In a time of uncertainty - Australian Medical Association (NSW)
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doctor
VOL 13 - N 04 - JULY/AUGUST 2021
THE NSW
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION OF NSW
AMA (NSW) CHAIR OF COUNCIL DR MICHAEL BONNING
MAKING A DIFFERENCE
in a time of uncertainty
Street Side Medics • Improving mental health literacy • Tackling air pollution
Dr Andrew Zuschmann
Obstetrician and gynaecologist, NSW
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Contents
8
ADVENTURES 21
IN MEDICINE RISKING
Chair of AMA (NSW) YOUR LIFE
Council, Dr Michael Bonning Should doctors risk
their lives responding
on taking the road less
to a disaster?
travelled.
14
STREET SIDE
MEDICS 23
OVER
REGULARS
5
Dr Daniel Nour is tackling
the healthcare needs GOVERNANCE
of Sydney’s homeless
How does a Rural Generalist President’s Word
population by addressing
fit into a complex system
barriers to access.
7
of medical education,
credentialing, and CPD?
18 30
From the CEO
26
AT THE
COALFACE HOLISTIC LENS Workplace Relations
GPs across NSW have
34
The Mental Health
spent incredible amounts of Commission of NSW is
time, money and energy on improving mental health News
participating in the COVID-19 literacy.
35
vaccine rollout.
32 Classifieds
36
AIR
POLLUTION Member Benefits
38
Air pollution is getting worse
across the State, explains Dr
Kim Loo. Financial Paracetamol
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doctor From the Editor
THE NSW
THE OFFICIAL PUBLICATION OF THE AUSTRALIAN MEDICAL ASSOCIATION (NSW)
The Australian Medical
Association (NSW) Limited
ACN 000 001 614
Street address
69 Christie Street
ST LEONARDS NSW 2065
Mailing address
PO Box 121, ST LEONARDS NSW 1590
In NSW, we have developed COVID, but more importantly
Telephone (02) 9439 8822 a new tradition – the 11am it highlights what one can
briefing.
Outside Sydney Telephone 1800 813 423
Facsimile (02) 9438 3760 achieve when you put service
Outside Sydney Facsimile 1300 889 017
beyond self.
Email enquiries@amansw.com.au
Website www.amansw.com.au
It’s the moment of the day
The NSW Doctor is the bi-monthly when everything else stops We’re also pleased to feature
publication of the Australian Medical
Association (NSW) Limited. and everyone tunes in to listen Dr Daniel Nour, who launched
to the Premier and Dr Kerry a GP-led mobile health
Views expressed by contributors to The NSW Chant. service for Sydney’s homeless
Doctor and advertisements appearing in
The NSW Doctor are not necessarily community last year. His tireless
It’s amazing how quickly
endorsed by the Australian Medical
commitment to grow Street Side
Association (NSW) Limited. No responsibility
one’s focus narrows during an
is accepted by the Australian Medical Medics is inspirational, and
Association (NSW) Limited, the editors outbreak.
or the printers for the accuracy of the another reminder that beyond
information contained in the text and
advertisements in The NSW Doctor. The Other plans, other concerns, the four walls of home, beyond
acceptance of advertising in AMA (NSW)
other issues tend to dim, and the 11am briefing, is a world
publications, digital, or social channels or
sponsorship of AMA (NSW) events does not everything hangs on the daily that keeps spinning and has
needs that have nothing to do
in any way indicate or imply endorsement by
the AMA. number – or rather the number
Executive Officers 2019-2021 of cases that have been active with COVID. And despite how
President Dr Danielle McMullen in the community, which has all-encompassing this pandemic
might seem now, one day we’ll
Vice President Dr Andrew Zuschmann
Chair of Council Dr Michael Bonning become the new barometer.
Hon Treasurer Dr Fred Betros
stop thinking about what we
This single-minded focus is
Chair, Hospital Practice Committee
Dr Andrew Zuschmann can’t do, and start thinking
Chair, Professional Issues Committee
Dr Kean-Seng Lim
a natural consequence of our about what we can do.
Board Member Dr Kathryn Austin shrinking worlds. Confined
Board Member Dr Costa Boyages
Board Member Dr Amandeep Hansa to our homes, our worlds now
DIT Representative Dr Sanjay Hettige
revolve around a new set of rules
of what we can’t do.
Secretariat
Chief Executive Officer Fiona Davies
Director, Services Kerry Evripidou I think that’s what I love about
Director, Workplace Relations
Dominique Egan
this issue so much. In this
edition we feature AMA (NSW)
Editor
Andrea Cornish Chair of Council, Dr Michael
andrea.cornish@amansw.com.au
Bonning, whose medical career
has taken him across the globe.
