Unveiling the New Edition of RACGP's Red Book with Professor Danielle Mazza

Welcome to another episode of "Be an Awesome GP"! Today, we are thrilled to sit down with Professor Danielle Mazza, a prominent figure in general practice and women's health. As the head of the Department of General Practice at Monash University School of Public Health and Preventative Medicine, Professor Mazza has played a pivotal role in updating the RACGP's Red Book.

In this episode, Professor Mazza provides an insightful overview of the newly launched 10th edition of the Red Book. She discusses the comprehensive updates and expanded chapters, covering essential topics like cancer prevention, women's reproductive health, eating disorders, and frailty. Professor Mazza also highlights the rigorous evidence-based framework used to develop the recommendations, ensuring they are relevant and trustworthy for Australian GPs.

Tune in to learn about the significant contributions the Red Book makes to preventive care in general practice, and how it aims to combat misinformation and provide GPs with the best tools and resources to serve their patients effectively. Don't miss this enlightening conversation!

Be An Awesome GP is targeted at GP's in the Australian Context. It is not specific medical advice for patients. The presenters views do not necessarily represent those of organisations they are affiliated with. 

Episode Transcript

(00:00):
Hello and welcome to another episode of Be an Awesome GP.
Today I am absolutely stoked to be sitting down with Professor Danielle Mazza.
Professor Danielle Mazza is a
distinguished leader in the field of general practice and women's health.
Serving as the head of the Department of General Practice at Monash University
School of Public Health and Preventative Medicine, she has made significant

(00:21):
contributions to advancing medical education and research.
While her resume is extensive and impressive, today we are sitting down to have
a chat about the recent development and update of the RACGP's Red Book.
Professor, welcome to the show. Thanks very much for having me.
So I'm going to throw to you, Professor Mazza, why don't you give us an overview

(00:41):
of the Red Book and what's happening?
Yeah, so the Red Book is one of the the key resources produced by the Royal
Australian College of General Practitioners.
And we've just launched the 10th edition, which I was very privileged to share
the chair, not share, the redevelopment of.

(01:06):
And the Red Book provides evidence-based recommendations to general practitioners
and those working in general practice settings.
On the delivery of preventive care.
So when we talk about preventive care, it's not only talking about screening,

(01:28):
but it's also talking about case finding and also about the kind of advice,
preventive advice, that we might give our patients.
And the Red Book, really, Really, the guidance is really focused on the majority

(01:49):
of patients that attend general practitioners.
It's not supposed to be providing guidance about specific smaller population
groups that might have really much higher levels of risk than the general population.
Yeah very good and i find

(02:11):
it's a really good document to practice sensible medicine
which is one of those things that is a real
joy as a gp yeah there's a couple of new topics perhaps you could give us an
overview yeah so i've been involved with the red book for several editions now
as a member of the writing group but when we came to develop this 10th edition,

(02:35):
one of the college staff gave me a copy of the original red book and it was very thin.
So it was only a few pages in length.
And what we have now is a reflection of really the breadth of preventive care

(02:57):
that we are required to deliver in the general practice setting.
And that really reflects the fact that the literature has really expanded in
relation to all of the kinds of preventive care that can be delivered.
So the 10th edition continues with the previous approaches in terms of taking

(03:21):
a life course approach and we have chapters commencing at preconception and
extending right through to frailty and older age.
And in this edition, we've updated the nature of the chapters that have been

(03:43):
included to reflect more content area across the range of cancers and body systems
where cancer can develop.
We've also extensively increased the number of chapters related to women's health,

(04:03):
women's reproductive health,
so that we really get that life course approach in prevention for women from
preconception right through to perimenopause.
And we've also expanded with new chapters in areas that are increasingly in
the press and where GPs are being asked lots of questions by their patients

(04:28):
and where we are aware of increased prevalence in those conditions.
And that covers topics like eating disorders and gambling.
I was actually really excited to see frailty mentioned. Josh,
it's one of the big issues we deal with and I'm almost tempted to have an exercise

(04:50):
by or some weights in my waiting room while people wait to see me.
Because it just really does make
a large difference if we can keep people healthy and in the community.
So I was really excited to see a frailty sector.
Yeah, I think what's great about this edition of the Red Book is that GPs can

(05:14):
be confident that the recommendations that are listed in the Red Book really
reflect the current state of the evidence.
And what we did to create the recommendations was undertake a scan of existing
guidelines from both Australia and around the world for their relevance,

(05:38):
for their rigour and for how up to date they were.
And then we went through a process where we chose the most relevant guidelines.
We sourced the recommendations from those guidelines and then we contextualised
them and made them relevant to the Australian setting.

