Issuu

AUTUMN 2017 | VOL. 102

Caring at the end of life AMA Queenslandâ€™s 2017 Budget Submission Structural issues, not staffing, plague maternity services Access to medicinal cannabis in Queensland

Doctor Q is free to AMA Queensland Members

LUXURY HAS ITS REWARDS PURCHASING A NEW LEXUS NOW WILL BE EVEN MORE REWARDING Earn one Qantas Point* for every dollar spent on any new Lexus until June 30

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FEATURES OF THE LEXUS CORPORATE PROGRAMME:

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Complimentary scheduled servicing expires at 3 years or 60,000km from the date of first registration, whichever occurs first. Conditions apply. See your Lexus dealer for further details. 2 Eligible employees must provide such documentary evidence as Lexus or the Lexus Dealer may require to confirm entitlement to receive preferential pricing. Terms and conditions apply. See your Lexus dealer for further details. 3 Visit http://www.lexusofbrisbane.com.au/about/about-us/benefits for full terms and conditions *Offer applicable to Private and ABN buyers, who are current members of AMA Queensland, on all new vehicles purchased between 1st January - 30th June 2017 and delivered by 30th June 2017. The Lexus of Brisbane Group reserves the right to extend any offer. Excludes demonstrator and pre-owned vehicles. You must be a member of the Qantas Frequent Flyer program to earn and redeem points. Complimentary membership will be offered to customers who are not already members. Membership and Qantas Points are subject to the terms and conditions of the Qantas Frequent Flyer Program available at Qantas.com/terms. To earn Qantas Points, Qantas Frequent Flyers must provide their membership number. Please allow six weeks for the points to be credited to your account. Points can only be awarded on the purchase of an eligible new vehicle between the 1st January - 30th June 2017. Points paid on total net contract price of vehicles after discount but before trade-in. 1

2 Doctor Q Autumn

CONTENTS

REPORTS

F E AT U R E S

Editor’s Desk

President’s Report

14 Access to medicinal cannabis in Queensland

CEO’s Report

Council of Doctors in Training strategic priorities for 2017

Structural issues, not staffing, plague maternity services

Managing the risks of practice growth

Beware of advertising your wares

Another example of the importance of recording discussions of risk

Health Vision to examine care at the end of life

Salary packaging myths unraveled

Caring at the end of life

Purchase an existing practice or start from scratch?

Changes to the Industrial Relations Framework affecting Queensland Health medical officers

Build financial and mental resilience to impacts of storm season

New super rules start 1 July 2017 – take action now or run the risk of paying higher tax in retirement

Doctors Health Fund: Celebrating 40 years

CURRENT ISSUES 22

New Health Minister must set the direction for federal health policy

AMA Queensland’s top 5 advocacy priorities for you in 2017

AMA Queensland’s 2017 Budget Submission

Why integrated care must stay high on the agenda

2017 intern orientation week (O week)

Cairns breakfast forum wrap up

AMA Queensland delivers compelling submission on black lung disease

Interview skills webinar

Know your working rights as a resident medical officer

AMA Queensland supports AMSA executive retreat

Dr Dinesh Palipana: A true story of inspiration Junior Doctor Conference - Future Frontiers in Medicine An understanding of simulationbased education and the clinical skills Simulympics

PEOPLE & EVENTS

Public holidays information

The key to reducing bullying at work

Building doctors’ resilience and wellbeing

Doctors rule on concession worth $82 a quarter

Looking back on internship

C A R I N G AT T H E E N D O F L I F E

BUSINESS TOOLS

Events Calendar

Annual AMA Queensland Conference

Local Medical Association round up

AMA Queensland Foundation: Supporting medical students through financial hardship

D R D I N E S H PA L I PA N A

LIFESTYLE 66

Dendy

QPAC: Double pass to 1984 by George Orwell

A city for all seasons - Queenstown

Durif, “it’s like Merlot on steroids”

Review: Allium, New Farm

Review: Yo-Yoga, New Farm

All about you

It’s tough on the frontline

InPrint: Murtagh’s Patient Education

2016 Foundation Christmas Appeal

JUNIOR DOCTOR CONFERENCE

BOARD OF DIRECTORS

Editor’s Desk Welcome to the first edition of Doctor Q for 2017. It has been a busy start to the year at AMA Queensland with our push for a maternity services review, the launch of Health Vision Part 5 on end-of-life care and the development of our pre-budget submission to government – plus the team has been on the road at intern orientation events right around the state welcoming Queensland’s new doctors in training. Read the inspiring profile on new intern member Dr Dinesh Palipana on page 12. Have a story you want to share in Doctor Q in 2017, or ideas for content you would like to see included in future editions? Contact me at m.fordruss@amaq.com.au. Michelle

Dr Chris Zappala President

Dr Bav Manoharan Treasurer

Dr Richard Kidd Appointed Director

Dr Shaun Rudd Chair of Board and Council

Dr Kirsten Price Honorary Secretary

Dr Jim Finn Appointed Director

Dr Bill Boyd Vice President

Dr Dilip Dhupelia Appointed Director

COUNCIL Dr Tom Arthur Gold Coast Area Dr Sharmila Biswas Far North Area Dr Kimberley Bondeson Greater Brisbane Area Douglas Brown Medical Student Observer Dr Lisa Byrom Greater Brisbane Area Dr Matthew Cheng Doctors in Training Craft Group

VALE ROSS NOYE Ross Noye from Macquarie Private Wealth passed away suddenly in late March. Many of you will have known our long association with Ross, as a corporate partner and a Director of the AMA Queensland Foundation since 2004. Our sincere condolences to Ross’ family and friends.

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

AU S T R A L I A DAY H O N O U R S Congratulations to the following AMA Queensland members who were recognised for their services on Australia Day. Adjunct Professor Lizbeth Moira Kenny AO

Adjunct Associate Professor Alan Stephen Sandford AM

Member of 35 years

Member of 28 years

Associate Professor William Brett Emmerson AM

Dr Leslie Clifton Thompson OAM Member of 41 years

Member of 37 years

Professor Steve Kisely Greater Brisbane Area

Dr Jim Finn Full-time Salaried Medical Practitioner Craft Group

Honor Magon Medical Student Craft Group

Dr Katherine Gridley Greater Brisbane Area Dr John Hall Downs and West Area Dr Geoffrey Hawson Retired Doctors Craft Group Dr Wayne Herdy North Coast Area Dr Scott Horsburgh General Practitioner Craft Group Dr Richard Kidd General Practitioner Craft Group

Dr John F. Murray Specialist Craft Group Dr Alex Ritchie Specialist Craft Group Dr Anil Sharma International Medical Graduate Craft Group Dr Harley Wilson Capricornia Area Dr Nicholas Yim General Practitioner Craft Group

Jane Schmitt Chief Executive Officer

Filomena Ferlan General Manager Corporate Services

Editor: Michelle Ford Russ

Doctor Q is published by AMA Queensland

Graphic Designer: Nathan Pitt

Dr Kevin King OBE Anaesthetist Late of Dutton Park Member of 70 years

Dr Bav Manoharan Greater Brisbane Area

AMA QUEENSLAND S E C R E TA R I AT

Dr Keith Warrington Zabell OAM Member of 37 years

OBITUARIES The following AMA Queensland members have recently passed away. Our sincere condolences to their families.

Dr Dilip Dhupelia Part-time Medical Practitioner Craft Group

Journalist: Chiara Lèsevre Advertising: Louise Glynn

Phone:

Holly Bretherton General Manager - Member Relations and Communications

(07) 3872 2222

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

amaq@amaq.com.au

Print Post Approved PP100007532

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

4 Doctor Q Autumn

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President’s Report AMA Queensland has recently released Health Vision Part Five – Care at the End of Life. Health Vision is a five-part document, released in stages over the last two years starting at public/preventative health, moving through education and workforce to now end-of-life care. We can be immensely proud of this work. It has helped shape policy thinking and advocacy over this period. Palliative care as a specialty, I think, is still evolving. One example of this is the difficulty in achieving a unanimous definition of what palliative care is when you ask people – including palliative care physicians. There’s also the curious tension between managing symptoms, supporting patients and families, and assisting in directing care versus this somewhat arbitrary threshold of only helping patients estimated to be within three months of the end of their life. As our population ages, and complex, co-morbid chronic disease is more common, it becomes obvious that many patients with difficult care requirements are going to need more involved palliative care assistance. The model of relatively unidimensional, pre-terminal cancer patients with pain who have a semi-predictable trajectory is superseded and prescient policy planning is required. Palliative care is now definitely more complex and more involved, and the patients are ‘sicker’ for longer. At the heart of our intent in making the fifth (and last) part of our Health Vision is to help point policy makers in this direction and convince them of the exigency. There is no question palliative care funding broadly needs to be increased. There are many facilities around the state managing with lean or negligible resources – both in public and private sectors. There remains a dearth of not just physicians, nurses and allied health, but also physical facilities. Moreover, as patients become more complex, for example need high levels of supplemental oxygen or greater pharmacologic and nursing support to promote comfort from itch, dyspnoea, nausea, depression or anorexia, then skill, expertise and facilities will need to evolve to accommodate this. I think it is important and timely for the profession to work with the government to augment and evolve palliative care services but also to promote understanding of advance health care planning and end-of-life care. One of the significant potential benefits of the MyHealth record, I’ve been able to understand, is facilitating easy access to an

6 Doctor Q Autumn

advance health directive regardless of where the patient is seeking care. As we know, patients and families always manage better when they have discussed these issues, when comfortable and able to do so with time to ponder and consider options. Unfortunately, doctors themselves have difficulty discerning the best time to open this discussion with patients – it’s definitely not easy. If we strive to make it a more routine part of care, then hopefully a great deal of the apprehension felt by all parties will decrease significantly. Not only, therefore, does the community have to develop comprehension and comfort with advance care planning – but so do all doctors! A concern I currently have is that access to services and professional assistance is somewhat dependent upon socioeconomic status. My observation is that patients who are well educated and ask thoughtful questions are much more accomplished at navigating the health care system and achieving good outcomes, including in terms of endof-life care. I can contrast patients known to me with Idiopathic Pulmonary Fibrosis or Motor Neurone Disease who have very different end-of-life experiences, significantly because of this variability. My hope, therefore, is that as we all become more proficient at advance health directive planning and end-of-life care, we diminish some of the inequity derived from variable health literacy, education and affluence in this critical phase of caring for our patients.

complex and, sometimes, younger patients. By contrast, the need from such patients is growing without any recognition that there is this increasing unmet need amongst this vulnerable group of patients. I am very proud that AMA Queensland has convened a working group to develop a planning document to help doctors, families and patients discuss end-of-life care desires, and planning for children and young adults with a terminal illness. Similar documents exist overseas but it was identified that a gap existed in Australia in this space. The working group, chaired by Dr Anthony Herbert, Director of Palliative Care at Lady Cilento Children’s Hospital, is developing a statement of choices for this sub-group of patients also. Our hope is this will reflect the adult document recently introduced in Queensland Health and become just as useful in time. This is one example of how our profession can lead positive change and, in cooperation with other health care providers, manage to make life for our patients a little easier and better.

Human resources are only a part of the current deficiency in service provision – capital expenditure must be planned for and a commitment made. This is harder to achieve, but in an election year, it is something I believe the profession should ask of all politicians. Acute medical wards are not the best places to care for dying patients in many circumstances – but finding a palliative care facility to accommodate patients with even minimal medical care requirements beyond pain relief, can sometimes be a challenge. Moreover, if you have a young patient who is dying and/or has complex care needs, frequently they have nursing and physical care requirements that exceed what can be offered in the home but simultaneously, no access to aged care facilities or other institutions if they’re not about to die imminently. Complex care requirements might be that they have a tracheostomy, the patient might require bilevel ventilation or they might require high-flow rates of supplemental oxygen – to use examples in my field. Many facilities balk at accepting care of these slightly more

Doctor Q Autumn

that will ensure a fairer, healthier and more compassionate health system for all Queenslanders. In short, we recommend the following three targeted investments:

CEO’s Report COMMITTING TO REDUCING ALCOHOLFUELLED VIOLENCE

AMA Queensland is pleased that the Queensland Government has retained the strongest elements of its licensing law reform. A mandatory ID scanning system in all venues will make a big difference, ensuring that intoxicated patrons who have been refused service in one venue cannot simply walk into another. Equally important will be ensuring that all bottle shops – not just newly opened ones – close at 10pm to help stop alcohol-fuelled violence moving from the streets into homes. AMA Queensland has strongly supported the liquor law reform since discussion began in 2015. Drastic action is needed to curb the frightening rise in alcohol-related assaults and any legislation that sees fewer patients in our emergency departments after a night out is a step in the right direction.

AMA QUEENSLAND’S 2017 BUDGET SUBMISSION

In our 2017 Budget Submission, AMA Queensland calls on the Queensland Government to fund three key projects 8 Doctor Q Autumn

1. Increase funding to the Office of the Health Ombudsman (OHO) and reform it. 2. Increase funding to palliative care and advanced care planning. 3. Establish a Queensland Medical Education Training Institute (QMETI) and reform the culture of our medical workplaces. We believe these key investments will ensure the accountability and sustainability of Queensland’s health system for many years to come. See page 26 for further information on the 2017 Budget Submission.

TORRES AND CAPE H O S P I T A L A N D H E A LT H SERVICE

AMA Queensland continues to liaise with the Torres and Cape Hospital and Health Service (TCHHS) regarding the governance and service delivery issues impacting upon our members and their colleagues in the region. We attended a stakeholder forum in November 2016 to discuss progress on resolving these issues directly from the TCHHS executive and other stakeholders in the region, such as Apunipima and the Royal Flying Doctor Service. While progress has been frustratingly slow, the process has yielded some initial positive steps, such as the decision taken by the TCHHS at the forum to engage Queensland Country Practice in finding solutions to workforce sustainability issues. We will continue to monitor the situation with the intent that a longterm plan is put in place to resolve these longstanding issues affecting members and their patients.

UPCOMING PROFESSIONAL DEVELOPMENT EVENTS FOR JUNIOR DOCTORS AMA Queensland together with our junior doctor representative group, the Council of Doctors in Training

(CDT), has worked tirelessly over the past months to provide our junior doctors with valuable professional development events for 2017, including our upcoming annual Junior Doctor Conference (JDC), now in its fourth year. It is the largest junior doctor-specific conference in Australia and features speakers from across the country to help inspire and inform junior doctors on their career path. Other events include our upcoming free member junior doctor leadership seminar on 30 March. This year, the CDT is bringing junior doctor mental health sharply into focus, with further expansion of the AMA Queensland Resilience on the Run program – Australia’s first comprehensive mental health and wellbeing training program supporting junior doctors. The program seeks to provide doctors in training with resilience skills necessary to handle the challenges of being a junior doctor. Over 270 interns have already completed this course since its inception in 2015. We are looking forward to rolling out Resilience on the Run in March at Ipswich Hospital. Visit the events calendar on www. amaq.com.au and keep an eye out in Online News, Events & Training and via our social media platforms to learn more about our upcoming events.

2017 COUNCIL ELECTIONS

Nominations will open in late March for the positions of President, Vice President, Chair and Council members. More information about the new positions and requirements for being a councillor will be provided once nominations open. The election results will be announced at our AGM on 12 May 2017. Finally, a warm welcome to our new Councillors – Dr Michael Clements, North Area Representative and Dr Michael Cleary, Greater Brisbane Area Representative. We look forward to working together to represent doctors and the issues impacting upon our members and their colleagues right throughout Queensland.

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

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Doctor Q Autumn

2017 intern orientation week (O week) AMA Queensland representatives visited hospitals throughout Queensland in January to support interns commencing their career. Together with the AMA Queensland Council of Doctors in Training, our Membership Team provided guidance and highlighted the benefits of joining our association, including representation on workforce issues impacting doctors in training, along with provision of career development support, resources and professional development events. Travelling to regional and metropolitan areas, the AMA Queensland team enjoyed meeting over 650 interns. A large

Royal Brisbane and Women’s Hospital orientation

Gold Coast University Hospital orientation

number of interns signed up, increasing our junior doctor membership base and ultimately, our advocacy power on behalf of doctors in training. Interns can join AMA Queensland for just over a dollar a day and membership is tax-deductible. Did you miss signing up during O week? For more information on intern member benefits and discounted services, please call the Membership Team on (07) 3872 2222 or visit www.ama.com.au/join-ama/QLD.

Mater Hospital orientation

Rockhampton Hospital orientation

Cairns breakfast forum wrap up

The Hon Cameron Dick speaking at the Cairns Breakfast Forum

Minister for Health, The Hon Cameron Dick, Dr Steve Hambleton and Dr Chris Zappala 10 Doctor Q Autumn

Over 50 people attended AMA Queensland’s free member breakfast forum in Cairns last November, taking the opportunity to raise local issues directly with the Health Minister. The Hon Cameron Dick MP discussed current Queensland Health initiatives and directions to support local doctors and their patients in Far North Queensland. Attendees also received an update on eHealth and the new Health Care Home by former E-Health Transition Authority Chairman and former AMA President Dr Steve Hambleton. Deborah Jackson, Claims Advisor

from MDA National, addressed participants on mitigating the risks around eHealth. Chaired by AMA Queensland President Dr Chris Zappala and sponsored by MDA National, the forum is a key annual event in North Queensland that ensures local members have a means of directly accessing the Minister. This year’s free member forum will travel to Townsville, continuing AMA Queensland’s commitment to support local doctors and their patients in Far North Queensland. Further information will be made available later in 2017.

