Cerebral microbleeds are a finding on MRI that are usually asymptomatic. There are two main aetiological pathways, one occurring as a result of uncontrolled hypertension and the other from the accumulation of amyloid-beta peptide. The link between cerebral amyloid angiopathy and Alzheimer’s Disease is not understood and even the impact that cerebral microbleeds more generally have on cognition. 

For the study discussed today, clients of an Australian memory clinic were retrospectively assessed for prevalence of cerebral microbleeds and how this correlates to performance on cognitive tests and formal diagnosis categories. Prevalence of multiple cerebral microbleeds was associated with poorer cognitive performance and more severe diagnoses. And there are suggestions of a shared instigator between Alzheimer’s Disease cerebral amyloid angiopathy. But novel anti-amyloid therapies can also cause increased bleeding risk, meaning that multiple microbleeds are a contraindication for these drugs. We hear how clinicians in the memory clinic balance therapeutic outcomes and potential risks.  

Guest
Associate Professor Paul Yates FRACP PhD (Austin Health; University of Melbourne)
 
Co-Host
Dr Duncan Austin FRACP PhD (Alfred Health; Cabrini Health)

Production
Produced by Dr Duncan Austin and Mic Cavazzini. Music licenced from Epidemic Sound includes 

‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Joseph Lee and Aidan Tan.

Key Reference
Prevalence and Associations of Cerebral Microbleeds in an Australian Memory Clinic Cohort [IMJ. 2025]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

A 46-year old man is admitted to hospital following a first time presentation of psychosis that involved barricading himself inside a neighbour’s home. At admission he appears disorganised with slow movements and speech. His rambling reveals bizarre delusional beliefs of a paranoid and persecutory nature. At moments he shows aggression towards staff but when examines reports occasional dizziness and an intolerance of cold. Physical examination reveals cool peripheries, sparse axillary and pubic hair, and soft adult-sized testicles. The investigating team suspect hypothyroidism and a complex series of investigations and therapies follows.

Guests
Dr Peak Man Mah FRACP  (Lyell McEwin Hospital, University of Adelaide)
Dr Malcolm Borg (Royal Adelaide Hospital)
 
Hosts
Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)
Mic Cavazzini DPhil

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physician Simeon Wong and medical student Cindy Shi. 
 

Key Reference (Spoiler Alert)

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Panhypopituitarism and psychosis in a male patient [Aust N Z J Psychiatry. 2010]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app. 

Pomegranate Health marks ten years of podcasting since its launch in June 2015. This episode will be one of two samplers that dip into the back catalogue of 131 episodes to showcase some of the most compelling stories. You’ll hear how podcast themes are identified from all the domains of medicine and professionalism. And a little bit about the motivations of long-time producer and presenter, Mic Cavazzini.

Pomegranate Health has several thousand listeners in over 150 countries. Three quarters of listeners are, predictably, in Australia and Aotearoa-New Zealand, but a full 14 per cent are located outside the traditional anglosphere. RACP is proud to provide this platform to showcase the great work and dedication of its members. It’s also a place where physicians can learn from the other professionals and patient advocates that make up the health system.

Sampled in this retrospective episode:
Prof Meera Agar from ​Ep33: Early days for medicinal cannabis
Dr Paul Drury and Prof Sophia Zoungas from Ep41: Targeting Diabetes
Prof Rinaldo Bellomo from Ep70: Zeroing in on “the renal troponin”
Dr Nic Szecket and Dr Art Nahill from Ep32: Cognitive biases in diagnostic thinking
Prof Ian Harris and Assoc Prof Louise Stone from Ep25: Dealing with Uncertainty Part 1
Dr Danielle Ofri from Ep38: Making a Connection
Michael Pooley as Dr David Hilfiker from Ep75: Feeling guilty- Medical Injury Part 2 

Credits
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Le Hustle’ by Polyrhythmics, ‘Your Wave’ by Cospe, ‘Soul Single Serenade’ by Dusty Decks, ‘Hollow Head’ by Kenzo Almond and ‘Illusory Motion’ by Gavin Luke. Music courtesy of FreeMusicArchive includes ‘I got 99 broadswords but this one isn't one’ and ‘Friends’ by Komiku and ‘Cree’ by Satellite Ensemble. Thumbnail image is the copyright of RACP. 

Editorial feedback kindly provided by RACP physicians Zac Fuller and Simeon Wong. Thanks also to RACP staff Kathryn Smith, Michael Davidson and Anne Fredrickson.
 Please visit the Pomegranate Health web page for a list of thankyous over the ten years. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

In this podcast we discuss low-value care that has emerged from a decay in the specificity of the terms “cardiac arrest” and “cardiopulmonary resuscitation.” Patients who experience cardiac arrest in hospital are rarely more than a minute or two away from defibrillation. But the proportion of shockable rhythms in these patients is low as the heart has typically stopped after the decline of other systems. In such conditions, chest compressions are more likely to cause unnecessary trauma than improve survival outcomes. 

