The GP Show

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: Kurt Gabauer, Acne in Adolescents, RACGP AFP, 2017 Emmy Graber, Treatment of Acne Vulgaris, UpToDate, 2017 Dover et al, Light-based, adjunctive and other therapies for acne vulgaris, UpToDate, 2017 Amanda Oakley, Acne management, Dermnet NZ, 2014 Titus et al, Diagnosis and Treatment of Acne, AAFP (USA), 2012 Lifestyle as Medicine RACGP AFP - https://www.racgp.org.au/afp/2016/april/lifestyle-as-medicine-%E2%80%93-past-precepts-for-present-problems/ 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 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.  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

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

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    

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

Today I am joined by Dr Johanna Lynch, GP, completing a PhD in primary care mental health assessment, post graduate training in grief and loss and a special interest in trauma and attachment. At least 1 in 8 consults in GP is related to mental health and this is increasing. According to the World Health Organization, unipolar depressive disorders alone were ranked as the third leading cause of the global burden of disease in 2004 and will move into the first place by 2030. Upskilling in mental health care is crucial in all areas of GP, not just classic mental illness but also in behaviour change, giving difficult diagnosis and managing treatments and expectations. What i love about talking with health professionals are their varied interests and developed skills. Johanna is a GP who has dedicated her life to mental health, and she is a treasure trove of wise analogies and useful resources.  As usual we barely scratched the surface.   The learning never stops...   Further reading: Australian Society of Psychological Medicine (ASPM) - https://www.aspm.org.au/ CORE assessment tool = Clinical Outcomes in Routine Evaluation - Outcome Measure http://www.coreims.co.uk/About_Measurement_CORE_Tools.html https://www.sussex.ac.uk/webteam/gateway/file.php?name=core.pdf&site=322 Mood Assessment Program (MAP) - https://www.blackdoginstitute.org.au/education-training/health-professionals/mood-assessment-program Internal Family Systems - Dr Richard Schwartz -https://www.selfleadership.org/

Today I am joined by A/Professor David Colquhoun, Cardiologist, Lipidologist, President of the QLD Heart Foundation, Co-President of the Clinical and Preventative Council of the Cardiac Society of Australia and New Zealand, and Senior Lecturer at the University of Queensland School of Medicine.  He has dedicated his life to reducing cardiovascular disease, and pleasingly with a strong focus on improving lifestyle factors.   Risk assessment and importance of using overall risk instead of single factors, Calcium score scan use, Risk calculation in those >75 years, Risk assessment and treatment options including mediterranean diet, exercise, mental health, social isolation, even owning dogs versus cats! Fibrates and triglycerides Post production: Mediterranean Diet detail and benefits Statins - efficacy, indication, side effects (fatigue, myalgia, diabetes, memory/cognitive impairment, rhabdomyolysis, haemorrhagic stroke) and bias in statin studies   Calcium Score Scans - http://www.csanz.edu.au/wp-content/uploads/2016/11/CAC_Position-Statement_Exec-Summary_ratified-4-August-2016.pdf Mediterranean Diet: https://academic.oup.com/eurheartj/article/37/39/2999/2414995/2016-ESC-EAS-Guidelines-for-the-Management-of    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684076/ https://www.ncbi.nlm.nih.gov/pubmed/26528631 http://www.bmj.com/content/337/bmj.a1344   Statins: https://www.ncbi.nlm.nih.gov/pubmed/27838722 Fatigue - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285455/  Memory - https://www.ncbi.nlm.nih.gov/pubmed/24247674  Diabetes - https://www.ncbi.nlm.nih.gov/pubmed/25887679  Myalgia/stroke -  http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31357-5.pdf,  https://www.mja.com.au/system/files/issues/ham00039.pdf Bias - http://www.bmj.com/content/349/bmj.g5949