AMD Newsletter 8 March 2019
This post concerns the concept of “diversity”, the response to which has become a major challenge for the College and which will require analysis, debate and policy development.
Australian and New Zealand societies, which were once culturally very homogeneous, have over the last few decades become increasingly diverse, in relation to community structures, personal beliefs and social policies. This diversity, moreover, has come to be seen not as a simple fact but as a value in its own right.
Along with this larger social process, the composition of the RACP has changed profoundly, with consequences that remain to be fully understood. The most obvious change has been the increasing proportion of female members. This is reflected in the fact that while the ratio of men to women among our 25,000 members is 57:43, among the 9,000 trainees it is 42:58. The cultural diversity has also greatly increased, with substantial numbers of our members either having been born overseas or coming from non-European cultural backgrounds. Of particular note are increased numbers of Fellows and trainees from Indigenous backgrounds and from families originating in the countries of Asia, the Asia-Pacific region, the Middle East and Africa, most notably from China, Vietnam and India. Unfortunately, it is impossible to be precise about the numbers because the College has not hitherto collected cultural and demographic data on its members, which is an issue that needs urgently to be addressed.
While today it is widely taken for granted that diversity is a good thing, it is important to remind ourselves that this has not always been the case – and indeed, even now it is not unanimously accepted. The philosophical history of the concept of diversity is itself interesting and commands a very extensive literature. The idea played an important role in the formation of the concept of “modernity” and of the societies that view themselves as modern. The development of the contemporary nation state, as a complex congeries of social groups responsible for multiple cultural and economic functions, required the clear delineation of conceptual and cultural boundaries that could no longer be achieved by the old divisions of social class and hierarchy. These boundaries defined the structures that stabilised the emerging society by linking them to the new forms of power. Some referred to obvious categories, such as gender, class and religion; others to less obvious domains comprising personal attitudes and behaviours, such as sexuality, manners, physical differences (through the idea of disability), and the relationship to the newly established legal structures (with the creation of prisons); yet others referred to abstract ideas like the concept of reason, which emerged as a major social phenomenon along with the rise of science and the appearance of the new concept of “madness”.
The delineation of these novel categories made possible the evolution of the stable systems of morality, law and power that were the hallmark of European societies between the seventeenth and twentieth centuries. There were, of course, multiple and egregious lapses: at times the victimisation of minorities was employed to ensure the continuation of a regime of power or authority and to oppose threats to authority.
It was only in the late twentieth century – in large part under the pressure of post-war migration patterns – that attitudes to diversity changed and the existence of community groups from a wide range of cultural backgrounds became accepted. Here, two opposing approaches arose, both of which continue as powerful themes in Australia and New Zealand. The first focused on social “inclusion” and “exclusion”, with the objective of incorporating culturally discrepant groups into the mainstream. The second, which is more recent, sought to establish “difference” not just as a value in its own right but as a motor of innovation and a source of novel creative possibilities in all the domains of social life. Many readers will be familiar with the extensive corpus of writing that addresses these issues in philosophy, ethics and the history of ideas, which includes major recent thinkers such as Michel Foucault, Jacques Derrida, Gilles Deleuze, Jürgen Habermas, Pierre Bourdieu, Emmanuel Levinas and others.
What do abstract ideas like these have this to do with the RACP? If it is true that the organisation has become more diverse in the manner described we need to decide which concept of difference we favour and how we wish to respond to the new conditions we face. We have also to decide how this affects our assumptions about roles with respect to our members and the services we provide to the wider community. If we see the problem as merely one of representation we will need to develop structures within the organisation to ensure that sufficient numbers of members who are women or from different religious and cultural backgrounds are included on the board, in committees, working groups etc. If we consider that the issue is not merely representation we will need to build into our processes strategies to ensure not just the inclusion of divergent voices, ethical standpoints and social attitudes but also ways in which they can actively help shape policy outcomes.
There are consequences too for our relationships with the broader society. If we see our role as serving, supporting and strengthening cultural diversity we will need to develop the relevant skills among our members, possibly requiring new training pathways, to serve the shifting needs of the community. Where a different medical tradition is part of the local culture this may on occasions generate tensions and ethical dilemmas.
