twrama 1841_august_2.. - AMA WA

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WESTERN AUSTRALIA
MEDICUS
Journal of the Australian Medical Association WA | August 2012 Volume 52 / Issue 7 | amawa.com.au

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Council
President
Dr Richard Choong
Immediate Past President
A/Prof David Mountain
Vice Presidents
Dr Michael Gannon
Dr Andrew Miller
Honorary Secretary
Dr Omar Khorshid
Assistant Honorary Secretary
Dr Janice Bell
Honorary Treasurer
Dr Simon Towler
Councillors
Division of General Practice (WA)
Prof Bernard Pearn-Rowe
A/Prof Rosanna Capolingua
Division of Specialty Practice
Dr Tony Ryan
Prof Mark Khangure
Division of Salaried and State
Government Services
Dr Dror Maor
Dr Daniel Heredia
Ordinary Members
Prof Gary Geelhoed
Dr Stuart Salfinger
Dr Marcus Tan
Co-opted Members
Dr Steve Wilson
A/Prof Frank Jones
A/Prof Peter Maguire
Prof Geoff Dobb
Dr Dror Maor
Dr Cassandra Host
Dr Ian Jenkins
Prof Ian Puddey
Prof Gavin Frost
Dr Alexandra Welborn
Mr Benjamin Host
Mr Ghassan Zammar
AMA (WA) Office
Executive Director
Mr Paul Boyatzis
Director: Industrial & Legal
Ms Marcia Kuhne
Executive Officers
Mr Michael Prendergast
Ms Christine Kane
Ms Clare Francis
Mr Gary Bucknall
14 Stirling Highway
Nedlands WA 6009
(08) 9273 3000
mail@amawa.com.au
www.amawa.com.au
Medicus
Editor and Director of
Communications
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
Contents
Features
Focus: Counselling
Fuel to the fire?
p.16
Independent Midwifery
Help or hindrance?
p.22
Cover story:
Plain packaging for
cigarettes
Butt seriously
p.26
Regulars
President’s Desk
p.2
From the Editor
p.3
Industrial
p.6
August 2012
News
p.12
Opinion
p.18,32
Soapbox
p.31
For the record
p.41
Snippet
p.43
Beyond Borders
p.46
Dr YES
p.48
Research
p.52
Travel
p.54
Food
p.56
Wine
p.59
Photography
p.60
Technology
p.62
Members only
Benefits & On the Town
p.64-65
Classifieds,
Professional Appointments
& Positions Vacant
p.67-71
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.
August MEDICUS 1

PRESIDENT’S DESK
Calling all
heroes of health care
by Dr Richard Choong
AMA (WA) President
The longer I serve as President of the Australian
Medical Association in WA, the more I realise the
simple truth of the power of doctors working together.
If the AMA (WA) did not speak out about the health
system and speak out about our patients, no one else
would. No one else is representing the big – and in fact
the small – issues and no one else is attempting to keep the
government honest on a host of important elements.
It is too easy for the government to point every week to
a small proportional increase in the number of beds that
we will see in two years or so with the opening of Fiona
Stanley Hospital as its answer to issues raised.
There have been some early wins for the government
with community-based care allowing for more care to be
undertaken at the patients’ homes, improved efficiency
within hospitals reducing the length of post-operative stay
and increased utilisation of day beds to deliver surgical
care. But all the easy wins have gone. The low-hanging
fruit has been harvested and what we will be left with is the
cold, hard reality that despite all best endeavours, we still
need more beds.
With the aging population, and a growing one too,
there will be increased demand on patient services – not
those that can be undertaken in the community, but
the level of care that requires the utilisation of inpatient
beds and the delivery of the best level of care in our
hospitals. Progressively there will be an increasing
complexity of presentations as the age of our community
grows both older and in size and this can only be
answered by more beds.
Fortunately the release of an HBF/West Australian
survey on the perception of health services in WA
highlighted that just 13 per cent of people thought there
was enough medical staff to meet needs and 9 per cent
thought there were enough hospital beds. Putting it
another way, 91 per cent of the community agrees with
us…there are not enough beds!
I do believe that beds are not the only answer and we
all need to look at how our available beds can be utilised
more effectively and efficiently, and that there needs to be a
dramatic increase in the services available at a community
level. It is well understood that significant investments
into community-based care that centres on preventative
care and healthy lifestyle has possibly the most significant
impact on the health of the community, and one of the
most effective uses of the health dollar.
But the government needs to acknowledge and engage
with one of the biggest components of the medical
workforce – the GP – to achieve these goals of increasing
the amount of care that can be centred around the home.
If general practice was better engaged and supported by
State Health, overnight the capacity of the health system
would be increased dramatically, the delivery of a skilled
workforce could be achieved with minimal outlay and
maximum rewards expected.
Over these last two months as president, I have met
both ends of the health spectrum. Those that believe in
and promote the issues about community engagement and
those that feel that the centre of all appropriate care can
only be undertaken in a tertiary hospital setting. Both are
wrong and right. The reality: there is no divide between
hospitals and the community; both are heavily reliant on
each other to deliver care to our community
In recent weeks, I have had some startling
conversations with politicians of all colours, both federal
and state, and I am astounded by the ignorance that
they have about health. Either they are not listening
or we, as an organisation, are not doing our job well
enough and need to focus more on educating our elected
representatives. Perhaps we need to encourage a number
of our backbenchers, both state and federal, to make
health their number one priority – to become a friend of
health, if you like.
But while members of parliament are always happy to
join or even establish parliamentary groups such as Friends
of Swaziland or Advocates for Night Pet Patrols, they are
unwilling to establish a “Friends of Health” where MPs
of whatever party can come together to discuss issues of
common interest, hear speakers and – heaven forbid – even
come to some agreement about the steps forward in health.
I live in hope on this point, and I really do dream of the
day when one or more heroes of the community stand up,
stand out and make health their issue, not just of the day,
but for their political career – not to attempt to get the job
of minister for health but to have a positive impact.
I have heard too many politicians and want-to-be
politicians use the cliché – “I have entered politics so I
can make a difference”. There is a clear opportunity for
them to do exactly that. Now is the time for heroes to step
forward. If you know of any, please let me know.
2 MEDICUS August

FROM THE EDITOR
Leading the charge against lighting up
Regular readers of the local print media in recent weeks would
have seen the use of the Australian Medical Association
(WA)’s logo as part of an advertising campaign. This campaign is
aimed at reducing the significant negative impact and growth of
obesity in our community.
It also highlights something the AMA (WA) has been proudly
involved in for many decades – public health campaigns.
The latest ads featuring the AMA (WA) logo are part of
a three-year campaign funded by the State Government and
organised by the WA Heart Foundation, and involving a range
of government and non-government organisations.
The campaign simply and clearly communicates the message
that obesity increases the risk of a range of diseases, including
heart disease, stroke, diabetes and certain types of cancer.
As the campaign advances, it will demonstrate how obesity
can be avoided. And the AMA (WA) is proud to be involved in
the campaign.
Most public health campaigns are long running as it can
sometimes take a significant amount of time to change individual
behaviours. Success can sometimes seem a very long way away
and a variety of groups and their supporters and agendas have to
be confronted along the way.
As one example, take the continuing push against bike
helmets where some normally sensible groups and individuals
have attempted to argue that preventing head injuries is not
important or that accidents only happen in certain situations
or environments.
But when change to behaviour and to expectations, does
occur, they are almost always permanent. Try suggesting that
smoking should be allowed in restaurants, for example, and
you get the picture.
It is now accepted that when sitting down at the cinema, a bar,
the football or a restaurant, the patron or patrons sitting next to
you will not be puffing away. But that single change needed years
of lobbying of government and opposition members as well as
arguing our point more publicly and a number of strong covers of
this very magazine.
But let us not forget that, once again, even that change was met
with resistance from a range of groups. A caller on talkback radio
recently said that he could remember when, after a night out, he
would have to hang his jacket and trousers outside because of the
smoke coming off his clothes.
The AMA in WA is widely acknowledged as having led
Australia on smoking and has won a number of awards along the
road – who would have thought that just 50 years ago, GPs were
featured in magazine ads advocating smoking!
In this month’s issue of Medicus, another leader of the push
against the dangers of smoking, Professor Mike Daube writes
for us on the next steps needed in the fight against tobacco. The
latest victory in the push against smoking was reinforced recently
following the decision by the High Court decision on tobacco
plain packaging.
The AMA (WA) called it one of the most significant for
decades in the fight against the dangerous impact of tobacco on
public health.
“This is a great day for public health and another step in
the fight to stamp out smoking once and for all,” AMA (WA)
President Dr Richard Choong said.
Dr Choong added the AMA (WA) had led the push
nationally for many years to curtail smoking and the latest step
by the High Court reflected years of campaigning by a range
of public health groups.
“We now look forward to the tobacco industry accepting this
outcome and getting on and implementing the decision of the
Australian Parliament,”
Dr Choong said.
The AMA (WA) does
not take its involvement in
public health campaigns
lightly – it is our
responsibility to be
involved in public
health including
public health
campaigns and we
approach each on its
merits and the views of
our members.
But if the carefullyplanned
outcome is better
public health, they are, at the very
least, worthy of careful consideration.
...who would have
thought that just 50
years ago, GPs were
featured in magazine
ads advocating
smoking
August MEDICUS 3

4 MEDICUS August

Nothing but the truth
MEDICAL CERTIFICATES
Medical certificates are legal documents and doctors who provide false sick notes risk their registration
Earlier this year, a ‘media sting’ by The Sunday Times revealed
some Perth doctors were handing out sick notes to patients
who openly admitted they were not ill. Just four doctors – out of
the 10 visited by the reporter – refused to provide a bogus sick
note. Dr Krystyna Ogonowska from Noranda Medical Centre
was one of those doctors, and President of the Australian Medical
Association (WA), Dr Richard Choong has since written a letter
to Dr Ogonowska commending her stance.
The investigation by The Sunday Times followed similar ‘media
stings’ in the Eastern States where some GPs were caught on
hidden camera issuing certificates that could not be justified.
The AMA (WA) once again cautions all practising doctors
to exercise care in completing medical certificates. Medical
practitioners who do not discharge their responsibilities
appropriately are at risk in terms of their registration.
The Medical Board of Australia’s Good Medical Practice: A
Code of Conduct for Doctors in Australia advises that doctors have
been given the authority to sign a range of documents such as
death certificates and sick certificates on the assumption that they
know, or reasonably believe, the statements therein to be true.
Good medical practice involves:
• Being honest and not misleading when writing reports and
certificates, and only signing documents you believe to be
accurate
• Taking responsible steps to verify the content before you sign
a report or certificate and not omitting relevant information
deliberately
• Preparing or signing documents and reports if you have
agreed to do so, within a reasonable and justifiable time frame
• Making clear the limits of your knowledge and not giving
opinion beyond those limits when providing evidence.
The AMA has developed specific guidelines on certifying illness.
These guidelines detail the responsibility of medical practitioners,
patients, employees and employers and certificate requirements.
Sections 8 and 9 state:
8. Date of Certificate
8.1. Certificates must be dated on the day on which they were
written. Under no circumstances can this be breached.
8.2. There may be medical conditions which enable the medical
practitioner to certify that a period of illness occurred prior to the
date of examination. Medical practitioners need to give careful
consideration to the circumstances before issuing a certificate
certifying a period of illness prior to the date of examination,
particularly in relation to patients with minor illness, which is not
demonstrable on the day of examination and add supplementary
remarks, where appropriate, to explain any discrepancy.
8.3 Medical Practitioners should be clear that their assessment
of the patient is based on the patient’s history and the findings of
the examination. The certificate may include information provided
by the patient but the medical practitioner’s assessment should be
based on illness observed by the medical practitioner or reported by
the patient and deemed to be true by the medical practitioner.
9. When a sickness certificate should not be provided
9.1. A certificate should not be provided where a doctor believes
that there is insufficient evidence of disability.
9.2. Wherever possible, doctors should avoid issuing certificates
to anyone with whom they have a close personal relationship.
The circumstances under which the certificates are sought can
vary. To assist in this process the AMA has designed certificates
to deal with two broad scenarios.
• Letter of support regarding fitness to work
• Standard medical certificate.
The letter of support can be completed in place of the medical
certificate if the doctor cannot confirm that the patient was ill,
for example, when the patient is seeking to claim payment for an
alleged illness that has already passed. The letter of support is
designed to deal with the situation where the patient stated their
illness commenced on a particular day and then subsequently
attends the practitioner after their illness is passed. It includes
provision for a patient declaration.
A standard medical certificate relates to situations where the
patient presents with an illness or is required to care for a relative
which the practitioner can verify as true and correct at the time of
attendance without disclosing the nature of the illness per se.
In both instances, of course, the practitioners may be called
upon to justify their certification hence they need to use the
correct form.
It needs to be remembered that medical certificates are legal
documents and underpin patients’ claims against their employers.
It is very important that doctors do not provide certificates that
could be construed as aiding or abetting a patient to defraud an
employer.
It is also appreciated that doctors will sometimes be pressured
by patients to issue certificates that are not supported by evidence.
Any medical practitioner who is unsure of their position in issuing
either a medical certificate or a letter of support should contact the
AMA for advice.
Copies of the medical certificate (and the letter of support) can be
purchased from the AMA (WA) Medical Products Division who can be
contacted on 9273 3000.
A full copy of the AMA’s Guidelines for Medical
Practitioners on Certificates
Certifying Illness
can be accessed at
ama.com.au/
node/6505.
Inserted in this month’s
Medicus for GP members is a
poster on medical certificates and
their significance. All GPs are
encouraged to prominently display
the poster at their practices.
To order additional copies
of the poster, please contact
membership@amawa.com.au
or phone 9273 3055.

INDUSTRIAL
NEW DIRECTOR
WELL EQUIPPED TO TACKLE ISSUES
The Australian Medical Association (WA) would like to
welcome Ms Marcia Kuhne as Director of Industrial
and Legal Affairs. Marcia replaced AMA (WA) veteran, Peter
Jennings who retired in July after 30 years. No doubt those are
big shoes to fill, but Marcia is more than up to the task having
a sterling career graph to her credit.
She comes to the AMA (WA) with many years’ experience
in industrial relations and health policy in both the public and
private health sectors. The past five years have seen Marciaact
as Manager of Industrial Relations Policy at the WA Chamber
of Commerce and Industry, advocating at the political level for
IR policy effective for business.
In senior IR consultant roles, Marcia represented businesses
and government agencies in advocacy before industrial
tribunals and in negotiating the settlement of industrial
disputes. This included negotiating the first Doctors’ Awards
with Peter Jennings.
In health policy and workforce roles, she managed
committees that developed new strategies to attract and
retain staff – bringing together educators, regulators and
health managers including trialling a new program to attract
students into nursing.
In her new role as Director, Industrial/Legal of the AMA
(WA), Marcia, a girl from the bush, is keen to explore
opportunities for greater levels of service for rural doctors and
to provide increased support for VMPs.
As clinical governance evolves and health department
structures change, so the need grows for vigilance from
medical practitioners to safeguard continuing leadership
in decision-making affecting patient care. The work of
Medical Advisory Committees, particularly in rural and
secondary metropolitan settings, is central to retaining
a sound basis for medical input into the management of
hospitals in those settings. Marcia looks forward to working
Experienced: In senior IR consultant roles, Marcia Kuhne has
represented businesses and government agencies in advocacy before
industrial tribunals and in negotiating the settlement of disputes.
closely with practitioners to hear their experiences and assist
them further to develop their pivotal leadership roles.
She also has a keen interest in securing beneficial employment
arrangements for women entering the medical profession to
motivate and retain this critical group of experts who add an
extra dimension to the health system.
If you have industrial/legal issues to discuss with Marcia,
please email Marcia.Kuhne@amawa.com.au.
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6 MEDICUS August

INDUSTRIAL
Superannuation Guarantee
(Administration) Amendment
The Superannuation Guarantee (Administration)
Amendment Bill 2011 was passed by the Federal
Parliament in March 2012.
The amendments to the legislation have two major
components, those being:
• to raise the Superannuation Guarantee age of an employee
at which the Superannuation Guarantee no longer needs
to be provided from 70 to 75; and
• to gradually increase the Superannuation Guarantee
charge percentage from 9–12 per cent.
The increase in superannuation contributions from the current
9–12 per cent will occur incrementally over the next seven
years. The first increase to 9.25 per cent will take effect from
1 July 2013, with the full increase to 12 per cent coming into
effect on 1 July 2019.
Financial Year Rate %
2012/13 9
2013/14 9.25
2014/15 9.5
2015/16 10
2016/17 10.5
2017/18 11
2018/19 11.5
2019/20 12
The above table illustrates the rate
at which superannuation guarantee
entitlements will increase each year.
Workers Compensation
Rebate increase
The Australian Medical Association is pleased to advise
that following representations by the Association,
Workcover has approved a 3.93 per cent increase in Insurance
Rebates for claims for reimbursement of medical fees for
treatment of compensable injuries under the State Workers
Compensation system as from 1 November 2012.
Note: These new rebates are however subject to formal
gazettal to legally establish the rates. Further information
will be provided when the rates are gazetted.
The increases to the new rebates take into account
movements in the Australian Bureau of Statistics wage price
index for Western Australia, the Consumer Price Index and
the AMA Medical Fees Index. The increase is on top of
increases achieved in previous years.
The adjacent table sets out some key anticipated rates.
These however should not be relied on unless confirmed
in subsequent advice following formal Gazettal. This advice
is provided now to assist in your forward planning.
The outcome provides another example of the substantial
benefits the Australian Medical Association provides to
General Practitioners, other specialists and their patients.
(1) Note 2012 rates are subject to formal gazettal to legally establish the
rates. Further information will be provided when the rates are gazetted.
industrial
Proposed Workers Compensation Rebate Fee Increase
Service
2011 2012 (1)
3.93% Increase
GP Surgery consultations,
content based, in hour:
$65.15 $67.70
Minor or Specific Service
1 (Level A or B)
$119.05 $123.75
Extended Service (Level C)
Comprehensive Service (Level D) $183.00 $190.20
Physicians
$247.40 $257.15
2
Consulting rooms first attendance $123.80 $128.65
Subsequent attendance
Surgeons
$140.70 $146.25
3
Consulting rooms first attendance $73.35 $76.25
Subsequent attendance
Anaesthetists
$73.15 $76.00
4 RVG per AMA fee
August MEDICUS 7

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The specialist Medical Scientist on site:
• Assess the samples immediately
• Ensuring optimal amounts of diagnostic cells
• Minimises over sampling
• Ensures sample adequacy and accuracy, avoiding non-diagnostic results
• Provides the best service possible with the interests of the patient as the main priority
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8 MEDICUS August
oceanicimaging.com.au

INDUSTRIAL
Industrial Update No. 6 (May 2010) titled Payment for
Public Holidays – Have You Been Paid Correctly? provided
advice to members as to their entitlements to be paid in
accordance with the relevant Industrial Agreement and also
advised of an understanding that the Association had reached
with Health Industrial Relations Service (HIRS).
Following the issuing of the above Industrial Update, HIRS
then sought to reinterpret the provisions of the Industrial
Agreement and determined that where a practitioner was
rostered off duty on a public holiday, they would only be
entitled to be provided with eight hours as a day in lieu rather
than be provided with a day off as an ordinary working day i.e.
10 hours in this case.
The Association again made many representations to both
Health Corporate Network (HCN) and HIRS in an attempt
to resolve the dispute. Given the position being adopted by the
Department, the Association proceeded to make an application
in the WA Industrial Relations Commission to have Clause 35
– Public Holidays interpreted.
The Association’s application was listed for hearing before
Commissioner Kenner on 21 February 2012. Commissioner
Kenner delivered his decision on 27 July 2012; the following
are extracts of the Commissioner’s decision:
“The Australian Medical Association and the Minister for
Health are in dispute as to the proper interpretation of a clause
of the Department of Health Medical Practitioners’ (WA
Country Health Service) AMA Industrial Agreement 2011
relating to public holidays. They cannot agree how a medical
practitioner is to be paid for a public holiday in circumstances
where a practitioner is not rostered to work nor otherwise
required to attend for duty. This dispute has arisen in the
Emergency Department Bunbury Regional Hospital. Given
the relevant clause is common to a number of other industrial
agreements between the parties, it also has implications across
a broader range of workplaces throughout the State.
Commissioner Kenner found in favour of the AMA saying:
“That for the purposes of clause 35 (4) the Department of
Health Medical Practitioners (WA Country Health Services)
AMA Industrial Agreement 2011, a practitioner who is
rostered off duty on a public holiday and is not required to
work on that day should be paid the number of hours that are
their usual daily rostered hours of work.”
Effectively what this means is that if you are rostered to
work 4 x 10 hours shifts per week and one of these shifts is
on a public holiday and you have not been required to work
on that day then you are paid as if the day was an ordinary
working day i.e. paid 10 hours or if the employer agrees be
allowed to take a day’s holiday in lieu at a time mutually
acceptable. The day in lieu, in this particular example, would
be a 10-hour day in lieu.
For more information please visit the Workplace Relations
- Industrial Updates section on www.ama.com.au or contact
Executive Officer Gary Bucknall on 9273 3000 or
Gary.Bucknall@amawa.com.au.
2012 Salary Survey results
Practices regularly contact the Association seeking advice
as to the appropriate or industry rates of pay for clerical,
nursing and other allied health professionals.
As a result of such requests, the Association conducted
a salary survey between 13 July 2012 and 15 August 2012.
Survey forms were sent to both members and non-members
of the Association who work as either general practitioners or
specialist private practitioners.
The survey results have now being analysed and are
available upon request by contacting Executive Officer Gary
Bucknall on 9273 3000 or Gary.Bucknall@amawa.com.au.
It is intended that a salary survey of practices will be
conducted again in July/August 2013. The Association
expresses its appreciation to those practices that participated
in the 2012 salary survey. Congratulations to Fremantle
Family Doctors who won six bottles of wine for completing
the survey.
Practices can now be assured that when they contact the
Association to seek information relating to salary rates, the
information provided will be accurate and reliable based on the
outcomes of the 2012 salary survey and will represent what is
generally paid to employees within the profession.
August MEDICUS 9

