Medical Forum WA 3/13

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CONTENTS FEATURES

GUEST COLUMNS

10 Darren Glass:

8 A Political Life Dr George Crisp

A Captain's Mark

20 Limit Jail Time

16 Trailblazer:

for Mentally Ill

Prof Louis Landau

Ms Margaret Doherty

21 Medicine Behind Bars 27 Driving the Public

Health Debate

NEWS & VIEWS 2 Letters to the Editor: More Hurdles for Senior Docs: Dr Iain Esslemont; Happy Pets, Happy People, Mr Tim Mayne; Specialists in the Loop, Ms Alison Gould; More on Euthanasia, Dr John Hayes

10

to Live Lighter Ms Jan Hallam

19 Who Sponsors Sport 22 Medico-Legal Q&A:

16

Dr Eric Yamen

37 East Timor Generosity Dr Ross Littlewood

39 Surgery for Traumatic

Shoulder Instability Dr Grant Booth Mr Simon Yam

42 Support Group: Heart

Support Australia 43 Joint injections:

24 Alcohol in

the Knee

the Headlights

31 Inspiring Others to

Coronary Stents

41 M Clinic Pitch to MSM

Dr Rob McEvoy

Surgeries

Oesophagitis

36 Absorbable

Scramble

30 Solar-Powered

5 Eosinophilic

35 J&J Hip Update

23 Doctor Information

and Election Priorities

CLINICAL FOCUS

Prof Piers Yates

Ms Morag Smith

29 E-poll: Youth Alcohol

Dr Will Thornton

Replacements – the Issues

Patient Tracking – Who's Responsible

Ms Jan Hallam

Revalidation?

Dr Tom Grieve

Answerable To Whom?

18 Gutsy Campaign

32 How Valid is

34 MoM Hip

4 Editorial: Doctors 12 Have You Heard?

Perth Pathology

Dr Mike Eaton

21

LIFESTYLE 44 Conferences:

Keeping it Real 46 Kitchen Confidential:

Hippo Creek

Aboriginal Health

47 Wine Review:

33 Path Labs

Cosham Wines

Without Walls

Dr Louis Papaelias

Mr Peter McClelland

48 Young Carers:

42 Beneath the Drapes

Putting Family First 49 The Funny Side

27 medicalforum

50 Doctor Storyteller 50 Singing Doctors 51 Jersey Boys:

Oh, What a Night!

52 Competitions

1

PUBLISHERS Ms Jenny Heyden - Director Dr Rob McEvoy - Director

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 (0430 322 066) 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 Journalist Mr Peter McClelland journalist@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 reect 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 indemniďŹ es 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 2 Thinking Hats

Letters to the Editor

More hurdles for senior docs Dear Editor, Dr. K.C. Wan, Consultant Occupational Physician, wrote a letter Protecting Rights of Senior Doctors (February, 2013).

I am also registered as "Non-Practising" for the same reasons as he, but have encountered another problem.

The definition of Registration Non-Practising reads as follows: "This type of registration may be suitable for medical practitioners who: t IBWF SFUJSFE DPNQMFUFMZ GSPN NFEJDBM QSBDUJDF t BSF OPU QSBDUJTJOH UFNQPSBSJMZ GPS FYBNQMF on maternity or paternity leave) or who t BSF OPU QSBDUJTJOH JO "VTUSBMJB CVU BSF practising overseas."

The Board's definition of 'practice' is: "OZ SPMF XIFUIFS SFNVOFSBUFE PS OPU JO XIJDI UIF individual uses their skills and knowledge as a health practitioner in their profession. For the purposes of this registration standard, practice is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on safe, effective delivery of services in the profession."

"Medical practitioners with non-practising registration cannot undertake any practice as defined above. They are not permitted to prescribe or refer, regardless of whether they are being remunerated."

One and a half years ago, my wife woke me at 2am with pain in her left breast. She was obviously UFSSJGJFE BOE * FYBNJOFE IFS UIVT VTJOH NZ TLJMMT and knowledge as a health practitioner in my profession". That morning, I took her to our GP and breast cancer was confirmed.

I had obviously broken the law and I reported myself to the Medical Board. Some months later, I was told to forget about it!

"GUFS ZFBST PG NFEJDBM USBJOJOH IPX DBO B EPDUPS forget his (or her) clinical skills?

(Dr) Iain Esslemont, Margaret River

Happy pets, happy people Dear Editor, 8F BU UIF 341$" IBWF MPOH been promoting the health benefits of pet ownership for people of all ages (Healing Power of Pets, November, 2012).

5IF KPZ PG IBWJOH B QFU JTOhU OFX UP NPTU "VTUSBMJBOT we have one of the highest rates of pet ownership per capita in the world. In fact our pets are such positive influences on our lives that one study found "VTUSBMJBO PXOFSTIJQ PG DBUT BOE EPHT TBWFE BCPVU CJMMJPO JO IFBMUI FYQFOEJUVSF PWFS POF ZFBS Research has shown that pet owners are generally healthier and happier than non-pet owners. They IBWF MPXFS CMPPE QSFTTVSF BOE DIPMFTUFSPM BSF MFTT EFQSFTTFE BSF BU MPXFS SJTL PG IFBSU EJTFBTF GFFM MFTT

MPOFMZ UIBO OPO QFU PXOFST DBO DPQF XJUI HSJFG BOE MPTT CFUUFS UIBO OPO QFU PXOFST BOE BSF NPSF active and find it easier to get to know people.

Pets are also great caregivers. They keep us company when we're sick or feeling down. They can make us feel safe while we're home alone and they keep an eye on the house while we're out. Dogs especially help us get out and enjoy the outdoors XIJMF HFUUJOH TPNF SFHVMBS FYFSDJTF They are great motivators and personal trainers, never wanting to miss a training session no matter the weather. Dogs can also help introduce us to people in the community, especially other dog owners, and they make great conversation starters.

We should be encouraging responsible pet ownership for all groups in the community.

Mr Tim Mayne, RSPCA WA

Specialists in the loop Dear Editor, Can I please request that GPs notify in writing all relevant specialists if one of their patients dies, specifically with a date and cause of death.

This courtesy would be greatly appreciated by the specialist rooms, as often the first knowledge we have of a mutual patient's death is when they do not attend an appointment. It is often a very awkward conversation with the family, who are already dealing with the grief over the loss of their loved one, when we call to ask why they have missed the appointment.

Sometimes the family do notify us but it is not the time or place to ask for a specific date (relevant for our computer records) and how the patient died (the first question asked by the specialist). I'm sure we are not the only specialist practice having these awkward conversations.

"OZ IFMQ XPVME CF BQQSFDJBUFE Ms Alison Gould, Secretary to Vascular Surgeons

More on euthanasia Dear Editor, The official Belgian Euthanasia report stated that "21.1% of those euthanased without consent had Dementia." Yet Dr Bulten and UIF MPDBM 8"7&4 QSFTJEFOU EFOZ UIBU QFPQMF XJUI Dementia are being euthanased. Truth has been a major casualty in the euthanasia debate.

Speaking on Channel 7, Dr Nitschke wants FVUIBOBTJB GSFFMZ BWBJMBCMF UP BOZPOF PWFS XIP is "tired of living". He admitted advising a healthy elderly woman who was "tired of living" how to obtain illegal drugs to commit suicide. Clearly Nitschke has no respect for the law and a Nitschkerun euthanasia clinic would be a minefield.

5IF %VUDI &VUIBOBTJB PSHBOJTBUJPO </77&> IBT announced plans to further liberalise the Dutch euthanasia law allowing euthanasia for anyone "tired of living" and with no medical requirement at all. This is the reality of euthanasia.

Dr John Hayes, Consultant Physician ED: See our E-poll on Page 29 medicalforum

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3

Editorial

Doctors Answerable To Whom?

Currently, the medical profession at large is excluded from any input to Medical Board panellist appointments. Why? Our E-poll results raise fresh questions.

T

he GFC, the Blaxell Report on St Andrew's Hostel, the UK Murdoch press, and Health Services Union rumblings together demonstrate how people at the top can behave badly, even corruptly. 'Transparency and accountability' in governance is the suggested antidote so that the average punter can monitor what goes on.

Or can they?

Peer review works both ways, surely. It is not necessarily about questioning the integrity of those currently involved, more inbuilt safeguards in the selection process.

")13"(1) and the new National Medical Board say they are converts but are they doing enough to quell unsubstantiated rumours of medical people manipulating the system to help mates or damage rivals, in the name of protecting health consumers?

saying it reflected a desire to hide final appointments from potential criticism, with only 4% saying those who currently control appointments believe no such criticism FYJTUT #VU TVHHFTUFE OPO EJTDMPTVSF NBZ CF UP QSFWFOU <VOEVF> JOGMVFODF PO panellists [38% were uncertain and 13% said scaring off applicants was the reason GPS OPO EJTDMPTVSF>

In my view, 'transparency and accountability' under the new national regime definitely includes panel appointments, especially TJODF PS TP 8" NFEJDPT XFSF 'grandfathered' across from the old system to sit in judgement on colleagues and their appointments remain a mystery.

This is a debate the profession needs to IBWF 'PS FYBNQMF IPX EP ZPV HFU UP CF B QBOFMMJTU "OZPOF DBO BQQMZ UIFZ TBZ though the National Medical Board says it JT OPU BQQPJOUJOH OFX QBOFMMJTUT GSPN 8" right now.

The most serious allegations about doctors around unprofessional conduct, health or performance are heard by panels or tribunals, sometimes in camera, and rightly so.

Investigating panellists face the difficult task of interpreting the facts, with inevitable bias.

Could the selection of particular panellists with known attitudes introduce untoward bias? It is important to remember that the investigation of less serious allegations are not open to public gaze through the 4UBUF "ENJOJTUSBUJWF 5SJCVOBM 4"5

judicial process.

5IF WBTU NBKPSJUZ PG PVS TVSWFZFE 8" GPs and Specialists (July 2012) with an PQJOJPO PO UIJT JTTVF BSPVOE XBOUFE transparency in the appointment of Medical Board panellists, with the opportunity to inform the Medical Board, in private, if

they feel a potential panellist was not fit and proper for the job. What if a panellist carries unusual gender bias, dislikes special-interest GPs, hates corporate practice, feels specialists need protection from criticism, or has been LOPXO UP BQQMZ FYUSFNF SFMJHJPVT PS QPMJUJDBM beliefs to others?

What's wrong with making that known?

Peer review works both ways, surely. It is not necessarily about questioning the integrity of those currently involved, more inbuilt safeguards in the selection process.

Disturbing as it seems, in this edition 34% of the 328 doctors surveyed were suspicious of Medical Board non-disclosure,

FACTS: Panel Appointments t 1BOFM BQQPJOUNFOUT BSF UP CF UBLFO WFSZ TFSJPVTMZ *O UIF QBTU QFPQMF XFSF JOWJUFE UP BQQMZ 5IF CFTU BQQMJDBOUT IBWF NBOZ BCJMJUJFT

t 5IPTF DVSSFOUMZ JOWPMWFE JO TDSFFOJOH GSPN UIF .FEJDBM #PBSE PS ")13" BSF MJLFMZ UP CF LOPXO UP DVSSFOU QBOFMMJTUT VOEFS UIF hPME TZTUFNh

t 6OEFS OFX OBUJPOBM MBX UIF POMZ QFPQMF XIP TDSFFO QBOFMMJTUT EVSJOH UIFJS BQQPJOUNFOU BSF .FEJDBM #PBSE NFNCFST 1PMJDF "4*$ BOE CBOLSVQUDZ QFPQMF UIF BQQMJDBOU QMVT POF SFGFSFF OPNJOBUFE CZ UIFN

t %PDUPST JO 8" TIPVME UIFZ LOPX PG TPNFUIJOH JOWPMWJOH BO BQQMJDBOU UIBU JT JO DPOGMJDU XJUI ")13" TFMFDUJPO DSJUFSJB DBOOPU DPNNVOJDBUF UIJT UP ")13" CFDBVTF BQQPJOUNFOUT SFNBJO IJEEFO

")13"hT PXO TFMFDUJPO DSJUFSJB GPS panellists include subjective measures such as integrity, reputation, impartiality, openmindedness, sound judgement, fairness, an understanding of the health sector and how broader health issues relate to the health profession, an ability to show respect, plus tact and empathy when dealing with the various people and issues involved in a panel hearing.

The applicant doctor makes a declaration BOE ")13" DIFDLT t 5IFSF JT OP DSJNJOBM SFDPSE EJTRVBMJGJDBUJPO CZ "4*$ PS past bankruptcy. t .FEJDBM #PBSE SFDPSET UP FOTVSF good standing. t 0OF PG UIF UXP PS UISFF SFGFSFFT nominated by the applicant. t 5IF BQQMJDBOUhT EFDMBSBUJPO PG BOZ conflicts of interest and "Such conflict generally involves opposing principles or incompatible wishes or needs." :FU ")13" EPFT OPU DIFDL XJUI 8" doctors! We have written seven times to ")13" 8" JO BT NBOZ NPOUIT BTLJOH why, without getting an answer, and the last request to State Manager Robyn Collins got a response that "your matter will be discussed

Continued Page 6 4

medicalforum

By Dr Tom Grieve

Perth Pathology (Perth Medical Laboratories Pty Ltd APA) 152 High Street Fremantle WA 6160 26 Leura St, Nedlands WA 6009 Ph 9433 5696 Fax 9433 5472

www.perthpathology.com.au Collection centres throughout the Perth metropolitan area including: Fremantle (Main Lab); Perth CBD, Atwell, Bedford, Belmont, Bentley, East Perth, Ellenbrook, Hilton, Joondalup, Kardinya, Kinross, Maddington, Malaga, Palmyra, South Lake, South Perth, Southern River, West Leederville

Tom graduated from the University of the Witwatersrand in 1974 and trained in pathology at the Health Services Centre in Manitoba, Canada, and School of Pathology in Johannesburg, South Africa.

He has been a Consultant Pathologist at the Baragwanath Hospital, Johannesburg (1983-1987), State Health Laboratory Service WA (1987-1993) and Western Diagnostic Pathology (1993-2012). His special interests include gastrointestinal pathology, dermatopathology, breast and gynaecological pathology.

Eosinophilic Oesophagitis Eosinophilic Oesophagitis (EoE) is a distinctive clinicopathological entity that has emerged over the last 15 years. Greater awareness has led to an increased incidence of the condition, probably diagnosed as reflux in the past.

T

KH SHDN DJH RI SUHVHQWDWLRQ LV \HDUV ZLWK D UDQJH RI PRQWKV WR \HDUV 0DOH WR IHPDOH UDWLR LV WR &KLOGUHQ SUHVHQW ZLWK YRPLWLQJ DEGRPLQDO SDLQ DQG UHIXVDO WR HDW '\VSKDJLD EROXV IRRG LPSDFWLRQ DQG KHDUWEXUQ DUH SUHVHQWLQJ IHDWXUHV LQ DGXOWV 0RVW SDWLHQWV KDYH D SHUVRQDO RU IDPLO\ KLVWRU\ RI DOOHUJLF GLVRUGHUV DVWKPD DWRSLF GHUPDWLWLV IRRG DOOHUJ\ 7KHUH DSSHDUV WR EH D JHQHWLF SUHGLVSRVLWLRQ 6HDVRQDO YDULDWLRQ LQ V\PSWRPV DQG HRVLQRSKLO FRXQWV LV REVHUYHG EoE represents a chronic immune/antigen mediated disease characterised clinically by symptoms related to oesophageal dysfunction and histologically by eosinophil SUHGRPLQDQW LQĂ DPPDWLRQ More than 15 eosinophils per hpf (peak value) is considered a minimum threshold for a GLDJQRVLV RI (R( 2WKHU FDXVHV of oesophageal eosinophilia PXVW EH H[FOXGHG VSHFLĂ&#x20AC;FDOO\ JDVWUR RHVRSKDJHDO UHĂ X[ GLVHDVH *25' DV HYLGHQFHG by normal pH of the distal oesophagus or lack of response WR KLJK GRVH SURWRQ SXPS LQKLELWRUV 33,

This is not entirely clear cut as there are some patients with histological criteria for EoE ZKR UHVSRQG WR 33, WKHUDS\ 7KLV PD\ EH WKH UHVXOW RI DQ DQWL LQĂ DPPDWRU\ DFWLYLW\ RI 33, RU DFLG UHĂ X[ FRQWULEXWLQJ WR WKH GHYHORSPHQW RI (R( 5HFHQWO\ LW KDV DOVR EHHQ SURSRVHG that PPI may contribute to the pathogenesis of (R( *LYHQ WKHVH Ă&#x20AC;QGLQJV WKH UHTXLUHG ODFN RI response to high dose PPI medication should SUREDEO\ EH GH HPSKDVLVHG 2WKHU OHVV FRPPRQ FDXVHV RI RHVRSKDJHDO eosinophilia include achalasia, connective tissue diseases, vasculitis, drug reactions, LQĂ DPPDWRU\ ERZHO GLVHDVH HRVLQRSKLOLF gastro-enteritis, hypereosinophilic syndrome, SDUDVLWHV DQG PDOLJQDQF\ (QGRVFRSLF Ă&#x20AC;QGLQJV LQFOXGH FRQFHQWULF PXFRVDO rings, vertical lines/furrows, granular friable mucosa, small white exudates, focal strictures DQG ORQJ VHJPHQW VWULFWXUHV 1R PXFRVDO DEQRUPDOLW\ LV VHHQ LQ RI SDWLHQWV Clinicians rely on the pathologists' interpretation of the oesophageal mucosal

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oesophagus in both normal and abnormal DSSHDULQJ DUHDV *DVWULF DQG GXRGHQDO ELRSVLHV are also recommended to rule out eosinophilic JDVWUR HQWHULWLV Treatment includes dietary elimination of antigen, dilation of strictures causing impaction, topical corticosteroids, systemic corticosteroids for severe dysphagia and /HXNRWULQH DQWDJRQLVWV References: Odze RD. Pathology of Eosinophilic esophagitis what the clinician needs to know. Am J Gastroenterol 2009;104:485-490.

Liacouras CA et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults.

J Allergy Clin Immunol. 2011 Jul:128(1):3-20.

Hurrell DO et al. Histopathological diagnosis of eosinophilic conditions in the gastrointestinal tract.

Adv Anat Pathol 2011;18:335-348.

Perth Pathology ELRSVLHV WR FRQĂ&#x20AC;UP D FOLQLFDO LPSUHVVLRQ RI EoE but there is some overlap in the pathologic IHDWXUHV RI (R( DQG *25' +LVWRORJLFDO Ă&#x20AC;QGLQJV ZKLFK VXJJHVW (R( Â&#x2021; ! HRVLQRSKLOV KSI SHDN GHQVLW\

Â&#x2021; (RVLQRSKLOLF PLFUR DEFHVVHV (4 + eosinophils) Â&#x2021; 3UHIHUHQFH IRU HRVLQRSKLOV WR DJJUHJDWH LQ VXSHUĂ&#x20AC;FLDO OD\HUV RI HSLWKHOLXP Â&#x2021; (RVLQRSKLOLF GHJUDQXODWLRQ Â&#x2021; 'LVWULEXWLRQ RI HRVLQRSKLOV WKURXJKRXW multiple biopsy sites can be patchy but is more often diffuse (lower, mid and upper RHVRSKDJXV DV RSSRVHG WR *25' ZKHUH they are located in the distal oesophagus Basal zone hyperplasia, intercellular oedema and elongation of lamina propria papillae occur LQ ERWK (R( DQG *25' In patients suspected to have EoE it is recommended that biopsies are taken after WUHDWPHQW ZLWK KLJK GRHV 33, WKHUDS\ %LRSVLHV should be taken from proximal and distal

General Pathologist / Managing Partner: Dr Wayne Smit 0410-488736 Histology / Cytology: Dr Michael Armstrong Dr Tony Barham Dr Tom Grieve

0417-094799 0416-577619 0409-849448

Infectious Diseases (Microbiology): Dr Laurens Manning 0400-783194 Haematology: Dr Rebecca Howman

0417-935873

Laboratory Director: Paul Schneider

0417-931850

Providing phone advice to clinicians and a comprehensive range of medical pathology investigations, including: Â&#x2C6; ,MWXSPSK] 7OMR +- IXG Â&#x2C6; ']XSPSK] MRGP 4ETW ERH *2%W Â&#x2C6; ,EIQEXSPSK] ]IW [I HS PEF GSRXVSPPIH -26W Â&#x2C6; & MSGLIQMWXV] MRGPYHMRK LSVQSRIW ERH QEVOIVW Â&#x2C6; 1MGVSFMSPSK] ERH 7IVSPSK] Professional personalised service from a noncorporate, pathologist owned and operated laboratory practice 5

Editorial

Doctors Answerable To Whom?

Continued from Page 4

with the National Office"â&#x20AC;&#x201D;nothing in the seven weeks since.

Between September 2011 and February 2012, eight medical practitioners were named as TFOJPS TFTTJPOBM NFNCFST BU 4"5 IFBSJOHT involving the Medical Board. These names are on public record on a website.

8F XFSF UPME UIF 8" .FEJDBM #PBSE QMBZT OP part in the appointment of future panellists.

If this is true, who does QMBZ B QBSU JO 8" 8F VOEFSTUBOE UIBU NBOZ QSFWJPVT 8" .FEJDBM #PBSE TUBGG BSF OPX QBSU PG ")13" 8" "OE HJWFO UIBU NPSF UIBO PG ")13" NFEJDBM SFHJTUSBUJPOT BSF POMJOF BOE ")13" IBOEMFT BMM NJTEFNFBOPVS

OPUJGJDBUJPOT XIBU EPFT UIBU MFBWF UIF 8" Medical Board to do?

References: (1) "Our commitment to transparency and accountability continues, with an expansion of the information published about legal issues and hearing decisions..." AHPRA Report Edition 11, January 2013 O

E-Poll: Medical Board Panellist Appointments We asked doctors in our latest E-poll what they thought about the confidential appointment of panellists â&#x20AC;&#x201C; with 325 responding this way:

Q

How would you explain why the national Medical Board does not make known to the wider profession in WA, prior to appointment, which WA doctors are to be offered panel positions to investigate complaints against other doctors [multiple choice]?

Uncertain. ................................................................................................38% Prevent people from trying to influence panellists before or after appointment. .................................................................

Desire to hide final appointments from potential criticism. ..........34% Fears of not being able to attract doctors to the panels. ..................13% 5IPTF DPOUSPMMJOH BQQPJOUNFOUT CFMJFWF UIBU OP 8" EPDUPS IBT information detrimental to an appointment. ......................................4%

Q

Do you think Medical Board hearings in WA should adhere to Section 183 of the National Law, in that investigating panellists (who are registered health practitioners) either reside or work outside WA? [See footnote.]

Yes. ............................................................................................................43% No. .............................................................................................................30% Uncertain. ................................................................................................27% ED. We got this one the wrong way around, sorry! The National Law says that in choosing a panel of three to hear a matter (two doctors, one community representative all chosen off an approved list), the National Medical Board must, if possible, choose a member from the jurisdiction in which the matter the subject of the hearing occurred. It's not completely kosher to make this interpretation from this poll result, but around 30% of surveyed doctors agree with that point of view.

Other. ..........................................................................................................4%

6

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7

Guest Column

A Political Life Dr George Crisp is making his third pitch for parliament at this month's state election. He talks here of doctors participating in the political debate.

A

doctor in politics? Surprising?

Certainly, judging by the response of a few of my patients. But there are some very good reasons to think about a political career or even a short stint of political representation.

"T B QSPGFTTJPOBM HSPVQ XF BSF XFMM acquainted with the concept of service to our community and all too aware of what that entails. Working in clinical practice, we have WBMVBCMF MJGF FYQFSJFODF BOE B VOJRVF JOTJHIU JOUP UIF MJWFT PG "VTUSBMJBOT PG BMM BHFT BOE backgrounds. Such a privileged perspective can add considerable diversity and depth PG FYQFSJFODF UP QPMJUJDBM QBSUJFT TP PGUFO dominated by lawyers and political hacks.

In contrast to most other professional disciplines, our training also gives us an understanding of both science and UIF IVNBOJUJFT "OE UIFSF IBT OFWFS been a more important time to elect representatives with an understanding of science. Many important political debates have been greatly impoverished and undermined by a lack of an informed scientific background. Even if we don't have

specific subject knowledge, we understand basic scientific principles and are able to critically evaluate scientific information.

We are also no strangers to making hard EFDJTJPOT PGUFO JO BSFBT PG TPNF DPNQMFYJUZ and requiring great sensitivity. Medical QSBDUJUJPOFST IBWF XFMM EFWFMPQFE FYQFSUJTF in working productively as autonomous professionals, both individually and within a team.

Then there is the issue of Health policy, which so far has been largely confined to NPOPMJUIJD EFQBSUNFOUBM TJMPT "T EPDUPST we have an informed health perspective HSPVOEFE JO QSBDUJDBM FYQFSJFODF and are well-placed to illuminate the health implications arising from policy formulation, particularly in the early 'drafting' phase.

There is now increasing recognition of a h)FBMUI JO "MM 1PMJDZh )J"1 BQQSPBDI UP limit health service cost growth and improve wider societal health beyond the scope of health services. That is certainly one area where we can be effective advocates.

Decisions made by politicians with no

IFBMUI TFSWJDF FYQFSJFODF DBO CF JOUFOTFMZ frustrating to those of us working at the coalface. Haven't you ever wished you could have some input, or at least raised an intelligent and informed voice during deliberations? Getting elected is one way to do just that!

There should be a lot more representation from the health sector within the parliamentary sphere, if only because it's the TJOHMF MBSHFTU FNQMPZNFOU TFDUPS JO "VTUSBMJB o BCPVU PG UIF "VTUSBMJBO XPSLGPSDF XJUI NPSF UIBO IFBMUI QSPGFTTJPOBMT Yes, I agree that most of the time politicians are hardly flavour of the month. That may be a little off-putting as a career choice but adding trustworthy, well-respected and credible representatives to their ranks would be a good thing. It would certainly broaden the political debate.

Of course, I'm not suggesting a parliamentary career would be everyone's cup of tea, far from it. But, as medical professionals, we do have much to offer QPMJUJDBM EJTDPVSTF CZ FYUFOEJOH PVS TQIFSF of influence beyond our clinical roles. O

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9

Feature

A Captain's Mark He's taken some screamers in the navy blue and gold and Darren Glass will be aiming for more of the same against the Dockers later this month.

Darren Glass first led the West Coast Eagles in season 2008. He's been handed the captain's jersey again for the 2013 season and is looking forward to doing battle with visiting teams at Subiaco Oval's, House of Pain. Darren concedes he has a few aches and pains of his own but sings the praises of the medical staff who help make those stratospheric high marks possible.

"The early morning walk to the bathroom can get a little bit creaky now and then but I've been pretty fortunate with injuries. The "'- XPSLT IBSE UP NPOJUPS UIF QBDF PG UIF game and the impact it has on players. It is tough on the body and it's not unusual for a player to carry a few niggles through a season," Darren said. " MPU PG PMEFS QMBZFST FOE VQ XJUI TPNF sort of surgery at the end of the year but they're often pretty minor like a clean-up of B LOFF "GUFS NZ MBTU IJQ PQFSBUJPO * XBMLFE out of hospital the same day! Most of the Eagles players have the surgery done here in Perth. Dr Peter Campbell has done both my TIPVMEFST BOE %S 1FUFS "OOFBS EJE NZ LOFF and groin operations." .FEJDBM TVQQPSU GPS "'- QMBZFST JTOhU confined to the operating theatre. On match day there's a plethora of specialists both on the boundary line and in the treatment rooms.

