DECEMBER 2009:
> HEALtH REfORM
> MONEY’S RuN
Out: tIME tO
StARt tHINkING >
DOES DENtIStRY
NEED REfORM
> A HEALtHIER
futuRE fOR ALL
AuStRALIANS?
COuRAGE, uRGENCY,
LEADERSHIp
NEEDED >
EHEALtH MuNDANE
HO-HuMMERY
SYDNEY MEDICAL SCHOOL MAGAZINE
Christopher & Anna Thorpe
Fine Aboriginal Painting & Antique Tribal Art
2 Cascade Street, Paddington 2010 Sydney NSW Ph: 02 9331 8302
www.thorpegallery.com.au
10 22 28
CoVer: Stephen Leeder. Director, the Menzies Centre for
Health policy, university of Sydney. photography by Ted Sealey
ConTenTS features
10 Cover Story: HeALtH reForM
regulars
4 eSSAge FroM tHe DeAn
M
SyDney MeDiCAL SCHooL MAgAzine DonT MISS THe BIG pICTure
DeCeMBer 2009 M
oney’S run out: tiMe to StArt
tHinking professor Bruce robinson
By Stephen Leeder
oeS DentiStry neeD reForM, or juSt
D 5 SCHooL newS
inCLuSion in tHe HeALtH SySteM?
research grant success / Supporting
By Hans Zoellner international students / Hoc Mai provides
HeALtHier Future For ALL
A safe drinking water / Frontiers of Knowledge:
AuStrALiAnS? CourAge, urgenCy, Australia China Health / Clinical care in
LeADerSHip requireD. Timor Leste, Carl Jackson Scholarship /
By Graeme Stewart Students campaign to reduce global poverty
C
LiniCAnS AnD MAnAgerS neeD to / When doctors get sick / Sydney Health
the magazine of the university of Sydney Medical work togetHer Matters / exhibitions bring the past alive
Alumni Association and Sydney Medical School By Clare Skinner / Celebrating achievements of students
MAnAging MeDiCAtionS and researchers / Deans Scholar: Arridh
Radius Editor By Jo-anne Brien Shashank / Deans Scholar Sam Lindquist /
Beth quinlivan bquinlivan@med.usyd.edu.au unDAne Ho-HuMMery: tHe verDiCt
M Josh Smith wins Joye prize
on eHeALtH reCoMMenDAtionS
Radius Office room 204 edward Ford Building A27
By Mohamed Khadra 27 MeDSoC report
the university of Sydney nSw 2006 ph 02 9036 6528 DonATIonS AnD MenTorS
fax 02 9351 3299
eAL iMproveMentS require
r
FunDAMentAL CHAngeS By Ineke Weaver
Editorial Committee tom rubin, Dr paul Lancaster, By Ian Hickie
Clinical Associate professor Charles george, M
inD tHe gAp: rHetoriC not reALity
professor robert Lusby For nurSeS alumni news
By Jill White and Mary Chiarella
Alumni News and Enquiries Diana Lovegrove
progreSS 29 reSiDent’S report
p
room 210 edward Ford Building
By Stephen Leeder Dr paul Lancaster
university of Sydney, 2006 new South wales
ph 02 9114 1163 email d.lovegrove@usyd.edu.au
web www.alumni.med.usyd.edu.au 24 SHAking up MeDiCAL eDuCAtion 30 LuMni ArCHive
A
By Tessa Ho young life lost in pursuit of medical
Design 10 group Publisher paul Becker knowledge
Published quarterly by 10 group for university of
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Sydney, Sydney Medical School. 10 group Level 1, 25 MAgnetiC ApproACHeS to
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o
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Medical School or the Medical Alumni Association. Adventurer
Member of the Circulation Audit Board. Audited
Circulation 14,299 copies.
DeAn’S MeSSAge
THe BIG
ISSueS
dean’s message Bruce Robinson
Dean
E arlier this year, Dr ian Mcphee wrote of
his lifelong experience of depression. it
was a compelling story. Although in many
I n this issue of radius, we are focussing on
the most recent series of reports on reform
of the health system.
professions depression is more widely
After years of discussions about health
acknowledged and understood than before, ian
reform, not to mention numerous reports, it
is the first high level clinician i am aware of
is understandable if clinicians and academics
who has been so open about his struggles to
prefer to focus on day-to-day urgencies rather
overcome this debilitating condition.
than invest time in understanding reform
the response was extraordinary. Several committees or proposals.
colleagues made contact to discuss their
this is a plea, though, for colleagues not to
own situation and within the university, there
be so distracted by the immediately pressing
has been interest from other Faculties and
thank you to everyone needs of their medical practice, or other roles,
individuals. in his conclusion, ian wrote that
for their support this that they don’t consider the big picture. there
he hoped Faculty, professional Societies,
year. I wish everyone are critical issues facing healthcare in this
Learned Colleges and colleagues everywhere,
compliments of the country, and change is happening. whether
would be more open to discussion of mental
holiday season and a that turns out to be fundamental change or
health, and he believed there was a need to
relaxing break. more fiddling at the edges is not yet clear.
see more programs of awareness raising and
support. But as professor Stephen Leeder points out in
his incisive discussion of health reform, this
Following publication, discussions in Faculty
is not the time for us to be sitting around and
have led to a new initiative, Sydney Health
waiting for changes to happen according to
Matters. it is being led by a committed group,
others’ agendas. we all need to be part of the
and will focus attention on the physical and
debate. if we are not, we can scarcely complain
mental health of students, of doctors and of
if the changes which occur are not helpful to
all members of Faculty.
the care we provide for our patients or to our
one of its first tasks is to review the content in lives as health professionals.
the personal and professional Development
Sydney Medical School, and our colleagues
theme in the medical curriculum, specifically
in nursing, Allied Health, Dentistry and
the first “p”.
pharmacy, play a critical role in producing
our Associate Dean (Student Support) Dr graduates who will serve health needs
narelle Shadbolt is developing a mental and teach future generations of health
health checklist to help us identify symptoms professionals. we therefore must engage in
and signs in ourselves and colleagues debate about how reform is undertaken.
that should prompt enquiry or referral to
Steve has reviewed recent reform proposals,
colleagues or the Doctors Health Advisory
leading into commentary from others in
Service.
Faculty including professor graeme Stewart,
this initiative encompasses all members of professor ian Hickie, professor Mohamed
Faculty and all students – not just medical khadra, and Dr Clare Skinner. thank you
students. More information will be published to professors jill white and Mary Chiarella
in radius and on our website in the future. our in nursing, professor jo-Anne Brien in
hope is that it will help to avert distress and pharmacy, and professor Hans zoellner in
tragedy, and it has my full support. Dentistry, for their perspectives.
4 rADiuS December 09
news
FACuLty newS
> RESEARCH GRANt SuCCESS > HOC MAI pROVIDES SAfE DRINkING WAtER > INtERNSHIpS
Sydney Medical School has enjoyed considerable success A new water purification system which delivers potable water WAkE-up CALL
with its nHMrC and ArC grant applications this year. in to viet Duc Hospital and Hoc Mai House in Hanoi, vietnam, was the recent difficulties for
its main category of project grants, the School secured an opened by the Chancellor, professor Marie Bashir on november 9. international students, who
additional $10 million compared with 2008 – up from $51.8 the water purification system is an initiative of Sydney Medical were not offered internship
million to $61.8 million this year, putting it well ahead of School’s Hoc Mai Foundation, and was jointly funded by Hoc Mai, positions have been
other major research universities in the category. the Australian government, and viet Duc Hospital. the plant resolved with all graduating
Among the groups which won major grants was the removes chemicals and bacteria, to provide safe drinking water students securing places
nHMrC Clinical trials Centre, with $2.4 million awarded for the hospital and neighbouring Hoc Mai House. for next year.
for new research as part of its FieLD study. Led by professor “Diarrhea is one of the leading causes of morbidity nationwide. the Dean, Bruce
Anthony keech, the research will look to identify genetic partly as a consequence, viêt nam is maintaining one of the robinson said the
contributors to type 2 diabetes, and whether the most highest rates of child malnutrition in east Asia,” said professor problems for students had
important genetic factors can be screened for in simple Bashir. served one useful purpose.
blood tests. “Although vietnam has made rapid progress in improving “they have been a
A group led by professor Alan Cass secured $1.8 million its water supply situation over the past decades, water quality, wake-up call of the need
to test a polypill strategy, which simplifies treatment for particularly the contamination of groundwater with arsenic, to overhaul postgraduate
people at risk of cardiovascular disease. professor Cass remains a serious emerging issue.” medical training. without
works predominantly in indigenous health – cardiovascular “Access to water of the highest quality is absolutely essential for reform, we are destined
disease is a major contributor to lower life expectancy any hospital and we are delighted to be able to support this much to see the events of the
of Aboriginal people compared with non-Aboriginal needed water purification system,” she said. past months repeated with
people. one of the identified problems is the gap between Hoc Mai this year celebrates 10 years of medical and increasing severity in the
treatment guidelines (involving multiple medications) and healthcare exchanges between the two countries. Chairman of years ahead, affecting local
actual practice. Hoc Mai, professor Bruce robinson, said the water purification as well as international
other large grants were awarded to researchers led system is one of many projects scheduled this year. others students.”
by professor john Myburgh from the george institute for include programs to build medical research capacity in vietnam, “just as important,
international Health ($2.1 million) for Crystalloid versus maternal and child healthcare teaching in Dien Bien phu, and without reform we will not
Hydroxy-ethyl Starch trial; to a group led by Associate the medical teaching program and curriculum development with be preparing young doctors
professor kim Donaghue from the Children’s Hospital at Hanoi Medical university. well for the realities of
westmead ($1.2 million) into intervention to reduce the risk modern health care and
of diabetic retinopathy and early adverse retinal changes in for the medicine most will
type 1 diabetes. Million dollar plus grants were also awarded eventually deliver,” he
to groups led by Clinical Associate professor Christopher said. A new approach was
Cowell from the Children’s Hospital at westmead ($1.3 needed, which included
milion), professor warwick giles from the northern Clinical providing clinical training
School ($1 million), Associate professor gordon Doig from in all health settings,
the northern Clinical School ($1.3), and Clinical professor both public and private,
guy Marks from the woolock institute of Medical research hospitals, primary care and
($1.2 million). community settings.
rADiuS December 09 5
news
FACuLty newS
> WHEN DOCtORS GEt SICk, by Ian Mcphee > SYDNEY HEALtH
My contribution to radius earlier this year generated considerable interest. Many people responded, sharing their stories and MAttERS
offering words of encouragement. there was contact with some for whom illness in family members had presented great tragedy Following publication of
and incredible upheaval. others told of personal experiences that mirrored my own. it is clear that not everyone receives care that Dr Mcphee’s story earlier this
is focussed on living successfully with an illness that continues to menace from the sidelines, despite efforts to keep it in check. year, discussions in Faculty
individuals, some complete strangers, continue to come up to me to thank me for speaking openly about a life with depression. have led to a new initiative,
Some have expressed the view that doing so has had the potential to influence many in the profession, while others have spoken Sydney Health Matters. it
of the positive effects that it has had on their own life. no one has been openly critical. is being led by a committed
there has been contact also from people outside medicine who have had radius passed on to them by a friend or relative, and group and will focus attention
in one case, a hospital maintenance manager who picked it up to read while on a ward of the hospital in which he worked! they on the physical and mental
too have responded positively, both to the sentiment expressed in the story and to me personally. health of students, of doctors
to all those who have made the effort to be in touch, thank you. and of all members of Faculty.
there were some, prior to the article’s publication, who had questioned my wisdom in “coming out”, genuinely fearing that it More information about
may have had a detrimental effect on my own health. it has been quite the reverse. there is a certain strength that comes with Sydney Health Matters will
being open. especially when expressed from a position of wellness, it confirms the reality of a life returned to “normal”, free from be provided as it develops, in
the nagging burden of self doubt and self recrimination that is the hallmark of a major depressive illness. it flags also the return future editions of radius and
of a positive sense of self, so easily lost in the constant marauding presence of the black dog. on the website. information
And what of effects beyond the initial impact of the radius article? is also available from Dr
Faculty has responded with the bringing together of individuals committed to seeing personal health matters more widely narelle Shadbolt, a senior
considered by undergraduates and alumni alike. there will be more from the Dean on this in the months to come. lecturer in Faculty who has a
Anaesthesia, a discipline with a regrettably high incidence of affective disorders leading to suicide, is, through the efforts of a long standing interesting in
highly motivated welfare of Anaesthetists Special interest group within AnzCA, bringing focus to the issues of impairment, early understanding and assisting
recognition of symptoms and early intervention. At the Special interest group’s most recent meeting i had the privilege of telling students and the profession
my story as part of a joint presentation with gordon parker of the Black Dog institute. importantly, this group is working to raise who experience health
awareness amongst anaesthesia trainees and, not unreasonably has posed the question, as yet unanswered: Are all individuals problems.
suited to the role of anaesthetist? to contact Dr Shadbolt,
these are small steps but clearly significant ones. in the meantime there exist the considerable resources of the Black Dog email: nshadbol@med.usyd.
Institute and beyondblue, each with a substantial web presence, accessible to all. And a reminder for those students or graduates edu.au
who believe they need confidential assistance either for themselves, a loved one or a colleague, there is the Doctors Health
Advisory Service - a critical player in my own path to recovery. And for families of individuals in need of assistance there is the
Medical Benevolent Association.
of course there remains work to be done. i would again urge all to consider how they might play a part.
Websites for support and advisory groups mentioned:
> www.blackdoginstitute.com
> www.beyondblue.org.au
> www.dhas.org.au
> www.mbansw.org.au
Dr Ian Mcphee is an anaesthetist and Clinical Senior Lecturer in Sydney Medical School.
6 rADiuS December 09
news
FACuLty newS
> fRONtIERS > CLINICAL CARE IN > CARL JACkSON SCHOLARSHIp > StuDENtS
Of kNOWLEDGE tIMOR LEStE the Dr Carl richard jackson scholarship has been CAMpIAGN tO REDuCE
AuStRALIA CHINA timor Leste’s Ministry awarded for the first time, to two third year medical students, GLOBAL pOVERtY
pARtNERSHIpS of Health, the national Adrian Lo and katherine Miller. the scholarships will globalHoMe, established
with senior research Hospital of guido valadares allow both students to travel to Cambodia for elective term in 2006 by medical students
and education colleagues and the institute of Health placements. at the university of Sydney,
in China, Sydney Medical Sciences in Dili, have joined Dr jackson graduated from the university of Sydney in used the opportunity of their
School hosted the Australia forces with the university 2007, but died in july 2008 of cardiac arrest, just prior to recent conference to promote
China partnerships in Health of Sydney to improve the his evening shift as a resident Medical officer at gosford its kevin 0.7 (kevinpoint7.
