Doctor Q November 2014

NOVEMBER 2014 . vol 92

AMA Queensland Membership Magazine

100 years of hunstanton

Double penalty for health assaults

Easy entry, gracious exit FREE TO AMA QUEENSLAND MEMBERS

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NOVEMBER 2014

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CONTENTS

this issue double penalty for health assaults

as part of the Queensland government’s safe night out strategy, people who assault a queensland government employed doctor, nurse or paramedic will face double the penalty.

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Current issues

REGULARS

18 easy entry,

4

From the Editor’s desk

gracious exit

6

President’s Report

22 playing the policy game to win

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CEO’s Report

24 ethical agony aunt: is it ever okay to prescribe a placebo?

30 Foundation News

10 letter to the editor

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26 a day in the life of a specialist: dr bill boyd 32 100 years of hunstanton

43 planning your next property move

40 health vision: human dignity in health care

44 make 2015 your best year in business

people & events

45 choose carefully in 2015

12 medico-legal conference

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14 intern readiness workshop 15 president’s tour 34 EVENTS Calendar

business tools

42 why use an insurance broker?

28 ama’s recent wins

16 Annual conference

36 Member News

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38 Obituary: dr dorothy herbert am

46 relationships with consultant clinicians: 48 tax office guidelines on paying owner doctors 50 medical indemnity for your practice entity and staff

Life

52 cars 54 Travel 56 Wine

Husband, surgeon, teacher, student and committee chair Dr Bill Boyd shows us his many hats in a single day.

58 movies 59 ON stage 60 all about you 61 ocker doctor 62 In print

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editor’s desk

from the editor’s desk Board of Directors

Michelle Ford Russ Doctor Q Editor Our final edition of Doctor Q for 2014 grew larger and larger while in production. We’ve been a busy bunch, with President Dr Shaun Rudd visiting Townsville, Hervey Bay, Rockhampton; holding our popular Medico-Legal Conference and our Intern Readiness Workshops, wrapping up our Annual Conference in Cape Town... phew.

We are also opening up our gorgeous

Hunstanton on it’s one hundredth birthday for members and guests.

One of the things we love about Doctor Q is the chance to look at things in a bit more depth. The new double penalty for health assaults legislation required some investigation, as does the elegantly titled Easy Entry, Gracious Exit model. Have a look and tell us what you think. Q

Dr Shaun Rudd President

Dr Kirsten Price Honorary Secretary

Dr Chris Zappala President-Elect

Dr Brad Horsburgh Elected Member

Dr Bill Boyd Chair of Council

Dr Josie Sundin Elected Member

Dr Bav Manoharan Treasurer

Dr Dilip Dhupelia Elected Member

Council Dr Tom Arthur Greater Brisbane Area Dr Sharmila Biswas Far North Area

obituaries Dr Brian William BARR General Practitioner Late of Cotton Tree Member for 10 Years Dr Brian Joseph ROUTH General Practitioner Late of Paddington Member for 62 Years Dr Mark Dening MCGREE Ophthalmologist Late of Sunnybank Member for 38 Years Dr Charles Michael STONES Psychiatrist Late of Belgian Gardens Member for 10 Years Dr Malcolm James Lees STENING OAM Obstetrician and Gynaecologist Late of Narrabeen Member for 76 Years

office closure

The following AMA Queensland members have recently passed away, our condolences to their families.

Dr Dorothy Helen HERBERT QM General Practitioner Late of Mitchelton Member for 55 Years Dr Ronald Henry Arthur PARKER General Practitioner Late of Oxley Member for 50 Years Dr Daniel Thomas O’CONNOR Obstetrician and Gynaecologist Late of Ormiston Member for 52 Years Dr Claude Bertram Russell MANN General Surgeon Late of Chermside Member for 72 Years Dr Desmond David McGUCKIN Paediatric Surgery Late of East Brisbane Member for 63 Years

Dr Noel Francis BARKER General Practitioner Late of Victoria Point Member for 26 Years Iain Stuart WHITEHEAD Anaesthetics (Intensive Care) Late of Toowoomba East Member for 53 Years Dr Hilary CROWLEY General Practitioner Late of Wynnum Member for 64 years Dr Platon BLACK ENT Head and Neck Surgery Late of Indooroopilly Member for 71 years Dr Peter W WHITE Internal Medicine Late of Bayview Heights Member for 56 years

The AMA Queensland office will be closed from 3pm, 23 December until 5 January.

We hope you enjoy a happy and healthy Christmas and New Year.

Dr Kimberley Bondeson Greater Brisbane Area Dr Bill Boyd Capricorn Area Dr Thomas Campbell Greater Brisbane Area Dr Vanessa Grayson Residents and Registrars Craft Group Dr John Hall Downs and West Area Dr Wayne Herdy North Coast Area

Dr Richard Kidd General Practitioner Craft Group Dr Luke Lawton North Area Dr Kelly MacGroarty Specialist Craft Group Dr Bav Manoharan Gold Coast Area Dr John Murray Full Time Salaried Medical Practitioner Craft Group Dr Paul Neeskens General Practitioner Craft Group

Dr Brad Horsburgh Greater Brisbane Area

Dr Kirsten Price General Practitioner Craft Group

Dr Sharon Kelly Specialist Craft Group

Dr Josie Sundin Greater Brisbane 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: Michelle Ford Russ Graphic Designer: Felicity Neal Journalist: Rachael Finley

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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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 PP100007532 Email: amaq@amaq.com.au

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PRESIDENT’S REPORT

Welcome, interns!

There’s been some particularly sombre news of late, but welcoming new interns to the fold is always a joy. We’ve had some cracking intern events so far, and look forward to supporting our newest doctors when they begin their grand adventure next year.

dr ShAUn Rudd President, AMA Queensland

Medical marijuana There has been lots of talk lately about the benefits of medical marijuana, particularly in managing pain, bladder dysfunction and spasticity in multiple sclerosis, tics in Tourette syndrome and involuntary movements in Parkinson’s disease. There has been talk in the media of cannabinoids being used to treat autism, epilepsy and even cancer.

Though there is a growing body of evidence regarding the therapeutic use of cannabinoids, it is still experimental. While

While marijuana has been a hot topic for many a decade, the research behind medical marijuana has been inadequate and poorly designed.

marijuana has been a hot topic for many a decade, the research behind medical marijuana has been inadequate and poorly designed. I look forward to seeing the results of stringent research and testing on medical marijuana.

Keep calm on Ebola In one of the great tragedies of our time, Ebola has now claimed close to 5,000 lives in Africa which have been reported, with estimates that the toll may be twice that number. I’m proud to see so many doctors and allied health workers volunteer their time, effort and pay to helping patients overseas. It’s a terrible disease which has hit a region with no resources and we must do all that we can to encourage and support those who wish to help their fellow humans.

AMA Parliamentary Dinner I attended the AMA Parliamentary Dinner a little while back with Dr Gino Pecoraro, CEO Jane Schmitt, AMA Vice President Dr Stephen Parnis and AMA Queensland Board Member Dr Brad Horsburgh.

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Welcome, interns After an incredibly successful Intern Readiness event in Brisbane in October, I’d like to welcome all our new interns who will begin their exciting first year in 2015. There’s no year like your first year and I hope you can enjoy the journey.

Remember that AMA Queensland are here to back you, so use us as you can: access our resources, rely on us for support and join your colleagues to make the medical field in Queensland a great place to work.

In our Internship Guide 2015, AMA Queensland Council of Doctors in Training Chair, Dr Tom Arthur, shares some of the words of wisdom given to him as in intern: “there is always someone to call”. He added to that “there is no clinical situation that you will have to face alone”. This is absolutely the case and I urge you to make the most of everything available to you.

While I realise it’s only November, this is our last edition of Doctor Q for the year, so I’d like to wish our members a happy and healthy Christmas and New Year. Q

ceo’S REPORT

Celebrating 100 years of Hunstanton

A grand tour of AMA Queensland’s very grand building seems a wonderful way to head towards the end of 2014.

JANE SCHMITT Chief Executive Officer, AMA Queensland

Hunstanton anniversary This year, we celebrate 100 years of our beautiful Hunstanton building, now known as AMA House. In 1914, Hunstanton was home to the L’Estrange family with their four young children. Over the years, we’ve collected as much information as we can on the building: the families that lived here, the stories and the photos. In 1993, we were lucky enough to receive a visit from Esther Mather (nee L’Estrange) who grew up in the house and was one of Australia’s first female aeroplane flyers, the Earlybirds. Her stories on the house were dutifully recorded.

Many of the stories and photos depict a child’s wonderland, with a pet boxer, and for a time, a pet emu who would drape its long neck over William L’Estrange’s neck for a pat. There are pictures of the children in fancy dress but also in their Victorian era white dresses and black tights.

The house has remained an important part of AMA Queensland and it’s place within Queensland history. The building is surrounded by streets bearing the names of our Past Presidents and while the house itself is an architectural historian’s delight, on its foundations lay our history too.

To celebrate the 100-year anniversary, we will be conducting tours on 4 December at 11.30am to 1.30pm. To RSVP, please phone our Membership team on (07) 3872 2222 or email membership@amaq. com.au. Members and guests are very welcome to attend and learn more about our heritage-listed home.

Foundation Christmas appeal The weather’s heating up, trees and decorations have been in the stores for at least a month and our thoughts are turning to Christmas. Christmas is generally a time for sharing with those less fortunate. Our AMA Queensland Foundation Christmas Appeal will soon be gaining traction and if you are looking for a great channel for your generosity, rest assured the Foundation do some some fantastic work. We are a small yet nimble charity who have achieved great things on behalf of our donors this year.

Read more on page 28. Your generosity will have a positive impact on the lives of many by helping us in our mission to relieve sickness, suffering and disability among Queenslanders in need.

On the topic of Christmas, I would like to wish all our members and their families a safe and joyful Christmas and New Year.

Our staff will be taking a small break and our office will be closed from 3pm on 23 December until 5 January.

Siyaphambili At our recent Annual Conference in Cape Town, a group of us had the chance to visit an orphanage in a local village in Langa, which is an outer suburb of Cape Town.

The orphanage is called Siyaphambili [pronounced See-ya-fam-bee-lee] means “moving on” in isiXhosa. The orphanage cares for children and young people who have been severely affected by the AIDS epidemic - primarily due to loss of their parents to AIDS. Siyaphambili also conducts an outreach program for teen mothers, grandmothers raising their own grandchildren, child-headed households and counselling in the area and has an after-school program and a daytime preschool group.

We were lucky enough to have the opportunity to interact with the children for an afternoon (playing football, reading with them and face-painting), most of whom had lost their parents to AIDS. The small group of us who attended were able to provide some basic hygiene and medical equipment for the orphanage, which they are always in need of. Siyaphambili Orphan Village is a registered South African non-profit organisation and one that a number of us are keen to stay in contact with. Q

Rosies have their new van!

Check out the thank you video at: www.amaqfoundation.com.au

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LETTERS TO THE EDITOR

Burnout – an observation On the cover of the recent edition, the question “How do we stop burnout?” was asked.

While I do not claim to have the answer, I would like to submit an observation.

Many years ago, when Royal Brisbane Hospital was planning a bone marrow transplant unit, I, as a senior staff member of the Queensland Radium Institute, looked into several units in UK and USA, on my study leave, to see how radiotherapy was contributing to clearing the patient’s marrow prior to transplant, then checking how isolated patients were nursed and fed during their recovery.

Burnout was a common feature in all except at the Methodist Hospital attached to the Mayo Clinic in Rochester, Minnesota.

The supervising RN gave me the probable reasons.

Her service was the only one in the two hospitals in Rochester that had a fourteen day roster.

All others had seven days.

Four consecutive days off duty was the desirable that had so many applying that she was able to recruit only those she judged as suitable. Staff were trained to the specific nature of their work. They were to ask if there was a possible need for advice, and they were supported. They were debriefed at the end of each shift by the supervisor on duty, so they did not take mental problems home when off duty.

So, very good management seemed the desirable, which could be more of a problem for

either those who are not proper managers or where numbers in the team are smaller.

The above may not be the perfect answer, but it is worthy of consideration.

Dr Bruce Kynaston

Co-payment shows value I have read with interest the article in the recent Doctor Q magazine concerning copayments. I was not part of the survey but I would just like to put in my views so that I can be included in this.

I have always supported the co-payment suggestion. If the patients do not have to pay

anything for a consultation, that is the value that they put on it. The $7 co-payment really is quite modest. It will incorporate a number of checks and balances, so the patient will not be significantly out of pocket.

Dr Alan Hilton

Doctor Portal:

the doctor’s complete online resource All the resources and information a busy practitioner needs is now just a click away following the launch of the AMA’s Doctor Portal website.

Doctor Portal brings together all the tools and resources doctors look for on a daily basis – the GP Desktop Toolkit, the Find a Doctor feature, the CPD tracker, the Fees List, policy guidelines, position statements, practice advice and support – as well as access to AMA publications including the Medical Journal of Australia and Australian Medicine, all in one convenient location.

No more wasted time digging around through the entrails of the web to find the information you need – Doctor Portal is your one-stop information hub.

Not only does Doctor Portal give you ready access to the information and resources you need, it gives you a way to connect 10

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with colleagues near and far through public and private forums.

Visit www.doctorportal.com.au to check out these and other features: Content sharing – Doctor Portal allows you to securely share information and ideas with colleagues, providing public and private forums that only other registered medical professionals can access and participate in; Find a Doctor – locate practitioners using the Find a Doctor feature, which gives you access to Medical Directory of Australia information, including current practice contact details and a scalable map – perfect for when you are referring patients;

All in one convenience: Doctor Portal features a refreshed MJA Bookshop, careers and jobs resources and the GP Desktop Toolkit, all at one site; Free access: Doctor Portal is a free service, and includes features exclusive to AMA members.

Doctor Portal is continually updated, ensuring that all information is current and you are never left out-of-date.

To explore all that Doctor Portal has to offer, visit: www.doctorportal.com.au

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MJA Bookshop - a convenient one-stop-shop for all your medical texts.

Jobs - search for jobs by location or specialty round Australia.

14/08/2014NOVEMBER 8:10:35 AM 2014 DoctorQ

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People & EVENTS

Medico Legal Conference More than 80 members turned out for AMA Queensland’s second annual Medico Legal Conference on 1 November.

Speakers tuned in to hear more about the new health complaints process from Queensland’s new Health Ombudsman Leon Atkinson-MacEwen, while Commissioner for Children and Young People Steven Armitage gave an update on recent Child Protection changes.

Rachel Drew and Katharine Philp from TressCox talked about the recent advertising guidelines changes while Dr Bill Kingswell (Executive Director, Mental Health Alcohol and Other Drugs Branch, Queensland Health) explained changes to the Mental Health Act.

