Medical Forum 03/12

WA’s Independent Monthly for Health Professionals

Russell Woolf Living On Air ... and loving it

• Curtin Medical School?

• Not Everyone’s Baby • E-poll: Health Waste

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March 2012

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Contents

Major Sponsor

NEWS & VIEWS

CLINICAL FOCUS

2 Letters

33 New Developments in

Chronic Heart Failure

SLEs Are Getting Real

Dr Mark Hands

E/Prof Louis Landau

Recruits Needed Prof John Newnham

Medical Money Dr Gerard Hardisty

3 Editorial

The Power of Being Positive Dr Rob McEvoy

35 Simulation for

4

Anaesthesia Education Dr Emelyn Lee

37 How to ‘Hit The

Books’

40 An Overview of

Hearing Implants Dr Peter Santa Maria

43 Secondary Victims of

Update: WA Surgical Audit

Homicide

Dr Ann O’Neill, PhD

14 Have You Heard?

18 E-poll

Professional Ethics and More

Health Waste Concerns

22 Abrolhos Group

Re-establishes Foothold

23 AHPRA and the

8

LIFESTYLE 44 Dr Sam Brophy-

Williams: A Life Less Ordinary Mr Peter McClelland

46 Bust Mystery Solved?

E/Prof Max Kamien

47 Let’s Hear it for

Bikabele!

Medical Board WA

Ms Morag Smith

26 2014: Curtin Medical

School?

48 Satire: Field of Bad

Dr Rob McEvoy

30 Beneath the Drapes

Practice Tip: Delivering Bad News, AAPM

31 Dr Nick Harrington –

Flying South

Mr Peter McClelland

Dreams

20

4 Pioneer: Dr Kingsley

20 Russell Woolf: ABC

Broadcaster

24 Health Minister

Dr Kim Hames

49 Wine Review:

Higher Plane Wines Dr Craig Drummond

50 Podiums, Powerpoints

and Mushroom Men

52 Competition Winners:

December Edition

GUEST COLUMNS

Faulkner but…

Prof Wendy Wardell

53 On the Funny Side

FEATURES

8 Not Everyone’s Baby

E-poll: Up Your Nose Patients

24

6 Young Men: Enemies

Into Friends

A/Prof David Indermaur UWA

16 Medical

Misinformation Dr Ullrich Ecker, PhD

29 Doctors Take On New

Jury Obligations

Hon Christian Porter MLA

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PUBLISHERS Ms Jenny Heyden - Director Dr Rob McEvoy - Director

Letters to the Editor

Medical money Dear Editor,

Medical Forum Magazine 8 Hawker Ave, Warwick WA 6024 Telephone (08) 9203 5222 Facsimile (08) 9203 5333 Email editor@mforum.com.au www.mforum.com.au

ISSN: 1837–2783 Advertising Mr Glenn Bradbury advertising@mforum.com.au (0403 282 510) EDITORIAL TEAM Managing Editor Ms Jan Hallam editor@mforum.com.au (9203 5222) Medical Editor Dr Rob McEvoy (0411 380 937) rob@mforum.com.au Clinical Services Directory Editor Ms Jenny Heyden (0403 350 810) jen@mforum.com.au Editorial Advisory Panel Dr John Alvarez Dr Scott Blackwell Ms Michele Kosky Dr Joe Kosterich Dr Alistair Vickery Dr Olga Ward SYNDICATION AND REPRODUCTION Contributors should be aware the publishers assert the right to syndicate material appearing in Medical Forum on the MedicalHub.com.au website.

Contributors who wish to reproduce any material as it appears in Medical Forum must contact the publishers for copyright permission.

DISCLAIMER Medical Forum is published by HealthBooks as an independent publication for the medical profession in Western Australia.

The support of all advertisers, sponsors and contributors is welcome.

Neither the publisher nor any of its servants will have any liability for the information or advice contained in Medical Forum . The statements or opinions expressed in the magazine reflect the views of the authors.

Readers should independently verify information or advice. Publication of an advertisement or clinical column does not imply endorsement by the publisher or its contributors for the promoted product, service or treatment.

Advertisers are responsible for ensuring that advertisements comply with Commonwealth, State and Territory laws. It is the responsibility of the advertiser to ensure that advertisements comply with the Trades Practices Act 1974 as amended.

All advertisements are accepted for publication on condition that the advertiser indemnifies the publisher and its servants against all actions, suits, claims, loss and or damages resulting from anything published on behalf of the advertiser.

EDITORIAL POLICY This publication protects and maintains its editorial independence from all sponsors or advertisers.

Graphic Design Pierre Design Graphique 2

In a society where your self-esteem depends on your looks and your status is commensurate with your earnings, David Borshoff’s article When The Piper Calls The Tune, February edition) is a timely call to the profession to reconsider its values. Are the lowest paid the least valued doctors? Conversely, are the highest paid the best doctors? Most of us would answer no to both questions.

But there are a few truisms. Specialists are better remunerated than GPs. Full-time public service doctors earn less than private practice doctors.

Do those that earn big incomes forsake compassion, dedication and the pursuit of improving patient welfare for the accumulation of wealth? Are there those who forsake complex patient problems for the simpler and often more lucrative?

Most of us know doctors who do. But only a few.

Being involved in teaching medical students, training young doctors and supervising trainee specialists, I don’t believe any of these people embark upon a medical career motivated by money. It’s just that something happens along the way. We develop a sense of entitlement.

And we sometimes lose perspective. Thus, the crass comments regarding school fees and the number-plate saying how you achieved your expensive car. By losing our perspective, we lose perhaps that which is most admired and valued in doctors – the respect of the community.

I don’t begrudge a skilled, highly trained doctor big earnings. But I despise the doctor who loses our raison d’etre - compassion, dedication and empathy in the alleviation of our patient’s maladies.

“Prioritise strategies to address gaps in simulation training within WA Health, provide strong clinical leadership for future planning, provide a nucleus of expertise, and begin state-wide coordination of simulation training resources across professions and disciplines.”

To assist in addressing gaps in WA’s simulation training, the Commonwealth Government provided $8.5 million over two years via HWA. The initial funding round identified $4.2 million for the establishment of the CSSU and distribution to universities, public and private health care providers for new equipment.

This will add to the capacity of SLE training in WA, enabling students and clinicians to practise their skills in a wide variety of scenarios, from advanced life-support and surgical procedures, to improving communication skills with distressed “patients” and “family members”.

In addition to the core DoH budget for simulation training, the State Government has identified a further $11.6 million over five years in the Junior Doctors Business Case for staffing, capital and non-capital costs for simulation learning in each Area Health Service.

Much training takes place in the workplace, while high-fidelity training, requiring sophisticated manikins, is delivered at dedicated simulation centres, such as the facility at ECU Joondalup, that at CTEC (UWA) and a new unit being established at SJOG Murdoch.

For more information about the CSSU and its initiatives, contact Dr Claire Langdon Claire.

Langdon@health.wa.gov.au E/Prof Louis Landau, Chair, Immersive and Simulation Learning Committee ED: See WA Health Simulation Training Strategy 20112013.

Dr Gerard Hardisty, Subiaco.

SLEs getting real Dear Editor, Simulated learning environments (SLEs) are essential to modern clinical education and training. The principle that trainees practise on simulated patients before treating actual patients is now well accepted in health professions.

A Clinical Simulation Support Unit (CSSU) was established for WA in January, 2012, with funding from Health Workforce Australia (HWA). Statewide consultation identified major gaps in clinical simulation training, especially in staffing, equipment and facilities and the need to better coordinate programs and resources.

With the support of stakeholders in the WA DoH’s Immersive Simulation Learning Committee (ISL) which includes public, private and other nongovernment organisations, the CSSU was set up.

Staffing currently comprises a coordinator (Claire Langdon) and senior program officer (Richard Clark), with a medical adviser appointment currently being finalised. The CSSU will:

Recruits needed Dear Editor, I write to ask support for a study that investigates whether regular exercise can prevent gestational diabetes in women with a prior history of the condition.

The study (funded by NHMRC) offers great health benefits to participants – two free health appraisals, one at 14 weeks of pregnancy and the other at 28 weeks, plus an excercise bike at home and advice from specialist trainers.

Please refer patients meeting these participation criteria to the Cycle Study Midwife on 9340 1705 or visit thecyclestudy.com.au for more information.

• 12-13 weeks pregnant, • Has had pregnancy diabetes before and • Will be located in and around Perth up to 28 weeks pregnancy We are confident that the results will help us to develop guidelines for exercise during pregnancy and finally break the cycle of gestational diabetes.

Prof John Newnham, School of Women and Infants Health

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Editorial

The Power of Being Positive Dr Rob McEvoy is not a TV host but he knows the X-factor when he sees it in other medicos, which gets him thinking...

Sad to say, but I’m in that age group where a night on the town often degenerates into discussing medical procedures or ailments, which relative has contracted what, whose funeral you attended or whose pet had to be put down. In the last few years, I’ve truly come to understand what Aboriginal patients in their 50s were telling me many years ago about spending every weekend travelling to a relative’s funeral.

For a variety of reasons, I’m not so big on ‘paying respect’ at a graveside, so when Dr Tony McCartney left us in October, the family’s newspaper notice caught my attention (see inset). It struck me as a thoughtful way to turn a miserable interlude into something better, and it led me to his fundraising website and some introspection.

Like many, I didn’t know Tony all that well, except that he seemed a nice bloke who was well respected in medical circles. As a gynaecological oncologist with considerable surgical skill, he was not only in demand, he rubbed shoulders with plenty of women facing death. All this makes the comments posted at www.mycause.com.au/mycause/ raise_money/fundraise.php?id=49237 more powerful. It is clear that colleagues, patients, their relatives, family and friends all related positively to the man, not just his expertise.

Words like warm, compassion, caring, humorous, understanding, optimistic and calm are used to describe his personal interactions that surely played a big part in allowing people to fight their cancers with confidence and without fear.

This can be the missing link for a lot of us these days – the ability to influence illness by imparting a positive outlook to the sufferer.

The old term was ‘bedside manner’. We saw nursing lose it, to be replaced by clipboards and technology, but the power of positive thinking is returning there. This was Tony’s true gift.

His people skills allowed him to set up successful cancer services for women that required collaboration between relevant craft groups and to pass on his knowledge by teaching gynae trainees, including the surgical techniques he pioneered.

Prof Yee Leung, who trained under him and who is now carrying on his work, describes why Tony will be hard to forget and replace.

“Tony had a unique personality. He loved people, and he loved being with people. Whilst he may not agree with an individual’s choice of lifestyle or belief, he had the rare ability to fully engage with that individual and treat them as if they were the most important person to him at that time.

This was the secret to his success. We have much to learn from this attitude, that it is the person we are looking after and not the item number,” he said.

Afterword: As if to echo these thoughts, we received a press release titled “Health professionals

urged to have greater empathy for patients”.

Two pain specialists, writing in Pain Medicine, were warning colleagues. Apart from the well-known ‘It’s all in your mind’, which in effect blames the person for their pain, the authors warn that pain clinicians can also start feeling negative towards patients they feel unable to help. This leads to ‘an extinction of empathy for the patient, or negative empathy’ and worse pain.

They suggest clinicians and patients find a “third space” in consultations where there is no power imbalance between the clinician, who is generally considered the expert, and the patient. l

Update: WA Surgical Audit WA has been a leader in its professional approach to the auditing of surgical performance. The WA Audit of Surgical Mortality (WAASM) was established by surgeon James Aitken, based on his experiences in Scotland, and produced its first annual report in 2004. The system has since been adopted nationally.

It involves the clinical review of all cases where patients have died in a hospital while under the care of a surgeon.

In March 2004, we reported WA surgeon

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participation in WA at 85%. Today, the RACS website says it is still 87%. Getting all private surgeons to participate in this voluntary scheme has been a problem. To further increase participation, it is now a compulsory part of the RACS CPD program and a condition of registration.

Part of the non-adversarial nature of the scheme, where honest responses look for a system change rather than apportion personal blame, was to afford legal privilege to any disclosure. Now the RACS says that although the WA Department of Health’s qualified privilege declaration under the Health Insurance Act 1973 (Cth) expired

in June 2011, this has no bearing whatsoever on the legal protection of the WA Audit of Surgical Mortality.

The College of Surgeons have a separate declaration under Commonwealth legislation that is independent of any qualified privilege arrangements that exist, or have existed, with the WA Department of Health.

The latest report shows the number of adverse events related to surgical deaths remains low at 1%, or three deaths in 2010. None were considered preventable. l

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Medical Pioneer

Kingsley Faulkner – Professional Pride A renown Perth surgeon casts a compassionate eye on professional ethics, generational changes, personal values and climate change.

Kingsley Faulkner has seen just about everything in his medical career – from an inverted uterus covered in sand to the latest developments in laparoscopic surgery and robotics. He is passionate about passing on that knowledge – both ethical and technical – to the clinicians of tomorrow while also doing his best to make sure that planet Earth will be worth passing on to the next generation.

We need to develop honesty, empathy and compassion to earn the trust of the community. That trust is hard to develop and easy to lose.

Early days… the Kimberley as District Medical Officer “An Aboriginal woman had delivered in a squatting position in a dry creek bed and came to the hospital with an inversion of the uterus. It was covered in sand – I’d never seen anything like it! We put her on a morphine drip, got a bucket of disinfectant and washed away as much sand as we could and then pushed the uterus back inside. She recovered and the nurses named the baby, ‘Sandy’.

“My professional background? I went to Muresk and did a Diploma in Agriculture, then to UWA where I did a couple of years of English literature, philosophy and economics before entering medical school.

I got married in my fourth year of medicine and took Robben’s Pathology on my honeymoon … I didn’t open it very often! I did one year in Port Hedland, some surgical training in England and then back to RPH and Fremantle before graduating in 1978 as a surgeon.

Family… and an unplanned destination “In 1891 my great-great grandmother and her eight children were on a ship bound for Sydney – they were so sea-sick that when the ship docked at Albany she said ‘right, that’s enough, we’re getting off!’ As a consequence, we’ve had a farm in the Porongurups that’s been in the family for well over 100 years.

“My wife was a History and English teacher and I have four adult children – no doctors among them – and six grandchildren. I have real environmental concerns regarding the future we’re leaving them – the most recent arrival can expect to live to about 2100. The world will be a very different place by then and it’s absolutely imperative we focus more closely on planetary health.

Youth… and the importance of mentors “I’m always encouraged by the enthusiasm and idealism of youth … and I never cease to be amazed by their electronic expertise!

The importance of role models and mentors 4

n ”The importance of role models and mentors in medicine cannot be overstated.”

in medicine cannot be overstated, you teach others by your own behaviour towards your colleagues, your students and your patients and their families.

“An ethical basis is crucially important – honesty and integrity as well as imparting knowledge, critical acumen and technical expertise. I was very proud to have been presented with the Dean’s Excellence in Teaching Award at Notre Dame in 2010. It’s recognition that the teaching of medical students is an important vocation.

Medical students… life-skills and maturity are assets “There’s a diverse group of graduates at Notre Dame – everything from journalists and astrophysicists to helicopter pilots and they’ve all thought deeply about doing medicine. It’s so important that the professionals we train aren’t just gung-ho technicians – we need people who can communicate with their patients and their colleagues. A good sense of humour is useful too! I’d also advise young doctors to develop a strong research base early in their careers.

Ethics and standards… and a frank admission “There are occasional cases of dishonesty and sometimes standards aren’t as high as we’d like but in a large profession you’re never going to have perfect results. There are more failures in character than there are in competency – some people become far

too focused on monetary reward and I have no great admiration for anyone who makes that their prime focus.

“I don’t regard myself as a technically outstanding surgeon but I’m very proud of my involvement with professional bodies.

I’ve been on the Council of the RANZCS for ten years with two of those as President.

It’s a wonderful opportunity to address some of the inequities in medicine.

Technology and the environment… back to where it all began.

“There’s an increasing reliance on technology within surgical practice – the use of robotics is well-entrenched in prostate cancer, for example. There have been some wonderful innovations and providing people are well-trained and know their limitations real advancements will continue to be made.

