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1 WESTERN AUSTRALIAMEDICUS Journal of the Australian Medical Association WA February 2013 Volume 53 / Issue 1 amawa.com.au

2 w ALL-NEW LS Arriving early 2013 You take care of your patients. We ll take care of you. AMA (WA) CORPORATE PROGRAM BENEFITS Included-scheduled servicing to 3 years, or 60,000km Discounted dealer delivery & corporate pricing Airport valet service Complimentary service loan cars or pick up & delivery 4 year/100,000km warranty [whichever comes rst] Lexus Drive Care providing 24 hour roadside assistance Complimentary Lexus magazines Premium ticketing Introductory Lexus nance offer on 2013 All-New LS To learn more about these exclusive bene ts or to test drive the all-new LS, contact Managing Director, David Jeary on Scarborough Beach Road, Osborne Park WA 6017 lexusofperth.com.au DL

3 Council President Dr Richard Choong Immediate Past President A/Prof David Mountain Vice Presidents Dr Michael Gannon Dr Andrew Miller Honorary Secretary Dr Omar Khorshid Assistant Honorary Secretary Dr Janice Bell Honorary Treasurer Dr Simon Towler Councillors Division of General Practice (WA) Prof Bernard Pearn-Rowe A/Prof Rosanna Capolingua Division of Specialty Practice Dr Tony Ryan Prof Mark Khangure Division of Salaried and State Government Services Dr Dror Maor Dr Daniel Heredia Ordinary Members Prof Gary Geelhoed Dr Stuart Salfinger Dr Marcus Tan Co-opted Members Dr Steve Wilson A/Prof Frank Jones A/Prof Peter Maguire Prof Geoff Dobb Dr Dror Maor Dr Cassandra Host Dr Ian Jenkins Prof Ian Puddey Prof Gavin Frost Dr Alexandra Welborn Mr Benjamin Host Mr Ghassan Zammar Contents 6 Raising the Curtain The 2013 AMA (WA) Clinical Conference is Russia bound February 2013 AMA (WA) Office Executive Director Mr Paul Boyatzis Director: Industrial & Legal Ms Marcia Kuhne Executive Officers Mr Michael Prendergast Ms Christine Kane Ms Clare Francis Mr Gary Bucknall 14 Stirling Highway Nedlands WA 6009 (08) Medicus Editor and Director of Communications Mr Robert Reid Deputy Editor Ms Janine Martin Advertising Inquiries Phone Mr Des Michael (08) Copy Submissions Phone Ms Janine Martin (08) or Services Business Services Manager Ms Noelle Jones Financial Services Manager Mr John Gerrard Medical Products Manager Mr Anthony Boyatzis Health Training Australia Manager Mr Geoff Jones The publication of an advertisement, article or inclusion of an insert does not imply endorsement by the AMA (WA) of the views, service or product in question, and neither the AMA (WA) nor its agents will have any liability for any information contained therein. 22 Cover Story: Health wins top vote WA State Election 2013 Features managing Bronchiectasis Onwards and Upwards University of Notre Dame Graduation Day REGULarS 02 President s Desk 03 From the Editor 04 Industrial 09 News 13 Event 18 Tomorrow s Health: The Future of Hospital Design 29 Opinion 36 Paying it forward Governor of WA Malcolm McCusker and wife, Tonya on giving back to the community 39 For the Record: Dr Adam Coulson 45 Dr YES 47 Snippet 54 Travel 56 Food 59 Wine 60 Technology Clinical Edge Professor Philip Thompson on 62 Drive 64 After Hours 66 Obituary 68 Member Benefits & On the Town 70 Classifieds Professional Appointments & Positions Vacant February MEDICUS 1

4 PRESIDENT S DESK Fighting the mind block by Dr Richard Choong AMA (WA) President Readers of Medicus would recall a recent article about a debate held at the University of WA where the proposition that Perth will fast become the capital of Australia, by its continuing economic might and its close relationship with Asia. After reading the article I began to think about our future as a state. By future, I mean our long-term future over the next century. Too often our media and our political leaders encourage us to thing about our future in much smaller bites three or four years often based on the election cycle. But my future is the future I see in the eyes of my young daughter, about to start school with the opportunities of the world before her. That future. We are a modern industrialised state leading Australian economic growth. But this was not always the way. For much of its history, Western Australia was a follower, a state that required the financial support of its much wealthier fellow participants in the great and continuing experiment of Australian federalism. Then we discovered that under our sandy top soil were minerals that the rest of the world wanted. And the economic boom began the benefits of which we are still reaping. And what do we have to show for this long-term boom? And how do we ensure that the benefits of our current growth continue long into the future? It is my belief that the only real long-term resource we have is our intelligence, our minds, our sense of innovation. This is why the AMA (WA) has placed the issue of medical research first and foremost on our list of five issues for the coming state election. As members would know, the Association has made research a major issue over the last two years. We have raised it publicly and with our political leaders. Just a few days ago, I wrote to Premier Colin Barnett about the issue, strongly advocating that for WA to stand proud and face the future as an educated and questioning society, it is vital that additional funding of $40 million annually be provided for ongoing health and medical research. This should be done, the AMA (WA) has argued, through the creation of a WA Medical Research Council. I have also consistently argued that research is one of the Five Pillars of our 2013 election campaign, along with Mental Health; Capacity Issues; Rural Health Care; and the exclusion of health from the State Government s Efficiency Cuts. But it is by advocating increased research spending that the AMA (WA) can help play its part in making sure Western Australia, our children, and their children, are set for the future. As I wrote to the Premier: The benefits of health and medical research are tangible. They include advancement in medical research and innovations in medical equipment resulting in prevention, early detection and improvements in disease and illness. Each of these advancements results in both the reduction in premature mortality of patients as well as reduced treatment times. I continued to the Premier: Hence direct benefits include improved health outcomes for the population, decreased costs and attraction and retention of highly-qualified and skilled medical practitioners. Increased innovation also means commercialisation in the biotechnology field and the opportunity to generate investment funding from international and philanthropic funding. I hope my letter is given the due consideration by the Premier an economist by training and he can see the amazing economic benefits health research offers. Western Australian research is used every day. And yet funding for research in WA has been heading backwards for more than a decade. Our share of national funding has also dropped and world-class researchers happy to stay in WA have no option but to fly out of Perth for points east, west or increasingly north to Asian centres of excellence. As President of the AMA in WA, I will be extremely proud to see any for WA to face the future as an educated and questioning society, it is vital that additional funding of $40 million annually be provided of our five issues taken up by a new government whatever its colour or makeup whether they be in the areas of additional beds or increased spending on mental health. But I will be proudest when, in the election campaign and then in the next State Budget, there is an announcement of the creation of a WA Medical Research Council with enough funding promised to make a significant difference to our record in research. Western Australians can and must think of the future a future that is more than mines and extraction. We must, I believe, work towards a future that combines what we are currently doing so well to include what we can do so well. A future that involves research and innovation for the sake of Western Australia. 2 MEDICUS February

5 By the members, for the members FroM THE EDItor Agenda: Regular AMA events include the Interns Cocktail Party, the Gala Dinner and the GP Breakfast series. Welcome to the first edition of Medicus for 2013! I hope all our readers managed to get some time to have a break over the Christmas/New Year period to recharge personal batteries for what will undoubtedly be a very busy year. We also hope 2013 will be a fulfilling, satisfying and healthy year for all Association members. No one needs to be told that there will be a State Election in WA on Saturday 9 March and now we know there will be a Federal Election on Saturday 14 September. Medicus in 2013 therefore, will take a decidedly political tone at various times over the next 11 months. However, as a former political journalist in both Perth and Canberra, this is one of the most exciting times of all and to have two elections in one year is almost beyond my most exotic dreams! A normal year for the AMA (WA) is punctuated by regular events such as the Interns Cocktail Party, the Gala Dinner, the President s Cocktail function, our regular GP Breakfast series and the AMA (WA) Clinical Conference. But our year is also highlighted by our advocacy on a range of issues, whether they are of industrial relations, immigration, training and education or financial flavours. The AMA is running one of the most extensive seminar programs in the Association s history this year, all for the benefit of members and on a wide range of subjects, reflecting the interests of members. Our membership continues to increase at a rate not seen for some years as does the range of services provided to members. Medicus is part of this membership offering and attempts to offer news of interest to members as well as medical articles that can be used on a day-to-day basis. In the last 18 months, Medicus has almost doubled in size and has increased its range of subject offerings. More interesting profile pieces, a monthly travel piece, dramatic covers and a new stronger political focus have all met with positive reactions. But we, of course, remain open to other suggestions for additional sections or pages. Medicus will always be a membership-based magazine, so feel free to send us your ideas of how the magazine can be improved further. The strength of any organisation comes from combined strength of members, not based on numbers or noise but on intelligent, well-targeted and sophisticated argument. Other groups might dress in funny outfits, run advertising campaigns or threaten to somehow cost votes if a political party doesn t do what they want to do. These tactics rarely work. Instead change is best argued for by using intelligence, fact, and the hard-won influence that the AMA is known for that brings about the best changes in public health in WA. To paraphrase the old saying, if the AMA was not fighting for better health in WA, who would? And if we were not doing it now, when should we be fighting for public health? February MEDICUS 3

6 INDUStrIAL Rights of Private Practice AND Quarterly Statements The Australian Medical Association (WA) has recently received a number of enquiries from practitioners who were having difficulty in obtaining quarterly statements of income generated in their name, consistent with clause 28 (3) of the Industrial Agreements. From provisions in various AMA Industrial Agreements Clause 27 Private Practice generally, states in part the following: (2) A practitioner at the time of being appointed be granted a right of Private Practice subject to the conditions of this agreement. (4) A practitioner shall, to the fullest extent permissible by law, exercise rights of private practice in any public teaching hospital or in any other public sector health care facility in which the practitioner works. (5) The hospital shall provide to the practitioner a copy of a patient election form or other evidence of an election to be a private patient, which would satisfy Medicare Australia or other applicable health insurers of the election to be a private patient for those private patients admitted under the care of the practitioner (6) A practitioner who does not comply with the terms and conditions under which facilities are made available to the practitioner for the purposes of engaging in private practice forfeits the ability to exercise rights of private practice. (7) If the employer determines that a practitioner is not exercising rights of private practice to the fullest extent permissible by law, the practitioner forfeits the ability to exercise rights of private practice. Where a practitioner elects to relinquish all private practice income in or using the hospital s facilities and assigns such private the practitioner on a quarterly basis a statement detailing total amount of accounts rendered and amounts collected (exclusive of GST) in the practitioner s name. Given that the Association is aware that a number of practitioners have requested quarterly statements which have not been provided, the Association has written to Health Corporate Network (HCN) seeking compliance with the Agreement to provide quarterly statements. HCN has subsequently advised that it is not responsible for the issuing of quarterly statements. HCN further advised that the contacts at site that are responsible for the issuing of quarterly statements are: North Metropolitan Area Health Service Mr Trenton Grieve South Metropolitan Area Health Service Mr Kevin Copping Child and Adolescent Health Service Mr Gordon Haywood. The Association has been provided with examples of instances where items relating to different specialties have been raised in the practitioner s name. Hence the Association strongly advocates that practitioners insist on receiving quarterly statements as provided for in clause 28 (3) so that they can reconcile their activity and to ensure that bills are not being sent out in their name that do not comply with the requirements of the Health Insurance Act. The full provisions are set out in the AMA Industrial Agreement available on the AMA (WA) website at Members with any queries should contact Gary Bucknall - their IHLC Representative or Medical Defence Association if they have any concerns. Classification 1 OCtoBER 2012 Consultation/Medical Administrator $94,304 Health Service Medical Practitioner $63,761 Non Specialist Qualified Medical Administrator/Senior Medical Practitioner/Vocationally Registered General Practitioner $70,372 practice income to the employer, the practitioner shall receive the Arrangement A Allowance in lieu as shown below: Clause 28 Private Practice Arrangement A subclause (3) states: (3) The employer in acting as agent for a practitioner shall ensure that no account is rendered which could place the practitioner in breach of the Health Insurance Act 1973 (Cwth). The employer shall, if requested, provide to 4 MEDICUS February

7 WESTERN AUSTRALIA

8 2013 AMA (WA) Clinical Conference Raising the curtain Join the AMA (WA) in remarkable Russia this August Fantastic: St Basil s Cathedral. 6 MEDICUS February

9 2013 AMA (WA) Clinical Conference Long regarded as a country of mystery and legend, Russia has a matchless depth of historic and cultural riches accessible to those who venture to this extraordinary country. Over the centuries, Russia has inspired great artists, poets and thinkers and is the land of great love stories Anna Karenina and Dr Zhivago. Later this year you will have the opportunity of visiting Russia with the AMA and see the places that inspired these stories. There could hardly be a more exciting time to visit Russia, a nation emerging from the throes of a vast political and cultural upheaval. Places previously off limits are now proudly showcased to visitors and after years of turmoil, the glories of Russia have been revealed as if from behind a screen, more accessible than ever before. Modern Russia offers visitors a treasure trove of cultural, architectural and artistic highlights. A stunning array of galleries and museums is located in Moscow and St Petersburg with treasures that are breathtaking in their beauty and opulence. For example, the State Tretyakov Gallery in Moscow is one of the most famous art museums in the world. Its collection covers a whole millennium of Russian cultural development. But Russia s artistic attractions are not only in galleries, but all around the cities, in the buildings, squares and even the subways. The street plan of Moscow looks like a spider s web, with the Kremlin at the centre. Iconic buildings located within the Kremlin include the Bell Tower of Ivan the Great with its distinctive golden onion dome; the white, five-domed Archangel Cathedral; the Armoury housing the gallery of royal regalia, thrones (including that of Alexander the Great), coaches and carriages; and the Cathedral of the Annunciation with its collection of priceless icons dating from the 14 th Century. Other highlights of Moscow are located in the vicinity of Red Square and include St Basil s Cathedral - the building that has come to symbolise Moscow. With its fantasy of colour, twisting shapes and oriental style, St Basil s was built between 1554 and 1561 to celebrate Ivan the Terrible s victory over the Tartar Khans of Kazan. The Bolshoi Theatre will be a feature of the AMA program for its sumptuous setting. This 18 th century theatre is fronted by a triumphant sculpture of Apollo s chariot topping the eight columned portico. A blinding abundance of red and gold decorates the interior with the curtain still embossed with the Soviet Hammer and Sickle. The AMA tour will also feature the Cold War Museum, housed in the super-secret bunker that served as the command post and the main artery for communication for the Soviet Union in the event of a nuclear war. Like Venice and Amsterdam, St Petersburg is a city on water, laced by rivers and canals, sewn together by hundreds of bridges. St Petersburg is regarded as Russia s cultural capital, with its magnificently preserved heritage reflecting the majesty of the Russian empire. A tour of the Imperial City of St Petersburg features the Baroque Winter Palace the opulent winter residence built for Tsarina Elizabeth between The patterned parquet flooring, dazzling chandeliers and extravagant history of the palace make the Winter Palace a must-see for visitors. The Hermitage, one of the most famous museums in the world, exhibits a collection of almost three million works of art from prehistoric and classical times, the Orient, Russia, Italy and Spain, Netherlands and Germany, France and England. The Hermitage s collections include works by Leonardo da Vinci, Michelangelo, Raphael, Rubens, Renoir, Cezanne, Manet and Titian. Star exhibits include Abraham s Sacrifice by Rembrandt, Ea Haere la Oe by Gaugin and La Danse by Matisse. No trip to St Petersburg is complete without a cruise on the labyrinth of canals and waterways, taking in many impressive bridges and landmarks. The AMA tour will include a day cruise and a stunning night time dinner cruise. Other highlights of St Petersburg include the Summer Palace and Park of Catherine the Great a fascinating monument of the world s architectural and gardening arts of the 18 th and 19 th centuries. Its three parks occupy some 600 hectares with over 100 architectural constructions from magnificent palaces and grand monuments to intimate pavilions and park sculptures. The AMA tour will also take in the Summer Palace and Park of Peterhoff with its 176 fountains, four cascades, majestic palace and gilded statues of ancient gods and heroes. To allow us to take advantage of the summer weather, the 2013 AMA (WA) Clinical Conference tour to Russia will be held between 1 14 August. Flying Emirates, we will travel to Moscow via Dubai and return from St Petersburg. Accommodation will be at some of the most historical and luxurious hotels in Russia, centrally located and with a range of excellent facilities and amenities. Full itinerary and cost details will be available shortly, together with details of the Clinical Conference academic program. For further information or to register your interest for the 2013 AMA (WA) Clinical Conference tour to Russia, contact Chris Kane at the AMA on or February MEDICUS 7

10 Envision Medical Imaging would like to thank all our supporters for their dedication throughout CT MRI X-RAY ULTRASOUND NUCMED DENTAL 178 Cambridge Street Wembley tel: fax: From The Doctors and Team at Envision We hope you and your family enjoyed a wonderful and safe holiday season, and wish you all the very best for Happy New Year

11 AMA (WA) 2013 Elections get involved! NEWS Australian Medical Association (WA) members are once again encouraged to take a strong interest in the coming AMA (WA) elections, not only by voting, but by getting involved and nominating for a professional special interest group. Included in this edition of Medicus is a nomination form for the positions of chair of special interest groups within the Division of Specialty Practice, and the Division of General Practice. In addition there are a number of positions within the Division of State Government Service. Nominations are now open, and must reach the AMA (WA) Returning Officer no later than 5pm on Monday, 11 March, This is an opportunity to increase your involvement in the AMA (WA) and to assist in serving your fellow members. Coming issues of Medicus will detail information about office bearer nominations. Midland Public Hospital marks first milestone The first major concrete pour at St John of God Midland Public Hospital for the radiology and nuclear medicine department was completed in December Minister for Health, the Honourable Dr Kim Hames, joined St John of God Health Care and Brookfield Multiplex to mark the first major milestone since construction of the 307-bed public hospital and co-located 60-bed private hospital began in August last year. St John of God Health Care s Group CEO, Dr Michael Stanford, said the 140 cubic metre concrete pour indicated the successful completion of five months of intensive preparatory construction works. We re beginning to see real progress on a number of fronts with piling finished, the first crane on site, and over 925 square metres of concrete floor slab for the radiology and nuclear medicine department just completed. This also means we are another step closer to opening the hospitals, which will increase access to free public health care for Level best: (L-R) Brookfield Multiplex Regional Director Steve McConkey, Minister for Health Dr Kim Hames, and St John of God Health Care Group CEO Dr Michael Stanford at the concrete pour. the people of Midland and surrounding areas with the number of patients treated locally rising from 35 per cent to 75 per cent, Dr Stanford said. The hospitals are due to open in late 2015 and will employ about 1000 staff. Upgrade for Adolescent Mental Health Clinic Young people with acute mental health issues will see significant changes at the State s most specialised adolescent mental health facility following a $4.5 million redevelopment. Mental Health Minister Helen Morton recently unveiled major upgrades to the Bentley Adolescent Unit (BAU), which provides acute inpatient mental health care to adolescents aged 12 to 18 years. Mrs Morton said the prison-like green walls and doors had been replaced with new furnishings and colour schemes, while the bedrooms had been made more comfortable. The modernisation of the Bentley Adolescent Unit means the facility s contemporary model of mental health care can be delivered more effectively, she said. Bathrooms have been completely renovated, the dining area is open and spacious, blackboard paint has been used in the bedrooms to encourage the residents artistic side and an outdoor basketball area will give the patients the opportunity to exercise. All this means better mental outcomes for young people in Western Australia. The Minister said input from young people and their families was at the centre of all aspects of the project s design and development. Feedback from young people and their families helped create an ideal therapeutic environment. This new environment will enhance the expert clinical care Bentley Adolescent Unit inpatients receive, she said. February MEDICUS 9

12 NEWS AMA (WA) signs milestone MoU with Health Minister After almost 18 months of intense negotiations, a key Memorandum of Understanding (MoU) has been signed with Health Minister Kim Hames that impacts on all Visiting Medical Practitioners. Formally signed on 19 December last year between the AMA (WA), the MoU represents a significant milestone after many Collaboration: AMA (WA) President Dr Richard Choong and Minister for Health Dr Kim Hames shake hands on a job well done. months of negotiations with the Department of Health during which attempts were made to dismantle the MoU s fundamental principles. The MoU governs matters relating to access, medical input into hospital policy through Medical Advisory Committees, clinical privileges and conduct processes and is the product of many years of negotiation by the AMA (WA). The revised MoU reflects input from AMA (WA) members and retains key issues: The Minister remains a party to the MOU It applies to all Visiting Medical Practitioners (VMP) providing services to secondary hospitals It applies to all salaried medical practitioners employed in secondary hospitals, and Includes proper processes for doctors to be assessed by peer review in relation to clinical and conduct issues. The AMA (WA) strives to strengthen mechanisms for medical input and the rights of doctors to compete for access and be fairly assessed. For further information about the MoU or to obtain a copy please refer to the AMA (WA) website. Our care surrounds you... hollywoodprivatehospital.com.au 10 MEDICUS February

13 Perth Radiological Clinic is pleased to welcome Drs Anuj Patel, Adrian Yoong, Helen Van Den Broeck, Ashley Bennett and Duncan Ramsay as new owners of the Practice. They join as equal equity partners in the ownership of Perth Radiological Clinic along with Drs Thornton Abbott, Richard Bessell-Browne, Martin Blake, Rudolf Boeddinghaus, Bill Breidahl, Tony Briede, Rodney Butler, Gavin Chapiekin, Brian Cleary, Stephen Davis, Michael Fallon, Kit Frazer, Kieren Gara, Rodney Greenberger, Susanne Guy, Roche Helberg, Sanjay Jeganathan, Susan Lamp, Joanne Lazberger, Martin Marshall, Mal McCloskey, Stephen Melsom, Andrew Patrikeos, Ramon Sheehan, Peter Shipman, Manoj Tharakan, Jacqueline Thomson, Rohan vanden Driesen, Sharon Winters and Eric Yau. Perth Radiological Clinic is one of Australia s largest private radiology practices owned and operated by radiologists. This year, Perth Radiological Clinic celebrates 65 years of providing medical imaging services to the people of Western Australia. For more information about any of our services please visit our website.

