Doctor Q Spring 2019

Doctor Q is free to AMA Queensland Members

SPRING 2019

ENV IRO N MENTAL SUSTA IN AB I LIT Y FOR

INDIVIDUALS PRACTICES HOSPITALS

WHEN IS AN EMERGENCY D E PA RT M E N T NOT AN EMERGENCY D E PA RT M E N T ?

T H AT ’ S A WRAP! OUR NEW WORKPLACE R E L AT I O N S ADVISORY PA C K A G E

Escorted Study Tours in 2020

Paediatrics and Childcare in India

Histories of the Caribbean and the Americas Cruise

Medicine in Japan with the RSM

13 – 27 February 2020

27 February – 12 March 2020

9 – 21 March 2020

Learn about paediatrics and child health in both North and South India, two very different - but equally fascinating regions.

Explore Mayan ruins, rainforests, wildlife, colonial cities and contemporary society on this cruise along beautiful coastlines with John and Susi Richardson.

Experience the magnificent culture and history of Japan and examine its approaches to medicine with rare medical access in conjunction with the RSM.

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Cruise Through History Along the Hooghly River

Obstetrics and Gynaecology in Nepal and Bhutan

Ecuador and Galapagos

17 – 28 March 2020

19 – 30 April 2020

From Kolkata cruise along the beautiful Hooghly River in Bengal and explore the long and rich history of this cultured province of India.

Journey through two spectacular mountain lands with distinctive cultures as you learn about history, contemporary society and women’s health.

Explore the rich cultural and bio-diversity of Ecuador with a naturalist tour leader, including the incomparable Galapagos Islands on a private charter yacht.

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History of Medicine in Turkey and Greece

Conflicts, Cures and Curiosities: A Cruise

Medical & Military History: Israel, Palestine & Jordan

8 – 21 September 2020

10 – 20 October 2020

26 October – 11 November 2020

History, medicine and culture intertwine as you travel with Dr Matt Young from Turkey to Greece through millennia of medical history.

An intimate cruise through the rich and varied histories of Greece, Albania, Montenegro and Italy with Natasha McEnroe and Simon Chaplin.

An epic journey through ancient lands with Prof. John Pearn visits Beersheba on the anniversary of the charge of the 4th Australian Light Horse in 1917.

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

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21 April – 3 May 2020

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CONTENTS

REPORTS

20

MAKING MEANINGFUL CHANGE

4

Editor’s desk

8

President’s report

10

CEO’s report

32

Council of Doctors in Training

38

Research roundup

40

Member news

42

Letter to the Editor

60

Foundation raffle raises almost $20,000

F E AT U R E S 12

Sustainability in healthcare: myths and mythbusting

20

Making meaningful change

22

PA hospital leading the war on waste

26

Health and environmental sustainability

CURRENT ISSUES BUSINESS TOOLS

24

M AT E R ’ S E N V I R O N M E N TA L SUSTAIN ABILIT Y JOURNEY

14

Starting at the beginning

16

What practices can do

18

Save money with a free green audit

44

Workplace Relations Advisory Package

19

Top 10 items found in the world’s oceans

48

Therapeutic Guidelines: Bone and Metabolism

24

Mater’s environmental sustainability journey

49

How to write a business plan

28

6 Rs of sustainability

50

A question of faith

29

Rags to charity riches

52

Making work life balance a reality

30

54

Mandatory obligations to report data breach

When is an emergency department not an emergency department?

56

Downsizing into superannuation and navigating a low yield world

34

Connecting with compassion, not a ‘corridor consultation’

36

Hospital soft drink ban to help fight obesity

58

Top five questions for your private health insurer

62

Green investment

LIFESTYLE 61

AMA Queensland celebrates 20-year partnership with Orbit World Travel

63

Lexus: committed to Kaizen

64

Restaurant review: Atelier Brasserie

66

All About You

67

Dendy Cinemas

68

Dr Matt Young: Selfies and self-esteem

69

PAXTON leads the way

74

InPrint: Quitting Plastic

PEOPLE & EVENTS

26

H E A LT H A N D E N V I R O N M E N T A L SUSTAIN ABILIT Y

41

Local Medical Association meetings

46

Events calendar

70

Dinner for the Profession

72

2019 Junior Doctor Conference

BOARD OF DIRECTORS

Editor’s Desk Putting your hand up to say ‘I’m trying to do something good’ leaves you open to a fair amount of criticism. For everything that one person or organisation is doing for the environment, there’s something that they’re not. We get so concerned about about calling out the hypocrisy, but surely it’s still worth the effort?

We hope to inspire you with this environmental sustainability edition of Doctor Q. We’ve got some practical advice and some great examples of individuals, practices and hospitals reducing their emissions and continuing the life cycle of our products.

You’re reading one of the only hard copy communications that goes out to all members, and even Doctor Q is available in soft copy if you prefer. Email us at membership@amaq.com.au if you would like to switch to an electronic copy.

Renewals will be coming out to you soon too. Would you prefer to receive your renewal by email? Just shoot an email to membership@amaq.com.au and avoid getting the hard copy letter in the mail.

Our current Doctor Q printer, Printworks, is accredited with Endorsement of Forest Certification Systems (PEFC) and the Forest Stewardship Council (FSC), uses vegetable-based inks, recycles 100 per cent of their surplus materials and use best environmental practice in their office and workshop.

Dr Dilip Dhupelia President Associate Professor Chris Perry Vice President

Dr Sarah Coll Specialist Craft Group

Dr Fatima Ashrafi Specialist Craft Group

Dr Hasthika Ellepola International Medical Graduate Representative

Dr Sanjeev Bandi Capricornia Area Representative Dr Kimberley Bondeson Greater Brisbane Area Representative Dr Maria Boulton Greater Brisbane Area Representative Dr Bill Boyd Immediate Past President Zoe Byrne Medical Student Representative

OBITUARIES

Professor Selim (Sam) Abraham MELLICK Researcher Late of Ascot Member for 70 years

Dr Jillian Mary NEWLAND Medical Administration Late of Cairns Member of 43 years

Dr Margaret Laura WARD General Practitioner Late of Buddina Member for 70 years

FOLLOW US: 4 Doctor Q Spring

Dr Bav Manoharan Member Appointed Director

Dr Hashim Abdeen Doctors in Training Representative

Dr Michael Clements North Area Representative

Dr Keith Eliott HIRSCHFELD Physician Late of Clayfield Member for 64 years

Dr Sarah Coll Member Appointed Director

COUNCIL

Michelle

Dr Edward Douglas JOHNSTON Radiologist Late of St Rowes Bay Member for 71 years

Dr John Hall Member Appointed Director

Dr Peter Isdale AM Skilled Director

Dr Marianne Cannon Greater Brisbane Area Representative

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

Dr Michael Cleary Chair of Board and Council

Dr (Deborah) Erica Gannon Part-time Medical Practitioner Craft Group Dr John Hall Downs and West Area Representative Associate Professor Geoffrey Hawson Retired Doctors Representative Dr Wayne Herdy North Coast Area Representative Dr Scott Horsburgh General Practitioner Craft Group Dr John de Laat Greater Brisbane Area Representative

Dr Bav Manoharan Greater Brisbane Area Representative Dr Katrina McLean Gold Coast Area Representative Dr Nikola Ognyenovits Specialist Craft Group Dr Rachael O’Rourke Greater Brisbane Area Representative Dr Fiona Raciti General Practitioner Craft Group 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

Katherine Gonzalez-Cork General Manager - Member Relations and Communications

Editor: Michelle Ford Russ

Doctor Q is published by AMA Queensland

Graphic Designer: Aleisha Coffey

Phone:

Journalist: Chiara Lesèvre

(07) 3872 2222

Address: PO Box 123,

Red Hill QLD 4059 Email:

amaq@

amaq.com.au

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

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

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Doctor Q Spring

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President’s report DR DILIP DHUPELIA

S U S TA I N A B I L IT Y I N H E A LT H C A R E Sustainability in health care is one of the top five policy priorities for AMA Queensland.

In Health Vision: Beyond 2020, AMA Queensland outlines how an environmentally sustainable healthcare system is imperative to human health and the overall functioning of the health system.

Additionally, at the recent Federal Council meeting, the AMA recognised environmental sustainability as a health emergency. As a result, the AMA has joined the American Medical Association, the British Medical Association, and Doctors for the Environment and is urging the Australian Government to develop a national strategy for health and climate change as a matter of urgency.

The AMA has also agreed to join the Global Green and Healthy Hospitals network as a ‘health, professional and academic organisation’ member to endorse the 10-goal agenda for environmentally sustainable healthcare. Our hospitals use vast quantities of resources and produce considerable waste contributing to emissions, and as a profession we have a duty of care to do what we can do easily and progressively.

We are a broad church of members and each of us will have different views on environmental sustainability.

The AMA has long had a position statement on climate change. Increasing our attention to this issue is a call we have received from a large number of our members.

ANTIBIOTIC STEWARDSHIP Members would have seen AMA Queensland member Dr Paul Bartley’s excellent opinion piece on antimicrobial stewardship published this month in the MJA Insight, Australian Medicine and The Courier Mail. Paul adds to AMA Queensland’s concerns by providing his expert view regarding the approach taken by Queensland’s Minister of Health and Ambulance Services to allow pharmacists to prescribe antibiotics for UTIs, whilst infectious disease specialists are raising their concerns regarding multi-

8 Doctor Q Spring

resistant pathogens and are urging members to be ambassadors and to have this subject front of mind in our daily practices. Congratulations, Paul, for the timely reminder.

P R I V AT E H E A LT H I N S U R A N C E As you are aware, affordability of Private Health Insurance continues to be a problem, despite the slight slowing down in the premium increases. However, each quarter we continue to see people leaving private health insurance and ironically each day we see stories about code yellow and ambulance ramping in our public hospitals. The other issue is more older people are joining health funds and younger people are quitting their cover. Something needs to give and the AMA Federal Council has this high on its radar as we call for simpler PHI policies. The sooner governments understand that the public sector will be unable to cope without a booming private sector, the better.

PRESIDENTI AL TOURS OF LOCAL M E D I C A L A S S O C I AT I O N S I have commenced my 2019 Presidential tours of Local Medical Associations across the state and I thank the Redcliffe, the newly formed Brisbane LMA and the Fraser Coast LMA for hosting great functions that gave me the opportunity to meet with large numbers of members and non-members face to face.

These visits are unique opportunities to gain firsthand feedback from members working on the ground, and in the coming months I will be visiting the Central Queensland, Bundaberg, Toowoomba, Cairns, Sunshine Coast, Gold Coast and Mackay LMAs.

A M A Q U E E N S L A N D AWA R D S AMA Queensland congratulates Dr Eleanor Chew, Gail Wason and Dr Col Owen for winning AMA Queensland’s prestigious awards at the 2019 Dinner for the Profession held at the end of July. Three very worthy recipients, and it was my pleasure, as President, to present these awards.

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.

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CEO’s report JANE SCHMITT

E N V I R O N M E N T A L S U S T A I N A B I L I T Y I S A H E A LT H I S S U E AMA Queensland has created this special environmental sustainability edition of Doctor Q to raise the alarm about climate change and its impact on health. The Australian healthcare system is responsible for seven per cent of Australia’s total carbon emissions, with hospitals producing 44 per cent of those emissions and GP clinics contributing to four per cent of total emissions.

The evidence is clear; it is time for Queensland to step up and implement practical changes to how the health system functions in hospital and health care settings (including GP practices) that will improve human health and reduce emissions.

For these reasons AMA Queensland has placed environmental sustainability and mitigating the impact of climate change on human health in the top five policy priorities of Health Vision: Beyond 2020. In Health Vision: Beyond 2020, we called on the Queensland Government to establish Sustainability Development Units within Queensland Health to provide advice about actions which will help the government and the health services achieve their targets for reducing emissions by 30 per cent by 2030 and zero emissions by 2050.

These actions include establishing benchmarks and targets for sustainability in health services, investing in green and sustainable infrastructure, and reviewing policies for energy, waste and water.

10 Doctor Q Spring

AMA has also called for the Australian Government to establish a National Sustainable Development Unit (SDU) to reduce carbon emissions in the healthcare sector, similar to England’s National Health Service (NHS). The UK’s NHS Sustainable Development Unit (SDU has achieved fantastic results, reducing healthcare emissions by 18.5 per cent and water use by 21 per cent within a 10-year time frame.

This has resulted in commendable financial savings, estimated at £90 million ($166.5m) per annum.

The primary recommendation from AMA Queensland is that Queensland Health adopt Sustainable Development Units (SDU) within Queensland Health to establish benchmarks and targets for emissions, waste and consumption, review of procurement policies in Hospital Health Services (HHS) and the development of an engagement strategy for doctors and other staff.

This edition of Doctor Q contains practical examples of actions practices can implement in order to be more sustainable and to significantly cut down on costs.

As you read through this edition, you will see there is some great work already underway. We’ve spoken to doctors, as well as practice and hospital staff and found some wonderful initiatives already in place that are saving money, creating efficiency and a more sustainable system.

We agree with the following statement from the Chairman of Monash University’s Sustainable Development Institute John Thwaites: “When we understand that climate change is a health issue, and that health is already being affected here in Australia and across the region, it is clear that there is an urgent need for action.

“Reducing and adapting to the impacts of climate change on health offers a clear economic imperative and benefit.

In particular, preventative and early actions can generate substantial public and private savings over time,” he said.

In a recent interview on ABC Radio, AMA Queensland Past President and AMA Vice President Dr Chris Zappala said “when you get extremes in weather, that does cause problems for health, and the obvious one is heat stress, and heat stroke, and death from that, and we do see higher mortality at those times, even in Australia, when those events occur.

“It’s also the flow-through effects to our water systems, our water availability, our food production possibilities, the direct effects of smog. I’m a respiratory physician, for example, and there’s no question there’s very compelling evidence that pollution causes direct harmful effects on the respiratory system, disease that is potentially life limiting.”

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

myths and myth-busting Myths regarding sustainability may cause healthcare institutions to delay implementation of much-needed sustainability programs. An understanding of sustainability is the first step towards creating and implementing effective and long-lasting sustainability measures.

Myth-busting can be used as a shield to deflect any myth-based criticism of sustainability, and may encourage colleagues, friends or family members to see the value of the sustainability movement without letting political persuasions get in the way.

MYTH 1

SUSTAIN ABILIT Y I S J U S T A FA D Some may wish to dismiss sustainability as just a fad.

The truth, however, is that sustainability will continue to grow and continue to drive change in healthcare. It is important to become involved and work together to address these issues.

MYTH 2

SUSTAIN ABILIT Y COSTS MONEY Sustainability saves money. Waste, water, power (e.g electricity), transport and procurement are massive costs in healthcare and sustainable action in these areas reduces costs. Sustainability may take some time, effort and money initially, but the business case is often built on returns from investment.

Sustainability’s expenses lie mainly in the short term. Unsustainable practices generally cost more both in monetary and non-monetary terms.

MYTH 3

SUSTAIN ABILIT Y IS A BUZZWORD Unfortunately, this is no myth. Sustainability is one of the most popular business buzzwords. Celebrities endorse sustainable products. Companies incorporate sustainable business practices in their operations. Governments enact laws promoting sustainability. There are plenty of non-sustainable companies and practices being greenwashed. Just as one critically examines the medical literature, so too must one critically examine action on sustainability.

MYTH 4

SUSTAIN ABILIT Y IS FOR GREENIES

The term sustainability is associated with a broad range of images, from the recycle symbol to tree-hugging, activist greenies. In the modern world, sustainability is part of normal business practice. Sustainability reporting has become a well-entrenched practice in the mining sector.

Conservation is conservative. Sustainability experts are now fiscally conservative enforcers who construct a business case and ensure it is enacted.

Sustainability cuts across all political classes and views and will continue to grow in importance.