After my last hip operation I walked out of hospital the same day!

"There are a couple of team doctors and Rod Moore and Gerard Taylor share that role at the moment. We have quite a big d medical contingent to keep us on the field on game day and that's everything from running repairs to pain-killing jabs.

That doesn't happen too often and the player always has the final say. The first consideration is always the long-term health of the individual."

7FSZ PGUFO B QMBZFS XJMM CVJME VQ B HSFBU relationship with a particular doctor and I've known Rod and Gerard my entire career. We've always had a really good rapport between the players and medical staff at the Eagles."

"Injuries are a part of football and when they happen you generally move on pretty quickly. You're usually into rehab 10

Q Darren Glass leading the West Coast Eagles through the player race

straight away and most players don't get too EJTIFBSUFOFE )BWJOH TBJE UIBU "OUIPOZ Morabito from the Dockers is on his third knee reconstruction and hopefully it won't be career ending. Players are resilient and we all know that if you want a long career in the "'- ZPV IBWF UP QVTI UISPVHI JOKVSJFT Darren turns 32 in May and is approaching the twilight of his professional career.

"My body is holding together really well at the moment. Obviously as you get a bit older it does get trickier but you're more attuned to what your body can do. When you

first arrive at the Eagles, and this applies to young immature players and those XIPhWF IBE ZFBST PG "'- FYQFSJFODF UIFZ assess and monitor every player. The club structures the training loads so that when you're in your mid-20s you do a lot of hard work but when you get old like me they look after you."

Playing in the specialist position as a backline defender, Darren's job is to nullify his attacking opponents. Other positions on the field have more pressing concerns.

5IF SVDLNFO XFSF HFUUJOH NPSF 1$- 5I <1PTUFSJPS $SVDJBUF -JHBNFOU> JOKVSJFT <1P DPN DPNQBSFE XJUI PUIFS QMBZFST 5IF "'- CSPVHIU in tthe centre-circle so that they didn't generate so m much force when they contested the ball.

Those Th sort of injuries have dropped away."

"OE UIBU PME DIFTUOVU BCPVU 4VCJBDP "O Oval being a particularly hard playing Ov surface? Paterson's Stadium (Subiaco Oval) sur management told Medical Forum that it's ma one of the most highly utilised stadiums JO " JO "VTUSBMJB BOE UIBU UIF "'- 1MBZFST "TT "TTPDJBUJPO SBUFT JU IJHIMZ *O UIF IBSE working wo centre square, after a battering by "VTTJF 3VMFT CPUI 3VHCZ DPEFT 4PDDFS BOE "V the odd concert, was replaced twice. Darren Glass Gla has spent more time on it than most.

"Subiaco is one of the harder grounds in UIF "'- CVU *hN OPU TVSF UIBU USBOTMBUFT into more injuries necessarily. We train on it all the time and love playing on the ground."

Drugs and sport is a hot topic at the NPNFOU XJUI BO POHPJOH "VTUSBMJBO medicalforum

You're into rehab straight away and most players don't get too disheartened.

Crime Commission investigation into organised networks infiltrating entire clubs and supplying banned substances. In a recent interview with The West Australian both %BSSFO (MBTT BOE "OESFX &NCMFZ SFBGGJSNFE their conviction that the club adheres to strict guidelines regarding supplements. So, could UIFSF CF B -BODF "SNTUSPOH GMZJOH VOEFS UIF SBEBS JO UIF "'"We're tested frequently and randomly under two different doping codes. We come under UIF 8PSME %PQJOH "HFODZ GPS QFSGPSNBODF enhancing (PE) drugs and the players have also agreed to an illicit drugs policy."

Darren said he'd be shocked if drug-taking JO UIF "'- XBT XJEFTQSFBE Technology has made a significant impact on the modern game with everything from ice vests, cooling tanks to hyperbaric chambers.

"It's certainly a big part of the game now and one of the real benefits is the use of GPS. We wear the monitors during games and training to track our work-rate and they get so much data out of them. The training staff

can then adjust training regimes and game time. It's all about looking after a player's body which is one of the keys to long career."

In elite sport mental preparation is just as important as physical conditioning and strength training.

"Nerves are a big part the game. I think the worst games I've played have been when I wasn't feeling a bit twitchy. It does start to build up getting towards a big game like a final and we all have our little routines, such as eating the same meal at a particular time. I've got a young family now so that means I don't have too much time to think about the game until I get to the ground."

1MBZJOH "'- JT XIBU *hWF XBOUFE UP EP ever since I was a young footballer in Northam. It's been a great career choice and a wonderful occupation." O

By Mr Peter McClelland ED: The Eagles meet the Dockers in the season opening match at Patersons Stadium on Saturday, March 23.

E-POLL: Sports Doping Scandal Doctors (n=328) in Medical Forum's latest E-Poll were stiff with their condemnation of complicity in the sport doping scandal, with a large number suggesting deregistration of a doctor found guilty and a third calling for restricted practice.

Q

How should the profession react to medical practitioners found to be actively complicit in doping sportspeople to enhance performance [multiple choice]? %FSFHJTUFS UIFN BMUPHFUIFS 41% $POGJOF UIFJS QSBDUJDF UP BSFBT PVUTJEF TQPSUT 34% /BNF BOE TIBNF QVCMJDMZ 30% h$PNNVOJUZ TFSWJDFh XJUIJO UIF QSPGFTTJPO FEVDBUJOH PUIFST BSPVOE UIF QSPCMFN /PUIJOH /POF PG UIF BCPWF 10%

Match Day Medicine West Coast Eagles medico Dr Rod Moore has been on the boundary line since the first bounce-down in 1986. The Q Dr Rod Moore sports medicine physician saw Darren Glass pull on an Eagles' jersey for the first time in 2000 but after 26 years, Rod's time with the Eagles is drawing to a close.

He spoke to Medical Forum about allthings-football, from injuries and surgery to the medical line of succession.

"It's a high-velocity impact sport so there's always the risk of collision injuries. But I see as many serious injuries in recreational medicalforum

BUIMFUFT BT * EP JO "'- QMBZFST "OE UIF injuries aren't necessarily age-related. Darren's certainly been pretty durable throughout his career and has had less than the industry standard relating to surgical procedures."

"O "'- QMBZFS XJMM DFSUBJOMZ IBWF NPSF surgery than a comparable age peer-group but that's because they're playing elite sport."

"The use of pain-killing injection varies from club to club and some are a little more aggressive than others. There's a common misconception that footballers have cortisone injections to allow them to play. They don't. They might have a local anaesthetic after something like a finger dislocation or to manage pain from a previous injury, but it's predicated on player consent and the specific situation. If a team is 10 goals ahead, or behind, with a quarter to go that will influence the decision. The

player's well-being always underpins that."

"The very first time we meet these young players, we tell them they are patients first and footballers second." " UZQJDBM NBUDI EBZ TFFT NF BSSJWJOH BU UIF ground about two hours before the siren.

I'll make any last-minute assessments of players and then there's the hurly-burly PG UIF HBNF "OPUIFS UXP IPVST BGUFS UIF game will be spent looking at injuries and arranging follow-up."

"I've been sharing the role with Gerard 5BZMPS GPS UIF QBTU ZFBST BOE "MFY Strahan started working with us last year.

It's all part of the succession plan, after 26 years it's time to hand over the baton. It's been a unique opportunity to combine my profession with my sporting interests." O

11

Have You Heard?

QIBSNBDFVUJDBMT -JCJHJSM DBQTVMFT GPS B CFUUFS TFY MJGF GPS XPNFO DPOUBJO TJMEFOBGJM 7JBHSB BOE UBEBMBGJM $JBMJT #FTU 4MJN capsules and Meizi Evolution Botanical Slimming soft gel capsules (both to lose weight) contain sibutramine (Reductil).

Amber Light

Recall health products Cars with sticking accelerators or faulty suspension, child car restraints that don't XPSL BOE QPSUBCMF %7% QMBZFST UIBU catch alight â&#x20AC;&#x201C; just some recent product recalls with a health and safety angle.

Find more at www.recalls.gov.au or EPXOMPBE UIF GSFF 3FDBMMT "VTUSBMJB BQQ BWBJMBCMF GPS CPUI J1IPOF BOE "OESPJE EFWJDFT PS USZ :PV5VCFhT "$$$ 1SPEVDU Safety. Other safety advisories we receive cover internet products that claim they are safe and natural but contain known

The hyperbaric chamber at SJOG Subiaco remains inoperative because its owners Hyperbaric Health (HH) need to be sure about commercial viability. The culprit is the cessation of the MBS item number for OPO EJBCFUJD IZQPYJD XPVOET XIJDI )) estimates accounts for ~30% of their caseload and they're evaluating patient numbers UP NBJOUBJO PYZHFO UIFSBQZ BT B EJSFDU DPTU GSFF PQUJPO )) PQFSBUF DIBNCFST BU MPDBUJPOT JO UIF "TJB 1BDJGJD SFHJPO including several in Sydney and two in Melbourne. They're hoping for a first-half 2013 cutting of the ribbon at Subiaco.

NFPs standards boost 8" TQFDJBMJTUT XF TVSWFZFE TBJE UPP NBOZ not-for-profit (NFPs), Institutes and such MJLF JO 8" TPNF TBZ 5IF GFEFSBM government is tackling registered charities with draft governance standards from UIF OFX "VTUSBMJBO $IBSJUJFT BOE /PU for-profits Commission. These cover the purposes and NFP nature of charities, accountability to members, compliance XJUI "VTUSBMJBO MBXT SFTQPOTJCMF GJOBODJBM affairs, and suitability and duties of those who manage charities. See www.acnc.gov.

au or the online forum www.notforprofit. gov.au or the proposed financial regulations at www.treasury.gov.au. The federal government also announced its "Better 5BSHFUJOH PG /'1T 5BY $PODFTTJPOT XJMM start from July 1, 2104.

Charity for a charity The Passages Resource Centre in Northbridge is the charity of choice for SJOG Subi, which no longer calls itself a charitable but a not-for-profit organisation.

Passages is one of a number of charitable organisations providing help for homeless ZPVUI UIJT UJNF ZFBS PMET o IFMQ with rental within their eight transitional independent houses, transport, job and health appointments, education and recreation support. To select charities of choice at SJOG Subi, the Director of Mission selects three that fit their Social Justice 7JTJPO BOE UIFO DBSFHJWFST FNQMPZFFT

make the final selection.

GESB â&#x20AC;&#x201C; an award winning super fund.

*ATA Awards. Voted as the best Member Services Centre in WA in 2011 (under 50 seats) and 2012 (31 to 80 seats). #As rated in the 2011 Investment Trends Member Sentiment and Communications Report. ^As rated in the 2012 Investment Trends Member Sentiment and Communications Report.

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

12

GESP0274

Once again, GESB has been rated the best Member Services Centre in WA.* Whatâ&#x20AC;&#x2122;s more, our members have voted us best for our customer service#, disclosure of fees and charges# and for our educational seminars and workshops^. Give us a call today on or visit JHVE FRP DX to Ä&#x;nd out how we can help you.

medicalforum

ePrescriptions on trial 5IF "$$$ IBT HSBOUFE JOUFSJN BVUIPSJTBUJPO GPS QSFTDSJQUJPO FYDIBOHF TFSWJDFT CFUXFFO F3Y 4DSJQU &YDIBOHF and MediSecure. Both compete for doctor electronic script lodgement at a participating pharmacy: one is Pharmacy (VJME CBDLFE UIF PUIFS 3"$(1 CBDLFE Until 2017 they have legal immunity from anti-competition court action, to come up with sharing script lodgements, badly OFFEFE CZ NPCJMF EPDT BOE QBUJFOUT JO 8"

Roll out the barrel Election time means the government media industry is eerily silent while we have much squawking from the political parties (see Page 27 for one event's coverage). But just before the power was cut, the health minister with the aid of the (now diminishing) Royalties for Region cash announced that Cunderdin and Pingelly would pilot new primary health care centres â&#x20AC;&#x201C; a GP working alongside allied health and maybe the odd specialist â&#x20AC;&#x201C; as part of $43.4m earmarked for the Southern Inland Health region.

Research push for CBTs TICHR's Dr Nick Gottardo (Medical Forum, October edition) recently hosted like-minded researchers for a Global Symposium of Brain Tumours funded by UIF 5FMFUIPO "EWFOUVSFST 0WFS BU 8"*.3 Dr Susan Peters published study results showing a correlation between childhood

CSBJO UVNPVST BOE EJFTFM FYIBVTU GVNFT if fathers-to-be worked near diesel-powered equipment around the time of conception PS JG QSFHOBOU NPUIFST XFSF FYQPTFE 1FTUJDJEFT BOE TPMWFOUT BSF OFYU

Pens down!

East Timor pathology services now boast an automated test reporting system in the DPVOUSZhT /BUJPOBM -BCPSBUPSZ BOE /BUJPOBM )PTQJUBM %JMJ 5IF -BC53", TZTUFN XFOU live last November after help from SJOG Pathology Development Program which has TFFO TJY WJTJUJOH TUBGG GSPN 8" BOE 7*$ Training up local staff is part of the gig now manual programming and transcription have been replaced.

promoting both men as Primary Care board members and suggesting recipients vote online for them as nominees for â&#x20AC;&#x153;this prestigious award that recognises contributions made to the welfare of Western "VTUSBMJBOTw 8IFO XF FORVJSFE JU TFFNFE that being connected to many people and using social media gave candidates the advantage. Only online voting counts. You could self-nominate, pay $300, and perhaps be amongst 40 winners to receive website, 'BDFCPPL 8" #VTJOFTT /FXT BOE .BSDI HBMB MBVODI DPWFSBHF -BTU ZFBS UIFZ HPU about 7000 online votes in total, the runnerup was a sole operator who we were told had strong social media connections, and the winner made it home with about 400 votes.

8" #VTJOFTT /FXT TBZT JU JT IBQQZ XJUI UIF FYQPTVSF JU HFUT BOE XF FYQFDU UIF entry fees this year. Eligibility is age <40, PXOFST FYFDT QSPGFTTJPOBMT XPSLJOH GPS B 8" company, and a minimum of two years in their current position. We were told Marcus was nominated by a previous winner and Daniel by someone in Silver Chain. O

Let it be known 5IFSF BSF OPNJOBUJPOT GPS UIF 8" #VTJOFTT /FXT VOEFS #VTJOFTT "XBSET Peopleâ&#x20AC;&#x2122;s Choice and Dr Marcus Tan (Primary $BSF 8" BOE .S %BOJFM .JODIJO 4JMWFS $IBJO BSF BNPOHTU UIFN "O FNBJM GSPN Primary Careâ&#x20AC;&#x2122;s previous CEO alerted us,

Growing to meet Western Australiaâ&#x20AC;&#x2122;s health care needs We are gearing up for the future with major redevelopments at our Bunbury and Murdoch Hospitals, completing in 2012 and 2015, and new public and private hospitals in Midland, opening in late 2015.

SJG26223

There will be more career prospects for doctors as we grow to six Western Australian hospitals, with new and expanded specialties. St John of God Midland Public Hospital will have signiďŹ cant specialist and junior medical workforce requirements.

s 59,400 more patients a year s 551 new beds s 1,230 extra staff s Extensive new facilities s Education and training prospects s For more information, visit www.sjog.org.au HEAD OFFICE Ground Floor 12 Kings Park Road West Perth WA 6005 T (08) 9213 3636 F (08) 9213 3668 E info@sjog.org.au

medicalforum

BUNBURY Cnr Robertson Drive & Bussell Hwy Bunbury WA 6230 T (08) 9722 1600 F (08) 9722 1650 E info.bunbury@sjog.org.au

GERALDTON 12 Hermitage Street Geraldton WA 6530 T (08) 9965 8888 F (08) 9964 2015 E info.geraldton@sjog.org.au

MIDLAND PO Box 1254 Midland WA 6936 T 1800 735 719 F 08 9213 3668 E info.midland@sjog.org.au

MURDOCH 100 Murdoch Drive Murdoch WA 6150 T (08) 9366 1111 F (08) 9366 1133 E info.murdoch@sjog.org.au

SUBIACO 12 Salvado Road Subiaco WA 6008 T (08) 9382 6111 F (08) 9381 7180 E info.subiaco@sjog.org.au

PATHOLOGY 23 Walters Drive Osborne Park WA 6017 T 1300 367 674 F (08) 9204 2974 info.pathology@sjog.org.au

13

Mercy Hospital Mount Lawley

The Family Birthing Unit is a state of the art maternity service catering for women and their families through all stages of pregnancy, labour, birth and the post natal period. The Family Birthing Unit, located in Mercy Hospital Mount Lawley is a private Catholic hospital operated ďLJ DĞƌĐLJ ĂƌĞ͘ ^ŝŐŶŝĮĐĂŶƚ ĚĞǀĞůŽƉŵĞŶƚ ǁŽƌŬƐ ĂƌĞ ĐƵƌƌĞŶƚůLJ underway in and around the hospital.

The Postnatal Ward is a 30 bed facility with 21 large rooms that boast double beds and private ensuites.

This enables families to stay together during WKH ¿UVW GD\V DIWHU ELUWK 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 eight bed Special Care Nursery and we can look after babies from 34 weeks.

There are 12 Specialist Obstetricians and one GP Obstetrician to provide expert medical care for women at Mercy Hospital. A list of these doctors is over the page. These doctors provide access to their expertise, on call 24 hours

a day. A group of experienced Peadiatricians and Aneasthetists provide planned and emergency on-call support whenever needed and there is an onsite RMO. Additional services include:

Antenatal classes and antenatal clinic.

Antenatal physiotherapy classes and postnatal information and advice.

Lactation consultant for inpatients as well as outpatients, during the week.

Specialist neonatal hearing screening.

Whooping cough vaccination program for parents.

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.

On site specialist gynaecology and imaging service.

Free WiFi.

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 WA 6050 t: 08 9370 9222 f: 08 9370 9488 e: hospital@mercycare.com.au

14

medicalforum

Meet our Obstetricians and Gynaecologists Specialists who deliver at Mercy Hospital Mount Lawley Dr Charles Armstrong MBChB MRCOG FRANZCOG

Dr Vincent Lee MBBS MRCOG FRANZCOG

General gynaecology, menstrual disorders, menorrhagia, endometrial ablation, endometriosis, laparoscopic VXUJHU\ SHOYLF Ă&#x20AC;RRU UHSDLU LQFRQWLQHQFH

Laparoscopic surgery, colposcopy, SURODSVH VXUJHU\ t: 08 9370 9812 e: drvincentlee@mygynae.com

t: 08 9370 9960

Dr Ana Perkovic MD FRANZCOG

Dr Pierre Smith MB ChB FRACGP FRANZCOG

Obstetrics and gynaecology, fertility, FROSRVFRS\

Low and high risk obstetrics, laparoscopic VXUJHU\ YDJLQDO VXUJHU\ LQFRQWLQHQFH

t: 08 9370 9790

t: 08 9370 9790

Dr Bruce Thyer MBBS FRANZCOG

Dr Patrick Wu LMusA AMusA MBBS (Hons)

Coloposcopy, incontinence surgery, tubal microsurgery, minimally invasive surgery, laparoscopic, hysterectomy, vaginal UHFRQVWUXFWLYH VXUJHU\

General obstetrics, colposcopy, vaginal surgery (hysterotomies and prolapse repairs), ODSDURVFRSLF WUHDWPHQW RI RYDULDQ F\VWV

t: 08 9370 9806

t: 08 9370 9790

Dr Donald Clark MBChB MRCOG FRACOG Colposcopy, general obstetrics and gynaecology, menopause, family SODQQLQJ t: 08 9272 7772

FRANZCOG

Dr Wei-Ying Chua MBBS FRANZCOG Polycystic ovarian syndrome, fertility SUHVHUYDWLRQ J\QDHFRORJLFDO VXUJHU\ t: 08 9315 2088

Dr Seonaid Mulroy BS (Hons) MBBS (Hons) Dr Glenn Lewis MBBS FRANZCOG

FRANZCOG

General obstetrics and gynaecology, FROSRVFRS\

General obstetrics, general gynaecology, XOWUDVRXQG

t: 08 9380 9330

t: 08 9381 8233

Dr Michael Gannon MBBS (WA) MRCPI FRANZCOG Dr Atef Saba MD FRCOG FRANZCOG Pregnancy after IVF, infertility, male infertility, recurrent miscarriage, ODSDURVFRSLF VXUJHU\ FROSRVFRS\ t: 08 9447 7748

General obstetrics and gynaecology, urinary LQFRQWLQHQFH SURODSVH DQQ SHOYLF Ă&#x20AC;RRU endometrial ablation, hysteroscopic surgery, laparoscopic surgery, medical problems in pregnancy, perinatal loss, recurrent PLVFDUULDJH t: 08 9382 9460

Find us on Facebook and Twitter medicalforum

A MercyCare Service

15

Trailblazer

Every Breath He Takes Prof Louis Landau has blazing trails in every sphere of his long and distinguished career but he never loses sight of the patient.

"You are a therapeutic nihilist with no future in psychiatry". With these words the course of veteran paediatric physician, researcher and teacher Prof -PVJT -BOEBVhT MJGF BOE DBSFFS DIBOHFE direction forever.

The Melbourne University graduate had started his first term as an intern at the Royal Melbourne psychiatry department in the mid-'60s and was asked to medicate patients and get them talking. In the course PG UIFTF BCSFBDUJPOT UIF ZPVOH %S -BOEBV FYQFSJFODFE IBJS SBJTJOH NPNFOUT UIBU chilled him to the bone.

"I complained to the head of the unit that I didn't feel it was appropriate I should be doing this because I didn't have the FYQFSJFODF * IBE OP XBZ PG LOPXJOH JG * XBT doing any good or not. He told me I was a therapeutic nihilist who had no future in psychiatry. I agreed with him. I can still hear him after 40 years!"

Psychiatry's loss was paediatrics gain and not long after he found himself working at the Royal Melbourne Children's Hospital where he stayed until 1983 before heading west to take up the chair of paediatrics at Princess Margaret Hospital.

My wife, Miriam, tells the story that she was on her guard because if I ever started a sentence with 'By the wayâ&#x20AC;Ś' she knew it was going to be something profoundly important. #PSO JO .FMCPVSOF -PVJT POF PG UISFF children, spent part of his childhood in Shepparton, 180km north-east of the city, where his father, keen to strike out on a venture of his own, bought an orchard.

"Unfortunately we had three bad seasons in a row and SPC wouldn't pay enough for the fruit to make a living, so he had to sell up and we moved back to Melbourne. We settled in $BSMUPO BOE * TQFOU UIF CFTU QBSU PG UIF OFYU two decades living, schooling and working in one square mile around Parkville."

Up until his final year at University High 4DIPPM -PVJT QMBOOFE B QIBSNBDZ DBSFFS but when all his friends were opting for medicine, he did too. Five decades on it still inspires him to shake off thoughts of retirement and contribute, now as an adviser for the Department of Health's Medical Workforce division. This move into policy wasn't, as he says, a lifelong ambition but an interest to take a stand based on good 16

Q E/Prof Louis Landau, centre, receiving his doctorate of letters in 2007 with Prof Lawrie Beilin and Prof Sonny Gubbay.

evidence between those who do nothing and those who act impulsively.

There are three thick intertwining strands to his outstanding medical career â&#x20AC;&#x201C; his clinical life, his research work and his dedication to FEVDBUJPO FTQFDJBMMZ BT %FBO PG UIF 68" Medical School between 1996 and 2003.

Each strand has taken him on adventures to unknown territory.

5IFZ TBZ UIBU UJNJOH JT FWFSZUIJOH BOE -PVJTh career is punctuated by being in the right QMBDF BU UIF SJHIU UJNF %VSJOH IJT ZFBST BU the Royal Children's Hospital, the paediatric respiratory department became the nation's main incubator and trainer in treatment and research.

"Our head was the inspiring Prof Howard Williams, and Dr Peter Phelan was his junior. Howard promoted research. He set up UIF JOJUJBM MPOHJUVEJOBM TUVEZ PG TFWFO ZFBS PME TDIPPM DIJMESFO o UIFZ BSF OPX I followed them from years 13 to 21 and it was the beginning of a lot of my research on the epidemiology of childhood illnesses, particularly asthma and allergies. I still get Christmas cards from some of my patients I saw in Melbourne 30 years ago."

"In Melbourne, we discovered that seven years was too late to start because most things had already happened, so the first study when we came to Perth was to start at birth, taking lung function measurements in a child's first year. We found that was also too late. So the OFYU TUVEZ UIF 3BJOF TUVEZ XF SFDSVJUFE JO pregnancy."

"Prof John Newnham was fortunately doing his study on ultrasound in pregnancy and had recruited 3000 women. The Raine study is now 23 years old and it's been fascinating watching these kids growing."

The move to Princess Margaret Hospital was another bend in the road.

"I came to Perth at the end of '83 to do a lecture at PMH. The chair of paediatrics

was vacant after the death of Prof Bill McDonald but I had no idea that the invitation to lecture was actually the board sounding me out if I would be interested in applying for the vacancy."

5IF TPGUMZ TQPLFO -PVJT TNJMFT TIZMZ XIFO asked what his teacher wife and two sons, then aged 14 and 12, thought about leaving UIFJS MJWFT BOE FYUFOEFE GBNJMZ JO .FMCPVSOF to head West when he was appointed to position in 1984.

"My wife, Miriam, tells the story that she was on her guard because if I ever started a sentence with 'By the wayâ&#x20AC;Ś' she knew it was going to be something profoundly JNQPSUBOU "T GPS UIF CPZT 1FUFS PVS younger son, turned to me and said dramatically, 'Well, this in the end of my life'. He was form captain and captain of the football team, for him it was a big thing, but as it turned out he became the school captain of Christchurch Grammar, so it worked out.

Our older boy, Jonathan, settled in easily."

There was no paediatric respiratory medicine JO 1FSUI XIFO -PVJT BSSJWFE BU 1.) %S 1FUFS -F 4PFVG XIP USBJOFE XJUI IJN JO Melbourne, had returned home and the pair together established the department. *UhT FYDJUJOH UP TFU VQ B EJTDJQMJOF #VU XF IBE to promote it to the paediatricians because up until that time respiratory illnesses were managed by general paediatricians â&#x20AC;&#x201C; as most of them should be â&#x20AC;&#x201C; but there is a small group such as cystic fibrosis and some other difficult diseases that need a tertiary specialist."

"We had to show them that we could offer something and that their practice wouldn't fall apart because they would MPTF UIF PDDBTJPOBM QBUJFOU "OE JU XPSLFE people acknowledged that and now it is a very strong department with outstanding research activity and performance." medicalforum

Now I'm meeting my patients who are sitting on committees with me and they are in their 30s and 40s.

Since 1984, there have been huge leaps in the science and the practice of respiratory NFEJDJOF XIJDI -PVJT JO QBSU IBT PWFSTFFO but he is most thrilled with the advances in the treatment of cystic fibrosis.

"I remember every one of my patients and their families. One of the saddest cases was a little girl who died at three from severe lung disease. Patients were dying as teenagers at that stage. Now I'm meeting my patients who are sitting on committees with me and they are in their 30s and 40s. Many have needed lung transplants but even that is now possible. The median age of survival has moved to over 40. When I started the median age was about eight."

