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SPRING 2017 | VOL. 104 Health Vision influencing change two years in Real-time prescription monitoring could save lives MOCA 5: laying the foundation for cultural change

An end to mandatory reporting? Doctor Q is free to AMA Queensland Members


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The Lexus of Brisbane Group looks forward to our partnership with AMA Queensland and their members. To discuss these benefits offered to you as a AMA Queensland member, phone or SMS our dedicated Lexus of Brisbane Group representative Derek Klette today.

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CONTENTS

18

M A N D AT O R Y R E P O RT I N G

ON THE AGENDA

22

M O C A 5 : L AY I N G T H E

F O U N D A T I O N F O R C U LT U R A L

26

P R O A C T I V E H E A LT H

VISION INFLUENCING CHANGE

CHANGE

REPORTS

F E AT U R E S

BUSINESS TOOLS

6

Editor’s Desk

18

An end to mandatory reporting?

49

8

President’s Report

22

10

CEO’s Report

MOCA5: laying the foundations for cultural change

Checklist for setting up in general practice

50

Management liability

24

AMA Queensland Council of Doctors in Training update

26

Health Vision influencing change two years in

52

Doctor vindicated in claim for defamation

44

Member news

54

Cloud storage of medical records

65

Foundation news: Helping Hear and Say open worlds of opportunity

56

Improving the heartbeat of your practice

PEOPLE & EVENTS

CURRENT ISSUES 16

Rural, regional and remote survey findings

20

WorkCover Queensland online invoicing saving time and money

28

One in two hospital doctors working unsafe hours

30

Growing from failure

34

Talking doctor to doctor: supportive communication with colleagues

36

Broaching end of life care for kids

LIFESTYLE

12

Junior Doctor Conference wrap up

46

Getting out and about

14

Dinner for the Profession wrap up

58

All about you

29

A Day in the life of a new GP practice

59

Dendy

32

Local Medical Association round up

60

Foodie discounts

38

Events calendar

61

Pirramimma – conquering the world

40

Women in Medicine - meet the speakers

62

New Orleans: A gumbo of music, culture, and history

42

Private Practice & Medico-Legal Conference speaker profile: Dr Toby Ford

64

Ocker doctor: Friends in the business

66

InPrint: Current Medical Diagnosis and Treatment 2017

48

Refer your patients to Vision Australia


Editor’s Desk The AMA Queensland Health Vision kicked off two short years ago, and we are already seeing results its proactive influence. Check out the results so far on p26. Mandatory reporting will be a hot agenda item at the Council of Australian Governments Health Council in November, so check out the stats on that one on p18. We’ve got a real mixed bag for you this edition - enjoy!

BOARD OF DIRECTORS Dr Bill Boyd President

Dr Bav Manoharan Member Appointed Director

Dr Dilip Dhupelia Member Appointed Director

Dr Kirsten Price Member Appointed Director

Dr Richard Kidd Member Appointed Director

Dr Kimberley Bondeson Greater Brisbane Area

Dr Dilip Dhupelia Part-time Medical Practitioner Craft Group

Professor Steve Kisely Greater Brisbane Area

Douglas Brown Medical Student Observer

Dr Katherine Gridley Greater Brisbane Area

Honor Magon Medical Student Craft Group

Dr Jim Finn Vice President Dr Shaun Rudd Chair of Board and Council

COUNCIL

Michelle

Dr Paul Bryan General Practitioner Craft Group

OBITUARIES

Dr Matthew Cheng Doctors in Training Craft Group

The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Professor Basil JAMES Psychiatrist Late of Townsville Member for 13 years

Dr Robert Clive ANDERSON Psychiatrist Late of Buderim Member for 47 years

Dr Jill Maude POZZI Anaesthetist Late of Newstead Member for 58 years

Dr Anthony Oliver ROBERTSON Surgeon Late of Carindale Member for 18 years

Dr Vernon JANNUSCH General Practitioner Late of Toowoomba Life member Member for 46 years

Dr Harold Alexander Bell FOXTON General Practitioner Late of Cleveland Member for 64 years

Dr Michael Cleary Greater Brisbane Area Dr Michael Clements North Area Dr Sarah Coll Specialist Craft Group

Dr John Hall Downs and West Area Associate Professor Geoffrey Hawson Retired Doctors Craft Group Dr Wayne Herdy North Coast Area Dr Scott Horsburgh General Practitioner Craft Group Dr Viney Joshi International Medical Graduate Craft Group

Dr Allan Edward COOK OAM, from Airlie Beach, was awarded for his service to medicine as an orthopaedic surgeon. Dr Terence James COYNE OAM, from Auchenflower, was awarded for his service to medicine as a neurosurgeon. Associate Professor Alan Mithra DE COSTA OAM, from Parramatta Park, was awarded for his service to medicine, and to the community of Far North Queensland. Dr Geoffrey Alexander HARDING OAM, from Sandgate, was awarded for his service to musculoskeletal medicine. Dr Roger Thomas WELCH OAM, from Southport, was awarded for his service to ophthalmology. 6 Doctor Q Spring

Dr John F. Murray Specialist Craft Group Dr Alex Ritchie Specialist Craft Group Dr David Shepherd Far North Area Dr Nicholas Yim General Practitioner Craft Group Dr Chris Zappala Immediate Past President

AMA QUEENSLAND S E C R E TA R I AT Jane Schmitt Chief Executive Officer

Filomena Ferlan General Manager Corporate Services

Editor: Michelle Ford Russ

Doctor Q is published by AMA Queensland

Q U E E N ’ S B I RT H DAY H O N O U R S

Congratulations to the following members who received a Medal of the Order of Australia on the Queen’s birthday.

Dr Bav Manoharan Greater Brisbane Area

Graphic Designer: Nathan Pitt Journalist: Chiara Lèsevre Advertising: Louise Glynn

Phone:

Holly Bretherton General Manager - Member Relations and Communications

(07) 3872 2222

Address: PO Box 123, Red Hill QLD 4059 Email:

amaq@amaq.com.au

Print Post Approved PP100007532

Disclaimer – All material in Doctor Q remains the copyright of AMA Queensland and may not be reproduced or transmitted in any form without permission. While every care is taken to provide accurate information in this publication, the material within Doctor Q is for general information and guidance only and is not intended as advice. Readers are advised to make their own enquiries and/or seek professional advice as to the accuracy of the content of such articles and/or their applicability to any particular circumstances. AMA Queensland, its servants and agents exclude, to the maximum extent permitted by law, any liability which may arise as a result of the use of the material in Doctor Q.


The Avant team

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To find out more, contact: State Manager - Growth (QLD) Michael Carr or Head of Medical Defence Services (QLD), Justine Beirne avant.org.au 0481 596 388 *IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. Doctor Q1235-5/03-17/0811 Spring 7


The Queensland Government will soon require MODDS to be updated weekly, but AMA Queensland is hoping to see real-time prescription monitoring by 2020. AMA Queensland began investigating the need for improved prescription monitoring after a 2015 inquest into the death of Toowoomba nurse Katie Lee Howman.

President’s report DR BILL BOYD

Probably the worst job I have had in my life was a short stint doing the night locum service in Brisbane when I first arrived in Australia. I was given a car, a doctor’s bag and a Brisbane refidex. I serviced the north side or the south side or the CBD. I spent much of the night navigating my way through dimly lit, poorly signposted streets to individuals who reported either migraine, back pain or renal colic and they would settle for nothing less than an injection of pethidine. We know that in societies of all kinds, across the world and reaching far back in time there has been a strong demand for mind-altering substances of one type or another. Odysseus tells how he was blown off course by foul weather, making landfall on an island where the inhabitants were clearly addicted to a narcotic they accessed by eating the lotus plant. Caffeine, nicotine, betel nut or kava, uppers and downers, it doesn’t really matter. Al Capone too knew about supply and demand. Governments have long tried to regulate those agents which, for want of a better catch-all, I shall refer to as substances of abuse. Depending on the government and the substance, that regulation might result in you paying a large tax such as on nicotine in Australia or paying with your life such as with amphetamine at the hands of the Punisher in Manila. 8 Doctor Q Spring

In Australia, as in most first world countries, opium and its derivatives are classified as substances of abuse but they may be used by licenced practitioners – doctors – as a means of relieving the dreadful pain associated with serious injury or genuine disease. Diamorphine or heroin is a very good agent for the relief of the severe pain of myocardial infarction.

Ms Howman died after taking an accidental overdose of fentanyl she obtained at Toowoomba Hospital, but the inquest heard she had visited 20 different doctors and 15 pharmacies in the 13 months before her death, amassing 71 prescriptions for pain medication. Real-time prescription monitoring might just have saved Katie Lee’s life, or at least raised a red flag for her family and friends. Tasmania introduced an effective monitoring system in 2008 and saw a huge decline in the number of opioid related deaths. Let’s figure out what they did and how they did it and see how we can apply it here.

As ever, in any regulated system, there are those who conspire to circumvent the regulations, often for selfish purposes – to feed their addiction for monetary purposes.

The Federal Government will develop a national prescription alert system, and while we are happy to see this issue being addressed, we have concerns about the amount of time it will take to develop a national solution.

There has been a surge in accidental opioid overdoses in Queensland in recent years – from 32 deaths among 15-54 year-olds in 2003 to 114 deaths in the same age group in 2013.

We are calling on the State Government to conduct a study of the Tasmanian model ahead of developing its own software solution for Queensland.

Doctors who are caught breaking the rules are faced with a high level of ‘please explain’ and if they cannot then there are powerful sanctions.

Such a system should enable pharmacists to scan prescriptions in real-time into the MODDS database and allow doctors to access the information from their desktop computers.

Patients who are dependent can be remarkably adept at working the system particularly by so-called doctor shopping and we have known this for a long time. At present, pharmacists manually upload records of drug prescriptions to Queensland Health’s Monitoring of Drugs Dependence System (MODDS) database once a month.

We believe the new state-based system should be in place by 2020 at the latest and could be integrated into a national system at a later date. Check out our Real-Time Prescription Monitoring position statement at www.amaq.com.au.


Noticed your energy rates going up? We could help yours go down.

On 1 July, some Australian energy retailers increased their rates by up to 20%. This means your business could now be paying too much for your energy. As the official energy partner of AMA Queensland, Make It Cheaper provides a free energy comparison service. You’ll either find a better deal on electricity or know for sure you’re already on a great rate. Win-win.

How much could your business save? Call the AMA Queensland Members Hotline directly on (02) 8077 0159 or Visit the website to upload a recent energy bill www.bit.ly/MiCAMAQ Note: This service is only available for members in the Energex network (not ERGON)

Doctor Q Spring

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CEO’s report

Last month, AMA Queensland hosted a forum with Queensland Health on suicide prevention and doctors’ wellbeing. Health stakeholders throughout the state gathered together to consider the impact and role of individuals, leaders and the system within the health environment in seeking help, providing support and recognising barriers and gaps. The outcomes of this forum will feed into the national forum in September.

M A N D AT O R Y R E P O RT I N G Statistics show that doctors often don’t seek medical treatment for fear of being mandatorily reported and losing their career. “It is a tragic reality that doctors are at greater risk of suicidal ideation and death by suicide. This year we have lost several colleagues to suicide. While there are many factors involved in suicide, we know that early intervention is critical to avoiding these tragic losses,” said Dr Gannon. At the August Council of Australian Government (COAG) Health Council, state health ministers agreed that supporting practitioners to seek mental health treatment was of paramount importance. Following a discussion paper and consultation with consumer and practitioner groups, the COAG Health Council will consider a proposal to amend the current provisions. It is a step in the right direction. We have been lobbying broadly at a state and federal level for many years to have consistent national laws and 10 Doctor Q Spring

RESILIENCE ON THE RUN

seek the introduction of the Western Australian exemption across the country. Western Australia’s provisions do not require treating doctors to mandatorily report their doctor patients. Of course, doctors still have a professional obligation to report in certain circumstances under the Good medical practice: a code of conduct for doctors in Australia.

In this year’s state budget, our Resilience on the Run program received full funding to be rolled out to interns statewide. The program was devised by the AMA Queensland Council of Doctors in Training in 2015 to increase resilience, manage stress and promote wellbeing among junior doctors. The program has already run successfully at hospitals in Rockhampton, Ipswich and the Metro South Health area (Princess Alexandra Hospital, Logan Hospital and Redlands Hospital) and we having been working closely with the government to further expand the initiative to all Queensland public hospitals with interns.

I N T E G R AT E D ELECTRONIC MEDICAL RECORD (IEMR)

P R I VAT E P R A C T I C E AND MEDICO-LEGAL CONFERENCE

We have recently had discussions with Queensland Health regarding the integrated electronic medical record (ieMR).

Our upcoming Private Practice and Medico-Legal Conference in October will help you future-proof your new or existing practice.

Members in various locations in Queensland have voiced concerns about the system and its useability and adaptability.

The comprehensive two-day program provides you with the opportunity to:

JANE SCHMITT

SUICIDE PREVENTION FORUM

strategic approach. Our feature on p26 shows our advocacy work on your behalf has resulted in a number of positive changes in the health system.

AMA Queensland want to ensure clinicians have increased input in the system and transparency regarding change, updates and interoperability. The Director-General has had direct involvement in discussions in AMA Queensland and a number of our members. We will keep you updated on progress on the ieMR and thank members who brought this to our attention. If you have concerns with the ieMR in your hospital, we want to hear your concerns.

H E A LT H V I S I O N

We are now two years into AMA Queensland’s Health Vision, which provides a guide to our advocacy work and provides government and stakeholders with a clear idea of our

master e-health, accreditation processes, cyber security and essentials for risk management; maximise opportunities for increasing practice revenue streams; receive invaluable advice from expert legal, accounting and insurance partners; choose sessions on starting a practice, or growing and improving your current practice; and earn RACGP and AAPM points.

Members and practice support staff in the employ of members can access preferential member rates. Contact the team at registrations@amaq.com.au or phone (07) 3872 2222 to register.


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Junior Doctor Conference AMA Queensland’s fourth Junior Doctor Conference took place in July with more than 200 junior doctors and medical students converging at the Hilton. The event kicked off with opening speaker Dr John Collee, on walking the unconventional path in medicine and the arts.

RESEARCH P R E S E N TAT I O N

Professor Karen Dwyer, part of the team that performed Australia’s first hand transplant, inspired delegates, while the inimitable Professor Gordian Fulde was very well received.

Winner: Dr Lauren Styan Introduction of a dedicated acute surgical unit improves clinical outcomes in acute appendicitis

Dr Kathleen Thomas received a standing ovation for sharing her story about the Kunduz hospital attack and her fallen colleagues, while Dr Renee Lim Skyped in from Berlin at 4am to tell more about practical techniques to improve doctor-patient relationships.

Runner up: Rachel Preisenberger Bridging the knowledge gap of perioperative warfarin management – a clinical audit

Delegates kicked up their heels at the evening cocktail party, where the winners of the inaugural Junior Doctor Awards were announced (see winners below).

