Medical Forum – January 2025 – Public Edition

Feeling the burn Summer edition | OA and exercise, menopause, resistance training

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EDITORIAL BACK TO CONTENTS

Cathy O’Leary | Editor

The sun sets for me While West Australians love the great outdoors, especially over the balmy summer months, the message from skin cancer experts is that we urgently need to re-invigorate the slip, slop, slap message.

As you read this you might be eyeing off the last of the Christmas ham to decide if it’s past the use-by, or you're already in the thick of intermittent fasting to shed the festive bulge.

Good luck either way!

January is also when many people head to the beach, armed with their chair, umbrella – or these days the ubiquitous beach cabana – and hopefully plenty of SPF50+ sunscreen.

I’m careful about sun protection but a recent screening of a new documentary about skin cancer – which we feature in our cover story this month – sent off alarm bells that made me want to slather on the sunscreen before I stepped out of the cinema.

While West Australians love the great outdoors, especially over the balmy summer months, the message from skin cancer experts is that we urgently need to re-invigorate the slip, slop, slap message.

Now some news from me – this will be my last sign-off as managing editor. After four wonderful years at Medical Forum doing the job I love best – health journalism – I am stepping down to pursue other interests and travel.

I am not leaving altogether, and will continue to contribute as a feature writer, but from this month Andrea Downey takes the reins as editor.

Andrea hails from a health journalism background, having most recently worked on a nurses’ magazine in the UK, and has been writing for our weekly e-newsletter for the past few months.

She comes with enthusiasm and new ideas and will strive to keep our readers informed and entertained as always.

So, 2025 really is a year of new beginnings!

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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.

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MEDICAL FORUM | SUMMER EDITION

JANUARY 2025 | 1

CONTENTS | JANUARY 2025 – SUMMER EDITION

Inside this issue 12 34

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FEATURES

IN THE NEWS

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Editorial: The sun sets for me – Cathy O’Leary

4 6 19 25

News & views

Slip, slop, slap for a $2 billion problem Bullying and other bad behaviour Life is a walk in the park Summer is entertainment

LIFESTYLE 39 Wine review: Fermoy Estate

In brief Metastatic breast cancer Babies beware – Dr Joe Kosterich

– Dr Craig Drummond MW

40 Navigating PTSD for kids 42 Take a hike for health

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Our bumper crop of competitions has seen winners heading off to the movies or enjoying locally made nougat in the past few weeks.

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WINNERS

And the lucky winner of our November doctors doctor prize from Marq Wines is Dr Helena Goodchild (pictured).

This month we have another fine selection of wine, this time from Fermoy Estate. Read the review by our Master of Wine Dr Craig Drummond on page 39 and then enter the competition by using the QR code or go to www.mforum.com.au and hit the competitions tab.

And for stunning entertainment under the stars, enter our competition to win tickets to WA Ballet’s 2025 season package. See page 37 for details.

CONNECT WITH US /medicalforumwa

/medical-forum-wa-magazine

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info@mforum.com.au

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

Clinicals

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

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Non-operative management of hip and knee OA – an update Dr Arash Taheri

Effects of Menopause on women’s health, wellbeing and productivity Dr Purity Carr & Christabel Samy

Clinical Editor Dr Joe Kosterich 0417 998 697 joe@mforum.com.au Graphic Design Ryan Minchin ryan@mforum.com.au ADVERTISING Advertising & Classifieds Manager Bryan Pettit 0439 866 336 bryan@mforum.com.au Clinical Services Directory Alice Miles 08 9203 5222 alice@mforum.com.au

Resistance exercise is medicine James L. Nuzzo

Patient is Person Dr Talia Steed

Guest columns

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 OUR PRINTER’S ACCREDITATIONS

Environment ISO 14001

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New strategies for melanoma Dr Helena Collgros & A/Prof Tony Caccetta

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.

21

Going wild a health hazard Professor Nathan Bartlett

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Vaping efforts needed beyond the school gates Dr Jonine Jancey & Dr Renee Carey

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JANUARY 2025 | 3

Funding boost for medical research The Hospital Research Foundation Group has welcomed a new partnership with the State Government which will provide $3.5 million for medical research in WA. Minister for Medical Research Stephen Dawson announced the agreement at THRF Group’s annual awards dinner in November, which will see the Government’s Future Health Research and Innovation Fund match the research group’s $1.75 million investment.

The $3.5 million in co-funding will support up to five three-year fellowships in preventative health across WA, with a focus on regional and remote areas, Aboriginal populations, culturally diverse communities, men and boys and those facing socioeconomic disadvantage.

The funding will include a range of project and seed grants, which will further research into treatment for cancer and neurodegenerative and cardiovascular diseases.

On the awards night, nine research projects were given funding by THRF Group to improve health outcomes for melanoma, bladder cancer, mental illness and bowel cancer.

Election wish list WA public health experts want the next State Government to increase spending on prevention to stem the tide of chronic disease and broader health problems.

The Public Health Association of Australia’s WA branch election platform calls on political parties to act on alcohol-fuelled family violence, climate change and youth detention, and to maintain restrictions on poker machines.

PHAA WA president Ainslie Sartori said that with the number of West Australians living with chronic disease increasing, and the health system straining under pressure, investment in prevention was crucial.

“We want to see at least 5% of the health budget allocated to prevention by 2029, and it’s disappointing that there is no clear reporting on progress on promises relating to spending more on prevention made at the last State election,” she said.

“We are hopeful that this can be turned around, with regular reporting of progress and increased 4 | JANUARY 2025

Hon Stephen Dawson MLC, THRF WA GM Dana Wallace-Campbell and THRF CEO Paul Flynn

Researchers from Edith Cowan University, UWA and Murdoch University were among the award recipients.

THRF general manager in WA Dana Wallace-Campbell said this year’s awards marked an expansion from the group’s traditional south metropolitan focus to a Statewide focus.

One of the projects to receive funding will look at high mortality rates from bowel cancer in the Aboriginal community to see whether it was related to a different type of cancer, access to screening or the efficacy of treatments.

Another project will look at the use of wearable technology to detect and prevent suicidal ideation in at-risk populations, with the goal of improving mental health care in schools and hospitals.

investment in prevention to ensure our WA health system is sustainable and cost effective.”

The election wish list calls for the next Government to: • increase investment in prevention and health promotion for a sustainable health system • address alcohol’s contribution to gender-based violence • protect children from the influence of harmful industries • raise the age of criminal responsibility to 14 • maintain electronic gaming machine restrictions • act boldly on climate change by setting a net zero emissions by 2035 target.

The three major parties have been asked to respond to the wish list, with the PHAA planning to publish a scorecard closer to election day, currently slated for March 8.

Cancer fellowships The Health Department has awarded two WA Cancer Fellowships totalling more than $488,000 to support the research and training

of medical practitioners in cancer care. Recipients were selected from a competitive field of applicants and are set to start their fellowships in the WA health system this year.

Both recipients have been awarded a fellowship through the research stream, which aims to develop research capability and facilitate high quality research.

• Dr Thomas Buss will be undertaking the ‘Empowering CAR T-Cell therapy patient care through innovative remote patient monitoring: A pilot trial in Western Australia’s research project at Fiona Stanley Hospital’. Dr Buss will be supervised by Dr Allison Barraclough and Dr Duncan Purtill.

• Dr Trisha Khoo will be working on ‘The HAPPEN Project – Holistic Antibody-Drug Conjugate’ research project at FSH. Dr Khoo will be supervised by Assoc Prof Andrew Redfern, Dr Katie Meehan and Dr Zayed Al-Ogaili.

continued on Page 6 MEDICAL FORUM | SUMMER EDITION

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NEWS & VIEWS

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NEWS & VIEWS

Virus target for MS MS Australia is bringing together the nation's top researchers to unlock the complex link between EpsteinBarr virus and multiple sclerosis in the hope of changing how MS is treated.

The EBV in MS National Collaborative Platform, launched at MS Australia's recent Frontiers in MS Research Symposium at the University of Sydney, aims to strengthen Australian research efforts into EBV and MS. EBV is one of the most widespread viruses globally, with around 90% of adults infected. The common virus can cause glandular fever, but many people experience mild or no symptoms and may never realise they carry it.

However, EBV infection increases the risk of developing MS, with virtually all people diagnosed with MS having a history of EBV, so investigating this link has become one of the most promising areas of MS research.

MS Australia's Head of Research, Dr Julia Morahan, says landmark discoveries in 2022 provided compelling evidence that EBV is necessary for the development of MS. “The immune response to EBV might set the stage for immune attack on continued on Page 7

On your bike

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continued from Page 4

Some of WA’s cycling doctors are expected to take part in the 2025 Hawaiian Ride for Youth in support of youth mental health, which takes place on March 25-29.

In its 23rd year, the annual ride supports the work of Youth Focus and is expected to bring together more than 150 riders and 40 support crew on the 700km ride from Albany to Perth over five days.

Participants include cardiologists, GPs and nurses, as well as staff from the WA Primary Health Alliance.

This year will also feature a strong multi-generational theme, with 16 family pairings, including some parents passing the baton to their children from bike to bike. The ages of the riders will range from 18 to 84.

The event raises awareness and funds for an issue impacting almost half of young Australians, with 40% of young people aged 16-24 having experienced a mental health challenge in the previous 12 months.

Across three distinct peloton routes—Coastal, Inland and Wheatbelt—the riders will stop in regional towns including Collie, Walpole, Busselton, and Katanning.

Along the way, the riders will visit 15 schools to share their personal stories and have conversations about mental health, to help students connect with Youth Focus and clinicians.

The Hawaiian Ride for Youth plays an important role in starting these conversations with students, given more than three-quarters of mental health challenges occur before the age of 25. Mental health experts believe getting the right support early can benefit a young person’s health, social connections, education and future career.

IN BRIEF Anaesthetist and former AMA WA president Dr Andrew Miller is now on the AMA Federal Council.

Hepatologist and gastroenterologist Professor John Olynyk has become a patron of Haemochromatosis Australia.

WA chair of the Royal Australian College of General Practitioners Dr Ramya Raman is now national vice-president of the college.

6 | JANUARY 2025

Infectious diseases physician Dr Duncan McLellan was St John of God Murdoch Hospital’s Doctor of the Year for 2024.

Chemo@home has been named a winner in the recent AIM WA Pinnacle customer service awards.

Among four members recently re-elected to MDA National’s Mutual Board is WA’s Dr Michael Gannon.

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NEWS & VIEWS

‘False claims’ on surgery

continued from Page 6 the brain and spinal cord in MS,” Dr Morahan said.

A key component of the platform is the national EBV in MS Working Group, with a team of more than 30 clinical and academic researchers working on MS Australiafunded projects, government initiatives, and other EBVfocused research projects.

STI self-test The TGA has approved an Australian-first rapid self-test kit for chlamydia and gonorrhoea in women.

The test developed by Touch Biotechnology is aimed at earlier detection to protect women from the risks of undiagnosed STIs. It is highly accurate, with one swab sample producing a positive or negative result for both infections in 15 minutes, whereas results from individual lab or PCR tests typically take one to three days.

STIs affect almost one in six Australians in their lifetime and over the last 10 years numbers have markedly risen, with rates of chlamydia and gonorrhoea increasing by 26% and 157% respectively.

Chlamydia is the most reported communicable disease in Australia, with over 110,000 reported cases in 2023, but often appears asymptomatic, and as a result some cases are undiagnosed, with people reluctant to test for the infection due to perceived stigma or lack of awareness.

Gonorrhoea presents itself with pain or discomfort in the throat, eyes, cervix and other areas but is often mistaken for other infections.

The Urological Society of Australia and New Zealand is reassuring patients undergoing open surgeries about claims they fare worse than those undergoing robotic surgery.

It argues patients undergoing open surgery for prostate cancer will still obtain excellent outcomes, and decisions should be based on the expertise of the surgeon rather than the platform used.

USANZ president Professor Helen O’Connell said she was shocked by some recent claims that traditional surgeries led to more severe and lasting side effects, which was scaremongering and causing unnecessary anguish for patients.

She said state governments faced significant cost pressure, and the funding of robotic platforms was just one of the priority areas for hospitals that also had to care for the general community who did not need access to the advanced technology.

Data comparing robotic versus open prostatectomy over the past two decades had generally favoured the robotic approach.

“While there may be minor improvements in length of stay and transfusion rates, men who undergo open prostatic surgeries in experienced hands may be assured they are not likely to suffer worse cancer or major side effects than men who undergo a robotic-assisted radical prostatectomy,” Prof O’Connell said.

Brain stimulation for MS

Outcome measures included balance, mobility, fatigue, quality of life, and pre- and post-falls questionnaires.

All participants showed significant improvement in their balance and mobility after six weeks and at six months, while the addition of tDCS prior to exercise had an additional benefit, particularly after six months.

WA research shows the benefits of combining non-invasive brain stimulation with exercise for people with multiple sclerosis.

Impaired balance and gait are common in MS, leading to worsened mobility, restrictions in daily activities and increased risk of falls.

The benefits of exercise programs in improving gait and balance are already well known.

The new study shows that noninvasive brain stimulation techniques related to neuronal plasticity processes enhance the effect of physiotherapy for balance and mobility impairment in people with MS. Clinical Professor Soumya Ghosh, head of Restorative Neurology Research at the Perron Institute and Consultant Neurologist at Perron and Sir Charles Gairdner MEDICAL FORUM | SUMMER EDITION

Clinical Prof Soumya Ghosh, left, Claire Tucak and Jennifer Eisenhauer in the Perron Institute clinic.

