The Good GP

In this episode of The Good GP, host Dr Krystyna de Lange is joined by Dr Allison Hempenstall, a General Practitioner and Public Health Physician from Far North Queensland, to discuss acute rheumatic fever and rheumatic heart disease.

Dr Hempenstall begins by defining acute rheumatic fever as an immunological response to group A streptococcus, which can lead to a constellation of symptoms impacting the heart and joints. She explains the progression from acute rheumatic fever to rheumatic heart disease, a condition characterised by permanent valvular damage to the heart following of acute rheumatic fever.

Outlining the symptoms and diagnostic criteria for acute rheumatic fever, referencing the Jones criteria and the helpful tools available such as the Rheumatic Heart Disease Guidelines and the ARF and RHD app. She also provides insight into the criteria's major and minor manifestations, including carditis, polyarthritis, Sydenham’s chorea, Erythema marginatum, subcutaneous nodules, fever, elevated inflammatory markers, and prolonged PR interval on ECG.

Highlighting the necessary steps for diagnosing acute rheumatic fever, including auscultating the heart, documenting fever, performing a 12-lead ECG, and obtaining relevant blood tests. The need for bedside documentation and comprehensive differential diagnosis is also covered.

In terms of management, Dr Hempenstall focused on creating a culturally safe environment and initiating treatment for suspected acute rheumatic fever promptly. This includes administering intramuscular penicillin and managing symptoms with paracetamol, with specialist consultation as needed. She also stresses the importance of early echocardiograms and the involvement of public health units.

For long-term management, Dr Hempenstall discussed the necessity of secondary prophylaxis with penicillin injections and regular echocardiograms. She emphasises the continuing role of primary care practitioners in follow-up care, ensuring adherence to prophylaxis schedules, and coordinating ongoing specialist reviews and yearly dental checks.

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 Krystyna de Lange welcomes back Dr Tim Jones, a General Practitioner and medical educator with a special interest in general paediatrics. Dr Jones shares his expertise on toddler sleep challenges, providing valuable insights and practical advice for GPs on how to address common sleep issues in young children.

Dr Jones discusses the variability of toddler sleep, emphasising the importance of sleep quality over quantity. He explains that while the average three-year-old requires about 12 hours of sleep per night, this can range from as little as nine hours to as much as 15 hours. The focus is on ensuring that the child is happy, healthy, and well-rested.

Dr Jones talks on the common presentations of toddler sleep issues in a general practice setting. He discusses the importance of thorough history-taking and screening for underlying medical conditions that might affect sleep, such as obstructive sleep apnea, eczema, and allergies. He emphasises the role of family dynamics, daytime sleep patterns, screen use, sugar intake, and physical activity in influencing sleep behaviour.

Various sleep strategies are explored, including addressing nighttime fears, managing dependency on specific items or people, and handling early morning wake-ups. Dr Jones highlights techniques like worry boxes, monster traps, and the "camping out" method to help children feel safe and transition to independent sleep.

Addressing the cautious use of pharmacological interventions, particularly melatonin, emphasising the lack of long-term safety data and potential side effects. He advises focusing on behavioural and environmental techniques before considering medication.

Dr Jones shares a valuable resource for practitioners: the Murdoch Children's Research Institute's "Sleep with Kip" website,

(https://sleepwithkip.com/) which offers evidence-based resources to support early childhood sleep.

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 continues the conversation on menopause with Dr Marita Long, discussing pharmacological management for troublesome menopausal symptoms.

Dr Long begins by addressing non-hormonal pharmacological options for women who either cannot use hormones or choose not to. She covers medications such as SNRIs (Venlafaxine or Desvenlafaxine), SSRIs, Gabapentin, Clonidine, and introduces Fesolinatant, a new treatment option recently approved by the TGA.

They then shift to hormonal menopause replacement therapy (MHT). Dr Long outlines which patients are suitable for hormonal therapy and which are not. She explains the different regimes, including cyclical and continuous treatment, emphasising the importance of matching therapy to the patient's specific needs based on their menopausal status and the presence of a uterus.

Covering the variety of hormone delivery methods available, such as oral, patches, and gels, noting the benefits and considerations of each form. Highlighting the importance of tailoring the approach to the patient's risk profile, particularly concerning cardiovascular health and breast cancer risk.

They concluded with Dr Long recommending effective resources such as the Australasian Menopause Society and Jean Hales for Women's Health, providing valuable information for both healthcare professionals and patients.

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 Podcast, host Dr Krystyna de Lange welcomes back Dr Marita Long to discuss the important topic of menopause. With her extensive experience in women's health, Dr Long provides clear and concise definitions that help demystify the terminology surrounding menopause.

Explaining key terms such as menopause, perimenopause, premature menopause, and premature ovarian insufficiency. She outlines the clinical nuances and the symptomatic variations that can occur during these different stages. Providing an in-depth look at the symptoms that women may experience during the perimenopause to post menopausal transition, including mood changes, sleep disturbances, hot flashes, and cognitive changes like brain fog.

Moving into the assessment phase, Dr Long dives into the appropriate investigations and when they are indicated. She emphasises the importance of a comprehensive evaluation for women in the midlife phase, noting when hormonal evaluations might be necessary and when they can be misleading or unneeded.

The discussion also covers non-pharmacological management strategies, focusing on lifestyle modifications such as exercise, diet, stress management, and self-care practices. Dr Long highlights how interventions like cognitive behavioural therapy (CBT) and certain lifestyle changes can alleviate symptoms and improve overall well-being during this critical time.

They aim to equip general practitioners with the knowledge and tools needed to support women going through menopause more effectively and empathetically, reinforcing the importance of individualised care and thorough assessment.

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 Sean Stevens and Dr Tim Koh are joined by Dr Chanika Ariyawansa, a WA-trained chemical pathologist with additional training in genetic pathology. Dr Ariyawansa, who holds significant roles in the Australian Association of Clinical Biochemistry, delves into the nuances of liver function tests (LFTs), exploring patterns and implications of abnormal results.

Firstly, with an examination of the prevalence and general patterns of abnormal LFTs, highlighting the commonality of mild and transient abnormalities. Dr Ariyawansa clarifies common misconceptions regarding LFTs, emphasising that not all markers in the standard LFT panel are liver-specific or directly assess liver function.

They also explain in detail individual LFT components such as bilirubin, ALP, GGT, AST, and ALT. The guest expert also categorises potential abnormalities into hepatocellular, cholestatic, mixed, and non-hepatic causes, with practical insights on each. Special attention is given to non-hepatic causes, analytical causes, and how these might influence LFT interpretation.

Dr Ariyawansa's expertise shines as she discusses managing patient anxiety around abnormal LFT results and the practical aspects of educating patients about their liver health. She stresses the utility of resources such as the Pathology Tests Explained website for patient education.

Wrapping up with an engaging Q&A session addressing specific scenarios like non-drinking patients with isolated raised GGT and the impact of statins on LFTs. She answers with clinical relevance, offering listeners practical strategies for understanding and communicating complex test results in 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 [email protected].

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 [email protected]

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 [email protected]

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

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 [email protected]

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 [email protected]

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 [email protected]