Designer
Gilly Bibb
gilly.bibb@amansw.com.au
His story is a reminder of what Andrea Cornish,
Advertising enquiries
Michelle Morgan-Mar
adventures are possible beyond Editor
michelle.morgan-mar@amansw.com.au
3 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.au
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President’s Word
BRACING FOR IMPACT
with a variant that is more easily AMA (NSW) has called for greater
transmissible, is a population that is resourcing of our hospitals to address
under-vaccinated – thanks to both these problems and the AMA has
a plagued rollout and some vaccine recently released a blueprint for a
hesitancy. new funding approach. This blueprint,
The State is now scrambling to get calling on the Commonwealth to
on top of this outbreak and day by day increase their contribution to 50%,
the worry of doctors increases about was just part of a brilliant document
what the impact on our hospitals will outlining AMA’s Vision for Australia’s
be if it’s too late. Health – I encourage you all to read it.
Unlike March 2020, we’ve had time To build the best possible health
and opportunity to prepare our health system for our future, we need both
system should the number of cases resourcing, and strong senior clinician
rise. We should also have learned engagement.
DR DANIELLE MCMULLEN experiences from overseas. I hope AMA (NSW) recently closed
PRESIDENT, AMA (NSW) those lessons are reflected in our our Senior Doctor Pulse Check
response. survey, which had more than 1000
What we continue to struggle with is respondents. The results are sobering.
capacity. One of you noted, “I have been on
The latest COVID outbreak The latest Bureau of Health the staff of my hospital for 40 years
Information results for January to and have never known it to be more
feels like we’re back where we March 2021 clearly reveal a hospital dysfunctional and for morale to be
started. But unlike March 2020, system that is under pressure. lower than it is now.”
we’ve had time to prepare Emergency department presentations Almost 70% said they do not feel
have rebounded to pre-pandemic valued by their hospital. More than
our health system should levels, with a 6.2% increase in Triage 80% of doctors indicated they are
the number of cases rise. category 2 (emergency) presentations. experiencing workplace stress, with
We should also have learned The number of emergency a significant number citing excessive
department patients treated within the workload and lack of resources as
experiences from overseas. clinically recommended time frames being contributors to this stress.
I hope those lessons are fell 1.7 percentage points from the AMA (NSW) will be evaluating these
same quarter the previous year, while results in more detail and outlining our
reflected in our response. the number of patients who spent response to Government accordingly.
four hours or less in the emergency We are currently producing a report to
department was down 3.0 percentage be released next month.
ONCE AGAIN, I find myself wishing points compared to the same quarter in In the meantime, stay safe Sydney.
I could write about something other 2020 – this was the lowest percentage And let’s work to get this under control
than COVID. Writing this column is of patients who spent four hours or (and keep it out of regional areas).
a bi-monthly exercise, but each and less in the ED for any quarter over the Together, we’ll get through this. dr.
every time it comes up, it seems there past five years.
has been a new development in the We’re seeing an increase in patients
pandemic that is hard to ignore. who require emergency care and a President@amansw.com.au
NSW is facing the most difficult corresponding decline in our ability @_daniellemcm
challenge we’ve had to date in to treat patients within the clinically
www.facebook.com/amansw
the COVID-19 crisis. Coupled recommended timelines.
5 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.au
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From the CEO
MAKING A DIFFERENCE
IN A TIME OF UNCERTAINTY
ONE OF THE DIFFICULTIES in my phone or email at any time.
job is that I often end up interacting Finally, I would like to remind all of
with doctors (and indeed non-doctors), our members of the importance of
during difficult times in their lives or taking care of yourselves and taking
their careers. care of each other.
It’s not uncommon to start In my interactions with doctors –
discussions with, “I wish we were not either in person or online – the sense of
meeting like this.” fatigue is evident.
Despite these often-difficult We have had months of cancelled
conversations, these interactions are plans and disappointed families and
often the most rewarding. people who have worked longer than
Being able to support our doctors is they should without taking leave.
at the core of what we do. While a “staycation” is not much
In situations where people feel they fun for anyone, it can be particularly
FIONA DAVIES are overwhelmed, I often encourage unfulfilling for doctors where the
CEO, AMA (NSW) them to find the things that they do feel demands of patients and calls tend to
they can control and hold onto it. intrude when you are not able to say, “I
In these uncertain times, we wanted am away.”
this edition of The NSW Doctor to So, now more than ever, remember
serve as a reminder of the amazing the supports available to you, check in
Throughout the pandemic, things that can be done as a doctor. with each other, allow a little additional
AMA (NSW) has continued to Our members have unique abilities patience and tolerance and hold on to
that allow them to make a difference in the things that matter to you. dr.
work to support doctors and people’s lives every day – and that is
their practices. something worth holding on to.
We’re here for you. Doctors have an extraordinary ability
not just to care for the patient in front
of them but for the community at large.
It’s a good time to remember those
ambitions and to think of the projects
and priorities you want to be working
towards.
Throughout the pandemic, AMA
(NSW) has continued to support
doctors and their practices. We have
provided advice on matters such
as vaccinations to QR codes and
everything in between. fiona.davies@amansw.com.au
Our dedicated Workplaces Relations
@FionaDavies8
Advisors are an excellent source of
www.facebook.com/amansw
support, and you can reach them by
7 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.au
Profile
ADVENTURES
Dr Michael
Bonning caving
in Iceland
in
Medicine
Before COVID, AMA (NSW)
Council members often started
Council meetings with a little
game they liked to call, ‘Where
in the world is Michael?’
