AMA(SA)'s RAH watch

68 Pages·2016·13.99 MB·English

MAGAZINE OF THE AUSTRALIAN MEDICAL ASSOCIATION (SOUTH AUSTRALIA) INC.
AMA(SA)’s RAH watch
AMA – join together or be pulled apart • Rural medical workforce: a looming crisis
Stewardship and health financing • Health services in community pharmacies
Volume 29 Number 6
AMA(SA) moves house • Elder abuse • SA gambling move • Life as an intern December 2016
Making a difference.
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Experience Precision Care
Contents 8

3 President’s column Cover
4 News & views
The AMA(SA)’s
5 Editor’s letter
‘RAH watch’
7 Gambling
10 Mental health plan The opening date of the new RAH
Have your say remains uncertain, but the AMA(SA)
continues to pursue questions and
12 WCH move?
concerns raised by members on
Confusing messages
clinical research space, outpatient
13 Euthanasia services and more.
AMA Position
Statement updated
18
15 AMA(SA) moves
19 Rural health Rural health
Looming crisis
Rural medical
21 Council news
planning crisis
23 AMA(SA) dispatches
25 Members lunch The AMA(SA) has long been concerned
26 High Tea about the sustainability of regional
32 Stewardship health services in SA. It is time for the
Health financing
government to lift its game in the rural
35 Elder abuse health arena, medicSA reports.
40 Motoring
43 Vale 29
Dr Frosty Hoare
Membership
45 Indigenous health
APY Exchange Is it time to join
49 Life as in intern the AMA?
51 Public health What do you do when you feel that the
Refugee screening
world in which you work has become
disconnected from your own part
54 Student news
in it? This is how many SA doctors
59 In practice
report feeling every day. The AMA(SA)
63 Practice notes
can help …
Australian Medical Association medicSA Disclaimer
Neither the Australian Medical Association (South
(South Australia) Inc. Editorial
Australia) Inc nor any of its servants and agents will
80 Brougham Place, North Adelaide SA 5006 Editor: Dr Philip Harding have any liability in any way arising from information
PO Box 134 North Adelaide SA 5006 Managing Editor: Heather Millar or advice that is contained in medicSA. The
Telephone: [phone] Director of Communications: Eva O’Driscoll statements or opinions that are expressed in the
magazine reflect the views of the authors and do
Facsimile: [phone] Cover image not represent the official policy of the Australian
Email: [email protected] Eva O’Driscoll Medical Association (South Australia) unless this
Website: www.amasa.org.au is so stated. Although all accepted advertising
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material is expected to conform to ethical standards,
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Heather Millar 0409 196 401 such acceptance does not imply endorsement by
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Production
Executive Contacts Typeset and printed for the AMA(SA) by All matter in the magazine is covered by copyright,
President Douglas Press Pty Ltd. ISSN 1447-9265 and must not be reproduced, stored in a retrieval
system, or transmitted in any form by electronic or
Dr Janice Fletcher: [email protected] Unsolicited material: mechanical means, photocopying, or recording,
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Chief Executive Officer AMA(SA) c/- the Managing Editor no later than six Images are reproduced with permission under limited
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medicSA DECEMBER 2016 1
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2 medicSA DECEMBER 2016
Janice Fletcher President’s Report
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WE often say that we want representative group. The AMA is not about the defunding of the current

aa governments – state and federal funded by government. That means we Statewide Gambling Therapy Service.
l
a l – to pay attention to health. can be fearless when needed. We are not The AMA(SA) has spoken out strongly,
a
G After all, it is the number one priority selling you anything. That means we have advocating for a move to mental health,
G
for most Australians, and is a primary no hidden agenda. And we are beholden and out of the DCSI portfolio.
requirement for success – whether you only to our members and the community.
