The Good GP

In this episode of The Good GP, host Dr Maria Li continues her conversation with Dr Katherine Wyld, a Queensland-based endocrinologist, exploring the topic of menopause pseudoscience and its impact on patient care. This second part in the hormones series explores the growing prevalence of misinformation around menopause and hormone therapy, and practical guidance for general practitioners.

Dr Wyld discusses several areas of menopause care commonly affected by false or misleading information, including:

• The use of hormone monitoring during treatment. Dr Wyld clarifies that routine measurement of estrogen and progesterone levels is not recommended for guiding menopause treatment. Dosing should be based on symptoms.
• Testosterone therapy in menopause. Evidence supports its use only for hypoactive sexual desire disorder; benefits for other menopause symptoms are not proven. Common side effects include acne, excess hair growth, and skin oiliness.
• Bioidentical hormone therapy. The term is unregulated and used as a marketing tool. Standard, regulated formulations are safer and more effective.
• Use of high-dose estrogen. Prescribing above recommended limits increases risk and is not backed by safety data. Referral to a specialist is advised for complex cases.
• Strategies for GPs when encountering unfamiliar therapies or requests for non-evidence-based treatments.When unsure, consult guidelines or colleagues and use trusted resources for evidence-based answers.

They aim to support GPs in navigating menopause-related consultations, equipping them to communicate clearly, critically evaluate new trends, and provide safe, evidence-based care to their patients.

Links & Resources: 

• Australian Menopause Society - https://www.menopause.org.au/
• British Menopause Society - https://thebms.org.uk/
• International Menopause Society - https://www.imsociety.org/
• Bioidentical Hormone Therapy information sheet - https://menopause.org.au/health-info/fact-sheets/bioidentical-hormone-therapy?highlight=WyJiaW9pZGVudGljYWwiXQ==
• Menopause complementary therapy information sheet - https://menopause.org.au/hp/information-sheets/complementary-medicines-and-therapies-for-hot-flushes
• Prof Susan Davis Instagram - https://www.instagram.com/professorsusandavis/?hl=en

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 delve into the topic of prostate cancer, which affects one in five men by the age of 85. Emphasising the importance of understanding this common yet complex disease, particularly focusing on the significance of early screening.

Dr Mullins and Dr Bourke begin by explaining the function and anatomy of the prostate gland, highlighting its role in fertility and common changes that occur with age. The nature of prostate cancer, distinguishing between slow-growing forms, which may not require treatment but need surveillance, and more aggressive types that can be life-limiting if not treated early.

Gaining insights into the symptoms associated with prostate cancer, such as urinary difficulties, blood in urine or semen, and unexplained weight loss. They also address risk factors, including age, genetics, family history, and the role of obesity in aggressive cancer forms.

They also provided an overview of the screening process, which involves the PSA (Prostate-Specific Antigen) blood test, now recommended over the previously standard digital rectal examination. They clarify the importance of screening guidelines based on risk categories, to ensure that everyone is informed about the appropriate age to begin testing based on individual risk profiles.

They discuss potential false positives in PSA testing, the next steps if a high PSA level is detected, and the significance of individual consultations for family history outside standard categories. While prevention of prostate cancer remains challenging due to a lack of modifiable risk factors, the importance of screening and early detection is underscored to improve patient outcomes.

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 Dr Katherine Wyld, a Queensland-based endocrinologist, for the first installment of a three-part hormones series addressing health misinformation in endocrinology. The episode focuses on thyroid and thyroid hormone-related pseudoscience, which is increasingly prevalent in social media and online health discussions.

Dr Wyld shares her experiences from clinical practice, and the most common misinformation trends, including:

• The use of thyroid extracts, supplements, and compounded thyroid treatments marketed as “natural” alternatives to standard therapy.
• The popularity of reverse T3 testing as a perceived superior diagnostic, despite a lack of supporting clinical evidence.
• The rise of restrictive diets (such as gluten-free and lactose-free) claimed to improve thyroid health without population-level evidence.
• The use of urine iodine level assessment in individual diagnosis, its limitations, and when it may or may not be appropriate.

Explaining why thyroxine (T4) remains the gold standard treatment for hypothyroidism, emphasising its safety, efficacy, and consistent dosing. 

Dr Wyld covers strategies for GPs when responding to patient requests for non-evidence-based tests and treatments. Providing practical advice on how to educate patients, maintain rapport, while reinforcing the value of evidence-based care. As well as when to consider referral to an endocrinologist for complex cases.

