medicsa oct14 cover final · 2015. 1. 12. · medicsa october 2014 1 australian medical association...

Placing the refugee debate on the health agenda • The Diggers’ DoctorRemembering SA’s war medicos • AMA federal president visits SARegional training networks • AMA(SA) visits Murray Mallee region

M A G A Z I N E O F T H E A U S T R A L I A N M E D I C A L A S S O C I AT I O N ( S O U T H A U S T R A L I A ) I N C .

medicSA

1914 – 2014:The medicine of war

Volume 27 Number 5October 2014

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medicSA OCTOBER 2014 1

Australian Medical Association(South Australia) Inc.

80 Brougham Place, North Adelaide SA 5006

PO Box 134 North Adelaide SA 5006

Telephone: (08) 8361 0100

Facsimile: (08) 8267 5349

Email: [email protected]

Website: www.amasa.org.au

Newland House Meeting Rooms

Telephone: (08) 8361 0102

Executive ContactsPresident

Dr Patricia Montanaro: [email protected]

After hours: (08) 8361 0100

Chief Executive Offi cer

Joe Hooper: (08) 8361 0109

medicSA

Editorial

Editor: Dr Philip Harding

Managing Editor: Heather Millar

Director of Communications: Eva O’Driscoll

Cover image

World War One photograph by Frank Hurley.

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DisclaimerNeither the Australian Medical Association (South Australia) Inc nor any of its servants and agents will have any liability in any way arising from information or advice that is contained in medicSA. The statements or opinions that are expressed in the magazine refl ect the views of the authors and do not represent the offi cial policy of the Australian Medical Association (South Australia) unless this is so stated. Although all accepted advertising material is expected to conform to ethical standards, such acceptance does not imply endorsement by the magazine.

All matter in the magazine is covered by copyright, and must not be reproduced, stored in a retrieval system, or transmitted in any form by electronic or mechanical means, photocopying, or recording, without written permission.

Images are reproduced with permission under limited license.

7Rural healthAMA(SA) visits Murray Mallee regionDr Patricia Montanaro and AMA(SA)CEO Joe Hooper visited the Murray Mallee region in August to give doctors an opportunity to discuss relevant issues directly with the AMA(SA) president.

6

News & viewsAMA co-payment modelto protect the vulnerableAt the request of the Prime Minister, AMA president A/Prof Brian Owler has presented the AMA’s alternative general practice co-payment model which aims to protect vulnerable groups in our community.

11

Cover story1914 – 2014: The medicine of warFrom the health care of refugees and asylum seekers, to remembering the South Australian medicos who have served in past confl icts, this issue looks at medicine and war – now and then.

Contents

3 President’s column

4 News & views AMA on the Ebola crisis; AMA(SA) Training opens doors

4 Editor’s letter Medicine and War

8 Fitness to drive

9 After-hours care

10 Federal president visits AMA(SA)

11 The Digger’s Doctor Book signing at retired

members’ lunch

12 Blood, Sweat and Fears 100th anniversary of RAN victory

13 AMA(SA) dispatches

15 Council news

17 In the media

18 AMA(SA) advocacy

21 Rural health Regional training networks

25 Road safety

26 Coronial inquest

27 Vale Dr David Hill

28 AMSA convention

29 In review

30 Student news

32 In practice

35 Practice notes

36 The schedule

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President’s ReportPatricia Montanaro

Health, budgets and spending

WE have been hearing a lot about budgets for a while now. The federal budget. The state

response. The cost of health and the question of what we can afford – what we should afford. If you ask any member of the public, I don’t think anyone will tell you they don’t want the best health system we can afford. But there has been a lot of rhetoric around what can be sustained, at state and national levels. How does it hold up? The federal Government has justifi ed its extreme health budget measures on the concept that health spending is out of control. But it is not – a fact highlighted in the recent report of the Australian Institute of Health and Welfare. It shows that total national spending on health grew by a record low of 1.5 per cent in real terms in 2012-13, underpinned by a big 2.4 per cent fall in federal government funding. Health’s share of the Commonwealth budget has fallen in the last seven years from more than 18 per cent to 16.1 per cent.

As state health ministers have been quick to point out over the past years, the federal government’s share of recurrent funding for public hospital services has been dropping (decreasing overall from 44.2 percent to 37 percent between 2002-3 and 2012-13). The report also shows that growth in state and territory government funding of health expenditure was relatively low. It grew by just 1.4% in 2012-13, which AIHW indicates is 4.2 percentage points lower than the average growth for the decade. The only jurisdictions to increase the proportion of their revenue spent on health in 2012-2013 were NSW and Victoria. In our state budget, health expenditure has ranged between 29 and 31 percent of total budget expenditure from 2006-7 to 2013-14, and this year sits at 31.4%.

December. There is a sense of urgency as system demand shows its hand, hospital upgrades remain on hold, and the new RAH seems more like a building and less like a building site as the days go by, but fi nding the right answers is no easy task. There is concern that this is more of an ‘in-house’ initiative for the public system under SA Health – a scope that is both limited and limiting, when we know that many of the challenges, and solutions, lie in the broader picture, which includes movements across the system.

To move away from budgets and their repercussions, there is plenty else going on, from competing bills to establish a (long overdue) Commissioner for Children and Young People; to WorkCover reform; dialogue about the new RAH’s ED model; an inquiry into co-morbidity; and the abolition, reformation or merging of a raft of government boards and committees. While some may be quite content to go their own way, there are signifi cant and unanswered questions about what lies ahead for SA MET (SA Medical Education and Training) and other Health Advisory Councils.

The SA Health Practitioners Tribunal is to transition to the SACAT ‘super tribunal’ but the Medical Board is to stay. Concerningly, the Health Performance Council is on the ‘abolish’ list. Established to provide independent reporting on health system performance, it is just coming to release its second four-yearly system report. For those interested in just how we are doing, it may well make interesting reading. These are some of the things on our desk now, but you will fi nd more in these pages, and in the Voice. If there is something else you think we need to look at, let us know – and for those of you working in the Riverland, we look forward to seeing you soon when we visit later this month!

Meanwhile, state budget measures such as the McCann review cuts continue to hurt.

In terms of the international picture, in 2012-13 we spent just 9.67 percent of GDP on health, and we have a very good health system to show for it. Unfortunately though, it is still a system that fails some. We have work to do, and that work is only hampered, not helped, by retrograde budget measures. I don’t need to tell you that our system is already under signifi cant pressure. We should be talking about how to improve our health system, not where to cut. We need better co-ordination of services, and better ways of doing things – supported by clinical leadership and less bureaucracy. We need to work smarter, and we need to talk about the right reforms, not shaping the answer to fi t the cuts.

At a state level, the premier has commissioned a study into the federal budget’s impacts on SA, undertaken by the Australian Workplace Innovation and Social Research Centre. It presents some striking statistics, including indicating that more than 265,000 (29.4 percent) of SA families will be worse off in 2017-18 as a result, fl agging that the impact will, in most cases, be felt most profoundly by those on low incomes. This further reinforces the AMA’s concerns about health impacts of the budget for those who are among the most vulnerable. The AMA will be continuing to call for the right health and reform conversations, and for our state and federal governments to step up to what is needed.

Meanwhile, the inward-looking ‘transforming health’ movement is proceeding with, at the time of writing, a discussion paper pending, and the mooted summit now looking like

4 medicSA OCTOBER 2014

AMA(SA) CouncilOffice Bearers

President: Patricia MontanaroVice President: Janice Fletcher

Immediate Past President

Peter Sharley

Ordinary Members

Chris Moy, Tarun Bastiampillai, Matthew McConnell, Clair Pridmore, David Sainsbury, David Scrimgeour, Paul Worley, Emma Rischbieth

Craft Group Representatives

Anaesthetists: Margaret CowlingGeneral Practitioners: Chris Clohesy Obstetricians and Gynaecologists: Stephen LanePaediatricians: Andrew KellyPathologists: Heather CainPhysicians: William TamPsychiatrists: Michelle AtchisonRadiologists: Nicholas Rice Surgeons: David WalshEmergency Medicine: Hendrika Meyer

Doctors in Training Representative

Tom Crowhurst

Regional Representatives

Northern: Nigel Stewart, John WilliamsSouthern: Peter Tait, Trevor Hodson

Salaried Medical Officers’ Representative

Andrew Russell

Student Representatives

University of Adelaide: Alyssa ParsonsFlinders University: Nick Stock

AMA(SA) Executive Board

Trevor Mudge (Chair), Margaret Cowling, Janice Fletcher, John McLaren, Patricia Montanaro, Peter Sharley, William Tam

AMA(SA) Office: Key Contact

Chief Executive Officer: Joe Hooper

Federal Councillors

Patricia Montanaro (State Nominee)Chris Moy (Area Nominee SA/NT)Susan Neuhaus (Craft Group Nominee: Surgeons)

The AMA(SA) office is located at 80 Brougham Place, North Adelaide.You can contact us by telephone on (08) 8361 0100, by fax to (08) 8267 5349 or email to [email protected].

Millions at risk if Ebola not brought under controlAMA president A/Prof Brian Owler has called on the Federal Government and the rest of the international community to do more to combat the spread of Ebola in West Africa.

AS this issue of medicSA went to press, the US Center for Disease Control and Prevention released estimates that there could be up to 1.4 million cases of Ebola in Liberia and Sierra Leone alone by the end of January 2015. The World Health

Organisation has described the worsening crisis as “unparalleled in modern times”, and warned Ebola could become endemic to the region.

The UN Security Council has passed a resolution declaring the outbreak to be a threat to international peace and security – only the second such declaration it has made about a health issue.

The CDC reported that, as of 8 October, there had been 8400 cases and 4033 deaths.

In its response, the US has despatched 3000 troops to Liberia to build 17 Ebola treatment units, provide logistical and engineering support for health teams, and to establish facilities to train up to 500 health workers a week to combat the disease. It has so far committed $US175 million to the effort.

So far, Australia has committed $8 million, including $2.5 million to each of the WHO and Medicins Sans Frontieres.

But A/Prof Owler said much more was needed, both from Australia and the international community. “What we’re witnessing is an evolving humanitarian tragedy of unprecedented proportions,” he told ABC News Radio. “This is the sort of thing of Rwandan proportions – different reason, obviously, but you can see this evolving.”

He said the Government had demonstrated through its actions in northern Iraq its ability was to deploy resources far away from Australia, and a similar effort was needed in West Africa.

He said Australia needed to provide, equip and staff mobile hospitals and treatment centres, as well as support the work of other organisations, such as the Red Cross.

He said Australian doctors and nurses were already on the ground and more were willing to volunteer to help combat the outbreak, but the country needed to provide them with the resources and support they needed.

Evacuation direct to Australia is considered nigh on impossible, given the 30-hour fl ight time involved and the complexity of arrangements that would be required to bring it about, and Foreign Minister Julie Bishop has warned any health workers travelling to the region that the Government did not have the capacity to evacuate them in case of infection. But A/Professor Owler said the Government should negotiate evacuation arrangements with other countries that are also sending health workers.

This article was written by Adrian Rollins for Australian Medicine, 30 September 2014 ©

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Medicine and War – a process of evolution

AS this issue goes to press, the talk is all about war. Wherever there is war, there is destruction, suffering,

injury, disease and death; and hence the involvement of medical personnel. In this issue, we feature a number of recent books and events which, taken together, refl ect the changing role of our profession in caring for the victims of confl ict as the nature of war has evolved over the past 100 years. In the fi rst truly global war, which began in 1914, some 16 million people lost their lives – 10 million of these military personnel, mostly killed in battle. The new book Blood Sweat and Fears (p12) contains accounts of SA medicos who confronted that awful death and injury toll. Another upcoming publication, an initiative of AMA(SA), is the South Australian Medical Practitioners War Memorial Book (p19) which lists SA doctors who served overseas in confl icts from 1899 to 1975, accompanied by the magnifi cent photography of Frank Hurley including the one so graphically depicting the horror of WW1 on medicSA’s cover. As we know, later generations of military doctors have been supported by better treatments and faster retrieval. Some of these had occurred by the time of the Korean War in which our life member Dr Donald (Doc) Beard served, as described in The Diggers Doctor (p11).

Of the some 60,000 Australian military personnel killed in WW1, the very fi rst was a medical offi cer (p12); and with equal irony, his death occurred on 11 September 1914, 87 years to the day before the event which can unequivocally be described as starting the ‘War on Terror’ which has occupied the past 13 years of this century of confl ict – and which is coming to develop a disturbingly global perspective. The main victims of this war are the tens of thousands of displaced persons and refugees, including some of those, including children, who are confi ned in our detention centres and who need treatment of a sort which could not have been envisaged by military doctors 100 years ago (p23-24).

Editor’sLETTER

5medicSA OCTOBER 2014

AFTER a lengthy process of establishing the business of the AMA(SA) Registered Training Organisation (RTO) the training outcomes we have long been waiting for have started to eventuate.

