In this episode, Dr Krystyna de Lange hosts Associate Professor Dr Alireza Ahmadvand, a practising GP with a special interest in gastroenterology at the Princess Alexandra Hospital in Brisbane, to discuss disorders of gut-brain interaction (DGBI).

Dr Ahmadvand elaborates on what DGBIs are and provides the latest insights into the pathophysiology, mentioning conditions such as irritable bowel syndrome and functional dyspepsia. He explains the diagnostic criteria and the importance of recognising these conditions in general practice, and highlights the role of GPs in identifying and ruling out structural abnormalities before considering a DGBI diagnosis.

They also covered the multifactorial nature of these disorders, including the impact of psychological and psychosocial factors, such as stress, anxiety, and depression, and the interactions between gut microbiome and gut function. Dr Ahmadvand outlines when GPs should consider DGBIs and what red flags to watch for, emphasising the importance of comprehensive evaluations and specialist collaboration.

For management, Dr Ahmadvand advocates for a multidisciplinary approach involving dietitians, psychologists, exercise physiologists, and gastroenterologists to provide holistic care. Pharmacological treatments, diet modifications, and psychological interventions, such as Cognitive Behaviour Therapy, are also mentioned as part of a comprehensive management plan.

Lastly, Dr Ahmadvand points GPs towards the Rome Foundation's criteria, the Gastroenterological Society of Australia, and patient-focused platforms like Gut Foundation Australia and the IBS Network. He also encourages keeping alongside of the latest research through journals like Neurogastroenterology and Motility.

Links & Resources:

Rome Iv Diagnostic Criteria For Fgids

• https://theromefoundation.org/rome-iv/rome-iv-criteria/
• https://theromefoundation.org/resources/rome-iv-criteria-booklet/ (downloadable booklet in PDF)

Patient Education Material

Irritable Bowel Syndrome (IBS)

• https://dietitiansaustralia.org.au/health-advice/irritable-bowel-syndrome-ibs
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/irritable-bowel-syndrome-ibs
• https://www.healthdirect.gov.au/irritable-bowel-syndrome-ibs

Resources From The Australian Journal Of General Practice

The lived experience of irritable bowel syndrome: A focus on dietary management

• https://www1.racgp.org.au/ajgp/2022/june/the-lived-experience-of-irritable-bowel-syndrome

Research Instruments/Projects

Valid Instrument for Evaluating Symptoms in the Clinical Setting - Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS)

In this episode, Dr Sean Stevens hosts a discussion on the topic of public hospital virtual clinics with three distinguished guests: Dr Morgan Rayner, a new fellow GP, Associate Professor Joanna Lawrence, a paediatrician at the Royal Children's Hospital in Melbourne and Director of the Victorian Virtual Specialist Clinic (VVSC), and Dr Dominic Mallon, an immunologist at Fiona Stanley in Perth and founder of the Virtual Immunology Clinic.

They explore the origins, purposes, and operational models of the Victorian Virtual Specialist Clinic and the Virtual Immunology Clinic. Associate Professor Joanna Lawrence discusses how the VVSC was established to enable GPs to access specialist expertise more swiftly, to reduce wait times for patients and enhance the ability of community physicians to manage patient care efficiently. Dr Dominic Mallon shares insights into the Virtual Immunology Clinic, how it has successfully reduced patient wait times and facilitated timely access to specialist care, especially in rural areas.

Dr Morgan Rayner also provides a first-hand account of using virtual consult services as a junior registrar, discussing the benefits of building relationships with specialists and improving patient care through timely consultations.

The VVSC is available to any GP working in Victoria. The collab-consult model is a free 20-minute case conference with a specialist (with or without the patient). The collab-consult enables GPs to access timely expert advice to support managing their patients in the community. CPD can be claimed for participating in a case conference. Booking is easy through https://vvsc.org.au/ or email VVSC@nh.org.au.

The Virtual Immunology Clinic is available to any GP in WA who is in or very near the Fiona Stanley Hospital Catchment area for public hospital outpatients services (South Metro, South West, Great Southern)

The link to register, log in and refer is: South Metropolitan Health Service - SMHS Online Services Portal https://smhs.health.wa.gov.au/Our-services/SMHS-Online-Services-Portal

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 thegoodgp@gmail.com

Mentioned in this episode:

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Lyrebird Health

In this episode of The Good GP, Karin Sekhon speaks with Professor Jayashri Kulkarni, a renowned psychiatrist, about premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

Professor Kulkarni explains the distinctions between PMS and PMDD, emphasising that PMS is more prevalent and generally involves physical symptoms like bloating and headaches, while PMDD affects a smaller percentage of women and includes severe psychological symptoms such as major depression, anxiety, and brain fog. She talks about the genetic and environmental factors contributing to PMDD, highlighting a specific gene complex that may be activated by trauma.

