Doctor Q November 2012 edition

NOVEMBER 2012 . VOL 81

AMA Queensland Membership Magazine

REFUGEE HEALTH DEEPEST AFRICA: EXTREME VOLUNTOURISM REAL LIFE FAIRY TALE – LI CUNXIN’S STORY FREE TO AMA QUEENSLAND MEMBERS

ONE-OFF LIFE INSURANCE MEMBER DEAL DoctorQ NOVEMBER 2012

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Addiction Medicine Specialist and President – Elect, AMA Qld 2013-2014

• Existing members may join as part of the 2013 member renewal by 31 March 2013 • New members may opt in when joining AMA Queensland prior to 31 March 2013 (without medicals or forms) by visiting www.amaq.com.au The AMA Queensland Members Life Insurance Scheme is supported by Suncorp who have a great reputation in providing quality insurance. The Scheme includes “own occupation” cover which means Members may receive a benefit if unable to work due to illness or injury as a medical practitioner but may be capable of performing some other work. Joining is easy with no additional application forms or medicals, so act now to take advantage of this offer. For example, a 40 year old female pays $177.59 per year which is only $14.80 per month, representing a great saving compared to the retail insurance rate of $31.29 per month.

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NOVEMBER 2012 DoctorQ

Annual Premium Rates EXCLUSIVELY FOR MEMBERS OF AMA QUEENSLAND AGE BASED PREMIUM FOR $250,000 INSURED BENEFIT

What is the exclusive AMA Queensland Members Life Insurance Scheme?

Compare our rates: Yearly Premium: Male Age

The scheme allows the Association to act collectively to obtain Life and Total Disability Insurance for members, providing: • Superior terms and conditions - eg, $250,000 cover in the event of death or total permanent disablement • Significantly reduced premiums • No questions asked, no application forms - just accept as part of your AMA Queensland membership renewal form or first time member application form • A once only opportunity to join the scheme

Age

Death and TPD AMA Male

Female

$143.71

$39.50

23

$141.98

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24

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22

Age

AMA Queensland group policy

Suncorp, nonsmoker retail policy

AMA Queensland group policy

Suncorp, nonsmoker retail policy

25

$135.11

$406.69

$42.54

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30

$122.14

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35

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40

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60

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Death and TPD AMA Male

Female

$197.89

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39

$218.03

40

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38

Yearly Premium: Female

Age

Death and TPD AMA Male

Female

54

$954.24

$741.35

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55

$1,056.42

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$177.59

56

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25

$135.11

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41

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57

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26

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42

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58

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27

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43

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59

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28

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44

$329.87

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60

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$1,392.40

29

$119.04

$57.73

45

$364.33

$308.54

61

$2,264.21

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30

$122.14

$63.81

46

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62

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31

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47

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63

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32

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48

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64

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33

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$85.07

49

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65

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34

$146.39

$94.19

50

$600.98

$504.36

66

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35

$160.42

$104.52

51

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67

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36

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52

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68

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37

$184.12

$131.50

53

$841.40

$668.43

69

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TPD definitions - exclusive for our members Our TPD cover applies an ‘own occupation’ definition: • This means if a member is unable to continue work as a medical practitioner, the insurer will pay a benefit even though the Member may be capable of performing some other work.

• The ‘own occupation’ definition is available for Members working as few as 10 hours a week.

DoctorQ NOVEMBER 2012

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CONTENTS

THIS ISSUE REFUGEE HEALTH

THE LOSS OF REFUGEE HEALTH QUEENSLAND PLACES MORE PRESSURE ON QUEENSLAND DOCTORS TO KNOW HOW TO APPROPRIATELY CARE FOR REFUGEES IN OUR COMMUNITY...

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FEATURE STORies 10 LI’S LEAP OF FAITH 32 EXTREME VOLUNTOURISM

business tools

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34 STAY CALM AND CARRY ON: IT’S GOOD PRACTICE 37 BE PREPARED: WHAT HAPPENS AT THE WORK PARTY, STAYS ON YOUTUBE

REGULARS 6

FROM THE EDITOR’S DESK

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LETTERS TO THE EDITOR

8

PRESIDENT’S REPORT

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CEO’S REPORT

38 TAX 101 FOR MEDICOS 41 WHAT MANAGEMENT BUYS 42 HOME OWNERSHIP: THE REAL COSTS

13 NEWS

Member news 45 OBITUARY 46 2013 MEMBERSHIP RENEWALS

The federal government recently committed to increase Australia’s intake of humanitarian entrants from 13,750 to 20,000 per year.

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48 DOCTOR WHO? MEMBER PROFILE

people & events 50 AMA QUEENSLAND STATE CONFERENCE WRAP-UP!

Current issues 22 TGA ADDS MIFEPRISTONE TO PREGNANCY MIX 23 THE LEADERSHIP PARADOX

52 ES MEYERS LECTURE

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56 ‘CONNECT WITH YOUR CAREER’ WORKSHOPS

27 THE QUESTION OF FOREIGN INVESTMENT IN AUSTRALIAN AGRICULTURE

31 TIS THE SEASON TO RING-A-DING-DING

53 ESSENTIAL WOMEN’S BUSINESS 54 AAPM CONFERENCE T

24 MEDICINE: NO LONGER A SAFE CAREER CHOICE

28 WHEN IS ‘THE END’ THE END?

47 SMARTPHONE APPS CONNECTING MORE DOCTORS WITH PATIENTS

Life

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59 WINE

64 MOVIES

61 INVESTING

65 ON STAGE

62 TRAVEL

66 IN PRINT

63 MOTORING

DoctorQ NOVEMBER 2012

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editor’s desk

SIX DEGREES OF SEPARATION HEATHER GRANT Doctor Q Editor Pulling together this edition of Doctor Q brought home just how the six degrees of separation theory actually works: how we are, on average, just six steps away, by introduction, from any other person in the world.

It started when chatting to urogynaecologist Dr Judith Goh about her volunteer work in Africa. That led to another chat—or should I say referral, to use medical vernacular?—and then another. The result was our inspiring feature on medical voluntourism (p 32).

Discussions of Africa had naturally turned to the strife many of those countries are in, and the numbers of people displaced. That piqued my interest in AMA’s position on refugee health (p18). About the same time, Australia’s UNHCR representative was in Brisbane for a breakfast.

Meanwhile, I’d heard that a phone service was silent, possibly because colleagues shied away from admitting their own problems for fear of being ‘dobbed in’ to authorities (p31). Dr

Margaret Kay is a passionate advocate for doctors’ health needs: and refugee health needs too it turned out.

And so the referrals continued: the UNHCR, AusAID and the Multicultural Development Association, among them.

During those discussions, I learnt a good deal about refugees and asylum seekers—and that the words are not truly interchangeable.

And then coincidentally I found myself face-to-face with one of the most famous asylum seekers in Australia: Li Cunxin, Queensland Ballet’s new artistic director. If you thought you knew it all having read Mao’s Last Dancer, think again. His story on page 10.

With all this talk and thought of places far away, holidays then came to mind.

Hence a sprinkling of articles with a festive flavour are here too.

A question lingered: where did 2012 go?

For me, this final edition of the year brings to a close my time with AMA Queensland. It has been a privilege to produce the past four editions.

Enjoy this bumper edition of Doctor Q. Adieu, happy holidays and take care. Q

READER SURVEY Doctor Q is your magazine: have a say in the stories brought to you. Go online to www. surveymonkey.com/s/DrQ, complete our short reader survey and you could win a grab bag of summer reading including Mao’s Last Dancer, Travelling Well and The Good Doctor:What Patients Want. Survey closes 20 December 2012. Q

OFFICE CLOSURE

AMA Queensland’s office will be closed from 20 December 2012 to 2 January 2013.

Michelle Ford-Russ returns from maternity leave mid-January 2013, in time for the March edition of Doctor Q

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

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NOVEMBER 2012 DoctorQ

BOARD OF DIRECTORS Dr Alex Markwell President

Dr Sharmila Biswas Honorary Secretary

Dr Christian Rowan President-Elect

Dr David Alcorn Elected Member

Dr Sharon Kelly Chairperson

Dr John Cox Elected Member

Dr Chris Zappala Treasurer and Specialist Craft Group

Dr Richard Kidd Elected Member

COUNCIL Dr David Alcorn Greater Brisbane Area

Dr Bav Manohoran Greater Bribane Area

Dr Tom Arthur Gold Coast Area

Dr Deborah Mills Part-Time Medical Practitioner Craft Group

Dr Sharmila Biswas Far North Area Dr Kimberley Bondeson Greater Brisbane Area

Dr Stephen Morrison Specialist Craft Group

Dr John W Cox Downs and West Area

Dr John F. Murray Full -Time Salaried Medical Practitioner Craft Group

Dr Ben Duke Greater Brisbane Area

Dr Carl O’Kane North Area

Dr Larry Gahan General Practitioner Craft Group

Dr Shaun Rudd General Practitioner Craft Group

Dr Noel Hayman Greater Brisbane Area

Dr Anil Sharma Capricorn Area

Dr Sharon Kelly Specialist Craft Group

Dr Jonathon Shirley Greater Brisbane Area

Dr Richard Kidd Immediate Past President

Dr Mason Stevenson General Practitioner Craft Group

Mr Nicholas Gattas Medical Student Group

Dr Jen Williams Residents and Registrars Craft Group

Dr Wayne Herdy North Coast Area

AMA QUEENSLAND SECRETARIAT Jane Schmitt Chief Executive Officer Filomena Ferlan General Manager Corporate Services Colleen Harper Manager - AMA Queensland Foundation

Holly Bretherton General Manager Member Relations and Communications Andrew Turner Manager - Member Services

Editor: Heather Grant Graphic Designer: Erin Sticklen Journalist: Barbara Ferres Advertising: Louise Glynn Doctor Q is published by AMA Queensland Contact Phone: (07) 3872 2222 Postal Address: PO Box 123, Red Hill QLD 4059 Print Post Approved PP490927/00049 Email: amaq@amaq.com.au Cover photo: Heather Pillans / AusAID

LETTERS TO THE EDITOR

WAKE UP CALL FOR AUSTRALIAN MEDICINE Those who attended the AMA Queensland conference in Madrid were faced with the reality of a system of government called Ineptocracy: a culture of debt-funded welfare entitlements.

In Madrid we saw thousands of rioters outside our hotel, protesting the Spanish Budget’s nine per cent fiscal reductions across all ministries, including health (and equating to a 40 per cent loss of services). These protestors faced off armed police with body armour, horses, dogs and tear gas.

Meanwhile in the rest of Europe, the French Budget introduced death duties on all assets, a top tax rate of 75 per cent and capital gains added onto income for taxation, all in an attempt to tax assets for welfare entitlements, while Greece, Italy, Ireland and the UK find themselves unable to fund welfare out of taxation and some, as we know, are seeking bailouts to fund their national debt.

Australia, lulled into a false sense of security by our land’s natural riches, needs to wake up. Our unemployment figures are misleading: they do not account for those under-employed (only working a couple of hours a week but capable of more) and they do not account for the extra 30,000 baby boomers annually retiring.

“Australia, lulled into a false sense of security by our land’s natural riches, needs to wake up.”

Along with realising wage increases and job security cannot be sustained without significant productivity improvements, and that there’s no money tree growing in any treasury office, it’s time to get serious with how public funds are doled out. I recommend the first task is placing guidelines for prioritising medical resources, considering the value back to the community from the medical service offered.

I’m prepared to be howled down but ask members to consider the burden our children will carry if we continue to borrow for the future to fund politicians’ popularity and support the growth of Ineptocracy.

DR JOHN W COX PAEDIATRICIAN AMA COUNCIL MEMBER, TOOWOOMBA

DoctorQ NOVEMBER 2012

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PRESIDENT’S REPORT

SMOKE AND MIRRORS NO MAGIC POTION—NO ‘HEY PRESTO’—CAN FIX QUEENSLAND’S HEALTH WORKFORCE AILMENTS BUT A BETTER BEDSIDE MANNER CAN CERTAINLY BE EXPECTED.

ALEX MARKWELL President, AMA Queensland The 12th annual AMA Queensland conference, held in Madrid, revealed some rather scary commonalities between Spain and Queensland. Given their well-published financial pressures, the Spanish are facing significant challenges with their health system: rising obesity rates, restricted access to health care, and increasing drive for efficiency.

And so it has been in the government precinct of Brisbane with frenetic activity particularly around Charlotte and George streets, creating a complex and evolving magical act of budget juggling, deficit-recovery fire displays, redundancy smoke and mirrors and impressive FTE disappearing acts.

Members, non-members (who soon became members) and other health professionals have turned to AMA Queensland, concerned about the slashed services and their impact on patient care.

Fearing the likely demise of public health services, including health promotion and population health, AMA Queensland joined forces with Public Health Association Australia (PHAA), Australian Health Promotion Association (AHPA), academics from interstate and Queensland, and local public health physicians. Professor Mike Daube’s recent address at the Health Media Club was highly critical of the government’s short-term approach to preventative health, setting the scene for what was to come. A joint media release and subsequent media interest helped raise awareness of the importance of preventative health and health promotion; unfortunately to no avail.

The Queensland Health corporate office’s compassionless restructure announcement brought with it 2,754 FTE redundancies, confusion, fear and uncertainty. Pathology services, tuberculosis control, health promotion, preventative and public health were major casualties. Budget day did nothing to allay fears or clarify

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NOVEMBER 2012 DoctorQ

the situation. Even greater redundancy numbers were attributed to Queensland Health, but without detail of likely targets.

Some fancy footwork from the Premier, Treasurer and Health Minister attempted to reassure punters this did not mean more job cuts. But as Doctor Q goes to press, weeks after those announcements, many working for these frontline Queensland Health agencies are none-the-wiser about their ultimate fate.

Privatisation, Public-Private-Partnerships and Efficiency were the themes of the 2012 Health Budget. On the surface, this appeared somewhat logical. No-one would ever accuse Queensland Health of being lean and mean. But how do said planned efficiency models accommodate teaching, training and research to the level required?

Private administration of the new Sunshine Coast University Hospital was announced in the media prior to consultation with local clinicians who had worked closely with the local hospital management to develop a vision and future for the area’s tertiary healthcare delivery. These clinicians

While the countdown to 2013 nears, the issues of 2012 won’t just vanish.

were rightly devastated to hear what was proposed, seemingly sans clinician or Board involvement.

Meanwhile 180 medical graduates—all international full-fee paying students who had applied to work in the health system in which they were trained—remain without internships for 2013. Workforce modelling

by Health Workforce Australia suggests we need every one of our medical graduates.

While the AMA has argued their right to access internships, negotiations continue with proposals including federal funding of private placements contingent on states picking up the remainder (and the tab). Meantime, the ethical debate about medical student numbers rages.

Resident medical officer positions are also under pressure. Doctors-in-training will need to consider all their options, including regional and rural facilities. Small communities may rejoice at the increased medical workforce filtering through the state to needy areas but this could be short-lived if junior doctors move interstate or overseas to chase training opportunities.

While the countdown to 2013 nears, the issues of 2012 won’t just vanish. We won’t wake from a bad dream. But I can guarantee AMA Queensland’s resolve to welcome our graduating students into our profession and continue to help doctors help patients.

Have a happy and safe holiday season. Q

ceo’S REPORT

AMA QUEENSLAND’S ABUNDANCE OF OPPORTUNITIES AMA QUEENSLAND IS MORE THAN THE AUTHORITATIVE VOICE OF THE MEDICAL PROFESSION, HEARD BY GOVERNMENT POLICY MAKERS AND COMMUNITY. WE’RE AN ORGANISATION OF OPPORTUNITY DESIGNED TO SUPPORT MEMBERS THROUGH ALL STAGES OF THE CAREER...

JANE SCHMITT Chief Executive Officer, AMA Queensland After 12 months negotiation, I am delighted to present the AMA Queensland Members Insurance Scheme. This product will be available to members from 1 January 2013. AMA Queensland has seen first-hand the effect of inadequate life insurance when members have become either totally and permanent disabled or died. The situation for the family worsens when it takes months for the insurer to pay out the policy. Needless to say, the additional stress of financial pressure at a time of grieving or while trying to focus on recovery is one no one wants.

With this in mind, AMA Queensland is introducing an insurance product for you with: Life and Total Permanent Disability cover of $250,000 no medicals or forms (a one-off opportunity for renewing members or new members joining before 31 March 2013) no exclusions for pre-existing conditions “total and permanent disability” definition is “own occupation”, meaning that if you can’t work as a medical practitioner, despite being able to do other forms of work, you still get paid out under this policy fast payment of claims (because there are no medicals, there is no claim processing required) low premiums—about 50 per cent less than on the retail market.

You will be included in the scheme unless you opt-out via your 2013 renewal notice.

We strongly encourage you to take up this new member benefit. More details are provided on pages 2, 3 and 46.

EXPANDING FIND A DOCTOR APP In addition to including our AMA Queensland GP members, our Find a Doctor Smartphone app now includes

members registered in the Specialist category. The app allows patients to locate a doctor in their area of choice and browse the interactive map for directions to the doctor’s address.

Read about this expanded service and how it can help your business —as well as our integration with Australia’s leading online appointment booking system, Clinic Connect on page 47.

CONFERENCE WRAP This year’s AMA Queensland annual conference was simply magnífico!

More than 180 delegates attended—one of our largest delegations to date, drawing a broad range of medical practitioners, accompanied by partners and families.

It was an interesting time to be in Spain: its economy is in turmoil with unemployment rates hitting 25 per cent, rates not seen in Spain since 1995. Like Greece, this is expected to rise. Some 25,000 protesters rallied against the austerity measures in the presence of 1,300 riot police outside our conference accommodation. With rubber

bullets being fired in an attempt to quell the enthusiasm of the protesters, it was hard not to acknowledge how removed we are in Australia from the stark economic reality in Spain today—the fallout of what we refer to as the GFC. The conference program feedback was extremely positive, confirming the strength of the conference program, its relevance to our members and its collegiate atmosphere. The kids’ club program was a lot of fun (as my two sons can attest) and gave delegates an opportunity to really focus on the conference while their children enjoyed their own Spanish experience.