We are calling on both state and
measure that as workforce participation,
So, if you are a doctor, unless you think federal governments to develop, fund
innovation, economic advancement, or
the health system is doing completely fine; and commit to a health framework for
indices of content.
unless you are certain you will never need Australians, not just focussing on the
Lately, though, it sometimes feels like it someone in your corner, fighting for you, acute end, and management of chronic
has all been the wrong kind of attention or your colleagues, or your patients; you diseases – an approach best defined as
– whether that has been poor patient should be a member. ‘Too little, too late’. Fundamental to this
co-payment models, scrapping of national are programs to improve the health and
funding agreements, or attempts to nutritional literacy of our communities.
So, if you are a doctor,
reform the system whilst moving to a new
There is a critical need for government
major hospital, grappling with an e-health unless you think
to focus on a workforce framework –
revolution, and cutting costs.
the health system particularly in rural and regional areas.
Whatever the issue, the AMA is there, I was saddened to attend the recent
is doing completely
listening to the concerns of members and funeral of the late Dr Peter Chapman,
presenting a voice for the profession. We fine; unless you are chief medical advisor for Country Health
look to our members for what fires to fight certain you will never SA. The State Government and Country
and where – as well as what flames of Health must build on his legacy to develop
need someone in your
innovation and success to fan. a sustainable rural health workforce for
corner, fighting for you, South Australia.
One of my predecessors was fond of
saying that if you are not prepared to or your colleagues, The AMA(SA) has its eye on the future
be part of the solution, you don’t get and, with that in mind, has expanded its
or your patients; you
to complain. On that basis, he didn’t operations to include a new entity – AMA
should be a member.
complain a lot, but when he did so it Skills Training – which will help to build
was to the Minister directly, in meetings the support workforce that is needed to
with Department and Country Health keep our health and community services
executives, and in the fora of public I sometimes hear that the AMA did (or strong into the future. I was delighted to
debate. Importantly, it was also not just didn’t do) something 5, 10 or 15 years present certificates at the graduation of
raising problems but proposing solutions, ago with which you disagreed. I guarantee our very first group of graduates just a few
and being prepared to engage on big that if you looked at the sum total of our days ago, and I look forward to hearing
ideas. That is how we work at the AMA. activity over those years, you would agree about their accomplishments.
with the overwhelming majority of it. But
Members get a seat at those tables. The The same goes for the new medical
opting out of membership is a mistake.
caveat that comes with this is that we graduates who will be working in our
Every doctor who is not a member
need your involvement. We need you (or hospitals next year. Speaking with them
means that there is less that we can do
at least some of you) to sit on our Council highlights the importance of continuing
for the whole profession, as well as the
and state and federal committees, and to the important role of the profession in
individuals in it. And there is a lot still to
provide feedback and an ‘early warning maintaining the health of the community.
do. In fact, the list is growing.
system’ on issues at the front line. We That is a core goal of the AMA,
also need your membership subscriptions: Our advocacy ranges from matters big to because we can accomplish so much
these are the price of an independent small. Recently, we have raised concern more together.
medicSA DECEMBER 2016 3
AMheadAing(SA)
Council A win for our rural doctors
Office Bearers THE AMA(SA) is pleased to The AMA(SA) has been advocating to
President: Dr Janice Fletcher announce that, following our the health minister about the importance
Vice President: Dr William Tam negotiations with Country Health SA of CHSA taking on an increased
(CHSA) over the last Rural GP Agreement, responsibility for supporting rural training
Immediate Past President
CHSA has confirmed that four of the five and research to attract more doctors into
Dr Patricia Montanaro FTE procedural GP training positions have our rural health system and to deliver a
Ordinary Members been filled for commencement in 2017. more reliable and better resourced rural
medical workforce. This has resulted in
Dr Chris Moy, Dr Tarun Bastiampillai, These positions will be one FTE registrar
Dr Matthew McConnell, Dr Clair Pridmore, in emergency at the Royal Adelaide the collaboration of AMA(SA), CHSA and
Dr Paul Worley, Dr John Woodall Hospital (RAH) and one at Lyell McEwin GPEx working together and achieving the
Hospital, and one FTE in anaesthetics above result.
