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tio Journal of the Australian Medical Association WA | August 2013 Volume 53 / Issue 7 | amawa.com.au
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Council
President
August 2013
Dr Richard Choong
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
Professor Bernard Pearn-Rowe
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 Service
Dr Cassandra Host 20
Dr Daniel Heredia
Dr Dror Maor
Ordinary Members
Prof Gary Geelhoed
Dr Stuart Salfinger
Dr Marcus Tan Cover Story:
Co-opted Members
Dr Steve Wilson AMA (WA) Charity Gala Dinner
A/Prof Frank Jones Awards, entertainment, fellowship
A/Prof Peter Maguire
Prof Geoff Dobb
Dr Cassandra Host
Dr Melita Cirillo
Dr Ian Jenkins
Prof Ian Puddey
Prof Gavin Frost
Dr Alexandra Welborn
Ms Lee Fairhead 16
Ms Tahira Bhatti
AMA (WA) Office
Executive Director
Mr Paul Boyatzis
Director: Industrial & Legal Health has a Postcode
Ms Marcia Kuhne Don’t underestimate the importance of the
Executive Officers
earliest years of life
Mr Michael Prendergast
Ms Christine Kane
Ms Clare Francis FEatU rES
Mr Gary Bucknall
14 Stirling Highway
Nedlands WA 6009
[phone] 05 The Value of Shared Values 51 New and improved
[email protected] Uncertainty reigns about what are Check out the revamped
www.amawa.com.au
the values of health AMA (WA) website
Medicus
33 Direct billing 58 A little bird told me…
Editor and Director of
Communications How to slam on the brakes The gains and drawbacks
Mr Robert Reid of social media
Deputy Editor
Ms Janine Martin
Advertising Inquiries rEGUL arS
Phone Mr Des Michael [phone]
Copy Submissions
Phone Ms Janine Martin [phone]
or [email protected]
02 President’s Desk 43 For the Record: 62 Travel
Services Dr Abby Harwood
03 From the Editor 64 Wine
Business Services Manager
Ms Noelle Jones 06 News 44 Clinical Edge 65 Food
Financial Services Manager
14 Industrial 47 Profile:
Mr John Gerrard 66 P hotography
Dr Jumoke Afolabi
Medical Products Manager
20 Cover Story:
MHer aAltnhth Tornaiyn Binogyatzis A MA (WA) 52 Opinion 68 M ember Benefits
& On the Town
Australia Manager Charity Gala Diner 54 AMA in the Media
Mr Geoff Jones 70 Classifieds
30 Research
55 Snippet
Professional Appointments
The publication of an advertisement, 35 Opinion 59 On the Shelf
article or inclusion of an insert does not & Positions Vacant
imply endorsement by the AMA (WA) of 40 Beyond Borders 60 Music
the views, service or product in question,
and neither the AMA (WA) nor its agents 61 Drive
will have any liability for any information
contained therein. August MEDICUS 1
PRESIDENT’S DESK
Patients will pay the price
for government’s folly
by Dr Richard Choong
AMA (WA) President
According to the recent National Health Performance unrealistic indexation are major contributors to an already-
Authority (NHPA) report, the number of patients who fraught situation.
are delaying seeing a doctor has risen. This has been attributed Keep in mind that more than 80 per cent of all services are
to cost concerns. still bulk billed in Australia; in WA, about 72 per cent of all
In some areas up to 13 per cent of adults with a long-term services are bulk billed.
health condition put off seeing a GP because of out-of-pocket The bulk billing rate reached a record high of 82.4 per cent
costs, underlining warnings from the AMA that holding in the March 2013 quarter, and there is evidence that patients are
Medicare rebates down until mid-2014 could come at the cost more likely to seek treatment when they do not face additional costs.
of patient health. A NHPA breakdown of patient health and access to care by
The delay, announced in the Federal Budget, is Medicare Local region found a strong
expected to save the government association between bulk billing
$664 million. But really, all the rates and use of GPs.
government is doing is risking By contrast, the NHPA
the incursion of greater cost – the found there was no particular
cost of patient health. correlation between how ill
There is no doubt that the a patient reported themselves
rising cost of healthcare is an to be, and their likelihood of
issue, but not all of Australia’s seeking treatment.
health-attributed costs are related The study indicates a
to medical care. In fact only 11 worrying trend among
per cent of overall health-related some patients to seek treatment
costs is associated with medical according to ability to pay rather than medical need.