8 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auProfile
DR MICHAEL BONNING, chair of deserts and some of the world’s
the AMA (NSW) Council, is notorious highest peaks, Dr Bonning works as a
for dialling in from far-flung locations general practitioner at Balmain Village
around the world. Health, as well as the Inner West
“I once did a Board meeting Respiratory Clinic and the vaccination
walking down in the Himalayas from service at Sydney Olympic Park.
Tengboche, Nepal,” he recalls. In addition to serving as Chair of
“I always felt as long as I had phone the AMA (NSW) Council, he currently
signal I could probably dial in from sits on the Board of GP Synergy as
anywhere.” Deputy Chair, is a Community Panel
Between working as the chief Member of Ad Standards, the medical
medical officer of Inspired Adventures advisor for DermaSensor, Adjunct
and spending 12 years as a medical Fellow of Macquarie University, and ▲ Above: to see each other
officer with the Royal Australian Navy, Non-executive director of Postgraduate Dr Bonning succeed,” he adds.
Dr Bonning has traversed across Medical Council of Queensland. (orange jacket) Whereas his sister
Southeast Asia, the Middle East, “I find general practice has so much climbing went into finance,
Mount
North and South America, the horn inherent opportunity in it. It allows me Dr Bonning was
Aconcagua in
of Africa, most of Europe, Pakistan, to do so many things and it’s a great west-Central
drawn to science.
India, several Scandinavian countries platform to step into other parts of Argentina He completed his
… if you throw a dart at a map, there is healthcare, technology, advocacy, undergraduate
reasonable chance he’s been there. military service – it all connects degree in science
COVID might have grounded Dr together.” at the Queensland
Bonning to Australia, but it hasn’t General practice might provide University of
stopped him from leading hiking the vehicle for these pursuits, but Dr Technology in 2005.
expeditions – in May, he took a group Bonning credits his drive to his family, Inspired by the
across the Larapinta Trail in the particularly his twin sister. military service of
Outback to raise funds for Interplast “We grew up together, played sport his grandparents,
Australia, a non-profit organisation that together, went to school across the he applied for the
provides plastic and reconstructive road from one another, and both of us Royal Australian
surgery in countries across the Asia are intrinsically driven… Navy’s Graduate
Pacific region. “We do very different things, but we Medical Program
When he’s not trekking across do push each other along and we want and subsequently
9 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auProfile
enrolled in the University of
Queensland’s medical school.
Throughout med school, Dr
Bonning was heavily involved in
student politics, and in 2007 he was
elected President of the University of
Queensland Medical Society (UQMS)
in his third year of medical school and
then President of Australian Medical
Students’ Association (AMSA) in his
final year. He also served as Chair
of the Ashintosh Foundation, the
charitable society of UQMS.
“I’m a joiner. I’m someone who
likes to be part of a big organisation
because when you work with others
and you have a shared purpose,
you can achieve a lot more than any
individual.”
His commitment and enthusiasm
for medico-political advocacy and his
academic achievements did not go
unnoticed. Dr Bonning was awarded
the Dr Magdalene Brodie Memorial
Prize for Paediatrics and made
Valedictorian of his graduating class in
2008.
During this period, Dr Bonning
says he was both encouraged and
inspired by Professor John Pearn, a
paediatrician and former Surgeon-
General of the ADF, as well as past-
patron of UQMS.
“He always encouraged and involved in fleet operations including ▲ Dr Michael acknowledging he
supported my goals in medicine and border protection, as well as counter Bonning in struggled morally
service with
the military.” terrorism and counter drug smuggling and with his own
the Royal
He received a leadership award operations in the Middle East, and mental health.
Australian
during his stint at HMAS Creswell and humanitarian and training missions in Navy “The purpose of
recalls the proud moment of being Southeast Asia and the Pacific Rim. a sovereign navy is
made Commanding Officer for the He helped organise medical and to defend borders,
Ceremonial Sunset, a naval tradition of healthcare support for dozens of protect shipping,
saluting and lowering of the Ensign at nations who brought ships to Australia prevent smuggling,
sunset. for the International Fleet Review. and to keep the
“I still have the sword used to He also had the opportunity to mark waterways safe.
command the platoon from that day … the ANZAC Centenary on the Greek But to intercept
and giving the order to fire a cannon Island of Lemnos near Gallipoli. and turn back
was cool too.” Despite these highlights, there were or detain people
Beyond medical school and officer challenges during his service with RAN who are trying to
training, Dr Bonning continued to and Dr Bonning is open about the escape places that
serve as medical officer with the psychological burden he carried while are not as nice as
Royal Australian Navy and was conducting border protection activities, Australia… it’s just
10 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auProfile
through simple luck that I was born in
Australia and therefore have privilege
and opportunity that few others in
world history have ever had – and
to stand there and be someone that
turns other people who may be in less
fortunate situations around is hard.”
He adds, “At no other time in my
service did I feel there was a conflict
between being a medical officer as well
as having a Hippocratic oath to uphold,
but that was a difficult time.”
