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									                                                       CPD Events June 2006
                                     Tuesday 6th June          ESDGP/EDQUM            CDM Beyond Pill Popping
Suite 103, Level 1                                                           Venue: Buon Ricordo Restaurant
35 Spring Street                                                             108 Boundary St, Rushcutters Bay.
Bondi Junction                                                               Time: 6.15 for 6.45pm
NSW 2022                             _________________________________________________________________________

Tel: 02 9389 0874                    Thursday 8th June   Women’s Health      Gynae Tutorial
Fax: 02 9387 4175
                                                                             Venue: Prince of Wales Private
                                                                             Level 7 Conference Room
ABN: 84 063 189 042                                                          Barker Street, Randwick
                                                                             Time: 6.00 for 6.30 till 8.30pm
                                     _________________________________________________________________________                        June 2006                         Eastern Sydney Division of General Practice                          Issue 128
                                     Tuesday 13th June   ESDGP/ St Vincent’s Skin Lesions Update
                                                                             Venue: Conference Room, Level 4                        InFocus this issue:                                   MSAP is?
                                                                             St Vincent’s Clinic, Darlinghurst                                                   The Medical Students’ Aid Project (MSAP) is a student-run organi-
                                                                             Time: 6.15 for 7.30pm                                                               sation dedicated to raising funds and sourcing equipment to meet
                                     _________________________________________________________________________                      Medical Director      2
                                     Monday 19th June    ESDGP/Aged Care     Maximise MBS Incentives                                                             the needs of hospitals in developing nations across the world.
                                                                                                                                    A View from Kings X 3
                                                                             Venue: Moore Park Golf Club                                                         MSAP began in 2001, when fifth year UNSW students returned
                                                                             Cnr Anzac Pde & Cleveland St Moore Park                Women's Health        4      from hospitals in third-world countries they had attended for
                                                                             Time: 6.30 for 7.30pm                                                               their elective term. Recognising the lack of even the most basic
EXECUTIVE:                           _______________________________________________________________________
                                                                                                                                    Families First        5      and vital medical supplies at these overseas hospitals, they de-
Chairman                             Wednesday 21st June The Sydney Clinic   Women & Depression
                                                                                                                                                                 cided to found a group of like-minded students keen to address
A/Prof Eugen Molodysky                                                       Venue: Arena Bar & Bistro
Ph: 9365 1333 Fax: 9326 9990
                                                                             Entertainment Qtr, Fox Studios                         Mental Health         6      this issue.
Vice Chairman & Treasurer                                                    Time: 6.45 for 7.15pm                                                               Over the last five years, MSAP has sent over $300 000 worth of medical equipment and
Dr David Rockman                                                                                                                    Adolescent Health     7
Ph: 9231 3211 Fax:9221 1482                                                                                                                                      pharmaceuticals to hospitals in developing countries, including Bolivia, Ghana, India,
Secretary                            Please complete the FAX BACK FORM (enclosed) to secure your place!!!                           CDM, PIP/SIP          8      Sri-Lanka, Malawi, Samoa, the Solomon Islands and Tonga.
Dr Ray Seidler
Ph: 9358 3066 Fax: 9358 3676                                                                                                        Immunisation          9      MSAP delivers specifically targeted supplies to developing nation hospitals visited by
                                                                                                                                                                 UNSW medical students in their elective term, based on a “wish list”: an inventory of
                                                             Division Report. Why use it?
                                                                                                                                    HMR                   10     low, intermediate and high urgency items requested by the hospital. The aid is trans-
Dr Danny Beran
Ph: 9389 3133 Fax: 9371 0620                                                                                                                                     ported under the guidance of medical students attending their elective placements
                                                    Whilst other results can be received electronically, such as pathology          NPS                   11     and direct contact is maintained with the hospitals. Students are in the country when
ADMINISTRATION STAFF                                results, specialist reports are still received by mail or faxed, and then ei-
                                                    ther retyped or scanned into the patient notes.                                                              the equipment is delivered enabling MSAP to effectively assess the suitability and effi-
Medical Director                                                                                                                    IM/IT                 12
Dr Jonathan Bentley
                                                                                                                                                                 cacy of the donation.
Ph: 9365 1333 Fax: 9300 9167             Direct secure messaging with your selected specialists.                                    Aged Care             13     In order to meet the specific needs of these hospitals MSAP raises funds and sources
Chief Executive Officer
Kevin Reid                           With Eastern Sydney Report , you can easily send secure requests electronically to your                                     specialist medical equipment. We encourage and greatly appreciate support from
                                                                                                                                    Advertisements        14     members of the ESDGP and have attached the wish lists for three hospitals that our
Programs & CPD Coordinator
                                     chosen service providers (i.e. Specialists) and have their report sent directly to your
Jennifer Dunn                        clinical software eliminating the use of fax or any other non-secure exchange meth-                                         students will be attending. (see page 2)
                                                                                                                                    Division Report       16
Mental & Adolescent Health Officer   ods resulting in low cost and better patient care. This means you will save money on pa-
Natasha Sekelja                      per, envelopes, stamps and time.                                                                                            For more information the medical students’ website is
                                                                                                                                    CPD Events            16
Women’s Health Officer                                                                                                                                                                                                  A/Prof Eugen Molodysky - Chair
Deborah Blackwood                                           First 6 months absolutely free!!
Aged Care, IM/IT & Accreditation
Practice Support Officer             If you would like to try this innovative new system free of charge for six months please                                  Australian Doctor Education and the Coppleson Committee for
Peter Stutely                        let me know and we will have you connected as soon as possible.                                                           continuing medical education present;
EPC, PIP/SIP & Immunisation          After the first six months if you are pleased with the system the cost is $35 per month.
Practice Support Officer
                                                                                                                                                               INTERNAL MEDICINE One-day seminars for GPs
Candi Madziar
                                                                    Save money & time                                                                          Earn 30 Category 1 points!
Practice Support Officer             This cost is easily offset by the savings you will make in other overheads and if you are                                 Melbourne 3rd June, Sydney 17th June Cost $195
Illone Utian
HMR Practice Support Officer
                                     not fully satisfied you can simply discontinue use.                                                                       Topics include;
Anita Schwartz                                                                                                                                                 • Diabetes- the worsening diabetic       ● Heartburn
NPS Practice Support Officer
Natasha Sekelja                                                     To get connected                                                                           • Hepatitis update                       ● Haematuria
                                                                                                                                                               • Internal medicine quiz                 ● "My joints ache"
Accounts Officer                                             Please call Peter at the Division                                      All contributions to
Maxine Fitzpatrick
                                                                                                                                    the newsletter are         • The screening neurological examination
                                                                                                                                    the views of the author
NEWSLETTER EDITOR                                                                 9389 0874                                         and not necessarily
                                                                                                                                                               Register and test your knowledge. Your chance to WIN $1,250 of travel vouchers. Win
Dr Claudia Lee                                                                                                                                                 the interactive quiz at the end of the day to collect this great prize.
                                                                                                                                    those of the Eastern
                                                                                                                                    Sydney Division of         For bookings or more information contact Australian Doctor Education on 1300 360 126
                                                                                                                                    General Practice           or
                                          Visit our Website at                                        Page 16
                                               Medical Director
                  The Predictable Surgery Program
   Public hospital surgery waiting times are surely a topic worthy of ongoing discussion
   and consideration.

