twrama 1990_final oc.. - AMA WA

WESTERN AUSTRALIAMEDICUS 

Journal of the Australian Medical Association WA | October 2012 Volume 52 / Issue 9 | amawa.com.au 

suicide 

breaking the silence

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Council 

President 

Dr Richard Choong 

Immediate Past President 

A/Prof David Mountain 

Vice Presidents 

Dr Michael Gannon 

Dr Andrew Miller 

Honorary Secretary 

Dr Omar Khorshid 

Assistant Honorary Secretary 

Dr Janice Bell 

Honorary Treasurer 

Dr Simon Towler 

Councillors 

Division of General Practice (WA) 

Prof Bernard Pearn-Rowe 

A/Prof Rosanna Capolingua 

Division of Specialty Practice 

Dr Tony Ryan 

Prof Mark Khangure 

Division of Salaried and State 

Government Services 

Dr Dror Maor 

Dr Daniel Heredia 

Ordinary Members 

Prof Gary Geelhoed 

Dr Stuart Salfinger 

Dr Marcus Tan 

Co-opted Members 

Dr Steve Wilson 

A/Prof Frank Jones 

A/Prof Peter Maguire 

Prof Geoff Dobb 

Dr Dror Maor 

Dr Cassandra Host 

Dr Ian Jenkins 

Prof Ian Puddey 

Prof Gavin Frost 

Dr Alexandra Welborn 

Mr Benjamin Host 

Mr Ghassan Zammar 

Contents 

4 

GP Breakfast 

PCEHR on the menu 

October 2012 

22 

Silence kills 

It’s time to talk about suicide 

AMA (WA) Office 

Executive Director 

Mr Paul Boyatzis 

Director: Industrial & Legal 

Ms Marcia Kuhne 

Executive Officers 

Mr Michael Prendergast 

Ms Christine Kane 

Ms Clare Francis 

Mr Gary Bucknall 

14 Stirling Highway 

Nedlands WA 6009 

(08) 9273 3000 

mail@amawa.com.au 

www.amawa.com.au 

Medicus 

Editor and Director of 

Communications 

Mr Robert Reid 

Deputy Editor 

Ms Janine Martin 

Advertising Inquiries 

Phone Mr Des Michael (08) 9273 3000 

Copy Submissions 

Phone Ms Janine Martin (08) 9273 3009 

or janine.martin@amawa.com.au 

Services 

Business Services Manager 

Ms Noelle Jones 

Financial Services Manager 

Mr John Gerrard 

Medical Products Manager 

Mr Anthony Boyatzis 

Health Training 

Australia Manager 

Mr Geoff Jones 

The publication of an advertisement, 

article or inclusion of an insert does not 

imply endorsement by the AMA (WA) of 

the views, service or product in question, 

and neither the AMA (WA) nor its agents 

will have any liability for any information 

contained therein. 

7 

Women in medicine 

Work-life balance 

Features 

GP Breakfast: PCEHR 

04 28 

More questions than answers 

22 

Cover Story: Silence kills 

It’s time to talk about suicide 

REGULARS 

02 Presidents’ Desk 

03 From the Editor 

7/48 Event 

09 Industrial 

14 News 

18/30 Opinion 

38 Tomorrow’s health: 

The future of Radiology 

46 

41 Snippet 

44 For the record: 

Dr Clayton Golledge 

51 Dr YES 

54 Travel 

56 Food 

57 Wine 

58 Drive 

51 

Dr YES 

Kimberley on the radar 

The fight continues 

The Sydney International 

Breast Cancer Congress 

No Smoke without Ire 

The battle against Big 

Tobacco can’t weaken 

60 Technology 

62 Photography 

64-65 Members only 

Benefits & On theh Town 

66-71 Classifieds 

Professional Appointments 

& Positions Vacant 

October MEDICUS 1

PRESIDENT’S DESK 

Waiting, watching, vocal 

by Dr Richard Choong 

AMA (WA) President 

It is always fascinating to see an idea take hold on the 

public mind, especially an idea that the Australian 

Medical Association (WA) has helped formulate and 

advocate. 

One of the great things as AMA (WA) President and 

one of the things I have most enjoyed in my four months 

in the job (yes, time is really going quickly!) is seeing the 

huge range of issues your Association is involved in. We 

are not just an industrial organisation, or public health 

advocates, or a training group, or run Dr YES, or provide 

investment advice to medical professionals. We seem to do 

it all! 

The debate on the health impact on Fly-in, Fly-out 

(FIFO) and Drive-in, Drive-out (DIDO) is one of those 

issues that has already had a major impact in terms of 

stimulating debate. The AMA has taken the lead in talking 

clearly about the short and long-term impact of FIFO and 

DIDO on health – both individual health and the health 

sector on a wider basis. 

The solutions to this issue have yet to be finalised. Many 

people at the moment seem to be waiting for solutions to 

be suggested by the current Federal Parliament inquiry 

into the issue. 

However the long-waited-for (and now obviously 

delayed) report will only keep the debate going and with a 

Federal Election likely to be in the second half of 2013, any 

government reaction to the recommendations is unlikely to 

be seen until 2014 at the earliest. 

The AMA has therefore been proposing potential 

solutions to the issues since we raised them in 2011. It 

has been interesting to see the way in which health issues 

around FIFO have become a key topic for discussion and 

debate. 

I was invited recently to attend a FIFO Forum organised 

by the Public Health Association at the University of WA 

– which was an excellent way in which to keep the debate 

going locally and to attempt to suggest some solutions 

while we wait (and wait) for the Parliamentary inquiry to 

report. 

Such distinguished members of the WA medical 

community as Tarun Weeramanthri, the Executive 

Director, Public Health at the WA Health Department; 

Professor Steve Allsop, Director of the National Drug 

Research Institute; Gemma Crawford, president of 

the Australian Health Promotion Association and Dr 

Maryanne Doherty, Associate Professor of Sexology, 

School of Public Health, Curtin University spent a 

morning discussing FIFO health-related issues. 

After hearing a number of papers on the issue, there 

was an active discussion by participants on the subject 

before breaking up into specific groups to discuss the most 

important issues for each participant and their proposals 

for next steps. 

It perhaps wasn’t surprising but was certainly 

encouraging when one participant in the Forum, who I did 

not know, stood to make his comments on the issue and 

quoted from the AMA (WA) submission submitted to the 

Parliamentary Inquiry as indicating some of the ideas and 

potential ways that health could be assisted. 

One of the major outcomes of the forum was the clear 

need for more research to be conducted within the FIFO 

issue. 

As we made it clear in the AMA submission to the 

Parliamentary Inquiry, this is an area where research 

is badly needed. There is, for example, still no clear or 

trustworthy data on the numbers of FIFO workers; there 

is no clear data on the health of FIFO/DIDO workers 

in particular and there are virtually no 

studies on the wider impact 

of FIFO on families or 

communities. 

Interestingly there 

are other conferences 

being organised on 

the issue and there …there are virtually 

are a number of 

no studies on the wider 

research projects 

currently getting impact of FIFO on 

underway. The 

families or communities 

AMA is proud to 

have played a small 

part in attracting 

attention on the issue. 

I am proud to be 

involved with, and President 

of, an Association that has assisted in 

creating debate about serious public health issues. We too 

await with some expectations the recommendations of the 

Parliamentary Inquiry. 

White we wait however, we refuse to be quiet. We have 

made a number of proposals not just for government 

assistance but for ways in which the private sector, 

especially mining companies can contribute. That is our 

role in the West Australian and Australian society 

and that is a role in the debate that I am proud to 

continue. ■ 

2 MEDICUS October

FROM THE EDITOR 

AMA (WA) advances into 

social media space 

Perhaps this is news that should be on the cover of 

this month’s Medicus because it will certainly change 

the way you see your Association. Just a few days ago, 

Australian Medical Association (WA) president Dr Richard 

Choong officially launched the AMA (WA) Facebook page 

and our Twitter feed. 

As a President who already has a strong Facebook 

presence, Dr Choong said it was time for the AMA (WA) to 

develop its online offerings to members. 

“This is an excitement development and one that I 

have been waiting to see for some time. With more than a 

billion people with personal Facebook pages – and rising – 

while Twitter is growing at an incredible pace and is used 

by millions to get their news and views to others, it was 

important that we increase our standing in this form of 

communication,” Dr Choong said. 

“Not to enter the social media world would be a 

disservice to our members and to the future of the AMA in 

our fast developing state. 

“This is the future of communication and we have to 

be in this social media space. This is not a new way of 

communicating; it has been with us for almost a decade, has 

already had a tremendous impact in wars, revolutions and 

policy developments and will continue to do so.” 

The AMA (WA)’s social media presence will be an 

additional source of information to our website (www. 

amawa.com.au) and of course Medicus, which continues to 

grow, both in page numbers and impact. 

The decision to enter the “social media world” was not 

a difficult one, mainly because that is where our members 

increasingly are making their presence felt. More and more, 

our members are getting their news not from the daily “old” 

media but from online news sources. 

Twitter itself is regarded as a news source. During a 

recent conference at the United Nations in New York 

on the day there was a multiple shooting just down the 

street outside the Empire State Building and I watched in 

amazement as the Twitter feed filtered through the room as 

the news cascaded from person to person. Second by second 

the news came through about the event that was happening 

just down the street. As each tweet came through, the 

heads of conference participants would look down, 

virtually as one. 

Prior to Twitter and similar applications, we relied on 

the web to provide our members information about their 

Association. Prior to that of course, we relieved on the slow 

(sometimes extremely slow) postal service and before that, 

word of mouth was relied on to pass information around the 

community. 

So in many ways, social media and the internet is just 

another way to pass on information, certainly faster but no 

more dangerous, suspicious or evil. 

I am reminded that before the introduction of television 

in Australia in 1956 the then Menzies Government formed 

a Royal Commission into the new-fangled thing. At the time 

it was thought the powers of a full Royal Commission were 

needed to get to the bottom of what television really was and 

what threats it posed to the generally somnolent community 

of the 1950s. 

Some of the evidence given to the Commission was of 

the most fearful order imaginable – suggestions of mind 

control, of socialist (or even communist) domination. This 

was despite many countries having fared fairly well with 

television for some years. 

Of course, TV was introduced to Australia and has 

had many positive – along with one or two negative – 

impacts. Overall however our community is a better 

educated more democratic and entertained society as a 

result of TV. 

Such has been the reaction to social media by some in 

the community that I fear a similar nervousness about 

the impact of what is, in effect, just another way of 

communicating with each other. 

For more information about our entry into the social 

media sphere, please go to the AMA (WA) website to 

click through to both our Facebook page (please feel 

free become a friend) and Twitter (feel free to become a 

follower). We look forward to welcoming you. ■ 

October MEDICUS 3

GP BREAKFAST 

Breakfast 

More than 70 general practitioners met over a 

seminar breakfast in late September to hear the 

latest information about the implementation of the Federal 

Government’s much-heralded Personally Controlled 

Electronic Health Record (PCEHR). 

While the AMA is supportive of patients having 

responsibility for their own health, there remain issues about 

how general practitioners should use PCEHR in their day-today 

medicine. 

Former AMA (WA) president Professor Bernard Pearn- 

Rowe told the meeting about the best – and the worst – aspects 

of the Government’s roll out of the program, but indicated 

that everyone wanted it to work for the good of their patients. 

The seminar also received a briefing from Melbourne GP 

bites into the PCEHR 

The debate about the Personally Controlled 

Electronic Health Record rages on 

and member of the Federal Government’s National Electronic 

Health Transition Authority, Dr Nathan Pinskier. 

Seminar participants were told that medical practices 

would need to make significant capital investments and well 

as time to make best use of PCEHR and that the AMA would 

continue to push the government to recognise the impost of 

the scheme on GOPs. 

A vigorous Q&A session followed the presentations with a 

volley of pertinent questions raised by attendees. AMA (WA) 

Councillor and GP, Dr Steve Wilson asked attendees to take 

their representative hats off and speak as GPs. 

“I can see an awful lot of practices scrambling towards this 

next year just to maintain getting e-PIP, which is substantial, 

without decent knowledge of the pitfalls, the legal issues, 

Informative: Dr Nathan Pinskier and Dr Bernard Pearn-Rowe 

present their views on the e-health record. 

AMA (WA) President Dr Richard Choong moderates at the 

GP Breakfast. 

4 MEDICUS October

GP BREAKFAST 

Please clarify: Dr Steve Wilson, Chair of AMA (WA) Council of General Practice and Dr Michael Jones ask some hard questions. 

the signing-on process, and the government’s terms and 

conditions which I think, are still too onerous towards the 

practitioner,” Dr Wilson said. 

“How dare the government make a mandatory leverage off 

the e-PIP as early as next year when this is definitely a work in 

progress,” he added. 

Dr Pinskier agreed it was a “problem” and pointed out he 

too was “stunned” when it was announced on budget night 

that non-registration for the PCEHR would mean no e-PIP. 

“They (government) will reap the consequences,” he said 

adding that unfortunately in the meantime, practices would 

have to make the call. 

Among other issues, questions were also raised about the 

deletion or suppression of records. In the current system, 

consumers can press the ‘remove’ button and the record will 

not be available to the doctor. The consumer can at a later time 

‘restore’ the information. 

“While this is not going to be a common event, it is certainly 

a concern, said Prof Pearn-Rowe adding the information could 

be forensically recovered, but this would be a time-consuming 

process. 

Dr Pinskier said the information was always available within 

the system, but it depended on the consumer. 

“The current advice for medico-legal people is that because 

this is a new world and a new state of affairs, if you are going 

to rely on the PCEHR, was to download the info, keep a copy 

and store it locally,” Dr Pinskier said. 

For the first time, during the seminar, tweets were sent to 

medical professionals who were unable to attend. ■ 

For the convenience of those members who were not able to attend, 

video of the seminar is available on www.amawa.com.au. 

For more on the PCEHR and the GP Breakfast, see Dr Steve 

Wilson’s column on page 18. 

Dr Nathan Pinskier briefed the gathering 

on what to expect in the coming months. 

Dr Karutha Jayaraman, Dr Tim Ong and 

Dr Bryan Meyerkort. 

Dr John Tomasich, Dr Adrian Hobley and 

Dr Karina Greenwell. 

Dr Stephen Jarvis and Dr Robert Chandler. 

Dr Moya Wood and Dr Patricia Dowsett. 

Dr Dele Babalola and Dr John Joyce. 

October MEDICUS 5

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EVENT 

Walking the tightrope 

Maintaining work-life balance becomes particularly precarious for women 

looking to make their mark in medicine 

The inaugural Women in Medicine breakfast was well attended by a cross section of 

female doctors. (Right) Courtney Majda, President of Fremantle Hospital’s RMO Society 

welcomes attendees. 

On 22 September 2012, the AMA (WA) and MDA 

National jointly sponsored the Fremantle Hospital 

RMO Societies’ inaugural Women in Medicine breakfast. 

The participants heard from Associate Professor Paula 

Johnson, Respiratory and General Medicine Physician and 

Dr Amanda Foster, General Surgery Fellow – both from 

Fremantle Hospital. 

Dr Foster discussed work-life balance and the challenges 

she faced working in general surgery through her experience 

on the training program coupled with starting her family. 

A/Prof Johnson discussed the important role of 

mentorship and teaching based on her experiences as a 

physician and academic. 

Dr Foster pointed out it was a challenge trying to balance 

safe working hours with the need to achieve a certain 

number of procedures to meet the expectations of the 

general surgical training program. She had several tips for 

the participants: 

At work: 

• Love what you do, do what you love 

• Collect mentors 

• Aim for perfection (after all, this is what our patients 

deserve). 

At home: 

• Try not to feel guilty 

• Accept help 

• Be flexible 

• Accept that nobody’s perfect. 

A/Prof Johnson discussed her experience working in the 

UK and how she was fortunate to find many supportive 

female consultants who assisted her greatly, albeit that some 

of her greatest supporters have been male consultants. 

Other advice A/Prof Johnson offered was: 

• Opportunities may arise, that at first glance do not 

appear to be part of your initial direction. But these can 

subsequently lead to other greater opportunities. 

• Ensure that you have something else other than purely 

clinical work as part of your consultant career. 

• Put boundaries around your family life as medicine will 

attempt to infiltrate every aspect of your world if you 

allow it. 

• It is vitally important to find and foster mentorships 

both for yourself and of others. 

The AMA (WA) was proud to be a part of this inaugural 

event for Fremantle given the work that the DiT Committee 

is currently undertaking via its Working Party on part-time 

employment seeking to establish part-time and flexible 

working arrangements and better work-life balance as an 

accepted and embedded part of employment options within 

WA Health. ■ 

Looking back: A/Prof Paula Johnson discussed her experience 

working in the UK and how she was fortunate to find many 

supportive female consultants. (Inset) Dr Amanda Foster recalled it 

being a challenge trying to balance safe working hours with the need 

to meet the expectations of the general surgical training program. 

October MEDICUS 7

Providing excellence 

in health care 

St John of God Subiaco Hospital provides excellence 

in health care by offering some of the most advanced 

technology and facilities, including ‘Marvin’, the 

first robot in Western Australia that has performed 

more than 500 prostatectomies for prostate cancer. 

Continuing to prove robotic technology is the way of 

the future, patients have enjoyed numerous benefits 

from successful robotic procedures at the Hospital. 

Committed to providing top quality medical and surgical post 

graduate education, the Hospital has recently launched two new 

and innovative programs for pre-vocational doctors, SMART 

(Surgically Mentored Applied Practice, Research and Training) 

and VIPER (Vocational Introductory Physician Experience 

Rotation). These programs provide exposure to personalised 

teaching by senior specialists, supervised clinical research 

opportunities and leadership and community engagement 

experiences. 

Spending significantly on social outreach initiatives each year, 

the Hospital has a long history of working with and helping 

people within the community. The latest service, Horizon House 

Dianella, is Australia’s first accommodation service solely focused 

on supporting homeless young women prepare for the birth of 

their baby and assisting them to find a secure home. Open since 

May 2012, Horizon House Dianella provides a safe and caring 

home for up to ten young women aged 16 – 22. 

With more than 1200 nurses and midwives, and 700 accredited 

medical specialists, the Hospital is renowned for its excellence 

in clinical care and is continually evolving to provide the best 

possible care for patients and visitors. 

Follow us or fill us in on what’s happening in your world 

St John of God Hospital Subiaco 

HEAD OFFICE 

Ground Floor 

12 Kings Park Road 

West Perth WA 6005 

T (08) 9213 3636 

8 F (08) MEDICUS 9213 3668 October 

E info@sjog.org.au 

BUNBURY 

Cnr Robertson Drive 

& Bussell Hwy 

Bunbury WA 6230 

T (08) 9722 1600 

F (08) 9722 1650 

E info.bunbury@sjog.org.au 

GERALDTON 

12 Hermitage Street 

Geraldton WA 6530 

T (08) 9965 8888 

F (08) 9964 2015 

E info.geraldton@sjog.org.au 

MIDLAND 

T 1800 735 719 

F 08 9213 3668 

E info.midland@sjog.org.au 

MURDOCH 

100 Murdoch Drive 

Murdoch WA 6150 

T (08) 9366 1111 

F (08) 9366 1133 

E info.murdoch@sjog.org.au 

SUBIACO 

12 Salvado Road 

Subiaco WA 6008 

T (08) 9382 6111 

F (08) 9381 7180 

E info.subiaco@sjog.org.au 

PATHOLOGY 

23 Walters Drive 

Osborne Park WA 6017 

T 1300 367 674 

F (08) 9204 2974 

info.pathology@sjog.org.au

INDUSTRIAL 

A matter of record 

The AMA regularly receives calls from patients of retired 

doctors needing to access or obtain a copy of their medical 

record. Unfortunately, the Association is not always able to assist 

some of these patients due to the fact that no contact details have 

been provided to the AMA by the retiring doctor. 

The Privacy Act 1988 (Commonwealth) created obligations for 

doctors working in private practice. What this means for doctors 

is that: 

• They have new obligations to safeguard patient privacy and to 

give patients some control over how information is handled 

• They are required to be more open with patients than before, 

and 

• They are generally required to provide patient access to the 

information held about them. 

• Doctors who are planning to retire or who are in the process 

of closing their practices, regularly contact the AMA asking 

how long they are required to keep their medical records. In 

Western Australia the requirement is: 

• For an adult: 10 years from the date of the last consultation 

• For a child: Until the child reaches 30 years of age. 

Since the Limitation Act 2005 came into effect on 15 November 

2005, in WA, these general periods are appropriate. However 

there are circumstances where an application can be made for 

an extension of time with which to start legal proceedings. The 

doctor should note different times apply for persons with a mental 

disability and indefinite retention is recommended for this group. 

You should also contact your Medical Defence Organisation to 

discuss this issue further. 

OPTIONS FOR STORAGE AND PATIENT ACCESS TO 

MEDICAL RECORDS: A retiring doctor has limited options. 

In the first instance he should attempt to have a colleague in the 

practice take over responsibility for the patient’s records. If the 

doctor practises on his own and is closing his practice, he should 

consider contacting colleagues who may be prepared to take over 

the patient records. If the doctor finds a colleague(s) prepared to 

take over the records, the retiring doctor should send out a circular 

advising of the impending retirement and include in the notice that 

the records will be held by the nominated doctor and the practice 

details. 

If no arrangements can be made to transfer the records to 

another doctor, then suitable arrangements must be made so that 

they can be easily accessed if required. 

It is also very important to inform patients as they contact your 

practice of the closing date of the practice and the new contact 

arrangements for accessing the patient records. If no arrangements 

can be made to transfer the records to another doctor, then suitable 

storage arrangements should be made and contact details provided 

for easy access. In this case, the doctor should: 

• Determine whether he will store the records himself or use a 

records management facility 

• If the doctor decides to store the records at home, he should 

ensure that the records are fully secured and protected from 

the elements (i.e. moisture etc.) 

• If opting to use a records management company, they should 

ensure they have a separate file or database of the patient’s 

files. Members can contact the AMA [(08) 9273 3008] for a 

list of records management companies. Costs for this service 

vary between providers. 

• Doctors who have electronic medical records should ensure 

that backup of the data is kept in secure locations. More than 

one backup copy should be made and stored. 

• Members should notify the AMA’s Membership Department 

of their retirement date and where their medical records are 

to be stored and the contact details for access to the records. 

An additional contact should also be provided to cover for 

those situations where the doctor is on holidays, in the event of 

illness or similar circumstances. 

The AMA, when contacted by patients seeking a copy of the 

patient record is then able to take the patient’s contact details and 

send the request to the doctor or the designated contact person for 

action. 

Members wishing to discuss this matter further can contact 

Michael Prendergast on (08) 9273 3008. ■ 

October MEDICUS 9

INDUSTRIAL 

Changes to ‘Keeping In Touch’ Day 

The Federal Government’s paid parental leave scheme that 

allows employees on unpaid parental leave to take their 

‘Keeping in Touch’ days without affecting 

their National Employment Standards 

entitlements take effect on 1 October. 

What is a ‘Keeping in Touch’ Day? 

A ‘Keeping in Touch’ day is a day on 

which an employee performs work for 

the practice in order to keep in touch 

with their employment so they can 

facilitate a return to that employment 

after a period of unpaid parental leave. 

Activities such as training days, planning 

days and conferences would meet this 

requirement. 

From 1 October 2012, the National 

Employment Standards will be 

amended so that an employee will 

be able to perform paid work for 

the practice on up to 10 ‘Keeping in 

Touch’ days while they are taking unpaid 

parental leave – without breaking the 

continuity of their period of unpaid 

Doctors in Training – 

The Department of Health Medical Practitioners (Metropolitan 

Health Services) AMA Industrial Agreement 2011 was 

registered on 28 January 2011, after long and difficult negotiations 

between the AMA and the Department. A number of significant 

improvements in both salaries and conditions were obtained. 

