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Dr Paul Chou: A Radiology Luminary Dr Paul Chou, Senior Consultant Radiologist and Interventional Radiologist at Lumus Imaging, sits down with The Medical Link to discuss his esteemed career in radiology, regenerative medicine and his penchant for men’s and women’s health.

ISSUE 147 | OCTOBER – NOVEMBER 2023

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THE MEDICAL LINK •

Contents 06 A Message From the GCMA President Prof Philip Morris AM FEATURE PROFILE 12

Dr. Paul Chou: A Radiology Luminary The Medical Link

EDITORIALS 16

Celebrating 15 years at GenesisCare Southport Dr Tulasi Ramanarasiah

18 Challenges Faced by General Practitioners in Queensland: A Comparative Study Between Urban, Rural & Remote Areas Anu Jose 26

Identify & Relieve Pain with CT-Guided Injections at South Coast Radiology South Coast Radiology

Pharmacy Pilot Fails to Keep UTI Patients Out of EDs AMA Queensland | Media Release

Imaging Guided Management of Back Pain: Our Approach at Panorama Radiology Specialists Dr Angus Watts

Cover & Other Credits: Macrovector on Freepik medicallink.com.au • 5

• THE MEDICAL LINK

A Message from the GCMA President Prof Philip Morris AM, President GCMA MB BS BSc PhD FAChAM (RACP) FRANZCP FPOA FFP ABPN info@drphilipmorris.com | 0422 545 753 | www.drphilipmorris.com

Dear GCMA colleagues,

hope you and your family and your practice and other professional endeavours are doing well. The next GCMA Thursday evening meeting is at 6.30 pm Thursday 16 November at Bumbles Café and Restaurant at Budds Beach, 19 River Drive, Surfers Paradise. The topic is on ‘Holistic Care for Veteran Patients’ by Dr Ken Cameron of Innovative Medicine. Levin Health will sponsor the dinner meeting. All members and their partners are welcome to attend. Please contact me at email pmorris@iprimus.com.au to let me know if you are attending. We also plan an end of year social function for our members and guests. Please keep a lookout for more details about this in coming weeks. I am pleased to provide a preliminary report the successful running of our

GCMA Samoan Medical Conference. A more detailed report will be published in the next edition of The Medical Link. This meeting was a collaborative effort between the GCMA, the Oceania University of Medicine, the Samoan Medical Association, the National University of Samoa Medical School and the Samoan Ministry of Health. It ran from 29-30 September at the Taumeasina Island Resort in Apia, Samoa. Over 110 delegates (doctors, medical students and other health professionals) attended the conference. Seven doctors came from American Samoa to the meeting and this was a historical occasion in that it was the first time American Samoa physicians attended a medical conference in independent Samoa. At the opening plenary session on Friday morning I was able to welcome delegates with the following speech:

alofa lava, hello esteemed guests, and honoured delegates, on behalf of the Gold Coast Medical Association (GCMA), it is with great humility and warmth that I extend a heartfelt welcome to each and every one of you to the beautiful shores of Apia, Samoa, for the remarkable gathering of minds, the GCMA Medical Conference. This conference stands as a testament to the power of collaboration, uniting the strengths and wisdom of numerous esteemed institutions and organisations. We are immensely grateful for the unwavering support and partnership of the Oceania University of Medicine, the Samoan Medical Association, the Samoan Ministry of Health, the National University of Samoa, as well as the generous support from Bond University and Griffith University. Our warm embrace extends not only to

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THE GCMA PRESIDENT'S REPORT •

our local Samoan and American Samoan delegates but also to those who have journeyed from distant shores to grace us with their presence. Your dedication to the field of medicine and your passion for sharing knowledge is what makes this gathering truly exceptional. To our esteemed speakers, who have selflessly given their time and expertise, we offer our sincerest gratitude. Your contributions are the cornerstone of this conference, and your wisdom will undoubtedly inspire and enlighten us all. We are especially delighted to welcome a multitude of senior medical students to this event. Your enthusiasm and eagerness to learn are a beacon of hope for the future of medicine, and we hope this conference will be a pivotal step in your journey towards excellence. A special thank you goes to the honourable Minister of Health for sending your representative to address and open this meeting. Your support and encouragement are deeply appreciated. Behind the scenes, there is a dedicated and hardworking team from the GCMA, the Oceania University of Medicine, and our esteemed medical colleagues in Samoa,

who have laboured tirelessly to make this conference a reality. To each of them, we extend our sincerest thanks. In the true spirit of Samoa, we welcome you all with open hearts and open arms to this gathering of medical minds. As we embark on this journey of knowledge exchange and collaboration, may our time here be fruitful, enlightening, and filled with camaraderie. Ladies and gentlemen, delegates and friends, we wish you a memorable and enriching experience at the GCMA Medical Conference. Fa'afetai tele lava, and best wishes for a successful conference ahead.

rofessor Asiata Dr Satupaitea Viali, Dean of the Oceania University of Medicine also welcomed participants. Prof Satu Viali, a senior Samoan cardiologist and also pastor of his Christian church, opened the meeting with an invocation and prayer and led the medical students in an ‘a cappella’ rendition of traditional Samoan hymns. The beauty of this singing brought tears to many an eye. The business of the meeting got off to a roaring start with keynote talks from

• A b l a t i o n f o r a t r i a l f i b r i l l a t i o n , S V T, atrial flutter & VT • Pacemakers & defibrillators • I m p l a n t a b l e l o o p re c o rd e r s • E l e c t ro p h y s i o l o g y s t u d i e s • Holter monitors (Rooti skin patch up to 7 days) • C o ro n a r y a n g i o g r a p h y • In-patient & out-patient consultations

Prof Alan Fraser (senior cardiologist from the United Kingdom) on Artificial Intelligence (aka ‘machine learning’) in Medicine, and Tagaloa Dr Robert Thompson (acting Director General of Health Samoa) covering the Health Profile of Samoa. In each symposium we were so pleased to have one or more contributing presentations from Samoan colleagues.

he conference got good coverage from local media. A journalist, Talaia Mika from the Samoa Observer wrote two articles about the meeting (see an excerpt below).

