Medicine: Dr Rahul Barmanray

From Arnhem Land to Maryland, addressing the global challenge of diabetes.  

A desire to work in chronic health came early for Dr Rahul Barmanray. A visit to Gunbalanya (Oenpelli) in North-West Arnhem Land as a high school student, was a pivotal moment for him as he contemplated what he wanted to do at university. He would come to return to remote Australian communities each year throughout his studies, working towards becoming an endocrinologist and diabetes specialist.

“It made quite an impression on me as a young student to see the burden of disease and to think ‘that’s something I really want to consider as a future career path, because I can see the need for it’,” he says. Being able to constantly solve problems and to work closely with patients to “figure out what the best path forward is for someone” is what appealed to the doctor early on.

“Working with people through their medical journey is very much what you do in endocrinology,” he says.

He notes how this can include working with patients who might be reluctant to make certain changes; or negotiating the pros and cons of drug side-effects. This may be coupled with the added challenges of navigating which drugs are subsidised by the pharmaceutical benefit scheme.

“Every time it’s about working with these different influences to work out what the appropriate path forward is for that individual,” he says.

In his final year of undergraduate study, Rahul had the opportunity to do an elective overseas in the endocrinology department at John Hopkins Hospital in Baltimore, Maryland. Once again, he was confronted with the high prevalence of chronic diseases in marginalised and disadvantaged groups. There were stark similarities to his time in remote Australia. It was a lightbulb moment for the young doctor.

“This experience convinced me that chronic disease is not only a problem in our own backyard. This a global problem and it’s an area that I really want to work in further,” he said.

Following his training, Rahul started work at the Royal Melbourne Hospital where he also undertook his PhD.  His research aims to improve outcomes for diabetes patients.

“There was an emerging understanding that optimising glucose levels of patients with diabetes in hospital would improve their outcomes, but it became clear to me that this knowledge wasn’t being implemented.”

“I’m interested in implementation science, that is, how to take the tools that we know work from randomised clinical trials and to use them in a hospital setting."

A career highlight for Rahul was working with a cross-disciplinary team at the Royal Melbourne Hospital managing a randomised control trial to investigate how to improve glucose levels in hospital before patients are referred home.

The results were clear, hospital infections declined amongst the group whose glucose levels were proactively managed by specialists and maintained at healthy levels. This is because when glucose levels are too high, patients’ immune systems are more compromised, making them more susceptible to infections – an ongoing problem in hospital stays. Additionally, Rahul explains that elevated glucose levels fuel bacterial infections, giving bacteria extra sugar to feed on. This makes the need to reduce glucose levels even more important.  

Rahul is also interested in the future of digital health and emerging technologies such as artificial intelligence (AI) to improve outcomes and to reduce waste. He explains that the implementation of electronic medical records (EMR) over the years has improved the capacity of teams to treat larger cohorts of patients more efficiently. He is also optimistic about the future of glucose monitoring in hospitals, for example, using non-invasive laser monitoring to replace single-use invasive continuous testing of glucose in the blood.

Meanwhile, current practices of looking at lists of patients’ blood tests, to decide where to intervene, are time-consuming. Rahul explains that AI- algorithms - can be harnessed to rapidly analyse data for faster diagnosis and treatment.

AI is also a tool that Rahul could see in action for clinical skills training.

Rahul always wanted to give back to the community who helped him on his way to becoming a doctor and found that teaching clinical skills was the way to do that.

“In Arnhem Land, where you can’t send off a blood test and you don’t have a team of specialists, you really rely on your sharp clinical skills to treat any and all problems,” he says.

This experience made him keen to teach others. Lecturing on clinical skills during the pandemic, Rahul created virtual classes to emulate some clinical experiences. He reflects on the rapid changes in AI that, just in the last year, make it more possible to generate dialogue with virtual patients to help train the next generation of doctors.

In addition to teaching clinical skills, Rahul is keen to give back through his work as an alumni mentor.  He felt that he’d always benefitted from the advice and mentoring of senior clinicians and wanted to do the same for others, so signed up.

Rahul participated in the ‘Ask Alumni’ mentoring program and has completed nearly ten sessions with students. He says that two or three of the people he has mentored have already gone on to undertake physician training at his workplace. This gives him a real sense of satisfaction about building a community and network and watching others progress along their career journey.

“I highly recommend it to anyone who is able to do so. It’s a great way to share your experience and I’ve loved it.”