FAQs

No, we do not. We operate a full-service private practice clinic with leading local clinical and administrative staff, along with the latest state-of-the-art diagnostic and therapeutic clinical technology, which enables us to offer patients a truly world-class clinical experience. This service is not possible to run on a Bulk-Billing model. Therefore, there are reasonable out-of-pocket expense associated with most consultations and procedures.

If you are a Medicare card holder and want to claim the Medicare rebate, you will require a valid referral from either a GP or another Specialist to entitle you to claim your Medicare rebate.

Patients who do not have a Medicare card, do not want to claim the Medicare rebate, or international patients do not require a referral to attend our practice and will be billed per our standard rates.

GP referrals are valid for 12-months and referrals from other Specialist are valid for 3-months.

Yes, you can. You can use a referral that is made out to a different specialist of the same speciality/vocation (eg: another general surgeon) to see Dr Kaushal.

In clinic

Private health insurance does not cover what is done in the rooms (unless you are an in-patient or overseas visitor with international travel insurance). If you are an international visitor with the necessary insurance, full payment is required at the time of the consultation, you will then be provided with a receipt to claim directly from your provider.

Surgery

No, you are not necessarily required to have private health insurance to be a patient in a private hospital. A ‘self-funded’ patient is someone who doesn’t have Private Health Insurance, but pays cash for their medical treatment upfront. This consists of the specialist’s fee, the anaesthetist’s fee, the surgical assistant’s fee and the hospital’s fee. It’s the hospital fee which makes up the vast majority of the cost.

Yes, we offer telehealth consultations where clinically appropriate.

Patients who are charged for a telehealth consultation are eligible for a Medicare rebate, subject to Medicare eligibility and the relevant MBS requirements. This applies to both initial and follow-up consultations.

Where Dr Kaushal bulk bills a telehealth consultation, the patient is required to provide written consent to allow the practice to claim the Medicare benefit. We will endeavour to obtain this consent before the consultation. A consent form will be emailed to the patient to complete and return before their telehealth appointment.

If a telehealth appointment is booked at short notice, the consent form may be sent after the consultation for the patient to complete and return.

If we are unable to obtain the required consent to bulk bill, the patient will need to pay the applicable private fee for the telehealth consultation.

Not every hernia needs immediate surgery. The decision depends on the type of hernia, your
symptoms, whether it is getting larger, your general health and how much it affects your
everyday life. For some men with a minimally symptomatic inguinal hernia, watchful waiting is
a reasonable option, although many eventually choose surgery because symptoms progress. A
painful or increasingly symptomatic hernia is more likely to benefit from repair. Femoral
hernias are generally treated more proactively because of their higher risk of becoming trapped.
The decision should therefore be individual rather than based simply on the presence or size of a
hernia

A hernia develops when tissue pushes through an area of weakness in the abdominal wall. In
most patients there is not one single cause. Ageing, inherited connective-tissue characteristics,
previous abdominal surgery, obesity and increased abdominal pressure can all contribute.
Activities such as heavy lifting or coughing may make an existing weakness or hernia become
noticeable, but it is usually too simplistic to say that one episode of lifting alone caused the
underlying abdominal wall weakness. Incisional hernias occur specifically through or close to a
previous surgical incision.

Strangulation means that tissue trapped within a hernia has lost its blood supply. Warning
symptoms include sudden or increasing severe pain, a previously reducible lump becoming
irreducible, marked tenderness or swelling, vomiting, abdominal distension and inability to pass
stool or wind. Skin over the hernia may occasionally become red or discoloured. A painful
irreducible hernia, particularly with vomiting or abdominal symptoms, requires urgent
assessment in an emergency department.

Gallstones develop when substances normally dissolved in bile form crystals and gradually
enlarge into stones. Most are cholesterol stones, although pigment stones can also occur. Risk is
influenced by several factors including age, female sex, pregnancy, obesity, rapid weight loss,
family history and some medical conditions. Many gallstones never cause symptoms and do not
necessarily require treatment. Treatment is usually considered when stones cause symptoms or
complications rather than simply because they are present.

