Issuu

SUMMER 2018

Resident Hospital Health Check - how does your hospital stack up? Australiaâ€™s national emergency - drought AMA Queensland challenges recommendations into pharmacy prescribing

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1 A business must be a Qantas Business Rewards Member and an individual must be a Qantas Frequent Flyer Member to earn Qantas Points with MIGA. Qantas Points are offered under the MIGA Terms and Conditions www.miga.com.au/qantas-tc. Qantas Business Rewards Members and Qantas Frequent Flyer Members will earn 1 Qantas Point for every eligible $1 spent (GST exclusive) on payments to MIGA for Eligible Products. Eligible Products are Insurance for Doctors: Medical Indemnity Insurance Policy, Eligible Midwives in Private Practice: Professional Indemnity Insurance Policy, Healthcare Companies: Professional Indemnity Insurance Policy. Eligible spend with MIGA is calculated on the total of the base premium and membership fee (where applicable) and after any government rebate, subsidies and risk management discount, excluding charges such as GST, Stamp Duty and ROCS. Qantas Points will be credited to the relevant Qantas account after receipt of payment for an Eligible Product and in any event within 30 days of payment by You. Any claims in relation to Qantas Points under this offer must be made directly to MIGA by calling National Free Call 1800 777 156 or emailing clientservices@miga.com.au. 2 Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd. MIGA has not taken into account your personal objectives or situation. Before you make any decisions about our policies, please read our Product Disclosure Statement and consider your own needs. Call MIGA for a copy or visit our website. 3 75,000 bonus Qantas Points offer only available to registered Australian medical practitioners who first insure with MIGA as a new client in a fully insured category, as a doctor in private practice, for cover commencing in the period on or after 21 December 2018 and on or before 31 January 2019, and who pay in full by 31 January 2019 or enter into a direct debit arrangement with MIGA by 31 January 2019 and have their first instalment successfully deducted. MIGA Terms and Conditions for bonus Qantas Points for Fully Insured are available at www.miga.com.au/qantas-bonus-tc-pp. You must be a Qantas Frequent Flyer member or a Qantas Business Rewards member to earn bonus Points. ÂŠMIGA October 2018

CONTENTS

REPORTS

Editor’s desk

Resident Hospital Health Check

President’s report

CEO’s report

Australia’s national emergency: the drought

Letter to the Editor

CDT update

AMA Queensland challenges recommendations into pharmacy prescribing

Research round up

Renew your membership

Foundation news

DINNER FOR THE PROFESSION

BUSINESS TOOLS

F E AT U R E S

CURRENT ISSUES

NEW: Osler Technology

Pregnancy termination

NEW: Cornerstone Medical Recruitment

Mandatory reporting must go further

Payroll tax alert

Bookkeeping essentials for your practice

Checking up on casual employment

The lovelorn patient

AMA losing confidence in MBS Review Taskforce

SMSF lending makes sense for medical professionals

MOCA 5 and Mater Enterprise Agreement update

Influencing physician health through prosocial behaviour

The balancing act of opioid prescribing

WOMEN IN MEDICINE BREAKFAST

PEOPLE & EVENTS

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

LIFESTYLE

Annual Conference wrap up

Restaurant review: Heritij

Dinner for the Profession wrap up

All About You

Women in Medicine Breakfast wrap up

Dendy Cinemas

River cruises

Private Practive and MedicoLegal Conference wrap up

Ocker doctor: Tribalism

Wine tasting evening

Intern workshop

Postcard from John Hopkins, USA

InPrint: Smart time management for doctors

2019 date claimers

Junior Doctor Conference meet the speakers

Patient referral spotlight: Cerebral Palsy Alliance

Doctor Q Summer

BOARD OF DIRECTORS

Editor’s Desk In this edition, we’ve got the results of our annual Resident Hospital Health Check (p26), we cover the health effects of the prolonged drought in Queensland (p32) and challenge recommendations into the pharmacy prescribing report (p38). I hope you get to spend some time with loved your ones over the summer - stay safe. Michelle

CHRISTMAS CLOSURE The AMA Queensland office will close at 3pm on Thursday 20 December and will reopen on Wednesday 2 January. We wish all our members a safe and happy festive season.

OBITUARIES The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Dr Ian ATKINSON Psychiatrist Late of Annandale Member for 21 years

Dr John Mario MCCARTHY General Practitioner Late of Cleveland 53 years of Membership

Dr Terence FARRELL Urologist Late of Tarragindi Member for 42 years

Dr Hugh Andrew Douglas MCCULLAGH General Practitioner Late of Cleveland Member for 15 years

Dr Allan George PERINA Surgeon Late of Tinana Life Member of 68 years Dr Samuel Roscoe STEVENS General Practitioner Late of Murgon 69 years of membership

Dr Daniel Craig GAFFNEY Dermatologist Late of Coorparoo Member for 4 years Dr Clement Frederick NOMMENSEN Surgeon Late of Buderim Member for 63 years

Dr Sarah Coll Member Appointed Director

Dr Mellissa Naidoo Member Appointed Director

Dr Bav Manoharan Member Appointed Director

Dr Peter Isdale AM Skilled Director

Dr Hashim Abdeen Gold Coast Area Representative

Dr Jim Finn Greater Brisbane Area Representive

Dr John de Laat Greater Brisbane Area Representive

Dr Fatima Ashrafi Specialist Craft Group

Dr (Deborah) Erica Gannon Part-time Medical Practitioner

Dr Chris Maguire Doctors in Training Craft Group

Dr Michael Cleary Vice President Dr Shaun Rudd Chair of Board and Council

Our cover photo for this edition is from Hamersley Gorge, Spa Pool, Karijini National Park, North West, Western Australia. Want to go there? Call Orbit Travel on 1300 262 885.

Ben Hancock Skilled Director

COUNCIL

Dr Sanjeev Bandi Capricornia Area Representative Dr Kimberley Bondeson Greater Brisbane Area Representive Dr Bill Boyd Immediate Past President Dr Paul Bryan General Practitioner Craft Group Dr Michael Clements North Area Representive Dr Sarah Coll Specialist Craft Group Haydn Dodds Medical Student Craft Group

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

Clare Mahon Medical Student Observer Dr Bav Manoharan Greater Brisbane Area Representive Dr John F. Murray Specialist Craft Group Dr Rachael O’Rourke Greater Brisbane Area Representive Dr Siva Senthuran Full-time Salaried Medical Practitioner Craft Group Dr David Shepherd Far North Area Representive Dr Nicholas Yim General Practitioner Craft Group

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

Filomena Ferlan General Manager Corporate Services

Holly Bretherton General Manager - Member Relations and Communications

Doctor Q is published by AMA Queensland

Graphic Designer: Aleisha Coffey

Phone:

Journalist: Chiara Lèsevre

COVER IMAGE

4 Doctor Q Summer

Dr Dilip Dhupelia President

Advertising: Louise Glynn

(07) 3872 2222

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

amaq@amaq.com.au

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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.

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President’s report DR DILIP DHUPELIA

Where has the year gone! It’s already time for me to pen a few happenings for the summer edition of Doctor Q, as we approach the festive season. As I mentioned at the start of my presidency, one of my priorities was to visit the Local Medical Associations (LMAs) around the state and investigate where LMAs previously existed but were currently inactive. Over the past few months, I visited Toowoomba, Central Queensland, Brisbane Northside, Redcliffe and Fraser Coast LMAs. Thank you for your wonderful hospitality during these meetings. By the time you read this, I will also have completed visits to Sunshine Coast and Cairns LMAs. These meetings are providing me with a great opportunity of updating members and non-members on AMA Queensland’s current advocacy work in important areas, such as mandatory reporting legislation, parliamentary inquiries, enterprise agreements, code of conduct and public health initiatives. Reciprocally, I am hearing face-to-face from our members the concerns and issues affecting them locally.

LMA MEETING UST TOOWOOMBA 22 AUG

In October, the Queensland Parliament’s Health Committee handed down their 11 recommendations regarding the establishment of a Pharmacy Council in Queensland. AMA Queensland not only put in a strong submission based on Council’s advice, but I also appeared in person at the public hearing of the pharmacy inquiry and voiced our strong concerns regarding the extended scope of practice for pharmacists, which the Pharmacy Guild and the Pharmaceutical Society of Australia are seeking. As President, these recommendations concern me greatly as they are not only a direct threat to marginal general practices still recovering from the MBS freeze, particularly in regional and rural areas, but also a major public safety issue by further fragmentation of holistic primary care provided by our GP members. The CEO and I met with the Health Minister and reiterated our dismay. 6 Doctor Q Summer

LMA MEETING B R I S B A N E N O RT H 9 O CTO B E R

AMA Queensland Council and Federal Council of General Practice have both undertaken to advocate and strongly oppose any recommendation which threatens the viability of general practice. AMA is pushing for a collaborative model with pharmacists working within general practice, residential aged care facilities and aboriginal medical services. It’s collaboration that we want, not fragmentation! The termination of pregnancy legislation has been passed you can read about it on page 24. We have told the Health Minister that AMA Queensland wants a significant communication and education strategy during implementation of the legislation, as to provide women and doctors with certainty around the clauses of the legislation. The debate regarding euthanasia and voluntary assisted dying will soon occur in Queensland. Victoria has recently

LMA MEETING H E R V E Y B AY 3 1 O C T O B E R

legislated for this, commencing 1 July 2019. Other states are also considering this issue. I have sought the views of our members and Council. Council has now directed the AMA Queensland Ethics Committee to consider our position. I will keep you abreast of updates on this important issue. I wish to remind all members that your 2019 membership is due for renewal. We are a membership organisation and your membership renewal is vital to the association. In early November, you would have received your 2019 renewal notice. Take advantage of our monthly direct debit payment and don’t forget about our Member-get-a-Member campaign offering a 25 per cent discount for each new member you introduce. See p48 for details on how to renew. Finally, I wish you all the compliments of the festive season and I hope you and your loved ones have a safe and enjoyable holiday season and some well-deserved rest and relaxation.

CEO’s report JANE SCHMITT

COMBINED COLLEGES WORKSHOP In our ongoing efforts to support, promote and advocate for the medical profession in Queensland, AMA Queensland recently convened a roundtable of the combined colleges. Present at the meeting were the Royal Colleges of General Practitioners, Physicians, Surgeons, Ophthalmologists, Psychiatrists, the College of Emergency Medicine and the College of Rural and Remote Medicine. It was very positive and productive roundtable. The group discussed a number of issues, including growing examples of areas where scope of practice for non-medical health professionals are being expanded, the proposed pharmacy council and pharmacy prescribing. We also discussed the new laws surrounding mandatory reporting and all agreed that: the wording of the bill was ambiguous and, as a result, doctors would avoid seeking treatment; doctors deserved the same level of access to care for their own health as they provided for their patients; practitioners were also patients and should have equal right to access confidential high-quality medical treatment as their own patients and all other Australians; and improved practitioner health led to improved patient protection. AMA Queensland and the colleges agreed to progress a joint statement on the new legislation, expressing disappointment at the lack of genuine, positive reform these laws represent and urging the State Government to make improvements to the bill. 8 Doctor Q Summer

H E A LT H I E R QUEENSLANDERS TASKFORCE AMA Queensland has united with Queensland’s leading health groups, including the Heart Foundation, Cancer Council, Stroke Foundation, Diabetes Queensland and the Brisbane North PHN, with the aim of harnessing the collective advocacy and knowledge to forge a healthier Queensland. The taskforce will work together on innovative, effective, practical solutions to help Queenslanders of all ages become more active and enjoy healthy lives. In October, I chaired the first Healthier Queenslanders Taskforce meeting and together we identified a number of practical objectives, rated based on high value and ease of delivery. The key priorities were: Developing a central website and smartphone app for seniors to find local exercise classes and healthrelated services. Promoting incidental activity programs in schools (i.e. standing for a few minutes during each class). Encouraging councils to provide consistency of equipment facilities in local parks across the state. The taskforce will meet regularly over the coming months and, once a final action plan has been developed, it will be presented to state and local governments for consideration.

DIGITISING PUBLIC HOSPITALS The Queensland Audit Office has finalised its report into how

Queensland Health is delivering its digital hospitals program. The audit will be tabled in Parliament at the end of the month and it is confidential until then. We have had a brief review of the report and we will provide the government with our comments in due course. I take the opportunity to remind you that you can send your feedback on the ieMR to our AMA Queensland e-health working group at iemr@amaq.com.au.

E R A D I C AT I N G H E PAT I T I S C The dream of eradicating Hepatitis C from Australia is almost a reality thanks to two of our GP members. Drs Matt Young and Joss O’Loan volunteer their time and resources to take hepatitis C treatment directly to disenfranchised and chronically marginalised people. The AMA Queensland Foundation recently pledged $7,000 to their Hep C Kombi Clinic project, enabling treatment for 100 new hepatitis C patients. We are now calling on you to support their efforts as part of our Foundation’s Christmas Appeal. See page 54 for details on how to donate.

SEASONS GREETINGS Finally, I would like to wish you all a well-deserved 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 2019.

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Letter to the editor Dr Sandra Hirowatari, Chair of the AMA Council of Rural Doctors wrote (9.10.18) on conscientious objection in the rural setting. It is a thoughtful, intelligent article that I would recommend all doctors to read. Termination of pregnancy and euthanasia are issues confronting the profession currently and with them the issue of conscientious objection. There appears to be circulated by some the misconception that those who express a conscientious objection to these matters do so as part of fringe religious fervour. There are doctors whose religious beliefs are a priority in these matters but also there are many doctors whose concerns are imbedded in their personal moral beliefs and their understanding of their role as doctors within the doctor patient relationship. Most doctors are primarily concerned for their patient’s wellbeing. That is after all the reason we practice medicine. Respectful consideration of both the individual doctor and the patient in both the public and private sector is vital. I have been a firm believer in the importance within the AMA of an understanding of views across the membership, if the Association is to represent its membership and maintain its membership numbers. With the recent Termination of Pregnancy legislation that was passed in Queensland and Victoria and the euthanasia legislation on the near horizon, there are many questions that require consideration. Many of those who choose Obstetrics as their career choice would no doubt see their role as the support of mothers, and possibly fathers on their journey to parenthood with hopefully the safe delivery of a new baby. Termination of a normal pregnancy may provide them with a significant dilemma which may or may not be associated with religious beliefs but rather personal principles. For the trainee in obstetrics and gynaecology the pressure to act contrary to their beliefs and principles may be enormous. These young doctors need a strong supportive professional association. 10 Doctor Q Summer

Consider also the impact the legislation will have on services within the public sector both in urban and rural Australia? The passage of legislation is one thing but its practical implementation produces many more issues. What public operating theatre time will be required? Which obstetricians or trainee obstetricians, anaesthetists and nursing staff will provide this service? The Queensland legislation with regard to a practitioner who has a conscientious objection states: If the request is by a woman for the registered health practitioner to perform a termination on the woman, or to advise the woman about the performance of a termination on the woman, the practitioner must refer the woman, or transfer her care, to— (a) another registered health practitioner who, in the first practitioner’s belief, can provide the requested service and does not have a conscientious objection to the performance of the termination; or (b) a health service provider at which, in the practitioner’s belief, the requested service can be provided by another registered health practitioner who does not have a conscientious objection to the performance of the termination. The AMA Position Statement on Conscientious Objection states: 1. Doctors (medical practitioners) are entitled to have their own personal beliefs and values, as are all members of society. There may be times, however, where a doctor’s personal beliefs conflict with their peer-based professional practice. In exceptional circumstances, and as a last resort, a doctor may refuse to provide, or participate in, certain medical treatments or procedures that conflict with his or her own personal beliefs.1 If a couple present at twenty-one weeks gestation with a normal foetus and request termination (it is a female foetus) the legislation states that I must refer the woman or transfer her care to a provider who would be prepared to undertake termination.

Sadly, the representatives of AMA Queensland who presented to the parliamentary committee prior to the passage of the legislation, when specifically asked about it, supported the view as stated in the legislation (refer or transfer care to a provider or service that will provide termination). This position is not consistent with the AMA Position Statement on conscientious objection as quoted above. Of course, the patient must be advised that one has a conscientious objection if that is the case, and doctors in this situation must do so in a manner that is cognisant of their patient’s emotional and physical well-being. However, as a doctor, to refer or transfer care of a patient requires one to take an adequate history. This could be misconstrued as impeding the patient’s access to care. Indirect referral as discussed in Dr Hirowatari’s article would not appear to be adequate under the Queensland legislative requirements. There is no doubt that euthanasia and physician assisted suicide is next on the horizon. Some of my elderly patients at times express a wish that they would rather no longer be living. On another occasion they will be hopeful and enjoying their life. Many years ago, I heard a woman from the Netherlands being interviewed positively about the death of her father through euthanasia. The decision for euthanasia seemed to be hers rather than her father’s. These matters are not simple and the AMA in the past has taken a careful approach respective of the diversity of opinion on these issues within its membership. The Association must listen to the diversity of views of its members and ensures that those who have a conscientious objection are protected and not dismissed as fringe religious fanatics. Dr Zelle Hodge

[1] For the purposes of this position statement, ‘participation’ may include indirect actions such as referring the patient to another doctor who will provide the service.

