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Caring to the End t Home Care: Consumers Rule t Training & ‘Dud’ Doctors t Ebola and Bullying t Art of Ageing t Clinicals: Stroke; Vertigo; Sarcopania; Resistant Bugs; Brain Exercise & More…

November 2016 Major Sponsors

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Relative Values A little book called Matthew’s Story landed on the desk last week which sparked a challenging conversation about values – what values underpin our society, our government, our health system. That’s not bad going for a 14-page booklet. Matthew’s Story is an anonymous piece being distributed far and wide by Children’s Equity, a charity formed last year by Perth physician Dr Michael Watson to make life easier for disadvantaged children, focusing on kids with developmental challenges and ear problems in remote communities. So what’s different about this story from all the other hearttugging stories we see every day in the media? Well, I guess it’s because it has no intention to tug at your heart strings. It doesn’t seek your pity, nor does it seek your cash. It simply wants you to question. What does an individual have to do or be in order to be considered simply themselves and valued as such? It is a serious question for our times. To retell the story here would diminish its impact; it would also be difficult not to resort to the very labels it sets out to challenge. We live in a world of labels which distinguish whether we belong or not. But to what do we belong? And who makes those decisions of whose labels are ‘in’ and whose are not? This is the reality of our world in 2016 where fear, rather than kindness, controls our values and decision-making. The health profession is a rare beast – doctors set out on their life’s work with these words ringing in their ears: “Into whatsoever houses I enter, I will enter to help the sick”. It underpins the core value of health care for all. ‘Regardless of your label, if you’re sick, I will help.’ Even though we are likely to fall short for a whole lot of reasons, it remains at the heart of a caring profession. That’s immensely powerful and yet so many things get between the healer and the sick. Matthew’s Story identifies ‘bureaucrats’ as one significant hurdle; there would be plenty of doctors who concur. The challenge for those labelled ‘bureaucrats’ is to construct policy that encourages good outcomes, while being flexible enough to acknowledge an individual’s right to be themselves, indeed, encouraged to be their very best self.

It was harsh and for many genuine public servants who work hard to make big systems work efficiently for the good of many, unfair. However, in order to protect society from Matthew’s ‘bureaucrats’, who run amok with their rulebooks and clipboards, transparency and accountability become critical to maintaining our rights.

In this issue, we examine the early days of the Consumer Directed Care revolution in aged care, thought up by politicians and bureaucrats to solve some difficult problems, g for so many ageing namely the brutal cost of caring Baby Boomers and creating new ways to care that would maintain some of their rights while addressing basic needs. And what an eye-opener it was to learn how organisations, many notfor-profit and religiously underpinned, are approaching the prospect of a deregulated and commercial marketplace where once stood an institution.

Ms Jan Hallam

Some in the aged care sector are even starting to re-evaluate the label ‘care’. They say the health system is paternalistic and has for too long being doing things ‘to patients’ rather doing things ‘with patients’ and the label ‘care’ robs the consumer of any say in their own lives. That’s a big leap but you get the idea!

In December, a copy of Matthew’s Story will be included with your magazine. Please accept it as a gift of the season. We think it has value and values to share, which may make a difference to the way we view the world and the people in it who are simply trying to be their best selves. Please pass it on to someone. By Jan Hallam

In 1949, as the icy winds of the Cold War blew across the world, George Orwell published the dystopic novel Nineteen Eight-Four and astounded the world with its bleak outlook on an individual’s frail chances of maintaining any sense of personal freedom in a world run by bureaucrats.

PUBLISHERS Ms Jenny Heyden - Director Dr Rob McEvoy - Director ADVERTISING Marketing Manager (0403 282 510)


EDITORIAL TEAM Managing Editor Ms Jan Hallam (0430 322 066) Medical Editor Dr Rob McEvoy (0411 380 937)

Clinical Services Directory Editor Ms Jenny Heyden (0403 350 810) Journalist Mr Peter McClelland

Supporting Clinical Editor Dr Joe Kosterich (0417 998 697) GRAPHIC DESIGN Thinking Hats

NOVEMBER 2016 | 1

November 2016 12

Contents 14




FEATURES 12 Spotlight: Ms Anne Carey 14 Doctors Drum: Training and ‘Dud’ Doctors 18 Consumer Directed Home Care 26 Artists of the Seventh Age

LIFESTYLE 46 Soccer Dad: Dr Jeff Thavaseelan 47 Funny Side 48 Social Pulse: GP16, Rotary 49 Wine Review: Rockcliffe Wines

NEWS & VIEWS 1 Editorial: Relative Values

50 51 52 52


6 6 10 25 26 36 44

Jan Hallam Letters to the Editor Being the best GP you can be: Dr Frank Jones Coaches should lead the way: Ms Amy Dyer Hitting the Funny Bone: Dr Izaak Lim Curious Conversation: Dr Ben Hewitt Have You Heard? Advanced Planning Lessens Suffering Targeting Tinnitis Beneath the Drapes Preventing Falls


Perth Pathology


Dr Martin Buck Theatre: Avenue Q Music: The Messiah Music: Welcome to Wagner Review: Cole Dr Lin Arias Competitions

Get the Spirit in Medical Forum’s



Clinical Contributors


Dr Tony Barham Barrett’s Oesophagus


Clin A/Prof Timothy Bates Preventing Stroke


Dr Astrid Arellano Resistant Gram Negatives


Dr Sean Maher Exercising the Brain


Dr Michelle Lai Timing Residential Care


Dr Sergio Starkstein Managing Adult Autism


Prof Gunesh Rajan & Dr Vincent Seet Vertigo Diagnosis & Management


Dr Angamuthu Arun Vulvodynia

FIND US ON FACEBOOK & TWITTER! /medicalforumwa/



Dr Rita Malik Sarcopaenia – How Important?

Guest Columnists


Dr Siany Hopkins Let’s Talk About It


Dr Chris Fox GPs and the Aged


Dr Natalie Ward No Progress Without Research


Capt David Martin Inflight Emergencies

INDEPENDENT ADVISORY PANEL for Medical Forum John Alvarez (Cardiothoracic Surgeon), Peter Bray (Vascular Surgeon), Chris Etherton-Beer (Geriatrician & Clinical Pharmacologist), Joe Cardaci (Nuclear & General Medicine), Alistair Vickery (General Practitioner: Academic), Philip Green (General Practitioner: Rural), Mark Hands (Cardiologist), Pip Brennan (Consumer Advocate), Olga Ward (General Practitioner: Procedural), Piers Yates (Orthopaedic Surgeon), Stephan Millett (Ethicist), Kenji So (Gastroenterologist) MEDICAL FORUM NOVEMBER 2016 | 3

Letters to the Editor

change, a number of tenets of our existing system should be incorporated into the new revalidation approach, with a focus on continuous improvement and lifelong learning.

Being the best GP you can be Dear Editor, The Medical Board of Australia’s (MBA) August interim discussion paper on revalidation had several parallels with the work the RACGP had already undertaken to strengthen continued professional development (CPD) for general practice. The 2017-19 Quality Improvement and Continuing Professional Development (QI & CPD) continues our approach of providing opportunities for GPs to reflect on their current knowledge and skill base, and make appropriate determinations on possible improvements in accord with their patient needs and that of their own professional pursuits. The addition of a planning learning and need (PLAN) activity makes this possible in an electronic format the first time. A PLAN activity involves a comparison of individual skill and knowledge to that of the expected standard of the profession. PLAN and the revised QI&CPD program were announced at our annual conference GP16 in Perth. The MBA’s initial proposals, should they be implemented, will have long-term consequences for the medical profession in Australia – many positive, but others requiring careful appraisal and reflection. Revalidation has been gathering apace, most notably in Europe. Prior to 2000, only six of 18 European countries mandated a compulsory CPD system. That number has since increased to 16 out of the 18 countries. (The other two countries make use of an incentivebased program.)

Being the best GP you wish to be means maintaining skills and knowledge to the level required by the profession for unsupervised general practice, and also having the opportunity to pursue knowledge and skills based upon practice and community need, and personal aspiration. Dr Frank Jones, Immediate Past President RACGP ........................................................................

Coaches should lead the way Dear Editor, Re: ‘What is the Ultimate Elixire of Sport?’ (October issue), what is frequently talked about in the media is the need for antidoping organisations to improve and advance their ability to test for prohibited substances and use increasingly advanced technology and intelligent testing regimes. What is often overlooked is anti-doping education and promoting a culture of anti-doping in sport. The World Anti-Doping Code states doping is fundamentally contrary to the spirit of sport and to fight it Anti-Doping Organisations must develop and implement education and prevention programs for athletes, including youth, and their support personnel (e.g., coaches).

Although a form of revalidation will bring us in line with our international contemporaries, the RACGP believes any proposal must reflect the unique Australian health provision environment.

Researchers (e.g., Barkoukis et al., 2013; Whitaker et al., 2014) have argued for the merits of a preventative stance by fostering young athletes’ anti-doping attitudes, diminished willingness to dope, and efficacy to resist doping-related temptations early in their sporting careers.

The RACGP considers that before any

As architects of the talent development

Good people do not need laws to tell them to act responsibly, while bad people will find a way around the laws. Plato (427-347 B.C.)

SYNDICATION AND REPRODUCTION Contributors should be aware the publishers assert the right to syndicate material appearing in Medical Forum on the website. Contributors who wish to reproduce any material as it appears in Medical Forum must contact the publishers for copyright permission. DISCLAIMER Medical Forum is published by HealthBooks as an independent publication for the medical profession in Western Australia.

The support of all advertisers, sponsors and contributors is welcome. Neither the publisher nor any of its servants will have any liability for the information or advice contained in Medical Forum. The statements or opinions expressed in the magazine reflect the views of the authors. Readers should independently verify information or advice. Publication of an advertisement or clinical column does not imply endorsement by the publisher or its contributors for the promoted product, service or treatment.

environment in sport, coaches play a crucial role in shaping the psychological experiences and actions of athletes. Under the WADC, part of the role of coaches is to educate and counsel athletes regarding anti-doping policies and rules, and use their influence on athlete values and behaviour to foster anti-doping attitudes. Coaches are uniquely placed to influence athletes’ attitudes and behaviours and reduce the risk of doping. Encouraging coaches to talk about anti-doping with athletes and maximise the effectiveness by which they communicate these messages is key to protecting clean sport. Led by Prof Nikos Ntoumanis of Curtin University, a group of internationally recognised experts in anti-doping, motivation and applied psychology are developing a coach-based program to prevent current and future willingness to dope in adolescent sport. The project, CoachMADE, is funded by the International Olympic Committee (IOC) and involves researchers from Curtin University (Australia), Leeds Beckett University (England), and Aristotle University of Thessaloniki (Greece). The results of CoachMADE will enable more efficient and evidence-based educational programs and campaigns to prevent doping through athlete support personnel. Coaches of athletes aged 14-18 years are being invited to take part by contacting or visit Ms Amy Dyer, Research, Curtin University ........................................................................

Editorial Comment Readers have asked about Major Sponsors… Major Sponsors of Medical Forum magazine work within the WA medical community. Each strives to offer something extra to the medical profession and is happy to be involved with this reputable industry publication. Medical Forum was founded over 20 years ago by two people within the profession, and the improved quality and readership of the publication since then speaks volumes for all involved. Independence, dedicated WA focus, and ethical behaviour are the cornerstones of the publication’s success. Major sponsorships are offered on that basis.

advertisements comply with Commonwealth, State and Territory laws. It is the responsibility of the advertiser to ensure that advertisements comply with the Trades Practices Act 1974 as amended. All advertisements are accepted for publication on condition that the advertiser indemnifies the publisher and its servants against all actions, suits, claims, loss and or damages resulting from anything published on behalf of the advertiser. EDITORIAL POLICY This publication protects and maintains its editorial independence from all sponsors or advertisers.

Advertisers are responsible for ensuring that

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News & Views

Hitting the Funny Bone A psychiatric registrar hits the boards to tell a cabaret audience some of the tricks of the trade – and how doctors are people too! “I loved theatre in school and then I became involved in cabaret and storytelling. My family has always been very supportive of the arts, my brother is a talented organist and my sister is an excellent dancer.”

One reviewer of Dr Izaac Lim performing Hamlet said he’d “turn up to watch him recite the phone book”. Izaac’s show, Malpractical Jokes, with its behind-the-scenes glimpses into the humour, absurdity and pathos of medical moments, promises to be far more interesting that!

“Our mother gets a lot of joy seeing us create something unique and she always comes to my shows multiple times.”

“It’s no secret that most people are curious about just what happens inside a hospital. This show goes one step further by lifting the lid on what might be happening inside the mind of a doctor.” “There are some funny moments but essentially this taps into the absurdity of it all, that life is a bit of a joke and sometimes we, as doctors, also feel like a bit of a joke. I hope there’ll be some emotional resonance with these stories and that the audience will see that we’re neither gods nor robots.” “I want people to know that doctors are mere human beings with flaws and quirks just like everyone else. And I’m aiming to entertain people, too!” The psychiatric registrar currently based at Albany Hospital readily concedes that medicos often see the raw side of life and sometimes it’s not all that amusing.

Dr Izaak Lim performs at the GP16 in Perth. Pic: Courtesy of RACGP

you’d cry. It’s well known that a lot of doctors develop a protective black humour because we’re often dealing with extreme situations.” “Sometimes it’s difficult to believe what happens out there in the real world. We see the ‘pointy’ end in a hospital environment and sometimes you come across things that are so terrible, so sad and yet there’s humour there too.” “I think it’s important to acknowledge just how uncomfortable we feel sometimes, and that life is essentially pretty absurd.”

“There are funny things that happen all the time in medicine. And there are others you just have to laugh about because if you didn’t

Izaac is the first doctor in his family but the artistic gene runs like a thread through the Lim clan.

Isaac certainly doesn’t regard medicine as a ‘second career’ and he’s under no illusion regarding the difficulties of the ‘creative’ life.

“I love my job as a doctor and I could never be a full-time artist. It’s a really difficult way to live with all kinds of uncertainties and genuine talent doesn’t always bring success. Nonetheless, the arts are important to me and I intend to keep that very much alive.” “I’m hoping this show at the Maj will humanise the doctor/patient relationship and enrich people’s understanding of just what’s going on in the consultation room.”

By Peter McClelland ED: Izaak performs Malpractical Jokes: A Medical Cabaret, at Downstairs at the Maj, November 3-5

Curious Conversations

Swimming with the Sharks If Dr Ben Hewitt decides on a career change, it’ll be safe for all of us to go back in the water The worst memory of my school days is… I don’t have any bad memories from school. It was pretty easy back then, there were no ‘parent projects’ and you weren’t judged by how many orphanages you visited. You were given a text book, you learnt it and reproduced it for the exams. If I could have one moment of glory on a sporting field… I’d love to win the Rottnest Swim because that would mean I’d beaten my brother, Tim. This is very unlikely to happen as I’ve undoubtedly entered a downward physiological spiral. My parents gave me… a set of golf clubs, which was the worst present I’ve ever received. After many years of a ‘hate/hate’ relationship with

6 | NOVEMBER 2016

these torture sticks I abandoned them in a golf course car park. They’re probably bringing pain and unhappiness to someone else now. I love orthopaedics because… it’s simple. The majority of problems we deal with are straightforward and our patients get better. We only really get into trouble if we try to fix the unfixable or operate when it’s not necessary. If I hadn’t chosen medicine I think I’d have made a good… professional shark fisherman. We have an acute shortage of these highly skilled men in WA. My new career, combining my love of fishing and my dislike of sharks, could only have a positive outcome.


By Dr Tony Barham Tony is a graduate of the University of Newcastle. He moved to Western Australia in 2000 to commence specialist training in pathology, receiving his FRCPA in 2005.

Perth Pathology (Perth Medical Laboratories Pty Ltd APA) 152 High Street Fremantle WA 6160 26 Leura St, Nedlands WA 6009 Ph 9433 5696 Fax 9433 5472

Tony's interests include skin, gastrointestinal and gynaecological pathology. He has been a consultant at Perth Pathology since 2011.

There are 52 collection centres across inner and outer Perth, Mandurah, and Secret Harbour. Please refer to the website for opening hours and addresses

Barrett’s Oesophagus Barrett’s oesophagus represents an adaptive response of the oesophageal mucosa to chronic reux-related injury. Its signiďŹ cance lies in the fact that it is the only recognised precursor of oesophageal adenocarcinoma. Management of Barrett’s oesophagus has progressed signiďŹ cantly thanks to therapeutic advances, but incompletely resolved issues remain. In Barrett’s oesophagus, the normal squamous epithelium is replaced by metaplastic columnar epithelium. For diagnosis, the alteration must be visible endoscopically and conďŹ rmed histologically. Similar to US practice, in Australia the metaplastic epithelium must be of intestinal type to be regarded as Barrett’s oesophagus. (British authorities continue to regard any type of metaplastic columnar mucosa as Barrett’s, but only intestinal metaplasia clearly predisposes to carcinoma.) Although intestinal mucosa comprises several different cell types, in the oesophageal setting essentially only goblet cells are relevant – the terms intestinal metaplasia and goblet cell metaplasia can be considered synonymous. Carcinoma arises in Barrett’s oesophagus from a progressive series of genetic events that manifest histologically in the form of dysplasia. Patients with conďŹ rmed Barrett’s oesophagus therefore enter a program of endoscopic surveillance, allowing risk assessment and early intervention.

Surveillance biopsies are classiďŹ ed as either negative for dysplasia, low grade dysplasia (LGD) or high grade dysplasia (HGD). In some difďŹ cult cases, it is not possible to be certain if dysplasia is present or not. In this situation a provisional diagnosis of “indeďŹ nite for dysplasiaâ€? is made. LGD confers a risk of progression to either HGD or carcinoma of approximately 1% per year. A diagnosis of LGD hence warrants increased surveillance (intervention may later be considered if LGD persists and is multifocal). On the other hand, HGD is associated with an incidence of carcinoma of at least 6% per year, necessitating deďŹ nitive treatment. Follow-up of a diagnosis of indeďŹ nite for dysplasia may vary depending on the endoscopic or histologic ďŹ ndings pertaining to a particular case, but generally includes increased surveillance. Research continues into other factors that may assist in prediction of progression, such as the extent of dysplasia. Unfortunately, histologic diagnosis and grading can be problematic. Potential areas of difďŹ culty include: sĂĽ h2EACTIVEvĂĽATYPIAĂĽDUEĂĽTOĂĽINmAMMATIONĂĽVSĂĽ true dysplasia sĂĽ ,'$ĂĽVSĂĽ('$ sĂĽ ('$ĂĽVSĂĽEARLYĂĽINVASIVEĂĽCARCINOMA sĂĽ2ECOGNITIONĂĽOFĂĽLESSĂĽ common variants of dysplasia (e.g. foveolar) sĂĽ)NTER OBSERVERĂĽVARIATION

Oesophageal biopsy containing metaplastic columnar epithelium. Numerous goblet cells are present (intestinal metaplasia), conďŹ rming Barrett's oesophagus.


There have been multiple attempts to develop ancillary techniques such as immunohistochemistry to assist in the diagnosis of dysplasia, but none have proved satisfactory. At present, the gold standard remains morphologic assessment. Like most laboratories, we routinely show abnormal biopsies to other colleagues with expertise in GI pathology.

The treatment of HGD and early invasive carcinoma in Barrett’s oesophagus has been transformed by the development of sophisticated endoscopic techniques. Lesions previously treatable only by oesophagectomy are now routinely managed by endoscopic mucosal resection and radiofrequency ablation. Multiple trials have shown that these procedures are effective in the treatment of HGD and early invasive carcinoma, with low complication rates. Incomplete response or recurrence of Barrett’s oesophagus (with or without dysplasia) is not uncommon, however, necessitating ongoing endoscopic surveillance.

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Letters to the Editor


It's All About the Patient As an early-career dentist, Dr Siany Hopkins suggests that better communication between doctors and dentists would benefit everyone, patients most of all. I was told a somewhat disturbing story recently by a fellow dentist regarding a frustrating encounter he had had with a local GP. The dentist was treating a patient who required a tooth extraction and was taking one of the newer anticoagulant medications. The current Dental Guidelines are quite specific regarding the required protocols when treating patients who are taking Warfarin, but the general recommendation for newer medications is to consult with the patient’s doctor. So the dentist wrote to the patient’s GP and again, a week or so later, when the initial contact was ignored. He followed this up with a phone call, was assured by the receptionist that the GP had received the email and would reply the same afternoon. The day of the extraction duly arrived and the GP still hadn’t responded. So, quite literally, the dentist decided to take the matter into his own hands. He walked into the surgery and handed the letter to the doctor. I’m not suggesting that this story reflects the usual practice of all GPs. In fact, I’ve found most to be very helpful and prompt to respond to my queries. And that’s coming from someone who works part-time in the public health system with patients who have complex medical histories requiring both chemotherapy and/or blood work.

On a broader scale, the above anecdote highlights the importance of inter-disciplinary communication between health professionals. When I studied at UWA, the medical, dentistry and podiatry students all commenced their studies together. While some dental students found diabetic ulcers disturbing and future podiatrists couldn’t handle looking at photos of periodontal disease, it was patently obvious that there are more similarities than differences between our professions.

a commitment to form open and productive relationships.

What is abundantly clear is that the patient’s best interests should always be our prime concern.

Common, recurring questions and ongoing issues could be aired in a collegial manner. And, who knows, there may be the added bonus of forming a professional network or two?

Perhaps it was less than desirable when these undergraduate degrees began to diverge down separate pathways. By the time I graduated I didn’t know any of the students graduating in other health areas. I think it’s important that we, as a younger generation of health professionals, begin our careers with

And compared with our older colleagues it’s probably much easier for us because email and related social media make contact simpler and almost instantaneous. It’s just so easy to keep lines of communication open. We’re all required to complete ongoing education so wouldn’t it be beneficial to have a multi-disciplinary ‘talk-fest’ every so often?

The medical sector is constantly changing, new medications are being introduced and antibiotic resistance remains an issue. Pooling our knowledge and engaging in open communication can only benefit our patients.

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Have You Heard?

Revalidated and Disrupted The hour-long member forum at the GP16 in Perth tackled the big issues of revalidation and digital disruption – an ambitious plan by anyone’s reckoning. The 30-minute digital discussion got bogged down in a 10-minute lamentation over the apparent phasing out of faxes, which left tech innovator and panellist Dr Marcus Tan a little bewildered. Yes, the profession has that far to go before it gets into coo-ee distance of the 21st century. Revalidation fared better. When MC Ali Moore asked WAGPET CEO Dr Janice Bell if she thought the Medical Board of Australia had made its case for revalidation her one-word answer – NO – brought the house down. The new College president Dr Bastian Seidel told the forum the College would work with the MBA on its revalidation quest but only to ensure common sense prevails. A no might be simpler.

It’s virtually a reality Jim is an elderly Australian farmer with mild dementia. He’s also an avatar with 50 different verbal and non-verbal responses and lives entirely in his own virtual world. Even so, some Curtin University Psychology and Speech Pathology students think he’s better than the real thing when it comes to learning how to communicate with patients. A study led by Dr Janet Beilby investigated undergrads self-rated communication skills, knowledge, confidence and empathy. After 30 minutes with either a current nursing home patient, an older actor trained to portray an elderly patient or Avatar Jim, Jim got the thumbs up. He apparently presented a communication challenge and students thought that was more realistic. Students had to work harder to build rapport and empathy because they couldn’t use comforting cues. “We recently gave Jim an avatar wife, Moira. They live together in an independent unit in an aged-care facility. While Moira mostly placates Jim or pulls him into line, she can also pose other challenges for students – not only having to deal with a patient’s reaction, but also the reaction of the patient’s carer or loved one,” Janet said.

Rural policies are working “General practice is not the sewer for people who think they can get a job there if they can’t get a job anywhere else.” That was the gauntlet thrown down at the last Doctors Drum forum on doctor training. This sentiment appears to be confirmed by the news from WAGPET that of the 1500 positions advertised this year, 170 remain unfilled because there weren’t enough good applicants. It was better news at GP16 with the launch of a WAGPET commissioned report by Kim Snowball revealing that more specialists were heading


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Have You Heard?

bush (numbers up 25% from 2007). Sustained investment in education and training has been the driver along with Royalties for Regions money rebuilding and upgrading country hospitals. However, GP proceduralists remain the backbone of country medical services, the report said. Reliance on overseas recruitment has also fallen. In 2005, 70% of procedural doctors were recruited from overseas and in 2015 this had fallen to 45%. For the ďŹ rst time, locally trained doctors were making up the majority of new arrivals into rural practice.

Anxiety over genital normality Back in May, we looked at the growing demand for female genital cosmetic surgery and now a survey of 443 GPs published in BMJ Open shows that a third of them had been asked for referrals by girls under 18 for genital cosmetic surgery. Lead author Dr Magdalena Simonis said girls as young as 15 were undergoing labiaplasties and other procedures, even though the medical consensus was that female genitalia did not reach maturity until around the age of 18.

At least half the requests came from girls and women whom GPs considered emotionally vulnerable, suffering from anxiety, depression, relationship difďŹ culties or body dysmorphic disorder. “There’s an epidemic of anxiety about normality,â€? she said. The study identiďŹ ed fashion, online pornography, perceptions of beauty, as well as brazilian waxes as playing a major role in forming women’s idea of ‘normal’. As of October 1, the Medical Board advises that girls under 18 receive mandatory counselling and a three-month cooling-off period.

Sugar-coated stats We took a second look at a media release sent early August by the Public Health Association (PHA), just after the report, Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011 was released by the Australian Institute of Health and Welfare. Diet, it said, had been underplayed as a contributor of the burden of disease, estimated at 7.2% of the 31% of preventable disease factors that include diet, tobacco use, alcohol use and physical inactivity. It went on to say that the Australian Bureau of Statistics (ABS) has assessed dietary intake directly against dietary recommendations and found only 4% of Australians ate enough nutritious food such as fruit and vegetables, grains, lean meats and dairy foods. ABS said a third of daily energy intake in the same survey came from discretionary food and drinks, yet PHA said that 75% of young people aged 9-18 regularly exceeded the WHO advice that free sugars should contribute less than 10% of total energy intake. There is such big disagreement

between these ďŹ gures we can only assume we are waiting for the obese kids to reach ‘burden of disease’ age before the ďŹ gures blow out. PHA suggests action like a sugar tax on soft drink, additional support for the Health Star Rating on packaged foods; and a comprehensive National Food and Nutrition Policy.

Path labs handover Ownership of 19 of St John of God Pathology’s laboratories and 180 collection centres in WA and Victoria transferred to Clinical Labs on October 10. SJG Health Care will hold a minority shareholding in Clinical Labs and CEO Dr Michael Stanford is on its board. The labs will operate under the SJG brand for up to 12 months until the company is fully integrated. Clinical Labs have a long-term contract with SJG hospitals for pathology services.

Protecting the vulnerable Submissions to the Australian Law Reform Commission’s inquiry into Elder Abuse have closed and on December 12 a set of proposals for law reform will be launched. WA Police and Advocare were among the local submissions. The inquiry will head to Perth again at the end of January for a new round of consultations and submissions on the actual reform proposals close on February 27. A report will be delivered to the Attorney General in May. See inquiries/elder-abuse/submissions

Best Practices


1300 728 133 www.mediďŹ


NOVEMBER 2016 | 11


Battling Ebola and Bullies Esperance RN Anne Carey has battled disease threats in developing countries all over the world but some time the hardest battles are closer to home.

The effects of systemic workplace bullying was the catalyst for WA Australian of the Year Anne Carey to fly to Sierra Leone and work for the Red Cross during the Ebola crisis. It was a dangerous and distressing time in West Africa, but the shadow of a bigger battle loomed large. “I’d honestly have to say that trying to negotiate my way through the experience of workplace bullying at the Esperance Hospital was a lot harder than dealing with the Ebola crisis. When someone in charge is denying a problem even exists there’s no possible way to move forward,” she said. “In some ways I feel fortunate to have had the Esperance experience, it certainly gave me a dose of added courage and that helped me through some tough times in West Africa.” “I’d had seven years of very happy work at Esperance before a new management regime made life hell for me and many others. I put in a formal complaint fully expecting to be treated with integrity and achieve a resolution that contained some degree of justice but I don’t think the current system is capable of producing an outcome like that.” “It was a very difficult period and the Health Department was taking an inordinate amount of time to process my complaint so I volunteered to go to West Africa in 2015.”

“After that, I spent time in the Tiwi Islands and One Arm Point in the Kimberley. It’s so sad to see the ongoing problems of indigenous health, they’re so entrenched and it’s affecting generation after generation. I think any form of solution lies in better education and improved communication. It’s absolutely imperative that Aboriginal people are involved in the process. A lot of money has been thrown in and a lot has been wasted.” “If we’re to have any hope of closing the gap we need to fully involve the people concerned and that means talking with indigenous Australians.” The Ebola crisis of 2015 figured prominently in our media and provided some pretty graphic footage. Anne was well aware of the dangers before she left to work in the treatment centres, so much so that she thought the outcome could have been highly problematic. Gotta go, get away “It was seven months into the workplace complaint process and I’d pretty much had enough so I put my hand up for the Red Cross position in Sierra Leone. There was a great deal of fear generated around this disease, much of it well deserved.” “At times, I honestly did wonder if I’d get back to Australia because there was no real capacity to evacuate if I contracted the disease.”

Answering the call in PNG Anne’s background was in nursing and midwifery within a missionary order in Papua New Guinea where she spent 18 years before leaving to do similar work in remote areas of the Northern Territory. “I’d always wanted to do that sort of thing so I went to the Central Provinces region. It was a very isolated and remote village and some of the people walked six hours to get to us for medical treatment. It’s a dangerous country. I was held up a few times on the road to Port Moresby and I was very lucky not to be physically assaulted.”

12 | NOVEMBER 2016

“The first hour in the treatment centre changed everything for me. A two-week old baby boy bled to death in my arms while his mother was sitting there in front of me. That was her seventh child to die from Ebola.” “The mortality rate was pretty close to 80%, which was just horrendous.” “All the people working in the field were so passionate about beating this disease and it was wonderful to be part of that. It was a privilege to go, and so inspiring to see the selflessness of the people who went there to help.”

“We won the battle in the end.” On her return to Perth, Anne found there was another hurdle to negotiate. Overreaction at home “I was disappointed with the bureaucratic process when I came back to Australia. At one stage, despite the fact that I had no symptoms and I was well beyond the contagious period, the health authorities wanted to put me in isolation, forcibly if needed.” “There needs to be a lot more support in place for aid workers when they return to Australia.” Anne’s role as WA Australian of the Year isn’t over yet and will see her stepping on to podiums across the country to spread the message. “I’m doing quite a lot of speaking around WA and then it’s on to Melbourne to spread the message. It’s important to bring about change in the area of workplace bullying and I’d like to see it put on the same platform as domestic violence. The suffering inflicted can be enormous.” “After that I’ll be back in Esperance. My partner, Donald Howarth, has set up a new GP practice and they need a Practice Nurse. And that’ll be me, for the time being.”

By Peter McClelland

As Medical Forum went to print Anne advised us that an external consultant found the bullying charge fully substantiated. Anne spoke in Melbourne, Ballarat and Bendigo on both Ebola and Workplace Bullying. She is now working as a Practice Nurse in Esperance and will be giving the Red Cross Oration at the University of Tasmania in December.


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‘Training and Dud Doctors’

It was a provocative title and it elicited some provocative discussion at our 10th Doctors Drum forum. The term ‘dud’ itself came under scrutiny but the meeting agreed with our surveyed doctors and the medical trainers who had been in our ear – that underperforming doctors were getting through the system. So was it having an effect on the image of doctors in the community and how does the profession propose to deal with ‘dud’ doctors? The answers were complex and with several trainers, a lawyer, a recent postgraduate and a consumer rep on the panel, the ideas came from many angles, however, if one word summed up the entire discussion it was communication – both on a personal and professional level. Without good communication skills, doctors would not be “competent, caring, compassionate or resilient”. The panel thought doctors’ good image was safe but there was no room for complacency. The answer really depended on who you asked. Patients almost universally would say ‘no’, especially those who interacted well with their doctor, whereas aggrieved patients or the media would say ‘yes’. But doctors subject to a complaint perhaps beat themselves up too much over just one unsatisfactory patient interaction: “High achievers and high performers can be very self-critical when someone responds to them in a difficult way,” said one panellist. And to solve the problem led us back to training.

Medical School: The Weeding Process

quotas and revalidation, because those are the doctors we really want.”

Ideally, it is at medical school the wheat from the chaff should be sorted. One senior trainer and panellist said high demand for places meant the rigorous stages of selection, instruction and assessment eliminated many candidates – but there was always room for improvement.

A director of medical education on the panel believed we shouldn’t undersell the current selection processes, they were rigorous and – “what we are ending up with is a cohort of high-achieving people, who mostly perform at a wonderful level.” He predicted that in the future there would be more multi-station interview panels to get the widest possible view of the candidate.

Communication skills were at the heart of the current selection process. The UMAT test which gauges interpersonal skills, empathy and personal understanding was tripping up many of the 1200 applicants for the 60 places at one medical school. And responding to an earlier Doctors Drum meeting when it was suggested that potential financial and legal consequences of failing non-performing students were frightening some trainers off, he said students would fail if they “demonstrated their inability to perform or were inappropriate” but every attempt to remediate poor students would be made. The room was asked what the qualities were of a good doctor. SMART, COMMUNICATORS, CARING, ADAPATABLE, PASSIONATE, ENERGETIC, RELISIENT, CLEVER, RESPECTFUL, DEDICATED were the responses. So how, asked one guest, do universities “find people with that spark and passion for continuous learning; who will be self-stimulated rather than being driven by things such as

This was music to the ears of the consumer advocate, who thought a consumer rep should be on the selection panel so that doctors of the future will not only be “clever people who can pass tests but people who can deal with the whole person they will eventually be seeing and who will also be able to ask for help if they need it.” She went on to call for medical students to have greater access to real patients with real problems before they left the classroom. From her experience, a lack of courtesy and helpfulness and poor health communication were responsible for most consumer complaints. By giving students exposure to patients early, she said, would help them learn to listen and understand the person sitting in front of them. Recent figures which showed Australia enjoyed one of the highest doctor-patient ratios in the world brought one doctor to his feet questioning the validity of our apparent shortage of doctors. The response from the

Supported by:


14 | NOVEMBER 2016


panel suggested that WA was adrift from doctor numbers in the Eastern States and we also had a serious distribution problem. Apparently there’s a ratio of four GPs in the Western suburbs to one in the Eastern Suburbs and rural and remote areas were still seriously under-doctored. “We need to find appropriate ways to channel post-grad training in such a way that working as a generalist (surgeon, physician or practitioner) in those areas is seen as a suitable career.”

Postgraduate Training: Crunch Time The critical clinical years of training became the hot topic of the morning – it was in these years the cracks in the training system and the flaws in the individual would become most apparent. So how are these flaws identified, remediated or removed? One young doctor on the panel said the increasing numbers of post grads was severely reducing the clinical opportunities for junior doctors, which in turn led to early commitment to training pathways because of the pressure on RMO jobs. Early honest mentoring was paramount if trainees were to address their flaws early, before training starts in earnest and mediation is required. One doctor questioned the all-round preparedness of junior doctors. She had “grave concerns” about the reduction of faceto-face training with a growing online focus, and important areas of medicine were not getting the attention they deserved.

A hospital trainer on the panel said there were gaps in the system where junior doctors were more likely to see a lung transplant than someone who needs a pap smear. “Some of that training and how registration is achieved will need to be defined because exposure to some procedures in a tertiary hospital will be quite limited, particularly as hospitals become more specialised.” He added community medicine as part of an internship was bound to happen. For now, rotation to hospitals around the state was being used to help close those gaps.

doctors. The struggling learner, whether it be in maths or some element of clinical training, needs scaffolding.” Team-based structure was lauded by the lawyer on the panel who said it was the very thing that held up when things went awry. Trust and team building One doctor voiced his concern about the reluctance of junior doctors to seek help

Need for outcomes en an engineer and A panellist who had been e doing medicine a maths teacher before ch could be learnt told the forum that much acher education. from the structure of teacher nical exposure The competition for clinical and experience meant a junior doctor could graduate withoutt experience in a number of areas. gameWhile some were not “gamechangers” she felt that every rotation nstrable needed to have demonstrable o support our outcomes. “We need to g them some junior doctors by giving d learning will structure. Standardised es for our produce great outcomes

See See www ww w.d doctor t d


NOVEMBER 2016 | 15

‘Training and Dud Doctors’

OTDs and should we be looking to hire more Australian-trained doctors?

recounting just 6% of 60 junior doctors present at another forum said they would approach their supervisor for support. How, he asked, could that culture be changed to encourage people who needed help to seek it from the right people? Mentors and peer support were the common suggestions along with regular feedback from consultants and registrars. Is it time for 360 assessment? [360 is a form of assessment where feedback on an employee’s performance is elicited from subordinates, peers and supervisors, as well as a self-evaluation by the employee themselves.] The panel generally favoured the process but it needed to be done sensibly and carefully to ensure it didn’t become destructive. For one GP on the panel, 360 gave him insight into how others perceived his practice. “Understanding what it means to the person you’re treating ensures that you are giving appropriate care.” However, it does require training. The lawyer on the panel said delivering feedback posed challenges for trainers. Done well the 360 scenario supported the messenger (we’re here

16 | NOVEMBER 2016

to help”) but there are legal challenges with bullying and harassment ever in focus. Training in general practice was brought into sharp focus with a doctor in the audience asking how it could be made more appealing to graduates rather than what he described as a default position. A representative from WAGPET made no bones about the fact that GP training selection was tough and uncompromising. Of the 1500 positions advertised this year, 170 remain unfilled because the quality of applicant was not there. “General practice is not the sewer for people who think they can get a job there if they can’t get a job anywhere else,” she said. Drawing students to general practice is an aim of the university trainer on the panel. “Most of the training is done in tertiary hospitals but most of the medicine is delivered in the community. Students need to spend more time with GPs.”

