AMD Newsletter 19 October 2018

President's Post 

Recent discussions with Fellows and trainees about how they see the role and function of the College have revealed a remarkable paradox. The organisation is widely perceived to be attempting to perform two contradictory functions. On the one hand, as our professional home, it is seen as a protector and shield against the demands of government and the wider society. On the other, as a body responsible for conducting examinations and supervising accreditation, it is seen as exactly the opposite: as a remote, authoritarian agency whose job is to exercise discipline and control. 

The coexistence of these two opposing roles is a source of confusion and sometimes frustration. This is especially the case in times of stress when appeals for support are answered with what could appear as bureaucratic indifference. The chagrin is exacerbated by the perception that the organisation we own and pay for poses itself against us as a hostile force representing the very adversaries from which we seek protection. 

How did such a state of affairs develop? The answer requires some historical reflection. This shows that while the dual functions of the College as protector and regulator are rooted in ancient tradition, they have assumed an antagonistic relationship to each other only in the modern era. 

Practitioners of the healing arts have always formed themselves into communities that provide mutual support, education and guidance. Historically, these communities were founded on a bond deriving from shared values and a common commitment to service.  In addition, their functions included the shaping of the practices of their members and simultaneously placing constraints on them. The ethos that thereby emerged carried a powerful regulatory force that has endured essentially unchanged for millennia. Throughout this history, the pedagogical function was not distinguished from that of providing guidance and mentorship to Fellow doctors. Rather, the two roles were seen as complementary and indissolubly linked. 

Despite their durability, the actual nature of the associations of doctors evolved over time. In the medieval period they were characterised by rigid hierarchies and were embedded within well-demarcated, stable, geographically located communities. With the mass migration to the cities that accompanied the formation of capitalism they merged with the heterogeneous structures that sprang up to resist the violence of the new society, in the form of friendly societies, mutual aid groups, journeyman’s associations etc. 

When the modern medical profession was established in the mid-nineteenth century doctors were granted a monopoly on the supply of health services, in return for which they were required to ensure the maintenance of standards through the provision of education and internal regulatory processes. This social contract worked satisfactorily, if at times uneasily, for more than a hundred years—in fact, right up to the end of the twentieth century—when the equilibrium was broken by the advent of the novel, radical ideologies of neoliberalism and its cultural manifestation, managerialism. Established in response to the needs generated by the greatly increased complexity of modern society, these new doctrines rejected the right to independence of civil society organisations, insisting that all had to be subject to the laws of the market and to the governance principles now demanded of the corporate sector. Health care, education, social welfare and even the arts now were compelled to serve narrow principles of efficiency, to deliver outputs defined by cost-benefit analyses, and to establish systems of control by managers invested with summary authority. The delicately balanced internal regulatory mechanisms that had endured for so many years gave way to new explicit regimes of power and regulation. 

The effects of corporatisation on the professional associations was profound. The traditional ways of working based on mutual aid and benevolent, if paternalistic, guidance were replaced by administrative systems composed of professional managers remote from the membership. This undoubtedly generated benefits with respect to efficiency and accounting but the price was high. In particular, the nexus between mutual support and pedagogy was broken, and the two functions were separated into the formal roles of advocacy and regulation. What had been an indissoluble unity was converted into a formal opposition. 

The story is a complicated one but the outcome is simple: the perception of the Fellows and trainees that the nature of our professional association has changed is correct. Its novel functions pose a dilemma that is yet to be resolved. 

So how should we proceed? Because this is a new problem the answer is not yet apparent. No formal guidelines or accepted solutions are available anywhere in the world. Nonetheless, reflection on the experiences of trainees—who more than anyone else within our own organisation have been at the receiving end of these changes—has suggested some possible strategies that could be explored. These include the rigorous distinction of the opposing roles and functions associated with support and discipline, the creation of safe spaces—virtual or real—to which members can go to find refuge in times of need, and the reestablishment of democratic processes of consultation and oversight to temper the newly formed hierarchies and regimes of power. 

Can our College be recreated in its original image as a place of mutual support and shared values while still fulfilling the educational and regulatory needs of modern society? Only time will tell. 