“Regarding the environment, the mining sector’s going full-throttle and there are dangers ahead – the burning of fossil fuels and climate change. The number of sceptical scientists seems to be decreasing but the issue is heavily politicised in Australia and we should be doing a damn sight more. My concern for this issue – and indeed my involvement with Doctors for the Environment Australia – taps back to where this all began – the beauty of the Porongurups and the time I spent there in my youth. l

By Mr Peter McClelland medicalforum

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Applications open at 9am on 13 February 2012 and must be received by 5pm on 31 May 2012.

For more information or to download the application form, please visit www.avant.org.au/scholarship

Australia’s Leading MDO

Guest Column

Young Men: Enemies Into Best Friends A/Prof David Indermaur, UWA crime researcher, looks at how to engage young men drawn into the cycles of violence and self-abuse.

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f we could just get men to behave like women our courts would lay idle and our prisons empty,” quipped a famous British judge. Her sentiments could also apply to the field of health where consistent findings link young men to drug abuse, self-harm, and risky behaviour.

How do we effectively reach out to young men who seem to disregard their health and cause problems not only for themselves but those around them? There are ways to appeal to them but before looking at them let’s have a quick look at the toxic trio of drugs, self-harm and risk taking.

or while out on the weekend, to dangerous driving and unsafe sex.

While young men’s aggressiveness, competitiveness, risk-taking and preference for a “short-time horizon” has been well explained by biologists, the critical question for health professionals is how do we engage young men caught up in the cycle of drug abuse, self-harm and self-defeating behaviours.

But the continual abuse of drugs quickly becomes about trading off long-term gains for short-term fixes and this “selling oneself short” connects us with the selfharm statistics that dominate the health problems faced by Western countries like Australia. Suicide accounts for more deaths in Australia than transport accidents with three times as many males as females killing themselves. In a country as bright and successful as Australia these statistics, which don’t count the legion incidents of self-harm, show what we may be missing out on despite our material success.

Staying with young men, a third set of statistics ties in with mental health, drug abuse and self-harm. This is the tendency to engage in risky behaviour of various forms, from violent altercations on the road 6

The key question at the individual level is connection or engagement – attracting young people into treatment. The language of this area tells the story. It’s about “treatment readiness” and moving people from pre-contemplation to contemplation – opening them up to the possibility of a different way that might work better for them. The greatest challenge involves sparking interest in them to think differently.

There is now much help available, especially with the governmentfunded “Better Access” program that allows GPs’ patients to be referred to suitable allied health professionals for treatment. Another federallyfunded program offers treatment for young people charged with minor offences, where there is a suggestion of a drug problem. There are good signs here.

A closer look at problem areas A recent article in the Lancet reported that Australia has one of the highest rates of use of common illicit drugs such as cannabis and methamphetamine in the world.

For an affluent country like Australia with one of the lowest unemployment rates in the world, we can’t blame economic woes for this love affair with psychotropics.

While there are obviously a number of reasons why people take drugs to excess, there is little doubt that the most proximal cause – one favoured by users themselves – is “to feel good”. The “feeling good” can be a result of the exuberance of thrill-seeking, a temporary escape from depression and self-hatred or a quick trip to a fantasy land where everything just feels good. As the saying goes ‘reality is for people who can’t handle drugs’.

Engaging with young men

The most important line of engagement sits with the GP. Getting someone to think differently about the problem is most important.

Macro approach How can we improve our reponse to this classically “difficult to reach” population?

To answer this we need to consider options at both the community (macro) level and the individual (micro) level.

To reduce alcohol-related harms at a community level, the simplest way is to reduce the availability of alcohol.

With illicit drugs the picture is more complicated – an ever-greater policeand-punishment approach is not likely to be effective, so we are left with trying to convince young people that abusing drugs is ultimately to their detriment. While the government continues to invest in advertising, education and health services, there is a limit to what can be achieved – it must be backed up with interventions at the individual level.

But the most important line of engagement sits with the general practitioner. The point of getting someone to think differently about their problem is most important.

Sometimes just asking questions is more powerful than pushing solutions, which might arouse suspicion and rejection.

Ultimately it is about the choices for the patient. Developing a “therapeutic alliance” is the most useful posture. From this base the penetrating questions can be posed in a non-threatening manner. Questions such as, “is this working for you?” or “is this where you want to be?”, encourages the patient to connect with their core values and reflect on the meaning of their behaviour.

Much young male behaviour is dictated by what they think others think of them.

Helping them see this and encouraging a healthy degree of independence and individualism helps them pull away from self-destructive behaviour.

Deeper down it’s about the conversations we live by and often this involves quite a nasty degree of self-judgment and criticism.

Moving on from this often requires some help, which is where the Better Access scheme is of value. This kind of help can enable the patient to turn things around and become their own best friend rather than their own worst enemy. l Ed. Readers can contact A/Prof David Indermaur on 0414 583 029.

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Feature: GP Obstetrics

Not Everyone’s Baby but…

GP Obstetricians are pivotal to Armadale Hospital’s comprehensive obstetrical services. This is one GP’s story as the service seeks out two more specialists.

When he spoke to us, Dr Gary White had only minutes before delivering a baby boy, a birth made more satisfying because it was a successful ‘VBAC’ (Vaginal Birth After Caesarean) at 40 weeks. He recalled for us his day – a normal birth, a Kiwi Ventouse for an OP, suction-cap delivery assistance at the VBAC, two inductions for pregnancy-induced hypertension and another woman in labour right now.

It’s a heavy workload that he gladly takes on within the unique setup at Armadale Kelmscott District Memorial Hospital; a setup that is testament to all involved.

What about that VBAC? “Last time the delivery was traumatic for her – undiagnosed placenta previa despite a clear scan, with heavy blood loss, and an emergency caesarean. This time around she retained her confidence and she was less stressed and kept control,” he said, with a hint of excitement in his voice.

“We are fairly earthy at Armadale and give a trial of scar when it is safe. And because the specialists are so pressured, it saves 8

There was a stage some years ago where a major obstetric crisis was traumatic for the mother and everyone involved. It got me thinking – keep going or pull out” - Dr Gary White manpower if we can deliver vaginally. We achieve about a 60% success rate with our VBACs particularly when offered to women who have had, say, previous OP position, failure to establish or progress, and so on. Our background caesarean rate at the hospital runs at 23-24% overall, which is one of the better ones in the State because of our approach to doing ECVs [external cephalic versions] and VBACs when we can,” he said.

A dedicated GP obstetrician, Gary has filled that role for 23 years since commencing general practice. He is one of eight GP obstetricians offering valuable services

at Armadale Hospital, both privately and publicly, in harmony with midwives and specialists.

“I guess I wouldn’t be in it if it wasn’t something I enjoyed doing,” he said. “There was a stage some years ago where a major obstetric crisis was traumatic for the mother and everyone involved. It got me thinking – keep going or pull out, and I burrowed in deeper.” He offered up sketchy details of an emergency forceps for APH and the subsequent death of the newborn.

“There was a lot of self-analysis and a few grey hairs but fortunately I didn’t take the option to pull out and whereas I used to deliver 70- 90 babies a year, I now do close to 400 a year. I’m primarily obstetrics with some general practice now.”

His reputation is built around continuity of care and a good reliable service, he says, as well as a “genuine approach to looking after mothers”. And the team approach at Armadale Hospital means they can successfully deal with just about any obstetrical scenario imaginable.

Continued Page 10 medicalforum

Feature: GP Obstetrics Continued from Page 8 The eight GP obstetricians form the core of the service, with three covering a mix of public and private cases and the rest only on call for public patients. The specialist obstetricians have recently decreased from three to two with the retirement of Dr ‘Bert’ Hellmuth after 25 years (having helped Gary enormously over the years). The midwives employed by the public hospital complete the team picture. Maud Bellas Maternity is a busy unit, with more than 1200 deliveries a year.

“The GPs run a publicly billed antenatal clinic at the hospital. It’s meant to be a costfree way of getting good care and it operates in tandem with a hospital-based antenatal midwifery service,” Gary explained, adding that the former is Commonwealth funded and the latter funded by State. The doctors review the mothers with uncomplicated pregnancies at 20, 28 and 36 weeks.

Complicated pregnancies are reviewed as required, with the specialists.

Weekend private on-call is mercifully rotated between two obstetricians and the three GP-obstetricians who do private work, which means Gary gets a break and can plan other activities. When the government took over.

Armadale Hospital from Galliers in 2005, the private obstetrics was maintained, and from December last year, private and public patients have been delivering in a common ward with single-suite rooms provided for private patients. The single rooms are slightly bigger and husbands can room-in if need be.

“It’s pretty important to have privacy and quiet for the new parents. I wouldn’t be

I firmly believe in supporting the public system but I get more satisfaction and less harassment from the private system. practising there if there wasn’t a mix of private and public care. I firmly believe in supporting the public system but I get more satisfaction and less harassment from the private system, like my coffee and a bit of a break in my private rooms. It allows me to maintain general practice, really.”

Gary works closely with two other GP obstetricians, Dr Adrian Jameson (Kelvale Medical Group) and Dr Nafeesa Moolla (Byford Family Practice). Adrian does anaesthetics as well, and Nafeesa originally hails from South Africa and came to WA from South Australia 18 months ago.

Gary’s interest in musculoskeletal medicine includes manipulative and acupuncture skills. He has two children studying medicine, and sees himself still doing

n Dr Gary White, of Armadale Hospital, above, with one of his babies.

obstetrics in five years. He said the arrival of two new advanced diploma registrars from King Edward (GP-obstetricians with C-section skills), will be good for the group, and he praises the specialist support for this initiative.

Hopefully, word will get around and two more obstetrician-gynaecologists will materialise to provide both obstetrics backup and non-acute gynaecology and fertility services at Armadale Kelmscott Hospital. l

By Dr Rob McEvoy

What GPs with Advanced Diplomas do There are 261 GPs diplomates in Western Australia – 43 with the previous DipRACOG and 29 with the new advanced diploma.

The advanced diploma trains GPs to do caesarians, after performing a minimum of 15 elective and 15 emergency LUSCS while in training. They are also trained to provide a variety of advanced GP obstetrical and gynaecological services. (See below) The Royal Australian New Zealand College of Obstetrics and Gynaecology are in the process of compiling a national database of the practice profiles of its diplomates – with only a 38% response so far.

The DRANZCOG training offers training for GP obstetricians/doctors who wish to: • Provide shared ante and postnatal

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care with specialist obstetricians, GP obstetricians or a specialist hospital • Provide office gynaecology • Provide family planning • Manage the antenatal care of low to moderate risk patients • Perform normal deliveries and assisted deliveries • Perform basic gynaecological procedures The DRANZCOG Advanced training is for those who wish to provide all of the above plus: • Manage complicated labours • Perform LUSCS (Elective and Emergency) safely and confidently • Provide support for GP obstetricians when specialist obstetricians are unavailable

• Perform laparotomies in emergency gynaecological situations • In special circumstances, be able to perform laparoscopies and/or colposcopies Albany Hospital, Joondalup Health Care Campus, Bunbury Regional Hospital, Kalgoorlie Hospital, King Edward Memorial Hospital for Women, Osborne Park Hospital, Rockingham General Hospital and Swan District Hospital are all accredited for DRANZCOG training.

All except Bunbury are accredited for Advanced Training.

The latest statistics from the Department of Health show there was a total of 14,071 babies born in public hospitals in WA – 12,085 born in the metro hospitals and 1986 in regional hospitals. l

medicalforum

Have You Heard? while travelling the same way. Don’t laugh ladies – statistics for women in the same age group jumped from 9.1 to 18.7!

Whispered stuff Mistaken identity Dr Graham Thom, a relatively new arrival on the dermatology scene in WA, has a namesake in the Amnesty organisation who has been touring our detention centre up north and declaring they are like funeral homes. The other Dr Graham Thom PhD is Amnesty International Australia’s refugee coordinator, which means Medical Forum missed out on a good local story. By the way, if you want to see where Australia could be heading go to http://wearethe99percent. tumblr.com/

Your say on research You’ve still got time! Submissions to the Federal Government’s Independent Review of Health and Medical Research close on 30 March 2012. The key issues? Health and Medical Research – Viability and Competiveness, Funding and Management, Strategic Directions and Translation Outcomes. www.mckeonreview.org.au for documentation, terms of reference and submissions.

Cycling mid-life crisis WA Health Department research says cycling-related hospital admissions have more than doubled for men aged between 45 and 64. It’s a big spike – from 20.8/1000 to nearly 50/1000. The research span (Jan 2000-Dec 2009) was a period in which the number of men donning colourful Lycra increased dramatically. And the car most likely to hit cyclists will come from behind

WA research on cancer and Aboriginal people has shown avoidance of treatment can come from belief the disease is a curse and untreatable by Western medicine. Titled, A Whispered Sort of Stuff, the report was funded by the NHMRC and Cancer Council WA, and written by authors Prof Sandy Thomson, Dr Shauli Shahid, Heath Greville and A/Prof Dawn Bessarab.

The Medical Board dance Medical competency has taken a front seat with the Donald Duck effect following ENT surgery, with SAT and the Medical Board doing their thing. How the new system works is a mystery to most doctors so the explanation on Page 23 may help.

New national body The divisions network has breathed a sigh of relief with the Gillard Government’s support of the morphing of Australian General Practice Network (AGPN) into the Australian Medicare Local Network in July this year, to support 60 or so Medicare Locals. It’s all about locally accountable,

Our super funds have rocketed to the highest rating.

The Chant West ratings logo is a trademark of Chant West Pty Limited and is used under licence.

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Once again, in 2012 independent ratings agencies es awarded our products their highest ratings.

Which means you can be condent your funds are always heading skyward.

medicalforum

Have You Heard? in Halls Creek and Fitzroy Crossing. At the same time, $1.6m has been spent to complete a new sobering-up shelter at Tennant Creek.

A year in construction, the new building is expected to be used by up to 4000 people by the end of this year. The Barkly Region

flexible, community-responsive primary health care services, thanks to some extra analysis and design from local clinicians and communities – “a wide set of stakeholders” this time, and general practice is having to offer something beyond itself.

Alcohol and Drug Abuse Advisory Group spokesperson says the rate of alcohol abuse in Tennant Creek is alarming and the shelter helps prevent domestic violence and relieves pressure on Police services.

Health Professional Online Services For those who have the PKI certificate sorted, the HPO website offers a number of helpful things. The MBS Items Online Checker www.medicareaustralia.gov.au/ hpos/ allows you to check the claiming eligibility for selected MBS items, currently 104, 116, 721, 723, 729, 731, 732 and 10900.

Other services available include Pathology Collection Centre search; ACIR; Centrelink forms fill-out online; Immunisation Incentive and Rural Incentive programs and HECS reimbursement scheme; Healthcare Identifiers Service; MBS Items Online Checker; National Bowel Cancer Screening Program; Patient Verification; PIP; Prescription Shopping Information; and view a patient’s care-plan history.

Apps and social sleuthing Are you trying to sort out what’s a useful app on your iPad or iPhone? Try this doctordriven review site www.imedicalapps.com.

On a related matter, we have learnt a quarter of managers use social media to screen candidates – examining discriminatory comments, inappropriate pictures or comments posted by past employees on Facebook or Twitter. On the good side, some look for positive social media clues. While others have sacked employees who take a sickie but place notes of their big day out on social media.

Alcohol up north A Wyndam man has become the first West Australian charged under last year’s changes to the Liquor Control Act which allow residents to declare their homes alcohol-free.

The occupants of only 10 homes across the state, mainly in the northern Kimberley and Pilbara, have done so since the law was introduced. Other attempts to reduce the harm caused by alcohol include light beer being the only legal takeaway alcohol sold

Paternal cigs risk leukaemia Acute lymphoblastic leukaemia is 35% more likely if dad smokes at the time of conception, according to Telethon Institute for Child Health Research’s Dr Elizabeth Milne. Damaged sperm DNA can still fertilise an ovum and the damage is pretty immediate as past smokers show no effect. Of course, with epigenetics, other environmental factors are likely to be at play and odds are 1 in 2000 children to start with.