INDUSTRIAL
Time for renewal
The AMA reminds all members to renew their medical
registration by 30 September 2012. The Australian Health
Practitioner Regulation Agency (AHPRA) is encouraging
registrants to renew online at www.ahpra.gov.au. To do this you
will need to know your User ID and your password. If you have
misplaced your User ID and password, contact AHPRA on
1300 419 495. Please note that your User ID is different to your
registration number that appears on the National Register.
If you have not yet renewed your registration, you would have
received electronic or hardcopy reminders from AHPRA. If you
have not received any reminders to renew or are unsure, please
check the National Register to make sure your details are up to
date or contact AHPRA on 1300 419 495.
There are four things you can do to prepare for your renewal:
Check your registration expiry date: You can check the
online National Register at www.medicalboard.gov.au to confirm
when your registration is due to expire and check your details.
Update AHPRA with your contact details: Make sure your
contact details, including your email address, are correct and
current. This will allow AHPRA to send you email renewal
reminders and to contact you if necessary. If you have your User
ID, go online at www.ahpra.gov.au, click ‘Online Services’ and
follow the prompts to update your contact details. If you do not
have your User ID, complete an online enquiry form, selecting
‘User ID’ as the category of enquiry or by calling 1300 419 495.
Watch for the reminder to renew: A reminder to renew
registration will be sent to each practitioner up to eight weeks
before registration expires. Set your email account to receive
communications from AHPRA and the Medical Board to avoid
misdirection to an account junk box.
Renew online, on time: The quickest and easiest way to
renew your registration is online. Make sure you renew on time
because under the National Law there is no option for AHPRA
or the Medical Board to renew your registration after it has
lapsed without a new application.
Renew or regret
Leaving renewal to the last minute may have serious
consequences for your practice.
• Should you fail to lodge your application to renew by
30 September, there is a late payment period during the
month of October.
• If you lodge your application to renew during the late
payment period ending 31 October, you will pay a late fee
of $170 in addition to the renewal fee of $680.
• If you fail to lodge your application to renew your
registration during the late payment period, your
registration will automatically lapse from 1 November.
• Once your registration has lapsed, you will have until 30
November to apply to AHPRA for a fast-track application
for re-registration at the cost of $340, in addition to
the registration fee of $680. If you apply through the
fast-track process, AHPRA processes most applications
within 48 hours of receiving a completed application.
Applications that include adverse declarations can take
longer.
• If you fail to re-register through the fast-track process by
30 November, you will have to apply for new registration
and only pay the registration fee of $680. AHPRA will
process your application as a new registrant within the
usual timeframe of up to 90 days.
• Should your registration lapse, you will not be able to
practice until your registration application has been
granted.
Compliance with the Fair Work Act 2009
The Association has recently assisted medical practices with
industrial issues following approaches to them by the Fair Work
Ombudsman. For medical practices there is a need to ensure that your
practice complies with the Fair Work Act and regulations, National
Employment Standards and that your employees are receiving the
correct entitlements in accordance with the Health Professionals and
Support Workers Award 2010 and the Nurses Award 2010. The
Association advises that non-compliance may lead to significant
penalties being placed on the practice.
In a recent decision of the Federal Magistrates Court, a small
business owner who failed to comply with the Act and Industrial
Awards, was ordered to pay fines totalling $20,000.
The Federal Magistrate said “that regardless of the size and
financial position of a company, “the law should mark its disapproval...
and set a penalty which serves as a warning to others.
“Compliance should not be seen as the bastion of the large
employer, with human resources staff and advisory consultants
(accountants, consultants, lawyers) behind them.”
The Association recommends that practices should ensure
compliance with the Fair Work Act, National Employment Standards
and Industrial Awards.
An audit checklist is available to practices that will assist in
identifying whether your practice is complying or not
Should your practice not be in compliance and require further
assistance please contact Gary Bucknall via email on
Gary.Bucknall@amawa.com.au or via telephone 9273 3000.
10 MEDICUS August

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August MEDICUS 11
14073 D

NEWS
Work begins on new Midland hospitals
Strong beginnings: (L-R) St John of God Health Care Group CEO Dr Michael Stanford, Federal Minister for Health Tanya Plibersek,
Brookfield Multiplex Regional Director Chris Palandri and WA Minister for Health Dr Kim Hames at the foundation laying ceremony.
(Above right) An artist’s impression of the St John of God Midland Public and Private Hospitals.
Work has officially begun on the 367-bed St John of
God Midland Public and Private Hospitals with the
first foundation laid recently at the Midland Health Campus.
The $430 million project will deliver a range of new and
expanded services to the community and a choice of public
and private health care when the hospitals open in late 2015.
Federal Minister for Health, the Honourable Tanya
Plibersek, and State Minister for Health, the Honourable Dr
Kim Hames, both attended the foundation laying ceremony
in recognition of their governments’ joint $360.2 million
investment in the construction of the 307-bed public hospital.
St John of God Health Care’s Group Chief Executive
Officer, Dr Michael Stanford, said after years of preparation
and planning St John of God Health Care, along with design
and construction partners Hassell and Brookfield Multiplex,
was delighted that construction was underway.
“We will be placing great focus on meeting our
commitments with the State Government to build the
hospitals on time and within budget as well as ensuring
we meet all our contractual obligations and performance
criteria.”
Lying in the heart of Midland, the new hospitals will
ensure access to high quality health care close to home for
the people of Midland and surrounding areas.
The St John of God Midland Public Hospital will offer
many new and expanded services, free of charge to public
patients, compared with those presently provided at Swan
District Hospital and have 50 per cent more beds than the
existing hospital.
The $70 million 60-bed private hospital is wholly funded
by St John of God Health Care.
In its first year of operation, the public hospital is
anticipated to treat about 29,000 inpatients, 55,000
emergency patients and 89,000 outpatients.
Fast facts
The new 307-bed St John of God Public Hospital will offer a range of services, including new and expanded services compared with those
currently offered by Swan District Hospital, with these being free of charge to public patients.
Some of the services will include:
• New intensive care / high dependency /
coronary care unit
• New cancer care service
• New adult rehabilitation service
• Expanded emergency department
• Expanded stroke and restorative rehabilitation
• Expanded mental health
• An increase to 24-hour anaesthetic cover
• Enhanced cardiology
• General surgery, including day surgery and surgical specialties
• General medical, medical specialties and geriatric and aged care
• General paediatrics
• Maternity, including antenatal and postnatal care and
neonatology
• Ambulatory care (outpatient clinics)
• Hydrotherapy pool
• Pathology.
12 MEDICUS August

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14 MEDICUS August
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NEWS
$75m hospital redevelopment plan
to boost health care in Peel
Need: An artist’s impression of the renovated and expanded Peel Health campus.
Health Minister Kim Hames should approve the proposed
$75 million redevelopment at Peel Health Campus as soon
as possible, the President of the Australian Medical Association
(WA) Dr Richard Choong said.
“This proposal offers a vital improvement to health services
in the southern corridor and Mr Hames must ensure that there
are no roadblocks placed in its way,” Dr Choong added.
Health Solutions (WA), the private company that operates
Peel Health Campus (PHC) has committed to expanding the
entire Mandurah-based hospital and to fully funding the $75
million redevelopment project.
Dr Choong said the Health Minister had personal knowledge
of the impact a fast-growing population in the Peel area was
having on health services in the area.
“As a local MP, Mr Hames knows full well that this proposal
by Health Solutions (WA) is one of the best ways to boost health
services in the area.
“This project, which includes a complete renovation and
expansion of the existing public hospital and emergency
department along with the construction of a new hospital
to include 86 beds, is just what is needed in the area as
soon as possible.”
“With a growing population and an ageing one as well, this
expansion is not only welcome but will go a long way to solving
capacity issues in the area,” Dr Choong said.
PHC Director of Clinical Services, Dr Aled Williams said:
“PHC has experienced an unprecedented increase in patient
demand during the past five years, particularly in its
emergency department and with the number of overnight
hospital stays.”
Additionally, the pressure on operating theatre space and
obstetric beds has continued to rise. “If the current growth rate
continues, the Hospital in its current state will be unable to cope
with patient demand by 2014/2015,” Dr Williams warned.
HSWA is ready to commence its redevelopment and
expansion project immediately, subject to government
approval. PHC is currently a 130-bed hospital with a 22-bed
emergency department.
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August MEDICUS 15

FOCUS
Could we be ADDING
fuel to
the fire? Tragic:
In early July, arsonists set fire to the historic
Mount Lawley Primary School.
by Dr Michael Gannon
Vice President AMA (WA)
In the early hours of Sunday 8 July, as my wife and I made
our way home from the AMA (WA) Awards Dinner, a trio
of teenage arsonists set fire to our daughter and son’s historic
100-year-old school.
A few short hours later we were at a hastily convened
meeting of parents and teachers at the local high school.
We were promised by the Mandarin from the Education
Department that professional counselling services would be
made available for our children. I started to wonder exactly
how appropriate trauma counselling was.
Certainly my mother was very upset, having seen the school
she attended in the 1950s reduced to ash. The anguish on the
faces of the Headmaster and teachers was most distressing,
with years of resources and hard work shamefully and
criminally incinerated in less than an hour. But does trauma
counselling really help five to 12 year-old-children? Could it
actually harm them?
When the World Trade Centre fell in September 2001, an
army of nearly 10,000 psychologists, counsellors and social
workers descended on New York City to help the survivors.
The evidence would suggest that the process of ‘debriefing’
i.e. encouraging the survivors to re-hash their trauma in many
cases provoked rather than prevented Post-traumatic Stress
Disorder (PTSD).
The patients that many of us see each week who came
via refugee camps in the Horn of Africa do not need to, nor
wish to re-live their personal experiences of the horrors of
famine, war, rape, poverty and dislocation. They have reached
Australia, often after many years of waiting, and now given
safe refuge, they have time to recoup and rebuild their lives.
The response of the Government, the Education
Department and my local community has been phenomenal
with a temporary school assembled in less than a fortnight,
ready for the new school term. The important role that
counsellors, GPs, psychologists and psychiatrists play should
not be denigrated. People trying to help should be praised for
their efforts, not criticised.
But maybe the counsellors should stay away and let the kids
enjoy their new playground, their brand new pencil cases and
their exciting new adventures. It is not enough to announce
that you are ‘here to help’, especially if you might actually be
causing harm.
16 MEDICUS August

FOCUS
When no talk is good talk
by Dr Margaret Lumley
Psychiatrist, Royal Perth Hospital
The recent destruction of the Mount Lawley Primary
School by fire represented a tragic loss of historic
buildings and an urgent need for relocation of the 400 pupils
of the school. However, a subsequent plan to provide the
children with ‘trauma counselling’ may prove more harmful
than helpful.
Clearly the aim of the planned counselling will be to help
the children to avoid developing psychological or psychiatric
sequelae to the event. Common sense would dictate that
early intervention should be expected to help the children
adjust to the loss and dislocation involved, and to stave off the
development of subsequent problems such as Post-traumatic
Stress Disorder (PTSD). However, this intention is misplaced.
PTSD is a relatively rare condition, and is a serious
and crippling psychiatric disorder. It includes painful
re-experiencing of the traumatic event, during waking
hours or as repetitive nightmares, withdrawal from the
normal activities of life, and hypervigilance and autonomic
hyperarousal in general.
PTSD in children and adolescents occurs as a result of a
child’s exposure to one or more traumatic events that were life
threatening or perceived to be likely to cause serious injury to
self or others. In addition, the child or adolescent must have
responded with intense fear, helplessness or horror (Lubit
2011(a)). Based on this definition alone, it is clear that, since
no children were at the school at the time of the fire, they are
unlikely to be affected.
However, the situation is now made more complex by the
planned institution of counselling. Contrary to what one might
intuitively think, early trauma counselling has been shown to
at best be of no benefit, but also, in a number of studies, to lead
to positively deleterious outcomes (Radley et al 2011, Cartier et
al 1998, Mayou 2000, Roberts et al 2009).
Pausing for a moment to consider the rich tapestry of
human history, it should be obvious that we are generally
fairly robust in the face of a range of natural and man-made
disasters. The healthy person will react to trauma in his or her
own way, and move on. The initial reaction, and subsequent
course of events, will be determined by a range of factors
including prior experience, personality style, presence of
supports, and the actual nature of the trauma and subsequent
events. Any attempt to get the person to ‘deal with emotions’
or ‘face facts’ or attempt to seek early closure, it seems, may
interfere with a natural process and lead to a poorer outcome.
Iatrogenic pathology may also be introduced by the
very experience of being offered ‘therapy’. We are very
psychologically suggestible, and the act of counselling
itself can plant the seed that we are supposed to be having
problems. Furthermore, group counselling, if employed, is
subject to contagion of distress and maladaptive reactions and
behaviours (Lubit 2011(b)).
Ideally, then, the children of Mount Lawley Primary
School should not be subjected to early ‘intervention’ of a
psychological nature, particularly given that none of them
are expected to have even witnessed the fire. But of course
parents and teachers need to remain sensitive to the needs of
the children, and, if genuine concerns arise with regard to
individual students, seek appropriate help then.
Dr Margaret Lumley is a psychiatrist at RPH working both in the
Emergency Department and the general wards in Consultation
Liaison Psychiatry. She has special interest and expertise in
psychotherapy and for many years ran the highly successful
CHANGES program at RPH, treating people troubled by
Borderline Personality Disorder. Dr Lumley has also participated
for many years on a panel of psychiatrists available to assist fellow
doctors and medical students in distress.
References:
Bisson JI, Brayne M, Ochberg KM, Everley GS (2007), ‘Early
psychosocial intervention following traumatic events’, American Journal of
Psychiatry 164: 1016 – 1019.
Cartier, IVE, Lamberts, RD, van Uchelen AJ, Gersons BPR (1998),
‘Disaster related PTSD in police officers: a field study of the impact of
debriefing’, Stress Medicine 14(3):143-8.
Lubit, RH (2011(a)) ‘Posttraumatic Stress Disorder in Children’ , http://
www.medscape.com/viewarticle/918844.
Lubit, RH (2011(b)) ‘Acute Treatment of Disaster Survivors’, http://www.
medscape.com/viewarticle/295003.
Mayou, RA, Ehlers A, Hobbs M (2000) ‘Psychological debriefing in road
traffic accident victims: Three year follow up of a randomized controlled
trial’, British Journal of Psychiatry 176(6): 589-93.
Radley JJ, Kabbaj m, Jacobsen L, Heydendael W, Yehuda R, Harman
JP (2011), ‘Stress risk factors and stress related pathology: Neuroplasticity,
epigenetics and endophenotypes’, Stress 14(5), 481-97.
Roberts NP, Kitchener NJ, Kenardy J, Bisson JI (2009) ‘Multiple
session early psychological interventions for the treatment of post
traumatic stress disorder’, Cochrane Database of Systematic Reviews
DOI:10.1002/14651858.CD006869.pub2.
August MEDICUS 17

OPINION
PFP: Pay for Performance or
“Patients Frustrate Physicians?”
by Dr Steve Wilson
Chair, AMA (WA) Council of General Practice
For some of you, the above acronym PFP may be new but,
indeed, financial incentives for outcomes in health have
long been in general and hospital practice – albeit not always
with good effect. It is when financial incentives reward what is
seen as positive changes in how clinicians behave.
But who decides and what tools determine what those
positive changes are? And of course potentially, it means
punishments for underperformace or poorer outcomes. And
why make just clinicians responsible for this? What about
patient behaviour?
With Medicare’s ridiculous time tiering, in GP-land (private
or direct-billed) the fee is effectively the same for six-minute
consults versus 18 minutes of solid graft. Over a decade ago, the
government saw fit to progressively shift the funding emphases
toward outcomes-based, non-volume (fee for service) funding
especially around big-cost diseases, aged and child care and
preventative strategies e.g. pap smears.
Certainly, to health financiers who want value for money,
you don’t just fund units of service but quality, safe outcomes.
And whilst ‘Fee for Service’ should be the cornerstone of health
financing, it often does not serve many areas well – such as
aged care where non face-to-face work is onerous, huge and
unrewarded.
With so many chronic diseases now accounting for the huge
burden of disease and cost, it seems reasonable to incentivise
clinicians for quality outcomes. However, where is the evidence
that it works? Or that it does not in fact ‘skew’ practice, and
indeed cause no harm or even worse, keep us busy meeting de
facto ‘process outcomes’ rather than real outcomes, which are
so hard to measure?
And what tools? The ever increasing list of Best Practice
Guidelines (BPGs) tells us what is optimal care in each
disorder. However years of experience have taught me, that in
individual patients, these ideals are simply not achievable and
potentially harmful but, could be used as a stick with which to
beat clinicians rather than as a carrot to feed them.
For example: “Beta-blockers are underused in heart failure,
as they have been shown to improve survival”. True. But take
Alan (74) who lives alone and who had a massive AMI in
September 2011; his Troponin peaked over 300. Alan survived
but cardiogenic shock ensued, marked hypotension followed by
a protracted recovery and good cardiac rehab – at least he is still
alive.
However, neither his cardiologists nor I can get his Bisoprolol
over 1.25mg/d without causing dizziness, falls and him to feel
dreadful. I am treating a human being, not a BPG. But if a
18 MEDICUS August

OPINION
bureaucrat decides that, say at least 25-50 per cent of my CHF
patients need to be on a b-blocker at say, at least 50 per cent or
more of the optimal dose (10mg), then I have not ‘performed’.
And what about patient behaviours?
Don and Joan are both DMIIs. Both were diagnosed in
1998 when they weighed 103kg each. Both are now over 110kg.
I have them on optimal doses of oral hypoglycaemics, ACE
inhibitors, CCBs, Statins, Aspirin and more. But while Joan’s
diabetes is fairly indolent (HbA1c remains consistently less
than 6.5 per cent), Don is developing poor control, increasing
albuminuria and every excuse as to why he cannot lose a gram
of weight.
In a chance encounter outside the local supermarket last
year, I saw not one scrap of fresh produce in their trolley; just
high fat, easy-to-prepare products. I have contributed to the
medicalisation of what are lifestyle and choice issues – the very
issues which led to this problem and now perpetuate it.
If PFP demands for example that I check his HbA1c at least
every six months and lipids, every 12-24 months, I may do it
(I do already). But if I am to be held responsible for ensuring
my diabetics achieve HbA1cs below 7 per cent or 7.5 per cent
when I am up against this sort of stuff, then I utterly reject it
– especially if the last or the next study shows worse outcomes
with over-aggressive lowering of glycated Hb.
Furthermore, and proudly, many clinicians began changing
their behaviour long before there were incentives to do so.
Think of the many GPs who computerised their practices, had
practice nurses, instituted care models, recall systems and met
targets just because it was ‘damn good practice’ – there is good
evidence for this including here in Perth.
Additionally, there is potential skewing of practice. There
is already ‘cherry-picking’ of the higher-paying item numbers
in the MBS. If, for example, you care for a large number of
poorly-controlled super-obese diabetics, then a carrot and
stick model could lead to refusal to accept or continuing to
care for the most ‘undesirable’ patients, lest they cause your
stats to look poor. You could cherry-pick the easier stuff and
flick those patients to the public hospitals or other practices,
i.e. lose the very reason we are doctors for fear of losing carrots
and being hit with very large sticks.
Finally, good outcomes can only be achieved with adequate
support, infrastructure and commitment by all – including
patients. And in fact, knowing who your patients are - i.e
patient or practice registration, a discussion in itself. You
cannot optimally manage diabetic patients without access to
all the necessary secondary services. Easy
in Perth maybe, perhaps not in the
Kimberley.
For me, money often
brings out the worst in
human behaviour – we
have already seen the
conflicts that the
changes in Practice
Nurse funding
created. And will this
adversely affect the
very reason we became
doctors or affect the
doctor-patient relationship
as we ‘insist’ patients try
to do things they simply won’t
entertain?
Finally, good
outcomes can only
be achieved with
adequate support,
infrastructure and
commitment by all –
including patients
We must tread carefully. Yesterday’s wisdom is tomorrow’s
folly – remember Helicobacter Pylori and that Judas sold Jesus
out for 30 pieces of silver.
August MEDICUS 19

OPINION
Ticked off
by Dr Cassandra Host
Co-chair, Doctors in Training Committee
The deadline has passed. Job applications for 2013 have
closed. I hope all of you remembered to submit your
application on time.
There are many tasks required to complete the desired format:
1. Working with Children Check (WWCC) – good, found
that. Still scanned on file from last year, not expired yet.
2. Police Clearance – sigh, not again! Another $65. Will they
accept the one from last year? It is not like I am changing
employer.
3. Australian Health Practitioner Regulation Agency
(AHPRA) registration – can’t they just Google it these days?
4. Certificate of Graduation – oh, that one is not required anymore.
5. Does all this stuff need certifying?
6. CV – that’s easy, update and…done!
7. Referees – I hope they reply if requested.
8. Selection criteria – teamwork, check. PPD, check. Teaching
skills, check.
This is an awful lot of effort to keep the same job I am already
doing. Bring back the good old days; your contract for next
year was “opt out” and not enthusiastically, “opt in and we’ll
think about it”.
Now I know I sound like a grumpy old woman when I refer
to the past, but this time every year, a letter would magically
appear in my letterbox – yes, when they would actually post
important correspondence to your house and not drop it on
the paper mountain in the common room.
That letter had a few tick-a-box preferences asking me if I
wanted to continue working at the hospital and then if I was
interested in taking an RMO, Service Registrar or Registrar
position. I would select a box or two and a few months later, a
contract would arrive by post. It was generally assumed that
I would return a signed offer of acceptance, but if I forgot
to reply, a nice lady from HR would call just to check that I
would be returning in the new year. Not anymore.
As a result of increased numbers of JMOs, there is now
the perceived threat that someone might miss out. Other
than interns and RMOs who have a centralised application
process, each Registrar (some organised training programs
excepted) has to apply to each hospital and individual job titles
separately. Spare a thought for the physician’s trainees who
had to complete both service registrar and registrar application
forms, planning for both failure and success in their exams.
Even departments that have tapped individuals on the
shoulder and specifically asked them to return next year
cannot guarantee the candidate will have a job until all
applications have been considered.
The result – many DiTs applying for several jobs at several
services to increase their chances of getting a job. This, quite
possibly, might be the reason why this year there are often
more than 50 applicants for the same job. Realistically, most,
if not all of these doctors will have applied somewhere else,
clearly only intending to accept one offer, with the others just
as back-up. This can create problems for departments that are
trying to secure adequate staffing for the next year, as doctors
can pick and choose or wait until all offers are in before
making a late final decision on a workplace.
Maybe I have just lived a sheltered life and this is how
the real world works. But it does seem a lot of effort goes
into reapplying each year for both applicants and medical
administrations alike.
Given the length of duration of training and therefore,
virtual guarantee of a return to the workplace in the future, it
would be nice if we could have the option of longer contracts
so we did not have to go through this process year after year.
This would also engender a culture of loyalty to our
chosen health service and “mother-ship” hospitals. But in
the meantime, we will all continue to do that last-minute
scramble to submit our applications before the deadline.
Laborious: Each Registrar (some organised training programs excepted)
has to apply to each hospital and individual job titles separately.
The AMA (WA) has written to the Director General and
continues to advocate that WA Health should use the provisions
contained within the Industrial Agreement where Health Services
can offer DiTs who are in accredited training programs a
contract for the length of time expected to conclude the training
program. The AMA (WA) has pointed out the ludicrous, costly
and inefficient process for practitioners having to apply each
year. The Department has, to date, failed in its duty to properly
consider cost-effective administrative practices. The AMA (WA)
is not prepared to leave the issue there and continues to pursue the
Department for a sensible solution.
20 MEDICUS August

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FEATURE
Independent
midwives:
helping or hindering?
The recent announcement from the Council of Australian
Governments (COAG) – that independent midwives no longer
need to engage in a collaborative partnership with an obstetrician
– has been slammed by the Australian Medical Association (WA).
AMA (WA) President Dr Richard Choong said Australia’s Health
Ministers have compromised patient care and safety by agreeing
to undermine collaborative care arrangements between medical
practitioners and midwives.
“The AMA strongly opposes this dangerous and unexpected decision.
“There has been no dialogue whatsoever on this serious about-turn
on an important policy that took years to implement,” Dr Choong said.
“Under the current process, the private arrangements mirror
those in the public hospital sector, where the entire medical, nursing
and midwifery team works together and understands the roles and
responsibilities for maternity care.
“The current arrangements already allow for midwives to have
collaborative arrangements with a medical practitioner employed or
engaged by a hospital authority and authorised by the hospital authority
to participate in a collaborative arrangement.
“Does this now mean that, should a delivery became complicated,
would the midwife have to transfer the care of the mother and baby to a
hospital administrator instead of a highly skilled medical practitioner?
“This change not only risks safe patient care, it is avoidable,”
Dr Choong said.
The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists (RANZCOG) has also come down hard on the COAG
announcement.
“In view of this development, RANZCOG considers it vital that
any public hospital administration providing support to independent
midwives is adequately resourced to cope with the anticipated
subsequent increase in unanticipated obstetric emergencies,” the
College said in statement.
RANZOG argued that a further increase in emergency cases had
a potential for adverse consequences, not only for women and babies
unexpectedly transferred from independent midwifery care (as happens
in a large proportion of planned homebirths, for example) but also for
women who had planned hospital delivery and could require emergency
obstetric care from the obstetric team at the same time, unexpectedly
dividing resources.
Eligible midwife Pauline Costins puts forward her argument in favour
of greater collaboration between midwives and medical practitioners.
Dr Michael Gannon, AMA (WA) Vice President also presents his views
disputing the agreement.