Interview skills webinar

MAXIMISING YOUR CHANCE OF SUCCESS FOR A COLLEGE INTERVIEW: CONTRASTING A GOOD VERSUS BAD INTERVIEW DID YOU MISS OUR INTERVIEW SKILLS WEBINAR IN NOVEMBER? Our first interview skills webinar streamed live in November 2016 and was a huge success with over 160 medical students and junior doctors dialling in. Careers coach Jane Anderson and her team of actors demonstrated mock interview scenarios and sample bestpractice responses to assist doctors in training maximise their chance of success in college interviews. The webinar recording is currently available for AMA Queensland members to view free of charge. For any enquiries, please contact the Events Team on (07) 3872 2222 or registrations@amaq.com.au.

AMA Queensland supports AMSA executive retreat Tarren Zimsen, Treasurer and Executive Director, Australian Medical Students’ Association (AMSA)

With the executive for 2017 being based in Queensland, the Australian Medical Students’ Association (AMSA) held their finance, sponsorship and advocacy retreats at AMA House in Kelvin Grove. AMSA volunteers from every state came to Brisbane to join the executive in planning for the year ahead. The retreat marked the start of a big year on AMSA’s events and advocacy calendar. To complement the attendees’ upskilling, AMSA’s executive officer conducted team

building exercises which proved to be a hilarious counterpoint to budgeting. AMA House was an ideal venue for the retreat with sufficient space to hold large meetings comfortably. AMSA extends their thanks to AMA Queensland for their support and looks forward to working closely with their Membership Team in 2017 and beyond.

Doctor Q Autumn 11

Dr Dinesh Palipana: A true story of inspiration Dr Dinesh Palipana, who became a quadriplegic from a car accident in 2010, tells us how he completed his medicine studies and became Queensland’s first quadriplegic medical intern. I did not grow up wanting to be a doctor. Oddly enough, I discovered a passion for medicine during law school. After going through the rollercoaster that is the entrance process, I was so excited to turn up to the first day of medical school in 2008. From needing the ability to help people with a variety of problems to never ending intellectual challenges, medicine delivered all the qualities that drew me to it. I knew this was my calling from day one. The first two years flew by. I acquired a large amount of information, sat exams and blew off steam with Friday afternoon trips to the nearby pub. At the start of third year, I began a clinical rotation in psychiatry with my now mentor, Professor Harry McConnell. A few weeks in, I was driving home from Brisbane on a gloomy Sunday night. It was 31 January 2010. Just after I crossed the Gateway Bridge, I entered a dark stretch of highway. Suddenly, my car lost control, presumably because it aquaplaned. When the car stopped, I tried to get out but I couldn’t move. I couldn’t feel my legs and I realised what had happened. After the usual skilled extrication and acute management from emergency services, I ended up at the Princess Alexandra Hospital, where I spent seven months. I’ll admit, there were some tough times. The world around me, as I knew it, slowly and inevitably self-destructed. Eventually, my family was dismantled. Any financial security was lost. Our family home was sold. My relationships changed forever. Some things remained, though. My passion for medicine never faded. I yearned to come back somehow. More importantly, I had a tireless mum, persistent mentors and a group of friends that never gave up on me. 12 Doctor Q Autumn

After hiding in Sri Lanka for some time, I began to clear my head. I gradually started putting life back together. During this time, Professor McConnell kept encouraging me to go back to medical school with what he calls “a gentle nudge”. In November 2014, I took the dive. Mum and I travelled back to the Gold Coast to start life again. Over the coming weeks, I attended meetings and clinical skills sessions at the medical school. Our idea was to gauge what I could and could not do, build workarounds, and set up a platform that would facilitate success. It worked, as we discovered many things that could be adapted for safe practice. After being away for five years, I turned up on the third year orientation day to a room full of new faces. It was scary but I felt welcome. I passed all the exams and sit here, in 2017, after finishing the first months of internship at the Gold Coast University Hospital. It was a huge relief to be offered a placement after years of dedication. It’s not magic. If you have something that really moves your heart, which is what medicine is for me, you just have to work. If you really believe in something and if you want something, there is absolutely nothing stopping you from getting it, if you just work and go at it every day. Believe that you can get there, let it consume you and you will arrive at that point. I am excited about the year. My plan is to spend this time becoming a great doctor and carve a career path into radiology. Regardless of what the future might bring, I am very thankful to everyone who has been a tremendous source of support in this journey. It has been with everyone’s belief in me that this became possible.

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Doctor Q Autumn 13

Access to medicinal cannabis in Queensland

Dr Jeannette Young, Chief Health Officer, Queensland Health and Dr Sue Ballantyne, Senior Medical Advisor, Queensland Health On 12 October 2016, the Queensland Parliament unanimously passed the Public Health (Medicinal Cannabis) Act 2017. At the time of printing, the Act and subordinate Regulations were to be implemented on 1 March 2017, providing the regulatory framework for the manufacture, prescribing and dispensing of medicinal cannabis in Queensland. Cannabis had been used therapeutically for thousands of years with early Greeks, Egyptians and Chinese all recorded as using cannabis to treat various medical conditions. In the 1920s it became a banned substance in the UK, and in 1937 a banned substance in the USA. In the last 10 years there has been a move towards legalising the medical use of cannabis products in a number of countries, while some have gone further and legalised recreational use of cannabis in adults as well. The cannabis plant itself has been well researched and is made up of as many as 400 different chemicals. There are about 80-100 different cannabinoids, the most common of which is Tetrahydrocannabinol (THC) and cannabidiol (CBD), and about 200 non-cannabinoids, including terpenes and flavonoids which give cannabis its flavour, taste and aroma. Research into the medicinal effects of cannabis or cannabinoids has been difficult, partly due to the illicit nature of the plant itself making clinical trials almost impossible. Recent changes by 14 Doctor Q Autumn

the Therapeutic Goods Administration (TGA) in Australia to re-schedule cannabis and THC to Schedule 8, from Schedule 9, have allowed for a more proactive and easier approach to clinical trials. In 2016 the Commonwealth Government amended the Narcotic Drugs Act 1967 to allow for cultivation and manufacture of medicinal cannabis in Australia. Cultivators and manufacturers are now able to apply for licences and permits to undertake these activities in any state in Australia. In addition, most states and territories have implemented access to medicinal cannabis products, either through their existing drugs and poison legislation, or by introducing new legislation. The legislation in Queensland allows for the following: Single patient prescriber: where a medical practitioner (specialist or GP) can apply to treat an individual patient with a medicinal cannabis product. The medical practitioner is required to provide evidence of the safety and efficacy of the requested product for use in that patient. The application may be reviewed by an expert advisory panel as part of the decision-making process for the delegate under the Act. Patient class prescribers: are specific medical specialists that are able to treat a group of patients with a specific medical condition/symptom with a specific medicinal cannabis product

Further information can be found at: https://www.health.qld.gov.au/ public-health/topics/medicinalcannabis/clinicians/prescribing https://www.health.qld.gov.au/ system-governance/legislation/ reviews/medicinal-cannabis

without having to apply for individual approvals. For example, a medical oncologist, who wants to be a patientclass prescriber, will be able to treat patients with chemotherapy induced nausea and vomiting with high THC products. It is hoped that this will streamline the process for patients. Clinical trial approval: the lead researcher will require approval from Queensland Health to undertake research/clinical trials. In addition to the Queensland Health requirements, because all medicinal cannabis products are unapproved therapeutic goods, TGA approval is also required to allow for the supply and importation of the products into Australia. While there appears to be some possible therapeutic potential for medicinal cannabis products, or particular cannabinoids, the research is very limited and more clinical trials are required to determine how medicinal cannabis can best be used in the future. Due to the limited amount of research available, it is not anticipated that medicinal cannabis will be first-line therapy for any medical condition at this time. Medical practitioners interested in prescribing medicinal cannabis products for their patients, as part of their treatment plan, should ensure they access upto-date and relevant literature so they can balance the benefits and risks of this treatment option.

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Structural issues not staffing plague maternity services Dr Chris Zappala, President, AMA Queensland Despite serious incidents and near misses regularly occurring in public maternity health services, the Queensland Government is overlooking both the extent and the root cause of the problem. In January, Health Minister Cameron Dick vowed to conduct a statewide review of midwife staffing levels throughout the state following the tragic death of a newborn. While this is an important first step in reducing maternal and infant deaths, it ignores the core issue – that midwives throughout Queensland are working without obstetrician supervision or input. This is not a recent crisis and the Health Minister is aware of AMA Queensland’s concerns. Last October, we recommended a number of changes to the way public maternity health services are delivered, purely to improve outcomes for mothers and babies. We have since repeated these concerns in meetings with the Health Minister. So, what will it take for the Health Minister to take decisive action? Last June, an independent clinical review of four incidents at Rockhampton Base Hospital identified issues including a failure to assess expectant mothers correctly and to notify obstetricians promptly when complications arose or labour was not progressing. These issues could be easily addressed by implementing the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) guidelines for when 16 Doctor Q Autumn

problems or concerns need to be raised with an obstetrician but, to date, Queensland Health has failed to do so. The problem does not lie solely in midwife staffing levels; it lies in the government’s commitment to a midwife-only approach that current Australian and overseas research shows is not the best model of care. Several research studies show that preventable trauma and deaths are continually occurring under midwife-led models of care. Here in Queensland, 11 babies in every thousand die in the public system, compared with seven per thousand in the private hospital system. Queensland’s private hospital system has a true multidisciplinary model of care, with obstetricians and midwives working together. Our public system has abandoned this model, which is a grave mistake that must be corrected. The Australian College of Midwives has argued that outcomes between public and private systems cannot be compared due to differences in populations and models of care. The Health Minister himself has said that mothers in the public system are more likely to have complex needs and chronic conditions, such as obesity and diabetes. And this is precisely our point – it is even more important for obstetricians to be involved from the outset. This doesn’t take away a woman’s right to choose how she wishes to give birth. But, when research shows the best outcomes for mothers and babies are achieved by maternity care teams led by an obstetrician, it is irresponsible to

sideline the only health professionals who can pre-emptively handle whatever complications arise during pregnancy and birth. An expectant mother in Queensland’s public system can go through her entire pregnancy and birth without ever being examined by an obstetrician. Even in a ‘low risk’ pregnancy, however, complications may develop that midwives simply are not trained to handle. In fact, recent Australian research shows that in about half of pregnancies assessed as low risk, an obstetrician will need to step in to deliver the baby safely. If an obstetrician is involved early on, complications may be anticipated and mitigated before they become serious. This is not ‘medicalising’ pregnancy and birth – it is simply providing the best level of care we can offer. In many cases, early intervention may save the life of the mother, the baby, or both. There are valid medical reasons for an obstetrician being involved in every pregnancy and we need not spend a single extra cent to use our currently employed obstetricians more effectively. That’s why we are calling for a truly independent review of Queensland’s maternity services, conducted by an impartial expert. We believe the government must undertake this immediately and fearlessly, without prejudice or favour, without worrying about the election cycle or fostering an impression that everything is fine. AMA Queensland wants to work together so that every mother-to-be has the best possible care and the best possible outcome – a healthy baby.

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Health Vision to examine care at the end of life Health Vision Part Five is the final part of AMA Queensland’s Health Vision series. It examines the way our health system approaches care at the end of life and how it can be improved. There are a number of issues concerning the way we handle care at the end of life in Queensland. The palliative care system is massively underfunded with a large amount of unmet need. This means service providers having to shorten the length of palliative care services they can provide; which can be worse if you live in a rural or remote area. Advance care planning is also an issue. The laws that guide advance care plans and advance health directives within Queensland and across the country are inconsistent and confusing. Every state has different laws using different terminology to create or recognise different types of advance care directives or medical powers of attorney, which take effect under different clinical conditions. This means an advance health directive (AHD) completed in Queensland may not be legally valid in other states and territories in Australia. This creates confusion for health workers, patients and families, and makes a national database – which is needed to ensure AHDs are respected even if you travel interstate – impractical. It is therefore not surprising to learn that despite the importance of this planning and the concept having existed since the early 1970s, there is low awareness of the value of planning your treatment options before you are unable to communicate your wishes yourself. Health Vision Part Five addresses these problems and offers solutions the government may wish to consider to remedy palliative care underfunding and improve the uptake of AHDs and other care at the end-of-life planning measures. Health Vision Part Five is available to read and download on the AMA Queensland website. www.amaq.com.au.

Caring at the end of life A M E D I C A L C U LT U R E F I T FOR THE 21ST CENTURY

Dr Will Cairns, Palliative Medicine Specialist, Townsville Hospital and Author of Death Rules

As we move deeper into this century, it is becoming increasingly apparent that we have been neglecting one of the most important roles for doctors. Lured by the siren’s call of modern technology, we have allowed ourselves to be distracted from values that have been at the heart of the compact between doctors and patients since we were shamans or barbers. Even when there was little that we could do to prevent people from dying, we could always sit at their bedside and provide comfort to them, and their family, while they died. Perhaps I am being unfair. I am not suggesting that it is anyone’s fault or that doctors don’t care about their patients. Cultural drift happened because our focus was distracted from the overall wellbeing of patients by the promise of technology and the intellectual demands of sub-specialty medicine, and we just sort of didn’t notice. The reality is that as both doctors and patients we have allowed part of ourselves to believe that we didn’t have to deal with death any more, or that it was always someone else’s job. The dominant focus on scientific medicine during our training permitted many of us to come to view our primary role as being the deliverers of technology. As we confuse the means with the ends, many patients have come to feel that, while they are receiving excellent treatments, noone is responsible for the whole of them. This has become a systematic problem and the culture of medicine is diminished in the process. The emergence during the latter part of the 20th century of palliative care (leading to the creation of the specialty of palliative medicine) as an essential component of healthcare was an early step to restoring the primacy of the overall goals of the patient. However, during my 28 years

18 Doctor Q Autumn

in palliative medicine, I came to realise that it was not sufficient that doctors help patients and their families to make wise choices only after all treatment options had been exhausted. Such decision-making needs to be initiated much earlier, integrated into our day-to-day lives as healthy young people and escalated when we develop our life-limiting illnesses. This can maximise the likelihood that the choices we make will be shaped by our personal goals, values and preferences. We will all die eventually and while modern technology has vastly improved both the quality and quantity of our lives, it cannot make us live forever, and it does bring physical, emotional, social and financial costs. A core role for all doctors is to help our patients navigate the minefield of choices. To do that we must support patients to:

consider what they value most as a foundation for decision making; develop a realistic understanding of what our healthcare technologies can offer them; and make wise choices from amongst those that are available.

These processes of Advance Care Planning (ACP) leading to quality care at the end of life are not simply single meetings resulting in the completion of a form. They play out over a lifetime. While any clinician can nurture ACP, a patient’s doctor should be the person best equipped to accompany them on this journey. This role is reflected in the new slogan from the RACGP:

“I’m your specialist in life.”

Perhaps the phrase could be expanded by “….and death”. A few months ago, I was involved in a teleconference where a senior doctor said something like, “Our junior doctors working overnight are too busy treating our very sick patients to be able to do ACP on them.” My reply was, “I don’t know that we can treat patients unless we know what their wishes are.” This doctor’s words reflect a place to which contemporary medical culture has drifted while our hand has been off the tiller. While our world is far healthier than it was 200 years ago, we all die eventually. The task for the next decade or so is not to try to reverse our course, but to promote the benefits of modern technology while reintegrating the values that made medical practitioners so respected. The AMA Queensland Health Vision Part 5: Care at the end of life promotes the necessity for all of us to make this journey.

Dr Cairns has certainly provided some candid and forthright views in this article. Health Vision Part Five aims to get doctors to have the conversation with their patients about advance care planning. In keeping with the theme of starting the conversation, we want to hear what you think! Do you agree with Dr Cairns, or disagree? Send us your thoughts via email to amaq@amaq.com.au or through our Facebook or Twitter channels, and we’ll follow up on your thoughts in the next issue of Doctor Q.

Doctor Q Autumn 19

Changes to the Industrial Relations Framework affecting Queensland Health medical officers Medical officers employed by Queensland Health are covered within the jurisdiction of the Industrial Relations Act 1999 (Qld) (‘the Act’). In contrast, privately-employed medical officers, including at the Mater Hospital, are generally covered under the jurisdiction of the Fair Work Act 2009 (Cth). In 2015, the Palaszczuk Government initiated a review of the Act which marks the first comprehensive review of the Industrial Relations Framework since the inception of the Act in 1999. The review, produced in March 2016, included 68 recommendations. The government accepted 58 of the recommendations, and on 1 September 2016, the Industrial Relations Bill 2016 was first introduced into State Parliament. ASMOFQ is pleased to announce that the changes were passed by Parliament on 1 December 2016 with the majority of changes coming into effect from 1 March 2017. The pyramid to the right provides a summary of your employment framework:

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Terms and conditions of employment

Policies, procedures and guidelines Directives

Medical Officers’ (Queensland Health) Certified Agreement (No.4) 2015 (MOCA4) Medical Officers’ (Queensland Health) Award - State 2015 (the Award) Legislation

Industrial Relations Act 1999 (Qld) | Hospital and Health Act 2011 (Qld) | Public Service Act 2007 (Qld)

How will this affect medical officers? The introduction of new protections will give medical officers similar protections to those employed under the federal system. These include:

up to 10 days of paid domestic violence leave: Medical officers (other than casuals) experiencing domestic violence will be able to access up to 10 days paid leave per year. Employees will also be able to utilise their “carer’s leave” in order to care for a person who has experienced domestic violence. Queensland will be the first state to implement paid leave for persons affected by domestic violence.

workplace bullying remedies: Medical officers will now be able to lodge an application with the Queensland Industrial Relations Commission (QIRC) for a “stop bullying order” if they believe they have been bullied in the workplace. The QIRC will then have to deal with this application within 14 days. general protections to protect public sector employees from adverse action: Medical officers will also be able to make an adverse action claim for protection from an action taken by the employer which adversely impacts on them as a

Amending the Hospital and Health Boards Act 2011 to enforce the duty to consult with unions before health employment directives are issued.

