AMD eBulletin 26 July 2019

President's Post

RACP opposes repeal of Medevac legislation

Since the Second World War about one million people fleeing persecution have settled in Australia and New Zealand where they have contributed profoundly, culturally and economically. While in earlier times refugees were welcomed, in recent years, with increasing numbers of displaced people worldwide, the efforts of successive governments have focused on preventing people reaching our shores.

From 2013, when mandatory offshore processing was introduced by Australia, large numbers of people were transferred to detention centres on Manus Island in Papua New Guinea and on Nauru. The vast majority had suffered persecution in their homelands, with many having been subjected to torture and rape, and their refugee status was subsequently formally confirmed.

Although it has been a requirement of international law for more than 70 years that refugees are provided with adequate protection and support, this has been denied to many of those held in detention under Australian law. In particular, the healthcare they have received has often been deficient. The health needs of asylum seekers are often great because of the suffering they have endured, and being held off-shore indefinitely with no clear end date in sight, continued separation from families, and denial of the opportunity to engage productively in social life can further exacerbate physical and mental conditions. Overwhelming evidence has documented the extreme health risks associated with offshore detention on Nauru and Manus Island.

The RACP has long opposed immigration detention in any form, on the grounds that it is harmful to physical and mental health and represents a significant breach of human rights. The College has repeatedly called for the closure of regional processing centres in Nauru and Papua New Guinea. It supports doctors and other health professionals in their efforts to care for their patients, to maintain professional standards and to take action to ensure that the health needs of those under our protection are properly met.

Over the last few years and particularly in the last 12 months a health emergency has developed on Manus Island and Nauru, as a result of the circumstances described above and the lack of availability there of specialist medical services. Even where transfers for medical care in Australia have been urgently recommended by health staff, long delays have occurred, in some cases of more than five years.

It was in response to this emergency that the so-called 'Medevac' legislation (officially called the Home Affairs Legislation Amendment (Miscellaneous Measures) Act 2019) was passed by the Australian Parliament in February 2019. This law provides for the temporary transfer to Australia of patients being held on Manus Island and Nauru to allow them to receive medical or psychiatric treatment or assessment that is unavailable there. Medical transfers can be triggered by the recommendations of two independent treating doctors, who can provide their assessments in person or remotely. The Minister for Home Affairs has a right to object to the transfer and if his refusal is based on medical grounds he can refer a case to the Independent Health Advisory Panel (IHAP) for review.

Under the Medevac legislation, the Minister still retains the power to overrule the IHAP’s decision on the grounds of an adverse security assessment or where the Minister knows that the person has a substantial criminal record and may expose the Australian community to a risk of serious criminal conduct.

The Medevac process has proved to be a rigorous, transparent and independent process that provides clear timeframes and ensures that decisions about medical need are made on appropriate grounds. Despite initial warnings that the legislation would open 'floodgates' and result in many hundreds of sick refugees and asylum seekers being transferred to Australia, in reality only a few dozen transfers have taken place since the Act came into effect and only a handful of cases have been referred for consideration by the IHAP, which has actually accepted the majority of the Minister’s objections. Despite this, the Australian Government has now introduced legislation to repeal the Medevac law which will result in a return to the previous unsatisfactory circumstances.

The RACP believes that the processes set out under the Medevac legislation are working and should be maintained. We believe that they have improved access to appropriate healthcare for refugees being held offshore by ensuring that medically appropriate transfers take place. We believe that the IHAP also has an important role in monitoring and reporting on conditions in offshore processing, thereby increasing transparency. The College considers that the Australian Government has a responsibility to maintain the standard of healthcare that has now been achieved through the existing legislation and has conveyed its view that repealing the Act would be a backward step.

The parliamentary debate on the repeal of the Medevac law, which includes a Senate Inquiry,  is expected to continue until at least mid-October, resulting in the Medevac law remaining in force at least until then. This means that there is an urgent need for assessment of the health conditions of the remaining refugees and asylum seekers on Manus Island and Nauru to determine if any of them require further assessment or treatment in Australia. Many Fellows and trainees from the College are currently volunteering to contribute to such assessments. Other members interested in assisting with this process are invited to do so (see below).