?

What have you heard Share the news

editor@mforum.com.au or ring the editor on 9203 5222

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15

Feature: Media

Medical Misinformation UWA School of Psychology researcher Ullrich Ecker provides some insights on why medical mud sticks and the best ways to remedy this.

I

n 1998, a Lancet paper and the associated press conference suggested a link between the common MMR vaccine and autism. By 2002, this suggestion had received widespread media coverage and vaccination rates dropped substantially (mainly in Britain but also elsewhere). This sounds like a prime example of science informing the public to help people make well-informed decisions, if it were not for one tiny wrinkle: the whole thing was a hoax.

There was no evidence for the purported link, the paper was retracted and the first author convicted of scientific misconduct.

Misinformation comes in many guises Scientific fraud is not the only source of health misinformation. Companies rely on misinformation to sell energising wristbands, “detox” fruit-juice mixes and homeopathic remedies. Prime-time television and other media—inadvertently or not—support them in their endeavour.

Pharmaceutical corporations likewise aim to promote the utility and safety of their products, but they are not as interested in publicising studies showing adverse or null drug effects.

Some misinformation results from “collective statistical illiteracy”, the widespread inability in patients, journalists and doctors to make sense of probabilities and base rates. An example was the surge

in abortions in Britain after the 1995 “pill scare”, initiated by reports that third-generation contraceptives led to an alarming “100% increase” in blood-clot risk (in effect, a less alarming risk increase from 0.0001 to 0.0002%).

There are also lots of common health myths of unknown origin, some harmless or maybe even beneficial (don’t mix antibiotics with alcohol), but others less benign, such your overweight child will magically “grow out of it”.

consequences. In the case of the MMR vaccine scare, these included major outbreaks of mumps and measles in Britain and Ireland, resulting in hospitalisation and death, as well as enormous amounts of money wasted on unnecessary follow-up research.

Finally, there is a growing trend to obtain health information from the internet. Apart from the obvious lack of credibility, one concern around the dissemination of misinformation is that people prefer to pass on information that is likely to evoke an emotional response, in particular disgust or fear.

Belief in misinformation Misinformation can have important

To help patients with tinnitus, dizziness or severe hearing loss, we suggest using these.

To empower GPs to effectively diagnose and treat these conditions the Ear Science Institute Australia is hosting an educational dinner on Tuesday 27th March at the UWA Club.

The event is RACGP accredited.

For more information and to reserve your place visit www.earscience.org.au/gpdinner or call Sandra Nair on 6380 4900 before 21st March.

ESI22079 MedForum_188x90_V1.indd 1 16

7/02/12 4:10 PM medicalforum

IT in Medicine

Feature: Media

By Peter McClelland

ECU Health Simulation Centre

So it is concerning that even after exposing the vaccine hoax, many people continue to believe the misinformation now. But why are the effects of misinformation so resilient and belief in it so long-lasting?

despite knowing it has been retracted.

People often prefer an incorrect model of the world to an incomplete model.

Second, retractions can fail because they necessarily repeat the misinfor-mation.

Explaining that the vaccine doesn’t cause autism repeats the vaccine-autism association, making it more familiar. It is well-known that people are more likely to believe and trust familiar assertions—I’ve heard this before, there must be something to it! Hence the retraction can potentially backfire and increase reliance on misinformation. This is most likely in older adults because familiarity-based memory declines less with age than more controlled memory processes. in Medicine, he sings the praises of the ECU

increased belief in the myths.

Knowing that any retraction leaves a gap, it is important to fill it, so a retraction should always be accompanied by a plausible alternative scenario.

While operating on cadavers offers unbeatable reality in some circumstances, training For example,simulated explaining that autism is caused by an interaction of genes and on sophisticated mannequins is reaching new levels.

On a cognitive level, people have a hard time unbelieving something they once believed. Simple “that’s-not-true” retractions are largely ineffective for two reasons. First, when people try to make sense of a causal relationship or an unfolding event, they build a mental model.

A retraction creates a gap. Such a gap feels uncomfortable and people use the easily available misinformation Pro-Vice-Chancellor of Health Advancement Prof Cobie Rudd is justifiably proud of the ECU Health Simulation Centre (HSC) on the Joondalup Campus.

“The Centre is unique in its design and the focus is specifically on learning through simulated challenges and sequential scenarios.

Practitioners follow a ‘patient’ across settings and providers from high to low acuity in clinical environments. Sessions range from clinical skills, human factors and patient safety training for multidisciplinary health teams using simulation mannequins, professional actors and task trainers,” said Cobie.

Clinical A/Prof Anaesthetics at RPH, Dr Richard Riley, is well aware of the human factor element in his field of anaesthetics and its links with simulation training in the aviation sector.

“Medicine is 30 years behind the aviation sector in the use of simulators for training and accreditation. There’s a strong parallel, obviously - Captain Chesley Sullenberger, who ditched the Airbus on the Hudson River, was the guest speaker at a conference I attended,” said Richard.

As chair of the WA Society for Simulation

Simulation Centre.

Furthermore, pre-existing beliefs contribute “Mid-way through of 2007 there were a number to the persistence misinformation.

People of funding involving information both UWA and the have a biasissues to cherry-pick Statesupports Government the anaesthetics that whatregarding they already believe, simulation lab atinformation UWA. It wasthat put out to while ignoring challenges tender in late 2010 and ECU were awarded their world views. So people who reject the contract… it’s a really well-run unit.” vaccination schemes (e.g. as an undue form HSC houses WA’s only patient will simulator with of government intervention) also be the ability gas exchange, more likelytotoprovide believerespiratory in the autism link. anaesthesia delivery, and patient monitoring

Similarly, many parents will prefer to a high with real physiological measures.

Such see ADHD as a genetically-determined fidelity mannequin is needed for the ANZCA disease andtraining may reject considering other anaesthetic courses offered several factors—it times a year.helps them avoid feelings of guilt and shame, and does not require them to question their parenting methods.

ECU Simulator Courses Debunking misinformation

n Advanced Complexjust Medical So are healthand campaigns flogging Emergencies (ACME). no. Several a dead horse? Fortunately, n Effective Management of Anaesthetic Crises communication techniques make (EMAC). debunking misinformation more effective. n Australian and New Zealand College To avoid increasing the familiarity of of

Anaesthetists (ANZCA) training course. myths, always start with the facts—“many n ECU have Inter-Professional Ambulatory Care. studies shown that the MMR vaccine is safe”. The common “myths vs. facts” approach is inefficient and can lead to an

in-utero levels of testosterone allows parents to “let go” of the vaccine misinformation.

Explaining why the misinformation was given in the first place (e.g. the scientist involved had a financial conflict-of-interest) can also help.

Finally, people with strong beliefs may not be open to rational arguments. Aggressive attempts to alter beliefs will only lead to HSC is particularly relevant in three key areas, alienation and stronger insistence on the according to Cobie Rudd. misinformation. Framing a correction “The Centre is absolutely in a non-threatening way,invaluable however,for canhighfidelity simulation training, inter-professional help, such as focusing on the benefits the learning and sequential simulation - the latter alternative brings with it.

avoids learning interactions that revolve around

Vaccination sceptics may be more likely to a single moment in a ‘patient’s’ journey.” have children immunised they are And,their concludes Richard Riley, theiffuture adequately informed appears to be bright. of the risks associated with non-immunisation while at the same “Medical simulation and immersive learning time their scepticism is respected. appears to be something of a federal Ed. You can priority contact and the they’re author ploughing at government millions of dollars into this area.” n ullrich.ecker@uwa.edu.au

Further reading (see links at MedicalHub.com.au): ‘collective statistical illiteracy’ www. psychologicalscience.org/journals/pspi/pspi_8_2_ article.pdf

Simulation Principles

‘pill scare’ www.ncbi.nlm.nih.gov/pubmed/10652971 n The

immersive simulations are great for

‘grow out of it’ https://theconversation.edu.au/ building confidence. mondays-medical-myth-dont-worry-kids-will-grown Simulation illustrates deficiencies in out-of-their-puppy-fat-4194

team interaction but allows reflection and ‘entrenched bias’ www.shapingtomorrowsworld.org/ discussion about differences between ideologyScience.html

professions, in a safe way. ‘debunking misinformation’ www. shapingtomorrowsworld.org/Debunking-Handbookn It highlights weaknesses in practice skills now-freely-available-download.html and communication. ‘ framing a correction’ http://papers.ssrn.com/sol3/ papers.cfm?abstract_id=1017189 l

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E-poll: GPs & Specialists

Professional Ethics and More Thanks to all the Specialists (n=71) and GPs (n=100) who responded to our E-poll within the short 7-day window.

We were overwhelmed by the comments made, which is great! Many answers show strong similarities between the two professional groups, particularly on the broad-brush issues.

Some responses we have held over until the next edition, simply to give them due coverage, so please bear with us. Our wine prize winners were Dr A.W. (GPs) and Dr D.O. (Specialists).

Big Tobacco Do you believe the Gillard government’s legislation to bring in plain packaging on tobacco in December this year is likely to be overturned on legal appeal by tobacco companies?

GPs Spec

Yes 26% ����������������������������������27% No 46% ����������������������������������48% Uncertain 28% ����������������������������������25%

Foetal Alcohol Effects

breast implants. The environmental protection agency was accused of letting the Esperance community down over the lead export scare. Chinese-made products have been adulterated and some have damaged consumers (e.g. powdered milk). Do you

think today’s younger generation of doctors will be facing more incidents like these because pursuit of profits will override concerns for human health and safety?

GPs

Spec

Yes 79% ������������������������������������ 80% No 13% ������������������������������������ 17% Uncertain 8%........................... ������������� 3%

Comments on Profits Before Human Health Both GPs and Specialists (n=14) said this problem has always existed, but in today’s world of communication more transparency is likely, although ongoing vigilance is necessary and it gets more complex as technology advances. Comments like: “Just look at tobacco and asbestos. We have to be vigilant and sceptical of big business’s ruthless disregard for anything other than the bottom line – reap the rewards and pass on the costs to someone else.

Just five doctors thought the situation today Do you think that doctors has improved, with comments like: substantially under recognise Foetal Alcohol Spec“There is greater awareness of substandard trum Disorder in infants prostheses, processed foods, and other and children, particularly items for human use thanks to better and where there are brain effects but little or no more transparent reporting by patient groups.

physical manifestations?

GPs Spec

Yes, by missing it altogether

25% ��������15%

Yes, but by attributing it to something else (e.g. ADHD).

47% ��������44% No 6% ������������7% Uncertain 28% ��������39%

Do you think that as a profession, we have been slow to promote ‘no alcohol’ in pregnancy for fear of putting the “guilts” onto mothers who have already had affected children?

GPs

Spec

Yes 31% ������������������������������������37% No 59% ������������������������������������44% Uncertain 10%............................ ��������19% Ed. Go to medicalhub.com.au and search ‘ foetal alcohol’ for a good update by local paediatrician Dr Desiree Silva, head of paediatrics at Joondalup Health Campus.

Profit Over Humanity Poly Implant Prosthese (PIP) has been accused of deception in producing substandard silicone 18

“The medical profession will continue to be at the forefront of discovering and intervening when harm comes to our patients.

In fact, more (n=9) wanted improved transparency or regulation.

“A lot depends on legal safeguards, penalties and whether laws to protect consumers are actually enforced” and “Australia needs a revamped TGA to evaluate and monitor implants, prostheses etc.

Many respondents (n=20) were clear that unethical pursuit of wealth, greed, and profit taking were the underlying illness, with comments like: “Let’s not start thinking we’ve just discovered a new relationship between capitalism and avarice.

“With the negative effects of the GFC on the bottom line of many multi-national companies, I suspect corners will be cut wrt safety to improve profits and governments will not be as vigilant.

“Sadly society has made money the short term arbiter of action - it always costs more

in the long run to put the damage right “There have always been people motivated by greed. You haven’t noticed how many regulations there are for everything?!

“Deceptive corporate behaviour has been happening for a long time and companies producing devices, medications, implants etc. need close oversight, criminal penalties for perpetrators and protection for whistleblowers.

A few (n=5) mentioned government – including the sell-off of things to the Chinese and that “balancing economic growth of a free market against restrictions and limitations that protect consumers and the environment is a tricky nut to crack”.

Slightly more respondents (n=9) honed in on other doctors as co-conspirators, with comments like this: “The more dependent we are on big corporations far distant from the frontline of care provision, the more likely it is that profit will trump outcome as the driving force.

“Yes, with drug companies forcing doctors to do stuff.

“Young doctors are likely to be more indifferent to these sort of issues as evident by their appalling insensitivity to the socioeconomic and political dimensions of health and illness.

Another seven pointed to other obvious effects within the medical profession, including: “This not only affects the individuals involved but also adds strain to an overburdened health care system.

‘The younger generation of doctors will be facing more problems with the safety of their patients when a lot of sub-standard materials/medicines and pressure to choose the cheaper institution/hospital/health insurance oriented cheap ones.

“We doctors need to keep highlighting our concerns, but, ultimately, it is the patient who must make the informed choice - we need to provide them with ways to find out that information.

A large group (n=19) felt changes in society contributed to the dilemma, such as “Deception is more prevalent” and “The public want the service at the lowest price”.

To this we add…

“As the economy becomes increasingly globalised, companies may be tempted to sell products which do not meet Australian standards.

“It’s scary... What pollution, synthetic, plastic toxins are we all exposed to ...it is anyone’s guess what these things are doing to us?!” l medicalforum

Health Waste Concerns With over 2,600 words written by both GPs and Specialists around waste in the medical system, we have attempted to summarise the main points here. More importantly, we will follow up some important points in future editions in more depth. So if anyone has more to add on the Key Pointers outlined below, please contact us (see www.medicalhub.com.au for feedback page). The E-poll question was:

tertiary hospital when treatment could be given in ACF; elderly patients go from ward to intensive care because staff not briefed on NFR etc measures.

• Patient assisted transport system (PATS): misuse by doctors and patients alike.

• Nursing homes and hospitals do not use patients drugs brought from home.

• Poor doctor communication: specialists saying they are not aware of other patient problems when they are listed in the referral; referral between specialists when they do not have previous investigations or referral results.

Clinicians can tell us a lot about inefficiencies or waste in our health system, whether public or private. In your experience with patient care, can you recall being annoyed by something you consider was repeatedly wasteful of human or other resources?

These responses are roughly in order of frequency…

• Metal instruments in disposable theatre/ suture packs.

• Disposable single-use everything in theatres – drapes, gowns, instruments (surgical packs), nurses or doctors opening/discarding unwanted sutures, bottles of antiseptic.

• Bureaucrats contributing nothing to patient care and not solving staffing or other problems at all or in time e.g. “change management” meetings that go nowhere. Health management grows while patient care diminishes.

• Excessive paperwork – about parking at QEII; conference travel for HCN; in Health Dept in trying to achieve anything; research projects seeking Ethics Committee approval; waste in producing care plans for hospitals or general practice.

• Slow public theatres, compared to private.

• Inappropriate admissions. Elderly patients transferred needlessly to a medicalforum

demoralising the staff and depriving the patients.

“I really dislike it when health authorities change their name or logo, which leads to new stationary being printed and the previous lot wasted.

“I work in the occupational health and perform pre-employment medicals.

Mining companies have a policy that each change of site [by a worker] requires a new medical, often including audiograms and spirometry. Some contracted workers have medicals every few months and some, who go up for a week or so to each site, have a new medical every few weeks. Each full medical costs about $400. The waste is enormous in cost and time. One contractor advised that for a week’s contract he has to allow for three weeks’ of medicals and inductions costing him thousands and contributing to the overall costs for any new project, with some not cost-effective.

Key Pointers

• Duplication and repetition of tests – pathology or radiology done in private because it is not available in public; requester does not review previous results; repeated in outpatients because referring GP doesn’t send; inadequate handover from A&E to GP; unnecessary testing of ‘the worried well’ where reassurance would suffice; blood tests being repeated between public, private and corporate (workplace medicals) sectors; time wasted in the phone queue chasing results at Pathwest.

