Medicus April 2016

IA

WESTERN AUSTRALIA

Journal of the Australian Medical Association WA | April 2016 Volume 56 / Issue 3 | amawa.com.au

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Followuson

Followuson

032416-411

032416-411

Council President Dr Michael Gannon Immediate Past President Dr Richard Choong

APRIL 2016

Vice Presidents Dr Andrew Miller Dr Omar Khorshid Honorary Secretary Dr Janice Bell Assistant Honorary Secretary Dr Marcus Tan Honorary Treasurer Professor Bernard Pearn-Rowe Councillors Division of General Practice (WA) Dr Steve Wilson A/Prof Rosanna Capolingua Division of Specialty Practice Dr Tony Ryan Dr Martin Chapman Division of Salaried and State

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Shattering the Silence AMA (WA) Survey reveals endemic sexual harassment crisis

Government Service Dr Mark Duncan-Smith Dr Dror Maor Ordinary Members Dr Daniel Heredia Dr Stuart Salfinger Dr David McCoubrie Prof Geoff Dobb Co-opted Members Dr Steve Wilson Dr Tim Koh A/Prof Peter Maguire

• Dr David Russell-Weisz • Dr Andrew Miller • Dr Omar Khorshid • Dr Melita Cirillo • Dr Chris Wilson • Dr Michael Page • Prof Shirley Bowen • A/Prof Angela Alessandri • Dr Michael Stanford • Kevin Cass-Ryall

Dr Michael Page Dr Chris Wilson Dr Ian Jenkins

Prof John Newnham Prof Shirley Bowen Mr Daniel Dorevitch Mr Sid Narula AMA (WA) Office Executive Director Mr Paul Boyatzis Director: Industrial & Legal

FEATURES

Ms Marcia Kuhne Executive Officers

Mr Michael Prendergast Ms Josphine Auerbach

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Mr Simon Bibby Ms Leah Pantelis

Passing on the public health baton Professor Mike Daube’s call to arms

14 Stirling Highway Nedlands WA 6009 (08) 9273 3000 mail@amawa.com.au www.amawa.com.au Medicus Editor and Director of Communications

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Making a Difference State President Dr Michael Gannon on why he is running for the AMA’s top job

REGULARS 02 President’s Desk 03 From the Editor 04 Industrial 06 Letters 8 Comment: Prof Mike Daube 11 Comment: Dr Michael Gannon 12 News 18 Cover Story:

Mr Robert Reid Deputy Editor Ms Janine Martin Advertising Inquiries Phone Mr Des Michael (08) 9273 3000 Copy Submissions Phone Ms Janine Martin (08) 9273 3009 or janine.martin@amawa.com.au 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.

58 Technology 61 Drive 62 Travel

43 Clinical Edge 48 For the Record: Dr Matthew Summerscales &

65 Wine 67 Food 68 Member Benefits & On the Town 71 Classifieds Professional Appointments, Positions Vacant, Rooms for Sale/Lease 75 Greensheet

Dr Michele Genevieve

51 Opinion:

Dr Michael Sala

52 Opinion:

Daniel Dorevitch

53 Opinion:

Sid Narula 54 AMA in the Media 56 Family Law

Shattering the Silence

40 Opinion: COGP 41 Opinion: RACGP

A P R I L 2 0 1 6 M E D I C U S 1

P R E S I D E N T ’ S D E S K

Stamp out instances which diminish our proud profession

T his edition of Medicus has on the topic as recently as October. I applaud my friend and colleague Dr Tony Bartone, President of AMA Victoria, for the outstanding work he and his colleagues have done in convening a symposium. The College of Surgeons' good work continues. Other state AMAs and Colleges are responding to the issue. In WA, we have convened a taskforce with nominees from the Health Department and representatives of the AMA to progress the issue. I am delighted that AMA (WA) Vice President and Head of Department, Orthopaedic Surgery at Fremantle Hospital, Dr Omar Khorshid, and Head of Department, Orthopaedic Surgery at Princess Margaret Hospital, been dedicated to the issue of Sexual Harassment. I wrote

Dr Kate Stannage, have accepted my invitation to represent their colleagues on this important group. Dr Melita Cirillo, previously Chair of the AMA Doctors in Training Committee, is also on the Taskforce and will provide an important junior doctor perspective. There can be no question that sexual harassment is unacceptable, unethical and entirely inappropriate. Unsafe workplaces threaten the safety of our patients. In recent months, the AMA has also written to other major employers including the Universities, St John of God Health Care and Ramsay Health Care. We hope to continue to work collaboratively with them on this very complex problem. Of course, the dominant employer in the health system is the Department of Health. There is broad agreement that there should be a zero tolerance approach to inappropriate behaviour. Working out appropriate reporting mechanisms will require careful thought. It would be inappropriate for the AMA to ‘own’ the process with doctors in training perhaps fearing the power of consultants and their relationships with AMA Councillors. We know from the survey on Sexual Harassment in the Workplace that the Health Department does not currently have the appropriate mechanisms for it to be reported without a threat to reputation and career progression. I do not believe the Medical Board to be the appropriate authority.