Next year, we’re off to Santiago, Chile, where our state conference will focus on ‘Health worldwide—challenges and future directions’. I encourage members to consider making the trip. Details will be in the March 2013 edition of Doctor Q. As we head towards the year’s end, I wish you and your families a safe and relaxing festive season and look forward to working with you again in 2013. Q

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Feature story

It can be a brutal transition to shift from dance to something else.

To be the best in ballet, as in medicine, is all-consuming.

Li’s

LEAP OF FAITH

MAO’S LAST DANCER LI CUNXIN WHOSE OWN LIFE BEARS ALL THE HALLMARKS OF A FAIRY TALE HAS CHOSEN CINDERELLA TO INTRODUCE HIS ARTISTIC DIRECTION TO DANCE LOVERS OF QUEENSLAND BALLET. HE TELLS DOCTOR Q EDITOR HEATHER GRANT HOW HE IS LIVING OUT HIS ‘HAPPILY EVER AFTER’.

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DoctorQ NOVEMBER 2012

Feature story

Q: Welcome to Queensland! Did your wife (former dancer Mary McKendry) influence your decision to move from Melbourne, given her Rockhampton roots?

Actually that had a lot to do with it! Over the years, we’ve been frequent visitors to Queensland and family is in Brisbane. While our two eldest children (Sophie 23 and Tom 20) are no longer at home, we are not emptynesters yet: we still have Bridie who is 14, living with us.

Q: You retired from professional dancing in 1999 to pursue a career in stockbroking. Why that and then?

It can be a brutal transition to shift from dance to something else.

To be the best in ballet, as in medicine, is all-consuming. I began my studies in accounting and financial services some years before retiring from dance and in 1997 began studies with the Australian Securities Institute by correspondence. Stockbroking was my way of providing financially for my family and I had to be the breadwinner.

I did not want my family to live poorly, as I had in China —although poverty here and there are worlds apart— and I was committed to continuing to help my family financially in China.

I left the stage but my heart was always connected to the dance world. I stayed involved through roles such as being on the board of the Australian Ballet, and continued to dance for fitness. There is nothing like an hour at the barre for a total aerobic workout, using every muscle, and to the enjoyment of music.

Q: Your business acumen must be a real bonus for a ballet company.

I’m not kidding myself that just because I came from the money market, money will follow me. There’s a credibility issue. There will be those sitting back waiting to see what I can deliver.

Q: And what do you want to deliver? You have an initial fouryear contract with Queensland Ballet.

I know I can take the Queensland Ballet to another level—to be one of the best global dance companies—but it will take a little more than four years! Quality is the signature of my productions. I will look at the best in the world and seek to meet—or exceed—that. I want more dancers too. But that won’t happen overnight.

Q: You said the changeover from dance to another career could be brutal. But surely dance is brutal too?

am thankful to the doctors I have come to know who’ve kept me in one piece. Doctors and dancers are a lot alike: to be the best requires single minded determination and practise, practise, practise.

Q: All of which makes a dancer’s life quite shortlived?

I believe the golden years are between 28 and 35 when life experience brings out the best in a performance, not just technically and artistically.

Q: You first visited the United States as an exchange student in 1979. At that time, your experience of doctors was quite limited, I gather.

My first need for medical treatment was as a 15-day-old baby when I sustained a very bad burn to my elbow. My family was too poor for medical treatment: we relied on Chinese medicinal herbs to heal it.

Chairman Mao introduced ‘barefoot doctors’ into provinces in the mid 1960s who were basically peasants selected for intensive three to six month basic health care and who still worked in the fields. I still remember my smallpox shot!

Q: You describe yourself as single minded. Is there one example that stands out?

Oh yes: not taking ‘no’ for an answer when I sought a visa to return to the United States after my first trip. Maybe I was naïve but I felt I had nothing to lose but to stalk the government minister responsible. After night upon night of waiting out in the cold for him, I was physically and emotionally exhausted. And then as fate would have it, he went off on a mission and the sign-off was secured by his five deputies in his absence.

(History records Li Cunxin did not return. His dramatic defection lead to a 16-year career with Houston Ballet, followed by four years as a principal dancer with Australian Ballet. Li was able to return to China to visit his parents a decade after his defection.)

Q: Have you ever reflected on what would have happed if Teacher Song had not pushed you forward in your classroom as a potential candidate for the delegates from Madame Mao’s Academy of Ballet to consider?

Absolutely! I would still be a peasant; maybe if I had been very lucky, a truck driver. My childhood friends are still there. But for some reason, there was a different destiny for me. Q

(Laughs) Yes, we do torture our bodies. Knees, ankles, hips, shoulders, back—you name it—they are stressed to the limit and I

WHAT THE 2013 SEASON HOLDS...

Photographs by Christian Aas

Li Cunxin has put together a mix of timeless cherished classics and vibrant new works on the big stage, sprinkled with intimate excerpts performed in studio, encouraging insight, discussion and support of emerging choreographers.

Dance Dialogue – Summer

7 - 16 February Thomas Dixon Centre

Elegence

(Erhter Vals, Three Preludes, Verdi Variations and a new work by Brisbane –based dancer/ choreographer Gareth Belling)

Cinderella

5-20 April QPAC Playhouse

Dance Dialogue – Spring

Giselle

21 June - 6 July QPAC Playhouse

The Nutcracker

Giselle will tour regional Queenland: Toowoomba, Caloundra, Maryborough, Gladstone, Rockhampton and Mackay.

2 - 4 August QPAC Playhouse

29 Aug - 7 Sept Thomas Dixon Centre 6 - 21 December QPAC Playhouse

DoctorQ 2012 DoctorQNOVEMBER NOVEMBER 2012

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INTRODUCING AMA QUEENSLAND MEMBERS LIFE INSURANCE SCHEME

Dear Member, Collectively, we are proud to support the launch of the AMA Queensland Members Life Insurance Scheme, providing AMA Queensland Members with $250,000 of Life and Total Permanent Disability cover, proudly underwritten by Suncorp.

AMA Queensland has done the leg-work to provide you with exceptional low-cost cover, with no forms or medicals required and no exclusions for pre-existing conditions - this exclusive offer is only available for renewing members or new members who join before close of business, 31 March 2013.

Whether you are just starting out in your career and have no life insurance in place, or are further down the track and are considering top-up insurance for peace of mind, it’s simple – your premium is included on your renewal notice for hasslefree cover.

For further information see the advertisement and premium rates table on page 2 and 3, and you can call 1800 623 349 for further information about the offer.

Endorsed by:

Jane Schmitt

Dr Sharmila Biswas

Dr Gino Pecoraro

Dr Alex Markwell

Dr John Cox

Dr Anil Sharma

Chief Executive Officer AMA Queensland, Brisbane

Emergency Physician, Royal Brisbane and Women’s Hospital, AMA Queensland President, 2012-2013, Brisbane

Dr Christian Rowan

Addiction Medicine Physician, PresidentElect AMA Queensland 2013-2014, Brisbane

Dr David Alcorn

Executive Director, Royal Brisbane and Women’s Hospital, Forensic & Occupational Psychiatrist; Board member, AMA Queensland, Brisbane

GP, Mount Sheridan Medical Practice, Honorary Secretary and Board member, AMA Queensland, Cairns

Pediatrician, Board member AMA Queensland, Toowoomba

Dr Vanessa Grayson

Junior House Officer, Caboolture Hospital and Chair, AMA Queensland Council of Doctors-in-Training, Brisbane North

Dr Sharon Kelly

Ear, Nose and Throat Specialist, Chair of the Board, AMA Queensland, Spring Hill

Dr Richard Kidd

GP, Immediate Past President AMA Queensland 2011-2012, Brisbane North This letter of support does not constitute financial advice. AMA Queensland recommends that you consult with your financial advisor if you have any questions about your financial needs and requirements and whether the AMA Queensland Members Life Insurance suits those requirements.

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NOVEMBER 2012 DoctorQ

Gynecologist, Obstetrician, Past President AMA Queensland 2010-2011, Spring Hill

Ophthalmologist, AMA Queensland Council representative, Local Medical Association President, Rockhampton

Dr Mason Stevenson

GP, Past President AMA Queensland 2009 – 2010, Sunshine Coast

Dr Chris Zappala

Thoracic Physician, The Wesley Hospital, Treasurer and Board member, AMA Queensland, Auchenflower

news

FROM RESEARCH TO RECIPIENTS

WELCOME TO MERF, THE FIRST FACILITY IN QUEENSLAND SUPPORTING THE FULL CYCLE OF RESEARCH VALIDATION, COMMERCIALISATION AND TRAINING OF NEW MEDICAL DEVICES AND TECHNIQUES.

In a Brisbane operating suite, a handful of surgeons stand at six stations, all concentrating on a new prolapse technique.

Cameras monitor their work closely, enabling Dr Ty Erickson to guide the procedure. Only, he’s not present. Nor are anaesthetists.

Dr Erickson, in his Salt Lake City, Utah, office, is viewing surgeons participating in a cadaveric workshop at QUT’s Medical Engineering Research Facility (MERF), a $10.7 million investment from Smart State days and industry partners Stryker and Medtronic, on the Prince Charles Hospital campus at Chermside.

“I would have given an arm and a leg for a facility like this when I was a registrar,” says Professor Ross Crawford, QUT’s chair of orthopaedic research.

Body bequests are the lifeblood of MERF’s anatomical education, medical research and surgical training.

As Anatomical and Surgical Skills Laboratory manager Jim Kelly says: “The body is dear; treat it reverently.”

Find out more about QUT’s body bequest program at http://cms.qut.edu.au/__ data/assets/pdf_file/0010/19666/ body-bequest.pdf

“MERF uniquely supports the full cycle of research, validation, commercialisation and training activities needed to ensure widespread adoption of new medical techniques and devices. It’s been designed to meet Australia’s emerging needs in surgical and artificial organ research.

techniques can be trialled and new procedures developed, all for better patient outcomes.

“We run workshops from the ankle to the head—spine, hip, knee, wrist, shoulder, trauma and gynaecology.

Anatomical and Surgical Skills Laboratory manager Jim Kelly says groups of surgeons from Japan, China, Brazil, Singapore and Korea have eagerly turned to the world-class facility for workshops.

“It’s a hands-on complement to the virtual hospital simulation at Queensland Health Skills Development Centre.

“We are unique in that QUT does not have a medical school—but we are strong in allied health and biomedical engineering. I see our place as providing a safe familiar training environment in which experienced doctors can upskill—we don’t accredit; in which new

“I also see a role for MERF in helping refresh rural doctors’ emergency procedures—like how to burr a hole in the skull or insert chest drains,” Prof Crawford says.

As have high school students: 1300 biology students last year alone—a ten-fold increase in MERF’s four-year life—gained an in-depth understanding of the body’s anatomy, both through examination and dissection, learning how the body works and why various diseases and conditions occur. Q DoctorQ NOVEMBER 2012

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NEEDING CAREER ADVICE? Whether you’re at the start of your medical career or have years of experience, there may come a time when you wonder: where to now?

NEW TOOL HELPS DIABETIC MANAGEMENT Changes to the way HbA1c test results for diabetics are reported in Australia are being phased in.

From July 2013, results will be reported in millimoles per mole (mmol/mol) instead of percentages.

To overcome confusion for people with diabetes, NPS MedicineWise has launched a new online HbA1c converter tool, www.nps.org.au/ unitconverter

“It might be confusing for people at first. A little bit like changing from miles per hour to kilometres per hour, it will take some getting used to, but the good thing is the change will bring us into line with international standards for reporting,” said NPS clinical adviser Dr Danielle Stowasser.

Doctors are urged to explain the change to patients and remind them that the new unit changes won’t affect how their condition’s management. Q

For now, the new AMA Careers Advisory Service focuses on the ‘young ones’— those just graduating, doctors-in-training and international medical graduates hoping to work in Australia—providing practical assistance such as professional resumé presentation, completing job applications.

In coming months, services will extend to help experienced medical practitioners seeking new career challenges or moves to new locations.

Check out AMA Careers Advisory Service website: http://careers.ama.com.au or contact careers consultant Kathryn Morgan on 02 6270 5410 or careers@ama. com.au Q

Orthopaedic Surgeon* required for Hillcrest Rockhampton Private Hospital, QLD This is a fantastic opportunity for an Orthopaedic Surgeon* to establish a fully supported private practice in partnership with the Hospital & be part of the exciting period of growth Central Queensland is experiencing.

Benefits: • A guaranteed minimum income of $400,000* pro-rata for the first 12 months • Consulting rooms, including full practice management provided free of charge for the first 6 months.

Our consulting suites are located on-site making it extremely convenient for managing in-patient care • Relocation assistance to the value of $5,000 • Accommodation assistance to the value of $8,000 • Marketing assistance to the value of $5,000 About Us: Owned & operated by Ramsay Health Care, Hillcrest Rockhampton Private Hospital is a 54 bed acute medical, surgical & mental health hospital. The hospital’s primary focus is orthopaedics, ophthalmology, general surgery, urology, plastic surgery, gynaecology, IVF, acute medicine, mental health & oral surgery.

Our theatre complex comprises of three theatres, three stage recovery & a day surgery unit, outpatient department, specialist consulting suites, on-site x-ray & a new Mental Health Unit.

To find out more…

Please contact Tracey Wust, CEO, Hillcrest Rockhampton Private Hospital on (07) 4932 1121; m: 0419 674 482 or e: WustT@ramsayhealth.com.au

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NOVEMBER 2012 DoctorQ

*Must have FRACS

news

TAKING ABI RECOVERY A STEP AT A TIME Communication, relationships and social impacts of stroke and other brain injury often lag well behind physical recovery.

That’s where a statewide Queensland Health program, Skills to Enable People and Communities (STEPS), comes into its own.

STEPS coordinator Ben Turner with peer mentor Scott McDonald who has the communication disability aphasia.

STEPS coordinator Ben Turner says the program helps 18 to 65 year olds grappling with an acquired brain injury understand how to better look after themselves and be active in their communities.

Over six weeks, STEPS provides a facilitated group program.

From there, ongoing networks of support are created, with participants running their groups in ways that suit them—from formal meetings to social catch-ups; even, in Cairns, a monthly fishing outing.

About 200 Queenslanders with ABI complete the STEPS program annually. Another 220 former STEPS participants attend its monthly networking meetings.

Ben Turner urged general practitioners to find out STEPS by contacting the Acquired Brain Injury Outreach Service 1300 727 403 (3406 2311 for Brisbane callers) or visiting www.health.qld. gov.au/abios. Q

The STEPS program and its support networks are established throughout south-east Queensland, Bundaberg, Mackay, Townsville, Cairns, Mackay, Mount Isa and Roma—but Ben Turner says if there’s a need elsewhere, ABIOS will do what it can to bring STEPS to a centre near you.

DoctorQ NOVEMBER 2012

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news

PRACTICE READY FOR NATURAL DISASTERS A land of... droughts and flooding rains. Perhaps not tourism authorities’ preferred view of Queensland but extreme weather is part and parcel of our state.

Is your practice ready should a natural disaster strike your community?

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Store data away from the general practice Keep complete and up-to-date back-ups of all clinical and practice data in safe premises offsite from your rooms. AMA recommends in another town or locality—even a virtual location—to protect this information from being lost in a natural disaster.

Keep your doctor’s bag well-stocked and ready to move In rural and regional parts, where roads can be cut off for some time, it is important to have extra provisions.

Plan a temporary general practice location Where would you see patients if your practice was damaged or destroyed in a natural disaster? Think about that now—rather than when the pressure’s on—and identify temporary premises with: • power (generators may be needed) • ongoing water availability and access • phone and internet connections • bathroom facilities; • consultation and waiting areas • access to essential equipment such as fridges, computers and printers.

Read the AMA’s Position Statement on Supporting GPs in the Immediate Aftermath of a Natural Disaster 2102 at http://ama.com.au/node/8167 Q

MOVE TO MENTAL WELLBEING Most people will relate to feeling happier and more positive after a work-out thanks to the natural release of endorphins. A growing body of evidence indicates exercise significantly helps a range of mental health conditions—from anxiety and depression to schizophrenia, post-traumatic stress disorder and substance abuse.

But Exercise & Sports Science Australia’s Anita Hobson-Powell stresses the exercise needs to be regular and sustained over a period of time—and that research points to home routines being more sustainable than programs requiring attendance at a gym for those with mental health issues. Q

ESSA’s recommended exercise guidelines • Moderate-intensity aerobic training, such as walking, running or cycling at 60-80% of maximum heart rate reserve, for 30-60 minutes per session, at least three days per week; and

• High-intensity resistance training over 80% of 1RM (the maximum weight a person can lift for one repetition) in a progressively difficult manner, with three sets of eight repetitions, for one hour on three days each week.

Seven Australians every day take their own lives. The toll that’s left behind is inestimable. Help stop suicide by raising awareness of the help that exists even when all seems futile. Pass AMA Queensland’s Suicide Watch YouTube clip on to friends and family – www.youtube.com/watch?v=MkGmo6C9xSo&feature=youtu.be

MAKE THIS MESSAGE VIRAL

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NOVEMBER 2012 DoctorQ

NEW LIGHT ON OLD WEAPON AGAINST DIABETES Ever-increasing evidence linking obstructive sleep apnoea (OSA) and diabetes has led the International Diabetes Federation to recommend all patients with diabetes be screened for OSA and vice versa.

SNORE Australia’s consultant sleep physician Associate Professor John Corbett said one of the driving forces behind the push for diabetes sufferers to be more actively worked up for OSA was the potential for optimal OSA treatment to improve HbA1c, insulin sensitivity, and fasting and postprandial glucose levels.

Small trials had shown reversal of metabolic syndrome as a result of successful CPAP therapy in OSA, Dr Corbett said.

“An integral element in eliminating OSA as a contributing factor to metabolic syndrome

is optimal assessment of respiratory disturbances during sleep,” he said.

demonstrated OSA was an independent risk factor for the development of diabetes.

“This requires a full overnight attended sleep study. Recent advances in sleep-medicine technology mean that patients can now be routinely assessed with high-definition video and digital recording of multiple physiological parameters. OSA screening based on questionnaires or limited-channel home studies, or relying on automated CPAP machines, are often insufficient to ensure that OSA patients are optimally treated, thereby depriving them of the important metabolic and other benefits of optimal treatment.”

