Issuu

SUMMER 2016 VOL. 101

CHAMPIONING OBSTETRICIAN-LED CARE

AMA QUEENSLAND’S DISCUSSION PAPER ON MATERNITY SERVICES

CARE AT END OF LIFE – HOW CAN IT BE IMPROVED? HEALTH VISION CHAPTER FIVE AIMS TO UNCOMPLICATE THE PROCESS

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22 CHAMPIONING OBSTETRICIAN-LED CARE AMA Queensland’s discussion paper on maternity services

OFFICE OF THE HEALTH OMBUDSMAN REFORM Urging a fairer sytem for Queensland doctors

CONTENTS 6

FROM THE EDITOR’S DESK

LETTER TO THE EDITOR

PRESIDENT’S REPORT

MEMBER NEWS - RENEW NOW

CEO’S REPORT

AMA QUEENSLAND FOUNDATION: WE’RE BETTER TOGETHER

CURRENT ISSUES 20

ADDITIONAL COUNCIL MEMBERS WELCOMED

COMPLAINTS: HOW DO DOCTORS COMPARE?

EUTHANASIA, ASSISTED SUICIDE AND THE LAW

SORTING CHRISTMAS LEAVE

HEALTH VISION TO EXAMINE CARE AT THE END OF LIFE

CHIEF HEALTH OFFICER’S REPORT 2016

AMA QUEENSLAND CONTINUES OHO REFORM CAMPAIGN

THE DIGITAL TRANSFORMATION OF OUR HEALTH SYSTEM

A TOOLKIT FOR EVERY PARENT

PEOPLE & EVENTS

CHIEF HEALTH OFFICER’S REPORT The report shows where improvements have been made and where future efforts need to be focused.

ANNUAL CONFERENCE WRAP UP

PRIVATE PRACTICE TOUR WRAP UP

INTERN WORKSHOPS WRAP UP

RESILIENCE ON THE RUN

A DAY IN THE LIFE OF AN ORTHOPAEDIC SURGEON

WOMEN IN MEDICINE WRAP UP

PRIVATE PRACTICE MEDICO-LEGAL CONFERENCE WRAP UP

LOCAL MEDICAL ASSOCIATION ROUND UP

OBITUARY: DR KEN FRY

HEAR GORDIAN FULDE AT JDC

PRACTICE INCENTIVE PAYMENT DIGITAL HEALTH UPDATE

FEATURES 22

AMA QUEENSLAND LAUNCHES MATERNITY SERVICES DISCUSSION PAPER

BUSINESS TOOLS 50

TREASURER CLARIFIES SUPER CONTRIBUTION RULES

TIPS FOR STARTING IN PRIVATE PRACTICE

COMMON RISKS IN CONTRACTS FOR MEDICAL PRACTICE OWNERS

PEACE OF MIND AND THE NEED FOR INSURANCE

IS IT TIME YOU TOOK A BREAK?

SERVICE AGREEMENTS

PRIVATE HEALTH UNDER REVIEW

PROFESSOR GORDIAN FULDE

LIFESTYLE

Australia’s best known emergency director will speak at the 2017 Junior Doctor Conference.

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DENDY MOVIES

HOW GOOD IS GRANGE?

OCKER DOCTOR: INTERN FLASHBACKS

GORILLAS IN THE MIST

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REPORT

EDITOR’S DESK

Board of Directors Dr Chris Zappala President

Dr Kirsten Price Honorary Secretary

Dr Shaun Rudd Chair of Board and Council

Dr Dilip Dhupelia Appointed Director

Dr Bill Boyd Vice President Dr Bav Manoharan Treasurer

Dr Richard Kidd Appointed Director Dr Jim Finn Appointed Director

Council In direct response to the Central Queensland Hospital and Health Service report into maternity services at Rockhampton Base Hospital, AMA Queensland put together a discussion paper on how to best face the challenges faced by maternity services in Queensland. President Dr Chris Zappala has covered it in his column on p8, and it’s covered in our main feature on p22. Dr Zappala also fronted the Queensland Parliament’s Health Committee’s enquiry into the Office of the Health Ombudsman. Read more about it on p30.

On a lighter note, we’ve held a number of successful events since our last edition: intern workshops, the Private Practice and Medico-Legal Conference, the Annual Conference in India, more Resilience on the Run workshops and the Women in Medicine breakfast. Find photos from these on our first few pages. We look forward to working with you in 2017. Enjoy your Christmas, Michelle Q

Dr Tom Arthur Gold Coast Area

Dr Wayne Herdy North Coast Area

Dr Sharmila Biswas Far North Area

Dr Scott Horsburgh General Practitioner Craft Group

Dr Kimberley Bondeson Greater Brisbane Area Douglas Brown Medical Student Observer Dr Lisa Byrom Greater Brisbane Area Dr Thomas Campbell Greater Brisbane Area Dr Matthew Cheng Doctors in Training Dr Sarah Coll Specialist Craft Group

The AMA Queensland office will be closed over the Christmas period from 3pm on 22 December 2016 and will reopen on Tuesday 3 January 2017.

Dr Richard Kidd General Practitioner Craft Group Professor Steve Kisely Greater Brisbane Area Honor Magon Medical Student Group Representative Dr Bav Manoharan Greater Brisbane Area Dr John F. Murray Specialist Craft Group

Dr Dilip Dhupelia Part-time Medical Practitioner Craft Group

Dr Paul Neeskens General Practitioner Craft Group

Dr Jim Finn Full-time Salaried Medical Practitioner Craft Group

Dr Alex Ritchie Specialist Craft Group

Dr Katherine Gridley Greater Brisbane Area

Dr Anil Sharma International Medical Graduate Representative

Dr John Hall Downs and West Representative

Dr Harley Wilson Capricornia Representative

Dr Geoffrey Hawson Retired Doctors

Dr Nicholas Yim General Practitioner Craft Group

AMA Queensland Secretariat

OBITUARIES

Jane Schmitt Chief Executive Officer

The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Dr Rupert GRAFF Cardiologist Late of Alderley Member 58 years

Dr Ivor Scott General Practitioner Late of Taloumbi, NSW Member 63 years

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.

6 | Doctor Q Summer

Filomena Ferlan General Manager Corporate Services

Holly Bretherton General Manager Member Relations and Communications

. Editor: Michelle Ford Russ Graphic Designer: Nathan Pitt Advertising: Louise Glynn Doctor Q is published by AMA Queensland Phone:

(07) 3872 2222

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

amaq@amaq.com.au

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REPORT

PRESIDENT’S REPORT Recently AMA Queensland together with the National Association of Specialist Obstetricians and Gynaecologists (NASOG) released a submission document to the Queensland Government making suggestions for the improvement of public maternity services. During previous discussions with the government regarding the review of maternity services at Rockhampton Base Hospital and the state of public maternity services in general, the government asked for a formal submission from AMA Queensland. In other words, the department’s recognition of a problem ultimately led to our discussions and submission. When midwife-only led care is compared to obstetrician-led care, there are considerably worse outcomes for both mother and neonate when the obstetrician is not involved. Queensland Health’s own reports confirm what has been published several years ago: that the perinatal mortality rate is double in public hospital midwifery-led 8 | Doctor Q Summer

care compared to obstetrician-led care, such as in the private sector. There is a several fold increase in third and fourthdegree perineal tears, greater admission to the neonatal intensive care unit, greater microencaphalopathy and intrauterine hypoxia when the obstetricians are not involved. I could go on. The literature is compelling and fully referenced in the submission. Beware the midwife habit of comparing midwife-led care with everything else including unassisted deliveries, home births etc, to incorrectly justify their defence. The overwhelming considerable reaction from the profession to our submission has been positive. In fact, there has been just two lukewarm responses from individual doctors in clinical obstetric departments, both of which I think require further examination. The first was the usual lament around insufficient specialist staff already unable to work any harder, and jeopardising good relations with midwifery staff by suggesting midwifery-only led care

is inferior to obstetrician-led care when we need midwives to fill the gaps in the medical roster. The second, otherwise known as the Queensland Health-approved response, was a ramble about how wonderful multidisciplinary care is and how fantastic the outcomes achieved in this particular maternity unit are. Sir Humphrey Appleby would have been delighted! Colleagues will hopefully have heard me discuss the critical importance of good medical leadership. Not just by the AMA, but also by us individually in our jobs and especially by those in positions with assigned institutional authority. Clearly this responsibility requires attempts to improve the quality of the service. Most distasteful therefore are work avoidance strategies which occasionally mar decision-making in public hospitals by clinicians. It therefore worries me when a public hospital specialist takes a dim view of our suggestion to more actively involve the obstetrician in maternity care, which is clearly associated with improved survival of and reduced morbidity for, mother and child. The AMA Queensland/NASOG submission lends weight to arguments by directors and senior staff specialists in public hospital maternity units to institute obstetrician-led care with an adequate specialist (and registrar) workforce. The submission is a boon to any director or staff specialist who wants to see the best for their patients and profession – not realising this is worrying. Let’s not ever shrink from promoting the virtues of our profession, particularly when it is in our patient’s best interests. Inadequate workforce is a separate issue

IN MATERNITY SERVICES, THE OPTIMAL MODEL OF CARE MUST INTIMATELY INVOLVE THE OBSTETRICIAN (OR GP OBSTETRICIAN) AT EVERY STEP OF THE PREGNANCY/ LABOUR AND NOT JUST TO RESCUE DISASTERS.

which can only be decisively addressed (and inferior, enervating role substitution models swept aside) when the optimal model of care is understood. In maternity services, this must intimately involve the obstetrician (or GP obstetrician) at every step of the pregnancy/labour and not just to rescue disasters. With collegiate support and a little positive re-direction I think we can manage complaint number one. But let’s never sacrifice our patient’s standard of care to work avoidance strategies or role substitution models we know to be inferior, as in this case. Lament number two worries me a little more. As a respiratory and sleep physician, I do not stay close to the obstetrics literature. I was genuinely shocked when I saw the data and I wondered how our obstetric colleagues manage and why nothing has been done to correct the marginalisation of obstetricians in public hospitals before now. It’s one thing to feel powerless to change the system (see above). It is truly deplorable however to gloss over problems and wilfully ignore inferior outcomes for mothers and babies – particularly when at least part of the solution involves empowering and enabling obstetricians to do their jobs effectively – something that should come naturally to us as doctors and especially to our medical leaders. Suggesting there is no problem and that we haven’t known about it for several years is just plain wrong and as a profession we should not allow this view to have any oxygen. At no point has AMA Queensland ever disparaged midwives or suggested we

can manage without them. At no point have we diminished the importance of multidisciplinary care. This does not, however, mean the obstetrician should not lead the healthcare team and be regularly involved in a patient’s care – which is all we have ever said (the Queensland Health review also recommended obstetricianled care). (Before our sensitivities run away from us, we have also emphasised that the patient’s usual general practitioner needs to be much more involved and whenever we say obstetrician one can substitute GP obstetrician). Poor outcomes led to the review by Queensland Health and hundreds of thousands of births are included in the published data over several years that constitutes the foundation of the AMAQ/NASOG submission. Anyone who therefore suggests a professional response to the current situation and data should be lukewarm or engages in attempts to discredit those who point out there is a (glaringly obvious) problem that needs a medical solution to improve outcomes, need to check their moral and ethical compass. Doctors have trained hard to do their jobs and accept considerable responsibility for their patient’s care and outcomes. We need not feel embarrassed by saying this or fearlessly drawing attention to evidence that suggests the healthcare system requires improvement. Failure to do either of these and lead healthcare when required will only disadvantage

our patients and sacrifice the jobs of our future generation of doctors. If too many obsequious staff specialists ‘go native’ and cover or obfuscate when there are genuine problems, rather than identifying and helping to solve difficulties and promote good care, then as a profession we have perpetrated an enormous and egregious disservice on our patients. Whenever we hear the sycophantic cover-up or see a failure to act, we must quickly and decisively identify that inappropriate behaviour and curtail it. The AMA is an independent body that can help the profession do this if one feels divided loyalties – one critical reason why we need our association. The Queensland Health Code of Conduct does not translate to an inability to identify deficiencies and improve systems wherever and whenever able. Any satisfaction among doctors who minimise genuine system deficiencies or problems that are associated with inferior outcomes for patients in a deeply misguided attempt to be a ‘team player’ need to be quietly, but definitively, corrected by their colleagues. As a profession we can support our colleagues and medical leaders to stand up for what is right – which sometimes will mean disagreeing with the bureaucratic mandarins. This is our job and part of the sacrosanct contract only we have with our patients. Patients, and the coroner, would expect no less. Q

Doctor Q Summer | 9

REPORT With this in mind, AMA Queensland recently hosted a free webinar for our general practice and practice manager members on the Future Practice model, which was pioneered by AMA NSW Board Member Dr Kean-Seng Lim. The Future Practice model was developed in consultation with GPs and practice management experts. The model aims to help GPs improve practice quality and sustainability whilst still providing high quality care.

CEO’S REPORT Team work removes research red tape We are very pleased to share a positive result which will remove a nonsensical administrative burden placed on researchers. A number of our members approached us earlier in the year to raise the issue and work with us to find a solution. Medical researchers were stuck with the unnecessary administrative burden of requiring approval under the Public Health Act 2005 to access a patient’s confidential information in circumstances where the next of kin had provided consent for the patient (who was unable to consent) to participate in a research project. The Act failed to recognise the ability of next of kin to allow patient health information to be released for research. AMA Queensland worked with our members and Queensland Health’s legislation and policy team to seek an amendment to the Hospital and Health Boards Act 2011 to enable more efficient disclosure of confidential patient information for research purposes. As a result of this consolidated team effort, the Bill has been progressed as part of the Health and Other Legislation Amendment Bill 2016. Future Practice It will come as no surprise to you to hear that general practice is under stress. Decades of under-funding, the current indexation freeze, and the possibility of co-payments or privatisation of Medicare are making the future of general practice very uncertain. Now is the time for general practitioners to start planning their practices and taking the future into their own hands.

10 | Doctor Q Summer

Hosted by AMA Queensland Board member and Chair of the Council of General Practice Dr Richard Kidd, this free member webinar features a range of speakers to help better understand the Future Practice model and provides GPs with options to tailor their practices to patients’ needs. We encourage all our GP members to view the webinar on the AMA Queensland YouTube channel (AMA Queensland Future Practice Webinar) to take advantage of the benefits of the Future Practice and get back to us with feedback or questions about their practice becoming a future practice. AMA Queensland – new constitution On 12 November, members voted to adopt a new constitution for the association. This is another sensible and contemporary step forward for AMA Queensland which will promote diversity, expertise and flexibility to co-opt required experience and skills to its Board, Council and committees. I thank the AMA Queensland Governance Committee and its Chair, Dr Dilip Dhupelia, for their support and drive to see these forward-thinking changes come to fruition. Membership renewal – thank you for your support AMA Queensland walks beside you throughout your career - regardless of your career stage, specialty or location. Your valued support as a member helps us maintain our vital representation work in the face of a shifting health landscape – ensuring that your role as a doctor is not eroded, that you have access to a fair and expedient complaints management system and ultimately, that the health system in Queensland is robust and sustainable for doctors and their patients.

