AMA(SA) medicSA, Summer 2023 by AMA-SA

SUMMER 2023-24

VOLUME 36 NUMBER 4

2023

A year in review

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Contents medicSA is produced by the Australian Medical Association (SA) Australian Medical Association (South Australia) 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 contact President Dr John Williams: president@amasa.org.au

President’s Breakfast

President’s report

From the medical editor

CEO’s report

The year in review

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) Cover Cover photo of AMA(SA) President Dr John Williams and Immediate Past President Dr Michelle Atchison by Blue Razoo

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. All matter in the magazine is covered by copyright, and must not be reproduced, stored in a retrieval system, or transmitted in any form by electronic or mechanical means, photocopying, or recording, without written permission. Images are reproduced with permission under limited license.

AMA(SA) President’s advocacy for members

Updates and reflections on a challenging 2023 from AMA(SA) committees and affiliated associations

Power and passion – the advocacy of the AMA •

Your AMA and its influence in 2023

•

AMA – speaking for all doctors

• Stemming the tide – the AMA’s fight against vaping 34

In brief – medical research from around the world

In his Honour – recognising King’s Birthday Honours recipients

Student news

People and partners – capturing key moments at the President’s Breakfast and other medical gatherings

Members’ benefits

It’s been a busy year since Ms Nicole Sykes joined the AMA(SA )Secretariat as CEO in June. Nicole (third from right) is pictured with (from left) Leonie Thomson (EA), Catherine Waite (operations and business development), AMA(SA) President Dr John Williams, Natalie Hall (business development and membership services) and Karen Phillips (policy, media and communications) at the annual President’s Breakfast on 8 December. Absent are Sharyn Kerr (administration) and Julie Boultby (associations). For more about the Breakfast, see page 4 and the social images on page 42. medicSA | 3

PEOPLE

President’s Breakfast

2 1

MA(SA) President Dr John Williams was pleased to welcome a special guest, AMA President Professor Steve Robson, to his President’s Breakfast at The Feathers Hotel on 8 December.

Dr Williams thanked Vice President A/Prof Peter Subramaniam; the AMA(SA) Executive Board, Council and committees, members and staff; and external friends and partners for their contributions to South Australian healthcare during a challenging year. ‘My experience in rural medicine and in my time in the AMA, including as President, is that doctors are easy to unite when it comes to patient care,’ Dr Williams said. ‘We work well together across specialties when it comes to delivering excellent care. ‘We need each other to provide that excellence, and we need all parts of the system to be working well to deliver that care. ‘My goal is unity in the profession and excellence in care.’

Professor Robson said he was pleased to attend the annual event and present the AMA Diversity in Medicine Award to AMA(SA) member Dr Fariba Behnia-Willison. With her daughter Nadia Willison in the audience, gynaecologist Dr Behnia-Willison accepted the award for her many years’ work advocating for women’s health and gynaecological care for marginalised women, through her practice and through her charitable arm, Desert Flower. Health Minister Chris Picton also addressed the audience, which included Deputy Leader of the Opposition John Gardner, AMA members, and representatives of organisations with which Dr Williams and CEO Nicole Sykes worked during the year. For more images from the President’s Breakfast, go to page 42. 1.

AMA(SA) President Dr John Williams welcoming the audience

AMA President Dr Steve Robson and AMA Diversity in Medicine Award recipient Dr Fariba Behnia-Willison

Dr Williams, CEO Nicole Sykes and AMA(SA) Vice President A/Prof Peter Subramaniam

Dr Williams, Health Minister Chris Picton and Prof Robson

Dr Williams (right) and Deputy Opposition Leader John Gardner

Dr Williams (left) and Prof Robson (second from right) with former AMA(SA) Presidents Dr Jill Maxwell, Dr Michelle Atchison, Dr Peter Ford and Dr Chris Moy

medicSA | 4

NEWS

President’s report Dr John Williams

I wasn’t expecting to have to defend our profession and our evidence-based pronouncements on COVID-19 as one of the last tasks undertaken as President this year. But when columnist Caleb Bond of The Advertiser joked about why doctors would be warning against increased risk of infection and suggested that ‘life is normal’ because ‘no one has died with COVID-19 this week’, I had to respond. In a letter that was fortunately chosen for publication in The Advertiser the following week, I emphasised why we doctors want to warn people about the increased risk of what experts are calling the ‘eighth wave’. I wrote that we are asking people to follow the hygiene practices we’ve recommended throughout the pandemic, to have vaccinations, to protect themselves and the vulnerable. I reminded readers that COVID-19 is not and has never been ‘mild’ – and suggested the families of the 1,632 people who had died of COVID-19 in South Australia at that point (as I write this, the total is 1,648) would agree with me.

Sometimes, interests other than ours win out. But even then, we are asked for input.

I took him to task for suggesting that Professor Nicola Spurrier and AMA Queensland President Dr Maria Boulton were engaging in ‘fear porn’ when they asked individuals and communities to do what they can to ‘avoid another disastrous Christmas’ – and that they came out with these messages, in his words, because they were ‘clearly missing the limelight’. As I wrote – and I understand other readers said in letters that were not published – doctors like Prof Spurrier and Dr Boulton, and their colleagues around the country, are far too busy to worry about the limelight. We have worked long and hard for nearly four years now to manage this virus and its impacts on our health, our families, our businesses and our health system. I hope none of us have a COVID-constricted Christmases this year. But unfortunately hope, prayers, and ill-informed insults about doctors isn’t going to be what stops it. I know that among our members there is anger and frustration that we are still having to advocate for evidence-based practices and behaviours to limit the impact of COVID-19 – in the media and even in government policy and decisionmaking. When did acting in the interests of all become so divisive that the very suggestion is mocked and belittled? I well

recall the comments from our thenPresident Dr Chris Moy in the early months of the pandemic when he asked Australians ‘to look past individual need and to demonstrate the generosity so evident during and after the summer’s bushfires’ just a few short months beforehand. And in the early days, that ‘one for all ‘ spirit was everywhere. The benefits of investing in healthcare to support economic stability were clear. But now, in so many ways, it’s every person for themselves. I am so glad, then, that our organisation and our profession can and does still stand up and defend science and medicine and facts. I am proud to represent our members when I speak in ministerial meetings, to the media and in professional gatherings of the need for decisions that evidence demonstrates are the right ones. Sometimes, interests other than ours win out. But even then, we are asked for input. We are asked to provide rules and criteria, including about those decisions with which we disagree. And we will continue to speak. As the year comes to a close, I thank the AMA(SA) Council for crystallising the professional perspective we need on so many issues and providing a solid foundation for our policy and advocacy work. In particular, thanks must go to Immediate Past President Dr Michelle Atchison, under whose leadership the year began, and whose commitment continues as a member of the AMA(SA) Executive Board. Michelle’s dedication to AMA(SA) provided a sound footing but big shoes for me to fill. The Doctors in Training Committee, under the leadership of Chair Dr Hayden Cain, has been especially vocal this year, including with the release of the Hospital Health Check. And the Committee of General Practice, with Chair Dr Bridget Sawyer a constant provider of information and advice, has been in the limelight more than usual due to the payroll tax and pharmacy prescribing challenges. Thanks to the Executive Board and to CEO Nicole Sykes who joined us in June, and to her hard-working Secretariat team. Best wishes for what I hope is a healthy, safe, restful and relaxing holiday season. And that the ‘fear porn’ worked.

medicSA | 5

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NEWS

From the medical editor Dr Roger Sexton

Whether we are ready or not, the Christmas and New Year period presents many of us with an enforced and essential break and an opportunity for personal and professional reflection and physiological restoration. It is good to put aside the worries of patients and the insoluble issues affecting the planet for just a few weeks while we focus on ourselves, our families and all those who enrich our lives and are at the core of our existence. Our work can so easily intrude more and more into our 168-hour week and squeeze out any time for those essential things that sustain us. The end of year can offer us time to reflect upon what we may have put aside or deferred during the year: contact with family and non-medical friends, engagement with special interests, reading and writing, team sport and mates, creative and artistic pursuits, performances, personal time with nature, peer group discussions and attention to good lifestyle habits.

We understand that the nature of our work is intense and it distorts our work-life proportions.

We may be tempted to spend the Christmas period completing unfinished work and gleefully undertaking email ‘clearances’ at a time when we know others will be away and things will slow down. Without interruptions we can truly have time to catch up! But should we? This is in our nature of course – to work longer than necessary and put aside the core elements of our sustainability in the service of others. But rest, above and below the neck, is a wonderful thing. I recall holidays spent with family away from my rural general practice for two weeks. This was most often timed to coincide with a CPD event, to reduce the cost! In those times, two weeks was the longest break from my ‘day job’ I could spare, but the effects were significant.

It raises the question: how much time away from work does a doctor need? Affordability and workload are often quoted as barriers to taking more than a couple of weeks’ leave, but a closer financial and taxation analysis of this can reveal some surprisingly good news. In my view, we are not typical workers who warrant a standard four weeks of annual leave. I would argue that six to eight weeks a year is a better starting point. This can allow a separation of holidays from CPD and allow some choice in how we take holidays, whether it be longer breaks or two weeks each quarter each year, for example. We understand that the nature of our work is intense and it distorts our work-life proportions. This deserves our closer reflection over the Christmas period, in the setting of the demands of our businesses, rosters, patients and the capacity of colleagues to cover our absences. A good first step is to plan holidays during 2024 well ahead and lock them in. So, as you reflect on this edition of medicSA and the year that has been, it is essential to ask yourself, ‘Am I going to work in 2024 the same way I have been working in 2023 – or is there a better way? How many breaks from work do I truly need?’ I know you will enjoy this summer edition of medicSA and I thank my colleagues in the team from AMA(SA) who have worked very hard to bring you all the editions this year. I wish you every success and the best of health in 2024.

By the second week, I usually noticed my focus was returning firmly to family and the little domestic things that made life sweet. I noticed a clearing of my complexion and a distinct improvement in my appearance. My physiological state was improving. ‘So that is what I really look like!’, I would say to myself as I stood before the mirror.

medicSA | 7

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NEWS

From the CEO Ms Nicole Sykes

s we all begin winding down in the lead-up to the summer break, I extend sincere thanks to our members and health partners for your support during 2023. It has been another busy year for everyone working in healthcare and I hope each of you can enjoy some well-deserved time off over the holiday period. Certainly, the first six months as CEO for AMA(SA) has been a whirlwind as I have met and got to know the team and became familiar with all the amazing work being achieved behind the scenes. Concurrently this aligned with the need for a new strategic plan and we commenced a review of our organisation’s strategies, goals and, most importantly, the value we provide to our members. It is imperative to understand our past and appreciate the present; to recognise the strategic pathways available to chart a course that meets the needs of today’s medical professionals and prepares the ground for the next generation of clinical leaders.

Change is not a threat, it’s an opportunity. Survival is not the goal, transformative success is. Seth Godin

The strategic review involved input from all corners of the organisation. We assessed our strengths, acknowledged our challenges, and identified opportunities that can redefine AMA(SA)’s role in the ever-evolving healthcare landscape. It was a collaborative effort, and I extend my gratitude to the hard-working staff, AMA(SA) Council and committee members, and our health partners for the feedback, knowledge sharing and brainstorming that has occurred over the past few months. I am truly grateful for the collective expertise our health partners and volunteers bring to the table. These partnerships are essential as we navigate the complexities of the health system where effective communication will be fundamental to delivering ongoing improvements in the years to come. I would also like to express my sincere appreciation to our President, Dr John Williams, and the AMA(SA) Executive Board for their unwavering support throughout my initial few months and as we prepare for this pivotal period of change. Their guidance and commitment to helping reimagining the future of AMA have been invaluable. As we formulate the strategic roadmap, our focus remains

clear: to deliver increased value and a representative voice platform for our members. As 2024 approaches, I am excited about our planned initiatives and opportunities for AMA(SA) and our members. Our commitment to the well-being of medical professionals, the advancement of medicine, and the advocacy for the highest standards in patient care is resolute. The next generation of medical leaders deserves an AMA that not only embraces the substantive history of our organisation but also reimagines the future with innovation and adaptability at its core. I look forward to sharing our plans at our 2024 Annual General Meeting and encourage our members to take this opportunity to attend and provide feedback. As the year comes to a close, I would like to finish by reflecting on the brief period I’ve spent in this role. It has been a rewarding experience that has granted me the privilege of participating in significant and impactful improvements on a large scale, surpassing anything I encountered in my previous roles within the health sector. Collaborating with a dedicated team to contribute meaningfully to our profession has been an incredibly rewarding experience. I wholeheartedly encourage anyone intrigued by the prospect of joining our committees, council, and board to contact me next year for further information if you’re interested in being part of this journey. Wishing each of you a safe and relaxing holiday season and I look forward to working together in the new year.

In life, change is inevitable. In business, change is vital. Warren G Bennis

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Speaking for our members

We’re told the pandemic is ‘over’, but - with good reason - AMA(SA) President Dr John Williams, his peers around Australia and colleagues in the South Australian health system have been cautiously advising the benefits of evidence-based measures to minimise the impact of COVID-19 infections. He has advised maintaining vaccinations according to health advice, wearing masks, measuring air quality, getting tested when symptoms appear, and choosing outdoor gatherings where appropriate. In the media and other gatherings he has emphasised that these and the ‘basic’ hygiene measures such as hand washing will both reduce the risk of COVID-19 infection and minimise the spread of other infections and illnesses that can be prevalent over the Christmas period. Meanwhile, the range of issues confronting the AMA in South Australia and around the country continues to be long, diverse and complex. On the following pages, we outline some of the many areas in which Dr Williams and AMA Federal leadership, and AMA(SA) Council, committees and affiliated associations, have sought to bring clinical expertise, counsel and ideas for the long-term benefit of members, the profession and patients in 2023.

AMA(SA) President Dr John Williams and AMA(SA) CEO Ms Nicole Sykes

medicSA | 13

END OF YEAR

In members’ interests AMA(SA) advocacy efforts in 2023 State Budget priorities Dr Williams urged Premier Peter Malinauskas and his government to focus spending in the 2023-24 State budget to fix the crisis in health care. Dr Williams said the State Government must follow the lead set by the Australian Government in its health-heavy Budget and continue the emphasis on health that contributed to its election in March 2022.

clinicians by far the most often-mentioned perpetrators. At the WCH, being bullied by senior medical staff accounted for 83% of the reported cases, followed by QEH (57%), LMH (56%), RAH (51%) and FMC (47%). Dr Cain said the survey showed junior doctors continue to report that: •

workplace issues affect their wellbeing

‘We cannot look past the ongoing code whites and ramping that continue to create system pressures,’ Dr Williams said. ‘Patients continue to wait unacceptably long times for ambulances and then for admission.

•

there are barriers to accessing study leave

•

work rosters prevent them fulfilling training requirements necessary for their progression through their training

‘But ramping remains a symptom, not the cause, of underlying conditions that plague our health system.’

•

Dr Williams said all state governments must work with the Australian Government to increase patient access to primary care. The AMA(SA) called on the State Government to prioritise funding for resources that would: •

keep people out of hospital

•

increase mental health services

•

expand and maintain the health workforce

•

improve rural health services

•

increase Indigenous health services.

Junior doctor workforce The annual Hospital Health Check (HHC) survey continues to reveal unacceptable levels of bullying, harassment and poor working conditions for junior doctors. AMA(SA) Doctors in Training Committee Chair Dr Hayden Cain said the 2023 HHC data showed more than 20% of trainee doctors at each major public hospital reported having been bullied or harassed in the 12 months before they completed the survey. One aspect of serious concern in this year’s HHC was that many junior doctors do not report bullying and harassment because they have concerns about ‘repercussions’ or that ‘nothing will be done’. Dr Williams said it appeared the fear of repercussions was justified, with senior medicSA | 14

•

they are concerned that workplace conditions will affect their ability to finish their fellowships or enter their chosen specialties they are not provided with adequate working and learning spaces.

AMA(SA) is now working with the UniSA Centre for Workplace Excellence, including Professor Michelle Tuckey, to develop a program it is hoped will be trialled in one LHN in early 2024 to improve workplace safety and culture for junior doctors and their colleagues.

wellbeing, and the health system. RevenueSA announced the proposed imposition of a new payroll tax on South Australian GPs in June. In doing so, it joined the Queensland, NSW, Victorian and ACT governments in deciding on a new interpretation of existing payroll tax law. Dr Williams said national calculations indicate a payroll tax on general practice would add as much as hundreds of thousands of dollars a year to operating costs. He said most GPs are contractors, not employees, and the tax has not previously applied. ‘This new, additional cost will wipe out the tiny profit margin most practices maintain,’ he said. ‘Our members – the GPs who kept South Australians alive and businesses operating during COVID-19 – are telling us they can’t survive this extra cost. As many as 30% are considering shutting their doors.’ Dr Williams, CEO Nicole Sykes and AMA(SA) Committee of General Practice Chair Dr Bridget Sawyer have been working with AMA(SA)’s legal and financial partners, Norman Waterhouse and Hood Sweeney, to clarify the implications for private practices.

This government was elected on a platform of reducing ramping and fixing our health crisis. 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.’ AMA(SA) President Dr John Williams

Payroll tax AMA(SA) has warned Treasurer Stephen Mulligan, Health Minister Chris Picton and other politicians that general practitioners will resign and retire, and practices will close across South Australia, if the State Government adds a new payroll tax to their operating expenses.

Minister Picton attended a meeting of the AMA(SA) Committee of General Practice at the AMA(SA) offices in October, hearing first-hand from GPs the impacts the tax will have on patients’ access to primary care. Other meetings have updated the Opposition on the impacts of the interpretation.

Dr Williams said the new cost will cripple general practice, with devastating effects for patients, their health and

This issue will continue to demand significant attention and advocacy in 2024.

END OF YEAR

Immediate Past President Dr Michelle Atchison presenting former Executive Board Chair Dr John Nelson with the AMA(SA) President’s Award at the AMA(SA) Gala Dinner

Pharmacy prescribing

Dr Atchison with Past President Dr Peter Joseph AM at the Life Members ceremony in May

Outline how data will be collected and recorded for evaluation purposes.

A commitment to reversing the decision if adverse outcomes are reported.

Design and implement a health communications campaign for GPs, nurses and pharmacists.

The AMA has been advocating about the risks to patient safety of pharmacy prescribing of UTI medications in many states for more than a year. Now it is South Australia’s turn to challenge this decision, with Minister Picton’s announcement in November that the South Australian Government will allow pharmacists to treat ‘uncomplicated UTIs’.

A sustainable rural workforce

‘This decision, along with experiments in other states, disregard all advice from medical practitioners for the health and safety for women in this state,’ Dr Williams said.

In 2021 the Rural Support Service (RSS) and the then-State Government agreed to a new contract with rural GPs in country hospitals that achieved a more than 20% increase in average pay to rural doctors.

