Draft Territory-wide Health Services Framework: content and consultation

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1 CANBERRA Informing the Canberra Doctormedica community since 1988 October 2017 Canberra Doctor is proudy brought to you by the AMA (ACT) Limited. Circuation: 1,900 in ACT & region Draft Territory-wide Heath Services Framework: content and consutation ACT Heath Minister, Meegan Fitzharris has announced the reease of the draft Territorywide Heath Services Framework saying that the Framework wi underpin the ACT s future heath system by enabing patients to access care when they need it, deivered by the right team in the right pace. ACT Heath says the draft Framework is a high-eve strategic pan that estabishes the overarching principes to guide the deveopment and redesign of heath care services across the Territory over the next decade. The draft Framework is focussed on integrating services across the three areas of heath care preventative heath, community-based care and care in hospita and wi guide the estabishment of cinica Centres to provide patients with integrated heath care. Cinica Centres ACT Heath says the Territory-wide Centres wi ensure speciaty services are integrated across the continuum of care (prevention in the community, care in the hospita and then management of care back in the community) to make it ACT Heath Minister, Meegan Fitzharris. easier for patients to navigate the services they need. Centres wi strategicay group speciaty services together to support patient needs to ensure care can be deivered in a co-ordinated way across heath faciities. The means of doing this is by faciitating coaboration between reated speciaties in the pubic and private sectors and with community-based services. Speciaty Service Pans ACT Heath says the Centres wi be supported by an overa Centre Service Pan, individuaised Speciaty Service Pans and appropriate Modes of Care. The individua Speciaty Service Pans wi be deveoped in consutation with medica, nursing and aied heath staff with input from externa and interna stakehoders. Speciaty Service Pans wi describe how the service wi be deivered across the Territory and be evidence-based. Both the Cinica Centres and Speciaty Service pans wi be deveoped over the next months with some service pans aready having been deveoped and impemented. Consutation Foowing the reease of the draft Framework, the consutation process wi acceerate and buid on the earier consutation undertaken with NGOs who currenty deiver cinica services to or for ACT Heath. Expressions of interest have been sought for a Territory-wide Heath Services Advisory Group and over the coming months, ACT Heath wi consut with interna and externa stakehoders to refine the draft Framework. ACT Heath says, the Advisory Group wi provide specific advice on engagement activities in the near future. There wi be opportunities for speciaty areas, representative groups as we as genera community forums on the draft Framework and service panning. ACT Heath has undertaken to incude expert advice from cinicians, heath personne and reevant heath care consumers, incorporating estabished best practice and advancements in medica technoogies and innovation that are achievabe within budget. The first genera community forum wi be hed in ate The draft Framework can be acc - essed at the ACT Heath website VOLUME 29, No. 9 CANBERRA DOCTOR: Informing the Canberra medica community since 1988

2 Medica Musings WITH PRESIDENT, PROFESSOR STEVE ROBSON At this time of the year we a begin to think about summer and the festive season. The years seem to become busier a the time, and Canberra s busy doctors are starting to ook forward to the usua string of parties, then hopefuy some we-earned rest with friends and famiy. Meeting with the Heath Minister The atter part of the year certainy has been very busy from the AMA (ACT) perspective. CEO Peter Somervie and I had the opportunity to meet with ACT Heath Minister, Ms Meegan Fitzharris, and a number of key topics were discussed. Minister Fitzharris is the COAG Heath Counci Chair for the next Heath Ministers meeting, and we pressed the AMA case for a nationa reaignment of egisation deaing with mandatory reporting. The mode in pace in Western Austraia is our preferred mode, and it wi remove the disincentive for doctors who need hep to seek and have the same eve of confidentia access that our patients do. We aso pressed the case for a arge-scae Territory-wide approach to Menta Heath services in the ACT, with a focus on the speciaist psychiatric workforce. Peter and I, aong with RANZCP ACT Chair, Professor Jeff Looi, had previousy discussed this in detai with Menta Heath Minister Rattenbury. We have urged the ACT Government to buid a sustainabe workforce by taking a view across both the pubic and private sectors. Let s keep our fingers crossed on this. The other hoary od chestnut is the nurse-ed wak in cinics. These are very expensive, with documents tabed in the Legisative Assemby showing that a singe patient visit costs $188 for the existing cinics. Compared to the cost of care provided by our wonderfu Canberra Genera Practitioners, this is breathtakingy expensive. We have proposed a round tabe of interested parties to try to find compementary soutions that are good for out-of-hours patients and better for the ACT budget. Stay tuned on this one. and meeting with the DG! We aso met with Ms Nicoe Feey, the Director-Genera of ACT Heath. Many of the same issues were discussed, but we received more detai about the Territory-Wide Services Pan that is being roed out currenty. An issue of specia interest to Canberra s doctors is the KPMG-ed review into the reationship between ACT Heath and the ANU Medica Schoo. We understand that the review has expanded, and there is a great dea of money at stake. We have pressed for a resoution to this as soon as practica, to provide certainty to a parties and especiay those Canberra doctors who contribute to training of the next generation of medica students. The da Vinci Codeine The Federa AMA and AMA (ACT), together with a other state and territory AMAs, have reinforced their support for the Therapeutic Goods Administration s decision to make a codeine preparations a prescription ony medicine from 1 February The issue of prescription-ony codeine has emerged again after State and Territory Heath Minister s wrote to the Federa Government expressing concern that codeine users wi need to access a GP for ongoing prescriptions and the impact this may have on primary care and the users themseves. The Pharmacy Guid has weighed in to support the State and Territory Heath Ministers and many of you wi have seen the reaction from the Guid and our AMA response to this. A batte worthy of a Dan Brown nove broke out over the up-scheduing of codeine, and what a batte it is. A AMAs have expressed their support for the TGA s decision to up-schedue codeine, but this aso supports Director-Genera of ACT Heath, Ms Nicoe Feey with AMA (ACT) President, Prof Steve Robson (right) and Deputy-Director-Genera, Chris Bone. the importance of uphoding the independence of the TGA in making decisions about medicines scheduing generay. The Roya Austraasian Coege of Physicians, the RACGP, Pain Austraia, the Rura Doctors Association and the Consumers heath Forum have pubicy weighed in to support the TGA s decision. Further detais are avaiabe in this edition of the Canberra Doctor and I encourage a of you to attend this important coegiate event. Farewe to Anish Sady, I have to report that Anish Prasad, our Hospita Organiser has eft us for empoyment with the Austraian Federa Poice Caring for coeagues Association. I d ike to thank Anish The Doctors Heath Advisory for the exceent work he has Service is hoding ACT Caring for done for AMA (ACT) and its members Coeagues dinner from 6.30pm particuary junior doctors on Wednesday the 23rd of November. and wish him we as he seeks This is a free event for to further his workpace reations doctors and medica students. career. [2] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017

