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 f...
Aug 27, 2017•27 min•Ep. 28
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, ...
Jul 30, 2017•29 min•Ep. 27
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 ev...
Jun 29, 2017•29 min•Ep. 26
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 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 everythi...
Jun 28, 2017•28 min•Ep. 25
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 inequit...
May 29, 2017•30 min•Ep. 24
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 paediatri...
Apr 26, 2017•27 min•Ep. 23
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 Psy...
Mar 30, 2017•26 min•Ep. 22
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 co...
Feb 27, 2017•27 min•Ep. 21
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 discuss the differences between these technologies in terms of cost and practical utility, using diagnosis of Mendelian cond...
Feb 26, 2017•25 min•Ep. 20
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 ...
Jan 30, 2017•30 min•Ep. 19
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 sc...
Dec 21, 2016•27 min•Ep. 18
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...
Nov 29, 2016•28 min•Ep. 17
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 int...
Oct 30, 2016•25 min•Ep. 16
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 methamphetam...
Sep 26, 2016•24 min•Ep. 15
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 seri...
Aug 28, 2016•24 min•Ep. 14
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 episod...
Jul 25, 2016•23 min•Ep. 13
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 i...
Jun 29, 2016•20 min•Ep. 12
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 Austral...
May 30, 2016•21 min•Ep. 11
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...
Apr 26, 2016•23 min•Ep. 10
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 revi...
Mar 29, 2016•25 min•Ep. 9
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 Rehabilit...
Feb 28, 2016•25 min•Ep. 8
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...
Jan 26, 2016•23 min•Ep. 7
'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 ...
Nov 20, 2015•23 min•Ep. 6
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. T...
Oct 26, 2015•18 min•Ep. 5
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...
Sep 28, 2015•19 min•Ep. 4
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 ment...
Aug 31, 2015•19 min•Ep. 3
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...
Jul 27, 2015•18 min•Ep. 2
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...
Jun 29, 2015•16 min•Ep. 1