Symposium, in Beijing in capacity of the critical care Hospital. He was 30 years old. com) funding campaign. the
november, one of a series workforce in timor Leste. His parents, Mr Brian and Mrs katherine jackson, campaign is pressuring the
of events to celebrate “the workshop was a established an endowed scholarship in his name. the Federal government to boost
the university’s growing team effort with eight of purpose is to provide annual awards to medical students who its international aid to 0.7%
relationships in China. our affiliated doctors and wish to gain experience in a developing country. of gross national income. it
welcomed by Sydney nurses providing specialist Carl completed a medical elective at the rose Hospital is an ambitious target - in the
university’s Deputy vice advice for development of in Cambodia, and gained greatly from the experience. in an Budget this year, 0.34% of
Chancellor, professor john the program and tutoring obituary published in radius last year, his family wrote that gni was allocated to overseas
Hearn, and with opening during workshops,” said he had been deeply affected by the plight and stoicism of the Development Assistance.
remarks by the vice Minister of Dr Dilharni Bandaranayake Cambodian people, and the experience hardened his resolve Students believe kevin 0.7
Health in the people’s republic from the office of global to specialise in orthopaedics. is an important starting point
of China, Dr Huang jiefu, the Health and program co- Accepting the scholarship, katy Miller thanked the jackson for increasing discussion
symposium brought together ordinator. family for their support of students wishing to work and learn about international aid and
leading researchers, educators For more information from experiences in developing countries. national obligations. they
and government officials to about timor partnerships, “i’m interested in Cambodia because it’s an opportunity hope it will encourage better
discuss health reform in China see the offie of global to learn about the challenges of healthcare in the developing understanding of Australia’s
and Australia, latest research, Health website: www.usyd. world. i’ll be based in phnom penh and hope to broaden my aid expenditure and of the
and medical education and edu.au/global-health/ clinical skills and experience in the context of a resource- Millennium Development
collaborations between the index.php challenged system,” she said. goals.
two countries.
the presence of high
level members from China’s
Ministry of Health, and the
involvement of research
leaders from the Chinese
Academy of Sciences and
from peking university, is an
indication of the strength of
relationships.
rADiuS December 09 7
news
FACuLty newS
> EXHIBItIONS BRING tHE pASt ALIVE > CELEBRAtING > DEAN’S SCHOLAR:
Special exhibitions focusing on particular facets of medical history are a new activity of the ACHIEVEMENtS ARRIDH SHASHANk
Faculty. the displays are located in the magnificent cedar showcases which now dominate the Of StuDENtS AND First year medical
Common room on the ground floor of the Anderson Stuart Building. this was originally the RESEARCHERS student Arridh Shashank
anatomy and pathology museum for student teaching and research, but after completion of the Sydney Medical School’s already has degrees in
Blackburn Building in 1936 the space became the Burkitt Library. it is now used as a gathering Scholarships, prizes and Biomedical and electrical
place for staff and graduate students working in the building and, increasingly for social grants reception 2009 was engineering. He was
functions associated with Faculty events. held in MacLaurin Hall on awarded a grant from the
the first historical exhibition “A Slice of Life” was prepared by yvonne Cossart, vanessa october 29. the evening Deans Scholarship Fund
whitton and Lise Mellor to coincide with the opening of the refurbished wilson Museum in 2008. celebrates the achievements to fund the presentation
it included an account of Anderson Stuart’s problems in establishing dissection in the Sydney of medical students and of of his research at the ieee
medical curriculum, and show cased the work of all six Challis professors of Anatomy. the researchers who received engineering in Medicine
emboldened by the interest shown in the anatomy exhibition yvonne and Lise embarked Medical Foundation grants and Biology Society (eMBS)
on a second, this time about plague. “rats in the realm”, which is now on display, crosses in the latest year. it also conference in Minneapolis,
the boundaries between science and the humanities. it includes bacteria, rats, fleas, a plague brings together the recipients uSA. “i presented my
doctor’s mask and herbal remedies as well as a justinian coin and a Bill of Mortality. the 1902 of awards with donors, research paper on the
epidemic of plague in Sydney featured period photographs of rats and rat catchers and political including alumni, friends and design, simulation and
cartoons about quarantine and also included a hawser disc and quarantine Station signage. professional organisations. fabrication of a low cost
the interdisciplinary approach was carried on in the symposium about plague held in Medical Foundation grants capacitive tactile shear
conjunction with the Medical Alumni History Day on campus. During the breaks, delegates were presented by the sensor for a robotic hand.
were able to inspect a display of books about plague from the rare Books Collection of Fisher recently elected president presenting my research
Library. these included medical texts, herbals, tracts and fiction dating from the Sixteenth to of the Medical Foundation, at the conference provided
eighteenth centuries. Mr roger Corbett. Dr paul invaluable experience and
After the symposium delegates adjourned to the Museum to enjoy light refreshments and Lancaster spoke about the feedback that i could not
witness the world premiere of “pepys plague”, an entertainment based on the events of 1665 contribution of alumni, otherwise achieve and this
in London. the “stars” were well known Faculty members and the text was devised by yvonne and the Medical Alumni is definitely something that
from the famous Diary, excerpts from contemporary royal proclamations and the “Advices” of Association scholarships. other students involved in
the royal College of physicians. research should undertake.
i was also trying to identify
areas in which i can
carry out research and
perhaps begin a phD. the
conference exhibited the
latest developments in
the medical application of
engineering. i am grateful
to the Dean’s Scholarship
Fund for the assistance.”
8 rADiuS December 09
news
FACuLty newS
SYDNEY MEDICAL SCHOOL
EDWARD fORD BuILDING A27
tHE uNIVERSItY Of SYDNEY NSW 2006
www.medfac.usyd.edu.au
Dean professor Bruce robinson
Deputy Dean professor David Cook,
professor Ben Freedman
ASSOCIATE DEANS AND HEADS OF SCHOOLS
Professor Glenn Salkeld - School of public Health
Professor Michael Field - northern Clinical School
Professor Craig Mellis - Central Clinical School
> DEAN’S SCHOLAR: SAM LINDquISt > JOSH SMItH Professor Chris Murphy - School of Medical Sciences
Second year medical student Sam Linquist was selected AWARDED JOYE pRIZE Professor Kathryn North - hildren’s Hospital at westmead
C
to represent Australian medical students at the 58th the winner of the joye Clinical School
international Medical Students Association’s August general prize, awarded on merit to a Professor Michael Peek - nepean Clinical School
Professor David Harris - western Clinical School
Assembly (iFMSA AM), in southern Macedonia. the Dean’s final year medical student, was Associate Professor Tony Brown - School of rural Health
Scholarship Fund assisted with expenses. joshua Smith. Professor Robert Lusby - Concord Clinical School
“the iFMSA is the largest student organization in the josh started in the Sydney
world, representing thousands of medical students from over Medical program in 2006, MEDICAL PROGRAM ASSOCIATE DEANS
Associate Professor Tessa Ho - Learning & teaching
eighty-seven countries. the iFMSA general assemblies are having previously completed a Professor John Mitrofanis - Stage 1 Coordinator
organised to facilitate discussion between medical students Bachelor of Medical Science at Professor Michael Frommer - Stage 2 Coordinator
from all countries to share opinions on local and global the university. He is currently Associate Professor Chris Dennis - Stage 3 Coordinator
issues. Students separate into standing committees which doing his pre-internship
ASSOCIATE DEANS
divide pertinent issues into more distinct categories. public placement in general surgery Professor David Burke - research
health, reproductive health and Hiv, human rights and peace, at Hornsby Hospital and due Professor David Handelsman - research Strategy
and medical education are a few of the areas which provide to commence his internship at Associate Professor Graham Mann - research Strategy
direction to these sessions. royal north Shore in january. Associate Professor Chris Roberts - ducational
e
Development
the focus for this general Assembly was paediatric “in the future i hope to pursue Professor Carol Armour - Career Development
health, especially children from developing and undeveloped a career with a generalist Associate Professor Simon Willcock - ostgraduate Medical
p
countries. the appropriate title of “investing in the health of flavour and find myself education & training
children and youth” was used as the basis for theme sessions particularly interested in critical Professor John Christodoulou - postgraduate Studies
Associate Professor Brett Hambly - ostgraduate Student
p
and breakout discussions. care areas such as intensive recruitment
throughout the five days of the conference, we were lucky care. i would like to take this Professor Robert Cumming - postgraduate Coursework
enough to be lectured by a range of inspiring speakers from opportunity to thank the joye Professor Stewart Dunn - Admissions
global organizations including the world Health organisation, family for their generosity in Professor Robyn Norton - global Health
Dr Lyndal Trevena - international
Médecins Sans Frontières, and the united nations providing this prize and for Professor Chris Liddle - information technology
international Children’s emergency Fund (uniCeF). in the support that they thereby Dr Narelle Shadbolt - Student Support
addition, i participated in discussions and workshops looking show to the achievements of Professor Jim May - Surgical Sciences
at medical education in a global setting. i also participated in students,” he said.
FACULTY EXECUTIVE
small workshops on conflict prevention and management, Tom Rubin - executive officer Sydney Medical School
leading small groups discussion, policy structure and drafting Dominic Curtin - Finance Director Faculties of Health
and effective lobbying techniques. it was amazing to see Ria Deamer - Manager Sydney Medical School
international bonds forged and political differences set aside. Kay Winton - Director Student Services
Joanne Elliot – xecutive officer office research & research
e
Since returning to Australia, i have been able to share training
new knowledge with my Sydney colleagues and i have also Karen Scott - executive officer office of Medical education
been inspired to initiate some student-led projects focused Beth Quinlivan - irector Communications & Community
D
on Australia’s current organ donation policy and to start relations
Diana Lovegrove - Manager Alumni relations & events
planning future global health initiatives. thank you to the
Dean’s Scholarship Fund for this opportunity.”
rADiuS December 09 9
Cover Story
10 rADiuS December 09
HeALTH
reForM
Money’s run out:
time to start thinking
By Stephen R Leeder
Stephen Leeder is professor of public Health and Community Medicine at the university of Sydney and Director of the
Menzies Centre for Health policy. Angela Beaton of the Menzies Centre helped prepare this article.
HEALtH REfORM tAkES Off IN AuStRALIA
Google finds two million sources with the exact phrase
“health reform”. Australia has made substantial deposits to
this cache in the past two years. The current Federal Labor
government came to power frothing with dire threats about
taking over the public hospitals unless the states lifted
their game. Then after the federal election in November
2007 came the Australia 2020 Summit in April 2008. One of
six streams in it dealt with health. Commissions of inquiry
into hospitals, health care more generally, prevention, and
primary care followed over the next year.
Nor has New South Wales been napping on the health
reform stage: the Garling Report, a rolling, ponderous
Tolstoyesque three-volume (12.6 Mb PDF file) work made
134 recommendations based on hundreds of pages of oral
evidence from doctors, nurses and others about what needs
to be done to improve acute care in our rather unhappy state.
This trumps the report, A Healthier Future For All
Australians, of the National Health and Hospitals Reform
Commission (NHHRC) published on June 30th this year: it
has a mere 123 recommendations in a meagre 7 Mb PDF file.
But if you add in the recommendations of the Preventative
Services Taskforce report Australia: The Healthiest Country
by 2020, a 1 Mb file with numerous targets and strategies
to reduce obesity, smoking and harmful drinking also
published recently, then the feds are back in front again.
A fEDERAL tAkEOVER?
Following the publication of these documents the Prime
Minister, Kevin Rudd, and other parliamentarians including
the Federal Minister for Health and Ageing, Nicola Roxon,
visited hospitals throughout Australia to discuss with
clinicians and managers the major problems in health
care provision. The discussion has concerned both the
recommendations of the NHHRC and also whether public
hospitals would fare better if financed directly from
Canberra. The NHHRC has recommended a revised approach
to hospital funding based more on performance - activity and
rADiuS December 09 11
Cover Story
efficiency – consistent with direct federal funding. A federal all, Australians take to their hospital beds in numbers that
takeover was Mr Rudd’s pledge prior to the federal election find no comparison in the rest of the world. It is as though,
unless the states and territories did better. beside an entitlement to a few weeks at the beach every
But there is more to health care than hospitals, as the year, we consider it OK to pop into hospital for a few days.
NHHRC report recognises and as expressed in a further What on earth is that about? (In passing, let me tell you:
report, this time from the External Reference Group of it is about failure of our investment in primary care and
the Primary Health Care Strategy. Both make a plea for community support, that’s what.) And of course serious
better connections among general practitioners and other questions about safety, quality, efficiency, equity of access,
community workers, and suggest that those publicly-paid and much else niggle away at our peace of mind.
community workers not remunerated through Medicare
should also receive their funding from Canberra directly WHY YOu SHOuLD BOtHER ABOut REfORM
rather than from the states. I hold the view that it is important for medical practitioners
Were this move to pay for all primary care from including medical academics to take a lively interest in the
Canberra to happen, and were hospitals simultaneously reform process, in part to inform it and in part to ensure
to be federally funded, we would have for the first time a that their interests and those of their patients are being
unified financing system. A single payer would reduce the served. Indifference of the sort that claims that all reports
state-commonwealth blame-game tensions: its superiority achieve nothing and simply gather dust is feeble and
as a mode of financing is supported by evidence from many unhelpful. It fails to understand the policy process.
health systems. My professional judgement as one interested primarily
While there is an ever present risk that hospitals would in health, secondarily in the way we maintain it and manage
suck dollars from primary care into their coffers – Boyle’s illness, and then, thirdly, in the policies that determine
Law of joined-up small and large institutions – it is possible the allocation of resources and shape the management of
that the load on public hospitals might decrease. This the system, is that we do need transformational change in
would require enlightened, tough regional or area resource the health system – not more fiddling at the edges on this
allocation to succeed. occasion, useful though that generally is.
If I am correct, then this is no time for us to be sitting
DENtICARE – A pROpOSAL WItH tEEtH back and waiting for things to happen entirely according
A further likely outcome is public funding for dentistry. to others’ agendas. It is one thing to advocate for ‘clinicians
While details of Denticare are sparse, the principle is sound. being more involved in clinical governance’ and altogether
At present millions of public dollars support dentistry, but another to argue for those same clinicians to bend their
only for those with private insurance: in 2004-05, 82% of admirably capable minds to larger questions of system
Commonwealth expenditure on dental services was spent change. It is the latter that is so hard and it is, at present,
on the Private Health Insurance rebate; this accounts for the latter that is most important.