Survey on Sexual Harassment in the Workplace, which show exactly how hard our colleagues have found it to report incidents in the past. Any mechanism also needs to recognise principles of natural justice in protecting the accused. We have seen with the change to the reporting culture to the Medical Board and AHPRA in recent years, how easy it is for our colleagues to face great stress, sadness and anxiety from vexatious claims. Sadly, the most frivolous of complaints can still take months to go away. The processes also need to be nimble enough to recognise changes in the dynamics of the profession. The most common form of bullying and harassment I have observed in my career has been the behaviour of midwives towards male medical students and female registrars. The attitude to young men on public hospital labour wards is one factor contributing to the fact that now only around 15 per cent of trainees in my specialty of Obstetrics and Gynaecology are male. This area of practice will be richer if this number increases again. I have no doubt that surgical practice will be a great deal richer if it can fix negative aspects of its culture and encourage more women to commence and successfully complete training. This month’s edition of Medicus will make for uncomfortable reading. But the amazing response to the survey suggests that we have a very sad, but very real problem. These issues are in no way limited to medical practice, but our hierarchical

In this edition, you will see the results of the AMA (WA)

Continued on page 3

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F R O M T H E E D I T O R

Re-tread Minister will be under pressure A ustralian Medical Association (WA) President Dr Michael Gannon sent The 2003-04 Annual Report, with its “Director General’s Overview” written harassment of all WA medical professionals was first decided on last

year, it has been an intensive job of writing the survey, collating the data, interpreting the worrying results and deciding the best way to approach what is obviously an insidious practice. More importantly, we did not want to just have a story about the survey, or even to just have a range of views about what we already knew was a problem. Rather, we wanted to start a discussion on how to find ways to fix this problem. The establishment of a Taskforce between the Health Department and the AMA (WA) is a small but a positive start. We thank all those who have put their hands up to join the Taskforce. It will not be easy work and it will, we suspect, be frustrating at times. We will be a better profession and a better society as a result of those who helped with the original idea, the questions, and those who will help plan the road ahead.

by Professor Mike Daube, reveals a total health budget of $3.1 billion, 646,000 emergency department visits and a total population of 1.94 million. The 2013-14 Annual Report, written by Professor Bryant Stokes, reports on a population of 2.6 million, a total health budget of $8.1 billion; and ED visits of just over a million a year. And not only is the department and health massively bigger than when Mr Day left it but the political pressure has also grown. Only time will tell if Mr Day’s revered “safe pair of hands” can handle the tsunami of problems currently lapping the upper levels of Dumas House. However, he can be reassured that the AMA (WA) is willing to assist him in the job. Before I end this column, mention must be made of the many hours that so many people gave to makes this edition of Medicus one of the most important we have published in years. Since the idea of a survey on sexual Thank you for your courage

a letter of congratulations to new State Health Minister, the Hon. John Day on the day he was sworn into his new ministerial position, beginning with the immortal introductory line: “Welcome back!” The AMA (WA) knows Minister Day well, and he knows the AMA, it should be said. We are confident that we will be able to work with him, and engage him in the same way that we did when he last had responsibility for the State’s biggest portfolio. Mr Day served as Health Minister from 1998 to 2001 and health is sometimes given by armchair psephologists as a reason that the Richard Court Liberal Government lost its bid for a third term. But while Mr Day might know his way around health, he will find a very different health service to the one he left a decade and a half ago and will be shocked with just how huge it has grown. It is fascinating to compare two annual reports from the Health Department.

To shine a light into the darkest corners of society is to promote change. ■

Stamp out instances which diminish our proud profession Dr Michael Gannon Continued from page 2

structures lend themselves to harassment and indeed bullying.

It is occasionally the case that the AMA’s industrial and professional

working environment, adversely affect the care we provide our patients. ■

There is an inherent power imbalance between teacher and student, between consultant and registrar/resident. Wherever this exists, there are some who will seek to take advantage of it.

responsibilities can be at odds with each other. This is not the case here, where we need to stamp out instances which diminish us collectively as a proud profession, and by producing an unsafe