Discussing the primary pharmacological treatments for PMDD, Professor Kulkarni advises starting with hormonal treatments like the combined oral contraceptive pill; she recommends the pill "Zoely" for its balanced hormone levels. She also elaborates on the use of SSRIs like sertraline for additional support and gives a stepped approach to treatment, including the possible need for hormone replacement therapy (HRT) or menstrual suppression in complex cases.

They also touched on the potential role of complementary therapies and the importance of holistic care, involving psychological support and lifestyle modifications. Professor Kulkarni provides guidance on when GPs should consider referring patients to specialists and emphasises the collaborative role of GPs in managing PMDD effectively.

If you want to learn more about this topic, consider the HER Centre Australia's online short course on Women's Mental Health: https://www.monash.edu/medicine/translational/psychiatry/short-courses/womens-mental-health

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 thegoodgp@gmail.com

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Lyrebird Health

Join The Good GP host Dr Krystyna de Lange in an episode with Dr Rebecca Starkie as they discuss the topic of cervical screening and the self-collection method in Australia.

Dr Starkie, a GP, practice owner, academic, medical educator, and researcher with a specific interest in women's health, shares her expertise on the success of self-collection for cervical screening. With the uptake of self-collection, especially among older women and those in remote areas, we have seen a reduction in barriers to cervical screening and improved access

They delve into the eligibility criteria for self-collection, discussing those who can opt for this method and those who still require clinician-collected samples. Expected changes in guidelines for the cervical screening program are also touched upon, emphasising the upcoming recommendations for test-of-cure processes.

Sharing insights for GPs on how to effectively explain and guide patients through the self-collection process, including the use of instructional resources and addressing possible patient concerns. Dr Starkie offers practical tips for handling abnormal test results and troubleshooting sampling challenges.

Dr Starkie recommended adopting a whole-of-team approach in general practice to support cervical screening efforts, underscoring the importance of involving practice managers, nurses, and reception staff in creating a positive patient experience.

Links & Resources:

• https://acpcc.org.au/practitioners/resource-hub/

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 thegoodgp@gmail.com

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Lyrebird Health

In this episode of The Good GP, host Dr Karin Sekhon is joined by Dr Jana Combrinck, an experienced women's health GP working in Perth and the current GP lead of Oasis Fertility Centre. They delve into the GP's role in fertility management.

Dr Combrinck discusses the prevalence of fertility issues, noting that one in six couples of reproductive age in Australia are affected by subfertility. Identifying advanced maternal age as a common cause, along with conditions such as polycystic ovarian syndrome (PCOS), ovulation disorders, and endometriosis. She emphasises the importance of considering male factors, which are responsible in at least 50% of cases.

Giving insights on the process for couples experiencing infertility. Dr Combrinck outlines a systematic approach, which includes taking a thorough history, conducting necessary blood tests, and performing imaging investigations. For male patients, a semen analysis is recommended as the first step.

Dr Combrinck also discusses the medications and supplements that GPs can prescribe to aid in fertility. For PCOS patients, metformin and myoinositol are suggested as first-line treatments. She provides a comprehensive guide on the use of letrozole for ovulation induction, emphasising the need for close monitoring. Supplements like CoQ10 and melatonin are recommended for women with reduced ovarian reserve, and Menivit is suggested for male patients with suboptimal semen analysis.

They also touched on when to refer patients to a fertility specialist. Referral timelines vary based on the age of the female partner and any known fertility-impacting conditions.

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 thegoodgp@gmail.com.

Mentioned in this episode:

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Lyrebird Health

In this episode of The Good GP podcast, host Dr Karin Sekhon talks to Dr Alex Shivarev, a public health physician from the WA Department of Health, to discuss the emerging public health concern of monkeypox, now also referred to as Mpox. Providing insights for GPs on the epidemiology, transmission, and clinical manifestations of the monkeypox virus, along with the distinction between the clade Ib and clade IIb strains.

