Medical Forum – December 2023 – Public Edition

Dr Sarah Paton:

My portrait of pain

Fertility & sexual health | Strep A treatment, kids’ chests & joints, age effects on fertility

MAJOR PARTNERS

December 2023 www.mforum.com.au

More medico-legal expertise, support and rewards Avant rewards member loyalty. And we’re there when it matters. y Receive premium rebates through our Loyalty Reward Plan* y Access medico-legal experts, 24/7 in emergencies y Local support, from Avant Law’s 80+ medico-legal solicitors nationwide y Expert advice to reduce your claims risk

It’s why more than 50% of doctors choose Avant.

Dr Penny Need Avant member

Find out more

avant.org.au/practitioners | 1800 128 268

IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. Please read the relevant Product Disclosure Statement or policy wording, available at avant.org.au before deciding whether to acquire, or continue to hold the product. * Eligible members receive a deduction from their premium ranging from 4% to 12% depending on their individual tenure with Avant. Not all members are eligible for a Loyalty Reward Plan (LRP) reward. Please see eligibility criteria, categories and rates on the website avant.org.au/Loyalty-Reward-Plan. The provision of any future LRP reward is not guaranteed. 11/23 (MIM-32)

EDITORIAL BACK TO CONTENTS

Cathy O’Leary | Editor

Beware back to the future ... the debate over the location of the new women’s and babies’ hospital – once destined for the QEII site in Nedlands but now headed to Murdoch – has given me flashbacks.

As I write this, shopping centres are full of tinsel and baubles and the end of another year is knocking at the door.

We’re in the midst of the eighth wave of COVID, but I have found it strangely reassuring. Yes, many people have been hit again – or curiously some are succumbing for the first time – and it’s not much fun.

But while it remains highly infectious, the scary numbers of hospitalisations from serious illness are not there. While we don’t have a ‘get out of jail free card’ yet, we can breathe a bit easier.

WA’s health system could do with some good news too. It has been a rugged year, with demand continuing to outstrip supply, particularly at our public hospitals.

And the debate over the location of the new women’s and babies’ hospital – once destined for the QEII site in Nedlands but now headed to Murdoch – has given me flashbacks.

As a health reporter back in the early 2000s, I remember the landmark Reid Review into the future hospital needs of WA and one of the things it most stressed – avoiding duplication.

Yet in a move to appease opposition to the new maternity hospital heading over the Narrows, there has been talk of having an additional smaller facility in Nedlands. I offer some free advice to Roger Cook and Amber-Jade Sanderson – don’t do it or it will come back to bite you!

But to end on a positive note, I commend to you our cover story on Perth doctor Sarah Paton, who turned the mirror on herself to paint her patient experience – and it was good enough to earn her a runner-up spot in a prestigious art prize.

It is a big year-end for us at Medical Forum, with our first-ever January edition underway.

In the meantime, we wish you a Merry Christmas and a happy and healthy start to 2024.

SYNDICATION AND REPRODUCTION Contributors should be aware the publisher asserts the right to syndicate material appearing in Medical Forum on the mforum.com.au website. Contributors who wish to reproduce any material as it appears in Medical Forum must contact the publisher for copyright permission.

DISCLAIMER Medical Forum is published by Medforum Pty Ltd (Publisher) as an independent publication for health professionals in Western Australia. Neither the Publisher nor its personnel are medical practitioners, and do not give medical advice, treatment, cures or diagnoses. Nothing in Medical Forum is intended to be medical advice or a substitute for consulting a medical practitioner. You should seek immediate medical attention if you believe you may be suffering from a medical condition.

The support of all advertisers, sponsors and contributors is welcome. To the maximum extent permitted by law, neither the Publisher nor any of its personnel will have any liability for the information or advice contained in Medical Forum. The statements or opinions expressed in the magazine reflect the views of the authors and do not represent the opinions, views or policies of Medical Forum or the Publisher. Readers should independently verify information or advice. Publication of an advertisement or clinical column does not imply endorsement by the Publisher or its contributors for the promoted product, service or treatment.

Advertisers are responsible for ensuring that advertisements comply with Commonwealth, State and Territory laws. It is the responsibility of the advertiser to ensure that advertisements comply with the Competition and Consumer Act 2010 (Cth) as amended. All advertisements are accepted for publication on the condition that the advertiser indemnifies the Publisher and its personnel against all actions, suits, claims, loss or damages resulting from anything published on behalf of the advertiser.

EDITORIAL POLICY This publication protects and maintains its editorial independence from all sponsors or advertisers. Medical Forum has no professional involvement with advertisers other than as publisher of promotional material. Medical Forum cannot and does not endorse any products.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 1

CONTENTS | DECEMBER 2023 – FERTILITY & SEXUAL HEALTH

Inside this issue 14 24

10

30

FEATURES

IN THE NEWS

10 14 24 30

1

Editorial: Beware back to the future – Cathy O’Leary

4 6 9 23 38

News & views

Cover story: Dr Sarah Paton – a portrait of pain ADHD – where to from here?

MBS genetic testing NeuroHub offers hope

LIFESTYLE 56 Custom-built for adventure 58 WA flora shines on canvas 59 Movie giveaway

In brief Teamwork needed to halt syphilis outbreak Campaign exposes ‘rotten fruit’ of vaping New healthy skin guidelines – A/Prof Asha Bowen

41 Focus on what matters – Dr Joe Kosterich

SP E

W

I

FROM THE E

RA

N

N GI

NC

The winner of our October doctors dozen from 3drops winery is Dr Lynda Ashton from Queens Road Surgery, pictured, while the lucky winners of double passes to see the action epic Napoleon will have received their tickets in the mail.

E DISTILLERY

WINNING TIMES

This month, we have a change from our usual wine competition and are instead offering three bottles of boutique gin from Esperance Distillery Co. Read Dr Martin Buck’s review on page 60 and for your chance to win, use the QR code on this page or go to www.mforum.com.au and hit the competitions tab.

CONNECT WITH US /medicalforumwa

/medical-forum-wa-magazine

/MedicalForum_

info@mforum.com.au

2 | DECEMBER 2023

www.mforum.com.au

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

CONTENTS

PUBLISHERS Fonda Grapsas – Director Tony Jones – Director tonyj@mforum.com.au

Clinicals

EDITORIAL TEAM Editor Cathy O'Leary 0430 322 066 editor@mforum.com.au Production Editor Jan Hallam 08 9203 5222 jan@mforum.com.au

43

45

46

Preventing childhood bone disease Prof Richard Prince

Visceral artery aneurysms Dr Marek Garbowski

Protracted wet cough Dr Rob Lethbridge

Journalist Eric Martin 08 9203 5222 eric@mforum.com.au Clinical Editor Dr Joe Kosterich 0417 998 697 joe@mforum.com.au Graphic Design Ryan Minchin ryan@mforum.com.au

49

50

Aged-related infertility Dr Rose McDonnell

Sore throat diagnostics and RHD Dr Janessa Pickering

53

55

Swabbing an ulcer for HSV? It could be syphilis.

Dr Grace Phua

Antibiotics for respiratory infections in children with neurodisability Dr Rachael Marpole & Dr Noula Gibson

ADVERTISING Advertising Manager Andrew Bowyer 0424 883 071 andrew@mforum.com.au Clinical Services Directory Andrew Bowyer 08 9203 5222 andrew@mforum.com.au CONTACT MEDICAL FORUM Suite 3/8 Howlett Street, North Perth WA 6006 Phone: Fax: Email:

08 9203 5222 08 6154 6488 info@mforum.com.au

www.mforum.com.au

Guest Columns

OUR PRINTER’S ACCREDITATIONS

Environment ISO 14001

This magazine has been printed using solar electricity, and the paper is manufactured with elemental chlorine-free pulps. Both printer and paper manufacturer are certified to ISO 14001, the world’s highest environmental standard.

34

35

37

39

OTs help NDIS gaps Samantha Hunter

Remove barriers for safe HIV care Aimee Rendell

Avoiding the perfect storm A/Prof Sarah Egan

Learning from UK’s kidney crisis Dr Richard Lipscombe

MAJOR PARTNERS

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 3

Growing pains St John of God Subiaco Hospital is expanding its pain management service to meet growing patient demand, with a doubling of the number of interventional pain procedures currently performed.

The expansion has been helped by a capital upgrade of an operating theatre in the hospital’s short stay unit, which was recently re-opened following a period of works.

The upgraded operating theatre is now primarily dedicated to interventional pain procedures and has been fitted with state-of-the-art equipment, including a new operating table designed to allow superior imaging for proceduralists.

CEO Tina Chinery said chronic pain was a significant social and economic burden in the community, affecting about 3.4 million Australians – or one in five people.

Tick for pertussis vax A Telethon Kids Institute and Curtin University-led study has found the maternal whooping cough vaccine given to pregnant mothers in the second or third trimester significantly reduces babies’ risk of infection.

Published in the journal Pediatrics, the results showed maternal vaccines were beneficial to babies, protecting them up to six months of age – the most susceptible period for infection, with whooping cough accounting for 70-90% of hospitalisations and deaths in babies.

The severity of the disease prompted calls for governmentfunded interventions, with a State vaccination program forming in 2014 which evolved into a federally-funded National Immunisation Program in 2018 for pregnant mothers, with a vaccine recommended at 28 weeks gestation.

Bumping up vaccination numbers to 52% meant whooping cough cases dropped 66% in babies up to six months of age in the first three years of the program.

Despite the program’s success, further research was needed to evaluate the best time for maternal vaccination and to measure any interference from the mother’s antibodies when babies received their standard infant whooping cough vaccines.

4 | DECEMBER 2023

Dr Reza Feizerfan and the pain service team

SJOG Subiaco is the only private hospital in WA with a pain service that operates seven days a week, allowing patients needing urgent pain management to be admitted to the hospital by their pain specialist for an interventional procedure or acute care on short notice.

It is also the only private hospital in the State to employ a pain nurse practitioner who works in an extended clinical nursing role and is qualified to request diagnostic investigations, prescribe medications and receive and make referrals.

The hospital’s pain service was set up in 2008.

The study, funded by the National Health and Medical Research Council and the WA Health Department, examined data from 279,418 motherand-infant pairs – representing a third of all births in Australia over four years – using health records from WA, Queensland and the Northern Territory.

Of the sample, 51% of women received their whooping cough vaccine around their late second trimester or third trimester of pregnancy.

The pilot will run for six months and currently has six agencies from different sectors confirmed to participate.

As 34% of referrals to acute public mental health services for young people in the Peel region come from medical practitioners, the pilot is seeking interest from local GPs to trial the approach.

Those interested can email PeelMHTaskforce@health.wa.gov.au.

GPs – more patients than ever No wrong door in Peel The Wandjoo Gateway pilot will start in late January for youth accessing mental health services in the Peel region.

The program seeks to provide support and advice for workers when referring and navigating young people (12-25 years) with mental health concerns.

It embodies a ‘no wrong door’ approach where every door is the right door for young people. The model works by ensuring that if the young person’s condition is not appropriate for a particular service, they are held by that service and helped to navigate the system to find the right one for their needs.

The program is designed for any worker who may interact with young people in their usual activities, such as teachers, youth workers and GPs.

General practice remains the costeffective engine of the health system, but more needs to be done to improve sustainability, the recent 2023 Health of the Nation report found.

The seventh edition of the Royal Australian College of General Practitioner’s report focused on attraction and retention of the general practice workforce, drawing on reflections and experiences of GPs and GPs-in-training via the nationwide RACGP Health of the Nation survey.

It found that GPs were seeing more patients than ever, with less than 1% of people reportedly being unable to see a GP when they needed to, and the average time GPs spent with patients increasing.

It found the GP workforce needed an continued on Page 6

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

NEWS & VIEWS

BACK TO CONTENTS

MAJOR PARTNER

From sample collection to results, your patients are safe with us

Laboratory Medicine Redefined Haematology

Microbiology

Biochemistry & Toxicology

Immunology

Prof. Catherine Cole

Dr Clay Golledge

Dr Jonathan Grasko Dr Yael Grasko

Dr Martin Stuckey Dr Meilyn Hew

Saturn Pathology | Level 2, 31 Cedric Street, Stirling 6021 | Phone: (08) 9253 4800

www.saturnpathology.com.au MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 5

NEWS & VIEWS Managing director of WA-based Neurospine Institute Colin La Galia has been appointed to the board of the Hospital Research Foundation Group, which covers 11 charities.

St John of God Subiaco Hospital has been recognised by the Australasian Gastro-Intestinal Trials Group as Australia’s most outstanding cancer research institute at the group’s annual scientific meeting in Christchurch, New Zealand.

Help for diverse Indigenous youth Funding for the first ever elder-led intervention to support young Aboriginal LGBTQA+ people brings new hope for the youth group most at risk of suicide in the nation.

Edith Cowan University has received a NHMRC/Medical Research Future Fund grant of $624,000 to develop and test the intervention, which has been developed from the Pride Yarns with Mob pilot project that provided opportunities for Aboriginal LGBTQA+ young people to connect meaningfully with elders.

The pilot resulted in young people expressing an increased level of cultural connection and feelings of acceptance and social inclusion within Noongar culture.

The study will be led by ECU Deputy Vice-Chancellor (Students, Equity and Indigenous) Professor Braden Hill and involve researchers from ECU, Murdoch University and the Telethon Kids Institute.

About 10% of Aboriginal young people aged 16-29 years report being lesbian, gay or bisexual and 4% as trans and gender diverse.

Maternity care at SJOG Mt Lawley is relocating to SJOG Subiaco as part of a consolidation of services across the metropolitan area.

Emeritus Professor Carol Bower, one of Telethon Kids Institute’s most influential researchers who played a seminal role in birth defect research, has won the Australian research community’s flagship award, the Peter Wills Medal.

There were two WA winners at the RACGP’s recent national awards. The GP-in-Training of the Year Award went to Dr Corey Dalton, and one of two Rural Registrar of the Year Awards went to Dr Dean McKittrick.

ECU cancer researcher Dr Mary Kennedy has been awarded Cancer Council WA’s Postdoctoral Research Fellowship, with $225,000 over three years helping to ensure every cancer patient in WA receives a referral for exercise from their cancer care team.

6 | DECEMBER 2023

Professor Hill said despite a comparatively high rate of suicide and mental health difficulties among LGBTQA+ youth, they remained one of the most under-served groups of youth in Australia in terms of tailored psychological support.

While they had strong pride in their identities, they reported low levels of mental wellbeing, feelings of belonging to country and culture, connection to spirit and ancestors, family and kinship, and poor physical health.

“The urgency for interventions such as this cannot be underestimated,” he said. “Recent survey data shows that 45% of Aboriginal LGBTQA+ participants had attempted suicide in their lifetime, and 19% in the past 12 months. This suggests there is a real risk that Aboriginal LGBTQA+ youth may not make it past young adulthood.”

continued from Page 4 urgent boost, because fewer medical students were choosing general practice training, while more GPs were looking to reduce their hours or leave the profession. Almost three in 10 GPs signalled their intention to retire in the next five years.

The report also found mental health was a growing issue, and the proportion of GPs reporting psychological issues in their top three reasons for patient presentations had increased from 61% in 2017 to 72% in 2023.

The new study, published in the Australian and New Zealand Journal of Public Heath, analysed adults’ views on alcohol and pregnancy to evaluate the impact of a public education campaign that aired in WA from January 2021 to May 2022.

The One Drink campaign, developed by the WA Mental Health Commission and Cancer Council WA, features a video of a baby-shaped glass being filled with red wine to illustrate that any amount of alcohol a mother drinks, the baby drinks too. The campaign has recently recommenced airing in WA.

General practice sustainability needed to be addressed to prevent practice closures, with four out of five practice owners concerned about the viability of their practice.

Public health experts say the research findings suggest many Australians of childbearing age do not understand the risks associated with alcohol use during pregnancy but are much more likely to abstain when informed of the risks.

Glass half full

Lead author Professor Simone Pettigrew from The George Institute for Global Health says there is no safe

New WA research shows hard-hitting campaigns can help prevent drinking during pregnancy.

continued on Page 8

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

IN BRIEF

BACK TO CONTENTS

MAJOR PARTNER

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 7

NEWS & VIEWS

level of alcohol use during pregnancy, and the community has a right to know the facts so they can make an informed decision.

“Previous research has found that around 35% of Australian women use alcohol at some stage during their pregnancy,” she said.

“Similarly, in this study we found that before seeing the campaign, almost one-third of men and women aged 18 to 45 were confused about the risks and thought it was okay for women to drink some alcohol during pregnancy.”

To evaluate the campaign, researchers surveyed male and female West Australians of childbearing age, both before and after the campaign ran.

“We found that 76% of survey respondents recalled seeing the campaign. We also uncovered positive signs that the campaign would help dissuade pregnant women from drinking,” Professor Pettigrew said.

“Additionally, we found that after the campaign had aired, 95% of women reported intending to abstain from drinking when pregnant – and both males and females were more likely to agree that pregnant women shouldn’t drink any alcohol.”

Price of menopause A Senate inquiry is set to examine the impact of menopause, and is due to report in September next year.

The terms of reference cover issues relating to perimenopause and menopause, including awareness, economic cost, physical impacts, mental and emotional wellbeing, caregiving responsibilities, government policies and programs, and cultural and societal factors.

Professor Jayashri Kulkarni, Professor of Psychiatry at The Alfred Hospital and Monash University, and director of HER Centre Australia, welcomed the move.

She said depression and anxiety caused by hormone changes during the menopause transition were still under-recognised and treated poorly.

“As a result, many women suffer for years,” she said. “This Senate Inquiry will hopefully assist in raising awareness and developing new approaches for women’s mental health issues.”

8 | DECEMBER 2023

Baby brain waves

BACK TO CONTENTS

continued from Page 6

New technology being used by the Newborn Emergency Transport Service based at Perth Children’s Hospital is helping to ensure that families from even the most remote WA communities can benefit from advanced intensive care techniques.

The portable, wireless, cloudbased equipment, funded by Perth Children’s Hospital Foundation, allows brain wave information to be viewed in real-time via an internet uplink and reviewed by medical staff up to 1800km away.

The first newborn to undergo brain wave recording while in transit was flying to PCH from Kalgoorlie late last year. During that journey, a Perth-based neonatology expert 600km away could review the baby’s brain waves in real time.

Dr Jonathan Davis, medical director for NETS WA, said that for every 1000 live births, up to three babies could develop abnormal brain function ranging from mild to severe due to lack of oxygen.

Hypoxic-ischaemic encephalopathy

Tailoring antidepressants for youth Pharmacogenetic testing might help optimise antidepressant treatment for young people, according to WA researchers.

In Australia, two in five people under the age of 24 suffer from a mental health condition. While antidepressants are widely prescribed for mood disorders such as depression and anxiety, there is significant variability in patient response and side effects.

But pharmacogenetics may offer a promising way to tailor a patient’s prescription based on their ability to metabolise drugs.

Researchers at the Perron Institute, UWA, Notre Dame and Murdoch universities and the WA Health Department looked at the use of pharmacogenetics testing in treating mental health issues, with a strong focus on youth depression and anxiety. Their review paper was

is diagnosed soon after birth and can result in life-long consequences, including disabilities such as cerebral palsy.

To improve long-term survival and reduce the incidence and severity of disability, babies diagnosed with moderate or severe HIE receive cooling therapy. It reduces a newborn’s body temperature to between 33.5 and 34.5C over 72 hours.

