Suicide continues to be a major public health issue in Aotearoa New Zealand, touching every clinician working in primary care. General Practice is often the first, and sometimes only, point of contact before a suicide attempt — meaning GPs are uniquely placed to identify risk, provide support, and intervene early.

In this episode of The Specialist GP, host Dr Louise Kuegler speaks with Dr Cheryl Buhay about the latest suicide data, key risk and protective factors, and effective management strategies. Together, they discuss how primary care teams can safely assess and manage suicide risk, when to escalate concerns, and how to look after themselves and colleagues affected by suicide.

The conversation also explores the importance of clinician wellbeing, collaboration with specialist services, and building confidence in these difficult but crucial consultations.

Key Discussion Points

• Current suicide data and inequities across age, gender, and ethnicity
• The most common risk factors and protective factors in suicide prevention
• How to conduct a safe, empathic, and thorough risk assessment
• When and how to involve specialist mental health services
• Support options for clinicians following patient suicide or distressing events

Practical Clinical Pearls

1. Risk assessment runs parallel to diagnosis – consider both static and dynamic risk factors across social, mental, and physical domains.

2. Maintain a high index of suspicion – approach with empathy, curiosity, and non-judgement.

3. Don’t overlook broader risks – such as poor self-care, child safety, or physical health deterioration.

4. Watch for paradoxical calm – a patient who suddenly appears serene after deep distress may be at increased risk.

5. Use the team – involve nursing, community, and peer supports early.

6. Seek help when unsure – contact local mental health triage or crisis services for immediate consultation.

Clinician Wellbeing

Caring for someone at risk of suicide can be emotionally demanding. GPs are encouraged to access support through:

• EAP programmes (RNZCGP, MAS, MPS)
• Skylight Trust – 0800 299 100 | www.skylight.org.nz
• Aoake te Rā – free counselling for people bereaved by suicide | 0800 000 053 | www.aoaketera.org.nz
• After a Suicide NZ – www.afterasuicide.nz

Email: [email protected]

Website: https://www.thespecialistgp.co.nz/

Dr Louise Kuegler and Professor Ian Reid explore osteopenia—what it means, why it matters, and how it fits into fracture prevention. Drawing on the latest evidence, including Prof Ian Reid’s and Prof Mark Bolland's work, we discuss diagnosis, lifestyle strategies, treatment thresholds, and patient-centred approaches to protect bone health and prevent future fractures. An update for Zolendronate use is also discussed especially in the context of osteopenia.

In this episode we cover:

• Definition of osteopenia and its prevalence
• Risk factors and the role of exercise in bone health
• Assessing fracture risk
• Management strategies for osteopenia
• The importance and role of Menopause Hormone Therapy
• Recent advances in Zolendronate's role in Osteopenia and Osteoporosis
• Addressing osteopenia in men

Practical clinical pearls:

1. Aim for a BMI >20 to protect long-term bone health. Educate adolescents and young adult women that being underweight increases lifetime fracture risk.
2. Screen by fracture risk, not osteoporosis alone. Start with a risk calculator such as FRAX or Garvan; use DEXA only to refine risk when the calculated risk is moderate or uncertain.
3. Zoledronate is effective across age groups and bone density ranges. Evidence supports use both preventively in women in their 50s and therapeutically in women ≥65, including those who are osteopenic. Dosing frequency should follow study protocols (e.g., every 18 months in older women; every 5–10 years in preventive regimens).
4. Vitamin D has a role in those at risk of deficiency. Particularly useful for people in rest homes, those with dark skin, or those living in low-sunlight regions (e.g., South Island).
5. Avoid calcium supplements—prioritise dietary sources. Supplements offer minimal benefit for bone density or fracture prevention and carry risks (kidney stones, constipation, potential cardiovascular effects). A balanced diet that maintains a healthy BMI (>20) is preferred.

Resources:

Reid, Ian R, and Michael R McClung. “Osteopenia: A Key Target for Fracture Prevention.” The lancet. Diabetes & endocrinology 12.11 (2024): 856–864. Web.

 Reid, Ian R, and Michael R McClung. “Osteopenia: A Key Target for Fracture Prevention.” The lancet. Diabetes & endocrinology 12.11 (2024): 856–864. Web.

 Bolland, Mark J et al. “Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age.” The New England journal of medicine 392.3 (2025): 239–248. Web.

 https://osteoporosis.org.nz/wp-content/uploads/2024/09/ONZ-2017-Guidance-for-New-Zealand.pdf

Email me:

[email protected]

Listen here:

Apple: https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299

Spotify: https://open.spotify.com/show/3485r5V7iF251QH9dpnC1i?si=qQ2CUMa-SRSWMfha2HRjXA

What are the realities of sexting and porn exposure among young people — what’s normal, what’s harmful, and how clinicians can respond with empathy and insight. To help unpack this, Dr Louise Kuegler is joined by Dr Claire Meehan, Senior Lecturer in Criminology at the University of Auckland. Through a real case, we discuss what happens when intimate images are shared without consent, and how to guide conversations that move beyond shame and fear toward trust, consent, and safety.

