AMD eBulletin 1 May 2020

President's Post

In this, my last post as AMD President, I would like to express my gratitude to all those who have provided assistance to me over the last two years. As there are too many to mention I will not list names, but only thank collectively the RACP staff and all the Fellows and trainees with whom I have had the pleasure of working during this time. These include members of the AMD Executive, Council and committees, and all those who have contacted me either to give or receive advice and support. They include those who have responded to concerns about the College and its activities, about issues facing the profession and the wider community, and about matters raised within these posts.    

The strength and resilience of our organisation is well-demonstrated by the extraordinary response we have together made to the current COVID-19 crisis which has presented to our two countries the greatest public health crisis in our histories. In a spirit of selfless devotion to the communities we serve, our members have acted with generosity, courage and dedication, often in circumstances that potentially put themselves and their families at risk. Although the danger has not completely passed, it appears that our efforts have not been in vain and that, despite tragic deaths in both Australia and New Zealand, the terrible disaster that appeared to be looming only two months ago has been averted.

Over the last two years there have been many other challenges, in respect of which some progress has been made, although not always with complete success. Trainee welfare remains a major concern and one on which we need to maintain a constant and ongoing focus. While we have achieved progress, there is still a long way to go to ensure that every trainee feels adequately supported and respected and has the confidence that he or she can turn to the College for assistance and guidance in times of need.

Similarly, we have a distance to go to ensure adequate representation of all our Fellows and trainees from the wide range of cultural groups that make up our diverse organisation. In both countries we need to acknowledge and support our Indigenous members, as well as address the ongoing inequities faced by their communities. The changing demographic composition of the medical profession and, in particular, the greatly increased number of women among our younger members, has also posed challenges within the College itself and in the medical workforce more generally, where the need continues for more flexible and appropriate approaches to work schedules, parental leave, training programs and other issues.

The recent success of the College in advocating for an extension of Commonwealth support for telehealth consultations demonstrates our potential ability both to improve working arrangements and to achieve a fair return for our contributions. There are many other issues in relation to which College support will be needed to protect our members and to ensure our ability to serve our communities most effectively. Our organisation, after all, encompasses practitioners from the major specialities covering, directly or indirectly, all areas of medicine. We have to work hard to make sure that the collective wisdom contained within our ranks is effectively tapped and that the specific needs of individual practitioners and Specialty Societies are identified and addressed.

For many years, the College has played a leading role in debates about ethical issues, both in medicine and in our societies more broadly. In the management of end-of-life issues, relationships with industry, conflicts of interest, global health, gender equity, clinical ethics, organ donation, pandemic response, research ethics, changing approaches to consent, confidentiality and privacy, and responses to technological change – in all these areas and more our members have made fundamental contributions, with significant and lasting benefits, both for clinical care and social policy. It goes without saying that these debates continue and, by their very nature, will never cease.

In all of this process of challenge and ferment, the College itself has not been free from controversy and internal division, as recent events have demonstrated. Here too, however, it is to be hoped that for the sake of our entire membership it will be possible for all involved to put aside personal interests and to work with renewed vigour to address the needs of our rich and diverse community. Here, it is the task of all of us to work to maintain healthy and respectful dialogues in which differences can be discussed, with the purpose and effect of generating greater benefit for all trainees and Fellows, regardless of their backgrounds or personal beliefs. If this is possible our future will be as bright as has been our past.   

Once again, I thank you for your support and for the opportunity to serve you.

If any member has concerns or questions or feels they need help or assistance please do not hesitate to contact the College. 

