Ep109: Cultivating a rural workforce

06/11/24 • 45 min

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 specifically on the shortage in health practitioners in the regions. Even in regional centres, the density of physicians by population count is two thirds what it is in the major cities. By the time you get to large rural towns it’s just over a third that baseline. In this podcast we discuss opportunities to lift recruitment and retention. This means improving the experience for trainees and the esteem for rural medicine in the eyes of the profession at large.

Guests
Adjunct Professor Graeme Maguire PhD FRACP MHM MPHTM (President Adult Medicine Division, RACP and Director of Medical Education, WA Country Health Service)
Dr Sarah Straw FRACP (WACHS Kimberley Regional Physician Team; Northern Hospital, Melb; Rural, Regional and Remote Working Group, RACP)
Associate Professor Matthew McGrail PhD (Head Regional Training Hub Research, University of Queensland)

ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes ‘The Envelope’, ‘Cast in Wicker’ and ‘Planting Flags’ by Blue Dot Sessions. Music licenced from Epidemic Sound includes ‘The Mission’ by J. F. Gloss. Photo by Pearshop on behalf of RACP.

Editorial feedback kindly provided by RACP physicians Steve Flecknoe-Brown, Zac Fuller, Aidan Tan, Sasha Taylor, Jia Wen Chong, Joseph Lee, Fionnuala Fagan, Stephen Bacchi, Chris Leung, David Arroyo, Nele Legge, Li-Zsa Tan and Thazin Thazin.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Previous Episode

[Case Report] 68yo with cardiometabolic risk factors and transient monocular vision loss

Pomegranate [Case Report] is a Q&A style podcast developed by trainees, for trainees. In our debut episode, we hear about w a who man presented to the emergency department reporting sudden onset vision loss in his right eye lasting several hours. He was 68 year old with a history of type 2 diabetes mellitus. Three differential diagnoses being considered were optic neuropathy, vitreoretinal disease, or corneal oedema following from potential uveitis. In this podcast consultant ophthalmologist, Dr Sumu Simon, walks through an approach to this presentation and an exploratory therapy.

Guests
Dr Sumu Simon FRANZCO (Queen Elizabeth Hospital; Royal Adelaide Hospital) Dr Brandon Stretton (Royal Adelaide Hospital) Dr Stephen Bacchi (Lyell McEwin Hospital)
ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Fionnuala Fagan.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

Learning points and Key Reference (spoiler alert)
1. This case underscores the critical nature of timely diagnosis and aggressive treatment in conditions like giant cell arteritis (GCA), where delayed treatment can lead to irreversible complications such as vision loss. Thorough history taking and clinical acumen are still key elements in establishing a diagnosis of GCA.
2. The patient's initial response and subsequent decline in vision illustrate the need for ongoing monitoring and readiness to adapt the treatment approach. It also shows the necessity of close monitoring of inflammatory markers and clinical symptoms.
3. Amaurosis fugax warrants urgent referral to an ophthalmologist.
4. High index of suspicion for GCA and prompt referral of GCA suspects will ensure best outcome for patients.
5. Progressive visual loss and elevated inflammatory markers should alert the clinician to glucocorticoid-resistant GCA.
6. The effectiveness of tocilizumab in this case highlights its role as a valuable treatment option for refractory GCA, especially when traditional therapies are not sufficiently effective. Targeted biologic agents may open up new treatment approaches in the future particularly in patients with progressive visual loss despite administration of intravenous methylprednisolone.
7. Managing complex cases like GCA often requires a collaborative approach involving rheumatologists, ophthalmologists, and other specialists to ensure comprehensive care and optimal outcomes.
8. There is often value in case reports to start the evidence cascade that is required to bring new, life altering treatments to the forefront.
The Role of Tocilizumab in Glucocorticoid Resistant Giant Cell Arteritis: A Case Series and Literature Review [J Neuroophthalmol. 2023;43(1)]

Next Episode

[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 simultaneous pancreas-kidney transplant two years prior to the presentation. There is no history of rejection of pancreatitis and serum creatinine appears normal.
The attending nephrologist walks through the elimination of differential diagnoses typical of any patient and also of particular relevance to a transplant patient.

Guests
Dr Chiang Sheng Lee FRACP (Lyell McEwin Hospital; University of Adelaide)
Dr Stephen Bacchi (Lyell McEwin Hospital)Dr Amitjeet Singh (Lyell McEwin Hospital)

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.
Editorial feedback kindly provided by RACP physicians Aidan Tan, Brandon Stretton, David Arroyo, Keith Ooi and Fionnuala Fagan. Thanks also to Adelaide medical students Benjamin Cook, Srishti Sharma and Prakriti Sharma.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

Key Reference (Spoiler Alert)
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Gadolinium-Induced Acute Graft Pancreatitis in a Simultaneous Pancreas-Kidney Transplant Recipient [Case Rep Nephrol. 2022]