NSW Dr November/December Issue 2023

THE NSW

VOL 16 - N 06 -NOVEMBER/DECEMBER 2023

doctor

THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION OF NSW

HEARING CLEARLY Can AI close the gap?

WOMEN IN LEADERSHIP Addressing the gender disparity GENERATIONS OF AMA Our oldest & youngest members share their experiences

WILL THE DOCTOR SEE YOU NOW?

The inquiry into healthcare funding

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WHAT’S INSIDE FEATURES The Special Commission of Inquiry into Healthcare Funding

What does it mean and how is AMA (NSW) responding?

8

Generations of the AMA

Memories, triumphs, hopes & dreams. Some of our oldest & youngest members swap stories

13

13

After the Rain

How the doctors of Lismore & Ballina are faring nearly two years on from the devastating floods

20

Technology tackling Australia’s hidden health problems Can AI solve the endemic hearing issues in remote Indigenous communities?

24

Is music the key to memories?

Finely tuned therapy helping dementia patients & their carers

Women in leadership

29

Addressing the gender disparity in healthcare

24

27

Tobacco & vaping legislation

31

AMA lobbies the federal government

Birth Trauma

32

AMA (NSW) addresses the NSW Upper House Inquiry

Health Heroes

Meet three amazing doctors from The Children’s Hospital at Westmead

Sexual Discrimination and Harassment Employers’ positive duty

36

34

REGULARS

40

President’s word: Preventing a Death Sentence

5

From the CEO: As You Support Us, We Support You

7

Events: A Night For the Profession gala dinner

40

Member benefits: Exclusive corporate partner deals for AMA (NSW) members

46

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EDITOR’S WORD

PRIORITISE YOURSELF ONE OF THE GREAT JOYS of my job is getting to know the remarkable members of AMA (NSW). The nondoctors on staff have a saying “Doctors must secretly have more hours in their day than we do.” It’s a joke of course but it is true that doctors seem to cram more into their days than many others do.

This is borne out in our article featuring some of our oldest and youngest members. As their careers progressed, the long hours and relentless demands were simply absorbed by older members.

Before they’ve embarked on their working lives our younger members named work/life balance as something they expect to be a very difficult juggle as they push themselves to help others, while putting in long work hours as well as necessary study to further their careers.

At the end of her first year of university, 18yo Gayathri Anand imparted the following advice to those who follow “…. develop healthy habits, such as participating in extracurricular activities, to maintain a balanced work-life dynamic. Prioritise yourself: take breaks, ensure adequate rest, and seek support when needed. This journey is a long marathon, so be sure to enjoy along the way.”

Here at AMA (NSW) we have been featuring a series of health hacks for doctors and their patients. With such seemingly gloomy skies hanging over doctors at this juncture we thought it was worth sharing their

colleague’s positive tips; • Battle a sedentary lifestyle. Do five squats in between consultations or every 15 minutes when you’re on a screen. Do exercises while watching tv and stretch during other moments like brushing your teeth • Four minutes of daily cardio is enough to improve life expectancy • Go for weekly brisk walks with like-minded friends for physical and mental health • Lay out healthy breakfast options the night before so you don’t skip breakfast • Have an accountability partner to ensure you’re keeping up your healthy habits • Set a monthly reminder to reach out to friends and family to ensure you keep up vital social contact • Make social media content patients can refer to if they have questions after a visit • Get gardening. It helps with psychological distress and improves cognitive function.

We’d love to hear your health hacks. We also welcome letters to the editor. Please email me at rahni.sadler@amansw.com.au

Rahni Sadler, Editor rahni.sadler@amansw.com.au @rahnisadler www.facebook.com/amansw

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PRESIDENT’S WORD

URGENT ACTION TO PREVENT A DEATH SENTENCE FOR A NEW GENERATION Respiratory health is a subject that is close to my heart, as is the firm belief that prevention is the best form of healthcare.

Dr Michael Bonning President, AMA (NSW)

We need a unified strategy across all jurisdictions to tackle the rise in nicotine addiction from vapes.

President@amansw.com.au @michaelbonning www.facebook.com/amansw

AUSTRALIA HAS BEEN WAGING a protracted though ultimately successful war on nicotine for decades, but we’ve now reached a crisis point where we risk exposing our young people to the ravages of nicotine addiction experienced by generations preceding them.

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 as a result of the AMA’s advocacy and tireless stakeholder collaboration.

Reliable evidence continues to grow, finding that vapes cause harm and are not safe or effective smoking cessation tools.

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 (EVALI), burns, cough, dizziness and nausea.

Terrifyingly, we don’t know what these products will do long term.

While manufacturers have claimed their products are therapeutic and made to help people quit smoking, none has registered its products on the Australian Register of Therapeutic Goods. Doing so would allow proper evaluation of safety and efficacy and would not have required the complicated reforms we are now working through.

Sales regulation is the responsibility of the states and territories, but it is

not well enforced.

Thankfully, in May, Federal 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 AMA advocacy, and we eagerly await their implementation.

In October I conveyed the AMA’s concerns about vaping at the Senate Community Affairs References Committee hearing into the Public Health (Tobacco and Other Products) Bill 2023. You can read more on page 31.

I also met with the head of the TGA to support its actions on vaping and be briefed on new developments.

Further to this AMA (NSW) made a submission to the NSW E-cigarette and compliance inquiry, where I am expected to give evidence.

In the lead up to my appearance at the inquiry I would appreciate any input from members of their experience of seeing patients who vape, the issues vaping causes for patients, and the ways in which you and your colleagues deal with the issue. Please email magazine@ amansw.com.au. We cannot make the same mistakes we made with conventional cigarettes. dr. amansw.com.au I 5

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FROM THE CEO

COURAGE AND RESILIENCE As you support us, we support you.

Fiona Davies CEO, AMA (NSW)

All of this work in supporting the medical profession would not be possible without the support of our members who contribute to ensure that we are strong and vibrant in standing up for the medical profession and our patients.

REGULAR READERS of the Sydney Morning Herald will be familiar with the delightful “The Two of Us” column. I particularly enjoyed a recent column which featured NSW state treasure, Dr Albert Shun and his equally impressive wife Petula Shun. In the article, Irish-born Petula talked about one of the neighbours who on seeing Dr Shun mowing the front lawn assumed he was the gardener. The neighbour thought that it was only “the Irish girl” and her children who lived at the house, because he so rarely saw Dr Shun.

This story resonated with me as the wife of a doctor who has had many discussions with our neighbours, all of whom comment about the hours my husband works. The demands of medicine have become even more pronounced as so many other professions have discovered more flexible work arrangements following the pandemic. While the demands of private practice are significant, it has been public hospital work that has experienced the greatest impact.

Public hospital work brings with it on-call demands and the need to fit in work when the hospital can accommodate them. It is the families of these doctors who pay a hefty price.

As you will see from the survey of doctors undertaken for the AMA (NSW) submission to the Special Commission of Inquiry (SCOI) into Healthcare Funding, this burden is growing larger. Many doctors are also deciding that the personal price is too high or are looking to limit their rostered time in the public system.

In preparing the AMA’s submission,

we wanted to draw out and highlight the value that doctors bring to our public hospital system and the impact on patients arising from the lack of doctors. We know there will be many competing demands for resources arising from the Special Commission process.

It is our job to provide thoughtful, well-reasoned advice. I would like to thank Dominique Egan, our Director of Workplace Relations, for bringing her extensive legal expertise to the AMA (NSW) response.

It is this expertise from Dominique and her impressive Workplace Relations team that has provided so much value to our members. From hospital issues to private practice concerns, our team of experts bring value to our members every day and provide services that I am incredibly proud of.

All of this work in supporting the medical profession would not be possible without the support of our members who contribute to ensure that we are strong and vibrant.

As you support us, we support you, Dr Albert Shun and all of the state’s doctors in securing the best possible outcome from the SCOI. On behalf of myself and all the staff of AMA (NSW), we thank you for your work throughout the year and wish you and your families a safe and happy festive season and new year. dr. fiona.davies@amansw.com.au @FionaDavies8 www.facebook.com/amansw

amansw.com.au I 7

WILL THE DOCTOR SEE YOU NOW?

The Special Commission of Inquiry into Healthcare Funding PRELIMINARY SUBMISSIONS CLOSED OCTOBER 31

AMA (NSW) Councillor Dr Fred Betros is concerned about worsening delays in elective surgery.

8 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

FEATURE

“Currently there is a dire shortage as VMOs are drawn away from the public system due to the poor working environment and disrespect.

The flow on effect is a worsening of delays in elective surgery.”

Dr Fred Betros, General Surgeon

IT WAS A KEY ELECTION PROMISE by the Chris Minns led Labor Party, and the first announcement by the new NSW Premier and his new Health Minister Ryan Park after their swearing in – a Special Commission of Inquiry to review healthcare funding in NSW. “It’s a priority of mine because it will provide an opportunity to examine how we are allocating precious taxpayers’ dollars,” Chris Minns said at his first press conference as Premier, held at Liverpool Hospital.

Prior to the formal announcement of the the Special Commission of Inquiry into Healthcare funding (SCOI) State Treasurer Daniel Mookhey spoke at a function held by the Health Services Union (HSU).

In response to a question about the funding of Visiting Medical Officers (VMOs) Mr Mookhey said “I was surprised to learn that we’re about to tip over to a billion dollars per year. We spend more per capita on VMOs than Queensland and WA which have a more dispersed health system and you make the

point that that is a system that needs to be looked at for savings.

You make the point that there’s a better way of doing it and I 100% agree with you on that one and that is something we’re looking forward to working with and making specifically part of the commission of inquiry to look into because I get about how much reform needs to happen in that space.”

AMA (NSW) President Dr Michael Bonning sought to clarify the issue “The treasurer recently stated that VMOs cost the system $1 billion a year. We don’t know where this figure came from, but it is wildly inaccurate. It appears he conflated the costs of locums and VMOs.” AMA (NSW) Councillor Dr Fred Betros told reporters it was an unfair attack on already worndown specialists: “VMOs are specialist practitioners engaged as contractors in public hospitals, usually for five-year terms, often served back-to-back. Many have been working for decades in the same community.

