This is the first episode of a new format called “IMJ On-Air” inspired by the RACP’s Internal Medicine Journal. Each episode will be have as guest-host a section editor or reviewer of the IMJ interviewing authors of a recent article. Often these will be Clinical Perspectives reviews which summarise the latest in management of major medical disorders. 

In this episode we have leading respiratory physicians from the Royal Melbourne Hospital presenting current best practice in the diagnosis and treatment of severe asthma. They explain why inhaled corticosteroids have become so ubiquitous and also the remarkable impact that monoclonal antibodies have made to the field. They also discuss the lifestyle factors that can be modified to improve outcomes, and why so many people with severe asthma go undiagnosed. Finally, they reflect on the lessons learned from the 2016 “asthma storm” that send 3000 people to emergency rooms in over a single evening. 

Key Reference
Overview of recent advances in asthma management [Witt 2022, IMJ]

Guests
Associate Professor Daniel Steinfort FRACP (Royal Melbourne Hospital; Principal Research Fellow, University of Melbourne)
Dr Ashleigh Witt (Royal Melbourne Hospital)
Associate Professor Nur-Shirin Harun FRACP (Royal Melbourne Hospital; Peter MacCallum Cancer Centre)
Professor Jo Douglass FRACP FThorSoc (Director of Research, Royal Melbourne Hospital; University of Melbourne) 

Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Tree Tops’ by Autohacker, ‘Crossing Borders’ by Mindserver Unlimited. 

Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review/amend the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. 

The National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders in Australia aspires to streamline referral pathways so that children can get the right help as early as possible. But despite the best intentions of many clinicians, there are drivers in the health system that make implementation difficult. There are constraints in the way specialists can be reimbursed for time spent managing a case through the diagnostic process. And the extent of developmental disorders in the community may not be reflected in the depth of training in this area. We also hear about some breaking research into a highly accurate diagnostic screening tool that could reveal just how prevalent ASD is in the community.

Guests
Dr Paul Hotton FRACP (Staff Specialist in Community Child Health and Child Protection, Sydney Children's Hospital Network; Chair of CCCH at RACP)
with input from Associate Professor Josephine Barbaro (Olga Tennison Autism Research Centre, La Trobe University) 

Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Falling from the Clouds’ by Sven Lindvall, ‘Lantern Room (Instrumental)’ by Torii Wolf and ‘Not Blue’ by Kylie Dailey. Image by Elva Etienne licenced from Getty Images.

Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD.

References
> Australian National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders
> Implementing the National Guideline online explainer 

The average age at which autism spectrum disorder is diagnosed four, though signs are often present well before that. Even where families and GPs may have concerns early in a child’s development, it can take a year or more for a consult with a paediatrician to become available. There are similar waiting lists to see other allied health and sub-specialists who may contribute opinions to a diagnosis. And there is some inconsistency as to what kind of supporting documentation is required to access support services at different layers if government. The Autism Cooperative Research Centre published a national guideline with 70 recommendations to streamline this process and improve equity for families from different backgrounds and living in different parts of the country. In this podcast we hear from a GP and a paediatrician working in regional practice about how this can help their patients receive early intervention in the critical developmental years. In Part 2 we get a response from the RACP’s Chair of Child and Community Health about underlying structural challenges including the paediatric training curriculum and the NDIS. 

Guests
Dr Jo McCubbin FRACP (Fitzpatrick House, Sale, VIC)
Dr James Best FRAGCP (Junction Street Medical Centre, Nowra NSW)

Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Sleeping Starchild’ by Daniel Fridell, ‘Falling from the Clouds’ by Sven Lindvall, ‘Lantern Room (Instrumental)’ by Torii Wolf and ‘Not Blue’ by Kylie Dailey. Image by Elva Etienne licenced from Getty Images.

References
> Australian National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders
> Implementing the National Guideline online  explainer

Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD. 
 

In the last episode we heard some powerful examples of the challenges faced by some practitioners in medicine. Every situation has its idiosyncrasies, but most people start out with a passion for what they’re doing. In today’s podcast we hear from doctor-career coaches Ashe Coxon and Sarah Dalton who help medics solve the workplace challenges, and remember what drew them to the profession. Associate Professor Peter Connaughton describes burnout as an occupational health issue, that needs to be solved organisationally. Those presentations were recorded at Congress 2021, but we also get a call from a listener wanting to share a simple gesture that can make a world of difference between colleagues stretched thin at a busy hospital. 