‘Pharmacists are not trained to diagnose UTIs. Mounting evidence in other states indicates women will be prescribed antibiotics for presumed UTIs that are in fact other conditions, including pregnancies, STIs and cancer. ‘We are also extremely concerned that the over-prescribing of antibiotics that has occurred – up to 97% in one evaluation in Queensland – will contribute to antimicrobial resistance.’ In response to a request from Minister Picton to provide recommendations of how the decision should be implemented, Dr Williams reinforced AMA(SA) opposition to the move and submitted criteria he said were ‘mandatory’ if the policy is to be implemented in a scientifically acceptable manner. The AMA(SA) requirements of such a trial are summarised below. 1.

Establish a collaborative model that requires each participating pharmacy to enter a formal agreement of collaboration with a general practitioner or general practice.

Record information in My Health Record.

Keep prescribing and dispensing activity separate to avoid a conflict of interest.

Establish minimum training for pharmacists.

Establish protocols for pharmacists to follow to ensure patient safety and privacy.

as previous governments have been unwilling to support teaching and training,’ Dr Williams said. ‘Our collaboration with RDASA has been extremely important in this process.’

More training for learner motorcyclists In South Australia, the Australian Medical Association (SA)’s Road Safety Committee was involved in the Rider Safe Reforms Stakeholder Information Session, chaired by the Registrar of Motor Vehicles, to improve motorcycle safety. This comes following the death of 18 motorcyclists in South Australia in 2023.

There were significant changes to the structure of these payments to offer an alternative to the traditional fee-forservice. This resulted in a greater number of practices signing a contract with their LHN. It also created an alternative model of engagement to provide an attractive alternative to locum models of care.

The South Australian Department of Infrastructure and Transport is considering enhancing training and assessment, which currently consists of two half-days’ training at its St Agnes facility or a regional facility for a learner’s licence, and an advanced half-day session six months later for the provisional permit.

In 2023 it was time to revisit the contracts. Since early this year AMA(SA) and the Rural Doctors’ Association of SA (RDASA) have been in negotiations with the RSS. As the year comes to an end, the contract has been renewed for an additional four years with an increase in remuneration of about 3%.

AMA(SA) suggested there should be information available about the potential legal consequences of irresponsible riding as many road users are probably unaware penalties may include prison. It also recommended more first-aid instruction and suggested mandating a minimum level of safety equipment for learners and probationary riders.

Dr Williams said it was most significant that there is now a recognition and facility to pay rural doctors to provide supervision and training for junior doctors in the regions.

Poor roadworthiness was emphasised, particularly with learner motorcycles that tend to be traded privately outside dealerships.

‘This is a highly significant step forward

AMA(SA) Vice President A/Prof Peter Subramaniam, President Dr John Williams and CEO Nicole Sykes with Health Minister Chris Picton medicSA | 15

END OF YEAR

The year that was AMA(SA) Road Safety Committee

fter a busy start and then a lull in the middle of the year, due in part to my overseas travel, the activity of the AMA(SA) Road Safety Committee our activity has ramped up again recently with a flurry of activity, particularly in the last few weeks. The statistics demonstrate that our cause remains as urgent as ever, with an increase in the South Australian road toll this year. Sadly, as I write this, 108 people have lost their lives on South Australian roads and 809 people have been seriously injured. This compares to 71 deaths and 652 serious injuries for the full 12 months of 2022. The AMA (SA) Road Safety Committee is the only dedicated road safety committee under the auspices of a state AMA branch in Australia and has been in existence over 20 years. During the year, the Committee has: •

•

met with the RAA to lobby for promotion of protective clothing for motorcyclists provided a submission to the state government Infrastructure Strategy Review, seeking safer infrastructure for all means of transport met with representatives of Optometry Australia to discuss areas of shared concern, particularly assessing fitness to drive

•

written to Transport Minister Tom Koutsantonis expressing our concerns about the possible legalisation of private e-scooters and suggesting measures to help mitigate risks

•

written to Police Minister Joe Szakacs and Regional Roads Minister Geoff Brock about the impact of the poor visibility of road line markings on road safety

•

contributed to the AMA(SA) submission to the South Australian Parliament’s Joint Committee on the Legalisation of Medicinal Cannabis.

Other topics of interest and discussion at our meetings have included: •

measuring and managing the cognitive and physical deficits frequently experienced by older drivers

•

new safety technologies in vehicles and the relatively slow uptake of these in Australia

•

permissible blood alcohol limits while driving, including the evidence for imposing a zero limit in preference to a 0.02 or 0.05 limit.

We are delighted to announced that the Lord Mayor of Adelaide, Dr Jane LomaxSmith recently accepted our invitation to join our committee as the local government representative. We look forward to working with Dr Lomax-Smith next year.

Alex Belperio (left) and Kale Rigano (third from left) of Norman Waterhouse, AMA(SA) CEO Nicole Sykes, RACGP SA Chair Dr Sian Goodson, Lisa Hickey of Hood Sweeney and Dr Williams during an AMA(SA) webinar on the implications of the new payroll tax interpretation medicSA | 16

As the only AMA body focused solely on road safety matters, the committee is now inviting members from other states to join us to expand our perspective and our voice. During a presentation to AMA(SA) Council and in other meetings, including with Doctors in Training Committee members, we reinforced the importance of our work and broadcast again the invitation for AMA(SA) members to join us. Otherwise, the composition of the committee remains unchanged, and apart from me consists of AMA(SA) members Associate Professor Rob Atkinson, Dr Bill Heddle, Dr Peter Ford, Dr Steve Holmes, President Dr John Williams (ex officio) and invited members Associate Professor Jeremy Woolley from the Centre for Automotive Safety Research at the University of Adelaide and experienced road safety consultant Mr Martin Small. I thank all committee members for their involvement and the AMA(SA) Council and Secretariat staff for their continued support. Dr Monika Moy, Chair rsc@amasa.org.au

Immediate Past President Dr Michelle Atchison presents Dr Michael Rice with the AMA(SA) Outstanding Achievement Award at the Gala Dinner

REPORTS

AMA(SA) Doctors in Training Committee

his has been another huge year for the AMA, and that includes the doctors in training (DiTs) of South Australia. We started the year by reviewing Ahpra’s Medical Training Survey (MTS) and using it to generate our Hospital Health Check (HHC). Once again the survey highlighted the plights of junior doctors in South Australia, with rates of bullying and harassment still concerningly high among multiple training and workload issues. Of particular concern were the comparatively low rates of bullying being reported (as opposed to what we believe are the rates of occurrence) in South Australia. This is why the introduction of the Vanderbilt University professional behaviours model at the Royal Adelaide Hospital has been of particular interest to AMA(SA) DiTs. While the Vanderbilt is in its infancy at the RAH, the HHC showed that it may already be having a significant impact on the culture of bullying and reporting. Its

apparent success has led to advocacy for the implementation of evidence-based culture and wellbeing systems at all SA local health networks (LHNs). This also ties in well with South Australia introducing a new psychosocial hazards and risks section to our Work Health and Safety legislation. The ongoing junior doctor crisis has only worsened since last year, causing a significant strain on workload and training for doctors in training in the state. This is best highlighted by the loss of accreditation of the Women’s and Children’s Hospital Neonatal Intensive Care Unit for trainees. Along with advocating for systemic changes the committee has sought positive changes to be implemented with the new WCH’s hospital build. This included campaigning against moving the medical education unit offsite, which would further disadvantage junior doctors requiring support. We also opposed the implementation of open-plan workspaces due to issues with patient privacy and infection control.

Doctors in Training Committee Chair Dr Hayden Cain releases Hospital Health Check data to the media

Next year’s implementation of the Australian Medical Council’s Continued Professional Development (CPD) Homes policy has also been an area of focus. From 2024 all doctors will be required to have CPD Homes to record their 50 hours of compulsory CPD. This affects junior doctors outside the two-year prevocational framework (that also

commences in 2024) who are not yet in an accredited training college. We are working with AMA(SA) on communication strategies to inform South Australian doctors of the requirements. AMA is also the only non-college AMC-approved CPD home, which places it in the unique position of being able to provide varied and personalised support to the heterogenous group of doctors in training. This has given us a great opportunity to work with AMA’s CPD Home to ensure that its version will benefit doctors in training in South Australia. We are very much looking forward to 2024 and the many ongoing avenues of advocacy that we can pursue – from monitoring the efficacy of the Vanderbilt system to following the implementation of the two-year prevocational framework and the deployment of CPD Homes. If any of this work is of interest to you or if there is another burning issue that you are passionate about I strongly encourage you to become involved with the Committee next year and help advocate to make medical training the best it can be for us all. Dr Hayden Cain, Chair ditchair@amasa.org.au

AMA(SA) Committee of General Practice

hree big issues have dominated the work and discussions of the Committee of General Practice (CGP) in 2023: new interpretations of payroll tax, the UTI pharmacy pilot and the establishment of Urgent Care Clinics. AMA(SA) President and CGP member Dr John Williams and I have been active in advocating in each of these areas on behalf of South Australia’s GP community. The committee invited our State Health Minister, Chris Picton, for a face-to-face meeting with us in September. The agenda covered the Urgent Care Clinics, the benefits of the Single Employer Model for attracting and retaining GPs, and other training and recruitment issues. Much time was spent outlining to the Minister the impending impacts of the payroll tax, which we told him threatened the survival of many practices and would lead others to cease bulk-billing patients so they could remain financially viable. We welcomed the opportunity for discussion, which was lengthy and vigorous, and

thank the Minister for taking the time to meet us. Chief Health Officer Dr Michael Cusack attended an online meeting in April. The committee outlined the broad area of expertise of our members, and highlighted specific difficulties in training, access to community care, and the problems with effective communication between public hospitals and GPs. The challenges we face in referring rural patients to non-GP specialists was also discussed. The CGP has provided a review of the Federal aged care initiatives, the claiming of the Medicare item number for practice nurses, and the Clinical Prioritisation Criteria for SA Health outpatients in various specialty areas. We have also been involved in work to improve the templates within the commercial software available to GP practices, in concert with the Australia Digital Health Agency, and I particularly thank Dr Chris Bollen for leading these efforts for us.

I would like to congratulate CGP member and former AMA(SA) Councillor Dr Penny Need, who received the 2023 RACGP GP Supervisor of the Year Award in South Australia. Penny’s efforts to train future GPs and maintain our profile are significant and greatly appreciated. During the year we farewelled from the CGP Dr Laureen Lawlor Smith and Dr Natalie Pink, both of whom are focusing on new adventures. I thank them both for their contributions over the years. The committee will continue to advocate for South Australian GPs in every way we can as we confront the challenges ahead in 2024. Dr Bridget Sawyer, Chair cgp@amasa.org.au medicSA | 17

END OF YEAR

CEO Nicole Sykes leads discussion during the Strategic Planning Day in November

AMA(SA) Council meets in the Dulwich offices in November

Immediate Past President Dr Michelle Atchison (third from left) with new Life Members (from left) Dr John Willoughby OAM, Dr Robert Hall, Dr Michael Kain, Dr Suzanne King, Dr Peter Joseph AM and Dr Ian MacIntosh

AMA(SA) History Committee

n my role as Secretariat officer for the AMA(SA) History Committee, it never ceases to amaze me how much living history can be extracted from our doctors, especially those ‘of a certain age’. They are living, breathing, history books and their combined knowledge, experience and skills should not be underestimated. They may have retired from their practices, their theatres and their hospitals, passed their genetics onto the next generation of doctors, and aged gracefully after a lifetime of helping others, but their commitment to the AMA legacy are astonishing.. The History Committee of the AMA(SA) branch was formed in the 1930s. It went into recession at an unknown date and was revived by a small enthusiastic group in 2007. Ever since the very first brushes with Governor Hindmarsh, what was the British Medical Association, now the Australian Medical Association or AMA, has parlayed with governments as a single and strong voice defending the profession. During 2023, the committee has been busily researching and adding to the historical dossier on the History Committee website. In its current form, the AMA(SA) History medicSA | 18

Committee is a small group including a past AMA(SA) President, an author, Queens Honours medal recipients, a university lecturer, a genealogy specialist and a sexual health expert. In April, the committee met with James Stevens MP, Federal Member for Sturt, to voice its concerns about the government’s funding cuts to TROVE, a most useful resource for Australian historians. In July, Ross Philpot represented the Committee in presenting a paper on prescribing practices over the millennia to audiences at the 18th Biennial Conference ‘Second Opinions’ of the Australian and New Zealand Society of the History of Medicine (ANZSHM), held at the University of Adelaide. Later in the year, the committee met with incoming AMA(SA) President Dr John Williams and CEO Nicole Sykes to discuss its role in the overall work of the AMA and the needs for the coming years. As memories fade, records disappear, and medical lore becomes buried, the importance of recording history cannot be understated. Developing a website, providing advice, preserving artefacts and recording episodes that have shaped AMA(SA) history are the very important

roles undertaken by these distinguished historians. If digitally recording historical events, narratives, biographies, and anecdotes interests you, the medical ‘retirees’ on the History Committee extends an invitation to join them in preserving the history of AMA(SA) for the benefit of all the medical community and in the public interest. Contact the AMA(SA) History Committee at email admin@amasa.org.au, or call (08) 8361 0101, for information about meetings and the work underway. Committee members: •

Dr Tom Turner

•

Dr Peter Joseph AM

•

Dr Peter Kreminski

•

Dr David Evans OAM

•

A/Prof Ross Philpot OAM

•

Mrs Margie Harding. Ms Sharyn Kerr, Administration Officer

REPORTS

Medical Benevolent Association of South Australia

BASA (The Medical Benevolent Association of South Australia) was established in 1881 as an offshoot of the SA branch of the British Medical Association. MBASA’s original constitution stated that ‘the objects of the association be to relieve distress occurring in the families of medical men practising in the colony of South Australia; and to aid in educating and bringing up their children; and to form bursaries and for the assistance of medical students, the sons of medical men. Claimants who are the sons of subscribers shall have precedence’. While the wording has changed, the basic premise persists. MBASA’s current constitution states that the objects of the association are ‘to assist medical practitioners who practise, or in the opinion of the Board have previously practised, predominantly in South Australia who are suffering financial hardship due to mental or physical disability or infirmity’ and ‘to assist spouses and/or children who are suffering

financial hardship due to the mental or physical disability, infirmity or death of a medical practitioner who has practised predominantly in South Australia’.. MBASA maintains its close relationship with AMA(SA), which provides secretarial support and financial management of the MBASA records. Our Board of Trustees consists of medical practitioners, former Presidents and members of AMA(SA) who offer specific expertise and experience. Trustees tend to be long serving – there have been only 10 chairs in the Board’s 141 years. MBASA is a charitable not-for-profit organisation. Its financial viability and ability to provide assistance depends on donations from individual medical practitioners and organisations. In the past decade MBASA has been particularly grateful for the financial support of the Chinese Medical Association of SA and Avant Medical. The trustees ask that all medical practitioners consider donating to help their colleagues and their families in need.

To make donations, request help, or request more information, MBASA can be contacted by email at mbasa@ amasa.org.au or by calling AMA(SA). The MBASA Board of Trustees comprises: •

Dr Jill Maxwell OAM (Chair)

•

Dr Michael Rice AM (Immediate Past Chair)

•

Dr John Wyett

•

Dr Rodney Pearce AM

•

Dr Janice Fletcher AM

•

Dr Peter Ford AM

•

Dr William Heddle AM

•

Dr Peter Joseph AM

•

Dr Patricia Montanaro

•

Dr Roger Sexton. Dr Jill Maxwell OAM, Chair

Past Presidents Dr Chris Moy, Dr Jill Maxwell, Dr Michelle Atchison, Dr Peter Joseph, Dr Peter Ford and A/Prof William Tam at the Strategic Planning Day

South Australia Indian Medical Association

he 2023 calendar year has been a successful, productive, and exciting year for the South Australian Indian Medical Association (SAIMA). As the year draws to a close, we can reflect on the many successful SAIMA traditions and activities. The highlight of the 2023 SAIMA year was the Annual Scientific Meeting and Charity Gala Dinner, which had a large turnout from all parts of the Indian medical and allied health community. The day involved key educational topics that helped improve knowledge and skills, while the night was filled with entertainment and excitement at the Adelaide Convention Centre. The event also made a positive contribution to Make a Wish Foundation, supporting a local charity that makes a difference to our community. We were focused on providing our

members more opportunities to socialise and network, with key sporting and social events held throughout the year to allow SAIMA members to stay active while socialising and mingling with peers. In September and October we organised and had teams in the City to Bay Fun Run and the inaugural Inter-association Badminton Tournament, competing with members from the Chinese, Pakistani and Sri Lankan Medical Associations in South Australia. We at SAIMA continued delivering relevant and engaging educational events in 2023, with multiple educational meets useful for various specialities and general practitioners organised, with topics including musculoskeletal medicine and dementia, some of which are the most common presentations seen by doctors. As we grow as an organisation into 2024, we are striving to provide advocacy, and

support, and engaging activities for our members, while also aiming to improve our representation of Indian junior doctor and medical students in this state. After our recent AGM, the SAIMA committee has a great mix of experience, knowledge and new ideas that will hold us in good stead to bring on new networking events, become an inviting space for new members to join and provide a voice to Indian doctors and health professionals. I thank the SAIMA committee for its tireless work this year and thank all our members and sponsors for their ongoing support. Dr Seshu Boda, Past President medicSA | 19

END OF YEAR

DREAMIN Foundation

REAMIN helped to fund Darlene Kafa, a nurse from Tonga, to attend the Asia Oceania ENT meeting in Brisbane in March this year. This large international meeting included a session on healthcare in lower and middle-income countries. Darlene is a senior nurse in Tonga, has had training in China, and is the coordinator of the ENT teaching program for the Pacific Islands which I lead on Sunday afternoons. DREAMIN contributed $3,000 to Darlene’s airfare, accommodation and expenses for the convention, with her registration costs met by the Australian Society of Otolaryngology Head and Neck Surgery. The World Health Organization has identified an urgent need for ENT surgeons in the Pacific. I was funded by the Department of Foreign Affairs and Trade to fly to Tonga where I saw 90 patients and performed 30 operations. I also met with the Assistant High Commissioner and reported that the IMF has allocated $20 million to help with infrastructure, especially for ear health. DREAMIN is planning the PACIFICA ENT project, which hopes to provide sustainable training for ENT surgeons in the Pacific.