Links & Resources: 

• American Thyroid Association - https://www.thyroid.org/
• Thyroid test (including reverse T3) patient information sheet - https://www.thyroid.org/thyroid-function-tests/
• ESA position statement on thyroid extracts / desiccated thyroid - https://www.endocrinesociety.org.au/downloads/20200903%20ESA_Position_Statement_Natural_Desiccated_Thyroid_Peter_R_Ebeling.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]. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Tim Koh welcomes Dr Michael Wright, President of the RACGP, for a discussion centred on the recently released Health of the Nation report. Now in its ninth year, the report serves as a key barometer for the state of general practice in Australia, covering trends in service provision, access, key challenges, and broader implications for practitioners.

Key Points: 

• Australian GPs delivered over 170 million services last year and saw nearly 23 million Australians, with more than 2 million visits each week.
• Survey data show 99% of patients reported being able to access a GP when needed, although some were unable to see their preferred GP, at their preferred time, or faced out-of-pocket costs.
• The top reason for GP consultations is psychological conditions (e.g., depression, anxiety).
• GPs are treating older populations and more chronic illnesses, resulting in longer and more complex consultations. Now lasting close to 20 minutes.
• Despite increased workload and complexity, per-person expenditure on general practice has remained flat for a decade, while hospital spending has increased.
• Nearly one-third of GPs have witnessed racism within the health system, and one in five have experienced it personally.
• The RACGP is committed to recognising, measuring, and addressing racism, guided by findings from its Aboriginal and Torres Strait Islander faculty.
• Continued efforts are needed to ensure long-term sustainability and quality care for Australian communities.

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 Jo-Lyn McKenzie, an ENT surgeon, researcher, and university lecturer based in Brisbane, for a discussion on chronic rhinosinusitis and its management in primary care.

Dr McKenzie begins by outlining the key clinical features that distinguish chronic rhinosinusitis from other common nasal conditions. Highlighting the importance of chronic nasal obstruction and persistent discharge, and that chronicity, which is greater than three months of symptoms, is a critical factor in making the diagnosis. Dr McKenzie also addresses the challenges of differentiating between chronic sinusitis and allergic rhinitis, its differences in symptom persistence, the nature of the discharge, and the utility of detailed history-taking.

They discuss the value and technique of medical management in the general practice setting. Detailing the use of high-volume saline nasal irrigation and intranasal corticosteroids as first-line treatments, providing practical tips to improve patient compliance and effectiveness. She stresses the importance of correct technique and regular use, addressing common misconceptions about side effects. 

Referral to ENT is discussed, with Dr McKenzie explaining when specialist review is indicated. She also comments on the accessibility of ENT services in both public and private settings.

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 explore the important topic of dementia prevention. With an aging population, dementia is becoming increasingly prevalent. 

The episode delves into what dementia actually is, addressing common misconceptions that it is solely a memory issue. They explain that dementia is a progressive condition characterised by a range of symptoms including memory changes, shifts in mood or behavior, and challenges in thinking.

Highlighting early signs of dementia, Dr Mullins categorises symptoms into memory changes, alterations in thinking, and shifts in personality, mood, or behavior. Notably, unusual placement of everyday items and confusion about time and place are also discussed. They stress the importance of early intervention and the benefits of speaking to a healthcare provider for advice, treatment, and supportive resources.

For those seeking proactive ways to prevent dementia, Dr Bourke introduces the CogDrisk tool from Neuroscience Research Australia, which provides evidence-based guidance on reducing risk factors. Prevention strategies cover a lifespan perspective, addressing early life education, lifestyle choices like managing cholesterol, diabetes, and blood pressure, as well as the significance of addressing hearing and vision issues. They also highlight depression, traumatic brain injuries, and social isolation as risk factors.

The episode also includes the importance of lifestyle habits like exercise, healthy eating, and maintaining social connections, alongside addressing any existing health conditions. Concluding with a reminder to take control of one's health and to utilise the available resources for reducing dementia risk.

Links & Resources:

• https://www.dementia.org.au/get-support/national-dementia-helpline
• https://www.dementia.org.au/
• https://cogdrisk.neura.edu.au/

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 special live episode of The Good GP, Dr Sean Stevens and Dr Catherine Bourke are interviewed by Dr Bethany Reynolds, Chair of the WA New Fellows Committee, at the RACGP Early Career GPs Conference in the Swan Valley, on Whadjuk Nyongar Country. Discussing key lessons and insights for GPs transitioning from fellowship training to early career practice.

Key topics covered:

• Business and Administration for New Fellows: The importance of setting aside funds for the first tax bill when transitioning to contractor status, and key considerations for thinking about oneself as a business, setting appropriate fees, and effectively communicating billing with patients.

• Understanding Risk and Wellbeing: Discussing not only financial and legal risks but also the psychological demands of general practice. Which includes practising within a supportive team environment and prioritising professional longevity.

• Shaping Your Practice and Case Mix: Exploring practical strategies for finding enjoyment and meaning in daily work. Mentioning the value of understanding personal drivers (ikigai), developing niche areas of clinical interest, and using support networks and mentors for ongoing professional development.