Continuous Learning: The Supervisor Lack of support for overseas trained doctors (OTDs) was raised and the questioner asked if complaints were proportionally higher for

Interesting, the three panellists who tackled this thorny issue didn’t have any facts or figures. One said we needed to do more training: anecdotally no one should be driving a taxi because they failed the exam and English as a second language should not be a barrier. Another panellist with rural experience said they preferred the term “unfellowed OTDs” – “we do have a problem in some rural and remote areas, which are hardest to staff, we take the doctors who are least experienced from overseas” – whereas greater respect to communities is shown if you can find the right doctor for the right area, who can practice with safety. Learning doesn’t stop at fellowship, though creating a culture of learning starts much earlier. Supervisors have an enormous role to play, in the pursuit of standards and lifelong learning according to one panellist. “Nurturing, professional development, supervision and passion are more important for shaping the future career of doctors than anything.” Performance management is a skill not many doctors are well trained in, said one panellist. Colleges are now mandating training for supervisors and a recent conference was convened to establish networks and peer support for GP supervisors. A good supervisor, said one panellist, needs training not to be hasty in passing judgement and in assessment must be spread across not just professional domains but other domains as well.


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NOVEMBER 2016 | 17


Hello Consumer Directed Care!


The aged care sector has often complained it is the poor relation, but government changes next year will see it become one of the most dynamic sectors in health. On February 27 next year, the vision of Living Longer, Living Better, introduced by the Gillard Government in 2011, reaches a milestone. On this date, the world of in-home care becomes a deregulated market and along with that revolutionary change comes stories of endeavour, frustration and, yes, excitement among the organisations which will be delivering the services. The area of most concentrated effort has been the cultural change necessary to transform these organisations – not-for-profit (and in some cases mission based), and for-profit – from care providers to a term now universally adopted, service providers. Their clients are now ‘customers’, who as of next year will decide which organisation provides what services with a budget in their control, subsided by Government, if eligible. Welcome to the world of Consumer Directed Care (CDC). Over the next several pages, Medical Forum retells the conversations with leaders of six aged care organisations to convey their individual stories of change and transition and what it means to them, their organisation, you and, most importantly, the ageing individual hoping to end their days in their own home. It is fascinating to hear how each organisation has set about facing the challenge, which one CEO described as the biggest social change since the introduction of Medicare. The policy has, since conception, had bipartisan political support – a concord that remains an island in a sea of political turmoil. It was popular for two essential reasons – it would save the Government billions as the country hurtles towards an aged care bubble brought on by ageing Baby Boomers and it was what the electorate resoundingly wanted. Votes and a money saver – what politician could ask for more? Over the interceding years, the Government has invested heavily in the MyAgedCare portal with the intention of it being the omnibus for individuals and their families on what will always be, at times, a difficult and tumultuous journey to end-of-life. Hopefully, Living Longer, Living Better will live up to its name. The MyAgedCare website probably does have all the answers, if you know the questions to ask and have the time to navigate through a labyrinth. If you haven’t had a play on this site, do. It is eye-opening and not just as a familiarisation to help your patients. With time’s winged chariot ever hurrying near, it can also offer insight for your own ageing plans. As the program hurtles on, it is expected to offer the transparency necessary in a free market to keep service providers on their game, including cost comparisons between

18 | NOVEMBER 2016

providers, and to keep consumers up-todate with policy changes and subsidy rates, which are reviewed bi-annually and aligned to welfare payments. The concept is based on the individual, their needs and wants to fulfil the goal of staying in their own home, so figures become a little meaningless until you nominate an income as a starting point. However, there are baselines and grades of assessed need. INCOME THRESHOLDS The income point where a co-payment will be charged Single...$25,792 Single, (separated due to illness)... $25,324 Couple...$40,050

HOME CARE PACKAGE LEVELS Subsidy rates paid per allocation day Level 1 (basic care needs)...$22.04 Level 2 (low care needs)...$40.09 Level 3 (intermediate care needs)...$88.14 Level 4 (high level previously Extended Aged Care at Home)...$133.99 ED: There are also subsidies for dementia, veterans, oxygen and feeding tubes.

The steps to get into the system are not complicated, but there are time delays to get ACAT assessment, which is necessary to instigate a care package. Anecdotally, the delays for ACAT assessment are between 6-8 weeks in WA, which is still receiving some state-funds until February. Wait times in the Eastern States are said to be much higher. This could simply be a bubble as people rush to get assessments done before February 27, but the Government will need to ensure there are enough assessors for future demand because unreasonable delays are critical for individuals and their families. However, service providers have indicated to us that interim help can be provided until an assessment was made. Here’s what some of them have to say. Mr Chris How, CEO Bethanie (NFP) Bethanie is doing a lot of work to reengineer itself to position itself in the market and to provide an awesome customer experience. At the same token, the world is not

Mr Chris How

going to stop turning come March 1. There will be a slow transition. We are applying the philosophy/approach of CDC across the board – to our retirement villages, residential care, home care and social housing. I find it really surprising that person-centre care is such a talked about topic. Who would have thought that putting the customer in the centre of their own care is so innovative! The customer should always be at the centre of your business. CDC is innovative only in the historical context of health care, which comes from a military model where medical and nursing care is regimented and task orientated. What that does is to create the patient as a passive participant – we ‘do to you, not do with you’. And that’s been translated to aged care. It is a paternalistic model. Changing government policy to deregulate the market and give funds to the consumer rather than the provider is the right model. We have to be flexible and offer services for various stages as people age. That’s at the heart of ‘person-centre care’, providing wants and needs for a particular stage of life. You can’t take a cookie cutter approach. Commerce comes to Aged Care CDC is making Bethanie more commercially astute and we are looking at other industries and how they do things and that’s no bad thing. There are commercial ways to influence your customer base, consider Qantas and its frequent flyer points. These ideas have been around for decades, it’s just that Aged Care has never thought that way. The Bethanie staff has been on a real journey with CDC for the past three years, especially as we come from a benevolent, church-based NFP space. We’re doing subtle things such as changing terminology. The collective term for our clients and residents is now ‘customer’. You can do interesting things around vernacular to change culture. Two years ago we would never have talked about sales and conversion rates and we are now and that slowly changes perception. It’s not confined to us – government is no longer talking about aged care funding, but rather aged care subsidy, which means the individual, if able, needs to put some skin in the game to get the care they need and we have to be able to advise them what their service options are. You can’t do that rapidly. Any provider who thinks they can change the culture of their organisation from one of benevolence to commercial sales in a short period will struggle. This doesn’t change our mission focus – we’re not looking at the commercial aspects to increase the bottom line, but to remain viable so we can maintain mission. MEDICAL FORUM


HERE It will be a challenge and we will be living in a washing machine for the next 3-5 year but we have a strong strategy that has positioned us well. Having that customer/hospitality approach to services is really where we need to be. When you think of the basic logic of that, how can that be wrong? Ms Michelle de Ronchi, COO St Ives (For Profit) About 18 months ago, St Ives sold its two residential facilities to grow services in the mobile and home-based businesses as the deregulation of the market presents opportunities.

One of the biggest challenges for this industry is workforce sustainability. We know that by 2050 we will need triple the workforce. The current Senate Hearing on the Aged Care Workforce is revealing the cracks and the real risks of casualisation of the sector. Unions want shifts of minimum four hours, while clients are now free to chop and change providers, because that’s their choice.

Ms Michelle de Ronchi

There have been huge changes for staff and consumers and there is a danger of industry fatigue. As of July last year we have transitioned about 1000 clients from the old world to the new world. That was bewildering for a lot of people. From a staff perspective, it’s all about looking at the client experience as the most important thing. If clients get a good service, staff are realising they will keep coming back. In the past, the system was very patriarchal: ‘We’ll send Lara to deliver your services and if you don’t like Lara well that’s too bad’. That’s not going to rub anymore because clients are paying for the service. There are potential risks of unscrupulous operators in a deregulated environment so people looking for services need to choose providers carefully. Look at those who provide transparency and haven’t just started up two months ago. Margins will be tight whether you are a for-profit or an NFP. We have invested in technology to help drive that consumer experience, developing a mobile app to monitor our service delivery. The biggest concern clients express to us is late service. Despite best intentions, traffic, breakdown etc can cause delays. Technology adds vale In the past we have relied on manual time sheets and hearing back from clients when something doesn’t happen, often well after the event. Now we have provided all 250 of our mobile staff in WA with a smart phone so any late changes and client alerts are logged into the app. When they arrive at the job, they scan a client barcode which tells us that the carer has arrived safely and updates the time sheet. If the carer has a problem getting to the job, we can alert the client immediately. There is accountability and support for everybody and allows us to stay in touch with our mobile workforce. These workers are undervalued by society yet they do a tremendous job. They work alone and are sometimes the only people our clients see during the week. Educating the public has landed with the providers and our liaison staff work with MEDICAL FORUM

clients and families to help them navigate the system. St Ives has also had booths in shopping centres, visited GP practices and pharmacies. A lot of people even those health professions don’t really understand what these changes have meant. At least we have been able to direct them where to go. CDC is a positive for GPs who are able to keep patients in their homes.

About 80% of my staff is part-time but if we are locked into minimum four hours, it will drive us to put people on casual contracts and that starts another ball rolling. We are competing for staff against acute, disability and residential aged care and we don’t have the population growth to go on. The community needs to embrace aged care. In the recent election, aged care didn’t crack a mention even though it is a $3.1b industry. The sector needs to be acknowledged and valued and deserves more funding than the prisons. Ms Anne-Marie Cox, Silver Chain General Manager, Social Care (NFP) In July 1 2015, the world of Consumer Directed Care in Home Care Packages came to our clients. The first wave of change was about choice and control but Ms Anne-Marie Cox I like the word participation – participating in how they want services deployed and for them to know how much their care costs – to themselves and to the provider.

The second wave peaks on February 27 with full market deregulation of Home Care Packages where the client has total choice of where they would like their money to go. And so the market is changing with competition and new market entrants and brands popping up. The challenge for us over the past 12 months has been educating clients and encouraging them to take their time to understand what’s right for them so their package can reap the full benefits to help them lead their best life at home. Organisations are creating new troubleshooter roles to help clients navigate the system and we seeing the emergence of private businesses operating purely as aggregators of services. Lots of different solutions are starting to emerge. Clients have to be able to trust whoever they sit down with. It’s not a 30-minute conversation. We don’t think that anyway.

Helping clients, carers and their families to understand what’s available and how that affects their life goals takes time and understanding over a number of conversations. When a GP has a patient in need of help, the first thing they need to know is how to access support. Doctors may refer patients to an ACAT and once the assessment is done, a level of care is approved. Eligibilities withstanding, from February 2017 clients will go into a prioritised queue, which the government will manage (the sector hasn’t been informed yet how prioritisation within that queue will be managed). Then depending on your prioritisation, sometime later you get your referral code and have 56 days to choose a provider. I’m sure there will be complexities, particularly in rural and remote settings where clients might not have a choice of provider because the cost of care delivery is much higher, which should not, but will naturally disadvantage those clients. From the moment of entering a service, it is the responsibility of service providers to start building relationships with their clients. Silver Chain has home care and health care divisions, which includes our well known palliative care services, so we can stay with a person all of their life. The next few months will be tricky as we move to that February deadline so clients need to be kept in the loop. Some have the benefit of time, others don’t so it’s important to encourage clients to educate themselves beforehand. Things are changing quickly and so can people’s circumstances. They are the vulnerable ones. CDC should be about building capacity in clients and improving supports to stay independent at home and their budget should be working towards their goals, not just their immediate needs. Ms Jenny Lawrence, CEO, Brightwater (NFP) If you look at the aged care and disability sectors – and we have businesses in both areas – we are living through the biggest social Ms Jenny Lawrence change in Australia since the introduction of Medicare. It’s a very positive change but organisations like ours, and we are not any different from any of the others, have got to respond on a number of fronts.

CDC is a completely new way of thinking. We are working with our staff, some who have been with us 40 years, to support them through the changes. The cultural changes are huge. We have to look at our staff culture;

continued on Page 21

NOVEMBER 2016 | 19

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HERE continued from Page 19 how staff interacts with our clients; how attractive we are to clients – we haven’t had to do that before.

have been working hard to attract staff to the sector and have been innovative in attracting younger people.

We’ve also got to look at the systems and processes we have. So while we have good computer systems they have worked for a different model. We are looking at a customer portal so that clients can log in and look up how much money they have left in their package and then they can communicate with us to let us know how they want to spend it.

Our inter-professional student programs involve students enrolled in medicine, nursing, dietetics, physiotherapy and OT from three universities. It’s a positive way we hope to change perceptions of working in this industry and given that 60-70% of our business costs is staff, it is a priority to keep people happy and well paid and safe in their jobs.

I agree with the change. Once I get to the stage where I need support, I will want to be able to manage my care and my money. Right now the system in WA is still transitioning with the number of packages still licenced by the Government and allocated to various states. Until it becomes fully deregulated, there will be waitlists. Clients hold purse strings Clients will manage their packages and want more control over who comes into their home. They will also want to decide the means by which they remain independent. We’re seeing people choosing to spend their money on things we didn’t expect. One person wanted to buy a Thermomix. If you have arthritic hands and you can’t chop your food, something like that makes a big difference to your life and your independence. There’s been very little government support for providers in the transition process. That means there are some advantages for the larger organisations as there is signiďŹ cant investment needed for new software, new processes, websites – but that’s what it takes in a more competitive world. We are creating a different industry. Workforce issues are substantial. It has stabilised post-boom but by 2050 the workforce in aged care will need to quadruple to cope with the Baby Boom demand. We

It’s my job to demystify the changes so staff can see things from the client’s viewpoint. There will be some people who won’t like working in that way but mostly people will embrace the change. Sometimes we think we know what’s best for the client and changing that attitude is the biggest challenge. The client will now direct care and we need to listen. If the client wants the lawns mowed rather than the bath cleaned, we have to accept that. To ensure needs are being met, we must build really good relationships with clients and families. We have coordinators who assess needs and talk to clients and families – that relationship is critical. Every so often it won’t work but more often or not we will be able to advise and negotiate. The CDC model is not unlike a hospitality model. It is about trust and relationships. Ms Stephanie Buckland, CEO, Amana Living (NFP) CDC in home care is probably just the beginning of aged are changes but they had to happen.


People are increasingly

Ms Stephanie Buckland

expecting to have a say in their own health care and are actively managing that care, so if they are requiring aged care services in general, we expect them to be more educated and savvy about their options. It’s important that consumers are aware of their rights and what services are available. Come March next year the consumer will be sitting with us at the table working through what is the best suite of services – what is the appropriate suite of services for that person? It’s an interesting question from an ethical perspective. The Government has strict guidelines as to what constitutes a service. One of the challenges from a government policy perspective is how will regulations change as the relationship shifts from one between provider and the government and the consumer and the government to simply consumers and the provider. Consumers will now be scrutinising statements and asking if they are getting value for money. Squeezing the little guys This new competitiveness in the market will put pressure on the smaller providers who are not going to stay competitive. Government is reducing barriers to entry so there will be more entrants in the market but there will also be winners and losers. With more elderly patients staying at home, GPs have an important role to play in their continued management. One of the things that we’re doing with home-care clients at the top level is to coordinate what we’re doing with the care plan of the client’s GP. We are working on a pilot project with Telstra to enable our home care coordinators, clients and doctor to connect so there can be a three-way consultation, which at the moment isn’t very practical. But there are challenges ahead. Recent cuts continued on Page 23


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HERE continued from Page 21 to the aged care funding instrument need to be analysed and home care funding needs to be increased. The most effective way to meet the care needs of our ageing population and reduce overall costs to the government, is to increase Home Care funding above the current Level 4 package. This will give more older people a choice to stay at home for longer. Mr Ashley Butler, WA Manager KinCare (For Profit) Kincare is a private family business established 25 years ago in NSW. It has been in WA since 2007 and it specialises in in-home care. We have about 500 customers Mr Ashley Butler in the WA market and employ about 225 people. We have a number of clients with complex care needs. We have invested heavily over the past 12-18 months to ensure that the customers are at the centre of care – and we have to acknowledge that care could be different for every person. We want Kincare to be an easy business to work with because it can be a convoluted space and we want to help people through the process, alleviate concerns and make it as simple as possible.

We have also invested heavily in employee engagement, training and educating our team about the important role they play. They see the customers every day of the week and can pick up changes in behaviour, in condition and really look for opportunities to engage with family to help them in changing circumstances. Our team is our single most important asset because they are face-toface with the customer every single day. It is an exciting time for in-home care – it is the future. The customer base want to stay at home for as long as they possibly can. A person looking to go into residential care pays a bond of $400,000 perhaps $600,000 or there is an in-home care provision option where you can access Government funds and supplement the number of hours. The cost of a residential bond would give you a lot of in-home care services for a lot of years. Family top – up packages For family not living close to ageing parents, adding an extra $100 a week can increase inhome care and make those family members more comfortable about being away from their parent. In April this year we launched Value Packs at various levels which can drive up 20% additional value. There is a built-in contingency for emergency but the extra hours in the packs allows more activity such as social networking, IT, home maintenance etc. Customers get a clear statement so they know where their money is going and it allows us to lock in staff because we know what services that customer will be receiving.

We are also working on a health package which would include nursing services. Contingencies would be built into those packages depending on how many hours of nursing is required. Currently we have a demographic which doesn't spend and takes the bare minimum but that market will definitely change in the next 5-10 years when we see the Baby Boomers needing care. They will drive value on their packages. It will be a different dynamic and we must remain nimble as we approach different scenarios. Delays in assessment have seen us working on a transition package. On March 1 there will be more flexibility where if someone has a sudden ‘life event’ and the hospital is looking to discharge, we can put services in to help tide them over until they are assessed and approved. Then they can decide who will provide the services going foreward. If it’s Kincare, great, if not that’s OK too at least they have received services that they needed when they needed them. We are starting to stretch out legs now and are forging good relationships with local GPs, not just with the referral processes but feeding back some of the health information we have collected from clients via our MyKincare app. That’s the kind of social support that people are looking for.

As told to Jan Hallam

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Guest Column

Advanced Planning Lessens Suffering Albany physician Dr Kirsten Auret writes here about her team’s research into advanced care planning and the good news is … it works. I’m a physician living in Albany, which means I may look after a person from first presentation of nasty symptoms, supporting their disease management to maximise quality of life and on to providing palliative care at the end of their life. This kind of practice has inevitably meant some of my patients have experienced medical crises before communicating what they would have us do in such circumstances and suffering unnecessarily. These clinical experiences dovetailed with a growing interest in advance care planning (ACP) and the passage of Western Australian legislation in 2010 that strengthened the law around end-of-life care provision. At about that time, my colleague, psychologistresearcher, Dr Craig Sinclair, joined me in the Rural Clinical School of WA. Hence the start our small team’s wonderful five years of researching ACP in the Great Southern.

Research nurse Ms Jill Thomas, Dr Kirsten Auret, Dr Craig Sinclair and research nurse Ms Fiona Williamson are involved in the RCS study into advanced care planning.

Going through the steps We have come to regard ACP as a health behaviour where patients may be more or less ready to engage in such types of conversations and documentation based on their particular illness experiences, their culture and their social circumstances. Framing ACP, like we do smoking cessation, with a change model in which people may be in precontemplation, contemplation, preparation, action or maintenance phases has been supported by our discussions with elderly residential care patients, those with cancer and those cared for in general practice. A simple prompt to consider ACP coming from a trusted doctor, especially following a change in health such as a new diagnosis or a recent hospitalisation seems to be a quick way of moving some patients into contemplation or action. Equally there are a minority for whom ACP is really ‘not for them’ and they are unlikely to ever engage in the process, rather preferring to leave management decisions at times when they may be unable to speak for themselves to the family or doctors. Our work in the Noongar community and with Dutch and Italian migrants suggest that ACP is a safe topic across these cultural groups but there may be differences in how people would like these discussions to occur and how willing they are to express and document individual preferences. Cultural and social factors As an example, the Noongar people we spoke with said that it was important that ACP was understood as being something “for all Australians” and that such conversations were first raised in safe, community-based settings, rather than when a person was


acutely unwell and perhaps isolated in hospital. Exploring how ACP best happens in rural general practice and hospitals shows us that there is keen interest in ACP and that most healthcare professionals in our region feel that the GP is a central facilitator of the process. Interestingly there are quite clear gaps between discipline groups in regards to who does what. No one seems to feel it is his or her role to ensure documentation is appropriately distributed or intermittently reviewed. Something that clinical teams still need to thrash out in their own contexts!

We are now seeing that engagement with clinicians about ACP has gradually resulted in changed culture and practice The Albany hospital has been a great collaborator and, through working with frontline staff, we have successfully created a locally accessible electronic register of ACP documents, which means it is much more likely that a patient’s plan will be available to the treating doctor in a timely manner. We are now seeing that engagement with clinicians about ACP has gradually resulted in changed culture and practice, with ACPs being done earlier and with patients themselves participating (rather than just their family) and the content of ACP documents being referenced in the clinical decisionmaking record.

Negotiating through conflict At times, ACP can be a tricky process to negotiate, especially if there is family conflict, and we’ve found some things that help. The first is that some of the skill set used by professional mediators in interest-based negotiation can be used successfully in the clinical context. This supplements the skills we are taught about breaking bad news and running family meetings. The Respecting Patient Choices model of using a trained nurse facilitator to provide time and practical assistance to patients and families in completing ACP does work in our setting and has been particularly successful in a recent project based in rural general practice and in the tertiary hospital setting. Helping a vulnerable cohort We are now completing a three-year study with Dr Fraser Brims’ group at SCGH Respiratory Unit looking at ACP in severe respiratory disease. The ‘surprise question’ was asking if the doctor would be surprised if a particular person died within the next 12 months. It has helped us identify a very sick cohort with over 30% not living out a year. We have clearly demonstrated that the nurse facilitation model does increase uptake of ACP in such patients. We look forward to reporting on the health-related quality of life, satisfaction with care and actual end-of-life care experienced by our participants. As part of this work, we will also be able to explore the health economic impact of ACP within our state health system. Important results are anticipated!

NOVEMBER 2016 | 25


Never too Old for an Artistic Life A collaboration between dementia patients and artists has produced outstanding results and hours of pleasure for all. A creative collaboration between Amana Living and Black Swan Portraiture Prize is a win-win for everyone. Amana residents have enjoyed workshops and screen printing sessions to create Andy Warhol inspired self-portraits, some of which will be exhibited in the Perth Cultural Centre. Amana Living Enrichment Manager Ms Emily Scarff is doubly pleased with a project that forms part of the Amana Spring Arts Festival. “It’s been a wonderful partnership, the first

time for both organisations to team-up in this way. Black Swan has never been involved with an aged care group before and this is the first time for us to be involved in an artistic endeavour.”

mentor our residents but they also speak passionately about their work and that’s taken this project to a new level.” Enrichment rocks!

“We expected a few hiccups but we’ve been pleasantly surprised.”

“Our residents quickly realised that this was a lot more than their usual Thursday morning craft activity!”

“There’s nothing particularly new about offering arts and crafts to older people but what’s different here is that we’ve got professional artists sharing their skills. They

The importance of enrichment programs can’t be overstated, says Emily. But the storm clouds of economic rationalism loom large.

Targeting ‘Ringing in the Ears’ Tinnitus is associated with deafness and can be helped by hearing aids, which is probably why many think of tinnitus as affecting just the elderly. Sure, age-related hearing loss and exposure to loud noise are predisposing factors. However, according to the Australian Tinnitus Association, around 20-30% of people experience tinnitus at some point in their lives, at any age, and it is persistent in about 10% of Australians. Australian Hearing hold regular workshops for tinnitus sufferers: this month’s meetings are November 23 (Bunbury) and November 30 (Busselton and Mandurah). Those with

26 | NOVEMBER 2016

tinnitus or their carers can attend (phone 97921200) – sessions are free and most appropriate for those over 18 years. The technologies available and suggested lifestyle changes are discussed. We know tinnitus is more common in people with a hearing loss or other ear problems but it can occur in people with normal hearing – annoying tinnitus can lead to fear, anxiety and depression, with frustration from poor concentration or hearing. How an individual thinks and feels about tinnitus is important. From the doctor’s perspective, some medications can cause or worsen tinnitus (see – aspirin, quinine,

aminoglycoside antibiotics, diuretics and some cytotoxics are the most well-known. Other common suggestions for management include avoiding silence, doing things to keep calm and relaxed, and limiting caffeine. Removing excessive earwax can also help. Patients can ask for online advice from an audiologist and get other information at As an aside, we are told celebrities that have suffered from tinnitus include Liza Minelli, Bob Dylan,, William Shatner and Barbara Streisand.


“I see my role as an important one, enabling older people to live the second half of their lives in the best possible way. It’s all well and good providing nursing and basic needs care but that needs to be complemented with meaningful activities that enrich lives.”

Emily Scarff

“That’s why this partnership with Black Swan and the artwork that’s coming out of it is so important.”

“This is a sector that has the potential to be severely affected by funding cutbacks and enrichment programs may well end up being first in the firing line. The market economy is becoming increasingly deregulated and while it hasn’t hit residential aged care quite yet, it will do.”


Everyone is welcome Emily tells the story of one woman who benefited from the inclusiveness of the Black Swan/Amana art program. “This person heard the group laughing and joined us at the table. She’s severely vision impaired and would often miss out on some of the activities but we were able to tailor the screen printing by talking about images and colours. She was actually able to ‘feel’ the ink sliding over the screen.” “My background is in occupational therapy so I try to look at ageing in a holistic way. I spend a fair amount of time thinking about that and it’s certainly given me a greater appreciation of my own grandparents.” Ms Tina Wilson is the Executive Director of ARTrinsic, the not-forprofit organisation behind the Black Swan Portraiture Prize, and is a passionate advocate for the visual arts in WA. “We approached Amana with the idea of doing these workshops and it’s turned out to be something exceptional! Amana also sponsors the People’s Choice Award, which encourages people to visit the exhibition and that, in turn, creates healthy debate and community engagement.”

Tina Wilson

“Anything that raises public awareness of older people is good because they’re often not given much prominence in current society.”

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“I haven’t got parents in aged care so I’m not too familiar with this area. It was wonderful to walk in and see the residents engaging with something that was obviously bringing interest and joy to everyone in the room. One lady was proudly holding up a pillowcase with her face on it and showing it to everyone!”

In Areas of:

“The faces of older people have so much character and that intensifies with age.”

x Paediatrics

Tina, an artist herself, sees the spin-offs from creative expression in highly social terms. “I see portraiture as a real opportunity to build a sense of community. In so many ways, it’s really all about people. When visitors come into a portrait gallery it generates so much conversation, the paintings tell human stories.” “So much of today’s world is obsessed with 10 second soundbites and a collaboration such as this is all about making long-term connections between people.” “I hope this project raises awareness and appreciation of older people. It’s so important to get their stories out there and give them the respect they deserve. We’re all going to be old one day!”

By Peter McClelland


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NOVEMBER 2016 | 27

28 | NOVEMBER 2016


Guest Column

GPs and the Aged It’s not all doom and gloom treating the elderly, suggests Dr Chris Fox. And there’s the added bonus of valuable insight into our own lives. As GPs we see patients of all ages but, if you stay in one place long enough, the appointment book fills up with lots of elderly patients with complex problems. We see them quite often and become familiar with their histories, their personalities, their foibles. If we’re doing our jobs well, they place trust in us and we become an essential support in their lives, particularly as they become frailer. And that’s a salutary reminder that we’re all on the same chronological conveyor-belt. So it makes sense to treat our elderly patients as we would like to be treated. Our youth-obsessed culture tends to view ageing as a descent into infirmity, ineptitude and irrelevance. Government health departments and medical insurers have a tendency to quantify the cost of the ‘Aged’ in monetary terms. If we look at the cost of health care in an average person's life, the bulk of it is concentrated in the autumn years and even more so in the last few weeks of life. We’ve all seen elderly people who see

Our youth-obsessed culture tends to view ageing as a descent into infirmity, ineptitude and irrelevance.

themselves as a burden to society. It’s hardly surprising that depression is relatively common and we, as GPs, need to be careful that we don’t confuse it with cognitive impairment. And yet there’s a tendency for some elderly people to try and hold on to the past with a thoroughly natural yearning to retain all the vigour and relevance they can muster. This can translate into a fear of change leading to a reluctance or refusal to comply with treatment regimes. We’re all well aware of the rising tide of geriatric Baby-Boomers but it’s important to acknowledge that every ageing patient is unique. Clear communication with a healthy dose of empathy is absolutely indispensable,

particularly when we have to strongly suggest that having a driver’s licence may not be such a good idea. I've worked in palliative care with Silver Chain Hospice for many years and it has strongly influenced my work as a GP. Here’s one story that’s instructive. A woman in her 90s with dementia was referred to the service. She was living in an aged-care hostel, her family was distressed to find her continually agitated and she felt that no-one really cared about her. A few years previously, she’d said that she wouldn’t want ongoing treatment if the quality of her life had diminished. Consequently, the family wanted us to cease her medication and allow her to pass away peacefully. The only trouble was that with the support from our service and the residential staff she brightened up considerably. She became more engaged, was clearly happier and ended up being discharged from the hospice. And that leads me to one of the positive aspects of our job as GPs. Sometimes we’re able to tell an elderly patient that they’re doing fine and just go out and enjoy life! MEDICAL FORUM

NOVEMBER 2016 | 29

Guest Column

No Progress Without Research Volunteering for medical research is a “win-win” for all concerned says Dr Natalie Ward from the School of Biomedical Sciences at Curtin University. Medical research is an important and necessary part of our health system. It’s a fundamental tool for driving change and underpins major advances in modern medicine. Clinical trials form the basis for the development of new therapies and treatment options, and often have the added benefit of exploring important preventative measures. There are many different reasons why an individual might volunteer for a medical research study. They often do so because they want to improve their own health and there are others who hope that the findings may help someone else, too. Altruism, in other words and that’s a very good reason. Medical researchers are always grateful to see a volunteer walk through the door. They make a valuable contribution to every project and, just as importantly, they get something back in return. Some of the benefits include a comprehensive medical review including an ECG and blood analysis over a lengthy period, depending on the nature of the study. Participants in research are also more aware of their own health and also more attuned to any significant changes. One of the real

If a change in medication implemented by an individual’s GP compromises the integrity of the research study, then, such is life! pluses is that feedback on health status, from blood analysis to diet, is sent to the volunteer’s GP as well. However, despite this ‘win-win’ scenario, recruiting volunteers for medical research is frequently a long and difficult process. Understandably, study-specific exclusion criteria often limit those who can take part in a particular study but there’s also an underlying lack of awareness regarding the importance of medical research. There may even be some understandable trepidation that studies may actually be harmful or have unintended consequences. Any person considering putting their name forward should be assured that strict protocols are in place and ethical considerations have been rigorously assessed

before a clinical study is implemented. And, of course, any vested commercial interests linked with a particular study are openly discussed in the initial stages of every research program. When a person volunteers for any form of medical research they should do so knowing that every precaution is taken to ensure that the process is both safe and potentially beneficial. Furthermore, all volunteers are monitored throughout the study and any adverse events are noted and prompt action taken. Any treatments are only administered after extensive background checks and researchers would always consult with a participant’s GP about these matters. If a change in medication implemented by an individual’s GP compromises the integrity of the research study, then, such is life! So for all the GPs out there, if any of your patients express an interest in volunteering for a medical research project there’s really nothing to lose and, potentially, a lot to gain for everyone!

BreastScreen WA is going paperless for GPs I’m excited that BreastScreen WA is changing the way they communicate with GPs. Shortly, GPs will receive the majority of correspondence (patients’ normal results and screening reminder letters) by electronic secure messaging. If you do not wish to receive your patient’s screening mammogram results electronically please email BreastScreen WA at

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30 | NOVEMBER 2016


Guest Column

The Sharp End A lot can happen when you're 10,000m above the ground. An inflight medical emergency conjures up a variety of scenarios, says Capt. David Martin. We’re sitting there, five miles above the earth, and hoping that today is not one that goes horribly wrong. Modern aviation is safe and highly routine, however, when problems occur things can turn pearshaped rapidly. Engine failure or fire, severe weather and turbulence are some of the scenarios that spring to mind but an inflight medical emergency poses some interesting dilemmas. There’s the balancing act between aircraft safety and the convenience of other passengers compared with the health concerns, often serious, of one individual. When someone is unwell and flying at a relatively high cabin altitude (possibly several hours from an airport let alone a hospital), the decision-making process can be problematic, at best. In the course of my airline career I’ve had to deal with medical issues from scuba-diving related Bends, to seizures, hypoxia and significant cardiac events. I’ve even heard another aircraft reporting an on-board brawl to Air Traffic Control (ATC) and requesting a medical team and police to meet the aircraft on arrival.

woman had gone into labour. We placed her in a more comfortable crew bunk and considered our options. Fortunately the weather was fine and there were a number of suitable alternate airfields along the east coast. We prepared for a potential change of destination and made radio contact with the RAAF Senior Medical Officer.

Here’s the balancing act between aircraft safety and the convenience of other passengers compared with the health concerns, often serious, of one individual.

We were able to listen to the ongoing dialogue between patient and doctor and descended to a lower altitude to minimise the time required to divert to an alternate airfield. All the time this was going on I wondered if I’d be the first Hercules captain to announce that the number of persons on board had increased by one!

I also know of at least one inflight suicide attempt, unsuccessful thankfully. And, of course, people do die. The cabin crew are then faced with the unenviable task of securing and screening the body in an often crowded passenger cabin. Flight attendants have basic first-aid certificates, there’s on-board medical oxygen and most airline operators carry a portable defibrillator. Before I joined the airlines I was in the Royal Australian Air Force (RAAF) flying C130 Hercules aircraft and one day, flying between Sydney and Townsville, we were presented with the following situation. I was advised by the loadmaster that a

Fortunately, the patient’s condition stabilised and we continued on to Townsville. An ambulance and medical team met our aircraft and took the woman to hospital. Later that night, we were informed that she’d been suffering from anxiety and stress and hadn’t gone into labour at all. Nonetheless, we weren’t to know that at the time and decisions had to be made. The buck stops with the captain and it’s my name on the flight-plan.


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Clinical Update

Preventing stroke


By Clin A/Prof Timothy Bates Medical Head of Stroke Service SJOG Midland Age is undeniably the greatest risk factor for stroke. Whilst non-modifiable, it reminds us that choices made in early life can have consequences later. All the risk factors mentioned below contribute to the increased stroke risk through all age groups, but especially older people. Risk factors explained

While the ED neurological disability that comes from stroke is well known, the ageing population means there is growing emphasis on identifiable risk factors. So what interventions work?

Hypertension is the leading modifiable risk factor for stroke and has multiple ways of causing stroke, including small and large vessel cerebrovascular disease, atrial fibrillation and left ventricular dysfunction. Recent trials have given discordant findings as to the degree of blood pressure lowering required for benefit. A pragmatic individualised approach of life style modification (e.g.; salt restriction, weight reduction) and medication to reach a systolic blood pressure of under 140mmHg is reasonable.

Lifestyle factors account for much of the observed modifiable stroke risk. Tobacco consumption, excessive alcohol intake, poor diet, lack of exercise and increased waist to hip ratio all increase stroke risk, and can also lead to other vascular diseases and malignancies. Abnormal lipids are a stroke risk factor, but are relatively more important in coronary artery disease. Consider treatment in those who qualify for lipid lowering therapy as per current guidelines. Although diabetes is a significant stroke risk factor, treatment hasn’t been shown to be significant in terms of stroke reduction, unlike microvascular complications of diabetes. Either way good control of diabetes should lead to stroke reductions. Atrial fibrillation (AF) is often protean and undetected until the time of stroke. Many AF strokes sit at the more severe end of the spectrum and frequently in elderly people. We need to identify and anticoagulate as many with AF as we can to prevent stroke including the elderly with a reasonable quality of life. Antiplatelet agents are not a suitable alternative. Post-stroke interventions Medication nonadherence is endemic worldwide. It is estimated that up to two thirds of patients discontinue their cardiovascular medications after stroke. Merely increasing compliance would lead to substantial reductions in all types of vascular disease. Finally, there is another prevention strategy. Many people can’t recognise stroke and have no idea what to do with someone having one. The NSF FAST (Facial weakness, arm weakness, speech disturbance, time to act) message is an easy way to educate patients. If people arrive at hospital early they may be able to access reperfusion therapy such as thrombolysis and clot extraction, which are both effective, but time dependent (preferred within 4.5 hours).



by Medical Director PROF JOHN YOVICH

Ovarian stimulation ... gentler, safer with targeted efficiency PIVET has been exploring treatment algorithms aimed at gentler stimulation for younger women with high ovarian reserve and stronger dosages for those, often older cases, with low ovarian reserve. Our latest rFSH dosing algorithms have recently been published in the prestigious journal Drug Design, Development and Therapy (2016:10 2561-2573). With the aim of collecting around 10 oocytes per case (a safe number to avoid OHSS; ovarian hyperFig 1: Proportion responding without stimulation syndrome), dosage increase. it shows that 24% of women respond well to dosages under 150 IU, whilst 48% of women require more than 300 IU to attain the appropriate response (Figure 1). World-wide the standard dosing schedules range from 150 IU to 225IU for most Fig 2: Egg numbers across all ages 20-51 clinics but egg numbers recently reported years. exceeded 15 in 38.2% compared with PIVET’s 11.6% (p<0.0001) which means most women outside PIVET are given dosages excess to need. OHSS has been an unpleasant side-effect of ovarian stimulation from the outset of using gonadotrophins in the 1960s and many women have required admission for complex IV fluid management along with paracenteses to drain ascites and pleural effusions as well as managing increased coagulopathy in extreme cases. Until recently most clinics reported 5-10% severe OHSS cases, and mortality has sometimes resulted. These cases were mostly associated with high oocyte retrievals (>15 eggs) and often highorder multiple pregnancies in the early period of ovulation induction. In Australia these problems have been controlled by ancillary strategies including a freeze-all policy when oocytes exceed 20, an uncommon event at PIVET nowadays (Figure 2). Applying the PIVET algorithms, OHSS is a rare event, occurring only when clinicians “over-ride” the algorithm dose trying to appease patients who believe their best hope is in “pushing the boundary”, an outmoded idea. PIVET continues to have results in the highest quartile for frozen embryos (Top of the Wazza) whilst collecting around 10 oocytes per case.