Conference boosts medical education

edical education linked to Samoa's health system is the focus of a two-day international medical conference currently underway in Apia. The Gold Coast Medical Association's Samoan Medical Conference started on Friday morning at the Taumeasina Island Resort and targets students and medical professionals and brings together speakers with academic, research and

• THE MEDICAL LINK

educational backgrounds on issues considered relevant to Samoa's health system. Speakers at the two-day conference include Samoa's Minister for Health, Valasi Tafito Selesele as well as the President of the Gold Coast Medical Association, Professor Philip Morris, Oceania University of Medicine's Prof. Athol Mackay plus Pule D. Viali Lameko and Asiata Prof. Satupaitea Viali and Prof. Alan Fraser from the University Hospital of Wales, Cardiff in the United Kingdom. Samoa's Health Director General, Aiono Prof. Alec Ekeroma was also scheduled to present but it is understood that he is currently abroad. In an interview with the Samoa Observer on Friday, Prof. Morris said this is their fourth conference where they've contributed to a local medical association in the Pacific and they are happy to be in Samoa to assist through these advanced medical talks. "Last year we came to Samoa and asked some of the doctors and people in the medical association if they're associated free of charge and with a program

that will cover areas of medicine that they might be interested in," he said. "We just like to contribute to the development of medical education and training in the South Pacific and with our brothers and sisters in the medical profession here.

Meanwhile, Prof. Morris is a distinguished psychiatrist and the President of the Gold Coast Medical Association who holds multiple leadership positions in prestigious organizations, such as the Pacific Rim College of Psychiatrists, the Australian National Association of Prac-

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THE GCMA PRESIDENT'S REPORT •

tising Psychiatrists, and the Australia and New Zealand Mental Health Association.

believe the meeting was much appreciated by our Samoan colleagues and enjoyed by the presenters and their families who made the trip to Samoa from Australian and the United Kingdom. The GCMA has now participated in four medical conferences in the South Pacific (two in Fiji, one in Vanuatu, and one in Samoa) where we have supplemented the program content with contributions from our GCMA doctors. I hope this legacy continues into the future. While in Samoa my spouse, Carole, and I along with Prof Stephen and Dr Lis Weinstein were able to visit American Samoa and make contact with the Governor’s office and visit the Lyndon Baines Johnson Tropical Medical Centre there. None of this happens by chance. Many people and organisations have put much work into preparing and running the conference. I wish to thank Prof Ste-

phen Weinstein and Dr Lis Weinstein, who managed the scientific program, my GCMA colleagues Prof Gordon Wright, Prof John Kearney and Prof Alfred Lam, and our Oceania University of Medicine collaborators Carmel Sang, Regina Frolova, and Prof Athol Mackay in Australia, and Prof Asiata Dr Satupaitea Viali and Pule Dr Vaili Lameko in Samoa for their sterling efforts. I acknowledge with much appreciation the generous financial assistance and in-kind sponsorship from Bond University and Griffith University and the Oceania University of Medicine. I am grateful for the wonderful contributions of all our Australian, overseas and Samoan presenters. I acknowledge National University of Samoa and the Samoan Ministry of Health who provided local assistance. The Taumeasina Island Resort, Apia was a delightful venue. I can recommend it to others wishing to stay in Samoa. Finally, I would like to thank our Samoan medical colleagues and students who attended the meeting for their support, encouragement, participation

and hospitality. Prof Stephen Weinstein will provide a more detailed report on the conference in a later edition of The Medical Link.

e are always looking to expand our membership. I encourage you to invite your doctor colleagues to join the GCMA. It is very easy to do. Just go to the GCMA website (www.gcma.org.au) and click through to the ‘Become a Member’ page to join. The GCMA is always ready to welcome new members to the leadership team. Please give me a call on phone number is 0422545753 if you are interested. I look forward to seeing you at the November Thursday evening meeting. Yours sincerely, Prof Philip Morris AM President GCMA

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Advertising in The Medical Link If you would like to advertise your products or services, positions vacant, rooms for rent etc. in The Medical Link, please feel free to contact us at admin@themedicallink.com.au. Advertising of medical services in The Medical Link should comply with the same advertising guidelines released in the Medical Board of Australia Code of Conduct: Be factual and verifiable | Not include testimonials | Only make justifiable claims regarding quality and outcomes | Not raise unrealistic expectation | Not offer inducements | Not make unfair or inaccurate comparisons between your services and those of colleagues The Medical Link is designed and published by Swan Management Services. It is the advertiser’s responsibility to ensure that advertisements comply with the Trade Practices Act 1947 as amended. All advertisements are published on the condition that the advertiser indemnifies the publisher and its servants against all claims, suits, actions, loss and/ or damages as a result of anything published on the advertiser’s behalf. DISCLAIMER: The contents of articles and opinions published are not necessarily held by the publisher, editor or the Gold Coast Medical Association. No responsibility is accepted by the publisher, editor or Gold Coast Medical Association for the accuracy of information contained in any opinion, information, editorial or advertisement contained in this publication and readers should rely upon their own enquiries in making decisions touching own interest. Unless specifically stated, products and services advertised or otherwise appearing in The Medical Link are not endorsed by the publisher, editor or the Gold Coast Medical Association.

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MEDICAL EDITORIAL COMMITTEE

Philip Morris, Geoff Adsett, Stephen Withers, John Kearney, Maria Coliat

GCMA MEMBERS gcma.org.au

GCMA EXECUTIVE COMMITTEE

President Prof Philip Morris 5531 4838 Vice-President Dr Maria Coliat 5571 7233 Secretary Prof Philip Morris 5531 4838 Immediate Past President Dr Sonu Haikerwal 5564 6255 Treasurer Dr Geoff Adsett 5578 6866 Specialist Representative Prof John Kearney 5519 8319 GP Representative Dr Katrina McLean 5564 6501 Academic Representative Prof Gordon Wright 5595 4414

Keeping the Medical Community Informed The Medical Link enriches the Gold Coast medical community by uniting the voice of its doctors. Here you will find insightful stories and the latest trends in field research conducted abroad, and of course, right here on the Gold Coast. Keep informed of new health services, developments in the medical profession, and general interest items. We invite you to submit your company updates, new recruits and promotions to the following email: admin@themedicallink.com.au And if you would like to advertise your products or services, positions vacant, rooms for rent etc. in The Medical Link, please feel free to contact us admin@themedicallink.com.au.