“Disposable suturing sets – use one instrument, the rest is waste! For heaven’s sake, can’t we consider some Third World countries that will use and need it? Mandatory work in these countries will be an eye-opener for many who know no better.”

“The massive over prescribing of antibiotics, especially by the six-minute medicine doctors, is scandalous both financially and ethically. It takes longer to educate the patient about viral illness than to buy into their beliefs that antibiotics cure colds.

“Every day, in the European Union, the same amount of food that is being consumed is thrown away. Just out of date, wrong shaped cucumbers, blemishes on apples, the list goes on. That really bothers me more than anything else and is indicative of a worldwide attitude of being precious and entitled.”

Other Noteworthy Anecdotes “State/Commonwealth “cost shifting” – immature politicians acting like school kids playing bouncy ball with taxpayers’ money.

“I am working in the public mental health service. I am disgusted with the futile and wasteful efforts of redesigning and reinvention of wheels in health care delivery/management structures. The higher executives far away from ground realities, doing their (mis)administration, aiming only at cost containment, is

“The major waste I see is medical expertise (especially our junior doctors) being wasted on overly complex discharge summaries and paperwork which was previously handled by nursing staff and allied health. There is far too much wasted on employing multiple nurse managers in the public hospital system."l

19

Feature: Celebrity

Russell Woolf – Living On Air From a childhood playing in the streets to labouring in an Israeli kibbutz, it’s been an adventurous road to the ABC radio studios for broadcaster Russell Woolf.

ABC 720’s Russell Woolf has been on quite a journey that includes a haberdashery shop, a kibbutz and colonic irrigation in Thailand. In his mid-20s he woke up and had a ‘light bulb’ moment – ABC Radio Perth! It took him 10 years to get there, he absolutely loves it and when the ‘ON AIR’ sign flashes he is as cool as a cucumber.

“I don’t feel any stress in front of the microphone, none at all. You couldn’t really do this job if your stomach was in knots.

To listen to people’s responses is wonderful – sometimes they’re funny, and others poignant and heartbreaking. Being on radio is perfect for me, it’s a fantastic feeling and I get so much out of it. If I had my way, I’d deliver my own eulogy – on my gravestone they’ll write, He Finally Stopped Talking!”

Remembering early days…

“My parents owned a haberdashery shop in Piccadilly Arcade and I can still remember the women coming in to buy style books and buttons, cotton and yardage for their

dresses. I used to catch the school bus into town and run amok in the city until Dad shut the shop. I worked there in the late 1970s but I wasn’t happy – I was probably a pretty painful employee.

“One thing I do remember is that as kids we lived and played on the streets. We rode bikes, we hit cricket balls and talked to the milkman and the rubbish collectors and left bottles of beer for them at Christmas. More recently the message to young people has been ‘get off the road and don’t talk to strangers’ but we’re starting to reclaim the streets again. I think we need to remind motorists that the local streets are meant for families – those streets actually belong to us.”

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medicalforum

Eureka moments…

Live on the wireless…

“Our family are members of the Perth Hebrew Congregation and after finishing school at Carmel College I went to Israel in the early 1980s – six months in a kibbutz and about the same time in Jerusalem. That was a defining moment in my life without a doubt. Israel had just invaded Lebanon, all the young reservists started going back to their army units and I was 17 years old and had never been away from home. My poor parents! I think I wrote three aerograms the whole time I was away.

“I was passionate about the broadcasting course. I sat in the front of the class, asked lots of questions, did a breakfast program on a multicultural community station once a week and worked at 6NR for no money at all. I loved the conversation of radio. I even used to listen to parliament! I knew I was going to get into the ABC eventually, I just didn’t know when.

“It took me 10 years – 18 months in Esperance, two years in Kalgoorlie and five years in Karratha before I grabbed a spot on the afternoon program with Verity James. Getting the chop from presenting the ABC TV weather at least wasn’t death by a thousand cuts. I was called into the boss’s office and a couple of minutes later that was the end of it. It was upsetting, but it was radio that was really driving me.”

“In my mid-20s I had another epiphany – I literally woke up one morning and thought, ‘Radio! I want to work in ABC Radio!’ I just missed the cut-off date for the WAAPA Broadcasting Course so I auditioned with 400 people the following year and 15 of us were accepted. I was so excited I leapt all over the bedroom for 10 minutes. I loved radio from the very beginning and I still love it!”

If I could change one thing?

“It’d be smoking. I was very young when I had my first cigarette, probably less than 10. At home there was a little wooden box full of cigarettes and I’d pinch a few – they were Alpines and they felt very cool on my throat.

On my gravestone they’ll write… He Finally Stopped Talking.”

“I tried to give up at a health spa in Thailand using hypnosis and it turned

out to be four days of utter hell! Fasting, no coffee – and I love my coffee – no alcohol and no cigarettes. They did colonic irrigation as well – 10 litres of caffeine and I thought, ‘you’ve got to be kidding me … I can’t drink the stuff and now you’re putting it up there!’”

“I stopped for three months and the cravings weren’t too bad but when the Eagles beat Sydney in the AFL Grand Final someone said, ‘let’s have a cigarette’. That turned into five or six and now it’s a pack a day. My wife, Kylie isn’t happy and my young daughter Bronte calls them ‘dirty, filthy stinking things!’.”

Russell appears addicted to life as well as cigarettes, if his personal predictions are anything to go by.

“I’ll be doing radio for a long while yet.

I love standing up in front of a crowd so maybe I’ll be doing a lot more MC work.

I’m a keen lawn bowls pennant player at the Mt Lawley Club so there’ll definitely be more of that. And when Bronte hits her teenage years I’m going to dig a moat around the house and sit on the verandah with a rifle, picking off the boys as they approach the house.” l

By Mr Peter McClelland

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5/07/11 11:34 AM

21

Rural Medicine

Abrolhos Group Re-establishes Foothold Late last year, about 30 like-minded health professionals made the trip from Geraldton to the Rat Island fisheries complex 80km offshore, for the Abrolhos Medical Conference. The main theme was rural generalist training in WA, with a firm intention to develop Geraldton as a medical training unit. The meeting included insights into relevant IT including use of Skype, voice to text software, and webinars.

Generalist GPs with procedural skills play a pivotal role in regional areas, especially coupled with upskilled nurses and allied health people. The aim is to develop more training in Geraldton in important disciplines such as anaesthetics (currently at Joondalup Hospital), along with paediatrics and obs/gynae.

The newly formed Abrolhos Group intends to promote this concept for WA in general and Geraldton in particular (as the Rural Generalist Pathway, much like in Queensland). Geraldton GP Dr Kim Pedlow, a rural generalist with interests in obstetrics, paediatrics and minor surgery, was one of the main instigators. He speaks of the procedural GP Paediatrics post he initiated

22

n A relaxed presentation

by Dr Kim Pedlow: (l to r) pharmaceutical manager, website developer, practice manager, midwife, two rural clinical school Year 5 students, and the legs of a local doctor.

with WACHS in Geraldton, where he made up with Drs Borcherds and Gibberd, a paediatric roster at the Geraldton Regional Hospital as GP paediatricians.

A shared community residency in paediatrics under WAGPET’s PGPPP program has started this year, assisted by the paediatric team at the Geraldton Regional Hospital that includes specialist paediatricians Dr Jehangir and Dr Ingram.

Formation of the Abrolhos Group has coincided with a rebirthing of the Rural Doctors Association of Western Australia, which will meet in Geraldton next April 27-29. l

RDAWA Committee President: Mike Eaton, Dardanup Vice President: Kim Pedlow, Geraldton Diane Mohen, Bunbury Treasurer: Secretary: Sarah Moore, Dunsborough Member: Mal Hodsdon, Kalgoorlie Regional Representatives Kimberley: David Atkinson Rob Whitehead Pilbara: Kim Pedlow Mid-West: Goldfields: Mal Hodsdon South-West: Diane Mohen &

Sarah Moore Great Southern: Clark Wasiun Wheatbelt: TBC

medicalforum

Medico-legal

AHPRA and the Medical Board WA Senior Solicitor for Avant in Perth, Ms Morag Smith, outlines how these organisations interact and how notifications are dealt with in WA.

T

he National Registration and Accreditation Scheme for medical practitioners (the National Scheme) was introduced on 1 July 2010, with Western Australia joining on 18 October 2010. Despite being in place for 15-18 months across Australia, Dr Joanna Flynn, Chair of the Medical Board of Australia (the National Board), has observed that some people are still confused about how the National Scheme fits together, in particular the interaction between AHPRA and the state boards. (1)

What does AHPRA do?

Under the National Scheme AHPRA’s functions include (2): • Providing administrative support and assistance to the National Board and its delegates; • Establishing and developing accreditation and registration standards, codes and guidelines; • Establishing and administering a procedure for all other matters relating to the registration of a health practitioner; • Maintaining a publicly accessible national register of practitioners; and • Administering a procedure for receiving and dealing with notifications.

AHPRA works in partnership with the National Board to implement and administer the National Scheme.

• In conjunction with AHPRA, updating the publicly accessible national register of practitioners.

Investigating notifications Notifications are submitted to AHPRA, which receives them on behalf of the Board.

In accordance with the National Law, AHPRA and the Board share complaints and notifications, however AHPRA cannot investigate or otherwise deal with notifications. (4) The Board can establish panels to conduct hearings about health, performance and professional standard matters.

What role does the State Administrative Tribunal have under the National Law? Generally, proceedings of a serious nature are referred to the SAT, which has a protective jurisdiction. The SAT is also responsible for hearing appeals against Board decisions.

The SAT can suspend or deregister a practitioner if it is satisfied that the practitioner is: • Not competent to practice; • Guilty of professional misconduct; • Not a suitable person for registration in the practitioner’s profession; or • Convicted of or the subject of a criminal finding for an offence, and circumstances render the practitioner unfit to practise the practitioner’s profession.

Role of Health and Disability Complaints Office have under the National Law? HADSCO’s role is to promote improved safety and quality in the delivery of health services. HADSCO also investigates health complaints and, if possible, seeks to resolve them through conciliation.

Examples of the sort of complaints handled

by HADSCO include allegations that a practitioner has (5): • Acted unreasonably by not providing a health service; • Acted unreasonably in the manner in which a health service was provided; • Denied or restricted an individual’s access to their health records; • Charged excessive fees; and • Not responded to or inadequately responded to a complaint.

HADSCO plays an important role in the investigation of complaints and notifications and there is open communication between it, AHPRA and the Board about all matters relating to notifications.

The latest information about the National Law is available on the National Board website: www.medicalboard.gov.au/ References 1 Medical Board of Australia Update – Message from the Chair: issue 3 – December 2011 2 S 25 Health Practitioner Regulation National Law (WA) 3 S 37 Health Practitioner Regulation National Law 2009 4 S 148 of the National Law 5 S 25 Health and Disability Services (Complaints) Act 1995

What are the roles of the National and State-based Medical Boards?

In accordance with section 37 of the Health Practitioner Regulation National Law Act 2009 (the National Law), the National Board has delegated matters relating to registration and notification to the State and Territory Boards. (3) As a result of the delegation of powers, the WA Board (the Board) is responsible for the following matters: • Overseeing and assessing the knowledge and clinical skills of overseas trained doctors to determine their suitability for registration in WA; • Overseeing the receipt, assessment and investigation of notifications; • Establishing panels to conduct hearings about health, performance and professional standards matters; • Referring matters relating to health practitioners to responsible tribunals; • Overseeing the monitoring of conditions, undertakings and suspensions imposed on a practitioners registration; and medicalforum

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Feature: Profile

Dr Kim Hames – Personal and Political Whether it is constructing a crème caramel or a new hospital, the WA Minister for Health loves to be there at the finish-line.

A former community GP and City of Bayswater councillor, a Member of State Parliament for 15 years and a keen fisherman. What’s next, a guest spot on My Kitchen Rules for the Minister who loves to cook?

The Deputy Premier and Minister for Health and Tourism just laughs at the mention of the popular TV show but there’s no doubt he loves twirling the pans. And he might be coming to a kitchen near you.

“I do regular stints at fundraisers in my electorate and one of the prizes is me cooking a gourmet meal in someone’s house. There are a few things I particularly like to prepare such as crème caramel, panna cotta and crème brulee. And after politics there’ll be a lot more time for both cooking and fishing – I caught a nice 9kg ‘jewie’ on my last trip out in a charter boat.”

The fishing rods are likely to remain in the back of the cupboard for a while yet. The Health Minister has decided to remain at the helm of one of the most demanding ministerial portfolios in the Barnett cabinet.

The Health infrastructure program is wideranging and extends right through until 2015.

“I was unsure about carrying on after the next election because I’ll be 60 by then. But I’ve just announced that I’ll be doing one more term and that’ll take me through until I’m 64,” he said.

“There are a lot of things happening in health, and tourism for that matter. A large number of hospitals will be completed during that time – Fiona Stanley and Albany towards the end of 2013, the children’s hospital in 2015 and Midland, Karratha and Busselton hospitals around the same time. That’s a lot of capital works construction and I’d like to be there to see them finished.”

Given his heavy ministerial workload, the practice of medicine has taken a back seat.

Kim Hames says it has been an invaluable background. And his media adviser says Medical Forum is an important part of the Minister’s briefing material.

“As Health Minister, my prior experience as a medical practitioner makes an enormous difference. I’ve had other ministerial portfolios where I haven’t had a similar background and it places you at an enormous disadvantage” he said.

“You’ve got people coming through the door doing presentations and constant 24

n Kim Hames in the neo-natal nursery at KEMH.

interactions with staff and you just don’t have the same depth of knowledge. The difference with Health is that I’ve been there and done that. I haven’t practised medicine for a while but I worked as a doctor when we were out of government from 2001 until 2005 and that’s not all that long ago. I still maintain my registration but it’s becoming increasingly difficult to do that.”

The transition from ‘doctor’ to ‘politician’

was both easy and difficult. For a battlehardened suburban GP there was no appreciable change in the workload, however the pay packet turned out to be a very different story.

“The hardest thing initially was the money.

In the mid-1980s I was a suburban GP with six kids earning around $110,000 a year. I would do a normal five-day week, Saturday mornings and one Sunday morning a month medicalforum

n Master chef: Kim Hames (left) cooks up a storm with Loose Box chef Alain Fabregues and Verity James at the Mundaring Truffle Festival. n Kim Hames commenting on the federal budget to a media pack. n Catch of the day: Kim Hames with two whopper dhufish.

and I was also on Bayswater council. The workload was about the equivalent of a back-bencher and when I actually made that transition I went down to $54,000 so it was a massive drop. And now, as a Minister, the workload’s about half as much again.”

The ‘4 Hour Rule’ has made print and TV headlines with opinions on its merits and shortcomings ranging across the spectrum. The Minister remains predictably optimistic.

I’ve got a competitive nature and I like to succeed at things.

There’s some of the father-son thing there.

“I think it’s been enormously successful.

Sure, there’ve been some negative views expressed but most of the people who’ve been interviewed or I’ve spoken with wouldn’t go back to the previous system.

“We’ve seen a significant drop in the mortality figures but there are some issues that need addressing – staffing arrangements and the management of specific units. We’ve got no industrial issues looming, other than one particular union and concerns over the external contracting of services. When I came to government, the hospitals were front-page news all the time and it was one crisis after another.

Of course, we used to promote that when medicalforum

we were in Opposition. We’ve been able to improve the way the system operates, the staff is happy and working well and I think they can see things are moving in the right direction.”

The public health system is a complex beast and it is inevitable that some issues remain lodged in the In Tray.

“On wait-list surgery issues we’re doing okay.

But we’re marking time here and we need to do better. It’s a significant period of demand right now and that hasn’t made it easier for people who’ve been referred to a specialist and haven’t been seen. In a similar way we’ve increased our surgery rates but all we’re doing is holding the line and that hasn’t allowed us to get the longer waiting times down to reasonable levels. There’s still quite a bit of work to be done to fix that.”

The contentious issues of nuclear power and euthanasia see Kim Hames donning two Ministerial hats – Tourism and Health. And he’s got strong opinions on both of them.