AMA(SA) Training is proud to offer the opportunity to enrol in quality nationally recognised training to enhance your professional development. We offer Vocational Education and Training (VET) in Practice Management, Health Administration, Disability, Leisure and Health, Management, Aged Care, and Home and Community Care.

On Tuesday 16 September, the initial Induction/Information session was conducted at AMA(SA) Training for the fi rst 10 students, all of whom followed up the session with a commitment to begin training.

During the program the students were introduced to our Course Ambassador Vicki Linden and our Training Coordinator Michelle Cockshell. Enthusiastic conversations were started around student induction and formats of fl exible delivery.

Inserted in this issue of medicSA is the AMA(SA) Training brochure. For further details on courses available and student information, go to www.amasatraining.org.au or contact Michelle Cockshell, Training Coordinator on 8274 6058 or [email protected].

AMA(SA) Training opens the door to new students

Students at AMA(SA) Training’s initial Induction/Information session.

IN August 2014, Professor Justin Beilby resigned from his position as Executive Dean of the Faculty of Health Sciences at the University of Adelaide.

“After coming to the diffi cult decision to step down as Executive Dean after more than 10 years leading the Faculty and over 35 years association with the University” Prof Beilby said, “now is the right time for me to return to my roots in clinical practice and focus my efforts on the local and national health reform agenda.”

Prof Beilby went on to mention some of his proudest achievements in the position – “fi nally securing the signifi cant capital works and infrastructure to support Health Sciences for the long-term at the University including the new Adelaide Medical and Nursing School within the South Australian Health and Biomedical Precinct in the West End; and the fact that the Faculty’s research output is now leading the University.”

The AMA(SA) would like to thank Prof Beilby for the many years of hard work and commitment he gave to the medical education, health research and training fi eld.

Professor Alastair Burt has taken on the role of Acting Executive Dean.

Prof Justin Beilby moves on


ON the release of the model in late August, AMA president, A/Prof Brian Owler called

on the Government to dump its seriously fl awed GP co-payments proposal and adopt the AMA model, which exempts the most vulnerable patients from extra cost burdens for their health care.

A/Prof Owler said the AMA has vigorously opposed the Government’s proposal since Budget night and has worked to produce an alternative model that is fairer and more equitable.

“The AMA has produced a health policy, not an economic policy,” A/Prof Owler said.

“Our model is based on the realities of day-to-day medical practice, and our objective is to provide higher quality primary care for all Australians.

“The AMA co-payment model protects vulnerable patients in the community, values general practice to encourage quality care and support prevention and chronic disease management, and it also sends a price signal for non-concession patients.

“We propose a minimum $6.15 co-payment (which aligns with the current bulk billing incentive) that applies to all patients, but the Government will pay the co-payment for concession card holders and patients under 16 years of age.

“Under our model, there will be no cut to the Medicare patient rebate, and there is an incentive for general practices to collect the co-payment.

“The AMA has long supported well-designed and well-intentioned co-payments, and that is what we are releasing here.

“Co-payments already exist. About 20% of GP visits currently attract a co-payment.

AMA alternative model protects vulnerable patients from co-payment painThe Government’s Budget proposal for a general practice co-payment has been universally condemned since it was announced. At the request of the Prime Minister, the AMA developed an alternative co-payment model which has now been released. It aims to protect vulnerable groups in our community while suggesting that, where people can afford to contribute to the cost of health care, they should do so.

“The AMA co-payment model allows GPs the opportunity to spend more time with their patients, provide preventive health care and chronic disease management, and place a value on the essential service they provide.

“It maximises the benefi ts of high quality primary care in general practice, keeping people well, and keeping people out of more expensive hospital care.

Our model is based on the realities of day-to-day medical practices, and our objective is to provide higher quality primary care

“We are confi dent that our co-payment model will stimulate robust debate in the community, in the political arena, and in the health sector, and remind the Government of the unfairness, inequity, and electoral unpopularity of its Budget co-payment proposals,” A/Prof Owler said.

The full model is available at: ama.com.au/media/ama-model-protects-vulnerable-patients-co-payment-pain

AMA co-payment: how it would work• No cut to Medicare rebate

• Practitioners free to set own fee

• $6.15 co-payment would apply to most GP services

• Government would pay co-payment on behalf of children younger than 16 years and concession card holders

• Co-payment would not apply to: residential aged care and home visits, chronic disease management services, health assessments, mental health treatment items

• Two-year delay on co-payment for pathology and diagnostic imaging services, pending consultation and review

• The inclusion of the co-payment in Medicare Safety Net calculations

• A1 rebates for general patients linked to the application of the co-payment

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AMA(SA) president and CEO visit Murray Mallee regionDr Patricia Montanaro and AMA(SA) CEO Mr Joe Hooper visited the Murray Mallee region in September, to meet with local doctors and speak with them about the challenges faced with delivering medical services in this region of South Australia.

DR Montanaro and Mr Hooper’s itinerary included visits to a number of general practice

clinics as well as hospitals in Mount Barker and Murray Bridge.

Murray Valley Standard’s Peri Strathearn reported that Dr Montanaro said Mannum doctors were concerned about the impact of the government’s proposed GP co-payment fee on marginal and marginalised patients, and the most vulnerable.

They also emphasised the importance of the Patient Assistance Transport Scheme, expressing their concerns

about funding, and wanted clarity around changes in government policy.

Doctors also wanted to make sure the health system was sustainable, suitably skilled and prepared to deal with the devastating effects of unemployment or natural disasters on their patients.

Dr Montanaro criticised the Federal Government for its failure to provide enough health funding, and also said that buck-passing between levels of government and departments within SA Health needed to stop.

She also emphasised the importance of encouraging country students to study medicine.

The AMA(SA) will visit the Riverland in the coming months to visit some of the practices, along with the Riverland General Hospital.

“I’m sure that we’ll visit Barmera, Berri, Renmark, Loxton and some of the smaller areas,” she said.

“The Berri Hospital redevelopment is something I’ve seen a number of times and I’m keen to see some of those facilities up and working.”

Photo: Courtesy of the Murray Valley Standard

L-R: GPs Peter Rischbieth, David Butler and Martin Altmann, Dr Patricia Montanaro, Bridge Clinic practice manager Jill Coombe and Joe Hooper.


THE Department of Planning, Transport and Infrastructure (DPTI) advises that drivers who

hold a car (C class) driver’s licence only and do not have a medical condition are no longer required to have an annual medical assessment completed by their doctor. The Department has indicated that other fi tness to drive requirements have not changed, and advises the following:

• Drivers are required to submit an annual medical assessment to retain a Motorcycle (R or R-date), Light Rigid (LR), Medium Rigid (MR) or Heavy Vehicle driver’s licence from the age of 70 years, due to the increased road safety risks driving these vehicles poses.

Changes now in effect for older driversChanges to medical fi tness to drive assessment requirements for some drivers 70 years and older came into effect in September. The Department of Planning, Transport and Infrastructure has indicated that other fi tness to drive requirements have not changed.

• Drivers with a medical condition recorded against their licence, irrespective of their age, will still need to submit a medical assessment in accordance with the review period outlined in the National Transport Commission Fitness to Drive Guidelines, available at austroads.com.au > Drivers and vehicles > Assessing fi tness to drive.

• All drivers, regardless of age, are required by law to report any medical condition that could affect their ability to drive safely.

• Health professionals are required to notify the Registrar of Motor Vehicles when a patient is diagnosed with a medical condition that requires regular medical assessment which may affect their ability to drive.

Those people who are no longer required to submit a medical assessment will no longer be sent a Certifi cate of Fitness form to complete. If a patient attends a medical practice with a Certifi cate of Fitness they have received in the mail, it must be completed and returned to Service SA, GPO Box 1533, Adelaide SA 5001.

We are advised that the Minister for Road Safety is continuing to consider future measures to ensure road safety is not eroded by the changes that came into effect on 1 September. More information is available at mylicence.sa.gov.au > Safe driving tips> Medical fi tness to drive.

For more information from the AMA(SA) on fi tness to drive, go to ama.com.au/sa/medical-tests-older-drivers.

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THE federal AMA has told Professor Claire Jackson, who is heading a Government-appointed review

of after-hours primary health care, that recent reforms to the provision of after-hours services have been a failure and there should be a return to incentives and targeted funding to assist GPs in providing such a vital service for their patients.

Health Minister Peter Dutton has commissioned the review amid widespread dissatisfaction within the medical profession about the previous Labor Government’s decision to hand responsibility for contracting and coordinating after-hours GP services to Medicare Locals, which are now set to go.

Chair of the AMA Council of General Practice Dr Brian Morton said recently

Round-the-clock GP care needs right supportThe AMA has urged the Federal Government to reinstate direct incentive payments to support general practices providing after-hours services.

that the botched handling of after-hours services by Medicare Locals had not only increased red tape and compliance costs, but had discouraged many GPs previously committed to providing after-hours care for their patients.

Presenting the AMA’s submission to Professor Jackson, AMA president A/Prof Brian Owler said the review was an important opportunity to undo recent policy failures and develop ways to strengthen and support the role of GPs in providing round-the-clock care for their patients.

“Cutting the direct PIP payments to general practices was a big mistake,” A/Prof Owler said. “It created a clumsy new layer of bureaucracy with Medicare Locals responsible for channelling the funding to after-hours service providers.

“Australia cannot afford to repeat the failed Medicare Local experiment with after-hours incentives, otherwise we will go down the same track as the UK, where general practice has largely walked away from responsibility for after-hours care,” he said.

A/Prof Owler said the review should consider the need for a higher rebate for after-hours services in rural and remote areas to refl ect the higher cost of attracting and retaining staff and operating facilities.

He also suggested that video consultations could be used more extensively to provide after-hours care in rural and remote areas.

The Jackson review is to be submitted to the Minister by 31 October. Questions and comments can be sent to [email protected]

news & views


ON 7 August, the AMA(SA) was pleased to welcome federal AMA president A/Prof Brian Owler

and Secretary General Anne Trimmer to Newland House.

Firstly, they met with Premier Jay Weatherill and Health Minister Jack Snelling to discuss the state-level perspective on public hospital funding cuts. AMA(SA) president Dr Patricia Montanaro and CEO Joe Hooper also attended.

A/Prof Owler then met with the Road Safety Committee (see report on page 25). Road safety is a topic close to

Federal AMA president visits AMA(SA)’s Newland House

(Top L-R) A/Prof Brian Owler, Premier Jay Weatherill, Dr Patricia Montanaro, Health Minister Jack Snelling

(Bottom) A/Prof Brian Owler, with the AMA(SA) Road Safety Committee (L-R) Dr Phil Harding, Dr Bill Heddle, A/Prof Brian Owler, Dr Patricia Montanaro, Dr Monica Moy, Dr Rob Atkinson

A/Prof Owler’s heart – he is the public face of the ‘Don’t Rush’ program in NSW aimed at reducing road trauma. In fact, the AMA(SA) is the only AMA branch to have its own dedicated Road Safety committee, so A/Prof Owler was very keen to meet with them.

A/Prof Owler then attended the AMA(SA) Council meeting in the evening. He spoke to Council on the AMA intervention in NSW on immunisation policy, the AMA proposal on co-payments, the new AMA Federal Council structure and a range of other topics (see Council News on page 16).

THE Commonwealth Club of Adelaide is holding a luncheon on Friday 7 November at the Adelaide Oval, Ian McLachlan Room West. The speaker is

Dr Brendan Nelson on ‘The Centenary of the First World War – the telling of our Story’.

Dr Nelson is director of the Australian War Memorial. Prior to this he was the Australian ambassador to Belgium, Luxembourg, the European Union and NATO.

Apart from overseeing a major transformation in Australia’s relationships with the European Union and NATO, Dr Nelson forged deep links with the communities of Flanders, where almost 13,000 Australians lost their lives during the First World War.

Dr Nelson was federal president of the AMA from 1993-95. He was subsequently elected to the federal Parliament of Australia. He became Minister for Education, Science and Training, then Minister for Defence when troops were deployed to Iraq, Afghanistan, East Timor and the Solomon Islands.

In 2007 Dr Nelson was elected leader of the Liberal Party of Australia, serving as Leader of the Opposition until September 2008 when he retired from politics and took on his ambassadorial appointment.

Dr Nelson has received many honours, including the AMA’s Gold Medal for ‘Distinguished Service to Medicine and Humanity’.

Bookings required by 2 November. Tickets are $45 each. To book call (08) 8265 2855.

Dr Brendan Nelson speaks at Commonwealth Club on centenary of WW1

AMA(SA) extends partnership with Commonwealth BankAMA(SA) has extended its partnership with Commonwealth Bank.

