Doctor Q is free to AMA Queensland Members
WINTER 2018 | VOL. 107
New President, Board and Council
MOCA 5 for newbies Digital healthcare update
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CONTENTS
REPORTS
16
4
Editor’s desk
8
President’s report
10
F E AT U R E S 16
AMA Queensland New President
CEO’s report
18
34
Council of Doctors in Training update
AMA Queensland New Board and Council
26
MOCA 5 for newbies
40
Membership insights
70
Foundation news
AMA QUEENSLAND NEW PRESIDENT DR DILIP DHUPELIA
BUSINESS TOOLS
30
CURRENT ISSUES
54
Specialist start up
14
2018 Budget submission
56
Estate planning
22
A digital update
58
Year-end tax planning considerations
24
Paediatric access to be explored in new Health Vision
60
Confidentiality vs risk of harm
28
62
Mind the gap
Single touch payroll - are you prepared?
64
Getting the right finance for your equipment
32
Trust and confidence in the employment relationship
36
Public bariatric surgery trial for diabetes
37
We need a hero
A DAY I N T H E L I F E O F A C O M M O N W E A LT H G A M E S DOCTOR
PEOPLE & EVENTS
38
12
Event wrap ups
65
Study on holiday
30
A Day in the Life of a Commonwealth Games doctor
66
Restaurant review
38
Almost Anatomical
68
All About You
42
Resilience on the Run
69
Dendy Cinemas
44
Events calendar
72
Dr Matt Young: great people, great activities, great venues
47
Meet the Speaker: Associate Professor Melissa Kang
73
Ah Lagrein... you’ve done it again
48
Junior Doctor Conference program
74
50
AMA Queensland Annual Conference
InPrint: Harrison’s Principles of Internal Medicine, Twentieth Edition
52
Local Medical Association round up
A L M O S T A N AT O M I C A L WHEN AN ARTIST STUDIES MEDICINE
LIFESTYLE
Doctor Q Winter
3
Editor’s Desk I love my job. I get to speak to people who are practising medicine in totally different ways and with different perspectives, like: Associate Professor Melissa Kang, just one of our amazing Women in Medicine speakers (p47);
BOARD OF DIRECTORS Dr Dilip Dhupelia President Dr Michael Cleary Vice President Dr Shaun Rudd Chair of Board and Council
Dr Fatima Ashrafi Specialist Craft Group
Dr Kat Gridley, who somehow finds the time to do amazing and exciting things (p30 and 66); Medical Student Lauren Squires, who turns anatomy lectures into pieces of art (p38);
Dr Bill Boyd Immediate Past President
Dr Margaret Kay, who’s life work is advocating for better care for doctors (p37); and
Dr Paul Bryan General Practitioner Craft Group
We look forward to working with our new President, Board and Council for this year also. If you would like to contact us in regards to Doctor Q, please email me at editor@amaq.com.au.
Dr Michael Clements North Area Representive Dr Sarah Coll Specialist Craft Group
Michelle
Haydn Dodds Medical Student Craft Group
OBITUARIES
Dr John Hall Downs and West Area Representive
The following AMA Queensland members have recently passed away. Our sincere condolences to their families. Dr Leslie Keith JOBBINS Head and neck surgeon Late of Durack Life member of 63 years
Dr Peter HEGARTY General Practitioner Late of Warwick Member for 58 years
Dr John Joseph O’HARA Pathologist Late of Dondingalong, NSW Life member of 75 years
Dr Peter Julian DUFF Anaesthestist Late of Townsville Member for 44 years
COVER IMAGE As noted in last edition, we are trying something different with our Doctor Q covers this year. We are featuring covers that inspire you to take a moment in your busy day to relax and have a few moments of peace and tranquility. This edition’s image is of the sandstone formations in Antelope Canyon near the old town of Page at Lake Powell, Arizona. Want to go there? Contact Orbit World Travel on 1300 262 885 or email travel@amaq.com.au 4 Doctor Q Winter
Dr Mellissa Naidoo Member Appointed Director
Dr Peter Isdale AM Skilled Director Ben Hancock Skilled Director
COUNCIL
Dr Kimberley Bondeson Greater Brisbane Area Representive
Dr Matt Young, who’s team is taking the stigma away from Hep C patients by driving around in a 1978 Kombi treatment van and wearing a flamingo-adorned shirt (p72).
Dr Bav Manoharan Member Appointed Director
Associate Professor Geoffrey Hawson Retired Doctors Craft Group
Clare Mahon Medical Student Observer Dr Bav Manoharan Greater Brisbane Area Representive
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 Dr John de Laat Greater Brisbane Area Representive Dr Chris Maguire Doctors in Training Craft Group
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
Editor: Michelle Ford Russ
Doctor Q is published by AMA Queensland
Graphic Designer: Aleisha Coffey
Phone:
Journalist: Chiara Lèsevre Advertising: Louise Glynn
(07) 3872 2222
Address: PO Box 123, Red Hill QLD 4059 Email:
amaq@amaq.com.au
Print Post Approved PP100007532
Disclaimer – All material in Doctor Q remains the copyright of AMA Queensland and may not be reproduced or transmitted in any form without permission. While every care is taken to provide accurate information in this publication, the material within Doctor Q is for general information and guidance only and is not intended as advice. Readers are advised to make their own enquiries and/or seek professional advice as to the accuracy of the content of such articles and/or their applicability to any particular circumstances. AMA Queensland, its servants and agents exclude, to the maximum extent permitted by law, any liability which may arise as a result of the use of the material in Doctor Q.
Escorted Study Tours in 2018 & 2019
History of Science and Medicine in Morocco
History of Medicine Cruise along the Volga
Medicine and Society in Cuba
5 – 15 October 2018
6 – 16 October 2018
Explore how science, medicine and culture intertwine on this journey from Tangier to royal Fes, onto Rabat and Marrakesh.
Cruise along the Volga River from Moscow to St Petersburg. Learn about Russia’s rich culture and fascinating medical history and stay in one of St Petersburg’s finest hotels.
This tour travels in the footsteps of previous successful Cuban study tours to examine the culture and renowned healthcare system of this music-filled tropical island.
www.jonbainestours.com/morocco
10 – 21 January 2019
www.jonbainestours.com/cuba
www.jonbainestours.com/hmedrus
Medical and Military History in Vietnam and Cambodia
Ethiopia: Historical and Contemporary
Caribbean Histories
17 January – 2 February 2019
12 – 26 February 2019
Travel through the languid, beautiful lands of the Mekong and learn about their overlapping medical, military and cultural histories.
Explore the unique and ancient heritage of Ethiopia with Dr Richard Marsh, an expert on its history, music and contemporary culture.
Learn about the histories of the people, plants and medicine of the West Indian islands on this wonderful cruise with medico-botanical historians Bill and Helen Bynum.
www.jonbainestours.com/vietmed
www.jonbainestours.com/ethiopia
www.jonbainestours.com/caribcruise
Ophthalmology in Vietnam
Palliative Care in Japan
Ecuador and Galapagos
17 – 28 February 2019
5 – 17 March 2019
27 May – 8 June 2019
Professional visits and meetings with ophthalmologists will provide excellent insight into ophthalmology and eyecare in Vietnam, alongside a full cultural programme.
Travel to the heart of this fascinating country and experience both historic and modern Japan while exploring Japanese approaches to palliative care.
Explore the rich cultural and bio diversity of Ecuador, including the incomparable Galapagos Islands on a private charter first class yacht cruise.
www.jonbainestours.com/ophthal
www.jonbainestours.com/palliative
www.jonbainestours.com/ecu
14 – 28 February 2019
In May 2019 Professor John Pearn will lead a tour to Norway, the Orkneys and Iceland, and in July Dr Paul Luckin will lead a tour to France, Belgium and Germany.
To book or enquire about these and other tours contact: Jon Baines Tours (Melbourne) Tel: 03 9343 6367 • Email: info@jonbainestours.com.au
www.jonbainestours.com
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*Available on selected new 2017/18 built vehicles purchased from 01/5/18 and delivered by 30/6/18. Lexus reserves the right to extend any offer. Recommended drive away prices shown includes 12 months’ registration, 12 months’ compulsory third party (CTP) insurance, a maximum dealer delivery charge, stamp duty and Luxury Car Tax (LCT) (if applicable) and premium paint. At participating dealerships. ^ Offer applicable to Private and ABN buyers, who are current members of AMA Queensland, on all new vehicles purchased between 1st February 2018 to 31st December 2018 and delivered by 31st December 2018. The Lexus of Brisbane Group reserves the right to extend any offer. Excludes demonstrator and pre-owned vehicles. Spicers Retreats Certificate is valid for period of 12 months and cannot be exchanged or redeemed for cash. Spicers Retreats two night luxury stay is available at the following properties only: Spicers Hidden Vale, Spicers Balfour, Spicers Clovelly, Spicers Tamarind, Spicers Potts Point and Spicers Vineyard Estate. Subject to Spicers Retreats availability. Spicers Retreats package can change without notice. Upgrades or additional nights available to purchase. See your Lexus of Brisbane Group dealer for full terms and conditions.
NX 300 LUXURY FROM $59,888 DRIVE AWAY*
RX 300 LUXURY FROM $79,888 DRIVE AWAY*
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 ^. 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 Derek Klette today. Derek Klette | Group Sales Manager | derek.klette@lexusofbrisbane.com.au | 0419 723 937
FORTITUDE VALLEY | INDOOROOPILLY | MAROOCHYDORE | SPRINGWOOD | SOUTHPORT
President’s report
DR DILIP DHUPELIA
As I write my first column for Doctor Q, I reflect upon the honour bestowed upon me by AMA Queensland members in electing me to this leadership position. Your trust in my leadership ability to take our association forward is appreciated and I will endeavour to do my best to lead, represent and advocate for our members as well as for the communities that we serve. My personal thanks to Professor Steve Kisely for competing in the ballot in such a gentlemanly manner. Steve has been an integral member of both the federal and state AMA Councils. I look forward to leveraging from his enthusiasm and commitment to the future of our Association. The elections also resulted in some new members on the AMA Queensland Council, some I have already met and some whom I am still to meet. I welcome you and thank you for nominating. It is remarkable how the AMA Queensland Council has strengthened over the past couple
of years and I have not seen such diversity of expertise before, for which we are all grateful. Under my leadership, Council will continue to be the policy making machine for our association and I intend to utilise the skills of our elected representatives to the fullest. AMA Queensland has a long, proud history of working collaboratively and successfully with state governments and health ministers in a bipartisan manner. Under my leadership, I commit to working in the same manner. By the time you read this article, I would have already had my initial meeting with Health Minister Steven Miles and would have also represented AMA Queensland on the medicopolitical forum panel at the RDAQ Conference together with the Minister and Shadow Health Minister. Rural issues and policies are flavour of the month at present for governments and AMA Queensland will remain vigilant in the areas of medical maldistribution and regional training
bottlenecks. AMA Queensland looks forward to working with the Rural Health Commissioner to see how the National Rural Generalist Program can improve and innovate the already very successful Queensland Rural Generalist Program. As part of public health awareness, AMA Queensland is calling on the government for a well-funded campaign to combat obesity. In addition, the daily reality of alcoholinduced violence goes on unabated at great cost to the community and also to the state’s health dollar. My focus for the year must remain on the future of AMA Queensland and in determining the best way forward for our doctors, for our patients and for healthcare delivery to the community at large. For this to occur, we need an even stronger AMA Queensland, a subject that I will write further on in future editions.
At the AMA National Conference: New AMA Vice President Dr Chris Zappala, new AMA President Dr Tony Bartone and AMA Queensland President Dr Dilip Dhupelia.
8 Doctor Q Winter
See some of our recent cases below:
Doctor Q Winter
9
CEO’s report
JANE SCHMITT
2018 - 19 QUEENSLAND BUDGET SUBMISSION Ahead of the 2018 State Budget, we presented our pre-budget submission to the Queensland Health Minister Steven Miles, with four key recommendations. 1. Public health AMA Queensland called on the State Government to step up the fight against Queensland’s obesity epidemic by re-introducing legislation to establish the Healthy Futures Commission Queensland. We would like to see the Commission take a whole-of-government approach to public health, starting with obesity. As part of the fight against obesity, we are lobbying for the Federal Department of Health to classify obesity as a chronic condition, rather than a risk factor. This will enable patients to access GP Management Plans for obesity alone. We are seeking the State Government’s support of our efforts in that regard. AMA Queensland has also stressed the need to develop new and innovative ways to raise awareness about the risk factors that can lead to obesity and we have called for funding for an innovative state-wide anti-obesity initiative that would specifically provide support by way of information and education to mothers, as the key influencers in their children’s eating habits. 2. Extending Resilience on the Run We were delighted to have our Resilience on the Run program recognised by Federal AMA as the Best Public Health Initiative for 2018. We have now called on the government
10 Doctor Q Winter
to boost funding for the program to include all junior doctors. In our budget submission, we also recommended: 3. Ensuring sufficient resourcing to the Office of the Health Ombudsman (OHO) in order to see complaints dealt with in a timely manner and triaged appropriately. The latter have been ongoing concerns, which we have raised with the OHO and the State Government over a number of years. We note that Andrew Brown, who was the acting Health Ombudsman, has recently been appointed Queensland’s new Health Ombudsman. We look forward to working with Andrew to significantly improve the complaints system in Queensland. 4. Establishing a new Queensland Medical Education Training Institute (QMETI) to ensure consistent training across the state. We will provide a detailed analysis of the budget outcomes in due course and we will continue our work with Minister Miles and his team to ensure AMA Queensland member views are heard. See page 14 for further information on the 2018 Budget Submission.
END-OF-LIFE CARE AMA Queensland has long been advocating for increased funding for care at the end of life initiatives. The health system needs to help patients and doctors to develop their comfort with discussing current and possible future health issues and articulating end of life care preferences.
AMA Queensland has recently called for death education to be taught in schools. The effects of our ageing population will be felt most by those at school today. Young people need to be educated about medical, legal and other issues that surround ageing and dying so they are capable of making informed choices when the time comes.
QUEENSLAND DOCTORS RECOGNISED Congratulations to:
AMA Queensland Council of Doctors in Training representative Dr Mikaela Seymour, who won the 2018 AMA Doctor in Training of the Year Award
Professor Judith Goh, who was named the 2018 AMA Woman in Medicine
Professor Beverley Rowbotham and Dr Chris Zappala, who were inducted into the AMA Roll of Fellows.
Former AMA Queensland President Dr Chris Zappala was also elected new AMA Vice President. This is an exciting time for Queensland. Chris was an outstanding advocate for the profession as AMA Queensland President and I have no doubt he will achieve great results in his new role.
WELCOME TO THE 201819 BOARD AND COUNCIL I welcome incoming AMA Queensland President Dr Dilip Dhupelia and Vice President Dr Michael Cleary and our new Council members, Drs Fatima Ashrafi, John de Laat and Rachael O’Rourke. I look forward to working together on our Strategy for 2018 – 2020 and our Health Vision, which guides our advocacy and sharpens our focus in working to strengthen the careers of our members and improve the health of all Queenslanders.
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Event Wrap ups
1.
1. Drs Timothy Chalk, Honor Magon and Ekta Paw. 2. Drs Nim Yau and Yun-Hsuan Lee 3. Panellists Dr Rhys Thomas, Shahina Bragaza, Professor Leonie Callaway, Drs Ekta Paw, Una Harrington, Katherine Gridley and AMA Queensland Council of Doctors in Training Chair Christopher Maguire.
2.
4. Drs Tony Cross, Chris Maguire and Rhys Thomas.
3.
4.
THRIVE IN YOUR JUNIOR DOCTOR YEARS A need to get the most out of the junior doctor years inspired many of our members to come along and hear a panel of senior and junior doctors discuss a range of topics crucial in staying healthy, happy and motivated during junior doctor years. The panel discussed navigating hospital politics, assertive communication and handling conflict, building leadership skills, self-care and teamwork. Thanks to sponsors MDA National, William Buck, BOQ Specialist and Doctors’ Health Fund. Congratulations to:
12 Doctor Q Winter
Dr Alice Jiao, who won a cardiologist-standard Harvey Elite stethoscope, thanks to WelchAllyn; Dr Douglas Brown, who won a Junior Doctor Conference two-day registration, including two nights at the Hilton Brisbane; and Dr Sidra Moiyad, who won overnight accommodation in the king suite at the Emporium Hotel.
