Doctor Q Summer 2019

Doctor Q is free to AMA Queensland Members

SUMMER 2020

AMA QUEENSLAND’S 2 0 2 0 H E A LT H PRIORITIES 2019 RESIDENT HOSPITAL H E A LT H C H E C K FINDINGS

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CONTENTS

12

WELCOMING NEW INTERNS FOR 2020

16

REPORTS

P R I VAT E P R A C T I C E A N D MEDICO-LEGAL CONFERENCE

F E AT U R E S

34

MEMBER PROFILE: DR BRODIE QUINN

BUSINESS TOOLS

20

Doctors’ Community platform takes off

54

Dealing with decline treatment

22

The locuming life

58

Buyer beware - tips for buyers

Council of Doctors in Training update

AMA Queensland’s 2020 Health Priorities

56

CEO’s report

26

2019 Resident Hospital Health Check findings

60

Strategic planning and why it should be on your to-do list

4

Editor’s desk

6

President’s report

8 36

CURRENT ISSUES

PEOPLE & EVENTS

LIFESTYLE

24

Mater SMOs and VMOs - we need you!

10

Townsville breakfast with the Health Minister

62

Surf’s up!

28

Hard-won agreement for flying doctors

12

Intern events

64

Operation donation All About You

Keep your eye on the ball

71st Bancroft Oration

66

30

13

Dendy Cinemas

Queenslanders love their GP

2019 Annual Conference - Edinburgh

67

32

14

68

Dr Matt Young: A Magpie for Me

38

A reflection on the mental health of doctors in training

16

Private Practice and Medico-Legal Conference

69

Forget Barossa - try the Adelaide Hills

40

Time for change

18

Women in Medicine Breakfast

70

42

CSDS supporting Queensland’s healthcare providers

34

Member profile: Dr Brodie Quinn

InPrint: Did he save lives?

A surgeon’s story

44

Research round up

48

Renew your membership

46

Making a difference to the environment as an individual

50

Local Medical Associations round up

52

Events calendar

Doctor Q Summer

3

BOARD OF DIRECTORS

Editor’s Desk Have you logged on to have a look at our new Queensland Doctors’ Community platform? It’s certainly a game-changer for debate and discussion on issues affecting your work. Find out more about it on p20.

We’ve had some wonderful events in the last quarter: Women in Medicine, the Townsville Breakfast with the Health Minister, intern events, Bancroft Oration, our Annual Conference and the Private Practice and Medico-Legal Conference. Check out all the photos in the following pages.

We hope you receive some sort of break over the summer and enjoy some time with your friends and family.

Michelle

The AMA Queensland office will close at 4pm on Friday 20 December and will reopen on Thursday 2 January.

We wish all our members a safe and happy festive season.

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

Dr Richard Harte KEATINGE General Practitioner Late of Tenterfield Member for 66 years

Dr Michael RYAN Physician Late of Maroochydore Member for 63 years

Dr Timothy Derwent Campbell FORSTER Ophthalmologist Late of Indooroopilly Member for 52 years

Dr Louis Joseph PIGOTT Ophthalmologist Late of Clayfield Member for 64 years Dr Barrie Richard LENNON Physician Toowong Member for 5 years

Dr John Hall Member Appointed Director

Dr Sarah Coll Member Appointed Director

Dr Bav Manoharan Member Appointed Director

Ann Fordyce Skilled Director

Dr Peter Isdale AM Skilled Director

Dr Hashim Abdeen Doctors in Training Representative

Dr Sarah Coll Specialist Craft Group

Dr Fatima Ashrafi Specialist Craft Group

Dr Hasthika Ellepola International Medical Graduate Representative

Dr Bav Manoharan Greater Brisbane Area Representative

Associate Professor Chris Perry Vice President

COUNCIL

Dr Sanjeev Bandi Capricornia Area Representative Dr Kimberley Bondeson Greater Brisbane Area Representative

Dr Bill Boyd Immediate Past President Zoe Byrne Medical Student Representative Dr Marianne Cannon Greater Brisbane Area Representative Dr Michael Clements North Area Representative

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

Dr Katrina McLean Gold Coast Area Representative Dr Nikola Ognyenovits Specialist Craft Group Dr Rachael O’Rourke Greater Brisbane Area Representative Dr Fiona Raciti General Practitioner Craft Group Dr Siva Senthuran Full-time Salaried Medical Practitioner Craft Group Dr David Shepherd Far North Area Representive Dr Nicholas Yim General Practitioner Craft Group

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

Filomena Ferlan General Manager Corporate Services

Katherine Gonzalez-Cork General Manager - Member Relations and Communications

Editor: Michelle Ford Russ

Doctor Q is published by AMA Queensland

Graphic Designer: Aleisha Coffey

Phone:

Journalist: Chiara Lesèvre

(07) 3872 2222

Address: PO Box 123,

Red Hill QLD 4059 Email:

amaq@amaq.com.au

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FOLLOW US:

WHERE YOU DRIVE THE AGENDA

4 Doctor Q Summer

Dr Michael Cleary Chair of Board and Council

Dr Maria Boulton Greater Brisbane Area Representative

CHRISTMAS CLOSURE

Dr Ross David GURGO Neurosurgeon Late of Indooroopilly Member for 26 years

Dr Dilip Dhupelia President

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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Qantas Business Rewards Members and Qantas Frequent Flyer Members will earn 1 Qantas Point for every eligible $1 spent (GST exclusive) on payments to MIGA for Eligible Products. Eligible Products are Insurance for Doctors: Medical Indemnity Insurance Policy, Eligible Midwives in Private Practice: Professional Indemnity Insurance Policy, Healthcare Companies: Professional Indemnity Insurance Policy. Eligible spend with MIGA is calculated on the total of the base premium and membership fee (where applicable) and after any government rebate, subsidies and risk management discount, excluding charges such as GST, Stamp Duty and ROCS. Qantas Points will be credited to the relevant Qantas account after receipt of payment for an Eligible Product and in any event within 30 days of payment by You. Any claims in relation to Qantas Points under this offer must be made directly to MIGA by calling National Free Call 1800 777 156 or emailing clientservices@miga.com.au  75,000 bonus Qantas Points offer only available to registered Australian medical practitioners who first insure with MIGA as a new client in a fully insured category, as a doctor in private practice, for cover commencing on or after 1 December 2019 and on or before 31 January 2020, and who pay in full by 31 January 2020 or enter into a direct debit arrangement with MIGA by 31 January 2020 and have their first instalment successfully deducted. MIGA Terms and Conditions for bonus Qantas Points for Fully Insured are available at www.miga.com.au/qantas-bonus-tc-pp. You must be a Qantas Frequent Flyer member or Qantas Business Rewards member to earn bonus Points.  Insurance is issued by Medical Insurance Australia Pty Ltd. MIGA has not taken into account your personal objectives or situation. Before you make any decisions about any of our policies, please read our Product Disclosure Statement and consider your own needs. Call MIGA for a copy or visit our website. © MIGA October 2019

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Doctors, Eligible Midwives, Healthcare Companies, Medical Students

President’s report DR DILIP DHUPELIA

I am now half way through my second term of Presidency and it has occurred to me that AMA Queensland (Board, Council and Management) is getting busier by the day due to increased demands for our input in myriad strategic policy changes and legislation, both at state and federal level. There is so much going on!

There are two recent events that made me ponder on the role of the President of our association.

Firstly, you will be aware that one of the actions that I have deliberately and conscientiously undertaken is to visit all Local Medical Associations (LMA) around the state, and to urge the reinvigoration of all the LMAs that have been inactive for a while and to encourage the formation of new LMAs where they don’t currently exist.

My presentations at these LMA meetings include the wins we have had, the areas where we currently have challenges on our hands, the areas where we keep a very watchful eye on events as they unfold, where we need to keep key people accountable, and the campaigns that we do for the public benefit. I always highlight that what we are doing as AMA Queensland is for the benefit of ALL doctors (GPs and non-GP Specialists, Private and Salaried doctors, doctors involved in academia, research and medical administration, Visiting Medical Officers, our Junior Doctors and our Medical Students), but that only a proportion choose to pay their membership fees. I always question WHY the non-members in the room should not belong. I remind them that AMA Queensland membership gives people a way to a congenial and ongoing relationship with the organisation and that a strong and increasing membership further enhances our credibility and is vital.

At the end of one recent LMA meeting, when I was casually chatting with those present, a doctor came up to me and said to me that she was immediately going to join AMA Queensland as she had not grasped the extent of our involvement in so many areas, and thanked me for my advocacy and leadership.

The second event that made me ponder about my role was the recent article in Australian Medicine by AMA Queensland’s Past President and current Federal AMA Vice President, Dr Chris Zappala, on AMA’s advocacy, where he correctly pointed out and questioned, that despite the unquestionable brand of the AMA and the influence it has on governments, media and the public, should we consider, (and I quote), “what aspects of this (advocacy) remain 6 Doctor Q Summer

effective and what components might be less useful and able to be substituted with new advocacy methods”.

I reflected on these two events and pondered on my role.

The position that the President takes is one that is directed by our policy making engine which is the AMA Queensland Council that is made up of our craft and area elected representatives. To a large extent, the Council’s positions guide how the President leads. This is complemented by the excellent advice that I receive from AMA Queensland’s executive working group. The Directors, CEO and our skilled secretariat are not only experts in various fields, but also have the historical perspective and the chronology of information in their respective areas. In addition, I have never hesitated to contact Past Presidents of our association when I need to seek their wisdom.

So, in a nutshell, the leadership elements of this role come down to advocacy, lobbying and representation. Lobbying is different to advocacy as the legal definition of lobbying usually involves attempting to influence legislation, which is definitely part of the role. I read recently that “lobbying always involves advocacy but advocacy does not necessarily involve lobbying”. Through advocacy, we try to bring about change, and the intent of this change is to help others; in our case, our members and our community. Therefore, it is imperative that the role encompasses being a strong advocate. And finally, the representation aspects of the role take place through sitting on various forums, committees, advisory groups, attending meetings with our important stakeholders and being the organisation’s face and voice in the media.

There have been many debates and scholarly articles as to whether or not leadership can be learnt. After 18 months in this role, I am convinced that leadership, the art of lobbying and the intricacies of advocacy can be learnt.

I certainly have.

Finally, I wish to remind members that your 2020 membership is now due for renewal. We are a membership organisation and your membership renewal is vital to the association. In November, you would have received your 2020 renewal notice. Take advantage of our monthly direct debit payment and don’t forget about our member get member campaign offering a 25% discount for each new member you introduce. You can renew your membership via BPAY, online or over the phone (see page 48 for more information).

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D O C T O R S ’ H E A LT H A N D WELLBEING

CEO’s report

JANE SCHMITT

MEMBERS DRIVING THE AGENDA ON QUEENSLAND DOCTORS’ COMMUNITY In November, we launched our latest member benefit, Queensland Doctors’ Community (QDC), a new peer-to- peer online platform for AMA Queensland members.

QDC has seen some interesting discussions in its first month. Members across the state have been logging on and robustly discussing changes to CPD for doctors, private health insurance, ED issues, climate and health, pharmacy prescribing, general practice billing, tax deductions for travel expenses, junior doctor fatigue and bullying, and entry criteria for training programs, to name a few.

The conversations highlight the issues that are vital to you and will inform our advocacy moving forward. The key role of AMA Queensland is to support, promote and advocate for members, and your views will ensure we are fighting for what is really important to you.

AMA QUEENSLAND 2020 OBESITY AWA R E N E S S W E E K AMA Queensland is currently developing a public education and awareness campaign aimed at battling obesity, curbing chronic disease rates and promoting healthy lifestyles.

AMA Queensland’s 2020 Obesity Awareness Week, from 9 to 13 March, will focus on simple, easy ways that everyday habits can be swapped for healthier outcomes. Practical tips and tricks to help Queenslanders of all ages become more active, swap sugary snacks for healthy ones and cut down on digital devices.

The messages will be distributed through a range of digital, social and traditional media channels.

Save the date and keep an eye out for further details on our Obesity Awareness Week and how you can get involved coming soon.

8 Doctor Q Summer

Doctors’ Health Service have just launched a new national website offering a central coordination point to link doctors and medical students to a range of support resources for their own health and wellbeing. www.drs4drs.com.au has a large menu of wellbeing strategies and where to find health care support, allowing medical professionals’ to find a GP, join a local support network, seek urgent advice, or participate in key events.

In 2020, we are introducing a series of LIVE Q&A webinars with key stakeholders via QDC, starting with new Queensland Health Director-General Dr John Wakefield PSM in January and Director of Digital Health and Co-Chair, My Health Record Expansion Program Adjunct Professor Steve Hambleton in February. Save the date to chat LIVE with Dr Wakefield on QDC on 30 January 2020.

In 2020, we will launch the new AMA Queensland app where you can access QDC, update and renew your membership profile, register for events, access membership benefits and discounts and more – all at the touch of a button. Keep an eye out for launch details coming soon.

If you haven’t had a chance to explore QDC yet, take a few minutes to login by using your AMA details and see what your colleagues are saying. The more members get involved, the stronger your voice will be. Read more on page 20.

A V I S I T T O T H E G P I S W H AT PAT I E N T S W A N T, N E W A M A Q U E E N S L A N D S U R V E Y S AY S AMA Queensland recently conducted a survey of more than 1,000 Queenslanders to determine community attitudes to primary health care delivery, including current preferences for future care models.

