Doctor Q Winter 2020 by AMA Queensland

Doctor Q is free to AMA Queensland Members

WINTER 2020

BRAVE NEW WORLD LIFE AFTER COVID-19 N E W P R E S I D E N T, BOARD AND COUNCIL

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CONTENTS

REPORTS

Editor’s desk

COVID-19 Advocacy at work

President’s report

COVID-19: the new normal

CEO’s report

AMA Queensland Foundation turns 20!

Meet your Council and Board members

P R I VAT E D O C T O R S TO FREE UP PUBLIC WAITING LISTS

BUSINESS TOOLS

F E AT U R E S

CURRENT ISSUES

Standing by customers and communities during COVID-19

Voluntary assisted dying and palliative care update

Investing in new equipment – is now the right time?

Private doctors to free up public waiting lists

Is COVID covered by insurance?

New President: Dr Chris Perry

How pandemics affect your wealth protection covers

New Vice President: Dr Bav Manoharan

When curiosity kills professional conduct

Doctors on the front line of a xenophobic pandemic

Keeping your practice going during COVID-19

Maintain a healthy, balanced lifestyle

A chance observation

Clinician wellbeing in the time of COVID-19

Research round up

NEW PRESIDENT: DR CHRIS PERRY

PEOPLE & EVENTS

LIFESTYLE

Obituary: Dr John Masel AM

Travelling after COVID-19

Events calendar

All About You

Meet the JDC speaker: Dr Richard Harris SC OAM

Dr Matt Young: Motivations

AMA Queensland Annual Conference

Beef cheeks in shiraz

InPrint

NEW VICE PRESIDENT: DR BAV M ANOH ARAN

Doctor Q Winter

BOARD OF DIRECTORS Dr Chris Perry President

Editor’s Desk With COVID-19 restrictions slowly lifting, we find ourselves in a brave new world after lockdown. It got many people thinking “what can we take away from this experience?” With so many less cases than anticipated, Queensland was incredibly lucky, so much so that many enjoyed lockdown as a time for home-cooked meals, more exercise and less traffic. Let’s hope we can move forward with more of the good from this experience and learn from the bad.

WHAT’S HAPPENING ON QDC? Queensland Doctors’ Community (QDC) is AMA Queensland’s member-only, real-time online platform where members drive the agenda. Vigorous discussion continues on: •

Dr Bav Manoharan Vice President Dr Eleanor Chew OAM Chair of Board and Council

Dr Nicholas Yim Member Appointed Director Dr Sarah Coll Member Appointed Director Dr Peter Isdale AM Skills Based Director

COUNCIL Dr Sanjeev Bandi Capricornia Area Representative

Dr Dilip Dhupelia Immediate Past President

Dr Kimberley Bondeson Greater Brisbane Area Representative

Dr Hasthika Ellepola International Medical Graduate Representative

Dr Maria Boulton Greater Brisbane Area Representative

Dr Erica Gannon Part-Time Medical Practitioner Representative

Dr Paul Bryan Greater Brisbane Area Representative

Dr Marco Giuseppin Downs and West Area Representative

Zoe Byrne Medical Student Representative

Associate Professor Geoffrey Hawson Retired Doctors Representative

COVID-19 - AMA Queensland provided daily COVID-19 updates on QDC throughout March, April and May. Members were able to voice ideas, concerns and provide information to each other regarding the virus and how it would be handled in Queensland.

Dr Marianne Cannon Greater Brisbane Area Representative

•

COVID-19 workplace relations and stimulus packages

•

Gender dysphoria

•

Pharmacist prescribing

Dr Eleanor Chew OAM Chair of Board and Council

Dr Cornelius “Kees” Nydam North Coast Area Representative

•

Electronic health records

Dr Sarah Coll Specialist Representative

Dr Nikola Ognyenovits Specialist Representative

Lachlan Crawford Medical Student Observer

OBITUARIES The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Dr Geoffrey Arthur HOCKER Physician Late of Coorparoo Member for 67 years

Dr Ian McKenzie SUNDERLAND General Practitioner Late of Aspley Member for 65 years

Dr Joseph Morgan SETHI Physician Late of Bli-Bli Member for 47 years

Dr Juozas Kastytis ZIUKELIS Psychiatrist Late of Surfers Paradise Member for 30 years

Dr George CORONES General Practitioner Late of Lutwyche Member for 75 years

Dr Raymond Morrice CASH Psychiatrist Late of Capalaba Member for 23 years

Dr Bav Manoharan Vice President

Dr Rachael O’Rourke Greater Brisbane Area Representative

Dr Chris Perry President Dr Fiona Raciti General Practitioner Representative Dr Tony Rahman Specialist Representative Dr Louise Robinson Gold Coast Area Representative Dr Siva Senthuran Full-Time Salaried Medical Practitioner Representative Dr Emily Shao Greater Brisbane Area Representative Dr David Shepherd Far North Area Representative Dr Maddison Taylor Doctor in Training Representative Dr Nicholas Yim General Practitioner Representative

AMA QUEENSLAND SECRETARIAT 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: Kym Lam Sam

Phone:

Journalist: Chiara Lesevre

(07) 3872 2222

Address: PO Box 123, Red Hill QLD 4059 Email:

amaq@amaq.com.au

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WHERE YOU DRIVE THE AGENDA

4 Doctor Q Winter

Ann Fordyce Skills Based Director

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.

Sleep Physician Consultations and Sleep Investigations IMPORTANT INFORMATION FOR REFERRING DOCTORS Queensland Sleep has recommenced in-hospital and ambulatory (home) diagnostic and titration studies, aligning with current Department of Health guidelines to relax the restrictions on elective surgery which were released on 21 April 2020. All patients will be screened pre-study and testing will be postponed if symptomatic, pending further medical investigation. • Pre-test screening will include:

• Increased PPE and distancing:

– Pre-test temperature screening. – Questioning to identify any fever, cough, sore throat, SOB , recent international travel or contact with someone diagnosed with or suspected of having coronavirus. Sleep Physician and Teleconsultations • Available via telehealth and telephone in line with the new MBS item numbers. • Referrals for consultations and/or sleep investigations should be faxed to 3217 2523 or sent via Medical Objects, Medical Director, Best Practice or Genie templates.

– In-lab sleep investigations performed in private rooms with bathroom. – Portable (home) studies performed in the patient’s home by sleep technicians. – 4m2 rule per person strictly adhered to.

Equipment Rental and Purchase • Queensland Sleep can facilitate the hire and sale of CPAP equipment via its retail arm Sleep Healthcare Australia. – Equipment and pressures will be supplied in line with the prescription and without modification. • Sleep Healthcare Australia is an authorised equipment supplier to DVA patients. • Continuous treatment monitoring by Sleep Scientists via 4G enabled rental equipment. – Usage and compliance data is uploaded to the cloud daily and can be accessed via a secure password protected site. – Compliance monitoring and 4G access is at no additional cost to the patient.

More Information? 1800 717 566 @clinical@qsdu.com.au

www.queenslandsleep.com.au

President’s report DR CHRIS PERRY

These are challenging times and certainly not the conditions I envisaged when I first decided to run for President of AMA Queensland. I am delighted to have been appointed President of AMA Queensland for the coming year, along with my Vice President Dr Bav Manoharan and I am conscious of the responsibility and the honour that members have granted me at a time of great change for Queensland and the community. I would like to pay special tribute to the hard work done over the past two years by outgoing President, Dr Dilip Dhupelia, one of the most organised and energetic Presidents there have been. Dilip has represented the medical profession and health services in Queensland with intelligence, thoughtfulness and flair. He has been a wonderful mentor for me over the last twelve months. His presence has also been felt nationally through his advocacy on Federal Council. Dilip will stay on as Chairman of the Nominations Committee and will continue to be a good source of advice for all of us. As you may be aware, after more than 11 years of extraordinary service, our Chief Executive Officer Jane Schmitt has informed the AMA Queensland Board of Directors and Council of her intention to depart her role at the end of August. Our organisation will keenly feel the loss of Jane’s knowledge and expertise, however, we will continue to reap the benefits of her visionary work which has steered AMA Queensland through a decade of growth and transformation.

6 Doctor Q Winter

A lawyer by profession, Jane has been committed to upholding robust governance standards and maintaining a solid financial position. Importantly, she has led the organisation from the front and has built strong stakeholder relationships and enduring commercial partnerships for AMA Queensland, which underpin our organisation’s continued success. I know I speak for many of our Past Presidents and Council members when I say that Jane’s sharp intellect, boundless energy and passion for this organisation, its staff and membership has been remarkable. She will be sorely missed. Her tenacity during challenging times, from the current COVID-19 pandemic to controversial doctor contract negotiations in 2014, has delivered outcomes that have served to strengthen our profession. Jane will continue to lead the organisation over the next three months while the Board engages in an executive recruitment process to secure a high quality candidate. We wish Jane great success and have no doubt we will find ways to collaborate further in future to continue enhancing outcomes for patient care in Queensland. Jane’s departure will add extra complexity to my term but we should regard this as an opportunity to reflect on what we do and how we can improve our services to members and the Queensland community at large.I look forward to working with the incoming CEO, the Board, Council and members in the best interests of doctors and the patients they treat.

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Doctor Q Winter

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NEW AMA MEMBER APP – LIVE IN JUNE

CEO’s report JANE SCHMITT

PRIORITIES DURING COVID-19 Over the last three months, AMA Queensland has worked tirelessly to support the medical profession and to ensure that both patient and doctor safety have been at the forefront of decisions made in response to COVID-19. We have held a number of member webinars and had countless interactions with our members, the State Government, Queensland Health, private hospital operators, Health and Hospital Services and medical defence organisations to address the issues affecting doctors at the frontline of the COVID-19 threat. We are very grateful for the collegiate and collaborative approach from our stakeholders. We worked around the clock to campaign for doctors for provision of personal protective equipment (PPE), economic support for practices, private hospital guarantees and COVID-19 private/ public hospital agreements, the importance of usual healthcare continuing, doctors’ health and well-being, restarting non-urgent elective surgery and the impact of COVID-19 on private practices. You can read more on page 16. We set up a dedicated COVID-19 page on our website and sent regular communications to members with the latest information on advocacy updates and COVID resources. In April and May, AMA Queensland focused on the need to gradually reintroduce activity into the private sector, as we called for a safe, fair return to elective surgery. We provided members with regular updates on the COVID-19 private/public hospital arrangements for non-GP specialists and flagged several issues of concern regarding these agreements. Following strong advocacy from AMA Queensland, Queensland Health announced a gradual resumption of elective surgery with Surgery Connect contracts to be used as the vehicle for all referrals of public work to private hospital providers. This was a significant result and move away from rates offered under the initial public/private COVID-19 term agreements. At the time of writing this article, however we remain concerned as we see variations in the contracts and therefore, strongly encourage members to carefully read contracts presented to them and to seek advice from AMA Queensland, if they have any concerns. As we emerge from the effects of COVID-19, we will continue to work with you to support your provision of high quality care to your patients. Please continue to highlight to us any issues in your practice or hospital by emailing covid19@amaq.com.au or via Queensland Doctors’ Community. 8 Doctor Q Winter

As we continue to look for innovative ways to support our members, I’m delighted to announce that AMA Queensland is about to launch the first-ever AMA Member app. The new AMA Community app will open even more opportunities for how we communicate with members in real time. The app will be available for both iOS and Android and will serve as an AMA member hub for content, networking, collaboration and events. Members will have access to dedicated news feeds and forums, a member directory with in-app direct messaging, one-click event registration and easy membership renewal - all in one place and at the touch of a button. Through the app, members will also be able to download workplace resources and access all their member benefits and discounts, and access Queensland Doctors’ Community (QDC). Never before has technology played such a critical role in helping us be informed and connected. We are in interesting times and now more than ever AMA Queensland is working on new ways to walk beside all members every step of the way. The new AMA Member app will be live available for download in June, so keep an eye out for launch details coming soon.

WELCOME TO THE 2020-21 BOARD AND COUNCIL I welcome incoming AMA Queensland President Dr Chris Perry and Vice President Dr Bav Manoharan and congratulate Dr Eleanor Chew on her appointment as Chair of Board and Council and Dr Nick Yim as Member Appointed Director. I also congratulate our new Councillors and welcome back those returning to another year in their representative roles (a full list in provided on page 22).

SAYING GOODBYE After more than 11 years as CEO of AMA Queensland, in September, I will start a new chapter in my professional life. It has been a privilege to lead Queensland’s peak medical association and to work alongside so many passionate, committed and inspiring people. I have gained a great deal of personal and professional satisfaction from my years at AMA Queensland, and would like to take this opportunity to thank you – our members – for your ongoing support in helping the organisation continue to enhance the role of doctors and improve patient care. Because of the dedication and commitment of members, staff, the Leadership Team, Board and Council, AMA Queensland has been able achieve outstanding results during my tenure. I will miss your inspiration and enthusiasm but take comfort in knowing I leave an organisation well-positioned to meet the opportunities and challenges of the future with a stable team of talented, professional and hardworking staff and large group of volunteer members who serve on our Board, Council, committees and working groups. I hope to have the opportunity to work with many of you again in my new role as Executive Director, External Relations for Mater Group and look forward to watching AMA Queensland continue advance the health care of Queenslanders.

YOUR MEMBERSHIP AT YOUR FINGERTIPS

Doctor Q Winter

Working for you during COVID-19 With tireless advocacy and ongoing support, AMA Queensland has been your powerful ally against COVID-19.

INFORMATION AND FRONTLINE ADVICE Our team set up a dedicated COVID-19 email address and answered a slew of calls from members. A dedicated COVID-19 webpage and Queensland Doctors’ Community have been updated daily with all of the latest information about the coronavirus outbreak, including AMA Queensland resources and advocacy updates, frequently asked questions for doctors, workplace relations updates, the latest information from the Federal Government, such as upto-the-minute updates from the Department of Health and Australia’s Chief Health Officer, as well as, resources, health plan and links to online infection control training. Information on MBS items for phone and video consultations was also included. The channels also included the latest information from Queensland Health, including, WorkCover costs, information on specialised collection centres and processes for COVID-19 testing and a list of fever and respiratory clinics. We installed an AMA Queensland’s primary care representative on daily updates from the State Health Emergency Coordination Centre (SHECC) regarding COVID-19. Our team started providing daily updates on our online platform, Queensland Doctors’ Community and members received regular updates from our CEO and President via email.

