medicSA Autumn 2023

Life, death and access to voluntary assisted dying

In this issue:

• ADVOCACY AGENDA - AMA(SA) CAMPAIGNS FROM PAYROLL TAX TO PHARMACY PRESCRIBING

• PRESIDENT ATCHISON REFLECTS ON HER TERM

• CELEBRATING OUR NEWEST DOCTORS

With more clinics across the state,

you’ll get a clearer picture.

OPENING SOON

Bringing MRI to the Fleurieu

Victor Harbor Town Centre

Adding to our existing clinics at Goolwa and Victor Harbor Hospital, this expansion of our radiology services creates capacity on existing services and allows us to bring Medicare supported MRI and Breast imaging services closer to those who live on the peninsula.

New Breast & Oncology Clinic

337 South Terrace

This is an expansion of our relocated breast services provided at St Andrew’s Hospital as well as a focus on oncology imaging and integrated healthcare making the patients journey as comfortable as possible.

For a clearer picture visit jonesradiology.com.au

medicSA is produced by the Australian Medical Association (SA)

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Executive contacts

President

Dr Michelle Atchison: president@amasa.org.au

medicSA

Editorial

Medical Editor: Dr Roger Sexton

Editor: Karen Phillips editor@amasa.org.au

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Production

Catherine Waite

ISSN 1447-9255 (Print)

ISSN 2209-0096 (Digital)

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It’s not widely known, but AMA(SA) President Dr Michelle Atchison is the very proud daughter of the long-time, internationally published, Advertiser political cartoonist Michael Atchison. To coincide with the end of Dr Atchison’s presidency in late May, we’re reprinting on the cover and on page 14 two of the editorial page cartoons in which Mr Atchison depicted aspects of South Australia’s health system, each featuring his infamous ‘dog with no name’ and as relevant today as they were when initially published. Dr Atchison is pictured here on her wedding day 1992 with her father, who died in 2009.

President’s report

Dr Michelle Atchison

It is difficult to believe that in a few short weeks, my term as President of AMA(SA) will be over. Asked to reflect on my two-year term for the article in this issue has triggered memories of challenges and crises, but also camaraderie and companionship, that I am sure I share with other doctors fortunate enough to have held this position before me.

It is impossible to know, though, whether the strange warps and wefts in time that seem to have occurred recently are unique to this period, because of the pandemic, or are a constant feature of this role, or just being adults. Time doesn’t ‘pass’, it gallops. It flees. We never have enough of it.

So, I am doing what I can to maximise the time I have as president before the annual general meeting (apologies in advance to the Secretariat staff!). For example, as I write this, we have in a few days our regular meeting with Health Minister Chris Picton. The agenda includes COVID (of course), new Women’s and Children’s Hospital planning and existing hospital accreditation issues, and patient access to the benefits promised by the Termination of Pregnancy Act (passed two years ago last month).

On 6 March, CEO Dr Samantha Mead and I met the Shadow Minister for Regional Health Services, for Preventative Health, and for Mental Health and Suicide Prevention, the Hon. Penny Pratt, to warn of the ramifications of any legislation that would increase access to vaping products, as proposed by One Nation MLC Sarah Game’s Bill to ‘regulate’ supply.

On the evening of 6 March, we staged a webinar to address members’ concerns that are mounting because of the payroll tax reforms occurring in the eastern states. As detailed on page 14, Federal AMA Vice President Dr Danielle McMullen and policy director Warwick Hough, and AMA Queensland President Dr Maria Boulton, kindly accepted our invitations to share their experiences of the campaigns in Queensland and NSW to counter political moves to impose payroll tax on private practitioners. We don’t know what may come in South Australia, but the interstate experience of this new tax shows we are better to be prepared.

On 2 March, we appeared before the Select Committee on Health Services to discuss the concerns outlined in our submission to the Committee of November

2022, and to present our perspective on the multi-faceted crisis in our health system. Among the issues discussed were the impacts of COVID and Long COVID on patients and the health sector, now and in the years to come; ramping and hospital logjams, and the effect of insufficient services at every stage of the patient ‘journey’ on overflowing emergency departments; planning for and accreditation of the Women’s and Children’s Hospital; and our concerns about any move to enable pharmacists to prescribe medication for urinary tract infections.

We discussed the work here and across the country to find solutions to the crisis in general practice, from overhauling Medicare to attracting more junior doctors to general practice. As we explained to the Select Committee, the ‘single employer model’ being piloted in the Riverland is one program that can contribute to solving the recruitment problem; a meeting with our peers in Tasmania, where it is about to be implemented, about how it could be rolled out across the state, was also in the diary this week.

And so it continues. For members, for patients, for communities – the AMA is here and our advocacy goes on.

As I prepare to vacate the presidency, I thank my predecessor, Dr Chris Moy, for his stewardship and for continuing to give so much time to AMA(SA) while passionately advocating for us all,inlcuding as federal Vice President. Dr John Williams has been a pillar of support as AMA(SA) Vice President, including and especially in leading AMA(SA) work on the rural doctors’ contracts and the single employer model. AMA(SA) Council Chair Dr Peter Subramaniam, Committee of General Practice Chair Dr Bridget Sawyer and Councillors have devoted time, expertise and guidance to help me.

I have been grateful for the open and valuable channels of communicaion with Minister Picton and his predecessor, Stephen Wade. Within SA Health, Dr Emily Kirkpatrick, Dr Michael Cusack and Helen Chalmers have answered my requests for statistics and sometimes sensitive analysis of what’s going on with COVID, ramping and other systemic challenges. And the small team we have in our Secretariat has always had my back. Thank you all.

We don’t know what may come in South Australia, but the interstate experience of this new tax shows we are better to be prepared.

Dr Dominic Barnes Member since

From the medical editor

Dr Roger Sexton

Ihave been reflecting recently on the good and not-so-good role models in my career and their influence on my personal and professional life. I am sure you have a list of your own role models –diverse in time and space and sector – each of whom has influenced you towards a new way of thinking, living or working.

My Glaswegian soccer coach in grade five used ‘profound disappointment’ to describe what he perceived as a lack of effort on the pitch as a powerful motivator. It worked. ‘I canna believe it!’ has remained on my hard drive.

My grade seven teacher was an outstanding, interested, energetic, innovative teacher. One day he turned classroom disarray into a learning opportunity when, during his temporary absence from the classroom, a noisy squabble between groups of classmates developed. Upon his return, he brilliantly and unforgettably turned this into a trial by jury. I was found not guilty.

In medical school, the wisdom of hospital consultants at the bedside was so instructive. The trusting faces of patients told a story of hope as the doctor sat on the bed. I have discovered the power of that calming bedside manner.

My student elective in rural general practice exposed me to the art and power of comprehensive general practice. This was an unforgettable fork in the road for me. I witnessed the importance of calmess

in a crisis, clear communication, patience, and prescribing a tincture of time.

Patients’ illness behaviour has taught me so much. Every patient is a tutorial and role models are everywhere. The bravery of the dying patient and the embarrassing puerile behaviour of mildly unwell adults teaches us how and how not to behave.

Engagement with non-medical friends and events exposes us to exciting and informative ‘parallel universes’ within society of which we can be otherwise totally unaware. This is where we can be exposed to and learn from the refreshing, distilled experience of outstanding others, for our own good.

Negative role models define our practice and behaviour, too. My overseas obstetric training experience exposed me to an angry and dangerous colleague and forged a much stronger awareness of patient vulnerability, ethics and professionalism. That was a seriously powerful career fork in the road for me towards doctors’ health, medical regulation and indemnity, and risk education.

Over time, we learn from a lifetime exposure to a range of role models. This helps us all manage ourselves and our relationships, the career choices we make and a wide range of personal and professional situations.

I invite you to reflect on this as you read this edition of medicSA

Adelaide to host world POTS specialist

One of the world’s leading researchers into mast cell disease and its links to postorthostatic tachycardia syndrome (POTS) and, most recently, Long COVID, will speak live in Adelaide in late March.

Dr Laurence Afrin has been invited to speak in Adelaide by the Australian POTS Foundation. He will deliver lectures in the SAHMRI Auditorium on North Terrace and at a dinner at Marryatville on 30 March. He will also participate in a webinar on 29 March

Adelaide cardiologist and POTS specialist Associate Professor Dennis Lau says that with increasing international evidence of exacerbated and new POTS symptoms among people reporting Long COVID symptoms, the POTS Foundation hopes to increase knowledge and awareness among South Australian clinicians of mast cell disease and POTS.

Dr Afrin has practised as an internist and haematologist/oncologist at the Medical University of South Carolina and the University of Minnesota, increasing his focus on mast cell disease over the past decade.

Since 2017, he has been developing an institute in New York for advancing care, research, and education in mast cell disease. He has published highly accessed articles about mast cell activation syndrome and a popular book in the field.

Dr Afrin’s visit to Adelaide follows his online participation in the POTS Foundation’s POTS Unmasked conference in October 2022.

Registration is not required for the SAHMRI event. Limited tickets to the dinner are free by registering here

Award-winning defence

Recognised

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Members

Doctors prepare to challenge new ‘patient tax’

AMA(SA) has for some time been examining if and when a new payroll tax interpretation may be imposed on private practitioners, and the timing and scale of that tax.

There has not as yet been any indication, public or private, from the South Australian Treasurer about whether he and his team are planning to introduce the tax in this state. But increasing concern among AMA members in South Australia led us to begin our public advocacy with a webinar that would outline the efforts of the federal AMA and other states to challenge the tax, and the legal state of play here.

In the webinar on 6 March, Federal AMA Vice President Dr Danielle McMullen and policy director Warwick Hough and AMA Queensland President Dr Maria Boulton joined our President, Dr Michelle Atchison to explain to members how a new interpretation of existing legislation in NSW, Victoria and Queensland is bringing financial and psychological pain to doctors.

Norman Waterhouse tax law specialist Kale Rigano then outlined his team’s understanding of the new interpretation in those eastern states, and why national ‘harmonisation’ of state legislation across the country suggests South Australia will follow their lead. A summary of their views of the situation here, and what may come, begins on page 10.

More than 50 AMA members and

practice managers heard Dr Boulton – a GP for 20 years and a GP practice owner for seven years – say that the looming imposition of payroll tax in Queensland is, according to AMA Qld members, the number one issue affecting them, ‘above the need for Medicare reform, and that is why AMA Qld has been advocating strongly on this issue.

‘The Queensland Revenue Office (QRO) released a new public ruling on the 22 December 2022 with further information on the interpretation of payroll tax law as it applies to GPs under service room agreements,’ Dr Boulton said.

‘This is yet to be challenged in the Queensland courts.

‘Even though GP tenants may not be employees for federal tax law purposes, it is the (new) interpretation of the QRO that under a relevant contract the income from GP tenants may be liable for payroll tax for state purposes.

‘With most practices unable to absorb the cost, payroll tax will be passed on to patients, thereby becoming a tax on patients accessing GP care. This will affect the most vulnerable in our community, including those with chronic disease and mental illness who visit their GPs more frequently.’

Dr Boulton said she had spoken with practice owners who were facing retrospective bills going back five years, who were facing closure and who didn’t want to leave their thousands of patients and aged care facility residents without a doctor.

Then, at National Cabinet on 3 March, Queensland Premier Annastacia Palaszczuk announced that Queensland GPs will be given a reprieve of 2.5 years from payroll tax – although the reprieve does not cover new practices.

‘We have requested further information from the QRO,’ Dr Boulton said, ‘but it seems that the retrospective period will also be waived together with the bills that have been sent to Qld GP practice owners.

‘The reprieve is a positive step. While we will continue fighting for an exemption this will give our GP members some breathing room – and make access to GPs more affordable for patients. AMA Qld is seeking further detail from the QRO on the amnesty proposal and have advised members to seek expert independent legal and accounting advice on their particular circumstances. New practices will not be covered by the amnesty.’

GP Dr McMullen said patients in the eastern states are concerned that the payroll tax inevitably will be a ‘patient tax’: every time patients go to see their GP or doctor, they will have this tax added to a bill already affected by an out-of-date Medicare system.

‘This is not something new for us – the AMA has been working on this since at least 2019,’ Dr McMullen said.

In recent talks with federal Health Minister Mark Butler, she said, the AMA had reinforced the pain the tax would cause, and the conflicting messages it sent about the value of team-based care within Australia’s general practices.

‘We have asked why, at a time we are talking about getting more funding to GPs (to alleviate the financial pressures on general practice and support the employment of nurses and allied health professionals in general practices) – why create a situation where that funding would be stripped back out by the states?

‘To impose a tax on that shared nature of practice flies in the face of everything we have been told to do over the past decade.’

As Dr Atchison told webinar participants, while we have not heard that the Treasurer has chosen to follow his interstate peers, the trend towards ‘harmonious’ law and interpretations across the country leads Norman Waterhouse experts, and us, to expect the worst. The webinar was not the first step in the AMA(SA) preparations for this challenge, and it won’t be the last. We will keep you informed as our campaign continues.

AMA(SA) is joining colleagues around the country asking why governments would add a new tax to the financial burdens of private practitioners and their patients, writes CEO Dr Samantha Mead.

AMA Vice PResident Dr Danielle McMullen

Medical practices can plan for payroll tax

South Australian doctors and practices should be ready to face the local implications of new interpretations of interstate tax legislation, write tax law specialists Kale Rigano and Alex Belperio of AMA(SA) legal partner Norman Waterhouse.

The issue of evolving judicial interpretation of payroll tax legislation has been extensively discussed across Australia in recent months (and years) due to landmark cases such as Chief Commissioner of State Revenue v The Optical Superstore Pty Ltd [2019] VSCA 197 (Optical Superstore) and Thomas and Naaz Pty Ltd v Chief Commissioner of State Revenue [2022] NSWCATAP 220 (Thomas and Naaz).

A close working relationship between AMA(SA) and Norman Waterhouse Lawyers led us to examine this issue and how private practitioners might safely navigate any new payroll tax landscape.

Here, we provide a summary of some key factors and recent developments. We will continue working with AMA(SA) to help the association and its members manage the ramifications of any legislative or interpretative change in the months ahead.

Payroll tax – in a nutshell

Unlike federal taxes such as income tax and CGT, payroll tax is a creature of state-based legislation and is overseen by state revenue authorities. It is essentially a tax imposed on each dollar paid in wages that exceeds a threshold set in each state and territory.

While the interpretation of state-based legislation typically differs from state to state (or territory), payroll tax legislation is ‘harmonised’ in Australia, making its interpretation in one state more directly applicable in other states. Essentially, this means that payroll tax legislation in all Australian states and territories (except WA) is largely the same, and likely to be

interpreted and applied in the same manner; however, the thresholds for payroll tax applying and the rates imposed are vastly different across jurisdictions. In South Australia, payroll tax starts to be charged on wages (including superannuation, fringe benefits, etc.) above $1.5 million (at variable rates), with the top rate of 4.95% payable on all wages above $1.7million.

Harmonisation is the main reason why South Australian medical professionals should be concerned about the NSW decision in Thomas and Naaz. While this case was decided in NSW, given the similarities of the legislation, it is likely that the authority will be applied in South Australia if tested here.

Effect of recent cases

Optical Superstore and Thomas and Naaz primarily centred on the interpretation of the ‘relevant contract’ provisions. Broadly speaking, the intent of these provisions is to enable state revenue authorities to capture in the payroll tax net payments made to independent contractors. These provisions are drafted very broadly.

Where a ‘relevant contract’ is deemed to exist, the person who supplies services under that contract is deemed to be an employee for payroll tax purposes, and the person (or entity) receiving those services is deemed to be the employer. Payments made by the ‘employer’ to the ‘employee’ under such an arrangement are then taken to be wages and will be included when determining the employer’s total wages and payroll tax liability for a given period.

For example, for medical practice entities, this can operate so that the

medical practice is deemed to be the employer of each doctor it has engaged, with the result that payments made to those doctors are included in the practice’s wages for payroll tax purposes.

Until recently, payroll tax legislation has not been interpreted to include doctors and deemed ‘employer’ practices in this way. But if the State Government decides adopt the interpretation set down interstate, and given the South Australian threshold of $1.5 million in wages, we expect that a practice with three to four fulltime GPs will now likely find themselves exposed to payroll tax, so that the payments to GPs will be added to the wages paid to administration staff, nurses, etc. – at a cost of 4.95% for each dollar over $1.7 million (and lesser rates for each dollar between $1.5 million and $1.7 million).

Notwithstanding the example above, it should be noted that the application of the ‘relevant contract’ provisions is not limited to GPs – it also applies to other medical specialists, dentists and allied health professionals. If applicable, the provisions can pick up payments made from Medicare, insurance providers, gap payments and PIP payments.

Operating as a service entity (that is, providing administrative services only to allow doctors to conduct their own medical practice) provides some protection, but it does not by itself stop the application of the ‘relevant contract’ provisions – and particular attention will be paid to how the service entity actually provides its services.

The result of these cases means that many practices and service entities may now be unwittingly in breach of their

payroll tax obligations (and may also have substantial historical liabilities as a result).

Further developments

Following these cases, the AMA has advocated to relevant state governments for the protection of medical practices against excessive payroll tax liabilities and has made significant progress in some jurisdictions.

However, in a ruling published on 22 December 2022, the Queensland Revenue Office (QRO) has signalled its intent to drag in medical billings from angles outside the ‘relevant contract’ regime, by relying on other provisions contained in the payroll tax legislation relating to third-party payments and employee-agency contracts (which, like relevant contracts, may be deemed to exist if certain broad conditions are satisfied). While we do not agree with the QRO’s position, given the harmonisation of our payroll tax legislation, in our view the QRO has signalled where the next battle may be fought.

What can be done?

Aside from creating fear and uncertainty, these recent developments have transformed the general position of payroll tax in a medical practice context, potentially exposing many practices around the country to retrospective and future payroll tax liabilities.

Understandably, these potential liabilities have left many within the profession extremely concerned. In our view this problem must ultimately be fixed by legislative intervention – such as providing an exemption on public policy grounds for payments made to medical

professionals, as sought by the AMA across the country.

It is important to note that the new interpretations will not affect all medical practices (as this depends on the particular facts and circumstances of each individual practice/arrangement). Some practices or service arrangements may already be structured so that the new interpretations have no application.

