Congress 2019: Connecting cultures, from paediatrics to palliative care - June/July 2019
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June/July 2019
Congress 2019: Connecting
cultures, from paediatrics
to palliative care.
IN THIS ISSUE
A healthcare consumer’s insight pg.16
Morals, ethics and Māori health pg.25
Physician heal thyself pg.30
Health issues in rural and remote populations pg.42
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Contents
2 A message from The President
3 A message from The Board
6 Queen’s Birthday Honours 2019
8 RACP Congress 2019
16
12 Members in the media
16 A healthcare consumer’s insight
18 Lessons from a koroua
22 First 1000 days. The window of opportunity for long term health
25 Morals, ethics and Māori health
28 RACP partners with Black Dog Institute to develop a physician health
and wellbeing program
25
30 Physician heal thyself
33 Integrated care – The future must be about partnerships
37 RACP Congress 2020: Balancing medical science with humanity
39 The do’s and don’ts of recruitment
40 Teletrials – Bringing regional and rural access to clinical
trials closer to home
42 Health issues in rural and remote populations
44
46
RACP Congress 2019 spotlights Indigenous health issues
Heart health researcher named a rising star by NSW Minister for Health 36
30
48 Finding value in what we do: health advocacy and reform
42
50 SPDP workshops leading the way for supervisors
52 Transition from paediatric care to adult medicine
55 IN MEMORY Thomas H. Hurley
56 RACP upcoming events
58 RACP Awards and Prizes
CORRECTION: On page 17 of the March/April print edition of RACP Quarterly, within
the article ‘Blood stem cell therapy brings hope to people living with Multiple Sclerosis’, the
sentence “At the moment we think that perhaps the sinus, which is a gland in the chest, makes
new cells in the immune system like a baby” should have referenced the thymus not the sinus:
“At the moment we think that perhaps the thymus, which is a gland in the chest, makes new
cells in the immune system like a baby.” We apologise for the error.
A publication of © The Royal Australasian College Health Medicine, Rehabilitation Medicine, and The views expressed in RACP Quarterly are
of Physicians ACN 000 039 047 ISSN 2206-3242 Occupational and Environmental Medicine and not necessarily the views of the College.
(Print) ISSN 2206-3250 (Online) 145 Macquarie the Chapters of Palliative Medicine, Addiction Publication of advertisements does not constitute
Street, Sydney NSW 2000. www.racp.edu.au Medicine and Sexual Health Medicine. Subscribers endorsement by The Royal Australasian College
Editorial Board: Associate Professor Mark Lane, represent over 45 medical specialties. The magazine of Physicians of the products advertised.
Professor Anne Cunningham, Dr Jeff Brown, is distributed throughout Australia, New Zealand
Ms Robyn Burley, Mr Duane Findley and and 47 countries throughout the world. If you would prefer to receive
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Contact details: RACP Quarterly, RACP, 145 RACP Quarterly, please email
Advertising Officer: Fay Varvaritis Macquarie St, Sydney NSW 2000 Tel: 1300 MY memberservices@racp.edu.au with
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trainees of The Royal Australasian College of 2 9252 3310 Email: memberservices@racp.edu.au the subject field.
Physicians, including the Faculties of Public
A message from
The President
I
Congress 2019 in Auckland ’ve had a lot of feedback from In other features, we profile the
many of you who attended College’s new partnership with highly
during May can quite rightly
about the positive atmosphere, regarded Australian mental health
be described as an how seamlessly and sensitively charity The Black Dog Institute and
outstanding success. Māori culture and language were the University of New South Wales to
integrated into the program, develop tools to support physician and
and the success of our inaugural trainee health and wellbeing. You can
Fringe Experience, showcasing learn more about this interesting and
doctors’ non-medical talents. topical project on page 28.
A personal highlight for me was the At Congress we featured two healthcare
humble but powerful opening keynote consumers as both presenters and
address by Sir Mason Durie on lessons award judges. This is an important
he has learned from patients and the milestone in highlighting how the
importance of Indigenous knowledge in College is now integrating a consumer
his approach to healthcare. You can read perspective into its work and programs
a summary of his speech on page 18. across the board. You can read more
about our Consumer Advisory Group
Of note also was our Extraordinary
on page 16.
General Meeting held during Congress.
You can read about the outcome of Finally, I would like to re-emphasise
all resolutions to amend the College that I welcome the Australian Charities
Constitution in the message from the and Not-for-profits Commission’s
Board on page 5. (ACNC) assistance to improve Board
Governance and culture.
Other highlights from Congress
featured in this issue are the importance I know our recent announcement
of the first 1000 days of life as a window regarding the Commission will be of
of opportunity for long term health on concern to members, but I assure you
page 22, the significance of partnerships our written and clinical examinations,
in the future of integrated care on page training setting accreditation cycles,
33 and the closing plenary ‘Physician and education renewal programs will
Heal Thyself ’ on page 30 which continue as normal. As the Board also
features the latest research on stated at our Annual General Meeting
physician burnout, as well as at Congress, the College remains in a
trainee and Fellow stories about sound financial position.
balancing patient care with
I undertake to update all of you as the
their own health and wellbeing.
Board works with the Commission.
We congratulate the 39
Fellows who were recognised Associate Professor Mark Lane
in the 2019 Queen’s Birthday RACP President
Honours. You can read the
full list on page 6. We also
prominently feature the RACP
Foundation Prize Winners
recognised at Congress and their
research.
