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Doctor
CANBERRA
Informing the Canberra
medical community since 1988
March/April 2018 | Canberra Doctor is proudly brought to you by the AMA (ACT) Limited. Circulation: 1,900 in ACT & region
Accreditation risk for ACT Health
Health Minister Meegan Fitzharris has announced that ACT Health has received a
preliminary accreditation report from the Australian Council on Healthcare Standards
that identifies several operational and policy areas that need urgent improvement. In
particular, the report identifies a small number of areas where patients were placed at
extreme risk including parts of the ACT’s mental health service.
In total, ACT Health failed to meet justice health facilities to assess
33 of the required 209 standards safety and risk to consumers.
– a disappointing result by any
account. ACT Health now has 90 AMA ACT’s Response
days to rectify the problems or Prof Steve Robson, AMA (ACT)
risk failing final accreditation or President responded to the pre-
receiving a shorter accreditation. liminary report by expressing “The real issue is the tools they
AMA (ACT)’s disappointment at have at their disposal and the rules
Minister Fitzharris, in releasing the the result but reassuring the pa- and processes they have to follow.”
preliminary report, said “Of note to tients and residents of the ACT
me are the findings of the ACHS that that he “remains confident that The recent decision to split ACT
there is a lack of clarity and a policy the standard of care at Canberra Health into two parts – policy and
gap between corporate and clinical Health Minister Meegan Fitzharris. operations – had come as a sur-
Hospital is very high.”
governance, and its recommenda- prise to the AMA (ACT) and “with
Mental Health Minister Shane
tion to review the governance sys- Prof Robson also recognised Director General, Nicole Feeley’s
Rattenbury said the adult mental
tem. These are precisely the issues the that “an incredible amount sudden departure, it engenders
health facility remained the saf-
that the ACT Health transition team of work goes into getting a ma- concern with everyone.”
est place in Canberra for anyone
is currently addressing as part of jor hospital like TCH ready for Prof Steve Robson, AMA (ACT) President.
at risk of suicide.
the ACT Health restructure that will accreditation and regardless Fixing the problems
of the current situation, I’d like care was under threat by govern-
be subject to consultation over the “Notwithstanding that we’ve got ACT Health now has 90 days to
coming months. some risks to deal with, it’s still the to acknowledge the many doc- ance and management issues.
“When the governance is wonky it rectify the issues and maintain
best place for them to be in terms tors, nurse and other staff who its accreditation. Interim Direc-
“This will enable ACT Health to sends ripples through the entire
of that supervision,” he said. have contributed. We all want a tor-General, Michael De’ath, said
focus on improving operational organisation,” Prof Robson said.
good outcome, but it hasn’t been
performance, governance and ac- The report recommended an he had convened an “extremely
achieved at this time.” “There’s been huge upheaval at
countability frameworks to better urgent independent external re- high level” group of senior exec-
provide patient-centred health- view of all mental health inpa- Prof Robson said hospital staff ACT Health recently and a lot of utives to ensure the criteria are
care to our growing population.” tient units, drug and alcohol and were frustrated that good clinical balls in the air. met by the end of July.”
VOLUME 30, No. 2 CANBERRA DOCTOR: Informing the Canberra medical community since 1988
Medical Musings
WITH PRESIDENT, PROFESSOR STEVE ROBSON
ACT Health Accreditation as the uptake and use of PHI has We all realise that there is a be- and the need for policies to cov- APRA statistics show an over-
It was with considerable concern major effect on medical practice wildering array of PHI products er the real costs of treatment. all ‘no-gap’ rate of 88.1% and a
that I learnt about the significant in this country – whether patients on offer, yet many leave patients In view of the changes made by known-gap of 7.3%: our profes-
failings identified in the prelimi- have PHI affects the referral pat- without cover when they need it Australia’s largest insurer, the sion is working hard to ensure
nary accreditation report for ACT terns of general practitioners, and most. As a way of helping doc- British-based company BUPA, it patients receive value for money.
Health. The real question, how- it directly affects specialists’ abil- tors and their patients deal with is important that private health
ity to offer inpatient care to their this uncertainty, the AMA Private insurance does not impact a pa- The Report Card emphasises
ever, is what we can do as repre-
patients. The Federal Government Health Insurance Report Card tient’s ability to choose the doc- the need for PHI to be simpli-
sentatives of the medical profes-
has undertaken some important is produced each year. It aims tor that is right for them, and to fied, more transparent, but also
sion in the ACT to work towards
reforms to PHI to help people un- to provide clear and simple in- have their treatment at a facility to cover the real costs of medical
achieving accreditation with in the
ninety-day period now allocated. derstand the different conditions formation about how PHI really that suits them. The Report Card treatment – including the theatre
that each policy category. These works. This year’s report was suggests that recent changes fees, equipment, consumables,
Almost inevitably, system errors hospital costs and staff time –
have been categorised as gold, released earlier on, at the height made by BUPA have the potential
will lie at the heart of the issues. rather than simply pointing the
silver, bronze, and basic. of a media storm involving sen- to be severely detrimental to pa-
However, I can’t help but believe finger at the doctor or pushing
sational reporting of the ‘gaps’ tients and doctors alike.
there is a bigger story to emerge Private Insurance and, indeed, increased out of pockets onto
charged by a very small number
given that only three years ago, the entire private health system This year’s report card clarifies patients. If people are looking to
of procedural specialists.