Best wishes,

Paul
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 program for next year’s International Medicine in Addiction (IMiA) Conference is shaping up to be a great mix of presentations from international and domestic clinical and research experts, as well as some fantastic practical workshops. Program highlights include:

  • Professor Jon E. Grant on Gambling and behavioural addictions
  • Professor Rajita Sinha on Stress and resilience
  • Dr Iván Montoya on New horizons/approaches in the USA
  • Dr Marc Auriacombe with an Opiate/addiction update from Europe
  • Dr Edward Ogden on Driving impairment
  • Dr David Cunnington on Sleep and alcohol/prescription drugs
  • Professor Peter Miller on Alcohol and violence

The Program Committee are calling for poster abstracts that relate to the conference themes: behavioural aspects of addiction; stress and addiction; and controversies in prescribing and practice. Poster abstract submissions are open until next Friday, 26 October 2018 and details on how to submit an abstract can be found on the conference website.

Register early for IMiA 2019 and you could save $145 on a three-day delegate registration. Early bird closes 30 November 2018.

Last week Associate Professor Yvonne Bonomo represented the Chapter at the Foundation for Alcohol Research and Education End Alcohol Advertising in Sport national campaign launch and roundtable held in Melbourne. This was an important event encouraging change across all professional sporting codes to reduce exposure of our kids to alcohol advertising.

You are reminded that the next Australasian Professional Society on Alcohol and other Drugs (APSAD) webinar in the RACP Specialty Society Webinar Series will be the non-medical use of anabolic-androgenic steroids: the challenges faced by the AOD and medical fields, presented by Dr Matthew Dunn and due to be held at 5pm AEDT on 30 October 2018. You can register for the webinar here. Alternatively, if you’re unable to attend you will be able to view the recording on the RACP website shortly after.

And for those of you who are attending the APSAD Conference in Auckland please join me and other AChAM Committee members for the AChAM Fellows’ Update, which will be held from 5.30pm to 6.30pm on Monday, 5 November 2018 in Gallery 3 of the Pullman Hotel, Auckland.

The Chapter Committee will hold its next face-to-face meeting at the RACP office in Sydney on Friday, 7 December. 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.

Dr Martyn Lloyd-Jones 
President 
Australasian Chapter of Addiction Medicine

AChPM President’s Report 

I had the great pleasure of attending the recent RACP Convocation Ceremony in Melbourne to present Fellowships and Clinical Diplomas to proud and worthy recipients of these career-changing qualifications. It was a proud day for the supporters of these hard working and diligent medical practitioners and was a ceremony with pomp and splendour. Congratulations to all those who have been awarded Fellowship of the College and of the Chapter in Palliative Medicine.

The AChPM Committee established the Spirituality Training Working Party in 2017 with the goal of developing recommendations for how best to support AChPM trainees and Fellows to develop their skills in spirituality. The Working Party held its final meeting on 17 September at which the group considered feedback received from stakeholders on its recommendation report. The Working Party has finalised the report and the AChPM Committee will now work towards implementing the recommendations.

The Chapter Committee met today for its final meeting of 2018. I will report on the discussions at the meeting in my next post. 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.

With kind regards,

Professor Greg Crawford
President
Australasian Chapter of Palliative Medicine

AChSHM President Report 

Dr Manoji Gunathilake and I met with Northern Territory Health Minister, Natasha Fyles, on Monday, 1 October to discuss the ongoing epidemic of infectious syphilis affecting Aboriginal and Torres Strait Islander Territorians. We advocated for improved sexual health medicine services in the region. The meeting was productive and Minister Fyles wishes to have ongoing contact on this issue.

I will be presenting on the syphilis epidemic at the Rural Medicine Australia (RMA) Conference and the RACP Northern Territory Annual Scientific Meeting in Darwin next week. The RMA conference is the national event for rural and remote doctors and is co-hosted by the Australian College of Rural and Remote Medicine and the Rural Doctors Association of Australia.

The AChSHM formally recognises the outstanding contributions made by Fellows of the Chapter through biennial awards announced at the AChSHM Annual Scientific Meeting. For 2018 the Chapter will grant an award for Outstanding Contribution to Education and Training in Sexual Health Medicine, and one for Outstanding Contribution to Research in Sexual Health Medicine. Nominations for the awards open next week and close on 31 October 2018. If you know a Fellow deserving of recognition for their contribution to Sexual Health Medicine I encourage you to nominate them.

Planning has commenced for next year’s AChSHM Annual Scientific Meeting due to be held at the Novotel in Brisbane on Saturday, 16 March 2019, and followed by a Trainees’ Day at the RACP Office in Brisbane on Sunday, 17 March. Further details will be announced in the coming months.

