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2022

Carmel Sparke DR GRAEME SIGGS is in line for a “ beer and a hug ” after he diagnosed a potentially deadly melanoma while watching the nightly ABC News bulletin .

The Adelaide GP noticed a suspicious looking lesion on the cheek of Professor Daniel Angus , who was being interviewed 2000km away in Brisbane about the dangers of online gambling advertising .

Following the interview , Dr Siggs used Google to find contact details for the communications academic at QUT , and consequently discovered images of him going back several years .

“ The spot was not always there , and it had grown in size over the last few years , so that further aroused my suspicions ,” Dr Siggs said .

He reached out to Professor Angus via email with the line “ This email could save your life ”.

“ I note that you live in Queensland and have red beard hairs and very fair skin , no doubt subject to many sunburns in your youth ,” Dr Siggs wrote .

“ If you have not yet had this lesion assessed by a skin cancer doctor or dermatologist , I would strongly urge you to do so . It could be a melanoma .”

He then explained he “ couldn ’ t help but notice ” the obvious irregularly pigmented lesion on Professor Angus ’ s right cheek that was “ new and growing in size ”.

Dr Siggs heard nothing for two months and assumed the advice must have ended up in a spam folder .

But on 17 May , he received an email from Professor Angus , thanking him for the life-saving surgery he had just undergone .

“ Hi Graeme , I owe you a beer and a hug if I ever find my way to Adelaide ,” he wrote .

“ While I had had this lesion checked out previously , and that GP was not significantly concerned , on your advice I went straight to another GP who ordered a referral to a dermatologist .

“ The dermatologist biopsied and confirmed this as an in situ melanoma .”

He reported he had been given the all-clear after his surgery — full skin flap rotation — with the plastics team happy with the healing .

“ I don ’ t feel that words convey the thanks and gratitude for you taking the time to reach out and encourage

me to have this looked at .” Dr Siggs said he was “ tickled pink ” to hear the good news .

“ When I first saw the lesion , just under his glasses , I thought , ‘ Gee , that looks suspicious for melanoma ’. So I thought I had better do the right

Professor Daniel Angus , post-operation ( right ).

Dr Graeme Siggs ( left ).

thing and let him know .

“ What I didn ’ t know at the time was that he was immune suppressed and had a family history of melanoma .

“ Put all those things together and he was at very high risk .”

FROM PAGE 1

And claims involving

the prescription of puberty blockers

would also be covered , provided Australian standards of care and treatment guidelines for trans and gender diverse children and teenagers “ are complied with at all times ”.

MDA National president Dr Michael Gannon said it was a decision based on the unknown risk of future negligence claims .

“ We knew we would get some flak for doing this ,” Dr Gannon said . “ But this [ decision ] is not a commentary on the ethics or morals of this treatment .”

He said the insurer ’ s underwriting committee and board had grappled with the decision for many months .

It could not ignore emerging claims in Europe and the closure of the Tavistock Centre in the UK in response to negligence claims brought by some former patients , he said .

MIGA , MIPS and Avant said they have not changed their cover on gender dysphoria .

But Dr Gannon argued it was impossible to price premiums to cover claims that may arise 10 or 20 years later because the risk factors for future litigation involving patients prescribed gender-affirming hormones before 18 years of age were unknown .

This was contrasted with obstetrics , another area of practice with a long tail but where the risk factors — such as failure to detect intrauterine

Dr Portia Predny .

‘ What about the legal risks of not providing treatment and then someone harming themselves ?’

growth or accurately interpret fetal monitoring during labour — were established .

“ Gender dysphoria has gone from something that might have been a very minor part of practice to significant growth in the number of individuals

querying their gender identity ,” Dr Gannon said .

“ On that basis , we think there has got to be at least some increase in the rate of regret .”

Although estimates vary , several large studies have suggested that about 2 % of patients who transitioned later regretted their decision .

But transgender GP Dr Clara Tuck Meng Soo , who was reconsidering

her MDA National membership , said the MDO was wrong to assume GPs operated outside of multidisciplinary teams when managing gender dysphoria in minors .

“ We refer patients to psychologists , psychiatrists , speech therapists , surgeons and endocrinologists all the time ,” she said .

“ I think the question for Michael Gannon is that , if he is so worried about the legal risks of us providing treatment , what about the legal risks of us not providing treatment and [ then ] someone harming themselves ?”

Dr Predny said : “ Despite MDA National ’ s statement that their decision is not a commentary on the ethics or morals of this treatment , it is a decision that has significant ethical and moral impact .

“ Access to gender-affirming care is already a huge issue .”

FROM PAGE 1 practitioners were often through the lawyers , which also obscured the need to escalate risk of harm , it added .

As a result , AHPRA teams may have been unaware of what was “ unfolding in the practitioner ’ s life until it was too late ”.

“ There were examples of communication with practitioners that was impersonal , legalistic and lengthy … sometimes at key trigger moments in the process .”

These “ key trigger moments ” included the first letter or phone call saying a complaint had been lodged , decisions to suspend health practitioners , and revealing the results of health assessments .

“ There were examples in all these situations where the practitioner either attempted suicide or died shortly after the trigger point ,” the report said .

It added : “ Communication regarding immediate action suspensions were of particular concern , especially when the practitioner did not appear to have a support network or a lawyer in place and had little grasp of the process .”

Among its recommendations were fortnightly updates for at-risk practitioners , clearer instructions for investigators on how to identify and manage mental health crises and flagging practitioners “ under extreme stress ” to ensure they received extra attention .

It also suggested a potential navigation service for some practitioners to “ guide [ them ] through our regulatory process ”.

The review involved interviews with 22 health practitioners investigated by the watchdog , one of whom accused AHPRA of having “ no transparency ” and being “ a brick wall ”.

“ AHPRA demands everything immediately and takes a hell of a long time to actually achieve anything themselves ,” another said .

A third practitioner described the complaints process as like “ having a colonoscopy without anaesthetic ”. The report said those being investigated described phone calls and emails going unanswered or long delays in getting responses .

‘ Communication was impersonal and legalistic .’

“ The lack of responsiveness by staff appeared to contribute to the sense by participants that the process was completely out of their control .”

In total , the expert advisory group made 15 recommendations , all of which AHPRA accepted .

If this story has raised issues for you , or you are concerned about someone you know , you can call the following support services 24 hours a day , seven days a week :

Doctors ’ health services

• ACT : 1300 374 377

• NSW : 02 9437 6552

• NT : 08 8366 0250

• Queensland : 07 3833 4352

• SA : 08 8366 0250

• Tasmania : 1300 374 377

• Victoria : 03 9280 8712

• WA : 08 9321 3098

Crisis support services

• Lifeline : 13 11 14

• Beyond Blue : 1300 22 4636