Everyday Medicine with Dr Luke Dr Luke Crantock

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

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

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

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

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

Over the past decade there has been an emergence of literature pointing to potential clinical benefits for a range of disease states through the adoption of slow breathing techniques. The popularity worldwide of the Wim Hof method adopted from eastern techniques has done much to pique interest. 



Notably the belief and practice of controlling one’s breath to both restore and enhance health is not new however and has been practised for thousands of years amongst Eastern cultures. Pranayama or Yogic breathing as well as Kundalini are well-known ancient practices of controlled breathing and exists in various forms often in conjunction with meditation.



A system of breathing developed in the 1900s by the Ukranian doctor Konstantin Buteyko claimed to successfully treat patients diagnosed with respiratory and circulatory disease possibly through reducing ventilatory dead space, increased tidal volume and by inducing favourable effects on the autonomic nervous system. Practised slow nasal breathing has been shown to extract 20 % more oxygen from each breath enhancing athletic performance.



Slow and controlled breathing through the nose with a respiration rate of between 6 and 10 per minute appears to be optimal for enhancing the Bohr effect. Getting there requires practice and adoption of nasal breathing techniques. The latter also delivers more Nitrous oxide, an important vasodilator which in relation to this subject is produced by the paranasal sinuses. Nasal breathing also filters and humidifies the air we breathe.



In this podcast I was interested to explore this fascinating subject with breathing expert, physiotherapist and snow skier Mr Allan Abbott. Allan has broadened his expertise with qualifications in physical education, ergonomics and acupuncture. He runs numerous seminars on breathing for performance including Athletes Master Classes incorporating high altitude training through his company Health Innovations Australia and has established the “Breathe Light Breathe Right” as well as the ‘Sleep Well be Well” programs. 



Allan subscribes to a notion that  breathing, sleep, diet, exercise and mindfulness are the major components to optimal health. Please welcome Allan to the podcast.



References:

Mr Allan Abbott.oxygenadvantage.com and ⁠www.healthinnovations⁠ .net.au



Breath- The New Science of a Lost Art. Penguin Books. July 20,2021.James Nestor



The Physiological effects of slow breathing in the health human. Russo et al. ⁠www.ncbi.nlm.nih.gov⁠



How Breath-Control Can Change Your Life : A systematic review on Psycho-Physiological Correlates of Slow Breathing. Zaccaro et al.2018. www.frontiersin.org.