2 RACP Quarterly
A message from
The Board
Since the last edition of 1 March 2019 – Melbourne cybersecurity governance and health
checks, mobile app and large package
RACP Quarterly your Board met The Board approved the RACP software development and cross sector
on 1 March 2019 in Melbourne Audited Financial Statements for healthcare market knowledge.
and 3 May 2019 in Auckland the 2018 financial year – with an
unqualified audit opinion by Grant
prior to the start of the RACP Thornton showing the College to be
2019 Congress. in good financial health, reporting a
comprehensive income of $1.7 million
There were a number of matters and remaining debt free with sufficient
for Board consideration, and in reserve funds to cover more than six
summary the following were months of operating costs.
discussed or agreed. We initiated a strategic review of
fees and operating costs including
benchmarking to comparable
organisations to provide us with better
understanding of the activities and cost Rob Stewart is a former National
structure of the College. This project is Managing Partner of Minter Ellison, one
being led by the Honorary Treasurer and of Australia’s leading law firms, with
includes a review by the Finance and extensive experience at board level as
Risk Management Committee. both Chair and Director. Both Rob and
We reviewed the College Risk Monica have been appointed for a
Management Report and Framework three-year term commencing at the end
including scheduling a Risk Strategy of the Annual General Meeting (AGM)
Workshop to be attended by the Board
and the Senior Leadership Group on 11
July 2019.
We approved the appointment of two
Community Directors to the RACP
Board to fill the two vacant positions.
Monica Schlesinger has significant
board and senior management
experience and her areas of expertise
include company turnaround,
June/July 2019 3
on 6 May 2019. We approved the In parallel, we reviewed the status and 3 May 2019 – Auckland
appointment of an independent Chair of timelines for the various interrelated
the Governance Committee, Mr Rob projects to be delivered over the next Directors received formal notification
Ryan, for a term of two years. He is five to six years under the Education from the Australian Charities and
currently working with the President to Renewal Program to meet the Not-for-Profits Commission that the
select four RACP Fellows from Australian Medical Council (AMC) RACP is being investigated by the
expressions of interest received to and Medical Council of New Zealand’s Commission. The Board has committed
appoint to the Governance Committee. (MCNZ) accreditation standards. to enter into a voluntary compliance
agreement with the Commission
As soon as the members of the A short additional Board meeting was in relation to improvement of
Governance Committee have been held on Friday, 5 April 2019 at the end Board culture and governance.
formally approved work will start on the of a two-day Board Strategy workshop.
priority work plan, including a review The Board: Directors approved amendments to
of the College Constitution, Code the By-laws concerning the process
• reviewed the Fellowship Committee and criteria for awarding the John
of Conduct procedures and By-laws
Discussion Paper, Future of Congress, Sands Medal and College Medal,
covering the RACP elections, ahead of
and noted the ongoing work of the following recommendations from
the 2020 election cycle.
Fellowship Committee the Fellowship Committee.
We reviewed the revised Conflicts
• reviewed a detailed briefing paper We also approved a change of
of Interest Policy and approved the
concerning a ‘safe and respectful name of the NZ Committee to the
implementation of a consultation
working environment’ with a Aotearoa New Zealand Committee
process involving the key Board
discussion on opportunities to raise and signed off on the Work Plan
sub-committees, after which
the profile of the College and to for 2019 to 2020 of the Consumer
the Board will review the final
establish safe and respectful working Advisory Group and the College
policy for formal approval.
environments for all Fellows and Policy and Advocacy Council Work
We also approved award of the College trainees Plan for 2019, as well as approving
Medals based on recommendations publication to members of the 2018
• reviewed and approved the draft
from the Fellowship Committee, and the RACP Progress Report to the AMC.
Notice of Meeting and Explanatory
establishment of the College Journals
Memorandum for the Extraordinary A detailed review of the results
Committee, and a relevant By-law.
General Meeting of the College to be of the College Staff Culture
Directors approved a five-year IT held at the conclusion of the Annual survey was held with guidance
Services Agreement with BPAC NZ to General Meeting on 6 May 2019 to from an external facilitator.
support the College technology upgrade consider the four resolutions received
program including the current key Basic from the requisitioning members Directors reviewed questions received
Training Curricula Renewal project. concerning proposed amendments to from members and drafted responses
the College Constitution. ahead of the Annual General Meeting
4 RACP Quarterly
and Extraordinary General Meeting Notice of Meeting and Explanatory
held on Monday, 6 May 2019. Memorandum which had been sent by
mail and email to all members prior
The next Board meeting will be
to the meeting and was also available
held on 12 July 2019 in Sydney.
to download from the RACP website.
Annual General Meeting The outcome of the members’ votes on
and Extraordinary the four resolutions received from the
requisitioning members was published
General Meeting on on the RACP website the day after the
6 May 2019 – Auckland meeting, reporting that all resolutions
The RACP AGM was held on Monday, had failed to attract the required votes
6 May during the lunch break of and consequently there had been no
day one of Congress 2019 and was changes to the College Constitution
attended by 121 members and the resulting from this meeting.
College Senior Leadership Group The Board had previously noted in
plus members who took advantage of the EGM Notice of Meeting and
the live web stream available through Explanatory Memorandum that a broad
the RACP website. After opening the review of the College Constitution
meeting the President introduced the and key By-laws would be undertaken
Honorary Treasurer Tony Tenaglia who as a priority with guidance from
reported on the 2018 financial year the Governance Committee and
key financial performance, followed by consultation with members prior to
the President’s report on the work and being submitted for formal approval by
achievements of the College over the members at an AGM or EGM called at
past year. The President and Honorary the appropriate time.
Treasurer then responded to member
questions, primarily concerning details
from the audited financial statements
published in the 2018 Annual Report.