14 % of total spending on dental health, the majority
of which is borne by the patient or their family. Under HOW REfORMS AffECt uS AND OuR pAtIENtS
Denticare dental services would be supported irrespective In this issue of Radius several members of your Sydney
of whether the patient had private insurance. Medical School whose careers are in areas of special need
in health discuss what they see to be the reform agenda.
Korda rJ, Butler Jr. effect of INCREMENtAL CHANGE OR REfORM? First, each of them comments on the need as they see it
healthcare on mortality: trends in These changes may be all that is possible at the moment. in their area of work. Second, they critique the current
avoidable mortality in Australia and
comparisons with Western europe. They are more managerial than structural. Is this what we reform agenda and documents, providing us with insights
Public Health 2006;120:95-105. want? As my Canadian colleague Steven Lewis and I wrote into what they regard as good proposals. Third, they tell us
in a recent article in the Medical Journal of Australia: where the lines of reform need to be stronger as they see it.
There is a case against reform. In advanced countries, It is true that Australia does not have a fiscal crisis in
health status has been steadily improving. Life expectancy is regard to health care – yet. Several exuberant, detached
up. Erstwhile rapid killers such as AIDS and several cancers and fantastical suggestions for changes in the way we
are now chronic conditions. Heart disease rates have declined. finance health care may change that. But in any case
Avoidable mortality has plummeted . Health technology is with unbridged inequities in access to care, dangerous
ever more dazzling, from high-resolution medical imaging unresolved quality and safety issues, a preventive agenda
to robotic surgery. There are more effective drugs than ever that we have to grasp and finance, substantial changes in
before. From diagnosis to surgery, health care is steadily less the demographic structure of our nation, mental health,
invasive. Health care practitioners are rigorously trained and dental health and Indigenous health all requiring more of
entry-to-practice credentials are on the rise. Citius, altius, us, we need to do more cerebrating about how we spend the
fortius: faster (technology, recovery, publication); higher health dollar in the future.
(credentials, spending, intervention rates); and stronger
(institutions, drugs, methods). Everything’s coming up roses, tIME tO StARt tHINkING
so better to fine tune here, innovate there, and stick with a As Steven Lewis reminded our readers at the conclusion
model of proven success. of our MJA paper on health reform, Nobel Laureate Lord
Well, quite frankly, wrong: we face problems that won’t Rutherford of Nelson (NZ), author of the planetary model
likely be solved by tinkering and simply trying to better of the atom that he then went on to split in 1917, said to
with more of the same. his charges experiencing the constraint of scarce resources,
On the money side, we see demand outstripping supply, “Gentlemen, we have run out of money. It is time to start
we have yet to take the social determinants of health thinking.” So, too, it is time for us think very seriously
seriously and spend money effectively on them, we do indeed about health reform – new models for a new age,
not have a preventive agenda, and perhaps strangest of please – in Australia.
12 rADiuS December 09
HeALtH reForM
Does dentistry need reform
or just inclusion in the health system?
By Hans Zoellner
Hans Zoellner is Associate professor in the Faculty of Dentistry and Head of oral pathology and oral Medicine, university of Sydney.
He is Chairman of the Association for the promotion of oral Health.
imagine if Medicare and public hospitals were limited to “basic medicine only”?
Dental health needs to be part of the system but the Denticare proposal to fund
basic dentistry only will institutionalise a two-tier system.
Australians enjoy enviously equitable and cost effective interpretation seems unworkable.
health services. Despite this, health reform reports It is worrying that Denticare would break the principle
should always be welcome because it seems sensible to of community rated health insurance, which has thus far
periodically analyse our system and consider possibilities helped keep insurance affordable irrespective of personal
for improvement. However, it is also incautious to fix health history.
something that isn’t broken, and this especially when the Notably, Denticare proposes to fund ‘basic dentistry
analysis seems incomplete. only’, and excludes many routine services including
Although current debate recognises alarming inflation of multi-canal root canal therapy, lower partial dentures, and
health costs, the monetary benefits accruing from improved crowns.
health and delayed retirement seem disregarded. Dire One thing I will share in common with most Radius
predictions relating to over-population by 18th Century readers is a full set of teeth, while another is that I would
economist Thomas Malthus have failed to eventuate, have suffered several extractions under Denticare. Imagine
because he could not anticipate the economic advantages if Medicare and public hospitals were restricted to ‘basic
of population growth and technological advancement. medicine only’. Patients would suffer, and practice
Dramatically restructuring health without first considering would become professionally dissatisfying. Rather than
the benefits of an ageing demographic would seem a eliminating current inequity in dental health, Denticare
Malthusian mistake. would institutionalise a two-tiered service, profoundly
We dentists find unhappiness with Australia’s health different from current arrangements in Medicine.
system odd because we experience the consequence of One welcome recommendation by the Commission is
our own bizarre exclusion. Dentistry is not covered by the establishment of internships for dental graduates. We
otherwise universal Medicare. Our training is not supported have long canvassed in favour of dental internships because
by internships, conjoint appointments or registrar of the potential to both improve training and expand
positions. Public services do not deliver comprehensive the public sector. It is consequently frustrating, that
dental care. In our area of health, chronic failure is because Denticare would fund public dentistry for ‘basic
the accepted norm. By any measure, be it preventable service only’, newly graduated dentists would be formally
hospitalisations, public waiting lists, access to services, deskilled during their internship.
active disease rates, or reports of uncontrolled pain, Inclusion of dentistry in Medicare seems the most
dentistry is a muddle. An obvious solution is to copy into sensible alternative to Denticare, and would fund service
dentistry those structures proven successful in medicine. in the private sector where most dentists work. Medicare
Dentistry doesn’t need reform, so much as to get into the would also liberate the public system to concentrate on
system. high quality services for those who cannot be seen in
It is encouraging that the National Health and Hospitals private practice settings. Dental Medicare has already been
Reform Commission recommends universal dental health trialled via the Enhanced Primary Care scheme, providing
insurance, but their ‘Denticare’ proposal is an ominously up to $2,125 of Medicare rebate per year for people
radical departure from the Medicare precedent. Under with chronic disease. Since establishment in November
Denticare, a 0.75% Federal government levy would 2007, over 250,000 people have received comprehensive
pay for risk-adjusted private dental health insurance. dental service under Medicare, so there is now sufficient
People without insurance would be directed to currently experience to properly fine-tune the scheme. Expansion of
overwhelmed public services receiving new support via dental Medicare over time to include the entire population
Denticare. would address current inequities, and bring dentistry into
A 15% gap for privately delivered Denticare services line with medicine. It would be a shame, however, if this
is foreshadowed by the Commission but it is unclear if achievement were undermined by overzealous reform of
insurers are to pay 85% of whatever dentists charge, or if our essentially excellent health system.
alternatively Denticare is to fix private practice fees. Either
rADiuS December 09 13
Cover Story
A healthier future for all Australians?
Courage, urgency, leadership needed.
By Graeme Stewart
Graeme Stewart is a Clinical professor in Sydney Medical School,
and Founding Director of the Institute for Immunology and Allergy research at the Westmead Millennium Institute.
Hospital clinicians look to the rudd government to
implement once-in-a-generation reform of Australia’s
health service. tinkering at the margins or incremental
change will not pull the public hospital system back from
the brink. the final report of the national Health and
Hospitals reform Commission fails to convey clearly either
the sense of urgency or the scope of needed change.
I am now in my 40th year as a doctor in a public hospital are just starved of funds; the demand has overwhelmed
system to which I have a passionate commitment. Over the them’. (Sydney Morning Herald, 9 Oct 2009).
past 10 years, I have become increasingly dismayed by the
decline in once great institutions and, with many others, NOt A CLEVER COuNtRY
am fearful for the immediate future. Inadequate funding On this background, there remains a remarkably stupid
to hospitals and universities has resulted in a reduction of aspect of health care funding that will not be corrected
beds to unsafe levels, ageing equipment, unattractive work without the direct intervention of the Prime Minister, as
environments and an excessive reliance on overseas trained a major part of his once-in-a-generation opportunity. Care
staff. University values of inquiry and scholarship are being outside hospitals looks after the less severe part of the
marginalised along with teaching, training and research, the disease spectrum and the worried well, is supported by
foundation stones for better health for the next generation. Australian government funding and is essentially uncapped
Poverty of resources leads to clinician frustration and at the point of service. The public hospitals provide care
disengagement. In a recent survey, two-thirds of senior for people at the severe end of the disease spectrum, with
doctors indicated that they had seriously considered a state-determined budget that is capped. The correct
leaving the public hospital system in the past 12 months. balance can only be achieved through the establishment of
A large number already have, at least in part and/or in a single funding agency, perhaps jointly administered by
spirit. The private sector offers an increasingly attractive federal and state governments. The subsequent challenge
alternative. - of avoiding the creation of an all powerful, remote
Commissioner Peter Garling SC put the NSW public bureaucracy and ensuring that responsibility and authority
hospitals under the microscope last year and concluded that are alignedat a local level - is not beyond us.
it was ‘on the brink’. Little has improved since; there is no But the starting point for reform must be the
money to do so. commitment of substantial new funds These urgently
needed ‘pennies from Kevin’ represent no more than the
‘puBLIC HOSpItALS AREN’t fAILING, tHEY’RE return to the public hospitals of the $3 billion per year
JuSt StARVED Of fuNDS’ taken out during the past 10 years and given to the private
Despite the difficulties, Australia still enjoys a remarkable sector. There are many options for this. The the tax rebate
public system. Paradoxically, the health outcomes delivered for private health insurance alone costs over $3.5 billion
in public hospitals continually improves due to the per year, money that would be better directed to the public
remarkable pace of advances in diagnostic capacity and new hospital system. The proposed rationale of taking the strain
treatment options. Miracles occur every day, even if the off the public hospitals was proved untrue by statistics
media reports only the mistakes. The questions, though, are noted by Deeble in the article referred to above.
how long will it last and how much better could it be? New
clinical tools are costly and the number of people, often of It’S NOt JuSt ABOut MONEY.
advanced age, for whom there is clear benefit is growing. Reform requires much more than extra dollars. But with a
Increasingly, access means ability to pay as procedures funding balance restored, clinicians, planners and managers
become available only in the private hospitals. As a nation, can work together to implement the major reforms needed
we could do so much better. As Professor John Deeble was to ensure best use of health resources and facilities, and at
quoted recently: ‘The public hospitals are not failing, they delivering safer and more effective care with appropriate
14 rADiuS December 09
HeALtH reForM
equity of access. This will not occur without the removal Australians’ (June 2009) but I get no sense of the urgency
of barriers created by multiple jurisdictions, principally needed. The report also covers major issues in community
between the commonwealth and state; a single funding health care and prevention; my brief was to address the
entity is a good start. This is equally true for workforce issues affecting the public hospital system, the better
planning, teaching and research with the Universities and resourcing of which should not be seen as their enemy.
health services currently under separate and disconnected There is substantial evidence that the Australian people are
administrations, the differing rail gauges of the 21st prepared to put more money into health care overall but
century. are seeking reassurance that it will be governed wisely and
The issues raised in this article have been recognised in spent well.
the final report of the NHHRC ‘A Healthier Future for all
Clinicians and managers
need to work together
By Clare Skinner
Dr Clare Skinner is a graduate of the university of Sydney Medical program.
She works as an emergency registrar at royal north Shore Hospital and is a founding member of theHospital reform Group.
there is a lot of talk about improving the health system at the moment, but
not much of a sense that any change is actually taking place. there is almost
nothing new among the recommendations presented to nSw parliament
by Mr garling, or in the report of the national Health and Hospital reform
Commission. the same ideas have been spoken and written about for years
by clinical leaders, academics and health commentators. what is lacking is
political courage.
In the eight years since I graduated from the Medical This will be difficult. The current generation of
Program at the University of Sydney, I have noticed a clinician-managers are deeply suspicious of government-
steady decline in the morale of public hospital clinicians. initiated reform. At present, they are busy explaining
Many doctors do not feel valued, and as a result have why they cannot meet demand-driven key performance
withdrawn from all but immediate clinical care activities. A indicators, while having only limited control over the
handful of specialty groups have almost entirely retreated to supply side; budgets, equipment and staffing. Health
the private sector. The impact on patient care is potentially management structures need to be flattened, such that
devastating. It is increasingly difficult to find doctors decisions about what to achieve are made centrally, but
willing to take on managerial responsibilities, to attend decisions about how to achieve are made locally, by clinical
hospital meetings, to participate in quality improvement directors working alongside ‘business’ managers. This
activities, and to actively teach, supervise and mentor will require honesty, transparency and respect in both
doctors-in-training. Further, the culture of disengagement is directions. An end to blame and ‘spin’.
role-modelled to medical graduates, who quickly adopt the In the meantime, the enthusiasm and intelligence
cynicism of their seniors, and plan careers which minimise of junior doctors should not be allowed to go to waste.
their interaction with the public hospital system. Postgraduate medical training should be re-imagined, to
In order to effect real, sustainable, health system reform, better equip graduates for the challenges of the future.
frontline clinicians need to be re-engaged in decision- Programs should be clinically-focused, efficient, flexible in
making. Clinicians and managers need to work together, delivery and duration, should allow for different learning
towards an agreed set of goals. Managers need to respect styles, and assessment should relate to clear educational
that the primary responsibility of the clinician is patient outcomes. Trainees should demonstrate understanding of
care, and in turn, clinicians need to acknowledge the the basic principles of evidence-based practice and health
constraints of the system, and get involved in working out economics. Those who show leadership aptitude should be
how limited resources can be effectively used, to provide encouraged to pursue further training in management and
the best care to the most number of patients. research, to lead our system into the future.
rADiuS December 09 15
Cover Story
Managing medications
By Jo-anne Brien
Jo-anne Brien is professor of Clinical pharmacology
at St Vincent’s Hospital and pro-Dean in the Faculty of pharmacy.
the garling report pointed out the high level at which
mismanaged medications cause harm and death in hospitals.
