Doctor Q is free to AMA Queensland Members
SPRING 2020
S T N PATIE OVER
S C I T I L PO
DOCTOR SURVEY FINDINGS TOP 3 ISSUES: 1. R O L E S U B S T I T U T I O N 2. I N E F F I C I E N T M A N A G E M E N T 3. P O O R F U N D I N G F O R S P E C I A L I S T S
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CONTENTS
REPORTS
F E AT U R E S
BUSINESS TOOLS
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Editor’s desk
12 Patients over politics
42 The health and wellbeing of you
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President’s report
45 Managing COVID-19 in the workplace
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CEO’s report
14 Queensland leading the country in real-time communication
52 AMA Queensland Foundation: Operation Donation
16 Telemedicine after COVID-19 20 The big issues for Queensland election 26 Conversion therapy: leaving doctors out of the firing line
CURRENT ISSUES
46 Learnings from a cyber insurance claim 48 A case of COVID-19 in a country town 50 Instant asset write off – should I buy a new car? 54 SMSF Lending – what you need to know
PEOPLE & EVENTS
LIFESTYLE
18 New AMA President and Vice President
10 JDC 2020: online and on demand
55 Queensland Outback Adventure
22 COVID-19 delayed pay rises
34 The Glimmer Podcast
56 Restaurant review: MICA Brisbane
24 Doctors need access to PPE
40 Events calendar
58 All About You
28 High Court ruling shows a day is a day
41 Local Medical Association round up
60 Dr Matt Young: It’s just a phase
30 We are physicians, we are leaders and we are human
61 Picardy is back 62 InPrint: The Good Doctor
32 Climate change letter to PM from Australia’s peak medical groups 36 Doctors’ Health in Queensland 38 Disruption to health system a chance to redesign care 39 Research round up
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J D C 2 0 2 0 : ON L I N E A N D O N D E M A ND
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N E W AM A P RES IDENT A ND VICE P RES IDENT
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#MEDB IK INI WE ARE P HYS ICI ANS, W E ARE L EADERS AND WE ARE HUM AN
Doctor Q Spring
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BOARD OF DIRECTORS Dr Chris Perry President
Editor’s Desk
Dr Bav Manoharan Vice President Dr Eleanor Chew OAM Chair of Board and Council
Dr Sarah Coll Member Appointed Director
Dr Peter Isdale AM Skills Based Director
Dr Mellissa Naidoo Member Appointed Director
Ms Ann Fordyce Skills Based Director
Dr Nicholas Yim Member Appointed Director
COUNCIL Welcome to our Spring edition of Doctor Q. I’m a big fan of podcasts (you’d only have to see All About You for my recommendations) and listened to a podcast on the Spanish flu in 1918. They covered so much political bickering over where the pandemic began, who had it, who didn’t have it, what measures each country was taking and complaints about the strict measures to control the spread. Sound familiar?
Dr Sanjeev Bandi Capricornia Area Representative
Lachlan Crawford Medical Student Observer
Dr Rachael O’Rourke Greater Brisbane Area Representative
Dr Kimberley Bondeson Greater Brisbane Area Representative
Dr Dilip Dhupelia Immediate Past President
Dr Chris Perry President
I think we are all pretty well over living in interesting times. I suppose at least we’ll have some interesting stories to tell in later years. Stay safe,
Dr Maria Boulton Greater Brisbane Area Representative
Michelle
Dr Paul Bryan Greater Brisbane Area Representative Zoe Byrne Medical Student Representative
WHAT’S HAPPENING ON QDC? Queensland Doctors’ Community (QDC) is AMA Queensland’s member-only, real-time online platform where members drive the agenda. Visit https://community.amaq.com.au or access via the AMA Community app. Vigorous discussion continues on: COVID-19 – AMA Queensland provided daily COVID-19 updates on QDC throughout June, July and August. Members were able to voice ideas, concerns and provide information to each other regarding the virus and how it would be handled in Queensland. PPE and issues with the supply chain
Dr Marianne Cannon Greater Brisbane Area Representative Dr Eleanor Chew OAM Chair of Board and Council Dr Michael Clements North Area Representative Dr Sarah Coll Specialist Representative
Conversion therapy
Dr Hasthika Ellepola International Medical Graduate Representative Dr Erica Gannon Part-time Medical Practitioner Representative Dr Marco Giuseppin Downs and West Area Representative Associate Professor Geoffrey Hawson Retired Doctors Representative Dr Bav Manoharan Vice President Dr Cornelius (Kees) Nydam North Coast Area Representative Dr Nikola Ognyenovits Specialist Representative
Pharmacist prescribing There is a private forum just for junior doctors. The hot topic on this page was discussion on training programs and if their entry criteria was transparent.
OBITUARIES The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Dr Arthur LOVE Surgeon Late of Upper Mount Gravatt Member for 51 years
Dr Anthony John MCDONALD General Practitioner Late of Tasmania Member for 66 years
Dr Fiona Raciti General Practitioner Representative Dr Tony Rahman Specialist Representative Dr Louise Robinson Gold Coast Area Representative Dr Siva Senthuran Full-time Salaried Medical Practitioner Craft Group Dr David Shepherd Far North Area Representative Dr Maddison Taylor Doctor in Training Representative Dr Ian Williams General Practitioner Craft Group Representative Dr Nicholas Yim General Practitioner Craft Group
AMA QUEENSLAND SECRETARIAT Dr Bav Manoharan Executive General Manager and Company Secretary
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: Cathy Ball
Phone:
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Address: PO Box 123, Red Hill QLD 4059 Email:
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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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President’s report DR CHRIS PERRY
ROLE SUBSTITUTION DOCTORS’ NUMBER ONE CONCERN AMA Queensland recently conducted a survey of more than 700 doctors to gauge the views of Queensland doctors about the current management and future direction of patient care in the public health system. In the lead up to the state election next month, AMA Queensland will present your views on the health system to the State Government, and call for improved collaboration with doctors to ensure Queenslanders receive the best care possible. The survey revealed that, regardless of where doctors practise in Queensland, role substitution is the number one concern. The survey findings can be found on page 12. The State Government’s recent push to trial COVID-19 testing in retail pharmacies – despite repeated opposition from doctors and pharmacists – is a prime example of this trend. AMA Queensland advised the government of the risks of testing people for COVID-19 in retail outlets, and the working pharmacists themselves are overwhelmingly opposed to the trial on safety grounds and yet it is going ahead. The trial is backed by the Pharmacy Guild of Australia but it has been vehemently opposed by working pharmacists and the Pharmaceutical Society of Australia which has called for an immediate stop to the trial. AMA Queensland called on the State Government to invest more in existing COVID-19 testing centres, rather than contracting out the important health measure to commercial enterprise. 6
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Fully equipped testing locations already exist with trained staff. We need to boost the number of these services and ensure there’s adequate supply of PPE such as head coverings, face shields, masks and gowns rather than encourage sick people to wander through shopping centres and retail outlets. We have urged the Government to immediately stop the COVID-19 testing and UTI pharmacy trials, and to reassess its role substitution policy as it impacts patients’ care across the broader health system. AMA Federal President Dr Omar Khorshid supported our concerns, writing to Queensland Health Minister Steven Miles to warn him that COVID-19 testing in pharmacies “is dangerous and poses unacceptable risks” to staff, customers and the wider community.
UPCOMING QUEENSLAND ELECTION With a state election looming in October, it is a very busy time for AMA Queensland advocacy. It will be interesting to see which health issues are identified as priorities by Labor and the LNP. Rest assured AMA Queensland will be there advocating and will be building on its Extended Scope of Practice campaign in the lead up to the 31 October election. We are also in the process of finalising our 11-point Action Plan for Better Health Outcomes for Queenslanders election document, outlining what AMA Queensland would like to see prioritised under the incoming government.
FAREWELL AMA QUEENSLAND CEO
RENEW YOUR MEMBERSHIP FOR 2021
After more than a decade of dedicated service to AMA Queensland, Chief Executive Officer Jane Schmitt was recently farewelled and we wish her great success in the next chapter of her career. Jane has boundless energy and passion for her work and we hope to find ways to collaborate with her in the future to further enhance healthcare for Queenslanders.
Finally, I wish to remind all members to look out for your 2021 renewal notice from 1 November.
The recruitment process for a new CEO is well underway, however given the unprecedented times we live in, the AMA Queensland Board has appointed Vice President, Dr Bav Manoharan, as the Executive General Manager and Company Secretary to maintain stability during this transition period and continue to support staff and members. We will work with Bav to advance a number of strategic advocacy campaigns in the lead up to the state election in October.
There has never been a more important time to continue your membership. With the world’s focus on health in 2020 and continuing for the foreseeable future, ensure your interests are looked after by continuation of your AMA Queensland membership. Now is the time to refer colleagues for membership. Each non-member you refer reduces your 2021 membership fees by 25 per cent (up to four referrals). Refer colleagues now to save on your 2021 membership.
GREATER SPRINGFIELD MEDICAL & OFFICE SUITES I often meet with medical professionals who are wondering where they will establish themselves. I can’t think of a better opportunity than here in Greater Springfield. The future is here; the future is now. Dr Robert Stable AM Emeritus Professor Bond University MBBS, DUniv (QUT), MHP, FRACGP. FAICD, FCHSM (Hon) Executive Chairman - Health City Springfield Central
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CEO’s report JANE SCHMITT
It’s with a mixture of nostalgia and anticipation that I write my last CEO report for Doctor Q. By the time you read this, I will have already signed off after 11 years with AMA Queensland and will have started my new role with the Mater Group at South Brisbane. I’ve taken a short trip across the river, but am staying with what I love – the healthcare sector. The past 11 years at AMA Queensland have been remarkable and I’m so appreciative of the opportunities, learnings, challenges and friendships that I’ve experienced along the way. This role has invigorated me, challenged me, stretched me and inspired me. I will truly miss the whole AMA Queensland team, our stakeholders and of course you – our members. It has been a privilege to meet so many of you over the years as we have taken AMA Queensland forward in what have sometimes been challenging and uncertain times, most recently during the global challenge of COVID-19. When I look back over old editions of Doctor Q, I realise just how much has happened in the past 11 years.
From the devastating Queensland floods, where we rallied the medical workforce to work in pop up clinics alongside the Salvation Army, to this latest challenge of COVID-19, we have experienced some of the most significant historical moments in Queensland. Together, we have advocated for significant and historic policy outcomes for our doctors – from termination of pregnancy to be treated as a health issue rather than a criminal issue, to advocating for a fair health complaints system. I have worked with our team to develop our incredible annual medical conferences that bring together the brilliance of doctors in far flung places around the globe. It has been a privilege to work with so many wonderful, caring and incredibly clever doctors. You have delighted me, educated me and supported me to achieve great outcomes for all doctors and for the wider health sector. I’ve been humbled by the way so many of you, as well as our wonderful secretariat team, have not only worked closely with me, but have welcomed me into your lives outside of work. AMA Queensland has been such a big part of my life. When I first started, my children were five and one years old.
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Just recently, that five-year-old got his driver’s licence and the one-year-old turned 13. They have always known me in my professional life as the CEO of AMA Queensland. Notwithstanding the odd bump in the road, it has been a fantastic journey and I am so grateful to have had the opportunity. Through this final column I would like to pay tribute to my team of exceptional staff that have helped to deliver a plethora of health policy, new technologies and operational results and, most importantly, support for our doctor members. I am leaving on a note of hope for the future, that this great member organisation will continue to grow and support all of our doctors – from our retired members who have given so much to the field of medicine to our junior doctors who will be our medical leaders of the future. I am excited about the next step in my career which continues my work in health advocacy at the Mater. I’m sure I will run into many of you along the way. If you see me around the traps, please come and say hello. Until then, stay well. Thank you, Jane Schmitt
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JDC 2020: online and on demand COVID-19 and the subsequent lockdowns put an end to attending many events physically, so this year’s Junior Doctor Conference went online. It meant that members could watch the content in their own time, it was easier to work around rosters and there was no need to worry about flights, accommodation and travel time. It opened the conference up to members around Australia. Dr Richard Harris SC OAM was our keynote speaker and kicked things off with some great advice: “Doing something a little bit different has been tremendously rewarding and I would really strongly encourage each and every one of you to just think about the possibilities available to us as doctors and even if that is just to travel interstate or within Australia, to as many different places as possible – overseas, even better – to see different systems and see different ways of doing things, because you will never ever regret getting a different perspective on your work. Take your own path and do something a little bit more bold, a little bit more exciting, and you never know what rewards might follow.”
JDC covered many important topics and points of discussion for junior doctors and medical students, including advice from training colleges, hearing from specialists regarding their chosen field of practice and insights into various career pathways.
POSTER AND OR AL PRESENTATIONS A plethora of research abstracts were also submitted this year, being presented in an adapted digital format opposed to the usual poster or oral presentation mode. The abstracts this year were of an extremely high caliber. 10 Doctor Q Spring
PANELS JDC hosted a number of panel sessions on suicide prevention, mandatory reporting, advanced care planning, improving your research, working rurally and live issues for doctors in training.
STUDENT AWARD WINNERS University of Queensland AMA Queensland Memorial Prize Anthea Gibbons William Nathaniel Robertson Prize Hannah Laycock John Bostock Prize in Psychiatry Sarah Cameron Harold Plant Memorial Prize Jordy White Lilian Cooper Prize Anthea Gibbons James Cook University AMA Queensland Medal of Achievement Praveen Tharusha Gurusinghe Bond University AMA Queensland Child Health Prize Keanu Mogno Griffith University AMA Queensland Children’s Health Prize Alexis Kenny
Thanks to the support of our generous sponsors and corporate partners, JDC was free for members this year.
AMA Federal Update
AMA Queensland Update
Mandatory Reporting Panel
Suicide Prevention Panel
Council of Doctors in Training update
Dr Richard Harris SC OAM
AMA Queensland Foundation
Doctor Q Spring 11
Patients over politics
AM A QUEENSL AND SURVEY REVEALS DOCTORS IGNORED AND PATIENTS AT RISK In recent years, successive governments have chipped away at the foundation of the health system in Queensland. This has served to undermine the role of doctors and to place too much emphasis on convenience rather than quality when it comes to patient care. Nowhere has this been more evident than in the rise of role substitution, with an increasing number of health practitioners performing tasks normally provided by qualified doctors. Examples of role substitution can be seen across the public health system, from pharmacists prescribing antibiotics to women giving birth without access to a doctor and nurses conducting endoscopies.
A recent AMA Queensland survey of 700 doctors found role substitution was the number one concern regarding the delivery of public health care. Of those doctors who completed the survey, more than 370 were based in urban areas while 300 identified themselves as regional or rural practitioners, providing a broad and diverse range of views. Regardless of where they practice in Queensland, the survey revealed clear consensus amongst doctors on some key issues: Role substitution is the number one concern, followed by inefficient administration within Queensland Health.
