AMD eBulletin 6 March 2020
The coronavirus epidemic
The developing COVID-19 (coronavirus) epidemic has understandably evoked fear and uncertainty in the Australian and New Zealand communities. The number of cases around the world continues to increase rapidly and more than sixty countries are now affected. The number of new cases outside China now exceeds those inside the country. In Australia, there have been more than forty confirmed infections and two deaths and in New Zealand there has so far been one case confirmed.
It is not known how the epidemic will progress or what toll it will ultimately take. It may be possible to contain it through rigorous quarantine and hygiene measures, but it is also possible that it will continue to spread, with devastating consequences. It is generally agreed that Australia and New Zealand are better placed than most other countries to defend themselves against the threat of a new pandemic, but all assessments so far have emphasised our limited ability to predict what will eventually happen. It is recognised that those most at risk will be older people with pre-existing medical conditions and those who live in high density settings such as nursing homes.
Under these circumstances, it is important that the College and its members show leadership towards the Australian and New Zealand communities and support for each other and other health professionals. It is necessary for us to keep closely aware of the regular updates from the Australian Chief Medical Officer and other relevant authorities, in Australia, New Zealand and elsewhere.
At this stage, we have been assured that it is safe to go about our daily business, but we have also been advised to take rapid and strict precautions if we come into contact with patients who could potentially be infective. These precautions involve the use of masks and other protective measures and should be instituted as early as possible after a threat has been identified. It is important for all physicians to familiarise themselves with published guidelines, both from national agencies and from their own institutions, about the steps that should be taken in relation to the diagnosis and management of a patient with a respiratory or other febrile illness.
We need to show support to doctors in the community, including general practitioners, who may feel especially exposed, both to actual risk and to the stress associated with it. Where appropriate, we can provide guidance to our patients, colleagues and others to maintain a focus on responsible practice and the wellbeing of the wider public. It is important that we do what we can to protect individuals and minority groups that may be especially vulnerable and to resist expressions of racism or xenophobia.
If the epidemic does develop it is possible that we will face additional challenges. The quarantine processes and new laws to limit personal freedoms in times of emergency may raise complex issues which will be the subject of vigorous public debate. There will be challenges in relation to the allocation of scarce resources—including how access to limited numbers of intensive care beds and related facilities will be decided. We will need to consider how to oversee the urgent efforts to develop and test new treatments in conditions where there is pressure to override well established regulatory and ethical conventions. Some of us may have to decide whether to expose ourselves to risk in the service of our patients or to object conscientiously on the basis that responsibilities to our families take precedence.
This is a time of uncertainty and the stakes remain high. If you have any questions about how to respond please do not feel afraid to ask, and we must all provide support to each other as we face this challenge together. Please also remember there are many resources available to members under the Health and Wellbeing page on the College website.
As always, feedback on the Presidential Posts is welcomed. Please send comments to:
Adult Medicine Division
Telephone: +61 2 9256 5444
The Australasian Chapter of Sexual Health Medicine Annual Scientific Meeting (AChSHM ASM) is only two weeks away. You're encouraged to register for what promises to be an enriching and informative day.
The Organising Committee is excited to announce that an international speaker will be presenting at this year’s AChSHM ASM, which will be held at the RACP meeting space in Sydney on Saturday, 21 March 2020.
Dr Mark Pakianathan is a consultant physician in sexual health and HIV medicine in the UK with a special interest in the sexual health of gay men and young people. Dr Pakianathan has transformed pathways for gay, bisexual and other men who have sex with men attending sexual health clinics, by enabling the development of an integrated drugs and sexual health service for this population. Dr Pakianathan will present on innovative models of care for people who participate in chemsex.
Gilead Sciences will be supporting Dr Pakianathan to speak at the AChSHM ASM.
There are also a number of other engaging and enthusiastic speakers presenting on topical issues, including:
- Associate Professor Adam Bourne presenting on chemsex among men who have sex with men
- Ms Maggie Smith presenting on STIs and PrEP and the transgender community
- Dr Jaimie Veale presenting on sexual health and sexual healthcare access for trans people in Aotearoa New Zealand.
To view the full program and register, visit the AChSHM ASM website.
