The Tea Room

There's been a swell of advocacy lately around breast density, which increases cancer risk while reducing the sensitivity of mammograms. The FDA in the US has recently mandated that women be notified by mammogram providers if they have dense breasts, giving them the opportunity to arrange supplemental testing. But BreastScreen Australia's 2020 position statement does not recommend the routine recording of breast density or the provision of supplemental testing for women with dense breasts. Professor Vivienne Milch, the government's medical advisor on screening policy, and Professor Bruce Mann, a breast surgeon and researcher, are two of our guests today in the Tea Room – the last Tea Room before we become The Medical Republic Podcast and go from weekly to fortnightly episodes. We also talk to two patients about their experiences with breast density and cancer, who find the lack of notification baffling – and a little bit 1950s. Dr Sandy Minck, a GP by training and a breast cancer survivor, said she was “dumbfounded” by the BSA position statement. “As a consumer I'm outraged. As a health professional, I'm dumbfounded. I just don't understand it.” Professor Milch says the program will conduct an evidence review on supplemental screening for women with dense breasts some time this year, although there is no guarantee of a policy change. “We're aware of the growing momentum of advocacy and of also some women's desire to know their breast density,” Professor Milch says, adding that different states have different policies. “Western Australia has been telling women about their breast density for some time, and then there are pilots in some services in [Queensland and South Australia]. “We may or may not have a policy change. But we'll be looking at the evidence.” Professor Bruce Mann, who works with the Roadmap to Optimising Screening in Australia (ROSA) project, says there is enough evidence to justify a change to BSA's screening regimen. “As women and the community becomes more informed, there is a danger that what is offered by BreastScreen will be seen as insufficient,” he said, which will lead to women opting out of BreastScreen and going private. “What we don't want in this country is a two-tiered system where those who know and can get the best, do, and everyone else gets what's offered to them. That's what we are working to avoid. “If you can show that by doing something different you are finding more cancers, fewer cancers are being diagnosed between screening rounds, and the stage, the size and the nodal status of cancers that are diagnosed is moving in a favourable direction, I believe that's sufficient to encourage implementation with a planned review in 10 years when the mortality information's there.” Hosted on Acast. See acast.com/privacy for more information.

South Australia's long covid clinic loves GPs and keeps them close.Dr Angela Molga is a clinical pharmacologist and geriatrician at the long covid clinic at Royal Adelaide Hospital.“We engage the GPs very early on, from the moment we receive the referrals. The patients are kept updated on the length of the waitlist and we also send them out resources specifically around self-rehabilitation,” she says.Dr Molga says the average age of the patients who were seen in the South Australian clinic last year was 47 years old.“These were previously healthy people. Little contact with the healthcare system, but now have multiple chronic issues. They have to change their lifestyle significantly, and then this also impacts their mental health,” she says.Also on The Tea Room medical reporter Cate Swannell shares the nitty gritty details of the long covid parliamentary inquiry report.Although long covid fails to get a mention in the federal budget Cate says the long covid parliamentary inquiry is pushing for $50 million. She says the RACGP has welcomed the recognition of GPs in the report.“They also have pointed out that many recommendations reflect what the RACGP has been calling for, for a long time. Particularly around data collection and research,” Cate says.Cate says the report seemed to hinge on the establishment of a national Centre for Disease Control which we saw confirmed in this week's federal budget.“They're also talking about expanding the list of eligibility for antivirals and there is a call for the establishment of a multidisciplinary advisory body to oversee the impact of poor air quality and ventilation on the economy,” Cate says.Join The Medical Republic at an interactive live webinar that will equip you with the knowledge and tools to treat long covid patients.Ask questions about including diagnostics and assessment, guidelines, billing and item numbers, and how to create a long covid clinic in a community practice.The expert panel include doctors treating long covid in family practices, leaders of tertiary care teams, clinical researchers and public health specialists. Hosted on Acast. See acast.com/privacy for more information.

What do you get when you cross advice from a health economist with that from a leading physiotherapist? Increased revenue and a better patient experience, say our guests on today's episode of The Tea Room.Scott Willis is president of the Australian Physiotherapists Association and a proud Palawa man. He says better results come from general practices who genuinely embrace allied health as part of the team.“If you have social events, invite them. Let them be part of your strategy of the practice. They might sometimes see things from a different angle and add value to where practice is heading,” he says.Mr Willis also says the business relationship amplifies when it wraps around the needs of the patients.“The number one thing is that both parties – GPs and allied health - believe that it's a partnership to make the patient journey better. I know it's a business transaction in terms of hiring a space or having some type of input within general practice, but it has to be viewed as more than that,” he saysTracey Johnson, health economist and CEO of Inala Primary Care, also favours multidisciplinary team care for patients. She also has a robust economic rationale for engaging allied health within a general practice.“Given the rents that people are now paying in this sector, it will be incredibly hard for you to survive if you don't have onsite allied health or pathology or pharmacy that you are subleasing to,” she said.Ms Johnson says that many doctors work part time and that hot-desking their rooms makes perfect economic sense.“Some doctors might work from 8:00am in the morning until 2:30pm and pick their children up from school. So, bring in some allied health who might to use those rooms from 3:00pm until 7:00pm. You get more utilization around those rooms, more marginal return, and generally things come together better for the patients as well,” she says.For more tips on how to optimise your allied health arrangements listen to the full episode.News flash: The Tea Room podcast is moving! In a few weeks we will stop being The Tea Room and broadcast instead as The Medical Republic podcast.Today's episode is already available on The Medical Republic podcast and can be found on Apple Podcasts, Spotify or your favourite podcast player. Subscribe now so you won't miss out on any new episodes. Hosted on Acast. See acast.com/privacy for more information.

Professor Rob Moodie describes himself as “an eternal optimist”. He needs to be. A long and distinguished career in public health has seen Professor Moodie tackle the “big four” industries – alcohol, tobacco, junk food, and fossil fuel – and these days he's added a fifth to the list, gambling. Those industries and corporate multinationals make up a large slice, but by no means all, of the commercial determinants of health – defined by Professor Moodie and his colleagues as “the products and practices of some commercial actors—notably the largest transnational corporations—[that are] responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity”. In a recent series in the Lancet, Professor Moodie, Professor Anna Gilmore from the University of Bath in the UK and other colleagues set out to define, conceptualise and frame an argument for paying attention to the commercial determinants of health and rebalancing the distribution of the profits of capitalism. Are Professor Moodie and his colleagues talking about the overthrow of capitalism? “We're talking about a much more responsible form of capitalism,” he tells TMR. “[At the moment] these corporations, don't pay the costs of their production and their consumption. Individuals and states pay the costs. And that means that money can't be spent on other things like education or other forms of healthcare. “They can completely externalise all the negatives, and they leave it for the rest of the society to pick up, literally what they've left behind. And that makes them more powerful.” Doing nothing to correct the balance of power between corporations and society could be catastrophic, says Professor Moodie. “We've grown up with an expectation, literally, that life expectancy will continue to increase, that our lives will get longer and better as we go grow older and that we'll have a happier society,” he said. “That notion of a fair go was built into our ethos, but it's been disappearing over the last 15 to 20 years. “We've watched all these indexes that are going the wrong way, whether it's around childhood education, childhood development, sustainability, biodiversity, press freedom, peace index, quality of life index, quality of death index – in Australia we used to be really up there. “This has been worn away.” We need a shift in our mindset and where we look for inspiration, says Professor Moodie. “We could go to the wrong place,” he said. “The US is not a place to go for overall policy inspiration. We need to look to northern Europe or Scandinavia, where there's a commitment to the society as a whole, and what that produces. “The greater the equality, the better the health, and there's a dictum that says if you want to live the American dream, go to Denmark.” Hosted on Acast. See acast.com/privacy for more information.