Each year, up to 50 babies across the state are diagnosed with HIE and require cooling.

published recently in the journal Frontiers in Pharmacology.

Authors Bradley Roberts, a PhD candidate at the Perron Institute and UWA, and Zahra Cooper from Perron, said their examination of literature found that understanding a young person's genetic traits provided the potential to tailor treatment to each individual, reducing side effects and improving treatment outcomes.

“However, there are hurdles to overcome, including a lack of evidence-based guidelines for primary care physicians, limited awareness and experience of GPs around genetic intervention, and community concerns around data privacy, equity and economic value,” Mr Roberts said.

“By understanding the barriers faced, we are one step closer to giving more young people taking antidepressants the opportunity to receive effective care.”

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

MAJOR PARTNER

Teamwork needed to halt infectious syphilis outbreak Western Australia is experiencing an ongoing outbreak of infectious syphilis. We need to work together across all sectors of primary care and tertiary health services to halt this outbreak and ensure better health outcomes for everyone.

Dr Belinda Wozencroft, a general practitioner with special interests in women’s health, sexual health and HIV medicine, says infectious syphilis has re-emerged as a significant public health threat over the past decade.

“Infectious syphilis is a notifiable sexually transmitted infection (STI) and has significant health implications due to the risk of congenital syphilis.

Tertiary syphilis, whilst considered rare, can cause dementia, blindness, hearing loss and cardiovascular issues, any of which is significant for the affected individual.

“However, it is congenital syphilis which really needs to be the current focus.

“Congenital syphilis occurs when syphilis is transmitted from an untreated mother in-utero to her child. It can result in stillbirth, premature labour and significant short and long-term health issues for the child. If detected and appropriately managed with a course of LA Bicillin for treatment and follow-up during pregnancy, the outcomes for the child can be significantly improved.

“Of significant concern, are pregnant women and women of reproductive age. The number of infectious syphilis notifications increased drastically from 11 notifications in 2014, to 271 notifications in 2022.

“Over the same time period, the number of notifications among Aboriginal females of reproductive age increased by almost 18-fold. With the rise in notifications in women of reproductive age, there has also been a significant increase in congenital syphilis notifications. From 2014

Dr Belinda Wozencroft General Practitioner Dr Belinda Wozencroft is a General Practitioner with special interests in women’s health, sexual health, HIV medicine and is an active PrEP prescriber. Originally, Belinda trained as a registered nurse and worked in remote Aboriginal communities before studying medicine at UWA. She has a Diploma of Obstetrics, Graduate Certificate in Women’s Health and Diploma of Child Health. Belinda is registered as an s100 prescriber for antiretroviral medications for people living with HIV. She is a Practice Principal at View Street Medical in North Perth.

to 2022, there were 14 congenital syphilis cases in WA. Of those 14 cases, five resulted in stillbirth or death.”

Infectious syphilis testing recommendations To assist with the detection of infectious syphilis in pregnancy, the Western Australian Department of Health recommends three tests for all pregnant women at: • booking • 28 weeks • 36 weeks (or at birth if earlier than 36 weeks).

Five syphilis tests during and after pregnancy are still recommended in the Kimberley, Pilbara and Goldfields regions, due to the high rates of infectious syphilis in those regions.

In addition, screen for syphilis if there are symptoms of concern which include a non-specific rash or an ulcer (at both genital and extragenital sites). Maintain a high index of suspicion for any ulcer, and check the ulcer with a syphilis PCR swab as well as syphilis serology. If another STI has been identified, remember to followup with blood-borne virus serology including syphilis serology.

What can GPs do?

1. Offer syphilis testing to all pregnant women. Testing at three time points in pregnancy can assist

with early detection and treatment.

Importantly, follow-up with women who did not attend for testing, or, if the pathology provider did not complete the test.

2. Offer opportunistic tests to all people aged 16-45 years.

The Department of Health is relaunching the ‘Healthysexual’ campaign which encourages people to get a syphilis blood test.

Patients usually respond positively to being offered a test in response to a campaign or public health program. Visit healthysexual.com. au for more information.

3. Get informed about testing and treatment. The Department of Health ‘Silverbook’ provides detailed information on testing and treatment for syphilis at health.wa.gov.au/silverbook 4. Get extra training. There are a range of training opportunities for general practitioners to test, treat and manage syphilis and other STIs on the ASHM website at ashm.org.au 5. Need some help? If you have questions about syphilis, contact the public health unit in your area.

6. Promote sexual health in your practice. The Department of Health offers free health promotion materials, that can be ordered from doh.getquickmail.com

health.wa.gov.au MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 9

BACK TO CONTENTS

CLOSE-UP

Striking self-portrait looks deep A rare illness caused Dr Sarah Paton to paint a haunting self-portrait. The piece won her a commendation in The Lester Prize and has given her joy and confidence in a new sphere.

By Ara Jansen

10 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLOSE-UP Only weeks after her 95-year-old mother died, Dr Sarah Paton was rushed to hospital with a diagnosis of osteomyelitis at the base of her skull and upper cervical spine.

would also be possible to interpret the canvas as someone in a locked room, like in an asylum.

While the eyes of the portrait immediately draw the viewer, the other striking element is Sarah’s hair. Though she didn’t lose any of it during her illness, it definitely became dry and coarse. While she exaggerated its spikiness, its texture remains a focal point of the piece.

Sarah was treated with IV antibiotics at home after being discharged and spent three months recovering. Suffice to say she didn’t feel too flash. When she got home from hospital, she took a look at herself in the mirror – and found someone she almost didn’t recognise. She snapped a photo.

“I looked at my eyes. It was haunting,” says the 64-year-old breast physician. “I’d seen that look on my patients, but I had never seen it on me. Then I thought I would paint it. I decided to do it in secret because I didn’t want to upset the family. Then Peter (her husband) discovered what I was doing and loved it even more than I did.”

It was only her second portrait, the first one had been of her dogs.

Peter suggested she enter it in The Lester Prize, WA’s most prestigious annual art prize for portraiture.

Choosing to create a painting wasn’t completely out of the blue

“I felt vulnerable with this one,” she says.

as Sarah has been painting for a few years. What was unusual, was the choice of a self-portrait and it being so stark and harrowing, when you compare it to her other work, which is abstract (think Miro and Picasso style), brightly coloured and usually features breasts somewhere.

One piece is titled Melittin, which is the main component in honeybee venom which is being explored in breast cancer research in WA. Her abstract works have been hung in various BreastScreen centres, but this is the first time she has had a piece hung in a gallery.

She entered Memento mori in the Lester and received the Highly Commended Prize from a field of 40 finalists, chosen out of nearly 950 entries. The painting created a lot of talk, with people telling its creator that they understood exactly the way the woman was feeling.

The painting features the subject standing in a grey bathroom, wearing a simple off-white top. It

At the Lester exhibition, Sarah saw young people stand in front of the work and cry; they thanked her for painting it. “It’s so humbling that something I can create for myself has such powerful impact on other people. That’s the beauty of the Lester, it offers an opportunity to transform people. Plus, I’ve learnt so much about my painting from everyone else.

“The exposure from the exhibition has been extremely affirming. It has given me the confidence to call myself an artist and made me realise that I’m actually good enough. That seems crazy I know.

I’m a positive person and I love what I do, and it’s so nice to still have firsts at this age. If I’m going to live as long as my mother, there’s so much to do!”

While she’s passionate about art, which remains a hobby, she’s also passionate about the work she does as a breast physician at Royal Perth Hospital and BreastScreen WA as well as doing one day a week at a skin practice. She’s on BreastScreen’s advisory board as well as teaching in her field.

Both Sarah’s parents were doctors so she grew up in a home where “medicine was the language”. She was a child who was always busy, always doing or making something.

A love and appreciation for art also featured strongly, in particular, her great aunt Dorrit Black, a painter and printmaker who was a pioneer of modernism in Australia.

Sarah’s father went to university in Adelaide, as Perth had yet to open a medical school, and returned to become the state’s first vascular surgeon. Her mother Nancy was an Adelaide local. After graduating as a doctor, Nancy married Sarah’s father and they returned to Perth.

Sarah is the youngest of four continued on Page 13

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 11

Discover the unique benefits of our sub-specialist team of experts

Body & Oncology

Head & Neck

Obstetric

Breast

Interventional

Paediatric

Cardiac

Musculoskeletal

PET & Nuclear Medicine

Chest & Thoracic

Neuroimaging

Urology

Doctor Priority Line

for urgent bookings and enquiries

9599 3929

New clinics opening in 2024

Armadale North and Murdoch Square Visit our new website

perthradclinic.com.au 12 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLOSE-UP

Striking self-portrait looks deep continued from Page 11 Comments from the Lester judges: daughters, her identical twin is three minutes older.

“I just came out of the womb ready to go for it,” Sarah says of her interest in many things, including medicine, and maintains she has never needed a lot of sleep. When she was old enough, she would listen in on her father’s one-sided medical conversations on the phone.

“I became familiar with the language of medicine at a young age.”

“Sarah Paton’s Memento mori is a raw self-assessment by the artist.

Paton appears within the composition as a ghostly apparition, with the face rendered drained of emotion, and her body pulled forward by the intensity of the eyes – holding the viewer in engagement. The psychological intensity of the subject is underwritten by the spare brushwork, the bleak colour and the searing splashes of the lights in the background. One cannot help but empathise with the feeling conveyed by the work. The starkness of the clinical colours chosen contribute to this sense of emotional and psychological lethargy. Despite this, there is a feeling of humanity to the piece; you get the sense of a real person – and bear witness to their pain.”

Inspired by Nancy – the most important person in her life – Sarah speaks often of her brilliance and always being willing to try new or interesting things.

“She was dux at medical school at a time when it was a difficult time for women in the profession. She went back to uni in her 50s and late 70s and studied philosophy and theology and with a little bit of encouragement from us, became an artist at 93. She has always been my inspiration. I feel like I have been able to do what she might have been able to do in another lifetime.”

Sarah says almost half her graduating class in medicine in the early 80s were women. Her mum was one of 12 in 1951.

The physician married “an ambitious man” – Professor Peter Leedman, director of the Harry Perkins Institute of Medical Research.

They’ve been married 40 years and figured out a way to advance both their careers, raise three kids and manage that sometimes elusive work-life balance.

Both studied medicine at UWA and worked their early years at Royal Perth Hospital. On moving to Melbourne, Sarah worked in general practice, paediatrics and went on to study dermatology. After finishing his PhD, Peter got a chance to do a post doctorate in Boston, where they spent three years.

Sarah continued her dermatology studies and in 2014 decided to upskill so she could work as a breast physician, and loves being able to operate from a holistic perspective, very clear that empathy and compassion can operate in the same space. She also

studied creative writing in her 40s.

“I learnt from my mum that it was never too late. Being able to be in someone else’s shoes and have a depth of empathy grows with age and human experience. It’s such a privilege. I love coming in contact with people from all walks of life, which is a reason I love working in the public system.”

Sarah was on holiday down south when she suddenly had to be hospitalised. She said returning south months later triggered her. The feelings lasted about five minutes. While it wasn’t pleasant, she says it was a valuable experience.

“I work with a team where we are managing extremely emotional and difficult illnesses, so what I’ve been through was valuable, from that perspective, even if it was unpleasant.

“I love what I do. We have friends who have largely retired and prefer to travel around the world. I was

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

raised in a family of academics.

I look at my relatives and they always appeared to be young, I think because of their intellectual pursuits. That creates a vortex of energy which I think keeps you young, active and engaged.”

Totally self-taught, Sarah’s recent art success has given her the confidence to consider an exhibition and maybe even an entry in the Archibald. It would be an opportunity to show off all the canvases she has stacked up at home.

“Painting gives me a sense of freedom. Viewing art does that for me a lot too, as I am sure it does for a lot of people. This has given me the confidence to do some more serious portraits.”

Sarah loves to walk and this year, alongside Peter, participated in her 11th Cancer 200 – Ride for Research in October. This year the 200km cycling event raised more than $8.8 million for cancer research at Harry Perkins.

DECEMBER 2023 | 13

Family ties tackle ADHD shortfall A psychologist and a general practitioner – who happen to be mother and daughter – have teamed up to find a new way to help children with ADHD who face long waiting times for specialist care.

By Cathy O’Leary

14 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE

BACK TO CONTENTS

FEATURE Perth-based Grace da Camara and her daughter Dr Madalena Bennett can relate to the frustration of families trying to get professional help for children with ADHD. Grace’s son – the youngest of her four children – grew up with ADHD in South Africa in the 1990s, and although he is now aged in his 30s, she still remembers the ripple effect it had on her young family at the time, including Madalena, her eldest child.

Their personal experience went on to spark professional interests in the health sector but down different paths – Grace in her capacity as a psychologist and Madalena as a GP. They decided to think outside the box when it came to supporting families affected by ADHD, and the result is an Australian-first resource – a series of three workbooks designed to provide accessible and practical help to families with children who have the condition.

Grace has long specialised in working with children, adolescents, adults and families affected by ADHD. She developed OnTrac, a cognitive behaviour therapy-based group program for tweens and teens, delivered through ADHD WA in collaboration with thirdyear medical students from the University of WA who chose OnTrac as their services learning project.

Madalena works in general practice, with a strong interest in mental health and a focus on a multidisciplinary approach to treatment. She regularly advocates for more education on ADHD for mental health professionals, including GPs. She graduated from the University of Cape Town in 2006, and moved to Australia in 2010, initially working at Sydney Children's Hospital, before moving to Perth where she

has worked in general medicine, aged care and mental health care before training as a GP. Madalena works with the RACGP’s specific interests ADHD, autism spectrum disorder and neurodiversity group, and has been involved in upskilling GP colleagues.

Another option While the workbooks do not replace specialist care, they are an option for helping children aged seven to 17 and their families while faced with long waiting lists to access an ADHD specialist paediatrician or psychiatrist in the metropolitan area, with even longer queues in rural and regional areas.

While the workbooks do not replace specialist care, they are an option for helping children aged seven to 17 and their families while faced with long waiting lists to access an ADHD specialist paediatrician or psychiatrist in the metropolitan area, with even longer queues in rural and regional areas.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

The workbooks – written under the banner What Lies Beneath Matters – were initially Grace’s idea, as she had already worked extensively in the field of ADHD. “As a mother who had a child with ADHD, I became a psychologist with a keen interest in the condition, and then over time I realised there wasn’t a lot of Australian resources for ADHD, and most of them were American.

“When I started volunteering at ADHD WA back in 2008 when we emigrated, I also realised that a lot of the issues I faced as a parent back in South Africa, many parents were facing the exact same things in Australia, so the seed was planted back then.

“Madalena was 10 years older than her brother, so she had seen the impact that ADHD has on families – it’s not just the person who is affected.

“So, we decided we could combine our two interests – as a mother-daughter team – because she comes from the medical perspective and I come from the psychological perspective.” continued on Page 16

DECEMBER 2023 | 15

Family ties tackle ADHD shortfall continued from Page 15 Initially, the OnTrac program was delivered with the aid of worksheets to 10 children in a group. They would often leave their worksheets behind after sessions.

Grace had the idea to create a workbook to keep the child’s progress in one place and connect their progress back to parents and carers and the child themselves.

Over the years, Madalena watched her mother struggle with “lots of pieces of fantastic papers” that she regularly presented at forums, so she also saw value in finding a way to formalise the resources to make them more accessible.

She became Grace’s sounding board, looking at the practicalities from a general practice aspect, with many patients presenting with ADHD but not being able to necessarily afford or be able see someone immediately.

Helping GPs help “It was looking at how GPs could use some of these resources within their appointment time, and bring patients back and assess them for ADHD, and then put little plans in place based on their symptoms of ADHD, in the primary care setting,” Madalena said.

16 | DECEMBER 2023

“It’s really challenging, and being in contact recently with a developmental paediatrician, he can hear the angst in families’ voices but he’s only one person, so we’ve been trying to collaborate with GPs with pre-assessments to try to offload some of those reviews, and open him up for new diagnoses.

“But it’s not a space that is easily accessible because GPs aren’t able to prescribe or change dosages, and there’s a medication shortage at the moment too.

“Only yesterday I had someone who can’t get their medication and can’t afford to go back to the psychiatrist, so they asked me to change their script, but I had to say I couldn’t.

“It’s cost-prohibitive and there’s so much of a waiting list, with GPs trying to fill that gap but our hands are often tied. And medication isn’t the only answer – for some families it is a quick fix but it doesn’t fix everything.”

Madalena said that in specific patients who had co-morbidities, often their medication helped them to navigate day-to-day life.

“We (GPs) have got the knowledge but often we can’t use it, but

hopefully there will be some new things coming up, so GPs could upskill in certain areas to work with mild symptoms of ADHD which we could at least help and manage while people are waiting for specialist care,” she said.

“Because these books are manualised, as long as you have a background and understand ADHD, and the child has ADHD, you can see where the difficulties lie, and you can tailor your sessions with the family.

“Not every GP will want to do this, but some will, and it will share the load while everyone is under the pump.”

One of the workbooks is a combined workbook for children aged 7-10 and their parents, while a second is for tweens and teens, and the third is for their parents.

The self-help workbook for younger children and their parents is part of the OnTrac ADHD program, based on Grace’s work with children with ADHD in individual and group settings.

The teenagers’ workbook presents a cognitive behavioural approach to managing ADHD, whether used in the OnTrac program or as a standalone resource. Three modules

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE

BACK TO CONTENTS

FEATURE cover psycho-education, adaptive thinking and practical coping skills.

Many teenagers did not want their parents to attend the program with them, so the parents’ book helped equipped them with knowledge so they could support their children.

Grace said it was often a challenging space to work in because there was “more to ADHD than met the eye.”

ADHD was often only seen as a behavioural issue, with hyperactivity, impulsivity and distractibility.

“Every presentation is unique, and there are so many co-morbidities. I wanted to include as many as I could, based on my one-on-ones, and also on research, and adapted to suit the different age groups,” she said.

“What people don’t see is that those behaviours are usually the result of the internal experiences and symptoms that are not visible.”

The pair were in talks with a range of healthcare organisations in WA and had made information about the workbooks known to the WA Health Department but had not received any commitment.

They still encountered people who “weren’t sure how much of ADHD is real” and that was challenged in many of their forums and discussions.

“We know these workbooks are something that could be rolled out very easily in the school system or in Health but there’s a lot of red

tape and hurdles to jump over,” Grace said.

“We also know the wellbeing of the whole family is at stake if families can’t get support. ADHD impacts on relationships, communication and emotions.

“Our hope is that this series, with its strong psycho-education component, will not only help the individual with ADHD, but also help their family members and friends who face many challenges when they’re supporting their loved ones.”

ED: The workbooks are available from UWA Publishing at www.uwap.com.au and bookstores.

Letter to the editor Dear Editor, I want to sincerely apologise to the readers of Medical Forum – especially ADHD specialists – for comments I made on the ABC radio (7/11/23), regarding the training of paediatricians and psychiatrists in diagnosis and treatment of ADHD. I stated that it was only a couple of days, which was factually incorrect. Many paediatricians have 6-12 months of intensive training and many more months and years of on-the-job training and experience. I’m sorry for my error and for causing offence.

I have great respect and admiration for the work ADHD specialists do, especially as I have two children with ADHD myself, and with many patients seeking ADHD care and having difficulty.