Guests
Dr Stephen Philpot FCICM (Alfred Health, Cabrini Hospital)
Dr Ash Coxon FRACGP (Townsville Hospital; Medical Career Planning)
Dr Sarah Dalton FRACP (Westmead Children’s Hospital; 
Associate Professor Peter Connaughton FAFOEM (Curtin University; University of Notre Dame) 

Production
Written and produced by Mic Cavazzini DPhil. Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes and ‘Exploring the Lake’ by View Points and ‘Into the Bone’ by Taylor Crane. Photo image licenced through Getty Images. 

Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Vicka Poudyal, Michael Herd, Rhiannon Mellor, Nele Legge and Amy Hughes.

Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD. 

Not a day goes by that there isn’t a headline about the overstretched health service and the struggling professionals within it. It isn’t COVID that has created this situation. The pandemic was just the straw that broke the camel’s back.

At the RACP Congress in May, ENT surgeon Eric Levi explained why burnout should be considered not as a mental health condition but as an occupational disorder. And apart from the stressors of the job itself and the work relationships, the medical profession has a way of consuming one’s personal life. 

Associate Professor Michelle Telfer talked about being hounded for two years by the conservative press over her work with young people struggling with their gender identity. And pain specialist Olivia Ong described how she’d been driven by an unhealthy professional identity until a traumatic spinal injury forced her to reconsider the meaning of self-care. Both physicians found the courage to take control of the situation and define their roles on their own terms.

Guests
Eric Levi FRACS (Royal Children's Hospital; St Vincent's Hospital; Ear, Nose and Throat Victoria)
Associate Professor Michelle Telfer FRACP (Director Adolescent Medicine, Director Gender Service at Royal Children's Hospital Melbourne; Murdoch Children’s Research Institute)
Dr Olivia Ong FAFRM FFPMANZCA (Monash Health, Advance Healthcare)

Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Into the Bone’ by Taylor Crane, ‘Below the Horizon’ and ‘Haunted Heart’ by Dawn Dawn Dawn and ‘Exploring the Lake’ by View Points. Photo image by Paul R. Giunta licenced through Getty Images.

 Wellbeing
Doctor’s Health Advisory Service Helpline 

Aotearoa-NZ:  800 471 2654
NSW/ACT: 02 9437 6552
VIC:      03 9280 8712
TAS:     03 9280 8712
SA:       08 8366 0250
NT:       08 8366 0250
QLD:    07 3833 4352
WA:     08 9321 3098

Lifeline
Australia: 13 11 14.
Aotearoa-NZ: 0800 54 33 54

Converge International
 Aotearoa-NZ: 0800 666 367
 Australia : 1300 687 327

For a transcript and further references please visit our website. Subscribe to email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. Fellows of the RACP can claim CPD credits for listening via MyCPD. 

In episode 78 we heard from some physicians who found themselves taking up the role of advocate, not just for their own patients but for broader system change. And health policy lobbyist Patrick Tobin explained how physicians and the College as whole can best get the attention of parliamentarians. For example, the RACP’s Healthy Climate Futures campaign calls on Government to make the healthcare system more resilient against the shocks of climate heating and extreme weather events.

To complete this series, this episode focuses on what happens to advocacy issues after they land on an MP’s desk, and how they get churned through the Canberra machine to eventually become policy. We hear the perspectives of two physicians turned politicians in interviews that first appeared as part of an RACP documentary called The Advocate’s Journey. 

Dr Mike Freelander practiced for 37 years as a paediatrician in Sydney’s southwest before being  elected to the federal Division of Macarthur in 2016. for the Labor party. Dr Katie Allen was elected in 2019 as the Liberal Member for Higgins after practicing at the Royal Children’s Hospital and directing the Australian Centre of Food and Allergy Research.

While the federal election in May 2022 rearranged some of the chairs at the table, the RACP is proud of all its members who have taken the brave steps of entering the political fray. The represent all colours of the political spectrum and we are grateful to have such influential champions for health policy.

Guests
Dr Rob Lethbridge FRACP (Perth Children’s Hospital) 
Dr Mike Freelander MP FRACP
Dr Katie Allen MP (at time of interview)

Production
Written by RACP Professional Practice team. Music licenced from Epidemic Sound includes ‘Ikigai’ by Twelwe and ‘No Show (Instrumental Version)’ by Penny Lane. Photo courtesy of Michael@Unsplash

Please visit the RACP website for a transcript. RACP members can claim CPD credits for listening via MyCPD. 

The globe has already warmed by more than one degree Celsius over pre-industrial levels and is on track to exceed two degrees by the end of the century. It doesn’t sound like a lot but this will have profound effects on human health with Australia being particularly vulnerable. Most obviously, Australia’s biggest cities will become furnaces in summer with a more than doubling of heat-related mortality. The rising temperatures will also increase frequency of the climate oscillations that delivered us record-breaking temperatures and bushfires in 2019-2020, followed by historic rains and floods last summer. 