The Foundation's work with Maranatha Health in Uganda continues to gain the attention of our supporters and this year we have contributed to a new truck, medical staff, and equipment. We look forward to supporting their projects into the future. We have continued our support and partnership with Adelaide Paediatrics to fund autism spectrum disorder (ASD) screening for young children and their families. Unfortunately, there are sometimes long waiting lists in the public sector and a specialist diagnosis is required before accessing NDIS funding for children’s therapy and support. DREAMIN Foundation is pleased to have been able to support another 12 families to undergo assessment and opening the door for life-changing therapy for these children. We are also in consultation with Royal Lifesaving SA regarding funding for an inclusive swim program for some of these children. Unfortunately, for the second year in succession we did not stage the DREAMIN Foundation Adelaide Cup Day function, but we did hold a raffle with more than $5,000 worth of prizes. The DREAMIN

Foundation was also the featured charity at the Australian Medical Association (SA) Gala Ball on 20 May 2023 at the Adelaide Town Hall. DREAMIN is an acronym for the Dean Richards Endeavour to Assist the Medically Ill and Needy. It honours the memory of the late Dean Richards, a stalwart of the Rotary Club of Prospect. It was founded in 2003 and supports appropriate medical intervention services for people in need in South Australia, Australia and developing countries. We rely on the generosity of members of the Prospect Rotary Club, associated medical professionals and members of the DREAMIN Foundation to raise muchneeded funds to continue our valuable work. If you would like to donate, please go to dreamin.org.au or find us on Facebook. Professor Suren Krishnan, Chair

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 medicSA | 20

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

SA MEMBERS OF AMA FEDERAL COUNCIL

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

NEWS

Council news November 2023

he shocking road toll and the impact of road trauma on the health system were the themes of a presentation from AMA(SA) Road Safety Committee Chair Dr Monika Moy at the November meeting of the AMA(SA) Council. Dr Moy outlined recent advocacy of the Committee, which is the only one of its type established within the federal and state branches of the AMA and which for more than 20 years has been campaigning for the greater use of technology, road maintenance measures and other tools. She noted that traffic incidents are the leading cause of death in children and teenagers in Australia, and said much could be done with more funding for safer road infrastructure design and maintenance. Whether people with legal prescriptions for medicinal cannabis should be permitted to drive is one question the committee has pondered this year, Dr Moy said. She said the committee had submitted its evidence-based position – that is, that there is no clear evidence that

December 2023

MA(SA) President Dr John Williams provided Council members with an update on AMA(SA) advocacy, starting with the UTI pharmacy prescribing trial treatment, which he said was being rolled out despite no support from any medical body. He said AMA(SA) will push for improved patient safety, governance and proper collection of data during the rollout so outcomes can be evaluated and it can be demonstrated whether or not it is doing harm. Dr Williams reported that he and CEO Nicole Sykes recently met with Chief Public Health Officer Professor Nicola Spurrier and SA Health’s Climate Change Lead Dr Kimberly Humphrey to discuss how AMA(SA) and SA Health can work together on initiatives related to the impact of health of climate change, and climate change on health, and the appropriate use of resources.

it is safe, so that the Committee cannot support the concept – as a contribution to a statement being prepared for AMA(SA) President Dr John Williams to present to the Joint Committee on the Legalisation of Medicinal Cannabis in early December. (The Joint Committee has since postponed this presentation until early 2024.) The Road Safety Committee has also considered the increased use and availability of e-scooters and the impact on emergency department presentations. Dr Moy said the committee had provided recommendations to the State Government about the need for designated infrastructure for e-scooters that will protect all road and footpath users, including pedestrians. In her report to Council CEO Nicole Sykes informed Council of the plans for the Strategic Planning Day on 4 November and the continuation of the constitutional review. She also noted the impending move of the Secretariat into smaller quarters within the Dulwich offices. Ms Sykes said she is aware of support among members and the profession for Dr Williams in his efforts to challenge the State Government’s new interpretation of

At the time of writing, the SA Health rural GP agreement is about to be finalised, following successful negotiations between AMA(SA), the Rural Doctors’ Association of SA and SA Health’s Rural Support Service. Input from all parties has ensured it will provide a fair deal for rural GPs and registrars in terms of recognition, renumeration and support. The ‘single employer model’ discussions with Rural Support Service are continuing; AMA(SA) is pleased to be able to use its connections and influence to bring parties together to facilitate the process and address issues related to implementing the model in different regional areas. Interpreting the new payroll tax requirements is an unresolved challenge for many private medical practices. The Council’s discussion focused on possible strategies for obtaining exemptions and raising public awareness about the impact the tax will have on patients, primary care, staffing, practices, ramping and emergency departments. This discussion will continue at the first meeting in 2024.

payroll tax, which Dr Williams told Council continues to be a major issue for GPs. Ms Sykes reminded Council of the importance of the AMA’s CPD Home – the AMA version of a new Ahpra-mandated online repository for storing CPD requirements – in recruiting new members, particularly among junior doctor groups. Dr Williams said he continues to work with of the Rural Doctors’ Association of South Australia, and with the support of the federal AMA industrial team, to negotiate the next contract for the state’s rural generalists. He reported that a submission from Rural Support Services has gone to Cabinet, and he is optimistic there will be an agreement in place before the current contract expires in early 2024. Council discussed issues that emerge when the electronic referral systems linking GPs and private specialists do not ‘talk’ to each other. Members discussed issues of privacy, duplicate referrals, how the health link works, which systems talk to each other, the differences in the public health system, and pros and cons of various systems.

Councillors expressed ongoing concern about the inequities in the health system and the ramping situation. All agreed there needs to be much more research into the drivers of ramping. Dr Bridget Sawyer, a member of the state government’s SA Health Ramping Taskforce, asked Councillors to provide any ideas and comments to her for discussion by that committee. Following the Strategic Planning Day held in early November, member recruitment and retention will now be a regular discussion item for Council. Council Chair Dr Hannah Szewczyk and Dr Williams thanked all Councillors for their ongoing commitment and hard work during the year and wished everyone a safe and restful break.

medicSA | 21

END OF YEAR

A strong voice for members The Federal AMA continued its broad advocacy efforts during the final months of another busy year, under the leadership of President Professor Steve Robson and Vice President Dr Danielle McMullen. Telehealth recommendations will affect access to healthcare

he AMA has suggested a draft recommendation to remove Medicare funding for initial telehealth consultations with non-GP specialists is outdated thinking and will seriously limit access to essential healthcare. The Medicare Benefits Schedule Review Advisory Committees (MRAC) is consulting on recommendations as part of a review of Medicare funded telehealth services. Professor Steve Robson said there were serious concerns within the profession about the proposed removal of funding for an initial consultation with a specialist. ‘Removing this funding will make it more difficult for patients to access healthcare in a timely fashion, while some patients will have to travel hundreds of kilometres to see a specialist,’ he said. ‘These services already require a referral from a GP with accompanying information about a patient’s condition and any decision on whether a specialist consultation should be face-to-face or via telehealth should be a clinical one. ‘The benefits of telehealth can’t be ignored. The AMA’s Health is the Best Investment report found the estimated benefit of telehealth from reduced travel in 2021–22 was $1.35 billion, and that further integration of telehealth across the whole health system could save up to around $14 billion each year.’

Ramping scorecard reveals dire SA situation

Prof Robson said the data shows ramping is worsening in most jurisdictions. ‘Behind every number and every statistic, there is a harrowing personal tale of a patient forced to wait far too long just to be transferred from an ambulance to the ED,’ Prof Robson said. ‘This issue continues to dominate news headlines every day. Patients, doctors, paramedics and hospital staff all deserve decisive action from governments to address ramping, ED overcrowding and hospital logjams.’ The report card shows South Australia is one of the worst performing states, with just 42.9% of patients transferred within 30 minutes in 2021–22 – significantly short of its 90% target. Prof Robson said measures used to report on ambulance ramping differ between jurisdictions, making it incredibly difficult to determine the true scale of the issue at a national level. ‘The haphazard and inconsistent way states and territories report on ambulance ramping data hinders national efforts to improve public hospitals and healthcare across Australia,’ said Prof Robson. Through the Clear the Hospital Logjam campaign, the AMA continues to call for an urgent injection of funds to address the current logjam and, in the longer term, reform to the National Hospital Funding Agreement to include a 50–50 funding split between the states and territories and the federal government. Funding to expand hospital capacity and funding for performance are also needed.

Legalising cannabis too risky

The AMA's 2023 Ambulance Ramping Report Card, which remains the only national snapshot of ambulance ramping in Australia, lays bare the grim state of the country's public hospital system and exposes the concerning lack of data transparency.

In a submission to the Senate Legal and Constitutional Affairs Committee examining the Bill, the AMA said any increase in cannabis use could also lead to ill-health for more Australians and impacts on Australia’s health system.

mbulance ramping continues to put the lives of Australian patients at risk, as a new AMA report card reveals all states and territories are failing to meet their performance targets.

medicSA | 22

proposed bill to legalise cannabis for recreational use must be shelved to prevent more people from using the drug and impacting the health system, the AMA has warned.

‘Legalising cannabis for recreational

purposes sends the wrong signal to the public, and especially to young Australians, that cannabis use is not harmful,’ Prof Robson said. In relation to medicinal cannabis, he said that for most conditions, there will be more evidence-based treatments available through a doctor or allied health professional that patients should explore before self-medicating on cannabis products. Prof Robson said Australians are already suffering detrimental health outcomes caused by recreational cannabis use, including anxiety, panic attacks, paranoia, memory loss and an increased incidence of schizophrenia, as well as bronchitis or cancer, cardiovascular system damage, and impaired reaction time and brain function. The submission says that while cannabis use should not be legalised, the current approach to cannabis regulation could be improved. ‘Cannabis use should be treated as a health issue, not a criminal issue,’ Prof Robson said. Harm reduction measures should instead be used such as court orders requiring counselling and education, or attendance at ‘drug courts’ which divert users from the criminal justice system into treatment.

Safe hours audit to look at doctors’ risk of fatigue in public hospitals

he AMA launched its 2023 Safe Hours Audit to examine the risk of fatigue among public hospital doctors.

Prof Robson said public hospitals doctors had suffered enormous strain over the pandemic years and were now dealing with the impacts of the hospital logjam. ‘We know that inadequate resourcing of our public hospitals is placing the system under incredible stress,’ Prof Robson said. ‘That stress is evident in story after story across the country about ambulance ramping and patients waiting years and years for necessary surgery because hospitals just can’t meet demand. ‘All of this combined means our public hospital doctors are under intense pressure.’

ADVOCACY

The AMA has run the Safe Hours Audit regularly since 2001 to gather data on how many hours public hospital doctors are working over the course of a week and determine the fatigue risks of current working arrangements. The last AMA Safe Hours Audit in 2016 found 53% of doctors were working rosters that put them at significant and higher risk of fatigue to the extent that it could impair performance and affect the health of the doctor and the safety of the patient. It confirmed that doctors at higher risk of fatigue typically work longer hours, longer shifts, have more days on call, less days off and are more likely to skip a meal break. ‘We know that fatigue and medical care don’t mix,’ Prof Robson said. ‘Fatigue can impair judgement and work performance, and potentially affect patient care and the wellbeing of doctors. We know that serious medical errors increase with frequent long shifts and that extended shifts have a similar effect to working under the influence of alcohol.’

Medicare bulk billing

he Australian Medical Association welcomes significant increases to Medicare bulk billing incentives that provide much needed cost-of-living relief for millions of Australians. AMA Vice President Dr Danielle McMullen said the decision to triple the bulk billing incentive for most standard GP consultations, announced in the May budget, was evidence of the government’s real commitment to providing more support for patients who need to see a GP.

federal budget designed to reform and support general practice. ‘But we know more work can be done. We will continue working with the government on developing new programs and initiatives that strengthen primary care and ensure GP-led care is affordable and accessible for all patients.’ Dr McMullen said increasing the bulk-billing incentives would provide vital funding support for general practice after years of neglect from successive governments. She encouraged all practices to ensure their software systems are up to date as the AMA continues to work with the Health Department to ensure a smooth rollout of the increased incentives.

AMA and private healthcare leaders call for reform

rivate health sector leaders and the AMA have agreed on the need to reform the health system, including out-of-hospital care models. Prof Robson told a workshop that while the private health system is a key pillar of the health system, reforms are needed to make the system more sustainable. He said the AMA’s recent research report on out-of-hospital care demonstrated the fragmented and complex nature of the system — a system in which some patients were disadvantaged and didn’t have the same access to new and effective models of care.

‘The AMA campaigned strongly for this extra funding, and we are pleased the federal government is taking a positive step towards investing in general practice to improve access to care,’ Dr McMullen said.

‘Our report showed that while some hospitals and insurers provide out-ofhospital care, it is not universal, and therefore not available to all patients, and doesn’t always involve shared decision making. For those who do have access, their clinician isn’t always involved. One of the reasons for this is that regulation and legislation are complex, and don’t encourage or support these new models of care.

‘This significant investment, equalling $3.5 billion over five years, is the starting point for improving the sustainability of general practice in Australia and was part of a significant package of measures in the

‘Regardless of who a patient is insured with, they should have access to these great models. But we don’t have consistency in product design, models, or financial arrangements.’

The workshop generated wide-ranging debate on the most pressing issues facing the system, the barriers to reform and opportunities for change. The outcomes of the workshop will inform the AMA’s ongoing advocacy to government on private health reform.

AMA pushes for better medical workforce planning Australia needs an independently funded health workforce planning agency to overcome the boom-bust approach to medical workforce planning, the AMA says. The AMA has written to Health Minister Mark Butler saying such an agency would provide robust advice on how many doctors Australia needs and the necessary reforms to support these doctors to work in the locations and specialties where they are most needed. The AMA released its new position statement on Commonwealth Supported Places (CSPs) and Medical Workforce Supply and Distribution, which also calls for taxpayer-funded medical school CSPs to be allocated and distributed according to community and workforce need. Prof Robson said while the number of medical students had massively increased in Australia, Australia’s medical workforce was still unevenly distributed, with oversupply in some specialities and locations and undersupply in others. ‘We need to see the recommendations of the National Medical Workforce Strategy implemented, and these include the creation of an independent health workforce planning and analysis agency,’ he said.

medicSA | 23

END OF YEAR

Our voice, our influence As the one national body representing all doctors, the AMA has achieved important advocacy success in 2023.

Single employer model for GP registrars

he AMA welcomed the Commonwealth’s announcement of single employer model pilots for GP registrars across Australia to encourage trainees to establish life-long careers in general practice. The AMA has been a strong advocate for a single employer model to provide GP registrars with wages and conditions comparable with doctors training in other specialty areas in public hospitals.

Private health

he final reports on the private health policy reforms were released by the Department of Health and Aged Care in June. The reviews, including recommendations on changes to the Medicare Levy Surcharge and premium rebate, were in response to the AMA’s call for reform in the 2020 Prescription for Private Health.

Budget 2023

he federal government earmarked billions of dollars for primary care and a host of reforms in this year’s federal budget that stemmed from the AMA’s campaign to Modernise Medicare. This included $3.5 billion to triple bulk billing incentive payments on specified GP consultation items from 1 November, with scaling applied to further benefit patients in rural areas. Member surveys showed strong support for this change. My Medicare was announced, providing a mechanism to strengthen the usual GP relationship and a platform to deliver additional funding for general practice in addition to fee for service arrangements. The Budget also contained $50 million for a wounds consumable scheme in general practice, which the AMA had first proposed in submissions to the MBS Review Taskforce, and delivered on other medicSA | 24

AMA campaign and policy recommendations, including: •

a longer GP consult item

•

a Workforce Incentive Payment increase

•

expanded telehealth access for My Medicare-enrolled patients and practices

•

funding for out-of-hospital care by GPs

•

more support for GPs visiting aged care facilities.

Supporting patients of GPs and non-GP specialists alike, the budget also included an additional round of Medicare indexation and a new indexation methodology. This followed the AMA demonstrating the ongoing impact of poor indexation on out-of-pocket costs for patients.

Medicines and Medicare

he AMA intervened to ensure the 24/7 telehealth support for MS 2-Step from MSI to Healthdirect included appropriate training and support for Healthdirect nurses. GPs are now allowed to prescribe ivermectin off-label again after the AMA’s submission to the Therapeutic Goods Administration (TGA). The AMA intervened with the Department of Health and Aged Care to fix the undervaluing of new dermatology items. On 1 March, the rebates for seven items for excisions of clinically suspected melanoma (31377 to 31383) were increased to align with the fees for existing benign skin excision items.

Aged care

n February, plans to privatise Aged Care Assessment Services Teams (ACATs) were dumped following significant advocacy by the AMA. The AMA has been the only organisation continuously speaking against the proposal since it was first introduced in 2019.

In response to a strong submission and direct engagement from the AMA, the Department of Health and Aged Care has amended its dementia action plan to no longer recommend additional training for GPs or for MBS items to be accessible only to GPs with a sub-specialisation in dementia.

60-day dispensing

ollowing years of advocacy by the Federal AMA, 60-day dispensing has now been introduced. The AMA launched a renewed campaign on 60-day dispensing early in the year through a coordinated ‘Checklist for Cheaper Medicines’ campaign. The AMA urged that it makes sense to make these medications more affordable for the many thousands of Australians who take them, while also easing pressure on the health system. By making medications more affordable, patients will be more likely to get their prescriptions filled and take these medications as required. Better medication compliance keeps people well and lightens the load on our health system, particularly our hospitals. ‘From a workforce perspective, the policy means fewer visits to a GP, freeing up appointments for other patients and supporting GPs to spend more time with patients who have more complex health care needs,’ the AMA argued.

Privacy Act

MA advocacy on proposed changes to the Privacy Act resulted in significant improvements to the proposed amendments to the Act. Through multiple submissions to the Attorney-General’s department, and direct lobbying, the AMA was able to remove amendments that would have: •

limited the ability to conduct health research

•

removed a child’s capacity to consent

ADVOCACY

•

a requirement to obtain parental consent for all persons under 16

•

increase privacy burdens on smaller practices.

Tobacco and vaping

tronger regulations on vapes were announced following AMA advocacy, including banning the retail sale of vapes and disposable vapes. Vaping reforms underway (as outlined in consultation in January and September) include changes the AMA has lobbied for since October 2021. These

include changes to Therapeutic Goods Order 110 and ending the personal importation scheme. AMA policies were also reflected in the National Tobacco Strategy 2023-2030. The strategy also reflects the AMA’s concerns with tobacco industry donations to political parties. Vaping advertisement bans along with improved regulation on tobacco to discourage people from smoking and vaping were introduced to Parliament under the Public Health (Tobacco and Other Products) Bill 2023. The AMA supported the Bill through both the

Department of Health and Aged Care’s consultation and through the Senate Standing Committees on Community Affairs inquiry.

Gambling

he AMA has consistently raised concerns about gambling and the extent to which young people are exposed. The Australian government announced in August that it will introduce new minimum classifications for video games that contain gambling-like content, a move the AMA has advocated for.

Federal AMA Vice-President Dr Danielle McMullen and President Professor Steve Robson medicSA | 25

ADVOCACY

The challenge of vaping Vaping is the new smoking, writes AMA Public Health Committee Chair Dr Michael Bonning.

icotine use in Australia has been progressively declining for decades, but governments were caught napping at the wheel as another threat came hurtling towards us: vaping.

