AMD Newsletter 3 May 2019

President's Post 

It’s time to think about governance issues in the RACP

The question of the governance structures and processes within the RACP has been raised by the proposals put forward to the Extraordinary General Meeting (EGM) of the College, to be held on Monday, May 6 2019. While the proposals themselves are anti-democratic and would not address the problems in the College that need to be solved (see below), they have nonetheless drawn attention in a welcome and constructive way to the need for a robust discussion about how our organisation should be governed.

Many Fellows and trainees have in recent years raised questions about whether the ‘corporatisation’ of the College in the mid-2000s has overall generated beneficial or harmful consequences. Certainly, the corporate model represented a radical departure from the traditional guild structure on which the Royal College of Physicians was based when it was founded more than 500 years ago and from the council-based organisation that characterised the first half century of the Australian College. The corporate model, which sought to mirror the organisational structures employed by commercial enterprises in the private sector, is hierarchical in nature and focused on tangible outcomes rather than relationships and processes. While ultimate control is nominally vested in a board, effective decision-making power is in reality passed to a skilled bureaucracy that operates according to principles derived from the market. 

While the corporate model undoubtedly can operate efficiently in relation to specific, well-defined goals, the experience of professional organisations is that corporatisation often leads to a sense of disenfranchisement and loss of engagement by the membership and a shift away from the traditional, largely democratic, values with which they were established. In many such organisations, including the RACP, this has generated dissatisfaction, along with pressure to return to at least some aspects of the traditional ethos.   

In response to the widespread recognition of the need for change, the current Board has initiated a process to revise the College Constitution. While the precise details are yet to be worked out, this will involve wide consultation with members of all levels of seniority, genders and ethnicities. Fellows and trainees will be asked how they would like the College and its Constitution to change. It is hoped that the conversations will be wide-ranging and will address not merely formal organisational relationships but also the deeper aspirations and values we want our organisation to support. The process will be used to create a discussion paper, following which proposals for change will be developed and put to a vote.

Against this open and democratic process of conversation and dialogue, the proposals put forward – without prior consultation – to the forthcoming EGM call for the establishment of a special category of member called “Respected Fellows” who will have summary authority to administer disciplinary processes in the College. These Fellows will be of at least ten years standing but no details are provided about how they would be appointed or by whom, or according to what principles they would operate. The concept that an unrepresentative group of older Fellows could be appointed in unspecified ways to exercise power over the rest of the membership is likely to be viewed by many Fellows and trainees as anachronistic and objectionable.

Nonetheless, to put the reform of the governance structures on the agenda of the College is a welcome and positive step which we must pursue with vigour. What the renewed governance relationships should look like is exactly what we need to define. The development of organisational structures that can genuinely support engagement and democratic processes in a body as large and complex as the RACP remains a challenge. If we are able to find a way to decentralise decision-making, increase consultativeness, enhance accountability, and guarantee of openness and transparency we may be able to create an example that can be replicated by other membership-based civil society organisations across our two countries.

It is to be hoped that the conversation about constitutional renewal can be initiated quickly and conducted civilly, respectfully and with full inclusiveness.

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

All AChAM Fellows and trainees should have received the AChAM Committee’s consultation on the draft Addiction Medicine Evolve List of low value clinical practices. I strongly encourage you to review the list and send your feedback and comments to racpconsult@racp.edu.au. Feedback is due today, however, if you make a submission over this weekend it will still be considered.

For those unfamiliar with Evolve, it is an initiative led by specialists at the RACP to drive high-value, high-quality care in Australia and New Zealand. The Evolve initiative identifies a specialty's Top Five clinical practices that, in particular circumstances, may be overused, provide little or no benefit or cause unnecessary harm. The Evolve initiative aims to change clinical behaviour, decision-making and reduce low-value care by developing and implementing strategies to support physicians. You can find out more information here.

The Chapter Committee will hold its next meeting at the College on Friday, 21 June 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.

Dr Martyn Lloyd-Jones
President 
Australasian Chapter of Addiction Medicine

AChPM President’s Report 

The AChPM Committee has been reviewing the Palliative Medicine Evolve List of low value practices and interventions over recent months. The list has been updated to focus more clearly on specialty-specific practices as the focus of Evolve has shifted in recent years to be more specialty-specific. Two of the previous recommendations have been replaced with the remaining three unchanged.

One of the two newly developed recommendations asks palliative care specialists to limit routine use of antipsychotic drugs to manage symptoms of delirium. This reflects current evidence that antipsychotics are associated with increased symptoms and reduced survival in patients with mild-to moderate-severity delirium. The second recommendation calls on physicians to target referrals to bereavement services at those family members and caregivers who are experiencing more complicated forms of grief. Evidence shows that most of the bereaved are resilient and there is no empirical basis for offering routine referrals to bereavement services to relatives of patients in palliative settings.