Collective bargaining will continue to be the basis for determining wages and employment conditions of state employees with the view that arbitration will only be used as a last resort.

The QIRC will be vested with the exclusive jurisdiction to deal with all workplace related anti-discrimination matters, with the Queensland Civil and Administrative Tribunal (QCAT) continuing to deal with these matters at the conciliation stage only.

Amending the Holidays Act 1983 insofar as to declare Easter Sunday a public holiday. This will mean that the Easter period will have four public holidays in a row being: Good Friday, Easter Saturday, Easter Sunday and Easter Monday. Any medical officers working on those days will be entitled to public holiday penalty rates.

result of them raising a workplace right. The purpose of the general protections part of the Act is to protect workplace rights, freedom of association and protection from workplace discrimination.

a right to request flexible working arrangements: Medical officers will be able to request a flexible work arrangement by applying in writing and providing reasons. This will only be a right to request a flexible work arrangement and is not an automatic entitlement for the work arrangement.

The Queensland Employment Standards (QES) will align with the National Employment Standards, including standardising parental, carers’ and compassionate leave.

Amending the legal representation arrangements within the QIRC to align with those at the Fair Work Commission. This will mean that a party may be permitted to be represented by a lawyer in certain proceedings (other than enterprise bargaining matters) if the QIRC finds that it is unfair to not allow legal representation.

How will ASMOFQ support members through the change process? It is anticipated that the flow-on effects from this legislation will provide Queensland Health and the individual Hospital and Health Services (HHSs) incentive to review and update their policies and procedures, especially the bullying and harassment and employee grievances policies, to ensure best practice is achieved. Throughout this process ASMOFQ will keep members up to date on the changes to their employment and how this will impact Queensland Health employed doctors. We will work in consultation with the Office of Industrial Relations, Queensland Health and individual HHSs to ensure the changes are implemented smoothly. Doctor Q Autumn 21

AMA PRE-BUDGET SUBMISSION 2017-18

Greg Hunt, Health Minister

New Health Minister must set the direction for federal health policy

AMA President Dr Michael Gannon said the appointment of Greg Hunt as Health Minister provides the Government with the perfect opportunity to change direction on health policy, and to consign any links to the disastrous 2014-15 Health Budget to history. Launching the AMA’s Pre-Budget Submission 2017-18, Dr Gannon said the key for the Government and the Health Minister is to look at all health policies as investments in a healthier and more productive population. “Health is the best investment that governments can make,” Dr Gannon said. “The AMA agrees with and supports Budget responsibility. But we also believe that savings must be made in areas that do not directly negatively affect the health and wellbeing of Australian families. “Health must be seen as an investment, not a cost or a Budget saving. “There are greater efficiencies to be made in the health system and in the Health Budget, but any changes must be undertaken with close consultation with the medical profession, and with close consideration of any impact on patients, especially the most vulnerable – the poor, the elderly, working families with young children, and the chronically ill.

22 Doctor Q Autumn

“But the AMA urges caution – and care. The Government must not make longterm cuts for short-term gain. Patients will lose out. “In this Pre-Budget Submission, the AMA is urging the Government to invest strategically in key areas of health that will deliver great benefits – in economic terms and with health outcomes – over time. “The first task of the new Minister must be to lift the freeze on Medicare patient rebates, which is harming patients and doctors. “Primary care and prevention are areas where the Government can and should make greater investment. “General practice, in particular, is costeffective and proven to keep people well and away from more expensive hospital care. It was pleasing to hear Minister Hunt use his first health media conference to declare that he wanted to be the Health Minister for GPs. “The Government must also fulfil its responsibilities – along with the states and territories – to properly fund our public hospitals. “So too, the Government must deliver on its commitments to improve the health of Indigenous Australians. “In this submission, the AMA provides the Government with affordable, targeted and proven policies that will contribute to a much better Budget bottom line in coming years.

“More importantly, the AMA’s recommendations will deliver a healthier and more productive population to drive further savings into the future.” The AMA Pre-Budget Submission 201718 covers the following key areas:

Medicare indexation freeze; public hospitals; health care home; Medicare reviews; Medicare levy; pathology; private health insurance; medical indemnity – underpinning affordable health care; medical care for palliative care and aged care patients; Indigenous health; mental health; medical workforce and training; obesity; nutrition; physical activity; alcohol and drugs; and climate change and health.

The AMA Pre-Budget Submission 2017-18 can be downloaded at: https://ama.com.au/sites/default/ files/budget-submission/Budget_ Submission_2017_2018.pdf This Submission was lodged with the Treasury ahead of the Thursday 19 January 2017 deadline.

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AMA Queensland’s top 5 advocacy priorities for you in 2017 In 2016, AMA Queensland had a number of policy wins of which we are enormously proud. From cutting red tape around medical research to getting a majority of medical representation on the Medical Board of Queensland, we have worked tirelessly to ensure that our health system is not only the best it can be, but that doctors are able to do their important, lifesaving work in a system that values and respects them. In 2017, we want to build on that work while also beginning to look at other important advocacy priorities. Here is just a taste of what is ahead this year and how we are working hard to support you.

The rural medical workforce AMA Queensland will look at the nature and distribution of Queensland’s medical workforce and will suggest policy improvements, which will help alleviate the pressure felt by our colleagues in regional, rural and remote communities. We will examine what policy and legislative amendments could be enacted to help address the paucity of medical professionals working in these areas with the ultimate aim being to alleviate the pressures on those doctors and their communities.

Medical leadership Strong medical leadership is vital in delivering quality healthcare. A health system with strong medical leadership helps minimise catastrophic lapses. However, there are few opportunities for doctors to increase their leadership skills, which has led to other professions trying to fill that gap. AMA Queensland will look at ways to increase opportunities for doctors to improve their natural leadership talents, and to impress upon policy makers the importance of recognising and fostering medical leadership. 24 Doctor Q Autumn

End-of-life care For practical and compassionate reasons, AMA Queensland believes Queensland should become a leader in end-oflife care in Australia. The fifth and final part of the AMA Queensland Health Vision will advocate for compassionate changes to help increase the uptake of Advanced Health Directives, and will call on increased funding for palliative care. Such changes will help our doctors and clinicians effectively care for their patients, and, where possible, the wishes of patients and their loved ones are respected.

Reform of the Office of the Health Ombudsman (OHO) Following successful advocacy by AMA Queensland in 2016 to review the performance of the OHO, AMA Queensland will press the government to implement reforms to improve the OHO’s performance and address impartiality and other structural issues. The Parliamentary Committee for Health has made four recommendations for reform of the OHO. AMA Queensland is considering these recommendations and will work constructively with the government to achieve an appropriately reformed Health Ombudsman which both doctors and the public can have faith in.

GP PIP and Medicare rebate issues Following strong advocacy from the AMA, the Federal Government agreed to a temporary amendment to the requirements for the Practice Incentives Program (PIP) Digital Health Incentive that came into effect on 1 May 2016. The AMA will monitor and review the implementation of the PIP Digital Health Incentive and continue lobbying the Federal Government on reversing the Medicare rebate freeze.

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Doctor Q Autumn 25 www.svphb.org.au

AMA Queensland’s 2017 Budget Submission ENSURING SUSTAIN ABILIT Y AND ACCOUNTABILIT Y

The 2016-17 Queensland Budget was the Palaszczuk Government’s second budget since being elected in 2015. In that Budget the government allocated $14 billion to health, a record spend that was welcomed by AMA Queensland. However, we also lamented the fact that much of this spending was not being targeted at issues which would reduce demand on our public waiting lists. Although the Budget contained numerous worthwhile and necessary spending measures, AMA Queensland believes a smart budget would avoid merely tinkering at the edges and make targeted investments that could deliver substantial long-term reform. In our 2017 Budget Submission, AMA Queensland calls on the Queensland Government to fund three key projects that will ensure our health system is not only funded by smart investments but considers its sustainability and accountability for many years to come. In short, we recommend the following. 1. Increase funding to the Office of the Health Ombudsman (OHO) and reform it: As outlined in our 2016 discussion paper regarding the OHO, we believe the performance of this vital office is being hampered by funding and legislative restraints. 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.

2. Increase funding to palliative care and advance care planning: In Part Five of the AMA Queensland Health Vision, we called on the government to increase funding to the palliative care sector in Queensland and to aim for a target of “Fifty over Fifty” – in other words, 50 per cent of people over the age of 50 will have a registered Statement of Choices or an Advance Health Directive in place by 2021. We believe this Budget, the last before another election, is the perfect opportunity to fund these initiatives.

3. Establish a Queensland Medical Education Training Institute (QMETI) and reform the culture of our medical workplaces: 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.

AMA Queensland believes these targeted investments will ensure a fairer, healthier, happier and more compassionate health system that all Queenslanders rely on. We look forward to discussing these recommendations with the government in further detail in the lead-up to the 2017-18 Queensland Budget release.

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Why integrated care must stay high on the agenda Dr David Rosengren, Chair of the Queensland Clinical Senate

‘It’s not what’s the matter with me, but what matters to me.’ Such a simple statement but it stuck in my mind as one of the most powerful to come from the Senate’s most recent integrated care meeting. It cuts to the core of why integrated care is so important and why we must remain committed to changing our health system. Historically, our system has been built on the person’s illness—we fix that and move on. All too often, the person is left fumbling their way through our complex system until they stumble upon the next healthcare professional to fix the next problem. This is no longer acceptable for our patients or our health system if it is to cope with the demand of an ageing population and increasing chronic and complex disease. We have to change the way we think about care and the way we, as clinicians, work together. We need to look through the eyes of the patient and ask, ‘What matters to you?’ When the Senate first met to discuss integrated care in October 2015, primary health networks (PHNs) were still finding their feet—integrated care was on the agenda but it was early days. Thirteen months later—at the Senate’s second integrated care meeting in November 2016 —we were operating in a very different environment:

PHNs and hospital and health services (HHSs) had made massive progress towards shared governance structures and objectives, and working collaboratively on many successful integrated care programs;

the Queensland Government had announced its $35 million integrated care innovation fund for new initiatives to better integrate care and address fragmentation, and a $361 million specialist outpatient strategy to tackle waiting times and improve the patient journey; and

28 Doctor Q Autumn

the Commonwealth Government’s Health Care Homes initiative had been launched and the Council of Australian Governments (COAG) announced bilateral agreement on the need for coordinated care for people with complex and chronic disease.

With such momentum behind us, Senate members and guests were challenged to consider how to take integrated care in Queensland to the next level. What systematic changes are required to make sure integrated care becomes ingrained in everything we do, in every decision that is made? How can successful integrated care models be sustained and rolled out? The Senate’s recommendations focus on the need to reconsider the way services are funded so that we can more easily move from siloed to collaborative care, and the need to evaluate and share learnings, good and bad, is critical to success. A coordinating body responsible for developing an integrated care framework, assessing health needs and collecting health outcomes data and providing tools for integrated care innovations to be robustly evaluated and shared could make a significant difference. While we must be careful not to layer innovation upon innovation without stopping to measure effectiveness, we must have the courage to, at times, take risks – if we fail we will learn. The Senate meeting report with the full list of recommendations is available at https://www.health.qld.gov. au/clinical-practice/engagement/clinical-senate/meetingspublications/previous-archive/default.asp. Follow the Senate www.facebook.com/qldclinsenate and https://twitter.com/qldclinsenate.

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AMA Queensland delivers compelling submission on black lung disease In recent years there has been an alarming trend among coal workers in Queensland – the re-emergence of Coal Workers’ Pneumoconiosis (CWP), also known as “black lung”. There has been a great deal of criticism around the general practitioners and radiologists who worked within the Queensland Coal Mine Workers’ Health Scheme (QCMWHS). Especially in respect of the latter, there has been commentary which suggests there has been a failure by Queensland radiologists in diagnosing CWP and that Queensland’s expertise is inferior to that of United States B-Readers. AMA Queensland’s recent submission to the Queensland Parliament’s Coal Workers’ Pneumoconiosis Select Committee specifically addressed and utterly rejected the commentary that Australian radiologists were less well trained or of lower competence than US B-Readers. In the submission, AMA Queensland noted the view put forward by the Government and some unions – that failures of prior diagnosis reflected a failure of local radiology expertise. This has led the Queensland Government to mandate that all CXRs taken in conjunction with the Health Scheme be sent to an American B-Reader in addition to a Queensland radiologist. AMA Queensland responded to this by making the following points in defence of Australian radiological expertise:

Diagnosis of positive CWP cases should not occur due to the International Labour Oranisation (ILO) classification

30 Doctor Q Autumn

alone because – as with any disease – it requires a range of diagnostic tools, including patient occupational and medical histories and the use of additional diagnostic tools such as Computerised Tomography (CT).

The ILO Standard is also based on film-screen x-rays (FSR), which a range of studies have found to have a lower sensitivity and specificity in diagnosis of CWP when compared to CT. Extremely early CWP may be misdiagnosed on a chest x-ray due to the inherent limitations of chest radiographs, not the failings of Australian trained radiologists.

Of the 248 CXRs sent to American B-Readers, 18 were reported as having “opacities consistent with simple [early stage] pneumoconiosis”. Local examination of the same CXRs had indicated that only two had pneumoconiosis. However, what is seldom reported in relation to this finding is that the NIOSH B-Readers were unable to come to a definitive analysis in any of the 18 cases. In each case it was reported that the opacities identified may have been due to emphysema rather than CWP. Accordingly, they were referred back to Queensland medical specialists – who have access to patient histories and CT examination – for definitive diagnosis. This supports the need for a centralised system where possible positive cases of dust-induced pneumoconiosis are discussed by a multidisciplinary team of Australian-based specialists.

The early stages of pneumoconiosis are easily confused with emphysema, chronic bronchitis and asthma; diseases which under x-ray can reveal the same small opacities as pneumoconiosis. Many miners also suffer from exposure to asbestos and silica in jobs undertaken prior to coal mining occupations. Such complex occupational histories further highlight the need for a closer relationship between the mining nominated medical advisors (NMAs) and radiologists.

AMA Queensland concluded Australian radiologists, who must complete a minimum of five years’ supervised vocational training and must pass an extensive series of written and oral examinations to report on medical imaging studies are world-class and, with adequate government support, able to diagnosis CWP. The requirement for calm and reasoned input from the profession has been critical in regards to this issue. Furthermore, the inquiry and regulations surrounding spirometry screening and nominated medical advisors will require ongoing input from the profession. AMA Queensland hopes to keep all doctors up-to-date as this important public health issue is addressed within Queensland. A full copy of the AMA Queensland submission into the QCMWHS is available on the AMA Queensland website. We encourage all interested parties to read the submission and we welcome feedback at policy@amaq.com.au.

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Doctor Q Autumn 31

Know your working rights as a resident medical officer AMA Queensland and ASMOFQ advocate for better employment conditions to support you throughout your career. As an RMO, employed with a Hospital and Health Service within Queensland Health, you are entitled to specific conditions contained in the Medical Officers’ (Queensland Health) Certified Agreement (No.4) 2015 (MOCA4) and the Medical Officers (Queensland Health) Award - State 2015. Below is a summary of some key issues that relate to your employment as an RMO.

HOURS OF WORK

76 ordinary hours per fortnight for full time employment.

Minimum of 4 hours per day with a maximum of 12.5 ordinary hours per day (inclusive of a 30-minute meal break).

All time worked in excess of 10 hours will be paid at the applicable overtime rates.

The employer has the right to formulate the final roster, provided:

You are given 4 rostered days off in any 14-day period. 2 of the days off must be consecutive.

You must not be rostered to work broken or split shifts.

Rosters may be changed by the employer by giving 14 days’ notice or a shorter period in emergent situations.

P U B L I C H O L I DAY W O R K

If you are required to work on a public holiday, you must be paid as follows: All public holidays, except for Labour Day, Show Day or Easter Saturday

Time and one-half (150%) with a minimum payment for 4 hours

Labour Day, Show Day or Easter Saturday

Double time and one-half (250%) with a minimum payment for 4 hours

Where your Rostered Day Off falls on Labour Day, Show Day or Easter Saturday

may be paid an additional day’s wage

OVERTIME

Overtime must be taken following approval from the authorised manager and must be paid as follows:

Monday to Saturday - Time and one-half (150%) for the first 3 hours and double time (200%) thereafter

Sunday - Double time (200%)

Public holidays - Double time and one-half (250%)

NIGHT SHIFTS

You may only be rostered to work a maximum of 7 consecutive night shifts in any fortnight.

If you work 7 consecutive night shifts, you must be released from duty for the following 96 hours.

If the majority of the shift is worked between 1800 on one day and 0800 on the following day, you must be paid an additional 15%.

This payment does not apply where a night shift is worked on weekends or public holidays.

All work performed between 0000 and 2400 on a weekend must be paid as follows:

Saturday - Time and one-half (150%)

Sunday - Double time (200%)

Payment is determined on a majority of shift basis.

Payment of overtime must not be unreasonably withheld by the employer.

ON CALL

If you are rostered on call, you must hold yourself available to return to work within 30 minutes.

You must be paid an additional allowance of 8% of the hourly rate of salary level 4 for each hour “on call”.

WEEKEND WORK

RECALL

When recalled you must be paid for the time worked calculated from home and back to home.

You must be paid a minimum of 2 hours at overtime rate.

may be granted another day’s holiday

may have an extra day of annual leave added to your annual leave balance

FAT I G U E L E AV E / REST PERIOD AFTER OVERTIME

You must have 10 hours off duty between shifts (“fatigue break”). There are exceptions to this rule when working overtime.

If the required break is not provided, you will be paid double time (200%) until you are released from duty.

If you feel fatigued as a result of work, talk to your manager about accessing alternative transport (i.e. taxi fare) home.

