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 ...
May 11, 2020•44 min•Ep. 58
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, b...
Apr 23, 2020•36 min•Ep. 57
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 Benef...
Mar 11, 2020•43 min•Ep. 56
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 complex...
Feb 05, 2020•41 min•Ep. 55
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 ...
Dec 09, 2019•42 min•Ep. 54
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 ...
Nov 12, 2019•33 min•Ep. 53
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 ...
Sep 16, 2019•34 min•Ep. 52
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, an...
Sep 04, 2019•32 min•Ep. 51
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 o...
Jul 21, 2019•26 min•Ep. 50
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 pathol...
Jul 11, 2019•32 min•Ep. 49
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 l...
Jul 03, 2019•36 min•Ep. 48
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, tho...
Jun 05, 2019•29 min•Ep. 47
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 ...
Jun 04, 2019•38 min•Ep. 46
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 Authori...
Apr 17, 2019•42 min•Ep. 45
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 ...
Feb 12, 2019•41 min•Ep. 44
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...
Dec 18, 2018•36 min•Ep. 43
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 var...
Dec 16, 2018•36 min•Ep. 42
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 improve...
Nov 20, 2018•36 min•Ep. 41
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...
Sep 26, 2018•30 min•Ep. 40
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 Pr...
Sep 25, 2018•31 min•Ep. 39
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 hea...
Jul 15, 2018•32 min•Ep. 38
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...
Jun 13, 2018•41 min•Ep. 37
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 rehabilitat...
May 23, 2018•33 min•Ep. 36
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 ...
May 03, 2018•29 min•Ep. 35
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...
Mar 19, 2018•36 min•Ep. 34
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 pr...
Jan 30, 2018•36 min•Ep. 33
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 mat...
Dec 20, 2017•34 min•Ep. 32
'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 popul...
Nov 29, 2017•39 min•Ep. 31
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. Caus...
Oct 16, 2017•30 min•Ep. 30
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 referr...
Sep 26, 2017•29 min•Ep. 29
