AMA(SA) medicSA - Spring 2023

TESTING TIMES

ƒ South Australia’s research future at risk

ƒ Local studies boost covid knowledge

also in this issue

• making sense of payroll tax

• a new ceo for ama(sa)

• streamlining hospital patient transfers

• the life works of king’s birthday honours recipients

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medicSA is produced by the Australian Medical Association (SA)

Australian Medical Association (South Australia) Inc.

Level 1, 175 Fullarton Road, Dulwich SA 5065

PO Box 685, Fullarton SA 5063

Telephone: (08) 8361 0100

Email: medicsa@amasa.org.au

Website: https://www.ama.com.au/sa

Executive contacts

President

Dr John Williams: president@amasa.org.au

medicSA

Editorial

Medical Editor: Dr Roger Sexton

Editor: Karen Phillips editor@amasa.org.au

Advertising medicsa@amasa.org.au

Production

Catherine Waite

ISSN 1447-9255 (Print)

ISSN 2209-0096 (Digital)

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Disclaimer

Neither the Australian Medical Association (South Australia) Inc. nor any of its servants and agents will have any liability in any way arising from information or advice that is contained in medicSA. The statements or opinions that are expressed in the magazine reflect the views of the authors and do not represent the official policy of the Australian Medical Association (South Australia) unless this is so stated.

Although all accepted advertising material is expected to confirm to ethical standards, such acceptance does not imply endorsement by the magazine.

56

Dr

John Williams

President’s report

Dr John Williams

‘The measure of intelligence is the ability to change.’

Albert Einstein

‘Everyone thinks of changing the world, but no one thinks of changing himself.’

‘Change before you have to.’

Leo Tolstoy

Jack Welch, Former Chairman and CEO, General Electric

As doctors, we are (or could be) changing – our practices, our tools, our attitudes – throughout the course of our professional lives. The body of knowledge available to me as a junior doctor is not the same as that which is available to me now, so of course I must change to accommodate as much information as I can about the human body, the human brain, medical treatments and the sciences that overlap with it. My patients deserve it.

industrial relations, corruption, workplace culture, climate change and organisational governance (none of which were offered as electives when I studied medicine). I’ve also responded to draft policies and media questions on matters closer to my areas of expertise: discharge procedures, COVID and Long COVID treatments and care, Ozempic use and shortages.

It has been a massive change.

Now that I travel more often from Port Lincoln to spend time in the AMA(SA) offices, I’ve also become aware of how much work is done by a small number of people in the AMA(SA) Secretariat. The office team has also undergone a huge amount of change in recent months –change that without its collective effort could have threatened our future in this state. We have a new CEO, Nicole Sykes – whose first column appears in this issue – and Leonie Thomson has joined the Secretariat as executive support for Nicole and me.

Along with my colleagues across the South Australian health system, I was deeply saddened to hear of the death of Dr Philip Tidemann on 26 July.

As reported at the time, Phil was in hospital with COVID when he died, his health weakened by a 20-month battle with aggressive bowel cancer.

As a cardiologist, Phil saved lives. But in establishing the Integrated Cardiovascular Clinical Network (ICARNET) project, Phil saved many more, especially in rural areas where the access to cardiac care it provided increased residents’ chances of surviving heart attacks.

We will acknowledge Phil’s legacy more comprehensively in the Summer edition of medicSA.

It’s not just about changes to diagnosing and treating ailments, however. There have been changes to the environments in which we practise, what we know about the impacts of climate change, how some of our patients wish to be recognised and the psychological trauma that can occur, if and for whatever reason that recognition is withheld. We know we can no longer treat students, junior doctors, nurses and other staff – or anyone! - as they were treated by some members of our profession in the past. We know rest is not a perk but a necessity.

It has been fascinating to monitor my own change in attitude about what the AMA is and what it’s for since assuming the presidency of AMA(SA) in May. I had been a member of Council for many years, and I’d joined then-President Associate Professor William Tam on a trip to talk to doctors in the South East. I accompanied Dr Chris Moy during his regional visit to the Eyre Peninsula in 2021. I’d watched and learned from my predecessor Dr Michelle Atchison during my two years as Vice President. But, as she warned me, it looks very different when you’re in the hot seat.

In four short months, I’ve been in meetings about and been the public face of AMA(SA) advocacy on payroll tax,

Perhaps most importantly, Nicole can look at the organisation with eyes untinted by a long history in or with the AMA. She is asking why things are done as they are and if they can be done differently. After staging a staff planning day last month to garner her team’s views about their employer and workplace, she is organising a strategic planning day for people close to AMA(SA) to gather our knowledge and perspectives. I am sure we will ponder thought-provoking questions and ideas that challenge the status quo, as we plan our future.

There is no doubt that medicine requires an organisation like the AMA. An organisation connected to its workers and its patients that can take a step back, look at the bigger picture and direct health to a better place than when it is guided by political agendas or business forces that are not connected or understanding of the delivery of good care.

Honest discussion and resultant change can be messy and uncomfortable. I look forward to considering with our members and everyone involved the changes we should make. Before we have to.

Dr Dean Conrad Member since 2013

From the medical editor

Dr Roger Sexton

But contagious ‘group think’ that defaults to a ‘woe is us’ mentality can infect the profession. This is labelling doctors as part of the problem and not part of the solution. ‘Struggling doctors who need help’ is a really bad look.

Individual doctors give hope every day to patients. We are trained as excellent clinical problem-solvers and apply these skills to individuals, families and communities. Are we equally effective at solving the bigger problems of the health system and within tertiary hospitals, institutions, organisations and broader society? If not, why not?

It may be that we are an ‘evidencebased’ profession where we expect that clinical research will be adopted in clinical practice. We are also encouraged to be risk-avoidant with a conservative mindset. We are accountable to our regulators and indemnifiers if we choose to practise on the fringe. Unfortunately, this can slow the process of clinical and organisational improvement within the profession and the wider health system.

When it comes to trials of new ways to organise our practices and departments, we are missing in action. Trials of ‘best organisational practice’ with respect to the way we work and manage the ‘service’ aspect of health care are lacking.

care professionals in the care of patients, colleagues and emergencies

• better access to online medical information for doctors and patients

• wearable technology to help monitor and optimise aged residents’ sleep patterns

• a wearable voice prosthesis for laryngectomised patients

• genetic testing for carrier screening and counselling services.

These innovators are action-orientated individuals and organisations that solve problems through innovation, attracting significant investment from others who share their missions.

Trials and research are part of the innovation needed on an ongoing basis. I do not see enough of this in the way the medical profession delivers health care. Research is often at arm’s length from those at the centre of a problem.

How many rural doctors, for example are engaged in research? Is the medical profession looking closely enough at the creative spaces in our world that combine existing ideas into something new that will drive health system solutions and efficiency?

Have you heard that the health system is in crisis at present, with too many insoluble problems?

In a way, allowing this mantra to be re-stated paints health system leadership and the workforce as somewhat dyscopic and unable to offer a solution.

The general public is yearning for health system leadership that is realistic and optimistic, and for reassurance that it will not fall over. Feedback from the UK is that its beloved NHS is close to breaking point. Waiting times to see a GP can be as much as four months. Clapping in the streets has not sustained it.

There is a sense here in Australia that we are not far behind, with signals including our workforce deficits in rural and remote Australia, delayed access to primary care and overloaded tertiary hospitals.

But we do not have to be so constrained or risk averse.

The entrepreneurial view is that taking risks and doing something delivers solutions more quickly. While these sit at a ‘sub-system’ level, this is where successful change starts.

A list of some of Australia’s innovators in the health sector makes for an interesting read. The private sector capital these innovators can attract – basically to fund practical solutions to solve practical problems – is notable. Many solutions sit firmly in the technological space. Examples include:

• hypnosis-based apps to help manage IBS, menopausal hot flushes and smoking cessation

• an online platform to assist chronic pain sufferers

• generative AI that drives a patient simulation platform, to train health

Consider your smart phone (or equivalent) for a moment. It arose from identifying the creative space between and then combining two existing products: the computer and the telephone. It has made the telephone virtually obsolete and changed the world.

We doctors are in very close contact with our communities. We hold precious data that is underutilised and possess a unique understanding of the problems that need solving. However, there are barriers that block the application of our problem-solving skills: time, training in research and data, clinical disconnectivity with universities, and a lack of risk-taking and entrepreneurship.

It is not the time to be conservative when solving the problems of the health system. Boldness is required. Our patients seek and expect from us optimistic leadership that offers hope and better access to high-quality health care.

I hope you enjoy this edition of medicSA

Research is often at arm’s length from those at the centre of a problem.

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New CEO for AMA(SA)

medicSA introduces new AMA(SA) CEO Nicole Sykes, whose first column follows below.

New AMA(SA) CEO Nicole Sykes began her career in health as a radiographer and medical sonographer with Dr Jones and Partners, eventually gaining a management role. She believes this provided a strong foundation in understanding the complexities of providing quality care to patients within specialist rooms and a hospital environment while balancing the needs of a business.

Nicole has since expanded her administration and leadership skills in country health, establishing a startup medical practice, and managing large specialist organisations.

She says projects such as developing purpose-built medical facilities and leading a large specialist group through the pandemic have fostered in her a broad and deep understanding of many of the issues confronted by working doctors. She is particularly passionate about ensuring the wellbeing of medical professionals through providing safe working environments in which all staff can thrive.

Nicole and her husband juggle their personal time volunteering as coaches and backstage at their daughters’ many sporting and performing commitments.

What attracted you to the AMA(SA) role?

The positive reputation of AMA and the influential role the association plays to improve the healthcare industry were certainly key factors initially. It was also incredibly appealing to change focus to leverage my experience from working within large specialist medical practices to add value within a broader collaborative network supporting doctors and improving healthcare services.

What are the organisation’s strengths?

The insight gained through collaborating with both members and large industry bodies to align a pathway forward for the benefit of the medical profession and the flow on this has to the community through the provision of quality services are exceptional.

An unexpected benefit I appreciate is the collaboration and support that occurs between the state and federal AMA CEOs and governing councils.

And challenges?

Our most significant challenge, like many associations lies in how we best

From the CEO

Iam so pleased to be joining the AMA at such a pivotal time, when the complexities of our health system demand commitment, expertise and collaboration from doctors to safely care for the needs of the South Australian community. Together, AMA(SA) and our members, particularly those volunteering and representing our wider membership group in advocacy and policy formation, play a crucial role in supporting all doctors to provide quality medical services.

I would like to thank our President, Dr John Williams, our staff, the Board, Council, and committee members for their warm welcome and support as I become familiar with the association at state and federal levels.

Over the past 12 weeks, I’ve gained real insight into how much work is done by

AMA(SA) and our federal and interstate colleagues, much of it behind the scenes. Our current work relates to:

• negotiating rural contracts and advocating for the single employer model

• eradicating bullying and harassment and building inclusive workplaces

• advocating for improvements to policies and systems within health and aged care system that currently contribute to ramping and hospital logjams

• planning the new Women’s and Children’s Hospital

• reducing the impact of the health system on climate change, and climate change on health. And, of course, payroll tax.

deliver value to our membership when much of the work being done delivers value for the entire medical profession.

What have you learned in the first 100 days?

Collaboration is key! Leveraging the amazing work being performed behind the scenes by dedicated staff, medical volunteers in all career stages, from medical students through to retired doctors, together with connecting with appropriate industry bodies assists in influencing positive change and better health outcomes.

What’s next, for 2023 and 2024 and beyond?

The previous president Dr Michelle Atchison and CEO Dr Samantha Mead have led AMA(SA) admirably through some challenging times. The energy to respond to COVID has tested many health organisations and the AMA(SA) has not been immune to this. The AMA(SA) team worked hard to navigate this period so with a new lens as incoming President and CEO, I hope we add value as we continue to plan and implement ways to collaborate with our membership as our core focus.

We are about to undertake a strategic review on what the future AMA(SA) looks like. We are gathering information about our members’ needs and how we can meet those requirements at all stages of their careers. In the coming weeks I will be distributing a survey about these issues and I encourage all doctors to submit ideas, or contact the AMA(SA) office. I am looking forward to working with members to set achievable goals to ensure AMA(SA) continues to evolve, so it remains a useful platform for all doctors, today and in the future.

If you have any ideas or concerns please contact me at nsykes@amasa.org.au. I look forward to meeting with as many of you as possible over the next few months and will be listening and learning to form the foundation of our future.

Welcome Home

Achieve your CPD compliance with ease.

At AMA’s CPD Home, we understand. We understand the new Standard and that non-compliance means your medical registration is at risk. We understand how best to support you to stay compliant each year.

At CPD Home we:

• provide full support to guide you through the new challenges

• uncover your daily work hours that translate to CPD activities help you target CPD activities that address your learning needs

• offer a flexible range of subscriptions to suit your career pathway

• provide a catalogue of Australia’s broadest range of CPD activities enable you to take control of your CPD anytime, anywhere

• support all doctors who require a CPD home. Trust

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New CPD Home a safety net for doctors

From 1 January 2024, all Australian doctors must comply with the Medical Board of Australia’s new CPD registration standard.

Under the Medical Board’s Registration Standard: Continuing professional development, doctors will no longer be able to self-manage their CPD. Each will require a ‘CPD home’ to meet the standard.

The chosen CPD home will help a doctor plan and track CPD activities relevant to their scope of practice, to meet the standard requirements and report their annual compliance to Ahpra.

Dr Mark Duncan-Smith, Chair of Doctorportal Learning Pty Ltd, trading as CPD Home, said the AMA’s CPD Home is uniquely placed to assist doctors with their professional development.

‘As the first new CPD home to be accredited by the AMC, CPD Home provides an accredited CPD Program and learning support service open to all doctors,’ Dr Duncan-Smith said.

‘We recognise there are some doctors, especially our younger colleagues, who have not had a structured CPD program and will need this service to comply with the new standard.’

AMA members who choose the AMA’s CPD Home receive a discount:

• $440 for AMA member CPD Home subscribers

• $220 for AMA member junior doctor subscribers.

Who does this affect?

Australian registered doctors required to subscribe to a CPD home by 1 January 2024 include: medical specialists

• IMGs not on a specialist pathway, with limited or provisional registration

• PGY3+ doctors not in a specialty training program

• all other general registration doctors including non-vocationally registered medical practitioners.

What do these changes mean?

• The new standard applies to all doctors who require a CPD home.

• Self-reporting CPD is no longer an option.

• Fifty hours of CPD activities must be completed annually across two domains of learning:

» Educational Activities

» Reviewing Performance and Measuring Outcomes.

• CPD Home will guide doctors through the changes relevant to their registered scope of practice.

For more information visit the CPD Home website

AMA(SA) COUNCIL AND EXECUTIVE BOARD

AMA(SA) COUNCIL

Office Bearers

President: Dr John Williams

Vice President: A/Prof Peter Subramaniam

Immediate Past President: Dr Michelle Atchison

Chair: Dr Hannah Szewczyk

Ordinary Members

Dr Vikas Jasoria

Dr Nimit Singhal

Dr Krishnaswamy Sundararajan

A/Prof William Tam

Dr Emily Kirkpatrick

Dr Rajaran Ramadoss

Dr Bridget Sawyer

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 Chris Moy

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

Southern: Dr Richard Try

Medical school representatives

University of Adelaide: Isaac Tennant

Flinders University: Jordyn Tomba

AMA(SA) EXECUTIVE BOARD

Dr Michelle Atchison, Dr Guy Christie-Taylor, A/Prof William Tam, Ms Megan Webster, Dr John Williams (Chair), Dr Peter Subramaniam

SA MEMBERS OF AMA FEDERAL COUNCIL

Dr John Williams, Prof Ted Mah, Dr Clair Pridmore, Dr Hannah Szewczyk, Matthew McConnell

Doctors’ contracts key to payroll tax

In the Autumn edition of medicSA, published in March, Norman Waterhouse discussed the implications of recent cases that have drastically shifted the widely held position on payroll tax in Australia’s medical profession. At the time, the South Australian Government had not indicated whether it would aggressively wield these interstate cases to impose significant payroll tax liabilities on private medical clinics – in line with the stance taken by eastern states – or take a more conservative approach in line with Tasmania and Western Australia.

Now, however, RevenueSA has started the new financial year by releasing its rulings and announcing a targeted payroll tax amnesty (amnesty) for payments made by medical clinic entities to contracted general practitioners (GPs).

How did we get here?

To distil the Optical Superstore and Thomas and Naaz cases into their key findings relevant to medical clinics, we note that:

1. Interstate courts and tribunals have viewed contractor arrangements commonly used in the medical profession as falling into ‘relevant contract’ provisions within payroll tax legislation, which may operate to deem a medical clinic as employer of a contracted doctor for payroll tax purposes

2. If a ‘relevant contract’ is deemed to exist (which, on the basis of the recent cases, is likely to be the case for most private medical clinics in South Australia), payments from a central clinic account to an individual doctor will be treated as wages for payroll tax purposes, irrespective of the clinic simply holding doctors’ fees in a central account on trust for each doctor.

These principles, and the relevant cases, are discussed in more detail in the previous edition of medicSA and on our website

The undertones of the ruling make it clear that RevenueSA intends to apply the recent case law as widely as possible.

The amnesty

Medical clinics that participate in the amnesty will not pay payroll tax on payments to contracted GPs during the period of 1 July 2018 to 30 June 2024. The amnesty intends to provide general medical clinics with time to review their arrangements, seek advice, and implement necessary changes to ensure future compliance with payroll tax obligations.

Upon expiry of the amnesty on 30 June 2024, all participants must begin complying with any payroll tax obligations.

The amnesty applies only to payments made to doctors registered as GPs with the Medical Board of Australia, meaning that payments made from a medical clinic to specialist doctors will not receive amnesty protection.

The amnesty also does not apply to payments to GPs who are employees or ‘common law employees’. This can be particularly important for medical clinics without written contracts with GPs, or where written contracts are so onerous that the contractor

would be taken as an employee for purposes outside just payroll tax (such as superannuation and leave entitlements).

Eligibility requirements

To be eligible for the amnesty, a medical clinic must:

• be a ‘designated medical practice’, meaning an employer for payroll tax purposes established on 22 June 2023 that conducts a medical centre business that either:

» meets the criteria for payroll tax registration under section 86 of the Act but is not registered for payroll tax in South Australia and makes payments to contracted GPs (Section 86 of the Act requires employers to apply for payroll tax registration if that employer pays wages exceeding a ‘prescribed amount’ per week during a month. The prescribed amount is currently $28,846 per week from 1 January 2019); or

» is registered for payroll tax in South Australia but is not declaring payments to contracted GPs for payroll tax purpose (meaning that medical clinics which have been doing ‘the right thing’ are not eligible for the amnesty)

• submit an expression of interest to RevenueSA by 30 September 2023

• make voluntary disclosure and, if not already registered for payroll tax, register in South Australia by 30 June 2024; and

• comply with ongoing payroll tax obligations after making voluntary disclosure.

