AMD eBulletin 26 June 2020
In the words of Simon and Garfunkel, "I get all the news I need on the weather report". Except, we don't. If, like me, you have been watching television and social media you will have been confronted by graphic images of men and women of colour and Indigenous heritage being assaulted and, in some instances, losing their lives before us, in juxtaposition with the equally dramatic loss of life due to the COVID-19 pandemic. These issues come together as marches in public spaces in support of the #BlackLivesMatter movement take place against the backdrop of the dictates of social distancing measures.
We are confronted by the thoughts and feelings these issues and images provoke in us. As physicians, we respond at both a personal and a professional level. At the professional level we seek to make clinical decisions with compassion based on evidence, acting with and on behalf of the person who is before us. Those of us with organisational or policy-making responsibilities have the same set of responsibilities and obligations. As responsible citizens we seek to act in the same way – with compassion and in our collective best interests.
How do we physicians make decisions and judgements when seemingly disparate issues come together (collide?) and we are forced to think and to act? Arguably we do so by seeking to answer two recurring questions, ‘What does it take to be a good person or physician?’ and ‘What would a good physician do in this particular situation?’.
No one could have foreseen the scale of the public protests in support of the #BlackLivesMatter movement as the COVID-19 pandemic marched on. We Kiwis and Aussies initially congratulated ourselves on our own good fortune in avoiding the first wave of the pandemic at least, whether by dint of effective political and public health leadership, an engaged and responsible citizenry or merely the benefits of a large and effective moat. However, it soon become apparent that we were not in a position to congratulate ourselves on avoiding the self-examination that the #BlackLivesMatter movement compels us to undertake.
In response to 99 Indigenous deaths in custody between 1 January 1980 and 31 May 1989, a Royal Commission was initiated in Australia. That 434 Indigenous deaths have occurred in custody in Australia since 1991 – and the simply outrageous statistics for Indigenous incarceration rates and health outcomes in general – suggests that this tragedy continues to unfold before our eyes and that our efforts to date are not effective enough. We, as citizens and physicians, are called to listen and reflect upon our own beliefs and assumptions.
We remind and ask ourselves, ‘What does it take to be a good physician?’ and ‘What would a good physician do, in this situation?’. The challenge now for we physicians collectively is to listen to Indigenous leaders and to act from our position of professional privilege to affirm that #BlackLivesMatter in both our countries; just as we have played our collective part to date in our response to COVID-19, by listening to leaders and experts in that field.
It takes strength to pause, reflect and listen to these voices before speaking and acting, and sometimes we are forced to make uncomfortable choices when confronted by ethical dilemmas. This is the professional responsibility of the individual physician as both advocate and individual actor from a privileged position in our society.
Lowitja Institute Chair and Alyawarre woman, Pat Anderson, recently spoke to the consequences of not undertaking this work. She issued a statement titled ‘Racism is killing us’, which describes racism as a key driver of ill-health and mounts a powerful argument that Aboriginal and Torres Strait Islander peoples will not seek out healthcare, and will not work in health services, if they do not feel culturally safe.
Similarly, the Waitangi Tribunal recently released a report noting that “the severity and persistence of health inequity Māori continue to experience indicates that the health system is institutionally racist…We accept that institutional racism is a determinant of health and wellbeing.”
We must take every single opportunity to be a good individual physician to ensure cultural safety for Indigenous patients and colleagues and not allow racism to flourish.
In late April, Victorian Deputy Chief Health Officer, Dr Annaliese van Diemen sought to do just this. She drew a parallel between the impact of the COVID-19 pandemic and the impact of European settlement of Australia on Indigenous Australians’ subsequent health and well-being. Responses to her tweet (innocent and thought-provoking though it was) were initially led by critics of both the right to expression and the validity of the use of this metaphor. In the time of COVID-19, her actions and the subsequent course of events tell us that a moment's reflection and the courage to give voice to that reflection can presage action and function as a call to arms.
For us collectively, as physicians, to seek to right the wrongs and to play our part in seeking to improve the health and wellbeing of Indigenous people and people of colour, we will need to listen to Indigenous voices, using our position of undoubted and unqualified privilege to speak out and, whenever and wherever it is possible to do so, to act courageously in order to truly affirm that #BlackLivesMatter.
Professor Don Campbell
Adult Medicine Division
Applications for the Research Entry Scholarships are currently open, and I encourage all AChSHM Fellows and trainees to apply. The scholarship is valued at up to $45,000 for one year and aims to encourage and support the promotion of research. All AChSHM Fellows and trainees are eligible to apply, with applications closing on Monday, 13 July 2020.
