In this week’s episode, the Good GP interviews radiologist, Dr Brendan Adler once again to discuss chest imaging tests and chest imaging nodules.

We explore the types of imaging tests and the role they play in the diagnostic process. Brendan also covers chest nodules, the causes, risks, features to look out for and guidelines for follow-up. 

Dr Adler is a radiologist and CEO of Envision Radiology. Brendan has a special interest in thoracic, musculoskeletal and cardiac imaging.

Chest imaging and chest nodules – Episode 97

The Good GP, the education podcast for busy GPs; brought to you by Dr Tim Koh, Dr Krystyna DeLange and Dr Sean Stevens.

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In this episode of The Good GP, guest host Dr Catherine Bourke engages with Dr Desmond Chih, an esteemed infectious disease physician and microbiologist, in a comprehensive discussion about tuberculosis (TB). Dr Chih offers an in-depth exploration of the distinctions between latent and active tuberculosis, drawing from his extensive experience at Western Diagnostics Pathology, St John of God Hospital, and Royal Perth Hospital. Focusing on the fundamental differences between latent TB, which involves a non-symptomatic infection contained by the immune system, and active TB, which is characterised by symptoms such as a prolonged cough, fevers, weight loss, and lymph node enlargement. Dr Chih elaborates on the diagnostic techniques, including the Tuberculin skin test and the QuantiFERON-TB Gold test, utilised to detect these conditions. They then shift the discourse to the epidemiology of TB in Australia, discussing the incidence of active and latent TB predominantly among migrants and the crucial public health responses required. They also touch upon the global concerns related to TB, such as multidrug-resistant strains, and the implications these have on both treatment and containment strategies. Addressing prevention strategies, particularly the importance of screening for latent TB in individuals who are about to undertake immunosuppressive therapies. The specialists responsible for prescribing these treatments are noted for their diligence in preemptive screenings to prevent the activation of latent TB infections. 
 Lastly, the conversation covers the management of active TB, reaffirming the use of the conventional four-drug regimen while also mentioning newer drug alternatives for resistant strains. Concluding with Dr Chih responding to listener questions about the risk factors and treatment options specific to various TB scenarios, providing a well-rounded perspective on managing this significant global health issue. 
 The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network 
 If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com Mentioned in this episode: Proudly supported by Medtech Global: The Good GP Podcast is sponsored by Medtech Global, they help GPs be GPs by working with clinicians in Australia and New Zealand to develop Patient Management Systems and healthcare technology. Visit the link for more information:  Medtech Global

Exploring Tuberculosis: A Deep Dive with Infectious Disease Expert Dr. Desmond Chih

In this episode of The Good GP, host Dr Tim Koh welcomes distinguished guest Professor Chan Cheah, a clinical and laboratory-based haematologist with a special interest in lymphoma. Professor Cheah, who practises at Sir Charles Gairdner Hospital and works with Western Diagnostic Pathology, explores the challenges and considerations of managing thrombocytopenia in general practice. Professor Cheah begins by explaining what thrombocytopenia is and discusses its prevalence. He addresses common causes and sheds light on the pitfalls like pseudothrombocytopenia—where an artificial drop in platelet counts occurs due to platelet clumping in EDTA-treated tubes. Important advice is shared on how a different anticoagulant, such as citrate, can be used to overcome this issue. He also explains the various age-related factors that should guide a GP's differential diagnosis process and details how different conditions might mimic or contribute to thrombocytopenia. He discusses important associated conditions such as Immune Thrombocytopenic Purpura (ITP), medication-induced reductions, and other infections that can manipulate platelet counts. They then pivot to the necessary diagnostic steps and laboratory investigations that are vital in assessing a patient with low platelets. Professor Cheah rounds off the discussion by covering urgent conditions like thrombotic microangiopathies and other haematological abnormalities, stressing the importance of urgent and precise diagnosis in severe scenarios. 
 Join Professor Chan Cheah in uncovering the critical aspects of diagnosing and managing low platelet counts, a commonly encountered yet complex issue in general practice. 
 If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com 
 The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network Mentioned in this episode: Proudly supported by Medtech Global: The Good GP Podcast is sponsored by Medtech Global, they help GPs be GPs by working with clinicians in Australia and New Zealand to develop Patient Management Systems and healthcare technology. Visit the link for more information:  Medtech Global