A medical clinic that does not satisfy each requirement listed above will not be eligible for the amnesty.

How to apply

As noted above, a medical clinic that wishes to participate in the amnesty must register their interest with RevenueSA by 30 September 2023. More information and relevant links is available on RevenueSA’s website

If a medical clinic is a member of a group for payroll tax purposes, each clinic within that group must separately apply for the amnesty if it wishes to participate.

After 30 September 2023, RevenueSA will contact each registered medical clinic with details about requirements for the amnesty.

Voluntary disclosure obligations

Valid voluntary disclosure will involve providing information ‘sufficient’ for RevenueSA to assess a medical clinic’s eligibility for the amnesty and payroll tax obligations. The exact level of detail required is still unclear. However, RevenueSA has noted that participating medical clinics will generally need to provide annual wage information (including payments to contracted GPs) for previous years of the amnesty period, as well as estimated wage information for the 2023-24 financial year.

An amnesty for general practice gives much-needed time for GPs to consider how the new State Government interpretation of payroll tax legislation affects them and their colleagues, writes Norman Waterhouse solicitor Alex Belperio.

Payroll tax causing major stress

While much of our public advocacy in recent weeks has focused on general practitioners, because of the looming 30 September deadline for signing up to the amnesty for general practice, we have been working - here and across the country - to help members in private practice in other specialties understand their payroll tax responsibilities. As with our GP members, we are strongly advising that all private practitioners seek advice from legal and financial experts in tax law, to ascertain their status and obligations.

Meanwhile, I have questioned how it is that after years of urging - even begging - people to be logical and follow the evidence, the science, the facts during the pandemic, we are now confronted with another issue on which we are asking for an evidence-based way forward. But this time it is the state treasurers we are urging to be logical, sensible and even economically smart.

On one hand we have the Australian Government and Health Minister Mark Butler investing billions of dollars into health, much of it committed to strengthening Medicare. On the other, state treasurers are grabbing a huge proportion of that money back, by demanding doctors pay what is for us a new cost, a new financial burden, one we have not previously been asked to pay.

As former AMA(SA) President and AMA Vice President Dr Chris Moy told the media this week, it’s ‘like an episode of Utopia or Yes, Minister’.

Except it’s not funny. It will cripple private practice, it will lead to more ramping, and it will affect the health and wellbeing of our patients.

Mr Butler told assembled media on Monday, 25 September that he does ‘urge all state governments to take a measured approach to payroll tax arrangements’ because he wants ‘to see that go into general practices, not into state treasury’.

‘As you consider your payroll tax arrangements,’ he said, pointing his comments at treasurers and state governments, ‘consider the impact on the backbone of our healthcare system, which is general practice.’

continued from page 12

Medical clinics seeking certainty in relation to the payroll tax treatment of their contractor arrangements may also provide copies of their agreements with contracted GPs to RevenueSA.

Practical considerations

With the registration deadline fast approaching, a medical clinic should urgently consider their current contractor arrangements and eligibility for the amnesty so they can submit an expression of interest to participate in the amnesty by 30 September 2023 (if suitable).

It is clear from the position put forward by RevenueSA (both in the ruling and in direct engagement with professional bodies such as AMA(SA) and RACGP that the medical profession should

In saying this, Mr Butler was virtually repeating what AMA(SA) has been saying in meetings with South Australia’s Treasurer, Stephen Mullighan, and Health Minister, Chris Picton. We’ve reiterated what this tax will do to the health system. We’ve asked for an exemption for medical practices, and the Treasurer has said no. We’ve asked that he consider applying the Queensland ruling, which makes it clear that patient fees, including any out-of-pocket expenses, will not be subject to payroll tax when they are paid directly by a patient to a GP for that GP service, and he’s said no. And we’ve asked that whatever financial penalty he imposes retrospectively, he consider changing the interpretation from this point on, to avoid devastating impacts on a health system already in crisis.

We explained to Mr Mullighan in a face-to-face meeting on 20 September that implementation of the new tax burden will lead to:

• less bulk-billing

• more expensive GP appointments

• more patients attending EDs with non-urgent conditions

• a major effect on private pathology, radiology and other providers, as referral pathways disappear

• longer essential surgery waiting lists, with flow-on effects for patients and the health system.

National calculations indicate a payroll tax on general practice would add as much as hundreds of thousands of dollars a year to operating costs. We have emphasised that it will wipe out the tiny profit margin most practices maintain, and that as many as 30% are considering shutting their doors.

As we have reminded the Treasurer and Health Minister in this state, and their Opposition counterparts, this government was elected on a platform of reducing ramping and fixing our health crisis. We understand – better than most – that there is no policy or quick solution to achieve that. But what won’t fix it is making it harder for general practice to play its critical role as the heart of the health system.

expect increased scrutiny and audit activity in relation to payroll tax obligations.

Our tax practitioners have had extensive involvement with AMA(SA) and other professional bodies in tackling these issues, and can help medical clinics with reviewing contractor arrangements, establishing sustainable operating models and navigating the effects of new payroll tax initiatives such as the amnesty.

Should you wish to obtain further guidance about your potential exposure, please contact Kale Rigano (Principal, 08 8210 1207 or krigano@normans.com.au), Marissa Mackie (Principal, 08 8217 1361 or mmackie@normans.com.au) or Alex Belperio (Solicitor, 08 8210 1230 or abelperio@normans.com.au).

It’s possible that the issue of payroll tax for medical practitioners and their practices is requiring more time and effort from AMA(SA) leadership than any other advocacy issue in recent years, except those related to the pandemic, writes AMA(SA) President Dr John Williams.

Doctors and a ‘good death’

Former AMA Vice President Dr Chris Moy says a new AMA Position Statement reminds us that a patient’s doctor has a vital role in managing

As Benjamin Franklin once said, ‘In this world, nothing is certain except death and taxes’. But despite the inevitability of death, end-of-life care remains an messy afterthought in terms of focus and resourcing in health policy.

This may be due to a denial of our own mortality, but also because of the hand balling of responsibility and poor coordination of policy for a form of care that is multidisciplinary and primarily provided in the community. And while for many the introduction of voluntary assisted dying (VAD) across the country is a welcome change, VAD is of itself not the panacea that will bring a ‘good death’ for all; nor does it alone solve the woes of end-of-life care.

What is required is a recognition among politicians and decision-makers that end-of-life care requires a genuinely coordinated approach with adequate funding so patients (including each one of us one day), at a time when they are at their most vulnerable, see a true team providing seamless compassionate care to allow them to have a ‘good death’.

After a 12-month consultation that included state and territory AMA offices,

the AMA has released its updated Position Statement on Issues Arising at the End-of-Life 2023. The statement covers a range of issues such as palliative care, advance care planning, access to services, groups with diverse needs, the cultural needs of Aboriginal and Torres Strait Islander peoples, children, decisionmaking capacity, health workforce and system development, grief and bereavement, carers and research.

As doctors, we have a duty to provide the care for a patient with a life-limiting illness that aims to alleviate pain and suffering, uphold the individual’s values and preferences for care, and allow them to achieve the best quality of life possible. As such, the Position Statement reinforces the importance of access for all patients and their families to timely, affordable, quality palliative care services, regardless of where they live in Australia.

Palliative Care Australia has identified a significant unmet need for palliative care and estimated the demand for palliative care in Australia to increase by 50% by 2035 and double by 2050, according to the Palliative Care Australia Roadmap 2022-27. To meet current and future demand, we must have appropriate, ongoing investment in palliative care

More South Australians access VAD permits

delivery at the national, state and territory levels, including in specialised services, general practice and residential aged care Facilities (RACFs), workforce development, research and data collection.

This investment must be accompanied by sufficient and adequate planning; funding; the training, coordination and clinical governance of health practitioners; and adequate health and related services to expand the trained palliative care workforce and break down the siloed approach to end-of-life care.

Investment in palliative care supports patients and their families and makes good economic sense. Palliative care services lift pressure from the health system through reduced use of health services (such as fewer hospital transfers and admissions, shorter hospital stays, and reduced use of intensive care units and EDs), better coordination of the health care system, and improved wellbeing for carers.

As the AMA, we must ensure palliative care is not simply the poor cousin in health funding but rather the core business of health.

SA Health released its second Voluntary Assisted Dying (VAD) Quarterly Report in August, highlighting the number of South Australians choosing VAD.

The report indicates that the program continues to receive positive feedback from participants and their families, specifically concerning the support and care provided to those applying for VAD permits. VAD was introduced in South Australia on 31 January 2023. The first quarterly report showed that 28 people had a permit issued by the Chief Executive of the Department for Health and Wellbeing (DHW) between 31 January and 30 April. Of the 28, 11 died with VAD medication and one died without taking the substance.

The second report revealed that between 1 May and 30 June (a shorter reporting period to bring the quarterly publications in line with standard reporting), 40 people received a VAD permit. Of these, 32 people who received a VAD permit, aged from their 20s to their 90s, had died at the time of the report’s release on 22 August. Five of these had degenerative neurological conditions, 19 had terminal cancer, three had respiratory failure and five ‘other conditions’. Five people died without using the medication available. Eight of the 32 were supported by medical practitioners and 19 people self-administered medication. Forty per cent died in regional South Australia.

The report notes there are 66 medical practitioners who have completed the mandatory training, among whom 17 are in regional South Australia, and another 46 registered or part-way through the training.

a ‘good death’.

Dr Chris Moy is Deputy Chair of the AMA Ethics and Medico-Legal Committee.

Council news

August 2023

AMA(SA)

Councillor and

AMA Council of Doctors in Training

Chair Dr Hannah Szewczyk is the new Chair of AMA(SA) Council, following her election to the position at the August Council meeting.

Dr Szewczyk assumes the position vacated by Associate Professor Peter Subramaniam, who was elected AMA(SA) Vice President alongside President Dr John Williams in May.

Dr Williams, who acted as Chair in A/ Prof Subramaniam’s absence at the meeting, welcomed Dr Szewczyk, who is training with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and has served on AMA(SA) Council as the DiT and now O&G representative.

Later, former President Dr Michelle Atchison was elected to the AMA(SA) Executive Board. Dr Williams said Dr Atchison – who as Immediate Past President is not an automatic appointment to the Board – would continue to offer her years of corporate knowledge to the Board table.

The meeting included discussion over SA Health’s ongoing approach to managing COVID-19 and Long COVID. Members noted that while COVID cases are lower than earlier in the year, the number of South Australians with Long COVID continues to grow, yet there is no clear evidence of SA Health resources addressing their needs.

It was noted that there was no specific allocation for responding to Long COVID in the 2023-24 State Budget handed down in June, and that regional residents, in particular, lack health and allied health services.

Meanwhile, the burden of diagnosing and supporting people with suspected Long COVID continues to fall on the shoulders of general practitioners (GPs).

Meanwhile, one Councillor commented that while he received his flu shot from his employer at no cost, his most recent COVID vaccination was obtained (at a cost) from the local pharmacy.

It was also noted that while many doctors continue to encourage patients and friends to have boosters, events such

as the trial determining the legitimacy of Warren Tredrea’s dismissal because of his refusal to be vaccinated against COVID may bring to prominence again the discrepancies between scientific information and other influences.

Council agreed that with Australians dying of COVID and the lack of action in addressing Long COVID, ‘getting the message out’ that COVID is still an issue requires more, targeted messaging.

The ‘tsunami’ of UK doctors considering and deciding to leave the NHS and accept roles in Australia presented opportunities for the AMA to offer assistance and recruit members, Council agreed. AMA(SA) is considering how to develop events, services and materials to support the IMGs from the UK and elsewhere who are vital to a health system that continues to face chronic workforce shortages.

Dr Nimit Singhal Ordinary Member

September 2023

Apresentation from AMA(SA) Vice President Associate Professor Peter Subramaniam on the Vanderbilt model and its value in peer-led workplace cultural change was an important agenda item for the AMA(SA) September meeting.

A/Prof Subramaniam detailed his experience of the program at Central Adelaide Local Health Network (CALHN),

at the request of Council after earlier discussions about persisting bullying, harassment and other workplace issues in the state’s training hospitals.

Vanderbilt University’s professional accountability program is an evidencebased, organisation-wide proactive approach to improve individual’s behaviour following a peer intervention, improving workplace safety and patient outcomes.

At the core of this model is the ability to identify and respectfully share feedback with peers or co-workers of unprofessional behaviours that do not align with the values of the organisation, allowing self-reflection and personal alignment with organisation’s culture of safety and excellence. It gives any organisation the framework to define critical standards of safety and professionalism, and address behaviours that undermine them, while promoting the positive behaviours occurring within the network.

The peer-to-peer support model encourages a ‘cup of coffee’ conversation where peers – ideally at equal level of seniority and working within comparable specialities – have an informal conversation highlighting the lapse in

Council acknowledged the contribution and service to the profession and South Australian health of cardiologist Dr Phil Tideman, who died on 26 July after a long battle with bowel cancer. professionalism, in a non-judgmental, non-confrontational way.

Council recognised the importance of such models in efforts to implement the AMA(SA)-led legislation to make boards accountable for the psychosocial safety of their staff, and ultimately improve patient care and outcome.

The second item, payroll tax, occupied most of the evening. New interpretations of state tax law mean medical practices are liable to pay payroll tax on payments made to contracted general practitioners (GPs) unless an exemption applies. Recent decisions interstate have created significant uncertainty and has the potential to threaten the viability of many medical practice entities, which often operate on thin margins and retain little or no profit at the end of the year.

It is clear this tax could be a death knell for many general practices. Though the tax is state-based, AMA will take a national approach to lobby for an exemption for general practice. In South Australia, the government has announced an amnesty on payments made to contracted general practitioners until 30 June 2024.

There is no council meeting in October and Council will reconvene in November.

Climate change among advocacy targets

Anational strategy linking health and climate change was among the policy documents to which AMA(SA) Council responded in recent months.

The AMA(SA) submission noted that the ‘National Climate and Health Strategy – Consultation Paper’ focuses almost solely on reducing the impacts of the health system on climate change, and does not propose much-needed actions and policies needed to reduce the impacts of climate change on the health of individuals and communities.

The AMA(SA) recommended that the immediate and long-term impacts on physical health, mental health, and the ability access services of emergencies such as the Riverland floods of late 2022 to early 2023 form a significant, additional section of the Strategy. It proposes to address the mental health impacts of climate change and ‘climate anxiety’, especially among younger people.

The submission put forward amendments to the strategy objectives to Identify and audit the contributors the health system’s contributors to greenhouse gas emissions and accelerate the reduction of greenhouse gas emissions from the health system. It also proposes an objective to Encourage the participation of governments, institutions, health providers and staff, and patients and communities, in reducing the health system’s greenhouse gas emissions.

The AMA(SA) submission said many of the strategies to reduce emissions, such as transitioning to renewable energy sources, improving energy efficiency, and adopting sustainable transportation, can also improve air quality, reduce pollutionrelated diseases, and enhance overall health outcomes. These actions can lead to cost savings in healthcare and improve the well-being of both patients and healthcare workers. However, if ‘Tackling health inequities’, ‘Population health and prevention’ and ‘One Health’ are to be ‘Principles’, underpinning the Strategy, the AMA(SA) suggested the Strategy must focus more on impacts of climate change on health.

The AMA(SA) observed that the public system has a major role in reducing the overall carbon footprint of the system, as about 40% of health system waste emanates from hospitals. The submission also pointed to the need for education programsfrom hospitals to small practices - to change behaviours such as turning off lights and reducing printing. The health sector has a role to play in setting modelling behaviours and AMA(SA) continues to advocate for a Sustainability Unit within the Department of Health (SA Health).

AMA(SA) Council suggested research to explore and record the impacts of the health sector on climate change, and vice versa. This would also record the immediate and long-term effects of bushfires, floods and other disasters on individuals, communities, and their health services.

Midwife prescribing

The AMA(SA) submission on a proposal to enable midwives to prescribe in public health services supported the principle that midwives should be appropriately credentialled and monitored in

their use of scheduled medicines that are commonly used in their particular context. It also broadly supported the approach to enable each facility or LHN to decide which drugs a midwife may prescribe, noting that this should be determined with medical oversight.

The submission also pointed to the need for regular assessment of the skillset and scope of prescribing midwives by a body independent of the nursing community. The AMA(SA) favours a GP team approach where midwives work within their scope of training, recognising that it is important that GPs remain central to post-natal care and early infant care.

Draft clinical prioritisation criteria for outpatient clinics

AMA(SA) members provided comments on several draft clinical prioritisation criteria developed by SA Health for GPs referring patients to outpatient clinics at public hospitals.

Submissions to SA Health covered criteria for:

• endocrinology

• hepatology

• plastic and reconstructive surgery

• geriatrics

• gynaecology

• neurosurgery

• ophthalmology (adult and paediatric)

• urology.

The AMA(SA) welcomed measures to improve the quality of communication between referring doctors and hospitals to promote timely access to outpatient services.

GPs raised concerns about the protocols replacing personal communication with specialists, especially if the diagnosis is complex. They said that while the protocols provide a useful filter, it is important to ensure there is appropriate support for GPs to manage patients who do not neatly fit the outpatient criteria. ‘Many issues can be resolved in a matter of minutes if GPs have rapid access to high-level advice from a consultant or senior registrar,’ they said. ‘It’s important to be able to talk and discuss with experienced colleagues rather than merely referring to emergency departments.’

The AMA(SA) raised concerns around cost shifting for pathology services implicit in the requirement of certain tests before the referral is accepted for triage.

The submission noted that there is an unrealised opportunity to engage the private sector to take on Outpatients where there is no additional capacity to do so within the department and a formal partnership between the public and private sector has the potential to significantly reduce waiting lists.

In a national advocacy submission, AMA(SA) has reiterated its concerns about climate change.

A strong voice

AMA and medical colleges call for immediate action to clear surgery backlog

The Australian Medical Association (AMA) has joined with medical colleges to call for immediate action over lengthening surgery waiting lists that are leaving thousands of Australians in fear and prolonged pain.

The AMA, Royal Australasian College of Surgeons (RACS), Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have written to federal Health Minister Mark Butler, calling for action in public hospitals.