I confess to being reactive and overly defensive in regard to the charge that GPs are unable to be trained MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

to play a larger role in ADHD diagnosis and treatment.

With some GP colleagues and the support of several organisations, we have for many months been exploring ways to improve the crisis in access to ADHD diagnosis and treatment for children and adults.

We have explored a bigger role for GPs – and this was one of the main recommendations of the recently released Senate inquiry report into ADHD. I knew, before my remark, that many paediatricians and psychiatrists are highly trained in ADHD care. The point I wanted to make – and obviously didn’t – was that a lot of doctors, including GPs, start with some (relatively small) training in certain areas, and get a lot more on the job, with colleagues and mentors. With training, support and guidelines, the outcomes are OK, and often excellent.

I hope that we can all continue to work toward fewer barriers to good ADHD diagnosis and treatment and hope my apology and clarification will be accepted.

Dr Tim Leahy, GP, Maylands DECEMBER 2023 | 17

BACK TO CONTENTS

FEATURE

GPs backed for a greater ADHD role The Senate inquiry into the diagnosis and treatment of ADHD has again put the spotlight on the role of GPs in helping people access care.

By Eric Martin The Senate inquiry into attention deficit hyperactivity disorder has found what many GPs and patients have discovered the hard way – that there is a stark lack of services, and those that are available are invariably costly.

The RACGP has welcomed recommendations in the inquiry’s report for GPs to have a greater role in the diagnosis and management of ADHD, which affects over one million Australians.

The inquiry drew on 700 submissions and the evidence of 79 witnesses across Australia, including Perth, drawn from professional and advocacy organisations, medical professionals, people with lived experience and the WA Department of Health.

While no single cause of ADHD is known, the report noted that to the best of clinicians’ knowledge, ADHD was an interaction of genetic, social and environmental factors – and was ‘highly heritable’, with an estimated rate of transmission between 70% and 80%.

Significantly, most people are diagnosed with ADHD before 12 years of age by a paediatrician, psychiatrist or psychologist, but through learned behaviours such as masking, many people are diagnosed much later in life or not at all.

18 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE The investigating committee found that barriers to assessment, diagnosis and support services included: • Lack of services – limited availability and long wait times for healthcare professionals to diagnose and provide medication and other supports; there was also a lack of services in the public health system, especially for adults with ADHD, and insufficient services in rural, regional, and remote areas • High costs of services – including insufficient coverage under Medicare, the Pharmaceutical Benefits Scheme and the National Insurance Disability Scheme • Poor consumer experiences – caused by lack of reliable information about ADHD, overly bureaucratic processes, fragmented care, inconsistent prescribing regulations, stigma and variable quality of healthcare associated with ADHD. Access to healthcare, supports and other environmental and social factors were repeatedly highlighted

as some of the most important factors in determining the impact of ADHD in adulthood.

disorder, learning disabilities, autism, conduct disorder, anxiety, depression and speech problems.

“Throughout this inquiry the committee has heard how peoples' experiences of accessing an ADHD medical diagnosis are generally long, difficult, expensive and time consuming, causing significant stress, anxiety and pressure on family relationships and school systems,” the report said.

The Royal Australia College of Physicians noted that “poor understanding of comorbidities and contributing factors can lead to poor quality assessment, relevant assessments not being undertaken, no assessment of learning ability, or alternative issues not considered in referrals.”

“… if children can be diagnosed early and treated, they are much better able to adapt and learn strategies to manage and work with their condition, and treatments have greater impact while the mind is more malleable. Treatment from a young age is irreplaceable and will yield ongoing benefits for the rest of their life.”

All this could result in higher caseloads for health professionals, and further delays in assessment and diagnosis.

The committee heard that for around 65% of people with ADHD, it coexists with another physical or mental condition, potentially increasing the complexity of a diagnosis and adding to its impact.

Common comorbidities in children included oppositional defiant

Research provided to the committee indicated that stimulant medication could reduce ADHD symptoms for 70-80% of people, but, in some cases, medication was not effective, while some people experienced undesirable side effects.

However, there were some positive experiences shared, with some attributing their experience to luck or to individual support people who helped them to access services, such as an "amazing" doctor or psychiatrist, or a "fantastic social worker".

As one person with lived experience explained: “Thanks to an understanding GP who said: 'let's look into it' instead of 'oh, everyone thinks they have ADHD now' I was able to finally understand myself. After lost jobs, years of incorrect medications, a stay at a mental health hospital and so many changed jobs, I could finally understand myself.”

WA Health acknowledged that while paediatric workforce modelling showed that WA still had capacity, if the current model of service provision for ADHD were to continue, it would be inadequate to meet the growing demand for services.

“It is imperative that alternative models of care be explored, tested, and supported to assist individuals and families waiting for a diagnosis and further management,” it said in its submission.

The RACGP WA’s ADHD working group agreed: “ADHD medicine involves taking a careful history, getting collateral

continued on Page 21 MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 19

At Christmas, we give thanks.

To our doctors and all involved in helping the Western Australian health care community, we say thank you and wish you, and those close to you, a Christmas filled with light and hope.

www.sjog.org.au 20 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE

GPs backed for a greater ADHD role continued from Page 19 histories, screening for other commonly occurring conditions, mental state and physical examinations, psycho-education, and shared decision-making. All of these are vital but time-consuming and spending longer in a GP consultation is not economically viable for GPs.” The committee heard of cases in which clinicians would not accept an existing formal diagnosis of ADHD, instead forcing people to undergo screening and assessment multiple times by a range of health professionals.

Another key issue addressed by the report was that not all adult ADHD medications were subsidised under the PBS, and there were limitations based on both age and dosage.

The report noted that under State and Territory laws, 'prescription of psychostimulants is generally limited to psychiatrists and paediatricians', with varying state-based requirements.

GPs and other primary care practitioners were permitted to prescribe psychostimulants in some jurisdictions, under limited conditions.

RACGP vice president Dr Bruce Willett said that many GPs were ready to help families who needed support with ADHD in a sharedcare model with psychiatrists, paediatricians and allied health professionals.

“The RACGP would also welcome reducing regulatory barriers so GPs with an interest in the area and appropriate training can commence and continue prescriptions for stimulant medicines for people living with ADHD,” he said.

There was also scope for increasing rebates for longer consultations because currently it is lower per minute than shorter consultations which disadvantaged people requiring longer with their GP, including patients with ADHD. “Increased investment in longer consultations is a simple way to build additional support for these patients,” he said.

WA Health highlighted the urgent

need for comprehensive training of GPs and was in favour of greater emphasis and investment in specific training of registrars in psychiatry, paediatric and general practice, and upskilling of qualified specialists in the areas of neurodevelopmental issues, especially ADHD. Undergraduate training and integrated and multidisciplinary care could better support more contemporary models of care.

These observations were supported

by Dr Tim Leahy from the RACGP WA ADHD working group, who noted that several elements would need to be put in place for this to be successful.

These included upskilling for GPs, federal and state policy and funding, including MBS items, funding for collaboration, and communities of practice between GPs and specialists to discuss patients and to upskill, timely assistance from specialists, and the availability of other allied health and mental health supports.

The WA working group suggested that GPs should provide the majority of care for the more than 50% of patients whose care is 'relatively straightforward.'

full scope. A significant number of GPs want to do more. About 1000 college GPs recently attended an ADHD upskilling course, not the usual 40 or 50.”

The Royal Australasian College of Physicians urged the Federal Government to implement the key recommendations, including supporting specialist physicians to work closely with GPs to improve the efficiency of ADHD assessments.

RACP also wants a review of specific PBS items to help improve the safety and quality of medications prescribed. President and paediatrician Dr Jacqueline Small said specialist physicians, especially paediatricians, played a critical role in delivering assessments and support for people with ADHD, and it was encouraging to see that the inquiry had adopted the college’s advice.

“As the inquiry rightfully identifies, people with ADHD across Australia continue to face many challenges and hurdles, and it is imperative that these are addressed,” she said.

“There will never be enough paediatricians and specialists to address the unmet need,” the group said. “There is a real cost too, GPs not being used to their

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 21

Dr Anne Halbert is retiring from her private Dermatology practice in December 2023.

Halbert Dermatology will continue to accept referrals as usual, with the only change being the new practice name, Hollywood Dermatology. The practice location and contact details are unchanged.

All current patients will continue to receive first class dermatology care.

All new adult and paediatric referrals are welcomed by our wonderful team of consultant Dermatologists:

Dr Patricia Le

Dr Rachael Foster

Dr Jeremy Ng

Dr Austen Anderson

(paediatric referrals only)

Dr Halbert thanks all referring doctors for their support over the years and wishes all colleagues and their families a safe and happy festive season.

Hollywood Dermatology Suite 6, Hollywood Medical Centre 85 Monash Avenue, Nedlands 22 | DECEMBER 2023

Phone: 9386 9073 Healthlink: halbderm Fax: 9386 6253 www.hderm.com.au MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

NEWS

Campaign exposes ‘rotten fruit’ of vaping

By Cathy O’Leary With laws that ban smoking in WA workplaces likely to be extended to vaping next year, the Cancer Council WA is campaigning to curb rising rates of e-cigarette use among young people.

The State Government has raised the possible extension of smoking bans to include vaping products on the back of a survey by CCWA that found 81% of WA adults thought vaping should not be allowed in places where smoking was banned.

Last month, the council launched a new digital campaign, Clear the Air, in a bid to prevent people taking up vaping, following new data that shows the number of 14-to-24year-olds who currently vape has skyrocketed since 2020.

cessation among people already vaping regularly,” Mr Reid said.

“At first, it’s the bright colours and sweet flavours that lure young people to vapes, but it’s the highly addictive nicotine content that can keep them hooked.”

National data shows that in 2020, 2% of 14-to-17-year-olds were vaping. By 2022, that number skyrocketed to almost 12%, which is more than a five-fold increase.

In 2020, almost 6% of those aged 18-24 years vaped. In 2022, that number had nearly quadrupled to more than 21%.

CEO Ashley Reid said the increase in vaping rates in Australia could undo decades of work protecting young people from the harms of smoking.

“This increase is particularly concerning given that people who have never smoked and start vaping are three times more likely to take up smoking in the future. Already, for the first time in decades, we are seeing an uptake in the rates of young people using tobacco,” Mr Reid said.

“Earlier this year, Cancer Council WA received $375,000 from Healthway to develop the first WAmade vaping prevention campaign to raise awareness about vaping harms, prevent uptake among those susceptible to vaping, and encourage

He said the new advertisements showed the “rotten truth” about vapes, such as harmful chemicals, addictiveness, and nicotine poisoning, all of which are hidden behind the deceptively innocent flavours found in vapes.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

Each Rotten Fruit advertisement begins by mimicking a colourful and fruity vape flavour ads.

“This quickly changes to a vape splitting apart to reveal confronting imagery related to the harmful truths about vapes, including a dead cockroach, a cadaver, a puddle of vomit, and a pile of cigarette butts,” Mr Reid said.

“Many of the young people we spoke to about vaping were shocked to hear there are more than 240 chemicals in vapes, that a single vape can contain as much nicotine as three packs of cigarettes, and that too much nicotine can lead to serious health problems like nausea, vomiting and even seizures.”

“Symptoms like vomiting, breathlessness, headaches and lung irritation can make it harder to work or study and can stop you from doing the activities you love the most. The toxic chemicals in vapes even have the potential to cause serious medical emergencies.”

The Clear the Air campaign will run until June next year across social media, streaming services and mobile apps.

DECEMBER 2023 | 23

BACK TO CONTENTS

FEATURE

To be, or not to be While genetic carrier tests for couples planning a family can be reassuring, they can present unexpected moral and ethical dilemmas for them and their doctors.

By Cathy O’Leary

24 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE

“On the surface, genetic screening sounds so straight forward and simple ... But these are nuanced conversations and I don’t know if as a society we’ve given enough thought to this, and with all due respect to the research that has been done, it’s all well and good until someone gets hurt.”

– Dr Wendy Burton

With one in 20 Australians believed to be carriers of the three most common genetic conditions, a recent move to offer Medicarefunded screening is expected to be taken up by many would-be parents.

Their genetic risk is often hidden because most carriers will not have a family history of the disorders.

About one in 240 couples will both be carriers, meaning they have a one in four chance of having a child who is affected by CF, SMA or FXS.

But that will have its own set of challenges for doctors, according to the Royal Australian College of GPs, as more people seek out information, advice and testing through their family doctor.

Royal Australian College of Obstetricians and Gynaecologists guidelines have long recommended that genetic carrier screening be offered to all families planning a pregnancy, but it has come at a cost – up to $450 a person.

Changes to the Medical Benefits Schedule from last month now allow women who are pregnant or planning pregnancy and their partners to freely access carrier screening for cystic fibrosis, spinal muscular atrophy and fragile X syndrome.

Now, following an application by the Royal College of Pathologists of Australasia, the three-condition carrier test is available at no cost, and that is expected to fuel increased demand.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

Understanding risk The RCPA said it was an exciting development for people considering, or in the early stages of pregnancy, because it would help them understand their risk of passing on these genetic conditions and help them make decisions about a pregnancy.

It said the three disorders were recognised as having either a significant disability associated with them, or were life-threatening or life-shortening.

Carrier testing allowed more reproductive options to people to avoid or better manage having a child affected with a disorder, continued on Page 27

DECEMBER 2023 | 25

Leading the way in Prosthetics and the treatment of Erectile Dysfunction.

Specialising in Penile Implants and Peyronies Disease.

With the largest partnership of Urologists in Western Australia, Perth Urology Clinic can manage all urological conditions, offering a wide range of treatment options.

Dr Shane La Bianca

Dr Manmeet Saluja

Dr Andrew Tan

Dr Alarick Picardo

Dr Jeff Thavaseelan

Dr Steve McCombie

Dr Trent Barrett

Dr Sarah O’Neill

Dr Matt Brown 26 | DECEMBER 2023

For urgent referrals or queries, use our GP Hotline on 1800 487 656 (Press 9). refer@perthurologyclinic.com.au Healthlink: puclinic Hollywood Clinic | Wexford Clinic MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE

To be, or not to be continued from Page 25 including some potential treatments that were available depending on which gene variants were inherited.

Testing could be performed on blood or saliva samples to see if a person was a carrier of CF, FXS or SMA. It was recommended that patients who underwent this type of testing speak to a genetic counsellor to discuss the results and co-ordinate further testing if necessary.

There were usually two options when referring for reproductive carrier screening – sequential or couple testing. Sequential testing was generally preferred and involved testing women who were planning pregnancy. Once their result was available, a decision could be made on whether their partner also required testing.

The other approach was couple testing, where pregnant women and their reproductive partners were tested simultaneously.

This was often preferred if a pregnancy had been confirmed, because it prevented delays in risk assessment, genetic counselling and diagnostic testing if needed.

Couples who were not yet pregnant had several options if found to have a high chance of having an affected child, including conceiving naturally and having the baby tested after birth, or having diagnostic testing during pregnancy, with the option for termination if the baby was found to be affected.

They could also have IVF and preimplantation genetic testing to select unaffected embryos or could have IVF using donor gametes who were not carriers of the condition.

Dr Wendy Burton, who sits on the RACGP’s specific interests antenatal and postnatal care group, said there were many complexities with genetic carrier screening, and it was important GPs were across them.

They were more likely to get patients seeking out advice now that the three-condition carrier screening was more freely available.

Not so simple “On the surface, genetic screening

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

sounds so straight forward and simple,” she told Medical Forum.

“We just add another screening test into the mix to help parents be informed about the likelihood of a child they would conceive being affected by a particular subset of medical conditions – the three being cystic fibrosis, spinal muscular atrophy and fragile X syndrome.

“But these are nuanced conversations and I don’t know if as a society we’ve given enough thought to this, and with all due respect to the research that has been done, it’s all well and good until someone gets hurt.

“Someone can get hurt, because what are the statements that we’re making about the value of individuals with these conditions?”

Dr Burton said cystic fibrosis was the most obvious example because it was the most common of the genetic conditions and there were now treatments. A diagnosis in

continued on Page 28

DECEMBER 2023 | 27

To be, or not to be continued from Page 27 2023 was quite different in terms of the expectations of the life of the affected person to what it was when she graduated in 1987.

She did not think GPs were necessarily well-equipped to deal with the issues that could present post-screening. It was important they understood what testing involved – what it could tell us and what it couldn’t, and the questions around what to do with what was found.

There were many issues to flesh out – assumptions by parents, limitations of tests, and unexpected flow on effects and psychological impacts. In some cases, results sent people down the path of IVF. not for infertility reasons, but for selection to avoid certain disorders.

“It’s quite complicated, and while we can celebrate that we have Medicare funding to help people

identify their risk, what do you do with that information?

IVF funding will only take you so far.”

“There are some good resources from the pathology companies, and patients will come in and will have done their Google research, but have they thought it through to the end?

Dr Burton said some people said ‘I just want to have all the tests’ and then after they said ‘I don’t know what to do now’ or ‘why didn’t you warn me it was going to be so hard?’.

“If they’re new to you, how do you begin to understand and know their value systems; because for some people having to make these sorts of decisions may be souldestroying, while for others it’s a no-brainer – of course they want to know, and they will make steps to reduce the chances of a child in their family being affected by a genetic condition.

Screening and making decisions on the results was more time-sensitive if there was already a pregnancy confirmed.

“You can’t be judgmental and you can’t assume anything – not across ethnicity or religious beliefs, or anything else.

“And in regards the public genetic services – do they have the staff equipped to deal with this? And the

“But if you’re already pregnant, and if knowledge about your carrier status might change how this pregnancy proceeds, then the sooner you make a decision the more straight forward it is, because now the clock is ticking, and a

Great Southern Specialist Centre

GSSC offers a variety of service

(GSSC) supports the delivery of

level options to suit your needs.

coordinated access to specialist

Our centrally located modern

medical services by offering facilities

facilities provide spacious

and professional support for

consulting rooms along with a

specialists.

dedicated team of administrative

We are currently looking to attract services from the following specialties to address areas of need:

Seeking Specialist Services

“Whether you’re planning a pregnancy versus being pregnant affects the timing because you can go home and think about it and look at all the resources. You can take your time to make a decision,” Dr Burton said.

and clinical staff who will work with your team to ensure your clinic runs efficiently.

• Paediatrics

• Dermatology

Scan the QR code

• Pain Specialist

• Neurology

to find out more

• Gynaecology

• Psychiatry

about GSSC

Talk to us about expanding your services into Albany and the Great Southern, a region with a growing population of over 60,000.

Call our Practice Manager Latrice Porter on 0439 520 183 or email latrice@gsspecialistcentre.com www.gsspecialistcentre.com

28 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE

FEATURE

BACK TO CONTENTS

as a guarantee. Even with all the science that we have, we can’t tell if your baby is deaf or blind, or has cerebral palsy or intellectual disability, and even some of the major cardiac anomalies don’t show on even the best ultrasounds,” she said.

“These are three conditions we can screen for, but there are thousands that we know of.”

There are already concerns that the three-condition carrier screening does not go far enough, with calls to expand the number of inherited conditions that should be included in free screening.

The current rebate does not cover expanded carrier screening, which is considered to be the gold standard in preconception genetic testing.

decision made under pressure is not the best way because you don’t have time to reflect.”