POSTER P R E S E N TAT I O N

Health Minister Cameron Dick joined delegates on Sunday to talk about Queensland Health’s Junior Doctor Research Fellowship.

Winner: Dr Kristen Haakons 15 years of inhaled nitric oxide use in premature neonates – a retrospective audit

Thank you to platinum sponsor, the Queensland Government, premium sponsor BOQ Specialist, major sponsors MDA National and Clinical Skills Development Service, and sponsors William Buck, MGR, Macquarie, Médecins Sans Frontières, TressCox Lawyers, Brisbane BMW and Doctors’ Health Fund.

Runner up: Dr Catherine Epstein Is there a doctor on board? Yes, you.

AMA Queensland Junior Doctor and Student Awards Junior Medical Officer of the Year Award Dr Anna Duggan

AMA Queensland Medal of Achievement Obert Xu

Registrar of the Year Award Dr Frances Hills

AMA Memorial Prize Liana Dedina

AMA Queensland Children’s Health Prize - Bond University Aneeka Alexander

William Nathaniel Robertson Prize Luke Aaron

AMA Queensland Children’s Health Prize - Griffith University Paul Stevenson

John Bostock Prize in Psychiatry Andrea Aebischer

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Harold Plant Memorial Prize Luke Visscher Lilian Cooper Prize Liana Dedina and Rachel Colbran

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1. Dr Gordian Fulde 2. Dr Andrew Jeyaruban, Jisha Nair, Tejas Singh, and Dr Joanne Baque 3. Health Minister Cameron Dick with Drs Mikaela Seymour and Alex Robinson 4. Drs Matthew Rogers, Marina Tan and Selena Blackwell 5. Arielle Tay, Angela Carbone and Dhwani Gohel 6. Drs Anthony Deacon and Dr Elizabeth White 7. Alysha Oze and Jannat Islam

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Simulympics This year’s Junior Doctor Conference had a little more blood and guts than usual with the Clinical Skills Development Service (CSDS). Two sweaty, blood-spattered teams of four doctors in training, from two of Queensland’s busiest and feistiest emergency departments battled it out in a mock emergency setting. The teams worked against the clock for 40 minutes, navigating an obstacle course of broken body parts, spurting arteries and crunching ribs. The Brisbane Northside Team, consisting of Drs Jacqui Marks, Alex Robinson, Mikaela Seymour and Krishna Pattabathula, narrowly beat the Brisbane Southside Team of Drs Katherine Gridley, Jonathan Slot, Mariya Farah Hamid and Ben Cohen. We extend our sincere thanks to both teams and CSDS for delivery of this outstanding learning exercise.

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Dinner for the Profession

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This year’s Dinner for the Profession was another glittering affair, with guests gathering to celebrate the profession and new President Dr Bill Boyd. As expected, this year’s event took on a particularly Scottish flare, with a traditional haggis ceremony and bagpiper. AMA Queensland Foundation President Dr Steve Hambleton spoke about the Foundation’s work with Hear and Say and AMA President Dr Michael Gannon spoke about AMA’s advocacy work. Guests enjoyed outbidding each other for some gorgeous items including a black diamond bracelet; antique chandelier earrings; a white and rose gold filigree ring (from award-winning jeweller Stephen Dibb); two tickets to the Birdcage pavilion at the 2017 Melbourne Cup, including flights and accommodation; an AFL football signed by the 2016 Brisbane Lions squad; and tickets to the Queensland Symphony Orchestra. The AMA Queensland Foundation took almost $20,000 in sales, which will support their important work. We extend our sincere thanks and gratitude to our generous sponsors for donating the auction items, as well as the bidders for taking part. After a three-course meal, guests enjoyed jazz and blues entertainer Herb Armstrong and the Royal Street Krewe.

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Thank you to our generous sponsors, who make events like these possible: Macquarie Private Wealth, BOQ Specialist, BMW, William Buck, MDA National and Lexus of Brisbane.

C O N G R AT U L AT I O N S

Congratulations to Citation of the Branch awardee Dr Joanna Tait, for her incredible contribution to medicine and her philanthropic work. Colleen Sullivan and Patrick Staunton were presented with AMA Queensland’s first associate memberships, awarded to non-medical practitioners who have given honourable and substantial service to the medical profession in Queensland. Immediate Past President Dr Chris Zappala announced the Queensland Medical Orchestra as winners of this year’s President’s Award.

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1. Herb Armstrong and the Royal Street Krewe 2. Mark McCombie, James Coll, Drs Sharmila Biswas and David Shepherd, Cathy Shepherd and Dr Sarah Coll 3. Tayla Tatzenko, Honor Magon and Natasha McNamara 4. The Queensland Medical Orchestra 5. Drs Madeleine Carney, Mikaela Seymour and Bavahuna Manoharan 6. Dr Maria Tan 7. Andrew Cox and Carla Wessels 8. Drs Jonathon Shirley, Robert Whiting and Christopher Price 9. AMA Queenlsand Councillors Drs Dilip Dhupelia and John Hall 10. Drs Beres Wenck, Joanna Tait and Anne Spooner 11. AMA President Dr Michael Gannon, AMA Queensland President Dr Bill Boyd and Immediate Past President Dr Chris Zappala 12. Drs Marosh and Lily Vrtik

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Rural, regional and remote survey findings Later this year, AMA Queensland plans to release a discussion paper on rural, regional and remote (RRR) medical workforce issues. As part of the planning and preparation for this work, we conducted a survey of members in RRR areas to help inform the discussion paper and to make it relevant, contemporary and focused on solutions.

“The survey results had some surprising findings” said Dr John Hall, the chair of the working group. “But it also confirmed many other things which those of us who work in RRR areas know all too well. Such as how long it takes to replace departing staff, and how distance from friends, family and professional opportunities makes solving those issues even more difficult.” Dr Hall explained that the problems highlighted in the survey demonstrated the need for AMA Queensland to develop a discussion paper that would address these issues. “Whereas a lot of the policy work that has gone into developing rural medical workforce solutions has taken a broad, national approach to the problem, AMA Queensland will examine ways in which the state-based Hospital and Health systems (HHS) can play a greater role. Using the results of the survey, we hope to provide policy solutions specific to each individual HHS so we can really address the issues our members in these areas have identified.” 16 Doctor Q Spring

Perhaps most worryingly, almost 86 percent of those surveyed felt that Queensland Health did not appreciate the challenges faced by doctors working in rural, remote and regional areas.

Most RRR members wanted more specialists in their area (43%), followed by GPs (23%) and rural generalists (21%).

“Financial incentives” ranked only slightly above “Better access to medical specialty training posts” as being the most likely work arrangement to improve recruitment and retention of medical staff in RRR areas.

Just over 50 per cent of members surveyed reported that the average length of time to replace departing medical staff exceeded 6-12 months. 43 per cent reported the delay being between 1-6 months. Only 5 per cent of members surveyed said it took less than one month to replace departing medical staff.

Most RRR members said distance from friends and colleagues was the greatest impediment to recruiting specialists in their region.

AMA Queensland’s discussion paper will analyse these results and more in greater detail and we hope to deliver tailored solutions to workforce issues in each Hospital and Health Service that covers rural, remote and regional Queensland.


Greater Springfield Specialist Suites

Artist Impression

Artist Impression

Be part of Australia’s largest integrated health and wellness precinct. Purchase or lease your own medical suite in the heart of Health City in Springfield Central at the new Greater Springfield Specialty Suites. Located within Health City in Springfield Central, and due for completion in 2018, this facility will be directly adjacent to the Mater Private Hospital Springfield, AVEO Springfield, Quest Apartments and childcare.

With areas from 34m 2 to whole floors of 474m2 over five levels (above ground floor retail and car parking), don’t miss this unique opportunity in the heart of South East Queensland’s growth corridor. To register your interest visit gssuites.com.au or contact Uma Ranchigoda on 0412 470 882

www.gssuites.com.au Doctor Q Spring 17


An end to mandatory reporting?

Mandatory reporting of impairment has been an important advocacy issue for several years now. However, at the recent Council of Australian Governments (COAG) Health Council meeting, the message seemed to be getting across. Federal Health Minister Greg Hunt told The Australian that any change should relax reporting requirements to “remove the perverse disincentive to seeking treatment”. COAG’s media release stated: “Health Ministers agree that protecting the public from harm is of paramount importance as is supporting practitioners to seek health and in particular mental health treatment as soon as possible. Health Ministers agreed that doctors should be able to seek treatment for health issues with confidentiality whilst also preserving the requirement for patient safety. A nationally consistent approach to mandatory reporting provisions will provide confidence to health practitioners that they can feel able to seek treatment for their own health conditions anywhere in Australia.” I’m sure you have all seen the increased media coverage of the suicide of doctors around Australia in recent times. There has been a galvanising of the profession and an outpouring of grief and frustration by family, friends and colleagues of these individuals who saw no other way out of their stressful lives than to end their own lives.

Dr Bav Manoharan, Director and Councillor AMA Queensland

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You may have heard of the various plans and proposals being put forward to try ‘fix’ this problem; a metaphorical Hydra of many ‘heads’, each with its own set of unique challenges, supporters, detractors and repercussions when beheaded. One such ‘head’ is the real and perceived barriers our doctors and other health


practitioners face when they are struggling with psychological stresses and diseases and attempt to seek professional medical help. In Queensland, these barriers come in the way of mandatory reporting legislation within the Health Ombudsman Act 2013. The original intention of the mandatory reporting legislation was to ensure the protection of the public by requiring doctors (and other health practitioners) to report colleagues under defined circumstances. This requirement to report included doctors who treat other doctors with an impairment. We know however that these laws, being written by lawyers for lawyers, are vague, difficult to interpret, ill fit for practical utilisation and open to interpretation by all and sundry. A treating practitioner is expected to understand and apply the legislation which requires them to mandatorily report an individual who “placed the public at risk of substantial harm because of an impairment”. The oft-quoted 2013 beyondblue study of over 12,000 Australian doctors revealed that one of the most common barriers to doctors seeking treatment for a mental health condition were concerns about the impact of mandatory reporting on medical registration (34.3 per cent) and concerns about career development and progress (27.5 per cent). The Western Australian Government recognised this concern and created a provision in their legislation to exempt treating practitioners from the need to mandatorily report their health practitioner patients. This does not preclude the treating doctor from their ethical and professional obligations to voluntary notify if they feel there is a risk with their patient continuing to practice. Understanding reporting trends in Queensland can be confusing as notifications can be made to either AHPRA or the Office of the Health Ombudsman (OHO) or both. In Queensland, 5,435 complaints

were made to the OHO in 20152016. 665 (12.05 per cent) were mandatory from health employers, practitioners or AHPRA. Only 249 of the 545 complaints led to opened investigations and of the 169 completed investigations, nearly 45 per cent resulted in no further action being taken. 57 cases (35 per cent) were referred to AHPRA for further investigation. The OHO does not provide the breakdown of those in relation to impairment. The AHPRA numbers tell us that in 2015-16 there was a 17.7 per cent increase in mandatory notifications to AHPRA nationally, however Queensland only received 15 mandatory notifications, of which six were of doctors. This represents 1.5 per cent of the national number of mandatory notifications. There were 284 health practitioners in Queensland in 2015-16 being actively monitored for health reasons (including physical or mental impairment, disability, condition or disorder including substance abuse or dependence) representing 28.4 per cent of the national total which is highly incongruous when correlated to the 15 mandatory notifications in the same time period. This suggests that the overwhelming majority of notifications are made voluntarily, in good faith, in adherence with a treating practitioner’s ethical and professional commitment to public safety.

treatment. This risk is particularly pronounced with mental illness where delaying treatment can result in a person ending up with a far greater level of impairment. What the current mandatory reporting legislation does successfully achieve is act as a barrier for health practitioners to seek and access medical care and support for issues related to mental health. The unnecessary stress a mandatory notification can place on an individual seeking treatment can amplify the psychological distress of this already vulnerable individual. These fears only drive a suffering individual to hide their problems, to avoid seeking support from their GPs, psychologists or their health practitioner colleagues and friends. We know that individuals under this stress may turn to other options to assuage their suffering - substance and alcohol abuse, self-harm or suicide. It is clear that the current legislative arrangements are not protecting health practitioners and, equally importantly, they are failing to protect the public. It is our sincere hope that this issue will be given the significance it deserves at the next COAG meeting of Health Ministers in November 2018 and prompt legislative change will occur in Queensland to allow us to achieve the right balance between maintaining public safety and the rights of doctors to seek the healthcare they require.

The OHO admits that in 2015-16, there has been abuse of the mandatory notification system with the increase in a pattern of vexatious complaints by reporting alleged professional misconduct by disgruntled colleagues, which no doubt led to undue anxiety and stress for the practitioners involved.

If you are a doctor who currently treats other doctors or health practitioners or if you are a health practitioner who would like to seek support, please contact the Doctors’ Health Advisory Service Queensland (07) 3833 4352 or the AMA Queensland (07) 3872 2222 for confidential advice.

No system is infallible, but a system that purports to protect the public also needs to protect those who treat the public. A system open to misuse and abuse could amplify the aversion felt by those who already may be avoiding help. As doctors, we know the dangers of delaying access to medical

References AHPRA Queensland Annual Report Summary 2015/16 (http://www.ahpra.gov.au/annualreport/2016/html/statesummaries/qld-at-a-glance.html) beyondblue National Mental Health Survey of Doctors and Medical Students (October 2013) Office of the Health Ombudsman Annual report 2015-2016 (http://www.oho.qld.gov.au/wp-content/ uploads/2016/10/Office-of-the-Health-Ombudsmanannual-report-2015-16.pdf)

Doctor Q Spring 19


WorkCover Queensland online invoicing saving time and money If you care for patients that are under WorkCover, there’s now an easier way to get those invoices submitted and paid. Did you know that if you are invoicing WorkCover Queensland, it is a legal requirement that you must send accounts for treatment within two months from the date of service otherwise you may risk not getting paid? WorkCover has two electronic invoicing options available, which will make invoicing faster and easier. Other benefits include:

rapid invoice processing timeframes which eliminate manual data entry; secure transmission of invoicing information from your practice directly to WorkCover, so there’s no need to scan or fax invoices; use your WorkCover Provider online account to track what stage your invoice is at; and easy online invoice processing and payment tracking.

BUSINESS TO BUSINESS (B2B) ELECTRONIC I N V O I C I N G I N I T I AT I V E WorkCover has worked with the following practice management vendors to develop functionality that lets you bill WorkCover directly through your software:

20 Doctor Q Spring

Genie – Genie Solutions PPMP Chameleon – Casemanager Gensolve Skyhealth – Proprietary solution Smartsoft – Front desk APM HealthKit

Note: WorkCover does not endorse nor promote any vendor over the other and further information about each product should be sought from the software vendor. If your software vendor is not listed above, they can contact WorkCover for more information about how to work with us electronically.

C R E AT E I N V O I C E S ONLINE

If B2B is not a current option for you, you can still create invoices online and receive the same benefits. To create an invoice directly into the system through your Provider Online portal, simply login by clicking on the Invoice tab. Once the invoice has been submitted, you can print or save a copy for your records. WorkCover’s online portal guide has easy, step-by-step instructions on how to create invoices online as well as information about other benefits associated with our online services.