12 Doctor Q Spring

MYTH 5

INTERVENTION IS NOT NECESSARY T O AT TA I N S U S TA I N A B I L I T Y Sustainability needs champions in healthcare. Change is never easy and unsustainable practices need to be changed. Enacting procedures or policies that promote sustainability in healthcare such as providing funds and setting up sustainability committees is important. The sustainability initiatives within healthcare facilities require widespread support if they are to succeed. Given the huge amount of resources used by healthcare, the potential for savings from improved sustainability should not be underestimated.

MYTH 6

THERE IS NO DEFINITION O F A N E N V I R O N M E N T A L LY S U S T A I N A B L E H E A LT H S Y S T E M An environmentally sustainable health system (ESHS) remains a vague concept for many. The World Health Organisation defines ESHS as one that “improves, maintains or restores health, while minimising negative impacts on the environment and leveraging opportunities to restore and improve it, to the benefit of the health and well-being of current and future generations�. In everyday language, this could be translated to: be sensible at work. Think first and use only what you need.

DR ANDREW JEREMIJENKO Occupational and environmental physician, Mater Private Emergency

MYTH 7

SUSTAIN ABILIT Y MEANS LOWER S T A N D A R D S O F H E A LT H C A R E The resources available in health care are not limitless and need to be used effectively. Sustainability can actually equate to better targeted use of resources to improve the standards not lower them. Not acting on sustainability may lower standards of healthcare in your facility.

MYTH 8

R E C Y C L I N G I S T H E O N LY W A Y TO ACHIEVE SUSTAIN ABILIT Y Recycling is not the only way to achieve sustainability. The 6Rs: reuse, rethink, repair, reduce, refuse as well as recycle (see p28). There are many ways to make health more sustainable and many different ways to think about how to improve sustainability in healthcare. What is important is to start thinking, planning and becoming sustainable.

MYTH 9

SUSTAIN ABILIT Y REPORTS WILL NEVER BE R E Q U I R E D I N H E A LT H C A R E Sustainability reports are already being prepared by healthcare organisations and help them measure, understand and communicate their performance, set goals, and manage change more effectively.

Building and maintaining trust in health care is fundamental. The value of the sustainability reporting process is that it ensures organisations consider their impacts on sustainability issues, and enables them to be transparent about the risks and opportunities they face.

MYTH 10

SUSTAIN ABILIT Y SUCKS It is understood that some like to use profanities to help them cope with a changing and unpredictable environment. The sustainability movement has gone from a niche interest to marketplace mainstream. Healthcare will embrace the change despite a few profanities along the way. The case against sustainability is not sustainable.

Doctor Q Spring 13

Starting at the beginning In late 2016, I was present at a climate and health roundtable meeting in Canberra. Senior bureaucrats politely told us - despite the well documented heat related deaths in Victoria in 2014 – that global warming was not on their radar as affecting the health of Australians, and that it only crossed their desks as a Pacific Island issue. My own experience was that during heat waves, and other disasters, hospital resources were often overwhelmed by surges of patient admissions. I realised I needed to learn more about the implications of climate change on human health and the national healthcare system, having read the Lancet statement that climate change was the greatest health threat this century.

Vulnerable populations - elderly, Indigenous, chronically ill, outdoor workers, and children - will be worst affected, even in our own population.

My first step was to look to my personal consumption choices, such as choosing low food -and wine- miles; eating less meat; using active transport (bikes and buses); driving a smaller/low emissions car; offsetting flights; and holidaying closer to home. Installing solar panels can reduce our carbon footprint and energy costs as well, or you can pay a little extra to purchase ‘green energy’.

Living sustainably is virtuous and a good role model to show that we can live happy and sustainable lives, but doesn’t change the economic system that is built on ever increasing amounts of consumption. Historically 90 companies are responsible for 60 per cent of emissions. So, while individual sustainable choices save emissions and may even be making us healthier, they may not be where we have most impact.

We can make significant inroads by insisting our money is invested, both directly and via superannuation, in ethical or sustainable companies. Voting with our feet as a consumer and shareholder is an effective way to drive change. Likewise as donors we can legitimately impact the climate policy of third sector organisations, who often champion marginalised populations.

Healthcare is responsible for seven per cent of overall Australian emissions, mostly hospital and purchasing-based. As clinicians, we can encourage and support environmentally sustainable initiatives, which have been shown to lead to cost savings as well.

As healthcare providers, we dispense preventive population health messaging and interventions on a daily basis. Collectively we make our voices heard when things such as anti–vaccination movements or tobacco marketing threaten our 14 Doctor Q Spring

DR MARIANNE CANNON Clinical Subdean, Uniting Care Health Clinical School, Emergency Physician and AMA Queensland Councillor

patients’ health, or it is undermined by commercial or political forces.

As doctors, we can leverage our impartiality, gravitas, and high community respect to support and drive good population health interventions.

As a respected profession, we can educate and advocate for mitigation and adaptation to the health impacts of climate change We are particularly vulnerable to climate disruption in Queensland.

It is by raising this, and the known solutions with our patients, colleagues, professional associations and leaders that we can have the most impact of all. The AMA has excellent policy in this area, and can play an important role as a non-partisan voice for the health implications of a changing climate. Many strategies to reduce emissions have health co-benefits, such as active transport reduces air pollution and obesity.

Speak to your colleagues, and let our leaders know the facts regarding warming and health. Demand their attention. It’s our core business, and then we can look our young people in the eye and say we did everything in our power.

Phone: 07 3830 3300 Fax: 07 3830 3399

Email: reception@brisbaneurologyclinic.com.au

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Doctor Q Spring 15

What practices can do Tertiary care facilities generate the majority of emission and ecological footprint that arises from the health care system.

However, private practices, both specialist and general practice, can still play a vital role in becoming more sustainable.

Investing in sustainability may save money in the long term, but shouldn’t be the only motivation for change. It is also important for doctors, with their respected positions in society, to show that caring for the environment is achievable without sacrificing quality of life. Maybe the quality of healthcare we deliver may even improve. Here are some tips that many of us may consider, or do more of.

GO SOLAR A medical practice is well suited to using solar power because the peak demand is during the day when the sun is shining. Even if you don’t own your own building, it is worth discussing this option with your landlord. The cost and embedded energy of the panels will be recouped in a number of years, then large savings will accrue from reduced energy bills.

ENERGY EFFICIENT DESIGN Buildings can be retrofitted with energy efficient LED lighting, and shading of external walls and windows, particularly west facing, will produce significant energy savings.

Ensure that heating and cooling is not operating in empty rooms or overnight, and establish practice habits for computers to be turned off at the end of each working day.

16 Doctor Q Spring

MANAGE WASTE Waste separation is important because infectious waste is around 10 times more expensive to dispose of than general waste and it’s a more energyintensive process. If they don’t come into contact with patients, these items are clean and recyclable. Additionally, other wastes such as paper used on day beds, if clean, can be recycled as paper waste rather than general waste, or clinical or medical waste.

Buy consumables in bulk to reduce packing waste. Maybe it is even time to reconsider the true lifecycle cost of disposables, such as speculums, and keeping the steriliser in use.

REDUCE PA P E R Computers were supposed to facilitate the paperless office, but many practices still print off paper copies and rely on scanning and faxing. Efforts to reduce paper will speed up the transition to secure electronic referrals and access to results, but new systems need commitment to learn and adopt to the technology. If you do need to use paper, at least insist on using recycled paper, which is affordable and of good quality now.

RECYCLE Recycling will only happen if supported by the availability of suitable bins and culture in the practice. Some practices have a paper recycling container in every consulting room and a general recycling bin in the tea room. Even a compost bin could be considered if you have any keen gardeners in your practice.

CHOOSE W I S E LY Medical imaging and pharmaceuticals carry a large ecological footprint.

Avoiding unnecessary tests and treatments can therefore have multiple benefits in reducing harms and healthcare costs, but also being more sustainable for our planet.

O N S L O W R O A D FA M I LY P R A C T I C E , P E R T H Ten years ago, Dr George Crisp wanted to show that having a sustainable practice can be done easily and would encourage patients to follow suit. He also wanted to show his patients how it could benefit their health. They started with a leaflet detailing the things that patients could do for their health that were also environmentally beneficial — for example, cycling to work instead of driving, and eating less processed foods, as well as opting for local and fresh foods.

DR DAVID KING Academic GP, University of Queensland and Immediate Past Chair of the Queensland Committee of Doctors for the Environment Australia.

The practice uses recycled paper, switched to energy-saving bulbs and installed bike racks and shower facilities to encourage staff to cycle or walk to work. There’s a vegetable and fruit garden and staff encourage children from the school across the road to harvest the produce. Patients and neighbours can bring food scraps in for the practice’s composting bins. It took three and half years to pay off new solar panels, after which they started saving $1,275 a year.

THRIVE MEDICAL, CAIRNS General practice Thrive Medical started in April 2016 in Cairns North. The practice operates from a 70-year-old rented house. They made some energy efficient renovations prior to opening – insulation, reflective coatings on the windows and solar panels. They also invested in quality furniture and equipment to last for many years.

Nowadays, the practice makes a big effort to minimise paper use. To do this, they send referrals via secure messaging. They otherwise send and receive faxes electronically.

Thrive Medical are auditing all incoming paper and advertising materials. They also reduce waste by sterilising instruments and separate paper kitchen and treatment room waste for recycling.

In the future, they hope to add more solar panels, purchase a solar battery storage system, plant some fruit trees out the back, install a bike rack for patient use and purchasing reusable speculums.

“At our practice we are all very concerned about the future of our planet. We feel strongly that the medical profession has a responsibility to be leaders in the changes needed to protect our environment and our future. We also recognise that the changes we have made in this regard personally and professionally have improved our health and well-being and we are keen to share this with our patients and colleagues. Beyond this, there is absolutely clear business sense in making these changes - we have saved a significant amount of money!” Dr Jane Barry, Thrive Medical

H E A LT H H U B , M O R A Y F I E L D When work started on the $100 million, 14,000sqm Morayfield Health Hub in 2017, the Health Developments Corporation wanted to include a broader sustainability program. The hub was built on an old Bunnings building and they used what they could from the old building.

The biggest green initiative for the site, though, is the 404kW solar power system, which will achieve payback in

just over four years from installation, saving the group $123,000 in energy bills each year.

“Health and climate change are so inextricably linked we wanted to make sure for this building we were actually able to have a sustainable model around what we were doing in terms of energy consumption,” said Director Dr Evan Jones.

“As the prices of batteries come down

and it makes economic sense, we’ll put in a battery system which will provide us with a very large uninterruptible power supply (UPS) that will be able to manage some of our power supplies through the night then,” said Dr Jones.

Beyond solar energy, Morayfield Health Hub has a broader sustainability program incorporating elements such as LED lighting, rainwater tanks and two electric vehicle chargers.

Doctor Q Spring 17

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18 Doctor Q Spring

ecoBiz also supports businesses by measuring energy, water and waste quantities and costs, and measuring reductions made.

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St George Medical Centre had an ecoBiz expert out to conduct a free audit last year, taking advice on way to save money on energy, water and waste expenses to their current building.

They were able to incorporate ideas while building their existing premises.

“I had a good idea of what I wanted to achieve in terms of energy savings, but with the ecoBiz coach’s assistance, I have been able to save even more,” said Alex Benn, St George Medical Centre’s Business Manager.

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Making meaningful change I grew up on an avocado and macadamia farm in northern NSW. We didn’t seem to waste much on a farm; we had wood for winter heating, the chooks ate most we didn’t, and the compost took the rest; there was a circle, a cycle, of life. I was slow to do much about environmental sustainability even though I fretted about what we were doing to the planet. When I was well into anaesthetic and ICU training, I realised that medicine itself was actually an extraordinarily wasteful profession:

anaesthetic colleagues if we could convert from single use to reusable trays to hold the drugs. Well how do you know if the reusable drug trays don’t have a higher carbon footprint, use more energy and water to clean, and cost more for the labour to reprocess?

Thus started my research path, a far cry from randomised controlled trials, but painfully fun nonetheless! I sought infection prevention’s blessings, found an expert in the field of lifecycle assessment and spent more time in the operating theatres.

We anaesthetists setting our exhaled anaesthetic gases off into the atmosphere to deplete ozone and add to the climate crisis or dumping drugs into waste that enters the water table

What we found was an area of research begging to begin. By replacing the single use drug trays with reusable trays we would be increasing our carbon footprint, and saving money; surprising to us on both fronts.

We surgeons and interventionalists dress and drape in oil (plastics), and increasingly use bucket loads of expensive single use items that once used end up burnt or chemically treated

We began novel recycling programs such as PVC plastics, and promulgated much greater theatre plastic wrap and paper/cardboard recycling. We undertook other life cycles of most anaesthetic equipment and found that again reusables would save money (about $5,000 per operating theatre per annum), but that the carbon and water footprints were higher.

We infectious disease physicians go to great efforts to keep patients safe from bacteria, but see mountains of plastics head off to the never never…

Have you ever wondered about why in medicine there is no cycle, nor circle, just a linear path of consumption leading to an ever-growing mountain of single use waste?

So, how did my story towards hospital sustainability at Western Health, Melbourne begin? When in the operating theatre I asked one of my

20 Doctor Q Spring

We also performed microbiological studies of anaesthetic breathing equipment and found that (with single use filters for each patient) washing circuits weekly had similar bacterial loads to washing daily, a finding confirmed by others.

We markedly reduced the use of desflurane (an anaesthetic gas with high global warming potential), and

similarly encouraged less use of nitrous oxide. We began a hospital sustainability committee and petitioned for a sustainability officer who was able to devote time, passion and effort (and save money) to making the hospital more environmentally aware.1 Particularly important was the area of local sustainability action plans, i.e. inviting hospital staff in different hospital fields (e.g. the dialysis ward, radiology) to consider what they thought were the most pressing environmental concerns needing rectification.

And yet, despite all of this waste, despite this move to single use equipment, there are some areas of medicine that are overtly more sustainable, more protective of the environment, and more efficacious to humanity. Preventive health is the very antithesis of such hospital waste.

All preventive health is sustainability by stealth: a GP preventing someone from becoming obese, treating early hypertension, vaccinating a child; a public health doctor influencing alcohol, tobacco and sugar tax legislation; a surgeon reducing trauma by seatbelt and gun laws; a physician encouraging exercise and active transport (walking, cycling, public transport). So, when a doctor worries that they’re not doing enough in their daily work activities to improve their carbon footprint, or that they’re failing to encourage environmental sustainability, consider all of these and other indirectly environmentally sustainable efforts that actually directly make life better for patients.

And should you then wish to explore further…

1. Read about the carbon footprint of healthcare,2,3 how important it is in Australia (seven per cent of Australia’s total emissions), where it’s big (hospitals), and how to reduce it, guided by the UK Sustainable Development Unit.

2. Consider knowing a little about life cycle assessment, and about discovering in more detail about how to reduce carbon hotspots.

3. Start with something simple to change in your practice, e.g. surgical gowns.

Know that even for Australia, reusable surgical gowns have about half the carbon footprint of single use gowns, mainly because they’re easy to sterilise in large numbers per steriliser load.

4. Recycling is challenging because it relies upon multiple folk to prevent contamination and encourage ongoing efforts. Always remember that reducing and reusing will generally be easier to do and save a great deal more.

5. Never forget that being more environmentally sustainable in healthcare is routinely more efficacious for the patient; avoiding and reducing waste really is better, safer, more resilient care.

DR FORBES MCGAIN

Anaesthetist and ICU Physician Western Health, Melbourne

6. Every field of medicine can contribute to healthcare environmental sustainability; from the neurosurgeon in a Brisbane tertiary hospital to the remote GPs on Thursday Island.

7. Many of the major medical colleges now have or are undertaking statements on environmental sustainability. Get involved in promulgating and advancing these statements to make them real!

8. You are not alone! There are folk in Australia (Doctors for the Environment Australia, Climate and Health Alliance), N.Z. (OraTaio), the UK (NHS Sustainable Development Unit, Centre for Sustainable Healthcare), USA (Global Green and Healthy Hospitals) and France (Comité pour le Développement Durable en Santé) amongst others around the globe keen to make healthcare’s footprint lighter. There is very recent call for the healthcare sustainability research agenda to be promoted.