Being a medical officer onboard a
military vessel also comes with its own
unique clinical challenges.
Dr Bonning describes the medical
and logistical challenges of being 900
miles from land and dealing with a
patient with acute appendicitis; and
in another scenario, flying a patient
with intracranial pathology by military
helicopter to New Caledonia and trying 300 charities and taken fundraising ▲ Kayaking same direction for
in Voss,
to coordinate care with doctors who trekkers around the globe, including a better, healthier
Norway
only speak French. treks in Mt Kilimanjaro, the Great future.”
Coupled with these obstacles is that Wall of China, Nepal, the Inca Trail Central to his
all of these patients are colleagues and and more. motivation for
friends. He says he was drawn to Inspired participating in
“The thing about being a military Adventures because it connects medico-political
doctor, especially a navy doctor, is people with causes that they support advocacy is the
you are essentially a small-town GP and for many people, having a belief that doctors
because you know everyone.” humanitarian motivation often need to have a say
Dr Bonning specialised in general pushes them to their outer limits. in the system they
practice, with additional training “When people trek on behalf of work in.
in high altitude physiology, diving an organisation or a cause that is “Engaging doctors
medicine, aeromedical evacuation, and bigger than themselves, they put to help construct the
emergency management in remote themselves out there to do things medical system they
environments. they never thought they could and work in is absolutely
His medical career afforded him that is incredibly rewarding to see.” essential for the
learning opportunities that lent itself system to work,” he
to expedition medicine. Or as he THE POWER OF PEOPLE says.
describes it, “you get taught in how Dr Bonning joined AMA on 24 According to Dr
to manage yourself in an environment January 2005 – he remembers that Bonning, the value of
where things fall apart under pressure day as it was the second day of O having a professional
and without support.” Week during his internship. association like the
Dr Bonning started working with “As I’ve said, I’m a joiner. I joined AMA is its shared
Inspired Adventures, a philanthropic the AMA, I joined my medical student sense of purpose
travel company that connects society, I joined AMSA, I joined and collegiality.
worthy causes with people seeking the military…I’m a huge believer in “Sometimes these
adventures, in 2014. collective action – or the will of an jobs we do can be
Since it was founded in 2001, the organisation supported by thoughtful a bit lonely. I’ve had
organisation has raised $38.6m for people who are all pulling in the my own experience
11 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auProfile
with loneliness – being the only doctor there was a director’s fee.
for hundreds of kilometres – and even “I wrote back – I was very apologetic
within Greater Sydney or NSW you can – I said, I’m very sorry but I’m a
feel like you are battling on alone in the medical student – I can’t pay a fee to
health system. But there are genuinely be on this Board.
friendly people out there to support “At my first Board meeting everyone
you and listen and I think everyone laughed. It was the other way around,
needs that.” they paid me a small stipend to be part
Mental health awareness has been of the organisation.”
a prominent feature of Dr Bonning’s In 2009, Dr Bonning undertook a
career – he spent six years (2008-2014) Churchill Fellowship to study methods
working as the Non Executive Director of promoting wellbeing within the
for beyondblue. medical profession and in 2010,
His involvement with the organisation beyondblue conducted a $2m world-
was sparked by a chance meeting leading study on doctors’ and medical
with beyondblue founder and former students’ mental health and wellbeing.
Victoria premier Jeff Kennett, who was The research from that study
invited to speak at the AMSA National became the basis for a reform agenda
Convention in 2008. which has been taken forward by the
On the morning of the presentation, profession.
Dr Bonning happened to be on the Dr Bonning subsequently became FAST FACTS
ground floor of the hotel very early. involved in advocating for funding for
The convention convenor spotted Dr the Doctors Health Advisory Services •B
est hike in Sydney:
Bonning and asked him to look after in Australia and as a Board member Jerusalem Bay
Mr Bennett for breakfast. of Doctors Health Service which •N
ext on the bucket list: Climb
“Jeff and I had a fairly robust was charged with distributing that Denali in Alaska
discussion about the mental health funding for services in the States and
• When the borders open I will:
space and by the time we walked to Territories.
…take my parents overseas
the top of the stairs for him to speak in When asked if he could cure one
front of an audience of 1000 medical thing immediately, Dr Bonning doesn’t • If I had one more hour in my
students he asked me join beyondblue hesitate. day I would… fit in an hour of
as a director.” “We know there is an epidemic tennis if I could
Dr Bonning recalls a few weeks later of loneliness. Lots of people like to • If I wasn’t a doctor, I’d be
he received a letter of invitation from be alone. But there is a difference a… a talkback radio host or a
the organisation which highlighted between being alone and being lonely podcaster – I just like talking
and I think we are caught in a growing to people
wave of loneliness, and I think the
“Engaging pandemic has probably made that
doctors to help
worse. And being a GP, a significant
number of people come to see me care. Doctors
construct the
because they are lonely.” need to work to
As Chair of AMA Council, his focus is ensure standards
medical system on ensuring that Council has exposure
to emerging issues such as the impact
of quality in care
are maintained
they work in of technology, the role of private equity,
value-based healthcare and overseas
and the positives
of virtual care are
is absolutely organisations taking an interest in
Australian healthcare.
made available to
everyone in the
essential...” “The biggest issue facing doctors
at the moment is the rapidly changing
community.” dr.
interface of healthcare with virtual
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MEDICS
Street Side Medics is tackling the healthcare needs of
Sydney’s homeless community by overcoming
barriers to access.