TO ARRANGE SOFTWARE SET UP OR OBTAIN FURTHER I N F O R M AT I O N

If you currently use one of the above practice management vendors or would like further information about WorkCover’s efficient electronic invoicing services, please contact Nyssa Johansen on (07) 3006 6852, email nyssa.johansen@workcoverqld. com.au or visit www.worksafe.qld. gov.au/medical/articles/electronicinvoicing-initiative to keep up-to-date with the latest workers’ compensation news for medical providers.


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Doctor Q Spring 21


What do you need to know going into MOCA 5?

The current Certified Agreement, (Medical Officers (Queensland Health) Certified Agreement (No. 4) 2015 (MOCA 4)) is set to expire on 30 June 2018 – so what do you need to know going into MOCA 5? The Australian Salaried Medical Officers’ Federation Queensland (ASMOFQ) will be representing your interests directly when negotiating the agreement with Queensland Health. In partnership with AMA Queensland, ASMOFQ will ensure that any agreement builds on and improves workplace entitlements, while also clarifying conditions to guarantee they are consistently interpreted and applied across each of the 16 HHSs. AMA Queensland will be lobbying government to ensure Queensland Health upholds their duties as the ‘system manager’ as dictated under the Hospital and Health Boards Act 2011 (Qld).

22 Doctor Q Spring

ASMOFQ and AMA Queensland understand the MOCA has progressed substantially since its original inception in 2005, including the abolishment of the Newman Government High Income Guarantee Contracts for SMOs. However, based on the queries our Workplace Relations Team has received from members since the introduction of MOCA 4, along with concerns obtained via the AMA Queensland Council of Doctors in Training (CDT) and the ASMOFQ Management Committee, we firmly believe improvements can be made to your working conditions in the future. To ensure a well-rounded agreement, we will be consulting and surveying all members to inform the development of a ‘log of claims’ which is reflective of what our members have communicated needs to be incorporated into the new agreement (MOCA 5). This will occur during August 2017. In September 2017,


Moca 5 - laying the foundation for cultural change “The certified agreement protects the most vulnerable among us. It is the standard that the hospitals must reach when deciding how we are treated. That’s why it’s so essential that we get it right.”

the Workplace Relations Team will consult CDT and ASMOFQ to assist in the development of the log of claims. We will consult with members again from October to December 2017 to finalise the log of claims which will be presented to Queensland Health in December 2017. It is anticipated that informal discussions will occur between ASMOFQ and Queensland Health later this year. However, it must be noted that under the legislation, the formal negotiation period cannot commence until January 2018. We encourage all members to complete the survey to ensure your voice is heard. If you would like to voice specific details regarding the MOCA 5 negotiations please contact us directly on (07) 3872 2222 or via email at MOCA5@amaq.com.au. It is also important members are aware of their workplace representatives who will assist with the negotiation process.

Ensure your membership is upto-date. Having a strong and united medical workforce behind the MOCA 5 negotiation team ensures your voice is heard at the negotiating table. Keeping your AMA Queensland and/ or ASMOFQ membership current ensures the department knows the medical officers’ log of claims is backed by 100% of the workforce. Encourage colleagues to join and you will also receive a referral discount of 25% off next year’s membership. Contact details: P: (07) 3872 2222 W: www.amaq.com.au E: MOCA5@amaq.com.au

JUNIOR DOCTORS

Dr James Finn The Prince Charles Hospital

Dr Matthew Cheng Princess Alexandra Hospital

Dr Nikola Ognyenovits The Prince Charles Hospital

Dr Chris Maguire Mater Hospital

Dr Kat Gridley QEII Hospital Dr Bavahuna Manoharan Sunshine Coast University Hospital

Dr Mila Dimitrijevic Greenslopes Hospital Dr Mikaela Seymour Royal Brisbane and Womens’ Hospital Dr Vinesh Appadurai Nambour Hospital

SENIOR DOCTORS Dr Stephen Morrison Royal Brisbane and Womens’ Hospital

Dr Suzanne Royle The Prince Charles Hospital

Dr Katharine Sinclair Lady Cilento Childrens’ Hospital

Dr Hau Tan Royal Brisbane and Womens’ Hospital Dr Chris Turnbull Royal Brisbane and Womens’ Hospital

RURAL AND REMOTE Dr Daniel Halliday Stanthorpe Hospital

Dr Derek Holroyd Proserpine Hospital

Dr Ekta Paw Townsville Hospital Dr Benjamin Wakefield Oakey Hospital

Doctor Q Spring 23


Council of Doctors in Training Update

Dr Matt Cheng, Chair, AMA Queensland Council of Doctors in Training

We are halfway through the year and I would like to take this opportunity to update all our members on the issues affecting Doctors in Training, and the progress we have made as the Council of Doctors in Training (CDT).

RESIDENT HOSPITAL H E A LT H C H E C K

We have released the results for the 2017 Resident Hospital Health Check to assist you with your intern and Resident Medical Officer (RMO) campaigns. They are available on our website with your AMA Queensland login. This is the second year we have conducted this survey which included 465 RMOs (approximately 20 per cent of the workforce). The results showed the top six RMO priorites being: 1. 2. 3. 4. 5. 6.

Clinical rotation preferences Teaching and education standards Unrostered overtime payment Annual leave allocation Personal safety at work Bullying and harassment

24 Doctor Q Spring

Concerningly, only 31 per cent of those who claimed overtime are not getting paid for it. Of respondents, 47 per cent of RMOs experienced or witnessed bullying and harassment and 77 per cent felt they could not do anything about it.

We are lobbying the state government to remove mandatory reporting requirements for doctors treating doctors to ensure they have the confidence to access mental health care in the same way as any other patient without fear of registration.

Hospital and Health Services across the state have been extremely responsive to these results, and we are working with each hospital to address them. Encouragingly, we will also be working closely with the Office of the Chief Medical Officer examining these results and addressing the issues you have raised.

We are drafting a letter to the Health Minister, so if you would like to add your support please contact me at cdt@amaq.com.au

We appreciate your efforts in participating in the survey. It is a useful tool to drive change to improve the working conditions for all RMOs across the state. Be sure to look out for next year’s survey.

M A N D AT O R Y REPORTING

Doctor suicide is an issue that resonates with all of us. Whilst a complex issue with many attributing factors, the CDT has been working to reduce the barriers for doctors seeking help. We believe a significant barrier for doctors seeking help is fear of deregistration under mandatory reporting laws. We know the dangers of delaying access to medical treatment, especially with mental illness. The current legislative arrangement is not protecting health practitioners, and as a result, not protecting the public either. Therefore, current mandatory reporting laws are not fit for purpose.

MOCA 5

Contract negotiations will shortly begin next year. In preparation for this, the CDT is preparing a log of claims which we will bring to the negotiating table. We need your assistance in generating this log of claims. I would also encourage you all to read through our current award (MOCA 4) available on the Queensland Industrial Relations Commission website. Contact me if you have any suggestions or additional items to include in our contracts. This contract will be applied to all of us as Doctors in Training for three years, so it’s important to get it right. There’s never been a more important time to have current membership. Refer your colleagues to join and receive 25 per cent off next year’s membership.

NEXT CDT MEETING

Please join us either in person or remotely for our next CDT meeting on Thursday 28 September. If you have any queries or issues you wish to raise, email cdt@amaq.com.au.


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Health Vision influencing change two years in The aim of AMA Queensland’s first Health Vision was to get on the front foot and tackle changes on which our members, from medical students, junior doctors, GPs, specialists through to retired doctors, had a unique perspective. Rather than responding to poor policy or practice, we wanted to give our members a platform to go about making real change to the health system. After extensive consultation with members, AMA Queensland launched the first part of its Health Vision in 2015, with five parts that would detail AMA Queensland’s advocacy and policy goals over the next five years. Change takes time, but already we’ve seen the Health Vision play a part in influencing health policy. Let’s have a look at how the Health Vision is going two years into its fiveyear cycle.

26 Doctor Q Spring

H E A LT H V I S I O N P A R T 1

Public health and generational disadvantage This chapter proposed that the government establish a whole-ofgovernment public health plan to combat Queensland’s biggest public health issues, such as obesity. It also emphasised the importance of GP vaccinations and called on the government to do more to meet its Close the Gap targets. Since its release, the first chapter of the Health Vision has played a part in influencing these initiatives from the Queensland Government:

more publicly-funded bariatric surgery to combat obesity;

establishing a Queensland Health Promotion Commission, which would be tasked with implementing a whole-of-government approach to public health;

Drive to 95, a partnership between Queensland Government and AMA Queensland to improve immunisation rates in communities where the herd immunity is below 95 per cent; and

increased emphasis on GP vaccinations, which again was a key recommendation in the Health Vision.

H E A LT H V I S I O N PA RT 2

Workforce and training This chapter urged an amendment to mandatory reporting laws in Queensland which would provide an exemption such the model in Western Australia.

There appears to be movement on changing Queensland’s mandatory reporting laws, with the government indicating that they are exploring how to amend these laws. We are working with the government to ensure that a health practitioner can see a general practitioner or psychiatrist to get help for their condition without fearing that the treating doctor will report them.


H E A LT H V I S I O N P A R T 3

Reprioritising health funding

In this chapter, AMA Queensland advocated for a trial of the Health Care Home (HCH) model, which we believed would empower general practice to provide an enhanced model of the already high level of care they provided to patients, potentially keeping patients out of the more expensive public hospital system. We based this recommendation on the final report of the National Health and Hospitals Reform Commission (NHHRC) which recommended a strategy where patients at risk of chronic disease could voluntarily enrol with a primary health care provider as their ‘health care home’. Sometime later, the Federal Government announced they would begin a trial of Health Care Homes. Although the AMA initially welcomed this decision, we became concerned that the model the Federal Government was proposing was less patient focussed and more akin to a cost cutting exercise. Through ongoing advocacy, we secured a short delay in the roll out of the HCH trial to allow more time to work on the details of the model. The government has also re-affirmed that the project remains a trial and is subject to review and evaluation. The AMA continues to engage with the Health Minister over the adequacy of HCH funding, given the government is asking GPs to do more for patients with no additional funding allocated.

H E A LT H V I S I O N PA RT 4

H E A LT H V I S I O N PA RT 5

In this chapter, AMA Queensland turned its focus to improving collaboration between the different levels of the health system. Health Vision 4 argued the Queensland Government should investigate how it can improve connections between the different parts of the health system. One of the ways in which it could do this, we suggested, was a system which would allow both GPs and their patients to track the status of their referral to a public hospital.

This chapter of the Health Vision was released in early 2017 and focused on care at the end of life. It proposed increased funding to palliative care services and advocated for a target of “50 over 50” – in other words, that 50 per cent of Queenslanders over the age of 50 should have an Advanced Health Directive (AHD) by 2021.

Unifying the health system

On 1 June 2016, Health Minister Cameron Dick announced a specialist outpatient strategy which will tackle waiting lists and improve access to specialist services by 2020. Part of this strategy included an online referral system which would allow GPs to easily manage and track a patient’s referral with consistent referral standards and electronic referral management systems. It also contained a number of proposals which aimed to improve collaboration between GPs and the state controlled public health system.

Care at the end of life

AMA Queensland is working closely with the Queensland Government’s Care at the End of Life project team, led by AMA Queensland member and State-wide Clinical Lead for Care at the End of Life, Dr Will Cairns. The impetus for change in this policy area is strong, and already other partnerships have begun to present themselves. AMA Queensland is working with the Queensland Law Society to improve Queensland’s Advance Health Directives and increase their uptake, and we are working with Queensland Health to develop either an AHD or Statement of Choices style document for paediatric palliative patients.

The AMA Queensland Health Vision is a little over two years old. As a five-year vision, there is still some time to realise all its policy solutions. We hope to have further good news on these targets when we report on the progress of the Health Vision again next year.

Doctor Q Spring 27


One in two hospital doctors working unsafe hours Over a one-week period in November 2016, 716 salaried doctors and doctors in training (DITs), including 675 hospital-based doctors, kept an online diary of their hours of work, on-call hours, non-work hours, and sleep time. The audit showed that one in two doctors are working unsafe hours that place them at a higher risk of fatigue. One doctor reported an unbroken 76hour shift. Other unsafe shifts lasted 72 hours, 59 hours, 58 hours and 53 hours. AMA President Dr Michael Gannon said the 2016 Audit – the fourth conducted by the AMA since 2001 – is an improvement on 2001 when 78 per cent of those surveyed reported working high risk hours, but it is worrying that there has been no improvement since the 2011 Audit, which also showed 53 per cent of doctors at significant risk of fatigue. “The audit warns that the demands on many doctors continue to be extreme,” Dr Gannon said. “It is disappointing that work and rostering practices in some hospitals are still contributing to doctor fatigue and stress, which ultimately affect patient safety and quality of care and the health of the doctor. “It’s no surprise that doctors at higher risk of fatigue reported working longer hours, longer shifts, more days on call, fewer days off, and skipping meal breaks. “We are dismayed that one doctor reported working a 76-hour shift in 2016, almost double the longest shift reported in 2011. “It is also a great concern the maximum total hours worked during the 2016 survey week was 118 hours, the same as 2006 – no improvement in a decade.” 28 Doctor Q Spring

The most stressed disciplines were intensive care physicians and surgeons with 75 and 73 per cent respectively reporting they were working hours that placed them at significant or high risk of fatigue.

“Administrators must also acknowledge that fatigue has a significant effect on doctors in training, who have to manage the competing demands of work, study, and exams.

Research shows that fatigue endangers patient safety and can have a real impact on the health and wellbeing of doctors.

“The audit found that six out of ten registrars are working rosters that place them at significant or higher risk of fatigue, compared to the average of five out of ten hospital-based doctors.

The 2016 audit confirms that the demands on public hospital doctors are still too great. Dr Gannon said that state and territory governments and hospital administrators need to intensify efforts to ensure better rostering and safer work practices for hospital doctors. “Reducing fatigue-related risks does not necessarily mean doctors have to work fewer hours, just better structured and safer ones,” Dr Gannon said. “It could be a case of smarter rostering practices, improved staffing levels, and better access to appropriate rest and leave provisions so doctors get a chance to recover from extended unbroken periods of work.

“Public hospitals need to strike a better balance for doctors in training. “They must provide a quality training environment that recognises that safe working hours and conditions for teaching and training will ultimately ensure high quality patient care.” The AMA’s National Code of Practice Hours of Work, Shiftwork and Rostering for Hospital Doctors (the Code) was revised in 2016. It provides practical guidance on how to manage fatigue, and eliminate or minimise the risks associated with shiftwork and extended working hours. This should be adopted as the minimum standard by all states and territories.


Day in the life of a new GP practice Drs Fiona Raciti and Maria Boulton opened their new practice, Family Doctors Plus, 18 months ago and recently won Telstra’s Queensland Business of the Year Award. We took some time to chat with the doctors to find out why their first year in business has been so stellar.