The ‘perfect’ baby Dr Burton despaired at the notion that couples could see test results as a reassurance their baby would

Some genetic experts have described the three-condition test as a good ‘first step’ but only the tip of the iceberg for wouldbe parents wanting as much information about their genetic risk as science allows.

be ‘perfect.’ There were hundreds of conditions that could affect a baby and it was naïve to think any test could guarantee a child would be born without any problems.

“We live in an era where perfection is valued, but there is no such thing

Wishing you a wonderful festive season from all of us from Perth Urology Clinic

GP Hotline: 1800 487 656 refer@perthurologyclinic.com.au Healthlink: puclinic Hollywood Clinic | Wexford Clinic

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

SAV E T H E DAT E

GP Urology Masterclass 2024 Saturday 8th June 2024, Westin Hotel angela@perthurologyclinic.com.au

DECEMBER 2023 | 29

BACK TO CONTENTS

FEATURE

A NeuroHub for WA a step closer People with a range of neurological conditions can start looking forward to an online community that will have information and services at their fingertips.

By Eric Martin More than 15 neurological organisations have united to help improve the health and research landscape for multiple conditions.

And GPs are an important part of the picture for the WA NeuroHub – a new research project of Edith Cowan University and Perron Institute.

The hub aims to centralise the key online resources for West Australians impacted by more than 600 different neurological disorders, which. when combined, are in the top five burden of disease groups for the state, including both fatal and non-fatal conditions.

Dr Travis Cruickshank, a research fellow at the Centre for Precision Health at ECU and adjunct senior research fellow at the WA Neuroscience Research Institute, is the visionary behind the project, which is being helped by strategy company Anthologie.

He was a principal investigator on a neurological disorders profiling trial, and much of his work has been dedicated to the design, delivery 30 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE and evaluation of tailored lifestyle interventions for individuals living with neurological conditions.

“The NeuroHub concept is an online health and research platform that is co-designed by the WA neurological community – people with lived experience, not-for-profit organisations, health professionals, researchers and industry,” he said.

“I came up with the original concept in 2014 when I was a PhD student.

I noticed a fair bit of disconnection between different not-for-profit organisations, researchers and clinicians and, in particular, disconnection between all these groups and the people who they were meant to be supporting.

“That disconnection created problems with obtaining funding and making sure we were delivering the personalised care that we needed to, as well as making sure that research was working well.

“Back then, I said that we needed to come together in a physical environment, and at that time, the WA Neuroscience Research Institute was established. They did a fantastic job, and they got a lot of philanthropic funding. It has advanced research and perhaps the delivery of health services, but does it have a direct impact on the people living with a condition?”

Barriers remain Dr Cruikshank said that when the institute was built, he waited to see whether it solved the problem, but eventually felt that even though many key players were together in that space, the barriers persisted.

“The consumer's voice was not heard. The physical building wasn't for consumers, it was for researchers and medical professionals. And when I started to see some of the old patterns of territorial behaviour begin to resurface in 2018, I also started having conversations with the community again,” he said.

became such a vital communication resource.

“More people wanted to access health information, health services and research information remotely rather than going to a physical structure, especially those who were immunocompromised or because of their disability made it hard to get to a physical location.

“We started thinking how to solve some of these significant problems and what we landed on was a destination that didn't have those physical restrictions or boundaries.

“And I feel like we're finally at a stage where the community is really driving this and we're heading down the right path, where consumers come first. They tell us what they want and what they need from this research platform and together, as a community, we take on this information, try to optimise bits and pieces and then head back to production.

“We were fortunate to have catalyst funding from WA Health and we have also partnered with Anthologie, a company that has helped design and run the workshops, as well as collect the insights that have emerged.

“We're still in the co-design phase and have undertaken two workshops, one with people with lived experience and the other one with the not-for-profit CEOs.” Once the workshops are complete, the team will develop a business proposal that will be presented to various government funding bodies, along with a signature registry demonstrating widespread community support for the initiative.

Strong support

“I wanted to gauge if the neurological community wanted to go down the digital path because a lot of them have clinical issues that may affect their ability to engage with an online health and research platform.

“As with anything, we've got people who are really behind this initiative, a few who are sitting on the fence and those against, but I would say 90-95% of people, including the CEOs, are very supportive.

They can see the benefit of it as a solution – that this centralised online location can get people to their not-for-profit organisations where they can more effectively provide targeted health services,” Dr Cruikshank said.

“Surprisingly, COVID really helped this initiative – it accelerated technology use because they had to do it. Digital technology

Even though West Australians are impacted by a diverse range of neurological conditions, despite the obvious differences, the workshops

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

revealed that there was still a great deal of commonality in many areas of people’s lived experience.

“Those with well-known genetic, neurodegenerative, or neurological conditions benefited from advanced health services, but despite a lack of similar care for a range of other non-genetic conditions, they were all talking about very similar things,” he said.

“Such as the difficulty of receiving a diagnosis and the importance of educating GPs about how to manage that process and the difficulty of finding reputable evidence-based information. And regardless of the neurological condition, they were talking about having a platform to help support them throughout their journey.

One-stop shop “Caregivers said the same, they wanted to be supported through the process and they wanted clear and transparent, centralised information. They wanted to go to one destination knowing that it has an up-to-date service directory, accurate information regarding their condition and pointed them to the right people.”

Dr Cruikshank said there were some groups that relished any support, particularly the functional neurological disorder group, because it did not have a not-for-profit organisation that supported them.

“They've got community support groups, but they don't have the resources. A big hope is that establishing this platform will allow important information and service directories to be established for these smaller or rarer neurological conditions because they often don't have the support to even establish a website,” he said.

“These vulnerable people bounce around the health system at significant emotional and financial stress for them and their family. I'm hoping that through this process they can come to NeuroHub and be recognised.

“We also hope the site fosters greater societal awareness that the neurological community is not just Parkinson's, stroke or TBI – it's Huntington's, Friedrich's ataxia, spinocerebellar ataxia, FASD and all the other conditions that make up this community. continued on Page 33

DECEMBER 2023 | 31

Bethesda Clinic is a voluntary, adult only, 75 bed clinic that provides multidisciplinary clinical services to aid recovery from mental health issues through inpatient and day patient programs.

Services Bethesda Clinic provides: Inpatient care and therapy programs managed by a multidisciplinary team.

Day patient therapy programs in the Wellness and Recovery Centre.

Psychiatric and psychological services for those experiencing mental health issues.

Specialties: DVA-accredited Trauma Recovery for veterans, military and first responder communities.

The first designated women’s-only ward in Western Australia, providing a safe recovery environment.

Alcohol and other drug use.

General mental health.

How to refer to Bethesda Clinic: Download the referral direct from our website bethesdaclinic.org.au/referrals Find us on HealthLink: Bethesda Clinic Contact Bethesda’s Triage Officer on (08) 6378 4999 or BC.Triage@bethesda.org.au

Bethesda Clinic 1 Honour Way, Cockburn Central WA 6164 Phone (08) 6378 4900

bethesdaclinic.org.au 32 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

FEATURE

A NeuroHub for WA a step closer continued from Page 31 “Just because they're not as prevalent, or perhaps you haven't been personally impacted by a particular condition, doesn’t mean that these people don’t need support.”

Dr Cruikshank said the workshops were a surprisingly emotional process, though genuinely heartening for all involved.

“I didn't expect it to be honest.

I've been in this field for a long time, and while I anticipated a little bit of emotion in the air, because we're talking about how we support people, the emotion and the connection that I saw was indescribable,” he said. wrong with them and they're also under financial strain.

“Attendees felt that for the first time they could meet other people with theirs or similar neurological conditions and they took great comfort in that.”

“GPs play nearly the most important role in the whole health sector because they have that level of contact and responsibility to ensure that the diagnostic journey is as smooth as possible. They're the ones who are going to get you to a neurologist in a timely fashion; be able to help you get on certain medication that you might need; they're the ones who are going to put you in touch with a not-forprofit organisation or other service providers that can support you.

He also pointed out that the issue of access to general practice care came up multiple times during both workshops and that people with lived experience and not-for-profit organisations felt that GPs were the missing link in the health chain.

“Every single person in the community, unless they have a genetic neurodegenerative condition or they have a catastrophic accident, initially goes to a GP with some sort of clinical issue that will eventually turn out to be a neurological condition,” Dr Cruikshank said.

“GPs are the people supporting them through their diagnostic journey and, for many of them, throughout their entire life, because they only go to see their neurologist maybe once a year, either for very specific issues related to the condition or medication changes – and even then, a lot of GPs manage most of their medication.

“GPs also treat their co-morbidities.

A neurologist isn't going to tell someone how to manage their comorbid diabetes, they're going to say, ‘go to your GP’.”

Dr Cruickshank stressed the importance of ensuring that

patients were supported from a psychological and social perspective throughout the period when they did not have a diagnosis, but were clearly manifesting clinical issues.

Lag time “Our neurological group goes through what we call a prodromal phase, where they have symptoms of a neurological condition, but are waiting to be diagnosed, which can be as long as two years,” he explained.

“It is during this stressful time, suicide becomes a threat, people quit their jobs, marriages and families break down. They're extremely stressed because they don't have an answer to what is

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

“A lot of not-for-profit organisations also said that they really wanted to speak to GPs because of the important role they play in managing care and trying to personalise the experience as much as possible.

“GPs are clever and many of them will have a suspicion about a potential diagnosis, that most often turns out to be correct.

“Potentially, there could be a dedicated section of the NeuroHub where GPs or even practices register their interest in seeing people with neurological conditions and providing holistic care – just as they do with women's health, skin cancer, and a range of other conditions.”

DECEMBER 2023 | 33

OTs plug holes in NDIS bucket Occupational therapists have an under-recognised role in Australia’s healthcare system, argues the head of their industry body Samantha Hunter.

Australia’s healthcare system is currently facing a critical shortage of allied health professionals, and occupational therapists (OTs) are in the eye of the storm. Turnover rates within the NDIS sector have surged to 25% in 2022 from 21% in 2020, while increased costs for clinical supervision and education pose additional challenges for organisations seeking to meet the demand for OTs. As the healthcare system grapples with issues of supply and demand, it is important to recognise the impact of OTs and their role within communities.

With the NDIS review underway, OTs are working to raise their voices and increase awareness of the vital work they do. OTs are like the problem-solving wizards of the healthcare world, equipped with an arsenal of strategies and devices to facilitate effective and safe engagement in various tasks.

OTs are the fastest-growing allied health profession and the third largest – representing more than 10% of the industry. There are more than 28,000 registered OTs working across the government, private and community sectors in Australia.

Occupational therapy helps people to overcome challenges so they can participate in activities (i.e. occupations) that they find meaningful. They can help people participate in daily activities, work, volunteering and social interactions.

Solutions can range from adaptive tools and customised exercise routines to techniques that improve fine motor skills. The aim is to make daily life and activities more manageable for people who face physical, psychological, or cognitive challenges.

OTs are instrumental in helping people get back to work after experiencing physical injuries or psychological traumas. By 34 | DECEMBER 2023

enhancing individuals' functional capabilities, they pave the way for smoother transitions back into the workforce. They also help people leave the hospital faster, or even better, support them in staying at home while they recover. This eases the burden on hospitals and frees up bed space.

But there is a problem bubbling away under the surface – current NDIS pricing does not readily support investment in the development of OTs, and organisations are increasingly pressured to find ways to address this vital need.

Despite the long-term financial benefit of OTs to the NDIS, the ‘Therapy Supports’ item price remains at $193.99 under the NDIS. This price freeze, now in its fourth year, together with cost of living pressures and business costs such as rent and registration, is taking a toll on both NDIS clients and OTs. The irony is that OTs can actually save the NDIS money and support the original aspiration of enhancing participant independence and greater participation. They do this

by reducing reliance on scheme costs by developing independence and participation in community and employment.

OTs provide a wide range of services, not all of which are currently recognised under the NDIS. For example, OTs with appropriate mental health training can provide focused psychological strategies.

These leaking holes in the NDIS bucket are causing a drain on both time and funding, taking the focus away from what is most important, which is supporting people to engage in society, one of the NDIS’s key pillars.

With the NDIS review in our sightline, OTs want to work with NDIA and others to improve the NDIS, with the aim of simplifying processes, reducing red tape, and ensuring the scheme's long-term success.

ED: Samantha Hunter is CEO of Occupational Therapy Australia.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

GUEST COLUMN

BACK TO CONTENTS

GUEST COLUMN

Remove barriers for safe care Using a person-centred approach to prevent perinatal HIV transmission is vital, says health promotions officer Aimee Rendell.

The use of accurate and inclusive language is essential in providing accessible and comprehensive health care. Many people with uteri are capable of carrying pregnancies, including women, transgender men and non-binary people.

This article uses genderinclusive language when referring to pregnant people and their experiences. The use of this language in practice is encouraged, with endorsement from peak medical bodies including RANZCOG. According to the World Health Organization, an estimated 1.3 million people living with HIV (PLHIV) become pregnant globally each year. Without intervention, the risk of perinatal transmission of HIV is 25-30%.

However, with timely access to antiretroviral therapies (ART) and the achievement of viral suppression either before, or during pregnancy, the risk of perinatal transmission can be <1%. Despite advancements in HIV medical technologies, there remains significant barriers to reproductive and sexual health care for many PLHIV, and thus, to the prevention of perinatal transmission.

The achievement of maintained virologic suppression using ART is paramount to achieving positive health outcomes for an individual and their neonate, however, there are a host of personal, social, and environmental factors that may influence an individual’s ability or willingness to adhere to medication and be retained in care.

in their healthcare, including decision-making processes. The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) outline four key components of person-centred HIV care: • centre a person's autonomy, dignity, and rights • respect a person's decisions and experiences • support a person to lead the dialogue about their health • build relationships grounded in understanding and trust The outcomes of care should be a combination of what is clinically assessed best for the individual and what they feel is best for them. This is best achieved with a multidisciplinary care team, providing culturally safe and accessible support across all aspects of their health and wellbeing.

Reproductive decision-making can be complex, with choices influenced by many personal, social, and cultural expectations. Greater complexity can arise for PLHIV who may be pregnant or considering pregnancy.

Misinformed ideas on the inability of a PLHIV to conceive and carry a healthy pregnancy, by society and healthcare providers alike, have limited the available reproductive options for PLHIV, with some people reporting being entirely discouraged from pregnancy altogether.

A holistic, person-centred approach to preconception, antenatal, and intrapartum and postpartum care is essential in ensuring the best health outcomes for PLHIV and in the mitigation of perinatal transmission.

Similarly, PLHIV have been advised not to breastfeed despite Australian guidelines outlining risk reduction approaches should a parent choose to breastfeed their infant. For PLHIV born in countries with high HIV prevalence, the medical and social advice provided around HIV and childbearing may differ to that available in Australia.

Person-centred care involves the active participation of an individual

Many PLHIV report a loss of trust and confidence in the healthcare

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

system due to experiences of prejudice and discrimination from providers. The absence or breakage of a patient’s trust in the healthcare system may result in disengagement from services and poor adherence to ART. Such negative experiences have discouraged some PLHIV from disclosing their HIV status to their clinicians entirely.

Healthcare providers are an essential source of information and support in reproductive decisionmaking, so it is important to make a conscious effort to establish trusting and understanding relationships with patients living with HIV. All patients carry their own experiences, values, and priorities regarding their health. The provision of all benefits, risks and alternatives regarding reproductive options and medication adherence without coercion or pressures enables PLHIV to make an informed decision about their health.

This risk-reductionist approach respects a patient’s autonomy whilst providing support in a collaborative decision-making process.

It is important to recognise the resilience PLHIV present and respect their ability to make the best decision for themselves when provided informed, accessible, and appropriate options, in a manner that is supportive and nonjudgmental.

Every person has the right to access high quality, inclusive reproductive and sexual health care without experiences of judgment and prejudice.

ED: Aimee Rendell is a health promotion officer at WAAC – previously known as the WA AIDS Council.

References are available on request to Medical Forum.

DECEMBER 2023 | 35

Dr Piet Claassen and his team extend our warmest greetings to all the family physicians of the Great Southern Region, their families and staff.

Thank you kindly for your support and referrals over the past 16 years.

Best wishes for your journey.

PSYCHIATRIC PRACTICE OPPORTUNITY ALBANY (WA) Consultant Psychiatrist I am retiring in March 2024 and offering an opportunity to a Psychiatrist to take over my well established practice of 16 years. I currently work only 4 days per week, leaving enough time for myself to enjoy this enchanting and historical town. Albany offers breathtaking beaches, wonderful walking trails and the best nature can offer.

The city sparkles with a variety of art forms and a lively music scene. It is the home of many writers, artists and musicians. The State of the Art Albany Entertainment Centre attracts International and National artists.

If you have a passion for people, nature and the art of psychiatry, this might be just the opportunity you have been waiting for. There are no after hours, no hospital patients and every weekend is a long weekend.

If you are interested, please contact me (see details below).

Dr Piet Claassen | Consultant Psychiatrist Great Southern Psychiatric and Psychological Services 36 | DECEMBER 2023

43 Aberdeen Street, Albany WA Email: admin@gspps.com.au | Phone: 9847 4900 MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

GUEST COLUMN

Avoiding the perfect storm A new Perth study is aimed at helping children and their parents deal with the pull of perfectionism, explains Associate Professor Sarah Egan.

Perfectionism is a word that often carries a heavy burden. It's the relentless pursuit of goals, setting excessively high standards, and an unwavering desire to achieve them. While these qualities can drive individuals towards excellence, they can also become overwhelming and crippling, leading to self-criticism, stress, procrastination and poor mental health.

Perfectionism isn't limited to adults.

We know it starts to emerge in childhood and acting early can be helpful. For children aged seven to 12 struggling with perfectionism, there's new hope on the horizon.

A study by researchers from Flinders and Curtin Universities seeks to examine the feasibility and effectiveness of a novel intervention where parents deliver cognitive behaviour therapy for perfectionism to their child, with the help of a guide. The study aims to recruit families whose children display perfectionism-related challenges that impact their quality of life.

Ways that parents and carers might notice perfectionism in their child include when their child feels bad about themselves if they don’t do very well at things (e.g. school, hobbies), continually sets goals for themselves that seem difficult to reach; tends to procrastinate, or put things off, even though they feel bad about it later; or spends a lot of time thinking about their mistakes or any errors in what they do.

anxiety, and eating disorders. In the context of children, perfectionism can lead to less social contact, increased fear and sadness, and difficulties in achieving academic goals.

The rise of perfectionism in youth over the past few decades is a cause for concern as perfectionism can be detrimental. This is where cognitive behavioural treatment comes into play. The treatment focuses on teaching individuals how to approach achievement without causing harm to their well-being.

Multiple studies have confirmed the effectiveness of the treatment in teenagers and adults in reducing depression, anxiety and disordered eating.

Perfectionism is not a simple concept to define. It encompasses two dimensions – the pursuit of excessively high goals and feelings of inadequacy and self-criticism when those goals aren't met.

The new study focuses on the Guided Parent-Delivered Treatment for Perfectionism. The program includes six modules, designed to be used by parents interactive learning activities, supported by an online guidance session once a week.

Both dimensions have been associated with psychological distress, including depression,

Each module contains information about perfectionism, activities for the parent to complete

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

independently, handouts for the parent to give to the child and discuss with them, and exercises that the parent and child complete together.