Medical school equips doctors to do many things. Managing LGBTQI+ patients probably isn't one of them.Dr Asiel Adan Sanchez is a GP and clinical tutor at the university of Melbourne. He knows first-hand how clinical environments can be off putting for people who are queer, trans and gender diverse. He's also created a solution for that called Wavelength - a learning tool that builds clinician skills and makes general practices safer for LGBTQI+ folk.Dr Sanchez gives a quick masterclass on the simple and practical ways to take away the “awkward interactions” that occur in many medical environments. They say a very common example is when taking a sensitive history and asking about gender affirmation procedures.“A lot of clinicians really struggle with asking those questions and often the language that they use is quite inappropriate. “ Have you had the operation?” for example. A patient might get this question all the time outside, in the real world, and if you don't explain to the patient what the rationale behind asking those questions is, it can be really distressing for them,” says Dr Sanchez.Dr Sanchez provides a graduated approach to inquiring about gender affirmation surgery, after building rapport through simple ways such as using correct personal pronouns.“I often tell medical students to fall back on the skills that they already have around cultural competency to build that rapport with the person. For example, you might be talking about work and family and what the patient does at home. Then you can ask “By the way, are there any pronouns that you'd like me to use?” And that's an organic and simple approach,” they say.Dr Sanchez created the Wavelength training module in 2016 when he was a medical student at University of Melbourne. Wavelength is now managed by the Australian Medical Student Association (AMSA) who are advocating for Australian medical school curricula to include better LGBTQI+ health content.Medical student Sophia Nicolades has researched the LGBTQI+ health curricula gap and found that the average hours of dedicated teaching was between zero and two hours across the medical whole degree.“We found that the groups with the poorest health care outcomes were also the least present in our curriculars those being trans people, intersex people, bisexual people. and those with intersectional experiences such as First Nations people and folks with disability,” Mx Nicolades said.Dineli Kalansuria, medical student and chair of AMSA Queer, is also working tirelessly to try and better the medical curriculum at Australian universities.“We would also love for some practising doctors to take part in the Wavelength module and let us know if they feel that it's relevant, if it's representative of the presentations that they've been seeing as well,” she said Hosted on Acast. See acast.com/privacy for more information.

Struggling to hang on to doctor staff? This episode offers more than a few gems of wisdom from the most unlikely location. Today, The Tea Room travels to Crystal Brook, a rural town 200 kilometres north of Adelaide. There we meet Dr Richard McKinnon co- owner of Crystal Brook Medical Practice – a small-town clinic that is anything but small. After 35 years in this farming community, he knows the hacks to running a thriving practice that allows plenty of time to play golf. The secret, it appears, is knowing how to retain registrars. “The current generation, quite rightly and no criticism at all, won't go to single-doctor practices, they won't go to two doctor practices and they probably won't go to three doctor practices. Because it's all about work life, balance and lifestyle,” Dr McKinnon says. At Crystal Brook Medical Practice registrars are “really looked after”, says Dr McKinnon. “They don't do any more on-call than I do. They're very well supported. And if they want to go and play netball in winter and they're on call, I'll cover them and they'll cover me when I want to go sailing. And the ones we like and who like us tend to stay,” he said. Providing great training is another major drawcard for registrars. At Crystal Brook they get hands-on experience assessing and treating conditions, like gout and polymyalgia rheumatica, which in a city clinic would be normally referred to another specialist. “I think rural GPs will do more procedures perhaps than our city colleagues because you don't want the patient have to travel 200 kilometres for treatment. And if you're not kind of putting patients at increased risk then we will do those treatments and try to encourage and teach the registrars coming through,” he said. Dr McKinnon sees an over reliance on “sophisticated investigations” in current training approaches in large hospitals. He believes this can compromise clinical acumen and the confidence to diagnose and treat some patients. “You go to Medical School, in my case for six years of medicine, then four years post-graduate. Basically you've done 10 years training. If you then don't use your clinical acumen, well, it just breaks my heart,” Dr McKinnon said. Hosted on Acast. See acast.com/privacy for more information.

When Professor John Skerritt first joined the Department of Health he was tasked with setting up a joint regulatory framework between Australia and Aotearoa New Zealand. “But then the government changed, and it was no, no, we don't want to do that,” he told TMR in an exclusive podcast. Instead, Professor Skerritt set about making the biggest regulatory reforms “in 30 to 50 years” via the establishment of the current Therapeutic Goods Administration. “We had to get on top of such issues as the use of strong opioids and so forth, things that were really important for patient safety and also a number of medical device reforms – gynaecological mesh, and hip joints,” he said. “And just when the 70-hour weeks went back to 50-hour weeks a little thing called covid came along.” That “little thing” turned into a response effort of which Professor Skerritt is justifiably proud. “The whole staff pulled together and really went beyond the pale,” he said. “There was such a sense of mission. Most people were working from home, but we were essential workers. Many of us were working in here, coming in through a ghost town. The laboratory people had to come in – they couldn't take their stuff and do it in the kitchen at home. “They were here at all crazy hours, working damn hard. That has to be the crowning achievement.” Along the way there have been moments of controversy, of course, but Professor Skerritt doesn't shy away from them. Not the least of them is what will occupy him in his last few weeks in the job – the nicotine vaping regulatory framework. “One of the biggest holes emerged because the previous government brought in controls on the border and then repealed it four or five days later,” says Professor Skerritt. “In the absence of requiring input permits, pallet-loads of this stuff comes in without requirement for permits, ends up distributed to 7-Elevens and online sales and all sorts of things. “Government has got to make a policy decision about whether they want to do something at the border. “I'm not going to pre-empt any decisions of government, because those final decisions are still being discussed among Cabinet members. “People [think] we make up the rules – we don't. Our role is to identify what options could be feasible in law and in practice, the range of options out there, get feedback, and put it up to ministers. Sometimes they're really big things like nicotine vaping, and it will involve all of Cabinet not just the health minister. “When we implement what is decided, that's the separation between the bureaucracy and the elected government. And that's the way it should be in a democracy.” Hosted on Acast. See acast.com/privacy for more information.

Treatment options are expanding rapidly for high cholesterol patients, says today's guest on The Tea Room. Professor Steve Nicholls, director of the new Victorian Heart Hospital, shares the latest in clinical trials and reveals a possible heart disease vaccine. “There's an approach now, in clinical trials, that uses fairly old-fashioned vaccine technology but instead of trying to go after some antimicrobial target, the vaccine is simply targeting (a cholesterol-inducing protein) PCSK9,” he says. He says that research advances are coming at cholesterol treatment from all angles. There are novel ways to tackle lipoprotein(a) and triglycerides, a new approach to high-density lipoproteins, and other injectables and oral agents that by themselves, or in combination with other therapies, will lower LDL cholesterol by 50%. “And then at the very end of all of this is gene editing and the idea that we may be able to have once-in-a-lifetime treatment for cholesterol. All of these approaches are now real and are undergoing clinical development,” Professor Nicholls says. Professor Nicholls also discusses the nocebo effect of stains and says that half of the patients who are prescribed stains will stop taking the drug within 12 to 18 months. “We know that statin intolerance is a really big deal,” he says adding that there is new hope for those patients. “We've just reported a really large clinical trial of a new agent called bempedoic acid, and that not only lowered cholesterol, but lowered the risk of heart attack, stroke, and death,” he says. Professor Nicholls also analyses the pros and cons of the Victorian Heart Hospital that his team opened four weeks ago. “It's been great to watch individual medical departments working together to think differently about the way we treat multi-system disease and provide great care for that. To watch that start to come to life is pretty exciting,” he says. Hosted on Acast. See acast.com/privacy for more information.

It's only March and politics already has a full dance card for GPs to foxtrot around. Luckily for The Tea Room, political reporter Holly Payne steps in today to lead us through the top stories of the year so far. First up, Holly spills the tea on her investigations into Ozempic and the marketing antics of manufacturer Novo Nordisk. Holly says the big pharma has now been suspended from a leading UK industry group for promotional misdemeanours. “Novo Nordis partly funded an event that promoted one of their semaglutide drugs but they did not mention any side effects of the drug. They've also sponsored the creation of weight loss medicine units (of curricula) for medical students,” Holly says. Massive demand for weight loss treatment has led to supply shortages in Australia but according to Holly's sources this probably won't improve until mid-year. Meanwhile, the dilemma continues as to who is most entitled to the weight loss/diabetes drug. Holly also delves into the payroll tax verdict and what the judges said in the Thomas and Naaz case. She contacted each state and territory to check for differences and reveals that Queensland is offering clinic owners an amnesty till 2025. However, Holly says that Western Australia is the premium state of choice for GPs who want to preserve their thin profit margin. “Western Australia is the fun outlier in that it's not part of the harmonized tax provisions. When I've corresponded with the WA tax office, they've basically said, “Thomas and Naaz doesn't apply here and we consider all GPs as contractors until otherwise”,” Holly said. Chronic traumatic encephalopathy (CTE) also takes the centre field in our political update, as Holly discusses a class action lawsuit against the AFL. She said that while the RACGP is calling for a change to codes none of the peak Australian sports medicine bodies have officially acknowledged the link between sports-related head knocks and CTE "They did indicate that they would likely be updating their position on CTE but there's no guarantee of when that will actually come out. It's often thought that the sports medicine bodies are particularly quite close to industry,” Holly said. As players and sporting institutions battle it out Holly suggests this is one game to watch. Who eventually gets the red card may have an expensive bill. “We've already seen a class action happen in America with gridiron. Those players won a $1 billion payout,” Holly said. Hosted on Acast. See acast.com/privacy for more information.

