New South Wales/Australian Capital Territory - April 2020
We are living in unprecedented times. The COVID-19 pandemic has been one of the most significant and all-pervasive public health challenges that medicine has faced in many years.
Never before has so much been asked of us as physicians. It is heartening to see that the profession has, once again, stepped up to the mark by demonstrating its willingness to adapt as the circumstances evolve, as they have done so dramatically in recent days and weeks.
We must be mindful that all Fellows and trainees are under huge amounts of pressure. The unique circumstances are placing additional demands on all of us and forcing us to make sacrifices. The consequences will be felt by all of those within our orbit, not least of which are our colleagues and families. Nonetheless, we must not lose our sense of purpose and optimism. Although I remain cautious given the variable international experience, there are encouraging early signs from the local response.
It is not surprising that we have seen an extraordinary growth in interest from physicians in telehealth. We held an education session on 1 and 8 April. The sessions, held on the telehealth platform itself, was way over-subscribed. Despite hosting over 500 attendees via video-conference, the technology proved to be robust and the feedback from participants was positive. For those who missed out, you can access the recordings on the coronavirus webpage, under the telehealth section.
On a related point, physicians are reminded of the temporary MBS item numbers for telehealth consultations (telephone and video conferencing). These MBS item numbers will remain in place until 30 September 2020. Although disappointing, the unique circumstances we are in mean that the clinical exams for 2020 have been delayed until next year. No doubt, this would bring much frustration and worry for trainees and supervisors. I would ask that physicians remain mindful of the wellbeing of the trainees and their supervisors. We will continue to work with the trainees, supervisors and the College to ensure minimal disruption to physician education and training pathways.
As a final point, I would encourage continued monitoring of the advice of the NSW Health and Clinical Excellence Commission guidance on the absolute latest in approaches to PPE usage and COVID-19 management.
Dr Adrian Lee BSc (Med), MBBS, FRACP
NSW/ACT Regional Committee Chair
If you are feeling anxious regarding COVID-19, you are not alone. These are unique and extremely uncertain times, and we want to remind all trainees that we are your voice when communicating concerns to the RACP. We are seeking feedback from all Basic Trainees and Advanced Trainees, regarding the issues affecting you including (but not limited to) exams, training certification, and progression through training.
Please contact us with any issues related to Basic or Advanced Training. We will collate your feedback and advocate on your behalf to seek clarification from the College. You can email us, or contact the College directly at the Basic or Advanced Training emails.
Dr Aimee Wiseman
Paediatrics and Child Health Medicine
NSW/ACT Trainees’ Committee Co-Chair
Dr David Martens
NSW/ACT Trainees’ Committee Co-Chair
Expressions of Interest (EOI) are now open across all of our College Bodies for various positions on councils and committees. View listings for more information on the positions on offer.
You are invited to express your interest in the below categories:
We recently held a number of extremely successful webinars on telehealth and electronic prescribing. Avant Mutual and the Australian Digital Health Agency joined the College in providing this vital information to all members nationally. We looked at the upcoming changes to electronic prescribing and how telehealth can support the safety and livelihood of our members during this uncertain time.
You can find the webinar recordings under the telehealth section of our COVID-19 page.
At Avant, we are aware that many doctors are concerned about how they can continue to provide care to patients, while also protecting themselves and their families during the coronavirus (COVID-19) pandemic.
On 29 March 2020, the Australian Government launched a revolution in telehealth when it announced a $669 million package to open up bulk-billed telehealth Medicare Benefits Schedule (MBS) items to all Australians. Through this package, the Government hopes to keep both patients and frontline doctors safe during the COVID-19 pandemic. Ideally, it will limit the unnecessary exposure of patients and health professionals to COVID-19 in situations where treatment can be safely delivered by video-conferencing or phone.
The changes to telehealth mark a major shift from using technology to improve medical services for people living in remote communities, to deploying it to fight a global pandemic. Bulk-billed services can be used by GPs, specialists, nurse practitioners and midwives as well as allied health professionals.
Dr Amandeep Hansra is a locally-trained specialist GP who has been working in the digital space in Australia for the past 10 years with particular focus on telehealth. She is currently Chair of the AMA NSW’s Systems and Technology Committee, sits on the RACGP’s Practice Management and Technology Committee and provides digital health consulting services, as well as working in private practice as a GP. She thinks that it is important for clinicians to realise that telehealth isn’t new to Australia.
