Pomegranate Health
Welcome to Pomegranate Health, a podcast about the culture of medicine. You’ll hear clinicians, academics and advocates discuss some big questions; How to difficult clinical and ethical decisions free from cognitive bias? How can communication with patients and peers be improved? And how to deliver healthcare most equitably and efficiently?
This is also the home of [IMJ On-Air], where authors from the College's Internal Medicine Journal present their work. [Journal Club] showcases RACP academics published in other journals. Meanwhile, the [Case Report] series is developed to guide Basic Physician Trainees on presentation of long-cases at their examinations.
Why a pomegranate? The fruit has featured on the coat of arms of the Royal College of Physicians of London since 1546. Listen here for the unlikely tale of how it made its way from ancient myth onto this podcast by way of Henry VIII.
Please continue the discussion in the comments section for each episode and send any feedback or ideas to podcast@racp.edu.au
Subscribe
Search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app. For some apps you may need to import . It also provides a single page you can search for topics that might interest you in specific podcast episodes. You can also sign up for an email alert when a new episode is published about once a month.
CPD
At each episode page there is a MyCPD link for Fellows to log hours of participation in a Category 1 Educational activity. Consider "levelling up" this experience into a Category 2 Performance Review activity. For example, you could organise peers into a journal club to discuss the podcast. This could be done in person, or virtually. Reflect on aspects of the story that relate to your own practice and how it could be improved and visit MyCPD Handbook for further guidance or discussion templates.
Latest episodes
Ep35: Acute Coronary Syndrome Part 1—Diagnosis
Chest pain and other symptoms suggestive of acute coronary syndrome (ACS) make up the majority of presentations to hospital, but no more than 17 per cent of patients end up having the diagnosis confirmed. Diagnosing acute coronary is complex, and should be guided by the 2016 guidelines of the Cardiac Society of Australia and New Zealand. This podcast outlines how ECG is used to diagnose ST segment elevation myocardial infarction, and which life-threatening differential diagnoses to look for. The role of high sensitivity troponin assays is also discussed, in the differentiation of non-STEMI and unstable angina, and also in risk stratification of patients for safe discharge.
Ep34: Diagnostic Error Part 2—Systems
In Episode 32 of Pomegranate Health, we discussed cognitive error in diagnostic reasoning. On this episode, we take a look at systems pressures that increase the likelihood of medical error, crystallised by the recent prosecution of U.K. National Health Service (NHS) paediatrician Dr Hadiza Bawa-Garba. Almost half of diagnostic errors are due to a combination of systems errors and individual cognitive error. Obvious systems effects come into play in understaffed acute care units; if a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. The stepping stones of ordering, receiving and reviewing diagnostic tests and scans also allow much opportunity for error and delay. Guests on this episode discuss mechanisms to improve efficiency.
Ep33: Early Days for Cannabis Therapy
Cannabis is a plant rich with potential therapeutic compounds and centuries of cultural resonance. However, only a few of the claimed medical effects of the plant have been proven by rigorous clinical trials in people. These include spasticity and pain in multiple sclerosis, chemotherapy-induced nausea and vomiting and some cases of epilepsy. But for many other conditions, systematic reviews have concluded that meaningful clinical recommendations cannot be made. In this episode, we explain how important it is to separate the effect of various cannabinoids in a systematic way, and why well-regulated research and prescribing will be safer for patients.
Ep32: Diagnostic Error Part 1—Cognitive Bias
This is the first of two episodes about errors in diagnostic reasoning. Misdiagnosis or delayed diagnosis occurs in 10-15 per cent of acute presentations, although fortunately only a tenth of these lead to serious consequences. But of concern is the fact that this figure hasn’t changed in three decades, despite progress in clinical knowledge. Cognitive errors result from jumping to conclusions on the basis of intuition and incomplete information. There are a hundred different types of such bias. On this episode, the most common types will be discussed, as well as strategies to force a more considered process of diagnostic reasoning.
Ep31: Ngā Kaitiaki Hauora
‘Ngā Kaitiaki Hauora’ translates as ‘guardians of health’. This podcast emerged from a meeting near Auckland organised by the RACP’s Māori Health Committee in November 2017. Members of various medical colleges and institutions came together to share perspectives on the delivery of health care to New Zealand’s population of Māori and Pacific Islander people. This conversation comes in the context of the Wai 262 claim, which is forcing a re-examination of the Crown’s obligations to the Māori population under the Waitangi Treaty of 1840.
Ep30: Being Human
Figures about burnout, depression and suicide are often reported on in the health workforce. These rates are typically twofold higher than they are in the general population, according to studies from New Zealand, Australia and around the world. Causes often given for psychiatric distress in the medical profession are the gruelling hours, the pressure of perfection, the unforgiving culture and the stigma associated with mental health issues. This episode examines how the system affects the individuals within it, and what can be changed for the better.
Ep29: Drug Interactions and Deprescribing
Drug-drug interactions might be responsible for a million hospitalisations in Australia every year. They have become more frequent over the decades, as more medications reach the market. More than half of people over the age of 75 are on five or more prescriptions—a state referred to as polypharmacy. This episode examines some of the systems that have led to current rates of polypharmacy, and some strategies for deprescribing. We also discuss a review from the Internal Medicine Journal on the common drug interactions physicians should be most concerned about.
Ep28: Transitions to Fellowship
Transitioning from trainee to consultant marks an exciting and daunting and step in a clinician’s career. Suddenly you take on responsibility for everyone on the ward—both patients and other staff. While the clinical skills have been hammered in over years of training, the ‘hidden curriculum’ can be harder to pick up. This episode captures the experience of striking out as a leader, manager and mentor to others. At the same time, recognising limitations and knowing when and how to seek help is all important.
Ep27: Severe Asthma
For years the management model for asthma has been empirical. The more serious the disease, the more the dose of controller therapy is increased. But this doesn’t work for everyone and a more rational approach involves identifying one of three distinct pathological pathways. This episode describes emerging diagnostic tools therapies such as monoclonal antibodies that are targeted to specific disease phenotypes.
Ep26: Dealing with Uncertainty – Part 2
Uncertainty is a frightening but unavoidable fact in every speciality. In the second of a two-part series, we look at the stigma and disorientation experienced by patients with medically unexplained syndromes, and some behavioural interventions for functional disorders. Since treatment outcomes are never guaranteed, we also discuss how a patient’s expectations must be managed from the beginning of a consultation, and the importance of long-term coping strategies.