• FEATURE PROFILE

12 • Issue 147

FEATURE PROFILE •

medicallink.com.au • 13

• THE MEDICAL LINK

r. Paul Chou is a distinguished figure in medical imaging. His journey to becoming a luminary in this field is marked by a wealth of experience and unrelenting commitment to professional development. His impressive career spans an eight-year tenure in his current position at Lumus Imaging. Prior to joining this network of affordable, accessible, and quality imaging, Dr. Chou honed his skills at the Mater Hospital in Brisbane, and before that, he contributed to the esteemed University Health Network in Toronto, Canada.

ne of Dr. Chou's notable areas of specialisation is men's health, with a particular focus on prostate MRI. His affinity for women's health, encompassing breast MRI with breast biopsy, dates to his formative years. “I’ve always had a keen interest in women’s health, even

14 • Issue 147

since medical school at the University of Melbourne,” recalls Dr Chou. “As a resident, I undertook a Diploma of Obstetrics and Gynaecology at the Mercy Hospital for Women in Melbourne, which further solidified my interest in this field of medicine.” Dr. Chou’s time during clinical fellowships at the University of Toronto allowed him to elevate his skills further, rendering him an expert in MRI breast and prostate imaging, as well as MRI-guided biopsy procedures. Notably, Dr. Chou now stands as one of the selected few radiologists in Australia entrusted with the intricate task of MRI-guided procedures.

eyond his clinical endeavours, Dr. Chou's collegiate involvement is equally notable. “I’ve been an active examiner for the Royal Australian and New Zealand College of Radiologists

As a practitioner committed to continuous professional development, Dr. Chou's sights are firmly set on the burgeoning field of regenerative medicine. He is a pioneer in the clinical applications of regenerative medicine across various subspecialties, including pain management and sports medicine.

FEATURE PROFILE •

(RANZCR) for the final OSCER examinations for many years,” Dr. Chou says. These are examinations that aspiring radiologists must pass. Additionally, Dr. Chou is a valuable member of the Clinical Radiology Case Reporting Examination Review Panel (CRCRRP) where he plays a pivotal role in the submission, review, and marking of critical examination papers. Dr. Chou has also held the esteemed position of Director of Training in Radiology for the College.

s a practitioner committed to continuous professional development, Dr. Chou's sights are firmly set on the burgeoning field of regenerative medicine. He is a pioneer in the clinical applications of regenerative medicine across various subspecialties, including pain management and sports medicine. “As an interventional radiologist,” Dr. Chou

“As an interventional radiologist,” Dr. Chou notes, “I have the unprecedented advantage of delivering these therapies with precision under imaging guidance. It’s a field of medicine that shows great promise and will see exponential growth.” notes, “I have the unprecedented advantage of delivering these therapies with precision under imaging guidance. It’s a

field of medicine that shows great promise and will see exponential growth.”

r. Chou’s journey through the world of radiology is marked by the continuous pursuit of professional development, whether in research or training. As the radiology field continues to evolve, Dr. Chou's contributions are sure to play a pivotal role in shaping its future. For more information please contact: Lumus Imaging Varsity Lakes 2 Lake St, Varsity Lakes, QLD 4227 (07) 5585 3700 www.lumusimaging.com.au

This feature profile was produced by The Medical Link. For more information on how to be featured, please contact admin@themedicallink.com. au or visit www.themedicallink.com.au,

medicallink.com.au • 15

"From the very beginning, there was a commitment by our dedicated team of doctors to seek to remain at the forefront of advancements in treatment techniques and technology."

16 • Issue 147

ADVERTORIAL

Celebrating 15 years at GenesisCare Southport Dr Tulasi Ramanarasiah MBBS, MD, FRANZCR Regional Medical Director – Gold Coast | Radiation Oncologist, GenesisCare Southport www.genesiscare.com/au

n September, GenesisCare marked 15 years of service to the Southport community. During this time, and under the headship of our team of five dedicated practitioners, who have a combined experience of over 60 years in radiation oncology at Southport, we have sought to offer access to best practice, care and treatment for patients and their families.

nder the leadership of practitioners like Professor David Christie, Dr Tulasi Ramanarasiah, and Dr. Selena Young, the original Radiation Oncologists when GenesisCare Southport first opened, together with A/Prof Sid Baxi and Dr Sagar Ramani, we have proudly achieved several firsts for local patients.

rom the very beginning, there was a commitment by our dedicated team of doctors to seek to remain at the forefront of advancements in treatment techniques and technology. Most recently, these advancements have led us down the path of personalised medicine, and increased our focus on community collaborations and survivorship.

ur stereotactic ablative radiation therapy (SABR) program was first offered at GenesisCare, Tugun in 2015 and then at the Southport centre from 2019. A non-invasive alternative to surgery for eligible patients, it has the potential to improve the quality of life of patients with several cancer types, including liver, lung, or prostate cancer by targeting tumours with high doses of radiation, while aiming to minimise damage to surrounding healthy tissue.1, 2, 3 In other words, in appropriate cases it can better enable us to undertake the precise work of tumour control in an outpatient setting2,3 – sometimes in as little as one treatment session.

n addition to providing access to modern techniques which would otherwise require Gold Coast locals to travel to Brisbane, our team prides itself on partnering with referrers to collaborate to achieve their patient’s best outcomes and experiences.

meetings across most tumour sites, as well as having access to a range of onsite allied health professionals who are skilled in supporting our oncology patients in navigating life during and after treatment.

isit the GenesisCare website to find out more about our service offering at Southport. genesiscare.com/au

References 1. Brown JM, et al. Int J Radiat Oncol Biol Phys 2014;88(2):254–262. 2. Foote M, et al. J Med Imaging Radiat Oncol 2015;59(5):646–653. 3. Qui B, et al. Front Oncol 2020;10:1165. This article is provided for information purposes only. It should not be used to diagnose, treat, cure or prevent any disease. Any medical procedure or treatment involving the use of radiation carries risks, including skin irritation and associated pain. Individual treatment outcomes and experiences will vary.

ur Radiation Oncology specialists engage in multidisciplinary team

medicallink.com.au • 17

Challenges Faced by General Practitioners in Queensland: A Comparative Study Between Urban, Rural & Remote Areas The following article is the work of a student of the Oceania University of Medicine, our partner organisation for the medical conference held in Samoa, 28-30 September, 2023. Anu Jose, MD jose.anu@outlook.com

18 • Issue 147

medicallink.com.au • 19

• THE MEDICAL LINK

Abstract

his study investigates the challenges faced by General Practitioners (GPs) in Queensland, Australia, and compares the challenges seen in urban, rural, and remote environments. The study uses a qualitative research methodology involving semi-structured interviews with 10 GPs across different regions of Queensland. The results show that GPs in Queensland face challenges such as increased workload and associated burnouts, low remuneration, Medicare challenges, increased administrative tasks, and aggressive patients. Unique challenges faced by urban GPs include difficulty in maintaining work-life balance and continuity of care to patients, while rural and remote GPs face challenges in staff retention and access to specialist care for patients. The study provides valuable insights into the working conditions of GPs and highlights the need for greater support and resources to address the challenges faced by GPs in order to ensure that they continue to provide healthcare services to all regions of Australia.