Pleasingly, the survey revealed 84 per cent of Queenslanders have a regular GP and the overwhelming majority believe their GP is a very valuable part of the health system. Respondents said the most valued aspect of having a regular GP was receiving medical expertise from a qualified doctor, followed by the opportunity for private conversations with their GP in a health care setting.

Looking to the future, three-quarters of Queenslanders would like other medical services co-located at their GP clinic with x-rays and scans the top of the wish list (56 per cent) followed by a pharmacy (53 per cent) and a psychologist (29 per cent). Queenslanders also want bulk-billing and more opportunities for same day, after hours and weekend appointments. Detailed survey findings can be found on page 32.

Overall, the survey revealed that GPs are highly valued by Queenslanders and are viewed as an integral part of the health system. There are, however, great challenges ahead for primary health care providers and AMA Queensland will continue to strongly advocate against expanded scope of practice for allied health practitioners and the serious and significant risks posed to the health and safety of Queenslanders.

In 2020, we will develop a similar survey focusing on specialists to explore issues around out of pocket expenses, private health insurance, regional access to health care and more.

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Townsville Breakfast with the Health Minister The Townsville medical community came together earlier this month for AMA Queensland’s Townsville Breakfast with the Health Minister.

Guests took the chance to discuss a number of issues with Health Minister Steven Miles and AMA Queensland President Dr Dilip Dhupelia, including diabetes management, regional training, mental health services, general practice, water fluoridation, as well as the impact from the floods earlier this year.

10 Doctor Q Summer

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For a limited time only, receive an upgraded 10 years/100,000km BMW or MINI Service Inclusive Basic package* when you purchase a new BMW or MINI between 1 October 2019 and 31 December 2019. Whether it’s a drive to the local pub or a road trip to Central Queensland, we have a vehicle for every occasion.

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Offers apply to new BMW and MINI vehicles ordered between 01.10.2019 and 31.12.2019 and delivered by 31.01.2020 at participating authorised BMW or MINI dealers by Australian Medical Association Queensland members or their spouse. Excludes fleet, government and rental buyers. Unless excluded, this offer may be used in conjunction with other applicable offers during the promotion period. *Complimentary service inclusive - Basic, including Vehicle Check, is valid from date of first registration or whichever comes first of 10 years/100,000km and is based on BMW or MINI Condition Based Servicing, as appropriate.

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N R E T IN

events

1. Tejminder Sidhu, Sufian Odeh and Leah Hind, 2. Shwe Yee Win, Guang G Lin and Ng Gwen, 3. Grace Elder, Talita Senewiratne Purssey, 4. Janani Jeganathan and Hugh Eigeland, 5. Cairns based AMA Queensland member, Sophie Manoy, discusses her medical identity during the Brisbane Intern 101 Workshop, 6. Alice Odam, Taylor Brooks, Oliver Coorey and JN Hardeman, 7. Sam Grace, Harry Collin, Jack Sharples, Joe Potter and Joel Priebbenow.

Throughout October and December, AMA Queensland host a number of final year student lunches at many hospitals across South East Queensland. These lunches culminate in the Intern 101 Workshops, held in Brisbane, Gold Coast and Townsville. These events provide valuable insight into varying aspects of their upcoming intern year.

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More than 70 people joined us at Victoria Park to hear 71st Bancroft Orator Dr Louis Peachey, whose topic spoke about how the myths of settlement bring its own shadows over our ability as a nation to move forward together.

Dr Louis Peachey is a Girrimay man from the Djirribaligan language group (Rainforest People) of North Queensland.

He is a Senior Medical Officer at the Atherton District Hospital where he works as a Rural Generalist Anaesthetist, and runs a regular clinic at Lotus Glen Correctional Centre.

Dr Peachey was the founding President of the Australian Indigenous Doctors Association, is a former Board member of the Australian College of Rural and Remote Medicine, and has been an advocate for rural and Indigenous health for more than a quarter of a century.

71st AMA Queensland Bancroft Oration And the Truth Will Set You Free (John 8:32)

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1. Dr Louis Peachey, 2. Drs Nicola Previtera and Ian Wilkey, 3. Dr Jane Mackerras and Jo Mackerras, 4. AMA Queensland President Dr Dilip Dhupelia, Dr Denis Lennox and Shirley Lennox, 5. Yun-Hsuan Lee and Garima Moudgil, 6. Kathryn Perry and AMA Queensland Vice President Associate Professor Chris Perry, 7. Drs Warwick Marks, Hasthika Ellepola and Robert Taylor, 8. Drs Gregory Day, Lindell Day, Karen Ramsay and Balazs Molner.

Doctor Q Summer 13

AMA Queensland Annual Conference More than 120 delegates gathered in Edinburgh for the 19th AMA Queensland Annual Conference in September. Delegates were educated and entertained by a line-up of world renowned speakers. Every session was packed with enlightening presentations and generating enthusiastic discussion and debate.

The Australian High Commissioner to the UK, The Hon George Brandis, QC, opened the conference and presented an excellent overview of the broad Australia/UK relationship. AMA Queensland President Dr Dilip Dhupelia gave a comprehensive overview of the theme, Global Trends in Health Care Delivery, to set the scene for the week.

LOCAL SPEAKERS

AUSTRALIAN SPEAKERS

EXPLORING EDINBURGH

It was then time for a line-up of local speakers: Professor James Garden spoke on medical history in Edinburgh.

Scottish Chief Medical Officer Dr Catherine Calderwood joined Dr Andrew Jeremijenko to discuss sustainability in health care. Dr Elizabeth Kelly, NHS, Scotland, spoke on aged care, end of life and assisted dying, and Professor of Medical Education and GP Dr Lindsey Pope discussed doctors’ health and wellbeing.

Professor Sunil Lakhani did two presentations on the evolution and impact of genomics on medicine and later, brain metastases. Dr Chris Zappala discussed the ignominy of pneumoconiosis, and Dr Sarah Coll spoke on innovations in orthopaedic surgery. Dr Chris Perry spoke on Indigenous health care delivery.

Outside the conference sessions, delegates had opportunities to explore Edinburgh with a walking tour of the Old Town and a visit to Edinburgh Castle, as well as a visit to the Scottish countryside and some Highland Games.

Dr Jennifer Logue addressed global obesity and Scottish Minister for Older People and Equalities Christina McKelvie spoke on loneliness and health.

1. Donna Kent, Drs Bob Brown, Dilip Dhupelia, Peter Kent with Carmel Brown, 2. Professor Joan Lawrence with Roddy Deans, who gave delegates a wonderful introduction to the history, customs and culture of Scotland, 3. The Farewell Dinner, 4. Drs Beata Rawdanowicz, Andrew Jeremijenko, Dilip Dhupelia, AMA Queensland CEO Jane Schmitt, Professor Sunil Lakhani and Dr Angela Livingstone, 5. Dr Elizabeth Kelly, 6. Dr Phillip Harvey, Colleen Sullivan OAM and Australian High Commissioner George Brandis.

Thursday Island GPs Drs Ruth Stewart and Tony Brown spoke on rural generalism and designing and delivering equitable medical services to the Torres Islands and Cape York communities.

Professor David Williams spoke on advances in forensic medicine and Colleen Sullivan OAM on global trends in health care practice management.

AMA Queensland Dr Dilip Dhupelia teamed up with AMA Vice President Dr Chris Zappala and British Medical Association Scotland Director Jill Vickerman to discuss the medical profession advocacy issues and activities.

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

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

Justin Greenwell Director, Mater Private Hospital Springfield

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

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Private Practice and Medico-Legal Conference H I T T I N G T H E M A R K I N P R I VAT E P R ACT I C E

The Private Practice and Medico-Legal Conference is a great way to learn more about best practice for your practice Whether on your way to starting a new practice or building your existing practice.

General practitioners, specialists and practice managers enjoyed a diverse program with dedicated educational streams.

Some of the sessions included: making sense of MBS reform, common issues and billing ethically; Medicare essentials for practice managers;

understanding the latest practice incentive payments; common specialist complaints and how to avoid them; an end of life law for clinicians workshop, presented by QUT; and

delivering excellence in patient care;

the new Rural Generalist National Program.

mandatory reporting;

The Private Practice and Medico-Legal Conference was sponsored by the National Home Doctor Service, BOQ Specialist, Cornerstone Medical Recruitment, Doctors’ Health Fund, Fortus Health Group, HWL Ebsworth, Lexus of Brisbane, MDA National, MGRS, Morgans, Perfect Practice and William Buck.

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1. Rural Doctors Association of Australia President Dr Adam Coltzau spoke on the new Rural Generalist National Program, 2. AMA President Dr Tony Bartone, 3. Associate Professor Michael Greco, 4. Joanne Gibbins and Carol Lubach, 5. Drs Kirstin Millar and Aaron Chambers, 6. Drs Marosh Vrtik and Emily Farrell, 7. Bruce Topperwien and Professional Services Review Director Professor Julie Quinlivan, 8. Drs Sarah Coll and Di Khursandi, 9. Dr Michael Clements, 10. HWL Ebsworth Partner Heinz Lepahe; MDA National Claims Manager Talitha Burson; AMA Queensland Senior Industrial Officer Michelle Cowan; WorkCover Industry Manager Tanya Cambey; and General Practitioner and Founder, Family Doctors Plus, Telstra Small Business Award winner Dr Maria Boulton with Chair AMA Queensland CEO Jane Schmitt, 11. Allison Vautin and Susan Rod, 12. AMA NSW President Dr Kean-Seng Lim presented a session on Clinical Governance for Practices, 13. Dr Fiona Raciti, 14. Professor Keith McNeil.

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Doctor Q Summer 17

Women in Medicine Breakfast MIND, BODY AND SPIRIT

f el s r ou y er t f a g Lookin

AMA Queensland’s Women in Medicine breakfast is always a highlight on the annual calendar.

Some guests rocked up early for a free yoga session with Mind Body Miko overlooking the Brisbane skyline.

The panel, Drs Yumiko Kadota and Bethan Richards, shared their candid insights, experiences and tips for navigating life and medicine.

4

1

2

3 5 18 Doctor Q Summer

7 6

1. Zahra Killin and Georgia Auger, 2. Drs Tisha Searles and Jennie Roberts, 3. Christalli Kossaris, Alysha Roulstone, Melinda Collinge and Dr Trish O’Connor, 4. Drs Clare Kao, Anna Singleton (with baby Lachlan), Frances Williamson and Kate Hughes with Dr Kao’s baby Oliver, 5. Drs Zoe Poiner and Vanessa Grayson, 6. Drs Fiona Raciti and Lauren Galt, 7.

Jessica Hewitt, Jacqueline Villalobos and Lauren Jackson, 8.

Drs Otilie Tork and Mellissa Naidoo, 9. Kate Roberts, 10. AMA Queensland CEO Jane Schmitt, speakers Dr Yumiko Kadota and Dr Bethan Richards with MC Sophie Scott, 11. Lauren Poon and Abigaill Reugebrink, 12. Drs Judith Somerville and Alex Bordujenko

8

11

9

10

12 Doctor Q Summer 19

Doctors’ community platform takes off

WHERE YOU DRIVE THE AGENDA

AMA Queensland’s brand new peer-to-peer, member-only platform, Queensland Doctors’ Community (QDC), launched on 6 November has started a wide range of conversations between members.

The opportunities to connect, communicate and collaborate are endless and the more you participate, the stronger your community will be.

COMMUNITY FORUM

QDC connects more than 9,600 members to share ideas, pose challenges, ask questions and advice and debate topical issues.

You’re able to share your views and experiences and discuss issues that affect you, your patients and the health system.

The platform shows AMA Queensland the issues that are vital to you and will drive the agenda in our advocacy work.

The conversations will inform our policies and will give us greater clarity on your top priorities.

QDC will help AMA Queensland communicate more dynamically with you, responding more quickly to your needs and providing you with valuable resources.

RESOURCE LIBRARY

MEMBER DIRECTORY

QDC also has a library for sharing documents, resources and more.

AMA Queensland has uploaded position statements, recorded webinars, the 2019 Resident Hospital and Health Check, the AMA Fees List, as well as AMA Queensland’s constitution and strategic plan. The library is not only for AMA Queensland to provide resources to you though – you’re able to upload and share useful content yourself.

QDC features a discussion forum as well as a member directory of all current members, which allows you to connect with peers, start discussions and build relationships.

Through the resource library you also have access to the daily media clips, which allow you to keep up-todate with a fast and comprehensive overview of the major health care news stories in Queensland and Australia.

There is no discussion too big or too small.

H O W T O LO G I N A N D J O I N T H E C O N V E R S AT I O N 1. Login at https://community.amaq.com.au/home using your AMA ID (Username) and password. If you are unsure of your AMA password, click here to reset.

2. Complete your profile 3. Start a conversation - post a message in the Open Forum discussion group

QDC TIP: TO ACCESS THE DISCUSSION FORUM IN ONE CLICK, ADD THE QDC ICON TO YOUR DEVICE’S HOME SCREEN (ADD SCREENSHOT OR SIMILAR) To acquaint you with the new platform, when you login to QDC you can find a Quick Start Guide and Video.

There is also a comprehensive FAQ section if you have any further issues.

The QDC Team is available to help out if you have any technical difficulties and to seek further information on any of questions you may have on health advocacy, workplace relation issues, your membership and benefits, attending events, accessing publications, policy development, benefits from corporate partners, or any matters relating to AMA Queensland. If you have any questions, please contact the QDC Team at community@amaq.com.au or call (07) 3872 2222.