Fasting insulin levels and elevated insulin-resistance scores in diabetes and pre-diabetes were also known to correlate with the severity of OSA.

While the cardiovascular complications of OSA, including hypertension, coronary disease and cerebrovascular events, were well recognised and of special relevance to diabetes, Dr Corbett said research had

Diabetes is the sixth-leading cause of death in Australia. Every day, 62 Queenslanders are diagnosed with the condition: 60 of them with the so-called ‘lifestyle-related’ type 2 diabetes.

Information on SNORE Australia, sleepdisorders, the links between OSA and diabetes, and sleep-study bookings can be found online at www.snoreaustralia.com. au, by telephoning (07) 5557 0055 (freecall to 1800 076 673), or by email to snore@ snoreaustralia.com.au.

Dr John Corbett and Associates Neurology Clinics Bulk billed neurophysiology service for your patients Short waiting time for bookings No out-of-pocket costs Billed straight to Medicare Workcover and insurance patients accepted and billed direct to insurer.

NERVE CONDUCTION STUDIES

EEGS (Electroencephalograms)

• Carpal tunnel syndrome

• Prolonged (3+ hour) EEGs

• Peripheral neuropathy

• Standard EEGs

• Muscular disorders

• 24-27 hour ambulatory and overnight EEGs

• Nerve entrapments

• Food and sleep deprived EEGs

CLINICS: 159 Nerang Street, Southport 4215 and 80 Armstrong Road, Meadowbrook 4131 All enquiries to 5557 0012 Email: admin@corbett.com.au Web: www.corbett.com.au

Please fax referral to 5557 0077 (we will contact the patient)

DoctorQ NOVEMBER 2012

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Feature story

REFUGEE HEALTH:

GETTING THE ESSENTIALS RIGHT THE LOSS OF REFUGEE HEALTH QUEENSLAND, PREVIOUSLY A STATE-WIDE NETWORK OF REFUGEE HEALTH SERVICES WITH AN EXPERIENCED DOCTOR JUST A PHONE CALL AWAY, PLACES MORE PRESSURE ON QUEENSLAND DOCTORS TO KNOW HOW TO APPROPRIATELY CARE FOR REFUGEES IN OUR COMMUNITY, DOCTOR Q’S HEATHER GRANT REPORTS.

Imagine Australia’s entire population and double it. That’s about how many people are displaced in the world by acts of war, natural disaster and human rights violations: some 43.3 million.

The federal government recently committed to increase Australia’s intake of humanitarian entrants from 13,750 to 20,000 per year. On past trends, about 13 per cent will re-settled in Queensland.

More humanitarian refugees being granted permanent residency, together with an increase in the number of asylum seekers

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living in the community (awaiting visa application decisions), places new demands on Queensland doctors, particularly GPs, to provide refugee health care at a time when a clinician-led refugee health service has been replaced by decentralised nursebased assessment.

“It was wonderful to know there was a clinician, a GP, who understood the clinical and practice management issues and who was just a phone call away,” says Dr Margaret Kay, a Brisbane GP who often sees refugees in her suburban practice.

“With refugee patients, we see the usual illnesses and the chronic conditions that we see in every community. We also see exotic diseases, such as the parasitic infection caused by Strongyloides stercoralis. This infection can be easily treated in the primary health care setting, but it is potentially disastrous if it is missed.

“Some patients don’t understand the concept of preventative health and its importance, simply because they’ve not had access to even basic health care previously.”

Feature story

MENTAL HEALTH With so much for a new Queenslander to take in, health may not be the first priority for a refugee. Mental health problems can be suppressed, hidden for fear of being ostracised, or worse, deported.

“Typically I see mental health issues emerge one or two years down the track, after the patient is more settled, but perhaps struggling with the new realities of living in Australia,” says Dr Kay. For people who have been detained as part of their refugee journey, either offshore or in Australia, mental health issues are often present when they arrive in the community.

Faster processing through detention centres—from up to 24 months to about three months—is being noted to significantly improve refugees’ mental health.

With refugee patients, we see the usual illnesss and the chronic conditions... we also see the exotic diseases, such as parasitic infection...

TOP PRACTICE TIPS 1 2

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While language may be a barrier, a smile is a universal sign of welcome. Everyone in the practice needs to remember how important it is to develop a trusting relationship.

If there’s a delay—because a doctor is running late or an interpreter is yet to arrive—let the patient know what’s happening. While the patient’s English may not be fluent, they will understand the gist of what’s being said and appreciate the courtesy. Everyone likes to be kept informed.

Rather than risk no-shows or late-comers impacting on the rest of your patient schedule, remind patients of appointment times the day ahead, via phone. Most will have a mobile phone as part of their resettlement program. Also consider how you arrange your bookings for your refugee patients: have you allowed enough time and should you make the booking at the end of your session?

Ensure you are aware of the visa that your patient has and whether or not there is a case-worker who can assist your patient.

GETTING THE TERMINOLOGY RIGHT Refugees have to move if they are to save their lives or preserve their freedom. They have no protection from their own state: often, their own government threatens to persecute them.

Asylum seekers are not necessarily refugees. An asylum seeker is someone who says he or she is a refugee but whose claim has not been definitively evaluated.

Photos: World Refugee Day, MDA; Kate Holt/Africa Practice; Jim Holmes/AusAID

DoctorQ NOVEMBER 2012

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Feature story

QUESTIONS YOU

NEED TO ASK When caring for refugee patients it is important to ensure that they have had a comprehensive medical assessment after arriving in Australia.

Asking these questions will optimise the care you can provide: Have you seen a doctor since arriving in Australia? Have you had a health assessment?

It is important to (a) follow-up results or (b) schedule a thorough health assessment if one has not yet been done. A special Medicare item number is available for refugee health assessment.

Are your vaccinations up to date?

Many refugees are under-immunised so it is important to check that the vaccinations have been completed by writing to the provider for documentation of the vaccines that have been given. Vaccinations, including hepatitis B, are available free for refugees.

How are you sleeping?

This is a useful question for assessing mental health and wellbeing. It also provides an excellent opportunity to open up the discussion about broader health issues. Q

USEFUL REFERENCES AMA Position Statement on Health Care of Asylum Seekers and Refugees http://ama.com.au/asylum-seekers Refugee Health Network of Australia (RHeaNA) – a national network working collaboratively to improve the health of people of refugee-background living in Australia https://www.mja.com.au/ journal/2011/195/4/refugee-healthnetwork-australia-towards-nationalcollaboration-health-care An excellent clinical resource designed to support clinicians caring for refugees in Australia can be downloaded from: http://refugeehealthnetwork. org.au/learn/guides/

ACCESSING AN INTERPRETER General practitioners and specialists can use the Doctors Priority Line, a free telephone interpreting service which helps medical practitioners communicate with non-English speaking patients when providing services that are: • claimable under Medicare • delivered in private practices • provided to non-English speakers who are Australian citizens or permanent residents.

Most refugees are permanent residents.

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The Doctors’ Priority Line is available 24 hours a day, seven days a week.

Registration is required to access the Telephone Interpreter Service National. This can be done online: www.immi.gov.au/living-in-australia/ help-with-english/help_with_translating/ medical-practitioners.htm If urgent, call TIS National on 131 450. Practice staff can also use TIS National to make and confirm appointments or provide test results.

Why not use a family member, friend or community member who speaks the same language?

That often seems like the easy solution—but would you normally ask a nine-year-old to enquire about his mother’s menstrual cycle, for example?

The interpreter service provides professional, confidential, appropriate communication assistance.

SNORE AUSTRALIA

SLEEP MEDICINE EXPERTS

SNORE AUSTRALIA

SNORE Australia is the largest provider of ‘Level 1’ Sleep Studies in Australia with over 25 locations on the Eastern Coast and expanding.

Cairns

Mackay Rockhampton

Noosa Caloundra Caboolture Redcliffe Brisbane Gold Coast Dubbo

Lismore

Clinics cater for all sleep disorders offering: Diagnostic polysomnography CPAP titration studies Multiple sleep latency tests Maintenance of wakefulness tests Full 28-channel overnight EEGs (available in parallel with all sleep studies)

Sleep studies are crucial for anyone with day-time tiredness, a heart disorder, hypertension, diabetes, obesity or depression.

Orange Sydney

Melbourne

Private and Bulk-billed services are available Operated by Assoc. Professor John Corbett and Dr Sean Tolhurst For further information call

1800 076 673

Hobart

or visit the website snoreaustralia.com.au

www.snoreaustralia.com.au Freecall 1800 0 SNORE

DoctorQ NOVEMBER 2012

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CURRENT ISSUES

TGA ADDS MIFEPRISTONE TO PREGNANCY MIX THE AUSTRALIAN THERAPEUTIC GOODS ADMINISTRATION HAS PROVIDED ANOTHER OPTION TO THE UNENVIABLE DECISION A WOMAN MAY NEED TO MAKE WHEN FACING AN UNPLANNED, UNWANTED OR UNVIABLE PREGNANCY.

BARBARA FERRES

Media Officer, AMA Queensland

The sexual revolution has come a long way in the 50 years since the contraceptive pill reached Australia on 1 February 1961. This tiny tablet allowed women, for the first time, to safely and effectively manage their own fertility, empowering them to make brave decisions about their life and career paths.

Along the way, Australia’s attitudes to family and fertility have changed with a dramatic rise in the number of same-sex couples using surrogacy and fertility treatments to become parents, more women choosing to significantly delay pregnancy into later life and many choosing not to have children at all.

to Australia in 2006, the TGA’s latest decision allows any doctor who successfully completes an online training course to prescribe mifepristone within the first seven weeks of pregnancy.

As the drug’s sponsor, family planning group Marie Stopes International Australia (MSIA) will supply mifepristone to doctors who complete the organisation’s online education program or who are fellows or diploma holders of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

James Cook University professor and AMA Queensland member Caroline de Costa was the first practitioner in Australia authorised to use the drug in private practice in 2006; in 2010 she was also licensed to use it at Cairns Base Hospital.

A new milestone was reached on 30 August 2012 when the Australian Therapeutic Goods Administration (TGA) approved the registration of the abortion-inducing drug mifepristone (commonly known as RU486).

Prof de Costa is cautiously supportive of the TGA’s decision: “It’s something we’ve been seeking for many years and it’s finally come to pass.

Overturning previously tight restrictions set in place following its initial introduction

“If it is available across Australia, it will be easier for women, in rural areas especially, to access abortion.”

Australia is the 51st country to register mifepristone, more than a decade after the World Health Organisation and the majority of Western European countries authorised its use.

Whether its introduction will be embraced by the medical community in Australia remains to be seen...

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Prof de Costa said it was common practice in many countries for women to access mifepristone up to nine weeks into pregnancy.

“It’s much more commonly sought from seven to nine weeks because it takes women time to make that decision about termination,” she said.

Thousands of Australian women every year choose to terminate pregnancies for a variety of medical, emotional and social reasons. They manage to do this despite the financial expense, complicated and inconsistent legislation, limited access and lack of information. TGA data shows that 22,500 Australian women had been prescribed mifepristone by the end of 2011 by only 187 authorised prescribers.

According to family planning organisation Children by Choice, out-of-pocket costs for an abortion in Queensland range between $450 and $800. The short window of opportunity, combined with medical and travel expenses, make a clinical or surgical abortion impossible for many women— particularly those in rural areas— and may lead to unsafe alternatives.

A MSIA spokesperson indicated plans ‘in due course’ to seek mifepristone’s inclusion under the Pharmaceutical Benefits Scheme, making it federally subsidised and therefore more affordable and accessible.

The TGA’s decision to expand the availability of mifepristone offers a genuine alternative to women confronted with very difficult circumstances. Whether its introduction will be embraced by the medical community in Australia remains to be seen but it is likely that as demand increases, mifepristone will become a more common option for women—as evidenced by the contraceptive pill. Q

CURRENT ISSUES

THE LEADERSHIP PARADOX – SHOULD LEADERSHIP BE TAUGHT IN MEDICAL SCHOOLS? ANATOMY, PHYSIOLOGY, BIOCHEMISTRY, ETHICS, CLINICAL SKILLS: THERE’S A LOT TO CRAM INTO A FOUR-YEAR MEDICAL DEGREE. SO WHY FACTOR IN LEADERSHIP SKILLS AS WELL?

KATHERINE GRIDLEY

UQMS Leadership Development Coordinator

Even in the most junior stages of our career, doctors are considered to be part of one of the most esteemed and well-regarded professions. Doctors have an immense amount of power, not only in the literal sense (e.g. detaining a patient by use of the Mental Health Act) but also in how they are portrayed and admired in society. We are acknowledged for preventing disease, healing the sick, fixing the injured and helping to bring new life into the world. At the very essence of this profession is our accountability for changing and saving lives.

However, to quote Winston Churchill, “the price of greatness is responsibility”, and doctors are by no means immune to this.

While we can hold patients’ lives in our hands, we are held accountable for their misdiagnosis, adverse events, failure of treatments and sometimes, death. The AMA Code of Ethics stipulates that we must “approach health care as a collaboration between doctor and patient”. This idea of a therapeutic alliance identifies why leadership is vital in the medical profession.

Doctors not only have the knowledge and

experience to treat a myriad of health problems, but are trusted with the ability to advocate for a patient that may not otherwise be heard.

LEADERSHIP INTEGRAL TO PROFESSION Far from being paternalistic, such a stand underscores one of the strengths of a true leader: understanding when to take charge and when to lead from behind. This can be seen most strikingly in palliative care.

A doctor who is not well versed in the concept of leadership may struggle when a cancer patient decides to stop treatment.

A medical leader can respect this decision and empower the patient by providing the means to enjoy their remaining days, dying in peace and with dignity.

Akin to this notion of leading from behind, is the idea that a leader can take any position within a team, not necessarily the front bench. Doctors, nurses, allied health, administration and general hospital staff form a healthcare coalition. ‘Teamwork in action’ is a reality for the daily functioning of the healthcare environment. A medical leader can recognise his or her own limits—be they physical, emotional or experiential—and ensure that the necessary allies are involved.

INVALUABLE LIFE LESSONS Recently, about 30 medical students from the University of Queensland, Griffith University and James Cook University took part in the UQMS Leadership Development Workshop, focusing on the theme of crisis management. These students were privy to entertaining and informative speeches from a variety of different professions, from emergency physicians to administrators and media personnel, about how to be a leader when faced with adversity.

The students particularly enjoyed discussing different crisis scenarios with three leading emergency physicians and a hospital medical director, gaining understanding as to how the professionals deal with a crisis.

Among the anecdotes of stress, challenge, fear and triumph was the overriding theme of crises being valuable learning experiences. A crisis is an opportunity to learn through strength, courage, insight and resilience —all of which are features of a good leader.

This generation of medical graduates are the doctors of the future. An army would not send a solider into battle without ammunition. Using that rationale, junior doctors should be readily equipped with the arsenal of leadership skills needed to tackle whatever challenges they may face. Q

A crisis is an opportunity to learn through strength, courage, insight and resilience – all of which are features of a good leader.

DoctorQ NOVEMBER 2012

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CURRENT ISSUES

MEDICINE: NO LONGER A SAFE CAREER CHOICE BUDGET RATIONALISATIONS COULD MEAN BOTH GRADUATING STUDENTS AND MEDICAL SPECIALISTS HAVE TO FIGHT FOR JOBS IN QUEENSLAND’S PUBLIC HEALTH SECTOR.

ANDREW TURNER

Workplace Relations Manager, AMA Queensland

A perfect storm appears to be brewing as budget rationalisations in Queensland hit both graduating students competing for limited intern placements and specialists seeking fewer salaried medical positions.

In 2000, 1,195 medical graduates competed for intern places across Australia. By 2009, medical graduate numbers had increased 99.2 per cent to 2,380. Not only has this created increased competition but pressure on hospital and health services to provide sufficient clinical teaching and learning opportunities.

Certainly the states were pushing for more med graduates back in 2004 because they needed more doctors. But a medical degree alone does not a doctor make. In doing what was asked, in increasing student numbers by 400 in April 2006 and another 250 in July 2006, we have a clear-cut case of ‘be careful what you wish for’: these extra students needed training, and training comes from state coffers.

identified for elimination such as fixedterm contractors and locums. Any further reduction of salaried doctor numbers remains uncertain.

Additionally, the Queensland Government’s commitment to return the state’s budget to surplus, through public sector savings, brings talk of redundancies, or a reduced number of medical positions, to the fore. While the government is committed to maintaining frontline services, some costs have been

Dr Ben Molyneux, deputy chairman of the British Medical Association’s Junior Doctors Committee, has described the situation as a tragedy for the graduate doctors unable to secure employment, and mismanagement of the higher education sectors. Each year in Britain, it costs GDP 260,000 of public funds to put each medical student through university.

Queensland Health’s ongoing staffing issues have forced many medical practitioners to consider entering private practice earlier than expected, according to a recent financial industry white paper.

The white paper has found that many young doctors are worried about the future of medicine.

Business was the last thing on the mind of many medical graduates who would prefer to take a public job, if one was available.

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NOVEMBER 2012 DoctorQ

Disturbingly, this issue of supply and demand is not Queensland’s—not Australia’s— alone. A recent newspaprt article summed up the UK situation as: “Up to 1,000 new doctors could face unemployment”.*

When will Australia face up to the reality of its own indisputable imbalance and make steps to correct it? The Commonwealth originally agreed to fund intern places for all locally trained medical graduates in 2013, but not in 2014 or 2015—and not full-fee paying international students. With a projected shortage of 100 intern posts, the Commonwealth now has made a one-off funding offer for 100 of these posts... if states sign up. While welcomed, the AMA maintains that a long-term commitment to traning is needed in conjunction with the higher education sector, must be struck to ensure the right balance.

Meantime, volume 3 of the Health Workforce 2025 white paper, creating a framework for a sustainable medical workforce across Australia, is due for release by year’s end.

