Pomegranate Health

the Royal Australasian College of Physicians

Pomegranate Health is an award-winning podcast about the culture of medicine, from the Royal Australasian College of Physicians. We ask how doctors make difficult clinical and ethical decisions, how doctor-patient communication can be improved, and how healthcare delivery can be made more equitable. Find out more at the website of www.racp.edu.au/podcast. Get in touch via podcast@racp.edu.au

All Episodes

In the last episode we talked about what patients or their families want to hear after a iatrogenic injury. Despite best practice standards for open disclosure, this occurs far less often that it should. The reluctance from health practitioners to be more transparent is in part due to a misplaced fear of exposure to liability, but perhaps the greatest barrier to incident disclosure is culture of medicine itself. The historic tropes of the infallible physician and the heroic surgeon are still strong today. Though team-based practice has become the norm, many doctors find it hard to admit to a mistake, not just to patients and colleagues but even to themselves. This podcast explores the guilt that can come about from having caused harm, and the cognitive dissonance this creates in one’s professional identity as a healer.  Guests Associate Professor Stuart Lane  FCICM  (Nepean Hospital; FMH lead for Education, University of Sydney) Professor Simon Willcock FRACGP (Program Head of Primary Care and Wellbeing at Macquarie University; Clinical Program Head of Primary and Generalist Care, Wellbeing and Diagnostics at MQ Health)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Far Away from Home’ by John Glossner, ‘Illusory Motion’ by Gavin Luke, ‘Heart of the River of the Sun’ by Lama House and ‘Struck By You’ by Seroa. Music courtesy of Free Music Archive includes ‘Harbor’ by Kai Engel. Image licensed from Getty Images. Additional voiceovers by Michael Pooley.Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group; Li-Sza Tan, Saion Chaterjee, Vicka Poudyal, Paul Cooper, Rhiannon Mellor and Lisa Mounsey.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 

Nov 9

51 min 29 sec

Medical injury occurs at a rate of about 12 per cent of admissions, and errors without consequence at a higher rate still. According to Australian and New Zealand guidance documents, disclosure of error “is a patient right, anchored in professional ethics, considered good clinical practice, and is part of the care continuum.” But many practitioners are fearful of the medicolegal consequences of disclosure, or unsure about how to present the details of a challenging episode in care. In this podcast we hear how they can provide victims of adverse healthcare incidents with the comfort they seek. Guests Professor Rick Iedema (Director Centre for Team-Based Practice & Learning in Health Care, King’s College London) Professor Simon Willcock FRACGP (Program Head of Primary Care and Wellbeing at Macquarie University; Clinical Program Head of Primary and Generalist Care, Wellbeing and Diagnostics at MQ Health)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Floating Kite by Tellsonic, ‘April Snow’ by Gavin Luke and ‘Five Below’ by Torii Wolf. Music courtesy of Free Music Archive includes ‘Cherry Blossom’ by Daddy Scrabble, ‘January’ by Kai Engel and ‘Remember the Archer’ by Scott Holmes. Image licensed from Getty Images. Additional voiceovers by Michael Pooley.Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group; Loryn Einstein, Lisa Mounsey, Rhiannon Mellor, Nele Legge, Sern Wei Yeoh, Joseph Lee, Marion Leighton, Oliver Dillon, Ilana Ginges, Rosalynn Pszczola, Lucy Haggstrom, Paul Cooper, Atif Mohd Slim, Victoria Langton and Ellen Taylor.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 

Oct 22

45 min 38 sec

There are many layers of public health interventions that can reduce the rate of transmission of the novel coronavirus. Social distancing, mask wearing, lockdowns and vaccines each nudge the reproduction number down. But you need all of them working together to make a significant impact, and that means you need the community on board. In this podcast we discuss the challenges and strategies around communicating public health messages to the public during a time of such high anxiety. Jessica Kaufman is a research fellow in the Vaccine Acceptance, Uptake and Policy Research Team at the Murdoch Children's Research Institute who presented her work to the RACP Congress in May. She outlined the principles and clarity, transparency and consistency that are needed to win the public’s trust when tough social restrictions need to be adhered to.    We also hear an interview with Professor Allen Cheng FRACP, who’s played this game harder than most. As Deputy Chief Health Officer of Victoria, he advised on implementation of the lockdown that brought Melbourne’s second wave to a halt after four long months. If being part of fun police wasn’t enough responsibility, he also co-chaired the COVID-19 Group at the Australian Technical Advisory Group on Immunisation which had to weigh up the suitability of the Astrazeneca vaccine as reports of rare side-effects and death were emerging in real time. He describes the fine balance between providing enough information for the public to be able to make informed decisions.Guests Dr Jessica Kaufman (Murdoch Children's Research Institute) Professor Allen Cheng FRACP (Alfred Health; Monash University; ATAGI; TGA)ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Passages’ and ‘Snowfall Intro’ by Kai Engel, ‘Become Death’ by Jahzarr. Music licenced from Epidemic Sound includes ‘Sunstorm’ by ELFL. Image licensed from Getty Images.  Feedback on this episode was kindly provided Frank Beard of the RACP COVID-19 Expert Advisory Group, and the members of the Podcast Editorial Group.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 

Sep 23

49 min 13 sec

The COVID-19 pandemic has brought to public attention, like never before, the work of public health physicians as well as epidemiologists, statisticians and computer modelers. The crisis also shown how hard it is to take decisions affecting the lives of millions when there is so little evidence to go on. Models of viral spread and interventions to mitigate these have become everyday discussion points, but few people understand how hard these are to put together. In this podcast we share expert talks that were presented at the RACP Congress in April and May. While they precede the latest developments of the delta strain and the National Plan to curb it by increasing vaccination rates, they clarify some of the first principles that go into creating these simulations, and the pressures of giving critical public health advice.Guests Professor Michael Baker FAFPHM (University of Otago)Professor Tony Blakely (Melbourne School of Population and Global Health, University of Melbourne) Professor Jodie McVernon FAFPHM (Director of Epidemiology, Doherty Institute) ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes, ‘Namaste’ by Jason Shaw, ‘Snowfall Intro’ by Kai Engel, ‘Become Death’ by Jahzarr, ‘The Time is Now’ by Borrtex. Music licenced from Epidemic Sound includes ‘Organic Textures’ by Johannes Bornlöf  and ‘Sunstorm’ by ELFL. Image licensed from Getty Images.  Feedback on this episode was kindly provided Frank Beard of the RACP COVID-19 Expert Advisory Group, and the following members of the Podcast Editorial Group; Rosalynn Pszczola, Seema Radhakrishnan, Duncan Austin, Sern Wei Yeoh, Paul Cooper, Adrienne Torda, Nele Legge, Keith Ooi, Lisa Mounsey, Marion Leighton, Stella Sarlos and Rhiannon Mellor. Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 

Sep 15

57 min 3 sec

In 2017, Victoria was the first state in Australia to pass voluntary assisted legislation and has been followed by Western Australia, Tasmania and now South Australia. Aotearoa-New Zealand passed its End-of-life Choice Bill two years ago and that will go live in November. This podcast draws on the experience of some very committed Victorian clinicians who share the lessons they've learned  over the last two years about practical implementation of VAD.The presenters were recorded at this year’s RACP Congress held in May. Palliative care physician Danielle Ko explained how Austin Health has prepared and supported its healthcare staff through this shift in practice. Palliative care Greg Mewett described the challenge of consulting remotely with patients in regional Victoria. Professor Paul Komesaroff reflected on some other points of friction in Victoria’s law as it stands and the practicalities of medical practice. And Professor James Howe talked of his work as a neurologist in a Catholic healthcare institution, and how tensions over assisted dying had been resolved. Guests  Dr Danielle Ko FRACGP FAChPM (Clinical Ethics Lead, Austin Health; VAD Review Board, Safercare Victoria)Dr Greg Mewett FRACGP FAChPM DRCOG (Ballarat Rural Health; Grampians Regional Palliative Care Team)Professor Paul Komesaroff FRACP (Alfred Hospital; Monash University)Adjunct Assoc Prof James Howe FRACP (VAD Review Board, Safercare Victoria)Dr George Laking FRACP (Auckland City Hospital; RACP President Aotearoa New Zealand)ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of Epidemic Sound includes ‘Like Clockwork’, by Benjamin Kling, ‘September Skies’ by Silver Maple, ‘Mistranslations by Rand Aldo, ‘Elm Lake’ by Elm Lake, Finally B by ‘Twelwe. Image licensed from Getty Images.Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Paul Cooper, Rhinnon Mellor, Loryn EinsteinPlease visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 

Jul 20

46 min 39 sec

Acute Kidney Injury makes a greater contribution to early mortality than acute myocardial infarction and it's been argued we should consider the concept of “kidney attack” to give it the weight that it deserves. But the presentation of kidney injury isn’t as overt or timely as a heart attack often is. While serum creatinine is a pretty good reporter of chronic impairment in kidney function it’s very insensitive to acute injury, so for two decades there’s been a concerted search for more proximal biomarkers of AKI. The three most promising candidates are neutrophil gelatinase‐associated lipocalin (NGAL), tissue inhibitor of metallo-proteinase 2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGBFP-7). Commercial assays for these exist that can predict moderate to severe AKI with a lead time of many hours in at-risk patients. But many questions remains as whether these are specific enough to be useful at point of care whether we have the interventions to respond to the information they provide, and what ‘false positives’ might indicate.Guest  Professor Rinaldo Bellomo AO FRACP FCICM FAHMS (Director of Research Intensive Care, Austin Hospital; University of Melbourne; Monash University). author of “Novel renal biomarkers of acute kidney injury and their implications” (2021) Internal Medicine Journal 51;3 pp316-318ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Downhill Racer’, by Blue Dot Sessions, ‘Making a Change’ by Lee Rosevere, ‘Fryeri’ by Kai Engel, ‘Subscribe to the New Internationalist’ by Tzara. Image licensed from Getty Images.Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Vicka Poudyal, Paul Cooper, Rhiannon Mellor, Duncan Austin, Seema Radhakrishnan, Phillipa Wormald, Victoria Langton,  Oliver Dillon and Loryn Einstein.  Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening and additional reading. 