Professor Louise Baur wants obesity taken out of the health portfolio and put in the laps of PM Anthony Albanese and his Cabinet colleagues. “Sometimes I think the best approach would be to take [obesity] out of the responsibility of the Minister of Health and put it squarely in the Prime Minister and Cabinet, because the solutions don't lie, in general, with health,” Professor Baur told TMR. “Or put it in Treasury, because it's something that costs,” she said. Professor Baur is president of the World Obesity Federation, and director of the NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood-Translate at the University of Sydney. Recently the World Obesity Federation published the World Obesity Atlas 2023 report recently, including some sobering news for Australians. Forty-seven percent of Australian adults will be obese by 2035, an annual increase of 2.2% between 2020 and 2035. Childhood obesity will increase at 2.6% per year. The impact on the national GDP of overweight will come in at 2.5%. It's a conversation that has been going on for decades in Australia, with seemingly little action or commitment despite the presence of the National Obesity Strategy. “In 1997, Australia was the first country in the world to have a national obesity strategy,” Professor Baur told TMR. “It was called ‘Acting on Australia's weight'. One of my colleagues now refers to it as ‘Waiting on Australia's act'. “We tend to say just eat less and exercise more – we certainly still see it as an individual responsibility. “We can't seem to see it as a whole community – as something that relates to broader policies. We as human beings are responding physiologically to what is a pathological environment. “We say to people, oh, just eat less and exercise more, but then we don't change the environment in which they live.” And what would Professor Baur say to PM Albo? “Let's implement the national obesity strategy and the previous versions of that beforehand,” she said. “A sugar-sweetened beverage tax would be a really good way to go. We could do much more to restrict unhealthy food marketing directed towards kids. We could look at innovative solutions to get healthy, lower cost foods to communities that need that. “And then I'd also really like to see improvements in the way that we treat people. “People living with obesity say that if they're treated with respect and if their concerns are met appropriately; if they're not just judged as someone who is big but as someone who has a range of strengths and challenges in their life; and if their health issues aren't just all subscribed to obesity, then they feel that they can come back to that GP, or to that health service. “So, our approach to people living with obesity is really important. We can make or break this person. In one sense, we can help support or encourage them even if their weight on the scales doesn't change. “Their life might be much better because of the way that you treat them as a GP.” Hosted on Acast. See acast.com/privacy for more information.

It's widespread and often misdiagnosed, but fetal alcohol spectrum disorder has finally been included in the MBS.This is a good thing, according to our guest Nirosha Boaden, a senior mental health specialist who is doing her PhD on FASD.International prevalence studies indicate that up to one in 20 children in Western countries could have FASD but there is no accurate data for Australia.Ms Boaden says FASD can manifest in behaviours that are often mistaken for attention deficit hyperactivity disorder and autism spectrum disorder. There are other misconceptions that Ms Boaden clears up in The Tea Room today.The assumption that FASD is only an issue for marginalised communities is wrong, according to Ms Boaden.“Alcohol consumption is not in just one part of our community. It's broadly across Australia. The highest rates of binge drinking are in adolescents up to 25 years and the highest rates of longitudinal drinking – a glass or two after work – are people over 35 years,” she says.The second misconception is that people with FASD always have sentinal facial features such as small eyes and thin upper lip.“We now know that you can have FASD with sentinel facial features or without. So, if there's been a confirmed alcohol use during pregnancy and maybe there's some impairment with the child cognitively, then refer it to paediatrics because they could really benefit from a diagnosis,” Ms Boaden says.The third FASD myth Ms Boaden wants to bust is the ongoing belief that an occasional drink during pregnancy presents no risk.“The latest research tells us that there's absolutely no safe level of alcohol during pregnancy,” she says. “Maybe when someone is pregnant we can all get together and do a Dry July for the whole nine months.”Ms Boaden says pathways for adults with FASD are inadequate and patients are likely to be either undiagnosed or overmedicated. She says polypharmacy is often an issue for FASD patients and that people with FASD have a higher risk of death by misadventure.As of 1 March, the MBS has included FASD under neurodevelopmental disorders. The age limit for neurodevelopmental disorders has also been lifted from 13 to 25 years and MBS has doubled the number of assessment services permitted.NoFASD Australia has published guidelines for clinicians to follow when prescribing medications to people with FASD. They are based on Canadian research that established a medication algorithm to guide prescribers. Hosted on Acast. See acast.com/privacy for more information.

Dr Clara Tuck Meng Soo is a Canberra GP and a transgender woman. She is now principal of the practice she joined in 1996 when it was owned by the legendary Dr Peter Rowland. Dr Rowland was one of the first out gay doctors in the country. He founded the practice in the early 1980s when the HIV/AIDS epidemic was first emerging in Australia. The practice became a safe haven for the LGBTQI+ community of Canberra. On 25 June 1996 Dr Rowland was shot and killed at his home when he disturbed two men who were trying to rob him. Although the judge at the time found insufficient evidence to call the murder a gay hate crime, many in the community felt that was exactly what it was. Today Dr Soo and her colleagues are well known for running a practice that is a safe and trusted health care space for trans and other gender-diverse people. “I would estimate that in an average week, probably about 30% to 40% of the patients I see are LGBTQI+,” says Dr Soo. “And a vast proportion of that would be people who are transgender. “In the early days, when I first joined the practice, we had quite a lot of lesbian and gay patients. Over the years that proportion has diminished, because I think that being sexuality-diverse is actually seen as being more mainstream now. So, a lot of patients who are gay or lesbian feel quite comfortable going to their local GP, expecting that GP will not be homophobic.” Perhaps because of the environment she works is, Dr Soo says she has not experienced much transphobia. She transitioned about five years ago. But things could have been different. “It may have been different if I had transitioned 20 years ago, when the social environment was much less accepting,” she says. “If I transitioned at that time, it may have been acceptable for some of my professional colleagues who are less comfortable with gender diversity, to actually voice that to me. That's not acceptable now.” Dr Soo will take part in the Human Rights Conference which will run from 1-3 March as part of Sydney World Pride. She will give a presentation on barriers to gender-affirming healthcare for trans and gender diverse people at 12.15pm (AEDT) on Wednesday 1 March. For more information about accessing the conference, visit sydneyworldpride.com. Hosted on Acast. See acast.com/privacy for more information.

World Pride is in full swing in Sydney and it's an opportunity to highlight the importance of positive experiences of healthcare for the LGBTQI+ community. Those positive experiences are badly needed as research shows that bad healthcare experiences can be a risk factor for suicidality, but good experiences are very much protective of mental health. “We found that having affirming experiences within health and medical settings was a strong protective factor,” Teddy Cook, Director of Community Health at ACON, told TMR's Tea Room podcast. “That's an important call to action for GPs. Affirming someone within your practice is a strong protective factor against suicidality and suicide attempts, which is pretty motivating. “I think sometimes we get a little bit overwhelmed with the idea of what affirming someone means. It really just means recognising someone for who they are, and respecting that. It doesn't have to be more complicated ... really hearing who they are, and then responding to that appropriately makes a massive difference. It really does.” That doesn't mean flying a rainbow flag in your waiting room is enough, however. Natalie Amos, a research officer at the Australian Research Centre in Sex, Health and Society at La Trobe University, was a co-author of the research. “We've heard participants say they tried to access healthcare that said it was inclusive, but [the practitioners] ‘knew nothing about how to treat or affirm my identity',” she told TMR. Research, notably, does not support that being trans is in itself a risk factor for suicidality, but that discrimination, harassment and assault are. There is no lack of training available for GPs who are interested in providing trans and gender-affirming care. “There is certainly lots of training available, more is coming, and it's about making sure that GPs are aware of it and where to access it,” said Teddy Cook. “The data from our paper tells us unequivocally, that when people can have a good experience within a healthcare setting of inclusive and affirming practice there are better outcomes ... and are able to have a higher quality of life, move through the world in a safe, affirmed way and feel respected as who they are. “A GP has a key role in all of that.” Hosted on Acast. See acast.com/privacy for more information.

