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Pomegranate Health is an award-winning podcast about the culture of medicine, from the Royal Australasian College of Physicians. We ask how doctors make difficult clinical and ethical decisions, how doctor-patient communication can be improved, and how healthcare delivery can be made more equitable.
This is also the home of [IMJ On-Air], a podcast to accompany the RACP's Internal Medicine Journal. Interviews with authors are conducted by specialist section editors. Find out more at the website www.racp.edu.au/podcast and get in touch via the address podcast@racp.edu.au
128 Episodes
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There is evidence that six months or more off the job leads to some loss of practical skills and knowledge and certainly, many doctors a loss of self-confidence. People take time out from medical practice for many different reasons but career breaks to raise children are more common than ever before. Paediatrics is one specialty where female representation exceeds 70 percent and it is also becoming more common for new fathers to take leave as primary carers. Senior staff at Sydney Children’s ...
![[Case Report] 74yo with dyspnoea after AF ablation](https://storage.buzzsprout.com/os4x17h65ezq3sne0vozk5ohk4rt?.jpg "[Case Report] 74yo with dyspnoea after AF ablation")
In this episode we hear about an emergency presentation to a South Australian hospital, of a 74-year-old male with shortness of breath. The curve ball is that he had undergone ablation for drug-refractory atrial fibrillation less than two weeks prior. This discussion gives an overview of developing technologies for AF treatment and developing knowledge about the possible complications. We also have some multiple choice questions to test your understanding. Guest Dr Shaun Evans, FRACP (Royal...
In Aotearoa-New Zealand, the proportion of doctors identifying as Māori has doubled from where it was a decade ago to over 5 percent. But there is still a long way to go before the workforce is representative of the broader population which is 17 percent Māori. The Auckland and Otago Medical Schools have in recent years turbocharged their intake of Māori and Pasifika students but these graduates don’t seem to have trickled through to the RACP in great numbers. Just 3.5 percent of general phys...
![[Case Report] 52yo with hand clumsiness after Chiari operation](https://storage.buzzsprout.com/qywqfgh9pvc293nr5bfbla96tqd6?.jpg "[Case Report] 52yo with hand clumsiness after Chiari operation")
This case report comes to you from Brigham and Women’s Hospital in Boston, a huge teaching hospital that serves the Harvard Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To complicate things, there was a past medical history of migraines and a family history of a Factor V Lei...
Professor Gary Lee established the first dedicated pleural service in the southern hemisphere in 2009, at the Sir Charles Gairdner Hospital in Perth. He says that pleural disease has finally come to be regarded as an area of subspeciality interest in its own right, not just a complication of other comorbidities. In this podcast he presents a potted history of key developments in the management of pleural effusion in particular. This is diagnosed in about 60,000 people every year in Aust...
![[Case Report] 42yo male with fever following liver transplant](https://storage.buzzsprout.com/44914wiixha942ewjntm12fugg4n?.jpg "[Case Report] 42yo male with fever following liver transplant")
This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from the Massachusetts General Hospital and Brigham and Women’s Hospital take listeners through the ca...
In the previous episode we heard how some rationally-designed therapies work on almost any cancer with the right molecular signature. Tumour-agnostic medications could be godsend for patients with rare cancers which have classically been overlooked by drug developers, and those with advanced cancers of unknown origin. 15,000 such patients have undergone comprehensive genome profiling of their tumours through the organisation, Omico. In this podcast, Omico’s founder explains that while the maj...
The genomic understanding of cancer has transformed a tissue-based classification model that had been dominant for 150 years or more. The last three decades have seen highly targeted therapies developed at blistering pace, and unprecedented improvements in patient outcomes. To date, these advances have been focused on more common cancers. The financing model for drug development means that rare cancers get overlooked, given the small pool of potential buyers relative to the costs and ri...
![[Case Report] 35yo male with proximal weakness and skin changes](https://storage.buzzsprout.com/yupjs6n45905dkjc8n712cukkrlo?.jpg "[Case Report] 35yo male with proximal weakness and skin changes")
This case report describes a 35-year-old Caucasian male presenting with 5 weeks of progressive weakness in the proximal limbs and trunk and associated changes to the skin. The man was previously well and not taking any regular medications. There are many pathways this undifferentiated patient could go down. Consultant physician, Professor Josephine Thomas demonstrates a systematic way to work through the differential diagnoses as would be expected in a long-case presentation for basic physici...
![[Case Report] 47yo with rapidly progressive respiratory failure requiring ECMO](https://storage.buzzsprout.com/gkf6573o9ep6er5dma7wjls6bh8v?.jpg "[Case Report] 47yo with rapidly progressive respiratory failure requiring ECMO")
In 2019 a man was referred to Royal Adelaide Hospital with worsening breathlessness and a productive cough. He was a 47 year old electrician with a history of tobacco smoking who’d been well before the onset of symptoms. Over a couple of admissions the patient’s condition progressed to type 2 respiratory failure. While the ultimate explanation for this presentation was a bit of a unicorn, the dramatic escalation of examinations and interventions runs through some textbook respiratory medicine...
![[Journal Club] Thrombolysis up to 24hr after ischaemic stroke](https://storage.buzzsprout.com/t9x0yuahlzb1elfhhxes5ewxk7ma?.jpg "[Journal Club] Thrombolysis up to 24hr after ischaemic stroke")
Thrombectomy for acute ischaemic stroke has undergone great advances in the last decade, but the expertise and technology is restricted to tertiary hospitals. Outside of large metropolitan centres, thrombolytic treatment can buy a patient time, but for almost 30 years the first line agent has remained unchanged. Alteplase is an analog of the human tissue plasminogen activator which activates plasmin to dissolve fibrin blood clots. For many years it was assumed that alteplase should be a...
