Episode 142. Common problems in Psychiatry with Dr Usman Riaz (part 2)

Episode 146. Into the Brain and Beyond with Neurosurgeon Rondhir Jithoo

Neurosurgeon Rondhir Jithoo has led an extraordinary life, growing up in South Africa with a medical father and deeply thinking anthropologist mother. He obtained his medical degree from the Nelson Mandela School of Medicine at the University of Natal and trained in neurosurgery at South Africa’s Wentworth Hospital where he received the Registrars Prize from the South African Society of Neurosurgeons and obtained his neurosurgery fellowship in 2000.

After relocating to Australia, he was awarded the Australasian Fellowship in Neurosurgery in 2004 and worked at Royal Melbourne Hospital where he developed an interest in spinal trauma, anterior spinal surgery and cranial surgery. This interest in cranial surgery took him to Frances’ famous neurosurgical epicentre in Montpellier to further his study and skills in the art of awake craniotomy.

At Montpellier Rondhir was able to develop skills reflecting the modern connectionist approach to neurosurgery which has revolutionised treatment of brain tumours. The traditional concept proposed by Paul Broca, and still taught, is that the brain is organised into different areas controlling specific functions. This localisation theory has now been disproven, and work with contributions from Montpellier has shown that the brain is organised in dynamic interactive networks capable of constantly readapting.

This connectionist approach explains why some patients can lead a perfectly normal life despite having a large tumour affecting an area of the brain previously considered crucial for brain function. The brain is able to compensate for lesions and its incredible plasticity allows it to reorganise itself to continue functioning normally. In awake craniotomy, providing lesions have not caused disability, tumours may be safely removed in real time using cortical mapping. By keeping the patient awake to verbal commands the impact of surgical resection can be carefully assessed and damage minimised.

After returning to Australia with this skill Rondhir served with the Australian armed forces in Iraq, assessing and providing acute neurosurgical assistance for battlefield traumas and is now intrinsically involved in contributing his skill and expertise to establishing and independent neurosurgical service in Darwin where he travels at repeat intervals throughout the year.

He is a head and clinic consultant of Neurosurgery at Alfred Health in Melbourne and is a member of the Victorian Audit of Surgical Mortality Committee as well as a postgraduate examiner for the Royal Australasian College of Surgeons.

I found Ron to be deeply philosophical and spiritual in his approach to the art of medicine and I’m sure you will enjoy this conversation with him.

References :

Mr Rondhir Jithoo: www.healthshare.com.au

www.alfredhealth.org.au

Episode 145. Medical Workforce - The Future with Mr Murray Bruce

The health and welfare workforces deliver diverse services through many private and public organisations. Combined these services employ more than 1 million people of which there were more than 642 000 health practitioners working in their registered professions in Australia in 2020. This included 105 300 medical practitioners, 350,000 nurses and midwives, 21,500 dental practitioners and 166,000 allied health professionals.

In this podcast we will consider more generally the positions of nursing and medical practitioners and a possible future landscape.

In the five years to 2021 only the equivalent of 4200 full-time General Practitioners were added to the workforce and on average both male and female GP’s have been trending towards fewer hours per worker. The AMA’s Plan to Modernize Medicare campaign reported:

1. Australia faces a shortage of more than 10,600 GP’s by 2031-32 and the supply of GP’s falling behind growing community demand.

2. The demand for doctors’ services increased by 58% in the decade to 2019.

3. That the most cost-effective method with the best outcomes for patients is GP led primary care. GP’s provide twice the number of episodes of care as hospitals per year for one sixth the expense.

Away from doctors the nursing and midwifery sector represent the largest workforce in the healthcare system accounting for 55% of total workforce however in a recent McKinsey survey one fifth of Australia’s registered nurses said they intended to leave the current role in the next year. Even before the pandemic a shrinking supply of nursing-school graduates and a decline in nurses migrating from other countries to Australia brought about nursing shortages.

These short-term demands are superimposed on longer-term demands caused by Australia’s population growth and aging demographic. The McKinsey 2021 Future of Work in Nursing Survey found that in addition to the figure above 41% of nurses surveyed said they were planning to move countries or leave direct-care roles entirely, leading to a calculated deficit of between 20,000 and 40,000 unfilled nursing positions. Similar results have been documented in the United Kingdom, France, Japan, USA, Singapore and Brazil.

In this podcast I was keen to pursue the workforce conditions and future strategies to manage them with Mr Murray Bruce, a young and energetic Lawyer with a welcomingly fresh set of ideas who is Director of Latrobe Community Health Service. Murray has extensive board and governance experience with expertise in strategic planning, risk management, commissioning, change management and policy development.

Please welcome Murray to the Podcast.

REFERENCES:

Mr Murray Bruce.Board Directors -Gippsland Primary Health Network.gphn.org.au

McKinsey and Company, Should I stay or should I go? Australia’s nurse retention dilemma, Sep 23rd, 2022

AMA report projects “staggering” GP shortage, Nov 25,2022

Health Workforce, Updated July 7, 2022 aihw.gov.au

RACGP-Health of the Nation, 2022 racgp.org.au

Episode 144. Dermatology with Dr Alvin Chong

Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these. Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone. Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression. A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology. In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care. It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education. Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne. Please welcome Alvin to the Podcast. References: Dr Alvin Chong ⁠http://spotdiagnosis.org.au/⁠ ⁠https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis⁠

Episode 143. Dermatology with Dr Alvin Chong (Part 1)

Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these.

Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone.

Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression.

A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology.

In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care.

It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education.

Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne.

Please welcome Alvin to the Podcast.

References:

Dr Alvin Chong

http://spotdiagnosis.org.au/

https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis

Episode 142. Common problems in Psychiatry with Dr Usman Riaz (part 2)

From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour.

Globally it is estimated that 5% of adults suffer from depression, affecting women a little more than men.

Anxiety disorders affect a similar number of people, characterised by excessive fear, and worry and related behavioural disturbances.

Bipolar disease is characterised by periods of depressive episodes alternating with periods where manic symptoms prevail. Affecting less than 1 % of the population, suicide risk is increased.

Addiction disorders embrace a long list of destructive habits. Post traumatic stress disorder (PTSD), schizophrenia, disruptive behaviour, and dissocial disorders as well as neurodevelopmental disorders are amongst the many conditions presenting clinically and often requiring psychiatric assessment.

I was also interested to discover more about the adverse effects of social media on teenage and young adults’ mental health and in this podcast, and was curious to explore some of the mental health conditions presenting commonly in primary practice and to understand the place of therapies available. It was a privilege to interview psychiatrist Dr Usman Riaz for this episode.

Dr Muhammad Usman Riaz is a fellow of The Royal Australian and New Zealand College of Psychiatrists and has sub-specialised in addiction psychiatry. He Holds a Master of Public Health with a major in Occupational Health and Safety from Monash University and Master of Psychiatry from the University of Melbourne. He is Director of Medical Service at The Langmore Centre in Berwick operated by St John of God Hospital. Please welcome Usman to the conversation.

REFERENCES:

Dr Usman Riaz-www.sjog.org.au

World Health Organization-Mental Disorders. Who.int

Selective Serotonin Reuptake Inhibitors-Stat Pearls www.ncbi.nlm.nih.gov

⁠www.beyondblue.org.au⁠