The Good GP

In this episode, host Dr Maria Li is joined by Dr Parth Shah, an adult and paediatric ophthalmologist based in Canberra and Sydney, to discuss paediatric squints, also known as paediatric strabismus.

Beginning with an overview of why paediatric squints can seem daunting for general practitioners, and the importance of a systematic approach to assessment. Outlining GPs responsibilities when encountering a child with possible eye misalignment: diagnosing whether a true squint or pseudo-squint is present, assessing visual function, and determining the urgency of referral to a specialist.

Practical steps for eye examination in babies, particularly at the routine six-week check. Dr Parth Shah offers guidance on inspecting eye alignment, performing the corneal reflex test using a pen torch or ophthalmoscope, and checking the red reflex to rule out conditions such as congenital cataract.

As babies develop, the use of dynamic tests such as the cover test becomes more reliable, generally from three to six months of age, allowing for assessment of fixation and equal visual development between the eyes. GPs are advised to initiate urgent referral at any stage if there is concern about poor visual function, abnormal red reflex, or significant limitations in eye movement.

Further exploring referral processes, noting that detailed documentation of GP observations, supported by photos or videos from parents, greatly assists ophthalmology triage and assessment.

Links & Resources:

1. http://www.squintclinic.com/
2. https://www.schn.health.nsw.gov.au/eye-problems-children-factsheet
3. https://www.aapos.org/resource-catalog/educational-resources
4. https://medicinetoday.com.au/mt/2017/april/feature-article/assessing-eye-problems-children – GPs can access this article via a free online Medicine Today subscription.

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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode, host Dr Sean Stevens is joined by Dr Paul Effler, Senior Medical Advisor at the WA Department of Health and Adjunct Dr at the University of Western Australia. Dr Effler is an experienced public health physician with extensive expertise in vaccine safety surveillance and has been a longstanding member of the WHO Global Advisory Committee for Vaccine Safety.

They explore the use of intranasal vaccines for influenza and COVID-19, which are now available in Australia. Dr Effler explains the mechanistic advantages of intranasal vaccines compared to traditional intramuscular injections, highlighting their ability to create mucosal immunity at the site where respiratory pathogens enter the body. Offering the dual possibility of preventing both clinical infection and onward transmission which is a key public health benefit.

Practical aspects of administering intranasal vaccines in general practice are discussed, including ease of use, absence of sharps and associated risks, and specific technique considerations.

Looking ahead, they also covered potential future developments in intranasal immunisation, including vaccines for RSV and pertussis, and the promise of platforms that do not rely on live attenuated virus. Dr Effler describes emerging models of self-administration and the possible implications for increasing vaccine uptake, while reaffirming the ongoing role of GPs in supporting safe and effective immunisation.

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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of This Could Save Your Life Podcast, hosts Dr Catherine Bourke and Dr Anna Mullins discuss Chlamydia trachomatis, the most common sexually transmitted infection (STI) in Australia. Providing an in-depth, evidence-based overview tailored for general practitioners.

Key discussion points include:

1. Epidemiology: Chlamydia remains highly prevalent in Australia, with over 100,000 recorded cases in 2024. The majority of cases occur in individuals aged 15 to 29.
2. Clinical Presentation: The infection is frequently asymptomatic, with 85-90% of individuals not displaying symptoms. When present, symptoms can include vaginal or penile discharge, dysuria, pelvic pain, testicular pain in men, intermenstrual or post-coital bleeding in women, and, less commonly, conjunctivitis and reactive arthritis.
3. Complications: Untreated chlamydia can result in serious complications such as pelvic inflammatory disease (PID) and infertility in women, epididymo-orchitis in men, and other sequelae including ectopic pregnancy, premature birth, and low birth weight in affected pregnancies.
4. Screening Recommendations: Outlining current Australian guidelines, recommending annual opportunistic screening of all sexually active women under 25, women with new partners over 25, sexually active men based on individual risk, anyone who requests screening, and individuals with a history of STIs or higher risk exposures.
5. Treatment: Uncomplicated chlamydia is typically treated with a one-week course of doxycycline. Complicated or extra-genital infections may require longer courses or intravenous antibiotics.
6. Contact Tracing: The importance of notifying and treating recent sexual partners (up to six months prior), offering tools such as anonymous online partner notification services to aid this process.
7. Prevention: Reinforcing the importance of barrier protection and patient education to reduce STI transmission.

This Could Save Your Life Podcast is under The Good GP podcast, 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 of The Good GP, host Dr Tim Koh is joined by Dr Jeff Ecker, an orthopaedic surgeon with over 35 years of experience specialising in complex hand and wrist conditions. Focusing on the assessment and management of finger fractures, an injury commonly encountered by general practitioners, but often associated with diagnostic dilemmas and management challenges.