“We don’t need nuclear power here in WA, we don’t have the population to warrant it and there are lots of other sources. And, quite frankly, I don’t think we need it in Australia either. We’ve seen environmental damage from nuclear reactors and Chernobyl was a clear example of that. For some countries, such as India and China the nuclear option is a necessity due to pollution from coal-fired power stations. It should be up to the countries involved to make their own decisions,” he said.

with that choice being available and I know there are those with a different point of view. I’ve had patients who, if they’d made that choice, would have devastated their families. I’ve also had others who’ve had positive experiences in the latter stages of their lives. I’m happy for people to be given pain relief to ease their pain but I don’t support euthanasia as an option.”

There are winners and losers at every finish line and the Health Minister definitely prefers the laurel wreath.

“I’ve got a competitive nature and I like to succeed in things. It’s just the way I am, there’s some of the father-son thing there.

I think most people want to be recognised for what they do and be able to look back and see that they’ve done something successfully. It’s a bit like the Australian cricketer Justin Langer when he was hit on the head by a bouncer and wanted to come back to the batting crease – everyone wants to be a hero. l

By Mr Peter McClelland

Five things you didn’t know about Kim Hames 1. His father was a Kimberley stockman.

2. He makes a mean crème caramel.

3. He has taken medical supplies to Bangladesh and Chernobyl.

4. He has represented three electorates: Dianella, Yokine and Dawesville.

5. He is a strong opponent of euthanasia.

“Regarding euthanasia, I’m just not happy 25

Medical Training

2014: Curtin Medical School?

First UWA, then Notre Dame, now will it be Curtin Medical School?

Medical Forum spoke to the main protagonist who believes this new bid is unique.

Professor Jill Downie, Pro ViceChancellor of Curtin’s Faculty of Health Sciences, is the driving force behind the attempt to establish a new medical school with a different teaching emphasis. Curtin Uni’s submission has gone to the federal government and the new Education Minister Chris Evans. Everyone is waiting for the release of the Health Workforce Australia training plan, which includes the blueprint for medical schools.

“I think if it’s favourable to our case and we can demonstrate both the need and what we have to offer, then Curtin getting a medical school is a matter of time. To start in 2014 we need approval in the next six months to fit in with Australian Medical Council accreditation,” Prof Downie said.

Putting aside the key selling points of their medical training program for a moment, do we need 100 new medical students in WA? If yes, why not ramp up student numbers at UWA or Notre Dame? And with more graduates in need of later clinical training, will we have the capacity to take on more interns etc?

Training capacity for more graduates questioned “There were three main concerns raised 2.5 years ago [by the federal government] that are no surprise: clinical training placements; clinical supervision; and internships PGY1 and 2, and beyond,” Jill explained.

“We’ve addressed clinical placements in talking with the various health services across the metropolitan area and also designing alternative strategies for clinical placements in the aged care sector, the community, and working alongside WAGPET. We are pretty comfortable that, with these strategies and the growth in metropolitan beds and the new hospital developments in rural areas, finding enough clinical placements for our students – 100 Commonwealth supported places – will be dealt with.

interns in the system when there will be about a 32% increase in hospital beds, just in the metro area.”

“In terms of clinical supervision, we have different models around inter-professional learning, especially in the first year of our program. Junior doctors tend to train the students in part, and there are more coming through, and together with the doctors we recruit from overseas and elsewhere we feel clinical supervision is taken care of in our planning.

People behind the bid

“We have to meet the core competencies of the AMC, so some medical student training will be in the tertiary and secondary hospitals in Perth, private and public, as well as the alternative settings we’ve identified in aged care, community medicine and rural and indigenous communities. There are more than enough places for 100 more students.

“For the internships, the State Government agrees that by 2019, when our graduates come out, they will need at least 100 new

A long list of adjunct professorial appointments have just been made, including various doctors and CEOs of Health Services, WACHS, WAGPET etc. (see list). They already have advisory groups of doctors around course themes.

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Inter-professional learning

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“The inter-professional approach we have taken here in the Department of Health Sciences is strategic. I set a vision four years ago for Curtin to be the leader in inter-professional education. Arguably, in four years we’ve become front-runners in Australia and we are knocking on the door internationally.”

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Every bid needs ‘big names’. Jim McGinty was on the steering committee but stepped down to chair the federal workforce training review. Other well-known committee members are Prof Con Michael (also on the AMC), Prof Bryant Stokes and Prof Gavin Frost (ND Dean). Dr Simon Towler is supportive, Jill says. Dr Neal Fong spends a day a week working on the bid and he is director of the Curtin Health Innovation Research Institute (CHIRI) that Jill says she established in 2007. The new medical school will be fertile ground for research output from CHIRI. Prof Mike Daube also has his Public Health Advocacy Institute within Curtin’s Health Sciences Faculty.

Prof Downie has been working on the medical school bid for 2.5 years. Her background is midwifery, maternal and child-health nursing, so she has a fair idea of how well things tick along when people co-operate and how wasteful it is of resources when they don’t. Hence her zeal for inter-professional learning, which she sees as one solution for the impending blowout in demand on health services.

Finance for healthcare professionals

26

The Australian Medical Students’ Association has disagreed, as has Prof Ian Puddey, from UWA. They say the planned increase in students has not been matched by a requisite increase in funding and support for universities, senior doctors and academics, or the creation of internships.

They say any new funding should go to established programs such as rural clinical schools and current medical schools.

Is ‘inter-professional learning’ just code for more efficient use of lecturers across disciplines? medicalforum

CURTIN ADJUNCT APPOINTMENTS Heathcare Leader Adjuncts Prof Bryant Stokes Dr Simon Towler (Chief Medical Officer) Ms Nicole Feeley (CE, SMAHS) Mr Ian Smith (CEO, WACHS) Mr Philip Aylward (CEO, Child & Adolescent Health Service) Ms Karen Bradley (Area Director, Nursing, SMAHS) Mr Chris Carter (CEO, Perth Primary Care Network) Ms Nicole O’Keefe (State Manager, DoH&A) Mr Chris McGowan (CEO, Silver Chain)

“No. It’s probably more expensive because we’ve not only got a more inter-professional first year but we have inter-professional education in workshops and the clinical settings across all years of all courses. It’s important to acknowledge that with the growing burden that mental health, aged care and chronic disease will bring, unless we change our models of health delivery we are not going to be able to keep up with workforce demand.

distinct rural focus. For the past six years, Curtin has been doing the lion’s share of training Notre Dame medical students in anatomy, physiology and human biology in their first two years.

“We absolutely believe that where you get the professions together, and train them together, there are significant gains.”

Inter-professional learning is made easier by the 22 allied disciplines training at Curtin, including nursing, midwifery, physiotherapy, social work, occupational therapy, psychology, biomedical sciences, oral health, pharmacy, nutrition and food science, health information management, epidemiology and biostatistics, sports, and rehabilitation science.

Curtin plans that each year, 100 17-yearold medical students will start their fiveyear undergraduate program, two years preclinical, then three years clinical, with a

Of course, the picture of cross-fertilisation is complete if medical students join the throng, and switching courses will become easier.

Dept of Medical Education Adjuncts Dr Paolo Ferrari (Nephrology) – pending Dr Daniel Xu (Clinical Senior Lecturer, UWA) – pending Dr Jeff Ecker (Hand and Upper Limb) Dr Fraser Moss (Corrective Services) Dr Nicholas Bretland (GP) Dr Nicolas Tsokos (Obs&Gyn) Dr Tonia Douglas (Paediatric Respiratory) Dr Peter Campbell (Orthopaedics) CHIRI Dr Carolyn O’Shea (Australian Family Physician) Dr Michael Civil (GP) Dr Wendy Cheng (Gastroenterologist) Dr Andrew Robertson (Disaster Management, WA Health) Dr Axel Hofmann (Patient Blood Mgt, WA Health)

Continued Page 32

WA Health puts the care into your career

DOH 12322 DEC’11

n Curtin University’s Professor Jill Downie

Faculty Adjuncts Dr David Russell-Weisz (CE, NMAHS) Dr Paul Mark (Clinical Services, SMAHS) Dr Richard Saker (Medical Services, Joondalup Health Campus) Dr Marcus Tan (Director, WAGPN) Dr Janice Bell (CEO, WAGPET) Dr Hugh Greenland (Consultant, Obs&Gyn)

While you care for others, we care for your career. find your opportunity at www.health.wa.gov.au

Alternatively, call (08) 6444 5815 medicalforum

27

The Family Birthing Unit at Mercy Hospital is a state of the art Maternity ward catering for women and the families during all stages of their pregnancy, labour, birth and postnatal period. Mercy Hospital is a Catholic hospital situated in Mt Lawley, founded by the Sisters of Mercy and is part of the MercyCare group.

The Postnatal Ward is a 30 bed facility with 21 rooms that boast double beds and private ensuites. This enables families to stay together during the first days after birth. Most of the patient rooms have stunning views of the beautiful Swan River.

The Birthing Suite has six delivery rooms with the latest facilities and technology. There is a four-bed Level 2 Special Care Nursery and we can look after babies from 34 weeks.

There are 10 Specialist Obstetricians and three GP obstetricians to provide expert medical care for women at Mercy Hospital. A list of these doctors is available by contacting Family Birthing Unit or accessing them from the website www.mercycare.com.au and following the links to the hospital page. These doctors provide access to their expertise, on call 24 hours a day. There is a Paediatric and Anaesthetic on-call roster to cover the unit 24 hours, as well as an RMO available on site.

Additional services include: • Antenatal classes and antenatal clinic.

• Antenatal physiotherapy classes and postnatal information and advice.

• Lactation consultant for inpatients as well as outpatients 6 days per week.

• Specialist neonatal hearing screening.

• Whooping cough vaccination program for mothers.

• Look at my Baby technology enables parents to upload to friends and relatives live images of their baby from their room – www. lookatmybaby.com.au • Virtual tour of the unit at www. mercycare.com.au and a tour every Sunday at 2pm to come and see the unit in person and ask a midwife any questions.

For further information or enquiries please contact Sharon Connolly, Nurse Unit Manager, Family Birthing Unit. sconnolly@mercycare.com.au or 9370 9420

Mercy Hospital Mount Lawley, Thirlmere Road, Mount Lawley 6050 • Tel 08 9370 9222 • Fax 08 9370 9488 • Email: hospital@mercycare.com.au

Medicine and the Law

Doctors Take On New Jury Obligations WA Attorney General Hon Christian Porter MLA outlines why new laws reflect community expectation that doctors take on more jury duty.

L

ast year Parliament passed the Juries Legislation Amendment Act 2011. That Act effected significant changes to the jury legislation in Western Australia of which one was the abolition of the concept of ‘excusals as of right’.

Prior to this Act, a substantial number of occupations and characteristics provided a person with an entitlement to be excused, as of right, from jury duty.

impact on waiting times for surgery or the level of training and oversight provided to young doctors. Obviously none of these outcomes would be desirable, however, these changes are highly unlikely to cause these outcomes in my view.

Reasons for negligible effect on medical services First, there is now a general entitlement for a person to, pursuant to s 34H of the

That list included fire and emergency services workers, medical practitioners, pilots employed by the RFDS, veterinary surgeons, psychologists, dentists, midwives, nurses, chiropractors, physiotherapists, osteopaths, pharmaceutical chemists, religious leaders, pregnant women, full time carers, and persons aged 65 and above.

This list consisted of two categories: persons for whom jury duty might be extremely inconvenient; and those important professions for which it was thought undesirable to occupy their time with jury duty, in the public interest. These general exemptions no longer apply.

Second, in predicting the overall impost of these changes on the medical system, the likelihood of any medical practitioner having to seek a deferral or exemption needs to be kept in mind.

The amending Act reflected agreement among all major political parties that every person whose work did not create an obvious conflict of interest with the duties expected of a juror should be entitled to, and expected to, serve as a juror.

Reasons why doctors are no longer exempt This change was not accidental. It represented the culmination of a twoyear consultation and law review process, and reflected the bipartisan intent of Parliament. A view had emerged, with some justification, that juries were not as representative of the wider community as they could be. The amending Act reflected agreement among all major political parties that every person whose work did not create an obvious conflict of interest with the duties expected of a juror should be entitled to, and expected to, serve as a juror.

Since the passage of this legislation, some organisations associated with medical practitioners have said this change will medicalforum

Consequently, if a summonsed doctor were genuinely unable to discharge jury duty without serious hardship or inconvenience to himself or the general public, there exists avenues for him to defer, and, in the event that they continued to be extremely busy thereafter, obtain a permanent excusal. (If any practical steps emerge that minimise the inconvenience for medical practitioners of applying for a deferral, the Government would be open to considering them.)

Juries Act 1957, apply for deferral or excusal from jury duty. Such a ground may include where, because of the nature of the person’s business or occupation, attendance in accordance with the summons would cause undue hardship or serious inconvenience to the person, the person’s family or the general public.

Where such grounds exist, jury duty may be initially deferred for up to six months.

If they are then unable to complete their jury service on the nominated date, they may apply for a permanent excusal, on the ground that circumstances not reasonably foreseeable have arisen that prevent them from discharging their jury service, or exceptional reasons exist why the person should again be excused under this section.

Persons required to sit on a jury are drawn from the electoral roll.

About 1.368 million people are on the roll from which about 7000 are required to attend for jury duty each year, which is roughly a 0.52% chance of an eligible elector being called in a year.

In the event that a person is one of the 0.52%, is unable to obtain a deferral, and is in fact empanelled as a juror, the average length of a jury trial in Western Australia is between three and four days.

Overall perspective Against what is a statistically very minor risk of a relatively moderate inconvenience to individuals must be balanced the importance of properly representative juries to society.

In this regard, every member of the public has a potential stake in the effective operation of the jury system because any member of the public, including any medical practitioner, might one day find themselves in a situation where, as a victim of crime, or as a person accused of a criminal offence, a properly representative jury with a proper balance of knowledge and life experience is of extreme personal importance to them. l

29

Medical Boundaries

Dr Nick Harrington – Flying South The propellers stopped spinning in Meekatharra for this ex-RFDS medico. Richer for both rural experiences he has now turned to anaesthetics training in Perth.

Nick must have a thing about aeroplanes - first as a Retrieval Officer for the RFDS in Port Hedland and then as a FIFO GP based in Meekatharra. From a road accident victim with a bilateral pneumothorax and spinal fractures to a throat-slashing attempted suicide in a remote Aboriginal community, Nick has seen a lot of rural medicine. Now he is back for a year of anaesthetics and some enjoyable cycling on his carbon-fibre Avanti road bike. Yes, he does wear a helmet!

“Meekatharra was part of my ACRMM GP Registrar requirement – two years in a rural and remote environment. Before that I was based in Hedland with the RFDS and it was that combination of emergency medicine and intensive care which I really enjoyed.

My main responsibility in Meekatharra was looking after the hospital but I really missed going out in the aeroplane. You’d be up there with a pretty good plan and then you’d get diverted to go somewhere more urgent ­– it keeps you on your toes! I was a bit uneasy for the first six months of being on-call… it is stressful.”

Nick has travelled a distinctly different path to a career in medicine.

“I grew up in Toowoomba and went to the University of Queensland. I wasn’t clear on what I wanted to do so I did Business Management and after that I went off to the army – one year of military service and then six years part-time. During that period I studied science and went on to medicine as a mature-aged student.”

“I came to Perth for the RFDS job – I’d had on-call experience as a surgical registrar in Qld but I needed a change. I was specialising far too much for my liking and it had a huge impact on the family – I’ve got two young and very active boys and a younger girl.”

The job has challenged his skills and tapped into his innovative thinking. He recalls

Nick’s Pitch Meekatharra GP Registrar Vacancy FIFO 2 weeks on/1 week off Patient continuity Advanced Rural Training Confidence-building Great diversity

medicalforum

one such experience. “A couple of postal delivery guys flipped their car 80km out of Meekatharra – running late and speeding.

We flagged down an ambulance going the other way… it was advanced life-care for one of them as soon as we got there, a head injury and waving his arms everywhere. We put a C collar on him, pain relief and oxygen and radioed ahead to the hospital to get ready for an intubation.”

