Journal of the Australian Medical Association WA - AMA WA

80 Pages·2012·22.44 MB·English

M E D I C U S
WESTERN AUSTRALIA WESTERN AUSTRALIA
Journal of the Australian Medical Association WA | December 2012 Volume 52 / Issue 11 | amawa.com.au
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Council
President
Dr Richard Choong December 2012
Immediate Past President
A/Prof David Mountain
Vice Presidents
Dr Michael Gannon C o n tE n t S
Dr Andrew Miller
Honorary Secretary
Dr Omar Khorshid
Assistant Honorary Secretary
Dr Janice Bell
Honorary Treasurer
Dr Simon Towler
Councillors
Division of General Practice (WA)
Prof Bernard Pearn-Rowe
A/Prof Rosanna Capolingua
Division of Specialty Practice
Dr Tony Ryan
Prof Mark Khangure
Division of Salaried and State
Government Services
Dr Dror Maor
Dr Daniel Heredia 18
Ordinary Members
Prof Gary Geelhoed
Dr Stuart Salfinger
Dr Marcus Tan 36
Co-opted Members
Dr Steve Wilson AMA (WA) Clinical Conference 2012
A/Prof Frank Jones
South American appeal
A/Prof Peter Maguire
Prof Geoff Dobb
Dr Dror Maor Rhonda Parker
Dr Cassandra Host
On our fight against dementia
Dr Ian Jenkins
Prof Ian Puddey
Prof Gavin Frost
Dr Alexandra Welborn
Mr Benjamin Host
Mr Ghassan Zammar
AMA (WA) Office
Executive Director
8
Mr Paul Boyatzis
12
Director: Industrial & Legal
Ms Marcia Kuhne
Executive Officers
Mr Michael Prendergast
Ms Christine Kane Clinical Handover Symposium
Ms Clare Francis UWA Dedication Ceremony
Mr Gary Bucknall Communication is key in
Welcoming our State’s newest doctors effective handover
14 Stirling Highway
Nedlands WA 6009
[phone] FEatU rES
[email protected]
www.amawa.com.au
Medicus
Editor and Director of 12 UWA Dedication Ceremony 22 Cover Story: AMA fights for
Communications A new journey begins Health
Mr Robert Reid State Election 2013: our wish list
Deputy Editor
Ms Janine Martin
Advertising Inquiries 18 AMA WA Clinical 46 The Outside Edge
Phone Mr Des Michael [phone] Conference 2012 Why children need to
Copy Submissions Informative and engaging spend more time outdoors
Phone Ms Janine Martin [phone]
or [email protected]
rEGUL arS
Services
Business Services Manager
Ms Noelle Jones
Financial Services Manager 02 Presidents’ Desk 41 For the record: 62 Technology
Mr John Gerrard
Medical Products Manager 03 From the Editor Dr Ruth Blackham 64 Drive
Mr Anthony Boyatzis 04 Industrial 42 Clinical Edge 66 - 68 Member Benefits &
Health Training
Australia Manager 07 News 48 Snippet On the Town
Mr Geoff Jones 26 Opinion 50 Members Only 70 - 73 Classifieds
The publication of an advertisement, 36 Profile: 54 Travel Professional Appointments
article or inclusion of an insert does not Rhonda Parker 56 Food & Positions Vacant
imply endorsement by the AMA (WA) of
the views, service or product in question, 38 Tomorrow’s health: 59 Wine
and neither the AMA (WA) nor its agents
The future of Obstetrics 60 Book Shelf
will have any liability for any information
contained therein.
December MEDICUS 1
PRESIDENT’S DESK
Lessons about leadership
by Dr Richard Choong
AMA (WA) President
Another year almost gone! I can say with enormous Christmas and the New Year. Rest, recuperate and enjoy
confidence that I have never had a busier year than the opportunity, no matter how limited, to relax with the
2012, with the possible exception of my first year at people you love and enjoy the company of.
medical school when I tried to prove to myself and my I worked out years ago that life is too short to waste
family that I could handle the responsibilities of being your time with people you either don’t love, enjoy or
a doctor. I have said publicly on a number of occasions respect – so spend time with those who are important to
that my car only knows its way between the Nedlands your heart.