What advice would you have for other doctors wanting to open a new practice? I would say take the plunge! It is incredibly empowering to have the ability to make decisions about how you practice medicine and look after your patients. When we were starting to think about opening a practice we made a choice - to take the easy road and stay where we were, knowing we could do things better, or be brave and take a chance. We backed ourselves and our ideas and here we are! Opening a new practice is hard work, long hours and many sacrifices, but 18 months into our journey, I know I wouldn’t have it any other way.

How have you done things differently? What is your approach? We were dissatisfied with five-minute medicine and the lack of holistic preventative medicine that is done in general practice. We knew we could keep people well, happy and healthy if we could empower them with time, education and confidence to look after their own health. Our

business model allows us to spend time with our patients to really ensure they understand their health. We run education sessions for patients, parents, kids and colleagues which allows us to provide much more detailed information to our patients. We offer puberty sessions for girls and boys, women’s health evenings, school readiness seminars and fundraisers where our colleagues help us educate our patients. We practice in a holistic way by focussing on preventative medicine and keeping people well. Our experienced allied health team to help us look after our patients. For example, we have a health coach who helps us nurture our patients both inside and out. Our lovely fresh, vibrant clinic encourages people to feel happy to come and see us.

A client survey showed 99 per cent of patients were satisfied with Family Doctors Plus. What would you attribute to this high satisfaction? Our excellent staff. We hand pick all our staff from reception, nurses, doctors and allied health. It is important people feel comfortable coming to the practice and interacting with our staff. It is like a big family! We take the time to get to know our patients really well and welcome them with a big smile when they come in the door! We also make sure our medicine is up to date and evidence best to make sure we are doing the best for our patients. However, we aren’t afraid to ask for help and our patients appreciate our close network of colleagues to help us when we need.

Dr Raciti, you’re a founding member of the Australasian Society of Lifestyle Medicine? Can you tell us about Lifestyle Medicine and how you’ve applied it to your practice? Lifestyle medicine is about looking at the whole person and their determinants of health and well being - environmental, work, social, diet, stress, sleep and how this impacts on their health. It is so important to address all these facets of people’s lives when looking after their health. I think sometimes that general practice can be about fixing an acute problem without thinking of the bigger picture. This is one of the things we do differently at our clinic.

Doctor Q Spring 29


Growing from failure The second time I failed, I felt much worse. I endured bullying for having dared to fail twice.

Dr Louise Teo Locum Medical Registrar/ Basic Physician Trainee I remember learning that I’d failed my exam. It was a Thursday and results for the physician training exam were to be released from 3pm. At three, we crowded around the ward computers, but the website had crashed. I refreshed until it finally loaded at home, at nearly midnight. It wasn’t the worst event of my life but it was still awful. It’s common as a doctor to feel you’ve failed as a person if you can’t accomplish something.

30 Doctor Q Spring

I struggled to focus on studying for a third consecutive year. Tears welled up as I read my notes. Breakthrough treatments announced during my first attempt were now listed on the PBS. It was fascinating but I was exhausted. I could have chosen to believe that my value counted on the exam or I could trust the remnants of my self-worth and focus on enjoying medicine.

IT WAS TIME FOR A BREAK

As junior doctors, we rely on feedback from our seniors in order to grow. We’re constantly adapting to ever-increasing positions of responsibility. With our long hours, it’s easy to continually rely on this feedback to validate your self-worth. With bullying, that can have serious consequences far beyond medicine.

I had learnt tons from working with many consultants who valued the trainee as a human of worth, who’d taught me so much. I would miss working with them.

LOCUMING SAVED ME

I was stunned, walking into handover during my second locum stint. The consultants at that rural Queensland hospital valued their staff. I was welcomed. With each new job, I slowly regained confidence. I began to appreciate little things, like the fresh air on a crisp Tasmanian morning, or kookaburras crowing along the NSW coast. The gecko plastered against the window in a ward north of Brisbane. Coming from Melbourne, that was hilarious. I met more diverse patients than I could have at home. The agencies asked if I’d try oncology. Were they sure? It would be similar to med regging. Later that year, I was offered a full-time oncology job. My skills had expanded in a short time.

Between jobs, I felt set free into the real world again. I saw non-medical friends. I read a lot about failure and growth. One day I started a blog. I hungered to know what others did beyond traditional clinical work. The first person I interviewed was a psychiatrist who’d triumphed after failing his exams. Now he runs a teleconsulting company. I found all sorts of people, from students to specialists, doing great things with their skills. They’ve survived setbacks. They’ve failed at various pursuits. But they’ve also succeeded and their biggest successes lie in their personal growth, for which no diploma exists, but should be prized throughout their journeys. I want to resume training when I’m ready. When you’re running your own project, you’re constantly learning. You fail a lot. But you learn to persevere or to start afresh. It’s a valuable journey. It’ll help me grow as a doctor. And it’ll help me sit that exam again.


Wherever the art of medicine IS LOVED, There is also a love of HUMANITY. (Hippocrates)

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Doctor Q Spring 31


Local Medical Association round up Redcliffe District Local Medical Association (RDLMA)

Ipswich & West Moreton Medical Association (IWMMA)

Gold Coast Medical Association (GCMA)

Contact:

Contact:

Contact:

Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3284 9777 Meetings: 12 September 25 October 1 December - networking function

Sunshine Coast Local Medical Association (SCLMA) Contact: Web: Email: Phone: Meeting:

Jo Bourke, Secretariat www.sclma.com.au jobo@squirrel.com.au (07) 5479 3979 26 October 30 November

Bundaberg Local Medical Association (BLMA) Contact: Email: Phone:

Dr Daud Yunus daud.yunus@gmail.com (07) 4152 2888

Mackay Local Medical Association (MLMA) Contact: Phone:

Dr Bill Boyd 0419 676 660

Phone:

Dr David Morgan, President; Dr Aletia Johnson, Meetings Convenor; Dr Thomas McEniery, Treasurer (07) 3281 1177

Brisbane Northside Local Medical Association (NLMA) Contact:

Dr Robert (Bob) Brown, President Web: www.northsidelma.com Phone: (07) 3265 3111 Meetings: 10 October 12 December

Toowoomba and Darling Downs Local Medical Association (TDDLMA) Contact:

Dr Mark Wyche, President; Dr Peter Schindler, Treasurer Web: www.tddlma.org.au Email: info@tddlma.org.au Phone: (07) 4633 1939 Wilsonton Medical Centre (Dr Peter Hopson) Meetings: First Tuesday of each month, 7pm at St Andrew’s Hospital, 280 North Street, Toowoomba

CAN’T FIND YOUR LOCAL AREA? 32 Doctor Q Spring

Chantell Badenhorst, Secretariat Manager Web: www.gcma.org.au Email: info@gcma.org.au Phone: 0419 780 505 Meetings: 21 September – clinical 19 October – clinical 17 November – social

Fraser Coast Local Medical Association (FCLMA) Contact: Email: Phone:

Dr Nicholas Yim, Secretary drnnyim@gmail.com 0421 659 892

Cairns Local Medical Association (CLMA) Contact: Phone:

Dr Sharmila Biswas (07) 4036 4333

Central Queensland Local Medical Association (CQLMA) Contact: Phone:

Dr Michael Donohue 0419 715 658

If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au.


Doctor Q Spring 33


Talking doctor to doctor: supportive communication with colleagues Vicky Dawes, Advisor, QDHP and Doctors’ Therapist Communication skills training, and specifically how to develop a good doctorpatient relationship, is an important component of medical training. Good doctorpatient communication offers benefits for both doctor and patient, including improved patient perception of doctor competence and better patient satisfaction, and resultant greater job satisfaction for the doctor. Reflection is a key skill for improving our communication. Honing our communication skills is part of our continuing professional journey. Just take a moment to consider a conversation when you felt completely understood. When your conversation partner just ‘got’ where you were coming from. Consider what it was about that interchange that helped you feel validated, respected and valued? Now take a moment to think of a time when a conversation hasn’t gone as expected. Maybe you were left feeling misunderstood, misinterpreted, frustrated or even embarrassed and ashamed for trying to express yourself. Two very different conversations? But what about the importance of doctor-to-doctor communication skills? Training 34 Doctor Q Spring

on how to communicate effectively with colleagues is often minimal or completely absent. Yet communicating effectively with our colleagues is essential. There are different communication skillsets: the confidence and assertiveness required of a junior doctor to speak with a consultant; having the difficult conversation when delivering negative feedback; and clear and concise communication necessary in critical scenarios. These all clearly fall within the remit of ‘work’ conversations. We are likely to expect these conversations, despite the minimal training. But what about talking to our colleagues about their personal wellbeing? What if our colleague is not quite themselves? Do we talk with the registrar who seems shaken by that trauma case? The JMO who is requesting sick leave? Do we dread the corridor consultation? Here are a few points that can improve these conversations - so our colleagues feel understood, validated and respected, rather than defensive, misunderstood, frustrated or even embarrassed. Refreshing and improving our communication skills with colleagues can have a positive effect on the colleagues we’re supporting. It also engenders a supportive workplace culture and improves our interactions with patients.

Pick your moment. Consider time and place – do you need to have the conversation right now, on the ward/amongst other staff and patients/between cases? Schedule a time; find a discrete location.

Check your non-verbal behaviour. Show that you are interested; make appropriate eye contact; try to minimise digital distractions.

Build trust and rapport. How can you help your colleague feel at ease?

Actively listen without judgement or interruption. Don’t be afraid of silence, quiet time to gather thoughts can be helpful. Use reflection to help your colleague know they have been heard.

Normalise and validate. Compassionately acknowledge what your colleague is experiencing. Be cautious about responding with your own ‘back-in-the-day’ horror scenario as this may appear dismissive or invalidating.

Encourage but be cautious about adding your own judgements as they may detract from the message.

Remember that you are not your colleague’s doctor. Your colleagues have a right to decide how much they disclose to you about their health, and don’t need to explain their reasons for taking sick leave. Supporting your colleague does not mean offering solutions, diagnoses or even advice. It is about support.

Refer on if necessary. Don’t leave your colleague stranded. There is no shame in acknowledging that you are not the appropriate support for this colleague. Your working relationship or personal relationship may make this inappropriate. Remember that QDHP is available for 24/7 support to doctors and medical students in Queensland.

QDHP

Queensland Doctors’ Health Programme


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Doctor Q Spring 35


Broaching end of life care for kids Being diagnosed with a life-limiting condition is not something any child or parent could ever be prepared for. Surviving the loss of a child is the most difficult life experience any parent can imagine. As clinicians, we have the opportunity and the obligation to do what we can to support young patients and their families through this incredibly difficult experience. And it all starts with a conversation. A conversation just like those we have with a woman about her choices during pregnancy and birth, or a patient undergoing cancer treatment, or a patient in the emergency department. A conversation with a young patient who has been diagnosed with a lifelimiting condition or who is nearing the end of their life about how they want to live is one that has the potential to make the experience less traumatic for everyone. It is, however, one of the most challenging and difficult conversations a clinician can have. Death and dying have traditionally been taboo subjects in our society, and as health professionals we are not generally equipped to initiate these discussions appropriately. Recognising this and following the launch of the Charter for care of adult patients at the end of life, a Charter for children and young people affected by a life-limiting condition has been developed*. 36 Doctor Q Spring

Importantly, the Charter has been developed in partnership with consumers —it is not just clinicians deciding what’s important for a young patient and their family. It aims to support young patients, their families and clinical staff to talk openly about their wishes after a diagnosis of a life-limiting condition and improve care at the end of life. It identifies communication as a shared responsibility between clinicians, patients and their family, and recognises that all of us have an important role to play to ensure that good quality care at the end of life is provided to everyone. At the launch of the Charter during Palliative Care Week at the Lady Cilento Children’s Hospital, North Brisbane mum Carolyn Wharton shared her insights from 12 years’ experience as a parent in the health system. Carolyn lost her daughter Madelyn last year at age 12. She said the actions of doctors, clinicians and hospital staff personally affect lives and have a direct impact not only on the patient but on the entire family’s life as well. ‘You can shape and guide lives, transform lives and devastate lives,’ she said. ‘Your approach, your mannerisms and your words will be remembered long after you leave the room.’ Carolyn said that the words and actions of parents and family members directly impact their child’s life as well.

The role of clinicians in supporting children and young people to live as well as possible after being diagnosed with a life-limiting condition is significant, writes the Chair of the Queensland Clinical Senate, Dr David Rosengren. ‘The Charter builds a two-way communication commitment that in turn develops a trust and support that is unfounded. Trust and communication plays such an important role in this difficult journey for a child and their family. It’s a partnership and it’s a commitment,’ she said. It’s time for conversations about care at the end of life to be normalised so that patients, like young Madelyn and her family, receive the highest quality care during and at the end of their life. I encourage all clinicians to embrace the Charter and embed the principles into daily clinical practice. For a copy of the Charter, visit https:// www.health.qld.gov.au/clinicalpractice/engagement/clinical-senate * The Charter for children and young people affected by a life-limiting condition was developed by the Paediatric Palliative Care Working Group of Queensland Child and Youth Clinical Network in collaboration with InFocus Disability Service, Hummingbird House and St Vincent’s Private Hospital, Brisbane. The Queensland Clinical Senate and Health Consumers Queensland also endorse the charter.


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Doctor Q Spring 37


Events Calendar 70TH AMA QUEENSLAND BANCROFT ORATION

How medicine can meet the demands of an ageing tsunami

WOMEN IN MEDICINE B R E A K FA S T

Leading lights Inspirational women in medicine

WOMEN IN MEDICINE BREAKFAST Date: Thursday 7 September Location: Brisbane Convention and Exhibition Centre Panellists: Radiation Oncologist Dr Bronwyn King has lobbied over 33 superannuation funds to divest themselves of tobacco shares. Dr Homa Forotan escaped Afghanistan and arrived in Australia as a refugee, and works tirelessly advocating for refugees. Dr Nikki Blackwell has worked in humanitarian emergencies in war-torn countries and is a founding member of the Alliance for International Medical Action.

38 Doctor Q Spring

WORKPLACE R E L AT I O N S WEBINARS Personal/Carer’s Leave and Compassionate Leave 101: Recording now available for purchase Managing underperformance: Friday 22 September, 12noon – 1pm Social media in the workplace: Friday 1 December, 9 – 10am Brush up on your workplace relations knowledge without leaving your office when you register for AMA Queensland’s Workplace Relations webinars, or register and receive the recording post-event. George Sotiris, Workplace Relations Manager at AMA Queensland is hosting the webinars.

B A N C R O F T O R AT I O N Date: Tuesday 21 November Location: Victoria Park Golf Club Join us for the historic Bancroft Oration, as this year’s orator, Dr Catherine Yelland, a geriatrician and general physician, speaks on how medicine can meet the demands of an ageing tsunami.

Visit www.amaq.com.au for more information or to register for our upcoming events.