ACT Health achieved an uncondi- is likely to be a flashpoint during the significant variation in t a save money, I would suggest that
tional accreditation. the next Federal election. More The Report Card shows that fund will pay towards a medical they are not deceived into down-
The current situation requires all importantly, it represents a ma- there are many policies on offer: procedure on behalf of the pa- grading to a junk policy. From the
of us to continue to do our best to jor investment for many families these provide greatly varying lev- tient. Some insurers perform AMA’s perspective, these junk
ensure that the goal of accredita- and it is critical that people with els of benefits, cover, and gaps. well overall, some only perform policies should not exist at all.
tion is achieved. I’ve made an offer PHI understand what the cov- Importantly, the 2018 Report well for certain conditions. As
er involves and will reimburse Card also highlights the increase procedural specialists know, The AMA will continue to fight
of assistance to Minister Fitzhar-
ris should that be required. them for care. The issues are so in profits for PHI funds. With the same doctor performing the for our patients’ right to choose
important that a number of Min- profits rising for insurance com- same procedure can be paid sig- the doctor that is appropriate for
Private Health Insurance isterial Advisory Committees are panies has come a rise in exclu- nificantly different rates by each them, and to have their treatment
Many of you will have been fol- busy providing advice to Govern- sions, and a rise in complaints. fund. This is an important and of- at a facility that suits them. We
lowing the media stories about ment. I should declare that I am a The Report Card also highlights ten overlooked story behind pa- will fight to ensure that doctors
private health insurance (PHI) and member of the MBS Review and something that we all recognise tient out-of-pocket costs, hidden can refer patients to the right
its affordability and value. I would the Ministerial Advisory Commit- – the need for PHI to be simpli- by high levels of no- and known- specialist – not just the one that
like to discuss this in some detail, tee on out-of-pocket costs. fied, with greater transparency, gap billing statistics. The latest an insurer deems appropriate.
Dr Rob Creer VALE
ORTHOPAEDIC The president,
Prof Stephen Robson,
SURGEON Board members
and staff of AMA (ACT)
extend their sincere
Sports Injuries of the Knee and Shoulder condolences to the
• Knee - Single and Multi-Ligament Reconstruction family, friends and
- Meniscal and Chondral Damage
colleagues of
- Patello-Femoral Pathology
• Shoulder - Instability Dr John Bernard
- Rotator Cuff and bicep pathology BAGGOTT
Joint Replacements
• Primary and Revision Hip/Knee Replacement
(Computer Navigated Knee Replacement)
• Reverse and Total Shoulder Replacement
Private/DVA/Workcover
Suite 5, 2 King Street Deakin (Sports Therapy Centre)
Tel: 6162 0807 email: admin@drcreer.com.au
[2] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 MARCH/APRIL 2018
Salaried Doctors bargaining: pay
increases and JMO education expenses
BY TONY CHASE, DIRECTOR OF WORKPLACE RELATIONS AND GENERAL PRACTICE
In these days of social media and the 24-hour news cycle,
Canberra Doctor readers could be forgiven if they are seen
to nod off when asked to read another progress report on
the Salaried Doctors enterprise bargaining round. While
the bargaining has been spluttering along for at least 18
months, there is some reason to be optimistic.
On 10 April with no fanfare, pre- The ACTU and others have point-
amble or warning, the ACT Gov- ed out that wage movements have
ernment announced that it had un- continued to stagnate. The ACT
dertaken a review of its November Government’s wage offer over a
2017 offer and improved the pay four year period seems to suppose
component to be: that this period of wage stagnation
will continue for the whole period
2.25% from the first full pay of the proposed agreement.
period in October 2017;
0.5% from the first full pay AMA claim for JMO medical
period in June 2018; education expenses and leave
1.35% every six months from Given the prospect of limited op-
the first full pay period in portunities for wage increases,
December 2018 to the first full the AMA (ACT) has continued to
pay period in June 2021; and focus on assisting its JMO/DiT
members in other tangible ways
With the Agreement to expire on and particularly as regards train-
31 October 2021. ing costs.
Wage stagnation The AMA (ACT) claim for Medical
This ACT Government offer must Education Expenses is that the al-
be seen in context. ACT Public sec- lowance be:
tor workers are being asked to ac-
Calculated as 12% of each
cept a minimal CPI based wage of- practitioner’s fixed wage
fer for a 4-year agreement. At the
same time, the ACTU is making Payable pro rata fortnightly wage movements over the This is to accommodate the cir- training objectives. The current ar-
submissions to support its highly from the first pay period on life of the Agreement. cumstances where training is re- rangements provides ACTH with a
ambitious claim to the Fair Work or after an agreed date quired for further study associated pre-emptive right to decline study
Leave with their training as a Doctor. leave. The AMA proposes this
Commission’s Annual Wage Re- Payable during periods of
view for a uniform 7.2% increase paid leave but is not counted The AMA is also proposing 3 clear clause be deleted or revised.
In addition to these changes,
to the minimum wage. Employer as salary for any other days study leave = (2 days prepara-
the AMA proposes together with Finally, in support of this proposal
groups are calling for a modest purpose of this Agreement. tion + 1 day for attendance at each ACTH, that we confer directly with the AMA proposes that there be
increase of 1.8% for those on the The allowance would be exam). This leave may be utilised each of the Colleges to determine a clear difference between what
minimum wage and $14.60 for the adjusted in line with general for study purposes outside the the appropriate level of study leave is considered ‘exam leave’ and
lowest award rates. percentage increases in study requirements of Colleges. to meet the Territory’s stated ‘study leave’.
MARCH/APRIL 2018 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [3]
PBS listing of HIV ASMR New Investigator Forum
The Australian Society for Medi- career researchers (
DG Departs as ACT Health is split
into Operations and Policy
On Friday 23 March Health Minister Meegan Fitzharris
announced that ACT Health will separate operational
health services from policy and planning function to
“improve access, timeliness and quality of health services
for Canberrans and those in the region.”