The agreement provided for an increase in salaries and allowances 

as follows: 

• 3.75% from the first full pay period commencing on or 

after 1 October 2010 

• A further 4% from the first full pay period 

commencing on or after 1 October 2011 

• A further 4.5% from the first full pay period 

commencing on or after 1 October 2012. 

In addition there was a further increase of 5.26 per cent associated 

with the move from a 38-hour week to a 40-hour week. 

The on call rates were also significantly increased, delivering a 

33.7 per cent increase, during the life of the agreement. The final 

increase is effective from the first full pay period on or after 

1 January 2013. 

There were numerous other changes delivering improvements 

for Doctors in Training by way of the last industrial agreement. 

Further information about these changes can be found on the 

AMA (WA) website at www.amawa.com.au under the ‘Latest 

parental leave. This will be reflected in the paid parental leave 

scheme. 

From 1 October 2012 you must: 

• Allow employees to suggest or request ‘Keeping in Touch’ 

days a fortnight from the birth or placement of their child, 

but requires employers to wait 42 days before asking 

employees for such a day 

• Provide that an employee doesn’t have to work a full day 

for it to constitute a ‘Keeping in Touch’ day 

• Stipulate that an employee who performs work on a 

‘Keeping in Touch’ day is entitled to payment under their 

relevant contract or industrial instrument 

• Clarify that employees who extend their unpaid leave by 12 

months get a further 10 ‘Keeping in Touch’ days 

• Enable pregnant employees who wish to do so to start 

unpaid parental leave more than six weeks before the 

expected date of birth, if the employer agrees 

• Deal with obligations where there has been a stillbirth 

or infant death and the unpaid parental leave has not yet 

started. 

Practices should review their Parental Leave Policies to 

ensure that you meet the new requirements of the National 

Employment Standards and ‘Keeping in Touch’ days. ■ 

MHS Agreement Salary 

increase 1 October 2012 

information for DiTs’ within the ‘Doctors in Training’ section. 

However, of particular note was the additional week of 

professional development leave which can accrue from year to year 

if unused. 

The Agreement provides for further salary increases of 4.5 per 

cent effective from the first full pay period commencing on or 

after 1 October 2012.This is the final increase in salaries that are 

specified within the 2011 Industrial Agreement. Practitioners are 

likely to see this increase within the pay period of 08/10/12 and 

21/10/12 which is paid on 25 October 2012. 

To view the new salary rates, please visit the Workplace Relations/ 

Industrial Updates section on www.amawa.com.au. 

The 4.5 per cent increase applies not only to your base salary but 

also your professional development allowance, and the on call and 

call back rates. ■ 

In the meantime if members have any queries regarding the Industrial 

Agreement or the increase to salary rates they should direct their 

enquiries to Clare Francis at Clare.Francis@amawa.com.au. 

If you are not currently a member of the Association we urge you to 

consider whether you will benefit from the work that is undertaken by 

your professional association. If you come to the conclusion that you 

are a recipient of the work undertaken by your Association you can 

contribute to the Association by joining. 

10 MEDICUS October

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INDUSTRIAL 

MEDICARE 

PATIENT REBATES 

FAILING TO KEEP PACE 

WITH TRUE VALUE OF QUALITY MEDICAL CARE 

Inserted in the month’s Medicus for our General 

Practice and Specialist Private Practice members is 

a poster regarding payment of accounts. This will be 

useful as a gentle reminder to all patients visiting your 

practice to pay their accounts in a timely fashion. 

To order additional copies of 

the poster, please contact the 

Membership Office on 

(08) 9273 3055 or 

membership@amawa.com.au. 

AMA Vice President, Professor Geoffrey Dobb has said the 

new Medicare Benefits Schedule (MBS) patient rebates, to 

apply from 1 November 2012, fail dismally to reflect the true value 

of quality medical care in Australia. 

The new MBS patient rebate for a standard GP consultation is 

$36.30, an increase of just 70 cents. 

The Government’s own data show that, in 2011-12, the average 

out-of-pocket cost for patient billed services for GP consultations 

was $26.97, an increase of $1.72. 

Professor Dobb said that the MBS indexation is totally 

inadequate. 

“It is not keeping pace with the increased costs of providing 

medical care and it is shifting higher costs to patients. 

“It is also undervaluing quality medical care,” Professor 

Dobb said. 

The AMA List of Medical Services and Fees better reflects the 

value of quality medical care and what is occurring at the coalface 

of health service delivery. 

This year, AMA fees have been indexed, on average, by 3 per 

cent. This compares with the Labour Price Index of 3.65 per cent 

and CPI of 1.75 per cent. The new AMA recommended fee for a 

standard GP consultation is $71, up from $69 in 2011. 

AMA indexation places significant weight on increases in the 

Labour Price Index in order to reflect 

increasing practice costs such as staff 

wages, and operating expenses such 

as rent, electricity, computers and 

professional insurance. These costs 

must all be met from the single fee 

charged by the medical practitioner. 

Professor Dobb said that the AMA 

List of Medical Services and Fees 

provides guidance to AMA members 

in setting their fees, based on their own 

practice cost experience. 

“Successive governments have failed to index the MBS fees in 

line with other key indices such as the Labour Price Index and 

CPI, let alone the increase in the cost of delivering quality medical 

care,” Professor Dobb said. 

“There is now a significant and growing disconnect between 

MBS fees and the realistic cost of providing the services.” 

Professor Dobb said that MBS indexation has also created an 

anomaly whereby patient rebates for seeing a nurse practitioner are 

higher than the rebates for seeing a fully-qualified doctor. 

“Consultations with Other Medical Practitioners (nonvocationally 

recognised doctors) are not indexed, but nurse 

practitioner consults are,” Professor Dobb said. 

“A nurse practitioner attendance of 30 minutes has an MBS fee 

of $39.75. The same consult with an Other Medical Practitioner 

for the same amount of time has an MBS fee of $38. 

“It is absurd that a patient will get a lower Medicare rebate for a 

more highly skilled service.” ■ 

FAST FACTS 

• Since 2005, MBS fees have been indexed on average 

by 2.09 per cent per year 

• Pathology and diagnostic imaging, and some medical 

practitioner attendance fees, have not been indexed 

at all 

• Since 2005, the average AMA indexation has been 

3.11 per year 

• While 81 per cent of GP services are bulk billed, there 

is cross subsiding by patients who incur a gap, and 

their gap is increasing 

• The AMA Fees List is indexed each year based on the 

AMA MFI, which compromises Labour Price Index, 

All Group CPI, Private Motoring CPI, and Medical 

Defence Insurance (MDI) premiums. 

12 MEDICUS October

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NEWS 

WA embraces 

Good Sports program 

First in: Greg Hutchinson, President of Alexander Park Tennis Club was presented with the Good Sports accreditation certificate by 

Healthway Chair Dr Rosanna Capolingua and WA’s Good Sports Manager Greg Williams. 

Research has shown there is a widespread problem with 

alcohol in sporting clubs which can result in significant 

risks and harm to club members, says Healthway’s Chair, 

Dr Rosanna Capolingua. 

A study in Western Australia found that three quarters of 

men (77.9 per cent) and two-thirds of women (68.4 per cent) 

were potentially drink-driving when they left their sporting 

club, she said. 

Dr Capolingua was speaking at the WA launch of a new 

partnership between the Australian Drug Foundation (ADF) 

and Healthway, which will combat risky drinking in the 

State’s community sporting clubs by bringing the ADF’s very 

successful Good Sports program to WA. 

In WA, the Good Sports program will work with 

Healthway’s Healthy Club program. Good Sports has been 

working with sporting clubs across eastern Australia since 

2001 to help clubs better manage alcohol issues and to create 

a more family-friendly environment. The program has more 

than 5000 clubs involved and independent research shows the 

program is making a real difference. 

In Good Sports clubs, there is a 22 per cent drop in risky 

drinking among club members on match day, short-term risky 

drinking drops by 15 per cent and long-term risky drinking 

drops by 14 per cent. Drink Driving drops by 8 per cent in 

Good Sports clubs on game days. 

The Australian Drug Foundation’s CEO, John Rogerson 

said: “It’s fantastic that the Good Sports program will now be 

available in Western Australia, which now makes the program 

officially national. This is a fantastic State to be in because it 

loves its sport and there’s a lot of it.” 

“We know the program works; since it started in 2001 we’ve 

had a significant impact on clubs’ drinking culture across 

Australia. So we’re really looking forward to having the same 

impact in WA,’ Mr Rogerson added. 

“We really want to tackle drink driving and we want to 

bring females and families back to the clubs by creating 

family-friendly environments.” 

Mr Rogerson pointed out the Good Sports program offered 

comprehensive support and expertise to sports clubs so that 

when a club became a Good Sports club, parents knew that 

their children would be protected from misuse of alcohol at the 

club, communities benefitted from reduced drink driving and 

players appreciated an improved club culture that had been 

shown to attract more sponsors, juniors and volunteers. 

“Healthway has been working with local sporting clubs for 

many years through the Healthy Club program,” 

Dr Capolingua said. 

“This new partnership with Good Sports will complement 

our work in this area and make available extra support and 

expertise for sporting clubs wanting to do the right thing by 

their members.” 

Alexander Park Tennis Club in Menora became the first 

WA sports club to become an accredited Good Sports club. 

Club President Greg Hutchinson was presented with the Good 

Sports accreditation certificate by Dr Capolingua and WA’s 

Good Sports Manager Greg Williams. ■ 

14 MEDICUS October

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NEWS 

Bethesda connects 

to online 

Palliative Care 

Resources 

Bethesda Hospital has become a founding collaborator 

with e-hospice, an initiative launched globally on 

2 October, and managed nationally by Palliative Care 

Australia (PCA). The Claremont-based hospital is the only 

private hospital in Western Australia to be a member of 

ehospice. 

The initiative is the first globally-managed news app and 

website that will deliver international news and intelligence 

on hospice, palliative and end-of-life care. Readers can go 

online or use their iPhone and iPad to access current news, 

best practice, jobs, and events from around the globe. 

Dr Yvonne Luxford, PCA Chief Executive Officer 

said that “ehospice will bring together the expertise 

and experience of the global hospice and palliative care 

community in one place for the first time”. 

Bethesda Hospital has an outstanding reputation in the 

provision of palliative care, through its 24 bed in-patient 

Palliative Care Unit (PCU), and its Palliative Ambulatory 

Service North (PASN) – a mobile consultancy service 

based at the hospital and funded by the WA Health 

Department. 

Bethesda has also just become a partner in a collaborative 

palliative care learning project with The University of Notre 

Dame (Australia) and University of Western Australia. 

This project provides nursing and medical students with 

the opportunity to learn about the provision of palliative 

care, either at the hospital or in the community whilst being 

Encouraging: Palliative Care Australia CEO Dr Yvonne 

Luxford said ehospice would connect the expertise and experience 

of the global hospice and palliative care community in one place. 

supported by Bethesda Hospital staff, a nursing scholar, and 

a palliative care physician. 

“Bethesda Hospital is committed and passionate about 

palliative care service provision, and being part of ehospice 

is a fantastic way to share our valuable resources and 

expertise with others, as well as provide easy to access 

information for patients,” said Yasmin Naglazas, Bethesda 

Hospital’s Chief Executive Officer. 

For further information or to download the app, please 

visit ehospice.com. ■ 

Committed: Bethesda Hospital is passionate about its palliative 

care service provision. 

Leading the way: The Claremont-based hospital is the only private 

hospital in Western Australia to be a member of ehospice. 

16 MEDICUS October

Food reform on the agenda 

The Australian Food and Grocery Council (AFGC) has 

launched the Healthier Australia Commitment, an industry 

first-initiative which will take measurable action to help reduce 

the incidence of chronic preventable diseases in Australia. 

The foundation members of the Healthier Australia 

Commitment comprise some of the largest food companies 

operating in Australia. They have voluntarily agreed to the 

following collaborative and collective targets for reductions in 

saturated fat, sodium and energy by 2015: 

• Reduce saturated fat in products by 25 per cent – equivalent 

to over 3 million kilograms of saturated fat removed from 

the food supply. 

• Reduce sodium in products by 25 per cent – equivalent to 

over 270,000 kilograms of sodium removed from the food 

supply. 

• Reduce energy, with a focus on energy-dense, nutrient-poor 

products by 12.5 per cent – equivalent to over 100 billion 

kilojoules removed from the food supply. 

Professor Simon Stewart, Head of Preventative Health at the 

Baker IDI Heart and Diabetes Institute, said that by focusing 

on diet and targeting those nutrients of concern associated with 

chronic preventable disease, industry is making a significant step 

towards improving the health of Australians. 

“Australia’s current rates of chronic preventable diseases such 

as obesity, Type II diabetes and cardiovascular disease are high, 

placing a strain on Australia’s health system. While there are 

many factors that contribute to maintaining a healthy lifestyle, 

improving the diet is a key factor and these 2015 targets set by 

the industry have the ability to significantly improve Australia’s 

health,” Professor Stewart said. 

The Healthier Australia Commitment’s foundation members, 

which represent more than 25 per cent of the food and grocery 

industry, include Unilever, Nestle, Campbell Arnotts, General 

Mills, Lion, Sugar Australia, Coca-Cola South Pacific, and 

Pepsico Australia. 

AFGC’s Chief Executive Officer Gary Dawson invited 

industry and non-industry organisations such as health groups, 

community associations and professional bodies, who share 

a vision to create a healthier Australia, to participate in the 

initiative. 

NEWS 

“Product innovation is just one pillar of the Healthier Australia 

Commitment, and a holistic approach combining diet and 

exercise is needed to address the health of Australia. We see the 

benefit in building alliances with other partners to help us meet 

these challenges,” Mr Dawson said. 

“The Healthier Australia Commitment will also address 

the imbalance between what we eat and the exercise we do, by 

partnering with peak professional body Exercise & Sports Science 

Australia (ESSA). 

“ESSA will be working with the Healthier Australia 

Commitment to launch ‘Exercise is Medicine Workplace Physical 

Activity Resources’, aimed at promoting physical activity and 

reducing inactivity in and outside of the workplace. 

“The Healthier Australia Commitment will also be connecting 

with Australian families through ‘Together Counts’ (www. 

togethercounts.com.au) an online platform to educate the 

community about the concept of energy balance, promoting 

healthy eating and physical activity, which is based upon the 

highly successful American ‘Together Counts’ Program, 

supported by Michelle Obama. 

“The Healthier Australia Commitment demonstrates the 

industry’s united approach to reaching nutrient reduction 

targets in the marketplace and believe this is a step in the right 

direction,” Mr Dawson said. ■ 

Food wise: Professor Simon Stewart, Head of Preventative Health at the Baker 

IDI Heart and Diabetes Institute said focusing on diet was key. 

(Above right) The Australian Food and Grocery Council’s CEO Gary Dawson 

said the Healthier Australia Commitment would help reduce the incidence of 

chronic preventable diseases. 

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October MEDICUS 17

OPINION 

PCEHR: POLITICALLY Controlled 

Electronic Health Record 

by Dr Steve Wilson 

Chair, AMA (WA) Council of General Practice 

Detailed: At the recent AMA (WA) GP breakfast, Dr Nathan Pinskier informed the audience on the National E-Health 

Transition Authority’s activities. 

My article this month very much complements Medicus’ 

article on the AMA (WA)’s GP Breakfast focusing on the 

PCEHR. However, I shall paint a card-carrying, practice-owning 

GP’s view of the imminent e-changes in General Practice – and I 

am not going to pull my punches. Nonetheless, let me say from the 

outset, that in principle, the AMA, I as CoGP WA Chair and all 

clinicians on the various AMA councils support the PCEHR in 

what it is supposed to achieve. 

Firstly and positively, I congratulate the AMA (WA) for 

hosting the GP Breakfast and distributing the AMA Guide on 

using the PCEHR. As one of the 80-plus guests, I found the 

NEHTA road show slick and the information valuable if you were 

intending to willingly, safely and unconditionally participate. GP 

presenter Dr Nathan Pinskier presented all the details well but 

amid the three-quarters of an hour of ‘white noise’ of the ‘how’, 

‘what’ and ‘when’, what I really heard were the well-placed ‘why’ 

comments. Furthermore there were questions from the floor, 

unambiguous pronouncements from those within the process of 

the fait accompli nature of all of this and statements, which just 

plain angered or frightened many of us there. 

For example, Dr Pinskier stated NEHTA actually had no idea 

of what the software vendors were building for the large sums 

the government was paying them. Medicare Locals are to receive 

$50 million for their role in PCEHR practice implementation and 

training, and I am sure the nationwide Roadshow budget would 

please a small African nation in foreign aid. 

I heard no fewer than six times “we will make it better over the 

years to come” – i.e. those on the PCEHR Clinical development 

18 MEDICUS October

OPINION 

systems will improve what’s there now. This is cold comfort 

considering the critical timeline begins in less than three months 

for the new e-PIP entitlements, of which there are five. The 

progressive tiers have gone and soon it’s all in or all out – i.e. you 

comply with all five components including the PCEHR or none of 

them. 

This potentially means a loss of all the e-PIP money to practices 

should you not take up the PCEHR, up to the $50,000/practice 

ceiling payment. And all while the MDOs are still advising of 

the risks, the potential for massive fines, the medico-legal liability 

arising from acting on incomplete information or the penalties 

if you access a patient’s PCEHR without them physically in the 

room, however practical or well intentioned. 

It is this government’s appalling ‘take a stick to GPs’ approach 

which leaves so many of us angry, bewildered and in an ethical 

and practical bind. As if it is not enough that there will be no 

dedicated funding for GPs to do this work (let alone how on earth 

we will absorb the additional workload it will generate), do not be 

ambushed by Minister Plibersek’s now famously empty August 

announcement on MBS Fees for PCEHR, which was positively 

media-promoted and falsely praised as if it were some sort of a win 

for the profession. Bollocks! It was nothing, merely that if you have 

a Level B consultation of already 17 minutes and you spend five 

minutes on the patient’s PCEHR, it will be allowed to become a 

Level C, so there may be a few extra dollars in it for you, nothing 

more. 

The fact is this Labor Government is struggling for political 

wins as far as it sees the forthcoming election. Despite their 

multiplicity of failures including the failed Health Reforms, Pink 

Batts and education among other issues, Australians are still fairly 

evenly divided on their policy achievements, even the Immigration 

debacle. 

But they are so fearful of the fallout of the Carbon and Mineral 

Rents Resources Taxes, they have utterly “tied themselves to 

the mast” on the National Electronic Health Record. Originally 

meant to be launched on 1 July 1 this year amid great fanfare, it 

infamously and very belatedly limped in with no real kudos and 

little media coverage ensuring that as few Australians as possible 

knew about it – instead leaving it largely promoted face to face 

through Medicare offices and mail outs. But I know in the run 

up to the election, the PCEHR will be very heavily promoted as 

a glowing success in an attempt to curry political favour with the 

electorate. And we GPs are the bunnies who are taking the fall 

over this no-carrots and all-stick approach. 

By the time you are reading this, the pitiful rise in the 1 

November MBS Fees List would have been released and all GPs 

and practices would have received a letter 

from the Department about the 

new eligibility requirements 

for the PIP e-Health 

Incentive, which represent 

a staggering rise in 

requirements for many I heard no fewer than 

practices. The first four 

six times: ‘We will 

of these requirements 

must be compulsorily make it better over the 

met by 1 February 2013 

years to come’…This is 

• Integrate health 

care identifiers into cold comfort 

electronic practice 

records 

• Ensure secure messaging 

capability 

• Achieve data records and clinical coding 

• Electronic transfer of prescriptions (e-Rx and Medisecure will 

be interoperable by January) 

• Personally controlled electronic health record system 

(by 1 May 2013) 

I am sure some practices will walk from the e-PIP; many I know 

remain undecided. Perhaps it will spur a huge shift away from 

bulk-billing as practices recoup the losses through fee-for-service 

and decouple themselves from block payments. I do know, it is a 

hell of a shabby way to treat GPs and as AMA (WA) President 

Richard Choong said, the government has not yet thrown enough 

money at this to walk away from it! 

It is a fight that I also took to the recent Federal GP Council in 

Canberra – to see if getting mad also meant getting some ‘Winds 

of Change’. Keep watching this space. ■ 

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October MEDICUS 19

OPINION 

A suitable script 

by Associate Professor Frank R Jones 

Chair, RACGP WA Faculty AMA(WA) Councillor 

common presentation to 21st century GPs is the 

A request for a ‘quick fix’ script, to solve nagging 

ailments with the gulp of a tablet. Prescribing is a complex 

issue, associated with a considerable risk of patient harm 

(note drug-related hospital admissions), which requires a 

deep understanding on a multitude of levels. Sometimes the 

skill is knowing when not to prescribe! 

The newly-qualified doctor in the 1930s had only a 

handful of useful therapeutic agents; today we literally 

have thousands. In a health environment where patients’ 

needs are increasingly complex, fast-paced pharmaceutical 

companies are working round the clock to keep up with 

the demand for new medicinal solutions. How can we 

keep up to date? In day-to-day practice, we have to rely on 

our medical software – your prescribing records must be 

contemporaneous! 

It is vital GPs not only know the drug, but also the 

person. QI&CPD programs involving therapeutics must 

continue to challenge and reflect adult learning principles. 

What would happen if there were multiple prescribers? 

How would collaboration work? Since November 2010, 

legislation has been in place that allows for non-medical 

prescribing. Health Workforce Australia (HWA) has been 

established to address the challenges of providing a skilled, 

flexible and innovative health workforce that meets the 

needs of the Australian community. It was set up by the 

Council of Australian Governments (COAG), which saw 

the need for a national, co-ordinated approach to workforce 

planning. One of its many forays into improving workforce 

planning is within the prescribing area, ‘the development 

of a national pathway to prescribing by health professionals 

other than doctors’. 

The Health Professionals Prescribing Pathway (HPPP) 

is a HWA project that seeks to deliver ‘a national approach 

to prescribing by health professionals, other than doctors, 

that covers important concepts such as prescribing models, 

competency attainment, registration and endorsement, and 

safety, quality and practice issues’. Another key component 

of the project is to develop an implementation plan for a 

national prescribing pathway. The safety of consumers 

is of paramount importance in the project. A stakeholder 

consultation has been completed (many competing voices), 

and a draft pathway trial is underway with a view to 

finalisation by mid-2013. 

20 MEDICUS October

OPINION 

Some other health professionals already prescribe: 

dentists, midwives, nurses, nurse practitioners, optometrists 

and podiatrists, as allowed by the legislation in each state 

and territory. For each of these professions, a defined 

formulary is in place. 

But what will all this mean for quality patient outcomes? 

Is it all for the good, or will there be downsides? 

The RACGP has maintained a position paper on nonmedical 

prescribing since 2009. The College has voiced 

strong concerns in response to the HPPP consultation phase 

(May 2012). Health service planning should be evidencebased 

and targeted to address specific needs or gaps. There 

is little, if any, good evidence supporting the safety of nonmedical 

prescribing. In addition, there is little evidence 

that in Australia, patients cannot access appropriate 

prescriptions via their doctor (isolated rural areas may the 

exception). The College position is that with no evidence 

base, increasing non-medical prescribing risks duplication 

of services with the risk of fragmentation of health care 

provision. Multiple prescribers also increase the chance of 

adverse events and this is compounded by the issue of polypharmacy. 

Role and taskforce substitution is not the answer 

to workforce shortage. 