The Extraordinary General Meeting
(EGM) commenced immediately
after the AGM with the items of
business contained in the formal
September/October 2018 5
Queen’s Birthday
Honours 2019
Congratulations to the RACP The New Zealand Order Officer (AO) in the
Fellows recognised in the 2019 of Merit General Division
Queen’s Birthday Honours. To be Dame Companion of the said • Professor Lex William Doyle
Order: FRACP. For distinguished
These awards highlight the service to medicine, and to
• Dr Susan Nicola Bagshaw
outstanding work RACP medical education, as a neonatal
FAChSHM, CNZM, of
members do and the importance paediatrician, academic, author and
Christchurch. For services to youth
of that work in local, national researcher.
health.
and international communities. • Professor Christine Julie
To be Officers of the said Order:
Kilpatrick FRACP. For
• Dr Marie Claire McLintock distinguished service to medicine
FRACP, of Auckland. For services through senior administrative roles,
to haematology and obstetrics. to the promotion of quality in health
care, and to neurology.
• Dr Christine Mary Roke
FAChSHM, of Auckland. • Professor Christina Anne
For services to sexual and Mitchell FRACP. For distinguished
reproductive health. service to medicine in the field of
haematology, to medical education
AUSTRALIA and research, and to academic
leadership.
Companion (AC) in the
General Division • Professor Richard George Pestell
FRACP. For distinguished service to
• Professor Ruth Frances Bishop AO medicine, and to medical education,
FRACP (Hon). For eminent service as a researcher and physician in
to global child health through the the fields of endocrinology and
development of improved vaccines oncology.
for paediatric gastroenteritis, and to
medical research. • Associate Professor Tilman Alfred
Ruff AM FRACP. For distinguished
• Professor David James Burke service to the global community
AO FRACP. For eminent service as an advocate for nuclear non-
to neurophysiology, to innovative proliferation and disarmament, and
treatments for spinal cord and brain to medicine.
trauma injuries, and to professional
medical organisations.
6 RACP Quarterly
Member (AM) in the • Associate Professor Michael John Honorary Member (AM) in the
General Division Murray FRACP. For significant General Division
service to geriatric medicine as a
• Professor William MacEwan clinician and educator. • Professor Jacob George FRACP.
Carroll FRACP. For significant For significant service to
service to neurological medicine, • Professor Clare Nourse FRACP. medicine as a gastroenterologist
and to people with Multiple For significant service to medicine and hepatologist.
Sclerosis. in the field of paediatric infectious
diseases. Medal (OAM) in the
• Clinical Professor Peter Thomas
Bye FRACP. For significant service • Emeritus Professor Anthony James General Division
to medicine, particularly to cystic Radford FRACP, FAFPHM. For
• Dr Christopher James Cunneen
fibrosis, and to medical education. significant service to medicine, to
FAFOEM. For service to
medical education, and to global
• Professor Ian James Cook medicine as an occupational and
health.
FRACP. For significant service to environmental physician.
gastroenterology, and to medical • Dr Nicholas Saltos FRACP. For
• Dr Malcolm Douglas Dobbin
research. significant service to medicine, and
FAFPHM. For service to medicine.
to education.
• Professor John Patrick Edmonds • Dr John Dacre England FRACP.
FRACP. For significant service • Professor Malcolm Ross Sim
For service to medicine as a
to rheumatology, and to medical FAFOEM, FAFPHM. For
cardiologist.
research. significant service to occupational
and environmental medicine. • Dr David Everett FRACP.
• Associate Professor Jonathan For service to medicine as a
James Ell FRACP. For significant • Professor Leon Abraham Simons
paediatrician.
service to medicine, and to medical FRACP. For significant service
education and research. to cardiovascular medicine, • Dr David Thomas McDonald
and to education. FRACP. For service to medicine
• Professor Michael Lindsay as a paediatrician.
Grayson FAFPHM, FRACP. • Associate Professor Richard James
For significant service to medicine Stark FRACP. For significant • Associate Professor Georgia
in the field of infectious disease. service to neurological medicine, Armat Paxton FRACP.
and to professional associations. For service to community health,
• Professor Winita Hardikar and to refugees.
FRACP. For significant service to • Professor Carolyn Mary Sue
medicine, particularly to paediatric FRACP. For significant service • Dr George Louie Williams FRACP.
liver disease and transplantation. to medicine, particularly to For service to medicine in the field
mitochondrial disease. of paediatrics and developmental
• Professor Constance Helen disability.
Katelaris FRACP. For significant • Professor James Leonard
service to medicine in the field of Wilkinson FRACP. For significant • Dr Gordon Eustace White
immunology and allergy. service to medicine, particularly FAChSHM. For service to medicine,
paediatric cardiology. particularly sexual health.
• Professor Steven Anthony Krilis
FRACP. For significant service
to medical research in the areas
of inflammation, thrombosis and
allergic disease.
• Dr David Alexander McCredie
FRACP. For significant service to
medicine in the field of paediatric
nephrology.
• Dr Prudence Joan Manners
FRACP. For significant service
to medicine as a paediatric
rheumatologist.
June/July 2019 7
T
Impacting health along the life his year Congress took an raised awareness of issues impacting
in-depth look at the range of physician and patient health along the
course. From paediatrics to
ways physicians, as specialists life course.
palliative care. As Specialists. together, impact patients’ lives from
Congress 2019 also introduced an
Together birth to death, from paediatrics and
exciting new initiative, the Fringe
child health to palliative care.