It focuses on speciality-specific workforce modeling. The implications of getting this right, taking into account supply, demand, training and distribution cannot be overstated. Without, Australia is set for irreconcilable tension. Q

PREMATURE PRIVATE PRACTICE PUSH

* The Daily Telegraph, 19 May 2012 www.telegraph.co.uk (http://www.telegraph. co.uk/health/healthnews/9274753/Up-to-1000new-doctors-could-face-unemployment.html)

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Contact us for free booklets to distribute to your patients Website: www.asbestos-disease.com.au Email: asbestoshelp@westnet.com.au

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For a discrete discussion, contact: Ross Tiller, General Manager Scan Business Brokers P: 0412 313 647 E: ross.tiller@scancorp.com.au www.scancorp.com.au 26

NOVEMBER 2012 DoctorQ

CURRENT ISSUES

TO BUY OR NOT TO BUY: THE QUESTION OF FOREIGN INVESTMENT IN AUSTRALIAN AGRICULTURE

THE SELL-OFF OF ICONIC COTTON PROPERTY CUBBIE STATION IN SOUTHERN QUEENSLAND TO A CHINESE CONSORTIUM HAS FIRED UP CALLS FOR A LAND REGISTER TO PROTECT AUSTRALIA’S FUTURE FOOD AND WATER SECURITY.

President, National Farmers’ Federation

Foreign investment has long been an integral part of Australian agriculture.

Global companies have been attracted by Australia’s reputation for high quality and safe production, our proximity to key Asian economies, counter-seasonal production for the northern hemisphere, relatively low levels of sovereign risk and a productivity record that is the envy of agricultural producers the world over.

Japanese investors hold strong interests in Australia’s red meat, grains and dairy sectors. The US, Australia’s leading source of foreign investment, has invested heavily in our red meat and grains industries as has Britain and Brazil. New Zealand has interests in our dairy sector and Singapore in our pork industry. The list goes on.

Australian farmers and regional communities have benefited from such investments, delivering significant amounts of capital into production systems at a time when bank finance was hard to come by, improving efficiencies and enabling Aussie farmers to better compete in a highly distorted global marketplace for agricultural commodities. For years, it seemed a win-win for all involved.

That was until 2007-08 when attention was drawn to the GFC. Not the Global Financial Crisis but the Global Food Crisis. Overseas, supermarket food prices escalated, leading to social unrest riots and protests in more than 20 countries, from Indonesia to Egypt.

intent of their investment: is it for commercial reasons or to ensure a consistent food supply for another nation’s people?

Such a shift raises the question around any foreign purchases being subject to the same tax and market access conditions as Australian farmers, ensuring an equal playing field.

So what needs to be done?

In the first instance, we need a national land register to monitor all foreign acquisitions or transfers of interest in Australian agricultural land or water. Currently, the Foreign Investment Review Board (FIRB) acknowledges many such land and water asset purchases fly below the disclosure thresholds (currently $244 million), therefore avoiding scrutiny. Talk of reducing FIRB thresholds is akin to putting the cart before the horse without a register of who owns what.

Farmers also need assurances that foreign investment—indeed, investment from any source—will not undermine existing marketing mechanisms and pricing transparency underpinning farm gate prices.

We need to be sure that the market remains open and transparent and that farmers are paid a fair price for their produce.

Photograph courtesy of Alan Redfern

JOCK LAURIE

Finally, and perhaps most importantly, Australia needs a clear food policy of its own.

Development of the federal government’s National Food Plan is a good start and the NFF is working on a farmer-led Blueprint for Australian Agriculture… but we’re in catch-up mode compared to other countries.

The United Nations warned that the security implications of rising food prices should not be underestimated. Governments responded with a range of emergency policy measures, many of them creating additional negative marketplace distortions. Food security was etched in the mindset of these countries and has not been easily forgotten.

But it didn’t shake Australia out of its ‘she’ll be right’ mindset.

Ultimately, we want to see more, not less, investment in Australian agriculture for the benefit of our industry—but we need to be very clear about the motives. Q

Instead, we have seen state-owned enterprises enter the market, blurring the

agricultural land is entirely

99% of Australian

agricultural businesses and

88.6% of Australian

AUSTRALIAN OWNED

Mungbeans, originating from the Indo-Burma region, are a very common ingredient in many food items, grown widely in central and southern Queensland.

DoctorQ NOVEMBER 2012

27

CURRENT ISSUES

WHEN IS ‘THE END’ THE END? THE POWER OF THE MEDICAL PROFESSION TO EXTEND AND SUSTAIN LIFE IS GREATER THAN IT HAS EVER BEEN BEFORE, MAKING IT ALL THE MORE IMPORTANT FOR DOCTORS TO BE MINDFUL OF THE CRUCIAL ROLE THEY PLAY IN LEGAL, AS WELL AS CLINICAL AND ETHICAL, QUESTIONS AND DECISIONS ABOUT DEATH AND DYING.

EMILY COTTERILL

Policy Officer, AMA Queensland

Over 40,000 deaths occur every year in Australia when the decision is made to withhold or withdraw the use of life-sustaining treatment like assisted ventilation, cardiopulmonary resuscitation and artificial nutrition. As the population ages, more of us will die in this way.

Alarmingly, emerging research suggests that the Queensland decision-making frameworks for end of life care may be failing patients, families and doctors when they need them most.

Queensland has several legal avenues in place to allow patients to make decisions

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NOVEMBER 2012 DoctorQ

about the care they want at the end of their lives, including advance health directives (AHDs) and enduring powers of attorney (EPA). However, concerns are emerging that these documents and laws are sometimes confusing and poorly understood.

Preliminary findings of a current Queensland University of Technology study imply gaps in doctors’ knowledge of the law which could expose doctors to legal liability.

Doctors play an important legal role in end of life care, especially where patients lack capacity to make decisions about treatment.

For example, a doctor must assess the condition of a patient to determine if the instructions in an AHD can be followed, based on the patient’s condition. Doctors must also determine whether to follow

the instructions of an enduring power of attorney, to ensure that decisions are made in the patient’s best interest.

Doctors have the important task of identifying the correct decision maker or process: whether an AHD, attorney or other person. The Queensland Law Society has pointed out that its members have noticed a preference among doctors to only use and recognise AHDs, even though in their absence, an EPA can be used and is valid for decision-making processes.

Worryingly, the law’s complexity in this area poses a ‘distinct barrier’ to doctors mastering its principles, say QUT researchers. Problems for doctors emerge when the letter of the law does not reflect

CURRENT ISSUES

Alarmingly, emerging research suggests that the Queensland decision-making frameworks for end of life care may be failing patients, families and doctors when they need them most. the norms of good clinical practice. For example, in Queensland the law appears to require consent from a decision-maker not only when providing treatment but also regarding decisions to withhold treatment, even when treatment is not clinically indicated.

Doctors on the ground are well aware of these challenges, and although there are barriers to a practised and fluent knowledge of the law, doctors should be mindful of the crucial role they play in the legal, as well as the clinical and ethical, decisions about death and dying.

More information about QUT’s research and the law in this area can be found at the QUT Health Law Research Centre website at www.hlrc.qut.edu.au. Q

ADVANCE HEALTH DIRECTIVE: A written document that allows a patient to give explicit instructions about medical treatment to be administered or withheld when the patient is terminally ill or permanently unconscious.

ENDURING POWER OF ATTORNEY: A written document that enables a patient to appoint another to make decisions about the patient’s health care and personal affairs if the patient loses capacity.

DECISION-MAKING BASICS According to the Queensland Law Society, if a health professional is presented with or caring for a patient with impaired capacity, the first question to ask is ‘who can make health decisions for the patient?’

If the patient has an advance health directive and has made a direction about who is to make decisions on their behalf, it is that person; or If there is a guardian appointed for the patient under the Queensland Civil and Administrative Tribunal, it is the Tribunal-appointed guardian; or If there is an attorney appointed for health and personal matters under an enduring power of attorney, it is that attorney.

Otherwise, it is a Statutory Health Attorney who is available (and in the following order):

1. The spouse of the patient (spouse includes married spouse, de facto partner or civil partner)

2. An unpaid carer for the adult who is over 18 years of age 3. A close friend or relative of the adult who is over 18 years and is not a paid carer of the adult.

If none of the above are available, the Adult Guardian makes the decision.

If a doctor has any concerns about the validity of the AHD or EPA, urgent referral should be made to the Queensland Civil and Administrative Tribunal.

DoctorQ NOVEMBER 2012

29

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CURRENT ISSUES

TIS THE SEASON TO RING-A-DING-DING THE DOCTORS’ HEALTH ADVISORY SERVICE PRESENTS FOUR SIMPLE SUGGESTIONS FOR BETTER DOCTOR HEALTH THIS FESTIVE SEASON AND IN THE YEAR AHEAD.

DR MARGARET KAY

Doctors’ Health Advisory Service Queensland

For more than 20 years, the Doctors’ Health Advisory Service Queensland (DHASQ) has operated a free, independent and confidential colleague-to-colleague phone helpline for doctors and medical students*.

Every fortnight, a GP has taken the phone, and been available, day or night; a willing volunteer ready to take a fellow doctor’s call and talk through a colleague’s health concern.

But for months now, the phone has been quiet. The question is why. Did we suddenly become a much healthier profession, making our service obsolete? That would be the best Christmas present for DHASQ. But that’s fantasy. While our phones are quiet, doctors with serious health issues are still coming to the attention of the Medical Board.

While it has always been our professional responsibility to report doctors whose impaired practice may cause patients harm, an unintended consequence of mandatory reporting, introduced in 2010, may be pushing colleagues-in-need further ‘underground’, depriving them of access to care. This is a complex area to investigate.

The ACT doctors’ health service has noticed a similar reduction in calls since mandatory reporting. Other states have not.

As temperatures soar through summer, and the festive season ramps up, financial worries (the big Christmas spend) and relationships (keeping family members happy—particularly tricky for blended families) are known to heighten anxiety and stress in the community. Doctors are not immune to these.

Add on the workload of covering for doctors on holidays, even just a few extra patients, and the fact that usual referral pathways can be more difficult to negotiate with fewer specialists and community services available and we have a formula for additional stress. Q

AS WE APPROACH THE ‘SILLY SEASON’, I ASK MY COLLEAGUES TO DO FOUR THINGS: ne someo P. Not ho will G A F w EL OURS meone GET Y with but so ndent care, e e k ak r p o e half. M you w ith ind you w e on your be atient’ e id v o pr cat tor-p T n advo al ‘doc re you have NO who ca to build a re efo b P RE ESS. G self e r r A u u im o o t y y e U k th , as with YO ICKN aps nship ndeed BER OM S rror the relatio ant illness. I our GP? Perh M E i R ! c y t n REM UNE F sues m We ge a signifi you last see r’s resolutio s . i a id M e d n Y h d n o w t M i l n I whe a Ne hea ulat er a st uld be Our ral pop s, canc ase, ju n this co e e d ca en s, col ar dis e g w CARE FOR YOUR gh ascul e, and th u COLLEAGUES. o c l l io-v . hea eop When you are calle card ther p ental ne else d on to be a o m o doctor for another like rience ke any tting a doctor, provide e li g le empathy as well as exp s just edin fear medical e u we n by ne you care. Sometimes wh s s n i e t ile keeping a n? of ve ow professional distan Too ague d off. Ha otectio ou ce, we forget to r e e y l p l f i m o e i c t do the caring too. off ? com ered ake to t uate in ice cov ke time t q a c t e ad ur pra ed to o e Is y enly n d sud CA LL DH AS (24 Q. h co o ch nfid urs) ta at. S enti —fo lki a ng omt l, 2 r a ca im 4-h n h es ou elp , jus r t .

1 2

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The Doctors’ Health Advisory Service Queensland is a registered charity providing a free volunteer-based service.

AMA Queensland Foundation supports its administrative costs.

The Medical Benevolent Association of Queensland financially assists doctors’ families in times of crisis.

Donations for both are tax deductible.

*DHASQ is also available to pharmacists, dentists and those professions’ students.

DoctorQ NOVEMBER 2012

31

Feature story

Extreme

VOLUNTOURISM

THE NICHE TRAVEL SEGMENT VOLUNTOURISM TAKES HOLIDAYMAKERS ON A MISSION, GIVING TIME, SKILLS AND ENERGY TO HELP ORGANISATIONS, ISSUES OR CAUSES RATHER THAN RELAX. DOCTOR Q’S HEATHER GRANT FINDS OUT WHAT DRAWS THREE QUEENSLAND DOCTORS BACK, AGAIN AND AGAIN, TO AFRICA.

Dr Judith Goh will be taking a break in December for a few weeks from her private medical practice on the Gold Coast and Brisbane but you won’t find her snowploughing in Aspen.

She’ll be carrying out vaginal fistula surgery on African women damaged during childbirth: something she’s done for more than 20 years.

Three times a year—for weeks at a time—Dr Goh travels overseas at her own expense to provide life-changing surgery.

“When you start young it becomes a way of life,” she smiles, shrugging away a question of when she last took an actual holiday.

“Fistulas are epidemic in Africa. We think of AIDs as being epidemic—lots of money is spent on AIDS in Africa because it has affected people in the West.

“Presentation of VV fistula is so very, very rare in Australia yet in Africa, millions of women suffer.

Useful websites Australian Doctors International www.adi.org.au/index Mercy Ships www.mercyships.org.au Medecins Sans Frontieres Australia www.msf.org.au/ YotKom Uganda http://yotkomuganda. blogspot.com.au/

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DoctorQ NOVEMBER 2012

“Here we can monitor labour, and intervene.

But in Africa, women can labour for days on end, tearing in the process and ultimately delivering stillborn babies.”

The social impacts of this damage, Dr Goh says, are horrendous.

“Women are shunned. They are considered unclean. In communities where polygamy is acceptable, the husband takes another wife and the woman damaged while birthing is relegated to nothing more than an unpaid housekeeper, if she is lucky.

“With few exceptions, these women come to me terribly embarrassed and shy. They believe they have been cursed: that they have done something wrong for this to have happened to them.”

Dr Goh spreads her visits between the Congo, Uganda and the multinational floating hospital Mercy Ship, which berths off the West African coast. It’s from there that she’ll operate in December.

Onboard the Mercy Ship, Dr Goh has theatre time for up to five operations a day over two weeks, and keeps her patients for the fortnight to heal – and educate.

Some of her patients are as young as 14; others have lived with their condition for decades. She fondly remembers an older woman who had been ‘wet’ for more than

Helping these women compensates any lost potential income.

30 years: “Every day post-op, I would ask through the interpreter how she was. She’d say nothing, roll away from me. One day, towards the end of the fortnight, I asked again and this time, she smiled and stood and followed me around the rest of my patient rounds. She was dry and so happy to show it.”

Dr Goh also appreciates visits by women surgically repaired, who return with babies.

It gives other women hope, she says.

For Dr Goh, being in private practice is no excuse for not volunteering time. She closes her books for about three months of the year to carry out the unpaid aid work: “We all have different values. For me, it’s a case of being organised and believing that, helping these women compensates any lost potential income.”

Feature story

Dr Neil Wetzig recalls the emotion of his ‘voluntourism’ turning point in 2003.

For some years, he had performed minor surgical outreach clinics in Kenya, Uganda and Tanzania as part of a church-organised mission. On one trip, he operated on a threeyear-old girl, caught in crossfire between Ugandan soldiers and the notorious Joseph Kony’s resistance army: “The surgery went well. Post-op was good but nurses fled during a thunderstorm overnight. The child was left behind, and died.

“A year earlier I had met a Congolese orthopaedic surgeon, Dr Jo Lusi, who had a vision for a hospital in Goma in which western doctors donated time and skills to help train local doctors in procedures.

“A few days after the incident in Uganda, I visited Jo Lusi’s hospital still in a pretty distressed state; wondering how medical care in Africa could be improved. And he showed me potential for a real sustainable difference to be made.”

Pulling together a group of like-minded Queensland specialists—plastic surgeon Paul Millican, radiologist Murray Thorn, anaesthetist Anthony Fisher and sonographer Sue Reid—Dr Wetzig has returned annually to the Heal Africa Hospital.

During his last two week trip in July, Dr Wetzig assessed 69 new patients and performed 27 major procedures including nine thyroidectomies for large goitres, removal of a large neck tumour wrapped around the main artery of an arm and seven major abdominal cases. Teaching is a vital part of the mission too.

“We’ve been careful not to overstep cultural lines. We work with the Congolese doctors and identify the needs of the hospital, of the patients, and fit those needs with the appropriate volunteers and with training.

What we’re doing is sustainable; capacity building,” he says.

“A lot was beyond local doctors’ capability but that’s changing. And to be honest, some of the situations I’ve dealt with have been beyond my comfort zone surgically too—like operating on a young woman who swallowed battery acid in an attempt to kill herself. That young woman now has an accounting degree and works for the hospital. She has a future, unlike the little girl left for dead in Uganda.”

Brisbane bayside general practitioner Dr Andrew Wright is another who fervently believes in improved primary health care through sustainability.

“I have a particular interest in paediatrics—50 per cent of the Ugandan population are under 15 —and maternal

health. The death rate during childbirth is 20 times that of Australia!” Dr Wright says.

He has made month-long annual pilgrimages for more than 10 years, volunteering his services at the poorly-equipped St Joseph’s Hospital eight hours’ drive from Uganda’s capital, Kampala: “It’s really basic: there’s no ECG machine, for example. A woman delivered an infant at 27 weeks. No humidicrib, no resus equipment. The infant just had to be wrapped in blankets and prayer. Nothing else could be done.”

Yet Dr Wright continues to believe in a brighter future and continues his efforts when not in-country, supporting a scholarship program enabling bright Kitgum students to pursue health science university studies and holding weekly Skype sessions with Ugandan doctors at Bregma Clinic to discuss patient care and administration. Q

DIPPING YOUR TOE This kind of medico-volunteering is not for everyone. “It can be pretty confronting. It can rock your boat,” says Dr Wright.

1. Consider one-off professional development visits.

2. Do some homework about what’s needed, where – and whether your skills and personality suit.

3. Donate to charities supporting improved health care.

DoctorQ NOVEMBER 2012

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BUSINESS TOOLS

STAY CALM AND CARRY ON: IT’S GOOD PRACTICE IT’S ALL WELL AND GOOD TO SAY ‘DON’T SHOOT THE MESSENGER’ BUT THE REALITY IS FRONTOF-OFFICE STAFF IN DOCTORS’ PRACTICES ARE IN THE FIRING LINE EVERY DAY.