The aim of the treatment is to help children to pursue meaningful goals without excessive distress – not lowering their standards, explore new thoughts, behaviours and less harmful avenues to achievement, and help parents identify perfectionism in themselves, promoting joint learning.

The research has been approved by ethics committees at Flinders University, the South Australian Department for Education, the Association of Independent Schools of South Australia, and Catholic Education South Australia.

For more information about the study email maya.jabs@flinders. edu.au. To sign up follow this link: Study Signup.

ED: Associate Professor Sarah Egan is from the Curtin enAble Institute and School of Population Health.

DECEMBER 2023 | 37

More than skin-deep New healthy skin guidelines will help improve overall health in remote and urban Australia, says TKI researcher Associate Professor Asha Bowen.

Skin health in Aboriginal and Torres Strait Islander communities is a priority for researchers at Telethon Kids Institute as skin conditions can lead to more deadly – and entirely preventable – health issues such as sepsis and rheumatic heart disease.

The institute’s Healthy Skin Team recently launched a new edition of the National Healthy Skin Guideline to help healthcare providers identify, diagnose and treat a range of skin conditions that can affect Aboriginal and Torres Strait Islander people in urban and remote settings.

The Telethon-funded guideline was authored by a multi-disciplinary team, including Aboriginal and Torres Strait Islander clinicians, and is now in its second iteration. The first edition launched in 2018 proved popular and given the expanded

scope of the second, it’s expected to be an even more relevant diagnostic tool.

The second edition builds on the first by including a broader range of skin infections that affect communities across Australia, including urbanliving families. The guideline includes impetigo, scabies, fungal infections, head lice, molluscum contagiosum as well as eczema – and includes treatments and therapies informed by newer research.

Lowitja Institute and the Menzies School of Health Research developed flip charts to help clinicians identify and diagnose skin infections in 2003. Given the useability of the flip charts, an updated fourth edition is now available to use alongside the guidelines, helping health professionals and Aboriginal families.

The healthy skin guideline forms part of a broader public health initiative to stop skin infections caused by bacteria like Strep A, Staph aureus and parasitic infestations developing into more problematic health conditions. Itchy skin caused by tinea or scabies, minor trauma or eczema allows entry of Strep A into the superficial layers of the skin to cause skin sores. Untreated skin sores can progress rapidly to sepsis and trigger kidney and heart conditions including acute rheumatic fever (ARF) and rheumatic heart disease (RHD).

All these downstream conditions have significant morbidity and mortality that could be prevented with high quality and early healthy skin practices. Additionally, attention to housing and housing maintenance continued on Page 39

Our warmest Christmas greetings, best wishes of health, happiness & work life balance for 2024 to all our referring doctors, allied health professionals, colleagues and their families.

Thank you for entrusting us to be part of the health and wellbeing of our mutual patients.

Best of true health Marek Garbowski & Perth Vascular Clinic Team Perth Vascular Clinic is WA’s leading vascular solutions centre. With state of the art management & treatment of conditions affecting vascular health we also offer minimally invasive vascular investigations and treatment.

Dr Marek Garbowski | Vascular & Endovascular Surgeon All enquiries & appointments bookings Phone: 6116 4955 | Email: reception@perthvascularclinic.com.au Visit our comprehensive website

www.perthvascularclinic.com.au

38 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

GUEST COLUMN

BACK TO CONTENTS

GUEST COLUMN

Learning from UK’s kidney disease crisis With 10% of the UK population inflicted with kidney disease, Australia needs to heed the warning signs, says Perth-based med-tech company boss Dr Richard Lipscombe.

A recent report from Kidney Research UK found the disease is currently affecting more than 10% of the UK population, with current dialysis needs of around 30,000 adults and children, stretching NHS capacity to its limits.

A Deloitte report released earlier this year found the disease is costing the Australian economy almost $10 billion a year.

While we’re not currently seeing the same level of strain on Australia’s health system, we will unless we make some significant changes.

The report also highlighted that investment in early detection could assist in identifying 400,000 cases and potentially reducing about 38,000 premature deaths and reducing demand for dialysis and transplant.

The UK – and the US, where the strain on the health system is even worse – are sending Australia an ominous warning about where we could be in a few years.

The economic and social burden of this disease is significant, and State and Federal Governments need to place greater emphasis on early diagnosis and prevention.

Already, Kidney Health Australia estimates around two million Australians are currently living with chronic kidney disease (CKD), although around 1.8 million are likely unaware they have the condition, due to a lack of symptoms.

While early diagnosis is vital in ensuring best practice treatment can begin sooner, it is prevention that will be key to changing the impending health narrative.

There is no cure for CKD, and the lack of symptoms means by the time people are diagnosed, as much as 90% of kidney function is lost, which cannot be reversed. It can lead to other issues such as high blood pressure, heart disease and ultimately kidney failure.

Three-in-four Australians are considered at risk of developing kidney disease, with diabetes now the most common cause.

While recommendations of lifestyle changes cannot be overstated, advances in prognostic testing are allowing changes in the at-risk cohort to be more

closely monitored, with the aim of preventing the disease from developing and/or progressing.

Such precision medicine technology can become another tool in the doctor’s kit, offering evidence-based data that can further encourage patients to start taking better care of themselves to avoid developing the disease in the future.

The benefits of this are two-fold – saving lives first and foremost, but also reducing the strain on our health system and allowing funding and resources to be redirected to other conditions.

While kidney disease is on the rise in Australia, when considering the numbers of people currently living with CKD in both the UK and US, we remain ahead of the game in terms of cases of the disease relative to our population.

We still have a shot at changing our path, and we should take the opportunity to do so.

ED: Dr Richard Lipscombe has a PhD in immunology is founding director and managing director of Proteomics International.

More than skin-deep continued from Page 38 by governments and decision makers is needed. This is beyond the guidelines, but important to continue to advocate for.

While the environment and structural issues need urgent attention, the problem also needs a focus that consolidates medicine with culture – a formula that has catalysed the development of a suite of health promotion tools that align with and complement this guideline.

The National Healthy Skin Guideline has expanded beyond biomedical models, with a range of other health promotion tools for family, school and general use that integrate culture. This model of healthcare utilises the cultural knowledge in Aboriginal and Torres Strait Islander communities by consulting with them to produce relevant promotion materials.

(See Treat Prevent Skin Sores and Scabies) a focus on community informed prevention activities led to the co-creation of a range of healthy skin books, with the local Aboriginal communities who informed the design, language and imagery.

The nexus of medicine and culture is producing a suite of culturally relevant material. In The SToP trial

ED: Associate Professor Asha Bowen is from the Wesfarmers Centre of Vaccines and Infectious Diseases based at Telethon Kids Institute.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

The National Healthy Skin Guideline is available for download on Telethon Kids Institute website.

DECEMBER 2023 | 39

40 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

OPINION BACK TO CONTENTS

Dr Joe Kosterich | Clinical Editor

Focus on what matters A person working in the automobile industry said recently that people were getting more hostile. He observed that before the COVID response he rarely saw signs saying, “abuse will not be tolerated”. It went without saying and, by the way, was not common.

The world will continue to turn without any of us. We can all do the best we can, but nobody is indispensable, and we need to remind ourselves of that.

Today, many businesses display such signs prominently. Medical practices and hospitals are not immune and this adds to the already considerable pressure we face. In turn, burnout is an increasing problem with a Mental Health Australia survey showing that in 2022, 84% of respondents said working in healthcare during the pandemic increased the amount of stress and pressure in the workplace.

The pandemic and response are over but the hangover remains. Stress levels are not helped by a shoot first and ask questions later regulator, a heavy handed bureaucracy more interested in boxes being ticked than patients being treated, and a public that increasingly expects miracles to be performed in real time. And our internal culture also isn’t always helpful!

But in life there is no future in blaming others if you want improvement.

As individuals we need to focus on what we can do to prevent burnout and manage stress.

With Christmas approaching, many will take leave. The world will continue to turn without any of us. We can all do the best we can but nobody is indispensable and we need to remind ourselves of that. We also can reflect on whether issues that arise are blips or catastrophes. The vast majority are the former, even though we may react as if they were the latter.

Take time to reflect on what is really important. Typically, on gravestones it describes a person in relation to their family, it is rare to see the day job listed. Thus make time with family and friends a priority and be present.

This includes getting off devices – and yes, we are no better than the rest of society.

Get out into nature, whether it is a park, the beach or the bush. This has been shown to be good for mental health. Maybe reflect on how you want to best invest your time next year and what you are no longer prepared to tolerate. Catch up on sleep. Do anything which is fun.

A January edition will appear for the first time next month so keep a look out.

I would like to thank readers and contributors for their support in 2023.

Best wishes for Christmas and 2024 to all.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 41

PMS 7441C C45 M73 Y0 K0 R150 G95 B167 HEX #965FA7

PMS 320C C100 M11 Y38 K0 R0 G155 B167 HEX #009BA7

Helping over 10,000 babies to be born since 2014

ON OR - OI/O T

–

FREEZI N G –

IVF

RO Z

GG –E

– IC S I – F

B RYO T RA N S F

ER

42 | DECEMBER 2023

ND

I–

Introducing our Known Donor Program Our range of fertility treatment options has expanded to include our newly launched Known Donor Program. As part of this program, patients can access affordable fertility treatment with donated sperm, eggs or embryos from a donor known to the patient. By facilitating sperm, egg and embryo donation in this way, we know that we can help more people grow their families in more ways.

OW

IU

Experienced Fertility Specialists Adora Fertility provides affordable IVF without compromising on quality. By referring your patient to one of our highly qualified specialists, they will receive a tailored approach to their fertility treatment plans with medications sensitive to their needs. Out-of-pocket costs are typically less than $2,000 for a fully stimulated IVF cycle. Give your patients the best chance of conception without the financial sacrifice.

KN

Dr Shanthi Srinivasan Fertility Specialist MBBS, MD, DNB, FNB (Rep Medicine), FRANZCOG

EM

Dr Mahalakshmi Ragunath Fertility Specialist MBBS, DGO, MRCOG, MSc, FRCOG, FRANZCOG

EN

Dr Gayatri Borude Fertility Specialist - Clinical Director MBBS, MD, DNB, FRANZCOG, M Rep Med

Adora Fertility Perth - 9 Perilya Road Craigie, WA 6025 08 6146 5100 I perthadmin@adorafertility.com.au I adorafertility.com.au MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLINICAL UPDATE

A new initiative to prevent childhood bone disease in WA

By Prof Richard Prince, Senior Honorary Research Fellow UWA Medical School Arthritis Osteoporosis WA is working with Edith Cowan University to develop immersive digital educational resources for teachers and students to increase their understanding of bone and joint disease, to strengthen knowledge about the musculoskeletal system and support learning and behavior change to optimise bone health and prevent disease.

This initiative aims to reduce childhood fracture and build optimal skeletal structure to reduce fracture rates in later life.

In WA, childhood bone disease, principally fracture, is more frequent than in 60-year-old women, as it occurs in up to 50% under the age of 18 years.

Thus, it should be taken seriously.

Childhood fracture is increasing in frequency and is associated with the increasing problem of childhood obesity. Achieving optimal peak bone mass and structure in adolescence sets the individual up for a reduced risk of fracture in the future.

Bone structure is related to the individuals’ genetics; an obvious example is height, itself determined by growth plate activity, that is strongly related to parental height.

However, important environmental influences can enhance or impair the process of bone growth.

These include physical activity and nutrition. Given that environmental factors account for 20-40% of peak bone mass, optimising these factors may be the difference between fracture and non-fracture.

Early intervention through education To establish the best foundation for good bone and joint health late in life, the WHO urges young people to participate in lifestyle strategies that support peak bone mass.

However, a recent review of the literature has identified that there is a distinct lack of resources that are pedagogically sound, curriculum-

Key messages Childhood fractures are underrecognised and increasing A new study aims to provide better education on bone health Doctors have a vital role to play.

aligned and, furthermore, few are interactive and engaging for school students, so knowledge transfer about this topic is limited.

An advisory stakeholder group including educators, coaches and health professionals have been surveyed and advise that there are currently limited Australian resources available to support curricula. Teachers estimated about one-to-two hours a year is spent on this topic and requested professional development.

The Bone and Joint Health Project of Western Australia is a collaboration between ECU, its funding partner Arthritis and Osteoporosis WA (AOWA) and Singular Health Group (SHG) to correct this deficiency by designing, implementing and evaluating pedagogically-sound, curriculum-aligned, digitally immersive educational resources to improve bone and joint health awareness and initiatives amongst youth.

This partnership provides not only a valuable opportunity to improve awareness, but also to help reduce the risk of developing health conditions, such as osteoporosis, osteopenia and arthritis. This project will develop age-appropriate aligned resources that are feasible and motivating for users to implement in schools and sporting clubs.

The approach uses co-design with all groups of end-users, including educators, parents, community/ child nurses, health professionals and sporting associations, to better understand the type of resources

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

that might be most useful and effective. These results will guide the future design, development, and uptake of pedagogically sound, digitally immersive educational tools about the importance of healthy bones and joints in youth.

After further consultation, a serious game will be developed as the activation point for learning, along with professional teaching and learning resources that are used in conjunction with this game.

A formal research trial among interested schools and sporting clubs will test and evaluate this prototype and resources, which will be curriculum-aligned and available once evaluated.

Role of medical practitioners As leaders in health care, medical practitioners will be asked to evaluate and advise on children’s bone health. Thus, it is important to be aware of this new initiative as it rolls out over the next few years.

Hopefully we can look forward to your support.

In clinical practice, it is likely that you will be involved in bone health in several situations. Most commonly after a traumatic fracture or stress fracture and secondly in situations of known risk such as children with malabsorption or receiving corticosteroids. In addition, given the important, if rare conditions of genetic predisposition, such as osteogenesis imperfecta, being aware of family history is also important. Your role in management of these problems is essential in reducing future disease.

If you are interested in further information, please contact Brittany Hanson brittany.hanson@ecu.edu.au The author acknowledges the contributions of Amanda Devine, Julie Boston, Aris Siafarikas and Kiranjit K. Joshi Author competing interests – the author is involved in the research described

DECEMBER 2023 | 43

Making IVF treatment accessible to people all over Western Australia

We offer a wide range of fertility services including: • • • • • • •

Fertility Evaluation Assisted Reproduction Freezing & Storage Genetic Testing Surrogacy Fertility Counselling Dedicated Donor program

New referrals welcome Concept Fertility Centre 218 Nicholson Road SUBIACO WA 6008 Phone: Fax: Email:

08 9382 2388 08 9381 3603 referral@conceptfertility.com.au

Find out more at conceptfertility.com.au 44 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLINICAL UPDATE

Visceral artery aneurysms

By Dr Marek Garbowski, Vascular Surgeon, Subiaco Visceral or splanchnic artery aneurysms represent a rare, but important pathology requiring medical practitioners’ awareness due to their natural history resulting in a potential lethal clinical course.

Visceral artery aneurysmal change can affect any of the arteries within the abdomen and pelvis. Despite relatively low overall incidence in the adult population, being estimated to range from 0.1% to 2%, visceral aneurysms pose a significant risk of morbidity and mortality.

The incidence in the older population increases to 10%. More than 30% of patients affected by visceral aneurysms will have an associated aortic, iliac, lower extremity, or cerebral artery aneurysm. This fact signifies the importance of screening affected individuals.

Those most frequently encountered visceral aneurysms affect the following vessels: the splenic artery 60% (SAA), renal artery (RAA), hepatic artery 20% (HAA), superior mesenteric artery 6% (SMAA) with coeliac, gastric, pancreaticoduodenal and gastroduodenal arteries being involved in 2-4% of cases.

The aetiology of true visceral aneurysms involves atherosclerosis, medial degeneration, fibromuscular dysplasia, collagen vascular diseases.

Factors specific to most common splenic artery aneurysms include multiparity, portal hypertension and post-transplant status.

A separate group of visceral pseudoaneurysms frequently result from infectious or inflammatory conditions, vasculitis, trauma and iatrogenic causes. All false visceral artery aneurysms display relatively rapid growth following the initial insult, therefore early intervention is indicated regardless of the aneurysm size.

Most of the true visceral artery aneurysms remain asymptomatic.

Clinical examination rarely contributes to improved diagnosis.

Key messages Complex endovascular techniques revolutionised management resulting in fewer complications, faster recovery and ability to treat challenging anatomy Splenic artery aneurysms encompass most visceral aneurysms. Pregnancy is a significant risk factor for rupture, with a high chance of maternal and fetal mortality (75-95%) Evidence increasingly supports interventions in all superior mesenteric artery, gastroduodenal artery and pancreaticoduodenal artery aneurysms due to their higher rupture rate.

Ever-increasing use of non-invasive investigations such as ultrasound and computer tomography has resulted in higher numbers of patients being diagnosed with visceral aneurysms.

This presents an opportunity to significantly reduce aneurysmrelated complications by referring patients for further assessment to vascular surgeons. Naturally, not all visceral aneurysms require immediate referral to a specialist.

Generally, all patients with visceral artery aneurysms with a diameter of 2cm or more, benefit from vascular referral and assessment. Naturally, any pregnant and childbearing-aged patients diagnosed with SAA require immediate referral to a vascular surgeon.

Pancreaticoduodenal and gastroduodenal artery aneurysms represent a specific group where no correlation between size and rupture risk has been shown. Considering high rate of rupture and mortality, consensus indicates treatment of these aneurysms regardless of size.

The natural history of most visceral aneurysms is still poorly understood.

Unclear rupture rates based predominantly on postmortem studies did not assist in providing clinicians with consensus dictating indications for treatment or specific treatment options.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

Significant advances in endovascular techniques, improved imaging and technologies contributed to a major paradigm shift in the management of visceral artery aneurysms.

Contemporary vascular and endovascular surgeons guide their clinical decision based on patient and aneurysmal characteristics.

Immediate benefits include the use of local anaesthetic/sedation, shorter hospital stay, faster recovery, and lower admission costs. Clinical advantages relate to the ability to treat patients who have significant comorbidities and/or hostile abdomen.

Potential drawbacks of endovascular treatment relate to access site injuries, contrast toxicity, endorgan embolisation and the need for prolonged imaging surveillance. Treatment failure rates are potentially higher compared with open surgery, however, this needs to be viewed cautiously as open surgery is frequently unable to deal with more anatomically complex aneurysms, which are often addressed with endovascular approaches nowadays.

Several endovascular modalities have been utilised. Often, combination of different techniques provides successful exclusion of the aneurysms and simultaneously maintains undisturbed flow through to the important vessels allowing ongoing organ viability. The most popular endovascular techniques include coil/particle embolisation, placement of covered stents or stent-grafts and use of flowdiverting stents.

Stent-assisted coil embolisation results in high rates of aneurysm exclusion and maintained flow through the affected artery. This technique was developed over the past decade and has significantly improved success rates when treating visceral aneurysm. Its main advantage relates to organ preservation (spleen, kidneys or bowel), avoiding partial or complete continued on Page 46

DECEMBER 2023 | 45

Protracted wet cough: beyond bacterial bronchitis

By Dr Rob Lethbridge, Paediatric Respiratory & Sleep Physician, Nedlands Wet cough is most frequently a normal response to viral infection but there has been increasing recognition of protracted bacterial bronchitis, defined as a wet cough lasting more than four weeks.