Hospital, said the aim was to see if combining transcranial direct current stimulation (tDCS) with conventional exercise therapy helped balance and mobility compared to exercise alone.

Participants received individualised exercise treatment and 12 sessions of real or sham tDCS for 20 minutes, followed by one hour of physiotherapy twice a week for six weeks.

“Our results suggest that the addition of tDCS before exercise provides a significant improvement in walking speed and balance in people with MS which lasts longer, compared to exercise alone,” Professor Ghosh said.

“Further study is needed to optimise the use of this relatively inexpensive and well tolerated device for rehabilitation.”

The study was supported by a MS Research Australia incubator grant, MSWA funding and the Perron Institute.

JANUARY 2025 | 7

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COVER STORY

Slip, slop, slap to soothe a $2 billion problem West Australians love the great outdoors, but a new campaign backed by a confronting documentary film has a clear warning for sun-lovers and doctors.

By Cathy O’Leary

8 | JANUARY 2025

MEDICAL FORUM | SUMMER EDITION

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COVER STORY Australia might be credited for inventing the cardiac pacemaker and the cochlear implant, but its reputation for being a trailblazer is also extending to a darker side of health care.

The country is becoming worldfamous for the downside of excessive UV exposure – with one of the highest rates of skin cancer, causing more deaths than the number of road fatalities.

While the human toll is enormous, so are the economic costs, estimated to be close to $2 billion a year nationally, including $200 million in WA where almost 1500 people were diagnosed with melanoma in 2020.

The price of spending time out in the sun has been laid bare in Conquering Skin Cancer, a feature-length documentary screening in cinemas over summer, with a simple mission to prevent skin cancer and find it early.

Skin cancer is the most common cancer in Australia, and over the past decade the incidence has increased by 50%, with one million skin cancers recorded annually.

Today, two in every three Australians will get a skin cancer in their lifetime and the World Health Organization predicts a staggering 68% increase in melanoma deaths by 2040.

And while ageing is strongly linked to the incidence of melanoma, children and teenagers can also get the skin cancer, with even a five-year-old WA child being diagnosed with melanoma.

While the main aim of the new film is to shift public complacency and the myth of the healthy tan, it has also sparked calls to have better training for GPs and more dermatologists to cope with the tsunami of skin cancers coming their way, particularly as a lifetime of sun exposure catches up with baby boomers.

The film has the support of peak bodies including the Cancer Council and the Australasian College of Dermatologists.

According to Cancer Council WA SunSmart manager Sally Blane, the belief that skin cancer messages such as ‘slip, slop, slap’ have done their job is wishful thinking.

Reframing sun worship “We must reframe our relationship with the sun because there is a misconception that (skin cancer MEDICAL FORUM | SUMMER EDITION

prevention) is done – that there’s been a 40-year investment so it’s OK and we can take the foot off the accelerator – when we know that is not the case,” she said.

“It’s incredible how many conversations we have with our leaders in WA and nationally where they say ‘aren’t we finished with this’, and we have to say ‘no, this is still an issue.’

“Everyone thinks they’re invincible and it’s not going to happen to them, or if you’re an older person and you’ve had a lot of sun in your life you might think you can’t change your outcome. But even if you’ve had significant sun exposure you can still change its trajectory.

“The one thing that all the experts in the documentary agreed on was that we, as a nation, can’t treat our way out of skin cancer because, while treatments are increasing incredibly, with amazing advances meaning melanoma is so much more curable, it’s also very expensive.

And those treatments are becoming more available for earlier stages, particularly for melanoma.”

Ms Blane told Medical Forum that up to 95% of skin cancers were preventable, and that meant more needed to be done to stop that impact on the health system, as well as the massive personal costs.

“A lot of people think BCCs (basal cell carcinomas) are pretty minor, and you just go to the doctors and get them cut out, but they’re still incredibly inconvenient and disfiguring, so I think we need to get away from that mentality,” she said.

“I also find it odd that we have this incredible amount of knowledge about skin cancer – it’s everywhere and everyone has had one or knows someone who has – yet we’re still, as a community, pretty complacent in terms of providing protection like shade.

“When it comes to the Aussie tan culture, things have improved, and we have moved on from the days from where people used to lie out in the sun.

“But our research is also showing that while young people put a lot of sunscreen on their face, because they’re concerned about ageing and the way they look, the rest of their body is fair game.”

Perth dermatologist and fellow of the Australasian College of Dermatologists, Dr Kate Borland, who spoke on a panel at a recent screening of the film, said one of the most common misconceptions was that skin cancer was symptomatic.

“In fact, the opposite is true, and you often don’t know they’re there. It’s really only squamous cell carcinoma that announces itself, and it grows rapidly and is painful,” she said.

“Basal cell carcinomas and melanomas are often asymptomatic, so you don’t notice them. That’s where skin surveillance comes into its own because you need someone looking at your skin to find these things.”

Dr Borland said another misconception was people thinking that because they had some SPF in their makeup, they did not need to wear sunscreen. continued on Page 10

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COVER STORY

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Slip, slop, slap continued from Page 9 “Often make-up and BB creams have SPF 15+ which is okay if you’re dark-skinned but for fair-skinned types absolutely not, and we also often forget to reapply sunscreen,” she said. “And while there is SPF30+, if you’re going to be outside in peak (UV) times why not go for SPF50+.”

Kids & melanoma Like all skin cancers, melanoma incidence rates are linked to ageing, as many years spent out in the sun take their toll.

The most dangerous of skin cancers, melanoma, affects melanocytes – the cells in the outer layer of the skin which form melanin, the pigment that gives skin its colour. Melanoma is particularly dangerous because it can quickly spread from the skin to other parts of the body.

More than 18,000 cases of melanoma of the skin were diagnosed in Australia in 2023, and the average age at diagnosis was 64 years in males and 60 in females.

However, while skin cancers are less common in young people, Dr Borland warned that even melanomas could occur in children and teenagers.

“There is a myth that it only happens in later life, but in our practice, we’ve had a five-year-old with melanoma,

Mark Lane, left, at Surfing WA

and only last week I found a melanoma on a 16-year-old,” she said.

“I’m seeing more and more patients in their 20s and 30s with basal cell and squamous cell cancers so the feeling that it can’t happen to me because I’m young is a big misconception.”

Conquering Skin Cancer, produced

by Mike Hill and Sue Collins, features some well-known survivors including Hugh Jackman, swimmer Cate Campbell and surfer Rabbit Bartholomew.

It also includes Perth skin cancer prevention advocate Dr Chandrika Gibson and Mark Lane, chief executive of Surfing WA, who share their battles with skin cancer and the lessons they have learnt about sun protection.

Mr Lane’s love for surfing began as a boy at Scarborough Beach but hours of sun exposure in the water added up, and he was diagnosed with stage 3 skin cancer in 2018, after finding a lump in the side of his neck.

That lump has so far triggered six years of treatment involving surgery, chemotherapy and radiotherapy.

"It's been brutal, and at one stage I thought they might as well start digging me a hole,” he said of his experience.

Early detection Dr Borland said some workplaces now offered free access to skin checks and mobile vans operated intermittently, but they only captured a small part of the population.

Chandrika’s story Perth yoga therapist Chandrika Gibson has needed surgery year in and year out since the first major skin cancer was treated when she was 26.

“That did shock me, because it was a tiny little spot on my face and the surgical incision was massive,” she explains in the film.

“I did have what I would now term ‘mirror trauma’ – which is quite a common experience – of being really shocked when I looked in the mirror after that surgery.”

Dr Gibson, who did a PhD into the psychosocial needs of people diagnosed with head and neck cancer, has worked with Cancer Council WA, Solaris Cancer Care, and Breast Cancer Care WA. In 2021, she allowed an advertising agency to model a

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COVER STORY “Skin cancer is now very common, two of three people will get skin cancers, but the screening is too ad hoc,” she said. “It comes down to Government policy giving free access, but it’s difficult because it’s not a simple test like for bowel cancer screening you can do at home – you need to go to them.”

She said that when it came to the question of whether people should see their GP, a skin cancer clinic, or dermatologist, she said they all did a good job.

“Any of those will be fine for your first port of call, and probably the easiest to access is your general practitioner but of course GPs vary in their skill level and comfort level in diagnosing and treating skin cancers, although they can refer on to someone like me,” she said.

“But sadly, there aren’t enough dermatologists, and that comes down to Federal funding of trainee positions, and that’s another avenue where progress could be made, and there’s been a lot of lobbying on that.”

Ms Blane said that while prevention was always better than cure, the film strongly promoted the value of early detection and regular skin checks in people at risk.

The Federal Government had announced about $10 million towards a national melanoma screening program, which would be targeted rather than for the general population.

“It’s still very early days, and certainly it’s all about knowing your risk, because not everyone needs to get their skin checked,” she said.

that in his experience “your GP does a pretty good job” but he did not begrudge spending money to see a specialist.

“But we acknowledge that a massive barrier for many people is finding someone to check their skin and it can be difficult particularly in regional WA, and this is something Cancer Council advocates for consistently.

“If you go to a skin specialist it will cost about $100 after your rebate, and then obviously you can go further up the chain to get even more specialist care,” he said.

“When you’re looking for someone, it’s often a GP, and you’re looking for someone who is using a dermatoscope (imaging device), and someone who is trained in that – regardless of their title.

“We know there’s not a massive amount of difference in terms of finding a skin cancer, whether it’s through a GP or a specialist. But we’d like to see better training and support for GPs, and making sure GPs are trained in dermoscopy is really important.

“And regionally, you often don’t have a choice in who you see, and it’s not standardised, and it would be great to have more support in that training for GPs, with a more comprehensive strategy.”

Recent data from online healthcare directory Cleanbill revealed that the average initial consult for WA dermatologists was about $257 and a follow-up consult cost $171, with Medicare giving a rebate of $84 for an initial consult and $42 for subsequent appointments.

“But if you think about it, it’s a couple of hundred dollars a year to at least know where you stand, so it’s a pretty good investment in your health.”

Ms Blane said the timing of the film’s release was opportune for WA, just ahead of the State election.

“We’ll be asking for a more comprehensive strategy to skin cancer – our ‘national cancer’ – which will include better training for health professionals on early detection, and more support for prevention such as minimum shade regulations in public spaces,” she said.

ED: For screening dates and information go to www.conqueringcancercampaign. com/conquering-skin-cancer. The film can also be rented through https://vimeo.com/ondemand/ conqueringcancer

More information on skin cancer is at www.cancerwa.asn.au

Mr Lane told the film screening event

prosthetic version of her major facial surgical wounds from skin cancer treatment, as part of a SunSmart campaign to educate people about the importance of sun protection when UV is 3 or above.

She grew up on a farm in Capel and said she was careful with day-to-day sun protection such as wearing hats and not working outside in the middle of the day. But she believes she got a lot of skin damage from covering herself in baby oil before swimming lessons at the beach to ward off jellyfish, attending agriculture shows, and sun exposure at school, especially on sports days.

30 separate basal cell carcinomas on my face, shoulders and back removed,” she said.

“Then when I was 30 years old, my partner spotted an unusual looking mole on my back that had changed, which turned out to be melanoma.

“In 2018, I had a ‘nest’ of BCCs on my right cheek, the scars of which are shown in the documentary, and in addition, I have since had surgery to remove lesions from the tip of my nose and right eyebrow.”

Dr Gibson said she hoped the documentary – and her confronting images – would motivate people to use multiple sun protection measures when they are outside and the UV level is 3 or more.

“From that first lesion when I was 19, I have had about

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Bullying and other bad behaviour

WA doctors have recently raised concerns about bad behaviour in medicine – particularly bullying and misconduct in academia.

By Cathy O’Leary

12 | JANUARY 2025

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FEATURE

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FEATURE Everyone has heard stories about bullying in medicine – from junior doctors being belittled by senior consultants to professors insisting on being lead author on research they had no hand in.

Last month, the results from the 2024 Medical Training Survey commissioned by Ahpra also found that more than 1000 doctors in training – or one in 20 – reported experiencing or witnessing sexual harassment.

One third of trainees said they had experienced or witnessed bullying, discrimination, harassment, sexual harassment or racism, spiking to 54% of Aboriginal and Torres Strait Islander trainees and 44% of interns.

While sometimes the source of bullying or harassment is external to the medical profession, other times the perpetrators are from within.

A paper in The Lancet Regional Health Western Pacific last year reported that the annual rate of bullying, discrimination and harassment experienced by Australian junior doctors within healthcare teams had remained fixed at 21-22% for 2019-2023, which more than doubles the average across all industries.

One third of trainees said they had experienced or witnessed bullying, discrimination, harassment, sexual harassment or racism, spiking to 54% of Aboriginal and Torres Strait Islander trainees and 44% of interns.

The researchers wrote that they had been invited to contribute a review article to a special issue of another journal with two guest editors, one from the same institution as the journal’s editor-inchief.

After submitting their manuscript, they received an unexpected request by the senior guest editor of the special issue to add an additional author from their institution as first author. The additional author was unknown to them and had not contributed in any way to the manuscript.

Many attempts over six months to clarify the request with both special issue guest editors, the administrative editor and the proposed additional author remained unanswered.