In late October, you would have received your 2017 AMA Queensland Member renewal notice, highlighting our achievements and how we have supported you throughout 2016. Each and every membership strengthens our collective voice. Annual membership is due by 31 December and can be paid conveniently via BPAY, online or over the phone (see page 48 for more information). In 2017, AMA Queensland will continue to represent the interests of our members across all specialties, through advocating for a health system that is properly resourced and funded and in protecting and promoting your important roles at the centre of quality healthcare provision. On behalf of the AMA Queensland Board and Council, I would like to thank you for your ongoing support. New AMA Queensland building After 20 years, we have done a major refurbishment of the AMA Queensland building. The refreshed space features an open floor plan, new meeting rooms and new furnishings. The re-configured space will allow team members to better collaborate and will significantly improve workflow. The renewed layout will provide for more effective communications across the organisation and will allow us to better assist members. We welcome you all to visit our newly renovated building. Happy holidays from the AMA Queensland Team Reflecting on the last year, I am truly proud of what we have been able to achieve in our advocacy work, workplace relations support, public health campaigns and member offerings. This work is only possible with the support of our dedicated Council, committees and secretariat – and of course the groundswell of support from our members. As this is the final issue of Doctor Q for the year, I would like to wish you all a welldeserved break over the holiday season and a happy and safe Christmas with your family and friends. I look forward to sharing another busy and challenging year with you in 2017. Q

LETTER TO THE EDITOR There was a report titled 6 things GPs should know about the new CPD in 6 Minute Medicine published on 10 October 2016. Apparently all GPs have to complete mandatory “self-evaluation” from January 2017 for the next triennium. Why blame AHPRA? Isn’t the RACGP responsible for this hairbrained scheme? This is the organisation which is supposed to look after GP interests. All they do to justify their existence is to create more and more bureaucratic requirements for GPs to practice medicine. They do not know whether they are Arthur or Martha. They believe in self-regulation as they are allowed to be chief cooks in the kitchen of the government prison camp. Frankly, in my opinion if they were to disappear overnight no GP would miss them and general practice would be better off. Did the RACGP consult the GPs about this scheme? Are the GPs going to accept this without any objections or are they just going to take it lying down? What about our AMA which is also supposed to look after our interests. Where do they stand on this issue? My heart bleeds for the gutless medical profession which is being enslaved by our own colleagues who are supposed to fight for us, protect us and make our life easy. Hippocrates where art thou? Dr Mal Mohanlal

Dear Dr Mohanlal, Your comments regarding increasing CPD requirements are timely. You will be aware the Medical Board of Australia has released its Expert Advisory Group interim report into revalidation. This is the latest piece in an ongoing discussion regarding re-validation, which at its heart entails a strengthening of CPD and enhanced performance review of doctors to identify those ‘at risk’ of making mistakes or actually making mistakes but not yet known to regulators. This results from a direct request from the Council of Australian Governments – so no wriggle room really. The AMA and AMA Queensland and I presume colleges and other groups have made representation to the Medical Board on behalf of the profession in regard to re-validation. One of the points I hear repeatedly made is that additional regulation, whether it be via enhanced CPD or performance review (and there will be enhancements of both over time whether we like it or not) must be evidence-based, be shown to improve patient outcomes and not be too onerous for doctors (or too expensive). It is important as a profession we continue to empower our colleges to evolve CPD programs. The Medical Board has suggested that purely didactic pursuits could be replaced by more practical and outcome-based assessments or activities, which has some intuitive merit. Nonetheless, it must remain the work of colleges to work out what is best for their discipline. Evolve they must though – if they stand still the consequences from government/regulators will likely be more unpalatable. All doctors need to get involved with their professional societies and colleges to shape how they want to undertake performance review and conduct CPD. We must do this better. The less corridor conversations we have about colleagues we know who are struggling but as a profession we fail to assist, the better. The more perfunctory assessment or CPD we do that has no clear relevance or genuine intent to improve our quality of practice, the better. If the profession wants to remain self-regulating and independent, then (non-onerous) evolution is required. If you do not like the direction current medical leaders are headed in – then get involved and change it. Failing this, suggest what we should do and we’ll continue discussion on your behalf with the Medical Board and colleges with this in mind to try to get an optimal outcome! Kind regards, Dr Chris Zappala AMA Queensland President Q Doctor Q Summer | 11

PEOPLE & EVENTS

AMA QUEENSLAND CONFERENCE – INDIA

The annual AMA Queensland Conference was staged in the fascinating country of India during the period 17 – 24 September. The host country was both interesting and exciting and delegates got to spend time in New Delhi, Agra and Jaipur as well as visit the mighty Taj Mahal. It provided a perfect setting for delegates to learn and enjoy each other’s company. The event kicked off with a fabulous cocktail reception in the hotel hosted by AMA Queensland President Dr Chris Zappala. The scene for the event was set-up to resemble a pop-up bazaar, complete with street stalls and magical entertainment and food. What a start to the week! In the conference room, our delegates were educated and entertained by a line-up of speakers of world renown, with the conference theme being Research – Turning it into reality. Every session was packed with enlightening presentations and generating enthusiastic discussion and debate. The conference was formally launched with an official, traditional Indian opening ceremony involving the lighting of lamps by our Chief Guest, Anupriya Patel, Minister of State for Health and Family Welfare, Chris Elstoft, Deputy High Commissioner for Australia to India, Professor Kameshwar Prasad, All India Institute of Medical Sciences and Dr Chris Zappala, President AMA Queensland. It was a very interesting and unique way to start the conference. The first formal speaker was Chris Elstoft, Deputy High Commissioner, and he spoke on the Australia/India relationship and its importance and value to both countries. He was quickly followed by our chief guest speaker, Anupriya Patel who spoke on health policy and services in India.

1. A side view of the Taj Mahal 2. Keynote speaker Professor Kameshwar Prasad 3. Lunch overlooking the Taj Mahal 4. A tiger in the wild, taken by Lisa Christensen 5. Conference delegates 6. Guests enjoy a cultural show

12 | Doctor Q Summer

Delegates were most fortunate to have four guest speakers from the All India Institute of Medical Sciences (AIIMS), they were Professor Kameshwar Prasad speaking on Differentiating poor research and fashion, from true innovation, as an essential skill in health care, and then Reflections on the day in the life of an Indian Doctor, challenges and practicalities in health care delivery. Prof V K Paul spoke on the Challenges of providing health care throughout India, Prof Balram Bhargava presented a session on Frugal innovation for health care in India. The final speaker from AIIMS was Dr Rajiv Narang, on Opportunities for research in India. Delegates also enjoyed two presentations by senior representatives from Johnson & Johnson Medical, India. Firstly, Sushobhan Dasgupta, Managing Director

Johnson & Johnson Medical India who spoke on Realising untapped opportunities for health care in India, and Dr Anish Desai who presented on The connection between medical research and health care outcomes.

Dr Ian Brown spoke on the topic of The Sleepy Patient

Also from the High Commission, a presentation from Gregory Harvey, Trade Commissioner, on the Contemporary health care landscape in India. It was an absolute pleasure to have these esteemed local speakers participate in our conference.

Dr Mellissa Naidoo on Accommodating a flexible medical workforce - can it be a reality?

Australian speakers to present were: Dr Anjali Jaiprakash, Research Fellow, Medical and Health Robotics, QUT. Anjali presented two sessions on Machine learning and the future of medicine and Robotic surgery â€“ today and tomorrow. Dr Chris Zappala, President, AMA Queensland, spoke on Pulmonary fibrosis, current research and concepts. GP Dr Dilip Dhupelia updated delegates on Rural health care access. Colleen Sullivan spoke on the role for the Practice Manager in research to improve practice outcomes.

KATHARINE PHILP Health Law Partner Katharine Philp of TressCox Lawyers presented on the topic of Inappropriate Practice and the Medicare Professional Services Review Scheme.

Dr Bill Boyd spoke on Contraception, family planning and population control in India

The program continued with valuable presentations by Ross Noye, Macquarie Private Wealth, on Securing your financial future, including a post-election superannuation update and current research issues. Katharine Philp from TressCox Lawyers spoke on important medico-legal issues and updated delegates on the role of the Professional Services Review Scheme. A summary of Katharineâ€™s presentation is below. The final conference session was an issues open forum chaired by Dr Zappala. Issues significant to the future of medicine were addressed and hotly debated. Outside the conference sessions, delegates had opportunities to explore these wonderful cities and regions beyond. A

Medicare audits are on the rise with various specialties enjoying more attention that others from time to time. Medicare has advised that between 2012 and 2015 up to $71.48 million in savings were achieved; almost three times the expected target of $20.7 million. This is said to be mainly due to changes in billing behaviours of medical practitioners interviewed under the Practitioner Review Program. Of note, however, is the fact that savings included millions of dollars repaid by practitioners, determined to have engaged in inappropriate practice under the Professional Services Review Scheme. Delegates were provided with a step by step explanation of the processes under

particular highlight was the visit to the Taj Mahal, a UNESCO World Heritage listed site, recognised as one of the seven new wonders of the world. Conference week concluded with a farewell dinner and what a way to wrap up a great week. The venue was the acclaimed City Palace in Jaipur and it provided a most elegant setting for a most enjoyable evening. Our sponsors Our wonderful sponsors received a special vote of thanks at the dinner. We were most fortunate to have the support and company of Ross and Mandy Noye (Macquarie Bank), Katharine Philp (TressCox Lawyers) and Allison Scifleet (Lexus of Brisbane). So that was conference 2016, a wonderful experience for all concerned and a visit to a country so different and exciting that it will stay in our minds for a very long time. It certainly exceeded many expectations. Many delegates commented that this was the best conference ever conducted by AMA Queensland. Finally, a big thank you to Ros and Andrea at AMA Travel Queensland, for yet another successful and well-organised event. Q

the Practitioner Review Program and Professional Services Review Scheme. Outcomes for doctors who have gone through these processes were used to illustrate possible outcomes and penalties. The take home messages included: 1. The importance of maintaining good clinical records which contain sufficient information to satisfy an MBS item descriptor; and 2. The importance of understanding both the MBS item descriptor as well as any Associated Notes. Delegates were encouraged to seek advice if they had any concerns about any MBS item numbers.

Doctor Q Summer | 13

PEOPLE & EVENTS

INTERN WORKSHOPS More than 300 final-year students turned out for AMA Queensland’s Intern Readiness workshops in Brisbane and on the Gold Coast, to get clued in on the dos and don’ts for their upcoming internship. Delivered by our doctor in training representatives, topics included prescribing and paperwork, ward call, the RMO application process for 2017, resilience and navigating the early stages of your career. AMA Queensland would like to thank our sponsors MDA National, BOQ Specialist, Doctors Health Fund, Brisbane BMW, Avant and William Buck for making this informative event free for participants. Don’t miss our Intern Readiness workshop in Townsville on 19 December. Q

Dr Anthony Ji from MIPS, Dr Eric Richman from MDA National and Tania Waring from Avant in a panel discussion on Navigating risks and complaints in your first year of practice

RESILIENCE ON THE RUN Over 170 interns have now completed the Resilience on the Run program in Queensland including interns from Metro South Health Service, covering Princess Alexandra, Logan and Redlands Hospital, and additionally, Rockhampton Hospital have just delivered Resilience on the Run for the second time.

Erin Moffat explained the RMO recruitment process

“IT CAN BE DIFFICULT TO SAY YOU’RE STRUGGLING. JUNIOR DOCTORS ARE UNDER A LOT OF STRESS AND PRESSURE AND I THINK WE NEED TO REALISE WE’RE HUMAN.” Intern, Rockhampton Base Hospital

Presented by resilience expert Dr Ira van der Steenstraten, the Resilience on the Run program focuses on developing techniques for resilience and mindfulness, better managing interpersonal relationships, navigating difficult scenarios on the job and practical steps for asking for help. If you would like more information on delivery of Resilience on the Run at your hospital in 2017, contact Holly Bretherton, General Manager, Member Relations & Communications, AMA Queensland at h.bretherton@amaq.com.au or on (07) 3872 2248. Q 14 | Doctor Q Summer

Doctors from the Rockhampton Hospital have completed Resilience on the Run training.

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www.svphb.org.au Doctor Q Summer | 15

PEOPLE & EVENTS

WOMEN IN MEDICINE Queensland’s influential women gathered for AMA Queensland’s premier networking event in August. More than 200 women joined together to hear from Doctor, Counsellor and Mentor Dr Arne Rubinstein on the key to maintaining long lasting and happy relationships.

Events like these are made possible by generous sponsors. Thanks to MDA National, Triple P, BOQ Specialist, Doctors’ Health Fund, TressCox Lawyers, William Buck and Lexus of Brisbane. There were a number of great prizes up for grabs, thanks to these sponsors: two nights at Gaia Retreat and Spa (MDA National); Stephanie’s spa voucher (MDA National); pearl necklace and earrings (Panda Pearls); Veuve champagne (William Buck);

a T2 gift hamper (BOQ Specialist); a Red Balloon gift voucher (TressCox Lawyers); and a gourmet hamper (Lexus of Brisbane). We look forward to welcoming you to our 2017 Women in Medicine event on 31 August. Check out photos from the morning on our Facebook page. Q

1. Alexandra Ward and Dr Catherine Llewellyn 2. Meri Tritton and Dr Nan Crimmins 3. AMA Queensland CEO Jane Schmitt 4. Speakers Drs Sally Cockburn and Arne Rubinstein 5. Drs Moira McQueen and Carmel Newitt 6. Drs Sarah McMahon, Jenny Gough and Kathleen Cooke.

16 | Doctor Q Summer

Doctor Q Summer | 17

PEOPLE & EVENTS

PRIVATE PRACTICE MEDICO-LEGAL CONFERENCE Two of AMA Queenslandâ€™s best conferences were merged this year: the Private Practice Conference and the Medico-Legal Conference to help better inform and engage members who are either starting or growing their existing private practice. Members and guests attended the two-day conference, eager for information on privacy policies, patient confidentiality, social media practices, improving practice processes and blended payment models, paying your staff appropriately, practice incentives and case studies in private practice. A hearty thank you to our generous sponsors for the event. Q

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18 | Doctor Q Summer

1. Dr Nenad Alempijevic won the sponsor passport prize, a Lexus RX350 F Sport car for the weekend, sponsored by Lexus Brisbane Group. 2. Keynote speaker Dr Stephen Walker from the Cognitive Institute 3. Drs Zabdiel Samidurai and Alison Green and Thomas Hadwen 4. Dr Paul Neeskens asks a question of the Exploring practice funding and Medicare compliance panel 5. Sharon Palmer and Darko Mihalinac 6. Drs Sanjeev Ranjan and Vikram Goel 7. Mr Wayne Mulvamy, Dr Alicia Kohn 8. Professor David Morgan OAM and Dr Margaret Kay 9. Dr Paul Lane, Co-designer of the Ten Cs Resilience Model 10. Julie Brooke-Cowden, Manager, Claims and Advisory Services (East), MDA National, Rose Kent, State Manager, Australian Health Practitioner Regulation Agency (AHPRA) and Andrew Lucich, Barrister, Queensland Bar. 11. The How to Excel in Private Practice panel: Dr Richard Kahler, Managing Director and Specialist, BrizBrain and Spine, Gae Nuttall, Senior Risk Advisor, MDA National, Sue Pocock, Business Manager, Scope Business Solutions and Dr Noela Whitby AM, General Practitioner, Carindale Medical Centre.

Doctor Q Summer | 19

FEATURES

2016-2017 BOARD AND COUNCIL Following on from the feature on AMA Queensland’s new Board and Council in the last edition, the Council now welcomes Dr Nicholas Yim, replacing Dr Paul Neeskens on the General Practitioner Craft Group, and welcomes back Dr Wayne Herdy to represent the North Coast.

COUNCILLOR

DR WAYNE HERDY

DR NICHOLAS YIM

North Coast Area Representative Specialty: General practice

General Practitioner Craft Group Specialty: General practice

“I aim to represent the views of my constituents to Council; to promote patient safety especially by diminishing role substitution and developing task delegation; and to assure the future of young graduates by promoting best education and best career prospects.”

“I hope to bring enthusiasm and representation to address issues facing regional Queensland. I intend to advocate for all doctors and to ensure the high standards of the clinical training, which I hope will in turn improve the health of our communities and patients.”

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CRUNCHING THE NUMBERS IN PRIVATE PRACTICE

George Sotiris, Manager, Workplace Relations, AMA Queensland and Paul Copeland, Director, William Buck Accountants hit the road throughout November and December to deliver seminars on crunching the numbers: staff hours, payroll, timesheets, Medicare item numbers, bulk-billing, patient appointments and profit and loss, as well as revenue and cost targets, patient satisfaction, patient times, and private versus bulk billing. The team visited the Sunshine and Gold Coasts, Toowoomba, Brisbane North and South, Ipswich, Cairns, Townsville, Mackay, Bundaberg, Hervey Bay and Rockhampton. Q

2 1. The Gold Coast seminar 2. The seminar in Toowoomba

20 | Doctor Q Summer

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Doctor Q Summer | 21

FEATURES

AMA QUEENSLAND LAUNCHES MATERNITY SERVICES DISCUSSION PAPER

22 | Doctor Q Summer

In October, AMA Queensland launched a discussion paper which examined ways in which the challenges which face maternity services across Queensland can be improved. AMA Queensland developed this paper in direct response to the Central Queensland Hospital and Health Service report into maternity services at Rockhampton Base Hospital (RBH). This report identified numerous issues common to many regional hospitals including midwife training, significant cultural issues and a poor recognition of deteriorating patients with slow escalation to the obstetrician. It also clearly indicated that there needed to be greater input into a women’s care and coordination of multi-disciplinary team efforts by an obstetrician. AMA Queensland believes the results of the Rockhampton Hospital Maternity Service review findings are reflective of long-standing practice challenges faced by maternity services across Queensland. There has been a slow transition to midwifery-led practice in recent years with a subsequent reduction in involvement by the obstetrician in public hospitals. AMA Queensland President Dr Chris Zappala called on Health Minister Cameron Dick to urgently reverse the midwife-led trend across the public hospital system to protect Queensland mothers and their babies. “Obstetricians are increasingly being called in only when a labour problem becomes serious or life-threatening, and are then expected to shoulder all responsibility for the outcome of the birth,” Dr Zappala said. “This is despite significant evidence that mother and baby benefit from specialist care throughout the entire pregnancy, so that possible complications can be

identified and mitigated at an early stage.” There is compelling data that the morbidity and mortality rate for mothers and neonates is significantly lower in the private system, where care is led by an obstetrician, as opposed to the public system, where care is led by the midwife with scant involvement of an obstetrician. This finding remains significant when adjusted for age, body mass index, co-morbidities and case complexity. According to the Queensland Maternal and Perinatal Quality Council Report 2015, the perinatal mortality rate (7.4 vs 11.1 per 1000 births), still birth rate (5.5 vs 7.4 per 1000 births) and neonatal mortality rate (1.9 vs 3.7 per 1000 births) are all significantly lower in private hospitals as compared to public hospitals Dr Zappala believed these facts speak for themselves. “In Queensland, the public system has a perinatal mortality rate of 11.1 per thousand births. By contrast, the private system – with an obstetrician-led model of care – has a rate of 7.4 per thousand births,” he said. Dr Gino Pecoraro, AMA Queensland Past President and obstetrician, agreed. “As an obstetrician, I recognise and respect the important role that midwives play in providing quality care to expectant mums but we can’t have a public health system that puts maternal and baby health at risk,” he said.