GPs who work with patients who are experiencing deprivation and poverty are intimately acquainted with the inverse care law -- the availability of good medical care tends to vary inversely with the need for it in the population served. Dr Liz Sturgiss, a GP and senior research fellow at Monash University, the phenomenon all too well in her clinical work. “To say that word -- poverty -- and focus on poverty is really uncomfortable,” she said. “We are a wealthy country, but we're noticing more and more that gap between people who are living in poverty and those who aren't in our everyday work. “As a GP, it's becoming apparent, that if you have money, the kind of care that I can organize for you is vastly different from my patients who are living on pensions and are unemployed. It gets really uncomfortable.” Dr Sturgiss has teamed up with fellow GP Dr Tim Senior to start a new RACGP specific interest group on deprivation and poverty, to provide peer-to-peer support for GPs caring for socioeconomically disadvantaged patients. In an opinion piece for TMR, Dr Senior wrote: “The health of our patients and the ability of our practices to respond to this is profoundly dependent on the circumstances in which people live, and these circumstances are profoundly dependent on people having sufficient money. “The GPs working in these areas have specific skills in patient engagement and empowerment, in managing multimorbidity and complexity and in advocating across multiple agencies for their patients. They exhibit the pragmatism that gets results among people the rest of the health system views as being ‘hard to reach'.” In this episode of the Tea Room Dr Senior and Dr Sturgiss talk about why they felt a SIG on deprivation and poverty was needed, what support GPs will be offered, and venture into the murky waters of “team care”. Hosted on Acast. See acast.com/privacy for more information.

Could water, salt and activewear help a long covid patient?In The Tea Room today we chat with Marie Claire Seeley, PhD candidate at the University of Adelaide and clinical nurse at the Adelaide postural orthostatic tachycardia syndrome (Postural Orthostatic Tachycardia Syndrome (POTS) clinic.She says most long covid patients at her POTS clinic respond to lifestyle management.“Even in the initial stages of long covid we see people having a relatively good response to increasing salt and water intake. Wearing good medical grade compression attire also keeps some blood pressure support for the thoracic cavity. These days you can get that in some of the athletic wear available,” Ms Seeley said.Alongside drug therapy, long covid patients at the Adelaide POTS clinic have been getting relief.“We recently had a doctor in this situation who hadn't been able to work for some months due to long covid. He was extraordinarily fatigued, brain fog, unable to stand, couldn't do surgery anymore. We advised lifestyle changes which he'd started implementing, then we put him onto Ivabradine.Ms Seeley saw the patient four weeks later and although not cured he was able to return to work.“It was astounding to see the change in him but I would say the majority have a more moderate response,” Ms Seeley said.Spurred by the lived experience of POTS over a decade ago, Ms Seeley's PhD investigates the link between long covid and POTS. Spurred by the lived experience of POTS over a decade ago, Ms Seeley's PhD investigates the link between long covid and the debilitating condition. Her initial findings show that over two thirds of long covid patients have POTS along with its typical symptoms of fatigue and brain fog.Her study is contributing to the burgeoning research indicating that many long covid patients suffer from POTS and that prompt diagnosis and early treatment could reduce the impact of long covid. Hosted on Acast. See acast.com/privacy for more information.

Cervical cancer rates are lower but participation in HVP screening needs a boost. This week on The Tea Room Professor Annabelle Farnsworth spills the tea on how the new national cervical screening program is going, five years on. Professor Farnsworth said that the new program is seeing cancer rates starting to drop but that there are challenges getting more people to participate. “One of the major issues that the whole new programme faces, is recruiting women, and people with cervices, into the programme. General practice has always been a very central part of cervical screening because the general practitioner can individualise conversations with each person,” she said. Professor Farnsworth said that in the old programme, general practices often had reminder systems that they ran themselves to encourage patients to come back for their regular check-ups. “Women's health check-ups were part of that landscape as well. In the new programme, some of those things may have fallen by the wayside,” she said. Professor Farnsworth also said varying rates of cervical cancer amongst different populations was a “big problem”. She said that First Nations people are dying from cervical cancer at higher rates than other Australians, as are people in rural areas who don't have equal access to further investigation and treatment services. This episode also looks at eligibility and MBS exceptions, self-test advantages and the overwhelming number of coloscopy referrals. Professor Farnsworth also nudges GPs to check out the online participant portal that GPs and practice managers can access to check their patient's status. Hosted on Acast. See acast.com/privacy for more information.

Sometimes the only decision is in what way will a patient stop living.In this second part of The Tea Room's special on voluntary assisted dying (VAD) we cover conscientious objection, patient choice and the personal impact of administering pharmacy that ends a life.Our first guest is Dr David Ward, a general practitioner obstetrician from Albany in regional Western Australia. As a doctor he is also involved in VAD and has the privilege of being close to the full circle of life – birth and death – through his work.He said that although VAD may appear to be quite negative and depressing, in his experience it's not often like that.“I don't think there's any getting away from what it means ultimately. However, there's certainly no doubt that you're with people at the other end of a very long journey. At people's houses, with their families and pets and in a situation which can be which can be quite nice and more positive than what you might initially think,” Dr Ward says.Our second guest is Dr Cameron McLaren, medical oncologist at Monash Health and director of Voluntary Assisted Dying Australian New Zealand. He's been involved in over 250 VAD cases.Dr McLaren said that there is an obvious demand for the service and not enough doctors accredited to provide it sustainably or equitably.“It would be nice to share this workload with other people” Dr McLaren says.However, he's also clear that no one should have to change their mind on about VAD.“I think whatever perspective you have is completely valid and should be protected and supported. Not all of us want to be neurosurgeons. Not all of us want to do colonoscopies. And we're free to choose the areas that we practice in accordingly,” he says.The stories each doctor shares are deeply personal, reflective and thought provoking. You might need more than one cup of tea for this episode. Hosted on Acast. See acast.com/privacy for more information.

By the end of this month, voluntary assisted dying will be a lawful choice for eligible patients across Australia. However, for many GPs, this end-of-life option is surrounded with complexity and conundrums. In a two-part series The Tea Room explores the legislation, support network and personal experience of doctors engaged in voluntary assisted dying (VAD). This episode we have a cuppa with Casey Haining, research fellow in the Australian Centre for Health Law Research, at Queensland University of Technology. She shares the recent changes in legislation. Ms Haining says that a “particularly prominent legal concern” for many doctors is breaching the Commonwealth Criminal Code by talking about voluntary assisted dying through a carriage service. “Because of this Commonwealth law there is a bit of hesitation around talking or conducting aspects of the voluntary dying process via telehealth. It is a grey area in terms of the interpretation and different states have interpreted it quite differently,” she says. Ms Haining encourages GPs to access the Centre for Health Law Research website that provides jurisdiction specific information and provides an overview on other aspects of end-of-life law. Medicare also needs to adapt to the new legislation, Ms Haining said. The MBS currently only provides patient rebates for consultations for VAD eligibility. There is no rebate for the actual administration. “VAD is not a quick process and it takes a lot of time for practitioners. Because this is going to be a lawful choice across juridictions the MBS needs to ensure that people who are dedicating themselves and electing to provide this lawful service are compensated adequately,” she said. Hosted on Acast. See acast.com/privacy for more information.