The paper blamed fragmented regulation, weak correction processes, conflicts of interest and a fear of retribution, and called for a new framework for Australian specialty colleges and healthcare leaders.

The researchers’ working ethos was that a person qualified as an author if they had contributed and fulfilled the standard authorship criteria based on the International Committee of Medical Journal Editors.

While there have been moves to stamp out bad practices, two recent publications authored by WA doctors suggest problems are still rife in medical academia.

But an extensive online search of the proposed additional author revealed neither a significant academic presence nor any apparent connection to the manuscript subject. While the senior guest editor of the special issue had a wider reputation, this was not the case for the other guest editor or the proposed additional author.

Several doctors, including a paediatric anaesthetist and WA finalist in the recent Australian of the Year awards, have called out what they say is the darker side of academia and editorial misconduct.

Speaking up Writing in the British Journal of Anaesthesia, Professor Britta Reglivon Ungern-Sternberg and three colleagues cited their own experience in a bid to raise awareness and encourage others to speak up.

MEDICAL FORUM | SUMMER EDITION

“More troubling, however, were the responses from colleagues we consulted about this request by the senior guest editor to add an additional author to our manuscript,” Prof Reglivon Ungern-Sternberg and her colleagues wrote in the BJA.

“While many shared their own somewhat concerning experience with the senior guest editor, none was willing to share anything in writing. The majority of colleagues, mostly senior and male academics, suggested caving in and not speaking up.”

Fear of reprisal Comments included: ‘Be careful, don’t ruin your career;’ ‘As a female, don’t speak up against the boys’ club, it will end badly for you’; ‘You might never get invited again to meetings on the continent of this person’; ‘You may find it difficult to get international funding; they can block you’; ‘Just withdraw the manuscript but don’t give any reason’; ‘Just accept it; while it is wrong, in the long run, it will help you move forward because this person is very influential.’

When challenged, the journal’s editor-in-chief confirmed that authorship should reflect a substantial contribution to the manuscript.

“However, to our surprise, the editor-in-chief suggested during both phone and extensive faceto-face conversations with two of the senior authors that the suggested additional authorship might merely be an ‘error’, despite no communication received from the senior guest editor on this matter when the authors sought clarification with the editor-inchief,” the researchers wrote.

“We had a discussion with the editor-in-chief about withdrawing our article unless the senior guest editor stood down…however, the editor-in chief cautioned us about potential legal repercussions, particularly for the senior guest editor but also for the editor-in-

continued on Page 15 JANUARY 2025 | 13

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FEATURE

Bullying and other bad behaviour continued from Page 13 chief himself and the journal, if the senior guest editor was removed.

“There were even several appeals to our kindness, and requests for us to consider the wellbeing and the potential repercussions (legally and career-wise) for the editor-in-chief’s well-respected colleague.”

The researchers withdrew their manuscript and later learnt that other authors had raised ethical concerns and withdrawn too. The editor-in-chief then confirmed that the senior guest editor would be removed from the special issue.

“Based on our experience, we see several learning points for authors, editors, editorial boards, and journals,” the researchers wrote.

“The editor-in-chief stated that anyone can make an error.

However, we do not believe the initial suggestion to add an additional author to a manuscript on which they had no input can be classified as a ‘simple error’.

On the contrary, this argument can be seen as an attempt to pressure us into pretending the attempted authorship abuse had never occurred and to protect their colleagues despite the lapse in ethical integrity.

“The reaction of our academic peers is concerning, demonstrating, on one hand, an acceptance of ‘normal misconduct’ and, on another, a dominant, overpowering theme of helplessness and fear that little or nothing can be done when power is abused.

“We felt an overwhelming sense of being trapped in a corrupt system that empowers these back-room associations.”

The researchers called for mandatory training on ethics, author and editorial conduct, as well as on whistle-blower safety, for all editorial roles and administrative staff.

Bullying is common Dr Tom Brett, a Mosman Park GP and director of the General Practice and Primary Health Care MEDICAL FORUM | SUMMER EDITION

Research Unit at the University of Notre Dame’s School of Medicine in Fremantle, also recently penned a paper on the issue, published in the MJA’s Insight magazine, detailing concerns about researchers with a history of bullying and harassment.

He argued it was time to enforce policies that protected against bad behaviour and weeded out the outliers, and said institutions needed to abide by their own policies when supporting victims of bullying and abusive behaviour in medical academia.

He said the bullying experienced by medical students as part of their clinical clerkships was welldocumented.

“What appears clear from the emerging literature is that bullying is very common, with up to 40% of French and American medical students reporting their experiences with bullying. In New Zealand, the evidence is even greater, with 54% reporting exposure to bullying in the clinical setting and, disturbingly, 74% reporting they had witnessed another medical student being bullied,” Dr Brett wrote.

“Is there a failure of the institution (medical school, university, research institute) to recognise psychopathic tendencies and bad behaviour in some of their staff members or do some covertly tolerate it?

“How many research leaders, medical and non-medical deans have had blatant examples of bullying and staff abuse reported to them and yet they have done nothing about it or, worse still, allowed the processes of the institution to cover it up?”

Dr Brett said bad behaviours were not just in research settings but also in hospitals and medical communities.

The increasing recognition of bullying and abusive behaviours in academic settings meant that most universities and research institutes had developed their own policies and protocols to

deal with such issues, but they did not always follow them.

HR no help The role of human resources in the management of reported episodes of workplace bullying was also critical.

“Some of the literature, including victim reports on academic bullying, is keen to advise potential accusers that it would be wrong to assume that human resources will be on your side, or will have no conflict of interest in how they investigate a complaint of abuse,” he said.

“One anonymous blogger stated that HR doesn’t exist to protect you, it exists to protect the employer from you.

“What if the research institute leader or dean are themselves latent victims of a bullying subculture and they lack the moral and ethical fortitude to speak up and tell the truth?

“For many, it is all about a power struggle that results in talented young researchers being driven away, those in leadership positions getting ridiculed and blackmailed into doing nothing while the toxic environment engendered by the bullies holds sway – for now.”

Sometimes the bully was tolerated or just moved to another location where the behaviour was likely to re-emerge.

Dr Brett said a recent position statement from the National Health and Medical Research Council was a good starting point in support of research institutions being willing to acknowledge that a problem existed and to support efforts to provide a workplace free of bullying and harassment.

“All research institutions should ensure their grant applications are free of researchers/investigators with a history of bullying and harassment,” he said.

“The defunding of such grants could be a powerful weapon to ensure that the NHMRC policy is strictly adhered to and not covered up.”

JANUARY 2025 | 15

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FEATURE

Life is a walk in the park A Perth GP-turned wellness author says she is not against pharmaceutical medications but it’s time to tap into more of nature’s medicines.

By Cathy O’Leary Perhaps it was her insatiable curiosity from childhood into the ‘what and why’ of how things work – including the human psyche – that led Dr Jenny Brockis to reinvent herself after suffering burnout as a GP. Feeling that something was missing in how she practised as a doctor, English-born Jenny left behind a successful medical practice in Perth more than 20 years ago to embark on a career in the wellness and workplace health.

While she is still registered as a medical practitioner she no longer practises as a GP, instead retraining to become a board-certified lifestyle medicine physician and author, swapping her stethoscope for manuscripts and whiteboards.

Jenny has written five books, the most recent being The Natural Advantage, where she takes her interest in the benefits of nature to the next level, exploring how time outside can recalibrate health and wellbeing.

“When I first left general practice in 2002, my main interest then was brain health, so I was very much into researching new neuroscience as it was then,” she says. “I became certified, so I did the basic training and then the fellowship in lifestyle medicine.

16 | JANUARY 2025

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FEATURE in our bodies when we simply go outdoors,” she says.

“But back when I did the exams around 2017, you only had the option of doing the American certification. Now we have the Australian version, which is so much better because our medical system is not the same as the American system – thank goodness.

“In primary care, and for GPs especially, we’re seeing a strong push towards green or social prescriptions as a means of helping people, particularly with their mental health.

“It’s a holistic approach, mostly in primary care, but it’s very inclusive and not just GPs – it’s all the allied health practitioners and we’re seeking to work more collaboratively for better patient outcomes, with a strong focus on prevention first.”

“There’s a lot of data coming out to support this, and no one is saying it’s going to cure everything, but it can make a significant difference to help people overcome loneliness and recover from anxiety or episodes of depression.

Nature’s medicine

Local training

“It can help to break that negative downward spiral and might mean not having to take some medication. I’m not saying we don’t need medications but there is more we can add in, particularly when recovering from illness.”

Training is done through the Australasian Society of Lifestyle Medicine, one of only seven lifestyle medicine organisations in the world, with the American group being the biggest and going for about 20 years.

Jenny says it took a while for the concept of the benefits of connecting with the natural world to catch on in Australia.

“The other members (of the society) in WA are all in general practice, with some GPs specialising in things like functional, integrative medicine,” she says.

“But it’s not just doctors, anybody who is in allied health can also do lifestyle medicine.

covering mental health, exercise, nutrition and sleep.

COVID lessons The confines of lockdowns during the COVID-19 pandemic confirmed her belief that there is something ‘medicinal’ about being outdoors.

“We follow the same holistic approach, that it’s better to keep somebody well rather than waiting for them to get sick and then fix them.

“Post-pandemic I now want to go back to my roots more deeply, but not back into general practice because that could be a bit tricky after all these years,” she says.

“Every time I go to see my GP, I’m quite glad I’m not in that space anymore. But having said that, I do still miss it, which is strange after all these years.

“I’ve spent my time since leaving general practice working in the corporate space, so I call myself a workplace health and wellbeing consultant, teaching the same stuff but doing it in a group setting rather than with an individual.

“What I really want to be is an advocate for lifestyle medicine, so my passion is writing, and in this latest book I try to highlight something straightforward and simple that could make a big positive difference to people.

“I talk a lot about sleep, burnout prevention, stress management – all the things that get in the way of us living a healthy life.”

“I’ve tried to make it accessible to everyone, because I’m very privileged to live in a beautiful leafy green suburb, but there are so many people who don’t have that, but even having a pot plant on a very small balcony is good.”

Jenny says a growing number of employers are getting the message and are keen for their staff to be healthy, because then they are going to be at work more often and perform better.

While she has been working in lifestyle medicine for the past 20 years, a few years ago she reached the point of wanting to delve deeper into the science and develop evidence-based guides MEDICAL FORUM | SUMMER EDITION

Jenny argues that wherever people live, there are possibilities available to them in some shape or form to get outside a bit more.

“We’ve closeted ourselves in our homes and offices for too long, and it’s not just a feel-good factor – there are definite physiological and psychological changes that happen

Jenny says nature’s medicine is not a new theory, with a study as far back as 1994 showing that hospital patients recovered more quickly and needed less pain medication after gall bladder surgery when they had a window looking out onto green space compared to those looking out on a brick wall.

She applauds local initiatives such as the pedestrian rainbow bridge linking Perth Children’s Hospital to Kings Park and other hospitals making green spaces for patients, visitors and staff. These could help to reduce stress and make people feel a bit better and give them more capacity to deal with whatever they had to face inside the walls.

Jenny says her latest book is part of the gradual educational process she has gone through, from the neuroscience of what causes Alzheimer’s to a more holistic approach of what keeps us well.

“It’s about the fundamentals of what we humans like to do, and how we integrate that into our daily lives which are becoming more complicated. It’s going to the basics of what really matters.”

Not surprisingly, she practises what she preaches daily, taking her two Hungarian vizsla dogs for walks past trees every day.

“It’s good for us too,” she says.

“Time in nature is medicine for everyone.”

ED: For more details go to www.drjennybrockis.com

JANUARY 2025 | 17

New strategies for melanoma A recent Australian melanoma conference put the spotlight on early detection, dermoscopy and artificial intelligence, write dermatologists Dr Helena Collgros and A/Prof Tony Caccetta.

The Australasian Melanoma Conference which took place in Sydney recently brought together specialists in the field of melanoma, including dermatologists, oncologists, surgeons, radiation oncologists, pathologists, skin cancer GPs and researchers.

Speakers outlined a road map toward achieving 'zero deaths from melanoma,' focusing on topics such as prevention, early diagnosis, early melanoma, high-risk patients and advanced melanoma.

For early detection, several risk prediction tools are available that consider well-known classical risk factors such as fair skin type, multiple naevi, and a personal or family history of melanoma.

However, these tools do not differentiate between in situ and invasive melanoma development.

Moreover, the absolute number of thicker tumours is still increasing, so we are still missing patients with no apparent risk factors who will present with thick melanoma.

It is also essential to redirect awareness and early detection messages to individuals with darker skin tones, encouraging them to check acral surfaces such as hands, feet and nails, where melanoma is more common in these skin types.

A significant focus of the conference was on artificial intelligence (AI), or augmented intelligence, for early melanoma diagnosis.

Most AI applications currently target single-lesion diagnosis using dermoscopy images. However, there is greater potential for AI in real-world applications such as enhancing screening through total body photography or as a second opinion tool for patients already under surveillance.

This real-world contextualised approach is currently being realised with newer datasets containing 18 | JANUARY 2025

AMC Digital Imaging and Decision Making for Melanoma Session Speakers (L-R): Dr Bruna Gouveia, Dr Alex Chamberlain, A/Prof Tony Caccetta, Prof Victoria Mar, A/Prof Serigne Lo, Dr Helena Collgros

macroscopic total body image tiles, rarer diagnoses (e.g. amelanotic melanoma, mucosal and nail melanoma) and darker skin types.