AMA QUEENSLAND COUNCIL OF DOCTORS IN TRAINING PRESENTS

Thursday 4 April 2019

PRACTICAL SKILLS FOR JUNIOR DOCTORS REGISTRATION TIME: 6pm TIME: 6.30pm - 9.30pm SEMINAR/WEBINAR TIME: 7pm - 8.30pm

NETWORKING:

CANAPES AND DRINKS: Upon arrival and from 8.30pm - 9.30pm

VENUE:

Royal Brisbane and Women’s Hospital Conference and Education Centre, Herston and via live webinar

COST:

FREE for AMA Queensland members; $150 for non-members

VIA LIVE WEBINAR FOR RURAL AND REGIONAL MEMBERS

From intern year right throughout your Doctor in Training years and beyond, you are required to teach, mentor and model best clinical and behavioural practice for those who follow in your path. So what makes for a great junior doctor teacher, mentor and role model? What are the techniques that are not necessarily taught in medical school? This practical panel (comprising junior and senior doctors) will discuss their strategies and techniques, and how their own positive and negative experiences along the way have influenced their style as teachers, trainers and mentors.

PANE L:

Dr Dilip Dhupelia, President, AMA Queensland; Director of Clinical and Medical Services, Queensland Country Practice, Queensland Health; and GP, SmartClinics; Dr Sally Aubrey, Registrar, Townsville Hospital; Dr Melanie Rule, Emergency Physician, The Prince Charles Hospital; (tbc) Dr Kate Kearney, Registrar, St Vincent’s Hospital (tbc) Dr Thomas Brennan, Anatomical Pathology Registrar, Royal Brisbane and Women’s Hospital

MC:

A/Prof Louise Cullen, Senior Staff Specialist, Department of Emergency Medicine, Royal Brisbane and Women’s Hospital

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As an AMA Queensland member, you will receive a two night luxury stay at a Spicers Retreat property of your choice upon purchase of your new Lexus 3 . With stunning destinations in South-East Queensland and NSW, each Spicers destination offers an exclusive, private escape from the world. Now is the time to experience another benefit of owning a Lexus. The hardest part will be choosing where to go. To discuss the Lexus Corporate Programme and all the benefits offered to you as an AMA Queensland member, please contact our dedicated Lexus of Brisbane Group representative Gavin Schiermeier today. Gavin Schiermeier | Group General Manager | gavin.schiermeier@lexusofbrisbane.com.au

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AMA QUEENSLAND’S ANNUAL CONFERENCE

The AMA Queensland Annual Conference provided a perfect setting for delegates to learn and enjoy each other’s company in the magnificent city of New Orleans. The event kicked off with a pleasant cocktail reception hosted by AMA Queensland President Dr Dilip Dhupelia. The conference was formally opened by the Australian Ambassador to the United States Joe Hockey, who also presented an overview of the broad Australian/USA relationship. With the theme The future of health care, delegates were educated and entertained by a line-up of speakers of world renown. Dr Dhupelia gave a comprehensive overview of the theme to set the scene for the week. He was followed by a talented line-up of guest speakers from UQ Ochsner Medical School, New Orleans. Professor Richard Milani spoke on Re-engineering hospital care to improve patient outcomes, Dr Todd Burstain presented on the Future of Electronic Medical Records and Dr Korak Sarkar spoke on Advances in 3D Printing and how this technology is reshaping complex surgery. Associate Professor Rajiv Gala and Dr Jody Morris from Ochsner provided a double act speaking on Connected health,

an emerging model of maternity care. Other speakers from Ochsner were Associate Professor George Chimento on Robotics in medicine, Associate Professor Leo Seoane (Head of School) on Training the physicians of the future, Dr Dana Smetherman on Consumerism in medicine and the final Ochsner speaker was Dr Gabriel Uwaifo on Obesity – A global problem.

“I enjoyed the conference and the company of the attendees very much” Jon Gordon (New York Presbyterian Hospital) spoke on Artificial intelligence in health care and an Past AMA Queensland Council of Doctors in Training Chair Dr Michael Bonning, currently based in New York, gave two presentations on Opportunities for the intersection of technology and medicine, and Health and General Practice as a good investment.

We also had a wonderful introduction to the history, customs and culture of the American South, and New Orleans by Frank Perez. Australian speakers Dr Anthea Woodcock spoke on the Future of forensic medicine, Dr Debora Garcia Alonso presented on the Future of cardiology, Colleen Sullivan spoke on Patient experience versus patient engagement and Associate Professor Noel Hayman spoke on the Future of health care in Indigenous settings. On the final day, Dr Dhupelia presented on Medical education and training in pursuit of rural medical workforce excellence. The final Australian speaker was Anna Mackintosh, Airline Pilot and Training Facilitator, Virgin Australian Airlines, whose topic was From the cockpit to the operating theatre – how to empower your staff. Dr Dilip Dhupelia then teamed up with American Medical Association Board Member Dr Bill McDade to discuss Medical profession advocacy issues and activities.

“I truly enjoyed the conference and learned a lot” OUR SPONSORS Our wonderful sponsors received a special vote of thanks at the dinner, with Allison Scifleet of Lexus of Brisbane in attendance. We were also most fortunate to have the support of HWL Ebsworth Lawyers and Macquarie Wealth Management.

14 Doctor Q Summer

AMA QUEENSLAND ANNUAL CONFERENCE SUN 22 - SAT 28 SEPTEMBER 2019

Doctors, practice managers, registered nurses and other medical industry professionals from around Australia are invited to attend the Annual AMA Queensland Conference in Edinburgh, Scotland from 22-28 September 2019. The program will feature high-profile British, Scottish and Australian speakers on a range of medical leadership and clinical topics in an exciting, and unique location. RACGP points will be on offer.

To find out more about the conference program or to register, please contact: Neil Mackintosh, Conference Organiser P: (07) 3872 2222 or E: n.mackintosh@amaq.com.au

Download a conference brochure from the events calendar at www.amaq.com.au

This year’s Dinner for the Profession took place in October, rather than its usual June, and doctors from all specialties and stages came together for an elegant evening. Dr Dilip Dhupelia was officially sworn in as 2018-19 AMA Queensland President and the Indian Medical Association was in attendance to congratulate Dr Dhupelia also. Emergency Physician and Clinical Researcher Professor Louise Cullen was awarded a Citation of the Branch, while Australian Association of Practice Managers Fellow Carmel Brown and Philanthropist Betty Byrne-Henderson were given Awards of Distinction. The silent and live auctions added more excitement to the evening, with a grand swag of items available. More than $7,000 was raised for the Hep C Kombi Clinic, which will allow Drs Matt Young and Joss O’Loan and their team to treat 100 more patients. Dr Matt Young gave an interesting speech on how the clinic came about and why it’s needed.

2 16 Doctor Q Summer

8 1. Hep C Kombi Clinic founders Drs Matt Young (left) and Joss O’Loan (right) with AMA Queensland Foundation coordinators Amanda Sanderson, Jennifer Burgess and Lisa O’Donnell 2. Colleen Sullivan, Carmel Brown, Paul Brown, Dr Peter Kent, Donna Kent, Drs Dilip Dhupelia, Bob Brown, Graham McNally and Cheryl McNally 3. Associate Professor Louise Cullen and Toni RÖssl 4. AMA President Dr Tony Bartone, AMA Queensland President Dr Dilip Dhupelia and AMA Vice President Dr Chris Zappala 5. Dr Paul Bryan and Cheryl Bryan 6. MDA National’s Jo Webb with raffle winner John Perry 7. AMA Queensland Council of Doctors in Training representatives: Drs Alex Cox, Melanie Sheath, Samantha Carmichael, Katherine Gridley, Chris Maguire and Hashim Abdeen 8. Drs Arun Dhaiya and Rachna Dhaiya

‘‘The Women in Medicine Breakfast us a beautif ul opportunity for women in medicine to meet, share and celebrate their amazing contributions to medicine whilst enjoying some valuable contributions from the guest panel members ’’

Women in Medicine

18 Doctor Q Summer

More than 280 women attended AMA Queensland’s Women in Medicine Breakfast to hear from our impressive panellists about how to seize every moment both personally and professionally and how to find and harness your passion in medicine.

AMA Queensland extends great appreciation to our speakers: Drs Fiona Lander, Linny Phuong and Melissa Kang, MC Sophie Scott and sponsors QML Pathology, MDA National, BOQ Specialist, HWL Ebsworth, Doctors’ Health Fund, William Buck and Lexus of Brisbane. Save the date - Thursday 22 August - for the 2019 Women in Medicine Breakfast.

On Associate Professor Melissa Kang, GP and former Dolly Doctor: “Very wise, mature, good advice for the young ones, humble and has great presence.”

On Dr Fiona Lander, doctor and human rights lawyer: “She was exceptional and provided some pertinent points about very difficult situations... would love to hear more from her.”

On Dr Linny Phuong, 2017 AMA Junior Doctor of the Year: “Inspirational young woman... she would have been particularly of interest to the younger doctors coming through.”

On MC Sophie Scott, ABC Health Reporter: “Asked great questions relevant to today’s needs... drew out some vital issues and conversations that very much need exploration in medicine.”

“ best breakfast I THINK THIS WAS THE

“I look forward to this event each year. I feel it is very important to celebrate and support women in medicine.” “It is truly inspirational to see women in medicine who ‘walk their talk’, and can speak from their lived experience and wisdom, as opposed to a ‘motivational’ pump-up.”

WE HAVE HAD

1. Drs Danica Eather, Catherine Duffy and Nicola Acworth. 2. Megan Crawford and Dr Susan O’Dwyer. 3. Drs Sarah Bell-Allen, Joanne Martin and Barbara Hall. 4. AMA Queensland CEO Jane Schmitt (centre) with panellist Dr Linny Phuong, MC Sophie Scott and panellists Dr Fiona Lander and Associate Professor Melissa Kang.

Doctor Q Summer 19

Private Practice and Medico-Legal Conference

5 20 Doctor Q Summer

Members looking to start or grow their private practice joined us in September for the Private Practice and Medico-Legal Conference. Developed in collaboration with our AMA Queensland Council of General Practice, Ethics and Medico-Legal Committee and corporate partners, the conference offered assured professional advice in three dedicated streams, catering to general practitioners, specialists and practice managers.

1. Panellists Drs Matt Young, Graham Hay-Smith, Judith Reddrop, Lily Vrtik and AMA Queensland Councillor Dr Michael Clements 2. AMA Queensland CEO Jane Schmitt chairs the panel on Thinking outside the square â€“ unlocking the secrets of practice longevity and success 3. Dr Marosh Vrtik and Brendan Louie 4. Colleen Sullivan OAM 5. Kylie Rickard asks a question of the panel 6. Meryl Willis, Carol Vona and Trudy Fitzgerald 7. Dr Steve Hambleton talks about the healthcare home 8. Mellita Limberg, Kylie Andrews and Suzanne Torge 9. Drs Michael Woodbridge and Brenda Graham

Doctor Q Summer 21

Internship 101 WORKSHOP SERIES 2018

More than 300 final-year students turned out for AMA Queensland’s 2018 Intern Readiness evenings in Brisbane and on the Gold Coast, to learn the tips and tricks of the trade not taught in medical school. Topics included surviving night duty, the Junior Medical Officer Recruitment process, senior medical officers’ expectations, combatting bullying and harassment and overtime. AMA Queensland would like to thank our sponsors Avant, BOQ Specialist, Brisbane BMW, Doctors Health Fund, James Cook University, MIPS, MDA National, QSuper and William Buck for supporting these informative free events. James Cook University final year students - don’t miss our Intern Readiness workshop in Townsville on Tuesday 18 December. Visit the Events Calendar on the AMA Queensland website for more details.

William Scalia, Casey Hawkins, Sallyanne Elder, Imogen Bellamy and Claire Barnes

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Jivanaah Dayalan and Nikhila Konduri Clinton Kerr, Isabel Scalia, Sam Bryant and Anthea Bach 22 Doctor Q Summer

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Pregnancy termination NO LONGER A CRIME IN QUEENSLAND In October, state MPs voted to remove pregnancy termination from the criminal code. The Termination of Pregnancy Legislation allows medical practitioners to provide compassionate and safe care to women, introduces safe access zones of 150 metres around clinics to shield women from harassment, allows for terminations after 22 weeks following consultation with two medical practitioners and provides for practitioners with conscientious objections to refer women to another medical practitioner or health service. Most importantly, pregnancy termination has been decriminalised in Queensland and medical practitioners can practice with legal certainty. For the past eighteen months, AMA Queensland provided advice to the Queensland Law Reform Commission and the Parliamentary Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee on the Termination of Pregnancy Bill. Previously, Queensland’s laws regarding pregnancy termination hindered medical practitioners in their duty to provide the best patient care. Medical practitioners performing pregnancy terminations in Queensland did so in a legal grey area that put both themselves and their patients at risk of breaking the law.

AMA Queensland’s position was also consistent with Federal AMA’s position on termination of pregnancy, as well as policy statements of other peak national and international medical bodies such as the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the International Federation of Obstetrics and Gynaecology and the World Health Organisation. Whilst AMA Queensland supported the overall aims of this bill, our advocacy work focused on two major areas. One area of concern described the requirements for termination after 22 weeks. These terminations are rare and constitute less than one per cent of all terminations in Queensland. As stated in the AMA Queensland submission on the bill, AMA Queensland asserted that the bill require a second medical practitioner to have consulted with and examined the patient prior to making a determination. This could take place by means of a telemedicine consultation if required.

For this reason, AMA Queensland supported reforming Queensland’s laws, so that women could receive safe and compassionate care and doctors could practice with legal certainty.

We also asserted that the legislation should not be considered in isolation and that the Queensland Clinical Guidelines: Therapeutic Termination of Pregnancy comprehensively address the clinical, psychosocial and medico-legal issues that are raised in relation to pregnancy termination. AMA Queensland recommended their continued use once updates reflected the legislative change.

AMA Queensland came to this position after extensive consideration with the member-elected AMA Queensland Council. The Council comprises 28 medical practitioners who have a broad range of skills and experience.

The second area of the bill AMA Queensland advocated for related to conscientious objection. AMA Queensland believed that this bill should have strong conscientious objection provisions.

24 Doctor Q Summer

The final legislation provided this certainty for doctors and is consistent with national and international ethical guidelines, including the AMA position statement on conscientious objection. Specifically the universal principle of ‘not impeding access to care’ was upheld. Recognising the differing opinions and understanding around referral processes as it relates to contentious objections, AMA Queensland is currently actively participating in reviewing the existing Federal AMA position on conscientious objections to provide more clarity to practitioners about their rights and obligations. Finally, although not included explicitly in the bill, AMA Queensland also vehemently opposed any consideration of gender-based terminations of pregnancy, except in the very rare cases of serious sexlinked genetic disease or illness as described by the National Health and Medical Research Council (NHMRC) Ethical guidelines on the use of assisted reproductive technology in clinical practice and research. This position is consistent with other international health bodies such as the World Health Organisation and the British Medical Association. Any practitioner who performed gender-based pregnancy terminations outside of these guidelines would likely be subject to disciplinary action from the Office of the Health Ombudsman and the Medical Board of Australia. The Termination of Pregnancy Act 2018 will come into effect on 3 December 2018. For more information, visit https://clinicalexcellence.qld.gov.au/ priority-areas/service-improvement/ terminationpregnancy

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2018 Resident Hospital Health Check

In 2018, AMA Queensland surveyed Resident Medical Officers (including those at Intern, Junior House Officer and Senior House Officer levels) to evaluate the state of their employment in Queensland, and compare hospitals across the state. Overall, 615 junior doctors, representing approximately 27 per cent of the total number of Resident Medical Officers working in Queensland, completed the survey. This is the third consecutive year the survey has been conducted. The questions were similar to the 2016 and 2017 surveys, so that results could be compared across the three years. Where insufficient data was obtained from a single hospital to make a fair assessment of that hospital, the data was merged based on geography and which Hospital and Health Service (HHS) that hospital belonged to. This yearâ€™s survey achieved a 30 per cent increase in participants compared with the 2017 survey.

THE

TOP 6

2. Annual leave process 16.8%

PRIORITIES AREAS FOR QUEENSLAND JUNIOR DOCTORS

34.1% 30.3%

9.7%

atisfi

not s

9.2%

sfied isfied ly sat e t a r mode

y sati

tl sligh

3. Being appropriately paid for unrostered overtime 1.

Clinical rotation preferences

55.9%

were quite to extremely satisfied

10.1%

13.4%

76.5%

NOT GET PAID

PAID

ALL

DID for claimed overtime

G0T SOME

of the claimed overtime

G0T PAID

the overtime they claimed

Further, only 26.3% of respondents claimed all the overtime they worked. Among those who did not claim:

28.2% 30.9% 42.6% 20.3% 31.7%

26 Doctor Q Summer

e isfied satisfi mely extre

sat quite

were advised not to claim by an Administration Officer or Senior Medical Officer feared it would negatively affect their assessment thought it wasnâ€™t worth claiming thought not claiming would reflect well on them thought their supervisors would think better of them for not claiming

4. Personal safety at work 45.9% 27.4%

If you require advice on any matters relating to your employment, please contact the Workplace Relations Team on (07) 3872 2222 or email workplacerelations@ amaq.com.au. Free confidential advice for members is just a phone call away.

were concerned that fatigue caused by long hours may cause clinical error

felt their safety had been compromised at work

Not a member of AMA Queensland? You can join at ama.com.au/join-ama to receive support and guidance on employment matters in addition to a range of professional development programs, services and benefits to support your journey in medicine.