Dr Michael Gannon AMA (WA) President

A P R I L 2 0 1 6 M E D I C U S 3

I N D U S T R I A L SNAPSHOTS

THE AMA (WA) understands that practitioners have recently been sent a copy of the Operational Directive 0639/15 which requires senior doctors to keep a daily record of their start and finish times or alternatively maintain a timesheet. It is the Association’s strong view that the Directive is in breach of the provisions of the AMA Agreements which have consistently referred to senior practitioners being engaged on a no-fixed hours basis consistent with professional practice, and which speak of a full-time professional commitment being an average of 40 hours per week. The Association has formalised its objection to the Directive to the Director General and has called upon him to withdraw the Directive as far as it pertains to medical practitioners. On the facing page is a copy of the Association’s correspondence. ■ PROFESSIONAL COMMITMENT - EMPLOYEE RECORD OF ATTENDANCE

SALARIES CLAIMS

CLINICAL ACADEMIC CONTRACTS

FURTHER TO ARTICLES published in the last several editions of Medicus , the AMA (WA) served its 2016 public sector salaries claim on the Minister for Health on 3 March 2016. WA Health’s Director General has advised the AMA that the Department will commence negotiations once approval has been obtained from the Minister and the Treasurer, expected by early April 2016. Updates will be published on the AMA website. Specific claims for WACHS doctors and clinical academics will follow in due course. ■

THE ASSOCIATION IS aware that clinical academic contracts are being questioned and may not be renewed, in some cases, at the time of expiry due to funding issues. If you are concerned about your future contract, please contact the AMA (WA). ■

PUBLIC SECTOR RECRUITMENT FREEZE

ON 21 DECEMBER 2015, the WA Government announced an immediate public sector wide external recruitment freeze. Despite the growing demand on healthcare services and the increasing burden placed on WA’s medical workforce, the recruitment freeze applies to all government agencies, including health. The AMA (WA) has opposed the recruitment freeze and surveyed members in order to gauge its impact on the provision of services in public healthcare facilities and the medical workforce. The results have indicated that the freeze has had a significant negative impact on the capacity of hospital departments to provide best practice patient care, while also negatively impacting the morale of medical practitioners. Respondents have highlighted services operating: with fewer staff than is clinically recommended by the specialist Colleges; on the basis of no leave cover for unfilled positions; and an

expectation that work will be completed in non-rostered, unpaid overtime. With departments reliable on locums to fill vacant positions, the cost of reliance on locums demonstrates the false economy inherent in the freeze. Respondents have highlighted their inability to access leave entitlements, leading to a lack of capacity to provide clinical services and a collapse in morale.The impact of the freeze has been greater felt in rural and remote areas, where services were already experiencing staff shortages, prior to the commencement of the suspension. The AMA (WA) continues to advocate for an immediate exemption for all health positions so that medical practitioners have the capacity to provide a safe and quality level of healthcare. ■

Continued on page 7

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I N D U S T R I A L

10 March 2016 10 March 2016

Dr David Russell-Weisz Director General Department of Health 189 Royal Street EAST PERTH WA 6004 Dr David Russell-Weisz Director General Department of Health 189 Royal Street EAST PERTH WA 6004

Dear Dr Russell-Weisz PROFESSIONAL RESPONSIBILITIES OF MEDICAL PRACTITIONERS Dear Dr Russell-Weisz PROFESSIONAL RESPONSIBILITIES OF MEDICAL PRACTITIONERS