-PVJT XBT BMTP PO UIF HSPVOE GMPPS helping to establish two of Perth's most significant medical research institutes â&#x20AC;&#x201C; the Telethon Institute of Child Health Research 5*$)3 BOE 8" *OTUJUVUF PG .FEJDBM 3FTFBSDI 8"*.3

In the search for a head of the then ICHR, -PVJT UVSOFE UP UIF EJTUJOHVJTIFE SFTFBSDI biologist Sir Gustav Nossal for advice.

"One of the most profound things I got from the selection process was a discussion I had with Gus Nossal. I asked him what he thought was the main characteristic we should look for in a director. He said 'that's easy, there is only one thing â&#x20AC;Ś generosity' and that was so true. It had to be someone who could work with others and not have their own self-interest uppermost. We appointed Fiona Stanley and that was a very good appointment. Similarly, I think Jonathan Carapetis will be terrific for the future."

-PVJT JT B DIBNQJPO PG SFTFBSDI BOE teaching, saying both need constant promotion to government.

"The current philosophy in health is activitybased funding, and clearly there's a good basis for that. However, we have to keep reminding people that it is not the sole activity that occurs in health, and health will suffer if we are reactive rather than proactive in areas of teaching and research."

"Research prevents people from needing UFSUJBSZ BOE FYUFOTJWF DBSF XIJMF UFBDIJOH is investing in the future good health of the state. We still have to keep pushing those things and ensure that they are in the model."

"But what won't change is the care and dedication doctors show to their patients.

These qualities are absolutely critical in medicine and those good qualities are still there." O

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By Ms Jan Hallam medicalforum

17

Health Promotion

Gutsy Campaign to Live Lighter The war on obesity has stepped up a notch with a campaign being led by the Heart Foundation WA and Cancer Council WA. You've seen the advertisments â&#x20AC;&#x201C; a fourpage wraparound of our daily newspaper and front and centre on our television and cinema screens. From the 'grabbable gut' to the lakes of adipose tissue strangulating PVS JOUFSOBM PSHBOT UIF -JWF-JHIUFS campaign has pulled no punches.

"OE JU JT KVTU UIF CFHJOOJOH PG B UISFF ZFBS DBNQBJHO CZ UIF )FBSU 'PVOEBUJPO 8" BOE $BODFS $PVODJM 8" UBSHFUJOH PCFTJUZ The two NFPs successfully tendered for the $9.1m Health Department promotion, which began in June.

Heart Foundation CEO Maurice Swanson said an important part of the brief was to put the campaign through a strict evaluation process.

He said a team Q Mr Maurice Swanson from the Centre of Behavioural Research in Cancer at the $BODFS $PVODJM PG 7JDUPSJB IBE CFFO FOHBHFE UP DPOEVDU UIF SFWJFX XIFSF 7JDUPSJBO residents would act as the control.

"We're interviewing 1000 people at various QPJOUT JO UJNF CPUI JO 8" BOE 7JDUPSJB *hWF only once in the past 30 years been involved in an evaluation where we had a control group in another state. That gives us a great deal of confidence about concluding that the differences we can detect are as a result of the

DBNQBJHO CFJOH SVO JO 8" .BVSJDF TBJE

in our advertising and other material."

So far two reports have been made since June and they indicate that people who are overweight are responding to the campaign more than people of normal weight.

"We have been careful to stress that we are not talking about the relative merits of different body shapes, we're talking about what we call central adiposity â&#x20AC;&#x201C; what in the BEWFSUJTJOH JT DBMMFE UIF hHSBCCBCMF HVUh "OE the simple message is that if you've got a grabbable gut then it's highly likely that you also have an additional load of visceral or UPYJD GBU

"That's a terrific finding for us because in previous campaigns, there hasn't been that level of engagement from overweight people.

This campaign is making them think more about the health ramifications of being overweight and there's evidence that they are responding and understanding the message

"MM UIF BEWFSUJTJOH IBT CFFO UFTUFE JO GPDVT groups to ensure we're getting the correct

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18

medicalforum

FACTS: LiveLighter t .PSF UIBO QFPQMF IBWF TJHOFE VQ UP -JWF-JHIUFS 'BDFCPPL QBHF JO UIF GJSTU TJY NPOUIT PG UIF DBNQBJHO t .PSF UIBO QFPQMF JO UIF GJSTU TJY NPOUIT TJHOFE VQ UP GPMMPX !-JWF@-JHIUFS 5XJUUFS BDDPVOU t 5IF -JWF-JHIUFS BEWFSUJTFNFOUT IBWF CFFO WJFXFE NPSF UIBO UJNFT PO :PV5VCF o NPTUMZ CZ NFO BOE UIPTF BHFE CFUXFFO BOE

t 5IFSF IBWF CFFO OFBSMZ WJTJUT UP XXX MJWFMJHIUFS DPN BV XJUI NPSF UIBO VOJRVF CSPXTFST t .PSF UIBO QFPQMF IBWF SFHJTUFSFE GPS UIF -JWF-JHIUFS .FBM BOE "DUJWJUZ 1MBOOFS

Who sponsors sport Here are some of the major sponsors associated with the major sporting codes and local teams.

AFL: Carlton United Breweries (CUB), Coca Cola, 014. /"# 5PZPUB #JHQPOE %PNBJO West Coast Eagles: SGIO, Bankwest, BHP Billiton Fremantle Dockers: Programmed, Woodside, Envision WAFL: "".* $6# $PDB $PMB 5"# 1MBZFS 4LJOT 5JDLFUNBTUFS 5IF 8FTU "VTUSBMJBO

message and also that we are not creating unintended consequences with the audience, such as eating disorders in either adults or young people. We've specifically asked questions to cover those issues and we've run a separate evaluation and an online survey to ensure those sorts of undesirable outcomes don't result. That study was concluded in December and there was no sign that the campaign messages were doing that."

The size of the obesity problem is such that Maurice said it was unrealistic that it could be solved in the three-year span of the campaign. However, it XBT B HPPE TUBSU JO UIF FOEFBWPVS UP DIBOHF UIF CFIBWJPVS PG UIF PG 8" BEVMUT BOE PG ZFBS PMET XIP BSF FJUIFS PWFSXFJHIU PS PCFTF The emphasis of Perth's public transport system in the current state election DBNQBJHO XBT BMTP HPPE OFXT GPS UIF -JWF-JHIUFS DBNQBJHO "Both sides of politics are falling over the other to tell us that they are investing more into public transport. There is very good evidence that people who use an active way of getting to work have lower blood pressure, lower levels of obesity and a better heart disease risk profile."

Maurice said investment in public transport and cycling were one of three QSJPSJUJFT GPS BEWPDBDZ JO UIF -JWF -JHIUFS DBNQBJHO The second is targeting junk food advertising, especially when it is promoted to children through sport.

"We don't think it's appropriate that sport should be used as a vehicle to promote junk food to the community. But it's not only junk food but also alcohol. Every major sporting team in the country has an alcohol sponsor.

It's more difficult to get across responsible alcohol consumption messages when all your sporting teams have got those brands front and centre." O

By Ms Jan Hallam

Cricket Australia: $PNNPOXFBMUI #BOL 7PEBGPOF 7# 5PZPUB #FU ,'$ #VQB Western Warriors: Hahn Superdry, Toyota, Perdaman *OEVTUSJFT $4#1 8" %FQBSUNFOU PG 4QPSU 3FDSFBUJPO -PUUFSZXFTU $PDB $PMB +BDPChT $SFFL Johnnie Walker, KMPG Tennis Australia: .-$ 0QUVT .FEJCBOL ,JB "VTUSBMJBO 4QPSUT $PNNJTTJPO Australian Open: ,JB "/; +BDPChT $SFFL 3PMFY *#.

NRL: 7# $PDB $PMB "".* #JHQPOE ,FOP )PNF Hankook, NiB, GIO, Telstra, Harvey Norman Soccer A-League: Hyundai, Qantas, Westfield, Be the Influence: Tackle Binge Drinking, Yes Optus Western Force: Emirates, Bankwest, McDonalds, ET Mining West Coast Fever Netball: "MDPIPM 5IJOL "HBJO 5FMTUSB %FQBSUNFOU PG 4QPSU 3FDSFBUJPO NBL: iiNet, Be the Influence: Tackling Binge Drinking, 7JSHJO "VTUSBMJB Wildcats: "MDPIPM 5IJOL "HBJO )FBMUIXBZ 1MBZFS 5"# 1PMJDF /VSTFT .VUVBM #BOLJOH Hockey Australia: "VTUSBMJBO 4QPSUT $PNNJTTJPO '.( 8" %FQBSUNFOU PG 4QPSU 3FDSFBUJPO #F UIF Influence: Tackling Binge Drinking

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RBS Morgans Perth | 08 6462 1999 Level 20, 140 St Georges Tce Perth WA 6000 www.rbsmorgans.com/perth 19

Guest Column

Limit Jail Time for Mentally Ill The MIA Act has the capacity to lock up a mentally impaired person indefinitely. This has to stop, says advocate Ms Margaret Doherty.

W

hy, in Western Australia today, are we locking away 'mentally impaired' men and women in prison indefinitely? The authority for this injustice is derived from an insidious 35-page piece of legislation called the Criminal Law (Mentally Impaired Accused) Act 1996 (the MIA Act). The Act is short as legislation goes but despite its size, it packs a powerful and inhumane punch. It is not just people with mental illness who may be affected by the MIA Act as its definition of 'mental impairment' also includes senility, intellectual disability and brain damage.

4IPDLJOHMZ UIF "DU BMTP BQQMJFT UP ZPVOH QFPQMF XJUI UIFTF DPOEJUJPOT "OZ PG VT XJUI such a vulnerable family member or friend JO UIJT TJUVBUJPO XPVME SFBTPOBCMZ FYQFDU their care and protection to be governed by the highest level of transparency and best practice available. This is not the case.

When people with 'mental impairment' are charged with criminal offences they may DPNF VOEFS UIF .*" "DU GPS UXP SFBTPOT Firstly, following psychiatric assessment,

they may be deemed mentally unfit to stand USJBM *O 8"hT $IJFG +VTUJDF TQPLF PG UIF JOBEFRVBDZ PG UIF .*" "DU XIJDI allowed him only two options in dealing with a person in this situation: unconditional release or the issuing of a Custody Order. " $VTUPEZ 0SEFS JT B UFSN PG JOEFGJOJUF detention supervised by the Mentally *NQBJSFE "DDVTFE 3FWJFX #PBSE .*"3#

"O BOOVBM SFWJFX UBLFT QMBDF UP XIJDI OFJUIFS the individual nor their legal representative IBT B SJHIU UP BUUFOE 5IF .*"3# TJUT behind closed doors and sends its reports to UIF "UUPSOFZ (FOFSBM PO XIPN UIFSF JT OP definite timeframe imposed to respond.

Secondly, a person may come under the .*" "DU JG UIFZ IBWF TVDDFTTGVMMZ QSPWFO B defence of 'Not Guilty Due to Unsound Mind'.

Contrary to popular opinion, using 'madness' as a defence is not a smart legal manoeuvre to a 'Get Out of Jail Free' card. Ironically, success with an 'insanity defence' may result in a person spending much longer in prison under a Custody Order than they would have if found guilty of the offence.

"OPUIFS QSFTVNQUJPO JT UIBU hNFOUBMMZ impaired accused' spend their detention in a

special treatment and care facility. However, successive governments have failed to build the 'declared place' mentioned in the 1996 "DU 5IFSF BSF CFET BU 8"hT POMZ TFDVSF forensic mental health facility, some of which are occupied by people waiting for courtEJSFDUFE QTZDIJBUSJD BTTFTTNFOU "DDPSEJOH UP UIF .*"3#hT "OOVBM 3FQPSU PG people with 'mental impairment' on Custody Orders are currently detained in prison â&#x20AC;&#x201C; 66% are of indigenous background.

4P XIBU DBO FBDI PG VT EP "TL ZPVS MPDBM candidates what their policy is around this legislation. Suggest three actions that need to happen urgently â&#x20AC;&#x201C; a transparent review with BMM TUBLFIPMEFST BO BNFOENFOU XIJDI MJNJUT the detention period to the length of time a person would have served had they been GPVOE HVJMUZ BOE UIF CVJMEJOH PG B EFDMBSFE place. These forgotten people and their families desperately need your support.

ED: Ms Margaret Doherty is convenor of community action group Mental Health Matters 2. She is a member of the Mental Health Advisory Council. O

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Web: www.heartcarewa.com.au medicalforum

Feature by releasing a healthy cohort back into the community it can have the flow-on effect of reducing the overall burden on the public health system.

Walking the Line A Medical Balance Act Many of our prison population are plagued with chronic ill-health and for the doctors working in the system it's an opportunity to change lives.

It may not be regarded as the sexiest end of the medical spectrum but for Dr Cherelle Fitzclarence, the Deputy Director Prison Health Services, prison medicine combines great challenges and wonderful rewards. Patient demands within a custodial environment are highly specific and differ significantly from those in the wider community. It's an area of great need in a unique context and the primary focus is always on the health of the individual patient.

Medical Forum sat in on a number of consultations at Casuarina Prison and witnessed the delicate juggling act between UIF FYJHFODJFT PG B QSJTPO FOWJSPONFOU BOE practical outcomes. The prison muster was BQQSPYJNBUFMZ PO UIF EBZ PG PVS WJTJU "I have great empathy for the disadvantaged in our community. I have a great passion for "CPSJHJOBM IFBMUI BOE B SFBM CFMJFG JO QSJTPO medicine as a viable and rewarding career choice. When I first started in the prison system, there was an attitude that you only did prison medicine if you couldn't get a job anywhere else," Cherelle said.

"Prison doctors were, and still are to TPNF FYUFOU MPPLFE EPXO VQPO CVU XFhSF changing that slowly."

5IFSF BSF $PSSFDUJPOBM $FOUSFT JO 8" NBOZ PG UIFN JO SFHJPOBM BSFBT "T GBS BT the patients are concerned there are some DPOUFYUVBM EFNBOET UIBU OFFE UP CF UBLFO into consideration.

"The first time I see a patient I say, 'Hello, I'm Dr Cherelle and thank you for coming to see me.' When they walk through medicalforum

the door it's a normal doctor-patient interaction. I don't care that they're prison JONBUFT *UhT FYBDUMZ UIF TBNF BT JG UIFZ XFSF coming to see me out there in GP land. I have no idea why a particular person is in prison and unless it's relevant I don't even look. My focus is on giving each patient a better future." *OJUJBMMZ XFhMM EP BO FYUFOTJWF QBUJFOU BTTFTTNFOU BOE FYBNJOBUJPO BOE XF VTF UIF "CPSJHJOBM .FEJDBM 4FSWJDF NPEFM to intervene early and screen for chronic disease and blood-borne viruses. It's very much about 'opportunistic medicine'. Issues such as smoking, alcohol, mental health, counselling and CBT for behavioural issues can be properly addressed for the first time. " QSJTPO TFOUFODF NJHIU TFFN UP CF UIF FOE of the world but, from a health perspective, it gives us a chance to turn lives around."

Prison Health is funded from within UIF $PSSFDUJWF 4FSWJDFT CVEHFU BOE 8"hT current allocation is less than all the other states. The current Prison Health Services #VEHFU JT KVTU PWFS N $IFSFMMF PVUMJOFT a case study that reinforces the point that

"We had one guy who was on a plethora of medications, they weren't working too well and he was grumpy and aggressive with the staff. We had a good discussion about issues, helped him understand the connections between behaviour, diet, and compliance with his treatment plan. We followed up with tele-health consultations and now he's got his diabetes under control, lost 30kg and he's stopped smoking. He's turned his life around." *O B QSJTPO DPOUFYU XFhWF HPU CPUI UJNF and structure. We're in a position where we can educate people and we've moved from applying a band-aid solution to making really valuable long-term health interventions."

The prison population is, quite literally, a captive patient cohort. However, a disproportionate number of them are indigenous and this effectively makes the QSJTPO TZTUFN UIF MBSHFTU "CPSJHJOBM IFBMUI TFSWJDF JO 8" "The cultural issues can be tricky but I've XPSLFE FYUFOTJWFMZ JO UIF ,JNCFSMFZ BOE they know me well. In many cases I've looked after one of their relatives on dialysis and that interaction is both rewarding BOE CFOFGJDJBM CFDBVTF XJUIJO "CPSJHJOBM culture familiarity and continuity is important. Most people are very forgiving when they know you're trying to do their best for them."

Cherelle is a firm believer that prison medicine is a valid and rewarding career path.

"The ideal prison doctor is someone who doesn't judge and actually wants to be there. You can make a difference. I'm well aware of the security issues, I've never felt frightened and I've only ever asked one person to leave the surgery."

"Prison health sites are approved for registrar positions and we have overseas-trained doctors in the system. To be effective you need to have a wide knowledge base, enjoy being challenged and proactive about the practice of best-evidence medicine." O

By Mr Peter McClelland

FACTS: WA Prison Health Service t 5IF DVSSFOU CVEHFU GPS UIF TFSWJDF JT N t 5IFSF BSF $PSSFDUJPOBM $FOUSFT JO 8" t "DDPSEJOH UP UIF MBTU BOOVBM SFQPSU < > UIF QSJTPO QPQVMBUJPO SBOHFE GSPN JO "VHVTU JODSFBTJOH UP B SFDPSE IJHI PG JO +VOF t 5IF EBJMZ BWFSBHF QSJTPO QPQVMBUJPO GPS JODSFBTFE CZ DPNQBSFE UP UIF TBNF QFSJPE UIF QSFWJPVT ZFBS VQ GSPN UP QSJTPOFST t QSJTPOFST PS PG UIF QSJTPO QPQVMBUJPO PO SFNBOE t "CPSJHJOBM QFPQMF JO DVTUPEZ < > DPNQBSFE XJUI < > OPO "CPSJHJOBM QSJTPOFST Source: WA Corrective Services Annual Report 2011-12

21

Medicolegal

Patient Tracking â&#x20AC;&#x201C; Who's Responsible?

Q

A recent NSW Court of Appeal decision confirmed that a corporate medical practice owes a duty to keep accurate and up-to-date records. What are the relative responsibilities of doctors and practices in these circumstances, and could future service contracts negate this ruling?

Ms Morag Smith, Avant's Senior Solicitor, answers the question for Medical Forum.

A

In the case of Idameneo (No 123) 1UZ -UE W %S (SPTT1 the NSW Court PG "QQFBM DPOGJSNFE UIBU QSBDUJDF companies owe a duty to maintain accurate records.

Background CS issued proceedings in the Supreme Court of NSW2 against three doctors and the NFEJDBM QSBDUJDF BGUFS IF BDRVJSFE )*7 GSPN IJT TFYVBM QBSUOFS -# XIP IBE BUUFOEFE the practice and requested an STD screen.

Due to an out-of-date address on her patient GJMF -# EJE OPU SFDFJWF B MFUUFS BTLJOH IFS UP attend for further testing.

8IFO -# EJE SFUVSO UP UIF QSBDUJDF TIF consulted a different doctor from her first visit. That doctor informed her that all her SFTVMUT XFSF DMFBS FYDFQU GPS DBOEJEB #BTFE PO UIJT BEWJDF -# IBE VOQSPUFDUFE TFY XJUI $4 XIP DPOUSBDUFE )*7 "O PVU PG DPVSU TFUUMFNFOU XBT SFBDIFE between the doctors and CS.

The doctors then made a claim against the practice company requiring it to contribute to the damages paid to CS on the basis that the practice breached its duty to keep up-todate and accurate records.

The Supreme Court found that the practice was 40% liable for the damages paid to CS on the basis of its failure to keep accurate records.

5IF QSBDUJDF BQQFBMFE UP UIF $PVSU PG "QQFBM but was unsuccessful.

In finding that the practice owed a duty of DBSF UP $4 UIF $PVSU PG "QQFBM SFMJFE PO the fact that, contrary to the traditional set-up, the doctors at the practice did not "own" the medical records, the practice did. The practice company was responsible for maintaining the premises, staff and administrative services, which includes patient contact details.

Based on the contractual agreement the Court found that there was a division of responsibilities between the practice that relieved the doctors of the responsibility

and liability for administrative matters including ensuring that patient records and contact details were kept up-to-date.

Could a practice company contract out of this duty?

Q Ms Morag Smith

There is nothing to stop a practice company amending their contract with medical practitioners to widen the indemnity clause and shift responsibility for maintaining records onto doctors. It is therefore important to obtain independent legal advice on all aspects of the contract before signing. O References: 1.

Idameneo (No 123) Pty Ltd v Dr Gross [2012] NSWCA 423 2.

CS v Biedrzycka [2011] NSWSC 1213

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Medical Marketplace

Doctor Information Scramble Keeping personal information current is crucial in all walks of life.

Dr Rob McEvoy takes a look at doctor data use. t *OGPSNBUJPO GSPN UIF Medical Journal of Australia subscribers.

Medical Forum maintains a comprehensive list of WA doctors, both GPs and Specialists, to allow us to communicate with the WA medical community and to post every doctor their free copy of the magazine. Times are changing. More young doctors are requesting electronic versions of each edition. Another trend is towards more control over how personal information is used â&#x20AC;&#x201C; we now have an array of check-boxes on our database to account for those who prefer no e-poll, want delivery to a home address, have a secondary email, etc. And heaven help us if we get it wrong!

Doctor information has commercial and strategic value and there are a lot of lists being maintained by different people, some more up-to-date than others. Maintaining list currency is a big job, given mobile doctors.

In this electronic age, communication lists are big business, even after implementing the protections in place for consumers. The GFEFSBM "." PXOFE "VTUSBMBTJBO .FEJDBM 1VCMJTIJOH $PNQBOZ ".1$P NBEF N last financial year from providing data and from subscriptions.

For those who lease their data, approved campaigns via email or post can target doctors according to age, gender, discipline, sub-specialisation, number of patients seen each day, languages spoken, non-medical interests, metro/rural and more.

".1$P TBZT JU JT UIF QSPWJEFS PG UIF NPTU comprehensive, accurate and up-to-date medical and healthcare data and marketing MJTUT *U TBZT %PDUPS -JTUT XIJDI DPOUBJO UIF doctors' preferred mailing addresses, are regularly updated from sources such as State Medical Registers, college and society lists, and returns from medical publishers.

The information sources they say are unique to them are:

Use of email addresses is a sensitive issue. ".1$P TBZT FNBJMT BSF SFTUSJDUFE UP clinically relevant information only, and is TFOU PVU CZ ".1$P %JSFDU POMZ after content has been approved.

"MM PVS FNBJM BEESFTTFT BSF 41". compliant, permission based/ 0QU JO XJUI QSJWBDZ QPMJDJFT XIJDI allow for third party marketing." (see www.ampcodatadirect.com.au). ".1$PhT TBUJTGJFE DVTUPNFST BSF MJTUFE BT pharmaceutical companies, advertising and direct agencies, medical publishers, allied health companies, and lifestyle companies. #Z BMM BDDPVOUT UIF GFEFSBM "." EPFT B reasonable job and with around 30% of "VTUSBMJBO EPDUPST BT NFNCFST UIFZ IBWF QMFOUZ PG FYUSB XPSL UP EP O

t 5IF .FEJDBM %JSFDUPSZ PG "VTUSBMJB t "." NFNCFSTIJQ JOGPSNBUJPO BOE

Data Trouble: Find A Doctor This story highlights the importance of currency in data management. The website (http://amafindadoctor.com. au) and coinciding iPhone application were launched Christmas 2010 by UIF 2VFFOTMBOE "." CSBODI VTJOH EBUB GSPN ".1$P UIF GFEFSBM "."hT publishing and database company.

The iPhone application is no orphan. It is designed to put health consumers in touch XJUI B (1hT QSBDUJDF "." NFNCFST POMZ o just key in the suburb or doctor's name, along with the State.

Responding to a comment that data appeared out-of-date, we took a random sample in May 2012 of 77 rural and urban doctors listed PO UIF 'JOE " %PDUPS XFCTJUF XIJDI ESBXT on the same data as the iPhone application, BOE TQPLF UP 8" EPDUPST BOE DPOGJSNFE another 18 doctors' details from practice staff "VHVTU 4FQUFNCFS

What we found: t PG EPDUPST XFSF BXBSF UIFJS OBNF BOE QSBDUJDF XBT MJTUFE PO UIF "."2 iPhone application. medicalforum

t 0ODF FYQMBJOFE PG EJTBHSFFE with the concept and the use of their information this way. (1) t 5XP EPDUPST SFDBMMFE B QBUJFOU XIP DBNF to them via this route (while others said it would be hard for them to know).

(1) Those who disagreed included: one person who had not been an AMA member for 4-5 years or at the depicted practice since 2009; two members who were not taking new patients; a GP who was rarely at the listed practice; a special interest GP who had a six-month waitlist; one GP semi-retired and seeing a few patients from home.

of around 28% (21 of 77). One listed GP had SFTJHOFE GSPN "." 8" TJY NPOUIT FBSMJFS Two had retired. Eleven GPs were listed at UIF XSPOH QSBDUJDF &JHIU (1T XFSF B NJYFE CBH PVU PG 8" TJODF FBSMZ SFUJSFE B ZFBS FBSMJFS OP MPOHFS SFHJTUFSFE XJUI ")13" phone call to doctor returns a chiropractic DMJOJD QSBDUJDF DMPTFE UXP JOTUBODFT OPU SFHJTUFSFE XJUI ")13" BOZXIFSF UXP JOTUBODFT EPDUPS EFDFBTFE .BZ

FACTS: Find A Doctor Data Shortfall

Poor data currency (at May 2012) " GFNBMF (1 XF TQPLF UP DPVME OPU VOEFSTUBOE XIZ JOGPSNBUJPO QBTTFE UP "."

8" IBE OPU CFFO VQEBUFE CZ 'JOE " %PDUPS "GUFS SFQFBU QIPOF DBMMT UP "."2 B TUBGG member disclosed that quarterly updates had not been occurring as planned and the last update she recalled was in early 2011, followed by an update in November 2012.

That's a big gap. No surprise then that the data we sampled in May 2012 had an error rate

t $ISJTUNBT "."2 MBVODIFE BO J1IPOF BQQMJDBUJPO UP MJOL "." NFNCFS (1T BOE IFBMUI DPOTVNFST OBUJPOBMMZ t 4FBSDIBCMF J1IPOF BOE XFCTJUF EBUB GSPN ".1$P XBT OPU VQEBUFE GPS BSPVOE NPOUIT t "T B DPOTFRVFODF XIFO XF TBNQMFE JO .BZ EBUB IBE B NBKPS FSSPS SBUF PG GPS 8" EPDUPST CVU XBT SFDUJGJFE JO BMM CVU UXP SFDPSET XJUI UIF /PWFNCFS VQEBUF 23

Public Health

Alcohol in the Spotlight You will be hearing a lot more about the health risks of alcohol as the public health campaign to reduce binge drinking, especially among young people, steps up a gear.

Now that the silly season is done and dusted and the country has returned to work, it seems the hangover of all that DIFFS JT MJOHFSJOH -BTU ZFBS NBSLFE B turning point in the campaign to put alcohol in the health headlights and it's heating up.