Author competing interests: nil relevant disclosures. Questions? Contact the author 9462 4000.


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NOVEMBER 2016 | 35

Clinical Update

Resistant Gram negatives - a growing threat Since the early days of penicillin we have assumed infections are treatable and curable but we cannot be so confident now. Resistant Gram negatives have arrived in our community and are here to stay. Without a serious effort from every prescriber to change how we use antibiotics the future looks grim and we risk a return to the pre-penicillin era of people dying from untreatable infections.

Antibiotic resistance is a growing global problem and dealing with it appropriately requires a major shift in professional behaviours.

Her gut will continue to be colonised with an extremely resistant organism, with no effective eradication treatment. What happens when this E.coli acquires a carbapenemase plasmid that renders meropenem ineffective? And how did she acquire such a resistant organism, given she had never been in hospital and had no prior medical history? This organism is already in our community. Rapid resistance spread Enterobacteriaceae acquire resistance genes on plasmids that spread between organisms rapidly. Previously susceptible bacteria are


over 50%. There have been outbreaks of highly resistant Klebsiella sp. in Victorian hospitals traced back to individuals who travelled to Italy and Greece. With frequent travel overseas, many resistant Gram negatives are imported in peoples’ gastrointestinal tracts.

Case in point Recently I saw a young woman with pyelonephritis from an extended-spectrum betalactamase (ESBL) E.coli resistant to all antimicrobials, except carbapenems. Given there was no oral option for her treatment, she was hospitalised and received meropenem, usually a ‘last resort’ antibiotic for the most resistant of Gram-negative infections. While she recovered, this story has some pessimistic overtones.

By Dr Astrid Arellano, Infectious Diseases Physician, Palmyra

GNR infections have higher mortality and morbidity rates (18-48%). Even in less severe infections, morbidity and costs can be higher because parenteral therapy is needed when no oral options are available. rendered resistant. More than one plasmid can spread at once rendering several classes of antibiotics useless in one bacterial interaction. Billions of bacteria colonise our gut and resistance plasmids spread quickly within and between people, so that resistant Gram negatives (GNRs), for which there is no effective eradication therapy, become part of the individual’s normal flora. Most GNRs are acquired and circulate primarily in hospitals and aged care facilities. This case heralds a scenario feared for years - highly resistant Gram negatives in the community. Australian rates are low but have doubled in eight years to around 4%, while South East Asia rates of carbapenemresistant E.coli (CRE) are 25-40%, and the Indian subcontinent and China have rates

Solutions in our hands A multi-pronged approach is needed. Most important is the practitioner’s ownership of the problem, asking whether an antibiotic is really needed. We hear how “just in case” antibiotics are prescribed without a clear infection diagnosis, when in reality very few people become septic in a timeframe that does not allow appropriate action. Harm is done by exposing the person’s colonising flora to multiple broad spectrum antibiotics – emerging resistance precludes antibiotic use when really needed. Studies show that up to 50% of antibiotic prescribing is incorrect. Aged care facilities have one of the poorest prescribing practices. Each year 50-75% of residents receive at

såBunbury GP Dr Andrew Kirke has joined the board of Rural Health West. såMs Malvina Nordstrom is the new WA state manager of IPN. såMr Paul Forden has been appointed to Executive Director for Fiona Stanley Fremantle Hospitals Group.

We are located close to the Swan River and offer a variety of specialties. Southbank Day Surgery has established an excellent reputation in the community for its high commitment to customer service, patient care and quality improvement.

såDr Ric Charlesworth (AO), Dr Jack Edleman (AM), Prof John Fletcher (AM). Dr Hannes Gebauer and Dr Diane Mohen were all recognised in the Queen’s Birthday honours in September.

We have undergone major refurbishments which include six theatres, CSSD and Dermatology and consisting of three procedural theatres. These are specifically designed to meet all Moh’s (Microscopically controlled surgical technique to remove skin cancers) patient needs. These have been designed to cope with the growing needs of the hospital and community.

såUWA medical student Will Crohan has won this year’s Alan Charters Prize for his essay on his overseas clinical placement in Lesotho. Meredith Cully won the WAMS Elective Photograph Competition for a picture taken during her placement in Timor.

Any queries please contact Bronwyn Grant on 0429 368 730 38 Meadowvale Ave, South Perth WA 6151 PH: 0893687344 WEB:

såDomestic violence survivor and advocate Dr Ann O’Neill PhD has been awarded the John Curtin Medal 2016 for her efforts in raising awareness and providing support to victims of family violence.

36 | NOVEMBER 2016


Clinical Update

Managing Infections by Multi-drug Resistant Gram Negative Bacilli Treatment

ESBL Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae

Mild illness e.g. cystitis (Must have symptoms of UTI, beware of asymptomatic bacteriuria which does not require antibiotic therapy)

Trimethoprimsulphamethoxazole or ďŹ&#x201A;uoroquinolone can be used if susceptible.

Always discuss with infectious diseases physician or microbiologist. Often no oral therapy available.

Severe illness requiring intravenous therapy (includes pyelonephritis)

Discuss with infectious diseases physician or microbiologist. Typically treated with carbapenem e.g. meropenem. Maybe aminoglycoside or quinolone, if susceptible.

Always discuss with infectious diseases physician or microbiologist. Requires specialised therapy.

McGreer infection criteria and only 20% had a microbiological specimen collected. Residents with impaired communication can have clinical deterioration without localising symptoms, making urinary tract infection difďŹ cult to diagnose. However, treatment of asymptomatic bacteriuria contributes to excess antimicrobial use in these facilities, as does inappropriately prescribed antibiotics for general deterioration of uncertain cause.


In this environment judicious antibiotic prescribing is likely to have the greatest impact and antimicrobial stewardship programs (required for hospital accreditation) will likely reach aged care facilities soon.

Plasmid: small mobile DNA package within bacterial cytoplasm containing resistance genes.

least one course of antibiotics. A recent Aged Care National Antimicrobial Prescribing Survey showed 70% of antibiotic prescriptions had no documented indication. In 60% there was no stop or review date. In one third of cases antibiotics were prescribed for longer than six months.

Antimicrobial use in our community is vast and extends beyond our prescriptions. Animal feeds and crops are affected in agriculture. National strategies now restrict agricultural use of antibiotics used in humans. There is also a push for a national database for antimicrobial prescribing, improving rapid microbiological diagnostics and reducing barriers for antimicrobial development.

Over 60% of residents did not meet

References available on request.

Extended spectrum beta-lactamase (ESBL): bacterial enzymes that confer resistance to beta-lactam antibiotics, including penicillins, cephalosporins and the monobactam aztreonam; Enterobacteriaceae: large family of Gram-negative pathogens such as Salmonella, Escherichia coli, Klebsiella, Shigella and Yersinia.

Carbapenem-resistant Enterobacteriaceae (CRE): Gram-negative bacteria resistant to carbapenem class of antibiotics, a class of drugs of last resort for multi-resistant Gram negative infections. ED: Pictures courtesy Dr Jonathan Chambers, Fiona Stanley Hospital

Author competing interests: no relevant disclosures. Questions? Contact the author on 9319 3811

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Fertility, Gynaecology and Endometriosis Treatment Clinic 38 | NOVEMBER 2016


Clinical Update

Exercise reduces dementia risk Dementia incidence in developed countries is falling! This has been attributed to better education building stronger neural networks, and better population control of cardiovascular risk factors. Smoking, diabetes, hypertension, obesity and physical inactivity are strongly linked to risk of dementia.

By Dr Sean Maher, Geriatrician, SJG Mt Lawley

We hear much ED about lifestyle modifications reducing dementia risk. What does the evidence tell us is good advice for patients?

One longitudinal study showed being overweight at 50 correlated with risk of Alzheimer’s Disease (AD). The higher the BMI, the earlier the onset of AD, and the greater the burden of beta amyloid seen on PET scans and neurofibrillary tangles at autopsy.

Another study showed that the fittest at age 50 had a 36% less chance of dementia than the least fit. Evidence shows improved cognition with exercise at all ages. Several randomised trials show significant cognitive benefits in older people undertaking moderate-intensity exercise for 150 minutes per week for six months, compared with gentle stretching exercise. Improvements are seen in executive functioning, and are durable, with benefits lasting for at least 12 months. Grey matter volumes on MRI improved and beta amyloid decreased. Which exercise? Resistance training benefits executive function while aerobic training improves verbal memory. Australian guidelines for physical activity recommend 30 minutes of moderate intensity aerobic activity (e.g. walking, swimming) on most days, and strength or resistance (e.g. weights) two days and including flexibility/balance activity where possible daily (e.g. tai chi, yoga). Further work is needed to provide the optimum balance of duration and intensity. Participating in cognitively stimulating activities and remaining socially engaged is associated with reduced dementia risk. Formal cognitive training can result in long lasting benefits. Evidence that it can delay dementia is limited. Social engagement is highly desirable for mood and quality of life. Consuming “brain healthy” foods and limiting unhealthy ones also has cardiovascular benefits. A 10-year study showed those with the best adherence to a variation of the Mediterranean diet, the MIND diet, reduced their AD risk by up to 53%. Modestly following the diet reduced risk by 35%.


Anne Gardner

Andre Wedekind

Post Dip. Aud., BSc

M.Clin.Aud., BHSc (Physiotherapy)

Dr Vesna Maric AUD., M.Clin.Aud., BSc (Hons)

The inner ear is particularly vascular and thus it is sensitive to poor cardiovascular function. Haemorrhagic or ischemic changes of the inner ear can manifest as a hearing loss with recent research indicating an initial decrease of low frequency hearing in such individuals. Cardiovascular risk factors coupled with an initial low frequency hearing loss may be used in the future to assist in ̅ii>ÀÞˆ`i˜ÌˆwV>̈œ˜œvV>À`ˆœÛ>ÃVՏ>À`ˆÃi>Ãi° Smoking and its effect on the cardiovascular system Ài«ÀiÃi˜ÌÃ>“œ`ˆw>LiÀˆÃŽv>V̜ÀvœÀ…i>Àˆ˜}œÃð-“œŽˆ˜} may impact the auditory system directly by its ototoxic effects, as well as indirectly by the vascular effects of smoking, such as increase blood viscosity and reduced availability of oxygen causing cochlear hypoxia. Smokers are 15% more likely to have a hearing loss than nonsmokers. The link of smoking with hearing loss risk has been shown to be dose dependant, so that the risk of hearing loss is increased in people who smoked more. Diabetes is known to be associated with cardiovascular disease. Uncontrolled type 1 or 2 diabetes can lead to angiopathy as well as neuropathy and these individuals are twice more likely to have a hearing loss compared to those without diabetes.

Multiple modalities is best

Hearing loss cannot be attributed to diabetes alone because of other compounding variables (presbycusis or noise exposure for example). However, the pathogenic effects of diabetes on the ear are thought to be due to both angiopathic and neuropathic properties.

In a Finnish RCT, 1260 older people at risk of dementia were advised that diet, exercise, mental stimulation and social activities could reduce vascular risk factors and dementia risk.

High blood glucose levels associated with diabetes can cause damage to the small blood vessels of the inner ear, similar to the way diabetes can damage the eyes and kidneys.

The intervention group received an individual diet, physiotherapistguided strength and aerobic training, computer-based cognitive training, group meetings to increase social time and more frequent feedback from clinical staff about their progress. After two years, the intervention group increased their cognitive scores by 40%, and reduced their vascular risk factors. Follow up over five years will examine if there are fewer cases of dementia.

Further, current research is investigating the effect diabetes has on the auditory nerve, with reports showing myelin `i}i˜iÀ>̈œ˜>˜`wLÀœÃˆÃœv̅i«iÀˆ˜iÕÀˆÕ“ˆ˜՘Vœ˜ÌÀœi` diabetics. References on request

Making these lifestyle measures enjoyable and accessible will have the best population benefit. Proven risk reduction programs may warrant reimbursement from health funds and Medicare! References on request. Author competing interests: no relevant disclosures. Questions? Contact the author 9370 9329


51 COLIN STREET WEST PERTH WA 6005 P: 08 9321 7746 F: 08 9481 1917 W:

NOVEMBER 2016 | 39

Clinical Update

Too early for residential care placement? Moving to long-term residential care is a life changing decision, perhaps emotionally devastating as it represents a loss of independence or separation from loved ones. It may be inevitable but many forms of alternative support are designed specifically for people with substantial needs but that do not need full-time care or who can live with disability, safely at home. Premature access to costly nursing care in a residential facility may preclude another person with disability from the necessary care.

Dr Michelle Mei Yee Lai, Deputy Director Medical Education FSH, Geriatrician and Perioperative physician, RPH and SJG Subiaco

and managing dementia to delay cognitive symptom progression. If family or spouse cannot provide tangible support, the clinician can initiate home care packages or HACC programs for people living with a disability – to promote quality of life and without losing independence that keeps them at home. By organising respite care in situations when the person’s carer is unavailable (e.g. spouse hospitalised or family travelling overseas), the person’s care needs can be met without the need for permanent placement.

Moving into full-time residential ED care is not taken lightly by patients. There is much the attending physician can do to assist patients struggling to live independently as this author tells us. with dementia, the current view supports an ongoing use of dementia drugs, as the withdrawal of optimal treatment is shown to double the risk of placement during 12 months of treatment2.

Questions to prevent premature placement CASE REPORT: A man on a disability pension due to chronic back pain from a car accident, presented with severe acute pain after a fall but was considered safe to discharge from the ED. Since then, he mostly stayed in bed and concerned neighbours brought him meals. Requiring increasing doses of opioids for his back pain, his GP was concerned he may no longer be able to live at home and referred him to Aged Care Assessment Team (ACAT).

Some situations, difficult to assess for family physicians, may be reversible without resorting to unnecessary placement in a care facility. When a person shows signs of struggling to live independently, ask these questions: 1. What is the patient’s premorbid function? Patients often compensate well in the setting of chronic conditions and continue to live independently with stable functional capacity. Those who live alone or socially isolated, physical frailty, have multiple comorbidities and polypharmacy are at risk of premature placement. Recent changes in mobility or function are red flags that should prompt a review.

His recent functional decline prompted the ACAT social worker to look further and after discussing with a geriatrician, the patient was admitted to subacute hospital care.

2. What is the trigger? Explore reasons for an increase in care needs, such as intolerance to new medication, undiagnosed altered cognition and recent acute medical illness. Care needs may be met with family or community support without placement. 3. Are contributing factors reversible or transient? Identifying and addressing factors that contribute to unmet care needs can delay placement. Reversible causes may be medical (overuse of drugs and suboptimal pain control), social (family on holiday) or psychological (self-neglect due to depression). The care needs may be transient while the initial triggers are being addressed. 4. What support systems are available? Social isolation or changes in social circumstances can be challenging but can be manageable with family support e.g. a new widow. Formal support service or respite care can be used to maintain the well-being of family carers and to prevent stress-related burnout. Simple questions to carers such as asking, ‘How are you coping?’ may uncover issues before a crisis. How can clinicians help? Early recognition and treatment of underlying conditions can reduce care requirements and costs in the long run. Examples include treating asymptomatic osteoporosis, using rehabilitative therapy to regain function after deconditioning from acute illness,

40 | NOVEMBER 2016

Diagnoses of severe vitamin D deficiency and a new T12 osteoporotic fracture were made. With vertebroplasty and optimisation of analgesia, he made functional gains to return home with a gait aid.

Prescribe for the elderly cautiously and ‘do no harm’ – regular reviews to keep treatment regimens as simple as possible is a useful strategy because those on complex medication regimes are prone to noncompliance and drug interactions. These can lead to non-specific symptoms and falls, and a cycle of ‘prescribing cascade’ (i.e. new medications are used to treat the side effects of another)1. Deprescribing high-risk and nonessential medications, and a Webster pack or medication monitoring may help. In patients

KEY POINTS så &ORåPATIENTSåSTRUGGLINGåTOåLIVEåå independently the solution may not be full-time residential care. så 4HEREåAREåKEYåAREASåTHATåDOCTORSåCANåå reassess to lighten the patient's load.

Finally, encourage partnerships between carers and community health workers. The carers keep patients socially engaged, and monitor their well-being. They should be encouraged to raise concerns. If in doubt, liaise with ACAT clinicians or case managers to explore supports available in the local community as alternatives to placement and arrange the best use of community services for assisted living at home. References 1 Kalisch LM, Caughey GE, Roughead EE, et al. The prescribing cascade. Aust Prescr. 2011;34: 162-6. 2. Howard R, McShane R, Lindesay J, Ritchie C, Baldwin A, Barber R, et al. Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (DOMINOAD) trial: secondary and post-hoc analyses. Lancet Neurol. 2015;14(12):1171-81.



Clinical Update

Managing adult autism spectrum disorder Autism Spectrum Disorder (ASD) has a frequency of one in one hundred , thus GPs will be managing increasing numbers of individuals with ASD. What are some of the challenges that general practitioners face? About 60-70% of those with ASD have an intellectual disability and about 30% have no or minimal language, making communication difficult or impossible.

By Prof Sergio Starkstein School of Psychiatry, UWA, Fremantle Hospital & Autism Assoc. of WA

Autism ED spectrum disorder is increasingly recognised in children. But what happens when these children grow up?

Compounded with the high threshold for pain frequently seen in ASD, it is not unusual for patients to present with serious medical conditions such as gastric ulcers with minimal complaint. One strategy to diagnose clinical problems in this population is to look for emerging or increased frequency of challenging behaviours, most often episodes of physical or verbal aggression, destruction of property, or self-harm. Communication barriers Since poor communication skills such as short and concrete speech and difficulty in understanding the abstract message are cardinal symptoms of ASD, to understand the problem at hand needs extra time for assessment. Another challenge is that ASD individuals may have poor social skills and usually eschew social contact. They are also uncomfortable with any change in their routines such as going to the doctor for a check-up. Those with challenging behaviours are often treated with neuroleptic medications that need control in terms of the metabolic syndrome. Some ASD individuals have 'needle phobia' making the basic routine evaluations almost impossible.

By Mr Peter Ammon Foot Ankle & Knee Surgery

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): så 2EST åAVOIDANCEåOFåACTIVITY så .3!)$S åSTRETCHING exercise program så /RTHOTICSåOFFåTHEåSHELF or custom så #ORTISONEåINJECTION (one only) så 3HOCKWAVEåTHERAPY

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. 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.

We know little about how ASD individuals age. Those with intellectual disability living in group homes may present with the motor side-effects of psychotropic medication, and the author has recently published a study showing that ASD individuals over age 50 have a 10 times higher chance of developing Parkinson's disease, compared to epidemiological norms. Strategies for management Given these limitations, what should be the best strategy to medically manage individuals with ASD? There is no empirical evidence to answer this question but here are some suggestions. I believe ASD individuals with moderate-extreme intellectual disability and/or no or poor speech should be treated in specialised general practices, fully trained in the management of this population. This will provide an innovative and high-quality service, which will allow further specialisation (e.g. neurological, dietetic and gynaecological areas). ASD individuals with mild intellectual disability and those with high functioning may be referred to their local GP but every practitioner should be provided with specific education courses, as well as access to a specialised tertiary ASD centre.

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 80-90% 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 6332 Facsimile: (08) 6332 6308 Author competing interests: no relevant disclosures. Questions? Contact the author on 9431 3333


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42 | NOVEMBER 2016


Clinical Update

Vertigo diagnosis and management

By Prof Gunesh Rajan (surgical) Dr Vincent Seet (medical) Vestibular Specialists

Targeted history and the examination are instrumental for correct diagnosis and subsequent treatment of vertigo. The challenge is to identify the specific aetiology.

Duration, Signs-Symptoms, Onset, Brain, Evolution, and Triggers.

We know from studies that tests alone identify about 5% of causes. History taking is therefore crucial. Patients often use unspecific terms such as ‘dizziness’ or ‘vertigo’ to describe a whole array of different symptoms and signs. Key indicators, which help generate a differential diagnosis, are in the symptom pattern, time pattern and trigger profile.

Ears: Is the ear affected during the attack? Hearing loss or hyperacusis during attack; fluctuating hearing loss; tinnitus, presence and character; otalgia; ear discharge; or correlation of ear symptoms with vestibular symptoms.

Some patients also require functional testing of the vestibular system, and imaging (MRI of the cerebellopontine angle and internal acoustic meatus, and CT of the temporal bones). For patients with acute vestibular symptoms, a two minute, three-item bedside oculomotor examination comprising head impulse test, nystagmus, skew test (HINTS) allows differentiation between acute peripheral vestibular lesions or central pathologies such as cerebellopontine angle infarctions.

Signs-Symptoms: The main symptoms and signs during the attack? Vertigo or head spin; imbalance-ataxia; nausea; light headedness; double-vision; oscillopsia; falling tendency; positional dependency; tilt sensations; falls; or associated loss of consciousness or syncope.

Frequency: How often are attacks? Several times a day; daily; weekly; monthly; unpredictable; or only trigger-related.

The FEDSOBET diagnostic mnemonic The most common vestibular conditions have distinct patterns of symptoms and signs that identify the cause. Rarer entities might require additional radiologic or laboratory testing. Our diagnostic algorithm is based on eight key questions, with mnemonic FEDSOBET representing the eight specific variables required for the diagnosis: Frequency, Ears,

Duration: How long are attacks? Seconds; minutes; hours; days; constant; event or trigger-related; or exercise-related.

Onset: When and how did it start? Brain: Any associated neurologic symptoms? Headaches; associated deficits; altered mental status; loss of consciousness; altered proprioception; polyneuropathies; or cerebellar signs. Evolution: Change over time? Progressive; declining; fluctuating; stable; or only related to triggers. Triggers: What triggers or actions bring on symptoms? Positional; pressure-related; noiseinduced; or head movements. A detailed targeted history and the neurotologic examination identifies the cause in

most cases. Imaging, objective audio vestibular testing and bloods might be required to rule out rare causes. Some treatments Most causes can be treated specifically with appropriate medication and/or vestibular physio. Around 5% of patients need surgery for pathologies such as the superior semicircular canal dehiscence syndrome, perilymphatic fistula (more common in Australia due to the popular recreational water sports and diving culture), tumours of the cerebellopontine angle (e.g. vestibular schwannoma) and vestibular disorders not responding to conservative treatment (e.g. BPPV; Meniere’s syndrome). Chemical ablation of the peripheral vestibular organ with Gentamicin has become very popular over the last decade as a first line treatment for Meniere’s disease not responsive to standard medical treatment, especially if there is functional hearing in the affected ear. It has also emerged as a tool to support and promote vestibular rehabilitation for certain chronic medical vestibular conditions where vestibular compensation is impaired (e.g. Ramsay-Hunt-syndrome). Latest treatments for a symptomatic Meniere’s disease with a deaf affected ear now include a surgical labyrinthectomy with simultaneous cochlear implantation – immediate resolution of vestibular symptoms with restoration of hearing. Any surgery to the vestibular system requires postoperative vestibular rehabilitation. References available on request.











Daily depending on triggers



Vertigo; Imbalance

Posttraumatic; Idiopathic; postsurgical


recurrent,days to weeks; migraine associated

Specific head positions


Individual cycle (daily,weekly, monthly etc.)

Aural fullness; Tinnitus

Seconds to days

Vertigo;imbalance; Motion hypersensitivity

migraine history; puberty

Sensory ura; Headaches; Photophobia, phonophobia

recurrent; intensity and pattern fluctuations

Visual stimuli; head movements; hormonal dependence; foods; fatigue and exertion


Individual cycle

Hearing loss, tinnitus, aural fullness during attacks

30 min to 24 hours

Vertigo in conjunction with the other ear symptoms



progressive with stable intervals of unpredictable duration

Exacerbations from: position; during cough or sneeze; or visual stimuli


Daily to monthly

Inconsistent ear symptoms; hearing loss; pulsatile tinnitus


Vertigo;imbalance; positional dependence of symptoms; motion hypersensitivity

Spontaneous; migraine history;



Positional exacerbation; exacerbation during cough or sneeze; visual stimuli




Vertigo & Nausea: days Imbalance: Weeks to months

Vertigo, Nausea-complex & Imbalance

Post infectious; spontaneous


Acute phase: days Recovery: Weeks





Depends on location & extent: days to weeks

Vertigo,imbalance,ataxia, motion intolerance; nausea-complex

Sudden; associated risk factors

Cerebellar or brainstem signs

Recovery over weeks with neurologic sequelae

Spontaneous; Head movements


Constant or individual cycle


Minutes to hours

Unspecific dizziness; imbalance;

Slowly progressive; frequently preceding vestibular disorder; associated personality disorders (panic attacks)


Stable to progressive

Visual stimuli; heights; crowded places; spontaneous

Table 1. Modifed after Wuyts FL, et al (2016) “SO STONED”: Common Sense Approach of the Dizzy Patient.. BPPV: benign paroxysmal positional vertigo; MAV: migraine-associated vertigo; MD: Meniere’s disease; VP: Vestibular paroxysmia; APV: acute peripheral vestibulopathy (formerly vestibular neuronitis); CVE: cerebrovascular event; PPPD: persistent postural perceptive dizziness;


NOVEMBER 2016 | 43

Clinical Update

Vulvodynia Vulvodynia is a chronic discomfort involving the vulva without relevant visible findings or a specific, clinically identifiable, neurological disorder. A diagnosis of exclusion, it is usually described as a burning or soreness rather than a pain. While generalized vulvodynia affects the whole vulva, localized vulvodynia affects a specific part (e.g. provoked vestibulodynia is pain felt only in the vestibule – the area around the opening of the vagina – usually in response to touch or pressure). Causation theories include damage or irritation of the vulval nerves (e.g. after childbirth), increased number of nerve endings in the vestibule, increased production of chemicals by vulval cells (causing inflammation), long-term reactions to certain infections, changes in hormone response and history of sexual abuse. Who gets it and examination? Vulvodynia affects women of all ethnic groups and ages. It is not hereditary. Lifetime prevalence is estimated at 8%. Provoked vestibulodynia is the commonest. Diagnosis starts with looking for causes of pain. Ask when symptoms occur, what treatments have been tried, and any prior chronic infections or skin problems. Examine the vulva and vagina carefully, using a moist cotton swab to touch areas of the vulva and vestibule to determine if pain is generalised or localised. The goal is to find where the pain is and the severity.

By Dr Angamuthu Arun Gynaecologist, Waikiki

Swabs for infection or biopsy may be needed. Treatment – things to try Advise avoiding soap, bubble baths, shower gels, shampoos, special wipes and deodorants. Suggest washing with a soap substitute (e.g. greasy ointments) to keep the skin soft and provide a barrier against irritation, and use petroleum jelly to protect the area from chlorine when swimming. Advise cotton underwear and cotton menstrual products if regular ones are perhaps irritating. Avoid any know triggers. Applying cool gel packs may bring pain relief. Local anaesthetic ointment can numb the area, bringing short-term pain relief. It can be used for extended periods. Long term use can (rarely) cause allergy to lignocaine. Medication options include amitriptyline (cream or tablet), gabapentin, pregabalin or vaginal diazepam pessary (from compounding pharmacies). Patients with vulvodynia who complain of sexrelated pain frequently have pelvic floor muscle dysfunction. Pelvic physiotherapy can relax tissues in the pelvic floor and release tension in muscles and joints. Biofeedback can train patients to strengthen the pelvic floor muscles. Trigger point therapy is another option. Painful intercourse may have emotional and psychological effects on sexual relationships; patients need to understand this, and communicate fully with their partner, discovering suitable techniques and lubricants.; psychotherapy and sexual

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Conditions that are relatively ED common and have a diagnosis based on the history alone (i.e. no physical findings) may prove frustrating to both medical practitioners and patients. These notes may help. counselling may be helpful. A vestibulectomy to remove painful tissue in provoked vestibulodynia, if other treatments have failed, helps relieve pain and makes sex more comfortable. It is not recommended for generalized vulvodynia. Further reading:

KEY POINTS så 6ULVODYNIAåISåCHRONICåLONG LASTING åå pain and discomfort of the vulva where there is no cause found.

så 6ULVODYNIAåCANåBEåGENERALISEDåORåå localised and provoked vestibulodynia is the most common presentation of the latter. så !LTHOUGHåSYMPTOMSåLASTåFORåYEARS ååå there are treatments to manage the symptoms. så 3URGICALåTREATMENTåSUCHåASååå vestibulectomy is indicated for women with provoked vestibulodynia when conservative measures fail.

Author competing interests: no relevant disclosures. Questions? Contact the author 9550 0300.

Falls and the elderly One in three people aged 65 years and over fall every year and the likelihood of falling increases for those with conditions such as dementia, Parkinson’s disease or receive services from home care agencies. While many falls don’t result in a serious injury, the older person is reluctant to let family or their doctor know for fear it might precipitate going into care. Curtin University Dr Elissa Burton said old age was not a cause, rather it was a loss of balance and strength, polypharmacy, problems with prescription glasses, wearing incorrect footwear or environmental issues such as tripping on a matt or poor lighting. “If the reasons for the fall can be determined the older person can receive some strategies from a falls specialist or a physiotherapist which may help and hopefully avoid or minimise falls in the future could lead to injury,” she said.


Clinical Updates

Sarcopaenia how important? Sarcopaenia is associated with frailty, cognitive decline and malnutrition. Identifying cases is important in order to prevent negative health outcomes such as falls (risk trebled), malnutrition and comorbidities, institutionalisation and death. The economic burden of sarcopaenia is significant (similar to osteoporosis) and set to escalate further. Diagnosis According to European guidelines, sarcopaenia is diagnosed initially by demonstrating poor physical performance. Specifically slow gait speed (less than 0.8 m/sec), low muscle strength (hand held dynamometry) and reduced muscle mass are the main factors used to identify cases. The SARC-F scale is a useful screening test. This measures strength, assistance in walking, any difficulty in rising from a chair, any difficulty in climbing stairs and number of falls in the past year Most cases of sarcopaenia are associated with a high Frailty index and mild cognitive impairment. It is vital to identify and treat the frailty.

By Dr Rita Malik Physician in Geriatric Medicine Nedlands

The FRAIL Scale is a very useful well-validated tool. It assesses fatigue, resistance, aerobic exercise capacity, illness and loss of weight. The presence of up to two factors determines a pre-frail state. Frailty is reversible and treatment may reduce further decline. Psychosocial frailty overlaps with physical frailty and includes depression, fear of falling, cognitive decline, anxiety, negative health perception, and fatigue. Physical factors Risk factors include anorexia of ageing, increasing age, impaired activities of daily living (ADL), impairment of the more complex instrumental ADL (IADL), cognitive impairment, physical inactivity, and depression. Comorbidities include CCF and COPD. The consequences of losing lean body mass and muscle are significant and include poor immunity, wound healing, increased risk of infection, falls, aspiration and pressure ulcers.

Awareness of the loss of muscle ED mass and associated function in the elderly is crucial in preventing an increasing epidemic of this problem that currently affects up to 9% of Australians aged over 65 and 20% in people over 80. for higher protein intake in order to prevent the sarcopaenia epidemic and its associated complications. Adequate protein intake (>1g/kg/day), adequate vitamin D and increased physical activity may assist in reducing sarcopaenia. Protein requirements increase further in the presence of chronic disease to 1.5mg/kg/day. Resistance exercise is of particular benefit. Replacement of deficient testosterone may be necessary. References available on request

Important aspects of management Dietary protein is essential to maintain muscle mass. Most older adults do not consume sufficient protein. New recommendations call

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NOVEMBER 2016 | 45


COACHING HELPS GET THE BALANCE RIGHT Kids wait for no one, and when you’re the coach of their soccer team you can’t be late for training as urologist Dr Jeff Thavaseelan has discovered.

One Perth urologist has found the perfect way to carve out time away from his surgical list. Dr Jeff Thavaseelan is a junior soccer coach and in the process that gives him plenty of quality ‘dad-time’ with his own children.

“Football West runs coaching certificate and licence courses. I did the Grassroots program initially, which focuses on the youngest kids and then completed a Junior coaching licence.”

“I really like coaching the younger age groups, I’ve taken my three boys through this stage and I’ll be doing the same thing with my daughter who’ll be in Under 8s next year. It’s great to be involved in our children’s sport and the Wembley Downs club is terrific!”

“I’m pleased to say that we don’t have too many problems with the ‘Ugly Parent’ syndrome. As coaches we try to make sure that the sheer enjoyment of playing the game comes first. One of the most important things is to make sure that every child gets a fair go. My pre-game nights are usually spent working out player rotations to keep the kids and their parents happy.”

“You can always find excuses to stay at work but when you’ve got 20 kids waiting for you for an afternoon training session you’ve just got to be there. It makes it so much easier to tweak the roster.” Jeff’s passion for the ‘beautiful game’ goes back to his own childhood. Soccer’s all in the family “I played club soccer as a young kid in a country town, but nothing even approaching a serious level. My wife’s equally keen. She has a German background so all the kids have the overseas club shirts and we all supported Germany in the last World Cup.” “All through the European season we have football on the television, from the English Premier League to the Bundesliga… whatever’s on, really. We’ve been members of Perth Glory for the past four years and we enjoy going to see them play.” “We took the kids to Melbourne to see Real Madrid and AS Roma but we’d really love to see some World Cup matches. We were in Europe when the last one was on and the atmosphere was amazing!” Jeff’s involvement with junior sport is underpinned by formal coaching qualifications and a commitment to inclusive participation.

46 | NOVEMBER 2016

Soccer boys

It’s all about the kids

Jeff's own su

persta rs

“When four of your own children are actively involved it does create some interesting situations. A typical football weekend means a lot of time in the car and some logistical coordination with other soccer families.” “My role does mean I’m pretty much tied to the team I’m coaching but I do the occasional swap with another soccer dad so that we can each see our other children play.” Jeff’s medical background adds yet another element to the equation. “Taking my mobile phone is a necessary evil but it stays in my back-pocket most of the time. People usually understand if I’m in the middle of screaming at the team and I just tell them I’ll call them back.” “I had one incident where an amazingly tough young girl broke her arm so I took off her shinguards and strapped it up until she could get to hospital. Apparently PMH thought it was a pretty interesting technique.” “One part of my specialty is neuro-urology dealing with spinal cord injuries. I’ve seen a bit of that coming from other codes at junior level because they try to mimic the professional

Scores again!

players. A lot of parents have switched their kids to soccer because of those concerns.” “Thankfully our children have been injury-free, apart from the usual skateboard dramas. They get a lot of enjoyment from their football and they’re better at it than I ever was.”

By Peter McClelland


architect can mistakes but an s hi ry bu n ca es. A doctor ents to plant vin only advise his cli

ght - Frank Lloyd Wri


THE GODFATHER The mafia godfather, accompanied by his lawyer, walks into a room to meet with his accountant. The godfather asks the accountant, "Where's the three million bucks you embezzled from me?" The accountant doesn't answer. The lawyer interrupts, "Sir, the man is a deaf-mute and cannot understand you, but I can interpret for you." The godfather says, "Well, ask him where the @#!*ing money is." The lawyer, using sign language, repeats the question to the accountant. The accountant signs back, "I don't know what you're talking about." The lawyer interprets to the Godfather, "He doesn't know what you're talking about." The godfather pulls out a pistol, puts it to the accountant’s head, cocks the trigger, and says, "Ask him again where the @#!*ing money is!" The lawyer signs to the accountant, "He wants to know where it is!"

MEXICAN SMUGGLER Juan rides up to the Mexican border on his bicycle. He's got two large bags over his shoulders. The guard stops him and asks, “What''s in the bags?” “Sand,” Juan answers. The guard says, “We'll just see about that. Get off the bike.” The guard takes the bags and rips them apart; he empties them out and finds nothing in them but sand. He detains Juan overnight and has the sand analyzed, only to discover that there is nothing but pure sand in the bags. The guard releases Juan, puts the sand into new bags, hefts them onto the man’s shoulders, and lets him cross the border. A week later, the same thing happens. In fact, this sequence of events is repeated every day for three years, until finally, Juan stops showing up. The guard later ran into him in a Mexican cantina. “Hey, buddy,” says the guard, “I know you are smuggling something. It's driving me crazy. It's all I think about. I can't sleep. Just between you and me, what are you smuggling?” Juan sips his beer and says, “Bicycles.”

The accountant signs back, "Okay! Okay! The money's hidden in a suitcase behind my backyard shed!" The godfather asks, "Well, what did he say?" The lawyer tells to the godfather, "He says that you don't have the guts to pull the trigger."

OBSERVATIONS ON GROWING OLDER Your kids are becoming you...and you don't like it ...but your grandchildren are perfect! Going out is good. …coming home is better! When people say you look "Great"... …they add "for your age!" You read 100 pages into a book before you realise you've read it. Everybody whispers.

BETTY SUE A guy is reading his paper when his wife walks up behind him and smacks him on the back of the head with a frying pan. “Hey!” He says, “What was that for?” She says, “I found a piece of paper in your pocket with 'Betty Sue' written on it.” “Jeez, sweetheart,” he replies, “remember last week when I went to the track? Betty Sue was the name of the horse I bet on.” “Ok,” she shrugs and walks away. Three days later he's reading his paper when she walks up and smacks him again with the frying pan. “What was that for?” He says. “Your horse called,” she replies.