The Australian Medical Association (WA) wishes to bring to your attention concerns raised by our members about the recently published Operational Directive (OD 0639/15) which directs senior medical practitioners to keep daily records of start and finish times or timesheets. As you know, senior medical professionals are employed pursuant to the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2013 (and mirror agreements applying to practitioners employed by WACHS, the DOH, UWA Clinical Academics and DOA) (the AMA (WA) Agreements). It is our understanding that the AMA (WA) Agreements were entered into in a spirit of trust and cooperation reflecting the professional commitment of medical practitioners to undertake all the necessary duties at times required to deliver good patient care. In other words, as required by the AMA (WA) Agreements, practitioners nominally work 40 hours in a week but are available to attend to whatever duties are required on a daily basis. In practice, hours are routinely altered and adapted to provide flexibility in delivering the best care possible to patients and to be available for all other clinical and non-clinical responsibilities of the role. This often requires working substantially more hours than 40 per week including remaining at work to complete duties that cannot be completed in a rostered shift. No overtime is payable for such additional hours on the basis that this is part and parcel of the professional commitment. Inherent in the professional commitment is the practice of not "clock watching”. The AMA (WA) asserts that in the vast majority of cases practitioners deliver extra service/hours to patients, colleagues and services beyond the nominal 40 hours per week. The OD, if implemented for medical practitioners as currently worded, added to what practitioners feel is a management obsession with clock watching will be extremely counterproductive. All good systems rely on trust, goodwill and flexibility to work optimally. A clock punching culture where management overtly distrust their staff is very likely to induce a reduction in real hours spent working, poor morale, demotivation and a major loss in goodwill as well as some experienced staff likely to leave the public system and direct their efforts to where they feel appreciated and supported to deliver the best care for their patients. The AMA (WA) calls upon you to withdraw the OD as it applies to medical practitioners. We are available for discussions as needed. Yours sincerely The Australian Medical Association (WA) wishes to bring to your attention concerns raised by our members about the recently published Operational Directive (OD 0639/15) which directs senior medical practitioners to keep daily records of start and finish times or timesheets. As you know, senior medical professionals are employed pursuant to the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2013 (and mirror agreements applying to practitioners employed by WACHS, the DOH, UWA Clinical Academics and DOA) (the AMA (WA) Agreements). It is our understanding that the AMA (WA) Agreements were entered into in a spirit of trust and cooperation reflecting the professional commitment of medical practitioners to undertake all the necessary duties at times required to deliver good patient care. In other words, as required by the AMA (WA) Agreements, practitioners nominally work 40 hours in a week but are available to attend to whatever duties are required on a daily basis. In practice, hours are routinely altered and adapted to provide flexibility in delivering the best care possible to patients and to be available for all other clinical and non-clinical responsibilities of the role. This often requires working substantially more hours than 40 per week including remaining at work to complete duties that cannot be completed in a rostered shift. No overtime is payable for such additional hours on the basis that this is part and parcel of the professional commitment. Inherent in the professional commitment is the practice of not "clock watching”. The AMA (WA) asserts that in the vast majority of cases practitioners deliver extra service/hours to patients, colleagues and services beyond the nominal 40 hours per week. The OD, if implemented for medical practitioners as currently worded, added to what practitioners feel is a management obsession with clock watching will be extremely counterproductive. All good systems rely on trust, goodwill and flexibility to work optimally. A clock punching culture where management overtly distrust their staff is very likely to induce a reduction in real hours spent working, poor morale, demotivation and a major loss in goodwill as well as some experienced staff likely to leave the public system and direct their efforts to where they feel appreciated and supported to deliver the best care for their patients. The AMA (WA) calls upon you to withdraw the OD as it applies to medical practitioners. We are available for discussions as needed. Yours sincerely

PAUL BOYATZIS EXECUTIVE DIRECTOR PAUL BOYATZIS EXECUTIVE DIRECTOR

L E T T E R S / I N D U S T R I A L

Dear Editor Your news article in Medicus of March 2016 (Volume 56 Issue 2), highlighting the advances that have occurred at Albany Health Campus in attracting high quality specialists omitted to mention the presence of a Specialist Anaesthetist. Dr Alice Poon, who has been a full-time Consultant Anaesthetist at Albany Health Campus and resident in Albany for the past five years has worked tirelessly to improve the safety and quality of anaesthetic care and acute pain management there. Her significant contribution to continuing professional development of the GP Anaesthetists and the theatre nurses at the hospital should not go unnoticed. The difficulty in attracting specialist Anaesthetists to country areas is well documented with a significant maldistribution in this specialty. If the contribution of these specialists is not acknowledged, the problem will be perpetuated. Sincerely, Dr Debra Coleman MB ChB FRACGP FANZCA MPH MHM Significant contribution should not go unnoticed

WESTERN AU

Continued from page 4 SNAPSHOTS

MEDICAL ENGAGEMENT

CLINICAL INDEPENDENCE

THE AMA (WA) has become aware that a practice is developing within the WA public sector whereby members are having their clinical independence questioned; being directed about how to treat a patient, which device to use and so on. Members are reminded that under the Good Medical Practice: A Code of Conduct for Doctors in Australia published by the Medical Board of Australia, consistent with the Health Practitioner Regulation National Law (WA) Act 2009 (the National Law), a medical practitioner has a duty to make the care of patients their first concern and to practise medicine safely and effectively. They must be ethical and trustworthy. The WA Health credentialing policy is also based on verifying the qualifications and experience of medical practitioners to determine their ability to provide independent care. “ Building on the National Standard, WA Health has formulated a consistent approach for credentialing and defining the scope of clinical practice of senior doctors with independent responsibility for patient care to be implemented in all WA publicly funded health services. ” Accordingly, members should feel confident challenging managers who seek to control or reduce clinical independence. If in doubt, don’t hesitate to contact the AMA. ■ Page 1 of OD 0287/2010 refers to:

THE AMA (WA) continues to raise with the Minister for Health and the Director General the disquiet expressed by members about the lack of medical engagement in the development of medical policy; contrary to international evidence that engagement with medical practitioners is a necessary component to an efficient and safe healthcare system where patient care outcomes are maximised. Decisions on key policy, governance and service delivery in WA hospitals and health service facilities are being made with little or no involvement of practitioners or the community. The principles of clinical engagement are enshrined in departmental policy, as referred to in WA Health’s Operational Directive 0287/2010 and also in the “Memorandum of Understanding between the Minister for Health, the Director General of Health and Boards of Management and the AMA (WA) in respect of Clinical Privileges, Conduct and Governance in WA Government Hospitals and Health Services”. Members are entitled to participate in clinical decision making and should contact the AMA if this right is being overridden. ■

