Ross River Virus - AMA WA

80 Pages·2012·16.41 MB·English

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iatio Journal of the Australian Medical Association WA | March 2012 Volume 52 / Issue 2 | amawa.com.au
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M E D I C U S
March 2012
Council
President
A/Prof David Mountain
Immediate Past President
Prof Gary Geelhoed
Vice Presidents
Dr Richard Choong
Contents
Dr Michael Gannon
Honorary Secretary
Dr Omar Khorshid
Assistant Honorary Secretary
Dr Janice Bell
Honorary Treasurer
Dr Simon Towler
Councillors
Division of General Practice (WA)
Prof Bernard Pearn-Rowe President's Page Opinion
A/Prof Rosanna Capolingua
Division of Speciality Practice Some light at the end of the Ross River Virus: it is time to act
Dr Tony Ryan tunnel?
p.39
Prof Mark Khangure
p.2
Division of Salaried and State
Government Services
Dr Nigel Armstrong
Prof Geoff Dobb
Ordinary Members
Dr Andrew Miller Industrial Research
Dr Daniel Heredia
Dr Stuart Salfinger AIMS Form: Urgent Giving birth after a caesarean:
Co-opted Members Information lowering the risk to babies
Prof Ian Puddey
Prof Gavin Frost p.9 p.41
Dr Stephen Wilson
A/Prof Frank Jones
Dr Peter Maguire
Dr Dror Maor
Dr Cassandra Host
Mr Ghassan Zammar
Mr Benjamin Host
AMA (WA) Office
Travel
Executive Director
Mr Paul Boyatzis
Deputy Executive Director
Mr Peter Jennings
Executive Officers
Mr Michael Prendergast
Ms Christine Kane
Ms Clare Francis
Mr Gary Bucknall Intern Cocktail Party
Medicus p.10 - 11
Editor and Director of
Communications
Mr Robert Reid The Longest Eight
Advertising Inquiries Seconds in the world
Phone Mr Des Michael [phone] Opinion
Copy Submissions p.58–59
Phone Ms Robyn Waltl [phone] GPs and Emergency Planning
or [email protected]
why are we ignored?
Services
Business Services Manager p.18
Ms Noelle Jones
Financial Services Manager
Mr John Gerrard
Medical Products Manager Members Only
Mr Anthony Boyatzis Cover Story
Health Training Benefits and On the Town
Australia Manager
Mr Geoff Jones p.64–65
14 Stirling Highway
Nedlands WA 6009
Web: www.amawa.com.au
Email: [email protected]
Classifieds
The publication of an advertisement
or inclusion of an insert does not
imply endorsement by the AMA (WA) Professional Appointments
of the service or product in question & Positions Vacant
and neither the AMA (WA) nor its
agents will have any liability for any Ross River Virus p.66–71
information contained therein.
p.32–37
March MEDICUS 3
President’s Page
A/Prof David Mountain
Some light at the end of
the tunnel?
The last few months have been an interesting time for modern obstetrics.
medicine and how it is perceived. On a number of fronts Elsewhere the anti-vaccination lobbyists and their fellow
I think we can feel that there has been some progress in travellers, although not having been legally stopped from
improved understanding of the value of the doctor (a real one spouting their dangerous and deluded ideas, have had major
that is – of medicine, not chiropractic, chiropody, pharmacy media condemnation and scrutiny. Overall there has been a
or chinese herbal medicine) to the patient and community renaissance in rational thought and debate on these issues,
they live in. What has renewed my faith in our standing in the and the primacy of scientific method and scrutiny has been
community? reinforced.