“Locums are engaged to meet

“I am a part of a specialist service in remote NSW and we are completely dependent on VMOs. Without them the service would cease to exist and there is no local alternative. It is difficult enough trying to recruit specialists to the bush and by discrediting our entire VMO workforce the government has simply made it impossible.“ AMA (NSW) 2023 survey

“At one stage we tried to find a locum but could not find one with the requisite experience.

So, we just worked harder ourselves.“ AMA (NSW) 2023 survey

short-term needs – like periods of leave or immediate demands where there is an uptick in activity.

Due to outdated industrial arrangements, locums have become an expensive part of ‘business as usual’ in our hospitals.

“Currently there is a dire shortage as VMOs are drawn away from the public system due to the poor working environment and disrespect. The flow on effect is a worsening of delays in elective surgery,” Dr Betros said.

“It should be noted that other than the ACT (and very limited numbers in Victoria and Queensland), NSW is the only state or territory in which VMOs in the public hospital system are independent contractors therefore making comparisons with other amansw.com.au I 9

FEATURE

“Our pay rate is one of the worst in the country and this is affecting the ability to attract and retain staff. We do not get paid for any overtime which is preposterous given the hours we spend at work when on call / after hours.

This needs to change.”

AMA (NSW) 2023 survey

states is obsolete and misleading.”

Faced with the reality of the inquiry, AMA (NSW) has done what it always does – taken the best advice on how the inquiry would be conducted and how best to influence the outcomes. AMA (NSW) Director of Workplace Relations and veteran of many legal and policy battles, Dominique Egan, took responsibility for preparing the submission.

AMA (NSW) has engaged HWL Ebsworth Lawyers, led by partner Scott Chapman and Kate Richardson SC. Mr Chapman started his career working on the 1990s VMO disputes. Ms Richardson SC has appeared before many inquiries, those recently have included the Folbigg Inquiry in NSW and the Lehrman Inquiry in the ACT. Preliminary submissions to the SCOI closed on October 31. As the peak medico-political organisation for the medical profession of New South Wales, AMA (NSW) has welcomed the opportunity to participate in and assist the inquiry.

“The key issue for AMA (NSW) and its members has been the absolute crisis in medical workforce, not only in rural and regional areas but also our metropolitan hospitals. Doctors have been telling us of lists not able to run and patients not able to be seen because there are no doctors available,” Ms Egan said.

Dr Kathryn Austin, Staff Specialist Obstetrician and AMA (NSW) Vice President said: “I work at Royal North Shore Hospital, one of the better

resourced and staffed hospitals in NSW. Every shift is short staffed, every one of us is talking about the fact that we are having to take on more and more - without any additional payment. Every one of us is talking about whether it is still worth it, even when we love what we do and we love our patients.

“As a Staff Specialist, I know patients don’t see a difference between a VMO, a locum and a Staff Specialist. To the public, we are all doctors and the HSU seems intent on undermining the support of award review for all doctors. This

“Workforce is leaving public healthcare as after-hours work is not paid or recognised- we run 6 operating theatres every weekend and 8 every evening to do planned and unplanned work. This has increased 200% over the last 10 years. The award is not fit for purpose.“ AMA (NSW) 2023 survey

10 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

is why the AMA is responding so strongly on this issue,” Dr Austin said.

Dr Sanjay Hettige, doctor in training and AMA (NSW) DiTC Cochair said: “Workforce and morale are now the most critical issues being talked about by doctors in training (DiTs). DiTs know NSW has some of the most outdated awards and the worst rates of pay, despite some of the highest costs of living – not just in metro areas but in our regional centres.” Dr Hettige said: “This is driving active discussions about why bother working in the public health system.”

Dr Jacqueline Ho, doctor in training and AMA (NSW) DiTC CoChair said: “AMA (NSW) has used the submission to highlight the impact of poor terms and conditions on patients and our health system, not just DiTs. As DiTs, we see and learn from our seniors. When we see them burned out and feeling undervalued, we don’t plan our careers around staying in the public hospital system. When we are paying off massive debts, we avoid specialities such as psychiatry and general practice where we feel we won’t ever recover financially.

Locuming or moving interstate after finishing training becomes a really attractive option. It could take a generation to change these views and fix this crisis.”

To inform the submission AMA (NSW) surveyed members working as or who had worked as VMOs and Staff Specialists in the public hospital system. Of the 752 survey respondents, 386 were appointed as VMOs, 252 employed as Staff Specialists, 71 were appointed as a VMO and employed as a Staff Specialist and the remainder were no longer working in the public hospital system.

Our survey respondents, many of whom have worked in the public

FEATURE

hospital system for more than 20 years (38%) and 25% of whom have worked in the system for up to 10 years, told us that 57% of their department was comprised of VMOs and Staff Specialists, 27.5% of their departments were comprised solely of VMOs and 15.5% solely Staff Specialists.

AMA (NSW) is hearing from members across the state that recruitment is difficult. Assuming the hospital is agreeable to recruiting additional consultants, the urgent need for industrial reform makes recruitment difficult. 81% of survey respondents said they had tried to recruit additional consultants in the last two years. Of those, recruitment had been successful in 57% of cases, unsuccessful in 24% of cases, and of the remaining 19% the outcome was variable with many indicating they had been unable to recruit for the full FTE being sought, thus recruitment was only partially successful. Others said they were required to reduce their clinical commitments to advertise for an additional consultant.

We asked why locums were engaged (or sought after), 33% said it was to cover planned leave and 15% to cover unplanned leave.

21% indicated that locums were engaged as a part of business-asusual service provision, and 12% for wait list reduction work.

AMA (NSW)’s submission called for urgent reforms to ensure doctors staffing the state’s hospitals were paid at a reasonable rate and guaranteed appropriate working conditions noting: “The current workforce is exhausted due to chronic understaffing. In addition, New South Wales doctors are amongst the lowest paid in the country, as the government continues to fail to address the need for reform of terms and conditions.

Award and contract conditions must be updated to attract and retain the best and brightest in our public hospital system.”

Dominique Egan said: “It remains entirely unclear how the Ministry of Health and Local Health Districts account for locum expenditure and whether it has captured VMO fees.

AMA (NSW) has made it clear in its submission that it is critical that there continues to be VMOs and Staff Specialists in the public hospital system and that locums have an important role. The submission emphasised that simply cutting or ending all VMO and/or locum arrangements would bring the public hospital system to its knees.”

Dr Michael Bonning said: “The NSW Health system and all who work in it showed incredible resilience and capacity to meet overwhelming challenges in response to the biggest health threat in a generation. They are the ones who know what to do so why not listen to them”. Cuts are not what we need now. As the Commonwealth is negotiating the National Health Funding Agreement, the Minns Government should be standing up for NSW hospitals and demanding greater funding.’’

Dr Kathryn Austin added: “As a consultant starting out in my career, it was important to me to have a role in our public hospital system.

The public hospital system is the only place we can provide the highest level services to the families experiencing the most difficult pregnancies. This is why we give up so much time with our familes, we do it for our patients. But when we can’t access basic entitlements like our TESL and where our work is not recognised and supported, it makes it hard to stay.”

As this is the preliminary submission of AMA (NSW), further submissions will be prepared in coming months. dr.

You can read AMA (NSW)’s submission at healthcarefunding. specialcommission.nsw.gov.au/ submissions/

“I was on call last week for four days straight. I provided care during the day. I had elective operating lists - clinics - in the mornings and emergency operating in the afternoon. I was required to attend the hospital. I was called at 11pm and then at midnight and then we prepared the operating theatre.

I operated on an emergency surgery at 2am. That surgery took me through until 6am .... I went home and was back at 8.30am ...That is what on-call surgery is and as the senior consultant you have to be there.”

AMA (NSW) 2023 survey amansw.com.au I 11

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FEATURE

OLDEST & YOUNGEST It was back in 1880 that AMA (NSW) began advocating for the doctors of this state, as the newly created NSW branch of the British Medical Association. Thousands of doctors have enjoyed the benefits of membership over generations. We thought we’d check in with some of our oldest and youngest members and share their experiences with you.

amansw.com.au I 13

FEATURE

DR (FRANCIS) HARDING BURNS, 98 ESTABLISHED THE FIRST UNIT FOR ALCOHOLISM AT BOTH ROYAL PRINCE ALFRED HOSPITAL, SYDNEY IN 1975 AND CONCORD HOSPITAL IN 1985

Dr Francis Harding Burns MB BS (Hons) 1948 FRCP (Lond) FRACP FAChAM, established the first unit for Alcoholism at both Royal Prince Alfred Hospital, Sydney in 1975 and Concord Hospital in 1985.

His early studies of emergency patients formed the basis for further research into indicators of problem drinking. In 1996 he received the Medal of the Order of Australia for his services to medicine.

What made you want to be a doctor?

My father was a country doctor and my mother was a nurse. From an early age they were keen that I become a doctor. I’d been dux of

my school and I was going to go to university and do classics but I didn’t get the grades.

I got a Commonwealth scholarship to study medicine at Sydney University where I started in 1943. I had a real struggle to find myself in the first two years of medicine, whereas a lot of the people just seemed to sail in and take it much better.

How did you end up focusing on alcohol dependence?

Initially I was a general physician.

I worked in the Diabetic Centre where I was particularly interested in hypoglycaemic agents. Later my clinical research interests became drug and alcohol related and in 1975 I was nominated to head the newly formed Alcohol Unit at RPA, which later became the drug and alcohol unit. I helped set up another one at Concord Hospital.

How did your colleagues respond?

It was a relatively new field and one which took time to find its place in the medical system. Early on I published a study which looked at a big cohort of admissions at RPA and analysed them for drug related problems. The incidence in all these other people, cardiology and diabetes and gastroenterology was high. No one was really doing anything about that. So, I offered myself as a consultation service to go around and see the people with substance problems.

Then my colleagues and I launched ourselves into early intervention and harm minimisation programs which

14 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

were somewhat novel here in Australia.

How did you gain the experience and understanding to deal with these issues?

Largely thanks to information we gathered overseas. I was a member of the World Health Organisation Collaborative Project on the Identification and Treatment of Persons with Harmful Alcohol Consumption. We developed AUDIT (Alcohol Use Disorders Identification Test) which is now the most widely used screening instrument for alcohol problems in all clinical settings.