The Chapter Committee met for the first time with its new members on 24 June 2020. The Committee focused on two key areas. The first was defining the roles and responsibilities within the committee and allocating the workload and responsibilities. Secondly, the Committee spent a considerable amount of time on what it wants to achieve over the next two years.
The Committee next meets on Wednesday, 2 September 2020. If you have any feedback for the Committee, please don’t hesitate to contact us through our Secretariat at email@example.com.
Professor Kit Fairley
Australasian Chapter of Sexual Health Medicine
Following the rollout of the College value proposition Specialists. Together – Educate, Advocate, Innovate in 2016, individual Chapters, Faculties and the Paediatrics & Child Health Division developed their own value propositions and narrative statements. The aim of the statements and associated advocacy material is to support the Chapter to have a consistent and simple way to talk about its value to key audiences.
The AChPM has now finalised its statement and associated toolkit, which is now available on the RACP website (behind member login).
I would like to also bring your attention to the currently open Expression of Interest for reviewers for the RACP Foundation Research Awards. The RACP Foundation is seeking EOIs for Fellows of the College to assist the Grants Advisory Committee with the review of applications for Research Awards, particularly the Research Entry Scholarships and Travel Grants for 2021.
The Chapter Committee will next meet on Friday, 14 August 2020. If you have any feedback or comments, please do not hesitate to contact us through the Chapter secretariat at PallMed@racp.edu.au.
Dr Michelle Gold
Australasian Chapter of Palliative Medicine
The Chapter Committee recently finalised its Evolve Top-Five recommendations on low-value practices. These are clinical practices that may be overused, provide little or no benefit, or cause unnecessary harm. You can review the recommendations, along with the rationale and evidence sitting behind each one, on the AChAM section of the Evolve website.
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.
Professor Nicholas Lintzeris
Australasian Chapter of Addiction Medicine
The New Zealand Order of Merit
To be Officers of the said Order
- Dr Garry Vernon Forgeson FRACP of Feilding
For services to oncology.
- Dr Janet Catherine Turnbull FAChPM FRACP of Porirua
For services to health.
Officer (AO) in the General Division
- Emeritus Professor Suzanne Mary Crowe AM FRACP
For distinguished service to health and aged care administration, to clinical governance, biomedical research, and to education.
- Professor Georgina Venetia Long FRACP
For distinguished service to medicine, particularly to melanoma clinical and translational research, and to professional medical societies.
- Professor Ingrid Margaret Winship FRACP
For distinguished service to medicine, particularly to clinical genetics and research, to cancer prevention, and as a role model and mentor.
Member (AM) in the General Division
- Professor Barbara Jane Bain FRACP
For significant service to medicine, and to medical education, particularly to haematology.
- Dr Gabrielle Afifee Cehic FRACP
For significant service to medicine, to nuclear oncology, and to professional medical groups.
- Clinical Professor Phoebe Joy Ho FRACP
For significant service to medical research, to haematology, and to professional bodies.
- Dr Douglas William Lording FRACP
For significant service to medicine, to endocrinology and andrology, and to the community.
- Professor Philip Leo Patrick Morris FAChAM
For significant service to psychiatry, to medical education, and to professional health organisations.
- Emeritus Professor Roger James Pepperell FRACP
For significant service to medical education, particularly to obstetrics and gynaecology.
- Professor Andrew Warwick Roberts FRACP
For significant service to medical research, to haematology, and to cancer organisations.
- Professor Ranjeny Thomas FRACP
For significant service to medical education and research, and to rheumatology.
Medal (OAM) in the General Division
- Dr Walter Patrick Leopold Abhayaratna FRACP
For service to medicine in the Australian Capital Territory.
- Dr David Robert Bell FRACP
For service to medicine, and to professional organisations.
- Dr Joseph Ken Montarello FRACP
For service to medicine, particularly to cardiology.
In May 2020, the RACP conducted a voluntary survey of all its practising Australian-based members on their use of the new Medicare Benefits Schedule telehealth attendance items introduced for COVID-19. A summary report
is available, highlighting the impacts of the new telehealth items and outlining key findings and recommendations.
Last week, Professor John Wilson AM, RACP President launched the RACP Online Congress Series. This is a first of its kind for the College and members, as we are delivering the series entirely online. From June to December, you can join live webinars and access on-demand content including videos, podcasts and past recordings.
Given the role physicians must play in the current healthcare crisis post COVID-19, the Online Congress Series is being delivered free for all members this year. Visit the Congress website to learn more about upcoming webinars.