Experience, which showcased the
Impacting health along the life course, different interests and talents of
the theme of RACP Congress 2019 our healthcare professionals and
brought over 900 delegates together in incorporated health and wellbeing into
Auckland, New Zealand. the program. Art and photography by
healthcare professionals was displayed,
“There is so much I could say about
main stage performances were enjoyed,
this Congress – Impacting health
morning workouts jogging around
along the life course. For me the
Auckland and yoga energised delegates
thrilling bit is that absolutely every
for the day ahead and mindful
speaker referenced health along the
activities allowed delegates a break
life course. The theme has absolutely
from the educational content.
been threaded throughout the whole
of Congress,” said Congress 2019 Lead “I’ve really enjoyed wrapping up our
Fellow, Dr David Beaumont. creative sides into the conference.
For example, this morning we had
Over the course of the three-day
three fantastic orations in the plenary
Congress there were 142 presentations
session, lots of science, lots of really
within 42 thought-provoking sessions.
solid stuff, fabulous learning and at
Big questions were asked, and big
the end a cardiologist stands up and
conversations were had across a wide
sings ‘I did it my way’. It’s just really
variety of issues spanning the breadth
gorgeous, so you come out of the
of the medical world.
session feeling really upbeat, everyone’s
Emeritus Professor Sir Mason chatting and there’s lots of energy, so
Durie’s opening keynote, ‘Indigenous fabulous. Good on the conference
knowledge and science: Doctors at the organisers for making such an effort
interface’, stimulated and invigorated with our creative side,” said Dr
delegates for the sessions ahead. Margaret Young FAFPHM.
Sessions covering the first 1000 days, Tikanga Māori – the Māori way of
the life course paradigm, obesity, doing things featured extensively
medically unexplained symptoms, during Congress. This theme flowed
chronic disease and integrated care, through the whole Congress and was
rural and remote populations and a key takeaway for RACP President,
health, the search for value in what Associate Professor Mark Lane.
we do, populism and public health,
“The more we understand the
transitioning from paediatric care
Māori way of doing things, or the
into adult medicine, the opioid
Aboriginal and Torres Strait Islander
epidemic and physician heal thyself
way, we start to understand and
8 RACP Quarterlyask questions about why. About
why Indigenous children are more WHAT DELEGATES HAD TO SAY
likely to be malnourished? Why is ABOUT CONGRESS 2019
this family living in substandard
“I’m looking forward to this afternoon when we’re going to have
accommodation? Why are asylum
the release of the policy of the first 1000 days. These are of critical
seekers being treated like criminals?
importance to the whole of medicine and I think will actually change
“Why do we invest money in the way our society views health and social factors together and that’s
heroic interventions at the end of going to be really really really important in taking things forward,” Dr
life when intervention at early life Cathy McAdam FRACP.
could make so much difference?
“I enjoyed the talk by Lex Doyle and the history of neonatal and
Important questions that were asked
retrolental fibroplasia, I found it very interesting from the point of view of
this Congress and we must keep
an older physician who treats older patients,” Dr John Mathew FRACP.
on asking difficult questions.”
“There was a performer this morning and that was fantastic. Just
Also drawing on the theme of Tikanga
seeing some of the different talents of medical professionals,”
Māori, Dr Beaumont spoke in his
Ms Josephine Davies.
closing remarks of the sub-theme he
introduced in his welcome speech: “As a paediatrician I think it’s very essential that we remember that a
kotahi tātou – we are one. lot of the determinants of health outcomes in adults start from early
childhood,” Dr Biola Araba FRACP.
“For me this has resonated
throughout Congress, particularly “The first session about science and culture and doctors at the interface,
the relationship we have with our I thought it was a very interesting talk and it was very realistic from a
patients and the fact that we are Pacific background,” Dr William May.
actually one with our patients.”
“Some of the thoughts we saw here are going to be the foundation for
Closing off Congress 2019 Associate internal medicine for the coming generations and one of the things that
Professor Lane said, “I hope this I see as very important is physician wellbeing, not just in terms of
Congress has broadened your thinking, looking after your patients but also to heal yourself,” Dr Krishnakumar
it has certainly broadened mine.” Kalpurath FRACP.
Presentation videos of selected “Having the Māori input all the way through and Sir Mason Durie’s
sessions from RACP Congress 2019 plenary bringing Indigenous knowledge and scientific knowledge
are now available on the RACP together was just wonderful and I can get a copy of it to spread the
YouTube channel: news to my colleagues back home,” Dr Margaret Rowell FRACP.
www.youtube.com/user/RACP1938.
“I think what is coming through from almost every speaker whether they
You can also view many of the
are local, international, they’re saying the same thing. That if we don’t
presentation slides. Selected sessions
connect to people at their level, we are not accessing them,”
and slides have only been released
Dr Sornalingam Kamalaharan FAFOEM.
where approval has been given by the
presenters, visit
www.racp.edu.au/fellows/resources/
congress-historical-resources. RQ
June/July 2019 9148 Presenters 911 Delegates 10 RACP Quarterly
584 Downloaded the app
42 Sessions
52 Posters
June/July 2019 11Members in the media
Lack of sleep ‘same as drink driving’, finds University of WA’s Centre for Sleep Science Director
Federal inquiry Professor Peter Eastwood, who took part in the inquiry,
said the Federal Government now needed to follow through
The importance of a good night’s rest has been laid out on the inquiry’s top recommendation that sleep health
following a Federal inquiry into sleep health awareness, becomes the “third pillar” of health, alongside diet and
with one WA professor saying the dangers of sleepiness can exercise.
no longer be ignored.