I brought back not just the Audit program but naltrexone and also the whole idea of biological markers to pick up whether someone’s been using. Had I not gone, I suppose we would have gradually heard about those things but they would have been delayed a long time here in Australia.

With the Alcohol and Drug Foundation we pushed through money to have an education program at every medical school in Australia for courses on substance use.

Of what are you most proud?

I guess I was pleased and gratified by the sort of esteem with which I was regarded. I was proud that I’d survived as long as I did with the people I did, and I was very proud of the support of my wife and my family.

What did the AMA mean to you?

Both my parents were strong AMA supporters. I joined the AMA soon after I graduated. I was nominated to go on the council at NSW but I was unsuccessful which I was disappointed about but I had very useful contacts through the AMA which helped me enormously. I was very impressed by the programs they put on for people renewing registration and by their advocacy.

I continued my full registration until about ten years ago.

FEATURE

DR. MARK KILLINGBACK, 93 A PIONEERING SPECIALIST COLORECTAL SURGEON

What inspired you to do medicine?

I was born into a working-class family in Merrylands NSW in 1930 and later graduated from Gosford High School. I wanted to become a psychiatrist and enrolled at the University of Sydney. In 4th year a visit to a psychiatric hospital caused me to lose interest in this specialty.

After graduation (1954) I spent two years as an RMO in Sydney and then Hornsby Hospital where I developed an interest in surgery.

In the 1950s it was necessary to travel overseas to seek experience and qualification.

My wife and I travelled to the UK in a rusty old cargo ship of 12,000 tons with 12 passengers. My position was that of ship’s surgeon valued at one shilling per month. In the middle of the Indian ocean a crew member developed acute appendicitis.

It was necessary to perform an appendicectomy. The procedure and outcome were successful despite the inexperience of the surgeon.

An important aim of the journey to London was to attain the fellowship degree of the Royal College of Surgeons. The pass rate of the final exam was about 15%. After 3 years of hospital duties and study, this hurdle was negotiated in 1960.

How did you become involved in colorectal surgery?

5 years in four hospitals provided the opportunity to learn the craft of surgery. The most influential was the St. Mark’s hospital which specialised only in diseases of the colon and rectum. The remainder of my career was determined.

Returning to Sydney in 1961, I was

fortunate to join the Edward Wilson unit at Sydney hospital which in 1970 became the first colorectal surgical unit in Australia.

You were the first surgeon in Australia to practice exclusively as a colorectal surgeon, what was the reaction?

In 1976 I converted my general surgical practice to colorectal surgery exclusively which at the time was not popular with many of my supporting GPs and surgical colleagues. A few general surgeons remained frankly antagonistic.

The history of surgery in Australia shows there was always significant opposition to the fragmentation of general surgery, for example orthopaedics and urology in the 1930s.

What are the best parts of colorectal surgery?

There is much satisfaction in all forms of surgery as well as extreme disappointment when unexpected morbidity and mortality supervenes.

Radical pelvic surgery while avoiding a permanent colostomy can be a special skill of the colorectal surgeon. Would I do it all again? The answer is yes, but surgery will be much different in the next life. Will surgeons be excising cancer or will the oncologist with drug therapy be more important to patients?

What made you join the AMA? I joined the AMA in my year of graduation. I thought then as I do now that it is a medical body that provides the profession with general medical information, representation, professional guidance in the practice of Medicine and protection from political interference.

“In the 1950s it was necessary to travel overseas to seek experience and qualification.”

Dr Mark Killingback, AM,MB,BS,MS(Hon),FRACS,FRCSEng, FRCS (Ed),FACS (Hon) amansw.com.au I 15

FEATURE

DR CORNELIA WHITEHOUSE, 91 ONE OF AUSTRALIA’S FIRST FEMALE OPHTHALMOLOGISTS

What inspired you to do medicine?

I did fairly well at school. I was dux of North Sydney Girls high school. At that stage, girls were leaving school when they were 15 to learn how to type or do housework. I said I wanted to be a doctor and everybody said “Oh, no. You can’t possibly do medicine. It’s too hard.” And I said, “Just watch me!” Fortunately, my family were right behind me and said, “Go right ahead”.

How has medicine changed since you began practicing?

Back then there were no antibiotics and surgery was fairly barbaric. You had scalpels and needles that you had to boil and sharpen.

At the first cataract operation I participated in I had to stand on a stool and shine a torch onto the eye because that was the best light a surgeon could get. We didn’t even have gloves because there were no gloves that were fine enough to let you know what you were doing.

I remember the first time I used a microscope it was magical because suddenly you could see bits of the eye that didn’t exist for you before except in textbooks.

Penicillin came into use and it was a wonder drug. Nowadays you have, you know, 50 or more antibiotics you can choose from, and you know what they all do, and they all work well. It was different then. I mean, nothing for hypertension. You went on a salt free diet and that was it.

What was the best thing about Ophthalmology?

What I liked about cataract surgery was that you removed a cataract and you saw your patient the day post op, and they had this big smile.

And then you saw them a month later and they still had the big smile.

It’s a life changing experience for them. That was very rewarding.

What was the best advice you ever received?

My mother kept saying “Make sure that this doesn’t take over your personality because you’re you.

You’re not a doctor. You’re you acting as a doctor.” That was very important, I think. Firstly, it stopped

me getting a swelled head. But when I retired it meant that that wasn’t the end of me being me. It meant I dropped the doctor bit and got on with everything else.

What makes you most proud of your career as a doctor?

I wasn’t that proud really. That was just what I did like everybody else.

I mean it’s just like plumbing it’s just a bit more delicate. Sure, you have to be a lot more careful and every detail matters but it’s still a bit of a repetitive thing.

Why did you join the AMA? I’ve been a member since I started medicine. It makes me feel like part of a group.

I remember the first time I used a microscope it was magical because suddenly you could see bits of the eye that didn’t exist for you before except in textbooks.

16 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

Dr Cornelia Whitehouse and her husband, Frank Sils in Switzerland

FEATURE

Gayathri (Gia) Anand pictured with Dr Francis Harding Burns MB BS (Hons) 1948 FRCP (Lond) FRACP FAChAM

GAYATHRI (GIA) ANAND, 18 1ST YEAR UNIVERSITY STUDENT

What inspired you to do medicine?

Growing up as a kid in India I was always fascinated with science.

I was a geek who from an early age, if someone had a sickness or disease, I would search it up and go through treatment. In India we have this thing called young doctors’ camp. You do it for two months during summer break. You shadow a doctor, assisting them, talking to patients. Through the camp I understood it’s not just about curing diseases or diagnosing them, it’s also about compassion and communication with patients.

How have you found your first year of university?

Sometimes when I’m studying, I feel overwhelmed and extremely stressed and I start questioning

myself. But I remember to adapt because I feel everyone has this passion within themselves which they must carry. I came all the way across from India to make it here.

That’s what motivates me.

My parents trust me enough to send me here. I can do this.

What advice would you give to incoming university students?

I would encourage students to develop healthy habits, such as participating in extracurricular activities, to maintain a balanced work-life dynamic. Prioritize yourself: take breaks, ensure adequate rest, and seek support when needed.

This journey is bound to be a long marathon, so be sure to enjoy along the way. Good luck!

What do you think the best and worst things will be about working as a doctor?

The best thing is you get to change lives and you keep learning new things. Sacrifice comes with success. I feel if you’re a new intern

it’s definitely going to be hard to manage work/life balance. It might be quite depressing at the beginning. I hope over the years you just get used to it and hopefully manage the balance better, recognising schedules don’t always go to plan.

Why did you join the AMA? What I like is that you don’t just have doctors, you also have medical students. At my stage this is the best part because if you’re doing medicine and you’re not in residency yet you get to join a group of people you can relate to. I’ve seen gatherings and group stuff and that’s really nice. The discounts are really cool too. dr.

I understood it’s not just about curing diseases or diagnosing them, it’s also about compassion and communication with patients. amansw.com.au I 17

FEATURE DHNANJAY SOUNDAPPAN, 23 FINAL YEAR MEDICAL STUDENT, LIVERPOOL HOSPITAL What made you go into medicine?

I always liked the academic aspect and the fact it is a dynamic field.

Ultimately it is such a privilege to care for people at the hardest moments of their life.

Have you chosen a specialty?

I’ve always leaned towards a physician aspect and I think cardiology but recently I’ve been thinking about my role as a doctor.

What can a medical degree do outside of the hospital? I’m really interested in things like public health and digital health. I don’t even know if I want to finish all of my training.

I think I want to start doing things that look at the healthcare system on scale.

What do you think will be the greatest

challenges of life as a doctor?

Work life balance. I think we always want to do what’s best for others even if that means pushing ourselves. Finding that balance when you want to do so much and achieve so much and help so many people, will be probably one of the hardest parts of my career.

How could the medical system improve for doctors?

From what I’ve seen as a student there always seems to be a lot of logistical things that get in the way of doctors doing the work that they want to, and there’s a lot of inefficiencies in the way they have to do their tasks. I feel like most doctors are time poor and their attention is always drawn towards

WAITING IN THE WINGS:

17-YEAR-OLD MAXIMUS POLLARD Maximus Pollard just finished year 12 at Wadalba Community School on the Central Coast. He plans to study medicine and has already applied to join AMA (NSW).

What inspired you to choose medicine as a career?

When I was little, my mum bought me lots of books and one was on the human body. I always thought it was the most fascinating thing ever.

Then in year six, my dad got diagnosed with amyloidosis, and he passed away at the end of year seven. It was a really rare disease and that made me want to learn everything about it. Ever since, I’ve been really interested in learning about nutrition and lifestyle, and how it affects cancer rates and diseases and how you can reduce them.

Do you have a specialty in mind?

I was thinking internal medicine in a hospital.

Why do you want to join the AMA? The best thing is the connections and getting in touch as a student, giving me resources to help and building industry connections. I thought it would be good to get that support and have outreach to other doctors.

I believe it’s not always what you know, but who you know. It’s all good and well to have an education and whatnot but if you don’t have those connections or people skills you can’t do as much.

What does the AMA mean to you?

The most important thing is it gives

18 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

a lot of menial tasks that’s stopping them from seeing patients as long as they want to.