A land of fable and fairytale and a primary care system where general practice is ‘the best job in the world'. If you've ever dreamed of moving to Scandinavia today's Tea Room might push you over the edge. Danish GPs earn more, are very highly regarded and get 10 paid days a year to research and boost the quality of the nation's healthcare. What's more, healthcare data is transferred seamlessly between all levels of care regardless of which patient management system a doctor uses. Our two guests today discuss Denmark's extraordinary healthcare model and what underpins its success. Professor Jens Søndergaard is a GP, clinical pharmacologist and, among other research affiliations, leads the General Practice Research Unit at the University of Southern Denmark. He says that a part of a successful healthcare model is financial remuneration. “GPs get a far better salary than hospital specialists. If you want an efficient healthcare system, you need very good doctors who see it as a very interesting career and also financially rewarding,” Professor Søndergaard says. Our second guest, Professor Janus Laust Thomsen, is also a Danish GP and is clinical professor and leader of Center for General Practice at Aalborg University. He says a key part of Denmark's success is the equivalent of a single patient identifier number. This enables “cradle to grave” management of patients who are listed with a GP as soon as they are born. Single patient identifier numbers also enable advantageous funding contracts. Professor Thomsen says that every general practitioner in Denmark has a funding contract with the government which is negotiated by a central organisation for GPs. “We have around 30% reimbursement on listed patients and 70% reimbursement on activities. This structure for reimbursement is negotiated each four years. We also have a very mature digital health system that, combined with our negotiations, gives room for very fast healthcare implementation,” Professor Thomsen says. It all sounds very hygge and you will be forgiven for looking up flights to Copenhagen after listening today. Hosted on Acast. See acast.com/privacy for more information.

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If you're a researcher who cringes at social media or public speaking this episode is just for you.This week's The Tea Room is a special episode for anyone engaged in medical research.We discover straightforward strategies for enhancing your profile and how to boost your odds at getting grants.Our guest, Kylie Ahern, knows a lot about science communications. In 2004 she started Cosmos magazine; Australia's award-winning science magazine. Now Ms Ahern consults to researchers and institutions about the secret behind getting grants and how to engage an audience authentically.“Ultimately science needs to be funded so you need to engage people and not just assume that they know about what you are doing and why,” she says.Kylie provides a solid place to start creating a science communication strategy for your research.“List the five top questions that people always ask about your research? How do you answer them? And then start creating content about that start putting it out there,” she said.Ms Ahern acknowledges that time is a challenge for most medical researchers but that fear also gets in the way of creating a strategy.“Think of the thing you fear the most, maybe it's talking or media, and lean into it. That the thing I tended to not do when I was younger,” she said. Hosted on Acast. See acast.com/privacy for more information.

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GPs treating patients with rheumatological disease have a lot to manage but there's new fact sheets and pathways to help. Hosted on Acast. See acast.com/privacy for more information.

Australia is advancing a national Cancer Plan and Mariella Attard, editor of Oncology Republic's editor, tells us how GPs will be affected. Marielle says a key driver of the Australian Cancer Plan is equity.“Cancer stats have been really good for Australians across the board. It's reduced by 16% except for Aboriginal and Torres Strait Islander people where it's actually gone up by 26%. So, the gap keeps growing,” Mariella says.Mariella also distills the latest oncology research including a link between uterine cancer and some treatments in hair salons. The research, published in the National Cancer Institute, included 34,000 women in the study.“Some people from different cultural backgrounds use hair straightening more often than others. And although it's a US study, it's still applicable globally,” Mariella says.Lung cancer has joined the spotlight too, says Mariella who flags a possible targeted screening program for smokers and ex-smokers between 50 and 70 years old. The Medical Services Advisory Committee has given a thumbs up to the program which is now before the government for consideration.Mariella also spills the tea about what happened after Hollywood star Ryan Reynolds live streamed his colonoscopy. Fortunately a podcast is sound only but tune in for the bottom line. Hosted on Acast. See acast.com/privacy for more information.

If the stress doesn't kill you it might cause long covid.  Given the stress many GPs are currently experiencing, this episode might make you want to don your mask again. Associate Professor Anthony Byrne heads up St Vincent's long covid clinic in Sydney. He spills the tea on what the clinic is up to and what they've learned this year, including the risk factor of stress. “The amount of anxiety and stress a person is under at the time of their initial infection is just as important if not more important that other risk factors such as having diabetes or having severe illness,” he said, adding that healthy lifestyle habits like going for a run could be a protective factor. Although it might not be sweet news, according to Professor Byrne many long covid patients also have doctors who are not hearing what they say. “Unfortunately, that is what I've heard from my patients. Some health professionals are not listening to them about some symptoms, such as fatigue. Fatigue is a real thing but it's hard to measure. So, doctors do need to have a default setting of believing patients when they're saying that they're fatigued,” he said. The good news is that long covid patients does eventually resolve for most patients. It's just a long road of debilitation until it does. “The word that's been used by many patients is “glacial”. It's just a glacial improvement and it's also up and down. There can be good days and bad days. But the overall trajectory for most people is improvement,” Professor Byrne says. We chat about the current parliamentary inquiry into long covid, the lack of mention in the recent federal budget and how St Vincent's long covid clinic is exploring hyperbaric treatment. Hosted on Acast. See acast.com/privacy for more information.

There are much better ways to run a clinic and health economist Tracey Johnson has crunched the numbers for you.It can be hard graft running a business but there are smarter ways to ramp up financial and professional rewards. Tracey Johnson in CEO at Inala Primary Care. She's spent years as a health economist, policy advisor and helping health-tech start-ups scale up big. Today on The Tea Room Tracey spills the tea on the simple economics of right-sizing GP clinics. “There's a sweet point if you've got four to five GPS, you know, there's a business model that can be formed around that. The next sort of tipping point seems to sit at around nine to 12 doctors, and then again up around 20 doctors,” Tracey says. Subleasing to pathology and other allied health is critical to being viable as is hot desking consult rooms across longer opening hours. Tracey Johnson says that if you're running a practice with nine doctors, and you've got the capacity to move up to 12 doctors, the way you might do that is by opening from seven o'clock in the morning until seven o'clock at night with doctors working different shifts depending on their lifestyle needs. “And by reducing the cognitive burden that happens from working too many hours on those really long days, practices are actually finding doctors enjoy their work more, you get more utilisation around those rooms and generally things come together better for the patients as well,” Tracey says. Tracey is also smashing down the traditional barriers between the Local Health District and Public Health Network in her region. And she has a strong motivation to do so working in Queensland's largest housing commission suburb. “We have the highest rate of disability pensioners in the state in this suburb. We have five jails just down the road. I've spent the last decade looking at what I can bring out of hospitals and give into patient hands and into the hands of primary care providers to actually make life better for everyone,” she says. P.s If $8 billion of fraud was floating around in your GP bank account we know this episode wouldn't be listened to. As it is, we know it will be very popular. Hosted on Acast. See acast.com/privacy for more information.

GP practice owners are business people as well as clinicians – this budget week, we hear about some of the issues that concern them most. GP practice owners are a bit like ducks, says Dr Jared Dart, a director of the Australian General Practice Alliance (AGPA), a GP practice owner and the co-founder of Welio, a telehealth platform designed to enhance practice viability. “They look like they're floating, but under the surface they're paddling fiercely,” he says in this week's episode of The Tea Room. “And the biggest problem is practice principals have nowhere to go. A GP can retrain or go on sick leave, but principals only have one option: to sell, and unfortunately, many are doing just that.” AGPA, formed in 2016, aims to represent the interests of GP practice owners like these. This week, Treasurer Jim Chalmers had inflation firmly in his sights when framing the first Labor Budget since 2013. Inflation is now one of the toughest challenges facing owners. “Medical inflation over the past two years has been particularly high,” says Dr Dart. “Our costs are at least 10% higher in our practice, and that's across the board – from electricity, wages and consumables to cleaning and rent. “Add into the mix things like payroll tax, which could bankrupt a practice principal, and you can understand why the stress is significant.” But it's not all darkness. Dr Dart firmly believes in the GP-owned business model, which puts purpose before profit, and says he stands on the shoulders of those who owned his practice before him. “They delivered the babies, they did the house calls, they took out the appendices, and the goodwill that builds over time is incredible,” he says. However, he also believes practice owners don't have adequate representation on the Strengthening Medicare Taskforce, which could compromise the panel's success. “They are missing out on the opportunity to take the perspective of people who run and implement general practice every day,” he says, “and the challenge I see is that the taskforce may not actually want to hear the truth.” Hosted on Acast. See acast.com/privacy for more information.

