Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
THE OFF ICIAL JOURNAL OF THE GOLD COAST MEDICAL ASSOCIATION INC NOVEMBER/DECEMBER 2011 ISSUE # 079 6 Gold Coast Conference marks ‘Coming of Age’ 14 Management of Pneumonia in Children Outside of Hospital 19 Financial Spotlight 36 Loooking through the Lens Dr John Corbett shares his love of photography Images available to download for ‘getaway’ screensavers CONTENTS GCMA NEWS Advertising & Editorial enquiries: Ingrid Meehan Medical Editorial Committee: Drs Peter McLaren, Geoff Adsett, Margaret Kilmartin and Philip Morris Graphic Design: Heather Gillard Printing: Beaudesert Times The off icial journal of The Gold coasT Medical associaTion inc NOVEMBER/DECEMBER 2011 ISSUE # 079 6 14 19 36 Gold Coast Conference marks ‘Coming of Age’ Management of Pneumonia in Children Outside of Hospital Financial Spotlight Loooking through the Lens Dr John Corbett shares his love of photography Images available to download for ‘getaway’ screensavers November/December 2011 Cover pic: The inaugural Gold Coast Medical & Health Sciences Conference 2011. On behalf of the GCMA, The Medical Link is designed & published by: John Campbell Communication & Marketing P/L. Back issues can be accessed on the GCMA website www.gcma.org.au/themedicallink ABN 95 073 940 600 PO Box 5170, Gold Coast Mail Centre, Queensland, 9726 Telephone: (07) 5575 7054 Facsimile: (07) 5575 7551 Email: [email protected] It is the advertiser’s responsibility to ensure that advertisements comply with the Trade Practices Act 1947 as amended. All advertisements are published on the condition that the advertiser indemnifies the publisher and its servants against all claims, suits, actions, loss and/or damages as a result of anything published on the advertiser’s behalf. DISCLAIMER: The contents of articles and opinions published are not necessarily held by the publisher, editor or the Gold Coast Medical Association. No responsibility is accepted by the publisher, editor or Gold Coast Medical Association for the accuracy of information contained in any opinion, information, editorial or advertisement contained in this publication and readers should rely upon their own enquiries in making decisions touching their own interest. Unless specifically stated, products and services advertised or otherwise appearing in The Medical Link are not endorsed by the publisher, editor or the Gold Coast Medical Association. 2 the medical link Next Clinical Meeting ............................................................................................................3 Executive Committee ............................................................................................................3 Advertise in the Medical Link Journal ....................................................................................3 Membership Benefits ...........................................................................................................3 Editorial Submissions ............................................................................................................3 VIP Syndrome ........................................................................................................................4 Obituary – Dr Max Henry Williams .........................................................................................4 Senior Active Doctors Category ............................................................................................5 September Meeting ..............................................................................................................5 NEWS Gold Coast Conference Marks ‘Coming of Age’ ..................................................................6 Euthanasia .............................................................................................................................8 Eye Clinic Team Prepares For Another Mission .....................................................................8 At Risk of Transferring a Genetic Disease? .........................................................................11 Delusions or Illusions and the Personality Disorders ..........................................................13 Management of Pneumonia in Children Outside of Hospital ..............................................14 Gut Microbiotica and our Immune System – We are what we eat .......................................15 Glaucoma............................................................................................................................16 Financial Spotlight ...............................................................................................................19 Hereditary Haemochromatosis with Elevated Serum Ferritin Levels ...................................21 Tips For Surviving Christmas ...............................................................................................22 Call For Volunteer Dr’s For Australia’s First Beach Medical Practice ...................................24 2012 – AMR’s 25th Anniversary ...........................................................................................24 Poor Sperm DNA Decreases Pregnancy Success .............................................................26 You don’t say? Patient-Doctor Non-verbal Communication Says a Lot. ..............................28 Medical Transcription for an Efficient Practice.....................................................................30 Why Patients Seek Second Opinion after Technically Successful Cataract Procedures .....31 EDUCATION & TRAINING Bond University ...................................................................................................................33 HOSPITAL UPDATE Gold Coast University Hospital............................................................................................34 Pindara Private Hospital ......................................................................................................35 Allamanda Private Hospital ..................................................................................................35 HEART BEAT Looking Through the Lens ..................................................................................................36 Robert Hitchins’ Book Review .............................................................................................37 Remember When ................................................................................................................37 Heart Beat Events ................................................................................................................38 Puzzle Corner ......................................................................................................................38 Advertisers Websites ...........................................................................................................38 Advertising of medical services in The Medical Link should comply with the same advertising guidelines recently released in the Medical Board of Australia Code of Conduct. These state that advertising by medical practices should: • Be factual and verifiable • Only make justifiable claims regarding quality and outcomes • Not raise unrealistic expectations • Not offer inducements • Not make unfair or inaccurate comparisons between your services and those of colleagues A NOTICE TO MEDICAL LINK ADVERTISERS Medical Link advertisers should comply with these guidelines NOVEMBER/DECEMBER 2011 - issue # 079 GCMA News Executive Committee PRESIDENT Dr Peter McLaren (07) 5532 3667 PAST PRESIDENT Prof Philip Morris (07) 5532 7655 GP VICE PRESIDENT Dr Margaret Kilmartin (07) 5575 7054 SPECIALIST VICE PRESIDENTS Dr Stephen Weinstein (07) 5519 8319 Prof Laurie Howes (07) 5575 7054 SECRETARY/TREASURER Dr Geoff Adsett (07) 5578 6866 HONORARY MEMBER Honorary Member Dr Claire Cuscaden RMO Association (07) 5575 7054 POSTAL ADDRESS PO Box 2163, Southport, Queensland 4215 Attention Members The GCMA Clinical meetings are being held in the Rex Lounge, Radisson Resort, Palm Meadows Drive, Carrara followed by a seafood buffet in the hotel restaurant. There are guest speakers delivering current topics of interest. Be sure to look out for email and fax communications for meeting dates to ensure your place. SPACES LIMITED – RSVP’s ESSENTIAL Phone: 5575 7054 or [email protected] There is no cost for attendance by members. Non-members are required to join GCMA. * CME/CPD/MOPS points available NOVEMBER/DECEMBER 2011 - issue # 079 Advertise in the Medical Link journal The Medical Link journal is the official journal of the Gold Coast Medical Association and is distributed every second month. If you would like to advertise your products or services, positions vacant, rooms for rent etc, in the Medical Link journal, please contact (07) 5575 7054 or [email protected] For advertising rates or previous issues, visit the website www.gcma.org.au/medical-link.html Membership Benefits The annual membership fee for 2012 is $100 plus gst. For those organisations with five or more doctors in-house, a special membership category is available which represents 25 percent discount on the individual membership rate for each doctor nominated. All those nominated within this category will be entitled to full membership benefits including invitations to monthly sponsored dinner meetings; priority for editorial in The Medical Link journal; a free entry in the Membership Directory; and an invitation to an end-of-year function to include their partners. Visit www.gcma.org.au to download membership application/renewal form. Editorial Submissions I would like to personally invite all financial members to submit articles to our Medical Link journal. Our journal goes out bi-monthly to all Gold Coast doctors. Our main requirements are for it to be in your area of clinical expertise, of general interest to our members and not a form of ‘advertorial’. Images (photos and illustrations) are encouraged. I would especially like to see some vignettes on medical practice as it was on the ‘Coast 20-30 years ago. We also welcome articles on your leisure interests eg cars, travel, music, sports, books, movies, etc. There is a journalist available to assist you with composition, if required. For further details, contact The Secretariat on 5575 7054 or email [email protected]. Dr Peter McLaren, GCMA President the medical link 3 GCMA News VIP Syndrome By Dr Peter McLaren (continued from the Medical Llink Sept/Oct issue) The main reason that people strive to get to positions of power, prestige and fame is their personality. Traits found in these people include narcissism, sociopathy and a wish to be in control. Their position may also have allowed these traits to flourish. In hospital, they may be subject to loss of prestige, power, autonomy and privacy. The specific problems related to their care can include: • History taking and physical examination may be less thorough • There may be excessive or fewer diagnostic tests • They may be over-treated or under-treated • The usual confidentiality rules may be waived • There may be too many or too few people involved in their care • Care may be by the highest ranking clinician rather than the most qualified • Self-indulgent demands may result in substance abuse. They also affect the staff and facility they attend. The clinicians treating them may be subject to: • The temptation to divulge information to increase their own personal status • Being star-struck and succumbing to the patient’s strong personality • Sharing their decision-making too much Obituary Dr Max Henry Williams 6th November 1940 - 28th September 2011 By Dr David Lindsay B When Max became a JRMO at Sydney Hospital in 1964, after graduating from the University of Sydney Medical School, I was a Pathology Registrar and unofficial coach of the interhospital Rugby team. Max became an integral part of both teams immediately, endearing himself to doctors, lift operators, porters, nursing and all manner of personnel. He obviously impressed the doyen of physicians and member of the Board of Censors of the Royal Australasian College of Physicians, Dr Alan McGuinness, as, in 1967 he was chosen from amongst his peers, to be Fellow in Gastroenterology, by ‘Mac’. In the same year he became, by examination, a Member of the Royal Australasian College of Physicians (MRACP). Six years later, having worked as a Fellow in Medicine and then Neurology Registrar at “RPA”, 1968-70, then as Clinical Research Associate, in the Department of Neurology, University of Newcastle-upon-Tyne, England,1970-72, he was elected to Fellowship of the RACP. In 1973, at the invitation of one of his Sydney Hospital physician colleagues, he returned with his young, still growing family to Goulburn, country NSW. He was to practice there, as a (the) physician-Neurologist for the region, until moving to the Gold Coast in 1998. Max then based himself at the Gold Coast Hospital as a Senior Staff Specialist Physician-Neurologist, but also practised at Pindara and Allamanda Private Hospitals; his expert opinion on headache, in particular, was widely sought and appreciated by both colleagues and patients, who wondered at, and secretly admired, his love of acronyms; who can forget SUNCT? Max was ‘king of the acronym’. His company, his joie-de-vivre, and the wisdom generated by his vast clinical and life experience, was enjoyed by his wife Lyn, and his extended family and friends, who also knew him as a jazz lover and afficianado, and green-fingered, avid gardener. Max taught and mentored young graduate doctors, and more recently undergraduate 4 the medical link Other staff may: • Be tempted to divulge information and collect souvenirs • Resent the increased workload and the lack of fairness if other patients are disadvantaged • Either give less than or more than normal contact Other patients may also object to loss of staff attention, loss of privacy or resent the V.I.P. ‘jumping the queue’. Some of the positives for the health facility itself include free publicity from bathing in the media spotlight and the promise of future donations. However, some of the negative effects include: • Increased staffing levels or workload • Decreased staff morale • Treating the politician or health administrator as a V.I.P. may prevent feedback going back into the system to those best-placed to effect change. The community might benefit from greater awareness of the particular disease and increased funding. Kylie’s breast lump increased breast cancer awareness tremendously as did Delta Goodrem’s Hodgekin’s lymphoma and Michael J Fox’s Parkinson’s disease. More on V.I.P. patient syndrome with doctors and their relatives as patients in the next ‘Medical Link’. medical students, and imbuing them with the same enthusiasm and compassion he had witnessed and developed at Sydney Hospital as Registrar for ‘Mac’, and at RPA where his equally impressive mentor was Dr John Allsop. All this from a boy who grew up in Sydney’s west, in Parramatta, adjacent to Cumberland Oval, home ground of his beloved Parramatta Eels, and where Max attended the local selective State High School (Parramatta Boys High). Unsurprisingly he was a School Prefect, and member of the 1st 15 (Rugby –not League) in his final year. In 1958 he attended Sydney University, first as a Veterinary Science student but, fortunately for the medical profession and his patients, he changed to the Medical Degree course, having successfully completed only Year one as a ‘vet’. His career ended here at the Gold Coast but not before he had endeared himself to another group of patients and colleagues, and established, and became the Director of, a Stroke Unit at the Gold Coast Hospital, the first in the region. Soon after his death Lyn travelled alone to London to personally unveil on October 30th, at The Royal Society of Medicine, an Honour Roll upon which Max’s name has been recorded for posterity, a fitting tribute to an excellent clinician, good