Jun 10

42 min 8 sec

This is the third and final part of our series on gendered medicine. We step back and look at the way that health care and research are funded. It’s been said that the health needs of women are undervalued by our existing fee-for-service model, down to individual item numbers in the Medicare Benefits Schedule. There’s also evidence that disease predominantly experienced by female patients receive less research investment. Is this blatant sexism or a symptom of other structural imbalance? And what do we do about it? Guest  Dr Zoe Wainer BMBS, PhD, MPH (Director of Clinical Governance, BUPA)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Lullaby’ by OOy, ‘Cocktail’ by Major Tweaks, ‘Soul Single Serenade’ by Dusty Decks, ‘Elm Lake’ by Elm Lake, ‘Kauko’ by Twelve, ‘Fugent’ by Lupus Nocte. Voice acting by Ai Leen Quah. Image by Claudius Vesalius courtesy of Wikimedia Commons. Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Ilana Ginges, Sern Wei Yeoh, Lucy Haggstrom, Nele Legge, Ketih Ooi, Adrienne Torda, Li-Zsa Tan, Loryn Einstein, Vicka Poudyal, Rhiannon Mellor, Rosalynn Pszczola. Other reviewers include Dr Lucy Mitchell and Rebecca Lewis, Elyce Pyzhov, Michelle Daley, Cristiana Palmieri PhD and Dr Anna Sidis DCP. Please visit the RACP website for a transcript and embedded citations. Fellows of the College can claim CPD credits for listening and additional reading. 

Apr 15

43 min 51 sec

Gender can be considered a social determinant of health, in the different pressures and expectations it puts on women and men. For example, the taboos around menstruation are so profound that many young women are dangerously naïve about their own reproductive health. Meanwhile, endometriosis, chronic fatigue syndrome, and other conditions associated with chronic pain have a stigma around them that means self-reports are often not taken seriously by health professionals. Historic notions of hysteria have a more profound impact on medical thinking than we might imagine, and in this podcast we ask what can be done to erase these. GuestGabrielle Jackson (Associate News Editor Guardian Australia, Author Pain and Prejudice)  ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Elm Lake’ by Elm Lake, ‘Soul Single Serenade’ by Dusty Decks, ‘Desert Hideout’ by Christopher Moe Ditlevsen, ‘September Skies’ by Silver Maple, ‘Fugent’ by Lupus Nocte. Image licenced from Getty Images. Voice acting by Paul Curtis. Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Ilana Ginges, Sern Wei Yeoh, Lucy Haggstrom, Nele Legge, Ketih Ooi, Adrienne Torda, Li-Zsa Tan, Loryn Einstein, Vicka Poudyal, Rhiannon Mellor, Rosalynn Pszczola. Other reviewers include Dr Lucy Mitchell and Rebecca Lewis, Elyce Pyzhov, Michelle Daley, Cristiana Palmieri PhD and Dr Anna Sidis DCP.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Mar 22

50 min 6 sec

This is the fourth and final part in our series on Global Health Security. Australia’s Indo-Pacific Centre for Health Security was launched in 2017 to provide development assistance to health services as far-flung as Fiji, Cambodia and Timor L’este. Its mission is always tailored to the needs of the partner government. In Indonesia it has provided training to the veterinary sector to foster antimicrobial stewardship. The 2020 COVID-19 pandemic was a sudden shock to the development agenda and has forced a rapid redeployment of resources. Since recording this interview there has been an additional $500 million dollar commitment to fund doses of COVID-19 vaccine and technical assistance to the Pacific and Southeast Asia. GuestsRobin Davies (Head of Centre, Indo-Pacific Centre for Health Security)Dr Stephanie Williams AFPHM (Australia's Ambassador for Regional Health Security, Indo-Pacific Centre for Health Security)ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Cast in Wicker’ and ‘the Zepplin’ by Blue Dot Sessions, ‘Linger’ by David Szezstay and ‘Dormir’ by Monplaisir. Photo by Lazslo Mates licenced from Shutterstock. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jan 31

44 min 9 sec

We traditionally think of cardiovascular disease as a man’s problem, but it’s the leading cause of death for women as well as men in most of the industrialized world. Despite great advances in the management of heart disease in recent years, women are still not getting the same quality of care as men. Readmissions and mortality following an acute myocardial infarction at least two times higher in women as they are in men.  Put simply, cardiovascular disease is better understood in men, the presentations and diagnosis occur more promptly, and therapies are more consistently delivered to male patients. In this episode we explore the subtle biases at every stage that nudge male and female patients down different health pathways and result in gendered health outcomes. Guest Associate Professor Sarah Zaman FRACP (Westmead Hospital, University of Sydney)Production Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Dew’ and ‘Vargtimmen’ by Da Sein, ‘Spring’ by Cora Zea, ‘Missing Memories’ by Christopher Moe Ditlevsen and ‘Feels Like I’m Going Crazy’ by Tigeblood Jewel. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Joseph Lee, Phillipa Wormald, Rhiannon Mellor,  Seema Radhakrishnan, Atif Mohd Slim and Li-Sza Tan. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jan 17

41 min 16 sec

In this episode we present some provocative solutions to problems presented in the previous two stories.We heard about pharmaceutical patents, and how embedded intellectual property law is in global trade relations. There’s this fundamental assumption that innovation occurs thanks only to the vigour of the private sector and the plucky entrepreneur. It’s even been said that financialized capitalism is “the greatest engine of progress ever seen.” But the reality is that shiny smartphones and targeted drugs wouldn’t exist without massive government spending on research. It’s public money that funds the riskiest stages of development, before private enterprise takes these products to market with the benefit of monopoly pricing. Dr Owain Williams and Associate Professor Peter Hill argue that states can demand more control over the outputs and pricing of drug and vaccine research, and that the current intellectual property regime is not the only way to stimulate innovation. In the second part Associate Professor Adam Kamradt-Scott talks about the lessons learned and not learned from pandemic modelling in past years. He also makes the case for establishing an Australian Centre for Disease Control with standalone jurisdiction, to cut through some of the conflict we’ve seen in recent months between state and federal leaders.  GuestsDr Owain Williams (University of Leeds) Associate Professor Peter Hill AFPHM (University of Queensland)Associate Professor Adam Kamradt-Scott (University of Sydney, United States Studies Centre)Production Written and produced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Cherry Blossom’ by Daddy Scrabble, ‘Sunstorm’ by ELFL, ‘Mister S’ by Tortue Super Sonic and ‘Club Crunk for Monkeys’ by Kromatic. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Leah Krischock, Saion Chaterjee, Priya Garg, Victoria Langton and Joseph Lee.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Nov 2020

42 min 25 sec

This is part 2 in our series on global public health and focuses on the impact of intellectual property laws on the development and distribution of pharmaceuticals. The COVID-19 pandemic has stimulated a frenzy of vaccine development never seen before, but also examples of hoarding, price hikes and vaccine nationalism. The crisis has brought together scores of governments, manufactures and philanthropic organisations to pool research outcomes and patents, but the response from big pharma has been mixed. We’ll discuss where the IP rules have come from and where exceptions are sometimes made for public health emergencies. We also discuss how pooled procurement mechanisms and advanced market commitments can help get drugs and vaccines to populations in developing countries and whether COVID-19 can prompt a permanent change to the existing IP regime.Guests Dr Owain Williams (University of Leeds) Associate Professor Peter Hill AFPHM (University of Queensland) Dr Deborah Gleeson (La Trobe University) Production Written and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Let Us Overcome’ by Tayler Watts, ‘Passages’, ‘Global Warming’ and ‘Salue’ by Kai Engel, ‘Electro Cool’ by 4T Thieves, ‘Capgras’ by Ben Carey and ‘Sunstorm’ by ELFL. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Leah Krischock, Saion Chaterjee, Priya Garg, Victoria Langton and Joseph LeePlease visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Nov 2020

44 min 33 sec

During the COVID-19 crisis there has been some criticism of the World Health Organisation as to whether it declared a pandemic soon enough or covered up for China’s failings. But few commentators have explained the role and responsibilities it shares with its member states in dealing with a pandemic. A prototype of the International Health Regulations were conceived during the cholera epidemics of the mid 1800s, and but the most current version of the IHR was formalised in 2005 in response to SARS. Associate Professor Adam Kamradt-Scott has documented the political and social factors that have accompanied the implementation of the IHR. In this podcast we consider how the unprecedented scale of the current pandemic and the mixed response from member states has challenged the viability of the WHO.GuestsAssociate Professor Adam Kamradt-Scott (University of Sydney, United States Studies Centre) Production Written and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Amsterdam’ by LASERS , ‘Capgras’ by Ben Carey and ‘Let Us Overcome’ by Tayler Watts. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group;  Rosalynn Pszczola, Li-Zsa Tan, Michael Herd, Sern Wei Yeoh, Oliver Dillon, Priya Garg, Ilana Ginges, Duncan Austin, Saion Chaterjee, Leah Krishchock and Lisa Mounsey Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Oct 2020

40 min 49 sec

In episode 59 we shared a sampler of the Essential Ethics podcast from the Children's Bioethics Centre, at the Royal Children’s Hospital, Melbourne. A couple of cases studies were presented to help us define “the Zone of Parental Discretion” – a space in which decision-making about a child’s medical care is conceded to parents even if it’s not optimal clinical management.Today’s thought experiments come from the oncology department. First, we’re asked to consider when an adolescent should be permitted to make autonomous decisions about their health, even if these would lead to worse clinical outcomes. How does a clinical team decide whether to accept this wish or to override it?    In the second case study, the final outcome has already been determined by an incurable brain tumour. A 14 year old girl has been diagnosed with a high grade medulloblastoma. Therapy has little chance of cure but around 30% of patients have their life prolonged by 2 or 3 years but comes with disabling side effects. The parents want to bypass recommended treatment and try prayer and natural therapies instead . Does this terminal prognosis broaden the zone of parental discretion, and how can the clinical team help the family with the terrible choices they have to make? GuestsProf John Massie FRACP (Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute)Associate Professor Clare Delany (Children’s Bioethics Centre, University of Melbourne)Diane Hanna FRACP (Royal Children’s Hospital, Melbourne, Walter and Eliza Hall Institute of Medical Research)Kanika Bhatia FRACP (Royal Children’s Hospital, Melbourne)Molly Williams FRACP, FAChPM (Royal Children’s Hospital, Melbourne) ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘A Path Unwinding’ , ‘The Air Escaping’ and ‘Vittoro’ by Blue Dot Sessions. Image licenced from Shutterstock.Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Lisa Mounsey. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Aug 2020