14 NEWS Australia Day Honours for AMA members The Australian Medical Association (WA) would like to extend its congratulations to all recipients of the Australia Day Awards 2013, and in particular: Dr Alan William Duncan AM Floreat For significant service to medicine in the field of paediatric intensive care as a clinician and educator. Professor Vincent Caruso OAM Crawley For service to medicine in the field of pathology. Professor Bruce William Robinson AM UWA School of Medicine, Nedlands For significant service to medicine in the area of research into asbestos-related cancers and to the community, particularly through support to fathers. Program helps reduce secondary cardiac event risk With about half of cardiovascular hospital admissions being secondary cardiac events, such as a heart attack, HBF has launched a rehabilitation program aimed at reducing a heart patient s risk of readmission. The health care provider joined forced with Cardiovascular Prevention and Rehabilitation WA (CPRwa) to deliver an intensive eight-week program for cardiac patient members on discharge from hospital. The individualised program came about following a pilot program that showed strong results on all measured cardiovascular risk factors. CPRwa Director, Associate Professor Craig Cheetham said the individualised nature of the program was its biggest advantage. It is delivered according to the patient s medical history and includes education, guided exercise, physical activity and psychosocial interventions. The multidisciplinary team supporting the patient includes coronary care nurses, exercise physiologists, dieticians, occupational therapists and pharmacists. A/Prof Cheetham said studies of similar programs found unplanned readmissions could be cut by up to half if patients underwent education, reduced risk factors and improved their overall well-being. The eight-week pilot program involved 160 patients who had undergone cardiovascular events such as a heart attack or heart surgery, and included three sessions a week. HBF said the results Dr Andrew Geoffrey Robertson CSC PSM Perth For outstanding public service as Director, Disaster Management and Preparedness within WA Health. Risk reduction: HBF s new program targets cardiac patients on discharge from hospital. were very encouraging with 92 per cent of participants meeting blood pressure targets, 72 per cent recording improvements in their body mass index and 96 per cent improving their waist measurement. Lifestyle factors were also improved with 58 per cent of respondents increasing their fruit and vegetable intake and 55 per cent reporting a better understanding of their condition. The number of participants who exercised daily also increased from 44 to 59 per cent. The HBF program is now available at five sites across the metropolitan area at Hollywood Private Hospital and community settings in Nedlands, Bayswater, Craigie and Melville. After Hours services are also available. For further details, visit health-management-programs/cardiac-rehabilitation-serviceprogram.html. 12 MEDICUS February

15 EVENT Twenty stellar years and counting It was ironic that the chosen theme of the get-together to mark two decades of Noelle Jones at the AMA (WA) was the Mad Hatter s Tea Party. After all, it s well known that if ever there was a straight-talking, no-nonsense, can-do individual to walk through the corridors of the AMA, Noelle would win first prize. Noelle s innings at the AMA commenced in 1992 when just 20 people staffed the organisation. Her resume at the time pointed to her prowess at typing at the underwhelming speed of 50 words per minute. It would not take long however for the AMA to discover a range of other abilities. If the history of the AMA (WA) was on Facebook and there was a timeline, the impact of Noelle s arrival would stick out as the beginning of two decades of massive growth. It s well known that Executive Director Paul Boyatzis and former Deputy Executive Director Peter Jennings were tough during Noelle s job interview. That didn t prove a deterrent for Noelle who had already spent some years honing her skills at negotiation and handling challenging situations at the Australian Bureau of Statistics and the then massive job finding organisation, the Commonwealth Employment Service. Noelle made her presence felt at the AMA almost immediately. Perhaps it was her long stint as a casual employee at the Wonderland of Toys that provided the skills that suited the AMA so well. Perhaps it was her time as secretary as the Old Haleians Hockey Club or her On the job: An AMA brochure featuring a smiling Noelle Jones in the 1990 s. Plenty to smile about: Noelle Jones at the Mad Hatter s Tea Party that celebrated her 20-year innings at the AMA. (Above right) Noelle with her 104-year-old mother, Dorothy and daughter Diane. time at the famed Edwards Business College that honed the touch necessary. But the hiring of Noelle sparked what will undoubtedly be known in the future as a golden period for the AMA in WA. Along with Paul Boyatzis, she successfully negotiated her very first contract with the Western Australian Centre for Remote and Rural Medicine (now Rural Health). Her husband Geoff Jones then joined the AMA family and helped plan the tender for the AMA Apprenticeship Centre. Noelle also played a significant role in the establishment of the Dr YES Foundation. While providing the leadership for the AMA s Health and Community Services arm, Noelle also took the time to manage the Medical Products Section and the AMA s Recruitment and Training Arm. At the Mad Hatter s Tea Party, Noelle, true to form, held a spot quiz on the various milestones the AMA s Health and Community Services Section has seen over the years. A loved member of the AMA family, Noelle s 20th anniversary has been met with a range of reactions from amazement at how fast the time has passed, to sincere appreciation of the dedication of one of the Association s most valued employees. Noelle has been pivotal to the development of the AMA in WA, AMA (WA) President Richard Choong said. Over her time with the AMA Noelle has shown an incredible ability to not only identify opportunities to offer a range of additional services to members but a great skill in delivering those services, he said. On behalf of AMA members I thank Noelle for her service. Everyone looks forward to the next 20 years. C ncerned? We ensure you hear your patient s treatment options. At Lions Hearing Clinics, our Master Degree qualified audiologists will give you an accurate picture of your patient s hearing loss and its causes. We ll keep you informed of any steps taken be it the prescription of hearing devices or lifestyle changes or we ll recommend onward referral pathways. As a patient focussed, independent provider, we strive to find the best treatment for your patient s hearing loss and lifestyle. To make a referral visit lionshearing.com.au/resources

16 UND GraDUation Onwards upwards and The 2012 Graduation Ceremony of medical students from the University of Notre Dame in Fremantle was a time for celebration, reflection and gratitude Well deserved: AMA (WA) President Dr Richard Choong with 2012 AMA (WA) gold medal winner Kenric Smith. Solemn oath: The graduands of 2012 take the Physician s pledge. Packed house: The Drill Hall was brimming with graduands from the Schools of Medicine, Law and Physiotherapy as well as family and well-wishers. 14 MEDICUS February

17 UND GraDUation In December 2012, 102 students from the University of Notre Dame s Medical School in Fremantle stood up and made the Physician s Promise. As they solemnly vowed to dedicate their lives to the service of humanity, practice their profession with conscience and dignity and always consider the health of their patients first, Western Australia s newest doctors came to be. The Graduation ceremony, which was held at the campus Drill Hall, was preceded earlier that week by a mass at St Mary s Cathedral and the Year 4 Prize Giving Ceremony. Following the conferral of awards at the Drill Hall, speeches were in order. In her address, UND Vice Chancellor Professor Celia Hammond reminded the graduands they were entering a profession that was respected and held in awe. But she advised them not to allow hubris to interfere with their goals. The Valedictorian speech was delivered by Kenric Smith, winner of the prestigious 2012 AMA (WA) Gold Medal as well as a clutch of other prizes. Looking back on the past four years, Kenric fondly recalled the many trips he and fellow classmates made to the Wheatbelt and the Kimberley regions. He quipped about how they would introduce themselves as student doctors as opposed to the less impressive-sounding medical students. His vote of thanks included the wonderful staff at Notre Dame, the students mentors in the workplace and their families. On a personal note, Kenric thanked his parents, his wife and their baby daughter who was born just two days after mid semester exams. Thank you for the sleepless GraDUating Class Prize Winners The Australian Medical Association (WA) Prize: Kenric Smith The Bower and Sherrard Honours Research Prize: Claire BertenshAW The Peter Anderton Memorial Prize: Silje Laskowski The Chandraratna Family Prize in Medicine: Kenric Smith The School of Medicine Medal: Keith Potent Personal and Professional Development Prize: Claire BertenshAW General Practice and Primary Health Care Research Award: Maeve Kiely The McNulty and Heyworth Prize: ABDel Ghobrial The Open Medicine Clinical Audit Prize: Clara MaraiS and Darren KarADimos The Notre Dame School of Medicine Prize for ENT: Maeve Kiely Grand: St Mary s Cathedral proved a fitting venue for the mass, which was held to commemorate the graduation. nights, dirty nappies and your award-winning smile, he said. Kenric went on to remind his fellow graduands that the future ahead was an exciting one. You are now part of this profession and entitled to all the benefits associated with receiving this honour. It is perhaps fitting that he chose to close his speech with the words most often attributed to American poet Ralph Waldo Emerson: To laugh often and much; To win the respect of intelligent people and the affection of children; To earn the appreciation of honest critics and endure the betrayal of false friends; To appreciate beauty, to find the best in others; To leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; To know even one life has breathed easier because you have lived. This is to have succeeded. The Fremantle Heart Patients Support Group Prize for Medicine: Kenric Smith The Notre Dame School of Medicine Prize for Surgery: Silje Laskowski The Dr Wally Thompson Prize: AnnaliSSe WilliAMS The Notre Dame School of Medicine Prize for Musculoskeletal Medicine: Renee Berry The Sweetman Family Prize: Kenric Smith The Notre Dame School of Medicine Prize for Palliative Medicine: Claire Bertenshaw The Dr Mark Rooney Memorial Prize in Psychiatry: Danielle Scoones The Dr Moya Wood Rural Practice Prize: Kenric Smith The Notre Dame School of Medicine Prize for Intenstive Care: Kenric Smith The Noel Dougan ANZSGM Prize for Geriatric Medicine: Claire Bertenshaw Dean S LETTER OF COMMenDatiON RECIPients Claire Bertenshaw Mardi Eastwood KATherine Hooper Maeve Kiely Silje Laskowski BenjAMin levy Ruth Payne MonicA rikard-bell Kenric Smith Amy Stokes Rebecca Vernon February MEDICUS 15

18 UND GraDUation Pic: Phillips and Father Photography and Framing Kathryn Algie Syed Ali Shauna Beech William Begg Jeremy Bennet Renee Berry Amy Bicknell Kelly Brown Megan Carroll Amanda Choong Marko Cvetkoski Andrew De Groot Mathew De Piazzi Sajanie De Silva Shilpa Desai Anna Dillon Rachel Dwyer OAM Mardi Eastwood Steven Ellingworth Mary-Jo Flavel GRADUating WITH BAChelOR OF MEDICine/BAChelOR OF SURgeRY Kevin Fontana Elyne Fontana Peter Forrest Arjun Gandhi Madeleine Gayler Abdel Ghobrial Katherine Grove Hoda Hall Sanjeewa Hewavitharana James Hickey Erin Hughes Donald Hulme Deborah Hutchinson Claire Isaachsen Anastasia Isakova Samantha Johnson Alia Kaderbhai Darren Karadimos Bani Kaur Maeve Kiely Alexander Knight Matilda Kolandaisamy Monique Krestan Rex Chun Yeung Kwan Laura Lallenec Silje Laskowski Sonia Lavin Megan Lovesey Andrew Luc Clara Marais Scott Martyn Tracey McCosh Sally McLaren Ross McNaught Krupa Mehta Rhys Morgan Marian Morrissey Jonika Mosedale Jana-Lee Moss Irumini Muthukumarana Kimberley Norton-Old Ruth Payne Laarnie Pe Benito Andrew Porritt Nico Prasetyo Ramya Raman Hendry Ramly Monica Rikard-Bell Dougal Robertson Farrah Rodrigues Sergio Sara Danielle Scoones Samuel Shales Abhishek Singh Joseph Singh Alexander Sleeman Kenric Smith Devinda Suriyaarachchi Eleanor Teo Andrew Thomson Jennifer Truong Maria Kristina Rey Vanguardia Rebecca Vernon Elizabeth Ward Jill Watson Ruvani Weerasinghe Sheruni Wijesundara Hari Wimaleswaran Karen Wong Vaughn Zabala Gabriella Zawada BAChelOR OF MEDICine/BAChelOR OF SURgeRY (HONOURS) Claire Bertenshaw Sarah Bowler Emily Brown Sarah Grainger Anne-Marie Harrison Katherine Hooper Benjamin Levy Keith Potent Amy Stokes Annalisse Williams 16 MEDICUS February

19 1. UND GraDUation Dr Claire Isaachsen flanked by parents Dr Louise Farrell and Dr Eric Isaachsen. 2. Dr Joseph Aaron Singh with father Dr Hardeep Singh and mother Nenet. 3. Dr Abhishek Singh and wife, Dr Shriti Singh. 4. Dr Arjun Gandhi with mother Ashima and grandmother Vidya. Father, Dr Ajay Gandhi was attending Arjun s sister s graduation on the east coast. 5. Dr Monica Rikard-Bell with parents Dr Delma Mullins and Dr Mark Rikard-Bell. 6. Dr Maeve Kiely with parents Patricia Kiely and Dr Dermot Kiely. 7. Dr Gabriella Zawada with mother Prof Gill Lewin, father Marek Zawada and sister Dr Katya Zawada. 8. Dr Kenric Smith with wife Marilyn and daughter Evangeline. 9. Dr Laura Lallenec with mother Jean Sloan. 10. Dr Ross McNaught with parents Dr Carol McGrath and Bruce McNaught. February MEDICUS 17

20 TOMorroW S HEALTH The future of Hospital Design An effective blueprint would need to carefully balance local priorities, predict the likely and acknowledge the unknown, says Morag Lee Hi-tech: With technology flourishing, items once considered a futurist vision are becoming operational realities. Previously in this column, health care professionals have discussed the likely future direction of their particular clinical services and acknowledged the ever-shifting face of health care delivery. All service improvements need to be supported by a suitable built infrastructure and as such, our health care facilities are changing to accommodate these developments. In addition to specific service changes, there is also a number of long-term global trends that is beginning to affect the health care delivery environment. DECENTRALISATION OF CARE DELIVERY: Perhaps the most significant change in recent years is the move to a more community-based delivery model as seen in the health care systems of Europe, the US and Australia i.e. taking the care to the patient as opposed to admitting them into the hospital environment. The built outcome of this scenario is a wider and more diverse range of localised health facilities, and a change in the traditional role of the hospital. The major inpatient facility now treats patients who are older, more acute with complex problems and multiple comorbidities, acting as the virtual hub to the care network and a training centre for outlying services. So with its adjusted roles and responsibilities, what will our hospital of the future look like? Again there are uncertainties but a number of trends are redefining the design of modern hospital developments. TECHNOLOGY: As well as enabling the development of the health care networks through electronic medical records, telemedicine, remote diagnostics systems etc, technology will play an important role in shaping the future of the hospital facility itself. We are already seeing more extensive usage of robotics in support services such as receipt and distribution, catering, pharmacy and pathology. These systems are undertaking repetitive labour-intensive roles and minimising human error, and their usage will only increase. We are beginning to employ building management software, maintaining and monitoring the built environment, controlling lighting, heating and critical-to-life systems as well as ensuring our climatic goals are being achieved. More technology-based systems are also being utilised within the actual patient care delivery field. Already in test sites in the US, health care providers are exploring the opportunities offered by innovations such as wireless vital signs monitoring, mobile patient tracking surveillance units, and telepresence robotic surgical devices operated through Ethernet or radio links. Items once considered a futurist vision are becoming operational realities. These changes may seem to offer a slightly sterile and inhumane future for our hospital buildings but at the same time as technology is flourishing, we have another major trend providing a very different focus for the hospital designer. 18 MEDICUS February

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22 TOMorroW S HEALTH Beyond the functional: Hospital architects are looking to create environments that attempt to respond to the emotional and psychological needs of their users. EVIDENCE-BASED DEVELOPMENT OF ENHANCED ENVIRONMENTS: Over the last years there has been a move to collect, review and publish empirical data that proves scientifically the benefits of developing positive health care environments environments that look beyond the functional and attempt to respond to the emotional and psychological needs of their users. Health care architects have always been aware of the benefits offered by features such as access to external views and natural daylight, the use of colour and art and positive external environments. We have attempted to deinstitutionalise the clinical environment while maintaining the function requirements. However it is often difficult to support desirable design outcomes with potential cost implications without a demonstrable balancing benefit. Evidence-based design is attempting to provide quantifiable business case benefits to support qualitative improvements in the health care environment, and health care providers are beginning to recognise that this is no longer a nice to have but rather an essential ingredient in the development of their facilities. ADAPTABILITY: Other global issues currently affecting hospital solutions range from items as diverse as the potential for terrorist attacks and dealing with major pandemics to climatic change and sustainability concerns and workforce availability. So, with so much ongoing change in a single system, how can we predict what our hospitals will look in 20 years time let alone within current building redundancy expectations for our larger facilities of 50 years plus? The only thing we can be certain of is change, which has long been accepted in the health design industry with many different strategies being adopted to deal with the unknown. Hospitals have been developed with standardised flexible templates, interstitial floors and expansion chassis all in an attempt to extend the life of the hospital while accepting that change during that lifespan was an expensive inevitability. Perhaps we need to look at more radical approaches. Do our hospitals need to have a life expectancy of years? Are there methodologies that make a 20-year life span more cost effective than the obligatory 20-year remodelling exercise? 20 MEDICUS February Should we be developing a disposable hospital or alternatively, a sustainable building with inherent redundancy strategies i.e. deconstructing the hospital to allow the release of areas no longer appropriate for hospital use to be given over to other functions? In summary, is it possible to develop a single vision for the hospital of the future, based on these trends and accepted future clinical models? I would suggest not. Whilst any planner or designer working in this field should be aware of current global trends, emerging technologies etc., they must also accept that the hospital facility should be a building in context responding specifically to the environment and population in which it is set and as such, to adopt a generic model would be inappropriate. It is fair to say, as discussed previously, that it is likely that our hospitals will become more acute in nature; that technology will take a much greater role in all aspects of patient care; that new design and build methodologies need to be explored to ensure the facilities long-term viability; and that our hospital environments need to sensitively recognise that they are supporting a temporarily vulnerable sector of the population. However the relative importance placed on these trends on any particular scenario will be dependent on a raft of local priorities geography, demographics, social context, epidemiology, staffing concerns and of course not least of all, cost. The challenge of the hospital procurer/designer is to carefully balance all these issues, avoid adopting flavour of the month solutions and develop a facility which is not only of its time and place, but looking to its future predicting the likely, but also acknowledging the unknown. Morag Lee is a senior medical facility planner with Silver Thomas Hanley, and is currently leading their health care design team in the development of the new Fiona Stanley Hospital. Ready to change: Today s hospitals have been developed with standardised flexible templates, interstitial floors and expansion chassis all in an attempt to extend the life of the hospital.