The group points out that while the National Hospital Funding Agreement (NHRA) needs reform, a new agreement won’t be introduced until 2025. New funding must be dedicated to clearing the surgery backlog, they say, with an estimated $4.4 billion — shared between state, territory and Commonwealth governments — needed over two years.

The AMA and the medical colleges are pushing for 50–50 funding in the new NHRA and the removal of the 6.5 per cent cap on funding growth, together with the reintroduction of performance funding.

The group says immediate action is required to help public hospitals expand capacity, as it is estimated the elective surgery backlog is likely to be more than 500,000 patients and growing, while the ‘hidden waiting list’ for initial public outpatient appointments could exceed 400,000, the group says.

The letter says new funding must be dedicated to clearing the surgery backlog, with an estimated $4.4 billion — shared between state, territory and Commonwealth governments — needed over two years.

Current wait times for publicly funded cataract surgery and elective surgeries for women are particularly distressing.

The group notes the need for efficiencies within the public health infrastructure by establishing facilities with dedicated surgical beds reserved for planned elective surgery patients to ensure emergency admissions do not occupy theatre and bed resourcing.

Private health insurance has been on ‘set and forget’ for too long

The AMA is calling for significant reform to private health insurance to help alleviate cost-of-living pressures on customers and the health system.

With reports revealing some providers are increasing Gold health premiums by up to 8 per cent, the AMA warns that many Australians are effectively being priced out of private health insurance policy products that meet their needs.

Professor Robson said the AMA submission to the Department of Health and Aged Care renewed calls for a Private Health System Authority to drive reform. Private Health Insurance continues to be an important incentive to encourage those who can have planned surgery in the private system and reduce pressure on public hospitals, he said.

‘Because of a lack of indexation things have drifted along and it really seems to be negatively impacting on people on lower incomes,’ Professor Robson said. ‘We need to make sure that anybody who wishes to take out private health insurance has a fair and equitable chance of doing that.

‘We think it’s actually time for an independent umpire — a private health system authority — to take the heat out of a lot of these things, take the politics out, and make sure that all Australians get a fair deal and the government gets value.’

The AMA is advocating for private health to adapt to more innovative and efficient models of care, such as home-based and community-based care, but do so in a way that ensures patient choice remains the hallmark of the system.

‘The system has to be sustainable, and it has to be all about patients and making sure they can access the care that they need in an affordable way, and they don’t have to seek care in the overloaded public system if it’s possible to avoid it,’ Professor Robson said.

The AMA’s submission argues for annual indexation of the Medicare Levy Surcharge after years of zero or inadequate indexation, which has led to unfair settings that negatively impact people on lower incomes.

It also recommends more frequent reviewing of private health policy settings which has been a key call from the AMA since the launch of the AMA prescription for private health in 2020

AMA and ADA join forces to call for a tax on sugary drinks

Australia must implement a tax on sugary drinks to help curb the country’s obesity crisis and slow down the rate of tooth decay and chronic disease, say the AMA and the Australian Dental Association (ADA).

Despite proven links to poor health outcomes, research shows Australians drink at least 2.4 billion litres of sugary drinks every year — enough to fill 960 Olympic-sized swimming pools. AMA research shows a tax on selected sugary drinks would reduce sugar consumption from soft drinks by between 12 and 18%, which would lead to far better health outcomes for Australians.

The AMA has recently publicly commented on issues ranging from surgery waiting lists to artificial intelligence. On these pages we summarise recent advocacy statements.

‘The AMA’s own research shows that adding just 16 cents to the price of a can of soft drink results in thousands of fewer cases of diabetes (-16,000), heart disease (-4,400) and stroke (-1,100) over 25 years but we now additionally know 500,000 dental cavities and their costs could be avoided over a decade with cost-savings of $63.5 million,’ he says.

AMA analysis shows the tax would raise $749 to $814 million in revenue each year, which could be invested into preventative health initiatives to improve the health and wellbeing of Australians.

This is supported by a Monash University-led research collaboration with Deakin University and the University of Melbourne which has found a sugar tax could prevent more than 500,000 cavities in the next 10 years.

Studies also reveal links between oral health and numerous chronic diseases throughout the body including cardiovascular disease, type 2 diabetes and Alzheimer’s disease.

Professor Robson said a broad range of measures would also be required to address social and cultural inequities that prevent many Australians from receiving regular dental care.

Read the new Australian study

Read the AMA’ research on a sugar tax

Read more about the AMA’s #Sickly-Sweet campaign

AMA welcomes successful 60-day dispensing vote

Millions of Australian patients will be able to access half-price medicines after the Senate passed the federal government’s 60-day dispensing policy after years in the pipeline.

Professor Robson thanked the Senate for ensuring that from 1 September, patients could access cheaper medicines while making fewer trips to the pharmacy to refill scripts.

‘This is an important day for Australian patients, who have been desperately waiting for much-needed financial relief amid this cost-of-living crisis,’ he said.

Professor Robson said the final Senate vote followed years of advocacy by the AMA and other health and consumer groups.

‘The AMA reignited the call for this policy in February this year and we have advocated for it every day since.’

Professor Robson thanked the many doctor, health and consumer groups that helped get 60-day dispensing over the line — including the Royal Australian College of General Practitioners, Consumers Health Forum, National Aboriginal Community Controlled Health Organisation, Asthma Australia, Breast Cancer Network Australia and many more.

AI can improve healthcare for Australians, but with robust rules in place

The AMA has delivered its first Position Statement on the use of AI in healthcare to provide a framework based on safety and equity to enable the careful application of AI technologies in healthcare.

The position statement covers the development and implementation of AI in healthcare and supports regulation which protects patients, consumers, healthcare professionals and their data.

Professor Robson told the media that with appropriate policies and protocols in place, AI can assist in the delivery of improved healthcare, advancing our healthcare system, and the health of all Australians.

‘The AMA sees great potential for AI to assist in diagnosis, for example, or recommending treatments and at transitions of care, but a medical practitioner must always be ultimately responsible for decisions and communication with their patients.

‘We’d like to see a national governance structure established to advise on policy development around AI in healthcare.

‘Such a structure must include all health-sector stakeholders like medical practitioners, patients, AI developers, health informaticians, healthcare administrators and medical defence organisations, Professor Robson said.

The AMA says policy makers must get ahead of any unforeseen consequences for patient safety, quality of care and privacy across the profession. This will require future changes to how we teach, train, supervise, research and managing the workforce.

‘One of the key concerns for any healthcare organisation using AI must be the privacy of patients and practitioners and their data. The AMA’s position is very clear about protecting the privacy and confidentiality of patient health information.

‘This is where regulation and oversight are really important; the healthcare sector must establish robust and effective frameworks to manage risks, ensure patient safety and guarantee the privacy of all involved.’

Welcome focus on private health

AMA advocacy is leading to federal government reforms to private health, writes Dr Michelle Atchison.

After a hiatus in private health reform during the pandemic, I’m pleased to report that the government is seriously considering reforms to private health. There is a strong focus on private health insurance right now thanks to the release of a raft of consultation papers this year, but we have bigger plans and have been working to get them on the agenda.

There are some positive suggestions in the actuarial work that the Department of Health and Aged Care commissioned which underlays these consultation papers. This analysis was proposed by the AMA in 2020 in the AMA prescription for private health insurance and raised again in the AMA repeat prescription for private health

AMA President Professor Steve Robson has also nominated private health reform as the AMA’s key priority for the second half of 2023 and beyond.

At its July meeting, the Council of Specialist Private Practice (CPSP) considered draft AMA recommendations in response to a consultation on actuarial studies that considered the structure of government ‘carrot and stick’ incentives that encourage Australians to take out private health insurance. These settings haven’t changed significantly or been indexed since 2004.

The AMA submission in response to these consultations welcomed proposed reforms, noting that for too long, private health policy has been on ‘set and forget’ mode, meaning the system is falling behind changing customer needs and demographics.

The AMA response was particularly supportive of recommendations to update and annually index the Medicare Levy Surcharge after years of zero or inadequate indexation that has led unfair settings that are now negatively impacting people on lower incomes.

We also expressed concern many people are effectively being priced out of private health insurance policies that meet their needs, as reports reveal some providers are increasing their Gold premiums by up to 8 per cent.

At its recent meeting, Council also considered an AMA Research report on out of hospital models of care in the private health system. The report was then approved by Federal Council at its August meeting and will be publicly launched soon.

Federal Council had identified development of this report as a priority following the AMA’s Private Health Summit last year, where stakeholders almost unanimously agreed that a well-governed expansion of the out-ofhospital sector could result in significant wins for everyone, most particularly patients.

However, in the absence of appropriate regulation in this space, vertically integrated insurers have become the main providers of this kind of care, with no clinical oversight of the programs they are developing. In addition, only people with the right kind of policy or insurer can access them.

potentially restricting clinical autonomy.

The AMA would like to see its proposed Public Health System Authority guide the evolution of a more varied out-of-hospital sector that steers away from vertical integration and managed care. A key enabler to achieving this is a minimum payment guarantee for the out-of-hospital sector that requires the private health insurer to pay even if they do not have a contract with the out-of-hospital provider.

In October, the AMA will hold a workshop with key stakeholders to hammer out a consensus on the details of our Private Health System Authority and other key CPSP private health reform priorities, including the declining availability of private obstetrics services and difficulties attracting psychiatrists to provide inpatient care.

One of the great strengths of the AMA is that it represents the whole profession. This gives the AMA great respect and power that no other medical organisation can hope to achieve. I have seen this in action, and I can assure you that your membership fees are not wasted.

However, from a private specialist point of view it also means one of my jobs is to keep up the high profile of private specialist practice within the AMA and ensure our major issues are dealt with as the highest priority.

Given the AMA President’s clear message that private health is a key priority now and into the near future, please rest assured that we are working hard on your behalf. Your support, your ideas and your membership fees all contribute to this. As an AMA member, you are making things better and helping shape the Private Specialist Practice of the future.

The consultation also requested responses to an Ernst and Young study on reforms to default benefits — benefits which are critical to ensure the power balance doesn’t swing too far in favour of the insurers.

There is also nothing stopping insurers providing a policyholder with lower benefits, or no benefits at all, if they choose to access out-of-hospital care from a provider not owned by, or contracted to, the insurer. Obviously, this is inhibiting the growth of non-insurer led out-of-hospital services, restricting patient choice and

Former AMA(SA) President Dr Michelle Atchison is Chair of the AMA Federal Council of Private Specialist Practice.

Testing times

South Australia has a long tradition of biomedical research that has transformed patients’ futures and saved lives.

But research requires funding and the recognition that the outcomes may not immediately affect the state’s or even the institution’s bottom line. In a special medicSA feature, globally renowned clinical academics point out that while the funding isn’t coming South Australia’s way, there are huge risks to our international reputation and capacity to attract the best talent.

Still, some research is occurring within our universities and hospitals and at the South Australian Health and Medical Research Institute – including a wave of studies exploring the effects and ramifications of COVID-19. Beginning on page 24 we present summaries of the work being done to help patients through this pandemic and minimise the effects of the next one.

An uncertain future

Funding for medical research in South Australia is perilously low, with many talented researchers likely to move interstate or overseas or leave the profession, warn some of the state’s most eminent researchers.

Professor Michael Horowitz, Director of the Endocrine and Metabolic Unit at the Royal Adelaide Hospital, says research funding in South Australia – particularly for collaborative research between medical clinicians and scientists – is at a very low ebb.

With a career spent entirely in Adelaide as a researcher, educator and clinician, and recently made a Member of the Order of Australia (AO) for distinguished service to endocrinology, particularly diabetes, Professor Horowitz says the research funding landscape in South Australia is bleaker than it has been at any point in his long career.

‘Involvement of clinician-scientists (including nursing and allied health professionals) is pivotal to advancements in medical care, particularly because of their distinct perspective. Unfortunately, clinician-scientists can be regarded as an increasingly endangered species,’ he says.

‘Some medical researchers have the option of moving into more secure clinical work but many clinician-scientists do not, obliging them to look elsewhere or outside the research sector for job security.

‘The budget for National Health and Medical Research Council (NHMRC) grants for the whole of Australia is about $900 million a year. When considered in relation to the wealth of Australia that’s not a lot of money.

Professor Horowitz says that South Australia has tried to gain a larger share of research funding by consolidating research through the South Australian Health and Medical Research Institute (SAHMRI) and by encouraging collaborations. However, he says, the success of this strategy is uncertain.

‘Throughout the majority of my career, the success rate for NHMRC grants was 15 to 20% nationally, and often higher in South Australia – now it is often less than 10%,’ he says.

A 2020 SA Productivity Commission Health and Medical Research Inquiry reported that only 6.6% of NHMRC funding was awarded to South Australia in 2019, down from 10.9% in 2000. NHMRC summaries show this slipped further to 3.7% in 2020, 5.4% in 2021 and 4.5% in 2022. In contrast, research projects in states such as Victoria and Queensland are increasingly successful.

Risk to research standing

There are concerns that South Australia’s research standing will be further affected by the proposed merger of the University of Adelaide, ranked at 89 in the world, and the University of South Australia, ranked at 363.

Professor Horowitz and others ponder whether this will have an impact on South Australia’s capacity to recruit and retain the sharpest minds, including elite PhD students, as the new combined institution maydrop below the top 100.

‘Adelaide has a history of being very strong in multidisciplinary clinical research. In part, that’s why I embarked on a research career and probably why I am still working at age 69,’ Professor Horowitz says.

‘I have terrific colleagues in both my clinical and research groups and my research continues to be intellectually challenging and stimulating,.’

Despite the challenges, South Australian researchers continue to deliver world leading scientific advances, he says. The internationally recognised multidisciplinary group Professor Horowitz has led since 2007 – the Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health –integrates researchers with clinical expertise in gastroenterology, endocrinology, intensive care and nuclear medicine, with basic scientists, and is part of international research collaborations. Training future clinician-scientists is a major focus.

In 2007 it was the first group in South Australia to be awarded a five-year CRE grant by the NHMRC, and against the odds the group received a second five-year CRE grant in 2012.

‘Despite the demanding research environment, our research performance is arguably better than when we received our initial two CRE grants,’ Professor Horowitz says. ‘However, to my profound disappointment, additional and necessary infrastructure support provided by the university was withdrawn as a result of fiscal constraints about three years ago.

‘I would like to see options for talented younger people improved substantially. I believe this is feasible – the costs, when considered in perspective, are not major.

‘Providing appropriate structures to support the development of future clinician-scientists – not just doctors, but also those in complementary clinical disciplines –would represent a very sound investment in the future,’ he says.

Internationally regarded gastroenterologist Professor Chris Rayner, who chairs the Scholarships and Fellowships Committee at the Royal Adelaide Hospital (RAH) and has worked with Professor Horowitz for about 25 years, agrees research grants are increasingly difficult to win.

Professor Rayner says many hospital research grants of around $40,000 to $50,000 that early-career researchers once used to generate pilot data to attract major NHMRC grants no longer exist. The Central Adelaide Local Health Network (CALHN) offers some Clinical Rapid Implementation Project Scheme (CRIPS) grants of up to $200,000 over two years, but these focus exclusively on research that contributes to shorter hospital stays and other ‘service delivery’ outcomes.

‘Support from institutions and structures must be addressed,’ Professor Rayner says. ‘At the moment, getting people out of hospital efficiently seems to be the only priority – an extremely short-sighted perspective.

‘There are also numerous institutional silos, so people at the different organisations aren’t actively encouraged to talk to each other about what they’re doing and collaborate. It’s a real challenge.

‘South Australia has a history of outstanding, world-leading research in medicine and bioscience. It also has numerous advantages as a location for research and clinical trials. Australia is seen as a favourable regulatory environment with attractive tax concessions. We should be attracting much more.’

Professor Rayner also observes the accelerating decline in the number of doctors who combine research duties with an intense

Senior clinical academics warn historically low funding and outcomefocused priorities place the future of medical research at risk.

clinical workload , with fewer than 50 people employed as ‘clinical academics’ in CALHN.

This has inevitably contributed to the reduction in research in specific areas in South Australia – such as the work once led by Professor of Surgery Glyn Jamieson that established Adelaide as a world-leading centre in gastro-oesophageal reflux treatment.

‘In the health system, we are told that we are in a state of emergency all the time,’ he says. ‘That’s a daily message.

‘Everything is about immediate clinical demand. There’s apparently no time to address the big picture.

‘We have to invest in the future and think beyond the immediate needs of today. Otherwise, we will inevitably lose outstanding people – or fail to attract them in the first place.

‘Even small-scale budget changes to boost funding for fellowships to support early career researchers, and small grants that are accessible and don’t have to focus on service delivery –these would be very worthwhile.’

Recognising the value

Professor Guy Maddern, a hepatobiliary surgeon based at The Queen Elizabeth Hospital and for three decades the Adelaide Medical School’s Professor of Surgery, agrees research support needs rethinking. ‘Governments need to recognise the real value in having vibrant, questioning people doing great research in public hospitals,’ he says.

With a role including both clinical care and research, Professor Maddern has been involved in running the Basil Hetzel Institute for Translational Health Research at TQEH for about 20 years.

Ongoing discussion about ‘what or who pays’ clinical academics and salaried hospital clinicians who want to split their working hours between research, clinical and teaching roles remains a significant handbrake on clinical research.

Disagreements between employers about who pays for what time spent by the researcher on clinical or research roles damages output, morale and the reputation of the state as an incubator of ground-breaking, world-changing science.

More clarity around research roles would help, says Professor Maddern. ‘We need more positions that are substantial appointments – 0.7 and 0.8 FTE rather than 0.2 and 0.3 – and identify within those positions the amount of time that will be quarantined for research.

‘In exchange, they need to generate outcomes – publications and bringing in funding – that can be measured and support higher-degree students in their research endeavours.’

Professor Maddern supervises 10 higher-degree students who don’t need additional funding to draft work emanating from their clinical opportunities.

‘I’m able to get reasonably substantial grants to employ clever people to do really clever work but obtaining grants is an administrative nightmare. That lack of administrative support means I spend my time on work that would be cheaper and better done by writers and admin staff.’

World-renowned academic cardiologist Professor John Beltrame, who is the Michell Chair and Medicine Lead at the University of Adelaide and Director of Research for the Central

Adelaide Local Health Network (CALHN) and senior consultant at the Queen Elizabeth, Royal Adelaide and Lyell McEwin Hospitals, agrees the chase for grant funding is frustrating. He says an application for a NHMRC or Medical Research Future Fund (MRFF) grant typically takes 100-plus hours to complete and researchers usually come away empty-handed.