42 min 7 sec

In the previous episode we discussed the presentations and screening of delirium, as well as the risk factors. Just as important as these medical and iatrogenic precipitants are a host of environmental triggers that are highly modifiable. Anything that contributes to a person’s disorientation and discomfort can increase the likelihood of a delirium episode. While a lot of these factors are compounded in elderly and frail patients, it’s important not to be fatalistic. Delirium can be reversed in a majority of patients by non-pharmacological means. There are no medications indicated for treatment anywhere in the world. Psychtropic drugs should only be considered in patients experiencing severe distress intractable by other means as they are associated with many adverse side effects.GuestsAdam KwokProfessor Meera Agar FRACP FAChPM (Liverpool Hospital, UTS) Professor Gideon Caplan FRACP (Director of Geriatric Medicine, Prince of Wales Hospital, UNSW)  ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes  ‘See You Soon’ by Borrtex, ‘Remember the Archer’ by Scott Holmes, ‘John Stockton Slow Drag’ by Chris Zabriskie, ‘Tam814’ by LJ Kruzer and ‘Listen, Lisbon’ by Loch Lomond. Picture licenced from Getty Images.Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Seema Radhakrishnan, Phillipa Wormald, Duncan Austin, Joseph Lee, Adrienne Torda,  Marion Leighton, Oliver Dillon, Atif Slim, Andrew Whyte, Rhiannon Mellor.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jul 2020

34 min 16 sec

Delirium is associated with an increased risk of falls, dementia and high dependency care, and all of this adds up to higher mortality. About a third of patients admitted to ICU or approaching the end of life experience delirium. But it’s notoriously underdiagnosed, so in this episode we talk about the presentations and detection of delirium. We also go through some of the medical risk factors, including dementia, infection and metabolic disorders like hypercalcaemia. But even more common than these precipitants, are a host of drugs that can alter cognition or increase agitation by their anti-cholinergic properties. Importantly, we also hear Adam Kwok described his experience as the carer of a patient going through the trauma of three bouts of delirium, and the challenges of care. Go to the next episode to hear about non-pharmacological management of those at risk of delirium, and the many caveats of psychotropic medication.GuestsAdam Kwok Professor Meera Agar FRACP FAChPM (Liverpool Hospital, UTS)  Professor Gideon Caplan FRACP (Director of Geriatric Medicine, Prince of Wales Hospital, UNSW) ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Noir’ by Daniel James Dolby, ‘You Are Not Alone’ by Borrtex, ‘Remember the Archer’ by Scott Holmes, ‘Cherry Blossom’ by Daddy Scrabble and ‘Listen, Lisbon’ by Loch Lomond. Picture licenced from Getty Images. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Seema Radhakrishnan, Phillipa Wormald, Duncan Austin, Joseph Lee, Adrienne Torda,  Marion Leighton, Oliver Dillon, Atif Slim, Andrew Whyte, Rhiannon Mellor.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jul 2020

31 min 57 sec

The ethical questions that come up in paediatrics can appear overwhelming to begin with. When can a child be said to have cognitive capacity and bodily autonomy? For those who don’t, where does the guardianship of the parent to give way to that of the medical professionals? When might treating one child have implications for the resources available to others? And what about not treating or vaccinating a child, if that’s what the parents want?All of these issues are tackled in the Essential Ethics podcast, produced within the Children's Bioethics Centre at the Royal Children’s Hospital, Melbourne. The Centre was established to promote the rights of young patients and to support families and clinicians facing some vexing ethical questions. The Essential Ethics podcast takes a case-based approach to demonstrate how dilemmas in clinical ethics can be worked through in a systematic way. A couple of these are presented here as part of the RACP Congress digital program. In the first story discussed, a child with autism spectrum disorder is suspected of having COVID-19, but the mother refuses testing as it will distress him for little gain. The second, real life case, is that of a 16 month old boy born with a developmental abnormality of the lower leg. In the most severe cases the recommended clinical management involves amputation, but this boy’s deformity can be corrected through a number of involved surgeries. Orthopaedic surgeon Chris Harris describes the confronting course he had to take. He is interviewed by paediatric respiratory physician John Massie and clinical ethicist Lynn Gillam. They are respectively the Clinical Lead and Academic Director of the Children's Bioethics Centre, and both have Professorial appointments at the University of Melbourne.GuestsProf Lynn Gillam (Academic Director, Children’s Bioethics Centre, University of Melbourne)Prof John Massie FRACP (Royal Children’s Hospital Melbourne, University of Melbourne)Dr Chris Harris FRACS (Royal Children’s Hospital Melbourne)ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Vodka’ by Transient, ‘Linger’ by David Szesztay and ‘Celeste’ by Adam Fitch. Image licenced from Shutterstock. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Saion Chaterjee, Jenae Valk, Michael Herd, Phillipa Wormald and Lisa Mounsey. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jun 2020

34 min 45 sec

In this episode we continue the discussion from Episode 56 about medical billing in Australia. Almost 500  million Medicare rebates are processed every year and for the most part these are claimed appropriately. But non-compliant billing could be costing the health system over 2 billion dollars annually. The vast majority of this comes down to misunderstanding of the conditions around MBS items, according to our guest Loryn Einstein of Medical Billing Experts.Every year the Department of Health shifts its attention onto a different specialty area to look at the statistical spread of claiming behaviour. Practitioners at the top end of the curve receive warning letters and flagged practitioners who persist with unaccountable billing behaviour will have their practice audited more thoroughly. Finally, they may be referred to the Professional Services Review, a sort of judicial panel made up of clinical peers.Questions have been raised by professional bodies and lawyers about the sensitivity of these processes to clinical nuance or procedural fairness, and the lack of education available to practitioners. We hear responses to such concerns from the Department of Health.Finally, we take a look at the huge range of private medical fees in Australia. Loryn Einstein considers how factors like regulation and supply and demand shape this market.GuestLoryn Einstein (managing director, Medical Billing Experts) ProductionWritten and produced by Mic Cavazzini. Tracks courtesy of Free Music Archive include ‘Shadow Lines’ and ‘Le Hustle’ – Polyrhythmiques, ‘Mr S’—Tortue Super Sonic, ‘Un desert’- Komiku, ‘Undercover Vampire Policeman’- Chris Zabriskie, ‘Friends and Apples’- Alpha Hydrae. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Sern Wei Yeo, Rhiannon Mellor and Seema RadhakrishnanPlease visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

May 2020

43 min 52 sec

COVID-19 has left few people around the world unaffected, and health practitioners are among those at the top of the list. Their daily and intimate service to public inevitably puts them at risk of catching the virus, while social distancing precautions can compromise the work that they do. Dreadful as the viral disease is, the bigger consequences of the pandemic may be on the disruption to routine healthcare.Consulting patients by video or phone can be a way to keep healthcare ticking over, but many doctors are nervous as they adopt it for the first time. In this podcast we go over some of the bureaucratic and tech support questions that clinicians have been asking during the current crisis. We also discuss the art of building trust with new patients, and conducting a physical examination through telehealth.  The guest speakers are oncologist Sabe Sabesan and paediatrician Michael Williams, who’ve been pioneering telehealth outreach to rural and remote Queensland for more than a decade.GuestsProfessor Sabe Sabesan FRACP (Director, Townsville Cancer Centre; James Cooke University) Dr Michael Williams FRACP (Director, Queensland Paediatric Telehealth Service)  ProductionWritten and produced by Mic Cavazzini. Tracks licenced from Epidemic Sound include ‘Fields 3 – Gunnar Johnsén, ‘By the Harbour’ – Mhern, ‘Leaving Serengeti’- Ooy, ‘Mega Woman IV’ – ELFL. Image copyright Shutterstock. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group;  Michael Herd, Li-Zsa Tan, Alexis Frydenberg, Sern Wei Yeoh, Andrea Knox, Seema Radhakrishnan, Phillipa Wormald, Priya Garg, Andrew Whyte and Ilana Ginges. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading. 