In this episode we cover:

• How common sexting is among teenagers, and why many view it as normal or positive

• What happens when images are shared without consent — and how to respond clinically

• The role of gender, double standards, and victim-blaming

• How pornography shapes expectations and behaviour

• What parents, teachers, and clinicians can do to help young people navigate digital consent

Practical Clinical Pearls:

• Normalise the conversation — sexting and porn exposure are common; avoid shame.

• Reframe risk, don’t moralise — talk about consent, trust, and relationships rather than “don’t do it.”

• Encourage rapid disclosure — reassure teens they won’t be punished for speaking up.

• Address gender and power — challenge double standards and affirm that harm lies in the breach of consent.

• Promote healthy alternatives — guide young people toward credible, age-appropriate sexual health education.

Dr Claire Meehan is a Senior Lecturer in Criminology in the Faculty of Arts at the University of Auckland. Her research focuses on how young people navigate digital technology, sexuality, and consent — including their understandings of pornography and the sharing of intimate images. She holds a PhD in Criminology from the University of Ulster and postgraduate degrees from Queen’s University Belfast. Claire is the author of The Politics of Porn for Young People in New Zealand and the forthcoming Young People and Sexual Consent in the Digital Age.

Resources:

Meehan C. ‘They’re Much Too Young’: The Entanglement of Porn, Pleasure and Age in Sex Education. J Sex Res. 2025 Jul;62(6):1028-36.

Meehan C. Talking with Girls about Porn. In: Mazzarella SR, editor. The Routledge Companion to Girls’ Studies. Abingdon: Taylor & Francis; 2024. p. 375-86.

Meehan C, Wicks E. Consent Isn’t Just a Girl’s Thing: Gender, Consent and Image Based Sexual Abuse. In: James-Hawkins L, Ryan-Flood R, editors. Consent: Gender, Power and Subjectivity. Milton (or London) : Taylor & Francis; 2023 Nov. p. 197-209.

https://netsafe.org.nz/ Netsafe NZ, helping NZ to be safe online

https://stopncii.org/ Stop Non- consensual intimate image abuse. StopNCII.org introduces innovative technology that is used by tech and industry companies to protect people from the sharing of their intimate images online.

https://takeitdown.ncmec.org/ This service is one step you can take to help remove online nude, partially nude, or sexually explicit photos and videos taken before you were 18.

What does kindness really look like in healthcare leadership — and why does it matter? In this episode of The Specialist GP, Dr Louise Kuegler chats with Dr Nicki Macklin about how visible, consistent acts of kindness can reshape culture, improve staff wellbeing, and strengthen relationships across clinical teams. They discuss the misconception that kindness is “soft,” and why it actually supports accountability and safer decision-making. You’ll hear practical ways leaders can embed kindness into systems so patients, teams, and organisations all benefit.

In this episode, we cover

1. The difference between empathy, compassion, and actionable kindness
2. How leaders can embed kindness into systems and culture
3. Real-life examples of kindness driving lasting change in healthcare settings

Practical Clinical Pearls

1. Empathy and compassion are vital, but kindness is what turns good intentions into real change.
2. Kindness isn’t just a feeling, it’s an action, small, deliberate, and visible.
3. Tiny acts of kindness, done consistently, build trust and reshape workplace culture.
4. Kindness doesn’t make leaders weak, it makes them credible and strong.
5. For kindness to last, it must be built into systems, not just left to individuals.
6. Patients benefit also when leadership is kind. Patients engage, they are safer and have better health incomes.

Email me

1. [email protected]

Visit our website

1. https://www.thespecialistgp.co.nz/

Episode Overview 

 Welcome to the first episode of The Specialist GP! I’m Dr Louise Kuegler — Specialist GP and medical educator — and in this episode, I introduce the podcast: a space where real listener-submitted clinical cases are explored with expert guests, turning them into practical, evidence-based guidance you can apply straight away in your consulting room. Each episode is designed to leave you with clear, actionable clinical pearls that make a real difference in your practice. 

 In This Episode We Cover 

• How the podcast works: sourcing real cases from listeners. 
• Partnering with expert guests to build practical management plans. 
• How episodes are CME-eligible and include an equity-focused lens. 
• A preview of upcoming cases this season, including osteopenia, risk assessment, gut health, and more. 

 Practical Clinical Pearls 

• Real cases make learning directly applicable to your daily practice. 
• Expert insights help you build robust, evidence-based management plans. 
• Episodes are clear, concise, and immediately useful for busy clinicians. 
• CME points can be logged, including under the equity-focused domain. 

Listen here:

• Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299
• Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

Contact me:

https://www.thespecialistgp.co.nz/