Introduction

eneral Practitioners (GPs) are at the frontline of healthcare in Australia, serving as the first point of contact for patients seeking medical advice and treatment. GPs are medical practitioners performing a crucial role in primary and preventive health care. A thriving, easily accessible, and high-standard general practice sector is vital for Australian healthcare. According to Royal Australian College of General Practitioners (RACGP 2018) report, more than 87.8% of the Australian population consult a GP at least once a year. GPs working in remote areas play a critical role in addressing the health challenges of people living in these areas as often GPs are the only available healthcare. Therefore, high quality and easily accessible general practices are crucial to the regional and remote Australian population. Queensland is the third populous

20 • Issue 147

state in Australia and the second largest in terms of area (ABS 2022). In 2021, there were 6,586 full-time equivalent GPs in Queensland, which translates to approximately 127 GPs per 100,000 people across the state (Department of Health and Aged Care 2023). The 2022 Deloitte Access Economics modelling estimated a deficit of 11,392 in Australian GPs by 2032 (Deloitte and Cornerstone Health 2022). This is a major concern, given that Australians rely heavily on general practice for their healthcare needs. Therefore, identifying and addressing the various challenges faced by GPs is essential to attract new practitioners and retain the existing ones in the field. Several national and international studies have identified various challenges that GPs face. However, there is a lack of qualitative research investigating the challenges facing Queensland GPs, and also exploring the GP challenges since the start of the Coronavirus Disease 2019 (Covid-19). Furthermore, there is also a gap in literature comparing the difficulties that GPs face in different regions of Queensland, based on their remoteness. This study investigates the challenges facing by GPs in Queensland and comparing the challenges seen in rural, remote, and urban environments. The definition used for classifying rural, remote, and urban areas is as per the Australian Statistical Geography Standard (ASGS): Volume 5 – Remoteness Structure (Australian Bureau of Statistics 2016). For the purpose for this study, the terms ‘urban’ is considered to mean areas defined as major cities by the ASGS remoteness area, while ‘rural’ encompasses inner and outer regional areas. Finally, ‘remote’ is considered to refer to remote and very remote areas according to the ASGS remoteness area. Identifying the challenges faced by GPs in Queensland, the third populous state in Australia, would provide valuable insights into the working conditions of GPs across the country.

Method

qualitative research methodology was used for this study, involving semi-structured interviews with GPs working across urban, rural, and remote areas of Queensland. A purposive sampling technique was used to select participants, ensuring an equal representation of GPs across different regions of Queensland according to the regional remoteness defined by the Australian Bureau of Statistics (two GPs each from major cities, inner regional, outer regional, remote, and very remote regions). The sample participants were recruited based on the availability of GPs in the regions and their willingness to participate in the research. The contact details of the GPs for the study were obtained from ‘Google’ searches and were contacted via telephone to participate in the research. The participants were assured of confidentiality and their personal identifying information was kept anonymous in the transcripts and data analysis. All participants provided verbal consent before participating in the study and agreed to participate in a 30 minute face-to-face or telephone interview. The interviews were conducted following a semi-structured interview guide (Appendix 1) and detailed notes were taken down during the interviews. The decision to write detailed interview notes rather than audio recording the interviews was made to maximise recruitment, given the small pool of potential participants in remote areas, and to reduce the risk of identification. The ten participants of the research were male GPs working in Queensland having at least 7 years of experience working as GPs. Six of the ten participants had their basic medical training oversees, while the remaining four graduated in Australia. All participants had been in their current roles for at least two years and worked for a minimum 38 hours per week. Additionally, the participants provided bulk billing service through Medicare (Australia’s publicly funded universal health insurance scheme). Overall, the

participants represented a diverse range of experiences and perspectives, allowing for a detailed exploration of the challenges facing by GPs in Queensland. Table 1 shows participant’s current work region and their basic medical training location.

Data Analysis

he data collected were analysed thematically to identify emerging themes. Each set of notes was reviewed multiple times to ensure familiarisation with the data. Open coding was used to identify relevant themes and concepts, and the codes were then grouped into categories and sub-categories based on their similarities and differences. The final themes were checked against the raw data to ensure that they accurately reflected the participant’s responses.

Results

en GPs were interviewed for this study, including two from major cities, two from inner regional, two from outer regional, two from remote, and two from very remote regions of Queensland. The participants were queried to identify the primary challenge for GPs, and the Table 2 above lists the responses by each participant. The semi-structured interview collected data revealing various challenges facing by GPs and the analysis of the data identified several common themes across the participants and also identified unique challenges in urban, rural, and remote areas. The below section details the themes identified during the data analysis.

Workload

articipants reported high workloads, with many working long hours and experiencing burnouts. GP participants from major cities reported that they are experiencing high patient volumes especially since the start of Covid-19 pandemic. However, GPs from inner regional areas, outer regional, remote, and very

remote areas reported moderate patient volumes, but they mentioned that they have more extended hours and on-call duties since they often provide extra services for aged care facilities and rural hospitals in the area. Many participants indicated that GP shortage is impacting their current workload. The participants were questioned about whether their workload is causing burnout, and more than 50% of them agreed that they have experienced burnout within the last year. The Figure 1 below displays the percentage of GPs who reported experiencing burnout in the past year.