Apr 2020

35 min 54 sec

Australia has one of the best value health systems in the world, but also some of the most Byzantine health regulation. Between the federal Medicare scheme, the state hospitals, the private health insurers and the patient, it’s not always clear how a provider should invoice their services.To explain some of the fundamentals our guest is former nurse and lawyer, Margaret Faux of Synapse Global Medical Administration. She also describes areas of ambiguity in the legislation and the Medicare Benefits Schedule which creates confusion as to when and where certain services can be billed, or which items should not be claimed together. While there are many traps for well-intentioned providers and loopholes for the less well-intentioned, there are some simple solutions that would make medical billing much more streamlined.GuestsMargaret Faux (CEO, Synapse Global Medical Administration)Production Written and produced by Mic Cavazzini. Tracks licenced from Epidemic Sound include ‘Organic Textures 2 – Johannes Bornlöf, ‘Temple of Runha’ – ELFL. Tracks licenced from Free Music Archive include ‘Here’s the Thing’ – Lee Rosevere, 'Secret Place' -Alex Fitch, ‘Electro Cool’—4T Thieves, ‘Please Listen Carefully’- Jahzarr. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Jenae Valk, Seema Radhakrishnan, Phillipa Wormald, Seema Radhakrishnan, Lisa Mounsey, Alan Ngo, Oliver Dillon, Rhiannon Mellor, Alexis Frydenberg, Duncan Austin, Keith Ooi, Sern Wei Yeoh.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Mar 2020

43 min 9 sec

This podcast is about one of many pathways in medicine; private practice. It’s a pathway that presents many opportunities, but also personal and financial challenges. When doctors are  starting out in private practice, they typically do so within the safety net of an established practice, and perhaps only for part of the working week. In a simple model, they would be renting a room in exchange for an agreed portion of the consultation fees, to cover administration costs.  The next level of complexity is setting up shop for oneself, and this requires registering a company in order to employ other staff. Finally, one can partner in a group practice, which may bring efficiencies of scale, but potentially also personality clashes with other shareholders. And behind all of this, there is the need to build awareness and trust in the community.  In this podcast we hear about the experience of a private rheumatologist of 25 years, as well as accounting and financial planning. Guests Dr Louis McGuigan FRACP (Consultant Rheumatologist, Miranda) Paul Copeland (Director, William Buck Chartered Accountants) Scott Montefiore (Managing Director Hillross Montefiore and Co.) Production Written and produced by Mic Cavazzini. Tracks licenced from Epidemic Sound include ‘Bookies’ – Jones Meadow, ‘Hollow Head’ – Kenzo Almond, ‘Fear Being Unfelt’- Ingrid Witt, ‘Dusty Delta Day’ – Lennon Hutton, ‘After the Freak Show’ – Luella Gren. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Ilana Ginges, Michael Herd, Li-Zsa Tan, Andrew Whyte, Joseph Lee, Jenae ValkPlease visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Feb 2020

41 min 2 sec

How many times have you thought “things would be so much more efficient if we had shared electronic health records?”  Australia, now has the My Health Record covering 90% of the population with individual profiles. It is proposed that this will improve safety especially for people with chronic and complex health care needs. It could reduce medication mismanagement and duplication of pathology and diagnostic imaging tests and help improve health literacy among the public.  And at the point of care it might prove safer for the previously unseen patient who arrives at emergency unable to say anything about what allergies they have or what medications they’re already on. But that’s only if everyone is putting information up there. It’s been a long process getting health providers to upload data the My Health Record routinely, and the uptake differs wildly between primary, secondary and tertiary care. In this podcast we visit each of these settings and hear what the different expectations are of this new tool, what are the benefits gained, and how well it fits into the workflow of a consultation. The RACP received support from the Australian Digital Health Agency for production of this podcast. GuestsA/Professor Nicholas Buckmaster FRACP (Gold Coast University Hospital)Dr Ron Granot FRACP (East Neurology and Clinical Advisor for Healthshare Digital)  Professor Meredith Makeham FRAGCP (Chief Medical Adviser Australian Digital Health Agency, Macquarie University)Production Written and produced by Mic Cavazzini. Tracks licenced from Epidemic Sound include ‘Far away star’ – Lishiod, ‘Straight out of the basement’ – SINY, ‘Leaving Serengeti’- OOyy, ‘Struck by You’ – Seroa, ‘Little Liberty’ – Paisely Pink. Image courtesy of Australian Digital Health Agency. Feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Ilana Ginges, Paul Cooper, Michael Herd, Marion Leighton, Li-Zsa Tan, Rebecca Grainger, Andrew Whyte, Alan Ngo, Jenae Valk, Joseph Lee, Seema Radhakrishnan, Lisa Mounsey, Phillipa Wormald, Pavan Chandrala, Andrea Knox, Rhiannon Mellor, Atif Slim and Leah Krischock. Thanks also to RACP staff Sandra Dias and Krista Le Claire. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Dec 2019

41 min 53 sec

Marrabinya is a Wiradjuri word meaning “hand outstretched.” It’s the name of a service in the Western New South Wales Primary Health Network which financially supports Indigenous Australians to attend specialist consultations.Aboriginal and Torres Strait Islander Peoples receive specialist medical care 40% less often than non-indigenous Australians. It’s easy to imagine communities out in the red desert and blame culture clash or the tyranny of distance, but most Indigenous Australians live in cities or regional communities. The Marrabinya staff explain how socioeconomic factors and institutional biases can accumulate to prevent Aboriginal patients from receiving the care they need. Marrabinya is an exemplary model of principles that RACP has formalised in the Medical Specialist Access Framework. Indigenous leadership, cultural safety, person and family-centred approach and a context-specific approach can all contribute to great gains in the health of Aboriginal and Torres Strait Islander people. Guests Marrabinya Executive Manager Donna Jeffries and chronic care link staff Desley Mason, Kym Lees, Possum Swinton, Sandra Ritchie, Melissa Flannery, Joanne Bugg, Jacob Bloomfield and Gaby Bugg. Production Written and produced by Mic Cavazzini. Music licenced from Epidemic Sound; ‘Dusty Delta Day’, ‘Hard Shoulder’, ‘Leather Feather’ by Lenon Hutton. ‘Melting Places’ by Andres Cantu. ‘That Impossible Last Breath’ by Da Sein. Image adapted with permission from Maari Ma Health.Valuable feedback to this episode was provided by Masita Maher (RACP Project Lead for Aboriginal Initiatives) and Terry Williams (Institute for Urban Indigenous Health and RACP Consumer Advisory Committee). Also the following members of the RACP Podcast Editorial Group; Seema Radhakrishnan, Michael Herd, Paul Cooper, Li-Zsa Tan, Ilana Ginges and Lisa Mounsey. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Nov 2019

32 min 36 sec

In the previous episode we talked about the science of pain, opioid analgesia and dependence. Now we look at the influence of culture, regulation and marketing on opioid prescribing for chronic non-cancer pain. First we ask which are the prescription opioids most commonly leading to dependence and why are they prescribed. Then we discuss the mixed messages that prescribers are getting from guidelines and pharmaceutical regulation. Ever-relaxing indications for pharmaceutical subsidies can nudge prescribing behaviour in the wrong direction.Tasmania was for many years the worst performer on measures of opioid use and harm, but this all began to turn around from 2006. Addiction medicine specialist Professor Adrian Reynolds explains how education, regulation and real-time prescription monitoring were brought together in that state.Finally, an undeniable influencer of prescribing behaviour are the promotional campaigns organised by pharmaceutical companies. Pain medicine specialist Chris Hayes explains that those within the medical profession will not be surprised by this, but can be vigilant about having their professional judgement compromised. A couple of case studies provide context for the RACP's Guidelines for ethical relationships between health professionals and industry.Guests Dr Christopher Hayes FFPMANZCA (Director Hunter Integrated Pain Service) Clin Assoc Prof Adrian Reynolds FAChAM (Clinical Director Alcohol and Drug Service, Tasmania)Production Written and produced by Mic Cavazzini. Music: Chris Zabriskie ‘Out of the Skies, Under the Earth’ and ‘What True Self Feels Bogus Lets Watch Jason X’;  Borrtex 'You Are Not Alone', Jahzzar 'Missing You' courtesy of Free Music Archive. Gunnar Johnsén, 'Task At Hand 2', 'Task At Hand 5' licenced from Epidemic Sound. Image courtesy of WikiCommons. Voice acting by Iain Muir, Bob Kotic and Phillipe Soulaine.Editorial feedback for this episode was provided by members of the RACP’s Podcast Editorial Group; Stella Sarlos, Lisa Mounsey, Michael Herd, Atif Slim, Rhiannon Mellor, Leah Krischock, Angela Chen, Genevieve Yates, Adrienne Torda, Philip Gaughwin, Rosalynn Pzcsola, Nele Legge, Marion Leighton, Oscar Russell, Jenae Valk, Li-Zsa Tan, Alan Ngo, Leah Krischock, Seema Radhakrishnan Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Sep 2019

33 min 59 sec

The dramatic headlines about the opioid crisis are all-too familiar by now. Australia and New Zealand have followed the lead of the US, and seen a fourfold increase in opioid use over the last thirty years. Most of this prescribing has been for chronic non-cancer pain, but systematic reviews will tell you that that there are no decent trials that would warrant use for this indication.In this podcast we’ll discuss some of the latest studies that have actually followed pain patients long-term, and provided evidence against the efficacy of chronic opioid use. Addiction medicine specialist Professor Adrian Reynolds talks about how to identify patients that have developed dependence on or addiction to opioids and how to wean them off this medication. And pain medicine specialist Chris Hayes describes an alternative approach to therapy, that involves breaking maladaptive pain associations in the nervous system.Guests Dr Christopher Hayes FFPMANZCA (Director Hunter Integrated Pain Service) Clin Assoc Prof Adrian Reynolds FAChAM (Clinical Director Alcohol and Drug Service, Tasmania)Production Written and produced by Mic Cavazzini. Music: Chris Zabriskie 'Out of the Skies, Under the Earth' and 'What True Self Feels Bogus Lets Watch Jason X';  Borrtex 'You Are Not Alone', Jahzzar 'Missing You' courtesy of Free Music Archive. Gunnar Johnsén, 'Task At Hand 2', 'Task At Hand 5' licenced from Epidemic Sound. Image courtesy of WikiCommons. Voice acting by Iain Muir, Bob Kotic and Phillipe Soulaine. Editorial feedback for this episode was provided by members of the RACP's Podcast Editorial Group; Stella Sarlos, Lisa Mounsey, Michael Herd, Atif Slim, Rhiannon Mellor, Leah Krischock, Angela Chen, Genevieve Yates, Adrienne Torda, Philip Gaughwin, Rosalynn Pzcsola, Nele Legge, Marion Leighton, Oscar Russell, Jenae Valk, Li-Zsa Tan, Alan Ngo, Leah Krischock, Seema RadhakrishnanPlease visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Sep 2019

31 min 41 sec

New Zealand doesn't have the same extremes of remoteness of Australia, but it does have a rugged landscape that results in small and scattered communities. And there is a strong rural identity, though the fraction of the population classified as rural is now around 16 percent.As you'll hear, the populations which are disproportionately under-serviced and in worse health, are not necessarily the most remote. The demarcations fall much more starkly along lines of socioeconomic status, and areas of need are as often in minor urban settings as they are in the country. But there are solutions, and great experiences to be had serving these communities. Guests Ross Lawrenson FRCGP, FFPH FAFPHM (University of Waikato and Population Health Advisor for the Waikato District Health Board) Dr Martin London FRNZCGP  Dr Douglas Lush FRNZCGPProduction Produced by Mic Cavazzini. Music licensed from FreeMusicArchive; 'Fervent', 'Cast in Wicker' by Blue Dot Sessions, 'Hypocritopotamus' by Doctor Turtle. Image licenced from Getty Images.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jul 2019