14 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auFeature
DR DANIEL NOUR is a full-time PGY2
resident at Royal North Shore, but
it’s his passion project – Street Side
Medics – which takes up most of his
time.
“I don’t necessarily need to go to
every clinic, but it’s pretty hard to get
me not to go. I love it.”
Street Side Medics is a not-for-profit
organisation which provides a GP-led
mobile outreach medical service for
people that are either experiencing
homelessness or are vulnerable.
The clinic operates out of a van that
has been custom-fitted as a medical
service with two different stations – a
medical support officer station which
acts as a triaging station and a GP
station.
The mobile clinic, which was
launched by Dr Nour last August,
operates alongside well-established
homeless services and shelters, and
provides care to the growing homeless
community in Woolloomooloo,
Parramatta, Manly and Brookvale.
Street Side Medics recently procured
a second van donated by LSH Auto
Australia but is in desperate need of existing food services and homeless ▲ Dr Daniel examination, basic
volunteers to help them expand their shelters three nights a week. The Nour and pathology, and minor
outreach. mobile clinic has a no-turn-away policy his team of surgical procedures.
They currently have about 145 and provides a walk-in service for the volunteers In the past 12
for Street
volunteers, of which about 25 are homeless, who know where and when months, Dr Nour
Side Medics
medical professionals. But the clinic is the van will be every week. says they have
centred around general practitioners. “This allows us to improve the seen “some weird,
“It’s a GP led service, so we really catchment of patients and build wonderful and
rely on them. The only thing that has rapport with them as we attend to amazing medicine”
limited our growth is trying to get more their acute and chronic healthcare – people making do
GP volunteers,” Dr Nour says. concerns,” Dr Nour explained. with what they have.
The commitment doesn’t need to be There are two teams of volunteers. But Dr Nour adds,
onerous. The team outside the van, which “most confronting
“Really all you need to do is come to usually consists of a social worker, are the health
the clinic for three hours and that’s it – physiotherapist, dietician and issues that have
we do the rest. Some GPs say they’d other general volunteers, approach been neglected for
really like to commit every fortnight individuals to see if they have any many, many years
or every week – we can always work health issues. Inside the van, there is that were easily
around their schedule, but it’s a a general practitioner and a nurse, or preventable or
minimum of 3 hours a month.” other medical practitioners. somewhat treatable.
The van is set up with all the We see people with
How does it work? common facilities necessary for a diabetes that has
Street Side Medicine takes its van to general practice, including medical gone untreated
15 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auFeature
for years and the complications organisation is a volunteer. Every single
associated with that.
“And there are more subtle things
one. They come because they want to
be there, and they come because they
“Most
like thyroid issues, skin cancers … I care. And that translates into the way confronting
are the health
remember a guy who came to me with they communicate with the patients.
haematuria – blood in his urine, and he “A lot of times they come in and they
issues that have
said, ‘I figured it was just because it might not tell us about three quarters of
was getting cold.’ So, one of the things the problems that they’re having. But
that we’re trying to change is health
literacy.”
they get to know us, they appreciate
the way that they are spoken to, the been neglected
Dr Nour recently treated a 29-year-
old man who has been homeless since
care that they are provided – they build
trust. Not only with the doctor but with for many, many
age 13. The man had a severe phobia
of being indoors due to childhood
the service. And they tend to come
back with more healthcare concerns.” years...”
trauma, but he came to the van to Dr Nour was motivated to start
ask for some wound dressings. After Street Side Medics while undertaking
chatting with the man, the doctor an elective at the Imperial College of diabetes. And if you
on duty discovered he is a Type 1 London. He recalls coming to the aid a do have diabetes, I
diabetic and hadn’t been using insulin homeless man having a seizure. After can actually give you
for the last four months. His blood speaking with the man’s friends, they the medication so we
sugar was 33 but his ketones and PH indicated the man – who doesn’t drink can start treating it.
were normal. As a result of his fear of or do drugs – had had several seizures “This gives people
being indoors, he refused to go see over the previous months, but usually positivity – we know
an endocrinologist. After dressing his in the back lane. what’s wrong and
wounds, the team found out which “And I remember thinking, why we’re starting to fix
medicine he normally takes and asked hasn’t anyone taken him to see a it.”