From 1 October 2018, ACT Health Restructure
will be separated into two organi- “This is all about making sure
sations, focussed on: Canberrans get the best possible
the delivery of quality health care and continue to be the health-
services, and iest people in the country. With
the strategic policy and our health system expanding and
planning stewardship of the increasing demand on our health
health system. services, now is the perfect time to
move towards a more contempo-
The Minister said that “the re- rary health system. This separa-
structure is will bring the ACT into
tion will enable a clearer focus on
line with every other Australian ju-
operational effectiveness and effi-
risdiction.”
ciency, and improve accountability
DG Nicole Feely to leave for health service delivery,”
As part of these changes, the ACT “The ACT Government will contin-
Health Director General, Nicole ue to invest in preventive, commu-
Feely will leave, and has advised nity and hospital-based services to
the Minister that “she will pursue build and improve health facilities
new opportunities,” in the ACT, for a Territory wide sys-
The Minister thanked Ms Feely for tem that is adaptable to the com-
her “commitment and focus. She munity’s changing needs.” Minis-
has been instrumental in begin- ter Fitzharris added.
ning this reform process within “Both organisations will continue
ACT Health, transforming strategy ACT Health’s commitment to the
and positioning ACT Health for a health of our community, specifi-
sustainable financial future.” cally an approach to health that is
“Her strategic insight and opera- all about people, as well as a com- Former Director-General Nicole Feely.
tional expertise has skilfully repo- mitment to quality, innovation, en-
gagement and accountability. to establish clinical Centres, which proved mental health services de- coordinated,” said Minister for
sitioned the Directorate for the
will group clinical services through livery, while also allowing mental Mental Health, Shane Rattenbury.
transition to a truly person-cen-
“The clinical and service planning Centre Service Plans and Specialty health policy to improve its focus
tred, integrated health service. Staff, employee representatives
underway through the Territo- Service Plans. – within Health and across Gov-
“On a personal level, we thank ry-wide Health Services Frame- ernment. The establishment of and health stakeholders and the
Nicole and wish her every suc- work will remain a key priority for Mental Health the Office for Mental Health will broader community will be con-
cess,” said Minister Fitzharris. government and we will continue “The separation will facilitate im- ensure that these efforts are well sulted.
CANBERRA EYE RELOCATION
CANBERRA EYE SURGEONS (formerly Canberra Eye Hospital) is moving to:
4 MAKIN PLACE, DEAKIN 2600
Our Phone number is the same: 02 6249 6000
Our Fax number is the same: 02 6248 8601
New Email: office@canberraeye.com.au
Our offices will be closed from Thursday 22nd February to Monday 26th February,
Re-opening at our new location on Tuesday 27th February 2018 at 9am.
We look forward to welcoming you to our new specialist facility.
DR MARTIN DUNCAN | DR IAIN DUNLOP | DR GAGAN KHANNAH | DR CHRISTIANE LAWIN BRUESSEL | DR SALIM OKERA
MARCH/APRIL 2018 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [5]
Post-operative treatments and
services for DVA clients
Hospital discharge planners and physicians can refer
eligible Department of Veterans’ Affairs (DVA) clients to
a range of DVA-funded medical and allied health services
for post-operative care and rehabilitation.
Hospital discharge planners have Occupational therapy (Factsheet
an important role in coordinating HSV23 – Occupational Therapy
the transition from hospital back Services via dva.gov.au)
into the community, and in consul-
tation with the surgeon and the cli- Physiotherapy (Factsheet HSV19
ent’s GP, will usually arrange treat- – Physiotherapy Services via dva.
ment referrals prior to the patient gov.au)
being discharged from hospital. Exercise physiology (Factsheet
Where a medical practitioner as- HSV30 – Exercise Physiology Ser-
sesses that additional services are vices via dva.gov.au)
clinically required, or where these
have not already been arranged Podiatry (Factsheet HSV20 – Podi-
by the discharging hospital, they atry Services via dva.gov.au)
can arrange the referrals for the Dietetics (Factsheet HSV21 – Die-
necessary medical or allied health tetic Services via dva.gov.au)
services.
See also: full list of clinical health
If the services are not available on
services (Factsheet HSV01 – Health
the Medicare Benefits Schedule
Services Available to the Veteran
(MBS) or the Repatriation Pharma-
ceutical Scheme (RPBS), the clini- Community) available to eligible
cian should contact DVA for prior DVA clients
Community Nursing appliances Maintenance
financial approval before progress- DVA also funds community-based services
Rehabilitation Appliances Veterans’ Home Care
ing with or arranging the treatment. services that can be accessed Program (RAP) — including program — including Convalescent Care
Key post-operative clinical treat- through a referral from a clinician, clinically required home carer support and Safety (Factsheet HSV77 –
ments funded by DVA can include: including: modifications and household Related Home and Garden Convalescent Care).
Doctors’ health
Dr Katherine Gordiev resources
Orthopaedic Surgeon Are you looking for a GP?
Shoulder and Upper Limb If you’re a junior doctor
MBBS (HonsI) FRACS FAOrthA
or medical student and
looking for a GP please
Dr Gordiev specialises in Arthroscopy, Reconstruction, Replacement contact AMA (ACT) and
and Trauma of the Shoulder and Upper Limb. This includes we will assist you to find a
arthroscopic and open shoulder stabilisation, shoulder replacement, local GP.
rotator cuff repair, elbow, wrist and hand surgery. She has practiced in
Canberra since 2005. Doctors’ Health
Dr Gordiev undertook Orthopaedic training in Sydney and Canberra Resources online
and further specialised for 18 months at the Cleveland Clinic in the
AMA’s Doctor Portal:
USA. She regularly attends local and overseas conferences concerned
with developments in the surgical treatment of shoulder, elbow, https://www.doctorportal.com.au/
wrist and hand disorders. Dr Gordiev participates in the teaching of doctorshealth/resources/
Orthopaedic registrars through the AOA training program. JMO Health:
Dr Gordiev seeks to ensure that her patients are well informed about http://www.jmohealth.org.au/
all treatment options available to them and to offer a high standard of Partly funded by DHAS and a
operative treatment and aftercare. Please visit her website or call her range of other organisations.
practice for advice or more information. Doctors Health Advisory Service
http://dhas.org.au/resources/
resources-for-junior-medical-
officers.html
On the DHAS website itself.