Pharmacy UTI trial – 60 per cent of doctors believe the State Government’s pharmacy urinary tract infection (UTI) trial poses a high or extremely high risk to patients. Many also noted it contradicted national and global efforts to curb antimicrobial resistance. Rural maternity – More than 90 per cent of doctors believe the State Government’s initiative to close and reduce maternity services in rural and regional areas is either quite dangerous, extremely dangerous or catastrophic for patient care. More than 40 per cent of doctors said appointing doctors with frontline experience to key policymaking positions should be the first step to improve patient care. 60 per cent of Queensland doctors feel their advice is often ignored in the public system. 38 per cent of doctors have little or no faith in the Queensland public system.
S T N E I PAT OVER
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S C I T I L O P
AMA Queensland is using its survey findings to advocate for improved patient care in the lead up to the state election on 31 October. We believe all Queenslanders deserve safe, quality and accessible healthcare and that altering the scope of training of health practitioners is not the way to deliver it.
COVID -19 TESTING IN PHARMACIES The most recent case of an expanded scope of practice can be found in the State Government’s decision to allow COVID testing in retail pharmacies in Queensland, despite repeated and vehement warnings about the serious risk this poses to staff and customers. AMA Queensland, RACGP, the Pharmaceutical Society of Australia and the Professionals Pharmacists Australia have all voiced their opposition to the move. Only the Pharmacy Guild of Australia supports the initiative. AMA Queensland President Dr Chris Perry has warned in media reports that this experiment could be ‘disastrous’.
URINARY TR ACT INFECTION (UTI) DIAGNOSES AND ANTIBIOTIC PRESCRIPTIONS IN PHARMACIES Queensland is the only state or territory in Australia to approve this trial which involves pharmacists charging customers at least $20 for a diagnosis based on three hours of online training about typical symptoms. Rather than a clinical trial, this is the result of a parliamentary committee recommendation and allows community pharmacists to prescribe and dispense antibiotics which have been proven to increase rates of antimicrobial resistance in other countries. The trial also allows pharmacists to provide the oral contraceptive pill to female patients more regularly and without having to renew their initial prescription. AMA Queensland Councillor and Wide Bay GP Dr Nick Yim, who worked as a pharmacist for four years before practising medicine, was the perfect spokesperson to explain to the media and general public, why this was a bad idea.
“The pharmacist will not have access to the patient’s medical history to correlate symptoms, will not send urine samples for testing and cannot examine the patient for symptoms of pelvic and bladder cancer which may be similar to infection,” Dr Yim said. Within his media interviews, Dr Yim made the point that pharmacists filled a vital and valuable role in the health care system, but they were not trained to be doctors.
EX TENDED SCHEDULE OF VACCINATIONS IN PHARMACIES The Queensland Government was the first in the country to increase the number of vaccinations that pharmacists are allowed to administer from three to nine – the same as GPs. In a recent article for Australian Journal of Pharmacy, industry consultants Bruce Annabel and Mal Scrymgeour outlined the challenges facing pharmacists in attracting new customers to their retail outlets. They recommended ten ways for pharmacies to accelerate profits and noted the money-making potential in the Queensland Government’s move to introduce a ‘large flotilla of new pharmacy immunisations’. Dr Yim has repeatedly highlighted the fact that GPs are able to provide many of these vaccinations free of charge for patients that meet certain criteria, while pharmacists will need to charge a fee for many of them.
REDUCING RUR AL MATERNIT Y SERVICES The Queensland Government has closed and reduced rural and regional maternity services with many women unable to access a doctor during the pregnancy or birth of their baby. Our survey showed two-thirds of Queensland doctors believe this move is having an extremely dangerous or catastrophic effect on health care in country communities. AMA Queensland Councillor and Chinchilla-based Rural Generalist Dr Marco Giuseppin leads the charge in this area and says the move means many rural women receive second rate care. “Queensland Health’s own perinatal data demonstrates the safety and viability of rural maternity services,” Dr Giuseppin says. “Maternity services provided in the bush have lower rates of intervention and comparable rates of complications to their city counterparts. This only happens because in these services doctors and midwives work together to deliver great care to patients.” AMA Queensland has called on all parties running the upcoming state election to detail their vision for providing health care for the people of this state and remains committed to working with all State Governments in delivering improved outcomes for Queenslanders. Patients, however, must always come first.
Role substitution:
the practice of other health practitioners delivering care normally provided by a qualified doctor Doctor Q Spring 13
Queensland leading the country in real time communication Now more than ever, AMA Queensland is developing new ways to walk beside all members every step of the way. Queensland Doctors’ Community, AMA Queensland’s online, member-only, real-time discussion platform was launched in November 2019 and has proved to be a hive of discussion on a wide variety of topics. There are several subgroups for junior doctors, student members and retired doctors
so they can discuss issues specific to their group. AMA Queensland launched its realtime, member-only app in June 2020. The two communication channels offer advantages that members haven’t had before – the chance to interact with AMA Queensland and other members in real time.
AMA Queensland has kept in close contact with AMA and other state AMAs while developing these channels. Queensland is working as the pilot to these channels eventually being rolled out around Australia, which means members will soon have the chance to discuss issues and interact with members all over the country as early as 2021.
Visit https://qld.ama.com.au/amaq_member_app for more information on how to log on.
MEMBERSHIP AT YOUR FINGERTIPS The AMA Member app was launched in June and will open even more opportunities for how we communicate with members in real time. The app is available for both iOS and Android and will serve as an AMA member hub for news, networking, collaboration and events. Members will have access to: a dedicated news feed a member directory with in-app direct messaging easy membership renewal resources
member benefits direct access to Queensland Doctors’ Community online platform
Through the app, members can download workplace resources, access all their ember benefits and discounts, and log on to Queensland Doctors’ Community (QDC). Download the app by 30 September and you’ll go in the draw to win one of five $50 VISA gift cards.
QUEENSLAND DOCTORS’ COMMUNITY If you haven’t already started or joined a discussion on Queensland Doctors’ Community (QDC), now is the time! If accessing QDC on your computer has held you back, you can now access QDC via the app directly on your phone.
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Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 to inspect or discuss further. An opportunity to practice in Upper Mount Gravatt, is available now. The Centre for Minimally Invasive Neurosurgery and Spine Surgery (CMINS) is located at Level 3, 12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis. Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists. CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care. Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design. Other features include:
On-site Parking. State of the art phone system. Lift access providing accessibility for all patients. Large kitchen and staff common area. Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices.
Other nearby specialities include: Neurosurgery An opportunity to practice in Upper Mount Gravatt, is available Neurology Ophthalmology now. The Centre for Minimally Invasive Neurosurgery and Spine Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 or discuss Surgery (CMINS) is located atto inspect Level 3, further. 12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis.
Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists. CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care. Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design.
Other features include: On-site Parking. State of the art phone system. Lift access providing accessibility for all patients. Large kitchen and staff common area. Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices. Other nearby specialities include: Neurosurgery Neurology Ophthalmology
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Telemedicine after COVID-19 COVID-19 and the lockdown changed many aspects of the way we live, but none more so than adopting technology our population had previously been reluctant to use. With a scarcity of personal protective equipment (PPE), as well as doctors and patients needing to isolate, the AMA played a significant role in the Commonwealth Department of Health’s decision to implement temporary telemedicine Medicare numbers until 30 September 2020 due to the COVID-19 pandemic. The $669 million agreement for new telemedicine arrangements allowed even more patients in Queensland to have consultations
with general practitioners and medical specialists without leaving home. AMA Queensland welcomed this announcement, which ensures telemedicine is widely available so patients can access care without the risk of exposure to or spread of COVID-19. Critically, the telemedicine announcement also reduced avoidable use of PPE. Prior to the telehealth agreement, doctors required PPE for any patient with symptoms suggesting potential COVID-19. Telemedicine consultations require no PPE. It cut down use of PPE, freeing the scarce supply for use elsewhere in the health system. While the government adopted a staged approach to the introduction of telemedicine, it was obvious from very early on that patients needed to be given broad access to telemedicine services.
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Since the temporary items were introduced in March, around 20 per cent of all Medicare-funded consultations with a doctor are now being provided by telemedicine, either over the phone or via video. Due to the rising popularity and convenience of telemedicine, AMA Queensland is calling on the Queensland Government to work with the Commonwealth Government to extend telemedicine beyond 30 September 2020 as a permanent change. However, there are some major concerns.
MANDATORY BULK-BILLING REQUIREMENT Currently, it is mandatory for GPs to bulk bill telemedicine appointments. Moving forward, GPs need to be able to follow their usual billing practices, as bulk-billing alone is not adequate for many practices to provide comprehensive medical care.
COST TO PRACTICES Many practices have had additional, unexpected costs added due to COVID-19, such as PPE, cleaning equipment, plastic screens and telemedicine has added costs to set up, such as server upgrades, headsets, cameras, telemedicine software, cables and IT support.
PHONE OR VIDEO CONFERENCE Regardless of whether a patient can see their doctor or not, as in, whether the consultation is by phone or video, the same medical experience to treat is required and the cost for the consultation should be the same.
POP-UP TELEMEDICINE MODELS As quickly as the telemedicine item numbers were introduced, pop-up telemedicine models started to take advantage of them.
10 MINIMUM STANDARDS FOR TELEMEDICINE IN GENERAL PRACTICE AMA is currently formalising a new set of standards for telemedicine in general practice – 10 Minimum Standards for Telemedicine in General Practice. These new standards are designed to ensure technological
Then AMA President Dr Tony Bartone addressed this in July: “The great majority of GP telehealth consultations to date have been in circumstances where a patient has an existing relationship with a GP, but we have seen the increasing and disturbing emergence of ‘pop-up’ telehealth models and models that are linked to pharmacies.” “The pharmacy arrangements fragment care and blur the important distinction between the prescribing and dispensing of medicines. Both the pop-up and pharmacy telehealth models are also unable to facilitate access to a face-to-face consultation when a patient needs one.” In the latest edition of Australian Journal of Rural Health, National Rural Health Alliance CEO Dr Gabrielle O’Kane warned of the threat to regional practices if the rules around telemedicine weren’t carefully written: “Rural health care providers’ businesses will be put at risk if they’re not protected from onlineonly providers based in the big cities that offer no local services, because it means these rural practices won’t be viable and people won’t be able to access face-to-face services when they need them.” On 10 July, the Federal Government introduced restrictions to the COVID-19 Medicare GP telemedicine items to circumstances where a patient has an existing relationship with a GP or general practice, other than for children aged under 12 months or patients who are homeless.
solutions are utilised in the provision of patient care on the basis that practitioners retain their discretion in determining the appropriate modality for providing a health service. These new standards do not replace or replicate the existing work done by RACGP’s Telehealth Video Consultation Guide which focuses
CONNECTIVITY Dr Gabrielle O’Kane warns that if telemedicine is here to stay, connectivity and quality need to be improved and local providers need to be protected. “Connectivity, including poor internet coverage, is still a big issue in rural, regional and remote Australia. It’s hard for health professionals to do a telemedicine consultation if the internet keeps dropping out on either their end or the patient’s end, or if one or both don’t have enough bandwidth.”
DIGITAL LITERACY In the article, Dr O’Kane also pointed out that there is still a lot of people in the community not not comfortable with technology. “We’re still finding that many patients, including those who are elderly or from non-English speaking backgrounds, find telemedicine difficult to use or don’t feel comfortable using it. So we need to invest in programs to improve digital health literacy for both consumers and healthcare providers.” The AMA will continue to have constructive discussions with the government over further refinements that can support the broad retention of telemedicine beyond September.
on MBS-funded telehealth services or the ACCRM Telehealth Video Consultation Guide which focuses on MBS-funded telehealth services but will replace the existing AMA Position Statement: Technology-based patient consultation – 2013. The standards are due to be completed at the next AMA Council meeting in November 2020.
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AMA QUEENSLAND
New Board Member Dr Mellissa Naidoo BSC BMBS DCH MHM FRACMA FCHSM GAICD CHIA
Specialty: Medical administration Dr Mellissa Naidoo has over 16 years’ experience in clinical and medical roles in the public and private sector. She advocates for leadership diversity and inclusive decisionmaking and has undertaken the Harvard Executive Women in Health Care program.
She is passionate about person-centred care, health system improvement and doctor health and wellbeing. “I have a strong interest in advocacy and governance and see serving on the board as a way of contributing to the strength of the organisation and supporting the interests of the medical profession and patient care.”
Member Appointed Director
AMA QUEENSLAND
New Council Members Dr Michael Clements MBBS BECON (HONS) MPH MHM DAVMED FRACGP FARGP FRACMA FACASM GAICD MRAES
Specialty: General Practice
North Area Representative
Dr Michael Clements served with the Royal Australian Air Force (RAAF) for 13 years. After working in various locations around the country and the world, Dr Clements now owns and works in a private practice in Townsville as a general practitioner and as a Designated Aviation Medical Examiner. He is a Fellow of the Australasian College of Aerospace Medicine, Royal Australian College of General Practitioners and the Royal Australasian College of Medical Administrators. He completed the DipAvmed in the UK in
Dr Ian Williams MBBS FRACGP GAICD
Specialty: General Practice
General Practitioner Craft Group Representative
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Dr Ian Williams has worked at the Camp Hill practice since 1986 and enjoys working as a General Practitioner and with the diverse multidisciplinary practice team. He is interested in all aspects of General Practice including improving the patient journey, as well as understanding and developing the role of the whole primary healthcare
2010 and remains active in the RAAF Specialist Reserve. Dr Clements continues to supervise general practitioners in training and works part-time as a Director of Rural Generalist Training for the Queensland Rural Generalist Pathway. “My goal on the AMA Queensland Council is to represent and promote the interests of North Queensland doctors and practitioners in private general practices, in particular those in rural and remote areas. AMA Queensland also offers a lot in terms of support and advocacy for junior doctors and general practice registrars and I look forward to supporting our members in North Queensland in these matters.”
team. Away from the practice, Dr Williams is Chair of the Brisbane South PHN and is a member of the Queensland Health Statewide Older Persons’ Health Clinical Network. In addition, he is a Senior Lecturer at the University of Queensland’s School of Medicine. In his spare time, Dr Williams is a passionate gardener. “I remain as keen as ever about general practice, and I’m keen to improve the healthcare of Queenslanders through the work of AMA Queensland.”
AMA
New President and Vice President At the National Conference in July, attendees elected Dr Omar Khorshid as AMA’s new President and Dr Chris Moy as Vice President. Dr Khorshid said his priorities for his term as AMA President are to: reaffirm the AMA as a strong, independent voice for health, with a critical role to hold governments to account, particularly on their handling of COVID-19;
restart efforts to address financial sustainability of the nation’s public and private health system and to fully utilise and develop the quality and capacity of public and private care; halt the slide towards funderdirected managed care;
MBBS FRACS FAORTHA FAMA ADVDIPMGT GAICD
Dr Omar Khorshid is an experienced medical leader and orthopedic surgeon, specialising in hip and knee surgery and working across the public and private sectors. He’s been on Federal Council for most of the last 15 years, and was AMA WA President from 2017 to 2019. During his tenure as State President, Dr Khorshid focused strongly on advocacy for better clinician engagement in public
Dr Chris Moy MBBS FRACGP FAMA
AMA Vice President
seek action from governments and the community on important public health issues, including climate change and climate health impacts.
promote the value and cost effectiveness of high quality general practice at the core of the health system and as a gateway to more expensive care;
Dr Omar Khorshid
AMA President
foster better gender equity within the leadership of the medical profession; and
Dr Chris Moy is a general practitioner with more than 25 years of experience and initially came to be involved with the AMA because of his expertise in aged care, palliative care and health communication systems. Dr Moy is a member of Federal Council and the Medical Practice Committee and is the current AMA SA President. Over the past four years, he’s been the Chair of the Federal AMA Ethics and Medico-Legal
hospitals. He also forcefully advocated in a range of key public health issues including obesity, vaccinations and alcohol abuse. Omar has held a leadership role throughout his career in a number of bodies, in addition to the AMA, including public hospitals, private practice and in medical education. In each of these roles, he has been able to achieve significant and long-lasting change against substantial odds.
