62 episodes

Pomegranate Health presents compelling stories about medicine and society: how doctors make difficult ethical and clinical decisions, how they can communicate with patients and how health delivery can be made more equitable. The podcast is produced by the Royal Australasian College of Physicians (RACP) to inspire excellence in practice.
You’ll hear from clinicians, researchers and advocates. Episodes are developed with the guidance of RACP members and listener input is always welcome. You can leave comments, find story transcripts and further resources for professional development at the website, racp.edu.au/podcast.

Pomegranate Health RACP

    • Science
    • 4.8, 45 Ratings

Pomegranate Health presents compelling stories about medicine and society: how doctors make difficult ethical and clinical decisions, how they can communicate with patients and how health delivery can be made more equitable. The podcast is produced by the Royal Australasian College of Physicians (RACP) to inspire excellence in practice.
You’ll hear from clinicians, researchers and advocates. Episodes are developed with the guidance of RACP members and listener input is always welcome. You can leave comments, find story transcripts and further resources for professional development at the website, racp.edu.au/podcast.

    Ep62: Essential Ethics in Adolescent Health

    Ep62: Essential Ethics in Adolescent Health

    In episode 59 we shared a sampler of the Essential Ethics podcast from the Children's Bioethics Centre, at the Royal Children’s Hospital, Melbourne. A couple of cases studies were presented to help us define “the Zone of Parental Discretion” – a space in which decision-making about a child’s medical care is conceded to parents even if it’s not optimal clinical management.

    Today’s thought experiments come from the oncology department. First, we’re asked to consider when an adolescent should be permitted to make autonomous decisions about their health, even if these would lead to worse clinical outcomes. How does a clinical team decide whether to accept this wish or to override it?  



    In the second case study, the final outcome has already been determined by an incurable brain tumour. A 14 year old girl has been diagnosed with a high grade medulloblastoma. Therapy has little chance of cure but around 30% of patients have their life prolonged by 2 or 3 years but comes with disabling side effects. The parents want to bypass recommended treatment and try prayer and natural therapies instead . Does this terminal prognosis broaden the zone of parental discretion, and how can the clinical team help the family with the terrible choices they have to make? 

    Guests

    Prof John Massie FRACP (Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute)

    Associate Professor Clare Delany (Children’s Bioethics Centre, University of Melbourne)

    Diane Hanna FRACP (Royal Children’s Hospital, Melbourne, Walter and Eliza Hall Institute of Medical Research)

    Kanika Bhatia FRACP (Royal Children’s Hospital, Melbourne)

    Molly Williams FRACP, FAChPM (Royal Children’s Hospital, Melbourne)



    Claim CPD credits and find links to additional resources at www.racp.edu.au/podcast.

    • 42 min
    Ep61: Delirium Part 2- Prevention and Management

    Ep61: Delirium Part 2- Prevention and Management

    In the previous episode we discussed the presentations and screening of delirium, as well as the risk factors. Just as important as these medical and iatrogenic precipitants are a host of environmental triggers that are highly modifiable. Anything that contributes to a person’s disorientation and discomfort can increase the likelihood of a delirium episode. While a lot of these factors are compounded in elderly and frail patients, it’s important not to be fatalistic. Delirium can be reversed in a majority of patients by non-pharmacological means. There are no medications indicated for treatment anywhere in the world. Psychtropic drugs should only be considered in patients experiencing severe distress intractable by other means, as they are associated with many adverse side effects.

    Guests

    Adam Kwok

    Professor Meera Agar FRACP FAChPM (Liverpool Hospital, UTS)

    Professor Gideon Caplan FRACP (Director of Geriatric Medicine, Prince of Wales Hospital, UNSW)

    Claim CPD credits and find links to additional resources at www.racp.edu.au/podcast.

    • 34 min
    Ep60: Delirium Part 1- Detection and Causes

    Ep60: Delirium Part 1- Detection and Causes

    Delirium is an acute disturbance of consciousness, attention, cognition or perception. It’s associated with an increased risk of falls, dementia and high dependency care, and all of this adds up to higher mortality. About a third of patients admitted to ICU or approaching the end of life, experience delirium. But it’s notoriously underdiagnosed, so in this episode we talk about the presentations and detection of delirium. We also go through some of the medical risk factors, including dementia, infection and metabolic disorders like hypercalcaemia. But even more common than these precipitants, are a host of drugs that can alter cognition or increase agitation by their anti-cholinergic properties. Importantly, we also hear Adam Kwok described his experience as the carer of a patient going through the trauma of three bouts of delirium, and the challenges of care. Go to the next episode to hear about non-pharmacological management of those at risk of delirium, and the many caveats of psychotropic medication.

    Guests

    Adam Kwok

    Professor Meera Agar FRACP FAChPM (Liverpool Hospital, UTS) 

    Professor Gideon Caplan FRACP (Director of Geriatric Medicine, Prince of Wales Hospital, UNSW)

    Claim CPD credits and find links to additional resources at www.racp.edu.au/podcast.

