Doctor Q Winter 2019

Doctor Q is free to AMA Queensland Members

WINTER 2019

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Voluntary assisted dying in Queensland

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2258.6 02/19 (0811)

CONTENTS

REPORTS

14

4

Editor’s desk

8

President’s report

10

CEO’s report

26

Council of Doctors in Training update

26

Member news

60

AMA Queensland Foundation supporting victims of the Far North Queensland floods

DR NICK YIM: PRESCRIPTION FOR DISASTER

F E AT U R E S 14

Prescription for disaster

16

Voluntary assisted dying in Queensland

18

Ethos a bad substitute for proper process

22

AMA Queensland Board and Council

CURRENT ISSUES BUSINESS TOOLS

32

D R M I C H A E L K E N N E D Y: HANGING ON THE TELEPHONE

46

Protecting you against a sticky situation

48

Three reasons why you can’t fill that job

50

How to manage superannuation contribution caps

52

The trouble with testimonials

54

Common private practice start-up myths

56

Get your employment contracts reviewed

58

Referral spotlight: Multiple sclerosis

59

How to get into your first home quickly

63

Medicine after hours

PEOPLE & EVENTS

42

MEET WOMEN IN MEDICINE S P E A K E R D R YU M I KO K A D OTA

12

Social photos

36

Obituary: Dr Stephen Morrison

37

Obituary: Dr Charles Roe AM

38

Events calendar

39

Local Medical Association meetings

41

Annual Conference

42

Women in Medicine

44

Private Practice and Medico-Legal Conference

20

Stop bullying applications

28

Update on the performance framework

29

Doctors secure significant MOCA 5 deal

30

The wellbeing of clinicians must be a priority

32

Hanging on the telephone

33

A second opinion is a patient’s right

34

Research round up

LIFESTYLE 62

Take a hike

64

Entertaining made easy with Gathar

66

All About You

67

Dendy Cinemas

68

Dr Matt Young: Limits

69

Lies, damn lies, statistics and wine

70

InPrint: John Murtagh’s General Practice 7th Edition

Doctor Q Winter

3

BOARD OF DIRECTORS

Editor’s Desk

Dr Dilip Dhupelia President Associate Professor Chris Perry Vice President

Dr Michael Cleary Chair of Board and Council

Dr John Hall Member Appointed Director

Dr Sarah Coll Member Appointed Director

Dr Bav Manoharan Member Appointed Director Dr Peter Isdale AM Skilled Director

COUNCIL There’s some serious debate going on around end of life care, euthanasia, voluntary assisted dying and physician assisted dying. I’ve included some definitions on the article to explain the difference on p16.

It seems to me that there’s a lot of misinformation in the community around dying: I’ve seen people who, when enough is enough, they’ve stopped seeing their doctor because they believe a doctor will prolong their suffering. I’ve known others who think a doctor won’t allow them to die at home instead of hospital. People with final wishes, like seeing the ocean or the night sky, may not have been able to do those things because they don’t realise it’s a possibility in a busy hospital setting.

So, while there’s some argument around palliative care funding, it seems the perceptions around palliative care also need some attention. We would want to ensure patients at this stage in their life have a full understanding so they are able to meet death on their own terms.

Congratulations to Dr Chris Cunneen and Professor Bruce Black, who were both awarded a Medal of the Order of Australia.

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

Dr Donald Baldock LEAMING Surgeon Late of Durack Member for 56 years AMA Queensland Council 19761982 Dr Stephen Christopher MORRISON Respiratory and Sleep Medicine Physician Late of Chapel Hill Past AMA Queensland Councillor ASMOFQ President Member for 30 years

FOLLOW US:

4 Doctor Q Winter

Dr John McNeil CAMPBELL AM Obstetrician and Gynaecologist Late of Newstead Member for 60 years Dr Eva Irene POPPER Obstetrician and Gynaecologist Late of the Grange Member for 61 years Dr Charles ROE Urologist Late of Stradbroke Island AMA Queensland Past President Emeritus Vice President Member for 77 years

Dr Hashim Abdeen Gold Coast Area Representative

Dr Sarah Coll Specialist Craft Group

Dr Chris Maguire Doctors in Training Representative

Dr Fatima Ashrafi Specialist Craft Group

Dr Hasthika Ellepola International Medical Graduate Representative

Dr Bav Manoharan Greater Brisbane Area Representative

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

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

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

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Doctor Q Winter

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President’s report DR DILIP DHUPELIA

This winter edition of Doctor Q is the first opportunity to thank AMA Queensland members who have given me the opportunity of leading the association for a second term, following the recent elections. But of course, what is more pleasing to me is the number of candidates that contested the various leadership, Board Director and Council positions.

This is a demonstration of colleagues who wish to belong and to give their time to lead, represent and advocate for our members; and it is a very healthy sign. I do encourage all those who were unsuccessful this year to remain involved in our association’s activities and committees and to put your names up again in the future.

My second term is going to be as busy as the first. Some of the unfinished issues that I will be involved in are to do with Health and Wellbeing Queensland, water fluoridation, real-time prescription monitoring, ensuring safe rural maternity services, monitoring public hospital performance, advocating for increased investment in palliative care, lobbying for appropriate aged care nursing ratios and involvement in the Parliamentary Inquiry into voluntary assisted dying. In addition, we must fight for larger mental health funding for our state and to ensure that any such increases are for delivery of services in a coordinated way to get best value for the health dollar.

Other unfinished issues are to lobby the State Government to deliver on our budget submission request for the continuation and extension of the Resilience on the Run program (now named Wellbeing at Work) so that we can support our junior doctors as they

8 Doctor Q Winter

commence their medical careers.

This successful program is aimed at equipping our interns with the necessary tools to deal with the demands of their jobs, with a focus on mindfulness and coping strategies.

During this year, I also wish to work much more closely with our Council of Doctors in Training. This group makes up a large part of our membership. Now that the Medical Officers Certified Agreement No.5 has been successfully negotiated with improved terms and conditions for our hospital-based doctors, we need to remain focussed on career pathways and ensuring equitable training opportunities to provide certainty of career progression. In addition, I am hoping to see a dramatic improvement and satisfaction in this year’s Resident Hospital Health Check survey, our fourth such survey. There should be no excuse for this not to happen as we have been consulting with hospital administrators each year about the issues and concerns our doctors have repeatedly voiced.

There are two unfinished actions in the mandatory reporting area as well.

Now that the legislation has passed, we will work with the department, AHPRA and the Medical Board to ensure there is a good education strategy and clear communication for our members. AHPRA has developed a Mandatory Reporting Awareness Campaign working group to assist in the development of transparent and easy to follow guidelines. Secondly,

the committee’s report also contained a “dissenting report” from the LNP members who stated that while they “generally” support the passage of the bill, they believe that the Queensland Parliament should adopt the Western Australia-Lite model here in Queensland. We will take this up as an election issue next year and continue to work with the Shadow Health Minister in this regard.

The Minister is determined to undertake the pharmacy trial for the prescribing of oral contraceptives and antibiotics for urinary tract infections.

We have written, once again, to all members of Parliament reminding them that whilst we support collaborative care, we oppose any expansion of pharmacist prescribing of schedule four medications outside of the COAG/ AHPRA governance framework agreed by all Health Ministers in 2016.

Through my federal AMA roles, now that the elections are over and we have Minister Hunt returned as Health Minister, I will be representing our members at federal level on private health insurance reforms, the issue of informed financial consent, MBS review, rural health issues as identified in the recent AMA survey, gender equity in our committees and the delivery of the investment, as promised during the election campaign, for general practice.

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CEO’s report JANE SCHMITT

A N E W P L AT F O R M FOR MEMBERS AMA Queensland will soon be launching a member platform for realtime, online peer-to-peer discussions with your colleagues. It will be a place to discuss and debate issues affecting you, your practice, patients and the health system, along with other practical advice from our partners and team eg. general finance, insurance, legal and workplace relations matters.

ISSUES CONFRONTING ED PHYSICIANS IN QUEENSLAND In response to members’ concerns about significant problems confronting staff in emergency departments across the state, AMA Queensland, in conjunction with the Australasian College for Emergency Medicine, recommended to Queensland Health numerous ways to help improve patient access and help manage doctors’ workloads, including introducing a metropolitan-wide road transfer service, ensuring patient offloading is appropriately distributed and finding additional beds at other private facilities to reduce pressure on emergency departments.

As a result of this consolidated team effort, Queensland Health and Metro South Health have acted upon a number of our recommendations, implementing short-term solutions at Logan and Redland Hospitals.

Other recommendations are under investigation.

We consider this to be a start to ongoing improvements for emergency department staff and patients across the state.

10 Doctor Q Winter

Over the next couple of months, we will arrange meetings at other emergency departments in Queensland and will continue to work with Queensland Health to ensure a state-wide, systemic response is implemented and emergency departments are appropriately resourced and supported to respond properly to community health needs.

CLOSE TO SECURING M A N D AT O R Y REINTRODUCTION OF FLUORIDE As a result of AMA Queensland’s relentless campaigning and lobbying for the Queensland Government to legislate the mandatory introduction of fluoride into Queensland water supplies, the government is working with us to consider the next steps as a genuine sign of their support in reintroducing fluoride back into the water supply across the state.

We will keep members abreast of progress on this important public health issue.

AMA QUEENSLAND AWA R D E D T H E P E A K P U B L I C H E A LT H AWA R D At the recent AMA National Conference held in Brisbane, AMA Queensland won the 2019 AMA Best Public Health Initiative from a State or Territory Government.

The award recognised AMA Queensland’s many years of lobbying for a whole of government approach to obesity and chronic disease which led to the establishment of Health

and Wellbeing Queensland (HWQ), the state’s first health promotion agency.

HWQ will focus on improving the health of Queenslanders, reducing health inequity, and reducing the burden of chronic disease.

Queensland Health acknowledged AMA Queensland’s contribution in the media statement announcing the establishment of Health and Wellbeing Queensland – truly an example of how AMA members can influence health policy at the highest levels.

It is the second year in a row that AMA Queensland has taken out an award at the AMA National Conference, following last year’s win for our Resilience on the Run program to support the mental health of doctors in training.

WELCOME TO THE NEW BOARD AND COUNCIL MEMBERS Following the close of ballots for AMA Queensland leadership roles, Dr Dilip Dhupelia has been returned as AMA Queensland President for another term. Dilip’s commitment and passion for the profession will enable AMA Queensland to continue effectively advocating on behalf of members.

I would like to welcome to Associate Professor Chris Perry as Vice President and Dr Michael Cleary as Chair. I also congratulate our new Councillors and welcome back those that are returning to another year in their representative roles (a full list is provided on page 22).

This is a steady and experienced team and I look forward to the next year and what we will be able to accomplish.

To find out more about the representative in your area or your craft group, we encourage you to visit www.amaq.com.au. Any information or issues you provide to your craft group representative, geographical representative, or AMA Queensland directly can then be raised at Council meetings with feedback provided to you.

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Teaching and Mentoring seminar In April, AMA Queensland held the Teaching and Mentoring: Practical Skills for Doctors seminar and webinar. More than 70 mentors and mentees gathered to learn more about teaching, mentoring and modelling best clinical and behavioural practice.

The panel featured: AMA Queensland President, Dr Dilip Dhupelia; Dr Sally Aubrey, Registrar, Townsville Hospital; Dr Melanie Rule, Emergency Physician, The Prince Charles Hospital; Dr Thomas Brennan, Anatomical Pathology Registrar, Royal Brisbane and Women’s Hospital; and MC Associate Professor Louise Cullen, Senior Staff Specialist, Department of Emergency Medicine, Royal Brisbane and Women’s Hospital.

IF YOU WOULD LIKE TO ACCESS THE RECORDED WEBINAR, P L E A S E L O G I N T O O U R W E B S I T E AT W W W. A M A Q . C O M . A U AND CLICK ON AMA QUEENSLAND MEMBER WEBINARS, UNDER EVENTS AND TRAINING.

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Our first Regional Private Practice Seminar Series toured Toowoomba; Mackay; Townsville; Brisbane South, North and West; Gold Coast; Sunshine Coast; Cairns; Rockhampton and Bundaberg from March through to the end of May. Michelle Cowan, Senior Industrial Officer, AMA Queensland and Samantha Miklos, Director, Cornerstone Medical Recruitment presented the series, which focused on avoiding or minimising the legal and cultural pitfalls during recruitment.

12 Doctor Q Winter

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Doctor Q Winter 13

Prescription for As someone who has worked both as a pharmacist and GP, I can say without a doubt the Queensland Government’s plan to allow pharmacists to dispense medicines without a prescription is fraught with danger.

In April, Health Minister Steven Miles announced a statewide trial allowing pharmacists to provide the contraceptive pill and antibiotics for urinary tract infections without a current prescription. The trial was recommended by a Parliamentary Committee into expanding the scope of services of pharmacists.

As a general practitioner who has worked on both sides of the pharmacy counter, it is something I am very concerned about.

Before I became a general practitioner, I completed a Bachelor of Pharmacy and worked as a community pharmacist for four years. I then completed a Bachelor of Medicine and Surgery (four yearsa), Residency (two years) and Fellowship Training (three years).

So, when a patient presents to me with symptoms of a urinary tract infection, and to an outsider our

discussions may seem relatively short and “easy”, it is those 13 years of training and experience I call on when diagnosing the problem and solution.

My training and experience allow me to consider that there may be an alternative diagnosis and to ensure there is appropriate management of the condition, followed by adequate health screening and safety netting.

A pharmacist, who is not trained as a general practitioner, may feel they can perform this same consultation easily due to the simplicity of the condition, but they don’t have the knowledge, training or background to ensure it is not something more serious which, left untreated, could become a major health issue.

This is a well-known cognitive bias called the Dunning-Kruger effect.

Allowing pharmacists to prescribe puts convenience ahead of patient safety.

There are too many unseen risks and potentially higher costs.

I am not dismissing the hard work that pharmacists do – I’ve been there.

During my training and employment as a pharmacist, we trained heavily in

pharmacology and became the experts of quality use of medicines.

Pharmacists are the final barrier of the ‘swiss cheese model’ to ascertain drug interactions, dosing and counselling to ensure the doctor has prescribed the right drug, at the right dose for the correct patient.

But the differences between the prescriber and dispenser is what ensures safety for the patient.

An element we often forget is community pharmacists have a direct conflict of interest if they begin prescribing.

During my time as a pharmacist, I had training in the workplace for ‘companion selling’, that is trying to boost sales of other products while selling prescribed antibiotics.

So, for example, if I was dispensing antibiotics for a urinary tract infection, I would recommend customers also try probiotics or cranberry or an immune booster.

I may have even promoted the odd fragrance or two during the festive season!

W H AT I S T H E U N D E R LY I N G M O T I V E F O R P H A R M A C I S T S T O A D V O C AT E F O R E X PA N D E D SCOPE OF PRACTICE? Pharmacy, like all areas of health, is underfunded because of the price-cutting of prescription medications from government and from within the pharmacy profession.

Pharmacists are not charging for their clinical expertise.

For example, one commonly prescribed antibiotic PBS fee is $13.08, however many pharmacies will charge $5.50 in the hope that customers will buy other items.

While this discounting saves money for the general public, it has affected the bottom line of pharmacy owners.

14 Doctor Q Winter

The way to improve the business of pharmacists is not to increase their scope of practice without also requiring they undergo the appropriate training. Health is not about convenience; it cannot be operated like a fast food chain. It is about the delivery of safe and quality health care.

Some may comment that the pharmacy-prescriber model has been successful overseas. I would rebut that comment by saying many countries will have doctor-dispenser models, along with de-regulation of pharmacy ownership, as this too allows for patient convenience, access and reduction of costs. In Australia, we don’t have these models due to our national regulations to ensure patient safety.

d isast er W H Y I S T H E L A R G E S T S T AT E O F A U S T R A L I A REJECTING THIS PROPOSAL? I’m pleased that the New South Wales’ Health Minister has rejected similar proposals to allow pharmacists to prescribe antibiotics and contraceptive pills.