The AChSHM Committee will hold its next face-to-face meeting on Friday, 30 November at the RACP Sydney office. 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

Alliance Strengthened

A new Memorandum of Understanding (MoU) signed between medical colleges in Australia, New Zealand and Canada is taking their collaborative relationship to the next level by formalising a vision, mission and objectives for future engagement.

Representatives from the Tri-nation Alliance – which comprises of the RACP, Royal College of Physicians and Surgeons of Canada, Royal Australian and New Zealand College of Psychiatrists, Royal Australasian College of Surgeons and Australian and New Zealand College of Anaesthetists – signed the MoU in Canada on Tuesday, 16 October.

Expressions of Interest to the RACP Clinical Ethics Support Working Party

Expressions of Interest are currently being sought for two members (including one trainee member) to join the new Clinical Ethics Support Working Party. The Working Party will also comprise a consumer member and six members of the College Ethics Committee.

Please complete the EOI form and forward with your CV to ethics@racp.edu.au by Thursday 1 November 2018.

For more information please visit the EOI webpage.

If you have any enquiries about the Clinical Ethics Support Working Party, please email ethics@racp.edu.au.

RACP Webinars

Webinar Series
In 2016, The Royal Australasian College of Physicians undertook a webinar service pilot in partnership with the Australian and New Zealand Association of Neurologists.

Due to the success of the initial pilot the service was expanded in 2017 and 2018. To date a total of 15 specialty societies have been involved in the webinar series, with over 60 webinar recordings available for RACP members to view.

Members are encouraged to review the recordings which can be found on the RACP website. Please note that these recordings sit behind your RACP member log in.

As new recordings become available they will be uploaded to the above webpage.

Upcoming Webinars available to RACP members

Australasian Professional Society on Alcohol and Other Drugs (AOD) – Dr Matthew Dunn
When:
Tuesday, 30 October 2018 at 5pm (AEDT)
Topic: The non-medical use of anabolic-androgenic steroids: the challenges faced by the AOD and medical fields.

There is increasing interest in the non-medical use of anabolic-androgenic steroids (AAS), with some suggesting we are facing a ‘looming public health problem’. The use of these and other performance and image enhancing substances pose some unique challenges for the AOD and medical fields.

This webinar will:

  • provide an overview of the types of substances people use
  • outline the purposes for use and the contexts within which they are used
  • present the short- and long-term effects experienced
  • consider how the medical community can engage this group.

Register in advance for this webinar here.

After registering, you will receive a confirmation email containing information about joining the webinar. 

Australian & New Zealand Society of Blood Transfusion – Dr James Daly
When:
Wednesday, 7 November 2018 at 5pm (AEDT)
Topic: Evolve - the ANZSBT's Top 5 recommendations

The Evolve list comprises of five clinical practices in transfusion medicine which may be overused, inappropriate or of limited effectiveness in a given clinical context. The Evolve list was compiled following a review of the evidence associated with the top five items chosen by the membership and the formulation of suitable recommendations for these items.

Register in advance for this webinar here.

After registering, you will receive a confirmation email containing information about joining the webinar.

These webinars are part of the Specialty Society Webinar Service that is being undertaken by the Royal Australasian College of Physicians in partnership with its affiliated specialty societies.

Please ensure that your computers meet the system requirements in order to avoid frustration or delay in joining the actual webinar.

You can join the webinar via PC, Mac, Linux, IOS or Android.

System Requirements:

  • An internet connection – broadband wired or wireless (3G or 4G/LTE)
  • Speakers - built-in or USB plug-in or wireless Bluetooth

For further information on joining a webinar as an attendee, please view the Zoom website via this link.

RACP Survey of Fellow Experience with Health Care Homes 

Stage one of the Australian Government Health Care Homes (HCH) trial commenced in 2017 and will continue until November 2019.

If you work in one of the trial Primary Health Networks of the Department of Health you may expect to receive an invitation shortly from the College to complete this survey. However, any Fellow with experience of or patients in a Health Care Home may respond. This is part of the College’s high profile work on Integrated Care, developing a Model of Integrated Care for patients with multiple chronic conditions, and Fellows are strongly encouraged to complete this brief online survey.

Start Here  to begin the online brief survey until 30 November 2018.