1. McGain F, Kayak E. Risk management: where are hospital ‘green’ committees and officers? Aust Health Rev 2010;34:523-4.

2. Eckelman MJ, Sherman J. Environmental Impacts of the US Health Care System and Effects on Public Health. PloS one 2016;11:e0157014.

3. UK NHS. Carbon Footprint update for the NHS in England 2015. (Accessed 12 April 2017, at http://www.sduhealth.org.uk/ documents/publications/2016/Carbon_Footprint_summary_NHS_ update_2015_final_v2.pdf.)

Doctor Q Spring 21

PA Hospital leading the war on waste Imagine the thousands of kilograms of waste produced by a hospital each year.

Water bottles, leftover food, cardboard and plastic packaging, single use items – so many people and so much waste.

In 2016, an anaesthetist registrar at the Princess Alexandra Hospital (PAH) commented that at the Mater, they recycled their IV bags. The PAH operations team looked into who might collect and recycle the bags at their hospital.

Prior to 2015, many of the PAH departments were carrying out their own initiatives separately and on an ad-hoc basis. PAH recognised this and started to coordinate measures across the entire hospital. They established a

sustainability committee made up of clinical and medical staff, pharmacists, nutritionists and physiotherapists.

From there, they started looking at all the materials going to landfill that could be recycled or continue on their life cycle in the hospital.

“We put on information sessions and supply the resources, but it’s up to the staff to choose to use it. In many cases, it’s little more than using the right bin.

We put on education programs but it’s generally the staff coming to us and asking for help in implementing a system for their area,” said Noel Matson, PAH’s Director of Operational Services.

“One of the guiding principles is the question: can this project continue

without the person championing it? If it’s only working because one person is particularly devoted to making it happen, then it’s not sustainable.”

“Many of these initiatives have significantly reduced costs in dumping landfill and actually brought a small income to the hospital. The income is used to enhance patient experience, with quiet rooms, extra seating and upgraded community gardens and spaces,” he said.

In 2018, PAH has reduced waste and introduced recycling initiatives to save 600,000kg in waste, reaching a total of 2,706,620kg of waste diverted since 2015.

KIDNEY DISHES

S I N G L E U S E S TA I N L E S S S T E E L

The PA Hospital has replaced 680,000 plastic single-use hard plastic kidney dishes per year with compostable sugarcane-derived biodegradable dishes. The new dishes have been greatly endorsed by staff.

Scissors, tweezers, and implements that don’t contact the patient have their own recycling bin and are made into new steel products.

COPPER WIRES

The wires attached to diathermy pads include copper which is able to be recycled. A bin was provided to the relevant areas of the hospital with staff educated to cut off both ends leaving the PVC covered wire for recycling. This option removes the time-intensive process of stripping the copper out but still brings a small income to the hospital instead of being sent to landfill.

P V C ( P O LY V I N Y L C H L O R I D E ) Through an agreement between PAH and Baxter Healthcare, a large quantity of PVC clinical waste products are returned to Baxter for recycling.

HARD AND SOFT PLASTICS Soft plastics like pallet wrap, medical sterile soft plastics in theatres like microscope covers, x-ray machine sterile covers and consumable packaging are collected separately and sent for recycling instead of to landfill. Hard plastics are also collected and recycled. The blue chairs at the PA Hospital drop-off are made by plastic recycled from the hospital. (Replas)

22 Doctor Q Spring

COFFEE GROUNDS AND FLOWERS With two cafes, one can only imagine the amount of coffee drunk by patients and staff in a hospital each day!

The coffee grounds and dead flowers are collected and used as compost.

CARDBOARD Cardboard is the hospital’s simplest recycling stream, it is recycled through the onsite harvest compactor, which has resulted in land fill reduction.

KIMGUARD STERILE WRAP Used for wrapping sterile instruments, staff just need to ensure the Kimguard wrap goes into the correct bin before it’s collected and recycled by an external supplier, reducing landfill and giving the wrap a second life.

P O LY S T Y R E N E These two items are recycled through the onsite harvest compactor. Segregation of Pallet Wrap and Polystyrene reduces land fill.

WAX

E - W A S T E A N D B AT T E R Y R E C Y C L I N G

D O N AT I O N S I N K I N D

When individual electronic equipment has reached the end of its useful life, it is assessed before finding its way to general waste. These items can be heavy and bulky contributing to a higher cost of removal. The PA Hospital is investigating metal recycling contractors to collect these items to reduce land fill.

They use wax for the target in radiation oncology. The offcuts of the wax, which don’t come in contact with the patient, are now recycled and used to make wax wraps for storing food. The wraps are sold at the hospital.

Since 2015, medical consumables that are often discarded or recycled like crutches and orthopaedic supports are routinely donated to charities such as local rotary clubs and packaged with other goods to provide to Asia-Pacific hospitals in need.

GENERAL AWARENESS

By identifying waste streams and training staff involved on the correct waste management process, PAH has decreased its general and co-mingle waste and now average 47 tonnes per month of Harvest Compactor waste.

PAH recycle all single use surgical use surgical pumps into eWaste streams from post-surgical wards. The hospital is a generous donator of equipment that still has useful life to other facilities in Australia and the Asia-Pacific region as benevolent contributions. Hospital staff separate and recycle all batteries to ensure they do not reach landfill and are recycled. Batteries are recycled at a financial cost, but as a commitment to the PAH’s responsibility to the environment and sustainable leadership.

W H AT ’ S N E X T The staff are investigating the possibility of purchasing a dehydrator to continue the lifecycle of 2,700kg of food waste produced each week. If dehydrated, the waste will be reduced to 10 per cent of that volume and used as fertiliser on the grounds.

Spinal patient Andrew Pocock has spent 14 months at the hospital and he’s made the most of that time by getting involved in the Spinal Injury Unit’s garden club.

“I wasn’t even interested in gardening until I was in hospital. Now, I’m planning out an Indigenous garden as well, with native foods like grass trees, Davidson’s plum and pig’s face,” said Andrew.

Faced with months in hospital, many of the patients are eager to lend their green thumbs to the hospital, some even returning after they’ve been discharged. Andrew was concerned about the garden’s upkeep after his upcoming discharge, but during our visit, a new patient was keen to bring his gardening expertise and help out.

The life cycle in the community garden continues as well, with a nurse harvesting the tomatoes and making green tomato chutney and gifting it to patients. When rosella is in season, the patients used the fruit to make rosella jam as part of their occupational therapy sessions.

Often these can then be sold at the cafes and gift shops.

Doctor Q Spring 23

Mater’s environmental sustainability journey Since 2007, Mater has been seeking ways to reduce its environmental footprint. Over 200 green initiatives have been pursued across the themes of energy, waste, water, transport, procurement, facilities design and engagement.

Mater is an active member of the Global Green and Healthy Hospitals (GGHH) network and has won various awards for its efforts. Key initiatives have included increasing recycling, reminding staff about turning off lights, changing lighting to longer lasting LED lights which use 57 per cent less wattage over the same area, encouraging the use of keep cups and improvements in Mater’s fleet management. The fleet has achieved considerable efficiencies and savings through a review of routes and discouraging staff from sitting in the car and leaving the engine running for long periods.

At Mater, ongoing incremental infrastructure upgrades are delivering savings in consumption and expenditure over time. One example is improving the energy efficiency of the

central energy plant at South Brisbane involving the introduction of new control systems and strategies, which are saving 20 per cent of the energy used on chilled water reticulation and saving $70,000 each year.

In addition, Mater is working hard to engage staff as a quality improvement endeavour. For example, over 4,000 have signed ‘the Sustainability Pledge’ of individual level behaviours. Mater is currently encouraging Waste Action Groups and ‘BYO cup’ campaigns.

Sponsored programs are also enabling Mater to recycle PVC tubing, masks and IV bags across 18 teams, diverting at least a tonne of waste from landfill each year.

“I am grateful to have the input of our clinical staff who are strong, respected voices helping to bring about change.

It’s not an easy task but a critical journey for Mater given our mission and the reality that the environment is closely linked with health outcomes in the community.”

In 2007, Mater’s Board of Directors committed to a set of environmental sustainability principles and agreed to look at ways to minimise the organisation’s impact on the environment. In 2008, a multidisciplinary sustainability committee

While the team admit there is a long way to go to replace old infrastructure, they are committed to implementing sustainable changes as time, money and workload allow.

Mater’s Project Officer for Environmental Sustainability, Ngaire McGaw said she was grateful for the input of so many doctors.

was established, comprising executive directors and senior directors from across Mater. They began an annual carbon footprint process in order to accurately identify environmental issues and annual improvements.

By 2010, a full-time dedicated position was created by Mater to coordinate the initiatives, identify new opportunities, monitor results, and collaborate with stakeholders.

24 Doctor Q Spring

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Health and environmental sustainability As a committed climate change activist, it was always a matter of time before the Hon Dr Steven Miles MP put sustainability on the Queensland Health policy agenda. The Brisbaneborn father of three was a loud and proud environmentalist long before he entered State Parliament, attending American politician Al Gore’s climate reality training program in Melbourne back in 2007. He’s remained loyal to the cause, earning the title of ‘climate change leader’ in Mr Gore’s 2017 book, An Inconvenient Sequel: Truth to Power which details Mr Miles’ commitment to curbing climate change as Queensland Environment Minister from 2015- 2017.

“I’m proud of what we achieved during my time as Environment Minister,” says the 41-year-old, seated at a table in the centre of his wood-panelled office in State Parliament.

“Re-terminating sand mining on Stradbroke Island, the reef protections which are still rolling out, the container refund scheme, banning plastic bags, new vegetation clearing laws were all important and so was rebuilding the climate change agenda which had really been dismantled.”

The health portfolio, Mr Miles admits, has other priorities and his attention has been focused on meeting the needs of growing demand since he was appointed Queensland Minister for Health nearly two years ago.

26 Doctor Q Spring

“It can be a challenge to prioritise sustainability in health, it’s fair to say,” he says. “When you’re in the day-to-day business of saving lives, that needs to be the priority and should be so. But that doesn’t mean it’s not important and I wouldn’t like to focus on it more.”

Perhaps surprisingly to some, Mr Miles has not set specific emissions or waste targets for Hospital and Health Services to try to achieve.

“In general terms, the Queensland Government energy policies apply to

“We are working on the basis that the waste levy itself will create a new impetus for Hospital and Health Services to seek to address energy.

Not only for the first time will it add a cost to their general waste, but there’s a higher charge for their regulated waste which is what hospitals have large amounts of. That should drive some incentives.”

While he has no plans to roll out mass climate change mitigation measures across Queensland Health, Mr Miles has set environmental initiatives in train, which will change the way the public health system operates in the future.

“I think it’s the system’s job to try to make it so that the best way forward for health care is also the most energy efficient and the least wasteful. The first and easiest runs are in energy usage and energy efficiency. That’s certainly the case with hospitals.

Hospitals account for more than 50 per cent of emissions within the health sector. Some of the equipment used in hospitals is extremely energy intensive, particularly imaging equipment.

“I’m proud of what we achieved during my time as Environment Minister” Queensland Health which include a 50 per cent reduction in emissions by 2030 and zero emissions by 2050.

In net terms, it’s certainly doable for Queensland Health though it may mean electricity usage is offset in other ways for some facilities.”

When it comes to reducing waste, he’s expecting the new levy, effective from 1 July this year, to do the heavy lifting.

“Within a decade, all new builds should seek to be at the highest possible green star rating with everything from LED lighting to sensor lights to more efficient equipment. It’s also about changing energy sources so we need to move more towards renewable energy, starting with solar on rooftops on all new builds and potentially in regional hospitals.

While hospitals are 24-7 operations, their usage peaks during the day when most surgery and outpatient services happen so there’s a strong opportunity for greater use of solar at hospitals.”

Moreton Bay Regional Council Mayor Alan Sutherland looking at plans for the new university in Petrie.

Mr Miles has launched a desktop assessment of Queensland Health sites to determine their energy use, when it peaks and what renewable sources may work.

“We’re also talking to other organisations about what kinds of models they might use,” he says.

“And we have a pilot program using solar panels at the forensic sciences buildings in Coopers Plains through a partnership with Planet Ark. It’s a demonstration of what that kind of partnership might look like for Queensland Health and I think we’ll see more of those kinds of things as well as direct investment where that’s more appropriate.”

Mr Miles says the other environmental priority within the next decade for Queensland Health will be reducing waste.

guidance and drive change across the system. It has also called for the creation of an Office of Sustainability within Queensland Health to establish emissions targets, invest in green infrastructure for the future and review procurement practices.

Mr Miles is broadly supportive of the suggestions.

“I’m not sure we need an Office of Sustainability to achieve outcomes, but I’m happy to consider it,” he says.

“I certainly agree that all future capital works and procurement plans for Queensland Health should have sustainability and energy efficiency measures embedded in them.”

Despite his political success, Mr Miles originally aspired to be a journalist.

Raised in Petrie in the Moreton Bay region by his father, a fitter at the

Golden Circle cannery, and his mother, a workplace health and safety officer, he dreamed of working in the media.

But journalism jobs were scarce when he graduated from University of Queensland in the 1990s and Mr Miles went on to study a PhD in political science before finding a career in politics.

He says his passion for climate change began when his wife was pregnant with their first child and it was his concern for his three children and the future of the planet that spurred him to run for State Parliament in 2014, campaigning on strong environmental protection messaging.

“My motivation in politics was always about future generations – health, education, the economy,” he says.

“But all of those things will be impacted if we can’t stop the planet from getting hotter.

“This will be more incremental, but we really need to look at waste minimisation. There’s been a real shift in recent decades to more waste – a lot more disposable and pre-packaged goods. With those kinds of disposables, there’s room to look at how much gets used and how the waste is recyclable.”

Currently, the only Hospital and Health Services with environmental sustainability measures in place are Darling Downs, Metro South and Townsville.

AMA Queensland is recommending dedicated sustainability officers be employed in each hospital to provide

Doctor Q Spring 27

6 Rs

of y t i l i b a n i a t s u s

REFUSE

REDUCE

Can you refuse to design something that really isn’t needed?

Can you refuse to use materials that aren’t recyclable?

If your design isn’t sustainable, will people refuse to buy it?

Can you reduce the amount of materials used?

Can you reduce the energy needed for manufacturing?

Can you reduce the waste and packaging?

REUSE Can the product be reused, perhaps in a new way, to extend its life?

Can parts be reused?

Is it easy to dismantle for reuse?

RETHINK

RECYCLE

Is this product really needed?

Can you rethink the product so it lasts longer?

Can you redesign the product so it’s easier to recycle?

Can you use recycled materials?

Can you use materials that can be recycled after use?

Can you design a product that is easy to recycle?

REPAIR Can the product be repaired easily?

Can it be repaired cheaply?

Can parts be replace, rather than the whole product becoming unusable?

28 Doctor Q Spring

Rags to charity riches In Victoria, surgeons, anaesthetists and nurses scrub for surgery and dry their hands on a Little Blue Towel, a sterile, single-use, 100 per cent cotton, lint-free towel that is the size of a tea towel. Dr David Hays, a Melbourne anaesthetist, thought that he might be able to give the towels a new life by washing and selling them to raise funds for the OTIS Foundation, a charity that provides retreat accommodation for people fighting breast cancer. He spoke with friend Dick Phillips while on a tinnie to raise money for OTIS and Little Blue Towels was born.

Large blue wheelie bins in operating, radiology, intensive care, day oncology, delivery or emergency departments in 74 hospitals across Victoria and the ACT are used to collect the Little Blue Towels. They are washed by Laundry Mates, an enterprise wholly owned and operated by people with disability living in or near Echuca, Victoria. The towels are then packed for sale by teams at Ability Works in Kew and Task Force in Echuca.

People buy the towels and use them in the shed, laundry, cars, boats, caravans, camping equipment, or on the barbeque. They are used in hospitality, general cleaning (especially window cleaning), printing, automotive and transport industries, as well as in preschools, golf clubs and fishing shops. They are also sold as promotional items with a company’s branding on them.