There is the potential to undermine continuity of 

care and the doctor-patient relationship. UGPA (United 

General Practice Australia) also has consensus on this 

issue: to ensure consistent high national standards, a 

national curriculum and a national assessment framework 

for prescribing. Any proposed framework must have 

‘strong linkages’ with medical practitioners. Prescribers 

should be limited to specified clinical 

areas and particular locations, 

where competence has been 

demonstrated and with 

fixed specified formulary 

areas. 

Even for an 

experienced GP, 

prescribing safely is 

a challenge requiring 

a good knowledge 

of medicine and 

therapeutics, as well 

as the subtlety of the 

diagnostic process. ■ 

There is little, if 

References: 

1. Australian Prescriber 2010; 33:166-7 

2. RACGP Submission to HWA 29 May 2012 

http://www.racgp.org.au/reports/47112. 

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of non-medical 

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October MEDICUS 21

COVER STORY 

22 MEDICUS October

COVER STORY 

SILENCE 

KILLS 

It’s time to talk about and confront the issue of suicide, 

says Jan Wynters 

In exactly eight minutes from the time you start reading these words, someone in 

Australia will attempt suicide. And in just over three hours, another will have succeeded. 

It is the leading cause of death for Australians under the age of 34; more people die by 

suicide in Australia than in car accidents. Suicide spells the end of the road for so many out 

there, but its journey begins somewhere, as it insidiously thrives on those seemingly small 

frailties and insecurities. For all the tragedy it unleashes, ‘suicide’ is not a dirty word, says 

Fiona Kalaf, Chief Executive Officer of Lifeline WA. 

“There is a combination of complex socio-cultural, religious and even political 

reasons why we did not talk openly about suicide in the past,” Ms Kalaf says. 

“It is only recently that we, as a society, have begun to understand that talking openly 

about mental illness and suicide doesn’t just reduce the associated stigma, it actually 

reduces the instance of suicide. 

“One of the most common misnomers is that by asking someone if they are 

contemplating suicide, you will somehow plant the idea in their mind,” Ms Kalaf says, 

“People exhibit certain signs – these are invitations to be asked the question.” 

International research has shown that when people seek help for mental illness, they have 

an exponentially greater chance of recovering. Not talking about suicide could cause what 

may have been an episodic experience to become chronic. It is time to bring suicide out of 

the shadows because it is preventable. 

Ms Kalaf insists Australia is in a far better space right now but there is still a disquieting 

reminiscence of where we were socially, culturally and even politically. 

Continued on page 24 

October MEDICUS 23

COVER STORY 

Continued from page 23 

Lifeline’s Out of the Shadows campaign, which began in followed by the Northern Territory and South Australia. The lowest 

2010, aims at shattering the awkward silence that seems to rates were in New South Wales and Queensland. WA’s suicide rate 

shroud the subject of suicide. 

remained higher than the national rate, at 10 per 100,000. 

Each year Lifeline organises Dawn Walks on World 

Certainly rural and remote areas experience a higher rate 

Suicide Prevention Day (September 10). Forty-six walks were of suicide than metropolitan areas. A 2007 report found 

held nationally this year and here in Perth, over 300 people that deaths by suicide in regional areas were 20 per cent to 

gathered for the solemn ceremony at Kings Park. 

30 per cent higher than in major cities. 

The Dawn Walk has a multi-pronged focus as Ms 

Australia also has a considerable problem with Indigenous 

Kalaf explains: “The event helps to raises awareness of the suicide, particularly in WA and the Northern Territory. 

importance of talking openly and safely about suicide. It helps According to the Menzies School of Health Research, there 

people who might be at Suicide risk of suicide in feel Australia 

they are not alone has been a significant increase in the rate of suicide amongst 

and that they can seek help. Moreover, it is a way for those Indigenous people in the NT over the past four decades. 

bereaved by the suicide of a loved one to come together in In June this year, Federal Minister for Mental Health Mark 

In 2006, 1,799 suicide deaths were registered in Australia. From 2003 to 2007, the combined annual 

quiet contemplation and reflection.” 

Butler appointed Menzies to help the Australian Government 

suicide rate for men and women was 9.8 per 100,000. 

Lifeline estimates 1014 people think about suicide every day to develop the first National Aboriginal and Torres Strait 

– 54,000 Western Australians The following called table Lifeline’s provides data 13 11 on 14 suicide service deaths Islander in each state Suicide and territory Prevention in 2006. Strategy. Tasmania 

in the year to 30 June 

had 

2012. 

the 

This 

highest 

means 

suicide 

that 

rate, 

every 

followed 

10 minutes, 

by the Northern Territory 

The project’s 

and South 

Team 

Australia. 

Leader, 

The 

Associate 

lowest rates 

Professor Gary 

were in New South Wales and Queensland. Western Australia’s suicide rate remained higher than the 

a West Australian in crisis is calling Lifeline. 

Robinson, says the Indigenous Suicide Prevention Strategy 

national rate, at 10 per 100,000. 

Suicide by State and Territory, 2006 

Table 2: Suicide by State and Territory, 2006 7 

Suicide Deaths 

State Males Females Persons Rate per 100,000 

New South Wales 401 103 504 7.3 

Victoria 332 112 444 8.5 

Queensland 278 62 340 8.3 

South Australia 129 41 170 10.7 

Western Australia 156 51 207 10.0 

Tasmania 55 18 73 14.7 

Northern Territory 26 3 29 13.0 

Australian Capital Territory 21 11 32 9.5 

Total 1398 401 1799 8.6 

Australia is recognised as having one of the highest ratios of male to female suicides (approximately 

Each year in WA, over 4:1) compared 200 people with complete other countries. suicide and an will be an essential step towards addressing the high rates of 

even greater number harm While suicide themselves accounts in suicide for 1.6% attempts. of all deaths, (1) To it accounts Indigenous for a much suicide higher across proportion the country. of deaths A series of community 

reduce the number of within suicides specific in WA, age groups. the State This Government 

is particularly evident forums in men in aged cities 20–25 and years, towns where across 1 in the 5 deaths country were held during 

are due to suicide. 

in 2009 committed to spending $13 million over the following July and August and culminated in a national workshop in 

four years to implement Suicide a comprehensive rates for men strategy aged 25–34 with increased a steadily September. from the early These 1990s. discussions Although rates will have provide the ground work for 

decreased in recent years, youth suicide remains a major concern. 

particular emphasis on young people, young men, Aboriginal the development of a national strategy. 

people and people who live in rural and regional Western Australia. Ms Kalaf says it is commendable that the broader 

The Strategy is aligned with the National Suicide Prevention community was now paying attention to the subject of 

Strategy: Living is for Everyone (LIFE) and provides a 

Indigenous suicide as in the past this, and death by suicide in 

framework and governance structure to guide initiatives in prisons have been political hot potatoes. 

Western Australia for the future. The LIFE framework contains “It’s good to see that governments are taking proactive and 

six action areas that will guide future suicide prevention activities positive steps to make a difference,” Ms Kalaf says. ■ 

and thereby contribute to a reduction in suicide and suicide attempts. 

The table above provides data on suicide deaths in each state References: (1) (2) Western Australian Suicide Prevention 

and territory in 2006. (2) Tasmania had the highest suicide rate, Stratergy 2009-2013. 

Lifeline WA offers 

three courses 

to educate the 

community about 

suicide: 

24 MEDICUS October 

• Read the Signs: A 45-minute forum which touches on the signs of mental 

Western Australian Suicide Prevention Strategy 

17 

illness and suicide risk, and offers pathways for help and intervention. The course is 

designed keeping in mind younger men but it can be adapted to all age groups. 

• Safe Talk: A four-hour, in-depth seminar which trains an OH&S representative to 

recognise the warning signs for suicide and even perform interventions. 

• ASIST: This is suicide first aid – a two-day course which equips certain people at 

the workplace with the knowledge to diffuse an emergency situation.

COVER STORY 

FIFO CONCERNS 

Fiona Kalaf, CEO of 

Lifeline WA, says the 

emotional and psychological 

dangers of working in a highpressure 

environment such as 

the resources sector are often 

discounted. 

“For mining and 

particularly the FIFO 

workforce, a range of 

risk factors make workers 

vulnerable. 

“Resources is a highperformance, 

male-dominated 

industry and in general, men 

are four times more likely 

to complete suicide than 

women,” Ms Kalaf says. 

Alarmingly one of the greatest risk factors for suicide 

is social isolation. And although FIFO workers operate 

in remote communities, they are dislocated from family, 

HELP AT HAND 

• Lifeline 13 11 14 

• Kids Helpline 1800 55 1800 

• Mensline Australia 1300 78 99 78 

• Salvation Army Hope Line for suicide bereavement 

support 1300 467 354 

• The Suicide Call Back Service 1300 659 467 

• www.lifeline.org.au 

• Lifeline WA (08 9261 4444): Locally, Lifeline WA 

offers a range of face-to-face counselling services, 

particularly for parents and families. 

Also visit www.lifelinewa.org.au. 

friends and support structures. Certainly, drinking alcohol 

or taking drugs at such a time is a recipe for disaster. 

That said, Ms Kalaf stresses there is just anecdotal evidence 

to support a co-relation between mental illness and the FIFO 

lifestyle. 

“Financial stress is a well-known contributor to mental 

illness and suicide risk.Many are drawn to FIFO work as 

it is lucrative; this instantly removes one of those stress 

factors.” 

The FIFO worker’s family is also a strong focus for 

organisations such as Lifeline WA. 

When a partner returns home intermittently and tries to 

re-socialise with the family, stresses could multiply. 

“Ideally, a FIFO worker should take time to unwind and 

re-adjust to the different environment,” Ms Kalaf says. “But 

he/she could be returning to a raft of domestic and familial 

duties – all pressures that sometimes seem insurmountable.” 

Lifeline WA is about to embark on a research project that 

will look into the relationship between the FIFO lifestyle 

and suicide risk in particular. “We want to have a better 

understanding of this area,” Ms Kalaf says. ■ 

• Headspace (08 9208 9555): (Youth) Headspace 

offers early intervention options for youth aged 

12-25 including counselling for mental health, 

alcohol and drug abuse, relationships and education, 

among other issues. Visit www.headspace.org.au. 

• Anglicare WA (08 9263 2000): Anglicare offers a 

wide range of counselling services and refuges. 

Visit www.anglicarewa.org.au. 

Please note that if you feel the person is in imminent risk 

of harming themselves, call 000. 

For doctors and medical students in crisis, or not sure where to go for 

help with personal or health problem, call Colleague of First Contact 

(Doctor’s Health Advisory Service in WA) on (08) 9321 3098. 

Please note: With the exception of WA, all other Australian states and territories require mandatory reporting of health 

professionals. In WA doctors treating other health professionals are exempt from making a mandatory notification if they 

become aware of notifiable conduct while in the course of providing treatment. 

SOS 

• 

Warning signs of 

suicide can include: 

SOS 

Sense of entrapment and hopelessness 

• Increased alcohol and drug use 

• Noticeable withdrawal from family and friends 

• Impaired judgement 

• Uncharacteristic behaviour 

• Agitated, argumentative and aggressive 

October MEDICUS 25

COVER STORY 

Compassion is key 


By Dr Alexandra Welborn - Psychiatrist, Royal Perth Hospital 

Member, Mental Health Advisory Council of the Mental Health Commission 

daily request of our Consultation Liaison Psychiatry 

A team at Royal Perth Hospital: “kindly assess this person 

who has attempted suicide by jumping…overdose…stabbing… 

cutting…burning…gassing…car crash…shooting…hanging”. 

Suicide is one of the constant sorrows of psychiatry, and its 

spectre is ever present in the minds and hearts of the clinicians 

working with troubled patients. Kindness is essential in the 

approach to patients who have harmed themselves. I have 

been asked to provide a clinical perspective on suicide for the 

readers of Medicus. 

Karl Menninger was an American psychiatrist who 

built his practice and a substantial legacy on the tenets of 

humanity, kindness and compassion for his patients. He 

sought understanding of the adverse early life experiences 

that contributed to patients’ difficulties. Menninger made 

the brilliant observation that suicidal patients may have three 

interlinking motivations. There is clearly the desire to die, 

but also present is the desire to be killed and the desire to kill 

(Menninger, 1938). 

Menninger’s beguilingly simple message provides a searing 

insight into the violence that is necessarily present in an 

attempt to end a life. Menninger’s understanding provides 

insight into both murder/suicides and patients who attempt 

suicide by enticing another to kill them, as is seen with those 

who set out to behave in such a way to be killed by police. 

Assessments for risk of suicide must therefore also include 

the assessment of the risk of homicide, and the risk of being a 

victim of homicide or accidental death. 

There are historical risk factors for completed suicide. 

Any previous suicide attempt is the single strongest risk 

factor for death by suicide (Hawton, 2005). A person who 

has made a previous attempt will then always carry this 

increased historical risk. Perhaps more useful are possible 

precipitants for suicide impacting on a person in the hours and 

minutes before their suicidal act. These include intoxication, 

interpersonal conflict, acute loss, shame and acute loss of selfesteem. 

Young people might be goaded to suicide by others 

on Facebook, Twitter and Tumblr. Precipitants are always 

intensely personal to the individual. 

Talking about suicide is sometimes difficult for nonpsychiatric 

colleagues, who may be concerned that bringing 

up the subject increases risk in suggestible patients. There is 

no evidence that speaking of suicide with patients increases 

their risk of acting. 

I tend to start with a question about thoughts – “Have you 

been troubled by suicidal thoughts?” This then progresses 

to exploring the presence of specific plans involving 

methods. This may require an interview technique called 

‘normalisation’, which implies that all people may have these 

thoughts from time to time. Closely observe the patient’s 

affective response when asking about methods. “Have you 

stockpiled tablets, bought a hose, strung up a rope, gone up 

to a height?” The final set of questions in the ‘thoughts, plans 

and intent’ pyramid is intent. If the person has plans try to get 

a sense of how likely they are to act on them, and when. 

Be alert for the possibility of evasiveness in a patient’s 

response as it may indicate that you cannot access that person’s 

intent. Racing thoughts indicate internal agitation. Crying and 

tearfulness can indicate high levels of distress. Psychosis must 

be excluded, and if present, is particularly concerning. 

What can we do? The most restrictive intervention for a 

patient who is assessed to be a risk of suicide is referral under 

the Mental Health Act to become an involuntary patient 

allowing secure care in a locked setting. Within the locked 

wards and on general wards the patient can also be managed 

with a 1:1 special. Medications have a place to assist with 

symptomatic relief based on diagnostic understanding. 

Known specific increased risk periods for suicide include 

transitional times such as the two weeks on release from a 

psychiatric hospitalisation, the two weeks on reception into 

prison whether remanded or sentenced and the two weeks on 

release from prison. Transition to care in the community requires 

high levels of interagency communication, and aspirations 

of seamlessness of care. Other times of risk in close-knit 

communities such as schools and prisons occur after a completed 

suicide in one of the members, and this is known as contagion. 

Prevention of access to lethal methods such as guns and cars 

is specifically important to consider in young people, as their 

impulsivity is greater for biological reasons. Another important 

point to note with young people is that if their friends express 

suicidal thoughts and ask for confidentiality, then the message 

that a responsible adult be told is critical (Brent, 2011). 

We cannot predict who will die by their own hand. We can, 

though, conduct a careful assessment, guided by experience, 

to inform a management plan. Establish a therapeutic alliance. 

Try to understand the person. Any management plan attempts 

to prevent in the short term, in the medium term and in the 

long term the death of the person, by suicide. However, it is not 

always possible to prevent suicide. Colleagues whose patients 

have died require extra compassion. To finish with the words 

of Menninger, “Hope is a necessity for a normal life and the 

major weapon against the suicide impulse.” ■ 

References: 

Menninger, K., & Menninger, K. A. (1938). Man against himself. 

New York: Harcourt, Brace and Company. 

Hawton, K. (2005). Prevention and treatment of suicidal 

behaviour. New York: Oxford University Press. 

Brent, D. A., Poling, K. D., & Goldstein, T. R. (2011). Treating 

depressed and suicidal adolescents: A clinician’s guide. New York: 

Guilford Press.

Determined: Associate Professor 

Gary Robinson hopes a concerted 

approach involving community 

action and action across services 

and agencies will help diminish 

the spectre of suicide. 

COVER STORY 

Fighting for 

life 

Menzies researchers traverse the country to speak to 

communities about preventing Indigenous suicide 

“Our mob don’t like asking for help. We are proud. It takes 

a lot of courage to ask for help,” advises a plain-speaking 

Indigenous community representative. 

He’s talking with researchers from the Menzies Centre 

or Child Development and Education (CCDE) who are in 

his region to collect information and stories about Indigenous 

suicide. 

“It can take a fair amount of courage for Indigenous 

people from regional or remote communities to stand up and 

talk in this environment,” says lead researcher, Associate 

Professor Gary Robinson. “Communities can go into denial 

about suicide and become too ashamed or 

frightened to talk about it openly.” 

Battling against the horrors of Indigenous 

suicide sounds like a grim task. However 

this recent series of consultations were 

characterised more by determination to make 

things better, than they were by any sense 

of despair. 

Researchers criss-crossed the country 

during August and September conducting 

public consultations in 16 capital cities and 

regional centres in points as far distant as 

Thursday Island, Hobart, Perth and Broome. 

Their ultimate task was to seek the 

information that may help to reduce 

the distressingly high rates of suicide in 

Indigenous communities around Australia. 

The team, lead by A/Prof Robinson, 

has been charged with capturing material 

to feed into the development of a National 

Aboriginal and Torres Strait Islander 

Indigenous Suicide Prevention Plan. It has spoken to more 

than 500 people and received over 50 submissions to the 

consultation website 

www.indigenoussuicideprevention.org.au. 

There was a steely resolve on the part of the Indigenous 

and non-Indigenous people who attended the sessions to 

apply themselves to the problem and work hard to develop 

answers to the scourge of Indigenous suicide. 

“There was a sense of hope on the part of people who want 

to be heard,” said A/Prof Robinson. “They want to know 

what the options are, and have input into the strategies that 

reflect the views of their communities.” 

There were some expressions of grief from community 

members present who referred to their direct personal 

experience of losing loved ones to suicide. The consultations 

provided a supportive environment and it seemed that people 

drew strength from being able to recount their own stories in 

a safe space. 

A healthy representation of Indigenous people was present 

at all the consultations. As A/Prof Robinson noted, there can 

be no suggestion that Aboriginal people are unwilling to take 

responsibility for developing solutions to the thorny problems 

they face. 

This was not an occasion for navel gazing, he added. 

People were focused on the distinctly concrete task of 

developing a strategy that will help save lives. They were 

animated by a sense that something could be done – and that 

something would be done to prevent suicide. 

“I was blown away by how much people knew and how 

willing they were to talk about things,” 

recalls Bernard Leckning, a research team 

member who attended a number of the 

consultations. 

“You are talking about people who 

are pretty determined to get something 

done. People were animated by a belief 

that something needs to be done about the 

situation.” 

Despite the nature of the subject matter, 

there were moments of humour. A video 

that featured Tiwi Islands crooners B2M 

warning against the misuse of social media, 

for instance, generated more than a few 

laughs. 

An Indigenous representatives at one 

consultation also regaled those present with 

a tale of A/Prof Robinson being chased by 

a feral donkey – apparently unimpressed by 

academic standing – during an earlier visit 

to Anangu Pitjantjatjara Yankunytjatjara 

lands of South Australia. 

Although the consultations have finished, the team still has 

an enormous task ahead to distil the wealth of material they 

have collected and synthesise it into a cohesive response for 

government by the end of October. 

They will also be acutely aware of the importance of 

honouring the contributions of the many Australians – 

Indigenous and non-Indigenous – who gave up their time and 

contributed their expertise at locations all across the country. 

“Tough topics often bring the biggest rewards in terms of 

working with people and finding common ground,” says 

A/Prof Robinson. 

The work of his team isn’t easy, he adds, but it is 

critically important to grapple with the reality of suicide if 

governments and research organisations are to partner with 

Indigenous communities in finding a way forward. 

“This bleak toll of misery must be stemmed,” A/Prof 

Robinson says. ■ 

October MEDICUS 27

FEATURE 

The fight continues 

More money is being spent on breast cancer research than ever before, but much work 

remains to combat the disease, say Elisabeth Black and Professor John Boyages 

The 7th Sydney International Breast Cancer Congress 

(SIBCC) was held at Darling Harbour from October 23–26. 

It reminded us that breast cancer remains the most common 

cancer to affect Australian women with 1:11 developing the 

disease before the age of 75 and 1:8 by the age of 85. Whilst the 

incidence of the disease has increased steadily over the last 20 

years, survival rates have improved. Between 1994 and 2007, the 

age-standardised mortality rate for breast cancer in women in 

Australia decreased by 27 per cent (from 31 deaths per 100,000 

women in 1994 to 22 deaths per 100,000 women in 2007). 

Despite the high incidence in Australia, which aligns itself to 

other developed countries, our mortality rates are considerably 

better than that of New Zealand, Canada and the UK. 

This improved survival has been attributed to early detection 

through BreastScreen Australia, improvements and advances to 

care including better utilisation of chemotherapy and hormonal 

treatments, more specific targeted treatments and the introduction 

of a multi-disciplinary and coordinated approach to care delivery. 

Federal and state governments have invested heavily in 

the development of evidence-based guidelines and a more 

co-ordinated and systematic approach to cancer control across the 

country. Government funding directed at improving outcomes 

through best practice and a collaborative approach to care have 

had an impact and there is a high level of commitment to these 

principles across sectors – public, private and non-governmental 

organisations. 

More money is being spent on breast cancer research than ever 

before, with 30 per cent of all cancer research funding in Australia 

being directed towards breast cancer and the key national breast 

cancer organisations – Cancer Australia, the National Breast 

Cancer Foundation (NBCF), Breast Cancer Network Australia 

(BCNA) and the McGrath Foundation – meet regularly to ensure 

a collaborative approach to strategy and implementation, working 

together (and independently) to achieve improved outcomes for 

women (and men) diagnosed across the country. 

As improved survival rates and population ageing converge, 

there will be an increasing burden of older breast cancer survivors 

that may not receive the same attention to care as they had 

experienced at diagnosis. Further, with the predicted increase in 

the incidence of breast cancer, the question arises as to what else 

can be done to make further in-roads into this disease. 

So where to from here? Many Australian health professionals 

think that there should be a greater focus on prevention of 

breast cancer. Identifying risk factors and communicating them 

effectively to the wider population isn’t easy. More research into 

areas such as modifiable risk factors and genetic risk profiling is 

required and much work needs to be done in this area. Certainly, 

there is a link, particularly in post-menopausal women between 

obesity and breast cancer. The Westmead Breast Cancer Institute 

(BCI), and others, have also examined the link between low 

Vitamin D rates and the risk of breast cancer but more work is 

required to fully understand this. 

Breast cancer screening has made a difference. We 

know that the earlier a cancer is detected, the better the 

outcome, yet despite this, we are still not achieving our 

population screening targets. This is partly due to the high 

rates of opportunistic screening through Medicare. The 

BCI has estimated, that when combined with Medicare 

‘defacto screening’ the participation rates, for many parts 

of NSW, in particular, are over 60 per cent , which is one 

of the highest in the world. At SIBCC, the role of new 

technologies such as 3D breast tomosynthesis and contrast 

mammography was discussed. 