70TH AMA QUEENSLAND BANCROFT ORATION

How medicine can meet the demands of an ageing tsunami Date: Tuesday 21 Nov 2017

Time: 6.30pm for a 7pm start

Venue: Garden Marquee, Victoria Park Golf Club, Herston Road, Herston.

Cost: FREE for AMA Queensland Members and non-members. Limited places are available.

Live webinar attendance is also available for regional and rural practitioners. Please indicate whether you wish to attend in person or via webinar at the time of registration Quick and easy online registration is now available. Visit www.amaq.com.au and follow the prompts to register, or phone (07) 3872 2222.

Oration outline Thanks to medical advances, improved public health and the ageing baby boomer generation, we have more older people than ever before. With this comes the challenge of dealing with dementia, chronic illnesses, disability and increased social welfare costs. However, we can meet these demands with good planning, wise allocation of resources, research, and the rational use of medical care. Attitudes towards older people are changing and we must ensure that our longer lives are well lived through careful health planning and resourcing.

Orator biography Dr Catherine Yelland is a geriatrician and general physician, and is the Medical Director of Medicine Service Line, at Redcliffe Hospital. Dr Yelland has worked with older people for 30 years and was previously the President of the Australian and New Zealand Society for Geriatric Medicine. Catherine is currently President of the Royal Australasian College of Physicians. Her interests are in clinical medicine, particularly in dementia, teaching of junior medical staff, service development and women in medicine.

Doctor Q Spring 39


Leading lights: inspirational women in medicine

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3

This year’s Women in Medicine Breakfast speakers are Australian doctors who have changed the world.

“We’re a dedicated cancer hospital,” she recalls. “There was nowhere else this could have mattered more. The idea that all of us, the doctors, the nurses, the occupational therapists, the speech pathologists, were invested in tobacco companies … well, it had to be fixed.” Realising that many of her colleagues would be just as unhappy to find they were supporting the global production of cigarettes, Dr King met with First State Super, who had merged with Health Super, and urged them to go tobacco free. First State Super CEO Michael Dwyer realised that a group with 40 per cent of its members in health services had $170 million invested in tobacco. HESTA followed six months later. Tobacco Free Portfolios was born. Four years later, Dr King has almost singlehandedly convinced 28 Australian super funds to divest at least $1.3 billion in tobacco companies. 40 Doctor Q Spring

1. Dr Bronwyn King, Radiation Oncologist and Chief Executive Officer, Tobacco Free Portfolios 2. Dr Homa Forotan, Medical Registrar, Princess Alexandra Hospital

Let’s start with Dr Bronwyn King, a radiation oncologist who was caring for patients with lung cancer at the Peter MacCallum Cancer Centre. She met with a representative from her superannuation fund in 2010 and found out her money was flowing to tobacco companies through a default option with her fund. “I thought it was a very bad fit for me as a cancer doctor. I had watched hundreds of people die from tobaccorelated disease,” Bronwyn reflects.

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3. Dr Nikki Blackwell, Senior Staff Intensivist, The Prince Charles Hospital

Women in Medicine breakfast attendees will also have the chance to hear from Dr Homa Forotan, the 2008 Young Australian of the Year and refugee advocate. Dr Forotan fled Afghanistan and came to Australia in 2005 with her family after her father’s outspoken opinions made him a target of Afghanistan’s government. “My father had to leave the country due to his political views and cultural views and as a highly-educated person he was seen to be a threat to the regime of the time,” Dr Forotan said. She founded the Association of Australian Tertiary Students from Afghanistan (AATSA) that fosters interest in higher education and professional networking among Afghan-Australian youth. Dr Forotan has been part of various communitybased initiatives that promote harmony, multicultural and interfaith dialogues. She is now a junior physician at Princess Alexandra Hospital studying cardiology, and continues to work tirelessly in the Brisbane community advocating for refugees.

Third speaker, Dr Nikki Blackwell, is best known for her work in humanitarian emergencies in Haiti, Pakistan, Ivory Coast, Liberia, Bandah Aceh, Niger, Mali, Burkina Faso, Guinea, Iraq, Iran and Jordan. In Dr Blackwell’s early career, she specialised in palliative care and was the Director of the Emergency Department in Mount Isa. She now works as a senior specialist in the Intensive Care Unit at The Prince Charles Hospital and was rewarded with a Queensland Public Service Medal for outstanding public service in patient care, trauma management and palliative care services. Dr Blackwell has been an advocate for greater professional, patient-centred care in response to humanitarian catastrophes. After many roles at Médecins Sans Frontières, Dr Blackwell became a founding member of the Alliance for International Medical Action (ALIMA). Register a table now for this year’s Women in Medicine Breakfast to meet these speakers and hear their stories. Discounted member rates available.


WOMEN IN MEDICINE B R E A K FA S T D AT E :

T H U R S D AY 7 SEPTEMBER 2017

TIME:

7 – 9AM R E G I S T R AT I O N F R O M 6.45AM – 7AM

VENUE:

BRISBANE CONVENTION & EXHIBITION CENTRE (BCEC)

AMA QUEENSLAND MEMBER R AT E S A L S O AVA I L A B L E F O R QUEENSLAND MEDICAL WOMEN’S SOCIETY (QMWS) MEMBERS

#amaqwim @amaq_president

Leading lights Inspirational women in medicine Explore the power of change at this inspirational breakfast. Commentated by respected media identity Melissa Watter of Sequel PR, meet inspiring women in medicine who have blazed a trail throughout their lives, personally and professionally. Join our panel of incredible women in medicine: Dr Bronwyn King, Radiation Oncologist and Chief Executive Officer, Tobacco Free Portfolios Dr Homa Forotan, Medical Registrar, Princess Alexandra Hospital Dr Nikki Blackwell, Senior Staff Intensivist, The Prince Charles Hospital

Are you overdue to catch up with your colleagues and friends? Register now - discounted member and group booking rates apply. Single tickets are also available. AMA Queensland members and practice staff in their employ can take advantage of member benefits and book their seats at heavily discounted rates. Member rates also apply to Queensland Women’s Medical Society members. Visit the events calendar at amaq.com.au to register or for more information.

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SPEAKER SPOTLIGHT

Dr Toby Ford Catch Dr Toby Ford at this year’s Private Practice and MedicoLegal Conference where he’ll share tips and traps learnt from 30 years in practice.

Dr Toby Ford is founder and CEO of Ford Health, a multi-disciplinary performance and preventative health practice with clinic sites around Australia. His team provides health risk management, logistics, health system navigation and sense making. They have been researching and quantifying how health, wellbeing and resilience effect productivity and performance in workplaces. Dr Ford is a keynote speaker at the upcoming Private Practice and Medico-Legal Conference. When Dr Ford recollects his time at medical school, there was a short lecture available on setting up practice. Toby recounts that some 30 years later, setting up and running his private practice has been a case of trial and error, with plenty of lessons learned along the way. “The first practice I owned was with three partners based at Wesley Hospital founded in 1988. In those days it was the first corporate health practice in Queensland and served predominantly executives and workers they employed. It was a real eye-opener for me as I had naively assumed that if one worked hard, the money would take care of itself. This was untrue and I learnt the hard way to not rely on such thoughts,” said Dr Ford. “If you can’t run a profitable sustainable business in anything else, then why wouldn’t the same apply to medicine? 42 Doctor Q Spring

A reality is that we all focus heavily on service delivery integrity and quality for our patients. I did this for far too long, before establishing the balance. Two of my best business mentors always asked me why we wouldn’t naturally assume similar rigour on the financial aspects of day-to-day operations. “Often, I have talked to other colleagues and discovered their discontent and resentment of the moneymen who slice and dice the heart out of care. This is true in some of the more shining examples of professional exploitation that we hear about. But there is a common ground we must all remind ourselves about and that is you can’t do consistent quality and go broke - it is too emotionally draining and prevents innovation and selfcontentment,” he said. “Placing a value on what we do is important. If it is undervalued by others for example, purchased for free or priced so as to create insolvency then this will grind our hearts over time. Please don’t, however, assume I would not endorse pro bono work, but only as part of our practice. One needs to be able to afford to do pro bono or it too can suffer sometimes,” he said. Having observed the workplaces of many corporate clients throughout Australia, Toby has seen great workplace culture at play, versus cultures that are not so great. He is passionate about developing an inclusive, happy culture at his own practice and he sees work as a place for his team to thrive, personally and professionally. It is important for the team to see the patient as number one, but attracting good team members to drive patient service and satisfaction is dependent on positive leadership behaviours, traits and chemistry. At the conference, Dr Ford will discuss tips for embedding a positive culture in the workplace, whether you are setting up a new enterprise or tweaking an existing practice.


P R I VAT E P R AC T I C E & MEDICO-LEGAL CONFERENCE

Future-proofing your practice Date:

Friday 6 – Saturday 7 October 2017

Time:

9am – 4.30pm

Venue:

Brisbane Convention and Exhibition Centre, South Bank

Cost:

Early-bird member discounted rates end 25 August 2017 and start at $290 for one day. Practice support staff in the permanent employ of an AMA Queensland member are also eligible for member early-bird rates.

CPD:

• Category 1 RACGP CPD Points have been applied for • AAPM points have also been applied for – to support the professional development of practice support staff.

The Private Practice and Medico-Legal Conference 2017 will focus on future-proofing your practice. From e-health, to passing accreditation, exploring new income streams for private practice, digital marketing and managing emerging risks in practice, we have you covered. The Friday program is designed for medical practitioners and practice support staff with a choice of two concurrent streams available for those who are new to practice, versus those who wish to develop and improve upon their existing practice procedures, technology and income. The Saturday program will appeal to both medical practitioners and practice support staff, and you can choose between practice management and/or medico-legal streams.

KEYNOTE TOPICS

KEYNOTE SPEAKERS

The importance of practice culture - what I have seen, learned and what we can do better.

Dr Jeannette Young, Chief Medical Officer, Department of Health

Passing the accreditation process for general practitioners and specialists – what you need to know.

Dr Toby Ford, Founder and Chief Executive Officer, Ford Health Group

Practice incentive payments – what other streams of income are available for you to access?

Dr Lily Vrtik, Plastic Surgeon

Dr Mark Craig, Practice Principal, My Medical Best Practice

Out of pocket costs and what’s on the horizon - the future of medical fees in private practice.

Damien Edmonds, General Manager, Edmonds Marketing

Supplying patient records to third parties such as insurers – what are the legalities?

Dr Nigel Prior, Addiction Medicine Specialist and Psychiatrist, Wentworth Clinic

HR essentials: Avoiding traps and ensuring you are compliant with Fair Work legislation.

George Sotiris, Manager, Workplace Relations, AMA Queensland

Legal, clinical and procedural considerations regarding the prescribing of medical marijuana for general and specialist practice.

Katharine Philp, Partner, TressCox Lawyers

Loryn Einstein, Managing Director, Medical Billing Experts

Registration is now available and discounted member rates available (also applies to staff employed by members). Visit amaq.com.au for more information on how to register, or phone (07) 3872 2222 to register now.

1 | Private Practice & Medico-Legal Conference 2017

Preferred Medical Indemnity Provider

Doctor Q Spring 43


New alliance with Make It Cheaper Due to the increased cost of electricity and gas that will affect your home and practice budget, AMA Queensland has partnered with Make It Cheaper, an electricity and gas comparison service. AMA Queensland CEO Jane Schmitt recently became a client herself and found switching electricity and gas providers quick and easy with expert and professional service. The team at Make It Cheaper looked at her rates, compared providers, and gave advice that saved both time and money.

Furthermore, using Make It Cheaper is a simple way to give back to AMA Queensland. The AMA receives a commission for every member who uses the service. This support allows AMA Queensland to continue our excellent work in providing quality services to doctors and in advocacy for the doctors and patients of Queensland. Call (02) 8077 0159 for a free bill comparison or visit www. makeitcheaper.com.au/landing/amaqld to upload a copy of your bill.

New members APRIL Doctors in training Dr Alana Rowan Dr Sarah Ayles Dr Seyed Panahi Dr Tegan Archibald Dr Kam Sandhu Dr Andrew Warren Dr Zhen Hong Dr Progga Saha Dr Ramali Mendis Dr Jacqueline Fradley Dr Phone Myat Bo Dr Madeleine Carney Dr Giselle Bell Dr Thomas Cooper Dr Fauzia Muhammed Dr Tegan Hamilton Dr Alison Lally Dr David Chettle Dr Katherine Strawson Dr Axell Jones Dr Janusz Krepski General Practitioners Dr Liam Rath Dr Archana Kothari Dr Alexandra Hofer Dr Mahaveer Jain Specialists

44 Doctor Q Spring

Dr Robyn O’Sullivan Dr Juanita Muller Dr Benjamin Fleming Dr Someswara Rao Attoti Salaried Medical Officers Dr Ruth Attard Dr Farheen Farheen Part-Time Practitioners Dr Peter Loa Dr Shailja Singh Dr Luke McLindon

M AY Doctors in training Dr Diluka De Silva Dr Imogen Andrews Dr Balakavitha Balaravi Pillai Dr Luke Visscher Dr Catherine Choi Dr Satnam Jaswal Dr Mariam Rizk Dr John Leou Dr Timothy Liu Dr Thushiyanthy Sivananthan Dr Bryan Hawarden

Dr Frances Hills Dr Madan Panda Dr Amanda Beech Dr Melissa White General Practitioners Dr Scott Hedley Specialists Dr David Wright Dr Khageshwor Pokharel Dr Yara Khedr Dr Robert Stowasser Salaried Medical Officers Dr Gihan Gunawardena Dr Neelima Gandham Dr Jeffrey Goh Dr Tristan Howie Dr Cleonie Jayasuriya Dr Edda JessenHabermann Dr Suntharalingam Sivananthan Part-Time Practitioners Dr Louise Teo Dr Kowsalya Murugappan Dr Karynne Finniear Dr Alex Mowat

Dr Susan Wiltshire Dr David Saltissi Dr Precious Lusumbami Dr Edwin Castrisos Dr Anthea Woodcock Dr Simon Menelaws Dr Michael Hurley Dr Jaime Hurley

JUNE Doctors in training Dr Elizabeth Hamilton Dr Priya Roy Dr Sanjana Dang Dr Shabana Kalla Dr AZ Low Dr Claire Baskin Dr Brendan Graham Dr Ulrike Dinkelmann Dr Kang Xiang Tan Dr Rahul Thomas Dr Alexandra Stewart Dr Vikram Iyer Dr Yasmin Pilgrim Dr Claire Panagoda Dr Aarti Chooramun Dr Edwina Morgan General Practitioners Dr Graeme James

Dr Duncan MacWalter Dr Vinothan Paramanathan Dr Matheesha Ranaweera Dr Paul Sargeant Dr Donal Watters Dr Kaung Tun Dr Aye Aye Mar Dr John Hagidimitriou Dr Nicola Shankey Dr Andrew Cronk Dr Gordon Ding Dr Fatima Ashrafi Dr Bhavnaben Meta Dr Christopher Aubrey Dr Thomas Perkins Dr Ben Riggall Dr Welwyn Aw-Yong Dr Brett Kennedy Dr Fiona Raciti Dr Maria Virginia Pereira E Cotta Dr Stephen Ansley Dr Attique Zafar Dr Stuart McAuley Dr Vanessa Tsui Dr Chirag Patel Dr Cindy Aubrey Dr Paula Conroy Dr Melanie Lyness Dr Madhu Lakshmaiah