The Trainees’ Day is held the day before the AChSHM ASM on Friday, 20 March 2020 and will have educational and interactive sessions on topics that have been requested by our trainees. The day is exclusively for Advanced Trainees in sexual health medicine. The program has been released and is available on the AChSHM ASM website, with highlights including:
- Dr Rohan Beresford presenting on shigella and other sexually acquired enteric pathogens in men who have sex with men
- Dr Michael Lowy presenting on male sexual dysfunction
- a session on training and the College website, exam resources and the AChSHM exit assessment.
The Chapter Committee will next meet on Wednesday, 24 June 2020 at the RACP office in Sydney. We are interested to hear your feedback about what you think the Committee’s policy and advocacy priorities should include. You can email the Committee through our secretariat with your ideas at firstname.lastname@example.org.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
I met with Dr Harry Nespolon, President of the RACGP on 11 February 2020 to discuss improving education on opioid prescribing in end-of-life care patients. At the meeting, we discussed collaborative ways in which the RACP can work with the RACGP to improve on the current understanding of appropriate use of opioids within the Australian palliative care context and to provide leadership and guidance for specialists and GPs in this complex area of practice.
On 18 February 2020, I attended a communication and education workshop on the appropriate use of opioids hosted by the Therapeutic Goods Administration (TGA). The purpose of the workshop was to bring together major clinical and consumer stakeholders to discuss a coordinated approach to communication and education on the reforms to the regulation of prescription opioid medicines.
I also participated in a National Pain Summit in Melbourne on 24 February hosted by the Faculty of Pain Medicine to develop a national pain strategy. It has been a few busy weeks with pain and opioids high in the consciousness of politicians, administrators and clinicians. As palliative medicine specialists we will need to watch and monitor how some of the proposed changes planned by the TGA might impact on our patients. The intention is that there should not be increased difficulties for palliative care patients to access adequate and appropriate amounts of opioids.
The AChPM Committee met on 18 February 2020 for a productive meeting where topics included the development of an annual trainee and Fellow award, the Spirituality Training Workshop and finalising the Committee’s narrative statement and advocacy toolkit materials.
Associate Professor Peter Poon and I were elected to general AChPM Committee Member positions in the recent College elections. Our terms in these positions will begin after the RACP Congress in May 2020 when my term as President of the Chapter concludes.
Expressions of interest are currently being sought for the following five positions on the AChPM Committee:
- Aotearoa New Zealand Fellow Representative
- Paediatrics & Child Health Division Representative
- Fellow Representative (General Committee Member position)
- Trainee Representative.
Nominations for the above positions close on Wednesday, 18 March 2020. View the full details, including how to nominate online.
The Chapter encourages you to register for the Spirituality Workshop, which promises to be an enriching and informative event. The Spirituality Workshop is a one and a half day workshop on the spiritual dimensions of palliative care, and has been designed for Advanced Trainees in palliative medicine. It is also suitable for any health professional interested in the spiritual care of their patients. The workshop will be held at the RACP meeting space in Sydney from Thursday, 23 to Friday, 24 April 2020. Register now as places are limited.
The Chapter Committee will next meet on Friday, 5 June 2020 at the RACP office in Sydney. If you have any feedback or comments, please do not hesitate to contact us through the Chapter secretariat at PallMed@racp.edu.au.
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
On 24 February 2020, Dr Rob van den Berg (Chair of the RACP SA Regional Committee), Dr Xiu Lim (SA Chapter Fellow and RACP Representative on the SA Govern Real-Time Prescription Monitoring External Advisory Group) and myself met with the Honourable Stephen Wade MLC (SA Minister for Health) and his staff to discuss the implementation of real-time prescription monitoring (RTPM) in the state.
We raised concerns with the Minister 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. This includes 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 Minister listened to our concerns, understood the issues raised and the need to plan carefully.
I am delighted to announce that Professor Adrian Dunlop has been appointed President-elect of the Chapter – congratulations Adrian. He will begin his term as President-elect after the RACP AGM in May 2020.
Expressions of interest are currently being sought for the following seven positions on the AChAM Committee:
- Trainee Representative
- NSW/ACT Branch Chair
- VIC/TAS Branch Chair
- SA/NT Branch Chair
- QLD Branch Chair
- WA Branch Chair
- Aotearoa NZ Branch Chair
Nominations for the above positions close on Wednesday, 18 March 2020. View the full details, including how to nominate online.
