Pomegranate Health

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This popular episode was first published in 2019. 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.

There are diagnoses that should raise red flags for driving fitness in various specialty areas, and a clinician can be drawn into the issue by two main pathways. The more straightforward 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 is when the clinician detects a new or worsening condition in a patient who is already licenced. They are expected to warn their patients off driving and in some jurisdictions to report them to the DLA if this advice isn't being heeded.

Chapters7:48 Legal expectations on a practitioner
17:20 Medical conditions affecting to fitness to drive24:48 Considering age in driving performance
35:28 Approaching driving ‘retirement’
45:28 Updates to national standards

GuestsDr 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 (University of UNSW)
Marilyn Di Stefano PhD (Victorian Department of Transport and Planning)
Serge Zandegu (Victorian Department of Transport and Planning)

ProductionWritten and produced by Mic Cavazzini DPhil. 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. Music licenced from Epidemic Sound includes ‘Knowledge is Power’ by Matt Large.

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This is the second episode of in the series, [Contagious Conversations] from the Australasian Society for Infectious Diseases. Expert guests in this series will come from right across the interface of research, clinical care and public health.

In today’s episode we look at the immense progress that has been made over three decades in the management of HIV. Once a fatal diagnosis, the disease can now be completely controlled by anti-retroviral therapy. Access to prophylactic treatment has also made a huge impact on rates of transmission in the community although barriers still remain to equitable access.

GuestsProfessor Sharon Lewin OA FRACP PhD (Peter Doherty Institute for Infection and Immunity, Director; University of Melbourne; Cumming Global Centre for Pandemic Therapeutics, Director)
Professor Dato’ Dr Adeeba Kamarulzaman FRACP FASc (Monash University Malaysia, President & Pro Vice-Chancellor; Centre of Excellence for Research in AIDS).
Richard Keane (Living Positive Victoria, CEO)

HostAssociate Professor Sanjaya Senanayake FRACP (Canberra Hospital; Australian National University)

ProductionProduction supported by Mic Cavazzini DPhil, and the Viral Hepatitis and HIV Special Interest Group particularly Dr Emma Paige and Dr Sushena Krishnaswamy. Thanks also to Inge Meggitt, events coordinator at ASID. Music licenced from Epidemic Sound includes ‘Exploring the Lake’ by View Points and ‘Emerlyn’ by Valante. Image copyright ASID (2026).

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This episode is a teaser for RACP LIFT 2026, a series of in-person events to promote Learning, Innovation and Forward Thinking. Coming up on the 1st of August in Melbourne there will be a Rapid Fire Clinical Update on Respiratory medicine, infectious diseases and critical illness. And on the 20th In Brisbane another one themed around Palliative medicine and also population health. In March, the Sydney RACP offices hosed a meeting on cardiometabolic and vascular health, and the talk shared here covers everything a generalist needs to know about metabolic dysfunction-associated fatty liver disease.

The seminar was presented by Professor Jacob George, Director of the Storr Liver Centre at the Westmead Institute for Medical Research, and author of over 1300 peer-reviewed papers. He explains why fatty liver disease is a "canary in the coal mine" for metabolic health more generally, how to diagnose using scans and bloods, and the use of the FIB-4 index. Professor George also describes how patients can be stratified and managed for risk of more complex liver disease and reviews outcomes from the latest pharmacological interventions.

GuestsProfessor Jacob George FRACP PhD FAASLD (The Westmead Institute for Medical Research, Centre Director; University of Sydney)

Chapters
3:09 MAFLD is a positive definition
4:29 How common are MAFLD and MASH?
5:58 How do you define metabolic health?
9:02 Mortality and cardiovascular outcomes in patients with T2D
10:07 MAFLD in primary care guideline
12:40 Current and future therapies for MAFLD / MASH
15:24 Management algorithm for MAFLD
16:50 Test your knowledge

ProductionRapid Fire Clinical Update developed by LIFT advisory group and hosted/recorded by RACP Events team and. Podcast production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Simmering Anxiety’ by Christian Andersen and ‘Little Liberty’ by Paisely Pink.

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Adverse drug events cause 5-15% of admissions to hospital and drug-drug interactions make up about a fifth of these. Most common are pharmacodynamic situations where two drugs have a similar outcome thereby overdoing the intended outcome. Pharmacokinetic interactions are more complicated to understand as they’re more indirect. For example, while medications are cleared by oxidative metabolism in the liver and gut, there are many drugs that interfere with the function of the cytochrome enzymes responsible. This can result in clearance of the first drug at too fast or too slow a rate.

Polypharmacy has become more frequent over the decades with more than half of people over the age of 75 on five or more prescriptions. This episode examines some of the systems that have led to current rates of polypharmacy, and strategies for deprescribing safely in a given patient. We're REWINDing it nine years after it was first published to celebrate the career of Professor Ric Day who has just retired after sixty years of service at St Vincent’s Hospital, Sydney. He has been a much-appreciated clinician and prolific research academic with several hundred published papers that have been cited more than forty thousand times.

Chapters0:50 Prevalence of drug interactions
5:52 Pharmacodynamic vs pharmacokinetic interactions9:25 Cytochrome enzymes
17:33 ACE inhibitors and more
26:48 Strategies for deprescribing

GuestsProfessor Richard Day AM MBBS, FRACP (St Vincent’s Hospital; UNSW),
Professor Sarah Hilmer AM PhD FRACP FAAHMS (Royal North Shore Hospital; Kolling Institute/ USyd).

ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Flying Pea’ and ‘Cherry Blossom’ by Daddy Scrabble and “Manly Nunn Steps Out” by Doctor Turtle. Music licenced from Epidemic Sound includes ‘Train Ride’ (Instrumental) by Alex Kehm and ‘Yellow Leaf’ by Autohacker. Image adapted for RACP

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Key ReferencesLife-threatening drug interactions: what the physician needs to know [Internal Medicine Journal]
Polypharmacy in older people: when should you deprescribe? [Medicine Today]

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Syphilis is often thought of as a disease from the historic literature, but in August last year, it was declared a Communicable Disease Incident of National Significance by Australia’s Chief Medical Officer. Case numbers have grown year on year since it became a notifiable disease in 2004, peaking at around six and a half thousand in 2023.

Syphilis is sometimes described as ‘the great imitator’ because it can have so many different presentations. And it can hide away for years before revealing itself in one system of the body or other. In this podcast we’ll go over the neurologic, ophthalmic and nephrotic symptoms that can eventuate, and also some worrying examples of congenital transmission seen today. Today’s podcast will expand your library of differential diagnoses and give you confidence to go down the pathway of testing, treatment and contact tracing. It has been promoted with financial assistance from ASHM and the Australian CDC.

GuestsClinical Professor Louise Owen FRACGP FAChSHM MBBS(Hons) (Statewide Sexual Health Service in Tasmania, Director; University of Tasmania)
Dr Janet Towns FRACP FRACGP AChSHM PhD (Melbourne Sexual Health Centre; Monash University) Dr Nele Legge FRACP PhD (Liverpool Hospital)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘A Forest Melody’, ‘Time Traveller’ by Tellsonic, ‘Reconstruct’ by Amaranth Cove and ‘Beat Street’ by VV Campos. Music courtesy of FreeMusicArchive includes ‘Namaste’ by Jason Shaw. Historic poster courtesy of the US Library of Congress Archive.

Editorial feedback kindly provided by members of the Doctors Aidan Tan, Courtney Dowd, Marion Leighton, Lauren Gomes, Rahul Barmanray and Rachel Murdoch. Dissemination of this podcast was supported by ASHM and campaign to Stop Syphilis.

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Contagious Conversations is a new series brought to you by ASID, the Australasian Society for Infectious Diseases. Once a month, these podcasts will explore evolving evidence and real-world challenges for the practice of ID medicine. The hope is that you’ll come away with practical knowledge to support your clinical confidence and continuous learning.

Expert guests in this series will come from right across the interface of research, clinical care, and public health. Today we start with a paediatrician from Melbourne and a clinical nurse from the Sunshine Coast, who both make an important contribution to Australia’s National Immunisation Program. As we’ll hear today, public adherence to the NIP has been declining in recent years. In today’s conversation we hear about some of the reasons for vaccine hesitancy in parents and ways to reinspire confidence.

Guests Professor Margie Danchin FRACP, PhD(University of Melbourne; the Royal Children’s Hospital; Murdoch Children’s Research Institute)
Wendy Tout (Public Health Unit, Sunshine Coast Health Service)

HostAssociate Professor Sanjaya Senanayake FRACP (Canberra Hospital; Australian National University; University of New South Wales)

ProductionProduction supported by Mic Cavazzini DPhil, the ASID Vaccine Special Interest Group chaired by Dr Archana Koirala and staff support from Inge Meggitt. Music licenced from Epidemic Sound includes ‘Exploring the Lake’ by View Points and ‘Emerlyn’ by Valante. Image copyright with ASID (2026).

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In Pomegranate <> we go back to some classic episodes from the last ten years that have stood the test of time. The first throwback takes us back to 2017 with episodes 20 and 21 titled “Genomics for the Generalist.” While there’s been a flood of genomic discoveries since this story was first published, it’s still a good primer on fundamental concepts and everyday challenges for the physician advising a patient. The expert guests include a genetic pathologist, a clinical geneticist, a genetic counsellor and a medical oncologist.

The podcast covers the different roles for single gene tests and whole genome sequencing, which has become much more accessible. We tackle question of disease risk and how to present uncertain predictive diagnoses to consumers. This is particularly relevant to using genome-wide association studies, which re finding more and more markers with very small associated risks of disease. This increases the likelihood of picking up diagnoses incidental to the ones a clinician might be looking for. The ethics of consenting patients to genome screening and informing them of incidental findings are also discussed.

Chapters3:04 Mendelian vs multi-gene diseases
6:42 Whole genome sequencing
10:09 Prenatal testing
12:38 What do physicians need to know?
17:07 Pharmacogenomics
19:52 Genetic counselling
22:40 Funding of genetic tests
33:46 Incidental findings
39:13 Consent and privacy issues

Guests (2026 affiliations)Professor Leslie Burnett FRCPA, FHGSA, FCAP (University of New South Wales; Virtus Health)
Professor Michael Gabbett FRACP (Queensland University of Technolgy; Mendel Genetics)
Associate Professor Kristine Barlowe-Stewart FHGSA (University of Sydney; Children’s Cancer Institute)
Prof David Thomas FRACP PhD (University of New South Wales; Omico)

ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes, 'Cloud Line' by Blue Dot Sessions, 'Is That You or Are You You?' by Chris Zabriskie, First Holes’ by Cory Gray, ‘Brand New World’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Abyss’ by Luwaks. Image customised for RACP.

Editorial feedback for 2017 podcast provided by members of the podcast editorial group Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Anutosh Shee and Dr Ellen Taylor, and Advanced Trainee Dr Katrina Gibson.

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While waiting for COVID-19 vaccines to be rolled out, Australian jurisdictions adopted strong social restrictions to minimise community transmission of the virus. It’s estimated that together, these public health measures spared around 50,000 lives up to December 2022 and that vaccines saved three times as many again. While this public health response the pandemic is described as one of the most effective in the world it did cause unintended social harms and lingering resentment. Our leaders and community need some sober reflection on how to we might respond to the next such pandemic respiratory virus.

Over two podcasts we look carefully at the how the cost-benefit calculation stacks up for each of the major interventions. In Part 1 we discuss the international borders closures and overcooked parochialism between state jurisdictions, and also how messaging around vaccine risks and mandates could be improved. In Part 2 we look at the controversial stay-at-home orders and interruptions to in-person schooling and even the evidence for faces-masks. Ultimately, there are some questions that can’t be answered scientifically, and it is for politicians and the public to decide what the cost of freedom and dignity against human lives left exposed.

Chapters Part 23:38 Social restrictions
16:39 Facemasks
21:19 Missing behavioural and epidemiological data
30:35 Psychological morbidity from social restrictions
39:39 Human rights and moral preparedness

GuestsProfessor Paul Kelly FRACP(Australia’s Chief Medical Officer during the pandemic)
Professor Catherine Bennett PhD GAICD (Deakin University; co-author of the “COVID-19 Response Inquiry” )
Professor James McCaw PhD(The University of Melbourne; modeler for the Federal government’s “National Plan”)
Lorraine Finlay PhD (Australian Human Rights Commissioner; co-author of the "Collateral Damage" report)

Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Organic Textures 2’ by Johannes Bornlöf, ‘RGBA’ by Chill Cole, ‘Axon Terminal’ by Out to the World, ‘Soundbed’ by Blue Saga, and ‘Echo (Kerstin Ljungstrom Remix)’ by Bonsaye. Music courtesy of FreeMusicArchive includes ‘Namaste’ by Jason Shaw. Image by Westend61 licenced from GettyImages. Editorial feedback kindly provided by members of the podcast editorial group Dr Rahul Barmanray, Dr Zac Fuller, Dr Aidan Tan, Dr Maansi Dr Arora, Joseph Lee and Fionnuala Fagan.

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Over two podcasts we look carefully at the how the cost-benefit calculation stacks up for each of the major interventions. In Part 1we discuss the international borders closures and overcooked parochialism between state jurisdictions, and also how messaging around vaccine risks and mandates could be improved. In Part 2we look at the controversial stay-at-home orders and interruptions to in-person schooling and even the evidence for faces-masks. Ultimately, there are some questions that can’t be answered scientifically, and it is for politicians and the public to decide what the cost of freedom and dignity against human lives left exposed.

Part 1 Chapters6:46 Border Closures
35:04 Vaccine Hesitancy

GuestsProfessor Paul Kelly FRACP(Australia’s Chief Medical Officer during the pandemic)
Professor Catherine Bennett PhD GAICD (Deakin University; co-author of the “COVID-19 Response Inquiry” )
Professor James McCaw PhD(The University of Melbourne; modeler for the Federal government’s “National Plan”) Lorraine Finlay PhD (Australian Human Rights Commissioner; lead author of the "Collateral Damage" report)

Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘End of the Ocean’ and ‘Raised by Wolves' by Tellsonic, ‘RGBA’ by Chill Cole, ‘Organic Textures 1’ by Johannes Bornlöf and ‘Echo (Kerstin Ljungstrom Remix)’ by Bonsaye. Image by mrs licenced from GettyImages. Editorial feedback kindly provided by members of the podcast editorial group Dr Rahul Barmanray, Dr Zac Fuller, Dr Aidan Tan, Dr Maansi Dr Arora, Joseph Lee and Fionnuala Fagan.

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A 62‐year-old man is undergoing a CT‐guided core biopsy of a lung nodule when he develops an iatrogenic pneumothorax. After admission to the Royal Adelaide hospital he has ongoing dyspnoea, oxygen desaturation, and chest pain not helped by a preexisting Chronic Obstructive Pulmonary Disease. The treatment for the patient’s symptoms doesn’t immediately go to plan but his care team apply a combination of recent technologies to bring the condition under control. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.

Guests
Associate Professor Arash Badiei FRACP (Royal Adelaide Hospital; Adelaide University)

HostsAssociate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; Adelaide University)
Dr Brandon Stretton (Central Adelaide Local Health Network;)

ProductionProduced by Dr Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and med students Srishti Sharma, Prakriti Sharma and Cindy Shi.

Key Reference (Spoiler Alert)

Persistent air leak successfully treated with endobronchial valves and digital drainage system [Altree, Respirol Case Rep. 2018]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

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Médecins Sans Frontières has projects in more than 70 countries that might be affected by natural disasters, armed conflict or disease outbreaks. Its clinics see over two million emergency room admissions a year and another 16 million outpatient consults. Emergency Paediatrics consultant Josephine Goodyer and ID consultant Tasnim Hasan are two of more than a hundred Australians and New Zealanders who contributed to MSF’s missions last year. Between them they have covered practice settings as varied as Kiribati, South Sudan and Gaza. In this interview they describe the experience shipping out with MSF on their first assignment and then the kinds of responsibilities one is given with more experience. We’ll also hear how gaps of six months or more affect career progression and financial stability back home.

Chapters3:05 Starting out with MSF
15:04 Practicing in a conflict zone
50:53 Career impacts

Guests Dr Josephine Goodyer FRACP (Canberra Hospital; Australian National University) Dr Tasnim Hasan FRACP (Western Sydney LHD; University of Sydney) Dr Aidan Tan (Sydney Children’s Hospital Network)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Intimacy’ by Alex Kehm, ‘At the end of nothing’ by Silver Maple, ‘Below the Horizon’ by Dawn, Dawn, Dawn and ‘Nagba Algooah’ by Ebo Krdum. Image by Pablo Tosco ©2018 used with permission by MSF. Editorial feedback kindly provided by members of the podcast editorial group Dr Aidan Tan, Dr Stephen Bacchi, Dr Rahul Barmanray, Dr Maansi Arora and Dr Leon Li.

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A 75 year-old man with severe aortic stenosis is deemed unsuitable for surgery on the basis of a porcelain aorta detected with cross-sectional imaging. The patient had, a decade earlier, been diagnosed with hypertrophic cardiomyopathy after presenting with cardiac arrhythmia. A dual chamber ICD was implanted at the time for secondary prevention and other comorbidities were managed.

The patient is now being considered for staged alcohol septal ablation (for the HCM) and transcatheter aortic valve replacement (for the aortic stenosis), however, additional complications force an experimental two-in-one procedure.

Guest
Professor Ross Roberts-Thomson FRACP (Central Adelaide Local Health Network; University of Adelaide)

HostsAssociate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; University of Adelaide)
Dr Alistair Leslie (Central Adelaide Local Health Network;)

Key Reference (Spoiler Alert)

Two-in-one: Combined transcatheter therapy for hypertrophic cardiomyopathy and aortic stenosis [IHJ Cardiovascular Case Reports (CVCR). 2020]

ProductionProduced by Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPDto record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

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In 2027, NASA’s is planning to land astronauts on the moon for the first time in 53 years with the expectation that there will be a permanent base there by the early 2030s. And the ever-humble Elon Musk reckons he’ll be sending people to Mars by then too.

This has prompted a renewed interest in the prolonged effects of space travel on the human body, and a lot of fascinating research has been conducted aboard the International Space Station over the last two decades.

