In this episode of our Tea Room long covid series we summarise the latest long covid research presented at last week’s Australasian covid-19 conference.Professor Anthony Kelleher, director of the Kirby Institute, is seeking the cause of long covid.What his team has found is persistent immune system dysregulation.“There is ongoing activation of the immune system, in a range of compartments,” he tells The Tea Room. “The immune system is still producing the cytokines that it normally produces early in infection against the virus, that would normally turn off within a couple of days to a couple of weeks.”Associate Professor Kari Lancaster, from the University of NSW, says “long covid” is possibly the first patient-made term in medicine, and explains how learning from patient experiences is central to effective treatment.“The effects of long covid are likely to have uneven effects across different groups of disadvantage,” she says. “So, talking about what other kinds of community support and social support and social care might be available, alongside clinical care, is really important.”

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Does your medical career have to suffer to ensure you have a healthy baby?This week in The Tea Room we hear new insights on the old dilemma that female physicians face. Professor Nancy Baxter of the Melbourne School of Population and Global Health has been researching the topic. Her findings have both good and bad news for women GPs who are considering pregnancy.Professor Baxter says that a female physician is more likely to have problems during pregnancy and delivery but their baby’s risk of mortality and morbidity was lower compared to non-physicians of a similar income.The reason for increased risk? Women putting off a family till they are older.“The reason that female physicians had worse pregnancy and delivery outcomes was because they were older. It didn't appear that the occupation itself was the driving force. It was the fact that that occupation resulted in women having children at a later age. And it's kind of ridiculous that we create these professions where it becomes really challenging to do what is normal and natural for the vast majority of people – that’s to have a family,” Professor Baxter says.This episode then also looks at whether freezing eggs is all it’s cracked up to be and explores the option of pausing medical school to have a baby.“Pregnancy seems to be a no-go-zone during medical school. That's something that that we need to reassess and create pathways for so that it is possible to be pregnant and have children during studies,” Professor Baxter says.

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“If we resource First Nations Health well, if we do this really well,” Dr Brad Murphy told The Tea Room, “‘closing the gap’ means we actually drive the health care of a whole nation.”It’s a bold vision, and it’s what he would have his eyes set on if elected next president of the RACGP.Dr Murphy’s professional and personal journey has taken him from medic in the navy to starting his own practice to becoming first chair of the RACGP’s National Standing Committee on Aboriginal Health.“We need to make sure we're growing our future generation of GPs,” he says. “We need to make this an exciting opportunity for them to consider, we need to sell it to them when they're in med school.“And we've got to do something to reignite the passion in our belly to make sure that our communities continue to get the very best care.”So, what would he do to achieve it – and how does it stem from his own personal journey?

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Dr Chris Irwin, a skin cancer specialist and president of the Australian Society of General Practice, describes himself as “a coalface GP”.“I’m someone who wants nothing more than to sit in his consult room, spend time with his patients and just do good for them,” he tells The Tea Room.But he has also set his sights on becoming the next president of the RACGP.General practice has reached crisis point, and Dr Irwin believes something positive needs to happen to avoid a slow, inevitable decline, with disastrous consequences both for patients and the profession.Strong leadership of the college could be a part of that positive change.“My vision is for a positive college that is willing to embrace change, a college that realises there's an existential threat to the future of general practice, and a college that stands up for GPs,” he said.When it comes to dealing with government, he says both carrots and sticks are needed.“The carrots need to be optimising budget issues for government, because that’s their primary concern,” he said, “and the sticks need to be that politicians understand negative press will hurt them when they pursue policies that harm patients and GPs.”So, what does Dr Irwin bring to the table, and why is building bridges so important for a leader?

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‘Once a nurse, always a nurse’ is the attitude that Labor’s Ged Kearney is bringing to her role as Assistant Minister for Health and Aged Care.This week, Ms Kearney joined The Tea Room to chat nursing, aged care, worker advocacy and refugee healthcare.The area that she’s most keen to sink her teeth into, though, is how healthcare is delivered differently between the sexes – the effects of which, Ms Kearney says, are “write large before our very noses”.“Starting at the top, [I am] getting everybody that I know who cares about this – and there's a lot of people out there that do care about this – to sit around a table and design perhaps an inquiry or a deep dive into [women’s health outcomes],” she says.Before entering politics in 2018, Ms Kearney worked as a nurse on a gastrointestinal ward and was federal secretary of the Australian Nursing Federation and in 2010 was elected president of the Australian Council of Trade Unions.Experience in both healthcare and union work have influenced her priorities for the role going forward.“I'm interested in healthcare for [culturally and linguistically diverse] groups, for our migrant communities, for our LGBTIQ communities for people who, for various reasons, have really serious barriers in accessing the healthcare system, particularly the primary health care system,” Ms Kearney says.