“THE PREVAILING BELIEF IN SOME CIRCLES THAT OBSTETRICIANS DO NOT NEED TO OVERSEE ‘LOW RISK’ PREGNANCIES IS INCORRECT.

Gynaecologists (NASOG), whose President Dr Gary Swift said the end goal was delivering better health outcomes for women and their babies.

“ALL EXPECTANT MOTHERS SHOULD BE ABLE TO ACCESS AFFORDABLE SPECIALIST OBSTETRIC CARE,” DR SWIFT SAID. “This discussion paper provides a framework for obstetricians and midwives to work together to deliver high quality maternity health care within Queensland’s public hospital system.” The model of care proposed by AMA Queensland recommends that obstetricians: review all new patients at their first antenatal visit at a public maternity service, prior to midwifery consult; review all patients on admission to labour suite for risk analysis and documentation; and review and examine all labouring patients every four hours. In addition, it recommends better communication and involvement with the patient’s regular GP. AMA Queensland believes it is vital that Queensland’s expectant parents have confidence in the public hospital system’s ability to safely deliver their newborn child into the world. It is our hope that our discussion paper helps to begin conversations between the government, ourselves and other stakeholders, so that we can ensure that confidence is well placed and well earned. Q

Even in ‘low risk’ pregnancies, almost half will require obstetrician assistance to deliver the baby safely.” AMA Queensland’s discussion paper also earned the support of the National Association of Specialist Obstetricians and

Doctor Q Summer | 23

CURRENT ISSUES

EUTHANASIA, ASSISTED SUICIDE AND THE LAW With the release of the fifth chapter of AMA Queensland’s Health Vision, end of life care, Katharine Philp from TressCox Lawyers clarifies the laws surrounding euthanasia and assisted suicide in Queensland. While it is no longer illegal for a person to end their own life (notwithstanding continued use of the expression ‘to commit suicide’), it is illegal to assist a person to do so. This reflects the general position in Australian law, which is that a medical practitioner may, consistent with good medical practice, withdraw or withhold treatment from a patient, but may not actively bring about a patient’s death, referred to as euthanasia. Assisted suicide is criminalised in Queensland by s 311 of the Criminal Code, which states: 311 Aiding suicide Any person who — a) procures another to kill himself or herself; or b) counsels another to kill himself or herself and thereby induces the other person to do so; or c) aids another in killing himself or herself; is guilty of a crime, and is liable to imprisonment for life. This provision is wide enough to encompass the provision of information or resources to assist suicide. Section 311 is also relevant to the practice of palliative care which has the effect of hastening a person’s death. The Criminal Code permits doctors, or others on the written order of a doctor, to provide palliative care which hastens death if the patient’s death is incidental to the care provided. The primary aim must remain the easing of pain and suffering, and the treatment must be reasonable in the context of good medical practice (s 282A). Accordingly, the Criminal Code would not exempt a medical practitioner from prosecution where the treatment provided in a palliative context goes beyond the level necessary to alleviate pain. Where the exemption in s 282A does not apply, the actions of the medical practitioner would be dealt with by s 311 or the Code’s general provisions establishing the crimes of murder or manslaughter. 24 | Doctor Q Summer

The distinction between palliative care and assisting suicide is less obvious in the case of providing care to a person refusing food or water to bring about their death. There is no requirement for a competent patient to accept medical treatment, or indeed food and water. This follows from the law’s respect for a patient’s bodily integrity, and the need for patients to consent to medical treatment. While there is no direct authority on whether providing palliative starvation constitutes lawful palliative care, the general principles articulated by courts interstate indicate that it is the fact of suffering that gives rise to the doctor’s ability to provide palliative care, not the source of that suffering. It would follow that medical practitioners may provide palliative care to a patient who is starving voluntarily, provided that the care is consistent with good medical practice and reasonable in the circumstances. Laws to allow medical practitioners to carry out voluntary euthanasia in a limited range of circumstances are currently being debated in Victoria. If passed, Victoria would become one of only a handful of jurisdictions in the world to allow this practice. For now, however, there is no such proposal in Queensland, and medical practitioners must adhere to the Criminal Code’s limits on lawful medical treatment.

Q 1.

For a more in-depth analysis of this question, see White B, Willmott L and Savulescu J, “Voluntary palliated starvation: A lawful and ethical way to die?” 22 Journal of Law and Medicine 376.

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Doctor Q Summer | 25

CURRENT ISSUES

HEALTH VISION TO EXAMINE CARE AT THE END OF LIFE Later this month, AMA Queensland plans to release the final part of its Health Vision. This last chapter of the Health Vision will examine the way our health system approaches care at the end of life, and how it can be improved. There are a number of issues facing the way we handle care at the end of life in Queensland. Evidence from people who work in palliative care tells us there is a large amount of unmet need in the palliative care sector, resulting in service providers having to shorten the length of palliative care services they can provide. This can be worse if you live in a rural or remote area. Compounding this underfunding is the fact that we simply do not know what the exact level of unmet need is. Despite a 2013 Queensland Parliament report recommending the government investigate and report on the level of unmet need in palliative care, and the government subsequently accepting this recommendation, it appears this modelling has never taken place. This means that even if the Federal and State Governments were to open their cheque books and fund the palliative care sector properly, we don’t know how much money and resources would be need to fix it.

26 | Doctor Q Summer

Advance Care Planning is also an issue. As is the case in other states, Queensland’s laws that guide advance care plans and advance health directives within Queensland and across the country are inconsistent and confusing. Every state has different laws using different terminology to create or recognise different types of advance care directives or medical powers of attorney, which take effect under different clinical conditions. This means an Advance Health Directive (AHD) completed in Queensland may not be legally valid in other states and territories in Australia. This creates confusion for health workers, patients and families and makes a national database – which is needed to ensure AHDs are respected even if you travel interstate - impractical. It is therefore not surprising to learn that despite the importance of this planning and the concept having existed since the early 1970s, there is low awareness of the value of planning your treatment options before you are unable to communicate your wishes yourself. Health Vision Part Five will elaborate on these problems, and will offer solutions which the government may wish to consider to remedy palliative care underfunding and improve the uptake of AHDs and other care at the end of life planning measures.

For practical and compassionate reasons, AMA Queensland believes Queensland should become a leader in end-of-life care in Australia. We believe that this last chapter of the Health Vision will be an important step in ensuring Queensland has that conversation, and that we enact compassionate changes which ensure that our doctors and clinicians are able to effectively care for their patients, and that, where possible, the wishes of patients and their loved ones are respected. Q

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Doctor Q Summer | 27

CURRENT ISSUES

PRACTICE INCENTIVE PAYMENT DIGITAL HEALTH UPDATE

As part of the 2016-17 budget, the government announced that it would be redesigning the Practice Incentives Program (PIP) to simplify the current incentives and to introduce a new Quality Improvement Incentive. The aim of the redesign was said to give general practices increased flexibility to improve quality care in areas such as detection and management of a range of chronic conditions, and to focus on issues specific to their practice population. The AMA had made repeated representations to Ms Ley since June regarding the harm the PIP changes would inflict on GPs already burdened by the Medicare rebate freeze. There was mounting evidence that a large number of practices could not meet the new requirement in time, for a moratorium on the requirement introduced in May that practices upload shared health summaries (SHS) for at least 0.5 per cent of their patients each quarter in order to qualify for the PIP Digital Health Incentive. Following this strong advocacy from the AMA, the Minister for Health, the Hon Sussan Ley MP agreed to a temporary amendment to the requirements for the Practice Incentives Program (PIP) Digital Health Incentive that came into effect from 1 May 2016. The AMA welcomes this decision to extend the deadline for general practices to comply with the new Practice Incentive Program (PIP) Digital Health Incentive to 31 January 2017. General practices registered for the eHealth Incentive will now have until the end of January 2017 to make up any shortfall in their SHS uploads from the first quarter of the new

28 | Doctor Q Summer

requirement (May-July 2016). Practices that opted-out of the first quarter now have the opportunity to catch up and receive their full incentive payment. Practices who do not intend to meet all the requirements of the Digital Health Incentive should withdraw. Recovery action for all incentive payments made to those practices that have not met their targets by the end of quarter three will be undertaken, except where practices experienced real issues outside their control which prevented them from doing so. Practices experiencing issues outside their control preventing them from meeting the requirements of the Digital Health Incentive can contact the Department of Human Services on 1800 222 032 or email pip@humanservices.gov.au to discuss. AMA President Dr Michael Gannon said the medical profession strongly supported the government’s My Health Record, and the Minister’s decision to extend the SHS requirement deadline would help shore up the goodwill of GPs to support its successful implementation. But it is important that the government continues to review the implementation of the PIP Digital Health Incentive. Members should also be aware that the Department of Health (DoH) is now publicly seeking stakeholder views on how the PIP might foster quality improvement and innovation. It has released a consultation paper – Redesigning the Practice Incentives Program, which can be accessed from the DoH on-line consultation hub. Q

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Doctor Q Summer | 29

CURRENT ISSUES

AMA QUEENSLAND CONTINUES OHO REFORM CAMPAIGN Earlier this year, AMA Queensland released its discussion paper which called on the Queensland Government to look at ways in which the Office of the Health Ombudsman (OHO) could be reformed. We developed this discussion paper in response to significant concerns AMA Queensland and its members have with the performance of the OHO, its independence from government and its adherence to principles of natural justice. As a result of AMA Queensland’s strong and sustained advocacy on the problems our members have communicated to us regarding their experiences with the OHO, the Queensland Parliament’s Health Committee, which has oversight of the OHO, began an enquiry to look at the OHOs performance. In August, the committee invited AMA Queensland President Dr Chris Zappala to provide public evidence to the enquiry. Dr Zappala’s evidence to the committee outlined the significant concerns we have with the performance of the OHO. Importantly, these concerns were also repeated in other submissions made to the committee by organisations such as AVANT and the Doctors Health Advisory Service, which

30 | Doctor Q Summer

was noted by the Committee Chair, Leanne Linard MP. The committee asked Dr Zappala if AMA Queensland had confidence in the OHO. Dr Zappala responded that we do not. He was also asked if he felt the OHO should be completely abolished. He responded by saying that our submission had been written with the view that the government would be reluctant to abolish the OHO completely and with this in mind, there are reforms that could make it workable. However, our ideal system would be to move away from a co-regulatory scheme to one where referral to the Medical Board via AHPRA is the first and only port of call for all complaints. We maintain our view that these are not exclusive positions to hold. The Health Committee is due to present its report on the performance of the OHO, and any subsequent recommendations it may make for its reforms, to Parliament on 2 December. While we wait for this report, AMA Queensland will continue to advocate for reforms to the OHO that not only ensure that patient safety is maintained but which ensures medical practitioners who are subject to a complaint are treated both fairly and quickly. We believe an appropriately reformed Office of the Health Ombudsman is an important evolutionary step to achieving this outcome. Q

COMPLAINTS: HOW DO DOCTORS COMPARE? Associate Professor David Morgan OAM from the Queensland Board of the Medical Board of Australia (QBMBA) explains how doctors compare with each other in subspecialty groups, matters dealing with monitoring and compliance, and mandatory reporting. How do you compare? Males and those aged over 60 are more likely to attract complaints than others. Some specialties also feature more prominently. Plastic surgeons are more likely to be the subject of a complaint, whereas our anaesthetic colleagues appear to be the most complaintfree. Patient expectations, the frequency of patient contact and the likelihood of adverse outcomes are all influencing factors. Remember that about 60 per cent of all notifications or complaints are not indicative of underperformance by the practitioner and result in no further action being taken by the board. How often are complaints received? The QBMBA deals with about 1,400 complaints annually. Only three per cent of the 20,000-odd practitioners in Queensland will be the subjects of complaints in any one year. 50 per cent of annual complaints come from the same three per cent of doctors.

There is a definite ‘frequent flyer’ group within our midst. This is one occasion when ‘platinum status’ is undesirable. Is there a special group? Yes, males, those over 60 and those who are engaged in predominantly medico-legal practice. Our colleagues are usually dealing with patients who are anxious and sometimes adversarial. The matters are complex, the historians are sometimes poorly focussed and there is a temptation for irritability and impatience. This is one branch of clinical practice that requires additional caution. Monitoring and compliance Following an initial complaint, those who are subject to special conditions will also be subjected to monitoring. There are usually about 400 of our colleagues being monitored at any one time. Unfortunately, as many as 10 per cent of that group can be non-compliant. Your board views this matter seriously and considerable

efforts are expended in ensuring that the highest standards are attained and maintained. What happens at the end of the process? It is encouraging to note that 80 per cent of our colleagues who were subjected to some form of monitoring and compliance program eventually return to unrestricted practice. Of the remaining 20 per cent of practitioners, some elect not to renew their registration. Others surrender their registration prior to the renewal date. Neither outcome is necessarily an adverse reflection upon the practitioner. Instead, it is a recognition of insurmountable difficulties which may prove to be incompatible with our goal of patient safety. Mandatory reporting This process applies to registered health practitioners, employers of registered health practitioners and education providers. It is enshrined within the national law to which I have previously referred. The one exception may be if you are the practitioner providing a health service to the underperforming practitioner. In Queensland, you are obliged to notify the Health

Ombudsman if you believe another practitioner has engaged in four specific activities. They can be summarised as follows: 1. Practised whilst intoxicated by alcohol or drugs. 2. Engaged in sexual misconduct in connection with practice. 3. Placed the public at risk of substantial harm because of an impairment. 4. Placed the public at risk of harm because of a significant departure from accepted professional standards. Although you may have no evidence that a practitioner has engaged in, say, illicit drug use which has a direct effect upon his or her practice, given the nature of the activity, is it something that reflects upon the practitioner’s general approach to life? Is this worthy of reporting? The national law is silent on the matter. It is left to you to determine. By next year, current board members will have reached the end of their term and I will introduce the new board members in the Autumn edition of Doctor Q. Q Studdert DM et al; New England Journal of Medicine, Vol 374(4) pp 354-362 2016.

Doctor Q Summer | 31

PEOPLE & EVENTS

A DAY IN THE LIFE OF AN ORTHOPAEDIC SURGEON Dr Sarah Coll is an orthopaedic surgeon based in Cairns and is a Specialist Craft Group Representative on AMA Queensland Council. We took some time with Dr Coll to find out what makes her tick.

Why did you get into orthopaedic surgery? I was an intern in Western Australia, and the surgeon I was working for, allowed me to assist. I was amazed at how beautiful surgery could be. While I was sure that surgery was not a career for me, I loved being in theatre. I then moved to Queensland, and was given an opportunity for a month to be an orthopaedic registrar. I loved it, and then realised that I had never really liked anything else in medicine. I was then offered a junior registrar post, and the rest is history. I was supported along the way by several senior surgeons, who went out of their way to help me, even though I did not realise this at the time. Are there particular conditions or procedures that you are particularly interested in? I love arthroscopic procedures I think that I can triangulate well 32 | Doctor Q Summer

because I did ballet as a young girl and so I have excellent upper limb proprioception. I do wrist, shoulder and knee arthroscopy, and I am learning to do hip arthroscopy, which is exciting. What do some of your daily tasks look like? I am currently suffering from an excess of ‘busyness’ and I am trying to address this. I get up at 5.30am, and ride my bike for an hour, I have breakfast and do a ward round, to start clinic at 8am. I operate three times a week, and have Thursdays off to catch up on chores and family responsibilities. I don’t really take a lunch break, as I have paperwork to do, and I tend to do paperwork again in the evenings. How do you balance your life and work? I am very careful to use my weekly planner, and while I tend to over-schedule, I am learning to factor in times to relax as I am at a point in my career where I can easily burn out. My children are both at school, which is an age that suits me, as I can talk to them about what they have done during the day, and we can discuss issues they are having. When did you open your own practice? I started private practice in 2007, as I sensed that I would struggle to get more theatre time in my public hospital as we

physically had no more theatres. I feel a sense of something missing when I don’t operate regularly. I started slowly, working a day a week, and then built up my days as time allowed. I had part-time staff until the ball really got rolling. My husband had a business and technology background and was instrumental in setting up our systems and protocols. I saw that you are only the second female to qualify after orthopaedic training. Why do you think we aren’t we seeing more females in this field? There seemed to be a fear amongst some senior colleagues that female orthopaedic surgeons would change the face of orthopaedics, and I think that is certainly true. I guess we all struggle with change, and I respect that, but I also felt that I

was capable of the job, and so I just kept trying. I talk to women who leave orthopaedics and I am trying to find out why - it is difficult because they say it is so many factors, and there is no one reason. I was quite single-minded about doing orthopaedics, and didn’t have any family distractions, then. Tell us a bit about working on AMA Queensland Council? I really had no idea what was involved, but have really enjoyed meeting colleagues from other professions and being involved in shaping the future of being a doctor in Queensland. I like looking forward, and the development of the Health Vision has helped me direct my focus and by working together we can achieve this. Q

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jobs.doctorportal.com.au Doctor Q Summer | 33

CURRENT ISSUES

SORTING CHRISTMAS LEAVE With the Christmas and New Year holiday period approaching, employers should be mindful of employee entitlements with regards to leave requests.

