AMD eBulletin 3 April 2020
The COVID-19 pandemic
As we are all aware, at this time in our two countries we are facing the greatest public health crisis in our history. Our members are at the forefront of the battle to save lives and livelihoods. Many are acting with courage and dedication, often in circumstances that potentially put themselves at risk. This is in the greatest traditions of our profession and demonstrates the determination and commitment that has made us so trusted and respected in our communities.
At this time of challenge I would like to thank all members of the Adult Medicine Division for your selfless service and congratulate you on the work you are doing, in whatever area of our profession you are involved. I would also like to extend, both personally and on behalf of our fellow members, my best wishes and fervent hopes for your safety and that of our colleagues and their loved ones.
The COVID-19 emergency has evoked vigorous responses from our governments, as well as from civil society organisations and the wider community. Despite some initial confusion in messaging, national Governments in both Australia and New Zealand, and State Governments in Australia, have now broadly agreed on strict measures to ensure social isolation and distancing to limit the spread of the virus. There is early evidence that these measures are starting to bear fruit.
The College itself has also responded vigorously, having established a COVID-19 Response Group, chaired by Patrick Tobin, which is addressing many pressing issues. Naturally, the safety of the RACP personnel has been a high priority, with almost all staff now working at home. The welfare of trainees has also been a high priority, especially in view of the fact that many are exposed at the forefront of the clinical struggle, as well as having experienced the disruption of the clinical exams. The College has expressed its strong feeling to trainees that no one should be disadvantaged by events that are out of their control. While our focus at this stage is, as it should be, on serving our patients and our communities, when the crisis is over we will ensure that trainees can continue with their education and the development of their careers with as little disruption as possible. This is a significant logistic challenge, but we will not let you down.
There are many other areas in which the College, under the leadership of the Response Group and with the assistance of several expert committees, is working to support members. These have included effective advocacy in Australia for the extension of telehealth arrangements, changes in both countries to relax CPD requirements, and strong and continuing advocacy for the improved availability of personal protective equipment.
We are providing expert advice to government, regional health authorities and the community on clinical matters and public health and occupational health issues. As always, our members are at the forefront of hospital planning, community education, and public discussions about safety and ethical issues.
This remains a time of uncertainty and the stakes remain high for all of us, including for our patients, our communities and our own families. It is a time when we all need to work together to support each other in order to overcome the serious challenges, and not inconsiderable dangers, we jointly face. I am confident that we will emerge from this period with the satisfaction that we have discharged with honour the duties with which, throughout history, the members of our profession have been charged.
If any member has concerns or questions of feels they need help or assistance please do not hesitate to contact the College directly, or me personally.
Adult Medicine Division
Telephone: +61 2 9256 5444
The AChSHM Annual Scientific Meeting (ASM) was held on Saturday, 21 March 2020 as a virtual meeting via Zoom due to the current COVID-19 pandemic. This was the first time the ASM had been run virtually, and it involved a lot of coordination from Lead Convenor Dr Vincent Cornelisse, the ASM Organising Committee, our guest speakers and RACP staff to convert the meeting from face-to-face to virtual on short notice. I’d like to thank all those involved, including delegates, for making the event a success.
Highlights of the day included a presentation by UK Consultant Physician in Sexual Health & HIV Medicine, Dr Mark Pakianathan (supported by Gilead Sciences), who presented on innovative models of care for people who participate in chemsex. The Penelope Lowe Trainee Prize presentations were held at the ASM, with Dr Suzanne Rix and Dr Arthur Wong presenting cases from their training. Both trainees delivered exceptional presentations, with Dr Wong being awarded the prize. Congratulations Dr Wong.
The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) has announced the creation of a National Taskforce to respond to the impact of COVID-19 on HIV, Viral Hepatitis and other blood-borne viruses (BBVs) in Australia. The AChSHM Committee intends to work closely with the National Taskforce to ensure appropriate guidance is available for sexual health medicine physicians.
As members may be aware, the Commonwealth Government announced that new telehealth (videoconferencing) and telephone consultation equivalents (with no restriction on location) have been made available for some specialist and consultant physician and paediatrician items. The RACP is currently consulting with College bodies and engaging with the government to ensure additional telephone and telehealth equivalent items are developed for the remaining physician and paediatrician items that are not currently included.
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 firstname.lastname@example.org.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
At such a time of unprecedented change and uncertainty, this message comes with my most sincere wishes that you all stay safe and well physically, psychologically, emotionally and spiritually. And I trust that the teams in which you work are able to be resilient and to support each other at this time.