20 Doctor Q Summer

AMA Queensland’s 2020 H E A LT H P R I O R I T Y 1 - M E N T A L H E A LT H

H E A LT H P R I O R I T Y 2 - OPIOID CRISIS

All Australians with a mental illness deserve ready access to quality mental health services based on their individual needs. Medical practitioners play an important role in the diagnosis and management of mental health across the continuum of care including referral to clinical services for patients with severe, chronic and complex needs.

In Queensland, there is an Opioid Crisis due to overprescribing of opioids (S8 medications), the lack of people trained as addiction medicine specialists, and lack of support and services for people addicted to opioids

AMA Queensland is calling on the Queensland Government to support the following strategies: i. Support the rollout of the Link-Me trial in more Queensland GP clinics. ii. Review the current requirements of mental health treatment plans (MHTP), iii. Improve mental health training for doctors iv. Improve the mental health workforce strategy for rural and remote communities in Queensland

H E A LT H P R I O R I T Y 3 - PA I N M A N A G E M E N T Consumers with chronic pain represent a huge burden of disease in Queensland with one in five people affected by the condition. There is an urgent need to increase funding for pain management services, establish safe and culturally appropriate pain management services for Aboriginal and Torres Strait Islanders and develop targeted training in medication management for medical practitioners.

AMA Queensland is calling on the Queensland Government to support the following strategies: i. Increase the level of funding for existing pain management clinics ii. Establish local based pain management clinics at Toowoomba, Ipswich, Bundaberg, Rockhampton, Mackay and Cairns iii. Establish additional pain medicine registrar positions iv. Develop targeted training in medication management for medical practitioners v. Improve access to safe and culturally appropriate pain management services for Aboriginal and Torres Strait Islanders

AMA Queensland is calling on the Queensland Government to support the following strategies: i. Work with AMA Queensland, medical schools and the Australian Medical Council (AMC) to review the philosophy of treatment of addictions within their curriculum ii. Support the creating of a new service improvement payment (SIP) to encourage medical practitioners to accept addiction patients as part of their practice iii. Establish additional training positions in addiction medicine.

H E A LT H P R I O R I T Y 4 - I N D I G E N O U S H E A LT H Access to health services is an important factor in health and wellbeing, however, for many Aboriginal and Torres Strait Islanders, there are barriers relating to availability, affordability, acceptability, appropriateness and poor communication with healthcare professionals. For Aborigines and Torres Strait Islanders who live in rural and remote communities, there needs to be more emphasis on the provision of safe and culturally appropriate health services.

AMA Queensland is calling on the Queensland Government to support the following strategies: i. Improve communication and partnership opportunities between health service providers, Aboriginal and Torres Strait Islanders (including elder) and doctors living in rural and remote communities to improve access to culturally appropriate health care ii. Improved coordination of health care, transport, accommodation and social support for Aborigines and Torres Strait Islanders living in remote communities who need specialist treatment in large urban centres during their period of treatment.

H AV E YO U R S AY AMA Queensland is seeking your feedback on these health priorities. Your views from the coalface will ensure AMA Queensland is advocating for what is important to you and will assist us to formulate our formal submission to the Queensland Government.

22 Doctor Q Summer

Health Priorities H E A LT H P R I O R I T Y 5 - A LC O H O L R E L AT E D H A R M Alcohol is one of the leading preventable causes of death and disability, with the annual cost of alcohol-related harm in Queensland estimated to be over a billion dollars.

Queensland emergency workers and police still report high levels of alcohol-fuelled violence and injuries, particularly during late liquor trading periods after midnight.

AMA Queensland is calling on the Queensland Government to support the following strategies: i. Undertake a campaign focusing on women’s drinking habits and drinking during pregnancy ii. the introduction of a minimum floor price for alcohol iii. a program focusing on reducing fetal alcohol syndrome iv. the geographical expansion of the Safe Night Precinct Project

H E A LT H P R I O R I T Y 7 - OBESITY

H E A LT H P R I O R I T Y 6 - H E A LT H Y M E D I C A L WORKPLACES Doctors need to work in safe, healthy hospitals so they can [provide the best possible care without the threats of bullying, sexual harassment and fatigue. The results of the 2019 Resident Hospital Health Check revealed more needs to be done with fear of negative consequences from speaking up; feeling unsafe at work and concern about making a clinical error due to fatigue related to long work hours still unacceptably high.

AMA Queensland is calling on the Queensland Government to support the following strategies: i. Support the expansion of Wellness at Work for PGY2-5 doctors ii. Change the mandatory reporting laws in Queensland in line with WA model iii. Support additional medical leadership training opportunities iv. Stop the expansion of scope of practice for non-medical health practitioners

The rates of overweight and obesity and associated chronic disease continue to increase despite numerous public health campaigns.

AMA Queensland is calling on the Queensland Government to support the following strategies: i. The AMA Queensland Obesity Awareness Week (including Screen Free Week) from 9-13 March 2020 ii. Introduce a sugar tax in Queensland iii. Restrict advertising of junk food, sugary drinks, alcohol and master brands on all 2000+ government-owned advertising spaces iv. Ensure that all hospitals and healthcare settings have healthy food options v. Re-introduce mandatory physical activity in Queensland public schools, especially in the senior levels of high school

H E A LT H P R I O R I T Y 8 - SUSTAIN ABILIT Y IN H E A LT H C A R E AMA Queensland recognises the latest findings regarding the science of climate change, the role of humans, past observations and future projections. The health care 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 emissions.

AMA Queensland is calling on the Queensland Government to support the following strategies: i. Establish an Office of Environmental Sustainability in Queensland Health ii. Set benchmarks and targets for sustainability in all public hospitals and health care settings iii. Undertake a pilot program for environmental sustainability in three rural and three metro hospitals

Please send your feedback through Queensland Doctors’ Community (QDC) at https://community. amaq.com.au or email Jeffrey Allen, Policy Manager AMA Queensland, at j.allen@amaq.com.au.

iv. Undertake a pilot program for environmental sustainability in 10 GP clinics

Doctor Q Summer 23

d n a s O M u S o r y e t d e e Ma n e w s VMO

Mater Senior Medical Officers’ and Visiting Medical Officers’ enterprise agreements are now up for negotiation. This is where we need your help! Our bargaining position is so much stronger when we have the largest possible backing from Mater SMOs and VMOs. The agreements actually expired 31 March 2018 but in the meantime, a 2.5 per cent increase was negotiated for 2018 and a two per cent increase was negotiated for 2019.

In September, ASMOFQ wrote to the Mater Hospital to begin negotiations and to discuss a wage increase for SMOs and VMOs from July 2019 including back pay.

T O J O I N N E G O T I AT I O N S : P: (07) 3872 2222

|

E: asmofq@amaq.com.au

The Mater responded with a commitment to provide SMOs and VMOs with the two per cent increase backdated to July 2019 and will begin negotiations for both agreements by March 2020.

Supporting Mater through redundancy In October, the Mater Hospital announced their imaging service “had some insurmountable challenges in remaining financially viable” and decided to outsource their imaging to Queensland X-Ray. It’s always regrettable when redundancies need to be handed out. Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) assisted the medical imaging Senior Medical Officers (SMOs) affected by the shut down to ensure all relevant entitlements were paid out.

On behalf of these members, we have secured: the relevant redundancy based on length of service three months paid out in lieu of notice period being worked for what the SMO would have earnt had they have worked.

This includes:

Right of Private Practice (ROPP) payments Professional Development Allowance Motor Vehicle Allowance Base Salary other entitlements e.g. Clinical Managers Allowance

Annual and Long Service Leave paid out ROPP paid on Annual and Long Service Leave paid out Superannuation under the Act Two per cent pay increase backdated and applied to all employment entitlements.

Separately, these members had an agreement where their ROPP was paid three months in arrears, which the Mater chose not to pay after these redundancies. ROPP is kept separate from standard employment entitlements and on behalf of members, we are now seeking legal advice on next steps.

These wins were made possible by our combined bargaining power: 100 per cent of the SMOs in Mater Medical Imaging are AMA Queensland/ASMOFQ members. It certainly makes our position stronger when we can speak on behalf of the entire department.

B E C O M E A M E M B E R : W: www.qld.ama.com.au/join P: (07) 3872 2222 24 Doctor Q Summer

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Doctor Q Summer 25

2019 Resident Hospital Health Check The 2019 Resident Hospital Health Check (RHHC) shows that nearly half of Queensland’s trainee doctors are worried about making a clinical mistake because they are exhausted from working excessive hours.

Bullying, while decreased from last year, is still a problem for 12 per cent of junior doctors. AMA Queensland’s Council of Doctors in Training Chair told media “It is very troubling that only a quarter of bullying incidents are being reported and 57 per cent of junior doctors fear negative consequences from speaking up. Importantly, 22 per cent said they had felt unsafe at work.”

The survey reveals a big discrepancy in satisfaction with the quality of junior doctor training. Cairns rated the highest 72 per cent said the training was very good or excellent - and Mackay Hospital the lowest on just eight per cent.

TOP 6 PRIORITIES IN QUEENSLAND The following are the 6 highest ranked domains in order of priority from 1 being the highest ranked.

1.

Clinical rotation preferences

2. Annual leave process

55%

ed

atisfi

3. Being appropriately paid for unrostered overtime 13% 7%

for claimed overtime

10%

9%

not s

NOT GET PAID

G0T

G0T PAID

ALL

PAID SOME

of the claimed overtime

quite

quite satisfied

ed

satisfi

d

tisfie

ely sa

m extre

4. Personal safety at work 22%

felt their safety had been compromised at work

the overtime they claimed

33%

46%

6. Working fatigued

26%

moderately satisfied

13%

14%

slightly satisfied

9%

not satisfied

26 Doctor Q Summer

isfied

ly sat

rate mode

80%

extremely satisfied

Residency education programs

d

tisfie

tly sa

sligh

18%

5.

25% 17%

were quite to extremely satisfied

DID

39%

concerned that fatigue caused by long hours may cause clinical error

did not have adequate breaks between shifts

ABOUT THE SURVEY In 2019, AMA Queensland surveyed Resident Medical Officers (including those at Intern, Junior House Officer, Senior House Officer and Continued Residency levels) to evaluate the state of Junior Medical Officer employment in Queensland, and subsequently compare hospitals across the state.

A total of 882 Doctors in Training across 19 hospital and health services responded to the survey, representing approximately 38 per cent of Queensland Heath’s 2,313 eligible Resident Medical Officers (RMOs). This is the fourth consecutive year the survey has been conducted. The questions were similar to the 2018, 2017 and 2016 surveys, so that results could be compared across the four years. This year’s survey achieved a 43 per cent participation increase from 2018.

The survey is designed to promote positive change in the hospital system and highlight areas that need attention. The RHHC also gives junior doctors a guide as to the hospitals that provide the best training and support.

DISCLAIMER The AMA Queensland Resident Hospital Health Check survey was completed on a voluntary basis by Queensland doctors in training (including those at Intern, Junior House Officer, Senior House Officer, and continued Residency levels).

The purpose of this document is to assist graduating medical students as well as current interns and residents with their decision making process when deciding on which hospitals to apply for in the upcoming intern and RMO campaigns.

This information is provided in good faith and should only be used as a guide, it is intended to be general in nature and is made available on the understanding that the AMA Queensland, ASMOFQ and the AMA Queensland Council of Doctors in Training do not make any comment or assertion that the information provided by participants is correct, or reflects the experiences of doctors who did not participate in the survey.

Before relying on the information contained in the survey results provided, users should carefully evaluate its accuracy, currency, completeness and relevance for their purposes, personal objectives and career goals, and should make their own enquiries, including consulting with the relevant Hospital and staff at the relevant Hospital.

Whilst every effort has been made to ensure the accuracy of the collation of the information in this survey, AMA Queensland, ASMOFQ, its employees, agents, contractors, elected officers and the AMA Queensland Council of Doctors in Training cannot be held responsible for the information provided by participants in the survey and cannot be responsible for any loss or damage arising from any person or organisation as a result of the publication of this survey of information. AMA Queensland, ASMOFQ and the AMA Queensland Council of Doctors in Training do not take any responsibility for the outcomes published in the survey.

Grades were derived by firstly estimating the adjusted rate of the observed number of affirmative responses using a risk adjusted model for gender, training level and country of graduation (logistic regression run in the full sample), separately for each question and hospital/HHS. Adjusted rates were averaged across each domain (with rates of negative outcome subtracted from 1 so that all rates reflected positive outcomes). Grades ranged from E- to A+, and were assigned by giving the middle score (i.e., C) to average scores falling between 0.4375-0.5625, with grades increasing or decreasing with each 0.0625 increase or decrease in the score. The overall grade was the average of each domain specific grade. Lastly, the overall raw percentage of responses for each question in 2019 were compared with the same question in 2018, with improvement (^5%), no change or worsening ( 5%) indicated by green, yellow and red traffic lights respectively.

Comparison of results among hospitals/HHS must be made with caution, as the survey did not involve a probabilistic sampling frame, but instead was open to the entire QLD RMO population, achieving a response rate of 38%. Further, as RMOs were not randomly allocated to hospitals differences in attitudes and expectations of respondents cannot be adequately controlled. This introduces biases into the results which cannot be accounted for. Thus, all differences among hospital/HHS should be interpreted as specific only to the survey respondents and must not be interpreted as representative of the experiences of all Doctors in Training in Queensland.