Desperately seeking
FEATURE
by Pauline Costins
Eligible midwife
collaboration
Collaboration’ is not a dirty word. Far from it. The
National Health and Medical Research Council
(NHMRC) defines collaboration as “a dynamic process
of facilitating communication, trust pathways that enable
health professionals to provide safe, woman-centred care.
Collaborative maternity care enables women to be active
participants in their care. Collaboration includes clearly
defined roles and responsibilities for everyone involved in
the woman’s care, especially for the person the woman sees
as her maternity care provider”.1
An eligible midwife is able to provide comprehensive
midwifery care for women who choose this model of care.
Of course, an eligible midwife:
• must have insurance
• must have a Medicare provider number
• requires collaborative arrangements
• women can claim a rebate for services
• can provide diagnostic tests; and
• can prescribe once endorsed (course current at Flinders
University).
An eligible midwife requires collaboration in order for the
midwife to claim the Medicare rebate utilising her provider
number. This process was set out in the National Health
(Collaborative Arrangements for Midwives) Determination
2010.
The collaboration can be in several formats – a formal
collaborative agreement, a referral letter, or the midwife
needs to clearly document the process of collaboration with
acknowledgement from the collaborating doctor (this last
point is difficult and arduous).
The course for pharmacology has been endorsed and
commenced at Flinders University. Once this is completed, the
eligible midwife becomes an endorsed midwife and is able to
prescribe from an approved formulary.
A continuity of the Midwifery Care Model can be offered
to all women regardless of the risk category. If at the booking
visit (eight to 10 weeks), a risk factor is identified (as per
ACM consultation and referral guidelines) the woman will
be referred to an obstetrician or GP obstetrician as soon as
possible for assessment and further advice. Some private
practice midwives would like to continue to provide midwifery
care for this woman together with obstetric care.
If the woman is low risk, then she will be booked in for a
hospital visit at 19–20 weeks where she will have her booking
appointment and if all is well, will continue to see the
midwife until 36/40 weeks where another hospital visit will be
scheduled.
Most women want a hospital birth (99 per cent) with
continuity of midwifery care. They want antenatal care in
the home and support at home for early labour. The woman
will labour at home until an established labour and will then
proceed to hospital for a planned hospital birth. The midwife
will care for the woman within the hospital setting and then
if all goes well, will transfer her home four to six hours post
birth. Furthermore the new mother will be provided with six
weeks postnatal care at home if she requires or requests this.
If the woman is low risk and requests a homebirth, this too
will be facilitated.
Eligible midwives work in a variety of settings and several
have some form of collaborative agreement with a GP
obstetrician. However, this does not yet include intrapartum
care. Current collaborative agreements in WA do not cover
intrapartum care. The state is not unique; with this issue
presently, there are about three collaborative agreements
throughout Australia that include all facets of care of which
Dr Andew Pesce is engaged in one. Presently in WA, only
two hospitals facilitate continuity of care for these women by
employing the midwives on a casual basis for the birth.
WA Health is developing a framework that includes
credentialing and access agreements but progress is slow. In
all other hospitals, the midwife accompanies the woman as a
support person – the women find this option unacceptable as
they have employed a midwife, not a doula.
Benefits for the women include true choice and better
outcomes. For the system, women are being diverted from
overcrowded hospital waiting rooms – early labour at home
prevents blocking labour ward beds.
There is countless evidence to suggest that women who have
continuity in labour have better outcomes. The woman will
bring a midwife to the labour room, again relieving pressure
on a busy labour ward...then a six-hour discharge and followup
care for six weeks if they so choose. GP obstetricians/
obstetricians can refer women to eligible midwives for
postnatal care, therefore discharging women earlier from
hospital.
Some benefits for doctors are that they can refer women to
an eligible midwife for shared antenatal and postnatal care to
free up busy surgeries. This can be easily achieved by referring
women to eligible midwives and this is a type of collaborative
arrangement2. This would then enable the woman/midwife to
claim Medicare using her provider number.
The legal responsibilities are the same for any health
professional; you work within your scope of practice and
ensure correct referrals are in place. Shared care utilising
Continued on page 24
August MEDICUS 23

FEATURE
Continued from page 23
the referral pathways would benefit the eligible midwife
particularly for antenatal and postnatal care. Once the woman
is admitted to hospital, the private midwife will operate within
guidelines of the hospital. All private midwives are required
by the Nursing and Midwifery Board of Australia (NMBA) to
work within the Safety and Quality Framework and the ACM
consultation and referral guidelines.
To reiterate, collaboration is about working together
to enable women to choose care that is based on the best
evidence, appropriate for them. It is about professionals
establishing a clearly defined and inclusive reciprocal
communication strategy – enabling us to work together for
the benefit of women.
Eligible midwives need referral pathways to enable full
benefits of having a provider number to access Medicare for
antenatal and postnatal care. Please consider the benefits of
working with an eligible midwife who is referring women or
engaging in a collaborative agreement with them. There is
much potential for women with a continuity of midwifery
model of care. This is about being a change agent. It is not
about homebirth. It is about offering women continuity of
midwifery care working in collaboration with doctors.
References:
1. National Guidance on collaborative maternity care. Australian
Government, Dept of Health and Ageing. P1. 2010.
2. National Health (Collaborative arrangements for midwives)
Determination 2010. National Health Act 1953.
Deliver us
from this debate!
Dr Michael Gannon
Vice President AMA (WA)
Representatives of the Australian College of Midwives
(ACM) recently met with representatives of the
Royal Australia New Zealand College of Obstetricians and
Gynaecologists (RANZCOG), seeking their support in
changing the National Health (Collaborative Arrangements
for Midwives) Determination and specifically the requirement
for midwives to enter a Collaborative Care Agreement with an
Obstetrician.
Then AMA Federal President and obstetrician,
Dr Andrew Pesce saw the legislation of a requirement for
collaboration as one of the triumphs of his Presidency.
He championed the collaboration and entered into an
arrangement himself at his Sydney practice.
The ACM resented the requirement, disappointed that the
much vaunted Maternity Services Review did not deliver a
model of care similar to that seen in either New Zealand or
Britain. Key protagonists in the small but vocal home birth
movement were scathing of then Minister for Health Nicola
Roxon and her failure to deliver their desired outcomes.
A communiqué from the Council of Australian Governments
(COAG) on 10 August stated that “Commonwealth agreed to
vary the determination on collaborative agreements”. This
means that private midwives will now be able to enter into
agreements with hospitals and area health services.
I understand Ms Costins’ frustration. She presents a fair,
sincere and impassioned argument. Public antenatal clinics
are very busy and far from perfect. Primigravid women are
commonly discharged
from Hospital 24–48
hours after delivery,
often exhausted and
tired, increasing the
proportion of women
unable to successfully
breastfeed and the
burden of Postnatal
Depression. Continuity
of a maternity care
provider is, as it stands, a
privilege of the wealthy. But why
have only three obstetricians in the
whole of Australia signed Collaborative Care
Agreements?
The dichotomy of high
risk and low risk is a
fallacy. Emergency
situations requiring
expertise commonly
develop without
warning
The greatest impediment is fear about late referral.
When there is a good relationship between patient/client and
caregiver, neither has a desire for it to end.
It is only about four times a year that I refer a patient to a
Maternal-Fetal Medicine sub-specialist. I may have delivered
their first child or that of their sister. I do not want to “give
them up”.
Those GP Obstetricians who do not perform caesarean
sections must lament the need to refer away on occasions.
Independent midwives will inevitably wait another four hours
in the first stage of labour or another hour in the second stage
24 MEDICUS August

FEATURE
before “giving up”, inevitably increasing the risks to mother
and/or baby. And those are the midwives without this ludicrous
notion that labour and birth are risk-free physiological events
in healthy women.
Like it or not, Independent Midwifery has an image
problem. Lisa Barrett, a midwife in South Australia, took
on (at least) three cases where babies died in circumstances
where timely caesarean section would very simply have seen
them born alive and intact. In the third birth the second twin
was asphyxiated and died – that mother having appeared
as a supportive character witness earlier in the coronial
investigation.
Ms Barrett crossed the Nullarbor and was involved in
a further disaster here in WA, having devolved herself of
her registration and acting as a doula (an unskilled birth
attendant) in a cynical attempt to try to avoid the scrutiny of
professional registration and requirement for indemnity.
The Victorian Coroner is investigating the case of the
death of a baby in 2010. A woman was labouring at home
under the “care” of an independent midwife despite having
had three previous caesarean sections and this baby in breech
presentation. After the patient was eventually transferred to
hospital, the midwife allegedly interfered with efforts made to
care for her baby.
Another woman Janet Fraser achieved notoriety for her
Joyous Birth Network and a website which referred to vaginal
examination in labour as “birth rape”. She laboured at home
after having had a previous caesarean section with her baby
dying of asphyxia in a “free birth”, with no skilled birth
attendants present at her delivery in metropolitan Sydney.
This is the kind of ideology that we are up against.
When independent midwives were given autonomy in New
Zealand, GP obstetrics became extinct and non-metropolitan
gynaecological services were decimated. None of these
proposed changes will have any impact on the income or
job satisfaction of private obstetricians in the metropolitan
area. But it will further weaken the morale of public obstetric
units, asked to inevitably pick up the pieces. Junior obstetric,
anaesthetic and paediatric staff will be damaged. In those
parts of the world that cannot deliver a five to 10 per cent
caesarean section rate, the deaths of mothers and babies are
daily occurrences. I can do a nice SVD. Midwives cannot
get a mother or baby out of trouble with a pair of forceps or a
caesarean section.
We live in a humane, compassionate society that sees
stillbirth as a tragedy. Society pays in many more ways when
children are brain damaged, their potential taken from them
the day of their birth, the most dangerous day of their entire
infancy and childhood.
Obstetrician-led care allows for women to labour and deliver
normally, but possessing the skill-set to reduce maternal/
perinatal mortality/morbidity with decisive operative vaginal
delivery or caesarean section.
Just as importantly, obstetricians are not constrained by an
ideology that “intervention” is of itself an undesirable thing e.g.
induction of labour. The stillbirth rate and caesarean section
rate are both significantly lower in women delivered at 40 weeks
as compared to 41–42 weeks.
If midwife-led care is so safe and complications in lowrisk
women so uncommon, exactly why is it they cannot get
indemnity insurance without a sweetheart deal from the
Commonwealth Government? Why have three State Coroners
expressed concerns about independent midwifery in the last six
months alone?
The dichotomy of high risk and low risk is a fallacy. Emergency
situations requiring expertise commonly develop without warning.
Handing the care of healthy women to midwives, away from
GPs and obstetricians will not improve outcomes or maternal
satisfaction. It is time that we stopped measuring epidural rates
and caesarean section rates as indicators of failure. It is long
overdue that we took pride in the way we deliver maternity care
in Australia. We have much to be proud of.
August MEDICUS 25

COVER STORY
Butt
seriously
It is time for WA to stub out any obstacles
that lie in the way of a smoke-free society
says Professor Mike Daube
T
he High Court decision on tobacco plain packaging is a massive win
for public health, a massive defeat for the tobacco industry, and – as
international reactions have shown – a massive boost for tobacco control
around the world. We should celebrate – but we cannot afford to be
complacent. There is much work yet to be done.
Smoking is declining in Western Australia as in other states. Health
Department figures show that only 11.1 per cent of adult Western
Australians over 16 smoke daily and 4.8 per cent of 12–17 year-olds are
weekly smokers. Anyone under 21 has grown up without exposure to direct
tobacco advertising. The introduction of plain packaging in December
will further reduce the attraction of smoking – which is why it has been so
ferociously opposed by Big Tobacco.
But international experience in tobacco control shows that complacency
can halt the decline. Tobacco is still promoted directly and indirectly
(look at how many popular movies just happen to promote smoking) – and
six decades after indisputable evidence that smoking kills, a quarter of a
million Western Australians still smoke.
There is now serious discussion about how we can aim to bring smoking
to an end. Various options are being mooted – banning sales to anyone
born beyond a specified year, mandating reduced supply of tobacco onto
the market, licensing schemes for smokers, setting a date by which tobacco
companies have to demonstrate that their products meet normal
consumer standards – and maybe, ultimately, banning commercial
cigarette sales.
In the meantime, we need to keep doing more because
smoking is uniquely harmful – the only consumer product
that kills half its regular consumers when used precisely
as intended.
Some of the action needed is national – such as tax
increases and plain packaging. But we also need action at the
state level.
We are no longer the national leaders. WA has previously been the
leader in action on tobacco, from medically-based campaigning to
QUIT campaigns to legislation. It is time for new approaches that will
26 MEDICUS August

COVER STORY
make WA smoke free – and save thousands of WA lives.
We need a new sense of urgency, with ambitious but
achievable targets.
We should set a target date for WA to become effectively a
smoke-free community – which I define as under 5 per cent
of adults and under 3 per cent of school students as regular
smokers. This would make WA the world leader – and is
absolutely feasible.
The following 10 point plan will get us there:
1. Set a target date of 2020 for WA to become smoke-free.
2. Reduce the number of tobacco licences by 10 per cent
each year. We impose constraints on locations where
alcohol can be sold. Why not this lethal product? WA
has 3900 tobacco sales outlets for an adult population of
around 1.7 million. We don’t need one tobacco outlet for
every 450 people.
3. Strengthen point-of-sale legislation. Despite the best
intentions of WA’s Tobacco Control Act, retailers can
still publicise cigarette brands. There should be no
brand information – simply a small notice that tobacco
is available, alongside a government-mandated health
warning.
4. The State Government should sue tobacco companies to
recover the costs of treating diseases caused by smoking.
American States did this in the 1990s and won vast
payouts through the Master Settlement agreement. If
that is too hard, increase the cost of tobacco licenses from
$204 ($510 for wholesalers) to amounts that better reflect
the costs of smoking to the health system.
5. A continued commitment to adequate expenditure on
strong, sustained, hard-hitting media campaigns, with
support for quitters.
6. Mandate comprehensive, well-supported Health and
Physical Education in all schools – a measure supported
by 96 per cent of WA parents. It is incomprehensible
that WA parents cannot be sure that their children will
be exposed to proper education on tobacco – or indeed,
alcohol, drugs or sex education.
7. Major new programs for disadvantaged groups –
indigenous communities, people with mental health
problems, and prisoners. Current promising programs
to address indigenous smoking need further support.
Sadly, the absence of serious system efforts thus far to
encourage and support smoking cessation in mental
health institutions and prisons in WA has been a
disgrace. It is encouraging that the new Minister for
Corrective Services has already expressed a wish to act in
this area.
8. Ban all tobacco lobbying and public relations activities.
We banned tobacco advertising 21 years ago but the
international companies are still actively promoting their
interests and opposing public health measures. The only
purpose of tobacco lobbying and PR is to maximise sales
of a lethal product. It should go.
9. Minimise exposure to
passive smoking. This
should include good
enforcement of current
restrictions; extending
non-smoking areas
in public places like
shopping malls;
ending anomalies
such as smoking
in beer gardens
and the casino,
which put both
staff and patrons
at risk; substantial
buffer zones around
areas where smoking is
Advantage: Tobacco plain packaging
has been a massive win for public health.
banned; and protecting
non-smokers in common residential areas.
10.Strong enforcement of current legislation so that no retailers
sell cigarettes to children. The latest Health Department
survey showed that an amazing 39 per cent of retailers
sell cigarettes to children. There is no excuse for this. Any
retailer knowingly selling cigarettes to
children should lose their licence.
There is no serious obstacle to
implementing this 10 point plan, beyond
taking on the tobacco lobby and its
fellow-travellers. The
prize is immense –
we can prevent not
only much ill
health and
suffering, but
the premature
deaths of tens
of thousands
of Western
Australians now
alive. Is that not
a worthwhile
challenge for any government?
And why wouldn’t they do it?
WA has a long tradition of
leadership in tobacco control,
led by medical and health groups
and governments of all
parties. It is time to reclaim
that leadership both in the
aspiration to a smoke-free
society and in the action that
will take us there.
In the past: Individual branding and
colours helped to promote Big Tobacco.
Mike Daube is Professor of Health Policy at Curtin University and
President of the Australian Council on Smoking and Health.
August MEDICUS 27

COVER STORY
Plain SPEAKING
By Professor Jonathan Carapetis
Director of the Telethon Institute for Child Health Research,
and Paediatrician at Princess Margaret Hospital for Children
grew up in a family of smokers. I remember those long trips
I in the back of the Valiant sedan, craning my head to the open
window to get a breath of fresh air, barely able to breathe and
feeling as sick as a dog. I recall well that sense of dread as I saw
my mother reach for her pack of cigarettes, knowing that I would
spend the next 10 minutes taking small gasps of air through
my mouth rather than my nose, to minimise the stench and the
feeling that I was breathing tainted air.
I reacted viscerally, determined never
to smoke in my life. My siblings weren’t
so lucky, taking many years to kick the
habit they picked up as teenagers.
As I went through medical school,
I learned more about the true impact
of tobacco around the world, and
the shameful tactics of the tobacco
industry in peddling their lethal wares.
From time to time, I would also pass
a cigarette billboard that had been
refaced by the Billboard Utilising
Graffitists Against Unhealthy Promotions (BUGA UP), usually
using humour to turn the message of the advertisement on its
head. It turned out that a lot of the BUGA UPpers in Melbourne
were young doctors or medical students as well, so it didn’t take
me long to hook up with a few of them.
Thus my career of clandestine public health advocacy began.
I have many tales of ingenious home-made spray can extension
devices (to reach those difficult billboards in high places), audacious
graffiti-ing during peak hour on busy train platforms, arrests by
unsympathetic policemen (who would often light up a Winfield
during the interrogation), haranguing of the pretty young things
decked out in Marlboro gear at the tennis, and the list goes on…
BUGA UP struck a chord with the Australian population, and
was part of a multi-faceted movement led partly by academics, but
largely by the community and community-based organisations,
that continues to this day. Governments have followed suit, and
legislation has allowed us to accelerate the falling rates of smoking
in all jurisdictions, in women and men, and in all age groups.
In the early years, governments were reluctant starters, taking
quite a while to realise both that being tough on smoking was a vote
winner rather than loser, and that the revenue they received from
tobacco sales was far outweighed by the costs they paid in treating
smoking-related illness. And now, with the failure of Big Tobacco’s
High Court appeal against the plain packaging legislation, Australia
has placed itself at the forefront of international efforts to reduce the
numbers of kids starting to smoke.
Young crusader: Jonathan Carapetis in his younger days, in
front of a billboard he helped to reface.
Make no mistake – this is about the kids. We have all heard
about the impacts of passive smoking on children with respiratory
diseases like asthma. We also know that it is in childhood and
adolescence that most smokers become addicted, and that this is
all too often modelled on the behaviour of their parents and other
significant people in their lives.
But there is more to it than that. We are only now starting to
unravel the long-term effects on
the next generation of smoking
by pregnant mothers and
passive smoke exposure during
childhood – deleterious impacts
that are likely to increase the
risk of chronic diseases and
early death in adulthood,
whether or not that child
becomes a smoker themself.
I feel an immense sense of
pride that plain packaging is
going ahead in this country,
and that other countries are looking to emulate the Australian
Government’s stance. Plain packaging should be the springboard to
further action, and Mike Daube outlines beautifully in the previous
article what that might look like. I would like to emphasise the seventh
point in his 10 Point Plan, about disadvantaged groups. As we see
smoking rates fall, there are some groups that are missing out. We
are making inadequate progress in tackling tobacco use in Aboriginal
and Torres Strait Islander people.
Amid all the rhetoric about Closing the Gap, we cannot lose
sight of the fact that tobacco is the single biggest cause
of early death in indigenous Australians. The emerging evidence
suggests that we need to do more of the established strategies
for Aboriginal and Torres Strait Islander people (because strong
action on adult smoking has strong results for whether kids
start smoking and get exposed to second-hand smoke), but also
consider new interventions within smaller social environments
(families, schools, health clinics) to change prevailing views
within many indigenous communities that smoking is a
“normal” activity.
And of course, let us remember our international
responsibilities. As Big Tobacco has seen its markets shrink in
wealthy countries, it has turned its attentions to booming markets
in low and middle-income countries, where lax regulation often
allows them to use sales and marketing tactics to addict young
smokers that would never be contemplated here. We are on the
right track – now is the time to ramp things up even further.
28 MEDICUS August