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24 COVER StorY STATE ELECTION 2013 Health wins top VOTE The AMA prevails, again, in making Health the No. 1 issue in the race to the ballot box It seems like a lifetime ago. In reality it was only a few months. The word towards the end of 2012 was that the 2013 State Election campaign would be about law and order, perhaps road congestion and some of the more contentious State Government building projects such as the football stadium. It would be about issues of lifestyle, roads, rubbish and the usual blame game in politics. Any suggestion that the campaign would be about health and related issues was met with derision, dismissal and a desperate heavy, audible sigh, as though to suggest such a thing was only demonstrating political ignorance. The State Government, so the theory went, would only have to point to substantial increases in health spending over the last four years and they would win the argument. The theory continued that the Opposition would therefore avoid mentioning the issue they could not win on. Our view however, has always been that the additional spending was necessary to cater for the future of health services in Western Australia. The jump in health spending over the term was welcome but it was also vital. With the current economic boom on, it was appropriate that a slice of the additional revenue to state coffers should go towards such a key issue for our standing as a state on the national and the international stage. But our determination to buck convention and political theory has paid off. AMA (WA) President Dr Richard Choong s pledge, highlighted on the cover of December s Medicus, was a brave and bold statement. We pledge to make Health the No. 1 issue in the coming State Election Campaign. In the President s handwriting, this was not only a pledge by your Association, but it was also a promise. Not quite written in blood, but a firm and loud undertaking all the same. Our five key issues for the campaign Research; Mental Health Care; Capacity Issues; Health to be excluded from the State Government s efficiency cuts; and Rural Health Care were only decided on after careful research and debate within the AMA. Immediately it touched a nerve, not just with the media but also with members. As one caller said, this should be our approach every election draw a line in the sand for all political parties to know exactly where we stand on the side of health. In an important contribution to the health debate, The West Australian newspaper had a public opinion survey conducted by respected pollster Patterson Research Group on key issues for WA voters. This survey clearly showed a dramatic change in key issues through the eyes of voters. According to Patterson Research, the top two issues in July 2012 were Economic Management (23 per cent) followed by Power Prices/Living Costs (17 per cent). Health issues were of third importance, languishing on 15 per cent. By late December 2012, the most important issue in the lives and minds of voters was Health (23 per cent); followed by the issues of Transport and Economic Management (both 21 per cent). Interestingly, on the day of the WestPoll appearing, we received a call from one political party wanting to bring forward their meeting with the Association to discuss our election issues. Obviously, the poll results sharpened the mind politically in a range of ways. Premier Colin Barnett defended both the Association s right to speak out on these issues and the Government s health record when he said on ABC Radio: The AMA and doctors are entitled to express their view as 22 MEDICUS February

25 COVER StorY any member of the community can. I d just say to the AMA, I mean step back a little bit and look. You ve had the biggest public investment in public hospitals in the State s history and WA has been acknowledged as having one of the best performing emergency departments in Australia. I m not saying it s perfect but it s a very good health system. And look, if anyone was ill or injured, I don t think there s a better place in the world to be in than Western Australia. (ABC Radio, 24 December 2012). When Health Minister Kim Hames was approached for comment about the AMA (WA) s key election issues, he spoke about previous campaigns by the AMA (WA). I think there s no question that their campaign had a significant effect previously and it was because and I m not just talking about under Labor government, under our government as well, we had serious problems with health. And, you know, I meet regularly, every month in fact with the AMA and talk through issues with them and the reality is that their two top priorities are also my top two priorities. So we re comfortable that we will have plans to address the issues that the AMA are concerned about because they re the same ones that we re concerned about. (ABC Radio 24 December 2012). Apart from front pages and strong radio and TV presence, your Association has had meetings with major political parties to discuss these issues and by the time you read this, would have held a forum on health issues to debate our issues publicly with Health Minister Kim Hames; Labor Party Health Spokesman Roger Cook; along with representatives from Greens WA. All members were invited to this event and as we go to print, the reaction from everyone was very positive. For those unable to make the event, we requested suggested questions that could be put to the political participants. The election will remain the AMA (WA) s major issue through until Election Day on March 9, This issue of Medicus contains more on the coming election, with contributions from the Health Minister and his Labor Party opponent. We make no excuse for making health, once again, the cover story of Medicus. February MEDICUS 23

26 COVER StorY Four years of gains, with more to come By Dr Kim Hames Minister for Health, Liberal Party (WA) Staring down the barrel of an election after four years of building the health system is a curious experience and not one I have done before as Health Minister. I don t know if, after March 9, the Liberal-National Government will have the opportunity to continue creating a health system that is the envy of the nation. Because although at times it s hard to believe, that is exactly what our health system is. We have come a long way. That said, I don t pretend the system is perfect and it feels like the work has only just begun. In terms of concrete advances, it s about a year since we started building the $1.2 billion new children s hospital and just over a year until we welcome the first patients through the doors at Fiona Stanley Public Hospital. These are part of a $7 billion capital works program which will upgrade, build or improve just about every hospital in the State by the time the election rolls around. Our next task is the $180 million redevelopment of Royal Perth Hospital to become a specialist 410-bed emergency and trauma centre, with capacity to grow into the future. Additionally, I opened the $54 million Comprehensive Cancer Centre during January, which is the first project started and completed during this term of Government and we ve poured the foundations out at the new Midland Public Hospital. In regional health, we just opened the new $170 million Albany Health Campus, construction is underway on the Busselton Health Campus and the $565 million Southern Inland Health Initiative has revolutionised health care in a part of WA that has long been neglected. For staff, since coming to Government we have increased our annual intern intake from 177 in 2008 to 300 State-funded places in An additional nine have been funded under an inaugural Commonwealth-funded program. Under this Government, we have offered internships to every appropriate In good hands: Health Minister Kim Hames wants the opportunity, once again, to plan for the future of WA s health. graduate of a WA medical school that has sought placement. Training has been supported by a $75 million package for a post-graduate program to produce 138 extra junior doctors by In terms of health care, we have the equal lowest average wait for elective surgery at just 29 days. Queensland is currently on-par with us but given the way they re travelling, we aim to overtake them soon enough. Once upon a time, our emergency departments were clogged as almost half the patients admitted through EDs waited eight hours or more for a bed. That number is now stable around 10 per cent again, the best in the nation thanks to the 4 Hour Rule Program. Former AMA (WA) President Gary Geelhoed published a paper in the Medical Journal of Australia which projected that this program saved 270 lives in It was the AMA (WA) that first highlighted the dangers of access block in the emergency departments, then sent a representative to accompany the Government to the UK to research the 4 Hour Rule program, and has consistently provided critical feedback to make sure we stay on the right track. Fremantle Hospital was named the best performing hospital for emergency access in the nation in an independent report late last year, with most of the top hospitals all being located in WA. Royal Perth Hospital had been top of the WA leaderboard during a big part of the assessment period, with Sir Charles Gairdiner Hospital not far behind, and Princess Margaret Hospital is one of the top performing children s hospitals in the nation. St John Ambulance has just recorded its best performance year on record despite facing an 11 per cent increase in demand and at times, severe ambulance ramping a symptom of a 24 MEDICUS February

27 COVER StorY health system facing increasing demand from an aging and growing population, with inadequate beds available until the opening of Fiona Stanley Public Hospital. On just about every parameter (with a few notable exceptions ambulance ramping is an ongoing issue), the public health system now is in better shape than it was four years ago. There are more doctors, nurses, and child health specialists and we have bolstered funding to programs such as Silver Chain and the Royal Flying Doctor Service. Of course, there is more to be done. Child health is still a major priority, along with indigenous health where huge leaps forward in things such as immunisation rates have been tempered by ongoing issues such as glue ear in remote communities. The Liberal-National Government is thankful every day to the health workers who have dedicated their lives to improving care to Western Australians when they need it most. But the work is not over yet. We have so many challenges ahead, not least ensuring a smooth transition to open services at Fiona Stanley Public Hospital and Midland Public Hospital, and of course, moving across all services from Princess Margaret Hospital to the new children s hospital. This will all occur during the next term of Government. Beyond that, we need to plan for the future by securing the future of King Edward Memorial Hospital, upgrade health services in Perth s growing northern corridor and of course, finish the $180 million redevelopment of Royal Perth Hospital By the time our projects are complete, we will have more doctors, nurses, ambulances, hospital beds and hospitals, GPs and child health services than we did when I walked into this job. I hope the Liberal-National Government has the opportunity to continue. Right priorities for a brighter future By Roger Cook Deputy Leader of the Opposition, Shadow Minister for Health, Member for Kwinana This election is about priorities, the right priorities. The Barnett Government has increased debt, slashed funding for services through efficiency dividends, and cut the public health system to the bone. Building projects in the city have been funded while services in the suburbs have been cut. WA Labor will focus on services, ensure that our hospital system is meeting the needs of our ageing and growing population and look after those who make it work our doctors and nurses on the front line. WA Labor, under Mark McGowan, shares the priorities of the AMA (WA) that the urgent needs of the WA health system are to respond to the crisis in our mental health system, expand the capacity of our hospitals, boost medical research, and grow the capacity of our hospitals. WA Labor will address these issues in the upcoming election campaign. The Barnett Government inherited a number of things Eye on the prize: Shadow Minister for Health Roger Cook wants the opportunity to sit in WA Health s hot seat - pictured here sitting on the chair in AMA (WA) headquarters commemorating his grandfather, Dr H.L. Cook s term as President of the Association in from the previous WA Labor Government a set of accounts the envy of the nation; the foundations for a new major tertiary hospital already paid for in advance; and a long-term vision for WA Health the Reid Review. The Reid review provided a blueprint for the future of our health system and, in some respects, the Barnett Government has continued WA Labor s plan. Western Australia has benefitted from the substantial re-build of WA hospital infrastructure over the last 10 years by both WA Labor and Liberal Governments. The Barnett Government, however, has simply not been able to meet the challenges of our workforce shortages or long-term health needs of our community. February MEDICUS 25

28 COVER StorY WORKFORCE: Health Workforce Australia has predicted that nationally there will be a shortage of 2700 GPs and over 100,000 nurses by This is on top of the disparities in geographical spread of specialists that see WA have just 8 per cent of the surgical workforce. These shortages, combined with the emerging crisis around the commissioning of the Fiona Stanley Hospital and our growing population, place the WA Health system at a tipping point. No hospital can function without dedicated doctors and nurses standing by the beds to care for patients. No Government can prepare for the long-term needs of our health system by ignoring the needs of its workforce. The WA Health system needs leadership in both the clinical and political domains if we are to attract young specialists, and drive innovation and reform in health. The political leadership cannot be maintained if the Minister is spending 50 per cent of his or her time on other portfolios. Health is not a part-time portfolio and the Barnett Government has lost its focus on health as the Health Minister is increasingly distracted by tourism industry concerns rather than the challenges of our health system. RESEARCH: We need to make our clinical settings rewarding and supported workplaces. Creating opportunities for young and emerging specialists to undertake research alongside their clinical work is crucial if WA is to attract and retain the best and brightest. Meeting the workforce shortages by boosting research opportunities will be a key focus for a McGowan Labor Government to ensure we have the health services our public so highly values. MORE BEDS, BETTER SERVICES: WA Labor, under Mark McGowan, will continue to expand and build our infrastructure in the regions and those parts of Perth experiencing high levels of demand. In , 649 patients were transferred from Joondalup Hospital. That number increased to 718 the following year and even more in Joondalup also has one of the busiest emergency departments in the country with 85,000 presentations in Consistent with the vision of the Reid Review, WA Labor believes that hospital care should be decentralised from the Perth CBD, and more aligned with where people actually live. We will invest in health in our northern suburbs. WA Labor will retain Royal Perth Hospital as a tertiary campus. The need to maintain beds numbers for our growing population and serve the inner city community makes this an essential part of our spread of bed numbers. REGIONAL HEALTH: WA Labor will spend a record $250 million on the Northern Health Initiative. We have already announced a $50 million redevelopment to more than double the size of the Newman Hospital. The Northern Health Initiative will also fund important services in the region in renal dialysis including more staff and a pilot program to test a mobile renal dialysis unit to allow people to return home to country for long periods at a time. A new 10-bed mental health facility will be built in Hedland (adding to the work of the previous WA Labor Government to begin construction of the Broome mental health facility), and the highly successful mobile Telethon glue ear service and prevention program will be extended to the Kimberley. WA Labor also understands that many patients who are coming to Perth are struggling to cope with the high costs of accommodation in the city. A WA Labor Government will spend an extra $3 million to assist PATS recipients with these increased expenses. MENTAL HEALTH: The report by Professor Bryant Stokes was a damning assessment of our mental health system and identified a critical shortage of mental health services in regional WA. Resources and service improvement must be brought to bear in this sector of the health system that provides care to our most vulnerable. Current facilities are stretched to capacity and mental health services need to be extended throughout Perth to areas of high demand. A HEALTHIER SOCIETY: While better hospital services are crucial, so are the primary and preventative health programs that help to keep people out of the health system. In 2011, WA Labor released the discussion paper, Growing Children Well. This policy paper will continue to inform our policies to have more Early Child Health Nurses engaged to deliver services to children in the early developmental stages of life. Preserving the budget for public and preventative health is important to continuing to improve our understanding of the health of our population. Research and resources must be focused on how we can change the attitudes and behaviour that are driving the growth in obesity and diabetes in our community, which is impacting on health and wellbeing. WA Labor has a vision for better priorities in Health for a better future. Continuing to make our hospitals and health the centre piece of our legacy, a WA Labor Government will continue to extend the principles of the Reid Review, build capacity in our hospitals and workforce, create more research opportunities, and increase mental health services. 26 MEDICUS February

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31 GP Supervisors a vanishing race by Dr Steve Wilson Chair, AMA (WA) Council of General Practice OPINION To quote NASA space officials: Houston, we have a problem namely the inadequately rising number of GP Training positions, too fast a rate of attrition at the outgoing end and a specialty still held in less regard than it should. Furthermore, even with the existing numbers of GP Registrars in training, we have a developing problem of falling numbers of GP supervisors to help train them. Where 25 years ago, more than 30 per cent of medical graduates went into family medicine, with modern graduates, frustratingly that is no longer the case. More graduate colleges and older graduands means more will head to the higher-paying specialties particularly procedurally-orientated specialties, where the financial return is higher. When I graduated 30 years ago, I had $79 in the bank, shared an old rental in Mosman Park, drove a 12-year-old Ford Escort, and, bought my jackets from Good Sammies. But I did not have one cent of debt. Modern graduates often finish owing in excess of $100,000 for their studies, and many will seek to clear that debt as quickly as possible, especially if they are older, married, have a family or want either of those now or soon. Not only are the raw numbers of GP trainees estimated to be inadequate, but changing work patterns, more parttime and female graduates, a desire for better work-life balance, and not to follow in the footsteps of their older colleagues, means it is quite likely we need 1.5 graduate FTEs to replace the GP of old. At the patient end of things, we have a rapidly ageing population of greater and greater medical complexity. We have been so successful at treating infectious diseases and reducing deaths from cardio-vascular disease, that people are living longer, especially women. Changing societal needs are seeing many older Australians moving into lifestyle villages, supported residential care, nursing homes, and communal lodge type accommodation. The GPs who serve those patients off-site are almost all over 40, and constitute now less than 20 per cent of the GP workforce. The average GP s age is just over 50 and they work over 40 hours a week on clinical work alone, let alone other commitments. The Federal Government views the efforts of these doctors as of little value and one only has to look at the Medicare Schedule patient rebate for these services to appreciate the Government s appalling failure to address this matter. Now, GP Registrars don t magically become cuttingedge GPs. Highly skilled GPs cannot exist without high quality training sites and GP Supervisors. And there lies the rub! A recent survey showed over a third of GP Supervisors was increasingly fed up and may give Registrar training away in the coming years. The causes for this are once again complex, but largely centre on the overall financial base for GPs. When it costs hundreds of thousands of dollars to run a practice annually and still deliver quality, comprehensive care, you just cannot keep absorbing the opportunity cost of teaching post-grads, and for that matter, undergraduates. The overall funding base in General Practice is largely dictated by clueless government policy, recurrently totally inadequate MBS indexation, ever-more-complex nonfee for service payments, reduced clinical time due to excessive red-tape and now, almost two generations of Australians (and 43 per cent of them on a concession card) with a sense of entitlement to be bulk billed, to name but a few. To compound this, senior doctors in retirement or semi-retirement have effectively been dust-binned by AHPRA and their skills lost to the overall teaching pool. GP medicine has in so many ways been reduced to a business/job not a vocation/calling where once we gladly gave back something to the profession and could afford to. Now many GP medicine has in so many ways been reduced to a business/ job not a vocation/calling where once we gladly gave back something to the profession and could afford to cannot afford to do it, financially or personally as teaching bites into private time as the chants for safe work hours and work-life balance ring out. In my view, GPs have the right to demand parity with other specialist doctors for teaching, with dedicated properly-funded teaching time which takes into account the huge infrastructural costs and workload demand. Minister Tanya Plibersek needs to realise that investing in even more GP training places and proper remuneration for GP supervisors is vital on all levels before it s too late, if not already. That investment must happen now. February MEDICUS 29

32 Moving to Best Practice, easy as Like eating brussels sprouts you know that changing your clinical software will be good for you but not something you want to face. Best Practice is different. Best Practice makes the changeover so easy you can try it out with all your practice data (the backup version of course) without committing. Sweet! We have MIMS Australia s most trusted drug database Support professionals who are truly supportive Speed and superior stability of 100% SQL performance Converting your data from MD2, MD3 and MedTech32 virtually automatic No ads, bolt ons or mixed file formats to compromise performance Great value subscription $948.75* for both Clinical and Management Discounts for practices larger than 4 Equivalent Full time GPs Half price for part time practitioners - $474.38* No downtime for updates or time-consuming maintenance More GPs voting for Best Practice with their feet *(includes GST) Tel: (07)

33 A new year, fresh challenges by Dr Cassandra Host Co-chair, Doctors in Training Committee new hospital year brings a lot of new challenges. There A are many new faces and we welcome the interns into the profession. It is always a reminder of just how daunting my first, day was and how much I have learnt since I commenced my first rotation in We need to remember patience and be supportive of our new colleagues as they make this transition. Moreover we need to make them feel welcome into a life-long teaching and learning environment. A new year can also mean a step up to a new role whether this is from RMO to Registrar or Registrar to Consultant (for the lucky few who have finished training). They experience different demands on time, workplace expectations and supervision is often equally as stressful as those first intern days. Without doubt, 2013 will bring new challenges. We are forever aiming to increase benefits for DIT members. Ongoing issues for DITs include: Specialist training placements Intern allocations and general registration HCN Job application processes Access to annual and study leave OPINION Access to part time work and workplace flexibility Patient examination policies Accommodation for doctors in rural areas Negotiations for the next Industrial Agreement. We welcome all DITs to become involved in the DIT Committee and share their problems, ideas and solutions. I also take this opportunity to say goodbye to Dr Dror Maor as Co-chair of DIT. Dror has been involved in the DIT committee for more than seven years and has been Co-chair since He has devoted countless hours of his free time in championing DIT issues and he will certainly be missed. I would personally like to thank Dror for his commitment, enthusiasm and wit as my Co-chair. Taking Dror s place is Dr Melita Cirillo. Melita has been heavily involved in the Committee and I look forward to working closely with her this Dr Dror Maor Dr Melita Cirillo year. Lessons learnt and remembered by Dr Maya Rajagopalan 2012 Intern at Royal Perth Hospital As I write this article my internship has wound to an end and throughout the corridors of Royal Perth Hospital, there are many new and unfamiliar faces. Mostly, these are our successors the new interns and it made me remember this time last year. It was my first day as a doctor and my first at RPH. Looking back on my internship, there are a few lessons that I have learnt. First, the most important thing to remember is that your patients rely on you to do the best job possible. Also, taking a few extra minutes to make patients feel at ease is one of the most significant things you can do. The second thing I found is that it takes time to adapt to new surroundings. Medical school does not prepare you for everything in the hospital; it cannot. It took a couple of weeks to settle in and know my place on the team. At times, I found it unnerving to manage the various personalities of the ward and to gain their respect. But I realised the more they respect you, the more they trust you. Every department has something new to teach you and a new way to inspire you that s the fun part about the job. Then there is the day-to-day work itself. It often felt that all we were doing was tackling endless piles of discharge letters (which was true a lot of the time). It helped to remember that the letters are the only way to ensure follow-up plans are established for your patient. Taking ownership of a patient s health care is your duty as an intern you are the link between the treating team, the ward staff, the patient and their loved ones. Finally, having good relationships with your colleagues is the best way to get through the internship year. Never underestimate how cathartic venting about your day over a beer at Milligans can be. I quickly realised being a doctor wasn t just a job, it was a lifestyle decision that influenced every part of my life. Now it s onto residency, which continues for me at RPH. Today, I feel I have more confidence to deal with difficult patients and know where my boundaries lie. Of course, mistakes will be made, but hopefully not the same ones as before. It is, I think, a resident s task to help guide the new interns. Certainly, we will still find things shocking; we will still feel emotions we haven t felt before; and each day will continue to be a learning experience. This past year at RPH has been an exponential learning curve, and I believe it was the best place where I could have started my medical career. I want to thank everyone who has played a part in my wonderful year and I look forward to the dynamic time in WA Health that awaits us all. February MEDICUS 31