The popularity of vaping among young people continues to surge while big tobacco companies rub their hands together with glee. These predatory companies have shown a complete disregard of public health interests by orchestrating an insidious campaign to make massive profits from a new generation of nicotine users. Australia has been waging a protracted, but ultimately successful, battle to reduce the rates of cigarette smoking, but now vaping is threatening to undo some of that good work. Since the rise of vaping, we have seen — for the first time in 25 years — an increase in smoking rates, with a three-fold increase in smoking by 14-17-year-olds in just four years. Thankfully, significant vaping reforms are moving quickly, largely because of federal AMA advocacy and tireless stakeholder collaboration. There is an increase in reliable evidence that vapes cause harm and are not safe or effective smoking cessation tools. Vaping is the new smoking. In early 2023, 8.9 per cent of Australians aged 14 and over were current vapers and 11.8 per cent were current smokers. While exclusive smoking was trending downwards in the year with a stable prevalence over time, exclusive vaping and the dual use of smoking and vaping was trending upwards, particularly in people aged under 35. These trends align with the evidence that vaping triples the likelihood of taking up conventional smoking, making it a gateway to smoking. Known acute health effects of e-cigarettes include seizures, nicotine poisoning and associated brain development issues for younger people, e-cigarette or vaping-associated lung injury, burns, cough, dizziness and nausea. As this is a relatively new product, long-term effects are not yet known. The National Health and Medical Research Council reports there are more than 200 chemicals in vapes. Some of them are also used in nail polish remover, weed killer and insecticide. Some are known carcinogens and can damage DNA. We are seeing an increase in vape-related calls to the Australian Poisons Information Centre, most of which are related to children and adolescents. Strong vaping regulation in Australia has been muddied by the tobacco and vaping industry, which spreads misinformation and intentionally markets products towards children and younger people. Vapes come in a wide variety of flavours, such as different fruits, lollies and desserts. Vape packaging is bright and colourful and can even resemble popular juice boxes or lollies. The manufacturers and distributors claim their products are therapeutic and aim to help people quit smoking. Yet none have registered their products on the Australian Register of Therapeutic Goods, which would allow proper evaluation of safety and efficacy and would not have required the complicated reforms we are working through now. These companies are still allowed to donate to political parties, clearly compromising government policy on public health matters. In October, I spoke about this issue and the Federal AMA’s concerns about vaping advertisements and sales at the Senate Community Affairs References Committee hearing into medicSA | 26

the Public Health (Tobacco and Other Products) Bill 2023. This Bill includes important tobacco control reforms and prohibits vaping advertisements in line with cigarette restrictions. However, it is disappointing to see the Bill does not prohibit political donations. Currently, vaping regulation is complicated and not well enforced, making it easy for people (particularly younger people) to access them. Nicotine-containing vapes are only legally available via prescription, but because people can personally import them with a prescription from overseas, it is incredibly hard to ensure they meet the standards of the Therapeutic Goods Administration (TGA). This personal importation scheme also makes enforcement much more complicated at the borders, facilitating black market supply.

Labelling misleads consumers Meanwhile, vapes labelled as non-nicotine are legally sold over the counter or online to those over the age of 18. However, most vapes include nicotine, even when they are labelled otherwise. When Border Force and the TGA seized 35 tons (yes, tons) of vapes in a joint operation, 85% were found to be falsely labeled as nicotine-free. This labelling deliberately misleads consumers, potentially causing new nicotine addiction. Sales regulation is the responsibility of the states and territories, but it is not well enforced. Some states, such as NSW, have ramped up their enforcement measures, while others are not doing enough. Online, vapes are marketed and purchased via social media platforms. This year, the AMA and the Australian Council on Smoking and Health awarded British American Tobacco the Dirty Ashtray Award for initiating and financing a pro-vaping astroturf campaign. The inaugural Exploding Vape Award was presented to Meta — the owner of Facebook, Instagram, Threads and WhatsApp — for failing to enforce its own policy, which is supposed to ban the promotion of tobacco or nicotine products on its platforms. Thankfully, in May, Health Minister Mark Butler announced a suite of vaping reforms, including a retail ban on all vapes, an importation ban and a ban on single-use vapes. For prescription vapes, the TGA will be tightening the minimum quality standards, including implementing pharmaceutical-like packaging, restricting flavours, ingredients and colours, and reducing nicotine concentrations and volumes. These announcements align well with Federal AMA advocacy, and we eagerly await their implementation. Also, in October, I met with the head of the TGA to support its actions on vaping and be briefed on new developments. We cannot make the same mistakes we made with conventional cigarettes. We need a unified strategy across all jurisdictions to tackle the rise in nicotine addiction from vapes. This includes urgently implementing the vaping reforms, particularly ensuring the prescription-only model is consistent in all jurisdictions. We must also remain vigilant against the threat of smoking. The AMA Public Health Committee will continue monitoring this issue and advocate to prevent future generations becoming addicted to nicotine. Dr Michael Bonning is a GP and President of AMA NSW

RESEARCH

New GP role in managing addiction Targeted questions can help GPs elicit important information to help patients with suspected gambling problems.

ith gambling losses rapidly increasing along with predatory advertising from gambling platforms, a routine question from a GP to their patients could be a lifesaver, says the Head of Psychiatry at Flinders University, Professor Malcolm Battersby. A recent study of sports betting by the Statewide Gambling Therapy Service found the question ‘how does gambling affect your mood’ was the most effective way of opening a discussion about gambling without the person feeling judged. A social media campaign that tested a number of questions designed to engage people in the early stages of gambling gained 90,000 impressions, 91 clicks and enrolled 32 people – a quarter of whom were identified as being in the early stages of a gambling problem. ‘We had to trial words to get people to click and we found the most effective words were “Is gambling affecting your mood?” That’s what worked,’ says Prof Battersby. ‘It would be very helpful for GPs to include gambling in routine questions about alcohol and drugs… You might say: “I always ask these three questions to everybody”. ‘When it comes to gambling, ask “do you occasionally gamble?”. If they answer yes, rather than asking “how much do you gamble”, ask “have you noticed that gambling affects your mood?”.’ Prof Battersby recommends following with a question asking if they have had an issue with gambling in the past 12 months, which he says has 92% sensitivity to gambling problems. He also recommends GPs ask if the person notices that sometimes they have an ‘urge to gamble’, which ‘is not blaming the person for being weak’. If a patient responds yes to any of these questions, clinicians could refer them to free services. In Australia, gambling – particularly online gambling – is increasing exponentially, especially since COVID-19, and while advocacy groups have attempted to dilute the impact of advertising with ads warning that gamblers are likely to lose, the evidence suggests this has limited impact. The latest advertisements about multi-bets are clearly focusing on the social aspects of gambling, targeting young men who are most likely to gamble online. ‘The whole social thing is that it doesn’t matter where the young person is; they could be on a date with their girlfriend or boyfriend and they can still be on the phone gambling,’ says Prof Battersby. A 2023 report by the Australian Gambling Research Centre estimates that Australians lose approximately $25 billion on legal forms of gambling each year, representing the largest per capita losses in the world. The rates of problem gambling in online users are higher than average at 3.9% of all online gamblers, according to a report from Central Queensland University.

For another group who are gambling quite a lot but losing, they’ll offer them free bets,’ Prof Battersby says. It’s the growing number of stories like this that has prompted governments around Australia to again explore ways to regulate gambling. A 2023 Senate Report into gambling has recommended a suite of measures including stronger consumer protections from licensed online gambling. The most important of these is to eliminate all forms of advertising for on-line gambling. ‘The other new worrying development is that gaming and gambling are now inextricably linked,’ Prof Battersby says. ‘Gaming companies have introduced gambling in games so you can pay for higher level icons or levels within the game.’ These types of strategies are also employed in children’s games, he says. It’s good for GPs to know about a Children and Media Watchlist that flags games are safe or that can lure children into gambling, says Profr Battersby. The good news is that gambling addictions can be treated, especially in the early stages, and there is a range of free resources for people seeking to regulate their gambling behaviour. ‘It only takes two to four months of treatment to turn around a gambling addiction. We use graded exposure to the gambling urge and cognitive therapy,’ he says. He cites as the most positive response to the gambling epidemic the Australian government’s Betstop, where gamblers can register to have themselves blocked from all phone or on-line gambling providers.

New study seeking participants A new study by the Statewide Gambling Service led by Dr Ben Riley uses a family intervention model to support families seeking help for their heavy gambler, recognising that fewer than 10% of gamblers seek help. Dr Riley is seeking family members to participate in this research; potential participants can find more information on the website or contact Dr Riley at ben.riley@sa.gov.au.

Resources •

The Statewide Gambling Therapy Service provides free face to face and telehealth (phone or video) assessment and treatment for the whole of South Australia.

•

There are also Gambling Help services and the Gambling Helpline on 1800 858 858.

In addition, whistleblowers have noted that gambling companies are predatory. ‘If someone looks like they are winning, they reduce their odds. Eventually if they keep on winning, they’ll stop them from betting. medicSA | 27

Return to Work scheme 2022-23

61,420

48,550 11,560

Employers insured with Return To Work scheme

$704M

employers

Small

Medium

25,320

Premiums charged

employers

Large

12,910 new claims

12,410

Total claims managed

2,566

1,310

claims still open from previous years

Whole Person Impairment (WPI) assessments* approved

*NIHL WPI data not available at the time of this publication due to a change in the method of recording data

12.3% Average WPI

Return to work rates 2022-23 Fully and partially return to work

4 weeks

13 weeks

26 weeks

103 weeks

83.2%

91.9%

94.7%

95.8%

$8.2M

$6.9M

$50M

Medical practitioners services and supplies

Surgery and procedures

$8.6M

GP attendances

Diagnostic imaging services

$3.9M

Specialist attendances

www.rtwsa.com Top 4 injuries by accepted claims 4,451

1,812

Traumatic joint, ligament and muscle / tendon injury

Musculoskeletal and connective tissues diseases

2,637

1,202

Wounds, lacerations, amputations and internal organ damage

Hearing loss

323

Psychological claims

Top 4 occupations by accepted claims

Top 4 industries by accepted claims

2,602 Manufacturing 2,267

3,527 Labourers

Technicians and

2,126

1,418

Construction

1,605 Wholesale/retail

Machinery operators and drivers

1,340 Health/social care

3,490

trade workers

Community and personal service workers

Mobile claims managers

140

Mobile claims managers

22,614 Mobile claims manager visits

1,884 Average visits per month

ADVOCACY

Doing more with what we have

We all have roles to play in limiting the costs of healthcare, writes AMA(SA) Vice President and vascular surgeon A/Prof Peter Subramaniam.

erspectives in healthcare design, planning, funding, administration and delivery are contextual and depend on where one sits in the supply chain, from design to frontline delivery. Organisations like the AMA advocate with particular perspectives. We respond to concerns about challenges such as ramping, safe-working hours, or challenges for the rural patient or the rural GP. Our motivation and purpose are to improve healthcare delivery within the system we use to provide care to our patients while supporting our colleagues. Yet it may be the system itself that creates some of what often seem impossible challenges. The Australian healthcare system is complex. It is a hybrid of primary and specialist care, private and public-funded services, with a complex mix of funding arrangements between federal and state. At 10% of GDP, healthcare spending in Australia rates in the top 10 of OECD countries. The cost of healthcare delivery is on the rise – and with it, the total spending on healthcare. Australia spent an estimated $241.3 billion on health goods and services in 2021-22 – an average of $9,365 for each person. The real growth (adjusted for inflation) in total health spending (recurrent and capital) was 6.0% more than in 2020-21. Current estimates that this trend is likely to increase exponentially are not challenged. In its most basic definition, price is the amount a buyer pays a seller in exchange for goods or services. Where the goods or services can be obtained without the purchaser or user providing remuneration, an indication of the price or cost of the purchased product can still provide information of the value of the goods or service obtained. While it can be argued that price or cost is not always a signal of value in healthcare, this information or signal makes transparent what is not obvious in health service delivery in our system – the high cost of healthcare. Healthcare is far from being a classic market for goods and services in Australia. The consumer is represented by a purchasing agent (governments and/or health insurers or other third parties) and generally do not operate within the market themselves (with some exceptions). As a consequence, in Australia, consumers (patients) do not generally need or have access to information outlining the cost of care.

Cost as a signal But cost is an important signal to the provider or funder, given that cost determines the level of financial resources required to deliver healthcare services. As recently as 2015, United Nations member states reiterated their commitment to universal health coverage (UHC) so that all people have access to quality healthcare without exposure to financial hardship. The interpretation that ‘without exposure to financial hardship’ is synonymous to ‘without contribution to costs’ is a sociopolitical perspective that is for each member state to decide. The idea that the absence of a price signal on cost of care in Australia contributes to overconsumption of healthcare – and medicSA | 30

therefore the demands on the finite capacity to meet this demand – is worthy of consideration. If this notion is correct, the ironic consequence is that overconsumption in a universal healthcare system with no price signal of cost ends up limiting access to those who need the system the most. Of course, price signalling should not be construed as the sole deterrent to inappropriate or overconsumption of healthcare. Oher pro-active strategies can achieve a similar end-point. Programs that promote selfcare can be intentional and incentivised and, if successful, can substantially reduce the overall burden and costs of healthcare. These programs are premised on the principle that the individual takes personal responsibility for their health and well-being and, where required and able, contribute to some of the costs of healthcare above and beyond the general contribution of tax, the 2% Medicare levy and (where applicable) the Medicare levy surcharge. A high political premium would have to be paid for such a pivot in Australia and it is unlikely to be paid. Price signalling – or the absence of it – may not just be a driver for overconsumption by the consumer. It is potentially also a driver for the overutilisation of healthcare by those providing care.

Controlling costs In the five-year period 2013-18, service volumes for vascular surgery grew by 8.4% per year. The cost of benefits increased by 6.0% per year over the same period. This growth is explained by an increase in the number of services per capita of diagnostic vascular ultrasound and angiography items – yet the incidence of vascular disease in the community (including diabetes), did not increase at the same rate. While AI, digitisation of healthcare, and investment in other technological innovations may be solutions, they come at a cost – especially if the current lack of controls on overconsumption and overutilisation is not contained. Successful control of costs, while maintaining and improving health outcomes, occurs in a culture where efficiency is seen as a worthy and altruistic pursuit in ensuring access for those who most need it. It is not just consumer and clinician behaviour that is an integral part of closing the gap between inefficient and costefficient healthcare delivery. There are other system influencers that affect the organic behaviour of our complex health system. While industry can be compatible partners in the endeavour of innovation in healthcare delivery, the risk of commercial conflicts of interest must be managed. Similarly, when we can stop the political debate on health system successes and failures (the latter more often the case) in the gladiatorial contests of state and federal elections, a more measured and consistent approach to healthcare design is likely to emerge. In the end, our most powerful tools in providing cost-effective, patient-centred care are the right data, intelligent analytics and the rigour of a scientific method agnostic to all other interests other than the patient. Cost-effective, high-quality healthcare in a financially sustainable design is what we need now – and it will help those who come after us.

DOCTORS

Working well

Enjoying your work is a major factor in preventing anxiety and burnout, writes Dr Roger Sexton.

hink for a moment about your professional working week, what work roles you undertake during this time and how much time you allocate to each. The week may consist of one or more of the following professional roles that are open to doctors to pursue and include clinical work: undergraduate and post-graduate teaching, research, medical records management, results follow-up, business and practice administration, College and AMA roles, and other voluntary ones such as mentoring. We all have our preferences. Of these, there will be one or more that you find worthwhile and truly enjoy doing and from which you derive more motivation and professional fulfilment. There will be others that you do not find satisfying and meaningful. The following is an example of a clinician who is finding that she is spending too much time on aspects of medical practice that she does not enjoy, and that rob her of the time and opportunity to pursue the aspects she loves. Dr AB is a general practitioner (GP) who is experiencing fatigue and has lately felt an emerging resentment towards patients with whom she feels less empathetic. An examination of Dr AB’s actual working week may reveal, for example, that she spends 25% of her time doing mostly unpaid administrative tasks, 50% performing clinical tasks – almost all of which are sedentary consultations – 10% travelling to and from other clinics and aged care facilities, and 10% on undergraduate teaching, with the remaining 5% on CPD and professional reading. When she considers her ideal working week, she wants 20% for research, reflecting her penchant for research and a long-term goal of doing a PhD that has not yet materialised. Due to her loathing and lack of understanding of business administration,

she deletes that from her working week as she finds it stressful and frustrating. (Unfortunately everyone else does also and refuses to take it on.) She optimistically identifies a further 20% for surgical and other procedures. She allots 20% to consulting work as she feels she is becoming de-skilled and has always wanted to do more procedural medicine, but has not done so due to the absence of a nurse and a treatment room at the practice. Her love of undergraduate teaching is reflected in her allocation of 30% for this. She allocates 10% for study and CPD and lecture preparation. Dr Tait Shanafelt, Chief Wellness Officer at Stanford, has been a recent visitor to Australia and published widely on the subject of burnout and its relationship to a doctor’s working week. His research concludes there is a critical point beyond which the risk of burnout becomes significant. This is when the doctor is working less than 20% of the time in their preferred area of practice. Dr AB is at risk and is exhibiting two of the three recognised domains of burnout: fatigue (exhaustion) and lack of empathy (depersonalisation, seeing people as objects). Her working week is clearly less than ideal and is just not satisfying her or providing professional fulfilment. This is very stressful and requires constant effort and internal motivation to continue but is ultimately unsustainable. Fatigue makes it easier for Dr AB to do nothing about it and more difficult to change. We can all reflect on this and compare it to our own lives. Yet taking even one action towards a more balanced working week can be powerful. Discussing this with your GP, a professional coach or clinical psychologist can be very helpful. Dr Roger Sexton is the medical director of Doctors’ Health SA

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medicSA | 31

RESEARCH

The beginning of life

A major conference in Adelaide in 2023 allowed specialists to present the latest news and findings in treating and managing reproduction and fertility, including the studies on these pages.

ffering trained psychological counselling as part of a fertility treatment is as important as investing in the clinical and scientific aspects, says Australian psychotherapist Rebecca Kerner. Ms Kerner is chair of the Australian and New Zealand Infertility Counsellors’ Association (ANZICA) and of the new Psychology and Counselling Special Interest Group for the Asia Pacific Initiative on Reproduction.

