The GP Show

This episode is only relevant really to RACGP registrars and their respective supervisors who are teaching them so sorry to everyone else!  But it is a source of significant anxiety (and requests to me to do an episode on) so I have covered it.

I shall cover the RACGP criteria of an excellent candidate (public info), the common mistakes I see registrars make and break down each area in more detail i.e. history, examination, investigations, differentials and management, and finally some further resources

Finally I am doing a specific child health topic after multiple attempts!

Today I am joined by Dr Anthony Morosini Paediatrician in both the public and private sector. He has an interest in evaluating growth so we had a nice discussion about some of the general principles, history, examination, investigations, management and variants of pathological and non-pathological growth patterns.

As always - enjoy!

Finally I am doing a specific child health topic after multiple attempts!

Today I am joined by Dr Anthony Morosini Paediatrician in both the public and private sector.  He has an interest in evaluating growth so we had a nice discussion about some of the general principles, history, examination, investigations, management and variants of pathological and non-pathological growth patterns.

As always - enjoy!

Today I am joined for an online chat by GP and medicolegal advisor for MDO Avant Dr Peter Walker.  Areas we discuss include:  

What are the most common reasons for doctors seeking medicolegal advice? 

What are the common reasons patients and colleagues complain?

What is the “complaint” process and possible outcomes? 

How can you reduce your medicolegal risk?

Today I am joined for an online chat by GP and medicolegal advisor for MDO Avant Dr Peter Walker. Areas we discuss include:

1. What are the most common reasons for doctors seeking medicolegal advice?
2. What are the common reasons patients and colleagues complain?
3. What is the "complaint" process and possible outcomes?
4. How can you reduce your medicolegal risk?

Just me today.  Ironically I have to postpone an interview with a paediatrician due to my son being sick.  

So instead I am covering some of the topics people have asked me about including acne management and because I love a bit of medical history, I am talking about the interesting history of anaesthesia. Finally I was stimulated by a recent RACGP AFP article to talk about the importance of assessing lifestyle history in detail to personalise and optimise lifestyle therapy.

Just me today. Ironically I have to postpone an interview with a paediatrician due to my son being sick.

So instead I am covering some of the topics people have asked me about including acne management and because I love a bit of medical history, I am talking about the interesting history of anaesthesia. Finally I was stimulated by a recent RACGP AFP article to talk about the importance of assessing lifestyle history in detail to personalise and optimise lifestyle therapy.

References:

1. Kurt Gabauer, Acne in Adolescents, RACGP AFP, 2017
2. Emmy Graber, Treatment of Acne Vulgaris, UpToDate, 2017
3. Dover et al, Light-based, adjunctive and other therapies for acne vulgaris, UpToDate, 2017
4. Amanda Oakley, Acne management, Dermnet NZ, 2014
5. Titus et al, Diagnosis and Treatment of Acne, AAFP (USA), 2012
6. Lifestyle as Medicine RACGP AFP - https://www.racgp.org.au/afp/2016/april/lifestyle-as-medicine-%E2%80%93-past-precepts-for-present-problems/
7. Lifestyle risk factors and corresponding levels of clinical advice and counselling in GP https://www.racgp.org.au/afp/2017/october/lifestyle-risk-factors-and-corresponding-levels-of-clinical-advice/#13
8. Denney-Wilson E, Fanaian M, Wan Q, Vagholkar S, Schütze H, Harris M. Lifestyle risk factors in general practice – Routine assessment and management. Aust Fam Physician 2010

Surrounded by the familiar beeps and glow of the hospital surgical theatres I had a thoroughly enjoyable chat with scrubs-donned Dr Johan Van Den Bogaerde Gastroenterologist and researcher. 

- What are probiotics and some important principles

- How do they work?

- Evidence for different conditions - IBD, IBS, diarrhoeal disorders, helicobacter pylori, atopic eczema and others

- Research bias 

- Working with real people who are suffering but that don't fit the guidelines = the clinicians dilemm

Surrounded by the familiar beeps and glow of the hospital surgical theatres I had a thoroughly enjoyable chat with scrubs-donned Dr Johan Van Den Bogaerde Gastroenterologist and researcher. We discuss probiotics and the various relevant themes around them. Topics we discuss include: - What are probiotics and some important principles - How do they work? - Evidence for different conditions - IBD, IBS, diarrhoeal disorders, helicobacter pylori, atopic eczema and others - Research bias - Working with real people who are suffering but that don't fit the guidelines = the clinicians dilemma Summary of the POSSIBLE uses: IBD Ulcerative Colitis and Pouchitis - VSL3, E. coli nissle and saccharomyces boulardi may help for remission. No clear evidence for chron's disease IBS - VSL3, bifido infantis - mixed studies, some positive and some only as good as placebo (~50% reduction in pain) Diarrhoeal disorders (antibiotics associated, childrens diarrhoea, c.dif and preventing travellors diarrhoea) = Lacto. rhamnosus, saccharomyces boulardii and Lacto. reuteri may be of assistance e.g. reduce duration of infectious diarrhoea by Helicobacter pylori - Saccharomyces boulardii and Lacto. reuteri - may reduce side effects to antibiotics and improve eradication rate Atopic eczema - Lacto. rhamonsus and Bifido. lactis reduce rate of atopic eczema in children by 80% if taken by mother during pregnancy and breastfeeding Atopic eczema - not clear, mixed studies as a treatment of atopic eczema Other possible use though studies are limited and early - bacterial vaginosis, major depression disorder, autism spectrum disorder, other CNS disorders, hepatic encephalopathy Doses and duration's vary Risks: Do not use in critically unwell or marked immunosuppression Side effects may include - constipation, flatulence, nausea, rash and others Don't forget the price tag Some of the many references: IBD - https://www.ncbi.nlm.nih.gov/pubmed?term=20517305, https://www.ncbi.nlm.nih.gov/pubmed?term=14684584, https://www.ncbi.nlm.nih.gov/pubmed?term=22161412 IBS - https://www.ncbi.nlm.nih.gov/pubmed/25780308 Diarrhoeal disorders - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748908/ , H pylori - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588086/ Atopic disease pregnancy - https://www.racgp.org.au/your-practice/guidelines/handi/interventions/children/probiotics-in-pregnancy-for-infant-atopic-eczema/ Eczema in children - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828648/

Probiotics and intestinal permeability-- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253991/

CNS disorders = https://www.ncbi.nlm.nih.gov/pubmed/27413138

Dr Genevieve Yates is a medical educator, a GP and a writer. Currently she is the RACGP Queensland Censor, RACGP Expert Committee member (Pre-Fellowship Education) and senior examiner, a performance assessor for AHPRA and a member of MDA National's Education Services Advisory Group (ESAG). She also works as an educator/ facilitator for MDA National and the Black Dog Institute. She is passionate about putting creativity into medicine, and medicine into creativity.

Today we discuss assessing fitness to drive, predictive factors for risky driving, assessment tools, legalities of reporting and much more.

Some further resources:

Dr Yates youtube clip - https://genevieveyates.com/2015/09/03/dont-just-sign-on-the-dotted-line-assessing-fitness-to-drive/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5257216/

https://www.racgp.org.au/afp/2012/april/dementia-and-driving/

Trail test - www.rgpeo.com/media/53150/trails%20a%20and%20b.pdf.

Drive Safe Drive Aware app = https://www.pearsonclinical.com.au/products/view/563

https://www.pearsonclinical.com.au/files/245101432704685.pdf

https://fmf.cfpc.ca/wp-content/uploads/2017/10/S183_Driving-and-Dementia_Practical-tips-for-the-family-physician.pdf