“On the ventilator they discovered that he had a pneumothorax so they put in two chest tubes. One of the doctors inserted an interosseous needle and then we had to do some surgery because he’d taken a chunk out of his right arm. We packed him off to Perth and received a commendation from the doctors down there. He had a major scalp laceration, a bilateral pneumothorax and spinal fractures but his brain was okay.”

You’d be up there with a pretty good plan and then you’d get diverted to go somewhere more urgent – it keeps you on your toes!

“He’d been a well-loved member of the community and it was hard for them.

Sometimes I replay these incidents in my mind and ask myself, ‘could I have done anything else?’ But I’m a bit of a pragmatist, everyone has their time and sometimes things are just stacked against them.”

On this occasion, there was a positive spinoff, albeit somewhat harrowing.

“We were the only RFDS crew north of Perth and a call came through for an Aboriginal man at Dirranbandi who’d tried to commit suicide by slashing his throat. There was only one nurse there… she was trying to hang on to his neck! We managed to save him.”

As Nick points out, it doesn’t end quite so happily all the time.

Nick’s plans for 2012 exclude both aeroplanes and remote medicine.

“There’ve been a few tough moments – we had a fellow out of Exmouth who’d had a massive heart attack. We intubated him and rang the consultants at Perth ICU to ask them if we’d missed anything… he had co-morbidities and previous heart attacks.

“I’m going to do a year of anaesthetics – six months in Joondalup and six months in Bunbury and then based in Perth. We love it here, the children are settled at school and we’ve got no thoughts of moving at this stage.” l

By Mr Peter McClelland 31

Medical Training Continued from Page 27

Will more collaboration solve our problems?

PIVET MEDICAL CENTRE Specialists in Reproductive Medicine & Gynaecological Services

FERTILITY NEWS

Medical Director Dr John Yovich

Embryo Biopsy for PGS Of all oocytes collected worldwide, less than 10% result in live babies. Resultant good quality embryos have a higher chance of translating to babies but even high-grade blastocysts have, at best, a 40% chance of becoming live, healthy infants.

Over the past 20 years the technique of embryo biopsy, followed by blastomere Senior Embryologist chromosome analysis has been Kirsty Douglas applied for pre-implantation genetic screening (PGS) to exclude the common aneuploidies such as Trisomies - Down syndrome (21), Edward’s syndrome (18), and Patau’s syndrome (13) as well as deletions such as Monosomy X, Triploidies eg XXX and Translocations – both Robertsonian & Reciprocal.

However all the work on PGS to date has been shown to be CGH with deleted 8, absent Y & gain X problematic and giving karyotype Monosomy 45XX, -8 a moratorium called on its use. This appears to be mainly related to the use of the Fluorescent In-Situ Hybridization (FISH) technique applied on 7-9 chromosomes.

A new technique for testing, Comparative Genomic Hybridization (CGH) is now available that allows all 24 chromosomes to be tested with greater reproducibility than FISH. One of these is known as the BlueGnome method as shown. This can be applied on day-3 embryos as well as blastocysts. We believe this will translate into an improved embryo selection method for quality embryos Blastomere biopsy, dayand resultant healthy normal 3 embryo, using laser. children.

“A lot of doctors believe this is the way of the future – that sharing and collaborating produces better results,” Jill said, adding that the accreditation bodies will ensure the core competencies of any of the collaborating disciplines, including medicine, meet standards.

“We are currently involved in a project at RPH, a student-led training ward, where the fourth-year students essentially take over the ward in the morning and work as a team. Evaluations of that approach have been so successful that RPH is keen to expand it into other wards. Students from different disciplines do an inter-professional assessment of a patient they share, they come up with an inter-professional care plan which they deliver, as well as care focussed in one particular discipline.

“There is no other university in Australia that has brought those disciplines together to learn. We have upskilled our academics so you might have a social worker and a pharmacy team teaching in the classroom during the first-year courses. We are really trying to break down the silos between the disciplines and it has been hugely beneficial for the students and the academics.”

What else will popularise the bid Another selling point is the rural focus, a very popular move these days, along with a focus on primary care and indigenous health. The projected medical workforce shortfall adds further pull.

“We will actively recruit students who are interested in areas of practice that are currently under-serviced – primary care, chronic disease management, aged care, mental health and Indigenous health. And our medical students will be taught in clinical schools that will be established in regional and remote priority locations across the State.

“We have developed the Curtin Regional Inter-professional Practice Schools initiative and have money from the State Government to run pilots in Geraldton and Albany. Those practice schools are loosely based on the Rural Clinical Schools model but they involve all of the health professions along with medical students to give an inter-professional team in the clinical setting.”

“We are developing clinical training schools in collaboration with UWA, ECU, Notre Dame and others at Joondalup. We have put infrastructure resources into the Cockburn Super-clinic and are working with them on an inter-professional model that will include medical students. We will have clinical school developments at Fiona Stanley and Midland.”

Teachers on notice?

Upcoming hospital developments will allow more training placements but do we have the right people to teach?

“People talk about changes in workforce delivery but you are never going to do that from the health service. You have to take responsibility as an education provider and ask, how do we educate health professionals of the future differently so that when they go out into the workforce they understand about innovative and creative ways of working together. I’m not an advocate of the generic health worker. I believe in drawing the strengths from each discipline but when you work together the whole is greater than the sum of the parts.”

LEEDERVILLE & BUNBURY

“I’m sure you will appreciate that to get this far at Curtin has meant extraordinary change and a real trust by the academics in every discipline that we are not going to diminish what they do. It is amazing how the academics are now learning from each other.”

For ALL appts/queries: T:9422 5400 F: 9382 4576 E: info@pivet.com.au W: www.pivet.com.au

There is no plan to take overseas students in the first five years, and only small numbers thereafter. l

NOW AT 2 LOCATIONS

By Dr Rob McEvoy 32

medicalforum

Clinical update

Relative new developments in chronic heart failure C

By Dr Mark Hands Clinical Assoc Professor (UWA) Interventional Cardiologist Western Cardiology Ph: 9346 9300

hronic heart failure (CHF) is complex, and although it accounts for significant hospitalisations and deaths, there have been improvements in recognition and treatment over the last 20 years.

This has been facilitated by relatively easy access to echocardiography and demonstrated benefits from long acting beta blockers, ACE inhibitors and aldosterone antagonists. As well, devices for biventricular pacing or cardiac resynchronisation therapy (in symptomatic patients with a left ventricular ejection fraction or LVEF<35% and QRS >120 milliseconds in sinus rhythm), and implantable defibrillation (in patients with a LVEF <35%), are being effective.

Relative new developments have included: • direct sinus node inhibition, • use of polyunsaturated fatty acids, • more aggressive treatment of cardiac arrhythmias, and • use of natriuretic peptide (BNP or N-terminal pro-BNP) in guiding treatment.

Direct sinus node inhibitors Ivabradine (a direct sinus node inhibitor) has recently been shown to decrease cardiovascular mortality and hospitalisation for heart failure in symptomatic patients with sinus rhythm >70 beats per minute(1). Whilst the benefit was largely due to reduction in hospitalisation, it occurred largely in patients already on highest tolerated beta blocker doses. An echocardiographic sub-study demonstrated

Ivabradine (CoralanTM) as a sinus node inhibitor, resulting in favourable LV remodelling in patients with LVEF <35% and a resting heart rate >70 beats per minute(2).

Direct sinus node inhibition with Ivabradine is worth considering for CHF patients with impaired systolic function and with a heart rate >70 beats per minute on maximum tolerated beta blockers.

Polyunsaturated fatty acids A trial has demonstrated a small reduction of mortality and hospital admissions for patients with CHF treated with omega-3 fatty acids(3), primarily in patients with a left ventricular ejection fraction (LVEF) <40%. Omega-3 fatty acids should at least be considered in patients for CHF who are symptomatic despite standard therapy.

Aggressive treatment of cardiac arrhythmia Atrial fibrillation is common in CHF. If sinus rhythm cannot be maintained, it is generally accepted that therapy is directed at controlling ventricular response rate and reducing thromboembolic risk with warfarin.

However, a small study found that pulmonary vein isolation (ablation therapy) for AF in patients with CHF has resulted in a high rate of freedom from atrial

fibrillation with improved symptoms, exercise tolerance and LVEF (4). Atrial ventricular node ablation (with back-up pacemaker insertion) or pulmonary vein isolation is considered when rate control is inadequate medically.

Natriuretic peptides Where titration of therapy is based on plasma natriuretic peptide levels (5-7), studies have reported a significant reduction in cardiovascular events in patients with CHF and low EF. It is reasonable for plasma natriuretic peptide to guide therapy in CHF patients with systolic dysfunction who are felt not to have responded adequately to conventional management. Costeffectiveness is yet to be proven.

References (1) Swedberg K etal Lancet 2010; 376: 1223-1230 (2) Tardit J etal European Heart Journal Clinical Trial update 1-9 (3) Tavazza L etal Lancet 2008; 372:1223-30 (4) Khan MN etal New England Journal of Medicine 2008; 359:1778-1785 (5) Jourdan etal JACC 2007; 49: 1733-1739 (6) Pfisterer M etal JAMA 2009; 301: 383-392 (7) Lainchbury J etal JACC 2009; 55: 53-60

Medical Forum Declaration: Western Cardiology contributes to the cost of this clinical update and the medical editor makes every attempt to ensure information is generic and to our standard.

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33

Clinical update

Simulation for Anaesthesia Education in WA H

By Dr Emelyn Lee, SIMAC Director, Staff Anaesthetist SCGH and KEMH

ealth care simulation has followed aviation. Both pilots and medical specialists need to develop finely tuned perceptual and motor skills, analyse complex situations, and make sound decisions in time-critical events. The similarities are evident, which is why simulators in hospital departments are now widespread.

They range from simple body parts to high-fidelity computer-driven manikins.

Medical (and especially anaesthetic) training increasingly uses simulators to provide effective learning, safely. Apart from the obvious advantage of not â&#x20AC;&#x153;practisingâ&#x20AC;? on an unsuspecting patient, simulated scenarios permit skill practice, team-work and clinical decision making that can be evaluated in a controlled environment.

Furthermore, timely feedback and debriefing from trained educators greatly helps active reflection and experiential learning. Rare crises (e.g. anaphylaxis or failed intubation) can be simulated to expose learners to events where their response times would be crucial to patient survival. Practice, as they say, makes perfect!

Cost-benefit choices One of the most complex high-fidelity patient simulators is the METI HPS manikin. It is computer-driven, using physiologically- and pharmacologically-based mathematical models. The top of the range Laerdal model, SimMan 3G, whilst still being high-fidelity and wireless, is relatively simpler to use with the console operator dictating end-point observations. At the relatively reasonable price of about $100,000 (compared to about $500,000 for a METI), most hospital departments are (not surprisingly) opting for a SimMan. Optional equipment and technical support for these simulators can make purchase costs even higher. And because it is critical to learning that the environment replicates realworld settings, there is the additional cost of appropriate medical equipment.

A place in training In the Australian and New Zealand College of Anaesthetists (ANZCA) training curriculum that starts in 2013, completion of an Effective Management of Anaesthetic Crises (EMAC) course will be compulsory. During 2.5 days, participants are taught in skills workshops using task simulators, and high fidelity scenarios using the METI and SimMan. While many hospitals have small simulation rooms to teach their trainees, the Edith Cowan University Simulation Centre in Joondalup recently won the tender as the State Simulation Centre, and is offering the EMAC course in WA. Teaching with high fidelity simulators can be complex, needing skills in debriefing, console medicalforum

Typical Simulation Scenario Learning objectives, simulation used, anticipated trainee responses are prepared beforehand. The instructors guide the scenario to bring out the specific learning points. In anaesthetics, the debrief is both technical (assessment, diagnosis, management) and non-technical (teamwork, communication, use of resources).

Example: Severe Anaphylaxis where hypotension, tachycardia, wheeze, high airway pressures and drop in oxygen saturations are followed by a PEA cardiac arrest (e.g. sinus tachycardia on ECG).

SimMan: Appropriate ventilation, chest compressions and the giving of certain drugs can be sensed by SimMan and relayed to the instructor at the console who alters the clinical signs dynamically to simulate an appropriate response.

METI HPS (more sophisticated): Manikin senses drugs given and any other intervention (ventilation, etc.) and automatically changes the clinical signs in a programed time-related response. Age and co-morbidities can be chosen for a patient scenario and METI will respond physiologically.

operation, management of immersion logistics, development of realistic scenarios and often acting! With various instructor courses specific to different simulator courses (ALS, EMAC, EMST, CCrISP, etc), Health Workforce Australia is starting a simulation educator and technician/coordinator training program. Named AusSETT, this will standardise the training of educators and technicians/coordinators nationally.

Anaesthetists in WA In the anaesthetics field in WA, various simulation fellowships are run at each of the major public hospitals.

At Sir Charles Gairdner Hospital we offer a six-month fellowship in simulation, plus education for anaesthetic registrars in their post-fellowship year, which includes the Simulation Instructor Modular Advanced Course (SIMAC). This runs for seven half days a week. Participants work with SimMan 3G in the simulation laboratory, culminating in teaching a workshop that they create.

SIMAC has been accredited by ANZCA as a generic instructor course, with the option for participants to transition into instructing in other courses (e.g. EMAC, ALS).

Registrars in other disciplines and SCGH nurses who are interested in education and simulation have also keenly attended SIMAC, to grow the pool of well-trained simulation educators in WA. As the training needs of medical/nursing students and specialist trainees increase, and avoiding harm to patients in this medicolegally-sensitive age is paramount, simulation in training will increase and the demand for well-trained simulation educators is greater than ever.

Ed. Dr Lee is also an EMAC instructor, ALS instructor, Obstetric simulation instructor, and Supervisor of Training at KEMH. The SCGH situation is outlined at www. anaesthesia.uwa.edu.au/go/about-us/ employment/sim-fellowship. n 35

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medicalforum

Professional Development

How to ‘Hit The Books’ Keeping an enquiring and open mind comes easy for some.

Others enjoy the stimulation that comes from journal clubs.

Medical information is said to double every five years and by the time results from a study are published in a reputable journal, more than two years have passed. In the age of instant gratification, where Google and online journals and webinars offer up the latest, we learn that journal clubs are not dead. Dr Brett Montgomery, a GP with a desire to learn and question, is a devotee who finds his journal club inspiring.

It’s an evidence-based medicine journal club or EBM JC for short! From Brett’s comments, we learn that an innate curiosity to discover things is a big driver, and both critical appraisal skills and computer skills are needed.

“I like the whole idea of EBM – being curious, harnessing that curiosity, seeking whatever information brings me closest to the truth to answer my question, and thinking critically about what it all means. It’s fine to rely on guidelines and experts but when possible, I get enjoyment out of really sinking my teeth into a topic,” he explained.

The journal club also offers a social dimension

medicalforum

– sandwiches, shared insights on research and different perspectives on patient and GP reaction to ideas.

“There is often a range of perspectives within the group, which helps me remember it is valid for different patients to have different perspectives too. I’m a real fan of sharing decision-making with my patients, and the EBMJC process helps me do it better.”

The group works like this. Every six weeks they meet, the group of 8-10 GPs comes up with a burning question around patient care, and the designated doctor looks into it, presents findings, the group critically appraises the literature, and discusses ramifications for their work.

Through the WA office, the RACGP library in Melbourne is a huge help. Paperwork picks up the CPD points and after attending at least four meetings and leading one cycle of literature-searching in 12 months, a group member is eligible for 40 QACPD points.

Brett says the EMB nature of the journal club is a different approach.

“We are not browsing through the latest journals, passively waiting for something

n Dr Brett Montgomery won the RACGP WA Faculty Budding Researcher Award in 2011.

interesting to turn up. We are beginning with our own curiosity, and then actively seeking answers.”

As expected, one problem with a lot of research is it cannot mimic general practice at its core – very specific patient subgroups or those with multiple co-existing conditions are missed, and quantitative issues take precedence over qualitative things.