The main objective risk to astronauts is exposure to galactic cosmic radiation. This can be reduced to some degree by shielding of space habitats, however, the impacts of microgravity are much harder to engineer away. In part 1 we’ll discuss spaceflight associated neuro-ocular syndrome and other sensorimotor impacts. In part 2 we’ll focus on the effects of microgravity on bone density and the circulatory system.

We’ll also talk through the management of a cases of suspected thrombosis on the international space station from a few years ago. Medical care on orbit has many parallels with the remote medicine you’re already familiar with.

Chapters4:55 Cosmic Radiation
18:34 Spaceflight Associated Neuro-ocular Syndrome
33:01 Occupational Hazards

ProductionProduced by Mic Cavazzini DPhil. Recording of ‘Also Sprach Zarathustra’ by Richard Strauss, licenced under Creative Commons from the Lud and Schlatts Musical Emporium Conducted by Philip Milman. Music licenced from Epidemic Sound includes ‘Orthosie’ by Ben Elson, ‘Spring Water’ By Chill Cole and ‘Temple of Runha’ by ELFL. Music courtesy of Free Music Archive includes ‘The Undertake’ and ‘Operation A’ by Borttex. NASA audio downloaded from SPACE.com YouTube channel. Image courtesy of NASA and WikiCommons. Image of first US moonwalk by Ed White courtesy of NASA and WikiCommons.

Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr Stephen Bacchi.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

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The record for the longest space-flight is held by physician-cosmonaut Valeri Polyakov. Back in 1994-95, he spent 437 days on the Mir space station and grew 4 centimetres in height through elongation of his spine in micro-gravity. Polyakov had an uncomfortable ride back to Earth in the very precisely customised descent module.

Microgravity also causes demineralization of weight-bearing bones that is faster than age-related decline. But the cosmonaut had worked out religiously for the entire mission and after his capsule parachuted to the ground he made a point of walking from it relatively unassisted. One of the main objectives of the marathon flight had been to prove that walking proudly onto the Martian surface after a 9-month journey might be possible, given it only has 37 percent the gravitational force that Earth does.

Microgravity additionally results in adaptive plasticity of the vestibular and sensorimotor networks and deconditioning of the cardiovascular system. Indeed, several years ago there was a medical emergency aboard the international space station when an ultrasound investigation revealed thrombosis of the internal jugular vein in one astronaut. In this podcast we discuss how management of cases like this has many parallels with remote medicine on earth. Part 1 of this series examined the risks of cosmic radiation and spaceflight-associated neuro-ocular syndrome among other things.

Guests Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace) Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania)
Dr John Cherry PhD FACRRM (Deputy CMO, Australian Antarctic Division)
Chapters1:08 Bone mineral density
15:35 Circulation and a case study in remote medicine
35:04 Historic medevacs from space

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Spring Water’ By Chill Cole, ‘At the End of Nothing’ by Silver Maple and ‘Mega Woman IV’ by ELFL. Music courtesy of Free Music Archive includes ‘Snowfall’ by Kai Engel. Graphic is AI-generated and shared online with a Creative Commons licence.

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A 72-year-old female presents to an Adelaide emergency department with bilateral eye pain and redness lasting several days. She has a history of hypertension, hypercholesterolemia and age-related macular degeneration for which she has received a range of medications. Anterior uveitis is identified as the proximal cause of the ocular pain but there are many possible aetiologies that require careful consideration. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.

Guests Associate Professor Jagjit Singh Gilhotra ,FRANZCO (Queen Elizabeth Hospital; University of Adelaide)
Dr Yong Min (Shane) Lee FRACP(Royal Adelaide Hospital)

HostAssociate Professor Stephen Bacchi FRACP(Lyell McEwin Hospital; University of Adelaide)

ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Key Reference (Spoiler Alert)

Bilateral occlusive retinal vasculitis secondary to intravitreal faricimab injection: a case report and review of literature [Lee, Eye Vis. 2024]

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Australia has just approved a second amyloid-targeting therapy for patients with incipient Alzheimer’s dementia. Lecanemab (Leqembi) now joins donanemab (Kisunla) on the Australian Registry of Therapeutic Goods but the impact of both has been modest in Phase III trials to date. After 18 months of therapy they delay progression of disease, as quantified on neurocognitive tests, by around 5 months on average.

For some, the prolonged independence and dignity will justify the $60,000 to $80,000 a year price tag for the drugs. But for the Pharmaceutical Benefits Advisory Committee “the high burden of [donanemab] treatment on both patients and the health system, combined with the risks and modest clinical impact, makes the drug unsuitable for PBS subsidy”.

This burden includes specialist consults, gene screening, multiple MRI and PET brain scans, and delivery of monthly or fortnightly infusions, adding up to another $20,000 in costs. Even before considering these logistical requirements, Australian memory clinics don’t have anywhere near the capacity to address the 245,000 new cases of early dementia or mild cognitive impairment every year.

Advocates see these disease-modifying therapies as a turning point for dementia research and argue for further investment in the systems infrastructure needed to roll them out. Sceptics argue that the available evidence instead questions the importance of amyloidosis in the Alzheimer’s disease cascade.

GuestsProfessor Michael Woodward AM FRACP FANZSGM FAAG FAWMA (Austin Health, Melbourne; University of Melbourne)
Dr Chrysanth Pulle FRACP (Prince Charles Hospital, Brisbane)

Chapters13:16 Time Saved
16:18 Costs of treatment
26:44 IMJ paper on resourcing
39:10 Scepticism and staging

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘RGBA’ and ‘Pulse Voyage’ by Chill Cole, ‘A Forest Melody’ by Tellsonic, ‘Axon Terminal’ by Out to the World, ‘Organic Textures 2’ by Johannes Bornlof and ‘Fugent’ by Lupus Nocte. Image courtesy of Wikimedia Commons and University of Pittsburgh.

Editorial feedback kindly provided by physicians of the podcast editorial group Ronaldo Piovezan, Aidan Tan, Hugh Murray, Joseph Lee, Rahul Barmanray, Simeon Wong and Sebastian Lambooy. Thanks also to Profs Bruce Campbell, Mike Parsons and Amy Brodtmann and registrars Jamie Bellinge and Karan Singh for additional insights into research methods.

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A 27-year-old male wakes up with weakness in the left arm and leg and gets himself admitted at Royal Adelaide Hospital. Shockingly, for an otherwise well young man with no significant medical history, a right middle cerebral artery acute ischaemic stroke is identified by CT angiogram. His condition deteriorates in hospital, and a mediastinal mass is discovered on review which gives a lead as to the distal cause. This conversation describes the expedient workup and methodical consideration of some rarer causes of ischaemic stroke.

Guest Dr Rudy Goh FRACP(Lyell McEwin Hospital, University of Adelaide)
HostAssociate Professor Stephen Bacchi FRACP(Lyell McEwin Hospital; University of Adelaide)

ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Key Reference (Spoiler Alert)

Disseminated Aspergillosis with Mediastinal Invasion Causing Fatal Stroke in an Immunocompetent Young Man [Case Rep Neurol. 2024]

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Diabetic ketoacidosis can be life-threatening but there’s some variability in the way it’s managed between health settings. Intervention involves intravenous insulin administration, hydration, electrolyte replacement and treatment of the underlying precipitant. In a survey of practitioners from 31 different hospitals in Australia there was an even split between those organisations which followed a fixed rate insulin infusion protocol, usually based on bodyweight, or a variable rate infusion protocol, titrated against blood glucose concentration.

Three quarters of survey respondents had worked at another hospital that had different DKA management protocols raising concerns about the cognitive load on junior health staff moving between institutions. In Europe there has been some normalisation towards fixed rate protocols, despite there being no good quality evidence for superiority. In this podcast we hear some theories from two of the authors of the study published recently in the Internal Medicine Journal.

12:40 SGLT2 inhbitor-associated ketoacidosis
17:26 The cognitive burden of variation across settings
25:11 the challenges of researching this questions

Guests
Dr Lisa Raven FRACP PhD (St Vincent's Hospital, Sydney)Dr Mahesh Umapathysivam FRACP DPhil (Southern Adelaide Diabetes and Endocrine Service; Royal Adelaide Hospital)

Guest HostDr Mervyn Kyi FRACP PhD(Royal Melbourne Hospital; Northern Hospital)

ProductionProduced by Dr Mervyn Kyi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Aidan Tan, Hugh Murray, Stephen Bacchi and Aafreen Khalid.

Key Reference“Heterogeneity in the management of diabetic ketoacidosis in Australia: a national survey” [IMJ. 2025]

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Pomegranate Health has been streaming since June 2015, so we’re going to share a few more classic eps from the last ten years. First up, presenter Mic Cavazzini digs deep to find the origins of the pomegranate, featured not just on this podcast but on the crest of the RACP. The journey starts 500 years ago at an unlikely place, the marriage of Henry VIII and the first of his six wives. You’ll find much of the pageantry reproduced at the web page.

We then hear from the wonderful staff at Marrabinya, a support service in western NSW that helps connect Aboriginal patients to specialist consultations. As heard in episode 53, and a handful of others, healthy equity for First Nations people is a value embedded in the mission of the RACP. At Pomegranate Health we also try to support physician wellbeing and career development. One podcast towards that end was Episode 55: Starting out in Private Practice. We hear a pep talk from veteran rheumatologist Louis McGuigan about when and how to back yourself in such a business venture.

Another episode with a practical theme was number 56 titled “Billing in Byzantium” where we heard how it is that a few billion dollars are inappropriately leaked from Medicare every year. Finally, in a sample from Episode 69. we hear about some of the structural bias in the health system that results in a gendered understanding of drug effects. All of these episodes and more, are now available on YouTube, as well as all the usual podcast browsing apps.

Sampled in this retrospective episode:
Desley Mason, Possum Swinton and Kym Lees from Ep53: Marrabinya
Dr Louis McGuigan from Ep55: Starting out in private practice
Margaret Faux PhD from Ep56: Billing in Byzantium
Professor Zoe Wainer from Ep69: Gendered Medicine 2- Funding and Research

Production CreditsProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Fair Game’ by Mizlo, ‘Salat Alsabah’ by Feras Charestan, ‘Your Wave’ by Cospe, ‘Dusty Delta Day’ by Lennon Hutton, ‘Corn Candy’ by Guustavv and ‘After the Freak Show’ by Luella Gren. Music courtesy of FreeMusicArchive includes JS Bach's ‘March Fur Die Arche’ performed by The United States Army Old Guard Fife and Drum Corps and ‘Notre Dame’ by Jahzarr. Allegri’s ‘Miserere’ performed by Trinity College under Creative Commons licence from archive.org.

Editorial feedback kindly provided by RACP staff Kathryn Smith, Arnika Martus and Ruby Nelson.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to

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Cerebral microbleeds are a finding on MRI that are usually asymptomatic. There are two main aetiological pathways, one occurring as a result of uncontrolled hypertension and the other from the accumulation of amyloid-beta peptide. The link between cerebral amyloid angiopathy and Alzheimer’s Disease is not understood and even the impact that cerebral microbleeds more generally have on cognition.

For the study discussed today, clients of an Australian memory clinic were retrospectively assessed for prevalence of cerebral microbleeds and how this correlates to performance on cognitive tests and formal diagnosis categories. Prevalence of multiple cerebral microbleeds was associated with poorer cognitive performance and more severe diagnoses. And there are suggestions of a shared instigator between Alzheimer’s Disease cerebral amyloid angiopathy. But novel anti-amyloid therapies can also cause increased bleeding risk, meaning that multiple microbleeds are a contraindication for these drugs. We hear how clinicians in the memory clinic balance therapeutic outcomes and potential risks.

Guest Associate Professor Paul Yates FRACP PhD(Austin Health; University of Melbourne)
Co-HostDr Duncan Austin FRACP PhD(Alfred Health; Cabrini Health)

ProductionProduced by Dr Duncan Austin and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Joseph Lee and Aidan Tan.

Key ReferencePrevalence and Associations of Cerebral Microbleeds in an Australian Memory Clinic Cohort [IMJ. 2025]

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A 46-year old man is admitted to hospital following a first time presentation of psychosis that involved barricading himself inside a neighbour’s home. At admission he appears disorganised with slow movements and speech. His rambling reveals bizarre delusional beliefs of a paranoid and persecutory nature. At moments he shows aggression towards staff but when examines reports occasional dizziness and an intolerance of cold. Physical examination reveals cool peripheries, sparse axillary and pubic hair, and soft adult-sized testicles. The investigating team suspect hypothyroidism and a complex series of investigations and therapies follows.

Guests Dr Peak Man Mah FRACP(Lyell McEwin Hospital, University of Adelaide) Dr Malcolm Borg (Royal Adelaide Hospital)
HostsAssociate Professor Stephen Bacchi FRACP(Lyell McEwin Hospital; University of Adelaide)
Mic Cavazzini DPhil

Editorial feedback kindly provided by RACP physician Simeon Wong and medical student Cindy Shi.

Key Reference (Spoiler Alert)

Panhypopituitarism and psychosis in a male patient [Aust N Z J Psychiatry. 2010]

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Pomegranate Health marks ten years of podcasting since its launch in June 2015. This episode will be one of two samplers that dip into the back catalogue of 131 episodes to showcase some of the most compelling stories. You’ll hear how podcast themes are identified from all the domains of medicine and professionalism. And a little bit about the motivations of long-time producer and presenter, Mic Cavazzini.

Pomegranate Health has several thousand listeners in over 150 countries. Three quarters of listeners are, predictably, in Australia and Aotearoa-New Zealand, but a full 14 per cent are located outside the traditional anglosphere. RACP is proud to provide this platform to showcase the great work and dedication of its members. It’s also a place where physicians can learn from the other professionals and patient advocates that make up the health system.

Sampled in this retrospective episode:
Prof Meera Agarfrom Ep33: Early days for medicinal cannabis
Dr Paul Drury and Prof Sophia Zoungasfrom Ep41: Targeting Diabetes
Prof Rinaldo Bellomo from Ep70: Zeroing in on “the renal troponin”
Dr Nic Szecket and Dr Art Nahill from Ep32: Cognitive biases in diagnostic thinking
Prof Ian Harris and Assoc Prof Louise StonefromEp25: Dealing with Uncertainty Part 1
Dr Danielle Ofri from Ep38: Making a Connection
Michael Pooley as Dr David Hilfiker from Ep75: Feeling guilty- Medical Injury Part 2

CreditsProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Le Hustle’ by Polyrhythmics, ‘Your Wave’ by Cospe, ‘Soul Single Serenade’ by Dusty Decks, ‘Hollow Head’ by Kenzo Almond and ‘Illusory Motion’ by Gavin Luke. Music courtesy of FreeMusicArchive includes ‘I got 99 broadswords but this one isn't one’ and ‘Friends’ by Komiku and ‘Cree’ by Satellite Ensemble. Thumbnail image is the copyright of RACP.

Editorial feedback kindly provided by RACP physicians Zac Fuller and Simeon Wong. Thanks also to RACP staff Kathryn Smith, Michael Davidson and Anne Fredrickson.
Please visit the Pomegranate Health web page for a list of thankyous over the ten years. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

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In this podcast we discuss low-value care that has emerged from a decay in the specificity of the terms “cardiac arrest” and “cardiopulmonary resuscitation.” Patients who experience cardiac arrest in hospital are rarely more than a minute or two away from defibrillation. But the proportion of shockable rhythms in these patients is low as the heart has typically stopped after the decline of other systems. In such conditions, chest compressions are more likely to cause unnecessary trauma than improve survival outcomes.

As retired UK palliative care physician Kathryn Mannix explains, “cardiac arrest” was originally reserved for unexpected events in relatively healthy individuals in the community. She says we need to separate this from the more progressive phenomenon that is better described as “natural dying”.

There is also a semantic breakdown in the understanding of what “cardiopulmonary resuscitation” entails. Surveys of Australasian medical practitioners show that the majority consider CPR to include defibrillation and drugs not just chest compressions and ventilation. As a result, Do Not Attempt CPR orders get perceived as being “a stop sign” to other treatments that may be beneficial. We hear from the NZ-based authors of that research, cardiologist Dr Tammy Pegg, intensivist Dr Alex Psirides and palliative care physician Dr Kate Grundy.

Chapters 4:00 CPR for out-of-hospital cardiac arrest
8:43 Overuse of CPR in hospitalised patients 20:08 Crude algorithms and failed conversations
40:17 Semantic confusion around what CPR entails
48:13 The midwifing of natural dying

GuestsDr Kathryn Mannix (www.kathrynmannix.com) Dr Tammy Pegg MRCP FRACP FC CANZ DPhil (Nelson Marlborough Hospital cardiology department)
Dr Alex Psirides FCICM (Wellington Regional Hospital intensive care unit)
Dr Kate Grundy FAChPM FRACP (Christchurch Hospital palliative care service; University of Otago)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Awash’ by Gavin Luke, ‘Fields 3’ by Gunnar Johnsén, ‘RGBA’ by Chill Cole and ‘Til All that’s Left is Ash’ by Ludlow.

Music courtesy of FreeMusicArchive includes ‘New Times’ by 4T Thieves and ‘Secret Place’ by Alex Fitch. Image by Yuichiro Chino licenced through Getty Images. Football commentary courtesy of UEFA Euro 2021.

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Fionnuala Fagan, Simeon Wong, Hugh Murray and Aidan Tan. Thanks also to RACP staff Arnika Martus and Kathryn Smith.