Proudly sponsored by:

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A panel discussion on end of life care included expert insight from the perspectives of the Clinical Senate, a General Practitioner, Emergency Department doctor, Clinical Ethicist, Palliative Care Doctor and Lawyer. Q

SAVE THE DATE Medico Legal Conference 2015

Saturday 7 November

People & EVENTS

Dr Cornelius Nydam And Dr Diana Khursandi

Dr Sanjeev Ranjan_dr Chau_dr Brenda Graham

Delegates were kept busy with interesting topics

Katharine Philp (Tresscox), Dr Jennifer Gunn, Dr Josie Sundin And Dr Glenda Powell

Mr Ishmael Perez Smith and Dr Hoe Lo

Ms Deb Jackson and Dr Josephine Sundin

Yvonne Simmonds, Dr Phillip Bushell Guthrie and Dr Jennifer Gunn

The End of Life Care panel DoctorQ NOVEMBER 2014

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People & EVENTS

Readying our interns

AMA Queensland’s first event for 2015 interns went off with a bang, with more than 250 interns checking in to find out more about what’s ahead in their intern year. Our very active Council of Doctors in Training (CDT) spoke on the nitty-gritty like prescribing and paperwork, tips and tricks, ward calls and workplace issues. They also learned more about superannuation, finance, medical indemnity from our valued sponsors, while James McNulty from Queensland Health ran through the RMO recruitment process. Q

Claire Mellick, Josef Witt-Doerring , Tegan Christelow, Rylan Hayes, Daniel Lancini, Jonathon Day 14

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Kathleen Capeheart, Rachele Quested and Kimberly Chung

People & EVENTS

President on tour President Dr Shaun Rudd and Workplace Relations manager Andrew Turner have been busy visiting members in Townsville and Hervey Bay in October, with more than 50 members turning out to dinner and cocktail events to discuss the issues affecting the medical profession in their region.

Final year students at the Fraser Coast University of Queensland Clinical School also enjoyed lunch with Dr Rudd and Andrew and gained some great hints and tips for the road ahead as a doctor.

Dr Rudd has continued to meet with local stakeholders to get better understanding of healthcare in regional Queensland and looks forward to meeting more members in his regional visits in the New Year.

TOP LEFT: Dr Nicholas Yim and Dr Shaun Rudd TOP RIGHT: Dr Paul de Jong and Dr Ian Truscott BOTTOM LEFT: Dr Andrew Hutchinson, Dr Alicia Veasey and Dr Paul Neeskens BOTTOM RIGHT: Dr Paul de Jong, Dr Anthony Young and Dr Shaun Rudd

Private practice Townsville Members from Townsville and surrounding areas enjoyed the Private Practice Conference in late October. They heard from a great range of speakers on how to set up your own private practice, or how to grow your existing practice.

The Conference also incorporated the Sanford Jackson Oration, where Orator Professor David Paterson examined the origins of antibiotic resistance and discussed pathways forward for today’s clinicians in their treatment of infection.

Dr Ernest Sanford Jackson (1860 – 1938) was a founding member of AMA Queensland, serving as President in 1895, 1911 and 1926. He was also founder of the University of Queensland Medical School and the Royal Australasian College of Surgeons in Queensland. Q

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People & EVENTS

2014 Conference delegates gathered in Cape Town, South Africa to discuss social determinants of health in September at AMA Queensland’s Annual Conference. Neil Mackintosh, Conference Coordinator wraps up another successful conference and gives us the highlights.

Our delegates were educated and entertained by a line-up of speakers of world renown, with the conference theme Health has a postcode – Social determinants of health. Every session was packed with enlightening presentations and generated enthusiastic discussion and debate.

CEO Jane Schmitt spoke on the AMA Queensland Health Vision, Colleen Sullivan educated delegates on how to manage patient expectations and Jenne Turner, Psychologist, addressed the issue of food addiction and obesity.

The conference was formally opened by Chris Munn, the Acting Australian High Commissioner to South Africa. Chris addressed the delegates on a wide range of bi-lateral issues including diplomacy and commerce.

Our local guest speakers from South Africa included Owen Jinka, who gave a wonderful presentation on local history, customs and culture. We were delighted to have the Deputy Director-General from the South African Department of Health, Jeanette Hunter, give a local perspective on the overall conference theme.

He was quickly followed by keynote speaker Professor Victor Nossar from Darwin, who delivered sessions on The Social Determinants of Health, The First Three Years of Life and Child Health.

We were privileged to have two senior medicos from Cape Town University address the delegates: Professor Tim Noakes and Professor Eric Batemen. Dr Albie de Frey from Johannesburg presented sessions on

Exploring Cape Town and beyond 16

Other Australian speakers to present were Dr Shaun Rudd on Managing a Good Death, Associate Professor Noel Hayman on Indigenous Health Issues, Dr Dilip Dhupelia on Delivering Health Care Where it is Needed Most and a CheckUP Census Report for 2013.

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Outside the conference sessions delegates had opportunities to explore this wonderful city and regions beyond. Some particular highlights within Cape Town were the city tour taking in fabulous Table Mountain, Culture and History Museum, St Georges Cathedral, The Company Gardens, colourful markets and much more.

Outside Cape Town a true highlight of the conference was our trip to the Cape Point Nature Reserve on the very tip of Southern Africa.

Health Has NO Postcode in Africa and How to keep Expats Alive in Africa.

The program continued with valuable presentations by Ross Noye (Macquarie) on securing your financial future, Katharine Philp (Tress Cox Lawyers) on important medico-legal issues (see adjacent) and Craig Wright and Justin Tyne from Experien Insurance Services on what the insurance industry is doing to assist address the nation’s health challenges.

A panel discussion on the final day considered the patients journey and how to make it a good one. The final conference session was an Issues Open Forum, chaired

by Dr Shaun Rudd, where issues significant to the future of medicine were addressed and hotly debated. Q

People & EVENTS

Our sponsors We were most fortunate to have the support and company of Ross and Mandy Noye (Macquarie), Katharine Philp (Tress Cox Lawyers) and Craig Wright and Justin Tyne (Experien).

A big thank you to AMA Travel Queensland, Ros and Andrea, for yet another successful and co-operative operation.

ig Wright CEO Jane Schmitt, Cra Dr Shaun Rudd (Experien), President ssCox). and Katharine Philp (Tre

President Dr Shaun Rudd with Acting High Comm issioner to South Africa Chris Munn

Mandy Noye, Dr Jo and Sandy Thela anna Tait nder

er Kent, Carmel Brown Donna Kent and Dr Pet dy and Ross Noye. and Dr Bob Brown and Man

President Mark Sonderup, Vice Dr Shaun Rudd with Dr and Jeanette tion ocia Ass l dica Me of South African ican r-General of South Afr Hunter, Deputy Directo lth.

Hea Department of

Katharine Philp TressCox Lawyers Health Law Partner Katharine Philp of TressCox Lawyers presented on giving evidence in her presentation How not to get caught in Court.

Doctors will either be called to give evidence of fact or as an expert in order to provide an opinion based on the facts. Delegates were informed about the following issues: The different standards of proof in civil and criminal matters; The tribunals that rely on expert opinion provided by doctors; The steps involved in the preparation of a report providing an opinion; The form of a report; Ethical obligations of doctors providing opinion evidence;

An expert’s paramount duty to the court which overrides any obligation to the party who may be responsible for payment of the expert’s fees; The different stages of giving evidence; Giving expert evidence when you’re the treating doctor; and How to survive cross-examination.

The cardinal rule in surviving cross examination is to listen to the question and make sure you understand it properly before answering.

Experts should also: Answer honestly and responsively but succinctly;

The qualities of a good expert witness;

If you realise you have made a mistake say so and correct your answer;

The protections afforded to witnesses and expert witnesses in particular;

Do not try to anticipate what the question is getting at or where the cross

examiner may be going with his/her line of questioning; Do not argue with the questioner, no matter how provoking he/she may be, always remain polite and civil.

Delegates were given practical real life examples of various traps and pitfalls so that they could hopefully avoid them if they find themselves in the witness box. TressCox Lawyers is a national firm, with more than 60 years experience representing Medical Practitioners in various areas of Health Law. TressCox Lawyers are well connected to the health industry, its peak bodies and key professionals, so offer a real understanding of the issues. When professional, ethical and commercial issues compete, their legal advice is sensitive to every nuance, influence and reality.

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Feature story

Easy entry, gracious exit

While previous recruitment models have concentrated on the continuity of the doctor, rather than the continuity of the practice or practice management structure Policy Advisor Leif Bremermann explores the elegantly titled Easy Entry, Gracious Exit model as another idea in the rural doctor shortage mix.

Easy Entry, Gracious Exit refers to a walk-in-walk-out approach, which aims to make general practice in challenging rural areas more attractive by enabling GPs to work as clinicians without having to become small business owners and managers.

Back in 1999, the lone doctor serving the town of Brewarrina, a small country town in North-West New South Wales, left at short notice. The NSW Rural Doctors Network (RDN) stepped in and provided a locum, but the Shire owned building had no furniture, phone, electricity or any other equipment necessary to run a local practice. Over the course of the next 20 months, a total of 22 locums were required before the practice could be returned to local ownership.

Meanwhile, three other North-Western NSW towns started to experience similar problems. Lightning Ridge saw its population of local GPs drop from three to nil. Walgett had only one permanent GP, and the Aboriginal Medical Service in Collarenabri had not had a permanent doctor for some time. The RDN had to step in for all of these services, which resulted in significant pressures on the organisation. It was clear that the traditional method of recruitment was failing the region and led to the development of the Easy Entry, Gracious Exit model.

Under the Easy Entry, Gracious Exit model, a local community entity ideally provides the infrastructure necessary for a local practice to operate, which the RDN leases. RDN provides all the furnishings, and employs practice staff.

A GP wishing to enter the community can then sublet the building from the RDN at a subsidised rate, essentially 18

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allowing them to enter the community easily, and leave graciously.

According to the RDN, the model has been a success, “improving the stability of the general practice workforce in Walgett and Lightning Ridge and also in the nearby communities of Brewarrina and Collarenebri” with good locum backups.1 AMA Queensland President Dr Shaun Rudd found himself in a similar position after serving the community in Casterton, Victoria. He owned half of the practice and ran a successful business, but when it came time to leave, he was unwilling to leave his patients in the lurch.

“Even if a doctor is able and willing to set up a business in a remote area, leaving isn’t easy. It’s very difficult to sell the practice and ensure your patients will be left in good hands. I went to considerable lengths – flying back to the UK – to find a colleague to emigrate and take over the business so that I could leave,” said Dr Rudd.

It seems the success of the program could be in the succession planning.

“The model would be at its most successful where there is buy-in from the local community, not just financially, but giving a community ownership over their access to healthcare,” he said.

Rural Doctors Association Queensland President Dr Tarun Sen Gupta is in agreement.

“Anything that promotes easy entry to working in the bush is positive,” said Dr Sen Gupta.

“Not every GP is going to be there for the long haul. It’s not a disappointment if a doctor leaves after three to five years.

Many doctors in different stages of their career feel their career was greatly enriched by working in the bush,” he said.

The Central West area is a great example of where a similar model has worked.

One or two doctor towns like Winton, Barcaldine and Blackall struggled for many years to fill vacancies until the Hospital and Health Service stepped in and developed a new model, employing these doctors as Senior Medical Officers.

These SMOs are contracted to work in private practices which are owned and managed by third parties.

However, it’s not a solution for every community. If a town has a GP who owns the practice and has plans to stay long term, then it’s a case of don’t fix something that’s not broken.

“The last thing you would want is for this model to be a threat to an existing general practice. It really must be adopted in response to community need,” said Dr Sen Gupta.

In AMA Queensland’s 2014 Budget Submission2, we called on the Queensland Government to commit funding towards investigating whether the Easy Entry, Gracious Exit model could be adopted in Queensland. This was followed by similar calls from Federal AMA, who have believe the model “could be a useful solution in circumstances where there is a chronic shortage (or in absence) of local medical professionals.” 3 It is clear that despite the best efforts of multiple governments over many years, health workforce recruitment and retention remains a significant problem in rural and remote areas. Although the AMA still believes that the best solution to a shortage of rural medical professionals lies in attracting and retaining, through good pay and conditions, permanent resident doctors in rural and remote areas, innovative solutions like the Easy Entry, Gracious Exit model deserves exploration in areas where this has otherwise failed to occur. Q

Feature story

Key Principles The AMA supports the Easy Entry, Gracious Exit model to improve access to quality health care for people in rural towns experiencing chronic shortage of doctors with the following key principles: The arrangement must ensure continuity and support good patient care.

The doctors should have complete independence in clinical decisionmaking.

The entity set up should not be in competition with a local practice (if there is one) and that local doctors (if any) should not be disadvantaged in terms of remuneration.

In order to ensure that services match the needs of the community, planning should involve the local community and all relevant stakeholders and strong linkages should be established and maintained with local government, relevant doctor organisations, allied health, the local hospital and Area Health Network, neighbouring towns and relevant Aboriginal health services.

The practice must remain responsive to the changing needs of the community and encourage rural capacity building.

The arrangement must ensure doctors have access to appropriate training, skills, experience or cultural preparedness for rural and remote areas.

Doctors who work at the practice must be supported if they choose to provide education and training to medical students and doctors in training.

The arrangement should provide a realistic and sustainable work environment with flexibility, including locum relief.

1

http://www.nswrdn.com.au/client_ images/246595.pdf

2

http://amaq.com.au/icms_docs/183696_2014_ AMA_Queensland_Budget_Submission.pdf

3

https://ama.com.au/position-statement/ easy-entry-gracious-exit-model-provisionmedical-services-small-rural-and-remote DoctorQ NOVEMBER 2014

19

CURRENT ISSUES

Double penalty for health

assaults

New Queensland Government legislation means double penalties for people who assault queensland government employed doctors, nurses and paramedics. Our Workplace Relations team takes a look.

People who assault nurses, doctors and paramedics will face up to 14 years in prison under tough new laws introduced as part of the Queensland Government’s Safe Night Out Strategy.

Thousands of health workers are punched, stabbed, bitten and spat on every year in Queensland while serving the public in their daily duties.

More than 24,500 health care employees reported being a victim of a violent incident at work in the past five financial years.

More than 4,400 health workers in the last financial year alone were victims of violence in their workplace.

Violence is frequently underreported owing to reporting processes being too time consuming, some simply accepting violence as “part of the job� and, saying that reporting was fruitless, as management did not take the risk seriously and nothing would actually change.

Unsuprisingly, data shows that many of the violent attacks against health care workers were fuelled by alcohol and drugs.

This very welcome legislation has been introduced as part of the Safe Night Out strategy, but still leaves out violence against private practitioners. Within the private sector one survey found 11 per cent of General Practitioners had been assaulted and 91 per cent had experienced verbal abuse.