He agrees there is a focus on funding research that can be immediately translated into benefits for patients rather than having a longer-term horizon.

But he says there are positive signs.

Collaboration between the state’s researchers and with international and interstate partners is the key to greater funding success, Professor Beltrame says.

‘Forums for hospital, university and SAHMRI researchers to promote their research activities to other local researchers are important mechanisms to facilitate collaboration, particularly between clinical, basic and epidemiological research fields,’ he says.

‘This is especially important for translational research, where clinician researchers do not have the time or expertise for the basic laboratory research and the lab researchers benefit from an opinion as to the clinical relevance of their research studies.’

Professor Beltrame is confident that collaboration-based initiatives will start to make a difference to South Australia’s success rate over the next few years.

The new independent cancer-focused medical research institute, South Australian immunoGenomics Cancer Institute (SAIGENCI), is one of the ‘good news stories’. ‘There’s also the Genomics Centre – these are both excellent institutions that are developing and hopefully will drive an improvement in South Australia’s grants success rates,’ he says.

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Public health measures support transmission prevention

While the World Health Organisation has announced the end of the COVID-19 global health emergency, South Australian research institutions are continuing to make new findings about the disease and its management.

A study led by Dr Adriana Milazzo at the University of Adelaide has found non-pharmacological interventions in South Australia such as border closures, contact tracing, physical distancing, community containment, personal hygiene, personal protective equipment (PPE) and testing capabilities were effective in slowing the spread of COVID-19.

In the absence of vaccines, public health measures of physical distancing, personal hygiene and mask-wearing were designed to prevent transmission at the population level by minimising the level of indirect and direct contact with COVID-19 virus-laden respiratory droplets or aerosols.

While the study found gaps in evidence for the efficacy of the non-pharmacological interventions, substantial reduction of

influenza cases in Australia to near zero further supports the impact of non-pharmaceutical interventions on respiratory illness.

The study notes decreases in notifications of other infectious diseases for invasive pneumococcal disease in England and invasive meningococcal disease in France. The authors say it is likely that non-pharmaceutical interventions were the main drivers in the reduction of vaccine-preventable diseases reported during the pandemic.

Mandatory face masks in public, isolation or quarantine, physical distancing and travel restrictions have been shown to contain COVID-19, and combinations of interventions were demonstrated to have a greater effect on reducing the spread of infection.

The study compiled a chronology of interventions implemented across South Australia and Victoria between 5 January 2020 and 1 January 2021.

COVID-19 cases in South Australia by week of notification to 2 January 2021 with timing of non-pharmaceutical interventions

‘The statistical models demonstrated a clear relationship between the introduction of each intervention and a reduction in the Incidence Rate Ratio two weeks later, the authors say.

The model for the effect of border closure showed important differences between states in the effects of the intervention, with the IRR for Victoria consistently larger than for South Australia, reflecting the much greater relative burden of disease in that state.

The effect of mask-wearing in Victoria appeared to remain constant between two and four weeks, while the IRR for lockdown in Victoria was 0.88 (95%CI 0.86–0.91) at two weeks increasing markedly in effect at three (IRR 0.53, 95%CI 0.51–0.54) and four weeks (IRR 0.34, 95%CI 0.33–0.35).

The study concluded that mask-wearing and lockdown were effective measures implemented in Victoria. Border control instituted in South Australia when the case burden was small (eight cases in the week ending 8 August 2020) was effective in decreasing COVID-19 incidence, while in Victoria border control was introduced when the case burden was higher (1,226 cases in the week ending 11 July 2020).

It took much longer for the combination of mask-wearing, lockdown and border closure to affect new case numbers in Victoria, the authors note.

Border closure in Victoria was less likely to have an impact two

weeks after introduction because case numbers were already high.

A modelling study examining the timing of public health interventions in Australia found that a combination of physical distancing and wearing face masks to be effective in controlling COVID-19 outbreaks if they are introduced prior to the number of cases exceeding six per day.

Mask-wearing produced the largest reduction in case incidence of all the interventions tested in our model for Victoria.

Lockdown in Victoria was also successful in reducing case incidence, with the greatest benefit observed at four weeks after its introduction. In other studies, evidence on the effectiveness of lockdown is less clear; stay at home interventions in American states were associated with non-significant 2.4% reductions in weekly COVID-19 related deaths.

Despite limited available evidence, studies have demonstrated some effectiveness of border controls and this study found border controls were effective at between two and four weeks after the intervention.

As interventions overlapped, it was difficult to disentangle each intervention's individual effect on case numbers. Despite this, the study showed that benefits continued to accrue for masks and lockdowns, with a clear reduction in the IRR for lockdowns across time, the authors noted.

COVID-19 cases in Victoria by week of notification to 2 January 2021 with timing of non-pharmaceutical interventions.

Researchers at Flinders University have found measuring a patient’s inflammatory response to coronavirus when hospitalised could help to identify those most at risk of severe, extended illness or even death from the respiratory disease and its variations.

Research led by Professor Arduino Mangoni of Flinders’ College of Medicine and Public Health has found Development of a simple test using routine information from laboratory data, the Systemic Inflammatory Index (SII), could be used to prioritise treatments and focus on individuals most at risk.

Inflammatory markers are already used to highlight outcomes and progression of many forms of cancers, as well as risk for stoke, non-alcoholic fatty liver disease and some heart conditions.

The study confirms the potential for routine assessment of the SII – particularly for patients presenting for hospital care – to tailor their anti-viral and other treatment to suit their risk profile and reduce long-term harms.

The reported pre-vaccination mortality rate in COVID-19 patients admitted to hospital is estimated at 17% with high mortality rates among general admitted patients and critical care cases leading to major pressure on resources which continued after the infectious disease emerged in 2020.

With vaccinations leading to high levels of population immunity to SARS-CoV-2, the World Health Organization recently highlighted the decreasing trend in COVID-19 deaths, the decline in COVID-19 related hospitalisations and intensive care unit admissions.

Inflammatory marker a life saver Deafness a COVID-19 side-effect

Anursing lecturer at University of South Australia, Kim Gibson, has used her own COVID-19 experience to inform research into a little-known side effect of the virus –sudden deafness.

The registered nurse with a clinical background in neonatal intensive care, has documented her experience with sudden sensorineural hearing loss (SSNHL) five weeks after testing positive to COVID-19. She was fully vaccinated.

Her findings and recommendations are published in the latest edition of the British Medical Journal Case Reports

Ms Gibson developed acute hearing loss in one ear, along with vertigo and tinnitus several weeks after experiencing a mild COVID-19 infection in 2022.

She was referred to an otolaryngologist who confirmed sensorineural hearing loss, a little known and poorly understood side effect of COVID-19 that is not listed as a common symptom on most websites, or by GPs.

A course of oral prednisolone and betahistine was prescribed, and her hearing slowly improved over subsequent months, although she continues to experience intermittent tinnitus.

‘The evidence around the short and long-term impacts of COVID-19 and vaccines is still emerging and the aim of this paper is to highlight the lesser-known side effects of the virus,’ Ms Gibson says.

‘We believe that clinicians should include sudden hearing loss as a potential side effect of COVID-19 when talking to patients. High-dose corticosteroids are a recommended first line of treatment for SSNHL and it is important that GPs promptly refer patients to specialists as soon as symptoms develop.

Ms Gibson said that despite working in health education, she was not aware of COVID-19 causing hearing loss.

‘I was unable to drive a car while experiencing severe vertigo. I needed to reduce my workload, negotiate flexible working hours with my employers and take a leave of absence from study. This was all due to a mild COVID-19 infection.

‘I was worried that the hearing loss would be permanent and that I would need a hearing aid. I now feel very nervous about a second COVID-19 infection. What if I experience this again, or even worse?’

Previous studies have linked SSNHL with COVID-19, as well as a potential side effect of COVID vaccination, but the evidence is still limited, Ms Gibson says.

A study of hearing loss during the pandemic showed that approximately one third of patients with SSNHL were positive with COVID-19 when they were referred to an audiologist. Other studies reported an increase of SSNHL in 2020 and 2021, including among asymptomatic people

Tool weighs vaccination benefits

The Immunisation Coalition COVID-19 Risk Calculator (CoRiCal) Coalition has been updated to enable parents to weigh up the risks and benefits of Covid vaccinations for children.

University of Queensland virologist Associate Professor Kirsty Short said the calculator was initially designed for adults based on their current circumstances and risks of getting Covid under different transmission scenarios.

‘This update allows parents to gather that same information and apply it to their children’s circumstances.’

Dr Short said one of the main challenges for parents and clinicians has been a lack of access to the latest evidence regarding vaccination risks versus benefits, or illness and deaths prevented, in children.

‘There is a lot of misinformation online about COVID-19 and vaccinations, so this calculator plays a critical role by providing tailored, evidence-based information in a convenient way,’ Dr Short said.

CoRiCal team member, Associate Professor John Litt from Flinders University, said promoting COVID vaccination in children was more important than ever, with current approaches yielding concerningly low uptake.

‘We’ve observed a very low vaccine uptake in children aged 5 to 11, with only a 10 per cent increase in the last six months,’ Dr Litt said.

‘It is therefore crucial decisions are informed by transparent risk-benefit analysis and effective risk communication, ensuring higher vaccine uptake in children.’

CoRiCal is a collaboration between the Immunisation Coalition, The University of Queensland, Queensland University of Technology (QUT), Sydney University and Flinders University.

The CoRiCal tool can be accessed here

Older drivers taking more risks

Older Australians have taken more risks when driving on roads since the introduction of COVID-19 lockdowns, affecting the number and severity of traffic crashes.

Dr Ali Soltani from the Flinders Health and Medical Research Institute at Flinders University, evaluated crash data before and after COVID-19 to determine the impact of the pandemic on the frequency and location of crashes involving older people.

Police-reported crash data for the over-65 population in metropolitan Adelaide was investigated for two periods: two years before and one year after COVID-19. The researchers found that during the lockdown period of the pandemic in 2020, there was a 20% reduction in the frequency of crashes involving older adults compared with the same period before the pandemic. This was surmised to be a positive effect of COVID-19 lockdown travel restrictions rules.

The researchers found that although reduced traffic volume resulted in fewer crashes overall, the severity of crashes was slightly raised as the crash hotspots shifted to higher speed zones.

“The changes in crash occurrence were strongly related to time and certain spatial characteristics of the environment,” says Dr Soltani.

Cases with three types of characteristics were prominent in the change: pedestrian–vehicle conflicts in areas of mixed land use; proximity to crash high-risk corridors; and distance from public transit stations in areas controlled by traffic-calming strategies.

Age-related factors tend to increase risk of crash involvement in

old age, older people are more vulnerable to injury than younger adults, and the proportion of older people in the population is increasing. Temporal and spatial factors also affect road crash risk, and this study provides insights into spatial patterns of road crashes involving older people, which could be used to improve road safety.

“It is vital to consider variations in the built environment regarding their impact on crashes within metropolitan areas,” says Dr Soltani.

He adds that improving the legibility of appropriate traffic signs at mixed-use zones in Adelaide’s inner suburbs that inform, warn and control speeds are essential for improving the visual knowledge and understanding for people to best avoid crashes.

The pandemic’s influence in reducing the number of crashes could also influence management policies for new ways of employing telecommunications throughout Australia to prevent unnecessary commuting. This would necessitate empowering the 65+ age population by increasing their digital literacy and facilitating online shopping, recreation, medical and health services and employment options.

“The results of the study could assist academics and policy makers in Australia to better understand multi-dimensional implications of the built environment on the road safety of the elderly,” says Dr Soltani.

The research – “Post COVID-19 Transformation in the Frequency and Location of Traffic Crashes Involving Older Adults” – has been published by Transportation Research Record: Journal of the Transportation Research Board. DOI: 10.1177/03611981231163866

New insights into immune responses

COVID studies led by Professor David Lynn Director, Computational and Systems Biology Program Lynn Systems Immunology Group at South Australian Health and Medical Research Institute (SAHMRI) and Professor of Systems Immunology at Flinders University, have identified new insights into COVID-19 immunity and Long COVID.

The COVID-19 Vaccine Immune Responses Study (COVIRS), led by Flinders University and SAHMRI, uncovered fundamental differences in how the AstraZeneca and Pfizer COVID-19 vaccines impact the immune system.

The study tracked the immune responses of 102 adults of varying ages living in South Australia immediately after receiving either the Oxford/AstraZeneca or Pfizer/BioNTech COVID-19 vaccines to assess early immune response.

They were also tested 28 days after every immunisation to evaluate B and T cell activity.

Professor Lynn said the study used a method of biological analysis known as ‘multiomics’ to examine immune responses in many different ways in thousands of blood samples.

Researchers were surprised to find that the Oxford/AstraZeneca vaccine elicits an unexpected memory-like response in the immune system after the first dose, recognising the vaccine as if it’s something it has seen before.

‘This response is targeted against the adenovirus vector in the vaccine, not the Spike protein and the intensity of this response correlates with the expression of proteins that act as a pre-cursor to thrombosis, or blood clotting.

‘While vaccine-induced immune thrombotic thrombocytopenia (VITT) is an extremely rare side effect associated with the Oxford/ AstraZeneca vaccine that none of the participants developed during the study, this research offers a potential explanation for the connection between the Oxford/AstraZeneca vaccine and the cases of VITT that have been reported,’ said Professor Lynn.

The study also found those who had only had two doses of the Oxford/AstraZeneca vaccine generally produced lower amounts of antibodies and less of a specialised type of T-cell that helps with antibody production compared to those who had two doses of the Pfizer/BioNTech vaccine.

This was rectified once they had their third booster dose of an mRNA vaccine, illustrating the importance of booster doses.

The study added evidence to the notion that COVID-19 vaccines offer some people more effective protection than others.

Older people generally have a lower immune response after two doses but a third booster dose is highly effective at overcoming this.

Immune responses induced immediately after vaccination predicted the subsequent B and T cell response to the vaccine measured a month later.

“One to two days after initial vaccination we measured gene expression responses in the blood which correlated with adaptive immune responses that mediate protection 28 days later,” Professor Lynn explains.

A further surprise to researchers was the finding that people who showed symptoms of fatigue and fever immediately after the third dose were more likely to have better T-cell responses.

Study shows no evidence of trained immunity

Other researcher led by Professor Lynn has found no evidence that two doses of Covid-19 vaccines leads to trained immunity (TI) against the virus.

Trained Immunity (TI) is defined as the long-term metabolic and epigenomic reprograming of innate immune cells, priming them for enhanced responses to subsequent challenges, including unrelated infections.

The study explored whether two doses of two doses of the BNT162b2 (the Pfizer/BioNTech mRNA vaccines) or ChAdOx1-S (Oxford-AstraZenica) vaccines induced altered innate immune responses or epigenomic changes consistent with TI in a cohort of

46 healthy adults. Baseline characteristics of ChAdOx1-S (n=13) and BNT162b2 (n=33) recipients were not significantly different.

This followed other studies that suggested ChAdOx1-S but not BNT162b2 vaccination induces TI.

The SAHMRI data suggest that long-term TI is not induced in human PBMC or circulating classical monocytes following two doses of either the ChAdOx1-S or BNT162b2 vaccines.

The authors note further investigation is needed to assess whether these vaccines have any effects on TI induced in 4 cell-types not analysed here (e.g. granulocytes). The data from this study are consistent with the conclusion that BNT162b2 vaccination does not induce long-term epigenetic reprogramming of monocytes.

Data suggest that any effects of these vaccines on TI after one dose are transient and not induced after a second dose, which is important given that the vast majority of people have received these vaccines as multi-dose regimens.

The findings therefore have important implications for current and future mRNA and adenoviral-vectored vaccines and support the safety of these vaccine technologies, the researchers say.

Long COVID insights

And a world-leading research collaboration in South Australia has delivered crucial insight into the lasting immune system dysregulation caused by COVID-19.

The study, conducted by experts at SAHMRI, Flinders University, the University of Adelaide, the Women’s and Children’s Hospital and the Royal Adelaide Hospital, showed that immune cells and gene expression experienced during the 6-month post-infection period hold clues to Long COVID.

The latest study results, published in BMC Medicine, indicates Long COVID could be linked to lower blood platelet count, with patients showing signs of thrombocytopenia (low platelet count) at six months post-infection compared to those who didn’t suffer Long COVID symptoms.

The research team profiled the immune systems of 69 people aged between 20 and 80 years old who contracted the original Wuhan strain of COVID-19, over a 6-month period post infection.

Of the total cohort, 47 were recovering from mild infection, 6 from moderate and 13 were recovering from severe or critical disease.

Around one-third expressed symptoms associated with Long COVID and were referred to a Long COVID clinic.

Professor Lynn says the research found persistent mild thrombocytopenia in people with Long COVID and one of the most common side effects of this condition is fatigue, which is also the primary symptom of Long COVID.

Most study participants showed significant immune system dysregulation for at least 12 weeks post infection, though the majority returned to normal levels by 24 weeks.

‘The level of disease severity doesn’t translate directly to the level of immune dysregulation and we haven’t been able to find any patterns indicating that an individual’s age or sex is a differentiating factor governing differences in recovery.

‘Clearly there are other factors at play that need to be explored,’ Professor Lynn says.

‘At this stage we’ve only been able to analyse data from the original strain of the virus, so it’s not possible to say how Delta and Omicron may vary the immune system response.’

The longitudinal analysis examined antibody responses, the expression of thousands of genes in the blood, and approximately 130 different types of immune cells, that were compared to healthy controls.

As well as a substantial increase in the number of immune cells and antibodies, researchers found there was also strong dysregulation of gene expression, particularly in those genes linked to inflammation.

The study has also added further evidence that those who have had COVID-19 develop some immunity to the virus.

Participants antibody titers indicated a high level of immunity for at least six months post infection, but it’s unknown whether the same result would be true for those who contract other strains.

Researchers will continue to follow the participants for three years to document how the immune system continues to respond long term.

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Dr Taranath and her team of eye health experts will continue to provide the highest level of ophthalmic care to all private patients from a single location iSight Specialists commencing in August 2023.

Subspecialty interests include paediatric ophthalmology, adult and paediatric strabismus, and ocular genetics.

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Urgent referrals accepted.

Research briefs

Study links cancer risk to RNA functions

Australian cancer researchers have made an important new connection between a person’s cancer risk and the functions of circular RNAs, a recently discovered family of genetic fragments present in cells.

