.

Located on the mezzanine floor of the new W Hotel, a meal at Three Blue Ducks also comes with a beautiful view overlooking Southbank and the Brisbane River.

Three Blue Ducks is open for breakfast, lunch and dinner, and is the perfect destination for post night-shift breakfast with the team, a long lunch with colleagues or dinner with a special someone.

62 Doctor Q Spring

Breakfast can be enjoyed buffet style or a’la carte and is a quick and easy option if you’re staying in the hotel overnight. Try a mushroom omelette with confit onion, tomato and chives, or perhaps their version of avocado toast with basil salad and cherry tomato. For something light and nourishing, enjoy their mango bircher with passionfruit and toasted nuts, or a coconut chia pudding with seasonal fruit and honeycomb. I do suggest eating out of your comfort zone though to try one of their ‘hot bowls’. Kedgeree, a flaked fish, rice and egg dish is served with toasted almonds and pickled ginger.

Broccoli cauliflower rice comes laden with kimchi and puffed wild rice. Or for a savoury take on porridge, try teriyaki eggplant with creamed corn and seaweed instead.

There are so many delicious options adorning the lunch and dinner menus that I’d strongly advise sharing your meals and trying as many different plates as possible.

But first, a cocktail. Swap your dry martini for the Earl Greyoni, served in a tea pot and poured over a sphere of ice for maximum theatrical effect. The earl grey gin with mandarin Campari and wild rose vermouth is smooth and satisfying without overloading the palate for what is sure to be a fabulous meal to come. For those wanting something more light and fresh, try the Humble Fig with vodka and elderflower liqueur or the Passionfruit Spritz with sparkling wine blanc vermouth. And as a nod to a few of our Queensland icons, there’s also a Spiced Mango Mai Tai and the aptly named Swooping Magpie with pineapple and Aperol.

Start with some small plates, like the tandoori quali with crispy curry leaves, raw fish with paw paw salad or heirloom tomato with stratciatella.

Couple these with some bread, perhaps the spiced lamb with macadamia and flat bread, or baba ganoush with pomegranate. I definitely recommend the haloumi, served hot in the cast

iron pan paired with the sweet tang of grapes and pickled beets. And you simply cannot overlook their sweet potato hummus - the smoky crunch of the charred onions blends seamlessly with the luxuriously smooth dip, proving to be a surprisingly light way to start the meal.

For mains, there is a selection of cold seafood like oysters, bugs and crab with tangy yuzu mayo, as well as items cooked on the coal-pit or in the woodfire. The 500g rib-eye on the bone with chimichurri is sure to satisfy the hungry, while the Moreton Bay bugs with XO butter and fermented chilli glazed chicken are sure to kick-start the palate as well as the metabolism. My suggestion however is the chargrilled king prawns - a lighter meal that packs an absolute punch with flavour, pairing the sweet and creamy prawn meat with the salty citrus punch of sautéed kale.

Easily my favourite dish on the menu.

The wood fire offers a whole fish with coconut rice, maple glazed roasted pumpkin with harissa, and a lamb shoulder big enough to serve three people. However, the porchetta with roast apples is a standout here, with a lingering spice on the tongue from

hot mustard and irresistibly crunchy crackling, which may tempt you to experiment with your own Sunday roast at home!

If you can make room for dessert (which I highly advise you do!), then crème brulee comes served with rhubarb, chocolate parfait is accompanied with pickled blueberries, or there’s a signature cheese board if you’re more savoury inclined.

However, the meringue is a must – a sophisticated version of an Eaton Mess, this veritable muddle of crispy meringue pieces, tart lemon curd, fresh berries, roasted nuts and a sweet but sour yogurt ice cream is like hunting for treasure where every mouthful tastes entirely different!

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

Three Blue Ducks is a feast to be experienced, whether you enjoy fine dining flair or just flavoursome honest food. Located in the new W Hotel, 81 North Quay, Brisbane City.

Open seven days a week for breakfast from 6.30am to 11.30am, lunch from 12noon to 3pm and dinner from 5.30pm to 10pm.

Doctor Q Spring 63

All about you C H A R I T Y: S T E P T E M B E R Organise a team and pledge to take 10,000 steps a day, or sponsor someone who will, for the month of Steptember and raise money to provide vital equipment, therapy and services to children and adults living with cerebral palsy. Register at Steptember.org.au to register and receive a free pedometer so you can get moving this Spring.

P O D C A S T: G L O B A L T R U T H S WITH DR KEITH SUTER Dr Keith Suter is Australiaâ&#x20AC;&#x2122;s leading media commentator on global affairs and geo-politics. This series gives you the global truths in straightforward and short episodes. One issue in global politics explained each week so you know what is really going on - what is really happening, why it is happening and what is likely to happen next.