3 Mandatory reporting and menta heath: key AMA issues for Minister Fitzharris Earier in October, AMA (ACT) President, Prof Steve Robson and CEO, Peter Somervie, met with ACT Heath Minister, Meegan Fitzharris for their reguar consutative meeting. These meetings are an opportunity to bring forward issues of mutua concern and to share information that either the Minister or AMA beieves is reevant and timey. This time, the major issues discussed were: Mandatory reporting With the next meeting of the COAG Heath Counci due for November and Minister Fitzharris to chair the meeting, mandatory reporting is front and centre on the agenda. The Heath Counci meeting wi consider the resuts of the consutation process on mandatory reporting as we move coser to a decision on changes to the provisions for treating practitioners to mandatoriy report medica practitioners who are their patients. AMA (ACT) aong with the Federa AMA and a of the state and territory AMAs have been pushing for a WA-stye exemption from mandatory reporting for treating practitioners. Minister Fitzharris istened to AMA (ACT) s presentation and took onboard the need to revise the current mandatory reporting framework in the ACT so as to not discourage medica practitioners from seeking treatment. AMA (ACT) wi continue to foow up on this issue to advocate for a WA-stye exemption to appy in the ACT. Menta heath Foowing AMA (ACT) s earier discussions with Menta Heath Minister, Shane Rattenbury, it has come to ight that ACT Heath has estabished a Medica Workforce Working Group to dea with psychiatric workforce issues in the ACT pubic sector. Whie the estabishment of the Working Group is a good start in deaing with the immediate pubic sector issues, it is ony one part of deaing with the overa psychiatric workforce issues in the ACT. The concern raised with the Minister Fitzharris (who retains an overa responsibiity for empoyment and operations) is that the need to approach the issues of the psychiatric workforce goes beyond the pubic sector (athough the pubic sector is both the immediate and a onger term focus) and any consideration of workforce shoud aso consider the private sector. AMA Heath Minister, Meegan Fitzharris, with AMA (ACT) President, Prof Steve Robson (right) and AMA (ACT) CEO, Peter Somervie. (ACT) s view is that a sustainabe workforce needs to incude options for working across both the pubic and private sectors. In addition, AMA (ACT) woud ike to see incentives to attract and retain particuary younger speciaists in the ACT. This shoud not be imited to the pubic sector and coud incude assistance and encouragement with estabishing private practices to sustain both the individua and the pubic and private sector workforces. This is a matter that AMA (ACT) wi continue to pursue with both Minister Fitzharris and Minister Rattenbury. Nurse-ed wak in cinics For a considerabe period of time, AMA (ACT) has been constructivey discussing with Minister Fitzharris a broader roe that genera practice coud pay in after-hours care in the ACT. On one hand, the ACT Government has impemented nurse-ed wak-in cinics at Tuggeranong and Beconnen (with two more panned for Gunghain and Weston Creek) but on the other hand, these cinics are expensive and there may be options that better integrate after-hours care into genera practice. In regard to the nurse-ed cinics, it s recenty come to ight that the two existing cinics cost $188 per occasion of service that represents a tota annua recurrent cost of $3.5m for each of the cinics. Given this cost, AMA (ACT) is of the view that compementary options to the current and panned cinics are worth exporing. To this end, AMA (ACT) has proposed a round-tabe of interested parties to discuss such options and report back to the Minister. AMA (ACT) thanks Minister Fitzharris for the opportunity to hod an extended discussion on these important matters. OCTOBER 2017 CANBERRA DOCTOR: Informing the Canberra medica community since 1988 [3]

4 Dr Omar Gaiani MBCHB, DIP O&G, FRANZCOG Gynaecoogica Surgeon Pevic Foor Medicine Urodynamic testing and outpatient cystoscopy Minimay invasive surgery for pevic organ proapse and stress urinary incontinence Bioogica graft (feta bovine dermis) for vagina wa proapse repair Outpatient botox badder treatment The AMA Indigenous Medica Schoarship Tibia nerve stimuation (Urgent PC) for overactive badder iauri treatment for painfu badder syndrome Capita Women s Heath, P: E: heo@cwheath.com.au 21 Napier Cose, Deakin ACT 2600 F: W: The AMA Indigenous Medica Schoarship supports Aborigina and Torres Strait Isander students to study medicine, and achieve their dream of becoming doctors. The President, Prof Stephen Robson, invites the ANU Medica Schoo Graduating Cass of 2017 to a Ceebratory Breakfast Between 8.30am & 10.00am on Thursday, 14th DECEMBER 2017 At Hote Ream 18 Nationa Circuit, Barton Each year, the AMA offers one Schoarship to an Aborigina and/ or Torres Strait Isander student studying medicine at an Austraian University, but with the hep of your tax deductibe donation, we can increase the number of Schoarships offered each year and hep grow the Indigenous medica workforce. Indigenous doctors have a unique abiity to aign their cinica and sociocutura skis to improve access to services, and provide cuturay appropriate care for Aborigina and Torres Strait Isander peope. Yet, Aborigina and Torres Strait Isander doctors comprise ess than 1 per cent of the entire medica workforce. Since its inception in 1994, the AMA Indigenous Medica Schoarship has heped more than 20 Indigenous men and women become doctors, many of whom may not have otherwise had the financia resources to study medicine. The AMA hopes to expand on this success and increase the number of Schoarships on offer each year to meet a growing demand for the Schoarship. By supporting an Indigenous medica student throughout their medica training, you are positivey contributing to improving heath outcomes for Aborigina and Torres Strait Isander peope. If you are interested in making a contribution, you can do so by downoading the donation form at: Further information about the Schoarship is avaiabe on the AMA website. For enquiries pease contact the AMA via emai at indigenousschoarship@ama. com.au or phone (02) (parking at Hote Ream for a minima cost) Graduates: no cost Partners & famiy members $40 per head RSVP by Monday, 11th December Karen, AMA (ACT) Executive Assistant on or reception@ama-act.com.au LIKE OUR FACEBOOK PAGE! For the atest medico-news in the ACT, Canberra Doctor artices, events and more jump on Facebook and Like our Page! It s easy, just search for AMA ACT in your search engine or on Facebook. With thanks to our sponsors: [4] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017