In Australia, current discussion of health reform has been quALItY uSE Of MEDICINE
triggered by the report of the National Health and Hospital A component of healthcare that has relevance for both
Reform Commission. Within New South Wales following reports is the importance of achieving Quality Use of
the Garling Report, the implementation of health service Medicines (QUM). Australia is fortunate to have an
changes has commenced. The Garling Report focussed on articulated policy for medicines use and health outcomes .
avoiding harm, often iatrogenic, and recognition of the The engagement of the Therapeutic Goods Administration
complex social organisation and high risk environment that and the Pharmaceutical Benefits Scheme to ensure timely
is a hospital. and appropriate access to safe, effective, and cost effective,
The high risks and actual harm associated with drugs is well understood. The partnerships between
medications was identified by Commissioner Garling, and he health practitioners and consumers to achieve Quality Use
made a number of direct comments and recommendations for of Medicines are key. The National Prescribing Service
clinical pharmacy services to address these. supports the implementation of policy and through
“I heard evidence that 26% of the 27,000 hospital related evidence-based practice initiatives.
incidents reported on the Australian Incident Monitoring ‘Quality use of medicines’ means that medicines
Systems to 2002 were medication errors. The level at which are used judiciously, safely and effectively to achieve a
medication causes harm and death within our hospitals has specific health outcome. Delivering QUM is difficult, given
continued largely unabated. Clinical pharmacy reviews are the complexities of both the health system and human
known to reduce considerably these harms. Readmissions are behaviour, and that medicines may be expensive, may or
materially reduced. The introduction of an electronic hospital may not deliver benefit, and may themselves cause harm.
pharmacy system would likewise be a major contribution to Both the use and lack of use of medicines may cause harm.
reducing the damage caused by medication error… the skills of Timely, accurate, reliable health information, including
clinical pharmacists are not being well used when they clearly medication histories, is needed to manage medicines well.
should be.”
Reports such as Garling identify issues for health service SOLutIONS REquIRE A WILL tO SuCCEED
providers and governments, and are meaningful for us all, Technology may be able to deliver ‘personalised’ medicines
as consumers as well as practitioners. The debate about routinely in the future but right now we need basic clinical
healthcare reform is rarely around whether or not there information available for our patients, whether they are an
is a problem. More often than not, the debate is around inpatient or in the community, and especially when they
who and what changes are to be made. Robust discussions are transiting between one sector and the other, and have
are appropriate but what is disappointing is where the several health care providers. Recommendations for patient-
heat is around a ‘turf battle’ rather than evidence-based, held integrated electronic health records are not new. The
achievable, equitable, fiscally responsible models for clinical hurdles in technology, incompatible information systems
care. This is a political process that has little to do with the and privacy concerns can all be managed if there is a will
interests of patients. to use this as an element to facilitate communication among
There is an opportunity for health professionals to providers and patients, and to see improvement in overall
show leadership in the advocacy for patients and improved clinical management and medication use. This was just one
health outcomes. The development of models of change, issue in the Reform Commission recommendations. It will
and subsequent implementation, should not be left only be interesting to watch!
to the politically active professional groups, particularly
if those groups appear to advocate for the practitioners’
incomes rather than patients. All practitioners who are at
the ‘coal face’ are aware of patients’ concerns and the need
to appropriately respond in professional and effective ways.
16 rADiuS December 09
HeALtH reForM
Mundane ho-hummery:
the verdict on eHealth recommendations
by Mohamed khadra
Mohamed Khadra is professor of Surgery,
university of Sydney, based at nepean Clinical School.
Advances in information technology provide the basis for creative solutions
to enduring health challenges. Against that potential, the eHealth
recommendations of the nHHrC are laudible, but pedestrian and mundane.
When I worked as a urologist in Wagga Wagga, as part of incident. Another example is the utilisation of eHealth
my role as Director of the School of Rural Health for the technologies to allow foetal health monitoring in remote sites
University of New South Wales, I would see patients who of NSW, led by Dr. John Pardy. A further example is the
had travelled to their appointment from such places as Hay, prenatal morbidity surveillance unit which seeks to establish
Denniliquin, Rand, West Wyalong and Tumut. There were a web portal for the collection of clinical data, and which is
general practitioners and small hospital facilities in each led at Nepean by Professor Michael Peek, in collaboration
of these places but no specialist, and to see a specialist, with researchers around Australia and in New Zealand.
patients had to travel. In the case of Hay, about 6 hours Against this background, recommendations 115-123 of
drive back and forth. Now, more than ten years later, as a the NHHRC Report present a series of eHealth initiatives
Professor of Surgery at the Nepean Campus of the Sydney which are pedestrian and mundane. They include proposals
Medical School, I see patients who are travelling in excess for electronic health records for every Australian, a national
of 8 hours to access my services as a urologist. system of unique identifiers that identify the patient, the
Geoffrey Blainey coined the phrase ‘the tyranny of provider and the facility, and they call for an investment
distance’ in the late 1960’s. Nearly forty years later, with in eHealth training, leadership and the develop of key
all the advances in information technology as well the health informatics tertiary qualifications. These are laudable
Googlification of our lives, little has changed for rural initiatives and are definitely to be supported.
and remote patients seeking medical care. The ‘tyranny of However, they are hardly solutions which will bring
distance’ remains a significant barrier to accessing specialist about a paradigm shift in the way we practice medicine,
health care, continuing education and professional support. or solve any of the challenges of remote access or health
The Federal Government has invested in the creation outcomes. Further recommendations envisage ‘that the
of the National Broadband Network, capable of providing Commonwealth Government mandate that the payment
the technological basis for as yet unimagined creative of public and private benefits for all health and aged care
health solutions to many of the challenges in providing services depend upon the ability’ of all health facilities and
good quality health care to all Australians. The solutions practitioners to share data across the national network - this
are limited only by the imagination of clinicians and to be established by 2012.
IT developers, and need to engage the clinicians and Integration between databases has been impeded
communities who will benefit from these solutions. throughout the history of computing by the economic
At the Nepean Campus of the Sydney Medical School, advantages for companies that devise platforms and norms
we have recently had a confluence of clinicians whose for datasets that are incompatible with those devised by
interest in eHealth and telehealth has created an intellectual other companies. Yet, the recommendation would see
eHealth primieval soup, whose evolutionary outcomes that all private and public health clinicians and facilities
will be creative and useful technologies to help bridge abandon current software platforms and adopt a national,
the tyranny of distance. The newly proposed Institute of universally compatible clinical information norm. The
eHealth at the Nepean seeks to unite these efforts, couple recommendation is unrealistic in the timeframe.
them with information technology specialists, and bring the Perhaps one needs to look beyond the NHHRC and look
solutions that emerge to reality. Nepean is unique in that it to the National eHealth Transition Authority (NeHTA)
stands at the gateway of rural and remote New South Wales. 2009-2012 strategy which outlines how they will lead the
One example is the virtual intensive care unit which was progression of e-health in Australia.
developed by Professor Pat Cregan and others. This allows We will all need to wait to see further developments of
a specialist at Nepean Hospital to receive 8 channels of the Authority and hope that the natural processes of the
information about a critical patient from a remote hospital, bureaucratic-centred health departments do not obfuscate
including sound and video, vital signs and pulse oxymetry. eHealth developments. Meanwhile, those of us in eHealth
The specialist is able to advise and direct every step of the research and development will continue ‘to strive, to seek
resuscitation, and apply their knowledge to the remote to find and not to yield’.
rADiuS December 09 17
Cover Story
Real improvements require
fundamental changes
By Ian Hickie
Ian Hickie is professor of psychiatry at the university of Sydney
and executive Director, Brain & Mind research Institute
the national Health and Hospital reform Commission is right to highlight
mental health services as one of the major areas of ongoing health inequalities
in Australia. But neither of the governance and financing models now being
advanced will result in the substantive changes necessary.
In 1997-98, only 38% of people with a mental health will not change the face of mental health. Much
problem received a service in any 12-month period compared greater emphasis needs to be placed on new systems
with 80% of people with a common physical health problem. of accountability, new financing systems, support for
In 2007-08, despite a decade of improvements in public innovation (particularly to support novel child and youth
attitudes and changes in access to psychological services, the services), purchasing of collaborative rather than individual
rate of service use had actually dropped to 35%. provider-based care systems and utilization of new
Over 75% of mental health problems commence before technologies – particularly those that could use Australian-
the age of 25 years and yet only 13% of young men and 31% developed and tested e-mental health systems.
of young women with a mental health problem received any Mental health advocates are looking for strong
service in 2007-08. We have not rolled out evidence-based leadership from the national government. The most
early intervention services for the major disorders, even substantive step would be towards single national financing
though the relevant service models were largely developed of all levels of care. We need the Commonwealth to build
in this country. The harsh reality for those consumers and the community capacity that would support not only early
families who are reliant on our various public systems, is intervention but also less reliance on acute hospitalization.
that despite all the promises and good intentions, substantive In my personal view, neither of the governance or financing
changes have not been achieved. We continue to focus on models the Federal Government is now advancing (take-
late rather than early intervention and restrict our services over of the community sector alone and/or partial funding
largely to those who are in the acute phases of illness. of public hospitals) will result in substantive changes.
It is with this reality in mind, that those who work in They appear to perpetuate the current dysfunctional
mental health have placed great hope in the work of the arrangements. Consequently, I have become much more
NHHRC and the rhetoric of the Rudd Government. Mental interested in whether the third alternative originally offered
health will not be improved without fundamental changes by the NHHRC (competitive social insurance models) may
in the Australian health care system. From our perspective, represent the style of fundamental change that is required.
we are stuck with two large and dysfunctional systems. Perhaps what is most obvious is that those national health
The first is the underfinanced, overregulated and non- values that we say we value (e.g. universal access, reduction
responsive public sector. Its mandate revolves around acute of health inequalities, minimal out-of-pocket expenses,
care services and hospital-based structures. Having grown regionally-responsive systems and person-centric care)
out of the asylum era, this system is still poorly integrated are not at the heart of the current system. Out-of-pocket
with the remainder of the medical system or the community expenses now constitute about 30% of total costs and will
care sector. The second is the fee-for-service primary continue to increase. The system is poorly equipped to deal
and specialist outpatient system. Due to the pressures of with the coming tsunami of chronic diseases, complex co-
geography and finance, these services are closely tied to the morbidities and demand for those procedures that people
economically-favoured areas of the capital cities. require as they age to maintain independent living.
The NHHRC has picked up some key elements of In Australia, health inequities and breakdowns in the
potential reform The most notable recommendations are the quality of care have been the immediate drivers of reform. In
emphases on youth-focused primary care services (based the next decade, however, the issues of rising costs, health
on the innovative Headspace model, in which the BMRI is inefficiencies and failures to introduce competition or support
a foundation member) and the national rollout of specialist innovation are likely to bring our system to the brink. If the
early psychosis services. It has also continued to emphasise Rudd Government fails to implement fundamental reforms in
greater integration with other key social services, housing 2010, it is likely that the whole system will slip towards the
and employment, and improved consumer and carer inadequacies that we are all too familiar with in mental health
participation. These are worthy recommendations and could – declining access, greater health inequities, unacceptable
be led by the national government at relatively little cost. variations in quality, greater out-of-pocket costs and increased
On their own, however, these service improvements reliance on acute care and hospitalisation.
18 rADiuS December 09
HeALtH reForM
Mind the Gap:
rhetoric and reality
By Jill White and Mary Chiarella
Jill White is professor of nursing and Dean of the Faculty of nursing and
Midwifery, university of Sydney.
Mary Chiarella is professor of nursing and Midwifery, university of Sydney.
redundancies, nursing positions
replaced with administrators, more
nursing assistants. welcome to nSw
post-garling.
The recommendations of the Garling Inquiry in New WHAt A pERpLEXING CONtRADICtION! Aiken, L, Clarke, S & Sloane, D.
(2002)Hospital Staffing, organisation,
South Wales held the potential to make a difference to the The public rhetoric about a dire skilled nursing shortage and Quality of Care: Cross national
outcomes of care in NSW hospitals - for patients and staff. and its impact on bed availability, the call for the Findings. International Journal of
They were based on an enormous body of research evidence government to educate more nurses, the department’s drive Quality Health Care, 14(1),5.
and the testimony of many expert clinicians. Now well past to recruit overseas prepared nurses, the introduction of Aiken, L, Clarke, S, Cheung,
the initial excitement about the potential for change, some r, Sloane, D, & Silber J (2003)
leadership programs such as “take the lead” and practice educational Levels of Hospital
of the current initiatives being rolled out in the name of a improvement programs such as “essentials of care”. nurses and Surgical patient
“response to Garling” are puzzling at best. These, juxtaposed with the clinical reality of redundancies, Mortality. JAMA290:1617.
Commissioner Garling acknowledged the pivotal role substitutions and the introduction of a large cohort of Duffield et al (2007) Glueing it
of the Nurse Unit Manager (NUM) in patient safety and Together: nurses, their work
assistants in nursing. In small numbers, assistants may
environment and patient safety. nSW
the quality of care, and was concerned at the progressive be an adjunct to the care team but should by no means Health: Sydney.
clinical detachment of this role. He suggested the be a substitution. This situation has been compounded Garling SC, p (2009) report of the
introduction of a role of “clinical support officer” to recently by a significant decrease in the number of available Special Commission into nSW
support NUMs in the administrative tasks that were taking places in NSW public hospitals for new graduates in new public Hospitals www.dpc.nsw.
gov.au/publications/publications/
them away from expert overview of clinical care at the unit graduate transition program, leaving many well prepared publicationlist-new#34182
level and the supervision of unit nursing care. What was and eager newly registered nurses disenchanted and
never foreseen was that in implementation, the clinical disenfranchised and who may never now enter the public
support officer roles would be introduced at the expense health system.
of nursing positions rather than as a complement to them. The rhetoric around evidence-based practice is brought
The Inquiry was sparked by a growing public concern into sharp relief with actions such as these, which run
for patient safety and particularly, the recognition and contrary to the findings of a strong body of international
action around the deteriorating patient. Watchful practice research (Aiken et al, 2002,2003) and even to that
and early detection fundamentally rely on well educated, commissioned by NSW Health itself, the major research
experienced nursing staff in sufficient numbers to be able to project Glueing it Together, (Duffield et al, 2007). This NSW
provide care. based research demonstrated that, at ward level, for every
10% increase in degree-prepared RNs in a unit, there is a
But WHAt ARE WE SEEING? concomitant 27% reduction in adverse events. It further
We are seeing clinical support officers replacing nursing showed that skill-mix (the proportion of RNs) is more
positions, and very high numbers of assistants in nursing critical to patient outcomes than the hours of care provided.
being introduced in substitution - not as adjuncts - to Commissioner Garling sought to improve clinician
registered nurses. Perhaps the most worrying, we are also engagement, to improve flagging clinician morale and to
seeing many nursing positions in several Area Health reassert the place of the experienced multidisciplinary
Services (AHS) being made redundant. These redundancies team at the centre of care. These redundancies, with their
extend across a wide spectrum of RN positions, including loss of experience and expertise, and the substitutions
Clinical Nurse Consultants who provide expertise and of uneducated pairs of hands are not only further
support to clinical nurses. Two of the area health services demoralising for the workforce but are potentially
in which this is taking place are areas of significant compromising for patient care. The deteriorating patient –
socio-economic hardship and that have traditionally had at the centre of Garling’s concern - may be at further risk
difficulty in attracting and retaining RNs. We understand if we are not vigilant about changes related to cost savings,
that a number of these redundancies have been offered to made in the name of patient care improvements, cloaked in
very experienced 8th year RNs who arethe backbone of the the name of implementation of the recommendations of the
experienced clinical ward based workforce. Garling Inquiry.
rADiuS December 09 19
Cover Story
The reasonable man adapts
himself to the world; the
unreasonable one persists
in trying to adapt the world
to himself. Therefore all
progress depends on the
unreasonable man.