Due to the COVID-19 pandemic the Spirituality Training Workshop scheduled to be held on 23 and 24 April 2020 has been postponed indefinitely. I would like to thank the Spirituality Training Working Party, Lead Facilitators Professor Doug Bridge and Dr Judith McEniery, and RACP staff for all the work they put into planning the workshop.
AChPM President-elect, Dr Michelle Gold, has been participating as the Chapter Representative on the Australian COVID-19 Palliative Care Working Group (ACPCWG). The ACPCWG is led by the Palliative Care Australia Board Chair Professor Meera Agar, and includes representatives from the Australian and New Zealand Society of Palliative Medicine (ANZSPM), Palliative Care Nurses Australia (PCNA) and the End-of-Life Directions for Aged Care (ELDAC) program. The ACPCWG has been established to provide expert palliative care input into government decisions and policies about COVID-19, support the ongoing provision of the best possible palliative care to the Australian community and to help optimise palliative care services preparedness as part of whole-of-health response to the COVID-19 pandemic.
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
Australasian Chapter of Palliative Medicine
In what is one of my last reports as President I will focus on what is for most of us the greatest challenge of our medical careers. The SARS-CoV-2 pandemic has brought out the best in many. I am continually impressed by the examples of leadership, responsiveness, and commitment of my colleagues who have been working tirelessly to ensure that our patients will be able to continue to access the care that they need and deserve throughout this crisis. One such example is the hard work that the President-elect and his colleagues have put in over the last couple of weeks to develop guidelines for the ongoing provision of opioid pharmacotherapies when the usual systems are disrupted.
The Chapter Committee is currently working on advocating for improved access to take-home Naloxone (THN) as an urgent response to the COVID-19 pandemic. This is required partly in response to the increased supply of methadone and buprenorphine medications, and partly in response to diminished access to treatment services, erratic drug supply in the community, and increased release of prisoners from custody. The Committee is currently discussing its options for advocacy work in this area.
AChAM NSW/ACT Branch Chair, Professor Adrian Dunlop, participated in the NSW Health Real Time Prescription Monitoring Reference Group meeting on Tuesday, 24 March 2020. At this meeting Professor Dunlop reiterated the Chapters concern that the effectiveness of RTPM relies on wider service planning and resourcing, and without this there is potential for its introduction to lead to unintended consequences, such as the diversion of patients away from prescription medicines toward illicit drugs and access barriers for those patients with medical needs, in particular patients with opioid dependence.
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 finishing I would like to express my thanks to all who have contributed to the work of the Chapter, fellow committee members and College staff, and those who continue to advocate for better policy, treatment, and outcomes for our patients.
Dr Martyn Lloyd-Jones
Australasian Chapter of Addiction Medicine
The College has been working closely with the Department of Health advocating to expand the current list of COVID-19 phone and/or telehealth services available for patients for specialist services on the Medical Benefits Schedule (MBS). This is Stage 5 of the critical work of transforming the MBS to support Australians impacted by COVID-19. The College has been consulting with all specialty societies, divisions, faculties and chapters to ensure that all remaining relevant and appropriate specialist and consultant physician and paediatrician items are given telehealth and telephone equivalent attendance items.
A new set of education and training principles have been developed to guide the College’s decision-making during the COVID-19 pandemic and provide our position on potential impacts to training.
This includes decisions about the impacts of training time and progression through training as a result of exam changes and cancellation of training events.
Our new COVID-19 Training and Accreditation Advisory Group are discussing these issues and will advise on key decisions. The committee recommendations will be provided to the College Education Committee and we will endeavour to let you know the outcomes as soon as possible.
The new COVID-19 Exams Advisory Group are also discussing contingency planning for all postponed exams.
As the COVID-19 pandemic continues to unfold we have had to consider all 2020 examinations.
Finding solutions to the impact of postponed exams has been a priority for the College to support trainees to continue progressing through their training and into their careers as physicians.
The COVID-19 Examinations Advisory Group which is made up of the chairs of all exam committees, and the College Education Committee have made the difficult decision to postpone most 2020 exams in light of COVID-19 and the increased demands on our health system and membership.
We are continuing to look at contingency plans for each exam and put measures in place to assist trainees through progression of training.
Divisional Clinical Examination (DCE) – postponed until 2021. Candidates eligible for the 2020 exam will be able to provisionally progress to Advanced Training in the new clinical year.
AFRM Module 1 Written Assessment – postponed to 2021.
AFRM Module 2 Clinical Assessment – postponed to 2021.
AFRM Fellowship Written (General) and (Paediatric) Examination – postponed to 2021.
AFRM Fellowship Clinical Examination (General) and (Paediatric) – postponed to 2021.
AFOEM Stage A Written, Stage B Written and Stage B Practical Exams – still under consideration.
