Pomegranate Health

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...

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 m...

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 di...

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 aroun...

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 poi...

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  ov...

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 i...

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...

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...

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 antimi...

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...

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 capitali...

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 philant...

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...

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 exp...

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 compoun...

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, in...

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 vaccina...

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, a...

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 routin...

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 Med...

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...

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...

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...

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 guideli...