The purpose of this document is to assist graduating medical students as well as current interns and residents with their decision making process when deciding on which hospitals to apply for in the upcoming intern and RMO campaigns.

32.1%

quite satisfied

25.8%

moderately satisfied

Residency education programs

14.9%

slightly satisfied

7.1%

not satisfied

41.9%

81-90 hours

Before relying on the information contained in the survey results provided, users should carefully evaluate its accuracy, currency, completeness and relevance for their purposes, personal objectives and career goals, and should make their own enquiries, including consulting with the relevant Hospital and staff at the relevant Hospital. Whilst every effort has been made to ensure the accuracy of the collation of the information in this survey, AMA Queensland, its employees and the AMA Queensland Council of Doctors in Training cannot be held responsible for the information provided by participants in the survey and cannot be responsible for any loss or damage arising from any person or organisation as a result of the publication of this survey of information. AMA Queensland and the AMA Queensland Council of Doctors in Training do not take any responsibility for the outcomes published in the survey.

Thus, all differences among hospital/HHS should be interpreted as specific only to the survey respondents and must not be interpreted as representative of the experiences of all junior doctors in QLD.

9.7%

3.9%

This information is provided in good faith and should only be used as a guide, it is intended to be general in nature and is made available on the understanding that the AMA Queensland and the AMA Queensland Council of Doctors in Training do not make any comment or assertion that the information provided by participants is correct, or reflects the experiences of doctors who did not participate in the survey.

Comparison of results among hospitals/HSS must be made with caution, as the survey did not involve a probabilistic sampling frame, but instead was open to the entire QLD RMO population, achieving a response rate of 27%. Further, as RMOs were not randomly allocated to hospitals differences in attitudes and expectations of respondents cannot be adequately controlled. This introduces biases into the results which cannot be accounted for.

6. Working a 76 hour fortnight

77-80 hours

The AMA Queensland Industrial Relations Team also provides confidential, assured advice to Doctor in Training members on employment terms and conditions, and any aspect of your employment that is causing you concern. You can contact the Team on (07) 3872 2222 to discuss.

The AMA Queensland Resident Hospital Health Check survey was completed on a voluntary basis by Queensland doctors in training (including those at Intern, Junior House Officer and Senior House Officer level.)

extremely satisfied

76 hours

If you would like to discuss any aspect of the AMA Queensland CDT Resident Hospital Health Check survey in greater detail, please email workplacerelations@amaq.com.au and a member of the Team will get back to you.

DISCLAIMER

20.2%

39.9%

FURTHER INFORMATION

91-100 hours

4.7% 100+ hours

Lastly, the overall raw percentage of responses for each question in 2018 were compared with the same question in 2017, with improvement, no change or worsening indicated by green, yellow and red traffic lights respectively. All analyses and reporting of results, including the derivation of the grade, were undertaken by an Epidemiologist (PhD) with considerable experience in research design and statistical analysis and a strong track-record in health/medical research.

Find out how your hospital scored: www.ama.com.au/qld/advocacy/resident-hospital-health-check Login with your member details to view the full results. Doctor Q Summer 27

AMA QUEENSLAND

Council of Doctors in Training update MOCA 5 We have been negotiating a new certified agreement (MOCA 5), running an industrial campaign to change the culture around the claiming and the payment of overtime, and building upon the successful establishment of the Resident Hospital Health Check to inform junior doctors’ employment decision making. With the in-principle agreement by the negotiating parties to the new MOCA 5, assuming it is voted in by doctors across the state, junior doctors can expect to see a significant increase in the professional development allowance and the vocational training subside, a 2.5 per cent pay increase and greater flexibility around retention of employment benefits. They will also receive three extra days of the PDL, and two extra days of exam leave among a number of other workplace improvements. These steps will bring Queensland further into line with other states, and improve the quality of life for hundreds of trainees and residents across the State. The ASMOFQ industrial team, and the CDT were instrumental in setting up these succusses, and I am deeply grateful to all of those who contributed to the planning and conduct of those negotiations.

that possible. Of particular note were keynote presentations by Brigadier Michael Bond (pictured below right) (Previous Commander of UN forces in South Sudan), Dr Dan Diamond (Coordinator of relief efforts for Hurricane Katrina in the US), and Dr Alessandro Demaio (pictured below left) (Global leader in the NCDFREE initiative) – a truly world class program. Save the date for the 2019 Junior Doctor Conference: 13-14 June at the Hilton Hotel.

FEDERAL CDT At a federal level I would also like to give a special thanks to Drs Hash Abdeen (Deputy CDT Chair) and Marco Giuseppin (Rural and Remote Portfolio Lead) for their able representation of the AMA Queensland at the Federal Council of Doctors in Training meeting. The federal council have worked tirelessly this year to set up a number of nationwide initiatives to improve the lives of junior doctors and Queensland remains active in that process.

DR CHRIS MAGUIRE

Senior House Officer, Queensland Children’s Hospital; and Chair, AMA Queensland Council of Doctors in Training

SURVIVING RURAL RELIEVING

Drs Honor Magon and Maddi Taylor worked hard on our end-of-year member’s seminar on thriving in rural and remote placements along with a rural and remote resource handbook.

R E S I D E NT H O S P ITA L H E A LT H C H E C K With the release of our 2018 Resident Hospital Health Check results, it is also clear that much work remains to be done in addressing the challenges that face our junior medical workforce in the hospitals. CDT looks forward to continuing our efforts to do this, and if you are interested in joining us, we welcome your input. I also encourage you to place your renewal to lend your support, helping us to do even more for you in 2019.

JUNIOR DOCTOR CONFERENCE With the successful conclusion of the 2018 Junior Doctors Conference (JDC), the JDC planning team have now actively begun putting together the program for next year with some great innovations already being coordinated. The conference this year was universally praised for its quality and value, and I would like to thank Holly Bretherton and her team for the hard work that went into making 28 Doctor Q Summer

Contact CDT on (07) 3872 2222 or email cdt@amaq.com.au

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Therapeutic Guidelines Limited Therapeutic Guidelines Limited (TGL) is an independent not-for-profit organisation. Its aim is to promote the quality use of medicines, and it does this through the writing, publication and sale of Therapeutic Guidelines. The Therapeutic Guidelines range of digital and print products is widely considered to be an unsurpassed source of best practice therapeutic information. Therapeutic Guidelines are written principally for prescribers (general practitioners and trainee physicians in particular) to provide clear, practical, succinct and up-to-date therapeutic information for the management of patients with specific conditions.

eTG complete is Therapeutic Guidelines’ core product and is designed for use on desktop computers and mobile devices. eTG complete has the latest version of all topics published by TGL in a range of convenient formats, including online, offline and download. Licence options are available to meet the needs of single users, clinics or larger organisations. eTG complete app The eTG complete app is also available. The app provides all of the eTG complete content for use on mobile devices and tablets. Ideal for those who practise in a variety of locations, or those in the rural and remote health sector. For more information, go to www.tg.org.au Doctor Q Summer 29

Mandatory reporting must go further The AMA is urging the Queensland Parliament to take advantage of the opportunity to make improvements to the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018. Under Council of Australian Governments (COAG) processes, the bill in the Queensland Parliament dictates the mandatory reporting laws for all states and territories, except Western Australia, where mandatory reporting laws are more sophisticated and robustly protective than this bill. The Queensland Parliament has the opportunity to save lives, and give doctors access to the same level of health care their patients enjoy. All Australians deserve this right and access. We want the national law to more closely reflect the protections provided to doctors by the WA legislation. We need the law to provide confidence and peace of mind to doctors and medical students that they can seek mental health care without fear of reprisal or threat to their medical careers. We do not want to see any more doctors or students taking their own lives because they were afraid to seek care. The only evidence that there has been proper consultation with the profession is in the Explanatory Notes for the bill, not in the actual bill. The final bill is the same as before the consultation. This must change. The bill should reflect the issues the AMA has raised. The bill should also reflect the points that are acknowledged in the Explanatory Notes.”

The latest AMA submission to COAG highlights the AMA’s specific concerns and recommended necessary amendments.

DR TONY BARTONE AMA President

Medical defence organisations (MDOs), other medical groups, and other health professions hold similar views. The onus is now on the Queensland Parliament to prevail where COAG has dithered. The other COAG Health Ministers must also push for changes. They must match their strident stated public concern for doctors’ health with some legislative action rather than hide behind the secrecy of a COAG meeting. The AMA has appeared at consultations, written submissions, and talked to governments over many years to highlight how a proper policy could be delivered and operated without problems. We have a law in Western Australia that works well to protect patients and save doctors. Ministers knew what had to be done, but the bill does not achieve their stated aim of helping our doctors. They rejected the WA model. They should now at least accept changes that will improve the current bill. The Queensland Parliament must listen and act to deliver the best possible bill. It will save lives. The AMA COAG submission is at https://ama.com.au/ submission/ama-mandatory-reporting-submission-2018

BACKGROUND Meta-analysis of a beyondblue literature review showed that male doctors had a 26 per cent higher risk of suicide, while female doctors had a 146 per cent higher risk of suicide, compared to the general population.

The same study showed that doctors report much higher rates of psychological distress and much higher rates of suicidal thinking than the general population or other population groups.

The Western Australian Parliament accepted the medical profession’s arguments, and the Western Australian National Law contains an explicit exemption from mandatory reporting for treating doctors.

An extensive study of more than 12,000 doctors by Beyondblue in 2013 revealed that 34.3 per cent cited concerns about their medical registration as a barrier to seeking treatment for a mental health condition.

The same study revealed that approximately two per cent of doctors reported that they had attempted suicide.

Australian Health Practitioner Regulation Agency (AHPRA) annual report figures show that mandatory notifications have risen in Western Australia since the exemption came into effect – from 12 in 2011-12 to 35 in 2016-17.

30 Doctor Q Summer

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Attn: MBAQ, Po Box 123, Red Hill QLD 4059 You can also donate via phone by calling AMA Queensland on (07) 3872 2222

Doctor Q Summer 31

With over 50 per cent of Queensland in drought and 100 per cent of New South Wales in drought, some believe the Australian Government should declare a natural disaster and respond in a similar way following Cyclone Larry in 2006. As well as dealing with the relentless drought over the past five years, many farmers have been frustrated by legislative changes to dam access and vegetation management. Dennis Rush, a cattle farmer in Texas, Queensland said said it’s just continuous stress worrying about cattle, crops and water. “Everyone needs to be aware of the potential this drought has to completely collapse the sheep and cattle industry in Australia, in particular. Once that happens it will be a domino effect for businesses and people living in the heart of this country”. “Our work more than doubles in these conditions. I know a guy who is spending $80,000 a week on buying feed. You can only keep that going for so long,” he said. Rob, a grazier supported by the Royal Flying Doctors Service (RFDS) Drought Wellbeing Service explained how the

drought was affecting his property: “It just grinds you down, the drought, it’s the fifth year and it just seems relentless. You wonder whether you can get out of bed in the morning to deal with it. It’s a bit like Groundhog Day – just keeps going around and around. “I’ve been moving cattle about, trying to move them to a little bit more feed and hope for the best. I’ve been trying to move or walk poor stock. It doesn’t make you feel good when everything you work for is on the downhill – they’re not worth anything to sell. “You think we’ll sell the whole place up, well who’s going to come and buy it? You put all your time and money into this asset, and it’s going downhill, it’s going backwards. The bank manager wants cash flow and see what’s happening. What’s going on? Are you going to make your payments or are you not going to make your payments? So, you end up borrowing more money against it and put another brick in the wall, I suppose. You’ve got to try and keep going.” Australian College of Rural and Remote Medicine President Dr Ewen McPhee said the drought creates some essential distinctions for farming communities.

“Most of the farmers I see will say “I’m not too bad, there are many out there worse off than me” - this is symptomatic of their unwillingness to self-identify as struggling. To a degree, it is the nature of farmers to delay gratification, they will say that drought is part of the rural lifecycle, that they have to take the rough with the smooth and this leads them to pushing through and denying warning signs (financially, socially and emotionally) until it is too late,” said Dr McPhee. “For our members it is important to be aware of this, to ask about these matters, to take the pulse of the communities in which they live and work. GPs working in rural areas are not immune to taking on emotional burdens, financial imposts (as people cannot pay for their care) and recognised staff attrition. Communities themselves suffer, whether it is the local police dealing with family violence or substance use, the local school dealing with children of distressed parents, or local businesses struggling as their market contracts,” he said. The Queensland Government has appointed two drought commissioners, former MP Vaughan Johnson and

A U S T R A L I A’ S N AT I O N A L E M E R G E N C Y

Drought 32 Doctor Q Summer

Thanks to the Royal Flying Doctor Service for their assistance with this article.

St Vincent de Paul’s Mark O’Brien and will inject $9 million into programs to deal with the social and financial impacts of the drought on regional Queensland communities and families. $4 million will go to the Wellbeing Service provided by RFDS over the next four years. Dr McPhee is also keen to see support for local GPs to help their local communities. “For GPs in rural areas, support is often lacking to allow them to do their work. It is incredibly common for urban organisations to think that the response is a group of experts, or worse, telehealth into rural communities, bypassing the health professionals who are surviving the journey with their patients. “The urban world view leads political and, consequently, health service responses that fail to ask people on the ground who have lived in their communities for many years and could provide much more rational, informed

intelligence on where investment might be of value,” said Dr McPhee. Alex, a mental health clinician with the RFDS Drought Wellbeing Service, said that a lot of these communities had been facing the drought relentlessly over the past five years. “The drought situation in Queensland has been pretty relentless. It may not be over the whole state the whole time, but it certainly seems to always be present in parts of the state,” she said. “I think people in the bush, so much of their work is their identity, so when work isn’t going well, they lose their sense of self and so often, I hear clinically, people talk about feeling like a failure. “There’s the compounding effect of pressure on relationships, drug and alcohol issues, particularly alcohol and that’s just the beginning.

“The thing about primary healthcare is that you can’t measure what you prevent, and the sad truth is I have discussions about suicidal ideation on most days.” AMA Queensland’s Chair of Rural, Regional and Remote Working Party Dr John Hall said male suicide rates double when you get to the bush. “The drought and its socioeconomic impacts, if left unchecked, is likely to cause a further rise in rural suicide rates. Rural Medicare expenditure is 40 per cent less than in major cities. Remote Australia has one third the amount of psychologists, but 20 per cent more hospitalisations due to mental illness. The suicide rates of young Indigenous people are five times more than non-Indigenous people. I would call on all levels of government to urgently invest in the mental health of rural Australians via increased access to, and funding for, increased GP and psychology services,” said Dr Hall. Grazier Rob said: “I think there’s something to be said for talking to a person, not a machine or a telephone and feeling like someone cares – that it’s not all for nothing, it’s not a lost cause. Someone actually cares what’s going on and that you’re not alone and you’re not as isolated as you think you are.

YOUR PATIENTS MAY BE ABLE TO ACCESS FUNDING FROM THE QUEENSLAND DROUGHT APPEAL.

VISIT QLDDROUGHTAPPEAL.COM.AU.

For doctors feeling the strain of caring for drought-affected patients, the Queensland Doctors’ Health Programme provide an independent, confidential, colleague-to-colleague support service at (07) 3833 4352.