Nathan Jones Australian Association of Practice Managers (AAPM) (07) 3103 5152

Front-of-office staff face the wrath of patients (and sometimes, doctors) when schedules run over. These best practice tips can help restore calm.

1. Proactively manage your appointment book, looking for bottlenecks or issues. Look at appointments for the following day or week, move patients as needed to avoid hold-ups.

qld@aapm.org.au

2. Use the waiting room screen in your practice

management software to identify patients who have been waiting for excessive periods... and do something about it. Perhaps a nurse can do some triage or a work-up or maybe the patient would like a cuppa.

3.

If your clinic is consistently overbooked, find out why. It’s likely to be a combination of the clinic, practitioner practices and the length of allocated appointments. As a practice, seek to create a schedule that flows more fluidly for everyone.

4.

Keep patients informed of significant delays, not just when they arrive but pre-arrival. Use the technology provided by mobile phones, text messages and emails to provide this courteous advice. Most people accept that the nature of a medical clinic involves some waiting but just how long is acceptable will depend on an individual’s own needs and demands.

5. The

practitioner-patient relationship is a unique one. Understand that the longer patients wait, the less appointment-compliant they become over time. Increased DNA rates are often a result of a practitioner who doesn’t run to time. So it pays to regularly go back and analyse how a clinic is booked and how it actually runs.

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NOVEMBER 2012 DoctorQ

6. Don’t

manufacture excuses to appease patients. You’ll get caught out!

7. Create

a waiting room environment that is more inviting than hard chairs with a TV tuned to infomercials: a place in which lingering longer is soothing rather than boring.

Crosswords, Suduko or light-hearted G-rated comedy help take patients’ minds off the wait.

8. When a patient is settling their account after

the consultation, acknowledge the fact they waited longer than expected for this visit. If another appointment is needed, suggest a time that is not as busy. This speaks volumes about seeing patients as individuals whose time is important too.

9. Reception staff: it’s rarely about you. People are

often not at their best when we meet them (sometimes for the first time!) and we have to remember that. Often when you cop it from a patient about a waiting time, they’re either unwell or not functioning at their best and the patient that you thought was very nice on arrival has turned into your worst nightmare!

Reception staff should never have to endure abuse. That’s why practice managers with great conflict negotiation skills are not only a clinic’s greatest ally but your front-of-office staff’s too. Q

AMA Queensland

DoctorQ NOVEMBER 2012

35

TRESSCOXLAWYERS LAWYERS TRESSCOX INCORPORATING MACROSSANS LAWYERS INCORPORATINGMACROSSANS MACROSSANSLAWYERS LAWYERS INCORPORATING TressCox Lawyers has now merged with TressCox Lawyers has now merged with TressCox Lawyers has now merged with Macrossans Lawyers, effective 11 October 2012.

Macrossans Lawyers, effective October 2012.

Macrossans Lawyers, effective 1 October 2012.

Combining practices gives opportunity to Combining our practices gives us the opportunity to service service Combining ourour practices gives us us thethe opportunity to service local and national clients even further. advise our local and national clients even further.

We can advise ourour local and national clients even further.

WeWe cancan advise corporate and commercial services; building on corporate and commercial services; building and onon corporate and commercial services; building andand infrastructure; fifinancial services; commercial litigation; infrastructure; financial services; commercial litigation; infrastructure; nancial services; commercial litigation;

immigration; insurance; health; workplace relations immigration; insurance; health; workplace relations andand immigration; insurance; health; workplace relations and employment law. employment law. employment law.

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Stephen Tonge Stephen Tonge Stephen Tonge Phone 073004 3004 3502 Phone 3502 Phone07 3004 07 3502 Mobile 0408 987 669 0408 987987 669669 Mobile Mobile 0408

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www.tresscox.com.au www.tresscox.com.au www.tresscox.com.au 36 Phone: 0707 Phone: 3004 3500 Phone: 073004 30043500 3500 NOVEMBER 2012 DoctorQ

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BUSINESS TOOLS

BE PREPARED: WHAT HAPPENS AT THE WORK PARTY, STAYS ON YOUTUBE TRESSCOX LAWYERS’ RACHEL DREW AND CASSANDRA HEILBRONN EXPLAIN HOW TO AVOID YOUR PARTY ANTICS BECOMING A LASTING BLIGHT ON YOUR REPUTATION AND EMPLOYABILITY THANKS TO SOCIAL MEDIA. The festive season is a perfect time to relax and celebrate the year’s achievements. But whether as an employer or employee, health practitioners need to remember that what happens at the work party has potential to be—and stay—on YouTube.

We see increasing disciplinary action due to social media posts as the lines between work and home blurs, with consequent impacts on reputation and employment.

However, a few preventative steps can ensure there are no such repercussions from your festive parties.

IT’S OUR POLICY Work parties are great for team building but they don’t mean policies go out the window with the helium balloons.

Circulate an office email specifying the end time of your work function. Inform people that if they want to continue to celebrate afterwards, it will not be part of the official work party.

The usual rules relating to compensation for work injuries and claims for harassment or discrimination continue to apply at work functions, and after.

Staff can claim compensation and possibly sue the employer for injuries or harassment suffered at, or connected with, the event. Setting clear guidelines before the party can help in defending claims.

Partner, Brisbane (07) 3004 3527 rachel_drew@tresscox.com.au

SOCIAL MEDIA The popularity of social media presents employers with challenges in promoting productivity and reputation management. A social media policy is essential if an employer wants to lawfully control the social media activities of their employees, both during and outside of working hours.

Recent cases have seen employees held more accountable for their online postings based on comments being seen as discriminatory, defamatory and/or offensive. Examples include: two NSW police officers disciplined for gossiping about a co-worker on Facebook, even though they used their personal computers and made the comments out of work hours.*

Workers (including contractors) should know if they are to find their own transport home.

Make sure alcohol is served responsibly and offer food. It is an offence to let underage workers drink.

Remind workers that policies regarding sexual harassment, social media use and drug and alcohol use continue to apply at all work functions.

Rachel Drew

dismissal of a worker who posted “wonders how the f**k work can be so f*****g useless and mess up my pay again. C***s are going down tomorrow”.

Staff need to know the social media policy and realise that investigations and disciplinary action could follow, even though posts were not made at work, or using work equipment. Q

Recent cases have seen employees held more accountable for their online postings...

Cassandra Heilbronn Solicitor, Brisbane (07) 3004 3510 cassandra_heilbronn@tresscox.com.au

SOCIAL MEDIA

SURVIVAL TIPS

1 2 3 4 5

Set a good example for younger colleagues.

Be careful of what you post online about work and work functions.

Remember, any comments about work and colleagues online could be grounds for disciplinary action.

Do not post any pictures of colleagues without their consent.

If you would not say it, do not type it!

If you have any questions or require advice in relation to your liability for work functions, contact Rachel Drew on (07) 3004 3527. *Police rapped for Facebook gossip http://www.dailytelegraph.com.au/news/police-rapped-for-facebook-gossip/story-e6freuy9-1226475200671

DoctorQ NOVEMBER 2012

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BUSINESS TOOLS

TAX 101 FOR MEDICOS WILLIAM BUCK’S JULIE SMITH PRESENTS THE FIVE MOST FREQUENTLY ASKED QUESTIONS SHE HEARS RELATING TO TAX AND BUSINESS FROM THOSE IN THE MEDICAL PROFESSION.

Julie Smith William Buck (07) 3229 5100 julie.smith@williambuckqld.com.au

Do I need to operate my medical practice through an entity such as a company or a trust or should I trade in my own name?

I am concerned about asset protection, especially in relation to my family home. What can I do about this?

The choice of whether to operate a medical practice through an entity or in your own name depends on your own specific circumstances; individualised advice should be sought to find out the best arrangement for you.

For most people, the family home is their most valuable asset. Therefore, protecting this asset is critical.

While an entity such as a company or a trust may provide some advantages including some level of limited liability protection, in general the advantages will not be significant, especially where a sole doctor practice is concerned.

As a guide, it is important to determine the tax treatment of the income that you earn so that you can understand how this will be impacted by any entities. An entity is only worth having if it is costeffective and assists you in reaching your goals.

Some of my colleagues have service trusts.

What are they and do I need one?

Service trusts are typically discretionary trusts (although they can also be unit or even hybrid trusts) set up to hold valuable practice assets, employ staff and generally look after the administration side of the practice. The trading entity pays a market value fee for the services provided and any profits can be distributed at the trustee’s discretion.

Service trusts are considered to be ideal structures for providing additional asset protection. They can also provide some ancillary tax benefits by allowing distribution of profits to a spouse or other family members.

What’s the big deal about self-managed superannuation funds and do I need one?

Self-managed superannuation funds (SMSFs) are considered useful for those who want to take more control over their superannuation.

For larger superannuation balances, the annual running costs of an SMSF may be less than those charged by a public offer fund. While it is generally considered that you need at least $200,000 in superannuation savings to make a SMSF worthwhile, you should discuss the option of setting up an SMSF with your financial advisor.

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NOVEMBER 2012 DoctorQ

If you are looking at buying a new family home, your best option may be to put this into your spouse’s name, subject to their own asset protection concerns. Alternatively, you might consider putting it in a discretionary trust—but be aware that this may preclude you from using the main residence capital gains tax exemption on eventual sale.

If you are looking at protecting your existing family home, you might consider transferring ownership into your spouse’s name (subject to duty costs). Alternatively, discuss a ‘gift and loan back’ arrangement with your legal advisor to determine whether it might be appropriate in your circumstances.

I’m looking at getting a new motor vehicle.

Should my business buy it?

This decision is usually based on a number of different factors: type of vehicle (does it meet the Tax Office definition of a ‘car’?) cost of vehicle likely level of work-related use personal circumstances Whether or not it is worth having the car in the business is determined by calculating the best deductions available in your circumstances. Your accountant should be able to assist you with this process. Remember, there is no one right answer for everyone: just because it is best for your colleague, does not mean that it is best for you. Q

DISCLAIMER: This article is intended to be general in nature and should not be relied upon by any person without seeking advice concerning their own circumstances.

Empowered Be Be Empowered Empowered William Buck Buck knows knowsyour yourindustry industryand andcan canempower empoweryou youtotomake makethe the right decisions when William right decisions when it it William Buck knows your industry and can empower you to make the right decisions when it comes comes to to your your finances. finances. comes to your finances.

Medical face a unique Medical practitioners practitionersand andleaders leadersofofhealth healthand andaged agedcare careorganisations organisations face a unique Medical practitioners and leaders of health and aged care organisations face a unique challenge; best quality of of care challenge; running runningan anefficient efficientand andsuccessful successfulbusiness businesswhile whileoffering offeringthe the best quality care challenge; running an efficient and successful business while offering the best quality of care for their their patients. patients. for their patients.

You can help you through You need need aa partner partnerwho whounderstands understandsthese theseunique uniqueindustry industryissues issuesand and can help you through You need a partner who understands these unique industry issues and can help you through the the financial, financial, business businessand andpersonal personalwealth wealthimplications. implications. the financial, business and personal wealth implications.

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DoctorQ NOVEMBER 2012 39 CHARTERED ACCOUNTANTS & ADVISORS CHARTERED ACCOUNTANTS & ADVISORS CHARTERED ACCOUNTANTS & ADVISORS

www.amaqis.com.au

Insurance renewal time getting you down?

Let’s face it insurance is boring.

But necessary.

We know doctors have a busy schedule, and while it may be easy to renew your insurance each year without proper revision, changes may have occurred for which you may not be fully covered and premiums need competitive comparison.

For peace of mind and taking the yawn out of renewal time, contact AMA Queensland Insurance Solutions.

All insurance needs covered for all members through AMA Queensland Insurance Solutions.

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AMA Qu eenslan d Insuran ce Solution Your Ins s urance Speciali sts

For more information phone: 1300 883 059

NOVEMBER 2012 DoctorQ

BUSINESS TOOLS

WHAT MANAGEMENT LIABILITY BUYS DOCTORS KNOW PREVENTION IS BETTER THAN CURE. SO IT FOLLOWS TO TAKE PREVENTATIVE STEPS TO MINIMISE FINANCIAL CRIPPLING BROUGHT ABOUT BY PERSONAL LITIGATION.

Private company directors and managers—even employees—increasingly face the very real risk of personal litigation from many of sources: minority shareholders, regulators, creditors, environmental groups, employees, customers and suppliers, to name a few.

Although you may consider that an allegation against the company or its directors by an employee or third party is completely baseless or without merit, without insurance you leave yourself exposed to expensive and time-consuming litigation to successfully defend any allegation.

Management Liability insurance is designed to protect the personal assets of the insured entity (business), directors and officers (meaning employees) by providing indemnity for any loss arising from a claim, as a result of a wrongful act, committed while carrying out their duties and obligations as required by those positions.

A good Management Liability policy should protect directors and officers for any legal liability they may incur personally in managing a corporation. It should also cover the business itself for certain types of claims such as wrongful dismissal and sexual harassment, claims relating to the staff superannuation fund and crisis management costs.

Due to complex legislation surrounding employment-related issues, cover for legal action brought against you or your business by an employee is very important. Employment Practices Liability Insurance is relatively new, designed to help employers minimise the risk and potential cost of claims made by employees, former employees—even potential employees— covers discrimination (age, sex, race, disability), unfair dismissal, wrongful termination, sexual harassment, and other employment-related allegations. Increasingly, companies are finding themselves vulnerable from the initial recruitment process through to the exit interview— even if an individual was never hired!

Scott Stewart AMA Queensland Insurance Solutions

Increasingly, companies are finding themselves vulnerable from the initial recruitment process through to the exit interview— even if an individual was never hired!

1300 883 059 scott.stewart@amaqis.com.au

Fidelity Insurance is another important cover that should be integral to any good Management Liability Policy. In simple terms, Fidelity Insurance protects a business or organisation against financial loss as a result of an employee’s /or officeholder’s dishonesty which can include loss of money, securities, or inventory resulting from crime. Common Fidelity claims allege employee dishonesty, embezzlement, forgery, robbery, safe burglary, computer fraud, wire transfer fraud, counterfeiting, and other criminal acts.

Whether you choose to purchase Management Liability Insurance or not, the simple fact is that without the protection of a suitable policy your business and all its directors and officers are exposed to a management liability claim— a claim that could financially cripple you personally.

AMA Queensland Insurance Solutions welcomes any inquiry you may have in relation to Management Liability Insurance. Do not hesitate to contact us to discuss the benefits of this or any other insurance policy. Q

The costs involved in defending against such allegations are not cheap. With this in mind, ensure that Employment Practices Liability is included in any Management Liability policy you hold.

DISCLAIMER: AMA Queensland Insurance Solutions is a joint initiative of AMA Queensland and Insurance Advisernet Australia Pty Limited ABN 81 072 343 643 AFS Licence 240549. AMA Queensland Insurance Solutions is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, Authorised Representative No: 320115. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.

DoctorQ NOVEMBER 2012

41

BUSINESS TOOLS

HOME OWNERSHIP: THE REAL COSTS

(AND WAYS TO MAKE IT YOUR REALITY) Barry Lanesman

ONLY 20 PER CENT OF DOCTORS-IN-TRAINING WILL BUY A PROPERTY IN THE FIRST 12 TO 18 MONTHS POST-UNI. INVESTEC’S BARRY LANESMAN OPENS THE DOOR ON SOME OF THE HIDDEN COSTS INVOLVED IN BUYING A HOUSE AND EXPLAINS HOW TO GET YOURSELF OVER THE WELCOME MAT.

Investec 1300 131 141 www.investec.com.au/medicalfinance

When you’re starting out in medicine, home ownership may not be on the radar. There’s a whopping great big HECS bill to pay, and living expenses. And then there’s the traditional bank requirement of a sizeable deposit to have saved.

One of the biggest hidden costs when getting a mortgage is Lender’s Mortgage Insurance (LMI).

The banks have to arrange it, and the insurer has to approve it. Requirements are strict. Many medical professionals just starting out can find themselves knocked back on income grounds because there’s no allowance given to your expected income trajectory: it’s all here and now.

LMI is a cost that you—as the borrower—carry; if you’re borrowing more than 90 per cent of the loan that can start to be quite expensive. And the LMI is not a tax-deductible expense, so there are no advantages to paying it.

That’s where Investec stands out, having made it our business to know young medical professionals and their priorities over the past 20 years. We can offer medical professionals mortgages of up to 100 per cent for owner-occupied properties, with discounted, fixed and variable rate options available, as well as offset accounts for all loan types with no LMI requirement. Rather than wait 12 months to save up a 20 per cent deposit, we’re here to support doctors move into their first home.

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NOVEMBER 2012 DoctorQ

Many medical professionals just starting out can find themselves knocked back on income grounds....

Having a 100 per cent offset account allows preservation of the debt while paying it down: an important tax strategy if you move out of that home—most likely to be an apartment— but hang on to it as an investment property. Here’s why: if you borrow $400,000 for your first home, then pay down half of it, then buy another property and hang on to your first one as an investment property, you can’t claim a tax deduction on it. Instead, you need to leave the loan at $400,000 and accumulate your repayments in a 100 per cent offset account, so the loan is the same; you pay only the interest. Money accumulated in the offset account is then available to buy the next property. Q

The information contained in this article (“Information”) is general in nature and has been provided in good faith, without taking into account your personal circumstances. While all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, no warranties in this regard are provided. We are not providing tax advice and we recommend that you obtain independent financial and tax advice before making any decisions.

The opinions expressed in this publication are those of the respective authors and do not necessarily reflect the opinions of Investec Bank (Australia) Limited.

FOUNDATION

DOCTORS DOING GOOD AMA NATIONAL PRESIDENT STEVE HAMBLETON TALKS ABOUT HIS PASSION FOR THE AMA QUEENSLAND FOUNDATION WITH ITS NEW MANAGER, COLLEEN HARPER.

