When can a child be said to have cognitive capacity and bodily autonomy? For those who don’t, where does the guardianship of the parent to give way to that of the medical professionals? These questions and more are discussed in two case studies from the Essential Ethics podcast, produced within the Children's Bioethics Centre in Melbourne.

Almost 500 million Medicare rebates are processed every year and for the most part these are claimed appropriately. But non-compliant billing could be costing the health system over 2 billion dollars annually. The vast majority of this comes down to lack of education about the MBS. Department of Health has an elaborate, and sometimes controversial way of identifying misuse of the system. Government regulation also influences the market for private medical fees as does supply and demand of certain specialties.

COVID-19 has disrupted delivery of routine healthcare in many ways. Consulting patients by video or phone can be a way to keep patients safe, 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.

Australia has one of the best value health systems in the world, but also some of the most complicated health regulation that ties together public and private payers. This creates some traps for well-intentioned providers and loopholes for the less well-intentioned.

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.