It's a massive week for health politics and The Tea Room is heading into the fray talking with Dr Chris Irwin who sat on a conference panel with Dr Margaret Faux and Dr Karen Price on Tuesday. Dr Irwin shares what was going on for him while he was on the stage at Wild Health Summit, as ideas for Medicare funding reform were volleyed about. He speaks candidly about the Medicare rorting story, by ABC and Nine, saying it was “a hit job” at an opportunistic time a week before the budget is handed down. His concern is for the story's impact on fellow GPs. “The immense harm that's been done to the mental health of general practice cannot be overstated,” he says. Dr Irwin says GPs need to organise and get on the front foot politically rather than waiting for crises and reacting. We've also distilled the other key political stories in a Tea Room chat with political reporter Francis Wilkins. Francis gives a round-up of the RACGP crisis summit saying that there was nothing really new in the discussions. On the flip side he said that the many GPs reported feeling more supported seeing that their concerns were not in isolation. Francis also shares some insight on the AMA pushback on nurse practitioners pulling their weight, saying he's “mystified” about why Professor Steve Robson, the new AMA president, chose to run with the review of GP collaboration so early in his term. We dive into the current state of flood funding for GPs and also ponder the chances of a royal commission into AHPRA. So grab a cuppa, take a well earned break and join us in The Tea Room. It's been a big week. Hosted on Acast. See acast.com/privacy for more information.

GP opens a long covid clinic at his family medical centre to meet the “crying need” for treatment.An early career GP, Dr James Zhang, saw the huge demand for long covid clinics so he decided to start one himself. As our guest on The Tea Room this week Dr Zhang explains how the clinic operates; from the assessment and management guidelines* he uses, right through to billing and referral partnerships. *Resources Dr Zhang mentions in this episode: Assessment tool: COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) Agency for Clinical Innovation guidelines: Clinical practice guide for assessment and management of adults with post-acute sequelae of COVID-19 St. Vincent's long covid clinic investigation requirements. Select the dropdown option ‘Long Covid Outpatients Clinic'. Hosted on Acast. See acast.com/privacy for more information.

Interoperability – or data sharing – is the lynchpin for all meaningful health reform in Australia. Why is this so? Michelle O'Brien explains all. She's one of Australia's most respected voices in digital health and joins us this week for a cuppa in The Tea Room. [[Acast embed code]] Michelle says that early disease detection, virtual care at home, better management of chronic disease and preventative health are all only possible with interoperability. MBS reform and outcome based renumeration also hinge precariously on this aspect of digital health systems. As a former business executive at Medical Director and MediRecords Michelle is leading the charge for interoperability at next month's Wild Health Summit in Melbourne. “My biggest fan club is gerontologists because they ‘get it'. They see how data can be used to detect early onset of ageing diseases and intervene. Getting a diagnosis earlier can change the progression of someone's life,” Michelle says. Can interoperability change the progression of healthcare in Australia? Michelle O'Brien is pretty convincing in explaining how it can. The Wild Health Summit is being held at Collins Square Event Centre on 16 October 2022. The theme: No greater time to align our digital health strategy with our health reform agenda. Hosted on Acast. See acast.com/privacy for more information.

Modern day slavery has many guises. Forced marriage, debt bondage in a suburban family restaurant, domestic and sexual slavery are but a few. According to Professor Jennifer Byrne, this week's guest, we're kidding ourselves if we think this is not happening in Australia. “It was estimated there were 15,000 people living in slavery in Australia in 2016. And the Australian Institute of Criminology, estimates that for every single person identified, there are four who are under undetected,” she says. Professor Byrne was the Interim Anti-Slavery Commissioner for NSW from 2018 to 2020 and is the director of Anti-Slavery Australia at University of Technology Sydney. She says doctors are well placed to identify slavery risks because they are used to assessing complex situations. She shares a story about how a GP helped prevent a forced marriage when a young woman was brought to a clinic with a family member who wanted to supervise the consultation. “The doctor had a very fine antenna and thought that there might be something that the young person wanted to disclose. The doctor found a way to interview the young woman by themselves and the young person said that she was terrified that she was going to be taken overseas for marriage. She had overheard conversations on the phone. She knew that documents had been prepared,” Professor Byrne said. Doctors now have a guide for patients who are at risk of forced marriage and other types of slavery. “The frontline workers guide is terrific because it's got a list of indicators, a list of the effects of forced marriage, referral information and it's readily accessible,” Professor Byrne says. Hosted on Acast. See acast.com/privacy for more information.

As if post-covid syndrome weren't confusing enough, its prediction data is all over the shop.Risk predictions for long covid have been as nebulous as the disease itself, leaving GPs in a predicament when counselling patients over boosters. In this long covid special we hear from Nature journalist Heidi Ledford, who unravels the tangle of long covid research and finds the common threads of risk prediction. Ledford's investigation into long covid statistics explores how well vaccination protects against the condition and why discordant studies create confusion. “Different studies suggest long covid risk is somewhere between 5% and 50%. If I'm an individual trying to make a decision, it's hard to calculate the personal risk-benefit,” she says. One of the problems with discordant results is the broad definition of long covid. Ledford also lists other challenges including how to define a control group, and the reality that national medical records do not fully represent underserved communities. Ultimately, it's still hard to predict how many people will get long covid. In June this year over 30,000 new cases of covid were detected each day in Australia. The likely impact of long covid is growing, but by how much? Hosted on Acast. See acast.com/privacy for more information.

For Adjunct Professor Karen Price, the changes wreaked by covid on her watch as RACGP president have been complex.“We encountered the effects of ideology and some pernicious politics in health, but we also found the heart of humanity,” she says. “We found it beautiful, we found it tragic, we found it flawed, fearsome and dangerous. How general practice changed probably reflects the whole world.”But the crisis in general practice has been years in the making. And while Professor Price has called vehemently for GPs to ditch bulk billing, the business model that meets both Australian patients' and practitioners' needs remains elusive.She's clear on the ground rules though.“The best model is the one that allows you to practise high-quality healthcare in a professional way to the most vulnerable people in your practice,” she says.“We've got to remember that Medicare is the patient's funding, and if the government is not funding the most vulnerable then that's a government issue, it's not a medical practice issue.”In this episode of The Tea Room, Professor Price also sounds off on professional lobbying, social media, capitation and the PSR.“If we think we can replace general practice, we're on a fool's errand because there is no other profession that does differential diagnosis and management and care coordination like general practice does,” she says. “It takes 12 years just to begin to understand what that means, and it probably takes another 20 years to master it.” Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.

Australia's first women's only, trauma-informed mental health facility has opened in a regional town south of Sydney.In The Tea Room this week Dr Karen Williams, medical director of the Ramsey Clinic Thirroul, talks about the why the hospital is needed.Women who have PTSD are too often diagnosed with multiple personality disorder, Dr Williams says. It's very different to diagnoses and treatments available to the defence force patients Dr Williams has previously worked with.“We don't tell a solider returning from deployment “You have a mental illness”, we diagnose PTSD and provide a variety of individualised treatment including yoga and therapy dogs. But for the one in five women in Australia who have experienced domestic violence there's almost nothing,” Dr Williams says.Mental health wards often have no locks on the doors and are shared with men who might be acutely intoxicated or acutely psychotic and where people are often screaming, Dr Williams says, adding that women are unlikely to get better in those spaces.Dr Williams provides clinical advice such as guiding GPs to look for sleep issues and chronic headaches that are unresponsive to treatment. She also cautions against sedating women with PTSD during the day.Becc Spradau, diversity and inclusion specialist, also joins us in The Tea Room this episode. In a candid interview she shares her experience with PTSD caused by sexual assault as a child. Becc has a message for the GP who finally diagnosed the PTSD.“I am just so very grateful that you took the time and you listened. You were able to really see what was going on and point me in the direction of some light,” she says. Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.

When you're desperate to recruit, your criteria can come down to “a pulse and a medical degree”, says our guest in the Tea Room today, Dr Todd Cameron.Yes, there are many analogies between recruitment and dating, and in this episode we mention most of them.Dr Cameron, of Scale My Clinic, knows the recruitment game well. He has grown medical clinics from start-up to public listing but says the current talent drought is a massive issue for clinic owners.“It's really the perfect storm. No doctors moving from overseas, less doctors moving within Australia and a really low number of graduates from medical school wanting to do general practice. I don't think many people would have seen it worse than what it is right now,” he says.Fortunately, Dr Cameron also knows how to cut through these challenges. In this episode he explains how to create a recruitment process that attracts the GPs who are a great fit for your clinic, and repels those who are not.Dr Cameron also has a suggestion for rural clinics who feel the talent drought more acutely.“You could target city doctors who have a light aircraft because they want a way of making their light aircraft tax deductible. You've just got to think laterally about who to target,” he says.