WEBINARS AMA Queensland delivered regular webinars to support members in responding to COVID-19. In February, AMA Queensland quickly moved to ensure we had the latest information to provide to members and engaged Queensland Chief Health Officer Dr Jeannette Young in a filmed webinar to answer members’ questions and concerns about the emerging COVID-19 threat, particularly for GPs. As part of our ongoing advocacy to ensure that reasonable arrangements were made between private hospital providers and non-GP Private Specialists in response to COVID-19, AMA Queensland held a number of webinars with Queensland Health, Queensland’s largest private hospital providers and representatives from Medical Defence Organisations. Read more on page 16. Members were also able to dial in to a number of online information sessions by our corporate partner, William Buck, on the COVID-19 Stimulus Package and the Jobkeeper scheme. 10 Doctor Q Winter

ADVOCACY Members and representatives on our online platform, Queensland Doctors’ Community, shared information and ideas on how to tackle the virus and how to keep patients safe. Many of the concerns put forward were escalated to the Queensland Chief Health Officer and Queensland Health Minister Steven Miles and were quickly implemented.

TELEHEALTH At a national level, the AMA worked with Federal Health Minister Greg Hunt to further expand telehealth under the MBS and called for all doctors to be able to use telehealth for any regular consultation with patients, not just for patients needing testing or care for COVID-19. This ensured patients continued to see their doctor for regular care without concern about the doctor or patient being exposed to COVID-19. On 29 March, the Federal Government announced: •

extension of telehealth item numbers for all GPs and nonGP Specialists to cover most consultations not requiring a physical examination;

•

doubling of the GP bulk billing incentive for telehealth;

•

removal of the prohibition on private billing for telehealth (where bulk billing does not occur); and

•

an additional GP practice viability payment through the Practice Incentive Payments (PIP) to support business continuity.

Since the Medicare telehealth items were introduced in March, around 10 million Medicare-funded telehealth services have been provided, either over the phone or via video, and the overall sense from GPs, other specialists, and patients is that it has been a success. AMA has been a strong telehealth advocate for many years and, with current arrangements due to expire in September, it is now working to provide the Federal Government with advice on how to integrate telehealth into day to day general practice and other relevant medical specialties.

PUBLIC SAFETY Australia generally has the benefit of seeing how things play out overseas before it becomes an issue here. The first Australian case of coronavirus was in Victoria on 25 January. The AMA declared the COVID-19 outbreak a national public health emergency on 13 March and called for mass gatherings to be banned. They also called for the best possible information and equipment to be made available to frontline medical and

health workers, as well as asking for a public health campaign to provide consistent and clear messages to allow Australians to guard themselves against transmission. On 18 March, the Federal Government began stage one lockdown, that included closing Australia’s borders; cancelling ANZAC Day activities; limits on gatherings; restricting visitors to aged care facilities; and restrictions on travelling overseas.

QUEENSLAND COUNCIL ELECTIONS Queensland’s borders were closed for non-essential travel on 25 March, but Queensland’s Council elections still went ahead on 28 March. AMA Queensland voiced concerns over the election going ahead amidst bans on mass gatherings and suggested some measures for making polling stations safer. After the election, we called for fines for not voting to be waived.

RETIRED DOCTORS In March, AMA Queensland called on retired doctors to register their interest in assisting with contact tracing and 13 HEALTH hotline advice to help manage the impacts of COVID-19. Over 60 retired members answered our call for help. Thankfully, our hospitals did not reach a point where they were unable to cope.

PERSONAL PROTECTIVE EQUIPMENT •

Bringing the government’s attention to the shortfall of personal protective equipment (PPE);

•

AMA Queensland surveyed members and repeatedly called for urgent clear and transparent communication to hospitals and the primary care sector regarding access to and distribution of PPE;

•

AMA Queensland partnered with AMA Western Australia to expedite the PPE availability to doctors in Queensland.

EASING PRESSURE ON PRACTICES With the onset of COVID-19, people cancelled their doctors’ appointments and practice owners started to become concerned about how they would continue to pay their staff. On 20 March, AMA Queensland called on the Queensland Treasurer to waive payroll tax for six months while many Queensland businesses were in free fall. On 24 March, the Queensland Government waived payroll tax for large Queensland businesses for the next three months and gave a refund for the previous two months. Smaller businesses will not be liable for payroll tax for 2019-20. AMA Queensland also sought a relaxation of long service leave regulations to provide options for employers who have staff without any annual leave or other leave they would be able to draw upon if required to self-isolate. In April, with many GPs seeing a 20 to 50 per cent slump of patients through their doors, AMA Queensland urged Queenslanders to continue seeing their doctor for existing conditions and for regular health care.

PRIMARY CARE AMA Queensland was instrumental in bringing together all primary care Colleges and Primary Health Networks for twice weekly teleconferences to discuss the issues faced by general practice, including how general practice could assist during the pandemic.

PUBLIC/PRIVATE HOSPITAL AGREEMENTS Aware of the pressure the virus would put on public hospital capacity, on 29 March, the AMA urged state and territory governments to utilise private hospitals for urgent and semiurgent medical care. A full run-down of this issue is provided on page 16.

JUNIOR DOCTORS COVID-19 has had a direct impact on education, training and clinical care for junior doctors. AMA opened communication with medical colleges and regulatory authorities about how we could work together to support doctors in training and mitigate the impact of COVID-19 will have on medical education and training over the next 12-18 months. The AMA Council of Doctors in Training outlined these concerns in the document AMA advocacy to support doctors in training during the COVID-19 response. The AMA Queensland Council of Doctors in Training formed a working group across hospitals in Queensland to discuss ongoing concerns affecting members. Their support focused on: •

Academic – exam cancellation, selection criteria, compulsory courses, career progression and student placements

•

Rights – sick leave, self-isolation leave, safe working hours, leave allowances, dependents and scope of practice

•

Wellbeing – promoting the Doctors’ Health Advisory Service and encouraging junior doctors to seek help

WORKPLACE RELATIONS ADVICE While COVID-19 has thrown the world into chaos, it has certainly thrown our workplaces into chaos too. The virus has meant so many staff are doing work that’s different to their usual duties, while many practices had a dramatic drop in appointments. AMA Queensland’s Workplace Relations Team has had the phones running hot, answering questions about: •

the Federal Government’s JobKeeper allowance – who is eligible, how to apply, how this works in with your current arrangements;

•

specific COVID-19 Workplace Health and Safety obligations for employer and employee;

•

changes to individual flexibility agreements and contract variations; and

•

standing down employees or asking them to take leave.

Doctor Q Winter 11

COVID-19 The new normal

12 Doctor Q Winter

Social distancing on Mount Tamborine.

COVID-19 sometimes brought out the best in people – people were often seen leaving messages for their fellow isolators.

General practices had to make clear to patients that anyone with any COVID-19 symptoms was to attend a fever clinic.

10.

Most practices, as well as pathology centres, suffered a down turn in business, with patients not wanting to seek help for fear of exposing themselves to the virus.

11.

With so many people at home, online shopping exploded. International items were held up in customs for long periods.

Australians didn’t let COVID-19 stand in the way of commemorating ANZAC Day, with many people standing on their driveways at dawn with handmade wreaths and drawings.

The IGA at Pullenvale had signs suggesting ways that shoppers could shop more safely.

12.

The IGA at Pullenvale had signs that explained the need for social distancing.

Children’s play areas became a possible source of infection.

13.

6. 7.

Outdoor gyms, skateparks, playgrounds, exercise equipment, basketball facilities, BMX tracks and barbecues were shut down for two months.

Retails stores had to enforce a maximum number of patrons in their store. Pictured here are people waiting for other shoppers to come out so they could enter the store.

Panic buying wasn’t just confined to toilet paper.

14.

Practice waiting rooms came with warnings, with many asking patients to wait outside or in their cars before their appointment.

15.

Fever clinics were set up around Queensland to test patients with COVID-19 symptoms.

16.

Panic buying set in early as people were unsure when lockdown might begin or what restrictions might apply.

17.

People were hesitant to go back to shopping centres, with many wearing gloves and masks.

18.

Queensland closed its borders and checks were carried out to ensure people weren’t travelling more than 50km from home.

19.

Supermarkets stayed open, with trollies wiped down; hand sanitizer (when available) was offered at arrival; limits on pasta, toilet paper, frozen fruit and vegetables and liquid soap. Stores also offered an hour for only vulnerable and elderly shoppers.

Doctor Q Winter 13

Voluntary Assisted Dying and Palliative Care update Voluntary Assisted Dying (VAD) has been a polarising topic for doctors and the public for many years in Australia, but particularly since the Victorian Government and, more recently, the Western Australian Government decided to legislate the introduction of a VAD scheme in their respective states. When the Queensland Government launched an inquiry into aged care, end-of-life and palliative care and voluntary assisted dying in November 2018, it signalled the possible future introduction of a voluntary assisted dying in Queensland. To strengthen our advocacy efforts, AMA Queensland formed an aged care, end-of-life and palliative care and voluntary

“due to COVID-19, it is unclear as to whether these new laws will be introduced before the October 31 election” assisted dying working group, with experts from the fields of aged care and palliative care to assist AMA Queensland Council with their response to the reports in the best interest of AMA Queensland members. On 31 March 2020, the Health, Communities, Disability Services and Domestic and Family Violence Committee released a report of their findings from their year-long inquiry. The Parliamentary Committee has recommended that VAD be legislated in Queensland for adults with advanced terminal medical conditions. Beginning in November 2018, the committee accepted 4,719 written submissions, held 34 hearings and heard evidence from 502 witnesses. The report tabled on 31 March made 21 recommendations as to how the Queensland Government should legislate VAD.

14 Doctor Q Winter

Premier Palaszczuk recently ordered the Queensland Law Reform Commission to draft legislation for the government’s consideration by 1 March 2021 – four months after this year’s October 31 state election. Both the Premier and the LNP leader have confirmed there will be a conscience vote regarding this proposed legislation. Submissions from stakeholders were due to be submitted on 15 April 2020, only leaving a two-week time frame to consult with members of AMA Queensland and to make an informed submission. Therefore, AMA Queensland wrote to the committee, along with several other stakeholders, requesting a much-needed extension. In addition to the tabling of the VAD report, on 24 March 2020, the committee tabled the Aged care, End-of-Life and Palliative Care Report, showing the committee’s findings from their inquiry in November of 2018. This report, which includes 77 recommendations for aged care and palliative care, aims to improve access to aged care easier, without compromising the quality of care. Aged care in Queensland has been a controversial issue for many years, particularly waiting periods and low standards of care. Everyone in need of aged care should be entitled to a high standard of care and shorter waiting periods. The inquiry also included a major investigation into the sudden closure of the Earle Haven Retirement Village to prevent what happened at Earle Haven from happening again. Unsurprisingly, the committee discovered that underfunding is the primary cause of low standards of care which leads to inadequate staffing, poorer quality and performance standards and inadequate care. AMA Queensland looks forward to the Queensland Government’s response to these recommendations to put an end to poor quality aged care in Queensland. The inquiry also investigated palliative care in Queensland which faces similar underfunding issues, which leads to limited access to palliative care by people when they need it most. Access to palliative care services is particularly an issue for those who live in regional and rural Queensland. It was the aim of this committee to attempt to fashion solutions for issues relating to access to palliative care.

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Doctor Q Winter 15

Private hospitals to free up public hospital resources In preparation for public hospitals struggling to cope with a possible huge number of COVID-19 cases, most urgent elective surgery was cancelled on 20 March.

members not to sign these contracts and strongly advocated for doctors to be paid fee-for-service rates, as had been utilised in the Surgery Connect model, rather than fee-for- time rates.

Following this, AMA called on the government to utilise private hospitals to free up public hospital capacity and to ensure the viability of our private hospital system, as the crisis worsened.

The low COVID-19 pandemic numbers and idle capacity in the private system had created a different circumstance in negotiating the public-private contracts. Work that would flow through this mechanism would not be related to managing COVID-19 patients, but rather more routine, elective work shifted from the public system into the private system.

On 30 March, the Commonwealth Government announced the Australian Government’s Private Hospital Viability and Capacity Guarantee, which would see private and public hospitals work together on a coordinated emergency response to the COVID-19 pandemic, with the Federal Government agreeing to fund 50/50 of generated activity with the states and territories and underwrite the gap between revenue received and private hospitals’ fixed costs. The guarantee required state and territory governments to establish agreements with private hospital operators.

We are mindful of the need to preserve the real and perceived benefits of private health insurance among patients

AMA Queensland urged Queensland Health to come to the table with a fair, reasonable fee-for-service model if it wanted to engage private doctors to help reduce its waiting lists, explaining that private doctors had the expense of running their practices and paying their own staff. On 20 May, Queensland Health’s Director-General determined that “Surgery Connect contracts should be used as the vehicle for all referrals of public work to private hospital providers”. AMA Queensland was grateful members’ concerns had been addressed in regards to fees, but still held concerns about the lack of clarity on whether there would be a forced allocation of time for public work, as the new contracts with private providers reserved the option for up to 50 per cent of elective surgery capacity to be allocated to public patients.

This was the plan for a health system overwhelmed by COVID-19 cases, as we were seeing around the world. Thankfully, Australia was able to keep COVID-19 cases low and the hospital system was able to cope with those cases.

A further concern was the lack of clarity of an end date for COVID-19 contracts with private operators. Further clarity was also required on whether idle capacity could be used for private patients, if not used by public patients.

As the Queensland Government worked to finalise arrangements with private hospital operators, AMA Queensland developed a set of principles for contracted work undertaken by non-GP Private Specialists under the COVID19 public-private partnership to help guide doctors in considering these contracts. AMA Queensland’s focus was to ensure non-GP Private Specialists were engaged for public work in private hospitals safely and fairly. Assurance of indemnity was a key priority, as was the temporary nature of the arrangements.

AMA Queensland advises ongoing caution regarding individual contracts and encourages members to seek advice from our team before signing a contract.

As private hospitals issued agreements for non-GP Specialists the COVID public-private partnership, AMA Queensland urged 16 Doctor Q Winter

It remains imperative that no doctor is shackled to a poor arrangement longer-term and we stand firm to defend the profession against any exploitative behaviour at this difficult time. We are mindful of the need to support our members as they try to rebuild their practices, to always retain the independence of doctors in decision-making and that the doctor-patient relationship is always of paramount importance.

8 APRIL A webinar took place between Queensland Health, private hospital operators and affected members. Over 220 non-GP private specialists dialled in to ask questions and hear the latest developments on the pending agreement with private hospitals. Members were able to ask questions in real time and the main issues centred on rates for private specialists treating COVID19 public hospital, scope of practice, indemnity and sick pay, PPE supply, as and well as questions on the reintroduction of non-urgent elective surgeries in private settings.

23 APRIL More than 135 members dialled in to the webinar to hear the latest developments and ask questions about the reinstatement of some non-urgent elective surgeries, an outcome reached through of extensive negotiations between AMA and the government. Queensland Health provided a brief overview of how the reinstatement of elective surgeries would occur in Queensland and updated participants on the continuing progress of signed agreements between private hospitals and the State Government. Representatives from the Mater, Ramsay Health, St Vincent’s, Healthscope and Cura Day Hospitals advised how elective surgeries would restart at their hospitals. In addition, representatives from Medical Defence Organisations including MDA National, Avant, MIGA, MIPS and Berkshire Hathaway provided clarity on the issue of indemnity. Following this webinar, several private hospitals issued contracts for doctors to consider for work under the COVID public-private partnership. AMA Queensland flagged several issues of concern, telling members: “There is considerable risk for non-GP private specialists to be forced into indentured, salaried arrangements with private hospitals and AMA Queensland does not regard this as being in the best interests of patients, hospitals nor individual doctors. Although ‘Surgery Connect’ is suspended while the COVID public-private partnership remains, an appropriate and fair fee-for-service model can still be employed and should be the style of any credible contract doctors are asked to consider, not a time-based VMO rate as quoted.” AMA Queensland urged members not to sign the contracts. Members flagged the concern that they were being asked to sign with a reference to remuneration being equivalent to 100 per cent of the Medicare Benefits Schedule applicable fee or fees calculated ‘in accordance with the Australian Medical Association Enterprise Agreement’. There is no such agreement in Queensland.

6 MAY AMA Vice President Dr Chris Zappala and new AMA Queensland President Dr Chris Perry hosted the webinar on 6 May to provide an update on the negotiations and the flow-on effects on members.

20 MAY AMA Queensland hosted its fourth webinar with Queensland Health and Queensland’s largest private hospital providers. The webinar provided members with news of the latest developments in public-private negotiations as well as proposed timelines for the stepped reinstatement of elective surgeries. Queensland Health’s Acting DDG and Chief Clinical Information Officer Professor Keith McNeil attended the webinar to address members’ questions and concerns in real time, while representatives from the Mater, Ramsay Health, St Vincent’s, Uniting Health Care, and Cura Day Hospitals advised of issues and processes at their facilities as they worked towards resuming normal activities. In late May, Queensland Health Director-General Dr John Wakefield determined that private hospitals in Queensland could gradually return to up to 100 per cent of normal elective surgery activity, subject to availability of PPE.

Doctor Q Winter 17

Meet new AMA Queensland President Dr Chris Perry STUDY Dr Chris Perry OAM has been a member of the AMA since 1977, when he graduated from the University of Queensland. He completed a Diploma of Tropical Medicine and Hygiene in Liverpool in 1980, became a Fellow of the Royal Australasian College of Surgeons in 1985 and held two fellowships in head and neck cancer in the UK and USA.

PUBLIC APPOINTMENTS Dr Perry has had public appointments in Brisbane in paediatric and adult otolaryngology head and neck surgery since 1987. He is a Professor at the University of Queensland. He is Chairman of the Multidisciplinary Head and Neck Clinic at the Princess Alexandra Hospital and an Immediate Past President of the Australian Society of Otolaryngology Head and Neck Surgery. Previously, he served as Chair for the Division of Surgery for the Royal Children’s Hospital; Councillor for the Royal Australasian College of Surgeons; Chair of the Queensland State Committee for the Royal Australasian College of Surgeons; as well as Councillor for the AMA State Committee.

RESEARCH Dr Perry has been involved with research with olfactory cells and paraplegia, and is currently involved in head and neck cancer research – his CV includes 50 papers, eight book chapters and 1,600 citations. He has collaborated with many scientists and clinicians including Ian Frazer, Alan Mackay-Sim and Chamindie Punyadeera.

PHILANTHROPIC WORK According to Dr Perry “Queensland has always had a group of ENT surgeons trying to do something about the horrendous rate of suppurative middle ear disease in Aboriginal Australians with its secondary deafness and education outcomes that maintain the poverty cycle.” As an ENT registrar, he had been on a few trips to Cape York Aboriginal communities and recognised that more needed to be Dr Perry and his wife in 1980 with daughter Emily outside their house in the rural hospital in Ghana done. He secured $1.6million in federal funding, which allowed them to set up a program that engaged 20 ENT surgeons to go to about 10 communities to see and operate on ear disease within the community. For three years, the doctors saw thousands of outpatients and operated on 15-20 patients a week. Later on, Dr Perry worked with the Aboriginal Liaison team at the Royal Children’s Hospital, who put together a more comprehensive outreach program and the Deadly Ears program was born. The program now leads Queensland Health’s response to reducing the rates and impacts of middle ear disease and conductive hearing loss for Aboriginal and Torres Strait Islander children across Queensland. “The program is very well regarded by the Queensland Government, the Aboriginal community and the Australian ENT community. I am very proud to have been involved in its inception and try to still go on two of their outreach trips per year. For 32 years, I have been going to Cherbourg and have some good friends in the community there,” he said.

18 Doctor Q Winter

WORK AROUND THE WORLD “As a PGY 4 with an early pass of the Surgical Primary Examination at the start of PGY2, I had a lot of non-training surgical positions at the Mater Hospital and at that stage still remembered my obstetrics, paediatrics etc. I was on the anaesthetic registrar day roster at the Mater and could resect bowel and do a Caesarean section. I wanted to travel and not get on to the surgical treadmill too early and have no different life experience to everybody else,” he said. From there, Dr Perry studied his Diploma of Tropical Medicine and Hygiene in Liverpool before he and his wife Kathy travelled to Ghana, which was in political crisis at the time. There, he worked in a two-doctor rural hospital in the town of Nkawkaw, home to 100,000 people. There were around 3,500 births per year and around 5,000 to 7,000 births in surrounding villages. Those requiring medical assistance were sent to the Nkawkaw Hospital. He worked in Ghana for around seven months before both he and Kathy fell ill and returned to Australia. In 1988, the Australian Ear, Nose and Throat (ENT) Society was looking for a doctor to go to Papua New Guinea to establish a national ENT training scheme. With tropical medicine qualifications, experience in third world medicine, he got the job and supervised ENT training in Papua New Guinea for 18 years and was a Visiting Professor and Examiner in surgical specialty examinations in USA, Malaysia and Papua New Guinea. Dr Perry treated soldiers at the Yeronga Military Hospital and then, as Lieutenant Colonel, he did two tours in Bouganville, Papua New Guinea in a peace monitoring group.

Two ENT trainees from PNG doing a dissection course at the anatomy school at University of Queensland

Prof John McGrath, Alan Mackay-Sim, Dr Perry, and Francois Feron

With a highlander from PNG near the start of the Kokoda Trail

Dr Perry with daughter Emily who is also an ENT surgeon. Son Brendan is also an ENT surgeon

WHAT DO YOU HOPE TO ACHIEVE AS PRESIDENT? “Australia’s Aboriginal people are not engaging in our hospital health system. Childrens’ hospitals were set up 150 years ago as children are not just little adults. They have special needs and different diseases and approaches to diseases than other people. The same with Aboriginal Australians. I think Australia needs to follow Canada and USA and develop a national Indigenous hospital network to engage Aboriginal and Torres Strait people early in a disease process and chauffeur them through the appropriate Tertiary Referral Hospital for their needs. Noel Hayman at Inala is pursuing this goal in association with the Institute of Urban Indigenous Health. There is a group in Townsville also pushing for this. I hope in my time in the presidency to help them achieve this goal” he said.

WHAT DO YOU SEE AS THE BIGGEST ISSUES FACING OUR MEMBERS? “COVID-19. Voluntary Assisted Dying. Palliative care. Task substitution by lesser trained people with a financial agenda. Underfunding of medical costs/practices leading on to quick second rate services by corporates,” he said. “Perhaps not such a big issue for doctors, but I would like to see some science in the use of single use items resulting in increased costs, waste etc for the protection against prion diseases when the predicted prion tsunami has not materialised. The first year of prion mania resulted in an extra $1.6 billion spent by Australia in single use surgical instruments.”

Doctor Q Winter 19

AMA QUEENSLAND NEW VICE PRESIDENT

Dr Bavahuna Manoharan

Dr Bav Manoharan is currently working as the Acting Deputy Director of Medical Services and Director of Obstetrics and Gynaecology at Logan Hospital, on a secondment from his Medical Administration role at Toowoomba Hospital. He has primarily been based in south-east and central Queensland and has previous experience as a general surgery and radiology trainee.

Dr Manoharan has had a long and deep history of service for the AMA, both in Queensland and nationally. He has been a member of AMA Queensland’s Branch Council since 2010 representing south-east Queensland and was heavily involved in major policy decisions by AMA Queensland over the years including termination of pregnancy, the Queensland SMO contracts crisis, euthanasia and physician assisted suicide, climate change, OHO legislation, medical schools expansions and the issues surrounding scope creed by nurse endoscopists, physician assistants, physiotherapists and pharmacists. He joined the AMA Queensland Board in 2014 and is a member of its Finance, Risk and Audit Committee and Governance committee. He was an executive member of the Queensland Council of Doctors in Training (CDT) from 2011-2018 and was responsible for designing and implementing the first Resident Hospital Health Check survey in 2016, lead and co-convened the inaugural AMA Queensland Junior Doctor Conference in 2014 and was part of the team responsible for AMA Queensland’s well-being program.

“2020-2021 is going to be a year replete with challenges for the medical profession in the recovery from COVID-19, but therein lies opportunity as well.” At the national level, Dr Manoharan currently serves as a Director of the AMA Board (2015-) and is member of the Medical Board of Australia’s Medical Training Survey Steering Committee. He is also a Clinical Reference Lead for the Australian Digital Health Agency, part of the Clinical Governance Committee and was part of the agency’s COVID-19 Response Taskforce, which led the design and implementation of several digital health initiatives to assist with the national response.

20 Doctor Q Winter

Bav has a very strong interest in medical workforce strategy and planning, advocacy, industrial fairness, and training and wellbeing of our senior and junior doctors. Professionally, he is interested in clinical governance, digital health (in particular better utilisation of digital health technologies for improved patient outcomes), population health (chronic disease and oncological management) and designing Value Based Health Care (VBHC) systems (recently completing the Harvard Business School VBHC Program in Boston). He is currently completing his Master of Public Health and Certified Health Informatician Australasia (CHIA) Qualifications. “It probably comes as no surprise that the ongoing COVID-19 pandemic and evolving recovery efforts will need to be the focus for the leadership of the incoming AMA Queensland Executive team and Council. “2020-2021 is going to be a year replete with challenges for the medical profession in the recovery from COVID-19, but therein lies opportunity as well. We know that our private colleagues (GPs and non-GP Specialists alike) have really been struggling over the last few months and the road ahead will be rough. We will stand beside them as we advocate to preserve the positive system reform that have come from the current pandemic (i.e. telehealth MBS items, electronic prescribing and improved digital systems), but ensure that the deficiencies of these are not precedent to the new baseline. We will also support them to ensure they receive fair and equitable compensation for any work they undertake to assist the load the public system will face as we come out of this crisis. Equally, we must address the significant challenges faced by our Doctors-In-Training; our stood-down GP registrars; our residents and PHOs whose attempts at readying themselves for training roles have been disrupted and the ongoing challenges faced by training registrars with interruptions to their training progression and assessments.”

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AMA QUEENSLAND

Dr Chris Perry OAM

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

Board

Dr Bav Manoharan

Specialty: ENT Surgeon

President

MBBS BSC GAICD

Specialty: Doctor in Training

Vice President

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 can understand.”

“It probably comes as no surprise that the ongoing COVID-19 pandemic and evolving recovery efforts will need to be the focus for the leadership of the incoming AMA Queensland Executive team and Council.” “2020-2021 is going to be a year replete with challenges for the medical profession in the recovery from COVID-19, but therein lies opportunity as well. We know that our private colleagues (GPs and non-GP Specialists alike) have really been struggling over the last few months and the road ahead will be rough. We will stand beside them as we advocate to preserve the positive system reform that have come from the current pandemic (i.e. telehealth MBS items, electronic prescribing and improved digital systems), but ensure that the deficiencies of these are not precedent to the new baseline. We will also support them to ensure they receive fair and equitable compensation for any work they undertake to assist the load the public system will face as we come out of this crisis. Equally, we must address the significant challenges faced by our doctors in training; our stood-down GP registrars; our residents and PHOs whose attempts at readying themselves for training roles have been disrupted and the ongoing challenges faced by training registrars with interruptions to their training progression and assessments.”

“There has not been a public/private surgeon within the AMA leadership team for some time in Queensland. As the VMOs are the major providers of public surgical services for Queensland Health, as well as the private sphere where they do more than half of the total surgery in Australia. They are an important cog in the wheel of health delivery.

Dr Eleanor Chew OAM MBBS, FRACGP, MMED(GP), FAICD

Specialty: General Practice

Chair of Board & Council

“As a Fellow of the Australian Institute of Company Directors, I have a clear understanding of my responsibilities as Director and Chair, and will work to ensure that the AMA Queensland Board exercises its responsibilities and fiduciary duty to support the association in serving its members. In my various roles representing the profession, I have gained valuable insights into the many challenges facing the medical profession, providing a sound basis for me to support Council to formulate policy and provide direction for the advancement of critical issues affecting Queensland doctors.”

Dr Sarah Coll MBBS FRACS FAOA

Dr Nicholas Yim

Specialty: Orthopaedic Surgery

BPHARM MBBS FRACGP

Specialty: General Practice

Member Appointed Director & General Practice Representative

“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.”

Member Appointed Director & Specialist Rep

Ann Fordyce

Dr Peter Isdale AM

FCA GAICD

PHD MAICD

Specialty: Restructuring and Turnaround Advisor

Specialty: Governance & Advisory

Skills Based Director

22 Doctor Q Winter

“Good governance and well-conceived strategy are cornerstones of excellence in memberfocussed organisations. I intend that my contribution to the AMA Queensland members’ benefit will be through support for the Board and management in applying effective, welltried principles and practice in wise governance.”

“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.”

Skills Based Director

“It is important for member-focussed organisations to provide support and representation of their members, through advocacy and member services, promotion and leadership. As a generalist advising on financial and business matters, I look forward to assisting and supporting the Board and management with their decisions which will impact AMA Queensland’s standing.”

AMA QUEENSLAND

Dr Sanjeev Bandi MBBS FRCSI FRACS

Council

Dr Dilip Dhupelia

Specialty: Urology

Capricornia Area Rep

LRCPS (IRE) DIP OBST ACOG FRACGP FARGP FAICD AFRACMA

Specialty: General Practice

Immediate Past President

“Having had extensive medical experience in both the public and private sectors, as well as within the federal and state government sectors, I feel I have a good grasp of health policy drivers, ensuring holistic care within a seamless patient journey and improvement strategies in areas such as integration of primary and secondary services in rural areas. 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.”