Following the roll-out of the RACP value proposition Specialists.Together – Educate, Advocate, Innovate, individual Chapters, Faculties, and the Paediatrics and 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 AChAM has now finalised its statement and associated advocacy toolkit materials, which are available on the RACP website (behind member login).
The AChAM Committee will next meet on Thursday, 2 April 2020 via video conference. If you have any feedback, questions or comments for the Committee, please get in touch via our secretariat at AddictionMed@racp.edu.au.
Dr Martyn Lloyd-Jones
Australasian Chapter of Addiction Medicine
Our College is calling upon members to submit expressions of interest to our new Gender Equity in Medicine Working Group (GEMWG). The GEMWG is being established to develop an understanding of the gender equity issues and barriers experienced by Fellows and trainees and examine what our College can do to better support gender equity in medicine. This is a great opportunity to be involved in an important College initiative and we encourage you to apply today.
Congratulations to RACP Fellow and Cardiologist, Professor Clara Chow, who is a finalist in this year’s NSW Premier's Woman of the Year Award.
Professor Chow will be the first female President of the Cardiac Society of Australia and New Zealand, and has shown great leadership and innovation through many achievements in cardiology over the years.
In 2015, Professor Chow led a review of patients deemed to have cardiac disease, which has since helped lessen unnecessary hospital admissions and in 2016, Professor Chow was the winner of the Google Impact Challenge award, for an idea based on a text message program aimed to support and educate patients with coronary heart disease.
She continues to develop a customised digital program to expand her research to help those with heart disease.
Congratulations Professor Chow.
Applications for the 2020 RACP Educational Development Study Grants close Monday, 23 March 2020.
Awards worth up to $10,000 are available for this round including:
- Richard Kemp Memorial Fellowship
- Aotearoa New Zealand Educational Development Grant
- Queensland Regional Committee Educational Development Grant.
To access the eligibility criteria and the online application form, please visit the RACP Foundation webpage.
The program for the International Medical Symposium (IMS) has now been released.
Exploring the theme of providing care to underserved populations, this event will give Canadian, Australian and New Zealand perspectives on how we can achieve positive health outcomes for people living in remote areas, those who are isolated or those who have any number of other social determinants.
The symposium brings together leaders from the medical profession, educators, regulators and policy makers to address big-picture subjects from across the medical education sector.
Join the conversation and register at the IMS website.
Congratulations to the following Fellows and trainees who have been selected as 2020 Research Awards and Grants recipients:
Career Development Fellowship
- Professor Anita Wluka – RACP Fellows Career Development Fellowship
Research Establishment Fellowships
- Associate Professor Rebekah Ahmed – Croxon Research Establishment Fellowship for Alzheimer Disease Research
- Dr Helen Barrett – RACP ESA Research Establishment Fellowship in Endocrinology
- Dr Rachel Joelle Black – Barbara Cameron ARA Research Establishment Fellowship
- Dr Ada Cheung – Cottrell Research Establishment Fellowship
- Associate Professor Philip Andrew Clayton – The Jacquot Research Establishment Fellowship
- Dr Leticia Miranda Alle Deveza – RACP ARA D.E.V. Starr Research Establishment Fellowship
- Dr Nidhi Garg – RACP Research Establishment Fellowship
- Dr Shom Goel – RACP Fellows Research Establishment Fellowship
- Dr Claire Louise Gordon – RACP Research Establishment Fellowship
- Dr Ingrid Hopper – RACP/Foundation for High Blood Pressure Research Establishment Fellowship
- Dr Jessica Howell – The Robert Maple-Brown Research Establishment Fellowship
- Dr Adam Nelson – Diabetes Australia Research Establishment Fellowship
- Associate Professor Piero Perucca – The Robert Maple-Brown Research Establishment Fellowship
- Dr Andrea Katharina Viecelli – The Jacquot Research Establishment Fellowship
- Dr Craig Thomas Wallington-Beddoe – The Servier 'Barry Young' Research Establishment Fellowship
- Dr Paul Andrew Yates – Vincent Fairfax Family Foundation Research Establishment Fellowship
Research Entry Scholarships