headquarters of the AMA and my clinic in Port In a caring profession such as ours, it is too easy to
Kennedy. It only knows the way to my home if I assist it. forget that we have to care for ourselves before we can
Such have been my directional challenges since I took offer care to anyone else. Occasionally it is important, if
over as AMA (WA) President. not vital, to slow down, smell the flowers, contemplate
And yet while busy, I can say that I have enjoyed the what we do and how we do it and recharge our batteries.
year immensely. The coming year is going to be an incredibly busy one
I have also learnt a lot about myself, about others and for all of us involved in the AMA in Western Australia.
about key issues such as leadership. Everyone has ideas Much of this issue of Medicus is devoted to the coming
about leadership, of setting a direction and how it can STATE ELECTION. I take this
and should be achieved. But only a few of us are called opportunity to remind all
to actually be a leader of an elective, leadership-based AMA (WA) members
organisation. that there will also be a
I have learnt a great deal about leadership while being Federal Election held
in this role, even over a relatively short time. Leadership in the second half
is not about being popular or trying to be everything to of next year. We
everyone. Nor is it about being buffeted by the vagaries also plan to make Respect is garnered
of events or the pressure of particular individuals. health a key issue
from strong leadership,
Respect is garnered from strong leadership, from being in the federal
from being willing to
willing to listen, consult and then making a decision. sphere and will
At times, leadership is about compromise, while be talking to all listen, consult and then
realising that it is not leadership to give away too much political parties.
making a decision
when offering compromise. That cliché of a ‘win-win’ Membership is
outcome is true, but occasionally it is better to stand growing like never
your ground and fight for what we believe is the best and before and we are
only outcome. setting the benchmark
Sometimes it is better to back away, bide our time and for other states both in
return to the battle when the timing is better. The AMA terms of public and political
has a record of achieving the very best for health in our impact, not to mention membership services.
state, but these achievements have not always come our But it is only the hard work and dedication of AMA
way immediately. staff that assists this growth. All the staff at the AMA
I have also got to know the game of elective politics a have my respect, support and best wishes for this
little bit better during the year. It is easy to be critical Christmas season.
of politicians from afar. But it’s when you meet with There is no other organisation that plays such a key
politicians on a regular basis that you realise it is not role in health in WA. There is no other body that has
that simple – politicians are seeking for the best outcome public health as its number one principle and there is no
too, it’s just that it might be a long way from the best other body that has delivered to both the public and to
outcome in our eyes. its members in the way we have.
My final message is a simple one – take it easy over And we will keep doing it in 2013 – and beyond! ■
2 MEDICUS December
FroM tHE EDItor
Next stop,
maybe Premier?
Remember the story in the media about a year ago that next term of Government. While Kim Hames has been seen as
Health Minister Kim Hames was planning to retire in the an excellent Deputy Leader of the Liberal Party and Deputy
very near future – perhaps as early as the 2013 State election? Premier over the last four years, he has also been seen as a good
For those fearful of such a momentous event, take a deep pair of hands who can handle virtually any problem thrown
breath, sit down and put it out of your mind. at him. It has also always been seen that Mr Hames has never
It is becoming apparent that the Minister is not planning on pushed his leadership qualifications before those of anyone else
calling Premier Colin Barnett to deliver any bad news for a few in the Liberal Party.
years yet. Not only is the Health Minister not going anywhere in Until a few months ago, it was generally accepted that if
the near future, but he is making it clear that he is enjoying his re-elected as Premier, Mr Barnett would, sometime in the next
portfolios of health and tourism more than ever. four years, hand over to the man who was Treasurer and MP for
Despite some saying there is no connection between the two the southern suburbs seat of Bateman, Christian Porter. With
ministries – both of vital economic and political importance to Mr Porter however, answering the unheard-by-others siren call
the future of Western Australia – they seem to Canberra and Federal Politics, the door to the
to combine well in the Minister’s mind, as he Premier’s office has been left wide open.
said recently providing an ideal combination, a Mr Hames would have few serious political
“Ying and Yang”. rivals if he decided to make it known that he was
Passing briefly through his Ministerial office interested in being Premier. And with little in the
a few weeks ago, surrounded by WA tourism way of serious political or personal baggage, he
posters, the Minister is clearly enjoying himself would have a reasonable easy inside run. Popular
enormously as more of the world discovers the with his colleagues and within the Liberal Party
wonders and beauty of our State. for not grandstanding and for delivering generally
Health, the Minister says, used to be a good policy, he would have a significant number
poisoned chalice for many governments. of votes in the party room without trying too hard.