AI is also showing early promise in predicting the risk of melanoma metastasis and assisting in adjuvant therapy selection for patients.

The issue of overdiagnosis was discussed including screening practices that lead to detection of a silent disease reservoir – melanomas in situ and thin 'minimally invasive' T1 melanomas that may never metastasise.

Other factors contributing to overdiagnosis are over-biopsy by clinicians and overcalling by pathologists, who may mistakenly classify benign lesions as malignant.

Research indicates poor intra- and inter-observer agreement among pathologists regarding melanocytic lesions, combined with a downward trend in diagnostic thresholds leading to more malignant diagnoses.

Overdiagnosis can result in overtreatment, which may cause harm to patients and increase healthcare costs. The challenge remains to determine which early

melanomas will progress to lifethreatening tumours, as the tools for this differentiation are still lacking.

Future research hopes to address this concern.

After the diagnosis of early melanoma, several risk progression prediction tools are available to help predict which melanomas will advance.

Some of these tools include panels of gene expression profiles (GEPs) and combinations of clinical and pathological variables with GEPs. Recent publications have proposed using ‘deep dermoscopy’ alongside histopathological indicators (such as Breslow thickness and ulceration) to predict melanoma metastasis and early-stage melanoma recurrence based on clinical and histopathological data extracted from electronic medical records.

For high-risk patients, guidelines recommend utilising total body photography (TBP) and sequential digital dermoscopy (SDD) to assist in early melanoma diagnosis while reducing the biopsy rate of benign naevi.

TBP serves as a comparative reference for future examinations MEDICAL FORUM | SUMMER EDITION

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Recent research indicates that patients respond better when immunotherapy is administered before lymph node dissection rather than undergoing surgery first and receiving immunotherapy afterwards.

AMC Co-Chairs and Australians of the Year 2024: Prof Georgina Long and Prof Richard Scolyer

since primary melanomas typically arise de novo (from new) or in association with pre-existing melanocytic naevi.

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SDD is useful for flat melanocytic lesions that are not suggestive enough to warrant excision but not completely inconspicuous, as well as for mildly atypical lesions that show change over time. Evidence suggests that SDD identifies featureless melanomas and reduces the ratio of benign to malignant excisions and the number of benign lesions removed.

In the near future, AI may be employed to classify lesions, providing more accurate and reliable diagnoses. Although AI is already integrated into certain photography machines, it is not approved by the Therapeutic Goods Administration and is currently limited to research (in silico and real world) applications.

The main takeaway in the field of advanced melanoma is the concept of ‘de-escalation of surgery’.

Neoadjuvant immunotherapy has now become the standard of care for stage III melanoma.

There is still a need to develop new treatment options for patients resistant to both immunotherapy and targeted therapy, such as personalised mRNA vaccines and new drugs currently in clinical trials.

We are moving toward a new era of precision oncology that combines clinical data with pathology, genomics, and other ‘omics’ to deliver personalised and effective treatments to patients.

The conference also featured a presentation of the Conquering Skin Cancer movie that launched in cinemas this November. This powerful movie is a must-see for all as it will undoubtedly raise awareness about skin cancer and melanoma.

It inspires us all to take action and make a difference in the fight against this disease, contributing to the goal of zero deaths from melanoma.

ED: Dr Helena Collgros and A/Prof Tony Caccetta are Fellows of the Australasian College of Dermatologists (FACD).

Doing the numbers on metastatic breast cancer Australia’s first advocacy group to address the needs of the growing number of women and men living with metastatic breast cancer was launched in October.

Medical oncologist and co-founder of MBC Action Australia Professor Frances Boyle said women and men with metastatic breast cancer had been forgotten in the sea of celebratory pink that focuses primarily on survivorship and recovery from breast cancer.

Many of those diagnosed with metastatic breast cancer desperately needed support, both emotional and physical, and many were missing out.

Novel treatments mean people with metastatic breast cancer are living longer, but cancer service organisations remain relatively unaware of this growing population, MEDICAL FORUM | SUMMER EDITION

so support services are lagging behind the advances in treatment and gains in survival.

A priority for MBC Action is to understand how many people are living with metastatic breast cancer in Australia. Currently, state and territory cancer registries do not collect and report staging or recurrence data. Without these data, it is not possible to report how many people are living with cancer that has metastasised.

Within Australia and internationally, it is recognised that this is a significant gap in cancer data ecosystem.

Dr Andrea Smith, co-founder of MBC Action Australia and cancer survivorship researcher at the University of Sydney’s Daffodil Centre, and cancer epidemiologist Dr Sally Lord have been working

with the Cancer Institute NSW to understand how existing cancer registry data can be used to report prevalence of metastatic breast cancer.

Dr Smith, who herself has a metastatic breast cancer diagnosis, has been campaigning for years around the importance of people with metastatic breast cancer being counted.

“Novel treatments mean we are living much longer. However, up until now no one knew how many people were living with metastatic breast cancer in Australia,” she said.

“If we don’t know these numbers, how can governments and cancer service providers plan for and deliver the appropriate care and support that we need?”

JANUARY 2025 | 19

GP Continuing Professional Development

Hollywood Heartland A Saturday symposium featuring all things cardiac

It’s easy to register

UWA University Club Hackett Drive Nedlands WA 6009

www.hollywoodprivate.com.au Saturday 15 February 2025 RSVP Wednesday 12 February

i

toplisss@ramsayhealth.com.au 0438 763 256

PROGRAM

Chaired by Professor Rukshen Weerasooriya, Cardiologist

LEARNING OUTCOMES

8.00am 8.30am

Registration Presentations and discussion Updates in heart failure management Dr Yuli Ten, Cardiologist Valvular heart disease, TAVI: recent case discussions Dr Phil Currie, Cardiologist Dr Karim Slimani & Dr Pragnesh Joshi, Cardiothoracic Surgeons Advances in cardiac electrophysiology and pacing Dr Kushwin Rajamani, Cardiologist Coronary CT – a mainstream test Dr Conor Murray, Radiologist Athlete heart health: considerations and management approaches Dr Sekaran Gana, Cardiologist Cardiac rehabilitation Tracy Swanson, Cardiac Rehabilitation Nurse Specialist Obesity and diabetes Dr Imran Badshah, Endocrinologist Cardiothoracic surgical patient journey at Hollywood Jean Bunt, Cardiothoracic Clinical Care Nurse Specialist Emergency Care at Hollywood Dr Suzanne Gray, Emergency Physician Interventional cardiology and stroke prevention Dr Richard Clugston, Cardiologist Evaluation & close

• Describe how to diagnose and treat heart failure

2.30pm

• Identify advances in cardiac electrophysiology and pacing • Describe role of coronary CT in the assessment of coronary artery health/disease • Outline assessment and management approaches to athlete heart health • Discuss the Hollywood Private Hospital cardiac rehabilitation program Sponsors

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Going wild a health hazard There are viral consequences of habitat encroachment and traditional food systems, warns Australian medical researcher Professor Nathan Bartlett.

Species survival is intricately linked with human actions, especially those related to habitat encroachment and our reliance on traditional food systems.

has already demonstrated how devastating such spillovers can be.

These interactions between species and the resulting disease transmission are not just hypothetical risks, they are real, ongoing threats.

While sustainability often focuses on resource management, the broader picture includes understanding how these actions impact both species and disease transmission in ways we cannot predict.

In recent decades, habitat encroachment has emerged as a critical driver of species decline and an unrecognised catalyst for disease transmission.

As humans push deeper into natural habitats, the once-clear boundaries separating different species blur, leading to increased interactions between wildlife, domesticated animals and humans.

This convergence of species, driven by deforestation, urbanisation and agricultural expansion, creates a fertile ground for pathogens to cross species barriers.

The emergence of diseases such as Hendra virus and Nipah virus are stark reminders of this reality. These viruses, which originated in bats, found new hosts in domesticated animals and, eventually, humans.

Such spillovers highlight the unintended consequences of bringing species together that would not normally interact.

Reduced species diversity, another consequence of habitat loss and agricultural intensification, further exacerbates the risk and impact of disease outbreaks. A rich diversity of species in an ecosystem often acts as a buffer against the spread of infectious diseases. However, when species are lost, this buffer weakens, allowing pathogens to move more freely among the remaining species, including humans.

MEDICAL FORUM | SUMMER EDITION

Intensive farming practices are particularly concerning in this regard. The overcrowding of genetically similar animals in confined spaces not only facilitates the spread of pathogens but also accelerates their evolution.

The frequent outbreaks of avian influenza bird flu are a direct result of such practices.

These high-density environments provide a perfect breeding ground for the virus, enabling it to mutate rapidly and sometimes acquire the ability to infect humans.

A recent example of this is the 2009 H1N1 swine flu pandemic, which emerged when different flu viruses mixed within a single host, in this case, a pig. Flu viruses are particularly adept at swapping genetic material, creating new strains with pandemic potential.

Our traditional food systems, which rely heavily on the exploitation of wild species, further complicate the scenario. The consumption of bush meat and the trade of exotic animals bring humans into direct contact with species and pathogens they would otherwise rarely encounter.

This close contact increases the likelihood of diseases jumping from animals to humans, as seen with coronaviruses and lyssaviruses.

The global COVID-19 pandemic

While we cannot predict every outcome of our actions, we can recognise patterns and take preventive measures. Protecting natural habitats, promoting sustainable farming practices, and rethinking our reliance on traditional food systems are crucial steps in mitigating these risks.

As scientists, we need to think beyond the immediate benefits of conservation and sustainability. It calls for a deeper understanding of how our actions affect the complex web of life on Earth. As we strive to protect species, we must also consider how our choices influence the dynamics of disease transmission and, ultimately, human health.

Species survival is not just about preserving biodiversity for its own sake, it's about safeguarding the intricate relationships between species, their environments and the pathogens they conceal.

Our own health and survival are intertwined with the health of ecosystems and the species that inhabit them. By addressing habitat encroachment and re-evaluating our traditional food systems, we can reduce the risk of future pandemics and ensure a healthier future for all species, including humans.

ED: Professor Nathan Bartlett leads the HMRI (Hunter Medical Research Institute) Infection Research Program, focusing on how environmental changes influence the spread of infectious diseases.

JANUARY 2025 | 21

Vaping efforts needed beyond the school gates GPs have an important role in anti-vaping measures, according to Curtin University public health experts Dr Jonine Jancey and Dr Renee Carey.

The Federal Government recently announced the nationwide rollout of a school-based vaping prevention initiative, OurFutures, which aims to curb youth vaping.

Developed by experts at the University of Sydney’s Matilda Centre for Research in Mental Health and Substance Use, this program combines input from educators and students to deliver evidence-based prevention strategies.

For GPs, the rising prevalence of vaping, particularly among young people, is impossible to ignore. A 2022-23 survey of Australian high school students revealed nearly one in three had tried vaping, with one in six reporting use in the past month.

These figures reflect a concerning trend, with vaping rates more than doubling since 2017.

Health risks of vaping Evidence linking vaping to adverse health outcomes continues to grow.

A 2022 review identified risks such as nicotine addiction (particularly among youth), poisoning, lung injuries, burns, and an increased likelihood of transitioning to tobacco smoking. Vapes often contain carcinogenic chemicals, including formaldehyde and heavy metals like nickel and lead. Inhalation exposes users to substances found in products such as nail polish remover and weed killer.

This 2022 review also found that there is limited evidence of the effectiveness of e-cigarettes as a smoking cessation aid in the clinical setting. While e-cigarettes may be helpful to some in their quit attempts, there is uncertainty about the overall balance of risks and benefits. A recent study published in BMC Medicine also found an increasing prevalence of e-cigarette use in ex-smokers, with many continuing to vape long-term.

22 | JANUARY 2025

While the long-term health effects remain uncertain, current evidence underscores the importance of preventing e-cigarette uptake, particularly among young people.

OurFutures program This school-based program will target students in Years 7 and 8 – a pivotal period when many begin experimenting with vapes – across more than 3000 schools. Delivered through four online lessons, it educates students about the harms of vaping, the influence of social

media and strategies for seeking help.

Early trials across 40 schools in New South Wales, Queensland, and Western Australia have shown promising results, with participants demonstrating improved knowledge and reduced intentions to vape.

This program is timely and a good start, as young people have told us they want vaping prevention messages in their schools to help them make informed decisions.

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GUEST COLUMN that there’s a lack of credible information available. Equally, school professionals, such as principals and teachers, recognise they are unable to deal with the issue of vaping among students on their own, and have been calling for support.

advice on protecting their teenagers from vaping harms, while other patients may inquire about using e-cigarettes as a smoking cessation tool, or they may present with health complications potentially linked to vaping.

Beyond education

The RACGP’s Supporting smoking & vaping cessation: A guide for health professionals outlines reforms to vaping regulations and vaping cessation, including assessing risks, prescribing cessation aids, and providing counselling. As vaping has increasingly become a more common topic in consultations, staying updated with these guidelines is important.

However, education programs like OurFutures are just one strategy. Young people operate in communities and are influenced by peers, family, social norms and societal structures. There needs to be a range of robust actions to stop exposure and access to vapes.