5 AMA (ACT) urges ACT Govt to maintain upscheduing of codeine The Federa AMA and AMA (ACT), together with a other state and territory AMAs, have reinforced their support for the Therapeutic Goods Administration s decision to make a codeine preparations a prescription ony medicine from 1 February The issue of prescription-ony codeine has emerged again after State and Territory Heath Minister s wrote to the Federa Government expressing concern that codeine users wi need to access a GP for ongoing prescriptions and the impact this may have on primary care. In addition, the Ministers expressed concern that some codeine users, particuary in rura and regiona areas wi deteriorate as they abandon medication due to out-of-pocket costs of seeing a GP. The Pharmacy Guid has weighed in to support the State and Territory Heath Ministers. AMAs back TGA A AMAs have expressed their support for the TGA s decision to upschedue codeine but aso the importance of uphoding the independence of the TGA in making decisions about medicines scheduing generay. The TGA has pubished its reasons for up-scheduing codeine and they are compeing deaths and iness from codeine use have increased in Austraia. This is despite a rescheduing decision in 2010 shifting many over-the-counter codeine medicines to Schedue 3 (pharmacist ony) medications. In addition, there is no evidence that ow-dose codeine (8mg-15mg/unit) provides any benefit beyond pacebo. To put this change in perspective, a other opioid medicines sod in Austraia are avaiabe ony on prescription (S4 or S8). Codeine is not avaiabe over-the-counter in 13 European countries nor in the US. Effective over the counter medications Patients who have short term pain wi sti have access to aternative over-the-counter painkiers which are more effective than owdose codeine without codeine-associated risks. AMA (ACT) has pointed out to ACT Heath Minister, Meegan Fitzharris, that the TGA s decision was based on facts and the advice of independent experts; it has the soe objective of protecting the pubic. AMA (ACT) stressed the importance of an independent reguator as the cornerstone of our heath system and that it was absoutey essentia no decisions be made that undermine its authority. Starting on October 16 the AMA Fees List has been aunched in its new onine format. The new website at ama.com.au/ wi be repacing the book and CD-ROM formats making it faster and more user friendy than ever before. You wi sti be abe to downoad PDF and CSV fies, pus access a range of new, usefu features incuding: Interactive dashboard to find, search and save AMA fees Search function that inks directy to AMA and MBS item descriptions Personaised user dashboard with option to store favourites Fee cacuator toos incuding a new Anaesthesia cacuator Abiity to print parts of, or fu PDFs of the Fees List Onine tutorias and hep toos Mobie and tabet compatibe Onine payment gateway for non-members Members are encouraged to og on eary and famiiarise themseves with the new website, before the Fees List is indexed and updated on 1 November. A financia AMA Members wi continue to have free, unimited access to the new website using their ogin and password for ama.com.au. For ogin assistance pease contact Member Services on memberservices@ama.com. au or AMA fees ist aunches onine For more information on the new Fees List, contact feesist@ama.com.au OCTOBER 2017 CANBERRA DOCTOR: Informing the Canberra medica community since 1988 [5]

6 AMA wecomes Prof Pau Worey as first Rura Heath Commissioner The AMA has congratuated Prof Pau Worey on his appointment to the new position of Nationa Rura Heath Commissioner. Wecoming the appointment, AMA President, Dr Michae Gannon, said that Prof Worey is a highy respected member of the profession who has made a substantia contribution to rura heath over many years. Prof Worey has a big job ahead of him, and he wi have the fu support of the AMA and other groups with a commitment to improving access to quaity heath services in rura, regiona, and remote Austraia, Dr Gannon said. The ong-awaited appointment of a Nationa Rura Heath Commissioner had the potentia to boost the profie of rura heath issues in Government decision-making and heath poicy deveopment. AMA ready to assist The Rura Heath Commissioner wi aso ead the estabishment of a Rura Generaist Pathway, which coud boost the much-needed recruitment and retention of skied practitioners in rura areas. The AMA is uniquey positioned to provide Professor Worey with advice on rura heath poicy. We have an extensive rura membership, incuding medica students, doctors-in-training, career medica officers, GPs, and other speciaists. The AMA has aso estabished the AMA Counci of Rura Doctors (AMACRD) to ensure our rura members have a strong say in our poicy and advocacy. We are excited at the prospect of working with Professor Worey, and ook forward to meeting with him as soon as he settes into the new roe. Prof Worey is currenty Dean of Medicine at Finders University. He is a past President of Prof Pau Worey, Rura Heath Commissioner. the Rura Doctors Association of SA, a previous nationa Vice President of the Austraian Coege of Rura and Remote Medicine (ACRRM) and is a current Counci Member of AMA (SA). Attention AMA ACT Members, The Doctors Heath Advisory service (DHAS) extends a warm invitation to a Doctors and Medica Students in the ACT for: DINNER and an INTERACTIVE EVENING When: November 23rd 2017 from 6.30pm Where: AMA House Conference room, Leve 3, 42 Macquarie Street, Barton We are very aware of the importance of doctors having their own doctors. At the same time, in these cinica encounters there are often chaenges faced by both the doctor as a patient and the treating doctor. Over the course of the evening, we wi workshop topics such as: Barriers to doctors seeking medica care. Strategies to hep ensure the best possibe outcome for both doctors. Medica students as patients. Confi dentiaity and mandatory reporting. A doctors and medica students are wecome. RSVP by 16th November to Sarah Foster at sarah.foster@dhas.org.au or Pease advise any dietary requirements. [6] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017

7 AMA NSW Looking for GPs wiing to take on doctors as patients AMA NSW is ooking for GPs who have an interest in taking on doctors as patients particuary junior doctors in order to deveop an onine directory. This is part of an effort to both encourage junior doctors to seek care and remove barriers to this happening. Neither AMA NSW (nor AMA (ACT)) has such a resource and the information reaching AMA NSW from DITs was that they were constanty being tod to have a GP but often had rotated away from home or just did not know where to turn. AMA NSW issues a ca AMA NSW decided to put the ca out in a very simpe way to members and via PHNs and the Doctors Heath Advisory Service. They have aso promoted it on socia media and wi be continuing to do so over coming months with a view to finaising a resource by the end of the year. If you are interested in taking on doctor patients, pease sign up by going to the AMA NSW s website at doctor-in-training-webeing/ The directory wi be pubished as a resource for doctors-in-training. The AMA NSW s Dr Kean-Seng Lim, Dr Brian Morton, Prof Saxon Smith and Dr Robyn Napier. AMA CAREER ADVICE HUB Don t Leave Your Career To Fortune The AMA s Career Advice Service wi assist you with: Career Coaching Appications, CV s and interview skis Rea ife advice; and Much, much more. For more information contact: Christine Bri (Career Adviser) careers@ama.com.au ama.com.au/careers/ OCTOBER 2017 CANBERRA DOCTOR: Informing the Canberra medica community since 1988 [7]