Promising to “fix health” in opposition, health The others he could win with a little effort.
often becomes the portfolio most likely to bring WA Minister for Health, Potential leaders are usually easy to pick –
a Government down. Dr Kim Hames remember when Barry O’Farrell, then a humble
It could well just be the calm before the New South Wales backbencher lost almost half
storm, but it is difficult not to admit that politically at least, his bodyweight and got rid of a Ned Kelly-like beard? He then
health has not created the pain for this government that it has began to be seen everywhere, talking up his connections and
brought for many others. his views on a wide range of issues. Immediately it was seen as
The Minister is careful to admit that there are “challenges a clear indication that he was beginning his run to be Premier.
ahead” such as potential budget cuts, the delivery of a fully- Although repeatedly denied by Mr O’Farrell, he quickly became
staffed and equipped Fiona Stanley Hospital and deciding on opposition and Liberal Leader and then Premier.
what services should be available at Royal Perth and Fremantle While not suggesting that Kim Hames has any weight to lose
Hospitals. (he hasn’t), or a beard to shave (he hasn’t one of those either),
But the Minister is also obviously confident that he has the there will be other signs. If the Minister for Health and Tourism,
necessary skilled people around him, both in his office and in the Kim Desmond Hames, MP for Dawesville, after the 9 March
Health Department to deliver solutions to these nicely named 2013 State Election begins making speeches about issues other
“challenges” as well as the unknowns that are expected in the than health and tourism, watch out – he will have taken his place
life of any minister. in the race for next Premier of Western Australia.
But the Minister’s declarations that he is staying on, and On a final note, please accept our Season’s Greetings to all
enjoying his portfolios, have another, fascinating, angle. members of the AMA (WA). It has been a very interesting if not
Some of his Parliamentary colleagues are beginning to think fascinating year, and your Association has once again played a
that he might just make a very good Premier sometime over the pivotal part in medical politics and public health in WA. ■
December MEDICUS 3
In DUStrIaL
AMA provides its log of claims
for new Industrial Agreements
Time is fast approaching for the Medical Practitioners’ and not able to access clear days off.
AMA Industrial Agreements that were registered in 2011 • Part-time practitioners to be paid overtime for all hours worked
to be renegotiated. The Agreements cover all salaried medical beyond their contracted part-time hours.
practitioners employed by the Department of Health, including • If required to resume duty or called back before having 10
clinical academics. hours free from duty, a practitioner cannot be rostered for
Your AMA representatives have considered members’ normal duty until having had 10 hours free from all duty.
comments regarding issues that have arisen from the current • Additional 25 per cent loading for hours worked under an
agreements and concerns expressed in the recent AMA survey. amended roster that has not been agreed with the practitioner.
The Association has, in response, prepared a list of demands Key specific additional issues for senior practitioners
for 2013 agreements. The claim has subsequently been formally • 70 per cent of time allocated to clinical duties (including
served upon the Minister for Health. teaching); 30 per cent to non-clinical duties.
While this is by no means a comprehensive list of all matters • Increase Heads of Department Allowance from 10 per cent to
included in the list of demands, some of the key issues the 25 per cent of Level 24 based on FTE supervised.
Association will argue for on behalf of medical practitioners • Insert Attraction and Retention Allowance.
include: • Increase professional development leave to three weeks of
• Salary increases of 12 per cent over three years and similar Conference/Education Time.
increases to all allowances including on call, professional The negotiation process will not get fully underway until the
development and costs of private practice. New Year but the Association plans to take every opportunity to
• Maintaining Public Sector Agreement conditions of press the claims with the Government from as early as possible.
employment for practitioners transferring to the private sector. The AMA (WA) will keep members informed of progress as the
• Restructuring of Private Practice Arrangements. process unfolds.