Annual leave Are you temporarily closing your medical practice over the holiday period? If so, you can direct employees to take annual leave or annual leave in advance during part or all of this period. Employers should provide as much notice as possible of close down periods during which employees will be directed to take annual leave, so if you haven’t already advised employees of your practice closure, you should do this as soon as possible. Clause 31.4 of the Health Professionals and Support Services Award 2010 (HPSS Award) and Clause 31.7 of the Nurses Award 2010 (Nurses Award) states that employees may be directed to take annual leave during part or all of a period where your medical practice is temporarily closed, provided such direction is reasonable. If you have 34 | Doctor Q Summer

employees who do not have enough annual leave to cover the close down period, they can be required to take annual leave in advance of accruing it, where this requirement is reasonable. If you are directing staff to take annual leave in advance over a close down period, or if an employee has applied for leave over the holiday period but hasn’t quite accrued enough to cover their absence, annual leave taken in advance by an employee should be processed as per the requirements of clause 31.3 of the HPSS Award or clause 31.8 of the Nurses Award. Both clauses state that the employer should document in writing the amount of annual leave taken in advance and keep a copy of this agreement as an employee record. An example template when providing annual leave in advance is included in Schedule X of the HPSS Award and Schedule D of the Nurses Award. Both clauses also state that if an employee takes annual leave in advance and their employment subsequently ends before they worked enough to finish accruing the leave already taken, the employer is able to deduct from the employee’s final pay an amount equivalent to the leave entitlement that was taken but not accrued yet. If an employee approaches an employer to ask for annual leave in advance, the employer is not obligated to provide this – there needs to be agreement between both parties. What about if an employee requests to take annual leave on short notice, or they make a request during their first twelve months of service? Some employers are under the impression that they don’t have to grant annual leave to employees during their first twelve months – but this is incorrect, as the National Employment Standards (NES) do not state

that an employee needs a minimum length of service before they can apply for leave. If an employee makes an application for annual leave on short notice, the employer should assess this on a case-by-case basis, and in line with their annual leave policy if one is in use at the practice. Having an annual leave policy can assist with reducing disputes, as it will enable employees to understand the employer’s expectations with regards to annual leave requests. AMA Queensland members can contact the Workplace Relations Team for a template annual leave policy. The NES provide that an employer must not ‘unreasonably refuse’ to agree to a request by an employee to take annual leave. A lack of appropriate notice by the employee, combined with a practice’s operational requirements, may mean that it is not unreasonable to refuse the leave. But what constitutes an unreasonable refuse is not defined in the NES – this is why an employer should carefully assess a proposed annual leave refusal on a case-by-case basis. Long Service Leave Do you have any long-serving employees who might be eligible to take long service leave over the holiday period? Long Service Leave (LSL) entitlements are provided for in the Industrial Relations Act 1999 (Queensland). The Workplace Relations Team can provide information on LSL requirements under this legislation, and can also complete LSL calculations for staff for a fee. Questions? AMA Queensland members who require more information, or who have any questions in relation to the above information, can contact the Workplace Relations Team on (07) 3872 2211 or workplacerelations@amaq.com.au Q

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To insure with MIGA, visit our website or call us on 1800 777 156 miga@miga.com.au www.miga.com.au Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by Medical Defence Association of South Australia Ltd. Before you make any decisions about any of our policies, please read our Product Disclosure Statement and Policy Wording and consider if it is appropriate for you. Call MIGA for a copy or visit our website. ©MIGA April 2016

Doctor Q Summer | 35

CURRENT ISSUES

CHIEF HEALTH OFFICER’S REPORT 2016

Queenslanders are enjoying good health by global standards and seeing significant improvements in health behaviours according to the latest report card on health in Queensland. Queensland’s Chief Health Officer, Dr Jeannette Young, has just released her sixth Health of Queenslanders 2016 report, a detailed snapshot of the current health status of Queenslanders. It is a valuable reference document for medical and health professionals, providing evidence-based insight into key and emerging issues for 4.9 million people in Queensland, highlighting where improvements have been made and where future efforts need to be focussed. Dr Young said, “it is encouraging that we are seeing significant improvements in healthy behaviours. Smoking prevalence is continuing to decline, and after many years of rising rates of obesity it finally appears to be stabilising. These two factors must however remain a significant focus of preventive efforts.” The report shows that smoking rates have halved since 1998 to 12 per cent of adults smoking daily in 2016. However, one in eight women smoked at some time during their pregnancy in 2014 with the rate for women living in areas of the highest socioeconomic disadvantage being 5.6 times higher than those in the most advantaged areas. While the high rate of obesity appears to have stabilised, two thirds of adults (an estimated 2.2 million people) and about a quarter of children (217,000) are either overweight or obese. Increasing activity and shifting patterns away from highenergy, low-nutrition foods to a healthier diet also remain a major focus of future prevention efforts. Small gains are being achieved in the health of Indigenous Queenslanders. The life expectancy gap reduced by around one year between

36 | Doctor Q Summer

2005–07 and 2010–12, and the risk of early death from cardiovascular disease, diabetes and injury has declined steadily. However, the report highlights that large disparities remain, with smoking rates being a particular concern. “We need to do more to address this problem and its debilitating outcomes such as lung cancer and chronic respiratory disease. It is essential to maintain the focus and investment on improving health outcomes for Indigenous Queenslanders if these issues are to be addressed.” Dr Young sees general practitioners as playing an integral role. The first point of contact between the public and the health system is frequently with their GP. The medical profession has a valuable and influential role to play in preventing lifestyle-related disease with 40 per cent of all adults in 2011–12 discussing lifestyle change with a GP in the previous 12 months. The report highlights the challenges ahead, among them the rapidly increasing number of hospitalisations. Over the past 11 years hospitalisations increased by 70 per cent, or an extra 70,000 hospitalisations per year. The primary health care sector will be a major asset in helping patients to avoid preventable hospitalisations thereby reducing the pressure on the increasingly stretched hospital system. The gains from falling death rates are resulting in longer life expectancy at birth, but also an ageing population - one in seven people were aged 65 years or older in 2016, in 20 years this is expected to be one in five. This will mean that patients will increasingly be presenting with more complex, multi-morbid health needs. “We need to be responsive to the health needs of an ageing and diverse population,” says Dr Young. “Our objective is to have people living longer and healthier lives through not only delaying death, but preventing illness and risky behaviours.” See the Health of Queenslanders 2016 report at www.health.qld. gov.au/cho_report Q

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CURRENT ISSUES

THE DIGITAL TRANSFORMATION OF OUR HEALTH SYSTEM The transformation to a digital health system is inevitable. We must continue to embrace it or be left behind, says the Chair of the Queensland Clinical Senate, Dr David Rosengren.

The Lady Cilento Children’s Hospital is using ‘Eye Gaze’ technology to help children with disability to communicate and interact.

Almost every aspect of our life can be performed online. We can do our banking via an app on our phone and buy our weekly groceries on the Internet. Yet one of the most important parts of our life - our health - is still offline for the most part.

The Gold Coast Hospital and Health Service has introduced pharmacy robotics to store and retrieve medicine, giving pharmacists more time with patients, medical and nursing staff.

For whatever reason, we as health professionals and the health industry have failed to fully embrace digital advancement in the same way that other aspects of our life and other industries have. That is not to say we haven’t made progress—we certainly have. St Stephen’s Hospital in Hervey Bay was Australia’s first fully integrated digital hospital and the Princess Alexandra Hospital was the country’s first public hospital to go completely digital. Cairns Hospital is the first in Australia to use maternity digital records and the first Queensland hospital to use paediatric and community digital records. Mackay hospital is undergoing the transformation to a digital hospital and there is a program plan to roll out electronic medical record systems across all of the Health Services in Queensland. We have also seen the introduction of many incredible digital technology solutions across the state.

38 | Doctor Q Summer

The orthopaedic unit at the Princess Alexandra Hospital has introduced 3D printing technology to print complex fracture models to assist in planning for surgery and with training registrars.

More than 180 Queensland clinicians attended the Senate’s digital health conference in August to explore what’s ahead in the ever-changing digital landscape. What became evident was that digital health is a people and not an IT project and that we must engage with our people and be thoughtful in the way technology is integrated. We learned that we must make an ongoing commitment to necessary investment in digital hospital infrastructure. And that to avoid a two-tiered health system, digital hospital solutions for regional and rural Queensland is of utmost importance. The Senate will advocate strongly around these points. Meantime, at an individual level we must do our part to keep the wheels in motion. We need to overcome some of the cultural hesitancies around IT/digital failures of the past and find the courage to overcome anxieties around information sharing.

We need to change our mindset around how we interact and relate to our patients and how we share responsibility for the decisions that are made. We need to understand that digital transformation must be more than simply a digital overlay of what we already do - we need to make sure that it provides improved ways of doing things. And most importantly we must appreciate that the bulk of our community want a digital health experience - consumers want to be active participants in their healthcare. Speaking at our digital healthcare conference, health consumer Christine shared her experience with the health system since being diagnosed with a chronic disease more than a decade ago. The first six years, she said, were offline (face-to-face) but since 2010 it’s been a combination of offline and online. Christine’s digital healthcare involves direct access to her specialist via email and mobile phone (calls and SMS), giving her a sense of ‘contributing to care, partnership, safety net, sharing control, enhanced care’. On her wish list, she told us, is a patient portal that enables the patient to access their medical record, interact with the clinical team, share stories with other patients, book appointments and provide feedback. Digital health is inevitable so let’s embrace it and allow the advancement to give our patients a better experience and an equal partnership in their healthcare. This can only be a great thing. Q

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Brisbane • Cairns • Gold Coast • Mackay • Toowoomba • Townsville Doctor Q Summer | 39

CURRENT ISSUES

A TOOLKIT FOR EVERY PARENT With the end of year looming, it’s a good time for parents to start preparing their kids for life’s major milestones, such as the start of kindy, prep, or even high school – all of which can cause families additional stress.

Here in Queensland, however, mums and dads have the advantage of free access to the world-renowned Triple P – Positive Parenting Program, thanks to a Queensland Government decision to provide more support to parents. Triple P gives parents a range of tools and strategies that they can apply to various parenting situations and help set children up for success. Triple P Queensland Program Director Carol Markie-Dadds said there was a common misconception that the program was only for parents who were having problems with their children’s behaviour. “All children benefit from being raised in a calm, consistent and positive home environment,” Ms Markie-Dadds said. “And with thousands of Queensland kids making the big step-up to kindy, prep or high school soon, parents can pick up tips to help their children enjoy a positive start. “Research has shown they do better in school, make friends more easily, feel good about themselves and are less likely to have behavioural or emotional problems when they’re older. “It also helps parents feel less stressed and more confident in their abilities.” Brisbane GP Dr Christine McAuliffe said GPs are in a great position to help parents access the free Triple P seminars, courses and DIY tools available. “Making sure all parents are aware that this resource is available to them is one of the most useful things that GPs can do for families,” Dr McAuliffe said. “Triple P is an evidence-based program which can help all parents – not just those who seem to be struggling.

40 | Doctor Q Summer

“It’s important to make sure our practice nurses are also aware of this free program, so they can recommend it during their interactions with parents.” Queensland parents can book in for one of the many free seminars or groups being held around the State or sign up for a DIY online program at www.triplep-parenting. net. “When you’re juggling work and a family, it can be hard to find time to attend a faceto-face course, so the do-it-yourself options make a great alternative,” Ms Markie-Dadds said. “The online option allows parents to work through interactive modules at their own pace. “It’s also a great option for parents in regional Queensland, who might not be able to access Triple P otherwise.” As part of the statewide rollout, Queensland GPs and general practice nurses can undertake Primary Care Triple P training, so they can provide brief consultations on specific issues over a few weeks. Participants receive a certificate of accreditation from The University of Queensland, and may be eligible for professional development points through the RACGP. To register your interest in free Triple P training and resources or to order free brochures and posters to promote Triple P to parents at your workplace, please email qld@triplep.net. Q

Doctor Q Summer | 41

PEOPLE & EVENTS

LOCAL MEDICAL ASSOCIATION ROUND UP Sunshine Coast

Bundaberg

Gold Coast

Contact:

Jo Bourke

Contact:

Dr Daud Yunus

Phone:

0419 780 505

Phone:

(07) 5479 3979

Phone:

(07) 4152 2888

Email:

info@gcma.org.au

Meetings:

Phone:

daud.yunus@gmail.com

Web:

www.gcma.org.au

23 February 2017

Brisbane Northside

23 March 2017

Fraser Coast

Contact:

Dr Graham McNally

Phone:

(07) 3265 3111

Contact:

Drs Thomas Dunn and Paul Neeskens

Web:

www.northsidelma.com

Phone:

0409 623 009

Cairns Contact:

Dr Sharmila Biswas

Phone:

(07) 4036 4333

Mackay Contact:

Dr Bill Boyd

Phone:

0419 676 660

Central Queensland Contact:

Dr Michael Donohue

Phone:

0419 715 658

Toowoomba and Darling Downs Contact:

info@tddlma.org.au

Web:

www.tddlma.org.au

Meetings: 13 December 14 February 2017 - Northside Heart and Lung

Ipswich and West Moreton Contact:

Dr Thomas McEniery

Phone:

(07) 3281 1177

Redcliffe and District Contact:

Margaret McPherson

Phone:

(07) 3121 4043

Web:

www.rdma.org.au

Meetings: 22 February 2017 28 March 2017

CANâ€™T FIND YOUR LOCAL AREA?

If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au. 42 | Doctor Q Summer

DR KENYON FRY (KEN) 23 June 1936 - 20 August 2016 Member for 47 years After graduating from the University of Queensland in 1960, Dr Ken Fry started work at the Royal Brisbane Hospital and later moved to the Royal Women’s Hospital, Melbourne. His training in obstetrics and gynaecology continued in Walton Hospital, Liverpool, UK after gaining membership of the Royal College of Obstetricians and Gynaecologists, London. On his return to Australia in 1970, he established a private practice on Wickham Terrace, Brisbane, and later was appointed to a VMO position at the Royal Women’s Hospital. During that time he was the Royal Women’s Hospital representative on the Postgraduate Education Committee at the Royal Brisbane Hospital. In 1998, he was appointed as a Senior Examiner at the Australian Medical Council, a position he held until recently. On retiring from private and public practice in 2000, he has been employed in a relieving position at the Royal Women’s Hospital, and since 2002 has been a tutoring second-year students in the Graduate Medical Course at the University of Queensland. A long-standing member of both the Northside Local Medical Association (NLMA) and the Redcliffe and District Medical Association (RDMA), he served as chairman, secretary and treasurer in the former and continued to be a committee member, while in the latter he was serving currently as secretary over the last three years. He was committed to continuing medical education and to this end he was a regular attendee at the associations’ monthly meetings. In this way, he made contact with the members and participated in question time discussions. Q

It is with great sadness that the NLMA acknowledges the passing of our great stalwart and friend Dr Ken Fry. Since my involvement with the local medical associations since the 1980s, Ken had been a great supporter and committee member for both the NLMA and RDMA. He willing gave of his time and expertise with good humour and perspicacity. Dr Bob Brown, President NLMA His frequent communiques and missives, wit and eloquent language will be sadly missed. He managed, in the years I knew him, to give sharp accurate comments and exposed more political processes and language to describe these processes than anyone else I have ever met. Dr Kimberley Bondeson, President RDMA I have been a serving member of RDMA since 1977 and whilst also being a close friend of Ken. He was always there at each RDMA meeting, giving his support and wisdom to its members. I wish to express my sincerest condolences to his wife Margaret and Ken’s family and friends for their loss. Ken will be sorely missed at RDMA. Dr Peter Stephenson, Treasurer RDMA He will be sadly missed as a true friend and he was a valued RDMA member and a strong and supportive educator. He volunteered hours of his time to serve on the LMA committees over the years with selfless devotion. Drs R Neilson, M Mohanlal, B Chan and P Marendy were the founders of RDMA. They had their meetings in the Physiotherapy Department at Redcliffe hospital. Dr Ken Fry joined within six months of their first meeting, along with his wife Margaret. Ken was the obstetrician at Redcliffe Hospital at the time. RDMA was set up to become part of the AMA, as an offshoot of the doctors’ reform society, as there were difficulties with the government. RDMA’s district included Bald Hills, Nudgee, Redcliffe, Caboolture and Bribe Island. Meetings were often held at Strathpine. Dr Wayne Herdy, Vice President RDMA Top right: Dr Fry with Redcliffe District Medical Association Treasurer Dr Peter Stephenson and wife Margaret.

Doctor Q Summer | 43

Rural Doctors Association of Queensland 28th Annual Conference

Charting New Horizons RDAQ 2017

Innovate l Navigate l Communicate l

8 – 10 June 2017 Mercure Townsville

RDAQ 2017 – Save the date! This year’s theme is Charting New Horizons ~ Innovate ● Navigate ● Communicate

Join us in Townsville this June for the unique RDAQ conferencing experience. The RDAQ conference will dock in Townsville on 8 June 2017 and will stay in port for three action-packed days. I look forward to embracing the theme of Charting New Horizons ~ Innovate • Navigate • Communicate. The conference will allow us to explore how best to evaluate, adjust and sail into the great adventures of rural health. I personally recommend RDAQ to you as a conference with a difference. RDAQ offers excellent clinical content with plenty of networking and social opportunities. Dr Michael Rice I invite you to join us in Townsville for RDAQ’s 28th annual conference which will deliver unique President, RDAQ educational and collegiate experiences. The program is bursting with comprehensive clinical and health policy sessions with expert speakers. Come along, engage with key decision makers and continue your professional development journey. The conference will be held at the Mercure Townsville from 8 – 10 June 2017.