There is no diet that reliably dissolves established gallstones. While waiting for surgery, many
patients find that large or high-fat meals trigger biliary pain, so smaller meals and reducing
particularly fatty or fried foods may help control symptoms. There is no need to eliminate all
dietary fat, and individual triggers differ between patients. Maintaining adequate nutrition is
more important than following an excessively restrictive diet. If attacks are frequent despite
dietary modification, this should be discussed with your surgeon rather than relying on diet
alone.

Typical biliary colic often settles within several hours. Pain that is severe or persistent,
particularly when associated with fever, repeated vomiting, jaundice, dark urine or feeling
systemically unwell, needs urgent medical assessment. These symptoms may represent acute
cholecystitis, pancreatitis, infection or obstruction of the bile duct rather than uncomplicated
gallstone pain.

Most people can return to a normal balanced diet after uncomplicated gallbladder removal. The
liver continues to make bile; the difference is that bile flows directly into the intestine rather
than being stored in the gallbladder. Some patients temporarily experience bloating or looser
stools, particularly after large fatty meals. It is reasonable to start with smaller, lighter meals and
increase the range of foods according to comfort. A permanent very-low-fat diet is not routinely
required after an uncomplicated cholecystectomy.

Smoking increases the risk of respiratory complications, cardiovascular problems and impaired
wound healing around the time of surgery. Stopping smoking before an operation reduces these
risks. Stopping for several weeks before surgery is associated with better outcomes, with greater
benefit from longer periods of cessation. Even when surgery is closer than this, stopping smoking
is still encouraged rather than continuing because the ideal timeframe has passed.

Obesity can increase the complexity of some operations and may increase risks such as wound
complications, respiratory problems and venous thromboembolism. For selected operations,
losing some weight beforehand may make surgery technically easier and improve perioperative
health. However, this needs to be balanced against the reason for surgery and how urgently
treatment is required. Preoperative weight loss should therefore be an individual
recommendation rather than an automatic requirement for every patient.

Surgical outcomes are influenced by both the operation and your health going into it. Important
areas include stopping smoking, maintaining physical activity where possible, optimising
diabetes and blood pressure, addressing significant anaemia or nutritional problems, moderating
alcohol intake and following medication and fasting instructions carefully. This process is
sometimes called prehabilitation or perioperative optimisation. Not every patient requires every
intervention; the goal is to identify the factors relevant to you before surgery.

It depends on the operation. For procedures where preventive antibiotics are recommended,
they are usually given shortly before or at the beginning of surgery so that effective antibiotic
levels are present when the operation starts. Many uncomplicated operations do not require
prolonged antibiotics afterwards. Longer treatment is generally reserved for situations such as
established infection, contamination or another specific clinical indication. The exact plan
depends on the operation and local antibiotic guidelines.

Never stop anticoagulant or antiplatelet medication simply because you are having an operation.
The decision depends on which medication you take, why you take it, the bleeding risk of the
proposed procedure and your individual risk of developing a clot if treatment is interrupted.
Some medications are temporarily stopped, some are continued and occasionally another
anticoagulant strategy is required. Your surgeon, anaesthetist and prescribing doctor should
determine the plan.

There is no single list that applies to everyone. Some diabetes medications, anticoagulants,
antiplatelet drugs and other medicines may need to be temporarily withheld or adjusted,
whereas many medications should continue normally. Recommendations can also change as
new evidence becomes available. Bring a complete medication list – including injections, over
the-counter medicines, vitamins and herbal preparations – to your preoperative assessment and
follow the instructions given specifically for your operation.

What was commonly called non-alcoholic fatty liver disease is now generally termed metabolic
dysfunction-associated steatotic liver disease (MASLD) when it occurs in association with
metabolic risk factors. It is frequently associated with overweight or obesity, diabetes, insulin
resistance, abnormal cholesterol and other metabolic conditions. Treatment focuses particularly
on sustained lifestyle improvement, physical activity, weight reduction when appropriate and
management of cardiovascular and metabolic risk factors. Importantly, a minority of patients
develop significant liver inflammation or fibrosis, so assessment should consider not just liver
enzymes but also the possibility of fibrosis.