Well, over the last few months there have been many Secondly, although there have been some very poor bits of
individual stories on varied topics in the media where policy recently, such as increasing independent prescribing
evidence-based practice has been the issue. And the rights to any “profession” registered with AHPRA and
profession’s thoughtful, forceful and principled replies in allowing pharmacists to prolong prescriptions, there are
many arenas have stood us in good stead. What is more, signs that this may be the high-water mark for these silly
the willingness to stand up for important principles and policies. The arguments martialled against these retrograde
fight against charlatanism, quackery, opportunism and the and fragmenting policies were effective in the public arena.
increasing fragmentation of health care have allowed many lay Commentators understood that having eight different
commentators to speak up and defend modern medicine for professions potentially prescribing and/or investigating for
the fantastic boon it is. one patient without a coordinator is dangerous as well as likely
So what are the principles and the issues that have been to be very expensive. As the costs and complications of this
driving these important debates? lunacy become apparent, a government desperate for real
First and foremost is the importance of evidence as the savings will pragmatically rein in these stupid programmes.
basis from which good care derives its authority. Second is the Finally although no profession or doctor is perfect and
need for a professional who understands how this vast array all systems have flaws, you can feel a grudging respect and
of evidence applies to the individual, their issues and total acceptance coming through in many commentaries that only
wellbeing. Finally the realisation that for effective health care, one professional group can look at the whole picture and
there has to be a leader and coordinator of the team. In the guide patients through the many pathways and pitfalls of
vast majority of circumstances that will be the doctor. modern health care. That professional is almost always the
The systematic application of the best research and a doctor, and most often the family GP. Because, in the end,
constant willingness to review your care and adapt to better patients and the commentariat do understand they don’t have
information are the hallmarks of good professional medical the knowledge or skills to pick which professional to go to for
practice and the scientific tradition. In many areas recently, which issue, medication or treatment. They do realise that the
fights have been fought (and mainly won) in the public arena. ability, knowledge and evidence base to know your patient well
In particular the teaching of non-scientific, implausible pseudo and holistically, and to diagnose, manage and coordinate care,
-health in universities has been challenged. In the UK most of only rests with one group. And that is the reason people rightly
the quackery courses are now closed or closing as universities trust their doctors. This trust is also why it is so important
have been shamed into removing them. Homeopathy looks for the profession to accept when there are problems (such as
likely to be named soon by the NHMRC as being both hospital infection rates and the need for routine handwashing),
ineffectual and implausible. In the area of supplements, and to advocate and lead sensible change of our own practices.
vitamins and other non-therapies spruiked by an unholy It is also one of the reasons we need to be involved in pushing
alliance of pharma, pharmacists, some celebrity doctors and public health policies that improve overall health.
naturopaths, the TGA looks like it is finally finding some So amidst all the retrograde spin that passes for policy, and
teeth. The Pharmacy Guild of Australia’s dalliance with the fragmentation of care under the guise of “coordinated”
Blackmores was exposed and lead to a humiliating public care, sold under the banner of “convenience”, I think the
retreat. Lawsuits against companies making ridiculous claims messages about scientific practice, caring, evidence-based
about supplements have again improved public awareness professionals and the increasing need for the doctor as patient
of the claims and products being pushed at them. In other advocate and coordinator are cutting through. There will still
areas such as home birth there has been much more comment be dark moments ahead, but in the end patients want the best
recently defending the safety, sense and spectacular success of health care, and most of them still know where to go to get it!
4 MEDICUS March
Business and medicine
go hand in hand
In thousands of cases medical professionals are also small
business people. In many other cases they are big
businesses and even very big enterprises. And
yet Government at all levels often forget medical
professionals when they think of businesses – they
seem to believe the provision of health is controlled
and guided by the Health Department, be it State
or Federal.
It also sometimes seems the Health Department
believes its own publicity and that it alone runs the
whole of health in WA. The reality is the Health
Department has almost no involvement in general
practice, which is the arm of health that most residents
of our great State have contact with.
Yet, think of almost any sector of government, virtually any
department, and you find some interaction with medicine, these areas of public debate.
especially general practice. General practice is the key to excellence in Australia’s
One general practitioner commented this week that world-class health system and must be encouraged and
apart from having to provide regular notification of various supported wherever possible.
diseases, her contact with the Health Department was GPs are not just skilled medical professionals providing
virtually zero. health care – they are also skilled business people, having to
Over the last year, the most regular contact this practitioner be mindful of business law, insurance, training and education,
had with government was with the Office of Energy – consumer rules, and a host of other regulations and legislation.