DR NICK YIM

AMA Queensland Council, General Practitioner Craft Group; General Practitioner; and former Pharmacist

Specific national prescribing protocols are required to be developed prior to changes in scheduling of medications.

Increasing the scope of practice of pharmacists is a gamble that we can’t afford.

Queenslanders deserve safe, quality and accessible healthcare but altering the scope of practice of pharmacists is not the way to deliver it. We need an appropriately funded health system, not short cuts and further fragmentation of care.

Instead of allowing pharmacists to take on the role of doctors, the government should focus on injecting more funding into general practice to combat the rise of out-of-pocket expenses and increase funding for pharmacists to collaborate with general practitioners within practices, removing the cap for home medication reviews, further incentivising the use of staged supply and dose administration aids.

The AMA has passed an urgent motion that the Federal Council and Federal President call for an immediate end to the trial of prescribing of antibiotics, paediatric vaccinations and oral contraceptives by community pharmacists in Queensland and nationally. The motion, put forward by Dr Bavahuna Manoharan, also calls for the Queensland Health Minister to adhere to national processes as occurring under the direction of the Council of Australian Governments.

Following contributions from the floor, all in favour of the motion, that went to issues of privacy, evidence-based medicine, incorrect prescribing, and Pharmacy Guild tactics, the motion was passed easily. The motion was seconded by Dr Yim.

Doctor Q Winter 15

Voluntary assisted dying in Queensland Queensland has only half the number of specialist palliative care services needed to meet community demand. That means thousands of Queenslanders are at risk of dying without the dignity, comfort and compassion they need and deserve.

90 per cent of the 29,500 people who die in Queensland each year would benefit from palliative care but many do not receive care that fully reflects their choices or meets their needs.

People in rural and remote areas suffer most, because we don’t employ

enough full-time health professionals to provide palliative care across the state, 24 hours a day.

With political and clinical leadership and adequate funding, we can offer people a better death, relief from pain, reassurance and support in their own home. We must be able to guarantee that our palliative care system can meet community need, particularly as a Queensland Parliamentary Committee considers the contentious issue of voluntary assisted dying.

DR DILIP DHUPELIA

President, AMA Queensland Importantly, AMA Queensland calls for the Government to support our 50 by 50 campaign, which aims to have 50 per cent of Queenslanders over the age of 50 signing an Advanced Health Directive (AHD) by 2022.

AMA QUEENSLAND COUNCIL OUTCOME When the AMA Queensland Council met on 17 May, they agreed that if the Queensland Government decides that laws should be changed to allow for the practice of euthanasia and/or physician assisted suicide, AMA Queensland must be consulted and involved in the development of relevant legislation, regulations and guidelines which protect:

all doctors acting within the law; vulnerable patients – such as those who may be coerced or be susceptible to undue influence, or those who may consider themselves to be a burden to their families, carers or society; patients and doctors who do not want to participate; and the functioning of the health system as a whole.

AMA QUEENSLAND SUBMISSION

SOME DEFINITIONS

On 23 May, the AMA Queensland submission made the following key points:

EUTHANASIA The word euthanasia comes from the Greek words eu and thanatos, and translates roughly to English as ‘good death’. It describes the practice of intentionally ending a life in order to relieve suffering

AMA Queensland does not support the introduction of voluntary assisted dying in Queensland. It believes doctors should not be involved in interventions that have as their primary intention the ending of a person’s life, although this does not include the discontinuation of treatments that are of no medical benefit to a dying patient.

AMA Queensland believes medical practitioners have an ethical duty of care to dying patients to ensure death is allowed to occur in comfort, with dignity and without pain even if the treatments/ medications being used to achieve this hasten death.

AMA Queensland calls on the State Parliament to recognise that palliative care is grossly under-resourced, particularly in regional and rural parts of the state.

AMA Queensland recommends that if the Queensland legalised voluntary assisted dying in Queensland, the medical profession needs to be involved in developing the relevant legislation and guidelines to ensure appropriate safeguards are included.

Euthanasia may be active - a deliberate act undertaken to end a patient’s life - or passive omission of an action which would reasonably be expected to keep the patient alive.

It is important to note that other actions made by a medical practitioner may lead to a patient’s death but are not considered euthanasia.

PHYSICIAN ASSISTED DYING Physician-assisted dying (PAD) is a subset of assisted suicide, whereby the patient’s death is enabled via means (for example, a drug) or by information (for example, how to use a drug) by a medical practitioner.

AMA Queensland believes doctors and medical facilities have the right to conscientiously object to voluntary assisted dying and that they should not be legally bound to participate.

VOLUNTARY ASSISTED DYING Is distinct from euthanasia as it is the patient taking the final action that will end their life, rather than the clinician. Unless the person cannot self-administer or ingest the medication then a clinician can administer.

AMA Queensland advised doctors to always act within the law to help their patients achieve a dignified and comfortable death.

Note: Euthanasia, physician assisted dying and voluntary assisted dying are not part of medical care but aged care, end of life care and palliative care are part of medical care.

LETTER TO THE EDITOR

Grave concerns on assisted dying As a GP of some 45 years, I am gravely concerned with the proposal that Queensland should legislate for voluntary assisted dying (VAD).

Such legislation would place some of the most vulnerable in our society at risk, in failure to provide adequate care when dying or in circumstances of physical or emotional ill health. It changes society’s view of the value of human life and in making the most vulnerable either through age or physical or mental ill health see their life as of decreased value they may be ‘pushed’ to agree to end it, or with the option of VAD, we will fail to provide funding for adequate care both physical and emotional of our most vulnerable.

The World Medical Association, as well as the British, American, New Zealand and Australian Medical Association do NOT support VAD, physician assisted suicide or euthanasia.

distinction to ending a patient’s life.

Many elderly or terminally ill patients at some time will say ‘just give me a needle’ ‘I want to go’. This is often a poignant request to know that their life still is of value even though they cannot do what they have in the past.

With some simple reassurance and, if necessary, modification of their medication, at their next appointment, they are more settled and have enjoyed some family or social event.

If, as a society, we do not provide that reassurance for our most vulnerable, that their life is still worthwhile even though their capacity to ‘function’ is not as great as others in our community, we are at grave risk of moving to a society where one’s contribution is weighed up and assessed and some considered less valuable than others.

The bringing in of legislation for VAD will interfere with the doctor-patient relationship. My role is to support my patients’ health care and ensure their comfort as they approach life’s end. With VAD, there are multiple conflicting demands that would interfere with my patients receiving that best care.

I will need to decide whether the patient request is a cry for reassurance and additional care or a desire for VAD. Quite frankly, with grieving relatives, legislative requirements, individual agendas etc it will result in complex difficulties for both patient and their treating doctor instead of the reassurance and best patient care that the patient should be given.

With VAD as an option, there are financial drivers to impede best palliative care options. Best practice palliative care must be funded and available to all dying patients. This must ensure patients have access to medication to keep them comfortable, even if it may hasten their death.

The primary aim of the medication is patient comfort in distinction to VAD in which the primary aim of medication is to end the patient’s life. There is an absolute difference in providing patient comfort in

Many of those in support of VAD appear to come to that position because of the death of a loved one in circumstances that the stillliving relative finds difficult. The presumption is if the family member had access to VAD, then the remaining relative would find the death more appropriate. Grief is a complex issue and each person grieves in different ways. To presume that the grief process would be lessened in the remaining living relatives, by access to VAD for their family member is

DR ZELLE HODGE General Practitioner; AMA Queensland Past President

unsubstantiated and questionable. It interferes in the care that can be given by creating a barrier in the doctorpatient relationship. This barrier is not only in the patient’s relationship with the doctor but also their relationship with others in the health care team.

Bereaved family members need support in their grief and VAD may not be the panacea that some envisage.

It would seem that in most cases where individuals support VAD because of their personal experience with a dying relative, the major issue is inadequate palliative care.

Palliative care must be appropriately funded and available for those in the terminal stages of life. We need to discuss and address the issues around increasing longevity and death but they are matters in which it is difficult to engage the community.

The choices we make around death are a result of the attitude of family and friends, the medical profession and society. VAD provides a ‘band aid approach’ to death for a few without allowing us to address the many more significant issues of living and dying and places the most vulnerable at risk.

The taking of human life via VAD has consequences well beyond the individual immediate death. We must address palliative care and the other complex issues of our modern society rather than ‘papering over’ these very significant challenges by legislating for VAD in Queensland.

Doctor Q Winter 17

Ethos a bad substitute for proper process If you make a complaint against a colleague, or if you have a complaint made against you, you have a right to natural justice. This includes the chance to know who is making a complaint against you and having the right to defend yourself. You also have the right to consult a union representative.

Luckily, if a complaint is made about you by another staff member, the dispute will play out according to the grievance resolution policy contained in the Medical Officers (Queensland Health) Award – State 2015 (The Award) and the Medical Officers’ (Queensland Health) Certified Agreement (No 5) 2018 (MOCA 5).

Unfortunately, the Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) and AMA Queensland have grave concerns about a complaints system called Ethos, as proposed by Metro North Hospital and Health Service (MNHHS), which oversees the Royal Brisbane and Women’s Hospital, The Prince Charles Hospital, Caboolture Hospital and Redcliffe Hospital.

The Ethos program, if implemented, as proposed, would be in direct conflict with the Award’s policy and procedures on how employee grievances should be raised and dealt with. Put simply, an employee would be encouraged to keep a complaint ‘in-house’ instead of reporting the grievance to HR.

The Ethos program’s complaint management system allows an employee to make a complaint, and the complaint can be traced back to the complainant. As above, it creates a separate and concurrent complaints management system, which conflicts with existing framework and grievance resolution. In particular, the Ethos program raises the question about employee entitlements in relation to natural justice and procedural fairness.

The system is currently in place at St Vincent’s Hospital in Victoria and it has encountered a barrage of problems.

Staff spoke anonymously to The Age newspaper and commented: “A lot of senior medical staff question the way this intervention has been applied,” one employee said. “You can’t access any documents about the complaint against you, nor is there any avenue to challenge because this is technically an ‘informal process’.

ASMOFQ and AMA Queensland also have particular concerns around the concept of an Ethos ‘messenger’. When a negative report by its nature about a staff member is made in the Ethos reporting tool, it is assigned to an ‘Ethos messenger’.

“The anonymity has led to frivolous complaints and some staff feel a divide growing between the messengers and ordinary staff.

Ethos is providing a system of no accountability for complainants, no just hearing and no records for due process.”

That staff member will then have an “informal, respectful and confidential conversation with the subject of the complaint who tells them how their behaviour has been perceived by another staff member and to offer an opportunity to reflect and think about ways they may behave differently next time”.

While the reports are intended to be confidential, suspicion always arises as to how the information will stay confidential and not become part of the hospital rumour mill. The program provides an opportunity to exercise power over a senior colleague and be aware of the dispute, and the parties, in question. It places a heavy human resources expectation on a staff member not trained in human resources.

The article also said the Ethos program had been blamed for triggering too many trivial complaints, which had caused significant stress for those complained against.

To be clear, ASMOFQ and AMA Queensland have no issue with the positive reporting side of Ethos.

It’s more than likely that these reports would be positive and work well towards a positive culture. We are also in great favour of staff training around dispute resolution and encouraging staff to address negative behaviour.

W H AT I S A S M O F Q D O I N G A B O U T I T ?

ASMOFQ has placed the Ethos program matter in dispute in accordance with the provisions of the Award. The team has invoked the status quo, which means the Ethos program has been stopped in its tracks until a resolution has been reached.

Several conferences have taken place in the Queensland Industrial Relations Commission (QIRC) as part of the dispute resolution process. MNHHS is consulting with the parties around changes to the proposed policy which does not breach the Award’s grievance resolution procedure.

18 Doctor Q Winter

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Stop bullying applications For the state and federal commissions, the ultimate goal in managing bullying is to resolve the disputes so people can resume mutually safe and productive working relationships.

W H A T C A N T H E C O M M I S S I O N D O T O S T O P B U L LY I N G ? 1 In an attempt to prevent bullying from occurring in the future, the commission may schedule a mediation session to try to help parties resolve the dispute themselves. If the commission thinks the matter is not suitable for mediation, or if the matter can’t be resolved at mediation, the commission may hold a conference or hearing to enable the commission to explore how best to approach a matter, or to determine whether an order can and should be made.

Most bullying matters are resolved without orders being required. In some cases, the commission will make an order if it is satisfied that:

the worker has been bullied at work by an individual or group of individuals; and there is a risk that the worker will continue to be bullied at work by that same individual or group.

The commission can only make an order if there is a risk the worker will continue to be bullied at work by a particular individual or group whose behaviours have led to the application.

Orders cannot be made where issues of bullying have already been sufficiently dealt with within the workplace, or where a worker is no longer engaged in connection with the workplace where they alleged the bullying conduct occurred.

W H A T I S A N A N T I - B U L LY I N G O R D E R ?

An anti-bullying order is a ruling made by a commission member after they have heard and determined a matter.

Anyone bound by the order must comply with it and courts can impose substantial penalties on parties who fail to comply. In anti-bullying matters, a commission member can make any order the member considers appropriate to prevent the complainant worker being bullied.

In both state and federal jurisdictions, an order cannot include a financial penalty or any kind of financial compensation.

The focus of any order is to prevent further bullying. Actions the commission might consider could include:

However, each case is considered on its merits and parties should consider the specific circumstances of the workplace when seeking orders or responding to proposals for orders.

provide all staff with anti-bullying training;

conduct training for all employees on appropriate standards of behaviour in the workplace, including a recommendation that the training be conducted by the Anti-Discrimination Commission;

ensure they have in place updated anti-bullying policies and complaints handling procedures;

commission specific training for management personnel who will be investigating complaints about workplace bullying to implement, and actively monitor, the effectiveness of control measures identified in risk assessments; or

arrange for a Work Safe inspector to attend meetings with parties.

Orders for individual parties include:

not make contact with each other;

only make contact via email during specific times;

not attend certain premises;

not denigrate or humiliate one another and behave in a way that is reasonable and professional;

not deliberately or unreasonably delay the performance of work;

requiring the individual or group of individuals to stop the specified behaviour;

maintain the confidentiality of the parties and their association with the terms of the order; or

regularly monitoring behaviours by an employer or principal;

complying with an employer or principal’s bullying policy;

refrain from making written and / or oral statements to each other or others that are abusive, offensive, or disparaging.

providing information and additional support and training to workers; or

reviewing the employer’s or principal’s bullying policy.

The commission cannot order reinstatement or the payment of compensation or a pecuniary amount.

1

Guide - Anti -bullying jurisdiction, Fair Work Commission online <https://www.fwc.gov.au/ documents/documents/factsheets/guide_antibullying.pdf>

2

Bowker and Ors v DP World Melbourne Limited t/a DP World and Ors [2015] FWC 7312 (16 November 2015) 126 – 127.

3

20 Doctor Q Winter

Orders for companies include:

Applicant v Respondent (unreported, FWC, PR548852, 21 March 2014.

An example of an order by the commission is: “[The perpetrator] “undertakes that he will not approach [complainant] for 12 months from the date of this undertaking unless he is required to do so to perform the duties and functions of his role at [employment].”

“I am content with that undertaking, but trust that when contact is necessary in the performance of their repective duties and functions, the contact is respectful.2 and; the alleged bully:

shall complete exercise at the employer’s premises and change out of gym gear before 8am;

shall have no contact with the applicant alone;

shall make no comment about the applicant’s clothes or apprearance;

shall not send any emails or texts to the applicant except in emergency circumstances; and

shall not raise any work issues without notifying the Chief Operating Officer of the repondent, or his subordinate, beforehand.3

The applicant was also ordered not to arrive at work before 8.15am. There was no end date on these orders.

Because the purpose of an order is to stop further bullying in the workplace, an application will likely be dismissed or orders not issued if:

an alleged bully no longer works in the workplace;

the target worker no longer works in the workplace;

the employer has taken reasonable steps to stop the conduct; or

the conduct occurred in the past and there has been no recent bullying conduct.

HELP AVAIL ABLE AMA Queensland can assist employers with questions about workplace bullying and can help employees being bullied.