Committee, where he’s helped navigate the passage of AMA position statements on complex and difficult issues, such as voluntary assisted dying, conflicts of interest and conscientious objection. Dr Moy has frequently been called upon to fulfill national media duties beyond his state duties. Recently, his calm manner has helped people across the country clearly understand and trust the health and scientific reasoning behind the often difficult decisions during COVID-19.
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The big issues for Queensland election With the Queensland election set for 31 October, AMA Queensland has developed an 11-point action plan for better health for Queenslanders. The document is our memberinformed plan for how Queensland taxes could be best spent for the good of our members, patients and the community.
ADVOCACY FOR MEMBERS 1. Strengthen the involvement of doctors in healthcare decision-making AMA Queensland believes an incoming government must strengthen medical leadership in the health system and support doctor-led, collaborative, multi-disciplinary healthcare to restore public confidence in the health system. Our members are calling for greater involvement in pandemic planning, in decisions regarding elective surgery and billing practices, a guaranteed supply of PPE for doctors in public hospitals and private practice and an improved model of discharge management between the hospital system and primary care. 2. Address medical workforce issues in regional, rural and remote communities AMA Queensland recognises that there are significant medical workforce issues in regional, rural and remote communities, a situation which has not been made any easier due to the current pandemic. 20 Doctor Q Spring
3. Improve the health of doctors Doctors require a safe environment to work in, in order to provide the best possible patient care. While AMA Queensland commends Queensland Health in their efforts to stamp out practices such as bullying, sexual harassment and fatigue, more needs to be done to improve the health of doctors.
ADVOCACY FOR PATIENTS 4. Optimise the use of digital technologies through clinical involvement
Support the use of telemedicine
ieMR
EMR in Northern Cairns
Electronic Prescribing
RTR and QSCRIPT
5. Invest in on-the-ground pain management services AMA Queensland congratulates the Palaszczuk Government for assessing the unmet need for pain management services in Queensland and releasing the report Pain is everyone’s business (mapping of persistent pain management services in Queensland), particularly as chronic pain affects one in five people at an estimated cost to the Queensland economy of close to $30bn per year. We need to expand adult pain management services, expand and develop paediatric pain services and enhance integrated care. 6. Strengthen the role of primary care in managing the use of opioids AMA Queensland is calling for urgent action on the misuse of opioids in Queensland. In 201920, 2.947m controlled drug prescriptions were dispensed in Queensland community pharmacies. This represents a 22 per cent increase since 201718 despite recent action by Queensland Health to expand the type of prescribers under the Queensland Opioid Treatment
Program, more support services through alcohol and drug services for people addicted to opioids and training modules on addiction medicine for doctors on eLAMP. Clearly the current strategies have been ineffective. 7. Improve the health of Aboriginal and Torres Strait Islander Queenslanders Aboriginal and Torres Strait Islander Queenslanders experience a disproportionate burden of disease compared with others. We need urgent action to establish a palliative care program, an Indigenous Hospital and Health System and address unmet need in oral health and pain management services. 8. Improve women’s health services in rural and remote communities AMA Queensland wants to see an incoming Queensland Government strengthen the role of specialist obstetricians and doctors with obstetrics experience in the delivery of maternity care. We believe the role of specialist obstetricians and doctors with obstetrics experience has been devalued in recent years by Queensland Health in favour of midwife-led maternity care in regional communities in this state.
ADVOCACY FOR THE COMMUNITY 9. Strengthen aged care, palliative care and choices at end of life The demand for quality palliative care in all healthcare settings is increasing as our population ages. Palliative care in Queensland is drastically underfunded, with Queensland only having half the number of specialist palliative care services to meet community demands. We need to improve health literacy about choices at end of life through a state-wide public education program and increased emphasis on advanced health directives.
AMA Queensland wants to see Queensland become a world leader in care at the end of life. This begins in the aged care sector. When Queenslanders enter the aged care system, there is an expectation that our most vulnerable citizens will be looked after. Currently, this is simply not the case in Queensland. 10. Reduce alcohol-related harm and violence Alcohol is the fifth highest risk factor contributing to disease burden in Australia, leading to alcohol-related harm and violence, Foetal Alcohol Spectrum Disorder, road crash fatalities, as well as 26 diseases and injuries, including six types of cancer, four cardiovascular diseases, chronic liver disease and pancreatitis. 11. Reduce carbon emissions in hospital and healthcare systems The healthcare sector is responsible for at least seven per cent of emissions, with GP clinics contributing four per cent and hospitals contributing 44 per cent of total global emissions.1 The Queensland Government is aiming to reduce emissions by 30 per cent by 2030 and reach zero emissions by 2050.2 AMA Queensland has placed environmental sustainability as one of the top priorities for 2020, and will continue to advocate for more action. AMA has joined the Global Green and Healthy Hospital network as a health professional and academic organisation and is willing to work with the Queensland Government towards a more sustainable healthcare system.
1 M alik, A., Lenzen, M., McAlister, S., McGain, F,. (2018) The Carbon footprint of Australian health care, Vol2 January 2018 The Lancet 2 D epartment of Environment and Heritage Protection, “Pathways to a Clean Growth Economy.”, 4. https://www.qld.gov.au/__data/assets/pdf_ file/0026/67283/qld-climate-transition-strategy.pdf
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JOHN COSGROVE Senior Industrial Advocate, AMA Queensland and Chief Industrial Advocate, ASMOFQ E: j.cosgrove@amaq. com.au P: (07) 3872 2222 M: 0417 972 038 W: www.asmofq.org.au
COVID-19 delayed pay rises A 2.5 per cent annual pay increase was agreed upon in the Medical Officers’ (Queensland Health) Certified Agreement (No. 5) (MOCA 5), as well as the Mater Resident Medical Officers’ Enterprise Agreement. This increase was due on 1 July 2020. However, when COVID-19 hit, both organisations decided to defer the pay increase. While the reason for this deferment is understandable, the correct process needs to be followed for this to occur: employees need the change to be put forward via ballot and voted on. Queensland Health did not follow the correct process, so the Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) raised this
22 Doctor Q Spring
issue and now medical officers under the MOCA 5 agreement will receive a 2.5 per cent increase in July 2021, and a newly-negotiated additional 2.5 per cent payment in December 2021. In relation to the Mater Resident Medical Officers’ Enterprise Agreement, the Mater sought to defer the pay increase payable on 1 July 2020, and communicated with ASMOF about the need to defer. ASMOF again argued that the correct consultation with employees had not been followed, and in any case, the agreement could not be varied retrospectively. ASMOF advised Mater of this accordingly and further that to delay the increase would represent an enterprise bargaining agreement breach likely to give rise to dispute.
Mater CEO, Peter Steer has since confirmed that the applicable increase was paid on 29 July. However, this advice came with the caveat that “Mater will in future seek an opportunity to review and realign these wage rates to meet the financial impact of this time and in order to enable a smooth employee rotational transition between Mater and Queensland Health.” This positon raises concern for us as we are unclear on the mechanism through which such an alignment could be achieved outside of an enterprise bargaining process.
Sleep Physician Consultations and Sleep Investigations IMPORTANT INFORMATION FOR REFERRING DOCTORS Queensland Sleep has recommenced in-hospital and ambulatory (home) diagnostic and titration studies, aligning with current Department of Health guidelines to relax the restrictions on elective surgery which were released on 21 April 2020. All patients will be screened pre-study and testing will be postponed if symptomatic, pending further medical investigation. • Pre-test screening will include:
• Increased PPE and distancing:
– Pre-test temperature screening. – Questioning to identify any fever, cough, sore throat, SOB , recent international travel or contact with someone diagnosed with or suspected of having coronavirus. Sleep Physician and Teleconsultations • Available via telehealth and telephone in line with the new MBS item numbers. • Referrals for consultations and/or sleep investigations should be faxed to 3217 2523 or sent via Medical Objects, Medical Director, Best Practice or Genie templates.
– In-lab sleep investigations performed in private rooms with bathroom. – Portable (home) studies performed in the patient’s home by sleep technicians. – 4m2 rule per person strictly adhered to.
Equipment Rental and Purchase • Queensland Sleep can facilitate the hire and sale of CPAP equipment via its retail arm Sleep Healthcare Australia. – Equipment and pressures will be supplied in line with the prescription and without modification. • Sleep Healthcare Australia is an authorised equipment supplier to DVA patients. • Continuous treatment monitoring by Sleep Scientists via 4G enabled rental equipment. – Usage and compliance data is uploaded to the cloud daily and can be accessed via a secure password protected site. – Compliance monitoring and 4G access is at no additional cost to the patient.
More Information? 1800 717 566 @clinical@qsdu.com.au
www.queenslandsleep.com.au
Doctors need access to PPE While doctors are used to putting their health and safety at risk in order to treat their patients, a global pandemic has highlighted our muchneeded doctors’ vulnerability. Dr Norman Swan explained that “COVID-19 has two or three times the transmission rate (compared with the flu)… and the case fatality rate for COVID-19 is around 30 times higher than the flu.” The availability and supply of personal protective equipment (PPE) has been a concern around the world since the beginning of the pandemic.
HOSPITALS
PRACTICES
The Australian Salaried Medical Officers Federation (ASMOF) has an ongoing dispute in the Queensland Industrial Relations Commission regarding PPE.
AMA Queensland is working with Queensland Health and the primary care sector to ensure clear and transparent communication to all frontline health workers in the community regarding access to and distribution of PPE.
This matter remains in abeyance for the protection of members and can be called on at any time if necessary to address any concern surrounding supply and distribution of vital PPE in Queensland. ASMOF recently attended Queensland Health’s PPE Distribution Centre at Richlands to inspect supply and confirm supply mechanisms were adequate. During the inspection, a number of issues were raised and ASMOF advised Queensland Health that we were considering calling the dispute back on. While awaiting further response to these issues, as well as a breakdown on the number and types of PPE, the Queensland Government has now released a video on social media confirming the number and types of PPE available.
In late August, AMA Queensland put the case out to media that many practices were paying thousands for PPE themselves because the Commonwealth’s PPE supply and distribution network was unreliable. GP practices in Greater Brisbane, Darling Downs and Gold Coast areas are now considered ‘moderate risk’ under Queensland Health’s new PPE guidelines, announced in late August and remain in place until at least the end of September. AMA Queensland Councillor and GP Dr Maria Boulton said this meant the clinic where she worked would need to provide masks for its 13 doctors and 15,000 patients. “GPs have had poor access to PPE from the start of the pandemic and it’s frustrating we find ourselves in the same position today as we were at the start of March with an unreliable supply chain and no transparency on availability,” she said. “We’ve been advised to source PPE through our private suppliers but they are hard to find and very expensive. Many GP clinics are already under financial strain because of the increased costs and decreased revenue during COVID-19. This will push many of them under.” Ms Boulton said GPs were committed to continuing to provide healthcare in their communities, but needed a greater level of support from all levels of government.
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“Allowing those at the frontline of our primary health care to go unprotected and unsupported is unacceptable,” she said.
Conversion therapy LEAVING DOCTORS OUT OF THE FIRING LINE In August this year, the Queensland Government passed the new Health Legislation Amendment Bill of 2019, which amends the Public Health Act 2005. This new bill bans conversion therapy, the practice of trying to change an individual’s gender identity and sexual orientation from homosexual or bisexual to heterosexual using psychological, physical or spiritual interventions. AMA Queensland acknowledges the harm that the practice of conversion therapy has on lesbian, gay, bisexual, transgender/transsexual, intersex and queer/questioning, asexual and other (LGBTIQA+) people. AMA Queensland supports the ban on conversion therapy. AMA Queensland also supports the inclusion of all unregulated practitioners involved in conversion therapy. Particularly in the case of a patient with gender dysphoria, a multidisciplinary team of medical professionals – paediatricians, general practitioners, surgeons, endocrinologists, gynaecologists, psychiatrists – is necessary to assist the patient investigating their dysphoria and their possible transition to their preferred gender. While the legislation was intended to protect LGBTIQA+ people from harmful and unethical interventions, AMA Queensland, after feedback from members, was concerned that the wording of the legislation could lead to the prosecution of health professionals providing evidence-based practices. As one of our members, Dr Cary Breakey wrote in his submission: “the legislation effectively puts any psychotherapy and family therapy practitioners at risk of offending if not “affirming” the child’s (or even adults) gender preference. Even gender clinics who do comprehensive evaluations of family and dynamic drivers of the child’s gender feelings could be vulnerable, especially if they identify powerful parental dynamics heavily influencing the child’s expression.” 26 Doctor Q Spring
This view is supported by another AMA Queensland member, Dr Peter Parry, who wrote in his submission: “Gender dysphoria varies with circumstances in any particular individual and some cases persist, whilst many desist and become more comfortable with birth gender or a same-sex orientation. In my view, the bill as it currently is written, does not provide sufficient protection for therapists to assist young people – in the area of gender dysphoria – to explore possible family, psychological or social dynamic causes of their gender dysphoria.” The Queensland Government passed the Health Legislation Amendment Bill 2019 on 13 August 2020, making Queensland the first Australian state to criminalise gay conversion therapy. While the government did not include all the changes AMA Queensland recommended, they did clarify the definition section about what constitutes an indictable offence, which means AMA Queensland members who are providing therapeutic services for those with gender dysphoria will not be in breach. This Bill now outlaws practices such as electro-shock therapy, drug and hypno-therapies with the intention of changing a person’s sexuality and gender identity. The ACT and Victoria have also committed to banning conversion therapy, which is a change AMA Queensland welcomes. AMA Queensland put forward that the definition within the bill should be:
“Conversion therapy is a treatment for which the only intent is to attempt to change or suppress a person’s sexual orientation or gender identity”. While this change was not implemented, examples were added to the Bill’s definition which made clear that medical professionals providing evidence-based practices would not be liable for prosecution. Within the bill, the definition of conversion therapy is: Conversion therapy is a treatment or other practice that attempts to change or suppress a person’s sexual orientation or gender identity. Examples — conditioning techniques such as aversion therapy, psychoanalysis and hypnotherapy that aim to change or suppress a person’s sexual orientation or gender identity; other clinical interventions, including counselling, that encourage a person to change or suppress the person’s sexual orientation or gender identity; or group activities that aim to change or suppress a person’s sexual orientation or gender identity. Conversion therapy does not include a practice that — (a) assists a person who is undergoing a gender transition; or (b) assists a person who is considering undergoing a gender transition; or (c) assists a person to express their gender identity; or (d) provides acceptance, support and understanding of a person; or (e) facilitates a person’s coping skills, social support and identity exploration and development.