ANNUAL LEAVE

If you are a full time RMO, you will accrue 5 weeks of annual leave per year.

1 of the above annual leave weeks is in compensation for work performed on public holidays.

If you are a “continuous shift worker”, you will accrue an additional week of annual leave on a pro rata basis (total 6 weeks per year).

Most HHSs will require you to take the annual leave in a block as determined by the employer.

For any queries about your entitlements, you can contact Sewar Mitanis, your dedicated Workplace Relations Advisor & Doctors in Training Representative, on (07) 3872 2228 or email s.mitanis@amaq.com.au. 32 Doctor Q Autumn

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

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

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

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

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

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Doctor Q Autumn 33

Public holidays information

N E W E A S T E R P U B L I C H O L I DAY A N D A T I M E LY P U B L I C H O L I D AY PAY R E M I N D E R With the upcoming Easter long weekend, AMA Queensland members who employ nursing, support services or health professional employees in their private practice may be scratching their heads as to what public holiday entitlements they need to provide to their staff. The addition of a new Queensland public holiday during the 2017 Easter long weekend may add further complications. The Workplace Relations team has prepared the below information to help members better understand their obligations in this area. Recent changes to the Holidays Act 1983 (Qld) have led to the creation of an additional public holiday on Easter Sunday from 2017. Therefore, employers will need to pay public holiday pay rates to employees covered by the HPSS Award or the Nurses Award, if they work on Sunday 16 April 2017 (unless an employer and employee have Individual Flexibility Agreement or other appropriate agreement that public holiday pay rates will not be provided). As a reminder, unless there is an appropriate written agreement indicating otherwise, employees who work on a public holiday are entitled to the following pay:

HPSS staff who work on a public holiday are entitled to double time and a half of their ordinary rate of pay. Nurses Award staff who work on a public holiday are entitled to – double time of their ordinary rate of pay; or

34 Doctor Q Autumn

in lieu of being paid double time, the employer and employee can mutually agree that the employee will have the equivalent number of hours worked available to take as leave, as per the requirements of clause 32.5 of the Nurses Award.

Casual employees who work on a public holiday are still entitled to their 25 per cent casual loading, in addition to the public holiday penalty which should be calculated on the employee’s base rate of pay (base rate meaning not including the 25 per cent casual loading). Full-time or part-time employees are also entitled to payment for public holidays not worked in certain circumstances (casual employees are excluded). Section 116 of the Fair Work Act 2009 (Cth) (‘Fair Work Act’) provides that part-time or full-time employees who are absent from work on a public holiday and who have ordinary hours of work on that day are entitled to payment at their ‘base rate of pay’ (as defined in section 16 of the Fair Work Act) for those ordinary hours. Employers should note that clause 32.3 in the Nurses Award provides an additional public holiday entitlement for full-time employees that do not work on a Monday-Friday basis. Clause 32.3 of the Nurses Award states: All full-time employees will receive a day’s ordinary pay for public holidays that occur on their rostered day off except where the public

holidays fall on Saturday or Sunday with respect to Monday–Friday employees. A rostered day off for the purposes of clause 32.3 refers to an employee’s day off outside their rostered shifts. For example, where a full-time employee under the Nurses Award is usually rostered Wednesday to Sunday, their rostered days off would be Monday and Tuesday. In this scenario, the employee would be on a rostered day off on Easter Monday, and therefore they should receive a day’s ordinary pay for this public holiday, even though they do not ordinarily work on this day. This is because where applicable, clause 32.3 varies the standard payment for public holidays not worked entitlements in section 116. Note: Clause 32.3 specifically provides that the additional payment does not apply to public holidays falling on a Saturday or Sunday where the full-time employee works Monday to Friday, so for most full-time employees under the Nurses Award, this entitlement will not be applicable.

QUESTIONS?

AMA Queensland members who have any questions in relation to the above information can contact the Workplace Relations Team on (07) 3872 2211 or workplacerelations@amaq.com.au.

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For more information, call us on

(07) 3834 4455 standrewshospital.com.au/workcover Brisbane CBD, Cnr of Wickham Terrace/North Street Doctor Q Autumn 35

QDHP

Queensland Doctors’ Health Programme

www.qdhp.org.au Our help line is (07) 3833 4352

C U LT U R A L C H A N G E

The key to reducing bullying at work By Dr Margaret Kay, Medical Director, Queensland Doctors’ Health Programme

References 1.

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/default-document-library/bl1132report---nmhdmss-full-report_web

McAvoy B, Murtagh J. Workplace bullying. The silent epidemic. BMJ. 2003; 326:776-7.

Shabazz T, Parry-Smith W, Oates S, Henderson S, Mountfield J. Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences. BMJ Open 2016; 6(6):e011462.

Australian Medical Association (WA). Shattering the Silence. Medicus 2016; 56(Apr):19-23

Australian Medical Association. Workplace Bullying and Harassment 2015 Available at https://ama.com. au/position-statement/workplace-bullying-andharassment

Expert Advisory Group on discrimination, bullying and sexual harassment. Report to the Royal Australasian College of Surgeons. Melbourne, Victoria: Royal Australasian College of Surgeons; Sept 2015. Available at: http://www.surgeons.org/media/22086656/EAGReport-to-RACS-FINAL-28-September-2015-.pdf

Markwell A. Smith S. Michalski M. Conroy S. Bell A. Performance management versus bullying and harassment: An educator perspective. Emergency Medicine Australasia. 2015; 27:468–472.

36 Doctor Q Autumn

Workplace bullying is a major concern for doctors’ health organisations. It is a significant cause of distress for doctors. The 2013 beyondblue report1, the first national Australian survey of doctors’ and medical students’ mental health, documented the association between bullying and stress and noted that overseas-trained and Indigenous doctors were more likely to experience bullying. A decade prior to this, McAvoy and Murtagh, two well respected Australian researchers, had already described bullying as the ‘silent epidemic’.2 They noted how organisational characteristics of the workplace can create a ‘toxic’ environment in which bullying can thrive. They challenged the international medical profession to demonstrate leadership for the community as a whole and address bullying within the health workplaces in which we work. While there have been many reports of bullying and harassment affecting medical students and junior doctors, senior doctors are not immune to this problem.3 More recently the media has focused on bullying within the surgical specialties, but surveys demonstrate that this problem is found across the specialties.4 The profession recently began consolidating its journey towards cultural change to address these issues. In 2015, the AMA updated its policy on workplace bullying and harassment.5 The Royal Australasian College of Surgeons also released its report directly addressing bullying discrimination and harassment at that time.6 This was followed by a series of interventions that focused on enabling positive cultural change. Other colleges have also responded in positive ways to overtly address these issues. Workplace bullying and harassment is an issue we all need to address. While many doctors do not personally experience bullying at work, recent surveys demonstrate that most doctors have witnessed bullying.4 It is also clear that few doctors report the bullying they witness. There are many reasons for this. Many doctors do not understand how workplace bullying is defined. Given the prevalence of bullying within our workplace, we have a responsibility to understand these issues. Concern is often raised that performance management can be misinterpreted as bullying.7 Again it is up to us as individuals to refine our skills in communication and education to ensure our teaching is delivered with the same skill that we practice our other career tasks. Similarly, we may worry about how our involvement in support for others might impact upon our own career. We might not know the right words to say, nor who to speak to for guidance. If we are to establish cultural change, we need to understand what support exists within the system in which we work, whether in private practice, in large hospital systems, or small regional centres. Establishing networks, mentors and personal supports can help ensure we have the foundation that enables us to be informed and prepared to step up when faced with these challenges. Whatever our role, junior or senior, we need to ensure we are well informed so that we can contribute and maintain the momentum to continue this positive change.

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Doctor Q Autumn 37

Building doctors’ resilience and wellbeing Dr Ira van der Steenstraten, MD, Life Coach at Breeze Life Coaching

The medical profession can be very rewarding but also very stressful. Without resilience, we are at risk of burnout. The National Mental Health Survey of Doctors and Medical Students in Australia published by Beyondblue in October 2013, showed that doctors and medical students experience significantly higher rates of psychological distress, anxiety, depression, burnout and attempted suicide compared to the general Australian population and other Australian professionals. This is independent of specialty or training stage (beyondblue.org.au). These alarming results prompted AMA Queensland to support the development of a resilience and wellbeing program for doctors called Resilience on the Run. The program focuses on preventing burnout and “compassion fatigue” by developing skills to cope with everyday stresses. Mindfulness techniques are presented to help participants become more aware of their personal stressors. Becoming more aware of stressors is important for learning how to deal with them better, thus lowering the likelihood of their harmful consequences. Mindfulness refers to training your attention to focus on the present moment without judging the experience. It can be effective in lowering levels of stress, anxiety and depression as you become less reactive to negative experiences, thoughts and emotions, and you practice having a more open, accepting and non–judgemental attitude. This helps you respond to situations rather than automatically reacting to them. Being more mindfully aware can help to improve doctors’ perceptual skills, leading to higher quality consultations and better outcomes for patients. 38 Doctor Q Autumn

Improving your wellbeing can start with some basic self-care measures: Make sure you sleep enough, eat healthy food, reduce your alcohol intake and do regular exercise (try taking the stairs instead of the lift). Take adequate breaks (do not do something energy-draining on your break) or do a short meditation – just 2-5 minutes can be enough to revive you and clear your mind. Consciously clear your mind between two patients so you can give each your full attention. Have self-compassion (this is not the same as self-pity). Being kind to yourself can lower feelings of shame which enables you to evaluate your work more objectively and improve where needed. Focus on the positives in your life. Start or end each day thinking of three things that went well or that you are grateful for. Connect to others. Invest in your support network and reach out to your colleagues when you see they are struggling. Make sure you create a sense of community at work as this helps to combat “compassion fatigue”.

Links to websites that support doctors can be found on the AMA Queensland website (amaq.com.au/page/ Advocacy/resilience-and-wellbeingresources-for-the-medical-profession). Additionally, the Queensland Doctors' Health Programme (formerly Doctor’s Health Advisory Service Queensland (DHASQ), provides a free, independent, confidential, colleague-to-colleague support service to assist doctors and medical students (dhasq.org.au). Doctors who are not already members are encouraged to join AMA Queensland (www.amaq.com.au) to access a range of networking events and opportunities plus dedicated support on workplace issues through their workplace relations services. Female doctors might also wish to join the QMWS (Queensland Medical Women’s Society), the voice of Queensland’s medical women (afmw. org.au/qld). Taking care of others starts by taking care of yourself! References The National Mental Health Survey of Doctors and Medical Students in Australia, Beyondblue, October 2013. Jensen, P.M., Trollope-Kumar, K., Waters, H., Everson, J. (2008). Building physician resilience. J. Can Fam Physician, 54(5): 722–729

Would you like to find out more about delivering the Resilience on the Run educational program at your hospital or practice? Contact Holly Bretherton, General Manager – Member Relations & Communications h.bretherton@ amaq.com.au or phone (07) 3872 2248 for further information.

POWER BILLS

Doctors rule on concession worth $82 a quarter The long, hot summer of 2016-2017 brought news that the Queensland Government is ready to cut the power bills of people living with type 1 diabetes, based on the advice of medical specialists. Many type 1 diabetic patients report that changing temperatures plays havoc with their daily control of blood glucose levels (BGL). Now a decision under the government’s Medical Cooling and Heating Electricity Concession Scheme is likely to become a talking point between type 1 diabetic patients and their GPs and specialists. Diabetes Queensland has been following developments on this issue and urges Queensland clinicians to familiarise themselves with the principles behind the decision and the grounds on which an application to the scheme might succeed. The issue surfaced late last year when a Toowoomba father of two type 1 diabetic children successfully applied to reduce in his family power bill by $82.50 a quarter. Mr Johnny Wapstra won the submission after raising the matter with his children’s paediatric endocrinologist. In response to two separate questions on the application form, the specialist certified that the children experienced “objective reduction of physiological functioning at extremes of environmental

temperatures” and “demonstrated loss of physiological function or significant aggravation of clinical condition at extremes of environmental temperature”. In response to questions from Diabetes Queensland, a spokesman for the Energy Minister Mark Bailey confirmed the decision. In a statement, the Minister said the scheme was not intended to help Queenslanders cool medicines such as insulin, but to provide support in cases where temperature variability had a direct impact on a person’s medical condition. “The Medical Cooling and Heating Electricity Concession Scheme provides financial assistance to households with an extra energy burden due to chronic medical conditions which require extensive use of air-conditioning,” he said. “People suffering from conditions, such as Multiple Sclerosis or severe inflammatory skin conditions are often adversely affected by changes in temperature and require cooling or heating to stop symptoms becoming significantly worse.” Mr Wapstra said the medical community should consider whether similar benefits should apply not just to those with type 1 diabetes, but to all insulin-dependent people with diabetes whose glycaemic control is affected by temperature.

Diabetes Queensland is a charity working to represent the needs and concerns of people with all types of diabetes. We employ health professionals and offer a range of face to face, telephone and online services to support people living with diabetes between their regular medical appointments. We support those providing clinical care in the field of diabetes by offering training, diabetes fact sheets and other resources. If we can help to support your diabetes-related practice, call our helpline on 1300 136 588.

He also questioned the need for applications to be endorsed by specialists when local GPs were likely to be familiar with individual cases and their record of BGL control. Mr Bailey said a total of $1.3 million would be spent this financial year to provide relief under the Medical Cooling and Heating Electricity Concession Scheme. It currently provides $329.96 (including GST) per year to eligible applicants, with eligibility reviewed every two years. “Queenslanders who are affected by changes in ambient temperature and who are therefore facing higher energy bills can apply for the Queensland Government concession if they meet eligible medical criteria and are supported by a qualified medical professional,” he said. The Palaszczuk Government was committed to fully funding a range of energy concessions and rebates to help households with their electricity costs. “We continue to fund medical concessions to protect and support vulnerable energy customers in times of need,” the Minister said. Other assistance measures include concessions for those using life support equipment, such as oxygen concentrators and kidney dialysis machines (worth up to $670 and $450 a year, respectively).

Doctor Q Autumn 39

New Members OCTOBER Doctors in training Dr Mia Harris Dr Leigh McKenzie Dr Jason Kim Dr Qinmin Ling Dr Jessica Byrnes Dr Alexandra Thiel Dr Matthew Sellen Dr Katherine Martinez Dr Stacey Compton Dr Adam Anderson General practitioners Dr Joanne Butterfield Dr Alexander Ha Specialists Dr Peta Wright Salaried medical officers Dr Mateen Allahwala Dr Veenu Mubarak Dr Arina Dan Dr Thomas Boakye Prof Tony Rahman Dr Morne Terblanche Dr Sinu Balakrishnan Dr Xiu Lee Dr Kavinderjit Nanda Dr Neil Beaton

Dr Allison Hempenstall Dr Rhys Youngberg Dr Henry Beem Dr Richard Kwee Dr Tiffany Vogler Dr Charana Arachchige Dr Matthew Cranstoun General practitioners Dr Brian Hawney Dr Thushara Gallage Dr Robert Teunisse Dr Usman Khan Dr Ralph ReevesSaunders Dr Safwan Sayyal Dr Nicole Higgins Specialists Dr Anand Gundabawady Dr Mark McGovern Dr Katrina Newbigin Dr Sharon Harding Dr Rachel Esler Dr Julio Alonso Babarro Dr Jason Paterdis Dr Adam Stirling Dr Gerard Adams Dr Raja Sawhney

NOVEMBER

Salaried medical officers Dr Justin Titmarsh Dr Adam Pritchard Dr Chen-I Lin Dr Wellappily Jayawardena Dr Francis Nolan Dr Sewwandi Francisco Dr Ni Ni Khin Dr Devaraj A. Supramaniam

Doctors in training Dr Sarah Li

Part-time practitioners

Part-time practitioners Dr Terence Sesnan Dr Minh Le Cong Dr Anna ThomasMergler Dr Alison Tigg Dr Sohn Tan

40 Doctor Q Autumn

Dr Moemen Morris Dr Phillip Marsh Dr Clare Kao Dr Susan Andersen Dr Lauren Essom Dr Karen Pui Dr Amit Nigam Other Dr Joseph Leer

DECEMBER Doctors in training Dr Sai Tip Dr Anzela Anzela Dr Sunny Dhadlie Dr Catherine Bella Dr Cara Fox Dr Nirosha Jayawardena Dr Jane Mason Dr Matthew Oates Dr Jun Kim General practitioners Dr Doug Morison Dr Michael Hayes Dr Abdul Rehman Dr Abdool Khatree Dr Hafiz Ziaullah Specialists Dr Sharon Miller Dr Eta Raicebe Dr Ronald Siu Salaried medical officers Dr Badieh Jafari Dr Laurel Young Dr Jacquelyn Wawryk Dr Amanda Allen Other Dr Meenal Mohan Dr Carolyn Vasey Prof Claire Jackson

Council of Doctors in Training strategic priorities for 2017 SUPPORTING JUNIOR DOCTOR MEMBERS TO BUILD THEIR CAREERS Dr Matthew Cheng, Chair â€“ AMA Queensland Council of Doctors in Training

The AMA Queensland Council of Doctors in Training (CDT) met in December to discuss and determine the strategic priorities for 2017. Last year, the CDT ran with the philosophy of ‘less is more’ by addressing a consolidated number of issues and dealing with these issues to a greater depth. This year, we will continue with this philosophy, but focus on delivering more tangible benefits to you.

We will also be running a free member seminar – Stepping up – Essential tips in leadership for junior doctors at the Emporium Hotel, Fortitude Valley on 30 March. We recognise that residents frequently step up into supervisory and leadership roles quickly, without much preparation. This event will help you make a successful transition and is also available by live webinar to support our regional members.