P: (07) 3872 2211 E: workplacerelations@amaq.com.au ASMOFQ can assist employee medical officers who are experiencing workplace bullying or are accused of workplace bullying.

P: (07) 3872 2222 E: asmofq@amaq.com.au Seek assistance as soon as there is a problem. Early intervention is the best way to manage workplace bullying.

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

Applications to the FWC or QIRC For members employed in the state health system, stopbullying applications will be filed in the Queensland Industrial Relations Commission (QIRC). Members who work with the federal award will deal with applications filed in the Fair Work Commission (FWC).

The jurisdictions are essentially parallel for the purpose of this discussion.

from commencing a proceeding for a breach of workplace health and safety laws for the same matter.

The bullying jurisdiction in itself is a straight forward area of industrial law to consider. The interplay with health and safety and workers’ compensation laws complicates matters when both employees and employers try to deal

with matters related to workplace bullying. The inclusion of industrial manslaughter by the Queensland Government, imposes further obligations on both state and federal jurisdiction employers to take timely steps to prevent harm to employees from workplace bullying.

A proceeding in the anti-bully jurisdiction does not prevent a worker

Doctor Q Winter 21

AMA QUEENSLAND

Board

Dr Michael Cleary PSM MBBS FA C E M M H A FRACMA A FA C H S E

Dr Dilip Dhupelia

Assoc Prof Chris Perry

LRCPS (IRE) DIP OBST ACOG F R A C G P FA R G P A F R A C M A FA I C D

OAM RFD ED (MBBS (UQ) DTM&H (LIVERPOOL) FRACS)

President Specialty: General Practice

Vice President Specialty: Otoloaryngology

“As President, I look forward to working within a wide-ranging team and hopefully add value to the fine work already being performed in representation, leadership and advocacy.”

“The interaction between the medical profession and the federal and state health departments, to the Ministers and potentially the Queensland Premier is very important. The AMA is the only lead organisation for all doctors in Australia. We need interaction with jurisdictions which is respectful and mature. We also need to be able to present ideas and messages to the community in a way that people understand.”

Dr John Hall

MBBS BSC (HONS) FRACGP FA C R R M DRANZCOG (ADV) GRADDIPRURAL

Board Director and Downs and West Area Representative Specialty: Rural Procedural Medicine and General Practice “I can advise the council on issues affecting the health of rural Queenslanders and their health care teams. I’ll highlight issues like strengthening the rural health workforce; access to essential health services, including quality primary care, emergency care, inpatient and maternity services; and strengthening access to local specialty services.”

22 Doctor Q Winter

Dr Bav Manoharan

Chair of Board and Council Specialty: Medical Administration and Emergency Medicine “Leadership by the medical profession in the design and operation of the Australian healthcare system is essential. AMA Queensland’s role in supporting the development of medical leadership is essential in ensuring wellconstructed and considered advice is provided to the community, government and health service managers.”

Dr Sarah Coll

MBBS FRACS FA O A

Board Director and Specialist Craft Group Representative Specialty: Orthopaedic Surgery “I am keen to represent regional doctors, and those who work too hard to represent themselves. I would like to see doctors advocate for their own quality of life and set an example of healthy living. I am interested in the role doctors have to play in advocating for change in nutrition and activity practices across their communities.”

Dr Peter Isdale AM PHD MAICD

MBBS BSC GAICD

Board Director and Greater Brisbane Area Representative Specialty: Radiology Registrar “We need to work to improve the quality of, and fair access to, training and education in both the prevocational and vocational arenas, including ensuring training is affordable to trainee doctors and working conditions and awards are protected and enforced. As an organisation, we need to prioritise our engagement with our membership and deliver value to them.”

Skilled Director Specialty: Governance and advisory “Good governance and well-conceived strategy are cornerstones of excellence in member-focussed organisations.

I intend that my contribution to the AMA Queensland members’ benefit will be through support for the board and management in applying effective, well-tried principles and practice in wise governance.”

AMA QUEENSLAND

Council

Dr Fatima Ashrafi MBBS DGO FRCS FRCOG FRANZCOG

Dr Hashim Abdeen BBIOMEDICINE MBBS

Dr Sanjeev Bandi MBBS FRCSI FRACS

Specialist Craft Group Representative Specialty: Obstetrics Gynaecology

Capricornia Area Representative Specialty: Urology

“I believe in patient-centred care that is respectful and responsive to the preferences, needs and values of patients and consumers. I am firmly focused on women’s health issues locally and internationally. I believe I will be a strong advocate for women’s health, our specialist doctors, trainees and most importantly our patients – diverse and multicultural ensuring that everyone has access to good quality care.”

“I am looking forward to representing the regional doctors from the Capricornia Area, and those of us who work hard in these trying times to balance work and family commitments.

I would like to see doctors be more proactive in influencing their own quality of life and set an example for healthy living. I am keen to be a role model to influence a change in the nutrition and activity practices across the wider community.”

Dr Maria Boulton MBBS FRACGP

Dr Bill Boyd MBCHB (DUNDEE) FRCOG FRANZCOG GAICD

Gold Coast Area Representative Specialty: Medical Registrar “I am in a unique position to gauge the advocacy, training, and wellbeing needs of doctors in training. Through my role I wish to inspire others to take part in medical leadership and to foster an inclusive AMA environment to maintain the legacy of the organisation and to produce strong medical leaders of the future.”

Dr Kimberley Bondeson

BSC (HONS) MBBS FRACGP DAME

Greater Brisbane Area Representative Specialty: General Practice, Aviation Medicine “My intention is to represent the views of doctors in the Greater Brisbane area: public and private doctors, specialist and general practitioners, and doctors in training. I will ensure the concerns of our patients and the public are listened to carefully and advocate for those who do not have a voice. We are proud to have set up ongoing dialogue between politicians, AMA Queensland and our local doctors.”

Dr Marianne Cannon MBBS MPH GRAD CERT HPE FA C E M

Greater Brisbane Area Specialty: General Practice

Immediate Past President Specialty: Obstetrics and Gynaecology

Greater Brisbane Area Representative Specialty: Emergency Medicine

“Opening Family Doctors Plus increased my awareness of the challenges faced by my GP and non-GP specialist colleagues, motivating me to become involved in creating positive change. Primarily, these challenges revolve around providing quality, evidence-based health care in the face of dwindling returns, inadequate MBS rebates and increased competition.”

“It is my intention to further the interests of our members. I will support and uphold AMA Queensland, its standards and aspirations and will work on behalf of the members towards achieving the goals of the association.”

“I have an ongoing interest in doctors in training wellbeing and how system factors inform their experience. I am acutely aware of the implications of climate on health and the medical workforce. I am inspired by those who bring integrity to leadership.”

Doctor Q Winter 23

AMA QUEENSLAND

Council

Dr Hasthika Ellepola MBBS MD FSLCOG FRANZCOG

Dr Michael Clements

MBBS BECON(HONS) MPH MHM DAVMED FRACGP FA R G P F R A C M A FA C A S M G A I C D MRAES

Dr (Deborah) Erica Gannon BPHARMACY MBBS

International Medical Graduate Representative Specialty: Obstetrics and Gynaecology

Part-Time Medical Practitioner Craft Group Representative Specialty: General Practice

“My vision is not only for AMA to be seen as a world leader for health, but to provide nationally consistent and streamlined health care system that supports its constitutes and wellbeing of our national population.

I also believe that the AMA can be a leader in shaping training in our junior medical craft groups, driving clinical quality and influencing health policy”.

“Championing leadership and advocacy for members, patients and the community in general, is of paramount importance. Personally and professionally, being involved with the AMA will provide me a platform to not only benefit others, but also allow me that opportunity to help maintain and uphold the traditions and integrity of the medical profession in which we work.”

Dr Wayne Herdy MBBS BA (HONS) LLB L L M FA C L M

North Coast Area Representative Specialty: General Practice “I aim to represent the views of my constituents to Council; to promote patient safety especially by diminishing role substitution and developing task delegation; and to assure the future of young graduates by promoting best education and best career prospects.”

24 Doctor Q Winter

Dr Scott Horsburgh BNURS MBBS FRACGP

General Practitioner Craft Group Representative Specialty: General Practice “I hope to focus on improving the MBS rebate for medical practitioners to help make general practice viable.

We need to keep advocating for improved clinical training pathways for medical students and junior doctors with access to general practice exposure during that time.”

North Area Representative Specialty: General Practice “I aim to represent and promote the interests of Far North Queensland doctors and practitioners in private general practices, in particular those in rural and remote areas.

AMA Queensland also offers a lot in terms of support and advocacy for junior doctors and general practice registrars and I look forward to supporting our members in Far North Queensland in these matters.”

Assoc Prof Geoffrey Hawson

F R A C P FA C H P M DIP CLINHYP C F T E [ ATA A ] F R C PA

Retired Doctors Representative Specialty: Clinical Haematology, Medical Oncology, Palliative Care “I am passionate about ensuring we medical professionals can continue to contribute to medicine and a lifetime of training does not go to waste.

If a retired judge can run a royal commission, why are we considered past our prime just because we retire?

Consideration needs to be made for genuine impairment but, if not impaired, why waste a resource?”

Dr John de Laat BSC MBBS DCH FRACGP

Greater Brisbane Area Representative Specialty: General Practice “AMA is dedicated to protecting healthcare and patients and it also fights for medical practitioners who advocate for their patients, often at the expense of advocating for themselves.

The care, knowledge and hard work of Australian doctors has made our healthcare system one of the world’s best and we must keep fighting to ensure it stays that way.”

AMA QUEENSLAND

Council

Dr Nikola Ognyenovits MD FRACGP FA C R R M FA C H A M ( R A C P )

Dr Chris Maguire MBBS GDIPIS BLANG

Dr Rachael O’Rourke MBBS FRANZCR CTCA

Specialist Craft Group Representative Specialty: Addiction Medicine

Greater Brisbane Area Representative Specialty: Radiology

“The medical profession needs a strong uniting force. Governments are limiting and giving away areas of our competencies. Lobby groups take over what we are best trained for which is to serve the public. As Assistant Secretary/Treasurer of ASMOFQ, I have experienced how supporting our peers can achieve substantial results.”

“Doctors in our hospital health systems are under increasing pressure by a bureaucratic health care system, determined to reduce the vital role of doctors in the delivery of health care.

I will work diligently to achieve the best outcomes for all our members and our patients and resist efforts to diminish the role of doctors in health care delivery.”

Dr Siva Senthuran MBBS BSC FRCA FA N Z C A F C I C M

Full Time Salaried Medical Practitioner Craft Group Representative Specialty: Intensive Care “I believe medical leadership and engagement between administrators and its front line clinicians needs to underpin to any drive for efficiency in an era of increasing health care costs.

Such engagement needs to be based on shared values transferred from websites where they are proclaimed into every organisational thought, word and deed.”

Dr David Shepherd MBBS FRACS FA O R T H A

Far North Area Representative Specialty: Orthopaedic Surgery “My intention on the AMA Queensland Council is to represent the views and needs of Far North Queensland doctors by acting as a conduit for communication between them and the AMA organisation.”

Doctors In Training Representative Specialty: Senior House Officer “I’m dedicated to improving the quality and nature of training that doctors receive. My aim, as a member of the AMA Queensland Council, is to see a focus on changing training culture to encourage strong, ethical leadership that values the trainee, and builds respect for the trainer. I will be working to see that doctors in training also have a forthright voice in health policy and advocacy in Queensland.”

Dr Fiona Raciti

MBBS (HONOURS) FRACGP DCH

Greater Brisbane Area Representative Specialty: General Practice “General practice is the backbone of the Australian health system but is often overlooked in both the national health agenda and the media. GPs have so much to offer the conversation about primary care, evidence-based first-class health care for our patients and issues facing business owners in general practice. ”

Dr Nicholas Yim BPHARM MBBS FRACGP

General Practitioner Craft Group Representative Specialty: General Practice “I hope to bring enthusiasm and representation to address issues facing regional Queensland. I intend to advocate for all doctors and to ensure the high standards of the clinical training, which I hope will in turn improve the health of our communities and patients.”

Doctor Q Winter 25

AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING

New team

The results are in –our AMA Queensland Council of Doctors in Training has been elected for 2019.

We have elected two deputy chairs: Drs Mikaela Seymour and Marco Giuseppin to support Chair Dr Hashim Abdeen.

Our newly elected portfolio leads are: Industrial Relations Portfolio

Dr Dilum Ekanayake

Dr Henry Su

Education and Training Portfolio

Dr Paria Saadat

Dr Shannan Searle

Rural and Remote Portfolio

Dr Tim Turk

Dr Nicola Campbell

Membership and Events Portfolio

Dr Helena Franco

Dr Honor Magon

Communications Portfolio

Dr Samuel Thambar

Dr Tahlia Gadowski

Advocacy Portfolio (newly created)

Dr Douglas Roche

The new CDT executive will decide hospital representative positions in due course. Thank you to everyone who nominated for a CDT position. All positions were extremely competitive this year and reflect the deep talent pool we have to draw on in Queensland. We hope that you’ll apply again next year.

We are keen for all Doctors in Training to be involved with CDT and welcome participation in our ‘open door’ meetings throughout the year, regardless of position. Please keep an eye out for the schedule of our CDT meetings for the 2019 year.

Member news PAY R O L L D E D U C T I O N

We have listened to your feedback and now it is even easier to pay your membership!

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

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

refer a member

AND RECEIVE A DISCOUNT ON YOUR MEMBERSHIP RATES

26 Doctor Q Winter

REFER 1 MEMBER

REFER 2 MEMBERS

REFER 3 MEMBERS

REFER 4 MEMBERS

25% discount on your membership

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Update on the performance framework

The Medical Board of Australia is working steadily with partners in the profession to build the Professional Performance Framework.

This long-term project will support doctors to take responsibility for their own performance and encourage the profession collectively to raise professional standards and build a positive, respectful culture in medicine that benefits patients and doctors.

Here is an update on our progress:

1

STRENGTHENED CONTINUING PROFESSIONAL DEVELOPMENT

Under the framework, all doctors will: do at least 50 hours of CPD per year, that is relevant to their scope of practice, based on a professional development plan and includes a mix of reviewing performance, measuring outcomes and educational activities participate in the CPD program of their CPD home.

Changes will not occur in 2019. The Board will consult widely with the profession and other stakeholders about a revised CPD Registration standard later in 2019. There will be a transition period so doctors, Colleges and CPD homes can revise their current arrangements to meet the new requirements.

4

2

ACTIVE ASSURANCE OF SAFE PRACTICE

Increasing age is a known risk factor for poor performance. The Board is proposing doctors who provide clinical care to have peer review (as part of their CPD) and health checks every three years from the age of 70.

We expect the vast majority of these doctors will demonstrate their ability to provide safe care to patients and remain in active clinical practice.

No date has been set for the introduction of health checks for doctors aged 70 years and older – it will not be in 2019.

We are identifying the clinical components of a practical and effective health check in consultation with a range of clinical experts. We will build a rigorous, evidence based approach and will consult widely with doctors and all our stakeholders about it.

CLEAR, RELEVANT AND CONTEMPORARY PROFESSIONAL STANDARDS AND GUIDELINES

We continue to work on a range of standards and guidelines. For example: we recently published revised guidelines on Sexual boundaries in the doctor-patient relationship we will introduce a revised Good medical practice: a code of conduct for doctors in Australia later in 2019. This follows a lengthy consultation process we are consulting on draft guidelines on complementary and unconventional medicine and emerging treatments with the Boards for other regulated professions, will be reviewing the mandatory reporting guidelines.

28 Doctor Q Winter

5

3

STRENGTHENED ASSESSMENT AND MANAGEMENT OF MEDICAL PRACTITIONERS W I T H M U LT I P L E S U B S TA N T I AT E D COMPLAINTS

Multiple substantiated complaints are a clear predictor of future complaints.

Three per cent of Australia’s medical workforce accounts for nearly half of all complaints made.

We will be working with our notifications team, including our clinical advisors, to define ‘multiple substantiated complaints’ and pilot formal peer reviews. We will review the pilot to determine its effectiveness and define the threshold for formal peer review for different areas of practice.