   NSW Health defines the average waiting time as the average of the actual waiting
   times (the time between the date of listing and the date of admission) for those pa-
   tients admitted during the month. For example, if half the patients admitted during
   the month had been waiting for one month and half had been waiting for three
   months, the average waiting time for the month would be two months.

   NSW Health has a list of other relevant definitions in relation to surgery and waiting times at

   The Predictable Surgery Program is an initiative of NSW Health which aims to limit urgent surgery wait-
   ing times to less than 30 days and booked (elective) surgery to less than 12 months. The Waiting Time
   & Elective Patient Management Policy at
   PD2006_020.html reflects this aim.

   At the time of writing details of the initiative, including advice for referring doctors, are proposed to
   be circulated by mail to medical practitioners.

   While there is no panacea the initiative hopes that better understanding of the system will lead to im-
   proved utilisation of the system.
                                                                                                      Dr Jonathan Bentley
                                                                                                          Medical Director
           Visit our Website at

   The Medical Students’ Aid Project (MSAP) - Wish List
   The list below has been compiled from the wish lists collected for three hospitals that students will be attending
   at the end of this year. Equipment not on this list will also be greatly appreciated.

   Medical Equipment:                                              Laboratory Equipment:
   •     Band-Aids                                                 •   Urine dipsticks
   •     Stethoscopes                                              •   Lancets
   •     Portable ECG machines                                     •   Alcohol prep pad
   •     Sphygmanometers                                           •   Microscope slides
   •     Tympanic membrane thermometers                            •   Haemoccult slides/developer
   •     Otoscopes                                                 •   Vacutainer needles & tubes
   •     Ophthalmoscopes
                                                                   Orthopedic Equipment:
   •     Ambou bags (adult and paediatric)
   •     Portable oxygen saturation probes                         •   Cervical collars
   •     Venturi masks, non rebreather oxygen masks                •   Clavicle splints
   •     T-piece for oxygen administration for endotracheal tube   •   Arm slings
   •     Nasopharyngeal Airways                                    •   Elastic Bandages
   •     Spirometer                                                •   Crutches
   •     Portable X-ray machine                                    •   Orthopedic table
   Surgical Equipment:                                             Obstetrics/Gynaecology/Urology:
   •     Plastic gloves                                            •   Vaginal speculum
   •     Hats, masks and shoe covers                               •   Urostomy bags
   •     Razors                                                    •   Colostomy bags
   •     Gauze                                                     •   Catheter bags
   •     IV cannulas                                               •   Cervical broom
   •     Scalpel blades                                            •   Pap Smear Slide Holders
   •     Sutures              Educational Equipment:               •   Foetal Doppler
   •     Diathermy            • Textbooks                          •   Ultrasound Transmission Gel
   •     Suction drains       • Cd-rom learning material