In addition to offering members Wealth Package Plus: Premier Broking and investment products as well as home lending, we have negotiated new special rates for EFTPOS services and can arrange for one of their Business Bankers to talk to you about:

• day-to-day banking including business accounts and merchant facilities

• funding options including business credit cards, asset fi nance and commercial loans

• insurance

• fi nancial planning.

These products can help you manage cash fl ow and risk, and help you expand your business.

This package is not available via the CBA Branch network. Members should contact the AMA(SA) on (08) 8361 0101 for further details and other great offers.

news & views


news & views

Date: Friday 14 November 2014, 6-9pm

Venue: College House, 15 Gover Street, North Adelaide, SA

Register by: Friday 31 October 2014 using the booking

form at ama.com.au/sa/christmas-party

Please note that there are limits on places so RSVP as early as possible to avoid disappointment.

the racgp sa&nt

faculty and ama(sa)

are delighted to invite members

and their families to attend the …

The night will also honour the recipient

of the McCleave/Thompson Award.

Complimentary tickets include:• delicious food and a variety of wines, donated

by winedirect.com.au

• door prizes, donated by the RACGP SA&NT

Faculty and AMA(SA)

• a special appearance by Santa Claus

(including free photos for children)

• an assortment of children’s entertainment

• music and much more!

Christmas party!Christmas party!

2 0 1 4

members’

The Diggers’ Doctor: book signing at AMA(SA) luncheonOn 10 November in the SACA Room at the Adelaide Oval, AMA(SA) past presidents, retired members and life members are gathering for their annual luncheon. They will have the opportunity to meet or re-aquaint themselves with Dr Donald Beard AM and Ashley Mallett, author of The Diggers’ Doctor – a book about the life of Dr Beard, who will be attending the luncheon for a book signing.

IN launching the book in June, General Sir Peter Cosgrove AK MC, govenor-general of Australia, said:

“His role as a doctor tending to soldiers in combat in Korea is a byword in the Australian Army. At the Battle of Kapyong in 1951 his inspirational care and leadership contributed to the love the soldiers had for this strong man of peace and compassion.

“His invariable good humour, stamina and great professional skill made him a wonderful role model for further generations of medicos in uniform. I am delighted that one of Australia’s great cricketers is writing about the Doc, one of nature’s gentlemen.”

Don Beard – ‘the Doc’ – is a familiar and much-loved fi gure at cricket grounds around Australia and the world.

“At all Sheffi eld Shield matches staged at Adelaide Oval, Dr Beard was a

regular visitor to our dressing-room,” writes Ashley Mallett in the book.

“Then early in the year of 1968, the Doc seemed to go missing. We soon learnt the reason for his absence that summer. The Doc, also a Colonel in the Australian Army, had gone back to war.”

Ashley Mallett is a former Test cricketer. His ambition was to take 100 Test wickets, a feat he achieved in his 23rd match, along with Shane Warne, Glenn McGrath and Graham McKenzie. Away from the cricket scene, Ashley teaches ‘Write Biography’ in Adelaide. The Diggers’ Doctor is Ashley’s 32nd book.

“What makes Ashley’s book all the more fascinating are its insights into Don’s childhood, his early career, his family, his friends and the extraordinary experiences he has had in all facets of his life along the way,” said Sir Peter.

We have two copies of The Diggers’ Doctor to give away. If you would like one, email your details to [email protected] or call 8361 0101

L-R: Dr Don Beard, General Sir Peter Cosgrove and Ashley Mallett


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BLOOD, Sweat and Fears: Medical

Practitioners and Medical Students of South Australia who served in World War 1 by Christopher

Verco, Annette Summers, Tony Swain and Michael Jelly contains over 200 biographies of SA doctors and medical students who served in the Great War.

The book was launched by His Excellency Rear Admiral the Honourable Kevin Scarce AC CSC RANR, then Governor of South Australia. His Excellency told over 150

Remembering the SA medicos who served in the Great War A new book, Blood, Sweat and Fears, which recognises the SA doctors and medical students who served in World War 1, was launched on 1 August 2014 at Keswick Barracks; meanwhile on 11 September, the Naval Association of Australia (SA section) held a Garden Memorial Service to commemorate the 100th Anniversary of the RAN action at Bita Paka.

guests “the book identifi es a remarkable group of men and women ranging from 65-year-old Professor Archibald Watson, the charismatic Professor of Anatomy at the University of Adelaide, to 18-year-old medical students.”

At the Garden Memorial Service held in the Naval Memorial Gardens, Peace Park, in North Adelaide on 11 September to commemorate the 100th Anniversary of the RAN victory at Bita Paka, attendees were invited to place either a fl oral tribute or a book on the plinth.

It was fi tting then that a copy of Blood Sweat and Fears was placed on a

plaque at the service by Brig (Rt’d) Rob Atkinson AM RFD, Representative Colonel Commandant, Royal Australian Army Medical Corps.

The assault on the Bita Paka wireless station in New Britain on the 11 September 1914, was the fi rst military action by Australian servicemen in World War 1. The fi rst casualty was a Naval Rating, the second an Army Medical Offi cer who unfortunately was the fi rst to die.

We have three copies of Blood, Sweat and Fears to give away. If you would like one, email your details to [email protected] or call 8361 0101.

news & views


AMA(SA) dispatchesCalling on AMA(SA) cricketing members!The South Australian Indian Medical Association and the AMA(SA) are looking to hold a combined cricketing event – with a match and a lunch. AMA(SA) members with an interest in cricket are invited to consider participating in an inaugural cricket match to take place to coincide with the Indian cricket team visiting Adelaide as part of the 2014-15 international season.

To register your interest, or for more information, contact Claudia on 8362 0109 or email [email protected].

Melbourne Cup Lunch is back!AMA(SA) members and their guests are invited to another special joint Melbourne Cup Charity Luncheon – but if you have not yet booked don’t delay – as we go to print, there are limited tables left. The luncheon is held in conjunction with the Law Society of South Australia and Chartered Accountants Australia and New Zealand. Join us on Tuesday 4 November, 12 noon – 5pm, Adelaide Oval Cathedral Room, Eastern Stand. Contact Melanie on 8361 0108 or [email protected].

2015 AMA(SA) Gala Dinner – Have you a charity to suggest?The AMA(SA)’s 2015 Gala Dinner will be held on Saturday, 9 May 2015. Save the date and gather your friends and colleagues for a great night. The AMA(SA) is also considering which South Australian charity to support – if you would like to nominate a charity, please contact Claudia on 8361 0108 or [email protected].

AMA(SA) and RACGP Christmas PartyThe AMA(SA) and RACGP will again be joining together for a Christmas celebration on Friday 14 November. Members of the AMA(SA), RACGP and their families are welcome. For registration details, see ad on page 11.

Our updated Privacy PolicyWe have updated our privacy policy to ensure it is up to date and meets the needs of the new privacy legislation. You can fi nd it on our website at ama.com.au/sa/amasa-privacy-policy. Any members with questions are welcome to contact us.

Past presidents, retired members and life members luncheonRetired members and life members of the AMA(SA) are warmly invited to attend the AMA(SA)’s annual Members’ Luncheon. There will be a book signing with Dr Donald Beard AM and Ashley Mallett, author of The Diggers’ Doctor (see page 11). This event will take place at the SACA Room at the Adelaide Oval on Monday 10 November 2014. To register, contact Melanie on 8361 0108 or email [email protected].

Volunteer sought – to help save the memories of some of our great medicosThe AMA(SA) Historical Committee is seeking volunteer support to review back editions of medicSA and its precursor the

SA Medical Review, and collate obituaries from them, in order that the AMA(SA) can maintain an electronic register of obituaries of SA medical practitioners. To fi nd out more, email [email protected].

Final AMA(SA) Council Meeting for 2014The AMA(SA) Council meets nine times a year. Meetings of Council are open to members. The fi nal Council meeting date for 2014 is Thursday 4 December. Any member wishing to attend should contact Claudia Baccanello on 8361 0109 or email [email protected].

Retiring?Don’t retire your AMA membership … Retired members can access all the benefi ts of membership for just $318 per year, including:

• 25% off Qantas Club membership

• free subscription to MJA and medicSA

• special travel offers

• a wide range of Ambassador Card discounts and special offers on accommodation, dining and leisure activities.

To renew your membership as a retired member, contact Melanie on 8361 0108 or email [email protected]

Help sought for new AMA book honouring SouthAustralian doctors who served during past confl icts

The Historical Committee of the AMA(SA) has almost fi nished compiling a book to honour all SA medical practitioners who served Australia during past confl icts. It comprises lists of medical practitioners who have served overseas from 1899 to 1972. It has been illustrated with photos, and also features three poems and a history of the project. The lists are on the AMA website at ama.com.au/sa/war-service.

Your help is sought to ensure the records included in the book are as complete and accurate as possible. Please peruse the list and advise any queries or corrections to the AMA(SA) Historical Committee Chair Dr Trevor Pickering at [email protected] or call the AMA(SA) offi ce to leave a message for Dr Pickering on 08 8361 0101.

dispatches

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AMA(SA) Council NEWS

Dr Andrew RussellCouncillor

THE council meeting of August 2014 was well attended, with the stars of the show new federal

AMA president Brian Owler and secretary general Anne Trimmer.

The meeting began with a discussion of the new Royal Adelaide Hospital (nRAH). Service planning has at last begun and the clinical leadership appointed. There is to be a patient-centred model of care with the nRAH to focus on acute care and The Queen Elizabeth Hospital (TQEH) complex and elective care, with implications for delivery of ICU and ED service.

Next on the agenda was the Federal Budget, with headline issues of GP

AMA(SA) Council MeetingAugust, 2014

co-payments and the implications of the Federal budget for hospital funding in South Australia.

This was followed by EPAS, the whole of health electronic medical record system already introduced at the Noarlunga Health Service, Port Augusta and RGH with the RAH next in line in preparation for its use in the nRAH. TQEH will need some level of access for conjoint records and shared patient care.

The Department of Health has established state wide change implementation committees based on Nursing, Allied Health and Medical streams. One concern expressed is that all committee members are drawn from SA Health rather than a more broad range. In particular, primary care and general practice are not represented.

Our president Dr Patricia Montanaro and CEO Joe Hooper have been very busy

with visits to regional centres. They also reported on Ministerial meetings that discussed ED crowding, lack of surge capacity and ‘ramping’. Intern numbers are confi rmed in the short term with local graduates to get full internships to 2015.

The agenda then moved to public health and the fragmentation seen in the management of environmental health problems, for example with TCE at Clovelly Park and ‘fracking’ in the South East and possible resultant pollution.

A/Prof Owler spoke about a range of topics including the AMA intervention in NSW on immunisation policy, the GP co-payment, medical fees, AMA Public Health position statements, and GP training. He fi nished with the issue of some specialist training schemes potentially trading away hard fought industrial agreements and the new AMA Federal Council structure.

Dr Margie CowlingCouncillor

COUNCIL was updated on the current state of EPAS (Enterprise Patient Administration System) by

Ms Margot Mains who has only recently moved from the position of Executive Leader of EPAS; and Mr Rhys Parker and Dr Sepehr Shakib, Director of Clinical Pharmacology at the RAH, who both act as EPAS adoption managers for SA Health.

There are currently seven sites and 4600 staff using EPAS but, since June, further roll-out of EPAS has been suspended while problems are evaluated. When the system is deemed stable enough it will then be slowly introduced to new sites. The use of EPAS in the new RAH is essential.

AMA(SA) Council MeetingSeptember, 2014

Dr Richard Heddle, Gastroenterologist from RGH, provided his personal view of the system and then Councillors who had worked with EPAS provided feedback. Among problems identifi ed were inconsistent reporting of pathology results, billing diffi culties with private patients, outpatient booking issues and the management of adverse events arising from the system.

Dr Trevor Mudge, Chair of the AMA(SA) Executive Board, reported to Council on the Board’s activities. He stated that the fi nancial position of AMA(SA) remains sound.

As previously reported, the AMA(SA) has now established a nationally accredited Registered Training Organisation. The fi rst of the certifi cate courses offered by the RTO will be run this month. Funding for the courses varies from student payment to grants that are available from the state and federal governments.

The Board and the Council have approved the Doctors in Training proposal for an enhanced DiT presence in social media. The content on the site will be carefully monitored and the use of the site in general evaluated after six months. It is hoped that adoption of this modern approach of communication will result in more DiTs engaging with the AMA.

Regularly at Council meetings Councillors are asked to raise any issues that are relevant to their craft group. Of interest among the points raised were the coming into effect of the Advanced Care Directives Act 2013 on 1 July and important changes to the Consent Act. Members are encouraged to read the changes available on the SA Health website. There are implications regarding the obtaining of consent for treatment in all situations where a person has impaired decision making as well as increased protections in emergency situations and changes in obligations when caring for the dying.

council news

heading


T H E L A W S O C I E T YO F S O U T H A U S T R A L I A


in the media

Top to Toe: The SinusesDr Patricia Montanaro discussed the wonders of the sinuses with ABC Radio ‘Afternoons’ presenter Annette Marner on 29 September 2014.