![[Case Report] 48yo with diarrhoea and lymphadenopathy](https://storage.buzzsprout.com/0ylo1d36r1o9vtuy45tqk4s0qyqp?.jpg "[Case Report] 48yo with diarrhoea and lymphadenopathy")
This podcast follows the case of a 48-year-old male with a 3-month history of diarrhoea and associated lymphadenopathy. A complex constellation of symptoms accompanies this presenting complaint, along with a key radiological finding that enabled the treating team to arrive at the correct diagnosis. Can you arrive at the correct diagnosis before the treating team? This case was managed at the Queen Elizabeth Hospital and is presented by Dr Andrew Vanlint from the Northern Adelaide Local Health...
![[Guest Lecture] Fighting hepatitis C in prisons and the community](https://storage.buzzsprout.com/1jamytmzsid1bzi63raxd6dbumta?.jpg "[Guest Lecture] Fighting hepatitis C in prisons and the community")
2This recording comes from the launch of the 2nd Monitoring and Evaluation Report on Hepatitis C Elimination in NSW. The work was conducted through the Kirby Institute under the guidance of infectious diseases specialist, Professor Greg Dore. As presented in this seminar, data show that the state is on track to meet the 2025 target set by NSW Health, and the national target for 2030, but there have been surprises along the way that have required an adaptable approach to surveillance and interv...
Dr Karan Singh loves his job as a registrar in nuclear medicine but he thinks there isn’t enough exposure to the specialty during medical school and basic training. In this podcast we spend a day in his department at Prince of Wales Hospital Sydney and get a taste of the many different referrals that come his way; a bone scan for a young man experiencing leg spasms after recovering from a car crash; myocardial perfusion imaging for an elderly gentleman with coronary artery disease; staging fo...
![[IMJ On-Air] Understanding readmissions better](https://storage.buzzsprout.com/qarfw2utytfa286hmqs9qhv64j0t?.jpg "[IMJ On-Air] Understanding readmissions better")
The LACE index is a prognostic algorithm for predicting the likelihood that a newly discharged patient will come back into hospital within 30 days because of complications. Today’s IMJ paper describes a validation of the LACE index in a regional Victorian setting. Identifying patients who are at risk could allow for better targeted care at the first admission, reducing harm to patients and inefficient use of healthcare resources. The researchers also tested a novel classification...
![[Case Report] 58yo with acute myeloid leukaemia and diplopia](https://storage.buzzsprout.com/55mq8xt1ahz7273zxe755413kvxy?.jpg "[Case Report] 58yo with acute myeloid leukaemia and diplopia")
This podcast follows the case of a 58 year old man who presented to the haematology department at Flinders Medical Centre with intravascular coagulation and leukocytosis. He was diagnosed with acute myeloid leukaemia and treated on standard cytarabine and daunorubicin combination therapy. Nine days after initiation, the patient developed painless diplopia and ptosis, and the story is picked up with a referral to the neurology department. Guests Associate Professor Stephen Bacchi (Lyell ...
The RACP Congress in May this year was opened by a fascinating lecture on mental health in the medical workforce, which has been trimmed down for audio. Professor Neil Greenberg is an occupational psychiatrist with more than 23 years in the UK Armed Forces. His extensive research within defence and health settings has informed a very pragmatic understanding of the impact of trauma and relationships in the workplace. Professor Greenberg overturns some entrenched beliefs we have about the prese...
![[CPD On Demand] Advance Your CPD Through Effective Supervision](https://storage.buzzsprout.com/kgsvs61dwyo9f4gsd7qgs6r21tim?.jpg "[CPD On Demand] Advance Your CPD Through Effective Supervision")
From 2024, supervising has been recognised as a Category 2 CPD activity. This short and insightful episode focuses on recent updates to the 2024 MyCPD Framework, highlighting the recognition of supervisory activities as a critical element of Category 2 Reviewing Performance CPD. Please join Professor Martin Veysey, a renowned expert in supervision and medical education, and Associate Professor Kudzai Kanhutu, College Dean, as they delve into the practicalities and strategic benefits of...
![[Case Report] 32yo with abdominal pain two years after pancreas-kidney transplant](https://storage.buzzsprout.com/qu55gstnbjqw0tv9qldl6o5pduv0?.jpg "[Case Report] 32yo with abdominal pain two years after pancreas-kidney transplant")
This case report has been developed by Trainees, to assist their peers with preparation of long-case presentations. It is not a fully-vetted Education resource but a “passion project” from editors of the Pomegranate Health podcasts. The case is that of a 32-year-old woman presenting with constant and dull abdominal pain that had been sudden in onset. The pain is accompanied by nausea and vomiting but bowel habits were unchanged. The patient has a history of type 1 diabetes and a simul...
Australia is a big continent and sparsely populated continent. 28 percent of Australians live in areas classified regional, rural or remote and their access to health services is much more limited. It’s estimated that between 2009 and 2011 there were 19,000 excess deaths in regional and remote areas as compared to the major cities. No doubt, socioeconomic disadvantage is factor in that mortality gap, but inequitable access to healthcare is also a major driver. In this podcast we focus...
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