Dr Hays said they did an audit two years ago and worked out that they were collecting around 32,000kg of towels, or around 532,000 towels in total.

“I thought I would collect a few thousand over a year from the hospitals where I work and raise a few thousand dollars but social media got hold of it and the whole program escalated. I am truly the accidental greenie! Although I did grow up in a small town in the Riverina, Deniliquin where I was taught to waste nothing. I have a lot to thank my father for!” said Dr David Hays.

“There are obviously running costs for the business but all profits go to the OTIS Foundation. We estimate that every dollar we earn they get 60 cents. The OTIS Foundation is a fantastic organisation which caught my attention on our trip down the Murray River. It is run out of Bendigo, Victoria and is a little bit different to all the other fund raising for breast cancer. I felt that regional Australia often gets lost in our hectic lives and it was time to put some money back into regional Australia. Gods knows they need it. I had been very lucky with my country upbringing, education and career and felt it was time to repay regional Australia.

“We have been working on a number of other recyclable, single-use, non-contaminated products namely plastic bowls, scissors, forceps and suture holders, but we were once again inundated with product and found it difficult to sell what we were collecting. Although there is definitely a market for these products out there, we have decided to wind this back temporarily while we concentrate on Little Blue Towels. Once we get the model right for Little Blue Towels and hopefully take it nationally, then we can revisit other single use recyclable non-contaminated items.

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Doctor Q Spring 29

When is an emergency department not an emergency department?

In 2006, an special emergency department allowance of an extra 25 per cent (ED25) was introduced to improve the low recruitment and retention rate for SMOs in emergency departments.

In January 2017, it came to ASMOFQ’s attention that a number of doctors were not being paid their ED25 because the emergency department where they worked was not recognised

by Queensland Health as an emergency department, but rather an emergency care centre.

This allowed Queensland Health to pay these Senior Medical Officers (SMOs) less than they should have been entitled to for their work.

ACEM MINIMUM S TA N DA R D S According to the Australasian College of Emergency Medicine’s (ACEM) minimum standards, an emergency department must have the following basic elements:

must operate structurally and

functionally within a hospital;

24-hour dedicated nursing staff with a dedicated Nurse Unit Manager or equivalent;

daily rostered medical staff and

24 hours a day, seven days a week access to medical staff after hours;

dedicated facilities to manage emergency presentations;

While the original complaint came from one hospital, it became clear to us that emergency physicians in hospitals throughout Queensland were not being paid the ED25.

co-located dedicated resuscitation

Under MOCA 4 (and subsequently MOCA 5) to be entitled to the ED25 Allowance you must be:

24-hour access to blood products; 24-hour access to laboratory

1. a Senior Medical Officer; 2. working an extended hours rostering arrangement; and 3. performing work in an emergency department.

However, if you are a member who is not being paid ED25 and believe you meet the criteria, please contact ASMOFQ at asmofq@amaq.com.au for a discussion around your department and the alignment with the ratio (rationale) in the decision.

SIGNAGE TEST/PUBLIC PERCEPTION TEST ASMOFQ will also consider evidence of how the department is advertised, signed and the public perception.

area with appropriate equipment to provide advanced paediatric, adult and trauma life support prior to transfer to definitive care;

and radiology services;

24-hour access to specialty care or advice;

24-hour access to retrieval services, as appropriate; and

if there are no emergency specialists (Fellows of ACEM (FACEMs) on staff then the Emergency Department must be part of an Emergency Medicine Network.

ACRRM GENERAL PRINCIPLES According to the Australian College of Rural and Remote Medicine (ACRRM) general principles, an emergency department must have the following basic elements:

Suitably trained nursing staff available 24 hours a day, seven days a week.

30 Doctor Q Spring

A triage process whereby patients are allocated priority based on clinical need.

A daily roster of medical staff

available in house or on call 24 hours a day, seven days a week.

Dedicated facilities to manage

emergency presentations including a dedicated resuscitation area with appropriate equipment to provide advanced paediatric, adult and trauma life support prior to transfer to definitive care.

A formal structure in place to be

able to access specialty advice 24 hours a day, seven days a week.

A formal structure in place to be able to access appropriate retrieval services 24 hours a day, seven days a week.

ASMOFQ has produced a comprehensive list of departments which are currently not receiving ED25 who we believe meet the definition handed down in the decision made by the Queensland Industrial Relations Commission (QIRC).

ASMOFQ has had a number of meetings with senior Queensland Health representatives in regards to this decision and our members’ feedback.

Queensland Health has provided ASMOFQ with a document which we believe does not accurately reflect the decision and has significant potential for some Emergency Department SMOs to miss out on the allowance.

ASMOFQ continues to advocate on behalf of members, ensuring all members receive the allowances they are entitled to, included associated back pay.

If you or any of your colleagues are not receiving the allowance and believe you meet the criteria under MOCA 4, please contact ASMOFQ urgently at asmofq@amaq.com.au.

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AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING

Update

As one of AMA Queensland’s largest and rapidly growing membership groups, the Council of Doctors in Training (CDT) nominated their 2019 Council at the beginning of the year.

Under the leadership of Dr Hash Abdeen, we have sustained many of our established portfolios, whilst welcoming a new advocacy portfolio to ensure the voices of junior doctors are heard loud and clear throughout Queensland.

The Council is also thrilled to welcome Drs Emily Shao and Rhys Thomas, junior doctor representatives of the Doctors Health Advisory Service Queensland, to join CDT in a formalised role as demonstration of our commitment to junior doctor wellbeing at the forefront.

Our flagship event, the 2019 Junior Doctor Conference, held on 15-16 June was again a great success. Junior doctors and medical students from around Queensland converged in Brisbane to share in the wisdom of subject matter experts on topics ranging from MedTech and artificial intelligence, to professional approaches to common workplace problems, and further on how to establish your image – everything from CV to social media. There were also hands-on workshops led by the incomparable Royal Brisbane and Womens’ Hospital Clinical Skills Development Service.

Health Minister Steven Miles joined us on the Sunday to respond to CDT’s ongoing requests for better workforce planning and accreditation of positions from PGY2 to Registrar years.

Behind the scenes, our council is working hard to establish stronger links with local hospital junior doctor groups, increase focus on GP and rural and regional junior doctor needs, as well as contributing to AMA Queensland policy on Voluntary Assisted Dying in Queensland and what needs to 32 Doctor Q Spring

be considered for junior doctors on the ground.

At our next CDT meeting, the advocacy team will be meeting with representatives from Doctors for the Environment (DEA), to establish our policy on climate change – specifically hospital generated waste – and what our generation of junior doctors can do to combat this moving forward.

Thank you to everyone who completed our 2019 Resident Hospital Health Check survey. We received a record 1,000 responses. The objective of this annual benchmarked survey is to determine whether hospitals are meeting the grade when it comes to providing your leave; your roster is timely and appropriate; you are encouraged to claim overtime that is payable; you can access the rotations you need to progress your career; and you are working in a healthy workplace environment.

We asked for your full and frank feedback on your current hospital of employment, so that we could recognise the hospitals that were ideal for Doctors in Training and those that needed improvement. The findings will be released in October, and we will then work collaboratively with hospitals to anonymously address identified areas of concern.

If you are not yet a member, the new membership model is an automatic deduction from your fortnightly pay for the price of a cup of coffee. AMA Queensland’s Workplace Relations Team can sort out problematic workplace issues behind the scenes so you can get on with your core business of patient care without worry. We are stronger together, and we encourage each of you to remember good working conditions ensure good community care and consider becoming a member.

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Connecting with compassion, not a ‘corridor consultation’ “Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognise our shared humanity.” -Pema Chödrön Doctors are talking about ‘doctors’ health’! Doctors’ health presentations are no longer in the small room at the conference, they are the focus of the plenary session across the breadth of medical specialty educational events.

it appears that we are now being trained to step well back when a colleague begins to recount their symptoms. Instead of recoiling, our professional response should be to listen. We have a responsibility to support our colleagues in seeking care.

We hear the message that we all need to find a GP. We are regularly reminded to beware of the ‘corridor consultation’. Yet, this increased awareness can mean that we are more attuned to when our colleague is not well.

When our colleague mentions a health issue, it is appropriate for us to attend and respond with empathy. Simply saying, “You should see a doctor about that,” is hardly helpful. Try these tips:

Telling a doctor to go to a doctor can be an uncomfortable conversation. Are we stepping outside of our professional role if we speak up? Is it appropriate to point out that odd pigmented lesion of concern?

Do we remind them to see their GP? Or do we just mention the name of that surgeon in the theatre next door (because he/she is great). Instant solution! - but did we just fail to ensure they are linked in to the comprehensive care they need.

Navigating the help-seeking process is not the sole responsibility of the doctorpatient. As colleagues, we should be prepared to support each other. We need to have the right words. We need to understand the boundaries. Yet we can’t abrogate our responsibility to care.

Many doctors don’t realise how important friends and family are when people are seeking health care. It is a part of the normal help-seeking process/pathway to ask a colleague at work or a friend about a health issue. If that colleague or friend happens to be a doctor, we might interpret this as a ‘corridor consultation’ and fail to help them progress along the path and see a GP. While we need to understand the potential for problems in the ‘corridor consultation’, 34 Doctor Q Spring

Use the ‘I’ word and personalise your

response “If I had a symptom (reflect their symptom) like that, I would go see my GP.” This normalises the help-seeking behaviour.

Support the help-seeking process by

DR MARGARET K AY

Medical Director, Queensland Doctors’ Health Programme

VICKY DAWES

Education Officer, Queensland Doctors’ Health Programme References 1. Kay M, Mitchell G, Clavarino A, et al.

Doctors as Patients: a systematic review of doctors’ health access and the barriers they experience. Br J Gen Pract.

2008; 58:501-508.

2. 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.

asking: “Do you have a GP you can see?” If they say no, then you can suggest they consider seeing the GP that their family sees, or to contact the Queensland Doctors’ Health Programme for help in finding a GP.

Suggest that another person could

support them in their health access – “Do you have someone who will be able to go with you?”

Facilitate some time off, so they can see their GP, if appropriate.

So, when your colleague mentions a health issue, or if you notice something of concern, respond with generosity and compassion.

This is not the same as a ‘corridor consultation’. You are not taking a full history or invading their privacy. It does take courage – but it is just what colleagues do (whether or not they are medical). It is what happens in a supportive healthy workplace.

QDHP

Queensland Doctors’ Health Programme

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Doctor Q Spring 35

Hospital soft drink ban to help fight obesity 1 July 2019 was a significant day for the health of Queenslanders. It marked the start of major changes to the types of drinks available from cafes and vending machines throughout the state’s public hospitals and health facilities.

High-sugar drinks (including highsugar soft drinks) will no longer be available, creating healthcare environments that promote healthy weight and lifestyle, and making it easier for patients, staff and visitors to make healthier drink choices.

The move follows a recommendation from the Queensland Clinical Senate’s ‘Every K over is not okay: Putting the brakes on obesity’ meeting in 2015. Held in partnership with Health Consumers Queensland, the meeting aimed to develop strategies to address the increasing rate of overweight and obesity in Queensland. In 2014/15: One in four (25 per cent) Queensland children were overweight or obese Two in three (65 per cent) Queensland adults were overweight or obese.

The changes introduced by Queensland Health have the potential to make a real impact on the health of our community.

They also demonstrate leadership in driving a prevention and intervention agenda for our future generations. While it can take some time for the prevention approach to take hold, it escalates once it becomes a social norm. Smoking is a perfect example of this.

It is critically important for the health profession to work in partnership with the community it services in tackling the obesity challenge. It is a complex issue that is costly to the community and the individual - around 70 per cent of people with obesity have at least one established morbidity - and that

36 Doctor Q Spring

requires action across multiple jurisdictions.

The Senate’s recommendation for a cross-jurisdictional taskforce to identify, develop and oversee the implementation of obesity prevention strategies has also been realised with the establishment of Health and Wellbeing Queensland.

Health and Wellbeing Queensland is an independent statutory body that will take a multi-strategy, multi-sector approach to enable illness prevention and health promotion investments and activities to be implemented across traditional portfolio boundaries.

Meantime, progress continues on the Senate’s recommendation for a healthy food choice strategy to be rolled out across the state to ensure healthier food options are available at Queensland public hospitals and health facilities. It is anticipated that implementation of food changes will be effective in Queensland’s Hospital and Health Services by 1 July 2020.

We don’t pretend to believe that we are going to solve the obesity epidemic overnight - this is a longterm challenge. But we recognise the importance of taking action now. If we are to sit back and do nothing, our next generation of Queenslanders is likely to have a lower life expectancy than their parents for the first time in modern history. We can’t let that happen. * The Queensland Clinical Senate is this year celebrating 10 years as Queensland Health’s strategic clinician advisory body.

DR ALEX MARKWELL Chair, Queensland Clinical Senate; and Emergency Physician, Royal Brisbane and Women’s Hospital

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Doctor Q Spring 37

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

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

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

O U T C O M E S I N R E L AT I O N T O D R I N K I N G G O A L S IN ALCOHOL-DEPENDENT INDIVIDUALS Addiction Medicine Research Review Issue 12 Reviewer: Professor Edward Ogden When discussing goals of treatment with the alcoholic patient, there is always debate about whether to aim for total abstinence or controlled drinking. This study followed 349 patients for five years and demonstrated that the group who identified abstinence as a goal at the outset had the best outcomes.

The group who selected abstinence had been drinking for longer. Maybe the patients with the most alcohol-related problems are the ones most likely to opt for sobriety. Many of the people with alcohol dependence choose not to seek treatment because they want to keep drinking. Trials have traditionally had complete abstinence as a treatment goal, although recently the trend has been towards harm reduction and stability. Here is solid evidence that we should not abandon sobriety as the gold standard.

D E T E CT I O N O F G LU T E N - F R E E L A B E L E D R E S TAU R A NT F O O D Gastroenterology Research Review Issue 68 Reviewer: Dr Kate Napthali Patients with coeliac disease need to adhere to a strict lifelong gluten-free diet, or risk complications of the disease, which can include iron deficiency, osteoporosis and liver function abnormalities, and in the worst-case scenario, lymphoma. Halmos and colleagues published a research letter in the Med J Aust in 2018, which analysed the gluten content of food sold as gluten-free meals in 127 randomly selected commercial premises in the City of Melbourne. It was found that nine per cent of 158 samples of food sold as gluten-free contained detectable levels of gluten. This interesting study design of crowd-sourced data

must be read with an understanding of the risk of extensive inherent bias of the design, but it is of interest and worth noting the result. Using a portable gluten-detecting device (‘Nima’), 804 users performed 5,624 tests of commercially available gluten-free-labeled food, with 32 per cent of such meals found to contain gluten. These rates are extraordinarily high, and confirm the anecdotal difficulties experienced by coeliac disease patients when purchasing food commercially. It should inform all clinicians working in the field to include such counselling of the risks associated with purchasing food labeled as gluten-free.

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

38 Doctor Q Spring

Save the date AMA QUEENSLAND ANNUAL CONFERENCE 20 - 26 SEPTEMBER 2020

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LISBON GENERAL ENQUIRIES:

AMA QUEENSLAND 88 L’Estrange Terrace Kelvin Grove Qld 4059 PO Box 123 Red Hill Qld 4059

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P: P: F: E:

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(07) 3872 2222 1800 626 637 (outside Brisbane) (07) 3856 4727 n.mackintosh@amaq.com.au

REGISTRATION: PO Box 4943, GCMC QLD 9726 P: 1300 262 885 (outside Brisbane) P: (07) 5556 7267 F: (07) 5556 7200 E: travel@amaq.com.au

Member news We’re already three quarters of the way through the year and the last quarter shows no signs of slowing down!

AMA POST NOMINAL In response to member feedback, AMA has introduced post nominal letters to denote membership of the AMA. You may use the post nominal letters AMA(M) while you are a current, financial member of the AMA. We encourage you to take up the entitlement to use the post nominal letters to publicly demonstrate your membership of the AMA.