The story of Australia’s treatment of refugees and asylum seekers is likely to be remembered by succeeding generations as an enduring dark, reprehensible shadow on our history. For their sake, and for the sake of those continuing to suffer in the offshore processing facilities established in our names, we must start the process of healing now.

College members prepared to assist with assessments of asylum seekers on Nauru or Manus Island are invited to contact me to express their interest. Comments and inquiries about this post are also welcome.

Paul Komesaroff
President
Adult Medicine Division
Telephone: +61 (0) 417 55 26 59
Email: paul.komesaroff@monash.edu

AChSHM President’s Post

I’m pleased to announce that the Lead Convenor for the AChSHM Annual Scientific Meeting (ASM) in 2020 will be Dr Vincent Cornelisse. Dr Cornelisse and the ASM Organising Committee will meet in the coming months to confirm the theme and begin developing the program. We look forward to releasing more details in the coming months.

Three awards will be presented at the 2020 ASM – the Penelope Lowe Trainee Prize, the AChSHM Award for Outstanding Contribution to Sexual Health Medicine, and the Award for Best Postgraduate Thesis in Sexual Health Medicine.

I encourage all trainees to get involved in the Penelope Lowe Trainee Prize, which is a fantastic opportunity to participate in the ASM and practice your presentation skills. Applications open on Thursday, 1 August 2019.

Nominations for the Award for Best Postgraduate Thesis in Sexual Health Medicine will also open on Thursday, 1 August 2019. Fellows and trainees who have been awarded a doctoral or masters by research thesis within the last five years are eligible to nominate. AChSHM members can nominate another person or can self-nominate.

The Award for Outstanding Contribution to Sexual Health Medicine formally recognises the contributions made by Fellows of the AChSHM. Nominations open on Monday, 26 August 2019.

The Chapter Committee will next meet via teleconference on Thursday, 5 September 2019. If you have any feedback or issues you would like to raise with the Committee, please don’t hesitate to contact us through our secretariat at shmed@racp.edu.au.

Associate Professor Catherine O’Connor
President
Australasian Chapter of Sexual Health Medicine

AChPM President’s Post

I encourage you all to complete the 'My Work Profile' section of your MyRACP account. The AChPM Committee is keen to advocate on behalf of our members on emerging workforce issues, but to inform any action we need good quality workforce data from our membership. The completion of your work profile takes around five to 10 minutes, so please go to MyRACP to contribute your information and enable us to better inform our understanding of the palliative medicine workforce.

Thank you to those who provided feedback on the revised Palliative Medicine Evolve List of low-value practices and interventions. The revised list has now been finalised and published on the RACP Evolve website. Two of the previous recommendations have been replaced, with the remaining three unchanged. One of the newly developed recommendations asks palliative care specialists to limit routine use of antipsychotic drugs to manage symptoms of delirium, and the other calls on physicians to target referrals to bereavement services at those family members and caregivers who are experiencing more complicated forms of grief.

The AChPM Committee will next meet via teleconference on Friday, 16 August 2019. If you have any feedback or comments for the Committee, please do not hesitate to contact us through our secretariat at PallMed@racp.edu.au.

Professor Greg Crawford
President
Australasian Chapter of Palliative Medicine

AChAM President’s Post

The Chapter has been busy in the policy and advocacy space, recently leading the RACP submission to the NSW inquiry on Sydney’s night-time economy and its submission to the consultation on the draft National Treatment Framework on alcohol and other drugs.

The Asia-Pacific Society on Alcohol and Addiction Research is holding its biennial conference in Kuala Lumpur from Wednesday, 27 to Friday, 29 November 2019. Many AChAM Fellows have been involved in this conference in the past, particularly in 2015 when it was held in Sydney. Interested members can view the program and register on the conference website.

For AChAM Fellows and trainees in Sydney, there will be a half-day symposium at Westmead Hospital on Thursday, 29 August which will provide an overview of harm reduction and of the relevant measures being undertaken by Western Sydney Local Health District’s Drug Health Unit. Speakers include Alex Wodak, Marianne Jauncey and Catherine Silsbury. Interested members can find more information on the RACP website.