The grading scheme has been updated since the 2018 survey: in 2018 the grades were assigned ‘relative’ to best and worst performing hospitals (the average score was firstly range normalised such that the best hospital was given an A+ and the worst an E-); while in 2019 the average grades were not rescaled such that grades were attributed to the absolute scores.

All analyses and reporting of results, including the derivation of the grade, were undertaken by an Epidemiologist (PhD) with considerable experience in research design and statistical analysis and a strong track-record in health/medical research.

F U R T H E R I N F O R M AT I O N If you would like to discuss any aspect of the 2019 AMA Queensland CDT Resident Hospital Health Check survey in greater detail, please email workplacerelations@amaq.com.au and a member of the team will get back to you.

The AMA Queensland Industrial Relations Team also provides confidential, assured advice to Doctor in Training members on employment terms and conditions, and any aspect of your employment that is causing you concern. You can contact the Team on (07) 3872 2222 to discuss.

Not a member of AMA Queensland? You can join at ama.com.au/join-ama to receive support and guidance on employment matters in addition to a range of professional development programs, services and benefits to support your journey in medicine.

Find out how your hospital scored at www.qld.ama.com.au/advocacy/ resident-hospital-health-check

Doctor Q Summer 27

Hard-won agreement for flying doctors Royal Flying Docto rs Service medical offi cer Dr Minh Le Cong

After two and half years of negotiation, the Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) is in the final stages of the Royal Flying Doctors’ Service Queensland’s (RFDS Queensland) first enterprise bargaining agreement (EBA).

RFDS Queensland doctors Minh and Shelly Le Cong first approached ASMOFQ about setting up an enterprise bargaining agreement in June 2017.

“This is the first EBA for RFDS Queensland medical officers.

We have only ever had a company terms and conditions agreement before but when this was overdue for renewal we decided that we wished to implement a formal EBA,” said Dr Minh Le Cong.

RFDS Queensland doctors were initially on individual contracts on a terms and conditions-style agreement, while RFDS Queensland nurses, pilots and administrative officers were all on an enterprise agreement. RFDS doctors in other states were also on an enterprise agreement.

The style of contract the RFDS Queensland doctors were on left them vulnerable to change and while it was negotiated every two to three years, there were few wage increases and those would happen on a case-by-case basis, rather than being extended to all doctors.

“A formal EBA will mean we will have the legislative protections afforded by the act as well as the Fair Work Commission as a legislative body to help resolve disputes related to our EBA. It will mean we can argue for more parity with similar medical officers in Queensland health and their EBA for this first round and future negotiations,” he said.

“This would bring us in line with the other professions within RFDS such as pilots, nurses and administration employees.

The biggest win for the RFDS Queensland members is the increase to Professional Development from $7,000 to $10,000.

This is to be calculated pro rata and paid through payroll.

“Moreover we wished to bargain competitively in line with other doctors who are already under an EBA, for example, with Queensland Health and their salaried medical officers,” said Dr Le Cong.

For each year the medical officers stay with RFDS, they receive a wage price index (WPI) increase, which means their wage will increase with the price of living.

28 Doctor Q Summer

The Drs Le Cong were appreciative of the efforts of the ASMOFQ team in providing industrial advice to progress them to an enterprise bargaining agreement.

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Keep your eye on the ball If you own your own practice, you are not only the doctor in the practice but also the business owner and employer as well. At AMA Queensland, we see so many situations where a doctor has handed over control in order to focus on treating patients – but with disastrous consequences.

As an employer, you cannot take your eye off the ball. You need checks and balances in place to ensure your practice is financially viable.

S TA F F E NT IT L E M E NTS

S TA RT A S YO U M E A N TO G O O N

One particular area where you need to keep your eye on the ball is staff entitlements. The AMA Queensland Workplace Relations Team recently assisted a member who wanted to retire from his private practice and found that some of his staff had accumulated long service leave, annual leave and time off in lieu that totalled more than $60,000.

It is important to have a framework set up before you open a business or at least in the early days, before unhealthy customs and practice can form with your employees.

It is a lot of money to pay out in a lump sum at the end of your working life and has turned happy working relationships into difficult ones.

The member concedes that the seeds for conflict were actually sewn when the employees began work for their practice 20 years ago. Had the rules around leave been set and made clear from the start, the outcome at retirement would be very different.

The member used an accountant for the annual practice tax return but the accountant certainly should have raised the potential outgoing cost of staff leave steadily rising in the background.

Whatever your relationship with your practice manager, you still need to have a good understanding of workplace relations yourself, as well as an overview of how your business is being run.

EE HAVE ACCESS TO FR AS A MEMBER, YOU AIL ADVICE FOR ANY TELEPHONE AND EM ONS MATTERS. WORKPLACE RELATI m.au

wradvisor@amaq.co P: (07) 3872 2222 | E:

30 Doctor Q Summer

Policies, procedures and codes of conduct are not unnecessary fluff, they form the employment framework and will help you to ensure clarity and consistency of standards in your workplace. They give you the opportunity to set the standards and ensure that your standards meet the legislated standards so you don’t fall foul of the law. Good standards also provide transparency in your business which is essential for an harmonious workplace.

You can’t expect to know everything you need to know about running a business. You do need to know who to talk to and who you can trust. Make sure your accountants and bookkeepers keep you up-to-date with the risks to your business and changes in their areas of practice.

Employment law specialists are your best support in meeting your obligations proactively and resolving disputes.

Human Resources professionals can be of assistance in helping you to implement the advice the employment lawyers give you. The AMA Queensland Workplace Relations Team is formed to assist you directly with employment questions. If you have associated concerns, they will then put you in touch with professionals who have demonstrated experience in their areas of expertise.

A team of trained professionals is your best support network to ensure a long and thriving business. Acting on their advice in a timely manner will help you to keep pace with changes and protect your business interests as well as reducing the likelihood of workplace disputes.

workplace relations

advisory package

GOOD GOVERNANCE Good governance is good business. Corporate governance is the framework that allows for a company to be directed and controlled and ensures that it is done accountably, ethically and responsively.

Good governance looks different for different sized-companies but is critical for all businesses.

Examples of good governance include: a well-drafted constitution; receiving sound advice from external advisers (e.g. an accountant or lawyer); maintaining licences, registrations and qualifications necessary to stay in business; ensuring relevant insurances are up-to-date; directors understand their legal responsibilities; policies and procedures in place; position descriptions and performance reviews for staff; financial controls in place; and adhering to formal reporting requirements e.g. Australian Securities and Investments Commission (ASIC), Office of Fair Trading.

Other systems and processes that can be adapted as the business grows include a more detailed business plan, more sophisticated data capture and reporting systems, more extensive human resources systems, risk management plans, a charter and more.

As this case study shows, the cost of getting workplace compliance wrong can be immense. The rules for managing employees are complex and ever-changing.

The good news is, we’ve got your back. The AMA Queensland Workplace Relations Team is uniquely qualified to help you manage your workplace the same way you manage your practice: efficient, compliant and using best practice.

AMA Queensland’s new Workplace Relations Advisory Package (WRAP) will give you up-to-date, relevant and practical support with all employment matters,

specifically focusing on medical practice. The package will give you the same phone and email support, but will supercharge that advice with free attendance to Workplace Relations training events and webinars, contracts, manuals, privacy essentials, audits, templates and leave calculations.

You’ll also stay up-to-date with changes in industrial relations and employment law to help your business to remain compliant with your obligations.

Visit www.qld.ama.com.au /wr-advisory-package.

Doctor Q Summer 31

Queenslanders love their GP

AMA Queensland recently surveyed more than 1,000 Queenslanders to determine community attitudes to primary health care delivery. The survey was designed to assist our General Practitioner members in continuing to meet community demands for healthcare delivery, both now and in the future.

The survey respondents were an even balance of gender and age ranges (18 – 65+ years) and were from urban as well as regional parts of the state, providing a well-rounded sample of those who access primary health care in Queensland.

The survey findings were generally very positive. Firstly, 76 per cent of Queenslanders believe their GP is very valuable and considered them their first port of call for health care. The survey explored reasons why respondents did or did not have a regular GP, as well as why they visit a small or large practice.

REASONS FOR NOT H AVING A REGUL AR GP

DO YOU H AVE A REGUL AR:

84.5% GP 51.5% 43%

Dentist

THE VAST MAJORITY OF QUEENSLANDERS WOULD C O N S U LT T H E I R G P FIRST FOR: flu and travel vaccinations

Hairdresser

flu symptoms

40.4% Pharmacist

minor ailments contraception

REASONS FOR H AVING A REGULAR GP Medical expertise from a qualified doctor having a private conversation with a trusted confidante

SERVICES WANTED FROM A GP bulk billing same day appointments, as well as after hours and weekend appointments other health services like x-rays, scans, pharmacy, psychology and physiotherapy in the same clinic

suspected infections back pain chronic stomach pain

SIZE OF THE PRACTICE

75%

77%

believe they get believe they’re more more personalised likely to see the same attention at a small GP at a small family family GP practice GP practice

They feel that they are in general good health They often find it hard to get an appointment with the same doctor when needed.

They sometimes feel that GPs rush their appointments as they have a full appointment book.

They feel that some GPs do not listen to them and use medical jargon.

The hours of GP clinics do not suit their particular lifestyle.

They have a personal preference for other health practitioners

54%

believe they’re more likely to get an appointment when they want one at a large medical centre-style practice

“As you would be aware, GPs are still recovering from the five-year MBS freeze that threatened sustainability and liability of their practices, particularly in rural and regional areas.

We are in the midst of a direct threat by Queensland Health who are pushing to extend scope of practice by allied health practitioners and the relentless lobbying by the Pharmacy Guild who wish to behave like doctors. This is on the basis that access to GPs is an issue and that there is little loyalty amongst Queenslanders to access primary care services from their regular GP or doctors working within the same practice.

AMA Queensland will continue to advocate for the primacy of General Practitioners as well as the healthcare needs of patients,” said AMA Queensland President Dr Dilip Dhupelia.

32 Doctor Q Summer

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MEMBER PROFILE

Dr Brodie Quinn It was more than just the thrill of highpowered machines and working in the sky, that attracted him to the job.

“It’s always interested me. I’ve worked in both rural areas and a big tertiary hospital, so retrieval medicine is the missing link that joins them together.”

Buckling up in the back of a helicopter for his first mission, Dr Brodie Quinn knew he was in for the experience of a lifetime.

He had decided to take a break from the bustle of the hospital and fly to his patients instead, as a Critical Care Doctor, on LifeFlight rescue helicopters - a decision he made, despite having taken only one chopper flight, before he underwent his LifeFlight training.

Dr Quinn joined the service in August this year, as a Retrieval Registrar based in Toowoomba.

His first month on the job was full of excitement - and discomfort from a sore neck, from trying to look out the aircraft’s windows, at the stunning views of Queensland.

“In the first week I wanted to be in the helicopter as much as possible, even if it was just doing medical equipment checks while it was stationary in the hangar,” Dr Quinn said.

34 Doctor Q Summer

The Toowoomba LifeFlight Rescue choppers can be tasked at any hour of the day or night, to retrieve sick and injured patients from hospitals and emergency scenes, across south west Queensland.

LifeFlight welcomes two intakes of registrars each year, who are based with aeromedical teams around Queensland, after undergoing an intensive training program.

They practise clinical scenarios and learn about working with aircraft, including winching and escaping in emergencies.

Now several months into the job, Dr Quinn is becoming a seasoned flyer, with a passion for retrieval medicine and a growing collection of prehospital medical experiences.

He says he has had to adapt his medical skills to his unpredictable workplace.

“One of the biggest challenges is the uncertainty of the patient deteriorating during the flight. You don’t have much time with them at the scene or hospital and once you’re in the air you’re restricted as to what you can do.

So you have to try to predict what could go wrong mid-flight, which might lead you to intervene earlier than usual.”

Dr Quinn says retrieval doctors also have to quickly learn how to work in varying environments.

“You may be working in the back of an ambulance or on the side of the road, rather than a bed. You have other emergency service personnel working around you.”

Although being the only doctor on scene is vastly different from working in a hospital, Dr Quinn says there’s always immense support on hand from the Queensland Ambulance Service Flight Paramedics, who play a crucial role on the aeromedical team.

He’s also built a close relationship with the LifeFlight pilots and aircrew officers.

“We’re working in a high functioning small team, that works really well and knows each other really well.”

He encourages other doctors considering retrieval medicine, to give it a go, especially if they’re nearing the end of their medical training.

“It’s great being able to perform meaningful interventions that you can do quickly, that actually make a difference to patient outcomes. It’s a very unique skillset that you can only get being out and about, doing retrieval medicine.”

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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.

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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.

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Doctor Q Summer 35

AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING

Update

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

As another year comes to an end, I would like to thank all of our junior doctor members and councillors for their support and hard work during the year. I want to especially highlight the great work of our Council of Doctors in Training (CDT) portfolio leads – each of them contributing to the betterment of education and training, workplace conditions, and wellbeing of junior doctors in Queensland.

This year we expanded CDT to include a wellbeing portfolio and advocacy portfolio. Together they have contributed to the Federal AMA policy on the Wellbeing of Doctors and Medical Students position statement. Further advocacy focused on climate change and its negative impact on health, with the CDT passing a motion in support of sustainable changes within and external to AMA Queensland. We will continue to collaborate with Doctors for the Environment (DEA) to align our advocacy on this important health issue.