friend, and a genuinely good man. His colleagues at the Gold Coast Hospital and Gold Coast Medical Association will miss him a lot! We offer our condolences to Lyn, his indefatigable wife, and their extended and loving family of children and grandchildren. NOVEMBER/DECEMBER 2011 - issue # 079 GCMA News Senior Active Doctors Category By Professor Philip Morris Dear Colleague, We have a concerning situation regarding older doctors who wish to give up full time practice but who want to continue to contribute to the profession as ‘senior active’ doctors. I have written a proposal below that addresses this issue. I would be very grateful for your support for this proposal, or if it is not acceptable in its current form, I would appreciate you suggesting changes that would meet with your approval. Medical careers, like the human life cycle, have a start, a middle phase, and a finish. Following a prolonged gestation of training, practitioners move on to their general practice or specialist disciplines and provide clinical care to patients, education and training to junior colleagues, and administrative support to hospitals and other medical organisations over decades of hard work. At some stage the doctor starts to think of slowing down, or contemplates full retirement. These days we know that moving from full time practice to full retirement in one step is not a good thing – for the practitioner’s physical health and mental health, and not for the profession either. Government policy is to encourage older workers and professionals to stay in the workforce longer, beyond current retirement age if possible. Yet, despite this encouragement for older professionals to remain active in their field, in the medical arena we have a situation that is hostile to this happening. The new Medical Board of Australia (MBA) has no registration category that allows older doctors to remain registered after giving up full time general or specialist practice. Older doctors are forced to go straight into full retirement. They are prevented from continuing to practice in a limited capacity as a doctor. This situation denies senior doctors the advantages of a graduated progression to retirement. It also means that these doctors cannot use their accumulated medical knowledge, skills and wisdom for suitable work such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/business organisations on medical matters, as well as being a body of registered practitioners available to assist in times of local, state and national disasters. This denies the community a precious medical resource that otherwise would be available. It is time this gap was filled. A new category of medical registration – termed ‘senior active’ – needs to be developed by the MBA. I propose the following model for the ‘senior active’ category. The description is based on the MBA Limited Registration – Public Interest category (MBA Registration Transitional Plan – Medical Practitioners – Item 17, 30.6.10). 1. Senior active registration would be a limited class of registration, but it would have unlimited duration. 2. The doctor would remain on the register of medical practitioners. 3. The doctor could participate in activities (either remunerated or as a volunteer) that use his or her medical knowledge, skills or wisdom outside the care of individual patients such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/ business organisations on medical matters, as well as being available to assist in times of local, state and national disasters. 4. The registrant may, without fee or reward, refer an individual to another medical practitioner (in fully registered medical practice) for the purposes of providing health care. The registrant may, without fee or reward, prescribe a therapeutic substance in extenuating or emergency situations under the following conditions: (a) the prescription involves the renewal of a prescription provided by another medical practitioner (in fully registered medical practice) within the previous period of six months and does not relate to a drug of addiction within the meaning of the relevant Poisons act, or (b) the prescription is provided to an individual who requires temporary relief or first-aid pending attendance on that individual by another medical practitioner (in fully registered medical practice), and (c) if the registrant undertakes limited prescribing as outlined in (a) and (b) above, the registrant must, within a 12-month period NOVEMBER/DECEMBER 2011 - issue # 079 preceding the date on which the prescription is prescribed, have undertaken professional education activities relating to the prescribing of therapeutic substances. 5. Maintenance of this category of limited practice would require an annual medical check by a general practitioner for registrants over the age of 80 years. A category of this nature would allow senior doctors to continue to contribute to the profession after leaving full time general or specialist practice. This would be good for senior doctors, the profession, and the community. This category allows doctors the limited capacity to refer individuals to other medical practitioners, and a limited capacity to prescribe therapeutic substances. It is possible that the doctor could exercise discretion and use this limited capacity to prescribe for him or herself, or for immediate family. This level of discretion is available to all doctors in fully registered medical practice despite the general advice from the AMA and medical boards that doctors should not treat themselves or their immediate family except in emergency or extenuating circumstances. Given the limited nature of referral and prescribing allowed in the senior active category, and the requirement to undertake relevant professional educational activities in prescribing, I cannot see any reason to deny this discretion to senior active doctors. To do so would raise the question of age discrimination. In my view the success of the category will depend on how restrictive the practice definition is and how much it will cost doctors to be registered in this category. The three major costs for this category will be the medical board registration fee, the indemnity insurance fee, and professional education expenses. If the total of these can be kept within reason (say well below $500pa) then the category may be an attractive place for senior doctors to maintain their registration after leaving full registration status in their discipline and before moving to full retirement. Your comments would be appreciated. Prof Philip Morris can be contacted on 5532 7655 September Meeting Guest speaker at the GCMA September meeting was Ophthalmologist, Dr John Kearney. His most interesting topic was ‘Decade of Success in Eyes and Australian Foreign Policy in East Timor’. Dr Kearney has worked extensively throughout Australia and overseas and is committed to helping patients in disadvantaged and Third World Communities. As a member of the Mercy Ships and the Pacific Island Projects, he has travelled extensively performing cataract and other surgery, giving lectures and assisting with skills transfers. Additionally, he has worked with Aboriginal and Torres Strait Islander health services on the Gold Coast, in Western Australia and the Northern Territory as part of the National Trachoma and Eye Health Program established by Dr Fred Hollows, as well as taking part in the Dili (East Timor) Eye Clinic with the International Red Cross and World Health Organisation. The meeting was proudly sponsored by Accountants and Business consultants, SkinnerHamilton, a local familyowned firm that is fast becoming a leader in accounting and business advisory services on the Gold Coast. (l-r) Melissa Skinner (Skinner Hamilton), Dr John Kearney, Chantell Badenhorst (Skinner Hamilton), Dr Peter McLaren, GCMA President and Jason Skinner (Skinner Hamilton). the medical link 5 Conference News Gold Coast Conference marks ‘coming of age’ The inaugural Gold Coast Medical & Health Sciences Conference held on October 28 – 29 marked a ‘coming of age’ of the Gold Coast in the fields of medicine and health sciences. Conference Convenor, Prof Philip Morris, said that with two established and well-recognised medical schools and health science facilities and the opening next year of the Parklands University hospital, the collaboration which was established to plan and present the conference was timely. There were four Breakout Sessions during the two day conference “As convenor, it was a great privilege to open this inaugural Medical and Health Sciences conference,” said Professor Morris. It marks another stage of our regional growth in the fields of medicine and health sciences with high quality clinical services operating from public and private hospitals, and from specialist consulting rooms and general practices across our district. “The pace of change has been dramatic – who would have contemplated all these things just 10 years ago? Prof Philip Morris, Dr Stephen Weinstein and Prof Mohamed Khadra The conference was a collaboration between Griffith University, Bond University, Queensland Health Gold Coast District, and the Gold Coast Medical Association. Professor Morris said that the combined effort reflected in the high quality of the scientific program covering a range of educational, research, clinical, and service delivery topics. Dr Mark Courtney, Mr Chris Leskew, Dr Stephen Markey and Dr Allan Friend “The success of this conference will set a template for making the Gold Coast a medical education tourism destination into the future. “No meeting is organised in a vacuum. Money and effort are required. Mrs Maja Khafaji, Dr Mohamed Khafaji and Bruce Richards (NABhealth) Dr Margaret Kilmartin, winner of the City Fertility luck prize giveaway pictured with Karen Cleaver (City Fertility) “We thank our conference partners Bond University, Griffith University, and Queensland Health for their support as well as our five major sponsors for their support – John Flynn Prof Mohammed Khateeb, Mrs Sarah CentenoKhateeb and Mrs Helen Planting Robbie Falconer and Narelle Morrison (Pindara) with Dr David Lindsay Uncle Graham Dillon delivering the Welcome to Country address Establishing the Future of Gold Coast Medicine & Health The Evolving Centre of Excellence in Education, Research & Clinical services 6 the medical link NOVEMBER/DECEMBER 2011 - issue # 079 Conference News Hospital, Pindara Hospital, Allamanda Hospital, Specialist Risk Solutions, and the Gold Coast Convention Bureau. We also thank BreastScreen Queensland for their support, the many other exhibitors over the two-day event, and, of course, the keynote speakers, symposium and workshop presenters and those who presented free papers and posters.” Dr Robert Hitchins said that the conference compared favourably with any conference he had attended. Prof Peter Henderson, Dr Peter McLaren, Barista and Mr Chris Leskew (Specialist Risk Solutions) Dr Kavita Chandra, special guest from the Fiji College of General Practitioners and Dr Stephen Weinstein, Program Director Dr Lis Weinstein, Norma Swain and Matthew Sturt (Gold Coast Convention Bureau) Amanda Clark (Great Ideas in Nutrition) with Suja Pillai, Griffith Medical Student Dr John Kearney and Prof Laurie Howes Prof Gordon Wright and Mrs Naomi Wright Dr Paul Bennett, Denise Cutajar and Michael Cutajar (Medeleq) Dr Stephen Weinstein, Martin Wiltshire (Risk Key Business Insurance) Prof Alfred Lam, Ms Melissa Leung “I have been attending medical conferences for more than 30 years, all over Australia and at many locations around the world. The programme, the venue and the catering of this Gold Coast conference were excellent and the convenors and organisers deserve hearty congratulations. “The variety of material covered in the academic program was impressive and the quality of the presentations reflected well on the local clinicians and researchers involved. The visiting speakers were all good and their contributions were all worthwhile but the local speakers more than held their own. The balance between local and visiting presenters was good. “We can be proud of our first Gold Coast Medical Conference with the poor attendance by local practitioners being the only sour note. Hopefully, the non-attenders will be inspired to attend next time when this conference is repeated,” he said. Abstract submitted by Paul Laurence Chantell Badenhorst and Jason Skinner (Skinner Hamilton) with Simon Moore (Investec) Abstract submitted by Caitlin Milligan Abstract submitted by Dr Frauke Warnke NOVEMBER/DECEMBER 2011 - issue # 079 the medical link 7 News Euthanasia By Dr Peter McLaren Euthanasia means a ‘good death’ , an achievement we all hope for when our time comes. What constitutes a good death? The choice of time? The choice of environment? The choice of company? The absence of things unsaid? The absence of pain and suffering? The retention of one’s dignity? There is a move underway to alter the laws on one type of euthanasia; that of medically-assisted suicide. The Northern Territory was the first province in the world to legalise voluntary euthanasia using medicallyassisted suicide. Four people took advantage of these laws, the first being Bob Dent. He used a computer controlled suicide machine designed by Dr Philip Nitschke, a long-time campaigner for the right of the terminally-ill to decide the timing and manner of their own death. They all suffered from terminal cancer. They all had good palliative care. They were all certified by two psychiatrists as not depressed at the time. Bob Dent was supportive of and grateful for the efforts of Dr Nitschke. Then the Federal Parliamentarian, Kevin Andrews introduced a private members Bill into the Australian Parliament which overturned the Territory’s legislation. Bob Dent had made a statement at the time of his death that was quoted in parliament: “If you don’t agree with voluntary euthanasia then don’t use it, but don’t deny me the right to use it if and when I want,” This is in keeping with the philosopher, John Stuart Mills’ famous ‘harm’ principle: “The only purpose for which power can be rightfully exercised over any member of a civilised community against their will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” The objections to changing the present legislation include the possibility of abuse of the laws by those with aged and infirm relatives, the ‘thin end of the wedge’ argument that the law will eventually include those that are disabled, that doctors should only be involved in preserving life and the religious stance that it destroys the principle of the sanctity of life. The Northern Territory laws in principle and in practice did not allow for the first two objections so maybe that legislation could be built upon. Medical hastening of death has been shown to be already quite common, occurring covertly and outside any legal structure. Surely that situation is equally prone to abuse? The fourth objection; that of: ‘sanctity of life’ has problems. Firstly, some members of our community are not religious. Also, medical advances now have the ability at times to prolong life and prolong suffering that may be both inappropriate and already ‘playing God’. Ultimately, there are those who, like Dylan Thomas, ‘Rage against the dying of the light’ whereas others feel that ‘an old man greets death the way a young man greets sleep.’ I feel that the choice of the individual should be part of any future legislation. (I do welcome any who have something to add to this important discussion to submit their own thoughts to [email protected]) PROVIDING VASECTOMIES SINCE 1993 PERFORMED IN OUR SURGERY UNDER LOCAL ANAESTHETIC DR GREG ANDERSON 5530 2822 www.goldcoastvasectomy.com.au Suite 5 ‘Bell Place’, Cnr Bell Place and Link Way MUDGEERABA Eye Clinic Team Prepares For Another Mission A local eye doctor continues to make a difference to people’s lives overseas. Having performed 72 eye operations in East Timor in July, Dr John Kearney and his team are now preparing to go to Micronesia in January to conduct similar procedures there. Dr Kearney, with Sister Barbara and his team, have been going to East Timor as part of the East Timor Eye Program for over a decade. Over 4,000 operations have been performed there, including cataracts and childhood eye diseases by different teams from Australia. “The plan is to keep returning and operating in East Timor until all the necessary work is done,” he said. “We are training up a local doctor in various procedures, with the aim that by 2020, the system will be self-sustainable. “We also have an optometry team in place, ensuring glasses are provided to the population.” Dr Kearney said the changes he had witnessed over the past decade in East Timor had been incredible, particularly in the past few years. 8 the medical link Dr John Kearney and his team “The chooks and pigs are finally out of the hospital yard and they are growing vegetables in the hospital gardens for food,” he said. “The homes are also being tidied up and there’s a distinct improvement in people’s health generally.” Dr Kearney said Ausaid had supplied surgical equipment while the Mudgeeraba Lions Club had donated $22,000 for photographic equipment that enabled consulting to be done remotely. In January, Dr Kearney and a team of four will travel to Micronesia where they will spend a week doing operations and examinations. For more information phone Dr John Kearney on 5532 9099. NOVEMBER/DECEMBER 2011 - issue # 079 SAXO DR ST TAREE UCK DD WIL LAKE HUGH MUNTZ NEWCA STLE ST BERMU DA ST REEK RD DA ST Y IC WA CLASS REEDY C BERMU MATTOCKS RD TREETOPS PLAZA EXECU R REEF DR RRIE BA DRIVE DRY PL TIVE E N PDE Q SUPER STORE PO R BURLEIGH WATERS N TC RUDMA UN I ST KER I ST KER MAR MAR ST UDA ST BERM UDA BERM I ST I ST KER MAR KER MAR ALLANDALE ENTRANCE B VD ON K MERMAID WATERS T JA S E TCE YTO W L C DRA OL ST STREET UDA QUEEN BERM ALLAM PRIVATEANDA HOSPITA L REET STREET H ST GOLD COAST HOSPITAL ET ET STRE HIGH R ST LE HIG QUEEN S T EE LITT G AN R NE ET NG RA NE E TR STRE ST ING TH RK EA PA ERN D UN NVAL HIGH SOUTHPORT AL UG CO IC CIF E PA IVAT ITAL R P SP HO MARYMOUNT CATHOLIC COLLEGE REEDY C BURLEIGH REEK RD CONNECTI KORTUM ON RD DRIVE We’re still lending to Medical Specialists and GPs. In fact, we never stopped. We’ve never stopped supporting business, both small and large, through the tough times and we remain committed to keeping your business moving forward. Ready to make the break? Talk to your local NAB Health financial specialist: Andrew Spanner 0448 177 266 [email protected] Jim Whitney 0448 202 019 [email protected] Biljana Nikolov 0439 729 738 [email protected] Adam Higginson 0400 308 964 [email protected] Bruce Richards 0439 762 110 [email protected] Source: APRA Monthly Banking Statistics/NAB-adjusted post publication: November 2008 – November 2010. ©2011 National Australia Bank Limited ABN 12 004 044 937 AFSL and Australian Credit Licence 230686 85061A1011 News IVF Give your business a health check Is your business structured to minimise your average tax rate? KPMG have a long track record of providing advice to medical professionals on how to create the most efficient and effective business model. Our services include: • Business structure and advisory services. • Due diligence. • Self Managed Superannuation Funds. • Retirement, succession and estate planning. • Tax and accounting services. For more information please contact Don Knight, Partner on (07) 5577 7555 or email [email protected] kpmg.com.au © 2011 KPMG, an Australian partnership. All rights reserved. September 2011. N08330PE. At risk of Transferring a genetic disease? Preimplantation Genetic Diagnosis (PGD) is a reproductive option for Biopsy couples at risk of passing a specific genetic disease or chromosome imbalance to their children. PGD Genetic Screening involves screening IVF generated embryos for genetic conditions prior to embryo transfer, with only unaffected Unaffected embryos embryos transferred to the uterus. This transferred provides the opportunity to screen embryos for genetic conditions before a pregnancy is established. Couples choose PGD over prenatal diagnosis for many reasons including objection to termination of pregnancy, loss of a child from the genetic disease, recurrent implantation failure or miscarriage. PGD testing may be appropriate for couples at risk of or who have experienced: • Passing a single gene disorder on to their children or a particular X-linked disorder • One partner carries a balanced chromosomal rearrangement • One partner has an altered sex chromosome complement (e.g. XXY) • Advanced maternal age (>36 years) • Recurrent implantation failure or miscarriage • Previous pregnancy with a chromosomal abnormality Genetic counselling helps to ensure that PGD is the right option for each couple. For more information contect Monash IVF on 1800 628 533 or visit Monashivf.com A couple choosing to try IVF is a big decision. Choosing the IVF clinic for them is just as important. Monash IVF is a specialist fertility clinic that prides itself on the latest technology, coupled with a personalised caring approach. Our highly trained specialists offer a wide array of assisted reproductive technologies so your patients have the best possible options at hand. So when your patients turn to you, turn to Monash IVF. JAM MON/0107 monashivf.com | Phone 1800 628 533 | Southport | Ballina | Hope Island NOVEMBER/DECEMBER 2011 - issue # 079 the medical link 11 Dr. Steven Stylian MB.BS.BSC. FRACP (Medical Oncology) FRACP (Clinical Haematology) Actively servicing the whole of Northern NSW and Gold Coast Regions in: • Clinical Haematology • Medical Oncology • Apheresis • Stem Cell Transplantation • Palliative Care • All urgent referrals accommodated • BULK BILLING AVAILABLE TO ALL PATIENTS AFTER THE FIRST VISIT • • Covering all areas in Haematology and Oncology • Together with Dr Patrick Tsang offering 24hr availability and care for all patients Leading edge treatments available, including management of acute discorders such as Leukaemia We welcome… Dr. Patrick Tsang (Clinical and Laboratory Haematologist) who has joined our practice and is ready to accept referrals. Pindara Hospital Pindara Specialists Suites Suite 1.01, Level 1 29 Carrara Street, BENOWA 4217 Ph: 5597 1305 Fax: 5597 1205 Satellite Clinics conducted in various locations News Delusions or Illusions and the Personality Disorders By Julie Le Franc Psychoanalytic Psychotherapist and Psychologist Personality Disorders are characterised by socially abnormal feelings and behaviours that can create a life of instability. When the DSM-IV describes the symptoms of the various personality disorders it refers to the pervasive pattern of those symptoms, characteristics with well developed roots reaching deep into the unconscious. These ingrained qualities and patterns of behaviour describe the way that person relates to, perceives and thinks about the world and themselves. The DSM lists ten personality disorders, grouped into three clusters. Cluster A : Paranoid, Schizoid, Schizotypal disorders) (odd or eccentric Cluster B : Antisocial, Borderline, Histrionic, Narcissistic (dramatic, emotional or erratic disorders) Cluster C : Avoidant, Dependent, Obsessive-compulsive (anxious or fearful disorders) (1). The Five Factor Model of personality are broad descriptive dimensions of personality that are; openness, conscientiousness, extraversion agreeableness and neuroticism. However, as a psychotherapist, simply knowing the personality disorder diagnosis does little to explain the nature of a person’s unique, individual problems. History and changing accounts: During the eighteenth century insanity was explained by the Lockean philosophical framework of enlightened rationality: delusions or illusions, fallacious thinking led human reasoning into the wrong (2). By the nineteenth century the realm of unsoundness changed to moral insanity the term used for criminals with an absence of conscience and with no self-control or sense of ethics (2). Dr Prichard emphasised that people with this mental disorder displayed eccentricity of conduct, singular and absurd habits combined with a wayward and intractable temper, with a decay of social affection and an aversion to relatives and friends formerly beloved (2). These individuals were considered to have normal intellectual capabilities but their behaviour was improper and indecent. In the twentieth century the American Psychiatric Association constituted the psychopath as amoral, antisocial, impulsive, an irresponsible individual satisfying their egocentric needs without concern for consequences and had little guilt or anxiety (1). Specifically, the psychopath displayed superficial charm with callous-unemotional traits (eg lack of guilt, persistent lying, callous use of others, good at persuasion due to a trait known as an absence of empathy or cold empathy) relatively stable across childhood and adolescence, youth and adults with a particularly severe, aggressive and stable pattern of antisocial behaviour (3). The terms sociopaths versus psychopath were defined as; sociopaths were thought to act within the law and psychopaths violated the law (4). Julie Le Franc Psychoanalytic Psychotherapist & Psychologist JP (Qual), B.A. Psych., Post Grad.Dip. Psych., M.A. Psychoanalytic (Melb) MAAP, MAPS, Post.Grad. Nutritional and Environmental Medicine (ACNEM) For the resolution of unconscious psychological conflicts. Available to individuals, couples (marital), families and doctors. • Major Depressive Dissorders • OCD • PTSD • Anxiety Disorders • ADD/ADHD • Dysphoria • Sleep Disorders • Grief/Loss • Coping with Change • Relationship/Marital • Chronic Pain • MVA & Workcover What causes the illness: Genes and environment have been linked in shaping human behaviour, and psychosocial stressors have been shown to have profound effects of a biological nature by changing the functioning of the brain (5). In the decade of the brain, brain research and the genetics of brain disorders are more apparent. In fact Brain Imaging is developing the ability to measure correlations between brain activation, psychological states and traits (6). With the development of functional neuroimaging lying has been shown to activate the anterior cingulate cortex that is typically involved in tasks that evoke cognitive conflict, and prefrontal areas important for holding task contexts in working memory and retrieving long-term memory. A critical part of the limbic system is the amygdala, the amygdala is important for the generation of emotions; moral decision-making is emotional in nature. Psychopaths lack emotions and empathy and this can be partly explained by a volume reduction in the amygdala and poor amygdala functioning in the psychopath. In The British Journal of Psychiatry, frontotemporal lobar degeneration (FTLD) was linked to complex behavioural changes in substrates of personality. The study involved thirty participants’ that underwent volumetric brain magnetic resonance imaging. A VBM analysis was implemented regressing change score for each trait against regional grey matter volume across the FTLD group. The quantitative measures of personality change in FTLD were correlated with changes in regional grey matter. It was established that the neuroanatomical profiles for personality traits overlap brain circuits previously implicated in aspects of social cognition and suggest that dysfunction at the level of distributed cortical networks underpins personality change in FTLD (6). References: (1) American Psychiatric Association. (1995). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association, 1995 (2) Prichard, J.C. (1996). Concept of moral insanity: A medical theory of the corruption of human nature. Medical History, 40: 311-343. (3) Frick, P.J., & White, S.F. (2008). Research Review: The importance of callous-unemotional traits for developmental models of aggressive and antisocial behaviour. Journal of Child Psychology and Psychiatry, 49; Issue 4, 356-375. (4) Pickersgill, M. (2010). From psyche to soma? Changing accounts of antisocial personality disorders in the American Journal of Psychiatry. History of Psychiatry, 21 (3) 294 – 311. (5) Gabbard, G.O. (2005). Mind, brain and personality disorders. Am J Psychiatry 162: 648 – 655. (6) Mahoney, C.J., Rohrer, J.D., Omar, R. Rossor, M.N., & Warren, J.D. (2011). Neuroanatomical profiles of personality change in frontotemporal lobar degeneration. The British Journal of Psychiatry. Published online ahead of print March 3, 2011, doi: 10.1192/bjp.bp.110.082677. Bookkeeping for Medical Practices Do you need more time? Are you setting up a new practice? We’re qualified accountants providing bookkeeping services. We can save you money, stress and free up time to allow you to do what you do best. Rooms: Level 1 Specialist Centre, 95 Nerang St, Southport Qld 4215 Consultations Saturday – Shop 49,Tweed Mall Centro,Tweed Heads 2485 Bulk Billing (conditions apply) For appointments: 0407 385005 or 5578 7577 (fax 5528 4822) NOVEMBER/DECEMBER 2011 - issue # 079 Contact Jenny on 0409 757 924 www.moneydoctors.com.au the medical link 13 News Management of pneumonia in children outside of hospital By Dr David Pincus, Consultant Paediatrician Lucy is a three-year-old girl who is generally healthy, but she seems to get lots of colds when she attends kindergarten. She has become much more unwell this time, and clinically has evidence of pneumonia. Her parents aren't very keen on giving antibiotics. What should you do? There have been significant advances in our understanding of both the aetiology and treatment of chest infections in children over the last several years, particularly with the influence of better diagnostic techniques and the influence of the new vaccines. A new set of guidelines have been published by the British Thoracic Society to reflect these changes and make the decision making process easier (Thorax.2011;66(10):927-928). Community Acquired Pneumonia (CAP) is a relatively common condition. Before the pneumococcal vaccine it occurred in approximately one in 300 children less than five years of age and approximately one in 700 children aged 0 to 16 years. The use of the seven valent pneumococcal vaccine led to decreased admission rates by 19% within one to two years, and approximately 30% when it has been used in the community for a period of time as has occurred in Australia. The introduction of the new 13 valent pneumococcal vaccine will decrease both the frequency of pneumonia and the proportion of bacterial cases. Using the new PCR techniques has meant that it is possible to determine the aetiology of the pneumonia in the large majority of cases. Between one quarter and one third are caused by a mixed viral and bacterial infection. The Streptococcus is the most common bacterial pathogen with Streptococcus pneumoniae causing 30 to 40% of cases and group A Streptococcus contributing up to 7% of cases. RSV is the most common virus (and tends to occur in mini epidemics around the year on the Gold Coast). Parainfluenza and influenza are seen during the winter months. Human metapneumovirus probably accounts for 8 to 12% of cases and can cause quite a severe illness similar to RSV. Viral infections are more common in children less than one year of age. This current guideline is not recommending testing for the aetiology of the pneumonia unless there is a severe or complicated case. There has been a significant move away from chest x-rays in the last decade. Certainly there is no need for a lateral chest x-ray unless it is impossible to determine the nature or whereabouts of a lesion seen on an AP film. Chest x-rays are not really helpful in determining whether the pneumonia is viral or bacterial. Obtaining blood counts and acutephase reactants such as the CRP are helpful but not diagnostic in differentiating viral and bacterial illnesses. A simple bedside investigation that is used a lot in the hospital setting but less frequently in the community is the measurement of oxygen saturation. Children with an oxygen saturation of less than 92% require oxygen therapy and even children who have saturations in the mid-90s but significant distress will benefit from oxygen. The guidelines emphasise the fact that many studies have shown that physiotherapy is of no use in pneumonia. In the paediatric ward we reserve chest physiotherapy for children with underlying conditions such as bronchiectasis, muscular dystrophy and cystic fibrosis where it can be helpful. So what about antibiotics for this child? If a child is only mildly unwell and is aged less than two years, it is appropriate to advise against antibiotics but with a clinical review if they don't recover appropriately. 