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NOVEMBER 2016 | 47

Social Pulse

A record 1800 delegates attended the national RACGP conference in Perth and while there were three solid days of workshops, plenaries, posters and forums, there was also time for all-important social networking. The gala dinner was a light-hearted affair with the nowregular appearance of Iron Man, organised by head of the SA faculty Dr Danny Byrne who delivers the workshops on iron therapy. WA doctors Dr Rohan Gay and Dr Fintan Andrews took our national awards – Rohan as GP Supervisor of the Year, befitting his dedication and commitment to GP training; and Broome-based Fintan the national GP Rural Registrar. The conference also saw the presidential baton change from WA’s Dr Frank Jones to Tasmanian Dr Bastien Seidel.

Research work at the National Centre for Asbestos Related Diseases (see September edition) has been given a $50,000 boost from a man who has defied the mesothelioma odds. However, time is running out for 72-year-old former builder Barry Knowles, who was diagnosed with the disease in 2010.


Clockwise from left: Retiring president Dr Frank Jones; New College president Dr Bastien Seidel; Former College president Prof Claire Jackson, AMA President Dr Michael Gannon and GP Dr Marian Bahemia; Dr Edwin Kruys, Dr Mike Civil and Dr Brad Murphy enjoy the evening; WA registrars kick up their heels at the dinner; Dr Jill Benson with her family.

Funds to carry on the fight

Only recently the tumours have become aggressive and Barry wanted to contribute to the work of NCARD in a fundamental way. He and his family handed NCARD’s Prof Bruce Robinson a cheque for $50,000 from the Reflections Through Reality Foundation at a Rotary Club Perth lunch last month. The Rotary clubs of Perth and Esperance and families affected by mesothelioma helped raised most of the money.

48 | NOVEMBER 2016


Wine Review

Surf and Turf at Rockcliffe The Rockcliffe vineyard started as an apple orchard in Denmark, which was planted to dry-grown vines in the late 1980s. In 2002 it was purchased by Steve Hall and in 2007 he was joined by Coby Ladwig, from West Cape Howe, and later Luke Eckersley, from Forest Hill. With this experience the winery has become diversified into single vineyard and regional wines as well as contract winemaking with a generous portfolio of wines. This tasting focused on the Quarram Rocks and Third Reef ranges, which are named after local surfing spots around Denmark. Rockcliffe has a generous portfolio of wines with the Third Reef Chardonnay and Shiraz being the standout wines.

By Dr Martin Buck







1. 2016 Quarram Rocks Sauvignon Blanc Semillon, $21 This is a very nicely balanced cool-climate blend with a great lifted floral nose and tropical aromas. The palate is clean, crisp, full of citrus flavours and finishing with grassy Semillon. This is lively, easy drinking blend ready for summer. 2. 2016 Third Reef 2016 Riesling, $25 The Third Reef Riesling are Chardonnay are very well made wines. The Riesling is a lighter, 11.5% alcohol, but does not lack anything in punch. Blossom and lime aromas are intense and lead to a full palate of green apple, citrus and steely acid. A combination with some fresh Albany oysters would be sublime. 3. 2015 Third Reef Chardonnay, $30 The Chardonnay is also a surprise packet with a strong French protocol, including whole bunch pressing, wild yeast and barrel fermentation. Delicate aromas of nectarines, lime and French oak add to the complexity. On the palate there is full, fresh fruit with a lingering softness and persistence. A very Burgundian wine with a twist of Denmark – certainly one for my cellar.

WIN a Doctor’s Dozen! Name Phone


4. 2014 Quarram Rocks Shiraz Cabernet, $21 This wine ticks all the right boxes for this blend – plenty of berries, some soft tannins, plums and spice. A medium-bodied wine ready for drinking and would be great with roast lamb. 5. 2015 Third Reef Pinot Noir, $30 Pinot is a challenge for any winemaker and Great Southern Pinot fruit has a great reputation. The 2015 Third Reef has great structure for a young wine. Big cherry flavours combine with delicate tannins to make this a very drinkable wine. Aged in French oak for 10 months, it has plenty of potential and would be fantastic with gamey meats.



.. or online at

6. 2014 Third Reef Shiraz, $30 This is a real beauty. Spicy, complex and brooding aromas merge into a palate of big fruit and savoury flavours. A “Syrah style” cool-climate Shiraz with a long, generous palate. This was my favourite of the reds and would only improve with medium to long term cellaring.

Wine Question: Which Rockcliffe wine has Burgundian influences?

Email Please send more information on Rockcliffe's offers for Medical Forum readers.

Answer: ...................................................

Competition Rules: One entry per person. Prize chosen at random. Competition open to all doctors or their practice staff on the mailing list for Medical Forum. Competition closes 5pm, November 30, 2016. To enter the draw to win this month's Doctors Dozen, return this completed coupon to 'Medical Forum's Doctors Dozen', 8 Hawker Ave, Warwick WA 6024 or fax to 9203 5333.


NOVEMBER 2016 | 49


n w o D g n i l l St ro

Q e u n e v A It’s a show that’s been described as the love child of South Park and The Muppets and it manages to steer its way through the precarious waters of political incorrectness with wit, charm and humour. So, why wouldn’t Melbourne actor Ross Hannaford, who plays Princeton/Rod, be excited? The actor/singer/dancer, who was last in Perth earlier this year in CATS, will be returning to Crown Theatre on November 26 with this Tony-award winning Broadway hit that has been packing crowds for the past 13 years. Avenue Q is described as a ‘coming-of-age parable’ with three human characters trying to look more convincing that the 11 puppets who tend to steal the show. “I feel a bit of cheat,” Ross told Medical Forum. “I just get out there and say the lines and the audience is in hysterics … it is written so well and is so clever, it makes it seem easy. The energy it generates on stage in the audience makes it a really great night out – it’s like seeing a comedy festival show.” The poster for the show trumpets FULL PUPPET NUDITY AND OTHER VULGARITIES but it is also moving, honest and has the ability to get people thinking. “Avenue Q is not frightened to touch on politically sensitive topics but that’s a good

50 | NOVEMBER 2016

thing, to get people talking about issues and ideas,” Ross said. “There are a lot of shows out there that may have gone so far they are no longer to everyone’s taste. Avenue Q sits in a world that is accessible, relevant and still makes people laugh about the absurdities of the world.” Ross, at 33, is a 24-year veteran of show business having made his professional debut in 1992 as a nine-year-old in Scrooge the Musical as Tiny Tim. “I must have done something right because I’m still hanging in here. Scrooge is a magical musical and it planted a seed for me. As a child I always wanted to go into the performing arts. I just wanted to sing and dance and tell stories and this show demonstrated to me that I could. I’m lucky enough to be still doing it.” Ross is considered one of the most versatile performers in Australia – Avenue Q is a singing/acting role but he has danced almost all of his life. Not surprising then to learn that all his siblings share the performing passion. His sister Esther was in Perth recently playing Audrey in Little Shop of Horrors, another sister Lauren was an elite gymnast who has moved into personal training and brother Calvin is in the Australian Ballet.

Ross Hannaford and 'Princeton'

dance and always took us to the theatre. She was very encouraging but never pushed … we just all fell into it. Dad was an industrial electrician. So we say we get our chutzpah from mum and coordination and focus from Dad. But, you know, he’s got a good voice, though he wouldn’t be caught dead singing outside the house, and he can move really well. Mum can’t sing or dance but has a huge personality!” “I studied at the Victorian College of the Arts secondary school and did a crazy amount of dancing. But I also wanted to sing and dance. My first gig as an adult was in We Will Rock You and the shows have kept coming so I never finished post grad – I’ve learnt on the job with some of the best in the business.” “Mum’s advice to be as versatile and as employable as possible rings in my ears. It’s a really tough industry to make a living in and get by day by day but it is so rewarding.” In that spirit, Ross is a great believer in creating his own shows. He and a friend are putting together a cabaret show Cheek to Cheek about Fred Astaire and Ginger Rogers and he has his third EP of original songs coming out this month.

So something must have been in the water at the Hannaford household!

“I like to be busy – you need to be in this business. If you want to work, you often have to create it yourself and learn to enjoy the great shows like Avenue Q when they come along.

“Mum is very arty. She encouraged us to

By Jan Hallam



All Roads Lead to Messiah

Christopher Richa

Bass-baritone Christopher Richardson, who heads to Perth for the Perth Symphonic Chorus’s annual performance of Handel’s Messiah on December 17, has taken his considerable musical talent on a ride through the lands of performancelevel cello and piano to a flirtation with contemporary singing to settle in the rich soils of operatic bass baritone where a career in oratorio and opera has taken hold and is flourishing. Thirteen years ago, on his graduation from the Hobart Conservatorium, he and his university sweetheart, classical singer Amy Dean, were married and the proud parents of a daughter. At 23, the aspiring professional musicians were up to their ears in nappies. “When our first child was born, Amy and I decided that we would have our family early and work where and when we could,” Christopher told Medical Forum. “We now have three children – two girls and a boy aged 13, 11 and 10.” The arts industry in Australia is relatively small, so networks and connections are vital. At the Tasmanian Con some serious musicians had made tree changes to the Apple Isle allowing Christopher to study with internationally regarded teachers such as pianist Beryl Sedivka, mezzo soprano Marilyn Smith and the acclaimed soprano Jane Edwards. Starting out a singing career with a young family may not have been the traditional



route to operatic fame and fortune but neither was it the end of opportunity for the couple – it meant thinking outside the box.

Music projects such as David Chisolm’s extraordinary work Kursk (a requiem for a Russian submariner) are among the performances on a large CV.

Christopher graduated with a performance award for piano and the most promising award for his singing but then came the hard slog of learning his craft. Performances in the concert halls of Hobart and oratorios around Tasmania with teaching in between helped pay the bills. Some luck with property investment in 2003 on the eve of the property boom helped the young couple keep their heads above water.

And critics are taking notice and awards are springing up too – a 2011 Royal Melbourne Philharmonic Aria Award and a scholarship to famous Wagnerian soprano Lisa Gasteen’s National Opera School among them.

“In 2003, we scraped together the money to buy a 4 x 2 just 10 minutes south of Hobart for $140,000 and in 12 months it had doubled in value, so for a few years we bought up property, renovated and sold,” Christopher said. “Five years ago, we decided it was time to become more adventurous with our careers. The children were all in school and we had transitioned through that hard slog of pre-schoolers. We considered relocating to the UK but talking to trusted friends and colleagues we decided to stay where our professional and personal networks were. So we made the move to Sydney.” And the work has rolled in – regular appearances with orchestras along the eastern seaboard, interesting roles with Pinchgut Opera, and exciting New

Christopher’s outing with Dr Margaret Pride’s Perth Symphonic Chorus will be the first time he has been west but the Perth concert will be his second Messiah for the season. “I’m looking forward to working with the PSC – and singing Messiah is wonderful. Handel and Bach are masters.” Christopher will share the stage this year with soprano Jennifer Barrington, countertenor Christopher Field and tenor Paul McMahon and the Perth Baroque Orchestra, led by violinist Paul Wright. Last year’s experiment to supplement the chorus with a people’s choir proved so successful that it is on again with rehearsals beginning in November. If you would like to sing in four of Handel’s magnificent choruses with the PSC then go to the website www. handels-messiah-christmas-choir-2016 for more details. By Jan Hallam

NOVEMBER 2016 | 51


PULSE-RAISING WAGNER Brass sections of orchestras love having the chance to play Wagner and stir up audiences. Richard Wagner (1813-83) is a composer who triggers some division among music lovers. There are those slavish devotees who adore every elongated note and those who have difficulty dissociating the politics of the man. However, what can’t be questioned are the sublime – and the revolutionary – aspects of the music. Wagner brought something new and very exciting to the ears of the world. On November 26 and 27 at the Perth Concert Hall, WASO principal conductor Asher Fisch leads the orchestra and acclaimed Wagnerian tenor Stuart Skelton in a program of Wagner arias, with Anton Bruckner’ s ninth symphony to send you home buzzing. Asher is himself a great Wagnerian scholar and when he’s not in Perth finds himself conducting in opera houses all over the world, often Wagner operas. “Wagner is one of history’s truly transformative composers. His music is endlessly

Franz von Lenbach’s 1895 portrait of Richard Wagner.

fascinating, dramatic and deeply moving. For a conductor, the chance to share and explore Wagner’s revelatory works with a wonderful orchestra and audience is quite simply a joy,” he told Medical Forum. One of the musical windows Wagner flew open was the use of brass as a solo and melody leading instrument. WASO’s principal trombonist Joshua Davis relishes the opportunity to take a dramatic lead in the concert. But the trombonist, who began playing in Salvation Army bands, told Medical Forum that even he came a little late for the Wagner love fest. “My background has been mostly the Romantics. I love listening and playing a lot of Beethoven and Brahms and have come to Wagner only in the past few years. It started with Mahler and Strauss and Wagner. To tell you the truth, the thought of playing in The Ring Cycle (Wagner’s epic four-opera magnus

Anything Goes Last month, Shenton Park GP Dr Lin Arias won tickets to see Michael Cole’s cabaret, Cole. This is what she thought of the show. He’s delightful, he’s delicious, he’s delovely. That’s Michael Griffiths as Cole Porter. As Porter, Griffiths crooned, chatted, and captivated us with stories. Porter was happily married while pursuing an active gay life, enjoying a wealthy, hedonistic lifestyle in New York, Hollywood and Europe. Tales of opening night worries, Porter’s musical inspirations and the woeful fear of having lunch with someone terribly boring, were

52 | NOVEMBER 2016

WASO Principal Tro mb onist Joshua Davis

opus) would terrify me,” Joshua said. “This upcoming concert is the perfect – bite-sized pieces and Wagner at his most dramatic and lyrical. People will know the music as soon as they hear it. It will be a great entry-point to his music.” “Asher understands the music to its core – and a commitment to doing it right. It is a joy to be playing these iconic themes.” Wagner requires big sound and that gives the brass a good opportunity to make their presence felt. “We have expanded the volume levels and the brass section has to give it a bit! The strings just have to forgive us. Wager’s big sound in the concert hall is a bit of an endurance test, but it’s also a lot of fun to do.”

By Jan Hallam

interspersed with much-loved tunes such as Miss Otis Regrets, Let’s Do It, Let’s Misbehave, It’s De-Lovely, Night and Day, and more. Griffiths camped it up, playing the piano with definitive style and flair, singing Porter’s songs as if he had written them. As an audience, we were smitten. By the end of the night, we all happily did as he asked, singing our hearts out, repeatedly, to the chorus of Another Op’ning, Another Show… until he said we could stop. WAAPA graduate Griffiths was in Perth earlier in the year for the Fringe Festival when he performed his Annie Lennox tribute. He is utterly charming and extremely talented. Hopefully he’ll be back soon.


Entering Medical Forum’s competitions is easy!


Simply visit and click on the ‘Competitions’ link (below the magazine cover on the left).

Movie: Office Christmas Party A good cast, potentially scary theme. Jennifer Aniston and Jason Bateman (Bad Bosses, Arrested Development) join the youngsters for an office comedy that hinges on sibling rivalry and hideous office Christmas parties. The safe hands behind the camera were also on Blades of Glory. In cinemas, December 08

Music: WASO & Wagner Principal conductor Asher Fisch is an expert on the Wagner repertoire and in his capable hands the orchestra and one of the world’s best Wagner tenors Stuart Skelton bring the master’s music to life. The first half features excerpts from Wagner’s Parsifal and Lohengrin; second half the giant ninth by Bruckner. Perth Concert Hall, November 25 and 26; MF performance 25/11, 7.30pm

Movie: Underworld: Blood Wars Vampire death dealer Selene (Kate Beckinsale) fends off brutal attacks from her many enemies of previous outings. In the next instalment of this popular franchise, she just might have to make the ultimate sacrifice. Fangs for the memories.


COMP Movie: Trolls (3D) In the beginning of Shrek (and its mandatory sequels) now the makes are focusing on another childhood favourite, Trolls, complete with colourful hear and magical properties. A fun family flick with the talents of Justin Timberlake and Gwen Stefani among others. In cinemas, December 1

In cinemas, December

Theatre: Avenue Q It has been described as an adults-only Sesame Street and this coming-of-age musical show has all the charm of the long-running kids TV show but that’s probably where the comparison should end. Puppets, animated by unconcealed puppeteers, sing and act alongside human actors a satire of high anxiety in a big wide world. Crown Theatre, November 26-December 10, 8pm

Music: Handel’s Messiah A highlight of the Perth Symphonic Chorus’s calendar is their annual performance of Handel’s Messiah, directed by Dr Margaret Pride. This year there is an impressive line-up of soloists including Jennifer Barrington, Christopher Richardson, Christopher Field and Paul McMahon.

Doctors Dozen Winner It was the lure of Upper Reach Wines that prompted Dr Chris Cokis to give himself a shot at winning this particular Doctors Dozen. Chris and his wife recently visited the winery in the Swan Valley and thoroughly enjoyed their 2014 Reserve Chardonnay. And, says Chris, there’s room in the cellar for more!

Perth Concert Hall, December 17, 7.30pm

Winners from the September issue Take Your Breath Away t Gambling with Genes t Asbestos Wake-Up t GP’s Remote Control t Respiratory Clinicals t Tale of Two Jags

Major Sponsors

Perth Pathology


September 2016

Movie – The Magnificent 7: Dr Dian Harun, Dr Anne Beaton, Ms Vincenza Frisina, Dr Andrew Toffoli, Dr Braad Sowman, Dr Simon Machlin, Dr Twain Russell, Dr Michael Allen, Dr Max Traub, Dr Beverly Teh Movie – The Girl on the Train: Mr Ray Barnes, Dr Narelle Kealley, Ms Kellie Ashman, Dr Leanne Hosking, Dr Alison Stanning, Dr Helena Goodchild, Dr Charles Armstrong, Dr Meilyn Hew, Dr Barry Leonard, Dr Alem Bajrovic Movie – Inferno: Dr Rachel Price, Dr Crystal Durell, Dr Michel Hung, Dr Heather Brand, Dr Amir Travasoli, Dr Glen Koski, Dr Alarna Boothroyd, Dr Sara Chisholm, Dr Jane Whitaker, Dr Peter Louie Movie – Café Society: Dr James Flynn, Dr Michelle Bennett, Dr Jenny Elson, Dr Lin Chan, Dr Senq J Lee, Dr Jun Wei Neo, Dr Ernest Tan, Dr Vesna Stanojevic, Dr Sayanta Jana, Dr Julia Charkey-Papp Cabaret – Cole: Dr Lin Arias Opera – The Pearl Fishers: Dr Stephen Adams

NOVEMBER 2016 | 53

ALLERGY & IMMUNOLOGY Dr Meilyn Hew MBBS, FRACP, FRCPA Adult immunology and allergy Special interests: så AEROALLERGY så URTICARIA så AUTOIMMUNITY


For appointments: Suite 42, Level 2, Wexford Medical Centre (sharing with Nexus Neurology) 3 Barry Marshall Parade, Murdoch 6150 Phone: 08 9332 2861 Fax: 08 9312 1576 Email:

Western Australia’s Who’s Who for Patient Referrals Allergy & Immunology Cardiology Cosmetic Medicine - Hair Loss Cosmetic Surgery Dermatology Ear, Nose & Throat Gastroenterology General Surgeons & Subspecialties Gynaecology & Gynaecological Surgery Gynaecology & Infertility Gynaecology, Infertility & Andrology Hand Surgeons Neurology Neurosurgery Nuclear Medicine Obstetrics & Gynaecology Obstetric & Gynaecological Ultrasound Ophthalmology Oral Medicine Orthopaedic Surgeons Paediatrics – Medical Paediatrics – Surgical Pain Medicine Plastic & Reconstructive Surgery Podiatry Services Psychiatry Radiology Renal Medicine Respiratory & Sleep Medicine Rheumatology Sexual Health Sports Medicine & Foot Orthodotics Thoracic Surgery Urology Vascular & Endovascular Surgery Vascular Imaging/Intervention

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Dr Ben McGettigan BSc(Hons) MB ChB FRACP FRCPA Clinical Immunologist and Allergist








så 3PECIALISINGåINåALLERGYåANDåGENERALåADULTåIMMUNOLOGY Please send referrals to: Respiratory West, PO Box 1382, West Leederville 6901 Phone: 9442 3900 Fax: 9382 8946



























Dr Jody Tansy MBBS FRACP Jody has commenced private practice at the Wexford Medical Centre managing all aspects of allergy and general immunology in adolescents and adults. Consulting from: Suite 42, Level 2, Wexford Medical Centre, 3 Barry Marshall Parade, Murdoch 6150 Please send referrals to: Phone: 9332 2861 Fax: 9312 1576 For urgent advice: 0435 084 085 or


Mr Ian Gilfillan MBChB, FRCS (Ed) & C/Th & DMI, FRACS Has recommenced practice. Operating at Fremantle & The Mount Hospitals. Provides a comprehensive service in adult cardiothoracic surgery including: s Valvular Heart Disease s Ischaemic Heart Disease s Lung Masses s Pleural Disease For routine appointments please call 9481 7655. For my advice and emergencies, please call me directly on 0412 356 216. No gap provider for inpatients services for HBF and Medibank Private. Mount Medical Centre, Suite 50, 146 Mounts Bay Road, Perth.

CONTACT Jenny Heyden Mobile 0403 350 810 | Email


DEADLINE 12md Wednesday 2nd November for December edition

8 Hawker Avenue, Warwick WA 6024 | Ph 08 9203 5222 | Fax 08 9203 5333

54 | NOVEMBER 2016




Dr Edmund Lee MBBS (Hons), FRACP Interventional cardiologist who has completed post fellowship training in coronary stenting, structural heart interventions (including ASDs, PFOs, HOCM, valvuloplasties), cardiac biopsies and right heart catheterisation at the Mazankowski Heart Institute, Canada. Suite 34/100 Murdoch Drive Murdoch 6150 Phone: 9366 1891 Fax: 9366 1900 Consults at SJOG Murdoch, Rockingham, Warwick Mandurah, Geraldton and Bunbury. Other special interests include: s Pacemaker implantation s Transoesophageal echocardiogram For all appointments, call 9366 1891 Urgent advice: 0422 895 111

Western Cardiology is the largest WA cardiology practice providing comprehensive expertise in both Adult and Paediatric Cardiology in Metropolitan and Regional Centres. This is combined with both private and public Hospital inpatient management. The comprehensive cardiology services include: Dr Mark Hands Dr Stephen Gordon Dr Philip Cooke Dr Brendan McQuillan Dr Johan Janssen Dr Paul Stobie Dr Chris Finn Dr Eric Yamen

Dr Barry McKeown Dr Rafeeq Samie Dr Peter Dias Dr Wen-Loong Yeow


Dr Joe Hung Dr Michelle Ammerer Dr Luigi D’Orsogna

We provide a comprehensive service in general cardiology and electrophysiology (Dr Samie), Interventional Cardiology (Dr Yeow) and specialist services in echocardiography and cardiac testing (Dr McKeown & Dr Dias).

Dr Andre Kozlowski


Dr Kalilur Anvardeen

Murdoch: Rockingham: Subiaco:

Suite 10, Galliers Specialist Centre, 3056 Albany Highway, Armadale Suite 59, Level 1, SJOG Health Care Murdoch, 100 Murdoch Drive, Murdoch Rockingham-Kwinana District Hospital Medical Clinic, Elanora Drive, Rockingham 176B Cambridge St, West Leederville

We have unique automated systems for remote digital reporting to ensure rapid report turn-around: s Resting and stress ECG s Holter and ambulatory blood pressure monitoring s Transthoracic and transoesophageal echo s Exercise and dobutamine stress echo s Coronary angiography s Electrophysiology services (general and AFib ablations) s Cardiac pacing s Trans-radial angiography & intervention For appointments: Telephone: 9391 1234 Fax: 9391 1179 E-mail: INTERVENTIONAL CARDIOLOGIST

Dr Tim Gattorna Dr Devind Bhullar

s Adult & Paediatric consultations. s Congenital Heart Disease. s Heart Murmur Clinic s Echocardiography: includes Stress, 3D, Transoesophageal and Paediatric Echos. s Resting and Stress ECG, Stress Thallium Studies. s Ambulatory monitoring (Holter, BP and Event). s Implantable Pacemakers & Defibillators. s Cardiac Resynchronisation. s Pacemaker Clinic. s Electrophysiology Studies including Arrhythmia Ablation. s Coronary Angiography, Coronary Angioplasty, Stenting and Transradial. s Percutaneous closure of ASD and PFO. s Percutaneous mitral and aortic valvuloplasty and septal ablation s Coronary Calcium Scoring (HeartRisk Scan). s Mitraclip

Western Cardiology is an independent practice without any corporate ownership and with no financial equity in any cardiac catheter laboratory. We provide inpatient cardiology services for all registered health insurance funds in Australia. 08 9346 9300 08 9388 2601 1800 802 601 08 9382 6111 0411 707 017

— — — — —

For all appointments Fax Free call for country enquiries 24/7 On-call Cardiologist Chest Pain Centre: 24 hour emergency cardiac care for your private patients/hospital admission at SJOGH Subiaco



A.Prof Chris Judkins MBBS MClinRes FRACP

Dr Jennifer Martinick MBBS

Interventional Cardiologist Notre Dame University WA Cardiology Fiona Stanley Hospital

President – International Society of Hair Restoration Surgeons (ISHRS) Specialising in Hair Restoration Over 27 years experience Over 4000 successful hair transplant procedures Offering the ‘Gold Standard’ in hair transplantation Martinick Technique™ Special Interests: s (AIRå4RANSPLANTATIONå så2EPROCESSING s &ACIALå(AIRå4RANSPLANTATIONå så(AIRå,OSSå4REATMENTS Consulting: Image 21 Suite 1/21 Stirling Highway, Nedlands WA 6009 Appointments: T: 08 9386 1104 F: 08 9389 6189 Email:

Dr Chris Judkins is an interventional cardiologist with both private and public appointments. Interests include percutaneous coronary intervention via radial access, the management of resistant hypertension, dyslipidaemia, and lifestyle intervention to decrease cardiovascular risk. Chris is involved in cardiovascular research directed towards a better understanding of the causes of heart disease and improving patient outcomes having completed a Master of Clinical Research, and is completing PhD studies through the University of Melbourne. Chris consults at Murdoch, Midland, Palmyra, Narrogin and Katanning. For appointments: Ph: 9366 1899 Fax: 9366 1765 Email: Urgent advice: 0414 468 332 Email: Web:


NOVEMBER 2016 | 55


DERMATOLOGY Dr Graham Thom MBBS (Hons), DCH, FRACP, FACD Dermatologist with special interests in: s skin cancer surgery including Mohs’ micrographic surgery s general medical dermatology s paediatric dermatology Phototherapy available

Academy Face & Body Perth’s leading Cosmetic and Laser Clinic.

Address: Suite 14 A SouthBank Central, 38 Meadowvale Ave, South Perth 6151

Dr Jayson Oates FRACS is one of Perth’s most highly trained and experienced Facial Plastic and Cosmetic surgeons.

Tel: 6162 1864 Fax 6162 1764

Academy offers a highly skilled team of doctors, nurses and dermal therapists providing a wide range of procedures and award winning treatments such as: s &ACEå,IFTSå s 2HINOPLASTYå s "LEPHAROPLASTYå s /TOPLASTYå s ,ABIOPLASTYå s ,IPOSUCTIONå s #OSMETICå)NJECTIONSå s 4HREADå,IFTINGå s 3NORE34/0å,ASERå s 3CAR,%33å,ASERå s -ONA,ISAå4OUCHå,ASERå


On site we have Academy Day Hospital – offering the lower costs and convenient benefits of the first government licenced day twilight sedation hospital in WA. Suite 1a Arcadia Chambers, 1 Roydhouse St Subiaco WA 6008 Tel: (08) 9382 4800 Fax: (08) 9382 4833

Public hospital positions at Royal Perth Hospital and Princess Margaret Hospital

Dr. Prasad Kumarasinghe MBBS, MD, FCCP, FAMS, FACD Dermatologist Consulting at: Western Dermatology Hollywood Medical Centre Suite 47, No 85 Monash Avenue Nedlands 6009 Tel: 08 9389 6736 Fax: 08 9389 6748 Westminster Specialist Centre 476 Wanneroo Road, Westminster WA 6061 Special Interests: Pigmentary disorders, Skin infections, Skin cancer surgery, Phototherapy For all Appointments please call: 9389 6736 or Fax: 9389 6748


Dr Tony Caccetta MBBS (Hons) FACD

Dr Chris Heyes

Dr Philip D.G. Singh MBBS(WA) FACD Dermatologist


Philip Singh is delighted to announce that he has commenced Dermatology consultations from brand new premises in South Perth.

Dr Austen Anderson

After recently spending time in South East Queensland gaining further specialist experience, with a focus on Cosmetic and Aesthetic Dermatology, he has returned home to Perth committed to continue offering the very best Dermatological treatment through his own private practice.


A Full Service Licensed and Accredited Private Dermatology Practice and Day Hospital Offering: s Day Surgery for Skin Cancer and Melanoma s Skin Cancer Surveillance s Hyperhidrosis Management (inc Botulinum Therapy) s Phototherapy s Contact Allergy Patch Testing Clinic s Eczema/Dermatitis Management s Psoriasis Management (inc Biologic Therapy) s Acne Management s General Adult Dermatology s General Paediatric Dermatology s Rural Outreach Clinics Merredin, Northam, Narrogin, Bridgetown Appointments: Phone: 9328 5007 Fax: 9328 4007 Email: Healthlink ID: Perthder Website: Address: 5-7 Robinson Avenue Perth WA 6000

At Perth Skin Specialists, Dr Singh will be providing a comprehensive Dermatology service covering all aspects of (but not limited to): s Adult & Paediatric General Dermatology s Surgical Dermatology s Skin cancer Screening/Skin Checks s Biopsies & Definitive Surgical Management (including flaps & grafts) s Hair & Scalp Conditions s Nail Problems s Immunological & Inflammatory Skin Diseases s Acne s Phototherapy s Cosmetics (facial rejuvenation, repairs, corrections, etc... s Including Laser, Botox & Fillers) Consulting: Perth Skin Specialists Suite 5, Level 2 7 Lyall Street South Perth WA 6151 Consultations by appointment Phone 9367 7546 - Fax 9474 1267 Philip warmly welcomes your phone calls regarding any professional queries or requests for urgent clinical consultations.

56 | NOVEMBER 2016




Dr Gary Moloney B.Eng(Hons)/B.Comm MBBS FACD Dermatologist s Eczema and Psoriasis s Adult and Paediatric Dermatology s Acne s Skin checks s Skin cancer surgery s Phototherapy For Urgent Appointments: Email: or fax 124 Loftus St, North Perth 6006 Phone: 9228 0795 Fax: 9227 5673 healthlink - loftusst

EAR, NOSE & THROAT Professor Gunesh P. Rajan MD, DM, FSCS, FRACS

Ear and Cochlear Implant Surgery Skull Base Surgery Robotic Head and Neck Surgery I am happy to announce that I am now able to offer my services to private patients. My areas of expertise: s Ear surgery for Children and Adults s Cochlear and Hearing Implant surgery for Children and Adults s Surgery for Vertigo and Balance Disorders s Robotic & Endoscopic Surgery for Skull base Tumors s Robotic & Conventional Surgery for Head & Neck Tumors Operating sites: s St John of God Subiaco s Hollywood Private Hospital s Mount Hospital s Fiona Stanley Hospital s Royal Perth Hospital Consulting sites: s Hollywood Medical Centre, 85 Monash Avenue, 6009 Nedlands WA s Spin Doctors WA, 54 Farrington Road, 6154 Leeming WA For appointments call (08) 9386 9487 Referrals: New Fax No: (08) 9467 6150 Email:


Ear Science Clinic: the specialists in implantable hearing technologies.

ͻMarcus Atlas ͻPeter Friedland ͻPeter Santa Maria

Candidates of all ages are comprehensively assessed for suitability for implantable hearing devices including cochlear implants ĞůĞĐƚƌŝĐͲĂĐŽƵƐƟĐĐŽŵďŝŶĂƟŽŶ devices, middle ear implants and .

ͻZŽŶĞl Chester-Browne ͻnjadeh Madiseh Ebrahimi ͻathy Sucher ͻElle Statham ͻůŝnjĂďeth Park ͻ<arin Van Der Merwe ͻŵie Grandidge ͻ<ate Jepsen

P ovided with the highest quality clinical care by a dedicated interdisciplinary team, r r and the latest evidence-based research, conducted at Ear Science e Australia.

ͻLisa Cockman ͻMaddie Brennan ͻsivien Schrader

Head of Service ͻ'ĞŵŵĂhƉƐŽŶ

Implant Audiologists

Speech Pathologist ͻharmaine Gibson

ZĂĚŝŽůŽŐŝst ͻŶĚy Whyte

Call: 1300 847 080 | Email: Web:


Dr Briohny Smith BSc, MBBS, FRACP Consulting at: Procedures at:

20 Fortune St South Perth South Perth Hospital, St John of God Mt Lawley & Kalamunda Hospital.

Address and contact details for All Referrals: PO Box 124 West Perth WA 6872 Phone: 6102 2030 Fax: 6102 2863 Mobile: 0402 113 980 s Gap-free, open access gastroscopy and colonoscopy service. s All aspects of general Gastroenterology and Hepatology. s Special interest in liver disease GASTROENTEROLOGIST AND HEPATOLOGIST

CSD GRAPHIC ELEMENTS Personal photo dimensions no greater than 27mm x 20mm with 0.5 pt border will be published, CMYK, at 300 dpi (jpg) Group photos can be negotiated with the CSD Editor, depending on size and presentation.

Dr Sam Galhenage MBBS(UWA) FRACP I have a continuing practice at South Perth Hospital Endoscopy Unit, 76 South Terrace, South Perth, 6151. I provide an open access gastroscopy and colonoscopy service, as well as consultation in general gastroenterology and hepatology, with a special interest in viral hepatitis and advanced liver disease. For open access endoscopy referrals: Tel: 9368 2333 Fax: 9368 2300 For consultations: Tel: 6102 2030 Fax: 6102 2863

Border thickness – when used, no greater than 2pt or 0.5mm Logo – text within a logo no greater than 5mm height (uppercase character or ‘h’); CMYK, 300 dpi (jpg).