Gut health is a popular term rather than a specific medical diagnosis. From a medical
perspective, we are interested in normal digestion, bowel function, nutrition and the interaction
between the intestine and its microbiome. A varied diet containing vegetables, fruit, whole
grains, legumes and other fibre-containing foods is generally supportive of gastrointestinal
health, together with regular activity and appropriate hydration. Routine commercial
microbiome testing or taking multiple probiotic supplements is not necessary for most healthy
people, and specific gastrointestinal symptoms should be investigated rather than simply
attributed to poor gut health.

Once an acute episode has settled, most people with diverticular disease can eat a normal,
healthy diet. A dietary pattern containing adequate fibre from vegetables, fruits, whole grains
and legumes is generally appropriate if tolerated. Fibre should be increased gradually because
rapidly increasing it can cause bloating in some patients. Dietary recommendations may need to
be modified for people who have narrowing of the bowel, previous bowel surgery or other
gastrointestinal conditions.

Generally, no. There is not good evidence that people with uncomplicated diverticular disease
need to permanently avoid nuts, seeds, corn or similar foods. During an acute episode of
diverticulitis, some patients find a temporary lighter or lower-residue diet more comfortable,
with the diet advanced as symptoms improve. This is different from permanently avoiding
particular foods after recovery.

The first-line treatment for most symptomatic haemorrhoids is improving bowel habit.
Increasing dietary fibre, adequate fluid intake, avoiding prolonged straining and reducing time
spent sitting on the toilet can significantly improve symptoms. Topical preparations may give
short-term symptomatic relief but do not address the underlying bowel habit. Persistent
bleeding, prolapse or symptoms despite conservative treatment may require procedures such as
rubber-band ligation or surgery depending on the type and severity of haemorrhoids. Rectal
bleeding should not automatically be attributed to haemorrhoids without appropriate
assessment.

Constipation can involve infrequent bowel motions, hard stool, excessive straining or difficulty
emptying. Common contributors include inadequate fibre intake, medications, reduced activity
and changes in bowel function, but there are many other possible causes. Management often
starts with appropriate fibre, fluid intake, exercise and sometimes medication to soften or
regulate the stool. New persistent constipation, particularly when accompanied by rectal
bleeding, iron deficiency, weight loss or a significant change from your usual bowel habit,
warrants medical assessment.

Chronic diarrhoea usually refers to recurrent loose stools lasting several weeks rather than a
short gastroenteritis-type illness. Causes include medication effects, lactose or other food
intolerances, coeliac disease, inflammatory bowel disease, microscopic colitis, bile-acid
diarrhoea, pancreatic disorders and functional bowel conditions such as irritable bowel
syndrome. The appropriate tests depend on the pattern of symptoms rather than performing
every investigation on every patient. Blood in the stool, weight loss, anaemia, nocturnal
diarrhoea or significant deterioration warrant more prompt investigation.

Bloating is extremely common and does not necessarily mean there is excess gas or a serious
disease. It can occur with constipation, irritable bowel syndrome, food intolerances, altered gut
sensitivity and certain fermentable carbohydrates. The important issue is the pattern. Persistent
or progressive bloating associated with weight loss, vomiting, gastrointestinal bleeding, anaemia,
a new change in bowel habit or a palpable abdominal mass deserves further investigation rather
than simply eliminating multiple foods from the diet.

Pilonidal disease usually develops when hairs penetrate the skin in the cleft between the
buttocks, producing pits, inflammation, sinus formation or abscesses. An acute painful abscess
generally needs drainage. Chronic or recurrent disease can be treated in several ways, ranging
from relatively limited procedures to excision and off-midline reconstructive operations. There is no single operation that is best for every patient, and treatment should be tailored to the extent
and recurrence of the disease.