8 OPINION Preparing the medica profession for assisted dying* BY DANE LYONS, ANU MEDICAL STUDENT Euthanasia and Physician Assisted suicide are topics that have been bubbing to the surface of debate for a number years. The Pariament of Victoria wi soon finaise a conscience vote on egisation that woud egaise vountary assisted dying and euthanasia. Whie the bi specifies vountary assisted dying, in cases where the patient is incapabe of administering the drug, the doctor woud administer the dose, meaning that the patient is receiving euthanasia. The Victorian egisation comes off the back of an upper house inquiry regarding end of ife choices, which recommended an assisted dying scheme be created and impemented. This egisation has the potentia to have a rippe effect right across the country if passed, and has had no troube in dividing opinions amongst the pubic and eading medica bodies. Understanding the terminoogy In the medica profession, Euthanasia is defined as the practice of intentionay ending a patient s ife to reieve suffering. Euthanasia can be active or passive, with passive referring to omission of treatment which woud be expected to keep the patient aive. Passive euthanasia is deemed acceptabe practice. Active euthanasia, the more contentious issue, is a deiberate act undertaken to end a patient s ife. Physician Assisted Suicide is defined as a physician aiding a suicide by providing the means for suicide or the necessary information for suicide to occur. For the purposes of this artice, the term euthanasia refers to active vountary euthanasia. The positions of representative organisations Earier this year, the AMA reeased a position statement which proposed that doctors shoud not be invoved in interventions that have as their primary intention the ending of a patient s ife. Paiative Care Austraia updated their position statement ast year, decaring that paiative care does not incude euthanasia or physician assisted suicide. In 2015, the Word Medica Association reaffirmed their 1987 statement that euthanasia... is unethica. In a recent survey, 50% of Austraian doctors beieved that they shoud not be invoved in euthanasia. The arguments against euthanasia can be separated into: Disagreement with the concept of intentionay hastening the process of death Those who do not beieve that such a concept can be Victorian Premier, Danie Andrews, right, with Deputy Premier, James Merino: on opposite sides of the vountary assisted dying issue. impemented in a way that maintains the utmost eve of pubic safety. To deve into the ethica side of the debate woud require a much onger artice, but I beieve that there are some important questions that we must ask ourseves is patient autonomy of greatest importance? Does the reief of suffering via a quick death or proonging of intoerabe ife do the most good for the patient? Can we maintain the utmost respect for human ife whie assisting in its demise? We need to chaenge our own initia emotiona reaction to the concept of assisted dying and contextuaise these reactions within the framework of our societa and biomedica perceptions towards death. Pubic interest considerations Arguments reating to the impementation of euthanasia, have the interests of the pubic at their core and therefore need to be appropriatey addressed. One such exampe is the notion that by egaising vountary euthanasia, we begin on a pathway to engaging in more dangerous and negative practices such as invountary euthanasia. This sippery sope argument is a consequentiaist ogica device that can be quashed by the mere fact that physician assisted suicide and or euthanasia has existed in paces such as Oregon and the Netherands since 1997 and 2002 respectivey. Studies have shown that physician assisted suicide has had no disproportionate impact on vunerabe peope within those jurisdictions. In Oregon in 2015, physician assisted suicide accounted for merey 0.39% of a deaths. In the Netherands, rates of euthanasia have risen to 4% annuay, however over 85% of these cases can be attributed to cancer, cardiac, pumonary and neurodegenerative diseases. These numbers do not refect communities in which a euthanasia or physician assisted suicide bi has ed to a downward spira. The topic of euthanasia is such an interesting debate as there are wide range of opinions that exist on a spectrum. At one end, we have those who beieve that the sanctity of ife shoud be preserved at a costs and giving up on ife is admitting defeat. Deputy Victorian premier James Merino went as far as saying that this bi endorses suicide, which is a ine I don t think our society shoud cross. Individua autonomy Whie on the other end of the spectrum, some have argued that peope shoud have compete autonomy over their ives and can freey make the choice to die at any time. Pro euthanasia advocate Phiip Nitschke, beieves that the Victorian bi does not go far enough to address the needs of the ageing popuation. Nitschke has stated that, it is a fundamenta human right for every adut of sound mind to be abe to pan for the end of their ife at a time of their choosing. Foowing this ine of thinking eads to asking: are we even having the correct debate? Do the strict guideines paced on such egisation merey interfere with a person s right to end their ife? As this compex, mutifaceted issue continues to be debated in the pubic forum, I urge us a to consider our thoughts, become informed and be prepared for this practice to be integrated into our heath care system. As medica professionas, we have a responsibiity to activey oversee the design, adoption and impementation of any euthanasia egisation. *References avaiabe on request. [8] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017

9 Aternative medicine in heath management: Is it ethica?* BY NUNZIO FRANCO, ANU MEDICAL STUDENT Austraia s compementary and aternative medicine (CAM) industry is one of the fastest growing, with companies seing about $4 biion of products per year. CAM refers to a wide range of products and treatments that are not considered to be part of conventiona medicine. Few have been abe to capture its definition more eoquenty than song-writer and comedian Tim Minchin: By definition, aternative medicine, has either not been proved to work, or been proved not to work [sic] you know what they ca aternative medicine that s been proved to work? Medicine. Attraction of aternative medicine But what is about CAM that is causing educated peope to beieve that a via of very expensive water can cure most of today s deadiest conditions? First of a, CAM has been around for a ong time, often presented as an aternative to boodetting or purging offered by 18th century medicine; I must admit it must have seemed the better choice in those days. Secondy, it is based on our tendency to find causation and association where there is none, as our brains are hard-wired to do so. Finay it is accessibe, and easy to reate to, certainy not as compicated as randomized controed trias, doube-binding and statistics that doctors keep mentioning. Doctors heath resources Are you ooking for a GP? If you re a junior doctor or medica student and ooking for a GP pease contact AMA (ACT) and we wi assist you to find a oca GP. Doctors Heath Resources onine AMA s Doctor Porta: doctorsheath/resources/ JMO Heath: Party funded by DHAS and a range of other organisations. Doctors Heath Advisory Service resources-for-junior-medicaofficers.htm On the DHAS website itsef. AMSA students and young doctors: about-the-campaign/ keeping-your-grass-greener/ Poor heath iteracy aso creates a breeding ground for compementary medicine. I beieve many CAM consumers woud put the homeopathic meatonin back on the shef if someone had taken the time to expain what homeopathy actuay is. Homeopathy: an exampe Whie I don t want to pick on a specific branch of CAM, et s take Dr. Hahnemann s homeopathic remedies as an exampe. Sometime during the 18th century, Dr. Hahnemann s decided the first principe of homeopathy: a substance that causes a specific symptom wi aso cure it. He soon reaised that giving too much of something to a patient can be very toxic, therefore the second principe quicky foowed: the more diuted the compound, the more potent it is. At the time it was not a probem that the typica homeopathic diution of 30C can be compared to having a drop of an ingredient in a spherica poo fied with water, with a diameter from the centre of the earth to the sun. When this became a probem, Dr. Hahnemann decided to revea the third and ast principe: water has memory! I don t have much to say on this one, except quoting T. Minchin again Take physics and bin it! Water has memory! And whie its memory of a ong ost drop of onion juice is infinite, it somehow forgets a the poo it s had in it! The point is that it is fundamenta that medica practitioners today understand what CAM reay is, and are abe to expain to any patient why it shoud not be part of their heath management. Having said this, there are many persuasive patients whose neighbour or great aunt was cured of a terribe iness with hypnosis after conventiona medicine had given up, and demands an expanation for it. An evidence base, pease This is where evidence based medicine proudy enters the scene. As you strugge to remember what you were taught in first year of medica schoo, you might mention the pacebo effect and the many studies that show its effectiveness, regression to the mean, the natura history of disease and that sometimes, doctors might have gotten the wrong diagnosis. Medica ethics and CAM When faced with the patient who takes natura remedies, most medica practitioners today are happy for them to continue to take the treatment as ong as the conventiona treatment is continued. But is it ethica for doctors to do this? There have been many reports of CAM being deeterious to patients with serious pathoogies. In Austraia, there is no independent assessment of the safety or efficacy of CAM remedies before they are aowed on the market and no contro over the quaity of products peope can purchase onine. As a resut, many independent studies show that some herba remedies can cause iver and kidney faiure due to the presence of naturay occurring toxins and heavy metas. Moreover there exist known interactions between certain prescription medications and CAM remedies, such as St John s Wort (Hypericum perforatum) and Cycosporine, which is known to ead to acute transpant rejection. Do no harm is definitey to be considered here by those practitioners who suggest or don t advocate against the use of CAM for serious conditions. Continued page OCTOBER 2017 CANBERRA DOCTOR: Informing the Canberra medica community since 1988 [9]