Key specific additional issues for Doctors in Training
• Increased number of days, evenings and weekends clear from For further information please contact Marcia Kuhne, Gary Bucknall
duty and higher penalties for practitioners required to work or Clare Francis on [phone]. ■
Health Department confirms
increase to WAGMSS
On 13 September 2012, the Australian Medical Association (WA) made representations to increase Visiting Medical Practitioners’
rates in accordance with the AMA’s Medical Fees Indices (MFI). This excluded the MDA component as the State covers
negligence claims, but not inquiries etc.
A little over two months later, on 23 November, the Health Department confirmed it had accepted the submissions made by the AMA in
September. As a result the following general adjustments are effective from 1 December 2012:
Group 1: Pathology – 2.78%
Group 2: Radiology – 2.81%
Group 3: Non-procedural General Practice – 2.99%
Group 4: Anaesthesia – 3.11%
Group 5: Physician, Psychiatry and Dermatology – 3.03%
Group 6: Surgery, not otherwise covered in Groups 7, 8 and 9 – 3.03%
Group 7: General, Vascular and Gynaecological surgery – 3%
Group 8: Obstetrics – 3.01%
Group 9: Neurosurgery, Orthopaedics, Plastic and Reconstructive surgery – 2.98%
Group S: Specialist consultations – 3.01%
The increases are consistent with the AMA MFIs reflecting individual specialty movements in costs and community movements in
income calculated by the AMA and utilised as a basis for the adjustments to the AMA list and consistently accepted by the Health
Department over many years. ■
4 MEDICUS December
In DUStrIaL
Personal Provision for consultations and
direct personAl supervision of procedurAl trAinees
Medical practitioners may not understand the Private Practitioners exercising rights of private practice have
Practice Arrangements when a member of junior medical an obligation to exercise that right to the fullest extent
staff performs an operation on a patient without supervision. permissible by law. Appropriate income maximisation is
The following is an extract of advice provided in Industrial supported but to be lawful:
Update No 4 (March 2012), following advice received from
1. A Patient has to have freely been given choice
Medicare.
between public and private.
THE CMBS (Commonwealth Medicare Benefits 2. Be seen in accordance with clinical need.
Schedule) Notes for Guidance state 3. There needs to be a Valid referral (see CMBS –
Consultations: The Federal Health Insurance Act 1973 Section G.6.1.for full details).
specifies that other than for a narrow group of services that 4. The hospital needs to provide the doctor with
may be rendered by or “on behalf of” a medical practitioner, patient election form (or other acceptable evidence)
medical benefits will only be payable if they have been personally (Clause 27 (5)).
performed by the billing practitioner e.g. Consultation items. For 5. Consultative services must be provided personally
exceptions refer to the CMBS Notes for Guidance (G.12 .1-2). whilst procedural service performed by trainees
Specialist and Physician Consultation items, for example, to be eligible for Medicare benefits MUST in
should be personally provided by that consultant even though a addition to these criteria be personally and
trainee might participate. continuously supervised in theatre by the
Procedures undertaken by trainees: …for procedural consultant.
services to bona fide private patients undertaken by procedural 6. There needs to be informed financial consent.
trainees, the supervising practitioner must be “present at all times Only you can determine the fee in each instance.
while the specialist trainee provides a medical service”. You cannot be directed by anyone as to the fee you
The billing practices of HCN are often the cause of mistakes determine either generally or in a particular case.
occurring with charging, including involving procedures 7. Remember YOU remain medico legally liable. You
undertaken by junior medical staff. Further, the Australian are only assigning income/billing not any potential
Medical Association (WA) is aware that practitioners have in the liability. The indemnity referred to above is exactly
past been requested by HCN or the hospital to assist in issuing that.
bills for patients treated years previously which raises a number of 8. Action by the employer seeking to induce
concerns. illegitimate cost shifting could result in
The Association has prepared a simple check list to ensure you misconduct and/ or fraud investigations.
do not expose yourself to potential fraudulent activities arising 9. If in doubt, seek independent written advice.
from the employer failing to seek such information as required in
a timely manner. This advice is general in nature. The full provisions are
For example, we understand that information had been sought set out in the AMA Industrial Agreement available on the
this year relating to procedures occurring in 2008, 2009, 2010, AMA (WA) website at www.amawa.com.au. Members with
and 2011. any queries should not hesitate to consult the Association,
If you answer NO to any of the questions below, decline to their IHLC Representative or Medical Defence Association
complete the billing form or ask HCN for more details. if they have any concerns. ■
Has the patient been given the choice to be public or private and if private, have you cited the election
1 Yes/No
form or other complying evidence of private election?