Proactive management with two weeks of antibiotic therapy helps to stop the cycle of infection and inflammation, aiming to prevent irreversible damage. In cases where treatment fails or where symptoms are recurrent on multiple occasions, further investigation may be warranted to assess for underlying conditions.

Much treatment of the below diseases is aimed at preventing bronchiectasis. Once established, bronchiectasis can lead to recurrent episodes of prolonged wet cough due to localised impairment of airway clearance and by acting as a nexus for bacterial disease.

However, it is a descriptive term defined by imaging findings and should act as a trigger for further investigation rather than be a final diagnosis. In children, a diagnosis of bronchiectasis requires a chest CT, as X-ray can be unreliable.

The most common airway abnormality found in recurrent wet cough is tracheo-bronchomalacia.

In cases of malacia, softness of the airway causes ineffective cough and predisposes to bacterial infection.

While most malacia is idiopathic,

Specialist investigations for recurrent / unresolved wet cough.

If performing any of these, should strongly consider referral.

abnormal arrangements of the cardiac vessels (vascular rings) compressing the airways can be surgically corrected and are an important differential.

Other forms of airway abnormality such as the presence of intraluminal lesions are far rarer but can be looked for with CT or bronchoscopy.

Cystic fibrosis therapy has undergone a revolution over the past few decades. The introduction of newborn screening and the more recent advent of transmembrane receptor modulators allow for early

intervention and often dramatic improvements in both duration and quality of life.

Newborn screening looks for raised immune reactive trypsinogen and is followed by genetic testing, but this process misses around 5% of cases. Failure to thrive, particularly in the presence of oily stools, should increase clinical suspicion. The mainstay of post-natal diagnosis remains a sweat test, and early diagnosis and intervention can significantly improve outcomes.

With aspiration, a clear history of an

Visceral artery aneurysms continued from Page 45 organ loss which otherwise would result in significant morbidity or mortality.

Patients undergoing endovascular treatment of visceral aneurysms 46 | DECEMBER 2023

should be placed on regular antiplatelet therapy usually with a single agent (aspirin 100mg daily). When treating splenic artery aneurysm, a small risk of complete or partial spleen loss exists, therefore patients benefit from a range of vaccines against

pneumococcal, meningococcal, and Haemophilus influenzae type b infections.

Author competing interests – nil

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLINICAL UPDATE

BACK TO CONTENTS

CLINICAL UPDATE

Key messages The most common cause of a prolonged wet cough is protracted bacterial bronchitis Accurate diagnosis of underlying conditions can help to provide prognostic clarity.

The treatment of cystic fibrosis has dramatically changed with the introduction of CFTR modulators inhaled foreign body can sometimes be difficult to elicit in children, and retained foreign bodies can cause isolated stricture, occlusion and result in bronchiectasis.

Chronic aspiration of oral secretions or food/fluids increases the potential for infection while also causing irritation and inflammation on its own. Causes for aspiration vary from trachea-oesophageal fistula to swallow dyscoordination, but all require further investigation and consideration of underlying nonrespiratory conditions.

Recurrent bacterial infections and their associated inflammation can damage the airway walls. The most common immune deficiency

associated with bronchiectasis is low immunoglobulin levels, but more extensive testing with lymphocyte subset analysis, mannose binding lectin level, complement function and/or vaccine response may be warranted.

cough include ‘unusual’ chronic infections such as tuberculosis, interstitial lung disease secondary to rheumatological causes or cancer therapies and cardiac causes. While many cases remain idiopathic, this is usually reassuring.

Recurrent viral infections rarely require further investigation as even 12 episodes of viral infection every year is normal in young children.

Cystic fibrosis aside, the mainstays of therapy are directed at breaking the cycle of infection and inflammation through the judicious use of antibiotics and airway clearance techniques. Even with these underlying conditions, antibiotics are usually only started after four-weeks of symptoms. While four weeks is reasonably arbitrary, it minimises risk to the airways while also reducing the potential for overtreating viral illnesses or their sequelae.

Primary ciliary dyskinesia is a dysfunction of the cilia found lining all the airways, including ears and nose, can be tough to diagnose conclusively. Cilia are hair-like structures vital for ‘cleaning’ the airways through consistent linear motion to move foreign material and infective agents to less vulnerable areas.

In ciliary dyskinesia, movement is either chaotic or absent, resulting in stagnation of the respiratory secretions and potential for infection.

Neither electron microscopy nor functional cilial assessment are foolproof and while genetic testing is improving, clinical tools such as the PICADAR score remain the mainstay of diagnosis.

Wet cough is incredibly common, however, prolonged duration in the absence of recurrent viral aetiology may represent an underlying abnormality. By clarifying the diagnosis, appropriate therapy can be initiated and provide prognostic clarity.

Author competing interests- nil

Other very rare causes of wet

Surgery for Heel Pain Heel pain is a frequent problem that presents to the general practitioner. Plantar fasciitis is the most common cause of under the heel pain. Most patients will improve with non-operative treatment but not all.

Surgery is a very effective form of treatment for this condition in patients with long standing refractory symptoms.

Before being considered for surgery patients should undergo at least six months of non-operative treatment that includes the following (in the appropriate order): • Rest, avoidance of activity • NSAIDs, stretching exercise program • Orthotics: off the shelf or custom • Cortisone injection (one only) • Shockwave therapy

Plantar fascia origin

Surgery can be open or endoscopic.

The principle part of the procedure is release of the plantar fascia near its origin on the heel. Historically only the medial half was released but recent literature supports more complete release.

By Mr Peter Ammon Foot Ankle & Knee Surgery

Open surgery is performed through a 3cm incision in the proximal arch and allows not just plantar fascia release but also decompression of the tarsal tunnel and Baxters nerve which is often implicated in heel pain.

Endoscopic plantar fascia release is indicated for those without nerve compression symptoms and is done through a much smaller incision using a camera assisted cutting device much like a carpal tunnel release.

Both open and endoscopic releases are performed as day cases and require approximately two weeks on crutches. Recovery is slightly quicker for endoscopic patients as you would expect. Patients can expect an 8090% chance of a good result from surgery. Complications are rare.

St John of God Medical Centre Suite 10, 100 Murdoch Drive, Murdoch WA 6150 Telephone: (08) 6332 6300 Facsimile: (08) 6332 6301 www.murdochorthopaedic.com.au Murdoch Orthopaedic Clinic Pty Ltd ACN 064 146 774 ABN 23 070 745 210

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 47

Your heart is in the best hands We provide comprehensive...

Priority Admission Service

Cardiothoracic Surgery

Direct Admission for cardiac and respiratory patients (Call the FREE PAS HOTLINE on 1800 668 681) which allows your patients to have immediate individualized care as they may if they present in a public ED.

Mount has opened the first private hybrid operating theatre in WA. We have performed over 700 open heart surgeries in total and are the lead TAVI program in WA.

Interventional Cardiology

Mount Hospital has the largest private ICU/CCU in WA with 24/7 Specialist & Registrar Cover.

Mount Hospital prides itself on being one of the leading providers of private cardiac care in the state. Shortly after its opening, Mount Hospital performed the first private heart bypass surgery in 1986. Since then, Mount Hospital’s cardiac service has grown. We provide integrated cardiology care incorporating diagnostic, therapeutic and procedural services in our state-of-the-art catheter lab.

Over 3,000 cardiac catheter laboratory procedures performed every year

150 Mounts Bay Road, Perth WA 6000 P 08 9327 1100 | mounthospital.com.au | Community of Care 48 | DECEMBER 2023

ICU/CCU

Rehabilitation Facilities Mount Hospital’s extensive multidisciplinary team offers a comprehensive rehabilitation programs for inpatients.

More than 550 cardiac surgeries performed annually

Mount Hospital

Over 200 thoracic surgeries performed annually

Mount Hospital

by Healthscope

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLINICAL UPDATE

Age-Related fertility decline: counselling & management

By Dr Rose McDonnell, Fertility Specialist and Gynaecologist, Claremont Ageing can have a significant impact on both male and female fertility outcomes due to inherent natural biological processes.

According to data released in October 2023 by the Australian Bureau of Statistics (ABS), the average age of both mothers and fathers has steadily increased since the mid-1970s.

Sixty per cent of births are to mothers who are between 30-39 years, a sharp increase from less than 20% in 1975. The average number of children is also less.

Despite total fertility remaining low, the fertility rate for women in their late 30s and early 40s has significantly increased, with the fertility rate of mothers aged 35-39 years almost doubling from 36.0 to 69.3 births per 1,000 women, and for mothers aged 40-44 years, it has nearly tripled from 5.5 to 15.8 births per 1,000 women.

This shift towards later parenthood for men and women follows trends to establish careers and securing economic independence before having children.

This may appear to be reassuring for those who wish to delay parenthood, but it often results in increasing medical intervention to achieve one’s dreams of parenthood. This can be associated with increased financial pressures as well as physical and psychological morbidity, particularly when fertility treatment is not successful.

Whilst the spotlight has been focused primarily on maternal age, there is increasing evidence that suggests that the father's age contributes to his offspring's chance of having an inheritable disease.

A literature review by Kaltsas et. al. shows a direct correlation between paternal age and decreased sperm quality and testicular function.

Whilst the definition of advanced paternal age has been debated, it is thought that men over the age of 40 can have poorer reproductive outcomes. DNA mutations and chromosomal aneuploidies have

Key messages Advanced maternal age leads to a decrease in fertility resulting in an increased need for ART Early pregnancy complications are higher for women of advanced maternal age due to increased risk of chromosomal and genetic disorders Women of advanced maternal age are at increased risk for late pregnancy complications, especially hypertension-related conditions, gestational diabetes, fetal growth restriction, preterm birth, and stillbirth.

all been linked to the father's advancing age.

Increasing paternal age affects the success rate of in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), and increases premature birth rate. Several conditions, including autism, schizophrenia, bipolar disorders, and paediatric leukaemia, have been linked to the advanced paternal age.

There are several ways that age can affect fertility in women.

Firstly, women are born with a set number of eggs that reduce over time. These eggs are exposed to radiation, unhealthy food choices,

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

alcohol, smoking and endocrine disrupting agents which can all affect the quality which results in increasing genetic abnormalities.

This in turn can result in an increase in time to conception, a decreased chance of conception and increased miscarriage. The ability to fall pregnant declines more rapidly from the age of 37.

Women who conceive later in life are more likely to conceive a pregnancy affected by autosomal aneuploidies such as trisomy 21, 13 and 18 and are advised to consider non-invasive prenatal testing after conception as well as additional first trimester screening tests.

Babies born to women aged ≥40 years have been shown to have a two-fold increased risk for cardiac defects, esophageal atresia, and craniosynostosis and therefore benefit from a detailed specialist ultrasound in pregnancy.

Increasing maternal age is also associated with an increase in menstrual irregularity due to a decrease in cyclical production of estrogen and progesterone which impacts on the ability to conceive.

Advancing age can also be associated with an increase chance of developing fibroids, polyps and adenomyosis all of which continued on Page 50

DECEMBER 2023 | 49

Sore throat diagnostics and Rheumatic Heart Disease

By Dr Janessa Pickering, Senior Research Officer, Telethon Kids Institute Strep A (also known as Streptococcus pyogenes, GAS) is a bacterial pathogen that infects the tonsils causing pharyngitis (sore throat) and impetigo (school sores).

In the past 12-24 months, there has been a marked increase globally in invasive Strep A infections including scarlet fever and sepsis.

Monitoring infections in Western Australia is crucial for preventing serious outcomes in the vulnerable, including young children, pregnant and postpartum women and older people. Strep A infections, which are most common in school-aged children, are treated with antibiotics.

Strep A remains susceptible to penicillin, contrary to widespread penicillin resistance in other respiratory microbes.

Treatment of suspected Strep A can involve the use of broad-spectrum antibiotics which may contribute to antimicrobial resistance. Penicillin is the best choice for treatment of a known Strep A infection, but medication shortages have made this challenging.

Australian guidelines recommend withholding antibiotic treatment for

Rheumatic Heart Disease (RHD).

RHD requires painful, monthly, prophylactic antibiotic injections to prevent future Strep A infections.

In many cases, life-saving surgical intervention is required to repair valvular damage. Australia has some of the highest rates of RHD globally. RHD predominantly occurs in children and young people living in remote communities of Northern Australia where access to health care and healthy living infrastructure can be difficult to obtain. Prevention and timely treatment of Strep A infections remains critical to interrupting the pathway to heart disease.

Figure 1

children at low risk of complications.

For those at risk, determining if Strep A is the causative pathogen over other viral or bacterial causes of sore throat is best practice.

Recurrent, untreated exposure to Strep A infections can trigger an auto-immune response in the body (acute rheumatic fever), which can lead to serious and permanent damage to the heart's valves –

Traditional detection of Strep A involves collecting a throat or skin swab sample for microbiological culture. Swab samples are spread onto blood agar plates and incubated to encourage bacterial growth. Strep A colonies are visualised with a cleared haemolysis zone (shown in Figure 1). Confirmatory tests for suspected Strep A may include bacitracin sensitivity testing (disc in Figure 1) and latex agglutination reactions.

Age-Related fertility decline continued from Page 49 can impact on the ability to fall pregnant and can alter pregnancy outcomes.

Whilst the advent of Artificial Reproductive Technology (ART) has given the gift of a pregnancy to many couples, it should also be highlighted that advanced maternal age is associated with an increase in ectopic pregnancy, preterm delivery, gestational diabetes, hypertensive disorders in pregnancy, intrauterine 50 | DECEMBER 2023

growth restriction, placenta praevia, stillbirth, post-partum haemorrhage, caesarean section and peripartum hysterectomy.

primary ovarian insufficiency to achieve a pregnancy with egg donation as can women who are perimenopausal.

A higher caesarean section rate has been largely attributed to labour dystocia with advanced maternal age regardless of parity and higher rates of postpartum depression that is delayed in onset is more common in women over the age of 35.

The importance of preconception screening including metabolic screening cannot be underestimated, to identify women who are at increased risk in pregnancy to ensure that a pregnancy is safe for both the woman and the unborn child.

Fertility treatment has enabled women with poor egg quality, diminished ovarian reserve or

– References available on request Author competing interests – nil

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLINICAL UPDATE

BACK TO CONTENTS

CLINICAL UPDATE

Key messages Strep A is common cause of sore throat and is treatable with antibiotics Repeated Strep A infections can trigger the development of Rheumatic Heart Disease Strep A point-of-care tests facilitate treatment and potentially RHD prevention.

These traditional methods remain the gold standard method for Strep A detection but require wellequipped laboratories and can take between 24 hours and five days for result confirmation. Children living in remote communities may face longer turn-around times due to sample transport needs.

Modern technologies for detecting bacteria and viruses show great potential for timely diagnosis in remote settings. Nucleic acid detection tests for Strep A work similarly to a COVID PCR test.

Depending on the platform, these tests can be highly portable and easily transported with health care providers.

In partnership with two remote health clinics, we tested such technology as part of our schoolbased Strep A surveillance study set in the Kimberley. Strep A point-of-care testing was easily performed on throat swabs, and results derived in under six minutes.

We found greater detection of Strep A compared with laboratory culture and that rapid results facilitated communication with families and their healthcare providers. Knowing Strep A was present coincided with an urgency for treatment that may otherwise be lacking in the absence of a microbiological diagnosis.

The opportunity to evaluate rapid testing has complemented our Strep A surveillance study, which aims to accurately document how common Strep A infections are in primary school aged children. This knowledge, the first of its kind in WA, will directly inform urgently needed public health measures.

This includes understanding how to prevent and limit the spread of Strep A, which is transmitted by person-to-person contact with saliva or nasal secretions.

A national project led by researchers at the Kirby Institute is under way to up-scale infectious disease rapid molecular testing in partnership with Aboriginal community-controlled health services. This model of care could represent a game-changer for Strep A diagnosis and treatment to resolve pharyngitis and skin sores and interrupt transmission of Strep A in the community.

There is currently no reimbursement for Strep A molecular point of care tests.

To enable equity in remote settings national combined efforts are required to achieve funded implementation. In summary, rapid sore throat diagnostics have the potential to support equitable prevention of superficial Strep A infections and serious complications.

ED: Dr Pickering works at the Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute School of Biomedical Sciences, UWA Author competing interests – nil

Here to Help Assoc. Professor Harsha Chandraratna General and Obesity Surgeon

Consulting at: SJOG Murdoch Medical Centre Suite 27 St John of God Medical Centre Murdoch, 100 Murdoch Drive, Murdoch WA 6150 Garden City Specialist Centre 537 Marmion St, Booragoon WA

Dr Bill Gong

Dr Steve Watson

Surgeons House 162 Cambridge St, West Leederville WA 6007 St John of God House 117 Anstruther Rd, Mandurah, WA 6210

Office Phone: (08) 9332 0066 | Mobile Phone: 0401809255 | Fax: (08) 9463 6202

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 51

Opening October in WATERFORD

New patients welcome

To book your appointment

Call ☎ 9452 9999

or book via

or on-line via

www.parkmedicalgroup.com.au

• Park Centre, U2, 779 Albany Highway, East Victoria Park • Victoria Park Central, U24, 366 Albany Highway, Victoria Park • Waterford Plaza, 230 Manning Road, Karawara

52 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLINICAL UPDATE

Swabbing an ulcer for HSV? It could be syphilis

By Dr Grace Phua, Metropolitan Communicable Disease Control While it is true that syphilis plagued people of centuries past, the unfortunate truth is that it is still affecting current-day Australia. Infection rates have been rising for at least a decade.

Infection rates are highest in remote Indigenous populations and among gay, bisexual and other men who have sex with men in urban areas. More recently, rates are increasing in women regardless of Indigenous status and residential area. In Perth, cases among women of reproductive age have increased more than 18-fold since 2015.

Caused by the spirochaete bacteria, Treponema pallidum, syphilis infection is well known as the ‘Great Imitator – its presentation can be mistaken for other diagnoses. Take, for example, the chancre associated with the primary stage of syphilis.

With an onset on average three weeks after exposure, the syphilitic chancre is characterised as ‘typically’ single and painless, but the frequency with which it presents atypically may lead to the diagnosis being missed.

What is the difference between a chancre and an ulcer?

A study of 64 patients with syphilitic genital chancres found that 34 patients (53% of the cohort) had single ulcers, while 30 patients (47% of the cohort) had more than one ulcer. Furthermore, 19 patients (30% of the cohort) experienced tenderness, with several describing marked discomfort from friction against underwear. Contemporary data in Perth supports these findings that presentations of chancres are variable. Note also that chancres may occur around the anus and in the mouth.

It is not always reliable therefore to differentiate syphilitic from nonsyphilitic ulcers on appearance alone.

To confirm or exclude syphilis, ulcers should be swabbed for a T. pallidum nucleic acid amplification test (NAAT, also known as PCR).

such as rash, alopecia, mucous patches (anogenital and oral) and condylomata lata, which are raised greyish-white lesions often found in warm moist areas. Condylomata lata can also be described as ‘wartlike’ and be mistaken for genital warts. They have high bacterial loads and swabs for syphilis PCR will yield a diagnosis of infectious syphilis.

Reversing the rise of syphilis Key messages Rates of syphilis infection have been rising in WA Cases among women in Perth have risen 18-fold since 2005 Swabbing ulcers for syphilis PCR can enable early detection.