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Despite filling more than half of places in Australian medical schools, women represent 45 per cent of all medical practitioners and just 36 per cent of specialists. Female representation dwindles further in many areas of clinical leadership, prompting what has been termed a “leaky pipeline”. It has been reported that women would progress at similar rates to men, and achieve similar remuneration, were it not for the time taken out from the profession to raise children. In this podcast we discuss what it would take to mitigate this so-called “motherhood penalty” through policy, workplace culture and better distribution of labour in the home. This discussion is important because it relates not just to the wellbeing and rights of individual medics, but also to the depth and diversity of the workforce.a

Chapters1:38 Better support of mothers returning to work
9:09 How leave and part-time work affects the medical workforce and the benefits of flexibility
19:56 The “motherhood penalty” on career progression of women to senior positions
33:52 Broader biases in society not just around gender roles but a health work-life balance

GuestsAssociate Professor Kara Allen FANZCA (Royal Melbourne Hospital; University of Melbourne)
Dr Jenny Proimos FRACP (Royal Children's Hospital Melbourne; Monash Centre for Health Research and Innovation;

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Melting Places’ by Andres Cantú, ‘Not Blue’ by Kylie Dailey. Music courtesy of Free Music Archive includes ‘Good Days’ by Cody Francis, ‘Planting Flags’ by Blue Dot Sessions, ‘Helice’ by Monplaisir, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by George Peters licenced through Getty Images.

Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Joseph Lee, David Skalicky, and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith and also to Sarah Anderson of La Trobe University for guiding me through some of the AIHW data.

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ST elevation is clearly a worrying finding that can herald life-threatening conditions, such as ST elevation myocardial infarction. But not all ST-elevations are created equal, and Trainees would benefit from considering a broader number of causes for this presentation. In today’s podcast the team will discuss a case of ST elevation observed in a 65-year-old female during the routine elective procedure of atrial fibrillation ablation. A range of pathophysiologies is discussed that can help listeners work though the differentials in a systematic way.

Guests Assoc Prof Pramesh Kovoor FRACP FACC PhD (Westmead Hospital; the University of Sydney) Dr Neil Warwick FANZCA (Westmead Hospital)
HostsAssociate Professor Stephen Bacchi FRACP (University of Adelaide)
Dr Joshua Kovoor (Ballarat Base Hospital)

Editorial feedback kindly provided by RACP physicians Aidan Tan, Aafreen Khalid, Hugh Murray and medical student Nivida Dixit.

Key Reference (Spoiler Alert)

Metaraminol-induced coronary vasospasm masquerading as ST-elevation myocardial infarction during general anaesthesia [Br J Anaesth. 2024]

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There is evidence that six months or more off the job leads to some loss of practical skills and knowledge and certainly, many doctors report a loss of self-confidence. People take time out from medical practice for many different reasons but career breaks to raise children are more common than ever before. Senior staff at Sydney Children’s Hospital have developed a day-long workshop to help medics brush off the cobwebs before they return to practice. It involves rehearsal of specific skills, refreshers on calculation and interpretation tasks and a high-fidelity critical care simulation. Just as importantly, there is open discussion and mentorship to support the transition back to work. The program is called Paediatric Returnees after Maternity or Extended Leave (PRAM) this podcast was recorded during a live workshop at the Kids Simulation Centre, Randwick.

GuestsWorkshop participants:
Elodie, Eliza, Emma, April, Stephanie, Lucy and Paula.

PRAM creators:
Dr Josephine Goodyer FRACP (Sydney Children’s Hospital, Randwick)
Dr Sasha Symonds FRACP FACEM (Sydney Children’s Hospital, Randwick)
Renee Byrne (Sydney Children’s Hospital, Randwick)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Elm Lake’ by Elm Lake, ‘Quiet Waters’ by Walt Adams, ‘Illuminations 4’ by Johannes Bornlöf, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by Maskot licenced through Getty Images.

Editorial feedback kindly provided by RACP physicians Sasha Taylor, Stephen Bacchi,Simeon Wong, Zac Fuller, Hugh Murray, Aidan Tan, Sern Wei Yeoh, Sasha Taylor and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

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In this episode we hear about an emergency presentation to a South Australian hospital, of a 74-year-old male with shortness of breath. The curve ball is that he had undergone ablation for drug-refractory atrial fibrillation less than two weeks prior. This discussion gives an overview of developing technologies for AF treatment and developing knowledge about the possible complications. We also have some multiple choice questions to test your understanding.

Guest Dr Shaun Evans, FRACP (Royal Adelaide Hospital; University of Adelaide)
HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Jasmine Le (University of Adelaide)

Editorial feedback kindly provided by RACP physicians Hugh Murray, Aidan Tan, Aafreen Khalid, Sebastiaan Lambooy, Amy Hughes and Lauren Gomes.

Key Reference (Spoiler Alert)

Delayed cardiac tamponade from pericarditis following pulmonary vein cryo-balloon ablation [IMJ. 2020]

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In Aotearoa-New Zealand, the proportion of doctors identifying as Māori has doubled from where it was a decade ago to over 5 percent. But there is still a long way to go before the workforce is representative of the broader population which is 17 percent Māori.

The Auckland and Otago Medical Schools have in recent years turbocharged their intake of Māori and Pasifika students but these graduates don’t seem to have trickled through to the RACP in great numbers. Just 3.5 percent of general physicians and 4.8 percent of paediatricians identify as Māori, and Pasifika doctors make up a further 1 and 2 percent respectively.

In this podcast, three Māori medics discuss how the culture of training environments can be made more welcoming to junior doctors with diverse ethnic backgrounds. This discussion takes place in light of an independent review into the clinical examination for paediatrics in Aotearoa-New Zealand which found issues with standardization, transparency and cultural safety. 2024 was a tough year for Māori Health more broadly, as it saw the disestablishment of a dedicated Health Authority, Te Aka Whai Ora, after just twelve months of operation.

Guests Dr Danny de Lore FRACP (Rotorua Hospital; University of Auckland)
Dr Matthew Wheeler FRACP (Tauranga Hospital; University of Auckland)
Dr Ngaire Keenan PhD (Sydney Children’s Hospital, Westmead; University of Otago)

ProductionProduced by Mic Cavazzini DPhil. Music provided courtesy of FreeMusicArchive includes ‘Periodicals’, ‘In Paler Skies’ by Blue Dot Sessions and ‘Wake Up’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Subdivision of the Masses’ by Philip Weigl and ‘Abyss’ by Luwaks. Image of Dr Danny de Lore property of RACP

Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Hugh Murray, Sasha Taylor, Anne-Marie Juengling and Simeon Wong. Thanks also to RACP staff Nick McCurdy and Sarah Millar.

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This case report comes to you from Brigham and Women’s Hospital in Boston, a huge teaching hospital that serves the Harvard Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To complicate things, there was a past medical history of migraines and a family history of a Factor V Leiden mutation. The identified diagnosis is one in which evidence is limited for aspects of management, and the topics of uncertainty and mentorship in medicine also arise in this discussion.

Guest Galina Gheihman, MD D(Brigham and Women’s Hospital; Harvard Medical School)
HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Haelynn Gim (Harvard Medical School) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Editorial feedback kindly provided by Dr Sebastiaan Lambooy.

Key Reference (Spoiler Alert)

Isolated Cortical Vein Thrombosis [Neurohospitalist. 2023]

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Professor Gary Lee established the first dedicated pleural service in the southern hemisphere in 2009, at the Sir Charles Gairdner Hospital in Perth. He says that pleural disease has finally come to be regarded as an area of subspeciality interest in its own right, not just a complication of other comorbidities. In this podcast he presents a potted history of key developments in the management of pleural effusion in particular.

This is diagnosed in about 60,000 people every year in Australia, mainly as a result of infection or malignancy. With mentors in the UK, Professor Lee conducted some of the earliest trials on fibrinolytics and DNAses to break down purulent effusions. They also put to the test protocols for pleurodesis via talcum insufflation that date back to the 1930s.

Professor Lee’s more recent clinical research has focused on the use of indwelling pleural catheters that a patient can use to drain pleural effusate when feeling breathless. He has also a made an important contribution to conservative management guidelines for primary spontaneous pneumothorax. This story is great example of how clinical practice emerges imperfectly from a soup of evidence, accidents, human biases and system.

Guest Prof Gary Lee PhD FRACP FRCP FCCP (Pleural Service, Sir Charles Gairdner Hospital in Perth; University of Western Australia).

Co-host
Dr Marion Leighton FRACP (Wellington Hospital).

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Reconstruct’ by Amaranth Cove, ‘Nagba Algooah’ by Ebo Krdum. ‘Vittoro’ by Borrtex provided courtesy of FreeMusicArchive. Image by ilbusca licenced through Getty Images.

Editorial feedback kindly provided by RACP physicians Aidan Tan, Maansi Arora, Simeon Wong, Hugh Murray and Vanessa Wong.

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This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from the Massachusetts General Hospital and Brigham and Women’s Hospital take listeners through the case and related issues in a step-by-step manner at a level targeted for trainees and generalists.

Guest A/Prof Camille Kotton (Massachusetts General Hospital, Harvard University)Dr Simran Gupta (Brigham and Women’s Hospital, Harvard University)

HostsAssociate Professor Stephen Bacchi FRACP (Fulbright Fellow, Mass General Brigham; University of Adelaide)
Christina Gao (University of Adelaide)

Editorial feedback kindly provided by doctors Maansi Arora, Brandon Stretton, Matt Lim and Ben Cook.

Key Reference (Spoiler Alert)

Coccidioidal Meningitis after Liver Transplantation in a Nonendemic Region: A Case Report [Transplantation 2006]

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In the previous episode we heard how some rationally-designed therapies work on almost any cancer with the right molecular signature. Tumour-agnostic medications could be godsend for patients with rare cancers which have classically been overlooked by drug developers, and those with advanced cancers of unknown origin. 15,000 such patients have undergone comprehensive genome profiling of their tumours through the organisation, Omico. In this podcast, Omico’s founder explains that while the majority have received recommendations about matched therapies, clinical trials are typically the only way to enable access. Professor David Thomas discusses why Australia’s Health Technology Assessment process appears to be so conservative and how the market price of next-generation oncotherapies might be brought down by changes across the local ecosystem.

Guest Prof David Thomas FRACP PhD (Director, Centre for Molecular Oncology UNSW; Founder and Chief of Science, Omico)

Professor Thomas or Omico have received grants, consultancies or research support from Roche, Astra Zeneca, Pfizer, Eisai, Illumina, Beigene , Elevation Oncology, RedX Pharmaceuticals, SunPharma , Bayer, George Clinical, Novotech , Merck Sharpe and Dohme, Boehringer Ingelheim, Hummingbird, Microba , BioTessellate , PMV Pharma, Australian Unity and Foundation Medicine.

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Multicolor’ and ‘Pulse Voyage’ by Chill Cole. ‘Impulsing’, ‘the City of Hope’ ‘Over Again’, and ‘Going Undercover’ by Borrtex provided courtesy of FreeMusicArchive. Image by Guido Mieth licenced through Getty Images.

Editorial feedback kindly provided by RACP physicians Simeon Wong, Stephen Bacchi. Thanks also to Kym Bramich and Arnika Martus on staff with Omico and RACP respectively.

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The genomic understanding of cancer has transformed a tissue-based classification model that had been dominant for 150 years or more. The last three decades have seen highly targeted therapies developed at blistering pace, and unprecedented improvements in patient outcomes.

To date, these advances have been focused on more common cancers. The financing model for drug development means that rare cancers get overlooked, given the small pool of potential buyers relative to the costs and risks of investment.

However, the molecular targets characterised in more common cancers are often found in cancers of a different histotype. As such, precision therapies will sometimes have tissue-agnostic efficacy and offer a lifeline for patients with neglected diseases or cancers of unknown origin.

Professor David Thomas has founded an NGO called Omico to enable such patients to undergo profiling for hundreds of potential molecular targets. In this interview he explains the rationale for the most promising pan cancer therapies, and in the next episode we discuss changes to the regulatory and funding model required to sustain this screening program.

Guest Prof David Thomas FRACP PhD (Director, Centre for Molecular Oncology UNSW; Founder and Chief of Science, Omico)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘the Orchard’ by Jakob Ahlbom; ‘Dusty Electronics’ and ‘Pulse Voyage’ by Chill Cole; ‘Tam’ by LJ Kruzer. ‘See you soon’ and ‘Going Undercover’ by Borrtex provided courtesy of FreeMusicArchive. Image by filo licenced through Getty Images.

Editorial feedback was kindly provided by RACP physicians Nichola Ball, Stephen Bacchi, Aafreen Khalid, Simeon Wong, Maansi Arora and Aidan Tan.

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This case report describes a 35-year-old Caucasian male presenting with 5 weeks of progressive weakness in the proximal limbs and trunk and associated changes to the skin. The man was previously well and not taking any regular medications. There are many pathways this undifferentiated patient could go down. Consultant physician, Professor Josephine Thomas demonstrates a systematic way to work through the differential diagnoses as would be expected in a long-case presentation for basic physician training exams. She's the Clinical Dean for the Adelaide Medical School at the Northern Adelaide Local Health Network.

Guest Prof Josephine Thomas FRACP FRACGP FANZAPHE PhD(Northern Adelaide Local Health Network; University of Adelaide)

HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Dr Caleb Chong (Northern Adelaide Local Health Network)

Editorial feedback kindly provided by Dr Brandon Stretton and Ben Cook.

Key Reference (Spoiler Alert)

*
A case of haemorrhagic myositis with concurrent anti-Ro52 and anti-NXP-2 antibodies treated with plasmapheresis [Rheumatology. 2020]

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In 2019 a man was referred to Royal Adelaide Hospital with worsening breathlessness and a productive cough. He was a 47 year old electrician with a history of tobacco smoking who’d been well before the onset of symptoms. Over a couple of admissions the patient’s condition progressed to type 2 respiratory failure. While the ultimate explanation for this presentation was a bit of a unicorn, the dramatic escalation of examinations and interventions runs through some textbook respiratory medicine; ECMO, infectious diseases, bronchoscopy, CT, interpretation of blood gases and the alveolar gas equation, stenting and ultimately transplantation. This is discussed in the careful manner expected of a long-case presentation in the physician training exams.

Guest Dr Thomas Crowhurst FRACP (Northern Adelaide Local Health Network)

HostsAssociate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr Brandon Stretton (Central Adelaide Local Health Network)

Key Reference (spoiler alert)

Case report of severe bronchial web-like stenoses after 'surviving the unsurvivable' [BMC Pulm Med. 2019]

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Thrombectomy for acute ischaemic stroke has undergone great advances in the last decade, but the expertise and technology is restricted to tertiary hospitals. Outside of large metropolitan centres, thrombolytic treatment can buy a patient time, but for almost 30 years the first line agent has remained unchanged.

Alteplase is an analog of the human tissue plasminogen activator which activates plasmin to dissolve fibrin blood clots. For many years it was assumed that alteplase should be administered within 3 hours of symptom onset, thus it was a big deal when in 2008, research showed that that window could be safely broadened out to four and a half hours.

Today’s guests have over the intervening years been pushing the envelope even further, in an effort to help the more than two thirds of stroke patients who present after that threshold. In this podcast, Professors Bruce Campbell and Mark Parsons discuss a trial of the relatively novel agent, tenecteplase. The publication in the New England Journal of Medicine showed that tenecteplase could improve patient outcomes even if administered up to 24 hours out from a large vessel occlusion. The researchers explain the steps that led up to their study, and the importance of perfusion imaging to identify candidates with salvageable brain tissue.

Key ReferenceTenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy [NEJM. 2024]

GuestsDr Duncan Austin PhD FRACP MRCP (Cabrini Health)
Professor Bruce Campbell PhD FRACP (Cabrini Health; Royal Melbourne Hospital; University of Melbourne)
Professor Mark Parsons PhD FRACP, FAAHMS (Sydney Neurointerventional Specialists; Consulting in Neurology, Maitland).

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort Out’ by Walt Adams and ‘the Appalachian Trail’ by Hunter Quinn. Image produced and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, Courtney Dowd, Saion Chaterjee and David Arroyo.

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This podcast follows the case of a 48-year-old male with a 3-month history of diarrhoea and associated lymphadenopathy. A complex constellation of symptoms accompanies this presenting complaint, along with a key radiological finding that enabled the treating team to arrive at the correct diagnosis. Can you arrive at the correct diagnosis before the treating team? This case was managed at the Queen Elizabeth Hospital and is presented by Dr Andrew Vanlint from the Northern Adelaide Local Health Network and University of Adelaide.

CreditsDr Andrew Vanlint FRACP AFRACMA (Northern Adelaide Local Health Network and University of Adelaide
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)

Key Reference (Spoiler Alert)

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Lessons from practice: Low attenuation lymphadenopathy on computed tomography leading to diagnosis of Whipple disease [Vanlint; Med J Aust. 2020]

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This recording comes from the launch of the 2nd Monitoring and Evaluation Report on Hepatitis C Elimination in NSW. The work was conducted through the Kirby Institute under the guidance of infectious diseases specialist, Professor Greg Dore. As presented in this seminar, data show that the state is on track to meet the 2025 target set by NSW Health, and the national target for 2030, but there have been surprises along the way that have required an adaptable approach to surveillance and intervention.

This is particularly true in correctional settings which typically have high rates of hep C transmission due to the amount of injecting drug use that takes place coupled with an absence of needle exchange programs.Presenting on this theme was Colette McGrath, who is General Manager of Population and Preventative Health for Justice Health NSW. Her very pragmatic approach is informed by almost a decade of experience working with this population.

Key ReferenceHepatitis C Elimination in NSW: Monitoring and Evaluation Report, 2024 [Kirby Institute]
Video Recording from launch event

GuestsProf Greg Dore FRACP (Kirby Institute, Viral Hepatitis Clinical Research Program Head; St Vincent’s Hospital).
Colette McGrath (Population and Preventative Health, General Manager, Justice Health NSW)

ProductionRecorded by Kirby Institute staff. Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Southern Sun’ and ‘Quiet Waters’ by Walt Adams, ‘Train Ride’ by Alex Kehm and ‘The Appalachian Trail’ by Hunter Quinn. Image produced and copyrighted by RACP.

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Dr Karan Singh loves his job as a registrar in nuclear medicine but he thinks there isn’t enough exposure to the specialty during medical school and basic training. In this podcast we spend a day in his department at Prince of Wales Hospital Sydney and get a taste of the many different referrals that come his way; a bone scan for a young man experiencing leg spasms after recovering from a car crash; myocardial perfusion imaging for an elderly gentleman with coronary artery disease; staging for prostate and breast cancer; and radiation therapy for a toxic multinodular goiter. The “reality audio” format gives a good sense of the daily tasks and responsibilities involved in this career pathway.