Dr Renuka Bodhinayaka Dr Daniel Galdau Dr Georgina Bright Dr Davy Michael Specialists Dr Alok Jhamb Dr John Currie Dr Suneth Jayasekara Dr Algenes Aranha Dr Peter Jackson Dr Martin Elmes Dr Frans Niemann Dr Vishnumurthy Sannarangappa Salaried Medical Officers Dr Shahir Hamid Mohamed Akbar Dr Dirk Lourens Dr Elizabeth Anderson Dr Paula Lister Dr Kylie Burns Dr Karen Richardson Part-Time Practitioners Dr Dionne Litton Dr Dominque G Carroll Dr Benjamin Jacob Dr Brigit Weld


When vision loss affects her daily life, it’s time to refer to Vision Australia. The allied health team at Vision Australia complement the work of eye care professionals. Our vision loss experts help patients use their remaining vision to get the most out of life. Your patients can also get help to access NDIS and My Aged Care funding. When to refer • Upon diagnosis of a permanent, non-correctable or progressive eye condition • Vision loss starts to impact everyday activities • Glasses no longer correct vision. To refer online or download free vision loss resources go to visionaustralia.org/AMA or call 1300 84 74 66 Gold Coast | Brisbane | Maroochydore | Townsville | Cairns

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Getting out and about

Dr David Shepherd Orthopaedic Surgeon AMA Queensland Far North Area Representative

Can you ride your road bike 782km in a week? Want to ride your mountain bike through the outback on property you can’t access any other way? How about spending time with a group of exciting, energetic people? If so, then the Cairns to Karumba (C2K) bike ride could be the adventure for you. As a ride that I have had the privilege of being involved with for eight years, I can tell you the experience will keep you coming back for more. The C2K ride was developed by the parents and citizens association of the Cairns School of Distance Education (CSDE) to raise money to provide remote students with the opportunities town school kids take for granted. The C2K ride is a 46 Doctor Q Spring

seven-day charity ride in Far North Queensland that has been running for over 20 years. It is fully catered and supported so all you have to worry about is getting you and your bike from one town to the next. Spending a night in a different town (usually at the rodeo ground) as the ride progresses across the Peninsula, is a perfect way to experience the transition from rainforest to bush and experience the romance of the sun setting on the Gulf. Days are usually capped by a cold beer (or glass of wine) and a superb meal from the catering crew. Your challenge, if you are on your road bike, is to ride every kilometre from the Coral Sea in Cairns over the Great Dividing Range and through the heart of the bush to the Gulf of Carpentaria. On the road ride, you settle into a pack of around 25 riders who travel at your speed. You will get to know your pack mates pretty well by the end of the ride and there have been many friendships (even romances) born on the ride. The longest days are about 150km but someone is always nearby to provide you with an encouraging word or helping hand. The dirt ride is a much younger beast starting around 10 years ago with some of the road riders looking for a new challenge. The dirt ride is mostly on cattle properties’ 4WD tracks but there are some surprises for the riders.

The aim is to ride in a traffic free environment and you will get to see farm infrastructure and meet station owners at their homes. There is a bit of transportation by bus between some parts of the ride but this is where you will get to know the other dirt riders and socialise. The ride is multifaceted with multiple ways to be involved – you can ride, volunteer or support a friend. It is not uncommon for a family to come and the parents take turns at riding and looking after the kids. Often riders come with a groups of friends with some riding and others providing support. The simplest way is to come as a supporter and this way you can explore the sights of the area and activities are often organised by the ride’s support coordinator. The real engine room of the ride is the volunteers and organisers. These people do the physical work of the ride and it is a great way to get involved with the day-to-day running of the ride. Many people show up every year because of the great camaraderie that volunteering in the C2K provides. All help is appreciated. Typically over $100, 000 will be raised and is used to fund CSDE projects as diverse as sports and music programs to first aid courses and leadership. Visit www.ridefnq.com. Next year’s ride is 30 June.


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REFER YOUR PAT I E N T S T O

Vision Australia People experiencing vision loss are three times more likely to suffer depression and twice as likely to experience a decrease in social independence.

group whose oldest member is 95 and the youngest, just over 40. Terry also speaks to the group members and checks in with them outside of the program.

Vision loss can dramatically impact a person’s life and everyday activities may seem difficult. With the right support and advice, people can continue to do the things they enjoy and remain independent.

ABOUT VISION AUSTRALIA

Whether it’s a young child learning to read, an adolescent heading off to university, a young adult embarking on world travels, or an older adult competing in a lawn bowls tournament, Vision Australia can support your patients to get the most out of their lives.

TERRY’S STORY

Terry was a bus driver for 30 years, a career which he thoroughly enjoyed. However, Terry began to lose his vision in 2000 and was diagnosed with retinitis pigmentosa. Four years ago, Terry lost his vision completely which is when he came to Vision Australia. Since then, Terry has had orientation and mobility training so he can get around safely and independently and he can be found at Vision Australia’s Brisbane woodwork shop every week. “I talk to all the old guys in the woodshop. People sense that I like to listen to them and it’s good to talk to people. ” Terry is also a valued volunteer. He facilitates a weekly telephone support 48 Doctor Q Spring

Vision Australia is the leading national provider of vision loss support. The allied health team at Vision Australia complements the work of eye care professionals. Our vision loss experts help patients use their remaining vision to navigate their environment safely, prevent falls and get back to social activities. We support people to:

learn the life skills and practical strategies to manage day-to-day activities; use technology to stay connected with family, friends and the outside world; travel safely and confidently with a white cane or Seeing Eye Dog; complete their education - from preschool through to university; start a new job, advance their career or protect their job; enjoy a well-rounded social life and participate in groups, clubs and recreational groups; and read and stay connected with what’s happening locally, nationally and around the world with over 46,000 titles including newspapers in our fully accessible library.

GETTING THE MOST FROM THE NDIS AND MY AGED CARE

The NDIS and My Aged Care can be confusing. The team at Vision Australia understands both funding schemes and can help your patients get the most out of their plan. When your patients work with Vision Australia to develop their NDIS or My Aged Care plans they put themselves in the best position to receive the support they need and to meet their goals.

REFERRING TO VISION AUSTRALIA When to refer:

upon diagnosis of a permanent, non-correctable or progressive eye condition; vision loss starts to impact a person’s ability to enjoy everyday activities; or when glasses no longer correct vision, or your patient needs support adjusting to vision loss.

To refer online or download free vision loss resources, visit the website visionaustralia.org/AMA or call 1300 84 74 66. You can also refer via: E: referrals@visionaustralia.org F: 1300 84 73 29


Checklist for setting up in general practice elderly. Are you interested in starting out in a growth area? Are property prices on the rise?

2. DECIDE TO EITHER BUY IN OR START F R O M S C R AT C H

Do you currently work in a practice? If there is a suitable succession plan, or an opportunity to buy from the current owners and take the reins, this might be worth considering.

DR BRETT ROBINSON

Chief Executive Officer BOQ Specialist www.boqspecialist.com.au

Setting up in general practice can seem daunting, but it doesn’t have to be. Follow the right steps, and you can quickly get back to what you do best with minimal fuss. It’s a good idea to think about how you want to run the business, who will be running it with you, the location of your clinic and whether your finances are in order.

1. RESEARCH YOUR DEMOGRAPHIC

One of the first things you will need to consider is your patients, so it is worth investigating the demographics of your preferred locations to work out who you are likely to attract. If you’re specialising in a certain field, think about whether your practice is close to your target market—for example, families, young singles or the

There can be less risk in this approach, because you are taking over a going concern. Hopefully you will know the practice well—and this includes the patients, the facilities, the location, the people and the politics. This sort of knowledge can’t be underestimated. However, you may be the type of person who prefers to build a business from scratch. You may have a vision to create the practice of your dreams. There are pros and cons to each approach.

3. SURROUND YOURSELF WITH GOOD PEOPLE You want to work with experts who know what they’re doing throughout the process. This starts at set up, with the banking, building and fit-out professionals. These are all people who need to share your vision from concept to realisation. The same goes for your practice colleagues. Think about whether you plan to go into business with other partners, or keep your hands firmly on the levers and employ a team of supporting health professionals.

4. THINK ABOUT THE S PA C E

good visibility from the main road? Is it easily accessible, with ample parking, public transport in the vicinity and handicap access? If not, how easy will it be to get the building up to your mandated standards? Consider whether you’re going for a purpose-built practice or planning to purchase an old building and renovate it. If you’re planning to own these premises, this will impact upon your financial liabilities and returns, now and in the future.

5. PROTECT YOUR INVESTMENT

If you’ve been considering going into business, you’ve probably got some capital put away. It’s vital to get information about securing finance to make your practice dreams a reality, and to ensure you’re not investing your savings unwisely. It’s a good idea to get advice from professionals about every aspect of the loan lifespan before you sign up for anything. Are you keen to seize the day? Contact us on 1300 131 141 to discuss how we can tailor a financial solution to your needs.

The credit provider is BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 Australian credit licence no. 244616 (“BOQ Specialist”). Terms and conditions, fees and charges and lending and eligibility criteria apply. The information contained in this article is general in nature and has been provided in good faith, without taking into account your personal circumstances. While all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, no warranties in this regard are provided. BOQ Specialist is not offering financial, tax or legal advice. We recommend that you obtain independent financial and tax advice before making any decisions.

Part of considering what the practice of your dreams might look like is the space itself. Does the practice have Doctor Q Spring 49


Management liability

“An employee was promoted four times during her nine-year employment within a three-practitioner office but lodged a case for breach of contract, racial discrimination, and emotional distress when she was not promoted to office manager after the office merged with another practice. After four years of legal action, the practice settled the case for $75,000 and defense costs in excess of $272,000”

The owners and managers of a medical practice are exposed to complex and varied risks (it’s not just about clinical risks). We see these types of employment claims and other management issues arise as often as clinical issues. Your first line of defence in the above example is compliance with employment law. We highly recommend you use the AMA Queensland Workplace Relations Team, who provide dedicated support and advice for private practice members and also access to user-friendly manuals containing practical advice on the fundamentals on running an efficient and legally compliant medical practice. AMA Queensland also regularly provide extremely informative training courses that your practice manager and senior staff can benefit greatly from attending. Your second line of defence should be appropriate insurance. Although you may consider an allegation to be completely baseless and without merit, without adequate insurance you risk funding your own expensive legal costs to successfully defend the allegation – and the compensation payout and costs if you lose. 50 Doctor Q Spring


Employment Practices Liability insurance is readily available and we believe the best way to purchase this product cover is through a ‘Management Liability’ policy. Management liability starts at circa $1,500 per annum and increases on higher policy limits and business size. Management Liability insurance not only covers Employment Practices Liability, but provides cover for a range of other management exposures including:

Directors and officer’s liability: Protects personal assets against losses arising from claims of wrongful acts by the businesses’ directors or officers. Company reimbursement: Your company can be reimbursed for payments it makes to indemnify directors or officers against claims relating to their actions as directors or officers. Corporate liability: This covers wrongful acts of the company (not just of directors), officers and employees. Statutory liability insurance: Under Statutory Liability legislation there are over 5,000 legislative provisions that can result in fines or penalties and over 700 provisions that can find a director personally liable. Statutory liability covers the fines, penalties and legal fees that can result from an accidental breach of statute law. These may include occupational health and safety laws, environmental laws and employment laws. Crime: provides cover for theft by employees and third parties. The rise of social engineering, phishing and cyber fraud are on the increase and we have seen clients transfer funds following a fraudulent invoice or a hacker changing the employee banking details in their accounting system resulting in funds being transferred overseas. Even the insurers that provide this cover aren’t immune to employee theft, with one major insurer losing $17 million to their national claims

manager through false invoicingif it can happen to them it most certainly can happen to anyone!1 Business crisis consultant fees: Generally reimburses expenses incurred in responding to a business crisis event, including independent management consultants. Tax audit costs: Covers accounting costs and expenses arising from a tax audit.

The cover provided under the employment practices section of a management liability policy is of specific importance given the complex legislation surrounding employment related issues. A recent report published by the insurer Dual Australia determined over 59 per cent of management liability claims are related to employment practices beaches. The report noted that under the Fair Work Act, there are some 17,000 unfair dismissal claims per year being processed, with the average cost of each claim being in the region of $50,0002.

JAMES WARWICK Senior Account Executive, Medical & General Risk Solutions P: 1300 883 059 E: james@mgrs.com.au

Disclaimer:

Employment claims can be made by employees, former employees, or even potential employees (during the interview process) and can include allegations of discrimination, wrongful termination of employment, sexual harassment, and myriad other employment-related claims.

Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687. Authorised Representative No 436893. The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.

There are some employment liability circumstances that are not covered. The most common exclusions are related to failure to meet your obligations to your staff in relation to employment benefits such as:

leave entitlements; redundancy or bonus pay; and/or underpayments or the back-pay of wages.

In simple terms, the policy will not cover entitlements you were required to pay under any employment contract or under any law. In addition to the employment section, there are generally also requirements for the practice to have crime controls in place (e.g. dual authorities on payments, approved vendor lists, etc.)

References 1.

Lessons Learnt from a $17M Fraud https://www. insuranceandrisk.com.au/lessons-learnt-from-a17m-fraud/

2.

Management Liability: The Evolution of a Revolutions: Jaydon Burke-Douglas https:// cdn2.hubspot.net/hubfs/2597761/DUAL%20 Australia/AUS%20Assets/Docs/Evolution_White_ Paper_260514.pdf?t=1500271175878

Doctor Q Spring 51


Doctor vindicated in claim for defamation Many of you may recall Dr Munjed Al Muderis, who spoke at AMA Queensland’s Junior Doctor Conference last year. Dr Al Muderis came to Australia as a refugee in 2000 from his birthplace of Iraq, fleeing Saddam Hussein’s regime, after he refused an order to surgically remove the ears of soldiers who had escaped the army. Dr Al Muderis completed his specialist training in Australia and pioneered the use of an osseointegratable femoral and tibial stem for attaching prosthetic legs for amputees. This technique has especially benefited war veterans, and Dr Al Muderis now travels the world lecturing and educating other orthopaedic surgeons in the technique. He has served as a reservist in the Royal Australian Air Force, and has been an ambassador for the Red Cross Australia, with whom he travels to third world countries to perform osseointegration operations on amputees, with much of the work carried out at his own expense. In short, Dr Al Muderis had a reputation of the highest order. In 2010, Dr Al Muderis performed a hip arthroscopy on Mr Gerardo Mazella. Not long after the operation, Mr Mazella accused Dr Al Muderis of damaging his pudendal nerves during surgery, resulting in a degree of numbness in his penis and scrotum and a loss of sexual function. The court found the medical cause of Mr Mazella’s complaints was likely to be related to lifestyle issues and a pre-existing condition which was the subject of a warning by Dr Al Muderis prior to surgery. At follow up appointments, Mr Mazella became more and more vitriolic in his accusations, and at one point threatened to “cut off (Dr Al Muderis’s) penis” and to kill him. On occasion Mr Mazella brought his brother, Rodney Duncan, to the appointments, who likewise threatened Dr Al Muderis. 52 Doctor Q Spring

After these threats, Dr Al Muderis told Mr Mazella he would not attend him anymore. Sometime after, Mr Duncan created a website on which he published a video of Mr Mazella speaking about Dr Al Muderis entitled “Dr Al Muderis the Butcher”. Similar material was published on other websites, as well as on Facebook, YouTube, Google Ads, and Vimeo.