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SOAPBOX
Soapbox
Dear Editor,
Consistency please
Readers of the May edition of Medicus may
be bemused by the AMA (WA)’s attitude to
government-controlled bureaucracies associated
with health care.
On page 29 (May edition), readers were told about
the newly-established Health Service Governing
Councils.
The article was focused mainly on the fact that
several prominent AMA figures had been appointed
to them, and made no comment on exactly what these
new entities will do. The article ended by saying that
AMA (WA) has called for “more information to be
provided...on how councils will work and how their
recommendations will be dealt with”.
In contrast, page 48 of the same edition provided
yet another vitriolic attack on Medicare Locals –
another (relatively) new government initiative. This
article made no mention of the fact that many AMA
members sit on the Boards of Medicare Locals.
Indeed, one of them is chaired by a member of the
AMA (WA) branch council.
Both of these initiatives may be good, or may be bad.
Only time will tell. But some simple questions apply
to both, so that an objective assessment can be made:
• What is their purpose?
• What do they replace?
• What problems with existing structures needed
to be corrected?
Michael Jones
M.B.ChB. D (Obst) RCOG
Past-president AMA (WA)
Dear Editor,
I write in fear for our excellent health system.
While increases in spending by the WA Government on health over
recent years have been very welcome, along with the construction of
new hospitals both here in Perth and in regional areas, it appears that
the State Budget will be under dire pressures in the very near future.
According to economic forecasts recently published by local media
the WA Budget will be under tremendous pressure due to a dramatic
fall in royalties collected from mining as the price of iron ore and
other minerals falls.
Already there have been predictions that whichever political party
wins the state election early next year will be forced to announce cuts
in spending across the board.
As a medical professional who is now getting on in years, I have seen
a number of these booms and the inevitable busts that follow.
Unfortunately, even my slightly addled memory reminds me that health
spending is never left out of these cuts. This only means that when the
good times return, health services have suffered and we never really
catch up.
I would once again call on all political parties to undertake to make sure
health services, the employment of doctors and nurses, the building of
desperately needed new hospitals and the education of future health
professionals be protected from any cuts.
The chance is there for us to continue to look after the growing health
needs of our growing and our ageing population.
The opportunity is also there for some parties to take the lead and say
that the bread and circuses of government will suffer first, and efficient
health spending will be protected.
If not, the AMA (WA) along with all other health advocates should
react strongly. We are not destined to repeat the past unless we allow it.
Signed:
A GP who has experienced the past – and can see the future.
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August MEDICUS 31

OPINION
Kids’ stuff
by Associate Professor Frank R Jones
Chair, RACGP WA Faculty and AMA (WA) Councillor
It is true as one grows older as a GP, one’s patient following
also seem to inextricably age. These days I see older patients
with complex co-morbidities, polypharmacy issues and an
increased expectation of survival associated with a good
quality of life.
Most of us struggle with the ageing process and the
prospect of loss of independence, and statistics bear this out.
As the demographics of the Australian population age, so does
the average age of the patient encountered in general practice.
The population of adults and seniors is rising at a faster rate
than the population of children.
What a medical pleasure it is then when I get to see a toddler
with a “simple” upper respiratory tract infection (URTI) or
cough. Or is it so simple?
Is this child really ill? How do I know? How do I teach
my registrar when it is okay to practice “watchful waiting”?
Does my registrar think “why here, why now”? In fact, is my
registrar seeing enough paediatric cases to be confident and be
deemed competent? Am I seeing enough cases to be as assured
as I was after my Diploma in Child Health training?
What about more “complex” paediatrics – developmental
issues and behavioural problems? What about an
understanding of the close interaction between the child’s
social environment and illness?
Our younger Aboriginal and Torres Strait Islander
populations have really complex unmet needs – morbidity
statistics speak for themselves. And then, how do we access
appropriate services for
these very vulnerable
A recent paper...suggested
patients? We all
that exposure of general
know how difficult practice registrars to
co-ordination
chronic illness in children,
of care is for the
and to a range of other
parents of a child
more acute diagnostic
with mixed physical
conditions, may be
and intellectual issues.
General practitioners increasingly limited
have a critical role in
advocacy here – know
your local referral pathways and
be a champion for your young patient.
A recent paper in the Australian Family Physician caught
my eye (Vol. 41, No. 7, July 2012). In essence, the paper
suggested that exposure of general practice registrars to
chronic illness in children, and to a range of other more acute
diagnostic conditions, may be increasingly limited. Somewhat
surprisingly, registrars spent most of their time in consultations
with patients aged 65 plus years and the least time with children
aged 5–14 years. Only one in 10 consults were with children less
than four years of age. Long consultations were virtually absent.
These figures are of concern.
How can we ensure our young doctors have adequate
exposure and experience on the one hand to recognise and
manage the acute sick child, and on the other, have the ability
32 MEDICUS August

OPINION
to assess and coordinate complex childhood issues?
As usual the answer lies in training programs and adult
learning principles. As a core requirement of Australian
vocational training, general practice registrars are required
to complete a hospital paediatric rotation or an emergency
department rotation with a significant paediatric caseload.
In addition, community-based paediatric exposure and
experience is required. There is an expectation that registrars
will gain experience in the management of acute and chronic
childhood illness.
The 2011 RACGP Curriculum for General Practice has
specific statement chapters on children and young people’s
health, as well as other chapters describing acute serious
illnesses and the management of chronic disease illness
applicable to both the child and the adult. The Red Book
provides age-specific guidelines for preventative activities in
general practice and the Colle ge recently released a Children
and Young People’s Health position statement (well worth
a read).
At the end of the day, a learning experience for a doctor
reflects the clinical situation, the learner, and the supervisor/
mentor/teacher/vocational educational program. Although I
am not a huge fan of a log book, perhaps we need to revisit
the concept.
In summary, general practice can support optimal
healthcare and development of children and young adults
through:
• Provision of a “medical home”
• Ensuring we practice evidence-based preventive health
activities
• Ensuring access to appropriate medical attention for acute
healthcare
• Delivering systems of care (developmental surveillance
and screening) to optimise and support bio-psycho-social
development of children; and
• Co-ordinating the health, social and education sectors
with the united purpose to improve health and early
childhood development.
References:
www.racgp.org.au/curriculum
Position paper “The role of general practice in the provision of healthcare to
children and young adults” available at www.racgp.org.au/policy/clinical.
FREEAMA (WA) Seminar for GPs
The next GP Breakfast Seminar, hosted by the clarification on how GPs could confidently provide
Australian Medical Association (WA), will be PCEHR under the current Medicare arrangements.
held on Wednesday 26 September.
Attendees will also be given updates on item
Naturally, the Personally Controlled Electronic number compliance, and AMA GP advocacy
Health Record (PCEHR) will be top of the list of and policy.
discussion points. The AMA will discuss why the Date: Wednesday 26 September 2012
biggest element of health reform now confronting Time: 7am–8.30am
GPs – the PCEHR – is being undermined by potential Venue: To be advised
legal hazards and financial disincentives, its impact on RSVP: Wednesday 19 September 2012
GPs and patients and what you can do about it. To register, contact Skye Connor. E-mail
The seminar will update you on the
skye.connor@amawa.com.au; phone 9273 3028;
implementation pitfalls, their legal and financial fax 9273 3073.
implications, including the Federal Minister’s recent
August MEDICUS 33

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Shades of grey colour
mandatory ‘ethics’
by Benjamin Host
President, Western Australian Medical Students’ Society
OPINION
Doctors have many obligations in their practice. Some of
these responsibilities are guided by training, accepted
best practice, individual morals and the collective ethics of
the profession. Others are required by law. The mandatory
reporting of infectious diseases, medical conditions, and
deaths serve many important roles for the community.
Comprehensive data collection and research, reducing the
spread of infectious diseases, appropriate follow-up of mismanaged
cases, and the regulation of potentially harmful medications –
mandatory reporting serves a number of goals. The ethical issues
regarding the reporting of these specifics are fairly clear-cut.
However, the mandatory reporting of health professionals is far
more complex.
It is mandatory for any health professional to report suspected
“notifiable conduct” of their colleagues – medical students
included. Contained in this definition is the requirement that
doctors must report a colleague that has an ‘impairment’ that may
put the public at risk of harm1.
There are many different things that can be considered
under the umbrella term ‘impairment’. It is likely
that mental illness, such as depression, could be
considered to be impairing the ability of a doctor
or other health professional to practice. In any
case of mental illness, it is of vital importance
that the sufferer is able to seek and receive
appropriate care and treatment. In the case
of doctors, this becomes even more critical in
order to ensure that there is no deterioration in
the quality of their practice.
However, if a medical practitioner knows that
they will have to be reported to the Australian
Health Practitioner’s Regulation Authority
(AHPRA) if they consult a colleague, then
this becomes an enormous disincentive to seek
treatment. For many doctors, their income, lifestyle
and reputation – their very identity – depends upon
their ability to practice medicine.
As this is the case, it seems likely that practitioners
would avoid seeking help in order to prevent placing their
careers in jeopardy. This is a huge barrier to care for doctors
and students at a time when they need it most.
Implicit in the above is the onus that falls on those doctors
who may be treating a colleague with an ‘impairment’. Imagine
the situation that they face, knowing that they legally must
report a colleague who has placed their trust in them. They
are condemning them to face the rigmarole of an investigation
and, if they do not report, they risk an investigation themselves.
Fortunately, this situation has been foreseen in Western Australia
and doctors treating other health professionals are exempt
from making a mandatory notification if they become aware of
notifiable conduct while in the course of providing treatment.
Though this amendment has been made to the Act in WA,
doctors in other states must contend with this issue whenever a
colleague seeks their professional help.
Through the mandatory and voluntary reporting processes,
there is also scope for a disgruntled colleague, patient or other
member of the public to make a malicious and
facetious report about a doctor. As the
system stands, once a report
is received and a preliminary
assessment carried out, AHPRA
can act to impose conditions on,
or suspend a doctor or student’s
registration, before a formal
Continued on page 36
August MEDICUS 35

OPINION
Continued from page 35
investigation has even been carried out. Consider the damage
that this can cause to the practitioner. The emotional anguish,
loss of income and damage to reputation that can occur is likely to
be irreversible, even if the claim is
eventually found to be false. Also,
the clinician is left with no
possibility of taking action
The emotional anguish,
loss of income and
damage to reputation that
can occur is likely to be
irreversible, even if the
claim is eventually found
to be false
against the accuser who
is protected “from
civil, criminal and
administrative
liability, including
defamation, for
people making
notifications in good
faith”.1 With the term
'good faith' being highly
subjective, it leaves the
falsely accused with little
basis to act.
Historically, the medical profession
has maintained the highest standards through colleagues holding
other colleagues to account. Though we have maintained the
basis of the profession on the highest ethical principles of
beneficence, non-maleficence, respect, autonomy and justice,
this ability for self-regulation has since been replaced by an
umbrella government agency that has its attention divided
between 14 health boards. The underlying goal of health
professional reporting, to protect the public from undue harm
caused by those few that are unscrupulous or dangerous,
is certainly worthy. However, the system in place and the
application of this law is unfortunately not without its flaws.
The deleterious consequences that follow for those who
are branded with unfounded accusations, or are dissuaded
from seeking appropriate help, are not in the interests of our
doctors and students, nor our community.
These laws do not achieve their goal, but instead place an
extra burden on the vast majority who acts in every facet for
the benefit of their patients and the community. Both parties
– the public and health professionals – need to be considered
to ensure that there is appropriate protection for both. After
all, what’s good for the doctor is good for the patient.
Reference: 1 Health Practitioner Regulation National Law (WA)
Act 2010, section 140.
The University of Notre Dame Australia is a Catholic university with campuses in
Fremantle, Broome and Sydney. The Objects of the University are the provision of
university education within a context of Catholic faith and values and the provision
of an excellent standard of teaching, scholarship and research, training for the
professions and the pastoral care of its students.
Are you interested in teaching?
We are seeking expressions of interests from qualified
and registered medical practitioners who would like to
become tutors to first and second year medicine students
at The University of Notre Dame Australia Fremantle
Campus. Prerequisite training courses are being held for
individuals who are interested in potential appointments
as Clinical Debriefing Tutors and Problem Based Learning
Tutors. The training course will provide you with an
outline of the requirements and expectations of the
positions with a view to future employment. Individuals
who successfully complete the training, and who wish to
pursue the option of employment, will be considered as
positions become available.
Problem-Based Learning (PBL) Tutor
You will spend two half days per week working with a small group of first or second year
students to learn basic sciences in the context of real-life medical problems. You will facilitate
this process by guiding discussions and students’ identification of purposeful learning
objectives. Tutors are trained in the educational principles that underpin problem-based learning
such that they are capable of effectively leading groups to rich learning outcomes.
Clinical Debriefing (CD) Tutor
You will conduct a tutorial for 1.5-2 hours per week. Sessions explore professional, legal,
ethical, quality and safety issues that emerge in PBL cases and student clinical experiences.
Tutors facilitate group discussions by evoking student thoughts and questions.
The next PBL Tutor Training Session will be on Monday 8 October 2012
from 5.00pm - 8.00pm and
The next CD Tutor Training Session will be on Monday 15 October 2012
from 5.30pm - 7.30pm
To register, or if you have an enquiry, please contact Elaine Paull for further information on (08) 9433 0290
or email elaine.paull@nd.edu.au
The University reserves the right to appoint by invitation or to make no appointment at all.
36 MEDICUS August

OPINION
Equity versus equality
by Ghassan Zammar
President, Medical Students’ Association of Notre Dame
It was a shock to many students when the Victorian Health
Department recently announced changes to the priority
listing for medical graduates applying for internship positions
for 2013. Unfortunately many did not see the humour when
the Postgraduate Medical Council of Victoria released the
information to final-year medical students on 8 June, the same
day that the application process closed. For those interstate
students who spent hours on their application, the timing of
the announcement simply added fuel to the fire.
Essentially, what these changes will mean is international
students (who are Australian temporary residents) graduating
from Victorian universities will be given greater priority over
Australian permanent residents graduating from interstate
medical schools. As with most states, Australian permanent
residents graduating from Victorian medical schools will
remain classified as priority one.
The changes have generated mixed sentiments by the
various medical students’ associations and within members
of the AMSA council. Whether you agree or disagree, these
current changes will have huge ramifications for final year
medical students who have been studying in WA. This is more
so evident at Notre Dame University, which is comprised of
an interstate student population of about 40 per cent, many of
whom have planned to return back home to begin their careers
as doctors.
There are many factors that come into
play as to why the new three-tier
system was developed. Many would
see Victorian universities as the
main instigators for the change,
pressuring the State Government
to increase job security for
international students that graduate
locally, and thereby increasing the
demand for full fee-paying positions.
This comes amid findings from
the 2011 Higher Education Base
Funding Review, which concluded
that medical degrees in Australia
were underfunded by up to $23,000
per student, per annum. AMSA
President James Churchill rightfully said: “Many medical
schools are significantly reliant on international student
revenue, the loss of which may have severe consequences for
the quality of medical education in Australia.”
Nevertheless, the relative impact that these changes will
have on the demand from international students taking up
highly-contested medical degrees is questionable. But for
the first time, we may see domestic students missing out
on internship spots that are filled by international
students studying in Victoria.
A primary factor
suggested for the change
in the internship selection
process is to bring about
a more “equitable”
system. It is
clear that many
international
students have
been discriminated
against for years
by the different
internship priority
rankings across
Australia, always
placing them towards
the bottom of the
priority listings.
Current AMSA figures
suggest that over 90 per
cent of the 370 expected
internship shortages in 2013
will be from international students
looking for work. Having paid a small
August MEDICUS August 37 MEDICUS 37

OPINION
Continued from page 37
fortune for their degree, the new system gives temporary
residents some reasonable chance of finding a position in the
state they have been trained in.
However, opponents of the change argue that overseas
medical students studying in Australia are made aware that there
are no guarantees to securing an internship position once
they graduate. Whether or not the universities are doing an
effective job of informing their students
is another question, and a big
issue that the International
Students’ Network deals
...the biggest backlash
to the changes... has
come from interstate
students who had
originally planned
to return home once
completing their
medical degree
with each year.
Obviously the
biggest backlash to
the changes made
by the Victorian
Government has
come from interstate
students who had
originally planned
to return home once
completing their medical
degree. Although the Council
of Australian Governments
(COAG) has guaranteed internship
positions are made available for all Commonwealth Supported
Places, to deny students the opportunity to work in their
home state, to be with their family and friends, can be just as
detrimental as not getting a job at all.
Although the original prioritisation system has never
been entirely based on merit, the new system does nothing
to remove the existing inequities and inequalities within the
application process. Instead, the discrimination has now
shifted against interstate-trained Australian citizens.
It will be interesting to see if the changes made will have a
domino effect nationally. If other states follow suit, this may
alter how students decide which medical schools to apply to
in the future. The Australian Health Ministers’ Advisory
Council (AHMAC) has also raised this as a concern, and aims
to assess the impact that the new Victorian system will have on
the availability and provision of internships across Australia.
So what is the answer? One solution may be to create a
merit-based national internship allocation system to oversee
internship placements of all medical graduates. This may
prove costly and difficult to implement however, as well as face
strong opposition from individual health care systems wanting
to retain their autonomy
in the decision making
process.
The core of the
matter is ensuring
enough internship
positions exist nationally
so that no medical
student, regardless
of residency status,
misses out on their
internship training.
Whilst it may seem
like a simple solution,
how this is successfully
implemented is complex
and multifaceted.
It requires not only
more funding by the
government, but also
much better planning
and communication
between the different
stakeholders, including
the 20 medical schools
across the country.
Disappointed: Shilpa
Shah, a final-year student
at the University of Notre
Dame had applied to work
as an intern in Victoria.
However following the
changes to internship
prioritisation, her hospital
interview that had been
organised was cancelled at
the last minute. Certainly,
the changed prioritisation
system has greatly affected
Shilpa’s chances of
receiving an internship
next year back in Victoria,
where her family lives.
She still awaits any final
round offers for her first
preference in Victoria.
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38 MEDICUS August

Firm foundation and support
helps Society on its way
by James Preuss
President, University of Western Australia Surgical Society
OPINION
Neurosurgery night: Dr Alex Koefmann, Wayne Rosen, James Preuss, Arosha Dissanayake, Professor Chris Lind and Lily Shelton at the
2011 Surgical Career Expo.
It was during my fourth year surgical rotation that the
idea of a surgical society at UWA first took root. At that
point in 2010, most of the major universities already had
established surgical societies. So when Winthrop Professor
Christobel Saunders proposed I initiate a surgical society
at UWA, I thought it a good idea. I had greatly enjoyed my
fourth year term and surgery was certainly a passion.
That summer, three other UWA medical students –
Lily Shelton, Arosha Dissanayake and Matt Greenway –
and I established the University of Western Australia
Surgical Society (UWASS). The society’s aim was to provide
surgically-orientated students an opportunity to experience
surgical-related events and workshops and provide a link
between interested students and local surgeons.
With this idea in mind, I told my then flatmate about our
plan. His reaction was along the lines of “Are you stupid?”
and “Do you have any idea how much work it involves?” –
and he was right. But it has been an amazing experience and
provided some good fun along the way.
By the beginning of the 2011 academic year, we had set up
the structure of the society and hosted our very first lecture
night. The UWASS launch saw 150-plus students attending
and over 50 expressions of interest to become a part of the
new committee. Student interest only grew from there with
over 350 members joining in our inaugural year.
Today, the UWASS calendar is packed with an array
of events including a monthly lecture series, suturing and
anatomy workshops and pre-intern sessions to help pave the
path into clinical medicine, and ultimately surviving the
internship surgical rotation.
Of course, the two premier events on our calendar are the
Women in Surgery Symposium and the Surgical Career
Expo.
The Surgical Career Expo is designed to develop a bridge
between our members and the greater surgical community
of Perth. The evening includes an interactive college and
industry display session with representatives from The
Royal Australasian College of Surgeons, The Australian and
New Zealand College of Anaesthetists, The Royal Australian
and New Zealand College of Obstetrics and Gynaecology
and The Royal Australian and New Zealand College of
Ophthalmology. UWASS members have the opportunity to
approach the various colleges and ask questions relating to
their field and the various application processes.
The evening concludes with a symposium session where
invited speakers discuss integral aspects of the surgical
training program and provide information to help aspiring
surgeons gain access to the elusive SET program.
This year’s Surgical Careers Expo will be held on
Wednesday 26 September and will discuss subjects such
as professionalism and communication as well as provide
a rural perspective to highlight the rural surgical options
available for interested members. The event is open to all
medical students and junior doctors across Perth.
The major events hosted by the UWASS are a true
reflection of the incredible support it has received from the
surgical and medical community of Perth. We are grateful to
the junior doctors, registrars and consultant surgeons who
have taken time out from their incredibly busy schedules
to talk to our members. As a result of the support from
Professor Jeff Hamdorf and the Clinical Training and
Education Centre, we have been able to facilitate sending
UWASS members to courses and workshops, otherwise only
accessible to residents and registrars.
All in all, developing the society has been a great
experience and taught me several invaluable lessons. It has
been a tough road but with many successes. This year will
be my last with the society as graduation draws near. I
look forward keenly to seeing a flourishing society in years
to come.
August MEDICUS 39