COLLEEN HARPER

Manager, AMA Queensland Foundation

Q: With all your other commitments, including your medical practice, leading AMA nationally and your family (four teenage children!), why do you still make the time to be president of the AMA Queensland Foundation?

Since commencing as a General Practitioner in 1987, I have had the opportunity and privilege of getting to know many of my patients and their families. Many have felt comfortable sharing their hopes, dreams and ambitions with me. Unfortunately, I also have seen how wracked with anxiety patients and carer family members can get as they battle issues such as ageing parents, chronic mental illness, or children with congenital or acquired disabilities.

What I struggle with the most as their general practitioner is the constraints within the health system that deny families access to services or care that they desperately need. I believe AMA Queensland Foundation can help bridge some of those gaps.

who have chosen to support the Foundation since its establishment in July 2000. Its many successes have included: • new wheelchairs for children suffering from Muscular Dystrophy • new equipment for the Red Hill Special School to assist education programs for students suffering multiple disabilities • incubators and Cytospin machines to support vital cancer research • vital signs monitoring equipment for regional hospitals • medical school bursaries for students at James Cook University who have a passion for rural medicine and are facing financial hardship.

Q: And latest developments?

During 2012 the Foundation underwent a review. We’re now at a point where AMA Queensland members’ input is needed to plan for 2013 and beyond.

Q: Tell us about the rest of the Foundation Board?

Q: Tell us about the AMA Queensland Foundation’s successes?

We have a very dedicated team made up of Alex Markwell, Jane Schmitt, Ross Noye, Lisa Story, Katharine Philp and our wonderful Patron Tim Fairfax, AM.

Firstly I would like to take the opportunity to thank 454 individuals and organisations

I would like to thank Neil Mackintosh, Foundation Executive Officer for all his hard

Tell us what you think AMA Queensland Foundation’s priorities should be. (Please tick) I/we would like the AMA Queensland Foundation to consider these ideas/suggestions:

The AMA Queensland Foundation was created by AMA Queensland doctors (people just like you) and members of the community to deliver vital medical services to Queenslanders unable to access them through other means. We really want to know what projects you would like the AMA Queensland Foundation to support, be it funding a baby clinic in a remote indigenous community or providing a hearing aid for an 80-year-old. Please take the time to fill out the questionnaire below. Q

ABOUT COLLEEN HARPER Colleen brings wide ranging fundraising experience to AMA Queensland Foundation. She was behind the enormously successful Eunice Science and Resource Centre Capital Campaign at St Margaret’s Anglican Girls School and was part of the State Library of Queensland’s fundraising team.

Name:

Address:

Ph (H):

(provide details)

Q: If you could say one thing to the AMA Queensland members, what would it be?

Personal Details

I/we have a patient who could benefit from the AMA Queensland Foundation’s support.

work and patience over the past 12 years. I am pleased to say Neil has only gone into semi-retirement; he remains organiser of our AMA Queensland state conference.

Ph (M): Email:

Please detach this form and post, fax or email:

Colleen Harper AMA Queensland Foundation Postal: PO Box 123, Red Hill Q 4059

I/we would like more information about making a donation to the AMA Queensland Foundation.

DONATE ONLINE

www.amaqfoundation.org.au

Fax: 07 3856 4727 Email: c.harper@amaq.com.au DoctorQ NOVEMBER 2012

43

AROUND THE REGIONS

LOCAL MEDICAL ASSOCIATION ROUND UP

JOIN YOUR LMA

STAY CONNECTED WITH COLLEAGUES AND UP TO DATE WITH THE LATEST HEALTH NEWS AND ISSUES AFFECTING YOUR LOCAL AREA. DON’T STAND ON THE SIDELINES —JOIN YOUR LOCAL MEDICAL ASSOCIATION TODAY AND MAKE A DIFFERENCE.

SUNSHINE COAST

TOWNSVILLE

FRASER COAST

Monthly dinner meetings are generally held on the fourth Thursday of each month.

For information on meeting dates and membership contact Townsville LMA President Dr Carl O’Kane.

For information on meeting dates and how to join, contact Fraser Coast LMA President, Dr Shaun Rudd.

Phone: (07) 4433 1111

Next meeting: 21 November - AGM

Next meeting: 22 November Venue: Maroochydore Surf Club Function Room, Alexandra Parade, Cotton Tree Time: 6:30pm for 7pm Convenor: Jo Bourke Phone: (07) 5479 3979 Fax: (07) 5479 3995 Email: jobo@squirrel.com.au For further information or to join visit www.sclma.com.au

Phone: (07) 4128 3644

GOLD COAST For information on meeting dates go to www. gcma.org.au or email info@gcma.org.au A membership form can be downloaded from our site.

Phone: (07) 5575 7054 Fax: (07) 5575 7551

BRISBANE NORTHSIDE

Email: info@gcma.org.au

Next meeting: 11 December – Christmas Dinner

REDCLIFFE & DISTRICT

Venue: Moda Events, Portside

Next meeting: 30 November

Time: 6:45pm for 7:15pm

Venue: Golden Ox Restaurant, Redcliffe

Convenor: Dr Graham McNally

Time: 7pm for 7.30pm

Phone: (07) 3265 3111

Convenor: Margaret MacPherson

For further information or to join, visit www. northsidelocalmedical.wordpress.com

Phone: (07) 3409 4429

For information on meeting dates and how to join, contact Bundaberg LMA President, Dr Daud Yunus.

CENTRAL QUEENSLAND Next meeting: 29 November Topic: Improving communication and support between Private and Public sectors, GPs and Specialists Venue: Hillcrest Private Hospital Time: 6:00pm for 6:30pm RSVP: harleywilson00@gmail.com Phone: 0419 277 611 For information on meeting dates and membership contact Central Queensland LMA Secretariat Dr Harley Wilson.

TOOWOOMBA For further information, go to www.tddlma. org.au or email info@tddlma.org.au

CAIRNS BUNDABERG

Fax: (07) 4124 0660

For information on meeting dates and membership contact Cairns LMA President Dr Sharmila Biswas.

Phone: (07) 4036 4333

Membership to the Toowoomba and Darling Downs LMA is just $50. To join, download an application form at www.tddlma.org. au/membership.html

Phone: (07) 4152 2888 Fax: (07) 4153 3245 Email: daud.yunus@gmail.com

CAN’T FIND YOUR LOCAL AREA?

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NOVEMBER 2012 DoctorQ

If your Local Medical Association does not appear above or your details are incorrect, please email David Hillier at d.hillier@ amaq.com.au with corrections, contact details, how to join, web address, dates for upcoming meetings and who to contact for further information.

obituaries

DR JOHN ALEXANDER NOBLE 31 July 1937 - 17 August 2012

John Noble was an outstanding ophthalmic clinician and surgeon, a pioneer in taking high-quality eye care to rural and regional Queensland.

The eldest of five, John followed his father, Dr Winston Noble, renowned GP and Health Minister in the Nicklin Government, into medicine, studying at the University of Queensland. Specialty training in Melbourne followed. John and wife Judy then settled with their young family in Toowoomba. He was soon drawn to extend his practice to more remote locations, providing diagnostic and surgical eye services to patients on the western Downs, the South Burnett, central Queensland coal towns, Bundaberg, Hervey Bay and northern NSW. To adequately care for patients across such a vast catchment, John invested in aircraft and a full suite of operating equipment.

By Dr Collette Sheridan John stayed ahead of the curve in his uptake of new technologies, being one of the first to use computerised records and to apply the innovation of laser and phaco-assisted surgery in his work.

John’s distinguished medical career spanned over 40 years and he was a loyal member of AMA Queensland for almost 50 years.

In his precious time off-duty, John loved relaxing by the water: sailing, fishing and beach-combing with Judy, his beloved children and grandchildren, and his muchloved dogs. He was a man of integrity, profound intellect, and quiet good humour who calmly faced life’s challenges with courage and fortitude. John made a notable contribution to regional Queensland’s ophthalmic services and will be sadly missed but fondly recalled by his treasured family, friends and colleagues. Q

AMA QUEENSLAND ALSO SADLY WISHES TO ADVISE THE PASSING OF: Dr Satish Prasad, 49 Obstetrics and Gynaecologist Late of Rockhampton Member for 8 years

Which of these people have a sleep disorder?

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DoctorQ NOVEMBER 2012

45

MEMBER NEWS

CONGRATULATIONS to the following doctors who are now elected members of AMA Queensland.

JULY DOCTORS IN TRAINING

Dr Christopher Darlington Dr Nicholas Egerton Dr Fraser Morton Dr Simon Ryder Dr Daniel Henderson Dr Bavahuna Manoharan Dr Yu Liu Dr Samira Moosavi Dr Vivienne Tan Dr Smriti Joshi Dr Peter Elepfandt Dr Laura Jones Dr Benjamin Lawry Dr David Nichols Dr Jolyon Bond Dr Chandrashekar Harlapur Dr Lenon Mandikiza Dr Thakur Singh Dr Christopher Arthur Dr Wai-Keung Lee Dr Gillian Wright Dr Alice Chang

GENERAL PRACTITIONERS Dr Alexander Ha Dr Saman Perera Dr Fatemeh Asadi Dr Raza Raza Dr Gawie Roux Dr Reza Safari Nejad Dr Anthony Jones

PART-TIME PRACTITIONERS

Dr Thomas Challenger Dr Deon Malone Dr Brett J Robinson Dr Juliet McKenzie Dr Tapasi Bagchi Dr Zubin Grover

SALARIED PRACTITIONERS

Dr Julie McGaughran Dr Ben Ryan Dr Mark Downing Dr Konara Samarakoon Dr Nilesh Parmar Dr Sean Brennan Dr Jeremy Cohen Dr Elizabeth Grosso Parental Leave Dr Melinda Heywood

AUGUST DOCTORS IN TRAINING

Dr Grant Giokas Dr Ian Dodsworth

46

Dr Mei Lee Dr Rowena Witham Dr Eshini Perera Dr Nasar Ahamed Dr Muhammed Shah Dr Tariq Mahmood Dr Margaret-Anne Provan Dr Gideon Oju Dr Zulema Perez Dr Karen Chai Dr Natasha Frost Dr Angus MacKinnon Dr Natalie Lindsay Dr Thusara Gallage Dr Renee Verkuijl

GENERAL PRACTITIONERS Dr Behzad Rafiee Dr Eoin G McCarthy Dr Alice McNab Dr Dion Dewar Dr Diamond Hira Dr Nicholas Sawyer Dr Unmesh Sinnya Dr James W Orforf Dr Mohamed Khafaji

2013 MEMBERSHIP RENEWALS Soon you will receive your renewals pack for 2013 which highlights our ever-expanding range of member benefits and key AMA Queensland achievements over the past 12 months.

The renewals pack also includes information about how to join our exciting new AMA Queensland Members Life Insurance Scheme (see page 2 for details).

Your renewals invoice this year will include both your membership subscription fee and your one-time offer, discounted premium for life insurance.

20 December, will have the chance to win an exclusive prize—a fully catered and hosted corporate suite at the Australian Open Series, Brisbane International at the Queensland Tennis Centre on Tuesday 1 January (day session).

This fantastic prize, valued up to $5,000, is proudly offered by our corporate partner Lexus of Brisbane. The corporate suite, which is air-conditioned and fully hosted, seats up to 12 people and the guest list is entirely up to you! Bring your family, friends or colleagues to share an incredible experience as world champion players such as Serena Williams, Maria Sharapova, Andy Murray and Leighton Hewitt battle it out on centre court. Q

PART-TIME PRACTITIONERS

Early birds who renew their AMA Queensland membership and join the AMA Queensland Members Life Insurance by

SALARIED PRACTITIONERS

AMA QUEENSLAND’S 2013 EVENTS

Dr Sarah Townsend Dr Trevor Sadler Dr Michael Tan Dr Ralph Pinnock

Dr Wayne Nicholls Dr Damien Abbott Dr Christian HamiltonCraig Dr Benjamin Clarke Dr Dwarakanathan Ranganathan Dr Terence Lyons Dr Christopher Coulter Dr Helmut Schoengen Dr Anupam Chaudhuri Dr Andrew Potter Dr Touraj Taheri Dr Nathan Smalley

JOINT PRACTITIONERS Dr Heather Crowe Dr Maimuna Shah Dr Robert Morrow Dr Kristen N Price Dr John Wang Dr Kah Yee

MATERNITY LEAVE

Dr Andrea Miller Dr Hina Bijelic

NOVEMBER 2012 DoctorQ

Thank you for the great response to our events survey. You asked for: • free member events and affordablypriced seminars

WINNER

Dr Paro Padding mita Das Gupt a to voucher n won a $1,000 of just for c travel o m online s urvey. T pleting the he generou sly prov prize was ided corpora te part by our AMA Tra ners, vel.

• topics such as improving the system, the future of health, clinical issues, medicolegal issues, and discussions on ethics and leadership in health

venues both in Brisbane and throughout regional Queensland

• sessions that are CPD-compliant and include high-profile speakers from the medical profession

• relaxed opportunities for networking and socialising with colleagues, partners and friends, including wine tastings

• programs tailored to your craft group or career stage

This valuable feedback is directly shaping AMA Queensland events’ calendar which will be distributed to members early in the new year. Q

• events that are conveniently held on weeknights and Saturdays at accessible

DATE R CLAIME

Our first event of 2013 will be an exclusive breakfast with Queensland Health Minister, the Hon Lawrence Springborg MP, on Thursday 21 February at Moda Portside. Further information will be in an upcoming Events & Training e-newsletter, including how to register for the event.

MEMBER NEWS

MEMBER EXCLUSIVE! Find out about the new improved mobile technology, developed by AMA Queensland, that’s putting AMA members within finger touch of patients.

AMA QUEENSLAND CONNECTS DOCTORS AND PATIENTS AMA QUEENSLAND IS PROUD TO ANNOUNCE THE EXPANSION OF OUR SMARTPHONE APPLICATION FOR FIND A DOCTOR TO INCLUDE FIND A SPECIALIST ALONG WITH FIND A GP, NOW INTEGRATED WITH AN ONLINE APPOINTMENT BOOKING SYSTEM, CLINIC CONNECT.

FIND A DOCTOR / FIND A SPECIALIST SMARTPHONE APPLICATIONS Following the popularity of our Find a Doctor Smartphone application, AMA Queensland has introduced Find a Specialist functionality. Both Find a GP and Find a Specialist can be downloaded onto iPhone and Android based systems. Free to use, their interactive mapping technology pinpoints precise locations along with practitioner details.

Users can also search through the app to locate a GP or specialist based on name or location.

Listing is free for AMA Queensland members, providing an ideal opportunity to promote participating doctors and practices.

View or download Find a Doctor or Find a Specialist at www.amaq.com.au CLINIC CONNECT Clinic Connect is Australia’s leading online appointment booking system. Its portal is

user-friendly and compatible with major practice management software systems to support an overall streamlining of clinic processes. Clinic Connect integrates fully with the AMA Queensland Find a Doctor iPhone and website listings, displaying the link to the relevant Clinic Connect online booking form for any AMA doctor who is a current Clinic Connect subscriber.

Clinic Connect is a proven, cost-effective way to manage patient appointments and enhance customer satisfaction by offering greater flexibility and convenience. Patients can now manage their bookings 24/7, check a doctor’s availability and select a suitable appointment time, without time-wasting phone-queues during business hours. This also frees up reception staff, allowing them time to give greater attention to patients and clinic duties.

AMA Queensland members get a discount when subscribing to Clinic Connect. Find out more by contacting James Sully at Clinic Connect on 1300 991 953. Q

clinic connect HOW YOUR clinic connect PRACTICE BENEFITS FIND A DOCTOR/FIND A SPECIALIST APP • Great promotional tool for your clinic or practice • Convenient way to find a colleague • Build your client base - for free!

CLINIC CONNECT • Improved office efficiency with less front desk interruptions, saving time and money • Ability to synchronise Clinic Connect with existing systems • Fewer no-shows and wasted vacant appointments

HOW PATIENTS BENEFIT FIND A DOCTOR/FIND A SPECIALIST APP • Convenient way to locate a doctor • User-friendly technology • Guaranteed accurate GPS maps CLINIC CONNECT • Convenient, accessible appointment making • Flexibility of online booking

DoctorQ NOVEMBER 2012

47

MEMBER PROFILE

DR DEBORAH MILLS

DOCTOR

WHO?

MEET A DOCTOR WHOSE PASSION FOR SEEING THE WORLD—AND HELPING OTHERS DO SO WHILE MAINTAINING A STATE OF WELLNESS—IS ONLY MATCHED BY CONCERN FOR THE STATE OF OUR PLANET’S HEALTH. AS TOLD TO HEATHER GRANT.

Q. You are Queensland’s original ‘travel doctor’. How’d that happen?

After graduating in 1983 and spending a couple of years in RockVegas (Rockhampton), I really wasn’t sure what I wanted to do—other than travel. I did some GP locums to fund the travel, and developed a great respect for GPs: they have to be on top of so many aspects of medicine.

My travel agent knew me quite well and on return from one trip mentioned there was a job going for a doctor who could look after travellers’ health needs predeparture. The rest, as they say, is history.

Q. Describe your practice now.

It’s wonderful! I have two clinics (one in Brisbane’s CBD and one on the city’s north side), employ 20 staff and have happy patients who are excited about their plans, not sick and keen to stay that way!

Q: Travel medicine must be complex: so many illnesses, so many countries. How do you skill yourself up?

There’s a lot more to it than needles. It is about information, and that’s changing all the time. I’m a member of the International Society of Travel Medicine which offers fascinating courses—like

visiting the sewerage systems of India!

Education really is the key. That’s why I wrote Travelling Well in 1989, using plain language patients would understand.

Every edition since—we’re up to 17—has updated information; much of it has come from feedback from travellers.

Q: What trends have you seen over the years?

People are travelling with very little notice. That has implications for the efficacy of vaccinations or medicines they may need.

From a practice perspective, it’s really hard finding good reliable staff.

Under 25s, be they doctors, nurses or administration, are internet savvy but not savvy about the real world.

NOVEMBER 2012 DoctorQ

HEALTH TIPS

Q: What’s most overlooked when it comes to travellers preparing for trips?