On 1 October, casual conversion clauses were introduced into federal awards, affecting the Nurses Award 2010, Health Professionals and Support Services Award 2010 and Medical Practitioners Award 2010. The clauses allow casual employees to convert to part-time or full-time positions if they have worked a regular pattern of hours for the current employer for a minimum of 12 months and that those hours could continue to be worked on a full-time or part-time basis without significant adjustment. Employers will need reasonable grounds to refuse to convert a casual employee, such as if the practice would need to significantly adjust the employee’s hours to accommodate them in a part-time or full-time role. The practice may also reasonably

refuse if they expect the employee’s hours to significantly change or be reduced in the next 12 months or the employee’s position will cease to exist. Employers must provide all casual employees with a copy of the new casual conversion clause under the relevant award within 12 months of their initial employment with the practice. For casual employees already employed as at 1 October 2018, an employer must provide those employees with a copy of the casual conversion provisions by 1 January 2019. We recommend employers provide the clause in a letter of notice of casual conversion that informs the employee of their right to request conversion to part-time or full-time employment and how they may do so. The letter should

The September 2018 decision from the FWC for the appeal of Skene v Workpac Pty Ltd [2016] FCCA 3035 has generated activity across employer and employee groups. The FWC upheld the original decision that the employee wasn’t a genuine casual employee for the purposes of the Fair Work Act 2009 (FWA) and awarded him compensation and penalties against the employer for breaching their obligations under the FWA. The amounts are yet to be determined. The original decision, was that the nature of the worker’s employment meant that he did not fit the established definition of a casual employee. That definition arises from 2001 case1 of where the Full Court of the Federal Court said: “… that the essence of casual employment is the absence of a firm advance commitment as to the duration of the employee’s employment or the days (or hours) the employee will work, but that is not inconsistent with the possibility of the employee’s work pattern turning out to be regular and systematic.”2 There is no one definitive test to distinguish between casual and permanent employees. There are several features characteristic of casual employment.” The employee argued that he was not a casual but a permanent full-time employee of Workpac Pty Ltd, a labour hire company that supplies labour to mining companies across Queensland. The driver claimed he was entitled to payment in lieu of annual leave once his employment with Rio Tinto Coal Australia Pty Ltd’s Clermont mine in central 34 Doctor Q Summer

also include a reminder that should the employee request a conversion to a permanent position, that the casual loading will no longer apply to their pay rate, and that they would instead be entitled to paid sick leave and annual leave. If an employee asks to go full-time or part-time, the employer has 21 calendar days to provide a written response if they intend to refuse the request. If the employee does not accept the grounds for refusal, the matter can ultimately be escalated to the Fair Work Commission (FWC) for a decision. A letter of notice has been drafted by AMA Queensland Workplace Relations Team in accordance with FWC recommendations which you can use as a template.

Queensland ended amid allegations of misconduct in 2012. The court found that the driver engaged as a casual under a labour hire arrangement was an employee who was entitled to annual leave payments under the Fair Work Act because his employment was: a) regular and predictable. His working arrangements and shifts were set 12 months in advance in accordance with a stable and organised roster; b) his employment was continuous, save for one period of seven days that went unpaid but which was arranged with the respondent’s client. For that purpose, the worker was under the direction and control of the client, not the respondent; c) his employment was facilitated by the fly in, fly out arrangement and the provision of accommodation at no cost to himself; d) the fly in, fly out arrangement was inconsistent with the notion that the worker could elect to work on any

At the heart of the WorkPac case is the question: what is casual employment? The Court found that “[t]he Fair Work Act contains no definition of casual employee… whether a person is a casual employee or some other type of employee is a question of fact to be determined having regard to the circumstances pertaining to the particular employee the subject of the Court’s consideration.” 4 The FWC also relied on a 1996 case in which Moore J found that: “Plainly it [casual employment] involves a notion of informality or flexibility in the employment following the engagement… A characteristic of engagement on a casual basis is, in my opinion, that the employer can elect to offer employment on a particular day or days when offered, the employee can elect to work. Another characteristic is that there is no certainty about the period over which employment of this type will be offered. It is the informality, uncertainty and irregularity of the engagement that gives it the characteristic of being casual.”5

day and not work for others without first making the necessary arrangements with the respondent’s client; e) there was plainly an expectation that the worker would be available, on an ongoing basis, to perform the duties required of him in accordance with his roster, until the assignment was complete: cl.5.4 of the general terms and conditions; and f) the evidence suggests that the work undertaken by the worker was not subject to significant fluctuation from one day, or one week, or one month, or one year to the next. The hours of work were regular and certain as revealed by the worker’s pay slips. There was no opportunity for the worker to choose not to work any particular shift or hours offered to him by the employer. It was not suggested that he could choose to work for some periods of seven days performing work according to his roster, but not other weeks, without special arrangements.3

Employers should take the following steps: generally engage casuals on a short term and not ongoing basis; assess rosters and employee mix regularly to ensure staff are properly categorised, particularly whether particular employees should no longer be categorised as casual employees; and seek industrial or legal advice where there is any uncertainty about the categorisation of casuals. The Full Court made a number of other important observations: the NES has primacy over terms and conditions of employment provided by all other instruments, including an enterprise agreement, modern award or a contract of employment; the provision of a casual loading in an industrial instrument is not inconsistent with the accrual of an annual leave entitlement; the question of whether an employment arrangement is casual in nature is viewed in the totality of all the relevant indicia; employers are not entitled through their contractual or industrial arrangements to unilaterally determine whether an employee is categorised as a “casual employee” as this would lead to arbitrary and capricious results; and the failure to provide annual leave entitlements to employees is a serious contravention worthy of the imposition of a penalty.

AMA Queensland offers a consulting service to private practice. We can review your workplace arrangements and provide advice about all aspects of staff employment. We also have contract templates available for purchase that are compliant with the applicable awards to reduce the risk of underpayment claims. Please contact us at workplacerelations@amaq.com.au or phone (07) 3872 2211.

1. Hamzy v Tricon International Restaurants trading as KFC [2001] FCA 1589. 2. Skene V Workpac Pty Ltd [2016] FCCA 3035, [73]. 3. Ibid, [81]. 4. Ibid, [69]. 5. Reed v Blue Line Cruises Ltd (1996) 73 IR 420, 425.

Doctor Q Summer 35

AMA losing confidence in MBS Review Taskforce AMA President Dr Tony Bartone has written to MBS Taskforce Chair Professor Bruce Robinson, warning him that the peak medical body is fast losing confidence in the review. The taskforce has recently dumped numerous Clinical Committee reports out for consultation at the same time, demanding responses within short timeframes in a “targeted consultation” – meaning that the reports are not widely available. Dr Bartone said the taskforce had worked on recommendations over the past few years, but now wants the medical profession to respond in just a few weeks or months. He has asked Professor Robinson to ensure these “unreasonable timeframes” are extended and that his taskforce be more flexible in its consultation. Dr Bartone also asked that the reports be made publicly available on the internet. The MBS Review Taskforce is assessing upwards of 5,000 items on the Medicare schedule with regards to best practice and value for money. Glaring examples of the irregularity of the taskforce’s work include the oncology review failing to consult with the Royal Australasian College of Surgeons; and the colonoscopy review inadvertently excluding the Australian Private Hospitals Association. These are just a few examples. “But it’s not just the review – if we don’t change how the implementation is carried out then we will have major financial issues as well,” Dr Bartone said. The AMA has raised with the Health Department, and the Health Minister on behalf of the AMA and the membership, the fact that making significant changes, without adequate lead time before commencement, means that neither the health funds, members, the AMA, or patients are able 36 Doctor Q Summer

to be part of an informed financial consent process.

intent of both the MBS Review and the Private Health Insurance reforms.

This is because while the department may be ready to implement items on a set date, unless they give the AMA, the health insurers and the profession time to know what the changes are, how they relate to the previous items, and then the ability to adapt their own schedules using the same methodology, then mayhem will ensue.

In reviewing the new items, it is clear the MBS Review Taskforce has given considered thought to amalgamating, deleting, streamlining and creating new items.

“You’ll either end up with insurers not ready with their benefit schedules, or insurers pricing the same service under the new items at a different price due to not having the information they need, or both,” Dr Bartone said. “How do I know this? Well that’s what is happening right now with the 1 November changes.” AMA members are upset because they don’t know what to charge under particular insurance arrangements or insurers gap schemes, and therefore can’t do an informed financial consent. One insurer has already lowered one fee for the same service, while other insurers are not yet ready with their benefit schedules. Indeed, most of the major funds have not yet been able to revise their schedules, despite it being two weeks after the items have taken effect. Without insurance schedules many patients will suffer from increased out of pocket costs, since insurers haven’t been able to help doctors set fees at the no or known gap levels. Worse, without insurance schedules, insurers may have to revert to default payments which are only 25 per cent of the MBS rate. This could deliver even larger out of pockets and significant short term bill shock, even when patients have high levels of coverage and have undertaken their due diligence. In the long-term we could see potentially even more variation across benefit schedules and inconsistencies with the

It has also employed a detailed process for generating new fees across the new items, with consideration to fee relativity compared to the old item structure. “Yet these changes and their intent will not be realised if the methodology for achieving the new structure is not released, and if sufficient time isn’t allowed for the sector to adapt,” Dr Bartone said. “And it wouldn’t be the insurers fault, nor the profession, nor the patients – we’ll have managed to create yet another problem simply from the implementation process.” AMA has called government to: increase the lead time it provides before new items take effect; provide the methodology and logic behind the changes, to give the funds and the chance to consider this; and convene a roundtable or consultation with the AMA and the funds about what else is required to protect patients from the potential of out of pocket expenses during the interim period.

Mater Enterprise Agreement The Australian Salaried Medical Officersâ€™ Federation, Queensland Branch (ASMOFQB) is responsible for negotiating the following Mater Hospital agreements:

Resident Medical Officer (RMO) Enterprise Agreement;

Senior Medical Officer (SMO) Enterprise Agreement; and

Visiting Medical Officer (VMO) Enterprise Agreement.

N E G O T I AT I O N U P D AT E Visiting and Senior Medical Officers may be aware that a 2.5 per cent administrative wage increase has been passed on to you, while Mater progresses with their remuneration review. We take this opportunity to update all members on the Mater Hospital RMO Enterprise Agreement negotiations. ASMOFQB has continued to advocate for the same entitlements as those working in Queensland Health will enjoy under the latest iteration to the Medical Officers Certified Agreement (MOCA).

WINS

CONCERNS

We are pleased to announce that at this stage of the negotiations we have been able to secure:

While ASMOFQB continues to advocate on behalf of our Mater members, we hold concerns regarding:

a three-year agreement;

the consultation provisions;

2.5 per cent pay increase per annum for the life of the agreement;

averaging arrangement clause;

back pay from expiry of the current agreement (1 July 2018);

20 per cent increase to the Vocational Training Subsidy for Registrars (currently $2,500 moving to $3,000);

almost 40 per cent increase to the Professional Development Allowance for Residents, excluding interns (currently $1,076 moving to $1,500);

60 per cent increase in Professional Development Leave, excluding interns (currently five days moving to eight days); and

a new entitlement to rest pauses (2x10 minute pauses per shift).

Now is more important than ever to ensure you are a member, as ASMOFQB continues to advocate for our Mater members to receive fair compensation and entitlements in line with what your Queensland Health colleagues receive.

FEEDBACK We are also seeking feedback from our Mater VMO and SMO members regarding the entitlements to be negotiated into their agreements. Please email your feedback to asmofq@amaq.com.au.

www.amaq.com.au | www.asmofq.org.au

queensland health moca resident medical officer 2.5 per cent pay increase per annum. Over 39 per cent increase in Professional Development Allowance (from $1,575.93 to $2,200 per annum). Over 39 per cent increase in Vocational Training Subsidy (from $2,626.50 to $3,670 per annum). 60 per cent increase in Professional Development Leave (from five days to eight days per annum). 100 per cent increase in Examination Leave (from two days to four days per permissible occasion).

wins

New entitlement for up to three daysâ€™ travel time for rural and remote doctors accessing PDL. New entitlement for two 10 minute paid rest pauses in the first and second half of the day with ability to be taken together to form one 20 minute paid break by agreement. Recognition of previous service for reinstatement of Professional Development Leave balances for RMOs who have a gap in service of up to 25 months. Doctor Q Summer 37

AMA Queensland challenges recommendations made into pharmacy prescribing

A report into pharmacy prescribing and a pharmacy council was provided by the Parliamentary Committee in October. AMA Queensland has examined the report and we challenge a number of the recommendations. AMA Queensland has concerns around the following recommendations: allowing pharmacists to provide low-risk emergency and repeat prescriptions; lowering the minimum patient age requirement for pharmacistadministered vaccination to 16 years of age; setting up a Queensland Pharmacy Advisory Council and then doing so without a doctor as a member; and for the Department of Health investigate ways to improve communication to consumers about the services individual pharmacies provide such as vaccinations (as opposed to promoting consumer consultations/relationship with their GP). AMA Queensland President Dr Dilip Dhupelia and CEO Jane Schmitt subsequently met with Health Minister Steven Miles and made clear 38 Doctor Q Summer

our opposition to these proposed recommendations. “Queenslanders must be able to trust that their health is being looked after by skilled, qualified doctors,” Dr Dhupelia said. He also called on the State Government to incentivise pharmacists to work within GP practices. “The public health system would save $545 million over four years by having pharmacists working within GP practices,” he said. “But that saving has been ignored by this committee. “Instead, it’s proposing changes that are dangerous to patients and could be disastrous for our health system.” The minister has indicated that he will consider the findings of the report before deciding which of the recommendations the government will accept. AMA Queensland will continue to make the case against these potentially dangerous recommendations and will update members in due course. AMA President Dr Tony Bartone said the recommendations not 5 only significantly fragment health care but will lead to worse health outcomes for patients.

“It is well known that the more that other non-medical health professionals are involved in prescribing, the higher risks of medication error and adverse reactions. We are in the middle of a real effort to introduce the medical home concept in Australia, where GPs are able to coordinate patient care, with full access to a patient’s medical history. “GPs are the only trained primary health professionals who have the skills needed to properly and comprehensively diagnose patients, prescribe the right medications, and refer patients to other health care providers as appropriate. “GPs currently work closely with their pharmacist colleagues on a daily basis and respect the unique skills they bring to the care of patients, particularly with respect to the quality use of medicines. “This report completely overlooks the reality of quality primary health care - it totally ignores the wellunderstood need in our health system to strengthen the coordination of care, and the need to encourage patients to have a long-term relationship with a usual GP or general practice. “The report also opens up a serious conflict of interest for pharmacists who will gain commercially through

MAJOR CONCERNS: 1

N O T S E PA R AT I N G PRESCRIBING AND DISPENSING It is a time-honoured principle to separate prescribing and dispensing based on safety that is to have two separate parties checking the clinical need/appropriateness, safety and dosing of a medication.

prescribing of medications, and then being able to dispense them.

The Australian Health Practitioner Regulation Agency (AHPRA) Prescribing Working Group in 2016 developed a clear national pathway for other health practitioners to prescribe but which requires clear steps in determining community need, a comprehensive survey of training, standards, accreditation and a requirement to gain approval at various levels including the AHPRA Scheduled Medicines Expert Committee and then Australian Health Ministers’ Advisory Council (AHMAC) before looking a state level approvals.

“We already know that pharmacies sell many complementary medicines that are not backed by clinical evidence. This highlights the retail pressure they are under to sell products to consumers regardless of patient need. “The recommendations in this report, if adopted, would set Australia on a dangerous course. “We have a GP-led model of care that is the envy of the world, and we know that GPs are highly accessible in most parts of the country. “We have primary care outcomes that are second to none.

CONFLICT OF INTEREST: M AT E R I A L G A I N

LO S S O F P R E V E N TAT I V E AND OPPORTUNISTIC CARE

RIGHT TO EXAMINE

“Any access concerns cannot be solved by providing a second-best alternative. “The Australian community deserves more than this. We need to build on this proven model of GP-led care, rather than undermine it by giving in to the retail interests of the pharmacy sector,” Dr Bartone said. The AMA Queensland Council has formed a working group which will devise a strategy to push back against the committee reports recommendations. Chaired by AMA Queensland Councillor and Board Member Dr Bavahuna Manoharan, the committee will work closely with both the Federal AMA and the medical colleges with the ultimate aim of ensuring patient safety is protected, patient care is not fragmented and decision makers understand the dangers an expanded scope of practice for pharmacists could mean for the Queensland health system.

I N V I O L AT I O N O F N A T I O N A L LY A G R E E D A N D DEVELOPED PROCESSES

If pharmacists can prescribe and dispense, this will affect patient safety. If it is good enough for doctors to separate prescribing and dispensing due to concerns about conflicts of interest impacting on patient safety, how are pharmacists different? In addition, pharmacists are in a more conflicted position because of the ability to upsell products, such as complementary medicines.

A visit to a GP will rarely cover only a prescription – it’s a chance to talk about preventative care and the bigger picture for the patient. Seeing the patient and understanding their history means more holistic care.

Pharmacists do not have the right to examine a patient, so how can they properly assess patients and prescribe? Doctor Q Summer 39

Influencing physician health through prosocial behaviour Optimising physician health has clear benefits for not only the individual physician but for the health care team, their patients and the health system in which they work.1 There is a growing realisation that optimising physician health requires interventions aimed not only at the individual doctor but also directed towards improving systems and culture within workplaces.2 However, moving beyond the inertia of the status quo and effecting change at a systemic or cultural level can appear a Sisyphean task. What if we could start small and effect change as individuals with our own daily interactions at a local level without waiting for organisational or systems level initiatives to be put in place? How many people do you interact with on an average work day? Medical colleagues, the barista at the hospital canteen, administrative staff, allied healthcare workers, patients, relatives… the list goes on. We may not know some of these people by name and may have never spoken to them, but we have a choice as to how we interact with each and every one of them. Do we avoid eye contact, or do we nod and acknowledge that we recognise them? Do we take for granted the roles these people play in the successful running of our workplace, or do we say thank you to express gratitude for the job they do? Do we accept that our juniors will be rotating out of our team in a couple of months’ time or do we take the time to get to know their names and individual qualities? Do we see these people as their job title or as individuals with their own strengths, vulnerabilities and interests?