5IF MBUFTU )%8" )FBMUI 1SPNPUJPO 4USBUFHZ 2012-2016 states that in 2010, 77% of West "VTUSBMJBOT BHFE ESJOL BMDPIPM )BMG PG this number said they drank at levels that put their health at high risk of harm from an alcohol-related disease over their lifetime, and 23% consumed alcohol at levels that put their health at high risk for an alcohol-related injury from a single occasion of drinking.

Males were more likely to drink at levels which placed them at risk of lifetime harm than females who drank (60% compared with 39%) though high-risk drinking behaviours declined with age for both men and women.

While sobering, the figures are no surprise.

They are reflected in our news diet, especially over a weekend and particularly over summer, TUBSUJOH XJUI -FBWFST DFMFCSBUJPOT o XIJDI brings us to the issue of under-age drinking.

5IF )%8" SFQPSU TBZT DIJMESFO BSF JOJUJBUFE into a culture of drunkenness at an early age. In 2008, a third of current drinkers aged BOE BHFE SFQPSUFE UIBU UIFZ drank alcohol with the aim of getting drunk. " MBUFS TFU PG GJHVSFT TFUT UIF OVNCFS MPXFS but it still concerns public health advocates.

Child health campaigner Prof Fiona Stanley

and public health campaigner Prof Mike Daube have been instrumental in the formation PG UIF "MDPIPM "EWFSUJTJOH Review Board, an initiative of the Q Prof Mike Daube McCusker Centre GPS "DUJPO PO "MDPIPM BOE :PVUI .$"": BOE $BODFS $PVODJM 8"

It's not the job of the science to tell you what you want to hear.

Kids should not be drinking under the age of 18.

5IF "."hT WPJDF IBT BMTP KPJOFE UIF UISPOH In September it co-hosted a national summit JO $BOCFSSB XJUI UIF /BUJPOBM "MMJBODF GPS "DUJPO PO "MDPIPM /""" UP SBJTF BXBSFOFTT of alcohol marketing to young people. The /""" JT DP DIBJSFE CZ .JLF %BVCF BOE JODMVEFT 1SPG 4UFWF "MMTPQ IFBE PG UIF National Drug Research Institute at Curtin 6OJWFSTJUZ BOE "." WJDF QSFTJEFOU %S (FPGG %PCC PO UIF FYFDVUJWF DPNNJUUFF BMPOH XJUI public health campaigners from other states.

5IF /""" IBT NFNCFS PSHBOJTBUJPOT *O JUT TUBUFNFOU UIF "." TBJE VSHFOU changes were needed to advertising standards

because "industry self-regulation was deeply ineffective and had failed". :PVOH QFPQMF JO "VTUSBMJB BSF SFHVMBSMZ FYQPTFE UP BMDPIPM NBSLFUJOH JO UIF USBEJUJPOBM DPOUFYUT PG UFMFWJTJPO SBEJP QSJOU and billboard media, and also increasingly in new platforms for marketing and promotion through digital technologies and new social media such as Facebook and Twitter," the "." TBJE :PVOH QFPQMF BMTP SPVUJOFMZ encounter alcohol promotion and sponsorship as a feature of music and sporting events where it is presented as a normalised part of being healthy and having fun."

Speaking to Medical Forum, Prof Mike Daube said this culture of binge drinking and drinking to get drunk was something that had crept up on us, a bit like obesity.

"Over the past couple of decades there's been a gradual change in the role alcohol plays in our culture. There are a number of mitigating factors contributing to that. We are becoming B NPSF BGGMVFOU TPDJFUZ ZPVOH QFPQMF IBWF much more freedom than the previous HFOFSBUJPOT UIFZ IBWF NPOFZ BOE UIFSFhT greater access to alcohol than ever before."

"MDPIPM IBT BMTP CFFO NPSF IFBWJMZ promoted than ever before and the range of products is vast which makes consuming alcohol more attractive, particularly to young QFPQMF "MM UIJT JT IBQQFOJOH JO UIF BCTFODF PG action to curb possible growing problems."

Some of the terrain of this new focus is

Shock Tactics Misleading -BTU ZFBS UIF Cancer Council PG "VTUSBMJB launched an advertising campaign which pulled no punches â&#x20AC;&#x201C; alcohol is a Q Prof Peter Thompson carcinogen was the unadorned message. The advertisements employed shock tactics not dissimilar to previous public health campaigns against smoking BOE )*7 In one advertisement a glass of red wine is spilled and as the wine spreads on the white tablecloth it is implied by the voiceover that alcohol travels through the body mutating cells along the way, with the punchline: "those mutated cells are cancer".

While the campaign of three commercials 24

XBT TIPSUMJWFE PO PVS 57 TDSFFOT JU EJE cause ripples, which Prof Mike Daube says was "no bad thing". * UIPVHIU JU XBT B HPPE DBNQBJHO JU XBT quite forceful and stirred people up a bit. It certainly stirred the alcohol industry up. I'm familiar in public health with something referred to as the scream test â&#x20AC;&#x201C; brewers, EJTUJMMFST XJOFNBLFST UIF ")" JG UIFZhSF unhappy you are probably on the right track."

Cardiologist Prof Peter Thompson was one who thought the shock tactics were misleading. Peter who works at SCGH as well as in private practice, also owns a winery in the Margaret River region.

"I think the campaign was not totally evidence based. It is true that some cancers BSF BTTPDJBUFE XJUI BMDPIPM FYDFTT CVU UP imply that whenever you take a sip of alcohol it goes to your tissues and causes cancer, which was the gist of the ads, I thought that was inappropriate."

"The cancers which are definitely caused by alcohol are cancers of the throat and stomach, possibly the bowel, especially in smokers, and there's some evidence of a slight increased risk of female smokers getting breast cancer but the evidence for that is based on associations with observational studies. The evidence is not secure enough in my view to run a big advertising campaign and frighten people out of their wits."

"I'm not accusing the cancer council of running a totally non-evidence campaign but their emphasis is what I'm concerned about. They didn't mention that there are some benefits on the heart, which are pretty well documented."

Peter said he thought what was driving all these campaigns was binge drinking.

"I'm fully supportive of campaigns to educate youngsters on the dangers of binge drinking â&#x20AC;&#x201C; I appreciate that it's a difficult social message to get across. But those campaigns in my view medicalforum

FACTS: Drinking teens t PG BMDPIPM DPOTVNFE CZ QFPQMF BHFE JT DPOTVNFE JO XBZT UIBU QVU UIF ESJOLFSTh BOE PUIFST IFBMUI BU SJTL PG BDVUF IBSN t PG ZFBS PME TUVEFOUT JO 8" SFQPSUFE ESJOLJOH BU MFWFMT DPOTJEFSFE UP QMBDF BEVMUT BU SJTL PG TIPSU UFSN IBSN t 0WFS UIF MBTU ZFBST BCPVU PG BMM EFBUIT BNPOH ZFBS PMET XFSF EVF UP SJTLZ PS IJHI SJTL ESJOLJOH

familiar for the man who became recognised internationally as a leading campaigner against Big Tobacco.

"We got our act together on smoking 30 years ago and we've seen some pretty good action â&#x20AC;Ś now we are getting our act together with alcohol."

He said the McCusker Centre was about generating a coalition and a consensus that would result in change.

"I've been asked if the campaign to curb alcohol is easier or more difficult than the tobacco campaign and I say they're different. It's important to stress that alcohol and tobacco are different. The fight with Tobacco was black and white â&#x20AC;&#x201C; the industry is downright evil."

"Unlike tobacco, alcohol is immediate. You can see the effect of alcohol abuse and it becomes a law enforcement issue as well as a health issue. What alcohol and tobacco have in common is the need for a consensus approach. What is hugely different is that we want to see the end of tobacco but we don't want to see the end of alcohol. I certainly don't want to see the end of my malt whisky this evening."

Mike said that everyone had a role to play to curb under-age binge drinking.

"Parents have a role to play but being a parent

isn't always easy. Parents may not have had UIF HVJEBODF UIFZ NJHIU IBWF IBE PO UIJT the school system hasn't helped. There is no mandatory drug and alcohol education in schools. Parents thought it was OK to give kids a sip here and there â&#x20AC;&#x201C; now there is growing evidence of alcohol and brain damage, so that is not the way to go."

"I think we've been a bit shy presenting the evidence the way it is. It's not the job of the science to tell you what you want to hear.

Kids should not be drinking under the age of 18. People have been pussyfooting around these issues. I don't think there's anything inconsistent in saying I enjoy a drink as an adult, but that it's not appropriate for kids.

That said, I don't enjoy a drink and then get in my car and drive. I think we have to look at our own behaviour."

Mike is optimistic that the fight against FYDFTTJWF BMDPIPM VTF XJMM CF RVJDLFS UIBO the fight against tobacco because "firstly the DPODFSO JT UIFSF FTQFDJBMMZ BNPOH QBSFOUT secondly, the impact of alcohol abuse is so FWJEFOU UIJSEMZ XF LOPX XIBU UP EP o XF have superb research which tells us what to EP GPVSUIMZ UIF BMDPIPM JOEVTUSZ JT TP CMBUBOU in its promotion that it's stirring people up in the other direction."

"OE UIFSF JT NVDI XPSL GPS UIF HPWFSONFOU to get on with. Education in schools is a

t 3BUFT PG BMDPIPM SFMBUFE IBSN JO ZPVOH QFPQMF IBWF JODSFBTFE TJHOJGJDBOUMZ PWFS SFDFOU ZFBST QBSUJDVMBSMZ UIPTF BHFE t 3FDFOU SFQPSUT TIPX UIBU DPNQBSFE XJUI ZPVOH "VTUSBMJBOT BT B XIPMF B MBSHFS QSPQPSUJPO PG ZPVOH 8FTUFSO "VTUSBMJBOT ESJOL BU MFWFMT UIBU QVU UIFN BU SJTL PG CPUI JNNFEJBUF BOE DISPOJD IBSNT Source: McCusker Centre on Alcohol And Youth

start. He would also like to see more controls over access of alcohol â&#x20AC;&#x201C; from point of sale to secondary supply to minors. "People think police have those powers, but they don't. If we give them the power, we might get some decent enforcement."

5IF HPWFSONFOU TIPVME FMJNJOBUF NJYFE messages, where the Health Department is saying one thing regarding the harm of alcohol, and the Department of Sport and Recreation and the Sports Minister are actively supporting alcohol sponsorship in sport.

"There's not one magic bullet. People used to say to me 'what's the one thing you can do', well the one thing you can do is have a comprehensive approach and you make sure you have a consensus on evidence-based action and then bluntly raise the temperature.

You keep making sure the issue is in the public eye and what can be done about it." O

By Ms Jan Hallam

Kill You, or Cure You should not translate into criticising people who want to have an enjoyable, high quality consumption of low amounts of alcohol."

"How you deal with that is a very subtle social question but the answer is surely not to be putting the fear of god into everybody about consuming small amounts of alcohol, which are arguably beneficial on the heart."

"When I say arguably, I don't think the case is closed at all. There's a lot of debate, criticism, uncertainty and inaccuracy about alcohol's relationship to the heart and if I can concede that, the cancer council should concede the same in relation to the evidence about cancer."

ED: In September the Winemakers Federation urged wine makers to caution pregnant women on their wine labels about the hazards of drinking alcohol on their unborn child. O

medicalforum

There's little wonder there is confusion about the effects of alcohol. Here is a sample of the info that has come over our desk in the past few months. t 'SPN UIF #PTUPO 6OJWFSTJUZ .FEJDBM $FOUFS " QPQVMBUJPO CBTFE DBTF DPOUSPM TUVEZ PG UIF SBSF OFVSPMPHJDBM EJTFBTF BNZPUSPQIJD MBUFSBM TDMFSPTJT "-4 IBT TIPXO UIBU UIF SJTL PG UIF EJTFBTF XBT GPVOE UP CF NBSLFEMZ MPXFS BNPOH BMDPIPM ESJOLFST UIBO BNPOH BCTUBJOFST t 3FTFBSDIFST BU UIF $FOUSF GPS &ZF 3FTFBSDI "VTUSBMJB $&3" IBWF GPVOE B DPOOFDUJPO CFUXFFO NPEFSBUF MFWFMT PG BMDPIPM DPOTVNQUJPO BOE BHF SFMBUFE NBDVMBS EFHFOFSBUJPO ".% $POTVNJOH NPSF UIBO H PG BMDPIPM QFS EBZ UIF DVSSFOU "VTUSBMJBO SFDPNNFOEBUJPO GPS NBYJNVN EBJMZ JOUBLF XBT BTTPDJBUFE XJUI BO JODSFBTF JO FBSMZ ".% PG BCPVU GPS CPUI XPNFO BOE NFO DPNQBSFE UP OPO ESJOLFST

t 'SPN UIF .BZP $MJOJD %SJOLJOH BMDPIPM NBZ PGGFS TPNF IFBMUI CFOFGJUT FTQFDJBMMZ GPS ZPVS IFBSU 0O UIF PUIFS IBOE BMDPIPM NBZ JODSFBTF ZPVS SJTL PG IFBMUI QSPCMFNT "SFBT PG CFOFGJU JODMVEF SFEVDF SJTL PG IFBSU EJTFBTF EZJOH PG B IFBSU BUUBDL JTDIFNJD TUSPLFT HBMMTUPOFT EJBCFUFT "SFBT PG DPOUSBJOEJDBUJPO *G ZPVhSF QSFHOBOU PS USZJOH UP CFDPNF QSFHOBOU QSFWJPVT IBFNPSSIBHJD TUSPLF JG ZPV IBWF MJWFS PS QBODSFBUJD EJTFBTF IFBSU GBJMVSF PS EJMBUFE DBSEJPNZPQBUIZ $POTFRVFODFT PG IFBWZ BMDPIPM VTF DFSUBJO DBODFST JODMVEJOH DBODFST PG UIF CSFBTU NPVUI QIBSZOY MBSZOY PFTPQIBHVT BOE MJWFS QBODSFBUJUJT BMDPIPMJD DBSEJPNZPQBUIZ TUSPLF IJHI CMPPE QSFTTVSF DJSSIPTJT PG UIF MJWFS TVJDJEF t 5IF )BSWBSE 4DIPPM PG 1VCMJD )FBMUI XFJHIFE JO XJUI B TJNJMBS BSUJDMF FOUJUMFE 5IF /VUSJUJPO 4PVSDF "MDPIPM #BMBODJOH 3JTLT BOE #FOFGJUT

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Election 2013

Driving the Public Health Debate The forum at Floreat was promoted as an opportunity for major parties to present their public health policies before the WA Election and answer questions.

T

he invitation from Curtin University's Public Health Advocacy Institute said the Public Health Election Forum was organised by many (1) but comments from the moderator Peter Kennedy and others highlighted AMA WA as a driving force behind the pre-election event on February 7. Many in attendance â&#x20AC;&#x201C; standing room only â&#x20AC;&#x201C; no doubt wished health was the 'number one' election item yet law and order, public transport, and other things were in contention. Both major parties indicated they would release information later, when it suited their campaigns, giving the impression, somewhat, of a stage-managed event by them.

The forum was a welcome opportunity to see how the health politicians performed â&#x20AC;&#x201C; who seemed to have genuine concerns and understanding for health management CFZPOE UIF OFYU FMFDUJPO "T FYQFDUFE FBDI TQFBLFS o %S ,JN )BNFT .-" -JCFSBM 1BSUZ 3PHFS $PPL .-" -BCPS 1BSUZ

BOE (J[ 8BUTPO .-$ (SFFOT o USJFE UP please the audience and the advantages for the incumbent were evident. The questions were civil, applause muted, and nothing was given away in heated debate. Whoever ends up in power will grapple with many competing interests and a health budget blowout, so this forum was a chance to compare political priorities, particularly in QVCMJD IFBMUI "T UP XIFUIFS JU XBT B WFIJDMF for change is hard to tell.

Roger Cook .-" -BCPS 1BSUZ TBJE UIF election "is a choice between a government that is obsessed with building developments JO UIF $#% BOE B 8" -BCPS (PWFSONFOU that will be focussed on services". By the time we go to press, his promised later policy announcements "around hospital capacity, NFOUBM IFBMUI FYQBOTJPO SVSBM NFEJDJOF and the Gallop vision of reigniting science BOE SFTFBSDI JO 8" NBZ IBWF PDDVSSFE )FSF BSF TPNF PG -BCPShT LFZ QPJOUT

Q Kim Hames (Liberals) delivers his 10 minutes' worth, while Peter Kennedy and Roger Cook (Labor) listen on.

Research: We are behind other states in our investment in medical research, making it less competitive for specialist clinicians.

Recognises huge demand increases and has BHSFFE XJUI "." 8" BCPVU UIF OFFE UP grow the number of hospital beds.

Past record: Highlighted tobacco control legislation and the Reid Review blueprint for reform, which the Barnett Government has followed.

Funding: Has introduced activity-based funding in governing councils, and a robust health budget that is activity based and responds to increasing demands. There is 6-8% growth across the whole system, not just EDs or other clinical services.

Preventive health: Keeping people out of hospital through promotion of lifestyle changes is as important as dealing with IPTQJUBM QSFTFOUBUJPOT " OFX 0GGJDF PG Wellbeing within the Department of Health will consolidate and enhance public and preventative strategies.

Public health: 5IF 1VCMJD )FBMUI "DU will be revised (now over 100 years old).

They recommit to re-signing the Closing 5IF (BQ $0"( BHSFFNFOU 8JMM TJHO the National Dental Health Partnership to cut wait lists on dental health, grown GSPN UP JO B GFX ZFBST 8"hT failure to join the national dental health program has meant $20m already foregone JO GVOEJOH "MDPIPM XJMM CF BO JNNFEJBUF preventative health action.

Rural and remote: &YUFOE UIF (MVF &BS #VT GPS "CPSJHJOBM )FBMUI JOUP UIF ,JNCFSMFZ

Dr Kim Hames .-" -JCFSBM 1BSUZ

Health workforce: Building hospitals is easier than attracting and retaining staff, so creating rewarding and supportive workplaces is crucial.

recalled how Dr Geoff Gallop won the FMFDUJPO VOEFS UIF TMPHBO PG 'JY 5IF Health System but the "health system in crisis" headlines evident to him seem to IBWF EJTBQQFBSFE TJODF UIF -JCFSBMT XFSF re-elected. "We have managed to turn the TIJQ <y > TP UIBU OPX JO KVTU BCPVU FWFSZ category we are one of the best performing TUBUFT )FSF BSF TPNF PG -JCFSBMhT LFZ QPJOUT

Specialists: Will support research to attract and retain early and mid-career specialists UP DVU UIF IPTQJUBM RVFVFT 8" IBT PG the population but only 8% of specialists.

Hospitals: "MSFBEZ JODSFBTFE UIF TQFOE on the development of various CBD and SFHJPOBM IPTQJUBMT QMVT N GPS UIF 4PVUIFSO *OMBOE )FBMUI *OJUJBUJWF <4*)*>

Hospitals: RPH stays as a 400-bed tertiary facility.

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Research: Recognised as a major funding issue â&#x20AC;&#x201C; state contributions have increased while federal funding has decreased. To HBJO UIF QSPQPSUJPOBM 8" TIBSF PG /).3$ GVOEJOH J F VQ GSPN NPSF money is needed to help researchers gear up to get Commonwealth money (to be announced later in the campaign and it will CF MFTT UIBO UIF "."hT TVHHFTUFE N

Past record: They supported the Reid 3FQPSU SFGPSNT FYDFQU GPS DMPTVSF PG 31) Preventive health: Took the credit for QBTTJOH UPCBDDP DPOUSPM MFHJTMBUJPO XJMM XBJU to assess if a reduction in the number of tobacco outlets will work before adopting BMM "$04) SFDPNNFOEBUJPOT $PNNJUUFE $20m over four years for children's Sport 'PS "MM QSPHSBN 1VU N JOUP DIJME health services after the parliamentary JORVJSZ BOE N JOUP DIJME IFBMUI OVSTFT Public health: N PWFS GPVS ZFBST IBT been allocated to new personnel for cancer services. He flagged more home-based palliative care funding for Silver Chain.

Pledged to put in place recommendations from the Stokes review into mental health services. On alcohol: cost of alcohol was B WFYFE JTTVF CVU TBJE B DIBOHF JO QVCMJD attitude would come from education, JODMVEJOH B MFBE GSPN TQPSUJOH IFSPFT "MDPIPM 4QFDUSVN %JTPSEFS XPVME CF B major task ahead.

Rural and remote: Emphasised the N JOWFTUNFOU JO UIF 4*)* IPTQJUBM Continued Page 28 27

Election 2013

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Choosing Your Politicians Continued from Page 27

developments at Karratha, Broome and Kununurra, plus the recently announced appointment of an indigenous health worker in every SFNPUF DPNNVOJUZ UP FYDMVTJWFMZ XPSL PO FBS IFBMUI Public dental health: Put the responsibility back on the Commonwealth but admitted that State services were deficient.

Giz Watson .-$ (SFFOT 8" TBJE )FBMUI XBT POF PG UISFF shadow portfolios she holds. "If we are going to make a difference in UIJT BSFB <QSFWFOUJWF IFBMUI> BOE CF TVSF UIF NPOFZ JT XFMM TQFOU PO UIF FWFS FYQBOEJOH EFNBOET XF IBWF UP TIJGU UIF EFCBUF BXBZ GSPN MBX BOE PSEFS <y> XF LOPX UIF MPOH UFSN JTTVFT BSF BCPVU LFFQJOH people healthy and promoting wellbeing." The Greens' emphasis was on getting cross party support for healthy initiatives and making connections between social determinants in the community.

,W QR ORQJHU PDWWHUV ZKLFK HOHFWURQLF VFULSW VHUYLFH WKH SKDUPDFLVW XVHV 0HGL6HFXUHÂ&#x160; SUHVFULSWLRQV DUH DEOH EH VFDQQHG LQ HYHU\ H3UHVFULSWLRQ HQDEOHG SKDUPDF\ LQ $XVWUDOLD 0RUH FRPSDWDEOH ZRUNLQJ FOLQLFDO V\VWHPV %HVW 3UDFWLFH *HQLH =HGPHG 0HGWHFK 0RQHW 0HGLQHW 3URÂżOH DQG 0' ,I ZRUULHG DERXW H3,3 ZH FDQ KHOS \RX FRQYHUW WR DQRWKHU VXLWDEOH FOLQLFDO V\VWHP 0HGL6HFXUHÂ&#x160; ZLOO QRW VORZ \RX GRZQ

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28

Q Dr Kim Hames MLA and Giz Watson

Preventive health: "CPSJHJOBM IFBMUI DBSF SFRVJSFT DIBOHFT JO housing, education and justice systems. "I have been trying to get DSPTT QBSUZ TVQQPSU GPS NJEEMF FBS JOGFDUJPOT JO "CPSJHJOBM DIJMESFO where repercussions go right through the community. If you can't hear you can't learn and you have a permanent disability. 80% PG "CPSJHJOBM QSJTPOFST JO %BSXJO QSJTPO IBE QSPGPVOE IFBSJOH disability. If you have poor health outcomes you are going to transfer costs to the justice system." She acknowledged the role of Janet Woollard in pushing tobacco control legislation, coupled with the Greens efforts in the Upper House.

Public health: Debate needs to be around substance abuse both BMDPIPM BOE PUIFS ESVHT "UUJUVEFT UP BMDPIPM OFFE UP DIBOHF she called for restrictions on alcohol advertising and urged other QPMJUJDBM QBSUJFT UP VODPVQMF GSPN BOZ ")" EPOBUJPOT %PDUPST OFFE CFUUFS USBJOJOH UP SFDPHOJTF "MDPIPM 4QFDUSVN %JTPSEFS 8FMDPNFE the debate on public transport, for which the Greens have been MPCCZJOH GPS EFDBEFT UIF QVCMJD OFFE NPSF FODPVSBHFNFOU UP XBML or cycle safely, to tackling obesity and mental health.

Funding: "T DIBJS PG UIF 4UBOEJOH $PNNJUUFF PO 'JOBODJBM Operations she looks at the value for money in provision of public health (e.g. Peel Health Campus).

Rural and remote: 4BJE JOJUJBUJWFT UP GJY UIF FOWJSPONFOU TVDI BT salt problems, required only small funding yet gave cohesion to rural communities.

Public dental health: They would continue to lobby at the national level. O (1) The Australasian Faculty of Public Health Medicine (WA), Australian Council on Smoking and Health, Australian Health Promotion Association, Australian Medical Association (WA), Cancer Council WA, Diabetes WA, Environmental Health Australia (WA), Heart Foundation (WA), Public Health Advocacy Institute of WA, Public Health Association of Australia, Telethon Institute for Child Health Research and the WA Alcohol and Youth Action Coalition.

medicalforum

E-Poll

Youth Alcohol & Election Priorities 328 doctors, GPs, Specialists and DITs (we don't know proportions because we forgot to ask!) responded within the sixday timeframe. That's from 428 people who clicked through to the survey, so thanks to everyone who stuck with it for five minutes! Winner of our wine pack was Dr JK. The results on Euthanasia and Eating Disorders we are holding over until our April Women's Health edition.

Q

Do you believe excessive alcohol consumption by younger people is something society should deal with through measures involving [multiple choice]?

Education at school ................................... 87% Family education on parenting and values.................................................... 87% Public health ............................................... 79% -BX BOE PSEFS.............................................

Uncertain ...................................................

Nil â&#x20AC;&#x201C; not a problem ......................................1%

Other (see comments below). .....................6%

EBOHFSPVT *O UIBU DPOUFYU XIZ OPU IBWF a drinking card like a driving card, and antisocial behaviour leads to banning from public drinking establishments?"

"More role models and greater opportunities for young people to enjoy their lives (social justice, employment and training opportunities, respect, etc)."

5IJT JT B DPNQMFY FOUSFODIFE QSPCMFN that needs all areas of influence to help initiate change. Coordination of these measures is essential."

"Commence an alcohol education program similar to the successful anti-smoking campaign.

"Why does the health industry advocate alcohol consumption when we see such damage from it in our practices â&#x20AC;&#x201C; a wine prize every edition of the magazine has references to doctors drinking alcohol.

1FSIBQT XF TIPVME USZ BOE MFBE CZ FYBNQMF One doctor suggested there needed to be more opportunities for teenagers to have fun without alcohol while another thought it might help if the older generation set a CFUUFS FYBNQMF

Comments While survey results pointed to educating young people as the top priority in our QPMM EPDUPST QSPWJEFE VTFGVM BEEJUJPOBM comment. Here's a sample.

< SFTQPOEFOUT> Mental health was chosen by 12 doctors.

Comments pointed to more funding, more staff, access, direct referral by GPs, youth services and community services, as well as: "Improved funding for inpatient facilities to accommodate acute, subacute, maintenance and relapse prevention care, and specifically to reinstate psychiatrists BT DMJOJDBM MFBEFST JO UIFTF TFSWJDFT UP actively re-establish psychiatrists as clinical leaders in child and adolescent psychiatric services with improved funding resources for new inpatient facilities and associated community child and adolescent mental health services."

General practice issues included allowing GPs greater use of skills, improved STI services and bowel ca screening, scrapping 'plans' and 'check ups' and increasing GP fee-for-service, health care closer to/in home, and increasing affordable aged care places.

Prevention JODMVEFE UBYJOH UIF IFMM PVU of cigarettes, adding a train carriage for free transport of people with bicycles (as JO 4XFEFO UBY UIF IFMM PVU JG OVUSJUJPOMFTT snack foods and fizzy drinks and subsidise fruit and veg, etc."