A Flinders University-led study published in Cancer Cell finds that specific circular RNAs can stick to the DNA in cells and cause DNA mutations that result in cancer.

‘While environmental and genetic factors have long been believed the major contributors to cancer, this revolutionary finding – which we call ‘”ER3D” (from ‘endogenous RNA directed DNA damage’) – ushers in an entirely new area of medical and molecular biology research,’ says Flinders University Professor Simon Conn

‘This opens the door to use these molecules as new therapeutic targets and markers of disease at a very early stage, when the likelihood of curing cancers is much higher.’

The research compared the neonatal blood tests or Guthrie cards of babies who went on to develop acute leukemia as infants with children without any blood disorders. This found that one specific circular RNA was present at much higher levels at birth, prior to onset of the symptoms of leukemia.

The findings suggest it is the abundance of the circular RNA molecules within certain individuals’ cells which is a major determinant for why they develop these specific cancer-causing genes or oncogenes and other do not.

Fatty fish consumption increases cell membrane fluidity

Eating fatty fish decreases the lipophilic index in people with impaired glucose metabolism or coronary heart disease, according to a new study from the University of Eastern Finland. The lipophilic index is considered a marker of cell membrane fluidity, and a low lipophilic index indicates better membrane fluidity and cardiovascular benefit.

The researchers used data from two randomised clinical trials to study the effects of fish and camelina sativa oil intake on the lipophilic index. The first study included 79 men and women with impaired glucose tolerance. The second study included 33 men and women with cardiovascular disease.

Study participants were randomly divided into four groups for a 12-week intervention: the camelina oil group, the fatty fish group, the lean fish group, and the control group in the first study. In the second study, subjects were randomly divided into the fatty fish, lean fish, and control groups for an eight-week intervention. The lipophilic index was calculated based on erythrocyte membrane fatty acids in the first study, and serum phospholipid fatty acids in the second study.

In both studies, eating four meals of fatty fish per week reduced the lipophilic index, which indicates better membrane fluidity. Better membrane fluidity has been associated with lower cardiovascular risk.

Finding rewrites understanding Parkinson’s disease

Researchers have solved a longstanding mystery about how a protein helps rid the body of damaged mitochondria in findings that could help lead to potential new treatments for Parkinson’s disease.

This answers a long-standing question about how Optineurin, a protein that is highly expressed in the human brain, helps the body remove damaged mitochondria.

The new research, published in Molecular Cell, solves a mystery about how the protein Optineurin recognises unhealthy mitochondria ‘tagged’ by PINK1 and Parkin proteins, enabling delivery to our body’s garbage disposal system.

The researchers found that Optineurin links damaged cellular materials to the garbage disposal machinery in a highly unconventional way unlike similar proteins.

PINK1 acts as a ‘watch-house’ inside the mitochondria, responsible for monitoring their health. When it detects problems, it activates Parkin, which tags damaged mitochondria for removal.

The new study revealed that Optineurin removes damaged mitochondria by binding to an enzyme known as TBK1. From there, they found that TBK1 goes on to activate a specific cellular machine that is key to generating these garbage bags around unhealthy mitochondria.

This finding may provide a framework to target PINK1 and Parkin mitophagy in disease and prevent the build-up of damaged mitochondria in neurons.

Fewer fractures for preterm and low birthweight newborns

Pre-term and low birthweight infants have fewer fractures in childhood than full-term and normal-weight newborns, according to a new a study based on one million children and nearly 100,000 fractures.

This contrasts with earlier smaller studies that reported an increased risk of fractures in childhood in children born pre-term and an earlier study from Finland which found that pre-term infants continue to have lower bone mineral density even in adulthood.

The study from the University of Eastern Finland and Kuopio University Hospital found that pre-term and low birthweight infants had significantly fewer fractures in childhood than other newborns. The difference was particularly evident in children born before the 32nd week of pregnancy, who had 23% fewer fractures than in children born full-term.

There were also fewer fractures in the group whose birthweight was less than 2,500 grams, and especially in the group whose birthweight was less than 1,000 grams.

‘It can be concluded that the risk of fractures in childhood is explained by factors other than the effect of being pre-term on bones. However, we know that pre-term children are less likely to participate in sports, and they have less risk-taking behaviour even as adults than full-term children,’ the researchers said.

They note further research is needed on whether foetal growth disorder, i.e., abnormal growth in relation to weeks of pregnancy, is associated with fractures in early childhood, as this was not addressed in the present study.

Scientists identify common cause of gastro

Atype of bacteria not routinely tested for has been discovered as the second most common cause of bacterial gastroenteritis.

In a study of over 300,000 patient samples, UNSW Sydney scientists have discovered that a type of bacteria known as Aeromonas are the second most prevalent bacterial pathogens found in patients with gastroenteritis.

It was previously believed that Salmonella was the most common cause of bacterial gastro after Campylobacter

‘Our results have found that Aeromonas are the second most prevalent enteric bacterial pathogens across all age groups, and in fact are the most common enteric bacterial pathogens in children under 18 months,’ the researchers say.

The team used quantitative real-time PCR testing of faecal samples and analysed data from 341,330 patients with gastroenteritis in Australia between 2015 and 2019.

The most frequent occurrences of Aeromonas enteric infections was in young children and individuals over 50 years old, suggesting a higher susceptibility to these infections during stages when the immune system tends to be weaker.

There was also an increase in Aeromonas enteric infections among patients aged 20-29 years, which could be attributed to increased exposure to the pathogen at this age.

These findings suggest that both human host and microbial factors contribute to the development of Aeromonas enteric infections. The high rate of Aeromonas infection discovered suggest that Aeromonas species should be included on the common enteric bacterial pathogen examination list.

AI platform targets safe use of medicines after discharge

Amajor new $2.9 million digital health project led by Flinders University will target the dosage and failures of prescription drugs used by patients at home after they leave hospital.

The ‘AutoMedic’ project aims to create a more streamlined and accurate electronic record of prescription medicine used by patients discharged from six South Australian public hospitals to better manage their recovery and longer-term health outcomes.

The trial will provide a useful model for a smart, scalable solution to detect and resolve medicine harm’, says Associate Professor of Digital Health Niranjan Bidargaddi, from Flinders’ College of Medicine and Public Health.

More accurate e-health solutions are expected to create an AI-enhanced medicine review for individual patients, supporting hospital clinical pharmacists to give advice or alternative prescriptions in a timely manner before discharge.

This new e-health system will help identify patients most at risk of adverse events due to medicine errors when in hospital and enable GPs and pharmacies to intervene and assist with such problems, which can lead to hospital readmissions.

The new system will work in tandem with the federal My Health Record platform, which collates prescription, imaging and pathology data from Medicare-funded programs, a new single electronic medical record (‘Sunrise AllScripts’) operating at public hospitals in SA.

Patient transfers key to clinical outcomes

The clinical lead of SA Health’s new State Health Coordination Centre

SA Health’s new patient transfer process will streamline transfers and admission processes and improve patient care.

Dr Megan Brooks is Clinical Partnerships Lead for SA Health’s new State Health Coordination Centre (SHCC) and has led the development of the Statewide Interfacility Transfer Process (SIFT).

The SHCC uses real-time data and insights to better understand patient and clinician needs in the community, emergency departments, hospital wards and sub-acute facilities across the SA Health System.

The SIFT project focuses on the tools and processes to support clinicians caring for patients requiring transfer between facilities. It is the result of a co-design process with clinicians from across the state, including Royal Flying Doctors Service and SA

Ambulance Service. One of the identified barriers was the lack of a standardised process that made it difficult to track patients who are awaiting transfers, another was the inability to record patient facing clinical information in the medical record.

Dr Brooks says SIFT will improve the coordination between Local Health Networks and SAAS to ensure that resources are available to facilitate safe and timely care for patients being transferred between hospitals – including those who are acutely unwell requiring inpatient admission via ED or returning to peri-urban/regional hospitals and rehabilitation care.

She says that current processes require clinicians to undertake multiple manual administrative tasks that could be addressed by electronic tools and better shared visibility of information. SIFT will capitalise on new IT tools to help clinicians record and access clinical information that will make transfers more efficient.

State Health Coordination Centre

Ward

says that the new process to transfer patients between public hospitals and health services will improve patient and clinician experience and reduce the administrative burden on clinicians.

‘Clinicians, hospitals and SA Ambulance Service (SAAS) are doing the best they can but the current systems do not offer them the visibility they need across the system, or the ability to record clinical information robustly’ Dr Brooks says.

‘We do know that on average there are 60 interfacility transfers via ambulance every day across the system. About 70% of these do not go directly to a hospital bed but via the emergency department, which can contribute to ramping and unnecessary delays to reaching a bed’. SIFT supports the identification of patients who do not require admission via the Emergency Department.

‘Optimising flow through the whole system will reduce the strain on our EDs, ensuring patients are admitted to beds on time and can return closer to home sooner.’

Dr Brooks says SIFT will use three tools to give clinicians and other staff who manage patient flow access to the information they need, when they need it:

• an e-form, completed by the clinician sending the patient to another facility when the patient has been accepted by that facility for admission

• SIFT dashboard – information collected from the e-forms into the real-time SIFT dashboard will provide visibility of interfacility transfers to hospitals, SAAS and other health facilities. A next stage will include transport bookings with the ambulance transfer details

• Electronic Medical Record (EMR) pre-visit – in facilities where the EMR is used, information in the SIFT dashboard will be used to open an EMR episode and support clinical documentation at the accepting facility. Where clinically appropriate, this will allow inpatient teams to document care plans, order medication or investigations, arrange beds

and place patients on theatre lists – all before they have arrived.

The SIFT tools have been designed to facilitate the transfer of all patients who have been accepted for inpatient admission by an inpatient service. SIFT excludes patients being transferred for a Mental Health reason (other systems exist) and patients not currently accepted by an inpatient service, or not known to require inpatient admission.

After a successful pilot in the South Coast District, Noarlunga, Modbury and Mount Barker District Soldiers’ Memorial hospitals, and consultation with more than 200 clinicians across South Australia, SIFT will be introduced across the state in coming months.

The SHCC has also assisted regional and remote clinicians working at non-EMR SA Health sites to access, where appropriate, Read-Only access to the EMR for their patients. The EMR pre-visit SIFT tool cannot be used by facilities not yet using the EMR; clinicians with read-only access will be able to read relevant documentation for their patients accepted by EMR site clinicians.

Dr Brooks says the clinical input has contributed to processes ‘that will enable real-time information sharing, improved clinical documentation, offering patients more timely care, and reduce administrative burden on clinicians’.

‘The State Health Coordination Centre will continue to work with clinicians statewide to provide better tools, systems, and processes for patient care,’ she says.

Dr Megan Brooks

The hidden pandemic of postoperative complications

While surgery is essential to treat a high proportion of health conditions, hospital waiting lists alone show us the increasing challenges in accessing that care in a timely manner.

The Australian Government Intergenerational Report 2023 tells us much about why: increasing demand for care and budgetary challenges. In addition, analysis of quality databases such as the American College of Surgeons’ NSQIP tells us that many patients in the future will have more complications and postoperative requirements.

What we increasingly understand from recent and ongoing work into peri-operative care, however, is that there is a lot which can be done to address these complications. In particular, data are emerging on interventions that improve patient outcomes and, usually by virtue of creating better health for patients, generate positive outcomes for the system in terms of efficient use of resources and costs. Having all stakeholders sit together and consider how we can drive this value-generating work has been the theme behind ‘The Hidden Pandemic’ Summit I in 2020, Summit II in 2023, and perhaps an international summit in 2024.

Summit I

On 6 March 2023, Summit I was held in Adelaide to start this process. Attendees represented professional Colleges and organisations, quality and safety organisations, public and private healthcare insurers and providers, academic institutions, and consumer groups. Principles to underpin change and improvement were generated, as were priority areas of unmet need. The output was summarised in the peer-reviewed literature

Summit II

COVID prevented a face-to-face follow up meeting until July 2023, when stakeholder groups again met in Adelaide with the broad objectives of reviewing the draft principles and identifying priority action items. Assistance in developing this summit this was gratefully provided in particular by Professor Tarik Sammour of the University of Adelaide and CALHN, and Professor David Watters of Safer Care Victoria.

We are most grateful for funding support from Edwards Lifesciences and CALHN/University of Adelaide’s PARC Clinical Research, for the facilitation provided by Dr Norman Swan, and for the organisational skills of Francesca Zappia, and Vicky Troptsidis from Eventful Projects.

A workshop on Advanced Recovery Room Care (ARRC) was held at RAH the afternoon before the fully body of the summit. This allowed delegates to hear first-hand about the unit from those on the ground, and to understand the theory and results being achieved. It was pleasing to see the enthusiasm for this concept flow into the full body of the summit, with calls for ARRC to be priority initiative nationally.

Health Minister Chris Picton kindly opened the summit, and we

were privileged to have Jack Buckskin provide a moving and entertaining Welcome to Country.

Speakers provided views on what they saw as the ‘ideal state’, the gaps, and what might be needed to close these gaps. Then the task of developing action plans was handed over to a series of focus groups. This included a ‘disruptors group’ of young students and doctors who challenged to find solutions to inevitable personnel shortages (not just in healthcare) by our international dinner speaker, Mr Tim Cook from nGAGE Talent – UK’s 2022 winner of the Queen's Award for Enterprise.

Key messages

A wealth of information was provided from a large range of perspectives, collected from presentations, focus group feedback, and very extensive notes of discussions.

A formal comprehensive report is being generated from Summit II and will be distributed widely in due course. However, a number of key messages and suggestions are already evident.

• The situation is urgent.

» Concern was universally expressed about the size and scope of the challenge facing the provision of surgical and peri-operative care. There were calls for the rapid formation of a national taskforce(s) to address the issue.

• System approaches underpin the solutions. These include:

» An explicit framework (or journey) to guide activity from the start to the end of peri-operative care is needed to provide a roadmap for all planning; the framework of ANZCA is one example (see figure).

» Formal assessment of patients’ risk and needs from when surgery is considered to guide decision-making, triage and streaming. Review and risk re-assessment when and as needed.

» Consistent evidence-based care pathways for patients with a range of needs – formal defined national suite of pathways is feasible and, if effectively delivered, will induce improved outcomes and value. Defined health pathways are not an unfamiliar concept, with Health Pathways being an example.

» Access to culturally appropriate pathways and care. Involvement of key stakeholder groups to ensure these are both available and delivered.

» Appropriate acknowledgement of performance. Mechanisms to support implementation of best practice (process) as well as endpoints (modifiable outcomes) are needed.

• Data and information is the foundation.

» Accurate information on process and outcomes relevant to key stakeholders (and including consumer-

Speakers came from across Australia to contribute to the second summit and new principles on minimising postoperative complications, writes Professor Guy Ludbrook.

relevant outcomes) is essential to guide performance and value. What is already collected, and what we now better understand should be collected, are not necessarily the same.

» Data will guide future directions – hypothesis generation.

» A platform to collect, analyse and share these data is essential. The concept of registries is not alien but existing databases are either insufficiently comprehensive, or poorly linked, or both. In an era of electronic medical records this is now highly feasible.

» The R&D division. An essential element of any business. Quarantined resources, and allowance and capacity for executives to explore change from the status quorapid testing (examine, iterate and fail or adopt fast). Don’t assume anything is working optimally.

» Standardised handover/communication. A priority is a national standardised discharge summary (possibly automatically generated), comprehensible to clinicians and consumers, provided at the time of discharge, and clearly identifying roles and responsibilities of clinician and consumers.

• Information technology

» Two messages from Tim Cook (nGAGE Talent):

○ Workforce challenges face all industries, and new roles and tools such as IT will be essential.

○ Today’s consumers wish to have control of, and choice in, their business.

» Our young ‘disruptors group’ imagined an end-to-end app that provides functions relevant also to nonhealthcare businesses:

○ Spans the peri-operative journey

○ Is a visible dashboard

○ Provides a comprehensive summary of health

data- from clinicians, wearables

○ Integrates with a national EMR

○ Analyses and curates data on eg risk (AI)

○ Assists/automates referrals, appoints and schedules

○ Creates and distributes data summaries

○ Functions as a passport for patients

• Standards

» A comprehensive national set of perioperative standards, evidence-based, is seen as a priority.

• Specific activities

» Preparation for surgery – risk assessment; care pathways, ‘preparation lists’ rather than waiting lists; re-evaluation of need over time; comms and activities shared across in- and out-of-hospital-sectors. Role for a national working group/network on this area.

» Early postoperative care – Advanced Recovery Room Care (ARRC) as a priority. Role for a national network/ registry

» Identify and support ‘best care’. Provision of clear evidence-based guidelines for decision makers on care which optimises value

The summit format has allowed a large group of stakeholders with an interest and passion for improved surgical and perioperative care to meet and share information and ideas. The summit report will, we believe, provide a clear summary of a range of options available to decision-makers.

There was a strong call for a national taskforce to deliver options for change. Regardless, we see value in continuing this Summit series as an independent ‘collation of the willing’ prepared to give time to proceed in this area critical to Australians’ health and wellbeing.

Professor Guy Ludbrook leads the PARC research group based at the University of Adelaide.

A peri-operative framework outling the phases and broad activities on a patient’s journey

‘You are not alone’

Former MIGA CEO Mandy Anderson shares her thoughts on the challenges and opportunities facing medical practice.

If medical results are generated by artificial intelligence and medical reports are constructed by Chat GPT and they are found to be inaccurate, who is responsible?

This is the type of question facing medical indemnity insurers, regulators, practitioners and patients in the unchartered territory of artificial intelligence (AI) applications in medicine, says medical indemnity specialist Mandy Anderson.

Having recently stepped down from her role as CEO and managing director of Medical Insurance Group Australia (MIGA) after 23 years with the organisation, Ms Anderson says the medical indemnity landscape is more complex than ever.

AI looms large on the horizon – as it does elsewhere – but managing the potential for harm and the implications for insurance are nowhere more difficult than for the medical profession, she says.

It is critical, she says, that regulators, key colleges and insurers in Australia seize this moment before AI becomes ubiquitous to set parameters around its use and clarify areas of responsibility and liability.

‘Radiology firms are already looking at using AI to assist with results and, in the US, some are using it to help with reports,’ she notes. ‘How do you make sure the information is right and, if it is wrong, who gets sued? How do you sue a machine – what if the machine has been wrongly calibrated, who is responsible?’ she asks.

Equally challenging are issues around quality assurance for cosmetic medicine and the changing nature of medical practice.