Government Medicare Scheme & GP’s Income

Ps in all regions reported that the Medicare funding and billing rules have a significant impact on their practices. All participants noted that GPs earn comparatively less income than other medical specialists since the low rate provided to the GPs through the Medicare scheme. Two GPs from the major cities reported that they are sometimes forced to reduce their time of consultation due to bulk billing constraints. Another participant from inner regional area men-

medicallink.com.au • 21

• THE MEDICAL LINK

Access to Services Including Specialist Healthcare

articipants from very remote areas reported challenges to access specialist care and medical investigation services as patients often need to travel long distance due to lack of facilities in the area. In addition to this, the two participants reported that there were often long wait times to access specialist appointments, especially through public healthcare.

Doctor-Patient Relationships

tioned that many General Practices are abandoning bulk billing. All participants indicated rising cost of providing care and low Medicare rebates. Furthermore, participants reported that Medicare complexity, as well as the increase in the government’s Medicare compliance activities, take time away from patient-facing care and have an impact on the quality of care provided.

Administrative Tasks

ll participants noted increasing administrative tasks added to their workload. This included paper works associated with patient consultations and practice management. Participants reported that these non-billable administrative tasks increased their already burdened workload.

Staff Retention

taff retention was one of the significant challenges reported by the participants from outer regional, remote and very remote areas. It is reported that it is often challenging to retain experienced GPs, registered nurses, and administrative staff. The remoteness of these regions was identified by the participants as one of the main reasons for the recruitment

22 • Issue 147

and retention challenges of healthcare professionals in these areas. One of the participants from the remote areas mentioned about General Practices are closing down in those regions due to lack of GPs. Most of the participants indicated that medical graduates are not very keen to choose a general practitioner career due to the comparatively lower income compared to other specialist streams. Participants in the major cities and inner regional areas did not identify the staff retention as a challenge.

ll participants reported high satisfaction with doctor-patient relationships. However, few participants reported experiencing aggressive behaviour of patients. Furthermore, GPs from major cities noted that they often have difficulty to provide continuity of care to patients, this means patients in these areas often do not have a regular GP. According to the participants from major cities, some of the reasons for this include high patient volumes and GP availability.

Professional Development

ll Participants reported that they have easy access to professional development opportunities.

Professional & Work-Life Balance

Discussions

ost participants noted that they are enjoying their work, however, participants from the major cities mentioned that due to the workload, they sometimes struggle to spend quality time with their families. On the other hand, participants from all other regions reported being highly satisfied with their work and personal life balance. A participant from very remote region mentioned that it is difficult to take time off from work due to lack of replacement. The below Figure 2 illustrates the proportion of participant responses to the question ‘how would they rate their overall job satisfaction?’

he findings of this study highlight the significant challenges facing by GPs working in Queensland. The several themes identified after the data analysis include workload, Government Medicare scheme and remuneration, administrative tasks, staff retention, professional and work-life balance, access to services including specialist healthcare, and doctor-patient relationships. All ten GPs who participated in the study identified workload as a significant challenge, with many of them admitting to experiencing burnout. International research has also identified workload and burnout as significant challenges among

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GPs that impact negatively on both patients and GPs (O’Dea, O’Connor, Lydon, and Murphy 2017). According to “The Health of the Nation” survey conducted by RACGP (2022), almost three in four GPs in Australia reported experiencing feeling of burnout over the past 12 months. Urban GPs noted a high volume of patients as one of the reasons for increasing workload and reports that the number of patients attending their practices increased since the start of Covid-19 pandemic. This argument is consistent with the research conducted by Copp, Isautier, Nickel, Pickles, Tracy, Doust, Bonner, Dodd, Ayre, Cvejic, and Trevena (2021) related to the challenges of Covid-19 facing by GPs in Australia. The RACGP identifies Covid-19 and the associated pressures of recent years as one of the reasons for the feeling of burnouts among GPs (RACGP 2022). Rural and remote GPs identified workforce shortage as the primary reason for their increased workload and burnouts. They work extended hours and perform on-call duties since they often provide extra services for aged care facilities and rural hospitals in the area. Retaining staff, including GPs, registered nurses, and administrative staff, was identified as a significant challenge by participants

from outer regional, remote, and very remote areas. In a survey in 2021, only 13.8% of final year medical students chose general practice as their top preferred speciality for their future, which marks the lowest figure since 2012 (Medical Deans Australia and New Zealand, 2022). Several studies have identified that attracting and retaining health professionals to work in rural and remote areas is a long-standing issue that persists over time (Carson, McGrail, and Sahay 2022). However, surprisingly, participants from the major cities and inner regional areas did not identify the staff retention as a challenge. All the GP participants, irrespective of the regions, reported that GPs earn comparatively less income than other medical specialists. This is in line with the survey conducted by RACGP (2022), which revealed that 50% of the respondents reported it is financially unsustainable for them to continue working as a GP. The RACGP survey results also indicated that 70% of GPs reported that the fee they charge for a standard consultation is too low and it does not provide fair remuneration for the care they provide. Furthermore, a national report (not peer-reviewed) surveyed 2235 Australian GPs and non-GP specialists, revealed that 65% of GPs reported a decrease in their

monthly income in recent years (Scott 2020). The literature shows that the specialists earn almost twice as much as GPs earn (Scott 2014). All the participants of this study reported having to perform significant number of administrative tasks, which can also be seen as a contributing factor to the increased workload of GPs. The participants unanimously stated that Medicare complexity, combined with government’s heightened Medicare compliance requirements, detract them from patient-facing care and compromise the quality of care provided. Further administrative tasks noted by the participants include patient record management, completing forms and referrals, communicating with insurance agencies, complying with reporting requirements, and undertaking other general administrative duties within the medical centres. A study conducted by Brown, Enticott, and Russell (2021) identified that a substantial portion of Australian GP’s work is comprised of non-billable tasks. The high volume of patient turnover and shortage of support staff also contribute to additional administrative tasks. A unique challenge for very remote areas is the difficulty in accessing specialist care and medical investigation services due to the lack of facilities in the area. Patients often need to travel long distances to receive such services. Accessing healthcare for people living in rural and remote areas is challenging due to various factors such as geographic spread, low population density, limited infrastructure, and higher cost of delivery of rural and remote health care (AIHW 2022). Due to the limited availability of local specialist services, rural and remote populations highly depend on GPs for their healthcare need (Department of Health 2016). Therefore, a high level of training and skill development programs are required to enable rural and remote GPs to provide quality care. Another challenge identified is the aggressive behaviour of some patients in the general practice settings. Aggressive behaviour against GPs and healthcare staff

medicallink.com.au • 23

• THE MEDICAL LINK

include verbal, physical or psychological aggression and is a serious occupational hazard. A survey conducted among German GPs revealed that 91% of GPs had faced aggression at least once in their career and 73% within a year of the survey (Vorderwülbecke, Feistle, Mehring, Schneider, and Linde 2015). Moreover, GPs practicing in major cities reported facing challenges in ensuring continuity of care for their patients, which results in patients in these areas not having a regular GP. The reasons cited by the participants include high patient volume and availability of GPs. Although facing various challenges as GPs, most participants reported a high level of job satisfaction. Despite difficulties in maintaining a good work-life balance, participants from major cities also reported a high level of satisfaction with their job. In a survey conducted by RACGP (2022), 70% of the GPs who responded reported being moderately or highly satisfied with their job. However, it is recognised that assessing job satisfaction through a brief interview is a challenging task since it is a multifaceted construct.