Rural doctors need clarity, fundingMurraylands doctors are concerned at the pace of change to their sector, AMA(SA) president Dr Patricia Montanaro told the Murray Valley Standard on 18 September 2014 (see page 7 for full story).

AMA offi cials to visit RiverlandOn 17 September, ABC Riverland Radio reported that Dr Patricia Montanaro, and CEO Joe Hooper will visit the Riverland in the coming months to talk to local doctors, and that they had just completed a similar visit in the Murray Mallee region.

Stress less Dr Patricia Montanaro discussed stress with National Pharmacies magazine Vital Health journalist Katie Langmore in September.

AMA(SA) in the newsThe AMA is often in the news, on topics as varied as health itself. Below is just a small snapshot of some of our recent media comment from the past month.

Talking country health AMA(SA) president Dr Patricia Montanaro discussed country health on 16 September 2014 with ABC Regional ‘Afternoons’ presenter Annette Marner and Narelle Graham on ‘Riverland Today’ in the wake of her recent trip to the Murray Mallee.

More beds at our hospital On 10 September 2014, Leader Messenger journalist Erin Jones reported on new rehab beds at Modbury (moved from Hampstead and with new facilities). Dr Patricia Montanaro said the AMA(SA) would continue to question the Government on what the reconfi gurations would mean for health.

ED overcrowding Dr Patricia Montanaro spoke on emergency department overcrowding, dashboard fi gures, bed block issues and the fl u on the 5AA news on 10 September.

Older drivers On 3 September 2014, A/Prof Rob Atkinson of the Pedestrian Council of Australia, RACS and the AMA(SA) Road Safety Committee commented on Channel 9 News on the SA government’s

proposal to scrap annual drivers’ license medical tests for over 70s who do not have a medical condition and replace it with annual self-assessments for those over 75. He said that a national approach would be of benefi t and that “if it impacts well then we take the evidence forward”.

Fitness to drive On 3 September 2014, Dr Patricia Montanaro discussed fi tness to drive with Leon Byner on 5AA.

Find out more about AMA(SA) media comment at ama.com.au/states/south-australia/media and national comment at ama.com.au/media

North Adelaide Hospital


advocacy

WorkCover reforms advanceIn August the State Government introduced into Parliament what it has described as “the most signifi cant reform of workers’ compensation in more than 25 years”. The Return to Work Bill is proposed to replace the old WorkCover scheme with an entirely new Act which the government claims will save registered businesses in SA more than $180 million per year.

Deputy Premier and Attorney General John Rau, who has spoken strongly against the current scheme, which he says “fails to help too many of the people it was designed to assist” has said that under the new scheme 94 per cent of injured workers would see an increase in benefi ts or be no worse off than under the current scheme.

The Return to Work Bill and accompanying South Australian Employment Tribunal Bill (which would establish a tribunal to review certain decisions arising from the new scheme) were passed through the House of Assembly in September and are, at the time of writing, with the Legislative Council.

The AMA(SA) supports early assessment of claims to allow timely treatment and therefore support return to work. Any restrictions on payments must not be such that they go against the objective of early assessment and treatment by creating fi scal barriers. The AMA(SA) and RANZCP have also both supported a different psychiatric model of assessment to that being proposed (GEPIC rather than PIRS). The AMA(SA) also supports many of the issues raised by the Law Society regarding access to the scheme, and would encourage the government to amend the Bill to reduce opportunity for legal argument which would only cause uncertainty for workers and doctors trying to operate under the scheme.

The AMA(SA) also hold that there must be signifi cant medical involvement in the development of any treatment protocols and guidelines that effect patient outcomes. We are emphasising that the Minister/Corporation must consult with the profession in relation to the development of the regulations and heed AMA advice to ensure complex medical cases are not disadvantaged by broad-stroke policy or guideline decisions. If the scheme is to

AMA(SA) at workimprove in the future it is important for the government to recognise the importance of medical participation. This requires the profession to have signifi cant input and infl uence in relation to models of assessment and treatment. If this is not accommodated, the present barriers to improvements in the system will remain.

Copies of the bills can be found at www.legislation.sa.gov.au and any members with interest or concern are welcome to contact the AMA(SA).

Boards struck offMembers will likely have seen news reports that the government is abolishing 105 boards and committees, with others to be merged or otherwise reformed, 58 being subject to further investigation, 117 to be reclassifi ed and 72 under consideration for retention. Government boards and committees were advised by the Premier earlier this year that unless they could make a case that they are absolutely required, they would go. Some may be happy to depart and be set up another way – others not.

The AMA(SA) has fl agged its close interest in any changes for the SA Health Practitioners Tribunal, which is set to be transferred to the newly established SACAT (South Australian Civil and Administrative Tribunal) - legislation is currently in progress to make such a transition for the Guardianship Board, and some others. Members have also been interested in what this will mean for the future of the Health Advisory Councils, which replaced Hospital Boards under previous legislation, particularly with reference to country areas.

Under the report, Health Advisory Councils for the country are marked to be declassifi ed. Just what this means remains to be seen. However, the metropolitian and Country SA LHNs’ Health Advisory Councils are ‘Governing Councils’ as required under the National Health Reform Agreement 2011, hence those stay. The Veterans Health Advisory Council is listed as “subject to further investigation”. The Health Performance Council is on the “abolish” list (listed for “alternative engagement model”), together with a range of others in the health fi eld. This may well be a signifi cant and concerning

loss in terms of independent reporting on health system performance, and the AMA(SA) supported the continuation of the Health Performance Council in its August submission to the HPC on its performance.

SA Medical Education and Training Health Advisory Council (SAMET) is to be reclassifi ed as not considered to be a government board or committee - what this will mean also remains to be seen. A range of other committees and entities of relevance to health and medicine are also fl agged for change. You can see the full report at yoursay.sa.gov.au.

Commissioner(s) for Children and the Royal Commission into the Safety of Children at RiskTwo bills to introduce a Commissioner for Children and Young People for SA continue to be in play as this edition of medicSA goes to press. Opposition Health Spokesman Stephen Wade’s bill has passed the Legislative Council, including noteworthy amendments intended to enhance independence, which had been a key concern and interest of the AMA(SA) in its advocacy in response to both bills. It has since been introduced in the House of Assembly. Meanwhile, the Government’s Child Development and Wellbeing Bill has passed the House of Assembly with signs of amendments to be considered for its next step in the Legislative Council. Our submissions can be found on the AMA(SA) website. While there are arguments about what is the best model, and certainly room for improvement, fi nally gaining this important role should still be an important step forward.

On a related topic, the AMA(SA) also provided feedback on the Government’s draft terms of reference for the Royal Commission into the Safety of Children at Risk. We proposed that the inquiry’s remit include the important aspect of how to support less children to require out of home care and how to protect more children through earlier and enhanced responses. This suggestion was not taken up explicitly in the fi nal terms of reference, but members with any comments on this important area are invited to contact us.


THE dinner was attended by MPs and senators from across the political spectrum, senior political

staff, health sector leaders, and members of the Federal AMA Board and Federal Council, representing all the States and Territories and all medical specialties.

Speakers included Minister for Health Peter Dutton, the Shadow Minister Catherine King, and the Health Spokesperson for the Australian Greens, Senator Dr Richard Di Natale, as well as federal AMA president A/Prof Brian Owler.

The AMA(SA) was represented by AMA(SA) president Dr Patricia Montanaro, CEO Joe Hooper, Dr Chris Moy and Dr Susan Neuhaus.

Annual AMA Parliamentary Dinner takes place in Canberra, putting the spotlight on healthThe AMA held its annual Parliamentary Dinner on 27 August 2014 at Parliament House in Canberra.

“A membership organisation should and must advocate and advance the interests of its members,” said A/Prof Owler. “It should do so in an ethical and moral framework, and that is our core purpose.”

“As a professional organisation that represents doctors, the AMA has to put the interests of patients and the health of the public as a priority.

“Advocating for the health of our patients is a key motivation for doctors who choose to actively serve the AMA. This is a genuine commitment – a passion for many.

“That is why many doctors choose to combine their busy clinical lives with their equally busy and time-consuming advocacy work with the AMA – at both the State and Federal level.”

spotlight

(L-R) Dr Patricia Montanaro, Deborah Monk of Medicines Australia, Andrew Southcott MP, Joe Hooper, Dr Susan Neuhaus, Nick Champion MP.

(L-R) Kate Thomann CEO AIDA, Dr Robert Parker, president AMA NT, Dr Chris Moy.

heading


A special business offer just for AMA(SA) members.To help keep your business moving, Commonwealth Bank has an exclusive offer

just for you. Just open a new Commonwealth Bank Business Transaction Account

by 31st of December 2014 and link it to your existing or new Commonwealth Bank

merchant facility.

To take advantage of this offer, just contact AMA(SA) Membership Officer Melanie Caruso on (08) 8361 0108 or [email protected].

Important Information: Offer only available to referrals made via the AMA(SA) Membership Officer Melanie Caruso between 01/07/2014 - 31/12/2014. *This offer is applicable to existing and eligible new merchant facilities. $To maintain the fee waiver, you must retain the required products, otherwise the offer may be withdrawn. Offer includes the monthly account maintenance fee of currently $10 on the Business Transaction Account linked to the merchant facility. Please refer to terms and conditions. ^The 0% p.a. promotional interest rate for purchases is valid for 10 months from the date of card approval. At the end of the 10 month promotional period for purchases, the interest rate converts to the standard purchase interest rate for the relevant card current at that time. A separate interest rate may apply for cash advances. Offer available only for a limited time and can be withdrawn at any time at the discretion of the Bank. Excludes Business Liability Business credit cards, Corporate credit cards and existing credit card accounts. This offer may be extended beyond the specified end date at the discretion of the Commonwealth Bank. Interest rates and fees are subject to change.

Full conditions of use will be included in our Letter of Offer. Applications for finance subject to the Bank’s normal lending criteria. Applicants consent to their name being provided to AMA(SA) to confirm eligibility. AMA(SA) may receive a fee from the Commonwealth Bank of Australia for each successful referral. This has been prepared without considering your objectives, financial situation or needs, so you should consider its appropriateness to your circumstances before you act on it. Terms and conditions are available from commbank.com.au Commonwealth Bank of Australia ABN 48 123 123 124. Australian credit licence 234945.

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T 08 7231 0900 | F 08 8361 9201E [email protected]

The Memorial Hospital

Please contact us for appointmentsPlease contact us for appointments or for pre-printed referral formsor for pre-printed referral forms to be forwarded to your practice.to be forwarded to your practice.

Sir Edwin Smith AvenueNorth Adelaide SA 5006

• Comprehensive Hearing Tests for Children of all Ages

• Child Friendly Environment

• Testing conducted in Large Soundproof Booth that complies with Australian/New Zealand Standards (AS/NZS1269.4)

• Medicare Rebate available

Announcing a newAnnouncing a new Paediatric Audiology ServicePaediatric Audiology Service opening in mid October 2014. . .opening in mid October 2014. . .

THE AMA plan is detailed in the AMA Position Statement on Regional Training Networks, released in

September. AMA President, A/Prof Owler, said that medical workforce shortage is a major health issue, particularly for rural and regional Australia.

“The overall distribution of doctors is skewed towards the major cities,” A/Prof Owler said.

“The available evidence shows that one of the most effective policy measures to address rural workforce shortages is the delivery of training in rural areas.

“If doctors have a good training experience in a rural area, they are more likely to stay.

“The AMA is promoting the establishment of regional training networks (RTNs) to bolster rural training opportunities, and to provide a valuable and meaningful career pathway for junior doctors who want to work in regional and rural Australia.

“Our plan would see the development of models for regionally-based specialist medical training that meets the needs of regional and rural communities.

“It is one part of a comprehensive set of policies needed to address regional and rural workforce shortages.

“The development of RTNs would help to promote careers in regional and rural centres and improve patient access to medical care.

“Many medical students have positive training experiences in rural areas, but prevocational and specialist medical training often requires a return to metropolitan centres.

“At this point in their lives, trainees develop personal and professional networks that are important to their future life and career path, and many are less likely to return to practice in rural areas.

AMA calls for regional training networks to help build future rural medical workforceThe AMA is calling on all Australian governments to collaborate on the creation of Regional Training Networks to maximise resources and expertise to produce a high level medical workforce in suffi cient numbers to meet the future health needs of rural and regional Australian communities.

“RTNs would enable junior doctors to spend a signifi cant amount of their training in rural and regional areas, only returning to the city to gain specifi c skills.

“The AMA wants to build on the investment that has already been made in training medical students in regional centres, and expand that to trainee prevocational and specialist doctors.