Specialty Groups
at the RAH and one at Flinders Medical
We acknowledge the efforts of Dr Peter
Anaesthetists: Dr Perry Fabian Centre. These four positions will be
Clements from GPEx in ensuring these
Dermatologists: Dr Jeffrey Wayte rotated into rural sites during the
positions meet the necessary standards
General Practitioners: Dr Penelope Need coming year.
and ensuring those in the positions
Obstetricians and Gynaecologists:
This is an important win for our rural will receive the best training and
Dr Jane Zhang
doctors and is a shift in the right direction. experience possible.
Orthopaedic Surgeons: Dr Jeganath Krishnan
Paediatricians: Dr Patrick Quinn
AMA releases plan to
Physicians: Dr Nimit Singhal
Psychiatrists: Dr Michelle Atchison
Radiologists: Dr Nicholas Rice eradicate Rheumatic Heart
Surgeons: Dr David Walsh
Doctors in Training Representative Disease by 2031
Dr Karthik Venkataraman
Regional Representatives
THE AMA has called on all
Northern: Dr Nigel Stewart, Dr John Williams
Australian governments and
other stakeholders to work
Salaried Medical Officers’
together to eradicate Rheumatic Heart
Representative
Disease (RHD) – an entirely preventable
Dr Andrew Russell
but devastating disease that kills and
Student Representatives disables hundreds of Indigenous
University of Adelaide: Mr Brian Gue Australians every year – by 2031.
Flinders University: Ms Anna Elias
AMA president, Dr Michael Gannon,
“RHD once thrived in inner-city slums,
AMA(SA) Executive Board said that RHD, which starts out with but had been consigned to history for
Dr Trevor Mudge (Chair), Dr Margaret seemingly innocuous symptoms such most Australians,” Dr Gannon said.
as a sore throat or a skin infection,
Cowling, Dr Janice Fletcher, Mr John
“RHD is a disease of poverty, and it is
but leads to heart damage, stroke,
McLaren, Dr Chris Moy, Dr Peter Sharley, preventable, yet it is still devastating lives
disability, and premature death, could
Dr William Tam and killing many people here in Australia
be eradicated in Australia within 15
– one of the world’s wealthiest countries.
AMA(SA) Office: Key Contact years if all governments adopted the
Chief Executive: Mr Joe Hooper recommendations of the latest AMA “In fact, Australia has one of the
highest rates of RHD in the world,
Indigenous Health Report Card.
Federal Councillors almost exclusively localised to
Dr Janice Fletcher (State Nominee) The 2016 Report Card – A call to action Indigenous communities.
Dr Chris Moy (Area Nominee SA/NT) to prevent new cases of Rheumatic
“Indigenous Australians are 20 times
Dr Susan Neuhaus (Craft Group Heart Disease in Indigenous Australia
more likely to die from RHD than their
Nominee: Surgeons) by 2031 – was launched in November
non-Indigenous peers – and, in some
in Darwin.
areas, such as in the Northern Territory,
The AMA(SA) office is located at er
80 Brougham Place, North Adelaide. Dr Gannon said the lack of effective this rate rises to 55 times higher.” sing
ei
You can contact us by telephone on action on RHD to date was a national The AMA Indigenous Health Report cr
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[phone], by fax to [phone] failure, and an urgent coordinated Card 2016 is available at ama.com.au > oc
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or email to [email protected]. approach was needed. Advocacy > Indigenous health © i
44 mmeeddiiccSSAA DDEECCEEMMBBEERR 22001166
heading
Dr Philip Harding
AMA welcomes proposed
Editor’s
modernisation of Medicare
LETTER
payments system
THE AMA has welcomed the Its many faults create inefficiency and FATHER Christmas has made his annual
government’s decision to replace inconvenience for doctors and patients. expedition down North Terrace to the
the IT system that delivers Magic Cave, but in terms of what is of
“Medical practices have now taken on
Medicare and related payments. interest to the health sector… there are plenty
much of the work of processing Medicare
of things either happening, not happening or
AMA president, Dr Michael Gannon, payments on behalf of the government,
about to happen at either end of the street or
and this can be cumbersome and
said that replacing the system is
in other parts of the Adelaide CBD.
time-consuming.
modernisation, not privatisation.