Dr Ecker highlights the potential seriousness of finger fractures, noting that even minor injuries can result in permanent impairment, significant hand dysfunction, and long-term complications if not managed appropriately. Discussing the importance of maintaining a high index of suspicion with finger injuries, recognising that early recognition and appropriate follow-up are essential to achieving optimal outcomes.

Providing the typical types of finger fractures and their clinical features. Subungual hematoma and associated terminal phalanx fractures. Mallet finger deformities (with and without fractures). PIP (proximal interphalangeal) joint injuries and their complications, such as boutonniere and swan neck deformities. Along with less common injuries around the MCP (metacarpophalangeal) joint

Dr Ecker provides practical tips for clinical assessment, stressing the importance of plain X-rays in all suspected cases, and the utility of CT scans or ultrasound if there is diagnostic uncertainty or persistent symptoms. He also addresses when to refer to a specialist, focusing on signs of instability, articular involvement, or tendon injury.

The episode concludes with practical advice on materials and techniques for conservative fracture management, with an emphasis on working closely with qualified hand therapists and prioritising early functional use.

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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP Podcast, host Dr Tim Koh is joined by Dr Jeff Ecker, an experienced orthopaedic surgeon based in Perth, to discuss the complexities of assessing and managing wrist conditions in general practice.

Dr Ecker outlines the importance of a thorough history and clinical assessment in patients presenting with wrist pain, emphasising that pain may originate from structures beyond the wrist itself, such as the distal radioulnar joint or even referred from the neck. He highlights common causes of wrist pain that GPs are likely to encounter, including arthritis, ligament injuries, and overuse conditions, and discusses the challenges associated with diagnosis.

Focusing on wrist arthritis, as a common cause of pain in older patients. He described key clinical features and examination findings, alongside considerations for distinguishing arthritis from other conditions. The approach to imaging, including the use of CT scanning to detect bony changes and calcium pyrophosphate deposition, is covered. He also outlined management options, from conservative measures, through to surgical intervention. 

Dr Ecker stresses the importance of patient-centred decision making, informed consent, and multidisciplinary collaboration between surgeons, therapists, and GPs. Surgical options including arthroscopy, joint replacement, and wrist fusion are explained, with considerations for patient selection and postoperative rehabilitation.

They conclude with practical advice for GPs supporting patients to maintain function and quality of life, emphasising resilience, adaptation, and the value of ongoing measurement and rehabilitation.

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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP Podcast, host Dr Tim Koh is joined by Dr Jeff Ecker, an experienced orthopaedic surgeon based in Perth with over 35 years of expertise in complex hand and wrist conditions. Discussing the assessment and management of wrist fractures, with advice tailored for general practitioners.

Exploring the most common wrist fractures encountered in general practice, particularly among older adults after low-energy falls. Dr Ecker emphasises a careful history and examination, and attention to associated injuries to the elbow and shoulder. He also discusses the challenges of seemingly minor wrist injuries in younger patients and the need for an accurate and early diagnosis to prevent complications such as non-union and advanced arthritis.

Reviewing imaging strategies, with recommendations on when to use plain X-rays, CT scans, or MRIs based on clinical suspicion and fracture characteristics. Dr Ecker calls attention to the limitations of MRI, especially in detecting ligamentous wrist injuries, and the need for ongoing clinical vigilance.

They also talked about management principles for minimally displaced wrist fractures, and the practical use of back slabs, thermoplastic splints, ensuring proper hand function throughout immobilisation. 

Effective analgesia choices and the critical role of rehabilitation in preventing stiffness and chronic pain syndromes were also discussed. Concluding with practical considerations for managing wrist fractures in aged care settings, reinforcing the need for individualised assessment and the avoidance of age-related bias in treatment planning.

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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Krystyna de Lange is joined by Dr Tegan Allin, rural generalist and GP obstetrician from Thursday Island live from the GP25 Conference, to discuss the topic of foetal rhesus screening and recent changes in Australian guidelines.

They began with an overview of anti-D prophylaxis and its importance for women who are rhesus negative. Dr Tegan Allin explains the pathophysiology of rhesus disease, risks associated with sensitisation during pregnancy, and the traditional approach of universal prophylaxis with anti-D immunoglobulin.

They then shift to the new availability of non-invasive prenatal screening (NIPS) for foetal rhesus status. Dr Tegan Allin describes how this serum-based test examines cell-free foetal DNA in maternal blood from 11 weeks gestation. With sensitivity and specificity over 99%, it allows for more targeted administration of anti-D only to those carrying a rhesus positive fetus.

Covering key practicalities of ordering foetal rhesus screening, including the appropriate gestational window (after 11 weeks and before 29 weeks), the importance of lab-specific request forms, and consideration of slight lab-to-lab differences in recommended timing.