him to come back next week. When doctor or a GP? And this one lady, I’ll The Street
the man returned, they gave him never forget her face, saying ‘Daniel’, Side Medics
the medicine and a glucometer. The and this is her words not mine, ‘Daniel, van is located in
team worked with an endocrinologist the NHS barely cares about you, let Parramatta every
to develop a plan and organised a alone us’.” Sunday between
telehealth consult. The endocrinologist Upon returning to Sydney, Dr 4.30pm-6.30pm,
recommended a Freestyle Libre Sensor Nour conducted his own research Manly every Monday
to help him keep a track record of his into healthcare services for people between 5pm-7pm,
blood sugar. Since then, the man’s experiencing homelessness and found Brookvale every
wounds have healed, his blood sugar that barriers include lack of awareness Monday between
levels have dropped and he’s on a of available services, prohibitive 7.15pm-8.30pm
much better trajectory. They’ve also costs, lack of transport, the level of and every Tuesday
referred him to an ophthalmologist for documentation required, stigma and at Woolloomooloo
his diabetic retinopathy. embarrassment, previous negative between 7.30pm-
“We’ve built good rapport with him, experiences, and distrust. 9.30pm.
and he trusts us enough that we’ve “The only real way to alleviate Medical
made a referral for the endocrinologist those barriers is, in my opinion, to practitioners
and the ophthalmologist to see him in take the service to them and be an interested in
clinic. That is big achievement for him.” opportunistic service. volunteering with
The success of Street Side Medics “There really is no GP-led mobile Street Side Medics
is dependent on trust and respect, Dr outreach service and there certainly are encouraged to
Nour says. is none that have the capability of email: volunteer@
“That underpins the whole service ours … I look at people’s risk factors streetsidemedics.
– having doctors who care, genuinely for diabetes and I can actually tell com.au or call
care. Every single person in the you within five minutes if you have 02 8324 7531. dr.
16 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auFeature
COVID-19
VACCINE ROLLOUT:
AT THE COALFACE
The vaccine rollout has been
bumpy ride thus far, but The
NSW Doctor recently chatted
with general practitioners who
have tried to make it as smooth
as possible for their patients.
Dr Charbel Badr, Hunters Hill Medical Practice
FOR MANY, Australia’s COVID-19 rebate was lower we would do it vaccination materials;
vaccine rollout has felt like a game anyway, because we want our patients • Printing vaccination cards for patients
where the rules change as you go. to be able to access it. Especially to use as a physical record and to
While we can all see the prize of our patients who are older and can’t keep track of their next appointment;
vaccinating our population against drive to somewhere like Chatswood or • A four-hour staff education workshop
this potentially deadly and easily Homebush.” and dry run of their vaccine clinic;
transmissible disease, getting to that When the Government put the call • Flowcharts for reception, with
point has been equal parts challenging out for EOIs, Dr Badr and his team pathways depending on whether the
and frustrating. spent more than 100 hours preparing patient was new or a current, and
Despite these obstacles, GPs across the clinic. Preparations included: retrieving medical records from their
the country have been active and • Converting an upstairs education area usual GP if needed;
willing participants in the program. to be used as a vaccine hub; • Running vaccination information on
• Creating appropriate signage; their waiting room TVs;
Hunters Hill Medical Practice • Establishing a pre-vaccination waiting • Creating a website specific to their
For Dr Charbel Badr, who runs Hunters area with social distancing; vaccine clinic, which allows patients
Hill Medical Practice, there was never • Creating a post-vaccination waiting to download the consent form and/
any question about the practice being area, with social distancing and a or new patient forms prior to their
involved in the rollout. staff member to monitor patients; appointment.
“Our practice ethos is to provide • Placing timers in the post vaccine
multidisciplinary care to patients in the area to alert patients when 15 Dr Badr says feedback from patients
community, so we were always going minutes is up; has been positive.
to provide the vaccine. It shouldn’t • Printing Government resources “I think it also gives patients
be just about the money. Even if the such as consent forms and post confidence when they see a process
18 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auFeature
and a protocol in place – they don’t feel
like this is something new.”
Initially the clinic received only
50 doses of AstraZeneca a week,
which was disappointing, given their
readiness to vaccinate more patients.
“The first few weeks we had lots of
staff capacity, lots of room capacity,
lots of patient demand, but no
vaccine.”
The early days of the vaccine rollout
were a bit chaotic, with many patients
calling, some getting upset and staff
struggling to find them appointments.”
“We tried to control it in those first
Drs Shanthini and Thava Seelan, Bridgeview Medical Practice
few weeks by concentrating on our
most vulnerable people, but as soon
as we opened up the appointments chronic disease. “However, many of our patients
online, they would fill in automatically “We have been eating, breathing and showed delayed acceptance following
and some of them would fill in with living COVID vaccinations for the last our positive approach and messaging
patients from far and wide.” couple of months,” says Dr Shanthini around the importance of vaccination,”
He adds, “From a continuity of Seelan. he says.
care perspective that created a bit Bridgeview started vaccinating its According to Shanthini, the
of a mess. Because somebody from patients in April and initially received Government’s decision to use general
Ashfield could come and get their 50 doses per week, but they began practitioners to roll out the vaccine was
vaccine here, and some of my patients planning for the rollout months before. a “master stroke of genius”.
could be going to the Northern Dr Thava Seelan says the practice “You cannot do something like this
Beaches – so just in terms of continuity held collaborative planning sessions without getting the GPs involved – you
and medical records – that was a bit with the practice’s doctors, as well need the relationship we have with our
difficult.” as administration and nursing staff, patients,” she says.
