AFPHM eBulletin – 8 February 2019
No Time for Games
A new call to action from health professionals: will you act?
The World Health Organization has called climate change the biggest and most urgent public health challenge of our time.
The 'biggest' because it fundamentally undermines the very foundation of our societies and what we need to stay healthy, such as clean air, clean water, food security and of course a stable climate. The 'most urgent' for if we don’t act effectively and decisively right now, then it is today’s children and future generation who will pay the biggest price with their health, and it will be too late to deal effectively with the catastrophic health impacts of climate change.
This is a great injustice, as it is our future generations who have least contributed to climate change, yet who will suffer the greatest impacts and be unable to stop it. It is really intergenerational inequity or theft.
The most recent Intergovernmental Panel on Climate Change (IPCC) special report published in November 2018 makes this abundantly clear. We must reduce our greenhouse gas emissions by at least 45 per cent by 2030 and 100 per cent by 2050 if we want to have a 'reasonable' chance of staying below 1.5ºC global warming. Going above 1.5ºC global warming means millions more deaths related to climate change and the end of the civilisations of many island nations around the world.
Beyond 2ºC warming, the impacts are almost unthinkable, with the erosion of civilisations as we know them, including conflict, famine and mass displacement of people.
The technical and economic solutions to the problem exist and there are many health co-benefits of action on climate change (such as improved air quality, improved physical fitness, and mental health), yet greenhouse gases are continuing to rise.
So what is the real problem?
The real problem is a lack of political will. Doctors for the Environment Australia (www.dea.org.au) has therefore launched a new campaign to harness the energy of health professionals and focus on children’s health: No Time for Games.
This campaign is based on the report of the same name, and an updated summary. The aim is to empower health professionals to speak up for those who do not yet have a voice but whose health will be most affected: children and future generations.
No Time for Games aims to take the politics out of climate change and remind politicians and key policy makers in Australia that this is primarily an urgent public health issue.
With the support from the RACP, prominent paediatricians, medical colleges and highly regarded health leaders such as Professor Fiona Stanley and Professor Kerryn Phelps,and health professionals right across Australia are being asked to pledge support for four key recommendations, which would result in effective action on climate change.
DEA will present all collected pledges of support to the Prime Minister and Health Minister in April this year before the federal election. A united voice for action on climate change from health professionals will help give our political leaders a mandate to act for the health and wellbeing of Australia’s children and future generations.
The pledge supports the following recommendations:
- An urgent effective and pro-active whole of government bipartisan approach to climate mitigation including a rapid and just transition to renewable energies
- Strengthening our primary emergency services, rural and mental health services to increasingly be able to respond to children affected by climate change
- Greening our health care systems, in which health professionals are well placed to be a driving force to significantly reduce greenhouse gas emissions and waste
- Consider divestment as an effective tool for divesting funds from fossil fuel related activities, similar to health sectors divesting funds from tobacco industries.
Pledge your support today by going to www.notimeforgames.nationbuilder.com and signing the pledge.
But there’s more.
Tell your colleagues about this initiative and ask them to sign as well. Declare your pledge on Twitter, Facebook, Instagram and other social media channels. We need to build a groundswell public health movement around this campaign by encouraging all health professionals to join in. This we can only do with YOUR help.
Now is the time for us as health professionals across Australia to speak with one voice, to protect health of those who do not yet have a voice.
For any questions or comments please email firstname.lastname@example.org and for more information visit notimeforgames.dea.org.au
Dr Ingo Weber
Ingo Weber is a qualified rural GP who trained in Anaesthetics and now works as a full time Anaesthetist at the Lyell McEwin Hospital. He lectures at both South Australian medical schools on the health impacts of climate change.
A message from your President
It has officially been declared that January 2019 has been Australia’s hottest month on record. We have seen searing heatwaves across most of Australia, extensive bushfires in Tasmania and elsewhere, floods in Townsville, and drought across much of Queensland and New South Wales. We are truly experiencing the impacts of human-induced global warming.