care – the remaining 89 per cent is predominantly related to The report confirms that our GPs and specialists have
complementary medicines and other unproven therapies. worked hard to be accessible and to maintain affordability of
Over the past two decades, the Medicare rebate has slowly drifted health care, with no additional assistance from government.
up broadly in keeping with the Consumer Price Index (CPI). It seems almost perverse, given the findings of the NHPA
Yet the nature and delivery of care over that same period report, that the government has pushed ahead with its decision
has changed dramatically. These days, patients expect and to freeze Medicare rebates, which only adds to pressure on the
demand the very best of care with quality outcomes. To keep affordability of medical services.
up with expectation, clinics are offering an expanded range If the government wants the bulk billing rate to be increased
of services that was not available or even offered when the or even sustained for that matter, either the rebate has to
Medicare rebate was established. increase or the delivery of services decreases.
The days of the solo GP with a single receptionist are The community however, wants to maintain the increased
disappearing. Today we have multi-doctor practices with quality of services and improved outcomes. As a result, serious
practice nurses, multiple receptionists, managers and decisions need to be made. The very tenets of universal ‘free
computerisation within a regulated and accredited framework. healthcare’ need to be challenged.
Some clinics even offer in-house dieticians as well as podiatry The cost of healthcare delivery is enormous and this will
and psychological services, while others are co-located with continue to rise in tandem with the increasing costs of equipment,
physiotherapy, radiology and pharmacy services. investigations and management. It will soon become too difficult
Certainly the world of General Practice has changed and too expensive to sustain this mantra of ‘free healthcare’.
significantly over the past 20 years. Along with these changes So the primary challenge to the government will be not to
comes the considerable cost associated with delivering the sustain ‘free healthcare’, but maintain ‘accessible health care’.
services offered – think rising staff salaries, rents, living costs The community and ultimately, the patient will need to
and other overheads. consider if the promotion of bulk billing is still in their best
We can all appreciate the cost of living in Western Australia interest. I do not believe that ongoing bulk billing and the quality
has escalated. Figures released in July confirmed that Perth is of improvements is sustainable.
the most expensive city in Australia, the 10th priciest in the Unfortunately the Federal Government doesn’t share my
world and the most expensive in the Southern Hemisphere. view – it remains willfully focused on its path to save dollars –
So it is not an apology that the cost of seeing a doctor has at the detriment of quality patient care. ■
increased. However the inadequate Medicare rebate and its For more on bulk billing, see page 33.
2 MEDICUS August
FroM tHE EDItor
LOL
(Lobby out Loud)
to delete bad policy
When medical professionals speak with one voice, it is a Dr Miller gave the example that the Australian and New
voice that is hard to ignore. When medical professionals Zealand Surgical Skills Education and training (ASSET)
join with other professionals, our combined voice is impossible program cost $3280, the Care of the Critically Ill Surgical
for governments not to hear and to respond to. Patient course cost $2735, and a GP attending a Clinical
On 13 April this year the Federal Government, through then Emergency Management Program (CEMP) workshops could
Treasurer Wayne Swan, announced that as part of a “down face combined costs of over $3000.
payment” to fund the National Plan for School Improvement, “This education is mandatory for doctors to provide the best
(aka Gonski Reforms) self-education expense deductions would possible health care. This isn’t about receiving tax breaks, this is
be capped to a maximum of $2000. about patient safety,” he said.
The government’s initial plan was to cap expenses to the This press release, along with others, had an immediate impact.
$2000 limit from 1 July 2014 – and it used an undertone of Within a few weeks every organisation likely to be affected
‘rorts’ to justify its cash-grab. had made their concern and opposition known and within the
“Without a cap on the amount that can be claimed under this same timeframe, more than 70 professional organisations had
deduction, it’s possible to make large claims for expenses such met in order to plan an overall battle attack.
as first class airfares, five star accommodation and expensive The Scrap the Tax website was also one of the outcomes of
courses,” the Federal Government statement said. working together to both educate the general public and the
Seriously underestimating the impact of its decision on a media about the likely impact of the plan.
range of taxpayers, the government argued: “This is a targeted Social media was used extensively to generate support, a
reform and the majority of those with self-education expenses tactic that had particular impact within the medical world, especially
will not be affected by this change.” Doctors in Training who would have been seriously and egregiously
Unfortunately this original statement was little more than impacted by the changes.
general verbiage with almost no detail. It was no surprise In fact, the AMA(WA) can report that no other issue has had
therefore that the first reaction was confusion. such a dramatic impact in the social media world.