NOVEMBER 2016 | 57


Dr Kannan Venugopal MBBS, MD, FRACP I have recently commenced private endoscopy work and consulting at St. John of God Hospital Subiaco and am working out of Suite 210, 25 McCourt St SJOG Subiaco WA 6008 For Appointments: Phone: 9388 3125 Fax: 9388 1987 Email: I continue to offer my services at Hollywood Hospital where I work out of Hollywood Specialist centre Suite 11, 95 Monash Avenue Nedlands, WA 6009 Phone: 9389 6933 Fax: 9389 6944 Email: Services offered include: ĂĽ sĂĽ !DULTĂĽ'ASTROENTEROLOGYĂĽANDĂĽGENERAL Hepatology consultations. ĂĽ sĂĽ 'APĂĽFREE ĂĽOPENĂĽACCESSĂĽGASTROSCOPYĂĽANDĂĽCOLONOSCOPY service for your privately insured patients ĂĽ sĂĽ 3PECIALĂĽINTERESTĂĽINĂĽTHEĂĽMANAGEMENTĂĽOFĂĽ)NmAMMATORY Bowel Diseases; Ulcerative Colitis and Crohnâ&#x20AC;&#x2122;s Disease ĂĽ sĂĽ !ĂĽ#APSULEĂĽENDOSCOPYĂĽSERVICEĂĽISĂĽALSOĂĽAVAILABLE


Dr Corinne Jones MBBS(UWA) FRACS FRCS Specialist Breast and Endocrine Surgeon â&#x20AC;&#x153;I have established an excellent and dedicated multidisciplinary team at St John of God Hospital Subiaco. I aim to provide surgery to the highest possible standard, while offering a caring and holistic approach to every patient, making their journey to Subiaco worthwhileâ&#x20AC;? All breast and thyroid cancer cases are discussed at multidisciplinary team meetings. Specialising in: s Breast Surgery s Thyroid Surgery s Parathyroid Surgery Operating at: St John of God Hospital Subiaco Consulting from: Suite C203 Bendat Centre, St John of God Hospital 12 Salvado Road, Subiaco. WA 6008 Tel: 6465 9223 Fax: 6465 9222 Healthlink edi: drcjones Email: Urgent advice 0458 536 475

For urgent referrals and advice, please contact 0411 886 118 GASTROENTEROLOGIST AND INTERVENTIONAL ENDOSCOPIST

Dr AndrĂŠ Chong MBBS, MD, FRACP Subspecialist procedural expertise includes: ĂĽ sĂĽ %2#0ĂĽIFĂĽURGENTĂĽORĂĽFORĂĽADVICE ĂĽPLEASEĂĽCALLĂĽDIRECTLY eg malignancy, obstructive jaundice, CBD stones ĂĽ sĂĽ %NDOSCOPICĂĽ5LTRASOUNDĂĽONSITEĂĽPATHOLOGIST ĂĽ sĂĽ /ESOPHAGEAL ĂĽDUODENAL ĂĽCOLONICĂĽSTENTING ĂĽ sĂĽ /PENĂĽ!CCESSĂĽ'ASTROSCOPYĂĽANDĂĽ#OLONOSCOPY Procedures at SJOG Murdoch Please note our new contact details Tel: 6262 0828 Fax: 6311 7333 Consulting at Suite 18, SJOG Medical Clinic, 100 Murdoch Drive, Murdoch WA 6150. GASTROENTEROLOGY & HEPATOLOGY

Mr Palan Thirunavukkarasu MBBS, MRCS, FRACS General Surgeon with post fellowship training in oncoplastic breast surgery. Specialising in: s Breast cancer surgery s Breast reconstruction, reduction and augmentation s General surgery â&#x20AC;&#x201C; open and laparoscopic Hospital appointments: s Mount Private Hospital s SJOG Midland Public & Private Hospital s Sir Charles Gairdner Hospital Consulting at: Consulting Suite 6 & 7, Level 1 SJOG Midland Hospital 1 Clayton Street Midland WA 6056 P: 08 9462 5694 F: 08 9462 4490

Mount Hospital Suite 5, 3rd Floor 140 Mounts Bay Road Perth WA 6000 P: 08 9321 0853 F: 08 9321 0857

For urgent advice: 0433 319 296

Dr Vanoo Jayasekeran MBBS MRCP(UK) FRACP PhD

Gastroenterologist and Interventional Endoscopist I provide open access endoscopy service and consultation in gastroenterology and hepatology. My special interest is in Interventional Endoscopy and in Pancreaticobiliary diseases. Urgent referrals are welcome. Consulting rooms: 111 South Street, BeaconsďŹ eld WA 6162 Open access endoscopy at: St. John of God Hospital Murdoch ĂĽ sĂĽ 'ASTROSCOPYĂĽANDĂĽ"ARRETTSĂĽSURVEILLANCE ĂĽ sĂĽ #OLONOSCOPYĂĽANDĂĽ"OWELĂĽ#ANCERĂĽ3CREENING ĂĽ sĂĽ %2#0 ĂĽ sĂĽ %NDOSCOPICĂĽ5LTRASOUNDĂĽ%53 ĂĽĂĽ&.! ĂĽ sĂĽ 6IDEOĂĽ#APSULEĂĽ%NDOSCOPY For all appointments: Tel: 9335 3411 Fax: 9335 6155 Email: beaconsďŹ For urgent advice: 0478 222 281

58 | NOVEMBER 2016

Dr Wen-Chan Yeow MBBS, FRACS Has new Subiaco rooms. General Surgeon with post fellowship training in Breast and Oncoplastic Surgery. Will provide comprehensive breast management and general surgical care. With special interest in: s Breast reconstruction s Implant augmentation s Breast reduction Consulting at: sĂĽ 3UITEĂĽ ĂĽ3*/'ĂĽ-URDOCHĂĽ-EDICALĂĽ#ENTRE 100 Murdoch Drive, Murdoch 6150. T: 9332 7770 F: 9332 7771 sĂĽ 0ERTHĂĽ3PECIALISTĂĽ"REASTĂĽ#ARE Suite 305A, SJOG Subiaco Clinic 25 McCourt Street, Subiaco 6008. T: 9382 4622 F: 9382 4611 Urgent advice (breast or general surgical): 0422 116 819


CLINICAL SERVICES DIRECTORY GENERAL SURGEONS & SUBSPECIALTIES Dr David Oliver MBBS, FRACS General surgeon with special interest in breast and endocrine surgery. Specialises in: s All benign and malignant breast conditions, including oncoplastic breast surgery (reconstructions done with plastic surgeon) s Works in multidisciplinary breast cancer team at St John of God Hospital Murdoch s Endocrine surgery - thyroid, parathyroid, adrenal lesions s Provides diagnostic ultrasound and needle biopsy for breast and thyroid lesions s General surgery including cholecystectomy, hernia repair and salivary gland surgery Consults at: Suite 50 Medical Clinic SJOG Murdoch 100 Murdoch Drive MURDOCH WA 6150 Operates at: SJOG Murdoch For all appointments: Phone: 9460 0041 Fax: 9310 8509 Urgent calls or advice 0419 988 628 Email: Healthlink EDI d7oliver

Perth Surgical Clinic Dr Farah Abdul Aziz B.Med.Sci MBBS MRCS FRACS I specialise in Oncoplastic Breast Surgery Breast cancer surgery Breast reconstruction Breast augmentation and reduction General surgery: Hernias (open, laparoscopic) Gallbladder, vasectomy, carpal tunnel and lymph node biopsy. Admitting and operating at: Bethesda Hospital, Mount Private Hospital, Hollywood Hospital, Sir Charles Gairdner Hospital and Osborne Park Hospital. I am a no gap provider and able to assess and operate on urgent patients within a week. Please ring my mobile on 0415 638 541 Now also consulting at Wexford Medical Centre, Suite 63, 100 Murdoch Drive, Murdoch 6150 All Correspondence to: Suite 36 Hollywood Specialist Centre, 95 Monash Ave, Nedlands 6009 Phone: 08 9386 5814 Fax: 08 9386 9599 E-mail: Website:


Derek Chen MBBS FRACS General & Upper GI Surgeon Continues to provide a service covering s all aspects of general surgery s special interest in Upper GI Surgery s gastroscopy & colonoscopy (open access)


Dr Kevin Dolan BSc MBChB FRCPS FRCSEd MD FRCS FRACS Over 4000 weight loss surgeries performed in WA s LapBand s laparoscopic sleeve gastrectomy s laparoscopic gastric bypass Operating and Consulting at: Glengarry Hospital, Duncraig Hollywood Hospital, Nedlands Mercy Hospital, Mount Lawley SJOG, Subiaco Correspondence PO Box 17, Duncraig WA 6023 Appointments Tel: 9246 2314 Fax: 9447 0210 Online at E: Emergencies 0422 045 767


Chris Couch - MBBS, FRACS, FRCS(Glas) Specialising in Laparoscopic: s Obesity surgery s Gastro-oesophageal reflux surgery s Biliary surgery s Hernia surgery Operating and Consulting at: s Mount Hospital (Perth) s Waikiki Private Hospital (Rockingham) Tel: 1800 816 556 (Freecall) Fax: 9592 3916 Mobile: 0417 969 373


Mr Michael Tan MBBS FRACS B. Pharm (Hons) Wishes to announce commencement of private practice at Hollywood Private Hospital Specialising in all aspects of General and Upper GI surgery including: s Oesophageal, Gastric and Pancreatic cancer management s Laparoscopic – Bariatric surgery – Anti-Reflux surgery – Hiatus Hernia repair – Gallbladder and Hernia surgery s Gastroscopy and Colonoscopy Hospital Appointments: Sir Charles Gairdner Hospital, Hollywood Private Hospital, Osborne Park Hospital Consulting from: Hollywood Medical Centre Suite 41/85 Monash Ave Nedlands 6009 T: 6389 0244 F: 6389 0255

Operating at s SJOG Murdoch s FSH & Bentley Hospitals Address: Suite 1, 96 Farrington Road, Leeming, WA 6149 Contact: Tel 9312 1888 Fax 9238 0765 For enquiries & urgent advice phone 0411 061 987 (all hours)


NOVEMBER 2016 | 59

CLINICAL SERVICES DIRECTORY GENERAL SURGEONS & SUBSPECIALTIES Mr Harsha Chandraratna MBBS FRACS General Surgeon with sub-specialist interests in: s Management of obesity within a multidisciplinary setting including bariatric surgery - s Pilonidal problems s Laparoscopic surgery including appendicectomy, cholecystectomy and hernia s Emergency surgery


Mr Simon Ryan MBBS FRACS General Surgeon with post-fellowship training in Endocrine Surgery Special Interests: s Thyroid, parathyroid and adrenal diseases. s Hernia, gallbladder surgery

Consulting and Operating at: å så3Tå*OHNåOFå'ODå(OSPITALå-URDOCH å så3Tå*OHNåOFå'ODå(OSPITALå3UBIACO å så0EEL 3PECIALIST #ENTRE -ANDURAH

Hospital Appointments: s Hollywood Private Hospital s Joondalup Health Campus s Sir Charles Gairdner Hospital

For all appointments: 9332 0066 or Fax 9312 1619 For urgent advice or emergency referrals: 0401 809 255 All correspondence: Suite 27/100 Murdoch Drive, MURDOCH 6150

Consulting From: s Suite 58, Hollywood Specialist Medical Centre 85 Monash Avenue, Nedlands WA 6009 s Suite 26, Level 2 Joondalup Private Hospital Shenton Avenue, Joondalup WA 6027 Public, Private, Workers Compensation and DVA patients welcome. For All Appointments: Tel: 9386 3070 Fax: 9386 3968 Urgent / Emergency Referrals: Mob: 0408 280 276

Mr Jon Armstrong FRACS, MBBS Mr Siva Gounder FRACS, MS, MRCSEd We provide services for: All aspects of Bariatric Surgery in a multidisciplinary setting with our team of dietitians and clinical psychologist. s Gastric Banding s Sleeve Gastrectomy s Gastric Bypass s Intragastric Balloon General Surgery - (except breast or colorectal) Endocrine Surgery Endoscopy Hollywood Medical Centre - 8/85 Monash Ave, Nedlands, WA 6009 Tel (08) 9386 2634 Fax (08) 9386 2167


Perth Thyroid Cancer Clinic Offering Comprehensive Thyroid Cancer Treatment: Multidisciplinary team, Risk stratification, Complete management and surveillance. Director: Mr Dean Lisewski BSc (Hons I), MBBS, FRCSI, FRACS Specialising in: s Thyroid, Parathyroid and Adrenal Surgery. s Minimally Invasive Endocrine Surgery. s Laparoscopic Surgery. s Neck and Salivary Gland Surgery. s Biliary and Hernia Surgery Operating at: s St John of God Hospital Murdoch s Peel Health Campus s Fiona Stanley Hospital s Sir Charles Gairdner Hospital Consulting at: Wexford Medical Centre Suite 78, 3 Barry Marshall Parade, Murdoch Tel (Secretary): 9310 7878 Tel (Lisewski): 0404 464 837 Fax (Referrals): 9332 4876 Health link: drliswsk

60 | NOVEMBER 2016


Mr Amro Labib MBBS, FRACS, MBBCh Special interests: å så %NDOCRINEå3URGERYå4HYROID å0ARATHYROID

Adrenal and Pancreas) å så "REASTå3URGERYå"ENIGNåANDåMALIGNANT å å så 'ENERALå3URGERYåELECTIVEåANDåEMERGENCY Consults at: Fiona Stanley Hospital Wexford Medical Centre Operates at: Fiona Stanley Hospital St John of God Hospital Murdoch For all appointments: Phone: 1300 665 559 Fax: 08 6316 7119 Email: Web: Rooms: Wexford Medical Centre Suite 78-3 Barry Marshall Parade Murdoch WA 6150 For urgent referrals phone 0431 803 733


Mr Andrew Finlayson MBBS FRACS General surgeon with three years post fellowship training in colorectal surgery. Specialising in: s Advanced laparoscopic surgery s Colorectal cancer s Surgery for inflammatory bowel disease s Pelvic floor disorders including prolapse and incontinence s Perianal and pilonidal disease s General surgery including gallbladder and hernia surgery Operating at: Hollywood Private, Sir Charles Gairdner and Osborne Park Hospitals. Suite 41 Hollywood Medical Centre 85 Monash Ave Nedlands WA 6009 For appointments phone 6389 0244 or fax 6389 0255





Prof. Jeff Hamdorf

Sue Taylor

Jeremy Tan

Front Row: Mr Alan Thomas, Mr Krishna Epari Back Row: Mr Sanjeeva Kariyawasam, Assoc Prof Mo Ballal, Mr Matt Henderson

Building on years of experience with weight control surgery, including Gastric Banding, Sleeve Gastrectomy and Gastric Bypass surgery, our multidisciplinary team specialises in establishing the necessary lifestyle changes for improved health and wellbeing and successful weight loss after surgery.

WA’s largest team of Specialists in Upper Gastrointestinal Surgery Private Consulting, Operating and Endoscopy at: SJOG Murdoch Public Appointments at: Fiona Stanley Hospital and/or Fremantle Hospital

“The RESHAPE programme has gathered our expert surgeons, primary care physicians, dietitian, psychologist and exercise physiologists under the one banner to provide the best long term outcomes for weight loss.

Laparoscopic Surgery including Cholecystectomy +/- Bile Duct Exploration Anti-Reflux Surgery and Hiatus Hernia Repair Hernia Repairs – abdominal wall & groin Heller’s Cardiomyotomy – for Achalasia Splenectomy Endoscopy (Diagnostic and Therapeutic) Gastroscopy & Colonoscopy (incl. Open Access) s Alarm symptoms – Dysphagia, GI Blood loss, Iron Deficiency +/- Anaemia, Persistent Vomiting, Unexplained weight loss s Reflux and Dyspepsia s Surveillance of Barrett’s Oesophagus ERCP (Contact us for Urgent Referrals) s Bile Duct Stones, Jaundice Oesophageal, Gastric, Duodenal Dilatation &/or Stents Endoscopic Mucosal Resection Bariatric and Metabolic Surgery Programs Multidisciplinary assessment & follow up Medical, Psychological, Nutritional assessment and support Surgical expertise in a wide range of options s Lap. Sleeve Gastrectomy – our most reliable and effective option s Lap. Gastric Bypass – Classic Roux-en-Y or “Mini” Omega Loop s Lap. Gastric Banding – popular in Australia s Revisional Surgery – Gastric Band removal, Conversion to Sleeve or Gastric Bypass, Hiatal Repair and other complex procedures s Endobarrier – endoscopic implant for diabetes & weight loss s Gastric Balloon – endoscopic implant for weight loss Upper GI and HPB Cancer Surgery s Complete Diagnosis & Staging, Multidisciplinary Team Assessment, Major Open & Minimally Invasive Surgery, Endoscopic & Surgical Palliation for Tumours of the Oesophagus, Stomach, Pancreas*, Liver, Gallbladder, Biliary Tract & Colorectal Liver Metastases s Our staff can also help facilitate urgent referrals for uninsured public patients with suspected malignancies to be seen in our Upper GI Cancer Surgery Clinic at Fiona Stanley Hospital *All Pancreatic surgery at Fiona Stanley Hospital as per WA Health Policy

Please phone us for urgent referrals and advice Suite 73-74 SJOG Wexford Medical Centre 3 Barry Marshall Parade Murdoch WA 6150

Our surgeons are also happy to see general surgical patients of a public or private nature at Western Surgical Health. Suite 2, 95 Monash Ave Gate 5, Hollywood Specialist Centre Nedlands, WA 6009 T: 6424 8596 F: 9389 1770 W: All correspondence to: PO Box 3478 Broadway, Nedlands, WA 6009

St John of God Hospital, Subiaco Suite 212, 25 McCourt Street Integrated Colorectal Cancer and I.B.D. Unit Specialists in the multi-disciplinary treatment of colorectal cancer/I.B.D. Perth’s leading colorectal cancer research unit Rapid access to imaging/colonoscopy Professor Cameron Platell Colorectal Surgeon

Mr Michael Levitt Colorectal and General Surgeon

Professor Ian Lawrance Gastroenterologist

Mr Paul Salama Colorectal Surgeon

Ms Christine Chidlow Continence Physiotherapist s on-site oncology/radiotherapy s laparoscopic colorectal surgery s trans-anal endoscopic microsurgery s all general colorectal surgery s inflammatory bowel disease s open access colonoscopy and endoscopy s all continence related issues Urgent bookings always available for new colorectal cancer patients Happy to provide second opinions For all bookings: 9382 4577

T (08) 6189 2500 F (08) 6189 2505 Healthlink uppergiw More information for patients and referrers on our website


NOVEMBER 2016 | 61


Prof Luc Delriviere MBBS MD FRCS FRACS Specialising in: 8*4'0%#-%'01#-&,'2#12#1'1 8*+*#060'%.-1203%2*.- 8#++$+#&&'0130('06 8'0-*#0'/#*0#$&.,*-#+5#++130('06 /'0#2*-(#2.++65..&0*4#2'.1/*2#+!.1/*2#+!3$*#%. McCourt Street Medical Centre !3*2'  %.302!20''2"'12''&'04*++'" Ph   | M   | F    E:5'+%.,'2)'+*4'0%'-20'5#%.,#3

GYNAECOLOGY & GYNAECOLOGICAL SURGERY Dr Panos Maouris, MBChB, MD, FRCOG, FRANZCOG General gynaecologist with special interests in endometriosis, ďŹ broids, menstrual disorders, prolapse, endometrial ablation, advanced laparoscopic surgery including hysterectomy. No Operation Gap for private patients & public lists for non-insured patients. Operates at Hollywood & Bethesda (private patients), and KEMH, Osborne Park or Joondalup Hospitals (public/non-insured patients). Appointments: Hollywood Medical Centre Suite 17, 85 Monash Avenue, Nedlands 6009 Tel 9389 9188 Fax 9389 9199

GYNAECOLOGY & GYNAECOLOGICAL SURGERY Dr Steve Harding MBBS FRCOG FRANZCOG 177 York Street, Subiaco 6008 Tel 6380 1864 Fax 9381 8033 Email: Mobile: 0414 932 927 Special Interests: s General Gynaecology s Laparoscopic Surgery/Hysterectomy/ Endometriosis s Vaginal Reconstructive Surgery/Prolapse s Colposcopy Operates at: St Johns (Subiaco), Bethesda Hospital, Hollywood Hospital, KEMH UROGYNAECOLOGY

Dr Phil Daborn MBBS, MD, MRCOG, FRANZCOG Urogynaecologist Specialising in: ÂŹ sÂŹ'ENERALÂŹ'YNAECOLOGY Including laparoscopic hysterectomy, management of ďŹ broids, ovarian cysts and abnormal uterine bleeding ÂŹ sÂŹ&EMALEÂŹ5RINARYÂŹ)NCONTINENCE Comprehensive urodynamics assessment, medical and surgical treatment ÂŹ sÂŹ0RIMARYÂŹANDÂŹRECURRENTÂŹPROLAPSEÂŹSURGERY Vaginal, laparoscopic and mesh repair ÂŹ sÂŹ3PECIALÂŹ)NTERESTS Laparoscopic Sacrocolpopexy for apical vaginal prolapse and Sacral Nerve Stimulation for refractory urinary disorders. Consulting rooms are located at Suite 5, 400 Barker Road Subiaco WA 6008 Phone: 9382 2055 Fax: 9382 2065 or email:


Dr Ganendra Raj Kader Ali Mohan (Dr Raj Mohan), MBBS, MRCOG, FRANZCOG, CGO

Dr. A S Arun MD MD DNB CCST, FRCOG, FRANZCOG Special interests: Holistic approach in the management of s Urinary Incontinence including Urodynamics s Botox injections to bladder s Pelvic Organ Prolapse s Chronic Pelvic Pain- Endometriosis & Bladder Pain Syndrome â&#x20AC;&#x201C; Evil Twin Syndrome s Abnormal Pap smears â&#x20AC;&#x201C; Colposcopy s Advanced Laparoscopic Surgery including hysterectomy s Menorrhagia (Heavy menstrual bleeding) s Vulval disorders (Vulvodynia) Consults at: 1. Waikiki Specialist Centre - 221 Wilmott Drive, Waikiki 6169 Tel: 9550 0300 Fax: 9592 9830 2. Perth Specialist Centre Tenancy 13, 11 Wentworth Parade, Success 6164 Tel: 9498 6277 Fax: 9414 3032 3. Belmont City Medical Centre, PO Box 136, Cloverdale 6985 Tel: 9277 3999 Fax: 9277 3677 Operates at: Waikiki Private Hospital, South Perth Hospital, Peel Health Campus Mandurah & The Park Private Hospital Mount Lawley No Gap Provider for gynaecological surgery For all appointments: Tel: 9550 0300 Fax: 9592 9830 Email:

62 | NOVEMBER 2016

Gynaecologic Oncologist specialising in: s Gynaecology Oncology s Complex gynaecological surgery s Laparoscopic Surgery in Gynaecology and Gynaecology Oncology s Colposcopy and management of pre-invasive disease of lower genital tract s Familial Gynaecological Cancers and prophylactic risk reduction surgery Consulting at Hollywood Medical Centre and operating at King Edward, SJOG Subiaco & Murdoch and Hollywood Private Hospital. For all appointments please ring Hollywood Medical Centre, Suite 32 Level 1/85 Monash Avenue, Nedlands on 9389 8900 or fax 9389 8911.

Dr Mini Zachariah, MBBS, MD, MRCOG, FRANZCOG Specialises in: s Advanced Laparoscopic/Hysteroscopic surgery s Endometriosis s Menstrual disorders s Pelvic reconstructive surgery for prolapse & urinary incontinence s Infertility s Colposcopy Consulting from: Suite 43, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, WA 6009 Tel: (08) 9389 5000; Fax (08) 9389 5222; Email: Operating at: Hollywood Private Hospital, St John of God Mount Lawley Hospital, KEMH


CLINICAL SERVICES DIRECTORY GYNAECOLOGY & GYNAECOLOGICAL SURGERY Dr Jade Acton MBBS, FRANZCOG, GrDipSurgEd Dr Acton is a gynaecologist who has completed a 2 year fellowship in advanced laparoscopic gynaecologic surgery. Specialising in: s Advanced laparoscopic surgery s Endometriosis s Menstrual disorders s Surgery for sub-fertility s General gynaecology s Colposcopy Consulting from: Suite H203, St John of God Hospital - Subiaco, 12 Salvado Road, Subiaco WA 6008 For appointments: Phone: 9388 3495 Fax: 9388 3798 To discuss patients phone 0409 276 635

Assoc Prof. Krish Karthigasu, Gynaecologist & Gynaecological Laparoscopic Surgeon, specialises in: s Advanced laparoscopic surgery s Endometriosis s Surgery for sub fertility s Menstrual disorders s General gynaecology s Colposcopy He offers consultations at Hollywood Medical Centre and operates at KEMH, SJOG Subiaco, Hollywood Private and Bethesda Hospitals. For all appointments please ring the Hollywood Medical Centre, Suite 32 Level 1/85 Monash Avenue, Nedlands on 9389 8900 or fax 9389 8911. All correspondence to PO Box 1753 Subiaco WA 6904.


DR ROGER PERKINS GYNAECOLOGIST Fertility • Preconception advice • Sterilisation reversals • Ovulation disorders • Male infertility

Gynaecology • Endometriosis • Fibroids • Menstrual disorders • Ovarian cysts • Abnormal Paps

Gynaecology: West Leederville. 9388 9099 Fertility: FSWA, Bethesda. 9284 2333


Fertility, Gynaecology and Endometriosis Treatment Clinic

When your patient’s family plan isn’t going to plan... Fertility North can help.


Dr Stuart Salfinger, MBBS, FRANZCOG, CGO Specialising in s Gynaecologic Oncology s Colposcopy s Management preinvasive disease of lower genital tract s Complex general gynaecologic surgery s Advanced laparoscopic procedures / total laparoscopic hysterectomy s Familial Gynaecologic Cancers and Risk reduction surgery The Consulting Suite St John of God Hospital - Subiaco 12 Salvado Rd Subiaco WA 6008 For appointments phone: 9388 3495 Fax: 9388 3798 To discuss patients phone 0417 956 007

Dr Vince Chapple

Dr Jay Natalwala

Medical Director Qualifications

Clinical Director Qualifications

MB, BS (London) FRANZCOG, MRepMed


Dr Santanu Baruah

Dr Gian Urbani

Fertility Specialist Qualifications

Fertility Specialist Qualifications



zCycle Tracking z Timed Intercourse z Artificial Insemination zOvulation Induction zIn-vitro Fertilisation (IVF) zIntra-cytoplasmic Sperm Injection (ICSI) zPregnancy Monitoring zDonor Services zSperm / Egg Freezing zOncology Fertility Preservation zEgg Freezing for Social Reasons zSemen Analysis

Dr Jiwan Steven Singh Advanced Laparoscopic Surgery s Laparoscopic Hysterectomy s Infertility management – IVF Preparative s Bladder dysfunction s Colposcopy for abnormal paps s Laser vaginal tightening, Labiaplasty Appointments: Tel 9309 3222 Fax 9309 3736 231 Timberlane Drive, Woodvale 6026 Operates at: SJOG – Subiaco, Mt Lawley (Midland TBC) Woodvale Private Hospital for Women {No Medical Gaps for Private Funds}

Dr Megan Byrnes

Dr Jane Chapple

Fertility Specialist Qualifications




Fertility GP

Suite 30, Level 2, Joondalup Private Hospital, 60 Shenton Avenue, Joondalup WA 6027 Phone: (08) 9301 1075 Fax: (08) 9400 9962 Email: Web:

Fertility, Gynaecology and Endometriosis Treatment Clinic


NOVEMBER 2016 | 63



of Western Australia

‡ Provides the full range of infertility investigations and assisted reproduction therapies. ‡ Is a recognised training centre for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. ‡ Is committed to acting in the best interests of patients by providing integrated counselling, investigative and treatment facilities. ‡ Provides an accessable, supportive and timely service responsive to your needs as well as the needs of your patients. Fertility Specialists of WA Bethesda Hospital Claremont Tel: (08) 9284 2333

Fertility Specialists South 764 Canning Hwy Applecross Tel: (08) 6217 3800

Prof Roger Hart1

Dr Mike Aitken1

Dr Doreen Yeap1

Medical Director

Obstetrician & Gynaecologist


Dr John Love1

Dr Tamara Hunter1

Dr Chris Nichols2

Obstetrician & Gynaecologist


Obstetrician & Gynaecologist

Dr Krish Karthigasu2

Dr Richard Murphy2

Dr Ashley Makepeace1


Obstetrician & Gynaecologist


Dr Roger Perkins1

Dr Wei-Ying Chua2


Obstetrician & Gynaecologist

1 Consults at Fertility Specialists WA 2 Consults at Fertility Specialists South


64 | NOVEMBER 2016




Dr Joo P. Teoh MBBCh MRCOG MRCP(Ire) MSc MD(Glasgow) Dr Teoh is UK (RCOG) subspecialist trained in reproductive endocrinology & infertility. He speaks ďŹ&#x201A;uent Mandarin, Cantonese, Hokkien and Malay (Bahasa Melayu). Special interest: sĂĽ -ICROSURGICALĂĽSPERMĂĽRETRIEVAL (improved success and quality) sĂĽ 2EPRODUCTIVEĂĽENDOCRINOLOGY sĂĽ -INIMALĂĽACCESSĂĽGYNAECOLOGICALĂĽSURGERYĂĽ sĂĽ )6&ĂĽINFERTILITY Consulting at: Concept Fertility Centre, 218 Nicholson Road, Subiaco 6008 Appointments: Tel: 9382 2388 Fax: 9381 3603 Email:


c/o Concept Day Hospital 218 Nicholson Road Subiaco WA 6008

Dr Lucy Williams Dr Graeme Thompson Dr Kevin Artley Dr Joo Teoh Dr Erica Shellabear Dr Mini Zachariah Dr Stephen Lee Dr Adam Gubbay Dr Bruce Bellinge Dr Peter Burton Dr Ram Tampi

Medical Director Consultant Gynaecologist Consultant Gynaecologist Consultant Gynaecologist Consultant Gynaecologist Consultant Gynaecologist Consultant Gynaecologist Consultant Gynaecologist Reproductive Biologist ScientiďŹ c Director Pathologist

Pioneers in Assisted Reproduction Offering all Infertility Treatments Specialists in Advanced Laparoscopic Gynaecological Surgery

Tel: 9382 2388 Fax: 9381 3603 Range of Services

Medical & ScientiďŹ c Procedures



Accreditation: sÂŹ 2#0! sÂŹ 24!# sÂŹ .!4! sÂŹ )3ÂŹ

s Infertility investigation s Natural Fertility Enhancement s Male Infertility Management s Assisted Reproduction s IVF/GIFT/ICSI s Assisted hatching s Embryo cryopreservation/ Frozen embryo programme/ Ovarian tissue cryopreservation s Blastocyst Culture s ArtiďŹ cial insemination (husband) s Donor sperm bank/Sperm banking for prevasectomy, chemotherapy or radiotherapy patients s Embryo/Oocyte/Sperm donation programme s Ovulation monitoring/Hormone evaluation s CGH (Preimplantation genetic screening) s Preimplantation genetic diagnosis s Semen evaluation s Infertility counselling s Surrogacy

Prof. John Yovich Medical Director

Dr Philip Rowlands Consultant Gynaecologist

Dr Gayatri Borude

Dr Mark Sillender

Consultant Gynaecologist

Consultant Gynaecologist

CSD GENERAL EXCLUSIONS No serif fonts Only upper and lower case permitted No underline â&#x20AC;&#x201C; instead we use bold or italics for emphasis. No white reverse type on a background screen unless there is prior agreement from the CSD Editor.

Dr Shanthi Srinivasan Consultant Gynaecologist

Dr Vasantha Reddygari Consultant Gynaecologist

NOW AT 2 LOCATIONS - LEEDERVILLE & BUNBURY For all appts: Tel: (08) 9422 5400 * Fax (08) 9382 4576 Email: * Web:


NOVEMBER 2016 | 65

CLINICAL SERVICES DIRECTORY HAND SURGEONS Lewis Blennerhassett MBBS, FRACS, Hand Surgeon. Expertise in all aspects of acute and chronic hand disorders, both paediatric and adult, is provided. 69 Thomas Street, Subiaco All appointments please Phone 9381 6977 Fax: 9381 5266 Emergencies phone 0438 040 993 - all hours

NEUROLOGY Dr Nai Lai Neurologist in teaching hospital and rooms offers EMG, general neurology consults and botulinum therapy for chronic migraines. Suite 34 Hollywood Specialist Centre, 95 Monash Ave, Nedlands 6009 Phone: 9389 9444 Fax: 9389 7518

Mr Michael Halliday BSc(Hons)MBBS, FRACS. Orthopaedic Surgeon specialising in hand and upper limb surgery. Main areas of interest: s Arthroscopic surgery of wrist, elbow and shoulder s Chronic wrist pain and instability s Elective hand surgery especially for Rheumatoid Arthritis and Osteoarthritis s Hand and general orthopaedic trauma Mr Halliday consults at the Murdoch Orthopaedic Clinic. Appointments for Murdoch are to be made through the rooms on 9313 8290 or Fax: 9366 1488. Mobile number for emergencies and advice is 0413 148 048.

Mr Craig Smith MBBS FRACS Hand, Wrist and Plastic Surgeon has his main practice at 17 Colin St, West Perth in association with Specialised Hand Therapy Services. This means that consultation, hand therapy and splinting are all available at one location. His areas of interest include all acute or chronic hand and wrist injuries or disorders, as well as general plastic surgical problems. He continues to consult in Bunbury and Busselton. For appointments or advice please call 9321 4420

Mr Peter Hales Perth Orthopaedic and Sports Medicine Centre 31 Outram Street, West Perth. My interests include: s Arthroscopic Surgery of Shoulder, Elbow, Wrist and Hand s Wrist and Hand pain, arthritis and instability s Acute Hand & Wrist Trauma Operating sessions at Bethesda Hospital, Claremont. For all appointments and enquiries please Phone: 9212 4200, Fax: 9481 3792

Dr Julian Rodrigues MBBS (UWA), FRACP Adult neurologist with particular expertise in Movement Disorders. Is pleased to announce the opening of Perth’s first private Deep Brain Stimulation service, operating at Hollywood Hospital. Accepting patients with advanced Parkinson’s Disease, Tremor and Dystonia. See website for further information. Botulinum toxin service for all neurological indications including Chronic Migraine, Dystonia, spasticity and hyperhidrosis. Continues to see all general neurology indications including workers compensation, MVIT and EMG/Nerve Conduction studies. For all appointments and enquires: Hollywood Medical Centre, Suite 45/85 Monash Ave, Nedlands 6009 Telephone: 9420 4900 Fax: 9386 9277 Email: Web:

Dr Isabella Taylor, MBBS (UWA), FRACP, PhD (Uni Melb) Epileptologist Specialising in: Epilepsy and EEG service (adults): s first seizure investigation and management s difficult to control epilepsy s EEG service Practice location: Hollywood Medical Centre Suite 27, 85 Monash Avenue Nedlands WA 6009 Telephone: 9386 3200 Facsimile: 9386 3255

Mr Angus Keogh FRACS, FAOrthA Hand and Upper Limb Surgeon My interests include: s Traumatic and degenerative conditions of the upper limb including hand and microsurgery s Arthroscopy of the shoulder, elbow and wrist s Elbow and wrist instability My private consulting rooms are at St John of God Subiaco. For all appointments phone 9489 8784 WorkCover accepted. I consult in the public system weekly at Sir Charles Gairdner Hospital. Phone: 9346 1189

NEUROLOGY Dr Ron Manasseh MBBS (UWA), FRACP Neurologist Continues to practice in General Adult Neurology and EMG at: Hepburn Heights Shopping Centre Specialist Consulting Suite 2/6 Blackwattle Parade Padbury WA 6025 Phone: 9403 6698 Fax: 9402 8929

66 | NOVEMBER 2016

Nexus Neurology (Anthony Alvaro, Jason Burton, Nerissa Jordan and Andrew Kelly)continues to provide outpatient neurological consultation services and NCS/EMG from our purpose-built premises in the Wexford Medical Centre at St John of God Hospital Murdoch. We have a strong clinical presence in the public system, including the new Fiona Stanley Hospital, and have the capacity to see patients urgently for clinical consultation, NCS/ EMG testing, inpatient consulting services and Botulinum therapy for suitable chronic migraine patients. For all bookings/enquiries please phone 9332 2861. Fax 9312 1576. Nexus Neurology Suite 42, Level 2 Wexford Medical Centre 3 Barry Marshall Parade Murdoch WA 6150


CLINICAL SERVICES DIRECTORY NEUROSURGERY Dr John Liddell - Neurosurgeon, MBBS, FRACS Specialising in adult cranial and spinal neurosurgery – with a leaning towards minimally invasive surgery. Consults at: s Suite 1, St John of God Hospital, 175 Cambridge Street, Subiaco 6008. For all appointments phone 9382 1933. Fax: 9388 1253 For urgent advice or A/H phone 0419 321 857 or 9382 6111

Prof Christopher Lind MBChB, FRACS Neurological Surgery Suite 1, Ground Floor, St John of God House 175 Cambridge St, Subiaco, WA 6008 Ph: 08 9382 1933 Mob: 0421 747 929 Fax: 08 9388 1253 Is joining Prof Bryant Stokes, Prof Neville Knuckey, Mr Peter Watson and Mr John Liddell at Neurological Surgery in Subiaco. Specialties: s Brain Surgery s Spine Surgery s Peripheral Nerve Entrapments s Deep Brain Stimulation for Movement Disorders s Facial Pain s Cerebrovascular disorders s Paediatric Neurosurgery Public Appointments: Sir Charles Gairdner Hospital, Perth Children’s Hospital, Royal Perth Hospital


Mr Andrew Miles MBBS FRACS, Neurosurgeon, provides a full neurosurgical service with special interest in: s Spinal surgery: Post-FRACS fellowship training in Melbourne & USA in complex spinal surgery. - chronic back pain, sciatica and cervical radiculopathy / myelopathy - spinal instrumentation and fusion - cervical and lumbar prosthetic disc surgery s Brain tumours: post-FRACS fellowship training in USA in brain tumour & epilepsy surgery - specialising in difficult tumours in eloquent cortex - awake craniotomy with cortical stimulation and functional brain mapping s All aspects of general adult neurosurgery and spinal surgery Consultation rooms at SJOG Hospital Subiaco and Murdoch for insured and worker’s compensation patients (no MVIT). Please Note New Phone/Fax Numbers All bookings please phone 6380 2600 or fax 6380 2029 For advice and urgent consultations at all times call 0413 057 264.


Dr Joe Cardaci MBBS FRACP FAANMS Nuclear Medicine Physician. Diagnostic Nuclear Imaging provides a comprehensive Nuclear Medicine service at Hollywood Private Hospital. Special interests in: s Musculoskeletal imaging including sports injuries s Myocardial perfusion imaging s Functional brain imaging. s Radionuclide therapy (liver and bone metastases, benign thyroid disease) For appointments please telephone 9386 2844 or Fax: 9386 2899. Please contact me should you have any questions regarding Nuclear Medicine procedures. I can be contacted on my mobile 0412 556 901.

OBSTETRICS & GYNAECOLOGY Dr Cliff Neppe B.Comm MB BCh FRANZCOG Consults at: Suite 17, 1st floor Joondalup Private Hospital Shenton Avenue Joondalup WA 6027 Tel: 9301 0722 Fax: 9301 2715 Email: Offers Obstetrics & Gynaecology at: Private: Joondalup Private Hospital and Glengarry Private Hospital Public: Joondalup Health Campus Special interests also include: s Colposcopy s Urinary Incontinence s Pelvic Floor Repair s Menorrhagia s Contraception s Infertility

Dr Vincent Lee MBBS MRCOG FRANZCOG Consultant Obstetrician and Gynaecologist Suite 3, Level 2, St John of God Mt Lawley Medical Centre, Ellesmere Road, Mount Lawley, WA 6050 Ph: 9370 9812 Fax: 9370 9814 Specialises in: s Obstetrics s General Gynaecology s Laparoscopic and Hysteroscopic Gynaecological Surgery s Colposcopy s Prolapse Surgery s Endometrial Ablation for menorrhagia control Dr Lee also offers private Obstetric care and delivers at St John of God Mt Lawley Hospital. He has private operating lists at St John of God Mt Lawley Medical Centre. Dr Lee is also a Visiting Consultant to Bentley Hospital. There is No Operation Gap for Privately Insured Patients.