F O S T E R A P O S I T I V E C U LT U R E OF MEDICINE, FOCUSED ON PAT I E N T S A F E T Y

The Board has an important role in helping build a culture of respect, in partnership with many others.

We support work being done to build a more respectful culture of medicine.

We also encourage a profession-wide focus on doctors’ health and want all doctors to feel comfortable to get help when they need it. Doctors’ health matters for individual doctors, for our profession and for public safety.

The Board allocates $2 million each year to Doctors’ Health Services Pty Ltd (DrHS) across Australia so doctors can seek help when they need it.

Doctors secure significant MOCA 5 deal

After a protracted period of bargaining with Queensland Health, commencing February 2018, the Medical Officers’ (Queensland Health) Certified Agreement (No. 5) 2018 (MOCA 5) was successfully endorsed by Medical Officers and certified via the Queensland Industrial Relations Commission (QIRC) in May 2019.

Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) negotiated MOCA 5 on behalf of the members.

The new agreement is in full effect from 31 May 2019.

The foundation of the agreement is the increase in wages for all medical officers of 2.5% from MOCA 4 rates per annum for the life of the Agreement and the increase in Professional Development Allowance for both Resident Medical Officers and Senior Medical Officers.

The first salary increase will be 2.5% effective from 1 July 2018. There will be over 39% increase in Professional Development Allowance for Resident Medical Officers and an increase to Senior Medical Officers’ Professional Development allowance to compensate for increasing costs associated with continuing professional development, upskilling and registration.

MOCA 5 WINS ALL MEDICAL OFFICERS 2.5% pay increase per annum from the MOCA 4 rates; new entitlement for two 10-minute paid rest pauses in the first and second half of the day, with ability to take’ the two pauses together to form a 20-minute paid break; and new Digital Recall pay entitlement.

RESIDENT MEDICAL OFFICERS Over 39% increase in Professional Development Allowance (from $1,575.93 to $2,200 per annum); over 39% increase in Vocational Training Subsidy (from $2,626.50 to $3,670 per annum); 60% increase in Professional Development Leave (from 5 days to 8 days per annum); 100% increase in Examination Leave (from 2 days to 4 days per permissible occasion); new entitlement for up to 3 days’ travel time for rural and remote doctors accessing PDL; and accrued Professional Development Leave to be preserved for 25 months, if a Medical Officer leaves the health service.

SENIOR MEDICAL OFFICERS Increase in SMO Professional Development Allowance: 1. $20,500 Year One 2. $21,000 Year Two 3. $21,500 Year Three MEDICAL OFFICERS WITH PRIVATE PRACTICE (MORPP) / MEDICAL SUPERINTENDENTS WITH PRIVATE PRACTICE (MSPP) MORPP AND MSPP will have their pay scales updated in line with the SMO (L13 - L18) pay scale. This will result in an approximate 11% increase upon certification with pay increases of 2.5% on top of this each year.

This is a milestone agreement for Queensland’s public hospital doctors, and a true sign of our members’ value in our public health system.

Over the past year, ASMOFQ has held a myriad of meetings with our members (in metropolitan and rural health services) to ensure the new agreement responded to and reflected the needs of our members.

W H AT ’ S N E X T ?

ASMOFQ, is seeking representatives for the following review committees under MOCA 5:

1. Rural and Remote Review Committee - clause 3.5 2. SMO Allowance Working Party (PDA and MVA) Committee - clause 3.5

3. Review of Resident Medical Officer Employment Arrangements Committee clause 1.17

Members who are interested in any of the above review committees, please email moca5@amaq.com.au.

Doctor Q Winter 29

The wellbeing of clinicians must be a priority

DR ALEX MARKWELL

It was during my days as a junior doctor that I first developed a passion for the wellbeing of clinicians.

As the then Chair of the Australian Medical Association’s Council of Doctors in Training, I became aware of a number of junior doctors who had died. Some had taken their own life, others died from illness or injury from a car accident on the way home from work.

Initially, I didn’t know any of them personally but I still felt the loss.

Raising awareness about doctor safety and wellbeing became a strong focus for the work of the council.

As we worked to empower junior doctors to take care of their wellbeing, we lost one of our own. A recent member of the council was killed in a car accident on her way home from work in a rural hospital.

A decade later we continue to see examples - sometimes very public cases - that show the wellbeing of the health workforce is an ongoing issue.

Sometimes it’s as a result of the work environment and those issues need to be addressed. Simple things like making sure healthy food is readily available at all hours can make a huge difference to the individual. A vending machine that sells fruit, nuts and other healthy snacks and meals is a great example of a simple yet highly effective initiative.

Rostering to support our circadian rhythm is necessary if clinicians

working shifts are to have appropriate sleep and recovery.

Culture within disciplines also needs to be a focus for change. In medicine, there is a culture of turning up to work irrespective of your own health - we have to get over that concept of ‘present-eeism’ and ensure we prioritise our own health as we would recommend for our patients.

It’s reasonably clear now that if a clinician is worried about their health they should be able to see their GP and get care without fear of being reported under the mandatory reporting legislation. There are ongoing conversations in this space.

The Queensland Doctor’s Health Programme provides a confidential, colleague-to-colleague support service for doctors and medical students facing difficulties. For more information go to their website https://dhasq.org.au/ At an individual level, we as doctors need to make sure we get the basics right - ideally having enough sleep,

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

nutritious food, exercise and taking the time at work to pause and be mindful for a moment before we carry on.

The link between clinician wellbeing and patient outcomes is strong. A range of studies show that healthcare providers who have poor health or suffer from burnout are much more likely to make medication prescribing errors, less likely to show compassion and empathy to their patients, and their patients are more likely to suffer an adverse event.

The converse is also true. Patients of clinicians who are healthy with high levels of job satisfaction have much better outcomes.

We must continue to find solutions to a healthier, safer and more productive workforce.

The Queensland Clinical Senate met in May to discuss the health and wellbeing of the workforce. A report of this meeting will be available on our website: www.clinicalexcellence.qld.gov. au/priority-areas/clinician-engagement/ queensland-clinical-senate/meetings/ health-wellbeing-workforce

* Dr Markwell is a founding member of Wellness, Resilience and Performance in Emergency Medicine https://wrapem.org 30 Doctor Q Winter

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

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

www.gssuites.com.au

Hanging on the telephone Dr Michael Kennedy reflects on his experience as a phone counsellor for the Queensland Doctors’ Health Programme, and encourages others to consider joining the team.

DR MICHAEL KENNEDY Retired General Practitioner and former QDHP phone counsellor

“Years ago, an opportunity arose, akin to a tap on the shoulder to do this job of taking the calls for DHAS(Q), now the Queensland Doctors’ Health Programme. It was largely a spontaneous decision in just getting on with it. So it doesn’t have to be a really big earth shattering decision to do this, although things are a little different to 20 years plus ago, I was a GP about 10 years out in general practice. GPs are well suited to this job. To be able to listen to the person on the other end of the line and get as much information as you can, not only the story, but the accent, anxiety level etc. You need to be able to write quickly. I imagine the modern doctors are able to write still, as my writing deteriorated much before the key board. You are involved more often with problems arising in the more bureaucratic world in which we now live e.g. students and registrar level in my experience.”

WHY WOULD ONE WANT TO DO IT? Well, it is interesting actually and over time you get to know more about doctors’ health. Another string to your bow, so to speak.

You will be involved with another group of doctors involved in this. I remember looking at the list of names and seeing people’s names who I respected and knew were capable doctors. So, in that sense it’s nice to be part of something like this.

YO U M AY G E T A F U Z Z Y FEELING BECAUSE YOU ARE HELPING YOUR COLLEAGUES. Or a sense of satisfaction because you’re doing your bit in the bigger medical community without the fanfare. Does that sound boring? Not really!

Y O U K N O W T O A LW AY S A S K A BUSY PERSON IF YOU WANT SOMETHING DONE? I believe you need to feel supported and I think this has improved since the early days. It is important not to feel one has to solve things straight away, rather to communicate to see what can be done, and this is where the support is needed and possible follow up.

I hope that maybe one reading this may start to consider this as a thread in their medical coat or dress.

At any rate, enjoy this part of your medical life and know that some doctors have been helped and careers changed by your discipline and learning.

If you are interested in becoming a Queensland Doctors’ Health Programme phone counsellor, please send an email to president@dhasq.org.au. For further information about DHAS(Q), please refer to our website: http://dhasq.org.au/

QDHP

Queensland Doctors’ Health Programme

24/7 HELPLINE (07) 3833 4352

32 Doctor Q Winter

A S S O C I AT E PROFESSOR GEOFFREY HAWSON

A second opinion is a patient’s right The patient sits opposite me, nervous as she seeks a second opinion about her cancer diagnosis. Three important questions I have are: why are you seeking a second opinion? have I met your expectations? (at the end of the consultation); and when I write to your referring GP, am I able to copy in your medical oncologist and/or your surgeon?

Tattersall1 found that, over a twoyear period, 6.5 per cent of patients attending a major cancer centre were seeking a second opinion (SO) (MJA 2009). Reasons given by those patients, and mine, include: more questions about treatment options or decisions; reassurance that the diagnosis and treatment already suggested were appropriate; (some patients I see do not want chemotherapy at all and are seeking reassurance that they do not need it. This involves a considerable discussion about the risks and benefits of adjuvant chemotherapy); needing more information about the cancer; and dissatisfaction with the information already given or the communication methods of the previous doctor.

Most patients who seek a SO in another hospital are generally in a higher socioeconomic group and have more familiarity with the health system. Some have concerns that seeking a SO may damage their relationship with their first doctor with whom they may wish to continue.

Patients have the right to make decisions about their own body and need plenty of time to discuss their concerns. Our crowded outpatient facilities often mean there is a constant struggle with time pressures to keep patients flowing through these clinics. Unfortunately, the same issues can occur in private rooms as well.

The advent of the electronic medical record has resulted in prolonged clinic times with much of the time taken up with looking at a computer screen rather than interacting with patients.

This further increases patients’ frustration and impedes our ability to notice subtle and not-so-subtle body language indicative of a patient’s lack of understanding or confusion.

There are now more cancers treated with an increasing array of treatment options meaning patients are being followed for longer periods of time and more frequently. Clinic crowding and increasing burnout amongst medical oncologists2, means that

AMA Queensland Council, Retired Doctors Representative, Director of Cancer Second Opinion 1. Tattersall et al. MJA 2009;191:209-12 “ Second Opinion in Oncology. The experience of patients attending the Sydney Cancer Centre.”

2. Medisauskatie, A. & Kamau, C. Psychooncology 2017; Jan23 “Prevalence of oncologists in distress: systemic review and meta-analysis’.

doctor-patient communication is being adversely affected.

Tattersall found that patients seeking a SO perceived the consultation to be longer. It is not known whether or not adequate information was given at the first consultation; often the trauma of diagnosis can lead to poor attention and memory recall. I have found that patients who seek a second opinion gain an opportunity to hear the same information and better absorb it the second time around. To cover patient concerns, my SO consultations are usually an hour and a half.

In Tattersall’s study, a SO changed either the treatment or supervising medical oncologist in 51 per cent of cases. For the majority of my patients, I find that the original medical oncologist has proposed a gold standard treatment but that the patient remains unconvinced or requires reassurance.

A second opinion is a patient’s right.

We need to appreciate this and in a respectful way accommodate patients’ desires. The difficult areas (not covered here) are what to do and how to do it when there is a difference of opinions, and the impact of potential time delays with commencing therapy.

Doctor Q Winter 33

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 10 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.

I S T H E R E A N A S S O C I AT I O N B E T W E E N ISOTRETINOIN AND ADVERSE MOOD CHANGES? Dermatology Research Review Issue 57 Reviewer: Dr Annika Smith This study adds to the published evidence that isotretinoin is a well-tolerated and effective treatment against severe acne, and can be used safely for most patients including those with a history of stable mental illness. The majority of patients did not experience adverse mood changes, with mean values of optimism and dysphoria improving during treatment. However, a small minority of patients were susceptible to severe mood deterioration (AR 5.4 per cent), particularly in conjunction with severe physical side effects, necessitating cessation of treatment (treatment dose 1 mg/kg by week six of therapy). While previous studies have suggested mood deterioration being associated with headaches while on therapy, this association was not demonstrated and physical adverse effects included a multitude of other unrelated symptoms and could not be associated with any baseline traits. The study was not able to identify any predictive factors for individual susceptibility to isotretinoin. It is important to reiterate to patients that overwhelmingly the effect on mood is positive and no causal link between isotretinoin and adverse psychiatric events has been proven. Despite this, I think it prudent for both patient and clinician to remain alert to the possibility. This study provides further evidence for significant improvements in mood associated with isotretinoin use, concordant with clinical improvement in acne. It also demonstrates that isotretinoin use in those with preexisting stable psychiatric illness is possible, which ideally should take place in concert with the patient’s relevant mental healthcare providers.

N O N A D H E R E N C E TO C A N C E R S C R E E N I N G L I N K E D TO I N C R E A S E D M O RTA L IT Y Oncology Research Review Issue 44 Reviewer: Dr Genni Newnham Chronic lifestyle-related illness is a significant health burden in the developed world. Modifiable factors such as poor diet, obesity, inactivity, cigarette smoking, and excessive alcohol intake contribute to a variety of chronic health conditions. Early detection of cancer allows early intervention with associated survival improvements and cost savings for the community.

Despite this, rates of screening for many cancers remain low. Previous studies have demonstrated an association between an unhealthy lifestyle and poor uptake of cancer screening.

These authors analysed data from over 64,000 people in the previously reported Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Their results confirm the significant contribution of human behaviour to mortality. Even after adjusting for other risk factors such as smoking, obesity, socioeconomic factors and co-morbidities, nonadherence to recommended cancer screening procedures was associated with a significantly increased risk of death from other causes. The task of modifying human behaviour remains one of our greatest challenges.”

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

34 Doctor Q Winter

Hard to resist.

Updated Antibiotic Guidelines out now.

With a compelling need to curtail growing antibiotic resistance, the latest Australian evidence-based guide to appropriate antibiotic prescribing is hard to resist. The Antibiotic guidelines have been extensively revised, and will be updated in real time as new evidence emerges.

Find new features, topics and patient support tools at www.tg.org.au

Doctor Q Winter 35

OBITUARY

Dr Stephen Morrison

M B B C H I R F R C PA C P P H D 30 December 1946 – 2 May 2019 Member for 30 years ASMOFQ President 2014 - 2019 We recently lost our esteemed colleague Stephen Morrison after a prolonged illness. Stephen was a highly regarded Thoracic and Sleep Physician who excelled as a clinician, researcher, administrator and advocate. It is hard to do justice to Stephen’s career but I would like to reflect upon his immense contribution to Thoracic and Sleep Medicine and in the lives of his colleagues and friends.

Stephen obtained his medical degree from Cambridge University, and undertook his post-graduate specialty training, including a PhD, in the UK, South Africa and Canada. His love of respiratory physiology was nurtured at the prestigious McMaster University in Canada. Stephen’s PhD examined exercise and recovery physiology – a challenging area of respiratory medicine that he taught generations of physicians with consummate ease throughout his career.

He commenced his specialist career in 1981 at Groote Schuur Hospital Cape Town, and in 1988, he was appointed as the Director of Thoracic and Sleep Medicine department of the Royal Brisbane Hospital, a position he held until his death. In 2007, he became the Medical Director of Respiratory and Sleep Specialists (soon to become Genesis Sleep Care).

Stephen was a most caring and compassionate doctor who prioritised patient care. His many appointments to both local and national advisory boards and committees (including but not confined to the Statewide Respiratory Clinical Network, the Asthma Foundation of Queensland and the Queensland Health Sleep Disorders Statewide Clinical Review Committee) in the respiratory and sleep medicine arena, reflected the high esteem in which he was held by peers. Stephen understood better than many the collegiate nature of medicine and was always striving to promote a cohesive and positive working environment for his colleagues.