RDAQ 2017 Program The RDAQ 2017 program runs from 8 – 10 June 2017 with one additional day of pre-conference workshops.

Venue Mercure Townsville Mercure Townsville is a four star hotel located on 11 acres of resort style gardens. With a wide variety of accommodation rooms, all delegates’ preferences will be well catered for. Facilities include a tropical pool, tennis courts, guest laundry and a business centre. The hotel is perfectly positioned to host RDAQ. Offering a tropical family-friendly atmosphere, there is no better place in Townsville to welcome our RDAQ delegates.

In 2017 we are providing longer breaks based on delegate feedback and extended the conference to start earlier. RDAQ 2017 will open at 5.00pm on Thursday 8 June 2017 with a special guest speaker and the official President’s welcome. The official opening will be followed by our welcome reception in the trade exhibit so new and old friends can catch up while learning about new products and services offered by our wonderful exhibitors.

RDAQ 20I7 – Register today! 8 - 10 June 2017 Mercure Townswille 44 | Doctor Q Summer

Networking and Family Programs In 2017, RDAQ will host a networking program featuring four exciting networking events. The program will give delegates the opportunity to take a break from the academic side of the event and enjoy the company of old friends and make new contacts. RDAQ 2017 will also provide a Queensland Rural Medical Family Network (QRMFN) family program. More information on the family program can be found on the conference website.

About Townsville Townsville was once akin with the navigational challenges posed by the Great Barrier Reef proving to be a brutal coastline for ships. Townsville’s rocky past has now adapted and is home to some of Australia’s best ocean diving sites formed by several shipwrecks off the coast. It is also home to Queensland’s 3rd largest port, an innovation that is inherently linked to the sustainability of Northern Queensland. As a gateway to the Great Barrier Reef, Townsville’s 320 days per year of sunshine and dry tropical climate allows visitors to enjoy this wonder of the world all year round. The Reef HQ Aquarium is the largest living coral reef aquarium in the world and plays a key role in communicating the importance of the reef to Australian and International visitors.

CONTACT DETAILS Barb Kos RDAQ 2017 Conference Manager Health Workforce Queensland GPO Box 2523, Brisbane, Qld 4001 Phone: 07 3105 7800 Fax: 07 3221 3748 Email: conference@rdaq.com.au Web: conference.rdaq.com.au

RDAQ 2017

Event Management services for RDAQ 2017 provided by Health Workforce Queensland

Doctor Q Summer | 45

REPORT

RENEW YOUR AMA QUEENSLAND MEMBERSHIP On behalf of the AMA Queensland Board and Council, thank you for your membership this year. AMA Queensland values the work that you do and assists you and your colleagues through our strong leadership, meaningful advocacy and trusted support. Throughout 2016, we have secured significant wins for doctors across every career stage and specialty. To allow us to continue with this support, your 2017 subscription is due by 31 December 2016. OHO review AMA Queensland has been working diligently on behalf of members to ensure Queenslandâ€™s health system is fair and equitable for doctors and the patients they serve. We have successfully called for a review into the Office of the Health Ombudsman and continue to provide input and consultation throughout the review process. MOCA 4 negotiations We effectively represented doctors in training during the MOCA 4 negotiations, securing a 2.5 per cent annual pay rise and increased professional development allowances. In 2017, we will commence member consultation ahead of the next round of negotiations to help further improve working rights and conditions. Resilience on the Run We also expanded our Resilience on the Run program to a number of hospitals around the state. This program seeks to equip interns with practical skills to improve resilience and wellbeing and we are working with other hospitals across Queensland to further implement this initiative next year.

comprehensive survey and publication to support young doctors in choosing which hospitals to apply for. Fighting for general practice For general practitioners we stepped up the fight against the Medicare rebate freeze, launching a campaign during the federal election that ensured the issue was front of mind for Australians at the polls.

Biller code: 134585 Please refer to your individual letter for BPAY details.

Taking on private health insurers On behalf of specialists, AMA Queensland advocated for increased transparency and clarity within the private health insurance sector. Scope of practice We have led the charge against the worrying trend of task substitution for salaried medical officers within public hospitals. AMA Queensland has called for a scope of practice model that ensures doctors and non-medical health practitioners are performing the roles for which they are trained. In October we delivered a set of recommendations to the State Minister for Health calling for the reinstatement of an obstetrician-led model of care in the public maternity health services. Every membership counts and your support will help us maintain our vital representation work in the face of a shifting health landscape at state and federal levels.

Resident Hospital Health Check

It is quicker and easier than ever before to renew and there will also be one of four $500 Coles-Myer vouchers in the draw for members who renew by annual payment or switch to annual payment by 31 December 2016*. Q

Finally, 2016 saw the launch of the first Resident Hospital Health Check - a

*View the 2017 renewals prize full terms and conditions at www.amaq.com.au/page/renewals.

46 | Doctor Q Summer

BPAY

Online Jump online to www.ama.com. au/join_renew and have your login and password ready.

Phone Phone our Membership Team on (07) 3872 2222 or 1800 626 637 (outside Brisbane) and have your credit card handy.

Mail

A hard-copy 2017 membership renewal invoice has been posted to your preferred mail address. Return your renewal tax invoice with payment to PO Box 123, Red Hill QLD 4059.

NEW MEMBERS JULY Doctors in training Dr Paul Heyworth Dr Zoe Butters Dr Rahul Snelling Dr Fahima Chowdhury Dr Keith Abel Dr Carla Patist Dr Md Rana Dr Samuel Daniels General practitioners Dr Barbara Young Dr Geoff Cashion Dr Md Murhsed Khan Specialists Dr Cullen O’Gorman Dr Hasan Titiz Dr Paul Davison Dr Tim Slack Dr Kurichi Marudhachalam Dr Richard Galluzzo Salaried medical officers Dr Erich B Schulz Dr Katherine Lau Dr Gustinna Wadu Chamin De Silva

Dr Michael Petrinchuk Dr Louise White Dr Shahid Waheed General practitioners Dr Troy Cartwright Dr Andrew Jackson Dr Christopher Ting Dr Abdullah Akram

Doctors in training Dr Daniel Charles Dr Catherine Wheldon Dr Ankur Bhatnagar Dr James Cockburn Dr Joseph Stevens Dr Shemanandhini Haima

SEPTEMBER Doctors in training Dr Jiahao Wong Dr Timothy Tattersall Dr Yujin Ko Dr Robert Crowley

Dr Andrew Cheung

Dr Alexander Croese

Dr Benjamin Hamilton Dr Venu Kondamudi Dr Chris Ball Dr Haitao Mo Dr Brigitte Martins

Dr Sarah Emmett

Dr Kavindri Jayatileka Dr Michaela Waak General practitioners Dr Eoin McCarthy

Dr Bashar Abdulrazak

Dr Ajilesh Chacko

Specialists

Dr Richard Mausling

Dr Owain Evans Dr John BouSamra Dr Una Harrington Salaried medical officers Dr Pieter Koorts Dr Gabriela Strey

AUGUST

Dr Michael T Smyth

Dr Julie Fergusson

Dr Vinay Srinivasa

Dr Sarah McDonnell

Other

Dr Michael Hughes

Dr Nakul Parashar

Dr Dion Noovao

Dr Wilfrid Sheil

Dr Ian Matthews

Dr Rajesh Gupta

Part-time practitioners

Dr Alison Hadley

Dr Toni Hampe Dr Yun Phua Dr Jonathan Hui Hwong Lau Part-time practitioners Dr Soraya Felix Dr Emmeline Finn Dr Andrew Chan

Specialists

Dr Ethan Oost Salaried medical officers Dr Digby Green Dr Melanie Armitage Dr Carel Pretorius Dr Urs Wilgen Dr John Riordan Dr Dean Taylor Dr Emma LeuMarshall Dr Shelley Le Cong Dr Jacobus Ungerer Dr Indren Moodley

Dr Rajesh Harjai

Dr Dihan Aponso

Dr Frances Johnson

Part-time practitioners

Dr Handoo Rhee Dr Laura Whenmouth Dr Muhammad Kashif Nadeem Dr Bheemsain Rajpal

Dr Joanne MacLean Dr Catherine Stoyanov Dr Devini Ameratunga

THE SPECIALITY TRAINING PATHWAY GUIDE The AMA Career Advice Service has launched its latest addition – the Speciality Training Pathway Guide to help guide your decision-making about which specialty pathway to follow. With over 64 different medical specialties to choose from in Australia, making the decision to specialise in a speciality can seem daunting. Concerns about length of training, cost of training and work-life balance are important factors in making these decisions, and information on the new site will help here too. The absence of a comparative and definitive guide was raised by our doctors in training and medical students. Responding to this need from our doctors in training and medical students, the AMA Career Advice Service has developed a comprehensive guide to the specialties and sub-specialities which can be trained for in Australia. The guide will be updated annually to reflect changes made by the colleges and the 2017 update will be uploaded shortly. The web-based guide allows AMA members to compare up to five specialty training options at one time. Information on the new website includes: college responsible for the training; an overview of the specialty;

The major specialities are there as well as some of the lesser known ones – in all over 64 specialities are available for comparison and contrasting. For example, general practice, general surgery – and all the surgical sub-specialities, paediatrics, pathology – and its sub specialities, medical administration, oncology, obstetrics and gynaecology, immunology and allergic medicine, addiction medicine, neurology, dermatology and many, many more. To find out more visit www.ama. com.au/careers/pathway This new addition to the Career Advice Service enhances the services already available which include one-on-one career coaching, CV template and guide, interview skills tips and, of course, the information available on the Career Advice Hub: www.ama.com. au/careers For further information and/or assistance, feel free to call the AMA Career Advisers: Annette Lane and Christine Brill – 1300 133 665 or email: careers@ama.com.au Q Please note current information within the guide relates to 2016 requirements. Information will be updated to reflect 2017 requirements soon.

entry, application requirements and key dates for applications; cost and duration of training; number of positions nationally and the number of fellows; and gender breakdown of trainees and fellows.

Doctor Q Summer | 47

FOURTH ANNUAL JUNIOR DOCTOR CONFERENCE 2017

Future Frontiers in Medicine S A T 1 J U LY - S U N 2 J U LY 2 0 1 7 H I LT O N B R I S B A N E Discounted early-bird member rates apply. Full program and subsidised student and doctor in training (DIT) member rates will be released in January 2017. Visit the events calendar for further information www.amaq.com.au

48 | Doctor Q Summer

PEOPLE & EVENTS

YOU ASKED AND WE HAVE DELIVERED This is how your valuable feedback is enhancing JDC What’s new? Clinical skills Simulympics Building your career through volunteering overseas Wine tasting networking event

HEAR GORDIAN FULDE AT JDC St Vincent’s and Sydney Hospital Emergency Director Professor Gordian Fulde has been confirmed to speak at the 2017 Junior Doctor Conference. As the closest hospital to King’s Cross, the emergency department at St Vincent’s Hospital sees a very different side to Sydney’s infamous nightlife. The inner-city hospital treats more than its fair share of bashing victims, drug addicts and homeless. Professor Gordian Fulde has been Director of Emergency at St Vincent’s Hospital and Sydney Hospital since 1983, and is Australia’s longest serving emergency director. Occasionally seen on docu-drama Kings Cross ER, Professor Fulde is most famous for his part in King’s Cross controversial lock-out laws, following the onepunch death of Thomas Kelly in 2012. “The drinking culture here in Australia plays a big part in a variety of issues for sure. Alcohol is everywhere and is encouraged constantly. I’m not antialcohol at all, I enjoy a social drink or two but it’s the difference between partaking, celebrating or nearly killing yourself or others by misadventure. Some people simply cannot handle alcohol and it ends up in some kind of tragedy or disaster. It happens and we see it,” said Professor Fulde.

He is passionately outspoken about the scourge of ‘ice’ which he says is overwhelmingly the main cause of serious injury to staff inside Australia’s emergency departments.

CPD for DITs and attendance certificate for your resume What’s back by popular demand? Junior doctor live issues panel Preparing for college interviews with Jane Anderson JDC oral and poster research competition Gala cocktail party and student/DIT awards

INTRODUCING AN INCREDIBLE LINE UP

With more presenters to be announced. Dr John Collee Former emergency doctor and screenwriter of world famous film scripts including Happy Feet, Master and Commander and Walking with Dinosaurs.

“Many drugs are dangerous and many drug issues are great cause for concern here but the trouble with Ice is that it’s cheap and very easily accessible and it is without a doubt, the most destructive drug that I’ve ever encountered.” Professor Fulde is actively involved in teaching and training students and staff and teaches them a simple message: “treat the person in front of you, as if they were a loved one, be it the patient, the relatives or the friends”. “I love being a doctor. I think it’s an incredible privilege. I love interacting with the patients and the staff, even if people are unhappy – it is very, very rewarding,” he said. See Professor Fulde speak at next year’s Junior Doctor Conference and he may pass on his secret to surviving more than 30 years of high pressure and late night: sleep. “I can sleep anywhere, any time, for any length of time and I can wake up and be fully functional,” he said. Hopefully he will tell us how. Q

Dr Renee Lim Director of Program Development, Pam McLean Centre, actress and TV presenter (cast in All Saints, East West 101 and ABC2’s latest program Please Like Me). Professor Karen Dwyer Transplant Physician, St Vincent’s Private Hospital, Melbourne Researcher and Deputy Head of School, Deakin University, Victoria. Doctor Q Summer | 49

BUSINESS TOOLS

ROSS NOYE

Macquarie Private Wealth P: (07) 3233 5805 M: 0438 779 955 E: ross.noye@ macquarie.com

TREASURER CLARIFIES SUPER CONTRIBUTION RULES Macquarie’s Ross Noye says that with further changes to superannuation reform, now is the time to review and implement strategies before 1 July 2017. The Federal Treasurer’s announcement on 15 September regarding further superannuation reform measures re-opens the door for nonconcessional superannuation contribution (NCC) strategies to be implemented before 30 June 2017, after more than four months of uncertainty on the issue. Treasury have released for consultation a third tranche of exposure draft legislation to implement the government’s remaining superannuation reform measures. The draft bill contains the following proposals: Reduces the NCC cap from $180,000 to $100,000 effective from 1 July 2017. Those under age 65 at any time during the financial year are able to bring-forward two or three years’ future NCC cap entitlements, depending on their total superannuation balance. The proposed rules effectively allow the use of the existing NCC rules up until 30 June 2017. Transitional rules will apply where the bring forward rule was triggered, but not fully utilised, in 2015/16 or 2016/17.

Disclaimer: This information has been prepared by Macquarie Private Wealth, a division of Macquarie Equities Limited ABN 41 002 574 923 AFSL 237504. It does not take into account your objectives, financial situation or needs. Before acting on this information, you should consider whether it is appropriate to your situation.

50 | Doctor Q Summer

Introduces a requirement that individuals must have a total superannuation balance of less than $1.6 million to be eligible to make NCCs and limits payment of the government co-contribution to those whose total superannuation balance is less than $1.6 million as at 30 June of the prior financial year, provided they do not have excess NCCs. Prior to this announcement, the May 2016 Federal Budget proposal of a $500,000 lifetime cap (taking into account all NCCs made from 1 July 2007) resulted in many super fund members refraining from making NCCs, pending legislation being introduced to, and passed by, parliament.

The 15 September proposals change that position. The new NCC proposals will not be effective until 1 July 2017, so the current NCC rules remain in operation throughout 2016/17. The draft legislation also includes amendments to consolidate the range of existing processes relating to release authorities used to release amounts from superannuation relating to excess contributions. Act now – the current contribution rules remain in place until 30 June 2017 The current rules allow NCCs of up to $180,000 per year and the opportunity for those who are under age 65 at any time in the 2016/17 income year to ‘bring forward’ an additional two years of annual NCC capacity. So, up to $540,000 of NCCs may be contributed before 1 July 2017. Macquarie has identified several groups who may have special interest in the 15 September proposals including those: 1. whose 65th birthday occurs in the period from 1 July 2016 to 30 June 2017; 2. who will have more than $1.6 million in super as at 30 June 2017; or 3. who wish to transfer as much as they can into super as soon as they are able to. If you fall into any of these groups, it is important you review your current position now and, where appropriate, develop and implement strategies to maximise your super benefits before 30 June 2017.

Discover a world of investment opportunities.

Macquarie has a highly experienced team of advisers and stockbrokers who can offer tailored financial advice. Offering access to a wide range of investment opportunities, Macquarie draws on leading analysts and highly rated research* to give you access to insights and expertise that may help you achieve your financial goals. For more information or for free initial consultation, contact Ross Noye on 0438 77 99 55 or Warren Acworth onÂ 0410 51 50 99. macquarie.com *Peter Lee Associates Review 2006, 2007, 2008, 2009, 2010, 2011, 2012. This information is provided by Macquarie Equities Limited ABN 41 002 574 923 AFSL 237504 (MEL). MEL is not an authorised deposit-taking institution for the purposes of the Banking Act (Cth) 1959, and its obligations do not represent deposits or other liabilities of Macquarie Bank Limited (MBL) ABN 46 008 583 542. MBL does not guarantee or otherwise provide assurance in respect of the obligations of MEL.