Examples — diagnosis and assessment of persons with gender dysphoria or gender non-conforming behaviour or identity; support for persons with social adjustments related to gender dysphoria; g ender-affirming hormone treatment; and other gender transition services, such as speech pathology services for trans-gender and gender-diverse persons who wish to alter their voice and communication to better align with their gender identity. Also, conversion therapy does not include a practice by a health service provider that, in the provider’s reasonable professional judgment, is necessary to — (a) provide a health service in a manner that is safe and appropriate; or (b) comply with the provider’s legal or professional obligations.
GUIDELINES FOR CLINICIANS AMA Queensland would suggest all medical colleges who have member doctors involved in treating gender dysphoric children (paediatricians, general practitioners, surgeons, endocrinologists, gynaecologists, psychiatrists), the National Health and Medical Research Council, the Medical Board of Australia, along with the Australian Medical Association, the National Association of Practising Psychiatrist (NAPP) and other representative medical bodies, to form a joint committee to develop a set of practice guidelines for the assessment and treatment of children and adolescents under the age of 18 years presenting with gender dysphoria.
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High Court ruling shows a day is a day THE FINDING On 13 August 2020, the High Court handed down a decision about the method of accruing and taking paid personal/carer’s leave under the National Employment Standards. The High Court has found that the entitlement to 10 days of personal/ carer’s leave is calculated based on an employee’s hours of work, not days. Ten (10) days of personal leave can be calculated as 1/26 of an employee’s ordinary hours of work in a year. In summary, if an employee’s regular work day is 12 hours, then their personal/carer’s leave (sick day) is also 12 hours.
THE CASE In August 2019, employees at a food manufacturing plant argued they were entitled to ten 12-hour days of personal/carer’s leave a year, due to their ordinary hours in a day containing 12-hour shifts. Under their employment contract, employees worked 36 hours per week, averaged over a four-week cycle. This resulted in their ordinary hours containing, on average, three 12-hour shifts per week. 28 Doctor Q Spring
Where an employee took personal/ carer’s leave for a day, the employee had 12 hours deducted from their leave accrual. This meant that employees were only receiving eight days of personal/carer’s leave per annum.
ACTION As a result, the Australian Manufacturing Workers’ Union (AMWU) representing the employees claimed that the National Employment Standards (NES), entitled them to accrue ten 12-hour shifts (120 hours for these employees specifically) of paid personal/carer’s leave per year of service. Section 96 of the Fair Work Act 2009 states: for each year of service with his or her employer, an employee is entitled to 10 days of paid personal/carer’s leave. an employee’s entitlement to paid personal/carer’s leave accrues progressively during a year of service according to the employee’s ordinary hours of work, and accumulates from year to year.
The interpretation of the word ‘day’ is central to the cause of the dispute. AMWU argued that the word ‘day’ refers to a normal ‘calendar day’, where employees are able to be absent from work over 10 calendar days in a year without the loss of pay (i.e. 120 hours for the employees in this case). Whereas the employer argued the word ‘day’ refers to a ‘notional day’ where the hours are calculated in reference of the employees average weekly ordinary hours divided by five.
EXAMPLE Jeffrey is a permanent part-time employee who will accrue personal/ carer’s leave on a pro-rata basis and is contracted to work 25 ordinary hours per week. Over the period of a year, Jeffrey works 1,300 hours (25 hrs per week x 52 weeks in a year). Personal/carer’s leave is applied at a rate of 1/26 of the total ordinary hours per annum. The calculation for this is: 1,300 hours per annum divided by 26 which equals 50 hours of personal/ carer’s leave per annum.
ACCESS TO THE LATEST EMPLOYMENT CONTRACTS
COMPREHENSIVE WORKPLACE RELATIONS MANUALS
FREE WORKPLACE RELATIONS TRAINING
PLUS LOADS MORE
(07) 3872 2222
workplacerelations@amaq.com.au https://ama.com.au/qld/wr-advisory-package
FRA N SMI TH PRA CTIC E COO RDI NAT OR
#MEDBIKINI
We are physicians, we are leaders and we are human The Journal of Vascular Surgery recently published an article ‘prevalence of unprofessional social media content among young vascular surgeons’1 which attempted to classify the behaviour of trainees based on their posts. Aside from the concerning use of fake accounts to gain access to review private social media accounts, the article also cited ‘intoxicated appearance’, ‘profanity’, ‘controversial political or religious comments’, ‘controversial social topics’ and ‘inappropriate attire’ as either clearly or potentially unprofessional. Inappropriate attire was deemed by the authors as ‘pictures in underwear’, ‘provocative Halloween costumes’ and ‘provocative posing in bikinis/ swimwear’1. Controversial political, religious and social comments were defined as ‘any derogatory or demeaning comments directed toward an individual or specific faith’ and ‘around specific stances on abortion and gun control’1.
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The team of seven authors, which included one female, then determined what was provocative, derogatory and demeaning1. While authors of the article noted that 68 per cent of the investigated profiles were male trainees1, by specifying that ‘bikinis’ were unprofessional they enabled bias towards women, as the clothing item is defined as a two-piece swimming costume2. The Journal of Vascular Surgery in the announcement of the article’s retraction claims that the authors ‘were attempting to advise young vascular surgeons about the risks of social media’3 but in reality what they have done is shame medical professionals, notably women, for their choice of attire and opinions on key health issues. Professionalism is a concept drilled into physicians from the beginning of our medical education4, what to wear, what to say and how to act. As such, unfortunately, the article did not come as a surprise to most. What was surprising was that physicians’ attire outside work captured on private social media posts was considered to affect their behaviour at work. From the retraction statement and Twitter posts from the authors following backlash, it seems that while possibly misguided, there was no harmful intent. However, what the article fails to recognise nor mention is the importance of activities outside of medicine in the prevention of physician burnout. McManus et al5 highlight the importance of hobbies
in not only preventing burnout but supporting humane behaviour and in fact increasing engagement at work by physicians. To that effect it is readily recognised that exercise, including swimming and cycling can decrease emotional distress and perceived workplace stressors6. This is supported by an innumerable amount of medical organisations including the Australian Medical Association7. This begs the question that if we are being encouraged to partake in activities outside medicine to make us better doctors, why are we also being shamed for doing so? The article in the Journal of Vascular Surgery had claimed comments on ‘specific stances on abortion and gun control’ were unprofessional1. This starkly contradicts requirements by the Australian Medical Council for medical students to demonstrate at graduation an understanding of health issues and determinants but also to communicate effectively in health advocacy4. Jones et al8 emphasise that physicians aren’t gatekeepers in gun control but play a key role in advocating for public health and safety. This is further purported by the American Medical Association who defines gun violence as a public health crisis which requires physician leadership9. A similarly divisive health issue is access and use of termination services10,11. Globally the laws vary from time to access, indications, methods and the depth of medical assessment required12.
As is with the general public, termination services can pull starkly different opinions within the medical profession. Conscientious objection refers to when a physician’s personal belief or values are in conflict with a patient’s appropriate treatment13,14. The key with the principle is that doctors who conscientiously object to a treatment must refer their patients in a timely manner to another medical professional who can provide them with the medical care they seek15. Thus the personal opinions of medical professionals, whether it be related to gun control or termination services, should not affect their care of patients nor their behaviour at work. It is not a novel concept for physicians to be critiqued for their attitudes, behaviour and opinions at work. What is undeniably unacceptable is for that critique to extend to our private lives which have zero impact on patient care or the workplace. The public and our profession needs to remember we are physicians but we are also human beings with opinions, hobbies and lives outside of medicine.
REFERENCES: 1. Hardouin S, Cheng T, Mitchell E, et al. Prevalence of unprofessional social media content among young vascular surgeons. J Vasc Surg. 2020 Aug;72(2):667-671. 2. Oxford Learner’s Dictionaries[Internet]. Bikini; [cited 2020 Jul 31]; [about 1 screen]. Available from: https://www.oxfordlearnersdictionaries.com/ definition/english/bikini?q=bikini 3. Journal of Vascular Surgery. Editors Statement Regarding “Prevalence of unprofessional social media content among young vascular surgeons” J Vasc Surg 2020;72:667-7 [Internet]. Society for Vascular Surgery; 2020 [cited 2020 Jul 31]. Available from: https://vascular.org/news-advocacy/editors’statement-regarding-“prevalence-unprofessionalsocial-media-content-among. 4. Australian Medical Council. Standards for Assessment and Accreditation of Primary Medical Programs by the Australian Medical Council 2012[Internet]. Kingston(ACT) : Australian Medical Council Limited; 2012 [cited 2020 Jul 31]. Available from: https:// www.amc.org.au/wp-content/uploads/2019/10/ Standards-for-Assessment-and-Accreditation-ofPrimary-Medical-Programs-by-the-AustralianMedical-Council-2012.pdf 5. McManus IC, Jonvik H, Richards P, Paice E. Vocation and avocation: leisure activities correlate with professional engagement, but not burnout, in a cross-sectional survey of UK doctors. BMC Med. 2011; 9:100. 6. Bretland RJ, Thorsteinsson EB. Reducing workplace burnout: the relative benefits of cardiovascular and resistance exercise. PeerJ. 2015 Apr 9;3:e891. 7. Australian Medical Association. AMA Survey Report on Junior Doctor Health and Wellbeing[Internet]. Barton(ACT) : Australian Medical Association; 2008 [cited 2020 Jul 31]. Available from: https://ama.com. au/system/tdf/documents/JDHS_report_FINAL_0. pdf?file=1&type=node&id=37410 8. Jones N, Nguyen J, Strand NK, Reeves K. What Should Be the Scope of Physicians Roles in Responding to Gun Violence. AMA J Ethics. 2018 Jan 1; 20(1): 84-90.
D R N ATA S H A ABEYSEKERA
Executive member of the AMA Queensland Council of Doctors in Training. She is currently working as a resident medical officer at the Royal Brisbane and Women’s Hospital.
E M I LY S H A O
Executive member of the AMA Queensland Council of Doctors in Training. She is currently working as a resident medical officer at the Royal Brisbane and Women’s Hospital.
9. Robeznieks A. America’s heartbroken physicians demand action on gun violence. The American Medical Association [Internet]. 2019 Aug 5 [cited 2020 Jul 31]. Available from: https://www.ama-assn.org/deliveringcare/public-health/americas-heartbroken-physiciansdemand-action-gun-violence 10. Raymond E, Kaczorowski J, Smith P, Sellors J, Walsh A. Medical abortion and family physicians survey of residents and practitioners in two Ontario settings. Can Fam Physician. 2002 Mar; 48: 538-544. 11. Harries J, Stison K, Orner P. Health care providers’ attitudes towards termination of pregnancy: A qualitative study in South Africa. BMC Public Health. 2009; 9: 296. 12. Berer M. Abortion Law and Policy Around the World in Search of Decriminilization. Health Hum Rights. 2017 Jun; 19(1): 13-27. 13. Shanawani H. The Challenges of Conscientious Objection in Health care. J Relig Health. 2016 Apr; 55(2):384-93. 14. Lamb C. Conscientious Objection: Understanding the Right of Conscience in Health and Healthcare Practice. New Bioeth. 2016 Apr;22(1):33-44. 15. Cowley C. Conscientious objection in healthcare and the duty to refer. J Med Ethics. 2017 Apr; 43(4):207-212.
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Climate change letter to PM from Australia’s peak medical groups Australia’s peak medical groups have written to Prime Minister Scott Morrison urging him to act on climate change as part of the COVID-19 pandemic economic response, in order to better invest in Australians’ health. Coordinated by Doctors for the Environment Australia, the letter is signed by: Doctors for the Environment Australia (DEA); Australian Medical Association (AMA); Royal Australian College of General Practitioners (RACGP); Royal Australasian College of Physicians (RACP); Australasian College for Emergency Medicine (ACEM); Royal Australian and New Zealand College of Psychiatrists (RANZCP); Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG); Australian College of Rural and Remote Medicine (ACRRM); College of Intensive Care Medicine (CICM); and Australian Medical Students’ Association (AMSA).
The letter states, in part: The world is in the middle of two global health emergencies: the viral pandemic and climate change. As we continue efforts to limit the spread of the COVID-19 virus, we must ensure that we also have a wholeof-government approach towards addressing climate change, which also has potentially catastrophic health impacts. Carbon pollution and associated global warming will have profound consequences on the fundamentals of human health: clean air, water, access to food and a safe climate. The letter highlights this year’s unprecedented summer of bushfires and associated smoke pollution which together claimed more than 400 lives, and resulted in the hospitalisation of more than 3,000 people for heart and lung problems. The letter also notes the psychological health impacts that are likely to be present for decades. To reduce carbon emissions, which also worsens air pollution, the letter calls for: a transition away from fossil fuels – both coal and gas – to renewable energy. investment in projects and technologies that preserve our natural environment. investment in green infrastructure and public transport, which would have the additional benefits of promoting physical activity that would reduce diseases such as obesity and diabetes, and substantially improve air quality. The letter concludes: Australia has an unparalleled opportunity to act on climate change and invest in a cleaner, healthier and more prosperous future. We urge the Australian government to ensure that health remains a central focus of all aspects of the COVID-19 economic recovery and to support a healthy transition to a climate resilient economy.
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We want our Registrars to know we are there for them. GPTQ is Queensland’s leading education and training provider for doctors training to become General Practitioners. CEO Kathie Sadler talks leadership, the COVID crisis and why General Practice means something to everyone. Leading the GPTQ team
After nearly three decades working in commercial and corporate law, Kathie Sadler describes stepping into the role of CEO at General Practice Training Queensland (GPTQ) 18 months ago as a game changer. “I have spent many years working in high level corporate environments, where I thrived on the challenge and enjoyed building my negotiation and governance skills, but this role has affected me in new ways,” Kathie says. “GPTQ is an organisation that has a direct impact on primary healthcare outcomes and it feels deeply important to be using my skills and experience in this realm.” Harnessing opportunities for innovation
The COVID-19 pandemic has brought with it major challenges, but Kathie says she and the GPTQ Executive Leadership Team have worked hard to approach the crisis as an opportunity for innovation. “We are operating within a new environment and there are challenges, but there are also new opportunities,” she says. When the country went into lockdown in March, GPTQ had been preparing to transition to a new IT platform. The transition, slated to occur over several months, was swiftly fast-tracked. “It was going to provide us with much greater agility and capability — particularly with digital communication — so we just did it,” Kathie explains. The COVID crisis also prompted a ‘rethink’ of operational management. “I have expanded our management and leadership teams to fine tune responsibilities and encourage more joint decision-making,” Kathie explains.