Not every polyp requires the same follow-up. The timing depends on the number, size and
microscopic type of polyps, whether advanced changes were present, whether they were
completely removed and the quality of the original colonoscopy. Some people can return to
routine bowel screening, while higher-risk findings may require surveillance colonoscopy after
one, three or five years. Therefore, a blanket recommendation such as repeat colonoscopy every
three years is not appropriate. Your recommended interval should be based on the colonoscopy
and pathology findings.

There is no standard interval that applies to everyone. Iron studies are checked when there is a
clinical reason – for example previous iron deficiency, anaemia, gastrointestinal bleeding, heavy
menstrual bleeding, pregnancy, bariatric surgery or particular dietary or medical risks. More
important than repeatedly measuring iron is identifying why iron deficiency has occurred.
Unexplained iron deficiency, particularly in men and postmenopausal women, may require
investigation for gastrointestinal blood loss.

Rectal bleeding has many causes, including haemorrhoids and fissures, but it can also occur with
polyps, inflammation, diverticular disease and bowel cancer. Persistent or recurrent bleeding
should therefore be assessed rather than assumed to be haemorrhoids. Heavy bleeding, dizziness
or fainting requires urgent assessment. Bleeding associated with unexplained weight loss, iron
deficiency anaemia or a persistent change in bowel habit also requires investigation.

Gastroscopy allows direct examination of the oesophagus, stomach and duodenum and permits
biopsies when required. It may be recommended for symptoms such as difficulty or pain with
swallowing, gastrointestinal bleeding, persistent unexplained vomiting, certain forms of
anaemia, concerning persistent upper abdominal symptoms or surveillance of particular known
conditions. Not everyone with uncomplicated reflux or indigestion requires gastroscopy; age,
symptoms, medication response and warning features all influence the decision.

Colonoscopy may be required to investigate rectal bleeding, iron-deficiency anaemia, persistent
changes in bowel habit, abnormal imaging, inflammatory bowel disease or a positive bowel
screening test. It is also used for surveillance after certain polyps or previous bowel cancer. For
average-risk Australians without symptoms, routine bowel cancer screening is based on an
immunochemical faecal occult blood test (iFOBT), not automatic colonoscopy. People with
symptoms or increased risk may need a different pathway.

Possible symptoms include rectal bleeding, persistent alteration in bowel habit, unexplained
iron-deficiency anaemia, abdominal pain, unexplained weight loss or occasionally bowel
obstruction. Importantly, early bowel cancer may produce no symptoms at all, which is why screening is important in people who feel completely well. Symptoms do not automatically mean
cancer, but they should be appropriately investigated rather than waiting for the next screening
test.

One of the most important steps is participation in appropriate bowel cancer screening. Other
modifiable factors associated with lower colorectal cancer risk include regular physical activity,
maintaining a healthy weight, avoiding smoking, limiting alcohol, eating a diet containing
adequate fibre and plant foods and limiting excessive processed meat consumption. People with
a significant family history may require a different screening strategy from the general
population and should discuss this with their doctor.

Most episodes of abdominal discomfort are not surgical emergencies, but some patterns require
urgent assessment. Seek medical attention for severe or rapidly worsening pain, persistent
vomiting, significant abdominal distension, inability to pass stool or wind, gastrointestinal
bleeding, high fever, collapse or fainting, a rigid or markedly tender abdomen, or pain associated
with feeling seriously unwell. Sudden severe pain deserves particular attention because
important abdominal conditions can initially present before all of the classical symptoms
develop.

Appendicitis often begins with poorly localised discomfort around the centre of the abdomen
that later becomes more prominent in the right lower abdomen. Loss of appetite, nausea,
vomiting and fever may occur. However, not every patient develops the textbook pattern –
children, older adults and pregnant patients in particular may present differently. Diagnosis is
based on the overall clinical assessment and sometimes blood tests, ultrasound or CT rather than
one symptom alone. Suspected appendicitis should be assessed promptly.