AMSA students and young
doctors:
http://mentalhealth.amsa.org.au/
Phone 02 6260 5249 about-the-campaign/
www.katherinegordiev.com.au http://mentalhealth.amsa.org.au/
Suite 7 National Capital Private Hospital, Garran 2605 keeping-your-grass-greener/
[6] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 MARCH/APRIL 2018
Patient focussed trauma care
in the ACT*
BY DR AILENE FITZGERALD
The Australian Capital Territory is undergoing a decade long redesign of its health
services. It is a bit sad that we have to designate ‘patient- focused care’ as a major priority
of the redesign. As clinicians, I am sure we like to think that our work is ultimately patient-
focused – be it through the provision of direct patient care, teaching, revising protocols,
reviewing literature or attending quality assurance activities.
Surely our consistent aim is pa- ings from which we can learn. non- operative management of
tient-focused care. So why the need blunt multi-trauma patients. Sur-
to ‘guide its establishment’? Could The cost of patient care gical intervention when required is
it be that our ability to holistically Health economics plays a signif- predominantly handled by ortho-
care for patients is impeded by ad- icant role in determining service paedic surgeons and other sub
ministrative or other processes? Do delivery. Asking clinicians to put specialties.
clinicians, administrators and poli- forward a business case for im-
proved patient care highlights the That is not to say that general
ticians share the same perception
surgeons shouldn’t maintain an Dr Ailene Fitzgerald, RACS ACT Chair.
of what patient-focused care looks tension between sustainability of
interest in trauma management,
like? What about the perception expenditure and best practice.
but clearly the model in the ACT
and expectation of patients? Often the true economic value of
where all general surgeons work-
service improvement gets lost in
Clinicians and administrators ing at a Major Trauma Centre are
the narrow process of costing a
must collaborate thoughtfully and required to be trauma consultants
specific resource and comparing
respectfully to understand each is outdated and does not deliver
it to a proposed potential saving
other’s views and determine the best patient outcomes.
within the restraints of that ser-
best way forward.
vice’s budget. Trauma care should be left to those
Clinicians must attempt to un- that wish to pursue a sub-spe-
Yet good fiscal management and
derstand the political pressures, cialty interest in this area, and to
best patient outcomes need not implemented. Probably the most senior clinicians. In the ACT, it has
competing priorities and complex clinicians who feel comfortable
be mutually exclusive. Perhaps if important facto r in the success been a long journey to persuade
issues that administrators face. with time critical decision-mak-
we were to focus more on overall of these teams is collaboration general surgeons and adminis-
ing in the acute management of
Administrators must truly listen to quality of care throughout the pa- among different sub-specialties trators of the need to implement a
multiply-injured patients. Trauma
clinicians and understand the daily tient journey, from injury preven- to ensure appropriate and timely best practice model.
resuscitation in Australian Major
challenges they face, where often tion to acute care to rehabilitation management of all injuries.
Trauma Centres is often led by Systems of care which truly sup-
the quality of patient care able to and reintegration back into the
Critical Care Consultants as team port patients and modern day best
be provided is heavily influenced community and return to work, the This model recognises that no one
leaders, with surgical decision practice are only possible through
by limitations within the system. true economic burden to society specialist has all the necessary
making the domain of the relevant careful, considered collaboration
Often senior clinicians are unique- would lessen. knowledge and skills to provide
proceduralist in collaboration with between administrators and clini-
ly placed to provide complex, well holistic care to the multiply in-
Changes in trauma care the team leader. cians. As clinicians we must also
considered, reasonable solutions jured. Implementing such a model
to challenging issues. Both cli- Trauma care is an excellent ex- In many of Australia’s Major Trau- requires a great deal of dedica- be prepared to continually evaluate
nicians and administrators must ample. Once perceived to be the ma Centres, a multi disciplinary tion by the clinicians involved and and adapt to ensure we are truly
listen to patients and their families domain of general surgeons, trauma consultant roster involv- a willingness by administrators providing the best care possible.
as they often have unique insights present day trauma care is large- ing critical care specialists and to put their faith in the expertise, *This article first appeared in RACS
of the system’s strengths and fail- ly comprised of critical care and surgeons has been successfully dedication and know ledge of their ‘Surgical News’ April 2018.
MARCH/APRIL 2018 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [7]
World Doctors Orchestra
BY DR ANNE BICKNELL
Barcelona Wednesday October 5th
The conductor stepped onto the platform. “Good morning everyone. We will start with the
Brahms: 2, 3, 1 ...” and off we went, straight into the Brahms 2nd symphony. So began
my introduction and first experience of playing with the World Doctors Orchestra. Despite
the no-nonsense beginning to the first rehearsal, this turned out to be an unforgettable
experience and a major highlight of my musical and medical life.’
I began learning viola at school and conductor. Stefan trained as the evenings after rehearsals
when the orchestra was in need a cardiologist and combines a and a formal dinner following
of another player. I took to this busy medical career as Professor the Barcelona concert provided
beautiful mellow instrument with and Director of the Institute for more opportunities to relax and
relish and for some years had my Social Medicine, Epidemiology enjoy meeting other members
heart set on becoming a profes- and Health Economics at Charite of the orchestra and their fam-
sional viola player. University Hospital in Berlin with ilies. For the Barcelona/Girona
multiple commitments as musi- concerts 94 medical musicians
In my last year of high school my participated, with most fields of
cian and conductor.
direction changed to thoughts medicine represented.