Credits

Dr Karan Singh
Staff and patients at Prince of Wales Nuclear Medicine and PET Department

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Salty Sails’ and ‘Nuna’ by Sindrandi, ‘Between Four Eyes’ by Czar Donic, ‘Organic Textures 2’ by Johannes Bornlöf and ‘Punjabi Swag’ by Aks and Lakshmi. Image by JohnnyGreig licenced through Getty Images.

Editorial feedback kindly provided by RACP physicians Jamie Bellinge, Joseph Lee, Sern Wei Yeoh, Zac Fuller and Stephen Bacchi.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

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The LACE index is a prognostic algorithm for predicting the likelihood that a newly discharged patient will come back into hospital within 30 days because of complications. Today’s IMJ paper describes a validation of the LACE index in a regional Victorian setting. Identifying patients who are at risk could allow for better targeted care at the first admission, reducing harm to patients and inefficient use of healthcare resources.

The researchers also tested a novel classification tool for scoring which readmissions are avoidable and which are just an unfortunate outcome of the patient’s illness. This could help more accurately track quality of care within and between healthcare service providers.

GuestsProf Christian Gericke PhD FRACP FAFPHM AFRACMA FRCP Edin FEAN FAAN (Calvary Mater, Newcastle; University of Newcastle; University of Queensland)
Dr Reinhardt Dreyer (South West Medicine ; University of Stellenbosch) Dr James Gome FRACP (South West Medicine, Clinical Director General Medicine)

ProductionProduced by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Treetops’ by Autohacker and ‘The Cold Shoulder’ by Kylie Dailey. Image created and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Aidan Tan, Joseph Lee, David Arroyo and Stephen Bacchi.

Key ReferenceCauses for 30-day readmissions and accuracy of the LACE index in regional Victoria, Australia [IMJ. 2024]

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This podcast follows the case of a 58 year old man who presented to the haematology department at Flinders Medical Centre with intravascular coagulation and leukocytosis. He was diagnosed with acute myeloid leukaemia and treated on standard cytarabine and daunorubicin combination therapy. Nine days after initiation, the patient developed painless diplopia and ptosis, and the story is picked up with a referral to the neurology department.

Guests
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr James Triplett FRACP (Flinders Medical Centre, consultant neurologist)

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

Key Reference and Learning Points (Spoiler Alert)

Painless progressive mononeuritis multiplex secondary to AML associated neuroleukemiosis [J Neuroimmunol. 2023]

(1) Chemotherapy can have neurological complications, including chemotherapy induced peripheral neuropathy (e.g., oxaliplatin).

(2) A third (oculomotor) cranial nerve palsy has multiple possible causes, which can be divided into painful vs painless causes, and compressive (classically with pupillary involvement) vs non-compressive (can spare pupil, as with microvascular insult) causes.

(3) Conduction block is shown by a significant reduction in compound muscle action potential, between proximal and distal stimulation, the criteria for which varies by nerve.

(4) Ascertaining whether conduction block occurs at compressible vs non-compressible sites can be a useful distinguishing feature for the various possible causes e.g. including compression, demyelination, and ischaemia, and

(5) Mononeuritis multiplex, while classically associated with a vasculitic neuropathy, has a number of causes, including leukaemia. This is the very rare condition known as neuroleukemiosis.

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The RACP Congress in May this year was opened by a fascinating lecture on mental health in the medical workforce, which has been trimmed down for audio. Professor Neil Greenberg is an occupational psychiatrist with more than 23 years in the UK Armed Forces. His extensive research within defence and health settings has informed a very pragmatic understanding of the impact of trauma and relationships in the workplace. Professor Greenberg overturns some entrenched beliefs we have about the presentation and management of mental illness, as does guest host Dr David Beaumont from the College Member Health and Wellbeing Committee. He reflects on the role of the Committee and how his own understanding of health has shifted in response to personal distress.

GuestsProfessor Neil Greenberg FRCPsych, FHEA, MFMLM, MInstLM, MEWI, MFFLM (Kings College, London; March on Stress)
Dr David Beaumont FAFOEM (Positive Medicine, Director; RACP Member Health and Wellbeing Committee)

ProductionProduced by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Blacklight’ by John B. Lund and ‘Lukas Got Lucky’ by Rate 44. Image by Richard Drury licenced through Getty Images.

Editorial feedback kindly provided by RACP physicians David Arroyo, Stephen Bacchi, Nele Legge, Ronaldo Piovezan, Rachel Murdoch, Aidan Tan and Rachel Bowden.

Counselling SupportCollege EAPMember service provided by TELUS Health
Australia: 1300 361 008
Aotearoa-NZ: 0800 155 318 (Aotearoa New Zealand).
See also the TELUS wellbeing app.

Doctor’s Health Advisory Service HelplineAotearoa-NZ: 800 471 2654
NSW/ACT: 02 9437 6552
VIC: 03 9280 8712
TAS: 03 9280 8712
SA: 08 8366 0250
NT: 08 8366 0250
QLD: 07 3833 4352
WA: 08 9321 3098

LifelineAustralia: 13 11 14.
Aotearoa-NZ: 0800 54 33 54

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Starting in 2023, the Medical Board of Australia and the Medical Council of New Zealand brought in what were called “Strengthened CPD” requirements. These put more focus on reviewing performance through self-reflection or peer feedback and on auditing outcomes of one’s practice. Within the RACP’s MyCPD Framework, these are described as Category 2 and Category 3 activities, respectively.

These regulatory requirements have caused consternation for some College members and the feedback has been taken on board from 2024. To help synchronise CPD seamlessly with practice, the value of research and supervision has been elevated. It’s now recognised that the time which goes into data analysis and writeup of research is better reflected under Category 3. Likewise, supervision is more than just an educational activity, as a supervisor can gain insight into their own practice from Trainee feedback that merits Category 2 credit. In this podcast, two of the RACP’s most passionate medical educators explain the changes and offer guidance on efficiently recording supervising activities using the MyCPD tool.

GuestsAssociate Professor Kudzai KanhutuFRACP GAICD (College Dean; Royal Melbourne Hospital; University of Melbourne)
Professor Martin Veysey FRACP, FRCP(GastroHealthcare; Australian National University)

ProductionCPD OnDemand project production by David Tarr. Audio editing by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Bookies’ by Jones Meadow and ‘Love Thing’ by Paisley Pink. Image created and copyrighted by RACP.

For more podcasts that you can credit to Category 1 CPD , please visit the Pomegranate Health web page. And there are many more educational videos and eLearning resources at RACP Online Learning.

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This case report has been developed by Trainees, to assist their peers with preparation of long-case presentations. It is not a fully-vetted Education resource but a “passion project” from editors of the Pomegranate Health podcasts.

The case is that of a 32-year-old woman presenting with constant and dull abdominal pain that had been sudden in onset. The pain is accompanied by nausea and vomiting but bowel habits were unchanged. The patient has a history of type 1 diabetes and a simultaneous pancreas-kidney transplant two years prior to the presentation. There is no history of rejection of pancreatitis and serum creatinine appears normal.

The attending nephrologist walks through the elimination of differential diagnoses typical of any patient and also of particular relevance to a transplant patient.

Guests
Dr Chiang Sheng Lee FRACP (Lyell McEwin Hospital; University of Adelaide)
Dr Stephen Bacchi (Lyell McEwin Hospital) Dr Amitjeet Singh (Lyell McEwin Hospital)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Aidan Tan, Brandon Stretton, David Arroyo, Keith Ooi and Fionnuala Fagan. Thanks also to Adelaide medical students Benjamin Cook, Srishti Sharma and Prakriti Sharma.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

Key Reference (Spoiler Alert)Gadolinium-Induced Acute Graft Pancreatitis in a Simultaneous Pancreas-Kidney Transplant Recipient [Case Rep Nephrol. 2022]

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Australia is a big continent and sparsely populated continent. 28 percent of Australians live in areas classified regional, rural or remote and their access to health services is much more limited. It’s estimated that between 2009 and 2011 there were 19,000 excess deaths in regional and remote areas as compared to the major cities. No doubt, socioeconomic disadvantage is factor in that mortality gap, but inequitable access to healthcare is also a major driver.

In this podcast we focus specifically on the shortage in health practitioners in the regions. Even in regional centres, the density of physicians by population count is two thirds what it is in the major cities. By the time you get to large rural towns it’s just over a third that baseline. In this podcast we discuss opportunities to lift recruitment and retention. This means improving the experience for trainees and the esteem for rural medicine in the eyes of the profession at large.

GuestsProfessor Graeme McGuire PhD FRACP MHM MPHTM (President Adult Medicine Division, RACP; Associate Dean of Medicine, Curtin University; Director of Medical Education, WA Country Health Service)
Dr Sarah Straw FRACP (Northern Hospital, Melb; Rural, Regional and Remote Working Group)
Associate Professor Matthew McGrail PhD (Head Regional Training Hub Research, University of Queensland)

ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes ‘The Envelope’, ‘Cast in Wicker’ and ‘Planting Flags’ by Blue Dot Sessions. Music licenced from Epidemic Sound includes ‘The Mission’ by J. F. Gloss. Photo by Pearshop on behalf of RACP.

Editorial feedback kindly provided by RACP physicians Steve Flecknoe-Brown, Zac Fuller, Aidan Tan, Sasha Taylor, Jia Wen Chong, Joseph Lee, Fionnuala Fagan, Stephen Bacchi, Chris Leung, David Arroyo, Nele Legge, Li-Zsa Tan and Thazin Thazin.

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Pomegranate [Case Report] is a Q&A style podcast developed by trainees, for trainees. In our debut episode, we hear about w a who man presented to the emergency department reporting sudden onset vision loss in his right eye lasting several hours. He was 68 year old with a history of type 2 diabetes mellitus. Three differential diagnoses being considered were optic neuropathy, vitreoretinal disease, or corneal oedema following from potential uveitis. In this podcast consultant ophthalmologist, Dr Sumu Simon, walks through an approach to this presentation and an exploratory therapy.

GuestsDr Sumu Simon FRANZCO (Queen Elizabeth Hospital; Royal Adelaide Hospital) Dr Brandon Stretton (Royal Adelaide Hospital) Dr Stephen Bacchi (Lyell McEwin Hospital)
ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Fionnuala Fagan.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

Key Reference and learning points (spoiler alert)The Role of Tocilizumab in Glucocorticoid Resistant Giant Cell Arteritis: A Case Series and Literature Review [J Neuroophthalmol. 2023;43(1)]

1. This case underscores the critical nature of timely diagnosis and aggressive treatment in conditions like giant cell arteritis (GCA), where delayed treatment can lead to irreversible complications such as vision loss. Thorough history taking and clinical acumen are still key elements in establishing a diagnosis of GCA.
2. The patient's initial response and subsequent decline in vision illustrate the need for ongoing monitoring and readiness to adapt the treatment approach. It also shows the necessity of close monitoring of inflammatory markers and clinical symptoms.
3. Amaurosis fugax warrants urgent referral to an ophthalmologist.
4. High index of suspicion for GCA and prompt referral of GCA suspects will ensure best outcome for patients.
5. Progressive visual loss and elevated inflammatory markers should alert the clinician to glucocorticoid-resistant GCA.
6. The effectiveness of tocilizumab in this case highlights its role as a valuable treatment option for refractory GCA, especially when traditional therapies are not sufficiently effective. Targeted biologic agents may open up new treatment approaches in the future particularly in patients with progressive visual loss despite administration of intravenous methylprednisolone.
7. Managing complex cases like GCA often requires a collaborative approach involving rheumatologists, ophthalmologists, and other specialists to ensure comprehensive care and optimal outcomes.
8. There is often value in case reports to start the evidence cascade that is required to bring new, life altering treatments to the forefront.

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Type 1 diabetes has a very high treatment burden in terms of direct costs, inconvenience and lost productivity for patients and their carers. Further, all the glucose checking, hormone replacement and consults don’t abolish the vascular complications associated with poor glycaemic control. Only in the last few years has it been possible to pharmacologically alter the course of type 1 diabetes and other auto-immune diseases without generating intolerable side effects.

Teplizumab is an antibody to CD3 which was presented to the world in 2019 as delaying the onset of type 1 diabetes in high-risk individuals thanks to its protective effect on pancreatic β-cells. It has not yet been registered by the Therapeutic Goods Administration but another immunomodulatory drug called baricitinib has. Baricitinib is an inhibitor of Janus Kinases indicated for the for the treatment of rheumatoid arthritis, alopecia areata, atopic dermatitis and even COVID-19.

In December of last year the results of a Phase 2 trial in patients with new-onset type 1 diabetes were published in the New England Journal of Medicine. After almost a year of taking the oral therapy, patients were found to have better glycaemic control and evoked C-peptide levels than those taking placebo, indicating a preserved ability to secrete insulin. In today’s episode, Pomegranate’s in-house endocrinologist interviews two of the study authors.

Key ReferenceBaricitinib and β-Cell Function in Patients with New-Onset Type 1 Diabetes [NEJM. 2023. 7;389(23)]

Guests
Prof Jenny Couper FRACP FAHMS (Women's and Children's Hospital, University of Adelaide) Dr Michelle So FRACP (Royal Melbourne Hospital, Northern Hospital)Guest HostDr Rahul Barmanray FRACP (Royal Melbourne Hospital)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort out’ and ‘Quiet Waters’ by Walt Adams and ‘The Appalachian Trail’ by Hunter Quinn. Music courtesy of FreeMusic Archive includes ‘I am a Man Who Will Fight For Your Honor’ by Chris Zabriskie. Image produced and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Amy Hughes, Stephen Bacchi, Fionnuala Fagan and Aidan Tan.

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Today’s guests are the hosts of This Medical Life, a wonderful podcast that delves into the archives of medical history. Dr Travis Brown describes the period after World War I when the Spanish Flu was killing tens of millions around the world. In the USA, whiskey was thought to be a powerful prophylactic but distribution was not an easy thing. Later in the episode (22min) is the equally unlikely tale of how the pomegranate made its way from ancient myth onto this podcast by way of Henry VIII and some mystical symbolism.

Guests

Dr Travis Brown MBBS, FRCPA (ClinPath Pathology)
Steve Davis MBA FAMI CPM (Talked About Marketing)
ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes ‘Mendo Mulcher’ by Polyrhytmiques, ‘Bach’s March fur die Arche’ by The United States Army old Fife and Drum Corps and ‘Notre Dame’ by Jahzzar. Music licenced from Epidemic Sound includes ‘Salat Alsabah’ by Feras Charestan and ‘Savannah Nights 1’ by Martin Gauffin. Image courtesy of Wikimedia Commons. Recording of Allegri’s Miserere from Trinity College under Creative Commons licence from archive.org.

Editorial feedback kindly provided by RACP physicians Chris Leung, Aidan Tan, David Arroyo, Ronaldo Piovezan, Rahul Barmanray and Ian Woolley.

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Last November an NHS Hospital Trust in Nottingham sought permission from the UK High Court to withdraw life support from a seven-month old girl called Indi Gregory. The devastated parents did not want to give up on her although they were advised there was no hope of treatment for her profound developmental disability. The family and the medical teams returned to court two more times, right up to the day that Indi was to be extubated.

Conflicts over care have always existed but their frequency has increased as medicinal advances present more options for intervention even in the sickest patients. Added to that, the online media environment allows advocacy campaigns to grow until they spill onto the streets outside hospitals and courtrooms.

This heightened tension causes moral injury both to parents and healthcare staff looking after child patients. The Medical Mediation Foundation has developed a conflict management framework to help avoid or de-escalate such disputes and keep attention focused on the best interests of the patient. In this podcast we hear from the director of the foundation, as well as three staff from the Starship Hospital, Auckland who have undertaken this training.

GuestsSarah Barclay (Director, the Medical Mediation Foundation)
Dr Louise Webster MBChB RANZCP FRACP (Paediatric Consult Liaison Team, Starship Hospital)
Dr Fiona Miles FRACP FFICANZCA (Paediatric Intensivist, Starship Hospital)
Fiona McIver (nurse specialist, Starship Hospital)

ProductionProduced by Mic Cavazzini DPhil. Recording assistance in Auckland from Dinesh Kumar. Music courtesy of FreeMusic Archive includes ‘December’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Ikigai’ by Twelwe and ‘Pulse Voyage by Chill Cole. Image by Photodisc licenced from Getty Images.

Editorial feedback kindly provided by RACP physicians Michael Herd, Rosalynn Pszczola, Rachel Murdoch, Sasha Taylor, Zac Fuller, Rahul Barmanray, David Arroyo, Rachel Bowden, Chris Leung, Fionnuala Fagan, Thazin Thazin and Aidan Tan.

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The theory that certain fatty acids are essential to the diet and associated with reduced cardiovascular risk has been controversial since it was floated in the 1950s.

In 1971 Danish researchers published the results from a cross-sectional study of Inuit people living on the west coast of Greenland. They ate a fish-based diet rich in polyunsaturated fatty acids known as omega-3s, which were found in their tissues along with much lower levels of pre-β-lipoprotein and plasma-triglycerides when compared to controls.

That association between a fishy diet and lowered cardiovascular risk has been replicated in multiple population studies since then and there are several ways omega-3 fatty acids could mediate the effect. They have anti-inflammatory and antithrombotic properties, lower circulating triglyceride concentrations and keep vessels impermeable to plaque forming lipoproteins.

For many years now clinical guidelines like those of the American Heart Association and the National Heart Foundation of Australia have explicitly encouraged dietary intake of omega-3s fatty acids for those at high cardiovascular risk. But such recommendations come despite considerable inconsistency in the outcomes from intervention studies on omega-3 supplementation over the past 25 years.

From several large RCTs there have been just as many negative or neutral associations as there have been positive ones. Professor Christian Hamilton-Craig has published a viewpoint review in the December edition of the Internal Medicine Journal attempting to explain these inconsistencies.