Highlighting the ongoing changes in first trimester antenatal management and the need for GPs to remain up to date with evolving testing protocols. Reinforcing the necessity of confirming neonatal rhesus status at birth via cord blood testing, even when negative results are obtained antenatally.

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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Sean Stevens is joined by Dr Terri-Lynne South live from the GP25 Conference, to deliver an overview of obesity management, with a specific focus on the use of GLP-1 and GIP dual incretin therapies in general practice.

Dr Terri-Lynne South outlines the current Therapeutic Goods Administration (TGA)-approved indications for these treatments in Australia. These include use in patients with type 2 diabetes, overweight with complications, chronic kidney disease and type 2 diabetes, obesity with obstructive sleep apnoea, and secondary prevention of cardiovascular disease. Noting that this field is rapidly evolving, with recent changes in indications and ongoing international developments.

Addressing the importance of setting realistic patient expectations regarding weight loss outcomes and the duration of treatment, emphasising that clinical obesity is a chronic, complex condition requiring long-term management. Evidence shows that weight loss achieved with GLP-1 therapies can be maintained over four years if the patient remains adherent, while early discontinuation often leads to significant weight regain.

Practical strategies for managing common side effects, mainly gastrointestinal symptoms like nausea and constipation, are described in detail. Dr Terri-Lynne South provides useful tips for patients, including hydration, dietary modifications, and mindfulness around portion size and satiety cues. 

The importance of a multidisciplinary approach is reinforced, including psychological assessment (screening for eating disorders, depression, anxiety, and complications like sleep apnoea), dietitian involvement, and possible referral to exercise physiology and psychology services where also clinically indicated.

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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of This Could Save Your Life Podcast, hosts Dr Anna Mullins and Dr Catherine Bourke provide a comprehensive overview of cervical cancer screening and prevention.

They start with the epidemiology of cervical cancer, outlining that it affects approximately 1 in 175 women or people with a cervix. Explaining the anatomy of the cervix and discussing the primary cause of cervical cancer: human papillomavirus (HPV) infection. They clarify that while HPV is very common and transmitted through sexual contact, most strains are cleared by the body and only a subset are associated with cancer development. 

Covering common patient questions regarding HPV transmission, family history, and the relevance of these factors to individual risk. They emphasise that unlike many other cancers, a family history does not increase risk for cervical cancer.

Practical advice is presented around recognising possible symptoms of cervical cancer, such as abnormal vaginal bleeding, pelvic pain, and changes in vaginal discharge.

Exploring the details of cervical screening in Australia, which has shifted from Pap smears to HPV-based testing. Outlining the process and options for HPV testing, including both clinician-collected and self-collected swabs. 

Screening start age (25) and end age (74) are clarified, as well as earlier screening for those sexually active before age 14, and the importance of starting screening upon sexual activity.

They also discussed cervical cancer prevention through vaccination. Referencing the development of the Gardasil vaccine in Australia, its almost 100% effectiveness against several HPV strains, and its routine administration to both girls and boys under the National Immunisation Program. 

This Could Save Your Life Podcast is under The Good GP podcast, 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 of the Good GP, host Dr Maria Li welcomes back Dr Katherine Wyld, endocrinologist, for the third and final part of the series on hormone pseudoscience. Focusing on adrenal hormone-related misinformation, commonly encountered both in general practice and on social media.

Dr Wyld tackles the adrenal hormone-related prevalent misinformations, including:

• The widespread misinformation about adrenal hormones, especially related to cortisol, circulating on social media and online platforms. Cortisol testing requires careful consideration of context and timing, as cortisol levels fluctuate significantly throughout the day.
• Dr Wyld clarifies that single-point cortisol measurements are rarely clinically meaningful, and that salivary and urine cortisol tests should only be used in specific, evidence-based situations.
• Dutch testing (dried urine testing for hormones) is not supported by endocrine societies due to lack of evidence, questionable logic, and high cost.
• “Adrenal fatigue” is not a real or recognized medical condition; there is no scientific evidence or data to support this concept.
• High cortisol is commonly blamed for stress, anxiety, weight gain, and fatigue, but it is rarely the cause unless clear evidence of Cushing’s syndrome is present. Features of Cushing’s syndrome to look for include diabetes, hypertension, significant unexplained weight gain, skin changes, and proximal myopathy.

Sharing strategies for GPs when faced with unfamiliar symptoms or patient requests based on pseudoscientific information. Dr Wyld encourages clinicians to be honest about knowledge gaps, consult reputable sources, and maintain open communication with patients.

Links & Resources: 

• Endocrine Society of Australia - https://www.endocrinesociety.org.au/
• US Endocrine Society - https://www.endocrine.org/
• Adrenal Fatigue patient handout - https://www.endocrine.org/patient-engagement/endocrine-library/adrenal-fatigue

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]. Visit www.thegoodgp.com.au for previous episodes and more information.