Further, if your practice is exposed (in our experience, this will be most practices), proactive steps can be taken to stop the operation of the ‘relevant contract’ provisions and alleviate the payroll tax concerns flowing from those provisions. This involves careful tax planning and commercial structuring (including a detailed review of the contractor agreement or service arrangements) to ensure that the reasoning applied in Optical Superstore and Thomas and Naaz, can be countered. What is less certain is whether RevenueSA believes the QRO ruling has any merit – but even so, we believe that with appropriate structuring the additional avenues of attack can be defended.

These arrangements will by necessity result in some operational and administrative shifts within the practice. However, once implemented, the practice’s administration should proceed largely as before – with GPs treating patients, and the administration making appointments and reconciling billings. Safeguarding yourself in this rapidly changing environment does not have to jeopardise the fundamental functionality of your business.

We are pleased to announce that, as a

preferred provider of AMA(SA), we have prepared a package to help practices determine their exposure under these new interpretations and, if exposed, provide advice as to the available options. We have also prepared a revised services agreement to avoid some of the pitfalls highlighted in the cases and guide future practice administration. Due to our relationship with AMA(SA) we can offer a discounted fee to AMA(SA) members.

To discuss your potential payroll tax liabilities, and whether the recent cases affect your practice or service arrangements, please contact Kale Rigano KRigano@normans.com.au or Alex Belperio ABelperio@normans.com.au at Norman Waterhouse Lawyers on (08) 8210 1207. Our experience advising clients in relation to state and federal tax jurisdictions extends over a large variety of industries and diverse tax profiles.

The content of this article is not intended to be legal advice and does not consider your individual needs and circumstances. Legal or other professional advice should be sought before acting or relying on this article or any part of it.

A President’s perspective

The Gala Ball in May will mark the end of Dr Michelle Atchison’s term as President of AMA(SA). Here, she reflects on a period of challenges and crisis - and incredible teamwork.

As I write this, there are a very few weeks remaining in which I can introduce myself as ‘President of the AMA in South Australia’. It is astounding how quickly my two-year term has passed, and I will vacate the chair knowing much was achieved – and there is much for my successor to address.

As I’ve said many times in the past 20 or so months, there really is no way of knowing what it is like to be the President of the Australian Medical Association in South Australia. In my experience, there is nothing like it. And you can’t know what ‘it’ is until you’re there.

When I was elected President in May 2021, I had on my CV terms as President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in South Australia, Vice President of AMA(SA) and Chair of the AMA(SA) Council. I thought I knew what intense advocacy looked and felt like. But as President. I became the face and voice of an organisation with the enormously responsible role of translating and influencing government policy so South Australia’s doctors are best able to do their jobs and support their patients and communities. I went from needing to know a little bit about everything in psychiatry to needing to know a little bit about ALL of medicine, including ‘superior’ skills in COVID.

And I was in a unique position where governments, media and the public turn to us, with me as that face and voice, for the

knowledge and advice to help the people of this state with some of the most serious issues in their lives.

That much I knew, or could predict. What I couldn’t predict until I sat in the President’s office was how the trust in our voice translates to a volume of work that is both challenging and extremely rewarding.

Of course, the timing of my presidency was impeccable. COVID. Ramping. GPs and Medicare. Everyone turned to us for help, guidance, information and answers. Sometimes the answers aren’t palatable to one or more of our audiences. But I’ve learned to keep sending the same message and to keep chipping away.

During my four years as Vice President and President, the landscape in which we practise medicine has been transformed. But while many aspects of the care we have provided has changed during the pandemic, there is much that holds true in the practice of medicine. The knowledge and training that prepares us to be doctors continues to increase and develop, thanks to colleagues here and around the world. The human body and mind, to which we apply our knowledge, have changed little over thousands of years. But the toll has been and is heavy.

In the first year of my presidency, the AMA federally and at state level were vocal in our efforts to protect specialists in private practice, to push for telehealth and electronic prescribing, to seek adequate compensation for providing COVID care, and to support

Dr Michelle Atchison with AMA(SA) Vice President Dr John Williams during their trip to the South East in October 2021

doctors in training and medical students. We sought regular meetings with government and urged them to ‘follow the science’ – and in South Australia we were fortunate that for nearly two years, this largely occurred. We reinforced that by prioritising health care, the economy would be better placed to recover. We advocated for general practice to lead the vaccination drive, and helped our patients understand what vaccinations they should receive and when. We helped doctors understand exposure protocols and testing procedures. We held regular webinars for our members to keep them up to date with the many changes to their practice. We called for urgent, easily available stocks of PPE to be provided to doctors on the COVID frontline. Towards the end of 2021, the wrecking ball hit again with the Omicron variant. As the world has been forced to adapt, so have we.

COVID-19 was not the only issue on my agenda. During 2021, AMA(SA) worked closely with the Rural Doctors Association of South Australia to negotiate for working conditions for rural doctors that adequately recognise the time and commitment they give to the patients and communities that rely on their care.

In late October 2021, we visited members and colleagues in the South East, and heard first-hand of the challenges the hospitals and practices face in attracting and retaining GPs and organising specialist appointments. I believe it is important for future presidents to continue these rural visits, it is too easy to be city-centric in our work and advocacy.

That trip coincided with the announcement on 26 October that South Australia’s borders would open to the eastern states,. And we have been battling the challenges of wave after wave in the 16 months since.

While case numbers increased exponentially in early 2022, we – along with politicians and voters – prepared for the election in March. It became obvious that health, and particularly ramping, was the key issue of that election. Yet despite the commitments that – along with the impacts of the border opening - possibly swayed voters to elect the Malinauskas Labor Party into office, there is little evidence the health system is in any major way any better off.

In relation to COVID, for example, the past year has been characterised by a political approach that has been a shrug of the shoulders. Politicians talk of COVID being ‘over’ – despite case numbers in the thousands and many deaths recorded every week. Road statistics remain in the headlines, but COVID data rates barely an occasional reference in the media.

Otherwise, the past few months have also been dominated by major issues that threatened, and may continue to threaten, doctors’ livelihoods and their capacity to practise. With Dr Williams and AMA(SA) Committee of General Practice Chair Dr Bridget Sawyer, we have argued vehemently against ‘scope creep’ – particularly pharmacy prescribing of UTI medication in South

A cartoon depicting problems in South Australia’s hospital services, drawn by Michael Athison, Dr Atchison’s father, for The Advertiser

Dr Atchison chairs the climate panel at the 2022 AMA National Conference in Canberra

Australia. In this, we have been able to draw on the campaigns of interstate AMA colleagues, as we have in supporting our members against any introduction of payroll tax for specialist contractors in private practice. These battles are not over.

We are also taking every opportunity to inform politicians and the media of the dangers of vaping. As I write this, we are awaiting the tabling in parliament of a Bill to ‘regulate’ the sale of vaping products, and are explaining to members of parliament the evidence indicating that the sale of vaping products must be limited to those for whom other methods to stop smoking have been unsuccessful.

While some issues have required intense but brief focus and responses, others have remained ‘on my desk’ throughout my presidency. COVID is, of course, one of these; looking back from where we are, with the impacts of the virus still very much with us the pandemic appears as series of health care crises within one mountainous emergency. Issues such as finding suitable PPE and planning how we physically manage patients within our clinics and rooms have largely been overcome. But then there are those issues that continue to plague us: for example, concerns related to vaccinations, where to find them, who should and must have them, and overcoming hesitancy; responses, even among clinicians, to Long COVID symptoms and care; and how we can be best prepared for the next wave, or the one after that, any of which could be caused by a variant worse than any we’ve seen.

The status of rural health services is another unsolved problem that has continued through my presidency. The increased reliance on locums, the generational loss of rural GPs (as seen recently in the South East), the lack of access to both GP and non-GP specialists in regional areas, and the loss of maternity services are among the features of a real crisis in rural health across the state.

Back in the city, AMA(SA) has commented on plans and designs for the new Women’s and Children’s Hospital (WCH) many times over the past two years. As mentioned to the Select Committee on Health Services earlier this month, we must have a hospital that is fit-for-purpose for generations – and at the same time we must be

able to provide world-class care, at the existing WCH until the new one is built.

The importance of hospitals such as the WCH and their role as teaching hospitals was pointed out when the WCH lost accreditation in some of its departments late last year. We must be able to train tomorrow’s doctors – which means providing them and their supervisors with ‘quarantined’ research and training time, even when the system is crashing around us.

We also have given advice to policy makers to ensure proposed Termination of Pregnancy and Voluntary Assisted Dying legislation meets the needs of South Australians and their doctors. These legislative reforms have enormous ramifications for South Australians, and we have reinforced to the relevant government and SA Health representatives the need to provide access to treatment emanating from them to all South Australians, as safely and effectively as possible.

Meanwhile, AMA(SA) has continued to plan for an economically sustainable future. After consultation with AMA(SA) Council, the Executive Board decided to sell AMA House, and we look forward to investing the capital to benefit members of today and tomorrow. I have also advocated for a climate sustainable AMA and began discussions, along with Doctors for the Environment representatives, about developing a Sustainability Unit within SA Health.

Leaving the presidency is bittersweet. I feel am now across most of the health issues South Australia and the AMA are facing, and it’s time to depart. I have been so impressed by how our opinions and advice are valued, and I truly believe we give the best evidence-based guidance we can – guidance that is also based on the wisdom of those around me. Thank you to everyone who has supported me.

In Spock’s words, ‘live long and prosper’.

Dr Atchison (centre) with AMA(SA) CEO Dr Samantha Mead and EA Mrs Claudia Baccanello (left) and receiving the President’s Medal from Dr Chris Moy (right), at the 2022 Gala Ball

Dr Atchison at the President’s Breakfast on 6 December 2022

Dr Atchison with then-AMA President Dr Omar Khorshid (right), Opposition Leader Peter Malinauskas and Shadow Health Minister Chris Picton after a media conference outside the Royal Adelaide Hospital on 16 March 2022. Mr Malinauskas and his party won the state election held three days later.

Mayday to quit smoking

South Australian smokers are once again planning to put away their cigarettes for the third annual ‘Quit your way in May’ campaign.

‘Quit your way in May’ is a quit smoking event that emphasises the importance of smokers quitting their own way. It establishes the 1 May quit date, provides platforms for participants to quit alongside other community members, and celebrates their quit smoking attempts with lots of encouragement.

The 2022 ‘Quit your way in May’ campaign achieved 1,323 registrations (155 more than in 2021) and 13,000 visits to the Quit your way in May website, indicating a large amount of interest surrounding the event and in quitting smoking. Of participants surveyed one month after the 2022 event, 78% had remained smoke free.

Research indicates patients who seek support from health professionals can more than double their likelihood of quitting smoking.

Quit Centre is a national online information bank developed by and for health professionals, with resources targeted to health professionals working in settings including general practice, pharmacy, primary care nursing, pregnancy, and maternity health. The resources provide health professionals with the most up to date information on smoking cessation, including practical guides, smoking cessation training, links to clinical guidelines, NRT (nicotine replacement therapy) videos and referral forms for Quitline. It also provides information for clinicians and other health practitioners to develop the skills, awareness, and confidence to deliver routine smoking cessation care.

It points to quitting tools such as the My QuitBuddy app, and distraction techniques to assist quitters to combat their cravings and withdrawal symptoms.

A brief discussion with a patient about their smoking can be fast, simple, and

effective. Quit Centre encourage health professionals to Ask, Advise, Help (AAH):

• Ask - ask and document smoking status

• Advise - at every opportunity advise the patient to quit and provide the most effective way to try

• Help - by offering a referral to Quitline for multi-session behavioural counselling and by facilitating access to clinically appropriate pharmacotherapy. A small change every day can add up to a lifetime of difference when it comes to quitting smoking. Every conversation from a trusted health professional to a patient can make a world of difference in a person’s motivation to quit, so every conversation about the benefits to quit smoking is valuable.

In 2023, the ‘Quit your way in May’ advertisement with animated buddies will

be back, demonstrating different distraction techniques. For example, Sporty Sarah says, ‘If you need a distraction, crank up the action’. Participants in 2022 said they identified with the characters and were able to come up with their own distraction strategies. For example, one participant, Chris said, ‘The cravings are a pain today, time to go and sort out the shed’.

AMA(SA) is again partnering with SA Health to support the event. Clinicians can help the ‘Quit your way in May’ event by supporting smokers to quit and encouraging them to register at quityourwayinmay.com.au

Free online training for health professionals to assist smokers to quit is available at www.quit.org.au/resources/ quit-education/quit-training/

2022 ‘Quit your way in May’ facts and stats

• In 2022, surveyed participants rated ‘Quit your way in May’ 8/10 for usefulness.

• More than 90% of participants surveyed would recommend ‘Quit your way in May’ to a friend.

• Two thirds of participants were female.

• Most were in the 46-55 age group.

• 22% were from regional South Australia (6% decrease from 2021).

• Of those surveyed:

o 50% stopped smoking by going ‘cold turkey’

o 34% used nicotine replacement therapy

o 22% sought help from a doctor or health professional

o 10% used quit smoking medication.

Doctors have an important role in encouraging patients who smoke to join the ‘Quit your way in May’ campaign, writes Drug and Alcohol Services South Australia’s Chelsea Murphy.

Dangerous territory

Enabling pharmacists to prescribe antibiotics for urinary tract infections (UTI) in South Australia will endanger the health of women, the AMA(SA) has warned.

In a submission to the South Australian Parliament Select Committee, the AMA(SA) notes that pharmacists are not trained to diagnose the range of conditions that might present as UTIs and pharmacies are not suitable spaces for women to discuss their symptoms.

Some women who have additional symptoms may not want to discuss them with a pharmacist and may withhold pertinent information to avoid awkward conversations. It would be usual for a doctor to ask about sexual activity and vaginal pain or discharge, questions that should be asked in private and with an understanding of what the answers mean, the AMA has explained.

AMA(SA) President Dr Michelle Atchison said interstate experiments allowing pharmacists to prescribe a range of medications were placing women’s lives at risk.

‘There is also nowhere in Australia – or anywhere else in the world – where such a move [to allow pharmacists to prescribe antibiotics] has provided evidence that an experiment like this is safe,’ she wrote.

‘Instead, there is mounting evidence that allowing pharmacists to prescribe antibiotics for UTIs, without proper screening and consideration of women’s clinical histories, risks missing indications of cancer and other serious conditions, and also pregnancies, during which medications should be considered very carefully.’

The submission to the Select Committee includes data and anecdotes collected by the AMA and others after the Queensland Government allowed pharmacists to prescribe UTI medication in an experiment in Northern Queensland.

An AMA Queensland survey of doctors in March 2022 identified at least 240 cases of women who needed further treatment, including one ectopic pregnancy, a missed cancer diagnosis and antibiotic resistance. Of the women who sought treatment for UTIs from pharmacists, 97 per cent were prescribed antibiotics, whether they needed them or not.

‘Also In Queensland, the pilot is under investigation as posing a serious threat to patient safety, with the people delivering it having a financial conflict of interest in its results,’ Dr Atchison says.

‘This is not how we trial medical programs in this country in 2022. It is certainly not the basis for expanding the pilots into different jurisdictions and for more conditions and treatments.’

While it is acknowledged that access to general practitioners is reaching crisis point – with Medicare funding failing to provide an economically feasible model for delivering services – broadening the scope of practice for those with different training is not the answer, says AMA(SA).

Patients need to be able to attend GP clinics to discuss their symptoms and medical history to make an accurate diagnosis.

Whereas the South Australian government suggests that

women with frequent UTIs might benefit from being able to readily access antibiotics from pharmacies, the AMA(SA) says this risks serious problems being overlooked.

The AMA(SA) submission says the Pharmacy Guild capitalised on Queensland’s one-house parliamentary system to introduce medical reforms with questionable benefit for patients but unquestionable benefits for pharmacies.

The AMA(SA) says the law in Queensland also fails to address a fundamental conflict of interest in having the people selling the antibiotics prescribing them which is likely to result in an increase in the use of antibiotics.

This occurs at a time when medical bodies around the world, including the World Health Organization and the AMA, are describing growing resistance to antibiotics as ‘one of the biggest threats to global health and development’.

Enabling pharmacists to prescribe antibiotics without reference to a patient’s history undermines efforts to monitor and enforce compliance with best-practice approaches for appropriate and judicious antimicrobial use, as required in Australia’s ‘National Antimicrobial Resistance Strategy 2020 and Beyond’, warns the AMA(SA) submission.

While Queensland Health pointed to ‘pharmacist models of care in comparable countries’, the AMA(SA) says the ‘models’ were not comparable.

New Zealand pharmacists must have a postgraduate clinical diploma or equivalent and have several years of clinical experience in a specialised area before applying for the 12-month postgraduate course.

United Kingdom pharmacist prescribers must have a minimum standard learning time of 26 days’ worth of structured learning and a 90-hour practical. Most work in general practices.

In Canada, limited emergency prescribing and prescription extension powers in 10 of 13 provinces. One province (Alberta) allows pharmacists to apply for additional prescribing authorisation. All information must be relayed back to the patient’s doctor. If it is a new condition, the pharmacist must refer the patient to a doctor for formal diagnosis and treatment.

The submission reports the model in New Zealand does not occur in isolated community pharmacies but in an integrated model with doctors. Likewise, the United Kingdom does not permit the scope of pharmacist-prescribing permitted in the NQ Pilot. The model in Alberta lacks sufficient scientific evidence to be relied upon and incorporates far more stringent requirements for referral to a doctor and record-keeping than that included in the NQ Pilot.

At the same time, the AMA(SA) observes pharmacists are not trained to prescribe safe alternatives when the commonly prescribed antibiotics are unavailable – a common problem currently in Australia.

‘Doctors do not want to compete with pharmacies, but to work with them to ensure all South Australians can access safe and effective care,’ says Dr Atchison.

Mounting evidence demonstrates why pharmacy prescribing of UTI medication is not in patients’ best interests.

Law in action

Two years after historic legislation to decriminalise abortion passed in the South Australian Parliament, South Australian Abortion Action Coalition coconvenor Brigid Coombe reports on progress.