At the existing RAH site, there have been so
“It is critical the AMA is closely involved in
“The AMA made it very clear during the many suggestions for future use – including a
the design of the new system to ensure it
election campaign that replacing the probable need to maintain part of its existing
meets the needs of doctors and patients.
backroom payment system for Medicare role for some time to come – that the Man
does not equate to the privatisation of “Medical practices must be properly in the Red Suit probably knows the likely
Medicare,” Dr Gannon said. supported by the government to outcome as well as anyone.
incorporate and implement new
At the western end of North Terrace, there is
“The current payment system is 30 equipment and technologies to benefit
some good news: the new Adelaide Health
years old. It is clunky and inefficient. patients,” Dr Gannon said.
and Medical Sciences building is near-
complete and executive dean Alistair Burt
AMSA welcomes
advises that it will open for teaching in the first
semester of 2017. Unfortunately, this does not
apply to its neighbour teaching hospital, beset
recommendations on
with a series of well-publicised delays which
need no further comment here, let alone the
medical complaints process question of whether there will ever be adequate
space for clinical teaching. At an early stage
in the development of the new RAH, when it
THE Australian Medical was protested that the Medical School, IMVS,
etcetera remained at Frome Road, someone
Students’ Association
in authority suggested that it might do medical
(AMSA) has welcomed the
students no harm to walk to West Terrace.
recommendations from the Senate
Now it seems that they might have to walk in
Inquiry report into the medical
the opposite direction for a while. One wonders
complaints process, specifically
whether the possibility of such an absurdly
in relation to bullying and sexual
farcical situation has caught the attention of the
harassment in the medical workforce.
scriptwriters for the next student revue.
AMSA support the recommendations
Elsewhere in the CBD, significant hospital
of the Inquiry, in particular the
development is being undertaken in the private
recommendations that: sector. One large hole in the ground off South
• all hospitals review their codes of
Terrace will become not just a car park, but
• all universities adopt a curriculum that conduct to ensure that they contain
a major extension to St Andrew’s Hospital,
incorporates compulsory education a provision that specifically states
including a dedicated cardiac ward together
on bullying and harassment that bullying and harassment in the
with day surgery and other facilities; while
workplace is strictly not tolerated.
• all universities accept responsibility another on the corner of Pulteney and Angas
This code of conduct should explicitly
for their students while they are on Streets will become the new Calvary Wakefield
include students as well as hospital
placement and adopt a procedure Hospital with half as many beds as the new
staff and volunteers.
for dealing with complaints of RAH, a 24/7 ED, and more. In our next issue,
bullying and harassment made by AMSA remains firmly committed to we will provide detail on these projects,
including the planning and consultative
k their students while on placement working collaboratively with all key
Stoc – this procedure should be stakeholders in health to ensure there is processes involved, which might be of interest
ol to SA Health.
S clearly defined and a written copy sustained action and resources provided
k/
oc provided to students prior to their to eliminate behaviours of bullying and Meantime, the medicSA team sends Season’s
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© i placement commencing sexual harassment. Greetings to all.
mmeeddiiccSSAA DDEECCEEMMBBEERR 22001166 55
hneeawdsi n&g views
Early diagnosis and
intervention essential
for children with autism
spectrum disorder
The AMA has called for coordinated action to speed up the diagnosis of Autism Spectrum Disorder
(ASD) in children, and to provide early intervention therapies to give children with ASD the best
outcomes possible.
AMA president, Dr Michael “There is no specific biomedical test for Dr Gannon also criticised anti-vaccination
Gannon, also called on the federal ASD – it cannot be diagnosed with a activists and others who made wild and
government to rule out any future blood test or a scan,” Dr Gannon said. misleading claims about the cause of
narrowing of the eligibility requirements for ASD, and peddled ‘miracle’ cures.