“We currently recruit almost a quarter of medical students with rural backgrounds and almost a quarter of Australian medical students go through Rural Clinical Schools.

“We have the graduates - now we need effective training pathways to convert into them into a well-distributed workforce for the future,” A/Prof Owler said.

The AMA Position Statement on Regional Training Networks is at https://ama.com.au/position-statement/regional-training-networks-2014

New RAH: tell us your questions!Site plans are online together with various documents and presentations describing what the new RAH is to be on the SA Health webite at sahealth.sa.gov.au > health reform > the new Royal Adelaide Hospital.

Service plans are advancing, and the ‘doors open’ day grows ever closer. You will have read the headlines and heard some of the debates and questions about what the new RAH world will look like. Perhaps your questions have been answered – perhaps they have not. Let us know, and we will take your questions forward. Send your questions to [email protected].


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Supported by


MEDICAL student representatives from the Australian Medical Students’ Association (AMSA)

met on 15 August 2014 with South Australian parliamentarians at Parliament House, Adelaide, to discuss the mental health impacts of Australia’s immigration policies concerning refugees and asylum seekers, including mandatory detention and offshore processing. Representing AFRAM (AMSA for Refugee and Asylum seeker Mental health), the students advocated for a genuine regional processing and resettlement framework; improved access to mental health services for refugees; enforcement of a 90-day time limit in detention; greater integrity in our political discourse; and a recognition by politicians of the social determinants of health (eg, education, housing, social support, employment, recreation, fi nancial situation) in contributing to poor health outcomes in this high risk population. Attended by local refugee advocates and health professionals, in addition to politicians, the morning tea event featured presentations by medical student representatives of AFRAM, and prominent human-rights barrister, Claire O’Connor.

There is strong evidence that the conditions of immigration detention are detrimental to the mental health of adults and children. In September 2013, there were 6579 people in closed immigration detention in Australia, including over 1400 children. According to the report Asylum seekers, refugees and human rights 2013 by the Australian Human Rights (AHR) Commission, refugees and asylum seekers often

Placing the refugee and asylum seeker debate fi rmly on health agendaA group of Adelaide medical students recently managed to generate support from all major political parties for a remarkable event at Parliament House. Here, Danielle Fitzpatrick, Thomas O’Neill and Arrhchanah Balachandran report on the students’ agenda regarding the refugee debate, and on page 24, we outline the AMA position on the health care of asylum seekers and refugees.

endure multiple stressors such as confl ict, persecution, loss, trauma and torture, making them more vulnerable to poor mental health outcomes. The conditions of mandatory detention and offshore processing place these individuals at even further risk of developing mental illness, according to a report by Schweitzer, Steel and Lacherez in the ANZ Journal of Psychiatry in 2006, issue 40.

rates are up to 10 times higher than they are in the Australian community and 60-80% of detainees are reported to have some form of mental illness including anxiety, depression, post-traumatic stress disorder (PTSD), self-harm and suicidal ideation.

In the time period 2011-13, there were over 4000 incidents of actual, threatened or attempted self-harm within Australian detention centres.

Concerning rates of self-harm are also seen in adolescents, with the rate of adolescent self-harm occurring at 12 times that of the general population.

Numerous factors have been identifi ed as contributing to poor mental health in immigration detainees. These include fears of being sent home, social isolation, separation from family and spouses, language barriers, confi ned living environments (including over-crowding) and exposure to hunger strikes and self-harm by other inmates. Furthermore, it is suggested that the mental health impacts of the detention environment are prolonged and persist beyond the detention period.

Furthermore, health professionals have grave concerns regarding the impact

of immigration detention on the mental health and development of children. A 2004 study of 10 families seeking asylum within Australia identifi ed that all of the children met the criteria for at least one psychiatric illness, with 95% being diagnosed with depression and 50% with PTSD. Equally concerning was the fi nding that one in two children had persistent suicidal ideation, and one in four had attempted self-harm.

Robjant, Hassan, and Katona conducted a systematic review of papers examining mental health amongst immigration centre detainees, reported in the British Journal of Psychiatry in April 2009. The review identifi ed that all papers reported high levels of mental health problems amongst detainees.

Further studies have found that, in Australian detention centres, suicide

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There is also evidence of psychological disturbance in children within immigration detention with children demonstrating impaired development and, in severe cases, regression. This included bed-wetting, sleep disturbance, separation anxiety and behavioral disturbances.

More recently, concerns have arisen regarding the conditions of offshore-processing facilities, implemented since 2012. In December 2013, Amnesty International released their report on the conditions on Manus Island. Their fi ndings included reports of cramped living conditions, inadequate sanitation and fresh drinking water, lack of activity and chronic boredom. There have also been reports of inadequate access to appropriate healthcare amongst these facilities, in particular mental health services.

AFRAM’s recommendations to politiciansAFRAM’s meeting with local politicians sought to inform attendees about the causal relationship between Australia’s punitive policies and higher rates of mental illness, initiate discussions about practical solutions to this issue, and enlist support for their campaign for improving mental health outcomes amongst refugees and asylum seekers.

In particular, AFRAM’s recommendations are as follows:

1. No child to be in mandatory detention.

2. Mandatory detention should be avoided wherever possible, and if used, should be constrained to a legally-binding maximum time.

3. Increased access to appropriate mental health services for refugees in and out of detention

4. An independent body with the power to investigate and advise on the health status of refugees to be established.

5. A new guardian for unaccompanied refugee minors in the community who is independent of the Department of Immigration and Border Protection to be established.

Improving the health outcomes for refugees and asylum seekers is a complex task. It requires the refugee debate to transition from being an issue for the political agenda to an issue of health injustice. As evidence for detrimental mental health impacts of Australia’s current punitive policies mounts, we are called to make a vote of conscience that prioritises the right of all individuals to sound mental health.

AFRAM wishes to thank the AMA(SA), in particular president Dr Patricia Montanaro, for its support of the AFRAM initiative.

If you are interested in supporting the AFRAM initiative, please contact the team at [email protected]

Full references for this article are available on request.

THE AMA’s position is that detention centres are harmful to the physical and mental health of

asylum seekers – especially children.

When the Position Statement was updated in 2011, then AMA federal president Dr Steve Hambleton said: “Despite improvements in the provision of health care to immigration detainees, the policy of mandatory detention and the remote location of most detainees mean that the health status of detainees continues to decline.

“The AMA is clearly focused on the health aspects of the asylum

AMA position on the health care of asylum seekers and refugees

seeker debate, which also touch on human rights, ethics, and the right thing to do.

“These are damaged people desperately seeking a new life in this country. They are often fl eeing diabolical situations in their home country. They are well acquainted with fear and danger and desperation. Some of them have been through torture, some have physical health problems, and many will have experienced mental health pressures.

“The risk of mental health issues becomes higher the longer they are in detention centres.

“Children are particularly vulnerable and the detention environment places enormous stress on them.

“Children often witness behavioural and psychological distress in adults, including their parents. They see violence and self-harm and they experience separation from family members.

“Unaccompanied children should never be placed in detention centres,” Dr Hambleton said.

The AMA Position Statement is available at ama.com.au/position-statement/health-care-asylum-seekers-and-refugees-2011

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THE AMA(SA) committee has had a strong input into federal AMA road safety initiatives, although rarely

meeting face-to-face and conducting most of its business by e-communication. At the outset of its most recent meeting in August, committee chair and past AMA(SA) president Dr Bill Heddle noted that this was the fi rst physical meeting of the committee since the death of Dr Bernard McEvoy, who had been a valued member for many years, and a minute’s silence was observed in his memory.

A number of the committee’s current activities were discussed including long-term goals; the recent success in the adjustment of regulations concerning probationary drivers in the light of evidence of delays in risk-taking maturity, particularly in males; and the current focus on changed rules in medical assessment of drivers over 70 years.

Rob Atkinson, who is Chair of the Royal Australasian College of Surgeons SA Regional Trauma Committee, indicated that there are signifi cant synergies, as have occurred in the past, between the AMA and the College of Surgeons, and he would take the federal AMA

AMA(SA) Road Safety Committee at workOn 7 August 2014 a meeting of the AMA(SA) Road Safety Committee was held to coincide with the visit to Adelaide of federal AMA president A/Prof Brian Owler, who has a strong interest in the subject and is the public face of the ‘Don’t Rush’ program in NSW aimed at reducing road trauma.

president’s proposal of an AMA Road Safety Forum forward.

He also indicated that the Australasian College of Road Safety is a progressive and overarching body in road safety in Australia and New Zealand, and would be a most appropriate partner with the AMA.

The problem of how best to translate advocacy and evidence into legislative change was highlighted, using the example of the recently introduced graded licensing for the young in South Australia.

The AMA(SA) presented good evidence to support these changes, but pursuit of the issue through the political process was predictably slow; had this not been the case, death and injury of a number of under 25s might have been prevented.

A better mechanism is needed, perhaps involving a bipartisan approach, and one suggestion is that of a Road Safety Commissioner or Ombudsman who could take good evidence forward in such a way.

Rob Atkinson also mentioned the unique South Australian problem of Stobie poles that act as a cheese cutter to a modern vehicle, which is designed to progressively crumble and protect the passenger compartment.

To protect these poles, for example with car or truck tyres, potting mix and succulents, with some community ownership of this, would highlight the problem as well as dissipate some of the force on impact.

The proposal by the federal president of an AMA Road Safety Forum was greatly appreciated and supported by the committee, which A/Prof Owler commended on its work. Watch this space!

In MemoriamDr Bernard McEvoyDr McEvoy, who died in September 2013 after several months of ill-health, had served the Woodside area as a respected general practitioner for many years. He was a passionate advocate for road safety particularly in the Adelaide Hills; there is a classic photograph of him standing beside an 80 KPH sign in the hills.

His contribution as a valued member of the AMA(SA) Road Safety Committee is greatly missed.

PHONE 8361 6836LEVEL 2 / 77 KING WILLIAM RD. NORTH ADELAIDE [email protected]

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Dr Angas Hains Dr Andrew Philpott

THE death in a nursing home from colchicine toxicity of a 76-year-old woman was the subject of

a fi nding handed down by Mr Mark Johns on 17 April 2014.

The fi ndings, which members may have seen briefl y summarised in an edition of The Voice on 1 September 2014, were based on expert evidence given to the court, and include observations that the risk of fatal toxicity is not well appreciated in the medical community, and that there were some discrepancies in dosage recommendations in sources reviewed by the court, these being MIMS and the Australian Medicines Handbook (AMH).

The Coroner was not critical of the treating doctor, noting in his summary “the confusion that appears to exist in the published guidelines about colchicine”.

The circumstances were that during previous admissions to a public hospital in August 2010 the patient had been given colchicine on three occasions but only for two or three doses, then on return to the nursing home colchicine had been given

Coronial fi nding: death from colchicine toxicityThe state Coroner, Mr Mark Johns, has requested that attention be drawn to the potential for serious toxicity in the use of colchicine for the treatment of gout.

500 µg daily for two months during introduction of allopurinol. With a recurrence of acute gout some four months later, colchicine was given 500 µg twice or three times daily for three days and then three times daily for fi ve days up until it was ceased when the patient’s general condition deteriorated, following which she died the next day.

Editorial commentmedicSA observes that, while the inquest fi nding refers to the sources of information on dosage recommendations used by its expert witnesses, as detailed above, it does not give detail on the extent of the “discrepancies”, except to say that a higher dose was recommended by MIMS than by the AMH.

The benchmark Australian source of dosage information is in fact neither of these publications, but the Therapeutic Goods Administration (TGA) approved product information (PI)1.

In this particular instance, the PI recommends that total cumulative dosage for an acute attack should not exceed 6 mg over four days, and in elderly patients 3 mg, and also makes it clear that multiple organ adverse

effects, including fatal outcomes, can result from overdosage.

The dosage recommendation given by MIMS, in both its 2011 and 2014 editions, is for the same maximum of 6 mg (3 mg elderly) per acute course as specifi ed in the PI, with an additional comment that this should not be repeated for at least three days.

The AMH does recommend a lower level of 1.5 mg/course, but states that this dose “is adapted from a defi nitive study that used 600 microgram tablets and so had a maximum of 1.8 mg/course; the Australian product information still refl ects the previously used higher dose regimen”.

With respect to the Coroner’s fi ndings, this is neither discrepancy nor confusion; it is evidence-based medicine.

Nevertheless, given that in the case in question the total dosage was at least 11 mg over nine days, the recommendation that attention be drawn to the possibility of serious toxicity arising from the therapeutic use of colchicine is strongly supported.

1 https://www.ebs.tga.gov.au/

coroner’s report


books and events

Leading Mount Gambier paediatrician remembered

David John Seymour HillMBBS, FRACP

1944-2014

IT was a childhood dream to become a paediatrician that made the late David John Seymour Hill a

household name in Mount Gambier for many years.