20% off websites

& logos for November* Contact & quote mf16 *Conditions apply


NOVEMBER 2016 | 67



Murdoch Obstetrics & Gynaecology


Dr Richard Murphy MBBS, FRACGP, FRANZCOG Consults at: 7 Ellen Street, Subiaco WA 6008 (Cnr York & Ellen Street)

Dr Zhuoming Chu MBBS, PhD (UWA), FRANZCOG Suite 85 Level 5, SJOG Wexford Medical Centre 3 Barry Marshall Pde, Murdoch 6150 Tel: 9312-2100 Fax: 9312-1295 Email:

Ph: 9200 6140 Fax: 9200 6150 Email: Web:

Dr Chu is a Western Australian trained Specialist Obstetrician and Gynaecologist. He completed his PhD degree in the University of Western Australia in1996, and has been a full time Consultant Obstetrician and Gynaecologist at King Edward Hospital since 2009. Dr Chu can speak Cantonese & Mandarin. He is a no gap provider with no out-of-pocket cost for gynae surgical procedures or deliveries. Special Interest: s General Obstetrics and Gynaecology s Vaginal Hysterectomy and Vaginal Repair s Colposcopy and LLETZ (LLETZ will be done at Public Hospital for uninsured s Advanced Laparoscopy including Total Laparoscopic Hysterectomy Patients for free)

Dr Adam Gubbay MBBS(WA) FRANZCOG Special Interests: s Obstetrics s General Gynaecology s Laparoscopic Surgery s Colposcopy s Infertility (Concept Fertility Centre) Dr Gubbay has a private Obstetric & Gynaecological practice. He delivers at St John of God Hospital Subiaco and Mount Lawley. He is a no-gap provider for most health funds. Dr Gubbay also works at Osborne Park Hospital and has access to public operating lists. He can see public patients at his rooms. Consults at: Suite 309, Subiaco Clinic St John of God Hospital 25 McCourt Street SUBIACO WA 6008 Phone: 9382 9550 Fax: 9388 8863

For all appointments: Phone: 9203 8777 Fax: 9381 2006 Email: See for more information Also consults at WOMEN Centre (


OfďŹ ce Gynaecology & Colposcopy Suite 31 Level 2 Wexford Medical Centre 3 Barry Marshall Parade Murdoch 6150 Tel: 9332 1876 Fax: 9312 1703 Email: We are NO GAP providers for in hospital gynaecology & obstetrics services.

68 | NOVEMBER 2016

Dr Stephen Lee MBBS (Melb) MBA (Melb) FRANZCOG Is now accredited at Glengarry Private Hospital for Obstetrics and Gynaecology. Consultant obstetrician, gynaecologist, and advanced laparoscopic surgeon at St John of God Subiaco, Hollywood Private Hospital, Concept Fertility Centre, and Glengarry Private Hospital. Specialises in minimally invasive gynaecology: s Laparoscopic Treatment of Severe Endometriosis s Laparoscopic and Hysteroscopic Myomectomy s Total or Subtotal Laparoscopic Hysterectomy s Advanced Operative Hysteroscopy for Uterine Fibroid, Septum, etc. New additional rooms at: Glengarry Specialist Centre, Suite 6/64 Arnisdale Road, Duncraig

PWSC is now conveniently located on site at SJOG Murdoch Campus.


Dr Murphy has a private Obstetric practice based at SJOG Subiaco, an appointment as Consultant Obstetrician and Gynaecologist at King Edward Memorial Hospital and admitting rights at Attadale and Mercy Hospitals. He also consults at Fertility Specialists South. Special interests include: Obstetrics, recurrent pregnancy loss, perinatal loss and subfertility. Surgical interests include: complex hysteroscopic surgery including Essure contraception, laparoscopy and vaginal surgery.


Dr Fred Busch MBChB FRANZCOG Is accredited at SJOG Subiaco and Glengarry Private Hospitals for gynaecology and obstetrics. He manages all aspects of general obstetrics and gynaecology. Special interests in gynaecology include: s advanced laparoscopic surgery (including hysterectomy and endometriosis surgery) s pelvic ďŹ&#x201A;oor repair and incontinence surgery s menorrhagia management s colposcopy Consults at: WOMEN Centre, 20/2 McCourt Street, West Leederville For all appointments: Phone: 9468 5188 Fax: 9381 2006 Email: Web:





Dr Philip K Rowlands

Consultant Obstetrician & Gynaecologist


Has now commenced his own private practice at Glengarry Private Hospital, encompassing all aspects of obstetrics and gynaecology. Specialising in: s Comprehensive obstetric care (inc VBAC) s Infertility (including IVF) s Hysterectomy (vaginal & laparoscopic) s Pelvic reconstruction for vaginal prolapse s Urinary incontinence surgery s Colposcopy s Laparoscopic / hysteroscopic surgery (advanced level 5/6) s Endometrial ablation s Cosmetic vulval surgery Extensive family planning services: s Fertility control (both medical and surgical) s Sterilisation s â&#x20AC;&#x153;DifďŹ cultâ&#x20AC;? Mirena/Implanon insertions and removals. s Management of failed pregnancy/miscarriage For all appointments please contact my Practice Manager Erryn Arnold at 50 Arnisdale Rd, Duncraig, 6023. Ph 9448 6064 Fax 9243 1867 All patients requiring urgent consultation will be seen within one week.

Areas of special interest include: s Obstetrics s Gynaecology - Advanced Laparoscopic/Hysteroscopic Surgery - Endometriosis - Menstrual disorders - Pelvic reconstructive surgery for prolapse & urinary incontinence - Colposcopy Consulting Rooms: Suite 3, Level 1, St John of God Mount Lawley Medical Centre, Ellesmere Road, Mount Lawley, WA 6050 Tel: 08 9370 9917 Fax: 08 9370 9289 â&#x20AC;&#x153;We are a NO GAP provider for in hospital proceduresâ&#x20AC;?


Western Ultrasound for Women Offering a comprehensive and advanced range of ultrasound services in obstetrics and gynecology

Suite 12 SJOG Medical Centre Ellesmere Road Mount Lawley WA 6050

Dr Pierre Smith

Dr Patrick Wu

Dr Ana Perkovic




Comprehensive Obstetrics and Gynaecology at SJOG Hospital, Mt Lawley. s Obstetrics s General Gynaecology s Laparoscopic Surgery s Abdominal & Vaginal Surgery

Dr Seonaid Mulroy

Dr Anthony Murphy

Dr Emmeline Lee





Tel 9370 9790 Fax 9271 7400


We do not charge gaps for in hospital procedures.

3D/4D Technology available at all sites

s Colposcopy s Infertility (not IVF) s Urinary incontinence

Refer to website for further information: Murdoch 08 9310 1888 West Leederville 08 9388 1340


NOVEMBER 2016 | 69



womens imaging services


Dr. Anjana Thottungal MBBS, MD, FRCOG (UK), FRANZCOG, DDU

Offering a comprehensive range of specialist scanning services in Obstetrics and Gynaecology. Obstetrics Ultrasound s Early Pregnancy/ Dating Scan s Early Anatomy Scan (12-14 weeks) & Counselling for Non-invasive prenatal testing (NIPT) s First Trimester Screening s Amniocentesis & Chorionic Villus Sampling s Fetal Anatomy Survey including 3D/4D imaging s Fetal Growth & Well Being Assessment

Gynaecology Ultrasound s Pelvic Ultrasound & 3D Pelvic Ultrasound s Assessment of Subfertility s Saline Sonography (Sonohysterography) s HyCoSy for Tubal patency testing s Sonovaginography & Assessment of severe endometriosis Suite 1 Level 1, SJOG Medical Centre Ellesmere Road Mt Lawley WA 6050 08 6162 1074

08 7123 4403

Dr Diane Davies

Prof Jan Dickinson

Dr Kristy Milward




Womens Imaging Services represents an experienced team of medical practitioners and sonographers dedicated to providing excellence in obstetric and gynaecologic ultrasound. Obstetric Imaging Early pregnancy ultrasound First Trimester Screening for aneuploidy and NIPT Early fetal anatomy survey (12-16 weeks) Prenatal diagnosis (CVS & amniocentesis) & fetal medicine consultation Cervical length screening Fetal anatomy survey Fetal growth and well-being assessment Multiple pregnancy assessment Gynaecologic Imaging Pelvic ultrasound Endometrial assessment with sonohysterography 'HHS,QÃ&#x20AC;OWUDWLQJ(QGRPHWULRVLV ',( DVVHVVPHQW Tubal patency assessment with HyCoSy Location: 442 Barker Road, Subiaco WA 6008 Ph: (08) 93821500. Fax: (08) 93821927 Email:

OPHTHALMOLOGY Dr Frederick J. Nagle MB, BCh, BAO, LRCP&SI, FRANZCO. Comprehensive General Ophthalmologist Post grad Diploma in Refractive Surgery Sydney University. Consulting at: 12 Clive Street West Perth 6005 Phone: 08 9481 8626


Provides comprehensive ophthalmic services with interests in: s Cataract Surgery / Refractive Lens Exchange (Multifocal Implants) s Glaucoma (medical and surgical) s Paediatric Ophthalmology / Squint surgery s Oculoplastic Surgery s Diabetic Retinopathy, Age-Related macular Degeneration Consults at: Southbank Central (off Mill Point Road), Suite 8, 38 Meadowvale Avenue, South Perth WA 6151 Also consults at Armadale Operates at: Bentley Hospital, Princess Margaret Hospital, South Perth Hospital, Perth Eye Hospital (West Perth) For all appointments: Phone: 9474 1411 Fax: 9474 1422 Emergency contact: 0421 595 654 Email:

70 | NOVEMBER 2016



OPHTHALMOLOGY Dr Tom Cunneen MBBS(Hons), MMed, FRANZCO Corneal, Refractive and Oculoplastic Surgery

We are pleased to announce the opening of our branch at 65 Church Avenue, Armadale 6112. Dr Jason Lim MBBS (UWA), FRANZCO Provides services in: s Cataract surgery s Glaucoma management - inc laser, penetrating (trabeculectomy and tube insertion) and non-penetrating glaucoma surgery (deep sclerectomy). s General Ophthalmology Operates at: s St John of God Hospital Murdoch s Bentley Hospital (Public uninsured patients) s Fremantle Hospital Dr Kai Goh MBBS UWA(Hons), FRANZCO Continues to provide clinical services in Cataract, Glaucoma and General Ophthalmology Operates at: s St John of God Hospital Murdoch s Bentley Hospital (Public uninsured patients) s Perth Eye Hospital, West Perth Specialises in: s Cataract Surgery and Laser Cataract surgery s Glaucoma management/Laser/Surgery

Murdoch Ophthalmology Suite 38, Level 2 St John of God Wexford Medical Centre 3 Barry Marshall Drive, Murdoch 6150

10 Churchill Ave, Subiaco Dr Cunneen is a dual fellowship trained ophthalmic surgeon accepting sub-speciality and general referrals. Public appointments at Sir Charles Gairdner Hospital and Fremantle Hospital Operates at: s Perth Eye Hospital, West Perth s St John of God, Subiaco s Sir Charles Gairdner Hospital and Fremantle Hospital Contacts: Phone: 9381 5955 Fax: 9388 3237 Email: Mobile 0420 425 974

Dr Alexandra Taylor, MBBS (UWA), FRANZCO Ophthalmologist Specialising in: Oculoplastic & Reconstructive Surgery (adults + children): s Eyelids/Brows – entropion, ectropion, ptosis, blepharoplasty s Lacrimal – watery/sticky eyes, lacrimal gland/sac masses s Periocular lesion excision + reconstruction (benign + malignant) – e.g. cysts, BCC, SCC, melanoma s Orbit – masses, thyroid eye disease Admitting privileges: St John of God Hospital (Subiaco) Practice location: Hollywood Medical Centre Suite 27, 85 Monash Avenue Nedlands WA 6009 Telephone: 9386 3200 Facsimile: 9386 3255

Branch: Armadale Medical Specialist Centre 65 Church Avenue, Armadale 6112 For all appointments: Phone: 6144 3033 Fax: 6144 3038 Email: Dr Tim Isaacs MBBS FRCOphth FRANZCO, Retinal Specialist is pleased to advise that he has commenced private practice at St John of God Subiaco.

Dr Robert Paul MBBS (UWA) FRANZCO Specialises in Cataract, Laser Eye and Refractive Surgery. He offers a comprehensive service in treating cataracts, corneal disease, shortsightedness, long sightedness and astigmatism. WA Laser Eye Centre provides: s Femtosecond Laser Cataract Surgery s Corneal transplantation and X linking /Kerarings for Keratoconus s State of the art Blade Free Laser Technology s Multifocal implants for Presbyopic patients s Implantable Phakic lenses for those not suitable for laser In addition to private practice I perform surgery on public patients at: s Bentley Hospital s Osborne Park Hospital

All Enquiries 533 Canning Highway Melville 6154


Ph: 9330 8463

Fax: 9330 6994

Suite 30, Hollywood Medical Centre 85 Monash Avenue Nedlands 6009

This is a new adult general ophthalmology practice, specialising in medical and surgical disorders of the retina, macula, choroid and vitreous including: s Cataract s Macular degeneration s Diabetic retinopathy s Retinal vein occlusion s Retinal tears and detachment s Vitreous haemorrhage s Epiretinal membrane s Macular hole s Ocular oncology including choroidal melanoma s Laser treatment of floaters Newest diagnostic imaging including Heidelberg OCT, wide field angiography, Humphrey field, Ultrasound Urgent and Emergency appointments available at short notice. Consults: Perth Retina, Suite 1-C, Ground Floor, St John of God House, 175 Cambridge Street, Subiaco Operates: SJOG Subiaco, Perth Eye Hospital, Royal Perth Hospital, Osborne Park Hospital All appointments and enquiries: T: 9381 5911 F: 9380 6620 For advice and afterhours emergencies mobile 0412 007 229

NOVEMBER 2016 | 71


Now Open in Rockingham and Murdoch Dr Michael Wertheim MBChB FRCOphth FRANZCO Comprehensive General Ophthalmologist Designated Aviation Ophthalmologist Consults at: s Suite 26 Wexford Medical Centre, 3 Barry Marshall Parade, Murdoch 6150 s Suite 8 Waikiki Specialist Centre, 221 Willmott Drive, Waikiki 6169 Operates at: s Perth Eye Hospital (formerly Eye Surgery Foundation), West Perth s Waikiki Private Hospital s Osborne Park Hospital s Bentley Hospital Special Interests: s Cataract Surgery s Pterygium Surgery All Appointments for Murdoch and Rockingham s Phone 08 9312 7222 s Fax 9312 7333 s Email s



Consults at: s Suite 36 Level 2, SJOG Wexford Medical Centre, Murdoch, 6150 s Suite 18, Galliers Specialist Centre, Armadale Kelmscott Hospital, 6112 Operates at: s St John of God Murdoch Hospital (private patients) s Bentley Hospital (uninsured patients) Dr Lai is a Western Australian trained Ophthalmologist who has completed an internationally renowned Cataract and Glaucoma fellowship at Toronto, Canada. Comprehensive ophthalmologist with special interests in Complex/Laser Cataract Surgery and Glaucoma management/Laser/Surgery Dr Johnny Wu MBBS(Hons), BMedSc, MMedSc, FRANZCO

Consults at: s Suite 36, SJOG Wexford Medical Centre, Murdoch 6150 s Suite 2, Midland Business Centre, 24 Victoria St, Midland 6056 s Suite 5, 10 Reid Prom, Joondalup 6027 Operates for both private and public patients at: s SJOG Midland & Murdoch Hospitals s Westminster Day Surgery s Bentley & Osborne Park Hospitals Dr Wu has completed 3 surgical fellowships in Australia, UK and Canada Special interests: Cataracts, Pterygium, Eyelids, Neuro-ophthalmology & Squints Surgery


Dr Phillip McGeorge MBBS, FRACS, FRANZCO, Ophthalmic Surgeon, is available for LASIK, laser cataract surgery, multifocal and monofocal lens implantation and adult general ophthalmology with early appointments. Sub-specialist in anterior segment surgery. LenSx Laser Cataracts and Traditional Surgery Phone: 9218 7666 Fax: 9218 7600

Dr Andrea Ang MBBS (Hons, UWA), MPH (Harvard), FRANZCO Ophthalmologist and Corneal Specialist Post-fellowship training in Cornea, Anterior Segment, and External Diseases at the Cincinnati Eye Institute, USA, and the Singapore National Eye Centre. Special interests: s Cataract surgery s Refractive surgery including LASIK and PRK s Pterygium surgery, corneal transplantation Consults at: s LEI Nedlands: 2 Verdun Street, Nedlands s LEI Murdoch: Suite 24, Murdoch Medical Centre, SJOG, Murdoch Operates at: s Lions Eye Institute, SJOG Murdoch & Subiaco (Private) s Bentley Hospital, Royal Perth Hospital (Public) Nedlands Appointments: 9381 0807 Fax: 9381 0864 Murdoch Appointments: 9381 0765 Fax: 9311 4134

Dr Chris Kennedy Retinal Specialist

MBBS (WA), PhD (Distinction), FRANZCO, FRACS

Specialises in Medical, Surgical & Laser treatment of: s Macular degeneration s Diabetic eye disease s Retinal detachment s Retinal vein occlusion s All other disorders of Vitreous, Retina & Macula Urgent & Emergency appointments for: s Rapidly deteriorating vision s Distorted vision s Loss of central vision or reading ability s Sudden onset of floaters or flashes s Bleeding in macula, retina or vitreous Consults: St John of God Eye Clinic, Suite 206, 25 McCourt St, Subiaco Operates: SJOG Subiaco, Eye Surgery Foundation & Osborne Park Hospital

All appointments Phone: 9313 6688 Fax: 9313 6988 Email:

Tel: 9382-9422

72 | NOVEMBER 2016

Fax: 9382-9423

Mobile: 0417-993-957



Professor Geoffrey Crawford MBBS (UWA), FRANZCO, FRACS

Ophthalmologist and Corneal Specialist Provides services in: s Laser refractive surgery, including LASIK, PRK, PTK s Phakic IOL’s and refractive lens surgery s Corneal transplantation, pterygium surgery s Cataract surgery s Keratoconus management, including corneal cross linking and implantable corneal ring segments Consults at: s Lions Eye Institute: 2 Verdun Street, Nedlands Operates at: s Lions Eye Institute (Private) and St John of God Hospital, Subiaco (Private) s Royal Perth Hospital (Public)


Dr Phillip McGeorge MBBS, FRACS, FRANZCO, Ophthalmologist and Refractive Surgeon, is available for laser eye surgery, lens implantation, laser cataract surgery, multifocal and monofocal lens implantation, treatment of keratoconus and other corneal disorders. Perth’s most experienced surgeon for LASIK and multifocal lens implantation. Phone: 9218 7666 Fax: 9218 7600

ORAL MEDICINE Oral Medicine WA Suite 3, 42-44 Parliament Place, West Perth 6005 Ph: 9226 2968 Fax: 9324 3693

Professor Graham Barrett MBBS,FRANZCO, FRACS Ophthalmologist and Corneal Specialist Provides services in: s Complex Cataract Surgery s Laser and refractive surgery, including LASIK and PRK s Corneal transplantation, pterygium surgery s Keratoconus management, including corneal cross linking and implantable corneal ring segments Consults at: s Lions Eye Institute: 2 Verdun Street, Nedlands Operates at: s Lions Eye Institute (Private) and St John of God Hospital, Subiaco (Private) s Sir Charles Gairdner Hospital (Public) Dr Steven Wiffen MBBS(Hons, UQ), FRANZCO, FRACS Ophthalmologist and Corneal Specialist Provides services in: s Corneal transplantation s Pterygium surgery s Cataract surgery s Laser and refractive surgery (LASIK/ PRK/ PTK/ CLE/Phakic IOL) s Management of ocular surface disorders s Keratoconus management, including corneal cross linking and implantable corneal ring segments Consults at: s Lions Eye Institute: 2 Verdun Street, Nedlands Operates at: s Lions Eye Institute and St John of God, Subiaco (Private) s Fremantle Hospital (Public) Dr Andrea Ang MBBS (Hons, UWA), MPH (Harvard), FRANZCO Ophthalmologist and Corneal Specialist Special interests: s Cataract surgery s Refractive surgery including LASIK/PRK/PTK and lens surgery s Pterygium surgery s Corneal transplantation s Keratoconus management including corneal cross linking Consults at: s Lions Eye Institute Nedlands: 2 Verdun Street, Nedlands s Lions Eye Institute Murdoch: Suite 24, Murdoch Medical Centre, SJOG, Murdoch Operates at: s Lions Eye Institute and St John of God Subiaco and Murdoch (Private) s Royal Perth Hospital (Public)

Dr Janina Christoforou BDSc(Hons), DClinDent(OralMed/ OralPath), FRACDS(GDP), MRACDS(OralMed), FOMAA Oral mucosal conditions: s Oral ulcers s Oral infections (Fungal, Viral, Bacterial) s Oral cancer s Benign oral neoplasms s Autoimmune and Immune-modulatory inflammatory conditions s Oral manifestations of systemic disease s Oral complications associated with chemotherapy and radiotherapy s Halitosis Salivary gland disease: s Dry mouth s Sjogren’s syndrome s Mucoceles Orofacial pain: s Neuropathic orofacial pain s Temporomandibular joint disorders s Burning mouth syndrome Appliances for Sleep-disordered breathing


Oral and Maxillofacial Surgeon Would like to inform his colleagues that he is restricting his practice to: s Temporomandibular joint disorders s Arthroscopic Surgery of the Temporomandibular Joint.

Address: SJOG Mt Lawley Hospital, Suite11-11A Medical Centre Ellesmere Road, MT LAWLEY 6050 Tel: 9370 9329 Fax: 9370 9350 Emergencies: 0417 924 422 Email: All correspondence to: 15 Florence Way, Dianella WA 6059 Email:

Nedlands Appointments: 9381 0807 Fax: 9381 0700 E: Murdoch Appointments: 9381 0765 Fax: 9311 4134


NOVEMBER 2016 | 73


Mr Peter Ammon MBBS(WA) FRACS(Orth) Foot, Ankle & Knee Orthopaedic Surgeon (fellowship trained) Practising at: s Murdoch, St John of God Hospital All aspects of foot and ankle disorders will be covered including s Minimally Invasive Foot Surgery s arthritis s injuries and fractures s foot deformity s neurological foot problems * Also acute and chronic knee disorders. For all appointments, please call: 6332 6300 Fax: 6332 6301 For a/h emergencies call: 0407 084 034

ORTHOPAEDIC SURGEONS Mr Michael Anderson MBBS, FRACS Orthopaedic Surgeon Special interests: Hip and Knee Surgery s Arthroplasty s Joint revision surgery s Arthroscopic knee surgery Offer a No Gap Cover for all health funds Department of Veteranâ&#x20AC;&#x2122;s Affairs patients welcome No WC, MVIT, Necks/Backs or upper limb Consults & Operates at: s St John of God Hospital (Murdoch) s SJOG Consult Rooms, 117 Anstruther Rd, Cnr Moat St MANDURAH 6210 Phone: 6332 6310 Fax: 6332 6313


Mr Reza Salleh MBBS(UWA) FRACS Is practising at Suite 217 SJOG Subiaco Clinic, 25 McCourt St, Subiaco. I have recently completed post FRACS fellowship training in foot and ankle surgery and knee arthroplasty in Melbourne, Sydney and at Guyâ&#x20AC;&#x2122;s Hospital, London. A comprehensive adult foot and ankle service is provided including s deformity correction s degenerative conditions s arthroscopic and tenoscopic surgery s trauma and sports injuries as well as knee arthroscopy and arthroplasty. Telephone: 9382 9102 Fax: 9382 9104 Mobile: 0418 942 235 all hours

Mr David RJ Gill, MBChB, FRACS Orthopaedic Surgeon Shoulder, Elbow, Wrist, Joint Replacement Special interests: s All Arthroscopic Shoulder reconstructions and stabilisations s Elbow & Wrist Arthroscopic reconstruction s Joint Replacement Shoulder Elbow Hip and Knee Private, DVA & Workers Compensation patients welcome. Public Patients - Peel region (Peel Health Campus Theatre List) Appointments and enquires: P 08 93863477 F 08 9386 5979 Email: Suite 38 Hollywood Specialist Centre 95 Monash Ave Nedlands WA 6009 Also, consulting Mandurah and Glengarry I am available on my mobile for advice 0439 863477 Mr Braad Sowman BDS, MBBS, FRACS Orthopaedic Spinal Surgeon I have recently completed post FRACS fellowship training in spine surgery in Brisbane. A comprehensive spine service is provided including: s Adult and Paediatric Spine s Degenerative Spine s Tumour (metastatic and primary spine) s Disc surgery s Spinal Trauma s Cervical, thoracic and lumbar problems s Orthopaedic Trauma Private, DVA, Workers Compensation and MVIT patients welcome. Public patient referrals for Joondalup Health Campus.

Mr Ben Kimberley MBBS, FRACS Orthopaedic Surgeon Special interests: s Hand and upper limb surgery s Arthroscopic surgery of upper and lower limb s Joint replacement surgery s Orthopaedic trauma including fractures and joint injuries

Operating at: St John of God Subiaco, Joondalup Health Campus and Royal Perth Hospital

Operates at: s Mount Hospital s Armadale Hospital s Hollywood Private Hospital s St John of God Wembley Day Surgery

Consulting at: St John of God Hospital, Subiaco Clinic Suite 302, 25 McCourt Street SUBIACO 6008

I provide a No Gap Cover on All Health Funds. DVA, ICWA and WC welcome. With a specialised interest in WC. Emergency review and treatment can be provided with rapid access to imaging and operating lists if required.

Joondalup Health Campus (Sessional rooms) Appointments and Enquires: Phone: 9382 9652 Fax: 9463 6468 For urgent advice 0410 698 922

74 | NOVEMBER 2016

Consults at: Suite 6/Level 4,140 Mounts Bay Road, Perth Tel: 9481 1990 Fax: 9481 1992




Mr Brett Bairstow BMedSc (Hons), MBBS (WA), FRACS Fellowship trained Orthopaedic Surgeon specialising in: Primary and Revision Hip and Knee Joint Replacement Knee Arthroscopy including ACL reconstruction

Mr Benjamin Hewitt MBBS, FRACS Orthopaedic Surgeon Knee, Shoulder, Hip and Sports Surgery

Regular operating lists at: St John of God Mt Lawley Hospital Main Consulting rooms: Mount Lawley Orthopaedic Clinic

Special Interests: s Arthroscopic surgery of the knee and shoulder. s Knee ACL and other ligament reconstruction. s Shoulder instability and rotator cuff repair. s Joint replacement knee, hip and shoulder.

Suite 6, L1, St John of God Medical Centre Ellesmere Road, Mt Lawley WA 6050

Please note change of address

Private operating rights at: Joondalup Health Campus. For appointments please telephone 9370 9838 or fax 9370 9837

ORTHOLOGY Suite 1, 48 Outram st, West Perth, 6005 Phone: 9322 1990 Fax: 9322 1991 Happy to provide advice anytime on 0419 048 142

Professor Bo Nivbrant MD, PhD, FRACS I am consulting at Mount Medical Centre, Suite 6, Level 4, 140 Mounts Bay Road and operate at the Mount hospital as well as SCGH. My areas of interest are: s Hip and Knee Replacements Surgery s Resurfacing and Revisions s Mini Invasive and Computer aided Joint replacements For appointments please Phone 9481 1990 or Fax 9481 1992

Mr Gerald Lim MBBS (WA), FRACS consults at Murdoch Orthopaedic Clinic, Cockburn Integrated Health and Waikiki Private Hospital. Special interests: s Hip Replacement surgery s Knee Replacement surgery s Arthroscopic knee surgery He operates at SJOG Murdoch, Waikiki Hospital and Armadale Kelmscott Hospital. He is able to see Privately insured, Public patients and Worker's Compensation patients. He offers a No Gap Cover for all major Health Funds. Please contact him at Murdoch Orthopaedic Clinic on 9366 1818 and 9311 4655, or on mobile 0415 366 081. Fax: 9311 4663

Mr Michael Edwards MBBS (Hons), FRACS Consults at: Mercy Orthopaedic Centre, St John of God Mt Lawley Midland Orthopaedics, St John of God Midland Special Interests: s Upper limb surgery: Shoulder, Elbow, Hand & Wrist s General Orthopaedic Trauma For all appointments please phone the main Mt Lawley rooms on 9370 9850


Dr Johan Mostert ࠮:OV\SKLY 2ULL:\YNLY`

Now consulting at: Š 367 Canning Hwy, Palmyra Š 82 Rosewood Ave, Woodlands Š 130 Hannan St, Kalgoorlie


t 08 9200 2270 f 08 9200 2271

Dr Matthew Lawson-Smith ࠮/HUKHUK<WWLY3PTI:\YNLY`

His special interests include: Š Hip and knee arthroplasty Š Knee arthroscopy, including reconstruction, meniscal repair and articular cartilage grafting Š Sporting injuries Š Trauma Š Medicolegal opinions P: F: E: A:


t 08 9200 6153 f 08 9200 2798

Dr Edward Baddour ࠮(K\S[ 7HLKPH[YPJ:WPUHS:\YNLY` :\IPHJV

t 08 9200 6059 f 08 9200 2758

08 9311 4800 or 1300JOINTZ (1300 564 689) 08 9311 4801 PO Box 491, Melville WA 6956



t 08 9200 2270 f 08 9200 2271



t 08 9200 6052 f 08 9200 3952



NOVEMBER 2016 | 75



Assoc Professor Kon Kozak MBBS(WA), FRACS, FAORthA

My interests include: s Shoulder and Elbow Surgery s Hip and Knee Surgery s Sports Injury and Surgery My main consulting rooms are at: Level 2, 280 Rokeby Road, Subiaco WA 6008 I also consult at: Glengarry Sports Medicine Centre, 1/64 Arnisdale Road, Duncraig For all appointments please Phone: 9381 3084 Fax: 9381 3054 For advice and afterhours emergencies mobile: 0419 902 030

Specialist interests include : s arthroscopic reconstructive techniques s all sports knee injuries s shoulder instability s shoulder rotator cuff conditions and “all arthroscopic” repair s joint replacement s orthopaedic trauma Operates at: Hollywood Private Hospital, Bethesda Hospital, Royal Perth Hospital, Joondalup Hospital, Mercy Hospital & regularly visits Port Hedland & Karratha Hospitals. For Appointments: Phone: 9389 3811 Fax: 9389 3899 Web:

Hari Goonatillake MBBS, FRACS (Gen Surg) FRACS (Ortho)

s Shoulder & Knee Arthroscopic / Reconstructive Surgery s Shoulder, Knee & Hip Joint Replacement Surgery Consulting at: St John of God Medical Clinic Suite 213, 25 McCourt Street Subiaco Tel: 08 9489 8722 Fax: 08 9381 8877 Operating at: s St John of God Hospital, Subiaco s Hollywood Private Hospital, Nedlands Private, DVA & Workers’ Compensation Patients My experienced staff are available to make all MRI, CT Scan, Xray and Hospital bookings. For appointments phone 9489 8722 or fax 9381 8877

Mr James Plant MBChB, BSc (Hons), FRACS Orthopaedic Surgeon Consults and operates privately at St John of God Hospital Subiaco. Public appointment at Royal Perth Hospital. Specialist interest include: s Hip & Knee Arthroplasty, Knee Arthroscopy s Arthritis Management s Trauma s Musculoskeletal Tumour Surgery I am a no gap provider for all major health funds and welcome Public, Private, Workers Comp, DVA and MVIT patients. Private Practice Address: Subiaco Orthopaedics, Suite 205, SJOG Hospital Subiaco Clinic, 25 McCourt St, Subiaco, WA 6008

Professor Richard Carey Smith Orthopaedic & Sarcoma Surgeon

Contact P 08 6389 0551 F 08 9346 6462 E Specialist Interests Muskuloskeletal tumour surgery Primary & secondary bone tumour Bone & soft tissue sarcomas Metastatic disease Hip Surgery Primary & revision arthroplasty Knee Surgery Arthroscopy Primary & revison arthroplasty including uni-compartmental

No Gap Cover We offer a no gap cover for all major health funds. We welcome public, private, workers compensation, DVA and MVIT patients. Operates s Hollywood Private Hospital s Sir Charles Gairdner Hospital s Princess Margaret Hospital s Osborne Park Hospital Private Practice Perth Orthopaedic Institute Entrance 6 Verdun Street, Nedlands 6009 Urgent Appointments – 0402 241 865

For appointments and enquiries: Phone: 0451 067 846 Email: For urgent advice please call 0449 828 577


Orthopaedic Surgeon Mr Toby Leys at the Perth Knee Clinic within Coastal Orthopaedics, provides specialist management of all conditions of the knee. s Sports injuries and conditions s Knee ligament reconstruction: ACL, PCL, multiligament s Knee arthroscopy s Realignment Osteotomy s Knee replacement: partial, total, revision Consulting at: s Bethesda Hospital Claremont s Wexford clinic, SJOG Murdoch s Peel Health Campus Appointments and Enquiries: Phone: 9230 6333 Fax: 9230 6332 For urgent advice please phone 0411411359

76 | NOVEMBER 2016



ORTHOPAEDIC SURGEONS Mr Peter Honey, MBBS, FRACS Orthopaedic Surgeon Hand, Wrist, Elbow, Shoulder and Knee Surgery. Special interests

Mr Ryan Lisle MBBS(Hons), FRACS(Ortho), FAOrthA Fellowship trained Paediatric & Sports Orthopaedic Surgeon, wishes to announce he has commenced practice with Midland Orthopaedics, offering both public and private services at the new St John of God Hospital, Midland. Special interests: s General paediatric orthopaedic surgery s Arthroscopic reconstructive surgery of the shoulder and knee s Arthroplasty of the shoulder and knee Sub-Specialty Interest: s Sports-related injuries in the adolescent athlete Hospital Appointments: s Princess Margaret Hospital/Perth Children’s Hospital s Hollywood Private Hospital s St John of God Hospital, Midland s Nickol Bay Hospital s Port Hedland Regional Hospital For all appointments: Phone: 9389 3877 Fax: 9389 3899 For on-line appointments and more information about services offered, please visit

s Joint replacement surgery of the hand, wrist, elbow, shoulder and knee s Arthroscopic wrist, elbow, shoulder and knee surgery s Treatment of sporting injuries (including knee ligament injuries) s Treatment of simple and complex upper limb fractures and dislocations. s Tendon transfer surgery (L’Episcopo, Eden Lange, transfers for scapular winging) s Paediatric upper limb surgery, including correction of congenital deformity Appointments and enquiries: 14 Altona Street, West Perth, 6005. Phone: 9481 2856 Fax: 9481 2857 Urgent advice or referrals: 0418 948 652

Winthrop Professor David Wood BSc, MBBS, MS (London University), FRCS, FRACS (Ortho) Consults and operates privately at Hollywood Private Hospital. Specialist Interests include: Knee Surgery: s Computer navigated knee arthroplasty – total and unicondylar – primary and revision s Autologous chondrocyte implantation

Mr Peter D’Alessandro MBBS Hons. (UWA) FRACS FAOrthA

Orthopaedic Surgeon I have completed more than 2 years of international sub-specialty fellowship training in Shoulder & Knee Reconstruction at the Chelsea & Westminster and Royal Free Hospitals in London, UK; and Hip Arthroscopy at the University of British Columbia in Vancouver, Canada. Special Interests: s Hip Arthroscopy s Arthroscopic Rotator Cuff Repair & Shoulder Instability Surgery s Multi-Ligament Knee Reconstruction s Shoulder and Knee Joint Replacement s Surgery for Athletes

Hip Surgery: s Minimally invasive primary hip replacement s Complex revision hip replacement Orthopaedic Oncology: s Primary and metastatic bone and soft tissue tumours Professor Wood offers no gap cover for HBF members. A gap will be charged to all other health fund members. Consulting Rooms: Perth Orthopaedic Institute Entrance 6, Verdun Street Nedlands WA 6009 For Appointments and Enquiries: Phone: 9386 6211 Fax: 9346 6462

Private Consulting & Operating: s Bethesda Hospital, Claremont s St John of God Hospital, Murdoch Public Hospital Appointments: s Fiona Stanley Hospital (Trauma) s Fremantle Hospital (Specialist Hip Arthroscopy Clinic) s Rockingham General Hospital


Appointments and Enquiries: Phone: 9230 6333 Fax: 9230 6332 For urgent advice please phone 0413 338 339 Email:

As a doctor-to-doctor communication, Medical Forum offers you considerable freedom to ethically promote your services to every medical practitioner in WA.


NOVEMBER 2016 | 77








Perth Orthopaedic & Sports Medicine Centre




Call 08 9212 4200 for West Perth appointments and 08 9534 8999 for Peel appointments

Telephone: (08) 6332 6332

Peter HalesReconstruction and Replacement Hand and Upper Limb Surgery Hand and Upper Limb Surgery Reconstruction and Replacement

Keith Holt Knee and Shoulder, Sports and Arthritis Reconstruction & Replacement Surgery

Peter Ammon Chairman Foot, Ankle & Knee Surgery

Graham Forward

Greg Witherow Hip and Knee Surgery Reconstruction and Replacement Surgery

Hip & Knee Surgery for Arthritis & Sports Injuries

Michael Anderson Hip & Knee Surgery Specialising in Joint Replacement

Greg Janes Hip, Knee and Shoulder Reconstruction and Replacement Surgery

Michael Halliday

Peter Annear

Hand & Upper Limb Surgery

Knee, Lower Limb & Sports Surgery Reconstruction & Replacement Surgery

Jens Buelow Knee and Shoulder, Sports and Arthritis Reconstruction and Replacement Surgery

Mark Hurworth Arthroscopy & Joint Replacement of the Hip, Knee and Shoulder

Greg Hogan

Paul Jarrett

Knee and Shoulder Surgery Reconstruction, Fractures, Replacement

Hand Wrist & Upper Limb Surgery

Markus Kuster (Professor)

Ben Jeffcote

Hip and Knee Arthroplasty, Revision Arthroplasty. Trauma and its sequelae

Knee & Lower Limb Surgery

Antony Liddell Knee, Shoulder and Lower limb surgery Hip and Knee Arthroplasty, Sports Surgery

Tony Jeffries Hand & Upper Limb Surgery

Travis Falconer Shoulder and Elbow, Upper Limb Surgery Sports, Reconstructive and Replacement Surgery

Ross Radic Knee and Shoulder Surgery Sports, Reconstruction and Replacement

Gerald Lim Hip & Knee Surgery

Allan Wang Shoulder, Hand & Elbow Surgery

David Wysocki Hip and Knee Surgery, specialising in Replacement and Revision Replacement

Duncan Sullivan Sports Medicine Physician Acute and Chronic Sports Injury Medicine Over 25 years of group practice at 31 Outram street, West Perth, 6005

St John of God Medical Centre Suite 10, 100 Murdoch Drive Murdoch WA 6150 Telephone: (08) 6332 6332 Facsimile: (08) 6332 6308 Murdoch Orthopaedic Clinic Pty Ltd ACN 064 146 774 ABN 23 070 745 210

Also consulting at: Duncraig, Murdoch, Esperance and Peel Health Campus Web site -

78 | NOVEMBER 2016




At Coastal Orthopaedics, we provide a comprehensive multidisciplinary orthopaedic service.