“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 Kimberley Bondeson BSC (HONS) MBBS FRACGP DAME

Specialty: General Practice, Aviation Medicine, Coal Mine Medicals

Greater Brisbane Area Rep

Dr Maria Boulton MBBS FRACGP

“My intention is to represent the views and voices of the doctors in the Greater Brisbane area. This includes both 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. Continuing ongoing monitoring of important local and national medical and political issues.”

Specialty: General Practice

Greater Brisbane Area Rep

“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.”

Dr Paul Bryan

BSC MBBS FRACGP DCH

Specialty: General Practice, Skin Cancer Medicine

Greater Brisbane Area Rep

Dr Marianne Cannon

MBBS MPH GRAD CERT HPE FACEM

Specialty: Emergency medicine

Greater Brisbane Area Rep

“I am actively engaged in medical education as a clinical subdean at UCH clinical school and have an ongoing interest in the wellbeing of doctors in training, particularly in hospital settings, and how system factors inform their experience. I am acutely aware of the implications of climate on the health of all Australians, and the implications of this for the medical workforce. As a parent of three young adult children, I am prepared to speak truth to power, as evidenced by my advocacy activities in the past. I am inspired by those who bring integrity to leadership, and strive to create a fair and sustainable habitat for human growth and wellbeing. If I can create positive change in the role of AMA Councillor, I would be honoured to serve in this role.”

“Our profession is at a crossroads: general practice and public healthcare remain chronically underfunded, of particular concern given the ageing population and growing burden of chronic disease; our rural workforce crisis shows no sign of abating, whilst the burgeoning number of graduates creates bottlenecks in the training pipeline and threatens the quality of vocational training; pharmacist and allied health groups continue to agitate for a greater role in primary care, whilst emerging technologies threaten to fragment care and undermine the doctor-patient relationship. As an AMA Queensland Council Representative, I intend to be a tireless advocate for junior doctors, general practice, and the medical profession in general.”

Dr Hasthika Ellepola MBBS MD FSLCOG FRANZCOG

Specialty: Obstetrics and Gynaecology

International Medical Graduate Rep

“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.”

Doctor Q Winter 23

AMA QUEENSLAND

Dr Erica Gannon B PHARMACY MBBS

Council

Dr Marco Giuseppin

Specialty: Emergency Physician

Part-Time Medical Practitioner Rep

BPHARM(HONS) MBBS JCCA

Specialty: Rural Generalist Anaesthetist

Downs and West Area Rep

“There is an assumption by many in the city and in politics that rural doctors are ‘stupid’ or somehow unable to make it in big city medicine. Nothing could be further from the truth. When we accept that rural practitioners; GPs and nonGPs alike; bring skills and knowledge equal to their city counterparts, we will have a health system that Australians can be proud of.”

Assoc Prof Geoffrey Hawson

FRACP FACHPM DIP CLINHYP CFTE [ATAA] FRCPA

Specialty: Clinical Haematology, Medical Oncology, Palliative Care

Assoc Prof Kees Nydam

MBBS FACEM FACHAM (RACP) AFRACMA MMED MHM

Retired Doctors Rep

Specialty: Addiction Medicine & Emergency Medicine

North Coast Area Rep

“I have a firm belief and commitment to Virchow’s notion that ‘Medicine is a social science and politics is nothing else but medicine on a large scale’. I see the AMA as a modern-day conveyor of that message. My major concern over the many years of working in healthcare, has been the relatively low genuine engagement rates by my colleagues, in the macro healthcare issues. Whilst the reasons for this are multiple and complex, the glue that binds engagement is authentic personal relationships. By this I mean a genuine desire to move outside our own silos, biases and agendas to see things as others see them. The main others are, of course, our patients and the community at large. I strive to always do this. This is the sole value proposition that makes us relevant as a profession. My hope and desire is to galvanise greater relevance and drive the necessary changes that we must take to navigate the future, rather than have them imposed on us. To succeed we will need to temper our own professional illusory superiority and the Dunning-Kruger effect.”

MD FRACGP FACRRM FACHAM (RACP)

Specialty: Addiction Medicine Specialist

Specialist Rep

MBBS FRANZCR CTCA

Specialty: Radiology

24 Doctor Q Winter

“Having reached the period of incipient permanent retirement, I am passionate about ensuring we medical professionals can continue to contribute to medicine and a lifetime of training does not go to waste. I hope to be able to lobby on behalf of our senior members. If a retired judge can run a royal commission, why are we considered past our prime just because we hang up our shingle? Consideration needs to be made for genuine impairment but, if not impaired, why waste a resource?”

Dr Nikola Ognyenovits

Dr Rachael O’Rourke

Greater Brisbane Area Rep

“I believe that the AMA is a powerful, important body and a community of members. Championing leadership and advocacy for members, patients and the community in general, is of paramount importance. Personally and professionally, becoming involved in 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.”

“I pledge to represent the needs of all doctors, but particularly the role and standing of doctors in our hospital health systems. These doctors 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 believe that only medically trained doctors have the skills to make the important decisions regarding the management of our patients. Only doctors can determine the important diagnostic tests and treatments options necessary to obtain the best outcomes for our patients. Only doctors can drive the vital relevant medical research and teaching that our public hospitals require. 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.”

“The medical profession needs a strong uniting force as we are experiencing loss on multiple sides. Governments are limiting and giving away areas of our competencies. Lobby groups from other professional bodies claim and take over what we are best trained for which is to serve the public. At the time of the ‘contract dispute’ when thousands of Queensland doctors expressed their united purpose, we all experienced how well it works when we unite as a profession. For the last five years, I have been the Assistant Secretary/Treasurer of ASMOFQ. There I have experienced how supporting our peers, who are in need of a professional organisation, can achieve substantial results. I wish to contribute to the work of AMA Council as a councillor to further strengthen our voice and to protect our interests.”

AMA QUEENSLAND

Dr Fiona Raciti

MBBS (HONOURS) FRACGP DCH

Council

Prof Tony Rahman

Specialty: General Practice

General Practitioner Rep

MBBS BMBCH MA PHD DIC FRCP FFICM FRACP PHD

“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.”

Specialty: Gastroenterology & Hepatology

Specialist Rep

“I am passionate about clinical medicine and how it must change to be fit for purpose and relevant to challenges going forward. This includes financial, governmental, governance and professionalism. These challenges require excellent communication skills, trust and relationship nurturing and building. This has to be relevant to all our peers, young, old and across specialties.”

Dr Louise Robinson BCOM MBBS (HONS) FRANZCO

Specialty: Ophthalmology

Gold Coast Area Rep

Dr Siva Senthuran

MBBS BSC FRCA FANZCA FCICM

“The Gold Coast is a vibrant community that has attracted a large number of general practitioners and specialists who are passionate about delivery of quality health care to its growing population. Every doctor has a duty to ensure that the standards underpinning medicine are flexible and up to date to reflect the constantly changing economic and medical environment.”

Specialty: Anaesthesia

Full-time Salaried Medical Practitioner Rep

“I believe that medical leadership and engagement between administrators and its front line clinicians needs to underpin 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 Emily Shao BSC MBBS MPH

Specialty: PhD candidate

Greater Brisbane Area Rep

Dr David Shepherd MBBS FRACS FAORTHA

“I have a strong passion for doctors’ mental health and wellbeing, gender equality and empowering junior doctors. Junior doctors make up 30% of the medical workforce. I would like to promote the voices and opinions of junior doctors and ensure we have a seat at the table in healthcare decisions and advocacy.”

Specialty: Orthopaedic surgery

Far North Area Rep

“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.”

Zoe Byrne

Dr Maddison Taylor MD BMEDSCI HONS (ACC)

Specialty: Doctor in Training

Doctor in Training Rep

BSC

Medical Student Rep

“Leadership and advocacy are integral elements to the core of medicine, to speak for those who need a voice, to connect and unify within our profession and to continue to critically examine healthcare. I hope to engage medical students in issues that will affect our patients into the future and to ensure that people feel their voice is important in advocacy.”

“During my time on AMA Queensland State Council, I hope to be a strong representative voice for Doctors in Training and to ensure that junior doctors, who are working on the front lines, are involved in creating the innovative solutions our healthcare system needs to continue moving forward and sustain a growing population.”

Lachlan Crawford

Medical Student Observer

Lachlan Crawford is a final-year medical student at the University of Queensland. He is currently attending AMA Queensland Council in the capacity of a medical student observer. Lachlan is interested in quality improvement, medical education, and patient safety. He is particularly interested in the role of organisations such as AMA Queensland in influencing change in health systems.

Doctor Q Winter 25

AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING

Doctors on the frontline of a xenophobic pandemic As the world battles an invisible, fatal and rapidly spreading enemy, a simultaneous outbreak of fear is not an unexpected consequence. Fear, in the setting of a pandemic, is often transmitted through misinformation and presents as xenophobia.1 The fight against coronavirus disease 2019 (COVID-19) requires unity among all human beings (at a safe 1.5-metre distance); however, those afflicted by fear are brandishing weapons of racism against their allies resulting in divides within their communities. COVID-19 originated in Wuhan, China, nonetheless, it is by no means a ‘Chinese Virus,’ a term ignorantly used by influential politicians.2,3 Unfortunately, this scapegoating of the Asian population is not an isolated incident. Influenza H2N2 in 1957 and influenza H3N2 in 1968 became known as the ‘Asian flu’

and ‘Hong Kong flu,’ respectively, and thus fuelled the antiAsian sentiment.4 It appears that COVID-19 is not an exception. Since the beginning of the COVID-19 pandemic, the Australian Human Rights Commission reports the highest number of monthly racial discrimination complaints this financial year with approximately one third related to the disease.5 The acts of discrimination in question range from verbal abuse, exclusion from public establishments, to physical violence.6 Acutely, these acts increase the risk of depression, anxiety and suicidal ideation in their victims.7 As a consequence, the mortality rate associated with COVID-19 increases, not due to the disease itself but at the hands of the common man. Perhaps the most disturbing aspect of this bigotry is its impact on healthcare workers. 26 Doctor Q Winter

Racism in healthcare is not a foreign concept. Not unlike the general population, Australian medical practitioners originate from highly diverse backgrounds with the majority born overseas.8 As an appalling side effect, non-caucasian physicians deal with patient prejudices regularly.9 In Good Medical Practice: A Code of Conduct for Doctors in Australia, the Medical Board of Australia suggests that doctors remove themselves from situations that pose a health and safety risk.10 However, it is unclear how this pertains to racial discrimination. As a result, most medical professionals ignore the abuse and continue patient treatment.9 In doing so, they risk receiving a formal complaint, judgement from their colleagues and, most importantly, damage to their mental wellbeing. Nevertheless, in light of COVID-19, xenophobia in hospitals is worse than ever.

The pandemic is testing the Australian healthcare system’s resources, capabilities and organisation like never before. As the government looks to ‘flatten the curve’ by retraining and redeploying staff, restructuring hospitals, and emphasising infection control measures, the fear of the unknown is palpable. During this unprecedented time, those on the front line of this fight need to feel safe and supported by their society in order to provide quality patient – and by proxy, community – care. Instead, there have been sickening reports of patients refusing to be treated by staff who appear to be of Asian descent at some of Australia’s leading hospitals.11 The Australasian College for Emergency Medicine, responsible for training much of the workforce at the very frontline of the pandemic, has also reported a marked increase in racial abuse

towards emergency department workers.12 Understandably, this has led to several staff absences, further depleting the already stretched resources. Healthcare systems rely on a team-based approach to patient care, and for this to occur, there must be mutual respect. If racial attacks persist at this increasingly tense time, morale will suffer, and Australia’s most vulnerable – the elderly, frail and sick – will suffer too. It is, therefore, a national priority that personal prejudices are forgotten and replaced with looking out for one another, just as carefully as the world has been looking out for fevers, coughs and recent travel. Due to the modern advancement of technology, the general population can receive updates on the daily progress of the worldwide battle against COVID-19 instantaneously. The media has been pivotal to the education of the masses and has facilitated the swift implementation of self-isolation laws. However, it also acts as a medium for sinophobic rhetoric. For instance, political leaders are shown misappropriating the global crisis for personal anti-immigrant beliefs and, thus, portraying individuals of Asian descent as the cause rather than the casualty.3 Fear is blinding, but now more than ever, humanity must gain the courage to pierce the veil of stigma with the sharp edge of self-education in order to overcome social fractures. It is time for Australia to channel its multicultural identity into a collective focus against a common enemy. The recognition of racial bias and correction of false information, both in the media and in-person, is vital to reduce unnecessary trauma in a time of turmoil and reinforce community wellbeing. Otherwise, the fight against racism will continue long after COVID-19 has gone. Viruses do not discriminate, why should people?

DR NAGA ANNAPUREDDY Executive member of the AMA Queensland Council of Doctors in Training. She is currently working as a Resident Medical Officer at the Prince Charles Hospital.

To report complaints about discrimination and human rights breaches, please visit the Australian Human Rights Commission website. For healthcare workers, please contact your state Doctors’ Health Advisory Service helpline for twenty-four hour confidential support and advice.

REFERENCES: 1.

White AIR. Historical linkages: epidemic threat, economic risk, and xenophobia. Lancet. 2020. Online without pagination. doi:10.1016/S0140-6736(20)30737-6.

Guo Y, Cao Q, Hong Z, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Military Med Res. 2020;7(11). Online without pagination. doi.org/10.1186/s40779-020-00240-0.

Devakumar D, Shannon G, Bhopal SS, et al. Racism and discrimination in COVID-19 responses. Lancet. 2020;395(10231):1194. doi.org/10.1016/S0140-6736(20)30792-3.

Kilbourne ED. Influenza pandemics of the 20th century. Emerg Infect Dis. 2006;12(1):9-14. doi:10.3201/ eid1201.051254.

Fang J, Renaldi E, Yang S. Australians urged to ‘show kindness’ amid reports of COVID-19 racial discrimination complaints. Australian Broadcasting Corporation Web site. https://www.abc.net.au/ news/2020-04-03/racism-covid-19-coronavirus-outbreak-commissioner-discrimination/12117738. Updated April 3, 2020. Accessed April 9, 2020.

Tan C. Racism undermines COVID-19 response. Australian Human Rights Commission Web site. https://www.humanrights.gov.au/about/news/racism-undermines-covid-19-response. Updated April 8, 2020. Accessed April 10, 2020.

Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511. doi:10.1371/journal.pone.0138511.