Sir Charles Gairdner Hospital’s head of Sleep Medicine
Telling your boss you can’t come to work because you’re too Department Professor Bhajan Singh FRACP said more
tired could soon be as acceptable as being bed-ridden with education was needed for the community and health
the flu. professionals about sleep apnoea, with about four out of
And new drivers could be educated about the dangers of five people unaware they had it.
driving “under the influence” of sleep deprivation. Professor Singh said it was also important to improve
That’s some of the suggestions to come out of the Federal access to treatment for sleep apnoea which was not funded
inquiry into sleep health awareness, with a parliamentary through Medicare.
committee this week releasing its report, Bedtime Reading. News.com.au, 14 April 2019
12 RACP QuarterlyStudy to probe gut health link to autism
QUEENSLAND adolescents with autism are
being recruited for a pilot drug trial testing the
controversial theory that poor gut health
contributes to behavioural and mental
health problems.
Paediatrician Honey Heussler FRACP, of
the Queensland Children’s Hospital, said the
experimental drug was designed to bind to toxins
in the gut, preventing them from being absorbed
by the body and reaching the brain, where they
could potentially cause symptoms.
Associate Professor Heussler said although
significant numbers of autistic children experienced
gastrointestinal problems, such as diarrhoea, it was
too early to say whether gut health contributed to
their autism.
The Daily Telegraph, 28 April 2019
Australia recording weekly
flu deaths before peak
winter season
AUSTRALIANS are dying on a
weekly basis from the flu, as experts
advise the population to
get vaccinated.
NSW-based virologist Bill
Rawlinson FRACP predicted
Australia could see “a couple of
million” cases of the flu this year –
about eight per cent of
the population.
Professor Rawlinson said he was
worried this year may be a worse
flu year than 2017 in Australia, with
laboratory proven cases running
at about three times the five-year
average for this time of the year.
Asked about how many influenza
deaths had occurred in Australia
during 2019, he said: “Certainly,
we’re seeing them on a weekly basis”.
The Daily Telegraph, 7 May 2019
June/July 2019 13Members in the media
FAST FACTS
Rheumatic fever: An entirely preventable disease
that kills
Acute Rheumatic Fever and YOUNG PEOPLE
Trishanne Miller, 15, is a “germophobe”. At the Sydney Royal Easter Show
Rheumatic Heart Disease are
AGED 5-14 last week the promising young soccer player refused to drink from the
P R E V E N TA B L E YEARS bubblers. Hand rails were also off limits.
6000
ARE AT HIGHEST RISK OF
MORE A FIRST EPISODE OF ARF She has reason to be wary. Trishanne is the third generation in her family,
THAN
PEOPLE ARE ON
Gudanji people from Borroloola in the Northern Territory, to have
RHD REGISTERS 53% 18% contracted the life-threatening disease rheumatic heart disease (RHD).
ACROSS AUSTRALIA RHD IS A DISEASE OF
& 40% of them are under
24 and at risk of premature SOCI AL of ARF reported of ARF in children Known to previous generations as scarlet fever, the disease is caused by
untreated strep which results in a sore throat and body sores. It has been
between 2010 and 2013 aged 5 to 14 years
death or disability.1 DISADVANTAGE was in children aged
5-14 years.3
are preventable
recurrences.2
94%
virtually eradicated from non-Indigenous communities.
Arnhem Land, though, has the highest rate in the world. The rate is about
of the ARF reported
in Australia is among 122 times higher among Indigenous Australians than non-Indigenous
Aboriginal and Torres
Strait Islander people.3 people, and it kills two young Indigenous people each week.
59 PER 6x 20-55x In Maningrida, NT, a pilot program that tested every single child – more
100,000 MORE MORE
The incidence of ARF is approximately Aboriginal and Torres Strait Islander people Aboriginal and Torres Strait Islanders
than 600 – for the disease in March and in November using hand-held
59 per 100,000 among Aboriginal and
Torres Strait Islander people and less
are more than 6 times more likely than other
Australians to be hospitalised for ARF and
are between 20-55 times more likely
to die from RHD than non-Indigenous heart scanners found 10 per cent had rheumatic heart fever or rheumatic
than 1 per 100,000 for other Australians.2 RHD.3 people.1
heart disease, said cardiologist Dr Boglarka Remenyi FRACP.
GOOD NEWS Two thirds of children who were diagnosed with rheumatic heart disease
ARF and RHD can be controlled through improved living conditions,
reduced overcrowding, access to health care and antibiotics. hadn’t been previously diagnosed with rheumatic heart fever. Following
Policy and research initiatives to better understand and reduce the
burden of RHD are underway.
the scans, three children were evacuated for emergency open heart
References:
1/ Australian Medical Association (AMA), 2016. AMA Report Card on Indigenous Health,
Available at: https://ama.com.au/system/tdf/documents/2016-AMA-Report-Card-on-Indigenous-Health.pdf?file=1
surgery, according to preliminary results expected to be published soon.
2/ Australian Institute of Health and Welfare 2018. Better Cardiac Care measures for Aboriginal and Torres Strait
Islander people: third national report 2017. Cat. no. IHW 197. Canberra: AIHW
The Sydney Morning Herald, 21 April 2019
3/ Australian Institute of Health and Welfare 2015. The health and welfare of Australia’s Aboriginal and Torres
Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW.
©RHDAustralia. August 2018.
© RHDAustralia www.rhdaustralia.org.au
Only 1 in 10 psychotropic drugs used for aged
care patients justified
Only about one in 10 prescriptions for psychotropic drugs
currently prescribed in aged care facilities are justified, the
Royal Commission into Aged Care Quality and Safety was
told on Tuesday.
A cultural change among GPs working in aged care facilities
was needed to change this, the Australian Government’s Chief
Medical Officer Professor Brendan Murphy FRACP said.
“Eight to nine out of 10 cases probably didn’t need and
shouldn’t be using those drugs,” Professor Murphy conceded
under questioning.