Recently we have seen the introduction of world-leading reforms that include Federal laws to stop the importation of vapes, only selling vapes in pharmacies to those aged 18 years and over, and limiting flavours (mint, menthol and tobacco). The WA Government is extending these laws by only permitting vapes to be supplied by pharmacies to adults with a medical prescription.

For GPs, these regulatory changes impact clinical practice. GPs may encounter this issue in various clinical contexts. Parents may seek

Advocate for prevention: Encourage broader public health measures, including stricter regulations and community-level interventions.

Vaping remains a dynamic and evolving issue, and GPs have a critical role in addressing its health implications. By combining patientcentred care with education and public health advocacy, clinicians can contribute to reducing vaping’s impact on the community while supporting healthier choices for their patients.

ED: Dr Jonine Jancey and Dr Renee Carey are from Curtin’s School of Population Health.

Practical takeaways Educate patients: Discuss the risks of vaping with patients, particularly young people and parents, and make them aware of education resources such as OurFutures.

Support cessation: Use evidencebased tools to help patients in quitting vaping or smoking.

Stay informed: Keep up with evolving regulations and the latest research on the health effects of vaping.

Here to Help Assoc. Professor Harsha Chandraratna Director Surgeon

Consulting at: Garden City Specialist Centre 537 Marmion Street, Booragoon WA 6154

Surgeons House 162 Cambridge Street, West Leederville WA 6007

Dr Steve Watson Surgeon

Dr Leon Cohen Surgeon

Mandurah – 360 Health 10/3 Dower Street, Mandurah WA 6210

Office Phone: (08) 9332 0066 | Mobile Phone: 0401809255 | Email: reception@oswa.com.au

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JANUARY 2025 | 23

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Urgent Lesion Clinic for suspected melanoma diagnoses or any urgent lesion (private health insurance rebates apply in our day procedure centre).

A/Prof Tony Caccetta MBBS (Hons) FACD Dermatologist

Personalised melanoma risk assessment to determine surveillance intervals and educate patients on risk factors.

Confocal microscopy for diagnosis and pre-surgical mapping of lentigo maligna (in situ melanoma) at complex and cosmetically sensitive sites (Dr Collgros).

Management of cutaneous toxicities related to medical oncology treatments (A/Prof Caccetta).

Dr Helena Collgros MD FACD Dermatologist

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perthdermatologyclinic.com.au 24 | JANUARY 2025

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OPINION BACK TO CONTENTS

Dr Joe Kosterich | Clinical Editor

Babies beware The first half of 2025 will see the proverbial babies kissed to within an inch of their lives as both WA and Australia have elections by May. History tells us that no first-term government has been ejected federally since 1931 and the WA government has a majority the size of the great outdoors.

The time and effort devoted to forms, accreditation and governance has passed a tipping point and is in counterproductive territory. The pendulum needs to swing back towards the primary role of the doctor being the needs of the individual patient rather than a third party.

However, we live in interesting times. Fun fact – apparently this is not an ancient or Confucian saying but was coined by Englishman Frederic Coudert prior to World War II – “One senses that nothing is off the table”.

Health will figure in both campaigns. At a State level, we will hear about plans to fix ambulance ramping, while in reality it increases each year. We will hear about plans for new facilities which won’t open until the 2030s and “investment” in the health system, whatever that means.

Federally, we hear about “strengthening Medicare”, bulk billing rates and also that vague notion of investing in health. Given the bare cupboard nature of federal finances, there seems little prospect of any increase in real-dollar terms.

Back in the real world, the public find it increasingly difficult to access health services and this is not because they may have to pay. It is because demand, fuelled by immigration, an ageing population and other forces, is outstripping supply which is about to fall off a demographic cliff. In addition, each time Ahpra (and with GPs the RACGP) adds extra busy work, more doctors elect to pull up stumps or reduce their hours.

Apparently, Pluto entered Aquarius in November and will remain there for 20 years. This happens roughly every 240 years. The last cycle saw the French revolution, American declaration of independence and arrival of the First Fleet.

So far, we have seen the French government collapse and a form of revolution in the US. Go figure!

What we need in 2025 is less interference/bureaucracy in the practice of medicine and a return towards the individual doctor patient relationship as the cornerstone. My wish is that we take at least baby steps in this direction regardless of who wins the elections.

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CLINICAL UPDATE

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Non-operative management of hip and knee osteoarthritis

By Dr Arash Taheri, Orthopaedic Surgeon, Mt Lawley Hip and knee osteoarthritis (OA) affects millions globally, significantly impairing their quality of life. Non-operative management strategies have garnered attention for their potential to enhance patient care without the risks associated with surgery, reflecting an updated perspective on OA treatment.

It is important to recognise that we still do not have an allencompassing single aetiology for primary OA, often being multifactorial or ‘idiopathic’. Additionally, radiographic markers of OA do not always correlate with symptomatic OA. Thus, it is imperative to tailor the management to individual patient psychosocial, physical and medical needs, and expectations in a holistic way.

My passion is empowering patients with strategies to avoid joint replacement. Approximately 80% of my new patients will receive some variation of the modalities outlined here, some often avoiding joint replacement for many years. There is much satisfaction in this journey of guided self-improvement for our patients, and I encourage you all to consider trying as many of these as you can within your time constraints.

Analgesics and supplements Non-operative OA management often starts with simple analgesics.

Paracetamol is recommended for initial pain management due to its efficacy at prescribed dosages and safety profile compared to NSAIDs, which offer significant pain relief, but require caution due to gastrointestinal risks.

Emerging evidence highlights the anti-inflammatory properties of palmitoylethanolamide (PEA), while the efficacy of glucosamine and chondroitin remains debated.

However, I still suggest trialling them as there are very little negative side effects. Fish oil and curcumin are recognised for their inflammation-reducing effects, and novel drugs promise innovative approaches to OA pain management.

26 | JANUARY 2025

Injectables such as corticosteroids provide immediate pain relief, albeit temporarily. Visco supplementation with hyaluronic acid (HA) faces controversy, underscoring the importance of careful patient selection. I use HA only in patients with mild to moderate OA, as sufficient cartilage is necessary for effective hydration.

Current research on plateletrich plasma (PRP) tempers its widespread use due to mixed efficacy results. Similarly, stem cell therapy shows promise, but requires more substantial evidence to justify its cost for routine use in OA treatment.

Lifestyle changes Pro-inflammatory diets are often high in calories, sugars, and unhealthy fats, leading to weight gain, obesity, and metabolic dysfunction. Excess adiposity and metabolic abnormalities, such as insulin resistance and dyslipidaemia, are known risk factors for OA development and progression as well as poorer outcomes.

The evidence suggests that proinflammatory diets may contribute to the exacerbation of symptoms in osteoarthritis patients through their effects on systemic inflammation, metabolic health, joint pathology and cartilage degradation.

Promoting anti-inflammatory dietary patterns rich in fruits, vegetables, whole grains, lean proteins, and healthy fats may help mitigate inflammation, improve symptom management, and slow disease progression in OA patients.

I recommend formal dietetics review for all obese patients.

Weight management plays a pivotal role in alleviating OA symptoms.

The reason is simple – physics! For instance, the knees endure up to 20 times the body weight, while the hips face up to 15 times the body weight. Consequently, even modest weight loss can dramatically reduce joint loads.

I aim to avoid operating on individuals with a BMI over 35, and actively support patients in achieving this target before considering surgery. Many negate the requirement for surgery when they lose the weight.

Intermittent fasting is a strategy I both personally practise and encourage, with a myriad of benefits. The most relevant is the potential anti-inflammatory effects and improvements in metabolic health. Novel pharmaceuticals, including drugs such as semaglutide, offer new avenues for weight control. For severe cases, bariatric surgery MEDICAL FORUM | SUMMER EDITION

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CLINICAL UPDATE benefits one receives. I have been exploring alternative therapies studied in the literature including mindfulness and meditation, shown to positively influence pain perception in OA patients.

Key messages Research efforts will likely continue to explore the intricate interplay between psychosocial, genetic, mechanical, inflammatory, metabolic, and age-related factors in OA pathogenesis

Sound therapy, using specific solfeggio frequencies, rhythms and binaural beats, aims to reduce stress and alleviate pain.

Techniques focusing on breath work and positive thinking further enrich the arsenal against OA pain.

Better understanding the complex aetiology of primary OA will pave the way for personalised, targeted therapeutic strategies aimed at preventing or slowing disease progression.

Cognitive Behavioural Therapy (CBT) addresses the psychological aspects of chronic pain, emphasising the importance of mental health in OA management outcomes.

may be considered, with evidence supporting its positive impact on OA symptomatology.

Physiotherapy, emphasising strengthening and flexibility, remains a cornerstone of nonoperative OA management.

Hydrotherapy offers a unique benefit by reducing joint stress during exercise, making it a valuable treatment modality for OA patients seeking pain relief and improved mobility.

In the pool, joint reaction forces are reduced to only three to four times

MEDICAL FORUM | SUMMER EDITION

body weight in the knees, allowing patients to elevate their heart rates while minimising stress on their arthritic joint(s). This creates a synergistic effect that facilitates weight loss.

Other options As an avid practitioner of transcendental meditation and meditating for over a decade, I can personally attest to the vast

Recognising the limits of nonoperative management is crucial.

When conservative measures prove inadequate in alleviating symptoms and their disability increases, referral for surgical evaluation becomes necessary, ensuring patients receive the most appropriate and effective treatment.

Author competing interests – nil

JANUARY 2025 | 27

Effects of menopause on women’s health, wellbeing and productivity in Australia

By Dr Purity Carr & Christabel Samy, GPs, Rockingham Several studies have recognised the menopausal symptoms such as joint pains, hot flushes and low morale impact significantly on the lives of women. Doctors need to appreciate the needs of individual women transitioning to menopause and perimenopause and assist in education, managing symptoms as they age.

“In a small study of 33 healthy premenopausal women, both total and free plasma testosterone showed steep declines with age. According to that study, a woman of 40 would have half the total testosterone concentration of a woman of 21. In those premenopausal women, plasma DHEA and DHEA(S) also declined steeply with age. Clearly, women also pass through an andropause with ageing”. We have also conducted a small local study.

The evolving significant menstrual period has significant impacts on the lives of women and society through economic, social, and physical wellbeing. According to a study by ROCG (UK) 2019, “the menopause affects all women at some stage in their life, but many women do not know what to expect during the menopause nor do they feel empowered to seek help when needed or able to manage their symptoms. This is particularly challenging for the

25% of menopausal women who experience severe symptoms and can lead to the onset of potentially avoidable health problems in the future.”

In The Lancet editorial, its quotes a study of 4000 of menopausal and perimenopausal women “almost half (45%) of women have not spoken to their general practitioner (GP) about their symptoms and 31% said it took multiple appointments with their GPs before they were properly diagnosed”.

Notwithstanding, the Women's Health Initiative (WHI) study reports that current data supports benefits of HRT, including symptom relief, quality of life improvement, prevention of coronary heart disease and osteoporosis, and mortality reduction. Notably, HRT does not increase all-cause, cardiovascular, or cancer mortality risk.

Variations in HRT efficacy and risks depend on factors such as product origin (body identical or equine), dosage, route of administration, and timing of initiation. Transdermal oestradiol emerges as particularly effective for vasomotor symptoms.

While oral estrogen increases venous thromboembolism (VTE) risk, transdermal forms are safer, especially for women at higher VTE risk. Oral estrogen also raises stroke risk, but transdermal options do not.

Natural micronised progesterone (MP) offers advantages over synthetic progestogens, including lower VTE risk, cardiovascular neutrality and possibly lower breast cancer risk, especially when used for over five years. MP also provides effective endometrial protection, making it a favourable choice in HRT. Recommendations favour transdermal estrogen to mitigate side effects, highlighting the importance of tailored treatment approaches in optimizing menopausal symptom management.

We typically observe significant improvement in symptoms within six weeks, with symptoms halving by this time frame, and by three months, patients often score close to zero on their Australian Menopause Society (AMS) Diagnosing Menopause: Symptom Score Sheet. If a woman's symptoms persist beyond this point, explore other potential causes, with the most common missed diagnosis being ADHD and sleep apnoea.

Hot flushes typically resolve within two weeks. Palpitations, tinnitus, and muscle spasms are among the first to improve. Joint pain and back pain may take six to nine months to significantly improve depending on the underlying pathology. Sleep and mood

Analysis of de-identified data

28 | JANUARY 2025

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CLINICAL UPDATE

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CLINICAL UPDATE

Key messages Menopausal symptoms can have significant impact on quality of life HRT has a legitimate role in alleviating symptoms Individualised care is key.

typically show rapid improvement, with the breakdown product of progesterone, allopregnanolone, exerting a sedating and relaxing effect without causing grogginess.

Around 90% of women experience improved sleep within half an hour to one hour of taking progesterone while a small proportion may report symptoms of intolerance, including bloating, anxiety, headaches, and fatigue.

When topical oestrogen is used appropriately, symptoms of genitourinary syndrome of menopause (GSM) improve within six weeks. Longer and more severe symptoms may take longer. Daily vaginal estrogen for two weeks followed by twice weekly thereafter may not provide

adequate symptom control for some women, necessitating more frequent use. Notably, vaginal estrogen is generally safe for use, even in women not on HRT, with gynaecologists often permitting its use in women on Tamoxifen.