ESSENTIAL C O N S I D E R AT I O N S FOR STARTING A P R I VAT E P R A C T I C E Corporate Partners provided an informative evening to outline key considerations when starting a private practice.
A M A Q U E E N S L A N D H E A LT H H U B S
AMA Queensland Health Hubs have been humming along nicely, with recent hubs in Springfield Lakes and Hervey Bay. Members have volunteered their time to help in the pop-up health check stand. They checked blood pressure, blood sugar, body mass index and lung function. The hubs are intended to address the statistic that 20 per cent of Queenslanders don’t visit their GP every year.
Proudly
hosted by:
Queensl
QDHP
and Doctors’
Health Program
me
AN INTRODUCTION TO MINDFULNESS FOR H E A LT H P R A C T I T I O N E R S
Presente d by reno wned clin practitio ician, ner the science Associate Professo academic, auth or and min r Craig Hassed, use to nav of mindfulness, dfulness this and igate the will step rigours of simple techniqu course will dem onstrate thro es you and your clin ical role professiona ugh how mindful s and resp your teams can ness can lly, and Proudly ons to increas sup e wellbein port peak clinical ibilities. Craig sponsored g in you by: perform r home ance and pers onal life. Date: Satu rday 10 March 201 Registra 8 About the tion tim presente e: 8.30am Associat r: - 9am e Professo r Craig Departm Course Hassed ent tim works at of mindful of General Prac 9am - 12. e: the tice and ness prog 30pm is coordin rams at mindfulness teaching, rese ator Monash Venue: arch and -based stre Hun clinical inte University. His meditati ss manage AMA Que stanton Veranda on, rests incl , ment, ensland ude ethics. He health promotio , 88 L’Estran n, integrat mind-body med is regularly ge Terrace icine, ive and invited to medicin oversea Kelvin Gro , e and s in hea speak and ve and has lth, prof run courses medical essi coll onal and A deliciou universities aborated with a educationa in Australia s, healthy number helping tea will l contexts mornin of the foun them to be serv g ding pres integrate national and inte ed. ident of similar con rnationa Associat Cost: Free the Australi l ion and tent. He for is a regu an Teac was regularly AMA Que lar med for ensland ia commen hers of Meditati mindfulness medical journals members $110 for on tator. He ; non-me and , integrat writes mbers. ed medicin has published thirteen e, and epig books on Craig also enetics. featured the com in the doc panion umentar e-bo y, The Con Chambe rs co-autho ok, The Mindful nection ness Man and wro collaboratio red ual, and te n with Mon the free online with Rich Mindful ash Univers ard ity and Futu ness course in reLearn.
AMA Queensland was overwhelmed with members of all ages and disciplines wanting to attend An introduction to Mindfulness for Health Practitioners. Presented by renowned clinician, academic, author and mindfulness practitioner Associate Professor Craig Hassed, who demonstrated the science of mindfulness and simple techniques to increase wellbeing. Thank you to sponsor Doctors’ Health Fund.
William Buck Director Paul Copeland spoke on getting financial structures in place; HWL Ebsworth Partner Lynette Reynolds stepped the group through essential legal considerations; BOQ Specialist Senior Consultant Simon Moore explained what you need to know about financing your group private practice; MGRS Senior Consultant James Warwick shared advice on how to manage risk through having the right practice procedures and insurance in place; and AMA Queensland Workplace Relations Manager George Sotiris spoke about selecting key staff, relevant employment legislation, policy and procedure and how AMA Queensland can support you.
PLACES ARE STRICTLY LIMITED
REGISTER NOW TO SECURE YOUR PLACE
ESSENTIAL CONSIDERATIONS
FOR STARTING A GROUP
PRIVATE PRACTICE
WEDNESDAY 18 APRIL 2018 TIME:
5.45pm for 6pm start - 8.30pm
LOCATION:
Hunstanton Verandah, AMA Queensland, 88 L’Estrange Terrace, Kelvin Grove
COST:
FREE for AMA Queensland members (and Practice Managers in the permanent employ of an AMA Queensland member)
Photo: Associate Professor Craig Hassed with Queensland Doctors’ Health Programme Director Dr Margaret Kay.
$99 for non-members
PO BOX 123 KELVIN GROVE, QLD, 4059 T: (07) 3872 2222 F: (07) 3856 4727 www.amaq.com.au
Doctor Q Winter 13
AMA QUEENSLAND
2018 Budget Submission This budget submission comes at a time when the health sector is going through significant change, not least of which is the appointment of a new Health Minister Steven Miles. Concurrently, the Office of the Health Ombudsman (OHO) is awaiting the appointment of a new Health Ombudsman. So there has never been a better time for Queensland’s health system to invest in things which will ensure the system stays as healthy as possible for many years to come. Our 2018 Budget submission recommends:
1 3
EXTENDING RESILIENCE OF THE RUN Following the success of Resilience on the Run, which has improved the mental health of Queensland interns, we have called on the government to extend funding for Resilience on the Run beyond the intern years to PGY 2 through 5.
REFORM OF THE OFFICE OF T H E H E A LT H O M B U D S M A N The appointment of a new Health Ombudsman will present an opportunity to reform the OHO to improve its performance. AMA Queensland wants the government to give the OHO the funding it needs while delivering reforms that will help restore trust in the OHO and deliver accountability and fairness.
Our budget submission provides the Queensland Government with a number of sensible policy solutions for them to invest in. When the Queensland Budget is handed down in June 2018, AMA Queensland will provide an update to members on any progress towards these goals via Pulse and the next issue of Doctor Q.
14 Doctor Q Winter
2 4
ESTABLISH A NEW MEDICAL TRAINING INSTITUTE AMA Queensland again calls on the Queensland government to fund the Queensland Medical Education Training Institute to improve the quality and consistency of the junior doctor training experience in Queensland, and to improve the resilience of our medical workforce.
P U B L I C H E A LT H A W A R E N E S S AMA Queensland calls on the government for assistance in developing an innovative education and awareness campaign which would help combat the obesity epidemic facing Queensland.
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www.ucmi.com.au Doctor Q Winter 15
AMA QUEENSLAND
New President
Dr Dilip Dhupelia
Dr Dilip Dhupelia has been elected AMA Queensland’s President. Dr Dhupelia is Director of Medical and Clinical Services, Queensland Country Practice, for Darling Downs Hospital and Health Service and works as a part-time general practitioner in Toowong. He is also a current Board member and Councillor of AMA Queensland, Chair of AMA Queensland Governance Committee, serves on the Federal AMA Councils of Rural Doctors and General Practice and is the new Vice President of AMA Queensland Foundation. “It is my belief that the qualities an AMA Queensland President should value are leadership, advocacy, representation, diplomacy and ethically being able to relay the position of our members to our employers, our funders for the benefit of community need. “We have a number of challenges coming up and I feel that with my experience, it’s the right time for me to lead the organisation,” Dr Dhupelia said.
REGIONAL AND REMOTE
D O C T O R S ’ H E A LT H
Dr Dhupelia worked for many years in regional areas and said it was important to encourage young doctors to work outside the South East and to provide more support for the families of doctors who decided to relocate to regional and rural areas.
“It is important that we pay attention to the health of our doctors. Therefore, we need to continue to lobby against the mandatory reporting laws and also ensure that the Office of the Health Ombudsman (OHO) and Australian Health Practitioner Agency (AHPRA) are timely in their complaints management and not take too long over vexatious and simple complaints,” he said.
“One of the things that I’m really passionate about is rural health. The recent appointment of a Rural Health Commissioner, the move towards a national rural generalist pathway, a focus on rural training positions for all disciplines and the recent federal budget announcements are indications that our governments are finally listening. “We are training doctors in large numbers, but this must equate to an equitable workforce distribution to almost one third of Queensland’s population who live in regional, rural and remote locations.
16 Doctor Q Winter
JUNIOR DOCTORS “Our junior doctors are the doctors of tomorrow and we need to look after them. They are in a training uncertainty environment at the moment and we need to ensure they get to the right end point of their training in a coordinated fashion,” he said.
MOCA 5 “Industrially, MOCA 5 discussions are underway. We need to make sure that our doctors who are working in Queensland public service are recognised, valued and respected.”
P R I V A T E H E A LT H INSURANCE “Every patient who has private health insurance deserves the right to be admitted to the hospital that they wish to attend, whether it is a private hospital or a public hospital, and to be treated by the doctor of their choice.”
P U B L I C H E A LT H “There’s a lot in the news about ice, but we mustn’t forget about alcoholfuelled violence. Forty per cent of all admissions in Queensland hospitals are for alcohol related conditions and 65 per cent of family violence and 50 per cent of child protection cases are alcohol related. We need to continue to ensure that the legislation we have in Queensland isn’t watered down. “I look forward to working with our members and for our members over the next 12 months.”
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Doctor Q Winter 17
AMA QUEENSLAND
Board
Dr Shaun Rudd MBBCH BAO ( B E L FA S T ) FA M A
Chair of Board and Council Specialty: General Practice “My goal is to represent and serve the members of our association and continue building a strong membership and financial base that provides us with a powerful lobbying platform.”
Dr Dilip Dhupelia
Dr Michael Cleary
Dr Bav Manoharan
LRCPS (IRE) DIP OBST ACOG F R A C G P FA R G P A F R A C M A FA I C D
PSM MBBS, FA C E M M H A FRACMA A FA C H S E
BSC MBBS GAICD
President of Board and Council Specialty: General Practice “As President, I look forward to working within a wide-ranging team and hopefully add value to the fine work already being performed in representation, leadership and advocacy.”
Vice President of Board and Council Specialty: Medical Administration and Emergency Medicine
Member Appointed Director and Greater Brisbane Area Representative Specialty: Radiology Registrar
“Leadership by the medical profession in the design and operation of the Australian healthcare system is essential. AMA Queensland’s role in supporting the development of medical leadership is essential in ensuring well-constructed and considered advice is provided to the community, government and health service managers.”
“We need to work to improve the quality of, and fair access to, training and education in both the prevocational and vocational arenas, including ensuring training is affordable to trainee doctors and working conditions and awards are protected and enforced. As an organisation, we need to prioritise our engagement with our membership and deliver value to them.”
Dr Mellissa Naidoo
Dr Peter Isdale AM
Ben Hancock
BSC (HONS I) BMBS DCH MHM FRACMA FCHSM GAICD
PHD MAICD
MFINPLAN MBA M P R O FA C C G C E C O F F PA FFIN GAICD PMESA CFP
Member Appointed Director Specialty: Medical Administration
Skilled Director Specialty: Governance and advisory
Skilled Director Specialty: Financial planning
Dr Naidoo has over 14 years’ experience in clinical and medical roles in the public and private sector. She advocates for leadership diversity and inclusive decision-making and has undertaken the Harvard Executive Women in Health Care program. She is passionate about person-centred care, health system improvement and doctor health and wellbeing.
“Good governance and well-conceived strategy are cornerstones of excellence in member-focussed organisations. I intend that my contribution to the AMA(Qld) members’ benefit will be through support for the Board and management in applying effective, well-tried principles and practice in wise governance.”
“I am honoured to serve the members of AMA Queensland as a Board member, to help assure the continuing success of the organisation in improving the conditions of the profession and to assist doctors in meeting patients’ needs.’’
18 Doctor Q Winter
AMA QUEENSLAND
Council
Dr Kimberley Bondeson BSC (HONS) MBBS FRACGP DAME
Greater Brisbane Area Representative Specialty: General Practice, Aviation Medicine “My intention is to represent the views and voices of the doctors in the Greater Brisbane area. This includes both public and private doctors, specialist and general practitioners, and doctors in training. I will ensure the concerns of our patients and the public are listened to carefully and advocate for those who do not have a voice.”
Dr Fatima Ashrafi MBBS DGO FRCS FRCOG FRANZCOG
Dr Bill Boyd
MBCHB(DUNDEE) FRCOG FRANZCOG GAICD
Immediate Past President Specialty: Obstetrics and Gynaecology “My intention is to further the interests of our members. I will support and uphold AMA Queensland, its standards and aspirations and will work on behalf of the members towards achieving the goals of the association.”
Specialist Craft Group Representative Specialty: Obstetrics and Gynaecology “I believe in patient-centred care that is respectful and responsive to the preferences, needs and values of patients and consumers. I believe I will be a strong advocate for women’s health, our specialist doctors, trainees and most importantly our patients, ensuring everyone has access to good quality care.”
Dr Paul Bryan BSC MBBS FRACGP DCH
General Practitioner Craft Group Representative Specialty: General Practice and Skin Cancer Medicine “General practice and public healthcare remain chronically underfunded; our rural workforce crisis shows no sign of abating; allied health groups continue to agitate for a greater role in primary care; whilst emerging technologies threaten to undermine the doctorpatient relationship. I will be a tireless advocate for junior doctors, general practice and the medical profession.”
Dr Michael Clements
Dr Sarah Coll
Haydn Dodds
MBBS B.ECON(HONS) MPH MHM DAVMED FRACGP FA R G P F R A C M A FA C A S M G A I C D MRAES
MBBS FRACS FA O A
BMEDSC MD C A N D I D AT E
North Area Representative Specialty: General Practice
“My goal is to represent and promote the interests of Far North Queensland doctors and practitioners in private general practices, in particular those in rural and remote areas. AMA Queensland also offers a lot in terms of support and advocacy for junior doctors and general practice registrars.”
Specialist Craft Group Representative Specialty: Orthopaedic Surgery
Medical Student Group Representative Specialty: Student
“I am keen to represent regional doctors, and those who work too hard to represent themselves. I would like to see doctors advocate for their own quality of life and set an example of healthy living. I am interested in the role doctors have to play in advocating for change in nutrition and activity practices across their communities.”
“The most significant issues facing medical students include bullying and sexual harassment, mental health, availability of internships, as well as quality education and support services, especially for rural and new established teaching sites.”
Doctor Q Winter 19
AMA QUEENSLAND
Council
Dr John Hall MBBS BSC (HONS) FRACGP FA C R R M DRANZCOG (ADV) GRADDIPRURAL
Down and West Area Representative Specialty: Rural Procedural Medicine and General Practice “I will advise the Council on issues affecting the health of rural Queenslanders and their health care teams. I will highlight important issues, including strengthening of the rural health workforce; access to essential health services, including quality primary care, emergency care, inpatient and maternity services; and strengthening access to local specialty services.”
Dr Geoffrey Hawson
Dr Wayne Herdy
Dr Scott Horsburgh
F R A C P FA C H P M DIP CLINHYP C F T E [ ATA A ] F R C PA
MBBS BA (HONS) LLB L L M FA C L M
B NURS MBBS FRACGP
Retired Doctors Representative Specialty: Clinical Haematology, Medical Oncology, Palliative care “I am passionate about ensuring we medical professionals can continue to contribute to medicine and a lifetime of training does not go to waste. I hope to be able to lobby on behalf of our senior members. Consideration needs to be made for genuine impairment but, if not impaired, why waste a resource?”
North Coast Area Representative Specialty: General Practice “I aim to represent the views of my constituents to Council; to promote patient safety especially by diminishing role substitution and developing task delegation; and to assure the future of young graduates by promoting best education and best career prospects.”
General Practitioner Craft Group Representative Specialty: General Practice “I hope to focus on improving the MBS rebate for medical practitioners to help make general practice viable. It is important that we keep advocating for improved clinical training pathways for medical students and junior doctors with access to general practice exposure during that time.”
Dr Viney Joshi
Prof Steve Kisely
Dr John de Laat
BSC MBBS FA C R R M F R A C G P FRSM AFRACMA AFCHSE POST GRADDIP ( A N A E S T H ) FA I M MAICD MCFP
MD PHD FRANZCP FRCPSYCH F F P H FA F P H M FA C H A M
BSC MBBS DCH FRACGP
International Medical Graduate Representative Specialty: Rural Medicine
“I am a committed rural generalist and medical administrator. My passions are rural medicine and aviation medicine. In addition to the practice of medicine I have sat on many boards. I believe that one of my strengths is corporate governance.” 20 Doctor Q Winter
Greater Brisbane Area Representative Specialty: Psychiatry, Public Health and Addiction Medicine “My aim is to refocus on advocacy and equity for all members irrespective of gender, age, career stage, practice location and country of graduation. Importantly, office-bearers must remain independent of party politics and pursue the interests of physicians and patients irrespective of the government in power.”