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TRALIA

WESTERN AUSTRALIA

BOSTON WASHINGTON NEW YORK

C O MM E N T

Passing on the public health baton

Professor Mike Daube AO Professor of Health Policy Curtin University

W hen I started working on tobacco in 1973 from the Royal College of Physicians of London, public health campaigns (or “pressure groups” as they became known) didn’t exist. The then-novel approach we developed with ASH (Action on Smoking and Health), entailed a rigorous emphasis on sound science, clear priority objectives and policy targets, bringing health organisations together in coalitions – and a combination of senior medical figures and youthful energy. In retrospect, I am amazed by the generosity of those senior figures. They knew they wanted a campaign to change attitudes among media, communities and governments, but they weren’t sure what that meant. They showed faith in a young man with long hair and purple suits who took them into confrontation with the powerful and exceptionally well- connected tobacco industry and into a new kind of advocacy that generated public attention, assorted threats from tobacco companies, and attacks from the industry’s political and other fellow-travellers. They provided wisdom, guidance, and unwavering support. I recall as a turning point my decision to start asking questions at tobacco industry Annual General Meetings. I had bought one share in each major company so that I could attend their showpiece events and ask innocuous questions – such as how many deaths their products had caused during the year. I was worried that my Board might not support this, so didn’t tell them and thought I might lose my job.

But alongside those senior

I need not have worried. Their only question was whether they could go to the AGMs themselves. In passing, those AGMs brought me two wonderfully enjoyable episodes. After one AGM, the Chairman of Rothmans privately offered me funding to work on any campaign of my choice other than tobacco; a few years later, an angry shareholder got up to berate the same company about falling sales, pointed across the room and shouted angrily, “and that’s the bugger that’s doing it”. More than 40 years later, the basics have not changed. Cynical industries still knowingly promote harmful products; many governments and decision-makers are still more interested in supporting harmful industries than in protecting the public’s health; there is still a need for active campaigners. We have also learned that a few campaigners supported by professional organisations and health groups can over time achieve remarkable results, despite powerful and massively funded opposition. And happily, there are still senior health and medical figures willing to stand up for the health of the community – as the AMA has often shown. But alongside those senior figures (who, alas, now include me!), we need They can bring the energy, innovative thinking, passion and resilience that campaigning needs, and importantly an understanding of what influences public and political thinking in an era where new technologies rule, and the opposition is new generations of public health campaigners to carry the batons.

figures…we need new generations of public health activists to take up the challenges

even more cynical, dishonest and sophisticated. Succession planning is needed in

campaigning as elsewhere. I hope that I and my generation can be as supportive as my mentors of the 1970s – and as willing to allow others to take the lead. Passing on batons doesn’t mean disappearing from the scene. There is much work to be done; we can encourage, train, offer whatever lessons we have gleaned from our experience, write, and even make the occasional foray into media and advocacy. But we must also learn to stand back from some of our roles, and support the next generations of campaigners as they develop new approaches, take risks, become “go to” people – and field the 4am media calls! The British American Tobacco company, whose products have caused millions of deaths, recently tweeted: “Passion is what excites and inspires us. It’s what we look for in graduates.” Whether it is tobacco, alcohol, Aboriginal health and disadvantage, obesity or any number of other important causes, I can only urge young doctors and health professionals to show their passion by becoming involved in public health campaigns. We need you to take over! ■

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C O MM E N T

Making a Difference State President Dr Michael Gannon on why he wants to run for the AMA’s top job F or those who are not aware, I have thrown my hat into the ring for the position of Federal President Certainly the Turnbull Government’s private polling suggested that it was politically non-viable. I am excited by the challenge of trying to win office,

of the Australian Medical Association. My decision follows approaches by a number of colleagues at both State and Federal AMA level. I understand what people have told me – it is extremely hard to win national office from Western Australia. I am also conscious that I will need to continue to enjoy the strong support of my AMA colleagues, my clinical colleagues, my family and friends. I have decided to run because the way we manage health in this country is at a crossroads, and the AMA needs strong leadership with an appetite to engage constructively with the Commonwealth Government, whoever is in power. The Minister, the Hon. Sussan Ley, already has on her desk, or will soon have, substantial reviews into the Medical Benefits Schedule, the Private Health Insurance industry and the Primary Healthcare sector. It is essential that the profession has a strong voice in Canberra and makes itself available for constructive interaction with the government in its response to the various report recommendations. I also fully understand the financial and political reality – money is extremely tight on both a federal and state basis. The politics are complex. Some have complained that the Abbott Government pulled $57 billion out of public hospital funding. Once compensation packages for the poorest in the community were taken into account, increasing the rate of the GST to 12.5 per cent or 15 per cent was said to be economically non-viable.