Identifying and Treating Thrombocytopenia: Expert Advice for GPs

In this episode, host Dr Sean Stevens welcomes Dr Michael Clements and Dr Kaylene Girgenti to discuss the practicalities and benefits of rural GP outreach. Dr Girgenti is a GP obstetrician with a unique practice split between Townsville and remote Karoombara Health Centre, which she commutes to by plane. Dr Clements is not only a pilot but also the Vice President of the RACGP, Chair of the Rural Faculty, and a practice owner of Clements Medical in Townsville and Magnetic Island. Dr Girgenti shares her motivations behind taking on rural work, emphasising the diversity and fulfilment it adds to her practice, alongside the notable appreciation from the communities she serves. She encourages early career GPs to seek diversity and engage with diverse work environments that rural practice presents. 
 Dr Clements discusses the journey of integrating remote services into his practice, explaining the initial challenges and the rewards that result from providing critical services to underserved areas. He outlines the strategic approach to adopting a rural clinic from the perspective of an urban practice and the role of funding and clinical governance. 
 They also touched upon the dynamics of GP service in rural areas, including the importance of continuity of care and the value it brings to both the community and the healthcare provider. 
 Concluding with advice for urban GPs looking to extend their services to rural communities, highlighting the potential of such a model for adding excitement, scope, and a sense of mission to their practice. 
 The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network 
 If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com Mentioned in this episode: Proudly supported by Medtech Global: The Good GP Podcast is sponsored by Medtech Global, they help GPs be GPs by working with clinicians in Australia and New Zealand to develop Patient Management Systems and healthcare technology. Visit the link for more information:  Medtech Global

From City to Country: Michael Clements and Kaylene Girgenti on Adopting Rural Clinics

In this episode of The Good GP, host Dr Sean Stevens along with Dr Rebecca Goadby interview Dr Alison Creagh, renowned for her expertise in intimate partner violence and contraceptive management. Alison addresses managing the side effects of long-acting reversible contraceptives (LARCs), focusing on contraceptive implants and intrauterine devices (IUDs). Alison discusses the common issue of unpredictable bleeding with contraceptive implants, providing detailed insights into identifying potential causes, assessing the pattern of bleeding, and discussing management options with patients. She highlights the significance of ruling out abnormal causes and offers a range of strategies, including reassurance, combined pill usage, anti-inflammatory and hormonal options, and considering alternative contraceptives, if necessary. Additionally, she provides guidance on addressing weight gain, headaches, loss of libido, and concerns around fertility associated with long-acting contraceptives, dispelling myths and offering practical advice to reassure patients. Their discussion then delves into challenges related to IUD insertions, addressing potential pain, bleeding, and cramping post-insertion. Alison outlines strategies for pain management during insertion, discusses the normality of bleeding patterns post-insertion, and shares management options for heavier bleeding or cramping.  The conversation concludes with Alison demystifying fertility concerns associated with LARCs, providing clarity on the rapid return to normal fertility post-discontinuation of contraceptive methods. The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialization. Learn more at www.talkinghealthtech.com/podcast/network If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com Mentioned in this episode: Proudly supported by Medtech Global: The Good GP Podcast is sponsored by Medtech Global, they help GPs be GPs by working with clinicians in Australia and New Zealand to develop Patient Management Systems and healthcare technology. Visit the link for more information:  Medtech Global

LARCs: Navigating Side Effects and Fertility Concerns with Dr Alison Creagh

In this episode of The Good GP, Dr Sean Stevens and Dr Rebecca Goadby welcome Dr Alison Creagh to discuss the differences between older progesterone-only pills - such as levonorgestrel and norethisterone - and the newer drospirenone ones. Alison outlines how the older pills primarily work through cervical mucus and, to some extent, blocking ovulation, while the newer drospirenone pills are more effective at blocking ovulation and have a wider window of time for pill intake. The impact on bleeding is also highlighted, with the drospirenone pills leading to more regular bleeding during the withdrawal section. Discussing the cost and payment options for the different pills, with the older pills being more cost-effective for those with healthcare cards, while the newer ones are more forgiving in terms of timing. Additionally, contraindications and missed pill windows for the two types of pills are explored, with specific attention to potassium levels in relation to the newer drospirenone pills. Alison further delves into the advice for the missed pill window and the potential side effects for both types of progesterone-only pills. The variability in individual responses to these pills is highlighted, as well as the potential need to try different types if hormonal side effects arise. The episode concludes with Sean Stevens thanking Alison Creagh for her valuable insights and highlighting the important takeaways from the discussion. The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialization. Learn more at Talking HealthTech. If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com Mentioned in this episode: Proudly supported by Medtech Global: The Good GP Podcast is sponsored by Medtech Global, they help GPs be GPs by working with clinicians in Australia and New Zealand to develop Patient Management Systems and healthcare technology. Visit the link for more information:  Medtech Global

Chest imaging and chest nodules – Episode 97

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