"Traditionally, the medical profession in Australia has been very skeptical about telehealth, but we need to appreciate that the concept isn’t new. The Royal Flying Doctors Service has been using tele-medicine since the 1920s when they began by providing support to patients in remote areas using two-way radios."
There are a number of medico-legal risks associated with telehealth that clinicians need to consider and make efforts to avoid or mitigate.
Risks can arise in the following areas:
- selecting patients as this involves making decisions about whether assessment and/or treatment can be undertaken in a clinically appropriate way via telehealth
- making diagnoses and developing treatment plans as errors can occur as a result of the limitations associated with non-face-to-face consultations
- trying to prevent the doctor-patient relationship and continuity of care being disrupted due to the use of telehealth
- maintaining confidentiality and privacy.
Dr Hansra agrees. "Yes, we need to be careful. Telehealth alone will never be the gold standard in providing health care. We need to weigh up the risks but we also need to appreciate that there are situations when the benefits of telehealth consultations outweigh the risks."
"For example, there are situations where we need to employ whatever method is most appropriate to deliver best possible healthcare to patients in the given circumstances. Telehealth can be invaluable in helping us to do this in situations where a patient lives in a remote area, or when we are facing a global pandemic, like COVID-19, and need to protect both patients and doctors from transmitting the infection."
"Should we move to a model of 100 per cent telehealth? Absolutely not. It is a matter of using telehealth as an adjunct to face-to-face consultations."
Dr Hansra says that another important thing for clinicians to understand is that telehealth is not so much about technology, but the way they deliver care to patients.
"Practitioners moving into this space need to avoid getting hung up on the technical aspects and focus on workflows. We need to focus on how to mitigate the risks, how to overcome the logistical challenges such as how to get a script to a patient, how to manage referrals and how to conduct a physical examination."
"Obviously, it is vital that the consultation is done properly if it is done via telehealth or you are going to run into problems. The patient has to have a good clinical experience. Clinicians and practice managers also need to realise that these changes will also involve a steep learning curve for patients."
A study commissioned by communications agency, Red Havas Australia, has found that for most Australians, this will be their first experience of digital health. Only eight per cent of people surveyed said that they had used virtual care before while 46 per cent said that they would rather see a healthcare professional in person. Despite this, Dr Hansra believes that doctors shouldn’t underestimate the ability of their patients to embrace technology.
"I’ve been particularly impressed by both the willingness and ability of older patients to master the technology behind telehealth. Often these people have more time to get on top of technology and are keen to use it if they feel that they are going to receive the same quality of care while enjoying the convenience of not having to leave their home to see a doctor, saving time and protecting themselves from infection."
This is supported by the Red Havas Australia’s survey, which showed that Gen X and Millennials were marginally more likely to be confident health technology users (18 per cent) than Baby Boomers and Gen Z. Interestingly, Baby Boomers (15 per cent) were more confident than the most ‘digitally native’ generation, Gen Z (10 per cent). Dr Hansra believes the key to achieving success with telehealth is to give patients choices.
"I believe we need to give patients more credit. We need to give them a chance to use telehealth. If they aren’t comfortable, or it’s not appropriate, then have a face-to-face consultation. In the end, the priority must be ensuring universal access to safe high-quality healthcare."
Additional information on telehealth
We have detailed FAQs and resources on our website. Good medical practice: a code of conduct for doctors in Australia applies to telehealth consultations as it does for face-to-face consultations. You should also ensure that you follow the Medical Board’s guidelines for technology-based patient consultations when providing care by telehealth.
Other useful resources include:
Head of Research Education and Advocacy, Avant Mutual
A Medicare funding model is anticipated in 2020 to allow genomic (exome) testing of children with a moderate to severe intellectual disability through their primary paediatrician.
The NSW research and implementation team working on this project have designed a short survey to understand what support NSW paediatricians need in order to carry out whole exome testing. The results of the survey will be directly used to inform the support and resources we implement in NSW.
Please take 10 minutes to complete the survey
If you would like to be interviewed to provide further insight please email the Implementation Scientist working with the team on this project, Hossai Gul
What are the benefits of WES for children with moderate to severe intellectual disability?