Senior Counsel assisting the commission Peter Gray said an
expert committee was convened this year which suggested
that only about 10 per cent of antipsychotics prescriptions
could be justified as effective.
The Age, 14 May 2019
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www.etranscriptions.com.au • info@etranscriptions.com.auA
healthcare
consumer’s
insight
B
“Healthcare is focused on those ut the observation highlights In an important milestone signifying
a growing view in healthcare that patient and consumer views are
who provide the care, not the
worldwide that consumers and now taken seriously by the RACP,
patients and consumers.” patients can offer valuable perspectives two healthcare consumers, Ms Debra
It was a provocative statement in shaping the system and the care it Letica and Mr Hamza Vayani, attended
by RACP Fellow Professor provides. As a College, we formally RACP Congress in Auckland as award
recognise the importance of consumer judges and presenters.
Des Gorman at Congress 2019
engagement, and that it needs to be Both have considerable expertise in
during a session on Māori genuine and not tokenistic. giving a community perspective on
healthcare (see page 25). healthcare initiatives, particularly
16 RACP Quarterlyfrom the perspective of social Established 12 months ago and led (Debra Letica) and the Podcast
inclusion of people with multi-cultural by Chair Associate Professor Nick Editorial Group (Melissa Cadzow).
backgrounds, and physical or mental Buckmaster, the group advises us on
Their views are sought when our College
health challenges. improving consumer engagement and
makes policy submissions such as a
Hamza shared a personal perspective of patient centred care across professional
recent paper to the Royal Australian and
a carer in the session ‘Transitions from standards and education, as well as
New Zealand College of Radiologists
paediatric care into adult medicine’. Debra policy and advocacy.
(RANZCR) on Ethical Principles for
presented at the integrated care session as They’re also tasked with supporting Artificial Intelligence in Medicine.
a feature presenter on ‘The future state of understanding of the shared role of
The CAG has now added another
Australia’s healthcare system’. patients and carers in clinical decision-
member, who’ll contribute an
For Hamza, attending and presenting making, as well as promoting the
Indigenous Australian perspective
at Congress was hard to do given importance of cultural competency and
on our work. Terry Williams is an
his personal experience caring for how this is supported and assessed in
Aboriginal Community Elder who has
a daughter with a chronic medical the workplaces of our trainees and their
worked as an Indigenous Community
condition. “It is raw, but I summoned supervising physicians.
Outreach Worker and in the Consumer
the strength to do it… as a parent of “By convening the Consumer Advisory Advocacy Group at Caboolture
two children, one with complex care Group, the RACP is shining a light for Hospital, as well as at Queensland
needs, it was a fantastic opportunity all other medical training colleges Health and the Institute for Urban
to attend and great to hear physician across Australia and New Zealand at Indigenous Health.
presentations and research, particularly the importance of engaging with
around the first thousand days of the All members of the CAG are looking
consumers and carers in the design and
child and perinatal infant health.” forward to being further involved
delivery of healthcare,” said Debra.
His presentation to attendees made across the College during the remainder
“Congratulations to the RACP.”
a powerful impact, with a physician of this year and into 2020. RQ
involved in caring for his daughter CAG members are now actively
remarking afterwards that a colleague involved in several peak RACP
had commented unprompted on the Committees and Councils. These
valuable carer’s perspective Hamza include: College Education
provided. You can read more about this Committee (Henry Ko), College Policy
session on page 52. and Advocacy Committee (Debra
Letica), College Council (Hamza
Debra says she enjoyed every moment Vayani) and the Aotearoa New Zealand
of Congress. “I felt welcomed and met Committee (Ezekiel Robson), as well
some amazing passionate people, all as joining sub-committees of interest
who just happen to be doctors. Congress such as the Integrated Care Committee
provided the opportunity for everyone
attending to network. Having informal
conversations with members of the
College, with their Consumer Advisory
Group (CAG) enabled us all to learn
from each other and share experiences
from both perspectives. It’s difficult
to understand how it is to walk in “B
y convening the Consumer Advisory
someone else’s shoes, sharing stories of
lived experiences creates empathy and a Group, the RACP is shining a light for
deeper understanding of the importance
of integrated care.” all other medical training colleges
Hamza and Debra are both part
of our CAG. They are two of six
across Australia and New Zealand at the
community members, all with a importance of engaging with consumers
background in health consumer
affairs, representing a wide variety and carers in the design and delivery of
of patient and consumer groups
across Australia and New Zealand. healthcare.”
June/July 2019 17CONGRESS FEATURE
Lessons from
a koroua
“You can always tell when a physician’s in trouble.
The patient’s tests have come back negative,
the drugs aren’t working; so, they ask for a
psychiatrist’s opinion!”
18 RACP QuarterlyW
ith that quiet, wry doctor’s in leaves could stay in the room at night.
joke, revered New Zealand
“No koroua, the leaves make carbon
psychiatrist Sir Mason
dioxide at night; that’s bad for the
Durie had a laughing Congress keynote
patient…” said the young house
audience in the palm of his hand.
surgeon, repeating the prevailing
Well known in Aoteoroa, Emeritus
wisdom of the time “…but why? Will
Professor Sir Mason Durie,
they make her better?”
KNZM, FRSNZ, FRANZCP,
has been instrumental in “Doctor, they are part of her,” the old
transforming Māori healthcare. man said.
Alongside a demanding many decades The young house surgeon was
long clinical career in psychiatry and speechless.
then in academia, he has served on
The leaves were from her tribal
many Māori health committees, and
homeland.
on many influential community and
national bodies. The tests eventually came back, and the
surgeon’s diagnosis of encephalitis was
In the initial minutes of his opening
confirmed. “What do you think caused
address, he ranged from Galileo’s
this illness?”, the young surgeon asked
contradiction of faith based teaching,
the old man. “A kanga; a curse,” the
and final papal recognition in 1992;
koroua replied. “Her mum ran away to
“…a long time to wait for your thesis
Australia with another man – so the
to be marked!” to the folly of Cartesian
child was cursed. Why doctor, what do
dualism and it’s influence on New
you think caused this illness?”