on a career in medicine. I was The orchestra meets and per-
accepted into the Sydney Univer- forms concerts 2-3 times a year My colleagues had come from all
sity Medical School. and now, 40 in different cities throughout over the world including Germany,
years later, I’m preparing for re- the world, with profits from the Spain, Italy, France, Netherlands,
tirement after a long career as a concerts donated to medical Sweden, Norway, Switzerland,
GP in Canberra. charities in the host country. The England, Ireland, Scotland, Cana-
members of WDO are all doctors da, USA, South Africa, Japan, Hong
Throughout my medical career I who give up their time from their Kong, Taiwan and Australia. Of the
have been able to relax and enjoy medical practices, fund their own 5 Australians in the orchestra, 4 of
playing music, without the ac- travel and expenses to share the us were fellow viola players.
companying stressors that a pro- enjoyment of coming together
fessional musician may often ex- WDO in Spain
to play and perform music with
perience. As well as involvement like-minded colleagues for a My husband and I travelled to Concert performance in Girona.
with local community orchestras, good cause. The committed lo- Spain 10 days before the or-
I have had the good fortune to be cal organising committees of chestra was due to meet. This ditori de Barcelona. Both concert Vocci della Natura (Voices of
a long-term member of both the the host city work hard to ensure gave me time to adjust to the halls are modern with excellent Nature) specially arranged
Australian and NSW Doctors Or- each concert is a success. demands of overseas travel and acoustics. The proceeds from the for our Orchestra by the
chestras which each meet once a also gave us an opportunity to Girona concert were donated to Spanish composer Jordi
year to perform concerts raising Members receive their parts for take a tour of the Andalusian re- The Oncological Foundation, the Cervallo who also attended a
money for medical charities. the concert program 2-3 months gion of Southern Spain. Our re- rehearsal and concert
AECC-Catalunya Against Cancer
prior to the concert week so hearsals took place in the Sem-
Last year I applied for a position and the Biomedical Research In- Schumann Cello Concerto
there is enough time for individ- inari Conciliar – a beautiful old
in the World Doctors Orchestra ual practice before the orchestra stitute of Girona. The Laboratory – soloist Louis Claret (Pablo
building adjacent to the univer-
(WDO) and was delighted to me meets. Three long and intensive of Molecular and Translational Casals was Louis’ godfather
sity, not far from La Rambla. We
receive an invitation to play with days are allocated for rehearsal had a large and very welcoming Oncology and Agatha Group (sup- and he was taught by his
them for the Barcelona/Girona in the week prior to the concerts. viola section of 16. porting women with breast can- brother Enric Casals)
concerts in Spain, October 2017. Further rehearsals occur before cer) were the recipients of the pro-
The performances were held at Brahms Symphony No. 2
WDO the weekend performances. ceeds from the Barcelona concert.
L’Auditori Palau de Congressors It was a huge thrill to be a part
The WDO was founded in 2007 by Sharing a glass of champagne, de Girona (about an hour’s drive The program was the same for of this orchestra and wonder-
Stefan Willich, artistic director sangria, and tapas together in north of Barcelona) and in L’Au- both venues: ful group of colleagues. I looked
[8] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 MARCH/APRIL 2018
The five Australians in the Orchestra – Drs Damian Thomson, Anne Bicknell, Brian Hughes, Patricia Samson and James Smith.
tive it can become to travel to the A special joy the websites for the New South
other side of the world to meet up Being part of a medical orchestra Wales Doctors Orchestra, Aus-
each year. I’m hoping to have the tralian Doctors Orchestra and
brings a special joy and excite-
opportunity to attend again for the World Doctors Orchestra. I high-
ment for the doctors involved.
around the stage in Barcelo- What an extraordinary experi- Jerusalem/Tel Aviv concerts in ly recommend it as a wonderful
2019. Meanwhile I look forward to If others in the Canberra med- way to relax away from the daily
na and thought “Wow! We have ence this is!” ical community are interested
receiving a recording of the con- stressors of medical life while
come from all over the world to Some of the members return to cert when I will enjoy sitting back further information including extending and enjoying your mu-
play together, we’re all doctors play regularly, others every few to re-live the excitement of this registration details and forth- sical experience with like-mind-
and have so much in common. years – it’s easy to see how addic- adventure all over again. coming concerts can be found on ed friends and colleagues.
Dr Sindy Vrancic Jamie Harradine Sue Witchalls Cara Gilbert
WE ARE MOVING
From 23 April 2018, the Shoulder2Hand Team will be relocating to:
Francis Chambers
Suite 17, Level 3, 40-42 Corinna Street
Phillip ACT 2606
Our contact details will remain the same:
Phone: 6260 4777 | Fax: 6260 4788
Email: reception@shoulder2hand.com.au
MARCH/APRIL 2018 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [9]
Dr Edward Fleming
– WWII Lancaster pilot
The following story was compiled by Louise Maher, ABC
Radio Canberra and first appeared on 8 March 2018.
Dr Edward Fleming served with
Bomber Command in WWII.
‘Before he had a licence to drive
a car, Melbourne-born Edward
Fleming was learning to fly Tiger
Moths with the Royal Australian Air
Force (RAAF).
By 1944 the then 19-year-old fly-
ing officer was piloting Lancasters
with Bomber Command in Eng-
land during World War II.
Next month he will return to where
he served, joining 14 other Austral-
ian veterans at the official opening
of the International Bomber Com-
mand Centre and Memorial Spire
in Lincoln. of the war after several months in
operational training units.
It honours the million aircrew and
support staff from 60 countries who Though initially “extremely dis-
played a key role in the Allied victory. appointed” to have missed out on
taking part in bombing missions,
Now 93, the retired Canberra sur- he later realised his good fortune.
geon looks back on his RAAF ser- Inside the cockpit of a Lancaster bomber (courtesy of Australian War Memorial).
vice as one of the most significant “I think you have an indestructible
complex at that time of your life,” “A little airfield… put on lights for Last year, with his son and daugh- “It was very exciting for me to hear
times of his life.
Dr Fleming said. us and we landed virtually out of ter, he attended a commemoration it again,” Dr Fleming said.