“We now have regular scheduled meetings between all of the teams so everyone is involved and engaged. All the cogs in our machine are working together collaboratively.” Advocating for General Practice
Since the pandemic began GPTQ has been a part of weekly COVID-19 Queensland Health Emergency Coordination Centre (SCHECC) teleconferences. “We share the information we are getting from practices on the frontline and we advocate for our Registrars, Supervisors and practice staff,” Kathie says. “These are unprecedented times and General Practice needs to be supported at every turn.” Keeping Registrars connected
COVID-19 has meant re-imagining how some aspects of GP education and training are delivered. “We have had to find new and innovative ways to make sure the interactions and touch points that are so important for our Registrars are still there,” Kathie says. “COVID has presented at a time when we have the technology to maintain high levels of connection between our Educators and Registrars and for that we’re grateful.” Partnerships
GPTQ works in close partnership with the RACGP and ACRRM to deliver education and training that shapes exceptional GPs. “Excellent primary healthcare is the backbone of our communities,” Kathie says. “We look at every cohort of Registrars as our best advertisement for General Practice, because if their training experience sets them on a path to a fulfilling career we know we’ll have people
knocking at the door to join this wonderful profession.” Taking GP education to the next stage
A transition is underway in the world of General Practice education and training. By 2022 training responsibilities will have been transferred from the Commonwealth Department of Health to the Colleges. “We are excited about the opportunities this will bring,” Kathie says. General Practice is vital
Coming from a professional background outside of medicine, Kathie says she was surprised to discover General Practice is not always given the recognition it deserves. “In the minds of a lot of people General Practice is not afforded the same respect as other medical specialties and I wasn’t aware of that before coming to work for GPTQ,” she explains. “This is mystifying to me because, as a mother of three very active children (now in their 20s), our family GP has always has been an important part of our life,” she says.
The impact a GP has on a person’s health trajectory should never be underacknowledged.
Educating, inspiring and preparing GPs to deliver quality primary care.
r e m glim
A
of hope
For a condition that affects one in six women in their lifetime, pregnancy loss remains a surprisingly taboo topic of conversation. The mere mention of the idea often feels anxiety-provoking at best, and like casting a ‘bad luck’ curse upon a mother at worst. ‘The Glimmer Podcast’ aims to change that, with the podcast and online program by Dr Ashleigh Smith offering a glimmer of hope during the agony of bereavement. We spoke to Dr Smith about her new venture, born from her own experience with losing her daughter Isla earlier this year.
As an obstetric registrar, even with the understanding that there is no such thing as a truly ‘low risk’ pregnancy, there is no amount of insider medical knowledge that can prepare you for this outcome. She was born at term with severe hypoxic ischaemic encephalopathy – it was all completely unexpected and culminated in having to make the very painful decision to extubate and palliate her when she was only two days old.
You not only had to deal with the loss of your beautiful daughter Isla, but you were then forced to do so without your usual support network due to the COVID-19 lockdown. My entire world came to a grinding halt. My husband had to go back to work at the hospital (as he is also medical). My family weren’t allowed to visit us. I stayed at home with our eldest daughter instead of sending her to day care, fearing the virus. Isla’s death, the pandemic, the grief, loneliness and isolation were so different to what I had expected of 2020.
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I n light of such unprecedented circumstances, you turned to support groups on Facebook but found they did more harm than good. We know the association between post-traumatic stress disorder and pregnancy loss, and recent literature calls for clinicians to view and approach bereaved mothers through the lens of trauma, much in the same way you would approach a returned soldier or victim of abuse. Contrary to this, many of the photos posted on charity-moderated Facebook forums are confronting and graphic, even for someone with a medical career. During this unprecedented time, it was not unusual for my Facebook feed to include images of friends and family, and then unexpectedly, a post from one of these forums would flash up – with a photo of a deceased baby. While I wholeheartedly appreciate the fact that these charity groups exist and are run on the good will of donations and volunteers, you also need to appreciate that publishing these images can be psychologically damaging to the unsuspecting viewer. This type of unpredictable trauma promotes hyper-vigilance and can be extremely harmful, especially when you are forced to relive the recent and unfathomable loss of your baby.
The Glimmer Podcast is not only a product of your remarkable resilience, but it has also become a fantastic resource for other women experiencing pregnancy loss. Why a podcast? Like many others in the face of tragedy, the only thing worse than it happening to your own family, is the knowledge that it continues to happen, every day, to others. In fact, stillbirth or neonatal death affects eight families every day in Australia. Furthermore, it affects millions worldwide annually. I decided to create a podcast, in part because I could do so from my living room over Zoom, but also because it
allowed me the freedom to ask the questions that I wanted to know the answers to, directed at the experts in the fields commonly accessed by grieving women. Questions like, “What did you find helpful?”, “Should everyone see a psychologist?” and “How do you know if you’re just going through grief or if you have PTSD or depression?”. With the Glimmer podcast, I now have an incredible ‘excuse’ to interview international speakers, psychologists, doctors, researchers and the international stillbirth alliance. These interviews can then be broadcast around the world, straight into the ears of the women and families that need to hear them – for free! It has proven to be an invaluable way to disseminate the wisdom and insights these experts have.
The response has been fantastic, with the podcast already reaching the #2 position on the iTunes podcasts chart in the genre. I didn’t expect for it to resonate with so many people, worldwide - not only with women in the early stages of their pregnancy loss, but also women 60 years later, their friends and families. After everything we have been through, I’m honoured to be able to produce something that is helping so many others. It feels like Isla’s legacy, and for that, I am so very proud.
seek out resources about perinatal grief to help normalise the process and feel a sense of unity in their own personal journey.
And finally, if you could give any advice to primary care or specialist clinicians managing patients living through pregnancy loss, what would it be? Listen more than you talk and gently steer the conversation with intuition and understanding rather than overloading her with pamphlets. Offer referral to perinatal loss grief counselling. Direct her to the support groups and online resources like SANDS, Bears of Hope, Red Nose (or even our The Glimmer podcast and 8-week online meditation and peer-support program). Individualise your care rather than reaching for stock-standard antidepressants or sleeping tablets. Never underestimate the importance of correctly identifying what is normal grief and what is pathological, particularly when the conditions can overlap significantly. Don’t be afraid to use the baby’s name – most mothers wish more people would say their baby’s name, even if it’s just so they can hear it being spoken aloud.
What would be your own advice to other grieving parents? Don’t let yourself go through this alone. Peer support is essential, because unless someone has experienced the loss of a child, they cannot truly comprehend the nuances of this unimaginably tragic and painful experience. I love mindfulness meditation and use it daily, as it has been proven to be effective in grief and allows me to centre my emotions in the present moment. I also encourage women to Doctor Q Spring 35
Doctors’ Health in Queensland Recently in these COVID-19 times, many of us have been reflecting on how best to support and enhance doctors’ health and wellbeing. Pursuing wellness has involved considering the many dimensions of wellness. While these may be categorised in many different ways, it is reasonable to consider physical, mental, social, spiritual, workplace, medicolegal and financial as key dimensions. Others may add or replace some of these with other dimensions such as environmental or emotional. The fundamental issue is that there are multiple dimensions. We need to foster our self-reflective skills to effectively address each of these dimensions. While doctors’ health and wellness may be a novel concept to some, for over thirty years, the Doctors’ Health Advisory Service (Queensland) (DHAS(Q)) has been championing these
issues and supporting colleagues when they most need it. Currently, DHAS(Q) is led by Dr Anne Ulcoq as President, supported by an active management committee, with doctors from a variety of specialties and stages of training together with other professionals who care, providing their expertise and insights. In 2016, DHAS(Q) established its service arm, Queensland Doctors’ Health Programme (QDHP). QDHP has been receiving a small amount of funding from the Medical Board of Australia. The funding is received at arm’s length via AMA to ensure its independence. The QDHP Board, chaired by Dr Ross Phillipson, has a diverse skill mix including medicolegal, accounting, business and HR skills complementing the medical expertise. This year, DHAS(Q) has announced it will be trading with a new name – Doctors’ Health in Queensland (DHQ) – Leading doctors’ health and wellbeing in Queensland. With its new branding, it is hoped that it will be easier for doctors and medical students to find help when they need it.
DR MARGARET K AY Doctors’ Health in Queensland
We are establishing a new ‘find a health professional’ portal to help doctors and medical students find a GP or psychologist to support help seeking and enable health care access. Visit us at: www.dhq.org.au Confidential, free, independent colleague to colleague support is available for doctors and medical students in distress 24 hours a day on (07) 3833 4352. Our phone number has always remained the same since our service began. DHQ is very grateful for its band of experienced general practitioners who regularly volunteer their time to take the calls from their colleagues. Our bespoke service is run for doctors, by doctors. If you are interested in providing this support, then feel free to contact us: admin@dhq.org.au We also have a number of resources available to help promote our service. We encourage everyone to ensure that their colleagues and medical students know about DHQ. We also provide doctors’ health education, including workshops, across the breadth of this field, including being a doctor caring for doctors.
Queensland Doctors’ Health Programme is the service arm of Doctors’ Health in Queensland. QDHP is an independent service supported through funding from the Medical Board of Australia.
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All electric, all Audi. The striking face of the future, now a reality in the present. The first all electric Audi is set to define a new era of mobility.
The all-new Audi e-tron.
audi.com.au Overseas model with optional equipment shown.
DR ALEX MARKWELL
Queensland Clinical Senate Chair
Disruption to health system a chance to redesign care COVID-19 has disrupted our health system and society. This has given us an unexpected and once-in-a-lifetime opportunity to disrupt the way we provide care. In a very short space of time, we have been able to innovate and implement new models of care so that Queenslanders can access care at, or closer to home. We have also seen a real shift towards stopping low benefit care.
what is possible when we are able to ‘just crack on and do it’.
Deliver care at or closer to home and centred around the patient
Queensland has realised the benefit of an early and pro-active political, social and public health response to COVID-19. We are one of a handful of countries able to contain this virus, giving the health system time to prepare and respond as the next cases of the virus emerge. COVID-19 will affect how we deliver care indefinitely.
Permanently discontinue low benefit care (LBC) that has been ceased during the pandemic
The enablers of this significant change can be attributed to having an overarching, clear and compelling goal, flexible funding, local permission to experiment and implement what was needed, effective communication and feedback, diverse engagement and collaboration in real time, intolerance of obstruction and establishment of networks across silos. The joint ownership of problems and solutions led to a flow of systems based on direct outcomes.
Redesigning what our “new normal” could look like is exciting, and clinicians, system leaders and consumers are all eager to be part of the process. No-one wants this true co-design opportunity to be missed. It is not feasible to return to the pre-COVID-19 normal.
The feedback and data tell a compelling story – change can work. Patients can receive care sooner and closer to home. Importantly, for our First Nations people, this means care on or closer to country. New collaborations and virtual care options have opened up access to some services which previously were essentially inaccessible. We have seen 38 Doctor Q Spring
To enable clinicians, system leaders and consumers across Queensland to contribute to this incredible reform, we held a virtual meeting of the Senate with around 200 people to discuss successful models of care during COVID-19 – which ones should continue and what barriers and enablers exist to make that happen. Acknowledging the jump in maturity of our networked governance system, the outcome from the meeting is a list of recommendations on the system-level strategies that are needed to embed these changes. These include:
Remove barriers to innovation and change to enable, not hinder, the delivery of efficient, modern healthcare Maintain the mature network governance, leadership and collaboration with health consumers and healthcare providers across sectors Ensure integrated and robust system-readiness from a supply perspective, including rapid scale up and distribution strategies. You can read more about the meeting and recommendations, which have been endorsed by the Queensland Health Leadership Board, on our website. The Senate will continue to focus on this important reform agenda and explore further opportunities for clinicians, consumers, health services and the system to work together to provide a better experience and outcomes for Queenslanders in ways that we always wanted but never thought possible.
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.
SYMPTOMS AND PROGNOSIS OF COVID-19 IN CHILDREN
SURGICAL SMOKE IN THE ERA OF THE COVID-19 PANDEMIC
Paediatrics Research Review Issue 29 Reviewer: Professor Nicholas Freezer
Urology Practice Review Issue 3 Reviewer: Associate Professor Eric Chung
The WHO declared COVID-19 a pandemic on 11 March, 2020. In children, COVID-19 is usually a mild illness. In rare cases, children can be severely affected. In April of 2020, reports emerged from the UK of a presentation in children similar to incomplete Kawasaki disease (KD) or toxic shock syndrome (Riphagen et al., Lancet 2020). Since then, there have been increasing reports of similarly affected children in other parts of the world. The syndrome has been termed multisystem inflammatory syndrome in children (MIS-C). The prognosis of MIS-C is uncertain, given that it is a new clinical entity and our understanding of the disease is still evolving. Though MIS-C has many similarities to KD and toxic shock syndrome, it is clear that the disease course can be more severe, with many children requiring intensive care interventions. Most children survive, but deaths have been reported. Of the approximately 230 cases of suspected MIS-C reported by mid-May 2020, there were at least five deaths.
The COVID-19 pandemic has raised concerns about the risks of surgical smoke, including during urological procedures. Although there are no documented cases of COVID-19 transmission via surgical smoke to date, there are cases of other viral transmission (e.g. HPV) to surgical teams via aerosolisation. This article discusses incorporating smoke filtration to protect surgical personnel to mitigate infectious smoke transmission during surgery, but concludes that further studies are required to clearly describe the occupational health risks to surgical teams from surgical smoke exposure.
Current and back issues of Research Reviews can be found at www.researchreview.com.au. Australian health professionals can sign in and download copies. Doctor Q Spring 39
Events Calendar AM WO A Q M UE BR EN I ENS EA N M LA N KF A S E D I C D’ S T2 02 INE 0
AMA QUEENSLAND PRESENTS
Private practice webinar training series 2020
M E N TA L H E A LT H
PRIVATE PRACTICE WEBINAR TRAINING SERIES
WOMEN IN MEDICINE BREAKFAST
FRIDAY 13 NOV EMBER
Join this highly regarded networking event with fellow colleagues of the medical industry.
THUR SDAY 15 OC TOBER
Customer Service 101 – Learning from retail and hospitality Are you interested in brushing up on your workplace relations knowledge from the comfort of your own desk? Join AMA Queensland’s Workplace Relations Manager Sarah Lock for an in-depth 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 focus this year will be mental health. Come along to learn from the panel, being chaired by Vicky Dawes from Doctors’ Health in Queensland.
2020 Events
Visit www.amaq.com.au/events for more information or to register for our events.
