Australia and New Zealand have seen a fourfold increase in opioid use over the last thirty years. Most of this prescribing has been for chronic non-cancer pain, but there is little evidence to support this indication. In this podcast we’ll discuss some of the latest studies that provide evidence against the efficacy of opioid use for chronic non-cancer pain. We explain how to identify patients that have developed dependence on or addiction to opioids and how to wean them off this medication. And we describe an alternative approach to therapy that involves breaking maladaptive pain associations in the nervous system.

In this episode we hear three perspectives on rural medicine in New Zealand-Aotearoa, recorded at the RACP Congress in Auckland. New Zealand doesn’t have the same extremes of remoteness of Australia, but it does have a rugged landscape that results in small and scattered communities. The populations which are disproportionately under-serviced and in worse health, are not necessarily the most remote, and the demarcations fall much more starkly along lines of socioeconomic status.

Remote settings in Australia only have 11 percent as many specialists per capita as major cities and this means that pathology is often more advanced by the time it’s diagnosed The medicine can be confronting but the training experience is great and rewarding. In this episode we visit Broome, two and a half thousand kilometres from tertiary facilities in WA, and find out what it’s like to train as a generalist up there.

A third of Australia’s population is classified as regional or remote, but as it’s such a big place it’s hard to provide comprehensive heath care all over. In this episode we visit the country town of Dubbo which services a catchment of 130,000 people across Western NSW. While need in this area is high, Dubbo presents an example of strong clinical leadership and training across many specialties.

Adolescence is a turbulent time as teens are faced not just with changes to their bodies, but to their moods and thought patterns as well. Young people with complex needs such as diabetes, transplant management or intellectual disability are the least likely to received dedicated transition support. The three speakers in this podcast explain that improving this transition process doesn’t require going way above and beyond regular practice, it just needs a little more coordination. And all the medical care in the world needs to fit in with the lifestyle that every young adult aspires to.

This episode was recorded at the 2019 RACP Congress in Auckland. The three speakers dealt with the profound influence that the early years of life have on life-long health, wellbeing, behaviour and socioeconomic outcomes. Together, these speakers demonstrated that the consequences of childhood disadvantage are borne not just by individuals and families but by all of society, and conversely that a community approach must be adopted to ameliorate this. The lectures were framed by the launch of an RACP position statement on early childhood titled “The Importance of the Early Years.”

Clinicians are drawn into the question of driving fitness in two main ways. The more clearcut is when a patient presents with a medical assessment form. The other is when they detect a new or worsening condition in a patient who is already licenced. Clinicians are expected to warn their patients off driving, and to potentially report them to the DLA if this advice isn’t being heeded. In this podcast we hear about some of the diagnoses that should raise red flags, and how to discuss cessation from driving with patients.

Pap testing has been one of the most successful public health interventions in history. But in Australia, that classic cytology test now plays second fiddle to HPV testing and New Zealand intends to follow suit by 2021. The most noticeable shift is that the interval between screens will now be five years rather than two. And women will enter the program at age 25 instead of 18. This episode will answer some questions that women and health professionals might have about the renewed cervical screening program.

This is the second of two podcasts about “digital disruption” in healthcare. We discuss autonomy in decision-making, and how access to health data is important to individuals. We’ll also hear about the cultural baggage attached to words like patient and consumer.

“Digital disruption” is what happened to the taxi industry at the hands of Google Maps and Uber or to the music industry with the onslaught mp3 files and digital sharing platforms. Democratizing technology is changing delivery of healthcare too and the expectations of consumers. What is the role of physicians in this brave new world?