Advocacy to support doctors in training

Addressing rural and remote issues

As always, I see our primary role in advocacy. The CDT remains the primary group looking out for the interests of all doctors in training across the state. Over the past couple of years, bullying and harassment has dominated the discussion. The CDT responded by developing the first Resident Hospital Health Check which included key trends on bullying and harassment across the state. We are currently developing a second version of the survey to be released in the near future to monitor changes at the local hospital level. I strongly encourage you all to contribute to the survey to ensure it remains a useful tool for change.

Education and training – relevant professional development events for your career The CDT has been working hard over the past couple of years to deliver more relevant programs to you. Notably, the Junior Doctors Conference (JDC) is our flagship event, and is the only one of its kind in the nation. JDC 2017 – Future Frontiers in Medicine – is on Saturday 1 – Sunday 2 July 2017 at the Hilton Hotel, Brisbane and features sessions on diverse career pathways, medical leadership, interview skills and obtaining your college program of choice.

Hospital representatives from nonmetropolitan hospitals continue to be very active in the CDT. These representatives provide important insight into the issues specific to their hospitals, which CDT can then help progress. The CDT aims to expand the number of hospitals represented. Focus groups will also be run in rural and remote areas to gauge key issues impacting our regional members.

Common industrial relations issues for junior doctors The next round of contract negotiations is approaching in the next year. The CDT has been prospectively researching common items with respect to contracts and rosters to include in our log of claims. AMA Queensland has also educated new interns on their working rights at our recent intern readiness events. We have found many of our members were not aware of the entitlements that are available to them. AMA Queensland has a dedicated junior doctor industrial relations representative, Sewar Mitanis, who can assist you with any issue you encounter at work, such as bullying and harassment, access to leave, overtime and payment issues. Sewar can be contacted on (07) 3872 2222 for a confidential chat. Sewar has also recently prepared a “Your rights at work” guide – see page 32 for this handy information.

Communications – follow us on social media The CDT will build a stronger presence on social media to provide you with relevant updates on issues facing doctors in training, including our Resident Hospital Health Check and MOCA 5 log of claims. Like us on Facebook and Twitter, if you haven’t already. We are also establishing a LinkedIn page shortly, so watch this space.

AMA Queensland doctor in training membership – spread the word Last but not least, the size of our doctor in training membership directly affects our ability to advocate and influence positive change to support you in your career. I would like to thank those doctor in training members who have renewed and encourage you to spread the word to your colleagues about the importance of being a member. Each and every member plays a part in our efforts to improve the working conditions and career prospects of junior doctors. For those members who are yet to renew, please call the Membership Team now on (07) 3872 2222 and help us to help you in 2017 and beyond. The CDT continues to grow in numbers and influence each year. However, the good work of the CDT relies on a strong membership base. If you wish to be involved in CDT, be kept updated on the issues affecting you or have issues you want to raise, please email cdt@amaq.com.au. Wishing you all the best for 2017.

Doctor Q Autumn 41

Looking back on internship

Dr Chris Maguire, Junior House Officer, Mater Hospital

There is a deep, twisting nausea that comes with commencing upon the unknown. It is a physical manifestation of our inherent desire for safety and familiarity, and it arrives for all grand shifts in life. At the commencement of medical internship this natural instinct is compounded by an orientation filled with nightmares: a pharmacist outlines all the ways in which a thoughtless scribble with your pen can devastate a patient’s outcomes; a hospital legal representative cautions you not to ‘be that one unlucky case’; a haggard SHO puts on a brave face and offers a few tips to ease the transition. My first shift as a doctor was in the Logan Hospital Emergency Department. After three months of holiday, I suddenly found myself responsible for three emergency beds – a scarce resource, and one that was expected to efficiently service a constant stream of new patients throughout the day. With a borrowed password for EDIS, and the logistical impotence that comes with an unknown workplace, I felt completely out of my depth. My saviour on that day was a very kind and experienced nurse. I remember turning to him, after fumbling my way through an initial assessment, and letting the brave face fall. “I’m going to need a bit of help today. I need you to let me know what I’m doing right and wrong, and not be worried about correcting me.” For the rest of the shift his calm guidance was my centre of gravity; the point from which I was able to assess what needed to be done, and how best to do it. He made me feel both capable and valued – a feat I still thank him for. There is so much anxiety attached to starting out in medicine that there is almost no time to recognise how far you’ve already come, and to feel the excitement of putting that hard earned progress into practical use. As one famous doctor, William Osler, noted, “from two points of view alone have we a wide and satisfactory view of life.” One in the dawn of our commencement, gazing with focus up toward the summit that must be scaled – full with eager potential and opportunity. The other from the peak of life’s 42 Doctor Q Autumn

achievement. All other moments are obscured by a “steep and broken pathway.” In Osler’s opinion the view from the conclusion was reassuring, but much less satisfactory than the one afforded from the commencement. Internship is the dawn of a medical career. Looking back at the end of mine, I feel a deep sense of wonder at the process that has taken me from the twisting dread of the orientation room, to the accustomed comfort of the acute general surgical ward, completing a final round before the new year commences. If you are an intern this year, congratulations on what you have achieved in getting to this place. Cherish this year because it will go quickly and don’t be afraid of making mistakes – there is always more help available than you might think. We are all here for you.

Doctor Q Autumn 43

Future Frontiers in Medicine S A T 1 J U LY - S U N 2 J U LY 2 0 1 7 H I LT O N B R I S B A N E

Day one

Day two

Dr John Collee

Dr Renee Lim

Former Emergency Doctor and Screenwriter Walking the unconventional path in medicine

Chief Medical Officer and Director of Program Development, Pam McLean Centre Looking to the future of patient-centred care and communication

Professor Karen Dwyer Nephrologist and Transplant Physician, St Vincent’s Hospital Melbourne; and Deputy Head, School of Medicine, Deakin University How a nephrologist became involved in hand transplantation: Australia’s first hand transplant surgery

Professor Gordian Fulde Senior Staff Specialist, Director of Emergency Department St Vincent’s Hospital Sydney; Senior Australian of the Year 2016 Emergency medicine in the ice age: Challenges and advice for junior doctors

Dr Kathleen Thomas Advanced Intensive Care Trainee, St George Hospital, Sydney; and Médecins Sans Frontières volunteer Leadership and team work from the front line of chaos 44 Doctor Q Autumn

Junior Doctor Live Issues Panel

The Hon Cameron Dick MP Minister for Health and Ambulance Services, Queensland Health The Health Minister’s Annual Address

Dr Tony Bartone, General Practitioner, Lalor Medical Centre and Vice President, AMA Dr Kate Kearney, Cardiology Advanced Trainee, St Vincent’s Hospital; and Deputy Chair, AMA Council of Doctors in Training

Jane Anderson

Dr Ruth Mitchell, Registrar, Royal Melbourne Hospital and AMA Junior Doctor of the Year 2016

Q & A with recent successful college applicants

Members of AMA Queensland’s Council of Doctors in Training

Clinical Skills Development Service presents Simulympics

Dr James Fielding, Former Doctor; Chief Executive Officer, Audeara; Chief Operating Officer, Field Orthopaedics; and Founder, Robotics Engineering Research Laboratories The MDA National session - Innovations in medical thinking and turning your research dream into a commercial reality

Careers Coach, Jane Anderson Consulting Building your personal brand in medicine and preparing for interviews

Brush up on your emergency clinical skills in this live simulated emergency department scene. Watch the teams battle it out against the clock, navigating an obstacle course of broken body parts, spurting arteries and crunching ribs.

Early-bird member registration closes 28 April. Members can register now and save with great early-bird rates. Don’t know your roster? Register now and a full refund is available if your roster changes.

An understanding of simulation-based education and the clinical skills Simulympics Simulation is a valuable tool in clinical education, and in Queensland, the Clinical Skills Development Service (CSDS) is well known for its wide variety of courses with immersive practice components. CSDS is one of the world’s largest providers of healthcare simulation. We are located at the Royal Brisbane and Women’s Hospital, Herston in Brisbane. The purpose built centre has 27 multi-purpose training rooms and a huge range of simulation equipment. CSDS caters to a variety of levels of medical professionals from diverse disciplines, including anaesthetics, emergency, intensive care, paediatrics and surgery. Some examples of our courses include Basic Life Support, Advanced Life Support, Basic Laparoscopic Training, Crisis Resource Management, Effective Management of Anaesthetic Crisis, Advanced Paediatric Intensive Care Simulation and Basic Assessment and Support in Intensive Care. Luke Wainwright, Simulation Manager at CSDS says, “The focus of our education and training is on technical and non-technical skills delivered mainly via blended

courses. We know that busy clinicians need to maximize what limited time they have for their education needs. With this in mind, CSDS creates responsive, interactive and engaging blended educational programs. These programs aim to maximise online and face-to-face learning times by using cutting edge technologies and simulation equipment. The face-to-face component of the courses use simulation, allowing you to have a ‘hands on, immersive’ experience. The realistic equipment and scenarios allow you to practice so you can master the procedure or skill.” CSDS will showcase Simulympics at the upcoming AMA Queensland Junior Doctor Conference on 1-2 July 2017. Simulympics is a competition between two teams of doctors in training; they race against each other and against the clock through simulated clinical skills stations and scenarios. Not only are these clinical athletes pitting their skills against each other, but our judges are also assessing teamwork, speed and clinical accuracy. Judged by a panel of simulation and clinical experts, only one team will be victorious! CSDS provides many more courses to assist in the development of medical professionals, and is more than happy to respond to any course enquiries. You can call CSDS on (07) 3646 6500 or send a course enquiry email through to CSDS - Admin@health.qld.gov.au

Events Calendar

R E G I O N A L P R I VAT E P R A C T I C E SEMINAR SERIES ONE

R E G I O N A L P R I VAT E P R A C T I C E SEMINAR SERIES ONE STEPPING UP: ESSENTIAL TIPS FOR LEADERSHIP AS A JUNIOR DOCTOR Time: 6.30pm – 10.30pm Date: Thursday 30 March 2017

Location: Emporium Hotel 1000 Ann Street, Fortitude Valley

Stepping up into supervisory and leadership roles as a junior doctor can be daunting. This panel discussion, including perspectives of senior staff specialists, registrars and an organisational psychologist, will explore first-hand accounts of transitioning into leadership roles, along with strategies and practical examples for best-practice leadership.

T R A N S I T I O N I N G T O P R I VAT E PRACTICE SEMINAR Time: 5.45pm – 8.30pm Date: Thursday 27 April 2017

Location: Hunstanton, AMA Queensland, 88 L’Estrange Terrace, Kelvin Grove

Are you considering the move to private practice in 2017? Presented by the industry experts and our corporate partners, this seminar will explore financial and accounting considerations, legal structuring issues, risk mitigation strategies, along with all the essential aspects of employing and managing staff.

Time: 9am – 12pm Date: Thursday 20 April Friday 26 May 2017 Compliance at work: A comprehensive guide to workplace health and safety audits. Join George Sotiris, AMA Queensland’s Workplace Relations Manager as he steps through the points your practice needs to consider to comply with WHS obligations.

Location: Sunshine Coast Gold Coast Toowoomba Brisbane West Bayside Brisbane North Brisbane South Mackay Townsville Cairns Rockhampton Gladstone Bundaberg Hervey Bay

20 April 21 April 28 April 2 May 3 May 4 May 5 May 9 May 10 May 11 May 23 May 24 May 25 May 26 May

DINNER FOR THE PROFESSION Time: 6.30pm for 7pm start – 11pm

Location: Marquee, Victoria Park Golf Club, Herston Road, Herston

Date: Friday 16 June 2017

Attire: Black tie

AMA Queensland proudly presents an evening of elegance and celebration of the medical profession. Enjoyed over a three-course dinner, the evening will include the Presidential Inauguration and awards of distinction. Entertainment will feature a silent auction with all proceeds being donated to the AMA Queensland Foundation.

For any event enquiries, please contact the Events team on (07) 3872 2222 or email registrations@amaq.com.au. 46 Doctor Q Autumn

Annual AMA Queensland Conference P L A N YO U R R O M A N H O L I DAY

With the theme “Personalised health care – Evolving health care needs through the cycle of life”, the conference will feature a range of worldleading European and Australian keynote speakers on the future of health care, including pertinent topics such as:

The personal journey in health care; Medico-legal issues in relation to personalised health care; The importance of mental and physical fitness throughout life;

Future challenges for infection management; Developments in precision medicine; Issues around end-of-life care; The Health Care Home;

Health care in the formative years; Practice responsibility in the treatment plan; and Shared patient records through life (including My Health records).

Delegates will be educated and entertained by eminent medical speakers from Rome universities, the World Medical Association and leading clinicians from Australia including:

The Australian Ambassador to Italy, Dr Greg French Prof Francesco Curcio, Professor of General and Clinical Pathology, University of Udine Medical School Dr Katriona Munthe, PhD, Consultant Psychologist, University of Siena Dr Marco Falcone, Department of Public Health and Infectious Diseases, University of Rome

Dr Chris Cunneen, Occupational and Environmental Physician, Brisbane Prof Roberto Verna, Sapienza University of Rome Ms Colleen Sullivan, Practice Manager, Brisbane Prof Pablo Requena, Vatican Medical Association.

TREVI FOUNTAIN The Trevi Fountain, not only the location of our favourite gelato shop in Rome, but also the largest and most famous Baroque fountain in Rome. Freshly restored, after 17 months under reconstruction, the fountain features Neptune (God of the Sea), flanked by two Tritons and symbolising the contrasting natures of the sea. Do as so many others do and throw in your coin to make your wish.

S PA N I S H S T E P S Within walking distance is the famous Spanish Steps, the Piazza di Spagna. Not only is this historic masterpiece beautiful to view but so are the fashion shops located in the Piazza and nearby streets. The area also hosts major fashion shows during the summer months, using the steps as part of the runway.

RACGP points will be on offer. For any enquiries about the program:

Keen to book your Roman holiday now?

Contact Neil Mackintosh AMA Queensland Conference Organiser E: n.mackintosh@amaq.com.au P: (07) 3872 2267

Contact Ros Bulat AMA Travel E: ros.bulat@worldtravel.com.au P: (07) 5556 7222

Doctor Q Autumn 47

Local Medical Association round up REDCLIFFE DISTRICT LOCAL MEDICAL A S S O C I AT I O N ( R D L M A )

GOLD COAST MEDICAL A S S O C I AT I O N ( G C M A )

Dr Kimberley Bondeson, President Web: www.rdma.org.au Phone: (07) 3284 9777 Meetings: 28 March 26 April 24 May 27 June 25 July 23 August - AGM 12 September 25 October 1 December - networking function.

Chantell Badenhorst, Secretariat Manager Web: www.gcma.org.au Email: info@gcma.org.au Phone: 0419 780 505 Meetings: 16 February – clinical 16 March – clinical 20 April – clinical 18 May – clinical 16 June – social 20 July – clinical 17 August – clinical 21 September – clinical 19 October – clinical 17 November – social

SUNSHINE COAST LOCAL M E D I C A L A S S O C I AT I O N (SCLMA)

IPSWICH & WEST MORETON M E D I C A L A S S O C I AT I O N (IWMMA)

Contact: Jo Bourke, Secretariat Web: www.sclma.com.au Email: jobo@squirrel.com.au Phone: (07) 5479 3979 Meeting: 23 March

Contact:

BUNDABERG LOCAL M E D I C A L A S S O C I AT I O N (BLMA) Contact: Dr Daud Yunus Email: daud.yunus@gmail.com Phone: (07) 4152 2888

M AC K AY LO C A L M E D I C A L A S S O C I AT I O N ( M L M A ) Contact: Phone:

Dr Bill Boyd 0419 676 660

48 Doctor Q Autumn

Contact:

Phone:

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

FRASER COAST LOCAL M E D I C A L A S S O C I AT I O N (FCLMA) Contact: Dr Nicholas Yim, Secretary Email: drnnyim@gmail.com Phone: 0421 659 892

TOOWOOMBA AND DARLING DOWNS LOCAL MEDICAL A S S O C I AT I O N ( T D D L M A ) Contact:

Dr Mark Wyche, President; Dr Peter Schindler, Treasurer Web: www.tddlma.org.au Email: info@tddlma.org.au Phone: (07) 4633 1939 Wilsonton Medical Centre (Dr Peter Schindler) Meetings: 1st Tuesday of each month, 7pm at St Andrew’s Hospital, 280 North Street, Toowoomba

BRISBANE NORTHSIDE LOCAL MEDICAL A S S O C I AT I O N ( N L M A ) Contact:

Dr Robert (Bob) Brown, President Web: www.northsidelma.com Phone: (07) 3265 3111 Meetings: 11 April 13 June 8 August 10 October 12 December

CENTRAL QUEENSLAND LOCAL MEDICAL A S S O C I AT I O N ( C Q L M A ) Contact: Phone:

Dr Michael Donohue 0419 715 658

CAIRNS LOCAL MEDICAL A S S O C I AT I O N ( C L M A )

CAN’T FIND YOUR LOCAL AREA?

Contact: Phone: Meeting:

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

Dr Sharmila Biswas (07) 4036 4333 17 March 2017

Supporting the art of general practice NEW TRIENNIUM, NEW LOOK, NEW PROGRAM COMING TO A CITY NEAR YOU IN 2017

19-21 MAY 2017

22-23 JULY 2017

SYDNEY SHOWGROUND SYDNEY OLYMPIC PARK

CROWN PERTH

1-3 SEPT 2017

10-12 NOV 2017

BRISBANE EXHIBITION & CONVENTION CENTRE

MELBOURNE EXHIBITION & CONVENTION CENTRE

PLATINUM SPONSOR:

Find out more at gpce.com.au

REGISTRATION NOW OPEN FOR SYDNEY!