“As an example, it may be easy to find out ‘how much this antihypertensive reduces my patient’s risk of a heart attack’, but it may be harder to find out ‘why so many patients are not taking their antihypertensive’.”

Continued on Page 39

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Professional Development Continued from Page 37 For many things, literature searching works a gem. Brett recalls seeing a teenager with shingles who had no pain at all. His question became, ‘should I prescribe antivirals to prevent post-herpetic neuralgia?’ He discovered how we predict this risk. Other questions answered include: • Inhaled steroids worth it in mild, persistent asthma?

• Does swimming affect infection risk in children with perforated ear drums?

• What is the better: colon cancer screen – colonoscopy for all, or after faecal occult blood testing?

• Do statins cause memory loss?

• Does PR prostate screening affect mortality?

“EBM journal clubs are essentially democratic and not very hierarchical. We are colleagues who differ in our special interests but take turns to investigate questions and to support each other. We don’t need an expert to tell us what to do. So it’s quite egalitarian. And quite independent too – there’s no drug company putting on the food.

“More fundamentally, I suspect EBM journal clubs may appeal to people who are naturally sceptical and inclined to question themselves and others. If you prefer to just be told what to do, then an EBMJC may not suit you. But if you like to ask questions, and to seek answers in the company of like-minded people, then I think it can be stimulating, practice-changing, and fun. But prepare yourself for finding out you have believed something incorrect for years!”

So Brett now finds himself a more critical thinker and aware of how others try and influence him. Getting answers from recent research is not such a precedent because discoveries and ideas take so long to be adopted into practice anyway. Quality of evidence is more important than its age.

“For questions that don’t need to be answered quickly, such as many preventive issues, and for the ones that are common enough to come up again and again, it is useful and rewarding to occasionally look into things in more detail. Our journal club gives me the space to do that.

It might be slower, and to some extent more difficult to get an answer this way, but I always come away with a richer understanding of the topic.”

As well as more critical he is now less dogmatic when he approaches clinical problems.

“One problem with guidelines is they often frame things in black and white: given a patient with disease X, treatment Y is first line. You feel like you have to prescribe this treatment, and your job is to talk your patient into it.”

“The nice thing about EBMJC is it helps me to think about shades of grey: treatment Y may be our most effective but if it only helps 1 out of every 20 patients over five years, and if it causes side-effect Z, then perhaps it’s reasonable if some patients make a different decision.

Awareness of these shades of grey helps me to be more patientcentred.”

Medical Forum asked how he finds the time, to which Brett responded, how do doctors find time for any education!

“EBMJC is not as onerous as you might think. At most meetings, another member has come up with the questions and found the articles, usually only one or two articles, and I just need to read those and rock up. When my turn comes to ask a question and search for the papers, that is a bit more work, but in a club of reasonable size, my turn might only come around once a year. That’s not a big commitment.

And we work around each other’s availability and holidays, etc.”

Ed: See www.racgp.org.au/afp/200801/200801doust.pdf l

By Dr Rob McEvoy

medicalforum

Workers’ Comp matters

By Michelle Reynolds Chief Executive Officer, WorkCover WA

The cost of workplace injuries is significant and borne by the entire community.

GPs can make a difference.

As a GP, taking a proactive role in a patient’s recovery and return to work needn’t require a big investment of time and effort - but it can make a critical difference in the outcome for your patient.

How can we help you?

1.

Filling out the First Medical Certificate

The information provided by the GP can significantly influence the outcome of a workers’ compensation claim. WorkCover WA’s advisory services can provide advice and assistance with filling out this form.

2.

ase conferencing and Return to Work C programs

GPs can help injured workers return to work sooner by working with their employer, the workplace rehabilitation provider and insurance claims manager to develop a Return to Work program. Case conferences rates can be billed to the employer’s insurer. WorkCover WA can provide further information and advice on how to get involved.

3.

ecoming an Approved Medical Specialist B (AMS)

To access the common law system and claim lump sum benefits for work-related injuries, workers must have their impairment assessed by an Approved Medical Specialist.

Gaining AMS accreditation is a simple and straightforward process, with benefits for both doctors and patients.

WorkCover WA provides a range of publications, forms and templates to assist GPs in fulfilling their responsibilities under the workers compensation system. Visit the WorkCover WA website at www. workcover.wa.gov.au or call WorkCover WA’s advisory services on 1300 794 744.

Advisory Services call centre 8am – 5pm weekdays 1300 794 744 1 Arnetz BB, Sjoren B, Rydehn B, and Meisel R (2003). Early workplace interventions for employees with musculoskeletal related absenteeism. Journal of Occupational and Environmental Medicine. 45 (5) pp 499-506.

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In practice: Secondary victims of homicide S

Dr Ann O’Neill, PhD

econdary victims of homicide are those people who grieve intensely following the murder of a family member, intimate other or close friend. Little research has been undertaken of this group of traumatised people and their interaction with medical professionals. However, the research that has been done suggests that more that more than half of those who seek help turn to their General Practitioner (Mezey et al.’s 2002).

Researchers R. Harrison (2000) and Hertz et al. (2005) have focused their research on the long-term relationships GPs and other allied health care providers, such as counsellors and social workers, build with secondary victims of homicide. These authors assert that once properly trained these professionals should routinely identify, screen, treat, and/or refer secondary victims of homicide as a means of primary (or early) intervention.

Health effects Increasingly homicide is being considered not just as a criminal justice issue but a public health issue as well. In my 2010 PhD thesis, which studied the social support experiences of 28 adult secondary victims of homicide in England and Australia, GPs featured as the second most-discussed community support source for them, with these people often visiting GPs at a time of extreme emotional distress.

It revealed that GPs predominantly delivered helpful experiences when they listened; asked how these people were coping; provided grief and trauma education; and, interestingly, refused to give tranquilisers before the funeral. However, less successful was when GPs prescribed excessive medications (which often meant that patients had no recollection of events); not mentioning or discussing the homicide; not allowing the time to get comfortable enough to discuss the loss; and/or judging the deceased as deserving of their fate.

and parole reviews, birthdays, anniversaries and other traditional family gatherings.

Once adequately trained, GPs can play an important role in screening for trauma, provide important information and education about this form of bereavement and refer secondary victims of homicide to appropriate specialised support services.

ED: Dr O’Neill is founder of Angelhands, a support organisation for the victims of violent crime.

References Harrison, R. (2000). The Impact of Stranger Murder on Families and the Need for a Multi-Agency Approach. Unpublished Masters of Philosophy, The University of Exeter, Exeter.

Hertz, M. F., Prothrow-Stith, D., and Chery, C. (2005). Homicide Survivors: Research and Practice Implications. American Journal of Preventive Medicine, 29(5, Supplement 2): 288-295.

Mezey, G., Evans, C., and Hobdell, K. (2002). Families of homicide victims: Psychiatric responses and help-seeking. Psychology and Psychotherapy, 1 (75): 65-75.

O’Neill, A. (2010). A Retrospective Exploration of Formal and Social Support Received: Experiences of Secondary Victims of Homicide in England and Australia, Curtin University of Technology, Bentley, Western Australia: unpublished thesis. n

Secondary homicide victims said they turned to their local GPs not only in the immediate time frame of the crisis but also in the ensuing weeks, months, and years, often seeking support in dealing with physical symptoms (insomnia, changes in appetite, somatic complaints, headaches, depression, anxiety), and psychological and emotional aspects of their trauma and grief.

The ability of the GP to acknowledge the emotional and psychological aspects of the grieving process beyond just responding to treating the physical manifestations was an important consideration for secondary victims of homicide. GPs who provided grief and trauma support and counselling, helped secondary victims of homicide understand the changes in their behaviours post the trauma.

However, some GPs were perceived to be unsupportive and unhelpful by rushing secondary victims of homicide during the consultation; avoiding discussion of the homicide and emotional needs; and over-prescribing sedatives or antidepressants.

Training for GPs These findings strongly echoed the need for GPs to receive training in managing post-traumatic grief symptoms, the appropriate use of medications, and on the wider social supports available to secondary victims of homicide. A model of three dynamic dimensions of social support is presented as a means to facilitate this learning.

It is, therefore, important that GPs have the opportunity to access training and guidance to help them in their supportive roles, especially during critical periods such as criminal trials, appeals

medicalforum

43

Leading a Life Less Ordinary Sierra Leone to Oxford is a big leap but medical scholarship winner Dr Sam Brophy-Williams thrives on a challenge, the bigger the better.

He has climbed mountains in Uganda, competed in the Rottnest Island Swim and worked in Sierra Leone. In Sam’s words, his ‘life less ordinary’ this year includes his passion for paediatrics at PMH. After that, courtesy of a prestigious Sir John Monash Scholarship, his eyes are firmly fixed on Oxford University and a postgraduate degree in Global Health Science.

“Gaining the scholarship is one of the things I’m most proud of – it’s quite humbling and I’m very excited about it. I made the final interview of the Monash and the Rhodes Scholarships last year and missed out on both of them. This is a bittersweet achievement – I’m not sure how many more years of missing out I could have taken,” Sam said.

The scholarship is linked to an international PhD or Master degree and is worth $50,000 a year for three years. He is keen to study overseas and acknowledges that the scholarship makes it possible.

“The course at Oxford is brilliant! It doesn’t just focus on statistics and public health data, it actually places the broader issue of health in a social, political and historical context. It also offers one entire term within the Oxford Tropical Medicine network in places such as Central America

and West Africa,” he said.

He has some experience of such far-flung places, and at the relatively young age of 25, has already had a taste of some pretty confronting medicine.

“I did some elective paediatrics in Sierra Leone in 2008,” he said. “It was the only children’s hospital in a country with a population of around six million people.

There were about 200 beds and next to no resources – it was harrowing and awful at times, and kids were dying who shouldn’t have.

“You learn a lot about medicine and yourself when you’re confronted with that sort of thing. It made me feel very privileged and until you experience it you don’t really have a full understanding.”

Those early encounters tie in with his current passion, paediatrics at PMH. He says children are a lot of fun to work with and the chance to intervene at a young age is a wonderful opportunity, or as he puts it: “You can change the trajectory of a life, and for generations to come.”

However, choosing medicine as a career was not a forgone conclusion for Sam. “I wasn’t one of those kids who’d always intended to do medicine and my parents aren’t doctors so I don’t have a medical background. I’d finished Year 12 at Christchurch and I’d done pretty well so it was more just a case of giving medicine a go.”

“My second choice would’ve been law, but having seen some of my mates working in the cut-throat world of the corporate legal system, I’m very glad I didn’t take that path.

“As a resident, it’s not the bad old days it used to be. We’re much better looked after with rostering and overtime. Those inhumane and dangerous hours of the past are gone – that’s better for us and our patients. It can be tough though, that pressurecooker environment really separates those who thrive on it and those who feel that it may not be for them.

I’m certainly in the former group.”

However, Sam is well aware that a hospital ward can be a tough and demanding place.

“Patients who are difficult haven’t made me want to stop practising medicine, but you do learn a lot about life in a hospital. People are at their most vulnerable, it’s a great lev-

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medicalforum

Achievers

n Gibb River Mountain Bike Race.

n Having fun at Bidyadanga in the Kimberley. eller and you see individuals at their best and worst,” he said. “Nonetheless, I saw some pretty inspiring examples of humanity at RPH.” As our conversation again turns to disadvantaged communities, Sam has some reflections on his experiences closer to home.

“As part of the Rural Clinical School I was lucky enough to do a year in Broome and the Kimberley region. It was a fantastic experience but there are some depressing aspects

Sam’s Student Doctor Checklist • Communication – talk and listen to your patients.

• Inspiration – you’ll need it at times.

• Fun – enjoy what you’re doing.

– alcohol in indigenous communities is one area that needs addressing. It has such a negative effect on the whole social and cultural fabric – it creates, in some cases, a completely pathological social structure. It’s going to take a long time to undo the damage and the Public Health sector can play a role here – things such as health education programs, immunisation and clean drinking water.”

And when it comes to making a difference, Sam has long admired legendary ophthalmologist, the late Professor Fred Hollows.

“Fred Hollows is a good example of someone who had the vision to make a difference beyond the individual patient, Sam Said.

“He set up a factory in Eritrea to make intraocular lenses and trained other surgeons to do similar work. He broadened his influence to do some good in a country with very few resources.”l

By Mr Peter McClelland medicalforum45

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History in the Making

Bust Mystery Solved?

RACGP archivist E/Prof Max Kamien explains how he used Medical Forum and some sleuthing to help solve the identity of a bust, discovered when the WA college relocated.

The bust was found in the clearing out that followed UWA’s sale of the Claremont Community Health Centre. I thought it was the late Dr John Bamford but stalwarts of the WARACGP in the 1960s were not so sure.

My search for an answer began in the WA-RACGP archives.

There is much there about John Bamford but no mention of a portrait or a bust. So I sent photos of this bust to The West Australian’s Can You Help? section, Medicus and Medical Forum WA. I also contacted the sculpture teachers from the Claremont School of Art, whose students would exhibit in the health centre.

No one could, with total confidence, identify the bust. Even Dr Bamford’s wife, Jean, was not absolutely sure. His previous doctor and practice partner David Watson, now retired to Albany, said it bore no resemblance.

But Dr Kevin Murphy – exFMP WA director, ex-Freo Hospital GP clinic – told Medical Forum the bust was that of Dr John Bamford, whom he remembered as a RACGP stalwart from the 1960s who had served as chairman of the WA-RACGP Board before his death in 1970 of an adrenal tumour (Medical Forum, Letters, September 2011).

n “The plaster statue has pride of place in my garden until someone lays claim to it.”

Watson says the painting was commissioned by the then Faculty Chairman, Dr James Watson, after the death of Dr Bamford. James was a member of the UWA Senate and a patron of the arts, who had a sense of history and occasion.

My hypothesis is that he asked Owen Garde, the favoured portrait painter of various vice-chancellors at UWA, to paint from a photo.

But Owen Garde’s son, John, also a portrait painter, assured me the painting A careful comparison of this n Mystery portrait was not by his father. Owen bust with the fine unsigned portrait of Dr Garde most likely delegated this to one of Bamford hanging in WA-RACGP College his many students. The painting and bust House, shows many similarities. Dr David appear to have been produced from the

E-poll: Up Your Nose Patients

Specialists have their say Some specialists rounded on patients who were aggressive – towards them, their surgery staff, or worse, the patient’s own children. Here’s more: “I’m a paediatrician. It’s the parents who get up your nose.”

“Who says, Dr you are my last hope, I’ve been to these 20 family practitioners and specialists and none have helped me.”

For fun, we asked specialists and GPs in our latest E-poll, ‘what kind of patient gets up your nose the most’.

Here’s our hand-picked selection.

“Who tell me what is right for them” and “Those that ignore my suggestions but continue to attend my clinic.”

“The ones who call you by your first name at the first visit and say you are the only doctor who understands them.”

same photo (perhaps the bust first to give a three-dimensional view that would assist the portrait painter).

Dr J.A.C. Bamford was a graduate of Cambridge University and Guy’s Hospital.

He and his family migrated to Australia in 1952. He practised in Douglas Ave, South Perth, and was an advocate of the Lamaze method of natural childbirth. His large obstetric practice nearly overwhelmed him.

But he found time to be a founding member and officeholder in what became the RACGP. He was chairman of the WA-RACGP research committee for many years. His study of the continuing education needs of WA GPs remains a classic of early work, for which he took four months in 1966 to visit every rural GP and one in four metropolitan GPs. That study is in both the national and WA college archives.l

“The older, wiser and knowledgeable wanting the benefits of the younger, naive and less knowledgeable; and believe their wisdom justifies their expectations. This is especially common among psychologists and teachers who have studied psychology. I am close to putting up a sign in my waiting room indicating they are not welcome as patients as their expectations are outlandish.”

“The ones who have consulted Dr Google first and try to tell me my job!!” and “The web surfers, Google doctors, the doula believers, the six-page birth plan! A la naturale!

“Those who walk over my waiting room carpet with oil on the soles of their boots.”