In the industrial relations space, CDT is focused on RMO employment contracts to ensure leave entitlements transfer with you. We are also advocating and assisting Hospital and Health Services to develop bullying and harassment reporting pathways that align with our award. We are always looking for enthusiastic junior doctors to be involved in this portfolio, so please contact us if you’re interested.

36 Doctor Q Summer

CDT is committed to our presence in many Queensland Health working groups including the Medical Workforce Advisory Group, Medical Students Liaison Committee and frequently liaise with our colleagues in the JMO Forum Queensland (JMOFQ). We contribute to many aspects of Queensland Health policy, with our Education and Training Portfolio currently collecting valuable feedback to help improve the annual RMO Recruitment Campaign to increase transparency and ease of the process.

Lastly, we have endeavoured to establish stronger relationships with our key stakeholders including the Medical Student and RMO Societies and also College Trainee Committees. If you are a Chair of your various committee in Queensland, please do not hesitate to get in contact so that we can work together on your advocacy issues.

Overall, we have had a very successful year in CDT with our last meeting in late November. With the close of the year will come elections early next year and I encourage each of you to be involved with your CDT. As always, if you have any feedback or just want to reach out – please email cdt@amaq.com.au.

I wish all of you a Merry Christmas and Happy New Year and look forward to working with you all in 2020!

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A reflection on the mental health of doctors in training It has been eight months since Dr Yumiko Kadota’s blog post on her experience as a Plastic Surgery unaccredited registrar at Bankstown Hospital in New South Wales. She described hundreds of hours of overtime and on-call work, the lack of supervision and support, and her subsequent burnout.1 While there was a huge outcry2 and a complete condemnation of the department that led to her experience, there was a sense of familiarity and painful resignation amongst doctors in training. The media has brought much needed public attention to the wellbeing of doctors in training. After Dr Kadota’s highly publicised blog post, the hospital apologised for her experience, and two doctors were rostered to cover her position.3 Less than two years prior to Dr Kadota’s blog post, New South Wales Health released a Junior Medical Officer Wellbeing and Support Plan in response to trainee suicides in 2017.4, 5 Safe Working Hours was a top priority, looking at Dr Kadota’s experience this priority does not appear to have made much ground.

Doctors in training are at high risk of being bullied in the workplace. 40 per cent of doctors in training in Queensland reported witnessing bullying or harassment in their workplace in 2018.7 The Socratic teaching method is powerful and normative from medical school to fellowship exams, however it can be eroded by denigrative comments or victimisation. We have a well-documented and unacceptable history of bullying. Professionalism is key to prevent this. Some colleges are leading the way with professionalism and teaching skills for hospitalbased consultants. Cultural change takes time. Hopefully the next generation of clinical leaders will break the cycle of bullying and harassment in our hospitals. The push for accreditation to become the next frontier, the “stick” and “carrot”, for eradicating bullying in departments is essential.8 What hasn’t been addressed is who looking out for the nonaccredited registrars who will fill the rota gaps while the registrars are removed for their protection and wellbeing?

The reality is that Dr Kadota’s experience is not uncommon, and remains symptomatic of an unsafe culture within the profession. Our profession’s cultural norm is to stay at work until the job is done. We fail to recognise that the work (especially administrative work) rolls down hill and our juniors are spending hours and hours in the evenings finishing discharge summaries, clinic notes, letters and endless forms and paperwork. Gruelling work is worn as a self-sacrificial badge of honour. As we progress through our training we progressively have more responsibility for patient care, and in Dr Kadota’s case, operating late into the evenings despite the full day’s clinical load. It is common to work over 80hrs a week.6 This is unsafe for our doctors in training and unsafe for our patients.

Finally, where do doctors in training turn for help?

When these systematic factors (work hours, bullying and harassment) take their inexorable toll, many barriers prevent doctors from seeking support. The profession’s “heroculture”, the hierarchal nature of medicine, fear of reprisal,9 and the need for supervisor references to secure yearly employment all create barriers.10 Beyond these, fear of mandatory reporting can prevent recognition of stress-related health problems being addressed early.

Mandatory notifications have increased in recent years and doctors in training are understandably nervous that a notification early in their career could be career-ending.

While the bar for notification is high, the obtuse rules are often misinterpreted.

1. Kadota Y. 2019. Available from: https:// mindbodymiko.com/the-ugly-side-of-becominga-surgeon/.

2017 [Available from: https://www.abc.net.au/ news/2017-04-13/doctor-suicides-prompt-callsfor-overhaul/8443842.

2. Lindsay T. Time to end unaccredited registrar positions: MJA InSight; 2019 [Available from: https://insightplus.mja.com.au/2019/5/time-toend-unaccredited-registrar-positions/.

6. Australian Medical Association. 2016 AMA Safe Hours Audit. 2016.

3. McKinnel J. Sydney surgeon quits dream job after seeing ‘the dark side’ of profession: ABC News; 2019 [Available from: https:// www.abc.net.au/news/2019-02-06/sydneysurgeon-doctor-hours-unsw-yumiko-kadotastress/10784238.

8. Aubusson K. Third major Sydney hospital unit banned from training junior doctors. The Sydney Morning Herald. 2019.

4. NSW Health. JMO Wellbeing and Support Plan.

2017.

5. Worthington E. Doctor suicides prompt calls for overhal of mandatory reporting laws: ABC News;

38 Doctor Q Summer

7.

Australian Medical Association Queensland.

Resident Hospital Health Check 2018. 2018.

9. Llewellyn A, Karageorge A, Nash L, Li W, Neuen D. Bullying and sexual harassment of junior doctors in New South Wales, Australia: rate and reporting outcomes. Australian health review : a publication of the Australian Hospital Association. 2018.

10. Aubusson K. Junior doctors on life support.

The Sydney Morning Herald. 2019.

11. Toogood G. SA Mental Health Commission.

2018. Available from: https:// samentalhealthcommission.com.au/dr-geoffreytoogood-why-ill-keep-talking-about-crazysocks-but-not-broken-bones-mental-health/.

12. Australian Medical Association Queensland.

Resilience on the Run 2019 [Available from: https://qld.ama.com.au/events/wellbeing-atwork.]

13. Doctors’ Health Advisory Services Queensland.

Medical Board of Australia and AMA join forces on doctors’ health 2015 [Available from: https://dhasq.org.au/medical-board-ofaustralia-and-ama-join-forces-on-doctorshealth-2/.

Doctors are vulnerable to mental health problems and progress is being made to shift the associated stigma. Crazysocks4docs started by Dr Geoff Toogood is a movement that raises awareness, starts a conversation, and challenges the word crazy as well as the culture, to allow doctors to feel that they could speak out.11 The AMA Queensland’s Wellbeing at Work (formally Resilience on the Run) program provides resilience and mindfulness techniques to interns in Queensland.12 Doctors’ health advisory services in every state, have been funded to offer colleague-to-colleague support recognising the unique challenges that a career in medicine can impact on our personal health.13 Good work is being done, but it’s not enough. Actionable changes to work hours, to support doctors in training including unaccredited registrars, and to reduce barriers to seeking help are needed. Picking up the pieces after doctors in training burnout or leave medicine is an ineffective strategy.

DR MARGARET K AY

General Practitioner, Senior Lecturer, University of Queensland, Medical Director of the Queensland Doctors’ Health Programme

Our patients share with us their health stories daily, and we pick out risk factors, investigate and diagnose and treat the problems. We know the risk factors for doctors’ in training burnout. We know the diagnosis. Time is overdue for leadership at a hospital, state and national level, to treat this problem.

If this article has highlighted difficulties that you are experiencing, please call DHASQ on (07) 3833 4352 for confidential support and advice.

This article was originally published at InSight+. Read the original here: https:// insightplus.mja.com.au/2019/41/mental-health-of-doctors-in-training-a-reflection/

D R E M I LY S H A O

QDHP

Queensland Doctors’ Health Programme

24/7 HELPLINE (07) 3833 4352

Medical Registrar, Redland Hospital, AMA Queensland Council of doctors in Training Wellbeing Portfolio Lead

D R K AT E E N G E L K E PHO General Surgery, Townsville Hospital; Board Director and Company Secretary, Queensland Doctors’ Health Programme; Adjunct Lecturer, James Cook University

Doctor Q Summer 39

Time for change If we continue to provide care that is low benefit to patients and high cost to the system, future generations will not have access to the same quality care that we expect, writes Dr Alex Markwell, Queensland Clinical Senate Chair.

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

None of us go to work with the intent of hurting our patients. But despite our best intentions, we know that we are often providing care that is of little or no benefit and could even harm our patients. Low benefit care consumes patient and staff time, is costly to the system and reduces our capacity to deliver high benefit care.

We know that our current health system is not sustainable and that without change the same quality care that we have come to expect will not be available to our grandchildren and their children.

But if we start to reshape the care that we provide and reduce unnecessary and unwanted treatment, we have the opportunity to shift our focus and resources to care that is of high benefit, ensuring patients receive better alternatives that are safe and effective and ensuring a more efficient and sustainable health system.

While there are many procedures and interventions that may provide little or no benefit to patients, a recent meeting of the Queensland Clinical Senate* gave 170 clinicians, consumers and system administrators the opportunity to choose priorities for change in Queensland.

Three priority areas were identified for statewide action: Improving the quality use of medicines to optimise care in frail and older patients Improving end of life planning and care in end-stage disease Reducing unnecessary daily blood testing.

Crucially, underpinning these priorities is the need to educate and empower consumers and their healthcare providers to discuss what care is needed, and identify which interventions are helpful and which are not. The B.R.A.N (Benefits, Risks, Alternatives, what if we do Nothing?) framework can help guide these conversations and make it easier to proceed (or not) when the choice is right.

Consumers have a vital role to play.

And we must ensure that clinical decision support tools (such as HealthPathways and Smart Referrals) are updated to guide and promote evidence-based practice by explicitly stating the benefit to patients of different management options.

40 Doctor Q Summer

Work also needs to be done on developing appropriate metrics to evaluate the impact of any interventions for reducing low benefit care, how the data will be collected and then made available to clinicians.

The Senate, in partnership with Queensland Health’s Statewide Clinical Networks, will work with the Department of Health, Hospital and Health Services and consumers to progress this important work.

Meantime, clinicians must begin to actively look for opportunities to reduce low benefit care in their everyday practice. We must lead by example and question our drivers for doing a test or procedure - ‘it’s always been done this way’ is not acceptable. In doing so, we will be educating the next generation of doctors and health professionals about low benefit care and the importance of thinking about the consequences of the decisions we make.

While this is a complex space, both because of the reasons behind it and the challenge of how we are going to improve it, Queensland clinicians are in a unique position. We have been entrusted to identify where change can be made and to drive that change. Let’s not waste this opportunity to be the leaders in this space and reduce care that is not helping, even harming, those who trust us to provide the best possible care and outcomes. *The Queensland Clinical Senate is Queensland Health’s strategic clinician advisory group.

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CSDS supporting Queensland’s healthcare providers If you don’t know us already, the Clinical Skills Development Service (CSDS) is a Queensland State-wide service committed to healthcare improvement through education, training, collaboration and innovation. Our centre is based at the Royal Brisbane and Women’s Hospital (RBWH). This year, CSDS celebrated 15 years of service to Queensland’s healthcare workforce. Proudly providing simulation-based education and training to Queensland’s clinicians with a passion for patient safety.

The service has grown to be one of the largest simulation networks in the world, with a range of services available, including our Pocket Centre Network (PCN). The PCN was established in 2006 and has grown to over 140 Pocket sites, stretching across all 16 Hospital and Health Services in Queensland and the Department of Health. This enables Simulation Providers access to resources to meet their local training and education demands.

As a service, we pride ourselves on being innovation champions. In 2018, we officially opened our Innovation Hub. This space was purpose-built for collaborative and facilitated problem solving. This year, CSDS launched the Healthcare Innovation Committee; developed to bring people across different areas of healthcare together, generating innovative ideas to address issues and challenge the norm. With a new vision for the future, the team is focusing on the needs of the state, and how CSDS can support those needs. The safety and quality of care provided to patients is important to us and we know we can help.

With a variety of courses available via online, face-to-face and blended learning methods, our primary focus is on the use of simulation to create immersive clinical scenarios allowing hands on experience, in a safe environment. Our digital and innovation teams evaluate and apply new emerging technology to encourage clinical and educational improvement.

Part of our transition towards our future vision brought with it a greater understanding of the opportunities in healthcare education programs. This led us to focus on new learning experiences for our clinicians.

42 Doctor Q Summer

Starting with the soon to be released, Maternity Education Program (MEP). This program is designed with flexibility in mind, allowing for the delivery of education programs that are responsive to the participants needs.

MEP is being launched across the State and is provided at no cost to Queensland Health employees. With a train the trainer available in 2020, facilities will have access to deliver the program locally, which will be of significant value for the rural and remote hospitals of Queensland.

We have started with the rollout of the MEP Foundation course in 2019 with great success and feedback. In 2020, we will launch the Advanced MEP course. Following that a selection of case-based scenarios, skills clinics, resources and other educational tools will be added to the MEP suite.

The co-design process included the State-wide Maternity and Neonatal Network, consumers and a maternity specialist as the project lead. We are confident that this collaborative approach to the program will set the benchmark for maternity education needs for the state.

This is the first of this style program we have launched, but there are more underway. CSDS strives to develop innovative learning solutions to address problems and challenges for clinicians and improve the standard of healthcare in Queensland. If you think we can help your area, please get in touch.