The latest suggestion was to give the states back the power they gave up during the Second World War to raise income tax. Reducing federal income tax by 2 per cent and allowing the states to raise up to 2 per cent income tax would clearly not increase the size of the pie. I write before any outcomes from the Council of Australian Governments (COAG) meeting on 1 April, but I predict that this proposal will be DOA. I bring the experience of having served two years as President of the nation’s most successful state AMA. On a daily basis, I have an interaction with Paediatricians and Anaesthetists in my clinical work. On a regular basis, I have interactions with referring GPs, Pathologists and Physicians. I have fond recollections of the 18 months or so I spent as a General Practitioner in both metropolitan Perth and regional WA. My time in Bunbury, Collie, Katanning, Kalgoorlie-Boulder, Paraburdoo and on Christmas Island taught me clinical independence, resilience and an undying respect for the difficult work done week in, week out by GPs. I still carry personal battle scars from working at King Edward Memorial Hospital in the middle of the Douglas Inquiry and the subsequent Medical Board inquiries that saw other doctors lose their jobs. This hardened me for the difficult decisions I make in my clinical work as an Obstetrician, and as President of the AMA. We have so much yet to do. There

to make a difference in the way health is run in Australia

Dr Michael Gannon

will be challenges to the public health initiatives that we in the AMA have fought hard to win, from those elements in society fighting against so called ‘Nanny State’ measures on tobacco and liquor reform. While none of the co-payment models were saleable to the profession or the public, and mercifully the proposed change to time limits for GP consultations were defeated, we still sit with a freeze on GP rebates, which threatens the viability of high quality practice. We have a government that is cutting capacity in the medical training pipeline at the same time that we have to find jobs for a record number of interns, before Curtin University takes its first student. We need to find high quality training positions and we need to find them soon. I see the ever-increasing squeeze on private medicine every day. The $6 million salary package for the new CEO of Medibank Private is good news for him, but surely a sign of different incentives in the for-profit Private Health Insurance sector. Sensible changes to the way we pay Continued on page 13

A P R I L 2 0 1 6 M E D I C U S 11

N E W S Medical research week at SJG Subiaco

ST JOHN OF God Subiaco Hospital is holding a medical research week from 9 May. Director of Medical Research at the hospital, Associate Professor Nik Zeps said medical research week provides the opportunity for health practitioners to increase their knowledge and skills about leading medical research. “It is the second year we have held the free event, which includes high calibre international and national speakers as well as CPD education seminars, clinical trial workshops, research symposiums and a student information evening. “The event also showcases the health and medical research being THE AUSTRALIAN TRIAL of a radical new approach to asthma treatment could revolutionise the way we approach the disease. Bronchial thermoplasty – a minimally invasive surgical procedure to prevent constriction of the airways – has been likened to the introduction of laser surgery to improve eyesight. “We’re at the tip of a new paradigm for how we treat asthma,” said Associate Professor David Langton, Director of Thoracic Medicine at Peninsula Health, Melbourne and one of the study’s lead researchers. “The results of these trials could have a global impact, and completely revolutionise our approach,” he said. An estimated 2.3 million Australians have asthma. About five to ten percent of these struggle to control their asthma

undertaken at our hospital and other St John of God Health Care facilities.” A/Prof Zeps said hospital-based research is critical to ensuring clinical care is underpinned by the best evidence available to improve patient outcomes and develop new levels of clinical excellence. “Last year the hospital supported 62 research projects, including 14 projects with external collaborators, five with junior doctors and 17 oncology clinical trials. Much of the research is undertaken collaboratively with clinical, university and donor partners.”

For more information, visit sjog.org.au/researchweek ■

Encouraging innovation: SJG Subiaco Hospital supported 62 research projects in 2015.

Revolutionary asthma surgery trialled in Australia

using traditional treatments such as inhalers, and suffer from regular attacks leading to visits to ER, and lost days of work and school. Bronchial thermoplasty has been found to dramatically reduce the number of attacks by using the application of heat directly on the lungs to prevent them constricting. The surgery involves an overnight stay in hospital, with the procedure being performed under general anaesthetic. A bronchoscope is inserted through the nose or mouth to allow a doctor to ease a catheter into the patient’s airway. Once it’s in place, the catheter tip is heated to 65 degrees for 10 seconds. The heat gets rid of excess smooth muscle from airways, which widens air passages and reduces the chances of an asthma attack.