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40 MEDICUS August

FOR THE RECORD
Boy from Britain
scores high
Dr Graham Farquhar, GP
Q. What inspired you to take up
general practice?
I enjoy contact with people within the community setting.
Diversification is possible with a medical degree, especially
within the speciality of general practice.
Q. What is the favourite aspect of
your job?
My favourite aspect is being at the helm of a terrific multidisciplinary
primary health care team at Leeming Doctors.
Q. What are the primary challenges
faced by general practice today?
The primary challenges within general practice are still
workforce issues, aged care and chronic disease management
and e-health initiatives.
Q: If you were Health Minister for a day...
As Health Minister, I would look after funding of aged
care facilities better, with a more generous offer to general
practitioners to manage patients in the primary health
care community setting, as opposed to co-ordinating their
hospital admissions.
Q: The people you would most like
to share a working lunch with?
Shame you didn’t ask about dinner dates...but for lunch, I
would invite those company CEOs whose vision could be any
aligned with primary care initiatives to ultimately fund and
improve primary health care services in the local community.
So being more specific, Richard Goyder and Sam Walsh
should be a good start – with Billy Connolly serving entrées,
Usain Bolt the main course and Miranda Kerr for dessert.
Q: Your greatest professional
achievement?
I was chuffed to qualify as a doctor back in 1984 in the UK.
To emigrate to Australia and start from scratch, later setting
up my surgery Leeming Doctors was very rewarding but
becoming Chairman of Fremantle Medicare Local is what I
would be most proud of.
Q: What would you be doing if you
weren’t a GP?
Attempting to reduce my handicap (golf) to get on to the
Seniors Circuit in Australia.
Q: What do you foresee in the future
for general practice?
Who truly knows? With a general election on the horizon,
both major parties have different agendas. Personally I see
a blended payment to GPs being introduced comprising of
a fee for service and capitation payment for chronic disease
illness. Most importantly National E-Health Transition
Authority (NEHTA) needs to get acceptable electronic
health records established, which will revolutionise the
primary care system.
Q: How do you unwind?
Ask my wife...I don’t. But yoga, pump swimming and golf do help!
Q: What’s on your iPod playlist?
Anything but Sid Vicious and Val Doonigan. Oh and not 50
Shades of Grey!
August MEDICUS 41

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MELANOMA CONFERENCE 2012
Hosted by the Scott Kirkbride Melanoma Research
Centre, the inaugural National Melanoma
Conference will be held on 23-24 October at the
Esplanade Hotel in Fremantle, Western Australia.
The conference program brings together the
world’s leading melanoma researchers to talk about the
very latest in melanoma clinical trials and outcomes,
molecular signalling pathways, radiology therapy
breakthroughs and much more. Distinguished guest
speakers include Professor Charles Balch (Professor of
Surgery at John Hopkins Medical Institute), Professor
Boris Bastian (Memorial Sloan-Kettering Cancer
Center), Professor John Thompson (Melanoma
Institute Australia), Professor Grant McArthur
(Peter MacCallum Cancer Centre), Professor Graham
Mann (MIA, University of Sydney) and Professor
Nick Hayward (Queensland Institute for Medical
Research).
To register please email
carolyn.williams@waimr.uwa.edu.au.
For more information visit www.skmrc.org.au.
WOOLDRIDGE FACES BAN
The former Health Minister Michael Wooldridge
faces a ban from corporate life over his stint as
chairman of the company that ran the failed retirement
village group Prime Retirement and Aged Care
Property Trust.
Dr Wooldridge, who was Federal Health Minister
between 1996 and 2001 and now sits on the boards of
two listed companies, faces the ban as one of five former
directors of Australian Property Custodian Holdings
(APCH) targeted in legal action brought by the
corporate watchdog.
The Australian Securities and Investments
Commission alleges Dr Wooldridge and other
directors of APCH breached their duties to investors
by authorising the payment of a $33 million fee to
managing director Bill Lewski when the trust listed
on the ASX in 2007. Investors pumped $550 million
into the float, only to see Prime Trust collapse into
administration in October 2010 after nervous lenders,
led by the Queensland bank Suncorp, appointed
receivers over its retirement villages.
RESEARCH NETS RCPA SCHOLARSHIP
research project which investigated and analysed cases of thyroid
A carcinoma in patients has earned a fourth-year medicine student on
Notre Dame’s Fremantle Campus an academic scholarship from the Royal
College of Pathologists of Australasia (RCPA).
Keith Potent, who is currently completing a Bachelor of Medicine/
Bachelor of Surgery (Honours), said he was “honoured, humbled and
overjoyed” to have received the scholarship.
The scholarship will provide financial assistance for Mr Potent to present
his research at future medical conferences and to have it published online.
His research project covered a retrospective analysis of cases of
carcinoma of the thyroid gland. While not as aggressive and malignant
as other cancers, men and women who have been exposed to high levels
of radiation or who have a family history of goitre are more susceptible to
contracting thyroid carcinoma.
Achievement: Professor Theo Gotjamanos
presents Keith Potent with the RCPA scholarship.
CONGRESS CALLS FOR WIDER USE OF TYPHOID VACCINES
On the back of the recent Coalition against Typhoid (CaT) congress, Australian immunisation specialists are calling
on all healthcare professionals to encourage patients to consider typhoid vaccinations before travelling to developing
and endemic countries.
The CaT congress which took place in Bangkok brought together global health leaders from across South and South-
East Asia, to discuss the high burden of endemic typhoid and the growing number of typhoid outbreaks in the region.
The CaT Congress recognised the serious impact of typhoid, particularly the rising and widespread threat of drugresistant
typhoid.
Panelists Dr Jeremy Farrar, Director of the Oxford University Clinical Research Unit, Vietnam, and Dr Christopher
B. Nelson, Director, Coalition against Typhoid, emphasised that typhoid vaccination efforts must be implemented in
conjunction with other public health programs, such as access to safe drinking water and the promotion of good hygiene
practices.
The congress has served as a timely reminder to Australian Healthcare Professionals that many Australians who are
preparing to travel would not have necessarily considered being vaccinated, even if they were travelling to a country where
typhoid fever was common.
According to the World Health Organisation, typhoid impacts an estimated 21 million people and causes more than
200,000 deaths across the globe per year.
August MEDICUS 43

AMA IN THE MEDIA
PATIENTS WAITING TO SEE
SPECIALIST DOUBLES
AMA president Richard Choong said he
welcomed greater transparency but believed
the numbers were underestimated because
they did not include referrals at secondary
hospitals or non-surgical cases referred to
tertiary hospital outpatient clinics.
“This gives a bird’s-eye view but we would
like to see more detail, including a breakdown
of waiting lists for surgical specialties, and we're
keen to work with the Government to improve
waiting lists and times,” Dr Choong said.
“In particular we need to improve the
integration between GPs and hospitals so that
we don't have all these thousands of patients
suffering pain while waiting months for their
outpatient appointments.”
The West Australian, 30 August 2012
PUSH TO BOOT FAST FOOD OFF
SPORTS FIELDS
Australian Medical Association (WA)
president Richard Choong said the WA
survey results showed people did not want
fast food companies on junior sports fields.
“I don’t want my young daughter to be used
as a marketing tool by the fast food industry
carrying a multitude of negative images when
she plays junior sports,” he said.
The West Australian, 11 August 2012
NEW MEDICAL SCHOOL HOPE
HITS HURDLE
AMA WA president Richard Choong said
his concern was how the system would cope
with even more medical students. “Already
the system is struggling to deal with interns
and offer career pathways, and we don't
have enough assurances from governments
they will meet the training demands for the
existing students,” he said.
The West Australian, 10 August 2012
DISSOLVABLE STENT A LIFE SAVER
“This one simple innovation will change lives,
extend lives - it will increase the enjoyment that
many people get from life itself,” State AMA
president Richard Choong said.
The West Australian, 8 August 2012
TV FLU AD MISLEADING, SAY
DOCTORS
Emergency medicine doctor and former
Australian Medical Association (WA)
president Dave Mountain said the campaign
could discourage sick people from going to
emergency departments and this could have
serious consequences.
“We see a lot of people coming in with flurelated
illness who are very sick, and they're
not people needing to be given a tissue to
blow their nose,” he said.
“They're coming in with pneumonia or
because their heart failure has worsened, or
they're frail and elderly and can't cope with
a flu-like illness. People can become so sick
they don't know if they just have a dose of the
flu or have raging pneumonia.”
Dr Mountain said while patients were
advised to see their GP where possible,
sometimes it was hard to get in straight away,
and it was dangerous to suggest
people feeling very unwell stay home.
The West Australian, 28 July 2012
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44 MEDICUS August

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BEYOND BORDERS
FIELDS
OFHOPE
Cambodia is still rebuilding itself
following its tortured past with
significant investment needed
for infrastructure, education and
training, says Dr Marcus Tan
“What is the use of living, if it be not to strive for noble causes and to make this muddled world a better place for those who
will live in it after we are gone?” – Winston Churchill
Cambodia is hot and dusty all year round with June a
particularly warm time to visit. In a city where plush fivestar
hotels, glorious temples and proud monuments are erected
adjacent to filthy slums, seedy massage parlours and grim
reminders of the tragic history of genocide that still scar the
psyches of the local Khmer people, the reasons behind my first
trip to Cambodia’s capital, Phnom Penh, were as contrasting as
the city itself.
Medicine as a career has been very good to me both
personally and professionally. Outside of my clinical work,
I now spend much of my time pursuing my dual passions of
supporting innovation and philanthropy.
It was my involvement in Start-up Weekend, the global
not-for-profit movement encouraging innovation and
entrepreneurship through an intensive, experiential weekend
competition that led to a chance invitation to judge at an event
in Cambodia.
Coincidentally, the charitable foundation I co-founded in
2005, Meridian, was most recently supporting Transform
Cambodia, a charity established by two Perth architects with
14 education centres giving 1400 children from the slums of
Phnom Penh opportunities to become the next generation of
leaders, teachers and professionals. This echelon of society
was systematically wiped out by the murderous Khmer Rouge
regime in the 1970s.
Many of these children have been plucked from lives in
third-world conditions, helping their families earn a living by
foraging amongst the municipal rubbish tip in their backyard
for recycled materials to sell.
This trip allowed me to witness the conditions that these
children and their families endure and helped give me
perspective on the culture and environment by which any
assistance could be rendered.
I was able to visit an AIDS orphanage, a rural health
clinic, an urban medical centre and even the most advanced
hospital in the country, co-located with an impressive school of
Medicine and Dentistry.
I was surprised to hear that prior to the Khmer Rouge,
Cambodia was more prosperous economically and more
advanced than Malaysia and Singapore, two of the region’s
most developed countries.
During the Khmer Rouge’s rule, everything Western
including medicine and books were eschewed or destroyed.
Doctors fled the country or were killed. Schools were
(Top left) Looking ahead: Children from the slums of Phnom Penh with the municipal rubbish tip in the background.
46 MEDICUS August

BEYOND BORDERS
Promising: Sen Sok International University
Hospital is the most advanced of its kind in
Cambodia.
Solemn reminder: The Shrine
of Remembrance filled with skulls
of victims at the Killing Fields.
Connecting: Dr Marcus Tan with some of
the children at one of Transform Cambodia’s
education centres.
transformed into internment camps, interrogation and torture
sites. Many lives were taken at the infamous Killing Fields just
outside the city.
It is apparent that Cambodia is still rebuilding itself
following this dark period in its history, with significant
investment required for infrastructure and replenishing people
with skills, education and leadership. Despite a plethora of
NGOs working in Cambodia, there is still a lack of quality
health care.
Cambodia has 0.24 doctors per 1000 people – this, in a country
of 13.4 million people. Compare this to Australia with about 22.3
million people served by 3.31 doctors per 1000 people.
Whilst there remains a significant amount of government
corruption, I was fortunate to have been serendipitously
introduced to Cambodia’s Secretary of State. This articulate,
multilingual gentleman with degrees in Economics, Computer
Science and Applied Mathematics gained in France and the
US introduced himself as the Cambodian equivalent of Hillary
Clinton. The story of his return to Cambodia to help rebuild his
home country is nothing short of inspiring and if he is an example
of the new breed of government officials helping to improve the
country, then Cambodia has much to be optimistic about.
I am currently hoping to return to Cambodia, and take
the thinking behind services such as AMA (WA)’s Dr YES
program to encourage local Cambodian medical students to
volunteer to provide health promotion activities combined
with a mobile clinic like that provided by Perth’s local
StreetDoctor service.
I have been privileged to grow up in Australia and I am
tremendously grateful to have been given opportunities many
do not receive. It is easy to forget how good we have it living in
Western Australia. I only hope my children realise how lucky
they are and I hope to, one day soon, show them how others less
fortunate live and inspire them to do something about it.
Meridian Global Foundation
Meridian was established in 2005 by a group of Perth-based
business people and professionals looking to give something
back to their community. The founders were looking for a
more sustainable and personal way to make a difference and
knew there were a lot of like-minded people who felt the same
way. The question was how to harness the passion, talents and
generosity of a new generation beyond just making a financial
donation to a charity. They realised that the fulfilment, passion
and inspiration associated with supporting worthy causes came
from a closer involvement.
Meridian is a public ancillary fund based on an endowment
model. It pools the funds of supporters and invests these funds
with the purpose of creating a sustainable ongoing cash flow to
support DGR-endorsed organisations into perpetuity.
Over the years, Meridian has supported charities involved
in young people, education and microfinance, including
Opportunity International, The Smith Family and Habitat
for Humanity. These projects meet Meridian’s values of
sustainability, empowerment and innovation.
Since its inception Meridian has donated tens of thousands
of dollars and volunteered thousands of man hours in support
of worthy charities.
Donations to Meridian are tax deductible and more
information can be found at www.meridianglobal.org.
August MEDICUS 47

DR YES
Valley visit a
success
On the road: The Dr YES team.
Team work: Dr Yes coordinators Sophie
Doherty and Michael Kirk.
Connecting: Dr YES team member Sarah Cole
holds an interactive session with students.
Students in the Avon Valley and Wheatbelt region had the opportunity
to discuss sexual health, mental health and alcohol and drugs as 14
Doctor YES volunteers toured the region in late June.
The Dr YES team arranged its annual Mini Getaway this year to the
towns of York, Cunderdin, Brookton, Toodyay, Northam, Kellerberrin
and Quairading. Spanning three days, the medical students delivered
the proven program to over 400 students from year six to 12. The visits
were well received and the ensuing feedback from parents, teachers and
students alike has been positive with requests for future sessions.
The trip to the Avon region was the first in a series of rural visits that
the Dr YES team will make over the coming months, which will include
ventures to the East Kimberley in September and the Great Southern in
late November.
Such trips are an opportunity to expand the horizons of the program
and successfully complement the fully booked-out metropolitan program
that resumed on the first day of students arriving back to school after the
June/July break.
Dr YES is a program that is proudly supported by the AMA (WA)
Foundation. One of its goals is to help break down the barriers preventing
young people from accessing health care and overcome some of the
common misconceptions about doctors.
48 MEDICUS August

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August MEDICUS 49

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August

COMMUNITY
FORGING A
STRONGER
CONNECTION
The President of the Australian Medical Association
(WA), Dr Richard Choong recently met the President of
the Chung Wah Association, Sammy Yap, at the Association’s
Nedlands headquarters to discuss common matters of interest.
The meeting followed local publicity around Dr Choong’s
election as President and mention of his Chinese heritage.
Although not Chinese speaking, Dr Choong has long had a
strong interest in China and the Chinese diaspora in Australia.
Dr Choong arrived in Australia at the age of two years, and
did not have the opportunity to learn Chinese. However his
wife, Carolyn, is fluent in the language and they are ensuring
their daughter Alexandra learns to speak the language of her
ancestors.
“I am well aware of the significant impact that Chinese
immigrants have had on the development of Australia virtually
since the arrival of the first fleet,” Dr Choong said.
“For example I find it exciting that the first Chinese national
to arrive in Western Australia landed just a few months after
Perth was founded and many thousands of Chinese have
contributed in a range of ways to life in the state since.
“I am proud to be the first Chinese AMA (WA) President
and am excited by the opportunity of working with Chung
Wah in coming months,” he said.
“I also look forward to developing my connections even
further with the local Chinese community while president and
beyond,” he added.
Shared interests: President of the Chung Wah Association,
Sammy Yap and President of the AMA (WA) Dr Richard Choong.
The Chung Wah Association was established in 1909 and
since then, has played a significant part in a range of issues
in WA.
The Association aims to promote the Chinese culture
through its cultural groups – the Chung Wah Dragon and
Lion Troupe, the Chung Wah Dance and the Chung Wah
Chinese Instruments Orchestra.
The Association also promotes inter-cultural exchange
through its School Visit Program. To promote the learning of
the Chinese language, the Association runs the Chung Wah
Chinese School at three campuses on Saturdays of the school
terms. The Chinese School is open to all. Currently there are
about 1100 students enrolled at the schools.
Another major program of the Association is the
Community and Aged Care Services. Services provided
include the Community Visitors Scheme, Centre-based Day
Care, Panda Community Aged Care Packages, Domestic
Assistance, Social Support, Transport, Day-long Respite
Care and Migrant and Community Services. The Centrebased
Day Care program has been extended to Vietnamese,
Cambodian and Thai seniors in recent years.
Medicus
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August MEDICUS 51

RESEARCH
Show us the money
The State Government needs to dig its head out of the sand and invest in
WA’s intellectual capability, says Associate Professor David Mountain
Winning minds: Professor Barry Marshall and Dr Robin Warren were the 2005 Nobel Laureates in
Physiology or Medicine for their groundbreaking research at Royal Perth Hospital between 1979 and 1984.
Recently Western Australia’s Opposition leader Mark
McGowan managed to get his head out of the daily
grind of spin and point scoring to talk about the future of
our State – generally seen as unusual for a state politician. It
was an important statement for someone wishing to become
Premier of Western Australia because it started an important
discussion we all need to have.
The reason it is important is that booms always bust – or at
very best slowly leak away like a fading party balloon. And we
have been riding the longest sustained boom in modern history
with 18 years of sustained growth and more in the pipeline
(unless China gets a very bad dose of unexpected economic flu).
What have we done during these golden years with the
rivers of gold (iron, nickel, gas etc)?
So far we have some new buildings and infrastructure
which was required (well, some of them at least) along with
some significant spending on new hospitals, schools and other
important social infrastructure.
But what has been very short on the ground has been major
spending to develop future industries to take over when the
mining boom eventually falters, commodity prices decline or
we price ourselves out of the mining market.
We need industries that provide high-paying, skill-based
jobs for our children. Trying to compete with the vast numbers
of lower-paid unskilled workers in the developing world is not
feasible given the already stratospheric costs of living in WA,
as anyone who has travelled overseas recently will testify.
So what should we be doing with the vast wealth we have
coming over the next decade or so?
We should not be just putting it in a future fund and hope
that we can all retire and live off the interest. We should
instead invest in producing world-class industries of the future
by investing in our best minds and the best potential industries
of the future.
We just happen to live in a state not merely blessed with
abundant space and natural resources but also a state that has
also produced amazing intellectual outcomes as well.
And we have some great areas where we already have a
strong record, strong industries or great natural resources to
grow future industries such as renewable energy, agricultural
research (particularly dry land farming), mining technology
and geology and sustainable marine industries. But along with
these should be biotechnology and medical research, where we
also have an admirable track record.
We have Australians of the Year who actually think and
produce life-changing research. We have produced Nobel Prize
winners. In fact, major medical research and ground-breaking
science has become common in WA over the last 20 years.
But unfortunately whilst we have been producing worldclass
outcomes and researchers, our governments have
woefully neglected research and innovation in our State. Our
share of national grants and research funding has declined
dramatically over the last few years as other states and the
Federal Government have realised how important medical
research is to a happy and healthy population, a wealthy
economy and new industries.
52 MEDICUS August

RESEARCH
We now receive less than a third of research funds per head
of population as visionary states such as Victoria and they
continue to protect funding for research and development.
Unfortunately our decline is increasing rapidly due to the
State Government’s inability to even get to first base on the
need for additional funds.
Other states have understood that investing in medical
research and researchers is not a cost but an investment that
pays back in spades. In terms of returns on dollars spent,
you get a more than 2:1 return in direct funds, taxes and
expenditure for your state from new companies, investment
and jobs. On top of this, countries and states that invest in
research consistently have better health outcomes, attract
better health professionals (and manage to keep them) and
more productive, healthier populations.
The more money that is put in at the beginning, the greater
the returns as new industries, jobs and additional research are
attracted to larger, well-funded centres. Manufacturers and
good quality high-tech companies will only base themselves
where there is good research and development as well.
No government can claim ignorance of the issues or that
no one has told them. Many reports have tried to warn WA
governments of the catastrophic short sightedness of scrimping
on research and development in our key industries.
The Australian Medical Association (WA) delivered to all
politicians a detailed review and report which added to many
others over the last 10 years about the need for immediate
reinvestment in our researchers and research infrastructure.
WA governments need to start thinking of how we best
transform ourselves from a mine and farm for our Asian
neighbours to a major hub for research and development that
they want to come and invest in.
So congratulations to Mr McGowan for starting the
conversation and let’s now hear from all our
politicians how they will turn that
into reality.
Talk is cheap, and
the future easy to put
off whilst you live
the easy life in the
boom. But now We now receive less than
is also the best a third of research funds
time to reinvest
in your best
per head of population as
brains, future
visionary states such as
industries, and
Victoria
your children’s
welfare. Spend on
the best investment
you can ever make and
reap the rewards for
generations to come.
A/Prof David Mountain is immediate past
President of the AMA (WA).
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August MEDICUS 53

TRAVEL
leasure
Pleasure
Trip
A visit to Prague throws
up all the expected sights
and sounds, and a few
unexpected ones too, says
Elizabeth Nell
54 MEDICUS August