Greater Brisbane Area Representative Specialty: General Practitioner “AMA is a group dedicated not just to protecting healthcare and patients, it also fights for all those medical practitioners who advocate for their patients, often at the expense of advocating for themselves. The care, knowledge and hard work of Australian doctors has made our healthcare system one of the world’s best and we must keep fighting to ensure it stays that way.”
AMA QUEENSLAND
Council
Clare Mahon
Dr Chris Maguire MBBS GDIPIS BLANG
Doctors In Training Representative Specialty: Senior House Officer “I’m dedicated to improving the quality and nature of training that doctors receive. My aim, as a member of the AMA Queensland Council, is to see a focus on changing training culture to encourage strong, ethical leadership that values the trainee, and builds respect for the trainer. I will be working to see that doctors in training also have a forthright voice in health policy and advocacy in Queensland.”
Dr John F. Murray
Dr Rachael O’Rourke
M B B S F FA R A C S
MBBS FRANZCR CTCA
Medical Student Observer Specialty: Student
Specialist Craft Group Representative Specialty: Anaesthetics
Greater Brisbane Area Representative Specialty: Radiology
“My vision is to increase student knowledge and participation within AMA and nurture this relationship in the new generation of medical professionals. Medical students face significant issues including mental health, availability of internship places and education and support services. Promoting female leaders and championing gender equality is another key personal interest of mine.”
“My intention is to present the concerns of specialist AMA Queensland members to the Branch Council.”
“I will represent the needs of all doctors, but particularly the role and standing of doctors in our hospital health systems. They are under increasing pressure by a bureaucratic health care system, determined to reduce the vital role of doctors in health care delivery. I will work diligently to achieve the best outcomes for all our members and our patients.”
Dr Siva Senthuran
Dr David Shepherd
Dr Nicholas Yim
MBBS BSC FRCA FA N Z C A F C I C M
MBBS FRACS FA O R T H A
BPHARM MBBS FRACGP
Full Time Salaried Medical Practitioner Craft Group Representative Specialty: Intensive Care “I believe that medical leadership and engagement between administrators and its front line clinicians needs to underpin to any drive for efficiency in an era of increasing health care costs. Such engagement needs to be based on shared values transferred from websites where they are proclaimed into every organisational thought, word and deed.”
Far North Area Representative Specialty: Orthopaedic Surgery “My intention on the AMA Queensland Council is to represent the views and needs of Far North Queensland doctors by acting as a conduit for communication between them and the AMA organisation.”
General Practitioner Craft Group Representative Specialty: General Practice “I hope to bring enthusiasm and representation to address issues facing regional Queensland. I intend to advocate for all doctors and to ensure the high standards of the clinical training, which I hope will in turn improve the health of our communities and patients.” Doctor Q Winter 21
A digital update The digital world affects us in all avenues of life. We are, however, just grasping the digital nettle in healthcare, recognising the opportunities that exist in this space to iteratively improve patient outcomes and experience, to transform from descriptive (retrospective) to predictive and prescriptive analytics at a population level and from there, on to highly personalised and precision medicine at an individual level. From a business perspective, digital technology will underpin an affordable and sustainable system in which to deliver these benefits to both individual patients, and to the population as a whole.
Digital transformation in its essence is about data – generating it, collating and analysing it and feeding back the results of those analyses to better inform decisions. Healthcare data is, and always will be, generated at the point of interaction between a clinician and a patient. Collecting that data and analysing it for patterns of disease presentation and response to treatment forms the basis of the practice of medicine today. Luminaries such as William Osler made an art form of clinical observation and pattern recognition based on the meticulous recording, analysis and sharing of data. The difference today is our unprecedented capacity to generate, record, analyse and share data and information via digital technologies. So just as the information highway has disrupted so many other businesses with platformbased models, so too will the power of information enable us to transform the way we provide healthcare in response to the extant and future challenges presented by changing patient demographics, patterns of disease, and economic variables. In Queensland, we are in effect replicating these platform based business models based on an enhanced ability to: capture data at the clinicianpatient interface (via the hospital eMR and digital GP systems etc); aggregate this data effectively through the use of standards and interoperability strategies; analyse this data with appropriate techniques including deep (machine) learning algorithms; and critically, feed back the intelligence generated to the bedside to enable more informed, and therefore better, decision making. Thus our ‘platform’ takes data from those who generate it at the clinical interface, aggregates and interrogates that data, and presents it back as high
22 Doctor Q Winter
quality information to those who need it to make well informed decisions (both clinical and non-clinical). There are five pillars in this digital transformation program: 1. engage and empower the person; 2. aid the clinician; 3. integrate services effectively; 4. run the system efficiently; and 5. create/deliver the future (precision medicine). These initiatives are all underpinned with critical infrastructure which supports patient and citizen identity, high level cybersecurity, robust and facilitative information governance, and interoperability of our systems based on standards based data collection and subsequent use. We have a unique opportunity to make all this happen following the government’s decision to endorse a single instance of an eMR across most of the state. This will considerably enhance our ability to share information effectively; initially at the secondary care level, but with the increasing functionality of the Myhealth record, also at the levels of primary and community care, and in partnership with individual patients and citizens. Much work to be done in pulling this all together, but exciting times nonetheless. AMA Queensland now has an e-health working group to monitor, identify challenges and receive feedback on the e-health system. To provide us with your experiences, concerns or tips, email us at membership@amaq. com.au and your comments will be referred to the working group.
GREATER SPRINGFIELD SPECIALIST & OFFICE SUITES Mater applauds Springfield City Group for the establishment of the specialist suites adjacent to Mater Private Hospital Springfield. The hospital is looking forward to productive conversation and partnerships with doctors who move into this facility. Justin Greenwell Director, Mater Private Hospital Springfield
Artist Impression
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With areas from 34m2 to whole floors of 474m2 over five levels (above ground floor retail and car parking), don’t miss this unique opportunity to grow your patient base in the heart of South East Queensland’s growth corridor. To register your interest visit gssuites.com.au or contact Uma Ranchigoda on 0412 470 882
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Paediatric access to be explored in new Health Vision Access to paediatric services in Queensland, both private and public, is under stress. If you need to access a paediatrician in the public system, you may face a wait of a year at minimum, but it is not unheard of to wait even longer than that, especially in rural and remote areas. In the private system, wait times are much shorter, but the average minimum wait before a patient first sees a paediatrician is around three months. The demands on the system for paediatric services makes these delays understandable, but nonetheless concerning. For parents who have received a suspected diagnosis of autism for their child, any time spent waiting is agonising enough. More importantly, early intervention, should the diagnosis be confirmed, is crucial to ensure that the child has the best possible outcomes in life. But early intervention and funding assistance are often not available until the diagnosis is confirmed by a paediatrician. For patients who have no choice but to access the public system, a wait time of one year or more to obtain an official diagnosis before beginning therapy is far from an optimal solution.
24 Doctor Q Winter
Improving access to paediatricians in the public system is therefore vitally important. But to find solutions, we need to understand the challenges facing the sector. Supply may be one reason. Although the supply of medical students who wish to enter paediatrics is healthy, with the latest Medical Deans report indicating Paediatrics and Child Health was one of the top six intended areas of future practice, Queensland Health’s Children’s Health Strategic Plan indicates that one of its future challenges will be increasing competition to obtain enough staff to meet demand. The workload for paediatricians in the public system appears to be one of the main reasons for the access delay. AMA Queensland has spoken to a number of paediatricians in the public system who have indicated that much of their workload is focused on treating on-going patients with behavioural issues as well as chronic disease. So how can we increase access when the challenges creating pressure on the system are not readily solvable? Queensland Health’s Children’s Health Strategic Plan contains a number of strategies, such as making
Child Health Queensland (CHQ) an enticing place to work to attract and retain staff, and working with external partners to improve service coordination and integration. While these are useful first steps, more needs to be done if we are to improve unacceptable waiting periods for paediatric access in the public system. AMA Queensland’s upcoming sequel to the Health Vision will explore some potential solutions to these issues. But beyond simply improving access, our new Health Vision will also look at how we can drive innovation to reduce the demand on the workload of public paediatricians. Finally, we will also look at how we can improve advance care planning for paediatric patients, a project AMA Queensland has been working towards in partnership with a number of talented children’s health experts for over a year now. While this work is well advanced, AMA Queensland would appreciate any feedback from members who work in children’s health. If you have any thoughts or comments on the challenges facing the sector or any solutions, please pass your comments through to our Policy Team at policy@amaq.com.au.
Moca 5 for newbies -
what is the moca 5 and why does it matter to you as a junior doctor
What is the moca 5? MOCA 5 stands for The Medical Officers’ Certified Agreement 5. It’s an agreement between you and your employer, Queensland Health. This agreement is re-negotiated every three – four years. This agreement ensures you get paid your wages, overtime that’s entitled to you, professional development allowance and leave. So it is the vehicle that delivers your: wages; overtime; professional development allowance; and professional development leave.
Why is this document so important to me? Without this agreement, you would not receive wage increases and improved terms and conditions on the job.
What does this have to do with ama queensland? Without AMA Queensland and our Council of Doctor in Training representatives, along with our partner union ASMOFQ, you would not receive improved pay, terms and conditions. We are the only doctorlead organisation that is in your corner, directly negotiating for you. Did you know your Medical Defence Organisation (MDO) cannot represent you at the bargaining table for the MOCA 5 negotiations? We are the only doctor-lead organisation that can represent your working rights and conditions. 26 Doctor Q Winter
I will get these increases anyway, right? Yes, but we need each and every junior doctor and senior medical officer on board as a member of AMA Queensland/ASMOFQ. The more members we have, the greater our bargaining strength – and the better the outcomes we can achieve for you in these negotiations.
What is ama queensland/ asmofq bargaining for to support junior doctors? increased professional development allowance – from one week to four weeks; increased professional development leave – from $1,500 up to $4,000; increasing the vocational training subsidy – from $2,500 to $6,000; and increasing your pay by five per cent per annum, which would be indexed annually. These increases are benchmarked from other states and territories.
RE E B
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refer a member AND RECEIVE A DISCOUNT ON YOUR MEMBERSHIP RATES
REFER 1 MEMBER
REFER 2 MEMBERS
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REFER 3 MEMBERS
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75% discount on your membership
No membership fee for one year
While you may be entitled to these terms and conditions (for example, overtime and professional development leave), we have found that many junior doctor members have experienced difficulties accessing overtime, and professional development leave. AMA Queensland membership entitles you to receive guidance and workplace representation in the case that you have been denied your rightful entitlements. In the last 6 months we have secured over $1.1 million in unpaid wages and entitlements across the public and private sector. We cannot help non-member junior doctors. Get your colleagues on board to support the MOCA 5 negotiations and to have the protection of our trusted workplace relations advisory services. If you refer a member, you will receive a discount on your membership fees. See below for details. Keep an eye on the AMA Queensland webiste for the most up-to-date information regarding progress with the negotiations. You can also contact the team on (07) 3872 2222 or email moca5@amaq.com.au
s. l doctor beside al We walk
RENEW YOUR MEMBERSHIP OR JOIN NOW AT WWW.AMAQ.COM.AU
5 a c Mo
l a t i p hos visits
tner union ASMOFQ AMA Queensland and our par spitals around will continue visiting public ho tations on the Queensland to deliver presen AMA Queensland current MOCA 5 negotiations. n Cosgrove will also Industrial Relations Advisor Joh issues affecting your be on hand to discuss topical istance. employment and provide ass
where Rockhampton Hospital, 12 June, 1pm Bundaberg, 13 June, 1.30pm Hervey Bay Hospital, 14 June, 1pm Maryborough Hospital, 14 June, 1pm - Live videoconference link to Hervey Bay Princess Alexandra Hospital, Brisbane 29 June, 1pm Gladstone Hospital, 6 July, 1pm Ipswich Hospital, 13 July, 1pm
Doctor Q Winter 27
Single touch payroll - are you prepared? Single touch payroll (STP) is being implemented into Australian businesses this year and all employers with 20 or more employees will be expected to be using this payroll system by 1 July 2018. Employers with 19 or less employees will be expected to be using STP by 1 July 2019. The Australian Taxation Office (ATO) wrote to all businesses with more than 15 employees to notify them of their obligations and to complete a headcount of the employees they had on 1 April 2018.
STP requires employers to report payments such as salaries and wages, pay as you go (PAYG) withholding and superannuation information from your payroll solution each time you pay your employees. It will not affect your pay cycle and you can continue to pay your staff either weekly or fortnightly.
It is timely that you review your business processes and ensure that you are paying your employees correctly, including a correct calculation of their superannuation entitlements. Also, check that your employees’ information is accurate, including their names, addresses, and dateof-birth.
These changes will require an upgrade or replacement of your existing payroll system and therefore it is important that you ask your payroll provider when they will be ready for STP.
For more information on single touch payroll, please visit the Australian Taxation Office website at www.ato.gov.au.
Support persons AMA Queensland’s Workplace Relations Team often have to advise employee and employer members on the inclusion of a support person in employment related meetings.
WHY A SUPPORT PERSON? Employers are required to ensure procedural fairness to their employees when dealing with performance management, workplace investigations or disciplinary action. Employees are entitled to have a support person with them when they are called to those types of meetings. The failure to allow a support person in those situations will likely result in a commission finding that procedural fairness was denied to the relevant employee.
ROLE OF A SUPPORT PERSON A support person is there to provide emotional support and comfort to the employee. A support person cannot actively participate in the discussion. They cannot provide an opinion or their observations in the meeting and they cannot answer for the person being interviewed or advocate for them. However, they can provide advice directly to the employee they are supporting and call for breaks in the interview. A support person is obliged to maintain confidentiality and cannot discuss the matter with anyone other than the person they are supporting.
WHO IS A SUITABLE SUPPORT PERSON? An employee can bring anyone they trust and feel comfortable with, including a colleague, supervisor, family member, union or legal representative. However, a support person must not be a potential witness to events that have brought about the interview.
28 Doctor Q Winter
U N I O N R E P R E S E N TAT I O N The law is not settled about the role of a union official during meetings with an employee. However, the principle is that an employee is entitled to be a member of a trade union and have that union represent them in workplace disputes. Denying a union official as a support person would likely result in a finding that the employee was not afforded procedural fairness. Although a union official may be able to make comments or ask questions in regards to the process, the employee must answer all direct questions which relate to the dispute.
BEST PRACTICE Notify the employee of an intention to have a meeting and that they may bring a support person. Clearly outline to the support person what their role is. Allow the support person to support the employee in the meeting. Be firm that the support person cannot talk on behalf of the employee. Be aware of any additional obligations which may exists under a workplace agreement.
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
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Doctor Q Winter 29
Going for Gold: GC2018 D R K AT H E R I N E G R I D L E Y GOT IN ON THE ACTION F O R T H E C O M M O N W E A LT H GAMES ON THE GOLD COAST IN APRIL FOR A C H A N G E O F PA C E , A ONCE-IN-A-LIFETIME EXPERIENCE AND A GEOGRAPHY LESSION. I patiently sat in the waiting room of the medical facility. Next door, numerous runners from different countries were receiving massage and physiotherapy treatment. Outside, the paralympians in their racing wheelchairs were steadily gaining pace around the warm up track. Down the hall were the audible squeals of the field athletes who weren’t forewarned about the temperature of the ice baths. And here I was, the doctor, sitting in the waiting room, watching the athletics heats on the television, occasionally giving out paracetamol for the odd headache but more often dishing out ice packs and water bottles to athletes who dropped by. This was a scenario so far removed from my every day job in emergency medicine, where the usual stress of bed block, barrage of worried parents and seemingly endless queue of kids with upper respiratory tract ailments was instead replaced by these superstar athletes preparing for their Commonwealth Games glory. And it was rather fantastic.
30 Doctor Q Winter
GC2018 was one of those ‘oncein-a-lifetime’ opportunities as an emergency registrar. A chance to be part of a multi-disciplinary team of physiotherapists, paramedics, nurses, sports trainers and massage therapists, all with the goal of providing the best patient care possible to these elite athletes in the lead up to their competition events. I was on hand at the athletics warm up track in case of any emergencies, with the pole vaulting and throwing events noted as being particularly high risk, perhaps made even more so in our case with the presence of an angry family of woodland ducks residing near the fence.