GuestsDr Paul Bridgman MB ChB MD FRACP FCSANZ FASE (Christchurch Hospital; St George Hospital; University of Otago)

Prof Christian Hamilton-Craig MBBS PhD FRACP FCSANZ FSCCT FSCMR FACC (Director, Noosa Hearts Cardiology; Noosa Hospital; Griffith University; University of Queensland)

Declarations of interest: nil

Key Reference

· Christian Hamilton-Craig, Karam Kostner, David Colquhoun, Stephen J Nicholls. Omega-3 fatty acids and cardiovascular prevention: is the jury still out? IMJ. 2023 Dec;53(12):2330-2335

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Niagara’ by Chris Shards and ‘Hollow Head’ by Kenzo Almond.

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Median survival for patients diagnosed with advanced cirrhosis is around 2 years and quality of life is poor. Fewer than a quarter of such patients receive referrals to palliative care and advanced care plans are also rare. Existing research from abroad suggests that hepatology staff aren’t familiar with referral criteria and assume that palliative services become involved only at the very end of life.

To try and reduce barriers to referral, clinicians at Royal Brisbane Hospital developed a model called Hepatocare. They adapted a palliative care referral algorithm to include cirrhosis specific markers and continuity of care between the teams was provided by a clinical nurse consultant. The model was piloted model in 30 consecutive patients to the liver clinic, and its impact was assessed on rate of referrals, incidence of unplanned admissions, length of patient stay and rates of polypharmacy.

Guests Professor James O’Beirne FRCP FRACP (Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)
Dr Richard Skoien MBBS FRACP (Royal Brisbane and Women’s Hospital; University of Queensland)
Dr Alison Kearney FRACP MRCP (Royal Brisbane and Women’s Hospital; University of Queensland)
Olivia Cullen (Royal Brisbane and Women’s Hospital)

Key Reference

Alison Kearney, Neha Tiwari, Olivia Cullen, Amy Legg, Ismail Arbi, Carol Douglas, Barbara Leggett, Mary Fenech, Joanne Mina, Paris Hoey, Richard Skoien. Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care. Intern Medicine Journal. 2023 Nov;53(11):1963-1971

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘After the Freak Show’ by Luella Gren and ‘The Cold Shoulder’ by Kylie Dailey.

Editorial feedback kindly provided by RACP physicians Aidan Tan and David Arroyo.

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Semaglutide, branded as Ozempic or Wegovy, is an analogue of glucagon-like peptide 1 which has glucose-dependent effects on insulin secretion. In this episode we discuss how semaglutide performs as an antihyperglycaemic agent compared to previous GLP-1 analogues and the soon-to-be launched tirzepatide. This dual agonist also binds receptors to glucose-dependent insulinotropic polypeptide, GIP.

GLP-1 and GIP are incretin hormones, secreted after food intake and involved in regulating gastric motility and appetite. The analogue therapies have resulted in weight loss of 10 to 20 percent in trials on patients with obesity or other weight-related comorbidities. For various reasons, however, they remain unsubsidised by the Pharmaceutical Benefits Scheme. This hasn’t stopped social media influencers driving up off-label demand from the wider public, creating a problem for regulators and the diabetic patients most in need.

Guests
Professor Chris Rayner MBBS PhD FRACP (Gwendolyn Michell Professor, Adelaide Medical School; Consultant Gastroenterologist, Royal Adelaide Hospital)
Professor Gary Wittert MBBch, MD, FRACP (Mortlock Professor, Adelaide Medical School; Senior Consultant Endocrinologist, Royal Adelaide Hospital)

ProductionProduced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Mister S’ by Tortue Super Sonic. Music licenced from Epidemic Sound includes ‘Multicolor’ and ‘Flower Fountain’ by Chill Cole, ‘Blacklight’ by John B Lund, and ‘Habitual’ by Ava Low. Image by Ketut Subiyanto courtesy of Pexels.

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, David Arroyo, Joseph Lee, Jia-Wen Chong, Li-Zsa Tan, Fionnuala Fagan, Stella Sarlos and Marion Leighton.

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We’ve known for a decade that about 50 percent of doctors meet the criteria for burnout, and the figure is up to 70 percent among trainees. But organisations have been left to come up with their own solutions to this, the result being that many simply offer band aid solutions rather than systemic ones. Unforgiving work conditions pose a problem for both recruitment and retention of staff to the health workforce. The New Zealand Health Department, Te Whatu Ora, forecasts that within ten years supply of doctors, pharmacists and nurses will fall short of demand by 14 to 18 percent. In response they have establish they have established a national Health Charter that sets the workplace standards to keep staff safe and engaged.

Australia is one step behind, but in early September there was a leadership conference aimed at developing a similar wellbeing strategy nationally. It was envisaged that there would be Chief Wellness Officers at every major health service, reporting validated metrics about their workforce to a national taskforce. And as explained in the keynote presentation at the conference, at the organisational level there are different responses appropriate to the three main domains that influence staff wellbeing; these being personal resilience, professional culture and basic administrative efficiency. This podcast captures reflections from wellbeing champions at several different Australasian health jurisdictions.

Guests Dr George Eskander MB DCH DRANZCOG FRACGP (Executive Area Director Clinical Services; North Metropolitan Health Service & Sir Charles Gairdner Osborne Park Hospital Care Group)
Dr Bethan Richards MB FRACP MMed MSportsMed (Head of Rheumatology, Chief Medical Wellness Officer, Royal Prince Alfred Hospital; Senior Clinical Lecturer, The University of Sydney)
Dr Joanna Sinclair MB FANZCA (Senior Medical Officer Wellbeing Lead, Counties Manukau Health) Victoria Hirst (Chief of Knowledge Networks, General Manager of Health Roundtable, Beamtree)
Associate Professor Anne Powell BPharm, MBBS, FRACP (Program Director of Physician Education, Alfred Health in Melbourne; Monash University)
Professor Jennifer Martin MBChB MA FRACP PhD GAICD (Chair of Clinical Pharmacology, University of Newcastle; John Hunter Hospital)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Thyone’ by Ben Elson. Music courtesy of Free Music Archive includes ‘A Path Unwinding’ and ‘The Zepplin’ by Blue Dot Sessions and ‘Summer Days’ by Kai Engel. Image by sturti licenced from Getty Images.

Editorial feedback kindly provided by physicians Aidan Tan and David Arroyo. Thanks also to Sarah Dalton and Fiona Fitzgerald for their coordination support.

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This is the final episode in a five part series about artificial intelligence in medicine. We start by weighing up the costs and benefits of relying more and more on automated decision-making in a health system that’s increasingly pushed beyond capacity.

One of the biggest time sinks for health practitioners is filling out and searching through medical records. Much of this work could be automated by natural language processors which are becoming more accurate thanks to deep learning.

The power of large language models has been demonstrated by the meteoritic uptake of ChatGPT and doctors are among those who have used it to summarise literature or draft letters. But professional organisations have raised concerns around privacy and accuracy of ChatGPT and there have also been some spooky demonstrations of its capacity for common sense and theory of mind.

Guests>Professor Brent Richards MBBS FRACP JJFICM (Gold Coast Hospital and Health Service; Director, IntelliHQ)

Affiliate Associate Professor Paul Cooper PhD FAIDH CHIA AFHEA GAICD (Deakin University)
Associate Professor Sandeep Reddy MBBS PhD IPFPH ECFMG CHIA FAcadTM FAIDH FCHSM SFHEA (Deakin University; Founder, MedAI)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Thyone’ by Ben Elson. Music courtesy of Free Music Archive includes ‘Headway’ by Kai Engel, ‘Gramaphone’ by Jahzarr and ‘Numbers’ by Crowne. Image by VM licenced from Getty Images. Computerised voice from Online Tone Generator

Editorial feedback kindly provided by physicians David Arroyo, Stephen Bacchi, Aidan Tan, Ronaldo Piovezan and Rahul Barmanray and RACP staff Natasa Lazarevic PhD.

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This is the fourth part in a series on artificial intelligence in medicine and we try and unpick the causes and consequences of adverse events resulting from this technology. Our guest David Lyell is a research fellow at the Australian Institute of Health Innovation (Macquarie University) who has published a first-of-its kind audit of adverse events reported to the US regulator, the Federal Drugs Administration. He breaks down those that were caused by errors in the machine learning algorithm, other aspects of a device or even user error.

We also discuss where these all fit in to the four stages of human information processing, and whether this can inform determinations about liability. Uncertainty around the medicolegal aspects of AI-assisted care is of the main reasons that practitioners report discomfort about the use of this technology. It's a question that hasn’t been well tested yet in the courts, though according to academic lawyer Rita Matulonyte, AI-enhanced devices don’t change the scope of care that has been expected of practitioners in the past.

**Guests

**Rita Matuolynte PhD (Macquarie Law School, Macquarie University; ARC Centre of Excellence for Automated Decision Making and Society; MQ Research Centre for Agency, Values and Ethics)
David Lyell PhD (Australian Institute of Health Innovation, Macquarie University; owner Future Echoes Business Solutions)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Illusory Motion’ by Gavin Luke. Music courtesy of Free Music Archive includes ‘Impulsing’ by Borrtex. Image by EMS-Forster-Productions licenced from Getty Images.

Editorial feedback kindly provided by physicians David Arroyo, Stephen Bacchi, Aidan Tan, Ronaldo Piovezan and Rahul Barmanray and RACP staff Natasa Lazarevic PhD.

Key References
More than algorithms: an analysis of safety events involving ML-enabled medical devices reported to the FDA [Lyell, J Am Med Inform Assoc. 2023]
How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices [Lyell, BMJ Health Care Inform. 2021]
Should AI-enabled medical devices be explainable? [Matulonyte, Int J Law Inform Tech. 2022]

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On the 28th of January 2022 a 75-year-old man was admitted to the regional Albury Wodonga Health Service with a high fever and Parkinsonian symptoms. The patient spent over a week in intensive care, but brain scans did not reveal an obvious aetiology and assays for a range of pathogens came up negative.

When serology eventually revealed the presence of antibodies against Japanese encephalitis virus this became only the second ever locally-acquired case on Australia’s mainland. Even more startling was the fact that the previous one had been way back in 1998 in Cape York, far north Queensland.

The Victorian patient was the first what would become an outbreak of 43 symptomatic human cases that resulted in six deaths. The JE virus would be detected in all mainland states and retrospectively linked to another fatality in March 2021 from the Tiwi islands of the Northern Territory. In this podcast we hear about the confluence of factors that brought a classically tropical disease to the southern states. The story is told from the perspective of the treating clinicians, microbiology specialist and public health physician who started putting the puzzle together from four sentinel cases.

GuestsAdjunct Associate Professor Ian Woolley FRACP (Monash Infectious Diseases; Monash University)
Dr Justin Jackson FRACP (Albury Wodonga Health)
Dr Sam Thorburn (Austin Health)
Dr Paul Kinsella (Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity)
Associate Professor Deborah Friedman FRACP (Victorian Department of Health; Deakin University)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Dusty Delta Day’ and ‘Hard Shoulder’ by Lennon Hutton. Image from Smith Collection/ Gado licenced from Getty Images. Editorial feedback kindly provided by Dr Aidan Tan.

Key Reference

Samuel Thorburn, Deborah Friedman, John Burston, Paul M Kinsella, Genevieve E Martin, Deborah Williamson, Justin Jackson. Sentinel cluster of locally acquired Japanese encephalitis in southern Australia. Internal Medicine Journal. 2023;53(5):835-840

Member access to Internal Medicine Journal, Journal of Paediatrics and Child Health and Occupational Medicine Journal

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This is the third part of a series on artificial intelligence in medicine. Previously we explained how to train and test machine learning models that assist in decision-making, and then how to iron out ergonomic friction points in the clinical workflow. We’ve mentioned how deep learning neural networks are more capable than classical models at dealing with big noisy data sets, but also that the reasoning they use to solve questions asked of them might be inexplainable users.

This creates a certain unease among clinicians and regulators like Australia’s Therapeutic Goods Administration. According to some, we just need to test outcomes from use of AI-assisted decision-making with same rigour we do for pharmaceutical interventions, not all of which we fully understand. But despite updates to the SPIRIT and CONSORT for reporting of randomised controlled trials, there hasn’t yet been a lot of high quality clinical research into use of AI-based medical devices.

**Guests

**Adjunct Associate Professor Paul Cooper PhD (Deakin University)
Associate Professor Sandeep ReddyMBBS PhD IPFPH ECFMG CHIA FAcadTM, FAIDH FCHSM,SFHEA (Deakin University)
Professor Brent Richards MBBS, FRACP, JJFICM (Gold Coast Hospital and Health Service; Director, IntelliHQ)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Thyone’ by Ben Elson, ‘Little Liberty’ by Paisley Pink. Music courtesy of Free Music Archive includes ‘Impulsing’ and ‘You are not alone’ by Borrtex. Image by WestEnd61 licenced from Getty Images.

Editorial feedback kindly provided by physician Rahul Barmanray and digital health academics Natasa Lazarevic.

Key References
A governance model for the application of AI in health care [Reddy, J Am Med Inform Assoc. 2020]
Machine learning in clinical practice: prospects and pitfalls [Med J Aust. 2019]
Evidence-based medicine and machine learning: a partnership with a common purpose [BMJ Evid Based Med. 2021]
Explainability for artificial intelligence in healthcare: a multidisciplinary perspective [BMC Med Inform Decis Mak. 2020]

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The allure of having devices and tasks assisted by artificial intelligence is that they will help overcome some of the natural limits of human cognition with regards to working memory and attention. And in helping with the mundane tasks, AI can buy clinicians back time to spend with the complex patients who really need it. But the way all this pans out will really depend on how seamlessly the machine learning devices fit in with the clinical workflow. Which aspect of clinical decision-making do they support and how are the consequences of error mitigated? Only a small fraction of research projects make it all the way to implementation, and in this podcast we discuss the ergonomic factors that need to be solved to effectively use AI in clinical decision support.

GuestsAssociate Professor Clair Sullivan MBBS FRACP FACHI FAIDH CHIA (Director, Queensland Digital Health Centre; University of Queensland)
Professor Enrico Coiera MBBS PhD FACMI, FACHI (Director, Centre for Health Informatics, Australian Institute of Health Innovation; Macquarie University).

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Alienated’ by ELFL and ‘Little Liberty’ by Paisely Pink. Image by Da Kuk licenced from Getty Images.

Editorial feedback kindly provided by physicians; Rhiannon Mellor, David Arroyo, Aidan Tan, Joseph Lee, Rachel Murdoch, Michelle Chong, Phillipa Wormald and digital health academics; Paul Cooper and Natasa Lazarevic.

Key References
The Last Mile: Where Artificial Intelligence Meets Reality [Coiera, J Med Internet Res. 2019]
We need to chat about artificial intelligence [Coiera, MJA. 2023]

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AI-assisted healthcare is reaching maturity in many applications and could alleviate some of the capacity gap increasingly faced by health systems . Over the next three podcasts we focus on artificial intelligence tools designed to assist directly with clinical practice.

Most commonly reported on are the algorithms capable of pattern recognition on medical images, that in some settings perform as well or better than expert diagnosticians at classifying disease. AI models have also been developed to perform regression analyses more complex than classical risk stratification aids.

The standard statistical algorithms used to solve these problems struggle when many variables are introduced, in which case deep learning models that mimic brain networks are sometimes a powerful alternative. In this episode we explain how machine learning algorithms are trained on particular tasks and where there are risks of error and bias being introduced.

In part 2, we identify the ergonomic issues that affect practical implementation of AI tools in the clinic and in the decision cascade. And in the final episode of the series we discuss the questions that regulators and lawyers should be asking of this new technology and what role natural language processors might have in medicine.

GuestDr Ian Scott FRACP MHA MEd (Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital; Professor of Medicine, University of Queensland)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Thyone’ by Ben Elson, ‘Broke No More’ by Cushy, ‘Desert Hideout’ by Christopher Moe Ditlevesen and ‘Alienated’ by ELFL. Music courtesy of Free Music Archive includes ‘Capgras’ by Ben Carey. Image by Olemedia licenced from Getty Images.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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In today’s podcast we try and understand the impact that racial bias makes on variation in clinical care. For example, racialized patterns in the use of analgesia were brought to light over 20 years ago but are still occurring today. In research from the UK published in March it was found that women of African or South Asian extraction were significantly less likely to receive an epidural during vaginal birth, or instrumental assistance with the delivery. The direct reasons for this variation were not revealed by the study, and could simply reflect the preferences of different cultural groups. But if that’s the case, it behoves us to address gaps in health education in a culturally sensitive way.

This podcast highlights the subtle drivers of racialized disparity at different layers of service delivery. At an individual level implicit bias can affect clinical decision-making. At an institutional level there may be known resourcing issues not being addressed, like availability of translators to help diverse patients understand what they’re consenting to. And all this takes place within the context of structural racism, the inequity that was long ago baked into society’s power structures. That’s particularly true in colonised countries like ours, so we also ask what it means to “decolonise” medicine.

GuestsWendy Edmondson PhDc (Cultural Advisor, RACP)
Dr Kudzai Kanhutu FRACP GAICD MPH (Dean, RACP; Deputy Chief Information Office, Royal Melbourne Hospital)

ProductionProduced by Mic Cavazzini DPhil. Recording assistance from Jon Tjhia in Melbourne and Fiona Croall in Adelaide.

Music licenced from Epidemic Sound includes ‘You break down’ by Czar Donic and ‘Repurposed’ by Cody Francis. Music courtesy of Free Music Archive includes ‘New Times’ by 4T Thieves and ‘Chasing Shadows’ by Scott Holmes. Image by rubberball licenced from Getty Images.

Editorial feedback on this episode kindly provided by physicians Sern Wei Yeoh, Aidan Tan, Rachel Murdoch, Priya Garg, Fionnuala Fagan, Phillipa Wormald, Amy Hughes and RACP staff Fiona Hilton, Rebecca Lewis, Michele Daly, Alexandra Kinsey.

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The first time most of us heard of monkeypox was in May 2022. The smallpox-like infection appeared to spring from nowhere and make its way through Europe then the Americas, almost entirely within the gay and bisexual community. But the first documented human case of mpox actually occurred in 1970 in Central Africa. It’s been endemic ever since, with tens of thousands of cases suspected to have occurred over the decades.