(05:58):
And I think what GPs can also be confident about is the strength of the evidence
that sits behind the guideline recommendations.
And for this, we've used a new framework, which is being used more extensively
in guidelines called the GRADE framework.
And that relates to where the evidence is really strong from randomised control trials,

(06:26):
then we mark that recommendation as a strong recommendation where we can be
very confident in the advice being given there.
But where there is very little evidence or no evidence and where the group has
come to a consensus decision, we annotate it as such.

(06:47):
So I think that that really provides GPs with
the opportunity to really understand the evidence base
behind the recommendations that are being made
and gives the GPs
the ability to push back on a
lot of the stuff that patients see in social media and through other means where

(07:13):
a lot of this space is actually being taken over by people with commercial interests. Yes.
And this is really making it tough when it comes to practising preventive care,
being sure that we are offering evidence-based advice,
not advice that is coming from someone with a commercial interest in the outcome.

(07:37):
And how long before you think we have to redo them again? Yeah,
well, this is quite a process and I'm not sure that I'll be putting my hand
up to chair it again next time.
I think it was one of the most complex pieces of work that I've ever undertaken.
I was very honoured to be working with some of the best GPs and GP minds in

(08:01):
the space of prevention in the executive and the chapter leads who were involved
in the redevelopment of this book.
We actually started this process before COVID but then when COVID hit we put
it on the back burner and reconvened once, particularly in Melbourne,

(08:21):
where we had such severe lockdowns.
When we were a bit freer from COVID, we recommenced and the whole process has
taken about two years from that point.
So equally, we have to keep abreast of this rapidly developing field and particularly
when it comes to prevention and,

(08:42):
you know, We are going to be increasingly affected by genomics and more personalised,
the ability to personalise and really tailor interventions based on specific
individual characteristics.
And these are a set of guidelines that need consistent.

(09:08):
You know, updating and we've actually made some
recommendations to government there should be
funding from government to the college
to produce these guidelines and preferably in
a living guideline format whereby there
is a process to continually update the evidence rather than waiting for the

(09:30):
whole thing to occur every kind of three to five to eight years or whatever
time it takes because it is it is a massive undertaking,
and i think that goes back to a point you mentioned earlier which is that a
social media cycle can go about 24 hours sometimes yeah and that's the sort

(09:51):
of misinformation we're.
Dealing with in the clinic on an average day sometimes yeah yeah i think the
fact that these These guidelines are also available online,
are very easy to search, and we've got a lot of very useful resources and links

(10:11):
in each of the individual chapters.
So, for instance, if we're recommending screening with a certain tool because
the evidence says that tool is the best one, then we link through to that tool.
And we've made sure to ensure that all of the resources that we recommend are

(10:32):
readily accessible through a quick link online to them.
We've also got links through to other information, often patient education information.
And I think it's helpful when we're undertaking preventive consultations to
have the guidelines up on the screen and actually show the patients what the

(10:58):
recommendation is and also where there are recommendations not to do things,
we clearly point that out.
And that's very important. I have patients who are so grateful when we have
a rational discussion about not doing things when it's not appropriate.

(11:18):
Yeah, and I think having the evidence to back it up and having it come from
the College of GPs is really important when it comes to those conversations.
Well, I will let you go, Professor. It has been an absolute pleasure talking to you.
Is there anything else you'd like to leave us with? No, I just hope that GPs

(11:40):
find the new red book useful to their daily practice.
I encourage people to have a look through.
The way we've presented it online is new and more accessible.
We've still got the old life cycle chart.
We can look at the age of your patient and see very quickly what's required

(12:02):
or recommended for that patient.
And I hope that the Red Book will actually lead to the prevention of disease.
And for me, that's a very meaningful outcome, both for our individual patients,
but also for our increasingly stressed health system.
Thank you, Professor. Okay.