25 min 42 sec

A third of Australia's population is classified as regional or remote, but as it's such a big place it's hard to provide comprehensive heath care all over. In the previous episode, we heard about an important referral centre in country NSW, but this episode takes us to Broome, a small town that's two and a half thousand kilometres from tertiary facilities in Perth.On average, remote settings like this only have 11 percent as many specialists per capita as major cities and this means that pathology is often more advanced by the time it's diagnosed. The medicine can be confronting but the training experience is great and rewarding. In this episode we hear from an advaced trainee, a consultant, and a rural generalist GP about the unique skills and models of care they bring to this environment. Guests Dr Lydia Scott FRACP (Broome Hospital) Dr Lee Fairhead (Broome Hospital) Dr Casey Parker FRACGP (Broome Hospital, at the Rural Clinical School of the University of Western Australia) Production Written and produced by Mic Cavazzini. Music licensed from FreeMusicArchive; 'Fervent', 'Cast in Wicker' by Blue Dot Sessions, 'Hypocritopotamus' by Doctor Turtle, 'Slow Burn' by Kevin McLeod. Image licenced from Getty Images.For a transcript and further references please visit https://www.racp.edu.au/pomegranate/view/ep49-training-in-the-bush-part-2. Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode and reading the resources below.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jul 2019

32 min 4 sec

A third of Australia's population is classified as regional or remote, but since it's such a big place it's hard to provide comprehensive heath care all over. As a result, chronic disease gets treated later and mortality is 1.3 time higher than it is in major cities, according to the Australian Institute of Health and Welfare.There are only 42 percent as many specialists per 100,000 population in regional areas as there are in major cities, but research shows that these experiences are more likely to lead to permanent careers in the country.In this episode we visit the country town of Dubbo about 6 hours drive northwest of Sydney. The base hospital services a catchment of 130,000 people spread across an area the size of Great Britain. While need in this area is high, Dubbo presents an example of strong clinical leadership and training across many specialties.Guests Dr Florian Honeyball FRACP (Dubbo Base Hospital, University of Sydney) Dr James Collett FRACP (Dubbo Base Hospital, University of Sydney) Dr Joel Riley (Dubbo Base Hospital, University of Sydney)Production Written and produced by Mic Cavazzini. Music licensed from FreeMusicArchive; 'Fervent', 'Cast in Wicker' by Blue Dot Sessions, 'Hypocritopotamus' by Doctor Turtle, 'Slow Burn' by Kevin McLeod. Image licenced from Getty Images.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jul 2019

35 min 47 sec

Everyone knows that adolescence is a turbulent time. Teens are faced not just with changes to their bodies, but to their moods and thought patterns as well. They might also be saying goodbye to familiar carers in the paediatric department, and in Episode 11 we heard how important it is to ensure a smooth transition to adult services, which tend to be more anonymous.This is especially true for young people with special needs such as diabetes, transplant management or intellectual disability, though they are the least likely to received dedicated transition support. The three speakers in this podcast explain that improving this transition process doesn't require going way above and beyond regular practice, it just needs a little more coordination. They were recorded at the 2019 RACP Congress. First, Dr Fran Mouat outlined Starship's transition program for young patients with diabetes, and some of the data showing its impact on glycaemic control after they've left paediatric care. Dr Rachael Harry leads a transition program for adolescents who'd undergone transplants early in life. With a moving case study, she described how all the medical care in the world needs to fit in with the lifestyle that every young adult aspires toFinally, Dr Colette Muir, described what this period is like for adolescents with developmental disabilities. Intellectual disability is associated with a lower quality of care throughout the lifespan, often because of “diagnostic overshadowing”—the phenomenon by which the complaints of such patients get attributed to the disability itself, rather than being investigated thoroughly in their own right. The RACP is a signatory to an international consensus statement called Equally Well, and has also published a position paper about transition of young people with chronic disability needs. Guests Dr Fran Mouat FRACP (Starship Children's Hospital, Auckland, Co-Chair of National Clinical Network for Intersex Disorders) Dr Rachael Harry FRACP (New Zealand Liver Transplant Unit, Auckland) Dr Collette Muir FRACP (Starship Children's Hospital, Auckland, New Zealand)Production Produced by Mic Cavazzini. Recording assistance in Auckland from Little Kong Productions. Music licensed from Epidemic Sound; 'Earthbound 3 by Joachim Nilsson; A Winter's Tale' by Magnus Ringblom; 'I Am Here Now' by Gunnar Johnsén. Image courtesy of Getty Images.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jun 2019

29 min 15 sec

This episode was recorded at the 2019 RACP Congress in Auckland and deals with the profound influence that the first 1000 days of life have on lifelong health, wellbeing, behaviour and socioeconomic outcomes.Professor Richie Poulton outlined the influential Dunedin Multidisciplinary Health and Development Study, which has followed over 1037 participants since 1972. All sorts of measures have been taken throughout the participants' lives, but Dr Poulton showed the incredible predictive power of one behavioural trait in particular: self-control.Paediatrician Dr Johan Morreau revealed how such associations between childhood deprivation and behavioural outcomes might be explained by developmental neuroscience. And finally, public health physician Professor Susan Morton showed some evidence from the Growing Up in New Zealand Study which reveals the importance of social factors in protecting against poor outcomes.Together, these speakers demonstrated that the consequences of childhood disadvantage are borne not just by individuals and families but by all of society. The lectures were framed by the launch of an RACP position statement on early childhood titled "The Importance of the Early Years" and another released last year on "Inequities in Child Health".Guests Professor Richie Poulton CNZM FRSNZ (Dunedin Multidisciplinary Health and Development Research Unit, Chief Science Advisor to the NZ Ministry of Social Development) Dr Johan Morreau FRACP (Lakes District DHB, Brainwave Trust) Professor Susan Morton FAFPHM (Director University of Auckland cross-faculty Centre for Longitudinal Research)Production Produced by Mic Cavazzini. Recording assistance in Auckland from Little Kong Productions. Music licensed from Epidemic Sound; 'Earthbound 3' by Joachim Nilsson; 'A Winter's Tale' by Magnus Ringblom; 'I Am Here Now' by Gunnar Johnsén. Image courtesy of Getty Images.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jun 2019

37 min 37 sec

Australia and NZ are made up of sprawling cities and far-flung towns, and driving is often viewed as a fundamental freedom. It can be hard for clinicians to challenge that freedom with patients who they consider unfit to drive safely. And harder still to deal with the consequences if a patient does have a crash.Clinicians are drawn into the question of driving fitness in two main ways. The more clearcut is when a patient presents with a medical assessment form. It's the Driver Licencing Authority in each state which ultimately issues the driving permits and may require the recommendation of a medical professional.The other way in which health professionals become involved is when they detect a new or worsening condition in a patient who is already licenced. Clinicians are expected to warn their patients off driving, and to potentially report them to the DLA if this advice isn't being heeded. There are diagnoses that should raise red flags for clinicians of all stripes. In this podcast we speak to a GP, a neurologist and an occupational therapist about how to discuss cessation from driving with patients, and where responsibilities lie in reporting to the Driver Licencing Authority.Guests Dr Genevieve Yates FRACGP (Principal Medical Educator RACGP, MDA National's Education Services Advisory Group, Black Dog Institute) Prof Roy Beran FRCP FAFPHM FRACP FRACGP FACLM (UNSW, Griffith University, Liverpool Hospital)  Dr Marilyn Di Stefano (Senior Policy Officer VicRoads, La Trobe University) Serge Zandegu (Manager of VicRoads Medical Review)Production Written and produced by Mic Cavazzini. Recording assistance in Melbourne from Sam Loy of Human/Ordinary. Music courtesy of Free Music Archive; 'John Stockton Slow Drag' and 'What True Self? Feels Bogus, Let's Watch Jason X' by Chris Zabriskie, 'Noir' by Daniel James Dolby, 'Hélice' by Monplaisir,. Image courtesy of iStock.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Apr 2019

42 min 6 sec

Cervical cancer is the fourth most common cancer in women worldwide, but it's almost entirely preventable. Incidence in Australia and New Zealand has fallen by half since national Pap testing programs were implemented almost thirty years ago, and it now it sits between 6 and 7 cases per 100,000 women. But this rate has been at plateau for over a decade, and Pap cytology now plays second fiddle to HPV testing. In December 2017 Australia seconded the Netherlands to adopt this as the primary tool in cervical screening, and New Zealand plans to follow suit in 2021.The most noticeable shift is that the interval between screens will now be five years rather than two. And women will enter the program at age 25 instead of 18. Modeling shows that this could halve the incidence of cervical cancer further and at much lower cost than the previous program. Some, however, are concerned about the costs and risks involved in the triage pathway. This episode of Pomegranate Health will answer some questions that women and health professionals might have about the HPV-based National Cervical Screening Program.Guests Associate Professor Julia Brotherton AFPHM (VCS Foundation, University of Melbourne) Professor Ian Hammond AM FRANZCOG (Chair, Renewal of the National Cervical Screening Program Implementation Committee, University of Western Australia)Production Written and produced by Mic Cavazzini. Recording assistance in Perth from Meri Fatin and in Melbourne from Jon Tjhia of Paper Radio. Music courtesy of Free Music Archive; 'Electro Cool' by 4T Thieves, 'Fryeri,' 'Headway,' 'Brand New World' and 'Mare' by Kai Engel. Image courtesy of Wikimedia Commons. The production manager was Anne Fredrickson.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Feb 2019