As retired UK palliative care physician Kathryn Mannix explains, “cardiac arrest” was originally reserved for unexpected events in relatively healthy individuals in the community. She says we need to separate this from the more progressive phenomenon that is better described as “natural dying”.
 
There is also a semantic breakdown in the understanding of what “cardiopulmonary resuscitation” entails. Surveys of Australasian medical practitioners show that the majority consider CPR to include defibrillation and drugs not just chest compressions and ventilation. As a result, Do Not Attempt CPR orders get perceived as being “a stop sign” to other treatments that may be beneficial. We hear from the NZ-based authors of that research, cardiologist Dr Tammy Pegg, intensivist Dr Alex Psirides and palliative care physician Dr Kate Grundy. 

Chapters
4:00 CPR for out-of-hospital cardiac arrest
8:43 Overuse of CPR in hospitalised patients
20:08 Crude algorithms and failed conversations
40:17 Semantic confusion around what CPR entails
48:13 The midwifing of natural dying

Guests
Dr Kathryn Mannix (www.kathrynmannix.com)
Dr Tammy Pegg MRCP FRACP FC CANZ DPhil (Nelson Marlborough Hospital cardiology department)
Dr Alex Psirides FCICM (Wellington Regional Hospital intensive care unit)
Dr Kate Grundy FAChPM FRACP (Christchurch Hospital palliative care service; University of Otago)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Awash’ by Gavin Luke, ‘Fields 3’ by Gunnar Johnsén, ‘RGBA’ by Chill Cole and ‘Til All that’s Left is Ash’ by Ludlow.

Music courtesy of FreeMusicArchive includes ‘New Times’ by 4T Thieves and ‘Secret Place’ by Alex Fitch. Image by Yuichiro Chino licenced through Getty Images. Football commentary courtesy of UEFA Euro 2021. 

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Fionnuala Fagan, Simeon Wong, Hugh Murray and Aidan Tan. Thanks also to RACP staff Arnika Martus and Kathryn Smith. 

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in

Despite filling more than half of places in Australian medical schools, women represent 45 per cent of all medical practitioners and just 36 per cent of specialists. Female representation dwindles further in many areas of clinical leadership, prompting what has been termed a “leaky pipeline”. It has been reported that women would progress at similar rates to men, and achieve similar remuneration, were it not for the time taken out from the profession to raise children. In this podcast we discuss what it would take to mitigate this so-called “motherhood penalty” through policy, workplace culture and better distribution of labour in the home. This discussion is important because it relates not just to the wellbeing and rights of individual medics, but also to the depth and diversity of the workforce.a

Chapters
1:38 Better support of mothers returning to work
9:09 How leave and part-time work affects the medical workforce and the benefits of flexibility
19:56 The “motherhood penalty” on career progression of women to senior positions
33:52 Broader biases in society not just around gender roles but a health work-life balance

Guests
Associate Professor Kara Allen FANZCA (Royal Melbourne Hospital; University of Melbourne)
Dr Jenny Proimos FRACP (Royal Children's Hospital Melbourne; Monash Centre for Health Research and Innovation;

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Melting Places’ by Andres Cantú, ‘Not Blue’ by Kylie Dailey. Music courtesy of Free Music Archive includes ‘Good Days’ by Cody Francis, ‘Planting Flags’ by Blue Dot Sessions,  ‘Helice’ by Monplaisir, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by George Peters licenced through Getty Images. 

Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Joseph Lee, David Skalicky, and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith and also to Sarah Anderson of La Trobe University for guiding me through some of the AIHW data.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

ST elevation is clearly a worrying finding that can herald life-threatening conditions, such as ST elevation myocardial infarction. But not all ST-elevations are created equal, and Trainees would benefit from considering a broader number of causes for this presentation. In today’s podcast the team will discuss a case of ST elevation observed in a 65-year-old female during the routine elective procedure of atrial fibrillation ablation. A range of pathophysiologies is discussed that can help listeners work though the differentials in a systematic way. 

Guests
Assoc Prof Pramesh Kovoor FRACP FACC PhD (Westmead Hospital; the University of Sydney)
Dr Neil Warwick FANZCA (Westmead Hospital)
 
Hosts
Associate Professor Stephen Bacchi FRACP (University of Adelaide)
Dr Joshua Kovoor (Ballarat Base Hospital)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Game show music courtesy of Waderman. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Aidan Tan, Aafreen Khalid, Hugh Murray and medical student Nivida Dixit.