What do you believe will be your greatest strength as a doctor?

Patients are so much more than just what they’ve come in with. I think taking the time to care about them as a person and consider what matters to them will hold me in good stead. I just care a lot.

Why did you join the AMA? AMA was always something I knew I was going to join because they were involved in advocacy for doctors and I especially like the things they do for doctors in training. I think it’s all about the representation. And if it’s a body that’s representing the medical workforce, I think you need the workforce to join. Inherently having more people as part of that organisation, I think does them more benefit because their views and their interests are being represented.

doctors more of a voice - strength in numbers. When it comes to pushing for policies or for help from government or others, if you have a strong united organisation, you can achieve so much more.

You’ve applied to be a member of the AMA before you’ve even been accepted into medicine, why?

I always try and put my foot in the door for everything. I put my hand up for anything because you just never know where it might lead… or what things that can help you with and get you places in life. dr.

Maximus Pollard and his mother Victoria

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FEATURE

AFTER THE RAIN How the doctors of Lismore and Ballina are doing nearly two years after devastating floods.

10 November 2023: Left to right Dr Vicki Liu, Dr Hilton Koppe, Dr Peter Leck, Dr Kerrilee Lake and Dr Nina Robertson celebrate surviving the floods.

Image: Sue Velovski.

“We needed organisations like AMA (NSW) to take leadership. We couldn’t advocate for ourselves as single practices, it was ineffective... We absolutely more than ever value the AMA.” Keen Street Clinic co-owner Dr Nina Robertson FROM CLEANING DIRTY WOUNDS in a BP service station and improvising medical procedures in evacuation centres, to enjoying a beer, a band and a tentative sense of hope, doctors in Lismore and Ballina have made a remarkable turnaround.

Before the Northern Rivers floods, Lismore’s Keen Street Clinic was bustling, busy and booked out.

Lismore was battling the pandemic along with the rest of the world and Keen Street Clinic was administering numerous Covid-19 boosters for residents eager to mingle after lengthy lockdowns.

“Before the floods we were very busy, we serviced 8,000 patients and were always fully booked doing Covid vaccinations and winter flu vaccinations” Keen Street Clinic coowner Dr Nina Robertson said.

As the town looked optimistically to greater normality after the peak of the Covid crisis, in February 2022 mother nature dealt a devastating blow. Torrential storms delivered hundreds of millimetres of rain.

Lismore was underwater.

It was Australia’s worst natural disaster since 1974’s Cyclone Tracy.

Once the floods hit, 18,000 people

20 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

Carrington Street, Lismore. March 2022 Courtesy Brendan Bernie in the town lost access to their regular GP. “The other clinic in town serves 10,000 patients and Lismore’s population is 40,000 so almost half of the town’s residents didn’t have access to their doctor. This was a frightening time for the town, no one knew what to do and we had to step up as health professionals” Dr Robertson said.

FEATURE

“The newly renovated building is just beautiful.

The fresh paint smells amazing, and I love practising in these new rooms. Had the flood not happened, would we have been able to renovate? Probably not.”

Keen Street Clinic co-owner Dr Nina Robertson

Dr Gudmundsen saw his patients out of smaller clinic rooms in St Vincent’s Hospital.

Image: Arli Kennedy When the water drained, they found all their equipment covered in a thick, slippery layer of mud.

Their technology, computers and backups had been destroyed.

Doctors from Keen Street Clinic set up a voluntary medical service at Southern Cross University Evacuation Centre.

“We were at our worst about 3 weeks after the flood when we really had nowhere to go. We were all working in evacuation centres but there was no proper set-up” Dr Robertson said. “It was all improvisation which was just ridiculous, we thought we were prepared” she said with a laugh.

“We did our best but how good can you be with no computers, no technology, we were handwriting scripts on paper, old style, which was tricky as we didn’t have access to medical records, it was a major emergency situation.”

Dr Sue Velovski, Specialist General Surgeon from Ballina describes her makeshift facilities at a Ballina service station.

“I was helping out at the local BP, where many residents were staying in their motor homes. I was cleaning people’s dirty wounds and assisting people with their medications, doing the best I could to help the community,” Dr Velovski said.

“No food could come into Ballina and the local fast-food restaurants were closed so people started fighting over the last drops of coffee at the BP and it started to get a bit dangerous.”

Dr Velovski recalls the frustration of watching politicians and the media coming in and out of town.

“Locals had lost their houses, but we had morning tv hosts coming in and staying at the resort just out of town. They didn’t have to stay to smell the daily stench, or clean up the mud, or see the local cafes filled with mud to the ceilings and watch them clean it out and open again within 3 weeks.”

Dermatologist Dr Ken Gudmundsen particularly felt the pressure, as his practice is one of just two dermatology clinics in the entire Northern Rivers region.

As a result of the extensive damage to his practice, he was forced to close his doors for three months, then began seeing patients from temporary rooms at St Vincent’s Hospital, Lismore, where he is still practising today.

Dr Gudmundsen said “We were lucky to find a place to re-open our clinic because a local surgeon was retiring from St Vincent’s Hospital.

The rooms are a lot smaller and we haven’t been able to offer all the

services we used to offer, like phototherapy.”

“However, we were grateful to have the opportunity, as the utter destruction of our rooms downtown meant too long of a wait for repair.

After 18 months we built back up to the situation where we could see almost as many patients as before the flood.”

Today Lismore’s Keen Street Clinic has been renovated and Dr Robertson has a more positive outlook and says she feels close to normal again.

“It is never going to be the same, but we are busy. Flood recovery is a very long process, but my partners and I feel optimistic that the clinic has a long-term future again.”

“The newly renovated building is just beautiful. The fresh paint smells amazing, and I love practising in these new rooms. Had the flood not happened, would we have been able to renovate? Probably not.”

Valued equipment was ruined in the floods.

Image: Ken Gudmundsen. amansw.com.au I 21

FEATURE

The situation in Lismore is a demonstration of the reality of advocacy - that it is a battle and is usually met with silence.

September 2023: Keen Street Clinic has been fully refurbished after the 2022 Floods.

Image: Lisa Gough

Keen Street Clinic has also been able to hire new staff, including a new nurse, registrars and GPs in training who are now providing much needed assistance to the clinic. Some staff who had left have now come back.

Dr Nina Robertson and Dr Ken Gudmundsen explain that they wouldn’t be where they are today without AMA (NSW).

AMA and AMA (NSW) held an emergency summit in Lismore in September 2022 to call for immediate funding from the government for affected medical practices.

“AMA (NSW) was able to bring together so many health organisations, health practitioners, politicians, and the media to advocate and draw attention to the issue” Dr Gudmundsen said. Dr Robertson recalls the efforts by AMA (NSW) CEO Fiona Davies “It was so refreshing to have someone like Fiona step in. It was like having an adult walk into the room who could come in and see things clearly.”

“She understood immediately that we were being treated as businesses rather than part of the healthcare system. She has been the advocate for all affected

healthcare businesses” she said.

Dr Gudmundsen adds “Fiona was steady, professional, and wise through the really hard times. She was quick to act once she realised our desperate situation and continued to move forward with perseverance and patience.”

“The summit was the first time that I felt the important people really cared enough. It was a hugely emotional day for me” he added.

AMA (NSW)’s Fiona Davies said “The hardest thing about advocating to government was that everyone was saying that it was someone else’s problem.

The state government said, ‘it’s not our problem’ and the federal government said, ‘we don’t want to take this on’.”

10 November 2023: New Interns gathered with the Northern Rivers Doctors Network, despite having no accommodation in the area.

22 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

The situation in Lismore is a demonstration of the reality of advocacy - that it is a battle and is usually met with silence.

Dr Gudmundsen explains the way he felt battling alone for almost a year. “It was hard to come to the realisation that state and federal governments have a very poor ability to respond to disasters and specifically do not appreciate the significant need for private medical practices in small towns, whose staff are at the frontline of keeping patients cared for as part of the response to the disaster.”

“The slow and reluctant government financial response has taken a toll on me mentally and financially that is unfortunately irreparable” he said.

By February 2023, struggling health professionals of the Northern Rivers region finally received half of the long-awaited grant funding from the Commonwealth and the NSW Government. This funding was less than half of what the AMA and other organisations demanded from the government.

Fiona Davies said the funding was achieved through the power of doctors coming together, turning up and presenting their best selves.

“They supported each other, and they showed their distress and frustration about the situation at hand.”

“Advocating for immediate funding was a complex issue. Individuals and medical practices can’t advocate to government on their own, they need to join together to be heard.”

“People think that advocacy looks easy, but it is actually really hard. You

FEATURE

never get the full, desired outcome but you just have to keep advocating. $5 million is better than nothing, that is the outlook that you need to have when advocating” Fiona said.

“We needed organisations like AMA (NSW) to take leadership. We couldn’t advocate for ourselves as single practices, it was ineffective” Dr Robertson said. “We absolutely more than ever value the AMA.” Dr Gudmundsen added “Local politicians Janelle Saffin and Kevin Hogan, and State Labor and Federal Nationals made very important contributions. The NSW Rural Doctors Network and the Medical Benevolent Association of NSW were very kind to me personally and worked with myself and other doctors.”

“The AMA have always helped me when needed, I have been a member for 30 years” Dr Gudmundsen said.

Locals gathered recently to celebrate how far they’ve come since the floods. Organised by

Northern Rivers Doctors Network and sponsored by AMA (NSW), health professionals met at the Seven Mile Brewery in Ballina, and heard from local band ‘Acid Bleed’, with guitarist local cardiologist Dr Adam Blenkhorn.

The night before it poured— reminiscent of February 2022.

Residents arrived very wet with umbrellas, which they all had a laugh about. The ability to breathe and laugh about the rain was relief felt by many.

“In spite of the torrential rain, we came together to celebrate that we made it out alive and we are here, happy today,” said Dr Velovski.

“We were joined by a strong group of doctors, young and old, from residents who had helped us in the floods, to retiring GPs and specialists.”

“The doctors’ group was created in 2017, it is open to all GPs and specialists in the Northern Rivers region. It is an important group and keeps the medical community

“Flood recovery is a very long process, but my partners and I are optimistic that the clinic has a long-term future again.”