Victoria has implemented harsher penalties against perpetrators this year as well. The legislation1 extends beyond the hospital and practice workplace to include any healthcare workers who are

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NOVEMBER 2014 DoctorQ

required to undertake house calls. Where convicted, the new legislation now doubles the maximum penalty to six months for perpetrators convicted of common assault.

In the smaller workplaces such as health care clinics or GP practices, the risk of violence may be lower but the impact of it is likely to be higher, as these workplaces are less likely to have the expendable money and resources to facilitate violence prevention and management.

Because exposure to violence bears both psychological and physical components, health care providers have a heightened responsibility in ensuring the safety of not only themselves but also the safety of their employees and other patients. Health and Safety is paramount regardless of the context, and medical practitioners need to familiarise themselves with what they are protected from and what they may need to put in place to protect others. Simply put: the higher the assessment of risk, the higher the responsibility of the employer to anticipate, and to prevent injury.

Left untreated, the exposure to violence and verbal abuse stems beyond the immediate incident. Damage to relationships and the confidence in the system, increased stress and anxiety levels, clinical errors, reduced productivity and burnout are only to name a few. It is important that personal tolerance and limits to abuse and violence are not neglected and that any one instance of violence can lead to a plethora of personal consequences.

Understandably, the occurrence of violence is not just by statistical probability as there are cultural and contextual variables that contribute to the nature of violence.

Efforts to address the reasons for patients lashing out at doctors should also be aimed at better understanding the situations in which violence occurs and the unique way in which violence affects medicine as a whole. Research is required to describe the epidemiology of aggression and violence toward doctors and to evaluate the efficacy of educational programs and interventions designed to prevent its occurrence. Q

1 Justice Legislation Amendment (Confiscation and Other Matters) Bill 2014

Forms of violence towards staff that will lead to prosecution are: biting spitting throwing bodily fluids and/ or faeces any serious bodily harm carrying a weapon or pretending to carry a weapon.

Women’s Diagnostic Centre

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DoctorQ NOVEMBER 2014

21

CURRENT ISSUES

Get involved

Playing the Policy Game to Win

Visit amaqhealthvision.com Send us an email at healthvision@amaq.com.au Follow us on facebook and twitter at amaqueensland using the hashtag #amaqhealthvision Come to one of our events Call us on (07) 3872 2222

Guest author Emeritus Professor Stephen Leeder AO, from the Menzies Centre for Health Policy, University of Sydney and Editor-in-Chief of The Medical Journal of Australia WRITES about the importance of clinician involvement in health policy.

The idea was this: cardiology services for a health area (population 750,000) in NSW needed a shake-up. The management decision was that they should be planned and coordinated by those providing the services in combination with managers and patients. This was one of several Service Development Groups, based on the NZ model, established by the health area managers. I had seen this process work well in another part of the state and was an enthusiastic supporter. I encouraged a senior cardiologist to join the group. He did. He assembled data about services currently available and what was needed in the future. He gathered epidemiological and demographic data (that was where I came

Too often when his or her authority has been challenged by others at the policy table the clinician packs his or her sports bag and leaves to play elsewhere.

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NOVEMBER 2014 DoctorQ

in) and evidence from clinical trials. His proposals were impeccable. He was ready to roll.

I met him on his way out of the first planning meeting at which he had presented his proposals to his colleagues and managers.

He was fuming. They had not automatically accepted what he proposed. “I told them but they didn’t listen!” he spluttered.

For many clinicians encounters with the world of policy are unhappy, boring and unsatisfying. They should not be. There is more in common between policy and practice than there is dividing them. Clinical care can be evidence-based but every clinician knows the evidence from clinical trials needs to be adapted judiciously to the distinctive needs and preferences of the patient. Indeed, the definition of evidencebased medicine makes this clear. Even so with policy. Brisbane policy academic Brian Head writes of three varieties of evidence that inform policy – metrics, experience and politics. They all matter: a policy for which political evidence suggests that the person responsible for it will be voted out of office leads nowhere. Head writes:

What works for program clients is intrinsically connected to what works for managers and for political leaders. Thus, the practical craft of policy development and adjustment involves ‘weaving’ strands of information and values as seen through the lens of these three key stakeholder groups. There is not one evidence-base but several bases.

To make a lasting contribution to policy you, the clinician, need patience, persistence and practice. You are only one of the players, not royalty. Your views need to be carefully put, fought for, debated, compromised, and where possible included in final policy decisions. Too often when his or her authority has been challenged by others at the policy table, the clinician packs his or her sports bag and leaves to play elsewhere.

Sometimes in a policy debate it may be that ‘exit’ is the appropriate action, but more often than we medicos avail ourselves of it, the most effective option is ‘voice.’

Don’t give up: the world of health policy needs you. Q

join your lma

AROUND THE REGIONS

Local Medical Association round up

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 Contact: Jo Bourke Phone: (07) 5479 3979 Cairns Contact: Dr Sharmila Biswas Phone: (07) 4036 4333 Townsville Contact: Dr Carl O’Kane Phone: (07) 4433 1111 Central Queensland Contact: Dr Harley Wilson Phone: 0419 277 611 Email: harleywilson00@gmail.com Toowoomba and Darling Downs Email: info@tddlma.org.au Web: www.tddlma.org.au

Bundaberg Contact: Dr Daud Yunus Phone: (07) 4152 2888 Email: daud.yunus@gmail.com Brisbane Northside Contact: Dr Graham McNally Phone: (07) 3265 3111 Web: www.northsidelocalmedical. wordpress.com Redcliffe and District Contact: Margaret McPherson Phone: (07) 3121 4043 Web: www.rdma.org.au Gold Coast Phone: 0419 780 505 Email: info@gcma.org.au Web: www.gcma.org.au

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

can’t find your local area?

DoctorQ NOVEMBER 2014

23

CURRENT ISSUES

Ethical Agony Aunt

The experts from our Ethics and Medico-Legal Committee answer your ethical dilemmas. Send your ethical dilemma to policy@amaq.com.au.

Dear Ethical Agony Aunt, ld be I have several patients who cou well’. d rrie ‘wo classified as among the es ach h They frequently visit me wit tion I and pains, and post-investiga wrong can find nothing significantly t we tha g hin not with them – at least, for. nt tme currently have a clinical trea clearly I want to help my patients, as ress they are experiencing pain and dist ng vidi pro ring and I have been conside m. the them with a placebo to help ical to My question is – is it ever eth I tell uld sho prescribe a placebo? And my patients about it when I do so?

Placid

The breach of trust... implicit in the prescription of an undisclosed placebo, may cause significant damage to the valuable therapeutic relationship you have with your patients.

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NOVEMBER 2014 DoctorQ

Dear Placid, The placebo effect does indeed have powerful and positive health benefits – so much so that considerable lengths are taken in clinical trials to discount it.

The placebo effect can alleviate the symptoms of many conditions including pain, nausea and fatigue. It works by conditioning the brain to expect that health will improve – this conditioning in turn leads to biochemical reactions in the brain which reduce symptoms. So in many ways, a placebo works in the same way as if patients were given drug treatment.

Research has shown that doctors do currently use placebos in their practice – both impure placebos (those with no pharmacological component) and impure placebos (substances with pharmacological effect, but not for the condition being treated eg. antibiotics or vitamins). A recent UK study found that 75 per cent of doctors use a placebo at least once a week.

One of the main contentious points about the use of placebo is that it involves deception of the patient – after all, if the patient knows that the drug they are taking is not a real drug, their expectation that it will actually work is greatly reduced.

And while some research has shown that known placebos can still be effective, lack of knowledge about the placebo remains the norm.

Treating a patient with a placebo (especially an impure placebo), without informing them about the drug and side-effects, may breach the principle of informed patient consent and expose patients to unwanted side-effects. In addition, over prescription of antibiotics may contribute to the growth of drug resistant bacteria in the community.

On the other hand, there are those that advocate that in some circumstances, the use of placebo may be justified – but only where they are low risk and prescribed within strict ethical limits.

So the jury is still out on this one.

In general, placebos should not be prescribed, and their effects and sideeffects of all drugs prescribed to patients should be clearly explained to them. The use of placebo may sometimes be helpful to a patient, but should be carefully considered. The breach of trust implicit in the prescription of an undisclosed placebo, may cause significant damage to the valuable therapeutic relationship you have with your patients – and may ultimately do more harm than good.

Aunt Agony Q

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DoctorQ NOVEMBER 2014

25

MEMBER NEWS

A Day in the Life of a

Specialist Husband, dog-owner, home handy man, surgeon, teacher, student, travelling doctor and committee chair, Mackay-based Gynaecologist and AMA Queensland Chair Dr Bill Boyd shows us his many hats in a single day.

MORNING Our north-facing bedroom wall is entirely glass with doors to a deck. High over the bush, there are no curtains. Whether it is the first photon of light or the first kookaburra which wakes Freddie the miniature Schnauzer I’m uncertain but as the mornings get earlier, so does she. There is no lying in, ever. Up. Two cups of black tea. iPad on. News.com. au. No nuclear war this morning. One cup to Julie. She’s flying to Brisbane for a Board meeting. Back tonight. Radio on 5.30am ABC news. Stand with cup on main deck. Listen to sounds of the bush in the still air as dawn advances over the islands.

Dogs (Bonny the Cavoodle has deigned to join us) stalk my every move. Okay then. Pull on rough shorts, T shirt, Nikes and first hat of the day – an ageing AMA State Conference hat from Zambia. Cacophony of barking till leads on. Off down the hill. Down and back takes 40 minutes with 100m descent. Birds, mozzies, small dead snake. Good cardio and I hope not a stress test. Sun is up. Julie on way to her plane. Smooch. See you tonight.

What’s for dinner?

Breakfast of black tea and home-made bread with mashed banana. Triage emails.

Ablutions.

OFF TO WORK Fine morning. Eschew the 4WD. Take the Smart car with roof down. Wet hair now

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dry. I’ll need my comb. Twelve minutes to work through rural then suburbia to the Mater. Via office to grab notes. Through the Mater front door and the foyer is filled with cruel aromas of coffee and bacon.

Sue smiling from behind the café counter and Jan at reception. Quick change to theatre fatigues and second hat of the day – a stylish, blue, rather fetching, bouffant number.

Theatre 2 with grinning Anaesthetist Keane raring to go. How can he be so cheery at this hour? Crew ready? Good morning ladies. Let’s do it. Magnificent, multicultural, medical medley with ambassadors from India, the Philipines, Malaysia, South Africa, Scotland – oh, and Australia. Each with their own stories, harmoniously buzzing through a list of day cases. No majors because I’m going out to the mining towns for three days from Wednesday this week. Community Radio, not too high, sets the mood.

My blue hat becomes a mortarboard as I meet my fifth year student. Polite and reserved she seems a little overwhelmed at the activity and the people. Where are you from? Malaysia. We’ve got a couple of minutes. We go to the computer and Google Earth her home village near the Thai border. We cone down – ‘look! That’s my grandma’s house!’

We are going to get along like a house on fire. Come and see this ovary.

LUNCH TIME List goes well. Gamble my lunch money on a hospital raffle. Time to duck home and let dogs out. Cobble two slices of bread with Bismark herring. I know my pickled fish are safe from pilfering in our house. 20 spare minutes so fit brush cutter with new cords and re-fuel. Bush hat in the sun.

Dress for consulting. Blue shirt and shorts.

Black shoes, white socks and no tie – this is the tropics.

MEMBER NEWS

AFTERNOON No spaces in doctors’ car park but the Smart Car is an easy fit. Run the gauntlet of the menacing magpie surveying from on high.

Sue and Kerri bright and welcoming. One patient waiting. Caller on hold – question about her pill. Certificate to sign, now. Short orientation for student – here’s the kettle and this is where you sit. Bring in first lady who has a nasty prolapse. She is delighted to meet the student and chats to her freely.

Normally a new patient gets half an hour and return visits 15 minutes but hey!

Students each come for a week. Teaching is constant, if repetitive. I take them to Proserpine Outreach but not out west as the 1,000 km drive is too demanding for them.

Mid-afternoon a new patient fails to attend.

Sue confirmed with her Friday by SMS but no show today. Okay, let’s sign results then triage incoming mail. Prioritise clinical stuff over assorted surveys then knock over some dictation. Green tea, nuts. Emails.

EVENING Suddenly its 5PM. Thanks girls, see you tomorrow. Home. Dogs effervescent.

Ride-on. Cut grass.

7 PM Chair Radio Station AGM. I’m President, again. Another hat.

8.30 PM home. Julie is back from Brisbane.

Curry and good red. Politics, people, pets.

Teamwork.

No TV. Emails. Study 40 pages of Company Directors course.

Last hat of the day – a peaty single malt, no ice – my nightcap. Q

27

AMA Queensland NEWS

AMA’s recent wins In the tough work required to advocate on OUR members’ behalf, sometimes it’s easy to forget the wins made nationally over the past year.

Scrap the Cap The AMA took the lead role in the Scrap the Cap campaign, which opposed the former Government’s proposed $2,000 cap on tax deductions for work-related self-education expenses.

Shortly after its election, the new Government abolished the policy measure ensuring that doctors can continue to claim the costs of work related self-education, which is fundamental to delivering high quality medical care for patients.

Medical training places The medical training pipeline remains under pressure, with significant numbers of new graduates seeking prevocational and vocational training places. The AMA has lobbied successfully against several proposals to establish new medical schools, which would only place further pressure on available training places.

The Commonwealth has also agreed to fund up to 100 additional intern places each year and work continues through the National Medical Training Advisory Network to develop a coordinated plan to ensure that future graduates are able to access sufficient training places, based on community need.

Practice nurses and health assessments After extensive lobbying by the AMA, the Department of Health (DoH) provided a satisfactory and clearly-worded clarification about the role of practice nurses when undertaking health assessments. This advice addresses concerns at a Department of Human Services (DHS) issued advice in

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NOVEMBER 2014 DoctorQ

June that stipulated practice nurse time would no longer count in MBS health assessment items.

The revised advice confirms the circumstances where the time taken by practice nurses in assisting in a health assessment is recognised.

Doubling of PIP teaching incentive The AMA successfully lobbied the Government to increase the PIP teaching incentive, having developed a proposal in 2012 showing that it was inadequate.

The May 2014 Federal Budget announced an extra $117 million to double the PIP teaching incentive for teaching medical students.

GP infrastructure grants The AMA effectively executed a campaign against the former Government’s GP Super Clinic program, highlighting that it was an expensive program that failed to reach the vast majority of the community and also supported unfair competition against existing practices. The new Government has abandoned this program and, in the May 2014 Federal Budget, the Government announced $52.5 million in funding for a rural and regional infrastructure grants program focused on supporting existing practices.