Negin J, Rozea A, Cloyd B, et al. Foreign-born health workers in Australia: an analysis of census data. Hum Resour Health. 2013;11:69. doi:10.1186/1478-4491-11-69.

Vogel L. Doctors on their own when dealing with racism from patients. CMAJ. 2018;190(37):1118-1119. doi:10.1503/cmaj.109-5633.

D R N ATA S H A ABEYSEKERA Executive member of the AMA Queensland Council of Doctors in Training. She is currently working as a resident medical officer at the Royal Brisbane & Women’s Hospital.

10. Good medical practice: a code of conduct for doctors in Australia. Australian Health Practitioner Regulation Agency Web site. https://www.medicalboard.gov. au/Codes-Guidelines-Policies/Code-of-conduct.aspx?fbclid=IwAR1PD2af2KetvQKDHaMy8ksLVGIMpoD0fdxNKTTDV4UW5YxI6sLbEtHyJaM. Updated March 28, 2017. Accessed April 12, 2020. 11. Melbourne health workers of ‘Asian appearance’ report racist coronavirus attacks. Seven News Web site. https://7news.com.au/travel/coronavirus/melbournehealth-workers-of-asian-appearance-report-racist-coronavirus-attacks-c-718610. Updated February 27, 2020. Accessed April 10, 2020. 12. Royal Children’s Hospital Melbourne staff cop racist abuse amid COVID-19 coronavirus fears. Australian Broadcasting Corporation Web site. https://www. abc.net.au/news/2020-02-27/childrens-hospital-staff-racial-discrimination-coronavirus-fears/12004690. Updated February 27, 2020. Accessed April 11, 2020.

Doctor Q Winter 27

Maintain a healthy, balanced lifestyle We’ve always emphasised the importance of maintaining a healthy, balanced lifestyle outside the medical sphere. However, it is a new reality that many of our non-medical interests and pursuits are temporarily off-limits. Here is an empirical prescription for junior doctors to keep fresh:

TRY SOMETHING C R E AT I V E Have you been particularly artistic in your past life, or is it something you’ve always been meaning to dabble in? Perhaps this could be the time to start some sketches, or rekindle your musical talents with a musical instrument that’s been left in your back room.

DECLUTTER TO DESTRESS Clean and tidy that room or area you’ve been letting get a bit out of hand, or maybe your desktop files and folders need reorganising. Even tidying up a little can clear your mind and reduce stress more than you may think.

DEBRIEF WITH FA M I LY A N D FRIENDS Just because you need to socially isolate yourself doesn’t mean that you should verbally isolate yourself. We have demanding responsibilities at the hospital – and even more so now – so make sure you give yourself the opportunity to debrief with others. If you’d prefer to speak to someone confidentially with mental health expertise, this is available to you through DRS4DRS (https://www.drs4drs.com.au/).

28 Doctor Q Winter

BE PRODUCTIVE W I T H S PA R E T I M E You may feel a little off-balance outside the work clock with the increased downtime. Take advantage of this time to accomplish tasks at home that you’ve been putting off for longer than you go remember; whether it be sorting paper collections at home or even filtering through old pictures and videos. This may be the perfect time to look back on old cherished memories, and find some good ones to frame!

DR DANIEL MAZZONI DHASQ Committee Member and Junior Doctor Representative

QDHP

Queensland Doctors’ Health Programme

24/7 HELPLINE (07) 3833 4352

LEARN A NEW SKILL Challenge your mind in an outlet away from your hospital or clinic of practice. Is there a language you’ve always been meaning to pick up? Or a few new cooking recipes you’ve been hoarding from Masterchef? These are great ways to keep your mind ticking at home.

ADVANCE YOUR CAREER Update that resume and get a headstart on your job applications for next year. Or perhaps you’re midway through a research project that needs some invigorating. If you feel you have some energy in the tank, you’ll thank yourself later for taking the stress off any lastminute scrambles.

AV O I D OVERWORKING We know this is easier said than done. Any extra medical commitment to the hospital is fantastic, but it should not be at the expense of your personal health. If you are picking up extra shifts to support the increased healthcare demand, make sure you still have enough time to eat and sleep to function at your best.

KEEP A POSITIVE MINDSET ‘Things turn out best for those who make the best of the way things turn out.’ Take care of yourself so that you can best take care of others.

A chance observation On return from the AMA Queensland Annual Conference last September 2019, I noticed this reassuring sign on the platform of the Preston, UK railway station. It made me feel good to see at the time, emotionally. It was like being given permission to be human, normalising and easing acceptance that things aren’t right. The sign designed to not isolate one and providing empathy.

That is the value of the sign - acceptance and an invitation for help.

DR MICHAEL KENNEDY

It’s a wonderful thing about language when we consider this message. The exact opposite is also the case. That it’s not okay to be not okay” particularly when we focus on doctors, or anyone else in reality.

Retired General Practitioner and former QDHP phone counsellor

The understanding of those two lines or ‘complexities of thought’ enable and encourage acceptance and stimulate the asking of the question “do I need to do something about my health and if so, what?” You know it is hard, as one is used to dealing the cards so to speak, to be in a situation to discern, if, when and what to do. Minimising the emotion is helpful for this to occur.

I liked this sign for a number of reasons: 1. Acceptance: it is the cornerstone to freeing one’s self to address a concern or reality, where things are not okay. 2. The added notice providing the invitation to seek specific help. 3. The basis of acceptance that being human, things may not go as we anticipate or wrong in some cases despite great effort or arising in life’s vortex.

The advantage of having a GP or support medical person, where one has become used to communicating with, looking at oneself with a touch of external medical discipline, is obvious. Vulnerability, feelings of inadequacy, failure, frustration and loss of control, lurk in one’s mind, I’m sure. This working familiar approach is far far better, particularly when needs arise. The existence of an already tried relationship rather than to climb many mountains during the same period is of great advantage. The benefits, as a result of the doctor knowing you over time with relationship and

understanding adds credibility to any statements /reports made in relation to yourself. The above two paragraphs cry out to me the word “insurance”, essential in other facets of life. This article, based upon a chance observation, is intended to provide some insight into the human aspect central to decision making when things become a bit “ordinary” for ourself. Two statements locked together, provide an answer where one is incomplete. Broadly, applications to complex questions with linear thought can provide flawed under achieving outcomes for our complex undertakings. I believe that GPs and doctors generally, operate in this complex space. It’s no wonder support is mandatory to manage in life and to survive the mental demands. Perhaps this complexity provides the attractions to writing this. Dr Margaret Kay’s. “Barriers to seeking medical help” is a suggested extension regarding the above topic.

QDHP

Queensland Doctors’ Health Programme

24/7 HELPLINE (07) 3833 4352 Doctor Q Winter 29

Clinician wellbeing in the time of COVID-19 Other ways to reduce feelings of anxiety include:

D R LY N N E M C K I N L AY

Senior Medical Educator, Cognitive Institute

DR ALEX MARKWELL

Chair, Queensland Clinical Senate and Emergency Physician

Caring for the health and wellbeing of patients is a priority for clinicians, but as COVID-19 evolves we must also prioritise our own wellbeing—including our mental health. Health professionals across Queensland are working around the clock to prepare our system for the increased, and possibly unprecedented, demand from COVID-19. The situation is changing rapidly and all the while we must be on top of the latest clinical advice to ensure we are providing the best possible care to those who need it. We are bombarded by media coverage of the situation abroad and locally—it is difficult to escape the overwhelming amount of information. Then, at the end of our shift, we return home to our family where we are also adjusting to a new ‘normal’. With so much upheaval and uncertainty that could continue for months to come, it is natural to experience feelings of anxiety. As clinicians, we set such high personal expectations that we forget we are humans first (clinicians second) and that feeling anxious, even fearful about COVID-19, is a very normal human response. As clinicians though, we have many skills to draw upon to help manage these feelings. One such skill is ‘compartmentalising’. Compartmentalising allows us to differentiate between work and home, so that while at work we do that to the best of our ability and then, once we arrive home, we switch our focus to our role within our family. One of the challenges we face at the moment though is how we stop our work spilling into our home life when COVID-19 is everywhere we turn. Creating a third space between work and home will support that transition —whether it’s showering and changing out of your scrubs or uniform before you leave work, listening to music on the way home or taking the dog for a walk as soon as you get home. 30 Doctor Q Winter

•

Be prepared and understand your role – build in redundancies where possible

•

Know your trusted source of information and make a deliberate choice to limit the amount of social media and mainstream media you are exposed to

•

Practice self-care and self-compassion - be kind to yourself and others

•

Practice civility, even when frustrated, as this increases your safety and that of others

•

Seek professional help if you think you have an anxiety disorder

•

Stay at home if you are sick—the concept of ‘presenteeism’ does not foster a ‘wellbeing culture’

•

Reframe – make a choice to explain certain negative behaviours positively where possible.

Our response to COVID-19 will be a marathon, not a sprint, so it’s important that over the weeks and months ahead we are aware of the symptoms of burnout. These include exhaustion, a perceived lack of personal accomplishment (i.e. my work doesn’t make a difference), and depersonalisation. We can all build simple habits to address these symptoms, such as: •

Recognise what re-charges your battery and build that into each day

•

Reflect on your day and recognise what you did well and what you are proud of

•

Focus on the things you are grateful for—gratitude is a well-proven strategy to improve health and wellbeing.

And of course, don’t forget the basics—get enough sleep, eat well and stay hydrated. There is no denying that we may feel overwhelmed and underprepared for what could be ahead of us. But by prioritising our own health and wellbeing, we can remain engaged in the care of our patients and have the opportunity to support our colleagues through these challenging times. 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/

RESEARCH ROUND UP

COVID-19 research reviews 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 expertâ&#x20AC;&#x2122;s chosen ten research papers from global journals with their commentary on the impact to everyday practice. We have handpicked some critical research articles from the special COVID-19 issue of Infectious Diseases Research Review with respiratory expert Professor Lutz Beckert.

NON-PHARMACEUTICAL INTERVENTIONS TO REDUCE COVID-19 MORTALITY AND HEALTHCARE DEMAND

PHYSICAL INTERVENTIONS TO INTERRUPT OR REDUCE THE SPREAD OF RESPIRATORY VIRUSES

Imperial College London, 16 March

Cochrane Review

Reviewer: Professor Lutz Beckert

This paper by the Imperial College London was published on the 16 March and gave enough modelling details for governments around the world to change their policies. The authors call COVID-19 the most serious respiratory threat since 1918 H1N1 influenza. With the lack of a vaccine and pharmaceutical treatments, they discuss the social impacts of the strategies to mitigate or suppress the epidemic growth. Their modelling is chilling at times, like estimating 40 million worldwide deaths without intervention (Nature News).

The use of facemasks in public is a topic of intense debate. Their use is influenced by cultural traditions, epidemiology, environmental science and the need to ration the limited resource of PPE. Published during a less pressured time, this Cochrane review was suggesting some efficacy of N95 respirators and simple surgical masks to reduce infections. The authors found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks. The Czech Republic is an example of a European country embracing masks (YouTube).

Bottom line: intermittent physical distancing with short periods of relaxation is likely to be the most successful strategy for the next 18 months.

Bottom line: in addition to physical distancing and handwashing, facial masks may reduce the spread of infections.

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

Doctor Q Winter 31

OBITUARY

Professor John Masel AM MBBS FRACR FRCR FRACP

23 June 1932 – 26 March 2020 John Masel was born in Stanthorpe, the son of Dr Harry Masel (1902-1973), a general medical practitioner and later esteemed specialist radiologist in Brisbane. Dr Harry Masel had bought a state-of-the-art x-ray machine in 1932, the most advanced on the Granite Belt where he practised. Initially thwarted in his endeavours to embark on a specialist career in radiology because of World War II, Dr Harry Masel completed his Graduate Certificate in Diagnostic Radiology at Sydney University in 1946. With that specialist qualification, in 1947 he established a specialist radiological practice on Wickham Terrace in Brisbane. His future radiologist sons, John and Leslie Masel, grew up in the family tradition. John Masel completed his primary schooling at Stanthorpe State School. A brilliant pupil, he was Dux of Nudgee College at the age of 16; and topped the Medical Course (1954) at the University of Queensland with First Class Honours. He was awarded the rare distinction for medical students of a University Medal at the age of 22 years. Four years after graduating, he passed his examinations for Membership at the Royal Australasian College of Physicians. Fellowships of the Royal Australasian College of Radiologists (1961) and that of the Royal College of Radiologists of the United Kingdom (1969) followed. During this time in private practice as a specialist radiologist in Brisbane, Dr Masel was appointed (1966) as a Visiting Specialist Medical Officer to the Brisbane Children’s Hospital. That appointment was to begin an ongoing association, as radiologist and subsequently emeritus, giving dedicated service to the children of Queensland, for almost five decades. Dr Masel served on the Federal Council of the Royal Australasian College of Radiologists for 14 years. In 1977, at the age of 42 years he was elected as the youngest President of the Royal Australasian College of Radiologists, later renamed the Royal Australian and New Zealand College of Radiologists. He also served on the Committee of the Australasian Society for Paediatric Imaging and was elected Chairman (1981-1982). These appointments were significant in that they brought the specialty of medical imaging at the Royal Children’s Hospital and Mater Children’s Hospital into national perspective. Dr Masel’s research interests centred on the medical imaging of genetic bone diseases. He collaborated especially with Dr Kazimierz Kozlowski, Senior Radiologist at the Princess Alexandra Hospital for Children in Sydney. Their published research again demonstrated the diagnostic power of medical imaging and its potential for syndromic

definition of enigmatic bone diseases. Dr Masel’s and Dr Kozlowski’s research described new genetic syndromes; and defined the range of radiographic features essential for diagnosis. Dr Masel also collaborated with colleagues to help define the DNA abnormalities underpinning enigmatic and rare genetic syndromes. Professor Masel was also particularly interested in the chest diseases of children. In these and related areas he published 46 papers in the international refereed literature. His erudition extended also to the classics. In a paper entitled “Imagines Facere Possum – the ability to construct correct descriptive words for radiographic images” published in Australasian Radiology, Dr Masel noted “The almost complete extinction of classical studies in school [which] has led to much inaccurate usage”. In that paper he went on to describe the correct etymology for various medical terms and gave examples of correct word stems and plural forms – noting that such terms as diverticulae were forbidden as the plural form of the singular diverticulum. Diverticula is correct. Professor Masel’s towering contributions to both teaching and research are acknowledged by all who have been privileged to work with him. For 25 years, from 1961, he conducted a weekly undergraduate x-ray teaching session for final year medical students at the University of Queensland; and another weekly session for consultant staff, registrars and resident medical officers. In 1992, the University of Queensland promoted Dr Masel to the rank of full Professor within the Faculty of Medicine. In 1998, his leadership and service in all aspects of the discipline of medical imaging was acknowledged by the decoration of Membership within the Order of Australia “for improvements to services for sick children in the field of paediatric radiology”. Dr Masel retired as Director of the Department of Paediatric Radiology in July 1997. He continued to serve thereafter as a Visiting Consultant Radiologist, and esteemed Emeritus of both Children’s Hospitals in Brisbane. In February 1998, his professional colleagues, led by Dr John Ratcliffe, instigated a fund call the John Masel Award. This was established as an Education Fund to enable radiology registrars from Queensland to attend conferences and training courses in paediatric radiology. Professor Masel AM passed away on 26 March and is survived by his wife Margaret, four children, 13 grandchildren and one great grandchild. Obituary from Professor John Pearn and Dr Matt Masel.