The majority of the athletes’ needs were musculoskeletal in nature, and for once, it was wonderful to take a back seat and watch my colleagues work their magic. I am still marvelled by the brute strength of our petite massage therapists thumbs versus the lofty shoulder girdle of the champion shot-putters, and how the experienced physiotherapists could differentiate 15 entirely different disorders and management plans from the athlete’s one presentation with ‘knee pain’. Some of these athletes come from incredibly poor countries with no medical or physiotherapy input before the games, so managing acute on
D R K AT H E R I N E GRIDLEY
Games inspires a sense of collegiality that is unlike what I’ve experienced in hospital before. We were all unpaid volunteers, yet had no qualms in helping our patients and each As medical staff, we were located other wherever possible. Covering around each of the competition venues each other for breaks was a nonand designated to either spectator or event. Referring a patient to another athlete care. Spectator care doctors discipline for a second opinion were paired with nurses and critical happened with ease. The majority care paramedics and responded to of the athletes themselves were unwell or injured patrons much in the gracious and appreciative, even for the same manner as a MET team would in little things like strapping tape and hospital. Athlete care doctors were a ibuprofen. Even when frustration was mixture of GPs, sports and emergency present, whether from us for the 6am physicians, and were either stationed starts without a coffee van in sight, in the Athlete Medical Facilities at or from the athletes when they were each venue, or were required to be injured, the animosity that usually present on ‘field of play’ (particularly accompanies it was nowhere to be in higher risk sports like wrestling and seen. People were disappointed to be weight-lifting). There was also a GP leaving on their last shifts to go back and emergency to their usual department jobs, because this GC 2018 WAS OF style ‘polyclinic’ one was just so at the Athlete’s OF THOSE ‘ONCEfulfilling. If only Village, with up every day could IN-A-LIFETIME’ to 250 patients a feel like this. day and on-site OPPORTUNITIES The games did radiology and AS AN EMERGENCY bring some pharmacy. Again, very unique our colleagues REGISTRAR. challenges to us were dealing with as doctors. We the difficulties of were constantly under surveillance managing acute illness, public health by the world’s media, so any time surveillance, acute on chronic ailments we were outside our makeshift tent, and language barriers, and that’s we were potentially on camera, a before navigating the extensive list of thought that suddenly made checking pharmaceutical drugs banned by the your phone or scratching your nose World Anti-Doping Authority. at the wrong time a slightly more This kind of environment just goes dangerous activity. We were instructed to show what health professionals on how to deal with VIPs and the can achieve. It is something that media, appropriate radio etiquette can only be experienced rather than and how to assist the paramedics with described, but the Commonwealth extrication, none of which I remember chronic injuries became an entirely new challenge. If that doesn’t give you a greater appreciation for our allied health partners, I don’t know what will.
Advanced Emergency Trainee, Lady Cilento Children’s Hospital; Deputy Chair, AMA Queensland Council of Doctors in Training; and Secretary, Queensland Doctors’ Health Programme. being covered in the medical school curriculum. My embarrassingly poor geography skills were challenged when meeting athletes from St Kitts, British Virgin Islands, Guiyana and Lesotho, when I had to ask where their country actually was. And you can certainly give credit to our paramedic and pre-hospital friends after you’ve carried around the defibrillator, a drug bag, an airway kit and an oxygen bottle for more than a few minutes in the midday sun. GC2018 had the motto - share the dream. At a time of year in paediatric emergency where every child seems to share the URTI, the Commonwealth Games was an incredible opportunity to try something entirely different. I would wholeheartedly recommend the games experience to any of my medical colleagues who are up for a challenge, who can look forward to working in partnership with our allied health family to make this ‘dream’ a reality for these remarkable athletes.
Doctor Q Winter 31
Trust and confidence in the The AMA Queensland Workplace Relations Team has written a series of articles about workplace bullying to assist you in managing situations that may arise in your workplace. The term ‘trust and confidence’ has a particular meaning when it comes to the employment relationship. The concept affects every worker, every day of their working life and yet is rarely considered. We are often asked questions about conduct matters relevant to the concept of trust and confidence in the employment relationship, such as recording of discussions, telling managers that workers don’t trust them or refusing to engage in meetings and events because a particular manager is involved. An employer has a right to reasonably control the work activities of an employee and an employee has a duty to obey the reasonable and lawful directions of their employer. The employee is required to act reasonably to retain the trust and confidence of their employer. However, there is no reciprocal right extended to employees at common law. In the 2013 decision of Commonwealth Bank v Barker1, the Full Federal Court considered the nature of the contemporary employment relationship and clarified the mutual obligations of employer and employee. They confirmed the duty of mutual trust and confidence is implied into all contracts of employment under Australian law. The implied duty amounts to a requirement that the employer must not, without reasonable cause, conduct itself in a manner likely to destroy or seriously damage the relationship of confidence and trust between employer and employee.
32 Doctor Q Winter
However, the High Court overturned the decision in Commonwealth Bank of Australia v Barker2 and held unanimously that there is no implied term of mutual trust and confidence in Australian law. The High Court did comment that the decision to imply a term of this kind was more appropriate for the legislature. As a result, the Queensland Government enshrined the duty in legislation by including in it in the latest version of the Industrial Relations Act3 (Act) in, stating “the main purpose of this Act is to be achieved primarily by…promoting productive and cooperative workplace relations including by recognising mutual obligations of trust and confidence in the employment relationship”.
Therefore, it is anticipated that the practical implications of the inclusion of the term itself in the objects will be limited in that it is intended that the term supports rather than expands existing protections for employees.”
In a report to the parliament in October 2016 the Department of Employment and Industrial Relations advised:
Along with mutual trust and confidence, the purpose clause of the Act provides for inter alia:
“In terms of the practical application of the inclusion of mutual trust and confidence in the objects of the Act, the provision will promote a standard of ideal conduct for good employers and employees. The object is given effect through the range of protections in the statutory framework... Queensland’s existing industrial framework provides employees with a range of protections and avenues to appeal and seek redress where an employer exceeds or breaches their legal duties. In addition, the Bill proposes enhancements to this range of protections including through the introduction of general protections and genuine consultative obligations, and the further institutionalisation of good faith bargaining principles.
So what does it mean to you and me? The inclusion of the provision in the Act means that you have something to rely on where you can demonstrate to the Queensland Industrial Relations Commission (QIRC) that your employer has acted in a way that is inconsistent with their obligation and in doing so has breached a substantive provision of the Act. Simply stated, the street is no longer one way for employees of the state of Queensland.
security in employment and consultation about employment matters, technological change and organisational change;
promote collective bargaining; preventing and eliminating discrimination, bullying and other unfair treatment in employment;
ensuring equal remuneration for work of equal or comparable value;
a right for employees to request flexible working arrangements to help balance their work and family responsibilities; and
supporting employees experiencing domestic and family violence by conferring leave entitlements and protection from discrimination.
employment relationship The concept has most recently been tested in a QIRC decision4 where it found when directing that an employer return a dismissed employee to their job, that: “the employment relationship is capable of withstanding some friction and doubts and that trust and confidence are concepts of degree. While [the employer] asserts that they no longer have trust and confidence in [the employee] that is because he believed the latter was guilty of misconduct by being deliberately untruthful to [a colleague]. In coming to that conclusion, however, he closed his mind to any other possible reason for [the employee]’s behaviour. Now that his decision has been reviewed and overturned by a Tribunal charged with the responsibility to review decisions of the type that he made, I am confident that [the employer] will step back and accept that he might have made a mistake and perhaps he should have given [the employee] the benefit of the doubt. In this respect [the employee] has made it plain that he wishes to return to his former position notwithstanding his treatment.”
If you are employed in the Queensland public health system and you think that your manager’s conduct may be inconsistent with their obligations under the Act, contact us with details about your concerns and we can advise you on what steps may be taken to address their conduct. Please also contact us if you are unsure about what you can do to protect your interests without putting your employment at risk. In the instance that employment is terminated, there is now an improved opportunity to have members reinstated to their position.
1
Commonwealth Bank v Barker [2013] FCA 942.
2
Commonwealth Bank of Australia v Barker [2014] HCA 32.
3
S 4 (e), Industrial Relations Act 2016 (Qld).
4
Farquharson v Queensland Racing Integrity Commission [2018] QIRC 001.
5
Commonwealth Bank of Australia v Barker [2014] HCA 32.
In the federal jurisdiction, the case of Commonwealth Bank v Barker5 confirms that there is no common law or legislative ground for a claim of mutual trust and confidence in the employment relationship. To achieve that comfort, the concept would have be form a term of a commercial employment contract. AMA Queensland financial members have access to industrial, workplace relations, legal and commercial assistance for both the public and private sectors of the medical profession. Contact the AMA Queensland Workplace Relations Team on (07) 3872 2222.
Doctor Q Winter 33
AMA QUEENSLAND
Council of Doctors in Training update Each year, AMA Queensland’s Council of Doctors in Training (CDT) sets itself the task of improving the life of all junior doctors in Queensland. At its core, that is what we do; and this year, we have had a unique opportunity do it.
These changes have not only strengthened the industrial process of AMA Queensland, they recognise the critical role that junior doctors play in the health system. It is a change for the better.
With a new CDT recently elected, the team has moved quickly to capitalise on the potential of a new year.
At a local level, the CDT has renewed its efforts to identify local concerns and pursue them for members. Whether this is canvassing local best practice for doctor well being and sharing that more broadly, developing educational opportunities, or even something as simple as identifying local sponsorship opportunities to get members cheaper coffee – we’re working on it.
At a whole of health level, AMA Queensland is deep into the negotiations with Queensland Health for the new industrial instrument. At these Medical Officer Certified Agreement (MOCA 5) negotiations, junior doctor claims have been prominent, and assertively supported by the entire AMA Queensland Workplace Relations Team. For the first time, a junior doctor has chaired the negotiations and lead every doctor-in-training industrial claim and the CDT Industrial Team has been given a strong voice in the overall AMA Queensland industrial strategy.
34 Doctor Q Winter
Our focus also remains future orientated, with the Junior Doctor Conference fast approaching, and the launch of our annual Resident Hospital Health Check (RHHC). The RHHC has become a pillar of our yearly advocacy effort, shining a spotlight on the real working conditions of our colleagues.
DR CHRIS MAGUIRE
Senior House Officer, Lady Cilento Children’s Hospital; and Chair, AMA Queensland Council of Doctors in Training
This insight continues to be a powerful advocacy tool to improve the system that we all work in. With hard work, this year can be a turning point for junior doctors. A chance for our industrial voice to be heard and our concerns addressed. A chance for us to create meaningful local changes to improve culture and workplaces. And a chance for us to develop a stronger future for the profession. I look forward to working with you all to make that a reality. Contact CDT on (07) 3872 2222 or email cdt@amaq.com.au
When vision loss affects her daily life, it’s time to refer to Vision Australia. The allied health team at Vision Australia complement the work of eye care professionals. Our vision loss experts help patients use their remaining vision to get the most out of life. Your patients can also get help to access NDIS and My Aged Care funding. When to refer • Upon diagnosis of a permanent, non-correctable or progressive eye condition • Vision loss starts to impact everyday activities • Glasses no longer correct vision. To refer online or download free vision loss resources go to visionaustralia.org/AMA or call 1300 84 74 66 Gold Coast | Brisbane | Maroochydore | Townsville | Cairns
Sarah, Vision Australia client
Ups and downs are for your working week, not your super. While you’re looking after your patients, it’s good to know someone’s looking after you. Every day at QSuper we strive to deliver strong returns with less risk.
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Doctor Q Winter 35
Public bariatric surgery trial for diabetes
A STEP IN THE RIGHT DIRECTION FOR QUEENSLAND There is no doubt that obesity is at crisis point in Queensland. Three in 10 adults and one in 14 children are obese with around 70 per cent having one or more co-morbidities. It is costing our community - obesity was estimated to have cost Queensland $11.5billion in 2015 - and individuals, many who have genuinely fought but lost the battle to lose weight. Studies have shown that when people with morbid obesity lose weight using lifestyle interventions, the weight is generally regained over time. Conversely, the evidence is strong for a good outcome - sustained weight loss and reduced co-morbidities - when bariatric surgery is paired with postoperative allied health support for a select group of patients. For example, bariatric surgery can deliver much improved diabetes control and even resolution of diabetes in many cases. In early 2017, the Queensland Clinical Senate asked more than 130 of the state’s senior clinicians to consider how bariatric surgery could be made more available in the state’s public heath system.
The Senate recommended that in addition to focusing on promoting healthy lifestyles and weight management through diet and exercise, bariatric surgery is provided as a publicly funded intervention for specific groups of patients in Queensland, such as those with diabetes. In response to the Senate’s recommendation, the Queensland Government announced in July 2017 a two-year, $5million trial of bariatric surgery for up to 300 Queenslanders with type-two diabetes from across the State. The Statewide Bariatric Surgery Initiative is now underway with 123 patients referred that meet criteria, 29 people having undergone surgery and 13* scheduled for surgery. Referral to the trial is open to patients with a BMI greater than 35 who are aged between 18 and 65 with type-2 diabetes (and not meeting treatment targets). To be considered, patients must also be seeing a public hospital specialist for conditions that may be improved by bariatric surgery. Referrals are only accepted from public hospital specialists and Aboriginal community controlled health services.
The initiative is run by a multidisciplinary team of bariatric surgeons, physicians, nurses and allied health professionals who consider patients using strict eligibility criteria developed from the most current Australian and international research. The initiative is a positive step in the right direction. It will, no doubt, save and improve lives while at the same time reducing demand for some services in the public healthcare system. Surgery certainly isn’t the answer to our obesity crisis, or for all morbidly obese Queenslanders, but it is an essential part of a multi-faceted and system-wide approach to the problem if we are to make inroads. We know the safest and best option to obtain a healthy weight is through healthy eating and exercise, but for those who have not had success with this approach, and have morbid obesity with suboptimally controlled type 2 diabetes, this may be the best option. Meantime, we must continue to empower the community by providing education about healthy food choices and the importance of regular exercise. We must continue to fight against sugary drinks being so readily available. And as health professionals, we must walk the talk – exercise and eat a healthy well-balanced diet. We must do what we can to steer the next generation down a path to better health. If we don’t start turning things around the next generation of Australians will have a shorter life expectancy than their parents for the first time in recent history. For more information about the initiative visit: https:// clinicalexcellence.qld.gov.au/priorityareas/service-improvement/statewidebariatric-surgery-initiative * Figures accurate as at 3 April 2018.
36 Doctor Q Winter
We need a hero DR MARGARET K AY Medical Director, Queensland Doctors’ Health Programme
While the doctors across this international field, who have been working in doctors’ health for decades, have embraced the increased discussion about improving the health of doctors, it is difficult not to be intensely aware of the hopelessness present in some of the doctors’ heath narratives that have been published recently.1 A recent example is one written by a junior doctor in UK. The article is well articulated. On reading the introduction I expected (or hoped) to find the positive twist at the end. There was none. Instead the echoes of desolation lingered. Doctors’ health is not a new concept. Change is needed and across the literature there are regular calls for change. The question is how to enable this change. Last year beyondblue published a guide to enabling health care institutions to become mentally safe workplaces2, as a follow up from their 2013 survey3. Similarly, a forum was held in Sydney last year with a focus on reducing the risk of suicide in the medical profession4. Failure to enable the change that is needed has been a recurring set back in the field of doctors’ health. There is no doubt that there is a need for robust leadership to enable change. The recognition of the need for cultural change has been regularly stated in the literature, though the solutions have been limited. Recently another systematic review was published focusing on examining the interventions designed to improve doctors’ health – to reduce burnout.5 (It is always interesting to see how few studies qualify for inclusion in these reviews, so the first finding is really that there is plenty of room for more research.) The authors classified the interventions as being either directed at the individual physician (by providing the skills that physicians need to help
them manage their health better) or directed at organisational change (addressing issues such as rosters and leave). Most interventions were directed at the individual physician such as mindfulness, stress relaxation or other therapies. These were associated with some improvement. However, interventions that focused on the organisational structures in the workplace had a greater impact on reducing burnout. This shouldn’t be a surprise because burnout is an organisational issue; burnout is not a measure of an individual’s failure. If we are to enable interventions that assist physicians (old and young) to flourish in their work, then leadership is essential6; leaders who can champion the cause of physician health. Leaders are those who can identify where there is a need for change in their workplace. Leaders can articulate the solution. Leaders can enable safe conversations that encourage us to work together to find a solution. Clearly we need leadership at the executive level. Organisational change requires a supportive policy environment. It is not enough to wait for the problem of doctors’ health to be solved by others. It is a collective responsibility. As each of us reflect on how we are looking after ourselves, we should also be considering what we can do to make a difference where we work. There are many amazing initiatives happening within individual departments of different hospitals and in small private practices. Many of these have been initiated by an individual who simply bothered to try to make a difference and in articulating their hopes aloud, they found others prepared to support them. It is our responsibility to encourage these organisational innovations for clinician wellness and be champions for change.