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PRIVATE PRACTICE CONFERENCE Date: Friday 27 November Location: Brisbane Convention and Exhibition Centre
DINNER FOR THE PROFESSION Date: Friday 27 November Location: Sky Room, Brisbane Convention and Exhibition Centre
MEDICO-LEGAL CONFERENCE Date: Saturday 28 November Location: Brisbane Convention and Exhibition Centre
Local Medical Association round up REDCLIFFE DISTRIC T LOC AL MEDIC AL A SSOCIATION ( RDLMA )
MACK AY LOC AL MEDIC AL A SSOCIATION ( MLMA )
Contact: Dr Kimberley Bondeson, President Web: w ww.redcliffedoctors medicalassociation.org.au Phone: (07) 3049 4444 Meetings: 30 September 27 October 20 November
Contact: Dr Bill Boyd Phone: 0419 676 660
SUNSHINE COA ST LOC AL MEDIC AL A SSOCIATION ( SCLMA ) Contact: Web: Email: Phone: Meetings:
Jo Bourke, Secretariat www.sclma.com.au jobo@squirrel.com.au (07) 5479 3979 24 September 29 October 26 November
GOLD COA ST MEDIC AL A SSOCIATION (GCMA ) Contact: Web: Email: Phone:
Professor Philip Morris www.gcma.org.au info@gcma.org.au 0419 780 505
IPS WICH & WEST MORETON MEDIC AL A SSOCIATION ( IWMMA ) Contacts: Dr David Morgan, President; Dr David Careless Vice President; Dr Thomas McEniery, Treasurer Phone: (07) 3281 1177 BRISBANE LOC AL MEDIC AL A SSOCIATION ( NLMA ) Contact: Dr Robert (Bob) Brown, President Web: w ww.northsidelocal medical.wordpress.com Phone: (07) 3265 3111 Meetings: 13 October 27 November FR A SER COA ST LOC AL MEDIC AL A SSOCIATION ( FCLMA ) Contact: Dr Nicholas Yim, Secretary Email: frasercoastlma@gmail.com Phone: 0421 659 892
TOOWOOMBA AND DARLING DOWNS LOC AL MEDIC AL A SSOCIATION ( TDDLMA ) Contacts: Dr Sally Sojan, 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) C AIRNS LOC AL MEDIC AL A SSOCIATION (CLMA ) Contact: Dr David Shepherd Phone: (07) 4031 8400 CENTR AL QUEENSL AND LOC AL MEDIC AL A SSOCIATION (CQLMA ) Contact: Dr Michael Donohue Phone: 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
The health and wellbeing of you The COVID-19 pandemic has introduced a new set of challenges many doctors have not experienced in their lifetimes. As we continue to live through this extraordinary global event, it becomes increasingly important that you continue to look after your own health while caring for the health and safety of others. The COVID-19 pandemic has placed a significant toll on our community and has caused uncertainty and fear around what is currently happening, and of what’s to come. This uncertainty and fear has been heightened for medical professionals who are dealing with the impact of COVID-19 on a daily basis. As the pandemic continues, anxieties among doctors and health professionals are continually evolving. Dr Kym Jenkins, Psychiatrist and Immediate Past President of RANZCP, says tangible worries that have troubled many healthcare workers include safety issues, such as the resourcing of PPE for staff and whether hospitals are able to accommodate an influx of COVID-19 patients. There also remains the possible risk of contracting the virus while responding on the front-line. “One of the most challenging things to work out from a mental health point of view is whether the healthcare worker is suffering from a mental health illness or whether they’re experiencing an understandable response to a completely abnormal situation,” explained Dr Jenkins. Although an increase in stress and anxiety has occurred across the healthcare profession due to COVID-19, those with a previous history of anxiety are more vulnerable at this time. Generally speaking, many of us have an increased level of baseline anxiety during COVID-19. The initial worries that were keeping us awake at night are to do with the fear that the worst is yet to come, not dissimilar to the devastating scenes observed overseas. 42 Doctor Q Spring
Doctors in private practice are also under significant pressure, adequately safeguarding their practice and staff, dealing with patients every day who may or may not be infected, shifting from face-to-face consults to learning how to navigate effectively through telehealth, and deciding whether to distance themselves from their family to avoid contaminating their loved ones in case they were infected, to name a few. The financial impact on private practice and allied health services is also becoming apparent, due to the temporary reduction of non-urgent elective surgery and social distancing measures restricting access to certain services. Those with families are having to juggle more roles, such as having to home school children and the stress that comes with blurring personal and professional lives.
THE CURRENT SITUATION AND BEYOND As we continue through more changes and disruption, we have witnessed parts of the economy gradually reopened and social restrictions slowly lifted. Although uncertainties around Victoria’s increase in cases, as well as clusters in parts of Sydney and regional NSW, continue to cause uncomfortable and uncertain times. This means also learning to deal with the consequences of living through a pandemic. “As time goes on we’re going to see more depression and despondency become apparent. The source of anxiety is going to be less in how people are handling things but a shift to those secondary considerations that aren’t directly related to the virus. It will be regarding the impact it’s having on their lives in areas such as relationships, career and income,” says Dr Jenkins.
This article was originally published in Avant’s ‘Connect’ magazine, with slight variation -‘Managing your health during a crisis’, written by Doctors’ Health Fund member and Avant Senior Medical Advisor Dr Richard Wilson.
As the world adapts to contain and fight the virus, the medical profession will have to accept COVID-19 as a longer-term, evolving event. This may mean that social norms will not go back to how it was pre-COVID-19, the general public will conform to a heightened sense of hygiene, and we will deal with evolving sets of anxieties as they unfold.
LOOKING AFTER YOUR OWN MENTAL HEALTH WHILE YOU LOOK AFTER THE COMMUNITY As we remain optimistic, the medical profession will emerge stronger together after having survived a pandemic. Not only are doctors faced with the enormous task of caring for others’ health and safety, but it is essential that you continue to look after your own mental health alongside your patients’. All Doctors’ Health Fund policies provide cover for services to help you look after your mental health and wellbeing, if and when you need to reach out for support. A wide range of mental health resources, support groups for health professionals, and COVID-related forums for doctors are available through various organisations and are updated on a regular basis.
We were made for you Preferred Provider
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Join the health fund where doctors belong You’re no ordinary doctor, so why choose an ordinary health fund? As the only health fund created for medical professionals, more doctors choose us for our quality cover and exceptional service. Our unique Top Cover Gold hospital pays up to the AMA list of medical services and fees, minimising potential out-of-pocket expenses and supporting you both as a patient and a medical professional. Plus, our generous extras covers give you complete choice of allied health provider, so you can choose who will treat you. We understand how valuable your time is, which is why our Member Service team will answer your call in less than 30 seconds. Talk to us today.
GET A QUOTE 1800 226 126 doctorshealthfund.com.au Join in just 5 minutes
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.
Managing COVID-19
IN THE WORKPL ACE As COVID-19 cases within Australia give no indication of easing up, state and territory governments have responded by imposing greater responsibility on employers to notify authorities of confirmed cases amongst their employees.
DO MEDICAL PRACTICES NEED TO NOTIFY OFFICIALS IN RELATION TO COVID-19 CASES? In Queensland, if there is a confirmed or probable case of COVID-19 at a workplace, including a medical practice, Queensland Health must be notified by the medical practitioner who confirmed the diagnosis of the infected employee. In addition, in Queensland, an employer must notify Workplace Health and Safety Queensland of a confirmed or probable case of COVID-19 which arises out of the conduct of that business, and which requires the person to have immediate treatment at the hospital as a patient.
DO WE NEED TO CLOSE OUR MEDICAL PRACTICE IF THERE IS A CONFIRMED CASE OF COVID-19? Generally speaking, there are three scenarios in which a medical practice may consider closing down their practice and undertaking a deep clean, being that: 1. there is a confirmed case of a staff member diagnosed with COVID-19, or; 2. a staff member has been exposed to a person confirmed as having COVID-19; or 3. a patient has attended the practice and has been diagnosed with COVID-19.
In these cases, employers should seek immediate advice from Queensland Health for their particular situation. It is natural that employers may face general concern from other staff members about potential exposure to the unwell staff member, and therefore the issue of a general closure will need to be considered. In the case of medical practices, the consideration will also extend to the safety of the patients. If an employer decides to voluntarily close their practice, it is important to appreciate that an employer may still have to pay employees. This is because an employer can only stand down an employee without pay under the Fair Work Act if the employee cannot usefully be employed because there has been a stoppage at work for which the employer cannot be reasonably held responsible. Employers can ensure they are providing lawful and reasonable directions by referring to published authorities such as Federal or State Government medical advice and Queensland Health announcements. A medical practice may also consider directing employees likely to have been exposed to self-isolate until test results clear them, or conducting telehealth appointments until a deep clean has been performed.
RACHEL DREW
Partner P: (07) 3135 0500 E: rachel.drew@ holdingredlich.com
ABOUT THE AUTHOR Rachel Drew is a partner at Holding Redlich, a law firm with offices across Melbourne, Sydney, Brisbane and Cairns. Holding Redlich provides a complete range of legal services for clients of all sizes including many of Australia’s largest public and private companies and all levels of government. Rachel specialises in providing legal advice to medical practices and facilities, including by preparing Services Agreements, Employment Agreements or Independent Contractor agreements to engage general practitioners, specialists and allied health professionals. Rachel also assists medical practices with employment issues which may arise during the employment relationship. Rachel has significant experience in representing employers in response to work health and safety incidents, including attending investigation interviews. Rachel’s experience includes preventing and resolving disputes on matters including professional misconduct and dismissal issues, discrimination and harassment complaints and contractual claims.
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Learnings from a cyber insurance claim Negotiating an insurance claim with insurers has many of the same characteristics as poker – generally the person that knows the most, is the expert, knows the rules of the game and that has the deepest pockets, tends to win. Even when holding the right cards, the inexperienced player can be talked out of winning. When lodging an insurance claim, the parallels are many: you’ve got to be holding the right insurance policy to start with; you’ve got to know how to play the game, how to ensure the insurer pays out - according to the technical and legal words in the insurance contract; and you’ve got to know how to prepare the information so the insurer will pay the claim, such as how to prepare financials to prove your lost revenue. Recently I helped a GP clinic finalise a cyber hacking event, covered by a cyber-insurance policy they held. The practice owner opened a phishing email and clicked... and by doing so, their entire system was encrypted with Ryuk – a type of ransomware that uses encryption to block access to a system, device, or file until a ransom is paid. Ryuk demands payment via Bitcoin. In our case the demand was for 15 Bitcoin (so circa $150,000).
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The practice immediately contacted their IT consultant. A decision was made to not pay the ransom and instead to wipe their systems and re-boot from a backup. All of the local backups on their server were compromised, so they used the overnight cloud backup. This process took several days (with the majority of services up and running within 24 hours), but the impacts lasted for weeks, key issues were:
5. As the practice used the My Health Records system, another breach assessment on whether the security or integrity of the My Health Record system was compromised, and if so, then notification to the Australian Digital Health Agency Healthcare. You can read more about this at My Health Record: www.myhealthrecord.gov.au/forhealthcare-professionals/howtos/ manage-data-breach
1. All of the electronic medical records for patients that day (the event occurred early afternoon) were lost. This meant all those patients had to be recalled and a new record of the consult entered.
6. Lots of time and stress placed on the practice owners and managers to ensure during the coming weeks and months. While the practice returned to normal operations within a few days these matters drag on with post action items, insurance claims etc.
2. Limited or no access to IT for approx three working days while the systems were rebuilt. Lost revenue, impact to patient continuity of care. The IT bill at this stage has hit almost $30,000 as the IT team were working around the clock to get the practice back fully operational. 3. There was some data that simply could not be recovered such as some pathology results. This resulted in another ~$40,000 of costs to get the data manually back into the medical records system. 4. A breach assessment had to be conducted to see if the matter was a Notifiable Data Breach, which would then mandate the privacy commissioner and every impacted individual to be notified their personal/health information had been “lost or subjected to unauthorised access or disclosure”. See NDB Scheme: www.oaic.gov.au/privacy/notifiabledata-breaches/about-thenotifiable-data-breaches-scheme/
At the initial stage of breach investigation, it became apparent the IT systems had only been encrypted and the hackers had not accessed any of the personal information (or any data whatsoever). The IT consultants did an excellent job documenting why no data had left the practice servers – this meant the lawyers appointed to assist in the breach assessment were able to advise quickly their initial view: All patients listed in the appointment book... were recalled and important medical information restored, I do not think that any notification needs to be made to My Health Records. I also do not think that any notification needs to be made to the Office of the Australian Information Commissioner (that is, I do not think that there has been an eligible data breach). I congratulate you and your practice on the swift risk management actions you took in recalling the patients and restoring the data. This initial assessment was later formalised confirming all systems were restored, all data re-entered and no unauthorised access.
INSURANCE ISSUES Despite my advice to them the year before, the client hadn’t purchased a specialist cyber/privacy insurance policy. Luckily however, as a part of the medical indemnity they had purchased, they were provided with a ‘free’ cyber policy. The client lodged a claim under this policy and dealt direct with the insurer. The insurers involved did two things initially: 1. Breach assessment – sent the client numerous links, information and essentially said to the practice “make your own decision on whether you believe this is a Notifiable Data Breach”. The client felt lost and helpless. 2. IT costs – advised the client as they felt the IT consultant was negligent in not having a better backup, they would only pay approx $3,000 of the ~$30,000 invoice (after deducting the excess) The client contacted MGR asking if we could take over management of the claim. Since that time: 1. The insurer appointed and paid for lawyers to undertake the breach assessment, which as noted previously, provided legal advice the incident was not a Notifiable Data Breach and didn’t compromise the My Health Record system. 2. The insurer fully paid:
a) the ~$30,000 IT fees less the excess,
b) the extra data recovery covers of ~$40,000,
c) the lost revenue for the three days of impacted trading (time excess of one day)
d) the employee overtime incurred due to the cyber event
The total paid by the cyber insurer was ~$90,000. So while the client was fortunate to end up with insurance to cover all of the costs and provide them the legal advice and guidance, they didn’t know
how to ensure their claim was paid and the insurer deliver on their promise to assist, in accordance with the terms of the policy. As I often say to clients, I can buy a scalpel, doesn’t mean I can do my own surgery... You can buy an insurance policy direct from an insurer, doesn’t mean it’s the right one, or that you’ll know how to use it when you need to claim. On finalising the claim, I asked the client a few questions on what they learnt. Here’s a summary of their commentary (some info redacted to protect privacy): What did you learn following this cyber event? I have learnt a lot including putting data breach response plan in place and understanding better the Notifiable Data Breach Scheme which determines if the breach is to be reported to OAIC and the patients What have you learnt about IT security? Maintain good computer habits, limit network access, use of antivirus and firewalls and how to better use password and passphrases. What extra IT security or other steps have you put in place to prevent the same thing happening again? A lot of changes have been put in place by my IT, we are also going to do cyber security training. IT security and privacy are now on the agenda! How important is it to have an IT provider who will drop everything and come straight away and fix the system, data etc. My IT is a guru and committed to his work. He got my business back t o function within 24-48 hours. He didn’t sleep for probably five days. It is rare to find someone who would drop everything and get your business back up in 24 hours. The forensic team commended him for his great work.
CHRIS MARIANI
Director P: 0419 017 011 E: chris@mgrs.com.au Authorised representative No. 434578
Disclaimer: Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687. Authorised Representative No 436893. Chris Mariani, Authorised Representative No 434578. The information provided in this article is of a general nature and does not take into account your objectives, financial situation or need. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.
Anything else you want to write about/ was MGR helpful? You cannot ask for a better insurance broker than Chris Mariani. The support I received during the cyberattack was incredible. I appreciate his untiring communication, numerous meeting, back and forth between us and the insurer. He got them to pay, when we had no idea how to. If you want to read a little more about privacy compliance and cyber insurance, read my article at https:// mgrs.com.au/cyber-insurance/ – this has some draft questions you should be asking your IT consultants about IT security, backup etc. I am also constantly banging on to clients about the need to develop a privacy framework, a part of this requires the practice to assess their IT security, staff training, backup and recovery processes and other risk management measures. You can read about privacy frameworks at the shortcut to the OAIC website: https://bit.ly/3jto7UP
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A case of COVID-19 in a country town Jack was self-isolating at home following his return from a road trip around the US when he received a call from a friend. “Hey! Just checking you’re still alive mate. I heard you’ve got coronavirus,” his friend said. “Facebook has gone right off!”