There are, I am told, a host of cities
around the world that can boast a sex
museum as one of their attractions. New York,
Amsterdam, Paris, San Francisco, Athens,
Moscow, even Shanghai all offer them as
part of the tourist experience. I suspect this
means that it is an attraction that holds its own
financially, so to speak.
But only one city has a museum offering
an even more specific attraction within
this particular genre. Only Prague, the
capital of the Czech Republic, I am reliably
informed, has a Sex Machine Museum. I
must say however that I remain open to others
suggesting cities that also offer this particular
feature. I once travelled hours out of my way
to see the world’s biggest rocking horse, only
to discover that in reality it is stabled in Gumeracha, South
Australia.
A Sex Machine Museum would, normally, create little
personal excitement and would certainly not make it onto my list
of potential points of interest. In the case of Prague however it
influenced my visit like a dominatrix.
As I was travelling to Prague for a conference, I accepted
an offer from a fellow attendee to rent an apartment in the
historic part of the city (Old Prague or Stare Mesto in Czech,
established by King Wenceslas I in the 13th century) and see
the real Prague. Great decision as it turned out, as most of the
restaurants and historic features of this wonderful city were,
literally, right outside our door.
But so was the Sex Machine Museum. In fact, our large
feature windows overlooked a small courtyard used by the
employees. While there was no discernable sex machine in the
courtyard, its other attractions meant that the small laneway that
we used to enter our apartment was also used by the hundreds of
museum patrons who it seemed were mostly American college
students on a break. And a Sex Machine Museum is not the sort
of place you visit with silent decorum. No. It seems the firm rule
is that you enter such an attraction only after posing for photos,
encouraging your fellow travellers to come with you, calling
friends around the world to tell them exactly where you are and
what historic site you are visiting – you get the picture.
I soon learnt to avoid the entrance as much as possible and
take the long way to the efficient metro each morning. This
was despite the signs around the museum promising me “an
exposition and explosion of mechanical erotic appliances, the
purpose of which is to bring pleasure”.
Most visitors to Prague would not put this particular museum
on their must-see list, but feel free to put Prague on your bucket
list. This is an amazing city that survived not just 40 years of
Communist indifference but centuries of war, internal battles,
bombing and uprisings.
One of the few cities to survive WWII and then to have the
dead hand of communism, Prague’s architecture is now one of
its great features.
Just walking around the city trying to get lost is one of the
Magnificent: The interior of Vitus
Cathedral and (right) the old town square.
TRAVEL
many attractions, but
try the walk very late
at night to avoid the
crowds.
Visitors should
put a walk over the Charles Bridge and a visit to
Prague Castle at the top of their list of features not to be missed.
Locals are understandably proud of the Charles Bridge that
like the city and the people themselves, has survived almost
everything history has thrown at it. At the bridge you can see
photos of the cranes put in place during the floods of 2002
which were used to pull out of the water any large pieces of
rubbish being carried down the river that had the potential to
damage the pillars. The length of the bridge features statues all
of which are worth consideration.
A walk along the Charles Bridge towards the Castle is one
feature not to be missed, as is a few hours spent soaking up
the beauty of St Vitus Cathedral within the confines of the
castle itself.
A personal favourite is the Museum of Czech Communism
which to anyone who grew up during the variety of uprisings
is extremely enjoyable. The fact that it now carries a number
of large statues of Karl Marx that no one wanted at the end of
Communism and that the museum itself is located within the
same building as a popular casino only adds to the enjoyment.
Also worth touring in the old town is the Astronomical
Clock which dates from 1490. Most people gather at the
bottom waiting for the 12 apostles to move around on the hour.
In reality Perth’s London Court clock demonstrates more
mechanical ability. Try taking the stairs and lift to the top of the
tower and watch those watching the clock.
And did I visit the Sex Machine Museum? On the final day
when I had an hour before making my way to the train station
to get the wonderful overnight express to London with all my
conference activities over, I made the decision to see what all the
excitement was about. Not to actually pay for the tour of course,
but perhaps to buy a T-shirt or a postcard for Mum? Exiting
my apartment, I took the daring left turn, the turn I had been
avoiding all week – only to find the crowds worse than ever.
This was not my day. Tourist interuptus?
August MEDICUS 55

FOOD
Your little kitchen helper:
My beef is ibeef
A cut above: Beef Essentials takes the guesswork out of cooking with beef.
With so many televisions shows on what we can cook and
how we can cook it, our culinary expectations have
never been higher. However, as all foodies know, expectations
often exceed skill, and there are few things in this world
sadder than a beautiful succulent piece of Australian beef
reduced to boot leather.
So it is good news that Meat and Livestock Australia (MLA)
has come to the rescue with Beef Essentials: Your practical
guide to Australian beef. No, this is not the latest in a long line
of cookbooks; it is in fact an award-winning iOS app.
Wanting to help consumers get the best out of good Aussie
beef, the MLA developed Beef Essentials, often referred to
as iBeef. Born out of the realisation there was a significant
“gap between beef products and cooking knowledge among
customers – particularly the younger, tech-savvy generation”
– this free app is a worthy kitchen helper.
MLA has kept it simple, making it easy to find what you
want quickly. iBeef has been broken up into four main areas –
Beef Cuts, Cooking Methods, Favourites and Cook.
As the name suggests the Beef Cuts section is an
alphabetical listing of the various cuts of meat with a
brief description. Methods provides a list of the various
ways beef can be cooked with step-by-step, easy-to-follow
instructions on this cooking technique. Favourites allows
you to collate the details of your preferred cuts and recipes
for quick referencing.
However, the real gem of this app is Cook. Cook is where
information meets practical application and this section is a
true little-kitchen-helper. By adding the cut you are using,
the desired cooking method,
the ‘doneness’ of the meat (e.g.
well-done) and its thickness,
Cook provides the required
cooking time. But unlike your
average timer, Cook alerts you
at each stage action is required
and what this action is, like “flip
your steak” or “stir and reduce heat
to…”.
Beef Essentials takes the guesswork
out of cooking with beef and helps you
choose the right cut and then cook it to
perfection. This easy-to-use, informationpacked
app was awarded the Lifestyle Mobile Apps Webby
earlier this year. The American-based Webby Awards are
the leading international honour for the world’s best websites
and digital projects.
This is amazing recognition for an app from Down Under.
The only downside of iBeef is it is just available for iOS
and it has been designed specifically for an iPhone. This
iPhone-specific approach means it does not take advantage
of the extra screen real estate of an iPad – displaying at the
native iPhone screen size, it hovers in the middle of the
screen surrounded by black nothingness.
However, regardless of these two nuances, if you have ever
found yourself wondering which cut of beef to use or what to
do with it, then Beef Essentials is for you and it being free is
an added bonus.
56 MEDICUS August

FOOD
Orange mustard
barbecue steaks
Serves: 4
Time: 15 minutes (preparation)
+ 8 minutes (cooking)
Ingredients
4 sirloin steaks
Finely-grated rind and juice of one small orange
1tbs seeded mustard
1tbs honey
Extra orange, sliced
Salad leaves to serve
Method
Brush each sirloin steak lightly with oil and season with salt and pepper. Combine the orange rind and juice, mustard and honey
and rub over steaks.
Preheat the barbecue flat-plate or char-grill plate to hot before adding the steaks. Cook on one side until the first sign of moisture
appears. Turn steaks once only. Barbecue orange slices for a few minutes on each side while the steaks cook.
Test the steaks for degree of doneness with tongs. Rare is soft, medium feels springy and well done is very firm.
Remove steaks from heat, loosely cover with foil and rest steaks for five minutes. Pile salad leaves, steak and barbecued orange
slices on plates to serve.
Handy hints
Ensure the barbecue is hot before you cook. Make it hot enough to sizzle the steak as it makes contact with the plate or grill.
Best beef steaks for barbecuing: fillet/tenderloin, rib eye/scotch fillet, sirloin/porterhouse/New York, T-bone, rump, round,
blade, and oyster blade.
Recipe courtesy www.themainmeal.com.au.
BOOK NOW
Team AMA (WA) 2011: Minister for Health Dr Kim Hames, Principal of
Paxton Hoad Real Estate James Paxton, former AMA (WA) President
A/Professor David Mountain and AMA (WA) Executive Officer Gary Bucknall.
Calling all kings of the swing
The annual AMA (WA) Foundation Charity Golf
Day tees off once again on Friday 12 October
2012, and bookings are now open. One of the most
popular events on Western Australia’s medical
calendar, the event has been running for nearly 20
years with the venue being the prestigious Royal Perth
Golf Club.
This is an ideal opportunity for members of both the
medical and business communities to mingle and enjoy a
day on the course. Funds raised support the Foundation’s
Dr YES (Youth Education Sessions) program, which
delivers health education programs to thousands of highschool
students around WA each year.
After an exciting day on the greens, prizes are
presented in the evening and guests get to enjoy a superb
three-course dinner followed by a charity auction.
To book, please contact Liz Gray on (08) 9273 3027
or email liz.gray@amawa.com.au.
August MEDICUS 57

AMA
opportunities to save on your
home loan.
AMA members receive an 0.85% discount on the standard
variable rate for home loans, investment home loans, viridian
lines of credit and portfolio loans.
Based on the current CBA rate of 7.01%*, this represents an annual saving
of $4,500 on a $500,000 loan.
*Rate as at 07/05/2012
For more information about the AMA / CBA Wealth Package, contact:
Chris Kane at the AMA on 9273 3060 or chris.kane@amawa.com.au
Melinda Walker at the CBA on 9211 1701 or walkerm@cba.com.au
This exclusive offer is only available through the AMA (WA) and
CBA Premier Banking.

WINE
Hail to THE EMPEROR
Then and now: At 82, Karl Stockhausen continues his love affair with fine wine.
(Above right) A younger Karl working the wine at Lindemans. Pictures: Briar Ridge Vineyard.
few weeks ago, while reading James Halliday’s column
A in the Weekend Australian Magazine, a sentence leapt
off the page that led to a frenzied search of the cellar.
The relevant part of the sentence was “… a bottle of 1965
Lindemans Hunter River Burgundy (one of the greatest
wines of the 20th century)”.
Having sampled as a teen, some of the Hunter River
Burgundies from the glasses of family members who
adored these wines, they left an indelible impression and a
determination to have some bottles of my own.
That was achieved while a university student using some
carefully saved dollars, with advice from people who knew,
at the then centre of the wine universe, Liberty Liquors, that
they should be carefully cellared. This was done and the few
that remained were woken by frenzied hands looking for the
fabled 1965 vintage. Sadly, to no avail, there were none. Wishful
thinking, at best. Certainly the vintages rudely awakened are
nice drops, but definitely not the 1965 Bin 3110.
Whose guiding hand was behind the making of this giant,
some would say leviathan, of a wine? Karl Stockhausen. Not the
composer, although in a way, he is a composer of sorts – in the
winemaking sense of the word.
Karl Stockhausen was born in Germany, but was unfortunate
enough to have his school years overshadowed by a world war.
His family migrated to Australia in 1955 and was resettled
close to the Hunter Valley vineyards. He would handsomely
reward Australia and the Hunter wine industry in particular for
offering his family a new beginning.
From 1959 to 1979, Stockhausen produced what are generally
regarded as amongst the finest Australian wines – all Hunter
vintages. The 1965 Lindemans Hunter River Burgundy Bin
3110 is even now, spoken of in reverential tones, as one of
Australia’s all-time great wines.
This 82-year-old winemaking giant has chalked up 50
vintages and is still active in the industry, as consultant to the
Briar Ridge Vineyard in the Hunter Valley, a tasting panellist
and show judging.
Halliday had this to say in an article he wrote in November
1994 titled Lindemans Hunter River Shiraz (Burgundy) 1959 –
1991: “Dark, deep red with some faint tawny characters on the
rim. The palate is fragrant, powerful and extremely complex,
like a bigger version of the 1959 Bin 1590, featuring an array
of aromas through earth to berry, but all sweet. The palate is
incredibly complex and multifaceted, with tannins running
throughout hugely concentrated and powerful briary chocolate
fruit. Properly corked, it will live for another 30 to 40 years. 14.5
per cent alcohol. Prime of its life; gloriously mature.”
Another wine commentator was told by Stockhausen that the
1965 vintage was a freak, in that it did not rain. Winemakers in
the Hunter tend to keep an eye out for the threat of a downpour.
There was also the fact that Lindemans had filled all its concrete
fermenters with white wines, requiring the Shiraz to wait until
February. The result was the fruit in the Ben Ean vineyard
began to shrivel, resulting in the 14.5 per cent alcohol level,
though Stockhausen thought it was closer to 15 per cent plus.
Little wonder it was 17 years before the vintage was actually
released. That would have set off financial alarm bells for the
Fosters bean counters who currently own the Lindemans brand.
It is arguable that the vintage would not have survived in the
brand’s current guise.
Thank heaven that all the ducks lined up as the saying
goes – a freak of a vintage, a winemaking legend with a great
winemaking team, and a producer prepared to give the vintage
the time it needed and release it when it was ready. If there is
any disappointment, and there is, there are no 1965 Hunter
River Burgundies in my cellar.
August MEDICUS 59

PHOTOGRAPHY
Make the histogram a habit
by Denis Glennon
have just returned from Namibia where I spent the last
I five weeks, three of which were spent leading a group of 10
Australian photographers on a self-drive photo safari and two, on
a private photography expedition into some of the most remote
territory on the planet – into the far north-west of Namibia, right
up to the Angolan border.
During the private expedition, I travelled for five days without
driving on even a gravel road or sighting another vehicle or human
being. The landscape here is “mars-like” and the nomadic Himba
tribes roaming these parts are truly inimitable. It is a distinct
privilege to photograph such austere, natural beauty and rarity of
culture. Being in such isolation and driving for up to seven hours
each day, all in dried-up river beds, off-road tracks and mountain
passes, allowed me time to think about the question most
frequently asked by the photographers in the group I led during
the previous three weeks.
The choice was easy. It was to help them understand, interpret
and make better use of the histogram on their DSLR cameras.
This was prompted by the behaviour of the three professional
photographers on the photo safari. Each of us automatically looked
at the LCD immediately after taking a shot. Most photographers
in the group thought we were looking at the image on the LCD.
When we explained to them we did not bother looking at the
image and instead it was the histogram that commanded our
attention, it opened several discussions and a whole new world for
many of them.
The histogram
The histogram is the key to interpreting your digital image. A
simple analogy will help you understand. The 10X4 mosaic in
Fig. 1 contains 40 coloured square tiles which are sorted by colour
and stacked accordingly in Fig. 2. The higher the pile, the more
tiles of that colour are in the mosaic. Think of Fig. 2 as a basic
histogram representing the colour distribution of the square tiles
in the mosaic.
Fig. 1: Mosaic of tiles.
A digital image is basically a mosaic of square tiles or
‘pixels’ which are tiny. Instead of sorting them by colour, like
we did manually in the mosaic of tiles, the computer in your
camera sorts the pixels into levels of brightness, and stacks
them accordingly, as shown in Fig. 3. For the purposes of
explanation, think of each ‘bar’ in Fig. 3 as being one pixel
wide, stacked by side, with no space between them. The height
of each vertical ‘bar’ tells you how many pixels there are for
that particular level of brightness, from the dark shadows on
the left, through the midtones in the middle, to the bright
highlights on the right.
On your camera LCD, you will not see a series of individual
‘bars’ having different shades, as in Fig. 3. Instead, a total of
256 of these ‘bars’ are shown bunched together, all in black, as
in Fig. 4. The left hand side is given a value of 0 (black) and
the right hand side a value of 255 (white), with 254 grey levels
in between. Fig. 4 is a nice example of a ‘good’ histogram from
a correctly-exposed photo, where plenty of details have been
captured in the shadows, midtones and highlights.
Fig. 3: Pixels stacked by level
of brightness.
Fig. 2 : Tiles stacked by colour.
Fig. 4: Histogram as seen on
camera.
60 MEDICUS August

PHOTOGRAPHY
Notice there are no are no ‘bars’ running vertically at either the
left or right hand side of the histogram in Fig. 4 – something you
wish to avoid in the majority of your photos.
‘Bars’ climbing vertically up the left hand side of the histogram
(like in Fig. 5) tells you that you have underexposed the image
and you did not capture details in the dark shadow areas. ‘Bars’
climbing vertically up the right hand side of the histogram (like
in Fig. 6) shows you have overexposed the image and did not
captured details in the bright areas.
you are wasting fully half of the available encoding ability of your
camera. The simple lesson is to bias your exposures so that the
histogram is snugged up to the right hand side, but not to the
point where you have some of the ‘bars’ climbing vertically up. If
the latter happens you have blown the highlights in your images
and these can never be ‘recaptured’. Using the ‘flashing alert’ or
‘blinking’ function on your camera will help avoid this happening.
To move the histogram to the right, simply let in more light
to the sensor, by opening the aperture further, or increasing
the time the aperture is open or increasing the ISO level.
Fig. 8 shows a ‘centred’ histogram and the same one pushed
to the right but not allowing it to climb vertically up the right
hand side.
Fig. 5: Histogram of an underexposed
image.
Fig. 6: Histogram of an overexposed
image.
If your histogram has verticals ‘bars’ running up both the left
and right sides, it means you has lost, or ‘clipped’ details in both the
shadows and highlights. This happens when the range of light levels
in the scene, from the darkest to the brightest, is more than the sensor
in your camera can cope with. There will be too much contrast in
what you are trying to photograph, to capture in one shot.
Fig 8: Histogram showing the principle of ‘shooting to the right’.
Use the histogram to help you shoot to the right
Fig. 7 shows a histogram box without the ‘bars’ and somewhat
arbitrarily divided into five equal zones or tones. Intuitively you
would think your camera’s sensor would be capable of capturing
and recording the same amount of digital data (or tones) from
each zone in any scene.
Fig. 7: Histogram divided into five zones.
Alas, this is not the way it works. The way it really works is
that the ‘Very Light’ zone captures fully half or 50 per cent of the
digital data (tones) available in whatever you are photographing.
The next ‘Light’ zone captures 50 per cent of what the ‘Very
Light’ zone has already captured. The ‘Medium’ zone captures 50
per cent of what the ‘Light’ zone has already captured, and so on
as we move towards the last ‘Very Dark’ zone. This means the first
three zones alone capture 87.5 per cent of the digital data (tones)
you can possibly capture in any photograph. The 85 per cent is
made up of 50 per cent (‘very light’ zone), plus 50 per cent of 50
per cent or 25 per cent (‘light’ zone), plus 50 per cent of 25 per
cent or 12.5 per cent (‘medium’ zone).
The message is clear. If you are not using the right-hand side of
the histogram for capturing and recording much of your images,
Fig. 9: Actual histogram straight from camera.
Fig. 9 shows the actual histogram for the Water Art photo
(pictured). This histogram is ‘straight from camera’ and is
the third image I took of the water breaking on the rock. By
interpreting the histograms for the two earlier shots, I increased
the exposure until I maximised the digital data gathered, without
blowing out the highlights. I have given myself the best chance to
work this image further in Lightroom or Photoshop, if I choose to
do so.
Almost all prosumer cameras and all professional cameras
allow you to view the histogram on the camera’s LCD so
that you can adjust the exposure and take the shot again, if
necessary.
Visit your camera’s manual to switch this function on so that
it automatically appears when you look at the LCD after taking
a shot. Soon you will not be using the LCD only for deleting
the poor and out-of-focus images. Concentrating on the
histogram will ensure you have much fewer images to delete.
August MEDICUS 61

TECHNOLOGY
You ain’t
seen
nothing
yet
Augmented reality is poised to change the
very landscape of our everyday lives
In April this year, Google publicly announced Project Glass.
Although many in the tech- arena were already aware of the
project, this was the first real opportunity to see this innovative
eyewear.
The latest hot ticket item in geek-space, this technology brings
together various new innovations which augment the world.
Google Glasses are expected to be released to developers in early
2013 and general consumers about 12 months later.
But why are Google Glasses, and technology like it, such an
anticipated item? It is because they are expected to be the next
leap forward in our tech immersion, as they augment reality in a
way no Smartphone can. Like computers did before them, this
technology will change the very landscape of our everyday life –
from shopping to surgery, nothing will be the same.
Augmented reality is a multi-sensory experience where
computer-generated information is overlayed on the real world.
So unlike virtual reality, which creates an alternate reality, AR
‘enriches’ our existing reality. Smart-phones are a small step on
the augmentation road, for example a QR code to hyperlink a
physical object or an app like Google Goggles.
All of these in one way or another have the ability to overlay
data onto the physical world. However, currently this process is
mediated via an intrusive device between us and the augmentation,
an experience that is novelty rather than part of someone’s daily
process. With new neuro-recognition and gestural response
technology, along with better data streaming and micro
components, a more seamless AR experience is almost upon us.
Google’s slimline AR glasses will mark the beginning of a new
generation of eyewear that provides hands-free access to a whole
new dimension for viewing the world: the public and private
space of the future will be a very different landscape.
If someone passes you in the street with something you would
like - a bag, pair of shoes or snack bar - just by focusing in on
that item, with your actual eyes, the computer will be able to
map you back to all the details you need to acquire that object.
And with retina display technology, you will use your unique eye
signature to sign in and pay without pushing a button. And don’t
worry about people taking your eyes out to gain access to your
account; modern retina technology needs your eyes attached and
functioning to work.
Advertising will no longer be a flat mono dimensional
experience. As you walk down the street, look at a magazine or
do a bit of retail therapy, when you see something you like, you
can bring it closer, turn it over and access the full product details.
You will even be able to try it on. Say you see a bangle you really
like, in a shop front or on a passer-by, just by focusing on it, a 3D
model of the object will appear before you. You can then view it
or save for later.
The same will apply with clothing; via a morphological map
of your body you will be able to try on clothes without having
62 MEDICUS August