WES results in a molecular diagnosis for approximately 40 per cent of children with a moderate/severe intellectual disability1,2,3.The data generated from this testing can also be re-analysed in future, as our understanding of genetics improves.
A genetic diagnosis can also:
provide closure and alleviate parental guilt
prevent further unnecessary investigations
assist with access to support groups and services
provide information for families for future family planning
1. Hamdan et al. PLOS Genetics. 2018 Oct, 10 (10) De Novo Mutations in Moderate or Severe Intellectual Disability
2. Clarke et al. NPJ Genom Med. 2018; 3: 16. Meta-analysis of the diagnostic and clinical utility of genome and exome sequencing and chromosomal microarray in children with suspected genetic diseases
3. Amor DJ. J Paediatr Child Health. 2018 Oct;54(10):1154-1158. Investigating the child with intellectual disability
So you can still learn from each other, engage with experts and your peers and contribute to the conversation we are now preparing to deliver Congress online. RACP Congress 2020 Balancing Medical Science with Humanity online program will explore the theme and deliver shared sessions and selected stream sessions for you to access from your computer or device.
You will be able to watch orations, interact with experts through webinars and listen and contribute to panel discussions via podcasts.
Details about the sessions and how you can access the program will be announced soon.
COVID-19 has left few people around the world unaffected, and health practitioners are among those at the top of the list. Their daily and intimate service to public inevitably puts them at risk of catching the virus, while social distancing precautions can compromise the work that they do. Dreadful as the viral disease is, the bigger consequences of the pandemic may be on the disruption to routine healthcare.
Consulting patients by video or phone can be a way to keep healthcare ticking over, but many doctors are nervous as they adopt it for the first time. In this podcast we go over some of the bureaucratic and tech support questions that clinicians have been asking during the current crisis. We also discuss the art of building trust with new patients, and conducting a physical examination through telehealth.
The guest speakers are oncologist Sabe Sabesan and Paediatrician Michael Williams, who’ve been pioneering telehealth outreach to rural and remote Queensland for more than a decade.
We understand you’re busy and on-the go, so discover our quality online education. Access a range of online learning courses, resources, lectures, curated collections and podcasts which have all been developed by members, for members. The interactive nature of our online learning resources enable you to learn from your peers. Accessible anywhere and optimised for mobile on-the-go learning, RACP Online Learning Resources are free for members and count towards CPD requirements.
Fellows can claim CPD credits by completing the Online Professionalism Program (OPP)
Looking for another effective avenue to claim CPD credits? We recommend considering OPP. OPP is an evidence-based, spaced online learning program. The program has been demonstrated in randomised trials to improve knowledge acquisition, boost retention, change on-the-job behaviours and improve patient outcomes.
OPP delivers short and practical case studies right to your inbox, and feature multiple-choice questions. These case studies are created by a Working Group whose experience is in the relevant field or topic. Each multiple-choice question takes about five minutes to complete, with an opportunity to re-attempt each question if answered incorrectly.
These questions are framed in clinical scenarios and are designed to encourage critical thinking. Each question links to a discussion forum for participants to engage in conversation about each case study. This is in acknowledgement that there is not always a right or wrong answer.
On 16 March 2020, the RACP’s Continuous Learning team launched the End-of-Life Care OPP Course to over 40 participants. The End-of-Life Care Course is designed to enhance physician’s skills with end of life and advance care planning.
The End of Life Care Course is comprised of 11 multiple-choice questions which will take participants three to four weeks to complete. Participants can claim CPD credits (one credit per hour) in Category 1: Educational Activities, for the time they spend on this resource.
If you are interested in the current End-of-Life Care course or future OPP courses, please register your interest by emailing firstname.lastname@example.org.
In 2017, Monash University surveyed health professionals regarding their knowledge, experience and views regarding the life insurance implications of genetic testing. In 2019, policy in this area changed, and we are keen to understand whether, and if so how, things have changed. You are eligible if you are a qualified health professional (other than a general practitioner) working in Australia or Aotearoa New Zealand who has direct contact (by telephone or in person) with clients who are considering genetic testing.
Please complete this important survey. It should not take longer than 10-15 minutes to complete, and can be anonymous. The findings of this project will contribute to a policy response to the Australian government regarding the current situation, and your participation will assist with gathering critical data in this space. For any queries regarding this research, please contact Jane Tiller.
Complete the survey