George Bernard Shaw,
Man and Superman (1903)
Progress
By Stephen R Leeder
.
the preceding contributions from correspondents in the far-flung community is exposed. It is entirely right, therefore, that how we
corners of the health science faculties reveal the diversity of as a prosperous nation manage those experiences should be a
views about need for health system reform in Australia. political concern. It is also appropriate that we all have a say in
the policies that will distribute our national resources in pursuit
the articles give insight into the response that we are making as of better health.
a community of patients, carers, health service professionals –
private and public, managers and politicians to those needs. Optimistic? Yes I am! the process of discussion, involvement,
debate, rumination, lobbying, complaining, advising and sharing
Soon after this issue of Radius reaches you, we will know what is the process of a democracy at work. Given that process, there
conclusions prime minister kevin Rudd, federal health minister is a big chance that improvements will follow. Maybe they will be
Nicola Roxon and her state and territory counterparts have drawn big scale – a federal takeover – but maybe they will be relatively
from the year’s commissions of inquiry into hospitals, community small, nibbling at the edge, improving this, fixing that. We shall
care and prevention. We may also know what they have in mind to see. this is a good space to watch. radius
do about funding and managing health care.
We know many of the problems and we have ideas about
solutions. ultimately health, illness, suffering and death are
intensely human experiences to which every member of our
20 rADiuS December 09
academy Travel
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tour leaders, our carefully April 1 Istanbul to Moscow – from the Caesars to the Czars
planned and managed tours 1 Grand Tour of Italy – Bay of Naples, Rome, Umbria, Florence and Venice
1 Classical and Ottoman Turkey – Istanbul, Cappadocia and the Aegean Coast
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1 Berlin and Dresden – History, art and culture in northern Germany
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Join us for a real travel November 1 Paris and New York – Old world and New
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Web: www.academytravel.com.au
DeAn’S MeSSAge
“To have lived through a revolution, to
have seen a new birth of science, a new
dispensation of health, reorganized
medical schools, remodeled hospitals,
a new outlook for humanity, is not
given to every generation.”
William Osler, John Hopkins Hospital, 1913
Tessa Ho
photography by Ted Sealey
22 rADiuS December 09
FeAture
Shaking up medical education
By tessa Ho
Tessa Ho is Associate professor in Sydney Medical School and
Head of the Medical program, office of Medical education.
A n enduring feature of modern medicine is the
constancy of challenges and change, and no more
so than in medical education and training.
Australia is undergoing the first expansion of medical
schools for 30 years. Changes in medical school intake are
tSuNAMI REpORt
Not only are the numbers rising, those riding the wave
are different from past medical graduates. There is an
81% increase in domestic medical graduates, from 1348 in
2005, to 2442 in 2012. We have an increasing number of
typically cyclical. From a baseline of 851 admissions to international students who have been allowed to remain
Australian medical schools in 1970, medical school intake in Australia since 2003, with 260 in 2005, to 500 in 2012.
rose to 1278 in 1980. In the 1980s and 90s, the Australian Domestic fee paying students were allowed into Australian
medical workforce was deemed to be adequate for the medical schools from 2004, although this ceased in
requirements of health services and the community, and 2008. There are more students in graduate entry medical
for more than 20 years there was no political pressure to programs (45%) and a steady upward trend in female
expand the capacity of our medical schools. In the mid medical graduates (55%).
1980s, there was a reduction to intake so that by 1990, the There are certainly differences in the educational,
1030 annual intake of medical schools was deemed surplus training and work environment faced by the medical
to requirements. workforce in the 1980s and the 2000s. Interns and residents
in the 1980s endured tight hospital rosters, days filled
AuStRALIAN uNIVERSItY MED SCHOOL GRADuAtES 1970-2016 with unending administrative duties with the emphasis
on service and scant attention to training or education.
The command structure was hierarchical, progressing from
short white coats for bottom of the rank, to long white
coats for registrars, and finally, a suit for the consultant or
“Sir”. Today, the rosters are flexible, with more humane
working hours and better pay. Mentorship, rather than
humiliation, is the norm. White coats are out and “Sir” is
a senior colleague on first name terms. Medical graduates
of the 2000s expect, and receive, education, training and
supervision.
What does the world look like for our current medical
graduates? According to Leeder, there remains a significant
disconnect between medical school and internship.
Sources: Karmel;2 Doherty;4 Medical Deans Australia and new Zealand;6
Department of Science, education and Training, university Statistics Section,
Our graduates tend to be older; many are married with
higher education data (customised dataset rFI 03/312). children and burdened with debt. They are concerned with
achieving and maintaining a work life balance, and are
MEDICAL StuDENt tSuNAMI trained to think, criticise and challenge. Many are working
More recently, Australia, along with the rest of the world, in urban settings, although some are taking up the recent
has found itself in the grip of a serious medical workforce initiatives to move to rural preferential intern placements.
shortage. By the late 1990s, severe medical workforce They are keen to secure equitable training experiences
shortages led to the decision to establish a number of new with exposure to good clinical teachers, and are open to
medical schools. By 2008, seven new schools had opened receiving that training in expanded settings outside the
and there are now 19 Australian medical schools. With this more traditional teaching hospital environment. They are
unprecedented expansion, the number of medical graduates strong advocates for patient safety and quality of care – and
is set to rise from around 1600 in 2005 to about 3000 in 2012. believe that intern education is critical to safe patient care
and sound postgraduate education. Nevertheless, intern
AuStRALIAN MEDICAL StuDENtS work remains mired in ‘administrivia’ – forms, logbooks,
year total number records, surveys, according to Leeder – 30% of the time of
2005 6,622 an intern’s work has no clinical educational value.
2008 9,445 After internship and residency, according to Harris et al
2009 10,405 (2004), more recent graduates (from 1996 onwards) decide
2010 11,408 on their specialties earlier compared to older graduates.
2011 11,922 By the end of the first postgraduate year (PGY1), 37% had
2012 12,053 chosen their specialty, 43% by the end of the second or
2013 12,296 third postgraduate years (PGY 2 and 3), 9% at the end of
the fourth and fifth postgraduate years. Only 11% chose
their specialty more than 6 years post graduation.
rADiuS December 09 23
FeAture
DeAn’S MeSSAge
More controversial is the recurring issue of the In their collective wisdom, these distinguished medical reFerenCeS
extremely long length of training of specialist doctors, faculty distilled the key educational changes that must be Joyce CM, Stoelwinder Ju, Mcneil
JJ and piterman L. “riding the wave:
more recently raised by Peter Garling (26 October 2009) implemented by medical schools:
current and emerging trends in
at a University of Sydney forum. This is not peculiar 1. Ensure student diversity (racial, ethnic, social, graduates from Australian university
to Australian medical training. The Chair of Surgery at geographic) so graduates can serve their community medical schools”. Medical Journal of
Eastern Virginia Medical School recently stated that the better. Australia 2007; 186 (6): 309-312.
most wasted year in all medical education is the 4th year of 2. Decrease the burden of student debt because debt acts Leeder Sr. Medical Journal of
Australia 2007
medical school. The President of Association of American as a deterrent to medical studies and has an adverse
Hager M, russell S, editors.
Medical Schools noted that some students would benefit effect on career choices. “revisiting the Medical School
from having 4th year of medical school count as the first 3. Truly integrate the teaching of science and clinical educational Mission at a Time
year of residency. In some New Zealand medical schools, medicine. of expansion”. Proceedings of
a Conference Sponsored by the
final year students are paid supernumeries. In a paediatric 4. Meaningfully use technology and educational theory Josiah Macy, Jr. Foundation;
clerkship in the United States, the senior year is designed for life long learning. Charleston, South Carolina, in
as a bridge between the undifferentiated medical student 5. Incorporate principles of patient safety, quality october 2008. Accessable at
www.josiahmacyfoundation.org.
and the focused postgraduate trainee. These senior medical improvement, public policy, public health into the
Harris 2004
students participate in portfolio and small group sessions curriculum for all students.
to discuss senior curriculum in paediatrics, receive advice 6. Meaningful interprofessional education, collaboration
about electives, resumes and applying for residency and teamwork as part of the medical program
programs. Australian medical schools and specialty colleges experience for all students.
are exploring ways of providing educational modules 7. Create clinical experiences which are less fragmented
credited by Colleges towards specialty qualification. and more truly representative of the experiences and
clinical problems of the patients they will serve.
RIDING tHE WAVE 8. Better integrate the whole continuum of education
In all the fear and trepidation about the “medical student from premedicine to continuing education – allow a
tsunami”, there is no systematic, considered discussion shorter duration, competency rather than time based
about the expectations and goals of this expansion. Surely, and with better coordination of the transitions.
it is up to us, as medical educationalists, to set a timely 9. Influence student career choices to better match
educational mission to use this expansion to address new society’s needs.
and unmet needs in medical education. In a recent discussion 10. Create educational models and environments which
paper from the Josiah Macy Foundation, prominent medical encourage the professional attitudes and behaviour
educationalists pointed out that we should not be arguing we prize and our society desires.
about the projected numbers or estimates of medical students Sydney Medical School has achieved much in its
or graduates, nor the funding – who pays and how much. curriculum reform.
The core issue is to how to educate our doctors for the future. This extraordinary period of expansion of medical
They argue that it is the responsibility of universities and student numbers is an unparalleled opportunity for Sydney
their medical schools to prepare doctors to better meet the Medical School to take a leadership role in thinking beyond
public’s needs and participate most effectively in a changing simply the numbers and the funding of places. Our focus is
health care system. to make sure we have a better alignment of Sydney Medical
School’s educational mission with the health needs of the
community we serve. radius
24 rADiuS December 09
FeAture
Magnetic approaches
to molecular medicine
the new $3 million tesla magnet
enables researchers to understand
complex molecular structures
Y ou might not be able to put a patient into it but
the new three tonne 18.8 Tesla magnet that was
recently installed in the basement of the School
of Molecular and Microbial Biosciences (MMB) has the
potential to make valuable contributions in the twin quests
millilitre or so of aqueous solution – sits comfortably at
room temperature, whereas the detection system, which is
only a matter of a millimeter or so away, is cooled to around
-253 ºC. It never ceases to amaze me how the manufacturers
have managed to engineer a configuration like that”.
1. pellecchia et al. (2008) nat. rev.
Drug Disc. 7, 738-45.
2. Hajduk et al. (1997) J Amer. Chem.
Soc. 119, 5818-27.
3. Brindle et al. (2002) nat. Med. 8,
1439-44.
to understand the causes of human disease and to make The technology also dramatically reduces the sample 4. Coen et al. (2008) Chem. res.
diagnoses. quantities required to carry out experiments. “With this Toxicol. 21, 9-27.
Every clinician is familiar with MRI (magnetic resonance new instrument, it is feasible to determine the molecular
imaging) scanners as a routine tool for imaging soft tissue structure of a small molecule or a metabolite with only a
and diagnosing conditions ranging from tumours to spinal microgram or so of purified compound,” says Associate
injuries to damaged ligaments. The first MRI images were Professor Joel Mackay, who led the application to the ARC
recorded in the late 1970’s, and the technology was built LIEF scheme to purchase the new $3M magnet. “Similarly,
on 30 years of development in nuclear magnetic resonance we can determine the high-resolution three-dimensional
(NMR) spectroscopy. NMR spectroscopy, in which the structure of a protein and investigate its function with as
magnetic properties of atomic nuclei are manipulated little as a few hundred micrograms of material.”
and detected, has long been used by chemists to probe The structure of a molecule is intimately related to its
the structures and shapes of molecules. Increasingly, function, so mapping the structure of molecules such as
biochemists and biomedical researchers have also been proteins is vital to understand how organisms function,
harnessing the power of NMR to determine the three- and how mutations can result in disease. Knowledge of
dimensional structures of proteins and other biomolecules. molecular structure is also essential when designing drugs,
NMR spectroscopy has been an important part of and high throughput screening of small molecule libraries
the research profile at the School of MMB (formerly the has become a common approach to obtain lead compounds
Department of Biochemistry) for nearly 30 years, since (i). As an example, Abbott Laboratories in the USA
medical graduate Philip Kuchel was appointed as Professor used NMR spectroscopy to discover novel tight-binding
of Biochemistry. inhibitors of the matrix metalloprotease stromelysin, which
“Over the years, our NMR work has covered a broad is involved in the pathogenesis conditions such as coronary
spectrum of activities, from quite theoretical methods artery disease (ii).
development through to literally dozens of collaborations A recent exciting development has been the use of NMR
with medical colleagues, who have been keen to understand spectroscopy as a tool for surveying the metabolic profile
the molecular foundations of the observations they had of a tissue or fluid (metabolomics), which can be a very
made in a cell-biological or clinical setting”, says Professor powerful approach for disease diagnosis, drug profiling and
Kuchel. even forensic detective work. For example, NMR spectra
The new instrument is the most powerful NMR of human serum samples have been used as a rapid and
spectrometer in NSW and was purchased by a consortium noninvasive method with which to diagnose coronary heart
led by the University of Sydney and including ANU, disease (iii), and many other applications of this type have
UNSW, Centenary Institute, Victor Chang Institute for been developed (iv).
Cardiac Research and the Garvan Institute for Medical NMR methods can provide insight into a very wide
Research. The spectrometer features a cryogenically cooled range of biochemical and biomedical problems and,
detection system that dramatically increases sensitivity, although researchers in MMB will be putting the new
cutting data acquisition times by up to a factor of almost instrument through its paces over the coming months, they
ten. This makes an enormous difference when you are welcome opportunities to collaborate with outside users to
talking about acquisition times of up to a week or more for provide a molecular perspective to their research. If you are
some experiments. wondering whether NMR spectroscopy might be able to
“This is cutting edge technology”, says Dr Ann Kwan, provide answers to your questions, contact Dr Ann Kwan
the NMR Facility Manager. “Your sample – usually a half- (02 9351-4120 or akwan@mail.usyd.edu.au ). radius
rADiuS December 09 25
FeAture
Study online: clinical
epidemiology more accessible
Sydney Medical School offers a wide
range of postgraduate courses, many
available entirely online, including
“Clinepi”.
S tudents studying clinical epidemiology programs at
Sydney School of Public Health can elect to study by
traditional face-to-face mode, or entirely by distance
learning, or a blend of the two.