TONY MYLNE Partner TressCox Lawyers

P: (07) 3004 3545 E: Tony_Mylne @tresscox.com.au

Dr Al Muderis commenced proceedings in defamation in the New South Wales Supreme Court in 2016. The court ruled in Dr Al Muderis’ favour after the defendants put up no defence to the publications, and made no apology for them. In assessing damages, the court had regard to the scale and severity of the publications, as well as the conduct of the defendants and absence of an apology. Dr Rosenblatt, an American orthopaedic surgeon, gave evidence that he came to Australia to study Dr Al Muderis’ osseointegration technique, after his patients researched it on the Internet and Facebook. The court inferred from this that social media and online platforms could therefore be particularly damaging to Dr Al Muderis. The court ordered damages against the defendants totalling $480,000. The court also issued permanent injunctions against the defendants from publishing further material impugning Dr Al Muderis. While defamation will rarely be as severe as this case, the rise of online patient review platforms has led to more doctors finding unflattering, and often inaccurate, comments about them online. These matters can often be resolved with a carefully worded letter, and doctors faced with these kinds of publications should contact their MDO or a solicitor for advice.

JOSHUA LIDDLE Solicitor TressCox Lawyers

P: (07) 3004 3518 E: Joshua_Liddle @tresscox.com.au


Look no further...TressCox Lawyers can assist you At TressCox we make it our business to know about Health and Aged Care. We can help guide you through the increasingly complex operational, legislative and policy framework. We can provide you informed legal advice on litigious, disciplinary and commercial issues at all levels. With considered legal advice we can assist you to operate a commercially viable business that complies with the health services industry’s unique and ever changing regulatory environment.

We can help you with: Setting up your practice, including buying a business, business structuring, contracts and advice on restraint of trade clauses Running your practice, including IR & Workplace Safety, employment, service, and locum contracts; and corporate governance Group practice issues and bringing in additional owners including partnership, shareholder and buy-sell agreements

Vanessa James-McPhee, Senior Associate

Brisbane P. (07) 3004 3512 M. 0438 874 511 Vanessa_James-McPhee@tresscox.com.au

Bill Hickey, Partner

Brisbane P. (07) 3004 3523 M. 0421 756 502 Bill_Hickey@tresscox.com.au

www.tresscox.com.au

Paul de Silva, Special Counsel

Brisbane P. (07) 3004 3520 M. 0422 858 807 Paul_de_Silva@tresscox.com.au

Selling your practice including helping to get ready for sale, workout and earn-out arrangements Resolution of disputes about restraints, contracts (including building contracts and shareholder agreements) and debt collection Regulatory issues including investigations by the OHO, AHPRA and Medicare Australia Your personal matters including buying, selling and leasing property and Estate Planning.

Tony Mylne, Partner

Brisbane P. (07) 3004 3545 M. 0422 044 210 Tony_Mylne@tresscox.com.au

Katharine Philp, Partner

Brisbane P. (07) 3004 3536 M. 0409 586 785 Katharine_Philp@tresscox.com.au

Lynette Reynolds, Partner

Brisbane P. (07) 3004 3555 M. 0416 069 573 Lynette_Reynolds@tresscox.com.au

P. (07) 3004 3500 @TressCox

Doctor Q Spring 53 @TressCoxHealth


KAREN STEPHENS Risk Adviser MDA National

P: 1800 011 255 E: peaceofmind@ mdanational.com.au

Disclaimer: This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy.

USEFUL I N F O R M AT I O N O N I N F O R M AT I O N SECURITY Office of the Australian Information Commissioner Guide to Information Security: oaic.gov.au/privacy/privacyresources/privacy-guides/ guide-to-information-security

Royal Australian College of General Practitioners Computer and Information Security Standards: racgp.org. au/your-practice/standards/ computer-and-informationsecurity-standards/ 54 Doctor Q Spring


Cloud storage of medical records Storing data in the cloud is becoming increasingly popular. Cloud storage involves storing data online, rather than storing it locally on a device such as a hard drive. The data files are stored on a server owned by a cloud service provider such as Google Drive or Dropbox. You must have connection to the internet to access the stored information. Benefits for businesses can include cost savings, access by multiple users, and data compatibility across different machines and browsers.

SECURITY RISK

Security is the big risk of handing over control of your data to an external vendor. Medical records contain data that is sensitive and subject to strict legal requirements. They are also extremely vulnerable to theft, because the information they contain has street value – it could be used for identity theft, to falsify drug prescriptions, claim false health benefit payments, and even enable stalking.1 Loss of security of your medical records could breach privacy law, harm patients, damage your practice’s reputation, or affect the practice’s ability to function. Under Australian privacy law, a practice must take reasonable steps to protect personal information it holds from misuse, interference or loss; and from unauthorised access, modification or disclosure.2 Each practice’s circumstances must be taken into account. A cloud-based system may offer better security than a self-hosted system in a practice without security processes or qualified maintenance staff. In a well-publicised case in 2012, Russian hackers demanded a ransom after encrypting and disabling a Gold Coast GP clinic’s

medical records.3 The fast pace of cloud development and the technical nature of data security may be daunting for doctors without extensive information technology knowledge. External assistance is recommended. A useful document is the Australian Department of Defence’s Cloud Computing Security for Tenants4 which aims to help a cloud user’s cyber security team, cloud architects and business representatives to work together to perform a risk assessment and use cloud services securely. Risk mitigations detailed include:

using a cloud service with particular accreditation (some providers may abide by the international standard for cloud privacy – ISO27018); annually testing an incident response plan; encrypting data sent to the cloud; multifactor authentication; encrypted backup stored off-line or with another cloud provider; having adequate bandwidth for reliable network connectivity; and contractually retaining legal ownership of your data.

Your contract with a cloud provider must address mitigations to security risks, persons who can access your data, and the security measures used to protect your data.

practice must take reasonable steps to ensure that the overseas recipient does not breach the Australian Privacy Principles.5 If you believe the country where the servers are located has similar privacy laws to Australia, you should obtain documentation such as independent legal advice to support this. If not, your options are to:

not use that cloud service provider; enter into a contract with the cloud service provider requiring them not to breach the APPs; and get consent from patients to disclose their information to the cloud service provider.

Seek further information and legal advice before embarking on any of these options. References 1.

Funnell A. Your Health Information is Neither Safe Nor Secure. ABC News, 12 Nov 2016. Available at: abc.net.au/ news/2016-11-12/your-health-information-is-neithersafe-nor-secure/8005338

2.

APP11 – Security of Personal Information. More information available on the website of the Office of the Australian Information Commissioner: oaic.gov.au/agencies-andorganisations/app-guidelines/chapter-11-app-11-securityof-personal-information

3.

Hicks S. Russian Hackers Hold Gold Coast Doctors to Ransom. ABC News, 11 Dec 2012. Available at: abc.net.au/ news/2012-12-10/hackers-target-gold-coast-medicalcentre/4418676

4.

Department of Defence, Australian Signals Directorate. Cloud Computing Security for Tenants. April 2015. Available at: asd.gov.au/publications/protect/cloud-security-tenants. htm

5.

APP8 – Cross-border Disclosure of Personal Information. For more information see the Office of the Australian Information Commissioner. Available at: oaic.gov.au/ agencies-and-organisations/app-guidelines/chapter-8app-8-cross-border-disclosure-of-personal-information

S E R V E R LO C AT I O N

The location of servers is a vital consideration in choosing a cloud service provider – servers in Australia are recommended. Some wellknown cloud services have servers located overseas. Australian privacy law requires that before personal information is disclosed overseas, a Doctor Q Spring 55


ANGELA JEFFREY Business Advisory Director, William Buck Accountants

Improving the heartbeat of your practice How can you create a healthy heartbeat for the teams that operate in your practice? The reality is that a healthy heartbeat is truly at the centre of every strong team. As such, effective engagement, collaboration and team work will always be the key drivers to ensure you can keep the lifeblood of your business flowing and ultimately, set your practice up for future success. It all starts with addressing each individual in your business. Make sure you provide them with a clear vision and understanding of their role within the overall team. It’s important they are aware of how their actions contribute to the operation of the practice and their motivation to support its patients, as well as each other. 56 Doctor Q Spring

Often, we focus too much attention on the individual performance and behaviour of employees, without understanding the negative impact a dysfunctional team can have on even the best intentioned and motivated individual. Equally though, a harmonious team can have a positive impact on those in the team who are lacking engagement, going through difficult times at home or feel overwhelmed with their workload. Therefore, creating a team that has a common goal and a healthy heartbeat can underpin the ongoing performance and retention of employees in your practice. Regular team meetings and communication will be the key components that will help you to get the best out of your teams. While it sounds simple enough, taking the time to understand what motivates them, how they best think and learn, and importantly their personal circumstances, will go a long way in influencing how they ‘connect’ to your workplace. Many team leaders will see most of their time taken up with the day to day operation of the practice and often will have little time to spend on engagement and encouragement at the individual level. However, this can be overcome by making sure

P: (07) 3229 5100 E: Angela.Jeffrey@ williambuck.com

regular communication with everyone remains a key driver in developing and maintaining a cohesive environment. Keep employees regularly updated on business activities, any key decisions being made, and the overall vision of the business. Ensure you also encourage two-way dialogue and opportunities to provide feedback. This will make sure employees feel they are being brought along the journey of the practice and that their voice is being heard. Team meetings should also include a ‘check in’ opportunity to encourage employees to connect with each other on a personal level. Combine this with meaningful and regular performance reviews and feedback, and you’ll have yourself a healthy, happy and engaged team.


SPECIALIST

ADVISORS TO THE MEDICAL

INDUSTRY WITH A DEDICATED HEALTHCARE PRACTICE, WILLIAM BUCK CAN HELP YOU STRUCTURE YOUR PERSONAL INVESTMENTS TO ACHIEVE THE AFTER-HOURS LIFE THAT YOU WANT.

CONTACT ONE OF OUR DIRECTOR’S FOR A CONFIDENTIAL & COMPLIMENTARY CONSULTATION

William Buck is experienced at structuring personal investments such as property or self managed superannuation funds, and can assist you with the following:

(07) 3229 5100

— Advice on setting up appropriate investment structures — Comprehensive assistance with your personal taxation affairs — Develop strategies to help you make the most out of your superannuation and investments, including assessing the taxation consequences

Paul.Copeland@williambuck.com Angela.Jeffrey@williambuck.com Julie.OReilly@williambuck.com

— Securing your financial freedom with business and retirement planning

Doctor Q Spring 57


All about you UNMASKED Turia Pitt Turia Pitt was one of AMA Queensland’s most popular Women in Medicine speakers, with her story of overcoming horrific burns sustained in a triathalon in 2011. Her second book, Unmasked, is more than a simple chronology of events – and against the backdrop of a neverending series of impressive physical feats, including climbing the Great Wall of China, walking the Kokoda Track and competing in Ironman competitions – this book unmasks the real Turia: funny, fierce, intelligent, flawed.

WALKING MEETING A walking meeting could be a way of getting some incidental exercise during the day, as well as some fresh air and a unique perspective. Instead of sitting still in a meeting room, office or café, organise a walking meeting in advance. The Harvard Business Review suggests picking a nice route with a view or landmark on the way to make it more interesting, and says that a small group of less than three is best for walking meetings.

STRAWBERRY YOGHURT CAKE 250g strawberries, stem removed and sliced 1 cup self-raising flour 1 cup wholemeal self-raising flour 1/2 cup raw sugar 1/4 cup shredded coconut 1 egg 1 cup low fat Greek yoghurt, plain 100mL olive oil

58 Doctor Q Spring

1. This can be made in a food processor, thermo style appliance, stand mixer or simply mixing by hand. Place all the ingredients except the strawberries into the bowl and mix or process until combined. 2. Add the strawberries, reserving a handful for the top and mix to just combine. You don’t want to overmix otherwise it will turn pink. 3. Pour into a lined 20cm x 20cm cake pan, lay the reserved strawberries on the top and bake in a 180 degree celsius oven for 45 minutes to 1 hour or until it is golden on top and bounces back when touched. Recipe from the book Cooking for Busy Mums. Visit www.cookingforbusymums.com.au for more fresh, fast, frugal, family friendly meals.


ANGELS IN AMERICA Part One: Millenium Approaches 9 September, 1pm | 10 September, 1pm Part Two: Perestroika 16 September, 1pm | 17 September, 1pm National Theatre Live

THE CROWN Set in the period before and after King George VI’s death, The Crown is the story of a young Queen Elizabeth taking the reins. Poor Liz has got a husband who’s struggling with his wife becoming the most powerful woman in the Western world, a party girl sister (who everyone seems to love) who’s having an affair with a divorcee, a monarchy that’s struggling to remain relevant and a prime minister as mentor who is well past his prime. Every time she turns around, there’s a centuries-old protocol to follow, her presence on the newly-invented television to consider and a fledgling paparazzi industry to avoid. This series will make you think of the royals in a different and possibly more sympathetic light.

America in the mid-1980s. In the midst of the AIDS crisis and a conservative Reagan administration, New Yorkers grapple with life and death, love and sex, heaven and hell. Andrew Garfield (Silence, Hacksaw Ridge) plays Prior Walter along with a cast including Denise Gough (People, Places and Things), Nathan Lane (The Producers), James McArdle (Star Wars: The Force Awakens) and Russell Tovey (The Pass). This new staging of Tony Kushner’s multi-award winning two-part play is directed by Olivier and Tony award winning director Marianne Elliott (The Curious Incident of the Dog in the Night-Time and War Horse).

TITUS ANDRONICUS 23 September, 1pm | 24 September, 1pm Royal Shakespeare Company

UPCOMING MOVIES* 5 September The Kingdom of Dreams and Madness

Win movie tickets for two! Name:

Telephone:

*Please note upcoming films may be subject to change

Shakespeare’s gory revenge tragedy presents us with murder as entertainment, and, as the body count piles up, poses questions about the nature of sexuality, family, class and society.

LE MISANTHROPE

7 September The Dinner 30 September John Le Carre Presents An Evening With George Smiley

The decay of Rome reaches violent depths in Shakespeare’s most bloody play. Titus is a ruler exhausted by war and loss, who relinquishes power but leaves Rome in disorder. Rape, cannibalism and severed body parts fill the moral void at the heart of this corrupt society.