Page 2                                                                                    Visit our Website at
                                                                                                                                  Page 15
                                                                                                                                A View from Kings X
                                                                                          There is a garden outside my practice. It is a small but luxuriant
                                                                                          tropical oasis in the middle of Kings Cross that I tend periodically to
                                                                                          reduce stress in my life. There is something life affirming about dig-
                                                                                          ging down into the earth and connecting with nature, especially in
                                                                                          the centre of the most densely populated area of Australia it is fasci-
                                                                                          nating what I have found their over the years because the foliage is
                                                                                          so dense, people stash all sorts of stuff in there.
                                                                                          Over the years I have found a complete car stereo system, assorted
                                                                                          briefcases, handbags, wallets and even a laser printer in its original
                                                                                          box. All of these items I conclude are the results of robberies. Recently I have begun finding other
                                                                                          less promising items in my horticultural fossicking. Moving down into the humus, I have discovered
                                                                                          tattered moth eaten prescriptions and what's worse they have been written by me! After nearly 30
                                                                                          years as a GP, I know that some patients don't comply with my suggestions for medication. Some for-
                                                                                          get to take the prescription from the desk as I push it across expectantly. Others deposit them in the
                                                                                          waiting room behind a chair or table. The most focused however leave them in the garden.
                                                                                          I have begun confronting those patients whose prescriptions, I have found decomposing in my little
                                                                                          plot. "Oh, that's where it went doctor, thank you for finding it. I knew I had it somewhere I won-
                                                                                          dered where it had got to for days after I saw you. Thank you for prescribing it again I promise I will
                                                                                          take it this time." Watching the patient I detect the tell-tale signs of prescription denial. Their eyes
                                                                                          roll back like Holland blinds and I am convinced that yet another of my well crafted prescriptions will
                                                                                          in its life in a garbage bin or making compost.
                                                                                          It has been estimated that nearly a half of all prescriptions written end up in this way and the cost in
                                                                                          the United States of unused or misused medication is estimated at over 200 billion dollars each year.
                                                                                          “There’s no point writing a prescription for me doctor, I can't afford that. Have you got any samples
                                                                                          to tide me over? Go on Dr, I know you get plenty of freebies from the pharmaceutical companies." it
                                                                                          is then that I notice the $10 packet of cigarettes sitting in the pocket of my hapless patient, who obvi-
                                                                                          ously has other priorities.
                                                                                          But perhaps the easiest way to create non-compliance is to make a dosing regime impossible. Some-
                                                                                          times I have been known to write a prescription for a detoxification regime which involves the patient
                                                                                          receiving a tapering dose over a week. Many of these patients cannot be trusted to self medicate ap-
                                                                                          propriately; I therefore specify a daily pharmacy pickup on the prescription. Now these prescriptions
                                                                                          are never found in my garden. They are however often found in the gutter, either in shredded form or
                                                                                          just discarded holus bolus.
                                                                                          And of course there is the opposite side of the coin. Those patients who take too much of a good
                                                                                          thing like the one who decided that prednisone on a limited dose fixed his asthma, but also improved
                                                                                          his appetite and sense of well-being. He continued taking a high dose of corticosteroid medication
                                                                                          until a month's supply had run out, when he returned looking for more.
                                                                                          “But I only wanted you to take it for four days and I wrote that on the prescription. Why did you keep
                                                                                          going?" I looked at his moon -faced features and realised that it was all down to my faulty communica-
                                                                                          tion. I had failed the most simple test.

                                  __________________________________                      It behoves us all to take a leaf out of the old-fashioned general practitioner's techniques. Make an ex-
                                                                                          cuse when you're doing a home visit and ask to use the bathroom, Peer into a patients medical cabi-
                                  Hurstville Gosford Canberra Wollongong Newcastle        net, you'll be surprised and enlightened. There, stuffed into the corners are many of your prescrip-
                                                                                          tions in the raw. Half taken antibiotic scripts, stockpiled anti-inflammatories including those that
                                           Pregnancy Termination                          have been removed from the pharmacopoeia like Vioxx. Boxes of untouched antihypertensives and 16
                                                                                          different cough mixtures
          •   Private & individual treatment
          •   Consultation & treatment by caring doctors                                  "The heavens doctor, is that where they've got to? Thank you for finding them. You're such a dear. "
          •   Only a 2 hour visit
          •   24 hours on call advice                                                                    Kings Cross. Part time VR GP 5-6 sessions per week for computerised,
          •   IUD insertion with sedation or under local anaesthetic 6-8 weeks post TOP                  accredited practice. Travel and addiction medicine, Free u/c parking and the
                                                                                                         best coffee in Sydney. Practice nurse and work with the film industry.
                                            Vasectomy also available
                                                                                          Call Dr Raymond Seidler: 0412251779 e:
                                              All Hours 9585 9599                                                                                        *Previously published in Australian Doctor 2005
Page 14                                                                                       Visit our Website at                                                                        Page 3
                                       Women’s Health                                                                                                                  Aged Care
   Debs Desk June 2006
   On the 16th May ESDGP & SESDGP held the first Obstetric Tutorial for 2006; the
   evening was a great success, special thanks to all the GPs who attended and the
   two guest speakers. Dr Siobhan Lee’s down to earth, practical clinical presentation                                                         P: 1800 052 222             E:
   was excellent and Dr Matthew Peres handled the topic of bleeding in the first
   trimester with his usual accomplished approach only to be called away at the end of the meeting to                   Commonwealth Carelink Centres are information centres for older people, people with disabilities and
   attend the birth of one of his patients. The aim of the tutorials is to bring together GPs and specialists           those who provide care and services. Centres provide free and confidential information on community
   in a less formal manor to promote greater discussion and understanding on clinical issues surrounding                aged care, disability and other support services available locally, interstate or anywhere within Austra-
   ANSC. It appears from the feedback from your evaluations that we have achieved this objective.                       lia.

   The RHW ANSC Committee Meeting was held at the beginning of the week and an interesting discussion                   The network of Commonwealth Carelink Centres was established in 2001 and there are now 65 'walk-in'
   developed on the issue of ultra sound scanning. As you may be aware the RHW asks all GPs, if possible,               shopfronts throughout Australia. Many shopfronts are conveniently located near, or within, shopping
   to organise a variety of scans in the first and second trimester. The first trimester scans include: a dat-          centres.
   ing scan (if unsure of dates) and a NT scan; important because women who do not book into the RHW                    When you contact a Commonwealth Carelink Centre, either by phone or in person, you will receive
   until 12-14 weeks may miss the opportunity to be offered these scans. The possibility of including a list            prompt and personalised attention
   of NT accredited practices was also raised and the possibility of this to be included in the RHW GP let-
                                                                                                                             Useful Telephone Numbers
   More contentious for the general population of GPs perhaps is the 18 week morphology scan because if
   the patient is not returning to them for ANSC who is responsible if the scan is reported as abnormal?                   Medicare Enquiries                   13 20 11          Carer Resource Centre               1800 242 636
   The outcome of the discussion was that: if a GP orders a morphology scan the patient is asked to return
                                                                                                                           Alzheimer's Australia                1800 639 331      Independent Living Centre           1300 885 886
   to the GP to discuss the result; the RHW OPD letter to GPs to be re written to include this request.
   The RHW phone system was again raised and there is some good news on this front as a fourth ward                        Dementia Helpline                    1800 100 500      Aged Care Rights Service            9281 3600
   clerk is about to be employed to answer the phone and make appointments. Yippee!!!
   The RHW would appreciate any further comments you may have on these issues.                                             National Continence Helpline 1800 330 066              Office of the Public Guardian       9265 3184