Doctor Q Summer | 51

BUSINESS TOOLS

CHRIS MARIANI

Director, Medical & General Risk Solutions

COMMON RISKS IN CONTRACTS FOR MEDICAL PRACTICE OWNERS

P: 0419 017 011 E: chris@mgrs.com.au www.mgrs.com.au Authorised Representative No. 434578

Recently news.com.au ran a story titled Worst contracts in sports history, which detailed how Ricky Williams, a former NFL star, signed a contract without reading the fine print, resulting in a significant portion of the $68 million contract value being unobtainable due to almost impossible performance hurdles. This is a common occurrence in business as well, where the ‘fine print’ goes unread. Almost daily we see medical practice owners also enter into sub-optimal contracts, or even worse in some cases - no written contract at all. Some would earn the title of Worst contract in medical history. The common theme in these circumstances is the practice owner failing to seek appropriate professional advice. While risks apply in every contract, three of the largest and most frequent areas where we see ‘fine print’ issues are: 1. ‘independent practitioner agreements’; 2. lease agreements; and 3. IT service/product provider contracts. This article focuses on the first contract type, but the concept of seeking appropriate advice applies equally to all contracts you may enter into. What’s an independent practitioner agreement?

Disclaimer: 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.

52 | Doctor Q Summer

Also often called a facility agreement, room rental or sessional agreement, this type of contract generally has the following features: The doctor wishing to work from the practice is running their own medical business (usually as a sole trader structure). The doctor pays the practice a service fee to use the rooms, admin and support staff (usually a percentage of their billings or a flat sessional fee). The doctor is free to use their own clinical judgement, but is usually required to adhere to the practice policies and procedures. The above structure is commonly used and attempts to deal with issue such as GST (e.g. GST

is payable by the doctor to the practice on the service fee) and secondly attempts to reduce the risk of the relationship being deemed to be an employer/employee relationship. Often, we find practice owners have used a free template available from various sources, or have ‘borrowed’ a template from another practice, without seeking advice on whether the contract is suitable for their circumstances. This exposes the practice owner in particular to a contract which may not reflect their needs and often the inadequacy of the contract is not discovered until the contract is challenged or there is a significant issue. What are some common issues that arise from an independent practitioner agreement? There are simply too many risks to list. We have seen practice owners tens or hundreds of thousands of dollars out-of-pocket or suffer significant reputational damage when things go wrong. Real-life examples of such situations we have witnessed includes: Practice A’s contract was poorly drafted and they became the ‘deemed employer’ after the practitioner made a complaint to the Fair Work Commission. This resulted in the practice having to pay employee entitlements such as superannuation, leave and other costs.

Practice B failed to have a written agreement and rented out sessional space to a practitioner, whose conduct will likely result in a significant claim against the practice. The practitioner fled the country following the incident and appears they were not registered or insured.

Practice C, whose contract did not allow for immediate termination, even though the practitioner was removing medical records from the practice and contacting patients from home. There are many other potential risks that a poorly drafted contract exposes the practice owner to. Compounding the risk is the fact many of these are considered commercial issues and outside the bounds of available insurance cover (e.g. having to pay employee entitlements because you have become the deemed employer). It is extremely important the practice seeks advice

and puts in place a contract which protects it as much as possible. It should be noted that having a ‘perfect contract’ still exposes a practice to potential legal fees and costs to enforce the contract. As a practice owner, how do I protect myself? See the contract as your first line of defence. Seek out expert advice – this may need to include accountants, lawyers, insurance brokers and others. Give your advisers a clear brief of your circumstances and make sure they are experts in their field. From an insurance perspective, many of the risks in contracts are not insurable so make sure you understand what risks you can and cannot insure. Develop a brief as a starting point to frame the discussion, particularly for your lawyers who will draft the contract. Your accountant will also need to ensure the money flow deals with GST and taxation. Once you have a draft contract you should also provide this to your insurance adviser to see how the contract might impact on your insurances, what extra insurances you should consider and what risks are not insurable. You should ensure all of your advisers have expertise in the medical area, as these contracts require specific knowledge and expertise. If they can’t demonstrate this, find someone who can. What should I include in my brief/discussion with my advisers? Whilst your adviser will have specific areas to discuss with you, you and your adviser will find it helpful if you have thought through what you require from the contract:

ITEM Relationship

DISCUSSION/INSTRUCTION WITH YOUR ADVISERS

ITEM Dispute

What dispute process should we have such as mediation required before legal action.

Medical Records

Who owns the medical records? Who has a right of access in the event needed to defend a legal or disciplinary action?

Privacy Legislation

Does the practitioner fall under your privacy policy? Are they required to attend your privacy training and follow your processes and controls?

Accessing you IT

Make your expectations clear. Can they log in remotely into your network from a personal PC which has no virus protection? What if their negligent act causes you to suffer a loss (e.g. a hacker gains entry due to their lax controls)

Define the contract length, agreed hours or days of work, can they access premises after hours, is there a list of services they can do (i.e. can they start doing major cosmetic procedures in the chair etc).

Indemnity

What indemnity clauses should you consider to protect the practice? Use the example of your nurse contributing to an error, or where they file away test results which results in the patient recall not occurring.

Define what policies and practitioner must abide by.

the

Money flow

Draft the right termination clauses so you can terminate the contract for a range of real life risks (such as de-registration, misconduct, the practitioner taking medical records or intellectual property out of the practice, etc.) What events can trigger immediate termination and what require a notice period?

Detail how the money flows and what to be aware of from an accounting, tax, GST, employment law perspective. Who provides the Tax Invoices, reporting? What auditing process is required?

Insurances, AHPRA registration

Consider restraint clauses to protect you from the practitioner taking patients, intellectual property and employees. Reasonable restraints may be enforceable and importantly they can also act as a ‘big stick’ to deter the practitioner from stealing your patients and employees.

Make it a requirement the practitioner holds their own insurances and are required to show proof of these policies prior to commencing and on renewal. This to include medical/professional indemnity, public liability and any other insurance required by law such as workers compensation (as applicable).

Force Majeure

What happens if the practice cannot provide the services such as the building burns down (e.g. should there be a Force Majeure clause).

How do I avoid/reduce the risk of being the deemed employer if the contract is challenged. Be clear of what the relationship is between you as practice owner and the practitioner. Consider highlighting that the practitioner is running their own medical business and as such is exposed to a range of risks. They need to decide on their own insurances, risk management strategies etc. I.e. they are not covered by the practice insurances as they are not your employee.

Scope of the services, duration, use of facility, etc

Termination

Restraint

DISCUSSION/INSTRUCTION WITH YOUR ADVISERS

Define the services you wish to provide (rooms, billings, nursing support). Equally list what is excluded.

procedures

Doctor Q Summer | 53

LIFESTYLE

COFFEE Intern Dr Chris Maguire ponders whether most hospital staff drink coffee for enjoyment or merely survival. I was assisting in surgery recently, holding a retractor (as interns are wont to do), only to notice my hand start trembling. With effort I firmed my grip, minimising the incessant vibration, and searching my mind for an explanation to the sudden weakness that had possessed me. Then it struck. Like a fuel gauge suddenly blinking red, my mind registered a caffeine deficiency. In my rush to make it to the ward in time that morning, I had missed my rendezvous with the café barista. Have you ever wondered what it would be like to not drink coffee in a hospital? I mean to seriously give it up: cold turkey, patch free, nil-hypnotherapy. That is the thought that immediately came to me. What if I weren’t so dependant? Think of the benefits: extra sleep, alertness, morning concentration and performance untethered from a morning stop-over at the hospital cafeteria. Eight dollars a day, over a year, re-allocated into my personal budget. Surely it was worth considering? But was it even possible, much less advisable? There is a passive acceptance of a coffee-drinking habit in hospital; a kind of normative expectation, in fact. Beware the non-coffee drinker, say’s the realist; they can’t be trusted. You can see it in the flat white glare of the consultant who offers a charitable beverage to you, only to have it refused. Or in the long black look of a friend who offers to buy a round only to have you turn them down. You don’t feel the need to indulge? Well, perhaps medicine isn’t really for you after all. Big coffee, of course, has done its part. It is now easier and cheaper to get a hit

54 | Doctor Q Summer

than ever before. Pod machines litter the staff-rooms of Queensland Health, while the crooning figure of George Clooney on television entices you to an inner-city pod retail dispensary with the ever-present promise of greater social approval. For the internationally-minded there are even fair trade varieties. You don’t drink coffee? Well, now you’re denying growth to the third-world as well. The tradition of workplace coffee consumption is probably universally present, but there is something that can be done in medicine that can’t be done effectively in other workplaces, and that is health-based research. The fetish with identifying the life-changing, or even lifesaving, qualities in coffee consumption has been remarkably persistent over the years. Even a cursory look over PubMed reveals an astonishing variety of purported benefits to consuming coffee, stretching from reductions in various cancer risks to protective effects over metabolic syndrome. No wonder then that the health conscious profession should find its avoidance unconscionable. However, much like medicine, the benefits of coffee are not merely scientific but inextricably linked to the artistry involved in crafting it. In some parts of the world the acquisition of this talent is taught over a period of years commensurate with medical training and has attained a mythical status. In hipster culture, the talent appears to be linked to beard length, and like a latter day Samson, one can eradicate the skill by simply shaving. I have yet to see a study linking coffee consumption with productivity in the hospital setting, but I daresay we are only one research grant away from a reasonable case for salary sacrificing the beverage. I offer these observations as a cautionary tale for health administrators everywhere – ignore the coffee cart at your own peril, the most valuable staff in your hospital are baristas. Q

IS IT TIME YOU TOOK A BREAK?

BUSINESS TOOLS

SHEHAN RAJAKUMAR

BOQ Specialist

As a busy medical professional managing your own practice, arranging a holiday is probably not top of your agenda. If you need an extra incentive to take the plunge and book that trip, BOQ Specialist’s Shehan Rajakumar highlights some reasons why a holiday could boost the health of your practice. According to a recent survey* undertaken in Australia, 57 per cent of small business owners and managers have not taken a holiday for more than a year, while 23 per cent haven’t taken a holiday in the last two years.

healthy way to help you rebalance a life that is often dominated by the demanding needs of your patients and your practice. Set a good example for your team

Some of the reasons Australian small business owners gave for struggling to take time off included feeling they needed to be available at all times and thinking they were too busy to take holidays. Absence will strengthen process

There’s never a good time to go away

By planning to take time off and away from the practice, you will have to make sure that processes in the practice are up-to-date and documented. Often, this sort of additional administration can be left undone. There will also be the additional comfort that you have prepared reliable backup in place when you need it. If sickness strikes, or unexpected issues arise that call you away from the practice for a few days, you will be prepared and know there are people who can hold the fort during unplanned emergencies.

It’s important to understand that there is never a good time to leave your practice to go on holiday. This is an unavoidable truth of running a business. Book time off well in advance so that you, your staff and your patients know what’s coming. It’s also hard to see the big picture when you’re working long hours and focused on the day to day. Time off could help generate some important revelations about improvements to your practice that can be made in the future.

You are an investment too Going on holiday is a form of investment. Just as you ensure that your practice equipment is properly serviced and repaired, you need to make sure that you, as one of your practice’s greatest assets – are in peak condition. As a busy medical professional, working long hours, it’s likely that your productivity in the long-term will ebb and flow through exhaustion and stress build up. A holiday could help you return to work revitalised and refocused. Spending time with friends and family is also a

BOQ Specialist offer a range of financial products and services specifically tailored to the medical sector.

As the person responsible for your practice, your medical staff look to you to determine the ongoing culture of the business. If you toil away, day after day, you may create a toxic culture where your staff feel unable to take time off. Some of the best practices ensure that employees have a fair work life balance. Set your team the right example by taking your annual leave. Your time away can also allow both you and your practice to grow. It’s during these periods that you see how well your practice is run. If you find it can’t survive without you, it’s clear that you don’t have a strong enough contingency or succession plan, and you will need to spend time empowering others, establishing better systems, and creating accountability.

By going on holiday, it also gives an opportunity for the rest of the team to learn to make decisions without you, through a reliable chain of command.

P: 1300 131 141

Looking for an extra incentive to book those flights? BOQ Specialist has recently launched the Everyday Plus account, the first everyday bank account in Australia that rewards account holders with Velocity Frequent Flyer Points^.

Disclaimer: *Survey conducted by Xero in 2015 ^ To earn and redeem Velocity Points you must be a Velocity member. Velocity membership and Points earn and redemption are subject to the Member Terms and Conditions, available at velocityfrequentflyer.com, as amended from time to time. The Everyday Plus account is exclusively available for clients deemed by BOQ Specialist, in its sole discretion, to be engaged in the practice of medicine, dentistry and veterinary sciences. BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence no. 244616 (“BOQ Specialist”). The information contained in this article (Information) is general in nature and has been provided in good faith and has been prepared without taking account of your objectives, financial situation or needs. Whilst all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, BOQ Specialist make no representations or warranties. BOQ Specialist recommends that you obtain independent financial and tax advice before making any decisions. The opinions expressed in this publication are those of the author and do not necessarily reflect the opinions of BOQ Specialist.

Doctor Q Summer | 55

BUSINESS TOOLS

PETER ARONEY CEO, Doctors Health Fund 1800 226 126 doctorshealthfund.com.au

PRIVATE HEALTH UNDER REVIEW The Federal Government has established its Private Health Ministerial Advisory Committee and among the first items for review is a ‘gold, silver, bronze’ product classification. The committee aim is to “bring together key stakeholders in the private health sector to work in partnership on the development and implementation of possible reforms to private health insurance”. This reform agenda was heralded as part of the coalition government’s election pledges in response to considerable debate over recent issues that have emerged in the private health insurance sector. The issues include the: rise of exclusionary health insurance policies; lack of standard terminology and transparency; inability to compare policies; and increased product complexity. The committee will advise government on a series of reforms covering: product design and consumer information; regulation affecting affordability and transparency; providing better value for rural and remote consumers; alternative funding models for general treatment; and other issues as directed by the health minister. Easy comparison is just the start Product classification is intended to give consumers pre-defined standards so that health insurance policies can be easily compared. In turn, this should provide a level of confidence of what is, and is not, covered and make it easier for the consumer to see what they have bought. Importantly, we hope the reforms will include removing junk policies, which often cover things already paid for by the public system. These are worthy aims which, if achieved, will assist the medical profession in its dealings with patients. But this proposal may only go part-way to resolving the current issues that have arisen

56 | Doctor Q Summer

in health insurance. While it is important to understand what treatments are, or are not, covered in a health insurance policy, it is equally important to understand the likely benefits available under a policy when the need for hospitalisation arises. This will depend on a number of factors including whether the health fund has a contract with the treating hospital and to what extent medical fees will be reimbursed. Cost versus value for money As we have pointed out in previous articles, some health funds have lowered the value of their medical schedules by not indexing for inflation or reducing the benefits paid for selected items. This means doctors might not be willing to operate under the terms of those schedules. The hidden out-of-pocket costs associated with policies that do not have widely accepted medical schedules can leave the consumer with a significant bill, even though the service was covered under the policy terms – the ‘hidden junk’. Communicating to consumers the future value of a product (which manifests after hospital admission) during the purchase decision may prove to be the bigger challenge that ‘up-front’ classification of the policy coverage. If not handled properly, we might find a perverse outcome where consumers with a ‘gold-level’ level policy are even more affronted when they find their policy not fully covering their hospital admission. Health funds have an obligation to provide affordable products to their members. But at what cost does this affordability undermine the value of health insurance? If the product is affordable, yet provides little real value (in that the out-of-pocket costs are so large or unexpected that the policyholder is forced into the public system) then surely we have lost sight of the original purpose of our service. We would like to see greater transparency around the performance of health insurance products at the time of purchase. This would allow consumers to make a more-informed choice and avoid surprises down the track. There is a balance between affordability and providing a valuable service, and this is the real challenge ahead for the reform agenda. At Doctors’ Health Fund we believe in providing quality health insurance that provides real value to our members while supporting the medical profession at the same time.

Member of Doctors’ Health Fund: Dr Dominic Barnes

Join the health fund for medical professionals When it comes to your health fund, you know better than anyone never to settle for second best. With Doctors’ Health Fund, you choose the provider to treat you and the type and level of cover that suits you. ■

Our PRIME CHOICE hospital product is comparable to the top cover of other health funds, with very competitive premiums

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Our TOP COVER hospital product pays up to the AMA list of medical services and fees.

Combined with our Total Extras cover you’ll get: ■

Unlimited general dental check-ups covered at 100% of the cost

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$500 optical benefits over two years per family member

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Benefits of a health management program including weight management and quit smoking.

Join the health fund with better cover, better extras, better value. • Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy.