The recent debate around over-diagnosis has been confusing 

The Sydney International Breast Cancer Congress 

The spirit of collaboration continued this October (Breast Cancer Awareness Month) with health professionals from all over 

Australasia converging on Sydney for the Sydney International Breast Cancer Congress (formerly the Leura Breast Cancer 

Congress). SIBCC (hosted by the Westmead Breast Cancer Institute) brought together Australian health professionals and 

international registrants, for an innovative, multi-disciplinary congress. Australia’s leading medical, nursing, allied health 

and breast cancer groups including Cancer Australia, the National Breast Cancer Foundation, McGrath Foundation, Breast 

Surgeons of Australia and New Zealand, the Australasian Society for Breast Disease, the Australian New Zealand Breast Cancer 

Trials Group, The Australasian Foundation for Plastic Surgery and the Cancer Nurses Society of Australia all contributed to 

this significant event. 

The International Cancer Screening Network (ICSN), a conference held since 1997 and coordinated by the US National Cancer 

Institute also joined the Congress and issues of epidemiology, screening (breast, prostate, lung, cervical) and the world burden of 

breast disease were also discussed. 

BCNA held a concurrent consumer conference on the last two days of the congress, with one combined (consumer and health 

professionals) plenary session on Friday afternoon, 26 October which was co-chaired by Julie McCrossin and Associate Professor 

Nicholas Wilcken. 

28 MEDICUS October

FEATURE 

for both health professionals and consumers alike but the 

evidence remains convincing –screening works and the rates of 

over-diagnosis are probably smaller than we think. Diagnosing 

and treating ductal carcinoma in situ early is a vital element in 

Australia’s world-leading low breast cancer mortality rates. 

Keeping the focus on the patient is paramount. Australia 

leads the world in its commitment to consumer involvement 

in healthcare and patient-centred care and a personal and 

individualised approach to treatment, is the current expectation. 

Genetic profiling and testing and detailed pathology reporting 

has allowed the 

development of 

this personalised 

approach. We know 

that responsiveness 

to all treatments 

(surgery, radiation, 

chemotherapy, 

targeted and 

hormonal therapies) 

is highly dependant 

on the patient’s cancer 

and the mutations 

driving it. SIBCC 

will commence with 

two sessions devoted 

to personalised 

medicine. A lot has 

happened in breast 

Priority: Elisabeth Black is Convenor of 

the Sydney International Breast Cancer 

Congress and Director of Research, 

Education & Practice Development, Head of 

Breast Care Nursing at the Westmead Breast 

Cancer Institute. 

cancer since the inaugural congress in November 1988. 

In this era of personalised medicine, this multi-disciplinary 

model will become increasingly important as more precise 

information at diagnosis determines the treatment plan and 

requires input from a variety of clinicians, specialist breast care 

nurses, allied health therapists, general practitioners and other 

health professionals involved in supportive and psychosocial care. 

Effective coordination and communication will be even more 

crucial as our patients progress along the treatment trajectory. 

At each stage their needs will change and bring a new set of 

challenges to be faced by the woman and the team supporting her. 

As more and more women are surviving the disease, they will 

be faced with living with the life-long effects (both physical and 

emotional) of their treatments. Survivorship care is complex and 

many of the long-term side effects of treatment impact adversely 

on quality of life. A recent report by BCNA has found that sexual 

well-being, a key aspect of quality of life, is often significantly 

impacted on by treatment and is one of the longest lasting and 

most devastating consequences of breast cancer and its treatments. 

Their research found that even though the majority of women 

said they had experienced negative changes to their sexual wellbeing, 

only 35 per cent of women had spoken to someone about 

this. Less t han a 

third of health 

professionals 

reported always 

addressing 

issues related 

to sexual 

well being. 

Bone health 

is another key 

area of concern. 

Having a 

Collaboration: Professor John Boyages 

is Chair of the Sydney International Breast 

Cancer Congress, Director and Professor 

of Breast Oncology, Macquarie University 

Cancer Institute and founding Director of the 

Westmead Breast Cancer Institute. 

sufficiently 

large and high 

quality oncology 

workforce to 

manage this 

patient load is 

a key challenge 

for the future. Translating research into evidence-based multidisciplinary 

patient-centred care – right across the treatment 

trajectory, is another. Access to psychosocial care and support 

(particularly for women living with metastatic disease) is another 

ongoing priority. The collaborative approach between breast 

cancer and consumer organisations together with a strong 

commitment to multi-disciplinary breast cancer care have 

contributed significantly to our recent advances in breast cancer 

care, but we can’t rest on laurels – we need to continue to work 

together to maintain the gains we have achieved in recent years 

and to prepare for those future challenges looming on the 

horizon. ■ 

References: 

1. Australian Institute of Health and Welfare 2011. BreastScreen Australia Monitoring Report 2008-2009. Cancer series no. 63. Cat. No. CAN 60. Canberra: AIHW 

2. Australian Institute of Health and Welfare 2010. Cancer in Australia 2010: an overview. Cancer series no. 60. Cat. No. CAN 56. Canberra: AIHW 

3. Australian Institute of Health and Welfare 2012. Cancer incidence projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: AIHW. 

4. Australian Institute of Health and Welfare 2012. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer Series no. 69. Cat. no. 

CAN 65. Canberra: AIHW. 

5. Breast Cancer Network Australia (2011): Sexual wellbeing and Breast Cancer in Australia 

6. Brennan, Butow & Spillane (2008): Survivorship Care after Breast Cancer in Australian Family Physician, Vol37, No 18. 

7. Cancer Australia ( 2012 ) Breast Cancer Statistics http://www.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/breast-cancer-statistics 

8. Economist Intelligence Unit (2011):Getting it all together- Connecting Australian Breast Cancer Care 

9. National Breast and Ovarian Cancer Centre (2010): Report to the Nation- Breast Cancer 2010 

10. National Breast Cancer Centre (2003). Multidisciplinary Care in Australia: a National Demonstration Project in Breast Cancer. National Breast Cancer Centre. 

Camperdown, NSW 

11. National Breast Cancer Centre (2005). Multidisciplinary meetings for cancer care: a guide for health service providers. National Breast Cancer Centre, 

Camperdown, NSW 

12. National Breast Cancer Foundation (2010): National Action Plan for Breast Cancer Research 2010. 

October MEDICUS 29

OPINION 

HCN: complex and out of control 

by Dr Dror Maor 

Co-Chair, Doctors in Training Committee 

We have written many articles and wasted much time 

with the numerous payroll debacles that come out of 

HCN. The AMA spends numerous hours every single week 

working for our members to find solutions for problems 

caused by HCN. Every day members call the AMA or speak 

to its representatives letting them know about incorrect 

payments, underpayment, payment at wrong levels, 

inappropriate deductions and even non-payment. Many of 

these have no rhyme or reason and when questioned, are 

often reversed. 

In an article at the beginning of this year I wrote: “If 

the government is not brave enough to get rid of HCN all 

together, then there must at least be changes all the way 

from the top down to create a culture different from what 

there is today.” 

This has obviously not occurred and the Health Minister, 

Director General and all those who are in charge of HCN 

are not only failing our patients but the public hospital 

system and us, as doctors by not fairly paying us what we 

are owed. 

Junior doctors who work every day in the WA Health 

System to help and do the right things by our patients 

continue to get ignored by HCN and even dismissed by 

the Health Department and Minister with regards to the 

debacle that is HCN. We continue to have much difficulty 

in understanding our pay slips and have very little way of 

working out exactly how often mistakes are made. This 

difficulty arises from the complexity of the payslips, the 

various additions and deductions that occurs with on calls, 

after hours and the numerous missed payments. For each 

30 MEDICUS October

OPINION 

day worked, one must continue to cross check three or more 

pay slips and not uncommonly, five to 10 entries just to 

ascertain exactly what has been paid and at what level. The 

amount of time and effort involved in canvassing through 

this paper barrage continues to grow and the mistakes 

continue to add up. 

So one must once again ask, why is this happening all 

the time and importantly, why are we continuing to put 

up with this? The systematic nature of these errors is 

more than just concerning. Without any doubt, HCN is, 

on a statewide basis, failing to provide an effective payroll 

solution for the WA health service. 

This should also cause us to ask further questions of the 

Department of Health and HCN. With new hospitals being 

built and the number of medical, nursing and allied health 

professionals required to work in the public health system 

further growing, concerns must arise with HCN’s ability 

to run those projects when far less complex projects such as 

payroll are not able to be performed properly. 

All junior doctors want from the payroll side of HCN 

is to be paid for what we work and deserve, not 

one dollar more. No one likes a doctor who complains 

about pay, but how much longer do we have to put up 

with this? The question of how HCN continues to allow 

the continuous and systematic debacle of doctors’ pay 

was asked at the very beginning of this year and so far, 

HCN and the people that are in charge of this have done 

nothing to fix this broken system. Every fortnight, as the 

pay slips arrive, the same problems continue. If the payroll 

side of HCN was a doctor, they would 

have, a long time ago, been 

hauled in front of the medical 

board and had their license 

to practice revoked. 

So far, apart from 

calling for a review, 

Every fortnight, as 

which like many 

other reviews has 

the pay slips arrive, 

implemented no 

the same problems 

change, HCN 

just continues to 

continue 

fail medical staff. 

The government was 

not brave enough to 

implement changes to HCN 

when doctors asked politely. 

So now the medical community 

must demand the resignation of the people in charge of the 

payroll debacles occurring within HCN. 

I am reminded that US President Harry Truman had the 

sign on his desk: “The Buck Stops Here.” Minister Kim 

Hames, over to you. ■ 

The Mount Hospital is located at the base of Perth’s prestigious King’s 

Park and is a 15 minute walk to the CBD. The Mount Hospital offers a 

variety of specialities for the population of Perth and Western Australia. 

With the states only private Level 3 Intensive Care Unit, the Mount offers 

Cardiac, Neurosurgery, Orthopaedic, Plastics, Oncology, and General 

Surgical services, in addition to Medical and Rehabilitation specialities. 

An exciting new opportunity has arisen for a Career Medical Officer 

(CMO) to join our Coronary Care team. This position will be based 

in our newly refurbished Coronary Care Unit (CCU), working closely 

with our renowned Cardiologists, Resident Medical Officers (RMO’s) 

and Coronary Care Nurses. This new position will be well supported 

by, a fulltime RMO and will include regular clinical education by our 

Cardiologists. You will also be working closely with the Medical Director 

to ensure that clinical care standards are adhered to and maintained. 

Our CCU is a busy 24-bed unit, which takes direct admissions via a 

Priority Admission Service (PAS) as well as assuming care for patients 

following diagnostic and interventional cardiac procedures, from our 

Cardiac Catheter Laboratories. Suitable applicants will preferably have 

experience in adult cardiology and coronary care, and be able to work 

independently with minimal supervision. 

The CMO will be responsible for managing the patient’s care on behalf 

of, and in liaison with the patient’s consultant, to ensure a high standard 

of care is maintained. The CMO will also attend to ward rounds upon 

request and attend Medical Emergencies and Cardiac Arrests. 

To be considered for this position you must: 

1. Hold or be eligible for APHRA registration and should have a 

Provider Number 

2. Previous experience in Adult Cardiology and Coronary Care, 

and be able to work independently with minimal supervision 

3. Exhibit exceptional communication and leadership skills 

4. Be aware of hospital licensing and accreditations cycles, and have 

suitable experience in managing and contributing towards hospital 

based clinical risk reduction strategies. You will work closely with 

the Medical Director to ensure that clinical care standards are 

adhered to and maintained 

This position is fulltime with commencement date as soon as possible. 

A generous salary package will be negotiated, commensurate with 

experience. 

Enquires and Applications to: Jean Tin - Coronary Care Unit 

Mount Hospital, Ph: 08 9327 1100, Jean.tin@healthscope.com.au 

October MEDICUS 31

OPINION 

Decisions, decisions 

by Dr Maya Rajagopalan 

2012 Intern at Royal Perth Hospital 

am writing this article at a time when my colleagues and 

I friends are finding out whether they have been accepted 

into a training program. Some have been successful but many 

haven’t. For those that have, it is a time of relief and joy as 

they realise that their hard work and determination has been 

rewarded through the acknowledgement of their seniors. For 

those that haven’t, it is either a time of stoic resignation to 

another year as a junior doctor as they continue their current 

goals or despair as they reconsider their future goals and 

aspirations. For the few months surrounding this key moment, 

the conversations in the Doctors’ Common Room focus 

on carefully dissecting what is required to enter into each 

specialty. 

The economics of medical training has become an 

increasingly topical subject, with such issues as university full 

fee-paying medical places being a regular in the news at the 

start of each academic year. What is not regularly discussed 

is the cost associated with building up the CV to a level where 

you will be competitive in your application to a specialty 

college. Courses, conferences and further qualifications can 

cost junior doctors thousands of dollars each year, placing 

financial strain on a population who have spent a significant 

time out of the workforce studying. 

Since the start of internship, there has been increasing 

pressure for my colleagues and I to choose a specialty in which 

to pursue a career. We are all too aware of the rising number of 

junior doctors in the system, the popularity of certain training 

programs, and the desire to perfect our work-life balance. 

This has lead many to base such an important decision on 

the knowledge and experiences we have gained so far, mostly 

coming from rotations in medical school. These experiences 

were brief and superficial, lacking the insight that is gained by 

working as a junior doctor in a specialty. 

So how can we improve this situation? I don’t believe that 

there is an easy solution. The financial cost incurred for 

training courses and attendance at conferences is a burden that 

must be carried. But what we can review in Western Australia 

is the ability of junior doctors to focus on terms in which they 

have an interest. We can look at the Victorian Health System, 

which offers early streaming 

into medical, surgical, and 

critical care rotations for 

Residency giving doctors 

more experiences – thereby 

mitigating the risk of pursuing 

a career in a field that they may 

later realise is undesirable. 

Such a change may assist in 

reducing the bottleneck that is 

developing due to increasing 

demand for specialty training 

by ensuring that applicants 

are certain of their career 

choices. ■ 

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OPINION 

A hard-earned thirst 

by Benjamin Host 

President, Western Australian Medical Students’ Society 

Alcohol. It is almost ubiquitous in our society. 

Relaxation, celebration and socialisation have somehow 

become inextricably linked to the consumption of alcohol. 

Whatever the occasion, birthdays, weddings, funerals – even 

a Sunday afternoon – the tradition is there to crack a beer 

or pop the cork on some champagne. Even without these 

occasions, the promotion of alcoholic beverages pervades 

our everyday life. Be it television, radio or print, the call to 

drink is incessant, regardless of the medium. 

Why? Why is it that we feel this compulsion to consume? 

Why is it that for so many, particularly our vulnerable 

youth, there is this drive to binge drink? Why must we 

drink to get drunk? Where did we start onto the path that 

drinking is so intimately linked to enjoyment that we cannot 

have a good time without being under alcohol’s influence? 

Whatever the reasons, the harmful effects of alcohol 

cannot be ignored. The immediate dangers of alcohol 

consumption including acute alcohol poisoning, drink 

Though frequently witty 

and often hilarious, what is 

being peddled in alcohol 

advertising is little more 

driving, unsafe sex than a poison 

and violence are well 

known. In addition, the 

long-term risks of liver and 

brain damage, as well as alcohol’s 

carcinogenic potential are indisputable. 

Becoming even more understood are the deleterious effects 

of alcohol on the developing foetus and the continually 

maturing brain of our youth. Action must be taken to 

counteract the plethora of harm and the cost that this 

imposes on the community. 

Just as it was in the campaign against smoking, the 

battle against the bottle has its opposition. Breaking the 

stronghold of alcohol advertising and the links between 

alcohol and sport are necessary steps forward. Though 

frequently witty and often hilarious, what is being peddled 

in alcohol advertising is little more than a poison. Brewing 

companies, hoteliers, large supermarket and liquor retail 


October MEDICUS 35

OPINION 

The benefits of 

Interprofessional Education 

by Ghassan Zammar 

President, Medical Students’ Association of Notre Dame 

Interprofessional Education (IPE) is a learning model that has 

become a growing and important component within Australian 

medical school curriculums. IPE involves learning with (and from) 

students in other health professions. One of the objectives of IPE is 

to further medical students’ understanding of the roles that other 

health professionals play, and cultivate collaborative work practices 

in the health care industry. 1 

Although interprofessional education is currently a dynamic 

area of curricular reform, it is not a new concept in medical 

education. Many medical students across the country share 

lectures with allied health students, and many are taught the core 

content areas such as pharmacology and clinical skills, by allied 

health professionals. 

In 2010, Royal Perth Hospital played host to the first 

interprofessional student-training ward in the southern 

hemisphere. Six beds within a medical ward at the hospital 

provided the setting for three consecutive two-week clinical 

placements. This involved health science students from nursing, 

physiotherapy, occupational therapy, social work, pharmacy and 

medicine. 

Notre Dame University also continues to foster collaboration 

within health professions by placing medical students with nursing 

and allied health staff in a variety of clinical settings. 

Having personally worked in health teams, the benefits of 

interprofessional practices have become increasingly evident. 

Health professionals working in collaboration to manage complex 

practice situations can synergistically maximise the strengths 

of each health care worker and improve the delivery of patientcentred 

health care. 

But in many instances, medical students continue to have little 

insight into the roles of other health care providers in such settings. 

It is therefore crucial that medical schools help develop 

a medical workforce that is competent in demonstrating 

interprofessional learning and practice capabilities. There needs 

to be a strong emphasis on teaching medical students the roles of 

allied health professionals. This will not only help break down the 

professional silos that have continued to create practice barriers, 

but also help ensure medical students develop the interprofessional 

practice (IPP) capabilities needed once they make the transition 

into the workforce. 

Student involvement in curriculum reform and development to 

include greater interprofessional education is also important, as the 

medical profession is often resistant to change, especially when it 

is seen to encroach on the traditional roles of the doctor. Student 

leaders can help champion IPE by collaborating with fellow 

students from different health professions in an informal social 

setting, with the aim of creating friendships that extend beyond 

the IPE experience found in the classroom. 2 

Professor Richard Johnstone, Executive Director of the 

Australian Learning and Teaching Council, summed it up well 

when he said: “I think it’s important for all of us to recognise that 

in providing the best possible student learning experience, we have 

an obligation not only to encourage in our students a strong sense 

of professional identity…, but also the capacity to understand, 

communicate with, and collaborate with those in other related 

professions.” 3 ■ 

References 

1. Centre for the Advancement of Interprofessional Education (CAIPE), 

1997. Interprofessional education - a definition. London: CAIPE 

Bulletin 13, p.19. 

2. Hoffman, S. J., Rosenfield, D., Gilbert, J. H. V., Oandasan, I. 

F. (2008). Student leadership in interprofessional education; benefits, 

challenges and implications for educators, researchers and policymakers. 

Medical Education 42(7), 654-661 

3. Dunston, R., Lee, A., Lee, A., Matthews, L., Nisbet, G., Pockett, 

R., Thistlethwaite, J. and White, J (2010). Interprofessional Health 

Education in Australia: Report of the Launch of the proposal The 

Way Forward. Sydney, University of Technology, Sydney and The 

University of Sydney. 

36 MEDICUS October

OPINION 


A hard-earned thirst 

chains alike have, and will continue to, pull out all 

the stops to ensure that we as a country continue 

to drink. 

However, this is merely one small aspect of 

this problem. What is needed is more than laws 

to restrict sales and advertising. Australians need 

a paradigm shift in how we perceive alcohol. 

Throughout Australia’s history, having a drink 

and getting drunk has been seen as more than 

just a pastime – it has been viewed as a right of 

passage. It is a tradition that has been seen to 

help define us as a nation. However, just because 

something is a part of our culture does not make it 

an inherently good thing. 

The change that Australia needs to prevent the 

harm from alcohol does not involve sweeping laws 

prescribing when and what we drink. It does not 

require a prohibition. The change Australia needs 

is a change in perception, and that change must 

start with us. ■ 

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October MEDICUS 37

TOMORROW’S HEALTH 

The future of 

RADIOLOGY 

Super computers and enhanced nanotechnology will help move 

radiology into another dimension, says Professor Mark Khangure 

Many of the major advances in the broad fields of 

medicine and surgery over the last 80 years or so 

have occurred as a direct result of innovations in diagnostic 

radiology including cardiac and coronary artery surgery, 

neurosurgery, and many of the minimally-invasive surgical 

procedures. 

Over the last 30 years, image-guided interventional 

procedures – ranging from occlusion of intracranial 

aneurysms, ablation of liver and lung metastatic deposits, 

angioplasty and stenting of narrowed blood vessels to 

drainages of abscesses – have replaced open surgical 

procedures. High quality imaging (CT, MRI and ultrasound) 

leads to accurate diagnoses and image-guided fine needle 

aspirations and biopsies (common and routine procedures) 

allow pathological confirmation, removing the need for 

surgical intervention for diagnostic purposes. 

Radiology in its broadest terms is the cornerstone of the 

provision of medical services. This is the present. The future 

of radiology is exciting and bright with a move into another 

dimension as more powerful computers and nanotechnology 

allow integration of genomic data with the imaging findings. 

Accurate measurements of volume, flow, perfusion, diffusion, 

and tissue density, among other things, will create the ‘science 

(to complement the art) of radiology’. 

Technological advancements: Next 

generation CT scanners will be even faster in data acquisition 

with much lower radiation dose, improved spatial resolution, 

automated measurement tools, and ‘virtual visulisation’ of 

the lumina and walls of blood vessels and the walls of hollow 

organs as currently applied to ‘virtual colonoscopy’. Blood 

flow measurements of the brain, spinal cord and other organs 

will be obtained in a matter of a few minutes to facilitate 

therapeutic decisions. Portable small units will replace 

in-theatre fluoroscopy enabling more accurate and safer 

surgical interventions coupled with lower radiation dose to the 

patient and medical staff. 

Medical ultrasound scanners will be more compact 

with improved resolution, better tissue characterisation 

and measurements such as vascularity, elasticity and 

compressibility of tissues. Ultrasound contrast media will 

greatly further enhance the accuracy of diagnoses. 

The current high field MRI scanners (3 Tesla) will be 

superseded by 7 Tesla units, already installed at some 

locations. PET/CT will be replaced by PET/MRI. The 

combination of these technologies provides high-resolution 

structural anatomical detail, functional information at the 

cellular level, and metabolic information with a significant 

reduction in radiation dose. This technology will be crucial 

38 MEDICUS October

TOMORROW’S HEALTH 

in screening the at-risk population for neurodegenerative 

disease such as Alzheimer’s and Parkinson’s disease and 

instituting therapy before the development of symptoms. 

Inflammatory diseases of the CNS such as multiple sclerosis 

will be more accurately defined and categorised at a much 

earlier stage. Cancer patients’ chemotherapy efficacy will 

be determined after a single dose of the drug by the ability 

to determine with PET/MRI whether the drug attaches to 

the tumor receptors and will be effective – personalising the 

treatment to the individual patient. 

MRI contrast media linked to specific antibodies will 

lead to definitive diagnoses without the need for invasive 

procedure in many organs with clinical and radiological 

features of a disease. 

High field MRI spectroscopy will supplement the imaging 

data and pinpoint metabolic pathways, which are deranged 

in various disease processes in all parts of the body to both 

confirm the diagnosis and aid therapeutic decisions. 

Angiographic assessment of very small vessels including 

coronary artery branches, renal artery branches, intracranial 

artery branches and digital artery branches will be non 

invasive. 

Imaging requests and patient appointments will be 

electronic and clinical details will be available to the 

radiologist via e-health links. This will ensure that an 

appropriate imaging study is carried out to answer the 

clinical question asked. All imaging will be digital and placed 

on a central server in a secure location (e.g. the Health 

Department) regardless of where the imaging is carried out. 

All imaging providers will be linked to the central server to 

download the imaging data and the report, with immediate 

access of this data when a patient provides the authority to do 

so. The federal e-health program will in due course allow this 

to come about. 