The approach we adopt will have a profound bearing on how we see our role in relation to minority groups and may determine crucial policies. It will deeply affect the way we approach issues like termination of pregnancy, voluntary assisted dying, the use of illegal drugs and climate change – which attract vigorous support and opposition from different sections of the community. The public debate about the treatment of asylum seekers and refugees is already primarily a discussion about what should be the proper attitude to diversity.
As the organisation continues to change, this is a discussion the RACP must and will have. Our first task will be to achieve gender equity and then to develop the structures to accommodate the more complex lines of difference within the community. To be able to do this, however, we will need to learn more about who we are and what our members want, and for this we will need reliable data and a robust process for conducting the discussions. If difference is indeed a motor of change the College has a bright future.
Professor Paul Komesaroff FRACP AM
President Adult Medicine Division
Telephone: +61 (0)417 55 26 59
As always, I am keen to receive comments, thoughts, and suggestions about the ideas contained in this article.
AChAM President’s Report
The International Medicine in Addiction (IMiA19) Conference was held last week from 1 to 3 March at the Melbourne Conference and Exhibition Centre. I’d like to take this opportunity to thank the conference Program Committee for all their hard work preparing an engaging and topical program. Thank you team.
- Dr Shalini Arunogiri, RANZCP
- Dr Nicholas (Nico) Clarke, RACP
- Dr Paul Grinzi, RACGP
- Dr Marianne Jauncey, RACP
- Professor Dan Lubman, RANZCP
- Dr Vicki MacFarlane, RNZCGP
- Dr Sam McBride, RANZCP
- Dr Hester Wilson, RACGP
I would also like to express my thanks to the RACP secretariat for all their hard work in assisting the committee and making the organising process as smooth as possible.
If you attended the Conference and you have any feedback, we’d love to hear from you any time. We’re always looking to improve the Conference and we’d love to hear your thoughts and ideas on how we can do this. Feedback can be sent to AddictionMed@racp.edu.au.
I look forward to IMiA 2021, which will be led by our esteemed colleague, Dr Hester Wilson.
The Chapter Committee will hold its next meeting on 15 March 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
Australasian Chapter of Addiction Medicine
AChPM President’s Report
The Chapter Committee held a productive first meeting of the year on 22 February 2019. The Committee discussed an RACP consultation on the devolution of policy and advocacy activity to the different parts of the College and Fellows with specific expertise. The Chapter Committee also completed work towards finalising the revision of our Evolve list of low-value clinical practices in palliative medicine, which will be available for consultation in the coming months.
You should have all received the RACP Member Satisfaction Survey via email last week. The survey aims to gain insights into your views about RACP communication, policy and advocacy, online resources, representation and value for money, and will help identify areas for improvement – I encourage you to complete it.
If you have any thoughts, comments or feedback for the Committee please do not hesitate to contact us through our secretariat at PallMed@racp.edu.au
With kind regards,
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
AChSHM President Report
Myself, Fellow AChSHM Committee Member Associate Professor Lewis Marshall, and the Chair of the RACP WA Regional Committee Dr Helen Rhodes, met with the WA Deputy Premier and Minister for Health the Honourable Roger Cook last week to discuss the ongoing syphilis epidemic in Central Australia in Aboriginal and Torres Strait Islander Communities. The meeting was productive and we will have ongoing contact with the Deputy Premier on this issue.
The AChSHM 2019 Annual Scientific Meeting (ASM) is only one week away – I strongly encourage those who haven’t already registered to go to the ASM website and register. The event will be an excellent opportunity to stay up-to-date with the latest issues in sexual health medicine and network with your colleagues.
I also encourage all Advanced Trainees in Sexual Health Medicine to attend the Annual Trainees’ Day which will be held the day after the meeting, on Sunday, 17 March. The Trainees’ Day is tailored exclusively for Advanced Trainees in Sexual Health Medicine and includes a very valuable session on assessment by Dr Carole Khaw, Professor David Templeton and Dr Eugene Priscott.
Applications have opened for the AChSHM Education Development (Study) Grant. The grant is worth up to $4000 and aims to support and encourage further educational training or develop educational initiatives in sexual health medicine. Applications close on Tuesday, 2 April 2018.