Ms Rebecca Kerner

She told the 2023 Congress of the Asia Pacific Initiative on Reproduction (ASPIRE) in South Australia that integrating psychological expertise and offering counselling support was important for patients and staff. Ms Kerner says that while the IVF world had an amazing focus on the clinical and scientific aspects of treatment, there was a third crucial area of expertise that must be included and integrated into the assisted reproductive technology (ART) clinic environment if health practitioners were to deliver truly patient-centred care. Research demonstrates the number one reason people stop treatment is the stress and fatigue associated with it, she says. ‘If you can properly support patients in their fatigue, maybe they can stay in treatment longer to get to the end goal or at least to leave in a way that feels manageable and affirming of their emotional needs,’ Ms Kerner says. ‘Even if they are successful, people will go back to you for baby #2 because you have supported them. From that point of view, it also makes business sense.’ She says there is a strong case to integrate this psychological expertise for the whole treating team, all members of which are responsible for delivering compassionate care. A key message from Ms Kerner’s research with patient experience has been the need to focus on the individual person and their needs, rather than the outcome. While people on the street tend to think

medicSA | 32

that IVF is a cure for infertility, Ms Kerner views it as a treatment option – and with at least one-third of patients not ‘taking home that longed-for baby’. certainly not an exact science. ‘And if we don’t start having conversations about this and focusing on what we can control, which is how we take care of them, then everybody loses out,’ she says. ‘My colleagues and I want people – even those who don’t take home a baby – to feel their experience was a good one. They don’t want to feel like they are failures. ‘If we support them to navigate through their grief and provide continuity of care beyond that, they can leave knowing that they can still lead a meaningful and satisfying life in a different way.’ The focus on the clinical aspects of treatment often leaves patients feeling unacknowledged, she says. Men particularly feel overlooked, including where there is a male fertility issue, while same-sex couples might have different needs of the IVF program. Ms Kerner also recommends that clinics offer trained psychosocial counselling as part of a ‘one-stop shop’, recognising that even just managing the time for various aspects of treatment can be difficult. European research shows that on average a woman undergoing fertility treatment misses 23 hours of work for every IVF cycle. In some communities, too, there remains a stigma around infertility. And while it can be tempting to tell patients not to worry, this can itself cause stress. ‘The research is clear: there is no biological link between stress and infertility. Stress does not cause infertility, but infertility does cause stress! ‘Clinicians can inadvertently say, “just relax, stay positive”. But this becomes another pressure. When things are tough, it’s okay to feel crappy and realise this is a normal response to a horrible situation,’ says Ms Kerner.

RESEARCH

Fear factor

A new study shows male patients find humour during consultations with doctors about their infertility to be insensitive and even traumatic. Dr Nicole McPherson

ypically, humour is used to deal with awkward situations in Australian male society. But when it comes to a discussion between a doctor and a patient about male infertility, a recent study has shown it’s best to leave the jokes aside. Researcher Dr Nicole McPherson says a mixed-methods study about the experience of men in assisted reproduction and IVF found humour and colloquial language in discussing male infertility was unhelpful. While the study found rich data from men who had completed the assisted reproduction process, it had difficulty recruiting men recently diagnosed or in treatment, despite reaching out to more than 40,000 men.

Humour is ‘super insensitive’ Dr McPherson – a research fellow with the University of Adelaide and the Freemasons Centre for Male Health and Wellbeing – told the 2023 Congress of the Asia Pacific Initiative on Reproduction (ASPIRE) in Adelaide that study participants reported that communication from clinicians about the diagnosis was often insensitive. ‘A lot of literature around conveying health information to men revolves around humour and colloquial language to help engage men,’ Dr McPherson said. ‘But because fertility is so attached to a sense of self, using humour in delivery of information about male infertility is actually super insensitive. ‘When there is a direct attack on someone’s sense of self, you cannot use humour – in this case, it amplified people’s sense of shame and guilt.’ Dr McPherson said previous research on psychological needs and medical and psychosocial support during IVF has largely focused on women’s experiences. Consequently, there are few information resources designed specifically for men around male infertility.

Her team explored men’s information and support requirements when they had been diagnosed with male factor infertility and were undergoing assisted reproductive technologies. ‘We found that men don’t get much support or have much information given to them,’ she said. ‘We also found that men feel there is societal stigma attached to male infertility, making it hard to talk about it openly.’ The study found that when they do want to speak about it, men prefer to speak with other men in a similar situation or a peer support group with members who had experienced male infertility. Quantitative data indicated that participants’ knowledge of factors relating to male infertility was limited – not dissimilar to previous research that found generally low levels of fertility knowledge despite high self-rated perceived knowledge. ‘We also identified that while they would prefer to have information sources available online, this need was not being met,’ says Dr McPherson. Three themes were identified from the qualitative analysis about men’s experiences and support needs when diagnosed with male infertility.

Theme 1: Threat to masculinity The study found being diagnosed with infertility made participants feel ‘less of a man’. They experienced shame and guilt about being the reason their partner could not have a child. This was most keenly felt if a donor was required. A diagnosis of male-factor infertility, particularly in the absence of femalefactor infertility, led participants to see themselves as ‘broken’ or at fault. This feeling of shame led to substantial difficulties discussing the diagnosis with others, often resulting in isolation. As one participant noted: ‘. . .it almost feels a bit dirty to talk about. You don’t talk about that stuff. And, I’ll be honest, it feels

like women can talk about their reproductive . . . issues quite openly… But as soon as a guy talks about (being upset), well, we don’t talk about that.’

Theme 2: Holistic care All participants discussed the unmet need for holistic infertility information, noting that that the emotional impacts of infertility were under-recognised. Participants said consults and treatment were highly medicalised, with doctors frequently discussing only the ‘facts’ of their infertility and offering practical steps they could take. One participant explained: ‘[W]ho do you go to even ask? I need a psychologist, who do I speak to? . . . I’m a clinician . . . I know how to access referrals for people, I’ve done all this kind of stuff, but that’s hard even from my perspective trying to find that specialist area.’

Theme 3: The power of words Language emerged as a central part of creating a positive or negative experience with health care services. Participants said communication from health care professionals was often insufficient and/or insensitively delivered. As one participant reported: ‘(The doctor said), “Your nuts are stuffed”. And that was very traumatic for me. Even though I knew in my own mind, he could have put it in a much gentler way.’ Some participants described using humour as a ‘coping mechanism’ to mask feelings of awkwardness and uncertainty. Participants said they found it difficult to know what to ask their health care team about their diagnosis and treatment for male infertility. All participants expressed a need for health care professionals to proactively provide them with information on what their infertility diagnosis could mean for them – both medically and emotionally – and longer appointment times to allow time to discuss concerns.

medicSA | 33

RESEARCH

Research briefs Detecting Parkinson’s before symptoms appear

Genes linked to hardened arteries

Improving hand osteoarthritis symptoms

Researchers at The Florey and Austin Health have shown it is possible to detect signs of Parkinson’s disease 20 to 30 years before symptoms appear, offering hope for screening programs and preventative treatments.

An international team of scientists has analysed data from more than 35,000 people and identified 11 genes that contribute to the hardening of the heart’s arteries, in a bid to find new treatments to prevent coronary heart disease.

A Monash University and Alfred Health-led study has found an affordable existing drug can help painful hand osteoarthritis (OA) that has until now been untreatable.

Florey Professor Kevin Barnham said Parkinson’s disease is usually very hard to diagnose until symptoms are obvious, by which time up to 85% of the brain’s neurons that control motor coordination have been destroyed.

The study in Nature Genetics was the largest such meta-analysis yet conducted to understand the genetic basis of coronary artery calcification. Unlike many medical studies, it contained a large proportion of participants of nonCaucasian backgrounds, including 8,867 individuals of African ancestry.

The study in Neurology shows how a known biomarker called F-AV-133 can be used with positron emission tomography (PET) scans to diagnose Parkinson’s disease and accurately track neurodegeneration. The team scanned 26 patients with Parkinson’s disease, a control group of 12 people, and 11 people with Rapid Eye Movement sleep behaviour disorder (RBD), which is a strong indicator of the disease. Each person undertook two PET scans two years apart. Key findings include: •

•

no significant changes in clinical symptoms in any of the participants according to currently available assessments for Parkinson’s disease by contrast, the PET scans showed ‘significant neuronal loss’ in three key regions of the brain in individuals with the disease, suggesting F-AV-133 is a more sensitive means of monitoring neurodegeneration than what is now available.

medicSA | 34

The team identified 11 genes, eight of which were new, and the role they played in coronary artery calcification. The researchers conducted gene queries and experimental studies in human coronary artery tissues and smooth muscle cells and demonstrated direct effects on calcification and related cellular processes. The study also confirmed that another gene called PHACTR1 plays a big role in calcification. PHACTR1 is also known to be a major driver of SCAD heart attacks and fibromuscular dysplasia. Scientists can now work to develop drugs or repurpose existing ones that can target the genes or encoded proteins to modulate the calcification process.

Published in The Lancet, the paper investigated methotrexate, a low-cost, effective treatment for inflammatory joint conditions such as rheumatoid arthritis and psoriatic arthritis. It has been widely used in Australia and globally since the early 1980s. Researchers found that methotrexate reduced symptoms in those with hand OA. A 20mg weekly oral dose over six months had a moderate effect in reducing pain and stiffness in patients with symptomatic hand OA. Senior author Professor Flavia Cicuttini, The Alfred’s Head of Rheumatology, said the study identified the role of inflammation in hand OA and the potential benefit of targeting patients who experience painful hand OA. ‘In our study, as with most studies of osteoarthritis, both the placebo group and methotrexate groups’ pain improved in the first month or so,’ Prof Cicuttini said. ‘However, pain levels stayed the same in the placebo group but continued to decrease in the methotrexate group at three and six months, when they were still decreasing. The pain improvement in the methotrexate group was twice as much as in the placebo group.’

RESEARCH

Exercise may boost cognitive function

Antibiotics no help in preventing joint replacement infections

Plasma technology hastens wound healing

Playing a single 18-hole round of golf or completing 6 km of either Nordic walking or regular walking may significantly improve immediate cognitive function in older individuals, according to a recent study published in BMJ Open Sport & Exercise Medicine.

The antibiotic cefazolin is typically used at the time of joint replacement surgery to prevent infection. But with the rise of antibiotic resistant bacteria, many centres have adopted the practice of giving both cefazolin and vancomycin to prevent infections, despite the lack of clear benefit.

Researchers at Flinders University have taken a major step in the field of wound care by using plasma technology to ‘transform’ Spirulina microalgae into ultrathin bioactive coatings.

Researchers aimed to explore the immediate effects of three distinct cognitively demanding aerobic exercises on cognition and related biological responses in older, healthy adults.

A clinical trial published in the New England Journal of Medicine and led by Monash University researchers in collaboration with orthopaedic surgeons and infectious diseases doctors has found that the addition of vancomycin did not protect against infection and may have led to more infections and more adverse reactions.

The study involved 25 healthy older golfers, aged 65 and above, who participated in three different acute bouts of aerobic exercise: an 18-hole golf round, a 6 km Nordic walking session, and a 6 km regular walking session. Each exercise was conducted in a real-life environment, with participants maintaining their typical pace, corresponding to brisk walking. Cognitive function was assessed using the Trail-Making Test (TMT) A and B, a widely used tool for evaluating cognitive function in older adults. Additionally, blood samples were collected to measure brain-derived neurotrophic factor (BDNF) and cathepsin B (CTSB) levels. Both have been suggested to reflect the benefits of exercise in the brain. Participants also wore fitness monitoring devices and ECG sensors. The study showed that a single session of any of the three exercises improved lower cognitive functions measured with the TMT-A test in older adults, although no significant effects were seen on the levels of BDNF and CTSB.

The Australian Surgical Antibiotic Prophylaxis (ASAP) trial looked at 4,239 patients without a history of MRSA in 11 hospitals across Australia, including regional and private hospitals. Patients were randomised to receive either vancomycin or saline placebo, in combination with cefazolin. Among all patients, the addition of vancomycin was no better than the traditional cefazolin antibiotic. Unexpectedly, in patients undergoing knee joint replacement, the risk of infection was higher in the vancomycin group, 5.7%, than in the placebo group, with 3.7% infection rate.

The innovative approach uses argon atmospheric plasma jet technology to transform Spirulina maxima, the bluegreen microalgae, into bioactive coatings which can tackle bacterial infections while also promoting faster wound healing and applying potent anti-inflammatory properties. ‘This holds promise, especially for the treatment of chronic wounds, which often pose challenges due to prolonged healing times,’ says Dr Vi Khanh Truong, from the Flinders University Biomedical Engineering Laboratory. ‘This novel approach could reduce the risk of toxic reactions to silver and other nanoparticles and rising antibioticresistance to common commercial coatings used in wound dressings.’ The study reveals a new patented plasma-assisted technology which sustainably processes Spirulina maxima biomass into bioactive ultrathin coatings that can be applied to wound dressings and other medical devices which accelerate healing, modulate inflammation and even protect patients from infection. The new technique could be readily applied to other types of natural supplements, Dr Truong said.

medicSA | 35

PEOPLE

In his Honour

An oral surgeon, a global primary care expert and a rural generalist were among the recipients of 2023 King’s Birthday Honours.

Prof Paul Sambrook AM

stablishing international standards for oral and maxillofacial surgery (OMS) and ensuring the Australian profession remains at the cutting edge have been driving forces for Dr Paul Sambrook for over 30 years.

Dr Sambrook says it’s important to find the time to advance the profession, as he has in a range of roles that straddle the medical, dental and research professions. These include roles as past President of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons, President of the Royal Australasian College of Dental Surgeons, President of the International Board for the Certification of Specialists in Oral and Maxillofacial Surgery, and a member of both the Australian Medical Association and Australian Dental Association. In addition to having a private clinical practice, Dr Sambrook is Head of the Oral and Maxillofacial Unit at the Royal Adelaide Hospital (RAH) and past director of training for oral and maxillofacial surgery for South Australia and Head of Oral and Maxillofacial Surgery at the University of Adelaide. It’s this generous approach, both in Australia and overseas, that has resulted in a King’s Birthday Honour as a Member of the Order of Australia. Dr Sambrook says the award shines a light on the work of many people who have worked to develop objective international standards for OMS and in research, including osteonecrosis associated with bisphosphonates used to treat osteoporosis. ‘I’m only one of several people that do a huge amount of work in raising the profile. By receiving the award, it brings the work – teaching, research, international aid and service – into the political forefront and to the forefront of the medical profession,’ he says. ‘Ultimately if you work in an isolated area and do what you have been trained to do, as the profession, you don’t move forward. As an individual you do but as a profession you don’t. Unless you can pass on the skills and experience you gained, it dies with you.’ Outcomes for patients have improved dramatically over the course of his career, says Dr Sambrook, for example with the use of digital technology now common in complex oral and facial reconstructions. Having been at the forefront of a program to develop OMS skills in Bangladesh in the 1980s, Dr Sambrook has seen first-hand the impact that collaboration can have in improving access to surgical care. medicSA | 36

In a nation that could barely feed its population and has on average about 20% of its country flooded each year, achieving an international standard of OMS was a huge ask. But with oral cancers accounting for 25% of that nation’s cancers due to betel leaf chewing and other factors, as well as cleft palates typically untreated until maturity or not at all, the need was great. He recalls that when he first travelled to Bangladesh as part of a team to set up a program of oral and maxillofacial surgery, the aim was to train local doctors to the point where they could perform surgeries. While he stopped going to Bangladesh in the mid-1990s, the unit established then continues to this day. Creating international standards for OMS through the International Board for the Certification of Specialists is an important way of raising the quality of care of all patients worldwide, says Dr Sambrook. In Australia, he helps safeguard OMS standards through training a new generation of surgeons. ‘I’ve been very pleased with the quality and the numbers coming up to do oral and maxillofacial surgery despite the long training programs we have,’ he says. ‘Australia provides a very high-level cutting-edge service. In Australia facilities are accredited, people are registered – if you go to another country, you’ve got no idea who is treating you or what their credentials are.’ Research in Australia in surgery has many challenges, including funding challenges, he says, but despite these Dr Sambrook’s team has exciting projects related to reconstruction and rehabilitation in the pipeline. ‘There’s still a lot to do – we’re only just scratching the surface. There are still a lot of cancer treatments that are not targeted or specific, they are undifferentiated. The new Bragg Centre for Proton Beam Therapy is exciting, even though OMS is not yet a priority for its use.’ ‘Reducing the side-effects of radiotherapy will be a gamechanger,’ Dr Sambrook says.

PEOPLE

Prof Michael Kidd AO

W system.

hen most people say they will go the ends of the earth to answer a burning question it is a flight of rhetorical fancy but for Professor Michael Kidd it is the real quest to produce an ideal future health

In an exciting new collaboration, he commutes – both in real time and virtually – from South Australia to Oxford and Sydney as the inaugural Professor of Global Primary Care and Future Health Systems at the University of Oxford and Director of the Centre for Future Health Systems at the University of New South Wales (UNSW). From a background in general practice as well as research, policy and academic leadership, Prof Kidd is ideally placed to pull together the diverse threads of a truly modern health system. Recent positions have included: Australia’s Deputy Chief Medical Officer during the COVID-19 pandemic, Director of the World Health Organization Collaborating Centre on Family Medicine and Primary Care, President of the World Organisation of Family Doctors (WONCA), Chair of the Department of Family and Community Medicine at the University of Toronto, and Senior Innovation Fellow with Canada’s Institute for Health System Solutions and Virtual Care.

System reform the focus The aim, he says, is to focus on the health system reforms we would like to see a decade or more from now and start implementing the necessary changes. His centre will initially examine seven key themes: •

improving equity of access to health care services and equity of outcomes

•

strengthening primary care and expanding care available in the community

•

transforming hospital care including greater person-centred focus and integration between health care providers and services

•

safe and appropriate adoption of digital health innovations

•

developing team-based health workforces to meet population needs

•

incorporating lessons from the COVID-19 pandemic into health systems

•

supporting future health systems to meet the challenges of climate change.

It’s a challenging task, but consistent with Prof Kidd’s drive to innovate and answer the curly questions that have emerged from his experience. He admits that he has ‘done quite a few things’ since graduating with a medical degree from the University of Melbourne in 1983. Prof Kidd was an early innovator in the use of computers in medicine, completing his research doctorate under the supervision of Professor John Murtagh AO at Monash University. He has worked as a GP in urban, rural and remote practices in Australia, Canada and South Africa, and helped steer the Royal Australian College of General Practitioners through difficult financial times during two terms as President, from 2002 to 2006.

academic and research positions, including as foundation Professor of Primary Care Reform at the Australian National University; Dean of the Faculty of Medicine, Nursing and Health Sciences at Flinders University; and Professor and Head of the Department of General Practice at The University of Sydney. Appointed as a Member of the Order of Australia in 2009, Prof Kidd has recently been made an Officer of the Order of Australia (AO). One gets the impression that these are brief punctuation points in a tome as yet half-written; there’s still much to do. ‘I’m only a few months into this joint academic appointment and I’m very much looking forward to setting up the centres at the two universities and working with colleagues carrying out important work,’ he says. He wants to bring together researchers from areas as diverse as computer science, architecture and design, social sciences, law and ethics, and business and economics, recognising that a high-functioning healthcare system needs more than clinicians and medical researchers. ‘COVID-19 showed the importance of engaging multidisciplinary teams in health care in meeting public health challenges,’ Prof Kidd says. Digital technology is an important tool, he says, but clinicians and consumers must be involved in the design and implementation of applications focused on improving the quality and safety of care. ‘COVID-19 shone a spotlight on the many groups in our population who are not as well served by our health systems, including many older people, people with a disability, people from non-English-speaking backgrounds, and people from low SES groups,’ he explains. ‘One important lesson is that many of our Aboriginal and Torres Strait Islander populations did better in terms of rates of infections and deaths from COVID-19 compared to the rest of the population, which is the reverse of what often happens with health outcomes. ‘Part of that was due to support being provided to community leaders and Aboriginal Community Controlled Health Organisations to determine for themselves how best to protect the members of their communities.’ One thing is certain about the future health system in Australia says Prof Kidd: general practice will continue to be at its heart. ‘We know that strengthening primary care is the basis for building strong health systems,’ he says. ‘But far more support is needed for general practice to continue its essential role in meeting the majority of the healthcare needs of the people of our nation.’