14 the medical link RISK KEY BUSINESS INSURANCE P T Y L T D ABN 79 126 939 777 RISK PROTECTION SOLUTIONS FOR BUSINESS & PROFESSIONAL CLIENTS Have you reviewed your life insurances recently? Is your important Life Insurance keeping up with you, your business & your debts? Martin S.P. Wiltshire ONE OF GOLD COAST’S LEADING RISK PROTECTION SPECIALISTS • PROVIDING A SAFETY NET FOR ALL YOUR BUSINESS INSURANCE NEEDS • Key Person Insurance • Partnership Insurance • Income Protection • Personal Risk Protection of Debts Contact Martin and his team on Martin, Paul & Katrina Wiltshire 0418 787 506 [email protected] • Fax: 07 5532 8876 Authorised representative Professional Investment Services ABN 11 074 608 558 • AFSL 234951 • Authorised Representative Number 316713 If the child is significantly unwell with pneumonia, antibiotics should be given. Amoxil remains the antibiotic of choice. It is effective, welltolerated and cheap. There has been a trend to add in a macrolide antibiotic in an attempt to cover Mycoplasma pneumoniae, but a Cochrane review did not even indicate that antibiotics improve the outcome in children with Mycoplasma lower respiratory tract infections. Patients who were just on Amoxil had very low failures rates, and macrolide antibiotics can be used if there is a failure of response. A recent trial in the UK in children over six months did not show a benefit of intravenous penicillin over oral amoxicillin, so children only need to be admitted to hospital if they have a more serious pneumonia and particularly if they require oxygen treatment or intravenous fluids. So what should we do about Lucy? If she is moderately unwell with evidence of pneumonia she should receive a course of Amoxil. I think these new guidelines are clinically helpful and generally very sensible. Dr Pincus can be contacted on 5564 9668. The Evandale Practice Associates, Psychiatrists Drs Lotz, Whittington, Katz, Bersin and Alexander welcome Drs Adams and McAuley and Psychologist Mr Asa Kenworthy. Drs Adams and McAuley have special interests in psychiatry of older age, intellectual disability and neuropsychiatric conditions. Appointments are now readily available for all associates. Mental Health Care Plan assessments and treatment are bulk billed. Bulk billing for other patients available on request. Telephone: 07 5510 3122 NOVEMBER/DECEMBER 2011 - issue # 079 News Gut Microbiotica and our Immune System – We are what we eat By Julie Albrecht - Accredited Practising Dietitian The coined phrase ‘you are what you eat’ has been bandied around for many years. It is no secret that what we eat, and how much, is reflected in our wellbeing and health. We now have research that shows that the food we eat, our environments and our lifestyle, all play an integral role in disease expression through the interplay of the microbiome of our gut. In a normal functioning gut there is a symbiotic relationship which is dependent on the presence of non-pathogenic bacteria. These microbes benefit both digestion and metabolism and benefit the development of a functional immune system. Research has now identified that there is an interaction between the host and bacteria that may lead to the development of Autoimmune and other allergic diseases within and outside the gut. There are a few studies that have demonstrated that difference in gut microbiotica between healthy individual and those with disease. There are now studies undertaken in humans and mice that show certain inflammatory diseases are associated with an altered microbiome (1) . The studies undertaken in mice provide growing evidence that gut microbiotica can influence peripheral immune responses and a likelihood that altered microbiome can influence the progression of disease. The study undertaken by Kallimaki etal revealed that genetically susceptible children with ‘normal’ colonisation did not develop allergic disease (1). This suggests that a combination of genetic susceptibility and an altered microbiome are necessary for disease development. There is also mounting evidence that certain species of gut commensals are required for the regulation of immune response, and that changes in gut microbiotica could result in a lack of immune regulation, outgrowth of more pathogenic microbes, and promotion of inflammation, particularly in genetically susceptible individuals (1). In the gut commensal bacteria, predominantly the phyla Bacteriodetes, produce SCFA – acetate, proprionate, butyruate, through the fermentation of complex plant polysaccharides. It is the SCFA that have an anti-inflammatory action. In order of increasing affinity the SCFA – acetate, proprionate and butyrate, bind with the G- protein coupled receptor GPR43. The anti-inflammatory effects of SCFAGPR43 have been identified in the colon, respiratory system (allergic airway inflammation) and joints (arthritis) in mice. The microbial product, peptidoglcan (PTGN), influences neutrophil priming, translocating across the gut mucosa, entering the circulation and bone marrow. This provides additional evidence of the systemic effect on the immune cells. Gut microbes have preferences for particular energy sources. Complex plant polysaccharides are the substrate source for beneficial microbes and hence promote their growth over the growth of other microbes. The digestion of complex polysaccharide cannot be achieved without the gut commensals, highlighting the symbiotic relationship. The role that diet plays in influencing the microbiotica of the gut is demonstrated through the experiments done with mice. When mice, stably colonised with human microbiome, were commenced on a Western diet – high fat, high sugar, there was a general reduction in Bacteriodtes phyla and increased in Firmicutes taxa, Clostridia, Bacilli and Erysipelotrichi. These modification in microbiotica resulted in changes in gene expression and metabolic pathways utilised by microbiotica (1). Within two weeks of commencing the Western diet the mice had greater adiposity which could be transferred to GF recipients following fecal transplantation (1. (cont’d next issue) References: 1. Jan kranich., Dendle M. Maslowski., Charles R. Mackay., Seminars in Immunology 23(2011)139 – 145. Julie Albrecht & Associates Provides comprehensive nutrition and dietetic services with 20 years experience by a committed team Sarah Markham 96 Ashmore Rd, Bundall Queensland 4217 Telephone: (07) 5592 4545 Mobile: 0411 597 357 Fax: (07) 5592 4254 www.foodbodylife.com.au Body • L • NOVEMBER/DECEMBER 2011 - issue # 079 Julie Albrecht Food • Overweight – adult and children • Eating Disorders • Cardiovascular Disease – Elevated lipid profiles / hypertension • Paediatrics – general nutrition, FTT, constipation, diarrhoea • Endocrinology – diabetes, IGT, PCOS • Gastroenterology – constipation, diarrhoea, IBS, Malabsorptive conditions, crohn’s disease, ulcerative colitis, NASH • Coeliac disease • Food chemical intolerances and allergies • Renal disease • Sports nutrition • Nutritional evaluations Team ife Conditions treated the medical link 15 News Glaucoma By Dr Pamela Weir MBBS (hons) MRCOphth FRANZCO, Ophthalmologist Glaucoma has always been one of those conditions studied by insomniac Ophthalmologists to help them get to sleep at night. I’m not really trying to say that glaucoma is boring. In fact, it has become a much more exciting topic in recent years with a clearer understanding of the disease and clever technology to help in diagnosis and monitoring of progression. When I was a young Ophthalmologist, anyone with intraocular pressures greater than 21 (the upper limit of ‘normal’) was treated for glaucoma. We started timolol ( a beta blocker) and spent many consultations with wheezy, depressed patients or resuscitating 80 year olds with pulse rates of 40. Any patient who had real glaucoma, ie with cupped optic discs and field defects usually required pilocarpine drops four times a day. They couldn’t see anything for about one hour after the drops, and often had an accompanying headache. Patients would gradually develop tunnel vision over a period of years and then in their twilight years go blind and have to be led around by their spouse. How times have changed... Glaucoma is a progressive optic neuropathy. Its progress is diminished or arrested by reducing intraocular pressure. There are many subsets of glaucoma including: Open angle glaucoma where pressure may be high, or within normal limits (normal tension glaucoma). Patients have accelerated optic nerve fibre loss and may be preperimetric (no detectable visual field loss) or perimetric (characteristic field loss). There are many secondary glaucomas including trauma, inflammatory and neovascular. Closed angle glaucoma where patients can present 16 the medical link acutely with a red eye to ED and a high pressure often in the 70’s. These patients have smaller eyes than normal which predisposes them to angle closure. Glaucoma is the second leading cause of blindness in the world (second to cataracts). Many people don’t know they have it as it is asymptomatic until it is advanced. It was a condition which could be elusive to diagnose due to its slow progression over years, but now with newer technology, accurate diagnosis can be at a much earlier stage. Risk Factors Systemic: first degree relatives affected, race (black > white), age >40 years with up to 15% of people affected by there 60’s. Normal disc Diabetes, vascular disease, systemic hypertension, migraine and vasospasm are all thought to be implicated. Ocular include ocular hypertension, myopia, thin corneas. The use of topical or systemic steroids can lead to increased eye pressure leading to glaucoma. Glaucoma Screening People with any risk factors should be screened annually from the age of 40. Patients without risk factors should have a full eye examination annually from the age of 60. Clinically, Ophthalmologists use a number of parameters to assess someone for glaucoma. These include: pressures, corneal thickness, optic disc cupping and visual fields. (continued next page) NOVEMBER/DECEMBER 2011 - issue # 079 News The difficulty in diagnosing glaucoma is pressures may be normal, optic discs may appear normal and visual fields usually don’t show any abnormality until at least 50% of nerve fibres are lost! Treatment Pressure in the eye must be lowered to slow the rate of nerve fibre loss. OCT will measure the nerve fibre layer thickness and compare it to a normative database which is age matched. Optic discs can look normal and the nerve fibre layer is thinned. Eyedrops for glaucoma have come a long way over the past 10 years with greater efficacy, less frequent dosing and a lower side effect profile. Many patients will be controlled with drops alone. Prostaglandin drops are the commonest. They have no systemic side effects and give patients long black lashes and darken hazel eyes. Not all thinning of the nerve fibre layer is due to glaucoma. Neurological problems such as Multiple Sclerosis and Pituitary tumours can also produce thinning. Selective Laser Trabeculoplasty (SLT) is a simple treatment which can be used as a first line treatment as well as adjunctive treatment with drops. It can be repeated down the track should the pressure elevate again. Not all OCT machines use a normative database and not all machines do a direct point by point comparison when a patient has a repeat test. The ‘lesser’ OCT machines which are often used by Optometrists may be helpful to screen patients but are generally not useful for following patients. It is useful for patients with poor compliance whether this is due to forgetfulness, laziness, financial reasons, arthritic reasons or ‘shaky’ reasons. The OCT Surgery for glaucoma is required when other options are limited and the glaucoma is progressing. The surgery has not really changed over the years and still involves putting a drainage hole in the eye, whether this is done with a knife or by using a shunt system. General health should be maximised in any disease, and glaucoma is no exception. Poor optic nerve perfusion is thought to be an important factor in glaucoma, especially the normal tension variety. Reducing atherosclerotic risk factors, improving vasospastic disorders and avoiding nocturnal hypotension in hypertensive patients by keeping night doses of antihypertensives to a minimum are all helpful additions to treatment. The take home message is glaucoma is a complex group of disorders which affects a large percentage of the population, especially the elderly. It is difficult to diagnose in its early stages without an OCT and requires long term follow up on a regular basis. For more information, contact My EyeSpecialist on 07 5592 7900. Now open at Robina Town Centre Dr Pamela Weir Shop 4110 I Level 3 I Robina Town Centre (opposite customer Service Centre) Specialising in: Cataract Surgery Macular Degeneration Glaucoma Eyelid Surgery Diabetic Eye Disease Neuro-ophthalmology Paediatric Screening I Robina I Queensland 4230 I TELEPHONE 07 5592 7900 All urgent referrals accommodated Leading edge equipment Post operative care Please contact one of our Ophthalmic Assistants for more information NOVEMBER/DECEMBER 2011 - issue # 079 the medical link 17 The newest surgical facility on the Gold Coast is the Southport Day Hospital located at the corner of Marine Parade and Railway Street. As a fully licensed Fully licenced and accredited by Queensland Health AS/NZS ISO 9001-2008 compliant. and ISO accredited facility SDH aims to provide local doctors with a relaxed venue for their day procedures. SDH is very well suited to a wide range of surgical procedures and with our 98 Marine Parade SOUTHPORT Phone 5555 7800 Cosmetic Surgery Plastic Surgery selection of Dermatologic Hand Surgery Lasers our facility allows for Urology a full range of Skin Cancer treatments and Dermatologic Gynae/ IVF procedures. For information Uro Dynamics about theatre sessions and costs Oro Facio Maxillary Surgery please phone Southport Day ENT Hospital on 07 5555 7800. Pain Management Don’t mention the war By David Just, Godfrey Pembroke Financial Advice Specialists Much has been written about the economic travails of many Euro Zone countries. Greece is the obvious focus, not because of the size of the Greek debt problem in isolation, but precisely because it is not in isolation. Greece is seen as a question of ‘contagion’ risk. Contagion is the risk that any Greek default will cause a much larger chain of events to happen. We know that Greece was not the only country running massive budget deficits. Portugal, Ireland and Italy have been doing the same thing for the best part of a decade and their debt size is much larger than Greece’s as a result of much larger economies to begin with. If Greece defaults, the international banks, the EU and IMF will start to focus on the possibility of these other countries following suit. In an attempt to recoup income for the risk associated with holding these countries debt, the bankers would look to charge ever increasing interest rates in a self defeating cycle that actually increases the likelihood of further default as these countries simply cannot meet their repayment bills. Therefore there is very