Research and teaching were always close to Stephen’s heart. He was a prolific researcher, who has published widely, across his career. He understood the key role research provides in informing our clinical practice and it was a measure of his administrative ability and dedication that he was able to foster high quality research through the Royal Brisbane and Women’s Hospital, University of Queensland and Genesis Care. Many of us, myself included, have had the honour of being taught and mentored by Stephen. His grasp of respiratory physiology was unsurpassed and it was something to behold watching Stephen recite and simply explain physiologic concepts that in a textbook seemed abstract and almost incomprehensible to most.

As Medical Director of Genesis Sleep Care, Stephen was instrumental in the attainment of NATA accreditation. He spent a great deal of time with scientists and trainees and helped ensure that the clinical service was of the highest quality. He has been an integral member of

36 Doctor Q Winter

the Clinical Management Committee over the best part of the decade.

Stephen used his skill and influence as a very effective advocate. He was incredibly supportive of scientific staff, administrative staff, junior medical staff and colleagues. One always had the sense that Stephen ‘was in your corner’. He was an elder statesman of our profession whose advice and counsel was regularly sought by doctors of all disciplines and ages. Stephen was passionate about bettering work conditions for his fellow doctors. He served on AMA Queensland Council for five years, served as Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) Vice President for four years and championed doctors’ rights as President from 2014.

Dr Justin Hundloe Dr Chris Davis first met Dr Morrison in Cape Town in the 1980s and said “Stephen’s legacy will include the tremendous positive enthusiasm he demonstrated in all his activities as well as his integrity, ethics and respect for others. To his enormous credit, whilst greatly challenged by his protracted and difficult illness over the last few years, Stephen demonstrated great courage and resilience whilst continuing to provide his expertise and support to others.

“Stephen will long be remembered by his colleagues and friends as a kind, thoughtful, wise, generous and considerate gentleman of the highest standing. In his passing, we have lost the pleasure and benefit of his friendship and collegiality, but what he has shown and given us will always be treasured and remembered.”

Dr Chris Davis

OBITUARY

Dr Charles Roe AM M B B S F R A C S FA M A

14 February 1919 – 15 January 2019 Member for 77 years AMA Queensland Past President 1964 Emeritus Vice President Dr Charles Roe AM came from a long line of doctors and was proud to leave a line of doctors as well: all three daughters, Dr Dorothy Steindl, Dr Frances Jenkins and Dr Esther Richard, all became medical practitioners, as well as his granddaughter Dr Esther Jenkins. Dr Steindl was kind enough to add to Dr Roe’s obituary for Doctor Q. “Dad was an amazing man in many ways. In his long life, he had many interests and achievements. He did well and enjoyed his years at Brisbane Grammar School, then completed his medical degree (in 1942), early because of the war,” said Dr Steindl.

Dr Roe completed his residency at the Brisbane General Hospital before working as an urologist at the Mater Misericordiae Hospitals for 29 years, then as relieving urologist until 1992. He was Chairman of the Mater Hospitals Visiting Staff and taught at the University of Queensland and Bond University.

“He joined the RAAF, and after marrying our mother Esther Wilson who had also graduated in medicine, was sent to New Guinea as a Medical Officer. He was mentioned in despatches, and in later years recalled a great camaraderie and many stories, though when we were young he rarely spoke of it.

Dr Roe was a Medical Officer in World War II for the No 76 Fighter Squadron, the South West Pacific Area and Senior Medical Officer for the Royal Australian Air Force (RAAF) Amberley Base. He continued to serve in the RAAF Reserve as Deputy Principal Medical Officer from 1947-1958 (Wing Commander). He was a consultant

urologist and venereologist for the RAAF from 1947 – 1980.

He wrote an account about RAAF pilot Jim Harrison, who was shot down in the South West Pacific Area called A Gremlin, a Kittyhawk and a Hungry Crocodile.

“After the war, the family settled in Yeronga. Dad started a general practice from home, as well as a urological practice on Wickham Terrace and the Mater Hospital, as you could in those days. He was awarded a Fellowship at the Royal Australasian College of Surgeons in 1977 in recognition of his work.

Dr Roe believed that physical and mental fitness would reward him with good health – a point that’s hard to argue when he lived to be one month short of 100! He excelled in veteran tennis as a finalist in the 80+ years Australian championships.

“He was very interested in medico political work as well, serving on the Queensland Branch AMA Council for years, and as President for a year. He was awarded an Order of Australia medal in 2011 for his services to medicine.

“All my life he loved to exercise, running every morning and playing tennis once or twice a week. Of course after he retired, he loved the Veterans Tennis, and enjoyed many overseas trips, becoming World Champion in his age division. I think he played until he was 95.

Dr Roe served on AMA Queensland Council from 1953 – 1972 and chaired various committees in that time. He was also the Queensland representative on AMA Council from 1959-1966. He was appointed an Emeritus Vice President in 1978. He was named as Fellow of the Australian Medical Association and was a member of the state executive of the Medical Benefits Fund of Australia for many years.

Dr Roe also served on the State Medical Planning Committee, the Mental Health Tribunal (1975 – 1989) and the Medical Assessment Tribunal (1975-1989). He was a Designated Aviation Medical Examiner (DAME) for the Civil Aviation Safety Authority (CASA) from 1946-2003, as well as a member of the Urological Society of Australasia from 1948-1996.

“He read widely, loved the old Greek plays and was interested in anything from thriller to biography to philosophical ideas. He enjoyed classical music; when I was young it was Brahms, but once he found Mozart, that was it, even to the point of presenting a program of his own records called Quaint Little Wolfgang in the early days of 4MBS. “He was very happy that he could spend the last 25 years of his life living on South Stradbroke Island, mostly on his own. He loved it all his life: fishing, swimming and surfing, running and walking on the beach, the bird life and the bush.”

Doctor Q Winter 37

Events calendar

Celebrating medicine in Queensland

#PPMLC2019

Dinner for the Profession

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

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

HITTING THE MARK

I N P R I VAT E P R ACT I C E

DINNER FOR THE PROFESSION

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

Date: Friday 26 July Location: Victoria Park Golf Club

Date: Friday 30 - Saturday 31 August Location: Royal International Convention Centre

AMA Queensland proudly presents a stylish evening exclusive to the medical profession to celebrate the incredible work of doctors throughout Queensland. This special gala evening will be enjoyed over a three-course dinner and includes awards of distinction and networking with friends old and new.

Whether you are starting out or already working in a practice, this two-day program will help you to reach and exceed your targets for patient care, growth, compliance and risk management. The program offers MBS updates by leading departmental speakers; case study-driven agendas focussed on current issues; and streams for specialists, general practitioners and practice managers.

#AMAQWIM19

AMA QUEENSLAND ANNUAL CONFERENCE

Looking after yourself

MIND, BODY AND SPIRIT

AMA QUEENSLAND ANNUAL CONFERENCE

WOMEN IN MEDICINE CONFERENCE

Date: Sunday 22 - Saturday 28 September Location: Edinburgh, Scotland

Date: Thursday 17 October Location: Victoria Park Golf Club

Hear from world leaders in medicine, network with colleagues and develop presentation and research skills at the 2019 AMA Queensland Annual Conference. Themed Global trends in health care delivery, this year’s program features a number of keynote presenters, including high-profile British, Scottish and Australian speakers.

MC’d by ABC Health Reporter Sophie Scott, our panellists Dr Anne Malatt (To Medicine with Love) and Dr Yumiko Kadota, (Mind Body Miko) will share their candid insights, experiences and tips for navigating the journey of life (and medicine’s) ups and downs. Take the time out to relax, recharge and laugh with friends over a healthy plated breakfast with a view of Brisbane’s beautiful skyline.

38 Doctor Q Winter

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 June 31 July 20 August (AGM) 18 September 29 October 29 November

Sunshine Coast Local Medical Association (SCLMA) Contact: Jo Bourke, Secretariat Web: www.sclma.com.au Email: jobo@squirrel.com.au Phone: (07) 5479 3979 Meetings: 27 June 25 July 29 August 19 September 31 October 28 November

Gold Coast Medical Association (GCMA) Contact: Professor Philip Morris Web: www.gcma.org.au Email: info@gcma.org.au Phone: (07) 5531 4838

Dr Bill Boyd 0419 676 660

Ipswich & West Moreton Medical Association (IWMMA) Contact:

Dr David Morgan, President: Dr Aletia Johnson, Meetings Convenor; Dr Thomas McEniery, Treasurer Phone: (07) 3281 1177 Meetings: 15 August 17 October 12 December

Toowoomba and Darling Downs Local Medical Association (TDDLMA) Contact:

Dr Mark Wyche, President; Dr Peter Schindler, Treasurer Web: www.tddlma.org.au Email: info@tddlma.org.au Phone: (07) 4633 1939 Wilston Medical Centre (Dr Peter Hopson)

Cairns Local Medical Association (CLMA) Contact: Phone:

Dr David Shepherd (07) 4031 8400

Brisbane Local Medical Association (BLMA)

Central Queensland Local Medical Association (CQLMA)

Contact:

Contact: Phone:

Dr Robert (Bob) Brown, President Phone: (07) 3121 4029 Meetings: 13 August 8 October 10 December (TBC)

Dr Michael Donohue 0419 715 658

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

CANâ&#x20AC;&#x2122;T FIND YOUR LOCAL AREA?

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

Doctor Q Winter 39

WWW.MBAQ.ORG.AU FINANCIAL ASSISTANCE FOR DOCTORS

THE MEDICAL BENEVOLENT ASSOCIATION OF QUEENSLAND WOULD LIKE TO APPEAL FOR YOUR SUPPORT.

A Medical practitioner could experience adversity at any stage in life...

MBAQ Can Help kindness ain for the tact and ag u yo k an th to ed “I want equently able to met with. I was subs my application was ships. Thank and pass two fellow n re ild ch o tw y m t suppor u do.” you for the work yo the team at ess my gratitude to pr ex ot nn ca I h ug “Tho y endeavour to rs in words, it is m MBAQ and its dono a huge difference at MBAQ has made th e ag ess m e th ad spre rous and also tance was very gene in our lives. The assis The Bible here ristian, but I quote Ch a t no am I . ely tim MBAQ.” ”...best exemplified by “Ask and it is given

This charitable association is run for the benefit of medical practitioners in Queensland and their dependents in times of need. We respond to applications from members of the medical profession who are in financial distress due to illness, injury and various other reasons. Adversity, financial stress and loss of income can happen at any time. Many of our colleagues have numerous financial commitments and when these commitments continue in the face of an unexpected event it may lead to a financial setback. Periods of absence from work due to illness, changes in personal circumstances may cause financial stress. Insurance payments are often available, but MBAQ might be able to provide short-term financial relief. Your continued support of this charitable organization is vital and greatly appreciated.

Yours sincerely

Dr Bob Brown

Donations - Please complete the following details: Name: Address:

Email:

Phone: Direct Deposit

Credit Card Visa

Mastercard

AMEX

Amount $ Medical Benevolent Association of Qld

Amount $

BSB: 034 034

Account no: 21 8871

Card No: Expiry date:

/

Cardholder’s name:

Signature:

CCV:

Cheque Amount $ Payable to MBAQ

Donate online at www.mbaq. org.au/support/#donate

Please return this form to:

Attn: MBAQ, Po Box 123, Red Hill QLD 4059 Fax: (07) 3856 4727

You can also donate via phone by calling AMA Queensland on (07) 3872 2222

Donations to the Association are tax-deductible and receipts will be issued.

AMA QUEENSLAND ANNUAL CONFERENCE 2019

Global trends in health care delivery S U N 22 - S AT 28 S E P T E M B E R 2019

SPEAKERS George Brandis, Australian High Commissioner to the UK Hear from world leaders in medicine, network with colleagues, and develop presentation and research skills at the 2019 AMA Queensland Annual Conference.

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

In an exciting and unique location, sessions will cover a range of medical leadership and clinical topics, including:

Dr Sunil Lakhani, Executive Director Research, Head, Breast Pathology Group, UQCCR Dr Chris Zappala, Specialist, Respiratory Medicine, Brisbane Dr Catherine Calderwood, Chief Medical Officer, Scotland Dr Andrew Jeremijenko, Occupational Medicine Specialist, Brisbane

generational trends and changing needs;

healthy health practitioners doctors health and wellbeing;

Dr Elizabeth Ireland, Chair of National Services Scotland

genetics/genomics and immunology;

innovations in sustainability in health care;

Dr Tony Brown, GP, Thursday Island

foetal and maternal medicine;

new trends in respiratory medicine; and

Dr Sarah Coll, Orthopaedic Specialist, Cairns

the future of forensic medicine.

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

end of life care and voluntary assisted dying;

Dr Ruth Stewart, GP, Thursday Island

Dr Anthea Woodcock, Forensic Medicine Specialist, Brisbane Colleen Sullivan OAM, Healthcare Practice Consultant, Brisbane Professor James Garden CBE, Regius Professor of Clinical Surgery University of Edinburgh Jill Vickerman, Director, British Medical Association Scotland

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

Doctor Q Winter 41

MEET THE SPEAKER

Women in Medicine D R YU M I KO KA D OTA

FOUNDER, MIND BODY MIKO “I never thought I would say this, but I broke. I give up. I am done. I surrender. I am handing back my dream of becoming a surgeon. I have nothing left to give. I don’t want it anymore. I’ve lost my ambition. I’ve lost my spark.

“I started 2018 with optimism and zest. This year would be my year. I would apply for the advanced training program for plastic and reconstructive surgery. I’ve done the hard yards, I’m good at what I do, and I have the right intentions… Fast forward to October and I find myself in a hospital bed, barely able to speak or move. If I wasn’t so resilient, maybe I wouldn’t have put up with the abuse for as long as I did. But I did. And all I can do now is focus on what I can do now to get myself back to my former, bouncy self.”

At the beginning of 2019, Dr Yumiko Kadota wrote a blog post called The ugly side of becoming a surgeon. The post told the story about a neurosurgeon reprimanding a registrar and stomping on her foot and breaking it. It detailed some creepy sexual harassment. As if that was not bad enough, Dr Kadota then detailed her experience being on call for 10 days a fortnight, as well as being forced to cover some of the on-call rosters for a different department. At the end of her first month, she had done more than 100 hours of overtime. Any complaints were met with buck passing and comments like “I remember doing those sorts of hours when I was your age. It’s good for you”.

On 1 June 2018, Dr Kadota resigned. She was on her 24th consecutive day of work, 19 of which were 24-hour on-call days.

She crashed her car on the way home. The head of department rang to urge her to finish her term. When she said no, they answered “You’re good at what you do…but if you can’t handle the hours, maybe this isn’t for you”.

We spoke to Dr Kadota ahead of her appearance at this year’s Women in Medicine Breakfast.

1 . H O W W O U L D Y O U EXPLAIN THE REACTION TO Y O U R B L O G P O S T, T H E U G LY S I D E OF BECOMING A SURGEON? The reaction to my blog post was an unexpected one. I had initially written it for myself, as a chance to reflect on what happened so that I could move on. It was quickly shared around the world, and has been read by nearly 200,000 people since it was first posted. It has been read by people around Australia, the US, UK, and as far as Colombia. Those who read the post resonated with the story, which highlights what global issues burnout and exploitation of junior doctors are in the medical profession.

2 . H O W D O Y O U W I S H YOUR EXPERIENCE HAD BEEN DIFFERENT? My experience should never have happened. My roster did not share the workload evenly between myself and the other registrars, and it soon affected both my physical and mental health.

I raised concerns about how it was affecting my ability to function at work. My concerns should have been taken seriously by the hospital, as it potentially could have put patients at risk.

3 . W H A T H A S A I D E D YOUR RECOVERY FROM THIS EXPERIENCE? I am still recovering, but the process has been helped by the support of my treating team, family, friends, and yoga.