Expanding training places for GPs The AMA’s 2013 GP Campaign for the Federal Election and subsequent 2013/14 Federal Budget Submission called on the Government to increase the GP training program intake. The Government

responded in the May 2014 Federal Budget and allocated an additional 300 GP training places, which increases the number of general practice training positions from 1,200 to 1,500 in 2014/15.

Rural GP VMO contracts The AMA’s authorisation from the Australian Competition and Consumer Commission (ACCC), which allows the AMA to collectively bargain with state health departments in setting the terms and conditions for rural GP Visiting Medical Officers, was renewed in March 2014.

GP Referred MRI The AMA has actively lobbied for GPs to be able to request MRIs for patients.

Following the introduction of new MBS items in November 2013, GPs can now request a limited range of MRIs for adults and children and we continue to lobby for the further expansion of this initiative.

Senior Medical Officer Contracts The AMA was heavily involved in the dispute with Queensland Health over SMO contracts, which had significant implications for salaried medical officers across the country through the potential for flow on to other states/territories.

The AMA and ASMOF successfully fought against many of the more draconian provisions of the proposed contracts and achieved are much fairer and more balanced arrangements for Queensland SMOs, including access to arbitration, unfair dismissal and independent dispute resolution. Q

FOUNDATION

Doctors doing good in 2014

Dr Sharmila Biswas (far right) with Rosies volunteers Lyall and Melissa, and Allen who is a patron of the Cairns outreach program

Looking back on another busy year for the AMA Queensland Foundation, it’s inspiring to reflect on what’s been achieved and the difference doctors doing good has made in the lives of so many.

Here are some of our proudest achievements for 2014: Thank YOU Doctor Campaign officially launched at the annual Thank You to Donors Cocktail Function.

William Buck donated a retinal camera to Associate Professor Noel Hayman and the Cunnamulla Health Centre in South West Queensland which will assist with screening for diabetes retinopathy in the Indigenous community.

The Foundation continued to assist financially disadvantaged medical students at James Cook University, welcoming second year student

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NOVEMBER 2014 DoctorQ

Louis Jenkins to the program as well as celebrating Amender Campbell’s graduation at the end of the year.

Rosies Cairns received $57,000 to purchase a new street outreach van just in time before their old van was put off the road, allowing them to continue to

provide food, drink, emergency clothing and blankets to Cairns homeless.

Foundation funded AMA The Queensland’s Lighten Your Load Campaign which was launched following recent alarming overweight and obesity statistics for those living outside cities.

Associate Professor Noel Hayman (second in from right) at the Cunnamulla Health Centre

FOUNDATION

James Cook bursary recipient Louis Jenkins Foundation Board members and Patron Tim Fairfax.

Kids from Red Hill Special School A social media presence was established with the Foundation launching its Facebook page, Twitter account and YouTube channel.

The Foundation unveiled workplace giving program.

its

new

Following on from the success of last year’s Christmas Appeal which resulted in a much needed four wheel drive vehicle for Dr Lara Wieland’s Out There Kowanyama program, Lara and the kids of Kowanyama received ongoing support again this year through Queensland X-Ray as well as receiving a significant gift from an anonymous donor.

the Foundation’s activities this year. So we would like to say a huge thank you to all our incredible donors, the Queensland Visiting Medical Officers Committee, and our major corporate partners: Queensland X-Ray; Sullivan Nicolaides Pathology; William Buck; Tresscox Lawyers; and MDA National. Q

$25,000 was received from Sullivan Nicolaides Pathology, being the final pledge of a $75,000 donation for a new, specially outfitted mini-bus for Red Hill Special School.

We are equally as proud of our achievements as we are humbled by the generosity of individuals and companies who supported

Dr Lara Wieland and the Kowanyama kids

Christmas appeal As Christmas approaches, what better way to celebrate the holiday season than by sharing what you have with those who are less fortunate? At this time for giving, we urge you to please consider making a gift to the Foundation. Keep an eye out for your chance to help when our letter arrives in your mail soon or donate online today at www.amaqfoundation.com.au.

Your generosity will have a positive impact on the lives of many by helping us in our mission to relieve sickness, suffering and disability among Queenslanders in need. Q

Doctors doing good

Do you have a project which needs financial assistance?

Contact The AMA Queensland Foundation: Phone: (07) 3872 2222 Email: amaqfoundation@amaq.com.au Website: www.amaqfoundation.com.au

DoctorQ NOVEMBER 2014

31

Feature story

100 years

of Hunstanton AMA Queensland’s home, AMA House, previously known as Hunstanton, celebrates 100 years this year. Built at the start of WWI, the heritage listed building holds some fascinating architecture and some quirky stories. Doctor Q Editor Michelle Ford Russ takes a look.

Many of our members have pondered our historical and unusual building when visiting the office. It’s pretty uncommon to see an imposing granite structure with a copper dome bearing the L’Estrange family Coat of Arms, particularly in Brisbane.

The house was built as a home for the L’Estrange family in 1914 and named after Hunstanton in Norfolk, the family’s ancestral home. As Mrs L’Estrange was afraid of fire, it’s believed Mr L’Estrange designed and built a fire proof home. The outer walls are non-cavity granite and brick, with the granite quarried at The Gap and Grovely, and the cement imported from Germany.

The house has a gabled roof with overhanging eaves of Marseilles terracotta

interlocking tiles. The verandah has large arched openings with rough-cut granite quoining with marble sill. Handcrafted Italian ceramic tiles with a black and white chequer pattern are a prominent feature at many of AMA’s smaller events.

The L’Estrange family sold Hunstanton to Dr James Duhig in 1929, who offered Hunstanton for sale to the then Queensland Branch of the British Medical Association in 1955.

Our beautiful building is a proud part of AMA’s history, and a proud part of Queensland’s history. Hunstanton was Heritage listed in 1995 and remains an elegant reminder of AMA’s history amidst our busy daily work. Q

2014 1914 32

NOVEMBER 2014 DoctorQ

Feature story

DoctorQ NOVEMBER 2014

33

events calendar

4 December Gold Coast 16 December Townsville

Intern Readiness Workshop

coming

up

what’s on 19 December

JCU Graduation Christmas Cocktails Reef HQ Aquarium, Townsville Let us help toast your graduation and welcome you to the medical profession!

This exciting end of year event will provide you with a chance to celebrate your graduation with past, present and future colleagues. Canapés and drinks will be provided. Registrations are essential.

26 February

Growing your career through research The Old Museum, Brisbane

For a junior doctor, research is one of the best ways to build your skill set and get the competitive edge. Join us for our Brisbane Research Evening that will cover the practicalities of getting started in research, integrating it into your career and presenting your research.

To view the full events calendar 34

NOVEMBER 2014 DoctorQ

Want to get the inside scoop on what to expect next year in your intern year? Presented by our Council of Doctors in Training Committee along with current firstyear intern representatives and our esteemed corporate partners, this free workshop will provide you with invaluable tips and first-hand advice to help you survive and thrive in your intern year.

4 December Hunstanton Open House

Hunstanton, AMA House

Come for a tour through AMA Queensland’s 100 year old heritage listed building. Once an elegant home to the L’Estrange and Duhig families, members and guests are welcome to attend an open house tour of one of Brisbane’s few early twentieth century structures.

Or to register for an event, visit amaq.com.au or contact the AMA Queensland Membership team on (07) 3872 2222 or email registrations@amaq.com.au

events calendar

2015 events 12 June

Presidential Inauguration

16 and 17 July

Junior Doctor Conference

16 September

Private Practice PCB

Women in Medicine Breakfast

7 November

17 November

Medico-Legal Conference

Confirm details closer to dates

27 and 28 June

Bancroft Oration

please note: 2015 dates and venues may be subject to change but are provided as a guide.

DoctorQ NOVEMBER 2014

35

MEMBER NEWS

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

AUG 2014

SEPT 2014

doctors in training

doctors in training

Dr Timothy Hanrahan

Dr Michael Berkley

Dr Welson Jao

Dr Katie-Beth Webster

Dr Terence Lim

Dr Manal Morgan

Dr Joyita Bhattacharya

Dr David Pratt

Dr Raja Sengupta

Dr Alice Dobinson

Dr Deepak Narayan

Dr Richard Sarafian

Dr Shiraz Nusair

Dr Sian Stephens

Dr James Noon

Dr Thilini Weligamage

General Practitioners

Dr Erin Walters

Dr Izabela OstrowskaKusiak Dr Najwa Mohammed Dr Zhong Pei Dr Timothy Vo

specialists Dr Brad Jones

Dr Craig Wilson Dr Maja Susanto Dr Linda Kemp

General Practitioners Dr Esteban Mondia Dr Christiaan Mostert

specialists

Dr Graham Lister

Dr John McAulay

Dr Stuart Collins

Dr Ian Webb

Dr Jason Free

Dr Patrick See

Salaried Practitioners

Dr David Agolley

part-time Practitioners Dr Anne Nixon Dr Kate Evans Dr Kathryn Heyworth

Salaried Practitioners Dr Michaela Marginean Dr Devinder Gill Dr Shane Anderson Dr Neelima Gandham

Dr Nicole Limberg Dr Justin Collum

Prof Francis Bowling

Dr Simone Becker

Dr Kelly Schilling Dr Derek Holroyd Dr Amanda Roberts Dr Joanne Dale

We have listened to you! Due to your feedback we are excited to now be able to offer BPay for the first time as a convenient option for you to renew your membership. You can also renew online by Visa, MasterCard or American Express and choose to pay monthly, quarterly or annually. Visit www.ama.com.au/renew to renew now. We also offer the opportunity to renew quickly over the phone by calling our membership team direct on (07) 3872 2222.

Swith to monthly instalments by 31 December for the chance to win a $500 Coles Myer voucher. *

renew & WIN!

to go in the draw to

win these great prizes!

Thank you to so many of our members for taking part in our annual event survey. Your feedback shapes our planning and we are committed to creating an engaging, social and informative events program. In 2015 we will be further developing the program in Queensland encompassing hospital lunches, free member seminars, social events and compelling conferences.

Expanding our event accreditation options beyond RACGP including RACS, RACMA, ACCRM and RACP Seminars to help you get the competitive edge in your career including presentation skills and how to get involved in research

NOVEMBER 2014 DoctorQ

Corporate Partners AMA Travel have offered an early-bird prize of two night’s stay at the luxurious Qualia Resort, Hamilton Island, including return travel from Brisbane, a generous $500 tab for food and beverages and a sunset cruise. Valued corporate partners Lexus have also offered a great early-bird prize of one night’s stay in a King Suite at the Emporium Hotel, Brisbane including complimentary valet parking and cocktails.* Q *View all terms and conditions for each prize at: www.amaq.com.au

ANNUAL EVENT SURVEY

This is what we are working on for next year:

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Renew by Monday

1 December 2014

RENEW

BY BPAY!

Dr Nicholas Tutticci

part-time Practitioners

Dr John McCormick

Your ongoing membership is vital to ensure a robust, collective voice for the profession - regardless of your career stage, specialty or location. Shortly in November, you will receive your 2015 AMA Queensland Member renewals notice, which highlights our significant achievements in member representation during a challenging year, along with our expanding range of member services, benefits and events.

Dr Christopher Randall

Dr Matthew Cronin

Dr Donna Bostock

Membership renewals

Forums to discuss and debate timely health policy and health reform issues Increased after hours face-to-face programs in your area and webinar options Programs including resilience, career progression, ethics, leadership and wealth management More free member events and cost effective conferences Better segmented marketing

and

streamlined

Expressions of Interest 106 Anzac Avenue, Redcliffe, Queensland, Australia

Moreton Bay Integrated Care Centre

This state of the art medical facility is seeking community focused medical practitioners and allied health service providers.

Situated adjacent to the Redcliffe Hospital, the Moreton Bay Integrated Care Centre (MBICC) is complete and ready for occupation.

Our community requires specialist medical disciplines and allied health providers such as: Paediatricians

Obstetrics

Exercise physiology

Physiotherapy

Pathology

Diagnostic Imaging

Dietetics

Podiatry

Endocrinologists

Diabetes

Mental health

Psychology

Oncologists

Audiology

Occupational therapy

Speech Pathology

Come and engage with the Moreton Bay Region in this community capacity building.

For further information and expressions of interest contact

LEVEL 2/145 EAGLE STREET, BRISBANE

07 3231 9777 www.bne.mcgees.com.au

MCG5548

Gavin Moore 0422 222 978 gmoore@bne.mcgees.com.au Justin Clarke 0419 704 412 jclarke@bne.mcgees.com.au

OBITUARY 24 September 1922 – 27 August 2014 Member for 55 years

Dorothy Helena Herbert AM BSc MBBS Dorothy Herbert’s medical and aviation career is now a silhouette in the collective memory of the Australian pioneer spirit and a local hero in the Charleville community.

Within her family, she was both a role model and someone who took an active interest in the studies and careers of the emerging generations.

Dorothy attended Ascot State School and then Somerville House finishing school in 1939, before studying science at the University of Queensland.

In 1942 she joined the Women’s Auxillary Air Force as a wireless operator based at General McArthur’s Headquarters in Brisbane. At the end of the war, she went back to complete her science degree, majoring in Physiology and Zoology. She completed her honours degree and worked as a demonstrator in the Zoology Department at the University of Queensland.

continued to fly Tiger Moths. In 1950, she also became a foundation member of the Australian Women Pilots Association (AWPA).

In 1953, she sailed to the United Kingdom via the Suez Canal. She worked as a Cadet Pilot for the Women’s Royal Air Force Volunteer Reserve, and ultimately became a Pilot Officer. She also worked as a Briefing Officer with the Royal Aero Club of United Kingdom.

In 1954, she returned to Brisbane to study medicine at the University of Queensland, graduating in 1958. She spent two years as a resident doctor at Brisbane General Hospital.

While studying and working as a biochemist she put money aside to undertake flying lessons at Archerfield. She gained her private pilots licence flying a Tiger Moth in 1947. In 1948, she worked as a biochemist /bacteriologist at the Leprosarium at Peel Island.

An interest in Charleville and Western Queensland developed after she had met Doctors Lou Airioti (general surgeon) and John Simpson (general physician) while visiting her sister Joan. Joan, a nurse, was working at Charleville Hospital at this time.

In 1961 she went to Charleville to work as a Locum Flying Doctor for the Royal Flying Doctor Service for three months. She then stayed in Charleville working in private practice until 1981. She assisted the RFDS intermittently during this time.

surgeon team with Dr Lou Ariotti, and would stand in for the flying doctor as required. At a time when there were few women doctors and fewer women pilots, Dorothy made quite an impression flying to remote communities with her three corgis in tow.