Given these impacts are being experienced at a little over 1oC above global average temperatures, it is clear that we (humanity and other species) are in for a rough ride, as global temperatures will continue to rise. So, what does this mean for our public health practice? This rapid change means that our future work will not be business as usual, but how will it change? No doubt this will vary according to where we live and the type of work that we do. Rather than tell you what I think, I’d love to hear from you. I’ve generated a three-question survey
to find out what you think. If you have time, I’d love to hear from you.
Last year I asked you about leadership. Thanks to the five people who completed the survey. Of the five, two had undertaken Royal Australasian College of Medical Administrators (RACMA) training in order to increase their leadership skills. A couple of respondents said that it is not possible to separate leadership from management and that we need to learn how to be better managers. What was clear from the respondents, was that our public health medicine training doesn’t necessarily prepare us to be leaders or managers, and that life experience or other qualifications were necessary. RACMA is offering a series of one-day leadership masterclasses that may be useful, and the AFPHM curriculum review is an opportunity to consider what more we can do to ensure that we Fellows are prepared for both leadership and management.
Finally, I’m happy to say that the RACP Board has formally responded to our Future of the Faculty Report. The Board has agreed for the report to be released to members and that discussions would commence to consider the report’s recommendations, in consultation with our colleagues in the Australasian Faculty of Occupational and Environmental Medicine and the Australasian Faculty of Rehabilitation Medicine. Watch this space for more details.
Associate Professor Linda Selvey
Lancet Reports Released
Two significant reports have recently been released by the Lancet:
AFPHM Communique – December 2018
The AFPHM Council Communique
for December 2018 is now available online. This communique provides updates on the work the AFPHM Council and Committees have been working on over the last few months.
AFPHM Webinar # 1 2019: ‘Remodelling Health Care for Aboriginal people in Remote Settings’
All members are invited to join the first AFPHM Webinar for 2019, presented by Northern Territory-based Public Health Physician, Dr Rosalie Schultz. Dr Schultz has worked in the public health sector in remote areas of Australia for over 20 years, working in a range of clinical and public health roles. Her presentation will draw upon her experience of working with Aboriginal people in remote communities.
Tuesday, 26 February 2019
3pm to 4pm AEDT
For information on how to join the webinar, go to the AFPHM Webinar #1 event page
To watch previous webinars, go to our Youtube playlist
If you are interested in presenting a future webinar, please contact AFPHM@racp.edu.au
RACP Fellows honoured
This year 35 Division, Faculty and Chapter Fellows were recognised in the Australia Day and New Zealand New Year Honours lists. We would like to congratulate the following Fellows of the AFPHM for their outstanding work.
Member of the New Zealand Order of Merit (MNZM)
- Dr Susan Mary Bennett Morton FAFPHM, for services to epidemiology and public health research.
Australia Day 2019 Honours
Officer (AO) in the General Division of the Order of Australia
- Professor John James McNeil AM, FRACP, FAFPHM, for distinguished service to medicine in the fields of clinical epidemiology and cardiovascular research, and to public health
Member (AM) in the General Division of the Order of Australia
- Dr Margaret Elena Hellard FRACP, FAFPHM, for significant service to medicine as an infectious diseases and public health physician and research scientist.
- Dr Paul Angus Lancaster FRACP, FAFPHM, for significant service to community health, particularly to perinatal and paediatric medicine.
- Professor David Carlisle Whiteman FAFPHM, for significant service to medical research in the field of cancer epidemiology.
Medal (OAM) of the Order of Australia in the General Division
- Dr Christine Maree Connors FAFPHM, for service to medicine through a range of roles.
A list of all Division, Faculty and Chapter Fellows who have been recognised for their exceptional work is available on the RACP website.
Register now – AFPHM Members Dinner
All members are invited and welcome to attend the AFPHM Members Dinner, to be held in Auckland prior to the RACP Congress on Sunday, 5 May 2019. This is an opportunity for you to meet and enjoy a meal with other members of the Faculty.
Sunday, 5 May 2019
7pm until 10pm
FISH Restaurant, Auckland, New Zealand
Further details are available online
RACP Congress 2019 – early bird closing soon
With early bird closing in two weeks now is the time to register your attendance to the RACP Congress 2019 taking place from Monday, 6 to Wednesday, 8 May 2019 at the Aotea Centre in Auckland, New Zealand.
The RACP Congress program is tailored by professionals in your field, professionals that regularly face the same situations and challenges as you. Register now to attend the AFPHM session on rural and remote populations and health issues. Australians and New Zealanders living in rural and remote areas generally experience poorer health outcomes than people living in metropolitan areas. They have higher rates of chronic disease and mortality, poorer access to health services and are often more likely to engage in behaviours associated with poorer health. AFPHM have invited speakers who have worked in rural and remote areas to discuss the various factors impacting these populations and how physicians can be better supported to achieve higher health outcomes for these populations.
RACP Congress 2019 key topics include:
- Life course theory ‘How do we impact health along the life course?’
- Obesity: rising to the challenge
- First 1000 days and non-communicable diseases
- Medically unexplained symptoms master class
- Mental health and addiction of patients
- Chronic disease and integrated care.
Early bird registration closes 22 February 2019.
Visit the Congress website to register and view the program.
Have you read our new position statement?
A position statement setting out the RACP’s role in improving Aboriginal and Torres Strait Islander health, including work within the College and our partnerships and advocacy outside the College, was released in December 2018.
The Aboriginal and Torres Strait Islander Health Position Statement was developed by the Aboriginal and Torres Strait Islander Health Committee (ATSIHC), chaired by Professor Noel Hayman.
A 2018 deliverable contained in the Indigenous Strategic Framework, the statement combines the RACP's existing support for Constitutional recognition of Australia’s First Peoples, development of a Treaty, a human rights approach to health equity, and advocacy for the health benefits of genuine reconciliation.
Read the Position Statement
Register now for the Tri-Nation Alliance annual International Medical Symposium
The Tri-Nations Alliance annual International Medical Symposium (IMS 2019) will be held in Auckland, New Zealand on Friday, 22 March 2019.
IMS 2019 is a one-day event bringing together representatives from international and local specialist medical colleges, medical schools, health services and regulators for an inspiring day where challenges are discussed, and new ideas explored.
The theme for the 2019 symposium is 'Visioning the impact of advanced technology on medical education' with a program featuring diverse sessions including:
- Professor Enrico Coiera – Trust and AI
- Professor Jenny Weller – Using simulation training to learn about non-technical skills management
- Associate Professor Rebecca Grainger – Current research on apps to monitor patient self
- Mr Andrew Connolly – Informed by AI: the systemic challenges before us
- Professor Jim Warren – Consumer health information revolution
- Mr Greg Cross – Using avatars for teaching
- Dr Jaron Chong – Training radiology residents when machines read imaging
- Professor Tim Shaw – AI in trainee assessment.
To view more IMS 2019 sessions and to register visit the IMS 2019 website.
PREP program requirement website content updated
The new Physician Readiness for Expert Practice (PREP) program requirements are now available on the relevant Basic Training and Advanced Training specialty pages.
The 2019 Basic Training program requirements apply to all trainees registered in a PREP Basic Training program in 2019.
The 2019 to 2020 Advanced Training program requirements apply to all trainees registered in a PREP Advanced Training program in 2019 and/or 2020.
PREP trainees and their supervisors should familiarise themselves with the updated program requirements for their specialty.
It is the responsibility of the trainee to ensure that they are following the correct guidelines for each training year.
Fellows funding opportunity
Grants worth up to $10,000 are on offer to RACP Fellows living and working in rural and remote Australia.
Importance of mulitsource feedback highlighted
As the RACP's new MyCPD Framework comes into effect, Dr Peter Roberts and other Fellows who are incorporating the changes into their practice and lifestyles, share their thoughts on Continuing Professional Development (CPD).
Accelerating the elimination of Viral Hepatitis
Viral hepatitis is a major threat to public health and a leading cause of death worldwide. Each year, viral hepatitis kills 1.34 million people, which is comparable with deaths due to HIV/AIDS, malaria, and tuberculosis.
With the advent of highly effective prevention measures and treatments, global elimination of viral hepatitis is a realistic goal; all World Health Organization (WHO) member states have committed to a global reduction in hepatitis-related deaths by 65 per cent and new infections by 90 per cent by 2030.