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35 OPINION Rural education adds real world edge by Lee Fairhead President, Western Australian Medical Students Society Positive outcomes: The Rural Clinical School of WA in Kalgoorlie. As I write this article, I have just received my results for the past academic year, completed in Kalgoorlie through the University of Western Australia s Rural Clinical School (RCS). And, as you read this article, a brand new cohort of fifth years from UWA and third years from the University of Notre Dame are settling into their new homes and communities for the eleventh year of the RCS program. The RCS is unique in that it offers students the opportunity to move away from Perth for a year and live and work in a rural community anywhere from Kununurra to Esperance and Albany to Narrogin. Students are taught by local GPs and specialists with the same curriculum albeit with a different focus as the students who remain in the city. Students are not just exposed to a new clinical environment but also to the lifestyle of a rural practitioner and to the varied, beautiful landscape of WA. Importantly, most sites also afford a unique exposure to rural and remote indigenous communities, their culture and health needs. WA s RCS program is undoubtedly one of the finest in the country and its students consistently finish having made a positive impact on their community; and it on them. The aim of the RCS program is obviously and openly to encourage positive rural experiences for medical students in the hope that they will return to work there, once qualified as doctors. There is clear evidence that this extended exposure to rural practice impacts positively on students and research continues to track their intentions and ultimate career decisions with regards to rural practice. Importantly though, the RCS experience plays an even wider role in ensuring that students receive adequate exposure to the realities of medical practice regardless of where they end up working. Understanding how simple things like referrals, transfers, follow-up and access to care for rural patients works in the real world means that we are well equipped to provide empathic care to rural patients in tertiary hospitals. In Kalgoorlie, we received hands-on experience delivering medical care to people as far away as Warburton, Eucla, Mount Margaret and in the town of Kalgoorlie itself. We were also involved in public health campaigns around ear and eye disease, public initiatives around sexual health, transporting patients on the Royal Flying Doctor s Service, and research on the Western Desert Kidney Health Project. This clinical work was then balanced by participation in our own individual Community Projects; mine involving the Cancer Council of WA s Find Cancer Early Campaign. The vastness of our clinical exposure was only matched by opportunities within the community where we participated in sport, art, music, community festivals and general relationship building. This is not unique to Kalgoorlie, and truly defines the breadth of experience of most students. Obviously not all students can participate in the RCS program, but its example provides a great model for all students, medical schools and health systems. If we are to continue to serve rural communities with adequate health care, extended and positive experience in that setting is essential to encourage doctors to willingly relocate from the tertiary centres in which they complete their junior doctor years. It is also vital that these opportunities continue beyond medical school and into our careers as junior doctors and trainees. The backbone of the RCS program is strong teaching combined with administrative and community support this is essential to ensure students and doctors genuinely want to pursue their careers in rural areas. As the RCS program continues to grow, in age and breadth, WAMSS will continue to be a strong supporter of both the program and the students who get the special opportunity to participate in it. February MEDICUS 33

36 OPINION Over the past few weeks, the MSAND executive and some of the staff from the School of Medicine have been discussing the issue of student professionalism. I wondered where individual professionalism comes from and whether such a thing can be taught either by an individual s family or be part of a curriculum. I read some literature on the subject and found that research out of North America emphasised the importance of providing formal curricular teaching. But how do we teach students professionalism especially when it involves personal, behavioural and environmental factors, not to mention the fact that medical students all come from different familial and cultural backgrounds in which certain values have been embedded? The definition of medical professionalism can be subjective or it can be defined by an organisation, of which there are numerous definitions. Some people define professionalism as being punctual, being dressed appropriately and using appropriate language when communicating with patients and fellow colleagues. This is all important, but I think there is more to it than that. The General Medical Council s publication Good Medical Practice defined medical professionalism as providing good clinical care, maintaining good medical practice, teaching and training relationships with patients, working with colleagues, probity and health. 1 The Royal College of Physicians in London defined medical professionalism as a set of values, behaviours and relationships that underpin the trust the public has in doctors, with doctors being committed to integrity, compassion, altruism, continuous improvement, excellence and teamwork. a joint approach 2 Research by Vimmi to professionalism Passi et al found that the five main between staff and themes for supporting students is a way the development of professionalism in medical forward students were curriculum design, student selection, teaching and learning methods, role modelling and assessment methods. They concluded that the five areas help medical schools focus their emphasis and approach to developing professionalism. 3 The Notre Dame Medical School supports the development of professionalism in their medical students by selecting students through a process which includes a submission of a personal statement and candidate interviews. The Medical School is currently working with MSAND to develop a joint approach to professionalism, one characterised by: 34 MEDICUS February The pros of professionalism by Tahira Bhatti President, Medical Students Society of Notre Dame Development plan: Associate Professor Chris Skinner, Chair of Professional and Personal Development at Notre Dame. Responsibility and respect for self and patients Compassion Obligations to community and societal expectations Honesty, probity and autonomy Self awareness and reflective practice Humility, social justice and non discriminatory practice Care of students and colleagues. Associate Professor Chris Skinner, Chair of Professional and Personal Development at Notre Dame is aiming for the Medical School in future years to develop a range of PPD and professionalism initiatives. These will include reflective practice development, professionalism, integration of ethics into the PBL curriculum, personal development (emotional intelligence, health and well being, spiritual awareness), and applied actionoriented PPD research and new approaches to transitional stages in the medical journey. MSAND is also developing ways of incorporating an approach to professionalism into our current mentoring program. So, after my initial thoughts about professionalism and wondering if it can be taught, I haven t quite come to a conclusion yet. However, I believe a joint approach to professionalism between staff and students is a way forward and develops a greater understanding of the subject to eventually achieve a better result. References 1. General Medical Council. Good Medical Practice. London: General Medical Council: Royal College of Physicians. Doctors in society: Medical professionalism in a changing world. Report of a Working Party of the RCP. London: Royal College of Physicians; Passi V, Doug M, Peile E, Thistlethwaite J, Johnson N. Developing medical professionalism in future doctors: a systematic review. Int. J. Medical education. 2010; 1:19-29.

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38 ProFILE Paying it forward Eighteen months after settling into Government House, Malcolm and Tonya McCusker are as passionate as ever about giving back to the community, says Melissa Coci The rumour around town was that the Governor, Malcolm McCusker and wife Tonya were two of the nicest people you d ever meet. However, walking up the winding path towards the regal façade of Government House did little to calm my nerves. Luckily, I had a chance to collect my thoughts in the morning room as I was told the Governor was running late. I wondered which corporate heavyweight he had allowed to monopolise his precious time. Twiggy? Gina? A quick glance at the visitor s register revealed the guests identities representatives from Volunteering WA. In amongst the many organisations of which the McCuskers are patrons, one of the issues they are most passionate about is raising awareness of the dangers of youth binge drinking (when people aged drink alcohol to get drunk). The McCusker Centre for Action on Alcohol and Youth (MCAAY) was established in September 2010 in conjunction with Professor Mike Daube, Executive Officer Julia Stafford, and Information and Research Officer Hannah Pierce. It s not about banning alcohol, the McCuskers said, it s about sensible consumption. We re not against a glass of champagne, or a drink, said Mrs McCusker. The issue is young people are drinking to levels that are harmful. Five thousand people die each year as a result of alcohol and there are 80,000 hospitalisations. We always read in the paper that our emergency departments are overflowing, and there are not enough beds. If we could take out a lot of these alcohol-related cases, the hospitals would be freed up, she added. The McCuskers are also concerned with the other flow-on effects of youth binge drinking such as stunted brain development, family issues, the burden placed on police and abuse of hospital staff. Hospital staff and doctors report an alarming increase in risks to their personal safety, and assaults by alcohol-fuelled patients in the Emergency ward. 36 MEDICUS February

39 ProFILE It has been established that the brain continues to develop until about the age of 25, said the Governor. The problem with binge drinking in the teenage years is that excessive alcohol can adversely affect the brain s development. And, as Professor Fiona Stanley s research shows, excessive consumption of alcohol by pregnant women may result in foetal alcohol syndrome - a condition in the newborn child for which there is no cure, he added. Besides spreading awareness of the ills of youth binge drinking, the McCuskers are also reaching out to WA s youth with their new program, Kids Who Give WA. Mrs McCusker believes the time is right to teach our children the importance of philanthropy. We ve got a society where some people have a lot of money, and some children display a sense of entitlement, rather than sense of duty to their community. We want to imbue these young people with a social conscience, so that they are eager to give back, Mrs McCusker said. With Kids Who Give WA, Mrs McCusker said every primary school will be encouraged to develop giving projects. Though the program is being rolled out on a voluntary basis, the McCuskers say the overall response has been very positive. As an incentive, the McCusker Foundation is establishing an awards system, (with) a total of $50,000 to be divided up amongst the various schools according to how well they ve been giving, said the Governor. It is clear that the McCuskers value the spirit of giving and wish to pass this on to the WA community. This generosity is most evident through their work with the McCusker Charitable Foundation. The Foundation is designed to cut through the bureaucratic red tape associated with funding grants particularly in the field of medical research. This is something that struck me and Tonya for years, His Excellency said. All medical research establishments spend a disproportionate amount of time trying to raise funds to keep their research going. Unfortunately these grants are sometimes only, for say, a three-year period and as you know, this research can take a lot longer than three years. The McCuskers hope by streamlining the grant application process, they can also decrease the brain drain WA is experiencing. Some of our State s brightest and best scientists and medical professionals are forced to move to the Eastern states where funding is easier to obtain. We seem to be getting less and less of the National Health and Medical Research Council funding. Fiona Stanley (founding Director of the Telethon Institute for Child Health Research) and Jonathan Carapetis (current Director of the Telethon Institute) are spending 30 per cent of their time writing grant applications! You think they should be spending their time on finding out the causes of asthma and autism, Mrs McCusker said. Governor McCusker is halfway through his three-year term and admitted accepting the position wasn t easy. Ultimately, though the fact that the Governorship would help the McCuskers spread their message of the joys of philanthropy, proved the clincher. Mrs McCusker pointed out that the position brought with it the opportunity to meet many people and, hopefully to influence more people, to give back to the community. There are corporates which do show a strong sense of social obligation, and are giving but there is still much room for increasing the level of charitable giving by both individuals and corporates. It s important to note that we re not in isolation and are working with a great team of supportive people, community leaders, medical leaders such as Associate Professor Rosanna Capolingua, Professor Mike Daube and Professor Fiona Stanley. Echoing his wife s sentiments, Governor McCusker stressed that they were mere catalysts eager to help various groups and some very laudable people achieve their goals. If we can do that by assistance through Government House, that would be great, the Governor said. As I left the grounds of Government House I couldn t help but think of how little I give back to the community. Over the past few years I d somehow developed the mentality that in my current job serving the community, I already did enough. I had conveniently overlooked that I also got paid handsomely for this charity, thus negating its true purpose. One cup of tea with the McCuskers and I was a convert to their school of giving such is the power of two of the nicest people you ll ever meet. YOUth Binge DRinKing CONSUMing OUR COMMUnity A man who wears several hats, chief among which is Director of the McCusker Centre for Action on Alcohol and Youth (MCAAY), Professor Mike Daube agrees youth binge drinking is a mounting concern. Market research conducted by an independent market research agency for the McCusker Centre last year with a good size sample of around 1500 people, showed 94 per cent of West Australians are worried about young people and alcohol, and 98 per cent about alcohol and violence. This market research also showed very strong support for the kind of action recommended by groups such as MCAAY and the AMA, Prof Daube said. Problems around drinking by young people are not new but over the last two decades there has been an increase in binge drinking. Slightly fewer young people are drinkers but those who drink are drinking at younger ages and drinking more. In the two years since its establishment, MCAAY has made significant inroads into raising public awareness. Prof Daube said he was particularly pleased that the WA Alcohol and Youth Action Coalition, which he co-convenes with Professor Fiona Stanley, already has over 80 member organisations in WA. I have no doubt that the level of both concern and support for action is much higher than it has ever been, he added. February MEDICUS 37

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41 FOR THE RECORD Regional player enjoys variety job brings Dr Adam Coulson Director of Emergency Medicine, Bunbury Hospital Q: What inspired you to take up Emergency Medicine? As a Resident, I had the good fortune to work under some inspirational Emergency Medicine (EM) specialists at the Gold Coast Hospital in Queensland. In addition, I enjoy acute medicine (in all its guises), the variety and not knowing what each day will bring. Q: What is the favourite aspect of your job? I get a real buzz from doing the things only a trained Emergency Physician can do. This extends beyond the bounds of mere knowledge and procedural skill into the realms of subconscious critical reasoning. Q: If you could give Minister for Health, Dr Kim Hames some advice I believe the true efficiencies in health care will come from WA Health adopting best practice public health programs and practising high quality and safe Clinical Medicine all of which is enabled by high quality ICT. At times, I think politicians and the electorate underappreciate the sheer complexity of modern health care delivery. This complexity needs to be acknowledged and managed. WA has a great depth and breadth of health care talent that should be tapped to provide the solutions to our challenges. In response to requests for his portfolio, I d advise Dr Hames to ask: How will this assure or improve patient care in a costeffective manner? Finally this state has a real need to improve the health of indigenous Australians. The current situation, whilst complex, is an international disgrace. Q: The people you would most like to share a working lunch with and why? Tim Winton (to ask how he sees WA evolving during these boom years); Professor Fiona Wood (to find out how she has managed to lead the delivery of a world-class service in a challenging public health environment); one of the fathers of evidence-based practice in EM, Professor Jerome Hoffmann (for advice on service delivery); Socrates (for some timeless wisdom) and Winston Churchill (for a crash course in leadership). Q: What are the advantages of practising/living in a regional town such as Bunbury? Is there a downside? First, I am lucky to serve a community which is grateful for and respectful of the care it receives. I have had more Thank You s since working in Bunbury than I ever received in any other hospital. There is also a great collegiate atmosphere in the hospital and I am lucky to work with some excellent medical, nursing and executive colleagues. Another big plus is the South West itself this is a great place to live. I enjoy a short commute to work, live near the beach and can enjoy truly spectacular geographic surrounds. I suppose the only downside is the isolation from other parts of the country (and the world), which can make travel and access to events challenging. Q:Do you believe that Rural Health is receiving the recognition and funding it deserves from the Government? Every person has a right to best practice, timely and equitable EM care wherever they are in the State. Clearly it is unreasonable to place tertiary hospital resources in every country town but true EM needs are time critical and I believe, a health care right. To those of us who work in regional and rural health care, there are glaring inequities in EM service delivery when we compare ourselves to our metropolitan neighbours. I would ask that the Government (Federal and State) seriously consider this and engage with the clinicians and invest the necessary resources to deliver this care. EM clinicians need to be part of the solution too. In my opinion, some aspects of the current WA Health Code of Conduct and the associated bureaucratisation of health hinder the kind of robust public debate that leads to service improvement. Q: What would you tell a young doctor looking to practise in regional WA? Go for it! The recent investment and growth in teaching and training capacity in country health really does provide for a valuable training experience (without the metro fighting for patients phenomenon). For a doctor looking to enjoy an interesting case mix in a young, growing health service where they can truly impact change for the betterment of patient care then there are real opportunities in regional WA. Q: If you weren t a doctor, you would be A chef. As my waistline is testament to, I enjoy my food. Q: How do you unwind? At the moment I am running. I read Born to Run to hit the trails. The paradox is the waistline remains. Q: What s on your ipod playlist? EMA & EMRAP (familiar to all EM Physicians), The Rolling Stones, Adele and Amy Winehouse. That said, I have six kids and any time for true solitary relaxation is strictly limited. February MEDICUS 39

42 CLINICAL EDGE Bronchiectasis - the re-emergence of an old disease An Approach to Management By Clinical Professor Philip J Thompson Medical Director, Lung Institute of WA Bronchiectasis was first described by Laennec in 1819 and he implicated Tuberculosis and Pertussis infection in its aetiology. Although it was regarded as a common condition until the early 1960s, it has received little attention thereafter with many doctors believing it is no longer an issue. This is far from the situation and in the future we are likely to see many more bronchiectatic patients as whooping cough and tuberculosis continue to occur worldwide in epidemic proportions. THE NORMAL AIRWAY VERSUS THE BRONCHIECTATIC AIRWAY: The normal healthy airway consists of a ciliated epithelium with sub-mucosal glands, smooth muscle, nerves and vasculature. The airways are constantly exposed to particles, pathogens, and foreign antigens. To cope with this constant insult, the airway has its own complex and sophisticated host defence system consisting of mucociliary clearance and innate and adaptive immune responses. Impairment of this system (congenital, inherited or secondary to environmental insults) increases the risk of bacteria progressively colonising the airways and generating their own local inflammatory response. The resulting increased inflammation, mucus production and bronchial hyperactivity leads to a significant impairment of airway function and further damage to neighbouring healthy airways. EPIDEMIOLOGY: It is difficult to provide reliable data on the prevalence of bronchiectasis. In the underdeveloped parts of the world, it is extremely common and this is likely to be the case in our Aboriginal population. In the developed world, it is an increasing problem. In the US epidemiological studies have reported the prevalence to be as high as 2.72 patients per However since CT scanning is required to make the diagnosis, data is likely to significantly underestimate the extent of the problem. Last year was a record year for whooping cough in Australia (adults>children) and as such, we will see a surge in bronchiectasis patients in the years to come. PATHOLOGY AND CLINICAL FEATURES: In bronchiectasis there is structural airway wall damage, poor clearance of airway secretions and impaired host defence leading to irreversible dilatation of airways, plugging of airways, chronic inflammation, airway obstruction and bacterial colonisation. The associated clinical features are increased viscous sputum production, cough, bronchial reactivity, haemoptysis, and sinusitis. Sinusitis is extremely common and often underrecognised in these patients. Many patients are mislabelled as recurrent colds, asthma or COPD. Patients rarely have fever or systemic markers of infection. DIAGNOSING BRONCHIECTASIS AND ITS NATURAL HISTORY: Diagnosing bronchiectasis can be difficult in that it is not generally considered as a possible diagnosis and needs to be consciously considered as the symptoms overlap significantly with those of common airway diseases. Bronchiectasis, not infrequently, is secondary to other airway diseases and so any observed increase in symptoms is often assigned to the primary condition. Once the diagnosis has been entertained then CT scanning is required for confirmation but the radiological criteria for making the diagnosis seems to vary between radiologists. Conversely as CT scanning of the lung occurs more frequently in the population, we are seeing more patients with radiological bronchiectasis who are relatively symptom free. This raises important questions about the natural history of this disease and suggests that for some there is a latent phase between airway wall damage, bacterial colonisation, airway inflammation and symptoms. It is likely that many patients have a phase of recurrent airway bacterial colonisation and airway reactivity that are treated with antibiotics with subsequent patient recovery. However as time passes, these become more frequent and severe and then more entrenched. CAUSES OF BRONCHIECTASIS: There are many causes of bronchiectasis some of which are very common in our society and many that are quite rare (Table One). Common causes include whooping cough, pneumonia and cystic fibrosis. (Table 1) Common Causes of Bronchiectasis 1 Post infection: TB, Pertussis, Measles, Pneumonia 2 Allergic Bronchopulmonary Aspergillosis 3 Immunodeficiency states resulting in recurrent infections 4 Poor Mucocilliary Clearance immotile cilia syndromes 5 Aspiration airway wall damage 6 Idiopathic? CF(TR) heterozygotes 7 Obstructive airways diseases 8 Bronchial obstruction stricture/tumour 9 Structural Lung abnormalities congenital 10 Systemic Diseases Inflammatory bowel disease, 11 Connective Tissue Diseases, Yellow Nail Syndrome. 40 MEDICUS February