1. https://amp.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2018/apr/23/burnt-out-doctor-whymatters?__twitter_impression=true 2. beyondblue, National Mental Health Survey of Doctors and Medical Students. Melbourne, Victoria: beyondblue; Oct 2013. Available at: http://www.beyondblue.org.au/docs/default-source/defaultdocument-library/bl1132-report---nmhdmss-fullreport_web 3. beyondblue. Developing a workplace mental health strategy. A how-to guide for health services. Melbourne, Victoria: beyondblue; 2017. https://www.beyondblue.org.au/about-us/our-work-in-improving-workplace-mental-health/healthservices-program 4. Doctors’ Health Services. National Forum on Reducing Risk of Suicide in the Medical Profession. Canberra: Australian Medical Association; 2017. https://ama.com.au/article/national-forum-reducing-risk-suicide-medical-profession-final-report 5. Panagioti M et al. Controlled Interventions to Reduce Burnout in Physicians. A systematic review and meta-analysis. JAMA Internal Medicine. 2016 -ePub ahead of print 6. Montgomery, A. The relationship between leadership and physician well-being: a scoping review. Journal of Health Care Leadership. 2016, 8:71-80.
Almost Anatomical Everyone takes different paths to medical school. Medical student and artist Lauren Squires had a background in research science and no intention to become a doctor until she undertook a Masters in Public Health. She entered medicine without ever having taken an anatomy class, or opened a copy of Netters. To cope with the steep learning curve of the University of Queensland’s MD program, Lauren turned to anatomy colouring books and hand illustrating her study notes. Finding a respite from textbooks and lectures, she created Almost Anatomical - a passion project focussing on creating pieces of whimsical watercolour anatomy art. “I’m interested in capturing the wonder we feel when we are first discovering how the human body works and fits together. The body is a beautiful and amazing thing- not only for how it looks, but for what it does,” she said. She loves creating pieces for medical clinics and similar places; works that are both anatomically correct and educational. She works in bright, non-anatomical colours, incorporating blooming flowers into pieces of anatomy. Now in her fourth and final year of medicine, Lauren is predominantly based at Ipswich Hospital. Recently, she created her first large oil painting for the QEII Hospital. “I find having a medicine-related yet creative side job has been a wonderful addition to my medical studies,” she said. “It’s always an interesting talking point when sketching diagrams with patients.”
38 Doctor Q Winter
LAUREN SQUIRES Medical Student
L e t t h e g a m e s b e g i n
O N LY O N E T E A M W I L L B E V I C T O R I O U S !
Compete against the clock and each other in a simulated action-packed clinical scenario. Join us at the Junior Doctors Conference Sunday, 24 June 2018 csds.qld.edu.au/simulympics2018
Metro North Hospital and Health Service
2
2% New members by join reason
Belonging to the peak medical association
39%
Membership insights
Lobbying in health policy areas Member benefits Workplace and industrial relations advice
AMA Queensland warmly welcomes our new members who have joined in the past four months.
Professional resources and training
35
%
We had a record month of new member joins in April, with 61 new members joining AMA Queensland.
2% 2%
Close to 50 per cent of new members were referred by existing members, who receive a 25 per cent discount off next year’s membership for each referral.
6%
New members joined from private and salaried practice, across a variety of career stages (see graphs).
If you didn’t receive your membership pack, or would like to discuss how you can make the most of your membership, contact the Membership Team on (07) 3872 2222 or email membership@amaq.com.au.
Interns
33%
Doctors in Training
New members breakdown
General Practitioners
24%
Our new and renewed members will have received their 2018 Member Benefits Guide, which details the exclusive services, resources, commercial benefits and discounted events that members can access. To view this guide online, visit www.amaq.com.au.
13%
Private Specialists Salaried Medical Officers Part-time Practitioners
11%
13 %
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40 Doctor Q Winter
RESIDENT MEDICAL OFFICERS
Y A S R U O Y HAVE
AMA Queensland in conjunction with the AMA Queensland Council of Doctors in Training is pleased to announce the third annual Resident Hospital Health Check Survey. The Resident Hospital Health Check Survey is an anonymous survey which provides you with the opportunity to ensure your voice is heard regarding: access to professional development leave;
hospital facilities; and
hours of work and overtime;
workplace culture including bullying and harassment.
THE SURVEY WILL BE EMAILED TO DOCTORS IN TRAINING MEMBERS IN JUNE THE SURVEY CLOSES AT 5PM ON 31 AUGUST 2018
Resilience on the Run 2018
Resilience on the Run sessions for 2018 have been well underway targeting interns at public hospitals across Queensland. Facilitated by resilience expert Dr Ira van der Steenstraten, the program focuses on the prevention of burnout and compassion fatigue amongst young doctors. It also assists with developing techniques for resilience and mindfulness, better managing interpersonal relationships, navigating difficult scenarios on the job and practical steps for asking for help. Excellent feedback has been received this year with 239 evaluation forms completed and returned to date. In response to the question, ‘How do you rate this session of Resilience on the Run’ on a scale of one to five where one is not good and five is excellent, 87 per cent or 208 responded with either a four or a five. The most common response to what were the three things you found most useful about the session related to mindfulness tips, techniques and exercises. Other common responses
included the interactive discussions with peers and sharing stories, self-care tips and self-awareness, awareness of compassion fatigue and awareness of resources and support available. One participant stated the most useful thing about the session was, ‘Bonding with colleagues regarding shared difficult experiences,’ whilst another stated, ‘it reminded me to practice mindfulness even outside of stressful situations’. When asked what your main personal ‘take away’ from the session was, the predominant responses included mindfulness techniques, self-care and self-awareness, STOP and take time out, signs of compassion fatigue and burnout. One participant stated, that the session was ‘a positive contribution towards promoting a culture of selfcare and resilience rather than denial and coping.’ Another participant stated that the session reminded them, ‘how important it is to be aware of your thoughts, feelings and emotions in order to be a better doctor’, whilst another participant stated it gave them a ‘better understanding of
burnout and compassion fatigue and strategies for identifying these in myself’. One testimonial received from a participant stated: “I had never really considered the reality/relevance of compassion fatigue, but Resilience on the Run made me realise that I myself show signs and need to consider selfcare. You have two big burdens. 1. The job. 2. Yourself. This program helps one and two become easier to manage”. Another participant reflected by stating, “These issues are underdiscussed. If nothing else, these sessions normalise discussions on employee mental health.” For all Resilience on the Run enquiries, contact the Business Support Team at AMA Queensland on (07) 3872 2222 or email resilience@amaq.com.au. Upcoming sessions of Resilience on the Run for June, July and August are listed on the AMA Queensland wesbite at www.amaq.com.au.
AMA Queensland is delighted to have won the AMA Public Health Initiative of the Year Award for Resilience on the Run at the recent AMA National Conference.
42 Doctor Q Winter
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Doctor Q Winter 43
Events Calendar
Visit www.amaq.com.au for more information or to register for our upcoming events.
MORE
2018
EVENTS MOCA 5 HOSPITAL VISITS Date: June and July Locations: Rockhampton, Bundaberg, Hervey Bay, Maryborough, Princess Alexandra Hospital Brisbane, Ipswich and Gladstone FREE FOR AMA MEMBERS AMA Queensland and our partner union ASMOFQ are visiting hospitals around Queensland to deliver presentations on the current MOCA 5 negotiations. See page 27 for dates and locations.
R E G I O N A L P R I VAT E PRACTICE SEMINAR SERIES ONE Date: June Locations: Rockhampton, Bundaberg and Hervey Bay This remaining dates in the series will cover the importance of a Code of Conduct and a breakdown of the Fair Work Commission’s four-yearly review on Modern Awards.
7 - 8 September Private Practice and Medico-Legal Conference 23 - 29 September Annual AMA Queensland Conference New Orleans 12 October Dinner for the Profession November December Workplace Relations Training Series Two 6 December Minister’s Breakfast Cairns
FIFTH ANNUAL JUNIOR DOCTOR CONFERENCE Date: Saturday 23 June - Sunday 24 June Location: Hilton Brisbane AMA Queensland’s fifth annual Junior Doctor Conference boasts a slew of local, national and international speakers who will inspire and educate our junior doctors on everything from global health to ground-breaking medical research, medical leadership, mental health and career development. Day two of the conference will feature emergency clinical skills competition Simulympics 2.
44 Doctor Q Winter
WOMEN IN MEDICINE BREAKFAST Date: Thursday 23 August Location: Victoria Park Golf Club, Herston Following the success of last year’s Women in Medicine panel, we invite all women in the medical profession to join our impressive 2018 panellists to learn how to seize every moment both personally and professionally and how to find and harness your passion in medicine.
FRIDAY 12 OCTOBER
VICTORIA PARK GOLF CLUB
FOR MORE INFORMATION VISIT WWW.AMAQ.COM.AU
women in medicine breakfast
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MEET THE SPEAKER
A/Prof Melissa Kang Since 1970, a long time before Dr Google, girls would write in with their most private or embarrassing health questions and the Dolly Doctor would provide a down-to-earth, non-judgemental and informed answer. Generations of girls learned about their bodies, sex, life, friendship, pregnancy and “things down there” from poring over the Dolly Doctor column in their Dolly magazine. Associate Professor Melissa Kang served the important role of Dolly Doctor from 1993 until the print magazine’s demise in 2016. Her passion for working with and for young people has defined her career – in fact, she is now leading the NSW Health-funded study Access 3 which explores the way young people navigate the health system in the digital age. She is an academic, a clinician, and an advocate for adolescent sexuality, sexual health and access to primary health care for young people. She is an Associate Professor at the University of Technology Sydney and a Clinical Associate Professor in General Practice at the Westmead Clinical School, University of Sydney. She has been involved in developing resources in adolescent and/or sexual health for GPs for the Royal Australian College of General Practitioners, NSW Health (Office of Kids and Families) and the Sexually Transmitted Infections Programs Unit for NSW Health.
What sparked your interest in adolescent sexual health? Truth be told, probably my own adolescence. I became aware as I grew into young adulthood of the doublestandards that existed about female sexuality, as well as the total absence of sex education in the school I went to. It struck me then as a terrible injustice not just for me, but for all young women.
Dolly Doctor came about in a time long before the internet but also when kids had access to their own internet-connected device. How do you think the questions young people have changed over the years? I think at the moment we are all grappling with the double edged sword that is technology. It has revolutionised young people’s access to information, and provides safe spaces for many young people to share and learn about themselves, especially for sexuality and gender diverse young people. On the other hand, it is a setting where discrimination, harassment and bullying can be perpetrated. So while many young women hopefully feel reassured when they see and share information about sex online, others may feel less confident or much
worse. The questions to Dolly Doctor didn’t change very much over the 23 years I wrote for the magazine. They were always about changing bodies, changing feelings and changing relationships. My sense, though, was that adolescent girls did have more knowledge, more language, to describe and discuss their concerns, while still having the same worries and anxieties. I sensed a slight increase in confidence to discuss pleasure in sex, while simultaneously a decrease in confidence around genital body image.
The internet has removed many barriers to health information for adolescents, but what kind of barriers still exist? One might be the abundance of often conflicting information on the internet – although young people are discerning consumers and generally know what website to trust. The other is that nothing is a substitute for having real conversations and discussing intimate things – with a romantic or sexual partner, with a friend, a parent or a health professional.
Can you give us some tips on developing a better rapport with adolescent patients? My first tip is always to suggest that (before we see an adolescent patient)
A/PROF MELISSA KANG
General Practitioner; former Dolly Doctor; Associate Professor, University of Technology Sydney; and a Clinical Associate Professor in General Practice at the Westmead Clinical School, University of Sydney
#amaqwim18 @ama _qld we close our eyes and remember back to our own adolescence and our most intimate thoughts and then imagining telling them to a stranger. In those moments of frustration because an adolescent won’t ‘talk’ it’s helpful to remember what it was like. Secondly, make sure adolescents and their parents/carers understand what’s confidential (and what isn’t). Finally, allow yourself time to engage and work on that – there are plenty of resources out there to help build those skills. Developing a doctorpatient relationship with adolescents has always been the most rewarding experience for me in medical practice. Young people are so incredible and to have their trust is such a privilege.
And finally, the question so many of us wanted to ask: surely some of the questions were made up? Were all the Dolly Doctor questions actually real? The magazine never made up a question – every question published was real, and unedited except for typos. Having read thousands of them over the years, I’m sure there were plenty of adolescent girls who had fun making them up and sending them in! Register now for Women in Medicine at www.amaq.com.au Doctor Q Winter 47
AMA QUEENSLAND’S ANNUAL CONFERENCE
Join us in New Orleans Perhaps Tennessee Williams said it best: “America has only three cities: New York, San Francisco, and New Orleans.” New Orleans is one of the world’s most fascinating cities, with a history as winding and arabesque as the stretch of the Mississippi River Delta upon which it sits.
New Orleans is the destination for the next AMA Queensland Annual Conference and will run from 23 – 29 September 2018. With the theme The Future of Health Care, the conference will feature a range of renowned presenters from the University of Queensland Ochsner Medical School, on the future of health care, including cutting-edge topics such as: wearable technology innovations in the hospital
setting; advances in 3D printing and how this technology is reshaping complex congenital heart surgeries; the future of Electronic Medical Records; training the physicians of the future (including a student’s experience); obesity - a global problem; the rise of robotics in medicine; exploring trends of consumerism in medicine; connected health: an emerging model of maternity care; and health and general practice as a good investment.
Confirmed speakers from the University of Queensland Ochsner Clincial School, New Orleans: Dr Richard Milani, Chief Clinical Transformation Officer,
50 Doctor Q Winter
Ochsner Health Systems Associate Professor Rajiv Gala, Director, Department of Obstetrics and Gynecology Dr Jody Morris, Chair, Department of Obstetrics and Gynecology, Ochsner Clinic Foundation Dr Korak Sokar, Senior Neurologist, Ochsner Health System Dr Todd Burstain, Chief Medical Information Officer, Ochsner Health System Associate Professor Leo Seoane, Head of School, UQ Ochsner Clinical School Dr Dana Smetherman, Section Head of Breast Imaging, Ochsner Health System Dr Gabriel Uwaifo, Senior Clinical Research Scientist and Endocrinologist, Ochsner Diabetes and Weight Management Clinical Research Institute.
Outside the conference sessions, there will be plenty of time to explore New Orleans and all it has to offer. Tours around the city will include New Orleans’ highlights such as the Garden District and its mansions and magnolias, a day trip to experience the marvels of Louisiana’s Bayou Country and the mystical swamplands, and optional ghost and cemetery tours or Mississippi River cruises.
PRE AND POST CONFERENCE TOURS Experience the best Cuba has to offer, visit The Deep South, taking in Memphis and Nashville, or cruise the magnificent Mississippi River on the American Queen Steamboat. Alternatively, Orbit World Travel can help craft your ideal tour option. Numbers are limited so be sure to book your pre and post Conference tours now.