‘Regulation becomes particularly important in defining the scope of practice that is acceptable, the qualifications needed and the standards for the facilities where procedures are performed,’ Ms Anderson says. ‘The Medical Board and (Australian Health Practitioners Regulation Agency) Ahpra have done good work to date on this but there is more to be done.’

The medical indemnity sector is also grappling with the growing number and cost of claims, which is likely to result in rising premiums. This is partly driven by changing consumer expectations, Ms Anderson says.

‘When something goes wrong, people (now) want more and expect more, and cost-of-living issues mean they are more focused on that than they used to be.’

While data shows the more empathetic and understanding a doctor is towards a patient, the better the outcome if something goes wrong, time and financial pressures may mean they are unable to deliver the desired level of personalised care.

‘The average doctor would say, “I need more time”,’ says Ms Anderson.

In this environment, burnout and fatigue among doctors is a significant issue, she warns. ‘When we are dealing with an environment where there are resourcing issues, workforce shortages, burnout and fatigue, things will go wrong - and they do.’

Fewer practitioners are wanting to work fulltime and even fewer want the responsibility of owning a practice, she says. New

Anderson

models of work practice are being developed to manage risks associated with part-time work. Corporate models are evolving to ensure continuity of care around results and referrals, for example, she says.

Workforce challenges are even more significant in rural and remote practice. As a recent appointee to the Board of the Australian College of Remote and Rural Medicine (ACRRM), these challenges are front of mind for Ms Anderson.

‘Resourcing is a challenge for general practitioners generally and even more so for rural practitioners. The fact that obstetric services are no longer available in many rural communities is very concerning for the families impacted. Increased focus at state and federal levels on the provision of those services is so important to maintain critical services for rural and remote communities,’ she says.

Given the challenges that many doctors face, she says, it is important for them to understand the support available when things go wrong. Keeping abreast of guidelines and communication about regulatory changes from Ahpra and the Colleges, and accessing resources offered by your medical indemnity insurer are particularly important, says Ms Anderson.

Medical indemnity insurers such as MIGA provide a 24-hour service staffed by experienced internal lawyers who can provide advice, support and guidance.

‘If something has gone wrong or you are worried, ring and get help – the lawyers will guide you and provide support as well,’ she says. ‘It’s important for a doctor to be aware help is there and you are not alone when there are complaints and other problems.’

Mandy

Longer waiting times for colonoscopies

National bowel cancer screening rates have lingered just above 40% since 2015 and colonoscopy wait times are exceeding the recommended 30 days, the latest National National Bowel Cancer Screening Program (NBCSP) Report reveals.

Bowel cancer is Australia’s second deadliest cancer, claiming more than 5,300 lives each year. More than 15,600 Australians are diagnosed with bowel cancer each year.

The latest national screening participation rate (2020-21) is nearly 41%, the same as it was in 2015-16, despite almost $20 million invested by the Australian Government since 2019 to raise awareness of the disease and the NBCSP. South Australia has the equal-highest rate at 44.4%.

Meanwhile, the wait time between a positive screening result and a subsequent colonoscopy has increased in every state and territory, with participants waiting between 119 days in some parts of Western Australia and 235 days in some areas of Tasmania. On this measure, South Australia is in the mid-range at 154 days.

Only 11,990 participants (15.6%) were recorded as receiving colonoscopies within the recommended 30-day time frame after a positive screening result.

Medical guidelines acknowledge that wait times exceeding 120 days between the first healthcare presentation (for symptoms or a positive screening result) and colonoscopy are associated with poorer clinical outcomes. The guidelines also state that a colonoscopy should be performed as quickly as possible after a positive screening result to minimise the risk of psychological harm.

Bowel Cancer Australia CEO Julien Wiggins said questions must be asked about why so few participants are receiving colonoscopies within the clinically recommended time frame.

According to the report, 2.49 million of the 6.1 million people aged 50-74 invited to participate in the NBCSP in 2020-21 returned their tests for screening. Of those who participated, 76,880 received positive results with blood detected in their samples.

One in 10 new bowel cancer cases now occur in people under the age of 50, who are currently ineligible to participate in the NBCSP.

Time between positive screen and diagnostic assessment, people aged 50-74, by state and territory, 2021 (days)

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NBCSP participation rate of people aged 50-74, by state and territory

Tables above and bottom left: AIWH (2023) National Bowel Cancer Screening Program; monitoring report 2023

In his Honour

Three senior academics and administrators were among AMA recipients of King’s Birthday Honours.

Professor Ruth Marshall AO

Faced with choosing between her role as medical director of the SA Spinal Injury Service and several other positions, Professor Ruth Marshall decided her existing job would be most interesting.

More than 37 years later she is still enchanted with the role, defying a self-confessed propensity for early onset boredom and despite not really enjoying spinal cord injury rehab as a registrar.

‘When I become bored, I’ll know it’s time to retire,’ Prof Marshall says with a laugh.

‘I fell in love with rehabilitation medicine when I was in my second post-graduate year, having been introduced to it in half a day in fifth-year med.

‘I knew this was the kind of work I wanted to do – helping people take back their lives, engaging them and helping them and working with a team of dedicated health professionals, including nurses and allied health.’

Her passion and dedication have led to her becoming an Officer of the Order of Australia (AO) for services to rehabilitation medicine, and particularly for working with people living with spinal cord injury and disease, teaching, mentoring and research. She became the first female president of the International Spinal Cord Society when elected in 2020 and will complete her term in October this year. Meanwhile, she continues to engage in international research to improve the experience of people living with spinal cord injuries and diseases.

Prof Marshall says the complexities of spinal cord medicine and rehabilitation – from clinical complications, to the psychosocial, to practical aspects of tailoring a wheelchair to a person and their home to the wheelchair – are routinely underestimated. It requires a balance between care and the capacity to foster independence by knowing when not to help.

‘When I got to Hampstead and the Royal Adelaide Hospital, I found there was so much to do,’ she remembers. ‘Then, after a while, I became interested in research because my registrar raised some questions I couldn’t answer.

‘I never came into spinal cord rehab or medicine generally to do research – I came to be a clinician and first and foremost I am a clinician.

‘For me, any research has to be related to what’s really important; that is, the people living with spinal cord injury who I look after. They are really central to what I do.

‘I consider myself incredibly privileged. Getting an AO is not the reason one does work but it is very nice to be recognised in this way.’

As the only person in South Australia in 1986 doing spinal cord medicine, Prof Marshall quickly realised the importance of mentoring and being able to call on people in Sydney and Melbourne for advice. Decades later, mentoring remains a joy.

She also continues to relish opportunities to visit regional and remote areas, particularly in the Northern Territory. ‘I’m very privileged to look after and work with our First Nations people,’ she says.

‘Getting people in wheelchairs out of the communities in small planes is difficult, so since 1994 I’ve been going into communities in East Arnhem region. I fly in with a nurse and often with an allied health person.

‘We have a lot of Indigenous patients – in Alice Springs more than 50% people living with spinal injury are First Nations people. There are a few in Darwin but also all over the ‘Top End’. Seeing them in their own place, on their own country is an enormous privilege and really wonderful.

‘To sit on the ground and talk to a grandmother about a grandson with spinal injury is a very special and not everyone gets to do that,’ says Prof Marshall.

Prof Marshall and her SA Spinal Injury Service team are engaged in a range of research projects, including rare international drug studies for spinal cord patients and a study of the lived experience of people with spinal cord injury and disease.

She notes that life has become significantly less challenging for most people living with spinal cord injuries and disease in Australia with changes in funding (NDIS and no-fault motor accident insurance) and technological advancements such as voice activated devices.

The new rehabilitation facility at Daw Park is a ‘showcase of innovation’, including ceiling tracks that can take slings to assist in moving patients, reducing the risks of manual handling.

‘Things have changed a lot. When I first started in spinal cord injury, young people were in nursing homes because they could not get funded personal care,’ she says.

‘NDIS costs a lot of money but sticking a 25- year-old in a nursing home is very expensive – it is actually cheaper to keep people at home. Technology and its uses for people with disability is exciting.’

Professor Ruth Marshall (second from right), Dr Andrew Lavender (second from left) and Dr Hugh Kildea receiving their AMA awards from then-President Dr Patricia Montanaro in 2014

Professor Michael Horowitz AO

Michael Horowitz’s mother was the only woman in her class studying science at Charles University in Prague when the Nazis invaded in World War II. His father had a doctorate in agricultural sciences from one of Europe’s oldest universities, in Krakow, Poland.

It is not surprising that young Michael, now Professor Michael Horowitz, would follow the path of research.

Science, like The Force in Star Wars, ran strong in the Horowitz family – to the extent that Professor Horowitz is an author of 767 peer-reviewed papers and 41 book chapters. He is responsible for ground-breaking research into the importance of gastric emptying in people with diabetes – work for which he was in June made a Member of the Order of Australia (AO).

Professor Horowitz’s father moved to Adelaide for a position as Head of Plant Genetics at the Waite Institute. His parents’ sustained love of Adelaide was instilled in him from birth and he has never left.

‘There were clear messages of the importance of people, the importance of Australia and the importance of scientific endeavour during my childhood, as well as that of classical music and good food, particularly Czech cakes,’ he remembers.

‘I’ve always been aware that money and possessions can be taken away, but what you did with your head, and particularly scientific endeavour relating to other people, were extremely important and meaningful.’

Yet he says that his interests in gastroenterology and endocrinology, which led to his King’s Birthday Honour, were mainly a matter of serendipity.

Having the good fortune to work with eminent supervisors and mentors – gastroenterologist Professor David Shearman and endocrinologist Dr Philip Harding – on a PhD focusing on the rate at which the stomach empties in people with diabetes, Professor Horowitz set his sights on a career as a clinician-scientist.

‘I was very fortunate with both my timing and the research environment. David Shearman and Phil Harding both encouraged me, and I recognised that I wanted to pursue a career as a clinician-scientist. The seeds, however, had clearly been sown by my parents.

‘The environment in Adelaide to support the development of clinician-scientists – doctors, nurses, dieticians, or, like my wife, with a background in nuclear medicine, was much better than it is today.’

Professor Horowitz recognised that there was a need for an improved understanding of the function of the gastrointestinal tract in diabetes. He says there are two interrelated elements: first, abnormal gastrointestinal function occurs very frequently in people with diabetes - in the broadest sense, probably as a result of nerve damage. In the 1980s, he and his team showed that about 50% of people who have longstanding type 1 or type 2 diabetes have abnormally delayed stomach emptying (gastroparesis).

The second element was that the rate the stomach empties is a major determinant of the magnitude of the rise in blood glucose after meals. It was thought that everyone’s stomach emptied at about the same rate, but he found there is about a four times variation in health, which is even greater in people with diabetes.

‘This has changed clinical practice, with the development of new drugs to improve blood glucose control in people with type 2 diabetes, by modulating the rate the stomach empties, including agonists of the hormone, glucagon-like peptide-1 (GLP-1 receptor agonists),’ he says.

‘The latter have recently been in short supply, as their efficacy to also induce weight loss in obese people, with and without type 2 diabetes, has been appreciated.’

He says it’s not a lack of willpower that about 95% of people who lose weight by diet, exercise or medication put it back on again.

‘When people lose weight, it induces a number of potent mechanisms to favour weight regain. If you are going to treat obesity with medication, it is only logical for medication, if effective and well tolerated, to be continued in the long-term.

‘It’s like suggesting that someone with treated hypertension who has a normal blood pressure should have their antihypertensive medication stopped.

He says the need for non-surgical treatment for obesity to be sustained poses a quandary for health administrators, ‘given that some 65% of adult Australians are overweight or obese’.

Clinical research remains a major interest for Professor Horowitz. He and his wife, Professor Karen Jones, continue to work together at the University of Adelaide’s Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, which he leads. The Centre continues to explore gastrointestinal motor, sensory, and hormonal function, particularly in the context of diabetes, appetite regulation, critical illness and ageing.

Professor Michael Horowitz (third from right) with the University of Adelaide’s CRE Translating Nutritional Science to Good Health team

Professor Brendon Kearney AO

Astrong desire to improve the health system and to establish a culture of physician leadership have been the overarching themes of Professor Brendon Kearney’s varied medical career, ultimately leading him to receive two Australian Honours, most recently as an Officer of the Order of Australia (AO).

Already a Member of the Order of Australia for work relating to establishing the Hansen Institute, supporting the Bali bombing rescue and contributing to the 2004 Banda tsunami rescue efforts, Professor Kearney received an AO in June for his work in health technology assessment (HTA).

HTA uses data to evaluate the safety, efficacy and costeffectiveness of a health intervention. The HTA drive, Professor Kearney explains, is to improve access to high cost/high value medical technology, based on data and evidence – a quest he began in the 1980s, creating the first HTA committee to advise on inclusions in the Medicare Benefits Scheme.

He was interested in HTA as a method of planning and managing the introduction of high-cost technologies that were emerging to treat burns, cardiac and other conditions, when it was clear that not every hospital could afford all the technology.

A haemotologist by profession, Professor Kearney has been

lured to leadership roles including as chief executive officer of the Royal Adelaide Hospital (RAH) and the then-Institute of Medical and Veterinary Science (IMVS) by a passion to solve problems in health care.

He studied how some of the most eminent international health organisations, including the Mayo Clinic, the Johns Hopkins University Hospital, and Massachusetts General Hospital achieved their success and what kind of physician leadership was necessary to build that success.

He has concluded that physician leadership needs to be better supported in Australia.

Yes, it has to be in a multidisciplinary team these days, but the physician should be part of the leadership team, he says; that’s what leads to better outcomes for patients and the community.

‘All doctors need to be physician leaders, even at the level of clinical practice,’ Prof Kearney says. ‘We are best placed to advocate for patients because we have a unique understanding of the patient-doctor relationship that other clinical groups may not have – and that’s from the level of clinical practice right through to leading clinical services and clinical organisations.

‘I think there is still a need for stronger physician leadership in medicine in Australia and in South Australia particularly. We know that if you have integrated service, teaching and research, the best quality outcomes occur in that setting when there is very strong physician leadership. Not all doctors realise they are physician leaders.’

Professor Kearney has just returned from chairing the Asia Policy Forum, which involved bringing representatives of South East Asian countries together with major pharmaceutical and technology companies to devise a strategy to implement universal health coverage across Asia.

‘We discussed high-cost technologies and how to introduce them in countries across the spectrum from low-income to well-developed countries to improve health care services,’ he says.

‘The project has made real progress. We supported early career training in health technology, and that gave ministers and departments confidence they could carry out their own assessments and make decisions about new technology.

‘We also worked on the basis that universal health coverage increases the GDP of a country – there is international evidence and experience, but it’s a very big step for countries to take.

‘Countries like Thailand and Indonesia have made remarkable inroads by using health technology to work out the basic benefit package for health care.’

Professor Kearney’s next project will capitalise on his HTA knowledge: he’s working with the WHO Committee on Medical Devices to ensure essential devices are available.

‘This work has come out of the COVID epidemic when countries such as India didn’t have the oxygen supplies we take for granted,’ Prof Kearney says. ‘We’ll advise the WHO executive on what needs to be done to provide essential technologies.’

A younger Professor Brendon Kearney

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Christine Mausolf President

As we lead into semester 2, I’d like take the time to reflect on the hard work of our committee members, not just for the medical student community but also to excel in their own studies and health. We have begun the semester by focusing less on a busy social calendar and more on ways to recharge ourselves and learn new skills.

In the spirit of student wellbeing and environmental stewardship, we organised a day away from study for all FMSS committee members, planting trees with Bio-R at Frahns Farm at Monarto. This new event was a great way for our committee to get to know each other better and to spend time outdoors on something productive that was not study. We all learnt new skills and interesting facts about the land and trees we were working with, fostering a sense of responsibility to promote a healthier and greener future.

With a focus on keeping active, we worked with the Adelaide Medical Student Society to host a new inter-society mixed soccer competition. While the Matildas contested the World Cup, we competed against the University of Adelaide’s medicine, dentistry, engineering and law societies. It was a successful event we hope to see continue in the years to come.

FMSS has also collaborated with our new Psychiatric Society to

enter the Push Up Challenge for the Push for Better Foundation. This is a fundraising event run in June, in which participants are challenged to complete 3,144 push-ups, representing the number of deaths by suicide in Australia in 2021. Each day there is a new mental health fact to help raise awareness and funds for mental health in Australia. Our members completed 34,971 push-ups, raising $1,400.We are immensely proud of their commitment to raising awareness and funds for Lifeline and Movember Australia. Together, we have made a tangible impact on the lives of those affected by mental health issues.

On the theme of mental health, FMSS members have attended and hosted events to educate and raise awareness of mental health in medicine. Several committee members were invited to attend the SASMOA Crazy Socks for Docs breakfast on the first Friday in June. This event highlights the many challenges doctors and medical students face with mental health and seeking help, aiming to break the stigma and encourage people to talk about it. With guest speakers including Federal Health Minister Mark Butler and author Dr Ben Bravery, students had a thoughtprovoking morning. We were able to meet some health VIPs and still make it back to class before 9:30 am! More recently our wellbeing officers staged an insightful Mental Health in Medicine workshop for our students. Here the students were able to learn from experts in the area on the management of common mental health crises as well as the services Flinders has to offer for students.

Our educational event calendar has continued to be busy. FMSS successfully ran its annual AUSLAN Workshop. Here, students were able to learn some basics to assist with clinical communication, as well as gain an insight into deaf culture and access to translation services. For our MD3s (third years), the end-of-year OSCEs (Objective Structured Clinical Examinations) are creeping nearer. Our incredible MD4 FMSS representatives, Rachel James and Will Burden, have created a whole new schedule of weekly teaching sessions and two full-day practice runs with volunteer patients and assessors. This outstanding work is helping ease the minds of the MD3s, giving them valuable knowledge and skills for their exam, taught by students who have just been through it. The education portfolio has organised the annual specialties pathway night, hearing from doctors in general practice, pediatrics, plastics and medical education. In collaboration with our surgical society, the team also hosted the Intro to Dissection night with advice on how to survive the anatomy subject, as well as an intro to suturing with pig trotters. Proceeds were donated to the Hutt Street Centre.

With our annual focus continuing to be on First Nations health, we also hosted our inaugural First Nations communication workshop. This brought together speakers with extensive experience working with local Aboriginal communities to improve medical students’ communication skills. We hope to continue hosting it in the years to come. During National Reconciliation and NAIDOC Week FMSS worked with the Adelaide-based Kumarninthi Cultural Workshops to host a silk painting workshop as well as canvas painting in the library.