Testosterone therapy, typically prescribed for hypoactive sexual desire disorder (HSDD), can improve energy, sense of wellbeing, and muscle toning, with the aim of achieving a free androgen index (FAI) of 2-3. Testosterone therapy complements estrogen therapy, with the goal of returning symptoms to premenopausal ranges.

Contrary to misconceptions, testosterone therapy does not typically result in masculinising effects like facial hair growth or deepening of the voice. The notion of a three to five-year limit on HRT is not scientifically based, and long-term HRT use has been shown to provide better outcomes for patients in terms of cardiovascular protection and metabolic improvements. Thus, HRT can be used indefinitely to manage menopausal symptoms effectively.

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.

From the viewpoint of a senior GP, the issues that have been identified with this research is that GPs in general are faced with compounding clinical issues based on the expectations of patients.

This could also be the result of macro issues dealing with standard MBS consultation criteria, shortage, and turnover of GPs, and reducing number of bulk billing clinics affecting access and affordability.

It is very common for patients to present with the ‘shopping list’ of complaints and this poses many diagnostic challenges for the time pressures for clinicians.

– References available on request The authors acknowledge the contribution of Prof Martin Samy and Caitlain Navarra-Babor Author competing interests – the authors were involved in the study quoted.

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

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CLINICAL UPDATE

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Resistance exercise is medicine

By James L. Nuzzo, PhD, Edith Cowan University Muscle strength is an indicator of human vitality. It fluctuates throughout the day, following a circadian pattern, and it also changes across the lifespan.

Muscle strength increases up until about 25-35 years of age after which it plateaus and then declines at a rate of about 10% per decade after the fifth decade of life. The rate of decline can differ based on patient gender and the muscle group assessed.

Loss of muscle strength with ageing is due primarily to reduced muscle mass (sarcopenia). Reduced muscle strength correlates with earlier mortality, increased risk of falls, and greater difficulty in performing activities of daily living. Thus, increasing or maintaining muscle strength is critical for living a long, healthy life.

The most effective way to increase or maintain muscle mass and strength is by participating in resistance exercise, such as weight training, or other musclestrengthening activities. Resistance exercise is safe, and it promotes many health benefits, including improved cardiovascular profiles, better walking and sit-to-stand ability, reduced anxiety and depression, and better quality of life.

For these reasons, professional exercise organisations in Australia and abroad have published position statements on resistance exercise participation for healthy ageing and for inclusion in treatment plans for conditions such as diabetes, cardiovascular disease, cancer, and motor impairments such as multiple sclerosis and spinal cord injury.

Public health bodies recommend that adults participate in resistance exercise or other musclestrengthening activities two or more days per week. Professional exercise organisations then further specify that exercise sessions include multiple sets of 8-10 different exercises that target all major muscle groups.

Nevertheless, a significant number 30 | JANUARY 2025

of Australians – roughly 60% – do not meet recommended guidelines for participation in muscle-strengthening activities.

Similar results are observed in other countries.

Multiple factors contribute to low participation in resistance exercise.

Key intrapersonal barriers include perceived lack of time, lack of exercise knowledge or confidence, not enjoying or prioritising exercise, and being ill or having a disability.

Common social or environmental barriers include family and work obligations, financial costs, lack of access to exercise facilities or programs, and transportation and exercise location challenges.

Clinicians can help patients overcome some of these barriers by informing them that there is no single resistance exercise script that everyone must follow. Some script specifications are based on the patient’s preferences and circumstances. For example, muscles can be strengthened by using different types of resistance, including dumbbells, weight machines, elastic bands, and one’s

own body weight. Also, resistance exercise can be performed in various locations such as at home, at the gym, at the park and at treatment facilities.

Ideally, patients would achieve the recommended guidelines for resistance exercise each week.

However, these guidelines should not preclude clinicians from also informing patients that “doing something is better than doing nothing” when it comes to the exercise volume on the patient’s muscle-strengthening script.

Health and fitness benefits derived from physical exercise generally follow a dose-response relationship, whereby more weekly exercise causes greater benefits. However, fitness benefits still occur at the low end of the exercise volume spectrum. In fact, given that perceived lack of time is one of the most frequently reported barriers to exercise participation, and many individuals do not participate in any muscle-strengthening activities, researchers have started to explore the scientific credibility of “minimal dose” resistance exercise.

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CLINICAL UPDATE

Key messages Adequate muscle strength is important for daily life Resistance exercise, even in minimal doses, improves muscle strength Patients should be encouraged to participate in resistance exercise.

Minimal dose resistance exercise refers to a volume of exercise that does not meet recommended guidelines but that might still improve muscle strength.

“Weekend Warrior” is one example.

With this approach, training frequency is minimised. All weekly resistance exercise volume is completed in one session, often on a Saturday or Sunday, if an individual works full-time during the week.

Another example is resistance exercise “snacking.” Snacks reduce session duration. They are brief bouts of exercise (5-10 minutes) performed once or more daily on most, if not all, days of the week.

Snacks would suit, for example,

patients who work from home and own equipment such as dumbbells or elastic bands.

Current evidence suggests that when these and other types of minimal dose programs are performed regularly over a few weeks, they improve muscle strength and some other outcomes

of health and fitness. This is especially true for individuals who have no previous experience with resistance exercise.

Thus, resistance exercise is medicine – even in small doses.

Author competing interests – nil

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CLINICAL UPDATE

Patient is Person

By Dr Talia Steed, Author & Yoga Teacher Perth Late last year, I was stuck. Lost.

Feeling uncertain about my career direction. Isolated. Examining deeper existential questions related to my life purpose and what I was doing here on Earth.

Being an emotional person, at the time this manifested as heightened emotions. Anxiety. Tears. Feeling restless, with nowhere to go.

One afternoon amidst this state, it was quiet at work and I was able to finish early. But where to go? I had so much time to myself that this itself had become a source of anxiety. Many people in this overly busy modern world perhaps could not fathom such a state of being.

Yet on my life path, endless alone time was a familiar state.

I had time for exercise, hobbies, to see family and friends and spend quality time with my husband, a luxury many yearn for and wish to create. Perhaps there are subconscious reasons though, why they don’t. Maybe the questions that might arise when alone with oneself for too long. The emotions that might surface. The thoughts that may enter.

Our society is based on a model where outrunning oneself is the key to staying afloat in this roller coaster ride, we call our human lives, but sometimes the Universe calls us to stop and really look within. But that afternoon was not a day for self-reflection. For connection to my deeper truths or higher self. I was in panic. I needed to connect. To be heard. To be seen by another. To feel understood.

And so, I did what so many people often do when needing the very same things. I made a last-minute appointment with the GP. Not a GP I had seen before, but another at the practice I attended.

As I entered the consult, I was acutely aware of how it felt to be in her shoes having worked in similar before. Often as the doctor, we feel as if we must do something to fix whatever it is that the person in front of us has presented with.

So, I said from the outset, in 32 | JANUARY 2025

attempt to make her job easier, that I just needed someone to talk to. I became emotional, hurriedly expressing my feelings due to being aware of the time pressure she was under. Delving straight into the deeper emotions and existential questions that had been on my mind. Just wanting someone to tell me, that it would all be okay.

But instead she pulled out the K10.

Or perhaps it was the DASS21, my memory eludes me, but either way it had the same effect. It was the point at which I knew the appointment had been a mistake.

That I was not going to get what I was looking for. She then proceeded to tell me, albeit the first time she had ever met me, that I was probably depressed. That perhaps medication was required.

Straight into diagnose, label, treatment.

Which made me wonder, at what point as doctors did we become so detached? So uncomfortable dealing with very normal human emotions. So quick to label, not for the sake of the person sitting in front of us, but to feel like we have done something. Solved something.

Fixed something.

And that sometimes instead of seeing patient, perhaps we could see person.

With the realisation that emotions are normal. Even big emotions.

And really if we were honest with ourselves, have we not felt anxiety, flatness, loneliness, or any other of the myriad of emotions that are a normal part of the human experience? And perhaps even more so, given the fact that doctor’s mental health is often a lot worse than that of the general MEDICAL FORUM | SUMMER EDITION

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CLINICAL UPDATE

Key messages Emotions are human and perhaps we can hold off on our medical model of diagnose, label and treat until it is necessary Remember patient is person and doctor is patient too Often what someone really needs when going through issues of the heart or mind is someone to see them. To validate their experience.

Not to ‘fix’ them, but to connect with another human being in a time of need.

The time has come for a medical revolution. The integration of science and spirituality is the key to facilitating true healing of the multilayered, complex human system.

population, with numerous studies to support this. So surely many of us know how it feels to have these thoughts and feelings running though us, and very much not wanting to rush into a diagnosis.

Label. Treatment.

So perhaps it is time to shift the

way we view mental health. I am not saying that the diagnosis and treatment of ongoing symptoms can’t be of value. There is a role for this. However we need to be less hasty in trying to move a person from where they are at in a given moment. To try to fix it.

The question we really need to ask ourselves in these situations anyway is, who are we really trying to fix it for? The patient, who just wants to talk and be heard and feel seen, or ourselves?

And perhaps it is time to expand our minds even further. To understand that our mental body functions within the greater whole of our physical, emotional, energetic & spiritual bodies, that comprise the layered dimensions of our being in its totality. So when there is something at play on the level of mind, perhaps we can widen our lens, to see that there may be something out of balance on a level beyond that which the symptoms are surfacing. Perhaps it is on the level of the soul, where the individual feels out of alignment with their true path. Or perhaps it is on the energetic level, where the individual has taken on far too

much beyond their capacity to process and integrate it all. Be it other people’s emotions, their own, or the rapid pace of life within the collective as it currently stands.

It is time to widen our framework.

Our models are outdated. Swinging from one polarity to another, from the metaphysical to the ultra-rational, it is time to find the middle ground. The balance point.

The integration of science and spirituality. And it is only from this place of open-mindedness to all possible contributing factors, that we, as doctors, will embody the true meaning of the word, Healer.

Author competing interests – nil ED: Dr Steed is author of Body Wisdom

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e h t s ' It er ies

S r e m Sum

Whether you love the outdoors, want to stay indoors, have a laugh or get your Fringe on this summer – there’s activities for everyone. It’s by no means an exhaustive list, but there’s plenty to keep you busy.

By Ara Jansen

Harvest in the Swan Valley

Harvest – a celebration of the season’s delights in the Swan Valley – returns in February. Each summer, Swan Valley businesses put on a range of seasonal offers, experiences and events to give visitors the opportunity to enjoy summer produce at its finest. It’s the perfect time of year to enjoy table grapes picked fresh from the vines, sweet watermelons, soft figs and rich tomatoes – lovingly grown by families of the valley for generations.

Find out more at swanvalley.com.au/harvest

34 | JANUARY 2025

Perth Festival and outdoor films

It’s the season of truth tellers and mischief makers at the 2025 Perth Festival. Riding alongside is the annual festival of international cinema over the summer, under the pines at Somerville Auditorium.

Program and tickets: www.perthfestival.com.au Don’t forget other outdoor cinemas across town including Telethon Community Cinema at Burswood, Joondalup and Murdoch, Moonlight Cinema in Kings Park, Rooftop Movies in Northbridge, Rendezvous Film Club in Scarborough Kookaburra Cinema at Mundaring Weir, Luna Palace Outdoor Cinema in Leederville, or if you want to take your car, Galaxy Drive-In, Kingsley. You’ll find free outdoor cinemas at Mindarie Marina and Northbridge Piazza or check with your local council.

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WHAT’S ON

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WHAT’S ON

Perth Comedy Festival

Art Gallery of WA

Laughter awaits at the Perth Comedy Festival 2025 from 21 April – 18 May on stages at the Regal Theatre, Astor Theatre, Rechabite Hall, Goodwill Club and Freo Social. Confirmations so far include the overseas contingent of Pat & Faye Shortt, Mat Ewins, Varun Grover, Ashwyn Singh, Schalk Bezuidenhout, Chris Parker, Guy Montgomery and Melanie Bracewell. The Aussie contingent includes Nazeem Hussain, Becky Lucas, Luke Heggie and Wankernomics.

AGWA continues with the hugely successful and much talked about TIME • RONE installation. In a world-first, legendary photographer Henry Roy will hold his first survey of 40-years of recollections and observations in Impossible Island. It brings together 113 photos taken from 1983 to 2023, with images shot in places such as his native Haiti, Ibiza, Paris, Dakar, Cameroon, Normandy, Marrakesh, Thailand and the Ivory Coast.

www.perthcomedyfestival.com

Runs to May 18 Form and feeling: artists’ studies of the twentieth century explores the centrality of drawing to the artistic practice of British and Australian artists, including Stanley Spencer, William Dobell, Russell Drysdale and Frank Auerbach. Drawn from The State Art Collection, this exhibition brings together significant figurative oil paintings and their preparatory drawings – a number of which have never been shown before.

Crown Theatre

Runs until May 4 Powerhouse soul and blues vocalist Mahalia Barnes plays Mary, Robert Tripolino as Jesus and acclaimed comedian, singer and writer Reuben Kaye stars as Herod in the classic stage show Jesus Christ Superstar.

Image: TIME • RONE installation view, The Art Gallery of Western Australia, 2024.

Image © RONE. Photo: Rift Photography.

The season opens 13 February Green is the word as the musical Wicked keeps spreading the magic until February 2. The Lord of the Rings – A Musical Tale hits the stage in March and Sister Act follows in April.