   Also for those who would be interested in an intense learning experience, North Shore Division of GP                    Seniors Information Service          13 12 44          Legal Aid Commission                9219 5000
   has extended an invitation to us to a Women’s Health and Infants Update on Saturday 3rd of June at                                                                             Aged Care Complaints                1800 550 552
   the Royal North Shore Hospital. It would be a fantastic opportunity for anyone who is keen to refer pa-                 Centrelink                           13 23 00
                                                                                                                                                                                  Resolution Line
   tients to the Royal North Shore ANSC program and gain some new skills or brush up on antenatal shared
                                                                                                                           Health Care Cards                    13 61 50
   care issues. For more details call Sue Kennedy on 9926 7923 and check the division website for details.                                                                        Aged Care Information Line          1800 500 853
                                                                                                                           Carer's Australia                    1800 242 636
   The other quick thing is a plug for our evening “Gynaecological Tutorial”, to be held on June 8 at the                                                                         TTY Service                         1800 810 586
   Prince of Wales Private Hospital. The guest speakers are: the ever popular Dr Terri Foran who will be                   Carer Respite Centres                1800 059 059      Council on the Ageing               9286 3860
   discussing STDs in pregnancy; Dr Mike Campion discussing the new NHMRC Guidelines for cervical
                                                                                                                           Commonwealth Carelink                1800 052 222      Ethnic Communities Council          9319 0288
   screening. For those GPs interested in colposcopy this may be an interesting meeting to attend. As al-
   ways these tutorials are limited to smaller numbers of GPs and are a great opportunity to discuss cases
   or any burning question you may have. Please RSVP to myself ASAP.                                                                                                                                                      Peter Stutely
   Also I would like to remind you that it is a requirement of the ANSC program that you are a current                                                                                                       Aged Care Program Officer
                                                                                                                             Visit our Website at
   member of the ESDGP or SESDGP, could you please check your membership details with Maxine 9389
   0874 or SESDGP ph 9663 5958
   Finally a web address not to forget: The Royal Hospital for Women web page, all the
                                                                                                                         South East Sydney Commonwealth Carer Respite Centre 1800 059 059 or 02 9599 0233
   ANSC fact sheets are on there for you to down load. The site is very comprehensive and easy to
   browse.                                                                                                               Commonwealth Carer Respite Centres are an initiative of the Australian Government Department of
                                                                         Thank you Deborah Blackwood                     Health and Ageing and Department of Family and Community Services, to respond to the respite needs
                     ESDGP Women’s health program Officer & Antenatal Shared Care GP Liaison Midwife                     of carers. Your local Commonwealth Carer Respite Centre is auspiced by The Benevolent Society.
                                                                                                                         A carer is a family member, spouse, parent, partner, friend or neighbour who provides unpaid care on
    Royal North Shore Hospital and Northern Sydney Division of General Practice                                          a regular basis. The person you care for may have a chronic or terminal illness, disability, mental
                     Women's & Infants’ Health Update 2006                                                               health issue or be an older person.

    Date:         Saturday 3rd June 2006                                                                                 The South East Sydney Commonwealth Carer Respite Centre can assist by:
    Venue:        Norman Nock Lecture theatre, Northern Clinical School, R N S H.                                        * Supporting carers during a time of crisis or emergency - we have an after hours on call service for emergencies.
                                                                                                                         * Informing carers about respite services in their local area and providing carer support.
    Time:         1pm till 5pm (Total of 8 Cat 2 CPD points)                                                             * Arranging respite in Nursing Homes & Hostels
    Speakers:     Dr Martine Walker, Dr Michael Melamdowitz, Dr Aidan McElduff, Dr Vijay Roach,                          * Organising planned & short term in home respite that is not regular or ongoing.
                  Dr Robert Lahoud & Dr Michael Nicholl                                                                  * Referring carers to other services for regular ongoing support which will assist them in their caring role.