mainly relating to the apparently difficult task of providing These days, many GPs regular ask themselves if they are a
a regular power supply. This is electricity that is essential to doctor or a business owner, a human resources director or a
ensuring vaccines are kept under the most optimum (that is trainer and teacher.
refrigerated) conditions! Your AMA represents general practice across the board
The second most regular contact with government and is increasingly taking a strong stance with government at
authorities, over the past year this particular GP had was with all levels. While the AMA meets with the Health Minister on
WA Police and local government to make repeated complaints a regular basis, it also meets with a range of other Ministers
related to graffiti on and around her practice. to make sure all departments remember how their decisions
The AMA (WA) sees and assists members with these sorts affect the health sector.
of issues almost every day – and has to deal with a huge range With the rapidly changing health environment it has never
of departments outside that of health, such as planning, main been more important to medical professionals for the AMA,
roads, industrial relations, training and even little known to be involved in administration in Western Australia. It
bodies such as the Country Housing Authority. is important to make sure the medical communities’ voice
Your Asscociation devotes significant resources to ensuring continues to be heard.
government bodies and bureaucrats understand the range of It is more important than ever for legislators to protect the
pressures and challenges faced by our members and that they health system, especially the role played by general practice.
consult the Association when contemplating policy changes. And as we approach the 2012-13 State and Federal budgets,
The wide stretch of general medicine means there is a range the role of the AMA (WA) will be even more important as
of likeminded stakeholders that the AMA works with on a the Government makes decisions on the provision of health
regular basis. These not only include organisations formed to across the State. There will also be major decisions made
tackle particular administration and policy issues, illnesses about workforce issues, as the Government attempts to tackle
or to raise money for further research. Over the years, the the fast growing (and aging) population and the shortage of
AMA (WA) has also developed close ties with groups such as medical practitioners to meet demand that already exists.
the RAC in key areas of common interest like road safety. As While the future remains bright for health in Western
AMA (WA) President, Associate Professor David Mountain Australia, the demands on medical professionals are ever
recently said, doctors are at the forefront of public issues such increasing, especially for GPs. The experts within the AMA
as road trauma, and should therefore play a major part in however are always here to provide advocacy and advice.
March MEDICUS 5
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Relationship Building
for a Better Future
Each year hundreds of Australian doctors work all over the Dr Younge graduated from the University of Southampton
world; sharing their knowledge and skills while at the same in 1987 and has over 16 years’ experience in emergency
time learning from their international colleagues. Equally, medicine. He has been instrumental in the development of
members of the international medical community come to our emergency medicine teaching programs, and has seven years’
shores to further develop and share their medical skills. experience as a paediatric emergency lead. He is also a college
This sharing is important to Australia being at the forefront examiner and lead for regional and local registrar training and
of health care delivery. The establishment of partnering emergency department clinical governance and guidelines.
agreements to help facilitate this process of exchange has His vast knowledge and experience means he is well equipped
become more commonplace, with medical practitioners from to assist PCH to become an emergency training center of
overseas providing enormous benefits to Australia’s health excellence, and his involvement in the implementation and
care system. This international collegial approach has also management of the 4-hour target* in the UK will provide
helped establish and maintain Australia’s world-class health invaluable guidance and insight.
care services. “The 4-hour target can be very stressful,” Dr Younge said.
One such partnering relationship has recently been “But if you asked the simple question, to most emergency
established between Peel Health Campus (PHC) and physicians in the UK, as to whether they would want to
Frenchay Hospital (FH) at Bristol in the United Kingdom. get rid of that target, they would say no. They just want it
PHC, in Mandurah, is working towards establishing de-emphasised slightly, in terms of the level at which it has
its Emergency Department (ED) as a training centre of to be achieved, and also they want lots of other services to
excellence. This, coupled with the ED’s need to meet be involved so the spotlight is taken off just the emergency
growing demographic demands whilst complying with the department, and instead put on the whole hospital.”