While clinicians are familiar with swabbing ulcers for Herpes Simplex Virus (HSV) PCR, syphilis PCR can be missed.

In a Melbourne-based study conducted from September 2022 to February 2023, T. pallidum NAAT was performed on anogenital swabs of patients referred by general practitioners for HSV NAAT. Over the study period, 2324 samples were collected across the Melbourne Pathology network, with 31 samples returning positive results for T. pallidum. Of these positive results, 11 (35%) were from patients whose GP had requested HSV NAAT but not T. pallidum NAAT.

When swabbing for syphilis PCR, syphilis serology should also be taken. A positive result should prompt initiation of treatment with 2.4 million units (1.8g) of intramuscular benzathine benzylpenicillin (available through the Prescriber Bag).

Early in the disease course, PCRs may be positive before antibodies are detectable. Treatment should be initiated without waiting for evidence of antibodies, though serology should be repeated on the day of treatment. Prompt initiation of contact tracing is also paramount to prevent re-infection and mitigate onward transmission.

Please refer to STI Management Guidelines for further details regarding management and contact tracing.

Both syphilis and HSV PCR can be performed on the same dry swab of the ulcer base. Be sure to specify ‘syphilis PCR’ on the pathology request form. Note that ulcers can be positive for both HSV and syphilis.

Clinicians can contribute towards reversing the rising rates of syphilis in WA and across Australia.

Accurately diagnosing ulcers caused by syphilis enables early detection and management of cases. In the presence of an anogenital and/or atypical oral ulcer, T. pallidum NAAT is a sensitive and specific test that should be used to confirm or exclude syphilis as a cause. Positive results are diagnostic of infectious syphilis and patients should receive prompt antibiotic treatment and contact tracing.

Condylomata lata

– References available on request

Returning to the ‘Great Imitator’ theme, during the secondary stage of syphilis, patients can present with dermatological manifestations

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

Author competing interests - nil

DECEMBER 2023 | 53

A new specialist sexual health clinic for Perth’s northern suburbs Sexual Health North, in Joondalup, we offer a wide range of services for our patients from the diagnosis and management of STIs, HIV, PrEP, Hepatitis B & C, trans and gender diverse health care for those over 18 years old, genital skin conditions and vulvovaginal medicine. Newer services include the provision of long acting reversible contraception (LARC) including intrauterine devices- hormonal and non hormonal, erectile dysfunction, premature ejaculation and menopausal symptoms.

As our service grows, we will expand and offer further services. Our clinic strives to create a friendly and knowledgeable service in an open-minded atmosphere. We aim to work with our colleagues in primary care and specialist settings for the total wellbeing of our mutual patients. We would also be happy to take calls about your patients.

Dr Christine Dykstra

Dr Michelle Yong

MBChB (U. of Auckland), FAChSHM

MBChB (U. of Liverpool, UK), FAChSHM, MRCP (UK), DIP G-U-MED, DFSRH

Dr Christine Dykstra trained and completed her fellowship at Royal Perth Hospital, where she has been a specialist sexual health physician for over a decade. With a keen interest in improving sexual health care in Perth, Christine has provided sexual health medical education at various universities and postgraduate programs in Perth.

Her most recent role in research was as the principal investigator for the Royal Perth Hospital site of the WA PrEPIT trial for the provision of HIV pre-exposure prophylaxis in Western Australia. Having lived in Perth’s northern suburbs for many years, Christine is happy to finally bring specialist sexual health care to the Joondalup and Wanneroo regions.

Dr Michelle Yong initially gained her experience in sexual health and HIV management at Royal Liverpool University Hospital, UK. Moving to Perth in 2012, she continues to develop her clinical skills at Royal Perth Hospital including transgender medicine.

Sexual health issues can feel embarrassing for many patients. Michelle excels at putting patients at ease with her non-judgmental and empathetic manner along with a healthy dose of humour. She would like to put her expertise to good use by setting up specialist sexual health service to serve the communities of the Northern suburbs.

In order to help reduce the rates of STIs in our community, we offer our patients the opportunity for on-site consultation, pathology / investigations , and medication dispensing with many acute STI treatments. For acute STIs, we try to keep fees to a minimum. You can contact our friendly team to discuss your patient’s needs.

3/5 Regents Park Rd, Joondalup WA 6027 Phone (08) 6119 9140 Email enquiries@sexualhealthnorth.com.au Healthlink EDI: shealthn (preferred for secure contact)

www.sexualhealthnorth.com.au 54 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

CLINICAL UPDATE

Antibiotic use for lower respiratory tract infections in children with neurodisability

By Dr Rachael Marpole, Respiratory Paediatrician, & Dr Noula Gibson, Research Coordinator Physiotherapist, PCH In children and young people with cerebral palsy (CP), a common non-progressive neurodisability, 18-24% of hospital admissions are respiratory related. Between 7-16% of this cohort have at least one respiratory admission per year.

Most CP admissions are in those who are Gross Motor Functional Classification Scale (GMFCS) V, unable to maintain head control or control a wheelchair. In addition, respiratory admissions for children with neurodisabilities are longer when compared to other children admitted for respiratory reasons.

Respiratory-related admissions are variably coded as pneumonia (aspiration, community-acquired, hospital-acquired), asthma, lower respiratory tract infection (LRTI), exacerbation of chronic lung disease or reflux. A recent single-centre study of children with non-ambulant CP documented 27 different antibiotic regimens used to treat acute LRTI during 90 admissions over a five-year timeframe.

Also, when this cohort is admitted with a LRTI or pneumonia, treatment for asthma is commonly given alongside antibiotics. This variability adds to the difficulties in researching and understanding this disease and its treatments in this population.

Our systematic review has identified a limited number of studies published on the treatment of LRTI in children with neurodisability. Given all regimens had clinical success, P. aeruginosa cover as first-line empirical treatment is unnecessary. Broad regimens (i.e., amoxicillin-clavulanic acid) were acceptable treatments in most patients. In the era of antibiotic resistance, clinicians should be using the narrowest possible spectrum for treatment of LRTI in children with neurodisability.

Based on a Delphi process with 85% agreement, a group of 60 experts recommended that all children with

Key messages Amoxicillin-clavulanic acid is effective for the treatment of LRTI in children with neurodisability Pseudomonas aeruginosa cover maybe required if initial response to treatment is inadequate or if more unwell at presentation Based on a Delphi process, a group of experts recommended that all children with neurodisability with signs of a LRTI are promptly started on antibiotics.

neurodisability with signs of a LRTI are promptly started on antibiotics.

Early treatment of LRTI is likely to benefit the most severely disabled patients by preventing worsening of exacerbation, need for intravenous antibiotics and admission to hospital. However, it remains controversial since this approach may drive antibiotic resistance.

Early treatment of suspected LRTI may also have reached consensus among the clinical expert groups for several pragmatic reasons.

The detection of the clinical presence of LRTI in children with GMFCS V CP is difficult in practice with chest X-ray frequently performed but revealing little.

Parental impression, utilising nuanced appraisal of their child’s symptomatic and functional change, not only can be key in detecting the presence of a LRTI, but also its severity, and may be more sensitive than the clinical impression of a health practitioner who is not familiar with the child when they are well.

Moreover, visits to healthcare facilities for children with GMFCS V are arduous and watchful waiting in this group is not practical as it might be for less medically vulnerable children able to easily

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

access medical care and re-present at a range of suitable facilities.

Due to sampling difficulties, it remains unclear what the microbiological aetiology of LRTI is in children with neurodisability. P. aeruginosa is commonly cultured from airway samples in children with pulmonary aspiration. As such P. aeruginosa cover is often a firstline treatment for LRTI in children with neurodisability. We would suggest that P. aeruginosa cover be considered when children with neurodisability present critically unwell at presentation, or if there is no improvement after two days.

With little clear difference in efficacy demonstrated, antibiotic choices for clinicians treating children with neurodisability and LRTI remain open with consumer preference a valid consideration. Cost, convenience, and ease of administration can be considered when making the initial choice of antibiotic with enteral antibiotics (which can be given at home) achieving similar treatment outcomes to those given by parenteral route frequently requiring hospitalisation and at very least, nursing support.

The evidence available on which antibiotics are most effective in treating LRTI in children with non-progressive neurodisability is poor. In this context, we have documented that, broad regimens (i.e., amoxicillin-clavulanic acid) are just as effective as P. aeruginosa cover and should be used to minimise the risk of antibiotic resistance. This review shows that future research should address both the definition of LRTI in children with neurodisability and treatment outcomes to determine which antibiotic regimens are the most effective.

ED: Dr Gibson is the Research Coordinator Physiotherapist at PCH. Author competing interests – nil

DECEMBER 2023 | 55

BACK TO CONTENTS

LIFESTYLE

Custom built for adventure As a thalidomide survivor, Monica McGhie has had to contend with plenty. However, her spirit of adventure has remained strong and, with a kitted-out motorhome, she’s forging new paths for people with disability.

By Ara Jansen When Monica McGhie started being grounded because her motorised wheelchair wouldn’t fit on smaller planes, she went looking for another option. A life-long traveller with a thirst for adventure and new experiences, the thalidomide survivor decided to customise a motorhome that accommodates manual and motorised wheelchairs so she could see more of Australia from the road.

Born with a rare condition known as tetra amelia, meaning without limbs, Monica was the fifth of seven children. Her mother firmly believed her daughter should lead a ‘normal’ life and she was included in everything her siblings did. She taught Monica there was no such word as can’t and brick walls were meant to be gone around.

“My mum encouraged me so much,” says Monica. “She and my aunt took me to Europe when I was 16. I think that’s when I fell in love with travelling and adventuring.”

In 2014, she discovered her condition was the result of the drug thalidomide.

It was a revelation that brought relief and closure. Knowing she wasn’t alone, sharing her experiences became a new part of her life’s journey.

56 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

LIFESTYLE

She was also part of a class action in the Victorian Supreme Court which approved $89 million settlement in February 2014 for Australians and New Zealanders living with severe deformities.

Australia has about 135 thalidomide survivors.

– she’s hiring it out to others who also want to find some freedom on the road.

Active on Facebook and Instagram documenting her adventures, Monica turned 60 in October and says she’s not ready to slow down.

There’s too much to do and see.

Plus, she’s a great auntie about 14 times.

With newfound understanding and confidence, she started a new chapter – bought a house, hired support workers and embarked on cruises to places such as Broome, Hawaii, Alaska and New Zealand.

When she was grounded once too often because her wheelchair couldn’t get through the cargo hold door, she decided to customise a motorhome so she could enjoy and explore remote WA. The motorhome – called Minus 4 Adventures – has an accessible entrance equipped with an automated wheelchair lift to accommodate all wheelchairs with safety and comfort. Wider aisles and spaces ensure comfortable manoeuvrability and promote freedom of movement.

The accessible bathroom is fully equipped with a roll-in shower, grab bars and a wheelchair-accessible sink. All the switches and controls are positioned at a lower, easily

accessible height and feature large, easy-to-use buttons. A trailer provides storage for all the necessary gear for a road trip and has a fridge that runs on power or solar panels. Monica has even found a portable CPAP machine which runs on a battery.

Monica’s favourite feature, though, is the passenger side of the driver’s cab. It has been fitted for a wheelchair so she can sit right up front, see exactly where she’s going and help navigate the trip, instead of being relegated to the back.

Now she has taken a few trips in Minus 4 Adventures – she travels with a driver, a friend/support worker and her chocolate lab Milo

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

Monica has loved the fraternity with other motorhome users she has met along the way and the ones who use social media to offer help, tips and travel ideas, especially for those with disability.

Ever seeking new adventures, Monica’s next trips include New Zealand and in 2025 doing a 113day cruise around the world.

Last month, she drove Minus 4 to Canberra, where the Prime Minister invited thalidomide survivors and their families in order to say sorry.

The national apology was followed by a dedication ceremony to unveil a monument to recognise these survivors and their families.

For more information about the motorhome: www.minus4.com.au

DECEMBER 2023 | 57

BACK TO CONTENTS

VISUAL ARTS

WA flora shines on canvas The York Botanic Art Prize is an art prize with a difference. All mediums are welcome as artists feature Western Australia’s fascinating native flora.

By Ara Jansen When you visit the 2023 York Botanic Art Prize over the summer, expect to be surprised at the kind of art you’ll see.

The prize is unique in that artists are invited to actively challenge traditional notions and conventions of botanical art with their entries. Artists must respond to the theme of native Western Australian flora and reference specific local species, but they can work in any medium, offering an opportunity to expand the field of what botanic art can be.

Mark Mohell’s winning entry in 2021 was a digital video work, as was the inaugural 2020 winner Kirsten Hudson.

Prize director and owner of York’s Gallery 152 Jenny Garroun says the prize was created to showcase artistic engagement with WA’s incredible native flora, but also draw attention to the issues and challenges that face its protection and conservation. The gallery hosts the exhibition of the finalists until the end of January.

“We want people to push the boundaries of what they think botanical art is,” she says. “Which is why the entrants work with everything from traditional painting to textiles, clay or film. This is what makes it unique and really interesting. We don’t exclude painting, drawing or traditional work, but we are also interested in pushing the envelope of what botanical art can be.

“It’s an opportunity to dig a little deeper into the spaces where science meets art. Through the prize we hope to connect art with science, to drive change, conserve our natural environment and preserve biodiversity for the long-term future of our planet. During that process we are also able to support new and important creative works.”

58 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

BACK TO CONTENTS

VISUAL ARTS

More than 9000 people visited the finalist exhibitions in 2020 and 2021, and now the exhibition will be held every other year. This year’s exhibition – Australia’s only contemporary botanic art prize – features 30 artists from WA and 17 from other states chosen from a field of 177 entries.

The WA finalists include Pippin Drysdale, James Crombie, Yoshiko Gunning, Kyle Hughes-Odgers, Tineke Van der Eecken, Clarice Yuen, Matthew McVeigh and Cynthia Orr.

presenter Professor Josh Byrne is the prize patron. This year’s judges were Dr Laetitia Wilson, Ron Bradfield Jnr and Professor Fiona Stanley.

Main Image: Ode to Grandis, Sarah Thornton-Smith (Artist) From top left: A Banksia Moment, Angela Ferolla (Artist); Graniticus, Robin Wells (Artist); Outside Gallery 152

See the York Botanic Art Prize at Gallery 152 (152 Avon Terrace, York) from November 26 to January 31, 2024.

Unlike other art prizes where the finished piece has to be sent for selection, the York prize requires proof of a concept. The judges want to know that each artist has the capacity to deliver what they are planning to create. This means only the finalists actually need to produce a finished piece of work.

This year for the first time, the prize was also opened up to overseas entries and while none were received, Jenny hopes it’s the start of wider notice.

“We’ve had interest from overseas and there was no reason to exclude these artists. Their work must still feature native WA flora, so in the future that might yield some interesting interpretations.

“We’re trying to encourage engagement and a greater knowledge about WA flora because we have such a diverse and fascinating environment that is under threat. For example, only 10% of native vegetation is left in the Wheatbelt. We have a crisis on our hands so the prize is also a way to document this.”

Environmental scientist, landscape designer, sustainability advocate and ABC TV Gardening Australia

WIN Greece is the word!

Palace Films is releasing the crowd-pleasing French comedy Two Tickets to Greece in cinemas on Boxing Day, just in time for a bit of post-Christmas recovery.

When childhood friends Magalie and Blandine cross paths after many years, they decide to finally take their dream vacation to Greece.

A widely entertaining tale of female camaraderie, Two Tickets to Greece was a hit at the Alliance Francaise French Film Festival earlier this year.

Medical Forum has five in-season double passes to win to this high-end arthouse film.

To enter, go to www.mforum.com.au and hit the competitions tab.

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

DECEMBER 2023 | 59

SPIRITS

BACK TO CONTENTS

Bush to bottle The Esperance Distillery was launched in 2020 as small family operation with a tiny 30 litre still and a plan to make gin with local botanicals.

It was certainly a brave decision for a remote operation during the COVID years. But persistence has paid off and now, with a larger still, they are producing a portfolio of small batch gins with a true “bush to bottle” ethos.

The Esperance Distillery range of spirits is well-made and interesting, with a commitment to sustainable operations in the distillery and packaging. I am looking forward to a visit to Esperance so I can try the full range of gin and vodka.

Review by Dr Martin Buck

I

W

FROM THE E

SP E

RA

N

N GI

NC

E DISTILLERY

Blue Haven Sunset (500ml $75) The Blue Haven Sunset spicy gin is a brilliant blue colour courtesy of the Darwin pea flower and has an intriguing nose of lemon and eucalyptus. Clever use of the local melaleuca gives some interesting flavours with the palate being improved with bright ginger notes. A light touch of chilli makes the Asian fusion theme come together. A touch of tonic makes a refreshing G&T with the colour morphing into blush pink.

Middle Island Pink (500ml $75) The Middle Island Pink gin has a slightly reduced alcohol strength at 40% and made with hand-foraged botanicals and local spring water. This gin uses native Australian hibiscus to give the pale pink colour and lemon bush for a citrus-style backbone. A botanical gin where the “less is better” approach works very well – clean spirit, delicate flavours and a very tasty summer drink.

Shiraz Gin (500ml $90) Combining wine grapes and gin is a uniquely Australian approach to making a liqueur. I really enjoyed the Shiraz gin, with the pressed Shiraz grapes soaked in a base gin made with tea tree, vanilla and sandalwood. A reddish amber colour in the glass with aromas of port and spice. The palate was full, sweet and juicy, perfectly served with a large ice block and a slice of orange.

60 | DECEMBER 2023

MEDICAL FORUM | FERTILIT Y & SEXUAL HEALTH

medical forum CLASSIFIEDS FOR LEASE

DUNCRAIG Highly Sought Rare Medical Suite + Unique opportunity as long term tenant retiring + 98sqm medical consulting suite + Ample parking + 3 consulting rooms + Opposite Glengarry Hospital Asking Rent $34,300 pa + GST & Outgoings For further details please contact Rob Selid 0412 198 294

MURDOCH Murdoch Health & Knowledge Precinct Suite 3.10, 44 Barry Marshall Parade, Murdoch • Superbly located ‘A Grade’ suite within master-planned medical community • 195 m2 brand new tenancy • Corner suite, abundant natural light • 2 under cover car bays • Fit-out contribution available • Suite may accommodate 4/5 consulting rooms, reception/waiting area, kitchen/breakout area, store records room, and other zones.

Be part of this brand-new complex and make your enquiry today.

Contact Paul Farris 0424 888 778 or paulf@rfre.com.au

HILTON 44 Victor Street, Hilton • Well located whole building in a thriving Neighbourhood Commercial Hub • 93.2 m2* m2 lettable area • 3 consulting rooms, reception/waiting room, multiple toilets plus shower, store and tearoom • Abundant on-site parking • Ready for your practice now.

Contact Paul Farris 0424 888 778 or paulf@rfre.com.au

RURAL PLACEMENTS

HARVEY Treendale Medical Group – GP Positions • DPA Area’s and MMM5 Available • FSP GP’s are welcome to apply • Busy & well established Medical Group with 4 Location in the South West of WA • Full time & Part Time GP Positions in Treendale & Harvey • Fully computerized and accredited modern practice with nursing and admin support • Well supported with large team of experienced GP’s • Situated in the beautiful South West Region surrounded by coast and forest and close to tourist areas in the south of WA • Only 1 ½ hrs from Perth • Family friendly working hours and no on call or hospital cover required • 65 – 70% of billings depending on experience Please forward CV and enquiries to Kylie Wilson kyliew@harveymed.com.au

METRO PLACEMENTS

DUNCRAIG Duncraig Medical Centre GP required Full time patient load available.