Locations Bethesda Hospital, Claremont Wexford Medical Centre, SJOG Murdoch SJOG Midland Perth Knee Clinic

Fiona Stanley Hospital Sir Charles Gairdner Hospital Fremantle Hospital Rockingham General Hospital Peel Health Campus

Waikiki Private Hospital

All appointments enquiries 9230 6333 Fax: (08) 9230 6332


Bethesda Hospital 25 Queenslea Drive Claremont WA 6010 Email:

The Hollywood Orthopaedic Group offer a comprehensive orthopaedic service For appointments, please phone our Rooms on

1300 2 ORTHO or 9389 3800 Nicholas Frost såPaediatric and Adolescent Hip Surgery såHip and Knee Replacement Surgery såArthroscopic Knee Surgery såGeneral Paediatric Orthopaedics s¬9389 3800 Michael Ledger såShoulder and Knee Surgery såSports Injuries såOrthopaedic Trauma s¬9389 3811 Nicole Leeks såGeneral Orthopaedics såFoot and Ankle Surgery såLower Limb Arthroscopy såPaediatric Orthopaedics s¬9389 3844 Ryan Lisle såPaediatric Orthopaedic Surgery såSports Shoulder and Knee Injuries såReconstructive Shoulder and Knee Surgery s¬9389 3866 Clem McCormick såHip and Knee Joint Replacement Surgery såSports Knee Injuries såPaediatric Orthopaedics s¬9389 3888 Jonathan Spencer såShoulder and Knee Surgery såHip Replacement Surgery såGeneral Orthopaedics s¬9389 3855 Aaron Tay såUpper Limb Surgery (Shoulder and Elbow Surgery) såSports and Replacement Knee Surgery s¬9389 3866 Colin Whitewood såGeneral Orthopaedics såHip and Knee Surgery’ såSports Knee Injuries såPaediatric Orthopaedics s¬9389 3833 Sean Williams såGeneral Orthopaedic Trauma såArthroscopic Knee Surgery and Sports Knee Injuries såHip and Knee Replacement Surgery (Primary and Revision) s¬9389 3822 Homan Zandi såUpper Limb Surgery (Shoulder and Elbow Surgery) såHand Surgery s¬9389 3868

Hollywood Orthopaedic Group Suite 3 Hollywood Medical Centre 85 Monash Avenue, Nedlands WA 6009 Telephone: (08) 9389 3800¬¬s¬¬&ACSIMILE¬(08) 9389 3899 Email:

NOVEMBER 2016 | 79




We Provide a NO GAP service with all major health funds. DVA patient welcome. WC and MVA referrals will be considered. Mr Simon Wall MBBS, FRCS(Tr & Orth), FRACS(Ortho)

s Hip and Knee Primary and Revision s Knee Arthroscopy s Sports Knee and ACL Reconstruction s Ilizarov Frames and Trauma Mr Thomas Bucher MBBS, MSc, FRCS(Tr & Orth), FRACS, FAOrthA

s Hip and Knee Primary and Revision s Arthroscopic Surgery of the Knee s Knee ACL and Meniscal Surgery s Trauma

Perth Shoulder Clinic, situated at Bethesda Hospital in Claremont provides a comprehensive service for the treatment of shoulder disorders including: •

Arthroscopic surgery for shoulder instability and rotator cuff pathology

Shoulder Arthroplasty including revision arthroplasty

Surgery for fractures about the humerus, scapula and clavicle

On-site physiotherapy

Mr Satyen Gohil MBBS(Hons) MRCS(Lond) FRACS(Orth)

s Arthroscopic Surgery of Knee and Shoulder s Shoulder Instability and Rotator Cuff Surgery s Joint Replacement of Knee and Shoulder s Knee ACL and Ligament Surgery & Trauma Mr Boris Brankov MD MS FRACS(Ortho)

s Foot and Ankle Surgery s Upper and Lower Limb Deformities s Bone Infection s Foot and Ankle Trauma Professor Piers Yates MBBS(Hons) BSc(Hons) MRCS(Eng) FRCS(Tr & Orth) FRACS(Ortho) FAOrthA

Sven Goebel operates and consults at Bethesda Hospital (private clients) and at Joondalup Health Campus (public and private clients).

s Hip and Knee Primary and Revision s Hip Resurfacing and Young Joint Replacement s Minimally Invasive Hip s Uni-compartmental Knee and Trauma Mr Andrew Mattin BSc. (Anatomy) M.Chiro. BMBS. FRACS. (Ortho) FAOrthA.

s Shoulder Arthroscopy and Replacement s Knee Arthroscopy and Replacement s Hip Replacement s Trauma Mr Benjamin Witte FRACS (Orth)

s Sports Knee Injuries s Cruciate Ligament Reconstruction s Knee Replacement Surgery (Uni/Total/Revision) s Primary Total Hip Replacement

Grant Booth operates at Bethesda Hospital and SJOG Hospital Subiaco as well as holding a public appointment at Royal Perth Hospital.

For appointments or advice contact: p. 9340 6355 f. 9340 6356 Perth Shoulder Clinic, Bethesda Hospital 25 Queenslea Dr, Claremont 6010

80 | NOVEMBER 2016

Assoc. Professor Gareth Prosser MBChB MRCS FRCS(Orth) FRACS(Orth)

s Hip and Knee Primary and Revision s Hip Resurfacing s Young Adult Hip Joint Preserving Surgery s Computer Assisted Surgery and Trauma

Our philosophy is to maximise function, aid early recovery and achieve long term success of patients requiring orthopaedic surgery. We specialise in minimising blood loss and optimising pain relief. We are available for advice and urgent appointments can be arranged via the rapid access clinics for acute upper and lower limb injuries including sporting injuries. Suite 15, Wexford Medical Centre, 3 Barry Marshall Parade, Murdoch 6150

For appointments Tel: 08 9312 1135 Fax: 08 9332 1187 Email:




Mr Tao Shan Lim MBBS (UWA), GDip Surg Anat, FRACS (Orth) Orthopaedic Surgeon Special interests: Hip arthroscopy s Repair of the hip labrum s Osteoplasty for femoro-acetabular impingement Knee arthroscopy s All inside ACL and PCL reconstruction s Complex and revision multi-ligament knee surgery Shoulder arthroscopy s Rotator cuff repair s Instability surgery Urgent advice or referrals: 0412 511 711 or (all hours) Mr Arash Taheri MBBS (Hons), BMedSci (Hons), FRACS (Orth) Orthopaedic Surgeon Special interests: Knee s Robotic arm assisted partial knee replacement (MAKOPlasty) s Fully computer navigated total knee replacement (TKR) s Sports knee injuries (all inside ACL reconstruction, MCL, Meniscal repair) Hip s Robotic arm assisted total hip replacement (MAKOPlasty – THR) s Gluteal tendon reconstruction s Proximal hamstring repair Sports s Ankle (arthroscopy, ATFL reconstruction) s Elbow (Tennis Elbow) s Trauma s All emergency upper and lower limb trauma

Dr Amanda Wilkins MBBS FRACP MPH Specialising in: Developmental delay, Autism, ADHD and Fetal alcohol spectrum. Referrals accepted for children aged 0-10 years. Introducing Dr Chester Tan, Paediatrician. MBBS FRACP Dr Tan has joined the Walcott Child Development Clinic. Referrals welcome for children and adolescents with developmental and behavioural issues, including ADHD and Anxiety Walcott Child Development Clinic 8 Walcott Street, Mt Lawley 6050 (08) 9272 4560 PAEDIATRIC & ADOLESCENT RHEUMATOLOGY

Dr Senq J Lee MBBS, DipCH, GCPRheum, FRACP Senq sees all aspects of Rheumatology/musculoskeletal medicine, and most General Paediatric condition except complex developmental/behavioural. For appointments or advice, please contact: Child & Adolescent Rheumatology 17 Lemnos Street Shenton Park 6008 Tel: 9380 9484 Fax: 9200 5722 Central Avenue Medical Centre 213 South Street Beaconsfield 6162 Tel: 9335 9884 Fax: 9430 8728 Email: Web:

Urgent advice or referrals: 0408 172 418 or (all hours)

Joondalup Orthopaedic Group Operating at: Joondalup Health Campus (public patients) Joondalup, Glengarry and Hollywood Private Hospitals Consulting at: Joondalup Orthopaedic Group Suite 5, Ground Floor Joondalup Private Hospital 60 Shenton Avenue, Joondalup WA 6027 Phone: 08 9300 1800 Fax: 08 9200 5748 Email: Website: Healthlink ID: JOGORTHO

As a doctor-to-doctor communication, Medical Forum offers you considerable freedom to ethically promote your services to every medical practitioner in WA.

Pioneers in providing private multispecialty health services to children of all ages in Western Australia. General Paediatrics:

Dr Aggie Judkins Dr Murali Narayanan

Paediatric Gastroenterologist & Hepatologist: Dr Ajay Sharma Dr Zubin Grover Paediatric Respiratory & Sleep Physician:

Dr Adelaide Withers

Paediatric Allergist:

Dr Benedicta Itotoh

Child & Adolescent Psychiatrist:

Dr Ettore Guaia

Paediatric & Fetal Cardiologist:

Dr Darshan Kothari

Developmental Paediatrician:

Dr Nikki Panotidis

Paediatric General Surgeon:

Mr Parshotam Gera

Paediatric Nutritionist & Dietitian:

Leah Queit

Clinical Psychologist:

Elizabeth Zelestis

Speech Pathologist:

Ansuya Rajoo

Continence Physiotherapist:

Natalie Bull

Continence Nurse Consultant:

Anna Thetford

Contact details: Suite 5 / 2 McCourt Street West Leederville WA 6007 Tel: (08) 6162 1615 Fax: (08) 9382 2637 Email:




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Child Neurology and Developmental Clinic


WAâ&#x20AC;&#x2122;s only private paediatric EEG (Electroencephalography ) provider since 2014. Direct referrals by GPs or specialists (Medicare rebated).

Dr Snehal Shah MD, FRACP.

Forms available through website:

All communication, correspondence and private bookings are through Perth Paediatrics.

Paediatric specialised EEG technicians with tertiary childrenâ&#x20AC;&#x2122;s hospital experience

Phone: 6162 1615 or 0401 916 441 Fax: 9382 2637

Same day EEG and neurology consults available for country patients. EEGs reported and consults provided by: Dr Maina Kava Paediatric neurologist Address: 14/4 Ventnor Avenue West Perth 6005 Phone: (08) 9321 9594 Fax: (08) 9321 0679

Providing Paediatric Neurology consultation with special interest in: Paediatric Epilepsy, stroke and headaches.

Email : Private Clinic Locations: så 0ERTHå0AEDIATRICS Suite 5/2 McCourt Street, West Leederville 6007 så 3Tå*OHNåOFå'ODå7EXFORD Suite 46, Level 3, Barry Marshall Road, Murdoch 6150 så 3UITEå å3PECIALISTå-EDICALå#ENTREå7EST

Joondalup Health Campus, Shenton Avenue, Joondalup 6027


Dr Kunal Thacker MBBS, DNB, FRACP Areas of Expertise: å så #OELIACå$ISEASE å så %OSINOPHILICå/ESOPHAGITIS å så #ONSTIPATION å så 'ASTRO /ESOPHAGEALåREmUXå$ISEASEå'/2$ å så )RRITABLEå"OWELå3YNDROMEå)"3 å så )NmAMMATORYå"OWELå$ISEASEå)"$ å så 2ECURRENTåABDOMINALåPAIN å så -ALABSORPTIONåDISORDERSENTEROPATHIESå å så ,IVERå$ISEASES He provides consultation and endoscopy services through St. John of God Hospital, Murdoch.

Dr Anne Oâ&#x20AC;&#x2122;Donnell MBBS(Hons), FRACP, PhD Specialist in Paediatric Respiratory and Sleep Medicine s snoring and obstructive sleep apnoea s night waking s frequent night terrors/sleep walking s excessive daytime sleepiness s behavioural sleep problems s asthma s chronic cough s recurrent respiratory infections She provides a paediatric sleep study service at SJOG Sleep Centre Subiaco and PMH. Suite 17, 2 McCourt Street, West Leederville WA 6007 For all appointments: Phone 6258 3562 Fax 6258 3563 For urgent advice phone 0402 424 849

Public appointments at Princess Margaret Hospital for Children, Subiaco and Fiona Stanley Hospital, Murdoch. For Appointments: Suite 46, SJOG Wexford Medical Centre, 3 Barry Marshall Pde, Murdoch - 6150. P: 9310 8778 F: 9310 1876


Dr. Ajay Sharma MBBS, MD, FRACP Public appointment (Sessional): Princess Margaret Hospital for Children.


Dr Darshan Kothari MBBS, FRACP Paediatric & Fetal Cardiologist I have moved my practice to Perth Paediatrics. Special interests: så !LLåASPECTSåOFå#ONGENITALåå!CQUIREDå(EARTå$ISEASEåINå.EONATES åå Children and Adolescence så &ETALåANDå)NTERVENTIONALå#ARDIOLOGY All Appointments: Perth Paediatrics Suite 5 / 2 McCourt Street West Leederville WA 6007 Please note new phone number 6162 1615 Fax: 9382 2637 Mobile: 0424 040 528 (for urgent advice and appointments only) Email: Website:

82 | NOVEMBER 2016

Providing Paediatric Endoscopy and Colonoscopy service at: SJOG Subiaco, SJOG Murdoch, Hollywood Private Hospital and Joondalup Health Campus. Special interests in paediatric IBD, IBS, GERD, neonatal and paediatric liver problems, Eosinophillic Esophagitis, Coeliac disease and nutrition of infants and Children. Also provide telehealth consultation for regional and rural patients. All communication, correspondence and private bookings are through Perth Paediatrics. Phone: 6162 1615 Mobile: 0401 916 441 (if urgent) Fax: 9382 2637 Email: You may contact directly on my mobile if you have any clinical questions. Clinic Locations: s Perth Paediatrics, Suite 5/2 McCourt Street, West Leederville s Princess Margaret Hospital for Children, Roberts Road, Subiaco s St John of God Wexford, Suite 46, Level 3, Barry Marshall Road, Murdoch s Suite 115, Specialist Centre, Joondalup Health Campus,, Joondalup s The Liver Centre WA, Suite 10/2 McCourt Street, West Leederville


CLINICAL SERVICES DIRECTORY PAEDIATRICS–MEDICAL Dr Veena Judge, MBBS (WA), FRACP, PhD Specialist in Paediatric Respiratory and Sleep Disorders. Special interests are: s Obstructive sleep apnoea - pre and post adenotonsillectomy assessment. s Behavioural sleep problems including daytime sleepiness & night wakenings s Asthma s Chronic cough s Recurrent respiratory infections She provides a sleep study service at SJOG Sleep Centre and PMH. Admitting rights to St John of God Hospital Subiaco and Murdoch, Respiratory & Sleep Medicine Unit at PMH & Joondalup Hospital Consults at Suite 305, SJOG Clinic , 25 McCourt St, Subiaco All appointments Telephone: 9382 9462 Fax: 9382 9463 For urgent advice phone: 0403 126 569

Jill Orford MBBS PhD FRACS specialises in General Paediatric and Neonatal Surgery. Areas of interest: inguinal and umbilical herniae, infantile hydrocoeles, undescended testes, hypospadias, laparoscopic surgery, hepatobilary and gastrointestinal surgery, skin, subcutaneous lesions and circumcision. Hospitals: Princess Margaret, SJOG Murdoch, SJOG Subiaco, SJOG Mt Lawley, SJOG Midland & Hollywood. Practice Locations: Wexford Medical Centre, Murdoch SJOG Mt Lawley Medical Centre All appointments: Tel 9370 9840, Fax 9370 9678 For advice please contact me directly: 0409 844 201


The Elizabeth Clinic offers young families comprehensive specialist health care and support to create strong family relationships. We have perinatal and infant mental health specialists, general adult psychiatrists, expert clinical psychologists, mental health nurses, child health nurses, paediatricians, a paediatric occupational therapist and a GP Lactation Consultant. We will provide preconception counselling, and support through fertility issues, and care from conception to middle childhood with a combination of individual and group treatment programs including the Circle of Security Parenting Program. A referral is necessary to our specialists but we can provide a comprehensive assessment for patients who self-refer. Dr Caroline Zanetti Dr Julia Feutrill Dr Leanne Priestly Dr Irina Kompardt Dr Mojdeh Bassiri Dr Marnie Rowan Dr Aggie Judkins Dr Emma Argiro Dr Simon Williams Ms Michelle Stuckey Ms Sue McElhinney Ms Bernadette Safe Mr Scott Nodwell


Perinatal Infant and Child Psychiatrist Perinatal and Infant Psychiatrist Perinatal Psychiatrist Perinatal Psychiatrist General Adult Psychiatrist GP Lactation Consultant General Paediatrician General and Developmental Paediatrician Paediatrician and Neurologist Psychologist Registered Psychologist Paediatric Occupational Therapist Psychologist/Psychotherapist

Contact Details: 08 9384 4565 fax - 08 9284 7408 222 Stirling Highway, Claremont 6010


Dr Japinder Khosa MBBS, FRACS General paediatric surgeon and urologist caring for neonates to 16 year olds. Japinder trained in paediatric surgery and urology at Royal Children’s Hospital in Brisbane and Melbourne before moving to Perth. She is a fellow of the Royal Australasian College of Surgeons. Operates at: s Princess Margaret Hospital & Joondalup Hospital for both Public & Private lists s Subiaco Private Hospital s Glengarry Private Hospital s SJOG Subiaco for private cases – on ad hoc basis s Kalgoorlie Regional Hospital – once every 3 months. Special interests: s General paediatric surgery covering undescended testes, hernias, cysts, foreskin problems and circumcision for medical and cultural reasons. s Paediatric urology covering hypospadias, hydronephrosis, vesicouretric reflux, UTI, urinary incontinence, buried penis and varicocele. s Laparoscopic general and urology. s Neonatal surgery. s Antenatal counselling for general and urological conditions diagnosed antenatally. Consults at: s Suite 204, Specialist Centre, Joondalup Health Campus, Shenton Avenue, Joondalup s Suite 5/2 McCourt Street, West Leederville s 476 Wanneroo Road (Westminster Day Surgery), Westminster s 48 Arnisdale Road, Duncraig s Kalgoorlie Regional Hospital, Piccadilly Street, Kalgoorlie Appointments: Tel: 9400 9192 or for urgent advice 0402 282 931

PAEDIATRICS–SURGICAL Mr Colin Kikiros, MBBS FRACS, Paediatric Surgeon and Urologist specialises in: s General paediatric and neonatal surgery s Minimally invasive (Laparoscopic and Thorascopic) surgery s Thoracic surgery s Correction of chest wall deformities s Treatment of hyperhidrosis s Paediatric Urology. s Burns Mr Kikiros consults at 8/10 McCourt Street, West Leederville (phone 9388 0606) and at the Specialist Medical Centre, Joondalup Health Campus (phone 9400 9800). He is also appointed to Princess Margaret Hospital. He can be contacted on mobile number 0411 477 754 for emergencies or advice.


PAIN MEDICINE Dr Mark Schutze, MBBS FANZCA FFPMANZCA Providing excellence in all aspects of Pain Management: s Interventional Therapy (Rhizotomy, Epidurals etc) s Multi-disciplinary pain management s Opioid management, Workers Comp & MVIT Consulting in Midland and Westminster, or via Telehealth T: 0403 786 878 F: 6316 1413 E: W:

NOVEMBER 2016 | 83




Dr Michael Kent, FANZCA, FFPMANZCA , Anaesthetist & Consultant in Pain Medicine has commenced consultation at: 3/16 McCourt Street, West Leederville 6007 For appointments Phone: 9388 8929

Fax: 9388 8168

Continues to consult at: s 18 Hardy St, South Perth 6151 For appointments Phone: 9367 2255 Fax: 9367 2299

Bryant Podiatry Clinic 19A Guildford Road (on Park Rd) Mount Lawley WA 6056 Ph 9371 1007

Fax 9370 3957

Prof Alan Bryant BSc(Pod), MSc, PhD Dr Jennifer Bryant BSc(Pod), MSc Podiatrists and Podiatric Surgeons Specialising in the conservative and surgical management of common foot conditions.


We welcome referrals from General Practitioners and Medical Specialists.

Dr Nathan Stewart MBBS, MS (Surg), FRACS Special interests: s Cosmetic surgery of the breast, face, body. s Body contouring/sculpting following weight loss/bariatric surgery. s All aspects of Hand Surgery, both acute, chronic and traumatic. s Skin cancers and their reconstruction. Address: Suite 215, 25 McCourt St, Subiaco or Suite 51, Wexford Medical Centre, 3 Barry Marshall Parade, Murdoch. For all appointments: Phone: 9380 0333 Fax: 9380 0300 For advice please contact me direct: 0417 473 509

UWA Podiatry Clinic Comprehensive range of reduced fee podiatric services available including: s Routine foot care for elderly patients s Paediatric assessment and treatment s Foot, ankle and foot-related sports injuries s Diabetic assessment/wound management s Podiatric surgical procedures s Foot orthotic devices UWA Podiatry Clinic has been contracted by the HDWA Disability Services Commission to provide podiatry services to eligible patients with mental and physical disabilities. GP and Specialist referrals welcome. 6488 4522 for general podiatry appointments 6488 4548 for surgical podiatry appointments Or email: Located at the corner of Park and Crawley Avenues, Crawley Web:


Specialist Podiatry & Podiatric Surgery We are Perthâ&#x20AC;&#x2122;s one-stop-shop for foot problems and provide the full-scope of podiatry treatment at our practice. Major Services include: s Custom made Orthotics s Treatment of Adult Foot Problems s Treatment of Childrenâ&#x20AC;&#x2122;s Foot Problems s Podiatric Surgery s Laser Treatment for Onychomycosis s Shockwave Treatment for Heel Pain Dr Andrew Knox BPodM, DClinPod qualiďŹ ed from the University of Western Australia and holds specialist registration with AHPRA as a Podiatrist and Podiatric Surgeon. He has interest in orthotic therapy and the surgical correction of common foot problems including in-grown toenails, hallux rigidus and mortonâ&#x20AC;&#x2122;s neuroma. Appointments and enquiries: Tel: 9383 3851 Fax: 9284 6107 Mobile: 0401 352 234 Practice address: Shop 8, 12-18 Napoleon Street, Cottesloe WA 6011

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Consultant Psychiatrist Is now practising at Suite 2, 29 Walters Drive Osborne Park 6017 - General Adult Psychiatrist For appointments please call 9201 3350 Or fax referrals to 9201 3355 Email: West Leederville Nannup, South West


GP HOTLINE 0430 709 459




Dr Philip Misur MBChB, FRANZCR

The following Drs are practising at the Marian Centre consulting rooms: Dr Jaroslaw Hyrnwiecki

General Adult Psychiatry, Depression, Mood, Anxiety Disorder, Adolescence Dr Martin Chapman General Adult Psychiatry, Depression, Mood, Anxiety Disorder, Bipolar Disorder Dr Ken Orr General Adult Psychiatry, Depression, Mood, Anxiety Disorder, Bipolar Disorder Dr Winston Choy General Adult Psychiatry, Depression, Mood, Anxiety Disorder Dr Gabor Ungvari General Adult Psychiatry, Depression, Mood, Anxiety Disorder, Bipolar Disorder Dr Willem van Wyk General Adult Psychiatry, Depression, Mood, Anxiety Disorder, Adolescence Dr Richard Magtengaard General Adult Psychiatry, Depression, Mood, Anxiety Disorder, Gender Dysphoria Anxiety, Bipolar Disorder, Chronic Pain, Depression Dr Simon Byrne Dr Pauline Cole Dialectical Behaviour Therapy Dr Clea Louw General Adult Psychiatry Dr Huw Williams General Adult Psychiatry Dr Annette Mackereth General Adult Psychiatry Dr Russell Hoyle General Adult Psychiatry Dr George Atartis General Adult Psychiatry Address: 200 Cambridge Street, Wembley 6014 Referrals: Phone: 9486 7399 or Fax: 9381 2612

is pleased to announce that he has joined Perth Radiological Clinic. Phil was formerly Clinical Director for SKG Radiology at Murdoch Hospital. He continues to practice at Royal Perth Hospital. His special interests include all aspects of body, interventional and oncological imaging including liver, biliary, pancreatic, renal, prostate, perineal and female pelvic MRI. He has expertise in performing subcutaneous and deep organ biopsies of lung, liver, kidney and lymph nodes. Web: Email:

Dr Matthew Prentice MBChB, PGCME, MRCS (Eng) FRCR, FRANZCR

is pleased to announce that he has joined Perth Radiological Clinic. Matt was formerly a Consultant Radiologist for SKG Radiology at Murdoch, Subiaco and Hollywood Hospitals, and before that, Consultant Radiologist working with elite sports people in the UK. His special interests include all aspects of musculoskeletal imaging including MRI, ultrasound and interventional musculoskeletal radiology.


Web: Email:

Envision Medical Imaging 178 Cambridge Street, Wembley (Opp. SJOG Hospital Subiaco)

175 Davy Street Booragoon (dental only) T: (08) 6382 3888 F: (08) 6382 3800 W:


Envision is an independently owned Radiology practice founded by local WA graduates. Offering specialist and general imaging services, Envision has ‘raised the bar’ to deliver excellence in diagnostic imaging every patient, every time! Our services include: s Ultrasound: including same day injections s MRI: GP rebateable referrals accepted s X-ray: low dose s CT: general and cardiac imaging s Nuclear Medicine scans s Dental: Cone Beam and OPG Same day appointments available and free parking behind the building.

is pleased to announce that he has joined Perth Radiological Clinic. A local medical and radiology graduate, Mark completed thoracic imaging fellowships in New Zealand and Vancouver, Canada before returning to Sir Charles Gairdner Hospital in 2014. He is currently also Site Director of Radiology Training at Sir Charles Gairdner Hospital and a member of the Radiology Department Executive Body. His special interests include all aspects of thoracic and cardiac imaging. Web: Email:

Imaging Specialists include: s Brendan Adler s Lawrence Dembo s Tonya Halliday s Tony Hayes s Tom Huang s Eamon Koh s Bernard Koong s Michael Krieser s Ronny Low s Kay-Vin Lam s Michael Mason s Patrick Ng s Carly Simpkins


RENAL MEDICINE Dr Simon Wei, MBBS, MMED, FAMS, FRACP Consultant Nephrologist providing clinical services to inhospital and consultation patient care in all aspect of adult renal medicine at: St John of God Healthcare Level 2, Suite 17-18 2 McCourt Street West Leederville WA 6007 Australia’s only NoCO2 accredited Medical Imaging Practice


Tel: 08 6258 3562 Fax: 08 6258 3563 Mobile: 0401 289 276

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Address: Suite 49, Hollywood Medical Centre, 85 Monash Avenue, Nedlands Tel: 6180 4360 Fax: 9389 7515 E: The Lung Health Clinic is delighted to welcome Respiratory Physician Dr Rajesh Thomas to its clinical team. Dr Rajesh Thomas is an experienced physician with clinical skill in the diagnosis and management of all adult respiratory diseases. Special interests: s The treatment of diseases of the pleura, such as pleural effusions and mesothelioma s The diagnosis and management of lung cancer, from a nodule on CXR to known disease s Advanced interventional bronchoscopy, including stents, pulmonary valves and endobronchial ultrasound Dr Thomas remains on staff at SCGH and is researching novel interventions for the treatment of malignant pleural effusions. Dr Thomas joins the strong respiratory team at The Lung Health Clinic, comprising Professor Philip Thompson, Dr Weng Chin and surgeon Mr Lucas Sanders, supported by a full lung function laboratory. Professor Philip Thompson is an experienced clinician, teacher and researcher with experience in all facets of respiratory disease. His particular respiratory interests are: s Lower airways diseases – asthma, bronchiectasis, COPD s Upper airway allergic disease – rhinitis, sinusitis s The diagnosis and management of cough and dyspnoea s Rare and complex lung disease s Lung cancer, diagnosis and management Dr Weng Chin has particular skills in the management of cardio-respiratory disorders: s Cardiac and respiratory failure and their interaction s Pulmonary hypertension s Lung cancer – diagnosis and management s Bronchoscopy s Advanced lung disease and transplantation Mr Lucas Sanders is an experienced cardio-thoracic surgeon with particular skills in keyhole videoscopic lung surgery. His particular interests are: s All surgical lung diseases, including primary and metastatic cancers s Chest wall problems and mediastinal masses s Lung volume reduction surgery s Videoscopic atrial fibrillation surgery s Thorascopic left atrial appendage occlusion Our laboratory managed by Lesley Store provides full respiratory testing including: s Spirometry s Lung volumes and gas transfer s Exhaled nitric oxide as a measure of asthmatic inflammation s Bronchial reactivity testing (mannitol) s Specialised testing of small airways s Six minute walk testing and oxygen requirements s Altitude testing and fitness to fly s Allergen skin prick testing


Dr Michael Prichard, MBBS, FRACP All GP referred sleep patients are seen by the consultant. Consultant physician with expertise in clinical respiratory and sleep disorders. Specific interests - common airway disorders, occupational lung diseases, obstructive sleep apnoea, excessive sleepiness and insomnia. Diagnostic services offered since 1995: s Portable (home based) and supervised sleep monitoring. s Full pulmonary function tests including cardiopulmonary exercise testing, provocation, gas exchange. s Bronchoscopy. Allied Services: s Nasal CPAP education and therapy. s Follow-up consultation & support service with practice nurse. s Exercise rehabilitation for chronic lung disease. Consultation locations: Perth CBD: Mount Hospital & Medical Centre – All services Joondalup Consultation, portable sleep studies, flow volume loops Mandurah Consultation, flow volume loops Murdoch: SJOG Hospital & Medical Centre - consultation, portable sleep studies, full respiratory Inpatient management: Mount Hospital, St John of God Subiaco & Murdoch For all appointments, T 9481 2244 F 9481 2255 E Perth Respiratory & Sleep Clinic Suite 27/146 Mounts Bay Road, Perth WA 6000 W:

Dr Sina M. Keihani MBBS (Hons), FRACP Respiratory Physician Sleep Specialist Murdoch Specialist Centre 78 Farrington Rd Leeming 6149 Ph: 6161 7647 Fax: 6162 0547 Dr Keihani provides a comprehensive service in consultations as well as inpatient care in all aspects of general respiratory medicine and sleep health. Services provided include: s Full lung function testing s Inpatient care with direct admission rights available to SJOG Murdoch DIRECT Sleep Study Referrals s Clinic (hospital) based sleep studies at our Attadale Hospital Lab s Home Based Sleep Studies available via Murdoch, Leeming, Joondalup, Attadale, Subiaco offices SleepMed Australia provides accredited services and is wholly independent of CPAP sales. *Teleconferencing facilities now available to support rural and remote consultations. Online referrals welcome. Urgent appointment requests or advice are always welcome on: 0401 800 197 (Mobile) or

The laboratory is happy to accept referrals for testing for the diagnosis and monitoring of lung and cardio-respiratory diseases, and preoperative lung function assessment. Tests are rapidly performed and detailed interpretation and advice provided by our physicians. Testing is available Monday-Thursday. To book, please call our reception.

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CLINICAL SERVICES DIRECTORY RESPIRATORY & SLEEP MEDICINE Dr Richard Warren, MBBS, FRACP is a Sleep and Respiratory Physician. Provides a full service in Sleep medicine with a special interest in: s Sleep apnoea s Sleep disorders related to neuromuscular disorders s Obesity related sleep hypoventilation Also provides a service in general respiratory medicine. Consults at 2/45 Oxford Close, West Leederville WA 6007 For appointment phone 9388 8804 or fax 9388 8806

RHEUMATOLOGY Dr Jack Edelman MBBS FRACP Consultant Physician in Rheumatology. Subiaco Rheumatology Clinic - 142 Churchill Avenue Subiaco - also at Midland, Wanneroo and Bunbury. Treatment of all Adult Rheumatology problems, osteoporosis, connective tissue disease, neck and back pain. Workers compensation and MVA assessment and treatment. All appointments Phone 9388 0399 - Fax 9388 0499

Dr Helen Keen MBBS(UWA) PhD(Leeds) FRACP CCPU (rheumatology) Consultant Rheumatologist, Royal Perth Hospital, Associate Professor, UWA Assoc/Prof Christopher Pantin BDSc Dental Sleep Medicine UWA Dr Valerie Bennett BDSc (Hons), Grad Dip Dent Sleep Med

Absolute Snore No More offers a viable treatment alternative to CPAP. Oral Appliance therapy is suitable as primary treatment for snoring and indicated in mild to moderate and severe cases of Obstructive Sleep Apnoea which have failed CPAP.