requirements of the 4-hour rule, is what underpins the “Some of the interventions that made the biggest difference
development of this relationship. in the UK were simply lengths of stay. Given the people
PHC has a 22-bed ED and sees approximately 45,000 who stay longest in hospital are generally older people with
patients a year, with a 4-hour rule target of 98% by April 2012. more complex medical requirements, you have to look at a
Demographic growth in the region has brought about a rapid whole package of social care for them in terms of respite care,
increase in demand, with the ED experiencing a 10% annual placement, family involvement and welfare-rights advice. One
presentation increase. Establishing PHC as a centre of training of the best things that has occurred as a consequence of the
excellence and meeting this growing demographic demand 4-hour target is very comprehensive early intervention in the
will require the experience and direction of highly skilled aged care area,” he said.
practitioners; hence the rotation of FH medical professionals Dr Younge’s placement at the PHC is not his first in
through the ED is an important component of PHC meeting Australia; he worked in Queensland about 12 years ago as an
its desired and required outcomes. emergency department consultant. At the time Dr Younge
Frenchay Hospital is a regional neurosciences centre that was still relatively new to emergency medicine and wanted
contains one of the United Kingdom’s leading emergency to develop his skills further. “I have a very high regard for
medicine facilities, seeing approximately 85,000 patients a Australasian emergency medicine, so I applied for the position
year, with over 97% of patients being treated and discharged, in Queensland as I knew I would learn a lot in Australia, and I
or admitted to hospital, within four hours of presentation. did,” Dr Younge said.
PHC will draw on FH’s wealth of experience and knowledge, Dr Younge confesses WA seems very different from
with several physicians from Bristol rotating through the ED Queensland, although he is not sure whether this is because
over the next few years. The first of these doctors, senior he has far more experience now or it is representative of a
emergency physician Dr Paul Younge, began at Peel early this changing Australia. “The WA population I am seeing at the
year. Peel Campus is a lot more multicultural than I experienced
“One of the reasons we set up this rotation is we have a in Queensland, so that is really good. And I am meeting a lot
well-established training and teaching programme in the UK, more indigenous people here than I did there, which is a really
which I am heavily involved in. The Peel Campus is growing interesting experience for me,” he said.
rapidly, so along with FACEMS we have expanded the “Western Australia is a fantastic environment; it is a
teaching programme for nurses and doctors,” Dr Younge said. wonderful place to be, the climate is great, the people are
88 MMEEDDIICCUUSS MMaarrcchh
friendly, and you have different and specific landscapes. There
is the ocean and so many different areas to visit – I am really
enjoying it! Perth is a lovely city; it has a very open, relaxed
feel,” he said. He and his wife have already enjoyed several of
the Perth Festival events and some of the local beaches. Dr
Younge also hopes to get an opportunity to head south to try
out his long-board on some of WA’s world-class waves.
Unlike his Queensland visit, this time around
Dr Younge is a highly experienced emergency
practitioner and educator. His wealth of
knowledge and experience, along with
that of his FH colleagues who
will visit the campus over the
coming years, will help shape
the future of the PHC in a
positive and productive way.
* 4-hour target is the UK
equivalent of Australia’s
4-hour rule. The term
‘target’ was adopted over
‘rule’ as the four hours was
seen as a benchmark to be
aimed for, not a rule that
was mandatory to achieve.
MMaarrcchh MMEEDDIICCUUSS 99
AMA (WA) 2012
A N
wards ight
& CHARITY
GALA DINNER
Saturday 7 July 2012 AT 6.30pm
State Reception Centre
Kings Park
The AMA (WA) will host the 2012 Charity
Gala Dinner and Awards Night in
recognition and support of the Dr YES
Youth Education Sessions. This unforgettable
evening will honour the achievements of outstanding
Western Australians who have made significant
contributions to medicine in WA.
Please join us for a magical
night of celebration,
entertainment and prizes.
Tickets are strictly limited.
Book now for this exclusive event by contacting Liz Gray
on 9273 3027 or email [email protected].
AMA Members $195 per head
Corporate Tables (10) $2,050
Dress Black Tie (Optional)
Supporting the
health of Western
Australia’s Youth
through Dr YES
10 MEDICUS March
AMA.GalaDinner.2012-v3.indd 1 8/02/12 9:25 AM