K E E P I N G U P - T O - D AT E It’s important to keep your membership details up to date! This ensures you receive our emails, your Doctor Q and can access your member benefits at your convenience. Did you know you can update your details online? Simply head over to ama.com.au/qld, login in the top right hand corner then click my account – it’s that easy. If you’d rather speak or email us, we’d be delighted to update your details for you – call (07) 3872 2222 or email membership@amaq. com.au and our Membership Team will be more than happy to help.

2020 MEMBERSHIP RENEWAL Starting in November, you will receive your 2020 membership renewal notice. We count on your support, your membership investment directly helps us to help you and your patients – it’s also fully tax deductable.

In our commitment to sustainability and the environment, we encourage members to opt for paperless renewal and renew online once you receive your notice. If you wish to receive only digital renewal notices, please do email us at membership@amaq.com.au and inform us of your commitment to reducing paper waste.

DID YOU KNOW? For convenience, annual payers can elect to switch to monthly payments, to do so contact the Membership Team on (07) 3872 2222 or membership@amaq.com.au.

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PA Y R O L L D E D U C T I O N We have listened to your feedback and now it is even easier to pay your membership!

If you are a Queensland Health employee, you can now pay your membership fees via Queensland Health supported payroll deductions. To opt in for this please visit: https://ama.com.au/qld/membership/join-ama-queensland/payroll-deductions Download the payroll deduction form and email to membership@amaq.com.au.

Our membership team will then update your membership profile and send on to your payroll office for processing. Your membership fee reduction will then appear on your fortnightly payslip and also on your Queensland Health Group Certificate.

40 Doctor Q Spring

Joining local medical associations AMA Queensland President Dr Dilip Dhupelia has been attending local medical association meetings around the state this year, most recently joining the Brisbane, Fraser Coast and Redcliffe Medical Associations. Dr Dhupelia took note of local concerns and updated the groups on AMA Queensland’s advocacy work.

Dr Dhupelia has more recently visited Central Queensland, Bundaberg and will be visiting Cairns, Gold Coast and Mackay before the year ends.

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

Ipswich & West Moreton Medical Association (IWMMA)

Contact:

Contacts: Dr David Morgan, President; Dr Aletia Johnson, Meetings Convenor; Dr Thomas McEniery, Treasurer Phone: (07) 3281 1177 Meetings: 17 October 12 December

Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3049 4444 Meetings: 29 October

29 November

Sunshine Coast Local Medical Association (SCLMA) Contact: Web: Email: Phone: Meetings:

Jo Bourke, Secretariat www.sclma.com.au jobo@squirrel.com.au (07) 5479 3979 31 October 28 November

Brisbane Local Medical Association (NLMA) Contact:

Dr Robert (Bob) Brown, President Phone: (07) 3121 4029 Meetings: 8 October

10 December

Gold Coast Medical Association (GCMA)

Fraser Coast Local Medical Association (FCLMA)

Contact: Web: Email: Phone:

Contact: Email: Phone:

Professor Philip Morris www.gcma.org.au info@gcma.org.au 5531 48380

Mackay Local Medical Association (MLMA) Contact: Phone:

Dr Bill Boyd 0419 676 660

Dr Nicholas Yim, Secretary drnnyim@gmail.com 0421 659 892

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

Wilsonton Medical Centre (Dr Peter Hopson)

Cairns Local Medical Association (CLMA) Contact: Phone:

Dr David Shepherd (07) 4031 8400

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

Dr Michael Donohue 0419 715 658

CAN’T FIND YOUR LOCAL AREA? If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au.

Doctor Q Spring 41

LETTER TO THE EDITOR

Voluntary assisted dying Dear Editor, I would like to respond to the paired articles by Drs Dhupelia and Hodge in the Winter 2019 issue of Doctor Q. I write this letter as a generally middle-of-the-road AMA Queensland member of a couple of decades, and an active Christian, who is struggling to reconcile the ethos of my profession and faith with the beliefs and desires of the patients I try to serve.

Dr Dhupelia’s article, which I assume describes an official AMA position reached after much deliberation, contains a definitional inaccuracy, a logical inconsistency, and a further moral dilemma. That aside, I believe it is a generally reasonable document.

Firstly, passive euthanasia is defined as “intentionally ending a life in order to relieve suffering by … omission of an action which would … keep the patient alive”. The footnote described this as “not part of medical care”.

In my experience, consideration of the role of attempting ventilatory, hydration/nutritional, or antimicrobial actions in the deteriorating patient is frequent. There is no question that the withdrawal of, or failing to start, such interventions might be done with intent to avoid prolonging the dying process, so we cannot claim that the primary aim is to maximise comfort (except if we frankly admit that comfort might be maximised by a briefer dying process); the doctrine of double effect does not apply here. Nonetheless, consideration of not providing such interventions is very much part of medical care in those situations.

Secondly, the AMA Queensland submission claims that, despite voluntary assisted dying (VAD) being “not part of medical care”, “the medical profession needs to be involved in … legislation and guidelines”. On what basis does the medical profession

42 Doctor Q Spring

insist on involvement in a supposedly non-medical issue?

To address these first two issues, the AMA Queensland needs: to redefine passive euthanasia; to redefine what is “not part of medical care”; or else to openly claim that doctors should not be involved in discussions about withholding life-maintaining therapies.

My own preference would be for the AMA Queensland to avoid defining for all doctors what is and is not medical care.

Finally, the AMA Queensland believes in a medical duty “to ensure death occurs in comfort, with dignity and without pain”. It might be that the only way to ensure such a death is to provide a treatment that intentionally hastens the dying process.

In that case, does our described medical duty outweigh the injunction that “euthanasia, physician-assisted dying and VAD are not part of medical care”?

Dr Hodge’s letter, in summary, covers the main physician concerns with relaxing legal and moral prohibitions around actively seeking to end one’s own life.

These include: fear about changes to the dying experience for those who do not seek their own death (the “most vulnerable”, de-funding palliative care); fear that the moral values of the future will be alien when judged by the moral values of today; and fears of “creating a barrier in the doctorpatient relationship”.

Even if we accept that this level of fear is justified (and I think a good case can be made that it is not), this line of argument places the fears of Dr Hodge and others of potential harm as of more importance than the very real harm that is occurring right now to the dying and their families by insisting on a death that, despite our medical promises, does not occur in comfort, does not occur with dignity, and does not occur without pain.

Surely the legislative lines can be moved

so as to both minimise the current harms and suffering, yet also guard against the fears that Dr Hodge described?

The fact that I am expected, with a straight face, to tell a patient with motor neurone disease that I have a duty to provide a comfortable and dignified death, but even providing information about VAD is “not part of medical care” smacks of paternalism.

Indeed, it was my discomfort with Dr Hodge’s description of her patient encounter that prompted this letter. If “many” elderly patients are mentioning to her (and to all of us, I am sure) their desire to approach their inevitable death in an intentional way, then we need to accept that at least a portion of our patient base have a rational, deeply-held, and entrenched belief that their life no longer enables them to flourish. How is “simple reassurance” and “medication” an appropriate response to such a sensible belief?

How does the patient being “more settled” or deriving some temporary enjoyment from a social event indicate that the patient would now decline “the needle” if offered?

I don’t have any easy answers for this, but I am grateful that the increasing public debate around VAD in the last decade or so has caused me to loosen my own beliefs on the issue. I am more comfortable actively raising the issue with both long-term patients and patients I might only see once in an emergency department. If a patient and I can explore their beliefs around “a good life, with a good death”, and whether they see their possible death in the near future as a thing to avoided, a thing to be welcomed, or just a thing, then the two of us can have a more meaningful discussion about potentially onerous death-deferring therapies that provide no symptomatic improvement in quality of life, like antihypertensives and diabetes therapies.

LETTER TO THE EDITOR To anyone reading this, I would highly recommend the writings of the philosopher John Hardwig, especially his article Going to Meet Death in the Jul/Aug 2009 edition of the Hastings Center Report.

Hardwig argues that, for the majority of people through the majority of human history, death has come too soon. It has struck suddenly and, consequently, the dying person and their loved ones mourn the lost potential of a fruitful life that now would never be.

Everything in our society is set up around this view of, and fear of, death: our morals and ethics, our myths and shared stories, our laws and customs, our religions and, especially for our current discussion, our view of what medical care is all about.

But now, in the last couple of generations, we are far more likely to meet death too late: “long after life has lost its usefulness and savour, long after we have ceased to have a ‘life’, perhaps long after we are even ourselves.” While our institutional beliefs are struggling to adjust to this new reality, our own generation is acutely aware of the risks of dying too late and, though hesitantly, are insisting on the right to have a say in dying at a time that is neither too early nor too late.

I think at a subconscious level, we are all aware of the dissonance between “the best patient care that should be given” (as Dr Hodge puts it), and the “good death” that we would want for ourselves and want available for our families. We need to reflect on why we are uncomfortable as a profession with explicitly helping patients to achieve a death that they reasonably and rationally desire.

Dear Editor Thank you for highlighting Voluntary Assisted Dying (VAD) in Queensland and outlining the definitions. As a long standing AMA member, I would like to see balance in the conversation and address the “grave concerns” raising by Dr Hodge in the letter to the editor in Doctor Q Winter 2019.

A recent review of the international experience into the legalisation of VAD published by Palliative Care Australia1 demonstrates that jurisdictions where VAD has been implemented had increased funding and access to palliative care services.

It found that in areas where assisted dying legislation was introduced, physicians sought to improve knowledge and understanding of end of life support services.

Most people express a preference to die at home. Again, the evidence shows that this is more likely to occur in areas with VAD and in particular, those who choose to end their life using assisted dying are highly likely to die at home. The paternalistic attitude of “doctor knows best” no longer is accepted by the general public (of whom over 80 per cent support VAD) or by the younger generation of doctors (those under age 30 and doctorsin-training) who are more likely to disagree with the current AMA policy of objection to VAD.2

Overseas, VAD legislation has been in place for over 20 years in some areas. Their experience shows that medical associations tend to change their stance from opposition to “studied neutrality” or to supporting the legislation with the increased use by patients and doctors. This demonstrates that the relationships between doctors and patients are not compromised and all legislation, including the recent Victorian VAD laws, include clauses protecting medical staff who do not wish to be involved.

Currently a number of medical associations including the Royal Australian College of General Practitioners, Royal Australasian College of Physicians, American Academy of Family Physicians, Royal College of Physicians (UK) and a number of state-based medical societies in the US have declared a “neutral” stance on VAD legislation which allows the law to be passed without traditional medical opposition. It is time AMA also takes this stance to ensure that when this legislation is enacted in Queensland, they can in good faith be part of the conversation and implementation of VAD and represent their members.

Dr Peta Higgs

The autonomy of a terminally ill person to end their life how, when and where they choose should not be dictated by their doctors’ religious beliefs.

I thank Drs Hodge and Dhupelia for their letters, and the stimulus it has given me to read further around this issue.

Dr Kenneth Barns

Doctor Q Spring 43

INTRODUCING THE NEW

Workplace Relations Advisory Package

AMA Queensland’s Workplace Relations Team has been: listening to our members and assisting with their individual workplace problems; listening to our members talk about their experiences in trying to get good advice and assistance from commercial organisations; and understanding that no-one is better placed to assist private medical practices with their workplace issues than the talented team of people who are dealing with practice principals and practice managers on a day to day basis.

The team has heard stories of practices paying as much as $15,000 each year to access contracts, policies and advice, to then find the information was not specific for their needs. They’ve assisted our members to untangle advice from HR consultants who clearly didn’t understand the law. Most importantly, they’ve been thrilled to hear the advice and support they’ve provided has helped our members manage some bad situations and make them better.

It occurred to us that AMA Queensland can offer medical practices the sort of support that is available from commercial operators at a much lower cost, specific to medical practices and better than existing operators. We also want doctors to have a service they can turn to that ensures they can keep their hands on the wheel of their business and access timely information to protect their investment.

For that reason, we are launching the Workplace Relations Advisor Service (WRAP).

WRAP will give subscribers a dedicated contact point where they can access all their employment and safety needs from a team that 44 Doctor Q Spring

is only focused on medical practice. We know that running a medical practice is not the same as running a standard commercial enterprise. The AMA Queensland Workplace Relations Team is uniquely qualified to help you manage your workplace the same way you manage your practice: efficiently, compliantly and using best practice.

Whilst all AMA Queensland members have access to phone and email support, WRAP supercharges that advice with free attendance at Workplace Relations training events and webinars, contract, manuals, privacy essentials, audits, templates and leave calculations. You’ll also stay up-to-date with changes in industrial relations and employment law to help your business to remain compliant with your obligations.

The cost of getting workplace compliance wrong, as we have seen in the media recently, can be immense.

The rules for managing employees are complex and ever-changing. The good news is; we’ve got your back. WRAP will give you up-to-date, relevant and practical support with all employment matters.

Never has there been so much pressure on businesses to their employment matters right and WRAP will help private practices do exactly that with a service offer that will move with the changing needs of medical practice.

We know that practice managers are important people in the running of a private medical practice. We’ve received so many requests for practice managers to have access to information, that we’ve created the Practice Manager Affiliate relationship to recognise the important part practice managers play in the businesses of our members.

Practice managers can now personally connect with our organisations via our Practice Manager Affiliate. They will: be able to use the post nominal PMA of AMA Queensland; receive up to 33% off rates to all our conferencs and events; stay up-to-date with our monthly PMA newsletter; and receive an affiliate certificateeach year.

Affiliates will also have access to a range of membership discounts through AMA Queensland corporate partners and if they refer new affiliates, they will go into the draw that month for a $50 Coles Myer voucher.

We are also planning more exciting developments for these VIPs who help our members to build and maintain successful practices.

For practices signed up to WRAP, practice managers will have complimentary affiliate status.

You can download the information and registration forms for these exciting new offers here or call us on (07) 3872 2211.

Doctor Q Spring 45

Events calendar AMA QUEENSLAND PRESENTS

Private practice webinar training series 2019

IP INTERNSH101

workshop

P R I VAT E P R A C T I C E W E B I N A R TRAINING SERIES

INTERNSHIP 101 WORKSHOP SERIES

Date: 11 October and 6 December Location: Webinar

Date: 15 October: Gold Coast 16 October: Brisbane 17 December: Townsville

Are you interested in brushing up on your workplace relations knowledge from the comfort of your own desk?

Join AMA Queensland’s Senior Industrial Officer Michelle Cowan for an indepth insight into current topical workplace relations matters via live webinar. If the webinar dates do not suit your schedule, you can register to receive a recording of the webinar/s to view in your own time.

The October webinar will discuss preparing for the festive season and the December webinar will cover dealing with emergency events. Register now

WOMEN IN MEDICINE Date: 17 October Location: Victoria Park Golf Club MC’d by ABC Health Reporter Sophie Scott, our panellists Dr Bethan Richards (Chief Medical Wellness Officer and Director, WellMD Centre SLHD) and Dr Yumiko Kadota, (Mind Body Miko) will share their candid insights, experiences and tips for navigating the journey of life (and medicine’s) ups and downs. Take the time out to relax, recharge and laugh with friends over a healthy plated breakfast with a view of Brisbane’s beautiful skyline. Register now

AMA Queensland invites you to a free workshop to learn the tips and tricks for transitioning from medical student to medical practitioner.

Served with drinks and canapés, we’ll cover overtime payments; surviving night duty; the junior Medical Officer Recruitment process; what’s expected of you; how important your medical indemnity organisation is; and findings from the 2019 Residential Hospital Health Check survey (RHCC).

R E G I O N A L P R I VAT E P R A C T I C E SEMINAR SERIES Date: 29 October - 5 December Location: Brisbane North, Mackay, Toowoomba, Bundaberg, Brisbane West, Hervey Bay, Brisbane South, Gold Coast, Cairns, Sunshine Coast, Gladstone, Rockhampton, Bayside, Townsville This series will focus on performance management: consistent and equitable management practices. Join Michelle Cowan, Senior Industrial Officer, AMA Queensland to examine performance management in your practice.