Dr Hill was born in Melbourne on 15 July 1944 when his father, Dr John Seymour Thew Tregarthon Hill, was still away due to World War II.

When Dr Hill was two, his family moved to Woodville and seven years later to Mount Gambier where his father worked as a long-time general practitioner at Ferrers Clinic and his mother Mary Darnton Hill was the city’s fi rst almoner (social worker).

From late childhood, Dr Hill intended to become a doctor and quite early on he wanted to be a paediatrician.

At 11, he went to boarding school at Prince Alfred College in Adelaide and while there, at the age of 15, was diagnosed with Type 1 diabetes.

A measure of his quiet determination was how he handled injecting himself with insulin every day – and later in university while handling study and sport – he never complained.

He enthusiastically played sport and was a house and school prefect.

After fi nishing secondary school, he studied medicine at the University of Adelaide while living at St Mark’s College in North Adelaide.

He successfully completed his studies in 1968 and was a resident medical offi cer at The Queen Elizabeth Hospital.

He completed a further residency year at the Children’s Hospital where he was subsequently paediatric registrar for fi ve years before leaving for Dunedin Hospital in New Zealand.

Married by that time to June (nee Munroe), they stayed for one year while Dr Hill worked as senior paediatric registrar and lecturer with the Department of Paediatrics at the University of Otago – also based in Dunedin.

Returning to Australia, he worked as a visiting paediatrician and subsequently senior visiting paediatrician at the Regency Park Centre for the young and physically disabled, and later on at the Adelaide Children’s Hospital and Flinders Medical Centre.

It was there that Dr Hill worked on one of the biggest single projects that highlighted his career, researching and proving claims that the low survival rate of South Australian children with cystic fi brosis were inaccurate.

During this time he also operated a private practice in North Adelaide.

From late childhood, Dr Hill intended to become a doctor and quite early on he wanted to be a paediatrician.

In 1987, he returned to Mount Gambier with his wife to set up a practice in Sturt Street where he worked as paediatrician at the old Mount Gambier Hospital on Lake Terrace.

Living in Toowoomba from 1995 to 2002, he was director of paediatrics and visiting specialist to surrounding clinics and hospitals including the Goondiwindi and Dalby hospitals.

Returning to the South East to fi ll a void that had been left in his absence, Dr Hill practised as a consultant paediatrician in Mount Gambier and in the latter position was also visiting paediatrician to the Millicent Hospital from 2002 to 2008.

As Mount Gambier’s only serving paediatrician for many years, it was a big loss to the community when he retired in July 2008.

While the region had struggled to attract paediatricians due to a reluctance to move to regional areas, the workload Dr Hill took on over many years was picked up by three new doctors following his retirement.

Dr Hill had an active interest in most sports, especially cricket, while he was also an excellent swimmer, crossing the Glenelg River before he was 11 years old.

This interest was later refl ected when he served as the honorary medical offi cer to the SA Amateur Swimming Association. He was mascot of Port Adelaide Football Club when still in Adelaide and retained the allegiance for the rest of his life. He was a much-loved paediatrician because of his gentle and knowledgeable approach.

Despite deteriorating health in his retirement, Dr Hill never lost his patience and dry humour.

His family life, children and grandchildren were a source of great pleasure to him – and him to them.

Much-loved by those he served across the region, Dr Hill was farewelled by family and friends after he died peacefully at the Mount Gambier Hospital on 3 July – less than two weeks shy of his 70th birthday.

He leaves behind, and will be sadly missed by, his wife of over 40 years, June, and children Mandie and Alistair, both living in London, Amy in Adelaide, Gus in Sydney and brother Ian and families.

This obituary was fi rst published in The Border Watch,18 July 2014.


events

AMA(SA) president Dr Patricia Montanaro welcomed AMSA delegates to Adelaide at the 2014

Australian Medical Students Association annual convention in July.

“The fi rst AMSA convention I went to was as a student, in 1982,” said Dr Montanaro. “Some parts I remember better than others, but I enjoyed them all, and was lucky enough to make friendships that will last a lifetime.”

The AMSA National Convention – themed ‘Un-conventional’ – brought 1850 medical students from across Australia and New Zealand for some part of the week, making it the largest student-run conference in the world (completely organised by a committee of 17 and a subcommittee of 70 full-time medical students from Adelaide and Flinders universities).

The week began with the Opening Ceremony, with live performances by the Adelaide University Medical Orchestra and a welcome address via video-link by Hollywood actor Hugh Jackman.

The most anticipated speaker of the week was Dr Patch Adams, the ‘Original Clown Doctor’ who delivered a plenary

AMSA convention an ‘un-conventional’ success

session and workshop (that went three hours overtime!)

Other highlights of the academic program included Dr Bob Brown’s session ‘A Natural Leader’, Dr Vyom Sharma’s session ‘Magician Practitioner’, Julian Burton’s ‘An Inspirational Survivor’, and ‘The Gourmet Pathologists’ where delegates learned how to make meals resembling pathological descriptions. SA emergency medicine specialist and former national AMA CDT chair Dr Andrew Perry presented on AMA membership and advocacy, as well as chairing a session.

“The annual AMSA convention is a fantastic tradition and one that is fondly remembered across Australia by all doctors who had the Convention experience as students,” said Dr Montanaro.

“The AMA in South Australia is delighted to have again supported the SA AMSA team. They have certainly livened up our offi ces with their preparations for this great event, and their passion and enthusiasm really is infectious. It reminds us what it is all about: the future of medicine – which is all of you.”

Dr Andrew Perry with 2014 AMSA president Jessica Dean.

Adelaide organisers of the AMSA convention.

Patch AdamsAMA(SA) president Dr Patricia Montanaro.

Lucky winner of BMW drive day drawn at AMA(SA) night out for DiTs and students

DOCTORS in training and fi nal-year medical students were invited to join the AMA(SA),

friends and colleagues for drinks and nibbles at Adelaide BMW in August 2014.

Members went into the draw to receive an Adelaide BMW Drive Day position, kindly donated by Adelaide BMW

and valued at $1,000, which entitled the winner to a day behind the wheel of top-end BMW vehicles, accompanied by racing legend Allan Moffat.

Lion kindly donated beer, cider and cheese, whilst Corporate Platters was kind enough to donate platters of food. A good night was had by all with Ms Jodi Hunt winning the drive day with Allan Moffat.

Jodie Hunt was the lucky winner of the drive day with Allan Moffat.

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Riding a Crocodile

Paul Komesaroff

A Physician’s Tale

RIDING a Crocodile, subtitled A Physician’s Tale,

chronicles a tumultuous few weeks in the professional and personal

life of Abraham Nevski, an academic consultant physician at Royal St John’s, a not-too-mythical teaching hospital somewhere in metropolitan Australia.

The author Professor Komesaroff (pictured above) will be well known to many readers as having a similar professional background, based at Monash, and with a major interest in the philosophy and ethics of medicine, on which he has written extensively. This is his fi rst novel.

It may be unusual for reviewers to lapse into the fi rst person, but I must. At age 15, I read a book, East Side General by Frank G Slaughter, an American surgeon – and yes, that’s his real name – which describes the exciting life of a major hospital. This book undoubtedly infl uenced me towards a medical career I had never previously considered.

Now, almost 60 years later, I fi nd myself with a book by another medical author in which the central character does everything that occupied my life for three decades – internal medicine with an interest in endocrinology, ward rounds, bedside student teaching, challenging interactions with colleagues, nurses and administrators, a structured interest in medical ethics, and an associated private practice with complex and sometimes loquaciously time-consuming patients. The resulting enforced refl ection of my own working life causes me to wonder whether I might be either the best or the worst person to undertake this review.

There is a clever plot which interlaces clinical vignettes arising in the wards of Professor Nevski’s practice with

events in his tortured personal life, a series of unexplained deaths, and a number of relevant contemporary issues including managed care, the implementation of advanced care directives, the empowerment of nursing staff, and the ill-effects of diminishing clinical governance.

The detail on these issues is accurate and suffi cient to satisfy the medically informed reader but not confuse others. Abraham does display familiar prejudices in some of his professional interactions: nurses, administrators, and possibly some surgical specialists, should perhaps take Valium before reading the book. Is it, as the publicity suggests, a “chilling detective story”? Read it and see.

The central character does everything that occupied my life for three decades …

Throughout the text is woven Nevski’s view that, for clinicians, ethics should be seen not as a numbered set of rules which govern practice as much as a continuum of those principles of thought and behaviour which govern every aspect of our interaction with others in daily life. It becomes tempting to see Abraham, in expressing these sentiments, as an alter ego of Paul Komesaroff himself – even the structure of his name, with its combination of Biblical and Slavic references, seeming somewhat coincidental.

Part of the plot sees Nevski returning to his offi ce to work on an article he is writing on these principles. While thought provoking, these sections are by comparison with the rest of the text heavy going and may fi nd some readers visiting the dictionary for interpretation of seemingly unnecessarily obscure or esoteric terms. Another minor irritation is the use, in an Australian publication, of US spelling alternatives, presumably the result of computerised spellchecking.

Overall, though, this is an entertaining, challenging and expertly crafted

book which will appeal in differing ways to a variety of readerships. Senior clinicians will enjoy the accurate depiction of hospital life, and students and junior doctors some insight into challenges their teachers might face. ‘Lay’ readers might appreciate what secrets might lie behind the professional mask of their doctor, but in any case will enjoy a voyeuristic journey through the drama of hospital medicine as lip-smacking as any episode of Grey’s Anatomy or RPA. Or was that RSJ?

Philip Harding

We have three copies of Riding a Crocodile to give away. If you would like to receive one, please email your contact details to us at [email protected] or call (08) 8361 0101.

Winners will be notifi ed directly and their names published in the December 2014 issue of medicSA.

Clarifi cationIn the August 2014 issue of medicSA, in the article ‘Coroner’s recommendation’ on page 10, it should be noted that the recommendations given in the article were relevant to matters raised in the coroner’s report rather than a verbatim list taken directly from the coroner’s report. The views expressed in the opinion piece are the views of the author, upon consideration of the coroner’s fi ndings.

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Medical students continue advocacy effoTom Eldredge

STUDENT NEWS: UNIVERSITY OF ADELAIDE

THE Adelaide Medical Students’ Society (AMSS) 125th Anniversary Week provided an excellent

opportunity to refl ect on how far the Society has come. Four events were held over the course of the week, each engaging different demographics and providing excellent networking opportunities. The highlight of the week was the 125th Anniversary Gala Ball, which was held at the National Wine Centre. The night was a roaring success, with light-hearted presentations from past AMSS presidents, as well as some live music from the Adelaide University Medical Orchestra to get everyone up and moving. It was excellent to see a mix of graduates and students attending, with a good time had by all.

The AMSS Annual MedBall, themed as ‘A Night in Shanghai’, was held on Saturday 6 September, with gorgeous gowns and dapper suits fi lling the Morphetteville Racecourse. I would like to

congratulate the recipients of the AMSS Awards – Ben Wingrove and Caitlyn Sun – who were awarded the O’Brien Memorial Awards, and Sam LaBroome as the recipient of the Patron’s Plate, the most prestigious annual award given out by the AMSS for outstanding contribution to the Society. Another great honour was awarded at the MedBall this year, with Thomas Crowhurst being presented with his Honorary Life Membership. Thomas’ dedication to medical students and the AMSS during his time at medical school was truly amazing and I am certain that he will continue to achieve amazing things in his future career.

The AMSS 125th Anniversary Week provided an excellent opportunity to refl ect on how far the Society has come.

The year is quickly coming to an end for fi nal year students, and as internship positions for 2015 continue to be offered, many students are facing hard decisions of whether to stay where they are or

move to another state. Some international students, however, have still not been offered an intern place at all, providing them with an immense amount of stress as they desperately seek internship places within Australia to receive their full registration. Many of the efforts of the AMSS and FMSS have unfortunately been unsuccessful, with no new funding for internship positions, despite the loss of 23 positions through the cessation of funding for the Prevocational General Practice Placements Program.

The AMSS AGM this year will be held on 18 September, with many fresh faces looking to throw their hat in the ring to become a part of the AMSS. It is always a bittersweet time of year however, as it marks the beginning of the end for the incumbent Committee and Executive. By the time of publication, the new offi ce bearers will have been elected – I congratulate all of the successful candidates and look forward to introducing the 2015 AMSS president in my next article for medicSA.

As usual, if you would like to fi nd out more information about the AMSS, please do not hesitate to get in touch with me at [email protected].

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rts on internships, while enjoying Medball!Annabelle Wood

STUDENT NEWS:FLINDERS UNIVERSITY

AFTER a fl urry of activity during July, August was a more subdued month for medical students at

Flinders, as second years undertook their fi nal set of exams before entering clinical student life. With the exams now complete, the Flinders Medical Students’ Society (FMSS) is looking forward to a strong fi nish to what has been busy and exciting year!