10 Reocating or cosing your practice? Be aware of your obigations in reation to your patients heath records BY DOMINIQUE EGAN, PARTNER & PATRICIA MARINOVIC, ASSOCIATE AT TRESSCOX LAWYERS Woud you know your egisative obigations in reation to your patients heath records if you reocated or permanenty cosed your Practice? Heath service providers (providers) must be aware of, and compiant with, a number of egisative requirements specific to the Austraian Capita Territory ( ACT ) when they reocate or permanenty cose their heath service practice (practice). Pubic notice Transfer request Whist a patient s transfer request can be made verbay, it is recommended providers request a transfer request in writing for certainty. Such requests ought to be dated, incude the patient s address and teephone number, stipuate whether the heath record wi be transferred to the patient or the patient s provider, and incude the patient s maiing address and / or the nominated provider s maiing address. Principe 11 of the Heath Records (Privacy and Access) Act 1997 provides that, at east 30 days before the proposed reocation or cosure of a practice, providers must give pubic notice of the practice s reocation or cosure. Further, providers must take other practicabe steps to inform each patient who has attended the practice of the matters mentioned in the pubic notice. Providers must ensure that the pubic notice states: The patient may request a copy or written summary of their heath record be given to them or to their nominated provider (transfer request); The transfer request must be made within 14 days of the pubic notice being pubished; Any fees that appy and, if fees appy, that the patient must pay these fees before their heath record wi be transferred; If the patient does not make a request within the 14 days, a copy of the patient s heath record wi be given to a stated provider or record keeper; and The address and contact detais for the stated provider or record keeper. Providers are aso required to notify ACT Heath of the pubic notice as soon as practicabe after the pubic notice is pubished. An onine form is avaiabe on the ACT Heath s website for providers to compete which, when submitted, is forwarded to the ACT Heath Services Commissioner. Fees The fees which may appy in reation to the transfer of a patient s heath record are set out in the Heath Records (Privacy and Access) (Fees) Determination 2016 (No 1). Fees incude those payabe for viewing a heath record, provision of a copy of a heath record up to 50 pages / more than 50 pages, and provision of a heath record summary. Timeframe for providing records If a provider receives a transfer request, it must provide the patient or the patient s nominated provider with a copy of the requested heath record or written summary within 30 days foowing the provider s receipt of the transfer request. If however a fee is payabe for the heath record, the provider must provide a copy of the heath record within 7 days after the fee is paid. In circumstances where a patient is receiving or needs urgent heath services, the provider must provide the patient or the patient s nominated provider with a copy of the heath records or written summary within 7 days after the date the provider receives the transfer request. A patient is considered to be receiving urgent heath services if another provider informs the provider that the patient is receiving or needs urgent heath services. This advice does not need to be in writing. Further, the provider may be satisfied that a patient is receiving or needs urgent heath services without the receipt of advice from another provider. For exampe, this may be based on the patient s medica history, the patient s immediate circumstances, or any other information or evidence which may be reevant in the circumstances. Faiure to receive patient request If a patient does not make a transfer request within 14 days of the pubic notice being pubished, the provider must provide a copy of the records to the provider or record keeper stated in the pubic notice within 44 days of the pubic notice being pubished. How does this impact you? The reocation or cosure of a practice is often a matter which medica practitioners do not consider in their everyday practice. The egisative obigations for providers in the ACT in reation to the reocation or cosure of a practice are substantia and, as outined above, a number of strict timeframes must be met. It is prudent providers are mindfu of their obigations in this regard and seek ega advice if they require any advice or assistance to compy with their egisative obigations. [10] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017

11 FDG PET/CT for recurrent breast cancer BY DR KHIMLING TEW, MBBS FRACS FRANZCR, CANBERRA IMAGING GROUP ASSOCIATE RADIOLOGIST A patient with a sterna mass from recurrent breast cancer and a sma ung nodue (4mm) was referred for FDG PET/CT scan. The mass showed markedy increased metaboic activity. Metastatic disease in an enarged interna mammary node was aso demonstrated (fig. 1). There was unexpected disease in a posterior paravertebra node (fig. 2). However, the sma ung nodue was not visiby FDG-avid. Fig 1 Fig 2 This case iustrates both the strengths and shortcomings of FDG PET/CT for breast cancer. In a study of 56 patients with ocoregiona recurrence, PET/CT showed more sites of metastatic disease than conventiona imaging in 57% and changed management from extensive surgery to paiative treatment in 36%. However, PET/ CT is ess sensitive for sma esions (<10mm) because of tracer/ detector imits and partia-voume effect. FDG PET/CT is usefu in evauating arger tumours, advanced and metastatic breast cancer. In a study of patient with primary tumours >2cm diameter, 21% were upstaged and 16% downstaged by PET/CT. Progression-free surviva was more strongy associated with staging by PET/CT than conventiona imaging. Lobuar carcinoma shows ess FDG uptake than other types, with reduction in sensitivity. High grade, oestrogen receptor negative and tripe negative tumours show greater FDG uptake. Cerebra, skin, soft tissue, peritonea and bowe metastases may be demonstrated. Extranoda metastases are associated with poor prognosis. FDG PET/CT is superior to bone scan for detecting ytic bone metastases and comparabe for osteobastic esions. It is aso usefu in evauating response to treatment after just 1 cyce of chemotherapy, avoiding futie chemotherapy in non-responders. PET/CT with Fuorine-18 estradio has been used to study tumour expression of oestrogen receptors in-vivo. The response rate of ER+ tumours (based on immunohistochemistry) to endocrine therapy is 55-60%. There is evidence that metastases are ess ikey to be ER+/PR+ and more ikey HER2+ than the primary tumour. MEDICAL BENEVOLENT ASSOCIATION OF NSW BY DOCTORS FOR DOCTORS The Medica Benevoent Association of NSW (MBANSW) Provides a free and confidentia support service to Canberra doctors in need and their famiy. Financia assistance and counseing support are avaiabe to coeagues who have faen on hard times through iness or untimey death. Support is aso avaiabe to medica practitioners who may be experiencing difficuties at work or in their persona reationships. The MBANSW is funded by your donations; pease aow us to continue to provide support and assistance to your coeagues in need by making a donation to the Medica Benevoent Association Annua Appea. Donations can be made visiting our website www. mbansw.org.au If you are concerned about your own situation or that of a coeague, pease contact the MBANSW Socia Worker, Meredith McVey on (02) OCTOBER 2017 CANBERRA DOCTOR: Informing the Canberra medica community since 1988 [11]