“The number of paediatricians, child
people with ASD to access the National
psychiatrists, and clinical psychologists The CEO of Autism Awareness Australia,
Disability Insurance Scheme (NDIS).
working specifically in ASD is limited, Nicole Rogerson, said that, for too long,
Launching the AMA Position Statement and the problem is magnified in rural and autism has been put in the ‘disability
on Autism Spectrum Disorder 2016 at remote areas, where few, if any, clinicians basket’, without proper recognition of
can make the diagnosis. the integral role doctors play in early
NSW Parliament House, Dr Gannon said
detection and supporting families.
that while ASD could be reliably detected “There are also no nationally consistent
at two years of age, Australian children guidelines for GPs on what to look for, The position statement is available at
with ASD are most commonly diagnosed and when and how to refer a child who is ama.com.au/position-statement/autism-
just before their sixth birthday. suspected of having ASD”. spectrum-disorder-2016.
For more information a
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6 medicSA DECEMBER 2016
news & views
South Australian gambling move:
international experts protest
International experts from Canada and New Zealand have spoken out against the SA State
Government’s controversial decision to defund the Statewide Gambling Therapy Service (SGTS) in
favour of a private psychology provider. The AMA(SA) continues to call for the service to be supported
into the future.
FIRST it was New Zealand, with Canada-based Prof David Hodgins,
gambling research luminary Prof from the University of Calgary’s
Max Abbot, based at the Auckland Department of Psychology, stressed
University of Technology, where he is the “strong empirical support” of the
the pro vice-chancellor and dean of the SGTS treatment, which has outcomes
Faculty of Health and Environmental published in peer reviewed journals when
Sciences. He is also a past president and he says most jurisdictions offer treatment
senior consultant of the World Federation not subject to scientific study. He too
for Mental Health, among other roles. strongly endorsed the SGTS team and
Then it was Canada, with Prof David service, describing it as “a gem”.
Hodgins, an expert in gambling treatment
This is an issue the AMA(SA) has
and research at the University of Calgary.
been pursuing for some months, and
Both have close knowledge of the
continues to press. AMA(SA) president Dr
SGTS’s work and leading cognitive
Janice Fletcher sees the comments from
behavioural therapy model. Both are
overseas as just the tip of the iceberg in
urging the SA State Government to
terms of the service’s potential to make
rethink the defunding of the current
a difference.
Flinders-based service. They were closely
followed by Prof Robert Ladouceur, of “The comments from Prof Abbott, Prof issues, drug and alcohol issues. It has
Université Laval, Canada. Hodgins and Prof Ladouceur highlight inpatient bed capacity for the most
the international significance of defunding complex cases or people at a distance.”
They add their concerns to those of
the current Statewide Gambling Therapy
the AMA(SA), which has long been “It has developed other leading
Service,” she stated.
expressing concerns on the move, and programs. It is training clinicians
the Royal Australian and New Zealand “This is a service that has been making a interstate and overseas in its leading
College of Psychiatrists (SA Branch). difference in South Australia for 20 years, programs. It is underpinning research
Prof Abbott highlighted the local and but has also built up the expertise and at the Flinders Centre for Gambling
international ramifications of the decision, world-leading programs that can have Research that can change lives and add
describing closure of the service as “a international impact – and are already to the world’s knowledge bank on how
loss globally”, and strongly endorsed set to make a difference on the larger to deal with gambling and the burdens
the service. world stage, such as through the large it brings. This is not about one service.
four-year New Zealand study using the This is about the big picture. That is why
“The SGTS and associated Flinders Centre
SGTS model.” the AMA(SA) is so concerned, why the
for Gambling Research, with their wider
RANZCP (SA Branch) is so concerned
university and health service connections, “When world-leading clinicians,
and why international experts are
have developed a unique combination researchers and academics speak out
so concerned.”
of comprehensive treatment provision, at moments like this, you know it is
public education and outreach, research, significant. You know it is something that The AMA(SA) continues to seek to
evaluation and interdisciplinary practitioner is really going to make a difference in meet with Minister Zoe Bettison, whose
education and training,” he said. people’s lives.” portfolio the service sits under, together
with the RANZCP SA Branch, and has
“The SGTS, of 20 years standing, and She feels the government has missed
written to SA Treasurer Tom Koutsantonis
Centre are at the forefront of innovation the point and failed to understand or
to seek the State Government to
and best practice internationally. The take into account what it has in the
commit funds to the SGTS at Flinders in
cognitive behaviour therapy program existing service.