- Dr Ei Thu Aung – AChSHM Research Entry Scholarship
- Dr Allison Anne Barraclough – RACP Fellows Research Entry Scholarship
- Dr Ming-yu (Anthony) Chuang – Vincent Fairfax Family Foundation Research Entry Scholarship
- Dr Nattakorn Dhiantravan – Arnott Research Entry Scholarship in Cancer Research
- Dr Sebastian Hultin – Jacquot Research Entry Scholarship
- Dr Georgina Laura Irish – Jacquot Research Entry Scholarship
- Dr Kushani Chamindira Jayasinghe – Jacquot Research Entry Scholarship
- Dr Prasanti Kotagiri – Jacquot Research Entry Scholarship
- Dr Tom Nevlin Lea-Henry – Jacquot Research Entry Scholarship
- Dr Michal Lubomski – RACP Fellows Research Entry Scholarship
- Dr Dharmenaan Palamuthusingam – Jacquot Research Entry Scholarship
RACP NHMRC Awards for Excellence (top-up scholarships)
- Dr Samantha Bateman – RACP Jacquot NHMRC Award for Excellence
- Dr Joshua Misha Lewis Casan – RACP NHMRC J J Billings Scholarship
- Dr Kathryn Connelly – RACP NHMRC CRB Blackburn Scholarship
- Dr Suddhasattva Suman Majumdar – RACP NHMRC Woolcock Scholarship
- Dr Hashrul Rashid – RACP NHMRC Kincaid-Smith Scholarship
- Dr Matthew Wheeler – NZ Research Development Scholarship
- Dr Hayley Barnes – Bushell Travelling Fellowship in Medicine or the Allied Sciences
- Dr Kylee Hannah Maclachlan – Dr Helen Rarity McCreanor Travelling Fellowship
- Dr Sabashini Kannan Ramchand – Bushell Travelling Fellowship in Medicine or the Allied Sciences
- Dr Kirsty Marie Sharplin – Margorie Hooper Scholarship (SA)
- Dr Alesha Anhhong Thai – Robert and Elizabeth Albert Travel Grant
- Dr Chang Ho Yoon – Rowden White Travelling Fellowship
The Research Awards are available to Fellows and trainees to support research, while Travel Grants are available to support short periods of research or study overseas.
Complete lists of 2020 Research Award recipients and for past years are available on the RACP Foundation award recipients webpages.
Each trainee is responsible for completing their own research project. Trainees can learn about conducting a research project by enrolling in our Research Projects online course
. It’s designed to support trainees through a detailed walk-through of the research process.
A trainee’s experience can be greatly enhanced by a supportive and informed supervisor. The Research Supervision online course
helps supervisors who want an update on research project requirements and the research process in general.
RACP Online Learning Resources
are free for members and count towards Continuing Professional Development requirements
The February 2020 issue of the IMJ (Volume 50 Issue 2) is now live on the RACP website and IMJ Wiley.
Key highlights from the issue are:
- Monogenic autoinflammatory disorders
- Metastatic colorectal cancer treatment
- Antibiotics in diabetic ketoacidosis
- Post-stroke sleep disturbances and rehabilitation
- TAFRO syndrome compared with Castleman disease
- A rare case of turmeric induced hepatotoxicity.
The Editor's Choice is an original article titled 'Get with the guidelines – Management of chronic obstructive pulmonary disease (COPD) in emergency departments in Europe and Australasia is sub-optimal' by Anne-Maree Kelly, Oene Van Meer, Gerben Keijzers, Justina Motiejunaite, Peter Jones, Richard Body, Simon Craig, Mehmet Karamercan, Sharon Klim, Veli-Pekka Harjola, Verschuren Franck, Anna Holdgate, Michael Christ, Adela Golea, Colin Graham, Jean Capsec, Cinzia Barletta, Luis Garcia-Castrillo, Win Sen Kuan and Said Laribi.
The RACP Policy Statement on Obesity notes that weight bias is prevalent in society and people with obesity often experience bias and stigma, also within the health system. Weight bias negatively impacts the mental, emotional and social wellbeing of people with obesity, affecting health outcomes and experience of healthcare. Healthcare providers must offer respect and dignity by delivering care that meets the needs of people with obesity.
Similar principles apply when physicians talk or write about the challenge of obesity and the people who face it. Our partners at the Obesity Collective are hard at work promoting the responsible model for communicating with media on this subject.
In collaboration with the Weight Issues Network and the Cancer Council Victoria, the Collective has developed a one-page media guide to help reduce the negative and stigmatising portrayal of people with obesity. As a member of the Collective, the College asks Fellows and trainees to consider the following:
- If you are doing an interview or providing expert input, please share the media guide with the journalist upfront.