T V: P E A K Y B L I N D E R S Britain is a mixture of despair and hedonism in 1919 in the aftermath of the Great War. Returning soldiers, newly minted revolutions and criminal gangs are fighting for survival in a nation rocked by economic upheaval. One of the most powerful gangs of the time is the Peaky Blinders, run by returning war hero Thomas Shelby (Cillian Murphy) and his family. While the violence is at times a bit rough, itâ&#x20AC;&#x2122;s also necessary to tell the story. Cillian Murphy gets the chance to show off some serious acting chops in his native accent while Helen McRory (or Mrs Malfoy to the Harry Potter fans) is a joy to watch. Bonus points for a soundtrack with Nick Cave and PJ Harvey.

WIN

kets c i t e i v mo ! for two

Name:

Telephone:

Member no:

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

Entries close 1 October Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au

64 Doctor Q Spring

JULIE 29 September, 2pm | 30 September, 2pm National Theatre Live Starring The Crown’s Vanessa Kirby, this new version of August Strinberg’s play Miss Julie, written by Polly Stenham, remains shocking and fiercely relevant in its new setting of contemporary London. Wild and newly single, Julie throws a late-night party. In the kitchen, Jean and Kristina clean up as the celebration heaves above them. Crossing the threshold, Julie initiates a power game with Jean – which rapidly descends into a savage fight for survival.

KING LEAR 3 and 4 November, 2pm National Theatre Live Considered by many to be the greatest tragedy ever written, King Lear sees two ageing fathers – one a King, one his courtier – reject the children who truly love them. Their blindness unleashes a tornado of pitiless ambition and treachery, as family and state are plunged into a violent power struggle with bitter ends. Starring Sir Ian McKellen CH CBE as King Lear himself.

CEZANNE PORTRAITS OF A LIFE 20 September, 10am | 22 September, 1pm Exhibition on screen Dedicated to the portrait work of Paul Cézanne, the exhibition opens in Paris before travelling to London and Washington. One can’t appreciate 20th century art without understanding the significance and genius of Paul Cézanne. Featuring interviews with curators and experts from the National Portrait Gallery London, MoMA New York, National Gallery of Art Washington, and Musée d’Orsay Paris, and correspondence from the artist himself, the film takes audiences beyond the exhibition to the places Cézanne lived and worked and sheds light on an artist who is perhaps the least known of all the impressionists – until now.

THE MERRY WIVES OF WINDSOR 6 and 7 October, 1pm Royal Shakespeare Company Down on his luck in the suburbs, John Falstaff plans to hustle his way to a comfortable retirement by seducing the wives of two wealthy men. Unknown to him, it’s the women of Windsor who really pull the strings, orchestrating Falstaff’s comeuppance amidst a theatrical smorgasbord of petty rivalries, jealousies and over-inflated egos. For a fat Englishman, a Welshman and a Frenchman, the only way is Windsor. David Troughton returns to the company as John Falstaff, following his recent title role in Titus Andronicus and Gloucester in King Lear.

UPCOMING FILMS Please note upcoming film are subject to change

20 September Beast Ladies in Black Smallfoot The House with a Clock in its Walls

27 September Don’t Worry, He Won’t Get Far on Foot McKellen: Playing the Part

4 October Venom 11 October Bad Times at the El Royale First Man Doctor Q Spring 65

Bringing hope to Queenslanders in need The AMA Queensland Foundation extends its gratitude to everyone who generously donated to the end of financial year appeal. Although we did not achieve our campaign target this year, your valuable contribution will still assist the MND and Me Foundation deliver support programs and equipment to families affected by motor neurone disease.

Recent grants supported by the AMA Queensland Foundation include:

funding care services to support a patient living at home;

purchasing a mobility scooter to enhance a patientâ&#x20AC;&#x2122;s independence; and

purchasing an alert pendant personal emergency call system to offer safety and security to a patient living alone who has a high risk of falls.

We will continue to share updates on how this essential funding is assisting MND patients and their families.

Donations can still be made at any time by calling (07) 3872 2222 or online at www.amaqfoundation.com.au/ donation. Any gift you can offer is life-changing.

Buy online from Di Bella Coffee

to receive a 10% discount and have 10% of your purchase donated to the AMA Queensland Foundation.

Use code AMAQ18 at checkout.

ORDER AT: WWW.DIBELLACOFFEE.COM

Silent Auction

The AMA Queensland Dinner for the Profession is scheduled for Friday 12 October 2018 at Victoria Park Golf Club. The elegant evening is a black tie gala event celebrating the incredible work of doctors throughout Queensland. An auction will be featured on the evening with all proceeds being donated to the AMA Queensland Foundation. To purchase tickets, please contact the Events Team on (07) 3872 2222 or email registrations@amaq.com.au.