On the fi rst Saturday in September, FMSS hosted its premier social event of the year, Medball. This year’s ‘Enchanted’ ball was held at the Playford Hotel in Adelaide. Students enjoyed this well-deserved opportunity to let their hair down in what can be an otherwise demanding course.

During the same weekend, a delegation of 37 Flinders’ students travelled to Sydney for the annual AMSA Global Health Conference. The theme of this year’s conference was ‘Jump In’.

Students attending the conference were privileged to hear from speakers including Lucy Perry, the CEO of Hamlin Fistula Ethiopia (Australia), Dr José Ramos-Horta, and Julian Assange. Students were also able to engage in lively discussion on pertinent issues such as the effectiveness of foreign aid, the success of the millennium development goals and whether or not there are too many charities in the world. As the future face of medicine, it’s inspiring to see so many of our students passionate about global health.

… the Flinders Medical Students’ Society is looking forward to a strong fi nish to what has been busy and exciting year!

In addition to our busy social calendar, FMSS takes pride in the academic activities that we hold for our members. Peer support and teaching continues to be one of our strengths. In addition to regular peer teaching sessions held throughout the year, in the coming months both fourth-year and third-year students will host practice OSCE

sessions for students in the respective years below them. These teaching sessions not only benefi t the students receiving the tutorial, but are also a fantastic opportunity for students to experience the role of being an examiner.

Regrettably, since writing for the last issue, there is limited further information to provide on the internship crisis. FMSS and AMSS are continuing our advocacy efforts to ensure that all South Australian graduates receive internships this year and in the future. Unfortunately, the lengthy process involved in allocating internships means that at the time of writing this article no international student at Flinders had received a job offer in South Australia. It is anticipated that international students will hear of job offers over the next month or so and I hope to provide a more positive update in the next edition.

FMSS elections are due to occur next month and I look forward to introducing you to our new president in due course. In the meantime, I would love to hear any questions or comments you may have about life as a medical student at Flinders. Please feel free to contact me at [email protected].


HIP replacement surgery is a very reliable operation with very good outcomes independent of the

approach. The Australian National Joint Replacement Registry has data on nearly 500,000 hip replacements with greater than 95% survivorship at 10 years with proven prostheses.

Recent years have seen improvements in length of stay and early return of function after joint replacement surgery. This is much more to do with improved anaesthetic techniques, early mobilisation and improved postoperative analgesia than the choice of approach.

The ‘anterior approach’ hip is not new and has been utilised since the beginning of hip replacement surgery in the 1960s. There has been a recent resurgence of enthusiasm for its use.

Claims of faster recovery and better outcomes do not stand up to scrutiny. Two recent scientifi c articles, one from the Hospital for Special Surgery in New York1 and the other from the Mayo Clinic2 fi nd NO signifi cant difference in length of stay, early return to function or

Surgical approaches in hip replacementRecent publicity in newspapers and on television claims improved outcomes and reduced complications with a ‘new’ anterior approach for hip replacements. Patients may have presented with copies of advertising material from company sponsored websites and public meetings. The SA Branch of the Australian Orthopaedic Association (AOA) believes there has been a one-sided presentation of the argument. It has provided AMA(SA) with the following statement which it considers to be a more balanced position.

indeed outcome when comparing different approaches.

The Australian Arthroplasty Society has produced a position paper3 via a working party of surgeons who utilise a variety of approaches. The position statement states:

1. There are multiple ways to approach a hip joint: none are ‘new’.

2. Surgical approach has little infl uence on results.

3. There is no scientifi c evidence that endorses one surgical approach over the other.

4. Surgeons should tell their patients which works best in their hands but should not claim an advantage over approaches used by other surgeons.

There is no superior way to perform hip replacement surgery and it is misleading to claim improved outcomes and reduced complications solely on the basis of the choice of surgical approach.

David Campbell, SA State Chairman of the Australian Orthopaedic Association

MEMBERS are likely to have read news reports earlier this year about TCE contamination and

may have received information from SA Health.

To help raise understanding the AMA(SA) has sought information for the profession from the Department of Health with respect to TCE and public health.

You can fi nd the overview on the AMA(SA) website at ama.com.au/sa/tce-information-sa-doctors.

TCE information for SA doctorsAfter reports of high levels of high levels of trichloroethylene (TCE) in soil vapour in a residential area in Clovelly Park earlier this year, the AMA(SA) has sought advice on behalf of members.

References1: Clin Orthop Relat Res. 2014 Feb;472(2):455-63. doi: 10.1007/s11999-013-3231-0. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Rodriguez JA1, Deshmukh AJ, Rathod PA, Greiz ML, Deshmane PP, Hepinstall MS, Ranawat AS.

2: Clin Orthop Relat Res. 2014 Aug 1. [Epub ahead of print] Direct Anterior versus Miniposterior THA With the Same Advanced Perioperative Protocols: Surprising Early Clinical Results. Poehling-Monaghan KL1, Kamath AF, Taunton MJ, Pagnano MW.

3. http://www.aoa.org.au/docs/default-source/subspecialties/arthroplasty_thr_members.pdf?sfvrsn=2

Trichloroethene, also known as trichloroethylene or TCE, is a colourless liquid industrial chemical used widely in industry for metal cleaning and in the manufacture of products such as adhesives, lacquers, dyes, perfumes and soaps.

While any exposure is at present unproven and indeed unlikely, if individual residents are concerned and there is a possibility of exposure they may wish to seek a medical review. Some of the possible health effects from

exposure are detailed on the AMA(SA) website. If you have a patient who is concerned about TCE exposure and health effects please direct them to contact Scientifi c Services SA Health on (08) 8226 7100.

A comprehensive review of TCE and health impacts is the Agency for Toxic Substances and Disease Registry (ATSDR) – Toxicological Profi le for Trichloroethylene (1997) and Addendum (January 2013), available at atsdr.cdc.gov/substances/index.asp

in practice


The FACTS about Women’s Health – no longer in the ‘too hard’ basketOn Saturday 29 November 2014 at the Tennyson Centre in Kurralta Park, you can hear the latest in Women’s Health, with practical tips for management in a general practice consultation.

This will be an interactive update covering topics such as menopause, contraception, STIs, cervical screening, abnormal bleeding, vulval medicine, GP care plans and early medical abortion, presented by the following South Australian experts:

• Dr Jane Elliott, GP and past president, Australasian Menopause Society

• Dr Clare Fairweather, GP at Pelvic Pain SA

• Dr Meredith Frearson, GP and RFDS Women’s Health Program

• Dr Tonia Mezzini, Director of Medical Services at SHine SA

• Dr Ea Mulligan, GP, Lecturer/research associate at Flinders University and director of the Pregnancy Advisory Centre

• Dr Ann Olsson, gynaecologist, president Australian and New Zealand Vulvovaginal Society, past president Australian Society for Psychosocial Obstetrics and gynaecology and medical director, Adelaide Women’s Health Centre

ACRRM points and 40 Category 1 points with RACGP pending. Cost $180 sapmea

and AMA members, $220; non-member rate, $180 GP Registrars and Students. To register go to sapmea.asn.au or call sapmea on 8274 6054.

New resources portal for doctorsA new doctor portal for AMA members – doctorportal.com.au – provides relevant information and resources for medical professionals, all in one centralised location. doctorportal delivers current, clinical and medico-political news, incorporating the Medical Journal of Australia, MJA InSight and Australian Medicine magazine. It also allows you to share content with colleagues and discuss content in private or public forums that only registered medical professionals can access. doctorportal also includes a new ‘Find a Doctor’ feature, a refreshed MJA Bookshop, careers and jobs resources and the GP Desktop Tool.

Role of practice nurses in health assessments clarifi edFollowing the release of erroneous advice from the Department of Human Services (DHS) about the role of practice nurses when undertaking health assessments, the AMA has been working hard to have this corrected and a defi nitive statement released.

The AMA was quick to respond on behalf of the profession and raised the issue with the Minister for Health’s offi ces along with

senior offi cials within the DHS and the Department of Health (DoH).

Through the efforts of the AMA Council of General Practice (AMACGP), working with both the DoH and DHS, defi nitive advice has now been issued – go to health.gov.au > fact sheets > Medicare Health Assessments: MBS Items 701-707 and 715.

It confi rms the long standing policy position that practice nurses can assist GPs in performing a health assessment and outlines the circumstances where the time taken by the practice nurse can be added to the time taken by the GP to complete the assessment.

The statement on the DoH website refl ects accepted medical practice, recognising that it is important for the GP to have appropriate involvement and overall responsibility for the service.

Circumstances where the time taken by practice nurses assisting in a health assessment is recognised include: information collection, including gathering of patient information for the medical practitioner and the taking and recording of routine measurements; and providing patients with information about recommended interventions at the direction of the GP.

The AMA welcomes this clarifi cation and has stressed that any future changes to the advice issued to GPs should only happen once there had been adequate consultation with the AMA and relevant stakeholders.

in practice

Calvary Obstetrics and Gynaecology

Welcoming Dr Ray Yoong

FRANZCOG MBChB MRepMed

Obstetrician and Gynaecologist

Special interests:· Obstetrics· Advanced laparoscopic surgery· Endometriosis· Infertility· Incontinence and prolapse surgery· Menstrual disorders· Colposcopy

Dr Yoong is now providing Obstetrics and Gynaecology services at Calvary North Adelaide Hospital.

For appointments call 08 8371 224419 Alexander Avenue, Ashford www.drrayyoong.com.au

Continuing the Mission of the Sisters of the Little Company of Mary calvarynorthadelaide.org.au

North Adelaide Hospital

CD38

59

heading


NEW CLINIC LOCATIONAOTS surgeons now consulting and operating at:

NORTH EASTERN COMMUNITY HOSPITAL580 Lower North East Road Campbelltown SA

• Early appointments• Very Short wait times for appointments and surgery• Specialised approach to all orthopaedic regions• Comprehensive care plans• Individualised treatment plans• Team approach to orthopaedic care

Bookings: (08) 7325 4800

Dr Robert BairdDr Robert FassinaDr Chien-Wen LiewDr Justin Munt

THE ADELAIDE CANCER CENTRE and ICON CANCER CARE ADELAIDE would like to introduce four new medical oncologists on staff: Dr Sarwan Bishnoi, Dr Meena Okera, Dr Christopher Hocking and Dr T Hsiang Tan. Phone 8292 2220, fax 8292 2230.

A/PROF MARGARET DAVY AM, gynaecological oncologist, wishes to inform that she has retired from private practice on 4 July 2014. Over the last year she has redirected patients who need ongoing care to appropriate specialists or back to their general practitioner.

Dr Neisha Wratten, also at 141 Kensington Road Norwood, has kindly agreed to store records of patients who have not attended and been offered this personalised arrangement.

Margaret thanks all referring doctors over many decades and also the patients who have entrusted their care to her. She will continue in her role as director of Surgical Specialties at the Royal Adelaide Hospital.

DR DANIEL HAINS, ENT surgeon, has moved to the Wakefi eld Surgicentre, 316 Wakefi eld St, Adelaide 5000. Phone and fax remain unchanged; 8332 9666 and 8364 2501 respectively.

DR RICHARD HAMILTON MBBS, FRACS, Plastic Surgeon, wishes to announce that his day surgery facility, Hamilton House Day Surgery www.hamiltonhouse.com.au has been recently re-accredited for three years by the Australian Council of Health Care Standards (ACHS) www.achs.org.au under the new National Standards.

Richard Hamilton continues to practice plastic surgery at Hamilton House at 470 Goodwood Road Cumberland Park. His special interests are skin cancer, hand surgery and cosmetic plastic surgery. He also consults fortnightly at Morphett Vale and McLaren Vale as well as monthly at Victor Harbor and Mount Gambier. He is also available for telephone advice to GPs and accepts emergency plastic and hand surgery referrals.

Referrals may be emailed if convenient to [email protected]. For all appointments phone Hamilton House 8272 6666.

STACE ANAESTHETISTS is pleased to announce Dr Evelyn Cheng has joined

NOTICESour practice as an associate specialist anaesthetist. Evelyn undertook her medical and anaesthesia training in South Australia and has also participated in programs at New York’s St Luke’s Roosevelt Hospital, Hong Kong’s Queen Mary Hospital and Cleveland Clinic in Ohio, USA.

Evelyn has visiting rights to all private hospitals in Adelaide and is a Fellow of the Australian and New Zealand College of Anaesthetists. We welcome Evelyn to our team who are committed to providing expertise in all areas of anaesthesia. For general enquiries, please call 8236 5000.

DR SUMU SIMON, eye surgeon, wishes to advise that she has commenced private practice at Eye Consultants SA. She has a public appointment at The Queen Elizabeth & Lyell McEwin Hospitals. She is returning from neuro-ophthalmology fellowship training in the UK, having previously completed fellowship training in medical retina at the Royal Adelaide Hospital.