On 7 July 2022, 16 months after the Termination of Pregnancy Act 2021 that removed abortion from criminal law in South Australia was passed, the Act was implemented in South Australia.

The South Australian Abortion Action Coalition (saaac) – a coalition of healthcare providers, lawyers, academics, students and healthcare advocates – had been campaigning to treat abortion as a normal part of healthcare and to remove barriers to access since 2016. saaac had also advocated for the passing of the Health Care (Safe Access) Amendment 2020 which prohibited intimidation near the premises of abortion providers, and immediately reduced the harm caused by anti-abortion protesters outside the PAC.

It was expected that implementation of the Act would occur soon after the law passed, so those needing and providing abortion services could benefit from its provisions as quickly as possible. However, advocacy by saaac, the AMA and RANZCOG was required before implementation finally occurred 16 months later.

Until the new legislation was implemented, all abortions in South Australia were required by law to be provided in prescribed hospitals with the certification of two medical doctors. Within the limitations of this framework, South Australia had developed a unique, high-quality system of public abortion services free for patients with Medicare eligibility (in every other jurisdiction except the NT, abortions are provided predominantly through the private sector).

South Australia was the only Australian jurisdiction where residents could not access early medication abortion (EMA) in primary care settings or by telehealth. This obstruction to care was felt particularly acutely after the COVID-19 pandemic began, while elsewhere in Australia people received the means for socially distanced abortions via telehealth.

While the Act removes many legal obstructions to improved care, especially significant for rural and remote patients, several impediments to access and quality care remain. Service availability and workforce development are among these. There is no state-wide coordination of services and Local Health Networks

are not accountable for providing abortion services for their populations. The waiting time for an abortion is frequently two weeks, even three weeks in times of high demand or lists lost to public holidays.

These delays cause distress for patients and result in abortions at higher gestation. A centralised intake system for public services, equitably provided across metropolitan and regional locations would remove administrative barriers and improve efficiency.

EMA up to nine weeks’ gestation can now be provided by doctors from GP practices and other primary care settings and by telehealth, effectively on a pregnant person’s request, as well as in hospitals. Devolving the provision of EMA to primary care will take pressure off hospital services but it must be available for free or minimal cost across services. The strategies to achieve this include funding a nurse-led public telehealth service out of the PAC, education and support for new providers. Allowing GP’s to hold a stock of the medication and giving the pharmacist a script later would also help.

Currently, there is a registration and training requirement to prescribe MS-2 Step (mifepristone and misoprostol), the only TGAapproved medical termination, and an authority script is required. The number of doctors and pharmacists who are registered to prescribe and dispense MS2-Step remains low. As a result, most regional areas are still without services, so that rural residents must travel to the city for care. The free training is a short online module and not required for obstetricians and gynaecologists. There are many supports available for new providers and 24-hour phone support for patients by MS Health nurses. saaac’s campaign ‘Ask your doctor’, which suggests patients ask their GP whether they provide EMA, will be launched shortly, to encourage uptake.

Although the legislation allows abortions from 23 weeks’ gestation, protocols to ensure access for later presentations must be implemented to ensure these complex procedures can be provided in the most appropriate location for clinical and cultural safety.

Maintaining the quality of service at the PAC is subject to the challenges of a health system under significant strain. The project ahead is to build the workforce of MS-2 Step providers and refocus support for this state’s excellent public abortion services.

www.saabortionactioncoalition.com

Termination of pregnancy | SA Health

https://www.wellbeingsa.sa.gov.au/evidence-data/pregnancyoutcome-statistics/notifying-termination-of-pregnancy

https://www.msiaustralia.org.au/for-clinicians/become-aprescriber-or-dispenser/

A duty of care

Doctors must recognise the impacts of their work and the health sector on climate change, write DEA members Dr Richard Le and Dr Vienna Tran.

It is no secret that climate change is a serious global issue. However, its impact on human health has not received the attention that it deserves. As clinicians, we are responsible for understanding the issues that affect our patients and communities. Dubbed by The Lancet as ‘the biggest global health threat of the 21st century’, climate change is no exception to this rule. Doctors for the Environment Australia (DEA) is one of many organisations that advocates for a cleaner, greener healthcare system by engaging with the public and meeting with members of parliament, including South Australia’s Health Minister Chris Picton.

Effects of climate change on health

An increasing average global temperature is having grave downstream effects on our health. Global heating is resulting in higher incidences of heatstroke and exacerbations of pre-existing health conditions, such as cardiovascular, respiratory and renal disease. Rates of hospital admissions increase during heatwaves, placing immense pressure on hospital emergency services.

A warmer planet increases the incidence of extreme weather events, such as storms, droughts, bushfires and floods. Australia is not immune. These events damage vital infrastructure and displace communities, impacting mental health.

Our duty as doctors is to be adequately informed about these well-documented effects of climate change on human health. Currently, students and experienced clinicians are co-designing a planetary health-organ system map for integration within Australia’s medical curricula. The Australian Medical Council is considering it as an additional accreditation step for medical schools. Its success may be the first step in improving how climate health is taught to medical practitioners, shaping how our workforce manages inevitable climate-related health burdens.

As we all know, the patient-doctor relationship is based on personal connection and trust. We can leverage this relationship to educate our patients on climate health, rather than relying on mass media. For example, we can engage in conversations about climate-related health and behaviour during consults and display climate-minded posters in GP practices.

Effects of healthcare

One of the fundamental precepts of medical practice is to ‘do no harm’. We follow this by providing evidence–based, high-value care for our patients. However, some of this care may involve environmentally wasteful, low-value practices that do not benefit our patients. With 7% of Australia’s total CO2 emissions coming from the healthcare industry, we have much room for

Source: Barratt et al, 2022. MJA

improvement. These emissions mostly stem from procurement of hospital goods, fossil fuel-based energy supply and pharmaceuticals. Other contributors include the masses of anaesthetic gases vented to the atmosphere daily. Unnecessary diagnostic imaging and pathology collection add to emissions: performing one CT scan and 100 Full Blood Counts together emits the CO2 equivalent of driving a petrol car for 37 km and 77 km respectively.

Many individuals and groups champion sustainable healthcare practice in their local area, but isolated silos of advocacy are not optimal. A coordinated response across local, state and national jurisdictions is required.

The 2022-2023 Federal budget committed $3.4 million in funding to the establishment and operation of a national Sustainable Healthcare Unit (SHU), a promising first step. Such a unit will provide leadership on implementation of evidence-based strategies, such as shifting to a preventative model of care, facilitating Australian hospitals’ switch to renewable electricity, and locally procuring medical supplies. South Australia has yet to establish its own SHU, but there still is time for us to lead change.

We have a duty of care to our patients. Amid the climate crisis, advocacy and environmentally informed practice are now critical components of this duty. Though it may seem overwhelming, we can all become involved individually, institutionally or on a macro-policy level. Using both bottom-up and the top-down approaches, we can collectively generate change. The will is there – we just need to act now.

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Australia Day honours

Dr Roger Sexton’s commitment to helping colleagues struggling with their own health issues has lead to his being named a Member of the Order of Australia (AM).

After many years as a rural general practitioner in Mount Pleasant and as a rural locum, Dr Roger Sexton was driven to jump in to help doctors drowning in overwork, weighed down by their sense of responsibility to patients.

Seeing colleagues at the point of exhaustion and despair, Dr Sexton had a founding role in establishing the Dr DOC program in 1999 and Doctors’ Health SA Program in 2010 – the latter becoming a national benchmark in educating and supporting doctors to build a sustainable working life.

During his involvement in medical complaints on the SA Medical Board, Dr Sexton became increasingly concerned that doctors who were clearly unwell and unable to practise to the best of their ability were being subjected to a disciplinary complaint process. He was convinced that this should be recognised as a health problem rather than something warranting a punitive process.

Since then, he has used a range of forums to champion doctors’ health and wellbeing, including as a director of the national Doctors’ Health Services board, chair of the Australasian Doctors Health Network, vice chair of medical indemnity provider MIGA and recently as convenor of the Doctors’ Health Conference in Adelaide.

For this work in doctors’ health, and for service to the medical profession, he was in January included in the Australia Day Honours List as a Member of the Order of Australia (AM).

The award follows his admission last year to the AMA Roll of Fellows, ‘for his contribution to the health and well-being

of medical students and medical practitioner colleagues’.

‘I was seeing colleagues experiencing multiple barriers to health care for themselves, as well as those in various stages of burnout – they were facing complex cases, on call all the time and not able to get the rest they required to do the job sustainably,’ Dr Sexton says.

‘There was also very disturbing news of doctors who had suicided and I felt that this was not being acknowledged for the sentinel event that it was. There did not appear to be a profession-wide and system-wide response.’

This became the impetus to work towards a program that would support doctors, and particularly those in rural areas, who lacked access to peer and professional support. The focus became educating doctors about how to ‘stay well’ in a very demanding profession and providing health services for doctors via phone support, telehealth, after-hours support and crisis intervention.

While his own workload seems heavy, Dr Sexton is a strong proponent of balance and harmony in all things: work balanced with sleep, exercise, nutrition, creative interests, and a focus on relationships because many busy doctors find that they lose their place in the family by working too much.

There’s plenty more to do though, he says – particularly as GPs are in crisis after years of too little funding in the sector. He says doctors are trapped by their desire to do the best they can for their patients and feeling that they have to do more and more with less.

This vulnerability is leading to a dangerous ‘scope creep’ from other

professions that will inevitably lead to lower patient care, Dr Sexton warns.

‘I’m energised by the impact of helping doctors. If, for every doctor you help to become sustainable, you are helping 2000 Australians, that’s pretty rewarding,’ he says.

STAY IN TOUCH

Dr Michelle Atchison @AMASApresident

AMA Federal @ama_media

@ama_south_australia

AMA(SA) @AMASouthAustralia

Why are you a plastic surgeon?

I think I always thought that being a doctor was a good thing to do. My father was a surgeon and had a very driven work ethic to help treat patients. I was drawn to plastic and reconstructive surgery as it is made of diverse challenges in surgery. In particular, it was in the emergence of microsurgery that was most challenging and complex. The tangible and visible changes in surgical procedures were appealing as a way to help patients manage their conditions and treatments.

What work do you do for Interplast?

Interplast is an Australian and New Zealand not-for-profit organisation that assists with plastic and reconstructive surgery in 17 different countries in southern Pacific and Asian countries. Since becoming involved in Bhutan, I have been on seven trips and become the Bhutan country coordinator for Interplast. An intrinsic love of remote travel and seeing what surgical challenges were needed made me interested in this region.

We have a formal agreement with the Bhutanese Government to allow us to visit and treat patients in the hospitals. We bring a team of surgeons, anesthetists, theatre staff and hand therapists.

We also bring surgical equipment and supplies so we are self-sufficient and don’t use their precious resources. We are asked to see and treat patients who have conditions that the local surgeons are unable to treat. This includes burn injuries, cleft lip and palate, complex wounds, hand injuries with tendons and nerves and a broad range of plastic surgical conditions.

One unique injury we are often asked to

treat is the Himalayan bear maul that may remove part of the face of the unlucky individual caught out in the mountains.

We are also training a young Bhutanese general surgeon in plastic and reconstructive surgery to help provide the country with some continual and independent treatment. We are meeting with the Bhutanese government on our next trip this year to try to establish a second trainee in this field.

Why do you support professional associations?

What starts as a small involvement turns into a bigger one! Working with your associations is actually one of the most interesting involvements that you can have, as you work with peers from all states and NZ. Examining the candidates in Royal Australasian College of Surgeons fellowship examinations is particularly challenging and rewarding.

What are you most proud of?

I don’t think in terms of pride, more completing a job as safely and appropriately as possible. I can think of one of these occasions when working for the Australasian Foundation of Plastic Surgery in the Northern Territory, undertaking wound healing teaching programs in remote communities. There we could train and then guide Indigenous health workers learning how to sew wounds which they mastered very quickly.

Getting thanks from patients from any type of work is rewarding. Providing surgical treatment to patients in Bhutan where there is no treatment available provides some personal rewards.

What does receiving the Australia Day Honour mean to you?

This is an unexpected honour and doesn’t really cross your mind. The honour is proposed by your colleagues who act to nominate you. I am sure a large number of worthy individuals have never been nominated.

What advice would you offer to someone starting in plastic surgery?

Firstly, get yourself the best possible training you can. You will need the best possible decision-making skills, dexterity, accuracy and efficiency. You will need all sorts of tools to help with time management, making back-up plans and providing support for patients and for your staff and yourself. Overseas travel and training help with skills you can bring home.

Secondly, there will always be a pathway alongside your training and career that allows you to contribute. It may be to involve yourself in the registrar training society, your College, or a benevolent institution. Whatever it is, it takes you out of your comfort zone and you help others. It may not be something you take up straight away in your training or early career, but keep your options open and seek them when they arrive. In my experience it will reward and sustain you.

Long-time AMA member Dr Tim Proudman is a Member of the Order of Australia (AM) after being awarded ‘for significant service to plastic and reconstructive surgery, and to professional organisations’.

Magic moments

AMA(SA) will stage a Gala Ball in May to honour President Dr Michelle Atchison and welcome her successor.

The Gala Ball will be staged at the Adelaide Town Hall on 20 May 2023.

AMA(SA) CEO Dr Samantha Mead said that for the foreseeable future, the AMA(SA) Executive Board had chosen to stage gala events to coincide with the election of a new president, which usually occurs every two years.

The most recent Gala Dinner heralded the presidency of former Vice President Dr Atchison, who assumed the role after Dr Chris Moy held the position for two years. It was also held at the Town Hall.

Dr Atchison said that after two successive scheduling conflicts, the AMA(SA) will this year stage the Ball on a night that does not coincide with an AFL match at Adelaide Oval.

‘As Crows fans, Chris and I were slightly distracted by audience discussion of one of the closest finishes at Adelaide Oval for some time,’ Dr Atchison said of the 2021 dinner.

‘It was an exceptionally successful night for all of us.’

Entertainment will be provided by magician and illusionist Matt Tarrant, who again performed to sell-out audiences at the 2023 Fringe.

The Adelaide-based ‘mentalist’, who recently won an award for Best Cabaret/Variety at FRINGE WORLD Festival, has promised a mesmorising evening that will flummox even psychiatrist members of AMA(SA) – including Dr Atchsion herself.

Tickets are available through the AMA(SA) website.

AMA(SA) COUNCIL AND EXECUTIVE BOARD

AMA(SA) COUNCIL

Office Bearers

President: Dr Michelle Atchison

Vice President: Dr John Williams

Immediate Past President: Dr Chris Moy

Ordinary Members

Dr Vikas Jasoria

Dr Laureen Lawlor-Smith

Dr Nimit Singhal

Dr Krishnaswamy Sundararajan

Dr Hannah Szewczyk

A/Prof William Tam

Dr John Williams

Practice group/region representatives

Anaesthetists: Dr Louis Papilion

Dermatologists: Dr Karen Koh

Doctors in Training: Dr Hayden Cain

Emergency Medicine: Dr Cathrin Parsch

General Practitioners: Dr Bridget Sawyer

Intensive Care: Dr Rajaram Ramadoss

Obstetricians and Gynaecologists: Dr Brian Peat

Orthopaedic Surgeons: Prof Edward (Ted) Mah

Paediatricians: Dr Patrick Quinn

Pathologists: Dr Shriram Nath

Physicians: Dr Andrew Russell

Psychiatrists: Prof Tarun Bastiampillai

Public Hospitals: Dr Clair Pridmore

Surgeons: A/Prof Peter Subramaniam

Southern: Dr Richard Try

Medical school representatives

University of Adelaide: Isaac Tennant

Flinders University: Jordyn Tomba

AMA(SA) EXECUTIVE BOARD

Dr Michelle Atchison, Mr Andrew Brown, Dr Guy Christie-Taylor, Dr John Nelson, A/Prof William Tam, Ms Megan Webster, Dr John Williams

SA MEMBERS OF AMA FEDERAL COUNCIL

Dr Michelle Atchison, Dr Matthew McConnell, Prof Ted Mah, Dr Clair Pridmore, Dr Hannah Szewczyk

AMA(SA) 2023 Gala Ball special guest Matt Tarrant

Council news

as Isaac Tennant of the University of Adelaide and Jordyn Tomba of Flinders University.

this is not a good use of resources; nor is it helpful for patients.

Dr Brian Peat Obstetricians and Gynaecologists Representative

February

As has become our custom, chair Dr Peter Subramaniam began the meeting on 2 February with an acknowledgement of the Kaurna people, the custodians of the Adelaide Plains and greeted us with some words from the Kaurna language. New medical student representatives were introduced

COVID was again the first item of business. Comments suggested that members believe the published numbers are an underestimate of the true number in the state. SA Health has called for expressions of interest for GP clinics to take on the task of the respiratory clinics due to close at the end of February. Councillors agreed that while there had been little word about access to the next ‘booster’ healthcare workers, at least, should be able to receive a fifth dose. (Federal Health Minister Mark Butler announced six days after the meeting that fifth doses would become available from late February.)

A huge effect of the pandemic has been the increase of elective (non-urgent) surgery waiting lists. At present the focus on reducing this has been to operate on Category I patients. The private sector is at capacity. Category III patients, such as those awaiting hip surgery, are being further delayed. In many cases, non-urgent cases are being delayed until they become urgent and an emergency. We noted that

The next item was the loss of training accreditation of several areas of the Women’s and Children’s Hospital: general medicine, and the paediatric and neo-natal intensive care units (PICU and NICU). It was explained that the fundamental problem is staff shortages, especially at the junior levels. One outcome is that teaching and research time are being sacrificed to provide a service function. It is a vicious cycle; without accreditation the units cannot recruit quality staff and cannot regain training accreditation. Without trainees, there will be no specialists. SA Health is aware, and the Minister is aware, but we await the solution.

Negotiations have begun for the new fee-for-service contract for rural doctors. Support was expressed for the so-called single employer model (SEM) for GP trainees.

The future crisis in general practice workforce was highlighted: only about 19% of junior doctors are expressing an interest in general practice as a career and many GP training positions are unfilled.

proposes to enable training medical officers to keep their entitlements such as for annual leave, sick leave and long service leave.