43 CLINICAL EDGE MICROBIOLOGY: In the early stages of bronchiectasis, organisms may be difficult to isolate or are those commonly found in the community such as haemophilus influnezae or pneumococcus. As the disease becomes more severe, and particularly if patients are hospitalised, more complex organisms such as pseudomonas dominate (Table Two). The spectrum of organisms colonising the airways reflects a Darwinian selection of organisms that can survive well in the human airway. Some of the adaptive survival mechanisms exhibited by these organisms include the ability to paralyse or bind to cilia, to inhibit secretory IgA and the capacity to form biofilms in the airways. Biofilms provide relative protection for bacteria from antibiotics. (Table 2) Most prevalent organisms isolated in bronchiectasis Haemophilus Influenzae Pneumococcus Moraxella Pseudomonas Nocardia Staph Aureus Non Tuberculous Mycobacteria None. Colonisation with Non Tuberculous Mycobacteria (NTM) represents a complex problem as it is often difficult to be sure as to the cause and effect relationship is it a coloniser or a pathogen in a given patient. This is particularly important as drug treatments are of long duration, costly, complex and not without side effects and have variable efficacy. This is particularly so in the immuno-compromised patient. If a patient has Pseudomonas or NTM, one should assume they have bronchiectasis until proven otherwise. resistance in patients with chronic bronchiectasis is a major issue that needs to be constantly considered, particularly for pseudomonas. Eradicating one organism increases the risk of it being replaced by another. Antiboitic side effects and the logistics of drug delivery are other important issues. Knowing which antibiotic to use, what dose, for how long, what delivery system and how many different antibiotics to prescribe all need to be constantly considered. If one can reduce the mucus content of the airway and reduce inflammation then it is much less common to see organisms proliferating and patients are generally much healthier. Inhaled steroids and beta agonists can help reduce inflammation and enhance mucociliary clearance. Physical exercise on a daily basis, practising airway clearance techniques taught by a qualified physiotherapist and the use of nebulised saline and/or mannitol are all useful approaches to reducing airway secretions. Sinusitis is extremely common in bronchiectasis and post nasal drainage of secretions is frequently misinterpreted as failed bronchiectasis treatment. Adequate nasal and sinus assessment and treatment are a fundamental part of bronchiectasis management. Some of the macrolide antibiotics are not only useful at reducing the common bacterial flora but also have an anti-neutrophil, anti-biofilm and anti-mucus production role. Six months use of a macrolide such as Azithromycin can have a major beneficial impact on the health of patients with bronchiectasis and significantly reduce their airway secretions. MANAGEMENT OF BRONCHIECTASIS: The aims of bronchiectasis management are to a) prevent the onset of disease, b) treat any reversible aetiological causes, c) treat acute deterioration, d) reduce chronic active disease, and e) prevent progression of the disease. Primary prevention revolves around public health education, vaccination and early treatment of predisposing conditions. It is important in bronchiectasis to treat the patient and not the organisms found in the airways. If a patient has increased symptoms and airways obstruction, then treatment is indicated (Table 3). Antibiotics clearly have an important role in reducing the overall organism load in the airway. The concept of totally eradicating organisms long term remains elusive. Antibiotic (Table 3) Features of Worsening Bronchiectasis Increased sputum, volume/viscosity Cough Features of Airways obstruction Breathlessness Haemoptysis. February MEDICUS 41

44 CLINICAL EDGE In patients who are chronically relapsing (>3-4 exacerbations per year) or who are clearly deteriorating radiologically or physiologically, then long-term antibiotics may have a role. This includes using tetracyclines, penicillins and inhaled tobramycin or colistin (Table 4). (Table 4) MANAGEMENT OF BRONCHIECTASIS PATHWAY A. Think could it be bronchiectasis 1. Recurrent colds, longer lasting colds 2. Chronic cough +/- sputum 3. Significant Sinusitis 4. DD chronic bronchitis/asthma/sinusitis. B. Obtain CT Scan of Thorax +/- Sinuses 1. Inform radiology dept. what you are looking for 2. Need to evaluate yourself (sometimes missed/ under-reported). C. Assess Cause, Severity 1. Previous Severe Lung Infection 2. Immunodeficiency 3. Cystic Fibrosis (sweat test) (genetics) 4. Cilial function (saccharin test/nasal brushings) 5. Autoantibodies 6. IgE/FBC/Aspergillus precipitins & skin test 7. Inflammation CRP/ESR/Complement 8. Detailed lung function 9. Microbiology (mcs/fungi/afb). D. Treatment and Management 1. Education about bronchiectasis 2. Sputum Clearance 1. Initial Exercise program 2. Physiotherapy appointment 3. Bronchodilator +/- corticosteroids 4. Immunisations 5. Advice on Rx of acute infections. E. Regular Review 1. Initially on a regular basis till stable 2. Then a minimum of annually (lung function) and possibly CT scan each three years. F. If fail to improve or frequent exacerbations 1. Azithromycin mg/week for six months high success rate 2. If 3-4 exacerbations per year then nebulised antibiotics may be indicated. WHAT THE FUTURE HOLDS? Primary prevention needs better public health measures and community education. There is a real need to find ways to diagnose bronchiectasis early and to have meaningful preventative strategies to limit progression to severe lung damage and colonisation. Finding better ways to suppress mucus production and to treat pseudomonas are high priorities. Currently we are on the cusp of seeing a much greater choice of inhaled antibiotics including inhaled liposomal ciprofloxacin and inhaled Aztreonam with early clinical trials appearing promising. The development of dedicated clinics and centres of excellence is the way forward as this will provide the critical mass of expertise required to deliver appropriate care. CONCLUSION: In bronchiectasis the key issues are to: improve Pertussis immunisation & TB treatment; think bronchiectasis and investigate appropriately; keep airways dry; treat organisms based upon the patient s clinical status; promote best physiotherapy techniques; consider using a six-month trial of Azithromycin and approach patients with a long-term preventative strategy in mind. Close up: A CT of thorax slice showing severe and extensive bronchiectasis. 42 MEDICUS February

45 AMA opportunities to save on your home loan. AMA members receive a discount of up to 0.85% on the standard variable rate for home loans, investment home loans, viridian lines of credit and portfolio loans. Based on the current CBA rate of 6.60%*, this represents an approximate annual saving of $4,250 on a $500,000 loan. *Rate as at 12/10/2012 For more information about the AMA / CBA Wealth Package, contact: Chris Kane at the AMA on or Melinda Walker at the CBA on or This exclusive offer is only available through the AMA (WA) and CBA Premier Banking. Commonwealth Bank of Australia ABN and Australian Credit Licence

46 NEW ZEALAND medical exchange program AMA Recruit is offering a unique opportunity for GPs to take part in a medical exchange program with a New Zealand partner. The program allows you to undertake a 6-12 month placement in an urban area in either the North or South Island of New Zealand. It provides career enhancement opportunities, a unique way to increase your medical knowledge and invaluable, highly regarded overseas experience. If you would like find out more about this exciting opportunity, forward your Expression of Interest to or call us at (08) to secure a place. We will also be holding information sessions for any doctors wanting more information about the program.

47 Dr YES Big days out DR YES Dr YES closed out the year with a successful trip to WA s Great Southern While the Dr YES team takes regular trips to visit schools in regional Western Australia, it s the big end-of-year trip that garners the most excitement and attention. November 2012 saw 19 medical students and four premedical undergraduates head for WA s Great Southern. This time around, the annual Rural Trip fit in a clutch of schools including Katanning, Narrogin, Denmark, Albany and North Albany Senior High Schools, Kojonup and Wagin District High Schools, Mount Barker Community College and Great Southern Grammar. Some of these schools had been visited during previous Dr YES excursions and the follow-up visits proved just as successful. Certainly, requests for follow-up visits demonstrate just how well the youth education sessions are enjoyed and remembered by teachers and students alike. The team also met with two former Dr YES co-ordinators Malcolm Franke and Kelvin Chan who were at the time undertaking their fifth year of studies in Albany s Rural Clinical School. Dr Yes Co-ordinator for 2012, Sophie Doherty said the feedback following the annual trip, had been excellent. Several new relationships have been forged with schools. Dr YES aims to maintain these and will work hard to revisit the schools, Sophie said. Dr YES visits a growing number of schools and students each year, and the program has continued to grow and develop since its beginnings. In reaching out to schools outside the metropolitan area of Perth, Dr YES is able to provide access to accurate and empowering information on health and health services to a wider group of young people. Adolescents in rural areas may otherwise not receive this information in such a Looking south: Some of the 23 Dr YES team members at the Gap in Albany. way that engages their interest and attention at an age when it is so important, and when they are at great risk of many health issues covered in the Sexual Health, Mental Health and Alcohol and Drug sessions. Dr YES aims to break down barriers of access to information on harm minimisation and primary health services. But if the Dr YES students contribute their time and effort in providing students with a new approach to health education, in return they receive so much more. These trips help us to expand our view as medical students by providing us with the opportunity to see new places and develop our skills in delivering sessions in different scenarios and circumstances, Sophie said. Our travels throughout regional WA have brought us in contact with so many different students and communities. It s interesting to hear so many different perspectives of health, to hear the various myths still entertained out there and to be asked so many different questions, she concluded. Connecting: The Dr YES medical students used skits and interactive presentations to get their message across. February MEDICUS 45

48 Annual Conference and Trade Exhibition 2013 PAN PACIFIC PERTH 23 and 24 March 2013 International speaker Clinical updates Hands-on learning workshops Paediatric case studies Networking opportunities HEAL TH Children of all ages health care across the continuum in rural communities C A RE Rural Health West Doctors Service Awards 2013 The Rural Health West Doctors Service Award ceremony will take place on Saturday 23 March 2013 during the Annual Conference and Trade Exhibition and will be presented by His Excellency Mr Malcolm James McCusker AC CVO QC, Governor of Western Australia. 46 MEDICUS December REgisTER February now

49 SNIPPET FiRST year NoTRe DAMe Medicine students receive traditional welcome broader understanding of Indigenous health and culture was at the centre A of a new initiative offered to first year Medicine students at The University of Notre Dame Australia s Fremantle Campus last month. Developed by the Fremantle School of Medicine s staff, the Toolkit program was launched as part of the new medical students orientation week. This was the first year that new students were formally welcomed by a traditional Smoking Ceremony and Welcome to Country, highlighting Notre Dame s commitment to honour the knowledge, the language, the traditions and culture of Indigenous Australians. We want to ensure that Notre Dame s future doctors recognise the importance of Indigenous health care in the wider community, said Professor Gavin Frost, Dean of the School of Medicine, Fremantle. The inclusion of these sacred welcome ceremonies is extremely important to our staff. They overtly support our commitment to graduate students who respect all people. In addition to highlighting the Indigenous curriculum, the Toolkit aims to promote the essential skills and knowledge required to successfully complete the four-year Bachelor of Medicine/Bachelor of Surgery (MBBS) program. Students participated in a series of experiential learning forums with a focus on philosophy, public health, Aboriginal health, biomedical sciences and research skills. Traditional ties: Whadjuck Ballardong Nyungar Elder, Marie Taylor, performs the Smoking Ceremony and Welcome to Country at Notre Dame s Fremantle Campus with assistance from first year Medicine student Aron O Regan. HeALTH issues linked to nearby liquor outlets People with more liquor outlets in their neighbourhood have higher levels of harmful drinking and worse mental health than those who live further away from such outlets, according to new research at The University of Western Australia. Co-author Associate Professor Lisa Wood, Deputy Director of UWA s Centre for the Built Environment and Health, said the study, which was recently published in the prestigious online US journal PLOS One, reinforced the WA Health Department s five-year plan for a healthier WA. One of the suggestions in the five-year plan is limiting the density of alcohol outlets, she said. We found that the average number of standard drinks per day and the rate of harmful alcohol consumption increased for each additional alcohol outlet in a neighbourhood. The researchers also found that the likelihood of being treated in hospital for anxiety, stress or depression increased as the number of alcohol outlets within walking distance (1600m) of home increased. While the association between alcohol outlet density and injury, crime and violence are well documented, this is one of the first studies internationally to specifically look at how this might impact on mental health disorders, Associate Professor Wood said. Study finds genetic collagen link to serious eye disease major national and international genetic eye disease research project A led by Australian researchers has identified a family of genes related to collagen that influence corneal thickness and disease risk. Winthrop Professor David Mackey, Managing Director and Chair of UWA Ophthalmology, said the finding was significant because a thin cornea was one of the risk factors for keratoconus as well as glaucoma, the second leading cause of blindness overall in Australia. A combination of these gene variants can result in a person having a thinner cornea and much greater risk of developing eye diseases, Professor Mackey said. He added while earlier, smaller studies had identified some genes for corneal thickness variation, the study published in the international journal Nature Genetics combined data from 20,000 people in Australia, Europe, North America and Asia in the largest analysis to date. These findings allow researchers to now target specific gene pathways involving collagen to help prevent and treat keratoconus and glaucoma, Professor Mackey said. Garden Week 2013: Garden lovers of all ages are in for a treat at Garden Week 2013 WA s premier outdoor event to be held at Perry Lakes Reserve in Floreat from April. AMA APPoiNTMENTS The Australian Medical Association (WA) has welcomed the appointment of Dr Kenneth Williams to the Anaesthetic Mortality Committee. Dr Williams was re-appointed for a period of three years, commencing 21 December In other movements, Dr Stephen Langford has been re-appointed as a member to the Fluoridation of Public Water Supplies Advisory Committee for a three year term that commenced on 22 October February MEDICUS 47

50 SUBMISSION DatES Medicus article submission dates for 2013 In order to distribute Medicus in a timely fashion, and to meet our commitment to readers, all article submissions are required by the following date: Issue Submission Date April 1 March 2013 May 1 April 2013 June 1 May 2013 July 1 June 2013 If you would like to submit an article for inclusion in Medicus please contact Janine Martin, in the first instance, at NOTE: These submission deadlines are for articles, classifieds and professional listings. For Display Advertisement timelines and submission requirements please contact Des Michael on (08) ESIA GP Educational Dinner BPPV Repositioning Manoeuvres Sudden Sensorineural Hearing Loss Bone Conduction Implants Paediatric Otitis Media Join us as we serve up the latest in ear health Ear Science Institute Australia is hosting its annual GP Educational Dinner on Monday 18th March at the UWA Club. This event is RACGP accredited. To reserve your place visit or call before 13th March MEDICUS February

51 going somewhere... Point yourself in the right direction when it comes to Travel Insurance. AMA Insurance Brokers can offer an Annual or Single Trip Policy to suit your needs. AMA INSURANCE BROKERS (08) Disclaimer: In preparing this information, AMA Insurance Brokers is not providing advice. It has been prepared without taking into account your personal objectives, financial situation or needs. Accordingly, it is important that you read the Product Disclosure Statement (PDS) of the actual provider carefully, and ensure that the PDS and the exclusions are appropriate for your business and personal needs. AMA Insurance Brokers ABN AFSL No

52 MEMBERS ONLY New members The AMA (WA) welcomes the new members who joined during December 2012 & January 2013 Kathryn Algie Tahir Babur Donna Bacon Berto Bauza Rodriguez Shauna Beech Han Beh Jeremy Bennet Sneha Bharadwaj Mitul Bhatt Naga Bolla Laura Bordoni Nathalie Brockman Kelly Brown Nicholas Bucknell Adam Cammerman Megan Carroll David Ching Jie Choo Paul Cohen David Cosford Corryn Craven Rachel Crawford Vanessa Culleton Aaron Cummings Helen Currie Mathew De Piazzi Phillip De Ronchi Romarna Dichiera Anna Dillon Sophie Dinnes Arosha Dissanayake Bonita Duan Jack Dulyba Andrew Duthie Rachel Dwyer Radhika Ellies Leesa Equid Robert Evans Muhammad Farooq Tiffany Foo Katherine Fuller Sarah Gane Dasun Ganhewa Peter Garnett Madeleine Gayler Abdel-Messiah Ghobrial Owen Gray Katherine Grove Rajitha Gunaratne Rachel Halls Pushap Handa Shane Head Chloe Heath Catherine Hercus Felicia Higgins Geoffrey Hillwood Rebecca Hogan Tabitha Holmes Benjamin Host Janet Hutchens Deborah Hutchinson Senthuren Isaac Claire Isaachsen Anastasia Isakova Claire Italiano Sumudu Jayasekera Samantha Johnson Matthew Jones Diana Jose Irwin Kashani Paul Khoo Ying Khoo Maeve Kiely Alexander Knight Wee Jin Koh Emma Lalor Silje Laskowski Kathleen Law Jasna Lee Marie Leknys Benjamin Levy Matthew Lewis Joel Yong En Lim Simin Lin Trent Little Andrew Liu Yee Lin Lui Ian Marcus Jennifer Martins Scott Martyn Maisie Maung Tracey McCosh Madeleine McLaren Ross McNaught Robert Money Jana-Lee Moss Khairil Musa Maliththa Muwanwella Kelvin Nathan Katharine Noonan Julia Norris Aine O Brien Jing Ong Yuni Ongso Tom Owen Ranjit Panda Ruth Payne Zelko Pecotich Adam Philipoff Shashi Ponraja Keith Potent James Preuss Sanjay Ramakrishnan Intan Ramli Hendry Ramly Saqib Rana Shoba Ratnagobal Kelly Ridley Farrah Rodrigues Johan Rosman Rebecca Ryan Stephanie Samuelraj Sergio Sara Danielle Scoones Dasha Simmonds Urvashnee Singh Raymond Sinnadurai Ben Sketcher Barton Smith Jemma Smith Sendhil Somasundaram David Somerville- Brown Jacqueline Soraru Emma Sorensen Peter Stone Jeremy Strahan Devinda Suriyaarachchi Andrew Swarbrick Victoria Swarbrick Lee Lee Tan Jen Min Tan Stephanie Tan Rachel Taylor Yuli Ten Eleanor Teo Phiyen Tran Celeste Trichardt Jennifer Truong Gina Tuch Maria Vanguardia Vanessa Verissimo Laurence Vogler Catherine Wallace Pavla Walsh Morgan Wang Elizabeth Ward Vida Wardhana Cory Watkins Jill Watson Ben Weber Casey Whife Stephen Whiting David Wicaksono Shanek Wickramasinghe Timothy Wilmot Hari Wimaleswaran Samuel Winfield Gemma Winkler Kanchuka Withanage Jian Lun Wong Karen Wong Elizabeth Woollard Bree Wright Bili Wu Gemma Yardley Zain Zaki Lindsay Zhou 50 MEDICUS February

53 the AMA Dr Tracey McCosh Intern Three weeks in as a junior doctor and I have found my new life worlds away from my life as a medical student. Each day I am confronted with new challenges and clinical situations. As I am still trying to find my place within the health care system, it is both an exciting and daunting time to be a junior doctor. I became a member of the AMA because I knew that it was an organisation that was well equipped and experienced in dealing with workplace issues if I were to encounter them. It is reassuring to know that there is someone to call who will support me and my rights. I also joined the AMA because of its strong role in advocacy. As we face greater student numbers and junior doctors in the public health care system, I wanted my voice to be represented by an organisation that has a strong focus on advocating for quality medical education and training positions. Not only does the AMA represent us, it provides opportunities for junior doctors to be involved in advocacy and health care promotion. I look forward to being an active AMA member in MEMBERS ONLY Members win for renewing subscription The Australian Medical Association (WA) would like to thank all those members who have renewed their 2013 membership subscription for their continued support. Members who renewed their subscription by 1 January went into a draw to win of exciting prizes such as ipads and travel vouchers. WINNERS LIST Dr BRUno PatROni Dr Roman MiKOsza Dr Thomas Ryan won an ipad won an ipad, and won a $2000 travel voucher. Renewing your membership is important to ensure that the AMA continues to advocate on your behalf on a range of issues including salary and conditions, workplace relations, medicolegal matters, health policy and public health. The AMA is the only organisation that effectively represents the interests and concerns of medical professionals from a range of specialties and disciplines and has the ability to represent the profession at the highest levels. If you haven t already renewed your membership, you can do so: Online at By phoning on (08) Faxing completed renewal form to (08) Posting completed renewal form to PO Box 133 Nedlands % COMPARISON RATE * RENAULT. ENJoY. Finance offer extended For a limited time. MEGANE HATCH FLUENCE SEDAN KOLEOS SUV LATITUDE SEDAN NO DEPOSIT REQUIRED PLUS $299 CAPPED PRICE SERVICING FOR 3 YEARS # The fun begins in your new Renault at 0% comparison rate finance with $299 capped scheduled servicing for 3 years before December 16. you ll also enjoy the peace of mind of a 5-year unlimited kms warranty and 24/7 roadside assistance. OffeR ends december 16 visit Melville ReNAUlT TOdAY. Melville ReNAUlT 164 LEACH HWy, MELvILLE 6156 TEL: DL13660 *Offer valid for approved applicants of Renault Financial Services (Australian Credit Licence Number ). 0% pa comparison rate for new or demonstrator Mégane Hatch, Fluence, Latitude, Koleos 4x2 and 4x4 vehicles. Finance term of 36 months; terms and conditions apply. Fees and charges payable. WARNING: This comparison rate is true only for the examples given and may not include all fees and charges. Different terms, fees or other loan amounts might result in a different comparison rate. Comparison rate for the purposes of the national credit code is based on a 5 year secured loan of $30,000, although these offers relate to a 36 month term loan only. Offer valid for all eligible models ordered by 16/12/2012 and delivered by 31/12/2012. Renault reserves the right to vary or extend this offer. #Scheduled services capped at $299 for 3 years or 45,000kms (whichever comes first) on new or demonstrator Mégane Hatch, Fluence, Latitude, Mégane Coupé-Cabriolet and Koleos diesel models only, and 3 years or 30,000kms (whichever comes first) on Koleos petrol models. Excludes Renault Sport vehicles. Offer based on standard scheduled servicing from new and normal operating conditions, and available on vehicles purchased by 16/12/ year unlimited kms warranty applies to Renault passenger vehicles from new excluding Renault Sport models. Demonstrator vehicles receive balance of new vehicle warranty.