Paul Komesaroff
President
Adult Medicine Division
Telephone: +61 2 9256 5444
Email: adult.med@racp.edu.au

AChSHM President’s Post

I would like to use this post to congratulate the AChSHM award winners of 2020 that were announced at the Annual Scientific Meeting (ASM) on 21 March 2020. This year the award for Outstanding Contribution to Sexual Health Medicine was awarded to two Fellows, Professor Basil Donovan and Associate Professor Lewis Marshall. Professor Donovan played a founding role in the establishment of the specialty of sexual health medicine in Australasia and has continued to lead the field as both a clinician and researcher for many years. Associate Professor Marshall has demonstrated outstanding and sustained commitment to sexual health medicine through his clinical work and his enthusiastic involvement in sexual health medicine training in Western Australia and nationally. Both have made significant contributions to the field and are truly worthy recipients of this award.

Dr Nicholas Medland has been awarded the inaugural Award for Best Post-Graduate Thesis for his thesis titled ‘Studies in the epidemiology of HIV infection and its treatment in the era of universal treatment recommendations and treatment as prevention’. This work established Dr Medland as a leader in research in the population coverage of HIV early diagnosis and treatment in Australia, and has had a huge impact on sexual health medicine in Australia.

Dr Arthur Wong and Dr Suzanne Rix presented case studies at the ASM as part of the Penelope Lowe Trainee Prize. Both trainees delivered outstanding and informative presentations on interesting cases that really engaged delegates. Dr Wong won the prize with his presentation titled ‘A case of Buschke-Lowenstein tumour of the penis with malignant transformation in a young healthy patient’.

Congratulations to all our award winners. I would like to thank the Lead Convenor of the ASM, Dr Vincent Cornelisse, and the entire Organising Committee for their work to develop and then urgently adapt the ASM to Zoom format when required, due to the COVID-19 pandemic.

I would like to thank Professor David Templeton, who is finishing his term as Chair of the Training Committee in Sexual Health Medicine, for his hard work during his time as Chair and congratulate Dr Carole Khaw who is replacing him.

My term as President finishes in early May 2020. It has been a great pleasure to work with the AChSHM Committee and RACP staff and I thank them. In early May, Professor Kit Fairley will assume the Presidency and Dr Massimo Giola the role of President-elect. My best wishes and congratulations to them both. 

The Chapter Committee will next meet on Wednesday, 24 June 2020. If you have any feedback for the Committee please don’t hesitate to contact us through our secretariat at shmed@racp.edu.au.

Associate Professor Catherine O’Connor
President
Australasian Chapter of Sexual Health Medicine

AChPM President’s Post

My two years as President of the Australasian Chapter of Palliative Medicine have flown past and this is my last report. I have been honoured to represent our speciality, advocating for greater awareness and consideration of palliative medicine within the wider practice of specialist physician endeavour, and increasing the acknowledgement and recognition of palliative medicine more broadly within the College, but also within our community. I am continuing on for a final term as a general member on the Chapter Committee. I wish my successor Dr Michelle Gold every good fortune.

A focus for me has been to promote recognition of leaders within palliative medicine. A particular highlight has been the successful nomination and acknowledgement of two of our senior pioneers in palliative medicine. The award of the RACP College Medal is a significant honour for these individuals, Associate Professor Will Cairns in 2019 and Clinical Professor Doug Bridge in 2020, and raises the profile and regard of our discipline. Associate Professor Cairns was a major force for the development of AChPM within the College and specialist recognition for all of those who had passion and experience but no framework or training path to follow. He has continued to expand the understanding and reach of palliative medicine at a state, national and international level. Clinical Professor Bridge is an early pioneer and practitioner of specialist palliative medicine, but his most recent success after a lifetime’s work and passion has been the development of a Spirituality Training Workshop within RACP for palliative medicine Advanced Trainees and Fellows. The first workshop has been deferred due to the COVID-19 crisis, but will occur as soon as it is possible to do so.

AChPM has also instituted two new prizes to recognise excellence within our Fellowship and our trainees. Watch out for more information about these initiatives in the near future.