Once the detail became clearer, however, the level of disbelief By touching education, so vital to the career path of all
about the government’s strategy grew. medical professionals and therefore our health as society,
The response was immediately negative – combined with the government had in effect, taken on a very large and very
amazement that the government saw this key piece of support unified slice of the population.
for education as some sort of ‘rort’ that needed to be curtailed. Every press release and every effort by the government to
Almost the first professional membership-based organisations justify its actions and every statement of opposition from a
to respond was the Australian Medical Association, in particular variety of groups were tweeted and re-tweeted.
the AMA (WA). Pressure was also put on the Federal Opposition to declare that it
In a stinging press release circulated three days after the would reverse the proposal if it won government at the next election,
announcement, AMA (WA) Vice-President Dr Andrew Miller a promise it (almost) made, at least undertaking to review it.
said the plan was “desperate”, “ill-considered”, “pitiful” and And then the government retreated.
would “dumb down the health community”. In a face-saving move, the government said it would “defer”
“The government deserves to be loudly condemned for the plan and will now come into force on 1 July, 2015, a year
this sneaky move and we call on the Federal Opposition to later than originally announced.
immediately guarantee to reverse it if it wins government in Depending on the election result it would appear that this
September,” Dr Miller said. particular “reform” while not “dead and buried” is certainly on
“I have never seen a move that hits both patients and health its last legs as a policy proposal likely to be introduced.
professionals as hard as this so-called reform does. This move Of course now is not the time to give up, lift the pressure or
guarantees Australia will have a weaker health service and less even lighten up on the campaign.
knowledgeable doctors. All professional groups will keep the pressure on both the
“This Government and this Prime Minister should be Government and the Opposition – whatever their colour. But
condemned for such a negative move,” he said. Association members can be confident that their voice has once
Many doctors must do at least one course a year in order to again been heard – and heard clearly and stridently.
maintain their qualifications, however these courses can cost in Such is the value of the combined power of the voice of
excess of $3000, he said. our members. ■
August MEDICUS 3
www.tdl.com.au
www.tdl.com.au
FEatUrE
Mutually-agreed principles are important to assist
health practitioners work in concert, says Dr Don Coid
Af ew years ago, 1200 unnecessary
Words used by four Australian health organisations
deaths occurred at the Staffordshire to identify organisational values:
Hospital in central England over a five-
WA Health RACS RACP RACMA
year period. The subsequent Inquiry into this scandal identified
a story of terrible and unnecessary suffering of hundreds of Advocacy x
people who were failed by a system which ignored the warning Care x
signs of poor care and put corporate self interest and cost control Collaboration x x
ahead of patients and their safety.1 Commitment x
According to the report’s author, Robert Francis QC, the NHS Compassion x
needed to set out the system’s ‘common values’. The overriding
Diligence x
value being that the patient is put first and that everyone associated
Excellence x x x
with the NHS should be informed by this ethos.
Integrity x x x
Although this report (of yet another hospital disaster in
Leadership x
the western world) makes much of possible changes in work
Professionalism x x x
practices to improve care, the document is particularly
interesting for the emphasis that it places on the need to improve Respect x x x
hospital cultures, underpinned by commonly-held values. Service x
Little is known about the way in which hospital cultures Teamwork x x
and their concomitant value systems can be enhanced in a
RACS – Royal Australasian College of Surgeons
systematic and logical way. RACP – Royal Australasian College of Physicians
RACMA- Royal Australasian College of Medical Administrators
And it is truly bewildering that an English lawyer should
X = values espoused by health organisation
have to point out the supremacy of the patient as the focus for
care. Especially in a country that had lauded the contribution that specialist physicians in Australia have a different set of values
of the NHS to UK life as part of the Olympic Games opening to surgeons who might be working in the same organisation.
program. The recommendations continue on, to suggest that You may argue that the described values of surgeons and
NHS staff should enter into express commitments to abide by physicians are mutually consistent and makes no material
NHS values. difference to health care.
In Australia, there has been a flurry of recent activity to But this doesn’t really make sense, even considering the
identify values for health and professional organisations. WA differing technical skills sets of these doctors. Mutually agreed,
health has its own set2 – confirmed in 2008, as do, for example, beneficial values are important to assist health practitioners
the Australasian colleges of medical administration3, physicians4 work in concert, especially in difficult clinical situations.
and surgeons5. But such folk come to healthcare systems from a vast array
However, the adoption and discussion of health service values of technical and cultural backgrounds. It is impossible for
has not been a prominent part of health service activity during them all to share the same beliefs without undergoing an
my medical career of more than three decades. explicit process of information, education, self examination,
I first became aware of this practice in the early 1990s. reinforcement and review.