3 September, 2pm | 6 September, 10am Comedie Francais

Member no:

Fill out the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au. Entries close 1 October Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au

Much to the horror of his friends and companions, Alceste rejects la politesse - the social conventions of the seventeenth-century French salon. His refusal to make nice makes him tremendously unpopular and he laments his isolation in a world he sees as superficial and base. Despite this, Alcest loves Célimène, a flirtatious woman from Parisian high society. He loathes this world for its hypocritical etiquette but, shaken by a public trial he is called to by this social circle, he must visit Célimène to ask for her help… (Presented in French with English subtitles). Doctor Q Spring 59


FEAST YOUR EYES ON 1 5 % O F F AT T H E S E LO C A L VENUES!

New membership benefits

Victoria Park Bistro HERSTON Open 7am to 11am for breakfast with lunch from 11am and dinner from 5pm Once you’ve finished networking with the bosses over a hit at the driving range, why not refuel with a view of the city at the Victoria Park Bistro. Organise a breakfast meeting over French toast with strawberries and cream, wood fired granola, house smoked salmon with eggs or classic avocado toast on sourdough. Or maybe treat your team to lunch or dinner with a more refined version of bistro favourites like nicoise salad, grilled rib fillet, slow cooked pork ribs, calamari, burgers or wood fired pizzas.

Use this URL to get your AMA Queensland discount coupon goo.gl/RkuC17

Kokobana Café

Corbett & Claude

Comuna Cantina

NEWMARKET AND ST LUCIA

I N D O O R O O P I L LY, G A R D E N CITY AND BRISBANE CITY

BRISBANE CITY AND PA C I F I C F A I R , G O L D C O A S T

Open 11am until late

Open 11am until late

A range of healthy and affordable gnocchi, share plates and salads make Corbett & Claude the ultimate easy lunch or dinner venue for junior doctors and medical students. As the recent winner of the QLD and NT Savour Awards for Excellence for their pizza, it would be rude not to try one of their incredible wood-fired creations like the four-cheese, the pumpkin and zucchini with feta and pinenuts, prosciutto and fig, pesto with broccoli, and the aptly named ‘consultant’, which with thin sliced potato, crispy prosciutto and rosemary may be easier to tolerate on a late Friday afternoon than your actual consultant… If that’s not enough to entice you, their amazing cocktails make for the perfect post -neverending-Friday ward round catch-up with the crew!

Latin American street food meets Mexican restaurant at Comuna Cantina, a vibrant explosion of colour and flavour that will please the eyes and the palate alike! Choose from a range of delectable salads, tacos, Mexican burgers and arepas (a must-try taco sandwich pocket), as well as street snacks like plantains with guacamole, or grilled corn with chipotle aioli. For those hangerinducing 18-hour days, the larger plates like the DIY tacos board and comuna nachos with chicken, beef or pork should fill the void. And for the ultimate indulgent treat, you can even have an espresso martini with a timtam on top!

Open 7.30am to 8.45pm Home of the fruit-laden acai bowl, robust coffee, raw treat and green smoothie, Kokobana Superfood Café also serves some impressive healthy burgers and pizzas for the ultimate easy dinner when you’re too tired to cook. Try the Vege Patch with haloumi and chutney, the Tokyo Pop with lean beef patty and wasabi mayo, the Little Miss Bunshine with chicken and mango salsa or the Vegan Kale and Potato patty, all laden with plenty of fresh salad. Their acai bowls have made waves for all the right reasons, with the Nutella Bowl proving to be the ultimate in guilt-free indulgence. This hazelnut acai blend topped with coconut yogurt and berries akin in taste to eating a jar of Nutella for breakfast, just without the concerned looks from your colleagues….

60 Doctor Q Spring

Looking for a restaurant voucher in your neck of the woods? We’ll hit them up! Email h.bretherton@amaq. com.au with suggestions.


Pirramimma – conquering the world Pirramimma is my favourite ‘old firm’ McLaren Vale producer and continues to produce stellar top-end reds that amaze wine lovers all over the world. Their imposing masthead War Horse Shiraz is temporarily taking a back seat to the lesser known, but no less imposing petit verdot.

PHIL MANSER Wine Direct

P: 1800 649 463 E: phil.manser@ winedirect.com.au

The Johnston family arrived in South Australia in 1839 and in 1892, Alexander Johnson, the tenth of thirteen children, purchased 97 hectares of rich farmland southeast of the then fledgling village of McLaren Vale. He named his land Pirramimma, an Aboriginal phrase meaning ‘the moon and the stars’.

The vineyard soils vary from sandy, on the rise, to rich dark loam on the flat. Over 60 per cent of the vineyards are planted to premium red wine varieties, including shiraz, cabernet sauvignon, merlot and petit verdot (for Australia’s first 100 per cent petit verdot wine), with chardonnay the largest single white grape planting on the estate. Winemaking at Pirramimma has been a family affair for well over 100 years and is now in the very capable hands of Geoff Johnston, grandson of the winery’s founder. Under his guidance, Pirramimma has seen many significant changes, including the construction of a 3,100 square metre, naturally cooled, rammed earth barrel storage facility, and the expansion of the land holdings from 97 hectares to 250 hectares, 180 of which are now planted to grapes.

Geoff is a winemaker with a world perspective. He is graduate of the Charles Sturt University and studied in France where his strong interest in the classic bordeaux grape variety, petit verdot, first developed. The petit verdot has fast become one of Pirramimma’s most successful wines on the world stage recently voted Best Red Wine of the Year at the 2016 International Wine Challenge. It’s as rich in colour as it is in flavour and offers red lovers intensity, complexity and length. A worthy inclusion in Pirramimma’s Black Label range. Ideally you’d experience this wine at the cellar door which oozes all the old world charm and history of McLaren Vale… if it’s not on your list this year add Pirramimma to your next visit to the ‘Vales. In the meantime, contact us for special AMA pricing.

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New Orleans: A gumbo of music, culture and history

Nestled on a bend of the Mississippi River, New Orleans offers longlasting influences of French, Spanish and African ancestry. With a past well-preserved in its architecture, music, food and lifestyles, New Orleans is most famous for its Mardi Gras. However, anytime of the year you’ll find New Orleans alive with ecliptic music, Creole and Cajun cuisine, and unique nightlife.

H I S T O R Y A N D C U LT U R E

The city has changed demographically in recent years, but it still maintains the quirkiness that made it famous. Founded by the French, the state of Louisiana was ruled for 40 years by the Spanish before being acquired by the United States in 1803. It was a place where Africans, enslaved and free, and Native Americans shared cultures and intermingled with European settlers. Isolation nurtured the ethnic mix, resulting in a united culture vastly different to the English colonies of further north. The culture of New Orleans is often referred to as a gumbo, a classic New Orleans stew of various meats and vegetables.

MISSISSIPPI RIVER ABOARD THE S T E A M B O AT N AT C H E Z

While there’s a plethora of attractions in New Orleans, make sure to catch a steam boat ride on the Mississippi. In the nineteenth century, steam power changed the world. The south got rich on the exports of cotton and sugar, carried by the big, beautiful boats. When railroads took over trade routes, steamboats switched focus to luxury and entertainment. Today, the only true steam-powered on the Mississippi is the Natchez, a memorial to the voluptuous curves and ornamentation of an earlier day. Since 1823, the Natchez name has meant ultimate beauty and speed on the big river. A trip not to be missed.

THE GARDEN DISTRICT

The Garden District is a prosperous residential area. A neighbourhood of spectacular 19th-century mansions built in styles ranging from Greek Revival to Gothic. Accessible from downtown via the St. Charles line streetcar, the Garden District is made for exploring. Make sure to take the time to tour Lafayette Cemetery #1, quite possibly the most photogenic necropolis on the planet. Reserve a table at local favourite Commander’s Palace, located across the street from the tombs.

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THE FRENCH QUARTER

Initially a trading camp, New Orleans was later organised into a fortified community, now known as the French Quarter. The old buildings, some dating back 300 years, show French influences with arcades, wrought-iron balconies, red-tiled roofs, and picturesque courtyards. The French Quarter’s main draw is Bourbon Street. You’ll find this street laden with street performers and fortune tellers as well as rowdy bars. If you’d prefer a tamer, family friendly, French Quarter experience, opt for a day tour. Don’t miss Jackson Square and the St Louis Cathedral.

MARDI GRAS FEBRUARY

New Orleans’ signature event was introduced to the city by its French settlers. Celebrations include almost daily parades, entertainment, and festivities that increase in intensity. Onlookers crowd the balconies and sidewalks to watch the parades, as strings of beaded necklaces are thrown from ornate floats. Bourbon Street is one of the main areas people congregate, nonetheless the whole French Quarter is generally packed. Book well in advance.

CAJUN-ZYDECO FESTIVAL - JUNE

With two stages of music, a huge crafts fair, and great food, the Cajun-Zydeco Fest is a dancehappy celebration. Cajun music has its roots in styles and traditions brought over from Europe more than 200 years ago. The music relies heavily on fiddles, guitars, accordions and crooning vocals to convey their distinctive sound. Often other instruments are added, such as washboards and horns. In addition to Cajun, Zydeco also includes the sounds of soul, R&B, rock, jazz, gospel and even hip-hop.

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Friends in the business Dr Matt Young, General Practitioner, Inala Medical Centre

I hit a chronological milestone recently. I chalked up 50. A half century. In cricketing terms the job is only half done and I hope the same applies for age. And while in cricketing circles the focus is always on looking ahead, in life the half ton is a marvellous opportunity to reflect on what has already transpired. Of course I have reflected on family and friends. The great mountains and rivers, the exotic places, the football and cricket fields I have enjoyed. And I took the time to think about what my medical career has brought me. Of course my patients have enriched my life tremendously. They’ve provided me with an entire spectrum of human experiences. They have flavoured my life to the utmost. But outside of patients, there are three main things for which I am incredibly thankful to medical life. As a family man, one primary function of a career is that it must pay the bills. There can be no denying that doctoring has certainly done this and it has enabled me to provide for my family and also to pursue my passions. Far more importantly than this though is that it has also led me to meet some extraordinary people. It has been a huge privilege to befriend some marvellous colleagues. In fact not so much colleagues, but friends, best friends. Brilliant, charismatic people, caring people, people with whom to go through life. People that enhance the good times beyond compare but also folk that have supported me and mine through the toughest times. While the friends and the pay days have been life defining, one other bonus of a medical life has only really started coming to light in recent years. Just as it has been inevitable that I am getting older, so too my friends and family members have aged. And it seems that age is a risk factor for just 64 Doctor Q Spring

about every disease. In recent years some of those closest to me have had some health scrapes and because of this, I reckon I have discovered the greatest benefit of a medical career. It has been absolutely magical to be able to have medical friends looking after my family and friends when they’ve needed expert care. Surgical friends that I have been able to ring and have them tell me they will see my nearest and dearest that morning or operate on them straight away. Vascular surgeons that have rejuvenated my relative’s carotids and cardiac surgeons that have replaced family members’ valves. Ophthalmological mates that have kept me being able to watch the Test cricket and face the new ball heat from opening bowlers. Obstetric friends that have delivered my two children and so shared with me the greatest two days of my life. Paediatrician friends that have then looked after those two bundles of joy. Orthopaedic mates that have kept me playing sport as the sun has distantly set on my youthful joints. GIT mates that have screened me from the top to the bottom of my gastrointestinal tract and done similarly for my family. Urological mates that have cured other friends of cancer and in doing so, dramatically changed the trajectory of so many lives that mean a lot to me. And of course 40 odd seasons of cricket have taken a toll and it has been a treat to have a friend keep an eye on my skin. As a GP it is also a real thrill to be able to direct my immediate family to our fraternity’s best. Universally my experience has been amazing. Every medical experience I have had as a patient or as a relative has been something to dream about. While tragic outcomes have sometimes been unavoidable, I have always found that my medical friends have always been incredibly dedicated, compassionate and expert in their care of my family and non-medical friends. There has always been medical expertise but just as importantly, there has always been emotional intelligence mediating the sort of emotional support that has been required. So doctoring has paid the bills, made me some cracking friends but as I get older I really think that having friends in the business is the very best part of being a doctor.


AMA Queensland Foundation President Dr Steve Hambleton with Grace and her parents

Helping Hear and Say open worlds of opportunity The AMA Queensland Foundation is proudly supporting Hear and Say to deliver essential hearing-related therapy services to children in regional Queensland. The Foundation has committed funding for three regionally-based Queensland children to participate in Hear and Say’s Telepractice Program. Through videoconferencing, the children are able to participate in essential speech and language development sessions in their own homes, easing considerable financial and emotional strain on their families who would otherwise have to travel extensively for therapy, or potentially forgo regular therapy altogether. Foundation President Dr Steve Hambleton recently had the honour of meeting one of our sponsored children, Grace. Grace has bilateral profound sensorineural hearing loss and one cochlear implant. She also has cerebral palsy and some associated 64 Doctor Q Spring

motor difficulties. Participating in the Telepractice Program is helping Grace realise her full potential. More than 30 families currently utilise the Telepractice Program across Queensland from areas such as Mount Isa, Rockhampton and Emerald. This number is expected to rise rapidly as Hear and Say continues to reach out to more families across Queensland. It costs Hear and Say more than $10,000 each year, for up to six years, to teach one profoundly deaf child to learn to listen and speak. Through the generosity of our donors, the Foundation is proud to be helping children access these life-changing services. To read more about the inspiring work of Hear and Say, please visit www.hearandsay.com.au

Thank you to our donors The AMA Queensland Foundation sincerely thanks its generous donors who contributed to our recent end of financial year appeal. Your support helped us exceed our campaign fundraising goal of $50,000. This essential funding enables the Foundation to continue its important work of helping alleviate sickness and suffering among Queenslanders in need. Please keep up-to-date with all of our project news and fundraising events via our website www.amaqfoundation.com.au. Donations can be made securely through our website at any time. Thank you for giving generously.


INPRINT

Current Medical Diagnosis and Treatment 2017 by Maxine A. Papadakis, Stephen J. Mcphee, Michael W. Rabow

Current Medical Diagnosis and Treatment by Papadakis, Mcphee and Rabow is the first annual internal medicine guide that clinicians turn to first. Never out of date and written by top clinicians, this trusted resource spans all fields of internal medicine, reviewing symptoms, signs, epidemiology, diagnosis, prevention, and treatment for more than 1,000 diseases and disorders. On every page readers find concise, evidence-based answers to key questions concerning both in-hospital and ambulatory patient care. In addition, sections feature a streamlined format that makes the latest diagnostic protocols, prevention strategies, and treatment options easily accessible. On top of updated references, drug information, treatment guidelines and recommendation, the 2017 edition includes a new section on gay, lesbian, bisexual and transgender health and an extensively revised chapter on foot disorders.

Win this book Fill out this form and email to competitions@amaq.com.au. Name:

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Entries close 30 September 2017

The Inte ntio for doctors nal Mentor in Me

66 Doctor Q Spring

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Doctor Q Spring 67


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