Zealand’s nascent mental health system.
“I don’t think it was a curse. I think it
But it was one humble, insightful and
was a virus,” said the young surgeon.
at times moving story that showed why
he quietly commands such widespread “A virus. Can you see it?”
mana, the Māori word for respect, “No.”
throughout Indigenous healthcare,
and many different areas of the public “Can you touch it?”
sector in New Zealand. “No.”
And it’s from early in his career – 1964 “Then doctor, I admire your faith in
– that this compelling story comes. things you cannot see or touch!”
He told the assembled Congress The experience shaped the young
of a koroua, a Māori grandfather, house surgeon’s early thinking on
who had driven his hallucinating the importance of cultural and
14-year-old granddaughter to a environmental dimensions in Māori
hospital in a regional New Zealand health and wellbeing, which he shared
city, convinced there was more to with Congress – 55 years later.
her condition than a diagnosis of
mental illness by a local doctor. Sir Mason spoke of the
interconnectedness of the
“There, they came across a young, broader physical environment
knowledgeable, but not very wise and health, drawing an analogy
house surgeon,” he states, gently with the coexistence of physical
smiling. “The eventual diagnosis was symptoms and mental illness.
viral encephalitis [an inflammation of
the brain caused by a virus], and she He compared Indigenous knowledge
was admitted.” with scientific knowledge: the former
being holistic, amalgamative, with
Each day, the grandfather, a shearer, accepted truths handed down,
brought flowers and, most notably, with outwards facing or centrifugal
fresh green leaves for the gravely ill thinking, older practitioners and
teenager and sat with her, asking if the knowledge being enhanced by time.
June/July 2019 19In contrast, he said, scientific
knowledge is analytical and HONORARY FELLOWSHIP AWARDED
breaks things down, is sceptical, At that evening’s Congress Gala Dinner Sir Mason Durie’s keynote
based on measurement, uses address was acknowledged by RACP President Mark Lane as one
centripetal thinking, often has of the highlights of Congress 2019, “…because he has walked the
younger practitioners, and path our College now needs to walk – improving health and wellbeing
that time aged science. through the combination of medical and Indigenous knowledge.”
Neither the Indigenous or scientific Associate Professor Lane said there are many names for this
approach to knowledge is inherently combination of the environment a community lives in and the health
right or wrong, they are simply of its people; holistic, Indigenous, Tikanga Māori, which translates as
different ways of looking at an issue. Māori culture.
Sir Mason also spoke of the relevance “Here’s another word for it: wise… I want to thank Sir Mason for
of land and environment in Indigenous sharing his wisdom with us.”
knowledge systems.
In recognition of that wisdom, his long and distinguished career and
He used an example from contributions to Māori healthcare, the Royal Australasian College of
Māoridom – when a person is Physicians has awarded an Honorary Fellowship to Sir Mason Durie.
welcomed onto a marae, it is their
iwi or tribe, their land, rivers and
mountains that are welcomed, not
just the individual themselves.
But, he contended, we miss a great deal
if we don’t also consider the broader
physical and social environment
our patients live in: “…we use the
microscope a lot in medicine, but we
should also use the telescope.”
All these years later, he still reflects
on lessons he learnt from the koroua:
mental health and physical health are
inextricably linked, always consider the
environmental determinants of health,
whānau, or family, are an important
part of that picture, spirituality needs
to be recognised as part of the journey
to wellness work between different
cultures and bodies of knowledge.
Sir Mason concluded by saying the
14-year-old female patient at the heart
of this story made a truly remarkable
recovery, considering the prognosis
for viral encephalitis patients in 1960s
New Zealand.
The koroua said makutu, the curse, had
been lifted.
The young house surgeon never
forgot those five lessons, and went
on to an internationally recognised
and eminent career, thanks to
a grandfather, a teenager – and
some fresh green leaves. RQ
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June/July 2019 21
ramsaydocs.com.au ramsay-health-care ramsayhealth.comCONGRESS FEATURE
FIRST
DAYS
The window of opportunity
for long term health
All children, no matter where pre and post-natal epigenetic positive changes to what could
they live or who they are, should profiles? What does the Dunedin be the most important years of
have the same opportunity study show us? How do we patients’ lives. The session was
to fulfil their potential. Many address these inequities in our chaired by Dr Patrick Tuohy with
children who experience communities? captivating and enlightening
inequities in health are also These are the questions presentations delivered by
disadvantaged in accessing a shared session at RACP Professor Richie Poulton, Dr
healthcare, leading to problems Congress 2019 set out to Johan Morreau and Dr Matire
now and into the future. What answer. It also explored how Harwood.
are the origins of adult disease we can address and make
and how do epigenetics affect
22 RACP QuarterlyW
elcoming delegates to three. They show that the early years • poor physical health
the session Dr Tuohy, a meaningfully predict what happens • drug and alcohol dependence
specialist paediatrician with down the track: “they predict important
• lower socioeconomic status
a particular interest in community child life outcomes not just from one
health, spoke of this topic as a paradigm particular area, but multiple important • crime conviction
shift in child health. “Following 20 years life domains and that prediction • single parent child-rearing
of research into the developmental withstands control for all the usual • welfare benefit use.
origins of disease and the new science suspects: distribution across social
around epigenetics we now have a lot of strata, cognitive measures, IQ and Following on from Professor Poulton’s
information about how the early years the like. It applies equally to men and presentation, Dr Morreau presented
affect the long term life course. women and it doesn’t result from the on the impact of deprivation in early
extremes driving the association,” said childhood on brain development.