THE PATIENT Jack was shocked. He hadn’t told anyone he had tested positive to COVID-19. As he lived in a small town in country Victoria, he was worried about his work prospects following his recovery if anyone knew about his diagnosis. Jack had avoided testing at his local practice and instead went to a large multi-disciplinary clinic over 30km away, where he felt he would have greater anonymity. As he became increasingly concerned about how his results were made public, Jack contacted the practice to speak to the doctor who had performed the test. However, the practice manager told him Dr Sharma was working at another practice that day. A Google search revealed that Dr Sharma mainly worked at the large clinic where Jack was tested, but he also worked one day a week at the practice in Jack’s town. Jack called the local practice to speak to Dr Sharma about how his privacy had been breached.
THE DOCTOR Dr Sharma was shocked when Jack asked him how his COVID-19 diagnosis had been made public. Although Dr Sharma had tested Jack at the large multidisciplinary clinic where he usually worked, he received the results on the day he was working at the local practice. Surprised at seeing the positive result in a patient with very minor symptoms, he had commented to the practice nurse that
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coronavirus had reached their small town, with a local man testing positive after returning from the US. Dr Sharma asked the practice nurse if she had told anyone else about the test results. “Only my flat mate, and I didn’t look at the patient’s results or give her a name – I just told her what you told me,” she said. On reflection, both Dr Sharma realised that a patient in a large rural centre wouldn’t be as easily identifiable as a young man returning from the US in a town with a population of 450 people.
MEDICO-LEGAL DISCUSSION Dr Sharma called Jack and apologised for the inadvertent breach of his privacy. He explained that while he hadn’t disclosed Jack’s name or discussed his personal health information outside of the practice, he hadn’t realised how easy it would be for the town locals to identify him by other means. The practice considered its obligations under the Notifiable Data Breaches scheme www.oaic.gov.au/privacy/ notifiable-data-breaches/, and determined that the breach wasn’t likely to result in serious harm to the patient and therefore didn’t need to be notified to the OAIC www.oaic.gov.au/ privacy/notifiable-data-breaches/. The importance of privacy was put on the agenda for the next practice meeting, where all staff watched and discussed the MDA National webinar on Privacy and Info Security in Private Medical Practice https://vimeo. com/300661346/9c834b4c89.
NERISSA FERRIE Medico-legal Adviser
SOME HANDY HINTS FOR MAINTAINING PATIENT PRIVACY IN YOUR PRACTICE: Have a good understanding of patient confidentiality. www.mdanational.com.au/ advice-and-support/library/ articles-and-case-studies/2017/08/ confidentiality Ensure your privacy policy is up to date, and that all staff receive regular privacy training. www.mdanational.com.au/adviceand-support/library/articles-andcase-studies/2017/11/privacyknow-how Include information on the appropriate use of social media www.mdanational.com.au/adviceand-support/library/blogs/2019/12/ are-you-oversharing-on-socialmedia and online professionalism www.mdanational.com.au/adviceand-support/library/articles-andcase-studies/2013/09/onlineprofessionalism. Make sure your systems are secure. www.mdanational.com. au/advice-and-support/library/ articles-and-case-studies/0000/00/ information-security-prevention-isbetter-than-cure Understand your obligations under the Notifiable Data Breaches scheme in the event of a breach. www.mdanational.com.au/adviceand-support/library/articles-andcase-studies/2019/06/reportingprivacy-breach-flowchart
Instant asset write-off
– SHOULD I BUY A NEW CAR? In March 2020, the Federal Government announced an increase in the Instant Asset Write-Off (IAWO) from $30,000 to $150,000 to provide economic support for business through COVID-19. Initially, the $150,000 IAWO threshold was due to expire on 30 June 2020. This has since been extended through to 31 December 2020. Essentially, businesses can claim an immediate deduction for multiple assets, new or second-hand, provided each asset costs less than $150,000. A common question we are asked is “should I buy a new car and claim it as a tax deduction?” Outlined below are a number of taxation considerations to take into account to assist you in your decision making.
1. D O YOU HOLD A VALID LOGBOOK? If you buy a vehicle to be used in your business but you also use the vehicle personally, you can only write off the equivalent percentage that is used for business purposes. As such, you need to maintain a logbook to work out the business use percentage. A valid logbook must: Be kept for 12 consecutive weeks Updated every five years Record the opening and closing odometer of trips Using the logbook method may result in the greatest deductible amount where the business use percentage is high. Your claim is based on the business use percentage of each car expense – fuel, repairs, registration, insurance, interest on motor vehicle finance and depreciation (capped at the motor vehicle car limit of $57,581).
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2. W HAT TYPE OF FINANCE CAN I USE TO PURCHASE THE VEHICLE? Common finance methods to purchase a motor vehicle are cash, hire purchase, chattel mortgage or a lease. Under the first three purchase options you will be the owner of the vehicle. If you choose to use a lease, you will not actually own the vehicle until the lease is paid out. As such, a leased vehicle would not qualify for the IAWO.
3. H OW MUCH CAN YOU ACTUALLY CLAIM AS A TAX DEDUCTION? If you purchase a car for your business, the instant asset write-off is limited to the business portion of the car limit of $57,581 for the 2019-20 income tax year. The business portion is supported by a valid logbook. As an example, if you use your vehicle 70 per cent for business use, the total you can claim as a tax deduction under the IAWO is 70 per cent of $57,581, which equates to $40,306. It is important you take the above into consideration when making a decision in relation to buying a motor vehicle for your business and obtaining an IAWO. You should discuss your personal circumstances with your accountant to determine what is the best method to claim your motor vehicle expenses including its depreciation.
J U L I E O ’ R E I L LY Business Advisory Director P: (07) 3229 5100 E: Julie.oreilly@ williambuck.com
THINKING OF BUYING YOUR OWN MEDICAL PRACTICE? William Buck can support your new private practice through: — Comprehensive assistance with your personal and business taxation affairs — Advice on how to structure your cash flow and maintenance of financial records — Practice structure advice, budgets and cash flow management — Assistance with insurances and compilation of assets and liabilities.
FOR MORE INFORMATION OR TO BOOK A CONSULTATION, CALL OR EMAIL US: — P: (07) 3229 5100 — E: qld.info@williambuck.com
f o n o i t a r e n e g t x e n e h t t r o p
s e o r e h frontline to n
p u s s u p l e H
The AMA Queensland Foundation is currently in its 20th year of operation, with the generous support of donors and corporate partners allowing the Foundation to continue its vital work and achieve a number of positive outcomes. One of our greatest achievements in our 20 years of operation is providing over $450,000 in financial assistance to 24 medical students studying in Queensland. Our first scholarship holder graduated in 2009. The AMA Queensland Foundation has received interim reports from this year’s 2020 medical student scholarship recipients and we are proud to be able to provide an update on their progress. Kayla Scully is in her third year of her Doctor of Medicine degree at Griffith University. The biggest highlight of her first semester of her clinical years was 52 Doctor Q Spring
delivering her first baby. Kayla said, “Somehow it was one of the most terrifying and beautiful experiences of my life… in fact, I was so stunned that I had to be reminded to hand the little one back to Mum!” Kayla stated, “Receiving the AMA Queensland Foundation scholarship provided the financial support that allowed me to remain focused on my medical education in such a stressful time. I am so thankful to the Foundation and its donors; their support has allowed me to continue to put my best foot forward.” Kayla is looking forward to her cancer care rotation as she is interested to see how clinical medicine and pathology intersect and to hear the stories of those living with cancer. She also hopes to make some contacts in haematology and start working towards research in the area to assist in her career progression.
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Supporting our scholarship students
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AMA QUEENSL AND FOUNDATION
The second scholarship award winner, Shaun Muggleton is in his final year of the Doctor of Medicine degree at Griffith University. A highlight from his medical studies in semester one of this year was completing two emergency terms as he felt the emergency team was very welcoming and great at providing learning opportunities. Shaun stated, “The AMA Queensland Foundation scholarship took a lot of financial pressure off my wife and myself. It was a significant relief to be able to continue paying bills and other costs of living.” We wish Kayla and Shaun all the very best with their studies. Applications for the AMA Queensland Foundation medical student scholarships are open in November of each year and close mid-February. Refer to our website for criteria and forms: www.amaqfoundation.com.au
HOW CAN WE HELP YOU? Recommend a funding initiative It’s so important for the medical community to come together to not only support the work of the Foundation, but to advocate on behalf of those who need the Foundation’s support. The Foundation is always searching for Queenslanders to support. We are a Public Benevolent Institution; this means our support must be specifically targeted at people in need and not broader general community programs. Do you have patients falling through the gaps? The Foundation can directly fund a patient of yours who needs financial support for a critical medical intervention or an organisation you are involved with that directly provides support to those who need significant assistance. The Foundation would also like to work with members to develop
or continue long-term projects that specifically targets those with significant needs in your community. The Foundation welcomes your funding applications for patients in need. Please see our website www.amaqfoundation.com.au for criteria and conditions.
HOW CAN YOU HELP? We ask that you please generously support the work of the Foundation as we receive no government funding and rely on gifts, grants, donations, bequests and corporate sponsorships to make the work of the Foundation possible. There are many ways you can support the Foundation to make a difference: 1. Make a tax-deductible donation during our annual tax and Christmas appeals. 2. P articipate in Operation Donation Week where doctors donate the proceeds from just one performance of your most common
3. Attend an AMA Queensland Foundation event. 4. Become an AMA Queensland Foundation regular giver by preauthorising monthly, quarterly, or annual tax deductible donations. 5. Make the AMA Queensland Foundation your charity of choice when participating in community events such as the Bridge to Brisbane, Gold Coast Marathon Festival or the Cairns Ironman. 6. Make a bequest in your will to ensure that the Foundation lives on. All contributions are gratefully received and acknowledged. For further information on how you can help please visit www.amaqfoundation.com.au. If you would like to speak to us about a funding initiative or making a donation, please don’t hesitate to call us on (07) 3872 2222 or email amaqfoundation@amaq.com.au.
DONATE ONLINE AT www.amaqfoundation.com.au
Yes, I want to give with my tax-deductible gift PERSONAL DETAILS
operation, procedure or service – again tax deductible.
PAYMENT DETAILS
Name:
Credit Card:
VISA
Address:
Number:
Expiry Date:
Phone:
Cardholder’s Name:
Email:
Cardholder’s Signature:
SUPPORT $100
$250 $500
Frequency: Once-off Quarterly
Other $ Monthly Annually
ACKNOWLEDGEMENT Donations are recognised in AMA Queensland publications. Please acknowledge my contribution in the name of:
Mastercard
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Cheque: Please make cheques payable to ‘AMA Queensland Foundation’
OTHER (Please tick) I would like more information about leaving a bequest to the AMA Queensland Foundation. I would like someone to contact me regarding a potential project/patient that the AMA Queensland Foundation may be able to assist with. PLEASE RETURN TO:
(30 characters max. i.e. The White Family, Mr T & Mrs S White, Sue & John White) I would prefer to remain anonymous.
AMA Queensland Foundation PO Box 123, Red Hill Q 4059
Thank you for your support! Doctor Q Spring 53
SMSF Lending
– WH AT YOU NEED TO KNOW Facilitating commercial property loans through your Self-Managed Super Fund (SMSF), can yield significant benefits when executed correctly and when it is right for your particular financial situation. The purchase of practice premises is rarely just an investment decision. It is also a commercial business decision. The cost to set up your own practice is high. The risk to a practice in having to move premises, possibly under short notice, or soon after acquisition, is so high that it would be considered an unacceptable commercial risk – hence why most doctors buy when they can. As with the common reliance on external debt funding to acquire assets, borrowing to buy practice premises is just as common. Choosing to utilise an SMSF to acquire premises is normally due to a combination of factors which include but are not limited to: You have enough money in superannuation from your days as an employee or contractor to fund the deposit and perhaps stamp duty on premises, but do not have this capital external to Superannuation. You want to make superannuation contributions as part of your financial plan on a regular basis. These contributions could be used to pay down the loan on the practice premises thus yielding a safe investment of return of, for instance, six per cent, which could be the interest on the loan.
SIMON MOORE
Finance Specialist credabl.com.au/amaq Live chat at www.credabl.com.au P: 1300 27 33 22 E: simon.moore@ credabl.com.au
The practice premises are a lifetime asset. This is likely to align with your strategy for retirement and superannuation. Plus you have the opportunity to capitalise on property ownership. The cost on rental to a third party, if applied to your own SMSF as landlord, is enough to service the loan and the interest on the property with a zero loss/gain sum. So why wouldn’t you do it? Taxation benefits in retirement – the SMSF in pension mode may be able to pay a tax-free pension to the practitioner in retirement.
Asset Protection. The tax rate in super is only 15 per cent lower than individual tax rate. This can also be appealing if you already own your own rooms. You may be able to sell your rooms to your own SMSF on commercial arm’s length terms.
If acquiring practice premises is on your radar, as it should be, have some early conversations with your accountant and lender on the process and structure involved in SMSF lending. It’s not for everyone, but if its right for you it might be time to reflect on bringing forward your plans. Credabl has recently designed a Guide to Self-Managed Super Fund (SMSF) Lending as a starting point for you, providing clear and readily accessible information on borrowing from your SMSF and the key things you need to know. VISIT BIT.LY/SMSF_LENDING_GUIDE TO DOWNLOAD YOUR COPY TODAY.
This article is a guide only and does not constitute any recommendation on behalf of Credabl Pty Ltd (ACN 615 968 100) or any of its related bodies corporate (Credabl). The information in this article is general in nature and we have not taken into account your personal objectives or financial circumstances or needs when preparing it. Before acting on this information you should consider if it is suitable for your personal circumstances. Credabl is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate.
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QUEENSL AND
Outback Adventure With border closures and the uncertainty of travel, now is the time to plan holidays close to home. The coastal areas of Queensland offer some amazing holiday experiences but if you are looking for something a little different, an outback adventure is certainly worth investigating. The landscapes are like no other, from red deserts to luscious waterholes, and all are waiting to be explored.
Begin by exploring the Central Queensland Town of Charleville, home of the Royal Flying Doctor Service base. Discover the RFDS museum and look inside their state-of-the-art Charleville base. Continuing west, further into the Outback, arriving into Birdsville by overflying the iconic Birdsville Racecourse just before landing and taxiing the aircraft right out the front of the Birdsville Hotel!
If you find the remoteness of outback Queensland a little daunting, touring by air is a great option. Orbit World Travel have partnered with Seair to bring AMA Queensland members a three-day Scenic Outback Adventure. Departing from the Gold Coast, the tour heads west over 2,000km into the Outback, dropping into Birdsville, Lake Eyre, William Creek, Innamincka and Cunnamulla. These iconic Australian towns give guests a true taste of the Australian outback.