Keen Street Clinic co-owner Dr Nina Robertson

Dermatologist Dr Ken Gudmundsen performs his original music and songwriting in Lismore once a month. Image: supplied. looking after each other, and we remind each other that we work together for the benefit of our patients, staff and communities,” said Dr Velovski.

While two years allows for breathing room, Dr Gudmundsen said it’s not champagne and roses in Lismore yet. He got through the hard times by focusing on his hobby of writing songs and playing guitar, to the delight of a foreverbonded community. dr.

amansw.com.au I 23

FEATURE

DRUMBEAT.AI

AN AMBITIOUS PROGRAM TO BEAT EAR-DRUM DISEASE IN RURAL AND REMOTE INDIGENOUS CHILDREN

“Aboriginal children have the highest rates of chronic middle ear disease, with associated hearing loss, in the world.”

WHAT IF YOU COULD FIND a solution to help address one of our most shameful health figures? That’s the aim of an ambitious team using artificial intelligence (AI) to try to solve problems before they begin.

Associate Professor Narinder Singh is a curious mix of farmraised country-boy and selfconfessed computer-geek who has combined a lifelong fascination with technology with his skills as a University of Sydney Professor of Otolaryngology (ear, nose & throat, head and neck surgery) to lead the project dubbed DrumBeat.ai.

He and his team have created an AI algorithm that can accurately detect ear disease, or the potential for it, from a simple image, so that rural and remote Indigenous children can be diagnosed and treated before lifelong damage is done.

“Aboriginal children have the highest rates of chronic middle ear disease, with associated hearing loss, in the world.” Associate Professor Narinder Singh explained.

“Long term ear disease in childhood can have a devastating impact on hearing which results in issues with speech and language development and has lifelong impacts on behaviour, social isolation, poor school performance, reduced job prospects and interaction with the criminal justice system, along with the need for repeated and complex surgical intervention–if that person ever receives a diagnosis or treatment.

“Unfortunately, despite many programs and hundreds of millions of dollars spent on tackling the issue, there has been little progress.

One of the key issues is the lack of access to ENT specialists.”

24 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

A seemingly intractable problem, which Associate Professor Singh felt his particular skill set might have a chance at tackling. He said “I grew up driving tractors and picking fruit after-school and on weekends on our family’s farm near Griffith, in country NSW, with the nearest ENT specialist being a 400km round-trip away in Wagga”.

“When I was 12, I convinced my parents to buy my first computer, a Commodore Vic 20. The entire computer ran on 3.5kb of RAM. It was 15 years before the internet was developed so I had to learn how to program the computer using library books and magazines.

So, you can see how I gained a very strong personal conviction for using computer technology to solve critical health problems for underserved rural communities.”

Associate Professor Singh maintained that passion as he progressed through his medical career and in 2018 began work on melding the two in a bid to make radical change.

“It was a combination of being aware of Indigenous ear disease as a critical problem through ENT, having grown up in the country and knowing the issues facing rural and remote healthcare and then having that background in technology and computers.”

ENT specialists simply aren’t available in rural and remote areas.

Instead, telemedicine has been utilised for Indigenous children in such communities. Local health

workers check the ears, capture otoscope images, perform hearing tests and then store and forward the data for metropolitan ENTs to review.

“While telemedicine has improved outcomes, it has several limitations.

The metropolitan specialist must waste a lot of time looking at normal ear images. There are significant delays between image capture, review and intervention which can result in complications.

Just as importantly there’s a missed opportunity for intervention at the crucial point of contact with the patient and data capture.”

Associate Professor Singh’s group collected a database of images from rural and remote Indigenous children in Queensland and the Northern Territory.

“Our dataset is unique. We have collected 10,000 images, all of them with the associated data—hearing tests, tympanometry and nurse impressions—that have been gathered over a 10 year period, from 93 Indigenous communities. It’s the exact data set from the actual patient population we plan on treating.”

Associate Professor Singh and his team, including a group of computer engineers and data scientists provided by Microsoft’s “AI for Good” program, have refined their AI algorithm through multiple iterations over the last few years.

Pre-teen Narinder with his first computer

“The dream really FEATURE is to close the gap and have no greater rate of ear disease in Indigenous Australians than the rest of our community.”

Associate Professor Narinder Singh, Head of Otolaryngology, Head and Neck Surgery at Westmead Hospital addressing AMA (NSW)’s Night For The Profession.

The algorithm has reached a level of sophistication where, when presented with a random otoscopic image, it is able to make a diagnosis with over 90% accuracy, outperforming individual human ENT specialists.

Additionally, AI allows Associate Professor Singh’s team to undertake novel tasks that even human ENTs are incapable of performing.

“In the latest version of the algorithm we are able to accurately predict the actual level of hearing loss just by looking at the otoscopic image alone. Even more exciting, in the next version of the algorithm, we expect to take completely normal-looking ear drum images and predict which children will go on to develop ear disease, despite having an ear that appears totally normal at the time of review. This will allow us to flag these children for extra attention to prevent such ear disease from developing.”

“So now the next big step is to actually test the AI algorithm in the field. By putting it in the hands of local health care workers we will assess usage and acceptance by nurses, audiologists, patients, their families and their communities.”

“That’ll be about a two-year process in Queensland, the NT and Western Australia, courtesy of a $400,000 grant generously awarded by the Ramsay Hospital Research Foundation. If we find that the AI algorithm actually changes outcomes

in the real world, then it is “Go-Time” to roll it out across Australia.”

“The dream scenario is a smartphone app that can link to a video-otoscope so that end users can put the otoscope into a child’s ear and get an instant, accurate diagnosis.

After deploying throughout Australia, stage two would be to use the same technology in underserved communities around the world; SubSaharan Africa, rural India, etc.”

“Equally, the same technology could be used in developed countries, in general practice, hospitals and emergency departments. If we were able to secure a commercial partner/ sponsor we could develop a product with a philanthropic model such that for every device that is bought, we donate another device to an underserved community.”

“The dream really is to close the gap and have no greater rate of ear disease in Indigenous Australians than the rest of our community.” dr.

Associate Professor Singh and the DrumBeat.ai team wish to acknowledge major support and funding from Microsoft and The Ramsay Hospital Research Foundation, as well as scholarships for Associate Professor Singh’s PhD students from the Passe and Williams Foundation and the University of Sydney and research funding from Avant Mutual. amansw.com.au I 25

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FEATURE

MUSIC + MEDICINE As this year’s theme of our annual gala dinner A Night For the Profession was Music & Medicine, and the recipient of funds raised was Dementia Australia, it seemed fitting that one of our guest speakers was Stephen Hunt from Music Health.

STEPHEN AND MUSIC HEALTH COFOUNDER NICC JOHNSON have developed a music app which uses science, coupled with AI technology in an attempt to radically change the lives of dementia patients and their carers. Not only has it been nominated for numerous awards, but it’s also received funding from Dementia Australia and is currently being trialled across the globe, including in partnerships with Oxford University and Berklee College of Music in New York.

“The right music positively impacts mood, behaviour and communication.

It empowers carers, reduces stress and improves quality of care.

Music Health founders Stephen Hunt and Nicc Johnson

“We believe we’ve created a product which tackles the behavioural and psychological symptoms of dementia, improving the lives of people with dementia, relieving the burden on carers and saving money on medications,” Stephen Hunt said.

Developed through a rigorous

three-year research and development process, the app known as Vera uses proprietary AI to analyse factors like the age of the dementia-affected person, where they grew up, and how they react to certain music, to crunch data and curate the music for the listener.

“We’ve built Vera to know and find the music that means the most and has the biggest effect for each person living with dementia.

It acts like a music detective, that

seeks out tunes that they used to love a long time ago but may have forgotten about, which their carers may have never heard of, and their families may not even know,” Stephen Hunt said.

“One of my favourite moments was in our initial research at Barossa Valley where we met Tom who had been in care for almost a decade.

His daughter would often visit him.

He hadn’t spoken for around two years and had lost his memory long before that. After a few music amansw.com.au I 27

FEATURE

Stephen Hunt from Music Health speaking to patrons at AMA (NSW) A Night For the Profession

sessions he began to speak again. He not only spoke but could sometimes remember her and told her stories from old memories she’d never heard. He sadly passed away not long after, but those memories were priceless to her.”

90% of patients with dementia develop behavioural and psychological symptoms (BPSD). These symptoms include delusions, aggression, screaming, depression, anxiety, wandering, and more. Critically, BPSD results in impaired quality of life, increased cost of care, and places a significant burden on caregivers.

While there is currently no cure for brain ageing and dementia, there are ways to slow down its effects.

One of the most powerful methods is through listening to music which stimulates sensations of nostalgia.

Studies have shown that by doing so, we can oxygenate the brain and keep its circuits healthier for longer.1 Listening and making sense of what we hear requires the involvement of nearly every region and neural subsystem of the brain.

Music activity is one of the most demanding processes for the brain, and just like physical exercise, this “brain workout” can be incredibly beneficial in maintaining brain health.

“The quick science of it is that someone with dementia has a low level of brain activity, and their short-term memory in particular is impacted. Their musical memory, however, is generally intact—it’s one of the last things to degrade.

And if we can stimulate that with personalised music, we’ll create a chain reaction in the brain, because music is a whole brain exercise for us to interpret the sound signal, and then listen for words. There’s all of these different aspects—the timbre, the rhythm, they’re getting processed in different parts,” Stephen explained.

In preliminary trials, the app has shown a reduction in anxiety, depression, stress, blood pressure and pain and an improvement in sleep, mood, memory, motor functions and cognitive function.”

“...listening to music... stimulates sensations of nostalgia. Studies have shown that by doing so, we can oxygenate the brain and keep its circuits healthier for longer.”

“Independent trials have shown an almost 20% improvement in symptoms, but they were conducted during Covid so we couldn’t meet the proper requirements, which is why we’re investing in the best research possible,” Stephen said.

“The right music positively impacts mood, behaviour and communication. It empowers carers, reduces stress and improves quality of care. Best of all, we believe that using Vera results in a reduction in

28 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

cost of care and over-prescribing of drugs.”2 The world’s largest music company, Universal, was so impressed with Vera it licensed its entire catalogue for the app, to develop “personalised music stations” designed to improve the lives of those living with dementia.