Dr Andrew Russell Physician Representative

March

Despite being an AMA(SA) Council member for some time, in various roles, I continue to be impressed by the breadth of the issues discussed within our Council.

We began with an update on a meeting with AMA Tasmania where recently a single employer model has been introduced for trainee medical officers within the health system. The model

The next agenda item was COVID-19. Many people are now eligible for a winter booster or 2023 dose with the focus on bivalent vaccines due from early March. It appears that most vaccinations will be delivered by general practices and pharmacies. The president is planning to discuss the future vaccination plans of SA health for public hospital staff with the Minister. Discussion about Long COVID referred to an SA Health webinar aimed at GPs but potentially useful for all doctors. This led onto a discussion of COVID-19 fatigue, workforce culture, and local and national responses.

We then addressed regional Issues and the closure of practices. Many country GPs are approaching retirement with a significant threat to future services. A member outlined their experience of a significant contrast between the responses in Victoria and in South Australia to a regional practice closure. AMA(SA) is again involved in negotiating contracts for rural doctors.

Accreditation for paediatric training at the Women’s and Children’s Hospital continues to demand resources. Issues include balancing clinical workloads; quarantined research, teaching and study time; and ensuring trainees receive adequate, supervised clinical experience within supportive learning and clinical environments. This requires a medical, cultural and human relations response.

Decriminalisation of abortion in South Australia as led to some changes in how women can and should be able to access terminations in South Australia.

We considered again the issue of junior doctor shortages. There is some frustration at the poor of data within the SA Health system. There are significant incentives for junior medical officers to move to other states.

There was mention of a federal roundtable on GP services as part of the Medicare modernisation and the election promised delivery of urgent care clinics without planning or consultation.

Nominations to join Council are now open. Members can nominate to fill several positions, and Councillors can nominate for the President and Vice President roles.

BENJAMIN ALLEN

BEN BEAMOND

COLLIE BEGG

SAMUEL BENVENISTE

SCOTT BRUMBY

DAVID CAMPBELL

NICHOLAS CHABREL

RICHARD CLARNETTE

ANDREW COMLEY

WILLIAM DUNCAN

CHI KANG GOOI

PETER LEWIS

BASEL MASRI

RORY MONTGOMERY

MARK RICKMAN

MICHAEL SANDOW

CHEN TU

ARTHUR TUROW

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Doctors are VIPs in accessing VAD services

South Australia’s law to provide access to voluntary assisted dying came into effect on 31 January.

VAD Review Board Presiding Member Associate Professor Melanie Turner reports on progress.

Now that the legislation has come into effect, how are things going?

Overall, people in the South Australian community are actively accessing information on voluntary assisted dying (VAD) and we are seeing enquiries and requests for information being made through the Care Navigator Service and the Local Health Network Liaison Nurses. People have also been making their first request to their doctor and commencing the formal process through the VAD Clinical Portal.

It has also been rewarding to see the hard work of the VAD Implementation Taskforce, chaired by Dr Chris Moy, come to fruition as well as the ongoing dedication of the VAD teams. The Review Board has a lot of confidence that the first month of operations has been safe, accessible and compassionate. How many doctors are participating in VAD?

We continue to see more doctors registering in the VAD Clinical Portal every day, as well as receiving contact from clinicians enquiring about training. We continue to encourage any doctors with an interest in VAD or who believe they may in the future provide access for their patients, to register online so we can notify them of online training and future face-to-face training dates and keep them informed. We have conducted face-to-face training as an alternative to the online training and having both options provides a more flexible approach to meet doctors’ availability. As of the end of February 2023, we had 86 doctors registered in the VAD Clinical Portal and 40 fully trained.

How many people have requested access to VAD in South Australia?

In the first month of VAD being operational in South Australia, 20 people made a first request to commence the process to access the pathway, and six

permits were issued by SA Health Chief Executive Dr Robyn Lawrence.

Permits issued is not an indication of the number of people who have administered the medication. Experience from other states indicates simply having access to the choice can provide comfort and reduce a person’s suffering.

The VAD legislation contains strict confidentiality provisions which prevent the disclosure of information except under certain circumstances. To protect the privacy of the people accessing VAD, the VAD Review Board will not provide data until it is sufficiently large so that there is no risk that a person might be identified through this disclosure. Has there been feedback from patients and families?

The Review Board has already been made aware of some lovely feedback provided by patients and families that demonstrates the compassionate approach taken by the staff supporting VAD. In particular, we have heard that the Care Navigators and Local Health Network Liaisons are highly regarded and have been respectful, thoughtful and gone above and beyond to assist patients.

How can people provide feedback on their experience?

We really welcome feedback to support the VAD Review Board to undertake its role in continuous improvement for VAD. Feedback provided directly to the relevant service by patient, families and by doctors is valuable in helping us to put a human face to the data we receive. The Review Board has also published a ‘personal reflection’ form that we encourage patients, families and doctors to complete. The more feedback we receive from people involved in VAD at any stage, the better we can review and inform changes to the VAD process and future legislation. The form is available on the SA Health website at

Personal+reflection+form+V3_fillable+(1). pdf (sahealth.sa.gov.au)

What support is there for doctors?

Doctors play such a crucial role in assessing eligibility and facilitating access to VAD and we continue to look at ways to provide information and support to practitioners. We continue to offer both online and face to face training to support doctors to be registered and eligible to support VAD.

The VAD Clinical Portal has been working well to facilitate the mandatory submission of forms and the permit application process. The Care Navigators and LHN Liaison Nurses have been providing coordination and patient support to assist doctors in facilitating each step of the pathway.

Finally, an expression of interest has been distributed to trained practitioners to invite them to participate in a VAD Community of Practice, which will provide a peer support network for doctors in a safe and collegiate environment. Interstate, many practitioners have found a community of practice to be a highly valuable and supportive group to be a part of.

Any final words?

The Review Board is committed to continuous improvement of safe and compassionate access to VAD. We are grateful to all of those who came before us to deliver this legislation and we will continue to ensure a high-quality VAD service to all South Australians. We will continue to monitor trends in the data to identify barriers to access and support doctors to maximise their ability to participate and support our community.

Accessing VAD - impact on life insurance

As voluntary assisted dying (VAD) has become legal in South Australia, it is likely medical professionals will over time have patients enquiring about the process and implications. While it is not the role of medical professionals to provide advice on life insurance and superannuation, it is important they understand the impact of the legislation on patients and their welfare.

How will choosing VAD affect a patient’s life insurance?

The Voluntary Assisted Dying Act 2021 (SA) (the VAD Act) will not affect a person’s eligibility for life insurance.

Section 228 of the Life Insurance Act 1995 (Cth) provides that:

‘(a) life company may only avoid a life policy on the ground that the person whose life is insured by the policy committed suicide if the policy expressly excludes liability in case of suicide.’

The Life Insurance Act 1995 (Cth) does not provide a definition of suicide. However, section 6 of the VAD Act provides that:

‘for the purposes of the laws of the State, the death of a person by the administration of a voluntary assisted dying substance in accordance with this Act will be taken not to constitute the death by suicide of the person.’

Since VAD is not classified as a suicide, a life insurance company is unable to expressly exclude liability where a person chooses VAD at the end of life.

Is a patient eligible for their superannuation if they choose VAD?

Yes, but subject to any eligibility requirements. The governing rules of a super fund set out when benefits can be paid and who they can be paid to, so the eligibility criteria may differ between super fund providers. A patient should check

with their super fund before commencing any VAD procedures.

A superannuation death benefit may be released to a dependant (as defined in the Superannuation Industry (Supervision) Act 1993 (Cth)) or to the trustee of a deceased estate after the superannuation fund member has died. If your patient is thinking of undergoing an end-of-life procedure, they should consider nominating a beneficiary with their super provider.

Nominations can be binding or nonbinding. A binding nomination means the patient can determine who should obtain the superannuation benefit upon their death, subject to the rules of the superannuation fund. A non-binding nomination grants the trustee the discretion to decide to whom the benefit is paid.

Can patients access a terminal illness claim from their superannuation?

If a person is diagnosed with a terminal illness, they can be eligible for ‘early release’ of superannuation. Policies differ among superannuation funds and insurers, but Schedule 1 of the Superannuation Industry (Supervision) Regulations 1994 (Cth) provides that a:

‘terminal medical condition’ will only exist if (among other requirements) two registered medical practitioners have certified, jointly or separately, that the person suffers from illness, or has incurred an injury, that is likely to result in the death of the person within a period that ends not more than 24 months after the date of the certification, and at least one of the registered medical practitioners is a specialist practicing in an area related to the illness or injury suffered by the person.’

The early release of superannuation for reason of a terminal illness is a lump sum benefit that is paid tax-free under the Income Tax Assessment Act 1997 (Cth). A

patient wishing to access the VAD scheme should obtain financial advice on whether it is advantageous to have the superannuation paid as a terminal illness benefit as opposed to being paid out after death, which can incur taxes.

How does the VAD Act interact with an advance care directive?

The VAD Act requires the patient to have decision-making capacity throughout the process of approval for treatment. In contrast, the advance care directive will only take effect at the point where the person ceases to have decision-making capacity. As such, a patient is unable to proactively consent to VAD in their advance care directive as it is directly contradictory with the need to have capacity at the time they undergo the VAD treatment.

We highly recommend that medical professionals refer patients with these concerns to financial advisers and accountants where appropriate.

It is important to note that doctors are legally entitled to conscientiously object to supporting access to VAD but are obliged to refer a patient to another doctor willing to provide information.

The implementation of voluntary assisted dying may raise questions among patients worried about any impact on their life insurance and superannuation policies, writes Lincoln Smith.

Decision-making capacity is the key

Patients may ask why advance care directives cannot include any intentions about VAD, writes Advance Care Planning’s Xanthe Sansome.

What are the most common questions people ask about advance care planning in general, and specifically in relation to VAD?

The main questions are, ‘When should I consider advance care planning?’ ‘What should I write?’ ‘Can it be overridden?’ ‘Can people with dementia do advance care planning?’ ‘Can I express in my advanced care directive (ACD) a preference for assistance in dying if I experience a debilitating medical event?’

Have doctors and others found challenges in explaining the differences and boundaries between voluntary assisted dying (VAD) and ACD in other states where VAD has been introduced?

The short answer is no. Both represent the right of a person to choose. A person can complete an ACD and they can also request VAD, however they cannot request VAD in their ACD. An ACD does not come into effect until the person loses the ability to make decisions for themselves, while you must have decision-making capacity to participate in and consent to VAD. So, they are actually mutually exclusive: VAD must happen before a person loses decisionmaking capacity, but an ACD only comes into effect after a person has lost this capacity.

Have you found that people expect to be able to nominate a wish for VAD in their advance care planning documentation?

Yes, people complete an ACD and express their preferences for future health care. VAD may be one of these preferences, despite the fact that assisted dying cannot be enacted if a person loses decisionmaking capacity as described above. How important is it to complete ACD before an illness robs a person of decision-making capacity?

It is vitally important that a person can articulate their directions and preferences for care and treatment and appoint a substitute decision-maker while they still have decision-making capacity. If this capacity is evident at the time of writing, people should not question what is written. None of us know when we might experience a stroke, other cerebral event or develop dementia that suddenly or progressively makes us unable to make decisions. We all need to choose now who we want to make decisions on our behalf and what it is we would want them to say (and tell them!). It is the strongest legal protection available to ensure the person's wishes will be respected.

Why does the Australian uptake of formal advance care planning documentation remain low?

Overseas studies suggest one of the reasons is that health professionals do not have sufficient knowledge, skills, confidence or time to start the conversation or know when to enact a document. Individuals report the main reasons are their age, health, emotion, lack of knowledge of process and rights, fear , and concerns over broken relationships and whether it will be followed correctly.

Australian researchers found residential aged care homes did not implement ACP for similar reasons and also a lack of resource and system support or residents’ cognitive capacity.

While most of us accept that death is inevitable, we do not like to think of dying as anything other than ‘dying peacefully in our sleep’. Despite more than 70% of Australians wanting to die at home, less than a quarter achieve this. People are not aware they can have a choice, do not want to be the one to raise it with clinicians and may believe, incorrectly, that treatment is ‘all or nothing’. Many cultures say death is a taboo topic and some religions believe life and death are pre-determined by their god.

What is the role of the GP or other clinician in supporting a patient in completing the advance care planning process?

The GP should initiate or progress the conversation about advance care planning. They should answer questions the person has, and be open about the likely trajectory of ageing and any conditions. They may be asked to sign an ACD, so they should be willing to discuss best medical practice and the realities of the decisions and preferences (for example, CPR is likely to have an X% success rate and has a XX% chance of causing a fracture to ribs). How has the pandemic affected people’s consideration of their end of life preferences and advance care planning?

Advance care planning became urgent health care planning in the pandemic. There had been an increased interest in people's wishes, and when people contract COVID the focus is on imminent care. Since COVID arrived, people's awareness that they might get very sick very quickly has improved their attitude and willingness to participate in end of life planning. Do most people who complete ACD do so to ensure their wishes are followed, or to support loved ones at that time, or both?

I think they are both key motivators –people want their wishes respected, but in doing so they hope to make it easier for their family.

National Advanced Care Planning Week <https://www.advancecareplanning.org. au/nacpweek>, from 20 to 26 March 2023, is an opportunity for people to learn more about advance care planning.

introducing our new orthopaedic surgeon, Dr Tom Gieroba

We are delighted to welcome Dr Gieroba to our sportsmed team.

Dr Tom Gieroba is an Australian-trained orthopaedic surgeon. Specialising in preventative care, treatment and rehabilitation for a range of hip and knee ailments, injuries and conditions.

He has undertaken further specialist fellowship training at St Vincent’s Hospital in Melbourne on arthroplasty and sarcoma surgery.

He has a particular interest in joint replacement, trauma and fracture management and sports-related knee injuries.

Trained in robotic surgical techniques, including robotic-arm assisted surgery with the Mako surgical robot, Dr Gieroba is able to offer his patients expert advice and a range of treatment options.

When not at work, Tom enjoys spending time with his wife and four kids. He also enjoys tennis and is part of sportsmed’s running club.

Dr Gieroba is available for consultation at our Stepney Healthcare Hub, with surgeries performed onsite, at our purpose built private orthopaedic hospital.

For all appointments & enquiries with Dr Gieroba, please call 08 8362 7788 or email ortho@sportsmed.com.au. You can also fax our team on 08 8362 0071.

COVER FEATURE

VAD changes ‘cause of death’ reporting

The introduction of voluntary assisted dying (VAD) in South Australia has profound implications for many of our members and the broader community.

One feature of end-of life-care that has already changed is to the form that reports a patient’s cause of death.

The Births, Deaths and Marriages (BDM) Registration Office has provided a new ‘cause of death’ form that doctors must now complete when certifying a death. The introduction of the form coincides with the availability of VAD in South Australia. Changes to the form

While most content remains unchanged, the form has been changed to:

• include questions to elicit the information required under section 84 of the Voluntary Assisted Dying Act 2021 from a medical practitioner about the death of a person who is the subject of an assisted dying permit

• include more information about deaths that must be reported to the Coroner

• re-order and re-format the content of the form

• allow the form to be completed electronically

• allow for the doctor’s electronic signature to be added to the form enable uploading of the form to a BDM webpage.

When to use the form

The form must be used for all deaths that must be reported to BDM, including but not limited to deaths through VAD.

In the case of a perinatal death (a live born child dying within 28 days of birth) or a stillbirth, a medical certificate of cause of perinatal death form should be completed.

Obtaining a copy of the form

An e-copy of the form can be accessed by emailing BDM at registrations.bdm@agd.sa.gov.au

Please contact Births, Deaths and Marriages on 131 882 or email registrations.bdm@agd.sa.gov.au if you have any questions.

AMA calls for indexed Medicare

The Australian Medical Association says critical problems in general practice of access and affordability can’t be addressed without better indexation of Medicare.

Comparing Medicare indexation of 1.6 per cent with the indexation figure of 3.7 percent for public hospital services, released recently by the Independent Health and Aged Care Pricing Authority (IHACPA), shows just how poorly Medicare is indexed, contributing to declining bulk billing rates and higher out-of-pocket costs for patients.

The IHACPA indexed the National Efficient Price (NEP) for 2023–24 at a rate of 2.9 per cent per annum, plus an additional 0.81 per cent to account for increases in the minimum superannuation guarantee between 2020–21 and 2023–24.

AMA President Professor Steve Robson said the formula for indexing Medicare was broken, and the IHACPA decision was more evidence of this.

‘The formula for indexing Medicare has become a joke. It is delivering an indexation rate that falls well behind the rate of increase in key economic measures like the Consumer Price Index, Average Weekly Earnings, and the Wage Price Index,’ Professor Robson said.

‘Years of inadequate indexation has meant the Medicare rebate no longer bears any relationship to the actual cost of providing high-quality services to patients. This is one reason we’re seeing more practices unable to offer bulk-billing for even the most vulnerable of patients, with wages and increasing practice running costs all funded from the rebate.’

The AMA analysed the effect of poor Medicare indexation on the item most often used by doctors, the Level B item for consultations lasting less than 20 minutes, and identified that the government has ‘saved’ $8.6 billion since 1993.

The AMA Gaps Poster demonstrates that successive

governments have been stripping healthcare funding from Australian taxpayers through poor indexation and shifting the cost of care onto everyday Australians.

‘We can see how poor indexation saves the government money, but this is really stripping out essential funding in Medicare by stealth, with patients bearing the brunt of higher out-of-pocket costs,’ Dr Robson said.

‘Doctors can’t keep absorbing these costs. If the government is serious about addressing affordability and access to medical care, including general practice, it just can’t ignore indexation – it’s as simple as that.’

The AMA Gaps poster illustrates how successive federal governments have failed to index the Medicare schedule fees in line with the CPI and average weekly earnings.

Research briefs

Size matters in food orders

Verbal size descriptors can prompt people to order a larger meal size online, according to new research from Flinders University

Having an XL (extra-large) option proved influential in determining a person’s choice for a larger order – although surprising restraint was shown by diners who admitted they were following dietary regimes.