Study Limitations

he research presented in this manuscript has several limitations that should be taken into account when interpreting the results. Firstly, the sample size is quite small, with only 10 GPs participating in the research. This may limit the generalisability of the findings, as the experiences and opinions of these 10 GPs may not be representative of the experiences and opinions of GPs more broadly. Secondly, instead of taking audio recordings of the interviews with the participants, notes were taken instead. Although care was taken to take detailed notes and not skip anything, there may be limitations to the accuracy and completeness of the information obtained. This method was used to maximise recruitment, given the small pool of potential participants in remote areas, and to reduce the risk of identification.

24 • Issue 147

Thirdly, there may be response bias among the participants, as the responses in the interviews were subject to the participants' willingness to disclose information and their own interpretation of the questions. This may limit the reliability and validity of the data collected. Fourthly, all participants were male GPs. This was due to recruitment issues and as a result, this study has a limitation of subjective sampling and may not fully capture the experiences and opinions of female GPs or GPs from diverse backgrounds. Overall, while the findings presented in this manuscript are informative, caution should be taken when interpreting the results, and future research with larger and more diverse samples may be necessary to confirm and extend these findings.

Conclusion

he study has identified the major challenges faced by GPs in Queensland. The challenges, common to urban, rural and remote GPs include, increased workload and associated burnouts, low remuneration, Medicare challenges, increased administrative tasks, and aggressive patients. Challenges unique to urban GPs include difficulty in maintaining proper work and personal life balance, and difficulty to provide continuity of care to patients. Whereas challenges unique to rural and remote GPs are staff retention and access to specialist care for patients. Overall, this study provides important insights into the challenges faced by GPs in Queensland and can inform the development of strategies aimed at improving health outcomes in both urban and rural areas of Queensland. Greater support and resources are necessary to address the challenges faced by GPs, and interventions from policy makers is required to ensure that GPs continue to service the urban, rural and remote healthcare needs of Australia.

References Australian Bureau of Statistics. 1270.0.55.005 – Australian Statistical Geography Standard (ASGS): Volume 5 – Remoteness Structure, Canberra. 2016 Australian Bureau of Statistics. National, state and territory population. Canberra: ABS. 2022 September. Australian Institute of Health and Welfare. Rural and remote health. Canberra: Australian Institute of Health and Welfare, 2022. Brown A, Enticott J, Russell G. How do Australian general practitioners spend their time?: A cross-sectional analysis of medicine in Australia: Balancing employment and life (MABEL) data examining'non-billable workload'. Australian Journal of General Practice. 2021 Sep 1;50(9):661-6. Carson DB, McGrail M, Sahay A. Regionalisation and general practitioner and nurse workforce development in regional northern Australia: Insights from 30 years of census migration data. Journal of Rural Studies. 2022 Apr 1;91:98-107. Copp T, Isautier JM, Nickel B, Pickles K, Tracy M, Doust J, Bonner C, Dodd RH, Ayre J, Cvejic E, Trevena L. COVID-19 challenges faced by general practitioners in Australia: a survey study conducted in March 2021. Australian Journal of Primary Health. 2021 Sep 30;27(5):357-63. Deloitte and Cornerstone Health. General practitioner workforce report 2022. 2022. Department of Health and Aged Care. General Practice Workforce providing Primary Care services in Australia. 2023. Department of Health. National Strategic Framework for Rural and Remote Health. Canberra: Department of Health, 2016 Medical Deans Australia and New Zealand. Medical Schools Outcomes Database: National Data Report 2020. Sydney: Medical Deans, 2022. O’Dea B, O’Connor P, Lydon S, Murphy AW. Prevalence of burnout among Irish general practitioners: a cross-sectional study. Irish Journal of Medical Science (1971-).

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2017 May;186:447-53. Royal Australian College of General Practitioners 2018, General Practice: Health of the Nation 2018, East Melbourne, Victoria.

Appendix 1 Interview Questionnaire Guide: •

Scott A. Getting the balance right between generalism and specialization: Does remuneration matter?. Australian Family Physician. 2014 Apr;43(4):229-32. Scott A. The impact of COVID-19 on GPs and non-GP specialists in private practice. Melbourne Institute: Applied Economic and Social Research, The University of Melbourne. 2020

•

Introduction: ं

General information

ं

Professional background

ं

Years for experience as a GP and duration in the current role

ं

Location of basic medical training

Understanding the challenges faced by GPs: ं

Primary challenges facing by GPs according to the participant. •

The Royal Australian College of General Practitioners. General practice health of the nation 2022. An annual insight into the state of Australian general practice – summary report. East Melbourne, Vic: RACGP, 2022.

Follow up questions: Is it a long-standing problem or a recently emerged problem; What are the contributing factors; How it is affecting the participant in their role as a GP.

Vorderwülbecke F, Feistle M, Mehring M, Schneider A, Linde K. Aggression and violence against primary care physicians—a nationwide questionnaire survey. Deutsches Ärzteblatt International. 2015 Mar;112(10):159.

Specific challenges in their geographic region in Queensland. •

Follow up questions: Is it a long-standing problem or a recently emerged problem; What are the contributing factors; How it is affecting the participant in their role as a GP.

ं

Any challenges in terms of Covid -19, doctor-patient relationships, work-life balance, remuneration, workload, support from the Government, and professional development. •

Follow up questions: Is it a long-standing problem or a recently emerged problem; What are the contributing factors; How it is affecting the participant in their role as a GP.