Page 4                                                                          Visit our Website at
                                                                                                                                                                                                                                     Page 13
                                                      IM/IT                                                           General Practitioners play an important role
                                                                                                                      in promoting and supporting breastfeeding
                                       ANNOUNCEMENT                                                                   In South Eastern Sydney, breastfeeding is promoted through a variety of ways
                                                                                                                      including Families First, a NSW Government multi-agency early intervention initia-
                                                                                                                      tive. Families First encourages services, including GPs, to work together to offer information, referral and support
   A mile stone in secure communications, paving the way for secure electronic transmission of                        to families requiring additional assistance, breastfeeding included.
   health information between Healthcare Professionals, was reached last week, when St.
   Vincent’s Hospital ‘went live’ with Division Report.                                                               The Australian National Health and Medical Research Council (NHMRC) currently recommends infants should be
                                                                                                                      exclusively breastfed until around six months of age, with continued breastfeeding and appropriate solid foods to
   Division Report enables data such as referrals, specialist reports and patient hospital discharge                  at least 12 months of age or beyond. Within NSW, however, breastfeeding initiation rate is high but tends to drop
                                                                                                                      off very quickly after the infant reaches three months of age.
   summaries, to be sent via the internet, while maintaining complete security and confidential-
   ity of clinical and patient details.                                                                               Research shows GPs are a valued and trusted source of infant feeding information for parents. Their role in pro-
                                                                                                                      moting and supporting breastfeeding is acknowledged in the new NSW Health Breastfeeding in NSW: Promotion,
   Piloted in October 2004, and supported by an ever increasing number of our members who                             protection and support policy.
   have already been connected, Division Report has quickly proved its great potential to aid the                     GPs can give women, especially first time mothers, the confidence to breastfeed by providing encouragement and
   exchange of patient health information.                                                                            accurate information or referral onto appropriate support services such as the Australian Breastfeeding Associa-
                                                                                                                      tion - especially when they experience difficulties. The GP Division’s Antenatal Shared Care Protocol Summary
                                                                                                                      and Breastfeeding Guide provide guidance to GPs in the care of pregnant and lactating women.
   The network of connected General Practitioners such as Dr. Raymond Seidler, a prominent
   Eastern Sydney GP and ardent supporter of Division Report and its benefits, specialists and                        Services offering breastfeeding support:
   allied healthcare providers, has now reached unprecedented numbers.                                                South Eastern Sydney and Illawarra Area Health Service - Child and Family Health nursing services
                                                                                                                      Provide support to families with newborns and children up to 5 years of age in Early Childhood Centres throughout
   The C.E.O of Eastern Sydney Division of General Practice, Mr. Kevin Reid, responsible for                          the Area Health Service. For locations access
   launching and driving the roll-out of Division Report, secured the networks continued success,
                                                                                                                      Royal Hospital for Women                       St George Hospital                        The Sutherland Hospital
   when Mr. David Roffe, the head of IT and St. Vincent’s Hospital agreed to implement and ‘go                        Lactation Consultant 9382-6341                 Lactation Consultant 9350-1111 page 181   Maternity 9540-7913
   live’ with the system.                                                                                             Parenting Education 9382-6541                  Parenting Education 9350-2162

                                                                                                                      Australian Breastfeeding Association (ABA) (
                                                                                                                      Offers mother-to-mother support through a breastfeeding helpline, local discussion groups, breast pump hire and
                                                                                                                      other breastfeeding aids – 8853-4999

                                                                                                                      Karitane ( – 9794-7852
                                                                                                                      Provide support, guidance and information to families experiencing parenting difficulties. They
                                                                                                                      encourage a flexible self-care model that is responsive to clients needs.

                                                                                                                      Tresillian ( – 9787-0855
                                                                                                                      A community service providing positive and practical advice on caring for babies, for both par-
                                                                                                                      ents and health professionals
   If you would like to become part of this network, please call the Division on 9389 0874 to or-                     Local Lactation Consultants
   ganise installation. You will also see on the back page, more details of the product, or alter-
                                                                                                                      On-line information resources
   natively, we could send you a Division Report brochure.
                                                                                                                      Australian Breastfeeding Association (ABA) (
                                                                                       Peter Stutely                  Information on topics such as successful breastfeeding, breastmilk supply, problems associated with breastfeed-
                                                                              IM/IT Program Officer                   ing, parenting, settling babies and weaning.
           Visit our Website at
                                                                                                                      National Breastfeeding Strategy
                                 Dr Jeff Bailey - Psychologist                                                        brfeed-index.htm)
                                        Assessment and Therapy for                                                    Australian Government's Department of Health and Ageing site that includes links to the Breastfeeding CHECK
                                                                                                                      module (a continuing education module for GPs) and education materials for families, particularly fathers, ethnic
          Personal Problems (anxiety, depression, OCD)                                                                and cultural groups, and disadvantaged socio-economic groups.
          Family/Marital Problems (transitions, child/adolescent adjustment)
                                                                                                                      Information in other languages
          Developmental and Educational Problems (ASD, ADHD, school performance, gifted-
          ness, careers)                                                                                              NSW Health and Queensland Health have websites with breastfeeding fact sheets in a number of languages.
                                                 e:                                                (
                                                                                                                                                                                                                              Andy Bravo
                                                     0415-555-786                                                                                                                                                           On behalf of
                                     Suite 7, 240 New South Head Road,   Edgecliff                                                                                                                               SESIAHS Lactation Group