Visit doctorshealthfund.com.au or call

1800 226 126

DHF148_8/16

Doctor Q Summer | 57

BUSINESS TOOLS

TIPS FOR STARTING IN PRIVATE PRACTICE

ANGELA JEFFREY

William Buck

P: (07) 3229 5100 E: Angela.Jeffrey@ williambuck.com Angela Jeffrey is Business Advisory Director at William Buck Chartered Accountants and Advisors.

When looking to commence private practice either as a contracting doctor, specialist, buying into a practice or starting a group practice, Angela Jeffrey from William Buck has a number of tips for you.

You don’t necessarily need a company to practice

Business structure: get it right from the start

You don’t need a company to be able to employ your spouse. If the circumstances are right, you can still do this as an individual. The requirements are also that all income from the company to be paid out to the doctor by the end of the financial year. Therefore there is no tax benefit.

Your business structure impacts on the tax treatments such as income tax, capital gains tax and stamp duties; legal liability and costs of, and ability to, add new investors. It can be a very costly exercise to unwind once set up or eventually on the sale of your practice. Disclaimer: *Survey conducted by Xero in 2015 ^ To earn and redeem Velocity Points you must be a Velocity member. Velocity membership and Points earn and redemption are subject to the Member Terms and Conditions, available at velocityfrequentflyer.com, as amended from time to time. The Everyday Plus account is exclusively available for clients deemed by BOQ Specialist, in its sole discretion, to be engaged in the practice of medicine, dentistry and veterinary sciences. BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence no. 244616 (“BOQ Specialist”). The information contained in this article (Information) is general in nature and has been provided in good faith and has been prepared without taking account of your objectives, financial situation or needs. Whilst all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, BOQ Specialist make no representations or warranties. BOQ Specialist recommends that you obtain independent financial and tax advice before making any decisions. The opinions expressed in this publication are those of the author and do not necessarily reflect the opinions of BOQ Specialist.

58 | Doctor Q Summer

For a practice set up, a company is good for the 30 per cent (or less) tax rate and defining clear interests. However it may not be good for capital gains tax. A discretionary or family trust is good for capital gains tax on sale and flexible distributions. However, it is not always the best option if both individuals are high income earners.

When starting in private practice, a company can add unnecessary compliance costs and offers you no additional protection from claims in relation to medical practice issues. It does not increase your asset protection in those circumstances.

A company can also potentially lead to payroll tax for high income earners. Get your finance structuring right Structuring your finance correctly can be the difference between accelerating your tax deductions in the early stages of your business (when it is needed most) and potentially not getting a deduction at all (if business sold earlier). The most common situation is the purchase of equipment and fit-out. We generally recommend that fit-out components are financed under a lease, as you obtain the lease payments as a tax deduction, rather than just 2.5 per cent depreciation (over 40 years) and the interest deductions that you would receive under a chattel mortgage. On the other side, we recommend that equipment is purchased using a chattel mortgage, so that you have access to the immediate deduction for items under $20,000 (if the practice meets the definition of a small business). You will also be able to obtain up to a 30 per cent depreciation deduction and the interest on the loan. Spouse and family members can be active participants in the practice A medical practitioner can employ a spouse or family members in their personal services business; provided the employment is bonafide and wages are at a reasonable level. A spouse working for the medical practitioner can receive a superannuation contribution up to the maximum age based limits without attracting tax avoidance provisions.

BUYING OR SELLING A PRIVATE PRACTICE? WILLIAM BUCK HAS A NUMBER OF PRIVATE MEDICAL PRACTICES FOR SALE IF YOU WOULD LIKE MORE INFORMATION ON WHAT IS AVAILABLE IN YOUR LOCAL AREA, PLEASE GET IN CONTACT WITH PAUL COPELAND OR ASIF JOOWALAY FOR A CONFIDENTIAL & COMPLIMENTARY DISCUSSION ON ALL OUR CURRENT LISTINGS. Phone: + 61 (7) 3229 5100 Email: Paul.Copeland@williambuck.com Asif.Joowalay@williambuck.com

Doctor Q Summer | 59 www.williambuck.com

BUSINESS TOOLS

DR JULIAN WALTER

MDA National Medico-legal Adviser P: 1800 011 255 E: peaceofmind@ mdanational.com.au

Preferred Medical Indemnity Provider

PEACE OF MIND AND THE NEED FOR INSURANCE As a solicitor, doctor and medico-legal adviser, Dr Julian Walter from MDA National explains why going without medical indemnity insurance is just too big a gamble. “But do I really need it?” As a doctor, I am always astounded to hear there are other practitioners out there who don’t have medical indemnity insurance. I refer particularly to junior doctors, where the cost of the insurance (if there is one at all) is less than two movie tickets and a takeaway meal. As a solicitor, I shudder to think of the legal costs associated with defending matters that would be personally incurred by those same uninsured doctors, if a matter did arise – the gnawing fear, not able to pick up the phone for advice for fear of costs, at a moment that could be one of the most harrowing points of their professional career. As a medico-legal adviser, I am distressed by calls we receive from uninsured doctors (often at the urging of one of our members whom we have previously assisted) involved in a matter and without anywhere to turn. So let us depart on a journey to see why medical indemnity insurance really does matters. It starts with a patient, a doctor who cared, and a healthcare roulette that sometimes doesn’t spin your way. So what could go wrong? It could be the warfarin you charted, the result you missed, the examination finding you overlooked, or the patient you discharged. But let’s leave these for another time.

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.

60 | Doctor Q Summer

Our patient, septic with pneumonia and pleurisy, had a central line placed earlier today. For the third time this afternoon the nurses seek review of the patient’s recurrent chest pain, reassuringly noting “the obs are ok”. What they missed is that elusive respiratory rate, now 35, suggesting all is not well. It has been a long day. Losing your cool down the phone seems oddly cathartic. “I’m busy. I will be there when I can.” After all, pleurisy is why the patient is here.

The staff go quiet. So when the MET call comes, it is a surprise. Resuscitation doesn’t go so well, taking longer than it should to diagnose the tension pneumothorax in the face of a new arrhythmia. Possibly the amiodarone you gave contributed to the death. Before you know it, you are completing the coronial referral, the family are threatening to sue, and the nurses are busy at the other computer completing a risk notification about your delay in attending and unprofessional tone. A really long day… Mandatory indemnity insurance requirements and what this means AHPRA-registered health practitioners require professional indemnity insurance. This is a legal requirement1 and breach can result in action by AHPRA against the practitioner. At AHPRA reregistration each year, we are asked to confirm our indemnity insurance arrangements. During your preceding period of registration, have you practised in accordance with the requirements of the Board’s Professional indemnity insurance (PII) arrangements standard when practising the profession in Australia?* But what kind of insurance is required? The Medical Board of Australia Registration Standard2 importantly tells us that compulsory insurance only refers to cover for claims – “insurance against civil liability incurred by, or loss arising from, a claim that is made as a result of a negligent act, error or omission in the conduct of the practitioner”. What we doctors would term ‘being sued’. Generally, employed doctors (think hospital employees) will have this simple level of cover provided by their employer, making them ‘employer indemnified’. If sued, their employer would indemnify the doctor, paying the costs of legal representation and any damages payable to the plaintiff that might flow from the claim.

Importantly, such doctors need to ensure they are still covered by their employer when working outside of their place of employment – perhaps on a rotation to a private hospital, GP practice, or locum work. Otherwise, they might find themselves footing the bill for a claim and also being in breach of their registration indemnity requirements.

position undermined by a poor quality response provided on your behalf is heartbreaking and may be very difficult to unravel. Complaints unnecessarily escalate, which is one step closer to an adverse finding about your performance or conduct. Proper early advice and experienced assistance in preparing your response is critical, as time spent here may save you literally months or years of worry. Call your MDO, no matter how trivial the complaint may seem.

So why do I need insurance from a medical defence organisation (MDO)? Being sued might be the most expensive medico-legal matter you will face as a doctor. However, it is certainly not the only risk.

Employment matters While you may have found yourself a big warm and fuzzy employer who looks after your every need, most of us haven’t. There is nothing like an employment dispute to bring this truth home. Suddenly you find yourself at odds with colleagues and the hospital itself. Your income provider becomes judge and executioner. Where do you turn?

Coronial matters Coronial maters often have little to do with your care. But sometimes the death of the patient is related to something you did as a doctor. Medical systems are complex. The beat of fate’s butterfly wings can fan a seemingly minor task into a subsequent vortex of disaster and shame.

Procedural fairness is often lost in the process. Who should be your support person? What about being ambushed in meetings, being reviewed by those with whom you are in conflict, and not being provided with an adequate complaint to which to respond?

Doctors reasonably worry about appearing at inquests. True, employees might receive assistance under the hospital’s legal representation at an inquest, assuming the hospital is being represented at all. Yet your interests may not coincide with the hospital, particularly where your care conflicts with that of other staff. Legal costs for a typical four-day inquest reach many tens of thousands of dollars. What if you need separate legal representation?

Employment matters are very challenging and can have irreparable impacts on your future career. Seek advice early on from your MDO. We work hand-in-hand with organisations such as the AMA.

The inquest will be years down the track. You are being asked to provide a statement to the Coroner now. How confident are you that the clerk in medical records has enough experience to guide you through this process? Years down the track, lawyers will be debating the meaning of individual words in your statement, and examining issues you had no idea would arise. So details do matter. As both doctor and solicitor, I cannot emphasise enough the importance of getting this statement right.

Medico-legal advice Not every call we receive reflects a disaster. Need help with preparing a police statement? Patient wants to write their will? Concern about who makes the decision for a patient without capacity? Uncomfortable with the after-hours decision to discharge a patient home against medical advice? Can you date that patient you met in the Emergency Department 12 months ago? Rest assured that no matter how challenging the query, we have likely had to assist someone on this before.

We assist in the preparation of statements, seeking to identify and address issues that will arise years down the track. Where needed, we also arrange your legal representation at inquests.

What you have at your fingertips is your team of medico-legal experts whose aim is to provide you with the best possible advice, so you can achieve the best outcomes in medico-legal matters, no matter when your time of need arises. We are relentless. We love what we do. We hope you will too.

AHPRA health complaint investigations/ disciplinary matters Each year, approximately one in 25 doctors will receive a complaint made to an AHPRArelated complaint body (e.g. Queensland Office of the Health Ombudsman).3 Some hospitals don’t assist or have much expertise with health complaints. If you are fortunate enough to be provided with legal assistance, having your own ghost writer is reassuring, as we assist in the shadows. My experience is that if hospitals provide generic responses on behalf of all staff involved in a complaint, necessary detail required to address concerns about your care is often overlooked. Seeing a doctor’s

Health Practitioner Regulation National Law s129 as in force in each State/Territory.

Medical Board of Australia. Registration Standard: Professional Indemnity Insurance Arrangements. 2016. Available at: medicalboard.gov.au/documents/default.

Australian Health Practitioner Regulation Agency. Annual Report 2014/15. 4541 notifications from 103133 registered medical practitioners. Available at: ahpra.gov. au/annualreport/2015/downloads.html

Doctor Q Summer | 61

BUSINESS TOOLS

LYNETTE REYNOLDS

SERVICE AGREEMENTS

TressCox Lawyers Partner

P: (07) 3004 3555 E: Lynette_Reynolds@ tresscox.com.au

Lynette Reynolds from TressCox Lawyers provides a rundown on service agreements: what are they and why do you need one?

Why do I need a service agreement?

Service agreement is the generic term used to describe the arrangement between a consulting doctor and the practice at which the doctor consults. There are a variety of different models which are used from fixed sessional room rates through to a percentage of billings.

2. A GST agency appointment is needed for the doctor in private practice model. 3. A well drafted agreement will provide certainty about the following issues (amongst other things):

The most common arrangement is for the consulting doctor to pay a fee to the practice of between 30 and 40 per cent in return for receiving certain administrative services such as reception, billing, access to the premises, supply of equipment and consumables.

a. who owns patient records;

There a two main ways that these agreements are usually structured:

e. what happens if one party is in breach, losses their right to practice or becomes insolvent;

1. The practice engages the doctor on the basis that the doctor provides services to patients of the practice for a fee paid to the doctor by the practice. Under this arrangement the practice pays the doctor a fee plus GST (e.g. 65 per cent of billings plus GST) and the practice retains the balance funds received from patient billings. 2. The second model is what is called the doctor in private practice model. Under this arrangement the doctor pays the practice a fee plus GST (e.g. 35 per cent of the doctor’s billings). The practice deducts the service fee from monies it collects from patients on the doctor’s behalf and pays the doctor the balance. The easiest way to identify which method is being adopted by the practice is to follow the GST. If the service company collects GST then the second model applies. If the service company pays GST then the first model applies. There is a distinct preference for adopting the second model for the following reasons: 1. There is less likelihood of the doctor being deemed an employee. 2. There is less likelihood of the doctor being caught by the extended definition of contractor under the Superannuation Guarantee contribution laws.

62 | Doctor Q Summer

1. The Australian Tax Office will request a copy of your service arrangements if it ever conducts an audit of either the doctor’s or the practice’s tax affairs.

b. is the doctor subject to a restraint; c. which party receives the SIP payments, PIP payments and practice grants; d. what period of notice is required by either party to end the arrangement;

f. what happens if a doctor is ill for an extended period; g. what happens if the practice is sold; h. practice specific issues. If you do not have a written service agreement, or the agreement is old and possibly out of date, we recommend obtaining advice from your accountant and lawyer to update and put in place a current service agreement.

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 industryâ€™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

Selling your practice including helping to get ready for sale, workout and earn-out arrangements

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

Bill Hickey, Partner

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

Robin Lonergan, Partner

Brisbane P. (07) 3004 9530 M. 0422 785 006 Robin_Lonergan@tresscox.com.au

www.tresscox.com.au

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 @TressCoxHealth

Doctor Q Summer | 63

LIFESTYLE

MET OPERA: DON GIOVANNI 3 December 1pm, 4 December 1pm and 8 December 10am Simon Keenlyside makes his Met role debut as the unrepentant seducer in Tony Award winner Michael Grandage’s staging of Mozart’s masterpiece. Met Principal Conductor Fabio Luisi leads a cast that includes Hibla Gerzmava as Donna Anna, Malin Bystrom as Donna Elvira, Serena Malfi as Zerlina, Adam Plachetka as Leporello, Matthew Rose as Masetto, Kwangchul Youn as the Commendatore, and Rolando Villazon in his Live in HD debut as Don Ottavio.

UPCOMING MOVIES* 1 December

1 January

Up for Love

Passengers

Trolls

12 January

8 December

Jackie

Office Christmas Party

Loving

15 December

19 January

26 December

Split

A United Kingdom Red Dog: True Blue Allied Sing

28 January 1pm, 29 January 1pm, 2 February 10am One of the most highly praised operas of recent years, which had its premiere at the Salzburg Festival in 2000, Kaija Saariacho’s yearning medieval romance L’Amour de Loin (Love From Afar), has its Met premiere this season. The production is by Robert Lepage, co-produced with L’Opera de Quebec, where it premiered to acclaim last summer, in collaboration with Ex Machina. Debuting Finnish conductor Susanna Malkki leads the performance, which stars Susanna Phillips as Clemence, Eric Owens as Jaufre and Tamara Mumford as the Pilgrim who carries messages of love between them.

MET OPERA: NABUCCO 18 February 1pm, 19 February 1pm, 23 February 10am Cymbeline is a ruler of a divided Britain. When Innogen, the only living heir, marries her sweetheart in secret, an enraged Cymbeline banishes him. But a powerful figure behind the throne is plotting to seize power and murder them both. Innogen embarks on a dangerous journey that will reunite Cymbeline with a lost heir and reconcile the young lovers. Melly Still directs Shakespeare’s rarely performed romance.

MET ART: I, CLAUD MONET 25 February 1pm, 26 February 1pm, 1 March 10am

Collateral Beauty

Rouge One: A Star Wars Story

La La Land

MET OPERA: L’AMOUR DE LOIN

Using letters and other private writings I, Claude Monet reveals new insight into the man who not only painted the picture that gave birth to impressionism but who was perhaps the most influential and successful painter of the 19th and early 20th centuries. Despite this, and perhaps because of it, Monet’s life is a gripping tale about a man who, behind his sun dazzled canvases, suffered from feelings of depression, loneliness, even suicide. Then, as his art developed and his love of gardening led to the glories led to the glories of his garden at Giverny, his letters reveal his humour, insight and love of life. Shot on location in Paris, London, Normandy and Venice I, Claude Monet is a cinematic immersion into some of the most loved and iconic scenes in Western Art.

Lion

26 January Manchester by the Sea A Monster Calls Live by Night *Please note upcoming films are subject to change

WIN MOVIE TICKETS FOR TWO! Name:

Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au

64 | Doctor Q Summer

Telephone:

Member no:

Fill out the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au. Entries close 10 JANUARY

If you believe just one person can change the world, imagine what we can achieve together. As a doctor, helping people is the very core of who you are. It isn’t a job – it’s a calling. Giving back and paying it forward is simply what you do all day, every day. Imagine then, what we can achieve if we all pay it forward for one united cause. Established by AMA Queensland doctors, the Foundation is our charity. We identify gaps and challenges in the health system and direct help to where it’s most needed. To do this, we call on the collective talents, resources and compassion of our 6,000 members across Queensland – doctors from every speciality and all career stages. Together, we reach those patients we can’t reach individually. This Christmas, you can help make the difference you set out to achieve when you first dreamt of studying medicine. Meaningful difference that completely changes the lives of our community’s most vulnerable and disadvantaged. Every donation allows us to relieve sickness and suffering among Queenslanders in genuine need. The part you play is priceless. Thank you for giving generously. Q

Donate online at www.amaqfoundation.com.au

PERSONAL DETAILS Name:

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Address: Phone (H):

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SUPPORT $100

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ACKNOWLEDGEMENT Donations are recognised in AMA Queensland Foundation publications. Please acknowledge my contribution in the name of:

r e t t e b We're r ot gethe

(30 characters max. i.e. The White Family, Mr T & Mrs S White, Sue & John White)

I would prefer my donation to remain anonymous.