Key Reference (Spoiler Alert)

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Metaraminol-induced coronary vasospasm masquerading as ST-elevation myocardial infarction during general anaesthesia [Br J Anaesth. 2024]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

There is evidence that six months or more off the job leads to some loss of practical skills and knowledge and certainly, many doctors report a loss of self-confidence. People take time out from medical practice for many different reasons but career breaks to raise children are more common than ever before. Senior staff at Sydney Children’s Hospital have developed a day-long workshop to help medics brush off the cobwebs before they return to practice. It involves rehearsal of specific skills, refreshers on calculation and interpretation tasks and a high-fidelity critical care simulation. Just as importantly, there is open discussion and mentorship to support the transition back to work. The program is called Paediatric Returnees after Maternity or Extended Leave (PRAM) this podcast was recorded during a live workshop at the Kids Simulation Centre, Randwick.
 
Guests
Workshop participants:
Elodie, Eliza, Emma, April, Stephanie, Lucy and Paula.

PRAM creators:
Dr Josephine Goodyer FRACP (Sydney Children’s Hospital, Randwick)
Dr Sasha Symonds FRACP FACEM (Sydney Children’s Hospital, Randwick)
Renee Byrne (Sydney Children’s Hospital, Randwick)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Elm Lake’ by Elm Lake, ‘Quiet Waters’ by Walt Adams, ‘Illuminations 4’ by Johannes Bornlöf, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by Maskot licenced through Getty Images. 

Editorial feedback kindly provided by RACP physicians Sasha Taylor, Stephen Bacchi,Simeon Wong, Zac Fuller, Hugh Murray, Aidan Tan, Sern Wei Yeoh, Sasha Taylor and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith. 

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. 

In this episode we hear about an emergency presentation to a South Australian hospital, of a 74-year-old male with shortness of breath. The curve ball is that he had undergone ablation for drug-refractory atrial fibrillation less than two weeks prior. This discussion gives an overview of developing technologies for AF treatment and developing knowledge about the possible complications. We also have some multiple choice questions to test your understanding.

Guest
Dr Shaun Evans, FRACP (Royal Adelaide Hospital; University of Adelaide)
 
Hosts
Associate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Jasmine Le (University of Adelaide)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Hugh Murray, Aidan Tan, Aafreen Khalid, Sebastiaan Lambooy, Amy Hughes and Lauren Gomes. 
 

Key Reference (Spoiler Alert)

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Delayed cardiac tamponade from pericarditis following pulmonary vein cryo-balloon ablation [IMJ. 2020]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

In Aotearoa-New Zealand, the proportion of doctors identifying as Māori has doubled from where it was a decade ago to over 5 percent. But there is still a long way to go before the workforce is representative of the broader population which is 17 percent Māori.

The Auckland and Otago Medical Schools have in recent years turbocharged their intake of Māori and Pasifika students but these graduates don’t seem to have trickled through to the RACP in great numbers. Just 3.5 percent of general physicians and 4.8 percent of paediatricians identify as Māori, and Pasifika doctors make up a further 1 and 2 percent respectively.

In this podcast, three Māori medics discuss how the culture of training environments can be made more welcoming to junior doctors with diverse ethnic backgrounds. This discussion takes place in light of an independent review into the clinical examination for paediatrics in Aotearoa-New Zealand which found issues with standardization, transparency and cultural safety. 2024 was a tough year for Māori Health more broadly, as it saw the disestablishment of a dedicated Health Authority, Te Aka Whai Ora, after just twelve months of operation. 

Guests
Dr Danny de Lore FRACP (Rotorua Hospital; University of Auckland)
Dr Matthew Wheeler FRACP (Tauranga Hospital; University of Auckland)
Dr Ngaire Keenan PhD (Sydney Children’s Hospital, Westmead; University of Otago)

Production
Produced by Mic Cavazzini DPhil. Music provided courtesy of FreeMusicArchive includes ‘Periodicals’, ‘In Paler Skies’ by Blue Dot Sessions and ‘Wake Up’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Subdivision of the Masses’ by Philip Weigl and ‘Abyss’ by Luwaks. Image of Dr Danny de Lore property of RACP
 
Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Hugh Murray, Sasha Taylor, Anne-Marie Juengling and Simeon Wong. Thanks also to RACP staff Nick McCurdy and Sarah Millar. 

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

This case report comes to you from Brigham and Women’s Hospital in Boston, a huge teaching hospital that serves the Harvard Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To complicate things, there was a past medical history of migraines and a family history of a Factor V Leiden mutation. The identified diagnosis is one in which evidence is limited for aspects of management, and the topics of uncertainty and mentorship in medicine also arise in this discussion.

Guest
Galina Gheihman, MD D (Brigham and Women’s Hospital; Harvard Medical School)
 
Hosts
Associate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Haelynn Gim (Harvard Medical School)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by Dr Sebastiaan Lambooy.

Key Reference (Spoiler Alert)

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Isolated Cortical Vein Thrombosis [Neurohospitalist. 2023]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.