AMD Newsletter 14 December 2018

President's Post 

It is usual at the end of a year to reflect on the successes achieved over the past twelve months and to express optimism about the time to come. While this year has undoubtedly been one of significant achievement for the College and the Adult Medicine Division (AMD), I am sure that all Fellows and trainees will agree that there is still a long way to go both to understand and to respond to the challenges we face.

The year 2018 has been tumultuous and at times difficult for our organisation. The failure of the examination in February caused pain to many trainees, on top of the pressure to which they were already exposed through work commitments and the preparation for an old-fashioned examination process. The College, through its then President, apologised to members for the failure and promised to release the findings of the two independent inquiries that were commissioned. The inquiries have now been completed and the Board has to consider the reports and decide how to share their conclusions with members.

Over the course of the year there has been much discussion about the need for reform within the RACP to restore transparency, democracy and accountability. While attempts have been made – not completely without effect – to address deep-seated governance problems it would, however, be disingenuous to claim that here major success has yet been achieved. Indeed, most of the year has been spent in uncovering the extent of the problems and searching for ways to transform entrenched obstacles to change. This has no doubt been frustrating for some members who have viewed the prospects of renewal of the organisation with hope and optimism.

Despite the lack of conspicuous progress so far, members can be assured that the commitment to reform and renewal remains undiminished. There are certainly great strengths and resources available to us. The College staff remain committed and loyal, displaying high levels of professionalism and creativity in their work. The Fellows and trainees remain eager to offer ideas and energy, as the great volume of pro bono contributions to education and service on multiple College committees demonstrates. The long-established tradition within the RACP of remoteness and bureaucracy is gradually being broken down, even if the pace is slow. Hopefully, members now feel more able to approach College officers and Board members to provide their views and seek support when they need it: indeed, the vigorous responses I have received to many of these posts suggests that this may be the case!

But there is no doubt that major problems remain. The pre-eminent issue is still trainee wellbeing. While a great deal of diagnostic work has been accomplished, and considerable progress has been made in revising the curriculum, here there is still a long way to go. The internal culture of the College still needs to be reformed so that employees can feel adequately supported and appreciated and members can feel that they are receiving the services they deserve. Workforce issues also remain a major concern. While these are largely out of the direct control of the College there is a great deal that we can do to influence change; the College has yet to flex its muscles in this area.

Within the College itself, we have barely started the process of repairing the relationships with the specialty societies, devolving and decentralising decision making and opening up the organisational processes to the scrutiny the members deserve. We have made relatively little progress towards achieving full transparency with respect to College accounts, public declarations of interests and devolving flexible and effective mechanisms for consulting members.

There are many professional and social issues that remain of intense concern. Voluntary assisted dying continues to be a major focus of attention, with the College Statement on the subject having been released last month after a lengthy and comprehensive consultation process. While the document has been widely acclaimed it is clear that many members remain unhappy with it, an indication that we need to keep the dialogue going on this important issue. Climate change, asylum seekers, Indigenous health, care of the elderly, global health – these and many other issues require our continuing engagement.

This end of year report probably makes unusually sober reading, highlighting as it does tasks to be accomplished more than stunning achievements. However, it is hoped that it emphasises that although achieving change is sometimes difficult and frustrating it is important to retain the vision and values with which the process was initiated.

As always, I am keen to receive comments, thoughts and suggestions about how we can continue the struggle to move forward. Indeed, success in our joint endeavours will depend on the continuing support, encouragement and quiet insistence of Fellows and trainees.


Professor Paul Komesaroff FRACP AM
President Adult Medicine Division
Telephone: +61 (0)417 55 26 59
Email: paul.komesaroff@monash.edu

As always, I am keen to receive comments, thoughts, and suggestions about the ideas contained in this article.

AChAM President’s Report

The AChAM Committee held its final meeting of 2018 on Friday, 7 December. At its meeting the Committee completed work on its Evolve list of low value practices, which will be released for consultation in the coming months. The Committee also discussed emerging workforce issues, the introduction of real-time prescription monitoring in various jurisdictions, and the South Australian Controlled Substances (Youth Treatment Orders) Amendment Bill and the issue of mandatory treatment more broadly.

As the Lead Convenor for the International Medicine in Addiction Conference (IMiA) 2019 I would like to invite you to join us in Melbourne from 1 to 3 March for this important event on the Addiction Medicine calendar. IMiA 2019 builds on the enormous success of the previous meetings, with a stimulating program that informs evidence-based addiction practice. Attending the conference is your opportunity to join us in promoting excellence in Addiction Medicine and will leave you with an enriched understanding of current and emerging issues in the field.

Program highlights include:

  • Professor Jon E. Grant - Gambling and behavioural addictions
  • Professor Rajita Sinha - Stress and resilience
  • Dr Iván Montoya - New horizons/approaches in the USA
  • Dr Marc Auriacombe - Opiate/addiction update from Europe
  • Dr Joseph Doyle - Hepatitis C treatment update
  • Dr Edward Ogden - Driving impairment
  • Professor Nick Lintzeris- Long acting buprenorphine
  • Dr David Cunnington - Sleep and alcohol/prescription drugs
  • Professor Peter Miller - Alcohol and violence

The Chapter Committee will hold its next meeting in early 2019. If you have any feedback, questions or comments for us, you can get in touch with the Committee via our secretariat at AddictionMed@racp.edu.au.

In the meantime, I would like to acknowledge the support I have received from the staff at RACP and also to wish you all a happy and, hopefully, relaxing Christmas and New Year.

Dr Martyn Lloyd-Jones 
President 
Australasian Chapter of Addiction Medicine

AChPM President’s Report 

The Chapter Committee met on Friday, 19 October at the RACP office in Sydney for a productive final meeting of 2018. You can read the Committee’s Communique from the meeting online.

On behalf of the AChPM Committee, I encourage all Chapter members to complete the College’s work profile in MyRACP, which seeks to establish a baseline database of the physician workforce. This will be expanded on over time, but is dependent on College members completing the survey so that the data is both there and meaningful. This is so important for our planning and support of trainees. You can access the survey via MyRACP, it only takes five to ten minutes to complete, so please invest in this for our profession.

The AChPM will next meet via teleconference in early 2019. In the meantime, if you have any feedback or comments for the Committee please do not hesitate to contact us through our secretariat at PallMed@racp.edu.au.

In closing, I wish everyone a happy Christmas and the very best for 2019.

With kind regards,

Professor Greg Crawford
President
Australasian Chapter of Palliative Medicine

AChSHM President Report 

The AChSHM Committee met for a productive final meeting of the year on Friday, 30 November. The Committee discussed the drafting of the model of collaboration with ASHM, the syphilis epidemic in Australia and New Zealand, opportunities for advocating for improved sexual health medicine services, and the issue of under diagnosis of pelvic inflammatory disease in young women.

Early bird registrations for the AChSHM 2019 Annual Scientific Meeting (ASM) close at midnight tonight. The theme for our 2019 ASM is New Frontiers with a running theme of technology, young people and Indigenous health within sexual health. A range of topics including transgender health, the syphilis epidemic in Australia and sexual health in youth will be covered.

The AChSHM appreciates your support for this event, which in previous years has been a valuable experience for Fellows, trainees, general practitioners and allied health professionals alike. It’s going to be a fantastic day with many enthusiastic speakers scheduled to present, including:

  • Dr Christopher Bourne presenting on Sexual Health in Youth
  • Dr Graham Neilsen presenting on Assessment in transgender patients
  • Syphilis update panel discussion with Professor James Ward, Dr Darren Russell, Dr Mandy Seel and Dr Lucas De Toca
  • Associate Professor David Whiley with a Mycoplasma genitalium update

I presented an update on the syphilis epidemic in northern and central Australia in Aboriginal and Torres Strait Islander People on 1 December at the RACP South Australian Annual Scientific Meeting, SA Horizons – Scanning the next 10 years. While in Adelaide, myself, Dr Alison Ward (Director of the Adelaide Sexual Health Centre) and Associate Professor James Ward (Head of the Aboriginal Health Infectious Diseases Research group at the South Australian Health and Medical Research Institute) met with the SA Minister for Health and Wellbeing, Honourable Stephen Wade MLC, regarding the ongoing syphilis epidemic.

On 27 November I attended the Aboriginal and Torres Strait Islander HIV Awareness Week activities in Canberra with Associate Professor James Ward, and met with several MPs.

The next AChSHM Committee meeting will be early in 2019. If there are any issues you would like to raise with the Committee, or if you have any feedback for us, 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

RACP Congress 2019

Join colleagues from Monday, 6 to Wednesday, 8 May 2019 at the Aotea Centre in Auckland, New Zealand, for RACP Congress 2019.