The Lancet Gastroenterology & Hepatology’s new Commission on accelerating the elimination of viral hepatitis sets out to appraise the current global situation and to identify priorities – for countries, regions, and globally – to accelerate efforts towards these ambitious targets.
The Commission is available free with registration on the The Lancet Gastroenterology & Hepatology’swebsite.
Seeking AFPHM representatives for committees
Are you willing to represent your colleagues and be a voice for the Faculty? Would you like to be part of creating positive change within the Faculty?
The Faculty is currently seeking Expressions of Interest for the following positions on:
Accredited AFPHM training positions
As a part of the AFPHM training program, trainees are expected to complete their core training in an AFPHM accredited training position.
A list of accredited AFPHM training positions is available on the RACP website
A new training program to support your clinical practice
End-of-Life Law for Clinicians (ELLC) is a new training program for clinicians and medical students about the law relating to End-of-Lifee decision-making.
ELLC has been developed by the Australian Centre for Health Law Research, Queensland University of Technology (QUT) and the Institute of Health and Biomedical Innovation, QUT, with funding from the Australian Government Department of Health.
ELLC is a free program, the online training modules are available on the ELLC online training portal.
For more information, please visit the ELLC website.
Guidance on implementing the The Misuse of Drugs (Medicinal Cannabis) Amendment Act 2017 NZ; exemption and statutory defence for patients requiring palliation (New Zealand)
What you need to know about the Act
The Misuse of Drugs (Medicinal Cannabis) Amendment Bill came into effect on 18 December 2018.
The Act provides an exemption and a statutory defence for people who require palliation to possess and use illicit cannabis, or a cannabis utensil. In the Act – ..."a person requires palliation if, in the opinion of a medical practitioner or a nurse practitioner, the person has an advanced progressive life-limiting condition and is nearing the end of their life."
What does the exemption and statutory defence mean?
A person with evidence from a medical practitioner or nurse practitioner that they require palliation would not be committing an offence if they possess or use illicit cannabis or a cannabis utensil.
People who do not have evidence at the time of questioning about possession and use of illicit cannabis, but can produce evidence from a medical practitioner or nurse practitioner that they require palliation in court, will have a defence against conviction.
How to certify a person requires palliation
A medical practitioner or nurse practitioner can certify that a person requires palliation (as defined in the Act). The certification is a written statement that in the medicinal or nurse practitioners’ clinical opinion, the patient meets the definition of palliation in the Act. The certification is not an endorsement of the use of illicit cannabis.
There is no prescribed template for certification in the Act. The documentation could be in the form of a letter and needs to contain:
- the patient’s name and address
- the practitioner’s name, address and Medical Council/Nursing Council number
- the date that the patient was seen
- a statement that s/he requires palliation as defined by the Act.
While the Act does not specify a requirement to renew certification, the Ministry recommends patients’ certification are renewed after 12 months.
Relevant links and resources
NZ Ministry of Health Website and example certification letter
The Misuse of Drugs Act 1975
Guidance on products containing cannabidiol (CBD) are now prescription medicines only (New Zealand)
The passing of the Misuse of Drugs (Medicinal Cannabis) Amendment Bill means some products containing cannabidiol (CBD) are now prescription medicines only.
- Products that meet the definition of a CBD product are prescription medicines.
- Ministry of Health approval is not required to prescribe, supply or administer products for medical purposes if they meet the definition of a CBD product.
- Medical practitioners and pharmacies are allowed to import CBD products, as are persons or companies holding a licence to sell medicines by wholesale.
- Individual patients may import CBD products provided they meet the requirements for importing prescription medicines (see below) but not any other cannabis based products.
- A maximum of three months’ supply is allowed on a prescription for CBD products.
For further information please refer to their website.
Did you know that Australians are living 25 years longer than we did 100 years ago?
The Australian Government has developed a new tool ‘Life Checks’, for Australians aged 45 and older to help them plan and prepare for a longer life. The website provides people with a free, quick and easy 'Life Check' to see how ready they are for the next stage of their life.