Funding included increased "FTE public medical positions instead of funding other non-essential plans e.g. Elizabeth Quay".

One doctor suggested succession was the answer, given the 24% population increase in 10 years, failing public infrastructure BOE QFSTPOOFM BOE /48 BOE 7*$ stealing funds.

"Raise the drinking age to 21 and stop all alcohol advertising before 9pm and during all sporting events" and "Restrict times and places for sale of alcohol and restrict advertising" and raising the price of alcohol was popular with a few.

"Stricter laws to hold parents responsible for the safety of their children."

"This is an issue that relates to personal character and social conduct. It is best addressed by role models setting DPNNVOJUZ TUBOEBSET PG XIJDI OFJUIFS social workers, nor Mike Daube have an understanding."

Q

"Public education and ongoing government funding for research into the impact of alcohol and psychoactive substances on the developing brain, the psychiatric and general medical complications when alcohol and psychoactive substance use are started in adolescence, and the burden of care emanating from the impact."

"TTJTUBODF UP (1T BOE TQFDJBMJTUT working in aged care .................................

&GGPSUT UP DIBOHF "VTUSBMJBO DVMUVSBM BUUJUVEFT SFHBSEJOH FYDFTTJWF BMDPIPM VTF and encourage the public to recognise that alcohol is a drug and should only be used in a responsible manner."

Healthy eating. ...........................................

"Public drinking is like driving â&#x20AC;&#x201C; a privilege not a right, and irresponsible abuse is

1VCMJD IFBMUI SFTFBSDI JO 8" ..................23%

medicalforum

Comments

Heading into a State Election, which of these health areas should be given priority by our elected representatives [choose up to FIVE]?

Improved rural or remote health services ............................................ 60%

Public hospital waiting times and access to hospital services ................

1SPNPUJPO PG FYFSDJTF UISPVHI town planning and support of consumer groups ....................................... 47% Restriction of marketing of sugary drinks to children. ........................ 38% .FEJDBM EJTFBTF SFTFBSDI JO 8" ............ 30%

Rural emphasis included "increase in 1"54 UP B SFBMJTUJD QFSDFOUBHF PG USBWFM costs" and more "specialist rural outpatient clinics", as well as more drug and alcohol services, a SIHI equivalent up north, and a "school doctor service to screen and initiate management of childhood obesity, vision, hearing and developmental problems".

Training positions were requested GPS JOUFSOT BOE 8#" GPS *.(T CZ UXP respondents, with another suggesting more rural GP training.

Aboriginal health assistance to GPs working in this area was only suggested by one doctor.

Hospitals featured in political promises of "magic hospitals to everyone â&#x20AC;&#x201C; perhaps they should just deliver on the promises of previous elections", then communityhospital integration was considered important by one doctor, while two wanted RPH kept open. O

Other (comment) ..........................................7% 29

Medical Marketplace

Sunny Side Up We are living on the third rock from the sun so solar power seems a logical way to save money and the planet, but is it stable enough for medical practice?

Medical Centres use a lot of electricity and it's not getting any cheaper. Two Perth medical centres are investing in solar power and it's saving money.

5IF OFYU UIJOH JT XIBU UP EP BCPVU TBGF vaccine storage?

Michael Travaglione, the practice manager at the Duncraig Medical Centre, is a recent DPOWFSU UP TPMBS QPXFS BOE -&% MJHIUJOH But he is also concerned about the loss of FYQFOTJWF WBDDJOFT BOE 8FTUFSO 1PXFS NBZ not be to blame.

8FhWF JOTUBMMFE -&% MJHIUJOH JO UIF TVSHFSZ BOE UIF OFYU TUFQ GPS VT XJMM CF B GVMM TPMBS power system with battery back-up. We had to throw out thousands of dollars of vaccines FBSMJFS UIJT ZFBS EVF UP B QPXFS QSPCMFN "OE it had nothing to do with Western Power.

The cover had been left off an electronics panel and when it started to rain we lost our electricity," Michael said.

"We often have tens of thousands of dollars in our vaccine fridge, especially at the beginning PG UIF GMV TFBTPO "OE TPNF WBDDJOFT BSFOhU DIFBQ 7JWBYJN DPTUT B QPQ BOE XF CVZ them in packs of 10 so there's $1000 right there. There's big money sitting in vaccine fridges."

Safe vaccine storage is an integral part of the (1 "DDSFEJUBUJPO QSPDFTT BOE WBDDJOF GSJEHFT are required to have 'temperature loggers' and most are fitted with an alarm and a data SFDPSE PG JOUFSOBM UFNQFSBUVSF XJUI $ UIF JEFBM 5IF %FQBSUNFOU PG )FBMUI BOE "HFJOH current guidelines stipulate that surgeries are required to record the minimum and

FACTS: About Your Fridge t $PME $IBJO #SFBDI $ BOE PS $ t "EWFSTF 7BDDJOF 4UPSBHF &WFOU $ MFTT UIBO NJOVUFT

t 'SFF[JOH $ NPTU DPNNPO SFBTPO GPS WBDDJOF EBNBHF t " $PME $IBJO .POJUPS $$.

TIPVME BDDPNQBOZ BMM WBDDJOFT EVSJOH USBOTQPSU

NBYJNVN UFNQFSBUVSFT BU MFBTU PODF FWFSZ business day.

The use of an uninterruptible powers supply (UPS) would help to prevent the possibility of a Cold Chain breach and the technology boffins have come up with 60litre portable units with an automatic UPS that lasts up to four days or a UPS to attach to your normal

vaccine fridge that can power it for between GPVS UP FJHIU IPVST 5IF OFYU RVFTUJPO JT XIBU are the most common power outage intervals in your area and will there be savings on insurance and vaccine replacement that recoup the UPS investment? %S "NJOEFS 4JOHI GSPN UIF )JHIDMFSF Family Medical Practice in Marangaroo is another true believer in the benefits of solar power. He recently installed a system valued BU BSPVOE UIBU HFOFSBUFT CFUXFFO VOJUT PG FMFDUSJDJUZ FWFSZ EBZ 8FhWF HPU TJY DPOTVMUJOH SPPNT TP UIF QPXFS bills at the surgery are very high and we wanted to contribute to the green energy environmental equation. We produce the solar energy during the day and it's used the TBNF EBZ 8F FYQFDU UP TBWF CFUXFFO on our power bills. The system will have paid for itself in five years, so it's a good long-term JOWFTUNFOU "NJOEFS TBJE He is also keeping an eye on back-up TZTUFNT GPS UIF TVSHFSZhT WBDDJOF GSJEHF "U the moment they are not cheap â&#x20AC;&#x201C; they can BDUVBMMZ CF NPSF FYQFOTJWF UIBO B GVMMZ installed solar system, depending on the power outage period you want to cover.

"The initial motivating factor for us was conserving energy and reducing our power bill, so the issue of a back-up for the vaccine GSJEHF NBZ XFMM CF UIF OFYU TUFQ GPS VT * think installing solar power is a worthwhile step for medical centres, particularly those in the medium to large category." O

By Mr Peter McClelland

Dr Ian Anderson Send-Off "GUFS BO BTTPDJBUJPO TQBOOJOH NPSF than 30 years, 21 of these operating at the Eye Surgery Foundation (ESF), %S *BO "OEFSTPO XBT GBSFXFMMFE CZ colleagues at a dinner held at Mosmans, upon his retirement.

"GUFS &4' %JSFDUPS %S "OESFX 4UFXBSU greeted more than 120 guests, Dr Philip House entertained with anecdotes of %S "OEFSTPOhT TDIPPM EBZT UISPVHI UP his professional career. In response, Ian recalled cataract surgery in the 1980s that involved lens removal through large incisions, at great cost to the patient.

Q Ian Anderson with Helen Hollingshead, his inaugural PA. 30

The introduction of Phaco surgery with smaller incisions and local anaesthetic techniques made Ophthalmic Day Surgery feasible, with added cost benefits.

%S "OEFSTPO BDLOPXMFEHFE IJT XPSL XJUI %ST (FPGGSFZ .PSMFU "OESFX 4UFXBSU 1IJM )PVTF 3PTT -JUUMFXPPE BOE (SBIBN 'VSOFTT He spoke of Helen Smith who ran the IPTQJUBM LOPXO UISPVHIPVU "VTUSBMJB BT B DFOUSF PG FYDFMMFODF UIF &UIJDT $PNNJUUFF and the staff he had worked with. He mentioned the formation of the charity, which has now distributed more than $1m to ophthalmic research, education and overseas projects.

While retired from practice, Ian's association with the Eye Surgery Foundation remains special to him. O

Q (Far right image inset) Ross Littlewood is flanked by Marissa and Roger Raymond.

medicalforum

Training

Inspiring Others to Aboriginal Health By supporting young doctors in the bush, Prof David Atkinson is making a huge difference to Aboriginal health.

1SPG %BWJE "ULJOTPO JT .FEJDBM &EVDBUPS XJUI UIF ,JNCFSMFZ "CPSJHJOBM Medical Services Council. He moved to Broome from Perth some years ago and has supported medical students, prevocational doctors and registrars throughout their training.

He keeps a personal eye on general practice trainees as a way of keeping them interested JO "CPSJHJOBM IFBMUI BGUFS UIFZ MFBWF )F is also pragmatic about what works in attracting doctors to the bush.

"Practices used to flog registrars in rural and remote settings to make them pay. Then the government paid the registrars' wages, which was a critical change. Money's one thing but you also have to keep people happy with project supervision and try and address the registrar's needs. If they are happy they tell others, and things build by word of mouth," he said.

This personal support is what carries the EBZ "OE IF JT OPU BMPOF " OVNCFS PG FYQFSJFODFE (1T IBWF QVMMFE VQ TUVNQT UP move north, or as he put it: "Doctors our age want to do something different in life and make a difference".

8JUI "CPSJHJOBM IFBMUI XPSLFST BOE OVSTFT KPJOJOH "(15 BOE "CPSJHJOBM NFEJDBM services, private practices and district hospitals accredited for PGPP placements, he has bolstered much needed medical services for the local community.

"Some registrars are overwhelmed with the health burdens but if you talk them through

Q Prof David Atkinson

it, they go away less disgruntled. They have someone to go to if they have a problem. " GBJS OVNCFS PG PVS GPSNFS SFHJTUSBST EP "CPSJHJOBM IFBMUI XIJDI JODMVEFT QSJWBUF health in the city." )F TBJE "CPSJHJOBM IFBMUI DBQUVSFT UIF interest of younger doctors who might get bored with seeing middle class 'white people' and what appears to be their mundane problems. " MPU PG (1T XBOU UIBU WBSJFUZ BOE XF give them that opportunity. You have the MJGFTUZMF BUUSBDUJPOT <PG UIF ,JNCFSMFZ> CVU you have them anywhere â&#x20AC;&#x201C; if you develop a relationship with the patients you can really NBLF B EJGGFSFODF IF FYQMBJOFE BEEJOH UIBU making a significant difference to one person in 10 in the Kimberley means a doctor might

impact on health in a way they might never achieve in the city.

"Compliance is an issue in health and "CPSJHJOBM QFPQMF UFOE UP CF NPSF USVUIGVM about their treatment â&#x20AC;&#x201C; at least you know they are not taking it, which is another challenge. There are also different cultural attitudes to ill health, which challenge younger doctors to sort out how they can make a difference."

He said that searching for solutions makes them better doctors for all patient encounters that follow.

"Because they are dealing with people across cultures they learn that if they can deal with them, everybody else is a piece of cake. They build their confidence." O

Q (l to r) Jane Anderson, Katrina Jones, Ian Anderson, Sally Clohessy and Lorraine Potts.

medicalforum

31

Guest Column

How Valid is Revalidation?

Dr Will Thornton wants some answers before general practice is plunged headlong into revalidation.

R

evalidation is the most significant current issue for GPs and yet it receives only cursory discussion, which is surprising when one considers the impact it will have on general practice.

Just speak to a UK colleague to see the full effect of a revalidation program!

The important question is why introduce revalidation? In the UK the spectre of a Shipman murdering patients created a professional need to respond to community outcry. However, I think locals would agree that revalidation does not prevent this sort of tragedy.

If, as the UK GP College President believes, that revalidation is a way of demonstrating to the public that doctors are up-todate and safe to practise, then I would strongly argue that it is a poor rationale for JOUSPEVDJOH B DPNQMFY DPTUMZ BOE MBCPSJPVT process. I would agree with political medical editor Paul Smith that inspiring public confidence and ensuring public safety are two different endpoints and they require two different processes.

Government of Western Australia

Department of Health South Metropolitan Health Service Royal Perth Hospital

" SFDFOU TVSWFZ CZ Australian Doctor [www.australiandoctor.com.au/news/latestOFXT EPDUPST EJWJEFE PO SFWBMJEBUJPO> with 340 respondents showed that only 20% believed in regular competency checks and indeed were more in favour of target checks for high-risk doctors. I think the Medical Board approach of it being consistently applied is both more equitable and appropriate.

So considering the pragmatics, there a few questions that need to be answered.

Who will be "the responsible officer" and do the peer review? It will mean diverting an already stretched workforce, especially with GPs involved in medical education, and if it is led by non-clinicians it has the potential of not being respected and simply consigned to another level of bureaucracy. " MFTT UIBO SPCVTU QSPDFTT XPVME CF B XBTUF of everyone's time, so it will need to be a process that can be administered to the "VTUSBMJBO (1T How will we afford this process? It will not be a cheap to create, roll-out or administer, so significant funds need to be allocated. I XPOEFS XIP XJMM DBSSZ UIBU CVSEFO "OE in terms of practitioner time, assuming our average GP to be earning a percentage of billings, how will the lost days of seeing patients be reimbursed?

How frequently will this process occur, and who will audit it? There are toolkits available, but they change almost annually and often need to be bespoke. Three or fiveyearly audits are often adopted but without any specific evidence for the rationale.

4P XIBU JT UIF "VTUSBMJBO TPMVUJPO GPS revalidation and a formalised process of clinical governance for GPs? Do we blindly follow the UK procedure seemingly like /FX ;FBMBOE 1BSUJDVMBSMZ CFBSJOH JO NJOE that we are yet to know whether there is any evidence that this process achieves its objectives or that after one five-year cycle there is something positive to gain.

Having gone through appraisals â&#x20AC;&#x201C; a component of revalidation â&#x20AC;&#x201C; a few times in UK, I can appreciate the strengths and weaknesses of the process. Significantly it is also dependent on the appraiser. My concern is that in the current environment, where there is a distinct lack of medical educators or others with this skill set, and that this paucity could weaken both the process, the uptake and indeed the genuine merit of the scheme.

"T JU JT SPMMFE PVU JO UIF 6, JU JT B significant issue in terms of personnel, cost, and opportunity cost. Seeing how it would fit into the private model of metro general practice and, indeed, resource-limited rural and remote areas is a challenge. O

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medicalforum

Pathology

Lab Without Walls For pathologist Tim Inglis it's a case of, if the viruses don't come to you then you hit the dirt tracks of the Outback in search of them.

D

Tim's got a track record of taking pathology PO UIF SPBE )F BOE DPMMFBHVF "EBN .FSSJUU TFU VQ -BC 8JUIPVU 8BMMT XIJDI aims to bring the latest in pathology diagnosis to remote locations.

r Tim Inglis is a PathWest/ UWA clinical pathologist and one of the prime-movers behind not-for-profit organisation, Lab Without Walls. Thanks to a National Science Week grant he set off along the Gibb River Road in North West WA late last year accompanied by a mobile pathology lab.

It's all part of an ongoing program that will see Arbovirus Vector research in the Kimberley and field laboratory support in Sri Lanka and Malaysia during 2013.

"In 2010 we ran our first field lab deployment to Dili in East Timor testing for TB, malaria and rapid confirmation of septicaemia. We were doing things that a medical clinic run on a charitable basis wouldn't be able to do and it was wonderful to be the first to do molecular TB work in that country."

"It's the first time we've taken one of these molecular devices on the road in "VTUSBMJB :PVhE OPSNBMMZ GJOE JU JO B large diagnostic laboratory, not bumping along the Gibb River Road. We used it time and time again and it didn't miss a beat. If we ever have to respond to a disease PVUCSFBL BU B SFNPUF NJOF TJUF JO 8" XF know we can do it. We've got the mining boom and more development on the Ord River so now's the time to be refining our ability to meet these disease challenges," Tim said.

*UhT CFFO B CVTZ ZFBS GPS -BC 8JUIPVU Walls â&#x20AC;&#x201C; we've had a total of eight QSPKFDUT JODMVEJOH TJY MBC EFQMPZNFOUT with everything from sending teaching microscopes to a district hospital in northern Malawi to testing for the usual TVTQFDUT PG 5# BOE NBMBSJB JO 4SJ -BOLB Choosing a career path can be fraught with difficulties but Tim caught the science and pathology spark early on. He had some wonderful mentors who fanned the flame of both clinical contact and the importance of research.

"OE JU HPFT CFZPOE JOGFDUJPVT EJTFBTFT too. There are the broader issues of nutrition and mental health considerations linked with working in a tropical industrial environment."

There is a distinct mismatch between the diagnostic resources in Perth compared with the remote, yet economically robust, northern part of the state. The research results from the Gibb River Road project have that disparity firmly in its sights.

It's the first time we've taken one of these molecular devices on the road in Australia.

"The capabilities here in Perth for treating DPNQMFY USPQJDBM EJTFBTFT BSF NVDI NPSF TPQIJTUJDBUFE UIBO UIPTF VQ OPSUI "OE XF need to remember that economically it's one of the most dynamic parts of the country. There's a little bit of enlightened self-interest here. I grew up in the country and I'm acutely aware of the differences between the city and the bush, but there's B QSPGFTTJPOBM FMFNFOU UPP &YDFQU GPS TPNF international travellers and FIFO workers we often don't see much of these diseases so it makes a lot of sense to investigate what's happening in these regions." medicalforum

Q Dr Tim Inglis mashing mosquitoes outside Broome Hospital

"OE TPNFUJNFT ZPV IBWF UP BDUVBMMZ DIBTF these things because it's best to have a look at them where they're actually occurring, rather than just seeing patient samples and then sending people down on the RFDS." Sometimes there are sad stories behind those samples. Constable Ryan Marron, XIP DPOUSBDUFE .VSSBZ 7BMMFZ &ODFQIBMJUJT .7& JO #BMHP JT POF PG UIFN "It's a terrible disease and the fielddeployable component of this trip had a strong focus on arbovirus infections transmitted by mosquitoes. If the QPQVMBUJPO OVNCFST JO OPSUIFSO "VTUSBMJB continue to grow we're definitely going to see a disease burden up there. The young policeman at Balgo is a particularly tragic case but it's by no means unique. There XBT B GMVSSZ PG .7& BOE 3PTT 3JWFS 7JSVT JO 8" MBTU ZFBS 5IF MBUUFS DBO CF WFSZ distressing for the sufferer and hopefully there'll be a vaccine on the way."

"I had an inspirational biology teacher at school in Scotland but my interest in field work came from a botany professor and a OFVSPQBUIPMPHJTU "T B GJOBM ZFBS TUVEFOU I worked in the pathology department at the University of Edinburgh on infectious diseases. In fact, they were focusing on what we now call Hepatitis B due to an outbreak in one of the renal units at Edinburgh Hospital. I went on to do my medical degree in Southampton and developed a strong and enduring interest in sepsis."

With travel becoming easier, it is also NBLJOH EJTFBTF NBOBHFNFOU NPSF DPNQMFY and trickier for GPs on the frontline.

"Travel medicine is becoming increasingly sophisticated and people are coming back XJUI TPNF QSFUUZ FYPUJD TUVGG 0OF PG UIF most important skills for GPs is to know the best person to refer a patient to and also to remember that just because travel isn't hFYPUJDh EPFTOhU NFBO UIFSF BSFOhU SJTLT O

By Mr Peter McClelland ED: www.labwithoutwalls.org; Tim's Blog: micrognome.priobe.net

33

CLINICAL UPDATE

MoM hip replacements.

What are the issues?

By Prof Piers Yates, Orthopaedic Surgeon, UWA Murdoch and Fremantle Hospitals

T

here is ongoing concern regarding metal-on-metal (MoM) hip replacements, with regard to some unexpected high failure rates, and their local and systemic effects in the body. Although large numbers of patients are at risk and many are having problems, MoM hip resurfacing still offers excellent outcomes in properly selected patients.

Background MoM hip replacements were implanted FYUFOTJWFMZ JO UIF 6, JO UIF T BOE 1970s but results were unpredictable and they were abandoned. In the late 1980s, better manufacturing and design led to the reintroduction of standard sized bearings (28mm and 32mm) for Total Hip Replacements (THR) and large head MoM IJQT NN CFDBNF QPQVMBS JO UIF MBUF '90s following the renewed interest in hip resurfacing for the young active patient.

Hip resurfacing is a special type of MoM IJQ UIBU NBYJNBMMZ QSFTFSWFT GFNPSBM CPOF including the femoral neck. Development of this implant was driven by the poor results of conventional THR in the young ZFBST FTQFDJBMMZ NBMFT )JQ SFTVSGBDJOH offered a fast recovery, low wear and high function in highly demanding patients.

Early problems related to errors in surgical technique and suboptimal patient selection, leading to neck fractures, neck thinning and groin pain. Nevertheless, the results with the original Birmingham hip were, BOE TUJMM BSF FYDFMMFOU FTQFDJBMMZ JO young, high-demand males with PTUFPBSUISJUJT 0"

Most implant manufacturers developed their own MoM hips, with about one million MoM hips implanted worldwide.

By the mid 2000s, it was becoming clear that certain groups of patients were less suitable for these implants, including females, patients with femoral heads less than between 36 and 48mm, and people with significant deformity, hip dysplasia, avascular necrosis and inflammatory arthritis. It was also clear that the original design (Birmingham) was doing much better than all the newer implant designs, thought due to a number of factors including clearance between the bearing surfaces, the completeness of the hemisphere, the deformation of the cup, the TVSGBDF GJOJTI BOE UIF GJYBUJPO )JHI GBJMVSF SBUFT XJUI UIF "VTUSBMJBO EFTJHOFE "43 GSPN %FQVZ JEFOUJGJFE FBSMZ PO XJUI UIF "VTUSBMJBO IJQ SFHJTUSZ IBT MFE to its withdrawal from the market, although NPSF UIBO IBE CFFO JNQMBOUFE XPSMEXJEF "43 SFWJTJPO SBUFT IBWF CFFO TP high, that the manufacturer has allocated $20 billion to pay for revision surgery (4400 "43 SFDBMMT BSF DVSSFOUMZ CFJOH EFBMU XJUI JO "VTUSBMJB

severe bone and soft-tissue destruction "-7"- "3.% FUD 5IFSF IBWF BMTP CFFO concerns regarding the local and systemic effect of metal ions in the body, which are XJEFMZ EJTUSJCVUFE JO UIF UJTTVFT 7BSJPVT systemic symptoms have been linked to high ion levels such as tinnitus, fatigue, neurological disturbance and skin reactions â&#x20AC;&#x201C; difficult to prove but certainly do occur JO UIF NPTU FYUSFNF DBTFT XIFO NFUBM JPOT BSF JO UIF T ONPM - 5IFSF is no evidence that MoM replacements predispose to cancer.

Current focus and surveillance The MoM implant combinations of most interest at present are conventional hip stems with large MoM heads, and hip resurfacing. Conventional THR with standard MoM head sizes (28-32mm) are in general doing well, although they have slightly higher revision rates than standard bearings (metal or ceramic heads on plastic liners). Hip resurfacing VTJOH #JSNJOHIBN BOE "EFQU DPOUJOVF UP IBWF FYDFMMFOU SFTVMUT JO QSPQFSMZ TFMFDUFE QBUJFOUT NBMFT XJUI 0" VOEFS ZFBST

Conventional THR with large bearings

Assessment of MoM Hip Clinical; measure serum cobalt and chrome ion levels; x-ray AP pelvis and lateral hip

ASYMPTOMATIC

28-32mm head Review 1yr, 5yr,10yr

34

>32mm head or resurfacing Review yearly for first 5yrs.

SYMPTOMATIC: Pain or limp

Measure CRP/ESR

Refer if: Rising ions; ion levels >135nmol/L; concern.

Refer to hip revision surgeon

Problem symptoms The problems relating directly to the MoM bearings are groin pain and soft tissue reactions to the bearing debris causing

NN BSF UIF CJHHFTU XPSSZ XJUI SFWJTJPO SBUFT VQ UP JO TPNF TFSJFT and this is the biggest problem group in 8FTUFSO "VTUSBMJB FTQFDJBMMZ "43

Guidelines for surveillance and management of these patients has been published by several authorities including UIF "VTUSBMJBO 0SUIPQBFEJD "TTPDJBUJPO 5IF #SJUJTI )JQ 4PDJFUZ .)3" BOE 5(" BMUIPVHI UIJT JT FWPMWJOH BT OFX information becomes available. In particular, the significance of cobalt and chrome ion levels in the blood is debated. *PO MFWFMT PG QQC ONPM - DPCBMU ONPM - DISPNJVN BSF BTTPDJBUFE XJUI poorly performing implants but up to 10% of implants with ion levels above this figure are fine. Rising levels over time are likely to be much more significant than a single measurement. However, activity levels, bilateral implants, renal function, laboratory variations and other implants (esp knee replacement) can influence ion levels.

Here are some pragmatic summary notes based on my interpretation of the current evidence (see flow chart).

Q Assessment of MoM Hip

medicalforum

CLINICAL UPDATE

Q MoM resurfacing post-op.

Q MoM THR post-op.

GP notes

Revise if: progressive bone or soft tissue loss, or solid pseudotumour, even if BTZNQUPNBUJD JPOT VTVBMMZ SBJTFE HSPJO pain and high ions or rising ions over threshold.

Watch if: asymptomatic/minor discomfort BOE OPSNBM JPOT OP QTFVEPUVNPVST asymptomatic/minor discomfort and raised TUBCMF JPO MFWFMT SFWJFX XJUI Y SBZ BOE JPOT BU TJY NPOUIT

Surgical problems: solid pseudotumours OFFE UP CF FYDJTFE BT UIFZ SFDVS BOE BSF associated with a poorer outcome â&#x20AC;&#x201C; they DBO CF EJTUBOU UP UIF VTVBM PQFSBUJWF TJUF BMXBZT TVTQFDU JOGFDUJPO DBO PGUFO MFBWF UIF TUFN XJUI 5)3 SFWJTJPOT BCEVDUPST BSF

"MM .P. 5)3 BOE SFTVSGBDJOHT need post-op follow-up clinically, biochemically (cobalt and chrome levels) BOE SBEJPMPHJDBMMZ FWFO JG BTZNQUPNBUJD conventional size heads (28-32mm) at routine intervals, larger heads and resurfacing more often. Refer when indicated (see chart).

Orthopaedic surgeon notes "MM SFGFSSFE QBUJFOUT TIPVME CF DMJOJDBMMZ biochemically and radiologically assessed.

'Normal' causes of failure need to be DPOTJEFSFE F H JOGFDUJPO "T B NJOJNVN artifact reduction MRI or CT should be performed.

often badly damaged and may need repair at revision (or later once the biology has TFUUMFE NBZ OFFE DPOTUSBJOFE JNQMBOUT JG TFWFSF NVTDMF EBNBHF VTF DFSBNJD IFBE JG macroscopic metal particles present.