•

Any other challenges faced by the participant.

•

Short answer/ yes or no type questions:

•

ं

How would the participant rate their work satisfaction.

ं

Would the participant recommend general practice to a medical graduate.

ं

Has the participant experienced burnout in the past year working as a GP.

ं

Does the participant see themselves changing their career in the future.

Closing: ं

Any other information the participant would like to share.

medicallink.com.au • 25

"A pivotal advancement to South Coast Radiology's CT guided injection services is the use of Advanced intelligent Clear-IQ Engine (AiCE) technology."

26 • Issue 147

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Identify & Relieve Pain with CT-Guided Injections at South Coast Radiology South Coast Radiology Varsity One, Level 3, 1 Lake Orr Drive, Varsity Lakes 1300 197 297 | www.scr.com.au

outh Coast Radiology (SCR) takes immense pride in extending its comprehensive range of services to include CT guided injections across its conveniently located sites spanning the Gold Coast and Tweed Heads regions. SCR’s commitment to patient well-being and cutting-edge technology is at the forefront of their approach, and a tenet of this focus is offering an alternative solution for those seeking pain relief when traditional methods have proven ineffective.

he range of CT-guided injections offered are administered by South Coast Radiology’s team of specialist interventional radiologists, who work with CT radiographers and technicians to treat the patient. The use of Computed Tomography allows South Coast Radiology’s radiologists to be extremely precise in targeting the affected area, with the capacity to be precise to the millimetre.

pecialised in treating issues related to the musculoskeletal system as well as neurological nerve and joint conditions, this group of interventional radiologists are well-equipped to assist patients in finding pain relief, offering a range of services including:

Nerve & Facet Injections

hese procedures are instrumental in alleviating pain caused by nerve compression or facet joint irritation, targeting the source of discomfort with precision.

Joint Pain Relief

or those suffering from joint-related pain, specialist radiologists provide effective treatments assisted by CT technology to help patients regain a degree of mobility and comfort.

Epidurals

pidural injections can provide relief for various conditions causing acute or chronic pain, including spinal stenosis or herniated discs. CT technology is used to guide needles, helping interventional radiologists reduce a patient’s inflammation and pain.

Biopsies

outh Coast Radiology’s radiologists perform biopsies to accurately diagnose and guide treatment for various medical conditions. This is regularly utilised in the detection of abnormal breast

tissue, and an expert pathologist will be on-site during these procedures.

pivotal advancement to South Coast Radiology's CT-guided injection services is the use of Advanced intelligent Clear-IQ Engine (AiCE) technology. This revolutionary technology uses the computational power of a Deep Convolutional Neural Network to enhance the quality of medical imaging while simultaneously lowering the patient’s exposure to radiation. The advancement of their CT technology to AiCE reflects their commitment to improved medical outcomes for the Gold Coast region.

ince 1967, South Coast Radiology has established a reputation as the Gold Coast’s leader in diagnostic medical imaging. They are dedicated to delivering healthcare excellence through state-ofthe-art facilities and compassionate care, and eagerly anticipate the opportunity to serve the medical community and their patients.

o gain a further understanding of the CT guided injection services offered by South Coast Radiology, be sure to check out scr.com.au or contact the South Coast Radiology’s Bookings Centre on 1300 197 297.

medicallink.com.au • 27

• THE MEDICAL LINK

MEDIA RELEASE

Pharmacy Pilot Fails to Keep UTI Patients Out of EDs AMA Queensland Media Release | 27 September 2023 media@amaq.com.au | www.qld.ama.com.au

ew figures show the number of urinary tract infection (UTI) cases presenting at emergency departments has blown out since pharmacists have been allowed to autonomously diagnose and prescribe UTI treatments in Queensland.

“This is not a criticism of our hardworking pharmacist colleagues, who we work with every day to get the best outcomes for our patients. It is a criticism of shortterm, short-sighted political band-aids that will not resolve our health workforce shortages.

Health Minister Shannon Fentiman released figures about ED presentations across Queensland’s 16 Hospital and Health Services (HHSs) showing 36,911 ED presentations between 2022 and April 2023 were due to UTIs.

“We continue to call on all levels of government and all sides of politics to work together to recruit, train and retain our own healthcare workforce, and to scrap dangerous experiments with patient health.”

This is up from 24,620 in 2020, the year pharmacists were first allowed to diagnose and sell antibiotics to patients without undertaking a basic urine test or seeking any medical oversight.

Background

“Urinary tract infections are serious and hard to diagnose, particularly in men and aged care residents, who make up the majority of UTI presentations at EDs,” AMA Queensland President Dr Maria Boulton said. “The Minister’s own figures show the UTI pharmacy prescribing pilot has not reduced the number of presentations to EDs. In fact, UTI presentations have increased since the flawed pilot began.

28 • Issue 147

•

The Urinary Tract Infection Pharmacy Pilot – Queensland (UTIPP-Q) began in 2020, allowing pharmacists to diagnose and prescribe UTIs in women after a brief online training course. There was no mechanism for the 6,751 women who took part in the trial to report adverse outcomes, other than directly to the pharmacist. AMA Queensland surveyed more than 1,300 doctors across the state in 2022 and found 240

• •

•

cases where doctors had to treat patients who experienced complications as a result of participating in the pilot. The most common misdiagnosis was having a sexually transmitted infection rather than UTI. At least six pregnant patients were misdiagnosed and sold antibiotics that are unsafe in the first 12 weeks of pregnancy, including one with a potentially lifethreatening ectopic pregnancy. The UTIPP-Q evaluation, carried out by QUT, found clinical protocols were not followed and one in two participating pharmacists said they would have found it difficult to not sell antibiotics after charging patients the $20 consultation fee. The planned North Queensland Scope of Practice Pilot, allowing pharmacists to diagnose and sell medications for 23 serious conditions, starts next year and has been expanded to the entire state with no consultation. More details about these pilots can be accessed at www.ama. com.au/qld/campaigns/stop-nqpharmacy-pilot

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At Lumus Imaging Varsity Lakes we specialise in Pain Management “It is important to me that I take my time with the patient and understand the source of their pain. We can perform a range of pain management techniques at Varsity Lakes, therefore I will engage with the referrer if I think we can offer a better option. Getting our patients back to doing what they love most in life is my motivation”.