66 Doctor Q Spring

Utilise the equity in your home UTILISING THE EQUITY IN YOUR HOME MIGHT BE THE ANSWER. BUT HOW DOES THIS WORK? Put simply, equity is how much you actually own of your current home - the difference between what it’s worth and how much you still owe on your mortgage. When it comes to property investment, it’s crucial.

Let’s say your home is worth $600,000 and your current mortgage limit is $350,000- your total equity would be around $250,000.

Banks won’t lend you the full amount however, so you need to calculate your useable equity-typically 80 per cent of the value of your home, less your mortgage debt (or sometimes more, if you’re prepared to take out Lenders Mortgage Insurance). In the example above, assuming a loan to valuation ratio of 80%, the bank value would equate to $480,000 less the current mortgage limit of $350,000 therefore representing equity of $130,000 that could be used towards an investment purchase.

W H AT D O E S T H I S S T R AT E G Y ACHIEVE? As a general rule of thumb, you can afford an investment property that’s four times the value of your useable equity.

In the above example, you could buy a second property valued up to $520,000.

Secondly, always be aware of any extra charges that you may incur - such as Lenders Mortgage Insurance (LMI), or fees for changing loans or making a new loan application.

Stay on the safe side and keep a financial buffer. If you don’t have any funds outside your home equity, it’s risky to use all of your useable equity in a new property investment. This might mean you have to put property investment plans on the shelf for a while, until you can | build up some reserve savings.

O T H E R FA C T O R S Remember that even if you have a lot of equity, you won’t necessarily be able to borrow against it. Lenders consider a range of factors when determining a loan amount, such as your current income, age, how many children you have and any additional debts.

Finally, if you’re serious about property investment, your first move should be making an appointment with your banker. It’s essential to plan your financial strategy before you make any investment decisions, and your bank can help you decide whether utilising the equity in your home is right for you. It’s also worth speaking to your accountant before making any decisions which affect your finances, and make sure you fully understand the risks involved.

The best part of home equity loans? You can use the equity in your new investment property to help fund the purchase of another investment property - an efficient way to build a property empire.

It sounds simple, but as always, there are things to consider.

W H AT Y O U N E E D T O C O N S I D E R ?

Firstly, you need to be sure you can afford the repayments on your new mortgage in addition to your current one, or you risk losing one or both properties. It’s important to calculate your loan servicing ability before you draw on your equity, as this may have an impact on the amount you want to access.

Disclaimer The credit provider is BOQ Specialist – a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian Credit Licence no. 244616 (BOQ Specialist). Terms and conditions, fees and charges and lending and eligibility criteria apply. We reserve the right to cease offering these products at any time without notice. BOQ Specialist is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. The information contained in this article (“Information”) is general in nature and has been provided in good faith, without taking into account your personal circumstances. While all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, no warranties in this regard are provided.

We recommend that you obtain independent financial and tax advice before making any decisions.

Doctor Q Spring 67

Let’s make Australia slim again D R M AT T Y O U N G

General Practitioner, Inala Medical Centre

I read recently that KFC is ‘celebrating’ 50 years of participation in the Australian culinary marketplace. It made me reflect on my memories of the good Colonel Sanders and his army.

When I was a little boy, my grandparents lived at Bribie Island. We’d head up there on Friday arvo and come home late on Sunday.

One day we spied an alluring new building at Chermside. It was kitted out with walls replete with red and white stripes and a huge rotating bucket circulating mesmerizingly atop a tall white pole. It offered fine dining inspired by an ex-Colonel all the way from exotic Kentucky in the USA. He had apparently discovered 11 secret herbs and spices that were ‘finger lickin’ good’. He was clearly a genius and this shop was the very first Kentucky Fried Chicken joint in Queensland.

It was an era before McDonalds, Hungry Jacks, Pizza Hut, Subway and Dominoes dominated the culinary landscape and the Colonel stood as the lone predatory dinosaur in the Jurassic Period of the fast food industry.

At Bribie Island, we only did four things.

We ate. Nana ensured every spoonful was infused with love. We swam at the beach and we played cricket in the backyard. Lastly, we slept. We were bronzed and lean. We were healthy. We were happy. At the beach we were surrounded by masses of other bronzed, lean Australians. Everyone laughed and smiled. We were a happy, content population. Road rage hadn’t been invented yet. Endocrinologists were sparse and barely needed. Diabetes was something that only afflicted unlucky little kids. No-one needed a dietician because healthy family recipes were passed on. The only line an exercise physiologist needed to know was “yes, just keep playing all the sport that you are playing, son.” The biggest shirt size was ‘L’.