12 Aternative medicine continued...from page 9 Patients who are overa we and use CAM to strengthen their immune system (watch out for autoimmune diseases) or cure infuenza with evening primrose, most of the time face no serious consequences. But imagine a scenario where a heathy patient with sudden weight oss, ow grade fever, night sweats and a ump in the neck deays their GP appointment to give natura remedies a chance to hep? What if the patient was finay diagnosed and treated with conventiona medicine, aongside CAM remedy and competey recovered, wi the credit be given to conventiona treatment or to the natura remedy? This is not important just so doctors can receive a pat on the shouder, but what if the patient decides that CAM remedy was the treatment that actuay worked. The story wi be tod to many peope and many more who might not be as ucky and present to their GP in time. Advocates against CAM It is my beief that doctors, as a group, have a mora, ethica, and a professiona obigation to advocate against CAM and the increasing roe it is paying in the management of patient s heath. The situation becomes more difficut in everyday practice when a patient decides to incude CAM in their disease management. In this situation it is up to the singe doctor to be abe to express their concerns without antagonising the patient. This must be done without compromising the deivery of effective and high quaity care, as the heath of the patient must aways come first. *References avaiabe on request. PRIVATE PRACTICE WORKSHOP: SAFETY and WORKERS COMPENSATION The AMA (ACT) s Tony Chase (Manager of Workpace Reations and Genera Practice) and David Seagrott (Principa Consutant, Austraian Heath and Safety Services) wi be speaking at this event and addressing concerns of particuar interest to medica practices in the ACT. DAVID SEGROTT MBA, BA (Admin) and Industria Safety Certificate. David has over 40 years experience in the heath and safety fied and hods professiona memberships of the Safety Institute of Austraia, the Austraian Institute of Company Directors, the Risk Management Institution of Austraasia and the Austraia and New Zeaand Institute of Insurance and Finance. David wi provide a comprehensive presentation on the safety issues ikey to be encountered in any medica practice incuding: Overview of WHS Laws in the ACT Hazards and Risks Vioence and Aggression in the workpace Buying and Harassment Manua Handing Working with Sharps and Steriization Hazardous Waste David wi aso tak aong with Tony Chase about the ACT Workers Compensation Scheme and how it works. TONY CHASE joined AMA (ACT) in 2016 and is an experienced workpace reations practitioner. He has worked across both the private and pubic sectors, appearing in most Austraian industria tribunas representing sma and medium businesses. Tony has aso worked as a workpace mediator and investigator for the Commonweath Government. Tony wi provide a comprehensive presentation on the foowing topics: An Overview The ACT Workers Compensation Act A sma business perspective Case Studies Why are workers compensation premiums so high in the ACT? Is your business vunerabe to caims? How to protect your business against unreasonabe caims. WHO SHOULD ATTEND: Practice principas, practice managers and other practice staff WHEN: 4-6pm Wednesday 22nd November, 2017 WHERE: AMA House, Leve 3 Conference room, 42 Macquarie Street, Barton COST: $100 for AMA members and/or their practice staff OR $200 for non-members and/or their practice staff CONTACT: Karen Fraser reception@ama-act.com.au or ca our office on [12] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017

13 Using shares to increase the yied on your investments Unfortunatey we are iving in a word where it is very difficut to receive yied in the traditiona manner. The RBA has driven rates so ow that traditiona savings account returns are virtuay zero, Bond rates are beow 2.7% and the property market has been driven higher by significant everage; this combines with the average combined capita city renta yieds being under 3.2% and you sti need to pay a the hoding costs!!!! So how do we create yied in such an environment? A strategy that a investors can use is to combine high dividend paying bue chips shares with exchange traded options. premium, but be taken out of the 1,000 shares by the owner of the ca. However, if that were to happen, he coud simpy buy his stock or Option back, and start seing cas a over again. Covered cas An investor coud consider the covered ca strategy against virtuay any bue chip stock hed. This is a great too as any income generated compements the fuy franked dividend yied. A covered ca is a strategy that consists of owning an underying stock and seing an option against the stock. Since a ca option represents 100 shares of the underying stock, you can se one ca against each 100 shares of stock you own. Because you own the stock, your short ca position is covered by the stock. A short option position by itsef (without the stock) is more risky, and requires a substantia margin baance. A short ca on stock you own, on the other hand, is a very conservative strategy that requires no margin. Let s dive a bit deeper into this strategy. As of the Wednesday 1st Juy, CBA was trading at $83 and as an owner of 1,000 shares, he sod ten cas against his stock position to create some extra yied. For exampe, he coud se ten September $85 cas for $1.25 each. If CBA stays beow $85 by the September expiration, he wi coect $1,250 tota ($1.25 x 100 for each contract) a yied of 1.5% in just three months. If he was abe to repicate this four times a year, he earn 6%. Add this to the annua 5.5% dividend yied and you are ooking at an investment yieding north of 10% aone. If CBA rises above $85, he wi have made $2,000 on his stock, pus he wi have banked the ca Writing Put Options Writing puts is a more compex strategy, but when broken down and understood, this can be a tremendous investment strategy, and a great way to create yied for a investors. Let s start with what a put is. A Put Option is a contract between two parties to exchange an underying stock, at a specific price, on a predetermined date. The buyer of the put has the right to se the underying stock at a set price. The seer of the put has the obigation to buy the underying stock at the set price. If you write a put, you are the seer of the put. This can be thought of in terms of insurance: you re the insurance agency, and the buyer of the put is the poicy owner. If the owner of the Put decides to exercise his right, you wi be required to buy the stock at the predetermined price. However, as the seer of the put (the insurance agency), you receive a premium. Here at Speciaist Weath Group we recenty estabished a sod put on BHP for some of our cients which was trading at $ We fet comfortabe that the goba refation trade woud continue and in turn support BHP. We were happy to buy the stock at $22.50 so we ooked to se the 30 contracts of the $22.50 puts for $0.50. The options were executed in eary Juy and are due to expire at the end of September (3 months) If the BHP stock price stays above $22.50 for the expiry of the September option, we wi coect the $1,500 we received for seing the Put initiay. This put is provided an income of 2.2% for three months which is 8.8% annuaised. There is risk associated with this trade: if BHP dropped beow $22.50, we woud be required to buy BHP shares at $22.50 ess the premium we received. But as I said earier, we are comfortabe buying BHP sub $22.50, which is a 6.6% discount to where the stock was trading at the time. This is a strategy many investors use to enter a stock at a predetermined price. If we fee that BHP is overvaued at its current price of $24.00, but am comfortabe buying the stock at $22.50 or ess, this is a great way to buy the stock at that eve if the price drops. And if it doesn t, we sti coect the premium and can aways se another put ater on. In concusion, there are countess ways to use options to create yied. Covered cas shoud be in every investor s paybook. And writing puts is a tremendous strategy to enter a stock at a good price and create additiona income. To find out how to create additiona income in your investments or SMSF, ca us for more information on these and other strategies OCTOBER 2017 CANBERRA DOCTOR: Informing the Canberra medica community since 1988 [13]