Ref: www.tga.gov.au/hp/information-devicesmom-hip-implants.htm O

The Hip Prosthesis Story %VSJOH UIF TJY ZFBST UIF "VTUSBMJBO EFTJHOFE %F1VZ "43 IJQ QSPTUIFTJT XBT on the market here, it was used in about QBUJFOUT DPOWFOUJPOBM "43 BOE SFTVSGBDJOH "43 %BUB GSPN UIF National Joint Replacement Register show that of about 197,000 conventional total hip replacements during 1999-2010, about 21,400 were metal-on-metal (MoM), as were about 14,000 resurfacing implants.

The DePuy prosthesis has been recalled but other MoM prostheses are now in the spotlight.

The New York Times last year reported UIBU %F1VZhT QBSFOU DPNQBOZ +PIOTPO Johnson had not been quick enough to acknowledge and respond to high failure SBUFT SFQPSUFE JO "VTUSBMJB *O GBDU JO FBSMZ UIF '%" IBE HJWFO IJHI SBUFT PG SFWJTJPO BT UIF SFBTPO XIZ 64" BQQSPWBM was not forthcoming. The newspaper suggested that DePuy's actions might undercut its defence of related lawsuits.

'VMM QSPTUIFTJT SFDBMM IBQQFOFE JO "VTUSBMJB in December 2009 and worldwide in "VHVTU Patients suing the company claim that metal debris from the hips, made from a cobalt and chromium alloy, causes tissue death around the joint. This type of local reaction can cause premature failure of MoM hip implants, and increase the risk of complications with revision surgery. There is also concern that chromium and cobalt ions from a wearing MoM implant can enter the bloodstream to harmful levels. medicalforum

In 2011, an article in the MJA suggested the DePuy product recall was likely to DSFBUF VODFSUBJOUZ BOE BOYJFUZ JO UIF QBUJFOUT VOEFSHPJOH IJQ SFQMBDFNFOU FBDI ZFBS JO "VTUSBMJB 1SPCMFNT XJUI the prosthesis had been reported by the "VTUSBMJBO 0SUIPQBFEJD "TTPDJBUJPO JO o UIF "43 SFTVSGBDJOH QSPTUIFTJT IBE B revision rate greater than twice the rate for all other resurfacing prostheses combined. *O BOE CPUI UIF "43 SFTVSGBDJOH and conventional prostheses were reported in the same light.

The MJA article said that at 6 years, the "43 DPOWFOUJPOBM QSPTUIFTJT IBE B BOE UIF "43 SFTVSGBDJOH QSPTUIFTJT BO 11.1% cumulative percentage revision rate. )PX NBOZ QBUJFOUT XJUI BO "43 QSPTUIFTJT will eventually require revision remains unknown but is potentially high.

"OPUIFS BSUJDMF JO UIF TBNF JTTVF PG UIF MJA SFQPSUFE QBUJFOUT XJUI "43 QSPTUIFTFT

FACTS: MoM Hip Prostheses t %F1VZhT .P. "43 IJQ QSPTUIFTFT XFSF SFDBMMFE JO %FDFNCFS t "SPVOE 8" QBUJFOUT IBWF UIFTF JNQMBOUT BOE BSF FOUJUMFE UP DPNQFOTBUJPO t "CPVU TFWFO UJNFT BT NBOZ .P. QSPTUIFTFT IBWF CFFO JNQMBOUFE BOE OFFE POHPJOH BTTFTTNFOU t 1BUJFOUT XJUI .P. QSPTUIFTFT NBZ HFU MPDBM BOE TZTUFNJD FGGFDUT GSPN SFMFBTFE DPCBMU BOE DISPNBUF JPOT

who seemed to show an association between high serum metal ion levels and systemic UPYJDJUZ 5IF UISFTIPME PG TJHOJGJDBOU CMPPE levels is unknown and needs researching.

With varying innate susceptibility amongst patients, other MoM hip prostheses that are not performing well are now a concern. *O "VTUSBMJB %F1VZ IBWF FOHBHFE $SBXGPSE $PNQBOZ "VTUSBMJB 1UZ -UE UP SFJNCVSTF GPS FYQFOTFT BTTPDJBUFE XJUI UIF SFDBMM PG UIF %F1VZ "43 QSPTUIFTFT 0VU PG QPDLFU FYQFOTFT MPTU FBSOJOHT BOE medical costs are covered for registered patients and if they seek compensation for pain and suffering and undergo revision TVSHFSZ UIFSF JT UIF %F1VZ "43 1BUJFOU Compensation Programme that bypasses the Court system.

'JOBMMZ UIF 5(" IBT SFDMBTTJGJFE BMM IJQ knee and shoulder prostheses from class IIb (medium risk) to class III (high risk) medical devices and from 1 July 2012 premarket assessment for any future devices will increase. O

35

CLINICAL UPDATE

RADIOLOGY

Absorbable coronary stents

By Dr Eric Yamen, Cardiologist, Western Cardiology. Tel 9346 9300

At SKG Radiology, we understand the importance of ensuring your patients receive the very best care.

Our branches offer a safe and comfortable environment for your medical imaging procedures.

Our team of highly trained Receptionists, Technicians and Radiologists are committed to providing you with the highest standard of patient care, every time.

SKG Radiology offers a fully comprehensive range of imaging services: MRI PET-CT CT

New M MandRI Service in u Marc rah from h 201 3!

Ultrasound (including Nuchal Translucency and Doppler scanning) Nuclear Medicine Fluoroscopy Mammography Interventional procedures General X-ray Dental X-ray (OPG) FNA Biopsy Bulk Billing SKG Radiology bulk bills pensioners and healthcare cards holders for all Medicare rebatable items at community locations (non-hospital locations), including Mercy.

www.skg.com.au 36

P

ercutaneous implantation of a metal stent is standard of care for many patients with stable coronary disease and acute coronary syndromes (ACS). Absorbable coronary stents are new technology with some advantages over metal stents for some patient subgroups but their role in the management of ischaemic heart disease is yet to be elucidated. In contrast, experience with the current generation of drug eluting metal stents is large, with a long track record of efficacy and safety.

Drug eluting stents (DES) are metal stents covered with a nonabsorbable polymer that is impregnated with small amounts of antiproliferative medication (similar to those used to prevent organ transplant rejection), designed to delay and truncate the healing process and prevent restenosis, reducing the risk of UIBU DPNQMJDBUJPO UP " NJOJNVN PG NPOUIT PG EVBM BOUJ QMBUFMFU UIFSBQZ %"15 VTVBMMZ BTQJSJO QMVT DMPQJEPHSFM JT recommended after DES implantation.

Absorbable stents "CTPSCBCMF TUFOUT IBWF UIF BUUSBDUJPO PG TDBGGPMEJOH UIF WFTTFM GPS B limited time during the initial healing period (months to a couple of years), without leaving the patient with a permanent prosthesis.

Several absorbable stents have been developed over the past decade, with variable results.

5IF "CCPUU "CTPSCTM stent is the absorbable stent closest to market.

Both the device itself and the drug-eluting polymer are composed PG MBDUJD BDJE EFSJWBUFT NFUBCPMJTFE JOUP DBSCPO EJPYJEF BOE XBUFS PWFS BQQSPYJNBUFMZ UXP ZFBST 5IF TDBGGPME FMVUFT FWFSPMJNVT BU BO JEFOUJDBM DPODFOUSBUJPO BOE SBUF UP "CCPUUhT 9JFODFTM stent (a commonly used second generation DES). In highly selected patients GSPN SBOEPNJTFE DPOUSPMMFE USJBMT UIF "CTPSC TUFOU IBT QFSGPSNFE XFMM DPNQBSFE UP 9JFODF XJUI MPX SBUFT PG BDVUF DPNQMJDBUJPOT restenosis and stent thrombosis. However, worldwide commercial use has been limited to about 2000 patients.

Advantages and disadvantages of an absorbable stent The lack of a permanent prosthesis may reduce the risk of late stent thrombosis, a major concern with DES. However, current generation %&4 QFSGPSN CFUUFS UIBO UIF PMEFS POFT XJUI FYDFQUJPOBMMZ MPX thrombosis rates. It is not clear whether this could be outperformed CZ UIF "CTPSCTM TUFOU GPS XIJDI UIF EVSBUJPO PG %"15 JT not shorter. $PSPOBSZ JNBHJOH XJUI $5 NBZ CF NPSF BDDVSBUF BGUFS "CTPSCTM implantation compared with metal stents, due to less imaging BSUFGBDU "O BCTPSCBCMF TUFOU NBZ BMTP BMMPX B CFUUFS UBSHFU GPS bypass surgery, in the event of disease progression.

The main disadvantage from the lack of a metal scaffold is that JU SFEVDFT UIF DPNQMFYJUZ PG MFTJPOT UIBU DBO CF USFBUFE IFBWZ calcification, tortuous vessels and bifurcations cannot be managed.

5IF "CTPSCTM TUFOU MBDLT UIF DMJOJDBM FYQFSJFODF PG %&4 XIJDI are used in large numbers around the world, and the device is OPU 5(" BQQSPWFE TP BWBJMBCJMJUZ JT SFTUSJDUFE UP TFMFDUFE QVCMJD IPTQJUBMT JO "VTUSBMJB O

Declarations: Author â&#x20AC;&#x201C; no competing interests. Western Cardiology has contributed to Medical Forum's production costs for this clinical update.

medicalforum

CLINICAL UPDATE

East Timor generosity

By Dr Ross Littlewood, Ophthalmologist

D

ifferent Australian outreach health services have been visiting East Timor since 2000, all keen to assist people in obvious need. Charities, volunteers, governments and organisations have collaborated at various stages to deliver ophthalmic and optometric services and train local people â&#x20AC;&#x201C; East Timor Eye Program (ETEP), college of surgeons (RACS), Optometrists Giving Sight, and AusAID in my case.

Internal violence delayed my first visit until FBSMZ XIFO TDFOFT PG FYUSBPSEJOBSZ squalor and misery confronted me, as well as an apparently endless supply of blind eyes with hyper-mature cataracts. It was the further need to resource an annual eye team visit to one health district that led me UP BQQSPBDI TQPOTPST BOE DPMMFBHVFT JO 8" I asked two charities for assistance â&#x20AC;&#x201C; the Eye Surgery Foundation, which owns the freestanding operating clinic in West Perth, and a charity administered by St +PIO "NCVMBODF 8" o BOE UIFJS HFOFSPVT responses have supported an annual visit ever since. This includes funding for nurses, surgical equipment and disposable supplies to perform up to 100 cataract operations.

In addition, donated major equipment has been installed including a photo slit lamp, PQFSBUJOH NJDSPTDPQF BOE :"( MBTFS 5IF 8" BNCVMBODF TFSWJDF IBT BMTP TFOU B fully trained ambulance officer each trip to assist with logistics and patient care. My

Q Getting on with the job in Maubisse

barefoot through thick bush and across mountains to access help. One blind man was led on horseback for two days to seek help, only to discover he had untreatable retinal blindness. Conversely, an elderly blind lady in Same, who tried to drown herself because of the guilt of burdening her family, was visited shortly after by the eye team. She is now independent, happy, and IFMQJOH IFS GBNJMZ BHBJO "O FMEFSMZ CMJOE person in a subsistence economy affects the entire family and can often prevent a child from attending school.

"MUIPVHI UIF TVSHFSZ JT DIBMMFOHJOH &5&1hT SFTVMUT FYDFFE 8)0 HVJEFMJOFT and each cataract operation has the potential to change the life of an entire family. ETEP has helped train Timorese nurses, optometrists, interpreters, and one ophthalmologist (with another on the way).

The aim is for self-sufficiency by 2016.

I am proud of the fabulous work done CZ NZ 8" DPMMFBHVFT BOE HSBUFGVM GPS all the support, especially from the Eye Surgery Foundation board (www. eyesurgeryfoundation.com.au) and St. John "NCVMBODF 8" XXX BNCVMBODF OFU BV O

Q Phil and Ross discussing post-op cases

colleague at the Eye Surgery Foundation, Dr Phil House, soon joined the project as EJE UXP OVSTFT XJUI TVSHJDBM FYQFSJFODF Cheryl Doran and my wife, Jill. Together with other medical volunteers and a group of optometrists, the locally sponsored team has been providing at least one visit a year since 2008.

"GUFS DPODFOUSBUJOH PO UIF DFOUSBM 5JNPS Maubisse region for several years, last year we moved further south to Same where there is no suitable operating facility. We used a derelict building with no power and had to improvise. There is still a critical lack of infrastructure in many regions outside Dili.

In fact, Timor is the poorest country on earth. Some local people cannot afford a bus fare so blind patients have been led

Eye Surgery Foundation has supported this article through an independent educational grant to Medical Forum.

Dr Ross Agnello Tel: 9448 9955 Dr Malcolm Burvill Tel: 9275 2522 Dr Ian Chan Tel: 9388 1828 Dr Steve Colley Tel: 9385 6665 Dr Dru Daniels Tel: 9381 3409 Dr Blasco D'Souza Tel: 9258 5999 Dr Graham Furness Tel: 9440 4033

EYE SURGERY FOUNDATION

Dr Annette Gebauer Tel: 9386 9922

Our Vision Is Improved Vision

Dr Boon Ham Tel: 9474 1411

Dr David Greer Tel: 9481 1916 Dr Philip House Tel: 9316 2156 Dr Brad Johnson Tel: 9301 0060

Expert Day Surgery for t $BUBSBDU &YUSBDUJPO BOE -FOT *NQMBOU t 1UFSZHJVN t (MBVDPNB t 0DVMPQMBTUJD 4VSHFSZ t 4USBCJTNVT t $PSOFBM 5SBOTQMBOU

Tel: 9216 7900 medicalforum

Dr Jane Khan Tel: 9385 6665 t " MM UZQFT PG 3FGSBDUJWF 4VSHFSZ LASIK, LASEK, PRK, CTK, Phakic Lens and 3FGSBDUJWF -FOT &YDIBOHF 3-&

Dr Ross Littlewood Tel: 9374 0620 Certified to ISO 9001 Standard

Dr Nigel Morlet Tel: 9385 6665 Dr Robert Patrick Tel: 9300 9600 Dr Jo Richards Tel: 9321 5996

Supporting Ophthalmic Teaching and Research

E: info@eyesurgeryfoundation.com.au 42 ORD STREET WEST PERTH WA 6005

Dr Stuart Ross Tel: 9250 7702 Dr Angus Turner Tel: 9381 0802 Dr Michael Wertheim Tel: 9312 6033 37

LOW OW

HIGH

OUR CT SCORED LOWER

THAN THE NATIONAL DOSE REFERENCE LEVELS

In 2011, the Australian Radiation Protection and Nuclear Safety Agency conducted the Australian National Diagnostic Reference Level Survey. The data established a measure of multi-slice detector CT doses for current diagnostic imaging practice in Australia, allowing individual practices to compare their doses against those of their peers.1

Australian Adult MDCT DRLs - (95% Cl) (Dose Length Product, mGy.cm) 1200

1200

1000

1000 900

800 700

Imaging Central is the only private practice that offers a state of the art Siemens 128 slice CT delivering the same dose reduction technology as Princess Margaret Hospital for Children: SaďŹ re Iterative Reconstruction CARE Dose kV CARE Dose 4D Adaptive Dose Shield

450 400 248

236 188

200

0

At Imaging Central, it is easy to compare our dose achieved with others as we include it on every CT report.

612

600

600 563

Head

Neck

164

Chest

National Dose Reference Levels

Abdo Chest Lumbar Pelvis Abdo Pelvis Spine Imaging Central 2

1 Australian Government, Australian Radiation Protection and Nuclear Safety Agency., viewed 29th Jan 2013 http://www.arpansa.gov.au/services/ndrl/index.cfm 2 Imaging Central Practice Reference Level Dose measured from Oct - Dec 2012

Head to our website for more information about our dose reduction technologies 38

.

medicalforum p: 9284 6900 f: 9284 2955 w: www.imagingcentral.com.au a: 345 Stirling Highway, Claremont 6010

CLINICAL UPDATE

Surgery for traumatic shoulder instability

By Mr Grant Booth, Orthopaedic Surgeon, Perth Shoulder Clinic, Bethesda Hospital.

Tel 9340 6355

T

raumatic dislocation of the glenohumeral joint is a common injury with an incidence in the general population of 1.7%. There is a high risk of recurrent dislocation in young patients and of associated rotator cuff tears in older patients. Arthroscopic reattachment of the torn labrum is a reliable technique unless there is significant bone loss, in which case open repair and transfer of the coracoid process is recommended.

Symptoms "GUFS UIF BDVUF EJTMPDBUJPO FWFOU BOE subsequent shoulder reduction, most patient's pain and stiffness settles over a 4-6 week period. Some patients may suffer further early frank dislocation PS FYQFSJFODF NPSF TVCUMF JOTUBCJMJUZ PS TVCMVYBUJPO PO DFSUBJO BDUJWJUJFT 5IFTF episodes may be painful or may just feel uncomfortable or be accompanied by a feeling of apprehension that the joint may fully dislocate. Patients with associated rotator cuff injury may complain of pain, restriction of arm abduction and weakness of overhead activity.

Q Fig3: 3D CT reconstruction of a significant bony Bankhart lesion.

Who should be offered surgery?

Q Fig4: 3D CT reconstruction of a united coracoid transfer (Latarjet reconstruction).

Q Fig1: Arthroscopic view of an anterior labral tear.

Q Fig2: Arthroscopic view of labral repair.

Clinical signs 1BUJFOUT TIPVME CF FYBNJOFE GPS HFOFSBMJTFE MJHBNFOUPVT MBYJUZ TIPVMEFS range of motion and rotator cuff integrity.

Specific instability signs include the sulcus sign when inferior distraction of the humerus relative to the glenoid creates a hollow between the lateral edge of the acromion and the humeral head. In the apprehension test for anterior instability UIF FYBNJOFS QMBDFT UIF QBUJFOUT BSN in 90 degrees of abduction and slight FYUFOTJPO XJUI UIF FMCPX GMFYFE 5IF BSN JT FYUFSOBMMZ BCEVDUFE TJNVMBUJOH UIF NPTU DPNNPO QPTJUJPO PG TVCMVYBUJPO PS EJTMPDBUJPO 5IF QBUJFOU SFBDUT XJUI BOYJFUZ or concern and often prevents the arm being placed in this position.

medicalforum

CT. In patients with suspected bony injuries a CT scan is the most useful investigation for determining the size and displacement of bone lesions.

MRI. MRI scans performed with intraarticular contrast accurately demonstrate glenoid labral tears and are the most accurate investigation to diagnose associated rotator cuff tears.

Ultrasound. While more readily available than MRI scanning, an ultrasound is less reliable at detecting rotator cuff tears especially in a painful and swollen shoulder post dislocation.

Recurrence risk The young patient. Studies have shown a high rate of recurrent instability following anterior dislocation with up to 90% of patients less than 20 years old and, 60% of patients 20 to 40 years of age suffering recurrence. Those participating in contact and overhead sport are particularly at risk of recurrence.

The older patient. While the risk of recurrence reduces with age the incidence of significant rotator cuff tears increases in patients over 40 years of age. These tears are often missed as it is difficult to clinically FYBNJOF UIF SPUBUPS DVGG JNNFEJBUFMZ BGUFS reduction and most patients are imaged with Y SBZT POMZ &YBNJOBUJPO PG UIF SPUBUPS DVGG at the follow-up consultation 10 to 14 days after the dislocation injury is essential, once the initial pain and swelling has settled.

"OZ QBUJFOU XJUI XFBLOFTT PS QBJO PO testing should have their rotator cuff imaged and I routinely image the rotator cuff in patients over 40 years of age.

What is the best imaging?

X-rays. The pre and post reduction plain Y SBZT DPOGJSN UIF EJSFDUJPO PG UIF EJTMPDBUJPO UIF TVDDFTT PG SFEVDUJPO BOE UP FYDMVEF associated bony injury. Fractures of the neck or the tuberosities of humerus should be FYDMVEFE 5IF SFCPVOE JOKVSZ PG UIF EJTMPDBUFE humeral head onto the glenoid often results in a glenoid rim fracture (the bony Bankhart lesion), a humeral head impaction fracture (the Hill Sachs lesion) or both.

Young Patients. Due to the high incidence of recurrent instability and particularly in those involved in contact sports, overhead sports, surfing and swimming, the option of arthroscopic labral repair is often discussed after a first-time dislocation in these patients.

Recurrent instability. "GUFS B SFDVSSFODF of dislocation, stabilisation surgery is recommended in most cases.

Associated injuries. "DUJWF QBUJFOUT XJUI significant rotator cuff tears or displaced tuberosity fractures require repair.

Open or arthroscopic surgery?

Arthroscopic stabilisation In patients with no significant glenoid or humeral bone loss, arthroscopic repair of the displaced labrum is a reliable procedure with a low recurrent instability rate of 4 to 6%. However, In the presence of significant bone deficiency, the failure rate of BSUISPTDPQJD MBCSBM SFQBJS SJTFT UP BCPWF Open labral repair and coracoid transfer (Latarjet reconstruction) In patients with significant bone loss, open surgery, involving transfer of the coracoid process of the scapula to the anterior glenoid to address the bone deficiency, is an established and reliable surgical solution with a low recurrent instability rate of less than BOE FYDFMMFOU GVODUJPO GPS SFUVSO UP TQPSU This procedure is recommended for patients likely to sustain further high injury trauma to the shoulder such as rugby players or bigwave surfers.

Rotator cuff tears "TTPDJBUFE SPUBUPS DVGG UFBST DBO CF USFBUFE arthroscopically at the time of arthroscopic labral repair or by an open technique. O

Declaration: Perth Shoulder Clinic has contributed to Medical Forum's costs in preparing this clinical update.

39

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Guest Column

M Clinic: Pitching Effectively to MSM

By Mr Simon Yam, Organisational Development Manager, WA AIDS Council

T

he M Clinic, established in July 2010 by the WA AIDS Council (WAAC), is for men who have sex with men (MSM).

It provides sexual health services in a way that encourages men most at risk of acquiring HIV to initiate testing, or to test more frequently. It does this successfully [see below], which is important given the closure of the Murray St Clinic, a peak in HIV diagnoses, the growth in FIFO men who have trouble leaving work to seek help, and the reduction in sexual fears with the more successful antivirals.

M Clinic has seen over 1680 clients since it opened, with more than PG DMJFOUT SFUVSOJOH GPS UIFJS OFYU SFHVMBS UFTU 5IF DPNNVOJUZ CBTFE PVUSFBDI TFSWJDF JO NFUSPQPMJUBO 1FSUI GVOEFE CZ 8" )FBMUIhT 4FYVBM )FBMUI BOE #MPPE CPSOF 7JSVT 1SPHSBN 4)##71

provides testing, treatment, vaccination, counselling, contact tracing, health hardware and health education for STIs. Male and peer-based: 6TJOH 8""$hT EFDBEF PG FYQFSJFODF JO QSPWJEJOH TFYVBM IFBMUI UFTUJOH JO DPNNVOJUZ TFUUJOHT QMVT FWJEFODF of the preference gay men and MSM have for peer-based services, male peers and male clinical nurses are the initial contacts and QSPWJEF NPTU TFSWJDFT "OBM TXBCT DBO CF UBLFO CZ UIF QBUJFOUT themselves, which reduces embarrassment for many.

Accessibility: Clinic hours are variable, services are drop-in, there is good parking and public transport, and testing is free.

Positive results are followed up by peer/nurse, and treatment and vaccinations are given by the nurse on orders from the doctor.

Personal health promotion is combined with clinical services: .FO DBO UBML PQFOMZ BCPVU UIFJS VOTBGF TFYVBM CFIBWJPVS BOE UIFJS NPUJWBUJPO GPS CFIBWJPVSBM DIBOHF )*7 BOE 45* UFTUJOH JT UIF tangible 'hook' to engage them in high quality and authentic pretest discussion. The clinic raises awareness of risks associated with NVMUJQMF QBSUOFST FTQFDJBMMZ XJUI VOQSPUFDUFE TFY PWFSTFBT JO IJHI prevalence countries.

Q M Clinic staff from West Perth

Population health promotion: M Clinic is integrated with a peer educator and support program, with a robust social marketing strategy to reach gay men and MSM. Key public health promotion NFTTBHFT JODMVEF SFHVMBS )*7 45* UFTUJOH BDDFTT UP USFBUNFOU BOE TBGF TFY QSBDUJDFT JODMVEJOH ZPVOH NFO BOE NFO GSPN DVMUVSBMMZ and linguistically diverse communities.

Partnerships with others: M Clinic works with various providers in the sector â&#x20AC;&#x201C; two pathology providers (Clinipath and Pathwest), IPTQJUBM 4FYVBM )FBMUI $MJOJDT 1VCMJD )FBMUI 6OJUT '18" 4FYVBM )FBMUI 4FSWJDFT OBUJPOBM )*7 SFTFBSDI DFOUSFT BOE PUIFST 1SF BOE QPTU FYQPTVSF QSPQIZMBYJT TIBSFE DBSF BOE SBQJE UFTUJOH BSF EJTDVTTFE XJUI 8" )FBMUI BOE PUIFST . $MJOJD XJMM CF QSPQPTFE BT one of several locations to use the recently-approved, rapid, point-ofDBSF )*7 UFTU "MFSF %FUFSNJOFÂ&#x2122; )*7 "H "C $PNCP UFTU

Location: /FXDBTUMF 4U 8FTU 1FSUI .FEJDBSF DBSET OFDFTTBSZ for pathology. Tel: 9380 4922 or visit www.mclinic.org.au O medicalforum

PIVET MEDICAL CENTRE Specialists in Reproductive Medicine & Gynaecological Services

Gynae News

Medical Director Dr John Yovich

Belladonna â&#x20AC;¦ and Cervical Shock

Dr John Yovich, Non-retiring Medical Director

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Atropa Belladonna (Deadly Nightshade). The berries and foliage contain tropane alkaloids including scopolamine, hyoscyamine and atropine.

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Atropine at the ready, but only occasionally used.

NOW AT 3 LOCATIONS LEEDERVILLE, JOONDALUP & BUNBURY

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

41

Support Group

Heart Support Australia

T

he Perth Metropolitan Branch of the national support group Heart Support Australia was set up by former patients who had previously undergone open-heart surgery to give emotional support for current heart patients and their families. Membership is now open to all heart patients and others who have an interest in heart health.

You can now prescribe exercise!

)4" JO 8" BOE IBT B XFFLMZ WJTJUJOH SPTUFS JO UISFF IPTQJUBMT <31) )PMMZXPPE BOE .PVOU> TFFJOH QBUJFOUT SFGFSSFE UP UIF HSPVQ CZ IPTQJUBM TUBGG " UFMFQIPOF TVQQPSU MJOF < > JT PQFO UP members of the public. Calls to this number are switched to the home QIPOF PG B )4" NFNCFS 1FSUI TFDSFUBSZ .S %BWJE .D"OESFX TBJE QFPQMF DPOUBDUFE )4" with questions relating to their surgery.

"They are wanting our perspective because we have lived through these issues. Questions such as 'What's it like to go through bypass TVSHFSZ h h*hWF IBE B IFBSU WBMWF SFQMBDFNFOU BOE * OFFE UP UBML XJUI TPNFCPEZ XIPhT BMTP CFFO UISPVHI JU h h.Z EPDUPS TBZT * OFFE a pacemaker â&#x20AC;&#x201C; what difference is that going to make to my life?'