Professor Catherine Crock AM opens Congress with her keynote address on 'Balancing science with humanity: how kindness restores the whole in medicine'.
Log in to the RACP Online Congress platform using your username and MIN to view the opening keynote address on-demand – one not to be missed.
Don’t miss your chance to apply for funding for 2021 under the following award categories:
Applications for Research Entry Scholarships, Research Development Scholarships, and Travel Grants are due on Monday, 13 July 2020.
Please refer to the RACP Foundation webpage for information on specific eligibility requirements for each award.
Nominations open Wednesday, 1 July 2020 for College Prizes. They acknowledge outstanding contributions and achievements made by Fellows and trainees in their respective fields.
We encourage you to nominate for the following medals:
- The John Sands Medal recognises a Fellow who makes a significant contribution to the welfare of the RACP and its members.
- The College Medal is aligned to the College motto 'Hominum servire saluti'. It is awarded to a Fellow who makes a significant contribution to medical specialist practice, healthcare and/or health of community through physician activities.
- International Medal recognises a member who has provided outstanding service in developing countries.
- Medal for Clinical Service in Rural and Remote Areas recognises a Fellow who has provided outstanding clinical service in rural and remote areas of Australia or Aotearoa New Zealand.
- Mentor of the Year Award recognises a Fellow who has made an outstanding contribution to mentoring or provided a high level of support and guidance throughout training.
- Trainee of the Year recognises a trainee who has made an outstanding contribution to College, community and trainee activities.
- The Eric Susman Prize is awarded by the College to a Fellow for best contribution to the knowledge of internal medicine.
Successful nominees are presented a medal at the RACP Congress and receive full Congress registration, return economy airfares and up to three nights’ accommodation.
Full details are available on the RACP Foundation webpage.
Applications for Trainee Research Awards open from Wednesday, 1 July to Monday, 31 August 2020. Trainees and New Fellows undertaking post-Fellowship training are encouraged to apply.
The Trainee Research Awards provide a valuable opportunity for trainees to present their research at an Australian regional or Aotearoa New Zealand event. The best presenters from each local event are invited to be part of the Research and Innovation stream at the 2021 RACP Congress.
Please send your abstract submissions or inquiries by email to your respective regional RACP offices.
The College’s advocacy on accelerated silicosis is jointly led by Fellows from AFOEM and the Thoracic Society of Australia and New Zealand (TSANZ) through the Lead Fellows Group on Accelerated Silicosis which comprises members of AFOEM:
- Professor Malcolm Sim – AFOEM President
- Dr Warren Harrex – AFOEM President-elect
- Dr Graeme Edwards – RACP spokesperson on silicosis
- Dr Beata Byok – immediate past AFOEM President
- Dr Alexandra Muthu
- Dr Evelyn Lee
and members from TSANZ:
- Dr Ryan Hoy
- Associate Professor Deborah Yates.
The Group also includes representatives from the Royal Australian and New Zealand College of Radiologists (RANZCR). The Group meets monthly by videoconference to discuss how things are progressing on our joint policy and advocacy activities on accelerated silicosis and to provide updates on recent relevant activities across the states and territories.
Nationally, the College and AFOEM representatives participated in a virtual workshop organised by the National Dust Disease Taskforce in March 2020 which focused on the development of nationally consistent clinical guidelines. Dr Graeme Edwards FAFOEM, and Dr Ryan Hoy FRACP, are both members of the Taskforce which was established in July 2019 as a direct result of sustained advocacy for a national taskforce by AFOEM and TSANZ.
In NSW, Dr Graeme Edwards FAFOEM and Associate Professor Deborah Yates FRACP, represented the College at a public hearing for the 2019 NSW Dust Diseases Scheme Review which focused on accelerated silicosis in NSW in September 2019, following the submission of the College’s response to this review. The College submission and the expert testimonies of Dr Edwards and Associate Professor Yates were extensively referenced in the Review’s report to the NSW Government published in March 2020. Many of the College’s recommendations were taken up in the report including calling for the NSW Government to immediately introduce a ban on dry cutting (Recommendation 9); implement a case finding study for respirable crystalline silica exposure in the manufactured stone industry, to improve the identification and assessment of workers at risk of exposure (Recommendation 11) and establish a silicosis register (Recommendation 12). It is encouraging that the NSW Government has already announced that it will ban dry cutting and make silicosis a notifiable disease from 1 July 2020 as well as agreeing to setting up a ‘silicosis health register’.
RACP Quarterly is our member magazine featuring healthcare and medical news. In Issue Two 2020 we move to our new online platform for this magazine.
