The Good GP

In this episode of The Good GP, Dr Madhur Ravikumara (Ravi), a paediatric gastroenterologist, joins host Dr Sean Stevens to discuss the topic of Helicobacter pylori (H. pylori) infection in children. 

Dr Ravi explains the differences between H. pylori infection in children and adults, highlighting that most children with this infection are asymptomatic. He emphasises that there is no evidence to support treating or eradicating H. pylori in children unless they have peptic ulcer disease. Dr Ravi also discusses the low risk of complications, such as peptic ulcer disease and gastric malignancies, in children with H. pylori infection.

Dr Ravi further explains that the current paediatric guidelines strongly recommend against the test and treat strategy for H. pylori in children. He emphasises that the primary goal of investigating GI symptoms in children is to find the cause and manage it, but there is no specific clinical symptom that indicates the presence of H. pylori. Therefore, routine testing for H. pylori in children is not recommended.

The episode delves into the potential beneficial effects of H. pylori in the stomach lining, such as protection against allergic conditions like asthma, eczema, and eosinophilic esophagitis, as well as a potential inverse relationship with the development of inflammatory bowel disease. Dr Ravi highlights that while these associations do not necessarily indicate causation, experiments have shown specific benefits of H. pylori in mitigating inflammatory bowel disease.

The episode concludes with Dr Ravi addressing the question of when to treat H. pylori in children and the need for further research to determine follow-up protocols and risk factors for gastric cancer in those with H. pylori infection.

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]

Links & Resources:

Helicobacter pylori in children: think before you kill the bug!

Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)

In this episode of The Good GP, host Dr. Sean Stevens continues the discussion on interventional pain management with guest Dr. Robin Park, a GP and pain specialist.

Head back to episode 140 of this podcast to catch up on part 1 of this discussion.  

In this episode, Robin continues to provide insights on the role of radiologists in performing procedures such as CT-guided interventions and emphasises the importance of clinical expertise in interpreting radiology reports. 

He also highlights the need for a multidisciplinary approach and the role of GPs in organising a patient's care before referring to a radiologist or pain specialist.

Robin discusses the types of procedures that radiologists can comfortably perform, including epidural guided injections and nerve root sheath injections. He mentions that some radiologists may also perform radio frequency ablation, although it is less common. He advises that GPs should be comfortable diagnosing and managing the condition before referring to a radiologist. He also mentions the availability of additional training for GPs in musculoskeletal medicine through organisations like the Australian Association of Musculoskeletal Medicine.

The conversation then shifts to the signs that indicate a patient is unlikely to benefit from interventional procedures. Robin highlights the importance of patient motivation and engagement in their own care. Unrealistic expectations and the desire for a complete elimination of pain are factors that may indicate a patient is unlikely to benefit from a procedure.

Robin stresses the importance of effective communication in managing patient expectations and helping them understand the limitations of interventional procedures. He emphasise the need for a comprehensive approach that includes psychological support, physiotherapy, and occupational therapy in conjunction with interventions.

To learn more about interventional pain management and the role of radiologists and pain specialists, tune in to this informative episode of The Good GP.

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, Dr Robin Park, a GP pain specialist, joins host Dr Sean Stevens to discuss procedures in pain management, in part 1 of a 2 part discussion.

Robin shares his insights on common procedures and how GPs can determine who is likely to benefit from them.

Robin emphasises the importance of a comprehensive approach to pain management, which includes education, allied health input, and pharmacological management. 

He stresses the need to view procedures as part of a larger plan that involves rehabilitation. Procedures, such as injections, provide a window of opportunity for patients to engage in rehab and improve their quality of life.

Robin also highlights the importance of managing patient expectations. While patients may desire a quick fix, it is crucial to communicate that procedures alone are not a cure-all. Rehabilitation and hard work are essential components of effective pain management.

Throughout the episode, Sean and Robin discuss various diagnostic procedures, such as diagnostic blocks, that can help confirm the source of pain. These procedures involve injecting local anaesthetic near specific nerves to determine if the pain is alleviated, thus providing diagnostic insight.

Tune in to this educational episode of The Good GP to learn more about procedures in pain management and how they can be integrated into a comprehensive approach to patient care.