    • 31 min
    Ep59: Essential Ethics in Paediatrics

    Ep59: Essential Ethics in Paediatrics

    The ethical questions that come up in paediatrics can appear overwhelming to begin with. When can a child be said to have cognitive capacity and bodily autonomy? For those who don’t, where does the guardianship of the parent to give way to that of the medical professionals? When might treating one child have implications for the resources available to others? And what about not treating or vaccinating a child, if that’s what the parents want?

    All of these issues are tackled in the Essential Ethics podcast, produced within the Children's Bioethics Centre in Melbourne. The Centre was established at Royal Children’s Hospital to promote the rights of young patients and to support families and clinicians facing some vexing ethical questions. The Essential Ethics podcast takes a case-based approach to demonstrate how dilemmas in clinical ethics can be worked through in a systematic way. A couple of these are presented in this episode of Pomegranate Health. In the first story discussed, a child with autism spectrum disorder is suspected of having COVID-19, but the mother refuses testing as it will distress him for little gain.

    The second, real life case, is that of a 16 month old boy born with a developmental abnormality of the lower leg. In the most severe cases the recommended clinical management involves amputation, but this boy’s deformity can be corrected through a number of involved surgeries. Orthopaedic surgeon Chris Harris describes the confronting course he had to take. He is interviewed by paediatric respiratory physician John Massie and clinical ethicist Lynn Gillam. They are respectively the Clinical Lead and Academic Director of the Children's Bioethics Centre, and both have Professorial appointments at the University of Melbourne.

    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)

    Dr Chris Harris FRACS (Royal Children’s Hospital Melbourne)



    Claim CPD credits and find links to additional resources at www.racp.edu.au/podcast.

    • 34 min
    Ep58: Billing Part 2—Compliance and the Free Market

    Ep58: Billing Part 2—Compliance and the Free Market

    In this episode we continue the discussion from Episode 56 about medical billing in Australia. Almost 500  million Medicare rebates are processed every year and for the most part these are claimed appropriately. But non-compliant billing could be costing the health system over 2 billion dollars annually. The vast majority of this comes down to misunderstanding of the conditions around MBS items, according to our guest Loryn Einstein of Medical Billing Experts.

    Every year the Department of Health shifts its attention onto a different specialty area to look at the statistical spread of claiming behaviour. Practitioners at the top end of the curve receive warning letters and flagged practitioners who persist with unaccountable billing behaviour will have their practice audited more thoroughly. Finally, they may be referred to the Professional Services Review, a sort of judicial panel made up of clinical peers.

    Questions have been raised by professional bodies and lawyers about the sensitivity of these processes to clinical nuance or procedural fairness, and the lack of education available to practitioners. We hear responses to such concerns from the Department of Health.

    Finally, we take a look at the huge range of private medical fees in Australia. Loryn Einstein considers how factors like regulation and supply and demand shape this market.

    Guest

    Loryn Einstein (managing director, Medical Billing Experts)



    Claim CPD credits and find links to additional resources at www.racp.edu.au/podcast.

    • 43 min
    Ep57: The Art of Telehealth

    Ep57: The Art of Telehealth

    COVID-19 has left few people around the world unaffected, and health practitioners are among those at the top of the list. Their daily and intimate service to public inevitably puts them at risk of catching the virus, while social distancing precautions can compromise the work that they do. Dreadful as the viral disease is, the bigger consequences of the pandemic may be on the disruption to routine healthcare.

    Consulting patients by video or phone can be a way to keep healthcare ticking over, but many doctors are nervous as they adopt it for the first time. In this podcast we go over some of the bureaucratic and tech support questions that clinicians have been asking during the current crisis. We also discuss the art of building trust with new patients, and conducting a physical examination through telehealth.



    The guest speakers are oncologist Sabe Sabesan and Paediatrician Michael Williams, who’ve been pioneering telehealth outreach to rural and remote Queensland for more than a decade. 

    Guests

    Professor Sabe Sabesan FRACP (Director, Townsville Cancer Centre; James Cooke University)

    Dr Michael Williams FRACP (Director, Queensland Paediatric Telehealth Service)

    Claim CPD credits and find links to additional resources at www.racp.edu.au/podcast.

    • 35 min

Customer Reviews

4.8 out of 5
45 Ratings

45 Ratings

~andyb~ ,

Fantastic

This is an excellent podcast by the RACP on a range of interesting and relevant topics. Fantastic job getting some quality experts in to discuss their fields. Keep up the high quality 👍

Dance student ,

Informative, topical and succinct resource

Excellent for medical students, as well as practising medical professionals.

Dr Graham Davison ,

Succinct professional content

The first episode on end-of-life conversations is excellent. I entered it out of curiosity, was pulled in because of brevity (15:18), liked the the brief fluent comments and summaries -- and that the website offers an episode transcription and references. Also the professional nature of production. Well done.

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