32 Doctor Q Winter

Dr Gert Tollesson

FRACS

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re to “Offering excellent patient ca stralia” adults and children across Au BRAIN AND SPINE SURGERY QUEENSLAND (BSSQ) Watkins Medical Centre Level 10, 225 Wickham Terrace, Spring Hill QLD 4001 P: (07) 3870 3708

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Office hours 8.30am to 4.30pm After hours acute referrals please phone 0417 791 407 Consulting at Spring Hill, Brisbane and Rockhampton

YOUR BEST COMMITTEE SUPPORT

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Coordinating all venue logistics, programs, sponsor engagement, marketing and promotional material, travel, and budgets.

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Handling member queries, renewals, production of newsletters, website updates along with database management.

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Doctor Q Winter 33

Events Calendar AMA QUEENSLAND PRESENTS

Private practice webinar training series 2020 JDC 2020 ON-DEMAND

P R I V AT E P R A C T I C E TRAINING SERIES

DATE: 27 June - 22 August 2020 LOCATION: Online Junior Doctor Conference (JDC) 2020 is going online! Due to restrictions surrounding COVID-19, AMA Queensland is bringing the 2020 Junior Doctor Conference to your screens as JDC On-Demand.

WEBINAR

Friday 17 July: Policy Essentials Friday 11 September: Performance management - Speaking with staff

Launching on Saturday 27 June, the conference will be run over seven weeks, with new content being released weekly. Keynote speaker is Dr Richard Harris.

Friday 13 November: Customer Service 101 - Learning from retail and hospitality

Watch national and local speakers, listen to informative panels and engage with sponsors and your fellow delegates – all from the comfort of your own couch!

Are you interested in brushing up on your workplace relations knowledge from the comfort of your own desk? Join AMA Queensland’s Workplace Relations Advisor Jaaden Morrall for an indepth insight into current topical workplace relations matters via live webinar. If the webinar dates do not suit your schedule, you can register to receive a recording of the webinar/s to view in your own time.

2020 Events

Visit www.amaq.com.au/events for more information or to register for our events. PRIVATE PRACTICE CONFERENCE Date: 27 November 2020 Location: Brisbane Convention and Exhibition Centre

DINNER FOR THE PROFESSION Date: 27 November 2020 Location: Boulevard Room, Brisbane Convention and Exhibition Centre

MEDICO - LEGAL CONFERENCE Date: 28 November 2020 Location: Brisbane Convention and Exhibition Centre

AMA QUEENSLAND ANNUAL CONFERENCE Date: 19 September 25 September 2021 Location: Lisbon, Portugal

WOMEN IN MEDICINE BREAKFAST Date: 15 October 2020 Location: Victoria Park Golf Park

Doctor Q Winter 35

JDC 2020 ON-DEMAND

Meet the speaker: Dr Richard Harris SC OAM Australian anaesthetist and cave diver Dr Richard Harris SC OAM gained international notoriety after he played a crucial role in rescuing a junior football team from the Tham Luang Nang Non cave in Chiang Rai Province, Thailand. His previous cave diving experience combined with his expert medical knowledge, saw him advise, overlook and navigate the treacherous and dangerous conditions to save the lives of twelve young soccer players and their coach. Dr Harris and technical diver, veterinary surgeon and cave explorer Dr Craig Challen SC OAM, were jointly awarded the 2019 Australian of the Year for their work in rescuing the boys. Both men were awarded the Star of Courage (SC) and Medal of the Order of Australia (OAM) by the Governor-General of Australia. The King of Thailand appointed Dr Harris as a Knight Grand Cross (First Class) of the Most Admirable Order of the Direkgunabhorn.

Recipient of the 2019 Australian of the Year, Star of Courage and Medal of the Order of Australia awards Starting out, Dr Harris completed his Bachelor of Medicine and Bachelor of Surgery at Flinders University in 1988 and completed his anaesthetics training in the UK and New Zealand. His regular day job is as anaesthetist with particular interest in anaesthesia for breast and endocrine surgery, ENT and acoustic neuroma surgery, upper GI surgery and endoscopy. Dr Harris is also an aeromedical consultant and anaesthetist for the South Australian Ambulance Serviceâ&#x20AC;&#x2122;s medical retrieval service (MedSTAR), as well as working on medical assistance teams in natural disasters in the Pacific region and taking part in Australian aid missions to Vanuatu. The Thai rescue was really a culmination of Dr Harrisâ&#x20AC;&#x2122; many years of combining his medical interests with his taste for adventure and lifelong interest in the underwater world. His love of underwater exploration has led him to work on National Geographic documentaries, feature films and with various teams worldwide in the role of diver, underwater cameraman and of course medical support. 36 Doctor Q Winter

Dr Harris has a professional and voluntary interest in search and rescue operations, establishing the first sump rescue training course in Australasia. On top of fellowships with the Australian and New Zealand College of Anaesthetists and the Australian College of Tropical Medicine, he is a member of the South Pacific Underwater Medical Society, the Undersea and Hyperbaric Medical Society, the Explorers Club of New York, the Cave Exploration Group of South Australia, the Australian Speleological Federation, the Adelaide Zoological Society and the Australian Photographic Society. He enjoys gaining new knowledge and skills within his spheres of interest, with recent courses in emergency management of severe burns, ultrasound in intensive care, major incident medical management and incident management courses.

FROM 27 JUNE Junior Doctor Conference Online REGISTER// qld.ama.com.au/events #JDC2020

AMA Queensland Annual Conference 2020

Bringing a healthy tomorrow POSTPONED TO

19-25 SEPT 2021

In 2021, we are looking forward to celebrating the 20th AMA Queensland Annual Conference in Lisbon, Portugal. We have been very fortunate in getting tremendous assistance from the Australian Ambassador and the Portuguese Medical Association and we already have very high calibre international and Queensland speakers in what is turning out to be an inspiring program. Key topics include: doctors’ health and wellbeing: challenges and solutions; emerging technology: artificial intelligence in medicine; how sustainability can transform healthcare; the ageing population and the increasing effects on healthcare; improving health services in rural and

38 Doctor Q Autumn

remote Australia; social media stress: effects on patients and today’s youth; drugs, alcohol and mental health; and solving obesity – a global problem.

doctors,

CBRE HP

THE CHAMPALIMAUD FOUNDATION

The Champalimaud Foundation focuses on cutting-edge research and strives to stimulate new discoveries and knowledge which can improve the health and well-being of people around the world. The Champalimaud Centre for the Unknown, based in Lisbon, Portugal, hosts the Foundationâ&#x20AC;&#x2122;s activities in the fields of neuroscience and oncology by means of research programs and the provision of clinical care of excellence. The fight against blindness is also supported through a focused outreach programme. In seeking to achieve significant advances in biomedical science, the Champalimaud Foundation has adopted a translational methodology, which establishes a direct link between research carried out in the laboratory and the diagnosis and treatment offered in the clinic. This connection and interdependency is at the core of the Foundationâ&#x20AC;&#x2122;s mission to bring the benefits of biomedical science to those most in need. The program will feature speakers from the Champalimaud Foundation, but we are organising a tour of the architecturally acclaimed facility as well.

LISBON

Portugal

Lisbon is one of the most charismatic and vibrant cities of Europe that effortlessly blends traditional heritage, striking modernism and progressive thinking. The capital city of Portugal has a rich and varied history on display, such as the imposing Sao Jorge Castle and Belem Tower. The view of the old city encompasses the pastel coloured buildings, Tagus Estuary and Ponte 25 de Abril suspension bridge. Within a very short distance from the city is a string of Atlantic beaches, from Cascais to Estoril. Lisbon is blessed with a spectacular range of eateries, a buzzing nightlife and glorious September weather. For more information, visit www.amaq.com.au/events.

Doctor DoctorQQAutumn Spring 39

ACCESS TO THE LATEST EMPLOYMENT CONTRACTS

COMPREHENSIVE WORKPLACE RELATIONS MANUALS

FREE WORKPLACE RELATIONS TRAINING

PLUS LOADS MORE

(07) 3872 2222 workplacerelations@amaq.com.au https://ama.com.au/qld/wr-advisory-package

FRA N SMI TH PRA CTIC E COO RDI NAT OR

Standing by our customers and communities during COVID-19 On 31 December 2019, when we were all celebrating the year that was and making plans and resolutions for the year ahead, it would have been hard to predict what 2020 had in store for all us. While uncertainty is unsettling, I take comfort in knowing that Australia has faced many challenges before, whether it be severe weather events, natural disasters or economic volatility and we have always emerged stronger than before. For us at Suncorp, while we continue to navigate the ever-changing COVID-19 environment, our top priority remains supporting the health and wellbeing of our people, customers and communities. Like most companies, new social distancing practices and isolation restrictions have changed the way we work, changed the way we interact with our team members and changed the way we provide essential banking services to our customers across the country. But I assure you, our commitment to being there for our customers when they need us most, remains unchanged.

BRUCE RUSH

Suncorp EGM Deposits and Payments P: 13 11 55

As the situation has unfolded, we have been evolving our way of working with more people working from home and supporting our customers online and via the phone. Where possible, our bank stores have remained open, but we have introduced additional measures to protect the health and safety of our store teams, including new hygiene, visitor protocols and opening times.

From a financial perspective, we know this can be a difficult and confronting time for many people, especially small business owners, and it’s critical to ensure they have the support they need to get through this period. The support options and financial relief measures introduced by Suncorp aim to support everyone who may be facing financial challenges as a result of this situation. Our dedicated COVID-19 support hub on our website, includes all the details of Suncorp’s support measures. Suncorp was also proud to donate $1 million to the Smith Family, which will see 500 digital inclusion packs be delivered to vulnerable kids across the country, giving them access to a device, the internet and support they need to remain connected to their teachers and classmates. COVID-19 has certainly put a spotlight on the growing digital divide facing many communities. The work we’re doing with the Smith Family will go a long way in bridging the digital divide cap and helping to ensure no one gets left behind during this crisis. On behalf of the entire Suncorp team, our thoughts are with those impacted by this virus and with those who are feeling the strain of what’s happening around us. And I want to assure all our customers and stakeholders that we continue to stand ready to you support you all through this.

Doctor Q Winter 41

Investing in new equipment – is now the right time? We are currently living in strange and uncertain times. From the pressures on doctors on the front line, to the strain on the healthcare system and its supply chain and, of course, your own personal health, we recognise the impact COVID-19 is having on the medical community is onerous and significant. For some, this is compounded by the devastating bushfires that swept the country recently leading to a challenging first half of 2020. It is at times like these that you may ask yourself what your approach to investing in new equipment should be. Reviewing your current business plans and strategies should be top of mind. If upgrading or purchasing new technology and equipment fits within those plans, then you should still consider the investment. Don’t forget that the financial year started on 1 July 2019 so prior to the most recent quarter, you have good earnings to manage with the tax man. Thanks to recent changes to the government stimulus package, you can also upgrade technology, support long-term growth in your practice and reduce your taxable income.

GOVERNMENT STIMULUS BUSINESS INVESTMENT

PACKAGE

SUPPORT

The government recently announced its goal to deliver support for business investment as part of its economic plan. This included a fivefold increase to the instant asset write-off threshold from $30,000 to $150,000 for eligible assets, which include new or second-hand assets first used or installed ready for use from 12 March 2020 until 30 June 2020 – unless extended*. Further, for eligible assets that exceed $150,000 acquired from now to 30 June 2021, you can now take advantage of accelerated depreciation with 50 per cent upfront and the balance over the typical depreciating useful life of the asset. Generally, tax deductions only apply at your marginal tax rate so in uncertain environments it’s critical to discuss your cash flow with your specialist advisor if you’re looking to take advantage of this.

SIMON MOORE

Finance Specialist credabl.com.au/amaq Live chat at www.credabl.com.au P: 1300 27 33 22 E: simon.moore@ credabl.com.au

WHAT FINANCING IS AVAILABLE? A common misconception is that you can only get the instant write off if you pay for the goods. This is not true, you can borrow the funds and still receive the benefit. Interestingly, often the interest on a loan over say three years will be similar to the interest you can earn on the equivalent cash in the bank. Facilities such as a chattel mortgage, lease and rental provide a range of financing options that can be tailored to best suit the needs of the business. As always, it’s best to speak with your financial advisors/ accountants about specific advice for your own situation, and the team at Credabl are always here to support your plans with bespoke funding solutions. Contact the Credabl team today to find out about your equipment and technology finance options.

EQUIP YOURSELF AND YOUR PRACTICE FOR SUCCESS Reviewing the needs of your practice is vital in ensuring your practice runs smoothly and efficiently, especially in times like this where there’s so much uncertainty. The equipment a medical practice needs to perform efficiently may vary based on your specialty and technological advancements or size and scope of the practice. Anyone fitting the eligible criteria should be seriously consider their options when it comes to buying assets used within their business, such as medical equipment, IT equipment, practice furniture and fitout and all work vehicles. This article is a guide only and does not constitute any recommendation on behalf of Credabl Pty Ltd (ACN 615 968 100) or any of its related bodies corporate (Credabl). The information in this article is general in nature and we have not taken into account your personal objectives or financial circumstances or needs when preparing it. Before acting on this information you should consider if it is suitable for your personal circumstances. Credabl is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. * The instant asset write-off scheme will expire on 30 June 2020, presenting a very short window of opportunity to take advantage. After June 30 2020, the arrangement will revert to an instant asset write-off for purchases Federal Government’s COVID-19 Economic Stimulus Package under $1,000, with all other purchases deducted under normal depreciation schedules, which depend on the normal operating life of the asset.

