The Good GP

In this episode, host Dr Krystyna de Lange welcomes Associate Professor Erin McMenimen, a clinical dermatologist with appointments at the University of Queensland Medical School and Princess Alexandra Hospital, to discuss Hidradenitis Suppurativa (HS).

Defining HS as a chronic auto-inflammatory condition, highlighting its similarities to inflammatory bowel disease and psoriasis. A/Prof McMenimen explains the disease's pathophysiology, noting that inflammation starts in the hair follicles and leads to scarring and sinus tract formation. Key associated factors are smoking, obesity, family history, and secondary infections.

They then shift to the signs and symptoms of HS, emphasising the importance of early recognition by GPs. A/Prof McMenimen outlines the diagnostic criteria, focusing on abscesses and boils in body folds and the significance of multiple episodes over time.

She also explains the Hurley staging system used to assess HS severity and describes the impact of HS on patients' quality of life, including pain, mental health issues such as depression and anxiety, and social isolation.

On the topic of management, They covered lifestyle interventions, including avoiding heat and friction, dietary adjustments, and smoking cessation strategies, followed by stepwise medical treatments like antiseptic washes, topical and oral antibiotics, and anti-androgen therapy. She also discusses advanced treatments for severe cases, including intralesional steroids, de-roofing surgery, and biologics like adalimumab and secukinumab.

A/Prof McMenimen underscores the importance of early referral to dermatologists for effective management and better patient outcomes, advocating for a multidisciplinary approach to care.

Links and Resources:

• Dermnet page on HS: https://dermnetnz.org/topics/hidradenitis-suppurativa
• UQ Dermatology Research Centre page on HS: https://dermatology-research.centre.uq.edu.au/research/hidradenitis-suppurativa
• HS Patient Brochure: https://dermatology-research.centre.uq.edu.au/files/1915/HS-patient-education-and-treatment-guide-pamphlet.pdf

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 [email protected].

In this episode, Dr Anna Mullins speaks with Professor Claire Jackson, a professor of general practice and primary care reform at the University of Queensland, about the e-consultation model and its impact on rural healthcare.

Professor Jackson describes the early days of the e-consult model, inspired by a successful program in San Francisco, and how it was initially trialled with positive results at Camp Hill Healthcare. The model, involving advice provided to GPs via a shared electronic medical record and email communication, has since expanded across Western Queensland and includes various clinicians from multiple medical specialties.

Delving into the role of Queensland Health in funding the e-consult model and discusses the importance of scaling the service statewide. Professor Jackson highlights the critical mass of referrals needed for service efficacy, as evidenced by experiences in Canada. She also addresses the challenges faced in getting GPs to notice and use the e-consult service.

They then discuss the broader challenges in general practice, such as administrative workload and funding issues. Professor Jackson reflects on how funding for general practice has evolved over the last 40 years and the current struggle to lobby for affordable support. The conversation emphasises the significance of maintaining a strong patient-GP relationship, especially during changes in practice models, and the unique mentorship and growth opportunities within the profession.

She notes the environmental benefits of e-consults, with a significant reduction in face-to-face visits and carbon footprint in rural areas. Furthermore, over 90% of GPs reported that the e-consult service greatly assisted in their management of cases and provided them with valuable educational advice.

Concluding with a discussion on the expansion plans for the e-consult service and the collaboration with the University of Ottawa to incorporate more specialties, thereby encouraging greater use among GPs.

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 [email protected].

In this episode, host Dr Anna Mullins speaks with Dr Preeya Alexander, a GP based in Melbourne who is passionate about preventative health. Dr Alexander utilises social media to debunk health myths and provide reliable health information to the public. She is also the author of "Rainbow Plate," "Eat Sleep Play Love," and "Full Plate," and the host of the podcast "Happy to Health."

Dr Alexander discusses the motivations behind her social media presence, which began in 2016 as a response to the spread of health misinformation. She shares her experiences managing her clinical practice, media engagements, and the challenges that come with addressing health misinformation online. Despite facing significant negativity from certain groups, including anti-vaccination activists, Dr Alexander remains committed to promoting evidence-based health information.

They also covered her approach to giving practical health advice on social media and her emphasis on preventative health. She highlights the importance of GPs providing small, actionable health tips to their patients, especially in areas like nutrition and physical activity. Discussing her books that focus on parenting and cooking, which provide practical, budget-friendly health advice.

Dr Alexander shares insights into her podcast, "Happy to Health," aimed at the general public. The podcast covers various health topics with expert guests, making complex medical information accessible and engaging for listeners.

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 [email protected]

In this episode, host Dr Tim Koh welcomes back Dr Michael Wright, Chief Medical Officer for AVANT, for an insightful discussion on the future of general practice. Dr Wright brings his extensive experience and perspective, having grown up in a family of GPs and having served as a GP for over two decades.