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 firstname.lastname@example.org.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
RACP Congress 2019
Now is the time to register your attendance at RACP Congress 2019 taking place from Monday, 6 to Wednesday, 8 May 2019 at the Aotea Centre in Auckland, New Zealand.
The AMD session The search in what we do, will delve into the value in our practice, exploring the role of the professional organisation, equity and justice and the concept of value-based healthcare.
RACP Congress 2019 key topics include:
- The key to unlocking optimal health – the life course paradigm
- Obesity: Rising to the challenge
- The first 1000 days – the window of opportunity for long term health
- Medically unexplained symptoms – masterclass
- The opioid epidemic – Iatrogenesis on a global scale
- Integrated care – the future must be about partnerships
- Closing plenary – physician heal thyself
Visit the Congress website
to register and view the program.
RACP Submission into the Royal Commission into Aged Care
The College is preparing a submission to the Royal Commission into Aged Care Quality and Safety.
Members may contribute to this submission by sending any input relevant to the Terms of Reference to Racpconsult@racp.edu.au.
Please provide your input by COB Tuesday, 30 April and be as specific as you can.
For further information please contact Dr Kathryn Powell, Senior Policy & Advocacy Officer, on +61 02 9256 5497.
2019 Palliative Medicine Communication Skills Workshop
Registrations are now open for the 2019 Palliative Medicine Communication Skills Workshop.
The workshop is a three day experiential learning opportunity run by experienced facilitators in teaching communication skills with the aid of simulated patients. This will enable you to develop and enhance your communication with patients, their families and with other health workers.
Previous participants have rated the workshop highly.
The workshop will take place in Sydney at the RACP office on Wednesday, 3 to Friday, 5 July inclusive. It is suitable for all advanced trainees in palliative medicine, as well as Fellows and those training in other specialties who have an interest in further developing their communication skills.
Focusing on learning outcomes, the workshop will involve a mixture of lectures, demonstrations, role play and feedback in carefully facilitated groups in an environment of mutual respect. Participants are asked to bring a willingness to share ideas and experiences.
Places are limited and priority will be given to currently enrolled trainees in Palliative Medicine and Fellows of the Australasian Chapter of Palliative Medicine.
The course fee is $2624 (AU) for trainees and $3280 (AU) for Fellows. This includes materials, morning tea, lunch and afternoon tea.
Registrations are now open via an application form on the RACP Events webpage.
Please contact PalliativeMedTraining@racp.edu.au if you have any questions.
Podcast: Cervical Screening – Less Is More
Cervical cancer is one of the most common cancers in women worldwide, but it’s almost entirely preventable.
In December 2017 Australia was the second country in the world to adopt HPV testing as the primary tool in cervical screening. This kind of test has many benefits, such as, the increased five year interval between screens (rather than two) and the requirement for women to start being tested at age 25 instead of 18.
Some, however, are concerned about the costs and risks involved in the triage pathway. This episode of Pomegranate Health will answer some questions that women and health professionals might have about the HPV-based National Cervical Screening Program.
RACP Member Satisfaction Survey
We want to hear your thoughts on RACP membership via our Member Satisfaction Survey (MSS). On Monday, 25 February 2019 all RACP members (including trainees) should have received an email containing the survey link from WoolcottResearch@woolcott.com.au with the subject line 'RACP Member Satisfaction Survey – Have your say'.
Please complete and have your say so we can understand your overall satisfaction with the College and identify areas for improvement. The survey closes on Wednesday, 19 March. If you have not received the survey email, please contact email@example.com.
The survey should only take approximately ten minutes. Woolcott Research provides aggregated results back to the RACP and any individual comments are not identified as being by a specific member.
Register now for the 2019 Combined Special Interest Group meeting
The 2019 Combined Special Interest Group meeting will be held on 26 to 28 July in Sydney.
Convened by the Leadership and Management special interest group, the theme Developing leaders with 20:20 vision will explore topics of relevance to current and emerging leaders, such as:
- Inclusion and diversity
- Building healthy workplaces
- Having difficult conversations
- Medical regulation
- Digital technology
For more information, visit the event website.