Study recipients were all female students, some following diets (restrained eaters) and some unrestrained. They were asked to select a side dish, drink, and dessert from one of three online menus with varying portion size options: SRL (small, regular and large), RLXL (regular, large, and extra-large) or SRLXL (small, regular, large, and extra-large).

Participants most frequently selected the ‘regular’ size for sides and drinks, or a small size for desserts. However, when an XL size was available, the ‘unrestrained’ eaters were more likely than ‘restrained’ eaters to select a Large or XL side dish.

The findings support an overall preference for a normal-sounding portion size. Professor Kemps says it would therefore be a useful strategy to reduce excessive calorie intake by also reducing the size of regular serving portions to an amount closer to current health guidelines.

‘These findings suggest that people may perceive a “normal” portion size based on the reference point option (calling it “regular”), rather than the middle available size option and thus select accordingly,’ she says.

Alzheimer’s treatment trialled

A pioneering treatment for Alzheimer’s disease, developed at the University of Queensland, is being tested in a safety trial underway in Brisbane.

The safety trial – with a limit of 12 participants – is the culmination of a decade of ongoing research led by Professor Jürgen Götz at UQ’s Queensland Brain Institute (QBI).

Professor Götz said the study was an important step to determine whether the ultrasound could be safely delivered, following pioneering discoveries about its potential use to improve memory function.

The 12-month trial treats an area at the back of the brain that is affected early in the course of Alzheimer’s disease.

Each participant receives four treatments which will be administered fortnightly, and after completing the course, they’ll have an MRI scan of the brain and a repeat cognitive test.

Information about the clinical trial is available at the Scanning Ultrasound Study website

Baby sleep interventions ‘safe’

They may seem like hell at the time for parents but interventions such as controlled crying have been demonstrated to help infants (and their parents) get a good night’s sleep, says Flinders University infant sleep expert Dr Michael Kahn.

A study of more than 2000 US parents of babies aged three to 18 months highlights the benefits and safety of behavioural sleep interventions (BSIs) – as difficult they might seem to implement.

The study found that implementing unmodified (cry it out) and modified extinction (controlled crying) interventions are effective in decreasing paediatric insomnia symptoms.

‘Our study provides further evidence for the safety of these interventions by demonstrating that parents who had and had not used them did not differ in measures of parent-infant bonding, parent depression, or parent sleep.’

‘Many parents may want to try these interventions but are reluctant given non-based claims that they are unsafe,’ Dr Kahn says.

‘Parents and clinicians should thus be aware of the range of safe evidence-based treatments available to ameliorate infant sleep problems, which could considerably improve parents’ health and wellbeing.’

Placenta study aims to reduce infertility

A study of the interactions between the early placenta cells and the mother’s uterus led by the University of Adelaide aims to help reduce infertility and pregnancy complications.

Chief Lead investigator, Professor Jose Polo, Director of the Adelaide Centre for Epigenetics at the University of Adelaide, says the project will focus on how the different placental cell types develop from embryo implantation to the first few weeks of development that occur before a woman is aware she is pregnant.

It will also identify important developmental check points in placenta cell development that lead to common pregnancy complications when they go wrong.

Researchers have known that pregnancy complications have their origins in the first days and weeks of pregnancy but needed a cellular and molecular toolkit to dive deep into the issue.

The five-year project is titled, ‘Using complex models of human trophoblast to study placental biology and disease’.

At-home tests could reduce colonoscopies

A new study has found there is a low risk of advanced bowel tumours following multiple negative home faecal immunochemical tests.

Lead author Dr Molla Wassie, an NHMRC Emerging Leadership Fellow in the Flinders Health and Medical Research Institute, says the research shows the faecal immunochemical tests could help identify those who could extend their colonoscopy surveillance intervals.

“Due to the risks, costs and burden on the health care system from surveillance colonoscopies for bowel cancer, there is a need to explore how we can further personalise screening intervals,” she says.

The team conducted a retrospective study of more than 3,300 individuals who had had no bowel cancer found at their previous colonoscopy and had been recommended to have another in three to five years, while also being sent a faecal immunochemical test annually.

‘We found the risk of the follow-up colonoscopy identifying advanced neoplastic lesions including cancer following a negative FIT was around 1 in 10, with this risk decreasing further with every subsequent negative result, with the risk only 5.7 percent after four negative tests,’ says Dr Wassie.

‘Our study supports the introduction of annual at home faecal immunochemical tests to be incorporated into surveillance programs.’

Screening increases walking chances

Children with spinal muscular atrophy (SMA) are more likely to walk, be more functionally independent and free of respiratory and feeding support when screened, diagnosed and treated shortly after birth, according to a new study conducted at Sydney Children’s Hospitals Network (SCHN) by UNSW Sydney researchers.

The findings show newborn bloodspot screening (NBS) for SMA, coupled with potential to access disease-modifying therapies, is correlated with greater motor milestone acquisition - those diagnosed before the onset of symptoms reach regular childhood developmental milestones.

The study, published in The Lancet Child & Adolescent Health, is one of the first to investigate the effectiveness of NBS for SMA beyond clinical trial populations. SMA is a potentially fatal genetic condition caused by a missing or faulty SMN1 gene and it is usually diagnosed after symptoms appear – by which point many children irreversibly lost up to 90% of their motor nerves.

chorus of voices’

The health of the medical profession was the focus of the biennial Australasian Doctors’ Health Conference held in Adelaide in December 2022. The conference title of ‘The thriving doctor: towards harmony, productivity, longevity’ deliberately asked delegates and presenters to consider ways to optimise the health of doctors at home and at work, over the long-term.

This was a significant event for many reasons.

It confirmed the existence of the growing and connected movement of concerned individuals and leaders across Australia who are committed to improving the health of the profession. It exposed a shift in awareness of the significant work, health and safety obligations of employers and their need to provide safe workplaces and humane work practices for their doctoremployees. And it highlighted three systemic issues: the need to include doctors’ wellbeing criteria in the accreditation of training places and practices, the need to address the regulatory duress and personal stress arising from Ahpra’s complaints process, and the expectation that doctors must simply adapt as best they can to whatever workplace conditions are offered to them.

International keynote speakers presented via Zoom. They included Dr Helen Garr, a British GP who heads the NHS Practitioner Health Program in the UK. This service has expanded from caring for doctors to now caring for the other health professional staff working in the NHS. It is a large, well-funded, whole-of-system service that is firmly embedded in the NHS structure. Nothing like this exists in any Australian government jurisdiction.

Dr Tait Shanafelt is a physician from California who has led the Stanford doctor wellbeing program for many years. His presentation emphasised the importance of embedding wellbeing officers in workplaces as advocates for change and the potential impact of even small changes in workplaces and to work practices. He discussed ways to highlight to administrators the return on investment.

Individual stories are always powerful. Delegates heard many moving presentations from exceptional doctors, working in difficult personal and professional circumstances, that were

cathartic for the presenters and enlightening and inspiring for their audiences.

I found the rural presentations especially moving. They personalised and underlined the key messages of the conference:

• the personal obligation to prioritise and optimise our own lifestyle habits and health care with a GP and a network of personal and professional advisers

• at the workplace level, the obligation of employers to provide a legally safe and humane working environment that supports doctors in their work and does not require excessive, stressful adaptation. Imagine, as one conference paper described, having to eat boiled rice for two weeks while working 24/7 in a remote community!

• at the system level, where accreditation of practices and training places includes doctor wellbeing criteria, and where the regulatory process around complaints is clearly understood by all involved as being efficient as possible and compassionate towards doctors.

Important connections were made at the conference. The national network of doctors’ health programs currently chaired by Doctors’ Health SA, has strengthened and will build their local program capacity. More wellbeing officers in tertiary hospitals will emerge. Aphra is examining the impact of its regulatory processes. Accreditation is emerging as a tool of change.

The conference affirmed to me the value of being persistent. Everyone gains from a healthier medical profession: our patients, ourselves, our colleagues and the next generation of doctors, the taxpayer and the health system. Programs must be independent and funded adequately to do the job properly.

We need a chorus of loud, coordinated voices to entrench self-care as a personal and professional obligation from medical school entry. We must advocate fearlessly for healthy workplaces and work practices and health systems that compassionately consider the wellbeing of doctors, wherever they work.

So, as I settle into my evening meal tonight, I will think of boiled rice and how special our colleagues really are.

‘A

Australasian Doctors’ Health Conference convenor Dr Roger Sexton reflects on a gathering staged at an important period in the recognition of the importance of doctors’ self-care.

Dr Roger SExton with Doctors’ Health SA colleague Kiara Cannizzaro

Unwell doctors fear reporting impacts

A new study reinforces evidence that doctors fear reporting symptoms of mental health or substance use issues, even to their doctors.

A study of the impact of the regulatory complaints process on doctors has found just what many have suspected – that it deters doctors with mental health problems from seeking help.

The study was conducted by doctor and lawyer, Dr Owen Bradfield, from the University of Melbourne, who interviewed doctors at the centre of a medical complaints process relating to mental health or substance use challenges.

A 2019 study by Beyond Blue found that doctors experience high rates of depression, anxiety and substance abuse, with risk factors including long working hours, stressful working environments, poor work-life balance, and easy access to medication.

Dr Bradfield interviewed 25 doctors, 21 with a history of mental health and substance abuse challenges and four with experience as treating doctors as patients.

The aim, says Dr Bradfield, was to to explore how unwell doctors experience regulatory processes and the impacts of those processes on their health.

He says he found interviewing the doctors ‘humbling’.

‘For many of them, I was the first person they felt safe talking to about their problems. Some had not wanted to burden their family or talk to their colleagues or peers, due to fear or shame,’ he says.

His study, published in the International Journal of Law and Psychiatry, found the regulatory complaints processes often resulted in the doctors receiving muchneeded treatment. However, it also found the regulatory processes themselves led to worse outcomes for the doctors and their communities, because they delayed seeking help.

‘One of the things I have observed in my career working in medical defence is the impact that a claim can have on some doctors,’ Dr Bradfield says. ‘Any kind of complaint from a patient …. strikes at the heart of what it means to be a doctor. As doctors, we can have strong perfectionistic traits.

‘When a complaint comes, it can be devastating to a doctor’s sense of identity and self-worth. While most doctors eventually deal with the stress, some suffer extreme reactions to having a complaint.’

He says doctors reported their fears of telling their own treating doctors that they had symptoms of mental health or substance-use challenges, for fear they would be reported and that the regulator would remove their registration.

‘Participants said regulatory processes triggered psychological distress, symptom relapse, and adverse financial and vocational implications. They also told us that these processes eroded their trust in regulators and regulatory processes and, if

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the situation were repeated, they would seek help overseas.

“It was a paradox – they were scared of seeking treatment because of being involved in the regulatory process, but then, because they were more unwell at the time they were reported, they often had worse health outcomes and suffered more severe regulatory sanctions … than they would had they had received help sooner.’

The study found that the regulatory approach, including fears that treating doctors do not understand their regulatory responsibilities, lengthy delays and a punitive or judgmental culture contributed to poor outcomes.

Dr Bradfield’s study concluded that, despite recent efforts by Ahpra to make regulatory processes kinder and more therapeutic, more work is needed.

This includes establishing regular, accessible, and personal communication with unwell doctors about the progress of the regulatory notification, improved staff communication skills and development of staff knowledge and understanding of mental health and substance use challenges.

Dr Bradfield also argues that these findings add further weight to growing calls to repeal mandatory reporting laws for practitioners who treat unwell doctors.

When you first log into the portal you will be greeted by an onboarding process that allows you to update your details, choose how you would like to present yourself to other members, and indicate which networking and other experiences you are interested in.

Once you’ve had some time to get to know the portal, we hope you’ll share your feedback with us at ama.com.au/mp.

Working well

It is well established that a healthy, safe and motivated health workforce is pivotal to delivering optimal patient outcomes through an efficient, sustainable and world-class health system.

Since its inception as an agency in 2020, the Commission on Excellence and Innovation in Health (CEIH) has recognised the importance of building a culture of workplace wellbeing across the health sector to enable a healthy, safe and thriving healthcare system. For our people to be their best and reach their full potential both personally and professionally, it is critical that our system, and the organisations within it, provide a work environment and culture that protects and promotes their physical and mental health and wellbeing.

Unfortunately, the current state of workforce wellbeing is suboptimal. Globally, healthcare workers have markedly high rates of absenteeism, burnout and mental distress compared to other sectors. The South Australian health workforce is no exception, with data showing our workers experience heightened levels of stress and struggle to establish a healthy work-life balance.

Designing a safe system

Sadly, (yet unsurprisingly), there is no single ‘quick fix’. We can, however, draw a line in the sand and work together as a sector to design our health system to prioritise, protect and promote the health, safety and wellbeing of our people.

Through engaging with key stakeholders and examining international and national best practice and evidence, my team has recently published a discussion paper titled ‘Strengthening healthcare workplace wellbeing in South Australia’ to bring this agenda to the fore. This paper describes the current state of healthcare workplace wellbeing in South Australia and presents a strategic approach to guide system-level action within our current context. Our aim is to stimulate and guide future efforts in

this space by building greater understanding and knowledge about the foundational elements that drive a healthy workplace culture in the South Australian healthcare context.

Where should we direct our efforts?

The CEIH believes the foundations for creating excellence in healthcare workplace wellbeing and culture lie at both sector and organisational levels. Our people must be empowered, supported and actively permitted to create innovative solutions that support their wellbeing and their ability to provide quality, efficient and effective care.

Through our analysis of the literature and evidence, together with understanding the state’s healthcare context through more than 50 key stakeholder interviews, a number of themes have emerged. These key themes are consistent across the sector and organisational level, are aligned with international workplace wellbeing best practice, and include:

• leadership commitment, governance and accountability for workforce wellbeing

• capacity and dedicated resourcing to proactively and strategically drive workplace wellbeing action

• organisational ‘wellbeing’ capabilities including leaders’ and managers’ ability to identify, prioritise and address work-related factors influencing workforce and workplace culture

• utilisation of data and application of consistent and validated metrics at both the sector and organisational levels. This informs action, benchmark and measure change, and enables stronger accountability for workforce wellbeing

• partnerships and collaborative action to tackle systemic issues affecting the wellbeing of our workforce, especially through deep engagement, participation and co-design with healthcare workers.

What can my organisation do to protect and promote workforce wellbeing?

Healthcare organisations can create a culture that ensures its workforce feels safe, supported and valued. Top-down efforts must be equally matched with strong engagement and participation from the frontline up. Establishing a sustainable and effective ‘wellbeing infrastructure’ within your organisation can ensure a culture of workplace wellbeing is driven across all levels.

To support organisations to do this, the CEIH have recently released a Building Workplace Wellbeing guide. Based on best practice, this step-by-step guide provides a road map for organisations to embed the foundational and evidence-based elements of a healthy, safe and thriving workplace culture. By building sustainable and effective structures and processes, organisations can rapidly identify workplace issues, forge pathways to accountable resolutions, and ensure people are appropriately empowered and resourced to look after themselves and each other.

To attract and retain our workforce now and into the future, we must value the protection and enhancement of healthcare worker wellbeing as a core component of an effective and safe healthcare system. I encourage you to check out the ‘Strengthening workplace wellbeing’ section of the CEIH website and trust that our resources will add value to existing efforts and help improve the quality of our healthcare system by looking after our most valuable resource – our people!

A new discussion paper outlines how South Australia’s healthcare organisations can build workplaces that promote staff wellbeing, writes the Commission on Excellence and Innovation in Health’s Katie Billing.

Katie Billing is the CEIH’s Executive Director Consumer & Clinical Partnerships.

Golden years

The AMA(SA) Student Medal was established to encourage academic achievement and student involvement in the life of the medical schools of the University of Adelaide and the Flinders University of South Australia. In 2022, Dr Michelle Atchison presented the Student Medal to Dr Elly Sarre of the University of Adelaide and Dr Kritika Mishra of Flinders University at the schools’ declaration ceremonies.

DR ELLY SARRE

Why did you become a doctor?

I’m passionate about working towards improved wellbeing and outcomes for people and our planet, and I get a lot of joy from working with and connecting with people. Becoming a doctor seemed like a perfect combination of these values. As doctors, we are privileged to work closely with our patients and their families; to be part of teams of compassionate, diverse and skilled individuals; and to advocate for issues that affect the health of our patients and communities more broadly. I had also seen the impact that good healthcare can have on a person’s life, and hoped to make even a small contribution to improving the trajectories of the people I care for, particularly through working in children’s health.

Was medical school what you expected?

Medical school was what I expected in some ways, particularly in terms of the strong academic focus, but there were also many parts of medical school that I didn’t expect. In first year, I had no idea how much medical school would push me to think mindfully and critically about the way I communicate, and to develop the adaptability and problem-solving skills to feel confident in navigating conversations, challenges and settings that previously would have felt well beyond my abilities. I didn’t realise that as a student I would be given so many opportunities to work closely with patients and to be a part of their healthcare experience, and to learn in so many different settings. For example, I had the privilege to complete placements at the Refugee Health Service in Adelaide and the Royal Children’s Hospital in Melbourne, spend a day with the Royal Flying Doctor Service and with the visiting medical team at the clinic in Tjuntjuntjara in remote Western Australia, and spend three months working in rural general practice in Port Lincoln and rural NSW. I didn’t expect medical school to fly by so quickly, either. I’m extremely grateful to have had the opportunity to experience such an incredible six years and for the knowledge, friends and mentors I have gained along the way.

How did you juggle your studies with other campus and external activities?

and I recognise that I am privileged to be in a position where I can do this. What inspired you to undertake the extracurricular activities?

I find it rewarding to be a part of communities of like-minded people and to contribute to areas that I am passionate about. I also know that I have a lot to learn from the people around me. Extracurricular activities have provided me with invaluable opportunities for developing understanding and learning new skills, such as helping me to see the practical applications of my academic learning. It’s also great for my wellbeing and a lot of fun to organise events and initiatives and to see people coming together as a community. What tips would you give to other students?

As a student, it can feel like there is pressure to have a sense of certainty in your career direction, which can be difficult when you are still trying to work that out for yourself. I think it can be helpful to focus on your individual strengths and the positive impacts that you can make on your patients and the people around you (even if it feels small at the time), and to take things day by day. You don’t have to know exactly where you are heading in the long run, but hold onto the good and meaningful moments as they pass.