W W W.M INDB O DY M I KO.COM/THE- UGLY-SIDE- OF- BECOMING- A-SURG E O N / 42 Doctor Q Winter

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

#AMAQWIM19 @AMA_QLD

f el s r ou y er t f a Looking

MIND, BODY AND SPIRIT THURSDAY 17 OCTOBER V I C T O R I A PA R K , H E R S T O N R O A D , H E R S T O N 7AM - 9AM

Yoga session

6am - 7am

Registeronline

W W W. A M AQ . CO M . AU E A R LY- B I R D R AT E S NOW AVAILABLE

MEET THE SPEAKER

Private Practice and Medico-Legal Conference

PROFESSOR

Professor Julie Quinlivan is the Director of the Professional Services Review (PSR), the agency responsible for reviewing and examining possible inappropriate practice by practitioners when they provide Medicare services or prescribe government subsidised medicines under the Pharmaceutical Benefits Scheme.

Professor Quinlivan will be speaking at our Private Practice and Medico-Legal Conference in August.

W H AT M AT T E R S A R E REFERRED TO THE PSR? Most practitioners will have no contact from Medicare or PSR during their career. However, 20 per cent of practitioners will receive an awareness-raising letter as a result of a special initiative by the Health Department. For example, in 2018 it was decided to issue awareness raising letters in regards to the prescription of schedule four and eight medications.

Approximately 10 per cent of practitioners may be audited. In an audit a practitioner is asked to check they have records to support billed services.

A further five per cent of practitioners may be enrolled in the Practitioner Review Program. These practitioners are identified by the Health Department either: by a complaint by a patient, another doctor or staff member lodged with the Medicare Hotline; or by a statistical analysis of their billing or prescribing demonstrating they are outliers.

The Health Department contacts these practitioners to ask for an explanation.

The explanation may satisfy the concern. If the Health Department has a persisting concern, it will refer the practitioner to the PSR. 44 Doctor Q Winter

Common items referred under the MBS are consultation items, chronic disease management items, health assessments and mental health items. Common items referred under the PBS are prescribing of antibiotics, schedule four and eight medications and expensive medications.

Providing a high volume of services, for example more than 80 services a day for more than 20 days, is also a concern.

HOW DOES THE PSR DETERMINE PRACTICE IS I N A P P R O P R I AT E ?

Inappropriate practice is defined as conduct in connection with rendering or initiating services that a committee of peers could reasonably conclude would be unacceptable to the general body of practitioners in the practitionerâ&#x20AC;&#x2122;s profession or specialty (section 82, Health Insurance Act 1973).

Many factors may lead to a finding of inappropriate practice. They include:

poor clinical outcomes; prescribing concerns; billing behaviour; or inappropriate delegation of tasks.

A finding of inappropriate practice is either a voluntary admission by a practitioner after a Directorâ&#x20AC;&#x2122;s review or else is made by a committee of peers who review a random sample of medical records.

W H AT I S T H E P U R P O S E OF THE MBS REVIEW? The MBS Review was established in 2015 to update over 5,700 MBS items that provide patient benefits for consultations, diagnostic tests and operations. The review has involved over 70 Clinical Committees to provide expert advice in each domain of clinical practice. More than 700 clinicians, consumers and health system experts participated in the committees.

absent or non-contemporaneous records;

HOW DO I AVOID BEING REFERRED TO THE PSR?

a lack of clinical indication for the service;

The single commonest failing of practitioners reviewed by the PSR is poor or absent medical documentation. Practitioners need to keep records that support items billed or prescribed and with sufficient detail that another practitioner can safely assume patient care.

poor record-keeping; inadequate consent; poor clinical input; inappropriate co-billing of other items not separately supported by the clinical record;

Practitioners should also adopt a healthy work-life balance.

#PPMLC2019

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

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

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

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

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

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

Q W W W. A M A

.COM.AU

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

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

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

Doctor Q Winter 45

Protecting you against a sticky situation Over the past year and a half, my wife and I have been trying for a child and have moved down the path of IVF. Aside from juggling the variety of pills, blood tests and supplements that the process entails, before the egg collection process there are a series of injections that are administered at home.

As my wife did not want to inject herself, she let me do the honours and (as a first-time needle giver) I was rather nervous. I did my best to compose myself before pinching the fat around the abdomen, taking aim and inserting the needle in a fast, deliberate and (hopefully) painless manner.

The focus I had during this process was laser-like, and over the proceeding days, my confidence grew. This resulted in more competent and faster administration. By the final days, I could do this in my sleep. After every administration, I would insert the cap over the disposable needle tip by pushing it against the wall away from me, then removing the head and dropping it in the sharps bin provided.

On my second last injection, I skipped putting it against the wall and, in my haste to put the cap on, just missed stabbing my fingertip with the needle.

If my near miss (as a result of my overconfidence and haste) occurred after only 10 days, imagine the number of near misses (and sometimes worse) that occur for a doctor over a 30year career. In some cases, with a patient who had presented with an undisclosed illness.

Data indicates that at least 18,000 Australian healthcare professionals suffer from a needle stick injury every year, with 80 per cent of the cases involving a contaminated needle.

Reputable insurance providers will offer needle stick cover, which can be added as a lump sum benefit and can be attached to your personally held Life cover, Total and Permanent Disability, Income Protection or Trauma (Critical Illness) covers. Sums can start from as low as $50,000 and can go as high as $1,000,000. This cover will allow you to claim if you contract occupationally-acquired HIV, Hepatitis B and Hepatitis C resulting from any

J O N PA P I N C Z A K

Financial Advisor, Medical & General Risk Solutions P: (07) 3117 2470 E: jon@mgrs.com.au

46 Doctor Q Winter

kind of ‘sharps’ accident, as well as ‘splash back’ and ‘inhalation’ of blood incidents (such as during surgery).

A common misconception is that your existing superannuation cover will include this as a benefit.

Superannuation laws preclude such a cover being held within the superannuation environment. The cover that most people refer to is Total and Permanent Disability which is generally held as a default within superannuation. In order to receive a pay-out for the above listed illnesses, the disease will need to weaken your body to the point where you could no longer work at all and are unlikely to ever return and is not payable merely on diagnosis of the condition.

While I am positive that you are more attentive, composed and skilled than I was when handling sharps with my wife, the volume of needles administered by medical professionals makes this form of cover a must and should be included as a part of any personal protection package that you put in place.

Authorised Representative No.434578 Disclaimer: For general insurances, Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No. 240549, ABN 15 003 886 687.

Authorised Representative No 436893. Life and Personal Risk Insurance services are provided by Stonehouse Financial Services Pty Ltd, Australian Financial Services Licence No. 292469, ABN 81 112 548 419. The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.

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

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

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

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

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

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

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

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

www.mgrs.com.au

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

Doctor Q Autumn 47

Three reasons why you can’t fill that job There is nothing more stressful than a position you can’t seem to fill. Sometimes making a few changes can slightly (or in some cases drastically) increase the applicant pool. There are three main reasons why roles go unfilled and all of these can be easily overcome.

SAMANTHA MIKLOS CEO, Cornerstone Medical Recruitment

1 2 3 YOU’VE OFFERED THE WRONG PA C K A G E

YOUR SELECTION CRITERIA IS TOO LIMITING

YOUR RECRUITMENT PROCESS IS TOO SLOW

One of the most common reasons vacancies remain unfilled is because the package doesn’t match the requirements of the job. However, it’s important to recognise that the package is so much more than the annual salary. Of course, it’s important to get the salary right, but many healthcare candidates report that work-life balance is more important to them than money. Work-life balance for these candidates includes flexible work arrangements; part time work; ability to purchase extra annual leave or take unpaid leave; and compensation for overtime.

In candidate short markets, sometimes the ideal candidate just isn’t available.

But this doesn’t mean the perfect applicant isn’t out there - they just might not be what you were originally looking for. Can you be more flexible with your selection criteria? Do they really need that much previous experience? Do you have the resources to support a less experienced applicant or even a graduate? Could you change any part of the job description?

Could you upskill an existing staff member and recruit a more junior applicant? While criteria are important, sometimes being too specific can limit your applicant pool. You may be scaring off great candidates, who don’t meet all the criteria but could add value in many other ways.

Great candidates are snapped up quickly and they often have multiple opportunities to consider.

If your recruitment process is time consuming and sluggish, you will lose applicants. It is imperative that you build momentum and enthusiasm with new applicants as soon as they apply. Phone them and thank them for their application. Inform them of your recruitment process and the relevant timeframes, then be sure to stick to those timeframes. Many candidates see a clunky, time consuming recruitment process as a sign of sluggish internal processes.

If you can’t offer that flexibility, there are lots of other ways to make the package more attractive: initial accommodation; long-term/subsidised accommodation; relocation allowance; a rental car; study leave; professional development allowance; bonus or incentive schemes; and a day off on your birthday.

48 Doctor Q Winter

If a vacant position is starting to negatively impact you, your team or your community, it might be time to consider where you can make a few changes. The worst case is you get no extra applicants. The best case is you find a candidate who exceeds your expectations. Whatever the case, don’t let a lack of flexibility or an attitude that “this is the way it has always been done” hold you back. Otherwise you will find you are spending more time dusting the empty chairs around you, than watching your team grow.

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How to manage superannuation contribution caps The constant changing of the contribution caps means individuals need to be diligent about how much they can contribute to superannuation in a year.

TERRI BRADFORD National Manager, Wealth Management

CONCESSIONAL CONTRIBUTION LIMITS $25, 000 pa per person (indexed)

NON-CONCESSIONAL CONTRIBUTION LIMITS Up to age 65

From age 65#

$100,000 pa per person, or up to $300,000 averaged over a three-year period $100,000 pa per person (three-year averaging not available)

#if age 65 or over, individual must meet a work test

CONCESSIONAL CONTRIBUTIONS Employer SG contributions (SGC), salary sacrifice contributions, personal deductible contributions, and contributions made by a third party (not a spouse), all count as concessional contributions.

Did you know?

If you exceed the concessional

contribution cap the excess amount is included in your assessable income and taxed at marginal tax rates plus an interest charge.

You can choose to retain the excess amount in your super account or have it refunded. If the amount is retained in super it will count towards the non-concessional cap.

Regardless of your choice the excess plus the interest charge will still be included in your assessable income.

From 1 July 2017, individuals

can claim a tax deduction on personal contributions regardless of employment status. This may be preferable to a salary sacrificing arrangement with your employer.

Consider: Expecting a salary or wage increase during the financial year? If you are sacrificing wages into super you 50 Doctor Q Winter

will need to take any SGC increase into account when working out how much to sacrifice during the year.

Changing jobs during the financial year? Have you considered total contributions received from all employers for that financial year?

The contribution caps apply on a per person arrangement, not per employer arrangement.

Are you expecting to receive any

bonus during the financial year? If yes, you may be able to contribute the bonus into super and claim a tax deduction. Consider what other concessional contributions have been made to ensure you donâ&#x20AC;&#x2122;t go over your concessional contribution cap.

Are you self-employed and expecting to retire shortly? If yes, have you made your election to claim personal contributions as a tax deduction before you commence a retirement pension from your super fund?

NON-CONCESSIONAL CONTRIBUTIONS Excess concessional contributions, personal, non-deductible contributions (overseas super fund transfers that are not part of the growth component), contributions made by your spouse on your behalf, and contributions made to a constitutionally protected fund and

Important Information: The information in this article is of a general nature.

It does not take into consideration any personal or individual goals, needs or circumstances. You should seek professional advice before acting on this information to make sure the strategies meet your individual circumstances.

are not taxed in the fund, all count as non concessional contributions.

How does the averaging principle work?

A person who is under age 65 can bring forward 3 years of nonconcessional contributions in 1 year, effectively allowing a total of $300,000 (or future indexed amount), and managed over three financial years without exceeding the cap.

MAXIMISING THE THREE YEAR BRINGFORWARD RULE BEFORE RETIREMENT Bruce and Margie are both 63 years old and each has less than $1.4 million in total in super. How can they maximise non-concessional contributions to super before they retire at age 65?

Margie can contribute an extra $100,000 due to the fact that at age 64 she can still use the three-year provisions. Depending on Margieâ&#x20AC;&#x2122;s actual birthday she could contribute a total of $300,000 in the year she turns 65 even if she has turned 65 at the time of making contributions, as long as her super balance was less than $1.4 million on 30 June of the previous year. Any contributions made after her 65th birthday means Margie will have to meet the work test first. There is a proposal to remove the work test for 65 and 66 year olds but this has not yet been legislated.

The trouble with testimonials A chiropractor was found to have used false and misleading advertising about being able to cure cancer and to have used testimonials in website advertising. He was given a criminal conviction, fined $29,500 and deregistered for two years. Although the claims about curing cancer were more serious than the use of testimonials, the findings in one of the hearings1 included the following: The two testimonial offences demonstrate that the practitioner took no steps to stay up-todate with current professional laws and standards on advertising, and failed to understand why such material may be dangerously misleading to patients.

THE L AW Section 133(1)(c) of the Health Practitioner Regulation National Law states that a person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that uses testimonials or purported testimonials about the service or business.

W H AT A R E T E S T I M O N I A L S A N D W H Y ARE THEY BANNED? A testimonial is a statement, review, view or feedback about a service. AHPRA advises2 that in the context of the National Law, a testimonial involves recommendations or positive statements about clinical aspects of a regulated health service.

Testimonials may be found under a tab or heading ‘Testimonials’ on a practice website or information brochure; in the Reviews tab on a practice’s or doctor’s Facebook page; or in comments on a practice’s or doctor’s Instagram feed.

Testimonials are banned as they can be misleading, and one person’s outcome may not be relevant to others. They are not objective or scientific and patients cannot assess their validity.

WHICH TESTIMONIALS AM I RESPONSIBLE FOR? You are responsible for reviews or testimonials which appear in advertising that you control – e.g. if you are the practice owner, you control your practice’s Facebook page.

You are not responsible for removing (or trying to have removed) testimonials published on a website or in social media over which you do not have control, e.g. ratemds.com.

However, a breach of the National Law may occur if you use such a review to advertise, respond to the review or re-publish it on your website.

You are not required to try and remove Google reviews.

However, if you respond to a Google review, this could be considered a testimonial if, for example, the response includes clinical aspects of care.

52 Doctor Q Winter

KAREN STEPHENS Risk Adviser, MDA National

W H AT R E V I E W S A R E A L L O W E D , A N D C A N I EDIT REVIEWS? AHPRA’s testimonial tool2 helps advertisers understand which reviews can and can’t be published. You can’t refer to clinical aspects, e.g. symptoms, diagnosis, treatment, outcome, or the skills or experience of the practitioner.

Recent publicity about HealthEngine3 altering negative patient reviews and publishing them as “positive customer feedback” led AHPRA to issue guidance4 that selectively editing reviews or testimonials may break the law.

W H AT I F M Y A D V E R T I S I N G C O N T A I N S TESTIMONIALS? If AHPRA becomes aware that advertising contains testimonials, they will write to the responsible practitioner asking them to check their advertising and correct the content to comply with the National Law. Usually a practitioner is given 60 days for this, after which AHPRA may conduct an audit to see if the changes have been made.

If the audit finds the advertising still non-compliant, AHPRA can impose conditions on a doctor’s registration that restrict how and what they can advertise. Fines may also be imposed by a court, and the Medical Board can take disciplinary action.

WHY CAN’T I USE TESTIMONIALS IF MY COLLEAGUES AND COMPETITORS ARE USING THEM? This is like saying: “Why can’t I speed when other cars are speeding?”

References 1. HCCC v Limboro [2018] NSWCATOD 117 2. AHPRA. Testimonial Tool: ahpra.gov.au/Publications/Advertising-resources/Check-and-correct/ Testimonial-tool.aspx 3. The Sydney Morning Herald, 9 June 2018: smh.com.au/healthcare/very-poorgp-booking-service-healthengine-sanitises-patient-reviews-20180608-p4zkb6. html?utm_source=Pulse%2BIT+-+eNewsletters&utm_campaign=0eb9565291-Weekend_ eNews_16_06_2018&utm_medium=email&utm_term=0_b39f06f53f-0eb9565291413074869&goal=0_b39f06f53f-0eb9565291-413074869&mc_cid=0eb9565291&mc_ eid=9a72c86cdd 4. AHPRA, 13 June 2018: Selectively editing reviews or testimonials may break the law: ahpra. gov.au/News/2018-06-13-media-release.aspx?utm_source=Pulse%2BIT+-+eNewsletters&utm_ campaign=0eb9565291-Weekend_eNews_16_06_2018&utm_medium=email&utm_term=0_ b39f06f53f-0eb9565291-413074869&goal=0_b39f06f53f-0eb9565291-413074869&mc_ cid=0eb9565291&mc_eid=9a72c86cdd

J U L I E O â&#x20AC;&#x2122; R E I L LY

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

Common private practice start-up

myths

Here are our top five common myths about private practice and how they can be avoided.

