Dr Brian Pezzutti

A meeting with Brian Pezzutti is like running a marathon race and a sprint all at once. I ask him how he has managed to keep up his intensity for so long? He turns to his wife Christine, a general practitioner until recently, and tells me she is the answer to that question. Christine had provided support in so many ways; his best friend and confidante, reliable money source when he was an MLC and now a guiding hand in retirement. Not that he is fully retired, he reminds me, with his anaesthetics still an interest. (He is excited about being able to work locally again now he is no longer Chairman of Northern NSW Local Health District board).

UWS students survey

As artists and arts lovers we know the immense value creating and enjoying art can have on enhancing mental health and wellbeing.

Now five medical students from the University of Western Sydney are conducting a survey on this topic with a focus on how people are coping during Covid-19 restrictions.They are in Lismore as part of their fourth year of study which includes carrying out some community research.

Students Ruban Sivakumar, Rory Sinclair, Jeyvin Nandakumaran, Tushar Vashisht and Sanju Sonnadara created the online survey especially for people living in Northern NSW.

The research topic was developed with the help of Dr Andrew Binns and Dr Tien Khoo. The aim of the project is to gauge what effect Covid restrictions are having on wellbeing, but the study will also provide an evidence base for arts organisations to use when applying for funding.

Both consumers and creators of the arts living in Northern NSW are invited to take part in the survey. The more participants in the study, the more valuable the findings, so please encourage those in your arts circles to take part.

Research lead Dr Natalie Edmiston said the research had a twofold role.

“As well as gathering evidence on the connection between the arts and mental health and wellbeing, it reminds people to look to the arts for support with their own wellbeing during these challenging times; particularly if they are struggling.”

The survey can be found here:


drawings by Jeni Binns

I have been prompted to write this due to an adverse incidence of a patient who received a Boostrix vaccine and went on to have serious problems that followed. It was basically a bursitis of a shoulder that resulted from the vaccine having been administered too high in the upper arm. This left the patient with an inability to abduct the arm for weeks. 

In view of the large number of vaccines being given in these times it may be worth considering the site of injecting. It should be neither too high nor too low. This may involve removing layers of winter clothing to give the injector good access to the correct site in the deltoid muscle of the upper arm – see diagrams. This can be time consuming in a busy clinic under pressure. 

Although a rare complication of vaccination it can be disabling for the patient causing an immune-mediated inflammatory reaction in the shoulder joint. The resulting problems can be bursitis, tendonitis, rotator cuff tears and fluid accumulation in the deltoid or rotator cuff. 

In summary, all vaccines can produce this adverse reaction if the injection is given too high. 

For more information see the RACGP article on Avoiding shoulder injury related to vaccine administration.

Drawings by Jeni Binns

NorDocs has completed over 12 months of webinars since the onset of COVID19  restrictions. Highlights from last year were interactive sessions with local specialists on the subjects of carotid vascular disease management, modern psoriasis treatments, management of breast cancer and new options in the treatment of restrictive lung disease. 

This year there have been meetings on the team approach in addiction medicine, the relatively common North Coast malady of mammalian meat allergy (MMA) and the options for advanced upper gastro-intestinal surgery at Lismore Base and St Vincent’s Private Hospitals.

Drs Helen Lloyd and Susan Tyler-Free discuss MMA pathophysiology and diagnosis
with facilitator and Nordocs Co-Chair Dr Louise Imlay-Gillespie

Between May-July this year the NSW Agency for Clinical Innovation ran a crowdsourcing challenge, inclusive of a Twitter chat, to gain insights and perspectives from clinicians, managers and consumers to contribute towards an action plan to tackle unwarranted clinical variation in NSW. 


It was a tweet on this feed that led to an invitation to author this article in which I discuss the background of clinical variation in health care with a focus on primary care, the Australian experience of identifying, understanding and managing variation, followed by strategies to address variation.

Variation in healthcare is not a new phenomenon. For example, a 1930s review of tonsillectomies across London boroughs found a 20-fold variation, leading to the conclusion that there was a ‘tendency for the operation to be performed as a routine prophylactic ritual for no particular reason and with no particular result’. A troublesome conclusion, particularly because at that time tonsillectomy operations led to the death of seven children every month in England.

Now, almost a century later, we continue to observe wide variations in clinical practice that cannot be explained by patient preference or illness severity. These variations are unwarranted.  There are three types of unwarranted variation:

  1. Variations in effective care and patient safety
  2. Variations in preference-sensitive care
  3. Variations in supply-sensitive care