Keen to book your pre and post conference tours? Contact Ros Bulat at World Orbit Travel Email: ros.bulat@worldtravel.com.au For any enquiries about the program: Contact Neil Mackintosh, AMA Queensland Conference Organiser Phone: (07) 3872 2267 Email: n.mackintosh@amaq.com.au Phone: (07) 5556 7267 or 1300 262 885
Doctor Q Winter 51
Local Medical Association round up Redcliffe District Local Medical Association (RDLMA)
Ipswich & West Moreton Medical Association (IWMMA)
Gold Coast Medical Association (GCMA)
Contact:
Contacts: Dr David Morgan, President; Dr Aletia Johnson, Meetings Convenor; Dr Thomas McEniery, Treasurer Phone: (07) 3281 1177
Contact:
Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3049 4444 Meetings: 26 June 25 July 28 August - AGM 12 September 30 October 7 December - end of year networking function
Sunshine Coast Local Medical Association (SCLMA) Contact: Jo Bourke, Secretariat Web: www.sclma.com.au Email: jobo@squirrel.com.au Phone: (07) 5479 3979 Meetings: 21 June 26 July
Bundaberg Local Medical Association (BLMA) Contact: Dr Daud Yunus Email: daud.yunus@gmail.com Phone: (07) 4152 2888
Mackay Local Medical Association (MLMA) Contact: Phone:
Brisbane Northside Local Medical Association (NLMA) Contact:
Dr Robert (Bob) Brown, President Web: www.northsidelma.com Phone: (07) 3265 4555 Meetings: 12 June 14 August 9 October 11 or 14 December
Toowoomba and Darling Downs Local Medical Association (TDDLMA) Contacts: Dr Mark Wyche, President; Dr Peter Schindler, Treasurer Web: www.tddlma.org.au Email: info@tddlma.org.au Phone: (07) 4633 1939 Wilsonton Medical Centre (Dr Peter Hopson)
Chantell Badenhorst, Secretariat Manager Web: www.gcma.org.au Email: info@gcma.org.au Phone: 0419 780 505
Fraser Coast Local Medical Association (FCLMA) Contact: Dr Nicholas Yim, Secretary Email: drnnyim@gmail.com Phone: 0421 659 892
Cairns Local Medical Association (CLMA) Contact: Phone:
Dr David Shepherd (07) 4031 8400
Central Queensland Local Medical Association (CQLMA) Contact: Phone:
Dr Michael Donohue 0419 715 658
Dr Bill Boyd 0419 676 660
CAN’T FIND YOUR LOCAL AREA? 52 Doctor Q Winter
If your Local Medical Association does not appear or your details are incorrect, please email amaq@amaq.com.au.
RACTICE & P R I VAT E P FERENCE N O C L A G E MEDICO-L
en tio n Br is ba ne Co nv nt re Ce n & Ex hi bi tio
AMA Queensland’s ever-popular Private Practice & Medico-Legal Conference is a comprehensive two-day program that gives you the opportunity to hear:
Register now online at
rd ay 8 Fr id ay 7 - Sa tu 18 Se pt em be r 20
*Subject to approval
WWW.AMAQ.COM.AU
E D I S T U THINK O E R A U Q S THE
RACGP & AAPM CPD POINTS AVAILABLE
Leading departmental speakers on Medicare billing and all of your MBS queries; Case study-driven agendas, featuring a range of panel discussions with highly experienced specialists, GPs and practice managers; and Dedicated streams for specialists, general practitioners and practice managers.
Keynote speakers Key topics
The health care home – update and future directions; How practice managers can get the best out of their practice support;
The Hon Justice Boddice, Supreme Court of Queensland Dr Steve Hambleton, General Practitioner, Kedron Park 7 Day Medical Centre; GP Representative on Health Care Homes Advisory Group Emma Hossack, President, Medical Software Industry Association Gary Smith, Practice Manager and Practice Management Lecturer, University of New England Heather McDonald, Director Education and Early Adoption, Australian Digital Health Agency Luke Toy, Director, Medical Practice, Australian Medical Association Megan Walker, Health Marketing Specialist and Director, Market Savvy
What’s new with My Health Record and the Digital Health Agency; Medical software – how doctors can maximise value now and work with industry to take advantage of innovations; Understanding the courts and expert evidence process; and Quality practice marketing – connecting you with the people who need you most.
Didactic Panels
Thinking outside the square - unlocking the secrets of practice longevity and success; Medicare compliance and MBS billing - unravelling the complexities; Private practice agony aunt panel.
Discounted early-bird registration is available for members and their support staff.
Doctor Q Winter 53
Specialist start up:
LESSONS LEARNED ON MANAGING RISKS
CHRIS MARIANI Medical & General Risk Solutions
P: 0419 017 011 E: chris@mgrs.com.au Authorised Representative No.434578
After setting up and running three successful businesses, Dr David Chettle studied medicine and specialised in obstetrics before moving to Toowoomba to set up Evolve Women’s Health. I first met David a few years ago at AMA Queensland’s Medico-Legal Conference (which is now the Private Practice and Medico Legal Conference, held in September). We stayed in contact over the next few years with David contacting me for advice on risk management, compliance and insurance as he developed his business plan to enter private practice. Before he opened the doors in March, I sat with David to ask him what he had learnt.
FREE things I did:
Talk with as many new and established private specialists in my field – taking their advice and learning from their mistakes!
Seek out mentors in my field - not just a paper expert, but someone who has built a successful private practice as well. I talked with them regularly (I had two in particular - Dr Gino Pecoraro and Dr Brad Armstrong – many thanks to them!)
Join the Business for Doctors closed Facebook page. I often learn things from my peers posting comments.
Disclaimer: Medical and General Risk Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Australian Financial Services Licence No 240549, ABN 15 003 886 687. Authorised Representative No 436893. The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.
54 Doctor Q Winter
W H AT D I D Y O U D O D U R I N G YOUR 18-MONTH PLANNING PHASE? Many of the experts/specialists I engaged I met at numerous conferences, workshops and events. I enlisted the help of medical specialist business advisors and consultants, accountants, solicitors, marketers, etc. I chose a legal firm that could handle property law for leases and commercial law for business structure, privacy, human resources and employment and information technology contracts. I actively sought out and hounded Chris Mariani - hassled him for a solid 15 months for endless advice and direction. Doctors need to have specialist risk management and insurance advice - for business, professional and personal. I also talked with lots of information technology providers - hosted vs own managed server, cloud vs computer based medical record software. Which medical practice software fits you best? There are not a lot of specialist medical marketers and web developers out there. If you employ the services of marketing, web or social media experts - they need to be fully across the Australian Health Practitioner Regulation Agency advertising guidelines.
HOW DID MGR ASSIST YOU IN PLANNING TO SET UP YOUR PRACTICE? Chris helped with two major areas:
advice on risk management and compliance issues; and advice and set up of the right insurances for my practice.
On the insurance side – he provided insurance costs relative to structure options. Chris recommended I seek out expert help with accountants and legal advice to marry up with accounting advice to holistically minimise tax and accounting costs, whilst maintaining maximum asset protection. Chris also helped identify and explain the risks involved with private practice, giving initial insurance estimates of potential costs based on my speciality and business structures. We spent lots of time talking about my medical indemnity needs and reviewing the various options and insurers. Chris provided a list of pros and cons for each relative to my specialty and structure. On the business side, Chris explained the range of insurances available, costs of each, what they do and do not cover, individualised advice as to what I need in my situation so as to not over/under insure against the risk. We had lots of discussions of newer risks in the field of cyber/ privacy – especially given new legislation on the Notifiable Data Breaches scheme. We talked about the risks associated with having my systems and data hosted professionally in data centres vs that of having an in-house server. Chris took me through privacy legislation and what to do to get compliant, AHPRA advertising guidelines, the risks of fraud in medical practices and other common risks. Chris’ expertise allowed me to better understand what is really covered and to what extent. He was able to draw on his own unique case study experience which allowed me to justify what insurances I should take. Chris even helped with providing me his privacy policy templates and other documents to help me get privacy compliant.
WAS THERE “THINGS YOU D I D N ’ T K N O W T H AT Y O U DIDN’T KNOW”?
Thankfully with my legal team and Chris’ help along with an amazingly keen IT firm (Greenlight ITC), we made significant headway to producing an agreement that is actually fair and reads as it should “you stuff up - your fault, you fix it, I stuff up, my fault”. A number of IT firms I spoke to commented “no doctor has every raised an issue with our contract and all signed without question”. I find it amazing that this is the case, because if you take the time to read the contract, no sane person would agree to it.
ANY TIPS FOR SELECTING T H E R I G H T C O N S U LT A N T S ? Do your own research first, then get recommendations from your trusted peers. Make a short-list of three in each area and get them to give you a complementary hour of their time. In the meeting tell them your story and vision and let them tell you what they can do for you. Ask about their costs - not hourly rates, cost for getting the job done. Ask them how they are remunerated. If they won’t give you any of the above, walk away. Seek out people who specialise in medical practitioners as their core business. Don’t pick an accountant or insurance specialist that does not fully understand medical. Ask them to give you a few names of their other doctor clients (after they have sought consent) and ask if you could speak to those doctors.
W H AT D O Y O U S E E A S T H E DIFFERENCE BETWEEN USING A BROKER VERSUS A DIY APPROACH? You might be able to do it yourself, but you need to access the covers, know how to read and interpret them - but that is all useless if you don’t know which covers you need. I have cover with a number of different companies as no single insurer is best for everything for my circumstances - some don’t have a full range of products needed, others only distribute their products through brokers. A specialist broker will save you money in two ways – firstly they will find the best value and appropriate policies for you and secondly and more importantly - saves you way more if you ever actually have the misfortune of making a claim. The peace of mind of having someone on my side, representing me is also important.
Probably my biggest unknown was signing bad contracts. I didn’t realise that pretty much every IT provider (at least all the ones I interviewed) contractually does not accept responsibility for any negligence. I learned if I signed these sorts of contracts, I would likely void my insurance covers. As doctors, we are responsible to patients if we make a mistake, so why shouldn’t our IT consultants (who are claiming expertise) be held to the same legal standard?
Doctor Q Winter 55
Estate planning Not surprisingly, many people put off implementing their estate planning. What may be surprising are the potential consequences of not taking steps to implement an effective estate plan during your lifetime. Estate planning involves putting in place strategies that protect your assets during your lifetime, as well as enable the successful transfer of your assets to your beneficiaries with minimum hassle and expense. Often, an effective estate plan does not simply involve preparing a will. It involves identifying assets held in superannuation funds, trusts and companies and effectively passing on control of those entities. Your estate planning measures should be integrated with your financial and business plans.
W H AT H A P P E N S I F Y O U GET IT WRONG? The importance of proper estate planning and related business succession planning, as well as the potential consequences of not getting it right can be best illustrated by way of the following examples: 1.
You hold assets personally (including a share in a family investment property as tenant in common) and are married without children. You pass away without a will and your entire estate is inherited by your spouse in accordance with intestacy laws in Queensland which operate if you pass away without a valid will. Your spouse passes away shortly thereafter without a will and your spouse’s parents inherit your estate under intestacy laws. Your family members are forced to acquire your share in the family investment property from your spouse’s parents for market value.
2.
You are married with children and have a will in place gifting your estate to your children in equal shares. On the death of you and your spouse, your children inherit your estate personally. One of your children operates a business and experiences serious financial difficulties resulting in bankruptcy. The assets received under your will are used to satisfy your child’s creditors.
3.
A medical practice is operated via a unit trust with units held by family trusts controlled by the respective doctors (related and unrelated). A verbal agreement exists that each unitholder will self-insure in an amount considered adequate to cover the respective doctor’s family and the business will be transferred to the remaining unitholders on the death of the respective doctor. An unrelated doctor dies and the insurance policy is paid out to the deceased doctor’s family members in an amount sufficient to cover the interest of the deceased doctor’s family trust in the business. However, the deceased doctor’s family also claims a share of the business.
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ANISHA SINGH Senior Associate, HWL Ebsworth
P: (07) 3169 4971 E: a.singh @hwle.com.au
W H AT C O U L D H AV E B E E N DONE TO AVOID THESE OUTCOMES? For each of the above scenarios, the following steps could have been taken to avoid the unintended outcomes: 1.
You could have prepared a will gifting your interest in the family investment property to your respective family members in the relevant proportions.
2.
You could have prepared a will gifting your estate to one or more testamentary trusts established for the benefit of your children and grandchildren. If structured appropriately, such trust/s will provide maximum protection for those assets against creditors and bankruptcy of your beneficiaries, as well as provide some protection for your beneficiaries in a matrimonial property settlement.
3.
A unitholders agreement could have been entered into between the trustee and unitholders of the unit trust operating the medical practice, stipulating the mechanism for dealing with the interest of each of the unitholders on the death of the respective doctor. For example, the remaining unitholders could have the option to acquire the interest of the outgoing unitholder in the same proportions as they hold units in the unit trust, for market value (less any proceeds of insurance received).
IS IT WORTH IT? The benefits of implementing effective estate planning will far outweigh the costs in the event of a mishap. Taking steps now will ensure that your wishes are fulfilled and avoid unnecessary stress for your family members after you pass away.
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
Adelaide | Brisbane | Canberra | Darwin | Hobart | Melbourne | Norwest | Perth | Sydney
Tony Mylne Partner P (07) 3169 4975 E tmylne@hwle.com.au hwlebsworth.com.au
Year-end tax planning considerations
JULIE O ’ R E I L LY
Business Advisory Director, William Buck Accountants P: (07) 3229 5100 E: julie.oreilly@ williambuck.com
The end of the financial year is coming. So, if you are looking for a little more in your refund cheque this year or are trying to reduce your tax bill, keep reading because prior planning can help to boost your financial position come tax time.
SALARY INCOME Most public hospital employers allow an employee doctor to enter into salary sacrifice arrangement. This is essentially where an employee forgoes a portion of their salary to pay for items in money which has not yet been taxed. The effect of this is that you do not pay tax on the amount that you salary package under this arrangement. Public hospitals have access to generous Fringe Benefits Tax exemptions with employees working within a public hospital having the ability to salary package up to $9,010 of benefits. These benefits can be in the form of mortgage repayments, rent, motor vehicle expenses and a variety of other personal expenses. An important tax planning strategy is to ensure your salary-packaging cap has been fully utilised.
OTHER INCOME Other income commonly received by medical practitioners comes in the form of investment income. As you will read, we have considered some tax planning opportunities around capital gains, superannuation and the small business instant asset write off (SBIAWO).
58 Doctor Q Winter
Capital gains A capital gain arises when a taxable capital assest is sold at a profit. For an individual medical practitioner, this most commonly relates to the sale of:
shares held as investments;
investment property; or
distributions of capital gains from managed funds.
It is important to review your asset portfolio prior to 30 June for any unrealised losses that could be crystallised prior to 30 June. Any loss on the disposal of an asset can be used to offset any capital gain made; for example, a capital loss on shares may be offset against a capital gain made on the sale of an investment property. Capital losses are not lost if not used, simply carried forward until such time as a capital gain arises. Review your share portfolio and if you have had a gain on some shares sold in the year, and are sitting on a loss from some other shares which are unsold, sell the shares with the loss and then, depending on your financial goals, you may reacquire the shares at a later date. Superannuation Superannuation contributions for both personal and employee contributions must be paid, processed and received by the super fund prior to 30 June 2018 in order to be deductible in the 2018 financial year.
Outlined below are the 2018 superannuation contribution caps: Concessional Contribution Cap $25,000 Non-Concessional Contribution Cap $100,000* Importantly, for doctors in practice there may be an opportunity to make a tax-deductible contribution to superannuation for your spouse prior to 30 June 2018*. Small business instant asset write off The recent budget announcements on 8 May 2018 indicated that the government will extend the SBIAWO to 30 June 2019. This concession allows small businesses with an aggregated turnover of less than $10 million to claim an immediate deduction for assets costing less than $20,000 (excluding GST), if they are purchased prior to 30 June 2019. Therefore, if you are a doctor in private practice, you may be able to claim a deduction for the purchase of new equipment, a small car, computers and phones if they are purchased and available for use prior to 30 June 2018*. * For members 65 or over but under 75 ** Conditions apply
ARE YOU READY FOR 30 JUNE? Get a second opinion today from the Tax Advisors to the Medical Industry.