The Birdsville Hotel built in 1884, has been a weathered sandstone refuge for weary travellers from all around the world for over 130 years. A destination in its own right, enjoy a cold beer as you take in the spirit and character of this historic pub. No visit to Birdsville is complete without a 4WD trip out to Big Red. Big Red is the first major sand dune of the Simpson Desert and is an idyllic location to watch the sun go down while sitting on one of the tallest of the 1,100 vivid red sand dunes. Spend the evening at the Birdsville Hotel conversing with fellow travellers, some of whom have been driving for days to get there. Day Two begins with a magnificent scenic flight over Big Red and the Simpson Dessert. Leaving Queensland into South Australia, your pilot will follow along the Diamantina River at low level through the Goyder Lagoon and then along the Warburton River into the northern tip of Lady Eyre (North). While tracking south over
Lake Eyre (North) your pilot will climb to allow you to see the sheer size of the 9,500 square km lake. Renowned for the amazing and changing colours of its surface, the only way to appreciate the scale of Lake Eyre is from above! Next, it’s on to the unique outback town of William Creek for a quick lunch break and continues following Lake Eyre (South) and onto the infamous ‘Marree Man’ before continuing north of Lake Eyre to follow the Cooper Creek to Innamincka to the famous Australian ‘Dig Tree’. Stepping back in time, learn about Burke and Wills and their incredible story of exploration across Australia. Overnight at the Innamincka Hotel, enjoy a hardy outback dinner and drinks before getting a good night rest for the final day. On the final day, your pilot transports you back east, returning into Queensland and stopping at Charlotte Plains Cattle Station. Still a working cattle station, Charlotte Plains remains home to several thousand head of sheep. Robyn, your host, introduces you to the unique lifestyle and challenges of an outback station. Charlotte Plains is also home to an artesian bore, spend the afternoon soaking in the stations insta-worthy bathtubs enjoying the toasty warm waters before returning to civilisation returning to the Gold Coast early evening.
Orbit World Travel – AMA Queensland preferred travel provider: P: 1300 262 885 | E: travel@amaq.com.au holidays.orbitworldtravel.com.au Doctor Q Spring 55
RESTAURANT REVIEW
MICA BRISBANE While many of us have tried a tasting menu or degustation before, how many of us can say we’ve had it for breakfast? MICA Brisbane opened in the new Breakfast Creek Lifestyle Precinct in April this year. While many other cafes were closing down for COVID-19, Clare and Shannon Kellam of King Street Bakery fame saw an opportunity to bring their vision to life, expediting the opening of MICA as a takeaway venue to serve coffee, fresh bread and their renown range of pastries and tarts. Since restrictions have eased, MICA has transformed into not only a popular patisserie and à la carte brasserie, but also host to one of Brisbane’s only breakfast tasting menus. Why just choose one dish for breakfast when you can try one of everything? 56 Doctor Q Spring
D R K AT G R I D L E Y Advanced Emergency Medicine Trainee, Royal Brisbane and Women’s Hospital
The five course menu starts with a fresh tropical juice and your choice of fine teas or coffee. First course is a sheep milk yogurt with granola. The yogurt comes as thick as ice cream, with a vibrant crunchy wattleseed granola, and syrupy sweet compressed fresh strawberries, laced with basil and mint. Second course is a sweet and sticky caramelised pineapple, with a biscuit-like macadamia crumble. The accompanying coconut water sorbet helps to balance the gentle lingering heat from the ginger and kaffir lime, and almost feels like eating dessert for breakfast! Third course is a wafe- thin citruscured Ora king salmon with fresh dill and a luscious whipped fromage blanc, topped with a poached egg. It comes served with a small loaf of their divine sumac sourdough, which
makes mopping up the wonderfully creamy combination of fromage and runny egg yolk just a little easier. While the first three courses are shared, the fourth course is your choice of a main meal - a traditional cheesy gruyere and Swiss mushroom omelette or their version of bacon and eggs Benedict. The red gum-smoked pork jowl comes grilled alongside a pesto-laden brioche-style English muffin with two poached eggs and a tangy Chardonnay hollandaise. If our experience was anything to go by, the penultimate course will make you concede defeat - until a basket of pastries arrives on your table for ‘dessert’. A selection of their finest croissants and danishes are hard to resist even when you’re about to burst, particularly their almond croissant. Luckily they can be taken home for later!
If the tasting menu is too much for your morning, each of the dishes are available individually on their à la carte menu, alongside the likes of crumpets with whipped cinnamon butter and apple compote, iron bark cold smoked cauliflower, and brioche pain perdu. MICA offers breakfast à la carte or their tasting menu from Wednesday to Sunday 7am to midday. The coffee shop, bakery and patisserie are open weekdays 6.30am to 3pm, Saturday 6.30am to 2pm and Sunday 7am to midday. Located at The Promenade, Breakfast Creek Lifestyle Centre, 194 Breakfast Creek Rd in Newstead.
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All about you... C H A R I T Y: EVERY LITTLE BIT HELPS Many facilities around Queensland offer those in need laundry and shower facilities, but do not have regular and reliable access to basic toiletries. Charity Every Little Bit Helps collect, pack and redistribute unwanted hotel toiletries, inflight amenity kits, cosmetic and make-up samples to those in need including the homeless, asylum seekers and victims of domestic violence as well as troubled youths through women’s refuges, homeless shelters, youth centres, asylum centres and community centres as well as via small government and community groups. So if you have some unopened toiletries at home or wouldn’t mind throwing some extras in your trolley when you go shopping, Every Little Bit Helps can get them to people who need them. Visit www.elbh.org.au to find drop off points.
BOOK: THE CUT Saving lives is meant to be above politics. In a troubled health system, where patient outcomes and personal gain are intertwined, Harvey Pearce discovers a disturbing and dangerous truth. In The Cut, Dr Harvey Pearce is an emergency specialist who has spent a career looking after the sickest patients and improving emergency care. When he uncovers politically orchestrated activities that kill patients, harm staff, hide deficiencies and hinder progress, he becomes determined to find a solution.
P O D C A S T: FORGOTTEN AUSTRALIA From the desperate struggle against Spanish Flu in Sydney and the weekend Melbourne was ruled by anarchic mobs, to Brisbane’s most puzzling murder mystery and the Lord Howe Islander who tried to save passengers on the Titanic, each episode of Forgotten Australia brings you an incredible true story that you didn’t learn in history class. Forgotten Australia is created by Michael Adams, a Sydney-based writer, author and television producer. 58 Doctor Q Spring
Across the city, episodes of patient injury and preventable deaths continue despite Harvey’s struggles with bureaucracy. He drives to investigate these events, and their sinister connections, whilst the establishment resists his efforts and its leaders continue to tolerate catastrophes. Dr Marcus Kennedy is a recently retired emergency physician and previous Director of Adult Retrieval Victoria.
TV: KILLING EVE
THE CUT
W IN this book!
Jodie Comer plays a bored, sociopathic international assassin who calls herself Villanelle, Sandra Oh plays an MI5 agent obsessed with female assassins who is recruited by a secret division within MI6, while well-known Irish actor Fiona Shaw plays a female spy “who had a great time in the 80s�.
Killing Eve is an epic game of cat and mouse, with Eve Polastri (Oh) fired from MI5 and assigned to chase the charismatic assassin, Villanelle (Comer), with the help of Carolyn Martens (Shaw). Eve crosses paths with Villanelle and discovers that members within both of their secret circles may be more interconnected than she is comfortable with, but forms an obsession with Villanelle that is more than enthusiastically reciprocated. Both women begin to focus less on their initial missions in order to desperately learn more about the other.
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 2020 Doctor QQ Summer Doctor Spring 59 59
It’s just a phase Just as life has phases, so too does medical life. The changing tides throw many people into your life. I reckon five types of people are vital in a medical life as you progress from young, keen medical student to wizened, greying veteran. The first phase involves the quest for inspiration. Someone to inspire you to continue the late nights of study. Someone who has worked hard and is driven by delayed gratification so necessary for forging through a medical degree. For me, it was my Grandad. He was lucky and unlucky by virtue of his year of birth. He saw the 20th Century unfold. Horse and carts became space travel. Computers, jets, and limited overs in cricket. Coming into the world in 1899, he was just old enough to head into the cauldron of World War 1 in 1917 and just young enough to sneak into the affray of World War 2 in 1939. As a veteran of two world wars, he understood life. He understood mateship, self-sacrifice and the importance of family. It was always family first for Grandad. He worked hard to provide, never shirking responsibilities. Retiring at 73 years old, he instilled in me the idea of hard work being fundamental to a meaningful life. If I was sick of studying, I thought of Grandad and was reinvigorated. The second phase of medical life requires a mentor. An older, wiser, more experienced doctor who takes a fatherly interest in you. Someone to guide you through that first formative decade of being a doctor.
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For me, two men filled this role. Barry and Sid were their names. Seasoned rural medical campaigners. They had seen it all and cured it all. They had stowed away over a century of practice between them and they treated me to all of their insights on medicine and more importantly, the life of the doctor. The third phase hit me in my thirties and forties. I needed a confidante. A medical mate to confide in. To discuss the vagaries of surviving as a GP. A bloke to listen and nod knowingly as I whinged about my patients, unrealistic expectations and the incessant threats besieging me. Threats like Medicare, lawyers, ombudsman, complaint letters. Someone who wouldn’t judge. Just empathise. This role was filled by a man I came to regard as my brother. He was Pete. He left us all last year, tragically prematurely. We went through medical school together and earned FRACGP tickets together. Despite failing a subject in sixth year and being consigned to a sup and hence not graduating with his mates, Pete still came to our graduation day to cheer for me and all his other mates. He was noble and selfless. At the most disappointing juncture of his life he still thought of his mates. Then the phases reach some symmetry. You become someone else’s mentor. You take a shining to some young doctor or student. They look up to you. Maybe they remind you a bit of yourself. Perhaps your idealised self. Their idealism, altruism, drive or charisma echoes some long-lost aspect of your own life. You throw them some suggestions. Some advice.
D R M AT T Y O U N G General Practitioner, Inala Medical Centre
A tip here or there about practicalities of medical practice or surviving the day in, day out grind of doctoring. In return, they provide youthful exuberance to keep you young at heart. Then the final phase. A fifth stage where you become inspiration for someone else. This is perhaps the most vital phase. Hopefully some youngster gravitates into your sphere of influence and decides to follow your lead and pursue medicine. This is perhaps your greatest legacy. I wonder how many of us consider this fundamental role. It has to be us who inspire the next generation of our profession to follow in our footsteps. So, don’t forget those vital people who made your career more navigable and never forget the vital role you have, inspiring and mentoring the next generation.
Picardy is back We are absolutely delighted to be offering Picardy Wines. Our Buyer and Sales Manager, Matt Wallace was the assistant winemaker there between 2000 and 2004. Picardy first made wine in 1996, becoming a pioneer of exceptional, cool climate Pinot Noir in Western Australia. Bill Pannell, Co-Founder of Picardy, was also a pioneer of the Margaret River region. He founded Moss Wood Wines back in the late 60s, arguably producing one of Australia’s finest Cabernets. In doing so, Bill had already established himself as an industry legend. Bill still loves Cabernet but was increasingly falling in love with Pinot Noir. So, he sold Moss Wood (after grooming his successor) and moved to Burgundy where he took a share in Domain Pousse d’Or. He eventually returned to Australia with the goal of producing exceptional Pinot firm in the belief that Pemberton was the very best place in WA to do so. After painstakingly locating an ideal site, Bill planted just a couple of acres of Pinot, utilising the Droopy, Upright, 114 and 115 clones. The first release
from 1996 was widely lauded as an exceptional wine, quite remarkable given the vine age. He also sourced and spent a decade importing the Burgundian Pinot clone 777 into Australia. This clone was one of those that was part of the lengthy ‘Bernard’ investigation into the finest clonal selections available from Burgundian producers. For this Bernard assessed over many years, the quality and yield of over 100 selections from the best sites belonging to the finest Grand Cru growers. 777 was one of those which rose to the top in terms of quality and which was also capable of producing a commercial yield. Despite being the sole holder of this clonal material in Australia, the Pannell Family chose to share cuttings. It is now revered here by top end producers such as Tomich Wines, Sidewood Estate, Foxey’s Hangout and Gilbert, they even include 777 on the labels of their flagship product. Since then Bill and Dan have managed to bring in an additional five Burgundian Pinot selections, bringing their total clonal count to 11. The first release which
PHIL MANSER
Wine Direct P: 1800 649 463 E: philmanser@ winedirect.com.au
contained all of these is the 2018 (which we now have in stock). To our mind this is the best Pinot Picardy have ever produced and is as good as any other Aussie Pinot available at the moment. Picardy is not just a love letter to Pinot though. They have also brought in four Burgundian clones of Chardonnay, 75, 95, 96 and 277 and consistently produce an exceptionally refined wine from them. They also make wonderful Rhone style Shiraz, excellent blends of Merlot, Cabernet and Cabernet Franc, and two exceptional blends of Sauv Blanc and Semillon.
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INPRINT
The Good Doctor: What it means, how to become one, and how to remain one Thomas H. Lee, MD Dr Thomas Lee, a renowned practising physician, healthcare executive, researcher, and policy expert, takes us to the frontlines of care delivery to meet inspiring, transformative doctors who are making a profound difference in patients’ lives – as well as their own. These revealing, intimate profiles of seven remarkable
physicians are more than a reminder of the importance of putting patients first. They provide an invaluable working model of what it means to be a good doctor, how to become one, and how to remain one for the benefit of patients and colleagues alike. It’s a model that sustains physicians themselves over years
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and decades, combating the constant threat of burnout. Their stories are not only powerful but offer practical lessons and insights into developing high reliability cultures, resilience, and improvement mindsets. This is what is takes to be a good doctor.
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NOVEL WINNER Dr Su Mien Yeoh won a copy of Better Luck Next Time by Kate Hilton, thanks to Allen and Unwin Publishers.
Our friends at Dendy Cinemas are only open on a limited basis due to COVID-19. Check out some of the classics on show for the time being.
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INPRINT BOOK WINNER Dr Yagyadut Gupta won a copy of Brukner and Khan’s Clinical Sports Medicine 5e, Volume 2: The Medicine of Exercise, thanks to McGraw-Hill Education.
Dr Hugh Bartholomeusz ceasing practice at Greenslopes
Dr Charles Steadman has ceased practice at Queensland Gastroenterology at Greenslopes and Mater
Dr Hugh Bartholomeusz wishes to advise that he has ceased practice at Suite 201, Ramsay Specialist Centre, Greenslopes Private Hospital. His patients for full skin examinations will continue to be treated within Skin Health Solutions at the current location and others around Brisbane. Appointments for these examinations can be made by calling (07) 3847 9492.
Dr Charles Steadman, gastroenterologist, wishes to advise that he has ceased practice at Queensland Gastroenterology, Suite 2F, Greenslopes Private Hospital and previously, the Mater Medical Centre, South Brisbane. His patients can continue all aspects of their care at Queensland Gastroenterology, Greenslopes. Appointments can be made by calling (07) 3324 1500.
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