Our modern centre is situated at the RBWH campus and offers a variety of venue hire capabilities. Providing facilities for conferences, forums, workshops or meetings through to multipurpose clinical skills labs and simulated clinical areas such as a ward and operating theatre. We are proud of our service and would love to support your event needs. Please see our website for competitive rates or send us an enquiry and one of our helpful and professional staff will be in touch.

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

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

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

CARDIOVASCUL AR RISK FACTORS OVER THE LIFE COURSE AS DETERMINANTS OF SUBCLINICAL MYOCARDIAL DISEASE CSANZ 2019 meeting Reviewer: Professor John French This study examined CV risk factors over ~30 years of life as determinants of subclinical myocardial disease. In 1985, 562 school children were selected and were followed up in both 2004–2006 and 2017–2019. Cardiorespiratory fitness, BMI and MAP were determined at baseline and at each follow-up. Cardiac function assessed with echocardiography, looking at LA size, LV hypertrophy and global longitudinal strain, was determined at follow-up. Interestingly, these parameters changed at different timepoints, and LA enlargement, cardiorespiratory fitness and BMI were associated at the final follow-up in subjects who were aged 39–49 years.

MAP at late follow-up was associated with LV hypertrophy. This very interesting study of longitudinal changes in myocardial parameters and health implies simple assessments such as BMI, MAP and cardiorespiratory fitness should be undertaken at school and early adulthood to target interventions.

T Y P E A N D T I M I N G O F M E N O PA U S A L HORMONE THERAPY AND BREAST CANCER RISK General Practice Research Review Issue 80 Reviewer: Professor Gerard Gill Since the Women’s Health Study (WHS), HRT for menopausal women has remained controversial. This systematic review will give GPs and their patients a good view of the risks of developing breast cancer. It is wise to remind readers that HRT does have some beneficial effects in certainly lowering the rate of hip fracture and bowel cancer. The advice given at the time of the WHS to use hormone therapy for the briefest time possible remains sensible. It is also important to remind patients that while the risk of breast cancer increases, the risk of death does not appear to be significantly higher.

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

44 Doctor Q Summer

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MAKING A DIFFERENCE TO THE ENVIRONMENT AS AN INDIVIDUAL:

What doctors and others can do Australia remains at cross-purposes when most of us profess advocacy and care for the environment and sustainable living yet we remain wedded to economic prosperity and preserving our resource-intensive high standards of living. The federal leaders we recently returned to government argue that Australia as a nation contributes a minuscule amount to global warming and climate change, choosing to blithely disregard our world-class per capita consumption and carbon footprints.

Doctors should take heart from outspoken school kids protesting around the world against the poisoned, heated and chaotic world that their parents may already have bequeathed future generations. The AMA, Climate and Health Alliance and Doctors for the Environment Australia, among others, continue to agitate the ruling classes for local, national and global policy change in a bid to avert humanity’s descent to irreversible ecological and climate catastrophe.

What can we as individuals do while waiting for system corrections slow in the birthing and implementation, because long-term mitigation strategies do not earn crucial votes and popular appeal? After mourning the short-termism of voters that prioritised new coal mining jobs in Queensland, remain mute on once-thriving rivers bled dry by irrigation/ diversion/overuse, and resisted weaning themselves of free single-use supermarket plastic bags, I gain solace in the empowerment of personal action.

46 Doctor Q Spring

As a hospital doctor, I rally with my sustainability colleagues against burgeoning single use medical waste, recycle IV giving sets and lobby to ban styrofoam cups and bottled water, as well as transition to paper free clinical practice.

As a doctor, I counsel patients about unhealthy lifestyles predisposing to diabetes and smoking related lung disease, hoping to reduce demand for carbon-intensive acute and chronic hospital care, such as joint replacements for the worn out knees of the heavy-set. Advocacy for preventative health translates to less health care demand in communities, reducing demands on environmental resources.

Using public transport, cycling and walking reduces staff need to drive to work, is healthier and less stressful.

A small or shared car ameliorates the surge in mammoth vehicle sales and saves on fuel expenses. I reduce consumption of single use discardables by bringing my moulded coffee cup (often gaining a discount at cafes), refuse plastic straws and frequently bring my own cutlery.

DR JOSEPH TING Senior Staff Specialist, Emergency Medicine, Mater Hospital and Adjunct Professor for Clinical Research Methods and Prehospital Care, School of Public Health and Social Work, Queensland University of Technology The third of perfectly edible food worldwide that is discarded disrespects the plant and food animal that is meant to feed us. Besides being environmentally detrimental, food waste is also a moral issue. With seven billion and ever more mouths to feed, humanity could reduce the onethird of food (animal and plant) that is wasted each day by shopping for, cooking and ordering at restaurants only as much as is needed to live healthily. The ultimate disrespect for nonhuman life is in thoughtlessly wasting what we kill. Even animals euthanised without pain and suffering do not deserve to go into landfill.

It is not difficult to for a doctor, indeed any individual, to make a whole lot of accumulated difference by simple acts that enact the mantra of reducing use, reusing and recycling. Although it takes a little more thoughtfulness and some planning at a personal level, these individual action sets allow Australia’s professed eco-advocacy to align with what how we live our daily lives. There is real value in practicing what we preach, both at home and at work.

Hundreds of experts.

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Fiercely independent, evidence-based and up-to-date treatment guidelines designed for health care professionals working at the point of care.

Researched and written by hundreds of Australia’s leading experts.

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Current AMA Queensland members are eligible for 20% off* a first time single user eTG complete subscription. Enter the code AMAQ19 at the checkout.

tg.org.au

Terms and conditions: *Offer ends 31/01/2020. Discount does not apply to the eTG complete app. This can be purchased for $50 as an addition to an eTG complete subscription.

AMA QUeensland is here to ass Securing an additional $100 million in payments for GPs who visit aged care facilities.

Continuing the fight against expanding the scope of practice for pharmacists.

Creating your onli Community platfo agenda, share idea

Conducting the yearly Resident Hospital Health Check Survey to gauge staff sentiment and promote positive change in the hospital system.

Seeing our recommendation for an overarching public health strategy to tackle chronic health issues like obesity become a reality in the creation of Health and Wellbeing Queensland.

Calling for additional training places in regional and rural Queensland.

Driving improveme MBS Review recomm

Renew your membership BPAY

Biller code: 134585 Please refer to your individual letter for BPAY details.

online to ONLINE Jump www.ama.com.au/join-ama and

have your login and password ready.

PHONE Phone our Membership Team on

(07) 3872 2222 or 1800 626 637 (outside Brisbane) and have your credit card handy.

MAIL

48 Doctor Q Summer

A hard-copy 2020 membership renewal invoice has been posted to your preferred mail address. Return your renewal tax invoice with payment to PO Box 123, Red Hill QLD 4059.

sist you work at your best by...

Moca 5

ine Queensland Doctors’ orm to allow you to drive the as and network with your peers.

Delivering wage increases and securing the best pay and conditions for hospital doctors (MOCA 5).

Lobbying government at all levels to tackle issues in the public hospital system.

ents in key mendations.

Lobbying for the Medicare rebate freeze to be lifted a year earlier in July 2019.

Advocating for a statewide, systemic response to issue confronting emergency departments.

by 31 December 2019 In 2020, you will drive the agenda whilst AMA Queensland will continue to walk beside, assist and support all members. The recently launch of your Queensland Doctors’ Community (QDC) (https://community.amaq.com.au) allows you to connect with 9,000+ colleagues and discuss issues affecting you, your patients and the health system. The key role of AMA Queensland is to support, promote and advocate for members, and your views from the coal face ensure we are fighting for what is really important for you.

Thank you for allowing us to support you in 2019 and we look forward to continuing to support and work for you in 2020.

convert to easy monthly payments or payroll deductions. no penalty fees applied.

Doctor Doctor QQ Summer Spring 49

Health hubs around Queensland Drs Nick Yim, Daniel Hempsey, Mankul Singh and Winnie Lee volunteered for the AMA Queensland Health Hub at Urangan Pier Park Markets in Hervey Bay last month.

AMA Queensland’s mobile Health Hubs are regularly held across Queensland to help identify those at risk of chronic and non-communicable diseases and to raise awareness of the importance of undergoing regular health checks with a GP.

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

Mackay Local Medical Association (MLMA)

Contact:

Contact: Phone:

Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3049 4444 Meetings: 25 February 25 March 28 April

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

Jo Bourke, Secretariat www.sclma.com.au jobo@squirrel.com.au (07) 5479 3979 27 February 2020 27 March 2020

Gold Coast Medical Association (GCMA) Contact: Web: Email: Phone:

Professor Philip Morris www.gcma.org.au info@gcma.org.au 0419 780 505

50 Doctor Q Summer

Dr Bill Boyd 0419 676 660

Ipswich & West Moreton Medical Association (IWMMA) Contacts: Dr David Morgan, President; Dr David Careless Vice President; Dr Thomas McEniery, Treasurer Phone: (07) 3281 1177 Meetings: 20 February (AGM)

Brisbane Local Medical Association (NLMA) Contact:

Dr Robert (Bob) Brown, President Phone: (07) 3121 4029 Meetings: 11 February 2020 14 April 2020

Fraser Coast Local Medical Association (FCLMA) Contact: Email: Phone:

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

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

Wilsonton Medical Centre (Dr Peter Hopson)

Cairns Local Medical Association (CLMA) Contact: Phone:

Dr David Shepherd (07) 4031 8400

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

Dr Michael Donohue 0419 715 658

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

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Osler and the AMA Queensland have joined forces to bring you this exciting offer. Join now and save $70 off your subscription fees, and Osler will donate $50 to the AMA Queensland Foundation.

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CPD HOME Did you know that all junior doctors will need to nominate a CPD Home to maintanin registration?

For more information visit:

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Doctor Q Summer 51

2020 Events January

30 June

27 28 August

28 August

29 August

29 September

20 26 October

28

December

tbc 52 Doctor Q Summer

QUEENSLAND DOCTORS’ COMMUNITY (QDC) LIVE WEBINAR QUEENSLAND HEALTH DIRECTOR- GENERAL, DR JOHN WAKEFIELD PSM

JUNIOR DOCTOR CONFERENCE AND CAREER EXPO Brisbane Convention and Exhibition Centre

P R I VAT E P R A C T I C E CONFERENCE Brisbane Convention and Exhibition Centre

MEDICO-LEGAL CONFERENCE Brisbane Convention and Exhibition Centre

A M A Q U E E N S L A N D F O U N D AT I O N DINNER FOR THE PROFESSION Sky room, Brisbane Convention and Exhibition Centre

ANNUAL AMA QUEENSLAND CONFERENCE Lisbon, Portugal

WOMEN IN MEDICINE BREAKFAST Victoria Park, Herston

BREAKFAST WITH THE H E A LT H M I N I S T E R Cairns

LISBON

Portugal

CBRE HP

Lisbon is one of the most charismatic and vibrant cities of Europe that effortlessly blends traditional heritage, striking modernism and progressive thinking. The capital city of Portugal has a rich and varied history on display, such as the imposing Sao Jorge Castle and Belem Tower. The view of the old city encompasses the pastelcoloured buildings, Tagus Estuary and Ponte 25 de Abril suspension bridge.

Within a very short distance from the city is a string of Atlantic beaches, from Cascais to Estoril. Lisbon is blessed with a spectacular range of eateries, a buzzing nightlife and glorious September weather.

The 2020 Annual Conference theme is Building a Healthier Tomorrow, with a range of Portugese and Australian speakers weighing in on the best path for future health care.

AMA QUEENSLAND ANNUAL CONFERENCE

20 - 26 SEPTEMBER 2020 GENERAL ENQUIRIES:

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

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

P: P: F: E:

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

Dealing with decline treatment It’s well known that a doctor needs to have the informed consent of the patient (or their substitute decision-maker) before any treatment can be provided, except in emergencies.

The patient needs to be able to understand and remember the information they’ve been given about the treatment, demonstrate their understanding of the nature and effect of their decision, and communicate the decision in some way (in writing or orally).

JANET HARRY

Medico-legal Advisor, MDA National

CASE STUDY 1 A nurse was diagnosed with probable ovarian cancer.

When imaging studies revealed a 17cm ovarian mass thought to be almost certainly malignant, the nurse was scheduled for surgery. However, she cancelled at the last minute after a visit to a ‘healer/ hypnotherapist’ recommended to her by a paramedic.

The healer treated her with black salve. She died in 2018 of ovarian cancer.

CASE STUDY 2 Your patient, aged 92, declines investigation for chest pain. On discussing it with her, she explains that she feels she has had a full and complete life and doesn’t wish to undergo all the “prodding and poking” involved.

She thanks you for your careful explanations and all the options you’ve outlined, but says she doesn’t want to be referred. True to her word, the patient doesn’t seek any further treatment. Several months later, she suffers a myocardial infarction and dies at home.

What if your patient refuses recommended treatment?

It’s important to keep detailed and meticulous documentation of all discussions and ensure the patient understands: the rationale and benefits regarding the proposed treatment;

potential side effects and risks of the proposed treatment; and

potential risks of not receiving the treatment.

C A PA C I T Y

CONSENT

A patient with capacity can decline treatment. Capacity is the ability to make and understand information relevant to a decision, and the ability to appreciate the reasonably foreseeable consequences of a decision (or lack of a decision).

Consent is not necessarily a single conversation. You may need to allow for a number of discussions and be sensitive to any particular circumstances.

Adults are assumed to have capacity.