Any questions may be sent to racpconsult@racp.edu.au

Kids off Nauru Campaign 

The RACP has signed onto the Kids Off Nauru campaign, urging the Australian Parliament to support the immediate transfer of all refugee and asylum seeker children and their families from Nauru to Australia for health reasons. Children and their families need an urgent assessment in a specialist tertiary level child health facility, where their medical, developmental and social-emotional (psychiatric) health can be assessed and treated in accordance with specialist recommendations. 

This campaign was the most successful social media campaign the RACP has conducted, the hash tag trended on twitter and it reached over 200,000 people across social media channels. This is based on RACP posts alone and doesn’t include other medical colleges.

Your voice is being heard, physicians are respected members of the community and governments listen to your messages– keep the campaign going and get active on social media. Use the social media kit and poster to join the RACP's calls for #doctorsforasylumseekers. Please also sign the doctors make change petition here.

We are encouraging members to write to or meet with your local Member of Parliament (MP) to advocate on this issue. Please use the template letter and Refugee and Asylum Seeker health position statement when writing to your MP. The Tips for meeting with MPs and RACP Advocacy Framework can assist with productive meetings. If you do meet with your local MP, please let us know at policy@racp.edu.au.

IMiA Registrations are Open

Register now for the 5th International Medicine in Addiction conference to be held from 1 to 3 March 2019 at the Melbourne Convention and Exhibition Centre. The program and other information is on the website.

Evolve Updates 

Handle antibiotics with care
As part of World Antibiotic Awareness Week (12 –18 November 2018), RACP Evolve is inviting trainees and Fellows to become Evolve Clinical Champions by pledging their support to reduce unnecessary prescribing of antibiotics. Find out how you can pledge your support by contacting evolve@racp.edu.au. You can also visit the Evolve website for more information

Research
Are you currently planning to undertake research as part of your Advanced Training? The Evolve recommendations offer an opportunity to undertake research in low-value care in specific health priority topics, such as bronchiolitis, antimicrobial stewardship, polypharmacy, high-risk medications and deprescribing.

Bronchiolitis clinical initiative
NSW Health and the Agency for Clinical Innovation (ACI) are currently undertaking a program that aims to address clinical variation in inpatient and emergency department management of bronchiolitis in NSW. It also aims to improve adherence to clinical guidelines and reduce potential harm from unnecessary testing and treatment.

Find out more about the Bronchiolitis Clinical Initiative and other low-value care research opportunities in your specialty by contacting evolve@racp.edu.au or go to the Evolve website.

Conference opportunities
The RACP has presented on Evolve at:

  • RACP Congress
  • Choosing Wisely Australia National Meeting
  • National Medicines Symposium
  • Australian and New Zealand Society of Geriatric Medicine (ANZSGM),
  • Society of Obstetric Medicine of Australia and New Zealand (SOMANZ)
  • Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW).

In November, we are looking forward to attending the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) in Adelaide. 

All Specialty Societies can request the RACP attend their conference to present on Evolve and low-value care and/or host an exhibition booth. For more information and to express interest in RACP attending your conference in 2019, contact evolve@racp.edu.au.  

Managing GORD with PPIs
RACP Evolve supports the NPS MedicineWise education program, which aims to reduce or stop Proton Pump Inhibitor (PPI) treatment when Gastro-oesophageal reflux disease (GORD) symptoms are well controlled. Find out more by visiting the NPS MedicineWise website.

How can you raise the reduction of PPI treatment with a patient? Watch RACP President Mark Lane include the GESA Evolve recommendation in a difficult conversation with a patient here

Strengthening CPD 

Following the recent release of the Medical Board of Australia’s Professional Performance Framework, a new 2019 MyCPD Framework comes into effect in November 2018.

The simplified Framework strengthens CPD by engaging Fellows in a range of CPD activities from three categories:

  • Educational activities
  • Reviewing performance
  • Measuring outcomes

It is likely you are already completing formal or informal activities that can be claimed in these categories.

To help you understand the changes, we’ve put together a list of common questions and answers, that explain what the changes mean for you and why they’ve been made. You can also download the 2019 Framework online.

Read More 

Rebooting CPD podcasts out now

The origins of regulatory changes on the CPD horizon and Fellows first-hand experience of the 'strengthened CPD' approach are the focus of two new Pomegranate Health episodes.

Listen now

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 

Please visit the medical positions vacant webpage for career opportunities.

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