Some people just need somebody who will listen to their concerns. )PXFWFS )4" 1FSUI EPFT OPU HJWF NFEJDBM BEWJDF The group's interaction is mostly with hospital doctors while visiting hospital.

"OESFX TBJE IF IPQFE UIF NFEJDBM QSPGFTTJPO XPVME WJFX UIF HSPVQ BT a source of support for their heart patients and asked them to consider EJTQMBZJOH )4"T JOGPSNBUJPO MFBGMFUT JO UIFJS XBJUJOH SPPNT O

Heart Support Australia Background: " TVQQPSU TFSWJDF GPS QBUJFOUT VOEFSHPJOH IFBSU TVSHFSZ SVO CZ GPSNFS IFBSU QBUJFOUT Current WA members:

As part of our commitment to health of Western Australia the team at Obesity Surgery WA, is now offering exercise programmes at no cost.

To enrol, we need a referral to our practice for exercise. Everyone gets a health review to check their suitability and will get a personal plan or get to join one of our group sessions. The service is open to anyone who needs a little help to get fitter, even if they are not considering surgery. < Mr Harsha Chandraratna Surgeon Jo Climo > Clinical Nurse & Exercise Co-ordinator

Obesity Surgery WA (08) 9332 0066 SUBIACO 42

MURDOCH

Budget: 'VOEFE CZ NFNCFSTIJQ GFFT BOE EPOBUJPOT UIF BWFSBHF CVEHFU JT 5IF OBUJPOBM PGGJDF PG )4" SFDFJWFT 'FEFSBM GVOEJOH NFNCFSTIJQ MFWJFT GSPN CSBODIFT BOE TPNF DPNNFSDJBM TQPOTPSTIJQ #SBODIFT BSF TFMG TVQQPSUJOH Contact details: 4FDSFUBSZ %BWJE .D"OESFX QIPOF &NBJM EBWFNDBO!CJHQPOE OFU BV 8FCTJUF XXX IFBSUOFU PSH BV 1PTUBM )FBSU 4VQQPSU "VTUSBMJB 1FSUI .FUSPQPMJUBO #SBODI 10 #PY #SPBEXBZ /FEMBOET 8"

BENEATHthe Drapes X "GUFS GJWF ZFBST BOE B SFDFOU TXJUDI GSPN 8"(1/ UP 1SJNBSZ $BSF 8" $&0 Debra Barnes has resigned and been replaced by Peter Mathie BT "DUJOH $&0 1FUFS IBT IJT PXO DPOTVMUBODZ BOE MJTUT %FQBSUNFOU PG )FBMUI "HFJOH $34 "VTUSBMJB BOE "54*$ amongst his previous employers.

X CEO of SJOG Health Care Dr Michael Stanford, has been appointed to the board of private retirement and aged care DPNQBOZ 4U *WFT %S 4UBOGPSE JT BMTP PO UIF CPBSE PG 3"$ Holdings, which took total ownership of St Ives in November.

X %JSFDUPS PG UIF .D$VTLFS "M[IFJNFShT 3FTFBSDI 'PVOEBUJPO Professor Ralph Martins, was awarded Officer of the Order of "VTUSBMJB 0" JO UIF "VTUSBMJB %BZ IPOPVST MJTU %JSFDUPS PG UIF /BUJPOBM $FOUSF GPS "TCFTUPT 3FMBUFE %JTFBTFT Dr Bruce Robinson XBT NBEF B .FNCFS PG UIF 0SEFS PG "VTUSBMJB ".

medicalforum

CLINICAL UPDATE

Joint injections â&#x20AC;&#x201C; the knee

By Dr Michael Eaton, RDA (WA) President, Rural Locums

M

any of us do not have the luxury of referring patients for ultrasound-guided joint injections because we practise in impoverished or remote areas, or patients prefer us to do it. Moreover, they trust us to do joint injections safely, efficiently and more cheaply (even after withdrawal of the MBS rebate). Patient benefits are quick and professional satisfaction comes from providing a simple and often highly effective treatment. This series aims to answer 'Yes' to the common question, "But can't you do this for me, doc?" Useful joint injections in general practice are a boon to many patients and are simple provided you make sure of your angles and proceed gently.

The Knee The knee joint is most commonly aspirated and injected. The pain of inflammatory DPOEJUJPOT TVDI BT 0" HPVU BOE SIFVNBUPJE can readily respond to a judicious injection when oral and topical agents do not provide enough relief. Remember other causes of knee or other joint swelling such as arbovirus JOGFDUJPO 3PTT 3JWFS 7JSVT DBVTFE UIF largest knee effusion I have ever drained and the patient was so grateful for the aspiration and injection that the cyclone gates he sent still occupy pride of place on my chook pen.)

Blood in any joint is an irritant and may need to be aspirated if haemarthrosis is not starting to resolve within 1-2 days (but not if there is a fracture).

Some words of caution: the wear and tear of bone on bone does not respond well to steroid VOMFTT UIFSF JT JOGMBNNBUJPO TVDDFTTJWF steroid injections may respond less each UJNF TP IPQF JO NPEFSBUJPO UIF JOKFDUJPO may be repeated in 2-6 weeks, depending on SFTQPOTF EP OPU JOKFDU TUFSPJE JG TVSHFSZ JT DPOUFNQMBUFE XJUIJO TJY XFFLT

Equipment t $MFBOJOH TPMVUJPO BOE TPNFUIJOH to apply it. t MPOH H OFFEMF < JODI PS NN JG BWBJMBCMF GPS JOKFDUJOH -"> t MPOH H OFFEMF <GPS BTQJSBUJOH BOE PS JOKFDUJOH> t Y NM TZSJOHF PS NM JG BWBJMBCMF PS OFFEFE <GPS BTQJSBUJOH> t Y NM TZSJOHF <GPS -" JOGJMUSBUJPO BOE TUFSPJE JOKFDUJPO> t 4UFSJMF BSUFSZ GPSDFQT PS OFFEMF IPMEFST [to hold the needle hub while swapping BTQJSBUJOH PS JOKFDUJOH TZSJOHF> t Y NM BNQPVMFT PG -" <GPS TLJO BOE TZOPWJVN JOJUJBMMZ BOE GPS NJYJOH XJUI ZPVS TUFSPJE> t BNQPVMFT PG ,FOBDPSU " <1#4 > PS POF PG ,FOBDPSU " <QSJWBUF TDSJQU> t #BOEBJE PS FRVJWBMFOU t ZFMMPX UPQ TUFSJMF TQFDJNFO KBS GPS MCS and crystalanalysis of aspirate.

Technique Scrupulous no-touch technique and sterile equipment prevents infection and avoids the illusion of enduring sterility that wearing gloves provides, which in turn leads some TFSJPVT DPOUBNJOBUJPO FSSPST "EWJTF QBUJFOUT medicalforum

Q Angle for anterolateral approach to knee joint injection.

that sterile equipment and a no-touch technique means that the only bugs that may get in are from their own skin.

Two main approaches are useful and easy â&#x20AC;&#x201C; the anterolateral and the lateral approaches (with medial and anteromedial also available).

Anterolateral approach.

1BUJFOU TJUUJOH LOFF GMFYFE UP XJUI the lower leg dependent. This opens up the knee joint and helps you find the sulcus that lies adjacent to the lower edge of the patella, above the tibial tubercle. Mark this site using slight pressure with the edge of a OFFEMF DBQ QSJPS UP XBTIJOH UIF TLJO UIF mark lasts a few minutes and will be more defined when Betadine is used to clean UIF TLJO 5IFO JOUSPEVDF UIF ( OFFEMF horizontally, aiming toward the centre of the KPJOU BOE JOKFDUJOH UIF -" BT ZPV HP XJUI B TMJHIU SFTJTUBODF BT ZPV NFFU UIF TZOPWJVN JOKFDU B MJUUMF NPSF -" IFSF 1BVTF BOE UIFO push through and aspirate. One advantage of an anterolateral approach is that by aiming horizontally you will not hit bone. Hold the hub of the needle with your artery forceps and unscrew the syringe, leaving the needle in place. Change needles by lining up the wider 14G needle alongside the one that is still in place then take out the first one and place the larger needle in the same hole, at the

same angle. This 'trick' makes it easy to find the same angle painlessly and is especially useful when injecting via the lateral or medial BQQSPBDIFT "TQJSBUF JODMVEJOH B TBNQMF GPS MCS. When the joint is 'dry', grasp the needle hub and change to the syringe for injecting (containing local anaesthetic and steroid, NJYFE JO UIBU PSEFS FBSMJFS *OKFDU EPXO UIF same larger needle, then remove and apply ZPVS #BOEBJE "TL ZPVS QBUJFOU UP HFOUMZ move their knee and confirm the analgesia.

"EWJTF UIBU UIFSF NBZ CF B USBOTJFOU JODSFBTF JO EJTDPNGPSU UIF OFYU EBZ BT UIF TUFSPJE HPFT UP XPSL "OZ XPSTFOJOH EJTDPNGPSU JT abnormal and must be reported.

Lateral and medial approaches.

From the side, find the T junction formed between the patella and the joint line. Mark BOE JOKFDU -" IFSF UIFO BEWBODF JOKFDUJOH as you go and angling the needle track down slightly to slide behind the forward sloping edge of the patella. If you feel a 'crunchy' sensation you have touched bone and your patient will usually show signs of pain. If so, withdraw slightly and adjust your needle angle down a little more, repeating until you feel the synovial resistance. Otherwise, the procedure is the same. O

Declaration: no competing interests.

43

Conferences

Keeping it Real In a world of webinars and teleconferencing, there is nothing that can replace the power of face-to-face networking.

Technology may be making life and practice a virtual experience but when it comes to conferences, Western Australian doctors like to meet their colleagues and peers eyeto-eye, hand shake to handshake. %PDUPST < (1T BOE TQFDJBMJTUT> JO UIF MBUFTU Medical Forum & QPMM IBWF TQPLFO PWFSXIFMNJOHMZ o TUJMM XBOU UIF QIZTJ DBM DPOGFSFODF FYQFSJFODF BOE XBOU UP MFBSO GSPN UIF FYQFSUT

4P JO B XPSME XIFSF JOGPSNBUJPO JT BU ZPVS GJOHFSUJQT IPX EP ZPV NBLF DPOGFSFODFT FOHBHJOH BOE JOTQJSJOH &WFOUT $PPSEJOBUPS BU 3VSBM )FBMUI 8FTU .T -FFTB 5IPNBT QMBOT GJWF DPOGFSFODFT B ZFBS UIF "OOVBM $POGFSFODF BOE 5SBEF &YIJCJUJPO JO 1FSUI MBUFS UIJT NPOUI UIF 3VSBM BOE 3FNPUF 3FUSJFWBM 333 XFFLFOE BU ,BSBKJOJ JO .BZ UIF "CPSJHJOBM )FBMUI $POGFSFODF JO +VMZ UIF 'SFNBOUMF $POGFSFODF JO 0DUPCFS BOE B 3FNPUF $PBTUBM &NFSHFODZ .FEJDJOF $POGFSFODF BU (OBSMPP 4UBUJPO JO 4FQUFNCFS

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medicalforum

Conferences

Q WA Health's conference last year and, opposite, Rural Health West's Rural and Remote Retrieval Weekend at Karajini.

E-POLL: When Medical Forum asked readers to give their opinions about conferences, the overwhelming majority of the 328 respondents said that physical conferences were still the best way to share information. Here's the results Is physically attending a conference the preferred way to share information and experience?

Q

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6ODFSUBJO What might be most important to you in attending a WA-based conference [multiple choice]?

Q

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By Ms Jan Hallam

From a small boardroom to a convention centre that caters for 1000, 4 ½ star accommodation, resort-style facilities and the harbourside attractions of Fremantle ensures your next conference will be so much more than just â&#x20AC;&#x2DC;conventionâ&#x20AC;&#x2122;al.

Sign your company up to our Priority Guest Rewards program for free and save up to 20% on hotel stays.

Much more than just â&#x20AC;&#x2DC;conventionâ&#x20AC;&#x2122;al

Donâ&#x20AC;&#x2122;t travel but do all the organising? Become a booker and earn booker points, which can be redeemed for rewards such as movie tickets, gift vouchers and more!

Get 5% OFF our Day Delegate Package* *Conditions apply. Valid until 30 June 2013

Visit www.rydges.com/fremantle call 9432 4000 or email functions_esplanadefremantle@rydges.com Corner Marine Terrace and Essex Street, Fremantle, WA

medicalforum

45

Kitchen Confidential

Manager of the Mystic Marriott Hotel & Spa in Connecticut while the GM was on leave. I have always had a passion for food and hospitality, so when I got back to Perth, I wanted to open a steakhouse, in particular, and approached Gareth.

Gareth: I grew up in South Africa and came to Australia with my family when I was in Year 10. I completed Year 12 at Hale. I started a Bachelor of Science degree in Aviation but didn't finish. I went to work as a kitchenhand at Trigg Island Cafe and worked my way up to cook. I have always had a passion for food. I've been cooking at home since I was 13. I left Trigg and went to work on the mines for a while and when I returned, I decided I'd like to learn about front of house management and got a job as the restaurant manager of Hippo Creek. Then I bought the business in 2003! I met Daniel at Hippo Creek when we'd opened at Hillarys and we decided to open Subiaco together.

What is uniquely South African about the restaurants?

You can see these type of steakhouses scattered throughout South Africa and the initial support by the South African ex-pat community here was an integral part of Hippo's growth. It has gone from a rustic 70-seater 'hole in the wall' in Scarborough, into a huge 280-seater at Hillarys; an intimate, upmarket offering in Subiaco, and most recently a venue at Waterford with a tavern licence.

It seems with every mining boom, steakhouses flourish. Has this been your experience?

I believe that there is definitely something to that. Mining booms increase expendable income and allow people in general to a better quality of product, which is what we offer.

We have had the mining companies supporting us, and if it is because of the mining boom, then we hope it continues.

Hippo Creek, Rockpool â&#x20AC;Ś are the punters these days keen to explore different kinds of meats and cuts?

Yes. Dry-aging meat is not a cheap exercise, and I believe that our customers know what they want and appreciate the process it takes to deliver the products we have on our menus. Food is an experience and people are more willing to try new things.

What is your most expensive steak?

Our most expensive individual steak is $80 for our 700g dryaged rib-eye on the bone, but the most expensive item we have (depending on size) is our Tomahawk, which can cost as much as $220 for 2.2kg and is designed to be shared.

Where do you source your meat?

Mostly from NSW. We use wholesalers in Sydney as well as local suppliers.

What is your favourite dish on the menu?

10 minutes with...

Daniel Gomer & Gareth Simpson Daniel Gomer and his wife Tayla and Gareth Simpson and his partner Nadine have taken the concept of the South African steakhouse to new heights with their Hippo Creek chain.

What is your background?

Daniel: I grew up in Johannesburg, South Africa, and went to Damelin College in Randburg, which is a sports school where I was part of an elite golf training academy. When I finished school in 2001, my family (I am one of seven kids) emigrated to Australia.

I studied Golf Management at the Australian Institute of Golf Management, then studied a Bachelor of Commerce at ECU. I went on to complete an advanced diploma in Hotel & Resort Management. After studying I went to the US and completed a two-year hotel traineeship with the Waterford hotel group, which owns 35 hotels including the Hilton and Marriott chains, as well as 25 restaurants and a casino. I worked across the board from washing dishes, cleaning rooms, to managing every outlet in the hotel from Front Desk/Reception to working as the General 46

(Daniel): It is the 1kg Wagyu rump cap [$100]. It has the richness from the wagyu, but also has the texture of the rump cut making it my personal favourite. It has a great blend of flavour and texture.

Hippo Creek's executive chef Adam Bastin has shared the recipe for this traditional South African vegetable side dish.

Chakalaka 1 onion, finely diced 2 tomatoes, finely diced 2 green capsicum, finely diced 2 large carrots, grated 2 x 400g tins cannellini beans, drained 1 tsp curry powder 2 red chillies, finely diced 100ml peri peri sauce 1 x 400g tin crushed tomatoes Pinch of salt Sautee onions and capsicum in olive oil until soft. Add curry powder and chilli and cook for a further minute. Add diced tomato and carrot and cook for two minutes. Add the remaining ingredients and simmer for about 10 minutes.

Season to taste

medicalforum

Wine Review

CoshamWines By Dr Louis Papaelias

Just 30 minutes from the Perth CBD, the picturesque Bickley Valley makes for an easy day visit with plenty of stops for sightseeing and relaxed dining. Bickley Valley is one of four sub-regions that make up the Perth Hills Wine Region, with its vineyards situated up to 300m above sea level.

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medicalforum

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47

Young Carers

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The co t of putting family 1st Q Caleb and his sister Meg

Caleb Anderson and Victoria Hancock are caring for siblings with medical disabilities. Their stories contain highs and the lows and the clear message emerging is the need for increased recognition and support for younger carers.

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The Arts

The

Mind's Child psychiatrist Dawn Barker's passion for words has seen the publication of her first novel and a guest spot at this year's Perth Writers Festival.

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By Mr Peter McClelland

Breathing Life into a Requiem And you thought a 36-hour intern shift was tiring? Talk to Bentley GP and Rural Health West's Dr Olga Ward, who sang her vocal cords to a standstill in Hong Kong where her choir, the WASO Chorus, performed with the Hong Kong Philharmonic under the baton of Dutch maestro Jaap van Zweden.

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Q WASO's singing doctors Susanna Fleck, Katie Langdon, Olga Ward, Jenny Fay and Moira Westmore.

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medicalforum

Musical Theatre

A catalogue of perfect pop songs, a story that will make your hair stand on end тАж Jersey Boys is a perfect night of theatre.

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medicalforum

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By Ms Jan Hallam

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Jersey Boys opens at the Crown Theatre on April 17.

WIN

51

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medical forum

ANAESTHETIST WANTED MT LAWLEY Dynamic specialist anaesthetist(s) required to replace retiring member.

Share rooms with long established hospital based group.

There will be no joining fee.

Accreditation at Mercy Hospital is mandatory.

Computerised billing system with excellent administrative/secretarial support.

For further information please call Lorraine on (08) 9370 9733

BOARD MEMBER WANTED BOARD MEMBER WANTED Fremantle Womenâ&#x20AC;&#x2122;s Health Centre seeks a female GP (VR) as a Board member.

This is a voluntary position that would suit someone with expertise in womenâ&#x20AC;&#x2122;s health medicine and an interest in the governance of a not-forprofit organisation.

FWHC is a community facility providing medical and counselling services, health education and group activities.

The Board currently has 8 members who are responsible for the governance and strategic direction of the organisation and meets monthly.

For more information check www.fwhc.org.au or Contact Diane Snooks 9431 0500 / director@fwhc.org.au

FOR LEASE

MANDURAH SPECIALIST CENTRE Fully furnished consulting suites are now available on a sessional basis in the new Mandurah Specialist Centre.

Reception support available if required.

Phone: Graeme Dedman on 0413 065 009 Email: graemed@wacardiology.com.au DAWESVILLE Opportunity for two GPâ&#x20AC;&#x2122;s t TRN .FEJDBM $FOUSF t *O OFX 4IPQQJOH $FOUSF t $PNQMFUJPO +VMZ t $BUDINFOU QFPQMF t 6O TFSWJDFE BSFB Ross on 0409 887 641 BANKSIA GROVE City of Wanneroo - WAâ&#x20AC;&#x2122;s fastest growing local government authority Opportunity for 3 â&#x20AC;&#x201C; 4 GPâ&#x20AC;&#x2122;s t 8JUIJO B %JTUSJDU PG 8PSLGPSDF 4IPSUBHF t TRN .FEJDBM $FOUSF t $PNQMFUJPO +VMZ "VHVTU t -BSHF DBUDINFOU Ross on 0409 887 641

ROCKINGHAM Sessional room for rent in specialist medical centre in central Rockingham.

Choice of two rooms, medical or allied health with communal patient waiting room.

Reception staff not available.

Sessions are four hours and currently available a.m. and p.m. $120 plus GST per session for allied health room and $160 plus GST per session for medical consult room, negotiable.

Contact Julie Neet, Practice Manager at julieneet@drbillpatton.com.au Telephone 9528 1511 (select option 0) Tuesday â&#x20AC;&#x201C; Thursday mornings after 9.30 am NEDLANDS Hollywood Medical Centre New fully fitted 86m2 suite on 1st Floor available for lease immediately.

Tel No. 0409 688 339/0400 066 160 MIDLAND Consultant Psychiatrist - Private Practice We have a fully serviced new room in an established clinic in Midland.

We would like to have a Consultant Psychiatrist join our practice. The rooms are fully serviced and reception will collect fees and process patients.

The lease of the rooms is negotiable and very reasonable so we can attract a specialist into a high need area. www.cygnetclinic.com.au Phone: 9467 7676 Fax: 9463 6311 Email: admin@cygnetclinic.com.au NEDLANDS Medical Specialist Consulting Rooms Fully serviced rooms and facilities for Specialist Consulting are available Suite 31, Hollywood Specialist Centre, 95 Monash Avenue, Nedlands.

Any enquiries can be directed to Mrs Rhonda Mazzulla, Practice Manager, Suite 31 Hollywood Specialist Centre 95 Monash Avenue Nedlands, WA 6009 Phone: 9389 1533 Email: suite31.hollywood@bigpond.com JOONDALUP Modern sessional suites available in Joondalup CDB Secretarial support available if required.

Phone 9300 3380 NEDLANDS Hollywood Medical Centre â&#x20AC;&#x201C; 2 fully furnished consulting suites on first floor, available for lease Some secretarial support available if required.

Phone 0414 780 751 MURDOCH Murdoch Specialist Centre Brand new stylish large rooms.

Please email you interest to: admin@sleepmed.com.au

FOR SALE MEDICAL SUITE(S) 10 McCOURT STREET WEST LEEDERVILLE These well located 61sqm medical suite(s) with two car bays each are opposite St John of God Hospital and ready for immediate occupation.

GORDON TUCKER R/E 0408 093 731 gtrealestate@iinet.net.au

FOR SALE OR LEASE

Looking for consulting rooms ?

To Buy or Lease Is close to Murdoch and Fiona Stanley Murdoch hospitals suitable ?

Then look no further!

With full fit out comprising 3 consulting rooms, fully furnished, set among GP, Physio and Pharmacy.

This 121 sqm Practice is perfectly located in neighbouring Bibra Lake just minutes from the new and existing hospitals.

Call Brian Devereux 0418 959 219 for more details Tel: 9494 3888 Email: brian@grwa.com.au

LOCUM WANTED GOOSEBERRY HILL Locum required for privately billing, very friendly, Family Practice in Gooseberry Hill â&#x20AC;&#x201C;15th April 2013 to End of June 2013.

Up to 5 days per week available.

Please e-mail your details to office@hillsfamilymedical.com.au or Telephone Peter on 9257 1121 PERTH Locums / Associates wanted.

Perth Medical Centre, Hay Street Mall.

Busy accredited privately owned practice, private billing, flexible hours.

Excellent remuneration for suitable candidates.

Phone: 9481 4342 Mobile: 0408 665 531

MARGARET RIVER Long established accredited family practice seeks GP or trainee to replace retiring Doc. Anaesthetics, Obstetric and surgical scope available but not essential.

Some afterhourâ&#x20AC;&#x2122;s commitment - not onerous.

Phone Sally 08 9757 2733 for more info

URBAN POSITIONS VACANT WINTHROP/MURDOCH Full time/Part time VR GPs needed to join Hatherley Medical Centre.

No longer Corporate and reopening in March 2013 with very experienced GP. Had been open for over 20 yrs and become a successful 8 doctor practice.

Services a large private billing underserviced area.

Purpose built centre, well-equipped with on-site procedural room, large nursing station, pathology, physiotherapy, pharmacy and dental.

Please call 0400 364 901 and get in early.

MURDOCH Doctor Required for Stress Testing Supervision WA Cardiology offers the most extensive cardiology testing services in Western Australia and is committed to providing the highest standards in patient care, diagnosis and GP support.

Medical Practitioners who share in this vision are invited to join our team of Doctors supervising exercise ECGs, exercise echocardiograms and Dobutamine echocardiograms at our various sites.

Training is provided and excellent remuneration based on a fee for service basis is offered.

Applicants must possess valid unconditional registration with the Medical Board of Australia and working rights within Australia.

To register your interest, please contact Graeme Dedman (General Manager) on 0413 065 009 or E-mail us at admin@wacardiology.com.au.

RURAL POSITIONS VACANT ALBANY VR GP required to join our 4 Doctor, busy, friendly family practice.

Full or Part time.

We are Accredited, computerised, full nurse support, experienced Admin team.

Excellent remuneration.

Clinipath pathology on site.

Phone Gaye - Practice Manager 9841 6711 Email: admin@hillsidefp.com.au

LANGFORD Due to one of our long term GPs taking an extended sabbatical in 2013, Langford Medical Centre is looking for a full time GP to commence in Jan/Feb 2013.

We are a modern, well equipped, accredited mixed billing practice.

Situated south of the river, Langford is one of the closest practices to the CBD that still qualifies as a district of workforce shortage.

For confidential enquiries please contact PM Mariette on 9451 1377

APRIL 2013 - next deadline 12md Friday 15th March - Tel 9203 5222 or jen@mforum.com.au

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medical forum BEACONSFIELD Well established, niche family friendly practice seeking VR Female GP to work flexible days and hours.

Fully computerised and accredited.

Good mix of private and bulk billing.

Please contact Practice Manager Linda on 9335 9884 or Email: centralavenuemc@optusnet.com.au WEMBLEY DOWNS *OWJUJOH BO FOUIVTJBTUJD 'FNBMF (1 UP join this long established, non-corporate, private billing practice with a huge well established patient load.

Email: managerbmc@gmail.com DUNCRAIG DUNCRAIG MEDICAL CENTRE requires a female GP. Flexible hours, excellent remuneration.

Modern, predominantly private billing practice with full time Practice Nurses.

Open 364 days: M-F 7.30am/9pm, Sat/ Sun/PH 8am/6pm Fully computerised.

Please contact Michael on 0403 927 934 Email: Dr Dianne Prior: dianne@duncraigmedicalcentre.com.au GREENWOOD Greenwood / Kingsley Family Practice The Kingsley Family Practice is seeking a full time/part time GP to join our growing team.

Our flourishing, non-corporate and predominantly private-billing practice is located in Greenwood.

The practice offers an excellent work environment and attractive remuneration.

There is computerised dermoscopy and a fully equipped procedure room on site.

A Podiatrist, Chiropractor, Pathology collection centre and Pharmacy are also conveniently located at the centre.

For further information please contact Dr Sheng Chao on 0402 201 311 or Email: kingsleypractice@gmail.com

FREMANTLE Fremantle Women’s Health Centre requires a female GP (VR) to provide medical services in the area of women’s health 1or 2 days pw. *U JT B DPNQVUFSJTFE QSJWBUF BOE bulk billing practice, with nursing support, scope for spending more time with patients, and provides recently increased remuneration plus superannuation and generous salary packaging.

FWHC is a not-for-profit, community facility providing medical and counselling services, health education and group activities in a relaxed friendly setting.

Phone: 9431 0500 or Email: Diane Snooks - director@fwhc.org.au or Dawn Needham clinical-manager@fwhc.org.au

SORRENTO V/R GP for a busy Medical Centre in Sorrento.