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We’re not letting the distance come between you and our team. Working remotely means our service just got more personal. At Credabl, our priority is making sure the medical community has easy and immediate access to the financial support they need to get through uncertain times and plan for the recovery journey ahead. From a video chat with a familiar face, to providing financial support to fund business or personal expenses, our specialist lending team is here to support you.

credabl.com.au/amaq

1300 CREDABL (1300 27 33 22)

Practice Purchase • Commercial Property • Goodwill Loans • Overdraft Facilities • Home Loans • Car Loans • Equipment & Fitout Finance • SMSF Lending The issuer and credit provider of these products and services is Credabl Pty Ltd (ACN 615 968 100) Australian Credit Licence No. (ACL) 499547.

Is COVID covered by insurance? The World Health Organisation announcement in March this year that the COVID-19 coronavirus outbreak would be classified as a pandemic has triggered governments worldwide into a flurry of action. For many medical practices and doctors, the measures introduced to help slow the spread of the virus have meant a significant reduction to revenue and forced changes to their business model. Telehealth introduced, procedures cancelled, staff working from home (where practical), staff stood down and other impacts. These changes have introduced additional risks. While this article mainly focuses on insurance, it is important to take risk management action first, as in many cases, insurance is not the answer – and at best will only respond to an insured risk, and not help mitigate/prevent it. Over the past few months, we have fielded many questions from clients around how insurances may respond. Commonly, the question starts as: “Do my practice insurances cover COVID19” This is a broad, open-ended question and not a straight-forward answer, as it depends on what risks/policies the person is referring to and the particular insurances they have in place. The main risk management and insurance discussions we have had with practices are per the table on the next page.

JAMES WARWICK

Senior Account Executive P: (07) 3117 2470 E: james@mgrs.com.au Authorised Representative No.434578

Disclaimer: DISCLAIMER: Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687. Authorised Representative No 436893. The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.

BUSINESS INTERRUPTION INSURANCE Many practices will (or should) hold Business Interruption (BI) insurance under a Business Package insurance policy. BI covers loss of revenue and additional costs incurred for a defined period (usually 12 months or more) where the insured entity is impacted by an insured event such as fire, storm, theft, or other physical event occurring at the premises. Most policies will also extend to cover other events such as a loss of public utilities and closure by government authority following certain events. The question now being asked is whether Business Interruption insurance will cover a practice for losses incurred directly or indirectly COVID-19? To be blunt, the answer will almost certainly be a no. While there may be a few exceptions to the above, given how insurance policies can vary widely, generally Business Interruption insurance will not cover disruption caused by a pandemic. This is for the simple fact that insurers (and their re-insurers) would never be able to hold the reserves of capital necessary to pay claims projected to be in the hundreds of billions or trillions of dollars - and a bankrupt insurance industry is of no use to anyone. This is also why war is excluded. So, to remove any doubt, insurers exclude cover for any disease

44 Doctor Q Winter

that is notifiable under the Quarantine Act 1908 and or the Biosecurity Act 2015, which as of 2020, includes COVID-19. Even where a practice is closed by order of public authority, exclusions such as this will exclude the claim: Cover is extended for loss that results from an interruption of your business that is caused by: a) any legal authority closing or evacuating all or part of the insured location as a result of: I. the outbreak of an infectious or contagious human disease occurring within a 20-kilometre radius of your insured location, however there is no cover for highly pathogenic Avian Influenza or any disease declared to be a quarantinable disease under the Biosecurity Act 2015 (Cth) (as amended) irrespective of whether discovered at your insured location, or out-breaking elsewhere. Insurance issues around COVID-19 are complex, as can be seen by this brief article. It’s important to review your individual circumstances and your policies. Seeking advice from your insurer can be a good starting point, but remember – often you will be dealing with a call centre person whose duty is to the insurer – and not to you. So speak to an insurance broker/ adviser who specialises in medical practices.

RISK AREA

ISSUES

INSURANCE RESPONSE

Impact to revenue

Is the reduction in my revenue covered either because my practice is closed by the health authority, patients simply stop turning up or certain procedures are now banned?

Most likely no cover under Business Interruption insurance (see Business Interruption Insurance section for further details). But every policy is different so your individual circumstances and policy need to be reviewed.

I contract COVID19, or I am required to self-isolate

Does my Income Protection insurance cover me?

Contact your financial planner who should be managing your Income Protection and life insurances. We understand that good Income Protection policies will cover you for any illness and there are no specific exclusions around pandemics. No cover applies until a diagnosis is made and you have a doctor’s certificate to say you are unfit for work - and then most policies have at least a 30-day waiting period. There are other issues to discuss with your planner such as life and TPD covers, what is within your superannuation, etc.

Occupational Health and Safety

What if a staff member contracts COVID19 at work?

Generally, Workers Compensation covers work-acquired illnesses from the date of diagnosis. Employers have a duty to take reasonable steps to provide a safe workplace. OH&S fines and other actions can be made against companies and owners/managers. A good Management Liability insurance policy will cover OH&S fines, legal expenses to defend/manage actions including Directors & Officers exposures. Also see https://www. worksafe.qld.gov.au/ and contact the AMA Queensland Workplace Relations team for employment related advice.

Employment / staffing

Due to a reduction in revenue we need to stand down staff, make redundancies, cease to give casuals hours

A number of insurances can respond to cover legal fees to defend an employment claim brought by a staff member. Management Liability will cover both the legal fees, and compensation awarded – but not where the compensation is an entitlement (e.g. if you are required to pay redundancy this is an employee entitlement and not covered by insurance). Contact the AMA Queensland Workplace Relations team for advice.

Medical Negligence or Public Liability

What if a patient contracts COVID19 while at our practice?

This could either be a medical negligence, or a public liability claim as it will depend on the circumstances. E.g. Legionnaires through the airconditioning will generally be regarded as a public liability claim. Check your policy as some do exclude the transmission of a contagious disease. For example, one medical indemnity policy excludes “the transmission of a contagious disease or virus by you if you knew or should reasonably have known or suspected that you were carrying the disease or virus”

Telehealth – medical negligence

What if a patient alleges medical negligence against me/my practice following a telehealth consult?

The better medical indemnity policies (for the doctor and practice) will specifically cover telehealth consults. There may be some requirements such as limited to Australian-based telehealth consults and to follow certain protocols etc. Check your own policy as cover varies. Most of the medical indemnity insurers have also placed FAQs on their website advising what they intend to cover.

Medicare billings

We are introducing Telehealth. What if we bill incorrectly?

The better medical indemnity policies (for the doctor and practice) will cover the legal expenses to assist you with an audit, including telehealth. No policy will cover any amounts you need to repay to Medicare (including under the Medicare Shared Debt Recovery Scheme). So ensure your billing practices are compliant.

Privacy Risks

We’ve introduced telehealth and also some staff are working from home, dealing with patient health information. What if we breach patient privacy?

Firstly, under the Privacy Act you need to take reasonable steps to protect patient privacy. The starting point should be a Privacy Impact Assessment (see https://www.oaic.gov.au/privacy/guidance-and-advice/guide-toundertaking-privacy-impact-assessments/) Insurance-wise, a good cyber/privacy policy will cover the legal and expert costs to assist you with conducting a breach investigation and if it is a notifiable data breach then actioning that accordingly. Your medical indemnity may provide some cover for a patient civil claim, the privacy fine (which can be up to ~$2million) and this depends again on your policy (some policies are much better than others, but regardless a separate cyber/ privacy should be help at the practice level)

Doctor Q Winter 45

How pandemics affect your wealth protection covers As COVID-19 has dominated the news cycle, we have been inundated with questions about how personal insurance providers are reacting to the pandemic and what it means for income protection policies. We have compiled a small FAQ section below to address any questions/concerns that you may have for yourself or someone that you know. Q: I was stood down from my employer due to COVID, will my income protection cover me for this? A: No, the purpose of income protection is to provide a monthly income to those who are unable to work due to their own physical illness or injury and does not cover being stood down, made redundant or general job loss. Q: If I contract COVID-19, will my cover pay out? A: Yes, if you are unable to work due to contracting the illness, your income protection will (in most cases) pay out. Keep in mind that your income protection will include a waiting period, which varies depending on the policy that you

have established. This can range from 14 days to two years and you will need incapacitated during this waiting period before your benefit will pay out. Q: I only have cover through my default super fund, will I still receive a payout? A: This will depend on your superannuation provider. For QSuper, a pandemic clause has been included. This states that QSuper will not pay a claim that arises (directly or indirectly) from a pandemic illness where your date of disablement occurs within 30 days of the commencement of your cover. If you already had income protection before 18 March, the 30-day waiting period would not apply and you will be covered. If you have just joined QSuper and your income protection is in force, you will not be covered if you contract a pandemic illness within the first 30 days of that cover going into force. It is worth keeping in mind that superannuation providers that offer insurance will provide what is known as â&#x20AC;&#x2DC;group coverâ&#x20AC;&#x2122;. With this type of cover, the superannuation fund has the discretion to change the conditions on the policy at any time, this may (in the future) include a pandemic clause

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

stating that they will not cover pandemic illnesses at all. If you have group cover, contact your super fund or ask MGR to look into it on your behalf to assess your exposure. Q: I donâ&#x20AC;&#x2122;t currently have any income protection, can I still get cover now or are insurers not issuing new policies/placing extra exclusions and underwriting criteria? A: For most providers, it is business as usual. If you are to undertake underwriting with a high-quality insurance provider (such as those we recommend), your duty of disclosure continues until the cover has been accepted and is in force. If you have had COVID-19 or contract it during the application/underwriting process, you may be subject to an exclusion and any complication that arises as a result of the illness may not be covered. As always, it is important to apply for covers while you are healthy as it guarantees the best outcome. The longer you wait to apply for cover, the more chance you will attract exclusions (as injuries and illnesses mount over your lifetime).

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:

Free insurance health check

• • • • • •

Medical Indemnity Practice Indemnity Management Liability Business Rooms Insurance Cyber Risks Personal Insurance (Life/TPD, Income Protection, Trauma)

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

PERSONAL INSURANCE

JAMES WARWICK

NICK WEBB

JON PAPINCZAK

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 Winter 47

When curiosity kills professional conduct

JANET HARRY

Medico-legal Advisor, MDA National

THE CASE

W H AT I F I A C C E S S E D T H E R E C O R D ?

A well-known rock band cancelled their tour and left the country with a plan to self-isolate at home. Prior to their departure, the lead singer became acutely unwell requiring hospitalisation and treatment after testing positive to COVID-19.

With so much personal health information being stored online, regular audits are conducted within hospitals to ensure there is accountability when it comes to patient privacy. At MDA National, we have assisted several doctors who have been investigated for looking at the medical records of their partners, other family members, or ‘celebrity’ patients.

No one knew the singer had remained in Australia – so when the star’s diagnosis was splashed across the front page of a gossip magazine, the hospital had no choice but to investigate the leak. The article included specific clinical information that could only have been known by accessing the patient’s medical record.

T H E I N V E S T I G AT I O N Several doctors at the hospital were asked to explain why they had apparently accessed the famous musician’s medical records. Although the investigation was being conducted by the hospital, the doctors were advised that they could be referred to the Australian Health Practitioner Regulation Agency if they were found to have breached hospital policy in relation to privacy.

48 Doctor Q Winter

Significant penalties can apply if you’re found to have accessed medical records when there is no clinical justification for doing so. In addition, there can be serious consequences at work – including disciplinary action, and even dismissal. Medical practitioners working in hospitals should ensure they only access records and other health information about a patient when involved in the care of that patient, or for a purpose approved under hospital policy.

THINGS TO THINK ABOUT •

Ignorance is a poor defence if you knowingly breach a patient’s privacy. Ensure that you know your hospital’s policy on privacy, as it’s not enough to claim you were unaware of its existence.

•

Make sure you log out after accessing your patient’s records so that your login credentials cannot be used inappropriately by anyone else. There are many good reasons to protect your electronic footprint, and patient privacy is certainly one of them.

•

If there is a universal login ID, ensure that you only access records where you’re personally involved in a patient’s care, or you have been directed to do so by someone senior.

•

If you believe there is a genuine educational or other reason for you to access patient information, discuss this with your supervisor and document the discussion before accessing the notes.

•

Remember that the bigger the celebrity, the greater the risk that their personal health will be inappropriately accessed, and an electronic audit trail examined.

Doctor Q Winter 49

Keeping your practice going during COVID-19 Are you finding it hard to manage your practice during this pandemic? While the way in which we do business has changed under the new normal of Covid-19 the foundations of a successful practice have not. It has never been more important to get back to the basics and review these fundamentals.

UNDERSTAND YOUR FINANCIAL POSITION Make sure you are maintaining up-to-date and accurate information. This is the key to making informed decisions, by ensuring that you keep your accounts current. The impact of restrictions imposed by the government, being able to pay outstanding debts, the ability to trade, hold onto employees, meet existing lease payments, and loan repayments are all assessed by your financial position.

ANGELA JEFFREY

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

CHECK YOUR ELIGIBILITY FOR GOVERNMENT ASSISTANCE The government has several stimulus packages available, some of which will happen automatically and others for which an application must be completed. Please see our website for an overview of these or feel free to call to discuss.

REVISIT CASH FORECASTS Consider any incentives that you are receiving such as JobKeeper, Cashflow Boost 1 and 2 and of course the impact on your expenses. Review and identify what expenses can be cut or deferred until the business picks up again. Review any expenses that are no longer working for your business and look to reduce or cancel these outgoings.

KEEP AN EYE ON YOUR KPIS Look at what is actually happening to your practice. Go back and assess what is happening now versus how it was going this time last year. Look at the key areas which drive the success of your practice, your patients, your services and most importantly, your team.

CONTACT YOUR BANK AND INSURERS Contact your bank or financial lender to discuss options available to you as many lenders are offering three to six monthsâ&#x20AC;&#x2122; loan repayment deferrals. This may also apply for relief from personal mortgages or loans. You may also be able to negotiate interest rate reductions. Also talk to your insurers, as you may be able to defer insurance premiums for up to six months, request a refund of unused premiums for any policies you may have needed to cancel and receive a credit or refund for any travel insurance premiums. Be sure to ask if you will still be covered if your premiums are deferred for a period of time.

SEEK ADVICE ON DEFERRING TAX PAYMENTS The Australian Tax Office (ATO) has given the option for the deferral of tax payments to September 2020 for any debts incurred January 2020 onwards where a taxpayer is having difficulty paying their tax. We recommend talking to your accountant or the ATO as soon as possible to discuss your situation.

TALK TO YOUR LANDLORD Be on the front foot and open a dialogue with your landlord and see if you can come to an arrangement. There is a Code of Conduct that has been released by the government and this can be found on our website.