Always interested in research and education, he has also held medicSA | 37

PEOPLE

Dr Gerard Quigley OAM

fter 33 years as a rural generalist in Cummins on the Eyre Peninsula, Dr Gerard Quigley might almost be a local.

Yet Dr Quigley was raised in Adelaide and went on to graduate from the University of Adelaide. He was lured to rural general practice by the idea that it was a realm in which you could create your own adventure. Then, as now, there was a doctor drought on the Eyre Peninsula. A story on the radio about the issue piqued his interest in moving to Cummins. Decades later, his dedication to the region, to the role and rural training – especially throughout an era in which rural towns have struggled to retain doctors – earned Dr Quigley a Medal of the Order of Australia (OAM) in this year’s King’s Birthday Honours List. Having worked as a Resident Medical Officer doing rural generalist training at the Modbury Hospital, and having spent some time working in Broken Hill and with his brother-in-law’s practice in Yorketown, Dr Quigley was attracted to the breadth of medical practice available as a rural generalist. ‘You can shape rural general practice to be whatever you want it to be,’ he says. ‘Being a rural GP can be what you want it to be. I trained to be a rural generalist so when I came to Cummins I was doing obstetrics and anaesthetics and you certainly needed a hospital to be able to do that. ‘Back 30 years ago virtually all the hospitals had doctors providing those services but that’s changed now. ‘I think the role of rural generalist outside of the regional centres is more around the emergency department and in-patient care and less about procedures – there’s less obstetrics and anaesthetics outside of the regional centres.’ In the ensuing years, Dr Quigley has become deeply connected to the community. With six kids and now grandchildren growing up in the region and a wife, Jo-Anne, who is Mayor of the Lower Eyre Peninsula, the Quigleys have become part of the fabric of Cummins. While there have been challenges, he notes, the rewards of

working in a regional community are manifold. ‘I am very fortunate. I work in a community where they care about you; they look after you. There’s no doubt the community is very important in keeping us here,’ he says. Family has also been vital, tolerant of the many times he has been missing-in-action on family events and even the odd trip that has had to be cancelled at the last minute. ‘Locum agencies struggle at times and there’ve been occasions where you try to plan in advance, say a holiday, and you are really not quite sure until a few weeks out whether you have a locum or not. ‘There have been occasions where we have had to cancel a trip because we couldn’t get a locum.’ Attracting rural doctors has been a recurring theme and, at the time of writing, towns north of Cummins had lost their primary services. This is despite the efforts of communities and local governments to attract doctors. ‘We really need to be able to attract experienced doctors to these areas and that’s about making it an attractive proposition,’ Dr Quigley says. ‘At the moment there is no difference between the rebate a doctor has if they are working in the leafy green suburbs, compared to working in Kimba or Cowell.’ ‘The real problem is that doctors attract doctors. We are lucky that we have an international graduate working towards fellowship in Cummins – we’ve got a couple of other registrars who are planning to start working there in the next six months or so. But if you don’t have that initial expertise in the town it is hard to develop.’ Fortunately, he says, efforts by the medical schools to provide students with training rotations in regional areas seem to be having an impact with a few students – city and country graduates alike – choosing rural internships. ‘The students are really switched on and they are well placed to move into rural practice. The exposure is working,’ says Dr Quigley. ‘The important thing for younger people is that they can set it up to be what they want it to be. The old picture of a GP doing anaesthetics, obstetrics, surgery – the whole lot – occasionally happens, I‘m sure, but there are lots of other options. ‘They should really consider what they want it to look like and make it happen because there’s abundant opportunity. On the Eyre Peninsula there are towns you could walk into where they’ve got the building, housing – everything ready to go and they could just walk in and make it look like what they want it to look like. ‘I’m lucky enough to have recruited three excellent doctors to train towards becoming specialist rural generalists, so I see myself working for a few more years to see how the training goes, trying to pass the baton on at some stage. ‘I can’t see myself working anywhere other than Cummins.’

medicSA | 38

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FLINDERS UNIVERSITY

MEMBERS

MedRevue performance

Christine Mausolf President

Each year the Flinders and Adelaide medical stuents’ societies (FMSS and AMSS) work hard to build a positive friendly (and sometimes competitive!) relationship among the students. This year there has been an increase in the number of social events held with the Adelaide Medical Student Society with the Vino Ventures event taking place at the wonderful Simon Hackett Winery in the Adelaide Hills. This day allowed students from both universities to socialise and network outside our campuses, following the inter-society soccer. The year was also characterised by increased emphasis by FMSS on sustaining the mental health dialogue in the field of medicine. Several initiatives were implemented with the goal of advocating for this cause, including events like 'R U OK day' and self-care challenges. In these challenges, we encouraged FMSS members to share images and videos of themselves engaging in activities that serve as their personal means of caring for their mental well-being. Some of our students also participated in the City to Bay, running the half marathon or the 12 km, raising money for the Flinders Foundation which supports the kidney cancer registry. We had the privilege of organising our LGBTQIASB+ Health and Inclusive Practice evening. Esteemed speakers including Dr Amy Moten, Lucy Solonsch and James Bonello shared their insights and experiences in the field, aiming to enlighten and provide recommendations for us aspiring healthcare professionals, to enhance our support and care for the LGBTQIASB+ community. There were also educational sessions such as the annual electives night, where fourth-year (MD4) students shared their elective experiences. They discussed how to arrange electives, the experiences during placements, and offered travel tips for

Vino Ventures at the Simon Hackett Winery in the Adelaide Hills medicSA | 40

international electives. Some of the presentations covered various elective experiences, such as paediatrics in Samoa, anaesthetics in New Zealand, intensive care in Alice Springs, general surgery in Oxford, a trauma elective at the Royal Adelaide Hospital, and retrieval medicine with South Australian retrieval service MedSTAR. FMSS was honoured to represent and present student ideas at the recent RACGP Think Tank. In partnership with Adelaide University Medical School and Flinders University College of Medicine, the event was designed to identify tangible and achievable strategies to encourage medical students and junior doctors to pursue general practice. We aim to change the narrative, so it more accurately represents the essential skills and knowledge GPs have. This year's annual Medball took place at the Adelaide Oval and was organised by our social portfolio, providing students with an incredible night to unwind. The theme of the event was 'Golden Age of Hollywood,' allowing hard-working students to relax and enjoy a night of socialising and dancing. The 2023 Flinders MedRevue presented a clever and creative adaptation of the iconic Wizard of Oz under the title ‘The Doctor of Oz’. It involved students from all MD cohorts showcasing their talents in the world of theatre. Overall, it was a production that appeared to be both enjoyable to be a part of and a fantastic way to engage in extracurricular activities during our studies. As this busy time of year comes to an end, we are so proud of all we have been able to achieve as a committee. We have been able to focus on improving the MD culture, education, advocacy and support. We look forward to welcoming next year's senior committee at our upcoming AGM and help set them up the best we can for a successful 2024.

Angelina Arora and Chrtistine Mausolf at the 2023 Wright Evans Medball at the Adelaide Oval

Christine Mausolf, Michal Wozniak and Grace Mackenzie at the RACGP Think Tank

ADELAIDE UNIVERSITY

MEMBERS

Randall Faull Doctors v Students Cricket Cup players

Vi-Seth Bak President

In its 135th year, the Adelaide Medical Students’ Society (AMSS) has been very active in its educational, advocacy, social, and philanthropic activities. I would like to share with you some of the AMSS highlights of 2023, including: •

an expansion of our Teaching Series lecture and tutorial program, to more than 30 lectures over the course of the year

•

co-writing with the Adelaide Medical School an official policy on the use of artificial intelligence for university coursework

•

staging the first full-scale Skullduggery and MedCamp since 2020

•

winning the first collaborative Soccer Cup between the AMSS; University of Adelaide law, engineering and dentistry societies; and the Flinders Medical Students’ Society.

A key partner of the AMSS since 2009 has been the Adelaide Medical Students’ Foundation (AMSF), a charitable body dedicated to supporting Adelaide medical students by providing scholarships and grants to students in need. The AMSF regularly awards research conference grants, travel scholarships, the Ral Antic Rural Health Grant, and a range of prizes and awards to recognise students. The Benevolent Fund is another of the AMSF’s key initiatives, providing emergency funds to students in financial crisis. In 2023, the AMSF provided 11 Research Conference Grants to enable students to travel interstate and internationally to present their published work across a range of disciplines. One travel scholarship was awarded to Daniel Subramaniam for his travel to Dr Jeyasekharan Hospital in Tamil Nadu, India, for a medical elective. The Ral Antic Rural Health Grant was awarded retrospectively to Eden Smith, for her travel to Canberra to attend

Daniel Subramaniam was awarded a travel scholarship for his medical elective in India

the Rural Medicine Australia 2022 Conference. The AMSF also awarded the following in 2023: •

Devitt Prize – Sahil Kharwadkar

•

Kildea Prize – Bridie Squire

•

AMSF Recognition Award – Kashyapchandra Avadhani

•

Student Teaching Award – Isaac Tennant

•

Intern Teaching Awards – Royal Adelaide Hospital – Dominic Spicer; Queen Elizabeth Hospital – Sean Liew; Lyell McEwin Hospital – Navya Jain.

We also recognised some of our longest and strongest supporters this year. In August, the AMSF, Adelaide Medical School and CALHN Medical Staff Society co-hosted a formal dinner to celebrate the retirement of the esteemed Professor Derek Frewin AO from clinical practice. As a former Dean of the Adelaide Medical School, Prof Frewin has been a long-time supporter of the AMSS and AMSF. On 15 October, we held the inaugural Randall Faull Doctors v Students Cricket Cup at the University of Adelaide ovals, with the two hotly contested matches ending with one win apiece for the doctors’ and medical students’ teams. The Cup is named in honour of Professor Faull, another former AMS Dean and current Head of the Central and Northern Adelaide Renal and Transplant Services (CNARTS). He is also the current AMSS Patron and has been a part of the AMSF’s board since its inception in 2009. The AMSF’s work to recognise and support medical students is aided by its generous supporters. If you would like more information on how to contribute, go to amsf.org.au or contact secretary@amsf.org.au.

Ral Antic Rural Health Grant winner Eden Smith medicSA | 41

PARTNERS & FRIENDS

Health Minister Chris Picton addresses guests

President’s breakfast

AMA(SA) President Dr John Williams welcomed colleagues and friends to the annual end-of-year President’s Breakfast celebration, this year held at the Feathers Hotel.

AMA(SA) Councillor Dr Jordyn Tomba

AMA(SA) Councillors Dr Bridget Sawyer and Dr Emily Kirkpatrick

RFDS Central Operations Chairman Peter de Cure and Dr Williams

MIGA CEO Tom Griffiths and AMA(SA) CEO Nicole Sykes

AMA Diversity in Medicine Award recipient Dr Fariba Behnia-Willison (right) and Nadia Willison

AMA(SA) President Dr John Williams (right) and University of Adelaide Provost Professor John Williams

medicSA | 42

PARTNERS & FRIENDS

Executive Board members Megan Webster, Dr Guy Christie-Taylor and Dr Michelle Atchison with former Chair Dr John Nelson (second from left)

Mrs Jan Turner, History Committee Chair Dr Tom Turner and Road Safety Committee member A/Prof Rob Atkinson

SASMOA President Dr David Pope, AMA(SA) President Dr John Williams and CEO Nicole Sykes

Ms Lydia Smalls, Dr Jordyn Tomba and AMA(SA) Doctors in Training Chair Dr Hayden Cain

RTWSA CEO Michael Francis, Law Society of SA CE Diana Newcombe and AMA(SA) CEO Nicole Sykes

Professor Michelle Tuckey of UniSA and medicSA medical editor Dr Roger Sexton

WCH Interim CE Rebecca Graham, Law Society of SA CE Diana Newcombe, Flinders University Dean (Education) College of Medicine and Public Health Professor Alison Jones and Department for Health and Wellbeing CE Dr Robyn Lawrence medicSA | 43

PARTNERS & FRIENDS

1 RACS Annual Dinner About 100 guests attended the Royal Australasian College of Surgeons (RACS) Annual Dinner at the National Wine Centre on 3 November. AMA(SA) President Dr John Williams was among those invited to hear SAPOL Commissioner Grant Stevens deliver the Anstey Giles Lecture on the topic of ‘Leadership in Crisis’. Associate Professor Robert Bauze was presented with the Sir Henry Newland Award for his outstanding service to surgery in South Australia. 1.

ACMA President and AMA(SA) Councillor A/Prof William Tam, RACS SA Chair A/Prof Amal Abou-Hamden, Australian Society of Otolaryngology Head & Neck Surgery President Prof Suren Krishnan, AMA(SA) President Dr John Williams, and AMA(SA) Councillor Prof Ted Mah

Dr Williams and Dr MaryAnn King

Commissioner Grant Stevens presenting to the audience

2 medicSA | 44

PARTNERS & FRIENDS

PMASA Gala The Pakistani Medical Association of South Australia (PMASA) held its Annual CME, AGM and Gala Event at the Adelaide Convention Centre on 25 November 2023. The CME program featured topics including the management of bariatric and metabolic disease, pathways to medical cannabis prescription in Australia, and a fracture workshop. During the AGM, four-year President of PMASA Dr Ayaz Aslam passed on the role and its responsibilities to Dr Rehan Hassan. The Gala Dinner was attended by about 200 guests, including South Australia’s Chief Public Health Officer Professor Nicola Spurrier. Entertainment was provided by Illusionist Matt Tarrant, with music from Farhan Shah and Sufi OZ. Oz Harvest was the local charity and Ali Hajveri Drug Bank the overseas charity supported by the event. 1.

MCs from left Abdullah Rizwan, Mischa Sheikh, Maryam Tahir, Rolland Deek

Hon Jing Lee MLC, Professor Nicola Spurrier and outgoing President Dr Ayaz Aslam

2023 PMASA Board members (from left) Dr Rehan Hassan, Dr Farukh Tehseen, Dr Muazzam Rifat and Dr Rizwan Latif

3 medicSA | 45

PARTNERS & FRIENDS

Multicultural Medical Badminton Tournament Teams from the Chinese, Indian, Pakistani and Sri Lankan medical associations competed in the first four-nation Multicultural Medical Badminton Tournament at the Adelaide Badminton Centre on 21 October 2023. Colleagues from the Australian Chinese Medical Association SA, South Australian Indian Medical Association, Pakistani Medical Association of South Australia and South Australian Sri Lankan Doctors Association enjoyed meeting in a non-work environment. ACMA ended the day victorious in three categories: women’s champions, open champions and over- 35 champions. The tournament included 84 players who competed in 94 matches. More than 200 friends, family members and medical colleagues watched as the participants demonstrated strength and athletic agility in their games. Dr Ayaz Aslan, who was PMASA President at the time of the tournament, said participants hoped it would become an annual event. He suggested there was the potential for more joint ventures in the future. 1.

Dr Neeraj Gupta, Dr Jaiveer Krishnan, and Dr Jolly Gilhotra

Mr Patrick Sing, Dr Sheldon Chong, Dr Wai Lee Ng, Mr Ben Chong, Mr Andrew Wong, Dr Boo Hin Khoo, Dr Ryan Choi, and Dr Michael Ee

Join the AMA(SA) Road Safety Committee and drive positive change! Are you passionate about road safety and eager to contribute to creating safer streets in South Australia? AMA(SA) Road Safety Committee is looking for dedicated individuals to join us in championing road safety initiatives.

Position: Committee Member - AMA(SA) Road Safety Committee Responsibilities 1.

Advocacy: Advocate for evidence-based road safety policies and initiatives.

Education: Contribute to educational programs to raise awareness of road safety issues.

Collaboration: Work closely with medical professionals, policymakers, and community groups to enhance road safety measures.

Policy development: Assist in the development of policies aimed at improving road safety outcomes.

Requirements •

Active membership with AMA(SA) or willingness to become a member.

•

Background or interest in road safety, public health, or a related field.

•

Good communication skills and the ability to work collaboratively in a team.

•

Commitment to attend quarterly committee meetings and actively participate in initiatives.

Benefits •

Contribute to the improvement of road safety in South Australia.

•

Network with professionals in the medical and road safety fields.

•

Enhance your leadership and advocacy skills.

