The GP Show

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

In this episode we discuss non-alcoholic fatty liver disease or NAFLD with Dr Jon Mitchell, Hepatologist and Head of Gastroenterology at the Sunshine Coast University Hospital.

We discuss:

- What is NAFLD?

- What is the prevalence?

- How is it caused?

- What is the spectrum and complications of NAFLD?

- What investigations are useful?

- What is the management?

- Is coffee good for the liver?

- What is the origin of the Fibroscan?

It was a pleasure to have on the show Dr Paul Grinzi who is a GP in Victoria. He juggles a few roles, balancing his clinical work in both rural and urban GP clinics with part-time medical education work. He's recent past chair of the RACGP Vic Drug & Alcohol committee and the key educator for the Victorian Government's 'Medication Assisted Treatment of Opioid Dependence' training program.

Today Paul gives us an overview of opioid dependence/use disorder, how to approach patients, being mindful of stigma and medication assisted treatment options suboxone and methadone including indications, use, side effects, common barriers and where to find further training.

Further training in this area is very accessible now often via online programs. Contact your State/Territory drugs of dependence unit for more information.

Enjoy friends

It was a pleasure to have on the show Dr Paul Grinzi who is a GP in Victoria. He juggles a few roles, balancing his clinical work in both rural and urban GP clinics with part-time medical education work. He's recent past chair of the RACGP Vic Drug & Alcohol committee and the key educator for the Victorian Government's 'Medication Assisted Treatment of Opioid Dependence' training program.

Today Paul gives us an overview of opioid dependence/use disorder, how to approach patients, being mindful of stigma and medication assisted treatment options suboxone and methadone including indications, use, side effects, common barriers and where to find further training.

Further training in this area is very accessible now often via online programs. Contact your State/Territory drugs of dependence unit for more information.

Enjoy friends

Today we review considerations in acute vision loss with our friendly ophthalmologist Dr Russell Phillips. He was the previous Head of retinal surgery at Flinders Hospital and frequent lecturer at Flinders Medical School.

I feel I must apologise for my ignorance in some areas in this episode and make it clear that it does not reflect the high level of knowledge of some of my fellow GPs. This was partly due to fatigue from an extremely long and busy day at the clinic and running late so I had no time to prep. Though the positive flip side of this is I think it is more "real". One of the challenges of general practice is the requirement to know anything at any point in time, which is near impossible. I think it is better to not pretend we are omniscient and just be genuine in the fact that we all need to brush up on conditions we see infrequently. So, I decided to leave it as it was.

Please see previous episodes for more detail on eye history and examination, and red eye.

Conditions we discuss:

Retinal and vitreous detachment

Retinal artery and venous occlusion

Amaurosis fugax

Optic neuritis

Migraines

Visual cortex disease e.g. strokes, lesions

Temporal arteritis/Giant Cell arteritis

Cataracts

and more

Associate Professor Craig Hassed is a GP, a Senior Lecturer at the Monash University Department of General Practice, and Co-ordinator of the mindfulness program at Monash University. He is also the writer of 12 books, researcher and international speaker in this field.

There are many pearls of wisdom in this episode that are extremely useful to learn and apply. We discuss the principles of mindfulness, how it applies in clinical practice, its role in mental illness, pain disorders and general healthy living, and resources for therapists and patients.

This is the first time I have used a program to record a land line phone call so you will notice my voice comes out of one speaker and his out of the other. I hope it is ok but it sounds fine to me!

Further reading and resources:

https://www.facebook.com/thegpshow.podcast/

A/Prof Hasseds books - https://www.monash.edu/medicine/spahc/general-practice/about/staff-students/hassed

Free course - https://www.futurelearn.com/courses/mindfulness-wellbeing-performance

Further training - https://www.monash.edu/medicine/scs/psychiatry/research/southern-synergy/mindfulness/mbct-prof-training

Dr Jon Kabat Zinn's books e.g. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and Illness, 2005

Chronic pain - Turk DC, Winter F. The pain survival guide: How to reclaim your life

Some of the evidence: https://www.ncbi.nlm.nih.gov/pubmed/26903081, https://www.ncbi.nlm.nih.gov/pubmed/28192793, http://www.bmj.com/content/351/bmj.h6919.full

Associate Professor Craig Hassed is a GP, a Senior Lecturer at the Monash University Department of General Practice, and Co-ordinator of the mindfulness program at Monash University. He is also the writer of 12 books, researcher and international speaker in this field.

There are many pearls of wisdom in this episode that are extremely useful to learn and apply. We discuss the principles of mindfulness, how it applies in clinical practice, its role in mental illness, pain disorders and general healthy living, and resources for therapists and patients.

This is the first time I have used a program to record a land line phone call so you will notice my voice comes out of one speaker and his out of the other. I hope it is ok but it sounds fine to me!

Further reading and resources:

https://www.facebook.com/thegpshow.podcast/

A/Prof Hasseds books - https://www.monash.edu/medicine/spahc/general-practice/about/staff-students/hassed

Free course - https://www.futurelearn.com/courses/mindfulness-wellbeing-performance

Further training - https://www.monash.edu/medicine/scs/psychiatry/research/southern-synergy/mindfulness/mbct-prof-training

Dr Jon Kabat Zinn's books e.g. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and Illness, 2005

Chronic pain - Turk DC, Winter F. The pain survival guide: How to reclaim your life

Some of the evidence: https://www.ncbi.nlm.nih.gov/pubmed/26903081, https://www.ncbi.nlm.nih.gov/pubmed/28192793, http://www.bmj.com/content/351/bmj.h6919.full

A/Professor Megan Munsie PhD is the Deputy Director for the Centre for Stem Cell Systems at The University of Melbourne and the Head of the Education, Ethics, Law & Community Awareness Unit at Stem Cells Australia www.stemcellsaustralia.edu.au

Stem cell therapy is something I am being asked more and more about so I did some research and came across A/Prof Munsie. Are they just another snake oil or do stem cells hold great opportunity for treating a wide range of severe and common disorders? Today we find out:

- What are stem cells

- What conditions is there consistent evidence in treatment?

- What treatment avenues are we exploring?

- Where is it too early to be recommending stem cells?

- The occurrence of commercial exploitation

- Risks, cost and ethics of stem cell therapy

Below is a list of helpful resources:

• NHMRC Quick Guide for GPs: Stem Cell Treatments
• NHMRC Stem Cell Treatments: Frequently Asked Questions
• Australian Stem Cell Handbook (co-developed by National Stem Cell Foundation of Australia and Stem Cells Australia)
• Patient Handbook - International Society for Stem Cell Research _ multiple languages
• Stem cell treatment and regulation - a quick guide for consumers - Therapeutic Goods Administration
• A Closer Look At Stem Cells website (also developed by ISSCR)
• EuroStemCell Factsheets about what are stem cells and how they could help different conditions
• MOVE - Stem Cell Treatments (PDF also available; co-developed with Stem Cells Australia and relates to muscle, bone, joint applications)
• Australasian College of Sports and Exercise Physicians - Position Statement on MSCs