Last year’s mpox outbreak eclipsed those numbers in just a few months thanks to a newly evolved strain. The confirmed case count totalled over 86,000 all around the world, though Australia and Aotearoa-New Zealand managed to keep numbers to 140 and 41, respectively. It’s a testament to well-coordinated community health in the developed world that the outbreak was reigned in within a few months of the index case in Europe.

But alongside this success story, there’s also a cautionary tale about global health strategy. Because mpox wasn't taken seriously in endemic countries, an incubator was created for this new strain to emerge. We also discuss the stigma associated with sexually transmitted infections and the pros and cons of applying this label.

GuestsDr Vincent Cornelisse FRACGP FAChSHM PhD (Royal Prince Alfred Hospital, Royal North Shore Hospital, Sydney; Kirby Institute, UNSW)
Dr Massimo Giola FRACP FAChSHM PhD (Te Whatu Ora, Tauranga, Rotorua)

ProductionProduced by Mic Cavazzini DPhil. Recording assistance from Melissa Cox, Mockingbird Music Studios, Tauranga. Editorial feedback kindly provided by Dr Aidan Tan and Dr David Arroyo.

Music licenced from Epidemic Sound includes ‘Cocktail by Major Tweaks, ‘Broke No More’ by Cushy, ‘Temple of Ruhnha’ by ELFL and ‘Razzamatazz’ by Jules Gaia. Music courtesy of Free Music Archive includes ‘Out of the Skies, Under the Earth’ by Chris Zabriskie, Image by Flashpop licenced from Getty Images.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record time spent listening and reading supporting materials. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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Medical and administrative records are normally collected to help the management of patients or institutions, but it can be time consuming to extract metrics useful for practice improvement. The field known as Practice Analytics seeks to transform these data and provide clinicians with a bird’s eye view of their case load and performance. Practice Analytics can draw attention to cases that stood out from the trend, not for any regulatory purpose, but simply to help clinicians reflect and improve. This could even act a shortcut to meeting the new requirements for CPD imposed by the medical boards.

GuestsProfessor Tim Shaw(University of Sydney; Research Director, Digital Health Cooperative Research Centre)Dr David Rankin (Director Clinical Governance and Informatics, Cabrini Health)

ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Transference’ by Ben Carey. Music licenced from Epidemic Sound includes ‘Emerlyn’ by Valante. Image by Courtney Hale licenced from Getty Images.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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In the first year of the COVID-19 pandemic, a handful of international studies showed that there was increased risk of adverse outcomes in hospitalised patients comorbid for diabetes. Odds ratios for mortality conferred by pre-existing diabetes ranged from 1.5 to 3.6. What this relationship might be in Australia was not known until researchers in Melbourne retrospectively examined electronic medical records from the two waves of COVID-19 in that city.

The prevalence of diabetes among Melbourne inpatients is around 35% and in 2020 over 70% of all Australia’s case load was in Victoria. This presented an opportunity to observe the relationship between the conditions with substantial statistical power. But while ICU admission and mortality were more common in those with diabetes than those without, neither diabetes nor hyperglycaemia were independently associated with in-hospital mortality. In this podcast the authors speculate as to why there was this deviation from patterns observed internationally. A possible explanation involves the receipt of dexamethasone therapy in patients with hyperglycaemia, which was found by other researchers to be preventative for COVID-19-associated mortality.

GuestsAssociate Professor John Wentworth FRACP (Royal Melbourne Hospital, Walter and Eliza Hall Institute)
Dr Rahul Barmanray FRACP (Royal Melbourne Hospital; the University of Melbourne)
Dr Dev Kevat FRACP (Western Health; Monash University)
Dr Mohammad Ashraful Islam (Goulburn Valley Health)

Key Reference

Rahul D Barmanray Diabetes IN hospital – Glucose and Outcomes in the COVID-19 pandemic (DINGO COVID-19): the 2020 Melbourne hospital experience prior to novel variants and vaccinationsInternal Medicine Journal 2021; 53(1)
Access to IMJ, JPCH and OMJ for RACP members

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Hospitalisation rates for cirrhosis are increasing in Australia in part associated with the high prevalence of obesity and subsequent non-alcoholic fatty liver disease. More concerning still is the frequency with which discharged patients are readmitted within 30 days. One systematic review put the average readmission rate at 26%, but the studies cited varied greatly in their inclusion and exclusion criteria and not much is known from Australia and Aotearoa-New Zealand. In the December edition of the Internal Medicine Journal researchers at the Austin Hospital Liver Transplant Unit in Melbourne reported a 46% readmission rate among their patients. This was based on a retrospective audit of medical records, which also suggested that a fifth of readmissions might have been preventable. Better adherence to practice guidelines when patients are first hospitalised for cirrhosis may reduce a significant burden on patients and the healthcare system.

GuestsProfessor James O’Beirne FRCP FRACP (Director of Gastroenterology & Hepatology, Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)
Dr Karl Vaz FRACP (Victorian Liver Transplant Unit, Austin Hospital)

Key Reference

Karl Vaz et al. Rate of early hospital readmission amongst cirrhotic patients is high in Australia: experience from a single liver transplant centre Internal Medicine Journl 2021; 52(12)
Free access to IMJ for members of the RACP

Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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ADAPT is a prospective cohort study that has been following up COVID-19 patients since the earliest days of the pandemic. It has allowed researchers to track the emergence of long COVID, a syndrome that includes symptoms such as ongoing breathlessness, fatigue, chest tightness and "brain fog".

Over the course of the study, participants have contributed blood cells, cardiac and brain MRIs, tests of respiratory function and more. The research has uncovered molecular and functional correlates that are helping to explain long COVID. Meanwhile, clinicians at the St Vincents’ Hospital, Sydney long COVID clinic are successfully applying rehabilitation strategies drawn from the treatments of chronic pain and other functional disorders.

GuestsProfessor Gail Matthews MRCP FRACP (Head of Infectious Diseases, St Vincent's Hospital, Sydney; Kirby Institute)
Dr David Darley FRACP (St Vincent’s Hospital, Sydney)
Professor Steven Faux FRACGP FAFRM FFPMANZCA (Director Rehabilitation and Pain Medicine, Vincent’s Hospital, Sydney)
Professor Bruce Brew AM FRACP FAAN (Director of the Peter Duncan Neurosciences Research Unit, St Vincent's Hospital Sydney)

ProductionRecorded at St Vincent’s Hospital for the Curran Foundation. Post-production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Tree Tops’ and ‘Yellow Lead’ by Autohacker and ‘Thyone’ and ‘Orthosie’ by Ben Elson. Image by PASIEKA licenced from Getty Images.

Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review the prefilled activity details then click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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Clinical complications suffered by patients during hospital stays are assumed to be preventable and to provide some metric of quality of care. To assist in their understanding and mitigation the Australian Commission on Safety and Quality in Healthcare established a national programme to track hospital-acquired complications (HACs) in a formalised way. Comparison data can be found through the Health Roundtable reports and it’s been understood that hospitals with higher complication rates may have a have a lower standard of care.

While the national HAC program has support from providers across all jurisdictions and makes good use of healthcare coding data some questions remain as to its methodology. In a retrospective audit of medical records published in the Internal Medicine Journal, Dr Graeme Duke and colleagues at the at Eastern Health Intensive Care Research have sought to validate the clinical significance of HACs identified within their service. Their research suggests that HACs are underreported by coding data, but that they are more strongly associated with patient-related factors than they are with deviation from clinical best practice. Dr Graeme and IMJ editor Professor Ian Scott discuss the research article and its implications for the national hospital-acquired complications programme.

GuestsDr Graeme Duke FCICM, FANZCA (Eastern Health Intensive Care Services)
Professor Ian Scott FRACP (University of Queensland, Princess Alexandra Hospital)

ReferencesGraeme J Duke et al. Clinical evaluation of the national hospital-acquired complication programme Internal Medicine Journal 2021; 52(11)
Access to IMJ, JPCH and OMJ for RACP members

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Reaching for Infinity by Dawn Dawn Dawn and ‘Nabga Algooah’ by Ebo Krdum. Image by SolStock licenced from Getty Images.

Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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About two thirds of Australians use complementary and alternative medicines but only around half of these people will mention it to their doctor. Patients in palliative care settings may be more inclined than most to try therapies from outside the box. But they are also more vulnerable to side effects and interactions given that their drug metabolism and clearance mechanisms are often impaired.

In this podcast you’ll hear the authors of a review article titled "Complementary and alternative therapies in the palliative setting." It’s published in the in the November issue of the Internal Medicine Journal which can be accessed by all RACP members at the login page racp.edu.au/fellows/resources/journals.

Professor Jennifer Martin and Joanne Patel describe how cannabinoid products, especially, have become more readily accessible to patients in recent years and often considered a panacea for many different symptoms. But given the wide variety of products each with a different concentration of active ingredients, drug effects are not always as a patient or doctor might expect. These compounds also have suppressive effects on P450 and other clearance enzymes which can alter the outcomes of other prescribed drugs.

GuestsDr Jonathan Brett FRACP FAChAM (St Vincent’s Hospital, Sydney)
Professor Jennifer Martin FRACP (University of Newcastle, John Hunter Hospital)
Dr Joanne Patel FRACP FAChPM (University of Newcastle, John Hunter Hospital)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Crossing Borders’ by Mindserver Unlimited. Image by DrAfter123 licenced from Getty Images.

Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review/amend the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

ReferencesComplementary and alternative therapies in the palliative setting [IMJ]
Access to IMJ, JPCH and OMJ for RACP members

Medicinal cannabis hub [TGA]
Medicinal cannabis products by active ingredients [TGA]
Drug Interactions [MIMs]
Australian Medicines Handbook
About Herbs database [Memorial Sloan Kettering Cancer Centre]
Understanding Complementary Thera

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This is the first episode of a new format called “IMJ On-Air” inspired by the RACP’s Internal Medicine Journal. Each episode will be have as guest-host a section editor or reviewer of the IMJ interviewing authors of a recent article. Often these will be Clinical Perspectives reviews which summarise the latest in management of major medical disorders.

In this episode we have leading respiratory physicians from the Royal Melbourne Hospital presenting current best practice in the diagnosis and treatment of severe asthma. They why inhaled corticosteroids have become so ubiquitous and also the remarkable impact that monoclonal antibodies have made to the field. They also discuss the lifestyle factors that can be modified to improve outcomes, and why so many people with severe asthma go undiagnosed. Finally, they reflect on the lessons learned from the 2016 “asthma storm” that send 3000 people to emergency rooms in over a single evening.

GuestsAssociate Professor Daniel Steinfort FRACP (Royal Melbourne Hospital; Principal Research Fellow, University of Melbourne)
Dr Ashleigh Witt (Royal Melbourne Hospital)
Associate Professor Nur-Shirin Harun FRACP (Royal Melbourne Hospital; Peter MacCallum Cancer Centre)
Professor Jo Douglass FRACP FThorSoc (Director of Research, Royal Melbourne Hospital; University of Melbourne)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Tree Tops’ by Autohacker, ‘Crossing Borders’ by Mindserver Unlimited. Image by Karl Tapales licenced from Getty Images.

ReferencesOverview of recent advances in asthma management [Witt 2022, IMJ]Access to IMJ, JPCH and OMJ for RACP members

Asthma action plan templates [Asthma Australia]
Global Initiative for Asthma [GINA]
Overview of recent advances in asthma management [Witt 2022, IMJ]
Thunderstorm-triggered asthma: what we know so far [Harun 2019, J Asthma Allergy]
Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study [Douglass 2022, J Allergy Clin Immunol]

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The National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders in Australia aspires to streamline referral pathways so that children can get the right help as early as possible. But despite the best intentions of many clinicians, there are drivers in the health system that make implementation difficult. There are constraints in the way specialists can be reimbursed for time spent managing a case through the diagnostic process. And the extent of developmental disorders in the community may not be reflected in the depth of training in this area. We also hear about some breaking research into a highly accurate diagnostic screening tool that could reveal just how prevalent ASD is in the community.

GuestsDr Paul Hotton FRACP (Staff Specialist in Community Child Health and Child Protection, Sydney Children's Hospital Network; Chair of CCCH at RACP)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Falling from the Clouds’ by Sven Lindvall, ‘Lantern Room (Instrumental)’ by Torii Wolf and ‘Not Blue’ by Kylie Dailey. Image by Elva Etienne licenced from Getty Images.

Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD.

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The average age at which autism spectrum disorder is four, though signs are often present well before that. Even where families and GPs may have concerns early in a child’s development, it can take a year or more for a consult with a paediatrician to become available. There are similar waiting lists to see other allied health and sub-specialists who can contribute opinions to a diagnosis. And there is some inconsistency as to what kind of supporting documentation is required to access support services at different layers if government. The Autism Cooperative Research Centre published a national guideline with 70 recommendations to streamline this process and improve equity for families from different backgrounds and living in different parts of the country. In this podcast we hear from a GP and a paediatrician working in regional practice about how this can help their patients receive early intervention in the critical developmental years. In Part 2 we speak to the RACP Chair of Child and Community Health about further structural challenges including the paediatric training curriculum and the NDIS.

GuestsDr Jo McCubbin FRACP (Fitzpatrick House, Sale, VIC)
Dr James Best FRAGCP (Junction Street Medical Centre, Nowra NSW)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Sleeping Starchild’ by Daniel Fridell, ‘Falling from the Clouds’ by Sven Lindvall, ‘Lantern Room (Instrumental)’ by Torii Wolf and ‘Not Blue’ by Kylie Dailey. Image by Elva Etienne licenced from Getty Images.

Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD.

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In the last episode we heard some powerful examples of the challenges faced by some practitioners in medicine. Every situation has its idiosyncrasies, but most people start out with a passion for what they’re doing. In today’s podcast we hear from doctor-career coaches Ashe Coxon and Sarah Dalton who help medics solve the workplace challenges, and remember what drew them to the profession. Associate Professor Peter Connaughton describes burnout as an occupational health issue, that needs to be solved organisationally. And we get a call from a listener wanting to share a simple gesture that can make a world of difference between colleagues stretched thin at a busy hospital.

GuestsDr Stephen Philpot FCICM (Alfred Health, Cabrini Hospital)
Dr Ash Coxon FRACGP (Townsville Hospital; Medical Career Planning)
Dr Sarah Dalton FRACP (Westmead Children’s Hospital;
Associate Professor Peter Connaughton FAFOEM (Curtin University; University of Notre Dame)

ProductionWritten and produced by Mic Cavazzini DPhil. Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes and ‘Exploring the Lake’ by View Points and ‘Into the Bone’ by Taylor Crane. Photo image licenced through Getty Images.

Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Vicka Poudyal, Michael Herd, Rhiannon Mellor, Nele Legge and Amy Hughes.

Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD.

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Not a day goes by that there isn’t a headline about the overstretched health service and the struggling professionals within it. It isn’t COVID that has created this situation. The pandemic was just the straw that broke the camel’s back.

At the RACP Congress in May, ENT surgeon Eric Levi explained why burnout should be considered not as a mental health condition but as an occupational disorder. And apart from the stressors of the job itself and the work relationships, the medical profession has a way of consuming one’s personal life.

Professor Michelle Telfer talked about being hounded for two years by the conservative press over her work with young people struggling with their gender identity. And pain specialist Olivia Ong described how she’d been driven by an unhealthy professional identity until a traumatic spinal injury forced her to reconsider the meaning of self-care. Both physicians found the courage to take control of the situation and define their roles on their own terms.

GuestsEric Levi FRACS (Royal Children's Hospital; St Vincent's Hospital; Ear, Nose and Throat Victoria)
Associate Professor Michelle Telfer FRACP (Director Adolescent Medicine, Director Gender Service at Royal Children's Hospital Melbourne; Murdoch Children’s Research Institute)
Dr Olivia Ong FAFRM FFPMANZCA (Monash Health, Advance Healthcare)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Into the Bone’ by Taylor Crane, ‘Below the Horizon’ and ‘Haunted Heart’ by Dawn Dawn Dawn and ‘Exploring the Lake’ by View Points. Photo image by Paul R. Giunta licenced through Getty Images.

WellbeingDoctor’s Health Advisory Service Helpline

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Subscribe to email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. Fellows of the RACP can claim CPD credits for listening via MyCPD. For a transcript and further references please visit our website.

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In episode 78 we heard from some physicians who found themselves taking up the role of advocate, not just for their own patients but for broader system change. And health policy lobbyist Patrick Tobin explained how physicians and the College as whole can best get the attention of parliamentarians. For example, the RACP’s Healthy Climate Futures campaign calls on Government to make the healthcare system more resilient against the shocks of climate heating and extreme weather events.

To complete this series, this episode focuses on what happens to advocacy issues after they land on an MP’s desk, and how they get churned through the Canberra machine to eventually become policy. We hear the perspectives of two physicians turned politicians in interviews that first appeared as part of an RACP documentary called The Advocate’s Journey.

Dr Mike Freelander practiced for 37 years as a paediatrician in Sydney’s southwest before being elected to the federal Division of Macarthur in 2016. for the Labor party. Dr Katie Allen was elected in 2019 as the Liberal Member for Higgins after practicing at the Royal Children’s Hospital and directing the Australian Centre of Food and Allergy Research.

While the federal election in May 2022 rearranged some of the chairs at the table, the RACP is proud of all its members who have taken the brave steps of entering the political fray. The represent all colours of the political spectrum and we are grateful to have such influential champions for health policy.

Guests
Dr Rob Lethbridge FRACP (Perth Children’s Hospital)
Dr Mike Freelander MP FRACP
Dr Katie Allen MP (at time of interview)

ProductionWritten by RACP Professional Practice team. Music licenced from Epidemic Sound includes ‘Ikigai’ by Twelwe and ‘No Show (Instrumental Version)’ by Penny Lane. Photo courtesy of Michael@Unsplash

Please visit the RACP website for a transcript. RACP members can claim CPD credits for listening via MyCPD.

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The globe has already warmed by more than one degree Celsius over pre-industrial levels and is on track to exceed two degrees by the end of the century. It doesn’t sound like a lot but this will have profound effects on human health with Australia being particularly vulnerable. Most obviously, Australia’s biggest cities will become furnaces in summer with a more than doubling of heat-related mortality. The rising temperatures will also increase frequency of the climate oscillations that delivered us record-breaking temperatures and bushfires in 2019-2020, followed by historic rains and floods last summer.