All metropolitan, remote and rural hospitals will be linked 

via PACS and e-health consultation with specific imaging 

specialists for an opinion on difficult cases. This opinion may 

be sought at a state, national or indeed at an international 

level. This will ensure that there is ‘value added’ to the 

specialist referrer in the opinion offered. 

Interventional radiology: Image-guided 

interventional procedures and developments in techniques will 

further reduce the need for surgical interventions. Ablation 

of solid tumors will be more effective than present with lasers 

of specific wavelengths for application in the thorax, liver, 

kidneys and osseous structures. Image-guided delivery of 

chemotherapeutic agents, via direct placement (as in vertebrae, 

liver and kidneys and other solid organs) or via micro catheters 

as in brain lesions, will increase the efficacy of these agents 

minimising systemic side effects. 

Stent placement in blood 

vessels, ducts and hollow 

viscera will be much 

more accurate with 

‘CT/angiography’ as 

currently employed About 15 per cent of the 

in intracranial 

health care budget is 

vascular 

interventions. 

consumed by imaging, of 

Developments 

which about 20 per cent is 

are underway 

to manufacture 

inappropriate 

biodegradable and 

bioactive stents, associated 

with fewer long-term 

complications. 

Stroke management has advanced 

significantly in the last decade or so with the use of thrombolytic 

agents-administered IV. Dedicated stroke units with 24/7 

service and rapid clinical and imaging triage will be the norm. 

Patients with large clot burdens will be managed with both 

IV thrombolytics and direct clot retrieval by highly-trained 

interventional neuroradiologists. This model is in operation at 

several locations worldwide and has a very significant benefit in 

patient outcomes. Developments in equipment and devices for 

intracranial aneurysm management, ruptured and unruptured, 

is leading to an ever-increasing occlusion of these lesions via 

interventional means. Treatment of intracranial vessel stenosis and 

acute occlusions is a challenge, but there is progress towards the 

design of appropriate stents. 

Research and training: About 15 per cent of 

the health care budget is consumed by imaging, of which 

about 20 per cent is inappropriate. In part, this is related 

to poor communication between referring clinicians and 

radiologists and in part, lack of understanding on the part 

of the requesting clinician as to which imaging modality is 

best suited to answer a particular clinical question. Medical 

students need to be exposed to imaging paradigms to 

ensure appropriate utilisation of imaging. This can be easily 

achieved via a Chair in imaging, which sadly is lacking in 

Western Australia. However, this position will come about. 

An academic position will stimulate research at a multidisciplinary 

clinical, medical student and basic science level 

with obvious benefit for the patients of this state. 

The molecule is in sight, but it is not the end game. ■ 

An AMA (WA) Council Member, Professor Mark Khangure 

is a respected clinical neuroradiologist working with SKG 

Radiology. He was previously head of Imaging Services at 

Royal Perth Hospital. 

October MEDICUS 39

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SNIPPET 

BREAST CANCER SURVIVAL 

IMPROVING 

Survival rates for breast cancer nationally are 

improving. However, 37 Australian women are 

diagnosed with breast cancer each day, according to a 

report released today by the Australian Institute of Health 

and Welfare (AIHW) and Cancer Australia. 

The report, Breast Cancer in Australia: An Overview 

shows the number of new breast cancer cases more than 

doubled from around 5300 to 13,600 cases between 1982 

and 2008. 

“There was a sharp increase in the incidence rate of 

breast cancer between 1990 and 1995, after which the rate 

has been stable,” said AIHW spokesperson Anne Bech. 

“The sharp increase in the incidence rate in the early 

1990s was most likely due to the introduction of the 

national breast cancer screening program in 1991.” 

Breast cancer is the most common cancer in Australian 

women and the majority of cases (69 per cent) are 

diagnosed in women aged 40-69. 

“The number of women diagnosed with breast 

cancer is expected to rise in the future due to the ageing 

population. Our projections indicate that in 2020 about 

17,200 new breast cancers will be diagnosed in Australia. 

This would equate to 47 women being diagnosed every 

day,” Ms Bech said. 

“Importantly, the report also shows that survival from 

breast cancer continues to improve in Australia, with these 

improvements due to both earlier diagnosis and better 

treatments,” Cancer Australia CEO Dr Helen Zorbas 

said. 

Between the periods 1982-1987 and 2006-2010, fiveyear 

relative survival from breast cancer increased from 72 

per cent to 89 per cent. 

“Although survival rates are improving, the impact on 

the lives of Australian women is high with seven women 

still dying each day from breast cancer,” Dr Zorbas said. 

SCAR TREATMENT TRIAL 

VOLUNTEERS SOUGHT 

Researchers from The University of Western Australia’s 

Burn Injury Research Unit are seeking people with keloid 

scarring to trial a new treatment that could halt growth of the 

scars while avoiding the side effects of current treatment. 

The tumour-like scars are benign but uncontrollable growths 

that can develop at the site of burn wounds or after simple 

injuries such as scratches, insect stings, ear piercings or needle 

injections. 

Researcher Patricia Danielsen, a visiting Danish 

dermatologist-in-training and visiting research fellow at the 

Burn Injury Research Unit headed by UWA Winthrop Professor 

Fiona Wood, said it was not clear what caused keloid scarring. 

However, it was more likely to affect people with darker skin 

pigmentation, seemed to be more common amongst women – 

perhaps because of their higher incidence of pierced ears - and 

typically affected people aged between 10 and 30-40 years of age. 

“You have some kind of trauma and the skin is repaired but it 

continues to build up and grow beyond the initial boundaries of 

the wound,” Dr Danielsen said. 

“Some people end up with quite a bulky tumour of scar 

tissue and have a lot of serious symptoms. They can have pain 

and itching and there’s quite a heavy psychological side to it, but 

they might not seek help because they don’t know we might have 

an alternative treatment for them, or they may have just given up.” 

Dr Danielsen said current treatment involved surgically 

removing the keloid scar, followed by corticosteroid injections 

into the wound. Surgery alone was never enough because the 

keloids grew back, often bigger than before. Growth-inhibiting 

adjuvant drug therapy was essential but the use of corticosteroid 

injections came with the risk of side effects. 

Instead, UWA researchers will trial the drug Verapamil, 

better known for treating heart complaints and migraines but 

which may also help to treat scar tissue. 

“Verapamil is very well known – we know all the side effects 

and they’re not too serious,” Dr Danielsen said. “The aim of the 

study is to see if the treatment is just as good as the traditional 

treatment but hopefully with fewer side effects.” 

During the year-long randomised trial funded by the Fiona 

Wood Foundation, participants will have their keloid scars 

removed under local anaesthetic by Professor Wood or Professor 

Suzanne Rea. At regular intervals over the following year, 

they will be treated with injections of Verapamil and closely 

monitored for signs of re-growth. 

“We can’t offer this treatment yet as a standard treatment but 

it is a well-known and widely known medication,” Dr Danielsen 

said. “We need first to know how it goes, with long enough 

follow-up time to be certain the keloid scars won’t regrow.” 

Researchers need about 30 participants aged over 18. People 

interested in taking part or who want to find out more can 

contact the Burn Injuries Research Unit on 6488 8133 or visit 

www.fionawoodfoundation.com. 

THE 2012 WESFARMERS’ HARRY PERKINS ORATION 

If researchers are claiming so many ‘breakthroughs’, why are so many of people still getting cancer? Are we really 

making progress? The answer is a definite ‘yes’. There is much hope and good news. Come to hear about the future 

of cancer research, new treatments and how can we work together to reduce the burden of cancer on patients and 

carers. 

The Western Australian Institute for Medical Research (WAIMR) invites you to an important oration by Professor 

Joseph Trapani (pictured left), who will be visiting Perth from the Peter MacCallum Cancer Institute in Melbourne. 

Date: 2 November, 2012 (4–5pm) 

Venue: The University Club of WA, Off Hackett Drive, Nedlands 

This year’s Wesfarmers’ Harry Perkins Oration is a not-to-be missed event for anybody in Perth who is interested in 

cancer research and immunotherapy. It is free, including refreshments, but registration is essential as places are limited. 

Please contact WAIMR on 9224.0333/9224.0324 or email margot.clarke@waimr.uwa.edu.au by 25 October 2012. 

October MEDICUS 41

SNIPPET 

TIME TO END THE INTERNSHIPS BLAME GAME 

T 

he Australian Medical Students’ Association (AMSA) is calling for an end 

to the political stand-off that threatens to send Australian-trained doctors 

overseas. 

AMSA President James Churchill said it was disappointing that the recent 

goodwill from the Commonwealth Government to provide $10 million to address 

the internship shortfall had not been matched by commitments from the States. 

“It is appalling that the states have simply turned their backs on Australia’s 

future doctors by not agreeing to fund the internship positions required,” 

Mr Churchill said. 

“Communities are desperate for Australian-trained doctors, but without 

internships these graduates will be forced overseas or to pursue careers outside 

the healthcare system. 

“The Commonwealth Government has committed funding for 100 of the 182 

extra internships required, and it is time that states came to the table and paid 

their fair share. 

“This issue is not about political point scoring, it is about investing now in the 

future of Australia’s health system. 

“We are not talking about a large amount of money – about $8 million split 

among the states. It is a small price to pay to keep Australian-trained doctors in 

our health system and serving our communities. 

“A funding agreement needs to be reached immediately to allow time for 

accreditation of these positions before new doctors are due to start treating 

patients in January 2013. 

“We don’t have time for the State and Federal Governments to continue to 

quibble; we need an agreement now,” Mr Churchill said. 

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HIGHER RISK OF COMPLAINTS AGAINST SOME 

INTERNATIONAL MEDICAL GRADUATES 

I 

nternational medical graduates are more likely than their Australian-trained counterparts to have complaints made against 

them to medical boards and receive adverse disciplinary findings, according to a study published in the Medical Journal of 

Australia. 

However, the results differed markedly by overseas country of training, according to the lead author Katie Elkin and leader 

of the research group Professor David Studdert, from the School of Population Health and Law School at the University of 

Melbourne, and their co-author. 

The researchers found that doctors who qualified in Nigeria, Egypt, Poland, Russia, Pakistan, the Philippines and India 

had higher odds of complaints than Australian-trained doctors. 

The numbers of international medical graduates (IMGs) in Australian clinical practice have grown and now account for 

nearly 25 per cent of doctors in this country. According to the authors, some high-profile cases featuring incompetent IMGs 

have ignited public concerns, but there is very little hard evidence about whether the quality of care delivered by this large 

section of our national medical workforce is better or worse. 

The researchers analysed over 5000 complaints resolved by the medical boards in Victoria and Western Australia between 

2001 and 2010 and found that overall, IMGs had 24 per cent higher odds of attracting complaints than Australian-trained 

doctors, and 41 per cent higher odds of having adverse disciplinary findings made against them. 

The big differences were among IMGs themselves. For example, complaint rates against doctors trained in some countries 

were more than five times greater than complaint rates against doctors trained in other countries. 

Despite having relatively high complaint rates, the contribution of IMGs from some countries to total complaints in 

Victoria and Western Australia was small, the authors wrote. The authors added more research was needed to uncover the 

reasons for the inter-country differences. 

The data used in the study preceded the move to a national practitioner registration system. 

“The recent move to a national registration framework should expand opportunities for research in this area,” they wrote. 

“Findings from this study should provoke and inform discussion about more sophisticated approaches to regulating 

IMGs”, the researchers concluded. 

In an accompanying editorial published in the same issue of the MJA, Professor Balakrishnan Nair and his co-author, 

from the Centre for Continuing Medical Professional Development at John Hunter Hospital, Newcastle, wrote that the report 

highlighted “the need for a proactive and tailored approach in assessing, mentoring and supporting IMGs, which, in turn, will 

improve patient care”. 

According to the authors, an unpublished survey conducted by their centre showed that, of 243 IMGs, one-quarter 

reported receiving no formal orientation and fewer than half received orientation lasting less than one day. 

“Instead of setting IMGs up to fail, we should be doing everything to set them up to succeed. If IMGs fail, both the 

Australian community and the medical profession will suffer,” they wrote. 

SNIPPET 

AUSTRALIA’S FIRST LIVER–INTESTINAL TRANSPLANT 

HAILED A SUCCESS 

Australia’s first intestinal transplant recipient remains well two years after his operation who described the breakthrough 

procedure in detail in the Medical Journal of Australia. Dr Mayur Garg and Dr Adam Testro, gastroenterologists with 

the Liver Transplant Unit at Austin Hospital, and their co-authors described how a team of 20 surgeons, anaesthetists and 

theatre staff performed the operation. 

Austin Hospital and Royal Children’s Hospital in Victoria recently joined the ranks of 35 centres worldwide that are 

equipped to perform this procedure, which can save the lives of patients with irreversible intestinal failure. 

The 32-year-old recipient had experienced bowel dysfunction since birth and had had multiple operations by the age of 18 

years. Since the operation, his psychological well-being and quality of life had improved markedly. He is now able to eat and 

has returned to full-time work for the first time in 14 years. 

According to the authors, there have been enormous advances in immunosuppression protocols, surgical technique and 

post-operative care since the first human intestinal transplant was performed three decades ago. Figures now show five-year 

survival rates of more than 50 per cent for intestinal transplants performed between 2006 and 2011. 

Prior to the establishment of this service, Australians who needed this operation either succumbed to their condition or 

had to travel overseas at great financial and psychosocial expense, said Associate Professor Simone Strasser, a senior staff 

specialist at AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, in an editorial in the same issue 

of the MJA. 

However, medical advances such as intestinal transplant would be stymied unless organ donation rates improved, she 

wrote. 

“We must have an effective and sustained improvement in organ donation rates to bring Australia in line with countries in 

North America and Europe that are able to provide transplantation to two to three times as many patients as we do.” 

October MEDICUS 43

FOR THE RECORD 

Fighting bugs 

and bureaucracy 

Dr Clayton Golledge 

Senior Consultant in Clinical Microbiology & Head of Infectious Diseases 

PathWest Laboratory Medicine WA & Sir Charles Gairdner Hospital 

Q. What inspired you to take up infectious 

disease medicine as a specialty? 

While a student, my school holidays were spent working 

at the Bacteriology Lab at Princess Alexandra Hospital in 

Brisbane. So, it seemed a natural progression to go down the 

Microbiology/Infectious Diseases path. 

Q. The most rewarding part of your job is… 

The rewards are many but in general, most of our patients 

respond to anti-infective therapy and show improvement and/ 

or cure. 

Q. What do you foresee in the future for 

Clinical Microbiology and Infectious 

Disease management? 

The future rests with better and more rapid diagnostics 

allowing increasingly targeted therapy. I do fear though, 

for the longevity of antibiotics and see a far greater role 

in time for immunotherapy and better disease prevention. 

At present, the bugs are getting their noses in front of the 

drugs. The premiership quarter looms! 

Q: Your message to WA’s Health Department? 

Can WA Health just cut back on the escalating bureaucracy 

that is consuming the profession, and allow those of us that 

want to treat people in a timely and professional manner to 

be able to do so without being burdened by having to attend 

endless meetings and complete so much paperwork? We need 

to put the fun back into the job. 

Q. The people you would most like to share 

a working lunch with? 

On the presumption that it is a local working lunch and we need 

to get somewhere, I would invite the Premier, Kim Snowball, 

Richard Choong, Fiona Wood and Gina Rinehart to bankroll 

the changes. David Coomer would be there to keep the food up 

to standard and John Kizon would also be in attendance as a 

mediator if I did not get my way. 

Q. Your greatest professional achievement? 

I do not really have one, I don’t think. It has been a series of 

baby steps, although I am proud of the way our Hospital in 

the Home service is running and I did play some part in the 

establishment of this some time ago. 

Q.What would you be doing if you weren’t a 

doctor? 

No doubt about this one. I always wanted to be another 

Dennis Cometti and even did a demo tape for the ABC when 

I was still at Wesley. Interestingly, Dennis always wanted to 

be a doctor and we still talk about swapping roles for a day. 

Being a shocking hypochondriac, his medical knowledge is 

good and I think he could probably bluff his way through. 

Q. How do you unwind? 

The beach or the bush beckon when I can get away. 

Unfortunately holidays are too infrequent at present. 

Q: Your fitness mantra? 

I still manage to get to North Cott for a bit of gym time and 

a swim in the early mornings about three days a week. It is 

gratifying to see quite a few medical colleagues there and 

know that I can still swim faster than Peter Cameron and Eric 

Moussambani. 

Q: What’s on your bedside table? 

A copy of How to win friends and influence people by Dale 

Carnegie. It was given to me by former AMA (WA) President 

Dave Mountain. My wife will attest to the fact that it remains 

untouched! 

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FOCUS 

No 

smoke 

without 

ire 

WA cannot slip in the continuing 

fight against Big Tobacco 

For years the Australian Medical Association (WA) has 

played a leading role in making smoking history. The 

AMA (WA) has written, pushed, argued and campaigned for 

a range of steps over the last three decades aimed to phase 

out smoking as a tolerable, acceptable or even fashionable 

practice. 

These years of lobbying a variety of governments, 

politicians, bureaucrats on ways to end smoking as an 

acceptable practice have been enormously successful and 

have undoubtedly improved the health and saved the lives of 

thousands of West Australians. The AMA (WA) has won a 

number of prestigious national awards for our battle against 

tobacco – certainly a change from the years when doctors 

were quite happy to see tobacco companies use their public 

standing to sell the product. 

Of course it sometimes seems that the fight, especially 

in the battlefield of public opinion was a case of two steps 

forward, one back. The latest success in that battle was the 

decision by the High Court on tobacco plain packaging, to be 

introduced on 1 December 2012. 

But like many public health campaigns, the tobacco 

industry was not immediately accepting of the changed 

environment and has begun fighting the decision on a range 

of grounds – including trade and intellectual property rights. 

It is also interesting to see how many tobacco products 

use menthol in them. Experts in the field believe this is 

because menthol makes the smoke smoother, and therefore, 

presumably, more palatable. This is more attractive to a 

variety of markets – especially kids – they start with the 

smoother product, get hooked, then stay with it or move on to 

other brands. 

History: Tobacco industry ads would often appear in 

medical journals. 

Experts in the field believe strongly that this this is 

therefore a “gateway” product, which must be examined 

closely for its use and addictive qualities. 

Also worrying in this seemingly endless “two steps 

forward, one back” game is the lack of leadership on the 

tobacco issue from the State Government. For example, 

the WA Tobacco Products Control Act 2006 required that 

a review of the manner in which the Act was operating 

and its effectiveness be conducted within five years. 

This was completed by the Health Department last year 

and its findings released by way of a discussion paper. 

Encouragingly, this review raised a number of options which 

would “further protect the WA community from tobaccorelated 

harm”. 

While not endorsed officially by either the Health 

Department or the Minister, the fact that they were 

seriously and carefully raised in a report written by the 

Health Department gave some steel to the spines of those 

continuing the fight against big tobacco. 

The 15 options raised in the discussion paper 

included: 

• Ban the sale of fruit and confectionary-flavoured 

cigarettes. 

• Introduce a buffer zone around entrances, air conditioning 

intakes and in relation to alfresco eating areas. 

• Introduce a complete ban on smoking in all outdoor eating 

areas. 

• Consider removing the smoking exemption given to the 

46 MEDICUS October

DRIVE 

Crown Perth Casino International Room. 

• Introduce a requirement that tobacco could only be 

sold by those over 18 years; and 

• Amend the provision providing a defence for 

smoking in a live state performance. 

While the report was generally positive about the 

impact of tobacco laws and regulations in WA in 

cutting smoking rates, there remained, the discussion 

paper said, much to be done. 

“These programs have been successful in driving 

down smoking rates. Despite this progress, smoking 

rates in Australia are still too high, causing needless 

suffering and thousands of preventable deaths each 

year,” the report said. 

“It would be a mistake to become complacent,” the 

report said, and detailed that approximately 15,000 

people still die in Australia from tobacco related disease 

and kills more than 1200 in WA every year. 

Earlier this month, more than a year after the 

Discussion Report was released; the Final Report 

was tabled in Parliament – without a word from the 

Minister Kim Hames. The final report says little new 

– but does show that of those parties and individuals 

who responded to the original discussion paper, more 

than half agreed with each of the recommendations on 

strengthening the act. 

For example, 88 per cent supported banning the 

sale of fruit-flavored cigarettes; 70 per cent supported 

the extension of smoke-free restrictions to public 

outdoor areas; and 77 per cent supported removing 

the exemption currently held by the Burswood Casino 

International Room. 

However faced with this degree of support for the 

recommended reforms, the Health Minster chose to do 

nothing and has said nothing about the issue. 

WA, in the past, has received the top awards for 

cutting smoking. Unfortunately WA has failed in this 

instance and is fast being passed by the other states. 

The report, of course, is also more than a year old. 

During that time we have had plain packaging, which 

has led tobacco companies to develop new forms of 

promotion, requiring further action at the state and 

federal level. 

In the meantime, we are faced with strong evidence 

that the WA public is on the side of taking firm 

action. The latest West Australian Newspaper/HBF 

Health Survey found that 56 per cent believe taxes 

on cigarettes should be increased – up from 52 per 

cent in 2011; 54 per cent agreed with the Federal 

Government’s action on plain packaging – up from 54 

per cent in 2011 and 37 per cent think said they believe 

the sale of cigarettes should be banned – unchanged 

since 2011. 

The Minister needs to take the lead on this issue – he can 

be confident that the public of WA want further action. He 

can also be assured that public health organisations will not 

allow him to forget the need for action. ■ 

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October MEDICUS 47 

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EVENT 

Obstetricians meet to discuss 

midwife-led care 

In late September, the Nedlands headquarters of the AMA 

(WA) was the scene of one of the biggest collection of 

obstetricians in recent memory. The meeting of GP and Specialist 

Obstetricians – both AMA (WA) members and non-members – 

was called by AMA (WA) President Dr Richard Choong in order 

to formulate a view on issues around midwife-led care, specifically 

the WA Health Department’s new Operational Directive to accept 

transfers of failed homebirths from the Community Midwifery 

Program. 

The Commonwealth Government’s decision to vary the 2010 

Determination on Collaborative Care was also discussed, along 

with continuing issues related to home births. There was disquiet 

about the moves by the State Government to change the current 

system, with a number of participants indicating great concern 

about replacing obstetricians, some with decades of experience, 

with four-year-trained midwives. 

“I was very excited to be able to hear the views about these 

changes from so many obstetricians,” Dr Choong said. 

“I will be able to use the views and the results of the meeting 

in our future discussions and negotiations with state and federal 

bureaucrats and politicians about maternity care policy,” he 

added. 

However, as one participant later said in a letter to Dr Choong: 

“Chairing an obstetricians’ meeting has been likened to herding 

cats.” 

Dr Choong, along with AMA (WA) vice-president 

Dr Michael Gannon, used the views collated from the meeting 

with obstetricians in their most recent meeting with Health 

Minister Kim Hames. 

The AMA (WA) has been vociferous in its criticism of State 

Government’s decision to alter collaborative care agreements 

New members 

The AMA (WA) welcomes the new members who joined 

during October 2012 

between medical 

practitioners and 

midwives. The 

August edition of 

Medicus carried a 

feature story on this very subject 

– with eligible midwife Pauline Costins arguing in 

favour of the change. 

“Eligible midwives need referral pathways to enable full 

benefits of having a provider number to access Medicare for 

antenatal and postnatal care,” Ms Costins said in the article. 

“Please consider the benefits of working with an eligible 

midwife who is referring women or engaging in a collaborative 

agreement with them. There is much potential for women with 

a continuity of midwifery model of care. 