Dr Shivarev explained what monkeypox is, its origins, and the different strains that have emerged. Discussing the recent increase in monkeypox cases globally and the response from both international bodies and local health authorities. He also highlighted the differences in transmission routes and the populations most at risk, including gay, bisexual, and other men who have sex with men.

Dr Shivarev mentions the vaccination with the JYNNEOS vaccine, which is available and recommended for eligible individuals. He also provided detailed guidance on the clinical presentation and diagnosis of monkeypox, emphasising the importance of history-taking and examination findings in identifying potential cases.

Lastly, they touched upon the future of monkeypox outbreaks and the potential for control measures to prevent further spread. Dr Shivarev reassures listeners that the risk of a wide-scale outbreak akin to the COVID-19 pandemic is low, given the effective public health measures in place and the community's prior successful response to the 2022 outbreak.

Resources and Links:

• ASHM Mpox Resource Toolkit - https://ashm.org.au/resources/mpox-resource-toolkit/
• Mpox Quick guide for primary health care workers WA - https://www.health.wa.gov.au/~/media/Corp/Documents/Health-for/Infectious-disease/Monkeypox/Monkeypox-quick-guide-for-clinicians.pdf
• Mpox (monkeypox) (health.wa.gov.au) (clinician focus)
• Mpox (monkeypox) (healthywa.wa.gov.au) (consumer focus)

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 thegoodgp@gmail.com

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Lyrebird Health

In this episode of The Good GP, host Karin Sekhon engages in an insightful conversation with Dr Judith Thompson, specialist continence and pelvic health physiotherapist and clinical director of BodyLogic Pelvic Health Clinic in Perth. She shares her knowledge on the benefits of pelvic floor physiotherapy and its broad applications across various stages of life and conditions.

Dr Thompson elaborates the training in becoming a pelvic health physiotherapist and outlines the range of conditions managed, including bladder and bowel continence, pelvic organ prolapse, and pelvic floor dysfunction in both women and men. They also covered management strategies for men post-prostate surgery and children with continence issues.

They also talked about the management of endometriosis-related pelvic pain. Dr Thompson explains the holistic approach taken, considering bladder, bowel, and pain management, and emphasises the importance of exercise, pelvic floor muscle assessment, and pacing plans. She also addresses the psychosocial elements, using tools like the 3PSQ for early identification of psychological factors influencing pain.

Financial barriers to accessing pelvic physiotherapy were also discussed, with Dr Thompson offering practical advice on leveraging public system referrals, EPC programs, and telehealth services to make treatment more accessible. Highlighting resources such as the Matilda app for endometriosis care and the Coast to Country program for rural patients.

Dr Thompson also touched upon the often-overlooked needs of young men experiencing lower urinary tract symptoms and pelvic pain, advocating for early physiotherapy assessment and holistic management.

Links & Resources:

• The Pelvic Pain Psychological Screening Questionnaire (3PSQ) - https://www.wmhp.com.au/sites/default/files/3PSQ.pdf
• Matilda Health - Home | Endometriosis surgery: care before and after to optimise outcomes. (matilda.health)
• Coast to Country Pelvic Health Clinic - https://pelvichealth.physio/wp-content/uploads/2023/12/Poster.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 thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health

In this episode of The Good GP, host Dr Sean Stevens sits down with Dr Jenny Brockis and Dr Amandeep Hansra to discuss their upcoming keynote presentations at GP24 in Perth. Providing insightful perspectives on the evolving landscape of general practice and the essential role that GPs play in the healthcare system.

Dr Jenny Brockis introduced her keynote address, "Happy, Healthy, and Fulfilled: Reimagining Practitioner Wellbeing," where she emphasises the importance of self-care for general practitioners. She discusses the complexities and challenges GPs face today, including the rapid changes in medical information, the increasing prevalence of chronic diseases, and evolving patient expectations. Dr Brockis advocates for a shift in practice to better support GP wellbeing to prevent burnout and ensure the highest quality of patient care.

Dr Amandeep Hansra shares her experiences in the digital health and innovation space and shares a preview of her keynote. Dr Hansra talks about her journey towards integrating digital solutions in general practice and the significant impact it can have on patient care. She highlights upcoming initiatives, including a hackathon designed to foster innovative solutions from frontline GPs. Dr Hansra also discusses her role as the Chief Clinical Advisor for the Australian Digital Health Agency, focusing on how government initiatives are building foundational tools to enhance digital health innovation.

Early bird registrations for the GP24 in Perth close on Monday, 7th of October. Visit racgp.org.au to secure your discounted rates!

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 thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health