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medicallink.com.au • 29

"Lower back pain is one of the most common clinical presentations in general practice and emergency departments around the world, and around 80% of Australians will experience back pain requiring therapeutic management in our lifetimes."

30 • Issue 147

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Imaging Guided Management of Back Pain: Our Approach at Panorama Radiology Specialists Dr Angus Watts MBBS (UQ), FRANZCR 13/117 Ashmore Rd, Benowa (in the Amart Complex) (07) 5654 5133 | panoramaradiology.com.au

ower back pain is one of the most common clinical presentations in general practice and emergency departments around the world, and around 80% of Australians will experience back pain requiring therapeutic management in their lifetimes.

egenerative disc disease (DDD) is commonplace with advancing age, especially in the lower lumbar discs which are subject to higher biomechanical loadbearing forces and torsional stressors, that from a radiological perspective it can almost be viewed as a normal part of the ageing process, and in many cases DDD alone may be asymptomatic.

isc pathology such as disc protrusions and discogenic osteophytosis causing nerve root impingement and radiculopathy, spinal stenosis, facetogenic pain, spondylolisthesis and sacroiliitis are common causes of morbidity in the acute and chronic settings in clinical practice. Identifying a specific causative pathology is not always straightforward, particularly in older patients with multiple coexistent pathologies. Whilst younger patients often present with a clear isolated causative pathology such as an L5/ S1 neurocompressive disc protrusion or L5/S1 spondylolisthesis resulting in L5 nerve root compression, in older patients with complex multi-level degenerative disc and facet joint pathology or spinal stenosis, identifying the specific cause of symptomatology can frequently be more challenging.

y new Benowa clinic, Panorama Radiology Specialists, offers subspecialist imaging and imaging-guided pain management procedures for spine and joint conditions using state-of-theart technology including 3T MRI with Deep Resolve image enhancement, 640 slice CT with AI dose reduction technology, and leading-edge high definition Ultrasound equipment including the Canon i700 which provides exceptional detail for fine ligamentous and nerve pathology, operated by our team of highly experienced imaging technologists and musculoskeletal-trained sonographers.

s Fellowship-trained musculoskeletal and interventional radiologists, my colleague Dr Sam Kruger and myself are often asked for an opinion on the likely cause of lower back pain and what imaging-guided interventional options may be beneficial in a patient’s individual clinical circumstances.

s radiologists, it’s sometimes easy to become overly focused on imaging aspects of back pain rather than stepping back and looking objectively at the broader clinico-radiological picture. Discussing and understanding a patient’s specific clinical symptoms, and correlating these with CT or MRI findings, is crucial to achieving optimal imaging-guided pain management outcomes. Not infrequently I find there is a discordance between clinical and radiological aspects of back pain. For example, we frequently see significant pathology on CT or MRI scans

located on the contralateral side, or in a different anatomical region altogether, relative to the patient’s presenting clinical symptoms.

ur role as interventional radiologists is to understand the clinico-radiological picture as a whole, to optimise the accuracy and efficacy of imaging-guided pain management, and to achieve optimal clinical outcomes. Managing patient expectations is also an important component of radiological intervention, as complex spinal pathology can not only be challenging to localise but may also vary considerably in terms of therapeutic response.

ne of the commonest clinical decision-points in terms of appropriately targeting imaging-guided pain management is differentiating facetogenic pain from radicular-type pain and spinal stenosis. CT and MRI have a key role in identifying and localising pathology such as disc protrusions, nerve root compression, facet joint pathology, synovial cysts and sequestrated disc fragments that may cause nerve root compression, and defining the presence and causes of spinal stenosis.

rom a radiological perspective, I routinely ask patients for simple but key clinical information that can sometimes get overlooked in a deluge of complex information. Not infrequently, a simple clinical history combined with a review of MRI or CT images, may prompt a re-

medicallink.com.au • 31

• THE MEDICAL LINK

view of the procedural approach being considered.

n cases where a patient has undergone multiple procedures, sometimes at multiple institutions, with limited success, my approach is sometimes to have a re-set, review prior MRI and CT scans and perhaps to think outside the box in terms of the key causative pathology. Is there an alternative pathology that might be a significant pain driver?

dentifying a symptomatic facet joint in patients with facetogenic pain and multi-level facet joint arthropathy is a common clinico-radiological challenge we encounter. There are varying approaches to localising a painful facet joint including a trial of CT-guided facet joint blocks or medial branch blocks, MRI to identify synovitis and reactive marrow changes, or SPECT-CT to

identify synovitis in metabolically active facet joint arthropathy. Once a painful facet joint is identified, CT guided medial branch blocks may be of value with a view to potential progression to RF ablation as a longer term pain management measure.

n patients with radiculopathy and radiological evidence of nerve root compression, we often recommend trialling a targeted CT-guided nerve root sheath block as an initial analgesic measure, then if symptoms persist potentially progressing to an epidural steroid injection if appropriate. CT-guided epidural steroid injections are generally a quick and well-tolerated procedure we frequently perform for patients with radiculopathy secondary to spinal stenosis, which may be discogenic or degenerative.

Our role as interventional radiologists is to understand the clinicoradiological picture as a whole, in order to optimise the accuracy and efficacy of imagingguided pain management, and to achieve optimal clinical outcomes.

xcluding underlying pathology which may mimic facetogenic or discogenic symptoms is also a key consideration in our diagnostic workup, including sacroiliitis, sacral insufficiency fractures (a commonly overlooked pathology in elderly patients), underlying osseous pathology such as osseous metastatic disease, and osteoporotic compression fractures. Panorama Radiology Specialists in the AMart complex at Benowa is a comprehensive doctor-owned clinic offering a range of imagingguided pain management options and industry-leading technology including 3T MRI with Deep Resolve image enhancement, low dose 640-slice CT, EOS scans and high resolution Ultrasound. Imaging-guided spinal and joint therapies include HCLA, hyaluronic acid, PRP and radiofrequency ablations. As Fellowship-trained musculoskeletal and interventional radiologists, Dr Watts and Dr Kruger are always happy to discuss musculoskeletal and general imaging diagnostics, and imaging-guided pain management options with referring clinicians. Clinical enquiries and appointments can be made by calling (07) 5654 5133, or online at panoramaradiology.com.au

Panorama Radiology Specialists' principal radiologist Dr Angus Watts (left) and Dr Sam Kruger (right).

32 • Issue 147

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