“By offering flexible study options we can attract
For more information about Clinical Epidemiology or to download a course guide,
see www.health.usyd.edu.au/future/coursework
clinepi@health.usyd.edu.au
For more information about the full range of postgraduate courses on offer,
students who may not have otherwise been able to please visit our website
undertake postgraduate study. Our part-time and full-time www.medfac.usyd.edu.au/futurestudent/postgrad/coursework/index.php
options, together with face to face or distance-learning
possibilities allow students to choose study that best meets
their needs and allows them to more easily manage their
study, work and personal lives, no matter where they “There are many great aspects of the Masters program in Clinical
live” said Angela Webster, Senior Lecturer in Clinical Epidemiology: the excellent faculty, the relevant courses and the
Epidemiology
pragmatic statistical skills. It was the flexibility I appreciated
Clinical epidemiology has been offered by the School
since 1994 and today it is the leading program of its kind in the most. The excellent on-line access allowed me to complete
Australia. The program brings together world-recognised half my courses from Canada and the other half in Sydney.”
leaders in epidemiology and biostatistics.
rahul Mainra
Degree programs in Clinical Epidemiology on offer Master of Clinical epidemiology student
include a Graduate Certificate, Graduate Diploma and a
full Masters degree. In addition to flexible study options
for degree programs, many units of study are available
as stand-alone professional development short courses.
Units of study are continuously updated, and new options
added ensuring the program remains at the cutting edge of
modern clinical epidemiology. New options include units
of study on genetic epidemiology and on qualitative health
research.
“Students apply for our courses for one major reason:
their vocational clinical training and other prior tertiary
training does not equip them for what they want to do.
Some students want to be able to tell potential employers
that they have clinical research skills as well as core clinical
competencies. Most want to interpret and use clinical
research in their everyday practice, and some want to do
high quality clinical research themselves.
Our alumni surveys consistently show that we can
provide these skills,” said Professor Jonathan Craig,
Director of the Program.
While the courses continue to attract applicants with
a medical degree, they are aimed at all healthcare workers
who have a clinical role. Past and current students include
junior and senior doctors, nurses, midwives, pharmacists,
physiotherapists and paramedics. radius
26 rADiuS December 09
MeDSoC newS
DonATIonS
medsoc news
AnD MenTorS
> CELEBRAtING SYDNEY MEDICAL > BOOk DONAtIONS AND ALuMNI
Ineke Wever president, Sydney university Medical Society - iwev6767@med.usyd.edu.au
their immediate network and direction from the wise
SCHOOL’S COMMuNItY MENtORING: pROJECtS fOR NEXt YEAR medical professionals who have gone before them.
this will be my last article for radius as i am Another exciting project to come out of MedSoc it would also be beneficial, i believe, for alumni to
becoming an intern next year and handing the recently is between globalHoMe, our global health stay in touch with the younger generation who will
reins of MedSoc over to the new executive who i group, and the MedSoc Bookshop. Both entities be determining the future of the medical profession.
am sure will continue the great work done by the independently came up with the brilliant idea of a this idea will be discussed at the next Medical
2009 MedSoc Council. i am immensely proud to be book donation scheme, whereby books would be Alumni Association meeting and i would encourage
graduating from Sydney Medical School and joining donated to developing countries that need them. any alumni who have ideas as to the logistics of this
the ranks of alumni who continue to impress and while the project is still in the development phase, challenging project to attend.
inspire me. several ideas have already been proposed:
the Australian Medical Students’ Association 1. one textbook for you, one for the world’ scheme
‘ > INtERNSHIpS AND INtERNAtIONAL
october Council was held in MacLaurin Hall and whereby alumni buying textbooks for themselves StuDENtS
among the remarks of appreciation and comments buy another for the stockpile of new textbooks MedSoc has continued its advocacy on internships
about looking like Hogwarts, i took great delight for a developing country medical school. and international students, hosting the nSw Medical
in reminding the Bond university representative 2. Donate your discount’ scheme, whereby alumni
‘ Students Council ‘the Medical Student tsunami:
that ‘this is what real sandstone looks like!’ can donate their MedSoc discount to a literacy Do you Have a future?’ on october 29th. generating
prestigious architecture is just one difference. the good cause such as the indigenous Literacy some media coverage, we continue to advocate for
newer medical schools also miss out on the sense project. increasing the number of internship spots while
of community that comes from being a Sydney A
3. second hand book donation scheme, where continuing their quality of teaching and supervision
university student and talking with past graduates alumni can donate their textbooks to those to cope with the increasing numbers of graduates.
who have spent decades in the health system, in need (however would need to have some
sharing a knowing tale about a particular building, exclusion to ensure MedSoc did not become a > tHANk YOu tO 2009 MEDSOC
teacher or tradition. repository for out-dated textbooks!). i would like to say a particular thank you to the
one project which i would like to see get off the MedSoc Council of 2009, all fifty-four of you! this
ground in the future, as it has had several false years Council has been enthusiastic and far-reaching
starts, is an alumni-student mentoring program. in their projects for this year and together we have
Students would benefit from having guidance in achieved many good things. i wish them the best of
regards to career options, support from outside of luck for the future!
Going THE
MEDSOC
Bush ? BOOKSHOP
Let us help. We ship FREE Australiawide
Visit www.medicalsocietybookshop.com
rADiuS December 09 27
australia’s online art space
sign up to our free e-news today
9 out of 10 Australians
don’t see enough colour each week
John Nicholson Satellite Graffiti (detail), 2009, plastic, 80 x 83.5 x 3cm. Image courtesy of the artist
and Sophie Gannon Gallery, Melbourne. www.artwhatson.com.au/sophiegannongallery
alumninews
president’s report
In a recent talk given mainly to medical the interest and enthusiasm of our alumni
students at the university of Sydney, professor and also to take advantage of mentoring skills
Sanjiv Chopra, faculty Dean of Continuing gained by our academic staff and alumni in
Medical Education at Harvard Medical School, other settings.
spoke on what he regarded as the ten tenets
In developing an effective mentoring program
of leadership. taking words beginning with
for all students, we need to consider the needs
each of the ten letters in ‘LEADERSHIP’, he
of special groups – our international students,
cited the exemplary qualities and attributes
those who have never previously lived in Sydney,
of historic and contemporary leaders in all
and our few Indigenous and refugee students.
walks of life. these included the skills and
attributes of: being a good Listener; Empathy In August our Vice-Chancellor, Dr Michael
and compassion; Attitude; the capacity to Spence, launched the university’s alumni online
Dream expansively; Effectiveness in doing networking community, called AlumniOnline.
the right thing; Resilience and a Resolute this will eventually enable you to search for
determination; a Sense of purpose; Humility colleagues and friends and to search, join and
and a sense of Humour; Integrity, Ideas, establish social and professional networks (see
Imagination and ability to Inspire; and www.usyd.edu.au/alumni). It also includes an
Principles and People skills. (So how do you option to mentor a student.
judge yourself on those characteristics?)
fledgling efforts at mentoring have started
professor Chopra asserted that anyone who in at least one clinical school. GMp1 students
followed his ten tenets would be on the path to at Western Clinical School receive advice
becoming a better leader and that clinicians can about their studies and student life from other
use these principles in caring for their patients. students in GMp3 (aptly named ‘Sherpas’).
Our GMp students recognise that much can be Also, students in GMp1 in all clinical schools
learnt about leadership and recently organised prepare a personal and professional
a Medical Leadership Seminar. those of us Development (ppD) portfolio. Some of our
who had graduated in the generations before alumni have been voluntarily interviewing
had heard virtually nothing on such topics! these GMp1 students towards the end of their
perhaps it was just assumed that we would first year. Interviewers offer friendly guidance
find suitable role models and informal mentors to students and both then provide brief
among our lecturers and tutors, within our comments to Sydney Medical School.
extended families and among local doctors. undoubtedly we will require a well coordinated
through our proud history as Australia’s approach to achieve effective mentoring of our
first medical school, Sydney has spawned students. While some in the wider university
> REuNION DAtES > OtHER pASSIONS
> CASE NOtES > REuNION REpORtS
pRESIDENt’S REpORt > ALuMNI ARCHIVE
numerous leaders in clinical care, medical consider that much mentoring can be done
education, research, and public health. by email, I think that face-to-face meetings
But we have been slow to develop effective should be an essential component, at least
programs of mentoring to advise our GMp for initial discussions. So how is mentoring
students, and those doing public health and best organised? It seems most feasible to
other postgraduate courses, on their student put students and mentors in touch with one
experiences and future career options. another through each of the city and regional
clinical schools, thus enhancing opportunities
In response to a request in a recent
for mentors and students to meet regularly.
e-Newsletter several alumni have made
suggestions about the desirable aspects of please send your ideas and suggestions to me:
formal mentoring. I have also had preliminary pallancaster@gmail.com, or call on (02) 9660
discussions with the Dean, some of his 0576. We are keen to hear from alumni who
advisers, student leaders, and the Medical would be happy to be mentors at the start of
Alumni Association Council. We aim to harness the GMp1 program in 2010.
ALuMni ArCHive
Young Life Lost In Pursuit
Of Medical Knowledge
tHoMAS CArLyLe pArkinSon 1884 - 1909
MB CHM 1906
So many of our pioneer doctors died untimely deaths
whilst striving to find cures for diseases ravaging
humanity at that time.
one hundred years ago, thomas Carlyle parkinson died
whilst working as part of the indian plague Commission
at the Lister institute of preventative Medicine in London.
parkinson lived through the outbreak of plague in Sydney
in 1900 before moving to London. He contracted plague
while working in the laboratory and died only three years
after graduating from the Sydney Medical School.
By Lise Mellor
Above: parkinson in laboratory,
Lister Institute.
Contents page: Thomas Carlyle
parkinson as prosector at the
Sydney Medical School 1903.
parkinson is second from left.
C arlyle Parkinson was born in Sydney and came to
the fledgling Sydney Medical School in 1901. He
was an enthusiastic and excellent student, coming
first in his year in each of the five years he completed.
Excelling in dissection, he became a prosector in 1903
for making opportunities for Australian medical researchers
and Parkinson joined his team.
Parkinson worked at the Lister Institute until October 1908,
when he was appointed to the Indian Plague Commission.
He worked alongside Sidney Rowland, a bacteriologist at the
with peers Arthur Moseley, George Bell, John Hill and Lister’s Isolation Laboratory at Elistree. The project involved
John Harris. As an undergraduate, he gained the Renwick growing large quantities of plague bacillus then grinding it
Scholarship for Natural Science and Comparative Anatomy before extraction by chemical treatment. The dangers of this
and the John Harris Scholarship for Anatomy and technique were well recognized: two deaths already from
Physiology. Parkinson graduated in 1906 and was awarded typhoid at the Lister in 1903.
the University Medal with special distinction. So far it has not been possible to find out the exact
Leaving medical school, he became Resident Medical nature of Parkinson’s work on plague, as the Lister Institute
Officer at the Royal Prince Alfred Hospital and a year later, Archive was severely damaged by World War II bombing
Resident Pathologist. In 1908 he transferred as Junior and there were no scientific publications identifying
Medical Officer to Callan Park Hospital. him as an author. However, we do know that in 1908,
As a young doctor, Parkinson retained the interest for the Institute was involved in preparation and testing (in
scientific investigation he had exhibited as a student and horses) of the potency of plague antiserum. This required
in 1908 successfully applied for the James King Travelling mouse protection tests using injections of live organisms –
scholarship to further his studies in England. Parkinson potentially with a risk to the experimenter.
had experienced the impact of plague outbreaks in Sydney The other method of research into plague vaccines that
in 1901-2 and had studied here under Sir Charles J Martin was active at the Lister at that time involved growing and
before Martin took up the Foundation Chair of Physiology purifying large batches of organisms before grinding and
at the University of Melbourne. When Martin returned extracting them. Centrifugation, pressure filtration and
to England and became director of the Lister Institute of grinding all generate dangerous aerosols, and such work
Preventative Medicine in 1903, it became a magnet for was conducted in ordinary laboratories with protective
young Australian doctors attracted to medical research. So clothing limited to gowns. Reports of laboratory acquired
it is not surprising that when Parkinson went to London infections and deaths are all too common in the early
to broaden his experience, he chose to join C.J. Martin’s microbiological literature of the period.
team at the Lister Institute where work on improved plague Parkinson contracted pneumonic plague and died two
vaccine was a major preoccupation. Martin was renowned and a half days later on February 4th, 1909, just before his
30 rADiuS December 09
ALuMni ArCHive
Grinding and extraction apparatus.
25th birthday. There was no coronial inquest. and neither he nor any the contacts became ill. Soon after, More interesting historical
Little is recorded about the manner in which he isolation bungalows were erected to house staff working information about thomas
contracted plague, however, if an inoculation injury was the with dangerous pathogens. Both Rowland and Macfadyen parkinson and other alumni
is available in Sydney Medical
source of his infection it would have led to classical bubonic (who had invented the grinding technique) later died of
School’s online museum:
plague with a localised buboe as its first manifestation. That laboratory infections while working on other organisms. www.medfac.usyd.edu.au
Parkinson suffered pneumonic plague suggests his illness was Minutes of the Lister Institute meeting of 1909 state that
caused by inhalation of plague organisms. the Chairman referred in feeling terms to the lamentable
Dame Harriett Chick was on the staff at the time and occasion and moved “that the Governing body hears
later co-authored War On Disease: the official history of the with deepest regret of the death of Dr Parkinson from an
Lister Institute (1971). She describes the plague research infection incurred during the performance of his scientific
being carried out and mentions Parkinson’s death, but her duties and expresses sympathy to the relatives of Dr
description is oblique and only adds mystery to his demise: Parkinson in their affliction”.
The organism...was grown in an isolated laboratory and if Parkinson’s obituary in The British Medical Journal
any worker suspected that he had received a small splash, for said that his “acquaintances will remember him as a keen
instance while inoculating a horse, he immediately had a bath worker, but his comrades realise that they have lost a good
of lysol. But close familiarity with the agents of death seems and trusted friend. He lost his life striving in the interests
often to breed something close to contempt for danger, and of others, doing a man’s work as a man should.”
even the best workers may, like rock climbers, have an off day Back in Sydney, there was no obituary in the Sydney
and make a slip in a familiar practice. Morning Herald but subscribers to a memorial for Parkinson
In 1909, an Australian guest worker, Thomas Carlyle established the Parkinson Memorial Prize for Pathology.