wide pressure to ensure Greece remains afloat and attached to the Eurozone. There is no certain way to ensure the worst case scenario of a full blown series of defaults does not eventuate and this small but real possibility is what has driven the latest market dive. Opinions on solutions abound but the most plausible seems to follow the lines of sharing the pain between the wayward and well behaved Euro members alike. If they are to be seen as a strong federation of economies into the future they must now stand ready to bail out those that have been playing outside the rules laid out for Eurozone membership. Of course, that’s all well and good if you’re on the receiving end of the ‘bail out’, but what about the taxpayers of the countries doing the giving? The largest of the national economies of the member countries is Germany. In the second half of the last decade the German government pushed through wide ranging austerity measures and tough labour market reforms. These reforms have led to strong growth, declining unemployment and the prosperity that comes with being the world’s second largest exporter despite a relative lack of raw materials. News Financial Spotlight commencement of World War 1. Some terms of the Versailles peace treaty ending that war were so economically crippling that many believe this set the stage for the German invasion of Poland to commence World War 2. After leading the Allies to victory in 1945, the United States began assisting the European economic recovery with direct financial aid. US State Department leadership under General George Marshall crafted the Marshall Plan concept whereby sixteen nations, including Germany, became part of the program and received administrative and technical assistance provided through the Economic Co-operation Administration (ECA) of the United States. European nations received nearly US$90 billion (today’s dollars) in aid. At that point in time, the benefit for the generosity of the US taxpayer would doubtless have seemed completely inequitable after the unimaginable loss of life that preceded it. This is Germany’s chance to write a completely different historical account for the 21st century. Taking their lead from the tremendous economic outcomes much of Europe received as a result of the financial assistance provided by stronger economies in the 1940’s and 1950’s, the German people can go a long way to ensuring a global economic melt-down is avoided. Yes it is unfair. Yes it will be painful. And Yes, they should do it. The economic benefit of averting total disaster, keeping the EU in tact and re-shaping the economic fortunes of those recalcitrant members will be reward enough for the future generations of the member states upon whose shoulders so much is being loaded. For a complementary assessment of your retirement objectives please contact Godfrey Pembroke on 56891222 – we are here to help. This advice may not be suitable to you because it contains general advice that has not been tailored to your personal circumstances. Please seek personal financial, tax and/or legal advice prior to acting on this information. IntegraVest Pty Ltd, ACN 115 467 144, are Authorised Representatives of Godfrey Pembroke Limited, ABN 23 002 336 254 Australian Financial Services Licensee and Insurance Broker. A member of the National group of companies. Registered Office 105-153 Miller Street North Sydney, NSW, 2060. Level 1, Suite 1 33 Scarborough St Southport QLD 4215 PO Box 20 Southport BC QLD 4215 The German economy is already one of the largest ‘net givers’ to the EU. Any successful end to the current debt crisis will involve the German people significantly increasing this net outgoing to support the debt ridden economies. Quite rightly the people of Germany are asking some seriously tough questions. Questions like: Why should we pay more tax for 40 years, work longer hours, retire later on less Government assistance than the Greeks and now spend our national income on paying their debts? Tough questions often require tough answers, so how’s this one: Because it’s already happened to you, so now it’s your turn. Germany’s place in the history books of the early 20th century does not make pleasant reading. When Austria-Hungary declared war on Serbia in 1914 their treaty with Germany meant the German’s were a party to the NOVEMBER/DECEMBER 2011 - issue # 079 Susan Howard Adv. Dip (FS), Dip FS David Just SSA, AFP, ADFS (FP), DFA [email protected] www.godfreypembroke.com.au/goldcoast Barry Van Es Adv Dip FS (FP), A.A.I.I Tel: 07 5503 0755 Fax: 07 5503 0766 the medical link 19 leaders in cancer care News Hereditary Haemochromatosis with Elevated Serum Ferritin Levels Is Phlebotomy Necessary? What are the Target Endpoints? By Hanlon Sia and Herman Lee (MBBS, MRCP and FRACP) Clinical and Laboratory Haematologists HOCA Gold Coast More than 90% of hereditary haemochromatosis (HH) is associated with C282Y or H63D HFE gene mutations. These result in increased iron absorption and potential total body iron overload. Prevalence of HFE mutations in the northern European populations is 10% for the heterozygous state and approximately 0.5% for the homozygous state. Excessive iron causes cellular injury through the generation of oxygen radicals, which promote lipid peroxidation within organelle membranes. Liver fibrosis, cirrhosis and hepatocellular carcinoma are the most serious complications of iron overload. While the biochemical markers (i.e. tranferrin saturation [TS%] and serum ferritin[SF] levels) may be high, the clinical penetrance (i.e. complications of iron overload) of HH is much lower. Even in the clinically important C282Y homozygote state, the clinical penetrance is reported to be between 1-28%, according to different studies. Within the C282Y homozygote population, liver cirrhosis only occurs in 1-10%, severe cardiac siderosis is rarely seen and SF levels are normal in 50% of female and 20% of male adults, meaning they may never require phlebotomy. Furthermore, not all C282Y homozygotes with elevated SF levels need phlebotomy. On the contrary, compound C282Y/ H63D heterozygotes and H63D homozygotes will only occasionally have liver iron levels in the range that is more characteristic of C282Y homozygotes. Liver damage has rarely been described in these patients and when present, is thought to be the result of co-factors like excessive alcohol use, hepatitis C infection or hepatic steatosis associated with metabolic syndrome. A small proportion of simple C282Y heterozygotes will have a slightly raised TS% or SF levels, but they do not develop significantly increased iron stores in the absence of other co-factors. Heterozygotes for H63D do not have an increased prevalence of iron abnormalities. S65C variant have very little influence on body iron stores, and therefore should not be tested. Phlebotomy of HH with increased SF levels: The normal level of TS% ranges from 15-50% for males and 12-45% for females. The ferritin level is age and gender dependent. For adult females the reference range is 15-200µg/L, although following menopause, levels progressively approach the adult male level of 30-300µg/L. It is important to note that increased SF levels are not specific for iron-overload. If SF level is disproportionately increased compared with TS%, the presence of a reactive increase in ferritin (which has no correlation with total body iron stores) associated with liver disease, alcohol use, infection, inflammation or malignancy, must be actively investigated. For instance, alcohol induces ferritin synthesis, and the elevated SF usually reverts to baseline level after 3-4 months of alcohol abstinence. Not all HH patients develop iron overload and not all HH patients with elevated SF levels require phlebotomy. The main clinical benefit of phlebotomy therapy is the prevention of liver damage due to iron overload. Early stages of hepatic fibrosis can reverse with phlebotomy therapy. Although the target SF level is commonly quoted as less than 50µg/L, the clinical and survival benefits of this has never been assessed in a randomised study of phlebotomy therapy. One should also realise that liver cirrhosis rarely develops in patients with SF less than 1000µg/L. The necessity of phlebotomy must therefore be tailored to the individual. phlebotomised to achieve iron depletion regardless of signs and symptoms. The decision to treat C282Y homozygotes with a moderately elevated SF of 200-1000µg/L, should consider the patient's preference and one’s own clinical judgement, remembering that SF levels do not rise progressively in all patients and not all patients develop cirrhosis. Observation with regular follow-up SF measurements can be considered as an alternative management strategy in some patients. Liver biopsy should be considered in C282Y homozygotes with a SF ≥1000 µg/L, or if non-HH risk factors for liver disease are present, in order to assess the relative contributions of each disease process. Phlebotomy involves removing 500ml blood over 15-30 minutes weekly if Haemoglobin (Hb) is >120 g/L. If Hb is ≤ 120 g/L, either a 500ml venesection every second week or weekly venesection using lower volumes (250-400 ml/session), should be considered. It is important to consider less frequent phlebotomy sessions if Hb is <110 g/L for three consecutive weeks. The patient's SF level should be quantified every month, or after every fourth phlebotomy session. Once the SF level is <200 µg/L, it should be measured every two weeks, or after every one to two phlebotomy sessions. The decrease in SF level with phlebotomy is infrequently linear. In the absence of solid evidence, it may be adequate to aim for a SF level below the upper limit of the reference range (300 µg/L for males and 200 µg/L for females), rather than the commonly suggested target of <50 µg/L. For patients unable to tolerate phlebotomy therapy, it may not be required at all if the SF is <1000µg/L and there is no organ dysfunction. Exjade, an oral iron-chelating agent, may be an option in the future once the results of ongoing trials are published. Phlebotomy should be discontinued once the desired target SF level is achieved, with periodic personalised phlebotomy sessions guided by 6-monthly SF measurements. It should be noted that iron accumulation rates vary greatly amongst C282Y homozygotes. The development of anaemia after a few phlebotomy sessions may indicate that the elevated SF was not due to iron overload. The evidence of iron overload (liver biopsy or liver MRI Ferriscan) should be reviewed before further phlebotomy is performed. Diet advice: HH patients should consider the following dietary advice: 1) Avoid iron supplement 2) Consume red meats in moderation 3) Consume alcohol in moderation. Patients with evidence of liver injury, hepatomegaly or cirrhosis should abstain from consuming alcohol 4) Limit supplemental vitamin C to 500mg/day (vitamin C increases iron absorption) 5) Use mineral supplements for specific deficiencies only 6) Avoid raw shellfish (risk of vibrio vulnificus infection) References: 1) Beutler E. Iron Storage Disease: Facts, Fiction and Progress. Blood Cells Mol Dis. 2007;39:140-147, 2) Adams PC. The Natural History of Untreated HFE-Related Hemochromatosis. ActaHaematologica 2009;122:134-139, 3) Adams PC et al. Hemochromatosis and Iron-Overload Screening in a Racially Diverse Population. NEJM 2005;352:1769-78, 4) Brissot P et al. Molecular Diagnosis of Genetic Iron-Overload Disorders. Expert Rev. Mol. Diagn. 2010;10:755-763, 5) Bassett ML et al. The Changing Role of Liver Biopsy in Diagnosis and Management of Haemochromatosis. Pathology 2011;43:433-439, 6) Bassett ML. HFE Genotyping: Maximising the Value for Hemochromatosis Patients and Families. J. Gastroenterol. Hepatol. 2010;25:1186-1188, 7) Allen KJ et al. Iron-Overload-Related Disease in HFE Hereditary Hemochromatosis. NEJM 2008;358:221-230, 8) Beaton MD et al. The Myths and Realities of Hemochromatosis. Can J Gastroenterol 2007;21:101-104, 9) Adams PC et al. Screening for Iron Overload: Lessons from the HEmochromatosis and Iron Overload Screening (HEIRS) Study. Can J Gastroenterol. 2009;23:769-772, 10) Adams PC et al. How I Treat Hemochromatosis. Blood 2010;116:317-325. C282Y homozygotes with SF greater than 1000 µg/L should be NOVEMBER/DECEMBER 2011 - issue # 079 the medical link 21 News Tips For Surviving Christmas By Amanda Clark, Dietitian Beat stress…Don’t let the silly season beat you. • • • Take time out to relax and do something for yourself such as enjoying a beach walk at sunset or treating yourself to a massage. If you’re working right up to Christmas, delegate Christmas tasks – people love to be involved and it takes the burden off you, for example enlist the kids to decorate, ask guests to bring a fruit platter or vegetables and dip. Focus on one thing at a time – don’t get carried away with what needs to be done tomorrow – concentrate on the here and now. • • You could avoid a nasty hangover too! For your days off keep on moving! – enlist the family and friends for a game of cricket or Frisbee after the big Christmas lunch. Visiting relatives and catching up with friends you haven’t seen for a while? Make a walk date rather than a dinner date. Keep healthy…. • • • • • • Don’t go to a party hungry – if you know it’s going to be deep fried nibblies, eat a low cal snack before you go such as a low fat yoghurt, fresh fruit or whole-wheat crackers and hummus so you can be more discerning. Pick up a bowl and cherries to take to festive occasions – they don’t need much preparation and you’ll know there’s something healthy on offer. Watch your portions at the buffet – eat off the smallest plate you can find and fill half of it with salad or low starch vegetables. Eat your favourite Christmas foods. For example, if you really enjoy trifle but aren’t too keen on stuffing, then eat according to what you enjoy most. When you choose that trifle – eat a small portion and really enjoy it! Focus on the flavour, the aroma and the texture and you will be surprised at how satisfied you are with a lot less. If it doesn’t taste as good as you hoped, abandon it. Pace yourself with alcohol & choose wisely – drink plenty of water in between each alcoholic drink to space out the timing. Avoid creamy alcoholic options and choose wine or light beer instead. Call us for free copies of ‘Tips for Education Surviving Pads available Christmas’ featuring the Portion Perfection Plate For clear, rr, concise, realistic advice refer to the Dietitians and Exercise Physiologists at • • • • Eat a healthy, filling breakfast – like natural muesli with low fat yoghurt and a handful of frozen berries as it will help keep hunger at bay if lunch is going to be late. Say ‘Oh well‘ not ‘what the hell’, the average person gains around 2kg at Christmas and doesn’t lose it later. If you overeat at one meal, get organised and back on track for the next one. Put on your dancing shoes! Instead of just sitting around a table, why not put on some tunes and turn up the volume. It’ll cut down eating time and burn some calories! If you’re putting on the Christmas feast, only cater for the number of people actually coming to the meal, don’t serve trifle and Christmas pudding and pavlova and … or you can guarantee you’ll be eating it for days after. • 3 Practitioners • Home visit services • Beachf Beachfront exercise class • Segmental body composition analysis • Practical tools and resou esources • Individual consultations • Premium & bulk billed services available • EPCs for diet and/ or exercise and group diabetes referrals for exercise welcomed See how much is right to eat with Portion Perfection By Amanda Clark, Gold Coast Adv APD Coolangatta & Broadbeach Ph 07 5536 6400 [email protected] www.greatideas.net.au 22 the medical link NOVEMBER/DECEMBER 2011 - issue # 079 News Call For Volunteer Dr’s For Australia’s First Beach Medical Practice In association with Surf Life Saving Queensland, Medical Rescue Australia which