After feedback from many of our members about the ongoing carbon footprint of printing and postage of the hard-copy magazine, we intended to transition at the end of this year to an online only publication. However, the COVID-19 pandemic has forced us to re-evaluate our plans and bring forward the move to an online only publication for the RACP Quarterly magazine from now and into the future.
In this issue we feature the RACP Fellows recognised in the Australia Day 2020 Honours and the Queen’s Birthday Honours 2020 in both Australia and Aotearoa New Zealand. Congratulations to the recipients – these awards highlight the outstanding work RACP members do and the importance of that work in local, national and international communities.
This issue also features a range of articles in response to the COVID-19 pandemic:
- How are our hospitals and members dealing with the COVID-19 pandemic?
- Supporting trainees through the pandemic
- The race to find a vaccine
- New Telehealth items for physicians and their patients
- The demand for access to Personal Protective Equipment during COVID-19
- Physicians leading the way on opioid treatment during a global pandemic.
Other highlights in this issue include ‘On the frontline of Australia’s worst bushfire season on record’, ‘Guidelines for ethical relationships between health professionals and industry’, ‘Navigating healthcare the Māori way’ and ‘Turning back the clock on heart attacks’.
Read RACP Quarterly Issue Two 2020 online now.
Access previous editions of RACP Quarterly on the RACP website.
The June 2020 issue of the IMJ (Vol 50 Iss 6) is now live on the RACP website and IMJ Wiley page.
Key highlights from the issue are:
- hyponatraemia in heart failure
- wrist temperature monitoring to detect infection
- ischaemic stroke in the young
- ultrasound imaging for thyroid pathology
- peritoneal catheters for malignant ascites
- end-of-life care for fibrotic interstitial lung disease.
The Editor's Choice is an original article titled 'Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective' by Pakeeran Siriratnam, Amelia Godfrey, Ellie O'Connor, Dora Pearce, Chih-Chiang Hu, Ashlea Low, Casey Hair, Ernesto Oqueli, Anand Sharma, Thomas Kraemer and Ramesh Sahathevan.
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 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 is 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 the 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 as part of the RACP Online Congress Series program.
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 Dr Chris Harris describes the confronting course he had to take. He is interviewed by paediatric respiratory physician Professor John Massie and clinical ethicist Professor 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.
- Professor Lynn Gillam (Academic Director, Children’s Bioethics Centre, University of Melbourne)
- Professor John Massie FRACP (Royal Children’s Hospital Melbourne, University of Melbourne)
- Dr Chris Harris FRACS (Royal Children’s Hospital Melbourne).
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 iTunes, Spotify or any Android podcasting app.
Listen to podcast
The Royal Australian College of General Practitioners, National Aboriginal Community Controlled Health Organisation, the Lowitja Institute and The Australian National University are working together to provide practical and timely advice for primary healthcare teams supporting prevention and management of COVID-19 for Aboriginal and Torres Strait Islander people across Australia.
An expert committee guiding the work is providing recommendations for healthcare workers operating in Aboriginal community-controlled health services and other primary care settings.
The first set of recommendations
was released on National Sorry Day 2020
, a day to acknowledge and recognise members of the Stolen Generations as part of an ongoing process of healing. Visit the NACCHO website for updates
The Commonwealth Department of Health has prepared a range of fact sheets
for health professionals regarding supporting the health of people with disability during the COVID-19 pandemic. In her capacity as President of the Australian Association of Disability Medicine
, President-elect Dr Jacqueline Small was part of the advisory committee which developed the resources and which has continued meeting to oversee the implementation of the plan.
The fact sheets complement the recently released Management and Operational Plan for People with Disability
and associated resources.
For over a decade, the College and other medical and public health bodies have advocated for effective, mandatory labelling of alcohol products with pregnancy-related warnings. Responsible Ministers from all jurisdictions are yet again preparing to debate this urgent matter. The decisive meeting is planned for mid-July 2020.
In March 2020, the Ministers delayed approving the evidence-based labelling scheme recommended by Food Standards Australia and New Zealand to allow for a review of the use of the colour red in the warnings. Best evidence clearly shows that the colour red is essential for the label to be noticed, trusted and understood as a warning. It is also clear that the alcohol industry has used the issue to further delay the mandatory implementation of clear and visible labelling of alcohol on the market.
Our close collaborators at the Foundation for Alcohol Research and Education have launched a timely online letter urging the Ministers to finally endorse the implementation of appropriate health warnings on alcoholic products across Australia. The College is a strong supporter of the letter.