Book using code ‘DRQ20’ before 7 April for 20% Early Bird Discount

GOLD SPONSOR:

SILVER SPONSOR:

GPS | NURSES | PRACTICE MANAGERS | REGISTRARS | ALLIED HEALTH Doctor Q Autumn 49

28th

ANNUAL CONFERENCE ��

Charting New Horizons

RDAQ 2017

Innovate l Navigate l Communicate l

8-10 JUNE

2017

MERCURE TOWNSVILLE

RDAQ 2017 – Secure your spot now! This year’s theme Charting New Horizons ~ Innovate • Navigate • Communicate will encourage delegates to connect, refresh and adjust their sails ready for great adventures in rural health. Do not miss your chance to be provided with the latest updates in clinical practice and topical presentation, policy and discussion forums as well as RDAQ’s traditional medico-political forum. PRE-CONFERENCE WORKSHOPS l

Doctors in training rural clinical skills workshop

l The

management of skin malignancy in rural practice l Ultrasound for rural practitioners l Musculoskeletal

NETWORKING AND SOCIAL PROGRAM l Student networking afternoon tea l Workforce

breakfast

l Friday

night social

l RDAQ

breakfast and AGM

l RDAQ

2017 David Horn memorial gala dinner and awards

FAMILY PROGRAM

PLENARY SESSIONS

l Museum

of Tropical Queensland

l Staying ‘off the rocks’, a compass for

l Billabong

sanctuary

l Children’s

entertainment

CONTACT DETAILS Barbara Kos RDAQ 2017 Conference Manager Phone: 07 3105 7800 Fax: 07 3221 3748 Email: conference@rdaq.com.au

navigating crisis points in domestic relationships l Making

community engagement work

Event Management services for RDAQ 2017 provided by Health Workforce Queensland

50 Doctor Q Autumn l

Innovate l Navigate l Communicate l

Warzones improve rural trauma care The horrific experience from some of the world’s major battlefields could one day lead to better emergency care for rural patients. Medical specialists at James Cook University and US defence personnel are trialling new treatments and techniques to reduce blood loss and shock during the initial, crucial minutes of a patient sustaining major injury. Leader of the JCU study, Prof Geoff Dobson said “The vast distances and diversity of climates and terrains place major limitations on pre-hospital trauma care and aeromedical retrieval to definitive care. Time is the killer.” Dr Dobson’s team and personnel from the US Special Operations Command and US Navy are developing a new ‘ultra-small’ volume drip therapy mixture to treat bleeding, shock and traumatic brain injury sustained in far-flung locations. Dr Dobson will be keynote speaker at the annual Rural Doctors Association of Queensland conference in Townsville on June 8. “In 2015, we showed that the therapy reduced internal blood loss by 60 per cent over five hours, and increased survival after traumatic brain injury with and without major blood loss and shock,” he said. “High quality pre-hospital telemedicine with rapid access to aeromedical transport is paramount to an effective and efficient health care system in the tropical north.”

Announcing RDAQ 2017 keynote speaker Dr Dobson holds a professorial chair in the College of Medicine and Dentistry, James Cook University. He has eight years’ experience specialising in cardiac research at the National Institute of Health. He is an elected fellow of the American Heart Association, and is also working with the US military on far forward resuscitation, spinal cord injury and burns.

RDAQ STREAM

CLINICAL STREAM

l RDAQ

l Infectious disease & rural health

members’ forum

l General practice funding: today &

tomorrow

l Hitchhikers

guide to medical administration l The doctor & the advocate

l Dentistry: pain pathology & the healing

forceps

l Safe practice & safe communities l Managing end of life care in a rural &

remote context

INTO THE FUTURE STREAM

DOCTORS IN TRAINING STREAM

l Refugee

l Rural medical education

health

l Caring

for people from LGBTIQ backgrounds

l Forensic

medicine in rural Queensland

l Mental

health services in rural Queensland

l Managing

alcohol use in chronic disease patients l RDAQ academic awards finalists’

presentations

l Pathways to rural & remote practice

Innovate l Navigate l Communicate l

Managing the risks of practice growth Many large multi-doctor medical practices start out life as small solo-doctor practices with perhaps a receptionist and nurse. The doctorowner is able to control many of the elements of the practice and often directly oversees most, if not all, of the ‘goings-on’ in the practice.

CHRIS MARIANI

Director, Medical & General Risk Solutions M: 0419 017 011 E: chris@mgrs.com.au Authorised Representative Number: 434578

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

52 Doctor Q Autumn

As the practice quickly grows, the same level of oversight is simply not possible. As a result, the doctor delegates control to staff, becomes increasingly busy with patients and as the saying goes – spends time in the business, rather than on the business. This creates numerous risks and without the right risk management strategies and insurances, leaves the practice exposed. The following example perfectly illustrates the risk of growth. This is from DUAL Insurance – who should have known better considering they provide an insurance product (‘Management Liability’) which covers a company against employee fraud: In a much talked-about session, the Asia-Pacific CEO took to the stage to spell out how an employee siphoned off $17 million, offering a warning that it could happen to any business. “The trauma that DUAL has been through in the last three months is something I’d never want any business to go through.” On 30 June, news broke that former employee Josie Gonzalez and her husband had allegedly misappropriated $17 million in insurer funds, via false invoices to a fictitious law firm, JAAG. Coates says the problem was DUAL’s processes hadn’t kept up with its growth. “When I first set up DUAL I was approving every invoice. I wanted to know

where every dollar went. As the business had grown, our two bank signatories were signing 800 invoices a month,” he says. “Many CEOs have asked me how we uncovered it, saying surely it was an issue of annual leave. It wasn’t at all and any of us who are running businesses and thinking annual leave is a logical way in the current technological age we live in to prevent fraud, is living in a different world. That control doesn’t work. No-one is ever really on holidays. We can still check out emails and keep the business going.” Coates says Gonzalez took every day of her annual leave. “If you’re serious about annual leave as a control you have to do what the banks do: for two weeks of their four weeks’ annual leave they block every single person’s system access,” he says. The fraud was uncovered because Gonzalez’s access to the system was blocked for part of her time on maternity leave. The employee fraud case above could equally occur in a medical practice – and frequently does. We speak at numerous doctor conferences annually and most times at least one doctor in the room will raise their hand to say they, or a colleague, were the victim of employee fraud. We are also seeing fraud by cyber criminals on the rise, and now is the time to tighten your financial controls and oversight. There is no easy solution to safeguard a medical practice from risk. There are however, steps every practice can take and the following is our philosophy on managing risks in a medical practice.

Insurance is only part of the solution - structure first, then risk management, insurance is last! Not everything is insurable. No amount of insurance can protect a doctor’s largest risks – their medical registration and reputation. Insurance should be a part of your ‘risk management framework’. Get advice from relevant experts on mitigating your key risks –accountants, lawyers, risk managers, insurance brokers, financial planners, IT consultants, medical billing experts, etc. Think in terms of “what can I do to protect my assets, liabilities, reputation and revenue?” Aim for three levels of protection: 1. First layer – asset protection/structure – what can you do to protect assets? 2. Second layer – risk management – identify and manage your risks. 3. Third layer –insurance – purchase the right insurances to cover your key insurable risks.

Spend your money on the right insurances

HERE ARE SOME STEPS PRACTICE MANAGERS CAN TAKE TO HANDLE RISKS IN THEIR MEDICAL PRACTICE.

Don’t insure the small stuff. There is also no point buying the cheapest policy if it doesn’t provide the cover needed. You might as well stick your money in the bank and self-insure! Understand what insurances you’re required to have by law or contract. Consider what other policies you may benefit from and judge these against your other risk management options – e.g. should I spend $1,000 on that insurance policy or spend it on my IT system to improve my backup, cybersecurity and IT supplier response times?

Start with your top 10 risks Do you know the top 10 risks in your practice? How are you managing these risks? What would be the financial loss, reputational damage or other consequence? What experts could you call on to assist should the risk eventuate? Conduct a workshop with your staff and brainstorm risks. Speak to other practices and experienced people who can share their insights and experience. Develop a risk framework with management oversight. Your top 10 risks should be written into a ‘Risk Register’ and reviewed and actioned at regular management meetings. Break your risks into key areas such as the following example:

Risk area: IT and key equipment What could go wrong:

Power outage Breakdown Cyber attack Privacy breach

Virus Loss of key supplier Back-up failure

Existing controls: Document the existing controls in place such as having a documented Disaster Recovery and Business Interruption Plan, service agreements with suppliers, annual IT security reviews, etc. Actions: Document what else you need to do, by whom and when.

Don’t DIY insurance – this also applies to advice from other experts such as lawyers, accountants, financial planners, IT consultants, etc. You have as much chance of getting it right as I do of performing neurosurgery on myself! You simply don’t know what you don’t know. You’re far better off focussing on your core skills and outsourcing the rest. The pharmacists’ “best stuff” is behind the counter and only accessed with a prescription. Insurance is often the same. Many of the best business insurers (and policies) are only available if you have a script –aka an insurance broker/adviser. You should also be seeking advice – so ask “what insurances do you recommend, are you providing me personal advice and is your duty to me or to the insurer?”

Prevention is better than cure (but it’s hard to cure the unknown) I once visited a paper-based psychiatry practice. They had been running for over 30 years and their medical records room was down an unsupervised corridor with patient toilets at the end. There was no door, let alone a lock to the medical records room. After some appropriate (risk management) counselling, they had a door and lock installed – far cheaper than the potential $1.7 million fine under Australian privacy laws. Even though they had walked past the risk every day, it never occurred to them they were not managing their risks appropriately; they were completely ignorant to the huge fine and huge risk staring at them every time they walked past.

Doctor Q Autumn 53

Beware of advertising your wares False or misleading advertising – however innocent – can be met with harsh penalties. The Australian Health Practitioner Regulation Agency (AHPRA) has established clear and thorough advertising guidelines.1 In order to protect public interest, AHPRA and the National Boards administer the Health Practitioner Regulation National Law (the National Law). Under the National Law, a regulated health service must not advertise in a way that:

is false, misleading or deceptive; uses gifts, discounts or inducements without the terms and conditions of the offer; uses a testimonial or purported testimonial; creates an unreasonable expectation of beneficial treatment; or directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services.

Complaints about advertising AHPRA received 300 complaints about advertising in 2014/152 across all regulated health professions. This was a decrease from 547 in the previous year.

If the practitioner fails to amend or remove their advertising, the Board considers (and often takes) disciplinary action – either for breaches of professional conduct under the National Law or for a statutory offence, which can be prosecuted through the magistrate’s court. Breaching the National Law’s advertising requirements carries a maximum fine of $10,000 for a body corporate or $5,000 for an individual, per offence. AHPRA has referred several more serious matters to the Australian Competition and Consumer Commission (ACCC). References: 1. Australian Health Practitioner Regulation Agency. Guidelines for Advertising Regulated Health Services. May 2014. Available at: medicalboard. gov.au/Codes-Guidelines-Policies/Guidelines-foradvertising-regulated-health-services.aspx 2. Australian Health Practitioner Regulation Agency. AHPRA Annual Report 2014/15. Available at: ahpra.gov.au/annualreport/2015/ 3. AHPRA and Chiropractic Board take Action on False or Misleading Advertising [Media Statement] – 18 January 2016. Available at: ahpra. gov.au/News/2016-01-18-complaints.aspx 4. Bird S. Beware Testimonials. Defence Update Winter 2014:18. Available at: defenceupdate. mdanational.com.au/en/Articles/bewaretestimonials 5. Australian Health Practitioner Regulation Agency. Guidelines for Advertising Regulated Health Services. May 2014. Appendix 6, p22. Available at: medicalboard.gov.au/Codes-Guidelines-Policies/ Guidelines-for-advertising-regulated-healthservices.aspx

FAQs Is my practice website considered to be advertising? Yes. Can I use images in advertising? Yes. Images of a real patient (who has provided written consent) are less likely to be misleading than stock photos or images of models. The guidelines state that “before and after” shots can be misleading or deceptive. They should be as similar as possible in content, camera angle, background, framing, exposure, posture, clothing, makeup, lighting and contrast. What about testimonials on social media? While testimonials are prohibited, doctors are not responsible for removing (or trying to have removed) unsolicited testimonials published on a website or in social media over which they do not have control. For example, doctors do not have control over the RateMDs website.4 Should advertisements for surgical procedures contain a warning statement? Yes. Advertisements for a surgical (or “an invasive”) procedure must include a clearly visible warning, with text as specified in the AHPRA guidelines.5 Can I use the terms “specialist” or “specialising in”? You cannot use the title “specialist” unless you hold specialist registration as recognised under the National Law. Alternate phrases might be “substantial experience in” or “working primarily in”.

Penalties A recent media statement by AHPRA and the Chiropractic Board stated:3 Over the last five years since the National Scheme began, the vast majority of practitioners have responded to the first AHPRA warning letter and amended their advertising, eliminating the need for and cost of further regulatory action. 54 Doctor Q Autumn

Preferred Medical Indemnity Provider

Disclaimer:

Besides the National Law, medical practices’ advertising must also comply with:

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.

the Australian Consumer Law, administered by the ACCC – in particular, regarding misleading or deceptive advertising; and laws administered by the Therapeutic Goods Administration – in particular, restrictions on advertising medicines.

Doctor Q Autumn 55

Another example of the importance of recording discussions of risk It goes without saying that good record keeping by medical practitioners is essential for the provision of good clinical care. It can also be vital in the defence of allegations of negligence against medical practitioners. Clause 8.4 of the Medical Board of Australia’s guideline ‘Good Medical Practice: A Code of Conduct for Doctors in Australia’ (the Code) provides that: ‘Maintaining clear and accurate medical records is essential for the continuing good care of patients …’ It follows that, a failure to maintain good medical records can also give rise to disciplinary action by the Medical Board of Australia. A West Australian cardiologist, Dr W, was recently disciplined by the Medical Board of Australia for behaving in a way that constituted unsatisfactory professional conduct by failing to obtain informed consent for a procedure and failing to maintain appropriate records of his discussions about risks with the patient.

Background facts Dr W was a Perth based cardiologist. He had a patient whom he had known for 30 years, a retired consultant gastroenterologist. The patient first attended on Dr W in September 2011. Various testing and procedures were performed and eventually Dr W advised the patient he would benefit from a coronary angioplasty. The patient was sent a consent form entitled Coronary Angioplasty in the mail. The consent form outlined a number of risks associated with the procedure, including the rare possibility of complications which 56 Doctor Q Autumn

could result in permanent damage and even death. The patient signed the consent form together with a hospital pre-admission summary and consent form. The pre-admission summary and consent form included a declaration that the patient had been advised of the material risks associated with the procedure, that the patient understood the risks, and that the patient had had the opportunity to ask questions and was satisfied with the information received. On 2 November 2011, the coronary angioplasty was performed by Dr W. Fifteen minutes after the procedure was performed, the patient was found to have suffered a stroke.

K AT H A R I N E P H I L P Partner, TressCox Lawyers P: (07) 3004 3536 E: Katharine_Philp@ tresscox.com.au

In reaching this finding, the panel noted the following:

The incident came to the attention of the Medical Board of Australia which resolved to refer the matter to a performance and professional standards panel hearing.

a) the system Dr W had in place by which documentation was provided to patients, particularly consent-related documents, was less than ideal;

During the panel hearing, Dr W gave evidence that in addition to the provision of the consent material sent to and signed by the patient, he also orally advised the patient of the risks associated with coronary angioplasty, including the remote risk of serious harm from heart attacks and strokes on 20 October 2011. However, there was no record of this discussion in his notes. The patient’s evidence, however, was to the effect that he did not recall such a discussion with Dr W.

b) it was concerned that the accuracy and thoroughness of the practitioner’s clinical notes and considered that the practitioner should have included reference to having provided a consent form and a booklet and having discussed the potential risks and complications with the patient in his notes.

Disciplinary proceedings

The panel found that Dr W had failed to maintain clear, appropriate, accurate and detailed clinical records of his discussions with the patient regarding risks and potential complications of the coronary angioplasty. Consequently, Dr W had behaved in a way that constituted unsatisfactory professional performance and issued a caution.

This decision is a reminder of the importance of not only providing appropriate warnings to patients, even if they are also health practitioners who are better placed to understand risks of procedures, but to ensure that the nature of the discussions with patients is recorded accurately. This article was written by Katharine Philp, Partner, TressCox Lawyers.

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

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

Vanessa James-McPhee, Senior Associate

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

Bill Hickey, Partner

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

www.tresscox.com.au

Paul de Silva, Special Counsel

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

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

Tony Mylne, Partner

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

Katharine Philp, Partner

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

Lynette Reynolds, Partner

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

P. (07) 3004 3500 @TressCox

Doctor Q Autumn 57 @TressCoxHealth

Salary packaging myths unraveled

ANGELA JEFFREY

Business Advisory Director, William Buck Accountants

Salary packaging can be a great way for doctors to get ahead financially, but many simply don’t get around to organising it or don’t know how to put it into action to save money. Quite simply, salary packaging is a process where you restructure the way in which you take your salary in order to save tax. The “packaging” involves paying for certain items in pre-tax dollars, with the balance of your salary paid like normal wages into your bank account (less your regular superannuation contribution and tax withheld). Here we explain some of the common myths of salary packaging.

MYTH 1

There’s not much benefit to me There are many benefits to having an effective salary sacrificing arrangement including reducing the tax you pay and increasing your disposable income. Essentially, salary packaging means that you save tax, which leaves more money in your pocket at the end of the year. This is due to paying for some items in pre-tax dollars, which reduces your taxable income. A reduced taxable income equates to less income tax and more savings! Depending on your employer, there are limits to how much you may salary sacrifice. Most hospitals and not-for-profit organisations have a limit of $9,010 per annum. The following example outlines the tax savings and additional disposable income available to a first year intern. As you can see, the $9,000 is used to pay for packaged items in pre-tax dollars. The tax savings are around $2,835 per annum, which directly correlates to the additional disposable income available.