In the Australian trial, 17 patients were treated from June 2014 to June 2015 in a number of different states. The results found the procedure to be safe, asthma control significantly improved, and the need for reliever medication reduced. The study also demonstrated for the first time that the procedure worked well in people with severe as well as moderate asthma, and that in fact patients with severe asthma responded best to the surgery. Lung health experts are now calling for the widespread implementation of the procedure in Australia to be considered. The research was being presented to lung health experts from across Australia who were in Perth earlier this month for the Annual Scientific Meeting of the Thoracic Society of Australia and New Zealand. ■

12 M E D I C U S A P R I L 2 0 1 6

N E W S

NEW CANCER TREATMENT RECEIVES PROOF OF CONCEPT FUNDING

A NEW APPROACH to treating tumours, developed at the Harry Perkins Institute of Medical Research, has received funding to explore its commercial potential. Dr Juliana Hamzah and her team developed a targeted drug to ‘soften up’ tumours, making them more vulnerable to immune cells and other anti-cancer treatments. A major hurdle for many cancer treatments is that cancerous tissue is stiffer than normal tissue, making it difficult for drugs to infiltrate tumours. Dr Hamzah said solid tumours are known to be firm and rigid, which can present a significant barrier for drug delivery. “In the case of breast cancer, for example, diseased tissue can be 10 times stiffer than normal breast, this makes it difficult to give an effective dose precisely where it is

needed,” Dr Hamzah said. She explained her new approach was significant because by softening the stiffened tumour tissue, anti‐ -cancer drugs could be delivered more effectively inside the tumour to kill cancer cells. The project has received UWA Pathfinder funding, which supports the team in demonstrating the effectiveness of the drug in pre-clinical cancer models before they partner with a pharmaceutical company to provisional patent for the drug which will protect the concept while she completes the investigation. She hopes to have the work completed by early 2017. In other news from the Perkins, Linear Clinical Research, the clinical trials arm of the Institute, has appointed a new CEO. develop the treatment further. Dr Hamzah has already filed a

Breakthrough: Dr Juliana Hamzah (extreme right) with her team (from L-R) Meenu Chopra, Yen Ling Yehow and Jenny Wang.

New Linear Clinical Research CEO, Dr Michael Winlo.

Originally from Perth, Dr Michael Winlo has spent the last six years between Silicon Valley and New York growing the health practice of the highly regarded analysis firm Palantir Technologies. He has now returned to Perth to start his new position as CEO from 4 April. ■

Making a Difference Dr Michael Gannon Continued from page 11

for prostheses are essential. Bundled payments where surgeons, Anaesthetists and assistants would have to fight over a single fee would damage collegiality and quality practice. We need to find novel ways to fund the health system. If government does not talk to the AMA and the AMA does not talk to government, we are both poorer, and it is our patients who will suffer. I am excited by the challenge of trying to win office, to make a difference in the way health is run in Australia, and the way in which the AMA relates to and negotiates with the Federal Minister. I believe I can provide high standards of leadership of the profession. I have had a successful time as Chairman of the Federal Ethics and Medicolegal Committee over the past two years. I want to see medical ethics and professionalism back at the very top of the AMA agenda. The votes will be cast by the 150 or so delegates to the AMA National Conference in May. I hope that my colleagues in WA will wish me luck. ■

A P R I L 2 0 1 6 M E D I C U S 13

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N E W S

IN BRIEF

WACHS AND LIONS EYE INSTITUTE PARTNER TO SAVE EYESIGHT People living with diabetes in remote areas of the Goldfields region can now access advanced retinal screening closer to home thanks to a new partnership between the WA Country Health Service and the Lions Eye Institute. The initiative provides patients with early screening for diabetes-induced vision impairment and uses telehealth or communication technology to deliver screening results to regional patients. Aboriginal health workers and nurses in Leonora, Laverton and Norseman as well as doctors at Kalgoorlie Health Campus have been trained by staff from the Lions Eye Institute to use a Digital Retinography System (DRS) to carry out retinal screening. CONSTRUCTION STARTS AT KATANNING HEALTH SERVICE Work has begun on the $32 million redevelopment of the Katanning Health Service, which will include a new emergency department. Expected to be completed in mid-2018, the Katanning Health Service redevelopment would deliver a new ED, medical imaging department and a new outpatient care facility. Surgical services and the associated sterilising department would be refurbished, and a new laundry and morgue would also be built. OUTBACK VISION VAN HITS THE ROAD The Lions Eye Institute’s Outback Vision Van, WA's newest mobile eye health clinic has begun holding clinics. The van, which will allow specialist eye care to be delivered to parts of regional and remote WA, has been made possible with the support of a $1.9 million Lotterywest grant and a $2 million Department of Health contribution. The 20-metre long van is fitted with the latest specialist equipment to provide comprehensive eye care for