“Flying anything is an enjoyable fuel at about four o’clock in the for his squadron at its former base
“In retrospect, I have absolutely no morning and got away with it. “But in particular, for me to think
experience… the Lancaster in in Lincolnshire.
doubt we would not have survived.” my children were hearing the same
particular because it was such an “We’d been circling around… to-
“There were about five or six… fel- thing and seeing the same thing
iconic aircraft.” On one occasion he and his crew tally lost in the dark… a terrible that had been so familiar to us.”
lost their way at night during bad feeling.” low people from the squadron of a
More than 55,000 Bomber Com-
weather over the English Channel. similar age group and that was a The trip to the memorial opening
mand members were killed during Commemoration trip very moving experience,” Dr Flem- for veterans and their carers is
the war in raids over enemy-con- The flight almost ended in tragedy. a moving experience ing said. being organised by the Bomber
trolled Europe, training exercises
“I had an instructor on board at Dr Fleming was one of 10,000 Aus- Command Association in Austral-
and accidents on the ground. A Lancaster bomber flew in trib-
the time and he broke the rules tralians who served with Bomber ia, supported by a $200,000 Com-
Dr Fleming joined 550 Squadron and gave a mayday call,” Dr Flem- Command; more than 3,400 never ute at one of the ceremonies they monwealth grant and community
(RAF) two weeks before the end ing said. returned. attended. fundraising.
[10] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 MARCH/APRIL 2018Book review:
AUTHOR: THOMAS MORRIS: PUBLISHED BY BODLEY HEAD 2017
THE MATTER OF THE HEART – A History of the Heart in 11 Operations ever-present problem of rejection? This is an interesting, well written
Today it is widely accepted, by both the medical profession and the public, that surgical Transplantation was in fact not a and informative book that all in the
treatment, for a wide variety of disorders of the cardiovascular system, is generally new idea, so why was Barnard first? profession should enjoy, and quite
safe, with low rates of morbidity and mortality. rightly it has received many excel-
Today for desperately ill patients,
lent reviews. Personally I would
mechanical support devices, such
highly recommend it, especially to
However, as Thomas Morris tells surgeon, just the necessity of trying as the ventricular assist device (VAD)
those unreasonable ones out there,
us in his book, ‘The Matter of the to relieve the suffering of patients, may be employed as a ‘bridge to
who are still looking for solutions
Heart,’ this was not always so. young and old, dying from cardiac transplant’ but what did the aviator
to the problems the profession en-
Indeed, as he points out, until the problems, not of their own making. Charles Lindbergh have to do with
late 1940s, cardiac surgery, except counters on a daily basis.
all of this? Was he really the inventor
for simple suturing of wounds, was Morris documents the trials and
tribulations, the failures, the out- of the first artificial heart in 1932 and Despite the spectacular success-
virtually impossible, with most at- how did the use of an artificial heart es of the last 60 years, there is still
tempts at anything more complex right disasters and occasional
triumphs as the cardiac pioneers lead to a bitter feud between Mi- much to be done. To quote Winston
ending in the death of the patient. chael DeBakey and Denton Cooley Churchill “the longer you can look
Spectacularly unsuccessful were attempted to revolutionise the way
medicine dealt with heart disease that would last 40 years and at one back, the further you can look for-
other unusual treatments of car-
and in doing so, developing new stage ended up in the courts? wards.” Thomas Morris reminds
diac injuries, such as cocktails of
techniques that gave hope and us that we all should remember
strychnine and whiskey, or ene- What next?
mas of hot coffee and whiskey. life to many. He also covers the how we got here today, so that we
development of pacemakers and So, now after a frantic 60 years of can move forward tomorrow.
Not surprisingly, these treatments
defibrillators, including the short tragedy and triumphs, research and
have faded from use today! Further reading
but spectacular period of nuclear innovation, we live in an era when
George Bernard Shaw said that “the powered pacemakers of the 1970s. intervention for all manner of car- For those who enjoy reading about
reasonable man adapts himself to diac problems is possible. These the weird and the wonderful, the
the world; the unreasonable man He covers the accidental develop-
advances now include diverse treat- tall tales and true from the leg-
persists in trying to adapt the world ment of coronary angiography by
Transplantation ments such as intrauterine surgery endary medical past, Thomas
to himself; therefore all progress Mason Sones and the various sur-
gical attempts to deal with ischae- Many people know the name Chris- on the foetus, trans-aortic valve Morris publishes a regular and en-
depends upon the unreasonable replacement (TAVI) for desperate- tertaining weekly blog on medical
man.” So it was with heart surgery, mic heart disease, including the tiaan Barnard, the South African
work of the tragic Rene Favaloro, surgeon who carried out the first ly ill, virtually inoperable and often history, to which you can subscribe
with many eminent and reasonable
whose suggestion of using conduits cardiac transplant in 1967, but how very elderly patients dying of severe for free. He details the problems
specialists worldwide agreeing that
of saphenous veins, to bypass ath- many know the ‘story behind the aortic stenosis, robotic surgery and and the attempted solutions to a
the surgical treatment of cardiac
conditions was virtually impossible. erosclerotic lesions, was really just story’ of this operation that was in percutaneous valve repair, develop- wide variety of medical problems
However, in the mid-20th century, following on from a suggestion of fact long in the making. Who were ments that would have been consid- which are both entertaining and
unreasonable men and women, Alexis Carrel in 1910. Sometimes the real heroes, the surgeons, the ered science-fiction a century ago. occasionally chilling. To find out
clinicians, scientists, technicians, there appears to be more to the patients or those who worked out So where to from here? Morris also more, go to his website, the URL is
and even desperate relatives of ter- story than we appreciate. how to deal with the difficult and speculates on what the future holds. thomas-morris.uk
minally ill patients, sought to slowly
change that perception, unfortu-
nately often through painful trial
and error, resulting in high mor-
tality rates but with occasional out-
standing results. Any success fre-
quently came at a high price even
after years of painstaking research
and it often encountered much op-
position, from an uninformed and
at times suspicious, even hostile
public and profession alike.