SEEK ADVICE AND KEEP UP TO DATE ON CHANGES Speak to your accountant to assist with formulating an action and assessment plan during this pandemic. It is also an important time to focus on what you would like your business to look like when we all come out of COVID-19. What systems and processes would you like to keep and the actions required to get back on track? William Buck offers tailored strategic recovery planning session, so we are here to help.

50 Doctor Q Autumn

SPECIALIST

ADVISORS TO THE MEDICAL

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

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

A M A Q U E E N S L A N D F O U N D AT I O N

The AMA Queensland Foundation turns 20! Established by doctors in July 2000, the Foundation supports AMA Queensland members to identify people in need of financial assistance. Our goal is to help alleviate sickness, suffering and disability amongst Queenslanders in need and to support our medical students at financial risk of not being able to continue their studies. To do this, we call on the collective talents, resources and compassion of our AMA members and supporters across Queensland. We are dedicated to championing and supporting doctors doing good.

20 YEARS OF MAKING A DIFFERENCE With the help of AMA Queensland members, the Foundation has contributed over $1.7 million to improve the health and wellbeing of many Queenslanders facing sickness, disability or financial hardship. The AMA Queensland Foundation has provided funding for the below programs and many more: •

Providing over $450,000 in financial assistance to 24 medical students studying in Queensland. Our first scholarship holder, Dr Emily Vagg, graduated in 2009.

•

Funding ENT surgical produces for 36 remotely-based Queensland children.

•

Supporting Drs Joss O’Loan and Matt Young by assisting to fund their highly successful Hep C Kombi Clinic.

•

Purchasing equipment to support those living with Motor Neurone Disease and Muscular Dystrophy.

•

Financially assisting Dr Lara Wieland’s Out There Kowanyama Leadership Program.

•

Funding specialised tele-practice programs for children living remotely requiring intensive speech therapy support.

•

Purchasing medical equipment to strengthen regional health screening programs.

•

Financially supporting Dr Sharmila Biswas’ Rosie’s Cairns street outreach program that provides vital service to the homeless.

52 Doctor Q Winter

HOW CAN WE HELP YOU? Recommend a Funding Initiative It’s so important for the medical community to come together to not only support the work of the Foundation, but to advocate on behalf of those who need the Foundation’s support. The Foundation is always searching for Queenslanders to support. We are a Public Benevolent Institution, which means our support must be specifically targeted at people in need and not broader general community programs. Do you have patients falling through the gaps? The Foundation can directly fund a patient of yours who needs financial support for a critical medical intervention or an organisation you are involved with that directly provides support to those who need significant assistance. The Foundation would also like to work with members to develop or continue long-term projects that specifically target those with significant needs in your community. The Foundation welcomes your funding applications for patients in need. Please see our website www.amaqfoundation.com.au for criteria and conditions.

HOW CAN YOU HELP? We also ask that you please generously support the work of the Foundation as we receive no government funding and rely on gifts, grants, donations, bequests and corporate sponsorships to make the work of the Foundation possible. There are many ways you can to support the Foundation to make a difference: 1. Make a tax-deductible donation during our annual tax and Christmas appeals. 2. Participate in “Operation Donation” Week where you donate the proceeds from just one performance of your most common operation, procedure or service – again tax deductible. 3. Become an AMA Queensland Foundation regular giver by pre-authorising monthly, quarterly, or an annual tax deductible donation. 4. Make the AMA Queensland Foundation your charity of choice when participating in community events such as the Bridge to Brisbane, Gold Coast Marathon Festival or the Cairns Ironman. 5. Make a bequest in your will to ensure that the Foundation lives on. All contributions are gratefully received and acknowledged. For further information on how you can help please visit www. amaqfoundation.com.au. If you would like to speak to us about a funding initiative or making a donation, please don’t hesitate to call us on (07) 3872 2222 or email amaqfoundation@amaq.com.au.

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

DONATE ONLINE AT www.amaqfoundation.com.au

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

Donations are recognised in AMA Queensland publications. Please acknowledge my contribution in the name of:

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PLEASE RETURN TO: (30 characters max. i.e. The White Family, Mr T & Mrs S White, Sue & John White) I would prefer to remain anonymous.

AMA Queensland Foundation PO Box 123, Red Hill Q 4059

Thank you for your support! Doctor Q Winter 53

Travelling after COVID-19 When COVID-19 restrictions are a thing of the past, travel will be a priority again. However, after the past few months of tough restrictions and social distancing, some of us may still be a bit wary of crowds. Well, there are plenty of options available to enjoy, with fresh air and open spaces. Some close to home and some a bit further afield. Here are some fantastic options close to home to get your bucket list started.

AUSTRALIAN HIKES How about a walk along the Great Dividing Range, through World Heritage Listed Gondwana Rainforest and see our native flora and fauna in all its glory? Experience wild luxury as you traverse through the Scenic Rim – and only one hour from Brisbane! At the end of each day’s walk, you will be welcomed with champagne and hot showers, chef-prepared meals and luxury accommodation. Or maybe Tasmania and a Bay of Fires four-day walk? Spend four luxurious days of superb beach and coastal walking that combines accommodation at a private standing camp and the stunning Bay of Fires Lodge.

HORSE RIDING Don’t want to walk? OK, that’s not a problem. How about The Man From Snowy River? Imagine a day of riding through the high country – stopping for the obligatory billy tea and damper for smoko. Then after you have fed your horse and set up camp, you can go for a walk and find a stream that has perhaps the sweetest water you will ever taste. Then feeling relaxed after an amazing dinner, sitting around a campfire under the Milky Way and spotting the Southern Cross you listen to the poem The Man From Snowy River.

HIKING OVERSEAS Ready to travel a bit further? When you think of blue skies, clean air and open spaces – think Montana. You can do a hike in Yellowstone National Park, a rafting tour in Glacier National Park and then how about a bit of fly fishing? Spend four days hiking in the Black Canyon of Yellowstone National Park. You will walk around 10kms each day, you can carry your own pack – or you can get a porter to carry it to for you. Each night you will camp under the stars and during the day see the amazing wildlife, mud pots and hot springs, pristine rivers, streams and lakes and the stunning mountain peaks as your background. Then after this bit of back to nature – spend a few nights in a luxury cabin on the banks of Yellowstone River. Walk outside your door and catch the trout of your dreams, dip in Chico Hot Springs and drink like a cowboy at the Old Saloon. These are just a few of the many amazing options that are available for those that want to avoid the crowds – there are so many more options like driving a Harley Davidson on Route 66, golfing in the Canadian Rockies, Barnbougle in Tasmania or one the many golf courses in the Bay of Islands in New Zealand.

Orbit World Travel - AMA Queensland preferred travel provider: P: 1300 262 885 E: travel@amaq.com.au holidays.orbitworldtravel.com.au 54 Doctor Q Winter

All about you TV: THE UMBRELLA ACADEMY On one day in 1989, 43 infants are inexplicably born to random, unconnected women who showed no signs of pregnancy the day before. Seven are adopted by billionaire industrialist Sir Reginald Hargreeves, who creates the Umbrella Academy and prepares his “children” to save the world. In their teenage years, though, the family fractures and the team disbands. Fast forward to the present time, when the six surviving members of the clan reunite upon the news of Hargreeves’ passing. They work together to solve a mystery surrounding their father’s death, but divergent personalities and abilities again pull the estranged family apart, and a global apocalypse is another imminent threat. On Netflix now.

BOOK: BETTER LUCK NEXT TIME An iconic feminist leader, elderly, powerful and respected, is mother to three adult daughters in various stages of self-destruction. Their whole life they’ve been told they could have it all, but why are their lives falling apart? The choices they’ve made over their adult years are coming back to haunt them. And how do they start again? Over the course of an eventful year, the Hennessey children contend with the big struggles of midlife: aging parents, raging teens, crumbling marriages and bodies, new loves, and the choice between playing it safe or taking life-altering risks. And as they inch toward a new definition of happiness, they might even persuade their parents - and themselves - that they’re all grown up.

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Doctor Doctor QQ Summer Winter 55 55

Motivations The corona crisis has seen the best and worst of our world on display. The death, the financial and psychological carnage and heart-breaking scenes of powerless doctors and nurses being pushed into battle with an overwhelming enemy in their daily struggles have been devastating. It parallels wartime in this sense. As much as I hate reading about the tragedies of the World Wars - the waste of humanity’s best bodies and minds – I also feel inspired by reading about the selflessness, self-sacrifice, incredible altruism and heroism. Some of the actions of brave young men and women during war times really move me to tears at times. I felt the same visceral reaction when I read about our doctoring brothers and sisters in Italy during the corona crisis. By mid-April, already a hundred brave doctors had died, victims of an illness they almost certainly contracted while saving other people’s lives on the front line. They had been serving their fellow man, serving humanity. It made me reflect on motivations. And specifically, the motivations that drive doctors. I can count on three main driving influences that keep us heading to our practices each day. I don’t doubt that money drives some of our actions. We are in the luxurious position of being guaranteed a pretty good wicket when it comes to pay. Not too many doctors live on the poverty line. I am sure at various stages of our lives, the financial gains of medical life come into finer focus. When the mortgage is at its most intimidating, when kids head off to private schools, when the arthritic back starts dictating that cattle class to London really is a struggle and the allure of horizontal travel in business class calls like a siren’s song. But I doubt too many of us are driven purely by the cash. Money can’t keep you interested for the 40 odd years of a medical career. Besides money, a sense of duty drives many of us at various times and stages of our careers. There are times when you know you need a holiday but that sense of having to “do

56 Doctor Q Winter

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

the right thing” for your practice, colleagues and of course patients forces you into the shower every morning and you just keep grinding it out. One more day, one more week, one more month. That delusional sense of being indispensable certainly percolates through our profession. But money and duty can’t explain the actions of those hundred Italian doctors and all their mates who were lucky enough to survive. No amount of money and not even duty’s call can drive a person to head into death’s jaws on a daily basis. There has to be something more. They were short on protective equipment - no masks, no gowns, no gloves and yet they still went to work to diagnose, comfort, treat and support their patients. And for the emergency teams, these patients were all total strangers. People they had never met. People who meant nothing to them until they entered their cubicle in the hospital. But in the eyes of these noble men and women, they were fellow human beings, suffering and in desperate need and despite the enormous personal risk, they served their fellow man. Each and every one of them is a hero, as heroic as any soldier facing their own mortality in the trenches of the Western Front, the slopes of Gallipoli or the jungles of the Kokoda Track. These noble medical champions faced the viral bullets every minute of their prolonged shifts. They suffered exhaustion, the loss of mates, the sense of futility and the sense of powerlessness that our khaki heroes know. They really made me proud to be a doctor. I suppose modern doctors have never known this personal risk. Doctors on the front lines during wars and doctors who practiced during various other infectious scourges faced these dangers every day. What must it have been like to be a GP during the various polio outbreaks or the small pox era? Fancy being a bloke like Dr Noel Chevasse who won two Victoria Crosses as he operated in the trenches of the Western Front. As modern doctors, perhaps, we have had a good run. It inspires me to know that this incredible sense of altruism is still alive in Italy.

Beef Cheeks in Shiraz Serves 4

INGREDIENTS

INSTRUCTIONS

Beef

Trim the beef cheeks and seal in a heavy based pan until dark golden on all sides. Remove and reserve and season with salt and pepper. Peel and dice the carrot, celery and onion, crush the garlic and caramelize until golden. Add the beef pieces back into the pan and throw in the thyme, bay leaves, a good pinch of salt and a few turns of freshly milled pepper. Deglaze with a good slouch of red wine and port. Reduce by half add the veal jus and stock. Bring to the boil. Taste and adjust the seasoning if necessary. Cover and place into a slow oven 140C for 4 hours, when the beef is tender, remove from the liquid and reserve. Strain and reduce the stock until you achieve a good beef and red wine flavour. The sauce should not be too sticky but with enough body to coat the back of a spoon. Adjust with more red wine as a reduction if necessary or a gastric of sugar and red wine vinegar if the sauce is not sweet enough.

4 pieces Beef cheek 1 Carrot 1 stick Celery 1 Onion 2 Garlic 1 Bay leaves 1 Sprig Thyme Salt Pepper 250ml Veal Jus ½ bottle Red wine ¼ bottle Ruby port Mash 2 large Potatoes 100g Butter 10ml Milk Salt Pepper Onions 4 large Onions 75ml Olive Oil Salt Pepper Sherry vinegar

Mash Scrub the spuds under running water to remove any dirt, dry and place on bed of rock salt approx 5mm thick – place into moderate oven 180C until the skins are crisp and the potato is fluffy inside. Pass through the mesh of a fine sieve quickly and place into a heavy based pot. Add a splash of boiling milk a sprinkle of salt and add half the butter. Whisk vigorously until smooth and creamy add the remaining butter to enrich and stiffen the puree. Reserve warm. Onions Peel and slice the onions finely and add a splash of oil to the pot. Start on a low heat to extract the sugars from the onions as they begin to wilt and soften. Add a pinch of salt a sprig of thyme. Increase the heat a notch and begin to brown and caramelize the onions, you should smell lovely sweet onion aromas. Add a splash red wine and reduce until almost gone. The onions should be soft, deep red and jammy in consistency. To serve: place a piece of beef cheek into a bowl, pile a spoon of the red onion marmalade onto the beef and add a quenelle of mash to the back of the plate. Sauce and serve. The Wine 2018 Manser Block 4 Shiraz, embarrassingly massive requiring a decant for at least an hour but truthfully this should be consumed over three days. The concentration of fruit comfortably overwhelms the 25 per cent new French oak which only compliments the layers and layers of black and blue fruits on offer. It’s 2016 predecessor ranked third in Grange Challenge #7 in Brisbane last year finishing in front of 2010 Grange – worth a look and a damn site cheaper than the former.

Doctor Q Winter 57

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Brukner & Khanâ&#x20AC;&#x2122;s Clinical Sports Medicine 5e, Volume 2: The Medicine of Exercise Peter Brukner, Karim Khan Brukner & Khanâ&#x20AC;&#x2122;s Clinical Sports Medicine, the world-leading title in sport and exercise medicine, is an authoritative and practical guide to physiotherapy for clinicians and students. This second volumne, The Medicine of Exercise, focuses on the health benefits of exercise and discusses the current medical issues in sport. The six sections are: physical activity and health; managing medical problems; exercising in challenging environments; exercise medicine for specific groups; performance and ethics; and practical sports medicine.

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INPRINT WINNER Dr Jan Covacech won a copy of Thin Sanity by Glenn Mackintosh, thanks to the author. Unfortunately, no one won Dendy tickets in the last edition, or in our monthly Events and Training enews either. Dendy had to close during the COVID-19 lockdown and hope to reopen soon. 58 Doctor Q Autumn

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