Listen out for the second part of this discussion, in an episode to be released next on this feed.

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, Dr Sean Stevens speaks with Dr Tilman Ruff, an infectious diseases and public health physician, where they discuss the alarming risks of nuclear war and the role of health professionals in preventing it. 

Dr Ruff sheds light on the significant threat posed by nuclear weapons and the urgent need for action to prevent their catastrophic consequences. Drawing attention to the recent movement of the Doomsday Clock, Dr Ruff explains the various factors contributing to the elevated risk, including geopolitical conflicts, failure of disarmament efforts, global climate change and escalating cyberwarfare. He emphasises the responsibility of health professionals to advocate for nuclear disarmament and highlights the impact that evidence-based advocacy can have in achieving reductions in nuclear arms.

Throughout the episode, Dr Ruff emphasises the importance of informed discussions and education on the risks of nuclear war. He urges health professionals, medical organisations, and individuals to engage in conversations about this critical issue, integrating it into teaching and organisational activities. Dr Ruff also highlights the potential impact of divestment from companies involved in nuclear weapons production, encouraging listeners to consider moving their funds to institutions that align with their values.

As the episode concludes, Dr Stevens and Dr Ruff emphasise the need for collaboration and engagement at all levels, from individuals to governments. They encourage listeners to support organisations like the Medical Association for Prevention of War and engage with local, state, and federal government levels to advocate for nuclear disarmament and the protection of global health.

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 is joined by Dr Alison Archibald, a Certified Genetic Counsellor at the Victorian Clinical Genetic Services, to discuss noninvasive prenatal testing (NIPT). 

NIPT is a screening test that looks at small pieces of DNA in the maternal blood to identify chromosome conditions in the foetus. This test can be done from about 10 weeks gestation onwards, and it can detect conditions like Down syndrome, trisomy 18, and trisomy 13. It can also determine foetal sex and screen for a wider range of chromosome conditions through genome-wide NIPTs.

Dr Archibald explains that NIPT can be offered to all pregnant women, but it's important to understand that it is a screening test and not diagnostic. False positive and false negative results can occur due to the analysis of placental DNA instead of foetal DNA. Diagnostic tests like amniocentesis should be offered to confirm any chromosome conditions indicated by NIPT. Furthermore, NIPT does not detect genetic conditions caused by smaller changes in DNA or single gene conditions.

The discussion also touches on the differences between NIPT and combined first trimester screening (CFTS). While NIPT is a more advanced screening test with higher sensitivity and lower specificity, CFTS is still a good alternative if the cost of NIPT is a concern. It is important for patients having NIPT to also undergo the 12-13 week ultrasound to assess foetal anatomy. Dr Archibald emphasises the significance of offering the ultrasound alongside NIPT to avoid missing any foetal abnormalities early on.

In terms of counselling patients about NIPT, Dr Archibald suggests explaining that it is a screening test with false positive and false negative results. Patients should be aware of the limitations of NIPT and understand what it does not cover. It is important to discuss the need for diagnostic tests if NIPT indicates an increased chance of a chromosome condition. Ultimately, the goal is to provide patients with comprehensive information about NIPT so they can make informed decisions.

Resources mentioned in this episode:

• NIPT 101 (resource for practitioners):  https://rise.articulate.com/share/ENEMgJZ0gB6_HRctkNu7cH3mpWMtO74g#/lessons/hw6hg1a8XFU-vCZzL5HC4b3BpYYzAHzd
•  Your choice decision aid (for patients): https://yourchoice.mcri.edu.au
• Down Syndrome Queensland practice resource (for practitioners) https://prenatalscreening.org.au/resources/prenatal-screening-practice-resource/
• One screened every minute: https://onescreenedeveryminute.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

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 speaks with Dr Michelle Dutton, the inaugural chair of the newly established Trans and Gender Diverse Healthcare Specific Interest Group (SIG) at the RACGP. 

Dr Dutton shares the goals of the SIG, which revolve around creating a safe and accepting environment for trans and gender diverse people to receive healthcare and empowering GPs to provide comprehensive care. The episode explores the need for upskilling in this area and provides a range of resources, including the trans and gender diverse healthcare page on GP learning and TransHub, a user-friendly resource for clinicians and patients. 