On our advocacy side, FMSS has been continuing to work closely with the MD course directors and year-level representatives to ensure student issues are raised and information is shared. FMSS senior vice president Jordyn Tomba and I attended the College of Medicine and Public Health’s annual retreat, learning more about the goals and participating in various workshops. We also attended the University’s open day to answer new and prospective students’ questions about applying for the degree.

I look forward to the last few events of the semester that our incredible committee has organised, and to encouraging the next year of students to step into the various leadership and advocacy roles.

Specialty Pathways Evening with Lauren Engstrom, Angelina Arora, Elaine Leung, Kate Star-Marshall, Michael Fyfe and Alexandra Larke

Palya (hello)!

Every year, the Adelaide Medical Students’ Society (AMSS) organises the APY Exchange, a school holiday program for the children living in the communities of the APY Lands. This year, eight students had the privilege to visit the communities of Pukatja and Kaltjiti from the 14-24 July with the support of the NPY Women’s Council. There will be another group of eight students travelling to the APY Lands in October this year.

The Anangu Pitjantjatjara Yankunytjatjara (APY) Lands are a local government area in the north-west corner of South Australia and home to the Anangu people. Anangu is a term used to describe Indigenous Australian peoples who speak the languages of Pitjantjatjara, Yankunytjatjara, or Ngaanyatjarra. The Anangu people have lived in what is now the APY lands for thousands of years, and it was a truly special experience to see the relationship Anangu people have with their country.

Health, social, and cultural services in the APY Lands are in part run by the NPY Women’s Council. The NPY Women’s Council was created in 1980, and part of its current role in the APY lands is to provide a youth program to provide structure for children outside school hours. This is particularly important during school holidays, when most teachers return to their families outside the community. Each youth program is typically run by a youth worker who works alongside Anangu support workers to ensure the program runs smoothly. Our role was to help them provide a fun, educational and health-orientated youth program for the children.

Each day in community began with offering the children breakfast, to ensure they started their day with a healthy meal. After this, we would play sports (football or softball) or work on arts and crafts activities with the kids.

One of the highlights was taking the kids on a bush trip with the adults. From digging for honey ants to cooking kangaroo tails, it was an absolute privilege to see how Anangu culture has remained strong for thousands of years.

At night we ran activities including ‘girls’ night’, basketball games, a community barbecue and a disco. The community barbecue was a bittersweet experience, as it was amazing to see so much of the community in one place, but it was also incredibly hard to say goodbye.

The AMSS APY Exchange has been an incredible educational experience for the medical students, providing us with valuable hands-on experience in a unique cultural setting. We’ve developed an awareness of Indigenous health and culture that contributes to our preparation for future practice in Indigenous health. We can say without a doubt that everyone who went on the exchange would be keen to return to the APY Lands. As convenors, it was our second time in the APY Lands, and it is an experience we cannot recommend enough.

The 2023 APY trip would not have been possible without the support from NPY Women’s Council, the Adelaide Rural Clinical School and the Australian College of Rural and Remote Medicine. If you or your organisation would like to support this unique program, please contact apyexchange@amss.org.au

Adelaide Medical School students during the annual APY Exchange

The Adelaide Medical Students’ Society’s annual APY Exchange is an important event on the AMMS calendar, write convenors Lauren Whitington and Leo Bowley-Schubert.

Honour roll

Addresses from students in each year of medical school prompted memories of the highs and lows of studying medicine among those present at the 2023 Adelaide Medical Students’ Society Medball, staged at the Adelaide Convention Centre on 26 August. The Medball was again a fantastic chance for students to come together and celebrate as an entire medical school. Other formalities included a speech from AMSS President Vi-Seth Bak and sixth-year speeches by Oliver Marshall and Chiara Mulqueen, who captured the nostalgia felt by the final year cohort and who now look toward the exciting entrance into our journey as doctors next year.

The awards ceremony acknowledged the generosity and achievements of students who have gone above and beyond in the name of their peers. It was encouraging to hear of the various ways these students had invested their time and efforts for the betterment of their fellow medical students.

The evening concluded with a live band and energetic dancing. I will certainly miss my time at the med school but am very thankful for the impact of the AMSS on my journey as a student as my cohort and I prepare to join the ranks of AMA(SA) as clinicians.

Isaac Tennant MBBS VI

AMA(SA) Student Representative – The University of Adelaide

1. The University of Adelaide’s 2023 graduating sixth-year cohort

2. Nominees for the 2023 Patron’s Plate award (from left) Scott Chandrasiri, Oliver Marshall, Henry Lock, Raffaela Skourletos, Sean Stobie, Caitlín Gilsenan-Reed, Grace Mitchell, Isabel Schilling, Simoné Richards, Vi-Seth Bak, Lena Eversheim, Alex Pittar

3. 2023 Patron’s Plate winner Scott Chandrasri (left) receiving the award from 2022 winner Dr Teham Ahmeds

4. First-year representatives Sienna Masen and Kyan Reimers address the crowd

5. From left: Sixth-year students Samiksha Mali, Amy Lu, Lara Beltrame, Jacqueline Chen, Vimbiso Chiodze

6. From left: Sixth-year students Chiara Mulqueen, Nathan Duong, James Santillo, Charlotte Blake, Lucy Brown

7. Nominees for the AMSS’s Daniel Mannix-O’Brien and Judith Ann O’Brien Memorial awards (from left) Stevie Young, Henry Lock, Kashyapchandra Avadhani

8. Back row from left: Fifth-year students William Proudman, Emma Tideman, Hannah Subramaniam, Sebastian. Front: thirdyear students Scarlotte Kulas, Annie Fewster, Georgia Williams

The body electric

Motoring writer Dr Robert Menz finds a new true north in Volvo’s striking Polestar.

What is a Polestar when it is neither Alpha Ursae Minoris in the northern hemisphere or Sigma Octantis in the south? Or a small Nissan Hatch?

For this edition of medicSA it is a sparkling white high-performance electric car that has been available in Australia for a couple of years.

Those of you who follow motorsport may recall a V8 Volvo S60 being raced in the mid-2010s under the Polestar brand – and may be wondering now why there is an electric Polestar. Volvo had had a two-decade relationship with Polestar, which developed its race cars and was the performance arm of Volvo a la AMG for Mercs. In 2017, and with its new Chinese owner Geely, Volvo decided to use the Polestar name for its jointly developed electric vehicles.

Polestar 2 was introduced into Australia in late 2021. The test vehicle was the top-of-the-range 300 kW dual engine all-wheeldrive version. There is also a less powerful front-drive version.

Maximillion Mussared, head of design for Polestar, had this to say about his creation:

‘Polestar 2 is a new icon of electric mobility. A futuristic version of avant-garde design and innovative technology that serves what is exciting template for what is to come from Polestar’.

A glance at the website suggests an exciting future with Polestar 3, a mid-size luxury SUV already available to order in Australia. Polestar 4, a compact SUV, the executive’s Polestar 5 and the grand tourer Polestar 6 will be rolled out over the next three or four years.

a vehicle

this level.

This line-up looks similar to offerings from Tesla and the Chinese-made electric car brands would seem to be natural rivals.

The test car has a combined power output from its two electric engines of 300 kW developing 660 Newton meters with a claimed range of 450 km – although using all that power to take you from 0 to 100 km/h in 4.7 seconds would certainly reduce the e-range.

Polestar is a striking looking car, and like many modern hatchbacks looks more sedan- like. The rear light comprises a strip right across the back of the car which is about 270 LEDs. There is a large glass roof which cannot open. As expected from a luxury car, the seats are very comfortable and heated for those cool winter mornings. Another really neat design feature was the frameless external mirrors. The driver position is multiadjustable. Polestar 2 has all the safety and infotainment systems you expect from a vehicle at this level.

However, there are a couple of quirks. One of the lack of a USBA charging point (although there were 2 USBC points) which was a

Polestar 2 has all the safety and infotainment systems you expect from

at

little frustrating because the Apple CarPlay required plug-in connection.

The Polestar was great fun to drive and the performance is, dare I say, electrifying.

The acceleration is seamless with all that torque available from the get-go. Certainly for country driving the acceleration made overtaking very safe, apart from the fact that it doesn’t take long to reach eye-watering speeds that could well attract the attention of the constabulary. Fortunately, however, common sense prevailed, and the total time spent at more than 110 km an hour amounted to only a few seconds of the whole week behind the wheel.

Much of the city driving and most of the country driving was achieved without lifting my foot from the accelerator. The regenerative braking meant that the Polestar slowed rapidly once the right foot was released from the accelerator. One of the very smart features meant that when the car was stationary it did not creep forward as many others do.

In terms of size, four adults sat comfortably when we ventured to a special luncheon at the Admirals Bistro at North Haven CYCSA (www.cycsa.com.au/restaurant-adelaide). The 440 L boot had no trouble accommodating our weekend’s paraphernalia for the seemingly mandatory trip to Victor Harbor.

In summary, the Polestar is a worthwhile addition to the increasing number of EVs available in Australia, occupying a niche until now almost dominated by Tesla. At $94,000 drive away this full-size hatchback represents moderately good value when compared to its competitors.

Test car made available by Polestar Australia.

Dr Robert Menz is an enthusiastic motorist who once owned a Nissan Pulsar Hatch. Despite driving many, he has never owned a Volvo.

Please contact the editor if you are interested in a guest spot for the motoring column.

GenesisCare, St Andrew’s relocates to new $80 million cancer centre

Now open

GenesisCare, in partnership with St Andrew’s Hospital, has re-located to a new $80 million cancer centre at 337 South Terrace.

The multidisciplinary team at GenesisCare will continue aiming to offer a high-quality, evidence-based care experience, designed to achieve the best possible clinical outcomes.

At GenesisCare, the team strive to offer rapid access to consultations and treatments across a range of tumour types.

Any medical procedure or treatment involving the use of radiation carries risks, including skin irritation and associated pain. Before proceeding with treatment, you should discuss the risks and benefits of the treatment with an appropriately qualified health practitioner. Individual treatment outcomes and experiences will vary.

genesiscare.com

AU_3295_P_v2_08.2025

No drag, no noise

A few weeks after his first experience driving an electric car, AMA(SA) Councillor Dr Shriram Nath is a committed convert.

When my wife and I decided it was time for a new car, we test drove petrol vehicles and hybrids. Having chosen a Toyota hybrid, we discovered we’d have to wait a year to collect it. So, we kept looking – and broadened our search to include electric cars.

During COVID-19, I had heard of the BYD brand, an EV Chinese company with what appeared to be an excellent compact SUV. One day, driving along Main North Road at Menindie, I saw a sign advertising the BYD-experience Centre.

My wife’s first question was about the European New Car Assessment Programme (ENCAP) rating of the car. When persuaded it has a 5-star Australian New Car Assessment Programme (ANCAP) rating, she was ready for a test drive.

We went and saw the car in the BYD experience centre. On initial inspections, we were impressed by the interior finish of the car and the boot space was adequate. We booked for a test drive

the following weekend.

It was a new experience for us. We had never driven an electric car. But the instructions were simple, so we decided to head for the (Adelaide) Hills.

The first thing we noticed that there is a touch-screen display screen which we communicated with the car. The absolute essential buttons like answering the phone were on the steering wheel.

My wife was the initial driver and pushed the pedal from 60 km to 100 km on M1. The feeling was enthralling – there was no drag, no noise suggesting the car struggling to go up the hill.

During that drive, the car sold itself. Two weeks later, we picked up our own new EV.

It has been a big steep learning curve (but joining the BYD owners’ Facebook pages for Australian and local owners has been very helpful). A new owner has to undergo a range anxiety (how

much the car will go on a single charge) which we’ve learned usually lasts for about a month. To break the range anxiety in the second week, we decided to take a long drive over the weekend to a town we’ve never before visited, Kaniva in the South East.

You can’t jump in an EV and expect a destination charger to be present in every town like a petrol pump station – at least, not yet. We were advised to download the ‘plug share app’, which tells us where we can recharge our car). As with petrol cars, the range claimed by the manufacturer is never the same as the car delivers.

We learned to consider what drains the battery – not just driving, but air conditioning, seat heating, the radio. Climbing a hill used more energy. Regeneration occurs when the car breaks and feeds back to the battery.

Kaniva is about halfway to Melbourne, just over 300 km from the Adelaide CBD. There was a destination charger in Kaniva and the motel we were going to stay overnight had a trickle charger (when you charge at a slow rate in a three-point AC plug).

We started midday and set the cruise control at 100 km/hour to increase the range. We drove past Murray Bridge, Tailem Bend, Keith and Bordertown; my calculations told me we should be able to reach Kaniva without a recharge. It was nerve wracking - when we reached Kaniva there was 5% charge remaining! But my range anxiety disappeared.

Looking to celebrate on a wintry day, we walked to the local pizza shop for a late lunch.

Kaniva is a rural town in Western Victoria. Grazing sheep are still very much part of a sustainable agricultural future for this area, with efforts to improve both soil health and plant biodiversity.

In 2010, local artist Sharon Merrett inspired a community-led public arts project to celebrate the town's sheep heritage. Now, the Sheep Art Trail that winds along the town’s streets features murals, tours and a wool stencil wall, recording over 100 property wool stencils. All sheep have been painted by local Kaniva artists and community groups, aged between eight and 80. If a visitor has the time, they can count the 57 sheep, four lambs and two sheep dogs.

We’ve learned that it is good manners to log-in to the plug share app while charging so other EV car owners can message you about charger availability or if you need help. No one was waiting, but a lady approached and started asking about the car and what we thought about it. This is common for EV owners, but for us it was yet another new experience.

The next day morning, we took the car to the destination 50 KW fast Evie DC charger. No car in sight meant we didn’t have to wait. Once we’d figured out what to do, it did take some strength to pull the tethered type-2 cable from the charger and connect to the car,

It took about one hour to charge. We walked again, this time past the Kaniva puppet shop where we saw on display the 40,320-piece jigsaw puzzle, which the Guinness Book of World Records has confirmed as the largest commercially made puzzle in the world, both in number of pieces and overall size at that time.

After a sumptuous breakfast, we headed for the Kaniva Silo, where David Lee Pereira has painted the Australian hobby bird, a relatively slender and long-winded member of the Falconidae family, the scented sun orchid (Thelymitra megacalyptra) to its left and the salmon sun orchid (Thelymitra rubra) on the right. The silo art is a tribute to the Little Desert National Park in the Mallee region of Victoria, home to 600 species of native plants, 220 s of birds and 60 native mammals and reptiles.

On the drive back, I could not help noticing the petrol stations I passed. The South Australian Government has provided the RAA with $12 million to work with Chargefox and install fast chargers in South Australia. The aim is that in the next two years, RAA/ Chargefox will install 536 EV charging points at 140 locations to create the state’s first EV charging network. More than threequarters of the sites will be in regional areas. The maximum distance between charging points will be less than 200 km – half the range of a typical EV car battery.

We decided to charge our EV at the Murray Bridge RAA ultra-fast charger. Within 30 minutes, the battery was full.

Paying at these and other EV chargers is through the individual companies’ apps. What did it cost us? I paid $10 for the trickle charge at the Kaniva Motel, and for an hour at the Kaniva charging station, $19.32 (38.646 kWh@ $ 0.50/kWh). At Murray Bridge, 45 minutes cost $21.44 (44.66 kWh@ $ 0.60/kWh, with 20% discount for RAA members included). Total cost $50.76 for a 700 km round trip.

We had recharged ourselves by the weekend trip and it was fun to break the range anxiety phenomenon. We also had the chance to show the car to AMA(SA) President Dr John Williams after our August Council meeting. He was excited sitting in the BYD and recounted his trips to Laos where BYD is popular and says he’s seriously considering an EV journey drive to Adelaide from Port Lincoln.

The Kaniva Silo

We’ve learned that it is good manners to log-in to the plug share app while charging.

Dr Michael Patkin AM

FRCS FRCSEd FRACS

Dr Michael Patkin was a pioneer in the field of surgical ergonomics. He earned the status of being a member of the Order of Australia in 2011 for ‘service as a surgeon and to the study and practice of ergonomics’. It was a worthy reward for a lifetime of dedication to his profession and his patients.

Michael was born in Melbourne in 1933. His first love was mathematics – he was fascinated by numbers, codes and measurement. He memorised the Dewey decimal system of book numbering and was never happier than in a library or bookshop. He taught himself shorthand and to touchtype, learned FORTRAN, studied semiotics and joined a pistol club to learn about tremor control. He loved chemistry and destroyed his parents’ bathroom while testing his knowledge at home.

The young Michael studied medicine at Melbourne University and the (now demolished) Prince Henry Hospital. His later work in ergonomics ran alongside his professional career as a surgeon but was largely voluntary – an expenditure of energy and imagination, rather than a source of income. He won a Prince Philip Design Award for his design of a needle-holder in 1970.

Along the way, he spent almost 30 years in solo surgical practice in Whyalla, on South Australia’s Eyre Peninsula. It is notable that this success was achieved in a regional city rather than a teaching hospital or formal academic institution.

Ergonomics – a branch of the engineering discipline of human factors dealing with people at work and the design and use of tools and equipment – was not a feature of surgical or medical training in the late 1950s when Dr Patkin began his career. However, eager to overcome what he felt were his own inadequacies as a newly qualified surgeon, he began what was to become a life-long study in hand function, visual acuity, instrument design, dexterity, seating, and the many skills necessary for safe and successful work in the operating theatre.

Dr Patkin recognised that existing study and international research in the field of ‘human engineering’ by Murrell (Australia), Tichauer (America) and Granjean (Switzerland) had much to offer surgeons looking for improved operating outcomes. He knew that smoother, quicker and more efficient operating skills would help patient outcomes and offer financial and other advantages to the health system and its workforce.

His first paper on the topic, ‘The Hand Has Two Grips’ appeared in The Lancet in 1965 while he studied in London. Returning to Australia with his family later that year he began work in the Hunter Valley and continued to research and write on a wide range of topics, producing his article ‘Ergonomic Aspects of Surgical Dexterity’ in 1967.

In 1974, after a brief period as Fellow in Surgery at the Royal Newcastle Hospital, Dr Patkin moved with his family to Whyalla to set up in surgical practice. There followed a hectic period of research, writing and lectures to health colleagues.

This was the era of the new ‘micro-surgery’ and Patkin provided input and expertise on ergonomics and the operating microscope to surgical leaders in the field.