“Those who want only ‘natural’ therapies”

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medicalforum

The Ear Science Institute and Bikabele are talking to each other. Recycled hearing aids make sure every word is heard clear as a bell in Bali.

A wonderful collaboration between the Ear Science Institute (ESI), the Lions Hearing Foundation and Bikabele Cares For Kids has spawned a group of West Australians dedicated to helping disadvantaged children in Bali. And the group is making a loud splash thanks to people like Sharon Safstrom and Bernie Jennings. Hearing-impaired children in two Bali orphanages, Klungkung and Karangasem, are listening for new opportunities.

Sharon Safstrom: “Restoring hearing restores communication. It’s who I am and what I do.”

Sharon Safstrom, ESI’s Community Liaison Officer, knows firsthand just how important effective hearing can be.

“I’ve worked in community education for ESI for 10 years, I have a hearing loss myself and without a hearing aid I couldn’t do my job. Restoring hearing restores communication – it’s a lot of who I am and what I do. It makes a huge difference to people’s lives.”

The recycled hearing aids, obtained from sources as diverse as hearing clinics to funeral parlours and serviced by ESI technicians, have many positive effects both here in Australia and overseas.

“There’s a real gap for services in Australia for people who aren’t on a full pension and can’t afford up to $5000 every year. And up until a year ago, WA was the only state that

GPs have their say For time-poor GPs, it’s not surprisingly the patient who comes into the surgery with a list as long as your arm who causes the greatest frustration.

“The chap whose fourth dot point is a perianal lump.” and “Patients who come to me with five complaints and then, at the end of the consult (after 30 mins), mentions he has chest pains.

“The druggies. Their stories are repetitive!

“Those demanding to be bulkbilled ( just prior to their world cruise)” and “ just one more thing doctor excuse me while I take this call” and “can your girls call me a cab!”

“The ones that ask me to do the investiga-

medicalforum

Philanthropy

Let’s Hear it for Bikabele! didn’t have this scheme – now we’re supplying hundreds of people with recycled hearing aids fitted by an audiologist. People in need are referred to us through their GPs and organisations such as Red Cross and Mission Australia.”

“It’s a little different with Bikabele obviously; people such as Bernie collect the devices from us and take them to Bali.

His organisation takes around 100 devices every year and we’ve been sending many more than that to Africa for quite a few years now. Bikabele organises with an audiologist in Bali to take an impression of the patient’s ear and do the testing. ESI plans to grow the Lions Hearing Foundation here in WA and for some of our audiologists to visit orphanages in Bali.”

Bernie Jennings from North Beach Lions: “Why can’t we do more?”

Bernie Jennings sees a gaping need every time he travels to Bali. His empathy for people with hearing problems, and hence his ESI involvement, stems from his wife’s tinnitus affliction for 20 years.

“I saw so many kids born into meagre circumstances – including hearing impaired orphans, who have so little opportunity for things we take for granted, like education. I thought, ‘Australia’s such a wealthy country, why can’t we do more?’.” So he did.

“I’m a volunteer at ESI and a member of North Beach Lions. We support two orphanages in Bali – Klungkung and Karangasem with a high proportion of children between the ages of 5 and 15 suffering from hearing

n North Beach Lions members support Klungkung orphanage in Bali, both with hearing aids and material goods such as the rice being unloaded here at the orphanage. problems. We collect the hearing aids from ESI and take them up to Bali – it’s so easy to put them in our hand luggage. An audiologist comes from Denpasar to the orphanage to adjust and recalibrate the behind-the-ear devices.”

And Bernie, just like Sharon at ESI, has high hopes for the future.

“A lot of children have undiagnosed hearing problems which leads to poor speech and then they’re looked upon as intellectually handicapped. When my grand-daughter was born she was tested two days after birth – we’d like to see the same sort of thing happen in Bali hospitals.” l

By Peter McClelland

tions requested by their naturopath or ask me to treat them based on the diagnosis” and “Those who pay naturopaths a fortune for their quackery, and then expect me to bulk bill them because they have a HCC.”

“The well-to-do ones who are on concession cards and the not-so-well-to-do ones that can’t afford to pay an account but have more up-to-date mobile phones, drink in excess and enjoy THC and cigarettes”.

“Nurses who think they are doctors!

(SERIOUS) The ones that cough, sneeze in my face ( FUNNY)”

“Neo-occult astrology herbalists.”

“Those who say, I don’t come to this practice but couldn’t get into my regular Dr, and proceed to tell you 10 new complaints” and “I usually see Dr XYZ, but it is Saturday morning and he does not work today as he goes sailing/golf.”

“The ones who take calls on mobiles DURING CONSULTATIONS and then lounge back and settle into a conversation about everything from who they saw on the weekend to what they are going to bring up at the next board meeting – but don’t worry I have strategies!!” l

“The ones that say ‘but my other doctor always ...’”

47

Humour

Field of Bad Dreams Our resident satirist Prof Wendy Wardell applies her distinct brand of gender bias to suggest a strange alliance of criminals and sports fanatics.

I think we can all agree that there simply aren’t enough sports injuries occurring.

I have no vested interest in this. It’s a wellknown fact that people who write for a living have the same affinity for sport as a snake does for tree-felling. No, I’m motivated only for the good of society.

The commonly perceived purpose of professional sport is to test human capability and supply a ripped body for models to hang on to while teetering on blue carpets.

But the unacknowledged reason that sport exists is to provide an outlet for the idiotic things people do that would otherwise be socially unacceptable.

Let’s face it – if you take the biffo out of rugby, all you’ve got is a bunch of neckless blokes on a large area of grass with no lawnmower and no purpose. All they have is a shared interest in seeing how far they can drive each other’s heads into the ground.

If you take the bat or ball out of the cricketer’s hands, you’re just freeing up their digits to text pressing invitations to young ladies

48

who have caught their eye and stirred their love sausage.

Don’t even get me started on golfers.

We need to invent more sports for the socially dangerous to participate in, so that normal people like writers can sleep safe in their beds. Injuries will inevitably happen, and this is a good thing as it will slow them down enough that the rest of us can run away more easily. At least until we get a stitch at the street corner.

Boys who showed signs of wayward behaviour were once funnelled into boxing clubs to focus their aggression in a socially acceptable way.

Even if it didn’t steer them onto the straight and narrow, repeated blows to the head at least limited any latent potential for becoming a Criminal Mastermind, making the police’s job – and their recruitment criteria – that much easier.

We need to invent new sports that can be used to distract and maim those bringing ill on society.

Road-ragers for instance could be recruited into a fusion of Formula 1 and wrestling.

Already, racing car drivers demonstrate

all the easy-going bonhomie of a school of politicians circling around a wounded leader. Imagine a sport where the adrenaline fuelled testosterone of 50 laps of Le Mans is then harnessed into inflicting Full Nelsons on fellow drivers at the finishing line.

We can be pretty sure that young wannabes will be so crippled with arthritis by the age of 20 that the ability to even flip the bird at a fellow road user will be but a distant happy memory.

Home invaders could find themselves recruited into a girl’s school hockey team, where they will be required to stand in the goalmouth without the usual padding and protection.

This will give them a very real understanding of how it feels to be set upon by a pack of merciless thugs who instinctively aim for the squishy bits.

We shouldn’t be filling up the jails with young miscreants when we have perfectly good sporting arenas that can house so many more. And what’s the worst that can happen – our sporting codes get a reputation for bad behaviour? l

medicalforum

On the Grapevine

Dr Craig Drummond Master Of Wines

Higher Plane Wines After a meticulous search for their ideal site Perth plastic surgeon Craig Smith and wife Cathy planted the Higher Plane vineyard in 1996 near Witchcliffe in the south of the Margaret River wine region. The same attention to detail was given to the vineyard establishment paving the way for the production of high-quality wines.

The Higher Plane Vineyard was bought by Roger Hill from nearby Juniper Estate in 2006. The same philosophy to pursue low yields and high quality has been continued and with added resources the brand is flourishing.

Three ‘Higher Plane’ range wines were tasted. The 2010 Chardonnay was barrel fermented in French oak and left on yeast lees for 10 months, and therefore shows all the wonderful rich characters that derive from these Burgundian techniques.

Dominant plantings are of the key Margaret River varieties of sauvignon blanc, semillon, chardonnay and cabernet sauvignon. These are supplemented by plantings of merlot, shiraz, cabernet franc, malbec, petit verdot and viognier.

This wine is drinking optimally now, and should drink well over the next couple of years.

Wines are released under two labels – ‘Higher Plane’ wines are from the property and are the very best that can be produced.

Wines in the ‘South by Southwest’ range come from estate fruit and fruit from other carefully selected vineyards in the area.

The emphasis is on varietal and regional character.

The two ‘Higher Plane’ reds impressed me.

Both showed a delicacy balanced against the intense fruit flavours that I especially enjoy. Not being a big fan of Aussie merlot I was humbled by the 2008 Merlot. The nose showed complexity with rich, ripe black plum and great cedary oak. Flavours included dark fruits with plum, black cherry and mulberry with a touch of aniseed. The tannins are silky, but firm for merlot, and so is the acidity. This is an impressive wine.

From the South by Southwest range I tasted the 2011 Sauvignon Blanc Semillon, and the 2009 Cabernet Merlot. The SBS was vibrant and refreshing with nice green fruits and a slight savoury touch to the nose, a lean and clean, crisp and crunchy palate with great flavours of capsicum and grapefruit. The acid finish makes it a good match for seafood, or it is a great drink just on its own on these warm summer afternoons.

Based on the wines already tasted, of course one expects the flagship MR Cab Sav to be very good – as it was. The 2009 Higher Plane Cabernet Sauvignon is a beauty. Give fruit from this exemplary vintage 15 months on quality French oak and what do you get? You get a wine showing wonderful trademark blackcurrant and mint aromas, a palate that is a balance of power and elegance showing blackcurrant and eucalypt.

The 2009 Cabernet Merlot is certainly a value for money wine. The nose is showing restraint, with cinnamon spice and a complexity derived from that hint of farmyard ferrel character. The palate shows the Margaret River earthy gravel, with a lighter fruit profile of redcurrants and raspberry. It has nice length and is certainly a wine for the medium term of up to five years ageing.

The high alcohol is not obtuse as the concentration of fruit disguises it and the oak is fine grained. A great style. This wine will cellar for 15 years or more.

medicalforum

This is a label worth following as it climbs the steep Margaret River wine ladder.

Wines can be ordered on hpw@higherplanewines.com.au

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49

Feature: Conferences

n Hands-on workshop experience.

Podiums, Powerpoints and Mushroom Men Gone are the long, dull, lecture style conferences. The modern conference is all about interactive displays, high-tech presentations and the odd bit of suturing practice.

A medical conference is a complex beast. There is a delicate interplay between location, professional development and entertainment. The first step is attracting delegates – such as the Royal Australasian College of Surgeons (RACS) – to a particular venue and then making sure that everyone, families included, has an interesting and enjoyable time.

Paul Beeson, CEO of the Perth Convention Bureau (PCB) is passionate about placing WA on the world stage as a conference destination. The PCB has been operating since 1972 with an annual budget of $5m and is on track to hit $395m in delegate expenditure since 2007.

“The average spend for a delegate is six times as much as other short-stay visitors.

Our job is to connect all the dots and end up with a really successful conference in a surprising destination – and Perth definitely falls in that category,” Paul says.

“We use a number of different strategies under our ‘Aspire Program’ involving scholarship and professional development awards to enable individuals to attend over50

Conference delegates spend six times as much as other short-stay visitors.” – Paul Beeson, CEO Perth Convention Bureau. seas conferences and network with their international peers. That makes it much easier to identify valuable bidding opportunities and connect them with local hosts such as the Perth Convention Exhibition Centre.”

The RACS will, for the first time, be one of the beneficiaries of the Aspire Program in 2012.

“We’re providing four convention travel grants to Fellows or Trainees of the RACS up to the value of $10,000 each. It’s wonderful to have the College on board as a partner in this initiative and I’ll be announcing the winners at the RACS Annual Congress in Kuala Lumpur in early May.” Once the conference is booked, organised and under way anything can happen as Nikki Drummond, Scientific Program Producer at Reed Medical Education, points out.

“One of the funniest things I’ve seen was at the General Practitioner Conference and Exhibition in Melbourne last year. The Australian Mushroom Growers had a stand at our exhibition and they had a guy dressed in a giant mushroom outfit. They used one of the workshop rooms to squeeze the man into his mushroom suit and when the delegates came back for the next session we heard shrieks of laughter – there was a giant mushroom stuck in the doorway!” she said.

After 17 consecutive years, most contingencies are covered for GPCE but attention to detail is still critically important.

“Doctors are time-poor and almost impos-

Fact Box: PCB 2012 Aspire Program • Four $10,000 RACS travel grants • N ine Professional Development Awards for academics • City of Perth scholarship • City of Mandurah scholarship Contact: Aspire project manager Luana MacDermott, luana@pcb.com.au

medicalforum

Conference Corner eHealth and Medical IT are developing at the rate of knots.” – Nikki Drummond, Reed Medical Education ised trips and tours are generally very good because I think many GPs see it as an opportunity for a family weekend away. We also put on social functions but our focus is really on the event,” said Nikki.

The Perth Convention Exhibition Centre (PCEC) hosts around 20 medical conferences each year, for between a few hundred to 1000 delegates.

n Fun and games at a medical conference. sible to contact by any other means other than their secretarial staff. Often that makes it tricky although we’ve made it as simple as possible for delegates to register and navigate their way around the event,” Nikki said.

“Timing is everything. We run our education sessions to a strict timetable although every now and then an enthusiastic speaker gets a little carried away. There’s always the odd hiccup but it looks pretty seamless on the surface.”

Nikki has a few things to say regarding medical conference delegates, most of it positive.

“It’s always reassuring to have so many doctors in the house and, given their professionalism, the conferences always run very smoothly and are pretty straightforward,” a PCEC spokesperson said.

“One thing we’ve noticed is the increasing sophistication of the presentations. A lot of the presenters are highly tech-savvy – we’ve even had multi-platform video linkups demonstrating live surgery. Obviously we don’t want any glitches in a situation like that so we have reliable back-up systems.

Even the exhibition hall is impressive – the pharmaceutical companies are always trying to outdo each other.” l

By Mr Peter McClelland

Aust Society for Infectious Diseases Conference Dates: 21-25/03/2012 Venue: Esplanade Hotel Fremantle Website: http://www.asid.net.au/ScientificProgram Sailing Into The Future

14th National Nurse Education Conference Dates: 11-13/04/2012 Venue: Pan Pacific Hotel Website: http://www.iceaustralia.com/ nnec2012 Keeping the Flame Alight

International Data Linkage Conference 2012 Dates: 1-4/05/2012 Venue: Perth Convention and Exhibition Centre Website: http://www.datalinkage2012.com.au/

Otitis Media OZ Dates: 2-4/05/2012 Venue: The Esplanade Fremantle Website: http://www.omoz.com.au/

ANZ College Anaesthetists Annual Scientific Meeting Dates: 11-16/05/2012 Venue: Perth Convention Exhibition Centre Website: http://www.anzca.edu.au Evolution: Grow, Develop & Thrive 2nd National Indigenous Drug and Alcohol Conference Dates: 6-8/06/2012 Website: http://nidacconference.com.au/ Beyond 2012: Leading the Way to Action

“The doctors are easy to deal with on the whole. I probably should add that with several thousand GPs attending our conferences, it would be unusual if we didn’t come across a difficult character now and then.

But we’re all human and you never know why someone might be having a bad day,” said Nikki.

New gadgets and fancy video links are on show and, as Bob Dylan once said, the “times they are ’a changing”.

“Medical technology is always offering something new and some presentations are extraordinarily impressive. Other seminars just stick to the facts – they’re much more about content and evidence rather than flashing lights. That said, eHealth and Medical IT are developing at the rate of knots. Every year brings new and fascinating developments.”

Extracurricular activities are an important part of any conference, particularly for “out of towners”.

“Interstate delegate numbers for our organ-

We’ve even had multiplatform video link-ups demonstrating live surgery.” – Perth Convention Exhibition Centre medicalforum

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