Dr Chris Ogonowski, the seventh and final candidate for RACGP president to join us in The Tea Room, brings an interesting CV to the table.He's been a doctor for 11 years, six of those in general practice, but he's also worked in law and briefly in investment banking.The Sydney-based GP is calling for more effective lobbying of government, closer engagement with the media to give GPs greater prominence, and more feedback from college members on what they want from the RACGP.But he's also concerned about the way GPs are treated.“My kind of ethos is that we are being treated as third-rate health professionals or backseat players behind specialists and, ever increasingly, behind allied health professionals.“During the pandemic, things like the vaccine rollout showed that we were put behind allied health professionals and other doctors who were not seeing patients. That's what really got my goat, if I'm honest, and that's what made me look a little deeper into running for president.”Dr Ogonowski wants to see a closer relationship between the college leadership and its members.“Trying to develop policy without proper member engagement is difficult,” he says. “I think the college tries to do this, but it's not being done as well as it could. Member apathy is probably at an all-time low – one out of 10 members voted at the last election.“If I was to be elected president, I can guarantee you'd be hearing a lot more from me than what's been heard in the last couple of years,” he says. “That's not a criticism of Dr Price; I've got tremendous respect for her. But I do think the RACGP has effectively disappeared from public view, so I'd like to get us back into the public eye and to explain these issues to the public.”

When Dr Julian Fidge speaks about pharmacist prescribing, he does so from a position of authority – for more than 10 years, he worked as a community pharmacist.“Pharmacists have a very sound set of skills, but they're just not trained to be doing things like diagnosing and treating UTIs,” he says. “It's well outside their scope of practice, their training and their education.”He also believes his research into syringe supply by community pharmacies has helped reshape pharmacy practice through the provision of clean injecting equipment.Dr Fidge is a GP and practice principal in Wangaratta, northeastern Victoria, with many years of Army Medical and NGO volunteer experience under his belt, including in several African countries.Among other things, he mentors and trains IMGs for RACGP fellowship, but is concerned about they way they're currently treated.“It is incumbent on the RACGP to support those members,” he says. “I've been horrified by some of the developments that really diminish the contribution IMGs make to healthcare in Australia.”And when it comes to healthcare, politicians of every stripe are largely the same, Dr Fidge says.“One of the first decisions the new Albanese government made was to declare some of the inner metro areas as areas of need and that will just pull doctors out of rural and remote Australia, negatively affecting rural and remote healthcare.“But I think this government is no better or worse than the last government,” he adds.If elected RACGP president, he would develop the college as a source of independent expert policy advice as well as help government projects that are doomed to failure.

Associate Professor Charlotte Hespe believes that to understand the mess general practice is in currently, it's helpful to look backwards.The Sydney-based GP is also chair of the RACGP NSW / ACT faculty, and head of general practice and primary care research at the University of Notre Dame.“Medicare is actually a system that's designed to be a ‘sick care' system, and that's probably one of the problems we're facing at the moment,” she says. “It was an amazing transformation of healthcare service when it was designed back in the 1970s.“But the problem it was designed to solve was actually about access for sick care – and that's the system that we got. And as Einstein would say, we cannot solve the problems that we're facing with the same thinking that we used when we created them.“So, unless we actually redesign our system to become a health care system, then it's doomed to fail.”The RACGP needs a strong leader at the helm if the college is to navigate its way out of the crisis – especially when the college is dealing with government, Professor Hespe says.“I don't think we've managed that relationship terribly well,” she says. “We've had a tendency to be a little bit subservient, and I think we've accepted advice to not cause too much disruption and not to be too noisy, when I actually think now is not the time to be subservient.“Thankfully, [Health Minister] Mark Butler appears to realise there is a problem, but we need to be fleas in his doggy coat so he can't forget about us.”So how does she intend to marshal her army of fleas?“My vision for the RACGP is absolutely about the college being respected by all of us – as being our professional home, the place that listens and helps us get the right things done. With 43,000 people, you're not always going to meet everybody's needs, but we need to understand the things that we can do and how we prioritise them and the most important at the moment is sustainability.”

Dr Kate Wylie makes no bones about the issue at the heart of her campaign for the RACGP top job.“Climate change is the greatest health problem of our time,” she says. “As health practitioners, climate change is our challenge and we need to acknowledge it, face it and prepare. Every problem we have is being exacerbated by it and to not address the climate health emergency would be a failure of our duty of care.”The question, of course, is how to go about it.“A college I lead would work in partnership with the other medical colleges to create a climate-ready and climate-friendly Australian healthcare system,” she says. “General practice has a lower carbon footprint than the hospital system, so supporting us is a win for our patients, a win for the economy and a win for our country's carbon budget.”Dr Wylie – who is particularly interested in mental health, women's health and transgender medicine – says that for her, being a GP is a matter of pride.“I find the ‘just a GP' narrative to be incredibly insulting,” she says. “We have a depth and breadth of knowledge that no other profession can lay claim to – and I think we should stand up for ourselves with that.“My vision sees general practice acknowledged as the foundation of our healthcare system and receiving the governmental support that we need to protect the health of Australians.“As president, I would advocate with strength and integrity, knowing that we save our government money and that a well funded and well resourced general practice workforce keeps people well and out of hospital.”

Dr Nicole Higgins' commitment to GPs' wellbeing stems from how she runs her own practice in Mackay, Queensland, as well as from her experience as chair of GPSA.“One of the things I was able to do at GPSA was build the organisation and secure its future – and I want to do the same for RACGP on behalf of its members,” says the country Victorian-born practitioner, who showed up in Queensland 20 years ago.Her own practice provides a ‘slow medicine' service.“We base our practice culture around quality, making sure we look after both the GPs and the patients,” she says. “Our standard appointment is 20 minutes and that enables us to practise the medicine that that we choose to practise.“Eight of our 10 GPs are women, and we recognise that women and our patient cohort, who are quite complex, require different care.“We are a mixed billing practice and I've shown that it's financially viable to run one, but it requires a different philosophy. It's not a churn and burn practice.”But being RACGP president also requires canny negotiation skills.“The trick with dealing with government is knowing when to work quietly and negotiate in the background, and when to push back loudly, and I've shown the capacity to do both,” she says. “I'm not afraid to speak out when we need to.”She also believes there's an important role for IMGs in the depleted GP workforce and that it's important to promote diversity within the RACGP.“I think we need to have our policy informed by the doctors who are the members,” she says. “One of the things I would like to have is an advisory council of culturally and linguistically diverse clinicians to actually inform RACGP about what's important.”

In this episode of our Tea Room long covid series we summarise the latest long covid research presented at last week's Australasian covid-19 conference.Professor Anthony Kelleher, director of the Kirby Institute, is seeking the cause of long covid.What his team has found is persistent immune system dysregulation.“There is ongoing activation of the immune system, in a range of compartments,” he tells The Tea Room. “The immune system is still producing the cytokines that it normally produces early in infection against the virus, that would normally turn off within a couple of days to a couple of weeks.”Associate Professor Kari Lancaster, from the University of NSW, says “long covid” is possibly the first patient-made term in medicine, and explains how learning from patient experiences is central to effective treatment.“The effects of long covid are likely to have uneven effects across different groups of disadvantage,” she says. “So, talking about what other kinds of community support and social support and social care might be available, alongside clinical care, is really important.”

Does your medical career have to suffer to ensure you have a healthy baby?This week in The Tea Room we hear new insights on the old dilemma that female physicians face. Professor Nancy Baxter of the Melbourne School of Population and Global Health has been researching the topic. Her findings have both good and bad news for women GPs who are considering pregnancy.Professor Baxter says that a female physician is more likely to have problems during pregnancy and delivery but their baby's risk of mortality and morbidity was lower compared to non-physicians of a similar income.The reason for increased risk? Women putting off a family till they are older.“The reason that female physicians had worse pregnancy and delivery outcomes was because they were older. It didn't appear that the occupation itself was the driving force. It was the fact that that occupation resulted in women having children at a later age. And it's kind of ridiculous that we create these professions where it becomes really challenging to do what is normal and natural for the vast majority of people – that's to have a family,” Professor Baxter says.This episode then also looks at whether freezing eggs is all it's cracked up to be and explores the option of pausing medical school to have a baby.“Pregnancy seems to be a no-go-zone during medical school. That's something that that we need to reassess and create pathways for so that it is possible to be pregnant and have children during studies,” Professor Baxter says.