“This is about being a change agent. It is not about 

homebirth. It is about offering women continuity of midwifery 

care working in collaboration with doctors,” she concluded. 

Dr Michael Gannon, who also heads the Department of 

Obstetrics and Gynaecology at St John of God Hospital in 

Subiaco, presented his views against the move. 

“The dichotomy of high risk and low risk is a fallacy,” 

Dr Gannon argued. 

“Emergency situations requiring expertise commonly 

develop without warning. Handing the care of healthy women 

to midwives, away from GPs and obstetricians will not improve 

outcomes or maternal satisfaction. 

“It is time that we stopped measuring epidural rates and 

caesarean section rates as indicators of failure. It is long overdue 

that we took pride in the way we deliver maternity care in 

Australia. We have much to be proud of.” ■ 

Jennifer Beale 

Sangeeta Bhat 

Amanda Boudville 

Ngaire Caruso 

Cuong Danh 

Stephanie Flukes 

Sara Foroughi 

Fabrizio Goria 

Wen Guha 

Ayon Guha 

Mohammed Hakeem 

Rashida Hakeem 

Maire Kelly 

Timothy Koh 

Darshan Kothari 

Olivia Lee 

Thomas Matthews 

Daniel Mo 

Deepti Prasad 

Hari Ramakonar 

Michelle Ross-King 

Roy Soon 

Matt Summerscales 

Helen Thomas 

48 MEDICUS October

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October MEDICUS 49

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DR YES 

Kimberley 

callinG 

Students around the Kimberley had the opportunity to 

discuss issues relating to mental health, sexual health 

and alcohol and other drugs as eight volunteer medical 

students from the University of Western Australia toured 

the region as part of the Dr YES program in the middle of 

September. 

The annual trip, sponsored by the Royal Flying 

Doctor Service, saw the students traverse the Kimberley 

from Kununurra to Broome, visiting Wyndham, Fitzroy 

Crossing and Derby in between. Spanning a week, the 

volunteers delivered the acclaimed program to over 400 

primary and high school students with all three modules 

being well received. 

The Kimberley provided a challenging environment in 

which to deliver the program, with differing cultures, vast 

distances and the varying ages of the students ensuring 

the volunteers were kept on their toes. The adaptability 

of the program came to the fore however and despite 

the challenges, sessions were delivered with vigour and 

enthusiasm, resulting in positive feedback from teachers 

and students alike. 

While in the Kimberley, the students had the 

opportunity to visit the Nindilingarri Cultural Health 

Service in Fitzroy Crossing. The meeting provided the 

opportunity to learn more about the practical application 

of holistic, cultural health to indigenous communities as 

well as a cross exchange of ideas, information and opinions 

relating to health promotion. 

The medical students also paid a visit to the RFDS 

in Derby, where they meet with Dr Dean Boyatzis who 

regaled them with inspiring stories of rural and remote 

medicine. Working with the RFDS has been a fantastic 

experience for the medical students and has given the 

Dr YES program access to students and communities in 

rural and remote areas of WA who are otherwise difficult 

to reach. 

Overall the trip was a great success with schools and 

communities requesting further Dr YES involvement 

in the coming years. The remainder of the year will see 

Dr YES finish off a fully-booked metropolitan schedule 

as well as travelling to Albany and the Great Southern 

at the end of November for the program’s annual rural 

outreach visit. ■ 

Driven: Dr YES team members Chance Drummond, Dylan Beinart, 

Michael Kirk, Malindi Haggett Sophie Doherty, Verity Moynihan, Jen 

Alderson and president of the Western Australian medical students’ 

Society, Benjamin Host. 

Learning curve: Dr YES coordinator Sophie Doherty interacts with 

school students. 

Challenging: The differing cultures, vast distances and varying ages 

of the students in the Kimberley ensured the Dr YES volunteers were 

kept on their toes. 

October MEDICUS 51

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52 MEDICUS October

AMA IN THE MEDIA 

WHY HAY FEVER IS GRIPPING WA 

Bassendean GP Steve Wilson, chairman 

of the AMA’s Council of General Practice, 

advised people to see their local doctor 

because new treatments were available. “I 

do get upset when I see people wasting their 

money because they keep buying packets 

of certain antihistamines and they don’t get 

any better,” Dr Wilson said. “They need to 

see a good GP because there are lots of new 

treatments that people don’t know about.” 

The Sunday Times, October 14, 2012 

AMA CONCERNED ABOUT 

CORONIAL INQUEST 

The AMA says the results of a coronial 

inquest into the death of a South-West 

woman highlight the need for improved 

health facilities. Professor Paul Skerritt says 

better services are needed for people after 

their discharge. 

ABC Radio, September 7, 2012 

DOCTORS DEMAND 

CHAPERONES 

Worried doctors want the Health 

Department to provide chaperones for 

patient examinations where needed, 

particularly in hospital emergency 

departments. 

Australian Medical Association emergency 

doctor Dave Mountain said in other cases 

concerns had been raised about doctors 

doing intimate examinations that were later 

found to be groundless. 

“There was a time when a health 

professional would have had the benefit of 

the doubt but now it seems very easy for 

doctors to find themselves in a situation that 

is at best unpleasant and at worse could see 

them before a judge,” he said. 

“The playing field has changed substantially 

and made junior doctors in particular 

nervous,” he said. 

The West Australian, October 10, 2012 

457 WORKERS HEALTH FEARS 

Australian Medical Association WA 

President Richard Choong said it was 

essential that the Federal Government 

plug an anomaly in regulations that meant 

many 457-visa workers were not health 

tested. Otherwise, Australia would be open 

to “diseases that have not been seen for 

decades” and potentially also blood-borne 

diseases. 

“The health of Australians will be at risk if 

action is not taken, given there has already 

been approval given for a huge increase in 

workers to come to Australian, particularly 

to work in the mining industry,” he said. 


DOCTORS FEAR MORE WILL DIE 

Doctors fear more patients will die in WA’s 

overcrowded hospitals because of a plan to 

strip at least $12 million from the public 

health system as part of budget cuts. 

AMA WA spokesman David Mountain 

said: “When a health system is as 

overcrowded as ours, when you continue 

to inflict damage on that system with more 

cuts, that means people’s lives will be lost.” 


WA HOSPITALS OUTPERFORMING 

OTHER STATES 

The Health Department says latest figures 

show WA’s Emergency Departments are 

outperforming their interstate counterparts. 

The AMA president Dr Richard Choong, 

says while WA’s Emergency Departments 

have performed well, the Government needs 

to work to ensure the standards stay high. 

“We have to realise that although we are 

very high on the stats, we can’t rest on our 

laurels and though we have the capacity 

to see the patients – that capacity needs to 

grow,” Dr Choong said. 

ABC Online, September 28, 2012 

ACTION URGED ON FOETAL 

BOOZE WOES 

Obstetrician Michael Gannon said while 

the National Health and Medical Research 

Council stated there was no safe dose of 

alcohol during pregnancy, the warnings 

about alcohol use were aimed more at 

women who consistently consumed high 

amounts of alcohol rather than those who 

enjoyed the “occasional social drink”. 

The West Australian, September 21, 2012 

FACEBOOK GAG FEAR HITS 

DOCTORS 

Health professionals including doctors and 

nurses could face new rules when using 

social media such as Facebook and Twitter. 

AMA (WA) President Richard Choong 

said (the new rule) was a waste of time and 

resources. “Our lives are already bound 

by our professional codes for conduct and 

on the whole doctors and other health 

professionals use social media appropriately, 

so I don’t know how this policy would add 

anything,” Dr Choong said. 

The West Australian, September 19, 2012 

Medicus 

Article Submission Dates for 2012 

In order to distribute Medicus in a timely fashion, and to meet our 

commitment to readers, all article submissions are required by the 

following date: 

Issue 

Submission Date 

November 

closed 

December 5 November 2012 

February 7 December 2012 

If you would like to submit an article 

for inclusion in Medicus please contact 

Janine Martin, in the first instance, at 

janine.martin@amawa.com.au 

NOTE: These submission deadlines are 

for articles, classifieds and professional 

listings. 

For Display Advertisement timelines and 

submission requirements please contact 

Des Michael on (08) 9273 3056. 

October MEDICUS 53

TRAVEL 

soul city 

SOUL 

city 

Kansas offers travellers a 

slice of the real America as 

Elizabeth Nell finds out 

54 MEDICUS October

TRAVEL 

Kansas City, Missouri is one of those 

quintessential American cities that offers 

the traveller a huge amount – yet is all too easily 

overlooked. It is also highly recommended as the 

ideal city to get a real feel for the American soul 

if you are flying from the east coast of the US to 

Australia. 

KC (as it is popularly known) is a wonderfully 

welcoming town that offers a taste of the real 

America and a chance to soak up the history, 

culture, shopping and food of mid-west USA. 

Situated almost at a central point in the 

continental United States, KC has remade itself 

after some decades of demographic challenge 

and societal change and seems to now be facing the future with 

new-found confidence. 

Easily seen in three days (I had four days there very recently), 

KC should be on the to-do list of anyone really interested in 

the growth and future of the US. Most visitors fly into cities 

on either the east or the west coast to see places such as Los 

Angeles, San Francisco, New York, even Boston. 

And yet the US is predominantly a land of smaller cities. 

Chicago, Illinois; Austin, Texas; Richmond, Virginia; Little 

Rock, Alabama; Sacramento, California; Salt Lake City; Utah 

and Portland, Oregon. All these cities reveal more about the US 

than a visit to New York ever will. 

And yet tourists – especially Australians – continue to pour 

into New York like lemmings looking for the real American 

experience, not realising that in many ways the city is fast 

becoming a type of traveler’s Disneyland where tourists talk to 

tourists and the person sitting next to you at breakfast or in the 

theatre is far more likely to come from Frankfurt or Tokyo or 

Madrid than somewhere in the US. 

KC – and other cities like it - is therefore a wonderful balance 

to the global nature of NY. The home of the American Jazz 

Museum, the impressive National World War I Memorial and 

Museum and the 1920s Spanish-style shopping area, Country 

Club Plaza, KC seems to have a great spirit that is easy to catch. 

Locals are intrigued that you have visited them, repeatedly 

asking what was it about their town that attracted me to call in 

on my way home. 

Founded 

in 1838 at 

the point 

where the 

Missouri 

and Kansas 

rivers meet, 

the city has 

at various 

points of its 

history been 

Talking points: The Nelson Atkins Museum of Art acts as a net to the 

giant shuttle-cocks sitting on the grass outside. 

(Facing page) Kansas City’s famous Union Station is worth a visit. 

Fountains galore: The J.C. Nichols Memorial Fountain on the 

Country Club Plaza in Kansas City. 

major transport hub (its renovated Union Station is worth a few 

hours at the very least), a hugely influential jazz and blues centre 

and has a fascinating African American history, especially of the 

days of segregation. 

The Jazz Museum shares a building with the Negro Leagues 

Baseball Museum which commemorates the history of the 

African American teams that flourished during the years of 

segregation. 

Claiming to have more fountains than Rome, the KC local 

barbecue style has also set the food style for much of the US. 

In fact, it is worth visiting KC for the food alone – especially in 

such landmark barbeque joints as Arthur Bryant’s or Oklahoma 

Joe’s. 

Especially important for history and political buffs, KC is 

just five minutes from Independence, the former home of US 

President Harry Truman which now features the Truman 

Presidential Library and Museum. Within the gardens of the 

Museum you will find his grave, alongside his wife Bess. 

The museum is a wonderful compilation and explanation of 

the second half of the 20th century, including his decision to use 

the atomic bomb, the formation of the United Nations and the 

huge post-war economic growth of the US. 

A short walk through the suburban streets of the dormitory 

suburb bring you to the simple home he and Bess retired to in 

1952 and where he would entertain world figures of politics and 

entertainment – but only for a maximum of 30 minutes. 

KC itself is also the home of a range of world class art 

galleries, including the Nelson Atkins Museum of Art, where the 

building itself acts as a net to the giant shuttle-cocks sitting on 

the grass outside. 

The great American city is not dead, but it is changing. Unlike 

dying cities such as Detroit, KC seems to have found a good 

mix of the past and the future. The towering demonstrations of 

1920s wealth, the hotels, have all been or are being renovated. I 

stayed in three of them, and all were impressive, both in terms of 

retaining their history and offering modern comforts. 

KC will welcome you. As a city it offers a real taste of the 

United States, especially when mixed with an offering of 

hickory-smoked pork, chicken or ribs barbeque! ■ 

a 

October MEDICUS 55

FOOD 

Finger-licking good 

by Sophie Budd 

Taste Budds, www.tastebudds.co 

With Melbourne Cup just a few gallops away, it’s time to get your picks ready for the big race – be it your favourite filly, that Philip 

Treacy hat you’ve been lusting after for months or deciding which high-profile marquee party to attend. 

However if you are holed up in the office (like most West Australians are) come 12 noon, don’t rule out celebrations later that evening. 

An informal gathering with friends, race reviews, some fancy tipple and seriously good nibbles could be the best way yet to cap off one of 

the most important days in Australia’s racing calendar. 

My recommendations for the menu? Keep it simple, always. Lean towards finger food – which rules out plates and cutlery. Think 

bite-sized versions of your favourite food and you shouldn’t go wrong – kebabs, mini fish cakes, arancini balls…the list is endless. Some 

of the serious contenders for my Cup Day party would be quiche and smoked salmon in some way or form. Happy racing! 

EGG CRÊPE ROLL FILLED WITH SMOKED 

SALMON AND CRÈME FRAICHE 

Preparation and cooking time: 30 minutes 

Makes about 25 

Ingredients 

4 eggs 

1 tbs cream 

Salt and pepper 

250g smoked salmon 

A small pot of crème fraiche 

Chopped chives 

Caviar 

Method 

Beat the eggs and cream, and season lightly. 

Heat a non-stick fry pan with a little spray oil and cook the 

egg like a pancake, nice and thin, flip or turn and remove. 

Cook the whole batch, then lay the crepes out on the bench. 

Smear the crepes with crème fraiche, lay the smoked salmon 

on the lower segment of the crepe and sprinkle with fresh 

chives. 

Roll up tightly and wrap the sausage shape in Gladwrap. 

Chill for 30 minutes. 

Unroll carefully, cut of the ends and cut into inch-deep 

pieces, lay on a platter and garnish with caviar. 

CRAB AND GRUYERE 

MINI QUICHES 

Preparation and cooking time: 30 minutes 

Makes about 24 

Ingredients 

3 pieces of ready-made puff pastry 

2 eggs 

1 tbs cream 

2 cups crab meat 

1 cup grated Gruyere cheese 

Salt and pepper 

Method 

Spray two mini quiche tins with oil, cut the pastry 

with pastry cutters (circles) and push into the trays. 

Cook for five minutes or until the pastry puffs up, 

but isn’t browning. Remove and with a tea towel, pop 

the air out, and create a space for the filling. 

Pop a bit of crab and Gruyere into each tart case and 

season. You can even add fresh herbs if like. 

In a bowl, beat the eggs and the cream and transfer 

to a ‘squeezy’ bottle. Squeeze a little of the mix into 

each tart, taking care that it doesn’t overflow. 

Bake at 190C until golden and all the egg is cooked. 

Serve with a sprinkle of paprika over the top. ■ 

56 MEDICUS October

WINE 

Online networks 

yield success for winemakers 

No one doubts that the internet has contributed 

greatly to our lives in a positive way and 

yet, along with the benefits there are a number 

of downsides. We are not here to talk about 

the negative aspects of internet use, but how it 

contributes to enhancing the exposure and profiles 

of family and winemaker-owned vineyards around 

the world. 

The use of social networks such as Facebook 

has rapidly gathered pace over the last two to three 

years to become a core part of their communication 

armoury. This has enabled the family-owned and 

winemaker-owned vineyard – the small players – to 

have a real voice. It has allowed them to bypass the 

Coles and Woolworths and other middlemen and speak 

directly with the consumers and admirers of their wines 

and wine-making philosophies. 

Some use it better than others, but there is a growing 

realisation and acceptance amongst this group that the use 

of social networks has clear advantages, particularly if used 

strategically. 

The renowned Alsace producer Hugel is a great example 

of the strategic use of the internet and in particular, social 

networks. You are informed about the history of the famous 

wine-making family and its heritage as well as the individual 

vineyards they own, and the importance of the terroir which 

produce their wonderful wines. 

Hugel has now taken what it perceives to be the next 

logical step and invited the world to follow their vintages on 

Facebook, Twitter and the Youtube Channel to witness the 

daily progress of its harvest. To show just how much this 

wine-making family believes in communication via this tool, 

Etienne Hugel recorded a video just five days before the start 

of the recent harvest on 24 September. The video was posted 

on Youtube and gave a short presentation by members of three 

generations of the family – André, Mark André and Etienne. 

Its message was pure and simple – pedigree and quality. 

Facebook provides you with daily updates and as well as 

what appears to be never-ending visits by wine enthusiasts, 

restaurant delegations and last but not least recently, a group 

of sommeliers from the Sopex’s Concours ASEAN. And 

for those keen enough to want the minutiae of the harvest, 

followers have access to loads of weather information, 

including a 10-day weather forecast for the Riquewihr region 

in Alsace. 

If your thirst for all things Hugel is still not sated, you are 

invited to follow Hugel on Twitter where your updates are 

provided in 140 characters or less. But wait, there is more, 

you can finally cap everything off with an Instagram feed. 

Had enough? 

‘What about Tumblr.’, I hear 

you say; and why not? Etienne and the rest of the Hugel 

clan are probably thinking about including Tumblr. right 

now. 

For those unfamiliar with the Hugel label, the family has 

been producing wine in Riquewihr since 1639. Riquewihr is 

the region of Alsace, which is highly prized for the quality of 

the wines that it produces, and the Hugel family’s vineyards 

cover about 25 precious hectares, half of which are in what’s 

known as the Grand Cru zone. The vineyards do not use 

fertiliser, and are low yielding with wines averaging roughly 

30 years of age. All the fruit is handpicked. Hugel also 

purchases fruit from the other growers who are under longterm 

contracts. Other villages in Alsace also contribute to 

the superb quality of the Hugel wine; again the grapes from 

those villages are handpicked according to a pre-arranged 

time table. 

Each wine is supervised by individual members of the 

Hugel family at every stage of its development and after 

bottling, the wine is cellared for at least two years, on 

average. Although Hugel is modest in size by comparison 

to other wine labels, it enjoys a worldwide reputation with 

almost 80 per cent of its wine being exported to more than a 

hundred countries. 

Being a winemaking family with a venerable history 

doesn’t mean it excludes the new and the innovative. 

Innovation is clearly something the family embraces with 

enthusiasm as is evidenced by the temperature control 

during fermentation and robotised palletisation at bottling 

in the vineyards. However, if you haven’t visited the family 

vineyards then, their willingness to invest in the future 

can best be seen by way of their innovative use of the 

internet. ■ 

October MEDICUS 57

DRIVE 

Living up to Grande ambitions 

by Dr Peter Randell 

smelt it immediately – hot oil. We had stopped to photograph the 

I last desert oak on the Great Central Road, some 35km west of 

Warakurna near the Northern Territory-Western Australia border, 

and that smell meant only one thing. Trouble! 

A quick look at the right rear wheel showed red mud running 

over the inner aspect of the mag wheel where the all-pervasive 

central Australian bulldust had met shock absorber fluid. Above, 

the shockie bent at an ungainly angle, resembling a nasty 

greenstick fracture. Our maps showed a spanner symbol back at 

Warakurna, and Warburton was an impossible 200km in front 

of us. We turned around and crept back over the corrugations for 

help. 

The outback, however, maintained its unpredictability, as 

the mechanic had flown to Perth the previous week, return date 

unknown. Lying on my back, looking at the now nearly completely 

dislocated piston of the shockie, I heard a young voice ask, “Can 

we help?” 

Anthony, Mike and Jamie were three young men from Perth, 

out in the bush on holidays. They proved to be bush mechanics 

with first-class honours, as they proceeded to rescue Gayle and me 

from our predicament. 

Out in the bush, when vehicles become truly terminal, they are 

pushed together into a car graveyard. Warakurna had a good one. 

A few hundred metres into the spinifex, we found a mish-mash 

of metal, mostly unrecognisable at first glance. Bushes and grass 

had grown through the skeletons of old Holdens, Falcons, station 

wagons and…even four wheel drives. Anthony spied a 60 series 

LandCruiser, upside down, wheels off, doors missing, and interior 

gutted. First made in 1980, these cars were a large part of the 

legend of Toyota toughness, which I had heard so often in the 

outback. 

The shockies, despite the years of exposure, had no overt 

damage and came off fairly easily with the boys’ tools. As backup, 

Anthony also stripped an 80 series of its not-so-good-looking 

shock absorbers. 

Next, the boys jacked up our Prado, took off the wheel which 

was placed on the ground under the side rails for safety, added 

a kangaroo jack to support the treg hitch for extra stability and 

removed the broken bits. With a bit of compression and a quick 

insertion, the 60 series fitted. A home-made rubber spacer was 

created from more graveyard remnants and bolted down tightly. 

Our heroes had taken three hours, and refused our offers of 

reward – of course, when we returned to Perth, I ignored that. 

This was the first sniff of trouble we had experienced in 

130,000km of travel around some of Australia’s most isolated and 

testing roads with the Prado. We bought it in June 2007 and two 

weeks later, headed off to the Simpson Desert. 

Preparation for serious 4WD work centred on good 

58 MEDICUS October

DRIVE 

communication ability. We installed the usual Citizens Band 

40 channel radio for convoy communication, added a High 

Frequency 100W long-distance radio and bought membership in 

VKS-737. This organisation runs a network across Australia with 

bases in Perth, Derby, Alice Springs and Mt Isa, among other 

centres. They have daily schedules of messages and links with the 

Royal Flying Doctor service. Finally, we also carried a satellite 

phone. 

Inside the Prado, we fitted a drawer system and cargo barrier to 

prevent flying objects from decapitating us in a rollover or head-on 

(a real risk in dune country). Under the bonnet, we installed a 

double battery system, and ran an Anderson plug to carry heavy 

amperage current through to towed vehicles. There was further 

electrical backup from a roof-mounted solar panel which could 

retro-charge the car batteries as well as feed into the caravan 

battery. On the Prado roof we carried a second full-size tyre/wheel 

to back up the same-sized combo on the van, which also had a 

spare on the back. 

We did not touch the Toyota suspension which in the Grande 

variant has extra lift capacity for higher clearance on demand, 

but did add a bullbar to avoid a roo in the radiator. Big spotlights 

finished off the additions, converting a $78,000 car into a $93,000 

mean machine. 

Our first adventure when all of these additions were still sparkly 

was a dash from west to east along the Great Central Road to 

Alice Springs, then onto the Simpson Desert. We left our off-road 

camper trailer at Alice – trailers are banned from the desert as they 

tear up the fragile track. From Mt Dare Hotel to the Birdsville Pub 

is serious off-road work, with the Prado using its constant 4WD 

capacity every inch of the way. 

For this heavy-duty work, over exactly 500km, we used just 

100 litres of diesel. That is a remarkable 20 litres per 100km. Our 

travelling companions in a Nissan Patrol manual 3-litre turbodiesel 

used 25litres/100km. 

I had been attracted to the Prado initially by the praise it 

had received worldwide for the then new 3-litre direct injection 

turbocharged D4-D engine, as well as the huge 180 litre capacity 


Trouble: The broken shock absorber that held up the trip. 

Adventure: Sporting a clutch of new additions, the Toyota 

Prado Grande heads into the Simpson Desert. 

October MEDICUS 59

TECHNOLOGY 

HIGH 

FIVE 

Apple claims it has released the best iPhone yet. 