She then moved to Tasmania in 1949 and worked as a biochemist /bacteriologist at Royal Hobart Hospital. Her concurrent interest in aviation continued as she joined the Aero Club of Southern Tasmania and

In 1963, she bought her first secondhand aircraft – a 1957 single engine Cessna. She used this plane to fly to emergencies of her own patients, to medical conferences, to western properties, and was part of a flying

Dorothy was a truly remarkable woman.

She devoted her life to medical care that often required courage – rural obstetrics and anaesthetics are not for the faint hearted and required stamina and lifelong learning.

Through her 91 years of life and service she was an inspiration to her family, many friends, medical colleagues and fellow pilots.

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OBITUARY In 1977, she cared for a premature baby who was successfully transferred to the Mater Mother’s Hospital using the government jet. Joh Bjelke-Peterson was Premier at the time and his pilot, Beryl Young flew the plane from Charleville to Brisbane. This was one of the first times a premature baby had been retrieved back to a Brisbane hospital and survived. It involved collaboration between neonatologist, Dr David Tudehope, Beryl Young, Joh and Dorothy to make this mercy flight happen.

She was part of a crew who landed a light aircraft on the new international airport at Denpasar in 1971. In 1972, she organised the national AGM of AWPA in Charleville over four days. In 1973 she became Chief Flying Instructor of the newly formed Charleville Soaring Club.

She gained her Gliding Certificate and was a part owner of a glider.

Tragically, in 1978, she was crushed under the glider in a freak weather accident. She was flown by RFDS to Prince Charles Hospital with a fractured spine and chest injuries.

She was in a coma for three weeks and ICU for five weeks. She returned to practice in a back brace after five months of sick leave. A changing of the guards occurred at this time, as Dr Chester Wilson commenced work in the same medical practice in Charleville. He initially stayed with Dorothy as she continued to rehabilitate after her accident. “Dottie was a very tough, very capable lady,” according to Dr Wilson. “She would look over your shoulder and she would make certain of absolutely everything that you were doing.”

In 1981, Dorothy left Charleville and semi-retired on the Sunshine Coast (with her Major Mitchell Cockatoo, Linda). She worked in General Practice, specialising in Acupuncture and Aviation Medicine. She retired from medical practice in June 1996.

It does not surprise us that Dorothy was a fierce critic of bureaucracy creeping into medical practice. She was also a member of the Maroochy and Caboolture Aero Clubs.

She also flew her last flight in this year to an AWPA conference in Longreach at the age of 75. Her flying record at this time included 2,200 hours.

She was awarded the Nancy Bird-Walton Trophy for services to aviation in Australasia in 1972. In 1997, she was made an honorary Life member of the Aviation Medicine Society of Australia for her contribution as a designated examiner of airmen for 35 years.

She was awarded the Order of Australia medal in 1999 for her service to rural

medicine through the RFDS and to aviation through the AWPA. She also received a Centenary Medal for her distinguished service to RFDS in 2001.

Through her 91 years of life and service she was an inspiration to her family, many friends, medical colleagues and fellow pilots. Through her life and achievements, we can remember Dorothy as a pioneer and innovator with a wonderful sense of adventure. Her family remember her as a good listener who was both perceptive and decisive. During her life at Charleville, Dorothy was vitally connected with her

church and regarded the clergy as friends, counsellors and colleagues. The same was true of her time at Buderim. The Judeo-Christian vision of wholeness, and flourishing through transformation, was the sustaining vision of her career. Q Contributed by Dr Anthony Herbert, Dr Paul Mercer and Rev Ron Herbert

DoctorQ NOVEMBER 2014

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CURRENT health vision ISSUES This is an abridged version of the invited Conversations Series address to the academic community of the Rockhampton Campus of the Rural Clinical School of the University of Queensland School of Medicine, given on 16 January 2013 by Associate Professor Llewellyn Davies OAM FRACP.

HUMAN DIGNITY IN

HEALTH CARE Mrs Daphne Jones is 73 years of age. She collapsed while shopping in a small town about 30km from the base hospital. The local GP is away, so she is brought in by ambulance to the hospital emergency department. Mrs Jones is given a diagnosis of postural hypotension related to both her pre-existing Parkinson’s disease and its obligatory treatment. A contributing factor is a urinary tract infection.

This in turn is possibly related to a previously diagnosed uterine prolapse. She requires admission, hopefully for only a few days.

She spends eight hours in the emergency department, on an uncomfortable trolley until she is brought from the ED to the medical ward around midnight. Her clothes are now finally replaced by a hospital gown, and because of urgency she is given incontinence underwear.

No other bed attire is available. The gown is oversized, and fastens at the back with edgeto-edge ties. She finds herself in a four bed bay.

The other three patients in this bay are men, one, Mr B, being a ‘wanderer’ with dementia.

So how does Mrs Jones find herself the next morning? Her bedrails are not up but the nurses instruct her not to mobilise on

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her own, because she has been correctly identified as a falls risk, and because she is on intravenous fluids. Mrs Jones is really worried that Mr B might come into her curtained bed space and is in any case highly unsettled by the proximity of strange men in the ward bay.

Mrs Jones is also conscious that when she gets up, the gape in the rear of her gown exposes her back and underwear. She is profoundly embarrassed by this loss of her personal dignity. She still has no personal toiletries, slippers or a dressing gown. She has no phone of her own, but the cordless ward phone is briefly made available so that she can call her closest friend. Unfortunately nobody who might bring personal effects to the hospital for her seems to be coming to town soon.

An edible but unappetising breakfast arrives, with which Mrs Jones struggles.

She is unable to properly flex her elbow because her intravenous cannula is in the antecubital fossa. The placement of this IV cannula compounds manual disability from her Parkinsonism. The hard-pressed nurses seem too busy to help Mrs Jones with meals.

Later in the morning, a team of doctors come round: the bed curtains are difficult to close properly because the tracks have jammed, and eventually the doctors give up, leaving a gap open to passers-by while her abdomen and chest are examined.

She gradually improves a few days following IV antibiotics for the UTI, and adjustment of her anti-Parkinsonian therapy. Her discharge is adequately managed and Daphne leaves the hospital with improved physical health.

However she fervently wishes not to have to return to an environment where successful medical treatment is bought only at the cost of injury to her human dignity.

Certainly Daphne Jones is an amalgam of different people, but the story of her journey is far from being an exaggeration. In my forty years as a doctor I have seen dramatic advances in the investigation and treatment of hundreds of medical conditions, and the science of treating physical pain has been an important part of this spectrum. However we seem to have neglected the little-researched but – at least to our patients – harsh reality of psychological pain occasioned by the hospital experience.

CURRENT health vision ISSUES

As doctors, we can both promote or diminish patient dignity through our communication styles, our manner and the respect we show.

It seems to me that Mrs Jones’ disgraceful gown, her accommodation, and her privacy are not just appropriate, but important concerns for her doctors, and indeed for every health professional. Respect, privacy, preservation of self-esteem, and avoidance of shame, are issues infrequently discussed, and difficult for patients to explain. Neglect of these issues results in diminution of the person both in their own eyes and in the eyes of others.

As doctors, we can both promote or diminish patient dignity through our communication styles, our manner and the respect we show. We should ask patients how they would like to be addressed, look people in the eye, and even if we are not conducting a detailed examination, recall that touch itself is therapeutic. As doctors, we should put ourselves in the patient’s place and ask ‘How would I like to be treated?’

An important theme in this reflection is the place of doctors as advocates in the widest sense, for patient welfare. So along with advocacy for the best medicines, the best equipment, and the safest care protocols, why should we not advocate for supportive environments, views to the outside world and assistance to move from beds?

Doctors can also promote dignity through advocating for systemic change. However, I believe there is a sense of nihilism among doctors about the matters that endanger the human dignity of patients. As examples, better gowns, individual rooms, more beds, more nurses, and terraces all will cost money.

We are led to believe that the budgets of

all our public hospitals are under the most extraordinary constraints. Many doctors will just go with the flow: they say: “the problems cannot be affected by any action of mine: why should we expect more funds to be available?” However, the danger is in perpetuating a system where compromised dignity issues are the norm, where we forget immutable principles of respect, and where compassion fatigue sets in.

Is the preservation of patient dignity in this technocratic age a lost cause? Not at all, and, just as we doctors confidently expect the technical aspects of our care to show continuous improvement, we should also expect the humanistic aspects of our care to improve too. These aspects won’t improve however unless we lead the way as advocates for our patients. We may not endear ourselves to administrators and politicians by advocating for reforms that improve patient welfare at the cost of stretched budgets, but this is part of our professional duty. Q

Get involved Visit amaqhealthvision.com Send us an email at healthvision@ amaq.com.au Follow us on facebook and twitter at amaqueensland using the hashtag #amaqhealthvision Come to one of our events DoctorQ 2222 Call us on (07) 3872

NOVEMBER 2014

41 41

Why use an insurance broker?

Craig Wright from Experien Insurance Services explains how using a broker has many benefits and debunks the myth that going through a broker can be more expensive.

As your life changes, so do your insurance needs. It’s important to regularly assess your level of cover and make sure it’s still reflects your current circumstances. If you’re getting married, divorced, starting a practice or increasing your debt levels, it may be time to review your levels of cover and your beneficiaries.

direct can sometimes appear to be cheaper and a quicker solution. However, you may not be aware of all the product details, know what’s best for your needs and circumstances or have missed a fundamental inclusion or exclusion of the policy. Direct life insurance may be restrictive and more expensive than products tailored to your needs.

claim forms and delivering it to their house, arranging a death benefit payment for the grieving family or assisting with many other complex aspects such as arranging probate.

It is essential that your insurance adviser has strong relationships with insurers and their claim managers and is able to ensure your claim is managed efficiently.

Insurance companies regularly enhance their products, and one needs to be aware of the current market offerings, in the insurance market. A professional broker is in a position to advise you of any changes that can be considered for your existing policy which may strengthen your cover. Often when dealing directly with an insurance company, your cover is not reviewed, and you do not benefit from being advised of any enhancements.

Understanding the fine print of insurance can be complex. Professional brokers know what details are included or excluded within a given policy and spend considerable time studying insurers’ documents. This allows them to confidently recommend the most appropriate cover options for your circumstances.

Craig Wright is a risk specialist with over 22 years experience in the insurance and wealth management industry. Contact Craig Wright on (07) 3018 8168 or craig.wright@ experien.com.au for an obligation free consultation on the best insurance coverage for your needs. Q

Does it cost more to use a broker?

No. In fact dealing direct may be more costly.

Getting your insurance over the counter or

The value of claim support

The value of insurance is never felt more than at claim time. This is when dealing with an insurance adviser (as opposed to dealing direct with an insurer) is so valuable. Advisers help with such things as, arranging a clients

DISCLAIMER: This information is of a general nature only and has been prepared without taking into account your particular financial needs, circumstances and objectives. While every effort has been made to ensure the accuracy of the information, it is not guaranteed. You should obtain a copy of the product disclosure statement and also obtain independent professional advice before acting on the information contained in this publication. Life Insurance services are provided by Experien Insurance Services Pty Ltd (ABN 99 128678 937). Experien Insurance Services Pty Ltd ABN 99 128 678 937 is a Corporate Authorised Representative (No. 320626) of ClearView Financial Advice Pty Limited ABN 89 133 593 012 AFS Licence No. 331367.

Life insurance premiums creeping up, how does $500 cash back sound?

As the preferred insurance provider to AMA Queensland, Experien Insurance Services are offering members an exclusive $500 cash back on your first year premium when you take out a personal insurance policy including Life, Income Protection or TPD insurance with Experien.1 Contact Craig Wright for an obligation free insurance review, 3018 8168.

Life Insurance services are provided by Experien Insurance Services Pty Ltd ABN 99 128 678 937. Experien Insurance Services Pty Ltd is a Corporate Authorised Representative (No. 320626) of ClearView Financial Advice Pty Limited ABN 89 133 593 012 AFS Licence No. 331367. General Insurance services are provided by Experien General Insurance Services Pty Ltd trading as Experien Insurance Services ABN 77 151 269 279 AFS Licence No. 430190. This information is of a general nature only and has been prepared without taking into account your particular financial needs, circumstances and objectives. While every effort has been made to ensure the accuracy of the information, it is not guaranteed. You should obtain a copy of the product disclosure statement and obtain independent professional advice before acting on the information contained in this publication. * Promotion only applies to new policies from the Experien Insurance Services (EIS) life insurance offering - Trauma Insurance, Total & Permanent Disablement (TPD) Insurance, Needle stick Cover, Life Insurance, Key Person Insurance, Income Protection Insurance, Business Succession (Buy/Sell) Insurance or Business Expenses Insurance - and not to any existing policies that are transferred to EIS as adviser or products offered by Experien General Insurance Services (EGIS). Only one rebate will be issued per client (or related entity/ party) and cannot be used in conjunction with any other EIS offer. The rebate only applies to the first year’s premium. Rebates will be issued to eligible clients at the end of the promotion period and only on policies that complete in the promotion period 31 December 2014.

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AMAQ_July_ad.indd 1 NOVEMBER 2014 DoctorQ

10/27/2014 1:30:53 PM

professional services

Planning your next property move

Australia’s love of property is unlikely to recede anytime soon. With interest rates remaining at an all-time low, BOQ Specialist’s Jeff Miller explains why now is the perfect time for you to take stock of your finances and consider your next move on the property ladder.

Choosing the right location and type of home for the lifestyle you want is challenging enough without also being overwhelmed by the financial choices and options available to you. If you are after a new primary residence, looking to renovate, re-mortgaging or if you’re buying an investment property, BOQ Specialist has the knowledge and expertise to find a financing solution that suits the needs ofbusy medicalprofessionals.

Assessing your finances

You might have a ball-park figure of how much you will need to spend on the kind of property you want, in the area you want but it’s a good idea to begin by working out how much you can afford to borrow in the first place.

Before you embark on buying property, I recommend that you seek professional financial advice which takes your personal circumstances into account. It’s vital that you understand the financial implications of your decisions and that you make the best decisions for your circumstances and your objectives. It’s all too easy to sign up for a loan that meets your immediate requirements, but doesn’t fit your medium and long term goals.

Improving the bottom line

Buying a home or investment property is one of the biggest financial decisions you’re likely to make.

It’s exciting, but there’s a lot at stake. Medical professionals are often so consumed with the dayto-day operations of their high-pressure roles, that you overlook personal finances. Choosing a home

Important information As you may know, Investec Bank (Australia) Limited has been sold to Bank of Queensland Limited (BOQ) and the name of the company has changed to BOQ Specialist Bank Limited (BOQ Specialist). We will continue to deliver a distinctive suite of lending and banking products for your personal and business needs. As a client your accounts and the manner in which they operate remain unchanged and you can expect the same high level of expertise and personal service.

loan can be difficult if you don’t know the pros and cons of each type. You often don’t have a lot of time to spare, but with a range of different options available and competitive interest rates, you really should be looking around the market for the best solution for your needs.