2 Has the patient received informed financial consent? Yes/No
3 Are you as the billing practitioner satisfied there is a valid referral in place? Yes/No
4 Did you as the practitioner personally perform the consultation and determine the item number? Yes/No
Did you either personally perform the procedure or anaesthetic being proposed to be billed in your
5 Yes/No
name or provide constant and personal in-theatre supervision of the trainee throughout the procedure?
Did you as the practitioner providing the service have the opportunity of assessing and notifying HCN
6 Yes/No
of the fee to be charged?
December MEDICUS 5
AMA
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home loan.
0.85%
AMA members receive a discount of up to on the
standard variable rate for home loans, investment home loans,
viridian lines of credit and portfolio loans.
Based on the current CBA rate of 6.60%*, this represents an approximate
annual saving of $4,250 on a $500,000 loan.
*Rate as at 12/10/2012
For more information about the AMA / CBA Wealth Package, contact:
Chris Kane at the AMA on 9273 3060 or [email protected]
Melinda Walker at the CBA on 9211 1701 or [email protected]
This exclusive offer is only available through the AMA (WA) and
CBA Premier Banking.
Commonwealth Bank of Australia ABN 48 123 123 124 and Australian Credit Licence 234945
nEWS
Mr Fix-it “While the
commissioning of FSH
for Fiona Stanley
occurs, the existing
clinical services
comprising SMHS have
The Chief Executive of the North Metropolitan Health to be both maintained
Service, Dr David Russell-Weisz has been appointed to the and redeveloped in line
job of delivering a fully-commissioned Fiona Stanley Hospital with clinical service
(FSH). plans. This is a body
The two-year role, after which he will return to his position as of work of significant
CEO of the North Metropolitan Health Service (NMHS), is a complexity and will
clear sign of just how important the delivery of FSH is as a flagship require increasingly
for WA Health. focused effort,” Mr
Australian Medical Association (WA) President Dr Richard Snowball said. Challenging: Dr David Russell-Weisz
Choong congratulated Dr Russell-Weisz on his appointment. He “For this reason has been given one of the toughest jobs in
health in Australia.
acknowledged the appointment as significant, albeit one that has I have taken the
come appallingly late to have an impact on planning for FSH. decision to separate the
“There has been growing concern about the progress of FSH commissioning of FSH from the day-to-day operations of SMHS
and we know the project is well behind schedule. The Health and the reconfiguration of the existing SMHS hospitals.” he
Department’s desired opening of the hospital in 2014 remains an explained.
elusive dream given that clinical involvement at this crucial stage As FSH CEO, Dr Russell-Weisz will “oversee and lead the
in the commissioning process remains so limited,” Dr Choong commissioning of FSH” and its incorporation within the SMHS,
said. expected in late 2014.
“The AMA (WA) has long expressed concerns about capacity Accepting the position, Dr Russell-Weisz thanked all staff at
in the WA Health System and while Fiona Stanley Hospital will NMHS for their efforts and dedication before assuring them of his
not completely rectify these ongoing issues, it is a positive step in return to the NHMS upon completion of the secondment.
the right direction. “I have accepted the above role acknowledging the significance
“Delivering a properly staffed and operating hospital is a huge of FSH’s successful delivery to the whole of the WA Health
job in today’s technical society. The AMA is confident that system,” Dr Russell-Weisz said.
Dr Russell-Weisz will deliver one of the best hospitals in Australia Dr Choong said the Government had given one of its best
that will be a testament to our role as leaders in national health,” performers one of the toughest jobs in health in Australia.