Register now to attend the joint Paediatrics & Child Heath (PCHD) and Adult Medicine Divisions (AMD) session on transitioning a patient from paediatric care to adult care and how it can be a complex undertaking. PCHD and AMD are combining to bring expert presentations from the paediatric and adult medicine spheres to seek solutions on how to smooth the process for patients, their carer’s and their medical teams.

RACP Congress 2019 key topics include:

  • Life course theory ‘How do we impact health along the life course?’
  • Obesity: rising to the challenge
  • First 1000 days and non-communicable diseases
  • Medically unexplained symptoms master class
  • Mental health and addiction of patients
  • Chronic disease and integrated care

Early bird registration closes 22 February 2019.

Visit the Congress website to register and view the program.

Best Poster Prize in Adult Medicine

Fellows and trainees are invited to submit an abstract for the opportunity to present at the Best Poster Prize in Adult Medicine to be held during the RACP Congress in Auckland, New Zealand in May 2019. Two categories are open:

Best Poster Prize in Adult Medicine (Fellow)
Best Poster Prize in Adult Medicine (trainee)

The best presenter for each category will receive $1000 and a certificate and be recognised at the Gala Dinner.

Abstract submissions are now accepted via the RACP Congress website.

Applications close on Thursday, 31 January 2019.

RACP becoming a supporter of the Global Initiative to End All Corporal Punishment of Children

The RACP and its Paediatrics & Child Health Division (PCHD) accepted an invitation from the Global Initiative to End All Corporal Punishment of Children to be listed as supporters on the Global Initiative’s website. The Global Initiative campaigns around the world to end corporal punishment of children. It generally seeks to partner with organisations in many countries and has collaborated with the College previously. Its campaign is strongly aligned with established College positions on child protection and physical punishment of children.

Corporal punishment has been illegal in all settings in New Zealand since 2005, but as the RACP is a trans-tasman College, it is now listed as a supporting organisation in Australia as well as New Zealand on an interactive map on the Global initiative’s website.

Other supporter organisations in Australia and New Zealand to date are:

Australia

  • Australian Human Rights Commission
  • Bega Valley Sanctuary Refugee Group
  • Commissioner for Children Tasmania
  • National Children’s and Youth Law Centre

NZ

  • NZ Human Rights Commission
  • Brainwave Trust Aotearoa
  • Action for Children & Youth Aotearoa
  • Youthlaw Tino rangatiratanga Taitamariki

While being a supporter does not entail any financial or other obligations, the College might be listed as a supporting organisation in future Global Initiative publications.

 

Lead Fellow reminder

Expressions of interest are sought from Fellows interested in nominating for the RACP Congress Lead Fellow role for 2020, with the possibility of extending to 2021.

The Lead Fellow and the Congress Planning Committee work with key stakeholders to implement the Board’s strategic vision for Congress.

Find out more

Survey of Clinician Researchers – Invitation to participate

The National Health and Medical Research Council (NHMRC) would like to invite all clinician researchers to participate in the 2018 Survey of Clinician Researchers. The survey is being conducted on behalf of NHMRC by ORIMA Research, an independent market and social research company.

By participating in this survey, you will contribute to research that will inform the NHMRC about:

  • whether there are appropriately clear and supported career pathways available to clinician researchers in Australia;
  • factors that enable some clinicians to enter research;
  • factors that enable some clinicians to maintain a career in research; 
  • factors that cause some clinicians to choose not to enter research;
  • major support mechanisms and enablers for clinician researchers; and
  • major barriers and current issues for clinician researchers.

Participation in the project will assist NHMRC in building a better understanding of the clinician researcher population in Australia. The RACP encourages you to participate in this important research as the project will benefit researchers from medical, nursing and allied health disciplines and in the longer term will aid the integration and translation of research into health policy and practice.

Ethics approval was granted for this project by the ORIMA Research Human Research Ethics Committee.

For more information, or to participate:

  1. read the Participant Information Sheet
  2. go to the survey website 

If you have further questions regarding the Survey of Clinician Researchers, please do not hesitate to contact:

 

Workshops to promote participation from Aboriginal and/or Torres Strait Islander women in the National Cervical Screening Program 

Around 55 workshops (free of charge to workshop participants) will be delivered across Australia in 2018 and 2019. The workshops aim to support healthcare providers and other relevant groups to promote cervical screening and the benefits of regular cervical screening to Aboriginal and/or Torres Strait Islander women, in accordance with the Renewal changes. 