How to apply: If you are ready to play a crucial role in road safety, please contact Dr Monika Moy via the AMA(SA) secretariat before 31 January 2024 at rsc@amasa.org.au or 08 8361 0109. Join us in our mission to make South Australian roads safer for everyone. Together, we can create lasting change and save lives. medicSA | 46

VALE

Dr Norman Shum BSc (Canterbury) MBChB (Otago) FRANZCP DipClinHypn MASH 1941 - 2023

he young Norman Shum was born in Christchurch after his mother and brother had arrived there as World War II refugees from China in 1939. Norman was named by the midwife who delivered him who liked the name Norman. His mother couldn't speak much English, so she just agreed to every question she was asked. That included the name Norman, which he never really liked. Norman’s father had already been in New Zealand for several years and had learned English while establishing an income with his own fruit shop business. Norman was distant from his much older brother, who left New Zealand for England and Canada when Norman was 19 to pursue a career in surgery. Another older sister, whom he never met, was not allowed to leave China and she died there. Norman’s Asian appearance andstarting school so soon after the end of the Second World War made his very early schooling challenging. However, that unpleasant episode led him to a small Anglican school where the nuns fostered his Christian spirituality and quest to learn. He became their star pupil and was happily able to attend Christchurch Boys High School. He was encouraged to take up medicine after being a graduate in psychology and philosophy at Canterbury University, Christchurch. On completing medical school at the University of Otago, Dunedin, in 1970, Norman – now Dr Shum – worked as a GP. In 1973 he started training in psychological medicine, but he felt he needed a more structured program and migrated to Adelaide in 1975 when offered a position at Glenside Hospital. He also started work at Ward 17 at the Repatriation Hospital, where he established an inaugural group therapy program. The model of developing and mastering new therapies before they were popular had begun. Norman qualified for College fellowship in 1979, already harbouring a passion for dynamic psychotherapy. He branched into child psychiatry for a short time and was also tutoring medical students at Flinders University in child psychiatry and general psychiatry. Later he left Glenside Hospital and his Repat position to set up a successful private practice in Salisbury, attracting 2,000 patients in the six years from 1983.

was locally and nationally recognised after he qualified in 1990. With the bonus of expertise in public speaking, he went on to share this skill with medical practitioners, psychologists and other psychotherapists, both as an educator and facilitator. He was the Director of Studies for the Australian Society of Hypnosis in South Australia for many years from 2000. In 1989 Norman decided to realign his work life balance and close the Salisbury clinic. He established a private practice at Eastwood that continued until 2022. Moving to Eastwood allowed him to engage more as a house husband and support his daughters’ schooling and their dancing, which became integral to their future careers. He also worked with the Medical Specialists Outreach Assistance Program, travelling to Coober Pedy every six weeks by plane for a three-day clinic from 2002 to 2018. In the last six years of his working life he became aware of the need to help patients in the field of gender dysphoria, and he became recognised for his work in this area. He was determined to use all his allocated time to help others and was still marking exam papers in hypnosis weeks before his death. Norman’s first marriage ended in 2006. After a few years of single parenthood, he married his second wife, Catherine, in 2010. It was the beginning of a happy time for them both, despite his illness in the latter years. Norman had many talents beyond his work and spiritual pursuits. These included jazz, cooking, pistol shooting, dance and tennis. Norman was a voracious reader and loved the English language. He devoted himself to martial arts, being successful in judo, wing chun and kung fu. His deepest passion for 20 years was in his practice of Aikido. It merged philosophy with his own unique clinical practice and he made good friends along the way. Norman died peacefully at Mary Potter Hospice in the presence of Catherine after a long battle with pancreatic neuro-endocrine carcinoma. He is survived by his daughters Veronica and Penelope and Veronica’s husband Robb Smart. He also had a good relationship with his two stepsons, Philip and Tim Heath. His thanksgiving service on 20 February 2023 was at St John's Anglican Church in Halifax St. It blended philosophies and spirituality from east and west, showing a sense of the universal family that Norman Shum strove to achieve. Dr Harry Hustig, friend and professional colleague of Dr Shum’s for 40 years, and Catherine Shum

His skill in hypnosis medicSA | 47

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Dr Philip Tideman AM MBBS FRACP FCSANZ 1959 - 2023

first met Phil in the mid-1990s when he became an advanced trainee in cardiology at the Flinders Medical Centre (FMC) and the Repatriation General Hospital. Because he had trained in general practice before starting physician training, we were similar in age. We had graduated from the Adelaide Medical School a few years apart and had daughters of the same age who subsequently did their schooling together. Even then Phil was an experienced clinician with a vision: to introduce the lifesaving innovations in acute and chronic cardiovascular care developed over the preceding decade to remote and regional parts of South Australia. Both of us had grown up in the Adelaide foothills with academic parents who had strong connections to the bush. Phil’s father, Arthur Tideman, became Director of Agriculture for the South Australian government and his mother, Ruth Tideman AM, was a school principal contributing to education across South Australia and Victoria. Phil had a robust and happy family life, growing up with his sisters Jill, Sally (his twin) and Robin. Phil was educated at Magill Primary School and then Prince Alfred College. After matriculation he started medicine at the University of Adelaide, graduating in 1985, and he interned at the Royal Adelaide Hospital. In 1986 he started the family medicine

program of the Royal Australian College of General Practitioners including rural general practice in Mount Gambier, and a Diploma of Obstetrics of the Royal Australian College of Obstetricians and Gynaecologists at the Mildura base hospital in 1988. In 1989 he started physician training as a basic trainee at the Royal Hobart Hospital and then the Royal Adelaide Hospital. He completed basic training and passed the FRACP Part I exams in 1994 and did a year of general medicine advanced training before starting cardiology training in 1995 at the FMC and the Repat. He was senior registrar in 1997 after receiving his FRACP and joined the staff at FMC as a staff specialist in 1998. He became a Fellow of the Cardiac Society of Australia and New Zealand in 2005. From 2002 he extended cardiology practice into the Limestone Coast region of South Australia with his colleagues from Flinders Cardiac and the Limestone Coast physicians’ group. From then on Phil worked tirelessly to improve the cardiovascular outcomes for rural, remote, and Indigenous patients with cardiovascular diseases. He was determined to make a difference for patients by examining what could be improved at all levels, from direct patient care to whole-of-system change. He was a chair, deputy chair or member of numerous

Pictured working at Naracoorte - Cardiologists Dr Phil Tideman and Dr Andrew Marwick with rural specialist GPs Dr Brian Norcock of Kincraig Medical Clinic and Dr David Senior from Robe Medical Clinic. Photo credit - Kincraig Medical Clinic medicSA | 48

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committees in many organisations, including Country Health, the National Heart Foundation, the Rural Doctors Association of Australia, the Royal Flying Doctors Service and in SA Health. Phil effectively leveraged the networks he built with point-ofcare testing and real-time electronic communications to deploy cardiovascular medical expertise to the bedside wherever the patient might be. Country practitioners were supported by his teaching and through the guidelines and protocols that he developed. This model has since been applied both nationally and internationally. The research program that he led gained more than $10 million in grant funding and produced more than 40 peer-reviewed publications, a number of which have received awards. From 2006 he took up the clinical director role of the Integrated Cardiovascular Clinical Network (iCCnet), which provided consultant-to-consultant support from regional areas to metropolitan services and supported the care of country patients with acute and chronic cardiovascular conditions.

Phil worked tirelessly to improve the cardiovascular outcomes for rural, remote, and Indigenous patients with cardiovascular diseases Phil was the key driver of the iCCNet system. It links clinics to hospitals and provides rural clinics with the ability to test, monitor and manage rural patients so patients suffering heart attacks in rural areas have the same level of care as their metropolitan counterparts. It has saved countless lives and is continuing to do so, in South Australia and elsewhere, as the success of the model becomes obvious. From 2010 this role was incorporated into Country Health, with Phil also having the role as deputy regional director of cardiology for the Southern Adelaide Local Health Network. Between 2019 and 2021 he headed the Statewide Cardiology Clinical Network of the Commission on Excellence and Innovation in Health. Phil’s final professional role was as clinical director of cardiology and the Integrated Cardiovascular Clinical Network SA, Rural Support Service, regional local health networks, SA Health, and senior consultant cardiologist in the Department of Cardiovascular Medicine, Division of Medicine, Cardiac and Critical Care at SALHN. Phil’s achievements have been recognised in many ways. In 2008 he was awarded the Medal for Clinical Services in Rural and Remote Areas of the RACP, and in 2011 he received the Australian College of Rural and Remote Medicine Distinguished Services award.

Dr Tideman with sister Dr Sally Tideman in the Flinders Ranges in 2022 rural patients with myocardial infraction’. This paper demonstrated the equalisation of outcomes for heart attack in rural and metropolitan patients. In 2017 he was a South Australian finalist for the Australian of the Year Awards. He received an AM in this year’s King’s Birthday awards. The last two years or so were not easy after Phil was diagnosed with an advanced malignancy. Throughout that time on treatment, he remained brave and optimistic, working as he was able. He died on 26 July, surrounded by the family he described as his ‘greatest joy’, wife Deborah and children Nicholas, Edwina, Charlotte and Alexander. The ICCnet that he created continues and he will be remembered with every call. AMA(SA) Council physician representative Dr Andrew Russell with the assistance of A/Prof Jo Harris and Dr Sally Tideman

In 2015 he was awarded the Sir Richard Stawell Memorial Prize for the Medical Journal of Australia 2014 publication ‘Impact of a regionalised clinical cardiac support network on mortality among medicSA | 49

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Dr Donald Beard AM (Mil.) RFD ED QHS MBBS FRACS FRCS(Eng) FRCS(Ed) 1925 - 2022

onald Beard was educated at Adelaide Technical High School and Adelaide High School, completing leaving honours before studying medicine at the University of Adelaide. He married Margaret Dunn in January 1962 at St Augustine’s Church Unley. They had two sons: Matthew, a physiotherapist in Adelaide, and Alastair, an accountant in Lancefield, Victoria. Apart from his family and friends, Don had three great passions: the army, cricket and surgery. He played club cricket in many countries. He played A Grade cricket and baseball for university and later cricket for Sturt as a fast-medium opening bowler. His cricket involvement continued for life. For 30 years he was Honorary Medical Officer for South Australian and Test Teams at Adelaide Oval, and he was also medical advisor to the Australian Cricket Board. Many international players sought his wise counsel, and he later became a close friend of Sir Donald Bradman. Don graduated in medicine in 1947. As a student, he had served in the Australian Army Medical Corps (AAMC), CMF (now Army Reserve). In February 1949, he volunteered for full-time Army service with the British Commonwealth Occupational Forces (BCOF) in Japan. In December 1949, he extended his tour of duty and was promoted Major. On the eve of his return to Australia, North Korea invaded South Korea. Don volunteered to serve in Korea, with a reduction in rank to Captain as the Regimental Medical Officer 3rd Battalion Royal Australian Regiment (RMO 3RAR), part of the 27th Commonwealth Brigade. Confronting, minus-30 degrees Celsius in Korea, Don had to improvise constantly, especially when treating frost bite. He developed a novel treatment in which soldiers were directed to rub Barbasol shaving cream vigorously into their hands and feet. Don taught first aid, wound management and fracture splintage to the battalion band members who were co-opted as stretcher bearers. The support medical team included a 14-year-old Korean refugee who, with the support of Don and others, later emigrated to Australia. On 22 April 1951, 300,000 Chinese invaded South Korea, with immediate impact on all operations. 3RAR was moved northeast to the slopes of the Kapyong Valley, a main invasion route as a blocking force. That evening a force of 4,000 Chinese attacked the 600-man 3RAR in a furious, close-quarter battle. Following intense fighting the 3RAR was ordered to withdraw to higher ground, having fought the Chinese to a standstill. Most casualties were evacuated, but 30 remained near the Chinese positions could not be overlooked. On several occasions, Don rode forward in a US Sherman tank under fire to pick up these injured solders, lashing them to the outside of the tank and returning promptly. Don then returned to the Royal Adelaide Hospital (RAH) surgical staff. In March 1953 he was given leave from the RAH, having been selected as the medical officer for the Australian contingent attending the coronation of Queen Elizabeth II in June 1953. He travelled in the aircraft carrier HMAS Sydney to the UK. Two highlights were the Coronation March, where he stood proud as the tall left marker in the front rank. He was later invited for drinks at Buckingham Palace by Major John Althorp, Equerry to medicSA | 50

HM The Queen, and father of Princess Diana. A memory for Don, when inside the Palace, was to receive a salute from then five-year-old Prince Charles. In 1955, Don returned to the UK for further surgical training and he passed the surgical exams FRCS (Eng) and FRCS(Ed) in 1957. On return to Australia in 1958, he passed the Australian College FRACS exams and then served on the RAH staff until 1963. He was appointed to the surgical staff of the Queen Elizabeth Hospital (TQEH) and remained there until 1973 when he was made the first Director of Surgery at the new Modbury Hospital. He held this post until his retirement in 1990. In the Army, having been promoted to Colonel, he volunteered for Vietnam in March 1968 and was then posted as the only surgeon at the 1st Australian Field Hospital at Vung Tau in April 1968. This period coincided with the cumulation of the Tet offensive and there were many casualties. Morale was low and standards of discipline had fallen. Colonel Donald Beard’s arrival restored humanity to the hospital. His reputation and professionalism were acknowledged, and all patients, friends, or foes, were to be treated equally. His generosity, tolerance, and good humour were noted by all. When blood supplies were short, fresh donor blood from available soldiers was used. Don would then shout lunch for the donors, to thank them for their lifegiving contributions. Don returned to Australia in June 1968 and was appointed Director of Medical Services (DMS) Army in South Australia for four years from September 1970. His record was well known and respected throughout the Army. If he believed in a soldier’s or officer’s worth, he would back them to the highest level. Don had many and varied interests, including a passion for music, opera and the arts, including the life and works of Robbie Burns. In the late 1980s, Opera SA, looking for a tall man, asked him to play The Ghost in Richard Strauss’ Elektra. His brief operatic career continued with parts in Samson and Delilah (Saint-Saens) and Verdi’s Macbeth. He delivered an outstanding oration, ‘Music and Warfare’, to the Royal Australasian College of Surgeons’ Annual Scientific Congress in June 2002 and again to the Quincentenary Congress of the Royal College of Surgeons of Edinburgh in 2005. He had a long interest in and concern about road trauma. In 1974 he was appointed Chairman of the SA Road Safety Advisory Council. He was Chairman of the SA State Committee Royal Australasian College of Surgeons (RACS) from 1978 to 1980. Varied committee memberships included the Sports Medicine Association, the Lords Taverners and the Australian War Memorial. Further military appointments included being made Honorary Surgeon to Her Majesty the Queen in February 1976, and he was made a Member of the Military Division of the Order of Australia in 1987. He was also a member of the Council of the Australian War Memorial. Former Governor General Sir Peter Cosgrove said in a tribute, Don’s ‘role as a doctor tending soldier in combat is a byword in the Australian Army. At the Battle of Kapyong his inspirational care and leadership contributed to the love this strong man had for peace and compassion’. Matthew Beard and Dr Peter Dudley AM

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Dr William (Bill) Rayner Fuller FANZCA FCICM 1930 - 2022

ill Fuller was born on 24 February 24 1930 in Firle, South Australia. He was the third son of George and Mignon Fuller.

He was educated at Norwood and Adelaide High Schools and received his Leaving Honours Certificate in 1946. In 1952 he became President of the Norwood High School Old Scholars Association. Bill graduated in medicine in 1953 having received the Elder Prize in first year. Bill was an enthusiastic sportsman, excelling particularly in baseball, for which, in 1951, he received the Capps Medal for best and fairest player in the South Australian League. During his university years he was awarded the University Blue in baseball and the University Club Letters in cricket. Bill did his internship at the Royal Adelaide Hospital and the Adelaide Children’s Hospital. He spent the years between 1955 and 1962 in general practice and during that time developed an interest in anaesthesia, his practice becoming increasingly as a GP anaesthetist. This led him to join the staff of The Queen Elizabeth Hospital (TQEH) and to specialise in anaesthesia. In 1968 he became a Fellow of the Faculty of Anaesthetists of the Royal Australasian College of Surgeons. Feeling that he needed more experience in cardiac anaesthesia and intensive care, Bill took his young family to London, and he spent most of 1969 and 1970 as a senior anaesthetic registrar at Hammersmith Hospital. Upon the family’s return to Australia in 1971, Bill was appointed senior registrar in anaesthesia at TQEH, and in 1972 he became director of the Intensive Therapy Unit. These were the earliest years of intensive care in South Australia and Bill guided the unit to become a teaching department for trainees in anaesthesia and intensive care. In 1982, Bill decided to return to anaesthesia and was appointed the director of the Department of Anaesthesia and Resuscitation at TQEH. During this time Bill developed the concept of the Friday Scientific Session, held within the confines

of the department, during which good wines were nosed, tasted and dissected for their subtle qualities. In 1995, Bill retired from hospital practice but continued to conduct locums in Whyalla, Darwin and Mackay, sharing his knowledge and skills for the benefit of country GP anaesthetists. In 1999 he was awarded the College Medal ‘for outstanding contributions to the College’. In retirement Bill continued his interest in good wine, played golf and cycled. He would recommend cyclists to ‘ride with the wind behind and end up near a train station so you can catch a train home’. He travelled widely with wife Jo, visiting Alice Springs, the Kimberley, Lake Argyle and Darwin, returning on the iconic Ghan. On a personal note, I am forever grateful for the support and direction Bill offered me when he appointed me a specialist to the ICU in 1976. He was an admired colleague and mentor to many who trained in anaesthesia and intensive care. Bill’s was a life well lived and his contributions to medicine were numerous. Bill died aged 92 on 20 October 2022, after a short illness. He is survived by his wife Jo, his sons Mark and Drew and daughter Penney, his grandchildren and great-grandchildren. Dr Ron Peisach wrote this obituary with the assistance of a history of Bill’s life written by his brother Oliver. It first appeared in the ANZCA Bulletin

EASTERN SUBURBS VR GP Hazelwood Clinic is a well-established GP owned and operated practice. We are seeking a VR GP to join our busy Eastern Suburbs practice – 4 days per week to full-time. Opportunity for future partnership also available. We are a private billing practice with wellequipped consulting rooms and a friendly and supportive medical, nursing and admin team and value a respectful team environment. We provide a wide variety of medical services including onsite Spirometry, 24 hour blood pressure monitoring, Holter monitor and ECG Enquiries to Jenny Lambert, 0419 409059 or email jennylambert@hazclin.com.au.