Flexible hours seven days Excellent remuneration – $200 to $300 per hour.

Predominantly private billing practice Modern fully computerised practice (Best Practice) Please contact Michael on 0403 927 934 or michael@duncraigmedicalcentre.com.au

FOR SALE

JOONDALUP PREMIUM QUALITY JOONDALUP MEDICAL SUITE – FOR SALE • FIRST CLASS MEDICAL FITOUT • PRIME GROUND FLOOR MEDICAL SUITE Altegra Property Group are pleased to offer 8/189 Lakeside Drive, Joondalup to the market for sale.

This newly refurbished ground floor medical/consulting suite comprises 98sqm consulting suite+ 3 car bays, located on the corner of Lakeside Drive & Reid Promenade, within walking distance of Joondalup Health Campus with ample street parking and easily accessible public transport links.

ASKING PRICE: $630,000 + GST Contact Anthony Morabito at Altegra Property Group on 0430 101 385 or anthony@altegraproperty.com.au

89

LEEDERVILLE Opportunity for a VR GP to join our busy, long established private medical practice in Leederville.

Fully computerised and well equipped GP practice with Pathology onsite Our practice is fully accredited and offers full support from a well-trained and collaborative practice team.

Please call Lorraine on 0487 589 829 or email practice.manager@oxfordstreetgp.com.au to discuss.

All enquiries will be kept confidential.

CANNINGTON PART TIME FEMALE BULK-BILLING VR GP REQUIRED IN CANNINGTON 85% OF MEDICARE BILLINGS OFFERED A unique and new opportunity for a female GP to be part of a team delivering holistic women’s health care.

ESSENTIAL REQUIREMENTS • VR General Practitioner • Experience in antenatal / postnatal care • Experience in contraceptive technologies • Willing to work with interpreters • Current Police Clearance and Working with Children Check WHY WORK WITH US? Ishar Multicultural Women’s Health Services is a highly reputable, not-forprofit, charity with a 30 year history of delivering specialised women’s health services to women from a refugee and migrant background.

• Flexible work hours • 85% of Medicare billings offered and no other on costs • Brand new clinic fit out • Experienced reception and administrative team • Focus on a niche area of women’s health • Work as part of a dynamic multidisciplinary team, comprising of a midwife, practice nurse, dietitian, psychologist, social worker and counsellor.

This is a unique opportunity for the right person, if you are interested in finding out more about the role please contact: Kim Duong, Services Delivery Manager; Phone: 9345 5335 or Email: kim@ishar.org.au

GLEN FORREST Glen Forrest Medical Centre GP Position The doctors at our practice enjoy clinical autonomy and practising on their own terms. There are no KPI’s or numbers of patients per hour. Our friendly, supportive administration team are there to assist with in-house IT and management of accounts. We use Best Practice software. We have a purposebuilt treatment room and separate procedure room for Mirena’s etc with a great team of nurses to support you.

Glen Forrest Medical Centre provides quality and comprehensive care to our patients including minor surgical procedures, women’s health (Mirena/ Implanon/IUCD), men’s health, IV fluids, iron infusions, mental health, paediatrics, adolescent health, complex medical comorbidities and palliative care.

Please contact Maria Clark on 08 9298 8555 or email mariac@gfmc.com.au

JOONDALUP The Best GP Job in Perth – Hands Down!

Here’s a job where you finally get Treated (and Paid!) like a Specialist.

We are looking for a motivated GP in Skin Cancer Medicine.

Join a clinic that puts you first and helps you excel in your career: • 100% Private Billed Skin Checks.

No exceptions.

• Procedures privately billed with high gaps • State of the art Mole Scanning Technology • Fast on boarding, training and mentoring • Happy staff and expert colleagues • Expand to Cosmetic medicine or Vein Sclerotherapy • $200 ph min • And more…..

What are you waiting for? moleclinic.link/Best-Job Please contact Practice Manager on 08 9301 1825

BALCATTA Clinical autonomy The role would suit a new Fellow or GP who wants to curate their own patient base with a guaranteed minimum offered for 3 months.

Work in a fantastic environment – a non-judgemental, respectful and safe space with a supportive nursing and admin team.

Enjoy an innovative, modern practice with the latest equipment and software (BestPractice).

Choose your hours – our clinic is open from 8am to 7pm Monday-Friday, 8-1pm Saturdays.

Get to know your colleagues with quarterly team-building activities Sub specialise – for the right applicant, we’re happy to support your special interest.

Central location - 15 minutes from the CBD, extensive parking available.

Contact: PracticeManager@balcattafamilypractice.com.au or call Debbie on 08 6478 3955

COMO

Opening for VR GP - F/time or P/time Full Private List available now from retiring GPs FRACGP essential Up to 70% private billings Unique opportunity to join our family orientated practice in one of Perth’s fastest-growing suburbs.

Enjoy working for a doctor-owned, non-corporate, well supported, and accredited practice.

Please contact the Practice Manager on 6165 2444 or email: reception@comogp.com.au

NEXT DEADLINE: For Classifieds, contact Andrew Bowyer – Tel 9203 5222 or classifieds@mforum.com.au

90

medical forum CLASSIFIEDS

EDGEWATER GP FT/PT Edgewater Medical Centre is an accredited, mixed billing, medical practice in Edgewater, Western Australia and seeking a General Practitioner to join our friendly, patient focused team.

Work place: You will be working with a dedicated and professional team of administration, nursing and health staff supporting GPs within this busy practice, providing a full range of medical services. The focus is on personal care, attention and expertise.

Role: As an experienced GP, this role will allow you to provide high quality primary health care services to the community, in keeping with best practice standards.

Essentials: • Applied knowledge, skills and experience in general practice • Unrestricted VR GP qualification • Full Australian Work Rights What’s in it for you: • State of the art equipment, technology & facilities • Supportive team • Doctor owned practice • Nurse Support • Onsite Pathology • No call outs– Week Day 8-5 roster • Free parking onsite • Flexible arrangements • 70% of billings • Initial Guaranteed payment of $150.00 per hour in first 3 months For a confidential discussion, please contact Cecelia – (08) 9306 1899 or CeceliaC@edgewatermedical.com.au

ATWELL Require VR GP’s Unrestricted for Part-time Positions: As an experienced GP, this role will allow you to provide high quality primary health care services to the community, in keeping with best practice standards.

Essentials: • Applied knowledge, skills and experience in general practice • Unrestricted VR GP qualification • Full Australian Work Rights What’s in it for you: • Supportive and Experienced Admin team • Doctor owned practice • Nurse Support • Onsite Pathology • Flexible arrangements • AGPAL Accredited Practice • Located near FSH and SJOG Murdoch • Mixed Billing (mainly Private) If you are interested please contact our Practice Manager for further information on 9332 5556 or email: adminmetrogp@metrogp.com.au BULL CREEK Bull Creek Medical – VR GP opportunity We are seeking full time or part time VR GP to join our friendly team.

It is a mixed billing well established practice providing quality health care for many years.

It is located closer to world class public and private hospitals and near by top public and private schools.

Flexible working hours and terms and conditions are negotiable.

If you are interested in this exciting opportunity, contact practice manager via email: admin_pm@bullcreekmedical.com or call on 08 9332 0488

PERTH Breast Clinic seeking VR GP Perth Breast Clinic is seeking an enthusiastic VR GP to join our expert team of breast physicians, 1 – 2 days per week.

Located in the Mount Hospital Medical Centre, Perth Breast Clinic offers a comprehensive service for women, from breast screening and diagnosis through assessment of symptoms, diagnosis and management of breast cancer and benign breast disease. The clinic is led by our specialist breast physicians who work as part of a multidisciplinary team comprising radiologists, surgeons, pathologists, oncologists, nursing and support staff.

We offer • Comprehensive training and mentorship by highly experienced breast physicians • Flexible work hours, 1-2 days per week • Mixed billing, low service fee • Onsite parking Requirements • AHPRA registration / Medical Indemnity insurance • Previous experience in women’s health • Advanced communication skills For further information, please contact Tasha Pratt by email tasha.pratt@healthscope.com.au or phone 0477 961 871

NEDLANDS Niche, Boutique Medical Centre looking for a VR GP Fully Private Our practice is situated in the Golden Triangle in the Western Suburbs.

Standard consult 23 - $100, 36 - $180 We are looking for a committed GP with excellent time management.

Full-time practice nurse with outstanding administration support.

One Saturday per month (AM only) with higher rates.

Please send through your EOI to: manager@nedlandsmedicalcentre.com.au BURSWOOD/CLAREMONT 75% OF BILLINGS!!

GP positions available in accredited mixed-billing clinics in Burswood and Claremont.

Looking for VR GPs and non-VR GP’s on a full time/part-time basis for weekday and Saturday afternoon sessions.

Fully computerised with on-site pathology and RN support.

Please contact Dr Ang on 9472 9306 or Email: info@thewalkingp.com.au

Contact Andrew, classifieds@mforum.com.au or phone 9203 5222 to place your classified advert

Opening October in WATERFORD

HIGH WYCOMBE VR GP POSITION – Full time/Part time • A busy, well equipped, fully computerized and AGPAL Accredited GP Practice in Perth, WA is looking for a VR Doctor • Flexible days and hours tailored to your need • Excellent RN and reception team as well as managerial support and onsite pathology • Clinical full autonomy guaranteed • Mixed Billings, using Best Practice Software • GP private ownership • Good income potential and emuneration at 72%, negotiable.

• $150 hourly minimum for the first three months.

The practice provides general GP services including skin check and many more.

For enquiries, Email: highwycombemc@bigpond.com Phone: 08 9454 6987

New patients welcome GREENWOOD Kingsley Family Practice We are seeking a part time or full time GP to join our well established, busy practice.

You will work in a highly equipped AGPAL accredited practice, alongside GPs with extensive specialised skills, including skin cancer surgery (including flaps and grafts), cosmetic medicine, ultrasoundguided musculoskeletal PRP injections, IUD insertion, ENT operating microscope use, and much more.

The practice itself is highly equipped, including on-site ECG, spirometry, ABI machine, ultrasound, digital dermoscopy imaging, ambulatory BP monitoring and a full time chronic disease management nurse.

Mixed billing, offering our GPs 70%.

All appointments privately billed on Saturdays.

For more information please email kingsleypractice@gmail.com or call our Practice Manager Tracy Weare on (08) 9342 0471

Positions available for suitably qualified Doctors and Nurses To apply please contact: practicemanager@parkmedicalgroup.com.au

To book your appointment

Call ☎ 9452 9999

or book via

or on-line via

www.parkmedicalgroup.com.au ࠮ Park Centre, U2, 779 Albany Highway, East Victoria Park ࠮ Victoria Park Central, U24, 366 Albany Highway, Victoria Park ࠮ Waterford Plaza, 230 Manning Road, Karawara

NEXT DEADLINE: For Classifieds, contact Andrew Bowyer – Tel 9203 5222 or classifieds@mforum.com.au

medical forum CLASSIFIEDS

Gosnells Healthcare Centre has a great opportunity for General Practitioner to join a very well-established practice.

The role would suit a new Fellow or GP who wants to curate their own patient base with a guaranteed minimum offered for 6 months.

Wonderful, friendly practice Experienced Doctors Very Large existing and loyal patient base Mixed billing practice Enjoy an innovative, modern practice with the latest equipment and software (Best Practice) 70% of billings- plus attractive relocation package Choose your hours, Our Clinic is open from 8am-5pm Monday-Friday.

On-site services include Pathology, Physiotherapy, Podiatry, Dietician Fully Accredited practice DPA Replacement Provider Number available Safety Net of $150 per hour for 6 months

If you are interested in the exciting opportunity please contact Phil at ceo@spectrumhealth.net.au Gosnells HealthCare Centre 2227A Albany Highway, Gosnells WA 6110

Hillarys Medical Centre is a very busy practice located 15mins from the Perth CBD along the coast. We have a strong focus on family & preventive health medicine.

We are a team of 10 doctors with excellent administrative and nursing support staff. We have been in Hillarys for 20 years with dedicated GP owners. We pride ourselves with providing exceptional health care to our community of Hillarys.

We have a modern purpose built well equipped 3 bed treatment room and 10 consulting rooms with quality equipment as well as a spacious staff & meeting room. We are also able to offer secure remote access and secure onsite parking. Pathology & Pharmacy are within our complex.

There is a high-income potential as we are mainly a private billing practice. We would also encourage doctors to develop their own special interests Our patient base is varied as well as a strong family base practice including women’s & mens health, skin cancer medicine, iron infusions, aviation medicine and more. Our nurses are committed to support for care plans & health assessments.

We are a 7 day a week (Mon to Thur 8am to 7pm, Fri 8am to 6pm, weekends 8.30 to 12.30pm) we have a variety of sessions available and the opportunity to share a Saturday roster with your fellow GP colleagues, with nursing support.

We would require: Current unrestricted registration with AHPRA as a general practitioner Current medical indemnity insurance Full Australian working rights and No DPA restrictions For confidential discussion please phone Dr Rod Parker 0447 117 013 or Dr William Thong 0403 171 061 or by emailing admin@hillarysmc.com

General Practitioner Join our friendly Health Services team to provide quality care and make a difference in Curtin Community’s health and well-being at our Bentley campus.

Part-time and full-time contractor/temp opportunities available Excellent working conditions and room facilities Administrative and Nursing support provided JOB REFERENCE Are you a caring and experienced General Practitioner? Join our friendly and collaborative team of general practitioners, nurses, medical receptionists, and a Practice Manager to make a difference to our Curtin Community’s health and well-being within our busy Medical Centre at our Bentley campus.

Our Medical Centre is a well-established and fully equipped practice with a total of 7 consulting rooms, a procedure room, treatment, and onsite pathology. The Centre is open Monday to Friday between 8:30 am and 4:30 pm. It is well-served by public transport and has ample parking.

We offer mixed billing (70% bulkbill) with flexible consulting hours. Our GPs are fully supported by a practice manager, registered nurses, administration staff and a mental health nurse practitioner. Our Medical Centre has high volumes of patient demands and full-appointment books during semesters. This is a large and diverse patient base offering lots of interesting work, plus walk-ins, opportunities for Healthcare Plans Health Assessments, and procedures.

Make tomorrow better

91

BENEFITS 70% of the billing/mixed billing Work full-time or part-time with flexible hours. You choose!

Excellent working conditions and room facilities Walk into a full & immediate patient base, OR create your own, with walk-in presentations Best Practice software in use throughout the practice REQUIREMENTS MBBS or equivalent Current AHPRA registration as a General Practitioner Vocationally Registered (VR) No restrictions To learn more about this opportunity, please contact Nandita Nadkar, Team Leader on 08 9266 7345.

For more information about our university, please visit www.curtin.edu.au Applications close: 15 December 2023

curtin.edu.au

NEXT DEADLINE: For Classifieds, contact Andrew Bowyer – Tel 9203 5222 or classifieds@mforum.com.au

92

medical forum CLASSIFIEDS Positions - Stress Test Supervising Physician Perth and suburbs

Northbridge Medical Centre is looking for a VR General Practitioner to join our well-established private billing medical practice located between Perth CBD and Mt Lawley Owned and operated by doctors High patient load Taking over existing patient base from relocating GPs Full Time or Part Time Position available now 65% billings with minimum of $150/ hour for the first 6 months Joining a team of 6 Doctors with supportive Nursing, Management and Marketing team AGPAL accredited, well equipped and fully computerized with Best Practice software Doctor’s parking available Requirement: MBBS or equivalent, Vocational Registration / Fellowship, current AHPRA registration

Are you seeking a workplace focused on best practice and excellence in clinical care?

At Perth Cardiovascular Institute we believe in providing more than just a diagnostic imaging service. Our team are committed to delivering an excellent patient experience along with clinically robust findings in a timely manner.

Senior staff perform as leaders and assist with training, mentoring and development of less experienced team members. Much of our time is dedicated to ensure our trainees develop superior skillsets to tackle even the most difficult of cases. We foster an environment that promotes asking questions, seeking feedback and sharing of knowledge.

We have world class, internationally renowned cardiologists within our group that support and develop individuals. Our cardiologists are approachable to discuss patient findings and encourage and enable team members to manage patients. In completing our daily duties we go above and beyond expectation with clients repeatedly providing outstanding feedback from their contact with us.

If you wish to know more about the role, feel aligned to the way we do things and are excited by the unique opportunity Perth Cardio offers then we would be thrilled to hear from you.

Please contact Adam Lunghi on Phone (08) 6314 6881 or info@perthcardio.com.au If you are looking to practice quality medicine in a supportive environment, please contact Dr Alex Koh on 0408 037 290 for a confidential conversation or email at Alex@northbridgemedical.com.au

District Medical Officer Christmas Island – Serving the local community Full time Ongoing Vacancy | Package is $400K+ and negotiable The Indian Ocean Territories Administration (IOTA) is currently seeking a motivated and suitably qualified professional to join our enthusiastic and multidisciplinary team as a District Medical Officer (DMO) within the Indian Ocean Territories Health Service (IOTHS) based on Christmas Island.

The IOTHS delivers a primary and acute health care service in two of Australia’s most remote and most spectacular settings Christmas Island (CI) and the Cocos (Keeling) Islands (CKI). The IOTHS includes a 24 hour eight bed hospital and primary care facility on CI and clinics on Home and West Islands in the CKI. The IOTHS is committed to “Working with our communities to keep us healthy for the whole of our lives”.

The DMO works in a team and is primarily responsible for delivering comprehensive medical services to the community of Christmas Island using a culturally appropriate approach. The DMO provides general practice services and inpatient care as required, after hours’ emergency medical care and preventative health care.

Our ideal candidate will have demonstrable and substantial experience working effectively in general practice in a rural and remote cross cultural environment, recent experience working in an Emergency Department and the ability to work independently, make sound medical judgements and manage the emergency environment. In addition, the successful candidate will be

committed to working collaboratively to deliver quality health outcomes and have excellent communication skills including experience in preparing reports.

The successful candidate must hold a current ALS2/REST certification or equivalent, will be registered, or be eligible for full registration, as a Medical Practitioner with the Australian Health Practitioner Regulation Agency (APHRA) and hold a post graduate qualification.

Further the successful candidate will hold a current driver’s license transferable to the Indian Ocean Territories, a valid Western Australian Working with Children Check and provide proof of vaccination or immunization as required by the IOTHS. For an application pack outlining how you can apply, please contact the IOTA Human Resources Team at IOTHRTeam@infrastructure.gov.au and quote position number 109318.

Applications close 4.00PM (Christmas Island local time) (CXT) (UTC+7), 9 November 2023

NEXT DEADLINE: For Classifieds, contact Andrew Bowyer – Tel 9203 5222 or classifieds@mforum.com.au

An amazing lifestyle opportunity for GPs Our beachside practice in Albany is looking for new GPs

FRACGP preferred, flexible arrangements Relocation assistance offered Large and diverse patient base, mixed billing

Your own spacious room Fully computerised and Doctor owned No on call or after hours

For a confidential discussion about your next career move, call Jean at 0400 605 529 or email jean.paradise@breckenhealth.com.au