The system is working quite completed training modules and “We are not dealing with the
smoothly now, but his main criticisms created a ‘COVID team’ which meets mainstream Australian public here – we
of the rollout is poor supply at the regularly to discuss updated COVID are dealing with people with varied
beginning, the Government’s decision vaccine information and guidance. experiences of the healthcare system
to develop a COVID vaccine specific The practice utilises two buildings … it’s a very unique relationship that
ordering and delivery system (as and has converted an adjacent we have with them.”
opposed to using the system already auditorium to be used as its vaccine In addition to the supply issues that
established for flu vaccines), poor clinic. The clinic has been modified plagued the rollout at the beginning, the
education and messaging. to meet the specifications outlined doctors’ other concerns included the
“All in all, it’s a new program and it’s by Government and includes multiple loopholes that have allowed people who
going to have some teething issues.” cubicles to allow vaccination of five were not eligible for Pfizer to receive
patients at a time. Whilst they are that vaccine at the state hubs, and lack
Bridgeview Medical Practice currently administering 300 doses per of communication and transparency.
Drs Thava Seelan and Shanthini week, they have capacity to ramp up to “GPs have been called the
Seelan are the principals of 500 doses per week. protagonists, we’ve been lauded as
Bridgeview Medical Practice, located Thava says demand for the vaccine the saviours, but we would really
in Toongabbie. The Western Sydney was initially very high but noted appreciate some strong support,
practice caters to a large multicultural increased vaccine hesitancy after because we have really invested a lot
community and has a mixed patient media reports of patients experiencing in this – time, energy, and money,”
base with a significant number of older the rare side effect of thrombosis with Shanthini says. dr.
patients and vulnerable patients with thrombocytopenia syndrome surfaced.
19 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auFeature
Should doctors
risk their lives
when responding
to a disaster?
Doctors must balance their duties (EMLC), briefly addresses doctors’ risk also have their own personal duties
of personal harm when responding to and interests in not becoming infected
to individual patients with their a disaster. and risking sickness or even death or
duties to protect themselves, The position statement affirms that spreading the virus to their own family
doctors must balance their duties to members and friends.
other patients, staff, colleagues individual patients with their duties to So what level of risk of personal
and the wider public from harm. protect themselves, other patients, harm should doctors accept? While
staff, colleagues and the wider public there is a general expectation within
from harm, highlighting that during the community that doctors will accept
‘ordinary’ clinical practice, these duties a certain amount of personal risk when
do not generally come into conflict, but responding to a disaster, this risk is not
ON 5 MARCH 2021, Amnesty during a disaster, tensions between unconditional or without reasonable
International announced that at least these duties may very well eventuate. limit. The current position statement
17,000 health care workers globally The current pandemic has turned says that doctors are entitled to protect
have died from COVID-19 over the last this potential eventuality into a stark themselves from harm and should not
year, forcing doctors both in Australia reality for doctors in Australia and be expected to exceed the bounds of
and around the world to confront the worldwide where doctors must weigh ‘reasonable’ personal risk.
very real question of whether they are up their duty to treat individual patients But the global pandemic has made
willing (or should be expected) to put infected with COVID-19 with their it clear that ‘reasonable’ risk is highly
their own lives at risk to treat real or duty to ensure they do not develop subjective, and the level of risk that
potential COVID-19 patients. COVID-19 themselves and become governments, employers, patients and
The AMA’s Position Statement on unable to work or risk infecting other their family members and others expect
Ethical Considerations for Medical patients, staff or those in the wider doctors to accept when responding to
Practitioners in Disaster Response community. a disaster may not be ‘reasonable’ to
2014, currently under review by the In addition to the professional duty to the medical profession or to individual
Ethics and Medico-Legal Committee reduce risk of personal harm, doctors doctors or their loved ones.
21 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auFeature
Globally, professional regulators and have an obligation to evaluate the risks identify a range of
associations set varying standards of providing care to individual patients factors that doctors
regarding the expectations of doctors versus the need to be available to should consider
in relation to risk of personal harm provide care in the future. when determining
when responding to disasters. While the expected standard what constitutes
For example, the Medical Board’s of doctors’ risk of personal harm a reasonable risk
Good Medical Practice states that: may be addressed differently in of personal harm
Treating patients in emergencies these examples, at least they are all and what they can
requires doctors to consider a range consistent that what is unreasonable do to mitigate their
of issues, in addition to the patient’s is for doctors to be placed at risk personal risk. While it
best care. Good medical practice of significant harm because of is not unreasonable
involves offering assistance in an inadequate or inappropriate safety and for doctors to accept
emergency that takes account of your protection, and advocacy to improve a certain amount
own safety, your skills, the availability that protection is an important duty for of personal risk
of other options and the impact on any medical professionals and those who when responding to
other patients under your care; and control any aspect of workplace safety. disasters, that risk
continuing to provide that assistance Doctors with apparently less agency or is not unconditional
until your services are no longer power, such as doctors-in-training or and we will continue
required. those in temporary employment, must to advocate that
The UK’s General Medical Council be protected from any implied or overt governments and
is more explicit in their own Good obligation to practice in conditions the wider community
Medical Practice, stating that: that are not as safe as it is reasonably have an obligation
58 You must not deny treatment practicable for them to be. to protect doctors
to patients because their medical Employers, managers and workplace and reciprocate and
condition may put you at risk. If a safety regulators have a duty to ensure support doctors
patient poses a risk to your health or that corners are not cut, and peer (and their family
safety, you should take all available group or management pressure is members) who suffer
steps to minimise the risk before not acting to decrease safety for any harm when caring for
providing treatment or making other doctor. patients. dr.