You can view the updated Palliative Medicine Evolve List in full here with the new recommendations highlighted. I encourage you to review and submit your feedback and comments to racpconsult@racp.edu.au by Thursday, 16 May 2019.

For those of you unfamiliar with Evolve, it is an initiative led by specialists at the RACP to drive high-value, high-quality care in Australia and New Zealand. The Evolve initiative identifies a specialty's Top Five clinical practices that, in particular circumstances, may be overused, provide little or no benefit or cause unnecessary harm. You can find out more information here.

The AChPM Committee will next meet via teleconference on Friday, 17 May 2019. 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 

Applications for the AChSHM Research Entry Scholarship have now opened. The scholarship is valued at up to to $40,000 for one year and aims to encourage and support the promotion of research in the field of sexual health medicine. All AChSHM Fellows and trainees are eligible to apply, with applications closing on Monday, 15 July 2019.

As previously advised, the Adolescent & Young Adult Medicine Committee are currently seeking expressions of interest (EOIs) for the position of AChSHM Representative. Interested Fellows should submit an EOI form and CV to paed@racp.edu.au by 26 June 2019.

The Chapter Committee will next meet at the RACP Sydney office on Friday, 14 June 2019. If you have any feedback or issues you would like to raise with the Committee, 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’s 2019 Australian Government Election Statement 

The RACP’s 2019 Australian Government Election Statement outlines our priority policy areas across the key themes of sustainability, equity and prevention. The statement spells out recommendations for future-proofing the Australian healthcare system. 

A suite of materials has been prepared to support Australian member advocacy around our election statement and is accessible from the RACP election campaign page. These include letter templates to be used to write to Members of Parliament or to your local newspaper, social media champion kits and fact sheets on key priorities. 

Please feel free to use these materials to make your voices heard right up to and including Saturday, 18 May, and to share your experiences with us, whether via social media or by emailing policy@racp.edu.au

RACP Congress 2019 – Keynote Speakers

RACP Congress 2019 is on next week in New Zealand from Monday, 6 to Wednesday, 8 May. If you're attending the event we urge you to attend the presentations of various keynote speakers including: 

Associate Professor Tilman Ruff  
Much anticipated keynote speaker, Associate Professor Tilman Ruff, is a public health and infectious diseases physician.

Tilman was inaugural Head of Travel Medicine at Fairfield Hospital and then Royal Melbourne Hospital, International Medical Advisor for Australian Red Cross, and serves on the WHO Western Pacific Region Hepatitis B Immunisation Expert Resource Panel.

Tilman is Associate Professor at University of Melbourne’s Nossal Institute for Global Health, which he helped establish. He was the first civil society representative on Australian nuclear Non-Proliferation Treaty delegations, civil society advisor to the International Commission on Nuclear Non-proliferation and Disarmament, and a delegate to the landmark Conferences on the Humanitarian Impact of Nuclear Weapons in Norway, Mexico and Austria (2013-2014). 

Associate Professor Ruff is scheduled to speak at Congress on Monday, 6 May 2019.

Dr Curtis Walker
Formerly a veterinarian, Dr Walker retrained in human medicine and qualified from Auckland Medical School in 2007. He obtained his RACP Fellowships in nephrology and general medicine in 2015 and 2016.

Dr Walker was President of the New Zealand Resident Doctors Association (NZRDA) for five years and serves on the board of the Māori Medical Practitioners Association (Te ORA). In 2015 he was elected to the Medical Council of New Zealand and was elected as Chair of the Medical Council in February 2019.

He is committed to ensuring our medical workforce and medical institutions are culturally competent and able to deliver culturally safe training to doctors and culturally safe care to patients. He is passionate about supporting doctors through the long years of specialist training and improving health equity in Aotearoa.

Dr Walker works as a renal and general physician at MidCentral District Health Board and loves living in Palmerston North with his wife and two young tamariki.

Dr Walker is scheduled to speak at Congress on Monday, 6 May and Tuesday, 7 May 2019.

Parliamentary inquiry into Australia's ‘Sleep Health’ 

The final report of a bi-partisan parliamentary inquiry into the nation’s ‘Sleep Health’ has been hailed as a defining moment for patients, clinicians and health experts, according to Australia’s two peak bodies on the critical subject of sleep.