Jeff Miller BOQ Specialist 1300 131 141 boqspecialist.com.au/medical BOQ Specialist offer a range of financial products and services specifically tailored to the medical sector.

In addition, personal circumstances, spending behaviour and property values are constantly changing, particularly as you transition into new stages of the investment life cycle, so it’s important to regularly reassess the loan structures and facilities previously taken out. This is not necessarily related to the service of the lender, but more to do with the suitability of the product for your current financial goals, and the ability of the lender to tailor a product closely to your individual needs. For instance, while a previous goal might have been to minimise the costs on loan obligations, now you might want to examine releasing equity for an investment property purchase or home upgrade.

Help is at hand

With so many considerations and decisions to make when you are looking at property you need someone who can work with you to find a product which suits your needs. We are here to help you think about all the possibilities and to assist you in finding the right solution. The reason BOQ Specialist can help you make the right decision is because, we have over 20 years experience in working with doctors, so we know your profession in a deeper way than anyone else. Q

Disclaimer: The information contained in this article (“Information”) is general in nature and has been provided in good faith, without taking into account your personal circumstances. While all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, no warranties in this regard are provided.

We recommend that you obtain independent financial and tax advice before making any decisions.

Financial Products and Services described in this document are provided by BOQ Specialist Pty Ltd ABN 94 110 704 464 (BOQS) as agent for BOQ Specialist Bank Limited ABN 55 071 292 594,AFSL and Australian Credit Licence 234975(BOQ Specialist). Both BOQ Specialist and BOQS are wholly owned subsidiaries of Bank of Queensland Limited ABN 32 009 656 740 (BOQ). Both BOQ and BOQ Specialist are authorised deposit taking institutions in their own right. Neither BOQ nor BOQ Specialist guarantees or otherwise supports the obligations or performance of BOQS or each other or each other’s products or services.

DoctorQ NOVEMBER 2014

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professional services

Make 2015 your best year in business Many practices leave the planning and organisation of their New Year marketing strategies till the last minute. Jason Borody from Vividus Marketing explains why now is the time to determine whether 2015 will be your best year in business, or if it will be a repeat of this year.

Jason Borody Director (07) 3282 2233 jason@vividus.com.au Vividus specialises in healthcare marketing for hospitals, medical centres, GP and specialist practices, and healthcare businesses.

Most practice owners start out with big, ambitious goals for the New Year. They want to get more business, build better relationships, increase patient loyalty and, hopefully, create sustainable growth.

Why do some practices almost always achieve these goals, while others start the year strong, just to fall back into old habits by February? It all depends on two things: 1. The goals you set 2. Your plan for achieving them Here are three simple, yet powerful things you can do to set better goals, make better plans and to make 2015 your best year in business.

Goal #1: Do what works, not what’s popular Following the crowd is a direct path into mediocrity.

This is truer in marketing than almost anything else. For example, in 2014, many business owners stopped investing money into traditional marketing channels like direct mail. Their plans were to invest the money into email marketing and social media instead.

But did you know that direct mail is still the most trustworthy channel for reaching new clients?

This is especially true when your competitors are all scrambling onto the internet, trying to take advantage of cheaper alternatives.

So when you see those marketing statistics about how businesses are investing more money into this media or that media, stop and look at the numbers that really matter. In many cases, the consumer behaviour statistics tell a completely different story.

Goal #2: Step out of your comfort zone They say magic happens outside of your comfort zone, so don’t be afraid to take a few risks and try something new – after all, this way of thinking will get you noticed.

Consider working on creating a video for your practice. The brain absorbs visual stimuli faster 44

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and video has a way of embedding itself into the memory much longer than text. This powerful and effective marketing tool can be efficiently leveraged via a wide range of platforms, shared across multiple social media channels and boost your visibility in search engines.

Make sure you are systematically tracking the source of each new patient enquiry to know what is working and what is not. More importantly, with accurate tracking numbers you can calculate the actual monetary return on investment from your marketing efforts.

Healthcare competition is increasingly fierce and medical practices that don’t step out of their comfort zones are likely to be lost in the crowd.

Goal #3: Create a simple follow up system Hire a professional copywriter to create 12 short follow up emails. Create six for people who filled in your online lead form but who haven’t come in yet. Create the other six for welcoming brand new patients, thanking them for business and asking for a review and a referral after their first visit. If you can’t hire a writer, have someone in your office write them. You can have them write one email a week and probably have all 12 ready by the time 1 January 2015 rolls around.

That’s a small amount of work considering that businesses that follow up on leads generate an average of 50 per cent more sales within 90 days of starting the follow up campaigns. Using this follow up system, you could easily make 2015 a year to remember. Q

professional services

Choose carefully in 2015 With a bumpy forecast ahead, Macquarie’s Ross Noye explains why careful asset allocation and stock selection is critical for the year ahead.

Volatility returned to capital markets in September and October presenting opportunities for traders and investors alike, as the Macquarie Strategy Team targets the ASX 200 at just under 5,900 by September 2015. This represents an increase of around 13.2 per cent plus dividends (at the time of writing, ASX 200 5,188), bringing the Total Shareholder Return (TSR) to around 17 per cent.

However, investors will need to be selective on stock choice and given the Australian recovery lags that of many of its international peers, investors may look to include a higher exposure to international investment markets. Other points to note include: The domestic economic expansion is to continue, but the pace of growth is likely to ease as the economy deals with declining mining investment and a fall in national income from lower commodity prices If the lower $A is sustained, it will provide a significant boost to domestic exporters The impending introduction of tighter controls on higher risk mortgages will provide the RBA with the flexibility to stimulate the non-mining economy without further stoking speculative housing activity The divergence in expected returns between the industrials and resources sectors has widened with Industrials forecast to significantly outperform resources, reflecting a poorer outlook for earnings growth for mining stocks than previously expected This divergence of growth outlook is also evident in the industrials sector where domesticallyfocussed industrial stocks are finding conditions challenging, while those companies with meaningful offshore earnings are leveraged to the stronger economic growth experienced by other developed world economies (US and UK in particular)

CURRENT PHASE OF THE ECONOMIC GROWTH CYCLE

Ross Noye Macquarie Private Wealth (07) 3233 5805 0438 779 955 ross.noye@macquarie.com Ross Noye is a stockbroker and financial advisor at Macquarie who specialises in investment and retirement planning.

Earnings per share growth for the domestic industrials sitting at 9.5 per cent while earnings for internationally exposed industrials stocks is expected to be higher at 14 per cent.

Portfolio positioning In line with Macquarie Research’s view of the global economic recovery, it continues to recommend an overweight position in international investments, with a preference for US equities, and in particular US technology, capital goods and diversified financial companies.

Macquarie Research expects the Australian economic recovery will remain comparatively weak relative to its developed peers. It believes investors can find the best prospective returns in companies able to access a better level of demand, either through strong business models and the relatively robust sectors of healthcare, business and consumer services, and/or higher growth international exposure. Q

The impending introduction of tighter controls on higher risk mortgages will provide the RBA with the flexibility to stimulate the non-mining economy without further stoking speculative housing activity

important information: This information is 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.

This information has been prepared by MEL and does not take into account your objectives, financial situation or needs. Before acting on this advice you should consider whether it is appropriate to your situation. Past performance is not an indicator of future returns.Except for Macquarie Bank Limited (Australian Credit Licence 237502) ABN 46 008 583 542 (MBL), any Macquarie entity referred to on this page is not an authorised deposit-taking institution for the purposes of the Banking Act 1959 (Cth). That entity’s obligations do not represent deposits or other liabilities of MBL. MBL does not guarantee or otherwise provide assurance in respect of the obligations of that entity, unless noted otherwise.

DoctorQ NOVEMBER 2014

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professional services

RELATIONSHIPS WITH CONSULTANT CLINICIANS: THE POTENTIAL PITFALLS Claire Smith

TressCox Senior Associate Claire Smith takes us through the recent case of Chaudry v Medical Board of Australia, which demonstrates the problems which can arise when a specialist consults patients from another’s clinical rooms.

Senior Associate (07) 3004 3531 Claire_Smith@tresscox.com.au Claire Smith is a Senior Associate at TressCox Lawyers with over 10 years litigation experience, primarily defending civil claims for damages.

In early 2013 the Medical Board took immediate action to impose conditions on the registration of an Immunologist and Allergist, Dr Chaudhry, following a notification from Dr Heyworth, a GP and the general manager of a specialist immunology clinic where Dr Chaudhry conducted part of his practice. The clinic was jointly owned

by Dr Heyworth and her husband, Dr HeyworthSmith, also an Immunologist. The clinic appeared to be a business conducted by Sabletoll Pty Ltd as trustee for the Heyworth Medical Service trust.

The notification concerned a holding file found in a clinic computer which indicated around 1,350 pathology reports from the previous year had not been checked by Dr Chaudhry. In deciding whether Dr Chaudhry posed a serious risk under the National Law, the Queensland Civil and Administrative Tribunal (QCAT) shed light on when a consultant clinician will be considered an independent contractor.

In the notification, Dr Chaudhry was described by Dr Heyworth as an ‘independent contractor’ to the clinic. The clinic provided administrative and nursing support while Dr Chaudhry maintained “full clinical independence as a consultant physician” and responsibility for the pathology investigations undertaken. QCAT accepted for the most part the description of the relationship, but maintained the categorisation as independent contractor was inaccurate to the extent that it intended to illustrate Dr Chaudhry somehow supplied services to the clinic.

QCAT found that Dr Chaudhry had the right to use the clinic’s premises, materials, equipment, business name and be provided with administration and support staff, but did not supply services to any immunology practice operated by Dr HeyworthSmith or Sabletoll Pty Ltd. Most importantly, the patients of Dr Chaudhry were not patients of the clinic.

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The misinterpretation of the legal relationship between Dr Chaudhry and the clinic, led to the false view that the patients who saw Dr Chaudhry at the clinic were both Dr Chaudhry’s patients and those of the clinic. Correspondingly, it led to the incorrect belief that the patient records stored on the clinic’s computer were the records of the practice. On the contrary, an agreement had not been entered into with Dr Chaudhry so as to make the patient records those of the practice.

After a detailed consideration of the evidence, it was ultimately determined that Dr Chaudhry had appropriately dealt with the pathology results.

QCAT also found that Dr Chaudhry did not pose a risk to his patients and the conditions on his registration were removed.

Dr Chaudhry’s position was that the notification should have been viewed in the context of a declining business relationship. Although QCAT accepted some exaggeration on the part of Dr Heyworth, it did not agree that the notification was made in bad faith. However, the misunderstanding of the nature of the relationship with Dr Chaudhry, albeit unintentional, had been significant. It was in part responsible for Dr Heyworth contacting Dr Chaudhry’s patients, after encroaching on patient confidentiality and accessing Dr Chaudhry’s patient records without consent, potentially causing them concern.

If Dr Heyworth had properly understood the nature of the relationship between the clinic and Dr Chaudhry this breach of confidentiality could have been avoided. This case provides a timely reminder to practices and practice managers to review contract documentation to ensure clarity in relationships with other practitioners. Q

“

“ , Partner

, Partner

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• Employment Contracts • • • IR & Workplace Safety • • Business structuring and contracts

•

• • • • •

professional services

Tax office guidelines on paying owner doctors The Australian Tax Office has released long-awaited guidelines on professional practice and tax avoidance. William Buck’s Julie Smith takes us through the new guidelines to show if your practice might be affected.

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

Julie Smith is Tax Services Director at William Buck Chartered Accountants and Advisors.

In many years of specialising in the medical industry, we have seen a great deal of confusion in the industry regarding the taxation of income generated by practitioners through their practices.

is also 65 per cent. All other profits can then be distributed amongst your family members.

In particular, where a medical practitioner owns the practice and is involved in its management, many have been tempted by the suggestion that they can greatly reduce their own income tax by not remunerating themselves on market terms for the work done, on the basis that they are owners.

On 2 September 2014, the ATO issued guidelines entitled Assessing the risk: allocation of profits within professional firms. They have stated that these guidelines apply to all professional firms, including the medical industry.

The Tax Office has now issued guidelines confirming this view and setting out its intention to undertake an audit program to find those who do not comply.

Within the guidelines, the ATO expressed concern about arrangements where the practitioner is not directly rewarded for the services they provide to the business, or receives a reward which is substantially less than the value of those services. In addition, they also expressed the view that they consider the general anti-avoidance provisions in the Tax Act have potential application where the “practitioner arranges for the distribution of business profits or income to associates without regard to the value of the services the individual practitioner has provided to the business”.

Background

ATO Guidelines – What is the risk?

Our view on this matter has always been that if it sounds too good to be true, it usually is! That is, the practitioner must be remunerated on a commercial basis for the work that they perform with patients and the remaining business profits can then be allocated between their family members’ tax effectively.

Many have been tempted by the suggestion that they can greatly reduce their own income tax by not remunerating themselves on market terms for the work done.

DISCLAIMER: This article has been prepared by Julie Smith of William Buck. The article is intended to be general in nature and should not be relied upon by any person without seeking advice concerning their own circumstances.

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ATO Guidelines – What is their view?

Generally, when you are a practice owner, there are two types of income you will earn through your business. The first is income generated from seeing patients and working day-to-day in the practice. The second is income generated from the business itself – predominantly through the efforts of other doctors and employees.

The general tax principles are that for the income that you generate from your own efforts, you must pay the tax on this income personally (irrespective of the business structures in place to receive this income). In simple terms, if you do the work, you pay the tax.

On the other hand, for profits generated by the wider practice, these will be taxed depending on how you own your interest in the practice, that is, either in your own name, through a trust or company (or a combination of these). In simple terms, if you own the asset, you pay the tax.

The ATO have indicated that they will begin audit compliance activity in the 2014-15 financial years.

They indicate that they will undertake audit activity on arrangements they consider high risk and do not meet one of the following guidelines: 1.

The practitioner is personally assessable at an appropriate rate. The ATO states a practice may set the rate based on the level of remuneration paid to the highest band of professionals providing equivalent services in the business; and/or

2.

50 per cent or more of the income to which the practitioner and their associated entities are collectively entitled to is assessable in the hands of the practitioner; and/or

3.

The practitioner and their associated entities both have an effective tax rate of 30 per cent or higher on the income received from the business.

The point of confusion comes where some practitioners seek to maximise the business profits that can be shared with family members through trust or company arrangements, by minimising the level of personal remuneration for personal work they perform. Many argue that although they see patients in the practice, the real ‘value’ they provide is the management of the practice, which is remunerated at a lower rate.

What do you need to do?

