Welcome to Pomegranate Health, a podcast about the culture of medicine. You’ll hear clinicians, academics and advocates discuss some big questions; How can one make difficult clinical and ethical decisions free from bias? How can communication with patients and peers be improved? How can healthcare delivery be made more equitable and efficient?
This is also the home of IMJ On-Air, where authors of the College's Internal Medicine Journal present their work. Expert advice on the current best standards for your practice.
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At each page there is a MyCPD link for Fellows to log credits for participating in educational activity. Please continue the discussion in the comments section below each episode.
Ep44: Cervical Screening–Less Is More
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.
Ep43: What’s in a Name? - Disruption Part 2
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.
Ep42: The Value Proposition - Disruption Part 1
“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?
Ep41: Targeting Diabetes
Glucose-lowering medications have been the mainstay of managing type 2 diabetes for 20 years. But a recent polemic between diabetes organisations has prompted an examination of specific targets for blood sugar in different patients. This episode explores the debate, and also summarises the use of new drug classes that don’t just lower blood glucose but appear to provide cardiovascular benefits directly in sicker patients.
Ep40: Rebooting CPD Part 2—Feedback and Audit
From 2019, there will be only three categories of activities in the RACP’s CPD framework, encouraging Fellows to participate in performance review and outcome measurement alongside more traditional educational activities. In this episode, two New Zealand Fellows discuss what they’ve learned about this ‘strengthened CPD’ approach since it was nationally implemented there four years ago.
Ep39: Rebooting CPD Part 1—Origins
In this episode we put continuing professional development (CPD) under the microscope, particularly the regulatory changes on the horizon. The Medical Board of Australia is emulating shifts already made by the Medical Council of New Zealand and regulators in Canada, the U.S. and the U.K. In some cases, this ‘revalidation’ movement has been fiercely opposed by doctors. But where did it come from, and why is CPD even necessary after you’ve already done 10 to 15 years of medical training?
Ep38: Making a Connection
An empathic connection and good communication between physician and patient can promote better outcomes. In this episode of Pomegranate Health, you’ll hear where major breakdowns in communication occur, and some remedies to improve this. We also discuss why some media report a ‘crisis of compassion’ in healthcare, and how empathic reflection can help both doctors and their patients.
Ep37: Ethical Dilemmas—Congress 2018
As medicine becomes more sophisticated, discussions about clinical ethics become more common. It’s now possible to support life in dire clinical circumstances, but physicians are not always sure if this is the right thing to do. This episode centres around ethical decision-making in two case studies. The first describes a three-year-old boy with a severe neurodegenerative disorder, whose parents are desperate to try an expensive experimental drug. The second is about a man ravaged by bowel cancer who has spent months on life-sustaining care.
Ep36: Acute Coronary Syndrome Part 2—Secondary Prevention
This is the second of two episodes about ACS, and deals with secondary prevention and adherence to therapy. One-fifth of people given a diagnosis of acute coronary syndrome (ACS) have another ischaemic event with six months of discharge. For secondary prevention, guidelines recommend pharmacotherapy, cardiac rehabilitation and lifestyle management. However, many patients are discharged from hospital without best-practice care, setting a trend for inadequate therapy long-term. Cardiac rehabilitation also needs to be modernised and personalised to keep patients engaged.
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.