But I rarely hear any discussion of values in day-to-day work. Getting these into the hearts and minds of the workforce
Corporate values are not always arrived at by a discussion with of health organisations should be the principal task of chief
staff. But some doctors have told me that by virtue of their executive officers and the most senior professional leaders.
medical training, they have absorbed the necessary values to The current uncertainties in what are the values of health
practice. If they have done so, they are rarely explicit about means we are still a world away from seriously working in
what their values are! sustainable, optimally-beneficial hospital cultures. We need to get
Groucho Marx said: “Those are my principles, and if you there, as a guarantor of avoiding ‘a Staffordshire in Australia’. ■
don’t like them...well, I have others.”
References:
I don’t suppose he foresaw the range of values that health
1. Report of the Mid Staffordshire NHS Foundation Trust Public
organisations might adopt. In the four organisations mentioned Inquiry. HMSO, London 2013
2. WA Health Code of Conduct, 2008
above, the RACP and RACMA have four stated values; the
3. RACMA core values: http://www.racma.edu.
RACS has nine while WA Health has six. They are all about au/index.php?option=com_docman&task=cat_
good things – refer to the table. view&gid=77&Itemid=154Our values
4. The RACP’s Organisational Values: RACP News 31,(6), 2011
The table identifies 13 praiseworthy values espoused by the four 5. http://www.surgeons.org/about/#values
health organisations. These data, amongst other things, identify August MEDICUS 5
nEWS
Medical professionals and other supporters of the and the impact it has on thousands of Australians every year.
Tonkinson Foundation met over a gala dinner recently to “Bowel cancer is the second most deadly cancer in
remember the impact that bowel cancer has on many in the West Australia…Research is the key to saving lives,” Dr Levitt said.
Australian community and the importance of further medical A recipient of a Centenary Medal in 2003 for service to public
research to save lives. education about colorectal cancer, Dr Levitt spoke of the many
The Tonkinson Foundation for Colorectal Cancer Research patients he had assisted in their battles against the insidious disease.
was founded in 2009, with the aim of enhancing the treatment Dr Nikolajs Zeps, Adjunct Associate Professor in the Colorectal
and improving the lives of people with colorectal cancer. Cancer Research Unit at the University of WA also spoke about
Each year across Australia, over 13,000 new cases of some of the research he is involved in. Importantly Dr Zeps
colorectal cancer are diagnosed, more than one third of whom is also Chair of the Cancer Biology Group for the Clinical
will ultimately succumb to the disease. Oncology Society Australia and member of the Research and
Established from the estate of two generous Western Data Advisory Committee of Cancer Australia.
Australians – Jean and John Tonkinson – the Foundation aims to About the Tonkinsons
better understand the nature of this deadly disease and find ways Jean and John Tonkinson agreed decades before their
to treat it more effectively through ethical, cutting-edge research. passing that they would commit their entire estate to establish
The Foundation also has as a major aim to raise awareness of a foundation for medical research for the benefit of Western
the impact of this disease amongst the WA community. Australians.
With former broadcaster Verity James as Master of John Tonkinson was 66 when he died of abdominal sarcoma
Ceremonies for the evening, the audience heard from a dynamic in 2000. Seven years later, Jean was diagnosed with advanced
young woman, Ashlin Fong, who had suffered from the disease. colon cancer and sadly passed away in 2008 at the age of 66, less
With her parents and fiancée in the audience, Ashlin told of than 12 months from when she was first diagnosed.
how, mainly due to her young age, she had not been diagnosed Their decision to make such a substantial gift to establish a
as early as she could have been and her successful journey to research foundation is a measure of their belief in the importance
battle the disease. of medical research and ongoing medical education. ■
The dinner, held on Ashlin’s birthday, also heard her positive For more information about the Tonkinson Foundation or for
message for others who are battling Colorectal Cancer. more information about colorectal cancer, please go to:
Dr Michael Levitt, a colorectal surgeon and Chair of the http://www.sjog.org.au/hospitals/subiaco_hospital/research/colorectal_
Foundation, also spoke about the insidious nature of the disease cancer/tonkinson_foundation.aspx
Finding cancer’s ‘Achilles Heel’ may save lives
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nEWS
Doctors are being forced to waste hours every week that could practitioners to obtain authority from the Department of Human
be spent with patients, waiting for government bureaucrats to Services to prescribe them.
answer phone calls under the Federal Government’s cumbersome Under the system, doctors phone the Authority Freecall service,
prescription authorisation rules. where an administrative officer decides if they can have the
An AMA survey has found that around 17 per cent of family necessary authority.
doctors seeking permission to prescribe certain medicines have to But the evidence shows that it has little effect on prescribing behaviour.
wait 10 or more minutes a day to get through to a Department of In 2008-09, 6.4 million calls were made to the Authority Freecall
Human Services clerk, while 3 per cent reported having to wait half Service, of which only 2.8 per cent did not result in an authority
an hour or more every day. being provided.