1. A VERBAL AGREEMENT IS AS GOOD AS A WRITTEN ONE Verbal or undocumented agreements are contracts that have been agreed by spoken communication only. The issue with these agreements is the difficulty to prove their existence, and to prove what the agreed terms are. Without a written agreement, it is often the word of one party against another. Undocumented agreements in service arrangements can lead to issues around payroll tax, superannuation, workers compensation insurance, leave and legal liability issues.

Verbal agreements on starting or buying into a private practice can hurt both parties, and there can be serious consequences for breaching a contract. It is recommended that any agreements should be recorded in writing in a properly drafted contract, and verbal agreements should be avoided at all costs. In the event you cannot avoid entering into a verbal agreement, make sure you keep records of correspondence and file notes about what was agreed, and then send a follow up email or letter confirming the terms.

2. AS A PERSONAL SERVICES BUSINESS, I CAN SPLIT MY I N C O M E W I T H F A M I LY Personal services income (PSI) is income that is gained mainly as a reward for the personal efforts or skills of an individual. As a medical professional, the income you earn is deemed as PSI. Under law, this income must be included in your personal income tax return in the year that it has been earned. Unfortunately, this means that you do not have the option to split the income with other family members to reduce tax. A penalty of 50 percent of the tax avoided plus interest applies to illegally income splitting.

54 Doctor Q Winter

3. THE TAX OFFICE DOES NOT LET ME USE A SERVICE ENTITY FOR MY PRACTICE The Tax Office does allow the use of a service entity in medical practice arrangements. A service entity is a separate legal structure established by doctors in private practice.

To ensure the validity of the arrangement there should be signed service agreements in place between the doctors (owner and nonowner) and the service entity. The service entity can make a profit, which needs to be at commercial rates.

4. BUYING A PRACTICE IS FOOL PROOF If starting your own practice is not an option, many doctors choose to buy into an already established medical practice. Options include purchasing a general or specialist practice or purchasing a share in one. This may seem like an easier option compared to starting from the ground up, however there are still risks with this choice that should be considered.

Many doctors only look at buy-in costs and issues, however other issues such as senior doctor dominance, exit strategies, financial return and timing of payments, and value of the asset purchased should all be considered before deciding the right approach to take.

5 . I N E E D A C O M PA N Y P R A C T I C E Starting a company when you start your own private practice is not essential and can add unnecessary compliance costs.

Having a company offers you no additional protection from claims in relation to medical practice issues and does not increase your asset protection in those circumstances. The Tax Office also requires all income from the company to be paid out by the end of the financial year, therefore providing no tax benefit. You also are obliged to pay wages from the company and PAYGW on those wages, meaning you lose your tax holiday.

Having a company can also lead to payroll tax for high income earners. Additionally, you do not need a company to be able to employ your spouse â&#x20AC;&#x201C; if the circumstances are right, you are still able to do this as an individual.

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

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

Get your employment contracts reviewed

H E I N Z L E PA H E Partner, HWL Ebsworth

Recent decisions in the Fair Work Commission (FWC) have examined annualised salary provisions within some Modern Awards. These decisions provide useful commentary as to the legality of having an annualised salary clause or an â&#x20AC;&#x2DC;off-setâ&#x20AC;&#x2122; clause set out in employment contracts.

Essentially, whether the applicable Modern Award contains an annualised salary provision or not, employers are lawfully able to pay their employees an annualised salary or an over-award payment provided it is adequately clear in the employment contract.

The FWC noted in relation to annualised salaries or over-award payments, that an annualised salary allows employers an increased degree of administrative simplicity, avoiding the necessity of the keeping and calculating of precise hours of work (at least contemporaneously), while at the same time, managing regularity of cash flow and labour costs. Further, the FWC noted the benefit to employees of having the security of a fixed and certain remuneration amount each pay period which would allow for certainty in respect of budgeting and obtaining finance, regardless of the variability of work.

MICHELLE CHADBURN

Associate, Workplace Relations and Safety, HWL Ebsworth

Where a Modern Award does not have an annualised salary provision, the common law provides guidance as to what is required to be included in an employment contract to lawfully provide an annualised salary or over-award payment. In short, under an employment contract an employer and employee may agree that the salary payable, or the over-award rate, under the contract has the purpose of satisfying the obligation to pay identified award entitlements. It is important that the employment contract is clear and that it is the intention of the parties that the annualised salary or over-award payments are compensating the employee for any award entitlements.

In other words, the contract clause ought to state that it is offsetting against any award entitlements pertaining to penalty rates, loadings, overtime and so on.

The importance of having an adequately drafted annualised salary or over-award offset clause may avoid a successful underpayment of wages claim against the business. An inadequate clause may expose the business to an underpayment claim (which can be brought for a period of six years) and/or prosecution by the Fair Work Ombudsman for noncompliance with the applicable Modern Award. If prosecuted, the business may face penalties for these technical contraventions in addition to the backpayment of these underpayments.

There is of course, the option to provide an Individual Flexibility 56 Doctor Q Winter

Arrangement (IFA) which may alter overtime rates, penalty rates, allowances or annual leave loading.

However, the key differences between an annualised salary or over-award offset clause is that, the IFA: cannot be a condition of employment (it must be entered into after the employment has commenced); and may be terminated by either the employee or employee by providing 13 weeks written notice (or earlier if mutually agreed).

Therefore, an adequately dr afted annualised salary or over-award payment offset clause that is clearly set out in the employment contract, will provide more certainty for both the employer and the employee.

In order to develop an effective annualised salary or over-award payment arrangement employers will need to:

consider which award entitlements they want to roll-up and which entitlements they wish to pay separately, as and when they arise; clearly articulate this in the offset or annualised salary clause; ensure the over-award payments are sufficient to compensate the employee for the entitlements they are rolling up, and monitor this on an ongoing basis; and be aware that some award provisions may not be offset and having a system in place to ensure compliance with those clauses (for example, non-monetary entitlements such as leave provisions).

If you have concerns about award compliance and offsetting award entitlements or annualised salary arrangements, it is recommended to take immediate action and review your current documentation.

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

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

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

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

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

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

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

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

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

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

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

REFERRAL SPOTLIGHT

Multiple sclerosis Multiple sclerosis is now a highly treatable disease. A short guide for general practitioners (GPs) and primary care providers (PCPs) provides advice to help diagnose and manage patients with multiple sclerosis. Find it now at bit.ly/MSBrainhealth Early diagnosis is crucial to long-term brain health. However, symptoms of multiple sclerosis are varied and it is therefore difficult to diagnose. There is also a perception that little can be done to treat multiple sclerosis. This is not the case.

This concise guide provides advice for GPs and PCPs, including how to: 1. Identify symptoms that may indicate multiple sclerosis in a timely manner

2. Refer patients to a specialist neurologist and MS clinic

3. Follow up with patients to provide ongoing care and support

The guide is based on an evidence-based international consensus report, Brain Health: time matters in multiple sclerosis, which describes a strategy to maximise lifelong brain health and includes recommendations on how to achieve this goal.

Key points of relevance to GPs and PCPs are highlighted in the short guide.

The diagnosis, treatment and management of multiple sclerosis is changing rapidly. There are more than 12 medications available on the PBS in Australia, with more in the pipeline.

By minimising delays in diagnosis and referral to a specialist, you can help to maximize brain health and improve the lives of people with MS. It is hoped that GPs and PCPs will find this guide useful and will share the information widely. To find out more and to read the full Brain Health: time matters in multiple sclerosis report and check out other useful resources, please visit www.msbrainhealth.org.

KEY FACTS MULTIPLE SCLEROSIS Is a neurological condition affecting the central nervous system (brain, optic nerve and spinal cord) that affects more than 25,600 Australians Is the most common chronic neurological condition diagnosed in young adults Is most commonly diagnosed between the ages of 20 and 40 Affects mainly women, with three in every four diagnoses Varies significantly from person to person: for some people, it is

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a disease that comes and goes in severity with periods of unpredictable relapse and remission, while for others it means a progressive decline over time Includes a variety of symptoms such as severe pain, walking difficulties, debilitating fatigue, partial blindness and thinking and memory problems.

Is more treatable and manageable than ever before, especially with a swift diagnosis and take up of new treatment options.

How to get into your first home quickly When you’ve settled into your career and are looking to buy your first home, being unprepared can lead to frustrating delays. Scouring property listings and making time to view houses can be stressful enough, so it’s important to be aware of the pitfalls that could slow you in reaching your goal. This guide will help you navigate some of the hurdles faced by first home buyers.

SAVING FOR A DEPOSIT For many people, saving a home deposit of 20 per cent can seem like a daunting task, but it doesn’t have to be.

Working out a budget and establishing a savings account is a good start. A 20 per cent deposit will likely be upwards of $100,000 if you’re looking to buy in a capital city, so it helps to figure out weekly or monthly savings targets.

BEWARE LENDERS MORTGAGE INSURANCE While many lenders will loan you 90-95 per cent of the purchase price, it’s worth remembering you may have the additional cost of Lenders Mortgage Insurance (LMI)—a oneoff fee to guarantee against default.

Look for a bank that will lend you a large percentage of the purchase price, but doesn’t necessarily insist on LMI. You should also speak with your bank to find out what types of savings accounts are available, as well as what term deposits are on offer. Term deposits typically have better interest rates than standard banking accounts which can help you reach your home loan deposit faster.

GETTING LOAN APPROVAL Getting pre-loan approval is also a great way of speeding up the finance process once you’ve signed the contract of sale.

An approval letter also shows sellers and real estate agents you’re a serious bidder.

Before applying for a home loan, it’s important you estimate your borrowing capacity correctly. Using a home loan calculator will help you work out what fortnightly or monthly loan repayments may be.

JEFF MILLER Specialist State Manager QLD, BOQ Specialist

Disclaimer Products and services are provided

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

Lenders will assess your loan application on your ability to meet those mortgage repayments based on your income, as well as a judgement of your savings record, debt and expenses.

OVERLOOKED COSTS AND TIME-WASTERS On top of your home loan deposit, it’s important to be aware there are a number of other costs you’ll incur before you set foot in your home.

Stamp duty is a tax levied when you buy a property. Its cost can vary from state to state, but it’s not a small change, so you need to be aware of it when you apply for your home loan. You can use BOQ Specialist’s stamp duty calculator at www.boqspecialist.com.au/expertise/stamp-duty-calculator.

Getting a building and pest inspection could save you from unfortunate and costly surprises down the track. It could also help you negotiate a better purchase price.

LOOK OUT FOR FINANCIAL SPEED BUMPS There are a host of legal speed bumps that can slow the settlement process and using a conveyancer or solicitor will save you time transferring the legal title, arranging the mortgage and other related documents.

If you’re buying at auction, remember there is no cooling off period, so if you’re the highest bidder when the gavel comes down, you’re bound to go through with the sale. It’s important you have a solicitor or conveyancer look at the contract of sale before bidding starts.

Doctor Q Winter 59

AMA Queensland Foundation supporting victims of the Far North Queensland floods The AMA Queensland Foundation Board has pledged $25,000 to help those seriously affected by the Far North Queensland Flood in 2019. Four months on from the floods, the physical and emotional devastation of the community is still evident.

Harrowing stories continue to emerge from people who have lost everything in this 1 in 500-year event. Full time medical student Rheannon Griffin was given a flood assistance grant from the AMA Queensland Foundation, and this has assisted in easing the financial pressure of refurbishing her home while she studies full-time.

Lisa Davenport also lost a lot of her belongings in the Townsville floods including her medical textbooks she needs to study medicine at James Cook University. Lisa was granted an AMA Queensland Foundation flood assistance grant, and said, “I really do appreciate the support of the AMA Queensland Foundation. The funding will be used to purchase text books and replace items lost during the floods.”

Lisa Davenport

Rheannon Griffin

My daughter and I were evacuated from our home due to the flood…when we returned it was filled with thick mud and sewerage. The clean-up was a very long process that caused a huge amount of emotional and financial stress. The walls in the house will be removed within the next month to eliminate the mould. During this time, we will need to find alternate accommodation again. Thank you AMA Queensland Foundation for the Far North Queensland Flood Assistance Grant. We are very grateful for the assistance this grant brings.

Our end of financial year appeal this year focuses on supporting those families devastated by the floods.

We urge you to make a tax deductible donation to the AMA Queensland Foundation to support us with this cause.

WHO T N IE T A P A W DO YOU KNO ISTANCE? S S A L IA C N A NEEDS FIN We are calling on our members in Far North Queensland to help identify patients who suffered significant hardship as a result of the floods. Please visit our website to obtain an application form and nominate a patient in need - www.amaqfoundation.com.au 60 Doctor Q Winter

DONATE ONLINE AT www.amaqfoundation.com.au

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PLEASE RETURN TO: AMA Queensland Foundation PO Box 123, Red Hill Q 4059

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Thank you for your support!

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Doctor Q Winter 61

Take a hike Today we are incredibly fortunate to be able to hike in some of the world’s most fascinating destinations on organised treks and in a very comfortable fashion. It’s the perfect way to enjoy the walk and take in the incredible scenery without the worries of carrying your gear, where to sleep, where to eat and getting lost. You don’t have to be an athlete or a clone of Sir Edmund Hillary to enjoy these fantastic walks. Sure, some trails may require you to have a higher level of fitness, but you’d be surprised to know that most can be done with a reasonable level of fitness and without any mountaineering skills.

Here are some of our favourites:

SCOTTISH HIGHLANDS

INCA TRAIL - PERU

Take a trek through the Scottish Highlands where red deer and wildcats roam. Experience the thriving fishing industries, pretty villages and tight-knit coastal communities of the north-east coast or the remote, sickle-shaped beaches of the Outer Hebrides. Pull on your boots and walk alongside the tranquil waters of an inland loch to an isolated bothy or climb beside the tumbling falls of a wild mountain river.

A great option when you are in Edinburgh for the AMA Queensland conference in September.

The Inca Trail is an 82km hiking trail linking the legendary Machu Picchu to the Sacred Valley. It is by far the most famous trek in South America and rated by many to be in the top five treks in the world, taking an average of four days to complete. The trek combines beautiful mountain scenery, lush cloud-forest, subtropical jungle and of course, a stunning mix of Inca paving stone ruins and tunnels.

N E PA L Nepal is renowned for its picturesque mountains, especially the mighty Mount Everest – the world’s tallest peak. However, there is so much more to discover with some of the most unique teahouses, monasteries and friendly locals in the world. The best way to explore this country is on your own two feet!

MOUNT KILIMANJARO BORDERING TANZ ANI A AND KENJA Kilimanjaro is the highest mountain in Africa and the tallest free-standing mountain in the world. At 5,896m it can certainly seem imposing - but to climb Mt Kili you don’t need any mountaineering skills - you just have to be of a reasonable fitness level. It is said that to climb Mt Kilimanjaro is the ultimate adrenalin rush and the greatest adventure.

KOKODA TRACK PA P U A N E W G U I N E A The Kokoda Track or Trail is a single-file foot thoroughfare that runs 96km through the Owen Stanley Range in Papua New Guinea. The track was the location of the 1942 World War II battle between Japanese and Allied – primarily Australian – forces in what was then the Australian Territory of Papua. This is the track of legends. It’s among the hardest challenges you may face, but with adequate training and preparation, it will provide an adventure of a lifetime, and finishing it will leave you with an incredible sense of accomplishment.

Looking for something a little close to home? Check out the Routeburn and Hollyford treks in New Zealand, or Tasmania’s Bay of Fires and Maria Island walks.