Dr Wright delves into the evolving landscape of general practice, comparing the experiences of new GP fellows with those of previous generations. He emphasises the importance of defining the scope of practice for GPs, highlighting the need for comprehensive, coordinated, and continuous care. They also address the pressures on Medicare funding and the necessity for alternative funding models to support the sustainability of general practice.

Dr Wright shares his thoughts on technological advancements, such as AI and data integration, which could significantly transform the way GPs provide care. He also touches upon the rise of corporate ownership in general practices and the need to maintain various practice models to serve diverse populations effectively.

Finally, they discuss the future GP workforce, exploring concerns about declining trainee numbers and the steps required to make general practice a more attractive career path for medical students and junior doctors.

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 [email protected]

In this episode, host Dr. Tim Koh, joins Dr. Michael Wright, Chief Medical Officer for Avant to discuss the emerging role of artificial intelligence (AI) in general practice, specifically focusing on AI scribes.

Dr. Wright outlines the benefits and potential risks of integrating AI scribes into medical practice. He highlights how AI scribes can enhance consultation notes by accurately recording patient interactions, thus allowing GPs to focus more on patient care and less on administrative tasks. However, he also points out the medico-legal and privacy considerations that GPs must keep in mind, such as data storage and compliance with state regulations.

Delving into professional and ethical considerations. Dr. Wright advises GPs to thoroughly investigate how AI scribes function, including data handling and storage, and to ensure patient consent is obtained. He also emphasises the importance of verifying AI-generated notes for accuracy before they are saved as part of the patient’s medical record.

They conclude with Dr. Wright's outlook on the future applications of AI in general practice. He envisions AI supporting administrative efficiency, improving billing processes, and potentially revolutionising how patient data is integrated and utilised across healthcare systems. He encourages GPs to approach AI scribes with an open mind, to trial these tools in their practice, and to be mindful of ensuring that the quality and safety of patient care are maintained.

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 [email protected]

In this episode of The Good GP, hosts Dr Tim Koh and Dr Sean Stevens speak with Geoffrey Sayer, CEO of Medtech, at the Digital Health Festival 2024. Geoffrey introduces Medtech, an electronic health record system designed to service practices in Australia and New Zealand, providing a comprehensive patient practice management system (PMS).

Beginning with an overview of Medtech's capabilities and its market presence. Geoffrey highlights the importance of having a flexible and future-proof PMS that allows for customization and integration with other software applications adaptable to the diverse needs of general practices.

Geoffrey explains the concept of APIs (Application Programming Interfaces) and their role in enabling third-party software to interact with Medtech's system. He introduces Medtech’s Application Layer Exchange (ALEX®), a sandbox environment where developers can create and test new applications that integrate with their PMS. This fosters an ecosystem of innovation, allowing practices to customise their systems to meet specific requirements.

Dr Sean Stevens queries about the potential of an app store for PMS, to which Geoffrey acknowledges the growing trend but emphasises the need for standardised APIs to ensure cross-vendor compatibility. They then explore the technical feasibility for GPs to develop or commission customised applications, enhancing their practice management experience.

Geoffrey predicts a hybrid model of PMS combining local servers with cloud-based services, advancements in inbox management, and an increase in AI-assisted functions. He acknowledges the appetite amongst GPs for more innovative, flexible solutions and the role that smarter data integration, particularly with wearable devices, will play in the future.

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 [email protected].

In this episode, host Dr Catherine Bourke is joined by Dr Gill Cowen, a multi-talented expert with roles including a senior lectureship at Curtin Medical School and a clinical research fellow at the Curtin Health Innovation Research Institute, to discuss advancements in concussion management.

Defining concussion and elaborating on the latest Australian Sports Commission concussion guidelines released in February 2024. They covered various aspects of concussion, including preventive measures in sports, the importance of strict adherence to game rules, and the role of mouthguards and helmets. Dr Cowen clarifies that loss of consciousness is not required for a concussion diagnosis and outlines the serious conditions that GPs must not overlook.

Gaining insights into available diagnostic tools such as the post-concussion symptom score, SCAT 6, and the Vestibular Ocular Motor Screening Tool (VOMS). Dr Cowen also updates on current recommendations for post-concussion management, moving away from complete rest and instead advocating for relative rest and limited screen time in the initial 48 hours. They also discussed return-to-play protocols, particularly the revised 14-day symptom-free period before re-engaging in contact sports and a minimum 21-day interval for returning to play.

They emphasise a conservative approach to repeated concussions within a season and acknowledge ongoing research on chronic traumatic encephalopathy (CTE) and its association with repetitive head trauma. Dr Cowen highlights that, in the current absence of predictive tools, a cautious management approach should be employed.