Amy Fey weighs in on the debate 

Early adopters eagerly awaiting the next big thing on the 

smartphone market might have been left feeling a little 

underwhelmed at the announcement of the iPhone 5. Many 

believed the long-awaited release would signal a new era 

and new image for Apple, but what came to fruition was an 

instantaneously familiar product with just the right tweaks, 

to ensure the iPhone is the best smartphone yet. 

iPhone fans will find instant comfort in the familiarity of 

the most recent instalment. At 2.31 inches wide, the handset 

weighs in 0.9 ounces lighter and is almost 0.08 of an inch 

thinner, but with a wider screen than the iPhone 4. 

Personally, I’m pleased Apple didn’t follow Samsung’s lead 

regarding screen size. The four-inch screen strikes just the 

right balance in increasing visual real estate without proving 

cumbersome. 

While individually subtle, combined – these changes make 

handling the lightweight handset in its brushed aluminium 

glory, a breeze. 

Internally is where you will find the iPhone 5’s most 

drastic improvements. Powered by the new Apple A6 

processor and the ability to connect to 4G on most 

Australian networks – the iPhone runs faster than ever. 

While the two cameras on the iPhone 5 have been 

bolstered, there has been criticism regarding a purple flare 

that can appear in photos taken directly into a bright light. 

In a rare public admission, Apple suggested: “Moving the 

camera slightly to change the position at which the bright 

light is entering the lens, or shielding the lens with your 

hand, should minimise or eliminate the effect.” 

Welcome features of the cameras include 720 pixel high 

definition and the ability to shoot in panorama mode, which 

is fantastic for capturing sporting events and landscape 

photography. 

Other major and somewhat unexpected changes were 

revealed on the accessory front, including new earphones – 

dubbed ‘EarPods’ and a lightning connector (power source). 

This is the first time that the EarPods have been tinkered 

with, but the improvement in comfort and sound quality is 

out of sight. 

As you might have heard, Apple has ended its love-affair 

Unibody case: The new iPhone 5 (above right) has an all-inone 

aluminium shell with rear glass panels top and bottom for 

Wi-Fi, GPS and Bluetooth reception. 

with Google Maps. This has resulted in less accurate data 

and information available. Apple has counted those missing 

features by adding turn-by-turn navigation thanks to Siri, as 

well as live road hazards that are displayed should there be an 

accident or road closure on your journey. 

As for the lightning connector, it’s much smaller than the 

original iPod cable connectors – and can be inserted either 

way up. It will be frustrating in the short term to re-establish 

your cable connection whether for the office, car or home. 

But I’m sure the lightning cable will win over many fans in 

the long run. 

iOS 6 also adds Passbook for electronic storage of tickets 

and vouchers to be activated based on your GPS location – 

for example, when you reach the airport or a venue for an 

event you have purchased tickets. This will be a fantastic 

asset once more organisations catch on – currently Starbucks 

and Ticketek cater for Passbook. But until that time, the jury 

will remain out. 

Unfortunately I’m here to quell rumours of the iPhone 5’s 

enhanced battery performance. Whether browsing emails 

and the web, texting or listening to the iPod, I find myself 

recharging by the end of the working day, even after leaving 

the house in the morning close to full battery life. 

So the question is – to wait or not to wait to upgrade to 

the iPhone 5? From my perspective, if you are eligible for 

an upgrade – join the iPhone 5 crowd. It truly offers a better 

user experience. If you’re not eligible, update your operating 

software and wait it out – the iPhone 4 and 4S are 

great phones that will tide you over until the next 

instalment. ■ 

60 MEDICUS October

TECHNOLOGY 

iOS 6 Highlights 

Apple’s latest operating system for mobile 

devices offers: 

• Siri: 

Open apps and post comments to social 

networks using voice commands 

• Facebook: 

Integrated into built-in apps like Calendar, 

Maps, Camera and Photos 

• Passbook: 

Stores copies of boarding passes, movie 

tickets, retail coupons etc. 

• Facetime: 

Video chat now works over phone networks 

as well as Wi-Fi connections 

• Safari: 

iCloud Tabs keeps track of open web pages 

on multiple devices 

• Maps: 

Google Maps replaced by Apple’s own 

mapping app that is vector-based for greater 

detail and includes audio sat-nav. 

Hear to stay: The new EarPods offer unparalleled comfort and sound quality. 


Living up to Grande ambitions 

fuel load. In city driving, the Prado was delivering 100km for 

just 9.3 litres. That is stunning for such a big 4WD. Thus we did 

not need to carry jerry cans of spare fuel like our friends. I found 

the automatic gearbox a joy in sand, as the down changes were 

seamless and there was no loss of forward momentum – essential 

in slippery sand. 

We returned via the Birdsville Track and Marree, crossing 

stony Gibber Desert near Coober Pedy. Like our friends, we 

were using Cooper tyres, and I must record the outstanding 

performance of that rubber. With softer pressures to allow the 

tyres to “walk” over the worst stones, we have yet to experience a 

flat tyre. That’s the entire 130,000km on one set. 

After picking up our trailers, we headed south to the Flinders 

Ranges to Willow Springs. Our friends had done some excellent 

homework for this trip and found a remarkable 4WD track 

on this former sheep station. The extraordinarily difficult and 

dramatic 62km long track wound through harsh scenery with a 

variety of surfaces, culminating in a difficult climb to one of the 

highest points in South Australia. 

At times, we were in low range, first gear, crawling with 

differential locks on, yet still sliding off granite rocks on our steep 

path upwards. 

Years later, I still get sweaty palms thinking about ‘Skytrek’ 

as it is known. The track of 62km took us nine hours. I would 

Solitary: The last desert oak on Great Central Road near Warakurna. 

recommend it as character-building and sphincter-tightening! In 

comparison, our trip home across the Nullabor was an easy run – 

an enjoyable way to complete our 9800km journey. ■ 

Part 2 of Dr Randell’s article will be published in the November 

issue of Medicus. 

October MEDICUS 61

PHOTOGRAPHY 

Come up trumps with your camera card 

by Denis Glennon 

What is the difference between deleting and formatting a 

card? There is a crucial difference between these two 

methods of image removal from your memory card, be it an SD, 

microSD or Compact Flash card. When erasing a card, individual 

images are deleted from their files on the card. You can erase one 

or more images at one time. If you have selected images to be 

‘protected’ through a menu option on your camera, these will not 

be removed by erasing. 

Formatting, on the other hand, deletes all images from the card, 

even the ones that may have been ‘protected’. It recreates the file 

system including new directories and folders where images are 

saved on the card. Unlike erasing, formatting has the benefit of 

improving the overall performance of a card. I never use the ‘delete 

all’ function on my camera or computer to clear a card; I always 

use the ‘format’ function in my camera. But, there are a few very 

important steps to complete before you hit the ‘format’ button. 

Foolproof method to avoid losing your 

images: 

• Download your images to your computer. 

• Confirm they have made it successfully to the chosen place on 

the computer. 

• Back them up to a second location, either when downloading or 

as a separate back-up step. 

• Only then, format the card, in the camera used to take the 

images and never in your computer or in a different camera. 

The main reason for not using the computer or another camera 

is that it helps prevent data loss caused by corruption that 

propagates across multiple user of the card. Using the computer 

opens the possibility of formatting the card with a different file 

system than is supported by your camera, which would then 

require you to reformat the card in your camera again anyway. 

To me, it is just simpler to format cards in the camera from 

which they were taken. 

Formatting the card in the camera just gives you a clean start for 

that card and, assuming everything works as it is supposed to, you 

will have a card ready for capture with that particular camera. 

In other words, a camera can certainly read a card formatted by 

that camera, but cannot necessarily read cards formatted by other 

devices. 

Whenever I start a shoot that I know is likely to result in several 

hundreds of images, I always start off by formatting the card in the 

camera I will be using. If the card hits an error during formatting, I 

know to immediately retire it. I’d rather find out I have a card at the 

start of a shoot than midway through it, or worse, when I’m trying 

to read the images later. 

What if you accidentally format a card full of your best images? 

If this happens, you are not an orphan; it happens to the best of us. 

62 MEDICUS October

The good news is the loss of images is only temporary – help is 

at hand. 

The first thing to do is stop taking photographs. Do not use 

the card again and store it in a safe place so that you will not 

accidentally try to use it in the middle of a ‘high-action’ shoot. 

You have two choices – try the recovery process yourself using 

free downloadable software or take the card to a professional 

photography shop, most of whom generally provided a ‘card 

recovery’ service, at little cost. 

If you decide to have a go, you will need a card reader, your 

computer and some software. For a simple ‘format’ or ‘delete’ from 

the card, and a fast recovery, try 

Free Undelete (available 

at www.officerecovery.com). For a corrupted or more complex 

format (where you perhaps continued taking photos), try Art 

Plus – Digital Photo Recovery (available at www.artplus.hr) or 

Recuva (available at www.piriform.com). For Mac users there is 

Photo Recovery on Mac (available at www.macrecovery.net). Art 

Recovery – Digital Photo Recovery 

charges about $25 for the 

software, the other two are 

free. 

The procedure 

for recovering your 

‘lost’ images is selfexplanatory 

and 

Unlike erasing, formatting 

easy to follow in 

has the benefit of 

all three pieces of 

improving the overall 

software. I have 

found three other performance of a card 

ways card corruption 

can occur, namely if 

you continually try to leak 

the last bit of power from your 

camera battery; if you accidentally 

switch off the camera whilst the read/write 

process is still happening and if you try to ‘pull’ the memory card 

out of its slot, before you eject it properly first. 

Finally, as an extra and inexpensive precaution, I replace my 

cards about every two years. ■ 

DON’T MISS OUT! 

REGISTRATIONS 

NOW OPEN 

Rural and Remote Retrieval Conference 

Thursday 16 May to Sunday 19 May 2013 

Karijini Eco Retreat | Karijini National Park 

Photo courtesy Dr Tony Celenza. 

APPROVED 

CAtEgORy 1 

ACtiVity AND 

2 DAy EmERgENCy 

gRANt $4,000 

Photo courtesy Dr John Stokes. 

To download a nomination form scan the code or visit 

www.ruralhealthwest.com.au/rrrconference 

October MEDICUS 63

Member Benefits 

In addition to the valuable services the AMA (WA) provides members, the Association 

also secures significant savings with a host of exclusive benefits. 

For more information, visit www.amawa.com.au/membership/memberbenefits.aspx 

Thompson Estate 

Cardiologist Peter Thompson is 

delighted to invite you to try his range of 

wines especially the ‘Locum Range’ and 

is offering a 10 per cent discount off the 

entire range, plus free delivery within WA 

to all AMA(WA) members. To view the 

entire range and find out more, visit 

www.thompsonestate.com. 

10% 

The Byrneleigh Perth 

The Byrneleigh Hotel offers a 

relaxed feel, perfect in keeping 

with its ideal location on Hampden 

Road in the heart of Nedlands. 

Members are invited to enrol via 

http://thebyrneleigh.com.au and start reaping the benefits 

of membership such as earning rewards points that can be 

used to purchase food or beverage and exclusive invitations to 

member-only events. 

BMW Corporate Program 

The BMW Corporate program 

will provide you with the following 

benefits when you or your spouse 

next purchases a new BMW 

or MINI from Auto Classic or 

Westcoast BMW including: 

• Complimentary servicing for four years/60,000 km 

• Complimentary use of a BMW during schedule 

servicing 

• Preferential corporate pricing 

• Reduced dealer delivery charges 

• Corporate finance rates to approved customers 

To find out more about exclusive offers for AMA 

(WA) members, contact John Clarke – BMW & MINI 

Corporate Sales Manager in WA – at Auto Classic on (08) 

9311 7533 or Westcoast BMW on (08) 9303 5888. 

Investec 

Investec provides specialist finance for personal practice needs, 

including equipment, fitout, motor vehicles, practice purchase, 

commercial and residential property overdraft facilities. 

AMA (WA) members receive exclusive offers and a tailored 

service. Visit www.investec.com.au or call 1300 131 141. 

Sal Salis 

Book a two-night stay 2 for 3 

at Sal Salis between 

1 August 2012 and 16 

January 2013 and receive your third 

night FREE! 

The nine luxury tents of Sal Salis – the only accommodation 

in the Cape Range National Park adjacent to Ningaloo Reef – 

are located in the heart of the newest World Heritage Area, the 

Ningaloo Coast. 

50% 

Penguins formal wear is a suit hire option. Designed in Europe, 

their clothing is crafted from the finest of fabrics and can be 

accessorised with an extensive range of coordinating fashion. 

Penguins is offering dinner suit or tuxedo hire, with shirts 

and ties, to all AMA (WA) members at a cost of $75; usually 

$135.50, this is a saving of about 50 per cent. 

Triumph Menswear 

Triumph Menswear is Penguins retail outlet and 

all AMA (WA) members are entitled to 20 per cent 

discount on all purchased items. 

20% 

64 MEDICUS October

On the TOWN 

To win a double pass to one of the following events, simply go to 

www.amawa.com.au/membership/onthetown.aspx 

Entries must be received by 4pm, Monday 5 November 

Alex Cross 

In cinemas November 8 

Alex Cross follows a 

young homicide detective/ 

psychologist (Tyler Perry) 

– from the worldwide 

best-selling novels by James 

Patterson – as he meets his 

match in a serial killer (Matthew Fox). 

The Allergy Epidemic: 

A Mystery of 

Modern Life 

In this book, allergy specialist 

and cutting-edge researcher 

Dr Susan Prescott (left) 

explores how 

and why we are 

experiencing 

an epidemic rise in allergic diseases, 

as well as the practical side of dealing 

with these potentially life-threatening 

conditions. 

The Sessions 


The Sessions is based on the 

true story of California-based 

journalist and poet Mark 

O’Brien (John Hawkes) who is 

paralysed by polio and at age 38, 

is determined to finally lose his 

virginity. Directed by Australian 

Ben Lewin, the film won the 

audience award at the Sundance Film Festival. 

Killing Them Softly 

In cinemas 11 October 

When their illegal card game 

is held up, and the life blood 

of the criminal economy is 

on the verge of collapse, the 

mafia calls in enforcer Jackie 

Cogan (Brad Pitt) to fix the 

situation. 

DREDD 3D 

In cinemas October 25 

Judge Dredd (Karl Urban) is the most 

feared of elite Street Judges in The Cursed 

Earth – a wasteland spreading across North 

America – with the power to enforce the 

law, sentence offenders and execute them on 

the spot, if necessary. 

Outback Survival 

This is a timeless, practical rundown 

on everything you need to know to 

survive in the outback. As the go-to 

survival man for ABC radio and TV, Bob Cooper’s 

incredible bushcraft skills have been developed 

through more than 25 years of experience in the 

outback. 

Seven Psychopaths 


From the team who created In Bruges, 

comes Seven Psychopaths, an inventive, 

violent and hilarious film starring Colin 

Farrell, Sam Rockwell, Christopher Walken, Woody Harrelson and Tom 

Waits. The story follows the trials of a struggling screenwriter (Farrell) who 

inadvertently becomes entangled in the Los Angeles criminal underworld 

after his oddball friends kidnap a gangster’s beloved Shih Tzu. 

Rachmaninov & The Ring 

Win a double pass for Friday 30 

November, 7.30pm, Perth Concert Hall 

Pianist Garrick Ohlsson returns to the 

West Australian Symphony Orchestra in 

an exhilarating concert featuring Rachmaninov’s Third Piano Concerto and 

an exciting collection of music from the Ring Cycle. 

Remembrance Concert 

Sunday 11 November, 2.30pm 

On Remembrance Sunday, St 

Patrick’s Basilica will echo with 

the solemnity and poignancy of 

some of the world’s most moving 

music performed by internationally-acclaimed organist, Dominic 

Perissinotto. 

October MEDICUS 65

CARDIOVASCULAR 

Perth Cardiovascular Institute 

• Dr Jay Baumwol 

• Dr Andrei Catanchin 

• Dr Matthew Erickson 

• Dr Susan Kuruvilla 

• Dr Michael Muhlmann 

• Prof Gerry O’Driscoll 

• Dr Jamie Rankin 

• Dr Matthew Best 

• Dr Michael Davis 

• Dr Arieh Keren 

• Dr Athula Karu 

• Dr Kaitlyn Lam 

• Dr Anne Powell 

• Dr Sharad Shetty 

• Dr Gerald Yong 

It is with great pleasure that we welcome Dr Arieh Keren to 

our fast-growing team of experienced cardiologists. Dr Keren 

will be consulting from our Nedlands and Joondalup rooms. 

He also holds a public appointment at Sir Charles Gairdner 

Hospital. His sub-specialty includes the advanced management 

of all cardiac arrhythmias in particular atrial fibrillation, and 

also the implantation of pacemakers, defibrillators and cardiac 

resynchronisation devices for heart failure management. Dr 

Keren has a particular interest in advanced management of 

defibrillator shocks and ventricular arrhythmias. 

Dr Arieh Keren is pleased to provide the ongoing care and 

services to patients and the referring physicians following the 

departure of Dr Andrei Catanchin. 

For bookings to see Dr Keren, or for any information regarding 

patients of Dr Catanchin, please phone 6314 6804 or email 

DrKeren.PA@perthcardio.com.au. 

The group provides a comprehensive cardiac testing service at 

nine conveniently located sites: Nedlands (Hollywood Private 

Hospital), Joondalup Health Campus, Bentley, Duncraig, 

Esperance, Midland, Mt Lawley and Rockingham. 

Services offered include Cardiology consultations, 

Echocardiography, Exercise Stress Testing, Monitor Fittings 

(Ambulatory BP, Event and Holter), and ECG. 

Visit www.perthcardio.com.au for more information on our 

services. For cardiology appointments: 1300 4 CARDIO. 

For testing appointments: 1300 HEART TEST. 

General enquiries: phone 6314 6833 • fax: 6314 6888 

Email: info@perthcardio.com.au. 

Professional Notices 

GENERAL SURGERY 

Perth Surgical Clinic 

Mr Karim Ghanim MB CHB FRACS 

• Surgical Oncology 

(breast/bowel and skin cancers) 

• Laparoscopic surgery 

(hernias, bowel and gallbladder 

• Colonoscopy and Gastroscopy (open access) 

Operating at: 

North: Mount Private and Bentley. 

South: SJOG Murdoch and Armadale hospitals. 

Consulting: Hollywood, Murdoch, Bentley and Galliers. 

Mobile: 0411 113 314 

Dr Farah Abdulaziz B.Med.Sci 

MBBS MRCS FRACS 

I specialise in; 

• Oncoplastic Breast Surgery, • Breast 

cancer surgery, 

• Breast reconstruction, 

• Breast augmentation and reduction. 

General surgery: 

• Hernias (open and laparoscopic), 

• Gallbladder, 

• Vasectomy, 

• Carpal tunnel and 

• Lymph node biopsy 

Admitting and operating at: 

Bethesda Hospital, Sir Charles Gairdner Hospital, 

Hollywood Private Hospital, Osborne Park 

Hospital and Mount Private Hospital. 

Mobile: 0415 638 541 

All correspondence to: 

Suite 36 Hollywood Specialist Centre, 95 Monash 

Avenue, Nedlands 6009. 

Phone: (08) 9386 5814; fax: (08) 9386 9599; 

E-mail: info@generalsurgeryperth.com.au 

Website: www.generalsurgeryperth.com.au. 

HAND SURGERY 

Lewis Blennerhassett MBBS FRACS 

Dr Blennerhassett is a plastic surgeon with postgraduate 

fellowship in hand surgery certified by the 

American College of Surgeons. Expertise in all aspects 

of acute and chronic hand disorders, both paediatric 

and adult, is provided. 

For all appointments, phone 9381 6977. 

Emergencies phone 0438 040 993 – all hours. 

66 MEDICUS October

AMA MEDICAL PRODUCTS 

introduces 

Welch Allyn is proud to announce the introduction of a new product offering 

– Partners in Care Services*. Designed to deliver flexible programs that cover 

all your service needs for your busy medical practice 

SUPPORT SERVICES 

• Extended Warranty Program 

Purchasing a new Welch Allyn device or currently have a Welch Allyn device still 

within warranty? Consider extending your warranty period by an additional 1 or 

2 years and have peace of mind that your devices will always be available when 

you need them. 

• Comprehensive Partner Program 

Your current Welch Allyn device out of warranty? Consider investing in a 

Comprehensive Partnership program and take advantage of: 

• Device parts and labour, with free delivery 

• Priority service - faster repair times 

• Free loan units, with free delivery 

• Software updates 

• Accessory protection. Free replacement of selected accessories, one per 

year per device. 

Everything is covered in an upfront agreement so there is nothing to worry about! 

EDUCATION SERVICES 

• On-line Clinical Training 

Take advantage of Welch Allyn’s on-line 

clinical education to help with either 

refresher training or the training of new 

staff. 

For best prices and to learn more about Partners in Care, contact 

AMA Medical Products Customer Service on (08) 9273 3022 

* Partner in Care agreements are available for many, but not all, Welch Allyn products.

Professional Notices 

Mr Paul Jarrett FRACS 

Hand and Upper Limb Surgeon 

provides a comprehensive service 

for elective and traumatic conditions for the 

hand, shoulder and upper limb at Murdoch 

Orthopaedic Clinic for Workcover and 

Privately Insured patients. Please call 9311 

4636 for appointments. I am happy to be referred public 

patients at Fremantle Hospital where I hold weekly clinics. 

Mr Craig Smith MBBS FRACS 

Hand, wrist and plastic surgeon has his main practice at 

17 Colin Street, West Perth in association with Specialised 

Hand Therapy Services. This means that consultation, 

hand therapy and splinting are all available at the one 

location. His areas of interest include all acute or chronic 

hand and wrist injuries or disorders as well as general 

plastic surgical problems. He continues to consult in 

Bunbury and Busselton. 

For appointments or advice please call 9321 4420. 

Mr Angus Keogh FRACS 

- Upper Limb Surgeon 

My interests include traumatic and 

degenerative conditions of the upper 

limb including hand surgery, arthroscopy 

including small joints, complex elbow 

and wrist instability. I consult in private 

rooms at St John of God Subiaco and St John of God 

Murdoch. I consult weekly at Sir Charles Gairdner 

Hospital – please call 08 9346 1189. 

Please call 08 9489 8782 for appointments. 

Workcover accepted. 

INFECTIOUS DISEASES 

Dr Desmond Chih MBBS FRACP FRCPA 

Infectious Diseases Physician and Clinical Microbiologist 

All aspect of adult general infectious diseases and diagnostic 

microbiology including 

• Fever of unknown origin 

• Bone and joint infections 

• Surgical infections 

• Skin and soft tissue infections 

• Travel related infections 

• Tuberculosis 

• Antibiotic resistance 

Consults at Joondalup, SJOG Murdoch (Inpatient) and Myaree. 

All correspondence to 74 McCoy Street, Myaree 6154 

Tel: 08 9317 0999 • Appointments: 08 9317 0710 

Fax: 08 9467 2826 

Email: Desmond.Chih@wdp.com.au 

OPHTHALMOLOGY 

Dr Michael Wertheim MBChB 

FRCOphth FRANZCO 

Comprehensive general ophthalmologist 

consults at: South Street Eye Clinic, 

Suite 10/73 Calley Drive, Leeming 6149 

Early and urgent appointments available 

Operates at: Eye Surgery Foundation, 

West Perth (private patients) Kaleeya Hospital, East 

Fremantle (public patients) 

Special Interests: cataract surgery, general ophthalmology, 

Uveitis For appointments, phone 9312 6033 or fax 9312 6044. 