Then in the 1980s, things changed. The mythical Colonel from America’s deep south started metastasizing like a malignancy.

Other cancers sprung up. Other almost militarily efficient regimes. A red headed clown and a ham burglar joined the fray. Fast food became a luxury, a treat. A Friday night entitlement. The love and pride that Nanas and Mums added into family dinners could no longer compete with 11 secret herbs and

68 Doctor Q Spring

spices or two all-beef patties and special sauce, lettuce, cheese, pickles and onions on a sesame seed bun. Just as the scenery on the trip home from Bribie changed with fast food dens of iniquity springing up like melanomas, so too the scenery at the beach evolved. Obese people started appearing and propagating. The bronze skin was still there but it was stretched and strained.

From the earliest Homo sapiens, 200,000 years ago right through to the 1970s, meal times were a time for families to sit, discuss, plan, set goals and nurture. It was a bonding time. As man first discovered fire, his small group of family members would sit and be warmed, they ate and they talked. Exchanged ideas, solved problems, passed on accumulated knowledge. They told stories, developed culture, art and music. Home-cooked family meals allowed our species to evolve and expanded the frontiers of humanity. Now, only the waist lines are expanding.

I appreciate that other factors are contributing.

House and land prices have exploded, so block sizes are shrinking and tragically back yard test matches are becoming extinct. Parents are too scared to allow kids to head to the park to play games with neighbourhood kids because of various threats. Instead, kids sit in their bedrooms riveted to computer games while their cricket bats and footballs, muscles and brains undergo disuse atrophy.

The problem of Australia’s obesity epidemic is tough to solve. Defining the causes of the scourge is a starting point. Vilifying a few American fast food icons seems easy and perhaps cliché. Bagging computer games is appealing. Of course, the wonderful set of life memories and friends I have collected over 40 years of playing sport always inspire me to say that sport is the answer.

Every kid should play team sport.

Perhaps another solution is really quite simple. Rather than the 11 secret herbs and spices that Colonel Sanders put in his chicken, I would rather just have one secret ingredient in my dinner. I’ll take my Mum and Nana’s best ingredient, their love. Let’s resurrect weekend family dinners and let’s make Australia slim again.

In defence of

Merlot doesn’t get much love here in Australia – variously accused of being thin and reedy (region too cold) or soft and fat (region too warm) but rarely awesome, refined, structured or fruitintense. Much of the blame for Aussie Merlot being ‘crap’ has been ascribed to our clonal selections of Merlot – the most widely planted being D3V14, sourced from UC Davis in California in the mid-60s. It can make superb wine, but it needs to be planted in the right sites and requires a lot of work in the vineyard to produce quality fruit.

Historically most Aussie producers simply haven’t treated Merlot with that level of care. ‘Proper’ varieties, like Pinot, Shiraz, Cabernet etc have more time and money spent on them in the vineyard and winery because they yield a better return on that investment. Merlot is often treated as an afterthought and is rarely provided the opportunity to shine in its own right … ‘straight Merlot’ bottlings in Australia are often comprised of the bits left over after the ‘more important’ and expensive Cab Merlot blend had been made … and everyone knows Cab Merlot isn’t as good as straight Cab, right?

That said, quite a few Aussie wineries can summon enough magic with the D3V14 clone to get you taking

a sideways glance at a second glass.

Irvine for instance, with very careful site selection and plenty of time invested in the vineyard with regards to shoot and fruit thinning, a hawkish eye to pick the fruit slap bang in the middle of its narrow ‘highest quality’ window and plenty of attention in the winery, have consistently produced good to superb Merlot, twice being awarded the title of Best in the World.

Leconfield have also long made rippingly good Merlot with the D3V14 clone, regularly picking up big points, golds and trophies.

So, it’s hard to know with Merlot what is most important – a winery and maker who cares about the variety or the actual clones used. Either way, Leconfield clearly care about the variety and have made the choice to transition away from D3V14. Now about 80 per cent of their straight Merlot is produced from Q4514 (sourced from Canada but of Italian origins) and 8R (from Argentina).

These clones, planted in the right spots, provide a better fruit to leaf ratio, earlier ripening, lower bunch weights, smaller berries, better intensity and purity of fruit. Perhaps as a result, Leconfield’s historically excellent merlot is on the path to becoming outstanding.

PHIL MANSER Wine Direct

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

C H E AT S H E E T

The name ‘Merlot’ is thought to derive from the Old French word for young blackbird, merle

It’s DNA links it to Cabernet Franc, Carménère, Malbec and Cabernet Sauvignon.

It is one of the grapes permitted for use in making Bordeaux wines, along with Cabernet Sauvignon, Cabernet Franc, Petit Verdot, Malbec and rarely Carménère.

Doctor Q Spring 69

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