Implementing the Tailored Activity Program (i-TAP Australia): Supporting people with dementia and their carers living at home
The National Health and Medical Research Council (NHMRC) have funded a three-year research project to investigate the implementation of “New Ways for Better Days” also known as the Tailored Activity Program –Australia (TAP-Australia) for people with dementia and their carers living at home. This project is being led by The University of Queensland, in collaboration with a number of other partners including CQUniversity. We are currently interviewing health professionals who might refer people to this program, and are seeking participants for Central Queensland and Wide Bay regions.
What is TAP-Australia?
TAP-Australia is a non-pharmacological intervention and is similar to interventions recommended in the NHMRC Clinical Practice Guidelines for People with Dementia.
TAP-Australia is delivered by Occupational Therapists in seven to eight sessions in the person’s home. The therapist assesses the person’s capabilities and strengths and then trains the carer to:
- tailor and adapt meaningful activities that are achievable for the person with dementia
- generalise these skills to other activities of daily living (ADL)
- use effective communication strategies and
- understand triggers for behavioural and psychological symptoms of dementia
What are the benefits of TAP-Australia to the person with dementia and their carers?
This program has been tested in multiple randomised controlled trials and found to:
- reduce occurrence of behavioural symptoms
- reduce the person with dementia’s need for assistance with ADL’s
- increase activity engagement
- reduce carer distress and burden of care
- improve quality of life
To understand the potential for TAP-Australia to be implemented in Australian healthcare settings, the project will involve two phases:
Phase one – Interviews to explore potential benefits and barriers to the implementation of TAP-Australia; these will be conducted with Geriatricians, General Practitioners, Practice Managers, Occupational Therapists and carers of people with dementia.
Phase two – We will be implementing and evaluating a number of strategies to increase the uptake of TAP-Australia including comprehensive training for Occupational Therapists in this program, who will then provide the TAP-Australia program to people with dementia and their carers throughout Queensland metropolitan, rural and regional areas. As part of this phase we will provide information to Geriatricians, General Practitioners (GPs) and Practice Managers about which providers are able to deliver this program starting in the second half of this year.
We are currently in Phase One of the trial and looking for GPs, Practice Managers and Geriatricians, especially within the Wide Bay and Central Queensland regions, to participate in a 30-minute interview at a convenient time and location; interviews can be conducted in person or over the telephone. Your input would be highly valuable and your time greatly appreciated.
To find out more please contact: Seona Areaiiti, Project Manager, iTAP Wide Bay via email.
New nationwide research on genetic testing in Australia
The Royal College of Pathologists of Australasia (RCPA) has unveiled new, nationwide research on Australia’s medical genetic testing, which was conducted for the Department of Health. The findings are being reported at the RCPA’s conference, 'Pathology Update', at the Melbourne Convention and Exhibition Centre this weekend by Project Leads, Dr Anja Ravine (Genetic Pathologist) and Dr Sarah Nickerson (Genetic Pathology registrar).
To view there findings click here.
The RCPA advocates for a collaborative approach for the successful introduction of pharmacogenetics in healthcare in Australia
The Royal College of Pathologists of Australasia (RCPA) have released a new position statement on the significance of genetic testing to predict a patient’s response to drugs, also known as pharmacogenetics. The RCPA is advocating for a collaborative approach with medical colleges and the wider medical profession, the Australian Government, educators, and researchers, with the aim of creating national guidelines that will facilitate the safe and appropriate introduction of pharmacogenetics in Australia. By using pharmacogenetic testing, a clinician can align a prescription with the patient’s potential for a beneficial or adverse response to a drug.
For further information on the RCPA, visit www.rcpa.edu.au.
Strengthened tenancy laws for victims of domestic violence
New tenancy laws that improve and strengthen protections for victims of domestic violence in NSW started on 28 February 2019.
Under the new laws, a tenant will be able to end their tenancy immediately and without penalty if they or their dependent child are in circumstances of domestic violence. They will not be liable to pay any compensation or additional money for the early termination.
The tenant will need to give their landlord or agent a domestic violence termination notice and attach one of the acceptable forms of evidence. Evidence includes a declaration made by a medical practitioner, such as a GP.