41 min 16 sec

This is the second of two podcasts about "disruption" in healthcare. We hear from members of the RACP Consumer Advisory Group about the way they see the power balance in health service delivery and how to increase participation.Consumer advocate Jen Morris discusses autonomy, and all the subtle aspects of informed consent. Another factor which can give the public a greater sense of agency in their care is access to health data.Consumer expectations are different to what they were twenty years ago. As Professor Des Gorman explains, the health system is a service industry like any other, and that terms like patient and consumer might be relevant to different points in person's journey through it.Guests Professor Des Gorman FAFOEM (University of Auckland; Executive Chair, Workforce New Zealand) Jen Morris RACP Consumer Advisory Group members Hamza Vayani, Debra Letica, Ezekiel RobsonProduction Written and produced by Mic Cavazzini. Recording assistance in Auckland from Richard Smith and the University of Auckland, and in Melbourne from John Tjiha of Paper Radio. Music under licence from Epidemic Sound ('Simmering Anxiety' by Christian Andersen, 'Into the Bone' and 'Frustration in Disguise' by Jimmy Wahlsteen, 'Organic Textures 2' by Johannes Bornlöf, 'The Sky Changes 2' and 'Calculate Journey' by Gunnar Johnsén ); and Free Music Archive ('To be Decided' by Mystery Mammal, 'Highway to the Stars' by Kai Engel and 'Waiting' by David Szesztay). Image under licence from iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Mahesh Dhakal, Rhiannon Mellor, Ellen Taylor, Joseph, Lee, Philip Britton, Alan Ngo, Rachel Williams, Phillipa Wormald, Rosalynn Pszczola, Richard Doherty Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Dec 2018

36 min 43 sec

In this and episode 43 we revisit the theme of 'disruption' from the 2018 RACP Congress. Disruption is what happened to the taxi industry at the hands of Google Maps and Uber. Or to the music industry with the onslaught mp3 files and digital sharing platforms.Democratizing technology is changing delivery of healthcare too and now permits remote consultations, automated dispensing, or even algorithmic diagnostics. The public also has access to more information, and even today, "Dr Google" is variously described as a tool or a hindrance.More importantly, consumer expectations are different to what they were twenty years ago. As Professor Des Gorman explains, the health system is a service industry like any other, and those working within it need to have a better understanding of the people who sustain that service. New delivery models are springing up all the time which may offer efficiencies and greater satisfaction in some consumer groups.Consumer advocate, Jen Morris, tells a story from the UK, where a man was able to bypass red tape around approval of prophylactic HIV therapy simply by setting up a website. She explains how clinicians shouldn't see the internet as a threat, but as a tool for enhancing consumer engagement. And how health literacy is more about navigating systems than it is about understanding biomedical fundamentals. Guests Professor Des Gorman FAFOEM (University of Auckland; Executive Chair, Health Workforce New Zealand) Jen MorrisProductionWritten and produced by Mic Cavazzini. Recording assistance in Auckland from Richard Smith and the University of Auckland, and in Melbourne from John Tjiha of Paper Radio. Music under licence from Epidemic Sound ('Simmering Anxiety' by Christian Andersen, 'Into the Bone' and 'Frustration in Disguise' by Jimmy Wahlsteen, 'The Sky Changes 2' and 'Calculate Journey' by Gunnar Johnsén ); and Free Music Archive ('To be Decided' by Mystery Mammal, 'Highway to the Stars' by Kai Engel and 'Waiting' by David Szesztay). Image under licence from iStock. The production manager was Anne Fredrickson.  Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Mahesh Dhakal, Rhiannon Mellor, Ellen Taylor, Joseph, Lee, Philip Britton, Alan Ngo, Rachel Williams, Phillipa Wormald, Rosalynn Pszczola, Richard Doherty Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Dec 2018

36 min 21 sec

Glucose-lowering medications have been the mainstay of managing type 2 diabetes for 20 years, but in April this year a polemic erupted around specific targets for blood sugar. The American College of Physicians recommended less stringent control than had been previously accepted, and invoked fierce criticism from other diabetes organisations around the world.It all comes down to the interpretation of four key trials between designed to show a link between intensive glycemic control and improvement in cardiovascular symptoms. On this episode, Dr Paul Drury and Professor Sophia Zoungas help make sense of the inconsistencies between the findings and explain how these inform individualised strategies for patients with different historiesIn recent years there have also been trials of new drug classes that don't just lower blood glucose but appear to provide cardiovascular benefits directly in sicker patients. These are the SGLT2 inhibitors and GLP-1 receptor agonists, and we'll summarise the use advised in a very recent consensus statement.Guests Professor Sophia Zoungas FRACP (Monash Health; Board Director, Diabetes Australia; Clinical Director, National Association of Diabetes Centres) Dr Paul Drury FRACP (Clinical Advisor in Diabetes, Ministry of Health)Production Written and produced by Mic Cavazzini. Recording assistance in Auckland from Alex Aylett-McMillan and in Melbourne from Rebecca Fary. Music under licence from Epidemic Sound ('Fields' and 'World Joy' by Gunnar Johnsén, 'Organic Textures' by Johannes Bornlöf). Image under licence from iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Phillip Gaughwin, Mahesh Dhakal, Marion Leighton, Rebecca Grainger, Rhiannon Mellor, and Alan Ngo. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Nov 2018

36 min 23 sec

From 2019, there will be only three categories of activities in the RACP's CPD framework, encouraging Fellows to participate in performance review and outcome measurement alongside more traditional educational activities. Performance review can include collegiate exercises like peer review of case outcomes, or surveys of patient experiences. Multi-source feedback is one sophisticated example that has been trialled by the RACP. Outcome measurement typically refers to clinical audits of case notes and there are many forms that can easily be implemented by Fellows. In this episode, two New Zealand Fellows discuss what they've learned about this 'strengthened CPD' approach since it was nationally implemented there four years ago.Guests Professor Tony Scott FRACP (Director of Cardiology, Waitemata Cardiology, Auckland) Dr Peter Roberts FRACP (CPD Director, RACP New Zealand; Wellington Hospital)Production Written and produced by Mic Cavazzini. Recording assistance in New Zealand from Charlotte Graham-McLay. Music courtesy Gunnar Johnsén at Epidemic Sound ('Task at Hand 2', 'Task at Hand 5', 'The Sky Changes 2') and Blue Dot Sessions ('Vittoro'). Image licenced iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Phillipa Wormald, Michael Herd, Rhiannon Mellor, Joseph Lee, Rachel Williams, Phillipa Wormald, Paul Jauncey, Rebecca Grainger, Philip Gaughwin and Alan Ngo. Thanks also to RACP staff Lianne Beckett, Michael Pooley, Elyce Pyzhov, Amy Nhieu, Shona Black, Abigail Marshall, Kerri Brown, Sandra Dias and Carol Pizzuto.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Sep 2018

30 min 7 sec

In this episode we put continuing professional development (CPD) under the microscope, particularly the regulatory changes on the horizon. The Medical Board of Australia is emulating shifts already made by the Medical Council of New Zealand and regulators in Canada, the U.S. and the U.K. In some cases, this 'revalidation' movement has been fiercely opposed by doctors. But where did it come from, and why is CPD even necessary after you've already done 10 to 15 years of medical training.Guests Professor Richard Doherty FRACP (Dean, RACP; Monash Childrens Hospital and University)  Dr Craig Campbell, MD FRCPC (Royal College of Physicians and Surgeons of Canada; The Ottawa Hospital)Production Written and produced by Mic Cavazzini. Recording assistance in Ottawa from Pop-Up Podcasting. Music courtesy Gunnar Johnsén at Epidemic Sound ('Task at Hand 2', 'Task at Hand 5', 'The Sky Changes 2') and Blue Dot Sessions ('Vittoro'). Image courtesy Neil Turner at Flickr.The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Phillipa Wormald, Michael Herd, Rhiannon Mellor, Joseph Lee, Rachel Williams, Phillipa Wormald, Paul Jauncey, Rebecca Grainger, Philip Gaughwin and Alan Ngo. Thanks also to RACP staff Lianne Beckett, Michael Pooley, Elyce Pyzhov, Amy Nhieu, Shona Black, Abigail Marshall, Kerri Brown, Sandra Dias and Carol Pizzuti. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Sep 2018

31 min 21 sec

An empathic connection and good communication between physician and patient can promote better outcomes. In this episode of Pomegranate Health, U.S. physician A/Prof Danielle Ofri discusses where breakdowns in doctor-patient communication occur—often in the first 10 or 20 seconds of a consultation. Dr Ofri, author of What Patients Say, What Doctors Hear, suggests ways for physicians to listen better, to be understood and promote adherence.Some media also report a 'crisis of compassion' in healthcare. Burnout of staff is a major contributor, and palliative care physician Dr Shamsul Shah describes how to mitigate it by convening groups to reflect on the emotional challenges of the job. She recently published an evaluation of Schwartz Center Rounds® (case-based reflections) run at Auckland City Hospital in the College's Internal Medicine Journal.Guests A/Professor Danielle Ofri MD PhD (Bellevue Hospital, New York; New York University School of Medicine) Dr Shamsul Shah FRACP (Auckland City Hospital)Production Written and produced by Mic Cavazzini. Music courtesy of Blue Dot Sessions ('Periodicals'), Sergey Cheremisinov ('Old Ally', 'Tavern'), and Loch Lomond ('A String- Instrumental'). Image property of RACP. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Philip Gaughwin, Michael Herd, Andrea Knox, Paul Jauncey, Rebecca Grainger, Joseph Lee, Rachel Williams, Mahesh Dhakal, and Katrina Gibson. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jul 2018