AMA Queensland Orbit World Travel er: vid pro preferred travel 5 P: 1300 262 88 m.au E: travel@amaq.co l.com.au www.orbitworldtrave

62 Doctor Q Winter

after Medicine hours Whenever somebody asks me what the best thing about working as a home doctor is, it’s hard to choose just one thing. How can I explain the rewarding nature of the job? The interesting clinical side, the rewarding yet challenging presentations of acute conditions and incredible flexibility to enjoy my lifestyle coupled with exceptional financial rewards!

I have worked in the after-hours space for 27 years and the diversity of patients and their symptoms on a daily basis is one of the most enjoyable aspects of the job. The variety and thrill of not knowing what will come from each home visit is an exciting part. It provides the opportunity to work on

weeknights and weekends, when GP practices are closed, treating patients at home for a myriad of acute, episodic illnesses. Illnesses that, while not lifethreatening, require medical attention.

With flexible rosters that suit any lifestyle, there is fantastic earning potential while still having time during the day for study, for family or other commitments. 13SICK National Home Doctor is supported by a national call centre that triages patients as well as a user-friendly mobile phone application and clinical platform.

DR UMBERTO RUSSO Chief Medical Officer, 24/7 Healthcare I like that afterhours care provides flexibility for patients too. Parents who are worried about their child’s high fever or earache; or carers who want a doctor to check their elderly parent after a fall, the service is invaluable to them and it’s so fulfilling to be a part of.

Doctor Q Winter 63

RESTAURANT REVIEW

Entertaining made easy with Gathar Love to host dinner parties but hate all the effort required? Wish you could spend more time with your guests and less time washing up?

In the current market of the shared economy, we are no longer afraid to let people give us a lift to work (Uber), deliver our take away (UberEats), complete odd jobs for us (Airtasker) and even rent out our own homes (AirBnB). The latest service to hit the market connects you with local culinarians to create a dinner party experience that will linger in the memory long after the last glass of champagne has been swilled.

Gathar is an exciting new service that pairs local chefs, cooks and bakers with people wanting a unique and exciting way to cater their next dinner party. After resounding success in Cairns, Port Douglas and the Tablelands, the service has gone south for the season and undertook their Brisbane launch in early May, with the Sunshine Coast and Gold Coast soon to follow.

The idea is remarkably simple but rather genius – you simply log onto their website, choose a set menu uploaded to the site by a local culinarian, choose a date, invite your friends and be prepared to be amazed as your own personal chef cooks your chosen menu for you and your guests in your own kitchen (whether that be

64 Doctor Q Winter

your own home, your holiday house, an AirBnB or the office!).

The set menus range from grazing platters for small groups to 10 course degustation, with prices to suit a variety of budgets. The culinarians range from professional chefs and restaurant cooks, to familiar faces from cooking reality TV shows, to talented multi-national home foodies and dessert whizzes – all of whom have been put through their paces by the Gathar team in time-pressured cooking tests to ensure that they can keep to schedule for you and your guests.

We were lucky enough to attend the Gathar launch in Brisbane, held at the beautiful Spires Residences in Brisbane City in their luxurious private dining room, complete with stunning city views and an infinity pool (which is free to hire if you stay at a room in their hotel). A dinner party just isn’t the same without a cocktail or two, and the home-delivery Cocktail Porter service was on hand to showcase their range of cocktail boxes, delivering all the ingredients you need to muddle, shake and stir your way through any cocktail party.

Our first culinarian of the evening was Stephanie Griffen from Platter Society, who produced a stunning cheese and antipasto platter to enjoy by the pool on arrival. A feast for the eyes as well as the palate, the platter would make

for the perfect addition to a night in with the girls, a family birthday, a picnic with pizazz - or even to brighten up your next board meeting!

Our next culinarian for the evening was chef Chris Sitkars of Black Ox Dining, who brought a wealth of experience to the table from his work in some of Melbourne’s top hatted restaurants. He served two courses, starting with wild line-caught kingfish served aburi style with smoked almonds, compressed cucamelon and an iridescent blood plum consume.

Creamy and delicate like sashimi with crispy fish skin crackling, coupled yet contrasted against the tart consume, with bursts of freshness from the melon, this was definitely a showstopper. We were then treated to aged beef with toasted pumpkin skin, locally foraged flowers and burnt pumpkin juice foam, complete by watching Chris plate the dishes in the kitchen himself (tweezers and all). The seared and roasted beef arrived medium rare and perfectly rested, coupled with the soft as silk pumpkin and local foliage to create a very memorable alternative to your simple Sunday roast.

Our meal concluded with home cook and extraordinary dessert talent Nicky Jurd (who is also one of Gathar’s founders and resident tech guru), who treated us to her ‘4 treasures of Mexico’ – a voluminous and light ground

D R K AT G R I D L E Y chocolate and chilli mousse, topped with crunchy pecans and popcorn, sweet agave syrup and edible flowers, served alongside Cocktail Porterâ&#x20AC;&#x2122;s Elderflower Gimlet. The gentle hum of the chipotle chilli served only to amplify the chocolate flavour, with the crunchy tidbits on top creating a textural dream for avid foodies like myself.

Advanced Emergency Trainee, Queensland Childrenâ&#x20AC;&#x2122;s Hospital; and member, AMA Queensland Council of Doctors in Training

It is safe to say that after the experience we had with some of the culinarians that Gathar has to offer, the next dinner party we organise will be substantially left stressful (and left to the professionals). With Persian, Italian, modern Australian, Vietnamese and many more cuisines on offer around the state, there is a menu to suit every one, and a wonderful opportunity to connect with a passionate cooks who are ready to share their experience with you!

Simply log onto www.gathar.com.au and search the menu section for your desired cuisine. Prices vary depending on the number of courses and include all of the ingredients (and for larger parties, the addition of a waiter).

Availability is negotiable between chefs, but with the success of Gathar in Cairns over Christmas time in 2018, we can only imagine that business will soon be booming in Brisbane!

Doctor Q Winter 65

All about you

GO GREEN: CONTAINERS FOR CH ANGE

P O D C A S T: CASEFILE TRUE CRIME Casefile is an Australian weekly true crime podcast that deals with solved or cold criminal cases, often related to well-known murders and serial crimes from around the world. The series is scripted and narrative, relying primarily on original police or mass-media documents, eyewitness accounts, and interview or public announcement recordings.

Some stand out podcasts include the Beaumont Children, the Belanglo State Forest murders, Roger Dean and Katherine Knight. Listen on Apple or Google Podcasts, RSS feed, Spotify, Castbox or Stitcher.

T V: AUSTRALIA IN COLOUR Australia in Colour is Australia’s history told via a unique collection of cinematic moments brought to life for the first time in stunning colour. Narrated by Hugo Weaving, it’s a reflection on our nation’s character, its attitudes, its politics, and its struggle to value its Indigenous and multicultural past. Australia in Colour gives us a chance to relive history from a fresh perspective. Available now on SBS on Demand.

66 Doctor Q Winter

Queensland has one of the lowest recycling rates in Australia, at around 44 per cent. Each year, approximately three billion beverage containers are generated in our state alone and are the second most littered item. To help us all improve our recycling efforts and keep our beautiful environment litter-free, the Containers for Change scheme lets people get a 10 cent refund for each eligible container returned to a refund point. Many schools, charity and groups (Scouts, etc) are collecting bottles and cans to fundraise and can coordinate this for you. Visit www.containersforchange.com.au to find out more.

S U P P O R T: N A I D O C W E E K 7 - 1 4 J U LY NAIDOC Week celebrations are held across Australia each July to celebrate the history, culture and achievements of Aboriginal and Torres Strait Islander peoples. NAIDOC is celebrated not only in Indigenous communities, but by Australians from all walks of life. The week is a great opportunity to participate in a range of activities and to support your local Aboriginal and Torres Strait Islander community.

UPCOMING FILMS Please note upcoming film are subject to change

17 July The Lion King

DIE WALKÜRE

18 July The White Crow

29 June, 1pm | 30 June, 1pm | 3 July, 10am The Met Opera

25 July The Keeper

Featuring some of the most glorious music ever written, Die Walküre is an unmissable epic story of monsters, gods, and humans on a superhuman scale.

A hugely beloved opera and often sell-out smash hit, the Met is proud to present the second installment of Wagner’s legendary Ring cycle. Starring Christine Goerke as the warrior goddess Brünnhilde, whose encounter with the mortal twins Siegmund and Sieglinde, sung by Stuart Skelton and Eva-Maria Westbroek, leads her on a journey from Valhalla to earthbound humanity.

M AT T H E W BOURNE’S SWAN LAKE

THE PRADO MUSEUM: A COLLECTION OF WONDERS

6 July, 1.30pm | 7 July, 1.30pm | 10 July, 10am Retaining the iconic elements of the original production loved by millions around the world, Matthew Bourne and award-winning designers Lez Brotherston (Set & Costumes) and Paule Constable (Lighting) will create an exciting reimagining of the classic production.

Thrilling, audacious, witty and emotive, this Swan Lake is perhaps still best known for replacing the female corps-deballet with a menacing male ensemble, which shattered conventions, turned tradition upside down and took the dance world by storm. Collecting over thirty international accolades including an Olivier Award in the UK and three Tonys on Broadway, Matthew Bourne’s powerful interpretation of Tchaikovsky’s masterpiece is a passionate and contemporary Swan Lake for our times.

WIN

kets c i t e i v mo ! for two

31 July Ophelia 1 August Fast and Furious presents: Hobbs & Shaw

THE AUDIENCE 20 July, 1pm | 21 July, 1pm | 24 July, 10am

13 July, 2.15pm | 14 July, 2.15pm | 18 July, 10.30am This stunning new event film featuring Jeremy Irons would like to do just that: let the Prado speak for itself.

Celebrating its 200th birthday in 2019, the Prado Museum will tell the story of its life, and take you on a spectacular journey in Madrid covering six centuries of Spanish history. History told through art, through the eight thousand masterpieces housed in the Museum’s collections, and the story behind each one. A painting is canvas, colour, matter, and form, but it is also the story of men and women, painters and kings, palaces and queens, wealth and misery, body and soul.

For sixty years Elizabeth II (played

by Helen Mirren) has met 12 Prime Ministers in a weekly audience at Buckingham Palace. Both parties have an unspoken agreement never to repeat what is said. The Audience imagines a series of pivotal meetings between the Downing Street incumbents and their Queen.

From Churchill to Cameron, each Prime Minister has used these private conversations as a sounding board and a confessional – sometimes intimate, sometimes explosive.

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healthy, there should be some limits set. So that rather than having to have uncomfortable conversations with patients, each doctor could merely blurt out, “Sorry mate, I have reached my limit for your type of case for the year. I can’t help you”. There would be no need for guilt, no need for angst.

The patient would simply stand up and walk away.

Limits Limits are important. Medicare thinks so. They love to tell you how many patients you can see each day.

How many long consults, how many excisions, how many care plans, ECGs and spirometry tests. Hospital administrators think so too. Some hospitals used to limit the number of hours of overtime you could claim before you started working not for time and a half, but for free.

Not that all authoritative bodies create contentious limits. The police force enforces tremendous limits for the common good. Speed limits are pretty vital, so too drink driving limits.

Lots of professionals and professional bodies seem to be keen to the idea of limits and so I started wondering about the sorts of limits that doctors should enforce. Maybe we should start imposing our own set for limitations to facilitate longevity in our working lives.

I am sure each area of medicine has its drags. The sort of cases that make your heart sink and shoulders slump.

Maybe even evoke a sigh. A look at the watch in the vain hope that knock off time might be just around the corner.

So, maybe in the interests of keeping members of our profession happy and 68 Doctor Q Winter

I thought the surgeons might benefit from a yearly limit on the amount of ischio-rectal pus they had to drain.

Surely that can’t be their career highlight. The stench must get them down. They could have a limit on the number of abscesses or even the total volume of anaerobic pus drained and accumulated over the year. Equally, every surgeon seems to dine out on their (de-identified) rectal foreign body stories and so maybe there should be a quota on these cases, too.

We can’t have any individuals getting more than their fair share of these ripping yarns.

Anaesthetists could be allowed to limit the number of patients with huge bull necks that are almost impossible to intubate. Surely each of these cases shortens an anaesthetist’s life expectancy by a finite number of minutes. Perhaps a limit on the number of rugby front rowers they put to sleep or a rugby forwards to backs ratio would benefit. For every ten front rowers they gas, they are allowed to choose twenty slender necked backs for their next cases.

The psychiatrists could start saying ‘no’ after a pre-ordained number of personality disorders or perhaps an upper number of Jesus delusions.

The orthos could shut up shop after their quota of back pains and the neurologists, after their fill of vague, non-descript headaches.

The gastroenterologists could shut their doors after a set number of cases of irritable bowel syndrome and our endocrine mates could head home

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

for the day after they’d had enough diabetics who refused to exercise, eat right, take their mediations and check their blood sugar levels.

The obstetric fellows could hang up their stirrups after a pre-determined number of obstructed labours or torrential post-partum bleeds. Surely no one deserves to have that sort of stress too often in their working year.

Cardiologists could start knocking back all the smokers who keep puffing after their third infarct and the respiratory teams could put down their stethoscopes after a few dozen smoking asthmatics.

I hoped to help out the ophthalmologists with a suggestion, but I suppose the thrill of curing blindness would never really get boring. (That and the rebates for cataract surgery.)

As a GP, I reckon we should be allowed to draw stumps after we have racked up our share of out of town blow ins claiming to have lost their scripts from their usual GP, for their narcotic analgesics and benzos. Maybe we could score a break after a certain number of authority hotline phone calls, listening to Mozart getting massacred as we wait for someone with limited medical training to tell us it is okay to prescribe medications.

I am sure limits could be useful. But maybe just having a bit of a whinge and some ventilation achieves the same aim. Maybe the best limits are the ones you can impose on yourself.

The number of hours per week and the number of weeks per year you can work without getting too cynical.

Lies, damn lies, statistics and wine After 30 + years in the wine industry I’ve just about heard it all so having finished a recent promotional trip late last year I thought I’d mention some of my favourite wine myths.

“WHITE WINE DOESN’T AGE WELL”

If you’re talking about a $10/bottle sauvignon blanc from the local bottlo I’d agree but it depends on the variety you’re talking about. In a previous article I referred you to some amazing Aussie examples of aged white such as Riesling and Semillon, particularly Riesling from Clare and Eden Vallie’s and Semillon from the Hunter. If your budget extends to Sauterne the French have been making some remarkable dessert wines for centuries.

PHIL MANSER Wine Direct

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

“T HE EVE N YEARS A R E T H E B E S T,

AREN’T THEY?” Don’t be embarrassed if you’ve repeated this, I hear it all the time and wish it was true. As a producer, I’d simply take some time off during those years having reallocated my stock to cover the off year. Reality is, Mother nature is as randomly kind as she is cruel and you only need look at years like 1963, ’71 and ’91 in many of Australia’s wine regions or ’89 and ’05 in France. Wine can err into vague generalisations like anything, much like the idea that all doctors are rich!

This brings me to my point – the world of wine is full of discovery, surprises and experiences. For many it’s an intimidating space so there’s often safety in generalisations but I ‘d encourage you to break out – stop and try wine on tasting, order something different from the wine list (get the waiter to choose), have a conversation with the wine guy at the local, put your wine in a paper bag and get your friends to guess what it is… why not? have fun!

“ YO U M U S T O P E N

T H E B OT T L E A N D L E T I T B R E AT H E ”

An open bottle of wine might breathe a little bit but in reality, you’re asking 750ml of wine to breathe through a tiny hole exposing a very small percentage of it to air. The idea of breathing a wine is to allow any undesirable volatile compounds to blow off and leave you with a better experience. To expedite this decanting (or pouring) the wine into a decanter, jug, urn (whatever works) will expose a much greater volume of wine to air, therefore speeding up the process. This is especially true of young wines. Old wines, particularly reds? Just open and drink, they’re dead already

The more you explore the less generalisations you’ll end up using and the more you’ll enjoy this amazing industry I love so much.

Doctor Q Winter 69

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70 Doctor Q Winter

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