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

46 Doctor Q Spring

AMA QUEENSLAND WO M E N I N M E D I C I N E B R E A K FA ST 2 0 1 9

@AMA_QLD #AMAQWIM19

W W W. A M AQ . CO M . AU

Therapeutic Guidelines: Bone and Metabolism The new version of Therapeutic Guidelines: Bone and Metabolism is now available in eTG complete.

These guidelines provide practical recommendations about managing disorders of the bone, and disorders of the pituitary, adrenal and thyroid glands.

The osteoporosis and minimaltrauma fracture topic contains new detail about starting treatment for osteoporosis following minimaltrauma fracture, and considering treatment for primary prevention of fracture. A new table comparing the advantages and disadvantages of different antiresorptive drugs helps guide treatment choice. Advice about

48 Doctor Q Spring

the duration of bisphosphonate therapy has been updated, and new information about potential harms of interrupting denosumab therapy is included. A new section about considerations before treating osteoporosis helps to identify patients with secondary causes of bone loss and fracture requiring specific treatment.

Updated advice about vitamin D deficiency explains who should have their 25-hydroxyvitamin D concentration measured, and who is likely to benefit from supplementation.

The thyroid disorders topics provide comprehensive and easy-to-follow guidance. The hypothyroidism topic contains new information about when and how to start thyroxine replacement therapy, and new patientspecific treatment targets. Updated advice is included to reduce the risk of complications in pregnant women with hypothyroidism or hyperthyroidism.

Adrenal and pituitary disorders can be confusing—these topics give

clear recommendations for complex disorders, and include information for clinicians who don’t treat these patients regularly.

Updated recommendations about glucocorticoid replacement for adrenal insufficiency and hypopituitarism advocate using the lowest effective dose for maintenance, while ensuring adequate dosing during illness or surgery.

The pituitary adenomas topic gives advice about identifying and managing conditions caused by functioning pituitary adenomas (eg hyperprolactinaemia and acromegaly), as well as management of prolactinomas during pregnancy and the postpartum period.

New severity-based dosage regimens for hypocalcaemia are included, as well as clear advice about interventions and referral for patients with hypercalcaemia, hypophosphataemia, hyperphosphataemia and hyperparathyroidism.

How to write a business plan Writing a business plan is the first step in setting up a practice or clinic. Your finance provider will require one before they will lend you money, but a business plan is also a map for you. It should help you refine your proposition and will give you an understanding of how much money you should be earning and spending, and how much profit you should make.

Before you prepare your plan, there are some important relationships you should have in place—an accountant, a lawyer and a financial adviser. Each of these professionals can advise you on the best structure for your practice whether it should be a trust or a company, for example.

Before starting your business plan, address any restrictions or restraints with your current employer. You should also find a name for your business; an ABN or ACN; any special licences or permits you need to practise; and a registered domain name for your website.

KNOW YOUR COSTS AND REVENUES Writing out your expected costs and sources of revenue will give you an idea of when your business will be profitable, and how profitable it will be. By writing out the numbers and adding them up, you will soon see where you can possibly save costs or increase revenues.

Do some research into where you want to practise and who your competition is.

This is important whether or not you have particular premises in mind. By doing that, it also becomes easier to answer the most important question: what’s unique about your practice?

WRITE YOUR PLAN Now you’ve gathered enough information to produce a business plan document which you can take to your finance provider, it’s time to write up your business plan. Include the following: 1. The basics—the name of your business, and the date you prepared the plan.

Under it, include your name, a business address (if you have one), and an ABN and ACN. 2. Details of your business—include any information on registered domain name, licences and permits.

JEFF MILLER Specialist State Manager QLD, BOQ Specialist

Disclaimer Products and services are provided

by BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence No. 244616.

All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges and eligibility criteria apply.

3. Location—situation of your business, your management structure and key personnel.

If you have particular premises in mind, write more about that too (including the rent or purchase costs).

4. Your Unique Selling Point (USP)—what’s unique about our proposed business?

5. Marketing plan—explain the size of your potential market, and the targets you’re setting to build your client base.

6. SWOT analysis—an analysis of your strengths, weaknesses, opportunities and threats.

7. The future—what is your vision for the business? What are your short and long term goals? What do you plan to do to reach those goals?

8. Financial objectives—these can be in the form of revenue targets or profit targets. How much money do you need to get started? How much of your own money are you planning to invest?

If you’d like to experience the difference of working with us, call 1300 131 141 or visit www.boqspecialist.com.au Doctor Q Spring 49

A question of faith Few cases are so ethically vexed as when the offer of life-saving treatment is pitted against a patient’s religious beliefs. In the case of a 17-year-old woman of the Jehovah’s Witness faith,1 her decision to refuse human blood products risked harming both herself and her unborn child.

CASE STUDY The patient was 38 weeks pregnant when she consented to delivery of her baby via induction of labour and, if necessary, a caesarean section. She was assessed to be at significant risk of a post-partum haemorrhage and was advised of the possibility that a life-saving blood transfusion might be required. Adhering to her faith, the woman refused to consent to the hospital administering human blood products.

Her mother, also of the Jehovah’s Witness faith, refused to consent to the treatment on behalf of her daughter.

On 31 August 2018, the hospital made an urgent application in the Supreme Court of Victoria seeking a declaration to authorise the administration of blood and/or blood products as considered reasonably necessary by the patient’s treating medical practitioners to save her life or to prevent serious injury during the course of induction of labour, labour, caesarean section and related procedures, and the postnatal period in regard to her pregnancy.

The application was opposed by the patient.

Exercising the Court’s parens patriae jurisdiction, the judge considered all the welfare interests of the 17-year-old patient – medical, spiritual, personal autonomy and identity – when deciding what was in the patient’s best interests.

ALICE CRAN Claims Manager (Solicitor), MDA National

Opinion from the Medical Director of Maternity who felt that the patient’s decision was partly motivated by her desire to please her mother and the support person from their faith community.

Several factors (including an earlier transgression of one of the principles of the Jehovah’s Witness faith) that cast some doubt on the patient’s maturity and the extent of her personal adherence to the tenets of her faith.

Outcome After weighing the evidence, the judge was not satisfied that the patient had enough understanding of the consequences of her choice.

He remained unconvinced that “… overriding [the patient’s] expressed choice would so rob her of her essential self as to outweigh the loss she would suffer through losing her life or sustaining a catastrophic injury. In summary, I do not consider that allowing her, in effect, to choose to die or only survive with serious injury is in her best interests taking into account a holistic view of her welfare (physical, spiritual and otherwise).”

After accepting the hospital’s undertaking to only administer blood products as a last resort, the judge made the declaration sought by the hospital.

Some of the factors impacting on that evaluation included: Opinion from a Child Psychiatrist who, following his assessment of the patient, was not confident that the patient understood the complexity and full implications of her decision to refuse human blood products should they be medically necessary.

50 Doctor Q Spring

References 1. Mercy Hospitals Victoria v D1 & Anor [2018] VSC 519 (31 August 2018) 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.

Making work life balance a reality Work life balance and flexible work options are increasingly becoming high on the list of priorities for job seekers. For many healthcare professionals, flexible work options to support a better work life balance are of greater value than a higher remuneration package. Many practices however, struggle to incorporate flexible work into their existing culture. It’s important to recognise that flexible work comes in many shapes and sizes, and in most cases has a very positive impact on recruitment and retention. There are many ways to incorporate flexible work into your business; and you may only need to introduce one option to significantly improve work life balance options for your staff.

SAMANTHA MIKLOS CEO, Cornerstone Medical Recruitment

DEFINE FLEXIBLE WORK

GIVE IT A GO

Flexible work options differ significantly across organisations. When considering what flexible work might look like for your practice, it is important to consider the size of your business and the expectations of your customers. It’s also imperative that you understand what flexible work means to you and your colleagues. A mistake many businesses make, is implementing a flexible work policy that does not add value to the existing staff, or negatively impacts customers. Before creating your policy, chat to your staff. Find out what flexible work options they would like to consider. Explore any impact these changes might have on customer service and patient outcomes.

You don’t have to have all the answers. Your staff might have some fantastic suggestions on how to make work life balance a reality in your practice.

Once you have some ideas – give it a go! You don’t need to try everything at once. Nor do you need to commit 100 per cent to your new options – perhaps run a trial. Assess the impact on staff and customers. Encourage discussion about the benefits and challenges and work to overcome these challenges together until you find the best solution.

It is important to continue to collaborate with your team to ensure that the options you have available continue to add genuine work life balance to your colleagues. As you become more comfortable with the concept, new ideas and opportunities might evolve. Perhaps you could recruit two part-time employees next time, rather than one full-time employee. Could you adjust the hours and days of work to offer more flexibility? Have you considered a nine-day fortnight or a rostered schedule such as two weeks on and one week off? Sometimes time in lieu for overtime, or the ability to take unpaid leave, is all it takes to make a big impact on work life balance.

Ultimately a strong flexible work offering that provides genuine work life balance for your staff, should become part of your recruitment and retention strategy, because a happy medical workforce, means better health for us all.

52 Doctor Q Spring

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PRIVACY LAW:

Mandatory obligations to report data breach From 22 February 2018, it became mandatory for an Australian business subject to the Privacy Act 1988 (Cth) to notify both the Office of the Australian Information Commissioner (OAIC) and any affected individual of an ‘eligible data breach’ as defined in the Privacy Act. Put simply, an ‘eligible data breach’ will arise when the following three criteria are satisfied:

and holds any health information is an organisation that is subject to the Privacy Act.

1. There is unauthorised access to, or unauthorised disclosure of personal information or a loss of personal information that an organisation holds;

In May 2019 the OAIC released the Notifiable Data Breaches Scheme 12-month Insights Report which reviewed the first 12 months of the NDBS and provides the following interesting statistics for health service providers to consider:

2. This unauthorised access, disclosure or loss is likely to result in serious harm to one or more individuals; and 3. The organisation has not been able to prevent the likely risk of serious harm to one or more individuals by taking remedial action.

Not every data breach will result in the need to make a mandatory notification to the OAIC. Instead, if a data breach occurs it needs to be assessed on its own facts and a decision made as to whether it is an ‘eligible data breach’. In many cases there may be a data breach however the resulting harm may not be serious or it may be that remedial action has been able to prevent the likely risk of serious harm. If a health service provider is concerned there has been a data breach legal advice should be obtained.

Many health service providers are still unaware that they are subject to the Privacy Act (in addition to their relevant State based privacy legislation) and are unaware of their obligations under the Notifiable Data Breaches Scheme (NDBS). To be clear, any individual, partnership or body corporate in Australia that provides a health service to another individual 54 Doctor Q Spring

(a) Health service providers were the top reporting sector across Australia notifying data breaches for the period from 1 April 2018 to 31 March 2019. This was not by a small margin. Health service providers notified 35 per cent of data breaches. The next reporting sector was finance which notified only 24 per cent. (b) The leading cause of data breach by health service providers was human error which accounted for 55 per cent of data breaches by health service providers. Compare this figure to:

(i) 35 per cent of data breaches related to human error in all other industries; and (ii) 60 per cent of the total data breaches notified in the Insights Report related to malicious or criminal attacks.

The fact that human error is the primary source of data breach in the health sector should mean it is the easiest of data breaches to rectify.

In this regard, the Insight Report sets out a number of best practice tips to manage and prevent, data breaches.

KAREN KEOGH Partner, HWL Ebsworth

P: (07) 3169 4971 E: k.keogh @hwle.com.au

These are: 1. All employees are to be trained on how to detect and report e-mail based threats, understand basic account security and protect their devices.

2. All entities should prioritise investments in improving overall security and where necessary, engage expert security advice.

3. All entities should have a data breach response plan which provides practical guidance on how to reduce the impact of a data breach and meet the APP entity’s obligations.

4. All entities should understand what data they hold and how a breach could impact their customers. An entity should understand whether a particular data breach is likely to result in serious harm for an affected individual.

5. The key guiding principles when managing data breaches should be transparency and simplicity.

These best practice tips should be followed by all health service providers particularly as the health sector moves towards digital technologies and other forms of innovation. This is not only important for medico-legal purposes but to provide optimal patient care and maintain trust in the doctorpatient relationship.

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 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

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

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

Downsizing into superannuation and navigating a low yield world

STEVE GREENTREE

Private Client Adviser

Morgans Financial recently hosted an investment seminar in Brisbane for members of AMA Queensland. It was well attended and covered a wide range of areas. However, two topics seemed to resonate with those present, 1) what to make of a low yield environment and 2) the Downsizer Contribution strategy.

LOW YIELD ENVIRONMENT Almost from the start of 2019, markets embraced the fact that bond yields were heading lower and possibly staying there for longer. This contrasted with the final quarter of 2018 in which global equity markets sold off heavily over concerns of the opposite. As a result, we’ve seen a flood of cash out of bonds and cash into higher yielding equities and in turn we have the Australian market approaching record highs.

Although this has delivered sound returns for investors we warn about the risk of being too complacent, particularly with valuations appearing stretched and the equity yield premium being at seven-year highs.

In fact, credit conditions globally are now so abnormal that no investor alive today has lived through such an environment.

Furthermore, with consensus earnings per share growth

56 Doctor Q Spring

sitting at one per cent for FY19, there is some concern that eroding earnings will not be able to support forecasted dividends.

superannuation balance is greater than $1.6 million. However, to be eligible the following needs to be adhered to:

We suggest the following:

1. You must be 65 years or older at the time the contribution is made

Temper expectations – the reality

is that the world is facing a prolonged period of low inflation, low growth and potentially tepid investor returns.

Avoid complacency – be prepared

to re-balance away from expensive, high yielding equities that may look attractive now.

Be opportunistic – be open to

re-cycling profits and to actively pursuing opportunities during inevitable market volatility (i.e. be greedy when others are fearful).

Diversify internationally – seek relatively compelling offshore equity investments amid tepid domestic conditions.

DOWNSIZER CONTRIBUTIONS Since the downsizer contribution policy was introduced 12 months ago it has been a resounding success. It allows those who are 65 or older to use the proceeds from selling their home to contribute up to $300,000 per person or $600,000 per couple to their superannuation. It does not count towards your contribution cap and it can still be made even if your

2. The contract on the sale of your home must have been on or after 1 July 2018 3. The home you are selling must have been owned by you or your spouse for 10 years or more prior to selling.

4. It must not be a caravan, houseboat or other mobile home.

5. The downsizer contribution is made within 90 days of receiving the proceeds from the sale.

6. You must not have already made a downsizer contribution from the sale of another home.

However, please be aware that while the family home is not assessable when calculating the eligibility for government funded pensions any downsizer contribution into superannuation will be. This means you could possibly have any government funded pension reduced or removed altogether.

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

Top five

questions

FOR YOUR P R I VAT E H E A LT H INSURER

As the rollout of the government’s private health Insurance reforms continues, here are some questions you should be asking your fund to ensure you are still getting the cover you need for the best value.

1 . W H AT T I E R I S M Y HOSPITAL POLICY IN? Health funds are now required to classify all their hospital policies into four tiers. These tiers are labelled gold, silver, bronze or basic based on the number of clinical categories included.

Gold is the highest tier and covers all 38 clinical categories. conversely, basic policies are only required to include a minimum of three categories (rehabilitation, psychiatric services and palliative care).

These new tiers are designed to make it easy for you to identify your level of cover.

excess payments to one payment per person per year, so the same person will never pay more than one excess payment per year, regardless of the number of hospital admissions.

3 . A M I L I K E LY T O P A Y A N O U T- O F POCKET COST? Even with gold-level cover, you may still need to pay out-of-pocket medical costs; you should ask about the proportion of services that the fund pays with no out-of-pocket costs. This will indicate the quality of the fund’s medical schedule.

There are also ‘plus’ policies, which offer coverage above the minimum requirement for a specific tier. Doctors’ Health Fund’s Smart Starter Bronze Plus, covers all bronze-level inclusions as well as some silver level inclusions like plastic and reconstructive surgery, and dental surgery. Sleep studies, which is a gold category, is also included.

Doctors’ Health Fund’s Top Cover Gold uniquely pays up to the AMA list of medical fees; this means members on this cover will have fewer out-ofpocket expenses.