• Managing Challenging Consultations: Strategies for handling heart-sink patients and complex consults, and the importance of setting boundaries, reframing expectations, and developing strong consultation management skills.

• Mentorship in Early Career: Both Dr Stevens and Dr Bourke share their experiences with mentors and the benefits of both formal and informal mentorship relationships. Encouraging to seek out mentors in various aspects of general practice and practice ownership.

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 Julia Rawlinson is joined by Dr Lynette Griffiths, GP registrar and perinatal clinical psychologist, and Dr Erin Seeto, clinical and counselling psychologist and Clinical Services Manager at the Gidget Foundation. Discussing the topic of perinatal mental health, focusing on the impact on families, the healthcare system, and the broader community.

Beginning with an overview of the prevalence and spectrum of perinatal mental health conditions, covering not only postnatal depression and anxiety but also a range of issues such as PTSD, birth trauma, OCD, and the significance of intrusive thoughts. Highlighting the effects of untreated perinatal mental health issues, including disruptions to parent-infant bonding, relationship stress, and risks to the mental and physical wellbeing of children. 

Providing practical strategies and advice for GPs to support and assess parents. The importance of routine screening for mental health concerns during both antenatal and postnatal visits. As well as the necessity of validating parents’ experiences, normalising mental health struggles, and engaging both mothers and partners in screening, to which their mental health may be different across genders.

Discussing key resources and support available for families and GPs across Australia, including telehealth services, group programs, public mental health services, and helplines such as those provided by the Gidget Foundation and PANDA.

Links & Resources:

For Clients: 

Fact Sheets: https://www.gidgetfoundation.org.au/resources/fact-sheets

Blogs: https://www.gidgetfoundation.org.au/gidget-blog

Podcast: https://www.gidgetfoundation.org.au/resources/1-in-5-mothers-1-in-10-fathers

Real Stories: https://www.gidgetfoundation.org.au/real-stories/gidget-angel-stories

For Health Professionals: 

How To Refer: https://www.gidgetfoundation.org.au/health-professionals/how-to-refer-a-patient

Resource Library: https://www.gidgetfoundation.org.au/resource-library

Other support services: https://www.gidgetfoundation.org.au/support/other-support-services

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 Maria Li speaks with Dr Katherine Wyld, an obstetric physician and endocrinologist, about hyperemesis gravidarum (HG). Outlining the distinction between common nausea and vomiting in pregnancy and the more severe and debilitating hyperemesis gravidarum.

Dr Wyld discusses the prevalence of HG, affecting about 1% of pregnancies, and its risk factors such as the history of HG and multiple gestations. She reviews tools for assessment, including the PUQE score, and says the need for clinical judgement, particularly where weight loss and electrolyte abnormalities are present.

Discussing management strategies as well; starting with single agents for mild cases, but initiating multiple antiemetics and supportive care early for moderate to severe cases. Dr Wyld covers the safety of first-line medications, as well as practical prescribing tips, monitoring frequency, and the importance of regular dosing.

Providing guidance on when to refer or escalate care, including red flag symptoms and criteria for hospital admission. They also talked about the mental health impact of HG, the importance of patient education and support, and assurance regarding typical pregnancy outcomes for most women with HG.

Links & Resources:

• Summary of nausea & vomiting and Hyperemesis, including medication list: SOMANZ-Management-of-NVP-Position-Statement-Updated-Oct-2023-FINAL-1.pdf

• Patient information sheets (including PUQE score):
• Hyperemesis-gravidarum.pdf
• NauseaAndVomitingInPregnancy_2024.pdf

• List of obstetric physicians: Obstetric Physicians - Society of Obstetric Medicine Australian and NZ

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 delve into the topic of overweight and obesity. Exploring the intricate relationship between body weight and health, emphasising that body fat alone does not define an individual's health status. Along with the importance of considering various health aspects, including mental, emotional, and social well-being, beyond just physical health.

Dr Bourke and Dr Mullins provide an overview of the multi-faceted causes of obesity, highlighting genetic, lifestyle, and environmental factors. Explaining that obesity is a chronic disease influenced by a society that promotes sedentary lifestyles and convenient access to high-calorie foods. 

They also cover the different methods used to assess whether someone is overweight or obese, including waist measurement, waist-to-hip ratio, and Body Mass Index (BMI), noting the situations where these tools may provide inaccurate results. They further explain the health risks associated with being overweight or obese, such as high blood pressure, diabetes, and certain cancers.

Addressing the challenges of weight loss, Dr Mullins and Dr Bourke discuss the body's natural mechanisms that work against weight loss, and they emphasise the need for a personalised approach to treatment. They explore various interventions, including dietary changes, exercise, medication, and bariatric surgery, and stress the importance of seeking professional medical advice for weight management.

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