Parkinson, working under Rowland, complained of feeling Established with a bequest of £225, the initial value of the
desperately ill. He was living at the time in Queensberry prize was £5, awarded annually for proficiency in Pathology
Lodge, where several of the bachelor workers were on the result of the Fourth Year Examination. Today the
accommodated. It was thought at first that he had influenza prize is awarded for meritorious performance in a pathology
and Hartley and Rowland looked after him. When it was Quiz conducted by the department and is valued at $750.
realised that his lungs were infected, (Sir) Martin came out At the Lister Institute a plaque was erected in the
from Chelsea and recognised that Parkinson had pneumonic Isolation Laboratory at Elistree to commemorate Dr
plague. There was nothing they could do to influence the result; Parkinson’s death with the words “died in faithful discharge
within three days of falling ill Parkinson died. of scientific duties”. The plaque is now housed with the
Hartley was given large doses of Haffkine’s plague serum Lister archives at the Wellcome Institute. radius
rADiuS December 09 31
ALuMni newS
case notes
1960s
frank Stitt
London etc.
From there, I moved to California
- two British pharmaceutical
Argentina.
I remain a real Hispanophile, and
very fond of warm weather! And
from 1980 until 1991. Then I got
divorced and closed the California
Prenatal Diagnosis Institute,
MBBS 1963 companies offered to fund a warm water. my amniocentesis practice, and
consultancy service so with began exclusively focussing only
some trepidation, I left full-time John D Stephens on ultrasound for the practice of
employment forever, something I MBBS 1967 prenatal diagnosis. I divided my time
have never regretted. I assembled a President of BRM (Bellingham between Palo Alto California (as a
team from UCLA and we were never Railway Museum) part-time parent and dad for my son
short of work. I am one of the founding members Mischa, who showed no proclivity
Through most of the 1980s, of an all volunteer run, non-profit what-so-ever for medicine. He joined
I based myself in San Francisco organisation that started the Google Co. in Mt. View immediately
and combined academic activities Bellingham Railway Museum in after he graduated from a liberal
(research and teaching) at UCSF and downtown Bellingham, Washington, arts college, Swarthmore, where
UCLA with an active consultancy where I have been living for the past he remains today) and Bellingham,
After graduation, I spent six years based on information technology 12 years. Washington State, where I now live
at Royal Prince Alfred Hospital as a in medicine. I was also heavily My interest started when I was permanently.
house officer, Cardiology Registrar, involved in AIDS research. My quite young, around eight years old, Six years ago, I opened up boxes of
and National Heart Foundation Spanish language skills drew me when I was given a HORNBY train the trains that I had bought hoping
research fellow. At the end of this towards Latin America, and I carried set. Life progressed in a new direction to ‘’play trains’’ with my young son -
period, I moved to Sydney Hospital out a number of studies in Mexico after I left Drummoyne Boys’ but the D put an end to that. So back
as a Fellow in Cardiology and sat and Argentina. In 1988, I accepted High School and entered Sydney into their gleaming red boxes they
for the Royal Australian College of an opportunity to move to Miami University School of Medicine in went, and into long term storage.
Physician’s (RACP) Membership as a Professor of Medicine and 1961.After graduation I did the usual (Train lovers may recognise that those
exam, gaining recognition as a Epidemiology, and physician at the residents training, and left Sydney RED boxes are all G scale LGB trains)
consultant physician. Miami Veteran’s Hospital centred on in 1970 for Oxford UK, where I When I reached age 60 yrs, I found
I left for London and ended up the AIDS research unit. started OB/GYN training which led to myself looking for an opportunity to
with a joint appointment at the I was given funds by the MRCOG in 1973. ‘’play with trains again’’. A group of
Medical Research Council (MRC) government of Puerto Rico to develop I left UK in 1974 and did a like minded retiree’s decided to start
and the London Hospital (in the East a healthcare information model for locum in Brandon Manitoba for a Railway Museum, and at age 66
End) as a Senior Cardiology Registrar. the island, which I did with a team 6 months while waiting for my years I feel it keeps me in touch with
One of my research projects took me of collaborators. Part of the model position as a physician specialist kids and parents of kids whom just
all over the UK for a study of risk included medical education and in at Stanford University Medical love everything to do with trains,
factors for heart disease: I thought 1998 we started the first Internet- Centre in California USA. That along with helping a new generation
it was pretty good to be paid (albeit based medical school in St Kitts lasted 4 years until I obtained a to come to value an alternative form
at UK rates) to be tourist, and went and Nevis. With my colleagues, fellowship in obstetrical genetics at of transportation to the almighty
all over the British Isles. This work we were invited to contribute by UCSF (University of California San automobile. For more details, please
sparked a new interest in information invitation to the British Medical Francisco) from1978-1980. see www.bellinghamrailwaymuseum.
technology and biotechnology Journal’s Millennium Edition. The I opened my own private practice org and maybe come visit me at The
innovation, skills that came in handy paper, titled “Universities without specialising in prenatal diagnosis and Museum.
later on. walls: new paradigms for medical ran a genetic amniocentesis facility
When other plans suddenly fell education”, attracted a lot of
through, I was recruited by the attention, resulting in my subsequent
drug industry, not something I had pursuit of technology-driven medical
considered up to that point, but education.
a quadrupling of my salary was More recently, I have been Vice-
compelling, plus the experience. Chancellor of new medical schools
So, I accepted a Medical Director’s in Samoa and Vanuatu. I do work
post for a Swiss company based in for WHO, and last year developed a
New York. Working in New York, faculty training package for the Fiji
with a virtually unlimited budget, Schools of Medicine and Nursing.
was a revelation after the threadbare This was built upon my earlier work
resources available in Australia, in Valencia, Spain, and Buenos Aires,
32 rADiuS December 09
ALuMni newS
AN uNuSuAL HOBBY fOR A REtIRED SuRGEON?
James Edwin Wright MBBS 1955
Brought up on a farm at Boambee, on the north coast factory making all their own hives and tools on site.
just south of Coff’s Harbour, something sparked an Penders are still in business, but hives are imported
interest in bees at the age of 12 or 13. Farmers on each from New Zealand and mechanical equipment from
side had bees and they were most helpful, one giving Italy. Prices were stable then and relatively cheap. I
me a hive box and a homemade hive tool and the other used to save up my pennies, order from their catalogue,
the first swarm out of his hives in spring. And so I had pay by postal note for delivery by train to Coff’s
my first beehive! Well may you ask why a boy would Harbour.
spontaneously develop such a passion when neither At 16 years of age I went off to Sydney University
parent was interested. I can only answer in words from and of course the bees had to go. Some 15 years later,
“South Pacific” when living in Newcastle, a swarm lobbed in my front
Who can explain it? garden. Of course, I had to have them but I had to get
Who can tell you why? some gear. Penders was a wonderful firm, for when
Fools give their reasons, I rang I was delighted to find that I was still on their
Wise men never try. record books and my credit was good! And that was
long before computerised records.
My second swarm came shortly after, in very I’ve had bees in a suburban backyard ever since but
different circumstances. I used to ride a horse to it is only since retirement 14 years ago that I have been
school, and on the way I saw a swarm of bees hanging able to exploit the hobby to the full, gain confidence
accessibly on a tree. I was late for school that day! This and reap maximum enjoyment from it. That was
swarm, however, was very aggressive and I didn’t like made possible by joining the Hunter Valley Branch of
them much. Being inexperienced and with limited the Amateur Beekeeping Association of NSW, and I
protective gear, I was timid and found the brood would strongly urge any budding beekeeper to start
box rather daunting. (Now it’s the most fun place to by joining this organisation. There is a lot to learn,
explore; it is the engine room of the colony.) support is needed to gain confidence and there is no
The nearest supplier of beekeeping equipment was better source of hands-on education than from other
Penders in Elgin Street Maitland where they had a the friendly experienced beekeepers.
Hot to go.
Need motivated employees for the summer
months who can contribute from the get-go?
SydneyTalent specialises in connecting University of Sydney
students with organisations needing a temporary customised
workforce. We handle initial screening and compliance, leaving
you free to concentrate on core business as demands warms up.
Minimise your effort and your outlay – call SydneyTalent on
(02) 8627 8000 and find out about the hottest team in town.
www.sydneytalent.com.au
rADiuS December 09 33
ALuMni newS
Alan Gale These onerous administrative March as described at www. from his training and try to stay fit
MBBS 1969 tasks have limited my time (and gazafreedommarch.org in an attempt just with the others.
expenditure) in restoring vintage to get Israel to lift the siege of Gaza.
motor vehicles and visiting with
Helen, still my wife after 41 years, my
two sons, one a lawyer in New York,
I expect to take with me as much as
will fit into my backpack of some
of the many items whose entry into
1990s
Loreto (Loren) Rose
the other a marketing director for an Gaza is severely restricted, like toilet MBBS 1999
international company in Canada. paper, children’s schoolbooks and
pencils, and children’s shoes. Because
Alexander frank John Bell I am so old and absent minded, it is
MBBS 1969 quite possible that I’ll forget to take
the stuff out with me.
The church I attend is trying to
After initial career priming (MRACP set up a sister church relationship
- subsequently FRACP) at RPAH with Gaza Baptist Church, and I very
(and changing direction to FRACS) much hope to visit them while I am
and St Vincents Hospital, I was in Gaza as well as the Community
the first Australian to be awarded Mental Health Program.
the prestigious Evarts A. Graham I’m back in Sydney after 4 years
Fellowship of the American
Association for Thoracic Surgery and
spent several years in America in
1980s
ferdinand Chu
in Melbourne, and working part
time since completing my specialty
training in Ophthalmology. As a
cardio-thoracic surgery culminating I did my residency at Launceston MBBS 1986 student, I had loved my experience
at the Mayo Clinic before returning General Hospital, Tasmania and working with kids and I have a
to St. Vincents Hospital and then went to Claremont Hospital, sub-speciality in paediatrics. Im also
subsequently RNSH. & the Sydney Perth, in 1970 as a medical officer. busy raising 2 girls – Amelia, who is
Adventist Hospital. While in WA, I gained the DPM almost two and half years old, and
For the next 22 years I had and MRCPsych, and went first Alyssa who is 6 months old. My
the privilege of assisting in the to Parkville Psychiatric Unit as a private practice is in the west, south
development of cardiac programmes registrar. I gained the MRANZCP , west and northwest and I have a
in nine countries from Pacific Islands worked at Mont Park Hospital as a public post at Bankstown Hospital.
& PNG to Mongolia, Nepal, Vietnam consultant psychiatrist, and then to In the decade since graduation,
and Myanmar in association with Hobson Park Hospital as Psychiatrist the highs have been marrying Nick
Sydney Adventist Hospital & Rotary Superintendant where I gained the during internship and recently,
International. This led to numerous FRANZCP . Since the age of 6, I have always starting a family. In the middle, I
awards including from the late king In 1983 I went to Ontario, where been a keen swimmer. Other than finished the ophthalmology training
of Nepal, the President of Fiji and I worked in various positions for swimming I have never taken other program in Melbourne. My biggest
the Shastin University of Mongolia 17 years, the last and most fulfilling sports seriously. low was the passing of my father 3
as well as many Rotary awards. as the psychiatrist for an Assertive I also have been working as a years ago.
Receiving the International Medal Community Treatment Team. radiologist in Hong Kong for 19 Ten years after graduation, my best
of the RACS in 2007 was a career In 2005 I returned to Launceston years. During the S.A.R.S. epidemic memories of medical school are the
highlight. General Hospital as Consultant in 2003, all swimming pools in the social networks: it was great to meet
Retiring from active surgery last Psychiatrist and worked in that territory were closed for health and get to know so many of my study
year (after almost 35 years of surgery) role until I retired in 2005, though I and hygiene reasons. When I had mates. It was great to learn with such
allowed me to accept the position of worked part time as Acting Clinical no means to do my only sport, I a diverse group and see us all grow.
Director of Clinical Training at the Director for a couple of years. turned to jogging which I have not Unfortunately keeping up to date
Royal Brisbane & Women’s Hospital Music has always been an previously contemplated doing. I has not been that easy! I also have to
and Associate Professor in the School important part of my life. Shortly started with 3 km, and participated thank those medical school parties
of Medicine at the University of after we returned to Launceston, I in my first 10km race within 7 weeks where I met Nick!
Queensland, satisfying my passions took up the oboe and currently play and my first half marathon within 2
for education & learning. in the Concert Band of the University years.
of Tasmania Community Music Banking on my progress in the
Program. After I retired I started previous 2 years, I bought my
learning to play the piano. triathlon bicycle, and have taken
The major passions in my life part in 3 half-Olympic distance races
though have been social justice and since. I am sure I would be able
peace. to complete my first full-Olympic Other Passions?
I am a member of the Medical distance race next month and my first
Radius will be running regular
Association for the Prevention of full marathon in 5 months’ time. stories on “other passions”. If you
War at www.mapw.org.au and of I firmly believe that the fun have particular interests outside
Physicians for Human Rights at derived from triathlon training is health and medicine, let us know.
www.physiciansforhumanrights.org, beyond anything describable. It also We will also continue with regular
and am a corresponding member of spaces out the stress that one has on Case Notes, and hope alumni will
Pax Christi at www.paxchristi.org.au. their body, thereby decreasing the still keep us up-to-date with news
At the end of the year I am chance of injury. In times of injury, of their career, family and other
developments.
going to Cairo and then to Gaza which is an inevitable thing in sports,
to take part in the Gaza Freedom one can always take a component out radiuseditor@med.usyd.edu.au
34 rADiuS December 09
ALuMni newS
reunions 2010
Does your graduating year have an important anniversary in 2010?
Let us help you contact your fellow graduates, issue invitations and
promote your event.
please contact your alumni reunion manager, Diana Lovegrove,
on (02) 9114 1163 or by email at d.lovegrove@usyd.edu.au.
