Ethics, codes of conduct, and challenging decisions are universal constants in medicine. Difficult situations and trying to do the right thing are not always obvious particularly when these decisions involve lots of emotions, family members, and have life and death implications. Ethics, and ethics committees, can help to provide a clear and consensus path for clinicians, patients, and family members. We discuss the role ethics and ethics committees have in modern medicine with our special guest.

This is the story of clinical ethics.

Useful links:

Free critical thinking course through UQ school of philosophy

Clinical Ethics Society of Australasia – Great organisation focusing on clinical ethics, with affordable membership and lots of access to resources. They run an excellent ‘ethics intensive’ and yearly symposium as well as other masterclasses throughout the year.

Australasian Association of Bioethics and Health Law – Major organisation for ethics and health law. Excellent conference each year.

Links to Dr Melanie Jansen’s poetry

Instragram: @drmelaniejansen_poetry

Dr Melanie Jansen’s debut poetry collection, All That Could Be Lost, is available online from 5 Islands Press and at independent bookstores.

Our Special Guest:

Dr Melanie Jansen who is a clinical ethicist and paediatric intensive care consultant

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Lipoprotein (a) (Lp(a)) was discovered in 1963 by a Norwegian geneticist by the name of Kåre Berg who studied particles that carried cholesterol in the blood. He found some patients had an additional protein on the low-density lipoprotein. Studies found that patients with elevated Lp(a) had increased risks of cardiovascular disease. However, the levels were not affected by diet, environmental factors, or medications. The result is that this test was largely ignored for the last few decades.

Recent dyslipidaemia guidelines released by the United States and Europe have returned a focus back on to Lp(a). They recommend that patients should have Lp(a) tested once throughout their life to assess their cardiovascular disease risk. The result can help identify which patients are at a higher risk of cardiovascular morbidity and mortality and who will benefit from lifestyle modification and early intervention.

This resource is referenced during the discussion: https://www.lpaclinicalguidance.com/

This is the story of lipoprotein (a).

Our Special Guests:

Dr Michael Page is a chemical pathologist at Clinipath in Perth, senior lecturer at the UWA Medical School, and immediate past President of the AMA (WA).

Listen:

This Medical Life podcast is available on all podcasting services and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.

Skin has always told stories. For thousands of years, those whose skin behaved differently — scaling, thickening, inflaming — were feared, isolated, and misunderstood. Psoriasis was long lumped together with leprosy, its sufferers cast out rather than cared for.

It would take centuries before medicine began to separate these conditions, and longer still before we understood what was really happening beneath the surface. Psoriasis is not an infection, not a curse, not a failure of hygiene. It is the immune system turning on itself, a complex, chronic inflammatory disease that affects not just skin but joints, confidence, and quality of life. It touches roughly 2-3% of the population, and for many it is a lifelong companion.

Today we have a clinical dermatologist and a dermatopathologist to help us understand what psoriasis looks like to the clinician, what it reveals under the microscope, and how our understanding of its immunological roots has transformed the way we treat it.

This is the story of psoriasis.

Our Special Guests:

Associate Professor Laura Scardamaglia, a Consultant Dermatologist, a Fellow of the Australasian College of Dermatology, and Clinical Associate Professor at the University of Melbourne.

Dr Grace Liu is an Anatomical Pathologist with Histopath in Sydney, Australia.

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The Artful Dodger is a television series on Disney+ that is a historical medical drama set in 1850s Australia with Jack Dawkins, the Artful Dodger from the world of Oliver Twist. Jack is a former pick pocket now surgeon who is reacquainted with old partner in crime, Fagin, who is keen for Jack to resume old habits.

The Artful Dodger takes pride in being one of the most historically accurate depictions of nineteenth century medicine and surgery. The hospital, surgical tools, and treatments are accurate portrayals of what we knew back then. We organised a discussion with its creator to take a deep dive into this entertaining show that both myself and Steve thoroughly enjoyed.

This is the story of The Artful Dodger

Our Special Guest:

James McNamara who is the creator, showrunner, head writer, and executive producer of The Artful Dodger available on Disney+.

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The complex symptomatology of hormonal diseases only started to be recognised in the 19th century as we learned about anatomy and physiology. When Doctor Robert Graves began piecing the hyperthyroid puzzle together when he saw patients with similar symptoms such as anxiousness, nervousness, aggitation, bulging eyes, and rapid/irregular heart rate. He realised this was a previously unknown condition to the medical field.

It would not be until the mid-20th century before we had a full understanding of the thyroid and thyroid diseases. Today, we have tests to diagnose and medications to manage. Graves’ disease accounts for 70-80% of all cases of hyperthyroidism.

This is the story of Graves’ Disease.

Our Guests:

Dr Liam Mulcahy who is studying physicians training with a strong interest in neurology. He was written a book called Beyond the White Coat: The Faces Behind Medical Eponyms.

Professor Duncan Topliss who is a senior endocrinologist at Alfred Hospital in Melbourne and Professor of Medicine in the Department of Medicine, Monash University.

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It has been well established in studies and articles that cholesterol lowering medications have significant heart morbidity and mortality benefits. However, high dosage trials did not show additional survival benefits but had increasing side-effects for patients. Therefore, the maximum dose for statins is not necessarily the best dose for patients.

This is the story of statin dosing.

Guest:

Professor Simon Dimmitt is a Consultant Physician working in General and Cardiovascular Medicine. He is Clinical Professor of Medicine at the University of Western Australia and Adjunct Professor, School of Medicine & Public Health at the University of Newcastle. His website contains Dose Tables and reviews for a modest subscription: Correct Dosing.

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Crucifixion was a form of punishment, humiliation, and execution. Adopted by the Ancient Romans, crucifixion was used on the State’s worst criminals on lower classes and slaves. As common as it was though, we know very little about how people died on the cross. In this episode, we take a closer look at crucifixion through a medical lens.

This image is not historically accurate. It was crafted within the guidelines of Gemini as a stereotypical rendering of crucifixion but our episode gets into the, sadly more brutal, truth.

This is the story of crucifixion.

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Recreational use of steroids and testosterone to enhance image and performance is on the rise. Over the last 70 years, testosterone and testosterone-like substances have been used extensively to enhance performance particularly in elite sports. Nowadays, the use is more widespread and occurs in the general community with far more drugs available to people via the internet. Unfortunately, the evidence users base their drug regimes on range from anecdotal and scant to wrong and dangerous. We discuss the use of testosterone (and other substances) to learn more, identify how we can look after patients who use anabolic steroids, and what risk factors we need to consider.

This is the story of anabolic steroids.

You can listen to Part One of this series here.

Our special guests:

Dr Tim Piatkowski is a senior research fellow at the University of Queensland on image and performance enhancing drugs.

Dr Mair Underwood is a senior lecturer in the School of Social Sciences at the University of Queensland and is an anthropologist of the body.

Professor Ken Sikaris is a chemical pathologist and Director of chemical pathology at Dorevitch pathology.

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This Medical Life podcast is available on all podcasting services and Spotify. Help support us on our donation page.

See omnystudio.com/listener for privacy information.