Helen is pleased to accept referrals for all adult rheumatological conditions, including osteoarthritis, inflammatory arthritis, connective tissue disease, crystal arthritis and osteoporosis. Helen has an interest in ultrasonography, and holds a certificate in physician performed ultrasonography. For appointments please contact: Subiaco Rheumatology 142 Churchill Ave Subiaco (t) 08 9388 0399 (f) 08 9388 0499

25 years of working closely with Consultant Sleep Physicians in Perth, has created a strong working knowledge of both the medicine behind OSA and the clinical skill to obtain optimal treatment outcomes. Consults at: Suite 2, 34 Outram Street West Perth WA 6005 Tel: 9486 1771 Fax: 9321 6108 Email:

Dr Mark Reed MBBS (Hons.) UWA FRACP

Dr Andreea Harsanyi MD FRACP

Dr Andrew Lim

Dr Mark Reed, Dr Andreea Harsanyi and Dr Andrew Lim


SLEEP & RESPIRATORY CENTRE CPAP Specialists We now offer Home Sleep Studies which measure EEG/ECG as well as body positioning and movement. Refundable by Medicare and accepted by Private Health Funds for purchase of equipment. Our Services: s CPAP/BI-LEVEL issues and trials (working closely with Physicians and providing appropriate patient care in order to achieve optimum results) s Home/hospital visits s Home diagnostics studies s Equipment rental/sales with aftersales support s Sales of equipment in general s Home oxygen services Locations in Riverton and Joondalup Outlets in Bunbury,Mandurah,Northam,York,Mt Lawley,Perth City,Innalloo 51 Hampden Road Nedlands WA 6009 Tel: 6389 1199 Fax: 6389 0707 Email for enquiries:

RHEUMATOLOGY JOINTS WEST Rheumatology Dr Ai Tran and Dr Priya Chowalloor provide a comprehensive and caring service specialising in the diagnosis and management of arthritis and musculoskeletal conditions. We aim to provide the best possible care to our patients and to improve their quality of life. For all enquiries: Wexford Medical Centre Suite 29, level 1, 3 Barry Marshall Parade, Murdoch 6150 Tel: 9332 2004, Fax: 9332 2005 Email


We provide comprehensive care in all aspects of Adult Rheumatology including; inflammatory arthritis, spondyloarthritis, osteoarthritis, osteoporosis, connective tissue diseases, gout and musculoskeletal disorders. Urgent referrals will be seen promptly and can be addressed to: Hollywood Rheumatology Hollywood Medical Centre Suite 56, 85 Monash Avenue, Nedlands 6009 Tel: 9389 6464 Fax: 9389 6654

Dr Andrew Taylor MBBS (UWA) FRACP Clin. Associate Professor (UWA)

Consultant Rheumatologist Services provided: så $IAGNOSISåANDåMANAGEMENTåOFåALLå2HEUMATOLOGICå$ISORDERSåINCLUDING – Acute Inflammatory Arthritis – Rheumatoid Arthritis – Gout – Spondyloarthritis (Psoriatic Arthritis and Ankylosing Spondylitis) – Osteoporosis – Vasculitis – Connective Tissue Diseases – Osteoarthritis – Regional joint and soft tissue problems så -USCULOSKELETALå5LTRASOUND Referrals and enquiries: Murdoch Rheumatology Suite 19, Medical Clinic, SJOGH 100 Murdoch Drive, Murdoch, 6150 T 9366 1636 F 9366 1637 E

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THORACIC SURGERY Dr Sanjay Sharma MBBS (UWA), FRACS, Cardiothoracic Surgical Fellow (Harvard Medical School) Boston

Dr David Millar MBBS Fellow of the European Committee of Sexual Medicine (FECSM) Dr Pam Quatermass MBBS Managing all aspects of female and male sexual dysfunction and hormone imbalance. Now offering Linear Low Intensity Shock Wave treatment for vascular erectile dysfunction Suite 27, Hollywood Specialist Centre 95 Monash Avenue,Nedlands WA 6009 Phone: 9389 1400 Fax: 9389 1411 Email: Web:

SPORTS MEDICINE & FOOT ORTHOTICS SportsMed Subiaco Level 1, 175 Cambridge Street Subiaco WA 6008 T: 08 9382 9600 F: 08 9382 9613 W: SportsMed Subiaco was established in 1998 with the vision of becoming the State’s premier health care facility. Today, we continue that vision with excellence in the diagnosis and management of sporting-related injuries. Services include: s Sports Medicine s Physiotherapy s Clinical Pilates s Hydrotherapy s Cardiac Rehabilitation s Women’s Health s Massage Therapy Sports Medicine Doctors: s Dr Gerard Taylor s Dr Scott Isbel s Dr Rod Moore s Dr Peter Steele s Dr Alex Strahan s Dr Jonathon Charlesworth s Dr Thomas Hill

Online bookings available @

CSD GENERAL INFORMATION Pictures: portrait shapes only Half page is 255mm (height) x 90mm (width) Placement is invoiced per column cm, at standard 90mm width

Consultant Cardiothoracic Surgeon offering a full service in diagnosis and management of: s Thoracic Surgery (effusion, pneumothorax, lung mass), Adult cardiac surgery, Hyperhidrosis surgery Now consulting at Joondalup Health Campus: Specialist Medical Centre (West), Level 2, Suite 205 Now operating at Joondalup Health Campus (Thoracic surgery), The Mount Hospital and SJOG, Murdoch. All urgent referrals (lung lesions) will be seen within the week. Mobile 0404 890 414 All Bookings: Suite 35, level 3 Mount Medical Centre 146 Mounts Bay Road, Perth 6000 Tel: 6162 0233 Fax: 6162 0543

UROLOGY Dr Robert Goodwin FRACS, FRCS(Urol)(UK), FEBU Dr Goodwin practices Specialist Urological Surgery and invites referrals for consultation and treatment at Hollywood Private Hospital. Trained in Urology at The Institute of Urology and at The Royal Marsden Hospital in London UK, achieving FRCS(Urol) in 2001. Since 2011 he has practised in WA and was awarded FRACS in 2013, Currently Head of the Urology Department at Sir Charles Gairdner Hospital. Special interests: s diagnosis and management of urological cancer s urinary stone disease and BPH s provides contraceptive (vasectomy) services and advice on continence, sexual function and Men’s health. After initial consultation Dr Goodwin is currently a no gap provider registered with all standard WA insurers and invites referrals for consultation, diagnosis, investigation and treatment of urological problems on this basis. For appointments: Michelle Williams (PA and Practice Manager) Suite 41 Hollywood Medical Centre 85 Monash Avenue Nedlands 6009 Tel. 6389 0244 Fax: 6389 0255 Email

VASCULAR & ENDOVASCULAR SURGERY Suite 27, Level 1 Wexford Medical Centre 3 Barry Marshall Pde, Murdoch 6150 Ph: 9310 2300 Fax: 9310 2322

Mr Faraz Shakibaie now consults at SJOG Murdoch, West Leederville and also at Armadale treating both private and public patients in a timely fashion. Special interests include s Minimally invasive endovascular intervention for aneurysmal and occlusive peripheral vascular disease. s Carotid artery disease. s Diabetic foot ulcers. s Varicose vein treatment (including endovenous laser and injection sclerotherapy). For appointments at any of the above locations, please call 9310 2300. For more urgent matters or general advice at any time, please call on mobile on 0423 857807 or email directly on Healthlink ID: murdvasc

88 | NOVEMBER 2016


CLINICAL SERVICES DIRECTORY VASCULAR & ENDOVASCULAR SURGERY Dr Patrice Mwipatayi MMed (Surg), FCS (SA), FRACS, Cert. Vasc. Surg (SA) Specialises in all aspects of vascular surgery including: s Management of aortic aneurysmal disease. s occlusive arterial disease s cerebrovascular disease s hyperhidrosis s Raynaud’s Syndrome s varicose veins management s legs ulcers management s all aspects of vascular access. Public appointment held at RPH, SCGH and all North Metropolitan Hospitals. Prof Patrice Mwipatayi offers NO GAP COVER for privately insured patients. Consults at: 1. Suite 36, Hollywood Specialist Centre, 95 Monash Avenue, Nedlands. 2. Suite 205, Joondalup Specialist Centre, 65 Shenton Avenue, Joondalup. For appointment and enquiries, please Phone: 9386 9588 Fax: 9386 9599 For advice and emergencies, please call 0419 920 332.


Dr Steve Baker FRACS, DDU Consults at: Murdoch

Suite 28, Wexford Medical Centre 3 Barry Marshall Parade Subiaco Suite 17, 2 McCourt Street Rockingham Waikiki Private Hospital Appointments: 9310 1022 Provides comprehensive care of vascular Mob: 0409 662 677 conditions with Special interests Fax: 9310 4451 så -INIMALLYåINVASIVEåCATHETERåTREATMENT of arterial disease (Claudication, Leg Ulcers, Aortic aneurysms) Healthlink EDI: drsbaker så 6ARICOSEåVEINåTREATMENT åINCLUDINGåLASERåSURGERY NO GAPS on in-patient procedures så #AROTIDåARTERYåDISEASE

Dr Peter Bray MBBS (UWA) FRACS (Vascular) Specialist Vascular & Endovascular Surgeon Head of Department of Vascular & Endovascular Surgery, St John of God, Subiaco Offering a comprehensive service for the diagnosis and management of all vascular conditions utilising the most appropriate method for the individual (endovascular, surgical and/or medical). For the convenience of patients and referrers, I provide a specialist vascular sonography service at all of my clinic locations. No gap provider for inpatient services. Consults at: Suite 39 Hollywood Medical Centre, 85 Monash Ave, Nedlands, Suite 305 St John of God Medical Clinic, 25 McCourt Street, Subiaco, Amity Health, Albany I am also available for Telehealth consultations. Telephone: 9287 7400; Facsimile: 9287 7470 Email: Healthlink: drpebray (HL7) Now Operates at: SJOG Midland (Public and Private), SJOG Subiaco, Hollywood, Bethesda & Mount. For professional advice or emergencies, please do not hesitate to contact directly on 0412 006 191.

Mr Stefan Ponosh MBBS (UWA) FRACS (Vascular) Vascular & Endovascular Surgeon Local graduate from the University of Western Australia, and Fellow of the Royal Australasian College of Surgeons. I provide a complete management service for all arterial and venous vascular conditions for both public and private patients offering open surgery, minimally invasive endovascular surgery as well as conservative medical therapies. We are pleased to announce our relocation to new specialised vascular consulting rooms at: Suite 3A, Hollywood Medical Centre, 85 Monash Avenue, Nedlands 6009 I am a staff specialist at Sir Charles Gairdner Hospital. Operate at: Hollywood Private Hospital, SJOG Subiaco, SCGH Consults at: Hollywood Medical Centre & Sir Charles Gairdner Hospital

Dr John Teasdale WA Vascular Centre offers facilities for Non-Invasive Ultrasound Diagnosis of Arterial & Venous Disorders and advanced Minimally Invasive Treatment options. All patients – Private, Pensioner, Veterans and Health Care Cardholder Arteries: Our latest Doppler/Duplex Technology provides the most accurate and least expensive method of diagnosing functional Arterial & Venous disease. This readily distinguishes leg pain due to arterial disease (which may become serious) from other causes. Invasive arteriograms or costly CTA or MRA scans are unnecessary in most cases, to plan a patient’s treatment. Endovascular Surgery: Advances in the latest techniques & technology for Endovascular patients (with blocked arteries to the legs/lower limbs). This is minimally invasive, using a fine needle placed through the skin into the artery in the groin – only requiring local anaesthetic and “twilight sleep”. This may be unilateral or bilateral & day case or overnight only hospital stay. Varicose Veins: Large or Small Varicose Veins. Duplex Guided Foam Sclerotherapy for Varicose Veins (DGFS) This latest minimally invasive injection treatment when carried out at WA Vascular Centre, is as effective, if not more effective than other more costly available forms of treatment, but avoids each of these latter treatment’s specific complications. These alternative treatments include surgery, or thermal (heat destroying) endovenous laser ablation (EVLA), or radiofrequency ablation(RFA) or intravenous superglue. These treatments also usually require adjunctive sclerotherapy of branches of varicose veins which cannot be treated directly or remain following these treatments.

I am a no gap provider for privately insured patients. For any advice and emergencies please feel free to contact me directly on 0403 239 956 or email me directly at

Perth (Bassendean), Fremantle, Joondalup, Mandurah & Northam. Appointments: Tel: 9279 4333 –

Appointments: Tel: 9386 6200 (unchanged) or Fax: 6389 2222 (Please note new fax number)


NOVEMBER 2016 | 89


Dr Marek Garbowski MBBS FRACS (Vasc) Vascular & Endovascular Surgeon Consults & operates from: s SJOG Medical Clinic, 218/25 McCourt Street, Subiaco s SJOG Specialist Clinic, Bunbury s Joondalup Health Campus, Specialist Medical Centre West, Suite 115, Joondalup s Glengarry Private Hospital, Duncraig s Public Appointments: SCGH, RPH, FSH, JHC Appointments: Tel 9382 9100 Fax 9382 9101 Dr Garbowski provides all aspects of diagnosis and management of arterial & venous diseases. His practice PERTH VASCULAR CLINIC offers convenient access to rooms-based non-invasive vascular investigations. Practice’s Website: Special Interests: s Comprehensive assessment and patient-oriented best medical and surgical management of all vascular problems. s Open and Endovascular (minimally invasive) management of Peripheral Vascular Disease, aneurysms & carotid disease. s Varicose veins - open surgery (primary and re-do operations}, Endovenous Laser Ablation (EVLT) and RF Ablation (RFA), Venaseal procedures, all variants of sclerotherapy. s Comprehensive care of leg ulcers & diabetic foot problems. s Thoracic Outlet Syndrome surgery (Cervical and 1st Rib Resections) s All aspects of vascular access (AVF, PD Catheters, Central Venous Access) s Management of Hyperhydrosis (Thoracoscopic Sympathectomy) s Vascular Exposures in complex clinical circumstances Mr Garbowski is a NO GAP provider with most Health Funds. Healthlink: drmarekg For prompt professional advice and emergencies please call: 0403 765 764

Vascular/ Endovascular/ General surgeon MB.BS, FRACS, FRCSE, DDU

Dr Sieunarine provides a comprehensive diagnostic and therapeutic service to all patients with vascular and renal problems. Dr Sieunarine offers vascular and endovascular services with No Gaps for public and private patients for ALL health funds, consultation and operations. Currently consults and operates from; Nedlands, Westminster, Joondalup, Midland, Armadale, Peel, Bunbury, Busselton and Geraldton. Vascular Lab testing including ultrasound and exercise Doppler are performed on site in the Nedlands office. Specialising in: s Endovascular stents and grafting s Leg ulcers s Angiography/ Percutaneous angioplasty s Renal access s Carotid disease: endarterectomy and stenting

s Varicose veins

s Aneurysmal disease

s Hyperhidrosis s Diabetic feet

For advice or emergencies contact 0417 927 611. Health Link: drksieun

90 | NOVEMBER 2016

Mr Brendan Stanley, BMBS, FRACS, Executive Member ANZSVS, is in private practice at the Mount Hospital, and has special interests in Endovascular repair of Abdominal Aortic Aneurysms (AAA) and Carotid interventions, both open endarterectomy and angioplasty with stenting. Brendan is interested in all vascular surgery, with a strong interest in interventional procedures because the techniques are less invasive and offer better recovery times. He still performs open surgery when appropriate for treatment of carotid disease, AAA, peripheral vascular disease, varicose veins and hyperhydrosis. Please direct all referrals, appointments, enquiries and correspondence to the main rooms at: Suite 52, Mount Medical Centre 146 Mounts Bay Road Perth 6000 Phone: 9481 0455 Fax: 9481 0045 Also consulting for both private & public patients at: North Consulting Suites Heartcare Peel Health Campus Suite 68-72, Level 4 110 Lakes Road SJOG Wexford Medical Centre Greenfields 6210 3 Barry Marshall Parade Murdoch 6150 No Gap Provider for privately insured patients for inpatient services. For advice at any time, please call on 0410 303 366

Mr Gregory (Chui) Then MBBS (UWA), FRACS (Vascular) Vascular and Endovascular Surgeon Special interests s Aortic aneurysms - minimally invasive or open surgery s Carotid artery disease s Peripheral vascular disease (claudication and foot ulcers) s Varicose veins – radiofrequency ablation or open surgery s Renal access Consults at: s Suite 27, SJOG Wexford Medical Centre, Murdoch WA 6150 s CVS Suite, 40 Davenport Street, Karrinyup WA 6018 s Peel Vision Centre, 32 Sutton St, Mandurah WA 6210 s SJOG Medical Centre, Mount Lawley 6050 s SJOG Medical Centre, Bunbury 6230 s Public Hospital: Fiona Stanley Hospital & Peel Health Campus

Dr Kishore Sieunarine

For all appointments please contact (08) 9386 9855 or


Operates at s St John of God Murdoch, St John of God Subiaco, s St John of God Mt Lawley, St John of God Bunbury s Hollywood Hospital s Peel Health Campus Welcome both public and private patients No gap-provider for all health funds For appointments please call 9310 2377 or Fax: 9310 2322 For emergencies or advice Phone: 0401 415 577 Healthlink ID: murdvasc

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Dr Rick Bond MBBS FRCS FRACS PhD Special interests: Varicose veins, Hyperhidrosis, vascular access surgery as well as carotid surgery. Full range of open and endovascular vascular surgery. Provides private services at: s 109/1 Silas Street, East Fremantle s Waikiki Private Hospital, Waikiki, Rockingham s Duchess Medical Practice, Busselton s SJOG Hospital, Murdoch For all appointments: Phone: 6397 5120 Fax: 6314 4723 Email: All correspondence: 109/1 Silas Street, East Fremantle WA 6158


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Comfort for The Patient Dr Sanjay Nadkarni - Endovascular specialist MBBS, FRANZCR, FRCR, FCP, MRCP, DA

Comprehensive endovascular management of varicose veins, peripheral arterial disease, uterine fibroids, varicocele, pelvic congestion syndrome and vascular ultrasound. Acute back pain management - CT guided facet joint, Nerve root sleeve and Epidural injections. CT guided facet joint rhizotomy. Outpatient, central venous access lines.

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Your WA Consultant – Jenny Heyden Tel 9203 5544 or Mob 0403 350 810

P: 9284 2900 F: 9384 5725 M: 0410 407 044 Moved to: 221 Stirling Highway, Claremont 6010 All correspondence to PO Box 473, Claremont 6910



Dr Luke Matar - Radiologist & Endovenous specialist MBBS, FRANZCR

Director of The Vein Clinic, a new purpose built clinic dedicated to the investigation and minimally invasive management of varicose veins and venous insufficiency. s Latest Endovenous laser technology for the ablation of varicose veins s Ultrasound guided foam sclerotherapy Phone: 1300 00 VEIN (8346) or 9200 3450 Fax: 9200 3451 Email: Web: Unit 6/28 Subiaco Square Rd Subiaco 6008

SUBMITTING PREPARED ARTWORK Any artwork submitted more than 5 working days before deadline (as a print ready pdf), cannot be guaranteed placement if modifications are required.


As a doctor-to-doctor communication, Medical Forum offers you considerable freedom to ethically promote your services to every medical practitioner in WA.

Western Australia’s Who’s Who for Patient Referrals NOVEMBER 2016 | 91


medical forum FOR LEASE

NEDLANDS Hollywood Specialist Centre. Two large furnished suites available with secretarial support. Available on a sessional basis Monday to Friday. Phone: Leon 0421 455 585 or Gerry 0422 090 355 SUBIACO Sessional Suites available at brand new specialist consulting rooms in Subiaco. Fully furnished and fitted out, ideal for medical specialists and allied health practitioners with the option for reception and secretarial support. Located near SJOG Hospital Subiaco. All enquires to or 0413 767 562 SUBIACO Consulting Room available Full Time or sessional. Rates negotiable. Contact Keith Grainger 93845186

SHOALWATER Sessional and/or permanent rooms available at our brand new Shoalwater Medical Centre. Fully furnished and fitted out ideal for medical specialists and allied health practitioners. Full secretarial support if required. Fully equipped treatment room and procedure areas available. Experienced and friendly nursing and admin team. Located near both the Waikiki Private Hospital and Rockingham hospital. Please phone Rebecca on 08 9527 2236 Email NEDLANDS Hollywood Medical Centre 2 Sessional Suites. Secretarial support available. Phone: 0414 780 751 EAST FREMANTLE Consulting rooms available in a new medical clinic on the ground floor of the â&#x20AC;&#x153;Richmond Quarterâ&#x20AC;? on Canning highway. Includes minor procedures operating theatre. Various options available from room use only, up to comprehensive secretarial, IT and promotional packages. Contact Rick 0404 758 182 or email


FREMANTLE Medical practice for lease in Wray Ave. Fully adapted heritage building with four treatment rooms, reception, waiting area, kitchen and toilet. High ceilings, medical grade wiring, new roof, polished boards etc. Optional store. 107 to 114 m2 Great location, exposure, parking and access. Call Susannah 0407 938 678 fremantle/124-wray-avenue

URBAN POSITIONS VACANT SHOALWATER MURDOCH Wexford Medical Centre consulting rooms available for lease. Modern and well lit. Secretarial support and IT system use available if required. Please contact Ai on 0410 786 007 or email NEDLANDS Fully furnished consulting suite available for sessional use. Monday - Friday at Hollywood Medical Centre. Please contact Jade on 0433 123 921 or

OSBORNE PARK Medical consulting suites on ground floor available for lease. Located at Osborne City Medical Centre on Scarborough Beach Road. Highly visible, easy access and ample free onsite parking. Flexible terms available and suitable for GP, specialist consultants or allied health. Pathology, podiatry, psychologist and dietitian are all onsite with radiology practices within close proximity. Multiple reception and waiting room facilities. Please call Michael on 0403 927 934 or MURDOCH Medical Clinic SJOG Murdoch Specialist consulting sessions available. Email:

MT HAWTHORN Sessional medical/allied health suites with ultrasound, uroflowmetry and secretarial support if required Contact: Elayne 0422 234 540 or email

SOUTH WEST WA GPâ&#x20AC;&#x2122;s Required t &YDFMMFOU0QQPSUVOJUZUPKPJO expanding Medical Group in the beautiful South West WA t &TUBCMJTIFENFEJDBMHSPVQJO)BSWFZ & Waroona with 2 new locations t #SBOEOFXMPDBUJPOTJOOFX development areas Treendale & Dalyellup t 'VMMZDPNQVUFSJTFEBDDSFEJUFE modern practices with nursing & admin support t PGCJMMJOHTEFQFOEJOH on experience t %84BOE"P/ Please email CV to

Contact Jasmine, to place your classified advert

F/T or P/T VR GP required for our modern state of the art medical centre located in Shoalwater (DWS), Full patient list ready to go. Minimum guarantee if required. Generous percentage. Offering modern surrounds and fully computerised clinical software. We are a friendly, privately owned and run centre. A full complement of nursing staff and administration team as well as onsite allied health, specialists and pathology. Please phone Rebecca on 08 9527 2236 or Email CV to

BENTLEY Rowethorpe Medical Centre is a non-profit, friendly practice seeking a part time GP to provide visits to our onsite residential aged care facilities. Practice-based consultations are also available. t 'VMMZDPNQVUFSJTFE t /FXMZSFOPWBUFEQSFNJTFT t .PEFSOFRVJQNFOU t 0OTJUFQBUIPMPHZ t )PVSTUPTVJUZPV For enquiries, please contact Jackie on 6363 6315 or 0413 595 676 LEEMING /PODPSQPSBUF(FOFSBM1SBDUJDFQSFTFOUT an exciting opportunity for VR P/T or F/T GP to join our team. Well managed long established 3 doctor practice with comprehensive CDM program. This is an excellent opportunity for a GP who wants to be busy and work as part of happy and well managed team. Enquiries to Practice Manager on 0419 959 246 or THORNLIE Thornlie Medical and Skin Cancer Clinic (DWS) is seeking a VR GP to help our friendly growing multicultural practice. Mixed billing, accredited, fully computerised with full-time nursing support. Computerised dermoscopy. Please email: or Call 0403 009 838

DIANELLA Dianella Family Medical Centre seeking a DWS VR GP to join our practice working part time. Monday â&#x20AC;&#x201C; Friday 6-8pm & Saturday mornings. Fully computerised, non-corporate, GMFYJCMFCJMMJOHXJUIHSPTT remuneration. Physio, Podiatrist, Clinipath & Pharmacy within the practice. Call Practice Manager Terri on 9276 3472 or Email resume to

BYFORD VR GP Female/Male GP required Full time or Part time Privately owned well established modern practice located in Byford, 30 minutes from CBD, DWS and area of need. Full admin and practice nurse support. Onsite Pathology, Podiatrist, Dental and Pharmacy. Fully computerised GPA Accredited Practice. Excellent remuneration, high billing from start, takeover existing patient base. Please email: PS1IPOF%S/BHB0434 049 767 OSBORNE PARK GP required for Osborne City Medical Centre. Flexible hours Monday to Thursday with optional afterhours. Excellent remuneration / $135 - $200 per hour. Predominantly private billing practice. Modern fully computerised practice with nursing support. Please call Michael on 0403 927 934

VICTORIA PARK Unrestricted Dr required to service 2 x psychiatric hostels located in Vic park. Excellent remuneration available. Contact:

OSBORNE PARK RAPHA CENTRE is dedicated to Womenâ&#x20AC;&#x2122;s Health specialising in Bio-Identical hormone optimization. Private billing, non-corporate, fully computerised, friendly team. Suitable for VR GP for rewarding experience in treating the root cause of most diseases with combination of nutritional and hormone balancing and more. Email: for confidential enquiries. Mentorship provided. SOUTH FREMANTLE VR GP required Fremantle area F/T P/T for Private Family Practice, Accredited, NJYFECJMMJOH '5/VSTFTVQQPSU SFNVOFSBUJPO Contact Practice Manager 9336 3665

DECEMBER 2016 - next deadline 12md Tuesday 15th November â&#x20AC;&#x201C; Tel 9203 5222 or

medical forum COMO Como Medical Clinic requires a full time or part time Male VR GP to join our friendly team. We are a small non-corporate, well-equipped, AGPAL accredited and mainly private billing practice. You will be well supported by the owner-doctor and two practice nurses. Flexible working hours and holidays (school holidays available). 0GGFSJOHSFDFJQUT Please contact Linley Gray on 0417 978 574 for confidential enquiries.

CLAREMONT Growing GP practice located in the trendy suburb of Claremont. PGCJMMJOHT Looking for VR GPs with unrestricted provider number on a part-time/full time basis for weekdays evening sessions (3pm to 8pm). Fully computerised with on-site QBUIPMPHZBOE3/TVQQPSU Located in a modern complex with access to the gym and pool. For further information please contact Dr Ang on 9472 9306 or Email:

KARRINYUP St Luke Karrinyup Medical Centre Great opportunity in a State of art DMJOJD JOOFSNFUSP /PSNBMBGUFSIPVST  /VSTJOHTVQQPSU 1BUIPMPHZBOE"MMJFE services on site. Privately owned. Generous remuneration. Please call Dr Takla 0439 952 979

PERTH Government medical officer position. Ongoing part-time. Flexible hours and schedule. Excellent rate of pay. Based in Perth City. General AHPRA registration required. /PODMJOJDBMBEWJTPSZSPMFJODPMMBCPSBUJWF congenial work environment. Relevant experience beneficial but not essential, training provided. Please send enquiries and/or resume, in confidence, to FREMANTLE INTERESTED IN WOMENâ&#x20AC;&#x2122;S HEALTH? Fremantle Womenâ&#x20AC;&#x2122;s Health Centre requires a female VR GP one day pw. Itâ&#x20AC;&#x2122;s a computerised, private and bulk-billing practice, with nursing support, scope for spending more time with patients, provides sessional remuneration, superannuation and generous salary packaging. FWHC is a not-for-profit, community facility providing medical, nursing and counselling services, health education and group activities in a relaxed friendly setting. Phone 9431 0500 or email %BXO/FFEIBN

BYFORD VR GP Required Accredited, busy, modern, non- corporate, mixed -billing practice. Full nursing support and friendly admin staff. Onsite Pathology, Dietician, Physiotherapist, Psychologist & Podiatrist. Phone Practice Manager on 0429 346 313 or email

SEVILLE GROVE Seville Drive Medical Centre is seeking a hardworking and enthusiastic VR F/T or P/T GP to join our friendly professional team. Our centre seeâ&#x20AC;&#x2122;s 200-250 patients per day, we also have an onsite pharmacy, pathology, allied health and visiting specialists. Full complement of GPâ&#x20AC;&#x2122;s, clinical staff and administration. Percentage of billings based on experience, with annual percentage increase. Please phone Rebecca or Debbie on 08 9498 1099 or Email CV to

JOONDALUP Full or part-time GPs required to join Candlewood Medical Centre. We are a busy multiple doctor family practice, mixed billing, accredited and fully computerised. Located close to pristine beaches with a wide range of amenities, providing for very attractive lifestyle choices. Please direct your resume or any enquiry to the business manager at Alternatively you can contact John Wong on 0414 981 888.

ALL AREAS 73TBOE/PO73TOFFEFEVSHFOUMZ DWS and area of need. Supervision available if required. Good income with initial guarantee. Additional income from Mole Scanner, Aesthetic Clinic & Travel Clinic. Chronic Disease Clinics with excellent admin and nursing support. Good doctor/nurse ratio. In house Physio, Podiatry, Psychology, Dietician. Enquiries to Dr Ben Banwait or 0416 893 131

SORRENTO F/T or P/T GP for busy Sorrento Medical Centre /PSNBMBGUFSIPVST available, we are like family, nurse & allied services on board, remuneration   Please call Dr Sam 0439 952 979

YOKINE Part-Time VR GP required for a small privately owned practice in Yokine. Two male, two female GPâ&#x20AC;&#x2122;s on site working part time. Family friendly practice with nursing support and a lovely team of receptionists. Our GPâ&#x20AC;&#x2122;s have full autonomy. Private billing. Fully computerised. Accredited. On-site pathology. Allied health rooms attached next to the practice. Excellent remuneration is offered to the right applicant, but we are not in a DWS area. Please contact Jess or Dr Peter Cummins for further information.

SECRET HARBOUR Secret Harbour Medical Centre VR GP wanted. PGGFSFE A generous relocation fee may also be offered. Brand new, modern and computerised. Contact: Dr Jagadish Krishnan Dr Vishnu Gopalan

COTTESLOE Azure Medical Cottesloe VR GP(s) required for Sunday mornings 10am - 1pm. Friendly, premium practice in Cottesloe, mixed billing. Lovely staff and patients. $140 / guarantee / percentage negotiable. Options to learn laser and other cosmetic treatments if desired, but not essential. 1MFBTFDBMM%S3JDIBSE/FXUPOPO 0429 621995 for further details.

ASCOT Seeking expressions of interest from motivated VR GPs wanting to take the next step in your career. Ever dreamed of owning your own practice but donâ&#x20AC;&#x2122;t want the stress of set up? We are seeking both GPs looking for partnership opportunities and those looking to enjoy work a state of the art, fully supported and modern built for purpose medical centre 10 mins from Perth CBD. Flexible working conditions with excellent remuneration in a private billing and fully privately owned centre. For an entirely confidential discussion please email WHITFORDS FT/PT Doctor required for friendly practice 73PGCJMMJOHT /PO73XJUIHFOFSBMSFHJTUSBUJPOGPS XFFLOJHIUTBOEXFFLFOETGSPN Please contact Dr Michael Gendy Or Dr Rafik Mansour Phone: 08 9404 4400

93 MOUNT LAWLEY Long established After Hours clinic Looking for a VR GP to work after hours shifts Flexible with hours Fully computerised and AGPAL accredited Private billing only Contact Gina on 0412 760 871 for further details JOONDANNA We are seeking a VR GP to join our friendly team on a part-time or full-time basis. /FX TUBUFPGUIFBSUNFEJDBMDFOUSF Flexible hours and billing. Percentage negotiable. Fully-computerised. /VSTJOHTVQQPSUGPS$%.1 Please call Wesley on 0414 287 537 for further details. REDCLIFFE Ascot Medical Group Part-Time VR GP Wanted for friendly General Practice /PO$PSQPSBUF1SBDUJDFXJUI Mixed Billings Accredited and Fully Computerised Sessions available: Afternoonâ&#x20AC;&#x2122;s and Saturday Morning (Alternate) Please contact Dr Cheng, Dr Hadi or Practice Manager on 9332 5556

BUTLER Connolly Drive Medical Centre VR GP required for this very new, state of the art, fully computerised, absolutely paperless, spacious medical centre. Fully equipped procedure rooms and casualty, well-furnished consult rooms, QBUIPMPHZ BMMJFEIFBMUI 3/TVQQPSU Abundant patients, DWS, non-corporate. Generous remuneration. Confidential enquiries Dr Ken Jones on (08) 9562 2599 Tina (manager) on (08) 9562 2500 Email:

HAMILTON HILL A female GP required for a clinic in B%84BOE"0/BSFBNJOVUFTESJWF from Fremantle. 3 Doctor GP Practice. Part time or Full time doctor considered Fully computerised practice. Rates negotiable Contact Eric on 0469 177 034 or Send CV to eric@ ROCKINGHAM Read Street Medical and Skin Centre F/T or P/T VR GP. DWS Location. Privately owned, private billing practice. Well established with existing patient base. Special interests encouraged. Fully computerised, excellent support staff. Onsite pathology available. Easy access to major shopping centre and public transportation. Contact us at Tel 08 9527 4976

DECEMBER 2016 - next deadline 12md Tuesday 15th November â&#x20AC;&#x201C; Tel 9203 5222 or


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SERPENTINE VR GP Required for practice only 2 years old, located in an ASGC-R2 location east of Perth. This practice is the perfect opportunity for a GP to work in the inner regional area of Perth located approximately 45 mins from UIF$#%5IJTJTB%84BOE"0/MPDBUJPO This large community busy practice is located next door to a pharmacy and can accommodate 2 full time GPâ&#x20AC;&#x2122;s. Admin and nursing services are provided along with onsite pathology and podiatrist/Dietitian. Excellent remuneration is offered. For more information please call 0419 959 246 or 0401 091 921 DUNCRAIG Duncraig Medical Centre requires a Female GP for immediate start. Fulltime patient load available. However, flexible with Monday to Friday hours. Excellent remuneration / $135 - $200 per hour. Predominantly private billing practice. Modern fully computerised practice with full time nurses. Please call Michael on 0403 927 934 or

Contact Jasmine, to place your classified advert

MADELEY 73/PO73(FOFSBM.FEJDBM Practitioners required for Highland Medical Madeley which is located in a District of Workplace Shortage. Highland Medical Madeley is a non corporate practice with 5 male GPs, 1SBDUJDF/VSTFT $IJSPQSBDUPS  Physiotherapist, 1 Dietician, 1 Podiatrist and 1 exercise physiologist. Sessions and leave negotiable, salary is compiled from billings rather than takings. 6QUPPGCJMMJOHTQBJE (dependant on experience). Please contact Jacky on 0488 500 153 or E-mail to BUTLER Butler Boulevard Medical Centre is looking for a Full Time or Part Time GP, HSPTTCJMMJOH Full Time or Part Time position also available. DWS welcome. /FX TUBUFPGUIFBSUNFEJDBMDFOUSF  Great facilities, Fully-computerised. 'MFYJCMFIPVSTBOECJMMJOH /03 /PO Corporate, Onsite nurse. Onsite Pathology, Physiotherapist, Dietitian, Podiatrist and Psychologist. Excellent Remuneration Call Practice Manager on 08 9305 3232 or Email resume to:

GENERAL PRACTITIONERS REQUIRED DWS and non DWS positions available in the South West and metropolitan area

FRANZCOG Opportunities Mandurah Obstetrics is a well-established local womenâ&#x20AC;&#x2122;s health clinic that offers comprehensive services in Obstetrics and gynaecology. In 2017 we are seeing the services of a Fellow (new graduates welcome to apply) to take on the role of either part-time (with overnight on-call) services (3 days per week) or full-time Obstetric services. The opportunity to expand and develop a successful O&G service within an already existing clinic provides the support and business links within the Peel Region. Private and Public patient services at Peel Health Campus opens the door for a forward-thinking practitioner who would like to remain within a short distance from the CBD. Opportunities are limited and applicants are invited to submit expressions of interest to:

GP required for GP4YP program

The GP4YP program (General Practice for Young People) is a service aimed at youth up to the age 25. We require a GP with training in youth health to work 6-8 hours a week. The hours are ďŹ&#x201A;exible so can be done in one or more days between Monday â&#x20AC;&#x201C; Friday and the GP will receive 100% of Medicare billing. For further information please contact Marina Trevino on either 9319 0555 or email

M e d i c al






Nurses, admin & allied health support as well as pathology on site



All our sites are fully accredited with AGPAL



Flexible hours, Full time or Part time available We are eager on expanding our centres in all areas, as we continue to recruit new doctors.

Are you looking to sell your practice? We are looking to grow our network of quality GP centres. Please contact us for a conďŹ dential discussion. For Further information please contact: Dr Brenda Murrison â&#x20AC;&#x201C; 0418 921 073 or Damian â&#x20AC;&#x201C; or 0423 844 268


FRACGP or equivalent highly regarded but not essential m il y P r a ct


â&#x20AC;&#x153;keeping Busselton healthyâ&#x20AC;?

Busselton WA Fulltime/Part time VR GP is required for The Sunshine Medical Centre & Family Practice

We are a small, privately owned boutique practice in the picturesque town of Busselton, 2.5 hours south of Perth with the opportunity of a great work/life/family balance. â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘

DWS welcomed Private billing, fully accredited Family friendly working environment Excellent remuneration Fully computerised with Best Practice software Professional Nurse and Administrative support

Call Jodi on 08 97514500 and CV to DECEMBER 2016 - next deadline 12md Tuesday 15th November â&#x20AC;&#x201C; Tel 9203 5222 or

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Metro Area GP positions available. IMG training available VR & Non â&#x20AC;&#x201C; VR Drâ&#x20AC;&#x2122;s are welcome to apply. Send applications to

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ARE YOU WANTING TO SELL A MEDICAL PRACTICE? As WAâ&#x20AC;&#x2122;s only specialised medical business broker we have sold many medical practices to qualiďŹ ed buyers on our books. Your business will be packaged and marketed to ensure you achieve the maximum price possible. We are committed to maintaining conďŹ dentiality. You will enjoy the beneďŹ t of our negotiating skills. Weâ&#x20AC;&#x2122;ll take care of all the paper work to ensure a smooth transition.


To ďŹ nd out what your practice is worth, call:


Brad Potter on 0411 185 006


Suite 27, 782 - 784 Canning Highway, Applecross WA 6153 Ph: 9315 2599


$7000/= SIGN ON FEE PAID Please contact Preksha on 0433 583 972 or 0417 881 234 for more information

ACL: 377 711 ACR: 482 358

ality WKH e y client DOXHIRU

With a reputation built on quality of service, Optima Press has the resources, the people and the commitment to provide every client with the finest printing and value for money. 9 Carbon Court, Osborne Park 6017 } Tel 9445 8380

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medical forum Lockridge Medical Centre

St John is seeking experienced doctors to work in our new Urgent Care Centres. Relevant experience in urgent care, rural general practice or similar will be highly regarded. Full or part time. Attractive salary package. For enquiries to join our dynamic team, please contact us via E: or P: 9334 1451

Doctors... Take Note! An exceptional opportunity has become available in a very successful practice.


Dynamic VR / Non VR required in South Lake, WA Excellent earning potential and opportunity for the right candidate (Full Time/Part Time) + High percentage offered + Non VR Preferably with General Registration + Located south side of the river in Perth, in a DWS & AoN area

+ Nurturing, friendly supportive team & working environment + Fully computerised with reliable administration support

Venosan Diabetic Socks

+ Pharmacy around the corner

+ Registered Nurse on site everyday

+ Great location with ample car park

+ Allied health services and Pathology on site

+ Options for ï¬&#x201A;exible hours available Please email your recent CV to or call 0466 210 369 for a friendly discussion.

The Magic of Silver for Sensitive Feet No Compression Silver Ion Therapy Contains the antimicrobial silver yarn Shieldex® which enhances a balanced foot climate. Tested and proven in controlling over twelve types of bacterial and fungal infections common on the feet and legs.

Apollo Health is seeking local Drâ&#x20AC;&#x2122;s with an interest in: - Skin cancer - General family medicine - Walk in/Urgent care For our practices in Armadale, Cockburn and Joondalup FRACGP required, Relocation incentives available For enquiries to join our dynamic team, please contact us via E: or P: 9334 1451


Silver yarn - is permanent and cannot be washed out of the socks.


Keeps feet cooler in the summer and warmer in the winter

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Your WA Consultant â&#x20AC;&#x201C; Jenny Heyden Tel 9203 5544 or Mob 0403 350 810

DECEMBER 2016 - next deadline 12md Tuesday 15th November â&#x20AC;&#x201C; Tel 9203 5222 or

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Waikiki GP Super Clinic Opening on 9th Jan 2017 GP Owned, 10 Consult rooms, 3 Minor Surgery All allied health, pathology, pharmacy& Dental 70 % of billings for foundation doctors Non VR GPs are also welcome Waikiki Village Shopping Centre, Waikiki For conďŹ dential discussion contact Amanda on 0449717201

or email






Ĺ&#x201D;.JOJNVN3FUBJOFSHVBSBOUFFE AHG Super Clinic Contact Person: Val Reeve Phone: 0415 322 790 Email:

DECEMBER 2016 - next deadline 12md Tuesday 15th November â&#x20AC;&#x201C; Tel 9203 5222 or

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