40 Doctor Q Summer

That’s all very well you might think, but what difference do these choices make to improving physician health or health system outcomes? Prosocial behaviour, otherwise known as carrying out kind acts towards others, has been shown to result in both short-term and longterm benefits in the workplace for both givers and receivers, including improved competence and autonomy, increased happiness and more life and job satisfaction. Not only that, but these behaviours have been shown to be contagious, with receivers carrying out 278 per cent more acts of kindness than non-receivers.3 The Ochsner Health System, in the US, implemented ‘the 10/5 Way’ as a ‘non-negotiable’. When within 10 feet of someone, employees make eye contact; within five feet and they acknowledge the other person with a nod, smile or hello. The system reported greater patient satisfaction and an increase in patient referrals as a result.4 Let’s look at the flipside. Inconsiderate words or rudeness, dismissiveness or aggressive communication, often described as incivility, has been shown to negatively impact on the recipient of the incivility with 80 per cent losing time worrying about the rudeness and 66 per cent reporting a decline in their performance (demonstrated to be impaired cognitive skills such as memory and attention). Incivility also affects witnesses who experience a 20 per cent decrease in their own performance and a 50 per cent decrease in willingness to help others.4,5 All of which can lead to worse patient outcomes and negatively impact patient safety.6,7 Bradley et al found 31 per cent of doctors in the UK were affected by incivility on a daily or weekly basis.8

VICKY DAWES

Education Officer, Queensland Doctors’ Health Programme

Let’s not underestimate the potential impact that every one of our seemingly minor daily interactions, whether positive or negative, can have, on not just the individuals involved but the health care team, patients and the wider health care system. In the words of social researcher Brené Brown, “The best way to really bring change to a group is to inspire people through a change in your own behaviour.”9

What if we could start small and effect change as individuals with our own daily interactions? References 1. Bodenheimer T, Sinsky, C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014; 12:573-6. 2. Gerada Clare, Chatfield Cat, Rimmer Abi, Godlee Fiona. Making doctors better BMJ 2018; 363 :k4147 3. Chancellor, J., Margolis, S., Jacobs Bao, K., & Lyubomirsky, S. Everyday prosociality in the workplace: The reinforcing benefits of giving, getting, and glimpsing. Emotion. 2018; 18(4), 507-517. 4. Porath, and Pearson. “The Price of Incivility.” Harvard Business Review 2013; 91, no. 1,2 (2013): 114-21. 5. Porath CL, Erez A. Does rudeness really matter? The effects of rudeness on task performance and helpfulness. Academy of Manag. 2007; 50:1181–97. 6. Dixon-Woods M, Baker R, Charles K et al. Culture and behavior in the English National Health Service: Overview of lessons from a large multimethod study. BMJ Qual Saf 2014; 23:106–15. 7. Joint Commission. Sentinal Event Alert 40: Behaviours that undermine a culture of safety. Oakbrook Terrace, IL: Joint Commission, 2008. 8. Bradley, V., Liddle, S., Shaw, R., Savage, E., Rabbitts, R., Trim, C., Whitelaw, B. C. Sticks and stones: Investigating rude, dismissive and aggressive communication between doctors. Clinical Medicine, Journal of the Royal College of Physicians of London, 2015; 15(6), 541–545. 9. Brown, B. Dare to Lead. 2018. New York, N.Y.: Gotham

Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 to inspect or discuss further. An opportunity to practice in Upper Mount Gravatt, is available now. The Centre for Minimally Invasive Neurosurgery and Spine Surgery (CMINS) is located at Level 3, 12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis. Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists. CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care. Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design. Other features include:     

On-site Parking. State of the art phone system. Lift access providing accessibility for all patients. Large kitchen and staff common area. Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices.

Other nearby specialities include: Neurosurgery An opportunity to practice in Upper Mount Gravatt, is available Neurology  Ophthalmology now. The Centre for Minimally Invasive Neurosurgery and Spine Contact Yasmine Griffin on tl@cmins.com.au or call 1300 559 533 or discuss Surgery (CMINS) is located atto inspect Level 3, further. 12 Mt Gravatt-Capalaba Road, Upper Mount Gravatt and has two consulting rooms available on a sessional or permanent basis.

Situated close to Westfield Garden City Shopping Centre, each consulting room has been purpose built for medical specialists. CMINS includes everything required for providing your patients exceptional service, whilst assisting in building a reputation of best practice in delivering high quality patient care. Administrative support, high speed internet, and high quality equipment is all set within a modern and contemporary design.

Other features include: On-site Parking. State of the art phone system. Lift access providing accessibility for all patients. Large kitchen and staff common area. Close to radiology (Queensland X-ray) and pathology (Sullivan and Nicolaides) practices. Other nearby specialities include: Neurosurgery Neurology Ophthalmology

Doctor Q Summer 41

The balancing act of opioid prescribing There is no doubt that prescription opioids have a place in pain management. The evidence is clear that wellmanaged opioid use is effective in a very defined group of patients. Outside of this group however, prescription opioid medication is putting patients at unnecessary risk of harm and even death. Over the past 40 to 50 years, we have seen an increase in opioid prescribing to the point that we now have alarming numbers of patients dependent on opioids or dying from overdose or related side effects. Nationally, deaths from pharmaceutical opioids now exceed those from heroin. Locally, Queensland has seen a 2.7 fold increase in drug related and accidental deaths from 2001-05 to 2011-15. The impact prescription opioid use has on morbidity is significant and this is particularly so for our elderly patients. Sent home from hospital on opioids for pain management, we impose upon them complications such as constipation, confusion, and delirium. As a result they may experience further adverse outcomes, such as a fall, and end up back in the emergency department followed by a lengthy admission. Among the general population, prescription opioid use can lead to car accidents, increased pain intensity, immunosuppression and recurrent infections, hormonal dysfunction, and osteoporosis among others.

Evidence supports opioid use for acute pain within a controlled setting for trauma, illness, peri- operative, cancer and palliative care patients. It is not, however, supported for the long-term treatment of chronic non-cancer pain. Prescribing opioids is a balancing act for medical practitioners. Naturally we want to effectively treat the pain our patients are experiencing but this must be carefully considered against the evidence and risks of side effects, misuse and abuse. Non-opioid pharmacological treatment options can be effective, but these too have their downside. Ultimately, medication has a finite role in chronic pain management. Evidence is growing for the long-term benefits of nonpharmacological alternatives, but it can take time for patients to accept and be willing to participate. Certainly, a great deal of work is underway at a national, state and local level to tackle the opioid issue. Among the initiatives showing promise in other jurisdictions and at a number of Queensland Hospitals are stewardship programs. In July 2018, the Queensland Clinical Senate hosted a meeting of 150 clinicians and consumers to consider whether a stewardship program could support the Stateâ€™s response to prescription opioid use. It was agreed that a stewardship program with a broader focus on pain management and high-risk pain medication, and not just opioids, should be considered as part of Queenslandâ€™s overall response to the problem. To be effective, the program would require a balance of persuasive and restrictive interventions built around ongoing education for clinicians and consumers, timely communication of pain management plans and strong clinical governance. There is an overwhelming desire among consumers, clinicians and system leaders to minimise unanticipated harm from opioids while ensuring people have access to alternative and appropriate treatments to relieve their pain. And I am confident that if we all continue to champion the cause we will see progress in this space. To read the opioid meeting report and full list of recommendations visit: https://clinicalexcellence.qld.gov.au/priority-areas/ clinician-engagement/queensland-clinical-senate

Dr David Rosengren Chair of the Queensland Clinical Senate

42 Doctor Q Summer

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Research Review Australia is an independent publishing organisation that puts together clinical research updates for Australian health professionals across more than 50 clinical areas. Every month, local experts choose ten research papers from global journals and comment on the impact to everyday practice. We have handpicked some key research articles from recent editions that are a ‘must see’ for those working in various clinical areas.

SUNSCREEN USE AND MELANOMA RISK IN AUSTRALIANS Dermatology Research Review Issue 52 Reviewer: Dr Warren Weightman This research has confirmed that regular sunscreen use prevents melanoma in young adults before the age of 40 years. The regular users were more likely to be female, younger, of British or northern European ancestry, higher educational levels, lighter skin pigmentation and a stronger history of blistering sunburn. This study was designed when sunscreens of SPF-8 were widely available, so there may be even more benefit with the higher SPF sunscreens used now. This strengthens the message that sunscreen needs to be used from a young age and continued throughout life.

PREVALENCE OF DI ABETES IN AUSTRALIA Diabetes Research Review Issue 109 Reviewer: Associate Professor Neale Cohen This is an Australian study from the highly respected and very successful team of epidemiology researchers in Perth, Western Australia. Data from the Fremantle Diabetes Study (FDS) have provided much of the understanding of diabetes prevalence and trends in Australia. This is now FDS Phase 2 (FDS2). Here the authors have used data from FDS2 and multiple other sources in an attempt to determine the ‘true’ rate of diabetes in Australia. The conclusion is that about five per cent of people have diabetes, of whom most have typical type 2 diabetes, but a substantial group (14 per cent) have other forms of hyperglycaemia with consequent need for a different therapeutic approach. It also may be that the phenomenon of there being an ultrahigh rate of undiagnosed diabetes in Australia may have reduced in recent times.”

I S C A N N A B I S U S E A S S O C I AT E D W I T H INCREASED RISK OF CIGARETTE S M O K I N G I N I T I AT I O N , P E R S I S T E N C E , AND RELAPSE? Addiction Medicine Research Review Issue 8 Reviewer: Professor Edward Ogden Here is complication to fuel the cannabis debate. Any approach to legalising cannabis will have to consider not only the direct implications of cannabis use but broader health risks associated with mixing cannabis with tobacco and increasing tobacco use. National US data showed that significantly more adolescents and young adults perceived marijuana as posing no risk after it was ‘medicalised’.” Current and back issues of Research Reviews can be found at www.researchreview.com.au Australian health professionals can sign in and download copies. 44 Doctor Q Summer

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POSTCARD FROM

John Hopkins, USA D R E K TA PAW

Candidate, Masters of Public Health majoring in Health Policy, Johns Hopkins Don’t miss Dr University, Ekta Paw at the Baltimore, 2019 Junior Doctor Maryland Conference, where

What does public health bring to mind? Perhaps epidemic control, contact tracing and quarantine for highly infectious diseases. Maybe public health is more about social determinants of health and examining disparities between various groups. It is probably less likely that the first things that would come to mind would be related to surgery, the environment or the law. Studying at the Bloomberg School of Public Health has really highlighted how broad the scope of public health can be. This idea is echoed by the Dean of the school Dr Ellen MacKenzie in supporting the concept of Public Health 3.0. Here is a quick foray into each of these topics, from what I’ve learned since being here. Dean MacKenzie’s main work focuses on trauma systems and it was my interest in surgery, which drew me to apply to Bloomberg initially. Injury contributes significantly to the global disease burden and more than 90 per cent of worldwide injury deaths occur in low and middle income countries where both prehospital and definitive surgical care are difficult to access1. The Masters of Public Health program here specifically has a mentoring program for students in the Johns Hopkins Surgery Center for Outcomes Research (JSCOR), as well

as the Hopkins International Injury Unit (IIRU). Both of these programs enable research into trauma systems, trauma prevention and surgical capacity building on a national and international level. Hopkins is one of the few programs with mandatory teaching in environmental health and it has really highlighted the importance of the built environment as part of health planning for populations. As clinicians, we are acutely aware of antibiotic resistance in the hospital setting, but when discussed from an environmental perspective, it was concerning to see how the use of antibiotics in livestock farming significantly contributes to evolutionary pressure on bacteria. Of key importance was also discussing the complex effects of climate change, not only on the environment, but from an economic and sociopolitical perspective due to effects such as resource paucity and infrastructure damage.

she will discuss postgraduate options.

While public health and the law may not seem particularly related, the faculty at the Center for Law and the Public’s Health will definitely convince you otherwise. There are frequent lunchtime sessions on a wide variety of topics at the school, but the one I attended to discuss the public health implications of the new US Supreme Court was jam-packed. The ability of US public health agencies to enact decisions without significant challenge from the legislature rests on a case (Chevron USA, Inc v Natural Resources Defense Council, Inc) from 1984, which may be overturned in the future by the new Supreme Court. We also discussed the role of the law in public health crises, how it can be a useful tool when used well or an impediment when ignored.

This is just a small snippet of the huge breadth and rage of topics, which are relevant to public health. I have been building experience and skills across the board from evolutionary biology to economic evaluation and everything in between. It is exciting to learn more about the external factors which contribute to health, in the hope that having a more nuanced understanding means better targeted interventions and improved care. 1. Gosselin R. Injuries: the neglected burden in developing countries. Bull World Health Organ. 2009;87(4):246-246. doi:10.2471/BLT.08.052290.

46 Doctor Q Summer

Breathe new life into your body. Discover the proven health benefits of Hyperbaric Oxygen Therapy. By using a pressurised environment to increase the bloodâ€™s oxygen levels, Hyperbaric Oxygen Therapy could help your patients overcome a range of debilitating conditions. From non-healing wounds associated with diabetes or other illnesses, to soft tissue radiation injury and radiation proctitis and cystitis as well as many other conditions, it offers a non-invasive, safe and cost-effective treatment option. Importantly, Hyperbaric Oxygen Therapy is evidence-based and medically proven â€“ acknowledged by Medicare and most health funds, and our facility at the Wesley Hospital has achieved The Australian Council for Healthcare Standards (ACHS) accreditation. To see how Hyperbaric Oxygen Therapy could help your patients recover faster, call us and discuss the treatment with one of our doctors today.

wesleyhyperbaric.com.au

07 3371 6033

Doctor Q Summer 47

AMA QUeensland has Working to improve indigenous health outcomes.

Opposing the push by pharmacists to expand their scope of services. Lobbying the Federal Government to increase the Medicare rebate.

Engaging with major medical, academic, food and physical activity stakeholders to address the obesity crisis.

Lobbying for a national mental health framework that invests in both prevention and treatment. Continuing to push for an end to mandatory reporting for doctors.

Assisting with bullying and harassment claims, as well as other workplace grievances.

Renew your membership BPAY

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

RENEW YOUR MEMBERSHIP BY 31 DECEMBER

online to ONLINE Jump www.ama.com.au/join_renew and have

Whether youâ€™re just starting out in your medical career or have an established practice, AMA Queensland is committed to protecting and enhancing your professional interests.

PHONE Phone our Membership Team on

In the past year alone, we have helped to secure $8 million in extra funding to improve the way the Office of the Health Ombudsman manages complaints and we have assisted in recouping more than $2.2 million in back pay for public and private medical officer members.

your login and password ready.

(07) 3872 2222 or 1800 626 637 (outside Brisbane) and have your credit card handy.

MAIL

A hard-copy 2019 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.

48 Doctor Q Summer

On top of that, we have participated in significant legislative changes including My Health Record privacy provisions and continue to oppose the extension of pharmacistsâ€™ scope of services.

made your day easier by...

Fighting for more secure privacy provisions regarding My Health Record.

Conducting the yearly Resident Hospital Health Check to gauge staff sentiment, encouraging hospitals to review and address issues identified.

Achieving $8 million in extra funding to ensure the Office of the Health Ombudsman resolves complaints more efficiently.

Helping resolve 4,200 member queries in relation to underpayment, overpayment, unfair rosters and workplace issues in public and private practice.

COMPLAINTS

Strongly negotiating for improved pay and conditions through MOCA 5, putting thousands of dollars back in your pocket.

Via our union partner, working with Queensland Health to ensure VMO employees secured $2.25 million in back pay and a 2.5% increase.

by 31 December 2018 Making a difference in peopleâ€™s lives is what you do. Making a difference in your life is what we are committed to do. At AMA Queensland, our top priority is to provide you with leadership, resources and opportunities to support the important work you do. Invest in yourself and pay your renewal today - monthly payment is available for your convenience.