Free stuff

Heading out over the summer? If you have a valid SmartRider you can travel to that event, concert or sporting event for free on all Transperth train, bus and ferry services. Free riding runs until 5 February.

Outdoors & roadies

If you’re heading out of Perth, check out the WA Museum’s Wanderland website to help you find a way to WA’s intriguing regional collections. Search and create your own trip at www.visitwanderland.com.au.

Don’t forget to stop in at a local gallery on your travels.

Whether it’s on foot, two wheels or with a paddle, if you want to get a hit of green, check out Trails WA. Search by trail type, region or experiences to find an adventure which best suits. Combine that with checking out more getting-outside info at Outdoors WA, in our trails towns of Dwellingup and Collie or the Bibbulmun Track.

The Hyde Park Festival is on 2 March and the Perth Festival of Healing happens on 29 March at the Cannington Exhibition Centre & Showgrounds. continued on Page 21

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WHAT’S ON

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It’s the summer series continued from Page 35

Fringe World 2025 7 January – 16 February

Step into a cosmic cabaret saloon perched on the edge of the galaxy, where space cowboys, alien drifters and the legendary Rodeo Sisters dazzle with mind-blowing performances and risqué circus performances. LASSÙ is the debut of producer and seventh-generation circus performer Merrik Ashton, of Ashton Circus fame. Debuting in Perth, Ashton’s adopted home, it promises to be one of the hottest tickets at Fringe World 2025. It runs under the bespoke big top at Taylor Reserve in Victoria Park, one of Fridge World’s new locations.

Dean Misdale celebrates 10 fabulous years of Fringe with the world premiere of Drag Me to Broadway. Hang onto your wigs as bedazzling drag virtuoso Misdale sashays into the glorious De Parel Spiegeltent for a new solo show that promises a night of glamour, showtunes and sheer entertainment featuring the sassiest songs from Priscilla, The Rocky Horror Show, Kinky Boots and many more in a night bursting with glamour.

She’s been sailing the high seas and performing on major cruise lines throughout Asia and New Zealand and Lisa Woodbrook is back with a new show called Millennial: Hits of the 90s and 00s. This time around, Lisa is joined with an entourage of dancers while performing some of the biggest hits from the likes of Britney Spears, Backstreet Boys, NSYNC, Spice Girls and Beyonce.

Expect high energy dance-offs, singalongs and much more. Sailing into The Pleasure Garden’s The Gold Digger.

Mel McGlensey is Motorboat.

Part woman. Part boat. Full clown.

McGlensey sets off in a new direction by artfully mixing clown, 36 | JANUARY 2025

physical comedy, burlesque and character improv to bring the silliest, sexiest, naughty and nautical show ever made about someone who is part-woman and part-boat.

Inspired by Etta D’Elia’s recent travels to the beloved Italian city, she presents From Naples...With Love.

Celebrating one of the most vibrant cities in Italy, she says Naples is famous for being the home of Mount Vesuvius, pizza, sfogliatelle pastries and the likes of Sophia Loren and Enrico Caruso. “It’s impossible not to be swept up by the city’s vivaciousness and the Neapolitan passion and zest for life, love, great food and of course incredible music,” she says. Journey to Naples at the State Theatre Centre.

Howl with the Hounds of Love and dance on the moors with Wuthering Heights. Multi-awardwinning performer, Sarah-Louise Young presents An Evening Without Kate Bush where she pays glorious tribute to the music, fans, and mythology of one of the most influential voices in pop music.

Penny Shaw is mostly known as a regular cast member of West Australian Opera and as a finalist on Australia’s Got Talent, but she’s singing a different tune with Let’s Do It. For two nights at the Ellington Jazz Club, she’ll be dipping into the songbook of Cole Porter, Irving Berlin and Rodgers and Hart.

Not for the faint hearted, Scottish storyteller and paranormalist Kevin Kopfstein is bringing his ghostly tales and collection of hauntiques.

From an 1800s Vampire Hunting Kit, Voodoo Doll, Cemetery Padlock, and even a child’s Haunted Doll.

You’ll hear their spooky stories and

experience chills, thrills, and contact with the spirits.

The internationally renowned artists behind hit shows, GODZ, Railed and PreHysterical will once again be showing off their jawdropping stunts, chiselled abs and raunchy humour with Elixir Revived.

Based on their first award-winning show Elixir, it follows four scientists who attempt to create the elixir of life. Working for an authoritarian pharmaceutical corporation, they are forced to test the concoctions on themselves. Mayhem ensures – the perfect blend of physical comedy and athletic prowess. And if it’s possible, even sexier.

Ascendent Messages is an immersive concert featuring new works for classical guitar, percussion and electronics by female composers. The guitar and percussion genre is an area of the Western art repertoire in which gender diverse composers are significantly underrepresented, with works by male composers outnumbering those by female composers 15 to one. Each work showcases the distinct voice of its composer, creating an engaging and diverse program that ranges from the tuneful to the experimental, which will resonate with both seasoned listeners and newcomers alike. It’s at Callaway Auditorium.

Side splitting comedy ventriloquism silliness with a light social commentary twist is what you can expect from Despicable Hehe as South African Conrad Koch takes us on a rollercoaster ride of puppets and comedy.

MEDICAL FORUM | SUMMER EDITION

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WHAT’S ON

WIN

Fringe for kids 7 January – 16 February

Fringe isn’t just for the big kids! Multi-Platinum and ARIAnominated DJ and producer Lenny Pearce has cemented a global reputation as the trailblazing architect of Toddler Techno and Baby Raves. He celebrates SpongeBob SquarePants 25th anniversary with a Reef Rave at Rechabite Hall.

The Little HOOHAA! is big laughs for little people – and the whole family. It’s an award-winning theatrical rollercoaster of comic sketches, song, slapstick and fun stuff that kids like. Interactive, hyperactive and heaps of fun, it’s happening at the State Theatre Centre.

The maddest of all mad scientists, Magnus Danger Magnus brings his all-ages electromagnetic, STEM-based extravaganza back to Fringe for weekends at 3pm. The Greatest Magic Show is a magical one-hour family spectacular at The Pleasure Garden at 4.20pm over weekends.

WA Ballet at the Quarry and beyond

WA Ballet has an impressive season for 2025, kicking off with its now iconic season at the beautiful quarry in City Beach. The Wild Between Stars: Ballet at the Quarry, in association with Perth Festival, runs from February 7 to March 1.

The night’s program features three world premieres from Australian choreographers including the title work by Loughlan Prior, whose previous works include the highly acclaimed Hansel & Gretel and Spartacus. Also on the program is a new creation from Lucas Jervies, Concerto Anniversary, a homage to the music of Tchaikovsky and the world premiere of Ripples, from Yawuru woman Tara Gower, inspired by the natural beauty of the Quarry itself.

Courtesy of WA Ballet, Medical Forum is offering a Ballet Season Package giveaway, with the winner receiving two A-Reserve tickets to both the Ballet at the Quarry season and the company’s thrilling production of Don Quixote, which has been choreographed by the late, great Dame Lucette Aldous AC (after Marius Petipa) with Spanish dance doyenne Deanna Blacher contributing to the fandango.

WA Ballet’s 2025 season continues with a blend of the classics and new works including a magical retelling of Alice in Wonderland, the effortlessly romantic Cinderella and an exciting world premiere of choreographer Alice Topp’s Butterfly Effect – a modern reimagining of Puccini’s Madame Butterfly.

To enter, use the QR code on this page or go to mforum.com.au and hit the competitions tab.

For more information about WA Ballet’s 2025 season go to https://waballet.com.au

MEDICAL FORUM | SUMMER EDITION

JANUARY 2025 | 37

THE WILD BEYOND

SEASON 2025 SEASON PROGRAM THE WILD BETWEEN STARS: BALLET AT THE QUARRY

GENESIS

7 FEBRUARY – 1 MARCH

LIVE AT THE WEST AUSTRALIAN BALLET CENTRE

LIVE AT QUARRY AMPHITHEATRE, CITY BEACH

Choreographers Dancers of West Australian Ballet

27 MARCH – 5 APRIL

Choreographers Loughlan Prior, Lucas Jervies and Tara Gower Season Sponsor EY In association with Perth Festival

DON QUIXOTE

ALICE (IN WONDERLAND)

16 – 31 MAY

5 - 12 JULY

LIVE AT HIS MAJESTY’S THEATRE WITH WEST AUSTRALIAN SYMPHONY ORCHESTRA

LIVE AT CROWN THEATRE Choreographer Septime Webre

Choreographers Dame Lucette Aldous AC after Marius Petipa

BUTTERFLY EFFECT

CINDERELLA

5 – 20 SEPTEMBER

21 NOVEMBER – 14 DECEMBER

LIVE AT HIS MAJESTY’S THEATRE WITH WEST AUSTRALIAN SYMPHONY ORCHESTRA

LIVE AT HIS MAJESTY’S THEATRE WITH WEST AUSTRALIAN PHILHARMONIC ORCHESTRA

Choreographer Alice Topp

Choreographer Jayne Smeulders

Season Partner Singapore Airlines

SUBSCRIBER BENEFITS Purchase tickets to multiple ballets in the same package order and save up to 20%*

Swap your tickets for another date up to 48hrs prior to your performance with no exchange fees

Discover more about subscriber benefits online

Subscriber booking: Visit waballet.com.au or scan here to enter The Wild Beyond of West Australian Ballet Season 2025. *ALICE (in wonderland) is not available in season packages. Season package holders will receive a link to purchase discounted tickets through Ticketmaster in their package confirmation email. A booking fee may apply. Full terms and conditions and privacy policy available online.

Historical Digital Preservation Partner

38 | JANUARY 2025

MEDICAL FORUM | SUMMER EDITION

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Review by Dr Craig Drummond Master of Wine

Fermoy Margaret River 2024 Semillon Sauvignon Blanc (RRP $30)

Fermoy Estate Margaret River Wilyabrup 2018 Cabernet Sauvignon (RRP $55)

A great expression of this popular regional blend. The season was warm and dry, resulting in an early vintage, with fruit of good quality. It was one of those nice years when the Marri blossom kept the birds from the vines. This wine is vibrant and enticing, with the 63% Semillon giving dominant aromas of fresh herbs and guava and the Sav Blanc adding citrus notes, pungency and spices. Palate weight is excellent by way of fermentation and maturation in oak. A nice wine, displaying the synergy of these two varieties in the classic Margaret River style.

Great to taste a wine again from that classic 2018 vintage. The wine is still youthful at six years, with deep garnet/red colour, the meniscus only slightly softening. The nose displays some beautiful development. The slow ingress of oxygen is evident, resulting in a wonderfully complex, integrated mix of superb fruit and oak. It has the Margaret River cassis foremost, backed up by silky black olive, sage and supported by cedary oak. This wine is drinking nicely now. Complex, integrated and complete, but has the structural elements to go another 8-10 years.

Needs to breathe off a little in glass to dissipate some ullage characters, but quickly freshens up. A 50% Cab Sav, 40% Merlot, 10% Shiraz blend. Displays aromas of dark berries, dried herbs and cardamon, with a distinct savoury edge, which leads to a supple smooth mouthfeel, a mid-weight, mid-length wine with a fruity finish. Tannins are softened by the Merlot. Oak is evident but not central to the style. Flavours of mulberry, redcurrant and black olive, with a touch of spice. A good everyday wine and should drink well up to five more years.

MEDICAL FORUM | SUMMER EDITION

FR

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Located in the Wilyabrup sub-region of Margaret River, in what one might call the ‘dress circle’, they certainly compare with famous neighbours in terms of quality production. The vineyard was established in 1985 and has 27ha of vines with plantings of the mainstream regional varieties – Semillon, Sauvignon Blanc, Chardonnay, Cabernet Sauvignon, Merlot and Shiraz.

Fermoy Margaret River 2020 Wilyabrup Cabernet Merlot (RRP $30)

ES

FE

It is indeed a pleasure to again review the wines of this great Margaret River producer. Since my first article in 2012, they have continued to climb the quality ladder.

Winemaking has been under the direction of the vastly experienced Jeremy Hodgson since 2015, and wines are marketed under several quality levels, the mainstay being the Fermoy Collection (or Estate Range), with Estate Reserve wines the pinnacle of quality and only produced from selected parcels of the best fruit.

M W IN

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Fermoy – an established quality producer

O

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WINE REVIEW

Fermoy Margaret River 2023 Reserve Chardonnay (RRP $80) This wine is from the top Reserve range, a classic MR Chardonnay and certainly my wine of the tasting. Has a luminescent mid-gold colour, attractive in the glass. The nose is rich, ripe and inviting. Shows hazelnut characters, and wonderful toasty oak. The fruit is intense, succulent and mouthfilling, and displays white peach, grapefruit, cashew and oatmeal. All the winemaking techniques come into play here – quality oak, creamy malo-lactic fermentation, lees stirring – all giving to an intense, balanced, complex and lingering wine. I love this wine now, but it will reward with a few years cellaring.

JANUARY 2025 | 39

Rob and his family at the start of their journey

Navigating PTSD for kids Former copper Rob Atkins has used his own story with PTSD to co-write a book to help others talk to their families about this significant mental health issue.