Up to 75% of the billing Contact: 0439 952 979

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PALMYRA Palin Street Family Practice requires a full or part-time VR GP. We, at this privately owned fully serviced computerised practice enjoy a relaxed environment with space and gardens.

Earn 65% of mixed billings.

For further information call Lyn on 9319 1577 or Dr Paul Babich on 0401 265 881 OUTER METRO PRACTICE – ALEXANDER HEIGHTS Full time/Part time VR/NON VR GP required to join our privately owned, fully accredited & computerised, noncorporate family practice.

Fully supportive including Practice Nurse, onsite pathology and a friendly working environment.

Contact Dr Jagadish on 0413 879 023 Email jags.krishnan@gmail.com Or Caroline – Practice Manager 0427 342 488 / caroline@theheights.com.au BYFORD GP’s Afterhour Clinic GP’s required for new Afterhour Clinic in Byford area excellent terms and conditions hours are negotiable We are an area of unmet need with a district of workforce shortage.

Contact: David Cowden Email: byfordfp@westnet.com.au Fax 9525 0093 Phone: 0413 273 778

PERTH Become part of the Perth Bigger Picture!

Long established and privately owned, Perth Medical centre is centrally located, accredited, fully computerised and privately billing.

We have recently renovated so come and join our team.

We have an interesting and truly diverse mixture of clientele; young and old, blue and white collar, travellers and residents.

You will be busy from day one and have plenty of opportunity to develop whatever branch of practice you choose with the backup of a team of locally trained colleagues.

We also have a team of nurses leading our chronic disease management program.

We are a social group who support one another, are flexible with hours and believe in maintaining a healthy worklife balance.

To avoid the rush hour, reduce your carbon foot print and keep fit why not bus, train or cycle to work? After work unwind at one of the CBD’s new bars.

Check us out www.perthmedicalcentre.com.au *OUFSFTUFE Call our practice manager on (08)9481 4342 or Dr Phil A/H 0411 108 883

INGLEWOOD/BEDFORD GP required.

A ready-made practice to walk into.

Hours negotiable.

Busy private billing, non-corporate QSBDUJDF PO UIF *OHMFXPPE #FEGPSE border.

Full time nurse and pathology on site.

Friendly and generously staffed.

Phone Steve, Carl or our practice manager Denise on 9271 9311 or Email salisburymed@iinet.net.au FREMANTLE General Practice in Fremantle requires VR GP FT or PT for privately owned family practice.

Accredited, computerised with fulltime Nurse support available. 65% of billings.

Phone: Practice Manager 9336 3665 MT LAWLEY Edith Cowan University, Student Health Services, Mt Lawley campus.

Part time VR GP with an interest in Women’s and Student Health required.

Well-equipped medical centre, accredited, excellent work environment, Registered Nurse support, flexible work arrangements.

For information: Dr Robert Chandler Phone: 08 6304 5618 E-mail: r.chandler@ecu.edu.au STIRLING LAKES Located on Karrinyup Road.

This busy medical centre requires a F/T or P/T VR GP. Opened Monday to Friday 8am-6pm.

The centre consists of 9 fully equipped consult rooms and a 2 bay treatment room.

Onsite services, Pathologist, Psychologist and Dentist. *G ZPV IBWF B TQFDJBMJUZ XF XJMM TVQQPSU BOE promote so you can achieve.

For expressions of interest Email: esther.mortimer@ipnet.com.au or Phone: 0418 371 724 WEMBLEY GP wanted for long established private, accredited Wembley Practice.

Sessions are negotiable but ideally Thurs/ Fri am or Mon to Fri pm or part thereof.

Our practice is fully computerised using Med Director/Pracsoft.

Practice Nurse on site, pathology and theatre.

Adjacent services include Physiotherapist, Podiatrist, Psychologist and Dietician including diabetic educator.

Please phone Pauline on 9381 9010 Email: wembleygp@westnet.com.au WHITFORDS GP - F/T OR P/T. We are fully computerised, well equipped, accredited practice.

Friendly practice Nurse and admin staff to support at all times, including Careplan/ Health Assessment Nurse.

Medical Centre has on site pathology, pharmacy and physiotherapy.

Please contact Jacqui, Practice Manager on 9307 4222 Email: jmarkouloop@iinet.net.au

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SOUTH PERTH VR GP required FT & PT Excellent River location in South Perth.

Non-corporate, private billing, fully computerised.

Friendly and efficient support staff.

F/T registered nurse and onsite pathology.

For more information contact Paris on 9367 1185.

Email: bhabibi@bigpond.com DALKEITH The Dalkeith Medical Centre requires a F/T or P/T GP to join busy privately owned and operated General Practice in the beautiful leafy suburb of Dalkeith.

We are fully computerised with Best Practice.

We have a dedicated team of doctors and staff and we are predominantly a privately billing practice.

There is no after hours or on call required.

Flexible hours and excellent remuneration is offered to the accepted applicant.

Please contact Trish at dalkmc@bigpond.com BENTLEY GP VR ‘with/without a view’ needed for privately owned family orientated practice.

15mins from Perth CBD, AGPAL accredited, fully computerised using MD/ Pracsoft.

Private billing.

Supported by clinical and CDM nurses operating from purpose built practice.

We offer 65% of billings.

Contact Alison on 0401 047 063 MT HAWTHORN Mt Hawthorn Medical Centre, a noncorporate accredited long established practice situated in a fast growing inner city suburb of Perth, seeks a part time or full time VR GP to join this highly desirable practice.

Fully computerised, Nurse Assistant.

Phone Rose 9444 1644 MT LAWLEY Position for a full time GP, working as a self-employed contractor in our accredited, fully computerised independent practice.

Excellent working environment, with modern facilities.

Quality nursing staff and an onsite diabetes educator/dietician.

Adjacent to the practice we have a pharmacy, and allied services, consisting of audiology, pathology, physiotherapy, podiatry, dental, and cardiology.

Visit our website: www.3rdave.com.au and if interested, ring us on (08) 9272 5533.

Please ask for Practice Manager Rachael Hadlow.

Alternatively, you may send an email to rhadlow@3rdave.com.au MIRRABOOKA Full time / Part time GP required for a very busy practice in Mirrabooka.

VR preferred. 75% Private and Bulk Billing Applications can be made via Email: mds@mirrabookadoctors.com.au or calling 0400 814 091

APRIL 2013 - next deadline 12md Friday 15th March - Tel 9203 5222 or jen@mforum.com.au

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HILLARYS Exciting Opportunity.

Join us in our brand new General Practice located NOR. Non-corporate.

We require a full-time or part-time GP for our practice.

Hours to suit.

No evening or weekend work required.

The practice is fully computerised and well equipped.

Private Billing and some bulk-billing Full-time Nursing support.

Pathology on site.

Please contact Practice Manager on 9448 4815 or Email: smc@westnet.com.au YOKINE - DR7 Our Yokine Medical Centre requires a P/T VR GP. Suitable for a female GP seeking a patient base.

This healthcare facility consists of 9 fully equipped consult rooms, a 4 bay treatment room and 2 procedure rooms.

Have the option to work after hours or DPNNVUF CFUXFFO PUIFS *1/ QSBDUJDFT For expressions of interest Email: esther.mortimer@ipnet.com.au or Phone: 0418 371 724 ALL PERTH GP doctors â&#x20AC;&#x2DC;Unsure about who to refer your patients? â&#x20AC;&#x2DC; For orthopaedic surgeon referral advice contact us.

POAB Recruitment Call Dr Oscar Dâ&#x20AC;&#x2122;Souza (Assistant Surgeon) 0412 598 493 or Email: oscar.streetdoctor@gmail.com MADDINGTON Maddington (DWS) is looking for a VR full-time GP. This privately owned and managed practice will offer up to75% billing to the right doctor.

Various locations North, South and CBD also available.

Please contact Phil on 0422 213 360 Email: phil27bc@gmail.com MANDURAH GP/Obstetrician required part time to join our friendly team with a view to partnership.

Excellent location, close to hospital and train station.

Midwife assisted.

Fully computerised Contact Practice Manager Vicki PH: 9535 4100 Email: practicemanager@mandurahobstetrics.com

WOODLANDS P/T or F/T VR GP wanted to join happy, non-corporate, mainly private billing practice. Good mix of patients, no weekends or afterhours. Great location, RN support. Would suit female GP. Contact help@thewoodsmedical.com.au or 9204 3900

WEMBLEY DOWNS P/T GP Position available - Wembley Downs Ocean Village Medical Centre requires a part-time VR GP for immediate commencement at our Wembley Downs practice.

Modern fully computerised and accredited private and bulk billing practice with practice nurses.

We are a non-corporate practice.

Visit our website www.ovmc.com.au.

Contact anthony.lau@ovmc.com.au for more details.

MOSMAN PARK Fantastic opportunity in excellent area for F/T or P/T GP Close to beach, shops and trains.

Ample space for your car, bike or surfboard.

Flexible hours to suit your lifestyle.

Baby-sitting service an option.

This is a GP owned group practice with all support services.

Freshly refurbished with all new computers and furniture.

Contact David Mortley on 9384 4426 or Email: mpmg@bigpond.net.au

BYFORD 2 Full-time GPs required.

Byford is a rapidly growing area and is continuing to expand.

Practice is fully equipped with 7 consulting rooms, 2 treatment rooms & employs 2 nurses.

Onsite Pathology, Podiatrist, Chiropractor, Masseur and Dentist Excellent terms and conditions are negotiable We are an area of unmet need with a district of workforce shortage.

Contact: David Cowden Email: byfordfp@westnet.com.au Fax 9525 0093 Phone: 0413 273 778 THORNLIE FT/PT GP required for a friendly new rapidly growing medical centre.

Computerised, non-corporate and no after hours required.

Outer-Metro area 17km from Perth. Pay 65% of receipts.

Contact Dr John Ku or Dr Sandra Lok on 9267 2888 or Email: thornliemedicalcentre@hotmail.com BENTLEY Rowethorpe Medical Centre is a nonprofit, friendly practice seeking a part time GP to provide visits to our onsite residential aged care facilities.

Practice-based consultations are also available. t 'VMMZ DPNQVUFSJTFE t /FXMZ SFOPWBUFE QSFNJTFT t .PEFSO FRVJQNFOU t 0OTJUF QBUIPMPHZ t )PVST UP TVJU ZPV For enquiries, please contact Jackie on 6363 6315 or 0413 595 676

FREMANTLE Part time or Full time (preferably VR) GPs wanted.

ELLEN HEALTH is a doctor-owned and managed General Practice operating from two locations in port city of Fremantle.

Well established patient base, offering a broad suite of services including nutrition and lifestyle, specialised pregnancy and midwifery care, community mental health nursing and skin clinic consultations. *G ZPV XFSF UP KPJO PVS UFBN XF XJMM PGGFS you: t " HSPXJOH EBUBCBTF PG 1SJWBUF #JMMJOH patients t " QSPGFTTJPOBM BOE EFEJDBUFE TVQQPSU team t " MJGFTUZMF UBJMPSFE UP UIF MPDBUJPO t )PVST PG XPSL UP TVJU PVS CBMBODFE lifestyle approach - Practice hours are Weekdays 8am-6pm, Saturday, 8am-4pm - No after hours, on-call or hospital work required at this time t )JHI MFWFM PG FBSOJOHT Contact Practice Manager Bridie Hutton 0413 994 484 Email: bridie.hutton@ellenhealth.com.au WEST PERTH GP sessions available at our privatebilling, accredited and fully computerised general practice.

Our busy practice serves a young, professional demographic as well as providing specialist sexual health services.

This represents an exciting opportunity for an enthusiastic practitioner to join our friendly team.

Morning and afternoon sessions are available.

Experience in family planning, sexual health and mental health would be an advantage.

Contact Stephen on 0411-223-120 Email: stephen@westperthmedicalcentre.com.au OUTER METRO PRACTICE - BEELIAR Full time/Part time VR/NON VR GP required to join our privately owned, fully computerised non-corporate family practice.

Fully supportive including Practice Nurse and friendly working environment.

Contact Dr Jagadish on 0413 879 023 Email: jags.krishnan@gmail.com Or Caroline â&#x20AC;&#x201C; Practice Manager 0427 342 488 / caroline@theheights.com.au NEDLANDS Full time VR GP for brand new 2 doctor non-corporate practice in shopping centre Predominantly private billing, weekends optional.

Close to UWA. Onsite practice nurse, pharmacy, physiotherapy, podiatry and dietitian in shopping centre.

Please contact Vasanthi at 0414 846 635 Email: nedlandsdoctor@yahoo.com.au

OUTER METRO PRACTICE â&#x20AC;&#x201C; SOUTH LAKE Full time/Part time VR/NON VR GP required to join our privately owned, fully accredited & computerised, noncorporate family practice.

Fully supportive including Practice Nurse, onsite pathology and a friendly working environment.

Contact Dr Jagadish on 0413 879 023 Email: jags.krishnan@gmail.com Or Caroline â&#x20AC;&#x201C; Practice Manager 0427 342 488 / caroline@theheights.com.au MANDURAH Mandurah coastal lifestyle 40 minutes from Perth.

VR non VR doctor required short term or long term.

No weekends or after hours.

Good remuneration.

Clinic has full time nurses, pathology, psychology, hearing centre, dermatologist and orthotics.

Contact practice manager Elaine 9535 8700 Email: elaine@mandurahdoctors.com.au WANNEROO FT / PT Female GP required for noncorporate family practice delivering excellent healthcare to our local community in Wanneroo (Perthâ&#x20AC;&#x2122;s northern suburbs, approved DWS area).

Our practice is fully computerised (Pracsoft and Medical Director), paperless and accredited.

We have a wonderful reception team, professional Practice Managers, and full nursing support.

Contact: Jody Saunders 0410 617 094 or Cheryl Barber 08-9405 1234 E-Mail CV to jsaunders.wthc@gmail.com or cbarber.wthc@gmail.com

APPLECROSS

FT GP wanted.

A rare opportunity to join Reynolds Rd 7 Day Medical Centre has just presented itself as a long term colleague moves out of general practice.

Commencing Jan or Feb 2013, donâ&#x20AC;&#x2122;t miss out on your chance to join this private billing, vibrant practice with immediate access to a full patient data base.

Confidential enquiries to the practice manager 9364 6633.

DIANELLA Non Corporate practice requires F/T and P/T VR GPâ&#x20AC;&#x2122;s to join 6 female and 1 male doctor team.

Our newly extended, long established, accredited, fully computerised practice is supported with 4 excellent nurses and 5 very friendly admin staff.

Our practice is mostly private billing and we offer excellent remuneration.

Please contact Practice Manager on 9276 3472 Email: dfmc@dianellamedical.com.au

APRIL 2013 - next deadline 12md Friday 15th March - Tel 9203 5222 or jen@mforum.com.au

78

medical forum

MURDOCH Doctor Required for Stress Testing Supervision WA Cardiology offers the most extensive cardiology testing services in Western Australia and is committed to providing the highest standards in patient care, diagnosis and GP support.

Medical Practitioners who share in this vision are invited to join our team of Doctors supervising exercise ECGs, exercise echocardiograms and Dobutamine echocardiograms at our various sites.

Training is provided and excellent remuneration based on a fee for service basis is offered.

Applicants must possess valid unconditional registration with the Medical Board of Australia and working rights within Australia.

To register your interest, please contact Graeme Dedman (General Manager) on 0413 065 009 or E-mail us at admin@wacardiology.com.au.

Reach every known practising doctor in WA through Medical Forum Classifieds...

INGLEWOOD *OUFSFTUFE JO USZJOH TLJO DBODFS NFEJDJOF Unique opportunity to join a busy noncorporate skin cancer practice.

Friendly atmosphere with strong emphasis on quality and patient service.

Flexibility to explore any area of skin cancer medicine, ranging from comprehensive skin cancer checks, dermoscopy, and minor to more advanced surgical procedures.

Continuing education and training provided.

Fully computerised, with modern facilities and nurse support.

Suit part time VR doctors looking for reduced paperwork, flexible hours and above average income.

Please contact admin@skincheckwa.com.au JOONDALUP Candlewood Medical Centre GP required to join our friendly team for After Hours work immediate start.

Weekdays 6 â&#x20AC;&#x201C; 9pm and Saturday 12 - 5pm Very Attractive remuneration Privately owned, AGPAL accredited general practice.

Fully computerised.

Contact Michelle 08 9300 0219

79

CVS are a leading cardiology practice that provides high quality diagnostic stress testing services.

We are seeking medical practitioners who meet the following pre-requisites: Â&#x2021; 5HJLVWUDWLRQ ZLWK WKH $XVWUDOLDQ 0HGLFDO %RDUG Â&#x2021; 0HGLFDO ,QGHPQLW\ ,QVXUDQFH Â&#x2021; /LIH 6XSSRUW 6NLOOV RU H[SHULHQFH Â&#x2021; +LJK UHJDUG WR GHOLYHU RXWVWDQGLQJ SDWLHQW FDUH ,I \RX PHHW WKHVH SUH UHTXLVLWHV ZH ZHOFRPH \RX WR MRLQ RXU WHDP RI VSHFLDOLVHG 0HGLFDO 3UDFWLWLRQHUV 6WUHVV 3K\VLFLDQV $V D 6WUHVV 3K\VLFLDQ \RX ZLOO ZRUN ZLWK VWDWH RI WKH DUW GLDJQRVWLF HTXLSPHQW FRQGXFW TXDOLW\ VSHFLDOLVW WHVWLQJ DQG LPSURYH \RXU GLDJQRVWLF (&* VNLOOV $Q DWWUDFWLYH UHPXQHUDWLRQ SDFNDJH ZLOO EH RIIHUHG WR VXFFHVVIXO FDQGLGDWHV DV ZHOO DV H[SHULHQFLQJ H[FHOOHQW MRE VDWLVIDFWLRQ DQG ZRUNLQJ FRQGLWLRQV CVS locations include: Joondalup, Karrinyup, Nedlands, Midland, Mt Lawley, Leeming, East Fremantle and Rockingham.

3OHDVH SKRQH $GDP /XQJKL WR GLVFXVV RSSRUWXQLWLHV DW &96 RQ 1300 887 997 or 0402 825 570 RU YLD H PDLO info@cvs.net.au

Are you wanting to sell your medical practice?

As WAâ&#x20AC;&#x2122;s only specialised medical business broker we have sold many medical practices to qualified buyers on our books.

Your business will be packaged and marketed to ensure you achieve the maximum price possible.

To find out what your practice is worth , call:

Brad Potter on 0411 185 006

We are committed to maintaining confidentiality.

You will enjoy the benefit of our negotiating skills.

85% Supplement your income: Are you working towards the RACGP? â&#x20AC;&#x201C; we have access to provider number for After Hours work.

Are you an Overseas Trained Doctor with permanent residency and working toward RACGP? - we have access to provider number for After Hours work.

take home,

Weâ&#x20AC;&#x2122;ll take care of all the paper work to ensure a smooth transition.

Suite 27, 782 - 784 Canning Highway Applecross WA 6153

Ph: 9315 2599 www.thehealthlinc.com.au

enjoy ďŹ&#x201A;exible hours,, less paperwork, & interesting variety....

Equipment Provided - WADMS is a Doctorsâ&#x20AC;&#x2122; cooperative e Essential qualiďŹ cations: U General medical registration.

U Minimum of two years post-graduate experience.

U Accident and Emergency, Paediatrics & some GP experience.

UĂ&#x160;Fee for service (low commission).

UĂ&#x160;nÂ&#x2021;Â&#x2122;Â&#x2026;Ă&#x20AC;Ă&#x160;Ă&#x192;Â&#x2026;Â&#x2C6;vĂ&#x152;Ă&#x192;]Ă&#x160;`>Ă&#x17E;Ă&#x160;Â&#x153;Ă&#x20AC;Ă&#x160;Â&#x2DC;Â&#x2C6;}Â&#x2026;Ă&#x152;° UĂ&#x160;Ă&#x201C;{Â&#x2026;Ă&#x20AC;Ă&#x160; Â&#x153;Â&#x201C;iĂ&#x160;Ă&#x203A;Â&#x2C6;Ă&#x192;Â&#x2C6;Ă&#x152;Â&#x2C6;Â&#x2DC;}Ă&#x160;Ă&#x192;iĂ&#x20AC;Ă&#x203A;Â&#x2C6;ViĂ&#x192;° UĂ&#x160; VViĂ&#x192;Ă&#x192;Ă&#x160;Ă&#x152;Â&#x153;Ă&#x160;*Ă&#x20AC;Â&#x153;Ă&#x203A;Â&#x2C6;`iĂ&#x20AC;Ă&#x160;Â&#x2DC;Ă&#x2022;Â&#x201C;LiĂ&#x20AC;Ă&#x192;°

UĂ&#x160;Ă&#x160; Â&#x153;Â&#x2DC;Ă&#x160;6,Ă&#x160;>VViĂ&#x192;Ă&#x192;Ă&#x160; Ă&#x152;Â&#x153;Ă&#x160;6,Ă&#x160;Ă&#x20AC;iL>Ă&#x152;iĂ&#x192;° UĂ&#x160; Â&#x153;Â&#x2DC;Ă&#x2022;Ă&#x192;Ă&#x160;Â&#x2C6;Â&#x2DC;ViÂ&#x2DC;Ă&#x152;Â&#x2C6;Ă&#x203A;iĂ&#x192;Ă&#x160;ÂŤ>Â&#x2C6;`° UĂ&#x160;Ă&#x160; Â&#x2DC;Ă&#x152;iĂ&#x20AC;iĂ&#x192;Ă&#x152;Â&#x2C6;Â&#x2DC;}Ă&#x160;Ă&#x153;Â&#x153;Ă&#x20AC;Â&#x17D;Ă&#x160; environment.

MIDLAND Excellent location close to the new Midland hospital due for completion in 2015.

Freshly painted high quality property with spacious rooms and ample parking.

Ability to have two specialists with separate receptions.

www.realcommercial.com.au/500555991 Contact: Noel Blanchard 0411 073 775 Phone: 08 9362 5333 | Web: timeconti.com.au

79

APRIL 2013 - next deadline 12md Friday 15th March - Tel 9203 5222 or jen@mforum.com.au

80

medical forum Venosan Diabetic Socks

Brand New State of the Art Medical Centres opening May:

The Magic of Silver for Sensitive Feet No Compression Silver Ion Therapy

Armadale & Cannington Candid Candidates id dates must have FRACGP or equivalent.

Centre rees are are located loca lo c t in DWS areas.

Centres To ďŹ nd o out more of ofďŹ c ďŹ ce@ e@ap apol ollo lo ohe heal altt al ofďŹ ce@apollohealth.biz | 08 6142 9275

Contains the antimicrobial silver yarn ShieldexÂŽ which enhances a balanced foot climate.

Tested and proven in controlling over twelve types of bacterial and fungal infections common on the feet and legs. t Silver yarn - is permanent and cannot be washed out of the socks. t Keeps feet cooler in the summer and warmer in the winter

Comfort for The Patient t Soft-Spun Cotton - Ultra soft cotton t Fully cushioned foot and fully cushioned sock t Comfortable for arthritic patients

Flat Seam Safety

General Practitioner â&#x20AC;&#x201C; Street Doctor Perth Central & East Metro Medicare Local Ltd (PCEMML) operates a mobile medical service, known as StreetDoctor.

This service provides primary healthcare to homeless and disadvantaged populations of Perth.

We are currently seeking an experienced Vocationally Registered General Practitioner to work at one of our Street Doctor Clinics held at a youth drop-in centre, located in Northbridge. The clinic is held on Monday afternoons between 1.00pm â&#x20AC;&#x201C; 4.00pm.

If you have an interest in working in community health and have a true passion for helping people in need we would like to hear from you. For further information please contact Tracey Snowden (08) 9376 9200.

No noticeable seams due to hand-linked toe section. This reduces chafďŹ ng and blistering that could result in infection and skin ulceration.

Non-restricting cuffs â&#x20AC;&#x201C; avoids restriction of circulation.

Colours â&#x20AC;&#x201C; available in Silver (essentially a white sock with Silver yarn) & Black.

Sizes â&#x20AC;&#x201C; available in 3 sizes (Small, Medium & Large).

Your WA Consultant â&#x20AC;&#x201C; Jenny Heyden RN Tel 9203 5544 or Mob 0403 350 810

To apply please forward your current CV to hr@pcemml.org.au

LIFESTYLE AND CAREER

!

BEAUTIFUL BUNBURY BUNBURY Opportunity awaits your practice.

1/138 Spencer Street South Bunbury t . $POTVMUBODZ TQBDF 8JUI $BS CBZT t ;POFE NFEJDBM SPPNT t QFS NPOUI QMVT WBSJBCMF PVUHPJOHT QMVT (45 t 1SFWJPVTMZ PQFSBUFE BT B 3BEJPMPHZ DFOUSF t 5IF QSPQFSUZ QSFTFOUT BT OFX t &RVJQQFE XJUI .BMF 'FNBMF BOE TUBGG UPJMFUT BT XFMM BT EJTBCMFE GBDJMJUJFT t )BWF OFX DBSQFUT UISPVHIPVU Be quick as opportunities like this donâ&#x20AC;&#x2122;t come along very often in the Southwest regional City of Bunbury Phone: Patrick Williams on 0407 990 886 Email: pat@sdea.com.au Bunbury Office 13 Stirling Street, Bunbury WA 6230 Phone: 9721 3533

Specialist and allied health opportunities!

A great opportunity for the right clinicians to own and operate their own practice or if preferred we can employ!

We have a combination of single rooms with dedicated reception or individual tenancies available â&#x20AC;&#x201C; come and have a look and choose for yourself!

Opens late April/early May Project Manager: Jill Riggall 0437 516 850 jill.riggall@breckenhealth.com.au GPâ&#x20AC;&#x2122;s are encouraged to contact Dr Brenda Murrison 0418 921 073 brenda.murrison@breckenhealth.com.au

APRIL 2013 - next deadline 12md Friday 15th March - Tel 9203 5222 or jen@mforum.com.au

80

Moving to Best Practice, easy as Like eating brussels sprouts â&#x20AC;&#x201C; you know that changing your clinical software will be good for you â&#x20AC;&#x201C; but not something you want to face. Best Practice is different.

Best Practice makes the changeover so easy you can try it out with all your practice data (the backup version of course) without committing. Sweet! s 7E HAVE MIMS n !USTRALIA S MOST TRUSTED DRUG DATABASE s 3UPPORT PROFESSIONALS WHO ARE TRULY SUPPORTIVE s 3PEED AND SUPERIOR STABILITY OF 31, PERFORMANCE s #ONVERTING YOUR DATA FROM -$

-$ AND -ED4ECH VIRTUALLY AUTOMATIC s .O ADS BOLT ONS OR MIXED lLE FORMATS TO COMPROMISE PERFORMANCE s 'REAT VALUE n SUBSCRIPTION

FOR BOTH #LINICAL AND -ANAGEMENT s $ISCOUNTS FOR PRACTICES LARGER THAN %QUIVALENT &ULL TIME '0S s (ALF PRICE FOR PART TIME PRACTITIONERS

s .O DOWNTIME FOR UPDATES OR TIME CONSUMING MAINTENANCE s -ORE '0S VOTING FOR Best Practice WITH THEIR FEET *(includes GST)

TTel: l (07) 4155 8800 0 www.bpsoftware.com.au b