OTHER Please tick I/we would like more information about leaving a bequest to the AMA Queensland Foundation.

PLEASE RETURN TO: AMA Queensland Foundation PO Box 123, Red Hill Q 4059

Ph: (07) 3872 2222 www.amaqfoundation.com.au ABN: 31 093 701 083

THANK YOU FOR YOUR SUPPORT! QFN-TAX-2016/DrQ

Doctor Q Summer | 65

LIFESTYLE

HOW GOOD IS GRANGE?

PHIL

Wine

Direc NSER t P: 1800 6 4 E: 9 46 phil.m 3 anse r@w ined irec

t.com

.au

At The Grange Challenge, run by Phil Manser of Wine Direct, a few eyebrows were raised as guests took a blind sample of six unnamed red wines to see if they could pick out the Grange amongst them. The night began with a stunning Grand Cru Blanc be Blancs Champagnes from Le Mesnil, a relative youngster in the context of champagne established in 1937. This was very well received and showcased the richness and intensity of flavour this village is famous for, no wonder really when you consider that a good deal of their fruit is bound for Krug and Salon with a little held back for their own label. A fitting prelude to the ensuing full frontal assault of young Australian shiraz.

swirled and tasted their way through the lineup. All that was required of them was to rank these wines from 1 (favourite) to 6 (least preferred). A fair fight by anyone’s standards as all the dressing was removed and only the wine could speak.

Unlike most tastings of this ilk the wines were served blind, six wines in six decanters numbered one through to six, each wine double decanted two hours before the event, one of which was Grange but which one? That was the question put to guests who eagerly embraced the concept and armed with their tasting glasses sipped,

This is the vinous equivalent of a blind folded BMW drive day where those attending are being asked which late model BMW did they least prefer such was the caliber of these wines but the results were interesting all the same.

2010

TIM ADAMS ABERFELDY SHIRAZ

FAVOUR

2010

PARACOMBE SOMMERVILLE ADELAIDE HILLS SHIRAZ

3 VOTES

6 VOTES

2 VOTES

66 | Doctor Q Summer

1ST

750

$ WHICH ONE DO YOU THINK IS THE GRANGE?

It’s fair to say that this is a tough class and while these statistics might be far from

In closing the night was a huge success, at least half the room got to cross Grange off their bucket list and some outstanding flagship reds were enjoyed by all. There is no doubt the mention of Grange is what oversubscribed this event and rightly so, Grange has set an impressive benchmark for decades but what is highlighted very loudly by this exercise is that there is some outstanding value at this level if you’re prepared to ignore the hype.

TED VO

RUNNER

PENFOLDS GRANGE

2. Which one do you think is Grange?

2009

1. What was your favourite wine?

TED VO

After an hour passed and everyone had revisited the contestants two simple questions were put to them…

exhaustive in terms of its findings, the point of the exercise was to get people to assess wine on its merits and that was certainly the case here. The Red Queen was a standout on the night but each wine had attracted their own following as was evidenced by the empty bottles, Tim Adams Aberfeldy in particular was guarded jealously to the last drop.

2013

KALLESKE JOHAN GEORG BAROSSA SHIRAZ

2012

DANDELION RED QUEEN EDEN VALLEY SHIRAZ

2012

ALPHA CRUCIS EMANUELLE BEKKERS MCLAREN VALE SHIRAZ

105

3 VOTES

11 VOTES

0 VOTES

GORILLAS IN THE MIST Ros Bulat from AMA Travel Queensland shares her experience of meeting an incredibly human-like family of mountain gorillas in Rwanda. Little prepared me for my experience in Rwanda. While I can admit that my knowledge of the atrocities that occurred there just over 20 years ago were limited before my visit, I was astonished to find a country that has such a collective focus on moving forward. I immediately noticed how clean the country was, not at all what I expected. My guide tells me that by law all Rwandans must clean on the last Saturday of every month. As we drive towards the imposing chain of volcanoes that borders Rwanda, Uganda and the Democratic Republic of Congo, the low clouds set a mystical scene. I’m excited knowing that tomorrow I will be hiking there in search of the elusive mountain gorilla. The mountain gorilla is critically endangered, with an estimated 880 left. No mountain gorillas are in known captivity, the gorillas we see in the zoos are lowland gorillas. The only place you can find them is in national parks in Rwanda, Uganda and Democratic Republic of Congo. While the gorillas are free to roam and can cross easily over unfenced borders, they do tend to regionalise themselves. My focus was the Volcanoes National Park, Rwanda. At my lodge the night before my hike, I was talking to those who had trekked that day, many of whom had two or three days planned. At US$750 per day for the National Park fee, I was hoping that my one-day experience paid off.

For more information call or email Ros at AMA Travel Queen sland.

P: 1300 262 885 F: (07) 5556 7200 E: travel@amaq.com .au www.amaq.worldtrav el.com.au

On the morning of my trek, all of the tourists huddled in a group with each guide picking people to join their group. Feeling rather rejected by being left until almost last, I was unaware that my guide had already made a special request for me to join

the group trekking the Hirwa family, that included the twins (three years old). The word Hirwa means ‘The Lucky one’ aptly named to celebrate the twins. While they do not guarantee a sighting, the fact that they have trackers certainly means you are not wondering aimlessly. After only a 90-minute trek, we had news that the family had been spotted. We had to leave all of our belongings and move forward only with our camera. We luckily came across them in the open. Watching these majestic creatures makes you realise how close on the genetic tree we actually are. For about 15 minutes we watched 10 of the 18 in the family interact. Dad was over the back picking fleas out of one of the twins, while the other twin was tormenting the smaller brother until eventually mum intercepted and gave the three-year-old a clip behind the ear. They had indicated that there was a newborn but he was not to be seen. The mother had sent one of the other females into hiding with the baby to keep him away from us. Again, sounding rather human like! Seemingly without discussion, the family all got up and decided to move on. We had all been told the rules, “stay at least seven metres away, unless they come in closer and if they become aggressive drop and be submissive”. The large silverback stopped within 50cm from one of our group and grunted at him to indicate he needed to move out of the way. At the same time one of the twins used a bamboo branch like a bungie cord and bounced upside down in the middle of our group. An extraordinary experience! There are several ways to get to Kigali, Rwanda with Qantas/Emirates via Dubai being one of them. While the mountain gorillas are certainly Rwanda’s golden ticket, it is not all Rwanda has to offer. Four days is a perfect duration.

Doctor Q Summer | 67

LIFESTYLE

ALL ABOUT YOU CHICKEN, PEAR AND BLUEBERRY SALAD 200g baby cos lettuce, torn

grilled and sliced

100g snowpeas, trimmed and finely sliced

1 cup reduced-fat Australian Greek-style yogurt

2 sticks celery, thinly sliced

1 tablespoon finely chopped fresh chives

1 pear, cored, quartered and thinly sliced lengthways 125g fresh blueberries or seedless grapes 2 small skinless chicken fillets,

2 teaspoons whole grain mustard freshly squeezed juice of half an orange

Arrange lettuce, snowpeas, celery, pear slices and blueberries on a large serving platter, scatter over the chicken. Combine yogurt, chives, mustard and juice then drizzle over the salad before serving. BBQ chicken is also suitable for this recipe. Simply discard the skin and break into bite-sized pieces. You will need 2 cups of chicken. Recipe from www.foodsthatdogood.com.au, developed by Dairy Australia. Visit the website to see a range of resources on diet and health for you and your patients.

ALL THE LIGHT WE CANNOT SEE

WHO DO YOU THINK YOU ARE?

Anthony Doerr

If you’ve missed this series, then chances are you’re not looking for your seventeenth cousin on your maternal side either. Each episode profiles the family tree of a celebrity, with several seasons of the Australian series currently on SBS On Demand. Some stand out episodes are those of Paul Mercurio, Toni Collette and Michael Caton. The series makes you wish you had your own team of genealogists working behind the scenes to find out your family’s fascinating stories.

A beautiful, stunningly ambitious novel about a blind French girl (Marie-Laure) and a German boy (Werner) whose paths collide in occupied France as both try to survive the devastation of World War II. Their stories illuminate the ways, against all odds, people try to be good to one another.

FUTSAL Summer is a time to move that soccer indoors and change the rules a little. With five a side, no offside rule and much less friction, futsal is a more concentrated version of soccer that will have you breaking a sweat in no time. Futsal is a small team sport so plenty to get you out and talking to someone other than your patients. Find a local indoor sports centre and get your fancy footwork underway this summer. 68 | Doctor Q Summer

AMA QUEENSLAND FOUNDATION

We're bertter CHRISTMAS APPEAL togethe

This Christmas, you can help change the lives of our community’s most vulnerable and disadvantaged. Every donation allows us to relieve sickness and suffering among Queenslanders in genuine need. For more information on our Christmas Appeal or to make a donation, see page 65.

INTERN FLASHBACKS Our Ocker doctor, Dr Matt Young reflects on his intern days and provides some off-the-cuff advice for new interns.

As the year draws to a close, exams are done and dusted, thoughts drift towards the year ahead and a whole swag of nervous new doctors are contemplating what lies ahead of them as they embark on their intern year. A GP mate of mine recently found himself up at the Princess Alexandra Hospital visiting a relative. He’d not been back there since he walked out the front door for the final time as an intern several years before. He reckoned he felt an instantaneous visceral reaction. His pulse sped up, his bowels tightened a tad, his neck muscles tensed up and he became aware of his breathing. Every corner he turned brought back a flood of memories. Some good, some bad and plenty of ugly ones. He saw one young bloke with a stethoscope, a name badge and a ringing phone. He knew the look, the exasperated look. That face that reflects that a young bloke’s level of knowledge, coping and ability are being swamped by a variety of medical tasks that he has no idea how to handle. I had been there, so had my mate and this poor young doctor was certainly there on this occasion. That awkward place, so far out of his depth it didn’t matter. My mate smiled a knowing smile and headed off in his far more relaxing role as a visiting relative.

numbers appeared on the pager or phone brought about an instant sinking feeling of desolation and despair. The ubiquitous aggressive registrar who always wanted one more investigation result when you were presenting your cases in the emergency ward. The times when the consultant had just shook his head and said ”no son, that’s not right” and the times we’d fluked getting a fancy diagnosis right and all the times we missed the obvious ones. We remembered all those drips we had to put in in the middle of the night on ward call, in patients whose invisible veins made them the bane of our lives. All those meaningless squiggles on ECGs, all those ridiculous shadows on chest X-rays and those fractures that were so obviously seen by any ortho reg but remained steeped in mystery to us. Ward call was the worst. Geez I hated nightshift ward call. Royal Brisbane, like Princess Alexandra, was a huge place. It was an endurance event running from one ward to the next. I remember one night when my pager had stayed silent for about an hour. It was heaven. “How easy is this?” I thought. I had just scored an hour’s pay for doing nothing. I sat down. Relaxed. Thought about cricket. I even made myself a cuppa. Revelled in life until I realised the pager’s battery was flat and when I rang switch I had

about 20 wards agitating for my attention. I should have remembered the final scene from All Quiet on the Western Front. When everything goes quiet, there is a bullet with your name on it whizzing towards you. The intern gig was a tough gig, especially considering I was only 23 years old. But I suppose other people have it tough at 23 too. I suppose a bit of pressure can be the making of a young person and especially a young doctor, as long as they have the right sorts of supports around them. A few final thoughts that I have collected from a variety of reputable sources might be useful for prospective interns. If a patient asks you how long you’ve been a doctor, try not to look at your watch. If the surgical registrar to whom you are presenting your appendicitis case is causing you grief and asks for the serum magnesium level before he’ll come and see the patient, have the courage to hang up and call his boss. Remember that the most expensegenerating instrument in any hospital is not the CT machine, the MRI machine or that robot that the urologists are using. It is the intern’s pen. And finally, remember that the toilet is a great place to hide when carnage and catastrophes are unfolding in the emergency department. Q

We both had a laugh in the tea room the next day, safe in our tea room, safe in our general practice and safe in our seniority and experience. Neither of us had any desire to return to our intern days but we were happy to reminisce for a while about our own internships. Our favourite bosses and our favourite nurses. The wards that always seemed very welcoming and helpful and the ones that when their phone Doctor Q Summer | 69

LIFESTYLE

IN PRINT

LISTENING, LEARNING, CARING AND COUNSELLING General Practitioner, Therapist, Researcher, Lecturer and Author Dr Cate Howell OAM has released a new book titled Listening, Learning, Caring and Counselling: The Essential Manual for Psychologists, Psychiatrists, Counsellors and other healthcare professionals on caring for their clients. The book is an authoritative, comprehensive guide full of ideas and technique designed to fill that role. The main emphasis of this highly accessible reference work is on how health and related professionals can assist clients as they work through the issues they commonly present with - such as anxiety, depression, relationship issues, trauma and grief. Case studies,

skills and tips for everyday practice make it a practical and user-friendly resource. Visit www.exislepublishing.com. au to purchase ($39.99). Q

WIN THIS BOOK

Thanks to Exisle Publishing, Doctor Q has a copy of Listening, Learning, Caring and Counselling to give away. Fill out the form to the left and fax it to (07) 3856 4727 or email competitions@amaq.com.au. ENTRIES CLOSE 10 JANUARY 2017

Name:

Member no:

DENDY WINNERS David Clark

Rhonda Boyle

Chris Ho

Allan Tham

Marjorie Busby

Caron Forde

John O’Sullivan

James Macdonald

BOOK WINNER Dr Jia-Woei Shyong won a copy of Murtagh’s Practice Tips, seventh edition, thanks to McGraw-Hill Education.

Frederick Leditschke Anthothy Kelly

88 L’Estrange Terrace, Kelvin Grove QLD 4059 PO Box 123 Red Hill QLD 4059 P: (07) 3872 2222 E: amaq@amaq.com.au W: amaq.com.au

Join our online communities Don’t forget to enter in this Doctor Q edition to win. 70 | Doctor Q Summer

Looking to expand your services or establish yourself in a new area? Having recently completed redevelopment, East Street Specialist Centre is now leasing fully fitted suites containing two to four spacious consultations room, with 10-foot ceilings and windows, for Specialists, Allied Health and other Medical Practitioners. Consultation rooms are also available on a sessional basis. Opposite Ipswich General Hospital, close to St Andrew’s Private Hospital and handy to public transport, this beautiful Heritage Listed building is the perfect location to start or expand your practice. eaststspecialistcentre.com.au For more information or to arrange a viewing please contact: Dr Sudeer Mahadeo 0400 116 982 | drsmahadeo@gmail.com Andrea Edwards 3812 0648 | eaststreetreception@outlook.com

New Mermaid Beach Office Suites

For Lease – Mermaid Beach new 2 level commercial development available in approximately 12 months. Central location and prominent corner position close to all amenities On and off site secure parking

Lift and individual shower and toilet facilities Suitable for medical practices and professional offices

Suites from 150 to 250 sqm For more information, please contact owner on 0412 094 256 or marino.1@icloud.com

ARE YOU LOOKING AT BUYING OR SELLING A

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Unique Medical Rooms “On the Terrace” in Brisbane CBD are now available

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Doctor Q Summer | 71

Buckle up… earn Velocity Points on your everyday banking We have some good news. Our Everyday Plus account will be the ﬁrst everyday bank account to reward you with 1 Velocity Frequent Flyer Point^ for every $10 of daily average balance in your account, calculated at the end of each month. There are no establishment or account keeping fees and you can redeem your points for ﬂights, merchandise, holidays and more. You will also have online and mobile banking, a 24/7 Client Service Centre and up to 10 free ATM withdrawals* from any major bank each month.

Apply now and get ready for take-off. Visit boqspecialist.com.au/everydayplus or call 1300 131 141

The issuer of these products and services is BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL no. 244616 (“BOQ Specialist”). Exclusively available for clients deemed by BOQ Specialist, in its sole discretion, to be engaged in the practice of medicine, dentistry and veterinary sciences. Terms and conditions, fees and charges and eligibility criteria apply. BOQ Specialist is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. You should obtain and consider the relevant terms and conditions from boqspecialist.com.au/everydayplus before making any decision about whether to acquire the product. We reserve the right to cease offering these products at any time without notice. *10 free ATM transactions per month per account at BOQ, Commonwealth, Westpac, St George, NAB and ANZ branded ATMs. ^ To earn and redeem Velocity Points you must be a Velocity member. Velocity membership and Points earn and redemption are subject to the Member Terms and Conditions, available at velocityfrequentflyer.com, as amended from time to time.

72 | Doctor Q Summer

BOQSA00602 V2 06/16