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55 AMA IN THE MEDIA HAMES RULES HOSPITAL S BAD LUCK AMA (WA) President Dr Richard Choong said Dr Geelhoed was respected for his honesty and commitment. The West Australian 26 January 2013 MOSQUITO DISEASE RISK HIGH AMA (WA) President Richard Choong said state and local government have to do more to reduce the risks from mosquitoborne diseases. Dr Choong said all local councils should be supported with the funds and resources to get something done in reducing the spread. He said leaving the responsibility for spraying in the hands of local government was inadequate. Donnybrook Bridgetown Mail 22 January 2013 RESULTS STILL PENDING ON REGIONAL FIFO INQUIRY After 18-months, the results of a Federal Parliament Inquiry into FIFO in regional Australia have not been released. AMA (WA) President Dr Richard Choong said there was great disappointment in the medical fraternity about the lack of a report. Everyone rushed to get their evidence in and we are still waiting 18 months later, he said. This is approaching farce and if it takes too long to come out, it will be lost in the election campaign. Pilbara News, 16 January 2013 CAGE FIGHTING HEADS UNDERGROUND Perth mixed martial arts fighters fear the State Government s ban on cage fighting will push the sport underground. But AMA (WA) Vice President Dr Michael Gannon said the State Government had not gone far enough. It could ban all MMA fights because they had almost no rules, could result in serious injuries and had no place in a civilised society. The West Australian 14 January 2013 PM MUST PUT HEAT ON JAKARTA, SAY DOCTORS Perth doctors have demanded Julia Gillard phone Indonesian President Susilo Bambang Yudhoyono to urge action to stop the sale of deadly bootleg alcohol to Australian tourists, complaining the Government is not doing enough to prevent more deaths. AMA (WA) President Richard Choong said the Prime Minister should stand up and show leadership after the death of Perth teenager Liam Davies from methanol poisoning. How many people need to die or be maimed before something is done? How many travellers need to be injured before both Australian and Indonesian authorities decide action is needed? Dr Choong said. The West Australian 10 January 2013 DOCTORS CALL FOR ACTION ON POISONING WA doctors want the Federal Government and Australian Federal Police to intervene and insist that Indonesian authorities do more to outlaw lacing drinks with methanol. AMA (WA) President Dr Richard Choong said given the foreign aid Australia gave Indonesia, it was important to add that serving methanol to tourists in drinks be treated as a serious crime. Feeding someone methanol, which is a poisonous substance, is a serious crime and we d like the AFP to work with their Indonesian counterparts to stop this behaviour, he said. The West Australian 5 January 2012 WESTERN AUSTRALIA S DEFINING MOMENTS WA risks dumbing down its doctors and getting the embarrassing reputation as the dumbest State. AMA (WA) President Richard Choong lamenting the lack of research funding. The West Australian 4 January 2013 NO DOCTORS AT HOSPITAL The Barnett Government has no hope of providing a fully operational Fiona Stanley Hospital any time in 2014 because no doctors have signed up to work there, warns WA s peak doctors group. AMA WA President Dr Richard Choong said he had been amazed at the slow pace of development at the flagship hospital in Murdoch, in terms of getting medical staff and information technology. So there s no hope, with what s happening at the moment, of delivering a fully and properly staffed, fully operating hospital at any time in 2014, which was supposed to be the year it officially opens and operates, Dr Choong said. Sunday Times, 30 December 2012 WA HEALTH CHIEF CALLS IT A DAY AMA (WA) President Dr Richard Choong said the public sector would miss Mr Snowball. However the really heavy lifting the successful equipping, staffing and opening of Fiona Stanley Hospital has been left for his successor, Dr Choong said. The position of director-general in the health department is the most important of all public service jobs and we hope the new person will be chosen very carefully. The West Australian 18 December 2013 February MEDICUS 53

56 TRAVEL wake up Wake up and smell the bacon! There s much more to Transylvania than blood, gore and grisly tales, says Teresa Neale Vienna like: A view of the old town in Sibiu. 54 MEDICUS February

57 The imaginative writings of an Irishman who never visited Transylvania have dramatically sold short a land overflowing with history, culture and natural beauty. And importantly, the nosh there is also remarkably good. Snide celebrity chef Anthony Bourdain must have left his brain back in New York when he decided to base his 2008 television gastronomic exploration of this former Austro-Hungarian principality, on experiences such as a Halloween dinner at a Dracula-themed restaurant, while being guided by a drunken Russian. Bourdain should have quit trying to reinforce stereotypes about former Communist lands and Bram Stoker s Dracula, and instead enjoyed himself by feasting on more of the many varieties of cheese, dried and smoked sausages, vegetables, stews, soup, and most importantly, pork, in all its glorious succulent forms, whose flavour has nothing to do with the often strong-tasting meat available in Australia. The beer is also good, if you can find the local product, because the area now manufactures many foreign brands. Cities to visit include Sibiu, Cluj, Brasov and Sighişoara where the real Dracula, Vlad the Impaler was likely born. Let s get this Dracula stuff out the way early. Vlad, also known as the Dracul (the dragon or devil), was a Wallachian (southern Romanian) prince whom Stoker based his character on because of the prince s fondness for impaling enemies, such as invading Turks, on stakes. Among Romanian peasants, Vlad is mainly remembered as a prince who defended his people from foreign aggression, and vampires play no role in local culture. Sibiu, rightfully known as the friendliest city in Romania in travel books, which was the European cultural capital in 2007, is a great starting point for Transylvanian adventures. Resembling a mini-vienna, it was established in proximity of a Roman settlement called Cibinium, which was abandoned by those invaders with the rest of the area in about 270AD. Almost 1000 years old, Sibiu or Hermannstadt Hermann s city a name that its now primarily Romanian residents still proudly use in recognition of its long heritage, was once a Germanic citadel and sits near the feet of the spectacular Carpathian mountain range. The Germanic or Hungarian character of many of Transylvania s cities is due to the territory being settled in the 1100s by Saxons and Hungarians after the Romans left. Transylvania only joined Romania in 1918, after it was annexed from the Austro-Hungarian Empire. The Romans predecessors were a Thracian tribe called the Dacians, who lived in the area hundreds of years before the birth of Christ. Looking back: A stamp, circa 1976, printed by Romania shows Vlad Tepes a Wallachian prince on whom Bram Stoker based his character, Dracula. Must-see: Sighisoara Medieval City. TRAVEL Like other Transylvanian cities and towns, Sibiu s walled old town comprises cobblestone streets, Gothic and Baroque stone structures, many of which house bars and cafes, providing wonderful archaeological and cultural eye candy for a stroll on one of its many warm summer evenings. And cold and rainy weather also doesn t stop Transylvanians from socialising in their cities. It simply drives them into atmospheric venues such as centuries-old cellar bars, where, surrounded by beautiful stone walls, a cup of coffee, or a glass of tuica (pronounced tsuica) the colourless spirit Romanians distil from plums and other fruit, or perhaps a brandy, which Romanians make remarkably well, is available to provide warmth. Sibiu s basic but beloved and world-famous Crama (meaning traditional restaurant) National, is one such bar. You have to walk down stone stairs through a trapdoor style opening to enter the dimly-lit stone cellar, which is furnished with wooden tables and serves the best hot tuica and mulled wine in the city, which like everything in there is sold at incredibly cheap prices, even by Romanian standards. Homemade open sandwiches offered there such as bread spread with dripping, onions and paprika, or a mashed bean paste, are perfect to accompany a drink or two. But the city also has plenty of upmarket clubs, pubs and cafes, where visitors can sip a cognac or boutique beer in more western surrounds, with a little jazz or piano music, or can dance to the latest electronic music well into the next morning. Food and drink play a big role in the life of Transylvanians whether on the street where you can buy covrigi, a skinny version of the German pretzel, or Romanian doughnuts, called gogosi, filled with vanilla cream, chocolate or jam or in restaurants such as the aforementioned cramas, which serve big portions of typical Romanian dishes such as cabbage rolls filled with pork. For meat eaters, it is worth re-emphasising that the pork in Transylvania is fantastic in all forms, but smoked ribs in particular need to be sampled, whether barbecued or in soup. Transylvanians, like many other nationalities in the region and the Balkans, fend off hangovers by eating a tripe soup before heading home from a big evening out. The Romanian version, ciorba de burta, is very mild-flavoured and is very tasty, especially when eaten with sour cream and garlic essential accompaniments to many Transylvanian soups. February MEDICUS 55

58 FOOD Welcome to Fruit Camp by Sophie Budd Taste Budds, Chowing down on fresh fruit is a great way to beat the summer heat. But if the usual slice, dice and bite is failing to appeal to your inner gourmand, incorporate your favourite fruit into a sweet treat, a cold soup or even a fresh salad. Tropical fruit soups could be an interesting option. Try a cold cherry soup, but keep it light by using drained yogurt instead of the more traditional cream. A cucumber and watermelon salad teamed with finely-diced jalapenos and finished with generous splashes of lemon juice and hoisin sauce proves a fantastic pick-me-up. Fruit can also play a leading role in delicious desserts. Think refreshing trifles, blueberry pies, cherry cobblers or strawberry tortes. Two of my all-time favourite dessert recipes have fruit taking centre stage. And here they are for you to try while they re ripe for the pickin. Pear and Frangipane Tart Preparation and cooking time: 1.05 hours Makes: 1 large tart Ingredients For the shortcrust pastry: 125g butter Zest of ½ an orange 100g icing sugar 2 egg yolks A pinch of salt 2tbs milk 255g flour For the pears: 4 pears 1 bottle red wine Spices (cinnamon stick, cloves, star anise) 1½ cups sugar For the frangipane: 3 cups almond meal 1½ cup sugar 6 eggs 240g butter 6tsp vanilla extract 6tbs flour Method For the pastry rub together the butter, zest, icing sugar, salt and flour. When combined, add the milk and egg yolks. Combine well, wrap in cling wrap and refrigerate for half an hour. Remove, roll out onto tray, fill with baking beans and blind bake until firm. For the pears peel and place them into the poaching liquor. Poach with the lid on for up to an hour till soft. Place poached pears in the baked tart case. For the frangipane blend the butter and sugar first followed by all the other ingredients. Place over the poached pears and bake at 190C until the frangipane is firm in the middle. Ameretti Roasted Peaches with Zabaglione Preparation and cooking time: 30 mins Ingredients 2 ripe peaches, halved and stoned 5 ameretti biscuits, crushed 3 large egg yolks 1/8 cup sugar Method Place the peach halves on a tray and drizzle with a little sugar. Heat in the oven at 200C on full grill for 10 minutes, until peaches are softened. For the Zabaglione, you will need a pan of simmering water and a bowl that fits on top of the pan. In the bowl, put the egg yolks and sugar. Whisk over the simmering water until the mix becomes thick and fluffy. You can even add a swig of your favourite booze at this point - I love to add some Frangelico. To serve, put the peaches on a plate, crumble the amaretti biscuits over them and spoon the zabaglione over the top. This dessert is best served straight away so the peaches and sauce are still warm. 56 MEDICUS February

59 2.9% Comparison Rate º with added peace of mind #. Right now, along with a sensational 2.9 % finance rate º on Aurion and Camry ranges you can enjoy an equally impressive Peace of Mind Pack #. That s extended warranty, roadside assist and it starts at $29,990 * driveaway on Camry Altise. Plus, there s $130 capped price servicing so visit City Toyota today. TOYOTAT SERVICE E ADVANTAGE CAPPED PRICE SERVICING TOYOTAT FINANCE AD ANTAGE FLEXIBLE, LOW RATE City Toyota Perth 63 Adelaide Terrace, Peth,WA 6000 Tel: citytoyota.net.au MRB693 DL12195 City Toyota Nedlands 199 Stirling Highway, Nedlands, WA 6009 Tel: *Driveaway price shown includes 12 months registration, 12 months compulsory third party insurance (CTP), a maximum dealer delivery charge, stamp duty and metallic paint. Driveaway pricing applicable for private and ABN buyers on vehicles purchased and delivered on or before 30 June 2013 at participating Toyota Dealers. Please visit toyota.com.au/specialoffers for further details. Toyota reserves the right to extend any offer. Excludes demos. While stocks last. Offer not available in conjunction with other registered fl eet discounts or offers. º2.9% comparison rate available to approved personal applicants & a 2.9% annual percentage rate is available to approved Bronze & Silver Fleet & primary producer applicants of Toyota Finance for the fi nancing of current generation Camry, Camry Hybrid, Aurion & selected demonstrator models. Finance applications must be received between 01/01/2013 and 30/06/2013 and vehicles registered and delivered by 30/06/2013. Maximum fi nance term of 48 months applies. Conditions, fees & charges apply. Comparison rate based on a 5 year secured consumer fi xed rate loan of $30,000. WARNING: This comparison rate is true only for the examples given and may not include all fees and charges. Different terms, fees or other loan amounts might result in a different comparison rate. #Terms and conditions apply. Extended factory warranty expires 12 months from the expiry of the new car factory warranty or once your vehicle has travelled 100,000kms whichever occurs fi rst. Roadside assist expires 4 years from vehicle purchase date. The Peace of Mind Pack is valid on eligible Camry, Camry Hybrid, Aurion & selected demonstrator vehicles purchased and delivered between 01/01/2013 and 30/06/2013. Toyota Finance is a division of Toyota Finance Australia Limited ABN , Australian Credit Licence Maximum payable for Camry (post Nov 11 production), Camry Hybrid (post Feb 12 production), Aurion (post Feb 12 Production) for standard scheduled logbook servicing (normal operating conditions) until fi rst of 4 years or 75,000kms (whichever occurs fi rst), up to the fi rst 5 services. Excludes Government & Rental vehicles. Contact your Toyota Dealer or go to toyota.com.au/advantage for other exclusions and eligibility.

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61 Bacchus would have approved Having a large extended family, the Christmas celebrations this past December were repeated on four occasions. This writer obligingly attended all these gatherings, albeit with a certain foreboding. Attending one festive dinner may be enjoyable but repeating the process three times over is an entirely different matter. Christmas 2012, however, turned out to be a complete surprise. Not only was the food at each attendance spectacular, the choice of wines provided was superb. Gone were the same old labels and in their place was a rich vinous feast of varietals from around the winemaking world. The Champagne that caught my attention, and dare I say it, everyone else s was a family-owned operation Tribaut Champagne. Four generations of Tribauts have put their energies and passion into producing their impressive, refined and delicate Champagnes. Their Cuvée de Rene is aged six to eight years on lees and has developed into a considerably complex and serious wine. At the Christmas dinner, this bubbly impressed everyone and questions flowed thick and fast as to its origin and where it could be purchased. The gathering sat in silence, with the exception of children, listening to a family member describe the vineyards, the owners, the location of the vineyards and literally everything else one could want to know about a label that produces lovely Champagne. The vineyards are situated in the best locations between Montage de Reims and the Marne Valley which is very close to Epernay. Champagne Tribaut s vineyards are made up of 30 per cent Chardonnay, 40 per cent Pinot Noir and 30 per cent Pinot Meunier. This wine is fantastic with cheese and a perfect accompaniment with sea food. Speaking of bubbles, another gem that graced the Christmas table was the Adria Vetriano Prosecco from the Veneto region in the hills of Triviso, Italy. It has an attractive biscotti nose and a lovely bright, fruity palate with hints of melon and pear. This is excellent on its own but for an interesting twist, pair it with peach juice for a delicious Bellini cocktail. A classy wine to have when you don t want to break open One doesn t expect a the Champagne. One doesn t expect decent Chablis at the a decent Chablis at the Christmas table but Christmas table but when it is does appear, when it is does appear, never refuse. This was never refuse one of those occasions where a Chablis Premier Cru Cote de Lechet by Domain Sylvian Mosnier was served. The wine is greengold in colour offering a bouquet Backyard beauties: Mandalay Estate in WA s Geographe region is churning out quite a few vinous gems. WINE that s ripe with an almost creamy appeal on the nose and a palate concentrated with good weight and flesh, along with a very ripe finale. This is really a wine to enjoy on its own or with food. There were also a few surprises crafted by a vineyard called Mandalay Road in WA s Geographe region. The name evokes all things Kipling, the Raj and spice and it is named after the royal city in Burma, which was located at the foot of Mandalay Hill. Not being a fan of Australian Chardonnays, it was a real surprise to taste this very crisp Mandalay Chardonnay The floral bouquet is balanced by fresh fruit flavours of peach on the palate and a lovely acid balance. The wine went beautifully with the lovely sea food on the table and is also recommended as an aperitif. Mandalay also produces another gem, the Sauvignon Blanc, Semillon. Their 2012 is very good, pale straw colour and tinges of lychee on the nose. A lovely crisp, dry wine with passion fruit and lemon sherbet flavours. The wine produces a clean palate with lots of acidity and length to finish. Zinfandel has never been much cause for excitement from this writer s perspective. However, the Mandalay version and also their flagship wine, was a surprise. This is an opulent wine which exhibits true Zinfandel flavours. It displays a full sweet palate of prunes, dates and raisins with hints of pepper and cloves with a minty bouquet. The wine also has also gorgeous mouth feel of black fruit with beautifully integrated oak. Tannins are gentle and the flavours are persistent and long. This is definitely one that can be drunk now or you could cellar it for up to five years. Both 2007 and 2008 have collected awards. February MEDICUS 59

62 TECHNOLOGY Click and you shall find Getting that doctor s appointment needn t be an uphill task, says Amy Fey In recent years, we ve become accustomed to making flight and hotel reservations at the click of a mouse. Now, an Australian-first website has extended this concept into the realm of health care, giving users the ability to search and book GP appointments online. The website, healthengine.com.au lists registered GPs available appointments across Australia, including after-hours clinics. HealthEngine Director and AMA (WA) Council Member Dr Marcus Tan said it was hoped the website, which launched a year ago, would play a part in relieving the pressure on public hospitals. Hospitals we know, are incredibly busy and under a lot of pressure. A lot of patients who go there can t find a GP during hours, he said. What we are allowing patients to do is find a GP easily and also allow the emergency departments to suggest where the patients could go as a resource, he said. It s incredibly easy for a patient to book. It takes only a couple of minutes from finding a practice that you want to see, a time that you want to see them, booking the appointment securely and having the verification that you have got a confirmed appointment. There are now 300 doctors offices (100 Perthbased) signed up to HealthEngine, with more than 400,000 appointments and 30,000 bookings to date. Also, 3.5 million Australians use HealthEngine a year to locate health practitioners making it one of the largest consumer health sites in the country. Doctors who are new to the practice are able to get new patients and for any gaps that come up because of late cancellations, doctors are able to fill that quite quickly as well, Dr Tan said. The HealthEngine app for iphone has also proven popular, with the added option to geographically locate the nearest GP practice in the case of sporting injuries or the need to make an appointment out of your locale. Success story: HealthEngine is playing a part in relieving the pressure on public hospitals. (Right) Marcus Tan. While Australia has only just begun to realise the merits of hopping online to find a doctor and line up an appointment, the US was quicker off the blocks. Back in 2007, two fresh-faced McKinsey consultants and a technical guru launched ZocDoc.com a website to help patients find local doctors, read verified reviews and book an appointment via the free iphone and Android apps. Great idea: ZocDoc helps patients find local doctors, read verified reviews and book an appointment via the free iphone and Android apps. 60 MEDICUS February