TECHNOLOGY
Hi-tech: A surgeon using AR technology to view diagnostic imaging information about a patient. AR technology allows full diagnostics to
be used, viewed and manipulated in surgery without the introduction of potential contaminants; AR has no actual surface. It also means the
surgeon can view and manipulate this data without needing to rescrub.
to take a single article off – sheds a whole new light on the
Emperor’s new clothes!
By hooking into already available data streams and recognition
software, you will know if a ‘friend’ is in your proximity and then
be able to view a real-time-path to them. It will also mark the end
of ‘now what is his/her name?’, as facial recognition and device
tracking will quickly generate all the data required. Data – which
only you can see – like their name, when you last connected and
how you know them, will display via your eyewear.
When you travel, you will have your own personal translator
that can read signs, help you get to where you’re going, tell the
shop assistant what you want, as well as give you a seamless visual
and aural experience of a bygone era which you can walk through.
In surgery all pre-operative imaging and diagnostics will be
3D-mapped onto the patient via the eyewear. Simultaneously
all the data being collected during the procedure will be
processed back to the device helping with risk assessments and
patient progress, whilst also providing details on alternative
courses of action.
The all grey dystopia cityscapes depicted in many books could
in fact one day be reality – when it will cost far less to build a
big grey concrete building and then map a virtual surface onto
it, which you can change quickly and inexpensively with your
standard laptop computer or even a hand-held device.
Whilst first generation Google Glasses will not have all the
A new view: Google’s slimline AR glasses will mark the
beginning of a new generation of eyewear that provides handsfree
access to a whole new dimension for viewing the world.
functionality mentioned above, it is clear AR devices will be with
us soon. And once they hit the market this technology will rapidly
advance and improve.
You may think Medicus has taken a trip into a fantasy world,
but AR is coming and it is coming fast. So hang onto your
hats because the world is about to become a whole lot more
interactive.
August MEDICUS 63

In addition to the valuable services the AMA (WA) provides members, the Association
also secures significant savings with a host of exclusive benefits.
For more information, visit www.amawa.com.au/membership/memberbenefits.aspx
Lexus
The Lexus Coporate program offers
AMA (WA) members a new standard
of luxury. The program includes:
*Scheduled servicing to three years or
60,000km
*Discounted dealer delivery and corporate pricing
*Airport valet service
*Complimentary service loan cars or pick-up and delivery
*Plus much more...
To find out more about exclusive offers for AMA (WA) members,
contact Craig Nylander, Corporate Development Manager at Lexus
of Perth on (08) 9340 9000.
Bose
The Bose Store Subiaco is delighted
to offer all AMA (WA) members a
reduction of 10 per cent off all Bose
equipment except Wave and Quiet Comfort.
Visit the Bose Store at 139 Hay St, Subiaco,
WA 6008 or phone (08) 9388 0099.
Pop in and experience the mind-blowing sound.
For information, visit www.bose.com.au.
Ae’lkemi
Ae’lkemi mixes old-world opulence
with visually-seductive and playful
surfaces and textures. Alvin Fernandez, Head Designer of
ae’lkemi is focused on unique handprints and organic textile
processes that represent femininity.
All of ae’lkemi’s designs feature the distinct
hand-finishing they are known for.
Ae'lkemi is offering all AMA (WA) members
15 per cent off floor stock.
Karijini Eco Retreat – an
authentic outback experience
Karijini National Park boasts spectacular
scenery with waterfalls, rock pools,
gorges and chasms. It is here you find the
multi-award winning, ecologically-sound
Karijini Eco Retreat, offering quality
accommodation, facilities and tours options
from April to October.
Experience nature from your furnished
Deluxe Eco Tent with en-suite and enjoy the alfresco
restaurant and bar.
10% DISCOUNT: Receive 10 per cent discount off the
cheapest advertised or internet rate for a Deluxe Eco Tent when
booked directly with the property prior to your stay.
*Subject to availability.not valid on public holidays OR Ocean Safari AQWA tours.
For more information visit www.karijiniecoretreat.com.au; email
reservations@karijiniecoretreat.com.au or call (08) 9425 5591.
GV Lawyers
GV Lawyers offers a range of services
including medico legal,
commercial, litigation, wills and
estates. AMA (WA) members receive a 20 per cent
discount on services. Visit the website or call Pino
Monaco on (08) 9325 6188.
Thompson Estate
Cardiologist Peter Thompson is delighted to invite you
to try his range of wines especially the Locum Range
and is offering a 10 per cent discount off the entire
range, plus free delivery within WA to all
AMA(WA) members.
To view the entire range and find out
more, visit www.thompsonestate.com.
Chefs of the Margaret River Region
Chefs of the Margaret River Region is a local publication that celebrates local produce
and offers readers a peek into world-class tastes along with exquisite wines. AMA (WA)
members enjoy a 20 per cent discount off the cost of the book. Simply visit http://www.
margaretriverpress.com/ and enter AMA2012 as your discount code when purchasing
the book online.
64 MEDICUS August

To win a double pass to one of the following events, simply go to
www.amawa.com.au/membership/onthetown.aspx
Entries must be received by COB Thursday 13 September 2012.
Seafood and Semillon
20 September 2012
6-8.30pm
Panorama Catering,
15/5 Rowallan Street,
Osborne Park, WA 6017
For years Chardonnay has
dominated palates when it
comes to food and wine pairing, but what about
Semillon? This Masterclass will prove once and for
all that Semillon deserves pride of place on Western
Australian dinner tables.
Join Panorama Catering’s Don Hancey, one of WA’s
most dynamic chefs, renowned for his ability to pair
regional produce and regional wine, and Kim Tyrer,
master winemaker at Galafrey Wines, to discover the
secret versatility of Semillon.
While Don conducts a variety of interactive
demonstrations using fresh local crab, learn how
each recipe matches the Semillon characteristics and
hear from Kim how the winemaking practices have
influenced each style
Arbitrage
In cinemas
27 September |
Madman Entertainment
A taut and alluring suspense
thriller about love, loyalty,
and high finance, Arbitrage
stars Golden Globe winner
Richard Gere (Chicago),
Academy Award winner
Susan Sarandon (Thelma & Louise) and Academy
Award nominee Tim Roth (Rob Roy).
On the eve of his 60th birthday, New York hedgefund
magnate Robert Miller (Gere) is the portrait of
success. But behind the gilded walls of his mansion,
Miller is desperately trying to complete the sale of
his trading empire to a major bank before the depths
of his fraud are revealed.
Struggling to conceal his duplicity from loyal
wife Ellen (Sarandon) and daughter Brook (Brit
Marling), Miller is also balancing an affair with
French art-dealer Julie Cote (Laetitia Casta).
Dvořák’s New World
7.30pm, Friday 12 & Saturday 13 October
Perth Concert Hall
Spend a joyous evening with the West
Australian Symphony Orchestra and hear
the uplifting sound of Dvořák’s Symphony
from the New World. This work, No. 6 on the ABC Classic 100,
features one of the best known Largo melodies of all time.
Beasts of the Southern Wild
In cinemas September 13
The most magical film of the year, Beasts of
the Southern Wild will inspire and remind
audiences of the magic that exists in all of our worlds.
The film centres around six-year-old Hushpuppy who goes in search of
her lost mother, faced with her father's fading health and environmental
changes that signal the unravelling of the universe, and is forced to
comprehend her place in the mysterious world around her.
After scooping top honours at both at Cannes and Sundance film festivals
this year, this much-anticipated film will open at Luna Leederville and
Luna on SX on September 13. For more information, visit
www.beastsofthesouthernwild.com.
Diary of a Wimpy Kid: Dog Days
In cinemas September 20
The Wimpy Kids are back on the big
screen – on Summer Holiday! Diary of
a Wimpy Kid: Dog Days (PG) is the
funniest and biggest Wimpy Kid film yet and perfect school holiday
entertainment. For more information, visit www.doawk3.com.au.
Ruby Sparks
In Cinemas September 20
From the directors of Little Miss
Sunshine comes a romantic comedy with
a twist. Paul Dano is a novelist struggling
with writer’s block who finds romance in
a most unusual way – by creating a female
character he thinks will love him, then
willing her into existence. Starring Zoe
Kazan, Annette Bening, Antonio
Banderas and Steve Coogan.
For more information, visit http://www.foxsearchlight.com/rubysparks/.
August MEDICUS 65

Obesity Surgery WA
New members
The AMA (WA) welcomes the new members who
joined during August 2012
Benjamin Ansell
Angeline Barker
Annemie Beck
Chelsea Beinke
Keiron Bradley
Philippa Jane Chidgzey
Jaclyn Chin
Suk Khan Choong
Juan Carlos D'Abrera
Stephanie Davies
Ashutosh Dixit
Hayden Elderfield
Charles McKibbin
Aoife Moynihan
Claire Murray
Sharon Nowrojee
Pieter Oosthuizen
Hiten Patel
Kaz Siddique
Sivapriya Siva
Niranjini Subramanium
Farid Taba
Ohnmar (Lily) Win
Ye Yint
Real Solutions • Real Support
Obesity Surgery WA offers a multidisciplinary team
approach to people with obesity and obesity related
problems.
We undertake pre-operative and post-operative counselling,
consultation with our dietician, physicians review and
surgery as our core business to achieve the best results
for our patients.
We also offer the opportunity for personal exercise
training, social interactions and more informal support
helping individuals through what is a difficult time in their
lives.
Real Solutions
Two Practical Surgery Options
• Laparoscopic Gastric Banding
Most popular choice in Australia
Safest obesity operation
Reversible and adjustable
Proven track record
• Laparoscopic Sleeve Gastrectomy
No adjusting once procedure is done
Hard to cheat
Better quality of eating
Ideal for people in remote areas
Real Support
Rachael Foster
Deryck Foulner
Peter Friedland
Ettore Guaia
Colette Halpin
Justin Hii
Rupert Hodder
Warwick Howe
Jami Ilyas
Benedicta Itotoh
Peter Jackson
Bijan Jahangiri
Anwar Jawad
Ziyad Luckman Khaleel
Ravi Mathew
Amir Zaman
Harsha Chandraratna
Surgeon
• Obesity Assessment Clinician -
Janet Barry
• Dietician –
Clare Jurczyk
Including -
• Motivational Counsellor
• Clinical Psychologist
• Personal Physical Trainer
• Physiotherapist
• Nurse Liaison and patient co-ordinator
Two convenient practice locations
Subiaco
SJOG Subiaco Clinic
Suite 321, 25 McCourt St
Subiaco WA 6008
Murdoch
Murdoch Specialist Centre
Suite 16, 100 Murdoch Dr
Murdoch WA 6150
66 MEDICUS August
Tel: (08) 9332 0066 Fax: (08) 9463 6202
www.obesitysurgerywa.com.au

Professional Notices
CARDIOVASCULAR
Perth Cardiovascular Institute
• Dr Jay Baumwol
• Dr Andrei Catanchin
• Dr Matthew Erickson
• Dr Susan Kuruvilla
• Dr Michael Muhlmann
• Prof Gerry O’Driscoll
• Dr Jamie Rankin
• Dr Matthew Best
• Dr Michael Davis
• Dr Arieh Keren
• Dr Athula Karu
• Dr Kaitlyn Lam
• Dr Anne Powell
• Dr Sharad Shetty
• Dr Gerald Yong
It is with great pleasure that we welcome Dr Arieh Keren to
our fast-growing team of experienced cardiologists. Dr Keren
will be consulting from our Nedlands and Joondalup rooms.
He also holds a public appointment at Sir Charles Gairdner
Hospital. His sub-specialty includes the advanced management
of all cardiac arrhythmias in particular atrial fibrillation, and
also the implantation of pacemakers, defibrillators and cardiac
resynchronisation devices for heart failure management. Dr
Keren has a particular interest in advanced management of
defibrillator shocks and ventricular arrhythmias.
Dr Arieh Keren is pleased to provide the ongoing care and
services to patients and the referring physicians following the
departure of Dr Andrei Catanchin.
For bookings to see Dr Keren, or for any information regarding
patients of Dr Catanchin, please phone 6314 6804 or email
DrKeren.PA@perthcardio.com.au.
The group provides a comprehensive cardiac testing service at
nine conveniently located sites: Nedlands (Hollywood Private
Hospital), Joondalup Health Campus, Bentley, Duncraig,
Esperance, Midland, Mt Lawley and Rockingham.
Services offered include:
• Cardiology consultations
• Echocardiography
• Exercise Stress Testing
• Monitor Fittings (Ambulatory BP, Event and Holter)
• ECG.
Visit www.perthcardio.com.au for more information on our
services. For cardiology appointments: 1300 4 CARDIO.
For testing appointments: 1300 HEART TEST.
General enquiries: phone 6314 6833 • fax: 6314 6888
Email: info@perthcardio.com.au.
CARDIOTHORACIC SURGERY
Mr Ian Gilfillan MBChB, FRCS (Ed) & C/Th &
DMI, FRACS
Operating at Fremantle & The Mount Hospitals.
Provides a comprehensive service in adult cardiothoracic surgery
including
• Valvular Heart Disease
• Ischaemic Heart Disease
• Lung Masses
• Pleural Disease.
For routine appointments, please call 9481 7655. For my advice and
emergencies, please call me directly on 0412 356 216. No gap provider
for HBF and Medibank Private. Mount Medical Centre, Suite 50, 146
Mounts Bay Road, Perth Fax: 9481 7611.
GENERAL SURGERY
Perth Surgical Clinic
Mr Karim Ghanim MB CHB FRACS
Surgical Oncology (breast/bowel and skin
cancers) Laparoscopic surgery (hernias, bowel
and gallbladder)Colonoscopy and Gastroscopy
(open access) Operating at: North: Mount
Private and Bentley. South: SJOG Murdoch and
Armadale hospitals. Consulting: Hollywood, Murdoch, Bentley
and Galliers. Mobile: 0411 113 314
Dr. Farah Abdulaziz B.Med.Sci MBBS
MRCS FRACS
I specialise in Oncoplastic Breast Surgery,
Breast cancer surgery, Breast reconstruction,
Breast augmentation and reduction.
General surgery: Hernias (open and
laparoscopic), gallbladder, vasectomy, carpal
tunnel and lymph node biopsy Admitting and operating at:
Bethesda Hospital, Sir Charles Gairdner Hospital, Hollywood
Private Hospital, Osborne Park Hospital and Mount Private
Hospital. Mobile: 0415 638 541
All correspondence to: Suite 36 Hollywood Specialist Centre,
95 Monash Avenue, Nedlands 6009. Phone: (08) 9386 5814;
fax: (08) 9386 9599;
E-mail: info@generalsurgeryperth.com.au
Website: www.generalsurgeryperth.com.au.
Mr Harsha Chandraratna MBBS FRACS
General Surgeon with sub-specialists interest in:
• Disease of the liver, pancreas and gallbladder
• Management of obesity
within a multidisciplinary setting including
bariatric surgery –oswa.com.au
• Pilonidal problems
• Laparoscopic surgery including appendicectomy,
cholecystectomyand hernia
• Emergency surgery. Consulting and operating at St John of
God Hospital Murdoch and Subiaco.For all appointments
Tel 9332 0066 • Fax: 9463 6202
August MEDICUS 67

Professional Notices
HAND SURGERY
Mr Paul Jarrett FRACS
Hand and Upper Limb Surgeon
provides a comprehensive service
for elective and traumatic
conditions for the hand, shoulder and upper
limb at Murdoch Orthopaedic Clinic for
Workcover and Privately Insured patients.
Please call 9311 4636 for appointments. I am
happy to be referred public patients at Fremantle Hospital
where I hold weekly clinics.
Mr Craig Smith MBBS FRACS
Hand, wrist and plastic surgeon has his main practice at 17 Colin
Street, West Perth in association with Specialised Hand Therapy
Services. This means that consultation, hand therapy and splinting
are all available at the one location. His areas of interest include
all acute or chronic hand and wrist injuries or disorders as well
as general plastic surgical problems. He continues to consult in
Bunbury and Busselton.
For appointments or advice please call 9321 4420.
Mr Angus Keogh FRACS
- Upper Limb Surgeon
My interests include traumatic and
degenerative conditions of the upper
limb including hand surgery, arthroscopy
including small joints, complex elbow and
wrist instability. I consult in private rooms
at St John of God Subiaco and St John of God Murdoch. I
consult weekly at Sir Charles Gairdner Hospital – please call
08 9346 1189. Please call 08 9489 8782 for appointments.
Workcover accepted.
HAND & PLASTIC SURGERY
Dr Robert Love MBBS FRACS (Plas) Dip ANAT
All hand surgery, microsurgery and plastic surgery
• Dupuytren’s Contracture
• Arthritides, Carpal Tunnel
• 24hr Emergency
• Requests for advice welcome
17 Richardson St West Perth and SJOG Murdoch
Tel: 9321 3344 • Mobile: 0409 132 602
INFECTIOUS DISEASES
Dr Desmond Chih MBBS FRACP FRCPA
Infectious Diseases Physician and Clinical Microbiologist
All aspect of adult general infectious diseases and diagnostic
microbiology including
• Fever of unknown origin
• Bone and joint infections
• Surgical infections
• Skin and soft tissue infections
• Travel related infections
• Tuberculosis
• Antibiotic resistance
Consults at Joondalup, SJOG Murdoch (Inpatient) and
Myaree. All correspondence to 74 McCoy Street, Myaree
6154 Tel: 08 9317 0999 • Appointments: 08 9317 0710
Fax: 08 9467 2826 Email: Desmond.Chih@wdp.com.au
NEUROLOGY
Dr Nai Lai MBBS, FRACP, Neurologist
Offers general neurology including EMG services
Hollywood Specialist Centre. Suite 34, 95 Monash Ave,
Nedlands. Tel: 9389 9444; fax: 9389 7518
For inpatient consults, Tel: 9346 3333
Mount Medical Centre Suite 26, 146 Mounts Bay Road,
Perth Phone: 9322 2714; fax: 9486 1198
OPHTHALMOLOGY
Dr Michael Wertheim MBChB FRCOphth FRANZCO
Comprehensive general ophthalmologist
consults at: South Street Eye Clinic, Suite
10/73 Calley Drive, Leeming 6149
Early and urgent appointments available
Operates at: Eye Surgery Foundation, West
Perth (private patients) Kaleeya Hospital, East
Fremantle (public patients) Special Interests:
cataract surgery, general ophthalmology, Uveitis
For appointments, phone 9312 6033 or fax 9312 6044
PSYCHIATRY
Dr Raj Sekhon
Dr Raj Sekhon is pleased to announce that he has commenced
private psychiatric practice in Rockingham. Raj is a local UWA
graduate (1996) and is a Fellow of The Royal Australian and
New Zealand College of Psychiatrists (FRANZCP), with an
interest in all aspects of general adult psychiatry. For referrals
or other advice please Ph: 9528 0996 • Fax: 9528 0850.
Sentiens Day Hospital
Please refer all private mental health patients to Sentiens
Clinic. Our patients usually have depression, anxiety,
bipolar, borderline personality disorder, drinking problems,
relationship problems, stress, PTSD, OCD and sometimes
eating disorders and schizophrenia.
We offer group programs in CBT (also evening), DBT
skills, creative therapy, alcohol management, mindfulness,
68 MEDICUS August

carer’s support, patient support, self-esteem, health and
wellness, exercise, anger management, interpersonal
skills, recovery/relapse prevention, stress management,
drug-related metabolic problems, anxiety management,
life skills, assertive skills, triage and online assessment via
PsychAssess and PsychScreen and online monitoring using
HealthSteps.
We have clinicians waiting to take your referrals.
Refer to Dr Dennis Tannenbaum or
Dr George Atartis (Consultant Psychiatrists) or directly to
Sentiens Clinic.
For referral advice, call Sharon on: 9481 1950 or
Fax: 9481 1952. You can now refer to Sentiens Clinic online
via www.Sentiens.com.
For all online programs visit: www.HealthSteps.net.au.
ORTHOPAEDIC SURGERY
Karl Stoffel MD, PhD, FMH (Tr & Orth),
FRACS
Professor of Orthopaedics and trauma surgery
provides a comprehensive service for elective
and trauma conditions for the hip, knee,
lower limb and all orthopaedic trauma at
Murdoch Orthopaedic Clinic for Workcover,
DVA and privately-insured patients. Please call 9311 4639 for
appointments. I offer a no-gap service for all major health funds
and will be very happy to see private, Worker’s Compensation
and Department of Veteran Affairs patients at Murdoch.
RADIOLOGY/NUCLEAR MEDICINE
Oceanic Medical Imaging
Leeming
Tel: +61 8 9312 7800
Fax: +61 8 9312 7878
Oceanic Medical Imaging Hollywood
PET-CT CentreGround Floor,
Suite 14, Hollywood Medical Centre
85 Monash Avenue, Nedlands 6009
Tel: +61 8 9386 7800
Fax: +61 8 9386 7888
www.oceanicimaging.com.au
Oceanic Medical Imaging offers a wide range of general
and specialist medical imaging utilising the latest imaging
equipment.
Services include:
• 64-slice cardiac capable CT
• Digital General X-Rays
• Ultrasound
• Digital OPG & Cephalometry
• Nuclear Medicine Studies and Therapy
• Bone Densitometry
• DEXA Whole Body Fat Assessment
• Stress ECG suite with Myocardial Perfusion Imaging
• PET-CT
• CT/Ultrasound-guided injections.
We provide a personalised, comprehensive and professional
digital imaging service.
Patients benefit by a short or no wait time for an
appointment, low radiation dose equipment, family-friendly,
comfortable clinic and affordable examination fees.
Perth Shoulder Clinic, situated at Bethesda Hospital in Claremont,
provides a comprehensive service for the treatment of shoulder
disorders including:
* Arthroscopic surgery for shoulder instability and rotator cuff pathology
* Shoulder Arthroplasty including revision arthroplasty
* Surgery for fractures about the humerus, scapula and clavicle
* On-site physiotherapy
Grant Booth operates at Bethesda
Hospital and SJOG Hospital Subiaco as
well as holding a public appointment at
Royal Perth Hospital.
Sven Goebel operates at Bethesda
Hospital and SJOG Hospital Subiaco as
well as Joondalup Health Campus where he
is able to see public patients.
For appointments or advice contact:
p. 9340 6355 f. 9340 6356 reception@perthshoulderclinic.com
Perth Shoulder Clinic, Bethesda Hospital
25 Queenslea Dr, Claremont 6010
www.perthshoulderclinic.com
PSCadvert-ver3.indd 1
3/4/12 6:16:12 PM
August MEDICUS 69