A reminder to all Fellows to continue to update your CPD credits before the end of the year.

If you have any feedback, questions or comments for us, you can get in touch with the Committee via our secretariat at AddictionMed@racp.edu.au.

Dr Martyn Lloyd-Jones
President
Australasian Chapter of Addiction Medicine

Treatment recommendations for MDR/XDR gonococcal infections in Australia

Guidelines for the treatment of infections due to Neisseria gonorrhoeae which are not susceptible to ceftriaxone and/or are resistant to azithromycin are now available.

These guidelines are intended for use by sexual health and infectious disease specialists. The recommendations were made by a working group reporting to the Communicable Diseases Network Australia (CDNA). They have been endorsed by CDNA and are supported by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). 

The guidelines, Recommendations for treatment of gonococcal infections in the era of MDR/XDR gonorrhoea include the recent change to the recommended routine treatment of uncomplicated gonococcal pharyngeal infections and the rationale for this. The recommended routine management of uncomplicated gonorrhoea is described in the Australian STI Management Guidelines, which include a link to the rationale for the change to treatment of pharyngeal infections.

College Gender Equity in Medicine meeting

You are invited to join your fellow members at an RACP Gender Equity in Medicine meeting on Tuesday, 20 August 2019 to showcase important gender equity initiatives and discuss the roles our College and membership can play to promote gender equity. 

Spaces are limited, so please register by Thursday, 15 August to avoid disappointment. 

When: Tuesday, 20 August 2019

Time: 6pm to 8pm (AEST)

Where: RACP Sydney Office, Level 19, Governor Macquarie Tower, 1 Farrer Place, Sydney
or
RACP Melbourne Office, Presentation Room, Level 2, 417 St Kilda Road, Melbourne
or
Via teleconference – dial in details will be provided on registration.

Call for reviewers – Research Entry Scholarship and Travel Grant Applications

Applications for Research Awards offered through the RACP Foundation have recently closed.

The Grants Advisory Committee (GAC) extends an invitation to Fellows who are willing to assist in reviewing the Research Entry Scholarship and Travel Grant applications. Reviewers will be assigned around 20-30 applications to review, with the review period from Thursday, 8 August 2019 to Thursday, 26 September 2019.

To assist the GAC with the assessment of over 160 submissions received for 2020 Research Entry Scholarships and Travel Grants, reviewers are urgently needed in the following specialty areas:

  • neurology
  • cardiology
  • oncology
  • endocrinology
  • paediatrics.

Expressions of interest will be accepted until Monday, 5 August 2019. Please email the RACP Foundation for more details.

Fellowship Medals

Nominations are now open for the following College awards acknowledging outstanding contributions and achievements made by Fellows and trainees in their respective fields:

Successful nominees are presented a medal at the RACP Congress 2020 in Melbourne and receive full Congress registration, return economy airfares and up to three nights accommodation.

If you have a mentor or colleague you wish to recognise, now is the time to nominate them for one of these prestigious awards. Nominations must be submitted by Monday, 16 September 2019.

Full details are available on the RACP Foundation website. You may also email the RACP Foundation for enquiries.

Ethics and High-Cost Drugs Ethics evening event

On 19 June 2019, an Ethics Committee event on ethics and high cost drugs was held at the College, and also webcast and recorded.

Dr Narcyz Ghinea presented on current and projected pharmaceutical spending patterns, and the degree to which current trends are sustainable and may contribute to low-value care.

Dr Wendy Lipworth presented the results of an empirical study which examined the strategies used by Australian cancer physicians to manage dual loyalties when prescribing high cost cancer medicines, between patient advocacy and health resources stewardship.

Dr Linda Sheahan FRACP provided an organisational ethics perspective on the role of Local Drug and Therapeutics Committees in overseeing the judicious use of medicines in hospitals, and decision making around drug approvals for Individual Patient Use.