GRADuAtING YEAR Of 1965 GRADuAtING YEAR Of 1950
when: Saturday 30th january 2010 when: Monday 15 March 2010
where: taronga Centre, where: Concord golf Club,
taronga park zoo, Majors Bay road, Concord, nSw
Bradley’s Head road, Mosman time: 12.15 for 12.45pm
time: 11am Cost: $80pp
Contact: r.wines@hcn.net.au or Contact: Brian pollard
Diana Lovegrove bpoll79@bigpond.net.au
d.lovegrove@usyd.edu.au or 02 9436 3516
Vladimir Ashkenazy invites you on a journey through the symphonic
GRADuAtING YEAR Of 1970 GRADuAtING YEAR Of 1955
music of Gustav Mahler. Over two years, he will lead from the bright
when: Saturday 20 February 2010 when: Saturday 10 April 2010
and innocent First Symphony through to the apocalyptic Ninth. Mahler’s
where: the great Hall, where: the royal Sydney golf Club music is deeply personal and deliciously emotional; it moves and swells
the university of Sydney time: 11:30am to fill the air and fill your heart – music that will take you on a journey.
time: 6.30pm Cost: tBA
Cost: $130pp Contact: john wright “A good journey. You could only envy that.” Vladimir Ashkenazy
Contact: Diana Lovegrove rebjohj@netspace.net.au
d.lovegrove@usyd.edu.au
GRADuAtING YEAR Of 1980 ON SALE
when: Saturday 1st May 2010 EnergyAustralia Master Series
WED 10 | FRI 12
Thursday Afternoon Symphony
Presented by Trust
4 JAN
GRADuAtING YEARS Of 1990 where: the great Hall, SAT 13 FEBRUARY | 8PM THU 11 FEBRUARY | 1.30PM
AND 1991 the university of Sydney
R STRAUSS Don Juan | MAHLER Blumine
when: Saturday 27 February 2010 time: 6pm MAHLER Songs of a Wayfarer | MAHLER Symphony No.1
where: the great Hall, Cost: tBA
the university of Sydney Contact: Diana Lovegrove
time: 6pm d.lovegrove@usyd.edu.au ON SALE
Cost: $140pp 14 DEC
Contact: reunion1990@live.com GRADuAtING YEAR Of 1956
when: tuesday 26 october 2010
where: the royal Sydney golf Club,
GRADuAtING YEAR Of 1960 kent road, rose Bay ON SALE
when: Saturday 13 March 2010 time: 12 noon Thursday Afternoon Symphony
Presented by Trust Emirates Metro Great Classics
4 JAN
where: the great Hall, Cost: tBA THU 20 MAY | 1.30PM FRI 21 MAY | 8PM SAT 22 MAY | 2PM
the university of Sydney Contact: jim purchas
R STRAUSS Guntram: Prelude to Act 1
time: 6pm jimpurchas@netspeed.com.au
R STRAUSS Burleske for piano and orchestra | MAHLER Symphony No.5
Cost: $120
Contact: Ann Sefton and Steven
kovacs (via d.lovegrove@usyd.edu.au) AND MORE MAHLER THROUGHOUT 2010 & 2011
Visit sydneysymphony.com for concert details
BOOKINGS All concerts are at the Sydney Opera House
Sydney Symphony 8215 4600 Sydney Opera House 9250 7777
Mon-Fri 9am-5pm Choose your seat at Mon-Sat 9am-8.30pm | Sun 10am-6pm
sydneysymphony.com sydneyoperahouse.com
TICKETS FROM $35* FREE programs at all concerts. Pre concert talk 45 mins prior.
Listen to audio clips & read programs at sydneysymphony.com
*Select performances. Sydney Symphony concerts On Demand at
Booking fees of $4-$8.50 may apply. sydneysymphony.bigpondmusic.com
PRESENTING PARTNERS: MEDIA PARTNER:
rADiuS December 09 35
ALuMni newS
reunion reports
1964 REUNION efforts outperformed the this initial get-together interstate on the night. A 1948 REUNION
organ. Marching through was followed by a 3 course jazz trio (formed from three
the jacaranda in the lawn Medicine and Our Varsity, dinner in the Great Hall. On 25 September, graduates
members of 1990s acid jazz
bore the ethereal but nostalgic from med dinners, following the first course of 1948 Su Med came
charting band Directions
ominous mauve cloud which followed. the congregation rose as to the university for the
In Groove) provided a
used to herald the rapid one to sing, with great anniversary.
A few reminiscences from chilled soundscape as we
approach of exams, at a time gusto and enthusiasm, We met at the Art Gallery
our year reps, Jules Black reconnected with faces not
in history when med exams three traditional university with Mr Justice Roddy
and Bob Bauze, completed seen for 10 years.
were truly fearsome events songs Gaudeamus Igitur, Meagher to view and discuss
for most of us (they passed the program (we had no As the buzz grew, we were
the Varsity and Marching with him his collection
30% of our Second Year). idea how naughty some escorted upstairs to tour
through Medicine - started when a senior
people had been) but the the Wilson Museum of
But the carillon was playing accompanied by Amy schoolboy - which was a
camaraderie lasted until it Anatomy, where we mingled
and the sandstone in the Johansen on the Great Hall singular experience. We
seemed the Yeomen Bedell with members of the year
quad glowed a welcoming organ. the meal and wines then walked down Science
himself would have to evict of 1964 who were holding
gold as the Year of ’64 met were of a high standard, a Road in the spring sunshine
us with his halberd, with the their reunion on the same
in the early evening of 24 fact that was remarked upon to lunch at the union
moon rising over the turrets evening in the Great Hall.
October for drinks and by many of those present. Withdrawing Room. peter
at the most photographic However the event wasn’t
renewed friendships, some Harvey welcomed us and
angle. A noticeboard was provided only a reunion but also the
not having met for 45 years. presented apologies and
in the Great Hall with long-awaited launch of our
Many thanks for this best wishes from colleagues
there was mild surprise on messages from colleagues 1998 senior yearbook, so
memorable time of who were absent overseas,
discovering how many of our unable to attend, requests after our group photo and
fellowship are due to interstate or because
cohort had achieved success for updated addresses for a toast to the university,
committee members David personal commitments.
and distinction in so many 1964 graduates who could the yearbook’s eventual
Gibb and peter Malouf, the funeral of George Hall
different fields, both locally not be contacted and a list but reluctant editors, tim
and to the Medical Alumni (MBBS 1946) who had been
and internationally. of deceased members of Shortus, phil Rome and paul
Association, without whom an esteemed teacher and
the year. Nicolarakis, proceeded to
Many faces were an attendance of 70 grads colleague to many of our
recognisable from the and 40 partners would not Jules Black assumed hand out the long awaited year was remembered.
yearbook, and some less so, have been possible. his traditional role as tome to their gracious peers.
During lunch, Roddy
but with conversation the Master of Ceremonies
Retirement and privacy few felt the urge to leave Meagher addressed his
years fell away, so by the and Margaret Lorang
laws make contact difficult by the official conclusion of philosophy of collecting - it
end of the evening we might provided useful reunion
over the years, so we the evening with a merry is indeed the essence of
have been about to head information together with
beg all grads to keep in band making their way to eclecticism. Eric fisher, who
back to the dissecting room recommendations for future
touch through the Alumni the Ancient Briton in Glebe grew up and later practised
together, without feeling any year reunions.
Association, and to give to continue catching up in West Wyalong close to
different from our student us any information about In summary: a great night through to closing time. temora, Roddy’s home town,
selves. thankfully, all that “missing” members, or was had by all. Gaudeamus Heart felt thanks to our thanked him on our behalf.
was safely behind us, but ideas to make our 50th Igitur! generous sponsors, the this is an outstanding gift
we did enjoy a tour of the anniversary in 2014 a Medical Society Bookshop, to the university and the
David Gibb
newly-renovated Wilson spectacular production. Experien Investec and the generous terms of the
Museum of Anatomy, in its pentagon Group, as well as bequest will benefit not only
Margaret Lorang
old home in the Anderson 1999 REUNION AND to curator Marcus Robinson students and academics
Stuart Building. the 45th reunion of 1964 SENIOR YEARBOOK for opening up the Anatomy but will be made freely
Dining tables had replaced
medical graduates was held LAUNCH Museum, the Medical accessible to visitors to the
on the evening of Saturday Alumni Association and the university.
rows of desks in the Great Graced by a beautiful Sydney
24th October at Sydney
Hall, and laughter the hectic spring afternoon, the class staff of the Medical Society the 61st anniversary is not
university. 110 graduates
scribbling and blank gazing of ‘99 - the penultimate full Bookshop for coordinating like the 50th, or even the
and guests assembled at
for inspiration of our former six year cohort prior to the the event. proceeds from 60th. It is not easy for some
6.30 pm in the university
visits. Some recalled in great introduction of the Graduate the evening will be directed to come to the event and our
quadrangle for an hour
detail the five-pronged gas Medical program - convened to supporting indigenous numbers will decline. All are
of pre-dinner drinks and
jets flaming in winter, and in the beautifully renovated medical students enrolled at encouraged to tell others
light refreshments with
the flags and statues which Anderson Stuart courtyard Sydney Medical School and a that there is continuing
background music from
decorated the walls in those with a punctuality that might facebook group (usyd Class enthusiasm to revisit the
the university Carillion
testing times and at our have surprised our former of ‘99) has been established university and to see again
provided by Amy Johansen.
Graduation. gastrophysiology lecturer to share photos taken on men and women whom we
the graduates proved to
and Dean, professor John the night, stay in touch and first met as freshmen in
A stirring rendition of be a lively group which
Atherton Young. also make the next reunion 1943.
Gaudeamus was led by revelled in renewing old
just that little bit easier to there will certainly be future
university carillonist and friendships and reminiscing Despite family and
organise. anniversaries. Linking our
organist Amy Johansen, who on the joys and hardships of professional obligations,
declared that our choral undergraduate life. several had travelled Paul Nicolarakis meetings to the splendid
36 rADiuS December 09
ALuMni newS
1. 1964 REUNION
2. 1995 REUNION
3. 1948 REUNION
4. 1946 REUNION
exhibitions, concerts and at the fistula Hospital in
lectures which are part of Ethiopia. Grosvenor Burfitt
the university calendar can Williams gave us an update
be an added attraction. on Don Dunlop and his
family and Alan Young noted
Harding Burns
that Don was still working
three days a week.
1946 REUNION Bill Gilmour and Harry
Medical graduates of Moore came all the way
1946 celebrated their from perth, WA, and
63rd reunion luncheon suggested the next meeting
1
overlooking the beautifully be in perth. Harry declined
manicured fairways of to give us his rendition of
Concord Golf Club on friday Lovely Hula Hands which he
25th September. sang at the Revue. Roger
Davidson sent apologies for
It was an exciting day with Julie fitzhardinge who was
22 graduates attending and busy with her horses west
a total complement of 34. of Sydney and Joy parry
A photograph of our whole expressed her delight to be
year at graduation was here and sent best wishes
posted on the noticeboard from Bettine O’Dea. After
together with some informal prompting from Jewell
snaps and a list of surviving Duncan, Gertie Angel-Lord
graduates, attendees and entertained us with some
apologies. obstetric experiences. Ewen
Sussman reminded us of
After catching up over
his clinical group at Sydney
drinks and canapés, a group
Hospital – seven of the
photograph was taken
twelve still surviving. It was 2
before proceeding to lunch.
great to see Nev Newman
Jack Blackman welcomed
who missed our last reunion
the guests and asked
due to a back operation.
them to think about future
peter Rogers quoted from
reunions. We sat down to
the travels of ulysses, Victor
a delicious lunch prepared
Bear spoke of the smooth
by the chef and the warmth
running of the Committee
of the occasion was very
and thanked Roger Davidson
evident from the chatter and
for arranging this very
some hilarious anecdotes
successful venue. thea
afterwards.
Robilliard spoke of her most
kevin White apologised happy and enjoyable life with
for his tremor and said we us in Medicine having been
would only hear every third to all of our reunions.
word as the microphone
It was suggested that the
passed his lips but he was
next occasion take place in
looking forward to Dick
12 months at a venue to be
Stephens’ 100th birthday. 3
selected by the Committee
Dick on the other hand was
– Jack Blackman, Victor
on cloud 9, admitted he was
Bear, Roger Davidson and
the only fossil present and
Alan Young. At about 3pm
promised he would be here
we wended our way home
next year.
and all agreed it had been a
Alan Young and John memorable occasion.
Austin reminded us that
Jack Blackman
Cath Nicholson Hamlin
was probably the most
internationally known
graduate of our year and
was continuing her work
4
rADiuS December 09 37
other passions
DeAn’S MeSSAge
Glenn Singleman
eMerGenCy MeDICIne
ADVenTurer
MBBS (Sydney) 1983
pG Diploma Communications (uTS) 1988
pictured here flying his V2 over a sea of cloud.
it was his first attempt at abseiling shortly after graduation which ignited
glenn Singleman’s passion for adventure. Since then, and following a great
tradition of expedition doctors including, from this university, Douglas
Mawson’s chief medical officer Archibald McLean (MD 1910), he has been
determined to combine a medical career with a love of the outdoors and
adventure.
“As a medical student, I enjoyed cross country skiing and world record after jumping from a cliff, the Great Trango
hiking but that was about it. Then just after graduation, Tower, close to 6000 metres high, in Pakistan. A film made
a colleague invited me to go canyoning. The first time I of the expedition and jump was seen by millions around
had to abseil, I nearly freaked out but the experience was the world and began a new career as an extreme sport and
exhilarating and I was hooked.” documentary film maker.
Canyoning, for the uninitiated, involves walking, The discovery of a higher cliff in 2000, this time in India,
climbing or swimming in usually narrow rocky rivers, provided a new challenge and eventually, his most rewarding
typically with steep descents which require canyoners to adventure. After six years of preparation, he and his wife
abseil or use ropes. “After that first experience, I started Heather Swan, in 2006 secured a second world record for
rock climbing then mountaineering. Then I met a guy who climbing to 6604 metres and diving off in winged suits.
was a BASE jumper. The risk mitigation approach he took Aside from world records, other expeditions have
was similar to the process I use in rock climbing - and in included ballooning over Everest, working as doctor and
medicine – to manage critical situations. He analysed the camera operator on James Cameron’s ‘Live from the Titanic’
dangers from personal, environmental and technological project. More recently, he and Heather have been preparing
points of view. He had a plan for predictable problems in to attempt a new world record for longest wingsuit flight
More information about Glenn’s each area.” (tip: long flight means starting high, in an early run he
adventures can be found on his In the 20 plus years since, minimising risk, controlling jumped from a balloon at 11,500 metres).
website www.baseclimb.com fear and stepping up to challenges, have become the themes In among the adventures, he has continued to practise
or in his wife, Heather Swan’s of his adventuring life. They have also provided a link back medicine, mostly in Emergency and most recently at
book ‘No Ceiling’.
to medicine, which he has continued to practise both as the Sydney Adventist Hospital in Sydney’s north. It is
an emergency care doctor in Sydney and on more than 16 not for the money - their expeditions are funded by the
expeditions to all corners of the globe. Of special interest rather more lucrative motivational/corporate speaking
is how individuals respond to fear, including why some engagements.
people are naturally less fearful and how far it is possible to “I still love to practise, I’ve never felt inclined to stop.
increase control over primitive fear systems. I’ve always worked in Emergency and it suits me, I like
If you can develop a good risk mitigation process the adrenaline rush and it provides you with a broad cross
and control your fears – two big ifs - he believes that section of medicine. What I really love about medicine
individuals can achieve almost unimaginable goals. is the mental discipline, it is the most mentally rigorous
From that early exposure to BASE jumping, he moved scientific pursuit one can engage in, every patient is a new
on to BASE climbing – climbing mountains and leaping off problem solving challenge. But pursuing adventure satisfies
with a parachute or in a winged flying suit. He claimed a another side of my personality.” radius
38 rADiuS December 09