“If we resource First Nations Health well, if we do this really well,” Dr Brad Murphy told The Tea Room, “‘closing the gap' means we actually drive the health care of a whole nation.”It's a bold vision, and it's what he would have his eyes set on if elected next president of the RACGP.Dr Murphy's professional and personal journey has taken him from medic in the navy to starting his own practice to becoming first chair of the RACGP's National Standing Committee on Aboriginal Health.“We need to make sure we're growing our future generation of GPs,” he says. “We need to make this an exciting opportunity for them to consider, we need to sell it to them when they're in med school.“And we've got to do something to reignite the passion in our belly to make sure that our communities continue to get the very best care.”So, what would he do to achieve it – and how does it stem from his own personal journey?

Dr Chris Irwin, a skin cancer specialist and president of the Australian Society of General Practice, describes himself as “a coalface GP”.“I'm someone who wants nothing more than to sit in his consult room, spend time with his patients and just do good for them,” he tells The Tea Room.But he has also set his sights on becoming the next president of the RACGP.General practice has reached crisis point, and Dr Irwin believes something positive needs to happen to avoid a slow, inevitable decline, with disastrous consequences both for patients and the profession.Strong leadership of the college could be a part of that positive change.“My vision is for a positive college that is willing to embrace change, a college that realises there's an existential threat to the future of general practice, and a college that stands up for GPs,” he said.When it comes to dealing with government, he says both carrots and sticks are needed.“The carrots need to be optimising budget issues for government, because that's their primary concern,” he said, “and the sticks need to be that politicians understand negative press will hurt them when they pursue policies that harm patients and GPs.”So, what does Dr Irwin bring to the table, and why is building bridges so important for a leader?

‘Once a nurse, always a nurse' is the attitude that Labor's Ged Kearney is bringing to her role as Assistant Minister for Health and Aged Care.This week, Ms Kearney joined The Tea Room to chat nursing, aged care, worker advocacy and refugee healthcare.The area that she's most keen to sink her teeth into, though, is how healthcare is delivered differently between the sexes – the effects of which, Ms Kearney says, are “write large before our very noses”.“Starting at the top, [I am] getting everybody that I know who cares about this – and there's a lot of people out there that do care about this – to sit around a table and design perhaps an inquiry or a deep dive into [women's health outcomes],” she says.Before entering politics in 2018, Ms Kearney worked as a nurse on a gastrointestinal ward and was federal secretary of the Australian Nursing Federation and in 2010 was elected president of the Australian Council of Trade Unions.Experience in both healthcare and union work have influenced her priorities for the role going forward.“I'm interested in healthcare for [culturally and linguistically diverse] groups, for our migrant communities, for our LGBTIQ communities for people who, for various reasons, have really serious barriers in accessing the healthcare system, particularly the primary health care system,” Ms Kearney says.

What could you do differently to grow your clinic's financial viability?It's a question The Tea Room asks this week. We chat with two former clinic owners who have found how to do business better and with more satisfaction and greater income.Dr Todd Cameron owned medical practices that became listed on the ASX. He says there are many ways to maximize revenue and lower manage fixed and variable costs but good business nous is essential.“Sometimes running a medical business can feel like you're running a wedding. You get a special surcharge on top of everything that you've paid for,” Dr Cameron says.Dr Sachin Patel co-founded the business consultancy Scale My Clinic with Dr Cameron. As a child, his parents owned a small business and he learned very early exactly how much effort it takes to run a business.“There's always this competition between needing to serve those you love and those that buy from you so that you can put dinner on the table. I've seen people struggle to get the rewards that their time and sacrifices deserve,” Dr Patel says.According to our guests this week the foundation to better profits is clinical excellence. They then they outline five big ticket items to improve profit including outsourcing, optimizing who does what and deep analysis on why and how much bulk billing really gets done.

Keeping your finger on the pulse of politics is annoyingly hard so we've distilled the latest stories in a quick Tea Room chat with political reporter Francis Wilkins.Francis gives a round-up of where the new federal government is at and says that the honeymoon period won't last. He also summarises the joint proposal made by the NSW and Victorian governments for better cooperation between GPs and hospitals. Does the proposal hold water when the GP tap is turned on federally but the hospital cup is held by states?The government committee on national laws is also explored in this episode and digital health gets a mention with interoperability heralded as the doorway to outcome funded models rather than fee-for-service.Will healthcare have reform or revolution? Or will the grand opportunity for change be missed?

An important factor has been missing in the assessment of pain, according to our guest this week on The Tea Room.Dr Manasi Murthy Mittinty practices at the Pain Management Research Institute at the Royal North Shore Hospital. In this episode she shares what she's recently learned about pain.“More and more research shows us that we need to take a biopsychosocial approach to managing pain,” she says. “It is very much a person-centered approach. ‘One size fits all' doesn't work for pain.”Dr Mittinty's pain research has taken her around the world including studies with patients from India, First Nations people from Appalachia in the United States and with Aboriginal and Torres Strait Islander people from South Australia.She says culture and spirituality are missing aspects in the conventional assessment and treatment of pain.Dr Mittinty has some helpful tips for GPs, including a new understanding of conventional pain assessment scales.“Most of the pain measurement we use clinically and research has never been adapted for Indigenous communities. The questions we pose to the patient do not always relate to, or reflect, their lived experiences,” she says.Dr Mittinty's learnings from the research were personal as well as professional. She says she was honoured to hear the stories from Indigenous elders and acquired insight into the multiple daily challenges being dealt with alongside proactive pain management.“I saw immense resilience in patients figuring out ways to help themselves deal with their pain,” she says. “Rather than focusing on the pain the patients would just keep moving on and doing the next thing that was required in their life. It was very inspiring for me."

Is the pandemic really behind us or have politics and mainstream media simply moved on to newer news?Despite the drop in popularity of covid stories, our guest in The Tea Room today makes it abundantly clear that it's not time to pop the champagne just yet.Bianca Nogrady is president of the Science Journalists Association of Australia and has faithfully provided The Medical Republic's covid coverage almost since the pandemic started. She's had her eye on the statistics for two years and the current trends alarm her.“We have become far too complacent with deaths from covid. And it's really bizarre that we used to get the daily press conferences when the deaths were numbered in the 10s to 20s and that was shocking, whereas now we can have 80 people die in a day and there's barely a whisper,” Nogrady says.Tune in to this episode for a summary of the latest covid conversations from someone who's had a bird's eye view of covid science and public discourse over the past two years. You may want to mask up.

Dr David Dembo says that data is full of signals that can help transform healthcare.That data might be a fluctuating heart rate, or the fact a teenager is listening to Barry Manilow – it all has a story to tell, we just need to listen.A former GP, Dr Dembo now heads up Health Catalyst Australia and New Zealand. In this episode of The Tea Room he speaks about how to use patient engagement tools, such as automated communication and remote monitoring, in a non-invasive way to augment care and maintain visibility before, during and after treatment periods.“Modern medicine is far too complex for humans unaided by technology to practise safely. That means you need data-informed decision-making at the point of care delivery. And the data is there, it just needs to be aggregated, read, cleansed and repurposed in a meaningful way,” Dr Dembo said.He says that clinicians and healthcare managers have tools at their disposal to optimise patient experiences, no matter who or where the patients are.

Drugs, diagnostics, liver compresses in a Swiss alpine spa ... Three international experts talk about treating post-acute sequelae of covid-19 (PASC).Long covid treatment is as complicated as the condition.From experimental drug trials to NHS-approved pathways, three experts from the US, UK and Australia share their treatment approaches.One thing all guests agree on is that long covid needs more research. Beyond that, views diverge widely.Is exercise counterproductive? How should inflammation be treated? When should you refer to a long covid clinic? Why is a nationally agreed pathway imperative?We asked Associate Professor Anthony Byrne from at the long covid clinic at St Vincent's hospital in Australia; Dr Bruce Patterson, former Stanford University professor and cofounder of private clinic IncellDx in the US; and Dr Melissa Heightman, clinical lead for the long covid clinic at the University College London Hospital.