Dr Ghinea and Dr Lipworth’s presentations are now available to view online

Important information about the cessation of workers entitlements to medical, hospital and rehabilitation expenses

As a result of the application of section 59A of the Workers Compensation Act 1987, one or more of your patients may no longer have their claim for medical, hospital and rehabilitation expenses compensated through the workers compensation system. They may need your assistance to prepare for this change.

The date these changes come into effect will vary, with some patients ceasing entitlements from September 2019.

If you are providing treatment/services to a patient(s) affected by these changes, you should gain a clear understanding from each patient when their entitlements will cease and let them know the costs of any treatment/services provided after that date will be their responsibility.

Treatments/services provided after the cessation date will not be paid by the insurer, even when previously approved.

The State Insurance Regulatory Authority (SIRA) encourages you to tailor your approach to affected patients and work collaboratively with insurer case managers to ensure patients receive appropriate support before their entitlements end.

You might consider actions to:

  • discuss and inform your patient(s) of medical and support services available to them and make referrals where appropriate. This could include through publicly-funded community, state or federal systems, or where applicable, services funded by private health insurers.
  • prepare a discharge plan with your patient(s) with the goal of developing self-management strategies to promote independence from health care. This will assist them with longer-term management of their injury or condition. 

For more information, you can follow this link to the Section 59A Information for health providers fact sheet, visit www.sira.nsw.gov.au or contact the patient’s workers compensation insurer case manager.

Aotearoa New Zealand Trainees' Day 2020 – Earlybird registration open 

Register today for Aotearoa New Zealand Trainees’ Day 2020. This event is developed by trainees for trainees and will be held on Saturday, 4 April 2020 at The Heritage Hotel in picturesque Queenstown.

If you are an RACP trainee, this event is for you. Whether you are a basic or advanced trainee, adult medicine or paediatrics, the Trainees’ Day will be inspiring and relevant for wherever you are in your training journey. Offering a variety of big picture topics and professional skills building, every NZ trainee should attend Trainees’ Day at least once during Basic Training and once during Advanced Training.

The Trainees' Day offers professional development and community building opportunities for all trainees at any stage of training. It is also supported as a recognised skills day by New Zealand District Health Boards and attendance costs are reimbursable and earlybird registration is open now.

Trainees’ Day is an opportunity to connect with the wider trainee community, take time out to think broadly and strategically about your career, and hear practical wisdom from experienced physicians and other professionals.

Register now for the RACP Aotearoa New Zealand Trainees’ Day 2020.

For more information email the RACP New Zealand team.

Upcoming changes to the Queensland Health (Drugs and Poisons) Regulation 1996

Dr Jeannette Young PSM, Chief Health Officer and Deputy Director-General Prevention Division at Queensland Health, has issued a letter regarding changes which came into effect on 1 July 2019 and may impact RACP members' prescribing activities. 

1 July notification requirement to the Queensland notifiable dust lung disease register

From 1 July 2019, Queensland medical practitioners from the following specialities are required to notify the Queensland Notifiable Dust Lung Disease register (NDLD register) if they make a diagnosis of a notifiable dust lung disease:

  • occupational and environmental medicine
  • respiratory and sleep medicine.

These specialists will be required to notify the NDLD register about a notifiable dust lung disease within 30 days of diagnosis using the approved form which is available via the NDLD Register website.

Notifications will be able to be submitted to the NDLD Register  via a secure portal.

Notifiable diseases include the following diseases caused by occupational exposure to inorganic dust:

  • cancer
  • chronic obstructive pulmonary disease including chronic bronchitis and emphysema
  • pneumoconiosis including asbestosis, coal workers’ pneumoconiosis, mixed dust pneumoconiosis and silicosis.

The Queensland NDLD Register has been established in response to the emergence of occupational dust lung diseases, including coal workers’ pneumoconiosis and silicosis. Changes to the Queensland Public Health Act 2005 and the Public Health Regulation 2018 provide a legislative framework for the NDLD Register.

Please note that the establishment of the Queensland NDLD Register is separate from a Commonwealth government arrangement to consider setting up a Dust Diseases Taskforce.