It has always been our view that you must pay tax on a commercial basis for the services that you provide. For example, if you see patients within your practice and other doctors that contract to you are remunerated, at say, 65 per cent of patient billings, your commercial remuneration for patient work

On this basis, we strongly recommend you review your structures and taxation with your accountant or consider a second opinion to ensure you are appropriately dealing with the taxation of the income generated from services that you provide to your practice and your patients. Q

With the issue of these guidelines, there is now clarity on how the ATO will approach the taxation of the different types of income you will generate from your practice. In addition, the ATO has effectively given notice that if your affairs are not compliant with the risk factors outlined; you are at high risk of undergoing an ATO audit on this area.

We understand you.

As specialists in the medical industry, William Buck’s advisors are well placed to help you make the right decisions when it comes to your finances.

William Buck (Qld) GPO Box 563, Brisbane QLD 4001 Telephone:+61 7 3229 5100 Facsimile: +61 7 3221 6027 williambuck.com

CHARTERED ACCOUNTANTS & ADVISORS

professional services

MEDICAL INDEMNITY FOR YOUR PRACTICE ENTITY AND STAFF Chris Mariani AMA Queensland Insurance Solutions 1300 883 059 chris.mariani@amaqis.com.au Chris Mariani is a medical indemnity specialist at AMA Queensland Insurance Solutions.

The number one mistake we consistently witness is a doctor (or practice manager) mistakenly assume the doctor’s medical indemnity will cover these complex structures, staff and activities.

DISCLAIMER: AMA Queensland Insurance Solutions is a trading name of KSLR Pty Ltd, a Corporate Authorised Representative of Insurance Advisernet Australia Pty Limited, AFSL 240549.

Corporate Authorised Representative No: 366807.

The information provided in this article is of a general nature and does not take into account your objectives, financial situation or needs. Please refer to the relevant Product Disclosure Statement before purchasing any insurance product.

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AMA Queensland Insurance Solutions’ Chris Mariani explains how an older view of a practice structure could leave you uncovered.

Around 15 years ago, a common medical practice structure was a solo practitioner with a nurse and receptionist. Medical Defence Organisations (MDOs) which provided cover to doctors generally held the view that the doctor, their practice entity and staff would all be covered under the doctor’s policy - as any mistakes made by the entity or staff were as a direct result and part of the doctor’s treatment of the patient. Around this time, the MDOs provided ‘discretionary assistance’, rather than detailing what was covered in the formal terms of an insurance contract.

Fast forward to today – and in modern day practices, it’s not unusual to see complex structures, multi-doctor or corporate ownership, room rental and independent service agreements and nursing/allied health/ others providing healthcare to patients. Now the MDOs provide indemnity via an insurance contract – so it’s important to read and understand the ‘fine print’.

Without a doubt, the number one mistake we consistently witness is a doctor (or practice manager) mistakenly assume the doctor’s medical indemnity will cover these complex structures, staff and activities.

An example we often provide to a multi doctor practice – a new patient arrives at reception and has never seen any of the doctors. They are complaining of chest pain and the receptionist asks them to wait in reception as all the doctors are busy. After waiting to see a doctor for 20 minutes, they suffer a heart attack in the waiting room. Assuming this incident turns into a negligence claim against the practice – which doctor’s policy should respond to the claim? Which doctor wants that claim on their personal record? Is the MDO to apply the claim across all five doctors’ policies (even Dr Jones who was on the golf course at the time?) and what if the doctors are all

with different MDOs with differing ideas on whether the claim is covered?

All the above issues can easily be solved by the practice holding its own medical indemnity cover. There are numerous benefits to the practice having its own policy, especially where you select the better policies which also extend to cover other common practice risks. There are also other insurances which should be considered by the practice, such as Management Liability, Cyber risks, Public Liability, Business Interruption, Workers Compensation to name a few.

So when can a doctor just rely on their own policy, rather than buying a policy for the practice?

You need to be very careful your personal medical indemnity can extend to cover your entity and staff. Let’s look at a simple practice - Dr Sally Smith is a GP and wholly owns her practice entity ‘Dr Smith Pty Ltd’. Dr Smith Pty Ltd employs a nurse and a receptionist who are under Sally’s direction and control.

Sally has her own medical indemnity insurance with one of the four MDOs. Does Sally’s policy also cover Dr Smith Pty Ltd and the two employees?

The answer – It depends on which MDO she is insured with. Two of the four MDO policies state cover extends to a wholly owned practice entity and a nurse and receptionist.

Whereas the other two MDOs will cover Sally’s practice entity, however one excludes the nurse and the other does not specifically extend to cover any staff at all.

So even in Sally’s simple practice structure, Sally needs to carefully review her MDO cover. Q

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.

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

For more information phone: 1300 883 059

lifestyle

Crossover to the Lexus NX

The NX is Lexus’ first entry into the compact crossover segment. Its edgy and striking design was developed to appeal to new customers seeking urban and active lifestyles.

Developed at all stages from the perspective of young, urban, luxury drivers, the NX sets new standards for future Lexus models.

The NX exterior has been designed to provide a feeling of agility not usually associated with an SUV while also being suitable for urban use. It embodies an aggressive form that makes its functionality and higher performance evident at a glance.

The NX is sculpted to look nimble while hinting at the incredible power concentrated inside. Front and rear flares fuse with the diamond-shaped body at the spindle grille, and innovative LED headlamps and daytime running lamps firmly express Lexus’ bold design language.

The NX is sculpted to look nimble while hinting at the incredible power concentrated inside.

A roofline peak towards the back of the vehicle provides ample headroom and accentuates the side profile, creating a tight silhouette.

The rear is punctuated by Lexus’ signature ‘L’ shape combination lamps, each with seamless LED lighting, while the bodywork echoes the spindle grille design at the front.

An innovative outer mirror and world-first door handle mechanism (with hidden key barrel and integrated lighting) add to the luxury appearance.

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The interior of the NX directly evokes the premium, urban feel of the vehicle, combining the structural beauty of a highperformance machine with a material feel that maximises luxury and functionality.

The centre silver frame is strongly embedded into the instrument panel, symbolising the strength of the vehicle, and knee pads located on both sides of the frame firmly support the driver and passenger.

Cabin design prioritises seating and interior space. The NX possesses the lowest hip point in the segment, adding to the connection between the driver and the vehicle and increasing overall head room. The quilted pattern of the seats and varied pad thickness express the crossover intention of the vehicle.

The NX also offers best-in-class luggage load length and rear seat leg space.

The new Lexus 2.0-litre turbo engine was tested over one million kilometres of various, often harsh road conditions and environments.

The direct-injection turbo engine features the world-first combination of a cylinder head with an integrated water-cooled exhaust manifold and a twin scroll turbo charger.

A new 6-speed automatic transmission has been adopted to match the new turbo engine. It features new torque-demand control logic, which calculates required engine torque to maximise the exhilaration of quick acceleration response and fuel efficiency.

The Lexus Valvematic system provides high torque through an expanded valve opening angle and VVT operation range in a 2.0-litre, naturally aspirated engine.

The power plant has a high compression

ratio and diagonal fuel injectors that optimize the fuel mixture to produce strong power throughout the rev-range. The engine is matched to a newly-developed, electronically-controlled S-CVT/Multi-drive sequential-shift transmission.

An array of innovative on-board technology complements the vehicle. Enhancing the console are a Lexus-first Wireless Charging Tray for portable devices, the first application of a new Lexus Remote Touch Interface with a touch pad, and a Panoramic View Monitor and comprehensive Multi-information Display. Driving technology includes a Lexus-first G sensor and boost meter, Heads-Up Display, All-speed Dynamic Radar Cruise Control, Blind Spot Monitor, and Rear Cross Traffic Alert.

The Panoramic View Monitor, introduced into a Lexus vehicle for the first time, helps the driver avoid other vehicles and pedestrians approaching from the sides.

This system combines video from four cameras mounted to the front and rear sides of the vehicle, offering a view of everything happening around the car, including in blind spots. The display is automatically adjusted based on gear-stick operation, with the system able to display enlarged views from above the vehicle.

Radar Cruise Control with All-speed Tracking Function maintains inter-vehicle distance within a set speed and supports the driver by detecting the vehicle ahead and ensuring that an appropriate distance is maintained from cruising speeds down to a stop.

The NX F SPORT version provides more aggressive and sportier design. F SPORT exclusive items include a mesh spindle grille, new front lower bumper, aluminium wheels, black outer mirrors, exclusive interior colour options, ornament panel and sport seats. Q

Drive it today. Contact Peter Thomas, Lexus Concierge, on 3327 1777 or email peter.thomas@lexusofbrisbane.com.au

LEXUS OF BRISBANE Cnr Moggill Rd & Rennies Rd, Indooroopilly Cnr Ann St & James St, Fortitude Valley lexusofbrisbane.com.au LEXUS OF MAROOCHYDORE 63 Maroochy Boulevard, Maroochydore lexusofmaroochydore.com.au LEXUS OF SOUTHPORT 161 Ferry Road, Southport lexusofsouthport.com.au

lifestyle

New York, New York Well, the secret is out! AMA Queensland’s 2015 Annual Conference will be held in New York. Ros Bulat from AMA Travel gives us the lowdown on why you need to book your ticket to the Big Apple post-haste.

Over 47 Million tourists a year visit the Big Apple from all over the world, making New York one of the most highly sought after destinations for both local and international tourists alike. It’s the perfect destination for first time travelers as well as offering an extensive array of amazing things to do for return visitors.

Did you know: About 1 in 38 people who live in the US, live in New York.

The first pizzeria was opened in New York in 1895. The price of a single slice of pizza, and the single ride on a subway have been approximately the same price for the last 50 years.

Time Square was originally called Longacre Square until 1904, when the New York Times moved there.

The Empire State Building has its own zip code. On a clear day, the Empire State Building can offer 80 miles of visibility, which covers areas as far as Massachusetts, New Jersey and Pennsylvania.

New York’s central Park is larger than the

principality of Monaco, and it can cost as much as U$289,000 to hold a one-year hot dog stand permit there.

The Federal Reserve Bank on Wall Street holds about 25 per cent of the world’s gold bullion.

New York City served as the capital in the 1780s before it was moved to Philadelphia and then Washington.

Phantom of the Opera is currently the longest show in Broadway history, with well over 9,000 performances.

New York City cabs are yellow, because according to car salesman John Hertz in 1907, Yellow is the easiest colour to spot at a distance.

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lP ark

Pre and post conference options are unlimited. Whether you are interested in an Alaskan Inside passage cruise, a show in Vegas or the political capital of Washington, we can create the perfect itinerary for you. Q

PHONE : 1800 26 2 885 FAX: (0 7) 5556 72 00 EMAIL: travel@ amaq.co m.au WEB: www.am aq.world travel.co m.au

re

tra

We look forward to you joining us in this thriving metropolis so you can experience not only these unique qualities of New York, but many more.

For more in AMA Tra formation call o r email R vel Quee os at nsland.

qua S s e Tim

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Isla y e Con

EMPIRE STATE BUILDING MANHATTEN TIMES SQUARE NEW YORK YANKEES lifestyle

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MUSEUM OF MODERN ART QUEENS AMA Queensland AnnualConference 20-26 September 2015 REGISTER NOW AT: WWW.AMAQ.COM.AU EARLY BIRD RATE ENDS 30 JAN 2015

DoctorQ NOVEMBER 2014

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lifestyle

2014: Vintage of the Year… AGAIN!

Do you detect a little cynicism about vintage reports from Phil Manser at Wine Direct? He stands guilty as charged, but proves the point that each vintage lauded or otherwise, has good and bad news.

Take 2011 for example, the wine press in many instances were scathing, particularly of McLaren Vale and Barossa, yet we saw numerous reds and whites from these areas that not only made the grade but were sold out before our faithful could back up for more.

2011 Dandelion Barossa Shiraz comes to mind, pepper, spice, black and blue fruits and for those that need the bling as well, trophy, four gold medals and 94 Halliday points. Great wine but sold out all too soon.

Play the wine not the vintage is the message

The vineyard is a unique working environment and when you see a vintage unfold with your own eyes there are various challenges along the way, many of which can be met in the vineyard. This is especially true in a biodynamic vineyard where cover crops are managed carefully to nourish the soil at critical times as well as encourage certain ‘helpful’ insects to proliferate. Vine canopies can be managed at critical moments in the season from allowing it to thicken providing important shade and protection to thinning it out nearer to harvest to help control fungal disease… and so on and so on… Words like ‘difficult’ or ‘challenging’ rarely translate into disaster and more often simply reflect our own working lives… a challenging or difficult week or month doesn’t always spell disaster does it? Life goes on.

it is the overt grapefruit character it exudes,

Don’t get hung up on vintage reports unless they include biblical references to plagues of locusts, abundant flies and livestock in bad health. Mother nature rarely gives people on the land a perfect ride yet in Australia we continue to enjoy fantastic wine regardless of the year.

of new and second used oak. This will cellar for

Phil Manser Wine Direct 1800 649 463 phil.manser@winedirect.com.au

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here. In my experience you’ll find gems and disappointments in any sort of season. This is what makes my job so interesting. Here are a couple of wines from this vintage I’ve enjoyed to date: 2014 Hamilton Adelaide Hills Sauvignon Blanc has surprised everyone here with its intensity and length. What I like most about a character I associate with savvies twice the price. At $15/bottle this is a steal.

2014 Turkey Flat Rosé is as serious as rosé can get. This is Grenache dominant but with the assistance of shiraz, cabernet and dolcetto this not only presents sweet red fruits on the nose but complexity on the palate with a balanced only semi-sweet finish. Delicious!

2012 Alpha Crucis Old Vine McLaren Vale Shiraz was bottled in 2012, but released this year. It’s crafted from Chalk Hill’s Heritage vineyard block which dates back to 1897. This wine is deep in colour and concentrated with layers of rich fruit supported by a combination 10 years and beyond and requires decanting for at least an hour before drinking. This is sourced from a handful of McLaren Vale vineyards that consistently feed Australia’s iconic Penfold’s Grange. Q

07 3833 2500 07 3833 2511 www.brizbrain.com.au

More than just a neurosurgery and spinal surgery practice, BrizBrain & Spine has partnerships with various organisations to help provide the best patient care possible.

Our partners

Our surgeons Dr Francis Tomlinson NEUROSURGEON & SPINAL SURGEON

BrizBrain & Spine’s partner clinic on the Sunshine

The Fortus Health Group provide executive management, business advice, accounting, marketing and IT services to the health industry.