Universal is where Music Health co-founders Stephen Hunt and Nicc Johnson met. Stephen grew up with a deep love of music and a strong desire to be a doctor. He started a science degree then fell into acting.

A two-year stint on Neighbours propelled a few years of touring the UK as a musician; followed by a decade-long journey innovating in the media industry before taking up a leadership position at Universal.

While working at Universal, Stephen was introduced to Nicc Johnson, a self-professed musicologist who grew up on Ibiza and began working as a professional DJ at 16. Nicc had already begun experimenting with AI. “We both had a deep belief in the impact of music on health, so we decided to try to make that a reality,” Stephen said. dr.

1. Efficacy of Brain Gym on the Cognitive Function Improvement of People with Dementia, Nov 2020 Jurnal Keperawatan Jiwa 2. Benefits of music therapy on behaviour disorders in subjects diagnosed with dementia: a systematic review, Neurologia May 2017

OPINION

Women need a more equitable share of healthcare leadership positions

Dr Sarah Whitelaw Equity, Inclusion and Diversity Committee Chair

Healthcare is a major Australian employer, with women comprising 75 per cent of the workforce. Yet nationally, women are underrepresented in healthcare leadership.

IN AUSTRALIA, only 45 per cent of public hospital board chairs, 39 per cent of private hospital CEOs, 38 per cent of state and federal chief medical or health officers and 45 per cent of medical deans are women.

Women make up most of the workforce but do not hold an equitable share of healthcare leadership positions. Gender disparity remains a prominent medical workforce issue, with many specialties having low proportions of female doctors despite almost 46 per cent of medical practitioners being female. In Australia, 15 per cent of surgeons are female, followed by just under 25 per cent of ophthalmologists and 24 per cent

of intensive care doctors.

Prioritising gender equity in leadership is vital for improving healthcare. Research shows the transformational and collaborative leadership style common with women has direct and positive impacts on healthcare outcomes.

The AMA Equity, Inclusion and Diversity Committee (AMAEIDC) develops policy and initiatives targeted towards enhancing equity and addressing inequitable and discriminatory practices that exist in the medical profession, and to consider how the AMA can actively promote equity and diversity of representation within the AMA’s own governance structures.

A key focus area for our work has been a commitment to improving gender equity within our membership, leadership and representative structures and the medical profession more broadly.

Since setting and reporting on targets for gender representation within federal AMA structure in 2019, the AMA has seen a shift towards more balanced representation on its councils and committees.

A key target was 40 per cent female, 40 per cent male and 20 per cent flexible (female, male or non-binary) as an average across all its federal AMA councils and committees. In 2022, the AMA achieved this target.

Women make up most of the workforce but do not hold an equitable share of healthcare leadership. amansw.com.au I 29

OPINION

While having a target in and of itself has given prominence to the importance of gender diversity in AMA leadership and representative structures, the AMA has also implemented initiatives to support gender equity including: • Promoting gender representation targets when seeking nominations to councils and committees • Developing practical advice and strategies to support gender equity in committee representation • Providing transparent explanations of what’s involved in participating in councils and committees • Running forums at each AMA national conference to highlight the importance of gender equity and work in this area.

In 2021 the AMA partnered with the Advancing Women in Healthcare Leadership (AWHL)

In Australia, only 45% of public hospital board chairs, 39% of private hospital CEOs, 38% of state and federal chief medical or health officers and 45% of medical deans are women. national initiative and is an advocate for gender equity in leadership within the medical profession. The partnership with AWHL has assisted us in undertaking an evidencebased organisational change management process, supported

by AMA leadership. At a workshop in August, AWHL and AMA state and territory leaders joined federal leaders to further discuss evidence generated to date on what works, what matters and what impacts

women in leadership – a key part of progressing our ongoing work to achieve gender equity for women and diversity at the AMA and across the sector.The evidence for the benefits of having women in leadership roles is clear with organisations increasing their share of women in leadership positions performing better overall.

The workshop arrived at a set of priorities which will guide our strategy to drive gender equity for women across the AMA and healthcare sector. dr.

Read more about the work the AMA is doing in support of advancing women in leadership and equity inclusion and diversity at : www.ama.com.au/equityinclusion-and-diversity

A key target was 40% female, 40% male and 20 % flexible (female, male or non-binary) as an average across all its federal AMA councils and committees. In 2022, the AMA achieved this target.

30 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

ADVOCACY

TOBACCO AND VAPING CONTROL

AMA (NSW) President Dr Michael Bonning recently gave evidence to the Federal Senate Community Affairs Committee - Inquiry into Public Health (Tobacco and Other Products) Bills.

Here is an excerpt from his opening statement:

“As a GP I see the problem of nicotine addiction daily with more and more young people vaping and smoking after a prolonged decline in nicotine product use.

More smokers, more vapers, more chronic cough new lung disease in young people, people who through their vapes are ingesting the equivalent of three to four packets of cigarettes per day. And with it the ingestion of other harmful chemicals and heavy metals which will impact their bodies over the coming years and decades.

The AMA supports the Public Health Tobacco and Other Products legislation, as it includes important

evidence-based measures to revitalise Australia’s tobacco and vaping control measures to protect Australians from harm.

While we’ve made so much progress with tobacco control over the past few decades tobacco use remains a leading cause of preventable death and disability.

Long term smokers on average die 10 years earlier than non-smokers and tobacco use is causally linked

“We cannot make the same mistakes we made with conventional cigarettes.”

to multiple diseases such as lung cancer, COPD and coronary heart disease.

It took decades for the health harms of tobacco to come to light with the powerful tobacco industry disputing the evidence and relentlessly promoting their addictive products. We see the same tactics at play today with vapes hooking a new generation onto nicotine by marketing directly to younger people and downplaying the health harms.

We do not want to make the same mistake as we did with cigarettes. We are glad to see the bill introducing prohibition measures for vaping advertising, bringing it into line with tobacco product prohibitions. We eagerly await the bills restrictions on social media marketing, as we know that that targets individuals, especially young individuals based on algorithms, this is an important first step to renewing tobacco and vaping control, but there remains room for improvement. The AMA calls for all political parties to stop accepting sponsorship, gifts or political donations from the tobacco industry, as this clearly compromises government policy on public health matters. The AMA also strongly advocates for vaping reform to be urgently implemented, including the implementing of a retail ban on all vapes to protect younger people becoming addicted to nicotine. The reforms under the Public Health tobacco and other products legislation of 2023 are a good start to achieving the goal of a 5% or less smoking prevalence in Australia by 2030. dr. amansw.com.au I 31

ADVOCACY

UNDERSTANDING BIRTH TRAUMA In October AMA (NSW) was called on to give evidence to the NSW Upper House committee examining birth trauma. AMA (NSW) was represented by Vice President Dr Kathryn Austin and CEO Fiona Davies. Here is an excerpt from Dr Austin’s opening statement: “While many births in this state and across the nation occur without complication, every birth, every day has the potential for risk. We believe that a lack of understanding of the scope of risk and frequency of birth impacts has contributed to the levels of trauma experienced.

In many, maybe most aspects of our lives we are used to having some and usually a large degree of control.

What cannot be prepared for is when things suddenly and unexpectedly go dramatically off plan.

We believe that women are not given enough preparation for the significant, overwhelming and often terrifying loss of control that can occur. This can happen to any woman at any time.

Birth is often low risk until it’s not anymore. Doctors are forced to make split second decisions to save mother, baby or both.

Birth by nature can be painful and unpredictable but that does not mean it will result in trauma.

We believe the best ways to reduce trauma are by: • building the confidence of women and their families by providing better antenatal and postnatal education • informing women of the spectrum of procedures associated with birth, • involving women in decision making as much as possible and • discussing birth outcomes in the postnatal period.

AMA (NSW) Vice President Dr Kathryn Austin & CEO Fiona Davies giving evidence to the Senate Select Committee These discussions should involve medical and midwifery input so that women understand and are made aware that whatever their hopes or plans, they may require medical intervention.

The AMA believes the best outcomes are achieved by a collaborative, multidisciplinary team-based model of care, with each profession supporting and respecting the opinion and approach of others.

When doctors, midwives and other allied health workers act in concert early recognition of risk factors that may cause pregnancy or birth complications are better identified, birth outcomes are improved and postnatal complications are reduced.

The AMA believes there needs to be realistic pathways to adequate antenatal education.

Just as important is postnatal education. Studies have shown repeatedly that when explanations are provided for what happened, why things did not go to plan and where necessary what intervention was required, the level of trauma felt is vastly reduced.

Among the solutions should be better training and resourcing for

32 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

those providing services for them.

We believe there should be greater screening for those who may be pre-disposed or at greater risk of birth trauma so that traumainformed care can be tailored to address further needs.

There must also be robust mechanisms in place to identify psychological distress and clear pathways to access emotional support and specialist support where needed as soon as is possible.

High quality maternity services rely on a stable medical, midwifery and allied health workforce. There is a concerning risk that the result of this inquiry could lead to a loss of workforce, thus inadvertently undermining the important objectives of increasing the medical and psychological safety afforded to patients. If the inquiry results in recommendations that are not safe for those working within the system, this could lead to a catastrophic failure to attract and retain the workforce we so desperately need”. dr.

amansw.com.au I 33

WORKPLACE RELATIONS

Employers’ Positive Duty to Eliminate Sexual Discrimination and Harassment Dominique Egan, Director of Workplace Relations

The Sex Discrimination Act 1984 (Cth) provides that employers have a duty to take reasonable and proportionate steps to eliminate, as far as possible, unlawful behaviours which are: • Sexual harassment: any unwelcome conduct of a sexual nature that a reasonable person, having regard to all the circumstances would anticipate would offend, humiliate or intimidate the other person; • Harassment on the ground of sex: unwelcome behaviour of a demeaning nature that happens because of a person’s sex in circumstances where a reasonable person would anticipate that the person who is harassed might feel offended, humiliated or intimidated by the behaviour; • Sexual discrimination: where a person is treated less favourably because of their sex compared to how a person of a different sex would be treated in similar circumstances or where an unreasonable condition, requirement or practice appears to treat everyone the same but in fact disadvantages people of a particular sex; • Conduct that subjects a person to a hostile working environment on the ground of sex: where a person behaves in a way that a reasonable person would expect might be offensive, intimidating, or humiliating to someone because of their sex; and • Victimisation: means treating or threatening to treat someone badly or unfairly because they report unlawful behaviours; assert their rights under the law; or help someone else to do so.