Dr Choong said. “The Association extends its unequivocal assistance to the
In appointing Dr Russell-Weisz to the newly-created role, the Health Department and Dr Russell-Weisz, in particular, as he
Director General of Health, Dr Kim Snowball also announced embraces the responsibilities of his new role in what are, without
that FSH would no longer come under the control of the South doubt, extremely challenging conditions. We wish him the very
Metropolitan Health Service (SMHS). best for a difficult job,” Dr Choong said. ■
Former Dr YES co-ordinator named Rhodes Scholar
On behalf of the AMA (WA), President Dr Richard Choong Katharine was awarded the WA Department of Health Prize in
has extended his congratulations to Public Heath for the highest mark in fourth-year
former Dr YES Coordinator Katharine MBBS in 2012. She completed her fifth year of
Noonan, who has been named one of studies last year at the Rural Clinical School in
Australia’s three Rhodes Scholars at Kalgoorlie, where she also volunteered for the
Large. Red Cross Soup Patrol and the Western Desert
Katharine (23) who has a passion for Kidney Health Project. Katharine also spent a
working with children and mental health month earlier this year working in paediatrics in
issues recently completed a Bachelor Tanzania.
of Medicine and Bachelor of Surgery “After finishing my studies at Oxford,
(MBBS) from the University of Western I want to return to Australia and establish
Australia. Katharine spent time as a government-funded training programs for
Dr YES Coordinator in 2009, and Dr professionals in mental health, that reach
Choong said it was a proud moment for throughout the country, making psycho-social
Well deserved: Katharine Noonan.
a member of the AMA (WA) team to assistance and medical care more accessible to
receive such an honour. children and their families,” she said. ■
December MEDICUS 7
nEWS
Driving a good
handover
Ag roup of doctors turning to a Formula 1 team to help
improve their clinical handover skills seems as far out
of left field as public health bosses taking a salary cut. Yet Dr
Ken Catchpole and his colleagues at the Great Ormond Street
Hospital in the UK discussed complex technical and team
dynamics with Ferrari’s Formula 1 team.
Dr Catchpole was in Perth recently to attend the Clinical
Handover Symposium to speak about his research in the field
of clinical transfers of care. Hosted by the Australian Medical
Association (WA) at the UWA Club, the evening began with a
welcome by Kim Snowball, Director General of the Department
of Health who chose the occasion to launch the WA Health
Clinical Handover policy. This policy is now available on the
Department of Health Circulars website (www.health.wa.gov.au/
circularsnew). A link to this site will also be on the AMA (WA)
website under Workplace Relations.
Also on the agenda were presentations by Professor Dorothy
Jones, Executive Director, Performance, Activity and Quality,
Department of Health; and WA’s Chief Medical Officer and
former AMA (WA) President, Prof Gary Geelhoed. RMO Dr
Precision: Ferrari’s Formula 1 team in action.
Maria McGill along with colleagues Dr Dhanvee Kandadai and
Dr Hannah Hessamodini discussed their recent research in WA However, as the organisation of healthcare has evolved, so have the
hospitals. requirements for effective handover.
A panel discussion featuring all the presenters as well as “If we don’t get it right, our patients simply won’t get the care
Meredith Walker from CNMO and Ingrid Thorniley from the or attention they need. Though this won’t always lead to disaster,
CHPO, rounded off the symposium. a poor handover can have a significant downstream impact on the
Dr Catchpole became involved in handover research at Great management of a patient, Dr Catchpole said.
Ormond Street Hospital, where his work in understanding Patients, he said, could experience many changes in their care
surgical safety found that the handover of patients from surgery to team over a day, and successive poor handovers could lead to
intensive care was one of the weakest links of the system. information becoming corrupted, changed or even lost.
“Since a handover is a transfer of responsibility, one of the most Echoing Dr Catchpole’s refrain, Professor Dorothy Jones said
important questions we first asked was ‘who is responsible?’”, Dr communication was key. And Prof Gary Geelhoed applied the
Catchpole said. significance of effective handover to the WA arena, recounting a
Dr Catchpole’s research found that when continuity of care couple of amusing anecdotes from his hospital rounds. Video of
was the responsibility of a small team who knew each other and the Symposium and the Power Point presentations delivered are
their patients well, transitions could be easy and spontaneous. on the AMA (WA) website under Workplace Relations. ■
Launch: Director General Kim Snowball announcing the release Game changing: Dr Ken Catchpole stressed the importance of
of the WA Health Clinical Handover policy. an effective clinical handover.
8 MEDICUS December