32 min 25 sec

As medicine becomes more sophisticated, discussions about clinical ethics become more common. It is now possible to support life in dire clinical circumstances, but physicians are not always sure if this is the right thing to do. There are questions about quality of life and best interests of the patient, questions about cognitive competence to make such decisions for oneself or questions about equitable distribution of limited resources.This episode was recorded at the RACP Congress in May and centres around two case studies. The first describes a three-year-old boy with a severe neurodegenerative disorder whose parents are desperate to try an expensive experimental drug. The second is about a man ravaged by bowel cancer who has spent months on life-sustaining care. You'll hear a variety of physicians express their views, and members of the College Ethics Committee describe how clinical ethics services can support decision-making in such cases.Panellists Professor David Isaacs FRACP (Children's Hospital Westmead, University of Sydney) Professor Ian Kerridge FRACP (Royal North Shore Hospital, Sydney Health Ethics) Professor Paul Komesaroff FRACP (Alfred Hospital, Monash University, Centre for Ethics in Medicine and Society) Associate Professor Jill Sewell FRACP (Royal Children's Hospital Melbourne, Children's Bioethics Centre, University of Melbourne) Dr Linda Sheahan FRACP FAChPM (St George Hospital, Sydney Health Ethics) Professor Cameron Stewart (Sydney Law School, Sydney Health Ethics)Production Produced by Mic Cavazzini. Initial interview conducted by Melissah Bell. Music courtesy of Daddy Scrabble ('Tune for Elli'), Jason Shaw ('Namaste'), and Kai Engel ('Highway to the Stars'). Image via Shutterstock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Philippa Wormald, Andrea Knox, Rebecca Grainger, Philip Gaughwin and Rhiannon Mellor.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jun 2018

41 min 16 sec

This is the second of two episodes about acute coronary syndrome (ACS). In part one, the discussion focused on diagnostic workup of acute coronary events. This episode deals with secondary prevention and adherence to therapy. One-fifth of people discharged with a diagnosis of ACS have another ischaemic event within six months, and the risk of dying increases the second time round.There is an established strategy for secondary prevention of ACS that includes pharmacotherapy, cardiac rehabilitation and lifestyle management. However, 75 per cent of patients are discharged from hospital without one or more of these tools. A recently published study in the Internal Medicine Journal suggests this sets a trend for care going forward. As Professor David Brieger explains, follow-up visits to the GP are unlikely to ensure best-practice pharmacotherapy if this was not prescribed in hospital.Cardiac rehabilitation may also not be as effective as it could be in reducing the risk of further ischaemic events. On this episode, Associate Professor Julie Redfern argues that the group exercise model is outdated, and a more personalised approach is needed to keep patients engaged.Guests Professor David Brieger FRACP (Concord Repatriation General Hospital, University of Sydney) Associate Professor Julie Redfern PhD(George Institute for Global Health, University of Sydney).Production Written and produced by Mic Cavazzini. Music courtesy of Jason Shaw ('Minstrel'), Lee Rosevere ('Become Death'), Sergey Cheremisinov ('Pulsar') and Loch Lomond ('Listen, Lisbon'). Image courtesy of iStock. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP Fellows Joseph Lee, Michael Herd, Marion Leighton, Rachel Williams, and Mahesh Dhakal. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

May 2018

32 min 38 sec

Chest pain and other symptoms suggestive of ACS make up the majority of presentations to hospital. 11 to 17 per cent of patients presenting to ED with such symptoms end up having the diagnosis confirmed. But follow-up studies of discharged patients show that up to six per cent of diagnoses are missed, and inappropriately discharged patients have a twofold higher mortality rate than those who are admitted.The 2016 guidelines of the Cardiac Society of Australia and New Zealand were developed to guide the rapid differentiation of patients presenting with suspected ACS. ACS takes in STEMI and non-STEMI heart attacks, and also unstable angina. This episode outlines the investigations used to distinguish these and other differential diagnoses associated with chest pain. First, electrocardiogram recordings are used to identify the occurrence of a myocardial infarction with ST segment elevation. If STEMI is discounted, the next most important step is to rule out other life-threatening causes of chest pain. Third in the diagnostic hierarchy is to establish whether there has been myocardial infarction without ST elevation, or unstable angina. This is where high sensitivity troponin markers become useful, and can feed into stratification protocols for assessing the risk of patients suffering future acute cardiac events.Guest Associate Professor Louise Cullen FACEM (Royal Brisbane and Women's Hospital, University of QueenslandProduction Written and produced by Mic Cavazzini. Additional audio recording from Michelle Ransom-Hughes. Music courtesy of Jason Shaw ('Minstrel, Pioneers'), Lee Rosevere ('Become Death'), Sergey Cheremisinov ('Pulsar') and Loch Lomond ('Listen, Lisbon'). Image courtesy of Science Photo Libary. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP members Paul Jauncey, Pavan Chandrala, Rebecca Grainger, Phillip Gaughwin, Rhiannon Mellor, Alan Ngo, and Mahesh Dhakal. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

May 2018

28 min 49 sec

In Episode 32  we discussed cognitive error in diagnostic reasoning. On this episode, we take a look at systems pressures that increase the likelihood of medical error, crystallised by the recent prosecution of NHS paediatrician Dr Hadiza Bawa-Garba. Almost half of diagnostic errors are due to a combination of systems errors and individual cognitive error. Obvious systems effects come into play in understaffed acute care units; if a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. The stepping stones of ordering, receiving and reviewing diagnostic tests and scans also allow much opportunity for error and delay. Guests on this episode discuss mechanisms to improve efficiencyObvious systems effects come into play in understaffed acute care units. If a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. And of course, long hours and fatigue will only reduce cognitive capacity. Hospital systems also include the stepping stones of ordering, receiving and reviewing diagnostic tests and scans. Missteps and delays in this cascade contribute to a large proportion of diagnostic errors. Guests on this episode discuss mechanisms to improve efficiency.Another important step in improving health systems is capturing and reporting error rates accurately. If clinical error is wrapped in culture of blame and punishment, it will make such disclosure more difficult. This concern has been raised in response to the recent prosecution of U.K. National Health Service (NHS) paediatrician Dr Hadiza Bawa-Garba, who had her licence to practice medicine revoked for her role in the death of a young patient. Six-year old Jack Adcock died on a chaotic day in 2011 at the Leicester Royal Infirmary that involved delays in the diagnosis and treatment of his sepsis. Today’s episode examines how widespread systems errors contributed to such mistakes.Guests Professor Jeffrey Braithwaite FAIM, FACHSM, FAHMS, FFPH-RCP, FAcSS, Hon FRACMA (Australian Institute for Health Innovation, Macquarie University) Associate Professor Ian Scott FRACP (Director, Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, University of Queensland) Associate Professor David Heslop FRACGP (University of New South WalProduction Written and produced by Mic Cavazzini. Additional audio recording from James Milson and Jennifer Leake. Music courtesy of Kai Engel ('Memories'), Jahzarr ('Become Death'), Sergey Cheremisinov ('Now You Are Here') and Loch Lomond ('Violins and Tea'). Image courtesy of Max Pixel. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Phillipa Wormald, Katrina Gibson, Rosalynn Pszczola, Andrea Knox, Philip Gaughwin, Rhiannon Mellor and Richard Doherty. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  <

Mar 2018

35 min 34 sec

Cannabis is a plant rich with potential therapeutic compounds and centuries of cultural resonance. At this moment in Australia, media accounts are full of patient stories and lab data suggesting benefit from cannabis for scores of different conditions, while politicians discuss laxer regulation of the drug and a new lucrative industrHowever, only a few of the claimed medical effects of the plant have been proven by rigorous clinical trials in people. Nabiximols is the only medicinal cannabis product currently registered in New Zealand and Australia, and it's indicated only for­­ the treatment of spasticity in patients with multiple sclerosis (MS). Systematic reviews of the research note strong evidence that cannabis can also help with the pain associated with MS, the nausea induced by chemotherapy and some cases of epilepsy. But for many other conditions like post-traumatic stress disorder, irritable bowel syndrome, immune disorders and Parkinsonism, reviewers concluded that meaningful clinical recommendations could not be made—there simply aren't enough studies of good quality. Cannabis is complex. The flower bud contains mostly cannabidiol and tetrahydrocannabinol (THC), but there are about 100 other cannabinoid compounds. On this episode, Pomegranate Health guests explain how important it is to separate the effect of these various components in a systematic way, and why well-regulated research and prescribing will be safer for patients. Guests A/Prof Peter Grimison FRACP (Chris O'Brien Lifehouse, University of Sydney) Prof Meera Agar FRACP (UTS, USNW, IMPACCT) A/Prof Carolyn Arnold FRACP (Monash University Alfred Health) Prof Samuel Berkovic AC FRACP (Epilepsy Research Centre, University of Melbourne) Prof Jennifer Martin FRACP (Australian Centre for Cannabinoid Research Excellence, University of Newcastle, John Hunter Hospital).Production Written and produced by Mic Cavazzini. Additional audio recording from James Milson. Music courtesy of Blue Dot Sessions (“Cloud Line”), 4T Thieves (“New Times”), Mystery Mammal (“Asylum”) and Jahzarr (“Please Listen Carefully”). Image courtesy of iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Dr Michael Herd, Dr Pavan Chandrala, Dr Marion Leighton, Dr Rosalynn Pszczola, Dr Mahesh Dhakal, Dr Rhiannon Mellor, Dr Rebecca Grainger, Dr Philip Gaughwin and Dr Paul Jauncey, as well as Louise Hardy (Manager, RACP Policy and Advocacy) and Ms Joanna Harrison (Senior Adviser, ACRE). Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jan 2018

36 min

Misdiagnosis or delayed diagnosis occurs in 10-15 per cent of acute presentations, although fortunately only a tenth of these lead to serious consequences. But of concern is the fact that this figure hasn't changed in three decades, despite progress in clinical knowledge. Errors in diagnostic reasoning occur at the same rate in senior clinicians as they do in juniors, even though mistakes from poor examination or knowledge become less frequent as one gains experience. Compared to problems in maths or physics, diagnostic problems are thought of as ill-structured: because information isn't readily available, the problem can keep changing and often you're not certain you've reached a solution and are free to stop searching. Cognitive errors result from jumping to conclusions on the basis of intuition and incomplete information. There are a hundred different types of such bias. On this episode, the most common types will be discussed, as well as strategies to force a more considered process of diagnostic reasoning. In about two thirds of cases, systems problems like design and workflow contribute to diagnostic error. These will be discussed in the second episode of this series. Guests Dr Nicolas Szecket FRACP (Auckland City Hospital) Dr Arthur Nahill FRACP (Auckland City Hospital). Production Written and produced by Mic Cavazzini. Music courtesy of Mystery Mammal ('To be Decided,' 'Data'), RGIS VICTOR ('Lampagisto') and Lobo Loco ('Spook Castle'). Image courtesy of iStock. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP members Dr Paul Jauncey, Dr Alan Ngo, Dr Katrina Gibson. Dr Marion Leighton, Dr Michael Herd and Dr Joseph Lee. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Dec 2017