P. 61 7 3229 5100 | F. 61 7 3221 6027 Level 21, 307 Queen St, Brisbane, Qld, 4000
Confidentiality
Vs
risk of harm
T H E K E Y E L E M E N T T O T H E D O C T O R - PAT I E N T R E L AT I O N S H I P I S T H E PAT I E N T ’ S E X P E C TAT I O N T H AT T H E D O C T O R W I L L H O L D T H E I R I N F O R M AT I O N I N C O N F I D E N C E But there are times when doctors are not required to maintain patient confidentiality and these exceptions are set out in both state and federal privacy legislation. However, under privacy legislation, there is no mandatory duty for doctors to disclose confidential information to third parties. Against this background, a recent finding by a Victorian Coroner suggests there are those who consider that doctors should make disclosures when exceptions apply.1
CASE HISTORY Ms Adriana Donato was murdered by her ex-boyfriend, James Stoneham, on 23 August 2012 in Essendon, Victoria. The focus of the inquest into Ms Donato’s death centred on the extent of Mr Stoneham’s disclosure to his case manager, Clinical Psychologist Dr Caroline Gregory, of any threat to Ms Donato’s safety, either implied or explicit. Ms Donato ended her relationship with Mr Stoneham for the second time in December 2011. By early to midFebruary 2012, there was a change in Mr Stoneham who struggled to deal with the breakup. From this time, Mr Stoneham was drinking excessively and taking illicit drugs. He was attending Dr Gregory for treatment. Dr Gregory last saw Mr Stoneham on 22 August 2012, the day before Ms Donato’s death.
MEDICO-LEGAL ISSUES The Victorian Coroner explored Dr Gregory’s obligations of confidentiality in the therapeutic relationship and the exemption to that confidentiality as set out in the Health Privacy Principles contained in the Health Records Act 2001 (Vic). The Coroner also examined whether the threshold for breaching confidentiality under the Health Privacy Principles – that the patient must 60 Doctor Q Winter
present a “serious and imminent threat to an individual”2 – was too high. Dr Gregory was shocked to learn about Ms Donato’s death. She stated that while Mr Stoneham had discussed feelings of anger, there was a vast difference between those feelings and what had happened. In her assessment of Mr Stoneham on 22 August 2012, Dr Gregory saw no risk of harm to anyone. At a consultation on 13 August 2012, Mr Stoneham had expressed aggression towards an unnamed individual and had thoughts of violence, but refused to disclose any details. There were earlier consultations where Mr Stoneham had expressed anger towards Ms Donato. As a result of expert evidence, the Coroner concluded that Dr Gregory should have questioned Mr Stoneham on 13 August 2012 about his thoughts of violence and she should have made specific reference to Ms Donato. The Coroner considered that if this had occurred, it may have led to a notification by Dr Gregory to the police. The Coroner commented that while the reporting of such matters is not mandatory, the spirit of the Health Privacy Principles demands that such matters must be addressed and that the reporting of above threshold cases should occur. In arriving at this view, the Coroner considered
that the threshold under the Health Privacy Principles was too high and acknowledged that, at a federal level, there is no requirement that the threat needs to be “imminent”. The Coroner recommended that the Department of Health and Human Services give consideration to the removal of the requirement that a “serious risk of harm” be also one which is “imminent”.
MEDICO-LEGAL ADVICE Under the Australian Privacy Principles (APPs), health information can be disclosed if it is a ‘permitted general situation’ – this includes if you reasonably believe that the disclosure is necessary to lessen or prevent a serious threat to the life, health or safety of any individual. References 1.
Inquest into the Death of Adriana Donato. Available at: coronerscourt.vic.gov.au/home/coroners+written+findings/ findings+-+inquest+into+the+death+of+adriana+donato
2.
Health Records Act 2001 (Vic). Health Privacy Principle 2.2(h).
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.
Mind the gap
KEEPING CHOICE AFFORDABLE The proposals announced by Bupa in March this year to remove its medical gap coverage where their customer is admitted to an uncontracted hospital, is a further blow to the reputation of the health insurance industry.
PETER ARONEY
While health funds are required to pay a minimum floor price to approved uncontracted private hospitals, Bupa’s proposals will remove their medical gap coverage, leaving the patient exposed to potentially large out-of-pockets where Bupa has no contract with the hospital. There is no doubt that any patient will be forced to think twice about using a doctor, or a hospital, when faced with the potential cost in those circumstances. Bupa has advised that such uncontracted hospital admissions are the minority. Yet industry observers have commented on the implications of this move; particularly the impact on healthcare decisions between doctors and patients.
P: 1800 226 126 E: doctorshealthfund. com.au
P R I VAT E H O S P I TA L COMPETITION
CEO, Doctors’ Health Fund
References
R E P U TAT I O N A L I M PA C T
1.
Cost control is important, especially at a time where the future sustainability of the healthcare system is under intense scrutiny. Like all health funds we do not shy away from robust negotiation with the private hospital sector, the majority of which (by bed count at least), is publically listed. While this is in the interests of our members, equally important is the diversity and competition that the smaller, often specialised hospitals, provide to the sector.
This also comes at a time when the private health insurance industry is facing serious reputational harm. Much of this is understandable when we hear cases of consumers who have made many years of personal sacrifice to maintain their health insurance, only to discover they aren’t fully covered when faced with a medical need. It is not unusual for consumers to be paying eight per cent1 and upwards of their after-tax income on health insurance premiums.
2. AMA, AMA Private Health Insurance Report Card 2018, Pg. 13, 26 March 2018 - https:// ama.com.au/article/amaprivate-health-insurancereport-card-2018
FA C I L I T AT I N G T H E RIGHT TO CHOOSE
WORKING C O L L A B O R A T I V E LY
At the same time, we cannot lose sight of the fact that at the very heart of private health insurance are the fundamental principles of ‘peace of mind’ and ‘freedom of choice’. It is difficult to see how these principles are upheld when health funds limit that choice by only providing medical coverage to hospitals with which they have chosen to enter into a contract.
Aussie families could be forking out 20% of their income on health cover by 2051, Feb 5, 2018, https://www.finder. com.au/press-release-feb2018-20-percent-incomehealth-insurance
With the current turbulence in the industry, we strongly believe that all of us involved in healthcare have a stake in this debate. And that a collaborative approach focused on upholding the core purpose of health insurance is key to addressing the challenges ahead.
surance r the health in fo n er nc co y ium increase ility being a ke average prem t es w With affordab lo e th ive year ve delivered sixth consecut e th d industry, we ha an 18 r th funds in 20 importantly, ou across all heal creases. More in lst e hi w ag er ed av ev ry st been achi ve ha s of below indu se ri e terms of average pric 2 t, open funds in es gg below industry bi e th with no-gap . tperform ou ed id to ov ue pr in g nt in we co ices be of medical serv r patients the percentage ctors and thei do to ce oi ch e or ealth Fund. This ensures m the Doctors’ H of e pl ci in pr l ta – a fundamen
62 Doctor Q Winter
Getting the right finance for your equipment To get the best results for your clients, you need the right equipment. Advances in technology mean you can get equipment that can have a great impact on case acceptance, productivity and patient outcomes, but that equipment comes at a price. Also, the way you pay for that equipment may be different depending on your career stage. For example, a brand new surgery will require a different cash flow structure to a well-established clinic looking to expand its treatment options. Is a lease a better option than just buying it? Or will you eventually pay it off, only to find out you need to update it almost immediately? The average bank won’t understand your business enough to help you make that decision, but we will. We work with you, your financial adviser and/or accountant to tailor an arrangement which fits with your circumstances. We also conduct a cash flow projection, considering factors such as how many patients need to be seen over the life of an asset to ensure it is profitable.
W H AT ’ S T H E B E S T T Y P E O F F I N A N C E F O R M E ?
There are a number of different ways to finance capital equipment. The right one for you depends on the stage of your career, the type of practice you have, and how you currently structure your finances. Options include:
HIRE PURCHASE LOAN: With this loan type, the lender purchases the assets you need and then hires them to you over an agreed contract period. The lender owns them until the loan and interest have been repaid in full. As a general rule, interest rates are often very competitive with a hire purchase loan, as the loan is secured by the assets purchased. Repayments are fixed and there are generally no ongoing fees.
CHATTEL MORTGAGE: This loan is similar to a commercial hire purchase, except you own the assets for tax purposes from the time of purchase. It is similar to a hire purchase in that it offers competitive interest rates, fixed repayments and generally no ongoing fees, and you may be able to claim the interest and depreciation as a tax deduction. A difference between this and a hire purchase loan will be the treatment of GST for tax purposes, so make sure you talk to your financial adviser or accountant about which one is best for your individual situation.
LEASE: Under a lease agreement, we purchase your assets and your payments are split into a number of monthly lease payments and a residual. You pay rent on your assets and at the end of the period, you can elect to purchase the goods for the residual amount. There are generally no ongoing fees and your full lease payments may be tax deductible.
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.
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PROFESSIONAL OVERDRAFT: An overdraft facility can be secured or unsecured, and you can make interest-only repayments or pay down the overdraft with principal repayments. You only pay interest on what you use rather than the whole credit limit, and the interest may be tax deductible. There are generally no ongoing fees.
Study on holiday Every year, millions of people around the world take to the seas on a cruising adventure and there are good reasons why. Cruise ships are the epitome of luxury floating resorts, offering an amazing choice of accommodation, entertainment, dining options and on-shore excursions that allow you to relax and rejuvenate, regardless of how you like to spend your down time. If you’re a busy medical professional, no doubt you’re in need of a holiday once in a while, however being focussed on furthering your career by undertaking study opportunities can often take precedence. What if you could do both?
STUDY WHILE YOU CRUISE There are a range of cruise options around the world that offer unique continuing education seminars that enable practising medical professionals to earn industryrecognised credits in their relevant field. Of course, the added bonus is that you have the opportunity to enjoy a luxury cruise at the same time. From casual and formal to contemporary and classic, these companies offer educational travel cruises to a range of exciting must-see destinations across the globe, from Alaska, the Caribbean and the Mediterranean to Europe, Hawaii, Antarctica and Asia. These courses are held while their ships are between ports, so you don’t miss out on the chance to experience on-board activities and memorable shore excursions in between your study sessions.
CHOICE OF PROGRAMS
FA N T A S T I C FA C I L I T I E S
Offering hundreds of programs in a variety of disciplines, many of these programs are facilitated by some of the world’s leading specialists and medical professionals. Regardless of what medical stream you practise, they involve accruing a range of contact hours and all courses offered are accredited for a variety of individual professions. It’s the ideal way to study abroad in the comfort of your floating home-away-fromhome. Depending on your individual circumstances, these may also attract industry accredited points.
In between study sessions, you can perfect your tennis stroke, attend an enrichment lecture, watch a feature film, relax by the pool, and enjoy all the experiences that shore excursions offer on a cruising get-away. Many educational cruises also feature special-interest entertainment ranging from classical music concerts and jazz festivals to golf clinics and murdermysteries-at-sea. In terms of things to do and ports of call, the world literally is your oyster – minus the hassle of packing and unpacking.
These cruises also welcome solo travellers and families with children and they can accommodate group bookings that allow you and your colleagues to take advantage of special rates while enjoying the benefits of studying together.
Of course, these cruises for medical professionals also feature superior facilities suited to study, from group discussion areas to conference rooms equipped with Wi-Fi connection and state-of-the-art audio-visual equipment.
F L E X I B L E PA C K A G E S These educational travel programs also suit busy professionals with flexible itineraries from three days to up to three months, and a range of accommodation from suites and interior rooms to those with balconies and ocean views. Guests can also take advantage of pre- or post-cruise packages that allow you to extend your holiday and make the most of both relaxation and study opportunities while you’re away. Holiday as you study? It’s a win-win!
ueensland avel - AMA Q Orbit World Tr : er id el prov preferred trav 885 2 P: 1300 26 aq.com.au am E: travel@ .au ldtravel.com www.orbitwor
Doctor Q Winter 65
RESTAURANT REVIEW
Old Tom Restaurant and Bar, Broadbeach The Broadbeach mall seems an unlikely place to find a boutique gin bar and fine-dining destination. However, Old Tom Restaurant and Bar is quickly changing this perception, with the latest addition to the Gold Coast’s food scene proving to be popular amongst locals and tourists alike. To start, it would be remiss to pass on one of their signature gin cocktails. The concept behind Old Tom lends itself to the Gin Act of 1736 whereby gin was heavily taxed to prevent excessive consumption. A picture of a tomcat was placed outside bars who would reward patrons with a shot of gin for placing a coin in the cat’s mouth, their way of circumventing the tax in place. Gin therefore features heavily in their beverage menu. Skip your regular gin and tonic and try a Four Pillars with finger lime, a Tanqueray with grapefruit and lime blossom or Beton with strawberry and cracked lemon. Better yet, try one of their house cocktails, like the Black Tom Collins with paper barked smoked lemon and charcoal, the Baby’s Breath with 66 Doctor Q Winter
lillet rose, hibiscus and macadamia, or my personal favourite, the aptly named Gingercillian, curing all ails with honey, lemon and ginger. If gin isn’t your potion of choice, there is an equally as impressive local and international wine and beer menu, unless the martini trolley of the week takes your fancy! The bar, a ’la carte and degustation food menus are under the careful guidance of chef Cody McKavanagh, who at 21 years of age has already worked for two Michelin starred restaurants and is building quite the reputation for his approach to foraging for his own ingredients. As what would be expected with a venue of this calibre, the bar menu is not your average spread of fried chicken wings and overpriced nuts. Feast on oysters, sashimi or whipped caviar, or for a more substantial feed, the pork belly croquettes, mushroom jaffle and Queensland crab toastie are sure to impress. The a ‘la carte menu reads like you would expect from a chef twice McKavanagh’s age and is bold in its
flavour pairings without intimidating the average diner. For entrée, try the glazed pork cheek with green mandarin caramel, or the smoked hen’s egg with forte aged comté sauce. For mains, it is hard to overlook the torched kingfish with foraged native ginger broth or Rangers Valley wagyu rump cap with Davidson plum puree. Dessert is equally as enticing, with the roasted almond custard with shortbread crumble, and strawberries and cream with smoked paperbark parfait and lemon myrtle broth a feast for the senses. But any experienced foodie cannot pass an opportunity to try the chef’s selected five course tasting menu, described as “a journey from the beach to the mountains”. To start, an amuse bouche of fried bread with whipped caviar and aged comte, a crunchy creamy mouthful so intensely delicious that you’d wish for an entire plate of them. First course features pacific oysters served in an umami and not overpowering roasted chicken emulsion, balanced with sweet and crunchy pickled kohlrabi. Next
D R K A T G R I D L E Y, Advanced Emergency Trainee, Lady Cilento Children’s Hospital; and Deputy Chair, AMA Queensland Council of Doctors in Training, Queensland Doctor’s Health Programme
arrives the poached squid with buttered dashi and sea lettuce, with squid so delicately tender and finely sliced that you would swear you were eating rice noodles instead. My standout dish of the evening and one I would happily devour en masse! The first of the main courses is the vegetarian option. Roasted cauliflower served with raisins soaked in pedro ximenz, brown butter almonds and a generous grating of sheep’s milk cheese has the perfect mix of fine dining flavour with home cooked comfort feel, a real delight. Next comes the Lachlan Valley lamb cooked rare with fried saltbush and charred cucumber sauce, another intricate balance of flavours and with lamb so good that the family Sunday roast pales by comparison. To finish the meal, the Valrhoa chocolate tart with crystallised forest moss may sound a little ridiculous, but proves to be wonderfully rich and bittersweet almost to the point of savoury. The side of double cream is not merely for decoration, as it helps to cut through the richness of the tart with ease, a dish for the heart and soul of the chocoholics amongst us. Old Tom in Broadbeach is a strong contender amongst the rapidly expanding food scene on Queensland’s glitter strip. It is worth the drive, if only to marvel in how wonderful a dining experience can be when pretentious hospitality is pushed aside in favour of a cosy atmosphere and allowing the food to speak volumes for itself. Doctor Q Winter 67
All about you MUSIC: S U R G E O N ’ S S P OT I F Y P L AY L I S T A recent American study showed 90 per cent of surgeons listen to music during surgery (not so surprising) and the majority of them listen to rock (v v surprising). Spotify’s survey showed Rock you like a hurricane by the Scorpions was the most played song in surgery, but worryingly, Eric Clapton’s Cocaine came in at number nine. Visit the Spotify app and search for Surgeons Soundtrack to see the top thirty songs voted by doctors for listening to in surgery.