Overall, it is estimated that the time spent by doctors on the A Department of Health and Ageing review in 2009 showed that
phone waiting for authority prescription approval is equivalent to “there were no substantial changes relative to historical growth trends
more than 25,000 consultations a month. observed in either total script volume or total PBS outlays” from
The system was set up to control the use of certain types of moving PBS authority medicines to streamlined arrangements.
dangerous or addictive medications but, following evidence that it In its 2009 review of the regulatory burden on business, the
was overly burdensome and prescriptive, the list was trimmed from Productivity Commission recommended that the system be axed,
450 to 200 items in 2007. and AMA WA President Dr Richard Choong said it was time for
But the AMA said that even in its more streamlined form, the Government to act on this advice.
PBS Authority system created significant extra work for doctors “There is no excuse for such red tape,” Dr Choong said. “Time spent by
with no demonstrable benefit to patients, and should be scrapped. family doctors waiting on a phone line is at the sacrifice of patient care.”
Drugs for cancer treatment, palliative care and pain He said the government could easily make a significant
management are among more than 100 medicines on the improvement in the productivity and efficiency of the medical
Pharmaceutical Benefits Scheme (PBS) that require medical workforce by terminating the system. ■
Make Health Star Label System mandatory: AMA
AMA WA President, Dr Richard Choong said that the Federal “Governments must now bring the industry into line by making
and State Governments should make health star ratings for the system mandatory.”
packaged food mandatory following moves by the Australian Food Dr Choong said more and more people are at high risk of
and Grocery Council (AFGC) to sabotage an important weapon serious disease and premature death from the obesity epidemic in
in the war against obesity. Australia.
Dr Choong said the AFGC has withdrawn its support for the “Tackling the high rates of overweight and obesity in Australia
voluntary health star rating system, which was adopted by Food and requires a range of measures, including improving our patterns of
Health Ministers in June after years of development, claiming high food and drink consumption.
costs and rating anomalies. “Consumers must be empowered to identify and choose healthy
“It is highly irresponsible for the food industry to walk away from food, and research shows that the health star rating system is an easier
the new system at this late stage,” Dr Choong said. and more effective way to improve consumer choices.”
“The AFGC has been heavily involved in discussions with According to the Australian Health Survey:
governments and public health advocates for more than 18 months • In 2011-12, 62.8 per cent of Australians aged 18 years and ov er
and has had plenty of opportunities to voice any concerns they may were overweight or obese (35.3 per cent overweight and 27.5 per
have had. cent obese); and
“The uncooperative food industry is clearly putting profits ahead • The prevalence of overweight and obesity increased in Austral ia
of public health by undermining a voluntary system it helped to put in place. from 56.3 per cent in 1995 to 61.2 per cent in 2007-08. ■
Better Chronic and Complex Disease Plan
The AMA is urging the Federal Government to improve care for patients “It provides patients with streamlined access to a broad range of
with chronic and complex conditions by giving them more time with allied health and other support services, and it supports a more proactive
their GPs and improving coordination of health and support services. approach to the delivery of care.
AMA President, Dr Steve Hambleton, said the AMA’s Chronic “Chronic disease is estimated to be responsible for around 80 per cent of the
Disease Plan: ‘Improving Care for Patients with Chronic and Complex total burden of disease and accounts for 70 per cent of health expenditure.
Care Needs’ sets out ways to improve the treatment of people with “Chronic disease must be well managed and coordinated to reduce
complex and chronic disease in primary care. its effect on patients’ health and wellbeing.
“The AMA plan offers patients with multiple chronic conditions and “Family doctors are highly-trained general health specialists, and are
related complex care needs, improved access to GP-coordinated quality in the best position to ensure patients with chronic and complex diseases
primary care,” Dr Hambleton said get the care they need.” The AMA Chronic Disease Plan: Improving
“The plan enhances existing arrangements, and supports patients to Care for Patients with Chronic and Complex Care Needs is at http://
spend more time with their family doctor when they need to. ama.com.au/node/5519. ■