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.

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.

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?

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.

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.

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.

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.

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.

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.

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.