The findings of the National Inquiry into Australia’s Sleep Health inquiry, conducted by the House of Representatives Standing Committee on Health, Aged Care and Sport, endorsed the Sleep Health Foundation and the Australasian Sleep Association’s four-year campaign to have sleep placed as the third pillar of health, alongside diet and exercise. The inquiry made 11 practical recommendations on ways Australia can drastically improve its sleep health, including fully funding a critical education campaign on sleep health awareness.

The full inquiry report can be viewed here.

Consultation on RACP revised conflicts of interest policy 

The College is currently undertaking a consultation on its revised Conflict of Interest Policy, which contains significant new revisions and additions. The deadline for feedback is 13 May 2019. If you are interested in providing your feedback to this consultation, please contact CPAC@racp.edu.au.

Pomegranate Health Podcast: Medical Fitness to Drive

Are you a physician concerned about a patient's fitness to drive?

Our latest Pomegranate Health Podcast speaks to a general practitioner, a neurologist and an occupational therapist about how to confront patients about reducing or ceasing driving, and where responsibilities lie in reporting to the Driver Licencing Authority.

Register to participate in the new Ethics eLearning Resource

Ethics lies at the very heart of what it is to be a physician and is as relevant now as it was when first discussed two and a half thousand years ago. The Ethics eLearning Resource focuses on the sorts of ethical issues that are a constant feature of health care, and it also addresses some of the ideas that underpin ethics, such as the relationship between ethics and the law and the difference between ethics and rights.

The aims of this resource are to:

  • encourage discussion and broaden thinking about the main ethical issues facing physicians
  • encourage reflection on appropriate courses of action in situations that may be ethically challenging
  • challenge participants’ understanding of, and attitudes towards, ethics
  • model ethical practice
  • and help participants reflect on their own and their profession’s ethical commitments.

eLearning@RACP is free for RACP members and counts towards Continuing Professional Development requirements.

If you have questions about eLearning@RACP please email digital.learning@racp.edu.au

Get the latest electrical devices with Member Advantage in Australia 

The Good Guys Commercial are your answer to accessing the latest and the best in smart devices, toasters and barista-style coffee machines for your home and much more, right at your fingertips.

Member Advantage has taken out the guesswork and made it easy for you to access these time-saving offers, all in one place.

Through your benefits program, get member-exclusive pricing on over 4,000 products with 24/7 online shopping and flexible delivery options*.

To find out more, visit your RACP Member Advantage website or call 1300 853 352.

Free breakfast special offer for RACP members with Millennium Hotels

Be it corporate travel to Auckland, a conference or event in Wellington, a unique cultural experience in Rotorua, a romantic winter getaway in Queenstown or a well-deserved family holiday in the sparkling Bay of Islands, there is a Millennium, Copthorne or Kingsgate hotel to suit your travel needs. With staff that are committed to providing a high standard of service and value, you’ll always enjoy a stay at a Millennium Hotels and Resort New Zealand hotel.

To warm you up this winter, take advantage of Millennium’s tasty deal exclusively for RACPmembers – get free breakfast each morning of stay per guest when booking along with 20 per cent off The Flexible Rate*.

As they say, breakfast is the most important meal of the day, and whether you’re a muesli fan or a toast and marmite person, we’ve got you covered.

To find your special promotion code, visit your RACP Member Advantage website or call 1300 853 352 or 0800 453 244 for more information.

Genomic medicine here to stay? Have your say.

Researchers from the Australian Genomics Health Alliance would like to hear from non-genetic medical specialists who work clinically in Australia.

They want to know about past, present and future aspects of genetics and health, including genomics in healthcare. It doesn't matter if you do or don’t know much about these areas, or don’t incorporate them into your practice at the moment.

By participating you will help shape future workforce practices and continuing education and training programs.

If you’re interested,  please complete this anonymous survey by Friday, 31 May 2019.

If you have any queries, please contact Dr Amy Nisselle, Specialist Project Officer, Australian Genomics Health Alliance at amy.nisselle@mcri.edu.au or +61 3 9936 6340.

This survey is an activity of the Workforce Development Program of the NHMRC funded Australian Genomics Health Alliance.

This survey has Human Research Ethics Committee (HREC) approval, The University of Melbourne (1646785.8).

Preventing Overdiagnosis 2019 Conference 

The December conference in Sydney, Australia will include a number of lively plenary debates about controversial and timely issues, involving high-profile players from across the healthcare landscape. 

There will be parallel panel sessions covering themes such as genomics, commercial determinants of health, and overdiagnosis and the media. 

We're also pleased to share that RACP Fellows Professor Robyn Ward and Professor Rachelle Buchbinder will be presenting at this exciting event.

More information is available on the conference website.

Conferences and Events 

Medical Oncology Group of Australia’s 40th Anniversary ASM

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses. 

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