“Long term conditions and chronic
Professor Poulton. He explained that early experience
disease in adulthood are some of the
big challenges for the health sector right builds a brain. “Genes are the blueprint
now. And it seems to me paediatricians, but experience is the carpenter, together
at long last, are going to be playing a they build a brain from the base up.
very important role in prevention of Building a brain is like building a
these sorts of conditions and uniting house – depending on the quality of
with our colleagues in adult medicine experience a child grows a weak or a
to address this particularly troublesome strong foundation.
and intractable problem.” “This foundation is critical for the
Professor Poulton, Director of the later development of executive skills,
Dunedin Multidisciplinary Health and including cognition, empathy and the
Development Research Unit, spoke ability to self-control and manage a life.”
about what the science says of the According to the Harvard Centre
One of the studies was about childhood
importance of the first 1000 days. But on the Developing Child, 90 per
self-control, something useful to study
not just the first 1000 days. Professor cent of a child’s brain growth
in this modern day and age where
Poulton also focused on conception happens before age five.
there’s really tempting distractions
through to preschool as at 1001 days
around us all the time. The study “Neurons in the brain build in early and
the importance of development doesn’t
used the composite measure; if you then middle childhood, but if we’re not
automatically go down a notch.
composite via multiple measures from using them then they get pruned away,
He presented on studies his team multiple sources you reduce the overall and with a brain it’s almost impossible
has done, drawing on data from the error. All the findings presented are to get them back later. A mature brain
Dunedin Multidisciplinary Health from the composite, but Professor doesn’t grow new neurons like a young
& Developmental Study (Dunedin Poulton assures “that if you just use one. The window of opportunity is
Study for short, run by Professor the age three measure, three decades when the child is very young,” explained
Poulton’s Unit) which has been going later you can predict significantly the Dr Morreau.
for over 40 years and is one of the outcomes we’re talking about, and the
most detailed and cited studies of “Development occurs when a baby,
pattern is exactly the same.”
human development ever undertaken. infant and child and somebody else
The study found a pattern is created interact – somebody who is crazy about
It is an ongoing longitudinal study
from age three onwards and your level the child and gives them time. Through
of the health, development and
of self-control during childhood has an observing, playing and interacting with
wellbeing of a general sample of New
impact on your health in later years. It others a young child’s brain grows and
Zealanders. The researchers recorded
found that those with lower self-control they develop their ability and their
over 1000 births in Dunedin in 1972
in their early years showed the highest identity.”
and have followed these people
rates of instance in their later years
ever since, even though only a third Therefore, if a child is deprived of
across the following areas (compared
have remained in New Zealand. interaction, this will impact negatively
to lower instance for those with higher
The studies show the importance of on their development. If in addition
self-control in their younger years):
the early years, going back as far as age they are exposed to a range of toxic
June/July 2019 23child and that the experiences of the
child in these years can have a lifelong
impact on their health. Investment is
needed during these early years in order
to prevent increased investment in the
later years.
If you are interested in hearing more
stressors, for example neglect or abuse about this session you can listen to the
etc, and don’t receive the needed Pomegranate Podcast episode 46, visit
support from caregivers then prolonged www.racp.edu.au/podcast.
activation of stress response systems
will occur and these can seriously derail
healthy brain growth and development. EARLY CHILDHOOD: THE IMPORTANCE
“This stress response can impair OF THE EARLY YEARS
the development of neural Launched at RACP Congress 2019 by RACP President, Associate
connections, especially in the Professor Mark Lane, the RACP policy position statement, Early
areas of the brain dedicated to Childhood: The importance of the early years, offers 47 policy
higher order skills, empathy, ability recommendations for improving early development and child health.
to control emotions and later
cognitive skills – creating lifelong “There are moral and ethical arguments for investing in children,
problems in learning, behaviour, children make up one fifth of our population, they make up 100 per cent
and physical and mental health. of our future,” said Associate Professor Lane, quoting the statement.
“A lack of a satisfactory first 1000 days The President of the Paediatrics and Child Health Division, Professor
(starting from conception) explains why Paul Colditz, said “investing in the early years of children’s health,
in NZ we continue to have one of the development and wellbeing is the most cost-effective means of tackling
highest rates of youth suicide, why we long-term health conditions and health inequity.
have such a high rate of incarceration “Investing in the health of our youngest members of society makes
and why we are seeing increasing sense on every level – it fulfils a basic human right, ensures a healthy
numbers of children and adults with a and educated future workforce and reduces the burden of disease.”
range of preventable metabolic related
conditions,” said Dr Morreau. The statement puts forward a number of recommendations for the
Government with a strong focus on parental and infant mental health,
Dr Morreau believes we know what nutrition, early childhood education and social welfare.
needs to be done, “Invest in our
workforce, especially those social The full policy statement can be accessed at www.racp.edu.au
workers, kaitiaki with the skills (cultural
and personal) to engage with the
families. Start with supporting pregnant
women, early in pregnancy and follow
through supporting the child and family
until the child is at least school age.”
The last speaker in the session, Dr
Matire Harwood, a general practitioner,
spoke passionately about the health
and social issues affecting children and
whānau (families) and urged delegates
to believe that “addressing inequalities,
particularly in the areas of Indigenous
health is not overwhelming and that it
can be done.”
From all speakers in this session it was
clear the early years, from pregnancy
through to at least school age is of high
importance for the development of the
24 RACP QuarterlyYou can also read