suitable alternative arrangements for Doctors’ willingness to risk
providing treatment. significant personal harm when
While the American Medical treating patients in disasters has also
Association’s Code of Medical experienced a temporal shift. Where
Ethics, Opinion 8.3 Physicians’ doctors once entered the profession
Responsibilities in Disaster Response seemingly willing to sacrifice their own
& Preparedness, advises that: lives to care for patients, as exemplified
Whether at the national, regional, or in the American Medical Association’s
local level, responses to disasters Code of Medical Ethics in 1847, which
require extensive involvement from directed: and when pestilence prevails,
physicians individually and collectively. it is their duty to face the danger,
Because of their commitment to care and to continue their labours for the
for the sick and injured, individual alleviation of the suffering, even at the
physicians have an obligation to jeopardy of their own lives.
provide urgent medical care during Many of today’s doctors are not
disasters. This obligation holds even in so willing to lay their lives on the line ABOUT THE AUTHOR
the face of greater than usual risks to and will need to consider their own Dr Andrew J Miller is the Chair of
physicians’ own safety, health, or life. personal morals and values when Federal AMA Ethics and Medico-legal
Committee and Immediate Past-
However, the physician workforce is deciding how much risk is reasonable
President of AMA WA.
not an unlimited resource. Therefore, to them.
when providing care in a disaster with As the EMLC examines this issue
its inherent dangers, physicians also during our policy review, we will
22 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auFeature
RURAL MEDICINE,OVER
GOVERNANCE, AND DIPLOMATOSIS
What is needed urgently is membership and CPD requirements. from many in the
Hospital credentialing bodies then city that Rural
a discussion amongst our proceed to make the diploma the Generalists are
profession about the how we “minimum” standard for practice in a “after their jobs”
given field – problem solved! when this has not
ensure that those who practice This solution sounds fantastic on been demonstrated
safely are not left out. paper, however underlying the concept practically.
are issues that demand and warrant The end result of
attention. this is that these
AS THE National Rural Generalist The first issue is that of talented Rural
Pathway begins to gather steam, it grandfathering: How do you address Generalists opt for
is imperative to look at how a Rural those already in practice in a particular two pathways. Many
Generalist fits into a complex system of field? This is an issue that tends to will return to the
medical education, credentialing, and disproportionately affect early career centrepiece of Rural
Continuing Professional Development doctors (usually 1-10 years post Medicine, which is
(CPD). fellowship) who face the prospect of the provision of
If we look at the Collingrove Definition needing to “retrain” to do a job they good General
of a Rural Generalist, that is, a are already doing safely. How do you Practice care. A
practitioner who is predominantly a GP manage those with experience and second cohort who
but with skills in emergency care and current CPD but without the piece of enjoy working in the
one or more advanced skill disciplines, paper? If you throw up roadblocks in hospital setting will
we are then forced to ask the question this process, a large proportion of newly opt to retrain as
– how do we prove that these clinicians minted Rural Generalists will leave or non-GP specialists
are up to the job? How do we ensure opt to retrain in non-RG specialties. in order to avoid the
that they meet the standards and The second issue is that of CPD and unrealistic, multiple
ongoing professional development fees. How many Colleges should a CPD burdens
required to provide quality care to our rural generalist maintain membership associated with a
rural and remote communities? with in order to practice? How many Rural Generalist
How do you, as a clinical governance fees should they have to pay? How skillset. Both of
professional, resolve this issue? many months a year must a Rural these options are a
At first glance, one looks at this Generalist spend on CPD for multiple loss to rural
issue and thinks the solution is different organisations at a loss to the
simple – “There’s a diploma for that!” community they serve? “An obsession with
– the last five years have seen the The “recently fellowed” Rural
proliferation of diplomas from various Generalist cohort is large, as Rural silos and ‘Diploma’
subspecialty colleges. These include Generalist is a relatively new specialty. qualifications leads
diploma qualifications in Obstetrics, In a world where “time” and “case
Emergency Medicine, and Prehospital numbers” are assumed to be markers to them picking
and Retrieval Medicine, with upcoming of competence, expectations around up their bat and
diploma qualifications in Anaesthesia CPD and maintenance of skills dictated
and Psychiatry in the works. Each of from and by subspecialists in the city ball and moving to
these qualifications is “renewable” and quickly become unrealistic. This is greener pastures.”
comes with their own separate College further fuelled by unrealistic concerns
23 I THE NSW DOCTOR I JULY/AUGUST 2021 amansw.com.auYou can also read