FAST-TRACK UROLOGY
Modern heart surgery
Modern heart surgery really began If you wish for your patients who are experiencing inappropriate
in the mid-1940s, in the Cotswolds delays in diagnosis and treatment, be Fast Tracked to avoid long
in England, and was born of the waiting times, Dr Maurice Mulcahy at Canberra Urology can Fast
tragic necessity of dealing with the Track your patients through the private sector for all urological
horrific chest and cardiac injuries to conditions including the following:
allied servicemen and women. The
unlikely hero was a young Ameri- • Acute Presentation of Ureteric Colic with
can surgeon, Dwight Harken who Non-contrast CT Urogram and FBC, UEC & MSU
would subsequently become the • Stone Disease
‘father’ of modern cardiac surgery. • Haematuria
Harken perfected an operation • Elevated PSA
to remove shrapnel and bullets,
• Bladder Outlet obstruction (BPH)
from the beating hearts of wound-
ed soldiers, without the benefit of • Testicular Cancer
the yet-to-be developed heart-lung • Renal Masses
machine. He operated successful- • Other Urological Cancers and Conditions
ly on 134 patients without a single
PLEASE PHONE: 02 6281 0222
death. In those days there were
no randomised controlled trials, EMAIL: reception@canberra-urology.com
protocols or guidelines to aid the
MARCH/APRIL 2018 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [11]The Latest MRI Technology now
available in Canberra MAGNETOM Vida
BY SIEMENS HEALTHINEERS
MAGNETOM Vida is the world’s first 70cm 3T MRI scanner
with BioMatrix Technology, equipped to embrace the
unique set of challenges that each and every patient
brings to the MRI exam. Variability due to patient
anatomy, physiology and even radiographer expertise
is expertly handled by this revolutionary new scanning
platform. Canberra Imaging Group is proud to have one
of the first BioMatrix MRI scanners in the countwry.
The Vida skillfully copes with the and provide unmatched image
increasing demands of clinical quality. The scanning platform
routine by truly embracing hu- provides artificial intelligence
man nature and automatically features that enhance every step
adapting to each individual pa- of the imaging process including
tient – ushering in a paradigm positioning, scanning and post
shift in MRI. Seamlessly inte- processing of the results so cas-
grated BioMatrix Sensors dis- es are ready for the radiologists
play the patient’s respiration rate to read in a timely manner.
automatically to help anticipate
The Vida also has access to the
challenging situations before
latest revolutionary applications
they happen.
to provide new 3T clinical capa-
In addition to the brand new Bi- bilities for all of your imaging
oMatrix technology, the MAG- needs. All of this means that your
NETOM Vida also has an all-new patients have access to the lat-
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to embrace full 3T performance the MAGNETOM Vida.
AMA LEADERSHIP DEVELOPMENT DINNER AMA National Conference
25 MAY 2018
25-27 MAY 2018 QT CANBERRA
Hear the story of the man behind the 2017 Nobel Peace Prize and his fight to
end nuclear weapons at this year’s AMA Leadership Development Dinner GIVING YOU A GREATER VOICE
KEYNOTE Debate the most pressing challenges facing the medical profession
Nobel Peace Laureate & Co-President of the International Physicians for the and the healthcare system at this year’s AMA National Conference.
Prevention of Nuclear War, A/Prof Tilman Ruff HIGHLIGHTS INCLUDE
AWARD PRESENTATION
Perspectives on health advocacy and the role of the AMA featuring a
The AMA Doctor in Training of the Year Award
panel of past AMA Presidents
Don’t miss out on this unique opportunity to wine and dine with your fellow
colleagues and medical students and view the very best of contemporary Leadership Development Dinner featuring Nobel Peace Laureate &
Australian photographs from the National Photographic Portrait Prize. Co-President of the International Physicians for the Prevention of
Nuclear War, A/Prof Tilman Ruff
TIME: 7:30-10:30pm
DATE: Friday, May 25, 2018 Policy debates on a range of topics from flexible work practices to funding general
VENUE: National Portrait Gallery – King Edward Terrace, Parkes, Canberra practice to reduce hospitalisation and more.
TICKETS: Medical Students – $85
Doctors in Training – $99, Other – $149 REGISTER TODAY to network with your colleagues and make a
difference to the future of healthcare. Discounts apply for AMA members.
REGISTER NOW: natcon.ama.com.au/register Visit natcon.com.au to find out more
ENQUIRIES: natcon@ama.com.au CONFERENCE ENQUIRIES: natcon@ama.com.au
[12] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 MARCH/APRIL 2018Rostering and JMOs
CONSULTING ROOMS AVAILABLE
ZedThree Specialist Centre located in Deakin is
offering Doctors and Allied Health Professionals
quality furnished consulting rooms. We currently have
Psychiatrists, Psychologists and Paediatricians in our
rooms and would welcome associated specialties.
Avid readers of Canberra Doctor will recall back in January 2017 where AMA (ACT) The rooms are available to be rented on a part-time
cautiously welcomed the introduction of a centrally co-ordinated rostering scheme for or full-time basis with administration support.
the Junior Doctor cohort around the Territory public health service. Industrial problems Please contact the Practice Manager on
admin@zedthree.com.au for further details.
associated with rostering and associated payroll issues across the Territory health
sector have perennially been the cause of industrial friction and wasteful disputation.
The AMA (ACT) Workplace Rela- ion with a minimum of fuss. If We would appreciate any feed-
tions Team are pleased to offer a MOSCETU continues to improve back on issues you may have with
tick of approval to ACT Health’s its operational efficiency the ben- rostering or related industrial
report card. The establishment of efits to AMA (ACT) members will issues, particularly as we move
the Centralised Medical Rostering deliver a less stressful working towards and new enterprise
Team (MOSCETU) (“the One-Stop- environment for our JMOs/DiT agreement for the ACT’s salaried
Shop) is beginning to deliver some members. doctors.
tangible improvements. AMA
(ACT) members have continue to
benefit from the improved com-
munication and response time.