By Ara Jansen

40 | JANUARY 2025

MEDICAL FORUM | SUMMER EDITION

BACK TO CONTENTS

MENTAL HEALTH

BACK TO CONTENTS

MENTAL HEALTH Rob Atkins calmly explains that he was sitting on a hill, with a rifle. At that moment, his faithful assistance dog poked his head through the crook of Rob’s arm and licked his face. He came back to himself and took a deep breath.

My Dad, My Hero

“I decided not to kill myself that day,” says for the former police officer.

“My dog was a lifesaver.”

A book about a first responder family and PTSD

When dealing with his own PTSD, Rob later told his wife they should write a book about how to share the mental health condition with the kids because there didn’t seem to be one for first responders.

At the time it was a throwaway line, but three years later, My Dad, My Hero has been released. It’s a children’s book designed to help families of first responders open up conversations about post-traumatic stress disorder (PTSD) and other mental injuries.

With the help of experts, Rob and his wife Chrysti have written the book which can be read with parents for kids in primary school, or independently for slightly older readers.

Ten per cent of professional first responders experience PTSD and similar mental health challenges due to the nature of their work, so the book provides an accessible and compassionate resource for children and families to understand these often-complex issues.

Professional first responders – firefighters, police, ambulance and 000 operators – face extraordinary pressures in the line of duty. The mental toll of witnessing and hearing traumatic events can lead to longterm emotional injuries, affecting not

only the individuals but also their loved ones.

The book helps bridge the gap in understanding by explaining PTSD and its impact in a way that is approachable for children, gentle and compassionate.

Rob was a police officer of 24 years and a soldier for six years before that, including peacekeeping in the Solomon Islands. He has cumulative PTSD (CPTSD), which he describes as death by a thousand cuts, resulting from prolonged trauma.

In his case, it was working as a police officer in Victoria and watching daily human carnage, violence and aggression, then later going home where his kids would want to play, but he was often too angry.

“Children often feel like it’s their fault,” says Rob. “Through the book we’re keen for kids – and the partners of first responders with PTSD – to know that they are not alone.

“Writing the story was quite easy but what was hard was finding the correct language, so we got some help from two psychologists to make sure we were on the right track.

“While my boys are now 16, 19 and 21, this is the book I would have wanted to share with them when they were little. I have a tremendous amount of guilt about the pain and fear I cost my family.”

Rob recalls that as a dad to his young boys he thought he was “killing it”. When the boys ran to greet him at the door when he arrived home, he didn’t realise they were testing to see if he was in a bad mood. If he was in a good mood, they’d play together. If not, the kids would run and hide. Rob says he now knows why they were always wondering what version of dad they would get – angry dad or fun dad.

“I became more and more the angry dad who walked through the door.

With this book we wanted families to know they are not alone. For quite a long time I couldn’t read it without crying because I felt so much guilt.

“This book is a communication tool for parents to start a conversation.

Showing the kids it’s not their fault and they haven’t done anything wrong. After the story, the second part of the book offers things mum and dad can do to help themselves feel better. For example, kids can encourage their parent to go out for some exercise, that maybe they can do together.”

The book has been published

by Victorian-based The Code 9 Foundation as a fundraiser with a serious message. The foundation – cofounded by Rob – provides a place of support for current and veteran professional first responders and 000 operators who live with PTSD, depression, anxiety and other mental health conditions that result from their service to the community.

Code 9 in Victoria is the call signal for an officer in trouble.

Among other initiatives, the foundation funds a number of assistance dogs each year, meals and home support, respite weekends and a camp for teens in households with a parent with PTSD. They have around 3500 members in their private forum across the country.

Copies of My Dad, My Hero are available in paperback for $22 at www.code9ptsd.org.au and www.mydadmyhero.com.au

MEDICAL FORUM | SUMMER EDITION

JANUARY 2025 | 41

Hiking for all

h t l a e h f o kinds

A desire to spend more time outdoors as an adult led to Kate Gibson starting to hike and then creating a business from it.

By Ara Jansen

42 | JANUARY 2025

MEDICAL FORUM | SUMMER EDITION

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ACTIVITIES

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ACTIVITIES When her son was six weeks old, Kate Gibson could finally get out of the house. She strapped the newborn to her chest and went for a hike in John Forrest National Park. The freedom felt fabulous – and being able to finally stand up straight felt equally special. Bless him, the baby slept the whole way, and Kate was reminded of why she loves the outdoors.

Hiking also helped her mental health when, after the birth, Kate’s new identity as a mother felt a little daunting.

Kate had hiked and walked for much of her pregnancy and soon after the birth, a monthly hike she had been organising turned into The Hike Collective. Like many such endeavours, it started as a casual group of people who wanted to hike. She also discovered that lots of people wanted to hike – even if very gently – but didn’t know how to go about figuring out the logistics.

These days the Hike Collective hosts around 20 to 30 hikes a month.

“Growing up in an outdoors lifestyle, I rode horses, did athletics and outdoor sports,” says Kate. “Moving to Germany in my early 20s led to me joining in the country’s most popular outdoor activity – hiking in the forests. When I came back to Perth I qualified as a personal trainer.

What I didn’t count on was how much time I would spend inside.”

Kate started training her clients outside to get “more green” into her

MEDICAL FORUM | SUMMER EDITION

day. In November 2016, she took a small group hiking – a couple of clients, her brother and her partner, who brought a friend. It was the birth of The Hike Collective.

“We didn’t go too far from the city, but word got around and soon there were 100 people turning up every month.”

Supporting her interest in mental health and a desire for philanthropy, you could join a hike for a gold coin donation which went to Beyond Blue.

The hikes continue to revolve around three ideas – movement has transformative power, connection is hugely important – whether it’s to someone else, self or nature – and that the outdoors and nature must be nurtured.

While she continues to hike, Kate made trail running her main outdoor hobby a few years ago. Living in the Hills, she also spends time out on her bush block, some of which has been tamed into a veggie patch. She walks the dog and also goes on bush scavenger hunts with her son, now six. Anything with a bit of colour he considers magical.

“Being outdoors helps both our mental and physical health,” says Kate. “Being able to get my son outside definitely benefits him if he’s going a bit crazy. It calms him and allows him to focus on using his hands more. I think it has the same power for adults too. It’s one of the main things we love about having a bigger block and living in the Hills.”

Kate takes her own prescription for nature very proactively. Rather than waiting until it’s too late, she makes sure her tank is always full.

Her number one go-to is always a walk with the dog but now her son can ride a bike, she can trail run at a speed he can pedal.

“I know people go hiking for physical health and mental wellbeing but honestly I think the calm you get from being outdoors in nature is even more beneficial than anything physical.” www.hikecollective.com.au For other opportunities to get more green into your world, check out www.outdoorswa.org.au/ places-to-go, www.trailswa.com.au or www.hikewest.org.au

JANUARY 2025 | 43

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52 | APRIL 2021

MEDICAL FORUM | CARDIOVASCUL AR HEALTH

medical forum CLASSIFIEDS FOR SALE OR LEASE

NEDLANDS Rare Large Medical Suite on Hollywood Campus • Huge 96sqm* medical suite • Generous waiting and reception area • 2 huge consulting rooms • Fully Fitted & Furnished Suite • 1 car bay on title • Ready for occupation • Central location within the specialist centre • Modern fit out • Exclusive basement storage area Asking Price $984,000+ GST Asking Rent $450/sqm + Outgoings + GST Luke Randazzo 0417 181 309 lrandazzo@brwa.com.au Rob Selid 0412 198 294 rselid@brwa.com.au

METRO PLACEMENTS

NEDLANDS / BENTLEY / MANDURAH / GERALDTON Consult rooms available for sessional rental – suitable for specialists or allied health 4 strategic locations in Nedlands, Bentley, Mandurah and Geraldton • Nedlands – Hollywood Specialist Centre, suite 23, 95 Monash Ave • Bentley – unit 3, 10 Mills St • Mandurah – unit 7, 21 Sholl St • Geraldton – 9 Urch St, Beresford For more info, contact practicemanager@apollocardiology.com.au or 6166 3737 Website link https://apollocardiology.com.au

FOR SALE

FOR LEASE

WEMBLEY 2 rooms available for lease Consulting room 15m2 Consult/treatment room 23m2 (has sink, can be sub-divided) Within Suite 2, 178 Cambridge Street, Ground floor Undercover car bays available for staff parking Opposite St John of God Hospital Subiaco Radiology and pathology in same building Physiotherapy available on site Great patient parking 600m walk from Subiaco train station Sessional basis considered Specific fit-out requirements to be discussed Admin support requirements can be discussed ·Suite facilities include new reception/ waiting room, kitchenette/break room, treatment rooms For more details or to view, contact Johan on 6166 3751 or jm@thebonejoint.com.au

PERTH Lot 3 / 140 Mounts Bay Road, PERTH Mount Medical Centre - RARE OPPORTUNITY MMJ Real Estate (WA) are pleased to present to market this rare opportunity to buy this 76sqm medical consulting suite located on the third floor within the Mount Medical Centre.

Key Features: • Strata area of 76sqm • Fully fitted with reception, meeting room and main consulting room • Small storage area • Kitchenette • Corner position with good natural light • Views towards Kings Park • 2 secure undercover car parking bays This unit is situated within a prime location adjacent to the Mount Private Hospital one of Western Australia’s leading private providers of Cardiology and Cardiac Surgery.

For more details or to inspect contact Tom Prout on 0434 746 259 or tom.prout@mmj.com.au

SOUTH LAKE Medical Rooms Available for Specialists and Allied Health Lakes Shopping Centre, Shop 2, 620 Northlake Rd, South Lake WA 6164 • Available for ALL Specialists and allied health professionals.

Opportunity to become a part of the GP clinic / support.

• Consulting rooms, reception/waiting area, kitchen/breakout area, store records room, and other zones.

• These consulting suites are situated on the ground floor of the medical practice.

• Pathology on site (Clinipath) • Room Sizes: – Room 3: 3.5 x 3.4 meters = 12 Sq m – Room 4: 4 x 3.2 meters = 12.8 Sq m – Room 5: 4 x 3.2 meters = 12.8 Sq m • Rent hourly and full time available.

• Rent negotiable.

For Further details and enquiries please contact p.manager@southlakefamilypractice.com.au or 08 9417 1009 PERTH INNER CITY & EASTERN SUBURBS Mature-aged Male Australian born & Australian Trained G.P. seeking full time work in Perth inner city Eastern suburbs.

Strengths include holistic care, computer literacy, and attention to detail.

Sees 4 patients per hour.

English and Yugoslav speaking.

Email gp@qld.red

MOUNT PLEASANT Queens Road Surgery is a busy GP owned general practice located in Mount Pleasant.

We are looking for a VR GP to join our well established practice.

We offer a supportive team based culture, experienced administrative staff and quality full time nursing support.

Queens Road Surgery is a fully equipped accredited practice.

For a confidential discussion please contact our Practice Manager Narelle 0412 113 584 or narelle@queensroadsurgery.com.au

SCARBOROUGH Doctor Opportunity at The Woods Medical Centre We are looking for an enthusiastic and experienced GP to join our growing team.

The Ideal Candidate: Strong General Practice Skills: • Proven experience in providing highquality patient care across a diverse range of medical conditions • Excellent clinical skills and a commitment to preventative healthcare • Experience in managing chronic diseases effectively • A keen interest in skin cancer management preferred but not essential. We offer a unique opportunity to combine comprehensive general practice duties with an opportunity to develop skin cancer screening and procedures for that candidate with skin cancer management interest.

Team Player and Communicator: • Ability to collaborate effectively with a supportive team of healthcare professionals.

• Excellent interpersonal and communication skills to build rapport with patients.

Essential Requirements: • FRACGP qualification • Vocational Registered • AHPRA registration.

What We Offer: • Supportive and friendly work environment with a focus on work-life balance • Nursing support • No weekends or afterhours work • Modern facilities and equipment • Best Practice software • Mentorship and training opportunities should you wish to develop skin cancer management skills • Opportunity to work alongside experienced practitioners in a collaborative setting • A location that is not far from the beach.

For more information or a confidential chat, please contact our Practice Manager at 0478 021 910 or email practicemanager@thewoodsmedical.com.au

CONNECT WITH US

NEDLANDS Hollywood Medical Centre Suite 36, First Floor, 85 Monash Avenue, Nedlands 87sq m – fully fitted, large reception, 2 consulting, 2 treatment & 2 store rooms.

Contact: Irene 0409 688 339

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

classifieds@mforum.com.au (08) 9203 5222

www.mforum.com.au

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

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medical forum CLASSIFIEDS

Consulting Suite in Murdoch Square State of the art new building in Murdoch Square precinct Well appointed with dedicated reception area Sessional or permanent lease available

Contact Michelle Cooper – Practice Manager 08 6183 1945 or admin@perthpain.com.au

FOR SALE

23 & 25 Mills Street Cannington Directly opposite Bentley Hospital

Combined land area = 2033 sq meters. Combined price is $2.5 M +GST 25 is a “Fini” built for purpose Medical Centre comprising a large waiting room, office space, 2 consulting rooms, minor theatre with change rooms, kitchen, and laundry facilities. 11 car bays.

25 Mills St. was built with the intention of expanding on to 23 Mills Street.

Contact Dr Tony Taylor – 0418 945 047 or thuff.t@bigpond.com for brochure of Plans and further information.

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

HERE FOR GOOD

Built To Care

GP Opportunities & Practice Acquisitions Jean Paradise 0400605529 Damian Green 0423844268