Details

No Package

Salary Package

Salary

$60,000

Less: Amount Sacrificed

($9,000)

Taxable Income

$60,000

$51,000

Tax Payable

$12,450

$9,615

Net wages paid by hospital

$47,550

$41,385

ADD: Reimbursement of amount sacrificed

$9,000

Total

$50,385

58 Doctor Q Autumn

$47,550

Tax Savings

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

MYTH 2

You can package at any time There are certain conditions that must be met to ensure you are entering an effective salary sacrificing arrangement. Essentially, salary packaging can only occur on salary you will earn in the future, rather than salary you have earned prior to establishing the salary packaging arrangements. It is therefore in your interests to set it up as soon as you start working. The salary packaging year runs from 1 April through to 31 March. For established packages, it is a good idea to revisit your salary packaging arrangements each March to ensure that you are making the most of the opportunities. This is especially important as your salary increases, as your tax savings are likely to increase along with the tax level you pay.

MYTH 3

I’m not sure about Fringe Benefits Tax and don’t want to pay any additional taxes Fringe Benefits Tax is a specific area of tax law that is designed to tax salary packaging arrangements. The good news is that in most cases, for doctors working in either Queensland Health, or the Mater Hospital system, there are exemptions to Fringe Benefits Tax that enable you to enter into a salary packaging arrangement and still access the benefits that we have discussed.

MYTH 4

It doesn’t matter what I package

$2,835

With such a wide range of benefits you can choose to package, you will need to explore what is most beneficial to you and your situation. Generally speaking, you should look to package benefits that are not tax deductible (otherwise you would claim them on your tax return). There are a large range of non-deductible benefits you can package and depending on the hospital you are employed by, you may even be able to package entertainment expenses such as your wedding reception!

SPECIALIST

ADVISORS TO THE MEDICAL

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

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

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

(07) 3229 5100

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

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

— Securing your financial freedom with business and retirement planning

Doctor Q Autumn 59

Purchase an existing practice or start from scratch? Purchasing a practice requires careful consideration and planning. Fortunately, you don’t have to go through it alone; BOQ Specialist has assisted hundreds of doctors across the country with both the financial and practical implications. To give you a hand with making the decision, here are some of the points to consider when deciding which way you might approach purchasing a practice.

Purchasing outright: a more predictable return on investment? When buying a practice outright, on face value, the cost of the practice may look more expensive. Our financial specialists across the country are seeing existing practices sell for over $200,000 more than the cost of setting up a practice from scratch. However, your return on investment when purchasing an existing practice may be more predictable because the practice is fully operational before you even walk in the door. In the same way, reviewing profit and loss for an existing practice can also be easier which makes applying for a loan simpler and takes up less of your valuable time. It also means that you could start to think more strategically about investing in new equipment earlier, which in the long run could further improve the bottom line of your practice. There’s also the benefit of goodwill when purchasing an existing practice. It might come with staff who know how to run the day-to-day operations and who have good rapport with patients. On the flip side, we notice that many doctors underestimate the time it takes to develop an excellent working relationship with existing staff. If you choose to hold on to pre-existing staff, you will need to work on navigating the change of ownership smoothly to ensure that loyalty from staff and ultimately, with patients, remains. 60 Doctor Q Autumn

Starting from scratch: an exciting opportunity? Starting a practice from scratch might be considered more exciting. It also comes with more freedom of choice - you can choose the location of your new practice, its size, fit it out exactly the way you want and establish your ideal team from the get-go. You might find that starting from scratch also presents you with more options on choice of premises. Commercial spaces can come up in a multitude of forms – whether that’s through a multi-occupancy office building, or a high street retail space or even an ex-residential property, there is certainly plenty of variety. Curb-appeal, foot traffic and parking are all important aspects to consider. With an increasing number of highrise buildings appearing in the major cities across the country, doctors are finding new opportunities to access dense populations in attractive spaces. With more flexibility on the size of your new practice and its location, you might also be able to consider partnering with ancillary service providers, creating a ‘one-stop’ solution for patients – all the treatment that they need in one visit. Remember though, there may be planning permission constraints that you will need to work through. You will certainly need to be prepared to start a practice and cover initial outgoings with few or no patients to begin with. Careful planning and a realistic business and marketing plan can help but you will need to be comfortable with a certain amount of risk before you reach break-even, as well as the time lag before you reach that point. You will also need to consider the added expense of hiring new staff and training them.

DR BRETT ROBINSON

BOQ Specialist CEO

BOQ Specialist has spent over 25 years helping professionals build and run their practices with a range of tailored financial products and services. BOQ Specialist’s Practice Ownership Guide is designed to help you navigate the process of owning a practice that’s right for your future plans and to help you understand the financial options available. To download a copy, please click [https://www.boqspecialist. com.au/expertise/guides/practice-purchaseguide], alternatively, you can call 1300 131 141 to speak with a consultant. The information contained in this article is general in nature and has been provided in good faith, without taking into account your personal circumstances. While all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, no warranties in this regard are provided. BOQ Specialist is not offering financial, tax or legal advice. We recommend that you obtain independent financial and tax advice before making any decisions.

Finding the right practice for you Whether it’s purchasing an existing practice or starting from scratch, you need to make sure you do what’s right for you. You may already know the owner or work in the practice that you ultimately want to own. If not, a good way to start looking for that opportunity is through your network – sales reps can be a good source of insider knowledge on commercial opportunities – or from a specialist practice sales professional who knows of owners looking to sell their practice. There are many things to consider but leveraging a number of specialists can help inform your decision and make it easier.

Build financial and mental resilience to impacts of storm season Doctors know that floods, cyclones and other natural disasters wreak havoc on the mental health of Queenslanders, particularly those facing the extra financial stress of rebuilding their lives. A survey of AMA Queensland members following the devastating summer of 2011 showed 60 per cent of doctors had seen or expected to see a spike in mental health cases. These days most of us know to batten down the hatches when clouds start gathering, but many Queenslanders aren’t aware of how to make sure their finances weather the storm. That is particularly true of the more vulnerable members of our communities, who might be more concerned about making it to their next payday than putting money away for a rainy day. But a new toolkit aims to help all Queenslanders bounce back more quickly if they are affected by natural disasters – and in doing so, alleviate some of the financial strain that can cause mental health issues down the track. Produced by Good Shepherd Microfinance with the support of the Queensland Government, the

Money Ready Toolkit aims to increase Queenslanders’ financial knowledge and resilience. General Manager of Marketing and Innovation Renee Hancock said Good Shepherd Microfinance was pleased to be working with AMA Queensland to spread the word to Queensland communities. “Research has shown that up to two thirds of people with money worries end up with physical or mental health issues1,” Ms Hancock said. “The elderly, single parents and ethnic minorities are particularly at risk. “By displaying the Money Ready Toolkit in their surgeries, or mentioning it to patients, GPs will be going beyond looking out for their patients’ physical and mental wellbeing. “They’ll be protecting their financial health too.” She said many people were unaware of what to do to ensure their financial wellbeing. “One in 10 Queenslanders is unsure if their insurance would cover the cost of rebuilding their home and a further one in 10 has no home insurance at all,” Ms Hancock said.

“If their homes were wiped out by a cyclone or bushfire, these people would be thousands of dollars out of pocket – and possibly also without somewhere to live.” She said the toolkit made it simple for people to check the health of their finances. “Even if you’re on a limited income, there are ways to improve your financial health and make sure you’re ready for whatever comes your way,” Ms Hancock said. “Improving the financial resilience of Queenslanders will often take only a few simple changes, but that can make all the difference to their mental health if they are affected by a natural disaster.” References 1.

2015. The Wesley Report: Facing financial stress.

The Toolkit can also be downloaded at www.goodshepherdmicrofinance. org.au/moneyready If you would like any further information or materials, please contact info@sequelpr.com

Doctor Q Autumn 61

New super rules start 1 July 2017 – take action now or run the risk of paying higher tax in retirement New superannuation rules have been passed into law and take effect from 1 July 2017, so members have just four short months to review their circumstances and make changes to maximise their retirement savings. In particular, super fund members should review their super contribution strategies and take action well before the 30 June 2017 rush or run the risk of being financially worse off in retirement. With this in mind, fund members might consider making changes to their circumstances sooner rather than later to take advantage of the existing higher contribution caps.

Sitting on cash and paying tax on interest at marginal rates? Consider a large non-concessional contribution to superannuation (up to $540,000 depending on your age and superannuation contributions history) before 30 June.

Planning to downsize your home? Consider downsizing before 30 June to use part proceeds to make a large super contribution this financial year.

If your member account balance is over $1.6 million you will not be able to make any further contributions from 1 July. This is the last year to make superannuation contributions to move savings into the low tax super fund structure.

62 Doctor Q Autumn

Estate planning: member account balances left for the benefit of non-dependent children may be taxed at up to 17 per cent. There are tax-effective strategies to help manage this impact.

P: (07) 3233 5805

Unused concessional contributions will accrue from 1 July 2018 on a rolling basis for a period of five years;

the government has confirmed that the additional 15 per cent tax on concessional super contributions will apply to those whose income exceeds $250,000 – currently the threshold is $300,000; and

the government will no longer remove the work test for super fund members aged 65 to 74. The work test rule must to be met in order to make any additional concessional or non-concessional superannuation contributions.

The key points of the super reforms are:

$500,000 lifetime nonconcessional cap has been dropped;

annual non-concessional contribution cap to be lowered from $180,000 pa to $100,000 pa from 1 July 2017 – so make the best use of the $180,000 cap by 30 June 2017;

the three-year ‘bring forward’ rule for non-concessional contributions will continue for those under 65;

individuals with a superannuation balance of over $1.6 million will be ineligible to make further nonconcessional contributions from 1 July 2017. The eligibility threshold will be based on an individual's balance as at 30 June the previous year;

the reduction to a $25,000 concessional cap will remain in place and commence from 1 July 2017;

the concessional or tax deductible contribution cap catch-up provisions will not commence until the 2019-2020 financial year.

This information is provided by Macquarie Equities Limited ABN 41 002 574 923 AFSL 237504 and does not take into account your objectives, financial situation or needs. You should consider whether it is appropriate for you and seek separate tax advice from a registered tax agent.

Take control of your financial future

The best decisions are made when you have all the facts Macquarie financial advisers provide expert guidance and keep you informed, so you can take control of your financial future with confidence.

To access the tools, insights and expertise you need to help make important decisions contact us today.

Call Ross Noye on 0438 77 99 55 or Warren Acworth on 0410 51 50 99 macquarie.com Macquarie Private Wealth’s services are provided by Macquarie Equities Limited ABN 41 002 574 923 (MEL) participant of Australian Securities Exchange Group, Australian financial services licence No.237504, 1 Shelley St, Sydney NSW 2000. MEL is not an authorised deposit-taking institution for the purposes of the Banking Act 1959 (Cth), and MEL’s obligations do not represent deposits or other liabilities of Macquarie Bank Limited ABN 46 008 583 542. Macquarie Bank Limited does not guarantee or otherwise provide assurance in respect of the obligations of MEL. This information which does not take into account your objectives, financial situation or needs and before acting on this advice you should consider whether it is appropriate to your situation. Doctor Q Autumn 63

Celebrating 40 years Doctors’ Health Fund is now in its 40th year, with plenty of reasons to celebrate. We take a look back to its beginnings when a group of AMA doctors started the Fund, how it has remained dedicated to the medical community over the years, and why there’s never been a better time to join.

The backstory The Fund was an innovative response by AMA members to significant changes in the Australian healthcare landscape in the mid-1970s. Until then, “when doctors treated other doctors or their families, it was unthinkable for them to charge anything for a medical service,” explains the Fund’s former Chairman, Dr Paul Nisselle. The introduction of the taxpayerfunded Medibank (later renamed Medicare) triggered the practice of doctors beginning to charge colleagues the Medibank rebate for in-hospital treatment. In late 1976 the NSW Branch of the AMA incorporated its own AMA NSW Health Fund as one way of resolving embarrassment among doctors where the treating doctor’s bill exceeded the Medibank rebate. “By then, doctors providing gifts as a way of saying ‘thank you’ to their treating doctor was no longer practical,” says Dr Nisselle.

64 Doctor Q Autumn

Dr Phillip Cocks, who is credited with the initial concept for the Fund, says “it developed its own impetus,” once it was on the AMA NSW Branch’s agenda. Together with doctors Stewart Fleming, Nicholas Larkin and Laurie Pincott, Dr Cocks played a key role in designing the Fund’s products at the time to meet the particular requirements of medical practitioners and providing the high quality cover the profession would expect. Dr Steve Hambleton, a Fund member and former President of AMA Queensland and AMA nationally, notes a defining feature from the Fund’s early days was the payment of benefits up to the AMA’s list of services and fees for in-hospital treatments. This remains in place today with our flagship hospital Top Cover, “which is still an offering unmatched by any other health insurer and enables doctors to show mutual respect to their colleagues,” remarks Dr Hambleton.

vote by Fund members, Doctors’ Health Fund became part of Avant Mutual in May 2012. By the end of June that year, membership jumped by 20 per cent and the Fund now insures over 33,000 people.

An enduring ethos The “by doctors for doctors” ethos of the Fund remains strong with:

high quality benefits supporting freedom of choice, clinical independence and fair payment for medical professionals’ expertise; personalised, quality customer service with satisfaction levels rated in the latest member survey at over 95 per cent; benefits only available for clinically-evidenced treatments; and advocacy and support for the medical profession and collaboration with professional bodies.

Between the mid-1980s when the Fund was opened to AMA members nationally and in 2005, when it was renamed Doctors’ Health Fund, coverage remained under 5,000 people. To broaden membership, eligibility to join was expanded to family and staff of doctors and a new period of growth ensued.

When asked what else sets the Fund apart from other health insurers, Dr Hambleton says it is the service fundamentals: “When you call, a person answers the phone and they are friendly and know what they are talking about. When you make a claim, it is processed promptly. The simple things really matter.”

The Avant advantage

Join Doctors’ Health Fund today – the only health fund serving the medical community with health cover tailored to your needs and encapsulated by: “Dedicated to you, dedicated to the profession”.

Fast forward to 2011 when Avant Mutual, recognising the synergy between its support of the medical profession as a mutual, not-for-profit medical defence organisation and Doctors’ Health Fund as a health insurer for doctors, proposed a union. Following a resounding favourable

Doctor Q Autumn 65

UPCOMING MOVIES* 9 March

30 March

Kong: Skull Island

Ghost in the Shell

A Monster Calls

Lego Batman

16 March

6 April

Loving

A Dog’s Purpose

A Cure for Wellness 23 March Beauty and the Beast Life Boss Baby

Table 19

13 April The Fate of the Furious Denial 25 April Guardians of the Galaxy 2

*Please note upcoming films are subject to change

ROMEO ET JULIETTE

HEDDA GABLER

18 March, 1pm | 19 March, 1pm 23 March, 10am Met Opera

1 April, 1pm | 2 April, 1pm 5 April, 6pm | 6 April, 10am National Theatre Live

The electrifying team of Vittorio Grigolo and Diana Damrau reunite for a new production of Gounod’s opera based on the Shakespeare play. Damrau makes her role debut as Juliette in Bartlett Sher’s new production, conducted by Gianandrea Noseda. Elliot Madore sings Mercutio and Mikhail Petrenko sings Frere Laurent. Sher’s staging is a La Scala production, initially presented by the Salzburg Festival, where it premiered in 2008.

Just married. Bored already. Hedda longs to be free...

Win movie tickets for two! Name:

L A T R AV I ATA

Telephone:

20 May, 1pm | 21 May, 1pm 25 May, 10am Met Opera

Member no:

Fill out the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au. Entries close 1 April 2017 Portside Wharf, Remora Road, Hamilton P: (07) 3137 6000 www.dendy.com.au

66 Doctor Q Autumn

Sonya Yoncheva brings her acclaimed interpretation of the doomed courtesan Violetta Valery to Live in HD audiences for the first time, opposite rising American tenor Michael Fabiano as her lover, Alfredo. Thomas Hampson sings one of his most acclaimed Met roles as Giorgio Germont, Alfredo’s disapproving father, in a revival of Willy Decker’s staging conducted by San Francisco Opera Music Director, Nicola Luisotti.

Hedda and Tesman have just returned from their honeymoon and the relationship is already in trouble. Trapped but determined, Hedda tries to control those around her, only to see her own world unravel. Tony Award-winning director Ivo van Hove (A View from the Bridge at the Young Vic Theatre) returns to National Theatre Live screens with a modern production of Ibsen’s masterpiece.

Supporting medical students through financial hardship The AMA Queensland Foundation has a proud, longstanding scholarship program established with James Cook University (JCU) that supports medical students who are experiencing financial hardship.

The AMA Queensland Foundation congratulates Dr Phillip Adams on his graduation and wishes him every success as he embarks on his medical career.

Each year, the Foundation awards a scholarship to a second-year medical student who relies on financial assistance to continue pursuing their studies. As well as maintaining a passing grade throughout the duration of their program, recipients must demonstrate an interest in rural or indigenous medicine. In November 2016, Phillip Adams became the 10th AMA Queensland

Foundation Scholarship recipient to successfully graduate, completing a Bachelor of Medicine / Bachelor of Surgery. Dr Chris Zappala met Philip at the James Cook University graduation event in December to congratulate him on his achievement and wish him well for his future endeavours. The AMA Queensland Foundation is currently supporting six scholarship recipients at JCU with a second-year 2017 recipient to be announced shortly. We look forward to featuring some of our recipients and their inspiring stories for choosing to study medicine in upcoming editions of Doctor Q.