Her sub-specialty interests include neuro-ophthalmology, adult ocular motility and medical retina. Surgical interests include small-incision cataract surgery, strabismus, adult squints and pterygium. For appointments please contact her North Adelaide Rooms on 8267 3211, fax 8267 1678.

ROOMS FOR SALE OR LEASE

CONSULTING ROOM MODBURYWell-appointed consulting room for lease on a sessional basis. Located in the Paragon Specialist Centre, Smart Road, Modbury, offering medical and allied health consulting facilities. Reception facilities, access to reserved parking, waiting room, staff kitchen and amenities all included in the rental cost. Please send enquiries to Dianne Wilson at [email protected]

ADELAIDE HILLS GPLong established family practice in the Adelaide Hills seeking part or full-time VR GP for sessional work. Join experienced doctors and practice nurse. AGPAL accredited. Best Practice clinical software. In-house pathology. Phone Sally McGregor on 8339 4344 or email [email protected]

ADELAIDE CITYCranford House, adjacent to St Andrew’s Hospital on South Terrace. Two large

POSITIONS VACANT

practice notes


consulting rooms, fi rst fl oor, overlooking the parklands with shared offi ce, waiting room and storage. Please phone 8223 7955 or email [email protected].

FLINDERS PRIVATE HOSPITAL Newly decorated Suite 201 Specialist Rooms at Flinders Private Hopsital, Bedford Park. We have space for a specialist, allied health or GP. Currently Dr Preetam Ganu (Obstetrician/Gynaecologist), Dr Sanjay Sinhal (Paediatrician) and physio are using the suite. We will endeavour to fi nd a suitable session time to suit your needs. Meet and greet, or bring your own receptionist. Please ring 8299 0302 and speak to the practice manager.

INNER NORTH EASTExperienced GPs required to fi ll positions of two retiring full-time doctors. Full-time or part-time sessions available at our accredited, fully computerised surgeries in the inner North-East suburbs of Adelaide.

Instant large patient database – will suit a doctor relocating to the city or someone looking at starting their career in a well-established general practice. Extensive on-site allied health and nursing support with excellent resources and facilities.

For an obligation free discussion, please ring the practice principal on 0401 674 051 or email [email protected]

NORTH ADELAIDERooms for lease, car park available at Hill Street Specialist Centre, phone 7200 3310 or 0402 471 093, or email [email protected]

ST AGNES SURGERY is seeking fulltime or part-time vocationally registered GPs. Positions are available as assistants with or without a view to partnership. St Agnes Surgery is a 7-day a week practice and is privately owned – with a focus on comprehensive patient care. Detailed information about the practice can be found at www.stagnessurgery.com.au. Enquiries to Pauline Murphy, practice manager on 8264 3333.

VISITING EAR, NOSE AND THROAT SPECIALIST (Fee-For-Service: Private Consulting)Country Health South Australia LHN has a vacancy for an Ear, Nose and Throat Specialist Surgeon at Mt Barker District Soldiers Memorial Hospital.

Private consulting facilities are available at the Summit Health Centre on the Hospital grounds.


the schedule

The Schedule: Upcoming Events

OCTOBER

Insight development Fund Dinner 17 OctoberAyers House, North Terrace insight-health.org.autickets [email protected]

The Commonwealth Club of Adelaide Luncheon Speaker Dr Donald Beard AM.RFD.ED.OHS. Colonel RAAMC The Digger’s Doctor, a life of service21 October 2014 – Adelaide Pavilion Bookings 8265 2855

Walk for Prems 2014 Life’s Little Treasures Foundation26 October – Karrawirra Southbank walkforprems.org.au

NOVEMBER

Melbourne Cup Charity Luncheon AMA(SA), Law Society of SA, Chartered Accountants Australia and NZ 4 November – Adelaide Oval Cathedral Room, Eastern Stand. Call Melanie 8361 0108; email [email protected].

AMA(SA) Council meeting6 November, 7pmCall Claudia (08) 8361 0109

The Commonwealth Club of Adelaide Luncheon Speaker Hon Dr Brendan Nelson, BMBS FRACP(Hon) FAMA. Centenary of the First World War – the telling of our Story 7 November – Adelaide Oval, Ian McLachlan Room WestBookings 8265 2855

Past Presidents, Retired Members and Life Members Luncheon10 November 2014SACCA Room at the Adelaide Oval

AMA(SA) and RACGP Christmas Party 14 NovemberCollege House, Gover StreetCall Melanie 8361 0108; email [email protected].

Successes & Failures in Telehealth (SFT-14)17-18 NovemberHilton Adelaideevent.icebergevents.com.au/sft-2014

ACIPC ConferenceAustralasian College of Infection Prevention & Control 23-26 NovemberAdelaide Convention Centreacipc.org.au

AAG ConferenceAustralian Association of Gerontology26-28 NovemberAdelaide Ovalaag.asn.au/national-conference

The FACTS about Women’s Health29 November 2014Tennyson Centre, Kurralta Parksapmea.asn.au, 8274 6054

DECEMBER

AMA(SA) Council meeting4 December, 7pmCall Claudia (08) 8361 0109

Submissions of event information are welcome to [email protected]. Event listing is free.

Emergency Plastic Surgery ServiceAt Adelaide Plastic Surgery Associates 0400 131 883

Adelaide Plastic Surgery Associates provides a 24-hour 7-day-a-week emergency plastic surgery service for WorkCover or privately insured patients.

Our emergency coordinator or one of our plastic surgeons will take your call at any time to organise the treatment of injuries requiring plastic surgery.

Level 4, 18 North Terrace, Adelaide SA 5000

P 08 8213 1800 F 08 8213 1811

E [email protected] W www.apsa.com.au

Tony MooreTim Edwards

Nick MarshallAnthony Porter

Darren MolonyBernard Carney

Peter SylaidisAmy Jeeves

Our plastic surgeons are:

VISITING EAR, NOSE AND THROAT SPECIALIST … continued

The Hospital is fully accredited by the Australian Council of Health Care Standards. Mt Barker District Soldiers Memorial Hospital is an acute care public Hospital offering a variety of surgical procedures including ENT.

Enquires to Noel Cornwill, Clinical Services Coordinator, Surgical Services, Mt Barker DSM Hospital. Enquiries welcome by phone 8393 1752 or email [email protected]. All applications close Friday 31 October. Send your expression of interest to the undersigned together with a curriculum vitae that evidences your registration as an ENT specialist with the Medical Board of Australia AHPRA (incorporating three professional referees) to: Ms Lynette Pascoe, Executive Assistant, Mt Barker DSM Hospital, PO Box 42, Mt Barker SA 5251. Or email to: [email protected]

mental healthissuesheadingAMA(SA) Member Benefi ts – in more ways than one!

A South Australian commercial law fi rm, Norman Waterhouse Lawyers provide legal advice for personal and professional matters. As an AMA(SA) member, you will have access to concierge service team – partners Lincoln Smith 08 8210 1203 or Sathish Dasan 08 8210 1253

• 5% discount on standard rates.

Hood Sweeney is a South Australian professional services fi rm providing valued accounting and wealth management advice to health professionals for over 30 years.

Hood Sweeney provides AMA(SA) members with a concierge service team – Lisa Hickey & Adrian Zoppa

Phone: 1300 764 200Email: [email protected]

Qantas Club membership is offered to AMA(SA) members at discounted rates. Qantas Club members can take advantage of exclusive world-wide facilities and services when travelling. AMA(SA) members receive over 25% discount on membership.

• 1 Year - $390.60 (save $119.30)• 2 Year - $691.50 (save $227.50)

One Path offers AMA members quality insurance products including Professionals Life Cover Plus and Income Replacement Plans. Protect your family whatever the future may hold. Choose from one of two cover options – Simple Cover and Underwritten Cover

• Apply online for a Life Benefi t of up to $1.5million.Use your AMA member login details for verifi cation.

AMA has worked with American Express to bring you a selection of highly rewarding cards. Simply choose from the AMA Gold Credit Card, the AMA Platinum Edge Credit Card, the AMA Platinum Reserve Credit Card, the AMA Gold Charge Card, the AMA Platinum Charge Card.

Go to www.ama.com.au/memberservices and choose the card that is right for you to enjoy the special rewards and savings the AMA has negotiated.

AMA members are entitled to a discount of up to 10%* off the recommended retail price of new Volkswagen vehicles.

• The discount ranges from approximately 2.5% to 10% on passenger vehicles.

* Please contact your dealership for further information on the discount structure and membership eligibility.

The AMA(SA) is proud to offer its members signifi cantly reduced rates to the Virgin Australia lounge. There are a great variety of work zones, from private meeting rooms to work stations and open-planned meeting areas; all supported with free access to wireless broadband. Travelling for business or pleasure, enjoy the lounge’s free-fl owing hospitality and a relaxed ambience.

• Joining Fee: $100 (Save $199)• Annual Fee: $300 (Save $100 per year)

AMA members receive Corporate rates on all rental vehicles. Free membership is also available to the Hertz #1 Club Gold which allows members to avoid the queues and formalities associated with completing a rental agreement.

• FREE membership to the Hertz #1 Club Gold for express service and VIP treatment in Australia and worldwide.

Go to www.ama.com.au/memberservices and use your membership login for further details.

Whether you need a new laptop, a server upgrade or a complete I.T. makeover for your offi ce, PowerBuy offers signifi cant savings and personalised professional support to help you with your buying decision.

To view the latest PowerBuy offers, go to www.ama.com.au/memberservices and use your AMA(SA) membership login details to access the benefi ts.

AMA(SA) and the Commonwealth Bank of Australia are pleased to introduce you to Wealth Package Plus, a complete package offering a range of Premier Banking, Broking and Investment products.

Of particular interest to members in private practice are the discount merchant rates which have been negotiated with the CBA for Eftpos facilities. This package is not available via the CBA Branch network. Contact the AMA(SA) on 08 8361 0101 for further details and other great offers.

Terms and conditions apply, for further details, please refer to: ama.com.au/sa/sa-member-benefi ts

tel: 08 8361 0101 fax: 08 8267 5349

PO Box 134, North Adelaide SA 5006

www.amasa.org.au

102014

GP Payroll is offering members of the AMA(SA) a “members only” discount of over $1,000 for the installation of GP Payroll services into their practices. This service includes leading Rostering/Time and Attendance software from WageLoch, and the provision of payroll services from a company with over 10 years’ experience in the health industry.

Contact Rebecca Smith on (08) 8304 8322 or email [email protected] and quote your AMA(SA) Membership Number.

AMA(SA) members are eligible to receive Platinum member benefi ts when they purchase a BMW Vehicle through Adelaide Motors. These benefi ts include:

• Complimentary BMW Service Inclusive for 5 years / 80,000km

• Corporate pricing• Reduced dealer delivery charges• Reduced rate on a BMW Driving

Experience course

Terms & conditions apply. Please contact Shane Ion on (08) 8414 3111 or via email [email protected]

Thesinger and Turner Travel Associates is a boutique travel agency based in Norwood and has access to the best value wholesalers, tour operators, cruise lines and airlines. With the experience of their consultants, they provide tailor made itineraries and create holidays with a difference. Contact Jane Thesinger on 1800 331 916 or email [email protected] to fi nd out about exclusive benefi ts available to AMA(SA) members.

Dr. Naomi McCullum

Avant member

NEW AND EXCLUSIVE RETIREMENT REWARD PLAN.

Membership with Australia’s leading MDO has its rewards. We’re

Avant, and everything we do is designed to benefit you. Prudent

financial management has contributed to our financial strength,

which means we can return more back to you than ever before.

We have a unique Loyalty Reward Program. We have the largest

in-house specialist medico-legal team of all MDO’s in Australia.

Plus, we’ve recently introduced our exclusive Avant Retirement

Reward Plan^, established to enable us to reward members’

commitment to Avant, their contribution to Avant’s financial

success and their years of practice.

Not all doctors are the same. The same goes for MDOs. That’s

why you need to choose one with more expertise and more

experience.

Avant is owned and run purely for the benefit of its doctor

members. So if you’re looking for an MDO that uses its financial

strength solely for the benefit of its members, Avant is the answer.

*IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268. ^The Retirement Reward Plan reflects the current policy of the Board for determining which members of Avant are eligible to participate in the Retirement Reward Plan and any Retirement Reward Dividends declared by Avant. The Retirement Reward Plan is entirely at the discretion of the Board and no member will be eligible to receive a Retirement Reward Dividend until such time as the Board declares a dividend in favour of that member. The Retirement Reward Plan is subject to change, suspension or termination by the Board at any time.

Your Advantagemutual group

To find out more, call 1800 128 268or visit avant.org.au

Whose financial strength makes for a more rewarding relationship?

Q:

Avant. Experience has its advantages.

medicsa oct14 cover final · 2015. 1. 12. · medicsa october 2014 1 australian medical association...

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