63 TECHNOLOGY ZocDoc was founded by Cyrus Massoumi, Oliver Kharraz, MD and Nick Ganju after Massoumi s eardrum burst during a flight and he was unable to make an appointment to see a doctor for three days. Massoumi was exasperated by the fact that he could buy groceries online and even purchase an engagement ring, yet booking a doctor s appointment via the web wasn t possible. ZocDoc initially launched in the New York area, broadcasting available dentist appointments to its user base. It has since expanded to cover more than 1600 cities in the US and to include primary-care physicians as well as six specialties allergists/immunologists, dermatologists, ear-nose-and-throat doctors, ophthalmologists, obstetrician/gynaecologists and orthopaedic surgeons. ZocDoc sign-up for users is free, while doctors pay a subscription fee of US$250 per doctor per month. On average, doctors using ZocDoc see an additional 100 patients on a monthly basis. In our world, we know 20 per cent of patients cancel on doctors at the last minute, and for the most part these appointments are practically inaccessible to patients who may be seeking an appointment, Mr Massoumi said. In a changing of the guard, ZocDoc is eliminating a reliance on paper files, telephones and time for process innovation. Electronic records might not win doctors over in the short-term, however, booking more appointments and filling schedule gaps like never before just might sell itself in the long-run. TSHC0008A Refer your patients to the experts in paediatric audiology. Now open, the Bendat Parent and Community Centre is a hub for Western Australian children and the community. This first-class hearing facility houses five state of the art audiology booths and brings together GP, ENT and child health nurse services alongside our own specialist team. Full hearing assessments, including otoscopic examination, tympanometry, audiometry and speech testing, plus electrophysiological testing (infant diagnostic assessment) including Otoacoustic Emissions (AE), Auditory Brainstem Response (ABR) and Steady State Evoked Potential (SSEP), are available for children from newborn to 18 years of age. Call Telethon Speech & Hearing on (08) for a referral pad for your practice. The Bendat Parent and Community Centre is the final capital addition to Telethon Speech & Hearing s Wembley campus. February MEDICUS 61

64 DRIVE Big, bold, beautiful and very British! by Dr Peter Randell The romance of Bentley s Britishness first struck me in 1972 when I took home a very second hand R Type of 1949 vintage. It was a moment of temporary insanity, as the asking price of $1750 was about half my annual registrar s salary. I had been seduced by the smell of Olde English Leather, the gear selector by my right knee, the long aristocratic bonnet and the snooty flying B on the end of the bonnet. That British look and feel is still present in the 2012 Bentley Continental GT V8. The body is now a sleek, large two-door coupe, with 2+2 seating, which can cope with adults in the rear on shorter journeys. Seats are outstandingly comfortable, with in-built back massagers in the front and of course, they are perforated, heated and cooled. With full electric adjustability for the seats and steering wheel, a correct driving position is easily attained. The dash is a grand affair with air inlets operated by chromeplated pull stops resembling that of an organ, and chrome rimmed circular instruments. The passenger faces a turned aluminium dash, and the driver has drilled aluminium pedals. All very sporty, old chap, but does it go? How about 2.7 tonnes of metal and leather reaching 100kph in 4.6 seconds! That is supercar acceleration, and is only 0.3 seconds faster if you decide upon the W12 engine variant. That rapid takeoff is accompanied by a deep guttural growl as the 4 Wheel Drive system bites without any wheel spin. There is the slightest hesitation from the twin turbos until the 660Nm of torque builds up and 500 horses throw the car forward. Check those 21-inch mag alloy wheels, and you will see giant brake callipers in the same dragon red as the bodywork. They will ABS-brake this big Grand Tourer to a face-distorting stop in even less time than it took to accelerate. Highway cruising, however, is a near silent and serene affair, serenaded by a concert hall-like sound system if you wish. There are eight speeds in the box, and though I tried the tip-tronic shifter and the slightly ungainly looking paddle shifters, the auto won me over with its smoothness and intelligence. It is able to jump four gears if throttle settings so dictate. It also drops four cylinders out of the firing order when not required, running as a more economical V4. Trying to be a good corporate citizen, Bentley has claimed economy of 10.6L /100km, but my enjoyment of the car showed nearly twice as much 98 octane being used. Despite the size and mass with a rear view camera and full safety electronics, the Bentley is an easy car to drive, responding like a standard vehicle until shaken and stirred, when it will fizz! Body control can be enhanced by touching the screen 62 MEDICUS February

65 DRIVE and beefing the suspension up to a harder setting. Steering is accurate and my impression of a little softness in response was probably only a result of climbing out of a Porsche Carrera S the day before. The Bentley is a Continental Grand Tourer by design, not a race track prospect like its German cousin. Oh yes, didn t you realise? This British façade hides a good deal of German input these days, as the Volkswagen group bought Bentley, continued production at Crewe in England but incorporated technology from the vast resources of the VW group. There is also a tie-up between Porsche and VW, but I am not sure which is the tail, and which the dog. This twin turbo 4 litre V8 was developed with help from the Audi group who have a TTV8 in the Audi RS6 Both companies and we consumers are benefitting from this international cross pollination of ideas and engineering. The skill in marketing the various makes lies in maintaining the emotive perceptions of the brands. In the case of the Bentley Continental GT V8, that classy, suave British romance is alive and well. The recommended retail price is $468,930 due to extensive options fitted. The bare Bentley is $404,700 drive away. Vehicle supplied by Chellingworth Motors. 85% take home, enjoy flexible hours, less paperwork, & interesting variety Equipment Provided WADMS is a Doctors cooperative Fee for service (low Non VR access to commission). VR rebates. 8-9hr shifts, day or night. Bonus incentives paid. 24hr Home visiting services. Interesting work Access to Provider numbers. environment. Essential qualifications: Minimum of two Accident and years post-graduate Emergency, experience. Paediatrics General medical & some GP registration. experience. Contact Trudy Mailey at WADMS (08) F: (08) E: WADMS is AGPAL registered (accredited ID.6155)

66 AFTER HOURS Docs on patrol Volunteering at the Australian Scouts National Jamboree presented a unique learning opportunity, says Scott Sargent Team work: Some of the members of the medical team included (L-R) Dr Ray White (NSW), Dr Cynthia Marnane (Qld), Dr Scott Sargant (WA), Dr Steve Hambleton (Qld, Federal President AMA), Mark Davidson (medical student), Dr Alan Kirkpatrick (NSW), Dr Michael Rice (Qld), Dr Pia Carey (NSW), and Ms Pieta Griffiths (Qld). What do two Professors of surgery, a Professor of Paediatrics, a Rheumatologist, an ICU fellow, an ED fellow, three country GPs, two Fremantle Hospital residents, one dentist, five medical students, the Federal President of the AMA and 9000 smelly Australian teenagers have in common? They were all part of the 23rd Australian Scouts National Jamboree held in Maryborough, Queensland from January More than 11,000 scouts and their leaders from across Australia and from 14 countries around the world descended on Maryborough in the beautiful Fraser Coast region to Dream It, Live It at AJ2013. Scouts working in patrols of six had to organise their way around 10 days of activities that included climbing, abseiling, trade skills, exploring the town of Maryborough and water sports at Hervey Bay. Tent homes were set up at the Maryborough Showgrounds and Equestrian Centre complex, complete with communal dining tents, bush kitchens and enough portable showers and dunnies to give Kenny a nervous breakdown. All the while, the scouts were supported by a veritable army of adult volunteers. Any town of 11,500 people needs a full-time medical service. Dr Michael Rice (FRACGP, FACRRM) from Beaudesert, Queensland also a long-time Scout Leader took on the role of Medical Director for the Jamboree. He managed to recruit a stellar cast of doctors (plus the Freo residents and a few medical students) to assemble the Medical Centre, tend to the inevitable accidents, exhaustion, acute or chronic conditions and occasional dysentery that could result from so many people living and interacting in such close quarters. Dr Rice had planned for around 5000 First Aid attendances and around 2000 formal medical and nursing consultations during the Jamboree, as well as about 800 prescriptions through the onsite pharmacists and dental cases. He had overseen the establishment of a 60-bed medical centre to cope with the workload. Sometimes it is not the scouts, but the grown-ups who become ill and the scouts first aid training comes in handy, Dr Rice said. Federal AMA President, Dr Steve Hambleton, whose own children attended their first Jamboree, was suitably impressed by both the scale of the whole event and the number of significant individual contributions that went into making it a success. It is a privilege to volunteer to help out with such a worthy outdoor activity, fostering so many skills in our children, Dr Hambleton said. Scouting develops young people s character and turns them into better citizens. For my part, this was the sixth time I d participated in an Australian Jamboree my first as a scout was in 1992 in Ballarat. This, however, was the first time I had been a member of the medical team, having previously had roles looking after and supporting the youth members directly or contributing to the delivery of activity programs. As a doctor, we seldom see healthy young people who stretch Worn out: A scout suffering the side effects of too much fun being treated in the intensive rest unit Continued on page MEDICUS February

67 2012/13 AMA/PolICe Medical Identification Card Joint initiative of the AMA (WA) and the WA Police Service Assists in identification when travelling to and attending medical emergencies Assists in appealing traffic infringements incurred whilst travelling to a medical emergency Free to members To request an application package for the Medical ID Card telephone or The card is only available to financial members of the AMA.

68 OBITUarY/ AFTER HOURS Grand vision embraced challenges Mr John Andrew Rogers will long be remembered by the ophthalmic and wider medical communities of WA, says Dr Philip House Ophthalmology was but one part of John s fulfilling life, which rewarded his incisive and perceptive personality on many fronts. After a happy childhood in Geraldton, he joined the Australian Airforce in 1944 at the age of 18. A promising flying career was terminated by demobilisation but led to an opportunity to study Medicine at the University of Adelaide. A Diploma of Ophthalmology followed whilst working at Moorefields and the Eye Infirmaries of Norwich and Sussex in the early 1960s. Following his return to Perth in 1966, consultant positions at Royal Perth and Fremantle Hospitals and with the RAAF took John to prominence within Perth s ophthalmological circles. In these early years of his practice, he made the difficult transition to using a microscope rather than loupes to operate with. Soon after he became an early adopter of intra-ocular lenses, which revolutionised the patient s outcome following cataract surgery. His quest for this new knowledge base took him to many parts of the world where his skills where honed and new friendships were formed with the leaders in the field of that era. Time as chairman of the WA branch of the Royal Australian College of Ophthalmologists helped to consolidate his reputation. In addition to his specialist work, John served 16 years on the Board of AMA Services (WA), with five as Chairman. His broader AMA legacy was to develop the AMA services and make them more relevant to members. This time consolidated his standing as an astute contributor to the wider medical community. Always one to take on broader challenges, John as a 60 year old, added windsurfing to his considerable golfing skills and then took up tennis as a 70-year-old. On quieter Mr John Andrew Rogers Born: 3 March 1926 Died: 27 November 2012 weekends, he enjoyed the serenity of the Swan River and the Levantine charms of Rottnest Island off Fremantle s shores seen from his beloved powerboat, the Jeanie Deans. As a Grand Master of the WA Bridge Club, a member of the Weld Club, the University Club and the WA Historical Society, John found ample opportunity to engage his considerable intellectual strengths. A voracious reader, John s broad interests still afforded him time to use his perceptive understanding of the world to very successfully follow the stock market. John is fondly remembered by his colleagues in the ophthalmic and wider medical communities of WA. His wife Dorothy, partner Beverly and extended family of four children, five grandchildren and three great grandchildren mourn the loss of a man whose strong work ethic led him to achieve greatly in a wellbalanced life whilst inspiring others to do the same. Vale John Andrew Rogers! In writing this obituary, Dr Philip House acknowledges the contribution from the Rogers family and in particular, John s son, Clive Rogers. Continued from page 64 Docs on Patrol themselves beyond the limits of their endurance and present with complications of exhaustion as a result of quite simply having too much fun. Dr Rice et al coined the term Jamboritis Fantastica to describe the syndrome at the 2007 Jamboree in Victoria and it has stuck like undies to chafing. The opportunity to work so closely with such emeritus medical colleagues, nurses, St John Ambulance volunteers and paramedics, as well as a great range of people from all walks of life made for a very special learning opportunity in both multidisciplinary acute care delivery, paediatric and adolescent medicine as well as managing primary care and emergency presentations in a remote setting with limited resources. We will shortly be recruiting for medical staff to assist at the 16th Australian National Venture in South Australia 2015 (for 15 to 18-year-old scouts) and the 24th Australian National Jamboree in New South Wales in If it sounds like an interesting way to spend your study leave you are absolutely right. For the scouts that attended AJ2013 (and a lot of their parents), the experience of living independent of their parents in a supported, safe, fun and challenging environment is a life-changing one. For me, it affirms the satisfaction to be gained in helping people to get the best out of themselves by helping them to manage their health. Plus, being part of such a large team of people, young and old alike, working together with common purpose is rewarding enough to get me signed up again. So, what did you do with your study leave? 66 MEDICUS February

69 The TDL team were a delight to deal with from start to finish. They delivered a magnificent garden that truly compliments our lifestyle. Dr Michael Aitken Design + build + Maintain tim davies landscaping (08)

70 Member Benefits In addition to the valuable services the AMA (WA) provides members, the Association also secures significant savings with a host of exclusive benefits. For more information, visit BMW Corporate Program The BMW Corporate Program will provide you with the following benefits when you or your spouse next purchases a new BMW or MINI from Auto Classic or Westcoast BMW including: Complimentary servicing for 4 years/60,000 km Complimentary use of a BMW during schedule servicing Preferential corporate pricing Reduced dealer delivery charges Corporate finance rates to approved customers. To find out more about exclusive offers for AMA (WA) members contact John Clarke BMW & MINI Corporate Sales Manager in WA at Auto Classic on (08) or Westcoast BMW on (08) Commonwealth Bank Commonwealth Bank is offering AMA (WA) members Wealth Package Plus, a complete package offering a range of premium banking, broking and investment products, including a discount of up to 0.85 per cent off the standard variable rate. Also available are significant savings on the merchant rates charged on credit and debit card transactions in your practice. 0.85% Mills Charters With Mills deep sea fishing 10% charters, you are booking a fishing experience of a lifetime. Captained by some of the very best fishing skippers in Perth, Mills charter boats leave Hillary s Boat Harbour, for fishing spots west of Perth, daily at 6:30 am (check-in time 6am). The boats return at 3pm to the Hillary s Harbour where the crew dish out the fish. Mills Charters offers AMA (WA) members an exclusive 10 per cent discount.* *Not valid on public holidays; Abrolhos Islands or Ocean Safari AQWA tours. Maitraya Luxury Private Retreat, Albany Idyllically positioned above the picturesque Albany coastline lies Maitraya one of Australia s most prestigious luxury retreats. With its private sealed airstrip, set among more than 500 acres of private and secluded bushland, Maitraya delivers to you the best of WA s renowned southern coastline, and offers breathtaking views of the picturesque Southern Ocean, nearby islands and surrounding mountains. The residence sleeps up to 16 people in complete comfort and includes eight spacious double bedrooms with king or two single beds, 11 bathrooms, an indoor heated pool, spa, sauna, gym and a large central glass-roofed atrium. Exclusive to AMA members, Maitraya is offering three midweek nights for the price of two (Tuesday Thursday). To book phone (08) or Thompson Wines Cardiologist Peter Thompson is delighted to invite you to try his range of wines especially the Locum Range and is offering a 10 per cent discount off the entire range, plus free delivery within WA to all AMA(WA) members. To view the entire range and find out more, visit WASO WASO (West Australian Symphony Orchestra) is Western Australia s largest and busiest performing arts company with a mission to touch souls and enrich lives through music. AMA (WA) members enjoy a 10 per cent discount off the cost of single reserve tickets to Masters and Classics series concerts. Visit the or call (08) for 2 10% 10% 68 MEDICUS February

71 On the TOWN To win a double pass to one of the following events, simply go to Entries must be received by 4pm, Wednesday 20 February. The Sweeney In cinemas 14 February Legendary Detective Inspector Jack Regan (Ray Winstone) and his loyal partner George Carter (Ben Drew) are old school crime fighters enforcing the law in a modern underworld. Armed and dangerous, the Flying Squad (rhyming slang Sweeney Todd) have their own unique way of operating, however, they always get the results. With a bank heist in progress and his old enemy making a re-appearance on the London crime scene, Regan will do whatever it takes to get the job done, even defying orders from his no nonsense Guv (Damian Lewis). Tearing up the streets of London, The Sweeney is a stylish, exhilarating action thriller directed by Nick Love (Outlaw), co-written by BAFTA-winning John Hodge (Trainspotting) and boasting a terrific British cast including Hayley Atwell (Captain America) and Steven Mackintosh (Underworld: The Rise of the Lycans). I Give it a Year In cinemas 28 February They always say that the first year of marriage is the hardest. So hard, in fact, that watching newlyweds suffer through things can be pretty fertile ground for comedy. I Give it a Year is a London-set romantic comedy from production house Working Title Films (Notting Hill, Bridget Jones s Diary, Love Actually) that charts the trials and tribulations of a young, mismatched couple during their first year of marriage. Featuring a brilliant ensemble cast, including Rose Byrne, Rafe Spall, Simon Baker, Anna Faris and Stephen Merchant, I Give it a Year is a modern and thoroughly enjoyable ride through love, chemistry and compatibility. Save your legs In cinemas 28 February Save your legs! is an inspirational journey from the heart of Australia, to the soul of India. It s the story of one man who refuses to lose his park cricket team to the realities of growing up. An uplifting adventure filled with comedy, cricket and Bollywood music Save your legs! is an odyssey from the suburbs to the subcontinent in pursuit of a lifelong dream. A Good Day to Die Hard In cinemas 21 March 21 John McClane (Bruce Willis) goes global. For the first time, A Good Day to Die Hard puts McClane on the international stage as a fish out of water in Moscow. The film introduces his estranged son Jack (Jai Courtney), an apple that has not fallen far from the tree, and who may even be tougher than his father. Despite their differences, they must work together to keep each other alive and keep the world safe for democracy. Directed by John Moore (Max Payne, The Omen). Broken City In cinemas 7 March In a broken city rife with injustice, ex-cop Billy Taggart (Mark Wahlberg) seeks redemption and revenge after being double-crossed and then framed by its most powerful figure, the mayor (Russell Crowe). Billy s relentless pursuit of justice, matched only by his streetwise toughness, makes him an unstoppable force and the mayor s worst nightmare. February MEDICUS 69

72 Professional Notices CARDIOVASCULAR Perth Cardiovascular Institute Dr Jay Baumwol Dr Andrei Catanchin Dr Matthew Erickson Dr Susan Kuruvilla Dr Michael Muhlmann Prof Gerry O Driscoll Dr Jamie Rankin Dr Matthew Best Dr Michael Davis Dr Arieh Keren Dr Athula Karu Dr Kaitlyn Lam Dr Anne Powell Dr Sharad Shetty Dr Gerald Yong It is with great pleasure that we welcome Dr Arieh Keren to our fast-growing team of experienced cardiologists. Dr Keren will be consulting from our Nedlands and Joondalup rooms. He also holds a public appointment at Sir Charles Gairdner Hospital. His sub-specialty includes the advanced management of all cardiac arrhythmias in particular atrial fibrillation, and also the implantation of pacemakers, defibrillators and cardiac resynchronisation devices for heart failure management. Dr Keren has a particular interest in advanced management of defibrillator shocks and ventricular arrhythmias. Dr Arieh Keren is pleased to provide the ongoing care and services to patients and the referring physicians following the departure of Dr Andrei Catanchin. For bookings to see Dr Keren, or for any information regarding patients of Dr Catanchin, please phone or The group provides a comprehensive cardiac testing service at nine conveniently located sites: Nedlands (Hollywood Private Hospital), Joondalup Health Campus, Bentley, Duncraig, Esperance, Midland, Mt Lawley and Rockingham. Services offered include Cardiology consultations, Echocardiography, Exercise Stress Testing, Monitor Fittings (Ambulatory BP, Event and Holter), and ECG. Visit for more information on our services. For cardiology appointments: CARDIO. For testing appointments: 1300 HEART TEST. General enquiries: phone fax: GENERAL SURGERY Perth Surgical Clinic Mr Karim Ghanim MB CHB FRACS Surgical Oncology (breast/bowel and skin cancers) Laparoscopic surgery (hernias, bowel and gallbladder Colonoscopy and Gastroscopy (open access) Operating at: North: Mount Private and Bentley. South: SJOG Murdoch and Armadale hospitals. Consulting: Hollywood, Murdoch, Bentley and Galliers. Mobile: Dr Farah Abdulaziz 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 and laparoscopic), Gallbladder, Vasectomy, Carpal tunnel and Lymph node biopsy Admitting and operating at: Bethesda Hospital, Sir Charles Gairdner Hospital, Hollywood Private Hospital, Osborne Park Hospital and Mount Private Hospital. Mobile: All correspondence to: Suite 36 Hollywood Specialist Centre, 95 Monash Avenue, Nedlands Phone: (08) ; fax: (08) ; Website: HAND SURGERY Lewis Blennerhassett MBBS FRACS Dr Blennerhassett is a plastic surgeon with post-graduate fellowship in hand surgery certified by the American College of Surgeons. Expertise in all aspects of acute and chronic hand disorders, both paediatric and adult, is provided. For all appointments, phone Emergencies phone all hours. Mr Paul Jarrett FRACS Hand and Upper Limb Surgeon provides a comprehensive service for elective and traumatic conditions for the hand, shoulder and upper limb at Murdoch Orthopaedic Clinic for Workcover and Privately Insured patients. Please call for appointments. I am happy to be referred public patients at Fremantle Hospital where I hold weekly clinics. 70 MEDICUS February