PSYCHIATRY 

Dr Raj Sekhon 

Dr Raj Sekhon is pleased to announce that he has commenced 

private psychiatric practice in Rockingham. Raj is a local 

UWA graduate (1996) and is a Fellow of The Royal Australian 

and New Zealand College of Psychiatrists (FRANZCP), with 

an interest in all aspects of general adult psychiatry. 

For referrals or other advice please 

Ph: 9528 0996 • Fax: 9528 0850. 

Sentiens Day Hospital 

Please refer all private mental health patients to Sentiens 

Clinic. Our patients usually have depression, anxiety, 

bipolar, borderline personality disorder, drinking problems, 

relationship problems, stress, PTSD, OCD and sometimes 

eating disorders and schizophrenia. 

We offer group programs in CBT (also evening), DBT 

skills, creative therapy, alcohol management, mindfulness, 

carer’s support, patient support, self-esteem, health and 

wellness, exercise, anger management, interpersonal skills, 

recovery road and relapse prevention, stress management, 

drug-related metabolic problems, anxiety management, 

life skills, assertive skills, triage and online assessment via 

PsychAssess and PsychScreen and online monitoring using 

HealthSteps. 

We have clinicians waiting to take your referrals. 

Refer to Dr Dennis Tannenbaum or Dr George Atartis 

(Consultant Psychiatrists) or directly to Sentiens Clinic. 

We would like to welcome Dr Amatul Uzma to the team of 

psychiatrists who is waiting for your referrals. 

For referral advice, call Sharon on: 9481 1950 or 

Fax: 9481 1952. You can now refer to Sentiens Clinic online 

via www.Sentiens.com. For all online programs visit: 

www.HealthSteps.net.au. 

68 MEDICUS October

RADIOLOGY/NUCLEAR MEDICINE 

Oceanic Medical Imaging 

Leeming 

Tel: +61 8 9312 7800 

Fax: +61 8 9312 7878 

Oceanic Medical Imaging Hollywood 

PET-CT CentreGround Floor, 

Suite 14, Hollywood Medical Centre 

85 Monash Avenue, Nedlands 6009 

Tel: +61 8 9386 7800 | Fax: +61 8 9386 7888 

www.oceanicimaging.com.au 

Oceanic Medical Imaging offers a wide range of general 

and specialist medical imaging utilising the latest imaging 

equipment. 

Services include: 

• 64-slice cardiac capable CT 

• Digital General X-Rays 

• Ultrasound 

• Digital OPG & Cephalometry 

• Nuclear Medicine Studies and Therapy 

• Bone Densitometry 

• DEXA Whole Body Fat Assessment 

• Stress ECG suite with Myocardial Perfusion Imaging 

• PET-CT 

• CT/Ultrasound-guided injections. 

We provide a personalised, comprehensive and professional 

digital imaging service. Patients benefit by a short or no wait 

time for an appointment, low radiation dose equipment, 

family-friendly, comfortable clinic and affordable 

examination fees. 

Envision Medical Imaging 

178 Cambridge Street (opp. 

SJOG Hospital Subiaco) 

Tel: 08 6382 3888 • Fax: 08 6382 3800 

Web: www.envisionmi.com.au 

Web: www.envisionreports.com.au 

(WebPAX online images & reports). Envision Medical 

Imaging is an independent Radiology practice, located 

directly opposite St John of God Hospital Subiaco on 

Cambridge Street, with free parking behind the building. 

Services include: 

Ultrasound: including injections 

MRI: GP referrals accepted 

X-ray: low dose 

CT: general and cardiac imaging 

Nuclear Medicine scans 

Dental: Cone Beam and OPG 

*Same day appointments available 

Imaging Specialists include: Michael Krieser, Brendan Adler, 

Lawrence Dembo, Bernard Koong, Conor Murray, Eamon 

Koh, Jeanne Louw and Tonya Halliday. 

ORTHOPAEDIC SURGERY 

Karl Stoffel MD, PhD, FMH (Tr & 

Orth), FRACS 

Professor of Orthopaedics and trauma 

surgery provides a comprehensive service 

for elective and trauma conditions for the 

hip, knee, lower limb and all orthopaedic 

trauma at Murdoch Orthopaedic Clinic 

for Workcover, DVA and privately-insured patients. 

Please call 9311 4639 for appointments. 

I offer a no-gap service for all major health funds and will 

be very happy to see private, Worker’s Compensation and 

Department of Veteran Affairs patients at Murdoch. 

Perth Shoulder Clinic, situated at Bethesda Hospital in Claremont, 

provides a comprehensive service for the treatment of shoulder 

disorders including: 

* Arthroscopic surgery for shoulder instability and rotator cuff pathology 

* Shoulder Arthroplasty including revision arthroplasty 

* Surgery for fractures about the humerus, scapula and clavicle 

* On-site physiotherapy 

Grant Booth operates at Bethesda 

Hospital and SJOG Hospital Subiaco as 

well as holding a public appointment at 

Royal Perth Hospital. 

Sven Goebel operates at Bethesda 

Hospital and SJOG Hospital Subiaco as 

well as Joondalup Health Campus where he 

is able to see public patients. 

For appointments or advice contact: 

p. 9340 6355 f. 9340 6356 reception@perthshoulderclinic.com 

Perth Shoulder Clinic, Bethesda Hospital 

25 Queenslea Dr, Claremont 6010 

www.perthshoulderclinic.com 

PSCadvert-ver3.indd 1 

October MEDICUS 69 

3/4/12 6:16:12 PM

GP LOCUM – MID WEST WA - 

Position No.: 500912 

URGENT LOCUM 

Immediate for three weeks 

• $1200 per day 

• Accommodation and vehicle provided 

• No on-call or visits required 

Location: This fully-computerised practice is situated in a major coastal 

town just nine hours from Perth at the mouth of the Gascoyne River. Popular 

world heritage sites lie south and north of the town including Shark Bay and 

the stunning Ningaloo Reef. 

Practice: This modern, fully-accredited training practice caters for an active 

patient load of 3,000 and is well equipped to offer comprehensive holistic 

healthcare to patients. The spectrum of health services extends from primary 

health programs through to secondary health medical services and to the 

provision of tertiary specialist and allied health services. 

The practice urgently requires the services of a GP locum for a period of 

three weeks to commence immediately. Hours are 8.30am to 5pm, 

Monday to Friday. To register your interest, please call Margaret Templeton 

on (08) 9273 3033 or email margaret.templeton@amawa.com.au. 

MUNDARING 

FT/PT VR GP (female 

applicants preferred) 

To join busy, friendly, modern, 

accredited, fully computerised, 

well managed private medical 

centre. 

Excellently-equipped 

treatment room with full-time 

RN support. 

Fabulous career opportunity, 

attractive remuneration and 

six weeks annual leave. 

Practice Manager – 

Jane Smith. 

Tel: (08) 9295 1988 

email: 

mundmed@iinet.net.au. 

MADDINGTON 

Maddington Medical Practice for lease 

Established doctor surgery of over 10 years in Maddington is looking for a principal doctor to take over. If you are 

currently looking to branch out on your own, this is ideal for you. Option to lease and/or buy available. 

Please contact Lucas on 0403 368 147. 

HOME OF 2011 GT-R 

FOR PERSONAL & PROFESSIONAL 

SERVICE CONTACT DEALER 

PRINCIPAL GREG ROSS 

THE LEGEND IS REAL. P.O.A 


9330 6666 


www.magicnissan.com.au 

DL0491

BICTON MEDICAL CLINIC 

VR GP required for PT/FT position by long-established busy practice 

Non-corporate practice with mixed billing. Would suit doctor with long-term view in a stable, friendly, family GP clinic. 

For confidential enquiries, contact: Dr Sam Messina by email – smess@iinet.net.au; or by calling 0417 948 551. 

Website; www.bictonmedical.com.au. 

Nedlands 

Hollywood Specialist Centre 

Professional consulting rooms available for rent. Fully 

furnished, reverse cycle air-conditioning. 

Quiet practice suite, sharing with a psychiatrist; suits 

other psychiatrist/clinical psychologist. 

Room available full time, or on sessional basis. 

Rates negotiable. 

Contact Dionne Hayward – 0407 779 314. 

INGLEWOOD 

GP required: full-time or parttime, 

with or without a view. 

Hours negotiable. 

We are a busy seven-doctor (three 

male, four female) private billing noncorporate 

practice in Bedford. 

Full-time nurse and pathology on site. 

Friendly and very well staffed. Phone 

Steve, Carl or Jeremy on 92719311 or 

email salisburymed@iinet.net.au 

APPLECROSS 

Applecross Medical Group is a major medical facility in the southern suburbs. Current tenants include GP clinic, pharmacy, dentist, 

physiotherapy, fertility clinic and pathology. Both the GP clinic and pharmacy provide a 7 day service. 

The high profile location (corner of Canning Hwy and Riseley Street Applecross), provides high visibility to tenants in this facility. 

A long term lease is available in this facility - the space available is 85m2, with the current layout including 4 consulting rooms, 

procedure room and reception area. Would suit specialist group, radiology or allied health group. 

Contact John Dawson – 9284 2333 or 0408 872 633. 

85% take 

home, 

enjoy flexible hours, less 

paperwork, & interesting variety… 

Equipment Provided – WADMS is a Doctors’ cooperative 

• Fee for service (low 

• Non VR access to 

commission). 

VR rebates. 

• 8-9hr shifts, day or night. • Bonus incentives paid. 

• 24hr Home visiting services. • Interesting work 

• Access to Provider numbers. environment. 

Essential qualifications: 

• Minimum of two • Accident and 

years post-graduate Emergency, 

experience. • Paediatrics 

• General medical & some GP 

registration. experience. 

Contact Trudy Mailey at WADMS 

(08) 9321 9133 

F: (08) 9481 0943 • E: trudy.mailey@wadms.org.au 

www.wadms.org.au 

WADMS is AGPAL registered (accredited ID.6155) 

October MEDICUS 71

Please forward submissions for Greensheets by 3 November for 

December edition. 

Contact Christine Kane at christine.kane@amawa.com.au. 

Youth Friendly Doctor Training 2013 Program 

The Youth Friendly Doctor Program (YFD) seeks to build the capacity of general practitioners to communicate 

more effectively with young people, address the barriers young people face in accessing health care and promote 

adolescent friendly policies, facilities and service delivery. This program is accredited with the RACGP and attracts 

Category 1 and or Category 2 QI&CPD Points. 

MODULE 1 

Workshop 1 – Ethics and the Law, 5 Feb , 4 Jun, 22 Oct 

MODULE 2 

Workshop 1 – Mental Health: Diagnosis and Assessment 

2 Apr, 5 Nov 

Workshop 2 – Psychosocial/Psychopharmacological Treatments 

16 Apr, 19 Nov 

MODULE 3 

Workshop 1 - Alcohol and Drugs, 5 Mar 

Workshop 1 - Sexual Health, 7 May 

MODULE 4 

Workshop 1 - Overweight and Obesity, 6 Aug 

Workshop 1 - Eating Disorders, 3 Sep 

For enquires relating to the YFD program or to enrol in the workshop visit: 

www.amawa.com.au/IntheCommunity/YFDTrainingProgram.aspx 

Phone (08) 9273 3000 or email yfd@amawa.com.au 

POSTGRADUATE EDUCATION & TRAINING 

Date Postgraduate Education & Training Contact Information 

29 Oct 

Medical Research Seminar Series – Advances in Type Two diabetes. Asst/Prof Vance 

Matthews. Venue: WA Institute for Medical Research Seminar Room QE11 Medical 

Centre, Nedlands: 12.30pm – 1.30pm with light lunch from 12 noon 

www.liwa.uwa.edu.au 

29 Oct 

Introduction to Eating Disorder Training - Part 2: Treatment strategies for the eating 

disorder including the roles of different professionals. Provides emphasis on the 

phases of eating disorders across time and on stages of motivation for change. Venue 

– PMH: 9am – 4pm 

Blanca.PrietoHugot@health. 

wa.gov.au 

30 Oct 

ENT Update – Suitable for GPs and Junior Doctors. The session will provide basis 

skills, and techniques in ENT diagnosis, treatment and referral with an overview of ENT 

emergencies. Accreditation: RACGP, NMBA, ACRRM, PRPD EM MOPS. Venue: The 

CENTER, Subiaco 8.30am to 4.30pm (8 hours) 

www.thecenter.org.au 

30 Oct- 

2 Nov 

Doctors’ Certificate in Sexual and Reproductive Health for Medical Practitioners. 

Venue: FPWA Sexual Health Service – 70 Roe St., Northbridge 

www.fpwa.org.au 

2 Nov 

Core Skills – ENT Sinus Surgery Workshop: Suitable for RACS Surgical Trainees in ENT 

– Junior Consultants and Registrars. Venue: UWA 

www.ctec.uwa.edu.au 

3 Nov Western Trauma Course – York WATEC@health.wa.gov.au 

72 MEDICUS October

WESTERN WESTERN AUSTRALIA AUSTRALIA 

WESTERN WESTERN AUSTRALIA AUSTRALIA 

POSTGRADUATE EDUCATION & TRAINING continued 

Date 

Postgraduate Education & Training 

Contact Information 

3 Nov Core Skills – ENT Facial Workshop: Suitable for RACS Surgical Trainees in ENT – Junior 


Consultants and Registrars. Venue: UWA 

6 Nov Introduction to ENT– Suitable for GPs, Junior Doctors, Medical students. 


Accreditation: CME, RACGP, ACRRM, NMBA. Venue: The CENTER, Subiaco 8 hours 

8 Nov 2012 Warren Jones Oration: Navigating the Future: Steering Between Innovation and 

Fashion. Venue: UWA University Club Auditorium 6.30pm – 8pm 

jacky.jarrett@health.wa.gov. 

au 

17 Nov 

17 - 18 

Nov 

22 Nov 

23 – 24 

Nov 

Western Trauma Course – Esperance 

IMG Forum – Navigating the WA Health System. Venue: Boulevard Centre, Floreat 

A-Z of Epistaxis - Suitable for Emergency Physicians, GPs, Junior Doctors. This session 

is designed to provide skills to identify and initiate treatment of epistaxis and to safely 

and effectively perform nasal packing and application of nasal splints. Accreditation: 

RACGP, NMBA, ACRRM. Venue: The CENTER, Subiaco 

The Cutting Edge: Emergency Procedures Practical Course. Suitable for GPs, GP 

Registrars and Nurse Practitioners. Venue: UWA 

WATEC@health.wa.gov.au 

rachel.patterson@racgp. 

org.au 



26 Nov Medical Research Seminar Series –Improving lung health by preventing prematurity. 

www.liwa.uwa.edu.au 

W/Prof John Newnham. Venue: WA Institute for Medical Research Seminar Room 

QE11 Medical Centre, Nedlands: 12.30pm – 1.30pm with light lunch from 12 noon 

26 Nov Eating Disorders - Eating Disorders Prevention and Promotion: Suitable for rural and 

remote professionals and GPs. This workshop will explore what we can do to prevent 

(and reduce) body image concern and the onset of eating disorders, with particular 

regard to safe information and practice about body image, nutrition and physical 

activity. Venue – PMH: 9am – 1pm 

Blanca.PrietoHugot@health. 

wa.gov.au 

29 Nov 

30 Nov 

Core Skills: Advanced Laparoscopic Colorectal Skills Workshop. Suitable for Year 4-5 

SET Trainees and Consultants in Colorectal Surgery. Venue – UWA 

Core Skills – Advanced Total Laparoscopic Hysterectomy Course. Venue - UWA 



11 Dec Emergency Skills and Crisis Management – Suitable for multi-disciplinary groups from 


specialty areas, medical nursing or allied health. Course provides a systematic team 

approach to the management of patient critical incidents. Accreditation: CME/CPD, 

ANZCA. Venue: The CENTER, Subiaco 

18 Dec ALS Algorithm and Defibrillation Safety – Suitable for GPs and Medical Officers. 

The course will provide interpretation and skills to apply the advanced life support 

algorithm and provide safe defibrillation. Accreditation: RACGP, NMBA, ACRRM. 

Venue: The CENTER, Subiaco: 4 hours 


October MEDICUS 73

0% finance on all Australian-built models. 

There are no catches with Toyota’s zero percent finance. You find the Australian-built model and price you’re happy with, and then you choose the 

finance term that suits you, up to four years. Best part is, you’ll pay absolutely no interest over the life of your loan. Of course, there are a few standard 

finance rules we all need to stick by. Some important conditions are at the bottom of this page, but do come in and see and we can take you through it. 

Ph: 9221 0888 

63 Adelaide Terrace 

PERTH 

CITY 

TOYOTA 

www.citytoyota.net.au 

Ph: 9284 8484 

199 Stirling Highway 

NEDLANDS 

DL12195 

MRB693 

*0% comparison rate available to approved personal applicants & a 0% annual percentage rate is available to approved Bronze Fleet & Primary Producer applicants of Toyota Finance for the fi nancing of current generation 

Camry, Camry Hybrid & Aurion models. Excludes demos. Finance applications must be received and approved between 19/9/2012 and 31/12/2012 and vehicles registered and delivered by 31/12/2012. Maximum fi nance term 

of 48 months applies. Conditions, fees & charges apply. Comparison rate based on a 5 year secured consumer fi xed rate loan of $30,000. WARNING: This comparison rate is true only for the examples given and may not include all 

fees and charges. Different terms, fees or other loan amounts might result in a different comparison rate. Toyota Finance is a division of Toyota Finance Australia Limited ABN 48 002 435 181, Australian Credit Licence 392536. 

^Driveaway prices shown include 12 months registration,12 months compulsory third party insurance(CTP), a maximum dealer delivery charge, stamp duty and metallic paint. Valid: X3929.

PostgraduateNews 




WESTERN AUSTRALIA 


POSTGRADUATE EDUCATION & TRAINING continued 

Register 

your 

Interest 

Postgraduate Education & Training 

IUD and Implanon NXT workshops – Venue: FRWA Sexual Health Services – 70 Roe 

St., Northbridge 

Contact Information 

www.fpwa.org.au 

Research 

Invitation to General Practitioners to join TechWatch to help identify critical incidents involving computer use in 

your practice. TechWatch is being conducted by the University of New South Wales and Flinders University and is a 

declared quality assurance activity under the Commonwealth Qualified Privilege Scheme. Join at www.techwatch.unsw. 

edu.au or call 1800 892 824 

Conferences and MeetingS 

Conferences and Meetings 

23-24 Oct Inaugural Melanoma Conference 2012 Venue: Esplanade Hotel Fremantle, 

Western Australia 

26-28 Oct Rural Medicine Australia 2012 – Venue: Esplanade Hotel Fremantle, 

Western Australia 

www.melanomaconference2012. 

org.au/ 

www.acrrm.com.au 

3 Nov CTEC: Tropical Medicine and Zoonoses Seminar Venue: Perth www.ctec.uwa.edu.au 

18 - 21 

Nov 

17th National Prevocational Medical Education Forum Venue: Perth 

Convention & Exhibition Centre. The theme in 2012 is Diamonds and 

Pearls: Brilliance and Wisdom in Prevocational Education. 

www.prevocationforum2012.com 

19 Nov 4th Australian Rural and Remote Mental Health Conference Venue: 

Adelaide, South Australia 

http://anzmh.asn.au/rrmh 

24 – 28 

Nov 

RANZCO AGM & Scientific Congress Venue: Melbourne, Victoria 

www.ranzco2012.com.au 

ARE THERE ANY PARTICULAR TOPICS OF INTEREST TO 

YOU THAT HAVE NOT BEEN LISTED? 

TELL US WHAT YOU WOULD LIKE TO SEE ON OUR 

SEMINAR PROGRAM FOR 2013. 

You are invited to provide feedback on all current or future 

events by emailing seminars@amawa.com.au 

October MEDICUS 75






Conferences and MeetingS 2013 

Conferences and Meetings 

22-27 Mar Thoracic Society of Australia and New Zealand - ANZSRS 2013 ASMs Venue: 

Darwin Convention Centre 

4-7 Apr Australian Hand Surgery Society Annual Scientific Meeting Venue: Darwin 

Convention Centre 

7 -10 Apr 12th National Rural Health Conference Venue: Adelaide Convention 

Centre 

26-29 May RACP Future Directions in Health Congress 2013 Venue: Perth Convention 

& Exhibition Centre 

2-7 Jun Royal Australian and New Zealand College of Radiologists – 9th General 

Breast Imaging Meeting Venue: Darwin Convention Centre 

www.thoracic.org.au 

www.tayloredimages.com.au 

http://nrha.org.au/12nrhc/ 

www.racpcongress2013.com.au 

www.bigmeeting.com.au 

24 – 29 

Aug 

31 Jul – 

2 Aug 

International Congress of Pediatrics 2013 Venue: Melbourne Exhibition 

and Convention Centre 

24th Annual Scientific Meeting of the Stroke Society of Australia Venue: 

Darwin Convention Centre 

http://www2.kenes.com/ipa/ 

Pages/Home.aspx 

http://strokesociety.com.au 

21 -25 Aug Australian and New Zealand Society of Cardiac and Thoracic Surgeons 

Venue: Darwin Convention Centre 

17 – 19 Oct GP13 – The RACGP Conference for General Practice Venue: Darwin 

Convention Centre 

www.tayloredimagines.com.au 

www.racgp.org.au 

2012 Events Calendar 

The AMA (WA)’s events, seminars and workshops focus on topics of interest and relevance to medical 

practitioners and practice managers. 

Day Time Title Email 

Code 

Venue 

Nov 

Sat 10th 9:00pm CPR Training for members 

This course provides participants with the skills and 

knowledge required to perform Cardiopulmonary 

Resuscitation (CPR) in line with the Australian 

Resuscitation Council (ARC) Guidelines. 

The outcomes of this unit also provide the participant 

with a nationally-recognised unit of competency: 

HLTCPR201B - Perform CPR 

Free for AMA Members 

Wed 14th 6:00pm CPR Training for Practice Staff 

The AMA is delivering a three-hour course for staff 

requiring CPR training to meet practice accreditation 

requirements. The course will also cover CPR following 

the Australian Resuscitation Council (ARC) Guidelines. 

The outcomes of this unit provide the participant with a 

nationally-recognised unit of competency: HLTCPR201B 

– Perform CPR 

T 

T 

AMA (WA), Nedlands 

AMA (WA), Nedlands 

For more information on 2012 events please visit www.amawa.com.au/membership/events.aspx 

Email Code: 

S – seminar@amawa.com.au 

T – traning@amawa.com.au 

E – event@amawa.com.au 

Y – yfd@amawa.com.au 

O – mail@amawa.com.au 

76 MEDICUS October

General 

Ultrasound 

Same day appointments available 

Abdo, renal, pelvis, testes, 

thyroid, salivary glands. 

Obstetrics. 

CT • MRI • X-RAY • ULTRASOUND • NUCMED • DENTAL 

Australia’s only NoCO2 accredited 

Medical Imaging Practice 

Carotids, DVT’s, Renal 

Dopplers and Leg Artery 

Dopplers for vascular studies. 

Musculoskeletal and Sports 

including injections. 

High quality care – every patient every time 

178 Cambridge Street Wembley 

tel: 6382 3888 fax: 6382 3800 

envisionmi.com.au

Are you connected to 

PRC Direct? 

Remote consulting has never been easier. 

Online images and reports now available on your 

iPhone and iPad - Anytime, Anywhere. 

Features: 

• Key images 

• Full patient history 

• Priority Reports 

• Transfer of images to other healthcare practitioners 

If you would like more information or to be connected, please contact: 

info@perthradclinic.com.au 

PRC3644 

www.perthradclinic.com.au 

Leaders in Medical Imaging

twrama 1990_final oc.. - AMA WA

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