Page 12                                                                       Visit our Website at
                                                                                                                             Visit our Website at                                                                  Page 5
                                                     Mental Health
   Teams of Two
   Another successful Teams of Two event was held on May 17 2006,
   bringing together GPs, Mental Health Professionals and Drug & Alcohol
   Professionals from Prince of Wales and St Vincent’s Hospitals.
                                                                                                                        New audit now available – Chronic Obstructive Pulmonary Disease –
   The evening was a huge success. The topic for the night “Alcohol and
   Depression” was enthusiastically examined by all present contributing to a greater under-                                         enrolments due in by Friday 2nd June
   standing of the how’s and who’s of better patient management in the community.
                                                                                                                       Please call the NPS on 8217 8700 to register for this audit. Check the bottom of your latest PIP
   Teams of Two centre more on professional networking than clinical skills development and                            statement to ensure your practice completes the correct number of audits, or call the PIP on
   evaluations indicated that both GPs and Mental Health and Drug & Alcohol Professionals rated                        1800 222 032.
                              ‘networking’ and ‘finding out about other services’ as the most
                              valuable take-home information from the night.                                           Other upcoming Clinical Audits are:
                                                                                                                          Proton Pump Inhibitors – enrolments July 2006
                                           The next Teams of Two will be held on Tuesday 18th July 2006.                  Analgesics – enrolments September 2006
                                           Topic and venue will be advised in due course. Make sure you
                                           check out updates in the next InFocus.                                      Enrolment forms for NPS clinical audits are distributed with NPS Prescribing Practice Review
                                                                                                                       (PPR). The forms can also be downloaded from or call Natasha at the Division.
                               You do not have to attend the previous events to come to this
                               Teams of Two night. Each module is run separately. However you                             TAIS - Therapeutic Advice and Information Service
   need to specify if you plan to attend 3 workshops because if you attend 3 Teams of Two work-                              A telephone service for health professionals
   shops in the 2005-07 triennium you will get 30 Cat 1 BOMHC CPD points.
                                                                                                                             Telephone: 1300 138 677 (local call charge)
                                                                                            Natasha Sekelja
                                                                              Mental Health Program Officer
                                                                                                                                       or email
             Visit our Website at
                                                                                                                       The National Prescribing Service (NPS) Therapeutic Advice and Information Service (TAIS) is a
                                                                                                                       national telephone service for general practitioners, community pharmacists and other health
                                                                                                                       professionals. For the cost of a local call TAIS provides immediate access to independent drug
  Borrowing to build wealth                                                                                            and therapeutics information such as:
  Rod Dunn* from RetireInvest Bondi says that an investment strategy that includes gearing is best suited                 interactions with other drugs, foods or complementary therapies - and how to manage these
  to people with a long term outlook on their investments and who are comfortable with the risks associ-                  side effects, especially unusual ones not included in the product information
  ated with borrowing money.                                                                                              safety of drugs in pregnancy and lactation
                                                                                                                          use of drugs for unlicensed indications - is there good evidence to support use?
  “The main advantage of borrowing money to invest is that you receive more return as you are investing                   information about new drugs.
  more money,” says Rod. “Say you invested $40,000 and borrowed $60,000 for a total investment of
                                                                                                                                                                                      Natasha Sekelja - NPS Facilitator
  $100,000. A 10% increase results in a total investment of $110,000 so your equity has increased from                        Visit our Website at
  $40,000 to $50,000. If you only had $40,000 invested, the increase would only be $4,000.”                                                                                      P: 9389 0874 e:

  Losses are also magnified with gearing and this is why this strategy should be considered as long term.
  In the long term growth assets should outperform the cost of borrowing, but in the short term there
                                                                                                                               ****** Remember ******
  may be substantial losses.                                                                                           Free Breast Screening at Bondi Junction
  If the loan is made for investment purposes and is invested to produce assessable income then the in-                The BreastScreen mobile breast x-ray van is returning to Bondi Junction for the annual visit and will be
  terest incurred on the borrowings may be claimed as a tax deduction. It is however important to obtain               open from Monday 29 May until Friday 28 July 2006. The mobile van will be located in Spring Street
  tax advice on your particular circumstances.                                                                         Bondi Junction, on the corner of Bronte Road, near the Eastern Suburbs Leagues Club. Opening times
                                                                                                                       are 8 am to 4 pm Monday to Friday and on some Saturday mornings.
  If you would like further information contact Rod Dunn from RetireInvest Bondi on 9369 3200.
                                                                                                                       Please encourage your female patients aged 50 to 69 years to attend for
                                                                                                                       their free screening mammogram. Women over 40 years can also attend
  This editorial does not consider your personal circumstances and is general advice only. You should not
                                                                                                                       upon request.
  act on any recommendation without considering your personal needs, circumstances and objectives.
  RetireInvest recommends you obtain professional financial advice specific to your circumstances.                     For appointments please phone - 9515 7842 or 13 20 50.
         •    Rod Dunn is an Authorised Representative of RetireInvest Pty Limited                                     For further information or to order resources such as a GP Referral Pad please contact Diane McLeod,
                                                                                                                       P: 9515 8749 F: 9515 8685 E:
                            (ABN 23 001 774 125), AFSL 238429.