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What could you do differently to grow your clinic’s financial viability?It’s a question The Tea Room asks this week. We chat with two former clinic owners who have found how to do business better and with more satisfaction and greater income.Dr Todd Cameron owned medical practices that became listed on the ASX. He says there are many ways to maximize revenue and lower manage fixed and variable costs but good business nous is essential.“Sometimes running a medical business can feel like you're running a wedding. You get a special surcharge on top of everything that you've paid for,” Dr Cameron says.Dr Sachin Patel co-founded the business consultancy Scale My Clinic with Dr Cameron. As a child, his parents owned a small business and he learned very early exactly how much effort it takes to run a business.“There's always this competition between needing to serve those you love and those that buy from you so that you can put dinner on the table. I've seen people struggle to get the rewards that their time and sacrifices deserve,” Dr Patel says.According to our guests this week the foundation to better profits is clinical excellence. They then they outline five big ticket items to improve profit including outsourcing, optimizing who does what and deep analysis on why and how much bulk billing really gets done.

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Keeping your finger on the pulse of politics is annoyingly hard so we’ve distilled the latest stories in a quick Tea Room chat with political reporter Francis Wilkins.Francis gives a round-up of where the new federal government is at and says that the honeymoon period won’t last. He also summarises the joint proposal made by the NSW and Victorian governments for better cooperation between GPs and hospitals. Does the proposal hold water when the GP tap is turned on federally but the hospital cup is held by states?The government committee on national laws is also explored in this episode and digital health gets a mention with interoperability heralded as the doorway to outcome funded models rather than fee-for-service.Will healthcare have reform or revolution? Or will the grand opportunity for change be missed?

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An important factor has been missing in the assessment of pain, according to our guest this week on The Tea Room.Dr Manasi Murthy Mittinty practices at the Pain Management Research Institute at the Royal North Shore Hospital. In this episode she shares what she’s recently learned about pain.“More and more research shows us that we need to take a biopsychosocial approach to managing pain,” she says. “It is very much a person-centered approach. ‘One size fits all’ doesn't work for pain.”Dr Mittinty’s pain research has taken her around the world including studies with patients from India, First Nations people from Appalachia in the United States and with Aboriginal and Torres Strait Islander people from South Australia.She says culture and spirituality are missing aspects in the conventional assessment and treatment of pain.Dr Mittinty has some helpful tips for GPs, including a new understanding of conventional pain assessment scales.“Most of the pain measurement we use clinically and research has never been adapted for Indigenous communities. The questions we pose to the patient do not always relate to, or reflect, their lived experiences,” she says.Dr Mittinty's learnings from the research were personal as well as professional. She says she was honoured to hear the stories from Indigenous elders and acquired insight into the multiple daily challenges being dealt with alongside proactive pain management.“I saw immense resilience in patients figuring out ways to help themselves deal with their pain,” she says. “Rather than focusing on the pain the patients would just keep moving on and doing the next thing that was required in their life. It was very inspiring for me."

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Is the pandemic really behind us or have politics and mainstream media simply moved on to newer news?Despite the drop in popularity of covid stories, our guest in The Tea Room today makes it abundantly clear that it’s not time to pop the champagne just yet.Bianca Nogrady is president of the Science Journalists Association of Australia and has faithfully provided The Medical Republic’s covid coverage almost since the pandemic started. She’s had her eye on the statistics for two years and the current trends alarm her.“We have become far too complacent with deaths from covid. And it's really bizarre that we used to get the daily press conferences when the deaths were numbered in the 10s to 20s and that was shocking, whereas now we can have 80 people die in a day and there's barely a whisper,” Nogrady says.Tune in to this episode for a summary of the latest covid conversations from someone who’s had a bird’s eye view of covid science and public discourse over the past two years. You may want to mask up.

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Dr David Dembo says that data is full of signals that can help transform healthcare.That data might be a fluctuating heart rate, or the fact a teenager is listening to Barry Manilow – it all has a story to tell, we just need to listen.A former GP, Dr Dembo now heads up Health Catalyst Australia and New Zealand. In this episode of The Tea Room he speaks about how to use patient engagement tools, such as automated communication and remote monitoring, in a non-invasive way to augment care and maintain visibility before, during and after treatment periods.“Modern medicine is far too complex for humans unaided by technology to practise safely. That means you need data-informed decision-making at the point of care delivery. And the data is there, it just needs to be aggregated, read, cleansed and repurposed in a meaningful way,” Dr Dembo said.He says that clinicians and healthcare managers have tools at their disposal to optimise patient experiences, no matter who or where the patients are.

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