The 'Life Check' covers finances, health, work and social life, and provides tips on healthy eating, exercise, achieving financial goals and maintaining good health and wellbeing. Once a person completes their check, they will be directed to tailored information to help them better prepare for a healthy and secure future.
For more information please visit the Life Checks website.
New Guidelines for healthcare workers living with a blood borne virus (BBV)
There has been an update to the Guidelines for healthcare workers who perform exposure prone procedures and healthcare workers living with a blood borne virus (BBV). Exposure prone procedures (EPPs) are procedures where there is a risk of injury to the healthcare worker resulting in exposure of the patient’s open tissues to the blood of the health care worker.
The Guidelines have been updated to reflect new evidence and are consistent with changes made by other countries. They provide information and recommendations for:
- all healthcare workers who perform EPPs
- healthcare workers who live with a BBV and perform EPPs
- treating doctors of healthcare workers with a BBV who perform EPPs
- public health authorities.
The new Guidelines allow healthcare workers living with a BBV, to perform EPPs, provided they abide by these Guidelines.
They also provide guidance for all healthcare workers who perform EPPs.
Healthcare workers who perform EPPs must take reasonable steps to know their BBV status and should be tested for BBVs at least once every three years. They are also expected to:
- be tested for BBVs after an occupational exposure incident
- be tested according to Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) guidelines following non–occupational exposure
- confirm that they comply with these Guidelines when applying for renewal of registration.
The new Guidelines, exposure prone procedure guidance and information sheets can be found on the Department of Health's website.
Billing multiple MBS items
The guide helps you understand Medicare Benefits Schedule (MBS) item descriptions and how to bill items together.
The updated guide, Billing multiple MBS items, has new information about complete medical services and the multiple operation rule.
It includes scenarios about:
- comprehensive and combined items
- interpreting common MBS phrases
- multiple attendances on the same day
- attendances with other health services
- independent procedures.
It also includes more detail about MBS item descriptions like:
- ‘attendance not payable with another service’
- ‘not being a service associated with’
- ‘not being a service to which another item in this group or subgroup applies’.
Conferences and events
The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.
- The Fifth International Medicine in Addiction (IMiA) Conference, 1 to 3 March 2019, Melbourne
- Food Safety 2019: Frontiers in Food Safety and Nutrition, 13 to 14 May 2019, Belgium
- 2019 Public Health Summer School Series, 11 February to 1 March 2019, Wellington New Zealand
- Health Literacy Masterclass, 13 to 15 February 2019, Melbourne
- Somatic Symptoms in Children and Adolescents, 15 February 2019, Westmead NSW
- When Doctors Lead – Rethinking Leadership: RACMA Masterclass, 16 February 2019, Adelaide
- NCIRS Seminar/Webinar for providers: Conversations with vaccine-hesitant parents: how the new SKAI website can help, Monday, 18 February 2019, Westmead NSW.
- Mindfulness for Wellbeing and Peak Performance: RACMA Masterclass, 21 February 2019, Melbourne
- Presenting with confidence: RACMA Intermediate program, Friday, 22 February 2019, Brisbane QLD
- 2019 Australasian Chapter of Sexual Health Medicine Annual Scientific Meeting, Saturday, 16 March 2019, Brisbane QLD
- NextCare Health Conference, 30 to 31 March 2019, Brisbane
- Global Health Security 2019, 18 to 20 June 2019, Sydney
Go to the RACP events list at any time to see what events are coming up.
AFPHM contact details
AFPHM Faculty enquiries (including Council and committees):
Rachel Smith, Executive Officer
Phone: +61 2 9256 9622
AFPHM Education and Training enquiries:
Anusha Kumar, Education Officer
Phone: +61 2 8247 6286
AFPHM Oral Examination enquiries:
Caroline Greenaway, Examination Coordinator, Assessment and Selection Unit
Phone: +61 2 9256 9681
AFPHM training site accreditation inquiries:
Site Accreditation Unit
Phone: +61 2 9256 9674
AFPHM CPD enquiries:
Office of the Dean (CPD)
Phone: +61 2 8247 6285
AFPHM New Zealand enquiries:
RACP New Zealand Office
Phone: +64 4 472 6713