specialises in the delivery of pre-hospital medical services, is starting Australia’s first beach medical practice this summer and is calling for doctors interested in providing medical support. They will join a mostly volunteer roster on weekends, treating minor injuries, assisting with triage and advanced life support until the ambulance arrives etc. The practice can be bulk billed for services provided. At this stage the Gold Coast-based organisation will be providing one medical team of volunteer doctor/nurse or doctor/paramedic on an ATV to the Surfers Paradise beach but it is expected the number of teams and locations will increase leading up to Christmas. All equipment is provided. Medical Rescue Australia is also assembling a smaller group of doctors to be trained in helicopter operations to assist the Westpac Helicopter on search and rescue missions. Mindset Change Waistline Change Life Change Stop your patient’s yo-yo dieting cycle at the Wesley Weight Management Clinic Heather lost 25kgs Training in equipment, ATV driving, beach operations, and radio use is provided, and DWS and AON status is offered so doctors can apply for provider numbers. The group will also be implementing Australia's first Online Cloud-based Medical Practice software approved by Medicare which will enable real time patient record keeping from anywhere on the beach and electronic referrals to the emergency department or the patients GP. It is an exciting high profile initiative that is hoped will improve safety and care on the beach for the Gold Coast community, but also reduce the burden on QAS and ED over-crowding this summer. Enquiries please contact Dr Glenn McKay, telephone 0414 625 494. Chris lost 77kgs Felicity lost 36 kgs 2012 – AMR’s 25th Anniversary 24 the medical link Brian lost 57kgs Together they’ve lost almost 200kgs! Read their stories at www.wesweight.com.au Health Fund Reclaimable Accept EPC Referrals ef Unit 8-10, 25 Upton St Bundall 11 Gold Coast Clinic Ph. 5570 2116 t er pa to o F i tien ur c r s t w lin t A ill ic r t F R s s e ecei oday *E xp ire E E s s m ve th and s 31 -1 ! * e n eir you 220 r Personalised, Healthy Weight Loss R As 2011 closes for another year we now reflect upon the upcoming year where we as an Association will celebrate our INC. Est. 1987 25th Silver Anniversary. Fun, friendship & education! In the mid-1980’s medical receptionists occasionally came together for meetings and social events arranged through local hospitals. These get-togethers were a forerunner to the inception of the Association of Medical Receptionists (Gold Coast) Branch in September 1987 by founder, Kadie Moyle (now Cheney) under the suggestion of Dr Laurie Kelly from the After-Hours. We sometimes have enquires asking us “What is the Association of Medical Receptionists”? Since its first meeting the Association has grown and become a well respected and highly professional body. The Association’s aim is to provide social and moral support to our members and to provide educational workshops and professional development sessions on subjects of specific interest to medical receptionists. Through these workshops we’ve able to show support to the Doctor’s in the training and professional development of their practice staff. These educational workshops would not have been possible without the support of our sponsors and doctor’s throughout our 25 years who have allowed us to tour or the use of their facilities. When I look upon the Association membership I see it has diversified from medical receptionists to now include managers, medical administive staff and nurses. To celebrate our 25th anniversary we have earmarked the 8th September 2012 to celebrate this event. It will also be the date for our 2012 Biennial Seminar. We ask that this be marked on your calendar and encouraged your staff to attend this educational day. For more information email us on [email protected] Noel Sefuiva, President NOVEMBER/DECEMBER 2011 - issue # 079 News Poor sperm DNA decreases pregnancy success New studies suggest that sperm with certain levels of DNA fragmentation serve as a strong predictor of reduced male fertility. Fertility Specialist Dr Andrew Davidson of City Fertility Centre Gold Coast said sperm that appears to be normal using traditional semen analysis methods may actually have extensive DNA fragmentation. “The usual evaluation of male infertility has typically been a semen analysis measuring count, motility and morphology of the sperm. However DNA analysis is now proving to be a valuable diagnostic tool for male infertility as well,” Dr Davidson said. The development of a healthy embryo is initiated when the chromosomes which consist of strands of DNA from the egg come together with those from the sperm. However, sometimes these strands can become damaged. Dr Davidson said it appears that if the sperm DNA fragmentation level is greater than 30 per cent the couple are likely to have significant reduced fertility potential, including a significant reduction in term pregnancies and a doubling of miscarriages. “The good news is that I have seen male patients who have significantly improved their sperm DNA quality through following some of the recommended treatments and go on to have successful pregnancies with their partners,” said Dr Davidson. It is obvious that having this information about the DNA quality of the sperm can be extremely helpful to couples and their fertility specialists, he said. City Fertility Centre can undertake the one hour sperm DNA fragmentation tests in their world class laboratories. For more information, contact City Fertility Centre on 1300 859 116. The causes of sperm DNA damage include drugs, chemotherapy, radiation therapy, smoking, environmental toxins, genital tract inflammation, testicular hyperthermia, varicoceles, hormone factors, infrequent ejaculation and the male’s age. Dr Davidson said depending on the cause of the sperm DNA damage some treatments can help to improve the DNA quality. These treatments include leading a healthier lifestyle, quitting smoking, avoiding exposure to toxins (e.g., fertilisers, fumes) and taking a daily supplement of antioxidants and zinc. According to a recent fertility and sterility study by Sakkas et al, up to eight per cent of infertile men have been shown to have high levels of sperm DNA fragmentation. es, t fe n o r pf ails o u r det n o with site f Now e web se 26 the medical link NOVEMBER/DECEMBER 2011 - issue # 079 News You don’t say? Patient-Doctor non-verbal communication says a lot. By Dr Isolde Hertess about the doctor and the patient. Communication skills go beyond the ability to interact with patients verbally and to document sufficient information. During an interview, eye contact and positive facial expression conveys interest and eye contact intervals should last for four to five seconds. Longer eye contact may seem be confrontational or intimidating. Listening without interruption means an interested doctor. Non-verbal communication (NVC) is behaviour that is not spoken or written communication. It creates or represents meaning. It includes facial expressions, postures, body movements, gestures and the tone of our voices. From our handshakes to our hairstyles, NVC reveals who you are as a doctor and how you relate to other people. One experience of NVC occurred recently during surgery when I had to tape my suddenly broken theatre shoes with sleek. The comment came form recovery that as plastic surgeon I could at least be wearing a decent pair of shoes. Approximately 70% of communication is non-verbal. NVC impacts on the success of your communication with patients more than the spoken word. This in turn impacts on patient care by influencing patient satisfaction, compliance with doctor’s instructions and treatment outcomes. As a consequence the incidence of complaints against the doctor then increases as well. Verbal and non-verbal communication combine to convey a message. You can improve your spoken communication by using non-verbal signals and gestures that reinforce and support what you are saying. As important as it is to pay attention to your own non-verbal signals attention, should be paid to any patient incongruent behaviours. If you are confused about a patient’s non-verbal signals, don't be afraid to ask questions. A good idea is to repeat back your interpretation of what has been said and ask for clarification. Posture, movement and appearance convey a great deal of information Statistically the average time before a doctor interrupts a patient telling the history is 18 seconds, only 23% of patients complete their statements. If allowed, patients usually take 60 seconds to complete their story if allowed to do so. The paralinguistic communication is the tone of voice, loudness, inflection and pitch. Words said in hesitant tone of voice might convey disapproval and a lack of interest. Be mindful of proxemics or the need for a person’s personal space. The amount of personal space needed when having a casual conversation with another person usually varies between 45 centimeters to one meter. Asking permission to get closer is good communication. Likewise, haptics, the communication through touch can communicate sympathy but be wary that it does not communicate over familiarity with your patients especially females. There is so much expected of us as doctors and we are only human. Some of us just seem to have a knack for using non-verbal communication effectively and correctly interpreting signals from patients. In reality, you can build this skill. Finally NVC is a clue to the emotions underlying feelings. So if you are feeling tired, hungry or stressed by financial, work or personal problems you will be transmitting negative NVC to your patients and staff. Take time to be aware of your emotions when you are at work and more importantly when you come home to your loved ones who have been waiting to see you. Gold Coast Renal and Hypertension Clinic Dr Mohamed Khafaji MBChB MRCP(UK) FRACP Renal Physician We welcome Dr Khafaji to his practices at: Pindara Specialists Suites Level 3, Suite 310 Carrara Street, Benowa 4217 John Flynn Hospital Level 6, Fred McKay House Inland Drive, Tugun QLD 4224 Contact details: Telephone 5598 0443 Facsimile 5598 0662 Email [email protected] 28 the medical link NOVEMBER/DECEMBER 2011 - issue # 079 News Medical Transcription for an Efficient Practice What is Medical Transcription? Medical transcriptionists are the miracle workers of the medical records. They transform doctors’ verbal dictations, into polished gems of written documentation. Pressured by tight deadlines, medical typists have the specialist knowledge and experience to work with highly technical recordings – that are often rushed, messy and mumbled! Staffing Emergencies Medical practitioners often employ medical typists on a casual or temporary basis. As the demands of a clinic fluctuates, relief staff are relied on during times of absence, overflow or backlog. Sourcing experienced and well trained professionals is a big challenge – and practice managers are wise to keep a contact list, in preparation for staffing emergencies. Practitioners can reduce costs by ensuring they dictate clearly, using the following hints. • Dictate in a quiet area with no background noise, including other people talking. • Organise any papers or reports you have to refer to, before you start dictating. • Pause slightly before speaking, at the start of the recording, and also at the end. This prevents words from being ‘clipped’. • Be consistent in the way you approach similar reports. This makes it easier to transcribe your work and lessens the chance of error. • Spell out uncommon medical terms, including diseases, drugs, or procedures. For more information contact Sue on 0438 717 698. Technology for Privacy and Convenience Technology now allows medical dictations to be uploaded and reviewed on Apple’s iPad, iPhone and Windows Smartphones – as well as traditional digital recorders. High quality typing services embrace these new technologies, and also provide their clients with a secure server, that ensures the protection of private information. Their clients may be provided with a personal mailbox and password, and can directly download, upload and send files from their iPhones. This is very useful for practitioners who use their iPhones to dictate! Strategies for Working with a Medical Typist Medical transcription usually takes four hours to transcribe a single hour of audio. Mumbled and poor quality recordings may take longer. Gold Coast Heart Centre cardiac diagnostic testing and consultations > > > > > > > > > Stress Echocardiography Transthoracic Echocardiography Transoesphageal Echocardiography Blood Pressure Monitoring Exercise Stress Testing Holter Monitoring Event Loop Recording TILT Table Testing ECG Reports Dr. John Bou-Samra Cardiologist, Pacing and Heart Failure Dr. Mathew Williams Cardiologist Ph: 07 5531 1833 Dr. Michael Greenwood Interventional Cardiologist Dr. Kang-Teng Lim Cardiologist, Electrophysiologist Dr. Jonathan Chan Cardiologist, Multi-Modality Cardiac Imaging Dr.Vijay Kapadia ‘Professional care with exemplary service’ Interventional Cardiologist 30 ALLAMANDA HOSPITAL JOHN FLYNN PRIVATE HOSPITAL PINDARA HOSPITAL Spendelove Street Southport 4215 Phone: 07 5531 1833 Suite 6A, John Flynn Medical Centre Inland Drive, Tugun 4224 Phone: 07 5531 1833 Opening soon the medical link NOVEMBER/DECEMBER 2011 - issue # 079 News Why patients seek second opinion after technically successful cataract procedures By Dr Robert Bourke Patients referred primarily for cataract surgery require careful preoperative evaluation for other factors that may also be contributing to their visual dissatisfaction. If these other factors are not identified preoperatively, patients will experience visual dissatisfaction after technically successful cataract surgery. However, the pre-existing problem can almost always be solved with careful evaluation, explanation, education and treatment. The advance to modern small incision cataract surgery has ensured a safer procedure for 95 per cent of patients and has provided improved outcomes, but, with advancing technology comes an increase in patient expectation. I’d like to focus on referred 2nd opinion patients who have undergone technically successful cataract extraction, where the treating ophthalmologist is happy with the post-operative outcome, yet the patient remains unhappy and sources a second opinion. Some common problems post-cataract surgery include: • Posterior Capsular Opacification. Clouding of the posterior capsule causes a progressive decrease in patient’s visual acuity post cataract surgery. The incidence of PCO is around 20%, and can develop after cataract surgery. It can be successfully treated in rooms with YAG laser capsulotomy. • Refractive Surprise. In general, most patient’s post-operative refractive outcome is emmetropia. In patients who are unhappy with their post-operative refractive surprise, glasses will generally suffice. Patients unhappy with spectacle correction could consider further surgical options. • Anisometropia. Anisometropia refers to an unequal refractive state for each eye. The solution is to balance the two eyes, which can be achieved by extracting the crystalline lens in the fellow eye, aiming for a refractive outcome matching the refractive status of the two eyes. • Vitreous Anomalies. Movement of the vitreous into the anterior chamber (AC) can lead to reduced visual acuity. Vitrectomy is warranted in cases where the vitreous is observed in the AC, and the patient is symptomatic. Patients who note significant vitreous floaters post cataract surgery, could also benefit from vitrectomy surgery. • Macular Pathology. ARMD, epiretinal membrane, cystoid macular oedoma - These pathologies require vitreoretinal expertise. Conclusion There are numerous reasons as to why patients can be dissatisfied with their vision following cataract extraction and