In this podcast we discuss the effects of this increasingly volatile climate on the health of Australians, from infectious disease to respiratory and even mental health. Professor Lynne Madden explains how the health system can become more resilient to these demands and what measures the RACP is asking Federal Government to commit to in preparation for this. Find out more about the "Health Climate Future" campaign here.

Guest
Prof Lynne Madden FAPHM (University of Notre Dame)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kauko’ and ‘Ikigai’ by Twelwe. Music courtesy of FreeMusicArchive includes ‘Nothing Else Matters’ by Mystery Mammal, ‘Namaste’ by Jason Shaw. Image credit; Jamie Kidston, Multimedia and Production Manager at Australian National University.

Please visit the RACP website for a transcript and supporting references. RACP can claim CPD credits for listening via MyCPD.

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Immune checkpoint inhibitors have revolutionised care for patients with advanced melanoma and other cancers. These days around half of patients with unresectable metastatic melanoma can expect to live to five years after a regime of agents such as nivolumab and pembrolizumab. That’s up to ten times the survival rate of patients a decade ago, when the chaemotherapy Dacarbazine was the front-line treatment.

Over half of these patients who respond to immune checkpoint inhibitors will go on to survive long-term but it’s still not possible to identify responders in advance. On top of this, some of the immune-related side-effects of therapy can be serious enough to require stopping therapy. Oncologist Matt Carlino explains how to approach the challenging conversations with patients about hopes around expectations for prognosis and quality of life.

The risk-benefit equation becomes harder to balance when considering treatment for grade III or even grade II melanomas, as an adjuvant to surgery. Associate Professor Carlino also discusses the process of getting these new indications listed on the PBS, or how treatment can be funded when they are not.

Guest
Associate Professor Matteo Carlino FRACP (Westmead Hospital; Blacktown Hospital; Melanoma Institute Australia; University of Sydney)

ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Headway’ and ‘Denouement’ by Kai Engel, ‘Tavern’ by Sergey Cheremisinov, ‘New Times’ by 4T Thieves. Music licenced from Epidemic Sound includes ‘Dusty Decks’ by Soul Single Serenade. Image licensed from Getty Images.

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.

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The core work of being a physician is demanding enough. But if you’re seeing patients come in day after day with ailments that have social determinants behind them, you may start to feel like Sisyphus; heaving that boulder up the hill only to have to start from the bottom every time it slips your grasp. Surely it would be better to change those socioeconomic drivers but where do you even begin?

In fact, the three word mission statement of the RACP is Educate - Advocate – Innovate. In this podcast, former General Manager of Policy and Advocacy, Patrick Tobin, explains how the College helps physicians put cases of health equity to those in power. We hear from Kids off Nauru champion Dr Helen Young, and Dr Jin Russell explains how to harness social media to capture the attention of politicians and journalists. The interviews are drawn from an RACP-produced documentary called The Advocate's Journey hosted by Dr Robert Lethbridge. It is ever-more relevant given the high profile of public health in recent times.

Guests
Dr Rob Lethbridge FRACP (Perth Children’s Hospital)
Dr Helen Young FRACP (Royal North Shore Hospital; The Children’s Hospital at Westmead)
Patrick Tobin
Dr Jin Russell FRACP (Starship Children's Hospital; University of Auckland)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Missing Memories’ by Christopher Moe Ditlevesen, ‘Kauko’ by Twelwe, ‘Full House Dusk’ by River Foxcroft and ‘No Show (Instrumental)’ by Penny Lane. Image licenced from Getty Images.

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.

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Note to listeners: Please consider joining the Podcast Editorial Group for 2022. Key responsibilities are to:
(1) Discuss potential new podcast topics and prioritise them for development
(2) For a chosen topic, suggest themes to explore and people to interview
(3) Listen to audio drafts and provide feedback to the producer to improve it before publication

Correspondence is conducted entirely via informal emails and the time commitment averages under 90 minutes per month. More information at https://www.racp.edu.au/podcast

This episode is shared from the Essential Ethics podcast produced at the Royal Children's Hospital in Melbourne. It is presented by paediatric respiratory physician John Massie and clinical ethicist Lynn Gillam who are respectively the Clinical Lead and Academic Director of the Children's Bioethics Centre.

In a series titled “Deciding with Children” they raise the following questions. When can a child be considered to have autonomy to make healthcare decisions for themselves? What intrinsic rights does a young patient have up to this age of so-called Gillick competence? How should responsibility for difficult decisions be shared between the patients, the parents and clinicians? And is it possible to minimise the moral injury when the wishes of the patient need to be over-ruled? For the full series go to rch.org.au/podcasts/essential-ethics.

Guests
Prof Lynn Gillam (Academic Director, Children’s Bioethics Centre, University of Melbourne)
Prof John Massie FRACP (Royal Children’s Hospital Melbourne, University of Melbourne)
Assoc Prof Clare Delany (Children’s Bioethics Centre, University of Melbourne)
Assoc Prof Daryl Efron (Murdoch Children's Research Institute, University of Melbourne)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel, ‘Going Undercover’, ‘I Have a Plan’, ‘See you Soon’ by Borrtex and ‘By the Harbor’ by Mhern. Image courtesy of Jin Han Tan at Flickr. Feedback on this episode was kindly provided by the following 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.

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This is the third podcast in a series about medical injury. First we talked about what victims of injury want to hear from the health system after such an event. And then we discussed the guilt and compromised professional identity that doctors might feel when they’ve been involved in a patient harm. We also heard how fear of medicolegal suits is a major obstacle to greater transparency. At least that’s the case in Australia, where litigation is virtually the only way for victims to get financial compensation for their hardship and ongoing care. New Zealand, by contrast, operates a no-fault compensation scheme where all such costs are born by the government, for harms from care that are relatively unpredictable. We’ll look at the advantages this system has, for patients and practitioners, but also at some of the issues that remain unresolved.

Guests
Associate Professor Marie Bismark FAFPHM (Melbourne School of Population and Global Health University of Melbourne).

Associate Professor Katharine Wallis FRACGP FACRRM (Head, Primary Care Clinical Unit, University of Queensland)

ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Circular’ by Silver Maple, ‘Into the Bone’ by Taylor Crane, ‘Heart of the River of the Sun’ by Lama House, ‘Disconnect’ by Gavin Luke, and ‘Five Below’ by Torii Wolf. Image licensed from Getty Images. Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group; Loryn Einstein, Phillipa Wormald 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.

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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.

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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.

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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.

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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.

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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 Einstein

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.

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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 pp316-318

ProductionWritten 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.

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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.

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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.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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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.

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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.

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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.

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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.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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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.

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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.

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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 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 ‘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.

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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.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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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.

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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 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.

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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.

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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.

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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 Valk

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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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)

ProductionWritten 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.

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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.

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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.

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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 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.

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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 FRNZCGP

Production
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.

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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.

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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)

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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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 to

Finally, 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.

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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.

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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.

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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.

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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 Robson

Production
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.

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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 Morris

ProductionWritten 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.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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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 histories

In 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.

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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.

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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.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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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.

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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.

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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.

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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 Queensland

Production
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.

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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 efficiency

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. 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 Wal

Production
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.

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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 industr

However, 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.

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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.

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'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.

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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.

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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.

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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.

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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.

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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 intervention

In 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.

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In this 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 intervention. We also ask whether hospital training might inadvertently shelter younger doctors from the experience of complex, chronic conditions, and how the simplicity of protocols can be misleading.

In the second 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.

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.

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It's estimated that socioeconomic (SES) factors are responsible for half of a population's health and wellbeing status. In comparison, medical services might determine only a quarter of health outcomes. Better targeting of social services and health resources is key to addressing this—but it's not just a macro-level problem, according to Professor Ross Upshur FRCPC of the Dalla Lana School of Public Health. He says that merging medical records with SES markers will help physicians manage inequity at every consultation via 'social precision medicine'. In his opening address at Congress, he also spoke about how codes of ethics in medical practice have changed over the years.

Associate Professor Sue Woolfenden FRACP is a paediatrician in the Sydney Children's Hospital Network, and spoke at Congress explaining how the biological and social determinants of health are entwined even before birth, with effects accumulating at every stage of development. Her research for the UNSW School of Women and Children's Health reveals why some culturally and linguistically diverse communities don't access antenatal services and pre-school care, and what clinicians can do to make services more accessible.

The podcast also features Dr Brett Sutton FACTM FRSPH, Deputy Chief Health Officer of Victoria, who participated in a Congress session discussing health advocacy, and dealing with issues that might conflict with political or media interests.

Production
This episode was produced by Mic Cavazzini. Music from Comma ('Between the Sunset and The Sea'), Gillicuddy ('Adventure Darling'), Blue Dot Sessions ('Downhill Racer'); photo courtesy iStock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Philip Britton, Dr Rebecca Grainger, Dr Joseph Lee, Dr Marion Leighton, Dr Alan Ngo, Dr Phillipa Wormald, and Advanced Trainee Dr Aaron Wagen.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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Patients with autism spectrum disorder (ASD) can present unique challenges for the emergency physician. As these patients often have trouble making sense of their own emotional and physical states, they can become very distressed when experiencing pain. Many are also limited in their language abilities, and therefore can’t communicate verbally what is wrong

In this episode of Pomegranate, carer Annette talks about raising her teenage grandson Aaron, who needs continual care. Consultant paediatrician Meenakshi Rattan FRACP (Campbelltown Hospital, NSW), and psychiatrist Kenneth Nunn FRANZCP FRACP (Children’s Hospital Westmead, NSW) share the techniques they use to calm distressed patients living with autism and make medical assessments. They also describe the appropriate sedation that might be used for the most agitated and aggressive cases, and how gaps in the transition of patients to adult care might be filled.

Production
This episode was produced by Mic Cavazzini. Music from Blue Dot Sessions ('A Path Unwinding'), Loch Lomond ('From Here to Iceland', 'Violins and Tea'), Chris Zabriskie ('Out of the Skies, Under the Earth'); photo courtesy iStock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Sherina Mubiru, Dr Alan Ngo, Dr Ellen Taylor and Dr Phillipa Wormald, Advanced Trainee Dr Katrina Gibson and Mr Quentin Abraham MNZPsS.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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This episode looks at one of the biggest steps in a physician's career: retirement. It's common to avoid thinking about retirement, and the idea can sometimes come as a shock—professionally, personally, or financially. This month, we speak with physicians both in and out of retirement, as well as two psychiatrists whose research focuses on medical professionals' identity.

Guests
A/Prof Jill Sewell FRACP (Royal Children's Hospital, Melbourne)
A/Prof Carmelle Peisah FRANZCP (Consultant Old Age Psychiatrist, Conjoint Professor UNSW, Clinical Associate Professor University of Sydney)
Dr Chanaka Wijeratne FRANZCP (Prince of Wales Hospital, Conjoint Associate Professor University of Notre Dame Australia)
Emeritus Professor John Dwyer FRACP (UNSW Medicine).

Production
This episode was produced by Zacha Rosen. Music from Lee Rosevere ('And So Then', 'Quizitive'), Chris Zabriskie ('CGI Snake'), Broke for Free ('Something Elated'); photo courtesy iStock. Pomegranate is presented by Mic Cavazzini, with Anne Fredrickson as production manager.

Editorial feedback was provided by RACP Fellows Dr Rebecca Grainger, Dr Dennis Hain, Dr Paul Jauncey, Dr David McBride, Prof Barry McGrath, Dr Alan Ngo, Prof Kim Oates and Dr Humphrey Pullon.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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This is a two-part series looking at how modern genomics is changing clinical practice, and how a physician can hope to keep up with the pace of discovery and technological development. Some single gene tests and gene panels have been available off-the-shelf for years, but whole genome sequencing is becoming more accessible and affordable every day. In the first episode we discussed the differences between these technologies in terms of cost and practical utility, using diagnosis of Mendelian conditions and rare developmental conditions as examples.

The second episode begins with the question of disease risk and how to present uncertain predictive diagnoses. This is particularly relevant to research using genome-wide association studies, which is finding more and more markers with small risks of disease. This increases the likelihood of picking up diagnoses incidental to the ones a clinician might be looking for. The ethics of consenting patients to genome screening and informing them of potential markers are discussed, as well as gene-targeted treatments at the cutting edge of cancer research.

Guests
Associate Professor Kristine Barlowe-Stewart FHGSA(GenCounsel) (Director, Master of Genetic Counselling Program, University of Sydney)
Professor Leslie Burnett FRCPA, FHGSA, FCAP (Chief Medical Officer, Genome One)
Dr Michael Gabbett FRACP (Royal Brisbane and Women's Hospital)
Dr David Thomas FRACP (Director, Kinghorn Cancer Centre; Director, Cancer Division, Garvan Institute for Medical Research).

Production
This episode was produced by Mic Cavazzini. Music from Blue Dot Sessions ('Cloud Line'), Chris Zabriskie ('Is That You or Are You You?'), Alex Fitch ('Celeste'), Cory Gray ('Terminal Two'), and Kromatic ('Club Crunk for Monkeys'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Anutosh Shee and Dr Ellen Taylor, and Advanced Trainee Dr 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.

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In the first episode we discuss the differences between these technologies in terms of cost and practical utility, using diagnosis of Mendelian conditions and rare developmental conditions as examples. We also talk about counselling parents through prenatal or preconception screening, and the psychological burden of genetic diagnoses. The potential of precision medicine and pharmacogenomics is also covered. Our second episode, published in tandem, begins with the question of disease risk and how to present uncertain predictive diagnoses.

Production
This episode was produced by Mic Cavazzini. Music from Blue Dot Sessions ('Cloud Line'), Chris Zabriskie ('Is That You or Are You You?'), Alex Fitch ('Celeste'), Cory Gray ('Terminal Two'), and Kromatic ('Club Crunk for Monkeys'); photo courtesy iStock. 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. 1

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This episode goes back 200 years to tales of the early Sydney colony. The lectures featured on the program were first recorded at the 'Our Healthy Heritage' seminar series, hosted quarterly by the Australian and New Zealand Society of the History of Medicine.

Dr Fiona Starr of Sydney Living Museums retells colourful accounts of the colony's first general hospital, better known as the Rum Hospital. It was built in 1816 by Governor Lachlan Macquarie, who saw an urgent need to maintain the health of the convict workforce. Prof Peter Curson describes the worst infectious diseases that struck the colony over the 19th century—from the measles outbreak that killed over 1,000 children to the plague epidemic that caused panic and social conflict. Peter is Emeritus Professor in Population and Health at Macquarie University. Also on this episode is Dr Lisa Murray, Historian for the City of Sydney Council, discussing the perennial problem of where to bury the dead in an era of incredibly high mortality.

Production This episode was produced by Mic Cavazzini. Music from Sláinte ('Banish'), The OO-Ray ('Barriers'), Studio Noir ('Alma Rubens, Clarine Seymour'), Aislinn ('Sliabh') and Jahzzar ('Notre Dame'); sound recordings from Freesound. Image courtesy of Thomas Fisher Rare Book Library, University of Toronto. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo 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.

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Sir Harry Burns and Dr Ruth Hussey OBE are public health physicians involved in 'whole-of-system change' in Britain's health and social care. They were invited to Australia in 2016 to advise NSW Health on such delivery models; this episode of Pomegranate features a special lecture presented at the RACP during their trip.

As the former Chief Medical Officer of Scotland, Sir Harry Burns has drawn worldwide attention to the social determinants of health and focused his energy on a citizen-driven scheme for 'salutogenesis.' He continues to comment on health inequalities as Professor of Global Public Health at the University of Strathclyde.

Dr Ruth Hussey was until recently the Chief Medical Officer for the Welsh Government Assembly and prior to that Medical Director for the National Health Service in Wales. In these roles she has pushed for a local approach to delivering high quality clinical services, which she calls 'prudent health care.'

Production
This episode was produced by Mic Cavazzini. Music from Jason Shaw ('Autumn Sunset, Back to the Woods') and Blank Kytt ('RSPN'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, 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.

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Almost three quarters of physicians surveyed in the U.S. admit to ordering at least one unnecessary test, procedure or treatment every week. In Australasia, EVOLVE is the RACP's initiative to minimise clinical practices that aren't supported by the current evidence base, and stems from the international healthcare campaign Choosing Wisely.

EVOLVE has recently published a list of the top five practices in general paediatrics that need to be pulled back. Developed in consultation with Fellows from the RACP Paediatrics and Child Health Division, its recommendations are:

Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.
Do not routinely undertake chest radiography for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in children.
Do not routinely order chest radiography for the diagnosis of asthma in children.
Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy.
Do not routinely order abdominal radiography for the diagnosis of non-specific abdominal pain in children.

This episode of Pomegranate explores the rationale behind these recommendations and some alternatives that paediatricians can adopt to improve their practice.

Guests
Prof Harriet Hiscock FRACP (Director, Royal Children's Hospital Health Services Research Unit; Director, Australian Paediatric Research Network)
Dr Sarah Dalton FRACP (President, RACP Paediatrics and Child Health Division; Clinical Leader, NSW Agency for Clinical Innovation)
Dr Hamish McCay FRACP (Paediatrics Clinical Director, Waikato Hospital).

Production
This episode was produced by Mic Cavazzini. Music from Comma ('Between the Sunset and the Sea') and Cory Gray ('Down to the Street'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Michael Herd, Dr Joseph Lee and Prof Peter Procopis.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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While more than half of all medical students and trainees are women, they make up only about 30 per cent of registered physicians. When it comes to clinical leadership positions it's down to single digits, and medicine's gender pay gap is worse than that of other industries

The reasons for this loss of talent, and disparities in pay, are both cultural and logistical. One significant factor affecting career progression is time taken out for child-rearing; the penalties associated with such an interruption appear to compound more in medical training than they do in other professions. But medical culture, reflecting the wider society, also contains structural biases that affect women. On this episode guests discuss the challenges for gender equity in the profession, and how role-modelling and leadership training may offer strategies to support the next generation of women doctors.

