When doctors are starting out in private practice, they typically do so within the safety net of an established practice, and typically renting a room in exchange for an agreed portion of the consultation. The next levels of complexity involve setting up a business for oneself, or partnering in a group practice. In this podcast we discuss the personal and financial challenges, and also how to build awareness and trust in the community.

Australia’s personal health record has been around for seven years, but it’s been hard getting health providers to upload data the MyHealth Record routinely. The uptake differs wildly between primary, secondary and tertiary care, so in this podcast we visit each of these settings and hear what the different expectations are of this new tool, what are the benefits gained, and how well it fits into the workflow of a consultation.

Marrabinya is a Wiradjuri word meaning “hand outstretched.” It’s the name of a service in the Western New South Wales Primary Health Network which financially supports Indigenous Australians to attend specialist consultaions. Aboriginal and Torres Strait Islander Peoples currently receive specialist medical care 40% less often than non-indigenous Australians. The Marrabinya staff explain how socioeconomic factors and institutional biases even in these settings can accumulate to prevent Aboriginal patients from receiving the care they need.

This episode looks at influencers of opioid prescribing. First we ask which are the opioids most commonly leading to dependence and why are they prescribed. Then we discuss the mixed messages that prescribers are getting from guidelines and pharmaceutical regulation, not to mention promotional campaigns by pharmaceutical companies. In Tasmania these influences have be countered by education, regulation and real-time prescription monitoring.

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.”