PCIOL implantation. In all of the above listed scenarios, a solution is possible. For any person, in any situation, education is key. The patient’s understanding of the education provided by the Ophthalmologist is equally important. The more education provided pre-surgery, the better the expectation post-surgery and if complications do then occur, the patient is ready for solutions to be provided. A full version of this article is available at www.visioneyeinstitute.com.au Transforming lives on the Gold Coast Byron, Peta, Nerang Benowa Sharon, Simon, Burleigh Waters Currumbin Valley Vision Eye Institute’s highly respected Gold Coast team specialise in the treatment of cataract, glaucoma, retinal diseases and general ophthalmology, as well as providing laser vision correction and other refractive procedures. They include Dr Robert Bourke, Dr Darryl Gregor, Dr Elizabeth Hagen, Dr Peter Heiner, Dr Frank Howes, Dr Jim McAlister and Dr Matthew Russell. visioneyeinstitute.com.au Vision Eye Institute Southport (07) 5557 8300 Vision Eye Institute Varsity Lakes (07) 5570 8600 NOVEMBER/DECEMBER 2011 - issue # 079 Vision Eye Institute Coolangatta (07) 5589 8300 the medical link 31 THE PHYSICIAN’S “WORD OF MOUTH” UPDATE Building bridges between Medicine and Dentistry Because of the close connection between headaches, muscle tension, and TMD problems, doctors should screen for musculoskeletal problems commonly associated with bad dental bites, TMJ pathology, and posture problems. Treatments are often conservative. Doctors Screen Painful Muscles & TMD • Quick muscle palpation exam reveals presence of painful muscles. • Muscle pain is common with TMD and jaw problems. • Doctors now screen for TMD and use dentists for definitive diagnosis. • Screen and treat TMJ/TMD problems Common muscle exam can help doctors screen for TMD. TMD is associated with headaches, ear problems, and facial/neck pain. Painful muscles are often the source of TMD related head and neck pain. The following guidelines will help the physician perform a quick TM joint and muscle palpation screening exam. TM Joint: Palpate directly over joint and on front wall of ear canal. Listen and feel for noise during open/close. Lat. Pterygoid: Place finger alongside maxillary wisdom tooth area. Direct pressure superiorly, medially and posteriorly, into the hamular notch anatomy behind last tooth. • Resolve headaches of dental bite & TMJ origin. Med. Pterygoid: Slide finger pressure along the medial mandible wall at level of floor of the mouth in molar area. • Reduce muscle tension & other contributing factors to migraines and tension headaches. Masseter: Palpate muscle using a bimanual finger grasp, one finger inside the cheek and the other outside on the cheek below the zygomatic arch. Clenched teeth reveal muscle. Scalene: Finger poke in small depressed triangular areas above and adjacent to the clavicle midline area. Muscles here can pinch cervical nerves traveling to brachial plexus creating dorsal hand paresthesia. Sub-occipital: Firm palpation at base of the posterior skull reveals head/neck imbalance. Trapezius: Stretch by tilting head and palpate with firm finger/thumb pressure. Painful trigger points often refer down the back or up side of face. For patients experiencing headaches or with neck and jaw pain, a quick muscle exam with positive findings justifies a tentative diagnosis for TMD and merits a referral to a dentist knowledgeable in evaluating and treating TMD. Treatments are often conservative and multidisciplinary. Temporalis: Palpate sides of head using fingers SCM: Turn head and hold muscle between thumb and finger and palpate up and down its length. For appointment referrals [email protected] Education & Training Faculty of Health Sciences and Medicine By Professor Richard Hays Dean Faculty of Health Sciences and Medicine This important research will create greater recognition and awareness of CFS, reducing the stigmatisation and disbelief encountered by individuals with this disease. The researchers at Bond University are recognised as a world leader for immunological research for CFS and as a leading contributor of information and shared knowledge within the medical research community. The Mason Foundation is one of the most significant contributor to international research in CFS. This is a fantastic success for Bond, and demonstrates the credibility and momentum of the CFS research platform at Bond in the highly contested area of biomedical and clinical research. We have also recently held a number of successful events at the Also in September, the Faculty held the first Sports Lecture Series. This event features the high performance coaches from three popular sports codes. The final lecture was held on Wednesday 9 November – visit the website for more details. Finally, congratulations also goes out to PhD candidates Christian Morro and Kelly Griesdale who placed first and second respectively in the Bond University three minute thesis competition. ROBINA Bond University is pleased to announce that Chief Investigators Associate Professor Sonya Marshall-Gradisnik, Dr Donald Staines and Professor Mieke van Driel of the Public Health and Neuroimmunology Unit (PHANU) were recently successful for funding from the Mason Foundation, which is Category One funding. The grant will fund new research into Chronic Fatigue Syndrome (CFS) and continue to build the CFS research platform developed over the past three years. This grant ($831,037 - over four years) represents one of the largest Nationally Competitive Grants received by Bond. The research project is the largest collaborative international CFS project to date, between Bond University, Queensland Health, Stanford University and Incline Village Medical Centre, Nevada. Faculty. In September, The Australian and New Zealand Forensic Science Society recently held a very successful public event attracting over 200 community members. The fascinating event showcased a 2007 Brisbane murder with presentations given by the team directly involved with the case. PRIVATE SESSIONAL CONSULTING ROOM AVAILABLE AT Close to Robina Hospital and Robina Medical Precinct • Prominent location with ample parking • New, attractive medical rooms • Available for full or half day • With or without secretarial support If you would like further information, or would like to discuss options please call 5 66 777 11 For Sale …Byron Bay Spectacular 10.4 Ha (25 acre) forest hideaway Sustainable family weekend/holiday retreat or rural residence 15 minutes from Byron Bay • 5 minutes from Mullumbimby • 40 mins from Gold Coast At 700 ft elevation this property has the magnificent deep freshwater Wilson’s Creek as it’s one km southern boundary. Predominately wet sclerophyll forest with stands of Hoop Pine, Brushbox and Rosegum, 2 Ha is well maintained fenced pasture. Abundant native habitat shelters koalas, wallaby, platypus, echidna and diverse birdlife. The residence has a private yet panoramic easterly forest and creek aspect. The residence is craftsman built of timbers unique to the North Coast. The windows and doors are Australian Red Cedar, cabinetry Rosewood, Spotted Gum and Bolleygum, ceilings Bluegum, Pigeonberry Ash and White Walnut, exposed beams Tallowwood, flooring Silky Oak and Spotted Gum and the cladding wide board chamfer Brushbox. NOVEMBER/DECEMBER 2011 - issue # 079 Water storage includes 40,000 litre rainwater, 20,000 litre pristine creek water and unlimited creek pumping rights with a three phase electric pump. The residence has undergone a complete master builder refurbishment in 2010, including new roof, solar hot water system, kitchen, hardwood floor, light fittings and repainted internally and externally. It now presents as a new home. Services include power, refuse collection, mail delivery, satellite TV, ADSL and school bus route nearby. A tiled low maintenance salt water pool, secure two vehicle garage and workshop, chicken run and undercover tractor/van space complement the residence. Rich volcanic loam vegetable gardens are easily established. This is a unique property and residence reluctantly for sale by its owners of 35 years. It is ideal as a sustainable family weekend/holiday retreat or as a rural residence within easy commuting range of the Gold Coast and Brisbane. For further details or to arrange a private inspection please contact 0438 553 416 Offers over $1.1 m considered the medical link 33 Hospital Update Gold Coast University Hospital New hospital’s ‘heart’ ready to pump Future employees of the $1.76 billion Gold Coast University Hospital (GCUH) were treated to a one and only glimpse inside the new facility’s ‘heart’, the Central Energy Plant (CEP) on 31 October this year. Gold Coast Health Chief Executive Officer Adrian Nowitzke joined current Gold Coast Health staff at the event, noting the central energy plant is just about ready to give the hospital site life. “The CEP is the first building on site to be completed, ready to provide energy and power to the remaining buildings on the site,” Professor Nowitzke said. Main entry including Gold Coast Rapid Transit entering to the hospital “Services to the clinical buildings must be maintained at all times; all systems in the plant have built in redundancy to ensure a maximum level of reliability even in the event of a major component failure,” he said. The plant also includes a water tank farm – five stainless steel tanks which combined hold 2 million litres of water – to store water for everyday use, as well as fire fighting. Staff will be given the chance to check out other buildings first hand as they are completed. L to R: GCUH Project director Don Glynn, GCHSD CEO Adrian Nowitzke, Lend Lease construction manager Ben Brown and GCHSD Executive Director Strategic Development Mike Allsopp inspect the underground tunnel that links the CEP to the main clinical services building. “The plant is linked to the hospital through underground service tunnels, providing the main hospital building with essential services such as electricity, water, air conditioning cooling water and medical gases,” he said. The completion of the central energy plant marks the first opportunity for staff to view in whole a completed building on the site. It will be the only opportunity to view inside the plant, as once it is commissioned, it will become home to specialised engineering staff and general visits will not be allowed. The CEP, known as Block P and located at the rear of the hospital precinct, will provide enough energy to power and cool the entire 19.4 hectare hospital site. The event formed part of essential site familiarisation for staff prior to moving the current Gold Coast Hospital to the site in early 2013. GCUH Project Director Don Glynn said that the CEP will be central to the functioning of the hospital when it is operational in early 2013. “Our emergency diesel generators and massive air conditioning chillers can generate enough electricity to power around 1000 average homes and cool up to 6000 homes,” Mr Glynn said. The next buildings to be completed include Block F (Mental Health Building) and Block E (Pathology and Education Building) both of which are scheduled for completion in April next year. With construction of the $1.76 billion Gold Coast University Hospital progressing on schedule, Southport is set to become a stronghold of public health services for the Gold Coast community. For more information on the Gold Coast University Hospital project, please visit www.health.qld.gov.au/gcuhospital Welcome to the new web site www.drjaypsych.com.au of Dr. Julian Boulnois Doctor, Psychiatrist, Author, Journalist, Broadcaster, Lecturer, Mental Health Advisor and Facilitator Dr Boulnois’ many years of scribbling ‘On the Other Side of the Couch’ has led to the creation of ‘A Selection of Poetry’ which is a great read for only $10.00* Dr Michael Read M.B.B.S is performing VASECTOMIES & ALSO CIRCUMCISIONS on adults, infants and boys in his clinic, as a local anesthetic procedure. No Hospital Admission. PHONE 55 31 11 70 FOR APPOINTMENTS 95 Nerang St Southport Qld 4215 www.vasectomyvenue.com.au 34 the medical link For more information contact Dr Boulnois and his team on 5571 1133 *incl GST [email protected] NOVEMBER/DECEMBER 2011 - issue # 079 Hospital Update Pindara Private Hospital South Coast Radiology (SCR) and Pindara Private Hospital (PPH) are poised to launch a new cutting edge CT scanning service on the Hospital campus. Reportedly the first of its type in Queensland, and the best available, the new Toshiba Aquilion Prime CT scanner is a coup for SCR, PPH and the Gold Coast medical community. Pindara welcomes new specialists Dr Susan O’Mahony Plastic and Reconstructive Surgeon Dr Susan O’Mahony undertook her Medical Degree at the University of Queensland and completed her Plastic & Reconstructive Surgery training in Brisbane, gaining Fellowship from the Royal Australasian College of Surgeons, before undertaking a two-year Fellowship Program in Cleft and Craniomaxillofacial Surgery in Brisbane and New Zealand. During her training Dr O’Mahony was actively involved in surgical research, investigating a side effect of Breast Cancer Surgery. In 2001 she was appointed to a Wellcome Trust Clinical Research Fellowship and was awarded a Masters Degree from the University of Cambridge in 2003. She recently completed a Doctorate at the same University. Dr O’Mahony’s practice encompasses most areas of Adult and Paediatric Plastic Surgery with a particular interest in Reconstructive and Cosmetic Breast Surgery, Body Contouring, Facial Plastic Surgery, Skin Cancer Surgery, Congenital Deformities and Otoplasty. She also has public hospital appointments at the Mater and Royal Children’s Hospitals in Brisbane where she specialises in the treatment of Cleft Lip and Palate and Craniofacial Congenital Deformities. Dr O’Mahony welcomes enquiries from her colleagues regarding their adult or paediatric patients who require Plastic Surgical care. She can be contacted on (07) 5597 5624. NOVEMBER/DECEMBER 2011 - issue # 079 Dr Danielle Ghusn Breast and Endocrine Surgeon Dr Danielle Ghusn is a graduate from the University of Queensland and underwent Surgical Training at the Royal Brisbane Hospital. After this, she completed two years as the Breast and Endocrine Fellow at a large Hospital in the UK, where she specialised in Oncoplastic Services for breast cancer patients. Dr Ghusn has been in practice for eight years and holds a position as Visiting Consultant Surgeon for NSW BreastScreen. She is a member of the Breast Section of the RACS, the Australasian Society of Breast Disease and is a full member the Australian Endocrine Surgeons. Dr Ghusn is interested in treating benign and malignant conditions of the breast, breast reconstruction, thyroid and parathyroid diseases and can be contacted on (07) 5598 0644. Allamanda Private Hospital Appointment Injects Further Confidence Healthscope’s appointment of a new General Manager for Allamanda Private Hospital assists progress on the Gold Coast University Private Hospital project with final negotiation nearing completion. David Harper has joined Healthscope and will work closely on the new private hospital to be co-located with the public Gold Coast University Hospital which is currently under construction on Parklands Drive opposite the Griffith University in Southport. David was previously responsible for peri operative services at Greenslopes Private Hospital for Ramsay Healthcare and has over 15 years experience in private and public healthcare. Healthscope Queensland and Northern Territory State Manager of Hospitals, Richard Lizzio, says he is confident David is the right person for the job. “In my experience working with David, he has the ability to achieve outstanding operational results as well as drive excellent clinical outcomes,” he said. “His doctor, patient and staff satisfaction are second to none that I have witnessed and I am extremely excited to have him on our