The documents used to end a tenancy due to domestic violence cannot be used or disclosed for any other purpose (unless compelled by law). For example, a property manager cannot use these documents as part of a reference check. The documents must be stored and disposed of securely.
Landlords and agents will also be prohibited from listing a tenant on a tenancy database if they ended a tenancy in circumstances of domestic violence.
More information on the domestic violence reforms is available on the NSW Fair Trading website.
Tri-Nation Alliance annual International Medical Symposium (IMS 2019)
Register now for the Tri-Nation Alliance annual International Medical Symposium (IMS 2019), in Auckland, New Zealand on Friday, 22 March 2019.
The theme for the 2019 symposium is Visioning the impact of advanced technology on medical education with a program featuring diverse sessions such as the debate.
Topic: Machines make better doctors?
Four healthcare professionals debate issues of the future. What areas of medicine can machines takeover? What areas will remain with human doctors? What upskilling will human doctors need to make best use of machines?
For the affirmative
- Physician, Associate Professor Rebecca Grainger
- Psychiatrist, Dr David Codyre
For the negative
- Surgeon, Mr Andrew Connolly
- Anaesthetist, Dr Lara Hople
Register now to hear the debate that will be followed by questions from the floor.
Other not to be missed sessions taking place at IMS 2019:
- Professor Enrico Coiera - Trust and AI
- Professor Jenny Weller - Using simulation training to learn about non-technical skills management
- Associate Professor Rebecca Grainger - Current research on apps to monitor patient self
- Mr Andrew Connolly - Informed by AI: the systemic challenges before us
- Professor Jim Warren - Consumer health information revolution
- Mr Greg Cross - Using avatars for teaching
- Dr Jaron Chong - Training radiology residents when machines read imaging
- Professor Tim Shaw - AI in trainee assessment
View the program and register for IMS 2019.
High Blood Pressure Research Council of Australia – Medicare Rebate for Ambulatory Blood Pressure Monitoring
The High Blood Pressure Research Council of Australia has undertaken a major initiative to apply for a Medicare Rebate for Ambulatory Blood Pressure Monitoring (ABPM) in the diagnosis of Hypertension.
Ambulatory Blood Pressure readings are more closely linked to cardiovascular outcomes than clinic blood pressure, and improved access to ABPM will support optimal cardiovascular health in the Australian community.
The application was submitted to the Medical Services Advisory Committee (MSAC) in late 2018 and after a preliminary meeting in Canberra, has now been placed on the MSAC website for public comment.
A public consultation survey is available here
. It should take 15 minutes to complete.
Health and Well-being of Children and Youth on the Move survey
Since 2017, more than 30 professional organisations, including The RACP, have endorsed the ISSOP's Budapest Declaration-on the Rights, Health and Well-being of Children and Youth on the Move. A survey has been created to capture the similarities and differences in the approach to refugee, immigrant and IDP children from paediatricians' home countries.
RACP members are invited to complete the survey, in order to capture the insights and experiences of a large sample of physicians from the Australia and New Zealand. The ultimate goal is to collect create the largest database from the paediatric perspective on this crucial issue.
The survey contains 16 questions covering demographics, borders, health conditions, and health systems. The survey take approximately 15 minutes.
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 31 May 2019.
If you have any queries, please contact Dr Amy Nisselle, Specialist Project Officer, Australian Genomics Health Alliance at firstname.lastname@example.org 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 HREC approval, The University of Melbourne (1646785.8).
Refinancing made simple: your 10 step guide
As a RACP member you receive a discounted rate for the life of a Macquarie Home Loan.
Your home loan is probably your biggest household expense – and with interest rates at an all-time low, there’s never been a better time to switch. Follow these simple steps to switch your home loan lender.
Request a call with one of Macquarie's banking specialists today and discuss the life of loan discounts that you have available through your benefits program with Member Advantage.
Find out more about our home loans here or call Member Advantage at 1300 853 352.
Macquarie Bank Australian Credit Licence 237502. Lending criteria, fees and T&Cs apply.
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.
There are no career opportunities advertised this month.