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Climbing Kinabalu

AMA(SA) Vice President A/Prof Peter Subramaniam ponders life and the ages while following in the footsteps of Sir Hugh Low.

hy climb a mountain? The classic response of its mere existence is tempered by consideration of the endeavour of ascent. The more practical questions of timing and physical abilities often arise after the original question is addressed. Mount Kinabalu is a majestic, hidden treasure of the Borneo wilderness. It is not far off the beaten track as direct flights are easily accessible to the step-off point of Kota Kinabalu, the capital of the Malaysian state of Sabah. Kinabalu is a discovery destination for locals, Malaysians, foreign tourists and some others. The latter group can comprise eco-tourists heading off to Sandakan for the orangutan sanctuary, adventure tourists ticking off mountains conquered, or the occasional ageing vascular surgeon marking the inexorable passage of time by taking a Quixotic tilt at the conquest. While the guidebooks provide the reassurance of suitability for anyone with a moderate level of fitness, there is no set of metrics for ‘moderate’. Nor is it particularly specific on the potential impact of altitude sickness on said or even presumed level. You first catch sight of Kinabalu on the three-hour bus transfer from Kota Kinabalu to the headquarters at the foot of the mountain. A stop en route at the village of Nabalu gives a first clear view of the majesty of its 13,435 feet (4,095 metres). It dwarfs every other mountain around it in the Crocker Range. The task ahead suddenly is a little more real and a lot more daunting. Aki Nabalu – the Kadazan name for the mountain, is the spiritual home of the indigenous Kadazan, where souls are transported to rest in eternity. We had learnt this during our pre-ascent visit to a Kadazan village a few days before climbing. The stories of the ancient connections to land, spirits and Mount Kinabalu as recounted by the Bobohizan (high priests) and Bobolian (high priestesses) of the Kadazan are reminiscent of the song-lines of First Nations peoples. Mount Kinabalu is much more than the intrusion of igneous rock into the sky (a ‘young’ granitic pluton of 8 million years, give or take a million either way). Kinabalu is an ancient and living sacred site of an ancient and gentle people (well mostly gentle, as head hunting is now no longer acceptable practice). On arrival at the Sutera Lodge headquarters, we are briefed, gear-checked, fed and introduced to our mountain guides – a mountain-fit group of Kadazan men and women, fearsomely athletic and friendly. The following morning, our packs are on our backs. Faux humour masks nervous anticipation in our demeanour and silent prayers are said for slightly dicky knees and slightly more crook backs as we begin the ascent at the base of the trail, Timpohon Gate. Over the first few kilometres, the sweaty meandering through tropical rainforest morphs into montane forest with a sparser canopy of ferns and conifers – and an associated drop in temperature. Every rest-stop along the way is staffed by ridiculously cute mountain squirrels who were obviously appointed by Kinabalu Parks to provide climbers with entertainment and distraction in exchange for a kindly word and food-scraps. The Laban Rata Resthouse at Panabalan Base Camp

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(10,700 feet/3,200 metres) is home for the night before the ascent to the summit. The temperature is alpine, the food and company are classic Malaysian and good, and the dormitory style accommodation is fun. The four (other) snorers in our dormitory, perhaps less so. We begin the ascent to the summit at 2 am. Headlights are on and our packs are lighter. Besides their hard breathing, the climbers are silent as we move from Base Camp to the summit. The climbers breathe hard as we move towards the summit. Otherwise, we are silent in respect to this sacred site of the Kadazan, and this breathless climber is pleased with that. (In 2015, the mountain was reputedly offended by deliberately disrespectful climbers who also offended their mountain guides. The mountain retorted with an earthquake, with rockfalls leading to the loss of life of 18 hikers and guides. Charges were laid, apologies of foreign governments procured and the Kinabalu placated.)

dark and gloom, for there is this mountain. The adventure of Kinabalu is beyond her beauty or the soul-changing view from her summit. It is more than her changing mountainscape, with its own cadence of changing sights and sounds as you ascend. The treasure of Aki Nabalu is the ancient Kadazan people who live and serve the mountain; whose connection to it is a magical note that adds to the wonderful hum of Sabah and Borneo and is a fine example of humankind’s endurance through millennia. This, perhaps, is the reason one should sometimes climb a mountain……

Sunlight breaks its overnight cover about 20 minutes from the summit. The temperature is sub-zero but the wonder of the moment makes it irrelevant. The glacial landscapes at this summit amid the tropics remind us how high we are and how old the mountain (the landscape reflecting glacial processes during the last Ice Age). The summit (Low’s Peak 4095.2 meters) is reached and my climbing companion (who doubles also as my much younger life companion) can breathe with relief that it appears Adelaide will not be short one vascular surgeon. The summit is named after Sir Hugh Low: 19th-century naturalist, adventurer, model civil administrator of the British Empire and all-around good guy. He was accompanied by Lemaing, a native guide from Kampung Kiau. (Unlike Sir Hugh, Lemaing was not a CMG, KCMG and GCMG but I am reasonably confident he would have been quite a bit fitter than Sir Hugh.) The mention of Borneo might recall (for some) dark memories of Sandakan for Australian prisoners of World War II and their connections. It may also highlight environmental anxieties for the future of the endangered Borneo Orangutan. But all is not medicSA | 53

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A more than civic duty Dr Robert Menz dives into the history and pedigree of Honda.

Another Honda you say? Fair comment and there is no real reason – apart from the randomness of, say, picking 4 As when selecting your seven letters while playing scrabble. However, this is a new model, with Honda looking to cash in our love for SUVs. What’s an SUV I hear you ask? Good question, and again, it is an example of the insidious Americanization (sic) of our wonderful Ozzie language. (There were muted howls of protest when the PBS changed ‘cephalexin’ to ‘cefalexin’ a few years ago, mainly from lazy docs like me who had to alter their ‘Favourites’ in the clinical software.) The first relevant usage of the term ‘SUV’ was in advertising brochures for the full-sized 1974 Jeep Cherokee (SJ), which used the wording ‘sport(s) utility vehicle’ as a description for the vehicle. Before that they were all 4WD, but then consumer demand led to smaller vehicles known initially as

AWD (all-wheel drive) or soft-roaders (as opposed to off-roaders). Now, however, many of these vehicles are FWD and barely more capable of driving off road than a Corolla. And they are now all called SUV, even the ‘king off the road’ Toyota Landcruiser. Which brings us back to Honda. Some models have a very long pedigree, such as the Civic, which dates back to 1968 and is still being sold under that brand name. Honda’s first foray into SUV territory was the CR-V, which first graced our shores in 1997. The HR-V appeared in 1999, and is still available, although there was a brief hiatus. Regular readers will recall the bright red all-electric HR-V from 2021. ZR-V is a new model, fitting between the C and H in size. There are three versions with the same 1.5L petrol engine as the test car, ‘turbocharging your joy with 131kW of power and 240Nm’ (to quote the brochure). The top of the range ZR-V is the hybrid e:HEV LX, producing 315Nm of torque. Prices range from $40,200 for the VTiX to $54,900 for the hybrid. The test vehicle price is $48,500. Honda is very transparent in its pricing as all figures are for drive away, whereas most manufacturers have a ‘retail price’ that is often several thousand dollars south of what you end up paying. Honda has a five-year unlimited km warranty, and also has five-year fixed price servicing with the first five services, capped at $199 each. Servicing is required every 12 months or 10,000 km, whichever comes first. The top-range VTIL is a very well-equipped car, with most of the items expected in this class, although of interest there is no sunroof. The centre console screen has an excellent ‘helicopter’ view when reversing that leaves no excuses for other than perfect parallel or reverse 90-degree parking every time. The infotainment system works very well, with easy and intuitive iPhone pairing and excellent sound quality through the 12-speaker BOSE sound system with subwoofer. Other features include leather-appointed heated front seats, 18-inch two-tone alloy wheels, 360° multiview camera system, and wireless phone charging. There is also the usual plethora of acronymophilic safety features, including lane departure warning (LDW), forward collision warning (FCW), collision mitigation braking system (CMBS), lane keeping assist system (LKAS), traffic sign recognition system (TSRS), adaptive cruise control (ACC) with low-speed follow (LSF), road departure mitigation system (RDM) and high-beam support system (HBSS). The grammar purists will chide me appropriately for referring to these initialisms as acronyms, but somehow initialismphilia does not roll off the typing fingers or tongue nearly as easily. Being a Honda, this vehicle presents no surprises when it comes time to get behind the wheel. Performance is brisk and handling is perfectly adequate. The ZR-V is relatively quiet. The continuously variable transmission (CVT) is, by definition, seamless, and this version includes steering wheel-mounted

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metal paddle shifters. I particularly liked the one-touch cruise control. In the week of test driving I had plenty of opportunity for rural driving. The morning I collected the car involved the cycling group ride from Stirling to Uraidla and I was easily able to fit the bike in the boot, which has a 370L capacity with the rear seats in place, increasing to 1302L with the rear seats dropped. Midweek involved a work trip to Hamley Bridge and Burra. This required a slight detour for lunch at Wendy's Cafe N Cakes in Balaklava, which has a wonderful range of delicious home-cooked cakes, tarts, biscuits, and even savoury stuff for the non-sweet of tooth, washed down by excellent Mahalia coffee, which the coffee aficionados reading this will know is roasted in Robe. The 365-km solo round trip was made easier listening to talking books courtesy of Libby (the state library online leading service) so time simply flew by. And then there was a weekend trip to Victor, with the boot readily swallowing luggage, eskies and other items with room to spare. In summary, Honda ZR-V is a worthwhile addition to the increasingly crowded medium-sized SUV market. Test car made available through Honda Australia. Dr Robert Menz is a GP and enthusiastic motorist who is yet to own a Honda, although there have been two Jazzes in the family.

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MEMBER BENEFITS

Ageing whites – why red drinkers need to read this…

’ve been a card-carrying member of the ‘aged white’ cult my entire career. There are not many of us but we’re there, lurking among the shadows at auctions, snapping up aged rieslings and semillons well below what they’re worth or fumbling around in quit barrels at independent wine shops or bottlos attached to country pubs. What on Earth drives us?

I can’t speak for my brothers and sisters who share this passion, but I can tell my own story, which thankfully started early in my career as a wine merchant in the UK. I had travelled to Bordeaux for Vin Expo ’93, which was, at the time, the world’s biggest gathering of wine producers showing their wares to would-be buyers. On the second night my desperate posse descended on a restaurant at 10 pm. I was sent to the wine shop to find something ‘interesting, white, not too expensive but make sure it’s the best thing since…’. Yeah, okay, we’ve all had that brief before… In the wine shop I found a remarkable looking white wine, a 1964 Bordeaux Blanc, light gold with level into the neck. When I calculated it in Australian dollars it seemed like a bargain, but I wanted to be sure. The merchant rolled his eyes and said, ‘follow me’. We walked a little way down an alley way and found an old man, well dressed in a crumpled, off white linen jacket and pants. The merchant showed him the bottle and for a moment he reflected on the label, mumbled a sentence or two and handed it back. The merchant then turned to me and said, ‘he says it started raining in this vineyard on October 8 that year but fortunately they had harvested two days prior, not precisely when they wanted to, but they knew it was going to be a wet year and there would be problems – and this should be fine’. Without hesitation I purchased all three bottles and took the first one back to the table. This wine was amazing, still showing some grassiness but the palate was full of honey, lime and lemon zest with a clean, long finish. This wine was 29 years old? Just amazing. I have since been a lover of well-aged whites and have only been able to replicate similar experiences in Australia through riesling and semillon. So, I say to red-only drinkers, wake up and taste these wines. They really are ‘red drinker’ whites, full of body and complexity and, unlike pinot noir, a less expensive journey. And who was the sage? I never knew. Drop me a line at phil.manser@winedirect.com.au or call me on 1800 649463. I have several to recommend for ageing and there’s associate membership to the cult on offer. I look forward to you joining us. Phil Manser, Sales Manager, Wine Direct

For information about Wine Direct’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. medicSA | 56

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f 34% Li new o t p Get u nt on any * discou rance policy u life ins

AMA members are eligible for a complimentary insurance policy review and up to 34% lifetime discount on any new policy purchased from AMA Life Insurance before 31 December 2023.

Contact AMA Life Insurance for more information  1300 763 766  enquiries@amalifeinsurance.com.au  www.amalifeinsurance.com.au *Terms: Conditions apply to the AMA Lifetime discounts on new policies issued by 31 December 2023. The discounts will vary depending on the policy type, your age, health and personal circumstances. The maximum discount of 34% applies only if you engage in the designated healthy lifestyle program and take out the Insurer’s health insurance.

AMA Life Insurance Pty Ltd is an Authorised Representatives of MBS Advice Licence Pty Ltd ABN 25 654 854 136 AFSL 536983. Any advice in this publication is of a general nature only and has not been tailored to your personal circumstances. Please seek personal advice prior to acting on this information.

medicSA | 57

MEMBERS

Dispatches HOLIDAY WISHES FROM AMA(SA) The AMA(SA) Secretariat staff wishes all members, colleagues and friends a safe, healthy and relaxing holiday season. Our office will close at 12 noon on Thursday, 21 December 2023 and reopen at 9 am on Monday, 8 January 2024. Please contact us in the new year with any questions and comments about AMA(SA) membership, services and advocacy.

The Secretariat team comprises: •

Nicole Sykes - CEO

•

Leonie Thomson - EA to the President and CEO

•

Karen Phillips - policy, media and communications

•

Catherine Waite - operations and business development

•

Sharyn Kerr – administration

•

Natalie Hall – business development and membership services.

observers. If you are a member and wish to attend the February or March meeting, please call Leonie Thomson on 8361 0109 or email lthomson@amasa.org.au.

MEMBER PORTAL Have you logged in to the AMA Member Portal? The portal is where you will also find all the information you need about the exclusive perks you can benefit from by being an AMA(SA) member. If you have forgotten your password, you can reset it here. When you log into the portal you can update your details, choose how you would like to present yourself to other members, and indicate which networking and other experiences you are interested in. Once you’ve had some time to get to know the portal, we hope you’ll share your feedback with us at ama.com.au/mp

2024 AMA(SA) COUNCIL MEETINGS

ANNUAL RENEWALS ARE OPEN

The next meetings of AMA(SA) Council will be held on Thursday, 1 February 2024, and Thursday, 7 March. There is no meeting in January.

By this time, members should have received the email containing your annual renewal notice. To renew your membership for the year 2024, simply use the exclusive payment link provided in the email.

Members may attend Council meetings as

Renew before 31 December 2024 and you will automatically be entered into a prize draw. If you wish to discuss your renewal or anything related to your membership, please get in touch at 08 8361 0108 or drop us an email at membership@amasa. org.au. We're here to assist you!

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.

DISCOUNT OFFER FOR JUNIOR DOCTORS Doctors in training can join AMA(SA) before 31 January 2024 and benefit from an exclusive offer. You can join AMA(SA) and subscribe to the AMA CPD Home with a single payment and enjoy a remarkable 50% discount on your 2024 membership fee. Visit www. ama.com.au/membership to join.

PRACTICE NOTES 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 medicSA | 58

CONSULTING ROOMS IN PSYCHIATRIC PRACTICE

Our psychiatric practice will have availability from January 2024. Corner office (top floor) available Mondays, Tuesdays, Thursdays and Fridays and a ground floor office available on Mondays and Tuesdays. We’re located close to the Adelaide CBD (Regent St North) with on-street parking for patients and parking at our rooms for doctors.

We offer a fully comprehensive and inclusive service with friendly, experienced staff. Please contact our practice manager Karina, with any further enquiries on (08) 8223 3304 or regent@regsec.com.au.

STAY IN TOUCH Dr John Williams @AMASApresident

@ama_south_australia

Dr Steve Robson @amapresident

AMA(SA) @AMASouthAustralia

Dr Danielle McMullen @ama_vice

Doctors in Training @AMASADIT

AMA Federal @ama_media

Australian Medical Association (SA)

MEMBERS

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.

Going away this holiday? Embark on your holiday journey with the ultimate travel experience, courtesy of your AMA(SA) membership! Take full advantage of exclusive promotions and unbeatable discounts with our esteemed partners: •

Hertz and Avis Budget Group: Enjoy the freedom of the open road with special discounts on car rentals from two industry giants, Hertz and Avis Budget Group. Your membership brings you savings that enhance your travel adventure.

•

Qantas Club and Virgin Australia: Elevate your air travel experience with exclusive perks from Qantas Club and Virgin Australia. Enjoy premium lounges, priority services, and special privileges that make your journey as memorable as the destination.

•

Urban Rest: Immerse yourself in comfort and style with Urban Rest's premium serviced apartments and hotels. As an AMA(SA) member, relish exclusive promotions, including a 10% discount with a special promo code and additional discounts for longer stays. Discover the joy of staying in well-designed spaces that prioritise your well-being.

•

AMA Travel Insurance: Ensure peace of mind on your travels with AMA Travel Insurance. Our comprehensive coverage is tailored to your needs, offering a safety net for unforeseen circumstances. Travel with confidence, knowing that your wellbeing is our priority.

This holiday season, let your AMA(SA) membership unlock a world of exclusive benefits, making your travels more enjoyable, comfortable, and worry-free. Wherever you go, make the most of your journey with the perks that come with being a valued member. Happy travels!

Gifts galore! Why not leverage your membership benefits? Enjoy exclusive promotions and discounts with: •

Wine Direct: As an AMA(SA) member, indulge in exclusive offers on a variety of premium wines, making your gift-giving memorable and refined.

•

Endota Spa: Treat your loved ones to the gift of relaxation with Endota Spa.

•

Harvey Norman Gepps Cross: Enjoy special discounts as an AMA(SA) member on home essentials.

Make your last-minute gift shopping a breeze by tapping into your membership benefits. These exclusive promotions ensure that your presents stand out and bring joy to the recipients. Happy giving!

And don’t forget... Exclusive car benefits and discounts, courtesy of your AMA(SA) membership! We've partnered with renowned automotive brands to bring you unparalleled savings and privileges. Indulge in the luxury and performance of Alfa Romeo, explore the innovation of Volkswagen Group, experience the safety and sophistication of Volvo, embrace the premium craftsmanship of Audi, and revel in the driving excellence of BMW—all at special member rates. Whether you're seeking elegance, cutting-edge technology, or pure driving pleasure, our partnerships ensure that your automotive dreams become a reality. Spark your journey on the road with the prestige and savings that come with being a valued AMA(SA) member.

AMA(SA) preferred providers medicSA||59 59 medicSA

...we’re here for you Support and guidance whenever you need it, from the experts in medical indemnity insurance. For assistance call our friendly team on 1800 777 156 or visit www.miga.com.au

Earn 75,000 bonus Qantas Points when you first insure with MIGA by 31 January 20241

Plus earn 1 Qantas Point per eligible $1 paid to MIGA for your medical indemnity insurance2

Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by Medical Defence Association of South Australia Ltd. Before you make any decisions about our policies, please read our Product Disclosure Statement and Policy Wording and consider if it is appropriate for you. Call MIGA for a copy or visit our website. 1 75,000 bonus Qantas Points offer only available to registered Australian medical practitioners who first insure with MIGA in a fully insured category, as a doctor in private practice, for cover commencing in the period between 1 December 2023 and 31 January 2024, and who pay in full by 31 January 2024 or enter into a direct debit arrangement with MIGA by 31 January 2024, and pay at least one instalment by 24 February 2024, who have not exercised their rights to cool off nor had their insurance cancelled by MIGA, as per the terms and conditions of the Policy. MIGA Terms and Conditions for bonus Qantas Points for Fully Insured are available at www.miga.com.au/qantas-bonus-tc-pp. 2 A business must be a Qantas Business Rewards Member and an individual must be a Qantas Frequent Flyer Member to earn Qantas Points with MIGA. Qantas Points are offered under the MIGA Terms and Conditions at www.miga.com.au/qantas-tc. Qantas Business Rewards Members and Qantas Frequent Flyer Members will earn 1 Qantas Point for every eligible $1 spent (GST exclusive) on payments to MIGA for Eligible Products. Eligible Products are Insurance For Doctors: Medical Indemnity Insurance Policy, Eligible Midwives in Private Practice: Professional Indemnity Insurance Policy, Healthcare Companies: Professional Indemnity Insurance Policy. Eligible spend with MIGA is calculated on the total of the base premium and membership fee (where applicable) and after any government rebate, subsidies and risk management discount, excluding charges such as GST, Stamp Duty and ROCS. Qantas Points will be credited to the relevant Qantas account after receipt of payment for an Eligible Product and in any event within 30 days of payment by You. Any claims in relation to Qantas Points under this offer must be made directly to MIGA by calling National Free Call 1800 777 156 or emailing clientservices@miga.com.au. © October 2023