- If you see disrespectful images or framing of obesity in reporting, feel free to contact the journalist and share the guide.
As part of this effort, the Weight Issues Network has started a library of respectful images to use when required. The longer-term goal is to expand the library by adding more Australian images. The Collective also has a new weight stigma page which will be updated as more research and resources relating to this issue become available.
If you need to refresh your memory on the College Policy Statement on Obesity, it’s available on the RACP website.
On Thursday, 27 February 2020, Professor Malcolm Sim, AFOEM President-elect, Dr Graeme Edwards, AFOEM Fellow and College spokesperson on accelerated silicosis, presented at a Silicosis Summit organised by WorkSafe Victoria in Melbourne. Dr Ryan Hoy, a respiratory and sleep physician and member of the Thoracic Society of Australia and New Zealand, also took part in the summit as an expert panel member. The event was attended by over 600 people from the stone masonry, construction and tunneling industries who came to learn about prevention of silica dust exposure in the workplace.
On Thursday, 27 February 2020, the NSW Government released the four-volume report of the Special Commission of Inquiry into the Drug ‘Ice’ and its interim response a month after the inquiry’s findings were delivered by Commissioner Professor Dan Howard. On 16 February 2020, the RACP had issued a joint media release with St Vincent Health Australia on 16 February calling for the NSW Government to make the Inquiry's report public. The RACP also made a submission to the Inquiry in May 2019 which recommended:
- more medically supervised injecting centres in areas of need to reduce overdose death and increase links to treatment and support services
- the urgent establishment of needle syringe programs in custodial settings to address not only the health of inmates, but also the wellbeing, health and safety of the broader community
- the establishment of carefully designed and evaluated pill testing trials to keep people as safe as possible at music festivals to be employed in conjunction with other harm minimisation measures including a stronger healthcare focus with priority resourcing for ambulance, medical support, protocol development and training so as to improve resuscitation, retrieval and transfer to hospital when overdoses occur
- the development of strategies for early identification of serious toxicity
- public messaging and support to attend a health facility with immunity from police action and positive partnerships between health and law enforcement.
The Inquiry's final report makes 109 recommendations to the NSW Government including more supervised injecting centres, pill testing; retiring its drug detection dogs; implementing a trial of a needle and syringe program in correctional facilities; establishing greater coordination of alcohol and other drug policy; decriminalisation; reframing substance use as a health issue; a greater investment in treatment, diversion and workforce initiatives; education and prevention programs; better data, reporting and research; a clear focus on priority populations, especially Aboriginal people who experience disproportionate impacts from ATS, rural and regional people and people in contact with the criminal justice system.
The NSW Government has already indicated it would not support the Inquiry’s recommendations to open more medically supervised injecting centres, run needle and syringe programs in prisons, allow consumer substance testing (more commonly known as pill testing) and stop using drug detection dogs. Its interim response states that "the Government will carefully consider the Inquiry’s findings and recommendations and will prepare a final response".
Improving the quality and safety of healthcare is at the heart of Evolve
. We regularly consult, collaborate and partner with RACP Fellows and trainees who are part of the Evolve Policy Reference Group. They play an important role in leading and shaping Evolve to make it more relevant and fit-for-purpose.
Join the Evolve Policy Reference Group by emailing your interest to email@example.com
Asthma is responsible for considerable morbidity and health care costs in Australia, with clinical differences in diagnosing and managing the condition in different age groups. The Global Initiative for Asthma strategy report April 2019 has recommended a change to first-line treatment of adults and adolescents with mild asthma.
Through Evolve, the Thoracic Society of Australia and New Zealand and the RACP Paediatrics and Child Health Division have developed recommendations to help medical practitioners reduce low-value care in diagnosing and managing asthma. These have informed the latest NPS MedicineWise asthma education program.
The program will rollout in 2 phases: the first phase – Paediatric asthma: breathing new life into diagnosis and management- focuses on the paediatric asthma population. Phase 2 commences later in the year and focuses on adults and adolescents.
Find out more
Read the latest news from the Medical Board of Australia.
- Australian Commission on Safety and Quality in Health Care's Better care everywhere Healthcare variation in practice, Tuesday, 20 to Wednesday, 21 July 2020, Sydney, NSW
- 20th International Vasculitis and ANCA Workshop, Sunday, 18 to Wednesday, 21 April 2021, Dublin, Ireland
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