They are free to make their own choices regarding treatment. If a patient declines recommended treatment, it doesn’t follow that they lack capacity. However, the decision must be given voluntarily. This means the decision must be made freely and not under undue pressure, coercion or manipulation.

A decision to decline treatment for a child is more complex.

Parents generally make decisions for children who are not mature minors. Parental power should be exercised in the best interests of the child and is not unlimited. It’s advisable to obtain legal advice in relation to such matters.

54 Doctor Q Summer

Consider involving the patient’s family in the discussion, with your patient’s permission.

An interpreter should be involved if needed.

Referring the patient to a colleague is a valuable strategy.

Consider writing a detailed letter to the patient containing your explicit advice and recommendations, inviting the patient to return.

The potential medico-legal consequences of treatment refusal may involve litigation, investigation by the Coroner and a complaint to AHPRA – so it’s important to ensure the situation has been properly managed and documented.

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

The locuming life

Dr Kenny Parra has a diversified career in the medical field. He has a permanent part-time role as a Salaried Medical Officer (SMO) in a rural emergency department, is also an Australian College of Rural and Remote Medicine registrar, does shifts in intensive care and does locum retrieval work.

“I started locuming six years ago and initially was attracted to the higher paying rates.

“Particularly when my children were young, there was the flexibility of working in my spare time and to choose the shifts that suited my family and I,” said Dr Parra.

“I love exploring and traveling to new areas and locum work has taken me to every state and territory in Australia, especially when doing retrieval locum work. It has also added an extensive range of experiences and knowledge to my skillset.

“Retrieval is extremely broad. From infants, to trauma to burns and myocardial infarcts.

“There are a lot of cases that cannot be managed at remote, small, nurse-only clinics and we take these patients to larger regional hospitals.

“I have transported trauma patients on a stretcher, in many interesting vehicle types on the way to an airstrip.

On one occasion, we had to go to a station to pick up a trauma patient, he had spinal injuries and the only vehicle available was a ute. We used our stretcher, immobilised the patient and transported him to the plane on the back of the ute.

56 Doctor Q Summer

“We have picked up trauma patients from public roads and have transferred septic patients from small hospitals to definitive care.

“I have seven years of intensive care, five years of retrieval and three years of emergency experience. I’ve been employed by Queensland Health as a permanent, part-time rural emergency SMO for two years. Now I also do some ICU hours (to keep my ICU skills up-todate) and locum as a retrieval doctor.

“Retrieval puts you in an unknown environment with limited resources and makes you think outside the box.

I also found that there was so much need in remote communities for help and wanted to apply my acute care skills out of intensive care units.”

Dr Parra said there were many things he learned doing locuming work that he applied to his practice.

“After working in a few EDs where nurses were not able to cannulate. We trained all our nurses and now they are all proficient at IV cannulation.

“I learned different techniques for reduction of shoulder dislocation, management of difficult airways on patients with severe facial subcutaneous emphysema and different nerve blockages,” he said.

Cornerstone’s Senior Recruitment Specialist Sahra Rabaud said locuming was a great way for doctors to do the work they love, but may not get the chance to do on a full-time basis, like retrieval.

“It’s nice knowing you are really helping a facility or a community in need. It’s great to find roles for doctors that they haven’t been offered before,” said Sahra.

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Doctors in Training

LEYNETTE REYNOLDS Parner, HWL Ebsworth

Buyer beware!

P: (07) 3169 4960 E: lreynolds @hwle.com.au

- TIPS FOR BUYERS

Congratulations! You have decided to buy an existing business. Here are some tips and hints to make the process smoother and reduce your risks.

1. Surround yourself with experts. (a) An accountant is essential to verify the financial and trading information about the business, as well as to provide you with advice about your new business and ownership structure. You should also get advice about the value of the business. (b) A lawyer will assist in properly documenting the transaction and checking title to the business assets. The lawyer will also assist with assignment of the various trading and other contracts. (c) A good financier to assist you with funding the purchase price, operating capital and other works. (d) You will also need a range of business insurances so speak with a broker who specialises in this area. (e) Consult an IT expert about transfer of data and records, particularly if you are intending to change practice management systems.

2. Do not sign a heads of agreement, letter or offer or similar without first getting legal advice. These documents can create a binding contract if not worded properly.

58 Doctor Q Summer

3. Before buying any business, you should carry out “due diligence�.

This involves checking the details of the business to ensure you are getting what you expect (and what you pay for!). Ask questions and keep asking questions until you fully understand the business, its assets, financials and people.

4. Consider what you need for the ongoing running of the practice and make sure those items are included in the contract. For example, any specialised equipment.

5. If there are key personnel, is the contract conditional upon them accepting an offer of employment?

6. Do you need the selling doctor to remain during a transition period (or longer)? Is there a proper contract for that arrangement?

7. Ensure the seller provides a restraint of trade to prevent them opening a new practice near the business in the near future or from poaching the employees or contracting doctors.

8. Often arrangements with contracting doctors are not documented, or not capable of assignment to the buyer on sale of the business. Is it critical that any contracting doctors agree to continue to work in the practice after the sale?

9. Are there restraints provided by any of the contracting doctors for the benefit of the practice? Can those restraints be assigned to you as buyer?

10. If the business premises are leased, the landlord is likely to require you to provide a bank guarantee for between 3-6 months’ rent as security under the lease. Factor this into your funding arrangements.

11. Is there any intellectual property that you need from the seller?

For example, the business name, website and its content, trademarks or logos. Are there operating manuals, newsletters or brochures with valuable copyright?

12. Ensure patient and other records are owned by the seller and are transferred to you.

These are a few of the more common issues that arise when looking to buy a business. The full extent of the issues to be addressed will always depend on the nature, size and location of the business being sold.

Do not underestimate the time and energy required during the investigation, contract negotiation and acquisition phase. There are many details to be managed and agreed.

Planning, an experienced support team and good advice is the key.

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

HWL Ebsworth offers clients more than 100 years’ experience representing medical practitioners in various areas of health and aged care law. The Health and Aged Care Services Team can help guide you through the increasingly complex operational, legislative and policy framework. We can provide you informed legal advice on litigious, disciplinary and commercial issues at all levels. With considered legal advice our team can assist you to operate a commercially viable business that complies with the health services industry’s unique and ever changing regulatory environment.

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

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

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

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

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

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

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

Strategic planning

AND WHY IT SHOULD BE ON YOUR TO-DO LIST W H AT I S S T R AT E G I C PLANNING AND HOW DOES IT BENEFIT YOUR PRACTICE? Strategy is about ‘thinking like a general’. The ‘general’ oversees what is happening across all units as the army fights to meet their objectives. The practice owner has a similar role when it comes to achieving the businesses’ objectives. So strategic planning is about identifying where your practice wants to be, understanding where it is and formulating actions to bridge the gap.

It’s about achieving your long-term business objectives and benefits your practice by allowing these objectives to be articulated and effectively communicated to each part of your practice. Good strategy aligns your practice, leads to an effective use of resources and ensures accountability and control for the owners and stakeholders.

W H AT I S E F F E C T I V E S T R AT E G I C P L A N N I N G ?

Strategic planning is a process, not an event. It is dynamic, agile and changes over time.

The process starts with a discovery and planning session in which in-depth questioning uncovers what is important, to determine the direction you wish your business to take.

The result of the session is the creation of a vision for your practice. This vision will be clear, concise, achievable and visible from all directions. Setting the vision is like placing a ‘flag on the hill’ it identifies and defines a common goal for the practice.

From here the strategic plan is developed, a roadmap which focuses on action, empowering business owners and holding the practice accountable. It is a roadmap, which acknowledges that strategy is living and breathing within a practice.

Something which is defined and shaped by culture and something that everyone must understand, embrace and work on.

60 Doctor Q Summer

W H AT H A P P E N S I F A BUSINESS HAS A GOAL B U T N O S T R AT E G Y ?

Without strategy, a business runs the risk of inertia, a paralysis which causes the practice to stay where it is, not growing, not changing with its environment and not being in touch with its customers.

The ultimate example is a practice failing to move with the times and eventually going out of business. The good news is, that it’s easy to stop this gradual decline through strategy. Having a goal is the first step and strategic planning sets the path and creates the actions and steps to achieve this goal.

W H AT I S T H E R E L AT I O N S H I P B E T W E E N S T R AT E G Y A N D T H E F I N A N C I A L R E S U LT S O F A PRACTICE? A practice is much more than a set of financial statements, it’s about the people and culture, the processes, the use of technology, the customers and the environment in which it operates.

Strategy allows you, the practice owner, to understand how these critical pieces fit together while the results allow owners to identify and monitor key drivers within each element of your practice.

It provides you with insight into the practice’s effectiveness and provides you with focus and clarity on improving these measures that matter, allowing you to drive the business forward.

WHEN SHOULD A PRACTICE I N V E S T I N S T R AT E G I C PLANNING? It’s never too late, nor too early to adopt a strategic approach irrespective of size or the business’s evolution. Without a plan there can be no direction for the practice. Strategic planning provides that roadmap and action to drive the practice to be profitable, sustainable and to reach that flag on the hill.

ANGELA JEFFREY

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

SPECIALIST

ADVISORS TO THE MEDICAL

INDUSTRY WITH A DEDICATED HEALTHCARE PRACTICE, WILLIAM BUCK CAN HELP YOU STRUCTURE YOUR PERSONAL INVESTMENTS TO ACHIEVE THE AFTER-HOURS LIFE THAT YOU WANT. William Buck is experienced at structuring personal investments such as property or self managed superannuation funds, and can assist you with the following: — Advice on setting up appropriate investment structures — Comprehensive assistance with your personal taxation affairs — Develop strategies to help you make the most out of your superannuation and investments, including assessing the taxation consequences — Securing your financial freedom with business and retirement planning CONTACT PAUL COPELAND FOR A CONFIDENTIAL & COMPLIMENTARY CONSULTATION

Phone: + 61 (7) 3229 5100 Paul.Copeland@williambuck.com

Our planet has seven oceans. Each ocean helps produce storms that bring about swell sending waves to bays, beaches and coastlines. Of those, only some waves are consistent enough to break daily. In Australia, we are blessed, to have a coastline with some of the best surfing on the world… Bells, Bondi, Burleigh, Byron and that is just the Bs! The world is full of tantalising surfing locations like Hawaii, the North Shore, Bali, Fiji and Tahiti. The list goes on.

SOUTH AFRICA

South Africa, whilst possibly best known for its wildlife, also has some fantastic surfing spots. Surf at Cape Town where you can surf in two different oceans on the same day and enjoy the nightlife, restaurants and bars of the Victoria and Albert Waterfront. Don’t forget about Durban, a smaller town on the opposite coast and the amazing Richards Bay which you’d regret missing out on. If you get into the water early enough to catch one of Durban’s famous sunrises you may also be lucky and share it with some of the local dolphins. While you are in South Africa why not combine it with a trip to one of the many famous game parks or beautiful Stellenbosch for a few wines.

FRANCE

France may be known for its wine and cheese but did you also know it features some of the world’s best waves?

France has a thriving surf culture along the Atlantic coast.

Biarritz combines history and surf. A great combination with plenty of places to stay and restaurants galore. While you are in France, why not grab a car and do a self-drive around Biarritz and Burgundy?

THE MALDIVES

The Maldives is not just calm waters and overwater bungalows in the 26 atolls. It is a true surfer’s paradise.

You can stay in a luxury resort, surrounded by the crystal blue water of the Indian Ocean and white sandy beaches while you either paddle out or take a short boat ride to some of the world’s best reef breaks.

AMA Queensland Orbit World Travel er: vid pro vel tra red prefer 5 88 2 26 00 P: 13 m.au E: travel@amaq.co vel.com.au tra rld wo bit holidays.or

62 Doctor Q Summer

COSTA RICA

Costa Rica lies between North and South America just nine degrees north of the equator and has beautiful warm waves and endless tropical beaches. In Spanish, Costa Rica means “rich coast” and with delicious food, vibrant nightlife and its impressive surf - it is certainly living up to its name. With over 300 sandy beaches, year round warm water, steady winds and constant swells – this is a surfing paradise. Cocles is a lively surf village with Caribbean and reggae influences everywhere.

The perfect place to spend a day or two learning to surf.

CAUSE

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A M A Q U E E N S L A N D F O U N D AT I O N C H R I S T M A S A P P E A L

The AMA Queensland Foundation is about doctors doing good. We support our colleagues who are ‘filling in the gaps’ by delivering and championing vital services and projects outside of those catered for by the public health system for Queenslanders in need.

It is 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.

For this reason, the AMA Queensland Foundation asks you to make a tax deductible donation of the fee charged to the patient from your most common operation, procedure or service during our “Operation Donation” appeal. Your support from just that one service will make a huge difference.

Thank you for giving generously.

ment loan Funding support programs and equip motor initiatives for patients diagnosed with of life. ty quali their ove impr to neurone disease

Securing Queensla nd Gove the Hep rnment CK funding eradicate ombi Clinic tea for m in the hepatiti ir q s C from Australia uest to . oat surgery for ked ear, nose & thr Funding fast-trac er children nd Isla ait Str Torres 36 Aboriginal and considerable ed fac o wh eensland living in remote Qu t. en atm g timely tre challenges accessin

dical ips that enable me Providing scholarsh ancial fin g cin en eri exp students who are dies. e pursuing their stu hardship to continu

64 Doctor Q Summer

Donating a new outreach van to Rosie ’s Cairns.