AMA QUEENSLAND E A R LY - B I R D R E N E W A L S TRAVEL PRIZE Renew by 31 December 2018 (annual payment) or have your first monthly or quarterly payment of the year successfully processed (15 January 2019) to be in the draw for an amazing travel prize valued at $3,500, courtesy of Orbit World Travel. Pack your bags for a three night stay in Hobart including flights, winery tours and Museum of Old and New Art (MONA) tickets. For full prize terms and conditions visit our website at www.amaq.com.au Doctor Q Summer 49

Events calendar

4 APRIL

22-28 SEPTEMBER

M A R C H / A P R I L / M AY

Women in Medicine Breakfast

Council of Doctors in Training presents Teaching and Mentoring: Practical Skills for Junior Doctors Free member event (see p11)

Workplace Relations Training Series 1 Recruiting well - avoiding or minimising the legal and cultural pitfalls during recruitment

1 1 M AY

Starting a private practice seminar - Brisbane Free member event

AMA Queensland Annual Conference (Edinburgh, Scotland)

17 OCTOBER

NOVEMBER/DECEMBER

Workplace Relations Training Series 2 Performance management - consistent and equitable management practices

7 NOVEMBER

1 JUNE

Bancroft Oration Free member event

Junior Doctor Conference and Careers Expo

15-16 JUNE

Council of Doctors in Training Career Development Seminar Free member event

2 6 J U LY

5 DECEMBER

Starting a private practice seminar - Gold Coast Free member event

Dinner for the Profession

30-31 AUGUST

28 NOVEMBER

Ministerâ€™s Breakfast Townsville Free member event

Private Practice Medico-Legal Conference

Visit www.amaq.com.au for more information or to register for our upcoming events. 50 Doctor Q Summer

AMA QUEENSLAND ANNUAL CONFERENCE SUN 22 - SAT 28 SEPTEMBER 2019

To find out more about the conference program or to register, please contact: Neil Mackintosh, Conference Organiser P: (07) 3872 2222 or E: n.mackintosh@amaq.com.au

WWW.AMA.COM.AU/QLD/EVENTS/LISTING

EARLY BIRD PRIZE Delegates who register and pay their deposit by 28 February 2019 will go in a

Lucky Draw to win:

Upgrade to a Castle View Room

Dinner for two during conference week

AMA Queensland optional afternoon tour for two, while in Edinburgh. (Based on two adults, twin share).

Download a conference brochure from the events calendar at www.amaq.com.au

Junior Doctor Conference MEET THE PEOPLE

who will inspire you at the 2019 JDC

dr rolf gomes

tim johnson

Dr Rolf Gomes established the Heart Bus, a 25m long clinic-onwheels that delivers specialist cardiology, respiratory, general medicine and endocrinology consultations and diagnostic testing to patients in the bush.

Legal Counsel Tim Johnson recently defended Dr Hadiza Bawa-Garba, whose medical registration was reinstated after she was found guilty by a criminal court jury of gross negligence manslaughter of a young patient. The case raised serious issues about the expectations on junior doctors and how they are sanctioned for errors in the workplace.

NEW

CAREER EXPO AT JDC

drs matt young and joss o'loan The guys behind the Hep C Kombi Clinic, Drs Matt Young and Joss Oâ€™Loan, realised that the people most in need of the Hep C cure may never visit a GP surgery or hospital. So, they took the least likely space for a treatment room, a 70s Kombi and took the medicine to the people who need it most in the places theyâ€™re more likely to be.

The 2019 Junior Doctor Conference will feature a career expo, where you can network with prospective employers and colleges: Royal Australasian

College of Surgeons (RACS)

Royal Australasian

College of Physicians (RACP)

The

Royal Australian College of General Practitioners - Queensland Faculty (RACGP)

The

Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG)

52 Doctor Q Summer

The

Royal Australian and New Zealand College of Psychiatrists (RANZCP)

The

Royal Australian and New Zealand College of Radiologists (RANZCR)

Australian

College of Rural and Remote Medicine (ACRRM)

Australian

College of Emergency Medicine (ACEM)

Discounted member early bird registrations are now open for the 2019 Junior Doctor Conference. Book now at www.amaq.com.au

Day one

Saturday 15 June

I N N O VAT I V E H E A LT H C A R E O N WHEELS - THE SUCCESS OF H E A RT O F A U S T R A L I A A N D T H E HEP C KOMBI CLINIC

Dr Vanessa Grote, Psychiatry Registrar, Princess Alexandra Hospital Michelle Cowan, Senior Workplace Relations Advisor, AMA Queensland

Dr Rolf Gomes, Founder, Heart of Australia Drs Matt Young and Joss O’Loan General Practitioners, Medeco Medical Centre and Founders, Hep C Kombi Clinic

SUPER-CHARGE YOUR CV AND BLITZ YOUR INTERVIEW Anita Fletcher, AMA Careers Advisor, Australian Medical Association

N AV I G AT I N G T R I C K Y T W I S T S AND TURNS ON JOB - HOW TO ENJOY THE DRIVE IN YOUR JUNIOR DOCTOR YEARS

C L I N I C A L S K I L L S D E V E LO P M E N T SERVICE PRESENT CLINICAL S K I L L S S P E E D W AY

PANEL: Dr Mellissa Naidoo, Director of Medical Services, Ramsay Health Care and Board Member, AMA Queensland

1: Airway station 2: CPR station 3: De-fibrillation station 4: IO egg challenge station

Katharine Philp, Partner, HWL Ebsworth Dr Michael Cleary, Executive Director, Metro Health South and Board Member AMA Queensland Dr Thomas Arthur, Surgical Registrar, Toowoomba Hospital

Day two

SOCIAL MEDIA AND BUILDING YOUR LINKEDIN, FACEBOOK AND TWITTER PROFILES - THE DO’S AND DONT’S FOR DOCTORS IN TRAINING Scott Oxford, Founder and Director,

AMA DOCTOR IN TRAINING LIVE ISSUES

Representatives from Australian medical colleges

PANEL: The Hon Steven Miles MP, Minister for Health and Ambulance Services

T E C H N O LO G Y I N M E D I C I N E : W H AT D O E S I T M E A N F O R Y O U NOW AND IN THE FUTURE?

Dr Dilip Dhupelia, President, AMA Queensland

Professor Frank Gannon, Chief Executive Officer and Director, QIMR Berghofer Medical Research Institute

Rachele Mitchell, Claims Solicitor, MDA National P O S T- G R A D U AT E C O U R S E S W H AT ’ S O U T T H E R E A N D W H AT ’ S W O RT H I T ? Dr Ekta Paw, Candidate, Masters of Public Health majoring in Health Policy, Johns Hopkins University, Baltimore, Maryland Dr Mellissa Naidoo, Director of Medical Services, Ramsay Health Care and Board Member, AMA Queensland; Dr Fiona Lander, Consultant, McKinsey & Co THE STORY OF DR H ADIZA B AW A - G A R B A A N D W H AT W E CAN LEARN Tim Johnson, Principal, Tim Johnson/ Law, London, UK Katharine Philp, Partner, HWL Ebsworth

Sunday 16 June

L A N D I N G T H AT C O L L E G E P L A C E OF YOUR DREAMS

Dr Amandeep Hansra, General Practitioner and Founder, Evermed Consulting and Creative Careers in Medicine

New Word Order

AMA Queensland Council of Doctors in Training representatives John Cosgrove, Senior Industrial Relations Advisor, AMA Queensland Dr Eric Levi, Consultant Ear, Nose and Throat Surgeon, St Vincent’s Hospital and The Royal Children’s Hospital

A LT E R N AT E C A R E E R PAT H W AY S I N M E D I C I N E PA N E L : T H E R O A D O F T E N M O R E T R AV E L L E D T H E S E D AY S Dr Nic Woods, Chief Medical Officer, Microsoft Australia Dr Evelyn Chan, Paediatrics Registrar, Royal Children’s Hospital Melbourne, and Chief Executive Officer, SmileyScope Dr Fiona Lander, Consultant, McKinsey & Co Dr Nelson Lau, General Practitioner and Film Maker

Doctor Q Summer 53

Supporting the Kombi Clinic to eradicate Hepatitis C The AMA Queensland Dinner for the Profession was held on 12 October 2018 at Victoria Park Golf Club. The elegant evening was a black tie gala event celebrating the incredible work of doctors throughout Queensland. A silent and live auction featured on the evening with all proceeds donated to the AMA Queensland Foundation, totalling $7,000. The Foundation’s project for this evening was the Hep C Kombi Clinic Project and this money will mean the team can treat 100 new

Matt and his colleagues consult, fibroscan and blood test all patrons on their first visit, then provide Hep C curative drugs and any necessary follow up at second consult, which is generally four weeks later. Patients are also provided comfort packs (containing toiletries), and socks and blankets thanks to a Knitters for Charity group. Hep C eradication is the end goal of the project, and we are excited to support such a worthy cause as part of our 2018 Christmas Appeal.

patients. Thank you to all those who kindly purchased items in the auctions and assisted in raising funds for the good work of the Foundation. The Foundation’s 2018 Christmas Appeal will also focus on the work of the Hep C Kombi Clinic championed by Drs Matt Young and Joss O’Loan. The project involves taking a Kombi van to various Hep C target-rich locations such as drug rehabilitation services and rough sleeping locations where

DONATE ONLINE AT www.amaqfoundation.com.au

Yes, I want to give with my tax-deductible gift PERSONAL DETAILS

PAYMENT DETAILS

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

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PLEASE RETURN TO:

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QFN-XMAS-2018-DRQ

54 Doctor Q Summer

Thank you for your support!

A M A Q U E E N S L A N D ’ S N E W C O R P O R AT E PA RT N E R

Osler Technology AMA Queensland has partnered with Osler Technology to provide access to the Clinical ePortfolio at a highly competitive price. The Osler Clinical ePortfolio combines efficient data capture, comprehensive reporting tools and predictive analytics to help you identify and manage your career development needs. Osler helps you understand your performance, learning and activity in ways you never imagined, helping you grasp opportunities and immunise yourself from mistakes Creating your personal Osler Clinical ePortfolio helps you meet the new Medical Board of Australia requirements for all doctors to nominate a continuing professional

development (CPD) home. Also, the ePortfolio helps you meet requirements by retaining your CPD records for up to three years. The data is mobile and cloud-based and entirely under your control. Over 40 procedural training pathways not only teach you how, but also allow you to demonstrate what you can do. AMA Queensland members can purchase an annual subscription for the discounted rate of $290 (saving $70). For each membership sold, Osler will donate $50 to support the work of the AMA Queensland Foundation. For more information, visit the following website: http://osler.community/amaq

New Doctor Checklist Scrubs

Coffee card

Stethoscope

Osler Clinical ePortfolio

Career success doesn’t just happen Take control of your future with an Osler ePortfolio: • • • • • • •

identify opportunities for growth verify your scope of practice showcase your achievements validate your training and experience stand out from the pack insulate yourself from error take your record wherever you go

Osler and the AMA Queensland have joined forces to bring you this exciting offer. Join now and save $70 off your subscription fees, and Osler will donate $50 to the AMA Queensland Foundation.

$70

off your subscription

$50

AMA Queensland Foundation donation

CPD HOME Did you know that all junior doctors will need to nominate a CPD Home to maintanin registration?

For more information visit:

ama.com.au/qld/corporate-partners/osler-technology

Doctor Q Summer 55

SAMANTHA MIKLOS

A M A Q U E E N S L A N D ’ S N E W C O R P O R AT E PA RT N E R

Director, Cornerstone Medical Recruitment

Cornerstone Medical Recruitment FINDING THE P E R F E C T M AT C H Finding the perfect job or staff member can be an overwhelming prospect, not to mention an incredibly time-consuming activity. Work occupies the majority of our week. It is crucial to our overall happiness and wellbeing to get it right. So how do you find the perfect match and fast?

K N O W W H AT YOU WANT If you are an employer, the first step is knowing what you want (beyond the job title) and understanding your internal recruitment process. It is imperative to understand the profile of employee you are seeking and the criteria that you will flex on. Nothing is more frustrating for a potential employee than an ambiguous job description coupled with a slow recruitment process. The medical sector has significant talent shortages, so time is of the essence. Job seekers must also know what they are looking for and be recruitment ready. What hours are you willing to work? What tasks won’t you do? Who do you enjoy working with? What location will best suit your personal situation? Is the remuneration package enough to keep you satisfied? Would a locum role, fixed term contract or permanent role be the best fit? Is your CV updated and tailored to the role you 56 Doctor Q Summer

are seeking? Have you contacted your referees? Are there criteria you might flex on for the right opportunity?

IT’S MORE THAN SKILLS Great recruitment is about much more than simply matching the right skillset. While skills and experience will always play a large role in recruitment, particularly in specialist fields, these are rarely the factors that result in successful, long term recruitment outcomes. Geographical considerations and personal circumstances are critical areas which must be understood when recruiting. Geographical considerations can be as simple as “do you enjoy the beach or the bush?”. But they can run far deeper to include location size and accessibility, available schooling, local amenities and infrastructure, extracurricular activities, availability of accommodation and cost of living. Personal circumstances are equally as important. If you are relocating, will this location suit your family? If you are commuting, is this sustainable long term? Will this job enhance your personal circumstances or create greater challenges for you and your loved ones?

I T ’ S N O T W H AT YOU KNOW A common misconception is that all jobs are advertised on job boards and

only active job seekers apply for jobs. The relationships developed between employers, employees and recruitment agencies, means that many of the best opportunities never actually make it to a job board. Recruitment Consultants are talking to employers and employees daily and drawing on their extensive networks to make the perfect match. Whether you are an employer or job seeker, your requirements will change significantly over time, sometimes within a matter of hours. It is therefore essential that you partner with a Recruitment Agency who can support you along this journey. As an AMA Queensland Corporate Partner, we are pleased to offer members support with locum, fixed contract and permanent opportunities across Australia. In addition, we provide career pathway advice, up to date market knowledge, strategies to overcome recruitment challenges, staff retention and engagement.

TAKE THE FIRST STEP When recruitment is done well the impact on local communities, health care teams and individuals can be life changing. As busy health professionals, we know your time is best spent supporting your local communities. So the next time you are about to recruit, or considering a career change, contact the team at Cornerstone Medical Recruitment, and let us make the perfect match for you.

What’s your perfect match? With locum, fixed contract and permanent roles Australia wide, your dream job is just around the corner. Positions are available for: • Doctors in Training • Senior Medical Officers • Specialist Doctors • General Practitioners • Allied Health Staff • Nurses & Midwives • Dentists

AUSTRALIA’S HIGHEST RANKED MEDICAL RECRUITMENT FIRM* * AS VOTED BY MEDICAL PROFESSIONALS ON GOOGLE

cmr.com.au

Payroll tax alert CONTRACTING DOCTORS Calculating payroll tax is not as straightforward an exercise as some people think. To ensure that you aren’t paying more than you need to, it is vital that you understand the employment status of your doctors. Many doctors work in medical practices as independent contractors and, as such, would not generally be considered an employee of the medical practice. This means that the medical practice does not have to withhold tax or pay superannuation and leave benefits for those contracting doctors. Payroll tax is imposed on wages paid by employers. In Queensland, the payroll tax rate is 4.75% on total wages paid by the employer above the $1.1 million annual threshold. Payroll tax is not imposed where total wages paid by the employer are less than $1.1 million.

EXAMPLE 1 - The doctor is contracted by the medical practice A medical practice enters into a services contract with a doctor who will provide services to the medical practice’s patients. This arrangement is likely to be subject to payroll tax “as a relevant contract” (even if the doctor is an independent contractor). This is because the doctor is performing services in relation to the performance of work for the practice.

With the move of much of the workforce from permanent employment to work on a contract basis, the payroll tax base is being eroded. In order to overcome this, Queensland (and the other States) have included far reaching contractor provisions in their payroll tax legislation that make payments to contractors subject to payroll tax unless the contractors come within certain limited exemptions.

JOHN CARAVOUSANDOS Partner, Commercial Group, HWL Ebsworth

LY N E T T E REYNOLDS

Partner, Property Group, HWL Ebsworth

A “relevant contract” (i.e. a contract subject to payroll tax) is a contract under which a contractor supplies to another person “services in relation to the performance of work”1. Is a contract with a doctor subject to payroll tax? This will depend on the terms of the contract. There are two common contracting arrangements for doctors.

EXAMPLE 2 - The doctor enter into a services agreement with a medical services company Under this agreement, the medical services company provides premises, account collection and booking services to the doctor in exchange for a service fee. The doctor sees the patient and is paid by the patient. The service company receives the patient’s payment and holds that payment on behalf of the doctor. The service company then pays the patient fees to the doctor (after deducting its service fee). This contracting arrangement is less likely to be subject to payroll tax because: the service company is providing services to the doctor (rather than the doctor providing services to the practice); and

the patient fees are paid to, and owned by, the doctor even if those fees are received by the service company on behalf of the doctor.

The above examples show how important it is to make sure that the payroll tax contractor provisions are considered so that the terms of a contract are clear in their intention. Otherwise the doctor’s contract may be subject to payroll tax. The above article is of general information and cannot be relied upon as advice. 1. See section 13B(1)(a) Payroll Tax Act 1971 (Qld)

58 Doctor Q Summer

UNIQUE OFFER TO AMA QUEENSLAND MEMBERS HWL Ebsworth is a full service commercial law firm providing expert legal services at competitive rates. Through our combination of legal specialists and industry experience, HWL Ebsworth is ideally placed to protect the interests of our clients while enabling them to achieve their commercial and operational objectives. HWL Ebsworth is currently ranked as the largest legal partnership in Australia according to the most recent partnership surveys published by The Australian and the Australian Financial Review. HWL Ebsworth is very pleased to have recently welcomed the team from TressCox Lawyers to the firm. This team offers clients more than 100 years’ experience representing medical practitioners in various areas of health and aged care law. The Health and Aged Care Services Team 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 our team can assist you to operate a commercially viable business that complies with the health services industry’s unique and ever changing regulatory environment. As a member of AMA Queensland, this partnership provides you with legal assistance and support, both individually, for your business and your staff. HWL Ebsworth will provide AMA Queensland members with an initial consultation by phone or in person at no cost (up to 30 minutes). Take advantage of this benefit with advice from highly qualified lawyers on: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪

Setting up your practice, including buying a business, business structuring, contracts and advice on restraint of trade clauses; Running your practice, including IR & Workplace Safety, employment, service, and locum contracts and corporate governance; Group practice issues and bringing in additional owners including partnership, shareholder and buy-sell agreements; Selling your practice including helping to get ready for sale, workout and earn-out arrangements; Resolution of disputes about restraints, contracts (including building contracts and shareholder agreements) and debt collection; Regulatory issues including investigations by the OHO, AHPRA and Medicare Australia; Your personal matters including buying, selling and leasing property; and Estate planning including creating and documenting strategies to transfer wealth from one generation to the next.