The centralised coordinated
approach to JMO/DiT rostering
and associated problems has
given AMA (ACT) Workplace Re-
lations staff an opportunity to
have members’ problems and is-
sues addressed in a timely fash- Recent MOSCETU clients.
FOR SALE or LEASE
HEALTHPOINT – Phillip, ACT
Healthpoint is a dedicated health building
in the Woden precinct in Canberra close
A News Magazine for all Doctors to the Canberra Hospital.
in the Canberra Region An opportunity exists to lease or buy
ISSN 13118X25 130sqm in this newly-constructed building
in the highly sought-after location.
Published by the Australian
Ideal for medical, dental or
Medical Association allied health practice.
(ACT) Limited Contact Michael: 0410 404 920
42 Macquarie St Barton
(PO Box 560, Curtin ACT 2605)
Editorial:
Peter Somerville
Ph 6270 5410 Fax 6273 0455
execofficer@ama-act.com.au
Typesetting:
Design Graphix
Ph 0410 080 619
Editorial Committee:
Peter Somerville
– Production Mngr
Dr Ray Cook
Dr John Donovan
A/Prof Jeffrey Looi
Advertising:
Ph 6270 5410, Fax 6273 0455
reception@ama-act.com.au
Articles:
Copy is preferred by email to
execofficer@ama-act.com.au
in “Microsoft Word” or RTF
format, (not PDF) with graphics
in TIFF, EPS or JPEG format.
Next edition of Canberra Doctor
May 2018.
Disclaimer
The Australian Medical Association (ACT) Lim-
ited shall not be responsible in any manner
whatsoever to any person who relies, in whole
or in part, on the contents of this publication
unless authorised in writing by it.
The comments or conclusion set out in this
publication are not necessarily approved or
endorsed by the Australian Medical Association
(ACT) Limited.
MARCH/APRIL 2018 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [13]Dr Sabari Saha Dr Hodo Haxhimolla
To Advertise
MBBS (Hons), FRACP
Suite 14, Level 5
National Capital Private Hospital
Geriatric Medicine Corner Gilmore Crescent & Hospital Road
Physician in Canberra Doctor Garran ACT 2605
Ph: (02) 6281 7900 Fx: (02) 6281 7955
n Prostate cancer treatment n Peyronies disease
l Comprehensive Geriatric email n Robotic radical prostatectomy n Male incontinence
assessments
reception@ama-act.com.au Robotic partial nephrectomy Laparoscopic radical nephrectomy
n n
l Falls assessments n Robotic pyeloplasty n Laser Treatment for BPH
n Erectile dysfunction n Laser stone treatment
l Cognitive assessments
n Penile Implant surgery n MRI guided prostate fusion biopsy
l Medication reviews
l Home visits & Residential
Aged Care Facility visits Associate Professor
Hospital admissions
can be arranged
ARDALAN EBRAHIMI
MBBS (Hons), MPH, FRACS
Bulk Billing available
HEAD & NECK SURGEON
suite 11/12, napier close, We specialise in tax planning and
l Thyroid surgery effective business structuring for
deakin act 2605
Phone: 02 6154 5031 l Parathyroid surgery medical and healthcare professionals.
Fax: 02 6169 4437 l Head and neck cancer Our services include:
l Salivary gland surgery • Tax return preparation
CANBERRA LASER AND l Facial paralysis surgery • Financial reporting
GYNAECOLOGY CENTRE l Robotic surgery • BAS preparation
• Self-managed super funds
l Microvascular reconstruction
• Practice establishment
colposcopy & laser
ADDRESS | Equinox Business Park, Equinox 4, Level 1 • Lending services
endoscopic surgery 70 Kent Street, Deakin ACT 2600
specialist gynaecology PHONE
FAX
| 02 6281 3022
| 02 6281 4432 6257 4144 bonsella.com.au
treatment of prolapse EMAIL | reception@canberraent.com.au
and incontinence
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MBBS, FRCOG, FRANZCOG Dr Liz Gallagher, Dr Omar Adham, Marita O’Shea
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DR SMITH SPECIALISES IN THE FOLLOWING: ~ MonaLisa Touch laser treatment
FAX 6273 3002
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l Hip replacement ~ General gynaecology
l Knee replacement ~ Urodynamics
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l Meniscus repair surgery
~ Treatment of abnormal pap smears
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Surgeon l Tibial and femoral osteotomies for arthritis
l Multiligament surgery
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~ Pelvic floor repairs
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Phone: 6221 9321 | Email: dsmith.admin@orthoact.com.au For further information please call the practice on 02 6282 2033
Level 2, 90 Corinna Street, Woden ACT 2606 or email reception@womenshealthonstrickland.com.au
Associate Professor
Dr Wisam Ihsheish
MBBS (Adel) FRACS (orth) FAOrthoA
A. J. Collins MB BS FRACS
Knee arthroscopic Breast and Thyroid Surgeon
surgery, hip and knee
replacements and Oncoplastic Breast Surgery – including:
general orthopaedics w Immediate breast reconstruction and
Accepting new referrals in breast reduction techniques
Canberra and Goulburn w Breast Cancer surgery
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5/5 Baratta St, Crace ACT 2911
Ph 6109 0002
Fax 6109 0003 Thyroid and Parathyroid surgery
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ELLESMERE Address: Suite 4A, Level 2
SPECIALIST CENTRE National Capital Private Hospital
56-58 Clifford St,
Goulburn NSW 2580 Phone: 02 6282 1191
Ph 4823 0223 Fax: 02 6282 8539
Fax 4822 5417
[14] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 MARCH/APRIL 2018MARCH/APRIL 2018 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [15]
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