For further information please visit the  NDLD Register website.

Australasian Sleep Association and Sleep Health Foundation honoured with the Associations Forum 'Achievement of the Year Award'

The Australasian Sleep Association and Sleep Health Foundation were honoured this month with the Associations Forum 'Achievement of the Year Award', for successfully advocating for the Federal Government to call a Parliamentary inquiry into sleep health awareness. A key recommendation from the inquiry is the acknowledgement of sleep as the third pillar of good health, alongside a healthy diet and exercise, paving the way for policy development in the area with an avenue to obtain funding.

The work now continues to raise government funding to bring all the recommendations from the Parliamentary inquiry to fruition, to enhance the health and wellbeing of the Australian public.

On the same evening the Executive Officer of the Australasian Sleep Association, Stephanie Blower, was inducted into the Associations Forum Hall of Fame, which was established to exemplify the good work being done in the association and not-for-profit sector.  This award acknowledged the 40 plus years she has worked in the not-for-profit arena.

Congratulations to all involved! 

World Congress of Internal Medicine invitation

The World Congress of Internal Medicine (WCIM) will take place in Cancun, Quintana Roo, Mexico from 1 to 5 December 2020.The congress promotes scientific knowledge, collegiality and friendship among Internal Medicine doctors from all over the world. 

The theme of WCIM 2020 is 'Present and Future of Internal Medicine'. The Mexican Organising Committee, along with International Society of Internal Medicine (ISIM) and many other international societies are preparing a scientific program with the participation of world experts and will have a variety of academic delivery formats to allow diversity in presentations and learning; these will include keynote lectures, symposia, open forums, workshops, expert discussion, scientific oral abstract presentation and more. The collaborative nature of the meeting will influence and steer the pathway of the future of Internal Medicine in the second quarter of this century. 

In addition to the strong academic and scientific collaboration and experience, the Congress also wants you to enjoy the incomparable hospitality of Mexico. The Congress have prepared a formidable sociocultural program that will offer the beauty of Mexico. 

For more information visit the World Congress of Internal Medicine website.

Apply to be a member of the College Research Committee

Expressions of interest are open for a Fellow to join the College Research Committee. The closing date has been extended to Monday, 12 August 2019.

Webinar: Impact of Medical Assistance in Dying legislation on medical practice in Canada

The President of the Canadian Society of Palliative Care Physicians (CSPCP), Dr Leonie Herx, has offered to share a perspective on the 'Impact of Medical Assistance in Dying legislation on medical practice in Canada'. This opportunity is offered to RACP Members via webinar on Friday, 9 August, commencing at 12pm NZST.

As well as being President of the CSPCP, Dr Herx is the Divisional Chair of the Division of Palliative Medicine and Associate Professor in the Department of Medicine, Queen’s University, Ontario. She co-founded the new Royal College of Physicians and Surgeons of Canada (RCPSC) Subspecialty Program in Palliative Medicine and is the Vice-Chair of the RCPSC Specialty Committee in Palliative Medicine.

The RACP respects and supports all its members and does not believe it is appropriate or possible to enforce a single view on a matter where individual conscience is important. This webinar is offered to enable balanced discussion of this important issue and Dr Herx’s views are her own.

View the RACP Voluntary Assisted Dying Statement

Boost your genomics knowledge

The Clinical Genomics for Physicians online course introduces physicians in Australia and New Zealand to the emerging field of clinical genomics. It aims to enable physicians to use genomics appropriately in their practice and engage with its evidence-based integration into the broader health system. It features video interviews with physicians already using genomics, interactive tools, quizzes and case studies.

The course covers:

  • human genome structure and function
  • genome sequencing and testing process
  • applications of genomic testing in healthcare
  • discussing genomic testing and results with patients and their families
  • ordering a genomic test or referring to genetics services
  • interpreting a genomic report
  • ethical, legal and social issues.

RACP Online Learning Resources are free for RACP members and count towards Continuing Professional Development requirements.

