Australian Doctor 15th September 2023 AD 15th Sept Issue

15 SEPTEMBER 2023
The country ’ s leading independent medical publication
Stay up to date with the latest at ausdoc . com . au
TWO IN THIS ISSUE
Common drug allergies HOW TO TREAT , PAGE 15
Antarctic doctor ’ s appendix NEWS , PAGE 5
Paul Smith Obesity and the word fat
OPINION , PAGE 14
Dr Bolton vs hospital bosses NEWS REVIEW , PAGE 34

‘ Obstetric violence ’ outcry

Doctors alarmed by inquiry ’ s term for birth trauma .
Paul Smith DOCTORS are criticising the adoption
of the term ‘ obstetric violence ’ by a parliamentary inquiry into the prevalence of birth trauma .
The inquiry has been dubbed the “ Me Too of childbirth ”, with more than 4000 submissions made to the NSW
Select Committee on Birth Trauma — many from women describing their experiences of alleged clinical incompetence and the lack of consent surrounding interventions .
During the first hearing last week , the inquiry was told that a third of women had experienced some form of “ obstetric trauma ” and around one in 10 had reported “ obstetric violence ”.
The figures were based on a 2019 survey of 8000 women by Professor Hannah Dahlen , from the school of nursing and midwifery at Western
Sydney University . But RANZCOG said it was alarmed by the language .
The college said the phrases , which were also used in the inquiry ’ s terms
of reference , implied that the “ obstetrician
intended the harm , which is unfair and vastly incorrect ”.
“[ The ] word ‘ violence ’ has a
It implies the ‘ obstetrician intended the harm , which is unfair and vastly incorrect ’.
grounding in the social and political philosophy literature , with a paradigm of victimhood and oppression by a powerful privileged group who deliberately
cause suffering ,” it said in its written submission .
“ Interventions are often carried out where the health provider is of the
opinion that the intervention is needed to prevent harm to the mother and / or the baby ,” it added .
“ Childbirth may cause significant physical and psychological damage to women , [ but ] it is quite extreme and incorrect to assume that ‘ intentional violence ’ is being perpetrated by Australian and New Zealand maternity care providers towards women and the babies in their care ,” it said .
Professor Dahlen , who fronted the inquiry last week , defended the term .
“ No means no — except , PAGE 2

GP plans $ 15 ‘ Premier ’ s Payroll Tax ’ patient fee

Sarah Simpkins PAYROLL tax is driving Dr Mukesh Haikerwal to charge patients $ 15 extra on standard consultations , which he plans to itemise on invoices as the “ Premier ’ s Premium Payroll Tax on Health ”.
The former AMA president and Melbourne GP is talking to his software company , lawyers and accountants about ways to get his message across on why the fee hike is necessary .
“ This is an unexpected cost , and with a very thin margin in the practice , it has to be passed on .”
There is one risk , he says . Itemising the $ 15 charge separately to the medical service could attract yet another tax — GST , for which medical care is an exemption .
Dr Haikerwal ’ s move follows new payroll tax guidance from Victoria ’ s State Revenue Office , published last month , which confirmed that GPs could be considered employees rather than contractors for tax purposes . The payroll tax rate in Victoria is 4.85 %, or 1.21 % for regional
employers , with a threshold of $ 700,000 .
Victoria and Tasmania remain the only states where GP practices have no amnesty from payroll tax .
In the ACT , Chief Minister Andrew Barr announced that practices could receive a two-year amnesty but only if they bulk-billed at least 65 % of patients .
It infuriated GPs , who accused him of blackmail .
But he then went on to accuse both the AMA and the RACGP of scaremongering , saying their warnings that GPs would have to add $ 20 to a consult to cover costs were based on ignorance about how payroll tax worked .
“ Their analysis , from my meetings with them , assumed that payroll tax was applicable on the entire payroll ,” he told the ACT Parliament .
“ They did not understand the $ 2 million tax-free threshold .
“ They undertook modelling and put a figure into the public arena that they have confirmed to me , in a meeting , was based PAGE 3
‘ This is an unexpected cost , and with a very thin margin in the practice , it has to be passed on .’
— Dr Mukesh Haikerwal
NEWSPIX