The industry and the decision-makers have had enough time. As the letter states, “watering down the label through changes to its colour, size or wording would be risking the health and wellbeing of thousands of Australians for years to come".
Please sign the online letter
and share it with your networks and on social media. It only takes a couple of minutes and is part of a wider campaign to persuade the Ministers to do the right thing, at last.
To support the implementation of Evolve and Choosing Wisely recommendations in clinical practice, we have developed 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 firstname.lastname@example.org
to get involved.
Doctors and medical students around Australia now have access to free, confidential telehealth mental health services through the new Drs4Drs Support Service
, which has been established by Doctors’ Health Services Limited (DrHS).
The Drs4Drs Support Service provides crisis support, as well as non-urgent mental health support, and complements services provided by the network of state-based doctors’ health advisory services that are also funded by DrHS.
Corporate mental health provider, Converge International, will deliver the Drs4Drs Support Service, deploying mental health professionals who are experienced in helping people work through workplace issues, conflict management, relationship concerns, financial problems, legal matters and lifestyle issues.
All services funded by DrHS are completely confidential. DrHS does not receive any information that could identify anyone using this service, as they appreciate patient privacy is paramount and provide the option of anonymity.
DrHS is a subsidiary of the Australian Medical Association (AMA), established with funding from the Medical Board of Australia to provide health and wellbeing support to medical students and doctors.
The Drs4Drs Support Service is funded by a grant from the Federal Department of Health, allowing participants to have up to three free telehealth counselling sessions.
Accessing the Drs4Drs Support Service is simple. Doctors and medical students can call 1300 374 377 (1300 DR4 DRS) or visit Drs4Drs.com.au
– a national one-stop-shop for wellness and support resources for the medical profession.
The College recently developed a Statement on Organ Trafficking condemning the trafficking in organs, including removing organs from living or deceased donors without valid consent or authorisation. As a further step to demonstrate support for ending organ trafficking, the RACP Ethics Committee has led the work of formal RACP endorsement of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.
The Declaration aims to provide ethical guidance for professionals and policymakers on how the benefits of transplantation can be maximised and shared equitably with those in need, without reliance on unethical, harmful and exploitative practises. The Declaration outlines 11 key principles to eliminate trafficking of organs and establish ethical frameworks for the legitimate sourcing of organs for transplantation.
The College is pleased to formally endorse the Declaration and is committed to upholding the principles of the Declaration in all our activities and supporting our members to do the same.
As part of research into glycaemic targets and diabetes management, members are invited to participate in a three-minute survey, answering seven clinical scenarios around HbA1c targets and pharmacological treatment choices in diabetic patients. The survey is directed at physicians, medical registrars, GPs and diabetes educators. Participants will be welcome to review the results and recommendations when available.
The research is being conducted by Dr Kirsten Neal (Endocrine Advanced Trainee), Associate Professor Roger Chen (Endocrinologist, St Vincent's Hospital), Professor Jerry Greenfield (Endocrinology Head of Department, St Vincent’s Hospital) and Professor Katherine Samaras (Endocrinologist, St Vincent's Hospital). Human Research Ethics Council approval 2019/ETH13029.
Please direct any questions to either Dr Kirsten Neal or Associate Professor Roger Chen.
Members are invited to review and provide comment on the following draft datasets developed by the International Collaboration on Cancer Reporting (ICCR):
- carcinoma of the oesophagus
- endoscopic resection of the oesophagus and oesophagogastric junction
- carcinoma of the stomach
- endoscopic resection of the stomach
- intrahepatic, perihilar cholangiocarcinoma and hepatocellular carcinoma (update of first edition).
The ICCR has been formed to develop common, internationally standardised and evidence-based cancer datasets for surgical pathology specimens. Using the best international approaches, and leveraging the knowledge and experience of world-leading pathologists, the ICCR aims to ensure that all cancer reports will be of the same high quality – ensuring completeness, consistency, clarity, conciseness and above all, clinical utility.
The ICCR has published 39 cancer datasets to date.
Your comment on the draft datasets is invited.
The documents will be available for comment until Friday, 7 August 2020. To provide feedback on the draft datasets, email any comments directly to email@example.com. Please include your name and country together with your comments. In regard to your comments or suggested changes, please be as specific as possible, including any relevant background information and supporting evidence, including which section/element of the dataset that your comments pertain to. It is understood there are different areas of expertise, and all comments and feedback on these draft datasets from all specialists in pathology are welcomed. It would be greatly appreciated if you could disseminate this notification to any other interested parties.
If you have any questions, please do not hesitate to contact Fleur Webster, ICCR Project Manager.
The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.
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