 In this podcast we discuss the effects of this increasingly volatile climate on the health of Australians, from infectious disease to respiratory and even mental health. Professor Lynne Madden explains how the health system can become more resilient to these demands and what measures the RACP is asking Federal Government to commit to in preparation for this.  Find out more about the "Health Climate Future" campaign here.  

Guest
Prof Lynne Madden FAPHM (University of Notre Dame)

Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kauko’ and ‘Ikigai’ by Twelwe. Music courtesy of FreeMusicArchive includes ‘Nothing Else Matters’ by Mystery Mammal, ‘Namaste’ by Jason Shaw. 

Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD. 

Immune checkpoint inhibitors have revolutionised care for patients with advanced melanoma and other cancers. These days around half of patients with unresectable metastatic melanoma can expect to live to five years after a regime of agents such as nivolumab and pembrolizumab. That’s up to ten times the survival rate of patients a decade ago, when the chaemotherapy Dacarbazine was the front-line treatment. 

Over half of these patients who respond to immune checkpoint inhibitors will go on to survive long-term but it’s still not possible to identify responders in advance. On top of this, some of the immune-related side-effects of therapy can be serious enough to require stopping therapy. Oncologist Matt Carlino explains how to approach the challenging conversations with patients about hopes around expectations for prognosis and quality of life.

 The risk-benefit equation becomes harder to balance when considering treatment for grade III or even grade II melanomas, as an adjuvant to surgery. Associate Professor Carlino also discusses the process of getting these new indications listed on the PBS, or how treatment can be funded when they are not. 

Guest
Associate Professor Matteo Carlino FRACP (Westmead Hospital; Blacktown Hospital; Melanoma Institute Australia; University of Sydney)

Production
Written and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Headway’ and ‘Denouement’ by Kai Engel, ‘Tavern’ by Sergey Cheremisinov, ‘New Times’ by 4T Thieves. Music licenced from Epidemic Sound includes ‘Dusty Decks’ by Soul Single Serenade. Image licensed from Getty Images.

Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 

The core work of being a physician is demanding enough. But if you’re seeing patients come in day after day with ailments that have social determinants behind them, you may start to feel like Sisyphus; heaving that boulder up the hill only to have to start from the bottom every time it slips your grasp. Surely it would be better to change those socioeconomic drivers but where do you even begin?

In fact, the three word mission statement of the RACP is Educate - Advocate – Innovate.  In this podcast, former General Manager of Policy and Advocacy, Patrick Tobin, explains how the College helps physicians put cases of health equity to those in power.  We hear from Kids off Nauru champion Dr Helen Young, and Dr Jin Russell explains how to harness social media to capture the attention of politicians and journalists. The interviews are drawn from an RACP-produced documentary called The Advocate's Journey hosted by Dr Robert Lethbridge. It is ever-more relevant given the high profile of public health in recent times. 

Guests
Dr Rob Lethbridge FRACP (Perth Children’s Hospital) 
Dr Helen Young FRACP (Royal North Shore Hospital; The Children’s Hospital at Westmead)
Patrick Tobin
Dr Jin Russell FRACP (Starship Children's Hospital; University of Auckland)

 Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Missing Memories’ by Christopher Moe Ditlevesen, ‘Kauko’ by Twelwe, ‘Full House Dusk’ by River Foxcroft and ‘No Show (Instrumental)’ by Penny Lane. Image licenced from Getty Images. 

Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 

This episode is shared from the Essential Ethics podcast produced at the Royal Children's Hospital in Melbourne. It is presented by paediatric respiratory physician John Massie and clinical ethicist Lynn Gillam who are respectively the Clinical Lead and Academic Director of the Children's Bioethics Centre.

In a series titled “Deciding with Children” they raise the following questions. When can a child be considered to have autonomy to make healthcare decisions for themselves? What intrinsic rights does a young patient have up to this age of so-called Gillick competence? How should responsibility for difficult decisions be shared between the patients, the parents and clinicians? And is it possible to minimise the moral injury when the wishes of the patient need to be over-ruled? For the full series go to rch.org.au/podcasts/essential-ethics. 

Guests
Prof Lynn Gillam (Academic Director, Children’s Bioethics Centre, University of Melbourne)
Prof John Massie FRACP (Royal Children’s Hospital Melbourne, University of Melbourne)
Assoc Prof Clare Delany (Children’s Bioethics Centre, University of Melbourne)
Assoc Prof Daryl Efron (Murdoch Children's Research Institute, University of Melbourne)

Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel, ‘Going Undercover’, ‘I Have a Plan’, ‘See you Soon’ by Borrtex and ‘By the Harbor’ by Mhern. Image courtesy of Jin Han Tan at Flickr. Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group.

Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources.