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 i...
Dec 20, 2017•34 min•Ep 32•Transcript available on Metacast '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&ap...
Nov 29, 2017•39 min•Ep 31•Transcript available on Metacast 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 ...
Oct 16, 2017•30 min•Ep 30•Transcript available on Metacast 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•Transcript available on Metacast 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 Za...
Aug 27, 2017•27 min•Ep 28•Transcript available on Metacast 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 hospitalisat...
Jul 30, 2017•29 min•Ep 27•Transcript available on Metacast 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 ...
Jun 29, 2017•29 min•Ep 26•Transcript available on Metacast 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 mak...
Jun 28, 2017•28 min•Ep 25•Transcript available on Metacast 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...
May 29, 2017•30 min•Ep 24•Transcript available on Metacast 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•Transcript available on Metacast 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 (Co...
Mar 30, 2017•26 min•Ep 22•Transcript available on Metacast 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•Transcript available on Metacast 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•Transcript available on Metacast 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 maint...
Jan 30, 2017•30 min•Ep 19•Transcript available on Metacast 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 ci...
Dec 21, 2016•27 min•Ep 18•Transcript available on Metacast 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 Fe...
Nov 29, 2016•28 min•Ep 17•Transcript available on Metacast 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 s...
Oct 30, 2016•25 min•Ep 16•Transcript available on Metacast 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 cryst...
Sep 26, 2016•24 min•Ep 15•Transcript available on Metacast 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...
Aug 28, 2016•24 min•Ep 14•Transcript available on Metacast 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•Transcript available on Metacast 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 D...
Jun 29, 2016•20 min•Ep 12•Transcript available on Metacast 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 situa...
May 30, 2016•21 min•Ep 11•Transcript available on Metacast 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 partn...
Apr 26, 2016•23 min•Ep 10•Transcript available on Metacast 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 provi...
Mar 29, 2016•25 min•Ep 9•Transcript available on Metacast 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 ...
Feb 28, 2016•25 min•Ep 8•Transcript available on Metacast 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•Transcript available on Metacast '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 phys...
Nov 20, 2015•23 min•Ep 6•Transcript available on Metacast 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 offi...
Oct 26, 2015•18 min•Ep 5•Transcript available on Metacast 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 wa...
Sep 28, 2015•19 min•Ep 4•Transcript available on Metacast 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...
Aug 31, 2015•19 min•Ep 3•Transcript available on Metacast 