14 Grief and bereavement: To support or treat?* BY SONIA FENWICK & MANDY COX, CANBERRA GRIEF CENTRE** To be human is to experience oss; of home, country, identity, resources, empoyment, reationship, heath, opportunity, future. And in response to this, we grieve. Grief is necessary and appropriate. Grieving is the process of adjusting to new in the wake of what has been taken from us through oss or death. Bereavement (the experience of oss foowing a death) is a oss accompanied with finaity ike no other. In these circumstances, the work of grief requires us to accept the reaity and finaity of the death, to process the ayers of oss that sit around the death, to confront and attend to the mutidimensiona aspects of the pain (physica, emotiona, cognitive, spiritua pains) and embark on the process of change, adaption and re-defining sef in the absence of the person. No magic or timeine There is no magic nor prescribed timeine for this process. It can t be hurried, nor shoud it be. Good bereavement outcomes rey on a number of factors but none so important as permission and support to grieve in the midst of re-shaping a new sense of iving. Humans have an innate capacity to grieve we with minima or no intervention from professiona services when permitted to do so. The bereaved instinctivey know what it is they need, or at east don t need, in order to attend to this experience. The bereaved are not broken, they are grieving. There is nothing to fix. Instead, in the absence of a key attachment which has been disrupted by death, grief seeks other supportive attachments without judgement or expectation. A too frequenty, grief is misdiagnosed, misabeed or missed competey. We seek ways to treat it, to move it aong, to create a more sociay acceptabe iusion of happiness to fit with a paradigm of weness. In many cases we pre-emptivey abe it depression and support it with a pharmacoogica response. Grief is not depression. It is sadness. Treatment may be necessary However, where major depressive disorder (MDD) presents in bereavement (more commony presents where there is a history of depression rather than a singe episode), evidence suggests, pharmacoogica treatment in coaboration with grief therapy can reduce the risk of more compex and compicated presentations in grief. As heath practitioners, we must be cautious about imposing our own fears (of cient deterioration in heath or other factors) on the bereaved. Toerance to hod the space of grief chaos is chaenging but essentia. A premature pharmacoogica response or inappropriate therapeutic intervention can inhibit and disrupt innate resiience and capacity, increasing the risk of compicated and pathoogica grief. In the midst of the most tragic of deaths and osses, most peope have a capacity to endure, survive and thrive, but ony where a grief sympathetic environment exists; one which is permissive, empowering and focused on what the bereaved are managing rather than what they are not managing (strengths based). Cient experience insights There is more to grief than Kuber- Ross. Research, studies and cient experiences have provided significant insight and advancements in our understanding of when grief is being deraied. In order to promote good bereavement outcomes, it is imperative that heath professionas upski in understanding the difference between heathy grief and more compex, compicated, pathoogica presentations. An experienced and trained grief therapist wi assist the bereaved to cope and manage the whoe grief response, eiminating the need to avoid, deny and medicate that which must be adapted to and ived with. Our experience with many variants of oss, indicates that for most ci- Grief is a human, not medica, condition, and whie there are pis to hep us to forget it there are no pis to cure it. The things is, nature is so exact, it hurts exacty as much as it is worth, so in a way one reishes the pain, I think. Juian Barnes, Leves of Life (2013) ents an average of 4-5 visits with a counseor (where the therapist is specificay trained in and experienced with grief) is sufficient to promote a new and heathy reationship with their grief. Foowing this time, cients might choose to return in anticipation of certain dates, occasions or where the presenting oss has been aggravated by another ife stressor/event. *References avaiabe on request. **Canberra Grief Centre is a private practice managed and owned by Sonia Fenwick and Mandy Cox, professionay registered counseors supporting death, dying and oss. Cients can sefrefer or consent to another person faciitating contact with the Centre. Sonia and Mandy are abe to consut with GPs about cient cases invoving genera or more compex presentations of grief as a means of designing a heathy bereavement pathway for the cient. Further information about on the services avaiabe can be found at BE REWARDED REFER A MEMBER AND RECEIVE A DISCOUNT ON OUR MEMBERSHIP RATES REFER 1 MEMBER 25% discount on your membership REFER 2 MEMBERS 50% discount on your membership REFER 3 MEMBERS 75% discount on your membership REFER 4 MEMBERS No membership fee for one year Qantas Cub membership rates for AMA members Joining Fee: $240 (save $140) 1 Year Membership: $ (save $119.30) 2 Year Membership: $ (save $227.50) (a rates are incusive of GST) To renew your Qantas Cub Corporate Membership contact the secretariat to obtain the AMA corporate scheme number. For new memberships downoad the appication from the Members Ony section of the AMA ACT website: For further information or an appication form pease contact the ACT AMA secretariat on or downoad the appication from the Members Ony section of the AMA ACT website: [14] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017