34 min 26 sec

'Ngā Kaitiaki Hauora' translates as 'guardians of health'. This podcast emerged from a meeting near Auckland organised by the RACP's Māori Health Committee in November 2017. Members of various medical colleges and institutions came together to share perspectives on the delivery of health care to New Zealand's population of Māori and Pacific Islander people. This conversation comes in the context of the Wai 262 claim, which is forcing a re-examination of the Crown's obligations to the Māori population under the Waitangi Treaty of 1840.On this episode, Reverend Hirini Kaa proposes that all institutions of civil society must be committed to recognising Indigenous sovereignty not just over land, but also the natural environment, the language, and cultural practices. GP Dr Peter Jansen and oncologist Dr George Laking describe the variation in medical care that Māori and Pacific Islander patients receive on a day to day basis, and how this can emerge in part through cultural 'mismatches'. And public health physician Dr Elana Curtis describes the successes and future targets of streaming Māori and Pacific Islander students into medical school.Guests Dr Peter Jansen FNZCGP FRACMA (Ngāti Raukawa, Mauri Ora Associates, Accident Compensation Corporation) Dr George Laking FRACP (Te Whakatōhea, Auckland City Hospital) Dr Elana Curtis AFPHM (Ngāti Rongomai, Ngāti Pikiao, University of Auckland) Rev Hirini Kaa (Ngāti Porou, Ngati Kahungunu, University of Auckland) Mr Chayce Glass (Tumuaki, University of Otago). Commemoration to Matua Leo Buchanan given by Dr Tuwhakairiora Williams.Production Written and produced by Mic Cavazzini. Music courtesy of Jason Shaw ('Autumn Sunset'), Doctor Turtle ('Making a Change') and Broke For Free ('Feel Good Instrumental'). Image of the Te Whare Tapa Whā health model by Sir Mason Durie, provided courtesy of NZ Ministry of Health: Manatū Hauora. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Dr Katrina Gibson and Dr George Laking and RACP staff Ms Harriet Wild, Ms Nicola Fowler, and Dr Cristiana Palmieri.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.   

Nov 2017

39 min 14 sec

The World Medical Association has just updated the Physician's Oath in the Declaration of Geneva to include the clause, 'I will attend my own health, well-being, and abilities in order to provide care of the highest standard.' This is in recognition of the often reported figures about burnout, depression and suicide in the health workforce.These rates are typically twofold higher than they are in the general population, according to studies from New Zealand, Australia and around the world. Causes often given for psychiatric distress in the medical profession are the gruelling hours, the pressure of perfection, the unforgiving culture and the stigma associated with mental health issues. This episode examines how the system might be shaped to improve physician wellbeing.If you or someone you know is struggling with mental health issues, please seek help—call Lifeline on 13 11 14. The RACP also provides a confidential, 24-hour support program for its members. Fellows can call 1300 687 327 in Australia, and 0800 666 367 in New Zealand.Guests Dr Geoff Toogood FRACP (Alfred Hospital) Dr Margaret Kay FRACGP (University of Queensland; Medical Director, Queensland Doctors' Health Program) Dr Hilton Koppe FRACGP.Production Produced by Mic Cavazzini. Recording assistance from Michelle Ransom-Hughes and Rebecca Fary. Music courtesy of Kai Engel ('Highway to the Stars'), Cory Gray ('Low Rollers'), Blue Dot Sessions ('Periodicals') and Lee Rosevere ('Here's the Thing'). Photo via iStock. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP Fellows Dr Marion Leighton, Dr Alan Ngo, Dr Michael Herd, Dr Phillipa Wormald and Dr Paul Jauncey.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.   

Oct 2017

30 min 15 sec

Adverse drug events cause about five per cent of admissions to a public hospital, although some studies suggest the figure could be as high as 15 per cent. That makes at least half a million patients in Australia and 55,000 in New Zealand every year. Drug-drug interactions make up about a fifth of these adverse events. They have become more frequent over the decades, as more medications reach the market. More than half of people over the age of 75 are on five or more prescriptions—a state referred to as polypharmacy. This episode examines some of the systems that have led to current rates of polypharmacy, and some strategies for deprescribing. We also discuss Professor Richard Day's recent review of drug interactions from the Internal Medicine Journal, and highlight the combinations physicians should be most concerned about.Guests Professor Richard Day FRACP (St Vincent's Hospital, UNSW) Professor Sarah Hilmer FRACP (Royal North Shore Hospital, University of Sydney).Production Produced by Mic Cavazzini. Music courtesy of Daddy Scrabble ('Flying Pea', 'Cherry Blossom'), Doctor Turtle ('Manly Nunn Steps Out'), and Scott Holmes ('Chasing Shadows'). Photo by iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Rebecca Grainger, Dr Alan Ngo, Dr Phillipa Wormald and Dr Michael Herd. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Sep 2017

28 min 50 sec

The transition from trainee to consultant marks an exciting and daunting step in a clinician's career. Suddenly you take on responsibility for everyone on the ward—both patients and other staff. And while clinical skills have been hammered in over years of training, the 'hidden curriculum' can be harder to pick up. The College has recently published How to Thrive as a New Consultant, a handbook to help navigate this period with confidence.For today's show, guest producer Zacha Rosen spoke to four physicians who look back on their transitions, from six months on to nine years on. They capture the experience of striking out as a leader, manager and mentor to others. At the same time, one doesn't need to have all the answers. Recognising limitations and knowing when and how to seek help is all important. This is equally important in the clinic and in regards to one's own wellbeing. The speakers in this episode describe how they maintain a healthy balance within and around their careers.Guests Dr Marion Leighton FRACP (Wellington Hospital) Dr Martina Moorkamp FRACP (Mercy Hospital for Women, Melbourne) Dr Lawrence Ong FRACP (Westmead Institute For Medical Research) Dr Ben Vogler FRACP (Cairns Hospital).Production This episode was produced by Zacha Rosen, with research assistance from Beverly Bucalon, and hosted by Mic Cavazzini. Recording in Wellington by Ryan Smith. Music courtesy of Lee Rosevere ('Thoughtful', 'Here's the Thing'), Chris Zabriskie ('Wonder Cycle'), and Rosie Catalano ('Waiting'); photo copyright RACP. The production manager was Anne Fredrickson.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Aug 2017

26 min 36 sec

Australia and New Zealand have relatively high rates of asthma by international measures, with a population rate of about one in nine. For years the management model has been empirical. The more serious the disease, the more the dose of controller therapy is increased. But this doesn't work for everyone. In at least 10 per cent of patients, there is an excessive symptom burden despite maximum controller therapy. Severe asthma is marked by frequent exacerbations that may require hospitalisation, and the chronic narrowing of the airways that can often present like COPD. A rational approach to treatment requires identifying one of three endotypes with distinct pathophysiology. Eosinophilic asthma, allergic asthma, and non-eosinophilic asthma can be differentiated by markers in blood and sputum. And targeted therapies have emerged, such as monoclonal antibodies to stages in the cytokine pathway that underlies eosinophil recruitment. It's also important to consider the co-morbidities and risk factors that contribute to the disease, and to coordinate therapy in a multi-disciplinary way. The guests for this episode published a 'Clinical Perspectives'; review in June's edition of RACP's Internal Medicine Journal.Guests Professor Peter Gibson FRACP (Hunter Medical Research Institute, Co-Director of the University of Newcastle's Priority Research Centre for Asthma and Respiratory Diseases) Professor Vanessa McDonald FRCNA (Co-Director of NHMRC CRE in Severe Asthma at HMRI, University of Newcastle).Production This episode was produced by Mic Cavazzini. Music from Jason Shaw ('Namaste', 'Timen Passing By'), Kai Engel ('Wake Up'), Mark Neill ('Shakey'). Photo courtesy iStock. The production manager was Anne Fredrickson. Editorial feedback was provided by RACP Fellows Dr Michael Herd, Dr Joseph Lee and Dr Tessa Davis, and Dr Steven Maltby, HMRI, University of Newcastle. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jul 2017

28 min 46 sec

Uncertainty can be frightening for patients and doctors alike, but it's an unavoidable fact of medicine in every specialty. In this two-part story, we hear from a GP, a paediatrician, a surgeon and a rheumatologist about how they navigate the grey areas of diagnosis and treatment, and maintain a patient's faith throughout. In the first episode, we examine the culture within the profession and general public that expects nothing less that perfection in medicine—technology that appears to make everything soluble, and pressure on doctors to back their hunches or to be heroic in interventionIn this final episode, we look at the stigma and disorientation experienced by patients with medically unexplained syndromes. While the definition of functional disorders still causes some debate, behavioural strategies for intervention can often have a great impact on the lives of these patients. Treatment outcomes are never guaranteed, however, and clinical outcome cannot be the only measure of success. Our guests each give examples from their specialty about how a patient's expectations can be managed from the beginning of the consultation. Guests Dr Louise Stone FRACGP (Australian National University) Professor Phil Fischer MD (Mayo Clinic, Rochester, Minnesota) Professor Ian Harris RACS (Liverpool Hospital, UNSW) Dr Rebecca Grainger FRACP (Wellington Regional Rheumatology Unit, University of Otago).Production This episode was produced by Mic Cavazzini. Music from Transient ('Vodka', 'Damascus'), Ben Carey ('Calico', 'Ghost Limb'); photo courtesy iStock. Recording assistance from Ryan Smith and Mark Flaherty. The production manager was Anne Fredrickson. Editorial feedback was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Tessa Davis, Dr Michael Herd, Dr Sherina Mubiru, Dr Pavan Chandrala, and Dr Alan Ngo. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Jun 2017

29 min 13 sec