AChPM President-elect, Dr Michelle Gold, has been participating as the Chapter Representative on the Australian COVID-19 Palliative Care Working Group. The Working Group has been active in recent weeks, including:

  • being invited to be an early participant in the National COVID-19 Clinical Evidence Taskforce, which is tasked to synthesise new evidence in order to provide national evidence-based guidelines for the clinical care of people with COVID-19.
  • supporting the Australia and New Zealand Society of Palliative Medicine in its development of COVID-19 guidance on critical palliative care practice.
  • facilitating the development of groups in every state and territory in Australia to coordinate the organisation of palliative care services to meet the needs of their population across wide geographical areas.

The Australian Government Department of Health has announced that specialist and consultant physician practitioners who are recognised to practise in pain and palliative medicine are now able to bill consultant physician telehealth services (91824, 91825, 91826, 91834, 91835 and 91836). If you are uncertain of your eligibility to claim the new telehealth items or would like to clarify anything further, you can contact Services Australia on 1800 810 586.

The Chapter Committee will next meet on Friday, 5 June 2020 via videoconference. If you have any feedback or comments, please do not hesitate to contact us through the Chapter secretariat at PallMed@racp.edu.au.

With my kindest wishes.

Professor Greg Crawford
President
Australasian Chapter of Palliative Medicine

AChAM President’s Post

This will be my last report as President and I am pleased to pass on the responsibility to Professor Nick Lintzeris who would in more normal times be taking over as President at RACP Congress.

On 8 April, Dr Adrian Lee, Chair of the RACP NSW/ACT Regional Committee and I attended an online meeting with the Senior Adviser to the ACT Minister for Health to discuss the implementation of real-time prescription monitoring (RTPM) of targeted high-risk medications in the state. We reiterated the Chapter’s message that to fully realise the benefits of the implementation of RTPM, the state must take practical steps to address wider systemic issues, such as improving training for GPs in managing patients with prescription drug and other substance use disorders, and for more complex cases, availability and access to addiction medicine and pain management services for which patients currently experience long waiting lists.

The RACP and the Chapter, along with a number of other organisations including the Royal Australian College of General Practitioners, Royal Australian and New Zealand College of Psychiatrists, and the Australasian Professional Society for Alcohol and other Drugs, have endorsed the Interim Guidance for the delivery of medication assisted treatment of opioid dependence in response to COVID-19: a national response. This document was developed by leading health professional and consumer organisations to assist clinicians in ensuring continuity of medication assisted treatment of opioid dependence during the COVID-19 crisis. It aims to provide guidance to clinicians in how to adapt treatment during this period of major transition and is intended to be read alongside state and territory guidance issued in response to COVID-19.

The Australian Government Department of Health has announced that specialist practitioners who are recognised to practise in addiction medicine are now able to bill consultant physician telehealth services (91824, 91825, 91826, 91834, 91835 and 91836). If you are uncertain of your eligibility to claim the new telehealth items or would like to clarify anything further, you can contact Services Australia on 1800 810 586. Further details of this are available from your state/territory Chairs.

The AChAM Committee will next meet on Friday, 24 July 2020. If you have any feedback, questions or comments for the Committee, please get in touch via our secretariat at AddictionMed@racp.edu.au.

In closing, I would like to express my thanks to all committee members, RACP staff and colleagues who have offered their knowledge, expertise and time over the past two years. The last two years have given me great insight into the tremendous dedication and skills held by my colleagues and I am assured that AChAM is in good hands. My only regret is that we did not manage to develop a comprehensive drug policy – a goal which I overly ambitiously set myself two years ago. Nonetheless a commitment to develop this body of work has been made and expressions of interest to join the Drug Policy Working Group will be sent out to Fellows once the COVID-19 climate allows.

My thanks to you all. My best wishes to you and your families.

