The Safe Practice Podcast

It has long been accepted that in patients who have undergone axillary lymph node dissection/clearance, the ipsilateral arm must not be used again for any sort of medical instrumentation. This frequently results in overuse of the other arm (and sometimes the feet and other creative sites) for vascular access. The outcome was often impracticality, discomfort, distress, and occasionally overt harm to the patient. All due to the theoretical risk of lymphoedema. But just just how theoretical is that risk? Very, it appears. Over the past 14 years, the weight of cumulative evidence has shown that there is very little to prove that instrumenting the affected arm increases the risk of lymphedemga. All of this has caused a recent shift in the clinical paradigm - so much so that the latest guidance in 2023 from The Australian and New Zealand College of Anaesthetists says it is safe to use the patient's affected arm for vascular access, vaccination, BP monitoring. In fact, ANZCA has a media release and a patient factsheet on this very topic. In this episode of the podcast, I chatted to anaesthetist Dr James Marckwald to clarify the evidence and context behind this new guidance. Hooray for medical advancement! ** All content and opinions expressed are those of the host and guest, and do not represent the views of any of the organisations with which they are affiliated.

The ability to acknowledge our limits is a foundational pillar of safe clinical practice, at all levels of experience and training. I began exploring this subject in Episode 12, and continued it in Episode 15 where I interviewed JMO Dr Jade Bevan to get a JMO perspective. In this episode, I am joined by surgical registrar and fellow medical podcast host Dr Anne Atkins to further enrich our exploration of this topic. Anne brings a wealth of experience as both a previous paediatrics trainee, and now as a general surgical registrar. For those interested in paediatrics, Anne and her colleague Dr Freya Bleathman host an excellent Paediatric Medicine and Surgery podcast called You're Kidding Right which I highly recommend. ** All content and opinions contained within this podcast are those of the host and guest, and do not represent the views of any organisations with which they are affiliated.

ENT surgeon Dr Marco Raftopulos joins me to discuss sudden sensorineural hearing loss: an otologic diagnosis that, if missed, results in a 70% chance of irreversible deafness. The good news is that if it is diagnosed and treated promptly, there is a 70% chance of recovery. This episode covers symptoms, assessment and emergency management, through the lens of a highly alarming case study - alarming because it's easy to see how the poor outcome could happen to any of us in our own clinical practice! An episode not to be missed for primary care practitioners, critical care clinicians and paediatricians (or indeed anyone to whom a patient may present with aural symptoms). 📌 All content and opinions expressed on this forum are those of the podcast host and guests, and do not represent the views of any organisation with which they are affiliated.

Bowel cancer is increasing at an alarming rate in young people, and is currently the biggest cancer killer of young Australians aged 25-44. In this episode, I sit down with colorectal surgeon and Bowel Cancer Australia spokesperson Dr Penelope De Lacavalerie to discuss some diagnostic pitfalls to avoid when it comes to the investigation and referral of suspicious bowel symptoms, in particular in young people. How young is too young to have bowel cancer? How can clinicians tell if PR bleeding is just haemorrhoids and not something more sinister? Should colonoscopy be delayed for pregnant or lactating women who present with suspicious symptoms? We answer to these questions, and more. The answers may surprise you. If you want to find Penelope, she has a website (mysydneysurgeon.com.au) and Instagram (@mysydneysurgeon). ** All content and opinions expressed in this podcast are the personal views of the host and the guests, and do not represent the views of any organisations with which they are affiliated.

As clinicians, we all know that it's important to ask for help early when we reach the limits of our scope. But what does that look like practically, when you are a junior doctor? To answer this question, I interview Resident Medical Officer Dr Jade Bevan for her insights. We discuss the principles and realities of acknowledging our limits and asking for help through the lens of real-life clinical scenarios (modified to protect the innocent). An episode not to miss if you are a JMO, about to become a JMO, or have a JMO in the family. **All content and opinions expressed in this podcast are those of the host and guest, and do not represent the views of any organisations which which they are affiliated.

As of 1 Nov 2023, Medicare rebates came into effect for reproductive genetic carrier screening. In this episode, I interview one of the clinical brains behind Mackenzie's Mission - Clinical Geneticist and Genetic Pathologist Professor Edwin Kirk. We discuss the clinical nuances of RGCS, and also shed light on some uncommon pitfalls and ways to address them. A must-listen episode for anyone who looks after pregnant women, is pregnant, or wishes to have biological children themselves. Resources alluded to in the podccast: The Genes That Make Us Public consultation process Centre for Genetics Education website ** All content and opinions expressed in this podcast are those of the host and guest, and do not represent the views of any of the organisations with which they are affiliated.

Our job as clinicians is to make a difference to patients, so it follows that our patients should be given every opportunity to voice what makes a difference to them. We call care that aligns with this concept "patient-centred", but really it is just good sense and basic courtesy. This is possibly my most important episode yet. Please comment and share if it resonates with you. **All content and opinions expressed in this podcast are those of the host and guests, and do not represent the views of any of the organisations with which they are affiliated.

"Fools rush in where angels fear to tread." - Alexander Pope. In this episode, I explore the hardly-groundbreaking, but crucially important practice of acknowledging one's limits. Health care is a team sport. The cavalry is there to be called. No clinician can be an island - at least not a safe one. ** All content and opinions expressed in this podcast are those of the host and guests, and do not represent the views of any organisations with which they are affiliated.**

General Practitioner Dr Samantha Saling joins me to discuss some case studies in reflective practive, illustrated through the lens of of real-life vaccination errors. Resources mentioned in the podcast: NSW Immunisation Specialist Service TED Talk: "Doctors Make Mmistakes. Can We Talk About That?" ** All content and opinions expressed in this podcast are those of the host and guests, and do no represent the views of any organisations with which they are affiliated.

