Pomegranate Health

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 podc...

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 necessa...

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,...

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 100,0...

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 you...

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...

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 c...

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 fidd...

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 age...

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 ev...

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 interpretati...

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...

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 co...

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 be...

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 eq...

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 est...

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...

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...

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...

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 fro...

'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 conve...

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 t...

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...

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...

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...