Dr Martyn Lloyd-Jones
President
Australasian Chapter of Addiction Medicine

Clarification on new Australian telehealth items

We have received the following clarification on the new telehealth items from the Department of Health:

  • Both recognised specialist and consultant physician practitioners practising in pain and palliative medicine, sexual health medicine and addiction medicine are able to bill consultant physician telehealth services (91824, 91825, 91826, 91834, 91835 and 91836).
  • Occupational and environmental health medicine physicians are eligible to bill specialist telehealth services (91822, 91823, 91832 and 91833).
  • Sexual health medicine, addiction medicine practitioners are able to bill telehealth services to prepare and review a management plan (92422, 92423, 92431 and 92432).
  • Public health physicians are able to bill telehealth services (92513-92516 and 92521-92524).

If there is uncertainty, Services Australia can advise practitioners of their eligibility to claim the new telehealth items and can be contacted on 1800 810 586.

He Tangata, He Tangata, He Tangata: Centre equity and Te Tiriti o Waitangi in all COVID-19 pandemic planning, strategy and responses

Aotearoa New Zealand’s COVID-19 pandemic response must centre equity for Māori and must honour the principles of Te Tiriti o Waitangi. Without an equity-centred pandemic response, Māori will experience multiple negative outcomes from this event. This is not acceptable.

“We are still operating under the fallacy that one size fits all. A national programme, while necessary, will lead to exacerbate health inequities. While things are being done for the general population, they don't have an equity lens, which is essential from the beginning.” 
- Professor Papaarangi Reid

Read and share the RACP Statement and look further to the Urutā statement for research and evidence from Te Rōpū Whakakaupapapa Urutā (National Māori Pandemic Group). Please share these as widely as you can, let's steer a new path.

New Pomegranate podcast: 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 the 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 Professor Sabe Sabesan and paediatrician Dr Michael Williams, who have been pioneering telehealth outreach to rural and remote Queensland for more than a decade.

Guests

  • Professor Sabe Sabesan FRACP (Director, Townsville Cancer Centre; James Cook University)
  • Dr Michael Williams FRACP (Director, Queensland Paediatric Telehealth Service)

Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode and reading the resources.

Subscribe to Pomegranate Health in Apple iTunesSpotify or any Android podcasting app.

Listen to podcast

College facilities remains closed for face-to-face meetings

The College continues to follow advice from the Australian and Aotearoa New Zealand Governments and recommendations for social distancing, hence all RACP offices remain closed for onsite meetings. Members will be advised when these circumstances change.

Request for input from members: College submission to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

Disability and the NDIS has been a key ongoing policy priority for the College and the broader health sector. The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the DRC) was established in April 2019 in response to community concern about widespread reports of violence against, and the neglect, abuse and exploitation of, people with disability.

The DRC’s terms of reference cover what should be done in all settings such as the home, schools, out-of-home care, the justice system, as well as in the disability support system to:

  • prevent, and better protect, people with disability from experiencing violence, abuse, neglect and exploitation
  • achieve best-practice in reporting and investigating of, and responding to violence, abuse, neglect and exploitation
  • promote a more inclusive society that supports the independence of people with disability and their right to live free from violence, abuse, neglect and exploitation.

The DRC has released four issues papers to date: education and learninggroup homescriminal justice system and health care for people with cognitive disability.

The RACP’s Policy and Advocacy team have developed a draft submission which covers a range of areas that the DRC is interested in and that the College has a position on.

Members are encouraged to provide feedback, with particular regard to the sections where it is noted that there are no College positions yet. Please provide feedback to Rebecca Randall, Senior Policy and Advocacy Officer, via RACPConsult@racp.edu.au by close of business Friday, 8 May 2020. We look forward to receiving your valuable feedback.

Quality and safety resources for members

Quality and safety are central to the delivery of healthcare in Australia and Aotearoa New Zealand. We offer a number of resources to help you create a culture of quality and safety in your healthcare setting. 

Register for the quality and safety online course to learn about developing a preventative mindset and identifying and remediating situations where the quality and safety of patient care may be compromised. 

Refer to the Quality and Safety Curated Collection for a peer-reviewed list of high quality resources on the topic. Or to learn about strategies for communicating effectively with patients about the risks and benefits of treatment options, enrol in the communicating risks and benefits online course.