AFPHM Oral Examination – postponed until 2021.
AChSHM Exit Assessment – currently proposed to be held as scheduled via video in August 2020.
We will provide trainees a minimum three months’ notice of any rescheduled exam to give time for preparation.
Cancer Australia has launched a dedicated hub providing coronavirus (COVID-19) information for people with cancer, health professionals and researchers.
People with compromised immune systems or pre-existing medical conditions, including cancer, may be at increased risk of contracting coronavirus (COVID-19) and increased risk of more severe infection.
The website features information for people affected by cancer and a repository of up-to-date, evidence-based resources and guidance from some of the most trusted sources in Australia and around the world for people affected by cancer, health professionals and researchers in the wake of the coronavirus (COVID-19) pandemic.
For more information on coronavirus (COVID-19) and cancer treatment, visit the hub.
The World Health Organization has warned that alcohol is an ‘unhelpful coping strategy’ for the stress and isolation of COVID-19 lockdown. Professor Michael Farrell of the National Drug and Alcohol Research Centre says there is little doubt alcohol consumption will increase in this “time of great social anxiety and stress", especially among vulnerable people.
Commonwealth Bank of Australia data shows alcohol sales have risen by 20.4 per cent compared to this time last year. Amid reported panic buying and stockpiling of alcohol, the Alcohol and Drug Foundation has expressed fears of increased domestic violence, accidents and injuries.
Trauma surgeons have warned that the availability of alcohol during the crisis, including via online sales and delivery, is likely to see an increase in the number of victims of domestic violence attending emergency departments. Chair of the Royal Australasian College of Surgeons Trauma Committee John Crozier said emergency departments in Sydney and Newcastle were already dealing with the effects of the pandemic.
In addition to an increase in accidental and domestic violence-related injuries, increased consumption of alcohol will likely result in a raise in acute hospital presentations for cardiovascular disease, stroke and depression, putting even more pressure on Australia’s overextended health system.
Western Australian Premier Mark McGowan stepped in to mitigate these potential harms by placing limits on takeaway alcohol. The restrictions are designed to assist with the state’s COVID-19 response.
The Foundation for Alcohol Research and Education CEO Caterina Giorgi says leaders must be able to deal with an unfolding crisis while acting to prevent future harm. “It would be an even greater tragedy if the fallout from COVID-19 was made far worse through a significant escalation of alcohol-fuelled harm in our community.”
restrictions on the trading hours for alcohol are especially needed in such times of an expanding physical and mental health crisis like COVID-19.
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 learning, group homes, criminal 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, 24 April 2020. We look forward to receiving your valuable feedback.
Access draft submission
The Australasian Chapter of Palliative Medicine (AChPM) has undertaken significant advocacy work on the important issue of restrictions on opioid prescribing for palliative care patients. There has been an increased focus at a government and regulatory level in Australia regarding opioid prescribing, which has impacted on those who are at the frontline in managing patients with chronic and acute pain, particularly in palliative care. AChPM President Professor Gregory Crawford FAChPM has undertaken meetings with the Faculty of Pain Medicine (FPM) and the Royal Australian College of General Practitioners (RACGP) to discuss how AChPM can work with them to improve education on opioid prescribing in end of life care patients. Professor Crawford also represented the College at a workshop hosted by the FPM which considered how the palliative care community can deliver the National Strategic Action Plan for Pain Management and a workshop organised by the Therapeutic Goods Administration on opioid communication and education activities.
More needs to be done to address the joint needs of investment in prevention and deep-seated health reform to better connect the Australian health system and address identifiable gaps in care. The College calls for the 2020-2021 Federal Budget to look longer term. Access the College’s 2020-2021 Pre-Budget Submission, which addresses the need for:
- prevention strategies on obesity and alcohol-related harm
- early intervention in mental and physical health of infants and children
- calls for more integrated approaches to care and for fundamental reform of the aged care system.
Learn how to work more sensitively and effectively with migrant, refugee and asylum seeker patients in this new online course.
Access the course
The course provides relevant facts and practical strategies for developing good cross-cultural communication and facilitating easier navigation of the healthcare system. The course includes the perspectives and stories of a diverse range of individuals to provide the full picture.
Accessible anywhere and optimised for mobile on-the-go learning, RACP Online Learning Resources are free for members and counts towards Continuing Professional Development (CPD) requirements.
The Queensland Notifiable Dust Lung Disease Register (the Register) has been fully operational since 1 July 2019. Queensland Health is encouraged by the efforts of respiratory and occupational medicine specialists in making notifications of notifiable dust lung disease to the Register, as required by the Public Health Act 2005, which enables the Register to fulfill its functions.