To some extent, the implications of jetlag, altitude problems, sexually transmitted diseases, and thrombosis, the importance of keeping childhood immunisations up to date... and the impact our travel has on the environment. Truly, our planet is in intensive care, on life support.

Infectious disease is often overlooked

Our planet is in intensive care, on life support...

48

TOP TRAVEL 1 2

• Don’t leave home without a traveller’s medical kit.

• Rather than throw away endless empty plastic water bottles, consider refilling with water that’s been boiled constantly for one minute – or use iodine tablets to make water safe to drink.

3

• If you must eat from street vendors, ensure the food is too hot to touch.

WIN! People are travelling with very little notice. That has implications for the efficacy of vaccinations or medications they may need.

as a potential for major disaster—and it’s because we forget the link to the environment. We forget that in the 1300s, the Black Plague killed about 30 million people because the environment at that time wasn’t being looked after. I’m a member of Doctors for the Environment Australia (http://dea.org.au) which highlights the absolute dependence of our wellbeing on healthy natural ecosystems.

Q: Do you still have the travel bug?

It’s tempered by the difficulty in finding appropriately trained and interested locums. But yes, I count myself lucky to have travelled—44 countries so far—and look forward to more.

Q: What words of wisdom inspired your career?

Back when I was a resident, and really didn’t know what I wanted to do, one of my consultants told me said: “Find something at which you can be the best in the world—and then you will be happy”. I did—and he was right.

PORTABLE INFO Dr Deb The Travel Doctor has developed a Vaccine Record for Travellers App, suitable for Android and iPhone/iPad. Her book Travelling Well is now available on iPad. Doctor Q has a hard copy of Travelling Well to give away as part of our readership survey prize pack. See page 6.

Q: You’re a member of AMA Queensland Council. Why is the organisation important to you?

The AMA is a voice that the public listens to. I’m grateful that my education was free, thanks to Gough Whitlam, and for that, I keep working and giving back to the community. Q

Q: What places have impressed you the most?

Bhutan, where the king decreed that gross national happiness is more important than its gross domestic product, and Antarctica: untouched yet the effects of the population and climate change are starting to show.

Q: What’s the one thing you would always pack?

The word ‘bomb’ is not something to be used around airlines but that’s what I call a combination ‘stopper’ and antibiotic that sorts our travellers’ diarrhoea and allows travellers to feel better within four hours.

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Conference

ULTIMATE CONFERENCE ENDORSEMENT:

MADRID—A MIXTURE OF OLD WORLD AND NEW, RELAXED, FRIENDLY AND SAFE— PROVIDED THE PERFECT SETTING FOR MORE THAN 180 DELEGATES AT AMA QUEENSLAND’S 12TH ANNUAL CONFERENCE IN LATE SEPTEMBER.

Structured around the theme ‘Prevention is better than cure—preventative health strategies for the 21st century’, its balanced approach to education and entertainment ensured enthusiastic discussion and debate.

Health topics ranged from the benefits of a Mediterranean diet and the implications of emergency medicine in public health through to management of work-related injury and illness, illicit drugs, pain and rehabilitation and the impacts on personal injury cases, and clinical observations on early cancer diagnosis.

Conference photos: Anthony Allan

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Beyond the confines of the conference walls, delegates explored the wonderful Madrid and the marvelous living museum of Toledo.

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for our co aq.com.au

.am Visit www

As medical practitioners well know, health care is not all about medicine. That’s where sessions on subjects from medical practice IT management, effective and affordable insurance, Medicare Locals and the new world of after-hours patient care provided timely guidance on new developments.

Ole!

Queensland Health’s restructure and its challenges was on everyone’s lips.

Conference

sponsor profile TressCox Lawyers’ Katharine Philp reminded conference delegates that the Medical Board of Australia must know of ‘relevant events’ in a medical practitioner’s life well before annual registration renewal time.

Under the Health Practitioner Regulation National Law Act (2009), doctors have seven days to tell the MBA of: being charged with an offence punishable by 12 months’ or more imprisonment Colleen Sullivan, Stuart Tait and Peter Steele put their best arm – or was it argument?

– forward in the great debate: ‘Is there a correlation between tattoos and intelligence?”

being convicted of, or the subject of a finding of guilt, for an offence which is punishable by imprisonment loss of appropriate professional indemnity insurance withdrawal or restriction of your right to practice at a hospital, or another facility at which health services are provided, due to your conduct, professional performance or health withdrawal or restriction of billing privileges under the Medicare Australia Act 1973 due to conduct, professional performance or health cancellation or restriction of your authority to prescribe, possess, supply or administer scheduled medication lodgement of a complaint about you to Commonwealth Health Agency or officer

Australia’s Ambassador to Spain Zorica McCarthy provided a warm “bienvenidos”

suspension or cancellation of your registration in another country.

Medical practitioners have 30 days to advise the MBA of the following changes: principal place of practice postal address for the purposes of receiving notices from the MBA name.

“While failure to provide such notice is not an offence, it could lead to disciplinary action and that’s distress and time that can be avoided. When in doubt, ask your legal adviser to ensure you fulfil the obligations imposed by this national law,” Ms Philip said.

Special thanks go to: Australia’s ambassador to Spain, Zorica McCarthy, who officially opened our conference Dr David Mariscal, a Madrid endocrinologist, who spoke on children and obesity Juan Jose Guemes from the IE Business School in Madrid who explained the Spanish economy Our sponsors — Medico-Legal Insurance Group, Ross Noye, Family Care Medical Services, TressCox Lawyers, Australian Association of Practice Management and AMA Travel. Q AMA Queensland CEO Jane Schmitt presents Juan Jose Guemes with a small token of appreciation.

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People & EVENTS

THE ES MEYERS LECTURE 2012: SLIDING DOORS ABOVE RIGHT: Following in great footsteps, ES Meyer memorial Lecture convenors Divya Viswanathan and Jessica Page with guest speaker Dr James Morton.

Twenty-five years after convening a University of Queensland Medical School ES Meyer Memorial Lecture, clinical haematologist, oncologist and founder of the AEIOU Foundation Dr James Morton found himself behind the rostrum again this year—this time as its key speaker.

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NOVEMBER 2012 DoctorQ

Dr Morton provided candid insight into decisions he had made, challenges faced and lessons learnt in a career that has seen him embrace skills well beyond the stuff med school teaches like lobbying, fundraising and advocacy.

Aside from his clinical accomplishments, including significant research, Dr Morton was behind the Leukaemia Foundation’s signature fundraiser World’s Greatest Shave which has raised more than $138 million since its establishment.

AEIOU, founded with his wife following the diagnosis of his own child with autism, provides early learning opportunities for children diagnosed with autism and now has centres across Queensland. About 80 per cent of its child ‘graduates’ enter mainstream schools.

Dr Morton’s presentation marked the 55th annual forum, honouring a founding father of the University of Queensland School of Medicine, Professor Errol Solomon Meyers. Q

People & EVENTS

ESSENTIAL WOMEN’S BUSINESS TressCox Lawyers’ Cassandra Heilbronn, Ellizabeth Quinn and Katharine Philp happily shared ins and outs of legal and life issues.

Savvy women members attended a recent free seminar at AMA House to learn from experts how to realise their career and lifestyle goals.

Takakao Kobayashi brought her daughter along, believing it’s never too soon to learn secrets to successful living.

Jennifer McAuliffe, Melinda Stantion, Suzanne Poulgrain and Katherine McNally

Topics as diverse as leave entitlements, working parents’ rights, social media and its place in health law and ways to minimise tax obligations for a comfortable financial future were presented by experts, chartered accountant and regular Doctor Q columnist Julie Smith, TressCox Lawyers’ Cassandra Heilbronn and AMA Queensland Workplace Relations’ Andrew Turner. Q

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People & EVENTS

AAPM CONFERENCE BUZZES WITH TRUST Healthcare practice managers from across Australia recently converged on Brisbane for the Australian Association of Practice Managers conference.

As well as being a chance to exchange ideas and experiences, the conference provided opportunity to refresh and learn new skills relating to finance, business and medico-legal issues as well as team dynamics and communication.

Biggest Loser trainer and Cleo Bachelor of the Year candidate Shannan Ponton was among a line-up of unusual guest speakers. The secret to his amazing team results on Biggest Loser came down to trust, he said: being able to get more from people than they ever imagined. Q

Double the size, double the value!

Receive a DOUBLE UPGRADE on your weekend rental of 2 days or more. Rental must be collected between Thursday noon and the following Monday midnight and include a Saturday night keep.

In addition, you’ll receive your AMA discounted rate and fee waived membership to the Hertz #1 Club Gold program. It all adds up to a great deal for AMA members from Hertz!

To make a booking, visit hertz.com.au or call 13 30 39. Be sure to quote CDP# 283826 and PC# 174521

For a better journey

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NOVEMBER 2012 DoctorQ

horatioTM

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After years of study and hard work getting where you are today, surely the most important priority is to protect your income? If you are unable to work due to illness or injury, an Income Protection policy will ensure you have an ongoing monthly income to provide for your ongoing living costs.

For more information on how you can structure a personalised protection portfolio, contact us for advice specific to your needs.

FREE CALL 1800 552 555 Medico Legal Insurance Group Pty Ltd is an Authorised Representative of Millennium3 Financial Services Pty Ltd Australian Financial Services Licence Number 244252

www.mlig.com.au Phone 07 3007 7800 Facsimile 07 3007 7822 55 DoctorQinfo@mlig.com.au NOVEMBER 2012 Email

People & EVENTS

GIVING MED STUDENTS THE JUMP ON INTERNSHIP

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NOVEMBER 2012 DoctorQ

It’s that time of the year when AMA Queensland hosts ‘Connect with Your Career’ workshops for graduating medical students.

With uni behind them (for now), thoughts turned to issues like workplace relations, overcoming the ward call blues and tips for safe prescribing.

Sessions held as Doctor Q went to press , on the Gold Coast and in Brisbane, were wellattended and overwhelmingly positive.

The last of AMA Queensland’s ‘Connect with Your Career’ workshops, generously supported by our sponsors, will be held on 12 December for James Cook University’s graduands. Q

events calendar

COMING

UP

21 FEBRUARY 2013 BREAKFAST WITH THE MINISTER

WHAT’S ON

Moda Portside Registration essential Join Queensland Health Minister Lawrence Springborg at Moda Portside.

Reservations essential. Check www. amaq.com.au/events for details.

NOVEMBER WORKPLACE RELATIONS TRAINING 19 November - 6 December Registration essential An essential for GPs and practice managers, your three-hour interactive workshop is being held in 10 locations. Contact Julija Ovnic, AMA Queensland on 07 3872 2216.

10 DECEMBER

13 DECEMBER

MOCA LUNCHES

GET THE COMPETITIVE EDGE

Cleveland, Redland Hospital Come along for an update on your Medical Officers’ Certified Agreement , meet AMA Queensland President Dr Alex Markwell and enjoy a FREE lunch!

TO VIEW THE FULL EVENTS CALENDAR MDA NATIONAL GRADUATE CELEBRATIONS December Gold Coast, Brisbane, Townsville MDA National celebratory breakfasts and lunches throughout early December for Griffith, Bond, James Cook and UQ medical graduates.

Registrations essential.

6:00pm - 8:00pm JAM Corner, Townsville A great networking opportunity to learn top working tips and tricks and also how mentoring can benefit your career. All doctors and students welcome.

Or to register for an event, visit amaq.com.au/events or contact Louise Glynn on 07 3872 2269 (email:l.glynn@amaq.com.au).

EXPERT EVIDENCE 21 March 2013 5.30 - 7.30pm AMA House, Kelvin Grove A Doctor’s Guide to presentation of expert evidence.

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lifestyle

OF CHRISTMAS Drops CHEER WINE DIRECT’S MATT WALLACE PLAYS SANTA’S HELPER WITH GIFT SUGGESTIONS AND PROVES TO BE THE HOST WITH THE MOST, PROVIDING HIS TOP DROPS FOR SERVING THIS FESTIVE SEASON.

TURKEY FLAT BUTCHERS BLOCK GSM 2010

BARWANG TUMBARUMBA CHARDONNAY 2012

O’LEARY WALKER SAUVIGNON BLANC 2012

Gold and 2nd highest points in class Royal Adelaide Wine Show Before the Royal Adelaide Wine Show, I said: “This is the best medium bodied red we have seen this year: a most generous palate and soft fine tannins. The fruit profile is complex and seamlessly integrated. This is exceptional drinking …”

Gold and highest points in class This is about as good as ‘new’ Chardonnay gets: a brilliant structure which showcases lemon flesh, minerality and stonefruits. The flavour keeps chugging from the tip of your tongue till long after it disappears from view.

2 Gold and 2 trophies Fresh and zippy with herbaceous characters and passionfruit bleeding into tropical fruit, this wine has more texture and mouth-feel than most Savvy Blancs thanks to the inclusion of some lees during the fermentation.

LAMBROOK ESTATE ADELAIDE HILLS SHIRAZ 2010

Bronze medal A clever blend of Adelaide Hills and Barossa fruit fermented in stainless steel and a little French oak. The wine is also stored on lees for several months. The net result is a wine that starts crisp and zippy but finishes rich and long and textural.

Gold and Montgomery Trophy for Best Red under $20 Very good booze, white pepper, vanilla and blackberries on the nose. Same on the palate with creamy vanilla and blackberries leading to a fine, powdery finish. Very smooth and exceptionally well-structured.

BRANDS LAIRA COONAWARRA CABERNET MERLOT 2010 Gold and 2nd highest points in class. Fivetime gold medallist elsewhere.

A wonderful nose: dusty cacao, Satsuma plum, musk and a brooding herbal note (aroma of sage as opposed to aura of sage).

The palate is pretty buff with fine tannin corsetry allowing a stunning display of pendulous fruits. Lovely now, and will cellar very well.

GRANT BURGE FIFTH GENERATION CHARDONNAY 2012

PATRICK OF COONAWARRA AGED RIESLING 2006 Gold and trophy A stunning wine which belies its age, with its freshness and almost ethereal lightness.

Don’t be alarmed though: this wine features pristine and intense Riesling fruit of the best kind. Citrus blossom, butter and toastiness are all here, in perfect balance and harmony.

GOUNDRY HOMESTEAD SAUVIGNON BLANC 2012 Gold and equal 2nd highest points in class A bit outlandish, this dinner guest has vibrant over-the-top tropical fruits popping aplenty. Give it a set of maracas and start whistling a little Peter Allen.

CORIOLE REDSTONE SHIRAZ 2010 Bronze medal An absolute cracker of a wine even if it ‘only’ scored bronze. Blackberries, plum, liquorice and Christmas cake spices stretch taut over a framework of acid and fine tannin.

ESKADALE VINEYARDS ODDFELLOWS CABERNET 2008 Gold and highest points in class This stunningly complete wine offers a stack of very ripe black and blue fruits without ever touching jammy. It’s big and, with its fine tannins, an incredibly moreish drop.

For the Royal Adelaide Wine Show’s complete dozen, go to: www.winedirect.com.au/wineshowdozen Q

Matt Wallace Wine Direct 1800 649 463 matt.wallace@winedirect.com.au

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We are pleased to welcome officially our latest corporate partner for investment and financial advisory services, Ross Noye, Senior Adviser at Macquarie Private Wealth.

Many of you may already be familiar with Ross and his team from regular article contributions in Doctor Q, keynote speaking at personal development events, an active Director of the AMAQ Foundation and proud supporter of AMA Queensland’s Annual Conference for over 12 years.

With more than 28 years in the investment and finance industry, Ross brings an impressive wealth of knowledge and experience for our members to utilise including: •

retirement planning

•

stock broking

•

self managed super funds establishment

•

private portfolio management

•

personal investment portfolio management

•

asset allocation advice.

BENEFIT FOR MEMBERS: As a member of AMA Queensland, the Macquarie Private Wealth partnership provides you with an initial 1 hour consultation by teleconference or in person at no cost. The AMA Queensland has also negotiated attractive fee reductions across all services including brokerage rates, investment management, retirement and financial planning advisory fees.

We encourage you to take advantage of the comprehensive services package provided by Ross and his team, which includes his Review, Reset, Restructure approach to wealth creation and management: •

reviewing investment strategies and portfolios

•

resetting financial goals and objectives

•

restructuring strategies and portfolio investments within agreed risk parameters.

HOW TO CONTACT ROSS:

•

a special low $450 fee to establish your own Self Managed Super Fund

Go to AMA Queensland website and simply click on his logo. Please also feel free to call, text or send an email.

•

margin lending without margin calls

Phone: (07) 3233 5805

•

access to managed direct share portfolios with $0 trades

Mobile: 0438 77 99 55

•

strategies to protect your investment capital from losses

Email: ross.noye@macquarie.com

•

simple strategies to increase portfolio investment income

•

ways to diversify into international investments without having to use managed funds.

Ross also offers AMA Queensland members:

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 237504, 1, Shelley St, Sydney NSW 2000.

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BEYOND THE BOOM REVIEW ASSET ALLOCATION AS INTEREST RATES ARE SLASHED AND THE US RECOVERY GAINS TRACTION SAYS INVESTMENT COLUMNIST ROSS NOYE.

Equities expected to ourperform commodities S&P 500 to CRB Spot index Ration Shaded areas indicate commodity booms 6,000

600 +305% 60

-62%

+1296%

-56%

50 56 62 68 74 80 86 92 98 04 10

Lower interest costs tend to boost Australian company profits...

Outlook - Boom-equilibria-boom, we have seen this pattern four times in the past 100 years. During the equilibria there has always been a renaissance in equities. We believe now is the time to review portfolio asset allocations with view to increasing Australian equity and international exposure with a focus on the US. Look to accumulate positions in favoured names as seasonal weakness tends to peak in September and October. We are bullish on the S&P 500 and favour US domestic cyclicals given the US housing recovery and the stronger US dollar.

We believe the commodity boom ended in 2011. We think four factors drove the boom; rising China demand, a slow supply response, the fall in the USD and financial innovations that led to a step change in money flows. China’s growth will continue, albeit at a slower rate, and with a shift to consumption. That said, we think other legs supporting the boom have dissipated as supply is catching up with demand, a stronger US outlook will support the USD, and we see money flows into commodities slowing.