RACP Online Learning resources are free for members and count towards Continuing Professional Development requirements.

Apply for Research Awards and Travel Grants

Applications are now open through the RACP Foundation for Career Development Fellowships, Research Establishment Fellowships, and Research Entry Scholarships which provide research funding for 2021. Upwards of 50 awards with a total value of $2.5 million are available across these award categories. It also includes Research Development Scholarships and Travel Grants.

The RACP Queensland Motor Accident Insurance Commission (MAIC) Research Awards offers up to $100,000 to promote research capacity and capability to improve knowledge on:

  • medical conditions or illnesses which cause or contribute to road traffic crashes (RTCs)
  • medical treatments or approaches that improve health outcomes for people involved in RTCs
  • rehabilitation of people who sustain a temporary or permanent disability through RTCs
  • improving longer term outcomes of people injured in RTCs including pain management, community re-integration, psychosocial, mental health and vocational outcomes.

The RACP MAIC Research Awards are normally tenable in Queensland unless there is a demonstrable benefit to the state of Queensland from the research being undertaken elsewhere in Australia. Awards are available under the Career Development Fellowship and Research Establishment Fellowship categories.

The College International Grant – Asia Pacific Region (Developing Countries) worth up to $10,000 is also available to medical graduates or specialists from outside Australia or New Zealand who intend to further their knowledge in fields of medical education and research. The application must be sponsored by a Fellow of the RACP and submitted before Friday, 31 July 2020.

Full details for these opportunities are available on the RACP Foundation webpage.

Bryan Hudson Medal

Congratulations to Dr Christopher Belder who has achieved the best performance in the RACP Written and Clinical Examinations in Adult Medicine.

Dr Belder completed his Basic Physician Training across The Royal Adelaide Hospital and Queen Elizabeth Hospital. He is passionate about applying evidence-based medicine to improve clinical reasoning and patient care. He is currently continuing with Advanced Training in Neurology at The Royal Adelaide Hospital.

 Dr Christopher Belder

COVID-19 update from the Medical Board of Australia

See the latest newsletter from the Medical Board of Australia covering the COVID-19 pandemic.

Monash University-led COVID-19 Work and Health Study

Monash University’s Insurance and Health Group is leading a study that seeks to understand the impact of COVID-19 on the work and health of Australians who have become unemployed or lost work during the pandemic. This study aims to provide unique and important data that can be used to inform decision making by workers, their employers and government as the pandemic unfolds.

The study is seeking participants who have lost work or become unemployed during the COVID-19 pandemic. It involves completing an online survey that takes about 15 minutes, on four separate occasions over a six-month period.

Further information about the study including how to enrol is available on the Monash University COVID-19 Work and Health Study website.

Ventilator Training Alliance App

As hospitals are procuring additional ventilators from wherever there may be supply, healthcare practitioners are having to operate a wide range of ventilator models and make, regardless of the ones that they have had prior training on. To serve this gap in ventilator training, the Ventilator Training Alliance formed by the participating ventilator manufacturers has launched the Ventilator Training Alliance App to provide healthcare practitioners easy access to training materials in a timely and convenient manner. The free app, powered by Allego, contains training videos and manuals for all ventilator types by all major ventilator manufacturers including Medtronic.

Together with Medtronic, the app to-date has training materials for ventilators from Dräger, GE Healthcare, Getinge, Hamilton Medical, Nihon Kohden and Philips.

Available offline and online, this app is ready for download worldwide in the Apple App Store and Google Play Store.

IMJ April 2020 issue available online

The April 2020 issue of the IMJ (Volume 50 Issue 4) is now live on the RACP website and IMJ Wiley.