The van provides much needed food and supplies, as well as a friendly face to those who feel marginalised within the Cairns comm unity.

Yes, I want to give with my tax-deductible gift

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PAYMENT DETAILS Credit Card:

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SUPPORT

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Cheque: Please make cheques payable to ‘AMA Queensland Foundation’

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ACKNOWLEDGEMENT

I would like more information about leaving a bequest to the AMA Queensland Foundation.

Donations are recognised in AMA Queensland publications.

Please acknowledge my contribution in the name of:

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PLEASE RETURN TO:

(30 characters max. i.e. The White Family, Mr T & Mrs S White, Sue & John White)

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I would prefer to remain anonymous.

DONATE ONLINE AT www.amaqfoundation.com.au

QFN-OPDON-2019-DRQ

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FEEL Doctor Q Summer 65 GOOD ABOUT

All about you BOOK: GOING UNDER Dr Kitty Holliday thought once she finished medical school and found gainful employment that her dream was just beginning.

But Kitty is in for a rude shock. Between trying to survive on the ward, in the operating theatre and in the emergency department without killing any of her patients or going under herself, Kitty finds herself facing situations that rock her very understanding of the vocation to which she intends to devote her life.

Written by Sydney doctor Sonia Henry, Going Under is a rare insight into the world of a trainee female medic that takes an unflinching look at the reality of being a doctor.

It explores the big themes - life, death, power and love through the eyes of Dr Holliday as she loses her identity and nearly her mind in the pressure-cooker world of the hospital. But it is also there that Kitty might find her own redemption and finally know herself for the first time.

WIN this book!

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

Name:

Gifts: think about an experience present. Organise a Secret Santa where your family member gets one big present instead of lots of little things they might not use. Buy local or make something yourself. Donate to someone’s chosen charity instead of a gift. Organise a day out with someone instead.

Lunch: Keep it simple. Don’t over cater for one day. Use your nicest plates instead of disposables. Enjoy each other’s company. Have a great Christmas!

The AMA Queensland Foundation’s Christmas appeal is underway and needs your support. The Foundation supports our colleagues who are ‘filling in the gaps’ by delivering and championing vital services and projects outside of those catered for by the public health system for Queenslanders in need.

Member no:

Entries close 15 January 2020

66 Doctor Q Summer

Wrapping: reuse gift bags and boxes, wrap with brown paper, fabric or new tea towels.

D O N AT E : O P E R AT I O N D O N AT I O N

Telephone:

Thanks to Allen&Unwin

GO GREEN: THINK GREEN THIS CHRISTMAS

The Foundation asks you to make a tax deductible donation to the AMA Queensland Foundation of the fee charged to the patient from your most common operation, procedure or service during our Operation Donation appeal. Your support from just that one service will make a huge difference.

UPCOMING FILMS Please note upcoming film are subject to change

M A D A M A B U T T E R F LY

26 December Jojo Rabbit Jumanji: The Next Level Sorry We Missed You 1 January Little Women The Gentlemen

18, 19 and 22 January 2.15pm The Met Opera American tenor Bruce Sledge made his Met debut as Almaviva in Rossini’s Il Barbiere di Siviglia, followed by performances as Ferrando in Mozart’s Così fan tutte, Tamino in Mozart’s The Magic Flute, Don Ottavio in Mozart’s Don Giovanni, and King of Naples in Thomas Adès’s The Tempest. Recent performances include Bacchus in Strauss’s Ariadne auf Naxos at Santa Fe Opera, Lord Riccardo Percy in Donizetti’s Anna Bolena at the Canadian Opera Company, Jean de Leyde in Meyerbeer’s Le Prophète at Deutsche Oper Berlin, and Macduff in Verdi’s Macbeth at Welsh National Opera.

This season, he also sings Contareno in Rossini’s Bianca e Falliero at Oper Frankfurt.

9 January 1917 16 January Bombshell

FRIDA: VIDA LA VIVA

IN SEARCH OF MOZ ART

25 January 4.15pm | 26 January 2.15pm | 29 January 12.15pm | 30 January 10.30am

26 and 27 January 2.15pm

Documentary Acclaimed actress and director Asia Argento will join us to uncover the two faces of the iconic artist through Frida’s own words: letters, diaries and private confessions. A deep dive into Frida’s art of opposites and dualism - pain and pleasure, darkness and light, moon and sun, life in death and death in life.

WIN

kets c i t e i v mo ! for two

Documentary Produced with the world’s leading orchestras and musicians, told through a 25,000 mile journey along every route Mozart followed, this detective story takes us to the heart of genius.

With rigorous analysis from musicologists and experts, a new, vivid impression of the composer emerges. It dispels the many common myths about Mozart’s genius, health, relationships, death and character, to present a new image, very different from Milos Forman’s Amadeus.

Name:

Telephone:

Member no:

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

Entries close 15 January 2020

Portside Wharf, Remora Road, Hamilton

WINNERS Dr Nigel Dore Dr Dan Mullany Dr Alison Green Dr Ken Bowes

Dr Siaw Kang Ho Dr Ashlea White Dr Andrew Cronin Dr Meg Cairns

P: (07) 3137 6000

www.dendy.com.au

BOOK WINNER Dr Michael Williams won a copy of Quitting Plastic, thanks to our friends at Allen & Unwin

Doctor Q Summer 67

A magpie for me I am constantly bemused and impressed by how seemingly insignificant conversations can have such a major impact on one’s life.

As doctors, we are probably responsible for quite a few of these throw away lines. Have you had your mammogram yet? How long have you had that mole? I think you need to lose some kilograms. Don’t you think your smoking has to go?

Sometimes people heed the message and take the advice and sometimes they don’t, but it is always gratifying on these rare occasions when they return a few months later to tell you that they did get that screening mammogram and the breast cancer that was detected is entirely curable because it was diagnosed early, or they return and proudly state that it has been 12 months since their last smoke and “streuth, I feel so much better doc!”

But sometimes the throwaway lines impact you. I remember one such yarn 17 years ago. A mate of mine had been acting as Souths Rugby Union Club Doctor and was busy for the next round. He hit me up to fill in for a Saturday arvo. While I had never been a sports doctor, I had always loved rugby, I had played at school and I had done plenty of emergency room work and so I thought why not? Variety is the spice of life.

By the end of my first five-hour shift of three games, I was hooked. While it was purely a volunteer gig, I did receive a Magpie Club shirt and a free hamburger. The shirt was a symbol.

68 Doctor Q Summer

A symbol of being part of a greater entity. Acceptance. Part of a club.

A brotherhood. A brotherhood that included so many former Reds and former Wallabies. The Honour Board dripped with the names of so many illustrious rugby legends. But even more significantly, the shirt linked me to a host of outstanding men and women.

I have met and befriended so many outstanding characters. People of substance, charisma and character. Fair dinkum Australian blokes. People that judge each other by the character of their hearts and not by any collections of assets or income or career status.

In contrast to so many professional institutions, there is no hierarchy. Every member of the club is a valued Magpie.

A mate. A man to rely on in a defensive line, a maul, a ruck or in a life crisis.

I met so many other volunteers who cooked the chips, served the drinks, ran the raffles and put the band aids on. Volunteers who painted the lines on the fields, mowed the paddocks, drew up rosters, washed jerseys, coached juniors. Spreading the passion for the grand game they play in heaven to a whole new generation of aspiring kids.

There have been so many highlights.

Crunching tackles, unbelievable length-of-the-field tries. Wallabies coming back to the club and playing with as much passion as if they were wearing the gold jersey against the All Blacks. Grand finals, premiership wins and heart-breaking losses. My favourite game was the 2015 Premier Grade Grand Final win when we snuck

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

into the semi-finals with a last-minute penalty kick after the hooter in the final round and then won our next two semi-finals in the dying seconds.

Miraculously we had snuck into the Grand Final. Come Grand Final day, our opposition had only lost twice all season and were the red-hot favourites, but the mighty Magpie men ran riot in wave after wave of black and white rugby perfection to score a premiership win for the ages.

A few thousand Magpies roared out the team song of A magpie for me…for what seemed like hours.

It makes me reflect on the importance of team sport. It is what makes our Great Southern land so unique. Our sunny days and our wide-open spaces make team sports so accessible. It breaks my heart to see so many kids so enraptured by computer and video games. They will never experience the mateship and undying camaraderie of running onto a field together with their mates.

Playing together, winning together, losing together, but no matter what, standing together side by side. It is such a metaphor for life and friendship.

17 years after my mate passed me the ball, I still rarely miss a game.

I still wear my Souths Rugby shirt with immense pride and I still sing the team song with pride and passion after every Magpie triumph.

Forget Barossa -

try the Adelaide Hills PHIL MANSER Wine Direct

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

Okay, so I may have a slight bias here but more and more of you are not just enjoying these wines, but many are visiting this amazing district showcasing the likes of Shaw and Smith, Nepenthe and many more.

Considerably cooler than the surrounding plains, the hills are washed in rain during winter months, and the peaks wrapped in fog. It is considered a high rainfall region compared to other Australian regions, but outside of winter the climate is warm and dry. Night time temperatures are the feature - notably cooler than the day when the sun sets. Worth noting is how the average rainfall increases the higher you go, with Mount Lofty picking up 1,400mm on the old splash-o-meter compared to 850mm just 10K down the road in Charleston. This range of moisture and altitudes results in a variety of soils, but in general are sand and clay loam over clay subsoils. A bit of shale and ironstone can be found, and the soil is acidic on average and rarely acidic.

The combination of climate and soil lends to superb coolweather whites like Riesling (if you watch for mould), Sauvignon Blanc, Pinot Noir and crisp Chardonnays.

Merlot, Shiraz, Cabernet Sauvignon can also be found, with the grapes maturing quite slowly in this climate, allowing the grapes to gain complex flavours.

HISTORY There are 60 or more labels coming out of The Hills with 29 cellar doors in operation as I write this with more to come (including my own). The earliest recorded commercial vineyard was operated by John Barton Hack in 1839 (over near Mount Barker). Quite a few German migrants settling in the region in the early 1840s planted at Hahndorf and Lobethal.

VISITING A mere half-hour drive from the city centre, the Adelaide Hills are located in the Mount Lofty Ranges, stretching in a narrow band some 70km long. Comprised of lovely valleys and winding ridges, the highest vineyards are close to 600 metres altitude in areas such as Summertown, Piccadilly and Carey Gully. Truly eye candy everywhere you look.

Doctor Q Summer 69

INPRINT

Did he save lives?

A surgeon’s story Dr David Sellu Reviewed by Dr Michael Mar Fan Being a Fellow of Royal College of Surgeons (RCS) but practised wholly in Australia, I was fascinated by coverage on David Sellu, FRCS, a senior colorectal surgeon of Sierra Leone descent but trained, graduated and worked in the UK. Sellu was sentenced in the Old Bailey in November 2013 for gross negligence and manslaughter for 2.5 years in jail over a patient’s death from a coronial inquest, even though he was cleared of any wrong doings in prior General Medical Council (GMC) reviews. The trial lasted nearly six weeks and the majority jury verdict has sent shivers down the spines of many surgeons, not only in UK but everywhere.

His conviction was thankfully overturned through not by the efforts of the British Medical Association nor RCS but through the ‘Friends of David Sellu’, a support group comprising colleagues that mounted and funded a challenge for his eventual acquittal. Despite the acquittal, Sellu did spent 15 months in various prisons around the UK and the rest in home detention and missed two Christmases with his family. His career was gone after the release, his son gave up medicine even before starting a career. A hefty price to pay for an incident that shouldn’t have reach the verdict that it did or even go to the Old Bailey for that matter.

The first chapter of the book dealt with his early childhood and brief career. A chapter dealt briefly with the incident that started the whole process. The chapter wasn’t loaded with the usual M&M numbers chart that I was akin to, but enough to paint the background. Personally, I would have liked more clinical information, but the book is intended for a more general audience. The bulk of the book is about the time he did in the prison. Here we read accounts of the atrocious conditions and interaction with various inmates.

Sellu gave some explanations regarding the incorrect and withheld information that led to his criminal conviction, even though he was cleared in a civil hearing. It was rather sad to note that the professional organisations that he belonged to were not interested in his plight whatsoever (one even wants to deregister him from the membership roll). He took a parting shot at the Coroners, Criminal Prosecution Services and the GMC as to whether his ethnicity had a part to play. It just made me wonder how, in a first world country like the UK, such an injustice can occur. As the preface of the book stated: ‘failure to overturn his conviction …. Would have serious implications for high-risk specialties regarding recruitment and retention of surgeons.’

WIN this book

This is an essential read for all surgeons, especially those working in a private hospital. As in Sellu’s case, some hospitals are happy to offload the surgeon as a sacrificial lamb even though the issue at fault, like always, is a systemic error and cannot wholly be blame on a single individual. Hence, a better and concerted effort for surgeons to own the M&M meeting in private hospital so that matters such as these can be reviewed by peers or independent colleagues. The law is different in Australia, especially medical manslaughter, but nevertheless going to the court or jail for that matter for an unjust verdict is hard to swallow.

Yes, he did save lives but it counted for nothing.

Disclaimer: The author knows one of the members of the ‘Friends of David Sellu’ but has not been in communication with him/her regarding this manuscript.

Telephone: Thanks to Allen&Unwin

Fill out this form and fax to (07) 3856 4727 or email to competitions@amaq.com.au Name:

Member no:

Entries close 15 January 2020 70 Doctor Q Summer

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Doctor Q Summer 71

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