We hear it a lot, but I would also reinforce the value of maintaining your life outside of medicine to help you cope with challenges such as burnout or feelings of failure. It can be easy for medicine to become all-consuming at times, but having a support network and things that bring you joy and meaning outside of medicine can be important for finding some space and keeping things in perspective.

Finally, enjoy the journey! Medical school provides some wonderful opportunities to build connections, make Dr Elly Sarre

For me, keeping busy with things that I am passionate about, outside of study, helps me stay motivated and focused. As we all know, study during medical school can be stressful and overwhelming at times, and I found that having other activities to focus on helped me keep perspective, and also to use my study time more efficiently. I am also lucky to have a family and support network who made balancing multiple commitments possible,

friends, learn, and develop new skills. There are challenges along the way, but embrace these where you can and say “yes” to the opportunities that come up. Now, in my first year as a doctor, medical school is a very special time to look back on. What are you planning to do now that you have completed your medical degree?

I am completing my internship in Darwin, and hope to pursue a career in paediatrics. In particular, some areas I would like to work in are climate change and health, Aboriginal and Torres Strait Islander health, refugee health and trauma-informed care. I hope to gain experience working in different geographical locations throughout my career. I think that learning from a diverse range of communities about ways of living, and the different challenges people face, will help me contribute more effectively to the delivery of responsive, adaptable and compassionate care.

DR KRITIKA MISHRA

Why did you become a doctor?

Medicine is an art form – an amalgamation of skills, clinical competence, cultural sensitivity and awareness, empathetic communication and life-long learning. Over time, I realised that my passion and skill set were suitable to the career of medicine, including my love for communication, problem solving, human interaction, and leadership. Similarly, I learnt that medicine was suited to me, being a challenging field where there is no end to learning, a place where

teamwork is integral to optimal patient outcomes and a strong workplace culture. These factors, in combination with my personal and work experiences, inspired me to strive to carve my own path in this important, demanding, and evolving field. Was medical school everything you expected?

Looking back, I didn’t anticipate the day-to-day of medical school. Stepping into university, much of what I imagined myself doing was related to the duties I observed doctors perform during my interactions with them. However, I perhaps hadn’t fully understood the depth of education and dedication required to reach this stage. Regardless of not appreciating the intensity of my daily schedule and the exact activities which would be involved, I loved and enjoyed medical school. This was thanks to the amazing friends I made in a supportive cohort, and the inspiring mentors and doctors I met along the way whom I will never be able to thank enough. How did you successfully manage your time?

It was truly an honour to have the opportunity to contribute to the lives of medical students and work with studentcentred staff in our College. I have always been passionate about leadership and holistic learning and development. While academic learning through lectures, textbooks, workshops and tutorials is important, the skills of communication, teamwork, conflict resolution, goal-setting and organisation are best learnt in a practical setting. Although there was a significant commitment of time and mental energy in these roles, there was no

better way to develop my professional skill set, which became apparent to me as I stepped into the clinical workplace.

However, organisation, punctuality, accountability and understanding my own limitations were also essential. Truly, I have no perfect answer to how I did all this; however, on reflection, I took each day at a time and broke large goals into smaller, short-term goals to ensure I was being realistic with my vision. I asked for help when help was needed and took guidance and advice from my colleagues.

Thus, in no way am I the only person responsible for the achievements of FMSS in 2022. On the contrary, I was supported by a hardworking, creative, and responsible team I thoroughly enjoyed working with, and I am lucky to have formed special, lasting friendships with them. What tips do you have for other students?

Medical school requires dedication, commitment, sacrifices, and resilience. However, with every challenge comes new opportunities to learn, with every failure there is a new motivation for success, and with every personal trial, a realisation of the need to be sensitive and responsive to the vulnerabilities of your future patients. Reflecting on my own experiences over the past few years, I have learnt that it is okay not to know, to be wrong, to be vulnerable and feel challenged. I have continually redefined what kind of medical practitioner I seek to be in the future and who I will emulate. As I have strived to learn and grow, often buried in textbooks and practice questions, I have at numerous times reminded myself to be kind to myself, and reflect on my achievements – big or small. I encourage others to do the same.

There is so much to enjoy at medical school. There are many special interest groups which enable you to pursue your hobbies outside of medicine. Finally, and perhaps most importantly, form a good support network consisting of family and friends both within and outside of this field, and similarly be a part of others’ support networks. Let us help each other help ourselves.

What are you doing now?

I am an intern at the Royal Adelaide Hospital. I am focusing on adjusting into a new clinical space with new colleagues and a different demographic of patients. In conjunction with work and research, I am trying to balance my time with seeing friends and family, and looking to continue to participate in my hobbies outside of medicine – art, cooking and baking. I am looking forward to a year full of hard work and learning!

AMA(SA) President Dr Michelle Atchison with Dr Kritika Mishra

The AMA(SA) congratulates the 2022 South Australian wishes for your careers and your lives

Flinders University MD/BMBS Graduates

Madelyn Agaciak

Urvashi Agarwal

Lori Aitchison

Hiba Al Naji

Hamza Ali

Annie Arnold

Hannah Beck

Carley Bell

Beatrice Bradley

Louise Brinkmann

Georgina Burke

Emily Burton

Sai Lekshmi Chandramohan

Phoebe Chapley

James Chataway

Nibir Chowdhury

Jake Christiansen

Sophie Clare

Brittany Collie

Emilia Corbo

Abby Dawson

Lucas Di Ubaldo

Julio Dominguez

Wei Du

Jacqueline Dunn

Sehrina Eshon

Rodney Evans

James Evenden

Lilian Fellner

Benjamin Forsyth

Harry Gaffney

Joachim Gleeson

Ying-Ann Gn

Philippa Good

Samuel Gray

Alexandra Greig

Lynette Griffiths

Darianne Growden

Gian Haasbroek

Ata Ul Hadi

Joshua Han

Jessica Hanna

Tia Hardie

Nicholas Harpas

Syarafina Hasnan

Nehal Hassan Ali Pour

Tao Hcao

Eleanor Horsburgh

Min Young Jang

Amy Johnson

Urja Tijen Joshi

Ariella Joyce-Tubb

Jayda Jung

Muhammad Lutfi Kamaludin

Dylan Kearvell

James Killian

Corey Kirkham

Venkata Kollimarla

Qiu-Yun Jasmine Kuek

Benedict Kwok

Bernard Lagana

Robyn Lambert

Sarah Lawrence

Bao-Chau Le

Nicholas Lee

Zoe Lee

Eu Hern Titus Leong

Janelle Eleanor Li Yi Leong

Jia Jun Beal Lim

Jeremy Loughlin

Lucy Lu

Sydney Ma

Alastair Magarey

Seak Khit Mah

Daniel Makary

Suzanne Mashtoub

Aashish Maurya

Megan McKeough

Kritika Mishra

Siti Nazihah Binte Mohamed

Khir

Jack Morris

Craig Munn

Amjad Mustapha

Suu Mon Myint

Priyanka Nagarajan

Sidharth Nambiar

Shalom Ndukwe

Elise Newman

Blessing Nyoni

Chloe O'Hara

Wei Jie Ong

Paulina Pajak

Galatiani Pakos

Jamie Pannett

Alen Pasalic

Kim Thien Pham

Qi Sheng Phua

Samuel Piotto

Jonah Poo

Akhila Rachakonda

Riya Ramakrishnan

Tomas Rice-Schaffeler

Jesse Richter

Ramy Robin

Kristie Rogers

Vanitha S

Chloe Salvemini

Maria Sarantou

Dominique Schell

William Schoneveld

Maurice Shanahan

Genevieve Rui Qi Shing

Paul Simpson

Athena Singh

Vanshika Sinh

Caitlin Skinner

Nicholas Smoker

Patrick Sowula

Isabelle Starmer

Matthew Steele

Taylor Strube

Claire Sully

Hanna Susan-Joy

Bryan Ju Wei Tan

Victoria Tang

Paul Athanasius Thalaivasal

Katie Thomas

Jessica Thomson

Anh Van

Aaron Veith

Brandon Wadforth

Jordan Wagner

Jesse Walsh

Isabella Walton

Simon Wark

Courtney Waterman

Jianfeng Weng

Nicole Williams

Andrew Willis

Xusheng Wu

Chi Lok Yeung

Kengadhevi Yogeswaran

Laura Zdanowicz

Yuze Zhai

Carolyn Zhang

Ruyi Zhang

University of Adelaide MBBS Graduates

Samantha Dinali

Abeygunasekara

Teham Ahmad

Terence Wee-Xiang Ang

Tasha Arnold

Laura Kate Aylkiffe

Nur Sakinah Fikriah Azmi

Domenico Barbaro

Kaitlin Mei Beddome

Nathan Andrew Behrendt

Ella Bertolus

Dimple Bhatia

Hannah Grace Bransbury

Layla Jasimne Bunjo

Levi Burgess

Ellen Callisto

Matthew Camacho

Angelique Natalie Camilos

Gabrielle Jennifer Capasso

Tinki Chan

Danielle Jane Chéné

Leanne Kim Li Chew

Myet Thwe Cho

Luke Cialini

Phua Yue Min Cyrstal

Ankita Das

Gampalage De Fronseka

Ayesha Dohnt

Casey Donehue

Alexander Duthy

Angela Catherine Eagles

Sophie Adelia Eblen

Raelene Swathie Emmanuel

Madalynn Jaidine Francis

Thisun Kolinda Gange

Nicole Gathard

Kristie Lee Goudas

Akash Gowda

Patrick James Graham

Luke Mario Green

Aishath Hanan

Luzern Tan heng-Yi

Jia Yi Hiew

An Thien An Hong

Marcus Jared Kang Jia Hong

Matthew Chan Kit Hong

Yue Huang

Tatyana Hubczenko

Olivia Jaeschke

Muskan Jangra

Catherine Jenkins

Tan Wen Po Jonathan

Helena Karapetis

Neha Kature

Emily Kelsh

Eliza Fecility Kennedy

Lachlan Peter Kennedy

Ashna Khalid

Benjanmin Ten Jen Khoo

Don Anh Le Kieu

Taylor Kilpatrick

Jaewon Kim

Yeji Kim

Matteus Wei Sheng Koh

Wei Liang Daniel Koh

Hei Yeung Kelson Kwok

Yongwoo Kwon

Gabriel La Paglia

Stephanie Maria Laden

Cindy Lam

Daniel Langridge

Shanna Lee

Caryl Shi Ying Lei

Harrison Lewin

Sean Jing Leng Liew

Francis Stanislaw Litwin

Hakim Fong Hor Loong

Bradley Lunnay

Eliza Madigan

Ashlia Laura Maharon

Mia Clarisse Santos Malagar

Mohammad Danish Mangi

Joseph Mann

Laure Taher Mansour

Brianna Carlene Marenda

Tanishq Mathur

Tapiwa Mativenga

Lucinda Miller

Aditya Mishra

Florencia Belén Moraga

Masson

Alec Campbell Morely

Duylan Morely

Leshya Naicker

Oshada Nanayakkarawasam

Isabella Jing-Ai Neoh

Tess Joanna Newton

Tri Nguyen

Kara Nimon

Madelyn O'Brien

Christine Xinzhu Ong

Tessa Pahl

Niki Panayiaris

Subin Park

Kate Louise Parkinson

Li Lin Peng

Udella Chan Wai Peng

Ayra Maria Perakath

Jayal Perera Amaratunga

Antonio Perotta

Huy-Dat Pham

Ines Marie Gabrielle Portella

Shyanne Jessica Premnath

Alicia Mary Pyper

Mahima Sarah Raju

Niamh Rees

Chelsey Renee Avers

Luke Rezk

Simon Riddell

Grace Isabella Dennis Roache

Rosie Annabel Robinson

Peter Rossi

Huda Ryaz Patel

Ahad Ismam Sabab

Jessica Sachse

Eleanor Sarre

Meg Schulz

Jenaya Lee Shelton

Steven Shi

Fattah Shohani

Sridhamya Sirikrishnabala

Emily Rose Slimming

Joshua Michael Smith

Dominic James Spicer

Mark Sredojevic

Nitya Sukheja

Holly Ada Sunners

Edward Surtandar

Kunwar Talwar

Daniel Tan

Khim Valerie Alday Tan

Kevin Tang

Claire Llina Taranto

Mirella Pia Taylor

Elena Te

Olivia Teh

Fiona Thoi

Aithne Bridget Tobin

Andrew Tong

Georgina Trotta

Jeremy Tu

Imasha Umayangani

Theodore Nicholas Veldos

Isabella Vinci

Amanda Mai-Thu Ngoc Vu

Pengnan Want

Che Kah Wee

Michael Wei

Rohan Wheaton

Erin Jane Widdison

Azemara Yilma Woldgabreal

Lung Hui Alexis Wong

Noah Wei Kang Wong

Toy Wong

Ven Woo

Sophie Katrina Woods

Lee Jia Xin

Nimreki Ascharaya Yapa

Yee Lyn Jong Yeon Yeong

Kirrily Yoon

Kirrily Zacher

Zhao

Australian medical graduates. We offer each of you our best in this most important of professions.

Christine Mausolf President

Each year with a change of leadership, the Flinders Medical Students’ Society evolves with new ideas, advocacy goals, and events. We value the great relationship between students that allows continuing growth within our roles to uphold our four domains: advocacy, culture, education and support.

Following the incredible leadership from former President Kritika Mishra and her committee in 2022, this year our committee aims to focus on facilitating vertical integration between year levels and across our NT and rural sites. We want to increase inclusivity among students and local community impact, and maintain our healthy relationship with the college to enhance transparency and communication.

FMSS has had a busy and exciting start to the year. We have welcomed a new cohort of first-year students embarking on their medicine journey from all over the world, starting at both our Adelaide and Darwin campuses. Our dedicated team of volunteers has staged two weeks of events for the students, helping facilitate their transition to the MD (Doctor of Medicine) but also importantly their new relationships between peers. This has included video guides on how students may find their way around campus, welcome lunches, quiz nights and meet’n’greet events to get to know students from the other year levels, with a few of these events pictured. There have been family-friendly events for new students with kids to get to know each other as well as an introduction to all our special interest groups and clubs. From experience we know these first few weeks of med school can be overwhelming with emotions of excitement but also nervousness and self-doubt. Looking back and having the support from events like these helped ease that transition, and set a tone of collegiality and non-competitiveness.

With the ease of COVID-19 restrictions, we have been able to welcome international students from day one, reintroduce some events and clubs (yes med-choir is back), but students have also been able to access the clinical environment earlier in the degree. I started med school in 2020, and it was not until my third year of study that I could appreciate how a hospital works, or had the opportunity to identify pathologies on real patients. We are excited to be working with the students and college to reintroduce clinical placements in earlier years and take this opportunity of ‘starting from scratch’ to find the most effective strategies. This is a process that also requires adjustment for the clinic and hospital

spaces as well as the clinicians who are providing supervision. Looking at our year ahead, I cannot wait to see what all our amazing new leaders in FMSS will achieve. They have a passion for not just supporting their peers, but also making lasting changes that will have a positive impact on many students to come. I hope we can continue to serve the students in the MD, empowering them through the many challenges faced throughout med school.

EASTERN SUBURBS VR GP

Hazelwood Clinic is a well established GP owned and operated practice.

We are seeking a VR GP to join our busy Eastern Suburbs practice – 2-4 sessions per week to full-time.

We are a private billing practice with well equipped consulting rooms and a friendly and supportive medical, nursing and admin team and value a respectful team environment.

We provide a wide variety of medical services including onsite Spirometry, 24 Hour blood pressure monitoring, Holter monitor and ECG

Enquiries to Jenny Lambert, 0419 409059 or email jennylambert@hazclin.com.au

FMSS VPs, secretary and prep-week convenors: Declan Fitch-Woolford, Angelina Arora, Benita Rajvi, Ella Anderson, and Elly Beal

Vi-Seth Bak President

Iam very fortunate and excited to be the President of the Adelaide Medical Students' Society (AMSS) for 2023.

This year has brought the eagerly anticipated return of the opportunity to study overseas, after the pandemic put a halt on global travel for nearly three years. For many students, international experiences are the highlight of their time at university. My peers are jetting across the world for electives in hospitals in Germany, Nepal, Vietnam, Mexico and more. Our exchange program with Aarhus University in Denmark has also resumed, with eight of our fifth-year students swapping South Australia for Scandinavia this semester, and we are welcoming eight Danish students in return. We have also welcomed eight new lateral entry students from the International Medical University Malaysia who have joined our fourth-year cohort, after the pandemic prevented intakes over the previous two years.

I personally returned recently from Cambodia, where I spent an unforgettable six weeks at a small non-profit hospital that provides an outsized range of orthopaedic, plastics, maxillofacial and ENT surgery at minimal or no cost to disadvantaged Khmer children and adults. This experience was as extraordinary and enlightening as it was fulfilling, and I can attest to the value of these overseas experiences in gaining new perspectives and cultural knowledge. The Children’s Surgical Centre in Phnom Penh performs remarkable work, but it relies on donations, which have decreased markedly due to the pandemic. I encourage you to find out more and support its mission at csc.org

Back in Australia, our committee looks to the year ahead with great excitement and optimism. Our students in years 4 to 6 are settling into daily life on the wards after a well-deserved summer break. We were fortunate to be able to conduct our Clinical Year Welcome and MIGA 6th Year

Welcome events without interference from COVID this year, and they were highly successful.

Meanwhile, our Year 1-3 students are preparing for the beginning of their academic year. We look forward to welcoming our new first-year students at our usual O’Week meet’n’greet and ‘trade fair’ of medical interest societies. Students are eager for the long-awaited return of Skullduggery and MedCamp to normal programming in the coming weeks, after a tough couple of years due to the pandemic.

The AMSS has had a long tradition of peer mentorship and teaching. This year, we are revamping and consolidating our previous peer tutorial programs into one program, the Peer Inter-Year Mentorship Program. We hope this will foster more inter-year friendships, reduce volunteer burnout, and improve the consistency and student retention in tutorial groups.