Dr Dutton also highlights the importance of joining the SIG to stay updated on educational opportunities.

The conversation also explores the challenges in gender diverse care, with a focus on combating disinformation and stigma surrounding trans identities. Dr Dutton reassures GPs that GP-led care for trans adults, including gender affirming hormone therapy, is supported by major national and international organisations. The episode concludes with a discussion on the power of simple gestures, such as using correct names and pronouns, in making trans patients feel safe and cared for.

To join the Trans and Gender Diverse Healthcare Specific Interest Group (TGD SIG) 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

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 is joined once again by Dr Tim Jones, a GP in Hobart with a special interest in general paediatrics. 

The topic of discussion is nocturnal enuresis or bedwetting in children. 

Dr Jones shares insightful information about the commonality of bedwetting, explaining that by the age of four, one in three children still experience bedwetting, with the numbers decreasing as they get older. 

Dr Jones emphasises the importance of addressing the social and emotional impacts of bedwetting, even though it tends to resolve naturally over time.

Dr de Lange asks Dr Jones about his approach to taking a history and conducting an examination when families seek help for bedwetting. Dr Jones highlights the significance of understanding whether bedwetting is a new concern or has always been present, as this can determine the underlying cause. He also discusses the importance of looking for associated conditions such as polydipsia, polyuria, constipation, and obstructive sleep apnea. Dr Jones concludes his explanation by outlining the key aspects of his examination, including palpating the child's abdomen, considering a genital exam, and assessing for signs of spina bifida or tethered cord.

Moving on to management, Dr de Lange asks Dr Jones about the general advice he gives to families once primary bedwetting with no underlying causes has been established. Dr Jones stresses the importance of understanding the parent's perception of bedwetting and tailoring the advice accordingly. He highlights the need to reassure parents that bedwetting is normal and not caused by anything the child is doing. Quoting statistics about the prevalence of bedwetting can help normalise the situation for families. Dr Jones and Dr de Lange also discuss the fact that in many cases, the child themselves are not overly worried about bedwetting unless it has been made a big issue within the family. Reassurance and de-stigmatization are often enough to alleviate concerns.  Dr Jones also shares his perspectives on medication management and when medications like Desmopressin and other medications might be prescribed.  

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 continues her conversation with Dr Tim Jones about the management of behavioural challenges in paediatric populations. 

Dr Jones emphasises the importance of focusing on one issue at a time in order to make a positive difference in the child and family's day-to-day wellbeing. He also encourages GPs to provide safe and supportive spaces for families, advocating for the child's voice and collaborating with allied health supports and learning environments. 

Additionally, Dr Jones discusses the value of parenting courses such as the Circle of Security program and the Positive Parenting Program, as well as the accessibility of parenting podcasts for busy families seeking additional information and support.

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, Dr Krystyna de Lange is joined by Dr Tim Jones, a GP based in Hobart with a particular interest in paediatrics. The focus of today's episode is on the assessment of behavioural challenges in children. Dr Jones discusses the impact of the pandemic on the mental and emotional well-being of children and families, as well as the challenges faced by primary care physicians in providing support and assistance.

Dr Jones shares the various behavioural challenges he has seen in his practice, including difficulties with school reintegration, social fear, and meltdowns, among others. He emphasises the importance of taking a comprehensive approach to assessment and acknowledges the need for dedicated time and space to appropriately address these challenges.

Dr de Lange and Dr Jones also discuss the importance of building rapport with the child and their family during the consultation. Recognising that families may already be overwhelmed, Dr Jones emphasises the need to focus on incremental progress and addressing the most pressing issues.

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/networkIf 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 interviews Associate Professor Karen Flegg, the President elect of WONCA. They discuss the upcoming WONCA conference in Sydney and why it's a special occasion for Australian GPs, being the 50th anniversary of the Melbourne conference. Karen shares her excitement about meeting colleagues from around the world and attending workshops and sessions to learn from international GPs. She also highlights the importance of environmental issues and the support of WONCA's Working Party on the Environment. The episode concludes with a discussion on how WONCA supports general practice education globally and advocates for the role of GPs in primary healthcare.

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]