conditions including cataracts, diabetic retinopathy and glaucoma. It plans to travel more than 24,000km each year, serving 16 regional centres and has the capacity to treat up to 200 patients a week. The Lions Outback Vision service will work in partnership with 20 community controlled Aboriginal medical services across WA. WA YOUTH DRINKING RATES LOWEST IN A DECADE State Government initiatives to reduce alcohol consumption in young people have resulted in fewer young people aged 12 to 17 consuming alcohol than at any time in the past decade. As former Mental Health Minister Helen Morton launched the latest phase of the Parents, Young People and Alcohol campaign last month, she said not only were fewer young people drinking, of those who drank, fewer drank at risky levels. “The latest survey of Western Australian school students shows the proportion choosing not to drink alcohol has more than doubled from 12.3 per cent in 2005 to 31.5 per cent in 2014,” Mrs Morton said. Family and friends were the main source of alcohol for young people and Ms Morton said the State Government’s new secondary supply laws, which ban providing alcohol to children in private settings without parental consent, empowers parents to deny access to alcohol. The survey also found that the young people who did drink were doing so less often. The proportion of students who said they had drunk alcohol in the week and month prior to the survey had almost halved between 2005 and 2014. Of those who drank in the previous week, fewer were drinking at risky levels or with the intent of getting drunk. Research also showed that almost all parents (96 per cent) were now aware that no alcohol was the safest choice for under 18s, up from 68 per cent in 2012. More than 60 per cent now denied access to alcohol, compared with 56 per cent in 2012. ■

Master classes for GPs

OVER 40 GENERAL Practitioners attended St John of God Murdoch Hospital’s first education session last month to hear an expert panel speak about the diagnosis and management of prostate cancer.

described the complex, and often controversial, diagnosis pathway and treatment options, as well as gave valuable information about the GPs’ role in diagnosis. GPs had the opportunity to ask questions and discuss the best way to

treat high-risk patients and those with various stages of cancer. The next session on Saturday 7 May will be an Orthopaedic master class for GPs. For all enquiries contact Events Manager Sarah Sydney-Smith at rsvp@educationondemand.com.au ■

A team of Urologists and a Radiologist

A P R I L 2 0 1 6 M E D I C U S 15

A M A ( WA ) AWA R D S It’s Awards season! Time to recognise the outstanding contributions of our doctors to the medical profession and the community

T his year the AMA (WA) will once again honour the achievements of doctors in WA Health. Nominations for the 2016 AMA (WA) Awards are now open and below are details for two awards that will be presented at the ceremony on Saturday June 25 at the Perth Convention and Exhibition Centre. AMA (WA) AWARD Nominations for the AMA (WA) Award are invited from all sectors of the medical profession, before Friday 29 April 2016 . It is expected that nominees will have demonstrated a tireless dedication to either the service of others, their chosen field, or be pioneers who have worked without seeking recognition for their efforts. Nominations should be accompanied by adequate evidence and include the names of supporting referees. The winner is presented with a fine bronze All awards will be judged by independent expert panels.

bust of Hippocrates.

For further detail contact Paul Boyatzis either by email paul.boyatzis@ amawa.com.au or phone 9273 3007.

Junior Doctor of the Year 2016

Nominations for this prestigious annual award open on 21 March 2016. The AMA (WA) Junior Doctor of the Year (Dr Camille Michener Legacy Award) recognises the significant and

Achievement: AMA (WA) President presents Dr John Zorbas with the Dr Camille Michener Legacy Award last year.

who is remembered as a staunch advocate and benevolent friend, well-liked and respected by all who knew her. Nominations will close at 4.30pm on Friday 29 April 2016 . For further information please contact Leah Pantelis leah.pantelis@amawa.com.au . ■

outstanding contributions of our doctors in training to the medical profession and the community in areas such as teaching and education; leadership and advocacy; and doctors' wellbeing and community service. The Award establishes a fitting legacy to the memory of Dr Camille Michener

NOTE: These submission deadlines are for articles, classifieds and professional listings. For Display Advertisement timelines and submission requirements please contact Des Michael on (08) 9273 3056. 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: If you would like to submit an article or clinical/research paper for inclusion in Medicus please contact Janine Martin in the first instance, at janine.martin@amawa.com.au Medicus article submission dates for 2016

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June

1 May 1 June 1 July

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November December

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16 M E D I C U S A P R I L 2 0 1 6

AMA (WA ) 2016

Charity GalaDinner & Awards Night

Saturday June 25 Perth Convention and Exhibition Centre BelleVue Ballroom at 6.30pm

Please join us for a magical night of celebration, entertainment and prizes

Tickets are strictly limited

Book now for this exclusive event by contacting Skye Connor on 9273 3028 or email skye.connor@amawa.com.au For more information, visit www.amawa.com.au AMA Members $270 per head / Corporate Tables (10) $2,950 Dress Black Tie (optional)