J O I N I N : D O N AT E L I F E W E E K Running from 29 July to 5 August, DonateLife Week is Australia’s national awareness week to promote organ and tissue donation. Events will be held across the week to encourage Australians to register their donation decision and to discuss their choice with loved ones. Nine in ten families agree to donation proceeding when the deceased is a registered organ donor. This drops to just 52 per cent where the deceased was not registered and the family had no prior knowledge.
T V: L U C I F E R The Devil, dissatisfied with his life ruling hell, decides to take a holiday in Los Angeles. His holiday, spent as you imagine the devil would spend his time, is interrupted by a murder outside his nightclub. The murder awakens something unfamiliar in Lucifer’s soul and he starts to work alongside detective Chloe Decker to punish the sinners. A delightful take on the devil walking the streets among us and debating the fued between good and evil. Oh, and it’s said that all Welshmen can sing - actor Tom Ellis has the voice of an angel, fallen or otherwise. Two seasons are on Netflix now.
ALSO HUMAN: THE INNER LIVES OF DOCTORS
WIN
ets k c i t e i mov ! for two Name:
Telephone:
Caroline Elton Caroline Elton is a psychologist who specialises in helping doctors. For over twenty years she has listened as doctors have unburdened themselves of the pressures of their jobs: the obstetrician whose own fertility treatment failed; the trainee oncologist who found herself unable to treat patients suffering from the disease that killed her father; the brilliant neurosurgeon struggling to progress her career in an environment that was hostile to women. Drawing on extraordinary case studies and decades of work supporting clinicians, Also Human presents a provocative, perceptive and deeply humane examination of the modern medical profession.
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Member no:
Fill out the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au. Entries close 1 July Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au
VAN GOGH 23 and 24 June, 1pm Documentary A stunning new exploration of the life and work of Van Gogh, through the eyes of his most devoted admirer and owner of the largest private collection of his artworks. Gain unprecedented access to legendary artistic treasures, experience the rare architectural beauty of the Kröller-Müller Museum and journey into the past through the Milanese, Florentine, Roman and Palladian Renaissance. With a special focus on the importance of drawing as part of his artistic technique, be immersed in the life of one of the world’s greatest artists as Van Gogh’s story reveals itself from Paris to Provence.
LUISA MILLER
CENDRILLON
16 and 17 June, 1pm Met Opera
14 and 15 July, 1pm Met Opera
James Levine and Plácido Domingo add yet another chapter to their legendary Met collaboration with this rarely performed Verdi gem, a heartwrenching tragedy of fatherly love. Sonya Yoncheva sings the title role opposite Piotr Beczala in the first Met performances of the opera in more than ten years.
Pandolfe, a country gentleman, has married Madame de la Haltière, an imperious countess. She and her daughters, Noémie and Dorothée, bully Pandolfe’s daughter from his first marriage, Lucette - known as Cendrillon.
UPCOMING FILMS Please note upcoming film are subject to change
14 June Incredibles 2 21 June Jurassic World: Fallen Kingdom 28 June Sicario: Day of the Soldado
CANALETTO AND THE ART OF VENICE 2 August, 10am | 4 August, 1pm Exhibition at the Queen’s Gallery Buckingham Palace No artist better captures the essence and allure of Venice than Giovanni Antonio Canal, better known as Canaletto. The remarkable group of over 200 paintings, drawings and prints on display offer unparalleled insight into the artistry of Canaletto and his contemporaries, and the city he became a master at capturing. The film also offers the chance to step inside two official royal residences – Buckingham Palace and Windsor Castle – to learn more about the artist, and Joseph Smith, the man who introduced Canaletto to Britain.
5 July Ant-man and the Wasp 12 July Muse: Drones World Tour 19 July Mamma Mia! Here we go again
26 July The Breaker Uppers 28 July Andre Rieu: Amore
Rhonda Lomax with her Service Coordinator, Sarah Durand.
Help bring hope to MND patients The AMA Queensland Foundation is proudly supporting the MND and Me Foundation to meet the needs of Queenslanders living with motor neurone disease (MND). The MND and Me Foundation delivers support programs, including equipment loan initiatives and in-home care assistance, to families affected by MND.
Care assistance is not available in Jimboomba within the next 12 months, Rhonda and Gary are on their own.
The AMA Queensland Foundation Board pledged $25,000 to the MND and Me Foundation in 2018 to support patients diagnosed with MND.
“He’s been working at the same place for 25 years, and now he’s been forced to move quite quickly from the familiar into the unknown.
One recipient of the foundation’s support is 60-year-old mother of two, Rhonda Lomax. Rhonda was diagnosed with MND in March 2017, with onset of symptoms in 2015. Prior to the grant, husband Gary met all of Rhonda’s support needs.
“This transition from husband to fulltime-carer of me and the household has been one of the hardest things Gary has ever undertaken.”
Rhonda is National Disability Insurance Scheme (NDIS) and Level 4 Home Care assistance eligible, however as NDIS is not due for roll out in Rhonda’s area until July 2018, and Home
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The AMA Queensland Foundation grant has been life-changing for Rhonda and Gary. Rhonda said, “receiving the grant has helped Gary ease into his role as a full-time-carer.
The AMA Queensland Foundation grant has given Gary time to process change, allowed him time to grieve, assess Rhonda’s needs, and importantly, adjust to sharing the care responsibilities for his wife.
Two Australians are diagnosed and two Australians die from Motor Neurone Disease every day. There is no treatment and there is no cure. This hideous disease doesn’t discriminate. We need your help because nobody should face MND alone.
Immediate funding for personal care and domestic assistance means that Rhonda is less likely to be at risk of falls and injury while Gary is at work. Gary said, “I’m so relieved that I don’t have to worry about Rhonda being alone in the house all day while I’m at work. The AMA Queensland Foundation grant really is life-changing for us.” The MND and Me Foundation is providing much needed support for people living with MND. Timely financial assistance is facilitating access to the right care, the right support and the right equipment at the right time. The AMA Queensland Foundation is helping to ensure that Queenslanders don’t have to face MND alone. As part of our end of financial year appeal, please join us in supporting the families of those suffering from MND by making a tax deductible donation to the AMA Queensland Foundation.
the ore about To read m ation’s Me Found d n a D N M ork visit amazing w m.au andme.co d n .m w w w
Do you have a project which needs financial assistance? Contact AMA Queensland Foundation Phone: (07) 3872 2222 Email: amaqfoundation@amaq.com.au
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Thank you for your support!
Doctor Q Winter 71
Great people, great activities, great venues
I am a pretty lucky bloke. I discovered my secret to life can be summarised succinctly in the words great people, great activities, great venues. The first couple of words, great people, comes down to fate a bit. I have been fortunate to meet some absolute champions and I suppose medicine has been a tremendous vehicle by which to achieve this. I met Jossy a few years ago when he rocked up for a job interview, aiming to become our practice registrar. One of his big selling points was that he loved rock and roll. In fact on his first day he immediately unveiled a huge Bob Dylan poster for his room. He was so laid back that he was almost falling over and his resume was pretty brief. I have discovered that in the great game of life it is vital to meet people that inspire you to be the best version of yourself that you possibly can be. Jossy has this knack. He inspires his patients on a daily basis but of more relevance to my story, he fires me up every lunch time in the tea room. We love having a few laughs and we love unleashing our imaginations to launch grandiose ideas. Usually the drug reps end up having to endure our lateral and occasionally delusional thinking but just sometimes we end up coming up
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with a functional idea. We work in a disadvantaged area and both treat a lot of narcotic-addicted people. In keeping with this, Hepatitis C is the scourge of our practice and the new treatments that have emerged have really captured our imaginations. We have almost wiped out Hep C amongst our regular patients and I must say that each cure is uniformly greeted with an appreciation that I have rarely ever experienced as a doctor. I have been kissed and hugged and squeezed like never before. Jossy has a phenomenal altruistic streak and suggested the concept of taking Hep C cures to those least likely to seek medical care. Of course we didn’t really need to do this out of a 1978 cream coloured Kombi that blares 60s and 70s rock but it’s more fun for us and the patients might love it too. We pitched this to a few potential sponsors and miraculously one jumped on board and all of a sudden, Joss and I commenced Thursday afternoon clinics at four drug rehabilitation centres across the great south east, curing Hep C out of what we lovingly call the Hep C Kombi Clinic. We have recruited a phlebotomist, a fibro scan operator and a dietician to join us. In keeping with the unconventional feel of our clinic, we all kit ourselves out in pink flamingo
Hawaiian shirts. If pink shirts help a man get in touch with his feminine side then I am not sure what side of my personality is being accessed by a pink flamingo Hawaiian shirt. The whole Hep C Kombi Clinic has been the best cure for my mid-life crisis and my general practice burn out. It has been reinvigorating and the best fun I have ever had as a doctor. Curing Hep C has been a thrill. I suppose as a GP the chance to cure life threatening diseases is not necessarily an everyday event. Curing Hep C is a magical experience, but doing it in a cream 1978 Kombi while wearing a pink flamingo Hawaiian shirt with Jossy is the highlight of my working life. A great person, a great activity and the Kombi has to be the greatest venue. I am a pretty lucky bloke.
D R M AT T Y O U N G General Practitioner, Inala Medical Centre
Ah Lagrein... YOU’VE DONE IT AGAIN
With appetites increasing for alternative varietals, here’s a rare one worthy of attention. We are big fans of Lagrein here at Wine Direct and have been ever since we latched onto the magnificent Geoff Hardy 2013 Lagrein. It’s taken us until now to find another one which we love as much – the 2016 Silhouette Lagrein.
HISTORY Lagrein is one of those varieties which can produce exceptional wines in a wide variety of different climates. Its home is in the Alto Adige/ South Tyrol in Northern Italy, which is bordered by Austria, Lichtenstein and Switzerland - a properly cold place to grow grapes. In spite of this, it produces massive, deeply and densely fruited, tannic, complex and long lived red wines.
IN AUSTRALIA Lagrein can also excel in the Murray Darling and Riverland which are pretty much at the opposite end of the climate spectrum to the grapes’ homeland. Australia’s production of the variety is only very recent, with few if any growers at the turn of the century and perhaps as little as 40 now. Plenty of these plantings are in the very warm climes of the Murray Darling and Riverland. One such example is the Silhouette 2016 Lagrein – a massive, black, tarry, blue fruit compote explosion of a wine. Drink it by itself with medics on standby or pair it up with a dinosaur or woolly mammoth steak.
PHIL MANSER Wine Direct
P: 1800 649 463 E: philmanser@ winedirect.com.au
FA S T FA C T S FOR YOUR NEXT DINNER
Lagrein is a true ancient grape mentioned as early as the 1500s (making it older than Cab Sav).
It is related to Syrah and Pinot Noir but higher in tannin and acid, giving excellent cellaring potential. Pinot Grigio is also found in Alto Adige where Lagrein is found.
Doctor Q Winter 73
INPRINT
Harrison’s Principles of Internal Medicine, Twentieth Edition (Volumes 1 & 2)
by Dennis L. Kasper, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo
The definitive guide to internal medicine is more essential than ever with the latest in disease mechanisms, updated clinical trial results and recommended guidelines, stateof-the art radiographic images, therapeutic approaches and specific treatments, hundreds of demonstrative full-colour drawings, and practical clinical decision trees and algorithms Recognised by healthcare professionals worldwide as the leading authority on applied pathophysiology and clinical medicine, Harrison’s Principles of Internal Medicine gives you the informational foundation you need to provide the best patient care possible. Trusted
Win this book Fill out this form and email to competitions@amaq.com.au
by generations of students and clinicians, this cornerstone two-volume text maintains its accessible, standard-setting balance between the scientific foundations of signs and symptoms, and the clinical management of the patient. This twentieth edition is more relevant—and essential—than ever, with a refreshed, userfriendly design and cutting-edge new content that reflects the latest foundational, bioscientific, and clinical insights across the full spectrum of medicine. Enter to win a copy of Harrison’s Principles of Internal Medicine, Twentieth Edition, thanks to McGraw-Hill Education.
BOOK WINNER Dr Kevin Chan won a copy of Sherris Medical Microbiology, Seventh Edition, thanks to our friends at McGraw-Hill Education.
Name:
Telephone:
Member no:
Entries close 1 July 2018 Don’t forget to enter in this Doctor Q edition to win.
DENDY WINNERS Doctor Q Dr Jeff Thomsett Dr Shymal Dhar Dr Lauren Exelby
74 Doctor Q Winter
Dr Dianne Little Dr Klaus Martin Beckmann
Events and Training enews Dr Declan Scragg Dr AJ Finnimore
WORKPLACE RELATIONS MANUALS
COMING IN 2018
Resident Medical Officers (PGY2+) Greenslopes Private Hospital, QLD Full-Time & Part-Time Training Opportunities Greenslopes Private Hospital is a 631 bed, Level 3 tertiary teaching hospital, offering a comprehensive range of services for private patients including:
Resident Medical Officer (JHO/SHO)
• Emergency Centre, ICU (Level 6), CCU • 19 theatres with robotic surgery & full array of investigative services
A broad range of medical & surgical allocations including ICU & CCU are available that are appropriate for general practice, physician, surgical or anaesthetic training.
The teaching structure includes: • Structured formal teaching program across the week • Sim Lab, Conference Facilities, Library & onsite University of Queensland Clinical School • Over 120 JMOs including Interns, Residents, Registrars & Advanced Trainees
You will work in a team environment to develop & implement management plans under the guidance of Registrars &/or Visiting Medical Officers.
For further information & to express an interest, please email Greenslopes Private Hospital on medicalservices.gph@ramsayhealth.com.au
greenslopesprivate.com.au
Fulltime – Base Salary $79,413 – $85,521 (dependent on years of service, increments in line with QLD Medical Officers Agreement)
Essential Criteria: • Current registration, or eligible for registration with the Australian Health Practitioner Regulation Agency (AHPRA) as a medical practitioner • Minimum 1 year full-time postgraduate employment as a medical practitioner in Australia or similar health care system
Get a taste of the good life with double points
Let your practice expenses shape your next adventure this end of financial year. Use your BOQ Specialist Signature credit card to purchase new equipment, fit-out or a motor vehicle, then convert it into a BOQ Specialist finance contract which settles before 30 June 20181, and for every eligible $1 you spend we will reward you with 2 Qantas Points2 or 2 Velocity Frequent Flyer Points.3 Fees apply.* . To find out more, visit boqspecialist.com.au/eofy18 or speak to one of our finance specialists on 1300 131 141.
The issuer and credit provider of these products and services 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, lending and eligibility criteria apply. Any information is of a general nature only. We have not taken into account your objectives, financial situation, or needs when preparing it. Before acting on this information you should consider if it is appropriate for your situation. You should obtain and consider the relevant terms and conditions from boqspecialist.com.au/eofy18. BOQ Specialist is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. We reserve the right to cease offering these products at any time without notice. 1 To earn 2 Qantas Points or Velocity Points per $1 of eligible spend, the equipment, fit-out, or motor vehicle acquired on the credit card must be financed with BOQ Specialist on a fixed term contract greater than 12 months and settled by 30 June 2018. For definition of eligible spend, refer to boqspecialist.com.au/cards. Available for lease, chattel mortgage, asset purchase or escrow (drawdowns must be in amounts of $10 000 or more). * A documentation fee of $445 and 1.5% credit card processing fee applies. For those applying for a BOQ Specialist Signature card, this must be done by 30 June 2018 and an annual credit card fee of $400 will apply. 2 You must be a member of the Qantas Frequent Flyer program to earn Qantas Points. A joining fee may apply. Membership and Qantas Points are subject to the Qantas Frequent Flyer program Terms and Conditions, available at qantas.com/terms. Qantas Points are earned in accordance with and subject to the BOQ Specialist Qantas Rewards Program Terms and Conditions, available at boqspecialist.com.au/cards. Qantas Points will be earned on eligible transactions only. Please allow 6-8 weeks after purchase for points to be credited to your Qantas Frequent Flyer account. BOQ Specialist recommends that you seek independent tax advice in respect of the tax consequences (including fringe benefits tax, and goods and services tax and income tax) arising from the use of these products or from participating in the Qantas Frequent Flyer program. 3 To earn and redeem Velocity Frequent Flyer Points you must be a Velocity Frequent Flyer 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. Please allow 6-8 weeks after purchase for points to be credited to your Velocity Frequent Flyer account.