Key highlights from the issue are:

  • Pill testing at music festivals
  • Parenteral nutrition during acute illness
  • Equity of sexes in medical specialties and congresses
  • Iron status among young women
  • Enterococcal bacteraemia – ‘silent but deadly’
  • Neurotoxicity in chronic lithium poisoning

The Editor's Choice is a clinical perspectives article titled 'Parenteral nutrition in adults during acute illness' by Kate Fetterplace, Darcy Holt, Andrew Udy and Emma Ridley.

Read IMJ

Evolve case studies

To support the implementation of Evolve and Choosing Wisely recommendations in clinical practice, we have launched two case studies depicting clinical scenarios in which recommendations on reducing low-value care apply. These case studies explore a clinical scenario based on one of the Evolve recommendations on low-value care.

Evolve is seeking enthusiastic Fellows and trainees to partner with us in developing case studies for more specialties. The aim of the case studies is to support Fellows and trainees to build an understanding of low-value care within their specialty and act as a tool for clinical educators and supervisors. Email evolve@racp.edu.au to get involved.

An update from the Obesity Collective 

When our partners, the Obesity Collective (OC), celebrated the first World Obesity Day in early March 2020, the impact of COVID-19 was just beginning to be felt across Australia’s health system, economy and society. Since then, frontline healthcare and community workers, including many members of the OC, have risen to the challenge of dealing with a major national public health emergency.

Across the wider community, COVID-19 related self-isolation and social restrictions pose challenges for healthy eating and activity goals and may affect access to usual care. On a systemic level, there is also hope that the current crisis will lead to a greater recognition of the value of the healthcare system, preventative health, and to appropriate strategic and financial responses to other public health challenges.

There has been emerging evidence (reference 1, reference 2) of a link between obesity, chronic diseases and worse health outcomes from COVID-19. The OC believes it is important to be aware of and communicate these observations clearly – it also notes it is critical to do so in a careful and balanced way that minimises risk of stigma, shame, and anxiety. This simple one-pager from Obesity Canada is a good example of clear non-stigmatising communications about COVID-19 and obesity.

We would also like to remind members that the OC Evidence Hub is growing, with the addition of a new chapter on the health benefits of weight loss by Dr Priya Sumithran, FRACP PhD, and updated sections on proposed improvements to Health Star Ratingimpact of food marketing on children, new approaches to restricting price promotions and the case for a tax on sugary drinks. The OC will soon launch a brochure offering patient-friendly, fat bias-free information about obesity, its causes, attendant health challenges and whether and/or how to consider weight loss.

Obesity Collective

OC Emerging Leaders

A group of OC members and volunteers are creating an Emerging Leaders group for younger professionals who are keen to influence the areas of prevention, treatment and communication about obesity and living with obesity. The group aims to raise awareness of stigma, build up the existing network and enhance ways of talking about and dealing with obesity. The OC is hoping to attract more young leaders in health professions as well as other young people who are interested in the challenge of obesity more broadly. To find out more or express your interest, please email the-collective.info@sydney.edu.au or dorota.sacha-krol@racp.edu.au.

Melanoma Institute Australia free resources

The Melanoma Institute Australia's website provides access to a free online portal of educational resources designed specifically for clinicians.

Discounted shopping with your benefits

Australian families are doing it tough with the recent COVID-19 situation and your benefits program can help you and your family save on household essentials and online shopping.

You can save five per cent ordering your WISH e-gift card online through your benefits website, giving you the full buying power of the e-gift card without paying full price. For example, if you order a $300 Woolworths e-gift card with a five per cent discount for $285, you can then use your e-gift card to purchase your entire weekly fuel and groceries up to the value of $300.

Easily available online, you can quickly save hundreds on weekly groceries, fuel and stores accepting WISH e-gift cards. You can even purchase them for your family and friends to use.

Purchase your e-gift cards online and browse the range of other retailers available. Visit your RACP Member Advantage benefits website.

*Terms and Conditions apply; credit card surcharges do not apply to WISH e-gift cards. WISH e-gift cards are typically delivered within 12 hours of purchase.

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