Adelaide is also host to the first Australian Medical Students' Association (AMSA) Careers Conference, which is set to be held at the Adelaide Convention Centre on 29-30 March.

We invite you to keep in touch with us on our Facebook page, our Instagram @ youramss and, for those with TikTok, our new account @ouramss. Please send me an email at president@amss.org.au with any questions or suggestions for 2023.

A selection of images taken at the AMSS orientation 2023

Marine mobility

The underwater world is a strange and challenging place for humans but for people living with disability it is a world of possibility and fun that is difficult to find on land. That’s the discovery of an Adelaide-based enterprise, Determined2, that has developed a pioneering approach to unlocking opportunities for movement and interaction for people with disabilities. It has twice been a finalist in the Telstra Business Awards, winning the State category for Social Change in 2019 and reaching the South Australian finals in the Championing Health in 2023.

It also represents the ‘holy grail’ in program development, being truly person-centric in design, having been developed by managing director and founder Peter Wilson after a motorbike accident in 2007 left him with significant physical impairments.

‘I had the classic experience of having had a near-death experience and, given hope, thinking maybe I should use the experience to make a difference,’ Pete says.

Despite extensive rehabilitation, he was unable to work in the same way he had before his injury. He had a lightbulb moment and decided to develop a program using scuba in the swimming pool as therapy.

He tried it with a few people, including a young lad who had become a tetraplegic and a patient with cerebral palsy who was non-verbal and in a wheelchair – both of whom experienced significant gains in mobility through the treatment, both under water and when they emerged back on the surface.

‘A big part of it was to make it fun – my experience of hydrotherapy was that it was boring – but this uses games to get people to do things they don’t even realise they are doing,’ he says.

It’s since been tried with people with autism who may not otherwise engage with other people in games and play.

The underwater environment provides a level playing field, with everyone’s face inscrutable behind a mask and breathing a challenge for all, That, Pete says, in itself can be a boost for people with disabilities.

Evolving from lived experience and observation, the program is now delivered by allied health practitioners such as exercise physiologists and is being rigorously validated as a therapy.

With a grant from the Lifetime Support Authority in 2017, Pete

set about finding a way to clinically evaluate the program with the help of rehabilitation medicine physician Dr Adrian Winsor and Associate Professor Kade Davison in the UniSA Allied Health and Human Performance team.

Initial qualitative studies of patients, doctors and other health providers revealed benefits including reduced pain and increased mobility, strength and confidence. It also showed that the psychosocial impact of the immersion was important.

‘People felt a real sense of achievement and empowerment. Under water they can leave behind their impairment and live in a different world for a moment,’ explains Associate Professor Davison.

‘The qualitative evidence is all pointing in the same direction, that people are deriving a benefit. There’s an overwhelming commonality in reports of improved sleep, mobility, management of pain – but we need to tease out the mechanism a bit.’

The Lifetime Support Authority is now funding a 2-year randomised control study, led by UniSA, that aims to discover other potential users. It has a rolling recruitment of people with acquired brain, spinal and other traumatic injuries who have completed hospital rehabilitation.

‘Going home after an accident is one of the toughest times for people, because they realise there aren’t too many things they are able to do better now than they could before,’ Pete says. ‘Immersion therapy could be one of them.’

Dr Winsor says that while it’s not for everyone with a disability (including those with lung pathology, uncontrolled diabetes or uncontrolled epilepsy), for many others immersion therapy can level the playing field.

‘We see immersion therapy as an extension of hydrotherapy – it allows total immersion,’ Dr Winsor says. ‘There are additional benefits with the additional buoyancy, additional freedom of movement.

‘Pete makes it fun – you don’t go there to swim 10 laps but if jumping through hoops is something you can’t do on land, it is something you might be able to do in the water. It’s an achievement.’

The Determined2 website has information about self-referrals. An approved doctor screens would-be participants to ensure they are suitable.

• Medical retina (age-related macular degeneration (AMD)

• Diabetic eye disease

• Retinal Vein Occlusion

• Retinal tears

• Medical retina (age-related macular degeneration (AMD)

• Surgical retina (retinal detachment, macular holes, epiretinal membranes)

• Diabetic eye disease

• Retinal tears

• Retinal Vascular Diseases

• Uveitis

• Cataract surgery

• Medical retina (age-related macular degeneration (AMD)

• Surgical retina (retinal detachment, macular holes, epiretinal membranes)

• Diabetic eye disease

• Retinal tears

• Retinal Vascular Diseases

• Cataract surgery

• Management of glaucoma

• Laser treatment for glaucoma

• Minimally invasive glaucoma surgical techniques

• Trabeculectomy

• Novel Glaucoma devices

Adelaide Eye and Retina Centre are pleased to welcome Dr Dev Supramaniam and Dr Neena Peter to the team.

• Medical Retina (age-related macular degeneration (AMD)

• Surgical retina ((retinal detachment, macular holes, epiretinal membranes)

• Diabetic eye disease

• Retinal Vascular Diseases

• Ptosis repair, blepharoplasty and brow ptosis repair

• Eyelid cancer excision and periocular reconstruction, including reconstruction of Mohs’ micrographic surgery defects

• Surgical Repair for watery eyes including endoscopic tear duct surgery

• Orbital surgery, enucleation, evisceration, orbital implantation and socket care

• Surgical rehabilitation of thyroid eye disease

• Use of Botox in the management of blepharospasm and hemifacial spasm

• Cataract surgery

• Pterygium surgery

• Cosmetic eyelid surgery

Dr Neena Peter

Dr Dev Supramaniam

Dr James Muecke Associate Professor Jolly Gilhotra

Dr Shane Durkin

Dr Michelle Baker

More than 250 guests attended the Australian Chinese Medical Association of SA’s Chinese New Year Celebration Dinner on 4 February 2023, with the theme ‘The Year of the Rabbit’. The event was held at the Adelaide BMW Showroom and featured a traditional lion dance.

1 – Assoc Prof William Tam, Assoc Prof Lilian Kow, Cindy Jade Shi and Dr Lydia Huang

2 – Paul McHugh, Fatima McHugh, Stacey Ann and Graeme Hedges

3 – Dr Kohei Funahashi, Dr Earl Lam, Dr Kristy Yang and Dr Leong Tiong

4 – Dr Khimseng Tew, Dr Dustin Pham, Thi Pham, Dr Stephanie Vuong and Dr Sharon Chua

5 – Dr Kim Le

6 - Karina Ng and Dr Kar Woh Ng

1 2 3 4

The Royal Australasian College of Surgeons Charity Ball was held at the Rose Garden Pavilion in the Adelaide Botanic Gardens on 1 February.Proceeds of the black-tie event benefited the Maggie Beer Foundation.

1 – Bridey Smith, Georgina Juniper, Dr Nick Smith and Dr Giri Krishnan

2 – Maggie Beer AO and Dr Ashani Couchman

3 – Dr Jennifer Catford and Dr Bernard Carney

4 – Lachlan Ophof, Sharon Kendall and Michael Eades

5 – Dr Conor Marron, Kate Marron, Dr MaryAnn King and Dr David King

Scene stealing

Adelaide weather presents fine opportunities for driving, but the eastern coast hasn’t been as welcoming. Motoring writer Dr Robert Menz tests new MG and Pajero models.

What does the name MG mean to you? MG has a history of letters such as pre-war TC and subsequent similarly shaped TD and TF. Perhaps you covet the streamlined A, or perhaps have owned one of the world’s second best-selling convertibles, the B (Mazda’s MX5 holds the title of best seller).

Cecil Kimber was the production manager for Morris Garages. In 1924, wanting to increase the performance of Morris products, he registered the octagonal MG emblem and introduced the slogan ‘safety fast’ to identify his sports cars.

With the demise of the MG Rover group in the mid-1990s, MGs are no longer sports cars. The MG Marque is now part of the Chinese government-owned SAIC Motor Corp, which has retained the octagonal emblem. Safety Fast lives on as the name of the magazine of the UK’s MG car club. There are three models of MG presently for sale in Australia: the diminutive 3 hatch, the compact ZS SUV, and the mid-sized HS SUV. The ZS range includes Australia’s cheapest fully electric vehicle. HS is a mid-size SUV, and although it is a little shorter in length and height than the Forester or RAV4, it is marginally wider than each. HS Vibe (with a 119 kW 1.5 L turbo petrol engine) starts at $31,990 drive-away at the time of writing and the top-ranging HS PLUS EV Essence test car is $52,690. More important, however, is the ready availability of many of the MG models, which includes two AWD models with 2 L 168 kW ICE (internal combustion engine).

At this price, you should be expecting an extremely well-equipped machine, and the MG does not disappoint. It’s a very smart looking car. I will not bore you by listing all the safety and Infotainment features; you can read them here https://resource. digitaldealer.com.au/

But allow me to highlight a couple of them. I was intrigued that the electronic instrument cluster would show up the current speed limit even when there where temporary roadworks with a 25 kph speed limit. I wasn’t sure if this was a supersmart, real-time, GPS and was intrigued to discover that one of the forward-facing cameras reads the speed limit signs on the side of the road and displays the speed, whether in navigation mode or not.

The panoramic sunroof has a tilt as well as slide function. And the high beam automatically dips in response to on coming or following traffic.

Neat features include ambient lighting which changes colour, and a red MG emblem projected to the ground when the driver’s door is opened at night. The cruise control had only 5 km/h increments, although it did hold the speed quite well.

Annoyingly, the regenerative braking did not work when the cruise control was set – for example, driving South Eastern freeway from Stirling to the toll gate –although it did add 2-3 km of electric driving if just coasting down the hill, feathering the brakes as needed.

The MG essence was a delight to drive and surprisingly nippy. The combined power of the ICE and electric engines is 189 kw/370Nm driving the front wheels through a 10-speed, automatic and electronic LSD (limited slip diff). The handling was not as impressive as the statistics would suggest, despite LSD and Michelin tyres. The front wheels squealed in protest if you tried to accelerate too hard through a tight corner. It’s surprising with all this power that MG has not introduced an all-wheel-drive version of the PHEV.

In addition, the instrument cluster does

not include an odometer and there’s no spare wheel, just a repair kit. The nonPHEV HS models have a space saver spare.

Ownership costs are kept low with a 63 km electric driving range, ideal for daily commute, seven-year unlimited kilometre warranty on the car and battery, and capped-price servicing. The only option you could consider would be a wall charger.

I managed two trips to Fleurieu Peninsula during my week behind the wheel. A sunny Saturday drive to Middleton took me to the inaugural Middleton jazz festival, held in the picturesque Abbott Reserve and featuring the cream of South Australian jazz performers. I also managed a mid-week geological trip with the Waterhouse Club exploring the fascinating rocks, strata, sediments, evidence of glaciation, and the Delamerian Orogeny. We travelled through time, from 2.6 billion-year-old rocks pre-dating all fossils to the last glacial period during which first Australians could readily walk to what are now islands such as Kangaroo and Tasmania. And we were eventually returned to the present with a delicious lunch at the Hotel Elliot.

In summary, the MGHS plus PHEV is a worthwhile addition to the increasing number of medium-sized SUVs. It is testament to the increasing quality of Chinese automotive manufacturing, and would be an appropriate step towards electrifying your garage if you are not yet prepared to go fully electric.

Vehicle supplied by MG Australia. MGs available to purchase through Newspot MG, which has a branch on West Terrace.

A challenging legacy

Iwas lucky to spend a week behind the wheel of a Pajero Ssport GLS 2WD in glorious Adelaide sunshine late last year.

Pajero was manufactured by Mitsubishi from 1981 but reached the end of its production line in 2021. However ,the Pajero name lives on in the form of the current test car, which was introduced in the mid-1990s under the Challenger name in Australia and changed to Pajero Sport with the third model in 2015.

Mitsubishi’s Triton ute forms the underpinnings of the Pajero Sport, which is only slightly smaller than the last Pajero model but in fact larger in all dimensions than the original 1981 Pajero.

Despite its name this is not a sports car but rather a very confident, mid-sized SUV. There is a range of models in both two and four-wheel-drive versions, all powered by a 2.4L turbo diesel boasting 135 kW and 430 useful Nm of torque and a seamless eight-speed gearbox. The base GLX model is a five-seater and all other models are seven seaters.

Driveaway prices at the time of writing range from $47,240 for the GLX 2WD to $64,490 for the top-of-the-range GSR. Wait times are quoted at 99 days. If you can get your hands on a new one, you’ll be covered by Mitsubishi’s 10-year warranty, which includes capped-price servicing and roadside assist.

I know at least two people who have bought these cars specifically for towing vans on some of the roughest roads in Australia, a testament to their toughness and the 3.1-ton towing capacity.

Pajero Sport is very well equipped with even the GLX model having a range of safety and comfort features including keyless entry and push button start and Apple CarPlay (although this does require cable connection to the now older USB-A connector).

Safety features include emergency

braking, stability and traction control, trailer stability assist and adaptive cruise control. Very importantly for rural driving, there is a full-sized spare tyre across the range.

The test car also has a power tailgate, integrated satnav, dusk sensing headlights and rain sensing auto wipers (which operated frequently). The higher-grade models simply have more luxury features. The four-wheel-drive models all have Mitsubishi’s Super Select four-wheel-drive system, including low ratios, selectable off-road modes and hill descent control.

The test vehicle had been set up for on-road towing with an aluminium bull bar and tow bar. Neither of these features was tested – despite us encountering a couple of suicidal kangaroos.

Despite its bulk, the Pajero Sport is nimble as a town car and has plenty of room for shopping. However, it really comes into its own in the country. The test vehicle’s handling abilities were much appreciated on a work trip to Yankalilla, and its touring capability passed a test with flying colours on a very long weekend trip to Wangaratta for the annual Festival of Jazz and Blues (https://wangarattajazz. com/ ).

My return trip through Deniliquin involved driving through some very heavy rain before reaching the river.

In summary the Pajero Sport is a very competent mid-sized SUV, a particularly comfortable touring car that is worthy of the Pajero name.

Next month, I’m swapping horse power for (Shanks’s) Pony power to walk the Larapinta Trail and raise funds in support of people with melanoma. If you wish, you can make a tax deductable donation at https://mpa-larapinta-2023.inadv.com.au/ robert-menz

Many parts of northern Victoria and southern New South Wales were flooded at the time but fortunately I only had to make two detours, avoiding Rochester and the great Alpine Road just out of

Wangaratta. An overnight stop in Nhill afforded the opportunity for an early morning stroll around the lake and Nhill swamp, a new discovery for me despite driving through Nhill many times. This area has strong aboriginal heritage and was a common meeting ground. The name Nhill apparently means early-morning mist rising over water and which was certainly the case when I was there. Some aboriginal people believe this mist to be their ancestors.

There was room in the back of the Pajero to take my bike which I used to commute around Wang and also to explore the city bike paths. Following the One Mile and Three Mile Creek shared paths proved tricky given the amount of water in both creeks and several of the underpasses where closed.

Dr Robert Menz is a motoring enthusiast who still thinks MGs should be British racing green and feature two doors and chrome bumpers. His family owned Pajeros for 20 years from 1985.

James Manson 1934

Dr James ‘Jim’ Manson was a colleague, mentor and friend to many at the Women’s and Children’s Hospital. Jim was one of the founders of paediatric neurology in Australia, indeed one of the first two paediatric Neurologists appointed to a dedicated specialist position, and his legacy is profound.

In addition to establishing the management of paediatric neurological disease, as distinct from adult neurology, he was among the first to introduce clinical electrophysiology diagnostics into routine clinical practice and pioneered the use of video-EEG – a major technical advance of the period.

As the first paediatric neurologist in South Australia, Jim worked tirelessly on behalf of his patients and was joined by his long-term colleague Kim Abbot in the 1970s.

The era of ‘Kim and Jim’ serving the South Australian community prevailed until 2010, and Jim maintained his unofficial involvement with the department until the COVID-19 pandemic.

Generations of children and families have benefited from his dedication, clinical ability, and care.

At a personal level Jim was humble and unassuming, though not to be mistaken for quiet and reserved! He held a sharp wit and was keenly observant.

As his great friend and colleague Paddy Grattan-Smith reflected, ‘Jim was a warm, reliable and welcoming gentleman, with his

softly spoken manner belying a larrikin spirit’.

Jim could engage on many a varied topic of conversation, ranging from his favourite sport of tennis and his unwavering support of the West Torrens Football club (on which there was often debate) to his extensive knowledge of English literature.

Indeed, as somewhat of a polymath, his academic interests extended beyond medicine into the discipline of philosophy, in which he undertook further university studies upon his retirement.

While there are many stories about Jim, and we will long remember him through their telling, Paddy recalls a particularly amusing one. At the Epilepsy Society of Australia meeting in Adelaide in 2015, Ernie Sommerville, an adult epileptologist, remarked: ‘Jim Manson has passed away, hasn’t he?’.

Paddy replied: ‘No, in fact, I’m having dinner with him tonight’.

Jim picked Paddy up in his car just as the day was closing and they saw Ernie walking back to his hotel. To the amusement of all, Jim wound down his window and called out to Ernie, ‘I ain’t dead yet!’.

Dr Nicholas Smith Head of Neurology, Women’s and Children’s Hospital

Dr Mark Yeatman Sheppard

FRCS FRACS 1919 – 2022

Dr Mark Sheppard was the fourth of five children of Bernard Aubrey and Constance Ethel Sheppard. Ethel’s father was Dr John Yeatman, who practised medicine in Auburn and later lived with Bernard and Ethel. He probably influenced Mark to do medicine.

Mark was educated in Brighton, and subsequently at Pulteney Grammar and St Peter’s College with the aid of scholarships. He served in the Cadet Corps from 1933 to 1936 and completed an accelerated wartime MB, BS at Adelaide, graduating in 1942 while performing part time Army [CMF] service.

Mark became a resident medical officer at the Royal Adelaide Hospital (RAH) in 1942 and married Mary Alexandriana Bidstrup, a nurse at the RAH, in June 1943. Their loving relationship lasted 75 years.

In January 1943 he enlisted in the Australian Army Medical Corps’ Second Australian Imperial Force (2AIF) as captain, joining his brothers Digby and David who were serving overseas. Fortunately, he was posted back to Adelaide before embarking on the Australian Hospital Ship Centaur in Brisbane. The Centaur was sunk by a Japanese submarine off the Queensland coast with few survivors.