Page 6                                                                         Visit our Website at        Visit our Website at                                                         Page 11
                                                     HMR                                                                                                       Adolescent Health
     WHY SHOULD YOU INTIATE HOME                                                                                       Youth Suicide and What YOU can do to prevent it:
       MEDICINES REVIEW (HMR)??                                                                                        Did any of you see “A Deathly Silence” 15/05/06 on Four Corners, ABC? It was
                                                                                                                       about a 17 year old boy who committed suicide. I missed it unfortunately, but
   1. HMR may assist your decision making                                                                              have heard a lot about it, and recently looked at the transcript and the
                                                                                                                       ensuing forum on the website. It’s very interesting
          HMR is the process by which you can ask a consultant pharmacist to visit a patient at home to                reading. They quote statistics which show that the rate of youth suicide has
          discuss medication with the patient or carer                                                                 decreased over the last 7 years, but that still more young people die by suicide than by road accidents.
          HMR is an opportunity for you to receive information and feedback that may be valuable in your               Have you seen any depressed young people lately? I know there have been several coming through the
          decision making                                                                                              doors of our group practice in the last week. At least they are coming in – there are indeed many who
                                                                                                                       don’t ask for help from us. And of course we as GPs are well-placed to help either ourselves or to
   2. HMR is VERY easy when your practice staff assist you                                                             access local services who can do so.
   Practice staff can:                                                                                                 I have re printed below an excerpt form Quentin Dempster’s interview with Professor Graham Martin,
                                                                                                                       Child and Adolescent Psychiatrist at University of Queensland, and “suicide prevention expert”. (He
          Identify suitable patients; e.g. patients having a GP Management Plan or a Team Care Arrangement             was involved in the “Keep Yourself Alive” GP training that was run several years ago – the Division has
          Discuss the HMR with the patient and explain the process to them                                             a copy of the materials –videos, audiotapes and written material, if you are interested). Please keep
          Fill in the referral form and collate the information to be sent to the pharmacy                             reading to see what you can do to help.
          Follow-up with the pharmacy and/or patient as needed
          Arrange the item 900 consultation with the patient                                                           Q. Let me ask you the hardest questions of all I suppose… first of all, what lessons can you draw from
                                                                                                                       this story, from this tragic story for parents?
   3. The Medibank Private blue icon shortcut is no more, but HMR is STILL VERY easy on                                A. For me a major part of the story is that I believe that this suicide was not preventable looking at the
   Medical Director:                                                                                                   whole story and the way that it unfolded with this particular young man’s personality. I think that
                                                                                                                       there are, there is a percentage of young people who are very much like Campbell, who take very
   A. Referral                                                                                                         clear decisions, follow those through and ensure, absolutely ensure that nobody will ever block their
          Open patient record                                                                                          actions. That’s a great pity and I think what it means in preventative terms is that we have to start
          Go to letter writer, file, new                                                                               much earlier looking at connectiveness, resilience and a whole range of other issues of self esteem,
          Choose “supplied templates”                                                                                  way back in primary school and building up young people to the point where the word suicide never
          Select “DMMR Form 1”; this is the referral form                                                              ever crosses their minds and where they’ve got many other alternatives than suicide so it does have an         Visit ou
          Follow prompts, fill in information either on the computer or print out the form and fill in by hand         implication for how we go about prevention. Having said that, I think that the efforts of professionals
          After obtaining patient consent, sign the referral                                                           have to be for the other 80 per cent of young people where there’s a very clear set of risks, a very
                                                                                                                       clear diagnostic profile and where we know that intervention whether that’s personal, inter-personal
          When completed, the HMR Referral is sent to the patient’s preferred pharmacy                                 or medication can have a major impact.
                                                                                                                       Q. And what should teenagers themselves do if they suspect a friend of theirs may just be slightly de-
   B. Management Plan                                                                                                  pressed or indeed if they’re depressed themselves?
   When the patient returns to discuss the management plan:                                                            A. Well friendships are extremely important and maintaining the connectiveness is again extremely im-
                                                                                                                       portant … I suppose my message would be if you think a friend is in trouble, even if you suspect that
      Open patient record                                                                                              it’s minor, you really should provide them with the opportunity to get some kind of help. Don’t hold
      Go to letter writer, file, new                                                                                   back. Don’t let confidentiality get in the way. Now the way to handle that is to say to your friend, look
      Choose “supplied templates”                                                                                      you’re telling me some pretty awful things, I’m getting really uncomfortable cause you sound like
      Select “DMMR Form 2”; this is the medication management plan                                                     you’re struggling and I’m going to need to tell somebody whether you like that or not, now if you don’t
      Follow prompts, fill in information either on the computer or print out the form and fill in by hand             like it, don’t tell me anymore but I really do need to tell somebody and this is what I think I should tell
      The patient should sign the form                                                                                 them.
      Send a copy of the ‘HMR Plan’ to the pharmacy and offer a copy to the patient
                                                                                                                       So I agree that connectiveness and resilience are vital. Supporting families to foster that begins early
                                                                                                                       of course. Adolescence gives us another chance – and connections with trusting adults outside the fam-
          When completed, claim item 900                                                                               ily may be helpful. That’s where we come in. We know how to identify those at risk. But we can also
                                                                                                                       encourage help-seeking behaviour in our young patients. Our new GPs in schools project aims to do this
                                                                                                                       at a community level. Australian research has shown that GPs talking to young people in school actu-
     Yes, it sounds easy, but if neither you nor your practice staff is sure of the ins and outs:                      ally increases help seeking behaviour in depressed young people. Really! (Wilson CJ and Fogarty K
                                                                                                                       (2002) The GPs in Schools Program: Building Bridges to General Practice. Published Proceedings, Youth
                Contact Anita at the Division for assistance and a practice visit                                      In Mind Conference, Australian National Alliance of General Practice, November 2002.
                         Tel: 9389 0874         Email:                                          Please keep the evening of August 2 free if you would like to be involved in our initiative in local high
                                                                                                                       schools. Thank you very much to those of you who have already expressed interest, and ideally there
                                                                                                                       will be a few more of you!
                                                                                                                                                             All the best, Karen Spielman - GP Advisor for Adolescent Health
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                                                                                                                                                                                                                             Page 7
                          CDM, PIP/SIP & Practice Support                                                                                                                    Immunisation