15 AMA ACT membership entites you to access this Member Reward Partner BELLUCI S RESTAURANTS Ph: (02) (Phiip) Ph: (02) (Manuka) Award winning, casua Itaian dining. Conditions may appy and you must produce your membership card to access these benefi ts. AMA ACT membership entites you to access this Member Reward Partner CRABTREE & EVELYN Ph: (02) Bath and body products, gourmet foods, candes, home decor, and gifts for any occasion Conditions may appy and you must produce your membership card to access these benefi ts. AMA ACT membership entites you to access this Member Reward Partner THE ESSENTIAL INGREDIENT Ph: (02) Inspiring great cooking with ingredients, books and cookware Conditions may appy and you must produce your membership card to access these benefi ts. FOR SALE GENERAL PRACTICE in TUGGERANONG region Long estabished Private biing Contact Richard on MEDICAL CONSULTING ROOMS FOR LEASE 3 Consuting rooms (12m 2 each) Lease singe room, if needed. Modern Fit-out Spacious waiting room Car park Short or Long term ease option Lidia Perin Medica Centre, Deakin CONTACT: David Grimmond Civium Property Group AMA ACT membership entites you to access this Member Reward Partner HOTEL REALM Ph: (02) Accommodation ony Conditions may appy and you must produce your membership card to access these benefi ts. AMA ACT membership entites you to access this Member Reward Partner EVO HEALTH CLUB Ph: (02) Hote Ream Conditions may appy and you must produce your membership card to access these benefi ts. AMA ACT membership entites you to access this Member Reward Partner Jirra Wines Jirra Wines Fax: You don t need to go to Tuscany for good Itaian wines. Canberra has a cimate very cose to Tuscany s. Conditions may appy and you must produce your membership card to access these benefits. AMA ACT membership entites you to access this Member Reward Partner Joanne Fowers Ph: (02) Beautifu Fowers and Gifts Conditions may appy and you must produce your membership card to access these benefits. Membership Rewards Program Partners ~ 10% discount* See Page 12 for detais * conditions may appy. To Advertise in Canberra Doctor Contact Karen Fraser emai: reception@ ama-act.com.au CONSULTING ROOM FOR RENT Fuy fitted out room with fu secretaria support on a sessiona or daiy basis in the John James Medica Centre. Contact or the Practice Manager on A News Magazine for a Doctors in the Canberra Region ISSN 13118X25 Pubished by the Austraian Medica Association (ACT) Limited 42 Macquarie St Barton (PO Box 560, Curtin ACT 2605) Editoria: Peter Somervie Ph Fax execofficer@ama-act.com.au Typesetting: Design Graphix Ph Editoria Committee: Peter Somervie Production Mngr Dr Ray Cook Dr John Donovan A/Prof Jeffrey Looi Advertising: Ph , Fax reception@ama-act.com.au Artices: Copy is preferred by emai to execofficer@ama-act.com.au in Microsoft Word or RTF format, (not PDF) with graphics in TIFF, EPS or JPEG format. Next edition of Canberra Doctor November Dr Caire Rebentrost GENERAL PAEDIATRICIAN Dr Caire Rebentrost is now taking referras for Genera Paediatrics incuding: Epiepsy Growth & Deveopment Eczema Constipation Asthma Adoescent Heath Paediatric Trave Heath & Vaccination Pease fax or emai referras to: Yarrauma Surgery & Professiona Suites 1/18 Bentham Street, Yarrauma ACT 2600 Ph: Fax: emai: reception@yarraumasurgery.com.au Dr Manina Pathak MBS, MPH, FRACP DEVELOPMENTAL & BEHAVIOURAL PAEDIATRICIAN Dr Manina Pathak is taking referras and providing paediatric evauation and management for a range of issues incuding: Autism spectrum disorders Attention probems (incuding ADHD) Deveopmenta deay Inteectua disabiities Learning difficuties at schoo and specific earning disabiities Behavioura and seep probems Deveopmenta assessment and surveiance of chidren with disabiities Famiy difficuties in managing chid deveopmenta deays/behavioura probems Pease fax or emai referras to: Yarrauma Surgery & Professiona Suites 1/18 Bentham Street, Yarrauma ACT 2600 Ph: Fax: emai: reception@yarraumasurgery.com.au Discaimer The Austraian Medica Association (ACT) Limited sha not be responsibe in any manner whatsoever to any person who reies, in whoe or in part, on the contents of this pubication uness authorised in writing by it. The comments or concusion set out in this pubication are not necessariy approved or endorsed by the Aust raian Medica Association (ACT) Limited. OCTOBER 2017 CANBERRA DOCTOR: Informing the Canberra medica community since 1988 [15]

16 ROOMS AVAILABLE for Sessiona/Daiy or Weeky use, serviced or unserviced rooms 25 Napier Cose, Deakin ACT Contact Rebecca GORDON FAMILY PRACTICE has a position avaiabe for a FT or PT GP Contact Cate on: Dr Hodo Haxhimoa Suite 14, Leve 5 Nationa Capita Private Hospita Corner Gimore Crescent & Hospita Road Garran ACT 2605 Ph: (02) Fx: (02) Prostate cancer treatment Robotic radica prostatectomy Robotic partia nephrectomy Robotic pyeopasty Laparoscopic radica prostatectomy Laparoscopic nephrectomy Laser treatment for BPH Laser stone treatment MRI guided prostate biopsy Erectie dysfunction Peyronie s disease Mae incontinence surgery To Advertise in Canberra Doctor Contact Karen Fraser emai: reception@ ama-act.com.au CANBERRA LASER AND GYNAECOLOGY CENTRE coposcopy & aser endoscopic surgery speciaist gynaecoogy treatment of proapse and incontinence Dr. P.M.V. Mutton MBBS, FRCOG, FRANZCOG for prompt, personaised and experienced care GREY STREET DEAKIN ACT 2600 FAX Orthopaedic Surgeon PRACTICE LOCATION Dr Wisam Ihsheish MBBS (Ade) FRACS (orth) FAOrthoA Knee arthroscopic surgery, hip and knee repacements and genera orthopaedics Accepting new referras in Canberra and Gouburn CANBERRA 5/5 Baratta St, Crace ACT 2911 Ph Fax GOULBURN ELLESMERE SPECIALIST CENTRE Cifford St, Gouburn NSW 2580 Ph Fax Dr Muhammad Choudhry FRACP GeriatriCian n Interest in kidney disease in the edery n Comprehensive geriatric assessment n Cognitive assessment n Home visits n Residentia aged care consutation provided n Buk biing Suit 11/12 Napier Cose, Deakin ACT 2605 Phone Fax Emai canberrageriatrics@yahoo.com Associate Professor A. J. Coins MB BS FRACS Breast and Thyroid Surgeon Oncopastic Breast Surgery incuding: w Immediate breast reconstruction and breast reduction techniques w Breast Cancer surgery w Sentine node biopsy Thyroid and Parathyroid surgery Address: Suite 4A, Leve 2 Nationa Capita Private Hospita Phone: Fax: Dr Damian Smith DR SMITH SPECIALISES IN THE FOLLOWING: Robotic & Computer assisted joint repacement surgery Hip repacement Knee repacement ACL reconstruction Meniscus repair surgery Tibia and femora osteotomies for arthritis Mutiigament surgery Achies tendon repair Patients do not need to have private heath insurance to be seen by Dr Smith in his consuting rooms. Phone: Emai: dsmith.admin@orthoact.com.au Leve 2, 90 Corinna Street, Woden ACT 2606 Dr Andrew Foote Obstetrician, Gynaecoogist & Urogynaecoogist Over 20 years experience Specia Interests in: - NEW: Botox Intravesica Injections for OAB - obstetrics - proapse - incontinence - Mona Lisa vagina aser 1/30 Bougainvie Street, Manuka Phone 1800 URO GYN WOMEN S HEALTH ON STRICKLAND Dr Liz Gaagher, Dr Omar Adham, Marita O Shea ~ Physiotherapy for pevic foor dysfunction, proapse, incontinence and pregnancy ~ MonaLisa Touch aser treatment ~ Obstetric care incuding high risk pregnancies ~ Genera gynaecoogy ~ Urodynamics ~ Treatment of abnorma pap smears incuding Coposcopy, biopsy and LLETZ treatment ~ Pevic foor repairs ~Incontinence ~ Treatment of endometriosis ~ Laparoscopic surgery For further information pease ca the practice on or emai reception@womensheathonstrickand.com.au New ocation in Braddon [16] CANBERRA DOCTOR: Informing the Canberra medica community since 1988 OCTOBER 2017