One of these functions is to provide a report to the Queensland Minister for Health and Minister for Ambulance Services. The first report of the Register will be provided to the Minister by Wednesday, 30 September 2020. The Minister will table the report in Parliament shortly after receiving it. Among other things, the report must include the number of notifications and types of notifiable dust lung diseases recorded in the Register from 1 July 2019 to 30 June 2020. Register staff will ensure that all notifications received by 30 June 2020 are included in the report.
The Approved Form to make a notification of a notifiable dust lung disease will be updated on 1 July 2020, so it is important to continue to check the Notifiable Dust Lung Disease Register website for updates.
The March 2020 issue of the IMJ (Volume 50 Issue 3) is now live on the RACP website and IMJ Wiley.
Key highlights from the issue are:
- HIV testing
- Driving with cardiac devices in Australia
- CMV management in stem cell transplantation
- Anaemia and bone marrow harvesting
- Under-detection of acute kidney injury
- Who is afraid of biosimilars?
The Editor's Choice is a Review Article titled ‘New Advances in the Management of Cytomegalovirus in Allogeneic Haemopoietic Stem Cell Transplantation’ by Michelle Yong, David Gottlieb, Julian Lindsay, Jen Kok, William Rawlison, Monica Slavin, David Ritchie, Ashish Bajel and Andrew Grigg.
Australia has one of the best-value health systems in the world, but also some of the most complicated health regulations. Amongst the federal Medicare scheme, the state hospitals, the private health insurers and the patient, it’s not always clear how a provider should invoice their services.
To explain some of the fundamentals, this podcast features a former nurse and lawyer, Margaret Faux, CEO of Synapse Global Medical Administration. Faux describes areas of ambiguity in the legislation and the Medical Benefits Schedule which create confusion as to when and where certain services can be billed, or which items should not be claimed together. While there are many traps for well-intentioned providers and loopholes for the less well-intentioned, there are some simple solutions that would make medical billing much more streamlined.
- Margaret Faux (CEO, Synapse Global Medical Administration)
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.
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My Health Record is a secure online summary of an individual's health information available to all Australians. Healthcare providers authorised by their organisation can access My Health Record to view and add to their patients' health information. Understanding how to register and upload to My Health Record can be challenging.
Watch Professor Steven Boyages' interview of Carey Doolan from the Australian Digital Health Agency, where they explore and provide practical advice to help you register and upload to My Health Record.
On 27 March, Co-Chair of the Integrated Care Working Group Dr Nick Buckmaster featured at the International Health Care Reform Virtual Conference presenting on complex subacute care and the RACP’s Model of Chronic Care Management.
Dr Buckmaster described how the healthcare system could be re-oriented away from episodic care bringing services together for the patient, and incorporating care plans linking care across sectors towards a more integrated approach. In practice, what this means is that a patient is supported and rehabilitated by a team, including a coordinator, a generalist specialist, GP and other key clinicians, such as other specialists and allied health care.
Visiting Medical Officer in General Medicine and Respiratory Medicine, Tamworth Hospital
A respiratory physician is required to provide services to Tamworth Hospital. The role involves:
- respiratory and general medical services to inpatients of Tamworth Hospital
- bronchoscopy (including EBUS) at Tamworth Hospital
- privately referred outpatients in your own rooms
- participate in the after hours general medicine on-call roster shared with 14 colleagues
- involvement in teaching of undergraduate and postgraduate programs.
About Tamworth Hospital
Tamworth Hospital services a local and referral community population of approximately 205,000 people. You will be joining one of the largest Rural Referral Hospitals in Australia. In July 2015 we opened our new $220 million acute services redevelopment. You will be supported by a collegial team of 16 physicians in specialties including respiratory, cardiology, nephrology, rheumatology, medical and radiation oncology, haematology, neurology, gastroenterology, rehabilitation and endocrinology.
Tamworth Hospital is a teaching hospital for the Bachelor of Medicine, University of Newcastle and the Joint Medical Program, University of New England and has accredited basic physician training posts in general medicine, and advanced training posts in cardiology, nephrology, medical oncology, general medicine and rehabilitation medicine.
With a population of 60,000, you will be living inland half-way between Sydney and Brisbane. Tamworth is a thriving regional city and includes ease of access with daily flights to the closest major capital cities, big wide open spaces, a welcoming and friendly community, affordable housing and great opportunities for you and your family to pursue your past-time passions.
Remuneration is in accordance with the Public Hospitals (Visiting Medical Officer Sessional Contracts) Determination.
Enquiries go to Dr Simon O’Connor, Clinical Director of Medicine via phone on +61 2 6767 7700 or Cheryl Hayes, Senior Medical Recruitment Consultant via email at email@example.com.
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