A new lump should be examined if its cause is not known. Many abdominal-wall lumps are
benign conditions such as hernias or lipomas, but examination helps determine whether imaging
or treatment is necessary. A lump deserves more prompt assessment if it is rapidly enlarging,
painful, firm or fixed, associated with unexplained weight loss or other symptoms, or if a
suspected hernia suddenly becomes painful and cannot be pushed back.

Laparoscopic surgery describes the approach rather than one particular operation, so recovery
varies considerably. Recovery after a straightforward laparoscopic hernia repair is different
from recovery after major bowel or upper gastrointestinal surgery. Many patients can walk and
undertake normal light daily activity relatively early, but fatigue and discomfort may last longer.
The best guide is the particular operation you have undergone, whether there were
complications, your type of work and how your recovery is progressing.

There is no scientifically appropriate single number of days that applies to every operation. For
driving, you should be free from sedating medication, able to sit comfortably, turn appropriately,
control the vehicle normally and perform an emergency stop without your wound or pain
preventing you from reacting safely. Insurance requirements should also be considered. Return
to work depends greatly on whether your work is desk-based or involves significant lifting or
physical activity. Walking is usually encouraged early after surgery, while heavier exercise is
introduced progressively according to the operation and your surgeon’s advice.

The best test depends on the clinical question. Ultrasound is particularly useful for gallstones and
a number of superficial or pelvic conditions and has the advantage of avoiding ionising
radiation. CT provides rapid, detailed assessment of many intra-abdominal problems and is
particularly valuable in emergency abdominal disease. MRI gives excellent soft-tissue detail and
is useful for selected hepatobiliary, pelvic, bowel and soft-tissue conditions. More imaging is not
necessarily better – the appropriate test is the one most likely to answer the clinical question.

Blood tests should not generally be interpreted in isolation. A result just outside the laboratory
reference range may be unimportant in one patient but significant in another. Doctors consider
the degree of abnormality, previous results, trends over time, medications, symptoms and other
investigations. Similarly, a normal blood test does not exclude every illness. The clinical context
is therefore more important than simply labelling an individual number as high or low.

Nutrition after bariatric surgery is deliberately staged to protect the operation while allowing
adequate hydration and nutrition. Patients generally progress from liquids to pureed or soft
foods and subsequently to normal-textured foods according to the procedure and bariatric
team’s protocol. Long-term priorities include adequate protein, portion control, eating slowly,
chewing carefully and maintaining appropriate fluid intake. Bariatric surgery requires ongoing
dietary follow-up rather than simply eating smaller portions of the same diet.

Long-term nutritional monitoring is an important part of bariatric care. Deficiencies can occur in
iron, vitamin B12, folate, vitamin D, calcium and other micronutrients, with the pattern and risk
differing between sleeve gastrectomy, gastric bypass and other operations. Patients generally
require ongoing supplementation, but the exact preparation and dose should be determined by
the operation performed, dietary intake and blood-test results. Regular biochemical monitoring
remains important even when a patient feels completely well.

A lipoma is a benign tumour made up predominantly of mature fat cells. A typical small, soft,
mobile and stable lipoma often requires no treatment. Removal can be considered if it is painful,
enlarging, troublesome because of its location or if the diagnosis is uncertain. A lump that is rapidly growing, unusually firm, fixed, deep or otherwise atypical should be properly assessed
rather than automatically assumed to be a lipoma.

An anal fissure is a tear in the lining of the anal canal. Hard stool and constipation are common
triggers, although diarrhoea can also contribute. Treatment starts by producing consistently soft
bowel motions using fibre, adequate fluid intake and stool-softening treatment where
appropriate. For a chronic fissure, topical medications that relax the internal anal sphincter can
support healing. Botulinum toxin is another option in selected patients. If medical treatment
fails, lateral internal sphincterotomy remains a highly effective surgical treatment, but the
potential effect on continence means that treatment needs to be individualised.