In 1985 Dr Patkin was elected President of the then Ergonomics Society of Australia and New Zealand. This appointment led to him travelling across Australia and overseas, bringing together the rich experiences of engineers, psychologists, medicos, architects, physiotherapists, human factors experts, and industry chiefs in the search for improved quality in workplaces, especially hospitals and operating theatres. The Ergonomics Society’s reach and importance expanded hugely during his Presidency, so the Society was well positioned when industry turned to it for advice and help when the repetitive strain injury (RSI) and workplace stress problems hit industrialised nations in the 1980s.

In 1986, in recognition of his long-time interest and involvement in computers and their relation to ergonomics, he was appointed Lecturer of the Year by the Australian Computer Society.

Increasingly, Dr Patkin was asked to consider solutions to the emerging workplace problems related to the ‘Information Age’ and the changing roles of people in offices and other work environments.

During the 1990’s Patkin directed his research towards keyhole surgery, which proved technically challenging for many surgeons practising it for the first time. Dr Patkin was familiar with the

Dr Michael Patkin in London in 1962

associated problems of tremor, confined spaces, poor lighting and bulky hardware, and sought ergonomic solutions that could be passed on through surgical training. These all came together in the paper “Ergonomics, Engineering and Surgery of Endosurgical Dissection Surgery” in 1995. He undertook research into the problems through videotaping narratives with operators across the world, during procedures, and conducted training sessions for surgeons in Adelaide.

These studies resulted in his major break-through work on ‘heuristics’, rules of thumb or mental shortcuts adopted subconsciously by skilled workers. Publications included ‘Fundamental Skills for Surgery’, a chapter in the training manual for the Royal Australasian College of Surgeons, and articles on surgical heuristics in the December 2008 issue of the ANZ Journal of Surgery which the Editor described as ‘priceless information which should be required reading for surgical trainees’.

Dr Patkin was a Fellow of the Royal Australasian College of Surgeons, the Royal College of Surgeons of England, the Royal College of Surgeons of Edinburgh, Fellow and Past-President of the Ergonomics Society of Australia and New Zealand, and a member of the AMA. Following retirement in 1999 he was appointed to an Honorary position in the Department of Surgery, at the University of Adelaide, The Queen Elizabeth Hospital,

Adelaide, and the Department of Surgery, Flinders University, Adelaide. He was appointed Adjunct Professor of Ergonomics in Surgery at Macquarie University, a Fellow of the Ergonomics Society of Australia, and a member of the Board of Governors, Communication Research Institute of Australia.

After retirement to Adelaide, Dr Patkin gave a series of lectures on ‘successful ageing’ to Fellows of the Royal Australasian College of Surgeons who were contemplating retirement, to help in self-assessment of their surgical skills and contribute to decisions about whether to retire or to remain effectively and safely operating where there was a community need. Other work included workshops on operating room and hospital design.

Dr Patkin undoubtedly gained personal fulfillment and satisfaction through his lifetime association with ergonomics. Surgery, and the patients and operators involved with it now and in the future, have also gained immeasurably through his inventiveness, determination, original thought, and his readiness to share his rich body of work with others.

Dr Patkin met and married Margaret in the Channel Islands in 1961. He was the father of four children and the grandfather of six. He died in Adelaide on 4 April 2023.

More information about Dr Patkin’s work can be found at mpatkin.org

Dr Patkin with colleagues Dr Sun Lee of Korea and Dr Sebastian Arena of the US, in Philadelphia in 1978

Dr Creston I Magasdi

Born in 1932 in Budapest, Creston Magasdi arrived in Australia in his late teens, not knowing a word of English. Within a few years, however, he was gaining distinctions in each year of his undergraduate course in medicine at the University of Adelaide, and eventually finishing in equal second place in his final year of studies. (He tied equal second with Dr Helen Broinowski, who later became the well-known as anti nuclear activist Dr Helen Caldecott.)

This remarkable achievement by the young migrant was published on the front page of The Advertiser.

Creston Magasdi arrived in Australia with his family in 1950. He began his new life in South Australia working at two jobs, one as a laboratory assistant at Faulding’s Pharmaceuticals and one as a weekend delivery boy, to fund his matriculation studies at night school.

He did so well in his exams that he was awarded an Australian Commonwealth Scholarship to study medicine.

During his university years, the proudly naturalised Australian joined the RAAF, beginning as a Cadet Officer, then Pilot Officer and a Flight Lieutenant, and eventually becoming a Flight Surgeon (Reserve) at Edinburgh RAAF Base. He was also an active member of the SA Squadron Sea Rescue Group.

In the early 1960s the young graduate worked as acting house surgeon at the Queen Elizabeth Hospital, having won the Thomas Davis Scholarship Cleland Prize in Pathology. In the mid-1960s he went overseas to further his studies, working as a registrar in surgery and orthopaedics at St Mary’s Hospital, London.

He later joined the United States Air Force, based in Stuttgart, Germany, as a medical officer.

Returning to South Australia, Dr Magasdi established a busy GP practice at Para Hills, where he became a much-respected family doctor. He also held the role of senior clinical supervisor at the Lyell McEwin Hospital.

Always interested in legal matters, Dr Magasdi spent the final phase of his medical career as a well-known medico-legal consultant based in North Adelaide.

But Dr Magasdi’s many interests ranged considerably further than various aspects of medicine. He had a lifelong interest in all levels of politics, particularly the work of local government.

In 1995, he was elected as a Councillor of the City of Adelaide. This, he used to say, gave him both the privilege and the responsibility of ‘having a say in the future’ of his community.

As part of his various community responsibilities, Dr Magasdi sat upon a large number of boards and committees: the Australia Day Council, the Development Committee, the council’s Finance Committee, the Aquatic Centre Controlling Authority, the Economic Task Force, the Sister City Committee, the Traffic Management Board, the Motorsport Board, the Parklands Authority, the Central Market Authority, the Simpson & Donkey Memorial Foundation and the Murray Darling Commission.

He took on all his roles with characteristic energy and dedication, and after some years he was elected as Deputy Lord Mayor of Adelaide.

Both he and his late wife Mrs Ann Magasdi were strong supporters of the work of the Mary Potter Hospice. Other community organisations in which Dr Magasdi took an active part included his 14 years with the Rotary Club of Adelaide, 30 years with the Royal United Services Institute, and 57 years with the Australian Medical Association.

In January 2016 Dr Magasdi was awarded the Medal of the Order of Australia (OAM) for service to local government and to the community.

As those who knew him recognise, Creston Magasdi was a formidable force who worked with characteristic enthusiasm, energy and dedication for the many organisations with which he was involved.

He came to Australia with virtually nothing, immediately set to work to educate himself, and over his long life achieved a great deal - personally, for his family, for his profession and for the South Australian community.

Dr Magasdi died on the Gold Coast on 1 June 2023. He is survived by his five children, nine of his 10 grandchildren, and two great-grandchildren.

Dr David Craddock

MBBS FRCS(England) FRACS

1936 - 2023

David Craddock was one of the country’s leading heart surgeons, internationally respected for his innovation, leadership and collaboration.

David Robert Craddock was born in Townsville in 1936, the third son, with a younger sister, of Thelma and Edward Craddock, a businessman. He was an excellent student and awarded scholarships to attend Townsville Grammar School.

In 1960, he graduated in medicine from the University of Queensland. His early medical training was at the Royal Brisbane and Brisbane Children's Hospitals but, as was customary at the time, he received most of his surgical training in the UK, where he achieved Royal Fellowships of Surgery in Edinburgh and London. In 1966 he was appointed a senior registrar in Andrew Logan's prestigious unit at the Edinburgh Royal Infirmary.

Two years later he returned to Australia, joining Darcy Sutherland at the Royal Adelaide Hospital’s cardiothoracic unit.

It seems extraordinary now, but in the early 1970s smoking in hospitals was rife – patients in their beds, doctors on their rounds. In Edinburgh it was forbidden in the cardiothoracic units, so David quietly began a campaign, first with the patients, then his unit’s nurses, and finally the entire medical staff of the hospital. As he stood up to address this as the last item on the staff society agenda, senior staff members including a senior physician put their feet onto the chairs in front of them and started blowing huge smoke rings into the air. The motion failed miserably. A year or so later, David succeeded.

In 1968, when he joined Adelaide’s cardiothoracic unit, it was performing about 100 open-heart operations a year. The addition of David Craddock as a second surgeon undertaking these procedures led to a large increase in the number of procedures performed – and with outstanding results when compared to world best-practice. By the time David was appointed director of the unit in 1977 there had been a seven-fold increase in the number of open-heart procedures.

During this time David oversaw the introduction of coronary artery surgery, which peaked in the 1990s at about 1,500 operations a year. He had attracted a team that included John Waddy, a brilliant cardiologist, and Veronica Cummings, their outstanding chief operating nurse. Their motto was ‘do the work and the funding will follow’.

One of David’s strengths was his ability to establish enduring connections with pre-eminent surgeons internationally: superstars such as Denton Cooley from the Texas Heart Institute, Norman Shumway from Stanford University, Bruce Lytle from the Cleveland Clinic, Hank Bahnson from the University of Pittsburgh and David McGiffin, in Alabama and more recently the Alfred Hospital in Melbourne.

He was also chairman of the Staff Society of the Royal Adelaide Hospital, chairman of the State Committee of the Royal Australasian College of Surgeons, on the Board of Cardiothoracic Surgery, and an Examiner for the Royal College, director of the Board of the National Heart Foundation and patron of the charity Heartbeat, founded by Bert Hughes from Whyalla, which raised close to $1 million for cardiac equipment.

By 2001, when he retired, David had performed approximately 10,000 open heart procedures, almost all at the Royal Adelaide Hospital, and the unit had performed about 28,000, quite a record.

A gifted sportsman, he played A-grade pennant golf at Royal Adelaide and once played in the Australian Open Golf Championship; a professional had withdrawn the day before the Open and 19-year-old David was offered the spot. But to qualify David needed a handicap of less than three. David’s handicap was three. But that afternoon, he shot a 69 off the stick, lowering his handicap to 2, and he qualified.

Golf, tennis, art, shooting and history were other interests. And racing. Colin Hayes, a patient who thanked David for an extra two decades of life, trained, with great success, three thoroughbreds – Daring Escape, Badinage, and Shadwell Lass – for David and friends, some of whom had been on Colin’s surgical team.

His was a full and busy life but family remained at its core. In 1961, David married Diane (eldest of four Strachan sisters from Ilfracombe) in St John’s Cathedral in Brisbane. It was a happy union that prospered for nearly 62 years. They had two children – a son, Nigel, who died in 1992, and a daughter, Susannah, who survives him with Diane, and two beloved granddaughters, Annabel and Lucy.

David Craddock was an outstanding Australian. He died, aged 86, on 7 April 2023.

Mark McGinness

Dr Craddock (in suit and tie) with Royal Adelaide Hospital theatre staff

Cheers to our new member benefit

AMA(SA) is pleased to announce that winedirect.com.au has joined the list of companies offering special services to our members. Among the benefits is a column about new and interesting wines that you’ll see in each issue of medicSA, written by winedirect.com.au Managing Director Mark Pradun for our members.

In this issue we introduce Mark and allow him to explain how winedirect.com.au works to select top quality wines for happy repeat customers.

My love of wine began about 30 odd years ago while I was working in retail liquor stores. Before too long I went out on my own and opened a bottle shop on Henley Beach Road, next to the Squash Courts. While there I found that many of my regular customers would call up and say, 'Mate, just put a dozen reds together for me. And can you drop it off on your way home?'. It was the birth of the direct sales model we use today.

A couple of decades on and I'm still getting the same phone calls from the same customers. The fact that we have been able to keep these original customers – and add and retain many, many others along the way – is testament to the high-quality service we provide. We offer good wine and our customers trust our recommendations. We stand by the wines we select.

I'm extremely proud that we've successfully expanded the business over more than 26 years while maintaining our independence.

We sell wine, write about it for national publications, and judge it for wine shows. And we taste hundreds of wines among the thousands available each week to ensure the wines we offer are top quality and excellent value. Some of them are belters from brands you know and love, while others are quirky gems from tiny quantity, independent producers.

We serve national and multi-national clients such as Commonwealth Bank, NAB and AMEX but also good mates who live around the corner. I look forward to serving you too.

For information about winedirect.com.au’s special service for AMA(SA) members, visit member benefits at ama.com.au/sa/ The offer is now available exclusively to AMA(SA). Offers can be viewed on the Wine Direct website.

Upcoming educational events

9 Oct

RANZCP SA 2023 Barton Pope Lecture

Adelaide, SA

Click here for more

26-29 Oct

SASMA - Sports Medicine in General Practice Course

Kurralta Park, SA

Click here for more

3-4 Nov

RDWA SARGA Paediatric Anaesthesia Conference

Adelaide, SA

Click here for more

19-21 Oct

Rural Medicine Australia (RMA) 2023

Hobart, Tas

Click here for more

1 Nov

SASMA Concussion Education and Skill Development for GPs

Adelaide, SA

Click here for more

24, 26 & 31 Oct

AMA(SA) New Doctor Infomation Session

Webinar, SA

For final year medical students and IMGs in SA. Click here for more

3 Nov

Royal Australasian College of Surgeons Papers Day

Adelaide, SA

Click here for more

8 Nov

RACP ASM - Thriving in medicine: The art of balance

Crafers, SA

Click here for more

If you are a not-for-profit organisation wanting to promote your major scientific or educational event please contact medicSA@amasa.org.au with details of your event including registration links for consideration of inclusion.

Dispatches

NEW FACES AT AMA(SA)

AMA(SA) welcomed two new faces in June. Nicole Sykes joined AMA(SA) as CEO after former CEO Dr Samantha Mead left to join the Australian Nursing and Midwivery Federation in June. For more about Nicole, see the article on page 9. Leonie Thomson didn’t have to go far to find her next professional challenge. The former Executive Assistant at ARAS, which occupies the ground floor of the AMA(SA) office building at Dulwich, now takes a few extra steps to reach the first floor for her role as Executive Administration Coordinator. Leonie is also the Executive Assistant to Nicole and President Dr John Williams.

The AMA(SA) team now comprises:

• CEO Ms Nicole Sykes

• EAC Ms Leonie Thomson

• Senior Policy, Media and Communications Advisor Ms Karen Phillips

• Operations and Business Development Mrs Catherine Waite

• Administration Officer Mrs Sharyn Kerr

• Administration Coordinator Mrs Julie Boultby

• Business Development and Membership Services Ms Natalie Hall

• RTO Trainer and Assessor Ms Michelle Stanojevic.

2023 AMA(SA) COUNCIL MEETINGS

The next meetings of AMA(SA) Council will be held on Thursday, 2 November, and Thursday, 7 December. There is no meeting in October.

Members may attend Council meetings as observers. If you are a member and wish to attend the November or December meeting, please call Leonie Thomson on 8361 0109 or email lthomson@amasa.org. au.

HAVE YOUR CIRCUMSTANCES CHANGED?

If your place of employment, employment status or contact details have changed

recently, perhaps because you’re no longer a student, you’re working part-time, or you’ve recently retired, please let us know so we can update your details.

If you’ve been a student member but are no longer a student, please let us know so we can upgrade you to a doctor’s membership. You’ll then have access to a range of additional state and federal benefits, including the Medical Journal of Australia (valued at more than $253) and the AMA List of Medical Services and Fees (valued at $515), which are not available to student members.

If you have any questions about your membership, please contact us at membership@amasa.org.au

ACCESSING THE AMA FEES LIST

The latest AMA Fees List is available and is under a licensing arrangement so that AMA members have access at no cost. Please access the list at https://feeslist. ama.com.au/ using your login details.

ROOM FOR RENT

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

Consulting room available for lease in wellestablished GP practice with on-site, undercover parking. Located in Tranmere between Burnside and North Eastern Community Hospitals, with highly experienced admin staff.

Contact Leah on 08 8365 1157.

ASSOC PROF GILLIAN MARSHMAN wishes to announce that she will be retiring from Dermatology practice from December 31st 2023 and Willan House Dermatology will therefore close at that time.

She would like to thank all her colleagues for the privilege of caring for their patients and their support over the years.

Dr Cassandra Chaptini will be practicing at Ashford Dermatology, after maternity leave, and Dr Aakriti Gupta will be joining Malvern Dermatology.

Member services

Discover even more about accessing our exclusive member benefits and services when you’re logged into the AMA(SA) member portal. Uncover the full spectrum of perks waiting for you on the other side of your login.

The ride of a lifetime

Unleash the power of luxury and innovation through our premium car offerings. As a member, you’ll enjoy access to state-of-the-art vehicles from BMW, Volvo, Skoda, Audi and Volkswagen that redefine driving. From sleek sports cars to eco-friendly marvels, each vehicle promises an exhilarating journey.

A toast to taste

Savour the finest flavours and indulge your senses with exquisite wines from winedirect.com.au. As the preferred wine supplier of AMA(SA), Wine Direct offers members access to rare vintages and carefully curated collections from renowned vineyards at excellent prices.

Members receive special access to the Wine Direct VIP page, available only to subscribers, which showcases the best offers available at any given time through the exclusive link found in the AMA(SA) members’ portal.

UpToDate®, the trusted physician-authored resource

UpToDate® provides reliable clinical answers, incorporating the latest medical findings and practical recommendations for patient care. With it, you’ll confidently address any clinical question that arises in your practice. Enhance your professional growth with UpToDate® at a special discounted rate.

Our partnership with winedirect.com.au also includes invitations to exclusive wine tasting events, a corporate gift service and the support of your own personal wine concierge, who will work closely with you to ensure you are ordering wine you will love.

Need a carton of wine for yourself, for the family or as referral gifts sent directly to your valued clients/referring doctors all over Australia? winedirect.com.au can organise that for you. Not only that, winedirect.com.au offers free delivery throughout Australia wide if you buy 12 bottles or more, easy. The site uses best-in-class technology and security and there’s a ‘wine goodness’ guarantee to ensure there is no risk when you purchase. If you don’t like a wine, just send it back

With a priority on providing industry-leading customer service, winedirect.com.au has enlisted experienced wine aficionados, judges, winemakers, and growers to ensure a personalised service to help you choose the right wine, whatever the occasion.

Unveil your inner radiance

Step into a realm of beauty and self-care where you are the centre of attention. Members receive exclusive access to Endota premium beauty products and rejuvenating spa experiences that will pamper you from head to toe. Visit the members’ portal for more information.

Discover more by contacting phil.manser@winedirect.com.au or visit the AMA(SA) members’ portal for an exclusive gateway to the VIP page.

Raise your glass and let each sip transport you to a world of sophistication and taste.

AMA(SA) preferred providers