Guests
Dr Catherine Yelland FRACP (President, RACP)
Dr Stefanie Schurer (University of Sydney)
Dr Elizabeth Sigston FRACS (Consultant Surgeon, ORLHNS, Monash Health)
Prof Helena Teede FRACP (Executive Director, Monash Partners Academic Health Sciences Centre; Director, Monash Centre for Health Research and Implementation).

Production
This episode was produced by Mic Cavazzini, with additional research from Beverly Bucalon and Dr Marion Leighton FRACP. Music from Blue Dot Sessions ('Fervent', 'Downhill Racer'); photo courtesy Sergio Santos. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Sarah Abrahamson and Dr Marion Leighton, and RACP staff member Ms Beverly Bucalon.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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Crystal methamphetamine, or ice, has been sensationalised in the media over the past decade. While raising awareness of the drug, such reporting has also stigmatised its users—both on the street and in the wards.

In this episode of Pomegranate, some of Australia's leading addiction researchers and clinicians explain how misleading the dominant narrative is and put straight some of the facts and figures behind the so-called ice 'epidemic.' They also discuss how characterising crystal methamphetamine as 'the most addictive drug ever' discredits the effectiveness of available and upcoming therapies.

Guests
Prof Alison Ritter (National Drug and Alcohol Research Centre, UNSW)
Dr Gilbert Whitton FAChAM (Bankstown Hospital, Sydney)
Prof Amanda Baker (Calvary Mater Hospital, University of Newcastle)
Assoc Prof Nadine Ezard FAChAM (St Vincent's Drug and Alcohol Service, University of Sydney).

Production
This episode was produced by Mic Cavazzini with music from Ben Carey ('Transference'), Mark Neill ('Threshold', 'Right Strafes Derision'), and David Szesztay ('Snow'); photo courtesy Sean Naber. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Michael Herd, Dr Murray Hunt and Dr David Lloyd-Jones. This episode was produced in partnership with NSW Health.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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Pyrexia, or fever of unknown origin (PUO) is a syndrome that challenges the diagnostic skills of every physician. It is defined by frequent fevers over 38.3 degrees Celsius, persisting for 3 weeks, which have eluded diagnosis by standard baseline tests.

Dr Rohan Beresford, Advanced Trainee in infectious diseases and microbiology and Professor Iain Gosbell of the University of Western Sydney, review the condition in September's issue of the RACP's Internal Medicine Journal. In a recent case series, they write, 22% of PUO cases were auto-inflammatory, 16% were attributed to infection, 7% were neoplastic, and 4% were due to drugs or other miscellaneous causes. But over 51% of patients with PUO were left with no diagnosis at all.

On this this episode, Dr Beresford explains how to rationally investigate patients with persistent fevers and manage their anxiety through the process. He is joined by paediatrician and infectious diseases specialist Dr Philip Britton FRACP (Children's Hospital Westmead), describing some of the conditions that more likely explain PUO in children, and Dr David Spriggs FRACP (Auckland City Hospital), who provides examples of the complexity of PUO in geriatric patients.

This episode was produced by Mic Cavazzini with recording assistance from Justin Gregory. Music from Chris Zabriskie ('I Am Running with Temporary Success from a Monstrous Vacuum in Pursuit'), Jahzaar ('Gramaphone', 'Aisles') and Scott Holmes ('Close to the Distance'); photo courtesy Armle. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Prof David Gordon, Dr Michael Herd, Dr Marion Leighton and Dr Christian Lueck.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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The National Disability Insurance Scheme (NDIS) is designed to provide better care for the 460,000 Australians who have significant and permanent disability. The NDIS supports individuals in making personalised therapy goals, accessing appropriate care, and participating in mainstream life. Since 2013 the scheme has had a staged launch across parts of Australia. This month, the NDIS will start rolling out across New South Wales and Victoria and will have complete coverage by 2019.

On this episode internal medicine physician Dr Robyn Wallace FRACP, of Calvary Hospital in Hobart, explains how the NDIS differs from past disability services, and rehabilitation specialist Dr Elizabeth Thompson FRACP shares the hopes her Sydney clients have for the personal funding. Kerry O'Kane talks of her relief at having found a secure future of care for her son in the ACT, while Dr Katherine Langdon FRACP describes the impact the scheme has had for paediatric therapy models in Perth.

This episode was produced by Mic Cavazzini with recording assistance from Diana Darmody. Music from David Szesztay ('Farewell', 'The Hangover') and Gillicuddy ('Adventure Darling'); photo courtesy Markus Spiske. Pomegranate's executive producer is Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Stephen de Graaff, Dr Robyn Horsley, Dr Anne Kynaston, Dr Robert Leitner, Dr Jacqueline Small and Prof Graham Vimpa

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading. ices

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Life expectancy for Aboriginal and Torres Strait Islander people is a decade lower than that of the non-Indigenous population. Addressing this disparity is one of the key priorities of the Closing the Gap initiative agreed upon by the Council of Australian Governments.

Today's speakers discuss where progress has been made and where resources are still lacking. Associate Professor Noel Hayman FAFPHM, FRACGP is Clinical Director of the Inala Indigenous Health Service in Brisbane. Ms Shannon Daly is an Aboriginal Health Practitioner who often works with Dr Joshua Francis FRACP, a paediatric infectious diseases specialist based at Royal Darwin Hospital.

This episode was produced by Anne Fredrickson and Mic Cavazzini, with recording assistance from Johanna Bell. Music from Doctor Turtle ('G of the Bang') and Rebecca Foon ('White Throated Sparrow'); photo copyright courtesy of Cameron Herweynen.

Editorial feedback was provided by RACP Fellows Dr George Laking, Dr Tamara Mackean, A/Prof Ashim Sinha and Dr Catherine Yelland, and RACP staff member Ms Helen Craig.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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The World Health Organization defines 'adolescents' as anyone between the ages of 10 and 19, and 'youth' as those between 15 and 24. The RACP uses the terms 'young people' and 'adolescent and young adult' to cover the whole range of 10 to 24 years. Regardless of how it's defined, the transition from childhood to adulthood involves a range of physical, mental, and psychosocial issues. If you're a teenager with a chronic health condition, the situation can be even harder.

For physicians in Australia and New Zealand, there has been no specific training to meet the needs of adolescents—until now. Over the past few years, the RACP has been working to create an adolescent and young adult medicine curriculum, which will become a dual training program in 2017. On this episode Prof Kate Steinbeck FRACP, Dr Michelle Telfer FRACP, and Dr Bridget Farrant FRACP talk about why adolescents and young adults need targeted care and the issues they face in the current system. They also discuss the new curriculum, and how interested Fellows and Trainees can get involved.

View the RACP's curated collection on adolescent and young adult health for an expanded guide to CPD tools.

This episode was produced by Alastair Wilson and Anne Fredrickson, with music from Podington Bear ("Now Son," "Whiplash String Swells," "Filaments"), and Kevin MacLeod ("Funkorama"); image courtesy Andy Maguire.

Editorial feedback was provided by RACP Fellows Prof Shanthi Ameratunga and A/Prof Jane Holmes-Walker, Advanced Trainee Dr Emma Mitchell and RACP staff member Ms Veronica Vogel.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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Medical practice is dynamic, and continually changes with evidence and experience. But costly or prolonged treatment doesn 't always translate into better outcomes for patients. In response, the College has launched EVOLVE—a partnership with specialty societies to identify and reduce low-value care.

EVOLVE is part of a growing international movement to examine clinical and consumer decision-making about overused, inappropriate, or potentially harmful medical treatments. As a founding partner of Choosing Wisely Australia, EVOLVE represents the College 's major contribution to the campaign: helping Fellows develop and promote lists of low-value care items for their specialty. On this episode Prof Rachelle Buchbinder FRACP, A/Prof Warrick Inder FRACP, and A/Prof Ian Scott FRACP discuss why they support the campaign, the process of developing low-value lists, and how they work with patients when the best course of action is…to wait.

This episode was produced by Anne Fredrickson, with music from Jahzzar ( 'Montmartre '), The OO-Ray ( 'Silhouettes '), Deerhunter ( 'Cryptograms ') and Delicate Steve ( 'Butterfly '); image courtesy EVOLVE.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Catherine Hill, A/Prof Ruth Marshall and Dr Catherine Yelland, and RACP staff members Mr Jason Soon and Ms Siobhan Marren.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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The gut microbiome is the subject of increasing research in medicine. Understanding this complex community offers potential new insight for treating a number of diseases—gastrointestinal and otherwise. But what's the evidence base?

In this episode Dr Peter De Cruz FRACP, Head of the Inflammatory Bowel Disease Service at the Austin Hospital, discusses his recent IMJ article 'Characterisation and Therapeutic Manipulation of the Gut Microbiome in Inflammatory Bowel Disease'. To provide further review, the episode also features an interview with Professor Finlay Macrae FRACP, Head of Colorectal Medicine and Genetics at the Royal Melbourne Hospital.

Included in the discussion are: the early establishment of the microbiome and its genetic and environmental influences, pharmacological and nutritional interventions targeting the gut, and some guarded recommendations about faecal microbiota transplantation.

This episode is presented in partnership with the Internal Medicine Journal, the official peer-reviewed publication of the College's Adult Medicine Division. Links to resources mentioned on the show are provided below. Dr De Cruz's full article is available via Wiley Online Library.

This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Podington Bear ('Caravan'), Kevin MacLeod ('Isolated'), and Adrianna Krikl ('Every Way', 'Wednesday'); photo courtesy Pacific Northwest National Laboratory (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Christian Lueck, Dr Kathryn Patchett and Dr Bruce Foggo.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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Obesity can seem like what strategists call a 'wicked problem'—a problem with so many parts that it's impossible to solve. But some things are changing. While prevalence is still high in developed countries, childhood obesity appears to be plateauing. Social movements like 'Health at Any Size' promote body positive approaches. And at Dr Nic Kormas' clinics, obese patients on average are able to lose 10% of their weight.

Dr Kormas FRACP is the senior endocrinologist behind the Metabolic Rehabilitation Programs at Concord, Camden and Campbelltown Hospitals. He's joined on the program by Dr Jacqui Curran FRACP, a paediatric endocrinologist at Princess Margaret Hospital in Perth; Boyd Swinburn FAFPHM, Professor of Population, Nutrition and Global Health at the University of Auckland; and Dr Sophie Lewis, a public health researcher at the University of Sydney. On today's episode, they talk about strategies and pathways available for addressing obesity—from the psychological to the physical.

This episode was produced by Anne Fredrickson, with music from Chris Zabriskie ('Readers! Do You Read?' and 'The Temperature of the Air on the Bow of the Kaleetan'), David Szesztay ('Point Zero'), and Ayla Nereo ('Oh Love'); photo by Scott Loftesness (via Flickr).

Editorial feedback was provided by RACP FellowsProf Chris Bullen,Prof Hugh Dickson,Dr Bruce Foggo, Dr Jacqueline Hewitt, A/Prof Matthew Links, Dr Rosalie Schultz and Dr Rima Staugas.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading. t

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By shaping the next generation of physicians, supervision affects the lives and health of patients. In this episode, our guests explore how the role of the supervisor has changed over time (as well as where the role ends), the skills needed for a good supervisor, and some suggestions on how to deliver constructive criticism. With combined decades of experience, they also share their thoughts on how to improve your own performance as a supervisor—and why they find it worthwhile.

Three experienced supervisors share their views: Dr Peter Davoren FRACP, an endocrinologist and former Director of Physician Education at Gold Coast Hospital; Dr Marion Leighton FRACP, a general physician based in Wellington who supervises both for the RACP and for the MCNZ; and Dr Josh Francis FRACP, a Darwin-based paediatrician who provides remote supervision for doctors in Timor-Leste. We also spoke to Alexandra Greig (AT, Public Health) to hear the thoughts of a doctor who is currently being supervised

Links to resources mentioned on the show are provided below. View the RACP's curated collection on teaching for a larger guide to professional development tools.

This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Scott Holmes ('Oceans Apart'), Squire Tuck ('Song for the Chameleon'), Cahill Locksmith ('Diamond Variety'), and Julianna Barwick ('I Wish I Could Create'); photo by Isaac Bowen (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Libby Smales, Dr Lionel Lubitz, Dr Mandy Fletcher, Dr Rachel Wong, A/Prof Matthew Links, Dr Marie-Louise Stokes, and Dr Hamish McCay, and RACP staff member Ms Erin Murphy.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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'One Health' is a contemporary movement based on a long-held observation: that the health of humans, animals, and the environment are inextricably linked. In the current issue of the Internal Medicine Journal, Prof Peter Collignon FRACP has published a One Health-informed clinical perspective: Antibiotic Resistance – Are We All Doomed? But paradoxically, he says, he's optimistic about the future

On this episode, Prof Collignon is joined in a review of his article by fellow ID physician Dr David Looke FRACP. They discuss the sobering trends in global and Australasian resistance rates, mechanisms driving the spread of resistance genes, and practical steps doctors can take for better antibiotic stewardship.

This episode is presented in partnership with the Internal Medicine Journal, the official peer-reviewed publication of the College's Adult Medicine Division. Links to resources mentioned on the show are provided below. Prof Collignon's full article is available via Wiley Online Library.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Prof David Gordon and A/Prof Matthew Links.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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Most preventive health messages focus on diet, exercise, and stress reduction. But are doctors taking this advice for themselves?

The Doctors' Health Advisory Service, or DHAS, was created in 1981 to offer confidential help to practitioners in both Australia and New Zealand. This episode features Dr Jill Gordon FASPsychMed, president of DHAS New South Wales; Dr Roger Sexton FRACGP, medical director of the South Australia office; and Dr Edwin Whiteside FRACP, director of the New Zealand office. They discuss why doctors may experience higher rates of depression and anxiety, and common fears around mandatory reporting. The conversation also includes Dr Kieran Le Plastrier (Western Sydney University), who is currently completing a PhD on 'the fit professional.

Dr Gordon's 'five steps to help a colleague' are:

Don't ignore the situation. Approach the person and the problem and ask if you can help.
Listen non-judgementally to what they say.
Give emotional support and any information you think might help.
Encourage them to seek professional help.
Encourage other forms of support.

Links to resources mentioned on the show are provided below. View the RACP's support services page for more organisations supporting doctors' health.

This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Podington Bear ('Driftwood'), Nick Jaina ('Mississippi Turn-Around'), Cory Gray ('Low Rollers'), and Doctor Turtle ('G of the Bang'); photo by University of Liverpool Medical Archive (via Flickr).

Editorial feedback was provided by RACP FellowsDr Hugh Aders, Dr Terence Donald, A/Prof Matthew Links, Dr Martina Moorkamp, Dr Kathryn Patchett, Prof Peter Procopis, Dr Simon Quilty, Dr Elizabeth Smales, Dr Emma-Leigh Synnott and Dr Barry Taylor.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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This month we're presenting a review of stem cell research and stem cell therapies from Professor John Rasko FRACP, head of the Department of Cell and Molecular Therapies at the Royal Prince Alfred Hospital

A self-confessed 'stem cell tragic,' Professor Rasko routinely separates the hope and hype surrounding any new medical research. In this episode, he reviews the stem cell treatments currently available in Australia and New Zealand, and a few of the many clinical trials worth watching. He also discusses why some patients engage with unproven and riskier procedures, and what advice he offers them.

Production
This episode was produced by Anne Fredrickson, with reporting by Michael Pooley. Music from Lloyd Rogers ('Red Fish on Television'), Podington Bear ('Many Hands'), The Womb ('Amiga Power Viking Funeral'), and Cloud Mouth ('Bedtime'); photo by Eckhard Völcker (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Chris Juttner, A/Prof Matthew Links, Dr Christian Lueck, A/Prof Ruth Marshall and Dr Emma-Leigh Synnott, and A/Prof Megan Munsie (University of Melbourne).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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In the final of our three-part series on end-of-life decision-making, we're integrating perspectives from the law.

For dying patients, their families, and their medical staff, the majority of decisions are reached without contention. But law in this field is complex, and varies by jurisdiction. As a result, doctors may possess knowledge gaps around end-of-life care. This episode features interviews with Prof Ben White (QUT) and A/Prof Colin Gavaghan (University of Otago). Links to resources mentioned on the show and other tools for continuing professional development (CPD) are provided below. View the RACP's curated collection on end-of-life care for an expanded guide to CPD tools.

Production
This episode was produced by Anne Fredrickson, with music from Lucky Dragons ('Open Melody'), Studio Noir ('Clarine Seymour'), BOPD ('New England Is Interesting'), and Satellite Ensemble ('Agnes'); photo by Julia Manzerova (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Martina Moorkamp, Dr Christian Lueck and Dr Marie-Louise Stokes.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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Treating a dying person goes beyond understanding their disease. In the second of a three-part series, we examine the importance of family and culture in end-of-life care—from the ICU to the neonatal unit.

This episode features interviews with Dr Andrew Watkins FRACP and Dr Peter Saul FCICM.

Production
This episode was produced by Anne Fredrickson, with music from Chris Zabriskie ('I am Running with Temporary Success…'), L.J. Kruzer ('Chantiers Navals 412'), and Sounds of Taraab ('Mahaba Wa Taka Nini'); photo by Alyssa (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bindu Bali, Dr Habib Bhurawala, A/Prof Matthew Links, Dr Hamish McCay, Dr Martina Moorkamp, Dr Rohan Vora, and A/Prof Nicholas Wickham.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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For our first show we're starting at the end: end-of-life care and decision-making. It's a hard topic to discuss with patients, but it might be the most important conversation we're not having.

This episode features interviews with Dr Amanda Walker FRACP, Dr Charlie Corke FCICM, and Dr Peter Saul FCICM.

Production
This episode was produced by Anne Fredrickson, with music from Podington Bear ('Into the Unknown,' 'Infant') and Rebecca Foon ('Hearts Mend'); photo by Amrita B (via Flickr).
Editorial feedback was provided by RACP Fellows Dr Sarah Dalton, Dr Bruce Foggo, Dr Emma-Leigh Synnott, Dr Ranjana Srivastava, Dr Stephen Streat and Dr Simon Quilty. lickr).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

Pomegranate Health: Recent Episodes

the Royal Australasian College of Physicians