2 . W H AT E X C E S S OPTIONS DO YOU OFFER?

Some funds operate preferred provider networks for their Extras policies; this means some of their policy benefits are only available at providers either owned or contracted by the fund.

Health insurers can offer a higher excess of $750 per year on their hospital policies ($1,500 for couples and families).

It is worthwhile asking your fund whether they have a cap on excess payments for couples and family policies. While some health funds require you to pay excess per admission, per person, Doctors’ Health Fund caps

58 Doctor Q Spring

4. DO YOU H AVE A PREFERRED PROVIDER NETWORK?

Always ask whether the benefits offered will be the same at your chosen allied health provider as they are at the fund’s preferred network.

Doctors’ Health Fund advocates for clinical independence and freedom of choice. With no restrictive preferred provider networks, you are free to choose who treats you.

PETER ARONEY

Chief Executive Officer, Doctors’ Health Fund P: 1800 226 126 W: doctorshealthfund. com.au

References 1.

Aussie families could be forking out 20% of their income on health cover by 2051, Feb 5, 2018, https://www.finder. com.au/press-release-feb2018-20-percent-incomehealth-insurance

2.

AMA, AMA Private Health Insurance Report Card 2018, Pg. 13, 26 March 2018 - https://ama.com.au/ article/ama-private-healthinsurance-report-card-2018

5. DO YOU OFFER DISCOUNTS FOR 18 TO 29-YEAR-OLDS? Insurers can now offer discounts to people aged between 18 and 29 on their hospital policy. This new initiative is designed to make private health insurance more affordable for young people.

This discount is voluntary and not all health funds will be participating.

Doctors’ Health Fund recognises the importance of young people within the private health system and has chosen to support this new initiative.

If you are under 30, ask your current fund if they are offering this discount.

If you are not completely satisfied with the responses from your fund, consider getting comparisons for more suitable cover; at Doctors’ Health Fund we can provide a comprehensive comparison over the phone and making the switch is easy because we take care of everything for you.

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As the only health fund created exclusively for doctors, we are dedicated to supporting you both as a patient and as a medical professional. n Our unique Top Cover Gold hospital pays up to the AMA list of medical services and fees.

Our comprehensive Prime Choice Gold hospital includes cover for all inpatient services eligible for Medicare n benefits with no exclusions and restrictions. n Choose to add Essential Extras and receive $500 benefits over two years for optical per family member, and 100% of the cost of up to two general dental check-ups per year1. n We also have no preferred provider networds so you have complete choice of dentist, optomertrist, phsiotherapist and allied health service provders.

Join the health fund that’s for doctors

Call 1800 226 126 today to talk to our expert Member Services team or visit doctorshealthfund.com.au Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy.

1. Check-ups limited to an examination, fluoride and a scale and clean where the fees are within the range of the usual, customary and reasonable charges.

J

AMA QUEENSLAND

Foundation raffle raises almost $20,000 The AMA Queensland Foundation’s recent raffle brought in almost $20,000, which will go directly to life-changing projects to help disadvantaged Queenslanders in need. The AMA Queensland Foundation relies on the generous support of donors and corporate partners to fund our projects. Thank you so much to everyone who purchased a ticket.

We acknowledge the generous contributions of Pavéction by Robert Bellamy, Lexus of Brisbane, Orbit World Travel, MDA National, Pia du Pradal, and Wine Direct for their prize donations and thank them for their support.

The AMA Queensland Foundation fundraising raffle was drawn at the 2019 Dinner for the Profession.

Congratulations to the following prize winners:

FIRST PRIZE: Dr Dilim Ekanayake (pictured left) won a $13,360 18ct white gold diamond set tennis bracelet and a worldwide jewellery insurance cover for one year. The prize was donated by Pavéction by Robert Bellamy.

SECOND PRIZE: Sequel PR won the ultimate Melbourne Cup experience, including two VIP tickets to the Lexus Birdcage on Melbourne Cup Day 2019; two nights’ accommodation and return Lexus race day transfers. This $8,500 prize from Lexus of Brisbane also includes a $1,000 travel voucher, compliments of MDA National.

THIRD PRIZE: Michelle Farquhar won a $1,800 Melbourne travel package, including return flights and accommodation at the Double Tree by Hilton Hotel Melbourne with breakfast for two.

The prize was donated by Orbit World Travel.

FOURTH PRIZE: Danielle Yamaguchi won a $1,000 voucher at high-end fashion boutique store Pia du Pradal, donated by Pia du Pradal.

FIFTH PRIZE: Dr Claire Muller (pictured below) won a $285 bottle of Dom Pérignon Champagne, 2008. This prize was donated by Pavéction by Robert Bellamy.

SIXTH PRIZE: John Velosa (pictured below) won six bottles of Turkey Flat Barossa Shiraz, 2015 worth $270, donated by Wine Direct.

60 Doctor Q Spring

AMA QUEENSLAND

celebrates 20-year partnership

WITH ORBIT WORLD TRAVEL

AMA Queensland’s dedicated and trusted travel provider, Orbit World Travel, celebrates 25 years in business this year, as it also enters its 20th year of partnership with AMA Queensland.

Breakfast on The Great Wall of China, Beijing, China

It was 1999 when Orbit World Travel (known then as World Travel Professionals), joined in partnership with AMA Queensland as a small boutique agency with two offices and a handful of staff. Since then, Orbit World Travel has become the largest privately owned travel company in Australasia with 15 offices in Australia, New Zealand and Singapore.

Lunch overlooking the Taj Mahal, India

Ros Bulat fondly recalls the very first AMA Queensland Conference in Rhodes, Greece in 2001. 120 delegates, many of whom are still regular attendees, had the opportunity to be part of a unique ceremony on the Island of Kos, the birthplace of modern medicine, where delegates recited their Hippocratic Oath!

This was back in the days with paper tickets, without online check-in or apps to track flights. Nobody travelled with mobile phones and the idea of having wireless internet on an aircraft was just a dream!

Since the very first conference, AMA Queensland members have had the opportunity to experience some incredible destinations. To name just a few:

The Bullet Train to Mt Fuji, Japan World Heritage UNESCO site, Toledo, Spain Stopping traffic while walking the second line through the French Quarter, New Orleans Pre/post conference arrangements to so many inspiring destinations (Machu Picchu, Kruger National Park, Cuba and more) This year, the 2019 Annual Conference was held in Edinburgh, Scotland, with some great surprises for those who will be in attendance.

As a member of the exclusive Virtuoso group of companies, Orbit World Travel can offer more exclusives, benefits and added value with many of the world’s leading hotels, cruise providers and tour operators.

Ros and Linda continue to be your luxury travel specialists – connecting you to the world by offering the same dedicated, award-winning service.

Majestic Victoria Falls, Zambia Summer Palace of Peter the Great, St Petersburg Historic Lone Pine, Gallipoli, Turkey

Neil Mackintosh (AMA Queensland), Andrea Reeves (Orbit World Travel), Daniela (Fourth Dimension, Italy), and Ros Bulat of Orbit World Travel.

Cuba post-conference tour

Vas Kasan, Prauin Kasan and Ann Dhupelia

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

Doctor Q Spring 61

Green investment The HESTA Eco Pool investment option has been rated the top performing superannuation investment option over five years.

This makes Australia the fourth most active country in the world for ESG awareness.

As well as doing good things for people and the planet, Rainmaker Information has rated the HESTA Eco Pool option the best performing environmental, social and governance (ESG) option over five years, with average returns at 10.3 per cent.

“With the growing popularity of socially responsible superannuation investment (SRI) options, it’s important to consider not only what these options exclude, but also if they’re investing in high-quality assets that will drive strong, long-term performance,” HESTA CEO Debby Blakey says.

The report, which publishes the superannuation information portal SelectingSuper.com.au, also showed that Australian interest in socially and environmentally responsible super products is high and growing.

Australian investors currently have $30 billion invested in specifically created ESG offerings through their super.

LEADING THE WAY “Eco Pool was the first socially responsible superannuation investment option launched in Australia,” Debby points out.

Launched in 2000 — at the dawn of the responsible investment movement — Eco Pool has had nearly two decades to grow up strong. That time has allowed the HESTA internal investment team to build long-term relationships with specialist external managers who can deliver on Eco Pool’s strategy: to find investments that are ‘best in class’.

“We’ve developed a portfolio of investments that are among the best performers in their respective asset classes, sectors or industry both financially and across a range environmental, social and governance factors,” Debby confirms.

“You don’t achieve this kind of outstanding track record of performance in your SRI option without also having a strong, long-term commitment to responsible investment that’s implemented across the broader portfolio and that’s integrated into all your investment decision making.”

CLEAN IS IN TOBACCO AND COAL CAN BUTT OUT A lot of socially responsible investment options highlight what they don’t invest in. HESTA is proud of excluding fossil fuel, tobacco and uranium from Eco Pool’s investments.

But it’s important to ‘look under the bonnet’ and check if what they do invest in can deliver strong long-term performance. In a nutshell: aiming to ‘do good’ for the planet should also mean doing well for HESTA members.

“While Eco Pool has more extensive restrictions than other HESTA investment options, it’s also got exposure to high green-rated core property and innovative clean tech private equity,” Debby says.

This combined focus on responsibility and high performance is the key to Eco Pool’s success.

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HARNESSING POWER FOR GOOD, TODAY AND TOMORROW The scale of HESTA means buying power to design investments within Eco Pool for both positive impact and potential return. “[We empower our managers to] address both our responsible investment requirements and customise a sophisticated fossil fuel restriction,” Debby explains.

“We love to invest with high-performing managers who are skilled at putting a long-term sustainability lens over their decision making.”

Source: Rainmaker Information, 2019.

Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information is current as at 9/9/19.

While every attempt has been made to ensure the accuracy and reliability of the information, it is not guaranteed in any way. Before making a decision about HESTA products you should read the relevant product disclosure statement (call 1800 813 327 or visit hesta. com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk).

Committed to Kaizen At Lexus, we believe it is our responsibility to lead the industry’s response to the environmental challenge. We believe environmental sustainability is the single biggest challenge facing our industry and our society this century. Our response affects not only our products but every aspect of our business and every person in it.

Guided by a clear vision of sustainable mobility, we are: pioneering ground-breaking environmental technologies such as hybrid cars; reducing the environmental impact of all our operations; minimising the natural resources we use in manufacturing and maximising recycling and reuse; and working with local communities to improve the quality of the environment.

We believe that given the time and skills, and through Kaizen (the Japanese word for ‘continuous improvement’), this is possible.

More than a decade ago, Lexus transformed the industry with the introduction of the RX 400h—the

world’s first luxury vehicle to pair a gasoline engine with a powerful, selfcharging electric motor.

Boasting a variety of advantages over traditional powertrains, from instantaneous acceleration to added fuel efficiency, all while surrounding the driver with exceptional craftsmanship, Lexus has been increasing its lead ever since.

With multiple models to choose from, each offering more to the driver while requiring less from the world, this is more than progress. It’s progress in fast-forward.

The Lexus history of hybrid innovation goes back further than any other luxury automaker.

It’s this experience that has enabled us to evolve this technology further than any other luxury vehicle manufacturer. After many generations of hybrid advancements, we now offer more hybrid models than ever before.

Through the development of a phenomenon we call ‘the power of h’, we’ve achieved superb results, supplementing the power of an advanced petrol engine with electric energy, resulting in a full line of Lexus Hybrids to perfectly blend fuel efficiency, instantaneous power and

indulgent luxury – all with nothing to plug in.

We believe that environmental awareness should never get in the way of natural driving feel, so we created a unique system ensuring acceleration worthy of a true performance car, with levels of refinement and stillness befitting a true luxury car. An ingenious mechanism that hides behind a driving experience that’s so intuitive, so connected – you’ll forget you’re in a hybrid.

Our emissions are low, and we’re continually exploring new ways to achieve our goal of zero emissions.

Lexus Zero Emissions goal goes beyond the road, it’s a concept we carry through all areas of our business.

Our tireless environmental efforts have grown out of a genuine respect and concern for our planet. No excuses.

No compromises. To safeguard the world for future generations, we’ve gone beyond conventional means of leaving less of an impact. We believe our efforts, along with everyone else’s, can do a world of good.

Doctor Q Spring 63

RESTAURANT REVIEW

Comfort and craftsmanship -

Cosy yet sophisticated. Homely but refined. Atelier Brasserie in Bowen Hills brings a whole new level of comfort to fine dining.

With its rather apt name, meaning ‘workshop’ or ‘studio’, Atelier feels less like a noisy fine dining destination and more like an intimate dining room for you to enjoy a feast of fancy with a friend or two.

As the name suggest, the emphasis is on the craftsmanship, where everything from entrees to cocktails to dessert is carefully designed to deliver a culinary experience rather than just your average fancy dinner.

Start with a cocktail. While favourites like the Negroni and Side Car feature, their creativity shines through mixes like the In Lust we Trust spritzer with strawberry infused gin and elderflower,

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the Lilywhacker with Hennessy and Aztec chocolate bitters, or the appropriately named Pharmaceutical Stimulant with butter vodka, cold drip coffee and popcorn infused syrup.

For entree, try the steak tartare with cured yolk and potato crisp, or the sumptuous yet light pillows of Moreton Bay Bug tortellini with parsnip and saffron. It is hard to resist the allure of Snail Risotto however.

The escargot lavishly smothered in garlic and parsley butter served with a creamy thick risotto will transport your tastebuds to the south of France, an unusual find for a Brisbane restaurant and one guaranteed to pepper the gossip of local foodies.

For mains, the house-made gnocchi with pumpkin and hazelnut cream makes for a worthy vegetarian offering,

while the eye fillet and barramundi are dependable staples that can do no wrong. It would be remiss however to overlook the confit duck with lentils, red currant and spinach; slow cooked to perfection and so wonderfully tender that it can be eaten with only a fork. The lamb rump with eggplant, tahini and cracked wheat rivals in its tenderness but with a subtle Middle Eastern flavour, the eggplant proving to be the perfect accompaniment to the medium rare roast.

Despite the inevitable tightening of the waistband from the portions served with generosity, I urge you to think twice before you wave away the dessert cart. Salted caramel and pistachio Mille-Feuille awaits with not a trace of artificial nut flavour to be found. It’s honest and brilliant, with enough salty and sweet to balance the

crunch of the pastry and cream of the pistachio with ease. The creme brûlée of the day is also a must, a luxurious pot of white chocolate and raspberry pudding opened with the satisfying smack of a spoon against crisp candied sugar. Heavenly!

a medley of textures, and excellence in cooking technique. In the fast-paced world we now live in, it is refreshing to take some time out to enjoy slower food, crafted with the kind of detail that only comes with time, patience and many an hour of careful practice.

Atelier achieves what many a fine dining restaurant cannot - it takes the focus away from the ‘fine’ and emphasises the ‘dining’. Their attention to detail comes less with gimmicky plating and more with robust flavours,

Atelier Brasserie is located at 5/45 King Street, Bowen Hills and is open for lunch 12-3pm, dinner 5-9pm Tuesday to Sunday (open until 10pm on Friday and Saturday) and Sunday brunch.

D R K AT GRIDLEY

Advanced Emergency Trainee, Queensland Children’s Hospital; and member, AMA Queensland Council of Doctors in Training

Doctor Q Spring 65

All about you BOOK: PLASTIC GAME CHANGER Our beautiful oceans are filling with plastic, devastating marine wildlife and disrupting fragile ecosystems. It is also threatening to become a human health disaster.

Plastic pollution awareness is higher than ever, yet most companies still generate too much plastic waste with their business-as-usual approach. This book inspires positive action with its five-step framework to accelerate business plastic reduction efforts, along with insights from five realworld plastic game changers, from a variety of industries, who share how they have done it too.

Plastic Game Changer is a practical guide for professionals who want to make a difference to plastic pollution. It will appeal to CEOs, HR leaders, sustainability leaders and people at all levels who feel compelled to do something meaningful to tackle the ocean plastic crisis.

Visit www.lessplastic.co.uk to order a copy.