We believe a secular shift has occurred in financial markets and in our view the commodity boom is over. We expect real commodity prices to fall. Given the need to fund retirement obligations, we expect pension funds and other investors to lift their equity allocations over coming years.

RBA to slash rates as it looks for the next growth engine to for the Australian economy.

Financial markets are expecting Australian interest rates to be sub-2.5 percent by the end 2013.

Lower interest costs tend to boost Australian company profits, providing impetus and support for share prices.

Investors should focus on companies with operational leverage. Non-resource company management has had to adapt to higher input costs during the decade long commodity boom to learn to become mean and keen to handle the headwind caused by the dramatic surge in input costs. That headwind has now abated, leaving a well honed operating environment capable of delivering higher profits on marginal revenue gains. The evidence is these businesses handle the post boom mini-cycle period with ease, producing dependable results period after period.

The dependable results are rewarded by investors “voting with their feet”. Investors reallocate funds to lower risk companies delivering dependable returns. PE ratios expand (i.e. share prices rise). That is why equity markets perform well in the periods between commodity booms.

From an asset allocation perspective, US equities are particularly attractive. The support of the ongoing housing recovery, and the reduction in energy costs driven by the increase in shale gas production are major catalysts.

As a net consumer of commodities, the end of the boom removes a major headwind for the US. While corporate margins are unlikely to rise from current high levels, we expect reduced pressure from rising material costs to lead to job growth as companies need to hire to boost their top line.

Equities generate stronger returns when real commodity prices fall, as increased earnings certainty encourages money inflows, leading to price earnings ratio (PE) expansion (read share prices increase). We believe this will be supported by asset allocation shifts to equities given we expect negative real returns from commodities and bonds. Q Graph source: Macquarie Research, August 2012

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lifestyle

LIVING THE

WHITE CHRISTMAS Dream

Then there’s ice skating on Central Park or Rockefeller Centre’s ice rink, Christmas carols

nie from Ros and Stepha Seasons Greetings nd. sla een Qu AMA Travel 885 PHONE: 1800 262 0 720 6 555 7) : (0 FAX EMAIL: .au travel@amaq.com WEB: vel.com.au www.amaq.worldtra

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A week later, the Rockefeller Centre’s giant Christmas tree lights up — 30,000 energyefficient LED lights that twinkle away until 7 January.

EDINBURGH, SCOTLAND Christmas in Edinburgh is like walking back in time to the medieval day of traditional royal marches and bagpipers playing Christmas songs. Fireworks light the skies, choirs, concerts and cabaret dinners ensure you’re entertained — and the Christmas Fair at Meadowbank Stadium fulfils every child’s dream.

If you can’t make it to Edinburgh for Christmas itself, try for New Year’s Eve. Home of Auld Lang Syne, the Scots will welcome you into their spirited street party, Hogmanay, as they see in 2013.

LAPLAND, FINLAND Where else will your Christmas feel more magical than the birthplace of Santa Claus?

You can escape the commercialism and pursue genuine adventure—snowmobiling to a reindeer farm, exploring the mythical Sarek National Park on husky sleighs, or ice fishing (called winter jigging)—but since you are in the neighbourhood, it would be rude not to stop in and say g’day to Santa and his helpers, found in Rovaniemi.

You just might find yourself becoming an honorary elf. Q

w

Ne

NEW YORK, USA There’s no place for Scrooge—or the Grinch—in the Big Apple at Christmas time.

Many say Christmas really kicks off in New York with Macy’s Thanksgiving Day Parade (November 22), drawing one million people along its route to see the marching bands, clowns and floats.

Dinner at Greenwich and drinks at Soho complete the Big Apple Christmas experience.

ur

OSLO, NORWAY Norway is definitely one of the whitest and snowiest spots in the world. Even on the sunniest winter’s day, put on your ski boots and sled down a snowcapped mountain.

The local metro will take you to the peak of Holmenkollen, where locals gather to enjoy mulled wine and some Fattigmann (traditional Christmas cookies). Red and yellow wooden cottages against a pure white blanket create a dreamy Norwegian landscape.

at Times Square, the Macy department store’s display windows and Radio City’s spectacular dance act with the Rockettes.

Y ork

L

SLEIGH BELLS TINKLING, FROLICKING IN FROSTY SNOW, BREATHING IN THE SMELL OF PINE NEEDLES: FOR MANY, THOSE ARE IMAGES INGRAINED IN OUR MINDS OF WHAT CHRISTMAS SHOULD BE LIKE. AMA TRAVEL’S ROS BULAT PROVIDES HER TOP FOUR PICK AND SAYS IT’S NOT TOO LATE FOR THAT CHRISTMAS DREAM TO COME TRUE…

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lifestyle

WOW... WHAT A ROADTRIP! ANAESTHETIST DR JONATHON SHIRLEY’S DREAMS CAME TRUE RECENTLY BEHIND THE WHEEL OF THE LATEST RANGE OF LEXUS VEHICLES TO HIT THE ROAD.

I need to be honest, upfront. I am quite possibly one of the least likely to be called a motoring aficionado. Familial responsibility has countered any hankering to vroom. Plus, baby seats are generally not a good look in a sporty number. Hence I usually drive around Brisbane in a staid Japanese family sedan...

Along the route, we communicated via walkie talkies (reminiscent of rally car races in my youth) and made pit stops to swap cars, ensuring that all five—the CT 200h hybrid hatch, New Generation GS 350 Luxury sedan, the 5.0 litre V8 ISF, the RX 450h and the LX 570 —were all personally road-tested.

But the good people from Lexus encouraged me not to hold back when my turn came, so off-road I went. Gravelly uneven surfaces were a piece of cake. Forget bone-jarring lurches. Comfort in all conditions was assured. Cruising in the suburbs, a driver could be oblivious to potholes.

But that doesn’t mean I don’t dream. And a few weeks ago, a dream came true as I found myself behind the wheel of not just one Lexus but five. And not in a showroom but on-road as part of a memorable overnight driving escape.

Two words sum up all five vehicles: superb; sophisticated.

The GS 350 was absolute luxury on wheels, purring softly.

It can be rather daunting jumping into the driver’s seat of an unfamiliar car, particularly a vehicle of such class. The Lexus dashboard is akin to what I imagine NASA space control is like. It’s impressive, but also very easy to use and not in the least distracting. I found the GPS navigation to be intuitive; a breeze to use.

But it was with enormous regret that I had to hand over the keys to the ISF with moon roof. I had big expectations. I’d been told this was the world’s first sequential eight speed automatic transmission with best-of-breed race-tuned suspension and gear changes in 0.1 seconds. Even to a non rev head, that sounds impressive. With Coldplay blaring from the CD—did I mention the superb sound system?— the ISF was poetry in motion, providing great control at good speed, hugging the Scenic Rim’s sweeping turns.

From Lexus of Brisbane, Indooroopilly, a group of AMA Queensland members new to the Lexus family departed, in convoy mode, manoeuvring through the Monday morning traffic onto the Western Freeway to Forestdale. We then meandered country back roads through Jimboomba, Beaudesert and Boonah to our final destination, the plush Spicers Peak Lodge.

Specific details of the cars driven

by Dr Jonathon Shirley are available on the Lexus of Brisbane website:

I found the hybrid hatch a tad squeezy but that’s a reflection of the driver: I am about 190cm tall and weigh 110kg. It’s a nippy little number, great for city driving.

The RX 450h and LX 570 are four-wheel drives: and the thought did cross my mind that drivers of these prestige models would probably not risk getting them muddy; that the nearest they’d ever see rough terrain was a speed bump in a school parking lot.

And because it was my favourite, Lexus kindly allowed me to drive the ISF back all the way to Brisbane the following day. Back to reality, to my clapped-out Jap sedan, parked around the corner from the Lexus showroom—and thoughts of what one day could be mine... Q

CT 200h

www.lexusofbrisbane.com.au/ct200h

GS 350

www.lexusofbrisbane.com.au/gs350

IS F

www.lexusofbrisbane.com.au/isf

RX 450h

www.lexusofbrisbane.com.au/rx450h

LX 570

www.lexusofbrisbane.com.au/lx570

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lifestyle Cast: Daniel Craig, Judi Dench, Ralph Fiennes, Javier Bardem Director: Sam Mendes

SKYFALL

Opens 22 November

Top secret MI6 files are leaked, compromising the identities of each and every undercover agent placed in terrorist rings around the world. When the agency itself comes under attack, James Bond (Daniel Craig) finds himself on a mission that takes him from Istanbul to the South China Sea to track down and destroy the threat, no matter the personal cost. But as secrets come back to haunt M (Judi Dench), Bond finds himself questioning his loyalty to her.

LES MISÉRABLES

Opens Boxing Day, 26 December 2012 Cast: Hugh Jackman, Russell Crowe, Ann Hathaway, Helena Bonham Carter Whether you’ve read Victor Hugo’s classic novel—considered one of the greatest novels of the 19th century—or seen the stage play, you cannot miss this big-screen musical adaptation of Les Misérables, the story of newlyreleased prisoner, Jean Valjean, struggling to survive during the French revolution.

SIZZLE SOOTHERS Beat the heat this summer by heading to Dendy Portside on Mondays for these Hollywood classics, screening at 10am and 6pm.

ORE FOR M ISIT INFO VOM.AU .C DENDY

Chariots of Fire

19 November

The Birds

26 November

All Quiet on the Western Front

3 December

The French Connection

10 December

Love is a Many Splendid Thing

17 December

Your practice staff have worked hard this year. Treat them to a film night. Organise a group booking or hire our 46-seat cinema for a more intimate event or our 192-seater for a real crowd!

DENDY ARTS OPERA Otello The Tempest La Clemenza di Tito

S T I R O P RTYDE !

PA

17, 18, 22 November 1, 2, 6 December 15, 16, 20 December

Contact Events and Publicity Manager Jenny Sonter for details of our function and cinema events package: jennys@ dendy.com.au

Ticket price includes canapés provided by Vagelis catering and light refreshments at interval.

BALLET An Evening with Kylian NATIONAL THEATRE LIVE Timon of Athens

9, 13 December 24, 25 November

Ticket price includes a complimentary muffin or Danish thanks to Vagelis and tea and coffee on arrival.

WIN MOVIE TICKETS FOR TWO Name: Postal address: Portside Wharf, Remora Road, Hamilton Ph: (07) 3137 6000 www.dendy.com.au 64

NOVEMBER 2012 DoctorQ

Phone:

FAX BACK TO (07) 3856 4727 or email amaq@amaq.com.au by 30 November

lifestyle

SPIRIT OF CHRISTMAS 7 & 8 December, Concert Hall, QPAC Spirit of Christmas, QPAC’s much loved annual celebration of the Yuletide season, is presented in the grandeur of the Concert Hall.

Featuring guest soloists, the 150-strong Spirit of Christmas Choir, symphony orchestra and grand organ, Spirit of Christmas is an occasion to enjoy uplifting songs, be inspired by the Christmas message and sing along to your favourite carols.

ORE FOR M ION MAT INFOR M.AU CO QPAC. 246 1 OR 36

THE MOUSETRAP From 28 December, Playhouse, QPAC

From the queen of the murder mystery, Agatha Christie’s The Mousetrap is an evening of intrigue and suspense where murder lurks around every corner. When a group of strangers are trapped together at Monkswell Manor during a snowstorm, they soon discover one of them is a murderer. A masterpiece not to be missed, this classic whodunit will leave you guessing till the end.

CLASSICAL MYSTERY TOUR 12 December, Lyric Theatre, QPAC

THE ILLUSIONISTS From 18 January, Concert Hall, QPAC In a world first, seven grand masters of magic, each with their own specialty and mind-blowing signature acts, come together in Brisbane for The Illusionists.

From never before seen illusions to jaw-dropping acts of levitation and escapes, The Illusionists is revolutionary, bringing the age old art of magic into the 21st Century. Cutting edge and contemporary, don’t expect rabbits and top hats, but do expect to be mesmerised.

The four musicians in Classical Mystery Tour look and sound just like The Beatles, but Classical Mystery Tour is more than just a rock concert. The show features two unforgettable hours of non-stop Beatles hits. Hear Penny Lane with a live trumpet section, experience the beauty of Yesterday with an acoustic guitar and string quartet, and enjoy the classical/rock blend of I Am the Walrus plus many more, all performed exactly as they were originally recorded.

From early Beatles music through the solo years, Classical Mystery Tour is the best of The Beatles like you’ve never heard them before.

WIN DOUBLE PASSES TO CLASSICAL MYSTERY TOUR

Name: Postal address:

Phone:

FAX BACK TO (07) 3856 4727 or email amaq@amaq.com.au by 30 November DoctorQ NOVEMBER 2012

65

lifestyle

PERFECTING PREGNANCY LAW, DISABILITY AND THE FUTURE OF REPRODUCTION

Prenatal and preimplantation testing technologies have offered unprecedented access to information about the genetic and congenital makeup of our prospective progeny.

Future developments promise to increase that access further still. The result may be greater reproductive choice but it also increases the burden on women and men to avail themselves of these technologies in order to avoid having a child who has a disability.

Doctor Q has a copy of Perfecting Pregnancy to give away. Simply fill out your details in block letters on the form and fax it to (07) 3856 4727 or email amaq@amaq.com.au.

COMPETITION WINNERS

CHECK FOR YOUR NAME!

Entries close 20 January 2013

66

NOVEMBER 2012 DoctorQ

The overwhelming question for legislators has been whether and, if so how, to regulate the use of these

WIN THIS BOOK!

technologies in the face of compelling but seemingly contradictory claims about the advancement of reproductive choice and the dangers of eugenic or discriminatory effects.

Perfecting Pregnancy (ISBN: 9780521765206) is published by Cambridge University Press and retails for $125.

It can be purchased online at http:// www.cambridge.org/aus/catalogue/ catalogue.asp?isbn=9780521765206 Q

Name: Postal Address:

Telephone:

DENDY WINNERS

QPAC WINNERS

BOOK WINNER

DOUBLE PASS WINNERS

Wendy Christie, Marjorie Busby and Kevin Lee See won double passes to Southern Cross Soloists in concert at QPAC on 18 November.

Helen Bajada won The Home Therapist, a practical selfhelp guide for everyday psychological problems, published by Australian Academic Press.

1. Joanne Sargeant 2. Nigel Dore 3. Joan Lawrence 4. Mahomed Seedat 5. Alfred lam 6. Liteng Chen 7. David Hasoon 8. Cecile Lander 9. Amanda Maitland 10. P.M. Johnson

CLASSIFIEDS FOR RENT / LEASE

4'2.%5%6'$#'%)2%73"1)*$+%8$3$()#'

SPECIALIST MEDICAL ROOMS (with balcony) available to share with Clinical Geneticist on either a full-time or sessional basis in Chermside Medical Complex. Separate reception areas, kitchen, smaller consulting room (suitable for procedures /Psychologist / Dietician). Secured car space. Other services in complex include Premion Radiotherapy, HOCA, Southerex Imaging, S & N Pathology, Day Surgery, General Practice and Pharmacy.

CONTACT Therese Gattas 0414 854 793 or

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email@brisbanegenetics.com.au

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FOR SALE Join Drs Mark and Lynda Spelman and Dr Alexandra Evans in this very exclusive piece of Australian paradise behind Noosa.

One Lakehouse available

www.weybapointlakehouses.com Call Peter Evans 0418 151 525

Help available when you need it five days per week

Services are flexible to suit your business needs

Experienced in the medical industry

CPA qualified accountant leading the team

Secure, long-standing organisation with a reputation you can trust

AMA QUEENSLAND

BOOKKEEPING SERVICE (07) 3872 2222

References available

PO Box 123, Red Hill Qld 4059 88 Lâ&#x20AC;&#x2122;Estrange Terrace, Kelvin Grove, Queensland 4059

Professional editing and

Registered BAS agent

Quality service

writing

Mobile: 0412 742 593 Email: words@heathergrant.com.au Web: www.heathergrant.com.au

DoctorQ NOVEMBER 2012

67

Is your equipment finance as complex as a triple bypass?

It’s time for a second opinion

As you well know, running a practice involves balancing a myriad of priorities. Purchasing equipment is high on the list, but it’s often devilishly complicated – it takes specialist expertise to put together a simple and cost-effective solution.

This is where Investec comes in. We specialise in providing financial solutions for medical and dental professionals, so our team thoroughly understands the pros and cons of different methods of funding your equipment. Whether it’s buying outright or leasing, you can rest assured that we’ll work out the optimal structure for you; even better, you can finance the equipment on an Investec credit card and earn Qantas Frequent Flyer miles on your eligible purchase.

Take a look at investec.com.au/medicalfinance or call one of our financial specialists on 1300 131 141 to find out how we can help.

O u t o f t h e O r d i n a r y™

Home loans | Car finance | Transactional banking and overdrafts | Savings and deposits | Credit cards | Foreign exchange | Goodwill and practice purchase loans Commercial and industrial property finance | Equipment and fit-out finance | SMSF lending and deposits | Income protection and life insurance All finance products are issued by Investec Bank (Australia) Limited ABN 55 071 292 594, AFSL 234975, Australian Credit Licence No. 234975 (Investec Bank). All finance is subject to our credit assessment criteria.

Terms and conditions, fees and charges apply. Information contained in this document is general in nature and does not take into account your personal financial or investment needs or circumstances. We reserve the right to cease offering these products at any time without notice. You should obtain independent financial, tax and legal advice, as appropriate.

Qantas Frequent Flyer points are earned in accordance with the Investec/Qantas Terms and Conditions available at www.investec.com.au/card. Points are earned on eligible purchases only. You must be a member of the Qantas Frequent Flyer program in order to earn and redeem points. Qantas Frequent Flyer points and membership are subject to the Qantas Frequent Flyer program Terms and Conditions. Full details are available at www.qantas.com/frequentflyer. Investec Bank recommends that you seek independent tax advice in respect of the tax consequences (including fringe benefits tax, and goods and services tax and income tax) arising from the use of this product or from participating in the Qantas Frequent Flyer program or from using any of the rewards or other available program facilities. Insurance products are offered by Experien Insurance Services, the preferred supplier of insurance products to Investec Bank.