To register, or for more information on the workshops, please contact The Benchmarque Group on telephone 1300 855 568 or by email at courses@benchmarquegroup.com.au

 

HIV information for health professionals 

NSW Health data shows a need to increase HIV testing among heterosexual men who have sex with men, and men at risk of HIV when having sex overseas.

HIV infection in these men is often diagnosed late, which can lead to avoidable HIV-related illness. Early diagnosis and treatment can lead to better health, and prevent HIV transmission to others.

NSW Health encourages health professionals to test all patients at risk of HIV infection, and avoid assumptions about a patient’s risk of acquiring the infection.

For further information visit the NSW Health website.

Newly released report on reducing opioid-related harm for surgical patients

The Society of Hospital Pharmacists of Australia's (SHPA) newly released report, Reducing opioid-related harm: A hospital pharmacy landscape, exposes national inconsistencies in the provision of pharmacy services to reduce risk of opioid misuse, extremely high use of sustained release opioids and poor handover of discharge information for use by General Practitioners.

According to SHPA, this is the "first Australian study to comprehensively analyse current hospital pharmacy practices around opioids has shone a light on the link between the prescribing and supply of opioids to patients after surgery in public and private hospitals nationally and heightened risk of long-term misuse and dependence, highlighting the urgent need for a coordinated, multidisciplinary response." 

 

Medical Board of Australia’s updated sexual boundaries guidelines

The Medical Board of Australia’s updated Guidelines: Sexual boundaries in the doctor-patient relationship, came into effect on 12 December 2018.

The updated guidelines complement the Board’s Good medical practice: A code of conduct for doctors in Australia and do not change the ethical and professional conduct expected of doctors by their peers, the community and the Board.

The updated guidelines were finalised following wide-ranging stakeholder consultation. The Board appreciates the contribution of stakeholders to the review of the guidelines.

The key changes to the guidelines include:

  • A change in the title to make the scope of the guidelines clearer.
  • Editorial updates that re-order the content, make it easier to read and clarify terms and definitions.
  • A new section on social media that complements the Board’s Social media policy.
  • A requirement for patient consent if medical students or anyone else is to be present during an examination or consultation.
  • Advice that an unwarranted physical examination may constitute sexual assault. This includes conducting or allowing others, such as students, to conduct examinations on anaesthetised patients, when the patient has not given explicit consent.
  • Replacing the term ‘chaperone’ with the term ‘observer’. The revised section on the use of observers reflects the advice and principles in Professor Ron Paterson’s report of the Independent review of the use of chaperones to protect patients in Australia, February 2017.

PHARMAC audit findings – Special Authorities for Melatonin

The Pharmaceutical Management Agency (PHARMAC) undertakes regular audits of Special Authorities (SA) applications and has recently completed an audit of Melatonin SA applications.

The audit revealed that a number of SA applications for funding were submitted where the criteria were not met, with a 28 per cent non-compliance rate overall. Non-compliance was found in two areas of applications reviewed:

  • Patients who did not meet the criterion of having a neurodevelopmental disorder. E.g. applications submitted for patients with depression and/or anxiety (54 per cent).
  • Patients’ notes did not record that behavioural or environmental approaches had been tried (46 per cent).

The audit findings underscore the importance of clinicians documenting in the patient notes when and how the relevant criteria are met.

Inappropriate use of SA criteria can lead to inequities in both access to treatments and in health outcomes from within the limited health budget, as the funds used for patients who did not meet the relevant melatonin SA criteria are then not available for investment in other treatments.

PHARMAC can take actions against clinicians submitting non-compliant applications including removing the ability to submit SA applications, requiring oversight by another clinician, and/or notifying the clinician’s College, DHB and the Medical Council.

There are options available if a patient does not meet the funding criteria if the clinician considers a treatment or medicine is in the patient’s best interest. For more information contact Jayne.Watkins@pharmac.govt.nz

PHARMAC is continuing to monitor melatonin prescription numbers and may re-audit melatonin SA applications in the future.

Conferences and Events 

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. 

Career Opportunities 

 There are no career opportunities advertised this month

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