   I’ll be returning to the Division fulltime from Monday 5th of June and look forward to assisting you with your practice                News on the Immunisation Front
   needs. Please don’t hesitate to contact me for information, resources and/or practice visits in the following areas:
                                                                                                                                As you may have read in the papers, there are two vaccines available for Rota-
           ∗   Immunisation                   – increasing rates & consequently remuneration, data cleaning and                 virus. The target patient group are very young babies (before 6 months of age),
                                                cold chain management                                                           who require either 2 or 3 doses depending on the brand used. The vaccines are
           ∗   Chronic Disease Management – including working with item numbers 721, 723, 725, 727, 729, 731 and                given orally, so thankfully do not mean one more jab for the little ones who get
                                                Allied Health & Dental Care Services referrals                                  vaccinated.
           ∗   PIP and SIP
           ∗   Practice Nursing – recruitment and education                                                                     Rotarix (by GSK) needs 2 doses, given at around 2 and 4 months. RotaTeq (by CSL) is given in 3 doses,
           ∗   Practice Support Workshops – education for Practice Managers, Nurses and Receptionists                           given at 2, 4 and 6 months of age. (It can be given at any time after 6 weeks as long as they are 4 weeks
   Information, resources and practice visits are available to all our customers in General Practice – GP’s, Practice
                                                                                                                                apart.) The advantage with RotaTeq is that it is ready to use, with no need to reconstitute it, and it
   Managers, Practice Nurses and Receptionists.                                                                                 may have a slightly broader level of cover (it is pentavalent as opposed to the monovalent Rotarix).
                                                                                                                                They can both be given at the same time as the other vaccines on the Childhood Immunisation Schedule.
   Medicare Australia’s New Initiatives
                                                                                                                                According to the PI, repeat dosing is not indicated if the baby spits out, vomits or regurgitates after
   As part of Medicare Australia’s commitment to improving forms, a range of initiatives have been developed and in-            administering the vaccine. Patients require a private prescription, and the cost is around $66 per dose
   clude:                                                                                                                       for RotaTeq (total $198) and $80 for Rotarix (total $160). The drug reps will happily thrash out why
                                                                                                                                theirs is the better drug, but apart from the obvious convenience of 2 doses rather than 3 for the
           ∗   A less complex provider number application form for new practice locations. The form is available on
               Medicare Australia’s website and can be completed and submitted online; and
                                                                                                                                former, and the advantages outlined above for the latter, there was nothing else that stood out.
           ∗   A new dental provider number application form that has been distilled from seven forms to one easy               The other issue with immunisations is the Measles outbreak.
               application available on the Medicare Australia website.
                                                                                                                                Professor Mark Ferson from the SEAHS Public Health Unit says that “Though there seems to be no further
   IMMUNISATION                                                                                                                 reports (since the large number of cases associated with a particular spiritual group that was travelling
                                                                                                                                through Australia), it is very important that GPs call the Public Health Unit if there is a suspected case.”
   How Many Of Your Practice Nurses Have Completed The Immunisation Accreditation Course?
                                                                                                                                It would be great if patients were educated about infectious diseases, and called to discuss their symp-
   Immunisation is one of the key roles for practice nurses, and to ensure that vaccines are given appropriately by             toms rather than attending the surgery, to minimise the risk of spread. If they do attend, the GP should
   nurses, ESDGP would like to encourage all PNs to complete The College of Nursing Immunisation Accreditation                  call the Public Health Unit whilst the patient is actually there. This way the staff at the Public Health
   Course. This 12 week fully external course provides the nurse with up to date information and as a result of changes         Unit can ask specific questions, and more readily direct the GP and patient as to the most appropriate
   to the 'NSW Poisons Act' in the 1990's, nurses who complete the course are able to give vaccines without a written
                                                                                                                                course of action, saving time for both GP and patient.
   doctors order. This saves time and increases practice based efficiency.
   ESDGP has fully funded places with The College. Please advertise this course to your nurses. For the process of              There are currently major outbreaks in Fiji and Germany, so those lucky people running off to watch the
   how to enroll your nurses please contact me at the Division on 9389 0874 or via email                  World Cup in Germany should be reminded to have a MMR vaccine. There has been an announcement by
   Enrolments occur monthly.                                                                                                    NSW Health to say they will provide free MMR vaccine to GPs for use in ALL susceptible people.
                                                                                                                                “People considered to be susceptible and who should receive MMR vaccine include:
                                                                                                                                Children, who should be vaccinated at 12 months of age and 4 years in accordance with the immunisa-
   The National Institute of Clinical Studies and ADGP are jointly running a campaign to increase flu vaccination levels
   in at risk groups from 42% to closer to that observed in older groups (~80%). The campaign website is listed below.          tion schedule; and anyone born after 1965 (i.e. 40 years or younger) who has never had measles and has
                                                                                                                                not had two doses of vaccine against measles, and does not have documented (i.e. serological) immu-                                                                                                          nity to measles
   There is a great deal of information on the website including the evidence for the effectiveness of the vaccination in       If patients are unsure of their measles and vaccination history, there is no contraindication to providing
   at risk groups; a guide to developing a registry of at risk people using Medical Director; a pro forma reminder letter
   for patients; a draft media release for the practice newsletter or local paper; and a number of NICS reports on vacci-
                                                                                                                                MMR vaccine now.”
   nation, including those on barriers at the practice and consumer levels, and the cost of illness and cost of vaccina-        Perhaps I, as the immunisation advisor, should be sent to the World Cup to check out the situation more
   tion.                                                                                                                        carefully…
   Information kits for every general practitioner have been mailed out and include:                                                                                                           Dr Ankita Roy - GP Advisor Immunisation
     ∗   An A3 poster for the waiting room, to raise awareness with “at risk” patients that they should be considering

         vaccination and discussing this with their doctor
         An A4 poster same as above for the GP’s room as a reminder to GP and patient
                                                                                                                                P/T VR or non VR GP required
     ∗   A little fold out “Are you at risk” reminder for the GP desk                                                           Experienced female GP or GP’s are required to join an established whole health medical
                                                                                                                                practice in Rushcutters Bay.
   A four page brochure for GPs with information on who is “at risk” (based on the recommendation from the Australian           The clinic has 2 part time acupuncturists/ masseurs and a 2 part time chiropractors work-
   Immunisation Handbook); information on barriers to vaccination from NICS focus group studies with GP’s, practice             ing to provide a “whole health” program for a stimulatory mix of mostly professional pa-
   nurses and consumer; and evidence based tips on how to increase vaccination.
                                                                                                                                tients and their children.
                                                                                                Candi Madziar                   Base wage is guaranteed whilst establishing your clientele.
                                                                            Practice Support, Practice Nurse &
                                                                                Immunisation Program Officer                                  Call 9356 3477 to arrange an interview
                                                                Ph: 9389 0874 Email:                                    Rushcutters Bay Family Practice
                                                                                                                                              3/50 Bayswater Rd Rushcutters Bay NSW 2011

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