In practical terms this means that employers must move from simply responding to incidents and complaints, to taking proactive steps to prevent the incident or complaint before it occurs.

Employers are required to take reasonable and proportionate measures to eliminate unlawful behaviours. What may be reasonable and proportionate will be determined by having regard to the size, nature and circumstances of the organisation, its resources, and the practicability and cost of taking steps. Many AMA (NSW) members are running medical practices that are small businesses, and so the steps to be taken will not necessarily be the same as those in a large corporation.

The Australian Human Rights and Equal Opportunity Commission has powers that include the following: • To conduct inquiries into employer compliance, • To provide recommendations to employers regarding compliance, • To issue a compliance notice to an employer, and • if needed, to apply to the Court for enforcement of a compliance notice.

These changes accompany the prohibition of sexual harassment in connection with work under the Fair Work Act 2009 (Cth). Under changes made earlier this year, it is now unlawful for a person to sexually harass another person in connection with work.

A person who alleges they have been sexually harassed can make an application to the Fair Work Commission to make a ‘stop sexual harassment order’ or otherwise deal with the matter under its dispute resolution framework.

34 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

Practice Owners need to be mindful that they have obligations to staff not only while staff are in the medical practice, but their obligations apply in connection with work and so extend to off-site and / or out-of-hours work related events including conference, social gatherings and functions.

The steps that AMA (NSW) recommend Practice Owners consider taking to discharge their obligations are as follows: • Ensure all Practice Owners participate in education about their obligations and unlawful behaviours; • Provide education and training to all staff about unlawful behaviours and that they will not be tolerated in the medical practice; • Ensure staff know how to raise any concerns they may have and be proactive in responding and managing any concerns; • Have a Practice Policy that all practice owners and staff can readily access, and review it regularly; • Consider whether there are changes you need to make to the workplace to ensure staff feel safe including regular consultation with staff.

The AMA (NSW) Workplace Relations Team is here to support you. We will attend your medical practice (in person or virtually) to conduct training for Practice Owners and training for staff.

Template policies are available for members. For more information about training and / or our template policies, please email workplace@amansw.com.au or call (02) 9439 8822. dr.

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Meet three wonderful doctors from The Children’s Hospital at Westmead, Dr Jacinta Trang, Dr Devin Deo and Dr Ashfaque Quadir.

DR JACINTA TRANG

DR DEVIN DEO

DR ASHFAQUE QUADIR

Health Heroes Do you know someone in the health system who deserves recognition? An individual? A group?

Going the extra mile (or ten) seems like an across-the-board expectation. Let’s highlight the incredible efforts of our members and those who support them.

Send us an email at magazine@amansw.com.au 36 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

FEATURE Devin with a patient in the oncology ward at The Children’s Hospital at Westmead

DR DEVIN DEO

Position: Senior Resident Medical Officer Nominated by: Dr Billy Tran

28-YEAR-OLD DEVIN DEO was not destined to be a doctor, well not as far as his doctor parents were concerned “They kept telling me all the horror stories ‘You’re gonna be awake until 3am while everyone’s asleep and you’re going to be wondering why.” They told me what a hard life it is to be a doctor, what a hard road I would be paving for myself.”

“Despite everything they told me they were such an inspiration to me. I think all the warnings somehow made me more determined to do it”.

“Then I had a patella dislocation with ligament tear, twice, and had it operated on by an orthopaedic surgeon, and he took such good care of me. It was awesome. From before the surgery to after and all the follow ups and everything. He just explained everything to me so well. He reassured me, and he was Devin Deo as a child in Malaysia

exactly the sort of doctor I wanted to be. Having gone through that experience of having somebody who not only was medically capable but who could also give that empathy and reassurance had a powerful impact on me. The way he conducted himself is still the basis of how I am trying to conduct myself.”

Devin was born in Malaysia but grew a love for Australia when visiting as a child. “There’s just something about the people that’s just so welcoming and I felt it would be a lovely place to be at.”

He was nominated by Dr Billy Tran who said “Devin is a hero because he’s so dedicated and passionate in striving to provide the utmost care to his patients. Devin consistently seeks to improve himself in terms of clinical skills and regularly goes above and beyond what is required of him in caring for his patients.

“He has an exceptional ability to communicate with patients and carers, which is especially powerful in his current rotation in oncology.

Devin has cultivated such a wonderful rapport and established deep personal connections with many patients and parents

“During one of his paediatric rotations, Devin was part of a team providing care to an extremely premature baby with poor family support who had a multitude of medical conditions, resulting in the baby having to spend many months in the hospital. What he did for that tiny baby was remarkable.”

Devin described the experience.

“This baby was born at like 26 weeks. He was in the hospital for more than 100 days and he pretty much spent every day on his own in this tiny little room. Because his parents weren’t there, and the nurses were so busy he was basically in bed all day, so the back of his head became flat. I would literally take him outside in a pram with the oxygen tank on and the nasal prongs on his nose. I would push him around the hospital corridors, and often around the little garden so he could get some sun. It was just so he could experience the world beyond the walls of his room.

I would carry him and just walk him back and forth and talking to him, giving him little cuddles.

“I always loved paediatrics right from the first time I was exposed to it during my medical school days.

There’s something quite beautiful about advocating for patients.

I guess kids need a bit more advocacy. Obviously, when you’re in hospital, it’s a very scary place and having seen kids at their worst… and some of them go through the most frightening conditions… very life threatening and debilitating conditions, yet somehow, they are so resilient in the face of all of that, they push through. And there’s that just sort of hope that you don’t really see in many other specialties or departments or very few others.”

“Both of my parents are doctors. They really discouraged me from becoming a doctor. But they inspired me and here I am.” DR DEVIN DEO amansw.com.au I 37

FEATURE

“A truly incredible inspiration for what a good clinician should be — not only is he kind but incredibly knowledgeable and always strives to facilitate a nurturing environment for his students.”

A STUDENT UNDER DR QUADIR’S MENTORSHIP

ASHFAQUE QUADIR

Position: Fellow Paediatric Intensive Care, Nominated by: DrJess Mills

Ash moved to Australia from Bangladesh when he was 4 and then spent most of his childhood growing up in a small rural town in NSW called Leeton.

Having finished his General Paediatric training in Sydney a couple of years ago, Ash is currently well into his second fellowship in Paediatric Intensive Care.

Ash explained “I went into paediatrics because it’s such an interesting and broad area of medicine. We look after patients as young as 24-week-old premature babies to 17-year-old adolescents.

“I was drawn to paediatrics because I quickly recognised how different the culture is in a children’s hospital. Everyone in the hospital, no matter who they are specialists, ward clerks, the kitchen staff, everyone, they’re all here for one reason - they love working

with children. It’s a very inspiring environment to be in.”

Ash is a pediatrician who works as a senior registrar in ICU where he regularly works 14 hours shifts.

“I find working in the intensive care unit the most rewarding experience by far. We have the privilege of looking after children and families through some of the most challenging times of their lives.

Seeing my little patients come back and visit when they are better, and smile and laugh is the best. My job is truly a privilege.”

Dr Jess Mills says “I nominated Ash because of his overwhelming dedication to his job and his colleagues. During his years as the Chief Resident at the Children’s Hospital at Westmead in 2020, Ash helped navigate his peers through the many challenges brought about by the pandemic. He has such a caring nature; he wouldn’t go home without doing a walk around the wards ensuring that all of the day teams had handed over and were not staying back late. He really cares.

Ash is currently a clinical lecturer with the University of Sydney and is actively involved with supervision of trainees and paediatric recruitment.

He has built a strong foundation

38 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

Ash as a small child in Bangladesh

in clinical leadership during his training culminating in his selection as one of fifty international candidates for Harvard Medical School’s Paediatric Leadership Program Certificate in 2019 and as the Children’s Hospital at Westmead Chief Resident Medical Officer in 2020.

“In Ash’s current job as one of the Senior Registrars in the Paediatric Intensive Care Unit at CHW, he helps to look after some of the sickest children in the country. In this role, Ash needs to be quick and thoughtful under pressure, be able to work cohesively in a big team and be able to communicate effectively in order to help these families through what may be the worst period of their lives. The long hours and demands of working in such an intensive environment can be very stressful for all the healthcare staff, but they just take it in their stride.” Dr Jess Mills said.

Ash believes his job is an honour and says that the rewards can outweigh the extensive demands.

“One experience that really warmed my heart was when I ran into one of my oncology patients years on.

I had treated him when he was 4.

He had leukemia. I had looked after him immediately after his diagnosis.

A few years later he saw me at the hospital café and ran up to give me a hug yelling “Dr Ash!”

DR JACINTA TRANG

Position: Basic Physician Trainee, Nominated by: Dr Domininc Ku

DR JACINTA TRANG Dr Jacinta Trang is a Basic Physician Trainee currently on her psychiatric rotation. She has been at The Children’s Hospital at Westmead since the beginning of 2023.

Jacinta grew up in Strathfield in Sydney She was fifteen when she first visited The Children’s Hospital at Westmead, arriving in dramatic fashion, via a plane from Canberra after a skiing accident at Thredbo.

“I ended up on the orthopaedic ward. The people who looked after me were incredible. I saw how the nurses and doctors were able to give me hope in a time which was very uncertain and walk me through that process of recovery in a really gentle and loving way. That’s what inspired me to do medicine. Since then I’ve always wanted to work at Westmead so coming here this year has been an absolute dream come true.”

From that moment in year ten she has wanted to become a paediatrician.

Dr Jacinta Trang as a toddler

“Last year, on my paediatric neurosurgical and rehabilitation terms, I was able to work with many patients and their families for almost the entire duration of the 20 weeks. For example, a few of the patients would come in with severe brain injuries, and at the time of presentation their prognosis would be uncertain. It was really rewarding to follow their journeys and see some of these patients exceed expectations and physically walk out of the department on discharge.

I loved being able to get to know patients and their families well and celebrate the small and big wins with them during their recovery. For me, this was so fulfilling.