My Health Record – Opportunities to better serve the population

Monday, 26 August 2019, 6pm to 7pm (AEST) Webinar

Join Dr Rosalie Schultz, Associate Professor Nick Buckmaster and the Australian Digital Health Agency for an interactive panel discussion on the opportunities My Health Record has for Indigenous health, integrated care and more. 

Register now 

New Pomegranate Health episode

Ep48: Training in the Bush Part 1—Country NSW

A third of Australia’s population is classified as regional or remote, but since it’s such a big place it’s hard to provide comprehensive heath care all over. As a result, chronic disease gets treated later and mortality is 1.3 times higher than it is in major cities, according to the Australian Institute of Health and Welfare.

There are only 42 per cent as many specialists per 100,000 population in regional areas as there are in major cities, but research shows that these experiences are more likely to lead to permanent careers in the country.

In this episode we visit the country town of Dubbo about six hours drive northwest of Sydney. The Dubbo Base Hospital services a catchment of 130,000 people spread across an area the size of Great Britain. While need in this area is high, Dubbo presents an example of strong clinical leadership and training across many specialties.

Harkness Fellowships in Health Care Policy and Practice 2020-21

The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career health services researchers and practitioners from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom to spend up to 12 months in the United States, conducting original research and working with leading US health policy experts.

AMC Expressions of interest

The AMC is inviting expressions of interest from their membership for the Progress Reports Sub Committee with positions for an Aboriginal and/or Torres Strait Islander member, a Māori member, and a member experienced in medical education.

The position descriptions, expected time commitment, information about the Sub Committee and application process are detailed in the following position descriptions.

Expressions of interest close Monday, 5 August 2019.

For more information, please contact Juliana Simon, Accreditation Policy Officer at specaccred@amc.org.au or +61 2 6270 9752.

New Informed Financial Consent Guide launched

The RACP is one of 13 leading medical colleges, societies and associations to co-badge the Australian Medical Association's Informed Financial Consent: A Collaboration Between Doctors and Patients. Other co-badged organisations include two RACP affiliated specialty societies, the Australasian Sleep Association and the Thoracic Society of Australia and New Zealand. The guide aims to empower patients to better understand medical costs, and engage in conversations with their doctors about their fees. It was launched on 23 July at Parliament House in Canberra by the Minister for Health, Hon Greg Hunt MP.

Expressions of Interest (EOI)

Join the Fellowship Committee as a Specialty Society representative
The Fellowship Committee is currently recruiting for a Specialty Society representative and would like to send out a call for expressions of interest to the Speciality Societies (except the Australian and New Zealand Society of Nephrology which is already represented). 

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. 

Australasian Society of Aerospace Medicine 'Humans In Space: Challenges for Exploration' short course, Tuesday, 3 to Saturday, 7 September 2019, Novotel on Collins, Melbourne


Webinars
The webinar program is now live, and is part of the Specialty Society Webinar Service that is being undertaken by RACP in partnership with its affiliated specialty societies. Please see below for information on upcoming webinars.

Dr Ann McCormack – Update in acromegaly
When: Wednesday, 31 July 2019, 6pm (AEST)
Register now

Professor Catherine Hill – Update on giant cell arteritis
When: Wednesday, 7 August 2019, 6pm (AEST)
Register now

Professor Brian Draper & Professor Sue Kurrle – Behavioural symptoms of dementia
When: Tuesday, 13 August 2019, 6pm (AEST)
Register now

Dr Shilpa Jesudason – Renal disease in pregnancy
When: Wednesday, 14 August 2019, 6pm (AEST)
Register now

Associate Professor Tomas Kalincik – Relapsing multiple sclerosis
When: Monday, 19 August 2019, 6pm (AEST)
Register now

Dr Janet Cheung – Over-the-counter and complementary sleep aids for insomnia: The implications of self-medication for insomnia in the real world
When: Tuesday, 20 August 2019, 6pm (AEST)
Register now

Go to the events list at any time to see what other events are coming up.

Career opportunities

VIFM Clinical Forensic Medical Registrar position

Applications for General and Acute Care Medicine Advance Training positions in Victoria are now open. Here are the contact details for most Victorian hospitals.

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