73 Professional Notices Mr Craig Smith MBBS FRACS Hand, wrist and plastic surgeon has his main practice at 17 Colin Street, West Perth in association with Specialised Hand Therapy Services. This means that consultation, hand therapy and splinting are all available at the 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 Mr Angus Keogh FRACS - Upper Limb Surgeon My interests include traumatic and degenerative conditions of the upper limb including hand surgery, arthroscopy including small joints, complex elbow and wrist instability. I consult in private rooms at St John of God Subiaco and St John of God Murdoch. I consult weekly at Sir Charles Gairdner Hospital please call Please call for appointments. Workcover accepted. OPHTHALMOLOGY Dr Michael Wertheim MBChB FRCOphth FRANZCO Comprehensive general ophthalmologist consults at: South Street Eye Clinic, Suite 10/73 Calley Drive, Leeming 6149 Early and urgent appointments available Operates at: Eye Surgery Foundation, West Perth (private patients) Kaleeya Hospital, East Fremantle (public patients) Special Interests: cataract surgery, general ophthalmology, Uveitis For appointments, phone or fax PSYCHIATRY Dr Raj Sekhon Dr Raj Sekhon is pleased to announce that he has commenced private psychiatric practice in Rockingham. Raj is a local UWA graduate (1996) and is a Fellow of The Royal Australian and New Zealand College of Psychiatrists (FRANZCP), with an interest in all aspects of general adult psychiatry. For referrals or other advice please Ph: Fax: HAND & PLASTIC SURGERY Dr Robert Love MBBS FRACS (Plas) Dip ANAT All hand surgery, microsurgery and plastic surgery Dupuytren s Contracture Arthritides, Carpal Tunnel 24hr Emergency Requests for advice welcome 17 Richardson St West Perth and SJOG Murdoch Tel: Mobile: INFECTIOUS DISEASES Dr Desmond Chih MBBS FRACP FRCPA Infectious Diseases Physician and Clinical Microbiologist All aspect of adult general infectious diseases and diagnostic microbiology including Fever of unknown origin Bone and joint infections Surgical infections Skin and soft tissue infections Travel related infections Tuberculosis Antibiotic resistance Consults at Joondalup, SJOG Murdoch (Inpatient) and Myaree. All correspondence to 74 McCoy Street, Myaree 6154 Tel: Appointments: Fax: Sentiens Day Hospital Please refer all private mental health patients to Sentiens Clinic. Our patients usually have depression, anxiety, bipolar, borderline personality disorder, drinking problems, relationship problems, stress, PTSD, OCD and sometimes eating disorders and schizophrenia. We offer group programs in CBT (also evening), DBT skills, creative therapy, alcohol management, mindfulness, carer s support, patient support, self-esteem, health and wellness, exercise, anger management, interpersonal skills, recovery road and relapse prevention, stress management, drug-related metabolic problems, anxiety management, life skills, assertive skills, triage and online assessment via PsychAssess and PsychScreen and online monitoring using HealthSteps. We have clinicians waiting to take your referrals. Refer to Dr Dennis Tannenbaum or Dr George Atartis (Consultant Psychiatrists) or directly to Sentiens Clinic. We would like to welcome Dr Amatul Uzma to the team of psychiatrists who is waiting for your referrals. For referral advice, call Sharon on: or Fax: You can now refer to Sentiens Clinic online via For all online programs visit: February MEDICUS 71

74 Professional Notices RADIOLOGY/NUCLEAR MEDICINE Oceanic Medical Imaging Leeming Tel: Fax: Oceanic Medical Imaging Hollywood PET-CT CentreGround Floor, Suite 14, Hollywood Medical Centre 85 Monash Avenue, Nedlands 6009 Tel: Fax: Oceanic Medical Imaging offers a wide range of general and specialist medical imaging utilising the latest imaging equipment. Services include: 64-slice cardiac capable CT Digital General X-Rays Ultrasound Digital OPG & Cephalometry Nuclear Medicine Studies and Therapy Bone Densitometry DEXA Whole Body Fat Assessment Stress ECG suite with Myocardial Perfusion Imaging PET-CT CT/Ultrasound-guided injections. We provide a personalised, comprehensive and professional digital imaging service. Patients benefit by a short or no wait time for an appointment, low radiation dose equipment, family-friendly, comfortable clinic and affordable examination fees. Envision Medical Imaging 178 Cambridge Street (opp. SJOG Hospital Subiaco) Tel: Fax: Web: Web: (WebPAX online images & reports). Envision Medical Imaging is an independent Radiology practice, located directly opposite St John of God Hospital Subiaco on Cambridge Street, with free parking behind the building. Services include: Ultrasound: including injections MRI: GP referrals accepted X-ray: low dose CT: general and cardiac imaging Nuclear Medicine scans Dental: Cone Beam and OPG *Same day appointments available Imaging Specialists include: Michael Krieser, Brendan Adler, Lawrence Dembo, Bernard Koong, Conor Murray, Eamon Koh, Jeanne Louw and Tonya Halliday. ORTHOPAEDIC SURGERY Karl Stoffel MD, PhD, FMH (Tr & Orth), FRACS Professor of Orthopaedics and trauma surgery provides a comprehensive service for elective and trauma conditions for the hip, knee, lower limb and all orthopaedic trauma at Murdoch Orthopaedic Clinic for Workcover, DVA and privately-insured patients. Please call for appointments. I offer a no-gap service for all major health funds and will be very happy to see private, Worker s Compensation and Department of Veteran Affairs patients at Murdoch. 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 Grant Booth operates at Bethesda Hospital and SJOG Hospital Subiaco as well as holding a public appointment at Royal Perth Hospital. Sven Goebel operates at Bethesda Hospital and SJOG Hospital Subiaco as well as Joondalup Health Campus where he is able to see public patients. For appointments or advice contact: p f Perth Shoulder Clinic, Bethesda Hospital 25 Queenslea Dr, Claremont MEDICUS February

75 GP RequIRED CLARKSON A GP is required for an accredited, fully-computerised, privately-owned GP practice in Clarkson. Pathology SJOG on site. Currently a solo practice. Vocational registration essential and fluency in Afrikaans preferable. Accent is on continuous personal care. Well equipped for small procedures. Please your expressions of interest to the practice manager: or phone Estelle on WEST LEEDERVILLE Medical consulting rooms West Leederville for sale in New Year. Renovated and well-appointed stand-alone circa 1920 s house with onsite parking. Large rooms, furnishings could be included, kitchen, two toilets, shower, built in reception. Expressions of interest are invited. Phone: BECOME PART OF THE BIGGER PICTURE Long established and privately owned, Perth Medical Centre is centrally located, accredited, fully computerised and privately billing. We have also recently renovated our rooms come and join our team and you will be busy from day one. We have an interesting and truly diverse mixture of clientele young and old, blue and white collar, travellers and residents. You will have plenty of opportunity to develop an interest in whatever branch of practice you choose with the back-up of a team of locally-trained colleagues. We also have a team of RNs leading our chronic disease management program. We are a social group which supports one another. We are flexible with hours and believe in maintaining work-life balance. Avoid the rush hour, reduce your carbon footprint and keep fit bus, train or cycle to work. Check us out at Interested? Call our practice manager, Anne on (08) or Dr Phil A/H GP RequIRED LOCATION INGLEWOOD A ready-made practice to step into. Full-time or part-time, hours negotiable. Busy private billing, non-corporate practice on the Inglewood/Bedford border. Full-time nurse and pathology on site. Friendly and very well staffed. Phone Steve, Carl or Denise on or DOCTOR REQUIRED LUNG INSTITUTE OF WA Part-time position with flexible hours with preference Mon - Wed (am), hours per week. The LIWA Clinical Trials Unit is highly regarded as the premier respiratory trial unit in Australia, conducting 15 trials in Currently a doctor is required ideally with clinical trials and/or research experience. Excellent salary packaging available. Please phone Meagan on or Medical Educator Part time or Full time An exciting opportunity to combine clinical work and medical education! Western Australian General Practice and Training (WAGPET) is seeking General Practitioners, preferably Fellowed, with an interest in medical education, to help deliver General Practice and generalist community training in Western Australia. The Medical educator role at WAGPET is varied and exciting. Based in Perth and working as part of a dynamic, enthusiastic team you would: facilitate small group learning face-to-face or via online technologies provide training and career advice to GP registrars and prevocational doctors provide additional training, help and support to doctors who are struggling with the demands of general practice have the opportunity to travel to some of the WA regions and support development and delivery of regional education programs develop and expand your skills through numerous professional development opportunities. You don t have to be an experienced educator as training into the position is provided. There is an attractive remuneration package and hours are flexible. If you would like to balance a clinical career with the opportunity to grow the next generation of General Practitioners please consider applying for a position with us. Applications should include a covering letter, curriculum vitae and address the selection criteria. A position description can be obtained from Applications close 4 March 2013 For more details contact: Dr Denise Findlay, Director of Education or Dr Janice Bell, Chief Executive Officer on February MEDICUS 73

76 Please forward submissions for Greensheets by 23 February for the April edition. Contact Christine Kane at Youth Friendly Doctor Training 2013 Program The Youth Friendly Doctor Program (YFD) seeks to build the capacity of general practitioners to communicate more effectively with young people, address the barriers young people face in accessing health care and promote adolescent friendly policies, facilities and service delivery. This program is accredited with the RACGP and attracts Category 1 and or Category 2 QI&CPD Points. MODULE 1 Workshop 1 Ethics and the Law, 5 Feb, 4 Jun, 22 Oct MODULE 2 Workshop 1 Mental Health: Diagnosis and Assessment 2 Apr, 5 Nov Workshop 2 Psychosocial/Psychopharmacological Treatments 16 Apr, 19 Nov MODULE 3 Workshop 1 - Alcohol and Drugs, 5 Mar Workshop 1 - Sexual Health, 7 May MODULE 4 Workshop 1 - Overweight and Obesity, 6 Aug Workshop 1 - Eating Disorders, 3 Sep For enquires relating to the YFD program or to enrol in the workshop visit: Phone (08) or POSTGRADUATE EDUCATION & TRAINING Date Course/Workshop Contact Information 7 Feb Emergency Skills & Crisis Management. Suitable for Multi-disciplinary groups from specialty areas, medical, nursing or allied health. 4 hour duration, $428 per participant. Venue: The CENTER, Subiaco 12 Feb The Vocational Graduate Diploma of Women's Health (52264) is a nationally recognised training program which covers 3 themes. First theme is Family Planning & Sexual Health - consists of 10 evening sessions 12 Feb - 16 Apr. Costis $685 for the entire theme or $80 for individual sessions of interest. Program held at the Agnes Walsh House Lounge at KEMH. Contact Amy Chatterton 14 Feb ALS Algorithm & Defibrillation Safety. Suitable for GPs, medical officers, nurses & paramedics. 4 hour duration, $275 per participant. Venue: The CENTER, Subiaco 15 Feb Anaesthetic Nurse Skills Workshop. Suitable for Nurses in the role of anaesthetic assistant. 8 hour duration, $450 per participant. Venue: The CENTER, Subiaco 15 Feb Anatomy of Complications Workshop. Suitable for Obstetric & Gynaecology Specialists. Venue: UWA wa.gov.au/brochures/ health_professionals/ wnhs0195.pdf Feb BSS Basic Surgical Skills Gynaecology. Suitable for KEMH Participants. Venue: UWA 22 Feb Patient Blood Management. Suitable for Consultant Surgeons or Senior Registrar in either General Surgery or Pelvic Surgery. Venue: UWA 25 Feb Full Day Workshop Introduction to Eating Disorders Part One Identification and Assessment This workshop is for a multidisciplinary audience (available via videoconference). Venue: Administration Building PMH 9:00am 16:00pm 26 Feb A-Z of Epistaxis. Suitable for remote area nurses, emergency department nurses, practice nurses, site medics, GPs & junior doctors. 90 minute duration, $165 per participant. Venue: The CENTER, Subiaco services/eating_disorders/ index.htm 74 MEDICUS February

77 PostgraduateNews Please forward submissions for Greensheets by 23 February for the April edition. Contact Christine Kane at WESTERN AUSTRALIA POSTGRADUATE EDUCATION & TRAINING continued 28 Feb 1 Mar 8 Mar 11 Mar 12 Mar 15 Mar 15 Mar 18 Mar 22 Mar 25 Mar Course/Workshop Core Skills: Foundations of Minimal Access Surgery. Suitable for Surgical Trainees, Lap Assist in General Surgery, Vascular, Gynaecology, Urology & Cardiothoracics, Scrub Nurses, Metro & Rural GPs. Venue: UWA Core Skills: Intermediate Laparoscopic Skills Workshop. Suitable for Surgical Trainees & Consultants in General Surgery, Vas Surgery, Gynaecology, Urology, Cardiothoracics. Venue: UWA Anaesthetic Nurse Skills Workshop. Suitable for Nurses in the role of anaesthetic assistant. 8 hour duration, $450 per participant. Venue: The CENTER, Subiaco Full Day Workshop Introduction to Eating Disorders Part Two Management Strategies We recommend that you attend Intro to Eating Disorders Part 1 before attending this workshop, or have had previous experience with or knowledge of identification and assessment of Eating Disorders and the underlying issues involved. (Available via videoconference) Venue: Administration Building PMH 9:00am 16:00pm Recognition & Management of Common Ear Disorders. Suitable for remote area nurses, emergency department nurses and practice nurses, GPs, junior doctors & site medics. 3 hour duration, $209 per participant. Venue: The CENTER, Subiaco One-day Workshop Communication & Counselling Skills to Support Breastfeeding. This workshop has been developed for health professionals using ABA s counselling approach. Please book early. Early bird registrations close on 1 Feb 2013 One-day Workshop Breastfeeding Essentials for Medical Practitioners. This workshop is designed specifically for medical practitioners and all presenters will be medical practitioner with extensive breastfeeding medicine experience. Please book early. Early bird registrations close on 1 Feb 2013 Airway Management. Suitable for remote area nurses, emergency department nurses and practice nurses, GPs, junior doctors & site medics. 4 hour duration, $255 per participant. Venue: The CENTER, Subiaco The Cutting Edge: Managing Skin & Soft Tissue Injuries. Suitable for GP, GP Proceduralists & Nurse Practitioners Metro & Rural. Venue: UWA Full Day Workshop Supporting Parents and Carers with Information and Skills Venue: Administration Building PMH 9:00am 16:00pm Contact Information services/eating_disorders/ index.htm asn.au/program/workshops asn.au/program/workshops services/eating_disorders/ index.htm 3 Apr Core Skills: General Surgery Trainee Workshop SET Apr Core Skills: General Surgery Trainee Workshop SET Apr Core Skills: Vascular Surgery Trainee Workshop SET Apr Core Skills: Oncoplastic Surgery. Surgical trainees in Plastics SET Apr Core Skills: Gynaecologic Surgical Skills Training KEMH Participants 12 Apr Core Skills: Plastics Consultants & Trainees in ENT & Plastics 5 Apr Anaesthetic Nurse Skills Workshop. Suitable for Nurses in the role of anaesthetic assistant. 8 hour duration, $450 per participant. Venue: The CENTER, Subiaco 8 Apr Half Day Workshop Cognitive Remediation Therapy (CRT) This workshop will be of particular interest to psychologists and occupational therapists. Venue: Administration Building PMH 9:00am 13:00pm 11 Apr Emergency Skills & Crisis Management. Suitable for Multi-disciplinary groups from specialty areas, medical, nursing or allied health. 4 hour duration, $428 per participant. Venue: The CENTER, Subiaco services/eating_disorders/ index.htm February MEDICUS 75

78 Please forward submissions for Greensheets by 23 February for April edition. Contact Christine Kane at WESTERN AUSTRALIA POSTGRADUATE EDUCATION & TRAINING continued 18 Apr Course/Workshop A-Z of Epistaxis. Suitable for remote area nurses, emergency department nurses, practice nurses, site medics, GPs & junior doctors. 90 minute duration, $165 per participant. Venue: The CENTER, Subiaco Contact Information 19 Apr Apr 30 Apr Patient Blood Management Suitable for Consultant Surgeons or Senior Registrars in General Surgery or Pelvic Surgery Interventional Pulmonology EBUS Bronchoscopy & Advanced Bronchoscopic Techniques. Suitable for Respiratory Physicians & Trainees ALS Algorithm & Defibrillation Safety. Suitable for GPs, medical officers, nurses & paramedics. 4 hour duration, $275 per participant. Venue: The CENTER, Subiaco CONFERENCES and MeetingS 2013 Conferences and Meetings 27 Feb The Ophthalmology Colloquia Series - All Ophthalmologists are invited to participate in the program by presenting a twenty minute talk at one of the meetings on an expertise or interest and can do so by contacting Jean-Louis desousa. Lions Eye Institute, Vision Science Lecture Theatre 6pm. The meetings are once a month and run for one hour Mar Panorama of Emergency Surgery 4th Annual State Conference Bunbury. Suitable for Consultants, Trainees, Registrars, GPs/GP Proced, Nurses, Paramedics, Anaesthetists, Allied Health, Med Students Mar Thoracic Society of Australia and New Zealand - ANZSRS 2013 ASMs Venue: Darwin Convention Centre 4-7 Apr Australian Hand Surgery Society Annual Scientific Meeting Venue: Darwin Convention Centre 7-10 Apr 12th National Rural Health Conference Venue: Adelaide Convention Centre May RACP Future Directions in Health Congress 2013 Venue: Perth Convention & Exhibition Centre ARE THERE ANY PARTICULAR TOPICS OF INTEREST TO YOU THAT HAVE NOT BEEN LISTED? TELL US WHAT YOU WOULD LIKE TO SEE ON OUR SEMINAR PROGRAM FOR You are invited to provide feedback on all current or future events by ing 76 MEDICUS February

79 New MRI rebates for GP referred services New GP referred paediatric MRI item numbers. Your patients under 16 years of age will receive a Medicare rebate for selected head, spine and joint MRI scans. Envision offers a short, wide bore MRI scanner ideal for children. 178 Cambridge Street Wembley tel: fax: Australia s only NoCO2 accredited Medical Imaging Practice

80 Is your equipment finance as complex as a triple bypass? It s time for a second opinion As you well know, running a practice involves balancing a myriad of priorities. Purchasing equipment is high on the list, but it s often devilishly complicated it takes specialist expertise to put together a simple and cost-effective solution. This is where Investec comes in. We specialise in providing financial solutions for medical and dental professionals, so our team thoroughly understands the pros and cons of different methods of funding your equipment. Whether it s buying outright or leasing, you can rest assured that we ll work out the optimal structure for you; even better, you can finance the equipment on an Investec credit card and earn Qantas Frequent Flyer miles on your eligible purchase. Take a look at investec.com.au/medical or call one of our financial specialists on to find out how we can help. Out of the Ordinary Home loans Car finance Transactional banking and overdrafts Savings and deposits Credit cards Foreign exchange Goodwill and practice purchase loans Commercial and industrial property finance Equipment and fit-out finance SMSF lending and deposits Income protection and life insurance All finance products are issued by Investec Bank (Australia) Limited ABN , AFSL , Australian Credit Licence No (Investec Bank). All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. Information contained in this document is general in nature and does not take into account your personal financial or investment needs or circumstances. We reserve the right to cease offering these products at any time without notice. You should obtain independent financial, tax and legal advice, as appropriate. Qantas Frequent Flyer points are earned in accordance with the Investec/Qantas Terms and Conditions available at Points are earned on eligible purchases only. You must be a member of the Qantas Frequent Flyer program in order to earn and redeem points. Qantas Frequent Flyer points and membership are subject to the Qantas Frequent Flyer program Terms and Conditions. Full details are available at Investec Bank recommends that you seek independent tax advice in respect of the tax consequences (including fringe benefits tax, and goods and services tax and income tax) arising from the use of this product or from participating in the Qantas Frequent Flyer program or from using any of the rewards or other available program facilities. Insurance products are offered by Experien Insurance Services (Representative No ), the preferred supplier of insurance products to Investec Bank.

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