“More recently, we had a patient on the ward who had had behavioural challenges for three years. It was very difficult for her school and family to manage and it seemed like there was nothing left for them to do. It was amazing to see how the medical and allied health teams came together to support this patient during her admission and ensure that she had adequate support on discharge. I followed up with her parents after she left hospital, and I was thrilled

to hear that she’s doing really well at home. To us, for the team, that was a massive win.”

Dr Dominic Ku said of Jacinta “Dr Trang has a heart of gold and it shows every day on the ward.

She really goes out of her way to give her patients the very best experience. She dedicates time to get to know patients and their families, actively listening, speaking words of encouragement.

“She understands that being in hospital can be challenging for children and tries to brighten the day of all those that she comes across. On her current psychiatry term, she has had dance parties with the children and joined in with ward activities to make them feel more comfortable and build better rapport.

For Jacinta, there’s no better place to be than The Children’s Hospital at Westmead. “I love working here at Westmead. I love that they just have such a holistic view of health. It’s not just about getting the patient in and out and making sure their physical ailments are repaired but it’s about ensuring that they are loved in this process. You can just see it in all the staff here and the amount of joy they have in doing what they do.” dr.

“I was a patient at this hospital in year ten after a skiing accident and have wanted to come back and work here as a doctor since then. I’m so grateful that this dream has come to fruition. I love working here.”

DR JACINTA TRANG amansw.com.au I 39

EVENTS

A Night For the Profession MUSIC & MEDICINE

Associate Professor Narinder Singh who is leading the Drumbeat.ai project

AMA (NSW) President Dr Michael Bonning and his wife Claire.

40 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

EVENTS It was the night that doctors dumped the scrubs and scrubbed up for AMA (NSW)’s gala dinner. On Friday 6th October at Hyatt Regency Sydney, AMA (NSW) hosted A Night For the Profession: Music & Medicine, a black-tie event not only celebrating doctors but raising much needed funds for Dementia Australia.

The black-tie event featured guest speakers Stephen Hunt from MusicHealth and Associate Professor Narinder Singh who is leading the Drumbeat.ai project. As the theme was music & medicine we had an array of musical acts including harpist Paul Nicolau, Sydney Chamber Brass and The Baker Boys Band.

The Baker Boys Band

Harpist Paul Nicolau

AMA President Professor Steve Robson

amansw.com.au I 41

A Night for the Profession

42 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

Stephen Hunt

amansw.com.au I 43

ADVERTORIAL

Meet with

Medi Financial

Chris Lahoud, Joe Caristo & Gary White

In October we filmed our first episode of what we hope will be a series of interviews with members, sponsors and affiliates. We dedicated the episode to the major sponsors of our Night For the Profession gala dinner – Medi Financial.

AMA (NSW) Director of Membership Engagement & Commercial Partnerships Gary White sat down with Medi Financial partners Chris Lahoud and Joe Caristo. Here’s an excerpt of their discussion: Q: First of all, who is Medi Financial?

JOE: Medi-Financial is a group of trained professionals solely catered to providing lending needs to the Australian medical community.

Everything from residential lending, commercial lending, asset lending, we have all financial solutions to our medico clients.

Q: We have a large and diverse member base with doctors at the start of their career and those that are further on in their career. Does Medi Financial service all cohorts of doctors?

CHRIS: Most definitely. We assist

clients all the way from inception to later on in their career potentially when they’re specialists. Although the large portion of our client base are doctors and specialists, we very much assist interns, junior doctors trainees absolutely any doctor in the Australian medical community we’ll tailor our services to.

Q: What lenders are on Medi Financial’s panel?

CHRIS: We have over 50 lenders on our panel, ranging from all the four majors in CBA, ANZ and NAB just to name a few, all the way through to second tier lenders and private lenders. Given that large cohort of lender base, we feel we can always tailor something to assist our client base.

Q: What is the key question that doctors are asking you, given the current times that we’re in?

44 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

JOE: Everything’s about rates, repayments, but also borrowing capacity. How much can I borrow?

Every bank assesses loans differently. And they all have their own assessment ability. You may be able to borrow more with bank A than Bank B, but Bank B might be providing a better rate or bank A might be providing a better rate.

So, what we do is compare the market with the 50 lenders and come up with a solution that enables us to look at your borrowing capacity as well as the best pricing in the market.

Q: Given that you do that research do doctors receive preferred rates or policies when it comes to loans?

CHRIS: Most definitely. As you can appreciate, rates are a caseby-case basis depending on the bank’s appetite for that particular transaction. But we feel we very rarely get beaten on price in fact, Joe believes we never get beaten on price.

JOE: I stand by it.

CHRIS: To answer your question directly, yes, our client base does get preferential pricing.

Q: Tell me a bit about how you got into the industry.

ADVERTORIAL

JOE: I have 13 years of banking and lending experience, predominately with the Westpac private bank and St. George private bank most recently becoming/being a director looking after ultra-high net worth individuals with their lending needs.

CHRIS: Similar to Joe, in banking for 15 years, progressed through the network after completing my tertiary education. I literally started off as a baby teller at CBA and progressed all the way through the network to a private banker.

We met at Westpac where I was a private banker, assisting ultrahigh net worth clients. So, what can we offer those particular clients?

It’s very much a high valued red carpet relationship management treatment with a significant network across the board.

Q: We like a red carpet as we’ve discovered at the gala dinner. You have an extensive team that can help deliver client’s needs. What sort of experience do you expect from your team?

CHRIS: All our brokers have a minimum of 10 years lending experience, and we feel that’s really pertinent in the industry given the clientele that we deal with. A generalised broker does not necessarily have the experience, especially with respect to lending to extremely high valued clients.

They’ve got very complicated financial structures. So that’s our day-to-day job. It’s been so for over 10 years, and we expect that all our staff have the same amount of experience.

Q: And I guess that’s why you’ve been able to build the panel of banks that you operate with.

JOE: Correct. Through our extensive banking relationships. We always have a solution for our doctors.

There’s never been once where we’ve turned to each other and said

The Medi Financial group at AMA (NSW)’s Night For the Profession; Jackson Fan, Renee Yarroll, Chris Lahoud, Joe Caristo, Pierre Leung, Aaron Anderhuber, Dani Fitch, Raymond Martinez.

“Well there’s no solution. What do we do?”. There’s always a solution for our doctors on the lending front.

Q: So such a tailored and redcarpet solution like you said, Chris, what does that cost because that will be important to our doctors?

JOE: Gary, we actually don’t charge our clients anything. When we introduce the lending to the bank, the bank pays us a referral fee. A lot of our clients have cheaper rates than the clients going directly to the bank.

CHRIS: And Gary we’re more than happy to sit down and workshop a transaction for a client completely obligation-free and free of charge.

So, we feel that that’s really a

differentiating factor we’re happy to put the time in and really get an understanding as to what our clients need and tailor our approach accordingly prior to moving forward with an application.

Q: So how can our clients get in touch with you?

JOE: That’s easy, go to our website medifin.com.au, call 1800 102 337 or click on our QR code. One of our brokers will contact you as soon as we receive your enquiry.

This advertorial contains information and content provided by a third party. Publication by AMA (NSW) does not constitute an endorsement or recommendation, and AMA(NSW) accepts no responsibility for the accuracy or reliability of the information and content.

amansw.com.au I 45

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The NSW Doctor is the bi-monthly publication of the Australian Medical Association (NSW) Limited.

EDUCATION

Views expressed by contributors to The NSW Doctor and advertisements appearing in The NSW Doctor are not necessarily endorsed by the Australian Medical Association (NSW) Limited. No responsibility is accepted by the Australian Medical Association (NSW) Limited, the editors or the printers for the accuracy of the information contained in the text and advertisements in The NSW Doctor.

The acceptance of advertising in AMA (NSW) publications, digital, or social channels or sponsorship of AMA (NSW) events does not in any way indicate or imply endorsement by the AMA.

Doctor-In-Training Director, Dr Sanjay Hettige

EXECUTIVE OFFICERS 2021-2023 President, Dr Michael Bonning Vice President, Dr Kathryn Austin Chair of Council, Dr Brian Fernandes Chair, Hospital Practice Committee Dr Andrew Zuschmann Chair, Professional Issues Committee and Director, Dr Costa Boyages Director, Dr Kean-Seng Lim Director, Dr Fred Betros Director, Dr Amandeep Hansa Director, Dr Theresa Ly

Staff Writers Isabella Angeli Isabella.angeli@amansw.com.au Ally Chandler Ally.chandler@amansw.com.au

48 I THE NSW DOCTOR I NOVEMBER/DECEMBER 2023

SECRETARIAT Chief Executive Officer, Fiona Davies Director, Services Kerry Evripidou Director, Workplace Relations Dominique Egan Director, Membership Engagement and Commercial Partnerships Gary White Editor Rahni Sadler rahni.sadler@amansw.com.au

Design Rebecca Strahan Advertising enquiries Kirsty Smith Kirsty.smith@amansw.com.au

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Welcome to your internship

AMA (NSW) CLINICAL SCHOOL VISITS The AMA (NSW) team has been out visiting clinical schools to support final year students with their transition to internship in 2024.

Schools visited so far include Nepean Hospital, Royal North Shore Hospital, Prince of Wales Hospital, the University of NSW and Macquarie University. Look out for the AMA (NSW) team at your clinical school or in your hospital over the next few months.

AMA (NSW) Director of Workplace Relations Dominique Egan presenting at The University of Sydney Northern Clinical School, RNS.

AMA (NSW) offers significant assistance and resources for doctors-in-training (DITs), both individually and collectively.

Our aim is to make DITs professional life a bit smoother and more manageable.

By joining the AMA, DITs are also supporting the most

powerful medico-political association in Australia.

Your membership actively supports advocacy efforts that shape our healthcare system which benefits both the patients and healthcare professionals.

AMA (NSW) Director of Membership Engagement, Gary White at The University of Sydney Northern Clinical School, RNS.

AMA (NSW) Workplace Relations Advisor, Melanie Fayad addresses final year students at University of NSW.

Together, we can make a positive impact.

Support us to support you!

Start your intern journey with AMA (NSW) by scanning the QR code