order that it can continue as a flagship
developed by the Centre has been
“The current service is much more than addiction treatment centre for SA. It
an shown to be highly effective.”
m just a treatment centre,” she stated. seems highly appropriate that some of
g
ber He anticipates the Flinders CBT model It is an integrated service. It is part of the newly established wagering tax funds
al
h “will, in due course, be the required a health and mental health service. It can be directed towards this purpose.
k/
oc therapy for people with severe gambling can deal with the most complex cases, With funding for the service set to end on
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© i disorders throughout New Zealand”. with co-morbidities, other mental health 31 December, time is of the essence.
medicSA DECEMBER 2016 7
hneeawdsi n&g views
The AMA(SA)’s RAH watch
The opening date of the new Royal Adelaide Hospital remains uncertain, but the AMA(SA)’s ‘RAH
watch’ continues, with the Association continuing to pursue questions and concerns raised by
members. Two key areas have been clinical research space and outpatient services. Read on for
the latest on these …
THE AMA(SA) has been
talking about clinical
research space at the new
RAH for some years now, as this
vital area initially appeared to
have been overlooked, or at least
overshadowed by the shiny new
SAHMRI next door. Crunch time
has finally come though, with the
government taking steps to assure
all that solutions are, if not all in
place, at least on the way. And not
before time. But at this point, how
do they measure up?
We reported on our most recent
advocacy about this in the last
issue of medicSA, including a
list of 18 key questions, and can
here report the response from the
minister, Jack Snelling. On theme,
he advises that “research and
clinical trials are considered an • Clinical research staff will have access groups to quantify the volume of
integral part of modern patient treatment to allocated workstations, quiet rooms expected activity”.
and will continue to be closely aligned and and meeting rooms able to be booked
• These discussions are also being used
incorporated into clinical services at the as needed.
to inform the requirement for a High
new RAH.” • The “reallocation” of part of the Acuity Research area (eg re location,
‘Teaching and Learning’ space as the size beds and unit governance).
The minister confirms that the new
‘Research Hub’ was discussed with
RAH will accommodate approximately • Clinical trial sponsors and researchers
appropriate CALHN leads.
180 research and clinical trials staff, will have the opportunity to view the
throughout the allocated Directorate • The “change in available space for new RAH and workspaces before the
administration space and Research Hub. teaching activities will not compromise RAH opens to ensure compliance with
These areas will be classified as ‘staff any of the planned clinical training at research agreements.
the new RAH.”
only’ and “are well placed to support the
In relation to the questions and concerns
high level of confidentiality and security • The new facility was designed to the AMA(SA) has raised on behalf
required for clinical trial administration and support a “just-in-time delivery of medical staff regarding outpatient
resources”. philosophy” in order to devote more services at the new RAH, SA Health
space to support clinical activities.
chief executive Vickie Kaminski has
Clinicians remain concerned, however,
• This extends to file management and indicated that:
about the space for interaction between
while “secure storage for files will be
patients and clinical trials staff, given • Clinician engagement is occurring via
available on each floor in the areas
the limits on outpatient space and staff forums, meetings, workshops
which house administration services, it
capacity. Outpatients itself remains a and written documentation.
will be limited”.
somewhat fraught proposition due to
• Potential processes are being drafted • This includes accommodation for
both the physical space limitations and with the contractor to ensure timely clinic support staff.
the not unrelated reduction in proposed
file storage and retrieval. Feedback will • The new model of care “will require
commissioned activity – said to be up to a
then be sought. new work practices”.
20 percent reduction on current levels. • Clinical research activity is planned • Provision will be made to structure coll
s
In relation to the clinical research issues to be accommodated in the Level work to better support clinic Dri
O’
raised by the AMA(SA), the minister has 3 Outpatient area and work is preparation and improve direct a
v
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advised that: “progressing with clinical trial communication with patients. ©
8 medicSA DECEMBER 2016