SUBIACO
Doctor required to work part time in Subiaco for local business specialising in pre-employment medicals and Injury
Management for mining, construction, recruitment, drilling and mining-affiliated companies. This is an opportunity to
join an established and successful company and will provide an opportunity to gain experience in the occupational health
field. This role is ideally suited for someone looking for part-time work with a team of nurses and physiotherapists.
All queries should be directed to Debbie Flynn on 0401283241 or via email to debbie@futurishealth.com.au
FOR SALE or
LEASE:
JOONDALUP CBD
Consulting Rooms/Office Suite
77sqm Ground floor premises
located 300m from Joondalup
Hospital.
$550,000 + GST or lease
$395/sqm + vo + GST.
For details contact owner on
9405 2019 (A/H).
FOR LEASE:
WEST LEEDERVILLE/
SUBIACO
Specialist consulting rooms for
lease/sub-lease
Opposite St John of God
Hospital, Subiaco
Large reception and waiting
areas
Consulting room and
For Lease
2 dressing rooms
Ample on-site For 54 parking Farrington Lease Road Leeming
Please 54 Farrington contact 0409 Road 980 198. Leeming
INGLEWOOD
GP required: full-time or parttime,
with or without a view. Hours
negotiable.
For Lease
We are a busy seven-doctor (three
male, four female) private billing noncorporate
54 Farrington Road
practice
Leeming
in Bedford.
Full-time nurse and pathology on site.
Friendly and very well staffed.
Phone Steve, Carl or Jeremy on
92719311 or
email salisburymed@iinet.net.au.
FOR LEasE
54 FARRIngTon RoAd, leemIng
superbly located premises. Situated nearby to the new Fiona Stanley Hospital and directly
An outstanding opportunity to exists to grow your Medical / opposite Consult the Leeming business Shopping Centre, inspection within of this this property superbly is a must. located premises.
opposite the Leeming Shopping Centre, inspection of this property is a must.
Area:
209 sqm
Situated nearby to the new Fiona Stanley Hospital and directly Area: opposite the 209 Leeming sqm Shopping Centre, inspection of this property
Lease Term:
3 years preferred
is a must.
Net Rental:
$45,000 + GST (Possibility of sub tenant to absorb rental costs)
Rent Reviews:
Area: 209 sqm | Lease Term: 3 years preferred | Net Rental: Net Rental: Negotiable.
$45,000 + GST (Possibility of sub tenant to absorb rental costs)
$45,000 + GST (Possibility of sub tenant to costs)
Fit out and Furniture: • Consult Rooms
• Available Facilities
• Two reception areas
Outgoings: Estimated at $55/sqm pa + GST for 2011/12 Outgoings:
Estimated • Full Kitchen at $55/sqm + GST for 2011/12 period.
period. • Individual Parking: suites Ample secure • Ample Supply parking storage available
• Specialist furniture available
•Air conditioning
Rent Reviews: Negotiable
Description:
An outstanding Rent opportunity Reviews: to exists to grow Negotiable. your Medical / Consult business within this
Fit out and Furniture:
• Consult Rooms
• Two reception areas
• Individual suites
• Specialist furniture available
70 MEDICUS August
Area:
Lease Term:
Net Rental:
Outgoings:
Rent Reviews:
Fit out and Furniture:
Parking:
Description:
Outgoings:
Description:
Inspections / Enquiries
• Available Luke Pavlos Facilities
• Full Kitchen
luke@dtzwa.com.au
• Ample Supply
Parking:
storage
Negotiable.
• Air conditioning
An outstanding opportunity to exists An to grow outstanding your Medical / Consult opportunity business within to exists this to grow your Medical / Consult business within this
superbly located premises. Situated nearby to the new Fiona Stanley Hospital and directly
Lease Term:
3 years preferred
Estimated at $55/sqm pa + GST for 2011/12 period.
superbly located premises. Situated nearby to the new Fiona Stanley Hospital and directly
opposite the Fit Leeming out and Shopping Furniture: Centre, inspection • Consult of Rooms this property is a must.
• Available Facilities
Parking:
Ample secure parking available • Two reception areas
• Full Kitchen
209 sqm
• Individual Inspections suites / Enquiries • Ample Supply storage
• Specialist furniture available
•Air conditioning
3 years preferred
David Martin
(08) 9325 5880 (08) 9263 8801
Luke Pavlos
David Martin
0408 $45,000 932 321 + GST (Possibility 0438 884 334 of sub tenant to absorb rental costs)
davidm@dtzwa.com.au (08) 9325 5880
(08) 9263 8801
Estimated at $55/sqm pa + GST for 2011/12 period.
Ample secure parking available 0438 884 334
• Consult Rooms
• Available Facilities
• Two reception Inspections areas / Enquiries • Full Kitchen
• Individual suites
• Ample Supply storage
Luke Pavlos
David Martin
• Specialist furniture available
•Air conditioning
(08) 9325 5880 (08) 9263 8801
0408 932 321 0438 884 334
luke@dtzwa.com.au davidm@dtzwa.com.au
Ample secure parking available
0408 932 321
luke@dtzwa.com.au
davidm@dtzwa.com.au

Mundaring
FT/PT VR GP
To join busy, friendly, modern, accredited, fully
computerised, well managed private medical centre.
Excellently equipped treatment room with fulltime
RN support.
Fabulous career opportunity, attractive remuneration
and 6wks annual leave.
Pract Mgr - Michelle Alton. Tel: 08 9295 1988
email: altonm@iinet.net.au
INGLEWOOD
GP required: full-time or part-time, with
or without a view. Hours negotiable.
We are a busy seven-doctor (three male,
four female) private billing non-corporate
practice in Bedford.
Full-time nurse and pathology on site.
Friendly and very well staffed.
Phone Steve, Carl or Jeremy on 92719311
or Email: salisburymed@iinet.net.au
APPLECROSS
MADDINGTON
Applecross Medical Group is a major medical facility in the southern
suburbs. Current tenants include GP clinic, pharmacy, dentist,
physiotherapy, fertility clinic and pathology. Both the GP clinic and
pharmacy provide a 7 day service.
The high profile location (corner of Canning Hwy and Riseley Street
Applecross), provides high visibility to tenants in this facility.
A long term lease is available in this facility - the space available is
85m2, with the current layout including
4 consulting rooms, procedure room and reception area.
Would suit specialist group, radiology or allied health group.
Contact John Dawson – 9284 2333 or 0408 872 633
Maddington
Medical Practice for lease.
Established doctor surgery of over
10 years in Maddington is looking
for a principal doctor to take over.
If you are currently looking to
branch out on your own, this is ideal
for you.
Option to lease and/or buy available.
Please contact Lucas on
0403 368 147.92719311 or
email salisburymed@iinet.net.au.
Scott Kirkbride Melanoma Research Centre
Inaugural Melanoma Conference 2012
23rd & 24th October 2012, Esplanade Hotel Fremantle
www.melanomaconference2012.org.au
The conference program brings together the world’s leading melanoma
researchers to talk about the very latest in:
• Melanoma clinical trials and outcomes
• Molecular signalling pathways
• Radiology therapy breakthroughs and palliative treatments
• Biomarker discovery
• Pathology and epidemiology studies
Distinguished guest speakers include:
INTERNATIONAL
Professor Charles Balch
Professor of Surgery at Johns Hopkins Medical Institutions
Professor Boris Bastian (UCSF)
NATIONAL
Professor John Thompson (Melanoma Institute Australia)
Professor Grant McArthur (Peter MacCallum Cancer Centre)
Professor Graham Mann (MIA, University of Sydney)
Professor Nick Hayward (Queensland Institute for Medical Research)
To register your interest and receive future meeting
announcements please RSVP to: susannah.mcalwey@waimr.uwa.edu.au
August MEDICUS 71

PostgraduateNews
Please forward submissions for Greensheets by 3 October
2012 for inclusion in the November edition.
Contact Jennifer Hughes at: jennifer.hughes@amawa.com.au
Youth Friendly Doctor Training
2012 Program
The Youth Friendly Doctor Program (YFD) seeks to build
the capacity of general practitioners to communicate more
effectively with young people, address the barriers young
people face in accessing health care and promote adolescent
friendly policies, facilities and service delivery. This program
is accredited with the RACGP and attracts Category 1 and or
Category 2 QI&CPD Points.
MODULE 1
Establishing Connection and Conducting Assessments
with Young People
Workshop 1 – Ethics and the Law in Young People
2 October 2012
Workshop 2 – The Psycho Social Wellbeing of Young People
This module has completed for 2012 and will re-run in 2013
MODULE 3
Risk Taking Behaviours and Harm Reductions among
Young People
This module has completed for 2012 and will re-run in 2013
MODULE 4
Eating Disorders in Young People and Their Management
Workshop 1 – Overweight and Obesity in Young People
This module has completed for 2012 and will re-run in 2013
Workshop 2 – Eating Disorders in Young People
This module has completed for 2012 and will
re-run in 2013
MODULE 2
Mental Health Disorders
Workshop 1 – Mental Health Disorders in Young People
Assessment and Treatment
This module has completed for 2012 and will
re-run in 2013
For enquires relating to the YFD program or to enrol in the
workshop visit:
www.amawa.com.au/IntheCommunity/YFDTrainingProgram.aspx
Phone (08) 9273 3000 or email yfd@amawa.com.au
POSTGRADUATE EDUCATION & TRAINING
Date Postgraduate Education & Training Contact Information
11 Sept A-Z of Epistaxis - Suitable for Emergency Department, GPs, Junior Doctors. This session
is designed to provide skills to identify and initiate treatment of epistaxis and to safely
and effectively perform nasal packing and application of nasal splints. Accreditation:
RACGP, NMBA, ACRRM. Venue: The CENTER, 1 Salvado Road, Subiaco
13 Sept Core Skills – Foundation of Minimal Access Surgery: Suitable for Surgical Trainees,
Laparoscopic Assistant in General Surgery, Vascular, Gynaecology, Urology and
Cardiothoracics, metro and rural GPs. Venue: UWA
14 Sept Core Skills – Intermediate Laparoscopic Skills Workshop: Suitable for Surgical Trainees
and Consultants in General Surgery, Vascular Surgery, Gynaecology, Urology and
Cardiothoracics. Venue: UWA
18 Sept Introduction to ENT – Suitable for GPs, junior doctors, medical students.
Accreditation: CME, RACGP, ACRRM, NMBA. Venue: The CENTER, Subiaco, 8 hours.
20 Sept ALS Algorithm and Defibrillation Safety – Suitable for GPs, Medical Officers. The
course will provide interpretation and skills to apply the advanced life support
algorithm and provide safe defibrillation. Accreditation: RACGP, NMBA, ACRRM.
Venue: The CENTER, 1 Salvado Road, Subiaco 4 hours.
www.thecenter.org.au
www.ctec.uwa.edu.au
www.ctec.uwa.edu.au
www.thecenter.org.au
www.thecenter.org.au
20 Sept
The Epidemiology of Injury in Scuba Diving. Presented by Dr Peter Buzzacott –
Research Associate at the School of Sports Science – UWA. Venue: Seminar Room B
Block QE11 Medical Centre Nedlands, 4pm
www.aea.asn.au/localchapters/peg
24 Sept Medical Research Seminar Series – Patenting for medical researchers the ins and outs.
Mr Gary Cox, Chairman, Partner Wray and Assoc. Venue: WA Institute for Medical
Research Seminar Room QE11 Medical Centre, Nedlands 12.30pm – 1.30pm with
light lunch from 12 noon.
24 Sept Creative Therapies for Eating Disorders: Suitable for rural and remote professionals
and GPs. This workshop will explore the use of creative media (art, writing, music,
dance and play) in therapy with individuals with eating disorders.
Venue – PMH: 9am – 1pm
www.liwa.uwa.edu.au
Blanca.PrietoHugot@health.
wa.gov.au
72 MEDICUS August

WESTERN WESTERN AUSTRALIA AUSTRALIA WESTERN WESTERN AUSTRALIA AUSTRALIA
POSTGRADUATE EDUCATION & TRAINING continued
Date
Postgraduate Education & Training
Contact Information
26 Sept Grand Round Education Series 4 – Infectious disease: sick returning travellers from SE
Asia, cellulites and PUO. Venue: RACGP WA faculty.
amy.felton@racgp.org.au
26 -28
Sept
Intervention Pulmonary: EBUS Bronchoscopy and Advanced Bronchoscopic
Techniques. Suitable for Respiratory Physicians and Trainees. Venue: UWA
www.ctec.uwa.edu.au
4 Oct Core Skills – Laparoscopic Upper GI and Bariatric Surgery: Suitable for SET 3 – 5
Surgical Trainees and Consultant General Surgeons. This course will focus on bench
top stapling, live laparoscopic animal workshop, cadaver workshop, laparoscopic
fundoplication and open Roux-en-Y gastric bypass. Venue – UWA: 9am – 6pm
www.ctec.uwa.edu.au
5 - 6
Oct
Anatomy of Complications Workshop– Suitable for Obstetric and Gynaecology
Specialists, Venue: UWA / KEMH
wendy.rutherford@health.
wa.gov.au
22 Oct Introduction to Eating Disorder Training - Part 1: Suitable for rural and remote
professionals and GPs. Provides an introduction to understanding, identifying and
assessing eating disorders, including information on screening, engagement and a
comprehensive multi-disciplinary assessment approach. Venue – PMH: 9am – 4pm
25 Oct Emergency Skills and Crisis Management – Suitable for multi-disciplinary groups from
specialty areas, medical nursing or allied health. Course provides a systematic team
approach to the management of patient critical incidents. Accreditation: CME/CPD,
ANZCA. Venue: The CENTER, 1 Salvado Road, Subiaco
26 Oct The Cutting Edge: Essential Surgical Skills: Suitable for GPs & Nurse Practitioners –
metro and rural. Venue: UWA
29 Oct Medical Research Seminar Series – Advances in type two diabetes. Asst/Prof Vance
Matthews. Venue: WA Institute for Medical Research Seminar Room QE11 Medical
Centre, Nedlands 12.30pm – 1.30pm with light lunch from 12 noon.
29 Oct Introduction to Eating Disorder Training - Part 2: Treatment strategies for the eating
disorder including the roles of different professionals. Provides emphasis on the phases
of eating disorders across time and on stages of motivation for change. Venue – PMH:
9am – 4pm
30 Oct ENT Update – Suitable for GPs and Junior Doctors. The session will provide basis
skills, and techniques in ENT diagnosis, treatment and referral with an overview of ENT
emergencies. Accreditation: RACGP, NMBA, ACRRM, PRPD EM MOPS. Venue: The
CENTER, 1 Salvado Road, Subiaco 8.30am to 4.30pm (8 hours)
Blanca.PrietoHugot@health.
wa.gov.au
www.thecenter.org.au
www.ctec.uwa.edu.au
www.liwa.uwa.edu.au
Blanca.PrietoHugot@health.
wa.gov.au
www.thecenter.org.au
30 Oct-
2 Nov
Doctors Certificate in Sexual and Reproductive Health for Medical Practitioners.
Venue: FPWA Sexual Health Service – 70 Roe St., Northbridge
www.fpwa.org.au
1
2012 AUGUST
EVENT
FEATURE
Coroner’s Court – Lifting the Veil
Wednesday 24 October 2012 Where: AMA (WA) 14 Stirling Highway, Nedlands
Presenters: Gary Cooper (Principal Registrar - Office of the State Coroner)
Janet Harry (Medico-Legal Advisor - MDA National)
This seminar will cover what you need to know about appearing at a coronial inquest from both the perspective of the
Office of the State Coroner and a medical defence organisation.
Doctors – of all specialities – are the most likely of any profession to be called on to give evidence at a coronial inquest.
This event is of particular importance for doctors of all specialities, and especially interns, residents and registrars. The
seminar will explain why you need the support of the AMA or a MDO when appearing before a Coronial inquest.
August MEDICUS 73

CITY TOYOTA NEDLANDS
“Follows Toyota’s Vision, Mission and Values”
The Vision
Most respected and admired company.
The Mission
To deliver outstanding automotive products to our
customers and enrich our community, partners and
environment.
Four Core Values
• Customer first
• Respect for People
• Continuous Improvements & innovation.
• International focus
City Toyota
We apply all of these beliefs
and values in everything we
do and the results follow.
METRO DEALER
OF THE YEAR FOR
4 YEARS IN A ROW
2008 2009 2010 2011
ALL NEW CAMRY AND AURION RANGE
Call Des Winter for your test drive on
9284 8447 or 0448 115 174
CITY TOYOTA NEDLANDS
199 Stirling Highway Nedlands
www.citytoyota.net.au
74 MEDICUS August
MRB693 DL12195

PostgraduateNews
Please forward submissions for Greensheets by 3 October
2012 for inclusion in the November edition.
Contact Jennifer Hughes at: jennifer.hughes@amawa.com.au
WESTERN AUSTRALIA
WESTERN AUSTRALIA
POSTGRADUATE EDUCATION & TRAINING continued
Postgraduate Education & Training
Contact Information
2 Nov Core Skills – ENT Sinus Surgery Workshop: Suitable for RACS Surgical Trainees in ENT –
Junior Consultants and Registrars. Venue: UWA
www.ctec.uwa.edu.au
3 Nov Western Trauma Course – York WATEC@health.wa.gov.au
3 Nov Core Skills – ENT Facial Workshop: Suitable for RACS Surgical Trainees in ENT – Junior
Consultants and Registrars. Venue: Perth
6 Nov Introduction to ENT– Suitable for GPs, junior doctors, medical students. Accreditation:
CME, RACGP, ACRRM, NMBA. Venue: The CENTER, Subiaco 8 hours.
www.ctec.uwa.edu.au
www.thecenter.org.au
17 Nov Western Trauma Course – Esperance WATEC@health.wa.gov.au
22 Nov A-Z of Epistaxis - Suitable for Emergency Department, GPs, Junior Doctors. This session
is designed to provide skills to identify and initiate treatment of epistaxis and to safely
and effectively perform nasal packing and application of nasal splints. Accreditation:
RACGP, NMBA, ACRRM. Venue: The CENTER, 1 Salvado Road, Subiaco
www.thecenter.org.au
Register
your
Interest
11 Sept
18 Sept
25 Sept
IUD and Implanon NXT workshops – Venue: FRWA Sexual Health Services – 70 Roe
St., Northbridge
Open to all General Practitioners
St John of God – Subiaco Hospital Ground Rounds
Dr Martin Chapman (Psychiatry)
Dr Eli Gabbay (Respiratory Medicine)
Mr Patrick Tan (Colorectal Surgery)
www.fpwa.org.au
http://www.sjog.org.au/
hospitals/subiaco click
on ‘Doctors’ tab to find
information ‘For GPs’
Research
Invitation to General Practitioners to join TechWatch to help identify critical incidents involving computer use in
your practice. TechWatch is being conducted by the University of New South Wales and Flinders University and is a
declared quality assurance activity under the Commonwealth Qualified Privilege Scheme.
Join at www.techwatch.unsw.edu.au or call 1800 892 824
2
2012 September
EVENT
FEATURE
A Literary Event with a Medico–Legal Twist
“Mystery as wartime Perth kicks up its heels.’Nedlands
Tuesday 16 October 2012 Where: AMA (WA) 14 Stirling Highway, Nedlands
Presenter: Deborah Burrows (nee Williams) (BJuris, LLB, BA Hons, M.Phil, MSc)
Senior Assistant State Solicitor: State Solicitor's Office
From an author with a rich background in Medical History and presently working as a lawyer in the legal profession
with the State Solicitor’s Office, Deborah Burrows brings to you a passion for crime, history, medicine and the law.
Interested in using your skills and knowledge in a literacy context? Join us for an evening of intrigue. Hear about
the creative process and the importance of medical aspects in a murder mystery. Discover how Deborah has used
medical evidence to help solve a gruesome murder, in her novel based in Nedlands and UWA campus during World
War II. “A Stranger in my Street” weaves murder, mystery and romance.
This event will appeal to aspiring (or established) authors, those with an interest in local history and doctors who
simply enjoy a good read (with a bit of a medical focus).
August MEDICUS 75

PostgraduateNews
Please forward submissions for Greensheets by 3 October 2012
for inclusion in the November edition.
Contact Jennifer Hughes at: jennifer.hughes@amawa.com.au
Conferences and MeetingS
Conferences and Meetings
10–12 Sep Population Health Congress 2012 Venue: Adelaide Convention Centre, SA www.phaa.net.au/pophealth.php
9 - 10 Oct 5th Multidisciplinary Breast Cancer Conference Venue: Mercure Hotel, Perth breastscreenwa@health.wa.gov.au
23-24 Oct Inaugural Melanoma Conference 2012 Venue: Esplanade Hotel Fremantle,
Western Australia
www.melanomaconference2012.
org.au/
3 Nov CTEC: Tropical Medicine and Zoonoses Seminar Venue: Perth www.ctec.uwa.edu.au
18–21 Nov 17th National Prevocational Medical Education Forum Venue: Perth
Convention & Exhibition Centre. The theme in 2012 is “Diamonds and
Pearls: Brilliance and Wisdom in Prevocational Education”.
www.prevocationforum2012.com
24 – 28
Nov
7 -10 Apr
2013
RANZCO AGM & Scientific Congress Venue: Melbourne, Victoria
12th National Rural Health Conference Venue: Adelaide Convention Centre
www.ranzco2012.com.au
http://nrha.org.au/12nrhc/
2012 Events Calendar
The AMA (WA)’s events, seminars and workshops focus on topics of interest and relevance to medical
practitioners and practice managers.
Day Time Title Email
Code
Venue
Sept
Oct
Nov
Tue 4th 6:30pm CV Writing and Interview Skills workshop S AMA (WA), Nedlands
Tue 11th 6:30pm YFD - Eating Disorders in Young People Y AMA (WA) Nedlands
Wed 12th 6:00pm CPR Training for Practice Staff T AMA (WA), Nedlands
Sat 22nd 9:00am CPR Training for members T AMA (WA), Nedlands
Wed 26th 6:00pm Writing Policy and Procedures for your Practice S AMA (WA), Nedlands
Tue 2nd 6:30pm YFD - Ethics and the Law in Young People Y AMA (WA) Nedlands
Fri 12th All Day 2012 Charity Golf Day E Royal Perth Golf Club
Tue 16th 6:00pm A Literary Event with a Medico-Legal Twist S AMA (WA), Nedlands
Sat 10th 9:00pm CPR Training for members T AMA (WA), Nedlands
Wed 14th 6:00pm CPR Training for Practice Staff T AMA (WA), Nedlands
Wed 24th 6:30pm Coroner’s Court – Lifting the Veil S AMA (WA), Nedlands
For more information on 2012 events please visit www.amawa.com.au/membership/events.aspx
Email Code: S – seminar@amawa.com.au
T – traning@amawa.com.au
E – event@amawa.com.au
Y – yfd@amawa.com.au
O – mail@amawa.com.au
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