Double pass to 1984 by George Orwell H I T T I N G T H E LY R I C T H E AT R E I N J U N E

1984 by George Orwell A new adaptation created by Robert Icke and Duncan MacMillan 14-18 June 2017 Lyric Theatre, QPAC More information www.qpac.com.au

Published in 1949, George Orwell’s book helped define the 20th century. Now, 1984 is re-examined in this radical, award-winning international theatrical blockbuster seen by more than 400,000 people. An exploration of surveillance and identity, 1984 presented a vision of the future that looks a lot like our present. Orwell’s fiction has become our reality. Described as "masterfully constructed and chillingly frank" (Limelight Magazine), this stage adaptation is a dynamic, political, technologyenhanced dive into Orwell’s complex vision. Our friends at QPAC have a free double pass to 1984 up for grabs – email competitions@ amaq.com.au with your full name for your chance to win. First in, best dressed. Doctor Q Autumn 67

Milford Sound, New Zealand is a real location. No Photoshop.

A city for all seasons Queenstown Queenstown is the adventure capital of the world and is certainly known for its amazing skiing. But what if neither of these things interest you? What if you are looking for a something a little more low-key in the warmer months? Don’t rule out Queenstown. The first thing you notice upon arriving in Queenstown is how friendly the locals are. It starts with the customs officials smiling and welcoming you to New Zealand. The city itself is a melting pot of nationalities. Young people from all over the world converge on Queenstown looking for seasonal work. They are all excited to be there and are super keen to land and keep employment. If you are on a self-drive holiday, you will not have to drive far before noticing the breathtaking beauty. I am sure we have all had the experience of looking at images in travel brochures and online that are touched up to make the water and sky look bluer! Certainly not necessary for Queenstown! It is simply the most naturally beautiful place (outside of Australia that is). Queenstown city is very small; access to restaurants and shops is easy and within walking distance from the centrally-located hotels. Don’t forget to stop at Ferg Burger in downtown Shotover Street, which is a New Zealand institution. I know the thought of lining up to buy a hamburger is completely foreign to us but it is worth the short wait. You can order and come back to collect it.

68 Doctor Q Autumn

or email rmation call For more info and. sl en avel Que Ros at AMA Tr 5556 7200 7) 885 F: (0 P: 1300 262 aq.com.au E: travel@am m.au orldtravel.co www.amaq.w

It’s easy to get around using Queenstown as central point when you have a car. I would suggest the following day trips:

Arrowtown – Just 25 minutes from Queenstown, this quaint little historic town is a beautiful day out. Try to time it so you can stop for a nice long lunch in either direction at Amisfield Winery.

Glenorchy – A 45-minute road or boat trip from Queenstown on Lake Wakatipu. It is the gateway to many spectacular walks, with the region famously captured in The Lord of the Rings trilogy. The Dart River offers many adventure activities if you are keen to see a little of the wild side!

Wanaka – Just one hour’s drive, I would describe it as a “low-key” Queenstown. A nice sheltered bay, some great biking tracks and plenty of restaurants.

The Wine Trail – The Central Otago region and the Gibson Valley is well known for its Pinot Noir. With over 80 wineries on offer, you have plenty to choose from. There are tours on offer if you can’t nominate a driver! Many of the better wineries have their own restaurants – one to look for (book in advance) is Mt Difficulty Wines.

Walter Peak High Country – The TSS Earnslaw had her maiden voyage in 1912 providing an essential link between the isolated farming communities along the lake and the outside world. Today you can take the 1 ½ hour return cruise or stop off at the homestead and experience a lunch or dinner. You can also enjoy a scenic horse ride in the region famous for Phar Lap’s offspring.

Milford Sound – Known as one of the wettest areas on Earth with in excess of 182 rainy days a year; but this only enhances the experience. The waterfalls created by the excessive rain sets a scene worthy of a Jurassic Park movie.

While Queenstown was a little more expensive than I expected, you really can’t go past this destination for a lowkey holiday. It has something to offer everyone in any season.

Durif, "it’s like Merlot on steroids"

Durif was originally something of a Rutherglen secret, with typically brilliant wines made by Morris, Stanton and Killeen, Campbells, Fairfield and others. Of late it has quickened its stride with plantings in the Barossa, Riverland and McLaren Vale. Durif is particularly well suited to warm climates as it is droughttolerant and seems to avoid shrivel, even in extreme conditions. It retains acidity and bright fruit even when very ripe, minimising the chance of dead or indistinct fruit finding its way into the glass. Handled well, it makes massive, tannic wines with an inky core of bright fruits and a strong spine of acidity. Fruit tends to plum and blackberries. You might also find liquorice, blood plum, cinnamon and cloves. Andrew Seppelt from Murray Street likens it to Shiraz on steroids and says it is “akin to eating fountain pen ink.” I tend to agree, although I liken it to Merlot on steroids, such is the appeal on the nose. In recent times in the Riverland, 919 wines have been making Durif. The current edition, from 2013 is magnificent. Satsuma plum, morello cherries and dark chocolate wrapped up in an abundance of gloriously soft, fine tannins. Like most Durif wines, it is massive, so let it breathe or pair it with a nice woolly mammoth steak. Jenny Semmler, 919 co-winemaker, had hands on experience working with Durif before deciding to plant. Doing vintage at Fairfield winery in the Rutherglen, she immediately fell in love with it. I hear her. When I visited the now defunct Fairfield they were showing the first Durif to win a gold medal at a major wine show, their 1994. The ‘90 and ‘92 vintages were also lovely, as was their ‘89 Vintage Fortified, also made from Durif. With eight vintages of Durif now in the shed, Jenny believes that Durif will produce stunning wine nine years out of 10 in the Riverland. She feels its suitability to the Riverland’s at times scorching climate will enable 919 wines to demonstrate that the Riverland can produce standout wines of a quality normally associated with the best producers from premium regions, and hopefully encourage others in the region to follow suit. She might be onto something, as Spook Hill, Banrock Station and the Riverland Vine Improvement Committee have all recently planted Durif. I like the sound of that. Here’s hoping Durif gets even more of a leg-up and is joined by yet more cross-country cohorts.

SER PHIL MAN Wine Direct

9 463 P: 1800 64 ect.com.au ser@winedir E: phil.man

REVIEW

Allium New Farm

Dr Katherine Gridley, Principal House Officer, RBWH; and Deputy Chair, AMA Queensland Council of Doctors in Training

Fine dining no longer requires a five-star price tag, thanks to the opening of Allium in New Farm. The masterpiece of chef James Gallagher and wife Kylie from The Sofitel’s French restaurant Prive 249, Allium embodies the concept that fine dining should not be reserved for special occasions, with elite cuisine served at bistro prices. Allium is open for dinner and Sunday lunch, with their a la carte menu best described as modern Australian, with a contemporary makeover of classic dishes. Entrees include the likes of venison tartare with watermelon, roasted quail with caramelised cauliflower, and buffalo mozzarella with bloody mary granita. The crowd favourite however is a lightly cured kingfish with green apple sorbet, crunchy cucumber and green apple pieces. An explosion on the palate with tangy freshness, it is a must-try dish and one that is almost too pretty to eat. Allium’s main meals feature corn-fed chicken breast with charred leeks, lamb loin with confit potato and market fish with black olive. The standout is black onyx petit tender with miso eggplant and black garlic, punctuated with textures of onion amongst a medium rare steak dressed with a delightfully thick sweet glaze. If you have enough room in your stomach for dessert, the sweets section is equally as creative. Chocolate creameux fudge brownie, passionfruit cheesecake, parfait and an Australian cheese platter are on offer to conclude a particularly delicious evening. The centrepiece of a visit to Allium is their tasting menu. Substantially less expensive than their CBD venue counterparts, a six-course degustation will set you back a mere $85, without compromising on quality, variety or exceptional service. Matched wines are an additional $50 and their abbreviated degustation known as ‘The Shortlist’ is also available for $55 on Wednesday nights. Allium’s current tasting menu is selected from their a la carte offerings and must be approached with an intrigued palate, empty stomach and stretchy dinner attire. A meal at Allium is an essential experience for the adventurous and inspired foodies amongst us. Allium is located at 148 Merthyr Road, New Farm and is open Wednesday to Sunday nights from 6pm and Sunday lunch between 12pm – 2.30pm. 70 Doctor Q Autumn

REVIEW

Yo - Yoga New Farm Ever wanted to down dog to Drake? Backbend to BeyoncĂŠ? Warrior II to the Wu Tang Clan? Well now you can, with the latest trend in vinyasa yoga set to the sounds of popular RnB music. Yo-Yoga in New Farm is not your average yoga studio. While the serene atmosphere and pleasantly welcoming yogis may seem familiar, you will soon find their chosen soundtrack is not. Vinyasa or flow yoga incorporates elements of strength, posture, flexibility and dynamic movement, which forms the unexpected yet perfect choreography for contemporary RnB music. While keeping in the yoga style rather than a dance class, the flow sequences are not choreographed in time to the music but instead styled to a similar tempo, making the class easy to follow and far less daunting for those without any dance or yoga experience. There is still an opportunity for savasana at the end of it all to help you catch your breath!

Yo-Yoga is a fun and upbeat way to exercise as well as practice mindfulness, an invaluable tool for busy medical professionals and stressed individuals alike. By donning some comfy pants and stretching to some soulful tunes, we can temporarily tune out from the anxieties of our everyday lives and focus on the here and now, perhaps returning refreshed with more of a spring (or twerk) in our step. Yo-Yoga is located at 5 Lamington Street, New Farm and offers a variety of classes from 6am to 6.30pm, 7 days a week. See www.yoyoga.com.au for more details.

Classes vary from hip-hop style to candlelight and slower stretchbased activities, to others based more on building strength. There is a style and class to suit every level, from complete novice to seasoned practitioner, as well as every level of confidence in between.

Doctor Q Autumn 71

BEEF SOBA NOODLE BOWL

All about you

270g soba noodles 1/4 cup (60ml) oyster sauce 2 tablespoons soy sauce 2 tablespoons mirin 3 teaspoons peanut oil 600g Coles Australian beef rump steak, thickly sliced 2 spring onions, thinly sliced 1 large carrot, peeled, cut into matchsticks 200g Swiss brown mushrooms, sliced 2 garlic cloves, crushed

WALKING THE DOG

1 bunch buk choy, trimmed, coarsely chopped

If you regularly forget your daily exercise, your dog can help you remember. Dog-walking is a great way to get out of the house, as you’re never alone with a pooch by your side. Choose a route with some hills and some great scenery and you’ll find exercise that you can look forward to – you might even meet your neighbours. If you don’t have time for a pet, befriend a neighbour and see if you can walk their dog!

Sesame seeds, toasted, to serve Prepare soba noodles following packet directions. Refresh under cold running water. Drain well. Meanwhile, combine oyster sauce, soy sauce and mirin in a small jug. Set aside. Heat 1 teaspoon of the oil in a wok over medium-high heat. Stir-fry beef in batches for 2 mins or until browned. Transfer to a plate. Heat remaining oil in the wok. Stir-fry spring onion, carrot and mushroom for 3 mins. Add garlic and buk choy. Stir-fry for 1 min. Return beef to the wok with oyster sauce mixture and noodles. Stir fry for 2 mins. Divide among serving bowls and sprinkle with sesame seeds.

VIKINGS Not for the faint-hearted, Vikings follows the story of Ragnar Lothbrok, one of the bestknown legendary Norse heroes and notorious as the scourge of England and France. The show portrays Ragnar as a farmer who rises to fame by successful raids into England, and eventually becomes a Scandinavian king, with the support of his family and fellow warriors. Watch on Netflix or buy the series at the SBS Shop.

GOOD ME, BAD ME

MELANOMA MARCH

Annie’s mother is a serial killer. The only way Annie can make her stop is to hand her in to the police. But out of sight is not out of mind. The secrets of her past won’t let her sleep, even with a new family and name. Blood is thicker than water . . . she is, after all, her mother’s daughter.

Melanoma March Brisbane is a fun community event where participants unite together and walk along a short course to raise awareness and funds for lifesaving research. It is an exciting day for the whole family - there will be entertainment, food, drinks and lots more. To register, or for more information, please visit www.melanomamarch.org.au.

Ali Land

72 Doctor Q Autumn

RCH JOIN THE MA MA TO END MELANO Help change the future of thousands of Australians diagnosed with melanoma each year by participating in Melanoma March 2017. Join a Melanoma March in 17 locations

Move for Melanoma by setting your own challenge to get moving in March.

Melanoma March is your chance to: Remember those lost to melanoma Support our dedicated researchers Inspire all Australians to help end melanoma

TO REGISTER, DONATE OR TO FIND OUT MORE, VISIT

MELANOMAMARCH.ORG.AU FACEBOOK.COM/MELANOMAMARCH

An initiative of

Supporting

It’s tough on the frontline

Dr Matt Young, General Practitioner, Inala Medical Centre

Summer in Australia, means only one thing. Playing it, watching it, talking it, living and breathing it. Of course that thing is cricket, because “cricket is the number one game in town”. It’s our national sport. Our unifying religion. It’s our identity on the world stage and it dictates our self- esteem just as the All Blacks do for New Zealand. The grand game has obsessed me since I was a nipper and I’ve been incredibly lucky to have played all round the world with my club. As time goes by and reflexes, joints and muscles start betraying me, I’ve had to adopt a more cerebral approach to my greatest passion. There are so many intellectual, psychological and even poetic facets to cricket and it is these infinite nuances that keep me captivated. One of my favourite past times is to create cricket metaphors for life because cricket really is life’s greatest metaphor. Recently, I thought about how unjust it is as a batsman (I have always been an opening bat) that just one mistake sees you undone. Bowlers can get away with a loose ball. It might get belted for six, but they still bowl their next delivery. Sometimes, luck jags them a wicket with a long hop or a full toss. Batsmen, however, live and die on every ball. It struck me that as doctors we are much like batsman. We live and die and more specifically trade, on our reputations. One slur can crucify your practice. Just one complaint from a patient, one unfortunate complication, one lapse in judgement, one tragic missed diagnosis and all of a sudden the house of cards of your medical reputation can tumble down. Sometimes you don’t even have to make a mistake. Vexatious patients can sling mud on the public stage and hope that some skerrick sticks. Just like a dodgy umpire’s call. Your career is under siege, your income jeopardised and your whole sense of self can unravel. Just like a run of low scores wreaks havoc with your batting and can see you out of the team.

Equally, sometimes you can be lucky. An opening batsman might play and miss a few or snick one through slips for four or survive a tight LBW decision. Sometimes as a doctor your mistakes don’t have terrible ramifications. Sometimes patients survive because of you and sometimes, despite. I thought about how unfair it was as a doctor, to have a whole career of outstanding medical and altruistic work outweighed by a single incident. I also thought about the tremendous impact issues like patient complaints and law suits make on the hearts and souls of individuals within our profession. The dramatic impact on mood and anxiety levels. The cascading impacts on families and friends. I thought about the horrendous rates of suicide and mental illness that our profession suffers and on how much of this is attributable to unreasonable expectations of excellence. It’s a tough gig being an opening batsman facing an aggro fast bowler with a new Kookaburra in his hand, but it is an even tougher gig being a doctor in a world where honest, well-meaning mistakes are not tolerated and compensation is expected. And just as every batsman must accept that almost every innings he plays will end in his demise, I also thought about the inevitability of having complaints and legal proceedings in medical life. The only ideas I had on how to cope with this inevitability were based on cricket. Firstly, just because you get the odd duck, doesn’t make you a lousy batsman. One duck doesn’t erase all the centuries you’ve scored over a career. The odd complaint in medical life is almost to be expected but doesn’t undo all the good deeds a doctor has done. Secondly, the harder you train in the cricket nets, the better the odds of success. So I suppose keeping up to date with new medical developments is paramount. And lastly, even when you get out, it’s essential to join your team mates for some laughs over a few cold ones. Getting together for debriefing with your medical mates is a great coping mechanism too when times are tough. Doctor Q Autumn 73

INPRINT

Murtagh’s Patient Education

Courtesy of our friends at McGraw Hill Education, we have one edition of Murtagh’s Patient Education to giveaway

First published in 1992 and now in its seventh edition, Murtagh’s Patient Education is the proven international standard for patient education material. This tried-and-tested resource provides GPs, general practice nurses, registrars and pharmacists with accurate, accessible information to distribute to patients. Written in simple, non-technical language, information on each condition is presented in a concise, friendly, single-page format so it can be easily photocopied or printed and distributed to patients to help them understand and manage their medical condition.

Win this book Fill out this form and email to

Among the 22 new topics in this latest edition are:

Telephone:

The Australian National Immunisation Program Schedule;

Ovarian cancer; Dengue fever; and Advanced care planning.

For further information, please visit: http://www.mheducation.com.au/murtagh-s-patient-education-7e

DENDY WINNERS Dr Roxanne Kempster Dr James Macdonald Dr Fred Leditschke

Dr Ken Bowes Dr Caron Forde Dr Alison Harris Dr Barry Hickey Dr Marjorie Busby

Dr Nigel Dore Dr Michael Clem

competitions@amaq.com.au. Name:

Member no:

Entries close 1 April 2017

BOOK WINNER Dr Rodney Morris won a copy of Listening, Learningm Caring and Counselling by Dr Kate Howell thanks to McGraw-Hill Education.

Don’t forget to enter in this Doctor Q edition to win.

2016 Christmas Appeal The AMA Queensland Foundation sincerely thanks our wonderful donors who generously donated to the 2016 Christmas Appeal. Thanks to your support, we can continue helping Queensland patients in need and support more medical students to complete their studies. Donations to the AMA Queensland Foundation can be made at any time via www. amaqfoundation.com.au/donate or by calling the Foundation office on (07) 3872 2222 during normal office hours.

74 Doctor Q Autumn

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