Katharine Philp Partner P (07) 3169 4974 E kphilp@hwle.com.au

Lynette Reynolds Partner P (07) 3169 4960 E lreynolds@hwle.com.au

Bill Hickey Partner P (07) 3169 4768 E bhickey@hwle.com.au

Tony Mylne Partner P (07) 3169 4975 E tmylne@hwle.com.au hwlebsworth.com.au

Bookkeeping essentials for your practice As a doctor and medical practice owner, it is important to understand how your practice and bookkeeping is managed. This ensures, at any stage, you can interpret the financial data in relation to how your practice is performing and be confident in the figures provided by your software.

J U L I E O â€™ R E I L LY

Buisness Advisory Director, William Buck Accountants P: (07) 3229 5100 E: julie.oreilly@ williambuck.com

Below we share our top tips for making sure your books are in order.

REVIEW YOUR PROCESS PA P E R W O R K

A C C E S S I N G I N F O R M AT I O N

e to find the paperwork your accountant or bookkeeper is requesting? Ensure you have good bookkeeping software in place.

Ensure you have a login to your bookkeeping software and know how to access the information.

COMPLETING END OF MONTH CHECKS AND BALANCES Before running any financial reports on your practice, it is imperative your books have been reconciled. If this has not occurred, the reports will not accurately reflect the period you are reviewing. 1. BANK ACCOUNT AND CREDIT CARDS Should be reconciled at the end of each month to the bank statement. Even if your bank data is feeding electronically into your software, it is important to ensure these reconcile. The next step is to review any outstanding transactions that have been outstanding for two months, three months or more? Review these regularly to ensure there are not any issues with collection or payment. 2. PAYABLES AND RECEIVABLES You should run these reports in your software and ensure all amounts are current. If they are not current (60 days, 90 days) they need review to ensure they are in fact receivable or payable.

3. FIXED ASSETS Have fixed assets been recorded correctly, including any costs in getting the asset ready for use? The instant asset write-off for assets costing $20,000 excluding GST has been extended to 30 June 2019. 3. PAYROLL AND SUPERANNUATION Does the amount of PAYG withholding tax per the payroll report agree to the balance on your financial statements at the end of the month? If not, are you behind on paying the Australian Tax Office? Have you checked the superannuation liability agrees to the payroll report and is being paid through the Australian Tax Office clearing house within 28 days of the end of the quarter? If superannuation is not paid on time, you may be unable to claim a tax deduction.

NEED A SECOND OPINION ON YOUR BOOKKEEPING? William Buck supports doctors and their practices with all aspects of bookkeeping including managing payroll and reviewing your end of month or end or quarter figures. William Buck can be engaged through AMA Queensland Bookkeeping on a monthly retainer or as a one-off engagement. Contact William Buck for a comprehensive review of your practicesâ€™ bookkeeping today. 60 Doctor Q Summer

BOOKKEEPING SERVICES Do your practice accounts need a health check? The Bookkeeping Services team at AMA Queensland provides professional and confidential services for your organisation. We offer a service that includes a complete payroll function (including superannuation, PAYG and payroll tax), creditors, debtors, bank reconciliations, provision of monthly financial reports as well as the completion and lodgement of Business Activity Statements. We communicate with your tax accountants to ensure services are performed efficiently; this reduces doublehandling and saves you money. Our team is also supported by a workplace relations department giving us access to current, accurate and timely HR advice when required. As registered BAS agents, our team can provide assistance in a wide range of services to suit your practice needs.

BOOKKEEPING

FOR FURTHER INFORMATION PLEASE CONTACT OUR OFFICE.

— Bank reconciliation, including reconciliation of the practice management software — Accounts receivable and payable

— P: (07) 3229 5100

— Monthly financial reporting and budgeting

PAYROLL — — — — —

Staff and doctors’ wages Locum doctor payments Superannuation Payment summaries Payroll tax

Our team has extensive knowledge of the Health Professionals and Support Services and Nurses Awards.

BUSINESS ACTIVITY STATEMENT — GST and PAYG lodgement monthly or quarterly

ACCOUNTING SOFTWARE SET UP — Including staff training and procedures

PRACTICE PROCESS REVIEW Review existing practice processes to ensure legislative compliance

— E: admin@amaqbookkeeping.com

There is no rhyme or reason to the romantic feelings some patients develop for their doctor. It may be a physical attraction, the result of an exaggerated deference to authority, or a reflection of the patient’s personal situation. A sympathetic ear, or simply being heard, can often trigger an emotional response from a patient. Whatever the reason, the potential blurring of the doctor–patient relationship can lead to significant professional consequences if not managed promptly and appropriately.

CASE STUDY A female patient in an abusive relationship always saw a female doctor in the practice. She was booked with a male doctor at short notice after her usual doctor left to deal with an emergency. The male doctor was sympathetic towards the patient who had been verbally abused by her partner the previous night. The patient’s usual doctor returned from leave, but the patient continued to book with the male doctor. The frequency of the visits increased and the patient asked the doctor for his mobile number in case of emergency. He provided it, concerned about the patient’s previous history of domestic violence. The patient didn’t use the number until late one night when he received a text:

My life sux - my time with you is all that keeps me going. Wanna meet 4 coffee?

NERISSA FERRIE Medico-legal Adviser, MDA National

DISCUSSION In hindsight, the doctor was able to recall the warning signs. The patient didn’t need to attend so often. She always booked his last appointment for the day and spent much of the consultation engaging him in conversation. The doctor was aware she was vulnerable and didn’t know how to raise the issue without causing her distress. Once he received the text, he realised the doctor–patient relationship was unhealthy and that he would need to end the therapeutic relationship. A medico-legal adviser assisted the doctor to write to the patient, stating it was in her best interests to find a new doctor or practice.

The doctor was very concerned, and he was unsure what to do. His wife, also a doctor, urged him to contact his medical indemnity insurer for advice.

Due to the risk of repercussions if the letter was opened by the patient’s partner, it was agreed that the doctor would explain the situation and provide the letter to her in person. The patient was embarrassed and she opted to move to another practice.

THINGS TO REMEMBER Doctors may feel responsible for the patient developing feelings towards them, but this is not usually the case. Over time, boundaries can blur gradually and subtly. It may seem easy to continue to see the patient rather than address the issue – but if warning bells are sounding, seek advice about ending the therapeutic relationship. The lovelorn patient is often vulnerable and should be managed sensitively. ‘Firm but kind’ is usually the best approach, as the patient may feel hurt and embarrassed when their advances are rejected. Embarrassment or naivety in these circumstances is understandable, but will carry little weight with AHPRA if it becomes clear that professional boundaries have

been breached and the doctor has not dealt with the matter in a professional and timely manner. Keep your professional and personal life separate, e.g. don’t accept friend requests from patients on Facebook and avoid discussing your personal life during consultations. Doctors sometimes continue the therapeutic relationship, fearing that the patient will make a complaint if they end the relationship. In our experience, we find that the risk of a complaint increases the longer you continue to see the patient. Return any gifts, but keep a record of text messages (as screenshots), emails, letters or cards in a separate medico-legal file.

If the therapeutic relationship is causing you concern or no longer healthy, please contact your medical indemnity insurer for advice on how to manage the situation. 62 Doctor Q Summer

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.

PAT I E N T R E F E R R A L S P O T L I G H T

Cerebral Palsy Alliance Cerebral Palsy Alliance help babies, children, teenagers and adults living with cerebral palsy and other neurological and physical disabilities lead the most comfortable, independent and inclusive lives possible. They provide world-class services for people and families living with a broad range of disabilities. The Cerebral Palsy Alliance (CPA) started life as the Spastic Centre in 1945 and was renamed the Cerebral Palsy Alliance in 2011.

LEARNING

SERVICES

Accommodation Communication aids Community access services Computer software, apps and accessibility Environmental Modifications Equipment Clinics Household aids Special interest programs Vehicle modification

Employability after leaving school Certificate Courses School readiness and school support School holiday workshops Early childhood intervention Conductive education Mentoring Prepare for the workforce A supported workplace Camps Toy swap

FINANCIAL Coordination of supports, including NDIS

MEDICAL

A dental clinic Check ups Exercise Physiology Family Support and Counselling Help with feeding and mealtimes Fitness and sport for children, teens and adults Movement skills Occupational therapy Help with social skills Physiotherapy Psychology Respite care Speech pathology

Lucy Jacka, General Manager of Fundraising at CPA, said “We simply couldn’t do what we do without our supporters and donors. Many people with cerebral palsy and their families require financial, physical and emotional support across a lifetime and some are amongst the most vulnerable in our community.” Joseph (pictured) aged one, has been attending Cerebral Palsy Alliance since 2017, following his traumatic birth, seizures and abnormal brain MRI. He has been found to have spasticity (muscle tightness) in both legs and reduced fine motor skills in his left hand. Lucy said, “Early diagnosis is imperative to get a child on the right path. The CPA has been able to help offer support and therapy to Joseph and his family.

“Our goal is to support children and families to allow them to live their best lives today through providing services and support programs that are not covered by the National Disability Insurance Scheme.”

CONTACT HOW TO REFER A PATIENT TO THE CEREBRAL PALSY ALLIANCE Email: ask@cerebralpalsy.org.au Call: 1300 888 373 Web: www.cerebralpalsy.org.au/about-conditions/refer-a-client-to-cpa/

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SMSF lending makes sense for medical professionals Medical practices aren’t like other businesses, but many financial institutions tend to treat them like that. For example, for many doctors, owning your own rooms through your self-managed super fund (SMSF) and leasing the property back to your business is a common strategy. Many major banks, however, have recently decided to discontinue lending into SMSFs for property purchases. At BOQ Specialist, we have a different approach. We know that once a doctor settles on a location, they’re unlikely to move for a long time and if the rental repayments to their SMSF match the loan repayments, that rent becomes something like a forced savings plan - hopefully one with a capital growth upside.

THE BENEFITS OF SMSF LENDING Property remains a savvy investment for owner-occupiers. Property is easier to look after. It’s something where you commonly require less expertise than that needed for equities investments and it is generally less volatile than equities markets. There are three principal benefits of borrowing through your SMSF to buy your own rooms: The SMSF is potentially a more taxeffective structure than your business; Your business doesn’t tie up capital in the property, because the SMSF is

doing so; and In the event of financial difficulty, there may be some protection for your SMSF investments.

Of course, there are also possible downsides involved in such a strategy. It means that your SMSF may be overly exposed to a single asset—even if that exposure is to your own business. There are also costs associated with getting a property into the fund. You have to have a separate instalment trust to own the property in trust on behalf of the SMSF. Often, there are also costs for the valuations, loan documentation and potentially stamp duty. It’s really a decision that needs to be carefully considered based on each individual’s circumstances to better understand whether the benefits outweigh the costs.

HOW DOES THIS WORK IN PRACTICE? How this may look in the real world is: a doctor has $700,000 in her SMSF. She sees some new rooms for $1million and decides to purchase the property using $500,000 of the SMSF’s assets and a $500,000 loan. Her SMSF will have to borrow using a limited recourse borrowing arrangement (LRBA). LRBAs are specific loan structures which allow super funds to borrow to acquire an asset and limits the security and recourse to the asset purchased. Once purchased, the business will pay rent to the SMSF, which has been determined on a commercial basis to be $1,500 per week, a gross yield of 7.8 per cent. Potentially, any rental income and capital gain on the sale of the property will only be taxed at a maximum rate of 15 per cent (in fact, the SMSF may not pay any tax). This opportunity is also appealing for practitioners who already own their own rooms. Under the present legislation, you may be able to sell your rooms to your own SMSF and hopefully watch the value increase over time as you stay there.

HUGH LANDER BOQ Specialist

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

HOW CAN BOQ SPECIALIST HELP? The tax benefits of this strategy may be greater than just relying on a capital gain on your property. Income in the SMSF is taxed at concessional rates. So, if your property is positively geared, effectively you are getting investment returns in super at a very reasonable tax rate. BOQ Specialist’s lending allow a higher level of gearing for doctors - up to 90 per cent for an owner-occupied commercial property. This allows those with smaller SMSF balances to consider getting into the property market.

Doctor Q Summer 65

RESTAURANT REVIEW

Heritij Forget everything you think you know about Indian food and embark on an Asian-Indian gastronomy like no other at Heritij. Part of the new Brisbane Quarter complex in the CBD, Heritij has a distinctive menu, combining traditional Indian cooking methods, with Asian flavours and local Australian produce. Head chef Manjunath Mural heralds from a family of doctors, but chose a culinary career instead. He has a special interest in modern Indian cuisine and is world renowned for his role as executive chef of Song of India restaurant in Singapore. He has twice earned a Michelin Star for Song of India, which remains the first and only Indian restaurant in the entirety of South East Asia to be awarded with such an honour. To say that Chef Mural knows how to create stunning food that will create lasting memories in your mind as well as on your taste buds is clearly an understatement. With embarking on ‘a gastronomic journey with an exciting explosion of flavour’ in mind, the team at Heritij have created a truly unique menu that strikes the perfect balance between respecting family tradition and celebrating innovation. Before you’ve even perused the food menu, their house cocktail list will leave you intrigued and excited about what is to come. Swap your espresso martini for a Dirty Chai Martini, with the welcome addition of house chai blend and Kahlua to this cocktail classic. Trade your French martini for a Watermelon Blush with vodka, Chambord, coriander and lime. Gin comes muddled with lemon and saffron syrup in the Saffronside, while a mint julep gets a makeover with tea in the Darjeeling Julep. However, I highly recommend the refreshing East West Sling – a sensational take on the Singapore Sling, swapping the usual

66 Doctor Q Summer

Cointreau for camomile cardamom shrub, yellow chartreuse, Beefeater Gin and pineapple. If cocktails are not your scene, their extensive whiskey menu may take your fancy, with a long list of Irish, Scottish, Australian, American, Indian and Japanese blends. Their wine menu of similar length heroes many of our own Australian and New Zealand drops amongst a fine selection from France, Greece and Italy. This gastronomic journey is a celebration of aromatic spice rather than heat, and begins with small plates or shuroo, which are adequate for an entrée or can be combined to create the ultimate Indian style tapas. Try handkerchief roti with pulled lamb and Bengali five spice, eucalyptus-scented samosa, crispy pork belly with vindaloo and wasabi crab, or pani puri featuring our native Kakadu plum. My suggestion is definitely the bhaji with shrimp, samphire and peanut chutney, as well as the papdi chaat – a play on Indian street nachos with a medley of crunchy textures amongst a delectable mix of pineapple, cumin yogurt and avocado. Next are a range of dishes from the tandoor, a large concrete oven creating the signature smoky flavour we recognise as tandoori. Try chicken thigh with thai basil and mint, lamb mince with galangal spice, vegetables with tomato kasundi or pippali chicken with lemon myrtle and cheddar. However, my favourite was definitely the pomegranate prawns – large king prawns bathed in an iridescent pink pomegranate marinade; their sweet tanginess paired perfectly with a cumin yoghurt and mint jelly. Mains are separated into aagaamee and phir (smaller and larger respectively). For something light, try the braised lamb shank with nutmeg, mace and saltbush leaves; or perhaps the half rock lobster with coconut

gassi. I whole heartedly recommend the spinach kofta, where luxurious green kofta come filled with cottage cheese, in a sea of curry flavoured with cashew and fennel. For the more ravenous, try the leg of lamb en flambé or the market fish with semolina crumb. However, it would be remiss not to consider the Curry Culture, a hearty selection of three curries with saffron rice and raita. Try mild but tangy Kashmiri lamb, spicy goan fish and silky smooth chicken makhna, or tasty spinach kofta with black lentil dal and vegetable masala. You cannot overlook the Heritij naans as an accompaniment, flavoured with mushroom, sesame and garlic no less. And if the curries are too meek for your robust palate, the staff are more

than happy to provide a supplemental bowl of chillies to get the heart racing! Sides include potato mash with cumin and turmeric, biryani rice, smoked aubergines with green chilli and for the courageous, gunpowder potatoes. And just when you think youâ€™ve seen everything, you can try their own version of fondue, a fascinating combination of gooey Emmental cheese with masala spice. When you reach the end of your gastronomical destination, you will find dessert, quickly followed by food coma. While the traditionally inclined may wish to try the elaneer payasam, a coconut sphere with rose water praline, the saffron cheesecake log with pistachio crumb as well as the chai and macadamia

ice cream have so far proven to be the crowd-favourites thanks to their impeccable balance of aromatic scents amongst creamy textures served with a side of crunch. Throughout this magnificent journey of spice, not once is there an overpowering of the senses. Every dish remains distinctively fragrant and unbelievably delicious, without leaving a trace of overbearing after-taste on the palate. Indeed, Chef Mural demonstrates at Heritij that Indian cuisine is no more about mouth-blistering chilli than it is about oily butter chicken from the local take-away. This is modern Indian food at its finest and is as much a feast for the senses as it is for the stomach.