Newro FOUNDATION New Ideas New Research New Hope

BrizBrain & Spine is committed to undertaking and supporting research to better treatment and post-operative care to patients with brain and spine conditions. We are proud supporters of the Newro Foundation. newrofoundation.com.au

OPERATING HOSPITALS

Dr Terry Coyne

The Wesley Hospital

NEUROSURGEON & SPINAL SURGEON

Holy Spirit Northside Chermside

scbrainandspine.com.au

Health Group

Our locations

PAEDIATRIC & ADULT SPINAL SURGEON

St Andrew’s Hospital Spring Hill

Dr Richard Kahler

Mater Private Hospital South Brisbane

NEUROSURGEON & SPINAL SURGEON

Dr David Walker NEUROSURGEON & SPINAL SURGEON

Dr Michael Bryant

Mater Children’s Private Hospital South Brisbane Mater Children’s Hospital South Brisbane

CLINIC LOCATIONS

NEUROSURGEON & SPINAL SURGEON

Dr Steven Yang

Spring Hill

Ipswich

PAEDIATRIC & ADULT SPINAL & HAND SURGEON

Chermside

Toowoomba

North Lakes

Lismore

South Brisbane

Mackay

NEUROSURGEON & SPINAL SURGEON

Sunshine Coast

lifestyle

MET OPERA Le Nozze di Figaro 22 November 10.30am, 23 November 1pm and 27 November 10am

ore for m isit info vom.au .c dendy

Carmen 6 December 10.30am, 7 December 1pm and 11 December 10am The Barber of Seville 31 January 10.30am, 1 February 1pm and 5 February 10am Die Meistersinger Von Nurnberg 21 February 10am, 22 February 1pm and 26 February 10am

GREAT ART ON SCREEN Great Art on Screen is a new series of cinema events that brings the world’s greatest art exhibitions to the screen. Exhibition will feature the world’s foremost upcoming art exhibitions, creatively captured live especially for the big screen.

Rembrandt

NATIONAL THEATRE Frankenstein V1 29 November 1pm and 1 December 6pm Frankenstein V2 30 November 1pm and 3 December 6pm Of Mice and Men 24 and 25 January 1pm and 28 January 6pm

20 December 10am and 21 December 1pm The Girl with The Pearl Earring 28 February 10am and 1 March 1pm

hold your function or birthday party at Dendy!

BOLSHOI BALLET The Legend of Love 14 December 1pm and 17 December 10am The Nutcracker 8 February 1pm and 12 February 10am

We love hosting corporate film nights and group bookings at Dendy. It is a great way to thank clients or staff – or perhaps you have a favourite charity that you would like to raise some money for? We have a functions pack and cinema package to suit all requirements – plus a specially tailored functions menu. Please contact Events and Publicity Manager Jenny Sonter on jennys@ dendy.com.au for a free quote.

COMING FILMS 6 November Interstellar 13 November My Old Lady 20 November Hunger Games – Mockingjay Part One 27 November Serena 25 November The Hobbit The Water Diviner Big Hero 6 St Vincent

like to as would m e in C y Merry Dend all a very d n a e n o that wish and trust s a m t s ri Ch hy, safe as a healt r h e n o ry a eve y New Ye and Happ

WIN MOVIE TICKETS FOR TWO Name:

Member No:

Postal address: Portside Wharf, Remora Road, Hamilton Ph: (07) 3137 6000 www.dendy.com.au 58

NOVEMBER 2014 DoctorQ

Phone:

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

CULTURE

Blak Electric 5 - 8 November, Cremorne Theatre The next generation of artists from the Aboriginal Centre for the Performing Arts (ACPA) claims the Cremorne Theatre stage in Blak Electric. A high-voltage fusion of drama, dance, music and song, Blak Electric tells the story of three young Indigenous people living in urban Brisbane. All three have different connections to country and culture; all must short circuit preconceived notions about what it means to be an Indigenous Australian in 2014.

Anything Goes From 28 July 2015, Lyric Theatre The stars are all aboard for this splendid and sassy production! Australia’s hottest new creative team, Helpmann Award winning Dean Bryant and Andrew Hallsworth stage a brand new production of Cole Porter’s de-lightful and de-lovely musical Anything Goes. This smash hit musical comedy, Anything Goes sets sail to Brisbane from July 2015!

Giggle & Hoot and Friends From 3 January 2015, Playhouse Jimmy Giggle, Hoot and Hootabelle are

and Jango this summer! Giggle & Hoot and

setting off on a giggle-icious live stage

Friends is a 50-minute stage spectacular with

adventure with their friends the Bananas in

everyone’s favourite songs, dancing, and of

Pyjamas and Hoopla Doopla’s Zap, Mimi

course fun and laughter.

Erth’s Dinosaur Zoo From 3 January 2015, Cremorne Theatre Dare to enter QPAC’s dinosaur lair! Following sell-out performances in 2012 and 2013, Erth’s Dinosaur Zoo returns to QPAC in January with a fun, educational and unique performance that will delight children over five and their families.

Name:

Win a family pass to Giggle & Hoot and Friends

e Mor for ation rm info com.au . c qpa 36 246 r o 1

Member No:

Postal address:

Phone:

FAX BACK TO (07) 3856 4727 or email competitions@amaq.com.au by 30 Nov DoctorQ NOVEMBER 2014

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all about you

TEN KEYS TO HAPPIER LIVING

booklovers

club

Looking for a new read?

Put that work down for a minute and check out these great titles. Q

Murder most abstract

CHILDRENS

A recently retired NSW copper, on the Gold Coast hunting for his retirement property in which to enjoy his twilight years, finds himself passing an old foe, Boltcutter, from the Kings Cross Underworld, as he walks toward Main Beach.

Before he knows it he is embroiled in the hunt for some missing Ian Fairweather paintings and trying to resolve a cold case or two.

The Hound from the Pound Jessica Swaim

Lonely Miss Mary longs for a four-legged friend. But when she makes the mistake of choosing the untrained basset hound Blue, no sooner does he howl AH-ROOoooooo! than her house has gone to the dogs! Dalmatians and dachshunds, sheepdogs and setters, poodles and pups of all spots are ruling the roost. Can Sam the canine trainer teach this menagerie some pawsitive tricks? A charmingly illustrated, rollicking text offers a doggone good time and a perfectly happy ending.

Introduce a new Christmas tradition Santa sends out a special scout elf in December to help create his naughty and nice lists. The cheeky elf is a gentle reminder for kids and grandkids to be on their best behavior leading up to Christmas time. He flies to the South Pole each night to report back. The best part is, the kids get to find him each morning and see what he’s been up to, whether it be creating snow angels in the flour, cruising with Barbie or helping around the house.

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actionforhappiness.org

fiction

Matthew Condon

ocker doctor

Is there a doctor in the house?

Following a calling to become a doctor will lead to being called on as a doctor any time of day or night, anywhere by anyone. As Superman strips off his tie and glasses, Dr Matt Young shows there are always a few choice times when doctors are called on to don the tights and cape.

Dr Matt Young General Practitioner

As a doctor you never really seem to be free. That accursed sense of responsibility never seems to fade even when you are on holidays. Being on call as a young (and pretty inexperienced) country GP certainly led to a fair dose of PTSD for me. For many years the sound of the phone ringing still saw my pulse speed up and no doubt my blood pressure rise. If we really do have a quota of heart beats before we peg out, then I certainly used up a few back in those days. I am sure I was having flash backs and nightmares for years afterwards. But even when you are away from work and not on call, that Hippocratic mentality still seems to surge in our veins.

It seems that every doctor who has been around for a while has a story to tell regarding emergencies on planes or shopping centres or some other public forum. As a young doctor there is nothing quite like the thrill or that intense feeling of self-importance as when the stewardess announces that there is a medical melodrama unfolding on the flight and that she’d love to know if there is a doctor on board the plane. The pride and the smugness of strutting out of my seat and heading up towards the first class seats for the first time is a feeling I will never forget.

I knew every girl was looking at me with ambitious eyes and every bloke was staring enviously. Everybody in the medical world might have known that I was just an intern, but on this day I was the saviour.

It turned out one of the first class toffs had a touch of the gastro (perhaps their caviar or their champagne was a trifle off) and after giving my advice I was unceremoniously dismissed and herded back to cattle classwhere I clearly belonged. No thankyous, no offers of a seat at the front end, no audience with the captain and not even a cheeky nip of the expensive

scotch that seemed to be flowing generously up in the posh end of society.

My next experience of medicine at 30,000 feet was flying to Canada. For the first time in my life I had the fortune to be asleep on an international flight when suddenly my wife was shaking my arm. “My husband’s a doctor!” she was excitedly yelling at the hostie and before I could finish my dreams I was being escorted up to the flash seats to visit a woman with a headache. The poor woman couldn’t sleep and the pillows weren’t really supporting her neck up in business class and I was beckoned to help expertly administer a Panadol or two. My sleep deprivation and my headache seemed to be of secondary concern as I was ushered back to my rightful station.

I started to realise that being a doctor is not just about 9 to 5. You never really seem to escape being on call and you certainly don’t ever seem to really be on holidays free from that oppressive and overwhelming sense of responsibility.

Unlike some famous British actors, I have very few good experiences at altitude. However I can claim to have treated a hippopotamus attack on the savannah of the Serengeti.

This unfortunate woman had incurred the wrath of a hippo’s maternal instinct when she inadvertently strayed between the globular mum and her half tonne baby. A triple treat of bite marks scarred her chest and as she drifted off into peaceful unconsciousness, monsoonal rain and gushing streams of mud added to my dilemma.

My medical kit was pretty slick I thought but I was quickly demasculinised by Fritz, a doctor from Germany who happened to be driving form Cairo to Cape Town and had decided he had better be prepared for every contingency. He had IV lines and antibiotics, oxygen and fluids. I think I even spied a ventilator in the boot of his 4WD. That’s the German way I suppose.

Good soccer players, good travellers. Long story short we both escorted the woman to a local hospital and a surgeon there sorted out her drastic wounds. She survived and I had a great story to trump all my medical mates’ stories about animal attacks.

There is nothing quite like the thrill or that intense feeling of selfimportance as when the stewardess announces that there is a medical melodrama unfolding on the flight and that she’d love to know if there is a doctor on board the plane.

Like every doctor I have treated lots of people outside of my office. Some of my holiday medical adventures have been my very favourite medical experiences. I have treated malaria in the Masai Mara, strokes in the Serengeti and altitude sickness in the Andes. Sometimes I have been thanked and sometimes not. The nature of medical life is such that you never really escape being on call, but I suppose that is part of the privilege of our profession. It is more than a job and it is more than a profession. It really is a vocation. Q

DoctorQ NOVEMBER 2014

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IN PRINT

Behavioral Medicine 4th Edition

A Guide for Clinical Practice Behavioral Medicine delivers practical coverage of behavioural and interactional issues that occur between provider and patient in everyday clinical practice.

Behavioural Medicine blends biological and psychosocial perspectives on human behaviour and applies them to the practice of medicine. The goal is to improve health care through understanding better what providers and patients each bring, behaviourally, to the medical encounter. A dual goal is to help primary care providers in the appropriate management of psychiatric disorders in the outpatient setting.

Doctor Q has a copy of Behavioral

Medicine to give away.

Simply fill out your details in block letters on the form and fax it to (07) 3856 4727 or email competitions@amaq.com.au.

Entries close 30 Nov

The first edition of Behavior Medicine in Primary Care established itself as the leading how-to book on the full range of behavioural issues and psychiatric disorders managed by primary care providers and as the only book suitable for providers-in-training and providers. The subsequent editions continued what the first book set out to accomplish - building the necessary bridge between intuition and research for those in a clinical setting.

Behavioral Medicine retails for $59 and is published by Professional McGraw Hill Education.

win this book!

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Telephone: Member No:

DENDY WINNERS

QPAC winners

IN PRINT

Double pass winners

Dr Michael Tuch and Dr David Wood won double passes to see Wuthering Heights at QPAC.

Dr Lifeng Chen won a copy of Physical Illness and Drugs of Abuse, provided by Cambridge University Press.

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Dr Chris Cuneen Dr Sally Sojan Dr Rod Hall Dr DavidMorgan Dr John O’Sullivan Dr Fred Leditschke Dr KF Bowes Dr Michael Lutz Dr Andrew Leggett Dr Nigel Dore

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competition winners 62

NOVEMBER 2014 DoctorQ

CLASSIFIEDS

Available Positions - General Practitioners 7Springs Medical Practice is currently seeking experienced General Practitioners for our modern, purpose built facilities. Excellent career opportunities.

7Springs Medical is a: • Mixed billing practice • Flexible and family friendly • Limited after hours (on roster with all doctors) • Teaching Practice

• Multiple experienced GP supports • Allied Health on site • Excellent facilities • Nice practice manager • Location - RA2

SUPPLEMENTARY CORRECTIONS NOTICE 2014/2015 DIRECTORY OF MEMBERS Please find a list below of AMA Queensland members who were mistakenly omitted from or whose entries contained errors within the initial 2014/2015 Directory of Members. Additionally, we have listed any member records that we have since been advised have changed after the date of Directory printing.

AMA Queensland extends its sincere apologies and would ask that you kindly note and cut out these changes and staple into your Directory copy on the relevant page listed.

If you have any further questions regarding the 2014/2015 Directory of Members, please contact the Membership team on (07) 3872 2222 or email membership@amaq.com.au Q Page 172 Specialists – Internal Medicine

Page 227 Specialists - ORTHOPAEDIC SURGERY

Georghiou, Paul R Specialty omitted – Infectious Diseases Wesley Medical Centre Unit 25, Level 2, 40 Chasely Street AUCHENFLOWER QLD 4066 P: 07 3870 5080 F: 07 3870 4611 M: 0413 430 510 E: pgeorghiou@wesley.com.au Special interests: AIDS/HIV Medicine, Oncological Infection, Infectious Diseases

Malisano, Dr Lawrence

Update - Dr is no longer visiting Strathpine Specialist Centre Brisbane Orthopaedic and Sports Medicine Centre Level 6 Specialist Centre 259 Wickham Terrace BRISBANE QLD 4000 P: 07 38346680 F: 07 3834 6637 Afterhours: 07 3833 4130 E: drmalisano@osteon.com.au Special interests: Adult Hip & Knee, Sports injuries and Reconstructive Surgery

Phone: 07 4529 2777 Email: employment@ sevensprings.com.au 881 Ruthven Street Toowoomba Q 4350 www.sevensprings.com.au

Cut out and keep!

Page 252 Specialists - Psychiatrists Atkinson, Ian

Retired Entry omitted for the 2014/2015 Directory of Members 62 Serissa Crescent ANNANDALE QLD 4814 P: 4725 5227 E: ian_atkinson@hotmail.com Special interests: Forensic psychiatry Page 278 Specialists - Rheumatology & Page 345 Medico-Legal - Rheumatology

Douglas, Bill Life Member, Retired Correction and update of entry in the 2014-15 Directory of Members: No longer works for Medilaw and works only for Medconsultants located at: Silverton Place 101 Wickham Terrace, Spring Hill QLD 4000 P: 07 3839 4788 F: 07 3832 6363 Afterhours: 07 3378 6522 (unchanged) Special interests: Medico-legal DoctorQ NOVEMBER 2014

63

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