T V: WAR ON WASTE A show with an AMA Queensland favourite, Craig Reucassel, who is on a mission to uncover how much waste we produce as a nation and what we can about it. Starting in 2017, War on Waste episodes have focused on the amount of food wasted from the farm to the fridge each year, plastic waste that ends up in oceans and ingested by marine life, the impact of coffee cups and fast fashion, the scourge of single-use plastic items like bottles and straws and the role of cafes, restaurants and fast food outlets in reducing waste. Our own Dr Michael Cleary stars in an episode on the changes made at the Princess Alexandra Hospital. Watch in on ABC iView now.

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GO GREEN: 1 MILLION WOMEN In Australia and around the world, women make 85 per cent of the consumer decisions that affect the household’s carbon footprint. 1 Million Women is a lifestyle revolution started by Natalie Isaacs to make bite-sized changes to reduce household energy, buy quality not quantity, cut meat consumption by half. The movement believes each small action, once multiplied by millions, is the key to solving the challenge of climate change. Visit www.1millionwomen.com.au to find out more.

C H A R I T Y: WORLD WIDE FUND (WWF) World Wide Fund (WWF) works in Australia and the Asia-Pacific to protect endangered species and habitats, meet the challenge of climate change, and build a world where people live in harmony with nature. WWF’s global mission is to stop the degradation of the planet’s natural environment and to build a future in which humans live in harmony with nature. They focus on sustainable fisheries, resilient marine ecosystems and clean oceans. Their drive is to promote a sustainable food system that will conserve nature and feed humanity. They are tackling climate change by working directly with entrepreneurs, investors and business to support and promote innovative, low carbon and zero carbon solutions. Visit www.wwf.org.au

UPCOMING FILMS Please note upcoming film are subject to change

3 October Joker

MASSENET’S MANON

9 October Metallica & San Francisco Symphony: S&M

23 November, 2.30pm | 24 November, 2.30pm | 27 November, 10am The Met Opera Manon is an opéra comique in five acts by Jules Massenet to a French libretto by Henri Meilhac and Philippe Gille, based on the 1731 novel L’histoire du chevalier des Grieux et de Manon Lescaut by the Abbé Prévost.

Massenet’s tale of passion, excess, and their consequences stars rising soprano Lisette Oropesa in the effervescent title role. Tenor Michael Fabiano is her ardent admirer, Chevalier des Grieux, with Maurizio Benini conducting Laurent Pelly’s enchanting production.

PUCCINI’S TURANDOT 26 October, 12.45pm | 27 October, 12.45pm | 30 October, 2.30pm Met Opera Franco Zeffirelli’s spectacular production returns to cinemas, with Yannick Nézet-Séguin, the Met’s Jeanette Lerman-Neubauer Music Director, conducting his first Puccini opera with the company. Powerhouse soprano Christine Goerke takes on the icy title princess, alongside tenor Roberto Aronica as the unknown prince vying for her love.

WIN

kets c i t e i v mo ! for two

10 October Gemini Man The Eulogy 11 October The King

A MIDSUMMER NIGHT’S DREAM

VAN GOGH AND J A PA N

9 November, 6pm | 10 November, 1pm | 13 November, 1pm

21 November, 10am | 23 November, 1pm | 24 November, 1pm

National Theatre Live

Exhibition on Screen

A feuding fairy King and Queen of the forest cross paths with four runaway lovers and a troupe of actors trying to rehearse a play. As their dispute grows, the magical royal couple meddle with mortal lives leading to love triangles, mistaken identities and transformations… with hilarious, but dark consequences.

One cannot understand Van Gogh without understanding how Japanese art arrived in Paris in the middle of the 19th century and the profound impact it had on artists like Monet, Degas and, above all, Van Gogh. Visiting the new galleries of Japanese art in Paris and then creating his own image of Japan – through in-depth research, print collecting and detailed discussions with other artists – Van Gogh’s encounter with Japanese artworks gave his work a new and exciting direction.

Shakespeare’s most famous romantic comedy will be captured live from the Bridge Theatre in London. Gwendoline Christie (Game of Thrones), Oliver Chris, David Moorst and Hammed Animashaun lead the cast as Titania, Oberon, Puck and Bottom. The Bridge Theatre will become a forest – a dream world of flying fairies, contagious fogs and moonlight revels, surrounded by a roving audience following the action on foot.

In this little-known story of Van Gogh’s art we see just how important his study of Japan was. The film travels not only to France and the Netherlands but also to Japan to further explore the remarkable heritage that so affected Van Gogh and made him the artist we know of today.

Name:

Telephone:

Member no:

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

Entries close 15 October 2019

Portside Wharf, Remora Road, Hamilton

P: (07) 3137 6000

www.dendy.com.au

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

Selfies and self-esteem Self-esteem is a fascinating thing. I see so many people coming through my practice who seem to be lacking it.

They seem powerless to improve it and it taints their decision-making in life, strains their relationships and impacts their careers. It lays waste to their mood and riddles them with anxiety.

I see young people chasing so many false gods in their desire to improve their self-worth. Trying to compensate for something. Searching from without when they should be searching within. I see people obsessed by the transient allure of attractiveness. I see them compare themselves to some externally defined ideal. Some picture of looks and fashion that external sources and industries have set and defined as desirable. So that, that same external industry can exploit these insecurities by selling vulnerable people their products to cure the alleged short comings. They promote the idea that deficient self-esteem can be improved by slapping on lip-gloss, eye shadow and longer eyelashes.

Or that all your manly short comings can be solved by a flatter abdomen facilitated by some new bit of gym kit or hair dye or a protein supplement or even the right sort of deodorant.

It didn’t seem to be this way when I was a young bloke. I wonder if

68 Doctor Q Spring

the obsession with social media and Facebook has generated it all.

People seem obsessed by images of themselves on their Facebook page. They all look the same with foreheads as flat and featureless as a Bolivian salt plain and pouting lips all threatening to devour everything around them.

It all seems very ‘me’ focused. Even pronouns have changed. ‘I’, ‘me’ and ‘mine’ have usurped ‘us’, ‘we’ and ‘ours’.

Comparison has become an obsession too. In a world obsessed with celebrity, people aren’t comparing themselves to their small peer group, they compare themselves with the whole planet.

Girls don’t see the best-looking girl in their class and say I rate pretty well, they look at the pouting faces on the Facebook pages of the most glamourous women on the planet and consistently come up short. Having a reasonable house and a reliable car doesn’t cut it anymore as people compare themselves to what multimillionaire celebrities live in and drive.

I reflected back on my youth and thought about where my self esteem came from. I reckon I am a pretty self-confident bloke and I think my upbringing is the reason. My family were always there for me. Because I played a lot of sport, I had a lot of mates. There

was always someone knocking on our door with a footy or a bat and a ball wanting to play. I won some games, lost some games and learnt how to deal with success and failure and as Kipling would say “treat those two imposters just the same”. I had mates to rely on, enhance the good times and buffer the bad. None of us worried about protein shakes, tattoos or shelling out for a machine to give us six-second abs.

The only photos we ever had taken of ourselves were the formal ones taken at the end of the season and the ones on school photo day. Self esteem was preserved by a goal, a try, a few good cover drives or a spectacular catch.

Popularity was ensured by sharing good and bad times with friends and not by how many people ‘liked’ the photo you posted on Facebook of yesterday’s lunch. We had a sense of team. Of community. We didn’t text or twitter. We got together and had yarns.

We didn’t take photos of ourselves, we did things together. We did things for our mates and they did things for us. You did favours and you received favours.

There was a sense of altruism.

And I suppose that is one great aspect of our profession. We do nice things for people in their hour of need. That should contribute to every doctor’s self-esteem. That, and a few great cover drives.

leads the way PHIL MANSER Wine Direct

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

Up until 10 years ago the mention of organic wine made many traditional wine drinkers in Australia shift uneasily in their seats wondering what they were going to get and much they’d have to shell out for an average wine.

Fast forward to today and an ever-growing list of impressive wines are emerging from a burgeoning community or organic wineries with Paxton leading the way. Achieving the status of a Certified Organic producer is rigorous but with the growing movement towards sustainability worldwide across many agricultural industries it simply makes sense.

By the way, none of this is new - in France, Italy and other parts of Europe this organic thing has been going on for centuries.

But what is it? The definitions vary depending on your source but put simply, organic wine is wine produced from organically grown grapes which are typically grown in bio-dynamic vineyards. The standards and policing vary from country to country, but Paxton see it very simply, “a farm is seen as a whole organism rather than a series of problems to be solved individually. It is the intention that PAXTON vineyards mimic the characteristics of a natural system.”

For example, soil health is fundamental in bio-dynamic farming, the encouragement of micro-organisms in soil helps make nutrient available naturally to the vines. This is encouraged through the use of composting and mulching, which also serves to keep weeds under control. Along the way worms thrive in these conditions helping to aerate the soil making the pathway for vine roots easier to traverse.

This subject demands more space than I can use here but the results speak for themselves through a range of brilliantly crafted fruit-driven wines that continue to attract critical acclaim. Whatever your metric, be it the wine, their Halliday Five RED Star rating or the fact they regularly supply the McLaren component of Penfolds Grange - bio-dynamic growing and organic wine are here to stay!

CERTIFIED ORGANIC SUPPLIERS TO GRANGE

H I G H E S T H A L L I D AY W I N E R Y R AT I N G Doctor Q Spring 69

Dinner for the Profession This year’s Dinner for the Profession brought doctors from all specialties and stages together for an elegant evening in the Marquee at Victoria Park Golf Complex. More than 200 members and guests enjoyed the chance to mingle and enjoy a three-course meal. The AMA Queensland Foundation held a fundraising raffle and the top prize was a $13,360 tennis bracelet, so the raffle certainly created some buzz among the audience.

AMA Queensland’s awards were announced on the night, with the gold medal presented to Dr Eleanor Chew OAM for service to general practice, medical education and governance. The medal for Excellence in Health Care went to Queensland Aboriginal and Islander Health Council Chair Gail Wason, Chair of the Queensland Aboriginal and Islander Health Council and CEO of Mulungu Health Service. Dr Col Owen AO was awarded the Rural Health Medal for his advocacy on behalf of rural doctors.

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1. Pavéction by Robert Bellamy, 2. John Velosa, Maureen Twomey, Kathryn Perry and Kevin Twomey, 3. Dr Otilie Tork, Louise Butler and Anna Wu, 4. Drs Bavahuna Manoharan, Liz Vujcich, Kate Ritchie and Maryam Bashirzadeh, 5. Imogen Pattison, Dr Elizabeth Jarvis and Paul Mula, 6. AMA Queensland’s Excellence in Health Care Medal winner Queensland Aboriginal and Islander Health Council Chair Gail Wason, 7. Entertainment provided by Sarah Collyer trio, 8. Drs Jason Wu and Chris Zappala, 9.

AMA Queensland Gold Medal winner Dr Eleanor Chew with Gary Voss, 10. AMA Queensland Councillors Drs Fatima Ashrafi and Erica Gannon, 11. AMA Queensland Foundation major prize winner Dr Dilum Ekanayake with jeweller Robert Bellamy from Pavéction, 14. Dr Russell Stitz and Ann Stitz, 15. Drs Chuong Nguyen, Andrew Pattison, Cassie Oxenford, Tyson Jones and George Denby, 14. AMA Queensland Chair A/Prof Michael Cleary and AMA Queensland CEO Jane Schmitt

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Doctor Q Spring 71

2019 Junior Doctor Conference ORAL RESEARCH WINNER Has your septic patient had enough? Unbound ceftriaxone pharmacokinetics in adult hospitalised patients with sepsis Aaron Heffernan

RUNNER UP The incidence of postoperative nausea and vomiting after caesarean section in patients with hyperemesis gravidarum during pregnancy: a retrospective cohort study Dr Nicole Jacobs

P O S T E R P R E S E N TAT I O N WINNER Resuscitation in haemorrhagic shock through the unrecognised inadvertent brachial artery cannulation Dr Timothy Gilmour

RUNNER UP Secondary prevention of fractures in rehabilitation patients with osteoporosis Dr Tiffany Wang

A T J D C B Y N I G H T, S T U D E N T A W A R D S WERE PRESENTED AS FOLLOWS: UNIVERSITY OF QUEENSLAND

JAMES COOK UNIVERSITY

Lilian Cooper Prize Edward Spraggon and Alexandra Miller

AMA Queensland Medal of Achievement Zali Grace Sorensen

John Bostock Prize in Psychiatry Anthea Gibbons

BOND UNIVERSITY

William Nathaniel Robertson Prize Owen Spratt

AMA Queensland Child Health Prize Elizabeth Thomas

AMA Memorial Prize Edward Spraggon and Carol Graham

GRIFFITH UNIVERSITY

72 Doctor Q Spring

AMA Queensland Children’s Health Prize Woo Sun You and Kirsty Allyce Whitmore

1. Heart of Australia founder Dr Rolf Gomes spoke about innovative healthcare on wheels 2. Drs Nicole Georgiadis, Michael Poulton and Jack Mackenzie 3. Dr David Liu asks a question 4. Dr Marco Giuseppin demonstrates optimum ventilation using a bag valve mask at the Clinical Skills Development Service workshop 5. Drs Antony Ji and Michael Chen 6. Drs Savini Liyanagama, Andrew Yong Gee and Honor Magon 7. Delegates enjoying a presentation by Dr Joss O’Loan about the Hep C Kombi Clinic 8. (L-R) Council of Doctors in Training (CDT) Deputy Chair Dr Mikaela Seymour, Aaron Heffernan, winner of the poster presentation and Dr Hash Abdeen, CDT Chair 9. James Cook University and AMA Queensland Medal of Achievement winner Zali Grace Sorensen and Dr Jacinta Sorenson.

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INPRINT

Quitting Plastic Clara Williams Roldan and Louise Williams Where do you start if you want to reduce the plastic in your life?

Especially when most of us are wearing it, eating and drinking from it, sitting on it, walking on it, and probably even ingesting it. Anywhere you go, plastic is within easy reach - even in Antarctica and the North Pole.

We didn’t quit plastic overnight. In fact, it’s still a work in progress. But along the way, we have learnt a lot - researching the issue from the grass roots up, speaking to people and finding out what works and what doesn’t. We take on the tricky questions, like ‘how will I wash my hair?’, ‘do I have to give up crackers?’, ‘what about my bin liner?’ and ‘is this going to be expensive?’

As we continue to remove throw-away plastics from our daily lives, we’ve discovered we’re friendlier with our local communities, we’re eating more healthy food, and de-cluttering happens by itself. It feels great!

Win this book Thanks to Allen&Unwin Fill out this form and

Telephone:

email to competitions@amaq.com.au Name:

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Entries close 15 October 2019

BOOK WINNER Dr Linda Kemp Dr Alison Green Alison Harris Dr Allan Tham Dr Su Mien Yeoh

74 Doctor Q Spring

Dr Mojtaba Hossein Zadeh won a copy of hn Murtagh’s General Practice, Seventh Edition, thanks to our friends at McGraw-Hill Education.

AMA Queensland is now part of something bigger at Officeworks.

Officeworks has partnered with AMA Queensland to provide you with the best products, services and solutions to help make bigger things happen for your business.

Register now for a 30 Day Business Account at officeworks.com.au/ ama-queensland

You’ll breathe easier with us on the team

There’s only one bank that really knows how to treat medical professionals and ensure they get the help and assistance they need.

And that’s us.

We’ve specialised in your profession since 1993. In those 25 years, we’ve learned a great deal about how you work and what you need. This experience has proved invaluable in building flexible solutions to help achieve your goals.

Call us anytime. We’re confident you’ll breathe a sigh of relief.

Visit us at boqspecialist.com.au or speak to your local finance specialist on 1300 131 141.

Car loans | Commercial property | Credit cards | Equipment finance | Fit-out finance | Foreign exchange | Home loans | Personal loans | Practice purchase | Practice set-up | Savings accounts | SMSF | Transaction accounts | Term deposits | Vehicle finance The issuer of these products and services is BOQ Specialist – a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL no. 244616 (“BOQ Specialist”).