D R K AT G R I D L E Y Advanced Emergency Trainee, Queensland Childrenâ€™s Hospital; and member, AMA Queensland Council of Doctors in Training

Heritij is located at 300 George Street Brisbane CBD and is open from 11.30am Monday to Saturday for lunch and dinner. Menus can be found online at https://heritij.com.au/. Doctor Q Summer 67

All about you

T V: S U I T S On the run from a drug deal gone bad, Mike Ross, a brilliant college dropout, finds himself a job working with Harvey Specter, one of New York City’s best lawyers. There’s lots of smack talk, throwing folders across the desk and out-manouevering, as well as some impressive business wear. The best reason to watch Suits though, is to watch the now-Duchess of Sussex before the royal family made her hand in her notice. Harvey’s the main star here, but he’s kind of a bully. Side characters Donna and Louis Litt (you’ve been Litt up) make it one to add to your watch list.

P O D C A S T: AUSTRALIAN TRUE CRIME Radio star, comedian and author Meshel Laurie and true crime author Emily Webb interview writers, victims, investigators and perpetrators about Australia’s true crime. Their tag line is ‘go beyond the news cycle to find out how people become killers, how people become victims, and what happens next’. They cover some well-known cases like Maria Korp, Robert Farquharson and Alison Baden-Clay and the stand out interviews are definitely those with the retired police detectives about how the perpetrators were caught. The hosts handle the interviews with great care and a focus on the victims and their families. Download now.

68 Doctor Q Summer

D O N AT E : AMA QUEENSLAND F O U N D AT I O N Our most affable Ocker Doctor, Dr Matt Young and his wiley sidekick, Dr Joss O’Loan, don their flamingo-adorned shirts, put on some 70s rock and venture out in their Kombi van to cure Hepatitis C. Matt talked about the how the Kombi clinic came about in one of his recent Doctor Q columns. The Kombi team aim to go outside the boundaries of hospitals and clinics and reach people in their own environment. Donate now at www.amaqfoundation.com.au or call (07) 3872 2222.

My nanâ€™s boiled

e k a c s a m Christ INGREDIENTS 375g mixed fruit 1 cup water or rum or half/half 1 cup sugar 1 tsp all spice 1 tsp cinnamon 1 tsp bicarb soda 125g butter 2 eggs 1 cup plain flour 1 cup self-raising flour

DIRECTIONS Boil all the ingredients in a large saucepan, except for the eggs and flour. Simmer for 10 minutes, then leave to cool for 20 minutes. Beat the eggs and fold in. Sift the two flours together and fold in. Mix with a wooden spoon, then cook on 180Â°C for one hour and ten minutes. You can press some almonds in to the top if you want to be fancy. Even if it turns out dry, just serve it with some custard.

Doctor Q Summer 69

UPCOMING FILMS Please note upcoming film are subject to change

20 December Colette 26 December Ralph Breaks the Internet The Favourite Vice Aquaman

THE MADNESS OF KING GEORGE III 15 December, 2.15pm | 16 December, 2.15pm | 17 December, 2.15pm National Theatre Live Starring Olivier Award-winners Mark Gatiss (Sherlock, Wolf Hall) in the title role, and Adrian Scarborough (Upstairs Downstairs, After the Dance). It’s 1786 and King George III is the most powerful man in the world. But his behaviour is becoming increasingly erratic as he succumbs to fits of lunacy. With the king’s mind unravelling at a dramatic pace, ambitious politicians and the scheming Prince of Wales threaten to undermine the power of the crown, and expose the fine line between a King and a man.

MARNIE 9 February, 2.30pm | 13 February, 10am Met Opera When a compulsive thief is caught red-handed and blackmailed into marriage, the strange new arrangement might hold the key to unlock her mysterious past. Nico Muhly’s Marnie, based the novel which inspired Alfred Hitchcock’s acclaimed psychological thriller, has its US premiere at the Met this season. Isabel Leonard stars in the title role opposite Christopher Maltman as her blackmailing husband Mark Rutland, Iestyn Davies as his brother Terry, Janis Kelly as Mrs. Rutland, and acclaimed mezzo-soprano Denyce Graves as Marnie’s mother.

70 Doctor Q Summer

VINCENT VAN GOGH - A NEW WAY O F S E E I N G 14 February, 10am | 16 February, 1pm | 17 February, 1pm Exhibition on Screen Perhaps more than any other artist, Van Gogh’s life has long captured the imagination of storytellers. Delving deep into his fascinating and sometimes deeply troubled world comes this definitive, awardwinning documentary directed by David Bickerstaff. Showcasing Van Gogh’s iconic works like never before and featuring exclusive interviews with the curatorial team at the Van Gogh Museum, this exhibition on screen favourite from season two makes a welcome return to the big screen.

1 January 2019 Mary Poppins Returns 3 January 2019 How to Train Your Dragon: The Hidden World 17 January 2019 Mary, Queen of Scots Storm Boy Glass 24 January 2019 Green Book

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River cruises

Every year there are more cruise companies offering more ships and itineraries on the major rivers in Europe and indeed the world. River cruises are being preferred over some of the more traditional coach tours. There are the benefits of cruising that we all love: the food and drinks; exploring a new port every day; the included shore excursions; the onboard spa; doing as much or as little as you like; travelling through the lochs; and especially unpacking just the once.

WHICH CRUISE IS THE RIGHT ONE FOR YOU? Your experienced travel specialists at Orbit World Travel can assist you to navigate the many options to find the perfect option that fits your expectations and budget. Some of the questions you need to ask yourself before setting sail might be:

Do you prefer a smaller ship? What type of cabin do you prefer? What is the benefit of a balcony? How many shore excursions would you like included? Is having your own butler the treat you deserve?

PORTUGAL

There are cruises in Portugal through the stunning Douro Valley – and why not continue your travel onto Spain?

FRANCE AND RUSSIA

When in France you can cruise on the Seine and The Rhone rivers or head north to Russia and cruise the Volga between Moscow and St Petersburg.

AMERICA

Cruise the mighty Mississippi, Colombia or Snake River on a paddle steamer or riverboat. Relive the traditional days of grace and grandeur with all today’s modern amenities.

VIETNAM AND CAMBODIA Cruise the mighty Mekong River from Siem Reap to Ho Chi Minh. Wake up every day to a new town and experience.

Did you know there are five-star cruise lines that offer magnificent newly built ships for river cruises – even with a James Bond style pop-up bar! They all offer different experiences - private opera concerts in castles or private recitals in local town halls, bike rides through the area or even a private feast in a hilltop castle overlooking the magnificent river below. There are numerous cruise lines that sail the iconic 15day Amsterdam to Budapest route. For those that haven’t done a river cruise before, it is a great starting cruise for anyone. However, there are many more on offer in Europe.

EGYPT

Journey along the Nile and follow in the wake of pharaohs as you cruise between Luxor and Aswan. Extend your stay to include the Pyramids at Giza and the amazing Abu Simbel

BOTSWANA

Enjoy a safari with a difference - the kind where you decide if you want to be up early with the birds or laze all morning watching game from the comfort of your bed. You can even cruise in much more luxurious accommodation than Bogey and Bacall on the original African Queen.

CHINA

Cruise the famous Yangtze River and see the amazing and ambitious The Gorges Dam project. Start your day with tai chi at sunrise.

EXCLUSIVE VIRTUOSO BENEFIT:

Receive one COMPLIMENTARY Hotel Night (subject to availability) either pre or post journey with every 2019 TAUCK RIVER CRUISE for bookings prior to 31DEC2018. This offer is combinable with Time on TAUCK (one COMPLIMENTARY Hotel Night* pre or post journey. *Xmas Markets River Cruises excluded from Time on Tauck promotion). MAXIMUM of TWO nights COMPLIMENTARY with any booking.

INDIA

Cruise the sacred Ganges from Kolkata. Let it be the starting point for your Indian adventure. Whilst in Kolkata visit Mother Teresa’s mission and then perhaps Varanasi and onto the Golden Triangle of Delhi, Agra, Jaipur… the options are endless.

MYA N M A R

Discover one of the world’s least explored destinations. Uncover the hidden secrets of the Irrawaddy River as your cruise from Mandalay to Yangon.

AUSTRALIA

Australia has its own river cruises on the mighty Murray River. You can cruise on an authentic recreation from Australia’s golden age of paddle steamers.

AMA Queensland Orbit World Travel vider: preferred travel pro P: 1300 262 885 m.au E: travel@amaq.co l.com.au ave dtr orl tw www.orbi

Tribalism D R M AT T Y O U N G

General Practitioner, Inala Medical Centre

Homo sapiens evolved 200,000 years ago. Evolutionary archaeologists concur our species is the pinnacle of hominid development. Maybe even the peak of the entire animal kingdom. Our brains are sensational. Lots of neuronal pathways and linkages enable us the capacity for abstract thought and to conjure up art and music, culture and complexity. We have binocular vision, can walk for hours and have complicated, complex language. We can love and hate, laugh and cry. All these attributes make up for our puny stature, our weak muscles, inability to climb, lack of claws and tiny teeth. We have no venom or poison. Besides Usain Bolt, none of us run very fast, we can’t fight, we have insipid roars, we’re awkward swimmers and we can’t fly. Our weaponry is pretty basic. Our biggest asset though is our sense of the social. We love to hang around each other in small groups. We are tribal. Always have been. Knocking about in small groups enabled us to swap stories and swap ideas. Tools were developed as we brainstormed, discussed, modified and built on the ideas of others. Fire was controlled. Knowledge was accumulated over 72 Doctor Q Summer Spring

succeeding generations. Oral histories were passed on as tribes sat around fires throwing another mastodon on the barbie. Then pictorial languages and later writing really nailed this concept. But always, it was the tribe that set us apart, to facilitate this accumulation of knowledge. Although it may not be entirely obvious, I still reckon we are still tribal. We might not cavort around in bear skins, live in caves or go hunting with spears together, but tribalism is still at the centre of our societies. We still feel the need to be part of a group. A team. A club. An organisation. It fulfils some ancient, primeval need. It is part of our species. We need to belong. We need kindred spirits with whom to talk, relate, communicate and live. We need people to rely on and share the great game of life. Pivotally, we need other people who we can see as similar, who are similarly aligned and whose interests are shared. Sometimes it is just as simple as people who look the same and share origins. Tribes rocking up to the footy, all wearing the same jerseys or large, hairy men with huge moustaches, all called Stavros all turning up to the Greek Club or Paniyiri. I see it in club sport. Spectators wearing their club colours, blindly supporting their organisation and sending all their vitriol and spleen at another tribe. Of course, actually running onto the paddock and playing sport with a club involves even greater personal investment into a tribe. The more you put in, the more you take

out. Running on to a field together as a football or cricket tribe is special. It really is tribal warfare. Sometimes, the essence of tribalism is the sense of ‘US’. And just as essentially, if there is an ‘US’ there has to be a ‘THEM’. Tribalism certainly has its downside when people focus on differences between tribes rather than commonality within tribes. I also see it in the workplace. Professional organisations, unions, businesses. They can be a wonderful source of camaraderie, support and belonging but also a focal point for rivalry, tension and angst. But let’s focus on positives. Creating a tribe of your own is a wonderful ambition. We need it. The work place is a classic opportunity to create that tribal vibe. I see far too many doctors isolated, living life as egocentric soloists, even within a group practice. Competing for patients, competing for jobs, competing in a consumerist, capitalist world. Trying to one-up each other and protect their territory. Some tribal support and synergy in the work place is invaluable. Valuing work mates and taking a personal interest in each other is such a basic tribal rite. Having friends instead of colleagues is vital. It makes work much less draining. So, get yourself a tribe. It’s an evolutionary requirement. Make your practice more conducive to making your work mates your tribe. Back each other. Support each other. At the very least, join AMA Queensland.

PHIL MANSER Wine Direct

P: 1800 649 463 E: philmanser@ winedirect.com.au

Wine tasting

Wine Direct’s Phil Manser hosted a wine tasting evening for members at Hunstanton, AMA Queensland in October. He presented grower Champagnes to wine enthusiasts, featuring the stunning Bernard Remy Grand Cru NV, 100 per cent Chardonnay Champagne from the most prestigious Grand Cru village of all, Le Mesnil. This was finished with relish and served as wonderful pre-cursor to four magnificent reds, including two winners of the Grange Challenge, previously held at AMA House. As good as these imposing reds were, Phil Manser stole the show with his own reserve wine 2016 Manser Block 4 Shiraz, which looked amazing next to its more expensive peers, one of which sits at $160/bottle. Members could purchase it on the night at $55 a bottle - quite the bargain given it will sell for USD$120/bottle when it makes it to Gordon Ramsay’s Steak Restaurant in Las Vegas.

Drs Tahlia Gadowski and Hannah Swan

The takeaway for all concerned is there is a world of top class wine if you’re game enough to move away from the big brands. Overall, a wonderful night of top end Champagne and Reserve reds – stay tuned for our next member wine event. Doctor Doctor QQ Summer Spring 73

INPRINT

Smart time management for doctors Kate Christie Review by Dr Sarah Coll

As medical professionals we are busy. As such, it is critical that as a profession we continue to focus on the mental health and wellbeing of doctors. Part A of Christieâ€™s book guides the reader through the 5 SMART Steps - a logical, simple to follow framework which every doctor can easily adopt. Part B provides productivity strategies targeted at the medical profession. Time management is central to success as a junior doctor, in establishing and maintaining a practice, continuing to study, and indispensable as we meet the expectations of our patients. Kate Christie takes a practical, no nonsense approach to assist us to better manage our time. She encourages the reader to understand exactly where they spend their time, identify what they can reject from their day or delegate, and what they can do differently or more efficiently to regain hours of lost time. She challenges us to think of time as not something we must manage, but as something we must invest. She provides the framework and motivation that allows us to continually reflect on what we choose to spend our time on, and to ensure we use all of our time well. Her book is punchy, insightful and humorous. It fulfils its intention of helping doctors reclaim precious time. Smart Time Management for Doctors is available in hard and soft copy on Amazon and in hard copy at www.timestylers com. For more information about Kate Christie, visit www.timestylers.com or connect via LinkedIn.

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Doctor Q Dr Christopher Que Hee Dr Barry Hickey

74 Doctor Q Summer

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Dr Chantel van Werkum won a copy of Williams Obstetrics, 25th Edition, thanks to our friends at McGraw-Hill Education.

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MEDICAL ALMONERS GROUP The MBAQ has helped establish a Medical Almoners Group comprised of medical practitioners who are prepared to visit colleagues who are patients in hospitals or nursing homes at their request to see if they can be of any help. They will not provide treatment and there is no charge. It gives the opportunity for those who have the time to help those needing emotional and social support. If you would like to arrange a visit from a medical colleague, or, would like to volunteer to visit a medical colleague, please contact MBAQ Coordinator on ph: (07) 3872 2222 or e: mbaq@amaq.com.au or visit: www.MBAQ.org.au

Doctor Q Summer 75

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The Everyday Plus Account. The only everyday account that allows you to earn points from a choice of two rewards programs. Earn 1 Qantas Point+ or 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 Qantas Points+ or Velocity Points^ for flights, merchandise, holidays and more. It’s an everyday account that could take you places. Visit us at boqspecialist.com.au/everydayplus to view our exclusive offers or speak to your local finance specialist on 1300 131 141. Car loans | Commercial property | Credit cards | Equipment finance | Fit-out finance | Foreign exchange | Home loans | Personal loans | Practice purchase | Practice set-up | Savings accounts | SMSF | Transaction accounts | Term deposits | Vehicle finance To earn Qantas Points you must be a member of the Qantas Frequent Flyer Program. A joining fee may apply. Membership and Qantas Points are subject to the Terms and Conditions, available at qantas.com/terms. ^ 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. * To determine the average daily balance for your account, add the closing balance from each day in the month together, and then divide the total by the number of days in the month. 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”). 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 here before making any decision about whether to acquire the product. We reserve the right to cease offering these products at any time without notice. The financial services material in this document has been prepared by BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL no. 244616 and not by Velocity Frequent Flyer (VFF) or by Qantas Frequent Flyer (QFF). VFF and QFF do not hold an Australian financial services licence to provide financial product advice and do not exercise control over the content of the document. VFF and QFF do not take responsibility for any financial product advice contained in this document. BOQS001783 V1 06/18