team.” Healthscope are currently finalising negotiations with Queensland Health for the new large-scale hospital, with construction plans and specialist recruitment underway. David says the Gold Coast University Private Hospital project is an exciting venture and one that will set the benchmark in healthcare on the Gold Coast and throughout Queensland. “The state-of-the-art private hospital will be unrivalled by any other on the Gold Coast and equal to the best hospitals in Australia,” he said. “From the design and fit-out; to the equipment, doctors, staff and procedures available, we are determined to surpass all expectations and set new levels of treatment and care for the people of the Gold Coast.” Gold Coast University Private Hospital is expected to include 233 beds with the capacity for an additional 120 beds, allowing immediate and easy expansion as needed. “The hospital will include 11 integrated operating theatres, a hybrid theatre and Cardiac Catheterisation Laboratory, all equipped with the next generation of technology,” David said. “There will also be space for at least a further four theatres, 750 car parks, and the hospital will offer an obstetric service with a 25 bed ward and five delivery suites.” With the design phase due to be finalised in 2012, David expects construction of the new hospital will start in mid 2013. “We have an excellent team focusing on this project and we see it as a priority for Healthscope and a necessity for the people of the Gold Coast.” the medical link 35 Heart Beat Looking Through the Lens By Dr John Corbett I have long been a passionate amateur photographer and I have tended in the past to blend my love of nature, gardening and flora with the intrigue of macro photography. Evidence of this passion can be seen on display in my neurology and sleep clinics (my ‘private’ photographic-art gallery) and I enjoy great pleasure in seeing patients trying to identify the exact nature of the macro photos they see – good macro images don’t necessarily give up their secrets easily. I did enjoy a recent holiday which was planned specifically for photographic opportunities but not of the macro kind, viz, a cruise from Argentina to Antarctica and then on to Rio de Janiero for Carnivale. The two destinations were polar opposites. Antarctica proved to be the ultimate example of ‘staged’ natural beauty and if there is ever a place to render a human seemingly insignificant, this is it. The vast, pure, silent expanses were punctuated only by the presence of such creatures as whales, penguins and seals. The opportunities for photography were limitless. Icebergs floated endlessly by and could not be more beautiful if they were carved by a renaissance sculptor. These scenes were so spectacular as to transform even a novice photographer readily into a master (but one with very cold hands from time to time!). Rio – by stark comparison – was a heaving mixture of music, singing, dancing (samba), drama, comedy, colour, beauty and movement. Everywhere you looked was an example of human imagination and creativity. In the grand parade (which lasted for two full nights), every performer, costume and float was meticulously detailed in all colours of the rainbow creating the perfect backdrop for the city to evolve into the world’s largest party. The infectious mood was of simple unbridled, carefree enjoyment. Hypnotic, ear-splitting samba beats made it impossible not to become involved and affected by the energy which seemed to flow freely for days on end, stoked by frenzied locals and visitors alike – believe it or not, two million people of all ages ‘party’ in wonderful, harmonious, community celebration. The nights were lit by countless lights creating a day-time ambience and a perfect photographic scenario – the most rank amateur of photographers could not fail to produce wonderful shots, and no two images could ever be the same, as no subject remained still or unchanged for long. • Expert travel health advice • Vaccinations - including Yellow Fever • Anti-malarials & Insect repellents FREE UNDERCOVER PARKING Level 2 The Vision Centre 95 Nerang St, Southport Queensland 4215 Website: www.travelmedicine.com.au (Opposite Gold Coast Hospital) 5526 4444 5527 1088 36 • Travel Products • Medical Kits the medical link For any person interested in photography, this holiday is an experience of a lifetime, and one that proved to be much more easily accessible and easily organised than we had ever expected. For those interested in seeing some of the images from this trip, I have posted some of my favourite shots at www.snoreaustralia/gcma. I would be glad to share these with any who are interested and you are free to save them as desktop wallpapers or screensavers. NOVEMBER/DECEMBER 2011 - issue # 079 Heart Beat Robert Hitchins’ book review The Emperor’s New Drugs: Exploding The Antidepressant Myth By Irving Kirsch Irving Kirsch is Professor of Psychology at Hull in the UK and Emeritus Professor at Connecticut in the USA. His published research into placebos is highly regarded. Before training in psychology, he played strings in Aretha Franklin’s backing band, which is sufficient to get my R-E-S-PE-C-T at least. More recently, he has examined clinical trials of antidepressants as reported in The Emperor’s New Drugs. Drugs became the mainstay of modern psychiatry coincident with the theory that neurotransmitter imbalances in the brain, correctable by specific drugs, caused mental illness after those psychoactive drugs were shown to affect levels of neurotransmitter breakdown products in spinal fluid. Chlorpromazine lowered dopamine levels so it was postulated schizophrenia was due to too much dopamine; antidepressants increased brain serotonin levels so depression was due to lack of serotonin. Using this logic, you could argue all pain is due to deficiency of morphine or that fevers are all due to lack of aspirin. And after decades of research, the neurotransmitter theory remains unproven. Staring in 1995, Hirsch reviewed published clinical trials comparing various depression treatments with placebos, and psychotherapy with no treatment. Most studies lasted 6-8 weeks during which time patients can improve somewhat without any treatment. Kirsch was unsurprised to find placebos were three times as effective as no treatment but disturbed that placebos were 75 percent as effective as antidepressants when judged by common scales of depression. He then obtained all data submitted to the US Food and Drug Administration (FDA) between 1987 to 1999 about fluoxetine, paroxetine, sertraline, citalopram, nefazodone, and venlafaxine. Drug companies must submit all clinical trials they have sponsored but only need two positive ones to get approval. Positive studies are published and widely publicised while negative ones are regarded as proprietary and therefore confidential, so remain unseen. Again, most studies were negative and placebos were 82 percent as effective as the drugs tested. Average difference between drug and placebo on the Hamilton Depression Scale (HAM-D) was 1.8 points – statistically significant but clinically meaningless. All six drugs were equally unimpressive. This book is concise, readable, and very disturbing. Lacking prescribing rights himself, Hirsch could be accused of ‘sour grapes’ but similar concerns are raised by Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker (a journalist), and Unhinged: The Trouble With Psychiatry – A Doctor’s Revelations About a Profession in Crisis by Daniel Carlat (a psychiatrist). Remember when... An excerpt from the ‘First 50 Years History of the Gold Coast Medical Association’ written and published by Dr Alistair Dick (Consultant Physician at Southport 1962 – 1993) The Local Medical Association’s Activities. Year by Year – 1991 The mood this year was again quieter, in keeping with the economy which was in recession. The cynical mood of the nineties was setting in; people were more concerned with consolidating and protecting their gains. The Executive included Dr Rob Hitchins, President, Dr Paul Bennett, Vice President, and Dr John Sing, Secretary, all specialists, and they tended to concentrate on the more serious issues, of which there were plenty. To start with, the LMA members, especially the GPs, were probably getting tired of being harangued about bulk billing for the past seven years; it was clearly a lost cause with over three quarters of all GP services being bulk billed. They were used to living in direct confrontation with the Government, but now there were new threats looming, multiple threats creating uncertainty. First there was the ill-fated co-payment scheme, which was not resolved until March 1992. Then throughout 1991 and 1992 there was a steady stream of reports and issues papers from the Macklin Inquiry, canvassing various options for improving health services, mostly designed to NOVEMBER/DECEMBER 2011 - issue # 079 reduce costs. There was talk of cutting GP provider numbers by 5900. Back at the workplace, Quality Management and Casemix were being introduced, complex issues which few really understood. The role of the administrators was focussed on plans and strategies, the patients and health workers like pawns in their game. Patients were now being referred to as clients or consumers. The older doctors and nurses were finding it difficult to accept their new status. The state government was also active this year in implementing new systems. On July 1 the old system of Hospital Boards was scraped and replaced by a system of Regional Health Authorities. The South Coast RHA included the Beenleigh and Beaudesert areas as well as the Gold Coast, and was responsible for the planning and administration of not only the hospital but all health services. Dr Hitchins was appointed as one of seven members of the new Authority to develop its structures and strategies, and meanwhile administrative chaos reigned. the medical link 37 Heart Beat soduko 9 7 8 4 5 2 9 8 1 3 4 7 6 5 1 5 3 7 2 4 7 2 1 8 6 9 5 Soduko answers available in the next issue SEPT/OCT 2011 soduko the MEDICAL LINK To have your community announcement considered for this page, please contact us on (07) 5575 7054 or [email protected] 5 1 3 6 9 answers 1 December 2011 Christmas Lights Competition – Gold Coast Entries are now open for Gold Coast City Council’s Christmas Lights Competition. Join hundreds of Gold Coast residents, businesses and community groups in lighting the city with the magic of Christmas. For more information visit www.goldcoast.qld.gov.au 3 December Arj Barker - Eleven Paradise Showroom, The Art Centre Gold Coast Returning to Australia with his new side spilling show. Arj Barker - Eleven will send an audience into roars of laughter as he discusses some controversial topics in a hilarious show. Tickets available from www.theartscentregc.com.au 24 December Scrooge: A Christmas Spectacular - 8pm Gold Coast Convention & Exhibition Centre All your favourite carols and a story for the ages. METRO Church presents a Christmas carols event for the whole family. Come and celebrate Christmas Eve at the Gold Coast’s premier carols event. Visit www.gccec.com.au 25 December Jupiters Christmas Lunch The Pavilion Ballroom, Jupiters Hotel and Casino. Food and entertainment from 11am. Tickets www.ticketmaster. com.au 26 December Gold Coast United Vs Brisbane Roar Skilled Park, Robina, Gold Coast Gold Coast United take on Brisbane Roar in the Hyundai A-League. Be a part of the action and excitement of a live game!!! Support your team at Skilled Park in Robina. Pre purchase tickets www.ticketek.com to be part of the action!! 31 December Gold Coast New Years Eve Fireworks The Gold Coast is a popular holiday destination. The Christmas and New Year season brings visitors from across the world to experience the beautiful Gold Coast. Enjoy the magical display of lights across the sky from a various of vantage points across Surfers Paradise, Broadbeach and beyond. Visit www.goldcoast.qld.gov.au puzzle corner 9 5 3 7 1 6 4 2 8 4 6 2 9 3 8 7 1 5 8 1 7 2 4 5 6 3 9 2 9 8 3 6 1 5 7 4 3 4 1 8 5 7 9 6 2 5 7 6 4 2 9 1 8 3 7 8 4 1 9 2 3 5 6 6 2 9 5 7 3 8 4 1 1 3 5 6 8 4 2 9 7 Advertisers’ Websites City Fertility Centre Gold Coast ...................www.cityfertility.com.au Dr Julian Boulnois .......................................www.drjaypsych.com.au Godfrey Pembroke Financial Consultants .....www.godfreypembroke.com.au/goldcoast Gold Coast Medical Typing ..........................www.gcmedicaltyping.com.au Gold Coast Vasectomy Clinic .......................www.goldcoastvasectomy.com.au Great Ideas in Nutrition ...............................www.greatideas.net.au HOCA Gold Coast .......................................www.hoca.com.au Inarc Design Queensland .............................www.inarcdesign.com Investec Professional Finance Pty Ltd ..........www.experien.com.au Julie Albrecht & Associates Pty Ltd ............www.foodbodylife.com.au Julie Le Franc Psychoanalysis Services .......www.julielefranc.com.au KPMG ........................................................www.kpmg.com.au Leading Steps.............................................www.leadingsteps.com.au Malisano ....................................................www.malisano.com.au Medeleq Pty Ltd ........................................www.medeleq.com.au 38 the medical link Monash IVF Gold Coast ..........................www.monashivf.com Moneydoctors Pty Ltd ............................www.moneydoctors.com.au Mudgeeraba General Practice .................www.goldcoastvasectomy.com.au NABhealth .............................................www.nab.com.au/health Newport Custom Shutters ......................www.newporttimbershutters.com.au physio@home .....................................www.physioathome.net.au Pindara Private Hospital .........................www.pindaraprivate.com.au Q Scan ..................................................www.qscan.com.au Skinner Hamilton Accountants & Business Consultants .www.skinnerhamilton.com.au Snore Australia ......................................www.snoreaustralia.com.au Southport Day Hospital ..........................www.cosmedic.com.au The Travel Doctor ..................................www.travelmedicine.com.au Vasectomy Venue .................................www.vasectomyvenue.com.au Vision Eye Institute ................................www.visioneyeinstitute.com.au Wesley Weight Management Clinic..........www.wesweight.com.au NOVEMBER/DECEMBER 2011 - issue # 079 SCP_468 DESIGN & MANUFACTURE OF QUALITY | TIMBER SHUTTERS & TIMBER VENETIAN BLINDS ALSO SUNSCREEN ROLLERBLINDS & ALUMINIUM SHUTTERS BRI S BANE T. 07 3 3 6 7 2 4 9 9 F. 0 7 3 3 6 8 3 0 3 8 | GO LD C O AST T. 07 5593 4031 F. 07 5593 8429 | www.n ewp o r t s h u t t er s .co m Medical Finance borrow up to 100% and buy the home you want, why wouldn’t you? At Investec, our mortgage products provide flexibility for owner occupiers to borrow up to 100% of the purchase price, or up to 95% of the purchase price for investment properties, without Lenders’ Mortgage Insurance. Enjoy the benefits of having a dedicated mortgage specialist who can offer competitive interest rates, offset facilities and a quick and easy approval process. Get into your home quicker. Contact your local banker, call 1300 131 141 or visit www.investec.com.au/medicalfinance. Home Loans • Asset Finance Property Finance • Deposit Facilities • Goodwill & Practice Purchase Loans E x p e r•i eCommercial n Income Protection & Life Insurance • Professional Overdraft Investec Professional Finance Pty Limited ABN 94 110 704 464 is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 AFSL 234975. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. We reserve the right to cease offering these products at any time without notice. Investec Professional Finance is not offering financial or tax advice. You should obtain independent financial and tax advice, as appropriate. NOVEMBER/DECEMBER 2011 - issue # 079 the medical link 39