References:

• Concussion guidelines: https://www.connectivity.org.au/clinical-guidance/health-guidelines/
• Concussion Fact Sheets: https://www.connectivity.org.au/guidance-for-clinicians/fact-sheets/
• Free short concussion courses: https://www.connectivity.org.au/courses/
• State Head Injury Unit Concussion Program: https://www.nmhs.health.wa.gov.au/Hospitals-and-Services/Public-Health/Head-Injury/Concussion
• mTBI Healthpathway: https://wa.communityhealthpathways.org/246668.htm
• Vestibular oculomotor screening (VOMS): https://www.youtube.com/watch?v=CJF6kJcFGqE
• Sport-related concussion: https://sma.org.au/resources/concussion/

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 [email protected].

In this episode of The Good GP, host Dr Anna Mullins welcomes back Dr Chris Conyard, an upper limb surgeon based in Brisbane, to discuss elbow tendinopathies. He shares his expertise on the natural history of elbow tendinopathies, their examination, and effective management strategies.

They begin with an overview of elbow tendinopathies, including their prevalence, clinical presentation, and challenges associated with treatment. Dr Conyard highlights the importance of rest and specific eccentric loading exercises in rehabilitation and explains the typical clinical course.

Delving into the physical examination of the elbow, touching on specific tests such as Cozen's test to diagnose tennis elbow and techniques for identifying golfer's elbow. They discuss the relevance of imaging in diagnosis, specifically when it should be considered, particularly in cases of suspected arthritis or when initial management fails.

Dr Conyard also provides valuable insights into non-operative management, including the use of topical NSAIDs, physiotherapy, and braces. He advises caution against steroid injections and suggests PRP injections as a potential second-line treatment. Concluding with advice on when to refer patients to specialists and the utility of specific imaging and nerve conduction studies.

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 [email protected]

In this episode, Dr Anna Mullins speaks with Dr Chris Conyard, an orthopaedic surgeon with a fellowship in upper limb surgery, about the management of rotator cuff tears and frozen shoulders.

Dr Conyard sheds light on the natural history of shoulder conditions, particularly the prevalence and progression of rotator cuff tears. He highlights the significance of various risk factors, including hand dominance, manual labour, diabetes, and smoking. Dr Conyard also discusses the impact of muscle atrophy and fatty infiltration on surgical outcomes.

Providing a detailed overview of the shoulder examination for rotator cuff tears, covering essential tests such as the supraspinatus test, external rotation test, and subscapularis tests. Dr Conyard emphasises the role of functional assessment and the importance of early intervention in acute tears.

They also covered imaging and first-line treatments, including the use of steroid injections. Dr Conyard explains when to consider steroid injections and the implications of repeat injections. He offers guidance on when GPs should refer patients to specialists, particularly in cases of acute tears, symptomatic progression, and failed non-operative interventions.

Dr Conyard addresses the management of frozen shoulder, highlighting the usefulness of steroid injections and hydrodilatation, particularly in the initial phases of the condition. He also discusses when to consider referral for surgical interventions such as manipulation under anaesthesia (MUA) and arthroscopic release, backed by evidence from the UK Frost Trial.

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 [email protected]

In this episode, Dr Krystyna de Lange is joined again by Dr Allison Hempenstall, a General Practitioner and Public Health Physician from Far North Queensland, to discuss acute post-streptococcal glomerulonephritis (APSGN).

Dr Hempenstall begins by defining APSGN and explaining how it is an acute autoimmune kidney condition triggered by a group A strep (GAS) infection. She elaborates on the socio-economic risk factors and the presence of nephrotoxic strains of group A strep that increase susceptibility to APSGN. Comparison is made with acute rheumatic fever, noting both similarities and differences.

Covering the classic triad of symptoms for APSGN – hypertension, haematuria, and oedema – and how to diagnose the condition through clinical presentations and laboratory investigations. Dr Hempenstall explains the importance of identifying haematuria through urine analysis and performing necessary tests for recent strep infections and complement levels (C3 and C4).

They then move to the appropriate management strategies, including the use of intramuscular penicillin for eradicating strep and symptom management through antihypertensives and fluid management. Dr Hempenstall emphasises the necessity of involving paediatricians for cases requiring hospitalisation and mentioning that any persistent hypertension in children should be addressed promptly.

Lastly, outlining longer-term follow-up protocols, stressing the importance of regular blood pressure and urine checks post-diagnosis and the role of health education in preventing future occurrences. Special attention to the importance of contact tracing and prophylactic measures for household contacts in order to curb the spread of nephrotoxic strains of group A strep.

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 [email protected]