I demystify, define, and break down reflective practice: ...step by step. *All content, opinions and perspectives expressed in this podcast are those of the host and guests, and do not represent the views of any organisations with which they are affiliated.

Nutritionist Monique Cormack joins me to discuss some common traps to avoid when managing iron deficiency. We discuss: Can iron deficiency without anaemia be symptomatic? Is it possible to correct iron deficiency with an iron-rich diet? (The answer may shock you!) Which oral iron formulation to choose? How to find out the elemental iron dose contained in an iron supplement? What is the MOST important thing to do after finding iron deficiency? ...and more! **All content, opinions, and perspectives contained within this podcast are those of the host and guest, and do not represent the views of any organisations with which they are affiliated.***

Ever wondered when beta HCG stops being useful as a tool for monitoring pregnancy viability? Obstetrician Dr Alex Owen joins me to discuss this important topic. Other nuggets of gold you will find in this episode: How a pregnancy loss is diagnosed. ASUM ultrasound criteria for pregnancy loss. https://www.ultrasoundtraining.com.au/wp-content/uploads/2020/10/2017-ASUM-OG-SoP.pdf The 4 valid indications for ordering a bHCG in the context of pregnancy (yes, there are only 4!) **All content, opinions and perspectives expressed in this podcast are entirely those of the podcast host and guest. They do not reflect the views of any organisations with which the host and guest are affiliated.**

Under what circumstances should breastfeeding mums who are undergoing surgery temporarily cease breastfeeding for the safety of their babies? Turns out, almost never! Listen to this episode where I interview anasthetist Dr Jacqui McPhee on this often-misunderstood topic. A must-listen episode for anyone who looks after pregnant women in the perioperative period. Resources mentioned in the podcast: · Mothersafe - https://www.seslhd.health.nsw.gov.au/royal-hospital-for-women/services-clinics/directory/mothersafe · ANZCA factsheets: o Effect of Anaesthesia on Breastfeeding: https://www.anzca.edu.au/getattachment/66d9238d-df7f-4658-a9d9-f681b9fee4bc/PG07(A)-Appendix-2 o https://www.anzca.edu.au/patient-information/anaesthesia-information-for-patients-and-carers/pain-relief-and-having-a-baby · Lactmed app · InfantRisk app · Breastfeeding-Anaesthesia website: https://www.e-lactancia.org/ https://www.breastfeeding-anaesthesia.info/for-clinicians · https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15179 **All content and opinions expressed within this podcast are solely those of the host and guest(s), and do not represent the views of any organisations with which they are affiliated.**

Don't fall into the trap of waiting for someone's down-trending ferritin to fall off a cliff before investigating. All iron deficiency starts in iron replete territory - the quicker we can identify a trend of dropping ferritin, the quicker we can find and treat the underlying cause. Find me on Instagram @thesafepracticepodcast. All content and opinions expressed in this podcast is my own, and are not the views of any organisation with which I am affiliated.

I provide a simple mnemonic (with a dramatic visual prompt) for remembering how to structure clinical documentation. Find me on Instagram @thesafepracticepodcast. All content and opinions within this podcast are my own, and are not those of any organisation with which I am affiliated.

Using a hypothetical case study, we discuss multiple important concepts regarding decision-making capacity: 1. Can the Mental Health Act be used to enforce treatment for physical ailments? Link to the NSW Mental Health Act: https://legislation.nsw.gov.au/view/html/inforce/current/act-2007-008 2. What is decision-making capacity? · When do we need to formally assess decision-making capacity? · What about patients with mental illness? Useful links: o NSW Health Consent to Medical and Healthcare Treatment Manual: https://www.health.nsw.gov.au/policies/manuals/Publications/consent-manual.pdf o NSW Government Capacity Toolkit: https://www.tag.nsw.gov.au/sites/default/files/2020-10/CapacityToolkit2020_1.pdf 3. Are health professionals obliged to prevent patients from making unwise health decisions? · What if those unwise decisions are likely to result in the patient's harm or death? Useful links: o NSW Health Consent to Medical and Healthcare Treatment Manual: https://www.health.nsw.gov.au/policies/manuals/Publications/consent-manual.pdf o NSW Government Capacity Toolkit: https://www.tag.nsw.gov.au/sites/default/files/2020-10/CapacityToolkit2020_1.pdf Find me on Instagram @thesafepracticepodcast. All content and opinions within this podcast are my own, and are not those of any organisation with which I am affiliated.

In this episode I discuss the concept of giving your patient the "permission to cease" an examination or procedure, the reasons why you would do this, and the benefits for the therapeutic relationship. Along the way we touch on the freeze response (a lesser-known cousin of the flight or flight response) and some key concepts of health ethics. I round it off by giving you my personal experience having deployed this technique for many years. Find me on Instagram @thesafepracticepodcast. All content and opinions within this podcast are my own, and are not those of any organisation with which I am affiliated.

Ever wondered which of the 200 obscure risks and side effects of a treatment you should warn your patient about? This episode gives you a conceptual framework - in the form of the "Common SMS" mnemonic - with which to consider this aspect of the informed consent. Find me on Instagram @thesafepracticepodcast. All content and opinions of this podcast are my own and not those of any organisations with which I am affiliated.

Many practitioners unduly fear saying sorry to patients after a clinical incident, for fear of inviting medicolegal liability. This episode unpacks why this fear is unwarranted (at least in Australia), and why saying sorry is important for both the practitioner and the patient. The episode references the Clinical Excellence Commission's Open Disclosure Handbook, which can be found at this link: https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0007/258982/CEC-Open-Disclosure-Handbook.pdf Find me on Instagram @thesafepracticepodcast. All content and opinions expressed in this podcast are my own and not affiliated with any organisation.