He completed his war service in Katherine and Darwin where the birth of his first child John Mark in 1944 was toasted by his Commanding Officer in the Darwin Officers’ Mess.

At war’s end he returned to Adelaide as assistant to the Director of Surgery at the University and Senior Registrar at the RAH. He entered general practice on Woodville Road with Doctors Waddy, Lyall and Russell, working long hours and studying surgery. He was a clinical assistant from 1948 to 1965 and gained his FRACS in 1953, sailing to England with his family in 1954.

In London he worked at Harrow Hospital, and with Rowden Foote, who specialised in varicose vein surgery, becoming an expert and later publishing on preventing recurrences in the ANZ Journal of Surgery, and in Phlebology.

After receiving his FRCS in 1956, he returned to Adelaide, where he practised in North Adelaide, private hospitals, and was visiting surgeon and director of the Varicose Veins Unit at RGH Daw Park for 20 years until 1980.

He was elected to the AMA(SA) Council in 1961 and remained until 1967, serving as Vice President for one term before being elected as President in 1965. He was also a director of the Medical Defence Association.

In 1968 he served in Vietnam as Surgical Team Leader, dealing with war injuries as well as conducting civilian surgery.

Mark enjoyed sailing, tennis and golf. He developed a small farm, and had a holiday house at Victor Harbor. He and Mary enjoyed long walks and they played bridge into their 90s.

Retiring in 1990, Mark entered Walkerville Nursing Home when Mary’s health deteriorated. She died in 2018. In this difficult time he enjoyed the love and affection of his children and their families, to whom he had been a model of kindness, modesty, fairness, idealism and morality. His values and his considerable support of charities were underpinned by a deeply sustaining Christian faith.

He is survived by his children, Mark, Felicity and Cecily, and their families.

Dr Peter Joseph

Dr Peter Alan Harbison

FRCS FRACS 1929 - 2023

Peter Alan Harbison was born on 4 January 1929 at Terowie, South Australia. He was the second son of Dr and Mrs Ernest Harbison. His early education was at the Jamestown Primary School. When his family moved to Adelaide, he attended St Peter’s College. He was a good scholar and outstanding at sport, excelling at high jumping and hurdling, and starring at football. In his last year at school in the Intercol Match against PAC he was nominated as best on ground and awarded the inaugural Opie Medal. In 2021 he donated his medal to the School archive. Peter was Captain of his House and a School Prefect.

His grandfather, father and brother John, and other family members were medical practitioners, and it was not surprising that on leaving school he enrolled in medicine at the University of Adelaide. He qualified MB BS in 1952. That year he played in the University A team [‘The Blacks ‘] which won both the SAAFL Premiership and the Intervarsity Competition. In 1954 he played eight games with the Sturt Football Club [‘The Double Blues ‘]. Peter’s name is on a picket in the fence surrounding Unley Oval. He took up pole vaulting when he left school. His grandfather had been State Champion, and so had his father Ernest and brother John. Peter in turn became State Champion. He was presented with a blazer and tie to represent Australia at the Empire (now Commonwealth) Games, but a last-minute ankle injury prevented him from competing. However, he was later part of the medical team when Australia competed in Wales in 1958, attending to the general health of athletes such as Dawn Fraser.

After graduating, Peter worked successively at the old Royal Adelaide Hospital, the Adelaide Children’s Hospital and for six months as the Government Medical Officer on Norfolk Island. In 1955 he sailed for the UK where he worked and studied at a number of hospitals. He gained his Fellowship of the Royal College of Surgeons in 1957. He became interested in urological surgery. One of his appointments was with the Urological Unit of the Ipswich and East Suffolk Hospital. During this time, he met Miss Joan Keeble. In 1960 he was appointed Fellow in Urology at the White Memorial Hospital in Los Angeles. While there, Joan flew to join him, and they were married. In June 1961 they returned to Adelaide. Peter had been overseas for six years. Peter and Joan had four daughters.

For many years he practised most successfully as a private urologist. At various times he had appointments at the old Royal Adelaide Hospital, the Repatriation General Hospital and at the Queen Elizabeth Hospital. He obtained the Fellowship of the Royal Australian College of Surgeons in 1963. He was President of the South Australian section of the Urological Society in 1976 and again in 1979, and Australian President in 1977-78. He was Examiner in Urology for the College from 1974 to 1980 and served on the Surgical Board of Urology in 1979.

Peter never lost interest in sport. He liked to organise and play tennis with his registrars. He raced several horses. He played golf almost all his life. He had the thrill of a hole in one just once, at the age of 80, and seeing it recognised on the appropriate board at Royal Adelaide Golf Club where he was a life member. He was also a life member of the South Australian Cricket Association.

He was passionate fisherman, and his family and friends had many happy holidays at Coffin Bay, where the whiting fishing and wild oysters were wonderful. Kangaroo Island fishing also proved attractive.

Before Peter retired, he worked for a short period in Riyadh, Saudi Arabia, and later practised in Darwin, where he had consulted for many years, and the Gold Coast. His wife Joan died in January 2013. Peter hated the telephone and never looked at a computer, but he became a voracious reader and excelled at crosswords. He regularly visited old or frail friends. He died on New Year’s Day 2023, three days short of his 93rd birthday.

Peter is survived by his four daughters – Penny, Vicki, Jacqui and oodle – 10 grandchildren and seven great-grandchildren, and by his partner Susan Brennan.

Dr John Henry Harbison

BM BS 1926 - 2022

Dr John Henry Harbison was born on 10 May 1926 in the home of his grandfather, Wallaroo mayor Dr William Harbison.

The house was called ‘Kirribilli’, meaning ‘good fishing place’ an appropriate start for John Henry.

John’s mother, Violet Mary Harbison, was attended by a Dr Harbison. This was inevitable as her father-in-law, Dr William Harbison; his brother, Dr David Harbison; her husband, Dr Ernest Harbison; and his brother, Dr Alan Harbison had the Copper Triangle pretty well sewn up. John’s life’s direction was pretty clear from the get-go.

Dr Ern and Violet, known as ‘Lizzie’, took baby John to live at Terowie, on the Broken Hill Line, where, three years later, Peter (later urologist Dr Peter Harbison) was born.

The family then moved to a practice in Jamestown, where Ern could indulge his passion for sport, business and doctoring.

When the 2nd World War came, Ern returned to the Army, having first enlisted in 1918. He was promoted to Major and ran camp hospitals for the 2nd Battalion.

By this time John had been sent to St Peter’s College in Adelaide, as a boarder. With Ern away at the war and John away at school, Lizzie packed up young Peter and moved to Adelaide.

John and Peter’s ties with the country stayed strong, and their holidays were typically spent at their grandfather’s big house at Wallaroo.

Ern didn’t come back from the war, dying of a heart attack in 1945 shortly before the armistice. John won a scholarship to study medicine at Adelaide University and was given permission to take it up even though he was only 17.

John found university hard at first, but the older students, returned soldiers like Don Beard and John Skipper, showed him the way.

He excelled at athletics and was state title holder for the high jump, hurdles and pole vault.

In 1950, John married Ina Patricia (Pat) Thyer, daughter of Dr and Mrs Lewis Thyer of Kadina.

Flush with a medical degree and a marriage certificate, Pat and John headed for Fremantle, where John had landed the job of chief medical officer at Fremantle hospital, a job he always said was the best job in the world.

In July 1951, Pat gave birth to Bill.

In 1953, John accepted the job of medical officer at the Woomera Rocket Range in far northern South Australia.

Pat and John made Woomera fun. They just ignored the atomic tests happening around them and the heavy atmosphere of the Cold War. Pat started an art club and brought noted and garrulous artists like John Dowie from Adelaide to inspire club members.

As a doctor, John was an Honorary Captain and could drink in the Officers’ Mess. But security was very tight. Every three years, all personnel had to move on. So, in 1956, and with second child Michael having joined them, they headed to Kadina.

Bill and Michael, aged three and five, were deposited with Pat’s

parents, while John and Pat caught a cargo ship for London, John working his passage as ship’s doctor before doing further medical studies in London.

They returned to South Australia and set off for John’s new chapter of some 60 years as ‘Doctor Harbison of Gawler’.

During this time he was a town councillor, Rotary member, church warden and medical director of Gawler Hospital –although hunting, fishing and golf were his passions.

John bought a share in Dr Hannan’s practice in Murray Street and they lived in a trust home in Rice Avenue on the river flat. Dr Gillan came and went, Dr Hannan retired and Pat’s cousin, Dr Curtis Deland, joined the practice.

With the entrepreneurial pharmacist John Duncan, they built the first multidisciplinary health centre, combining pharmacy, dentists, doctors and dry cleaner in one large, modern new building.

At 92, John finally retired from medicine, as the oldest registered general practitioner in Australia.

In his last year, he lost his wife his brother, Peter, and his best friend Harry Brown. But he also travelled a great deal and spent a lot of time with his children, who learned how genuinely interested he was in his at that time eight, and soon to be 10, great-grandchildren.

He is survived by his four children, 10 grandchildren and 10 great grandchildren.

Michael Harbison

New guidance for doctors’ super

A health fund superannuation scheme is one means of managing finances in the case of future hardship, writes AMA(SA) Councillor Professor Ted Mah.

Ahealth fund superannuation scheme is a type of savings program in which a health fund sets aside a small amount of money for each member to be accumulated over a period of time.

It has the potential to reduce health fund premium, increase membership and membership retention rate of health fund, and to provide financial stability for members during times of economic hardship, However, it is important to consider the potential problems, such as the potential for members not saving enough money or withdrawing funds for reasons other than maintaining their health fund membership and ensure that the scheme is managed by an independent body and carefully designed to be accessible to all members regardless of level of subscription.

One of the main benefits of a health fund superannuation scheme is that it can provide financial stability for a member during times of economic hardship. This can help to ensure that a member can continue to access necessary health services, even if facing financial difficulties.

Such a health fund superannuation scheme is not only cost neutral to the government but can also help reduce the burden on public hospitals and the wider healthcare system.

Another benefit is that it may help to increase the membership subscription and membership retention rate of health funds. More membership subscription is likely to reduce the premiums. To ensure transparency, such accumulated fund should be managed by a centralised independent body unrelated to health fund

However, there are potential problems. Members may not save enough money to cover the cost of future health needs. They may withdraw funds for reasons other than maintaining their health fund membership. The scheme may not be financially accessible to everyone.

To overcome these problems, it is important to ensure that the scheme is designed to be accessible to all members, regardless of level of subscription. It is also important to ensure that the scheme is properly administered, to prevent members from withdrawing funds for

reasons other than maintaining their health fund membership.

An additional incentive is for the health fund to offer a higher rate of savings for members who do not make claims for hospital services, and a bonus contribution for members who do not make any claims for a certain period of time. A rewards program for members who engage in healthy behaviours can motivate members to take a proactive approach to their health. This can encourage the use of preventive care services and good health maintenance, which can ultimately help to reduce the cost of health care for the fund and the members.

It is important to note that these incentives should be designed carefully so they do not discourage members from using necessary health services as they need them. The fund should also ensure that the incentives are not discriminatory and are accessible to all members regardless of their health status.

If you have any comments on the proposal, email membership@amasa.org. au.

Hood Sweeney financial planning experts Daman Arthur and Jackson Harvey explain new superannuation laws.

For medical professionals in the South Australian public health sector, it’s important to have a superannuation fund that aligns with your specific financial goals and objectives.

Under new laws that took effect in November 2022, members of the Super SA Triple S superannuation fund, including doctors in the public health sector, can now choose the superannuation fund they wish to contribute to.

Until the new laws were enacted, public servants were required to be members of one of Super SA's superannuation funds.

Medical professionals can now consider which superannuation fund is appropriate for them.

Super SA Triple S remains the default superannuation fund for South Australian

government employees. It is a constitutionally protected fund, meaning that tax on concessional contributions (such as superannuation guarantee and salary sacrifice) and earnings is not payable until the benefits are accessed or rolled over. The compounding effect of this could provide substantial additional retirement benefits.

Other superannuation funds don’t work in this way as the tax on concessional contributions and earnings is paid at least yearly. For example, retail and industry funds withhold the tax on concessional contributions as the contribution is received.

Super SA Triple S also allows for concessional contributions above the concessional contribution limit to be made without triggering excess contributions.

However, where contributions up to or more than the concessional contribution limit are made to a constitutionally protected fund any further concessional contributions made to a taxed superannuation fund, will be treated as excess contributions.

In addition to helping you navigate superannuation funds, Hood Sweeney Securities (AFSL 220897, ABN 40 081 455 165) can also help you review your existing investments and discuss ways to optimise your portfolio for growth and stability. We work with you to develop a comprehensive financial plan that considers your current income, expenses, assets, liabilities, and long-term financial goals.

Contact Hood Sweeney Securities to schedule a free consultation with a financial planner.

The information in this article contains general advice and is provided by Hood Sweeney Securities Pty Ltd, AFSL 220897, ABN 40 081 455 165]. That advice has been prepared without taking your personal objectives, financial situation or needs into account. Before acting on this general advice, you should consider the appropriateness of it having regard to your personal objectives, financial situation and needs. You should obtain and read the Product Disclosure Statement (PDS) before making any decision to acquire any financial product referred to in this article.

Annual General Meeting

The annual general meeting (AGM) of AMA(SA) will be held at the AMA(SA) offices at 175 Fullarton Road, Dulwich, from 8 pm on Thursday, 4 May 2023.

Members of the AMA are welcome to attend the AGM, to hear reports of activities conducted on behalf of members in 2022.

You may register your attendance by contacting ea@amasa.org.au or phoning (08) 8361 0109.

2023 AMA(SA) Council meetings

The next meetings of AMA(SA) Council will be held immediately before the AGM, beginning at 7 pm on Thursday, 4 May, and at 7 pm on Thursday, 1 June.

Members may attend Council meetings as observers. If you are a member and wish to attend the May or June meeting, please call 8361 0100 or email admin@amasa.org.au

Nominations for AMA(SA) Council

AMA(SA) members are invited to consider nominating for AMA(SA) Council. Nominations close at 5:00PM on Thursday, 23 March 2023.

The Specialty Group representatives and the Public Hospital Doctors’ Representative are elected biennially in the odd numbered calendar year. Please note that:

• A candidate for election as the representative of a specialty group must be a member of that specialty group and must be proposed by members of that specialty group.

• If you are interested in nominating, please contact Mrs Claudia Baccanello on 8361 0109 or ea@ amasa.org.au for a nomination form. For other queries about joining Council, please contact AMA(SA) CEO Dr Samantha Mead at CEO@amasa.org.au

Hamilton House Plastic Surgery

RICHARD HAMILTON MBBS, FRACS, plastic surgeon, wishes to notify colleagues that his private clinic Hamilton House Plastic Surgery is fully accredited under the rigorous Australian National Standards (NSQHS) for health care facilities and also by the American Association for the Accreditation of Ambulatory Surgical Facilities International (www.AAAASF.org).

Richard Hamilton continues to practise plastic and reconstructive surgery at Hamilton House, 470 Goodwood Road, Cumberland Park with special interests in skin cancer excision and reconstruction, hand surgery and general plastic surgery. He also conducts a ‘see and treat’ clinic for elderly patients with skin cancer. Convenient, free, unlimited car parking is available.

Richard also consults fortnightly at Morphett Vale and McLaren Vale, and monthly at Victor Harbor and Mount Gambier/Penola. He is available for telephone advice to GPs on 8272 6666, and readily accepts emergency plastic and hand surgery referrals. For convenience, referrals may be faxed to 8373 3853 or emailed to admin@hamiltonhouse.com.au

For all appointments phone Richard’s friendly staff at Hamilton House 8272 6666. www.hamiltonhouse.com.au

Nominate a colleague for an AMA(SA) award

Nominations are open for AMA(SA) Awards, to be announced at the 2023 Gala Ball on 20 May. Members may nominate a colleague for one of the following awards:

• AMA(SA) Award – recognising outstanding contribution to medicine.

• AMA(SA) Medical Educator Award –recognising outstanding contribution to medical education.

Nomination forms and eligibility criteria are available on the website.

Accessing the AMA fees list

The latest AMA Fees List is available and can be accessed by AMA members at no cost at https://feeslist.ama.com.au/ using your login details.

Melanoma Patients

Australia Fundraiser

Next April 26 – May 1 your Motoring Editor, Dr Robert Menz, is swapping horsepower for Shanks’s pony power. I have always wanted to walk Larapinta and I am looking forward to the trek, and in doing so raising funds in support of people with Melanoma. Many of us have treated such people.

There are several spots available if Larapinta is still on your bucket list, or feel free to donate. This is not the whole Larapinta, but 50 km of highlights carrying a day pack.

Please join in on https://mpa-larapinta-2023.inadv.com.au/ or donate at https://mpa-larapinta-2023.inadv.com.au/robert-menz

Rooms for rent

Two consultation rooms for rent in beautiful, heritage-listed Hutt St. Adelaide, building. Doctors’ parking on-site. Full secretarial support available. Rates negotiable. Two long-term physicians working part-time. Inpatient locum private hospital physician work also available.

Contact: Frances 0488 596 760.

Non-prodedural rooms available to rent on session basis

May Health, 28 Ward Street, North Adelaide

We welcome enquiries from Psychiatrists/Mental Health GPs. Contact Jacki 0490 174 302 https://mpa-larapinta-2023.inadv.com.au/robert-menz

Experts for your financial health

Hood Sweeney is a long term partner of the Australian Medical Association of South Australia providing accounting and financial planning* services to their members.

Our Health team understands the complexities of everything from setting up a medical practice – including IT and service fees – to selling it, along with personal financial planning*, wealth protection*, tax strategies and performance coaching.

For a second opinion on the fiscal fitness of your practice or your personal finances, email our Health team on amasa@hoodsweeney.com.au or call 1300 764 200.

Liability limited by a scheme approved under Professional Standards Legislation

Adrian Zoppa Representative* Financial Planning

Helen Hadjisavva Accounting

Mark Mullins Representative* Life Insurance

Lisa Hickey Business Advisory